MULTIPLE BIOMARKERS FOR PREDICTING MAJOR ADVERSE CARDIAC EVENTS IN AT-RISK PATIENTS UNDERGOING DIAGNOSTIC CORONARY ANGIOGRAPHY: RESULTS FROM THE CATHETER SAMPLED BLOOD ARCHIVE IN CARDIOVASCULAR DISEASES (CASABLANCA) STUDY

Aims Low-density lipoprotein cholesterol predicts cardiovascular events in patients with diabetes. However, it is uncertain whether serum triglycerides level is also associated with an occurrence of future cardiovascular events in diabetic patients. We aimed to test whether serum triglycerides is associated with first cardiovascular events in diabetic patients. Methods and results We recruited 5042 participants with diabetes mellitus from the standard versus intEnsive statin therapy for hypercholesteroleMic Patients with diAbetic retinopaTHY (EMPATHY), multicenter, prospective, randomized, open-label, blinded-endpoint study. Median follow-up was three years. We evaluated an association of serum triglycerides with first cardiovascular events in cox-regression hazard models adjusted by age, sex, hypertension, current smoking, low-density lipoprotein cholesterol, and body mass index. Cardiovascular events were defined as (a) major adverse cardiac events including myocardial infarction, stroke, or cardiac death; and (b) cardiovascular diseases including myocardial infarction, unstable angina, ischemic stroke, or large artery disease or peripheral arterial disease. Serum triglycerides were associated with major adverse cardiac events (adjusted hazard ratio: 1.021 per 10 mg/dl; 95% confidence interval: 1.007–1.035; p = 0.0025) and cardiovascular diseases (adjusted hazard ratio: 1.023 per 10 mg/dl; 95% confidence interval: 1.013–1.034; p = 0.0000077). Comparing the top quintile (>185 mg/dl) with the bottom quintile (<79 mg/dl), the adjusted hazard ratio increased 1.89 (95% confidence interval: 1.03–2.80, p = 0.04) for major adverse cardiac events, and 1.90 (95% confidence interval: 1.18–3.07, p = 0.007) for cardiovascular diseases. There were no overall interactions of triglycerides and treatment assignment (standard/intensive statins) on both outcomes ( p-trend = 0.33 for major adverse cardiac events, p-trend = 0.62 for cardiovascular diseases). Conclusions Serum triglycerides were associated with first cardiovascular events among high-risk diabetes patients with hypercholesterolemia and retinopathy.

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A study on modified accelerated diagnostic protocol to safely discharge low-risk chest pain patients in emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918820750 ◽

2019 ◽

Vol 27 (3) ◽

pp. 134-145

Author(s):

Kok Siew Yean ◽

Mahathar Bin Abd. Wahab ◽

Mohd Idzwan Bin Zakaria

Keyword(s):

Chest Pain ◽

Low Risk ◽

Major Adverse Cardiac Events ◽

Short Stay ◽

Treadmill Test ◽

Cardiac Events ◽

Exercise Treadmill Test ◽

Adverse Cardiac Events ◽

Exercise Treadmill ◽

Risk Patients

Background: Evaluation of chest pain patients in emergency departments to distinguish between high-risk patients who require admission and low-risk patients who can be managed as outpatients is a challenging task. Objective: The aim of this study was to evaluate the efficacy of Observation Ward Short Stay Evaluation Service for Chest Pain Protocol to identify and safely discharge low-risk patients with low incidence of major adverse cardiac events within 30 days. Methods: This was a single center prospective observational study, conducted from 1 March 2016 to 31 August 2016 at the Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur. Observation Ward Short Stay Evaluation Service for Chest Pain Protocol was used to evaluate patients presented with chest pain or angina equivalents. The components involved Thrombolysis in Myocardial Infarction (TIMI) score, serial electrocardiograms, high-sensitivity cardiac troponin T, and exercise treadmill test. Low-risk patients were patients with TIMI < 2, normal serial electrocardiogram, high-sensitivity cardiac troponin T ≤ 14 ng/L, and negative exercise treadmill test. If anyone of the components was not fulfilled patients were considered as high risk, and they were either admitted or referred to clinic for further intervention. Low-risk patients were allowed for discharged. All patients were followed-up in 30 days for any incidence of major adverse cardiac events. Results: Totally, 174 patients were studied. Observation Ward Short Stay Evaluation Service for Chest Pain Protocol managed to discharge 102 (58.6%) patients, and 84 (82.4%) of them underwent exercise treadmill test. About 46 (54.8%) patients had negative exercise treadmill test, whereas 38 (45.2%) patients had either positive or inconclusive exercise treadmill test, and they were referred to physician clinic for further cardiac assessment. None of the patients with negative exercise treadmill test developed major adverse cardiac events in 30 days. The sensitivity and the negative predictive value (NPV) of Observation Ward Short Stay Evaluation Service for Chest Pain Protocol were both 100%. Conclusion: Observation Ward Short Stay Evaluation Service for Chest Pain Protocol can be applied in emergency departments to identify and safely discharge patients with low risk of major adverse cardiac events in 30 days.

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Intracoronary Doppler– and Quantitative Coronary Angiography–Derived Predictors of Major Adverse Cardiac Events After Stent Implantation

Circulation ◽

10.1161/01.cir.103.9.1212 ◽

2001 ◽

Vol 103 (9) ◽

pp. 1212-1217 ◽

Cited By ~ 20

Author(s):

Michael Haude ◽

Dietrich Baumgart ◽

Edoardo Verna ◽

Jan J. Piek ◽

Chris Vrints ◽

...

Keyword(s):

Coronary Angiography ◽

Stent Implantation ◽

Quantitative Coronary Angiography ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Intracoronary Doppler ◽

Adverse Cardiac Events

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Prognostic Value of Computed Tomographic Coronary Angiography for Long-Term Major Adverse Cardiac Events after Liver Transplantation

Journal of Clinical Medicine ◽

10.3390/jcm10143132 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3132

Author(s):

Doo-Hwan Kim ◽

Young-Kug Kim ◽

Tae-Yong Ha ◽

Shin Hwang ◽

Wooil Kim ◽

...

Keyword(s):

Liver Transplantation ◽

Coronary Artery ◽

Coronary Angiography ◽

Prognostic Value ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Computed Tomographic ◽

Adverse Cardiac Events ◽

Computed Tomographic Coronary Angiography

Computed tomographic coronary angiography (CTCA) has prognostic value for early major adverse cardiac events (MACEs) after liver transplantation. However, the association between CTCA and long-term MACEs in liver transplant (LT) recipients remains unknown. We evaluated the association between CTCA and long-term MACEs within 5 years after living donor liver transplantation (LDLT). A total of 628 LDLT recipients who underwent CTCA were analyzed between 2010 and 2012. MACEs were investigated within 5 years after LDLT. The factors associated with long-term MACEs in transplant recipients were evaluated. Only 48 (7.6%) patients developed MACEs. In the Fine and Gray competing risk regression, a coronary artery calcium score (CACS) of >400 combined with obstructive coronary artery disease (CAD) (subdistribution hazard ratio: 5.01, 95% confidence interval: 2.37–10.58, p < 0.001), age (1.05, 1.01–1.10, p = 0.018), diabetes mellitus (2.43, 1.37–4.29, p = 0.002), dyslipidemia (2.45, 1.23–4.70, p = 0.023), and creatinine (1.19, 1.08–1.30, p < 0.001) were independently associated with long-term MACEs. CACS (>400) combined with obstructive CAD may be associated with MACEs within 5 years after LDLT, suggesting the importance of preoperative noninvasive CTCA in LT recipients. The evaluation of coronary artery stenosis on CTCA combined with CACS may have a prognostic value for long-term MACEs in LT recipients.

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