GWTG-HF score and acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Post-hospitalization (PH) risk stratification is crucial. The Get With The Guidelines Heart Failure score (GWTG-HFS) predicts in-hospital mortality (M) of patients (P) admitted with acute heart failure. Objective To validate GWTG-HFS as predictor of PH early and late M and readmission (RA) rates, in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from admissions between 1/01/20168 and 11/12/2019. Patients who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA). Statistical analysis used non-parametric tests, logistic regression and ROC curve analysis. Results 268 patients with ACS, mean age was 66.4 ± 12.5 years old and 59.7% were male. The diagnosis was unstable angina in 2.6%, non-ST elevation myocardial infarction (NSTEMI) in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. 41.8% of the P were or had been smokers, 68.5% had hypertension, 34.5% were diabetic and 50.9% had dyslipidaemia. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis <50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the P had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 1mM rate was 1.9% and 1yM rate was 7.8%. Age (p = 0.034), diabetes (p = 0.031), KKC (p < 0.001), BUN (p = 0.003) and LV function (p < 0.001) were predictors of 1mM. Age (p < 0.001), HR (p = 0.009), KKC (p = 0.032), BUN (p < 0.001), sodium (p < 0.001), creatinine (p < 0.001), Hb (p < 0.001), LV function (p < 0.001), de novo AF (p < 0.001) and number of arteries with significant disease (p = 0.044) were predictors of 1yM. Logistic regression and ROC curve analysis showed that GWTG-HFS was able to predict 1mM (Odds ratio (OR) 1.18, p = 0.005, confidence interval (CI) 1.05-1.33; area under curve (AUC) 0.872) and 1yM (OR 1.16, p = 0.001, CI 1.09-1.24, AUC 0.838) with excellent accuracy, and 1mRA (OR 1.10, p = 0.006, CI 1.03-1.18, AUC 0.677) and 1yRA (OR 1.04, p = 0.024, CI 1.01-1.08, AUC 0.580) with poor accuracy. A sub-analysis regarding NSTEMI P showed that GWTG-HFS was able to predict 1mM (OR 1.20, p = 0.010, CI 1.05-1.39, AUC 0.902) and 1yM (OR 1.15, p < 0.001, CI 1.07-1.23, AUC 0.817) with excellent accuracy. On the other hand, sub-analysis regarding STEMI showed that GWTG-HFS was not able to predict 1mM (p = 0.495) but was accurate at predicting 1yM (OR 1.18, p = 0.048, CI 1.00-1.39, AUC 0.881). Conclusion This study confirms that, in our population, GWTG-HFS is a valuable tool in PH risk score stratification in ACS, particularly NSTEMI.

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Acute heart failure: predicting early in-hospital outcomes

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.019 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Santos ◽

S Paula ◽

I Almeida ◽

H Santos ◽

H Miranda ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Acute Heart Failure ◽

Roc Curve ◽

Real Life ◽

Study Data ◽

Curve Analysis ◽

Older Age ◽

Invasive Ventilation ◽

Roc Curve Analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge. Older age (p < 0.001), lower SBP (p = 0,035) and need of inotropes (p < 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p < 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage. Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p < 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p < 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84). Conclusion In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

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Abstract 153: Rural Systems of Care: Real World Observations and Trends in ST Elevation Myocardial Infarction Patient Characteristics, and Correlations of Arrival Mode to Outcomes

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.153 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Scott Mikesell ◽

Jeffrey Sather ◽

John Gallagher ◽

Richard Mullvain ◽

Tomasz Stys ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Congestive Heart Failure ◽

Cardiac Arrest ◽

Systems Of Care ◽

St Elevation Myocardial Infarction ◽

Lv Function ◽

Direct Transfer ◽

St Elevation ◽

Transfer Group

Background: Minnesota, North Dakota and South Dakota have been enhancing statewide systems through infrastructure and clinical education regarding ST-elevation myocardial infarction (STEMI) since 2010 in an attempt to equalize access to timely reperfusion in rural areas. A trend in faster time to reperfusion has been observed for STEMI patients who transfer directly to Percutaneous Coronary Intervention (PCI) capable facilities via Emergency Medical Services (EMS) and receive a pre-hospital 12-lead ECG in comparison to those who first present to a non PCI capable facility. This improved time to STEMI recognition and reperfusion may be associated with improved outcomes. Methods: Data was collected via ACTION Registry-GWTG from 2012-2015. The cohort was defined as STEMI patients who received PPCI with interfacility transfer (n=1010) and without (n=376) and who receive a pre-hospital 12-lead ECG (n=1078) and do not (n=308). The association between mode of transport, time to PPCI, and outcomes including LV function, in hospital clinical events, and in-hospital mortality were analyzed by unadjusted association. Multivariable adjustment was performed using covariates from the previously developed and validated ACTION mortality model to determine the independent association between arrival mode and outcomes. Results: The direct transfer group demonstrated shorter cumulative times (79 vs. 145 min., p=<0.001) to coronary reperfusion as compared to the interfacility transfer group. The pre-hospital ECG group experienced a shorter time to transfer (40 vs. 55 min., p=<0.001) to a PPCI center consistent with earlier system recognition and activation for a STEMI patient. The direct transfer and pre-hospital ECG groups had a statistically significant less risk of in-hospital cardiogenic shock, congestive heart failure, cardiac arrest and death as a composite end-point, p=0.011 & <0.001 respectively. During the years of 2012 to 2015, the performance of pre-hospital ECGs has increased. Conclusion: Implementation of Mission Lifeline programming was associated with significantly lower risk of in-hospital shock, congestive heart failure, cardiac arrest and death in STEMI patients presenting via EMS through increased utilization of pre hospital ECG, education, and hospital triage and procedural PPCI streamlining.

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GRACE score vs GWTG-HF score: risk stratification in acute heart failure

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.046 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Santos ◽

S Paula ◽

I Almeida ◽

H Santos ◽

H Miranda ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Risk Stratification ◽

Acute Heart Failure ◽

Roc Curve ◽

Curve Analysis ◽

Invasive Ventilation ◽

Roc Curve Analysis ◽

Post Discharge ◽

Grace Score

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Therefore, early risk stratification at admission is essential. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (IHM) of patients admitted with AHF. GRACE score estimates risk of death, including IHM and long-term mortality (M), in non-ST elevation acute coronary syndromes. Objective To validate GRACE score in AHF and to compare GRACE and GWTG-HF scores as predictors of IHM, post discharge early and late M [1-month mortality (1mM) and 1-year M (1yM)], 1-month readmission (1mRA) and 1-year readmission (1yRA), in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean GRACE was 147.9 ± 30.2 and mean GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the patients needed non-invasive ventilation, 8% needed invasive ventilation. IHM rate was 5%, 1mM was 8% and 1yM 27%. 6.3% of the patients were readmitted 1 month after discharge and 52.7% had at least one more admission in the year following discharge. Older age (p < 0.001), lower SBP (p = 0,005), higher urea (p = 0,001), lower sodium (p = 0.005), previous history of percutaneous coronary intervention (p = 0,017), lower GFR (p < 0.001) and need of inotropes (0.001) were predictors of 1yM after discharge in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p < 0.001), higher 1mM (OR 4.13, p = 0.001) and higher 1yM (OR 1.96, p = 0.011). On the other hand, KKC at admission did not predict readmission (either 1mRA or 1yRA, respectively p = 0.887 and p = 0.695). Logistic regression confirmed that GWTG-HF was a good predictor of IHM (OR 1.12, p < 0.001, CI 1.05-1.19) but also 1mM (OR 1.1, p = 0.001, CI 1.04-1.16) and 1yM (OR 1.08, p < 0.001, CI 1.04-1.11). GRACE also showed the ability to predict IHM (OR 1.06, p < 0.001, CI 1.03-1.10), 1mM (OR 1.04, p < 0.001, CI 1.02-1.06) and 1yM (OR 1.03, p < 0.001, CI 1.01-1.03). ROC curve analysis revealed that GRACE and GWTG-HF were accurate at predicting IHM (AUC 0.866 and 0.774, respectively), 1mM (AUC 0.779 and 0.727, respectively) and 1yM (AUC 0.676 and 0.672, respectively). Both scores failed at predicting 1mRA (GRACE p = 0.463; GWTG-HF p = 0.841) and 1yRA (GRACE p = 0.244; GWTG-HF p = 0.806). Conclusion This study confirms that, in our population, both scores were excellent at predicting IHM, with GRACE performing better. Although both scores were able to predict post-discharge mortality outcomes, their performance was poorer.

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Risk factors of coronary microvascular obstruction (Preprint)

10.2196/preprints.20998 ◽

2020 ◽

Author(s):

Yong Li ◽

Shuzheng Lyu

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Logistic Regression ◽

Microvascular Obstruction ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Neutrophil Percentage ◽

Percutaneous Coronary ◽

St Elevation

BACKGROUND Coronary microvascular obstruction /no-reflow(CMVO/NR) is a predictor of long-term mortality in survivors of ST elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI). OBJECTIVE To identify risk factors of CMVO/NR. METHODS Totally 2384 STEMI patients treated with PPCI were divided into two groups according to thrombolysis in myocardial infarction(TIMI) flow grade:CMVO/NR group(246cases,TIMI 0-2 grade) and control group(2138 cases,TIMI 3 grade). We used univariable and multivariable logistic regression to identify risk factors of CMVO/NR. RESULTS A frequency of CMVO/NR was 10.3%(246/2384). Logistic regression analysis showed that the differences between the two groups in age(unadjusted odds ratios [OR] 1.032; 95% CI, 1.02 to 1.045; adjusted OR 1.032; 95% CI, 1.02 to 1.046 ; P <0.001), periprocedural bradycardia (unadjusted OR 2.357 ; 95% CI, 1.752 to 3.171; adjusted OR1.818; 95% CI, 1.338 to 2.471 ; P <0.001),using thrombus aspirationdevices during operation (unadjusted OR 2.489 ; 95% CI, 1.815 to 3.414; adjusted OR1.835; 95% CI, 1.291 to 2.606 ; P =0.001),neutrophil percentage (unadjusted OR 1.028 ; 95% CI, 1.014 to 1.042; adjusted OR1.022; 95% CI, 1.008 to 1.036 ; P =0.002) , and completely block of culprit vessel (unadjusted OR 2.626; 95% CI, 1.85 to 3.728; adjusted-OR 1.656;95% CI, 1.119 to 2.45; P =0.012) were statistically significant ( P <0. 05). The area under the receiver operating characteristic curve was 0.6896 . CONCLUSIONS Age , periprocedural bradycardia, using thrombus aspirationdevices during operation, neutrophil percentage ,and completely block of culprit vessel may be independent risk factors for predicting CMVO/NR. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023213; registered date: 16 May 2019).http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4. Key Words: Coronary disease ST elevation myocardial infarction No-reflow phenomenon Percutaneous coronary intervention

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Predictive CT features for the diagnosis of primary pulmonary mucoepidermoid carcinoma: comparison with squamous cell carcinomas and adenocarcinomas

Cancer Imaging ◽

10.1186/s40644-020-00375-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaohua Ban ◽

Xinping Shen ◽

Huijun Hu ◽

Rong Zhang ◽

Chuanmiao Xie ◽

...

Keyword(s):

Logistic Regression ◽

Roc Curve ◽

Multinomial Logistic Regression ◽

Univariate Analysis ◽

Ct Imaging ◽

Squamous Cell Carcinomas ◽

Curve Analysis ◽

Imaging Features ◽

Roc Curve Analysis ◽

Ct Features

Abstract Background To determine the predictive CT imaging features for diagnosis in patients with primary pulmonary mucoepidermoid carcinomas (PMECs). Materials and methods CT imaging features of 37 patients with primary PMECs, 76 with squamous cell carcinomas (SCCs) and 78 with adenocarcinomas were retrospectively reviewed. The difference of CT features among the PMECs, SCCs and adenocarcinomas was analyzed using univariate analysis, followed by multinomial logistic regression and receiver operating characteristic (ROC) curve analysis. Results CT imaging features including tumor size, location, margin, shape, necrosis and degree of enhancement were significant different among the PMECs, SCCs and adenocarcinomas, as determined by univariate analysis (P < 0.05). Only lesion location, shape, margin and degree of enhancement remained independent factors in multinomial logistic regression analysis. ROC curve analysis showed that the area under curve of the obtained multinomial logistic regression model was 0.805 (95%CI: 0.704–0.906). Conclusion The prediction model derived from location, margin, shape and degree of enhancement can be used for preoperative diagnosis of PMECs.

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Right choice of a method for determination of cut-off values: A statistical tool for a diagnostic test

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i3.9296 ◽

2014 ◽

Vol 5 (3) ◽

pp. 30-34 ◽

Cited By ~ 19

Author(s):

Balkishan Sharma ◽

Ravikant Jain

Keyword(s):

Logistic Regression ◽

Discriminant Analysis ◽

Diagnostic Test ◽

Roc Curve ◽

Traditional Method ◽

Statistical Technique ◽

Curve Analysis ◽

Operating Characteristics ◽

Roc Curve Analysis

Objective: The clinical diagnostic tests are generally used to identify the presence of a disease. The cutoff value of a diagnostic test should be chosen to maximize the advantage that accrues from testing a population of human and others. When a diagnostic test is to be used in a clinical condition, there may be an opportunity to improve the test by changing the cutoff value. To enhance the accuracy of diagnosis is to develop new tests by using a proper statistical technique with optimum sensitivity and specificity. Method: Mean±2SD method, Logistic Regression Analysis, Receivers Operating Characteristics (ROC) curve analysis and Discriminant Analysis (DA) have been discussed with their respective applications. Results: The study highlighted some important methods to determine the cutoff points for a diagnostic test. The traditional method is to identify the cut-off values is Mean±2SD method. Logistic Regression Analysis, Receivers Operating Characteristics (ROC) curve analysis and Discriminant Analysis (DA) have been proved to be beneficial statistical tools for determination of cut-off points.Conclusion: There may be an opportunity to improve the test by changing the cut-off value with the help of a correctly identified statistical technique in a clinical condition when a diagnostic test is to be used. The traditional method is to identify the cut-off values is Mean ± 2SD method. It was evidenced in certain conditions that logistic regression is found to be a good predictor and the validity of the same can be confirmed by identifying the area under the ROC curve. Abbreviations: ROC-Receiver operating characteristics and DA-Discriminant Analysis. Asian Journal of Medical Science, Volume-5(3) 2014: 30-34 http://dx.doi.org/10.3126/ajms.v5i3.9296

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Association of Interleukin 8 and Myocardial Recovery in Patients with ST-Elevation Myocardial Infarction Complicated by Acute Heart Failure

PLoS ONE ◽

10.1371/journal.pone.0112359 ◽

2014 ◽

Vol 9 (11) ◽

pp. e112359 ◽

Cited By ~ 15

Author(s):

Trygve Husebye ◽

Jan Eritsland ◽

Harald Arnesen ◽

Reidar Bjørnerheim ◽

Arild Mangschau ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Heart Failure ◽

Interleukin 8 ◽

St Elevation Myocardial Infarction ◽

Myocardial Recovery ◽

St Elevation

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The risk of admission acute heart failure in ST-elevation myocardial infarction patients and air pollution with PM2.5

European Heart Journal ◽

10.1093/eurheartj/ehab724.1453 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Sinkovic ◽

M Krasevec ◽

D Suran ◽

M Marinsek ◽

A Markota

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Air Pollution ◽

Acute Heart Failure ◽

St Elevation Myocardial Infarction ◽

Vascular Events ◽

Limit Values ◽

Predictive Role ◽

St Elevation

Abstract Introduction Air pollution, in particular exposure to particulate matter fine particles of less than 2.5 microns in diameter (PM2.5), increases the risk of cardiovascular events. Short-term exposure (hours to few days prior) to increased PM2.5 levels even may help trigger ST-elevation myocardial infarction (STEMI) and heart failure exacerbation in susceptible individuals. The risk of vascular events is increased even in exposures below the current European air quality limit values (mean annual levels for PM2.5 less than 10μg/m3, 24-hour mean level less than 25μg/m3). Purpose To evaluate predictive role of PM2.5 levels ≥20 μg/m3 one day prior to hospital admission for the risk of admission acute heart failure (AAHF) in STEMI patients. Methods In 290 STEMI patients (100 women, 190 men, mean age 65.5±12.9 years), treated by primary percutaneous coronary intervention (PPCI) in 2018, we retrospectively registered the AAHF, defined as classes II-IV by Killip Kimbal classification. Additionally, we registered admission clinical data, potentially contributing to AAHF in STEMI patients such as gender, age ≥65 years, prior resuscitation, admission cTnI ≥5 μg/L (normal levels up to 0.045 μg/L), comorbidities, time to PPCI, and mean daily levels of PM2.5 ≥20 μg/m3 one day before admission. Mean daily, freely available, levels of PM2.5 were measured and registered by Chemical analytic laboratory of Environmental agency of Republic Slovenia. We evaluated the predictive role of admission data for admission AHF in STEMI patients. Results AAHF was observed in 34.5% of STEMI patients with the mean daily PM2.5 level 15.7±10.9 μg/m3 on the day before admission. PPCI was performed in 92.1% of all STEMI patients, in AAHF in 87.1% and in non-AAHF patients in 94.7% (p=0.037). AAHF in comparison to non-AAHF was associated significantly with female gender (50.5% vs 25.9%, p<0.001), age over 65 years (71.3% vs 45%, p<0.001), prior diabetes (33.7% vs 14.8%, p<0.001), left bundle branch block (LBBB) (10.9% vs 0.5%, <0.001), admission cTnI ≥5 μg/L (46.7% vs 25.9%, p<0.001) and mean daily levels of PM2.5 ≥20 μg/m3 one day before admission (31.7% vs 19%, p=0.020), but nonsignificantly with arterial hypertension, prior myocardial infarction, anterior STEMI and time to PPCI. Logistic regression demonstrated that significant independent predictors of AAHF were age over 65 years (OR 3.349, 95% CI 1.787 to 6.277, p<0.001), prior diabetes (OR 2.934, 95% CI 1.478 to 5.821, p=0.002), admission LBBB (OR 10.526, 95% CI 1.181 to 93.787, p=0.03), prior resuscitation (OR 3.221, 95% CI 1.336 to 7.761, p=0.009), admission cTnI ≥5μg/l (OR 2.984, 95% CI 1.618 to 5.502, p<0.001) and mean daily levels of PM2.5 ≥20 μg/m3 (OR 2.096, 95% CI 1.045 to 4.218, p=0.038) one day before admission. Conclusion Mean daily levels of PM2.5 ≥20μg/m3 one day before admission were among significant independent predictors of AAHF in STEMI patients. FUNDunding Acknowledgement Type of funding sources: None.

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Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction

Open Heart ◽

10.1136/openhrt-2018-000852 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000852 ◽

Cited By ~ 5

Author(s):

Artin Entezarjou ◽

Moman Aladdin Mohammad ◽

Pontus Andell ◽

Sasha Koul

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

High Risk ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Clinical Event ◽

Left Ventricular Ejection ◽

Increased Risk ◽

St Elevation ◽

The Impact

BackgroundST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI.MethodsA total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models.ResultsOne-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality.ConclusionsLAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.

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Abstract 12455: Evaluation of N-Terminal Pro-B-type Natriuretic Peptide as a Therapeutic Response Biomarker in Group I Pulmonary Arterial Hypertension

Circulation ◽

10.1161/circ.130.suppl_2.12455 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Aaron M Wolfson ◽

Micheal L Maitland ◽

Vasiliki Thomeas ◽

Cherylanne Glassner ◽

Mardi Gomberg-Maitland

Keyword(s):

Heart Failure ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Roc Curve ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Goal Directed Therapy ◽

Group I ◽

Target Values ◽

Pulmonary Arterial

Purpose: Goal directed management of left heart failure with an NT-proBNP target-based approach has some evidence of providing a survival benefit. To evaluate the potential utility of serial NT-proBNP measurements for goal-directed therapy in right heart failure we retrospectively assessed NT-proBNP as a predictor for survival in Group I pulmonary arterial hypertension (PAH) patients. Methods: We identified 103 Group I PAH patients from a pulmonary hypertension registry who had baseline elevated NT-proBNP prior to either the initiation or escalation of therapy and at least two serial NT-proBNP measurements. In a two-step process, we (1) estimated baseline NT-proBNP and slope (rate of change of NT-proBNP) with a linear mixed-effects model using all patient data and then (2) compared the power of serial versus single measurements in predicting survival with measured and model-derived values of baseline NT-proBNP with a Receiver Operative Characteristic (ROC) curve analysis . Survival was determined using the Kaplan-Meier methodology. Results: ROC curve analysis revealed significantly higher AUC for model-derived NT-proBNP values compared to the measured values (AUC: for baseline 0.74 vs 0.66, p= 0.009; for slope 0.78 vs 0.66, p= 0.02). Optimal cutpoints for prediction of survival on baseline NT-proBNP were 2012 (measured) vs. 1810 (model-derived) pg/mL. The optimal cutpoint for model-derived change in NT-proBNP was -0.004 log10pg/mL/month. Sensitivity, specificity, and negative predictive values for the three predictor variables were: 64%, 67%, 80% (measured baseline NT-proBNP), 61%, 80%, 81% (model-derived baseline NT-proBNP) and 73%, 57%, 85% (model-derived slope). Conclusions: In PAH patients, serial NT-proBNP measurements better predict survival than single measurements. This retrospective finding reveals that changes in NT-proBNP are associated with overall survival in PAH patients, and set initial target values for a pilot prospective study of NT-proBNP goal-directed therapy.

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