Clinical outcome after acute coronary syndrome in Japanese patients: An observational cohort study

ObjectivesSerum calcium levels (sCa) were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyse the association between sCa and long-term mortality in patients with acute coronary syndrome (ACS).DesignA retrospective observational cohort study.SettingSingle-centre study with participants recruited from the local area.ParticipantsA total of consecutive 13 772 patients with ACS were included in this analysis. Patients were divided based on their sCa profile (≤2.1 mmol/L, 2.1–2.2 mmol/L, 2.2–2.3 mmol/L, 2.3–2.4 mmol/L, 2.4–2.5 mmol/L,>2.5 mmol/L) and followed up for a median of 2.96 years (IQR 1.01–4.07).Primary outcomeLong-term all-cause mortality.ResultsDuring a median follow-up period of 2.96 years, patients with sCa ≤2.1 mmol/L had the highest cumulative incidences of all-cause mortality (16.7%), whereas those with sCa 2.4–2.5 mmol/L had the lowest cumulative incidences of all-cause mortality (3.5%). After adjusting for potentially confounding variables, the Cox analysis revealed that compared with the reference group (sCa 2.4–2.5 mmol/L), all the other groups had higher mortality except for the sCa 2.3–2.4 mmol/L group (HR, 1.32, 95% CI 0.93 to 1.87). Restricted cubic splines showed that the relationship between sCa and all-cause mortality seemed to be U shaped. The optimal sCa cut-off point, 2.35 mmol/L, was determined based on the shape of restricted cubic splines.ConclusionsAltered serum calcium homeostasis at admission independently predicts all-cause mortality in patients with ACS. In addition, a U-shaped relationship between sCa and all-cause mortality exists, and maintaining sCa at approximately 2.35 mmol/L may minimise the risk of mortality.

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Prospective observational cohort study of early recurrent TIA

Neurology ◽

10.1212/wnl.0000000000010317 ◽

2020 ◽

Vol 95 (12) ◽

pp. e1733-e1744

Author(s):

Matteo Foschi ◽

Lucia Pavolucci ◽

Francesca Rondelli ◽

Luca Spinardi ◽

Elisabetta Favaretto ◽

...

Keyword(s):

Cohort Study ◽

Observational Cohort Study ◽

Large Artery ◽

Prospective Observational Cohort Study ◽

Stroke Incidence ◽

Long Term Outcome ◽

Coronary Syndrome ◽

Observational Cohort

ObjectivesTo evaluate the frequency, clinical and etiologic features, and short- and long-term outcomes of early recurrent TIA.MethodsThis prospective observational cohort study enrolled all consecutive patients with TIA referred to our emergency department and diagnosed by a vascular neurologist. Expedited assessment and best secondary prevention were performed within 24 hours. Primary endpoints were stroke and a composite outcome including stroke, acute coronary syndrome, and vascular death at 3, 12, and, for a subset of patients, 60 months; secondary outcomes were TIA relapse, cerebral hemorrhage, new-onset atrial fibrillation, and death resulting from other causes. Concordance between index TIA and subsequent stroke etiologies was also evaluated.ResultsA total of 1,035 patients (822 with a single TIA, 213 with recurrent TIA = 21%) were enrolled from August 2010 to December 2017. Capsular warning syndrome and large artery atherosclerosis showed the strongest relationship with early recurrent TIA. The risk of stroke was significantly higher in the early recurrent TIA subgroup at each follow-up, and most stroke episodes occurred within 48 hours of index TIA. TIAs with lesion, dysarthria, and leukoaraiosis were the 3- and 12-month independent predictors of stroke incidence after early recurrent TIA subgroup. Index TIA and subsequent stroke etiologies showed substantial concordance. An ABCD3 score >6 predicted a higher risk of stroke recurrence over the entire follow-up.ConclusionsOur study evaluated long-term outcome after early recurrent TIA. Our observations support the importance of promptly detecting and treating patients with early recurrent TIAs to reduce the high early and long-term risk of poor clinical outcomes.

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