scholarly journals Moderate coffee consumption associated with lower risk of mortality in prior Acute Coronary Syndrome patients: prospective analysis in ERICO cohort

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Andreia Miranda ◽  
Alessandra Goulart ◽  
Isabela Benseñor ◽  
Paulo Lotufo ◽  
Dirce Marchioni
Keyword(s):  
Acute Coronary Syndrome ◽  
Lower Risk ◽  
Coffee Consumption ◽  
Positive Association ◽  
Inverse Association ◽  
Coffee Intake ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
All Cause Mortality

AbstractCoffee is one of the most widely consumed beverages around the world. Several studies have observed an inverse association between coffee consumption and all-cause mortality in population-based studies. Nevertheless, little is known about these associations in patient populations with a prior Acute Coronary Syndrome (ACS). To examine the association between coffee consumption and the risk of mortality in patients with a prior acute myocardial infarction (MI) or unstable angina. Data were from the longitudinal prospective study “Strategy of Registry of Acute Coronary Syndrome Cohort - ERICO”. The cohort involved 1,085 patients diagnosed with ACS, between 2009 to 2013. For this analysis we used data after 180 days until 4 years’ follow-up, totalizing 928 participants. The coffee consumption was obtained using a questionnaire multiplying the reported frequency by the reported portion size. Subsequently was calculated the average of coffee intake (mL/day) and categorized (cups/day) into ≤ 1, 1–3, and > 3. Information on mortality was ascertained by medical registries and death certificates. Cox regression models to estimate hazard ratios (HRs) for mortality according to coffee consumption adjusted for potential confounders were performed. Kaplan-Meier survival curves with the log-rank test were analyzed. Most patients (99.0%) drank coffee, and the median total coffee intake was 125 mL/day. During a median follow-up of 4 years, a total of 111 deaths occurred, including 59 CVD-related and 24 MI-related deaths. Moderate coffee consumption was inversely associated with all-cause mortality. Participants who consumed 1–3 cups of coffee/day, showed an 81% lower risk of all-cause mortality than those who consumed ≤ 1 cup/day (adjusted HR 0.19; 95%CI: 0.11, 0.34). For patients with higher coffee consumption (> 3 cups/day), there was a positive association with mortality, with HR of 2.10 (95%CI: 1.05, 4.22). Corresponding HRs were 0.22 (95%CI: 0.11, 0.48) for 1–3 cups/day and 2.66 (95%CI: 1.04, 6.83) for > 3 cups/day for CVD mortality; and 0.23 (95%CI: 0.07, 0.71) and 1.59 (95%CI: 0.25, 10.0) for MI mortality, respectively. After stratification by smoking status the analysis revealed lower risk of all-cause mortality in never and former smokers drinking 1–3 cups/day (HRs 0.10; 95%CI: 0.04, 0.24 and 0.18; 0.08, 0.42, respectively). Among current smokers there was a positive association between > 3 cups/day and mortality (HR 8.50; 95%CI: 1.18, 16.35). The moderate consumption of coffee, impacted in a lower risk of all-cause, CVD and MI mortality in patients with a prior Acute Coronary Syndrome, particularly in nonsmokers.

scholarly journals J-shaped relationship between admission diastolic blood pressure and 2-year cardiovascular mortality in elderly patients with acute coronary syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Jiang ◽  
S Wu ◽  
M Wang ◽  
H Li ◽  
X Zhao
Keyword(s):  
Blood Pressure ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Diastolic Blood Pressure ◽  
Lower Risk ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Coronary Syndrome ◽  
All Cause Mortality

Abstract Objective To investigate the relationship between admission diastolic blood pressure (DBP) and subsequent cardiovascular and all-cause mortality in elderly patients with acute coronary syndrome (ACS). Methods This is a retrospective observational study. Consecutive patients ≥65 years of age admitted for ACS at a 2,300-bed tertiary hospital from December 2012 to July 2019 were included. The association between admission DBP and cardiovascular and all-cause mortality during hospitalization and over the follow-up period among this population were analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 67 mm Hg; Q2, from 67 to 72 mm Hg; Q3, from 73 to 80 mm Hg; and Q4, above 80 mm Hg. Results A total of 6 785 patients were included in this cohort study. Mean (SD) patient age was 74.0 (6.5) years, and 47.6% were women. Mean (SD) follow-up time was 2.54 (1.82) years. A non-linear relation was observed between DBP at admission and cardiovascular and all-cause mortality during hospitalization and over the follow-up period using restricted cubic splines. After adjustment for potential confounders, patients in Q3 or Q2 had lower risk for 2-year cardiovascular death by Cox proportional hazard model compared with patients in Q4 (hazard ratio [HR] 0.66; 95% confidence interval [CI], 0.48–0.90, P=0.010, for Q3 vs Q4; and HR 0.72; 95% CI, 0.53–0.99, P=0.041, for Q2vs Q4), while patients in Q1 had similar risk for cardiovascular death with that of patients in Q4. Meanwhile, when compared with patients in Q1, patients in Q3 had lower risk for 2-year cardiovascular death (HR, 0.72; 95% CI, 0.53–0.97, P=0.033). However, lower or higher admission DBP was not an independent predictor of 2-year all-cause mortality in this population. Conclusion Among patients aged ≥65 years admitted for ACS, there is a J-curve relationship between supine admission DBP and risk for 2-year cardiovascular death, with a nadir at 73–80 mm Hg. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support Study population and selection Adjusted multivariate COX regression

Abstract 309: Is Right Bundle Branch Block Associated with Poor Outcomes in the Setting of an Acute Coronary Syndrome? A Systematic Review and Meta-analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ahmad Hazem ◽  
Sunita Sharma ◽  
Amit Sharma ◽  
Cameron Leitch ◽  
Roopalakshmi Sharadanant ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Forest Plot ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
All Cause Mortality

Importance: Up to 10% of patients with acute myocardial infarction (AMI) have right bundle branch block (RBBB), and RBBB has been associated with a higher risk of mortality. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with AMI. Acute coronary syndrome (ACS) Data Sources: We have systematically searched Ovid, Scopus and Web of Science through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts, selecting studies that described all-cause mortality or cardiovascular death in patients with RBBB and suspected ACS. We excluded studies that reported unadjusted outcomes. Knowledge synthesis: We pooled risk ratio with hazard ratio in studies reporting those outcomes. When reported, odds ratio was converted into risk ratio using reported event rate in each study’s unexposed -read: non RBBB- group. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: Eighteen studies were found that reported eligible data. All were observational studies, involving over 89,000 patients. In short-term follow up (up to 30 days), RBBB on presentation was associated with higher all-cause mortality rate, compared to patients without RBBB (RR 2.23, 95% CI 1.76-2.82). There was a trend for higher mortality at long-term follow up (range: 6 months-16 years) that did not reach statistical significance (RR 1.45, 95% CI 0.93-2.25). Figure-1 demonstrates the forest plot. Risk of bias was assessed with the Newcastle-Ottawa scale and majority of included studied were deemed moderate to high quality. Conclusion and Relevance: RBBB is associated with a more than 2-fold higher risk of all-cause mortality in patients with AMI at 30 days follow up. Patients with AMI and RBBB represent a high risk group for adverse outcomes. A sentence on the differential findings for new vs. old RBBB and association with outcomes could follow here.

All-Cause Mortality Following an Acute Coronary Syndrome: 12-Year Follow-Up of the Comprehensive 2002 New Zealand Acute Coronary Syndrome Audit

2019 ◽  
Vol 28 (2) ◽  
pp. 245-256 ◽  
Author(s):  
Chris J. Ellis ◽  
Greg D. Gamble ◽  
Michael J.A. Williams ◽  
Phil Matsis ◽  
John M. Elliott ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Coronary Syndrome ◽  
All Cause Mortality

scholarly journals P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 9 (6) ◽  
pp. 1657
Author(s):  
Po-Wei Chen ◽  
Wen-Han Feng ◽  
Ming-Yun Ho ◽  
Chun-Hung Su ◽  
Sheng-Wei Huang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Lower Risk ◽  
Coronary Intervention ◽  
P2y12 Inhibitor ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups.

scholarly journals Thyroid function, renal events and mortality in chronic kidney disease patients: the German Chronic Kidney Disease study

2020 ◽  
Author(s):  
Ulla T Schultheiss ◽  
Inga Steinbrenner ◽  
Matthias Nauck ◽  
Markus P Schneider ◽  
Fruzsina Kotsis ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Thyroid Function ◽  
Positive Association ◽  
Inverse Association ◽  
All Cause Mortality ◽  
Disease Study ◽  
Reduced Kidney Function

Abstract Background Hypothyroidism and low free triiodothyronine (FT3) syndrome [low FT3 levels with normal thyroid-stimulating hormone (TSH)] have been associated with reduced kidney function cross-sectionally in chronic kidney disease (CKD) patients with severely reduced estimated glomerular filtration rate (eGFR) or end-stage kidney disease (ESKD). Results on the prospective effects of impaired thyroid function on renal events and mortality for patients with severely reduced eGFR or from population-based cohorts are conflicting. Here we evaluated the association between thyroid and kidney function with eGFR (cross-sectionally) as well as renal events and mortality (prospectively) in a large, prospective cohort of CKD patients with mild to moderately reduced kidney function. Methods Thyroid markers were measured among CKD patients from the German Chronic Kidney Disease study. Incident renal endpoints (combined ESKD, acute kidney injury and renal death) and all-cause mortality were abstracted from hospital records and death certificates. Time to first event analysis of complete data from baseline to the 4-year follow-up (median follow-up time 4.04 years) of 4600 patients was conducted. Multivariable linear regression and Cox proportional hazards models were fitted for single and combined continuous thyroid markers [TSH, free thyroxine (FT4), FT3] and thyroid status. Results Cross-sectionally, the presence of low-FT3 syndrome showed a significant inverse association with eGFR and continuous FT3 levels alone showed a significant positive association with eGFR; in combination with FT4 and TSH, FT3 levels also showed a positive association and FT4 levels showed a negative association with eGFR. Prospectively, higher FT4 and lower FT3 levels were significantly associated with a higher risk of all-cause mortality (Nevents = 297). Per picomole per litre higher FT3 levels the risk of reaching the composite renal endpoint was 0.73-fold lower (95% confidence interval 0.65–0.82; Nevents = 615). Compared with euthyroid patients, patients with low-FT3 syndrome had a 2.2-fold higher risk and patients with hypothyroidism had a 1.6-fold higher risk of experiencing the composite renal endpoint. Conclusions Patients with mild to moderate CKD suffering from thyroid function abnormalities are at an increased risk of adverse renal events and all-cause mortality over time.

scholarly journals High-Sensitivity Troponin T vs I in Acute Coronary Syndrome: Prediction of Significant Coronary Lesions and Long-term Prognosis

2017 ◽  
Vol 63 (2) ◽  
pp. 552-562 ◽  
Author(s):  
Brede Kvisvik ◽  
Lars Mørkrid ◽  
Helge Røsjø ◽  
Milada Cvancarova ◽  
Alexander D Rowe ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
Prognostic Accuracy ◽  
All Cause Mortality ◽  
Coronary Lesions ◽  
Long Term Prognosis

Abstract BACKGROUND High-sensitivity cardiac troponin (hs-cTn) T and I assays are established as crucial tools for the diagnosis of acute myocardial infarction (AMI), as they have been found superior to old troponin assays. However, eventual differences between the assays in prediction of significant coronary lesions and long-term prognosis in patients with acute coronary syndrome (ACS) have not been fully unraveled. METHODS Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390 non-ST-elevation (NSTE) ACS patients were evaluated in relation to significant coronary lesions on coronary angiography (defined as a stenosis >50% of the luminal diameter, with need for revascularization) and prognostic accuracy for cardiovascular mortality, all-cause mortality, as well as the composite end point of cardiovascular mortality and hospitalizations for AMI or heart failure. RESULTS The mean (SD) follow-up was 2921 (168) days. Absolute hs-cTnI concentrations were significantly higher than the hs-cTnT concentrations. The relationship between analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by the area under the ROC curve (AUC), revealed no difference between hs-cTnT [AUC, 0.81; 95% CI, 0.77–0.86] and hs-cTnI (AUC, 0.81; 95% CI, 0.76–0.86; P = NS). NT-proBNP was superior to both hs-cTn assays regarding prognostic accuracy for both cardiovascular and all-cause mortality and for the composite end point during follow-up, also in multivariate analyses. CONCLUSIONS The hs-cTnT and hs-cTnI assays displayed a similar ability to predict significant coronary lesions in NSTE-ACS patients. NT-proBNP was superior to both hs-cTn assays as a marker of long-term prognosis in this patient group.

Prognostic impact of right ventricular overload in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Sato ◽  
Y Ogihara ◽  
T Kurita ◽  
H Mizutani ◽  
A Takasaki ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Right Ventricular ◽  
Laboratory Data ◽  
Prognostic Impact ◽  
Entire Study ◽  
Poor Prognostic Factor ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Right ventricular (RV) overload is associated with adverse outcome in patients with chronic heart failure. However, its prognostic value in acute coronary syndrome (ACS) patients remains unknown. Purpose The purpose of this study was to investigate the prevalence and prognostic impact of right ventricular overload in ACS patients. Methods We studied 2797 ACS patients from Mie ACS registry, a prospective and multicenter registry in Japan. They were divided into 4 subgroups according to the severity of RV overload and the extent of Left Ventricle Ejection Fraction (LVEF) assessed by echocardiography before hospital discharge. High RV overload was defined as trans-tricuspid pressure gradient (TRPG) ≥40mmHg and preserved LVEF was defined as ≥50%. The primary outcome was defined as 2-year all-cause mortality. Median follow up duration was 730 days (1–2215 days). Results High RV overload was detected in 76 patients (2.7%). In basic patients characteristics, high RV overload patients were significantly older and higher killip classification than low RV overload patients (P<0.01, respectively). Laboratory data in high RV overload patients showed lower hemoglobin level and higher serum creatinine level than those in low RV overload patients (P<0.01, respectively). Echocardiographic findings in high RV overload represented lower LVEF, higher rate of moderate or severe mitral regurgitation and left atrial enlargement than those in low RV overload patients (P<0.01, respectively). During the follow-up periods (median 730 days), 260 (9.3%) patients experienced all-cause death. Multivariate cox hazard regression analysis for all-cause mortality demonstrated that high RV overload was an independent poor prognostic factor in the entire study population. Among patients with preserved LVEF, high RV overload resulted in an increased risk of all-cause mortality compared to low RV overload (P<0.0001). Conclusion In ACS patients, high RV overload strongly contributes to worsening of prognosis regardless of the extent of LVEF. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

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