Outcomes of nonagenarians with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Echarte Morales ◽  
P.L Cepas Guillen ◽  
G Caldentey ◽  
E Martinez Gomez ◽  
J Borrego-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk Population ◽  
High Morbidity ◽  
Baseline Characteristic ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
All Cause Mortality

Abstract Background Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials. Objective The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management. Methods We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed. Results 523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p<0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p<0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p<0.01) or STEMI groups (p<0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03). Conclusion An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Complete versus culprit-only percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome: a meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Sakurai
Keyword(s):  
Myocardial Infarction ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Coronary Revascularisation ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Background The clinical benefit of complete or culprit-only percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) still remains controversial. Purpose The purpose of this study was to investigate the clinical outcomes of complete or culprit-only PCI in patients with unstable angina and/or non-ST-segment elevation myocardial infarction. Methods PubMed, the Cochrane Library, and Web of Science were queried to conduct a meta-analysis. The same terms or relevant studies were also queried on the website of the U.S. National Institute of Health and relevant reviews. The primary endpoint was the incidence of major adverse cardiac events (MACE: the composite of all-cause mortality, myocardial infarction, or coronary revascularisation) during follow-up period, and the secondary endpoints were the incidences of each component of MACE. When multiple follow-up results were reported in the same study, the latest results were abstracted. Pooled estimates were calculated using a random-effects model. Results Nine studies (60345 patients) were included in this meta-analysis. The risk of all-cause mortality (odds ratio (OR): 0.79, 95% confidence interval (CI): 0.64–0.98, p=0.03) or coronary revascularisation (OR: 0.71, 95% CI: 0.50–1.00, p=0.05) were lower in the complete PCI group than in the culprit-only PCI group, whereas the risk of MACE (OR: 0.98, 95% CI: 0.65–1.49, p=0.94) or myocardial infarction (OR: 0.77, 95% CI: 0.54–1.08, p=0.13) was similar between the 2 groups. Conclusions In this meta-analysis, complete PCI is associated with a lower risk of all-cause mortality or coronary revascularisation, and a similar risk of MACE or myocardial infarction compared with culprit-only PCI in patients with NSTE-ACS. Funding Acknowledgement Type of funding source: None

scholarly journals Circulating Marine and Vegetable Omega-3 at the Time of ST-Segment Elevation Myocardial Infarction and Incident Hard Clinical Endpoints

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1483-1483
Author(s):  
Aleix Sala-Vila ◽  
Iolanda Lázaro-López ◽  
Ferran Rueda ◽  
Germán Cediel ◽  
Antoni Bayés-Genís
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Hospital Readmission ◽  
Omega 3 ◽  
St Segment Elevation ◽  
Clinical Endpoints ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality

Abstract Objectives Dietary marine omega-3 eicosapentaenoic acid (EPA) is readily incorporated into cardiac cell membranes, partially replacing the omega-6 arachidonic acid (AA). Blood omega-3 is an objective marker of their intake over the last days. Increasing blood EPA at the time of a ST-segment elevation myocardial infarction (STEMI) relates to a smaller infarct size and preserved long-term left ventricular ejection fraction. We explored whether blood EPA at the time of STEMI also relates to a lower incidence of hard clinical endpoints. We also explored whether blood alpha-linolenic acid (ALA, the vegetable omega-3) modulates such association. Methods We prospectively included 944 consecutive patients treated with primary percutaneous coronary intervention in a single tertiary referral hospital. We determined fatty acids in serum phosphatidylcholine (PC) at 12 hours of evolution. The primary outcomes were cardiovascular disease-related hospital readmission and all-cause mortality after 3 years of follow-up. We constructed multivariable Cox proportional hazards models, calculating risk estimates as hazard ratios (HR). Results The mean age of the cohort was 61 years and 209 (22.1%) were women. During follow-up, 130 patients (13.8%) were readmitted for cardiovascular disease, and 108 (11.4%) died. After adjustment for known clinical predictors, multivariate analysis showed that EPA in serum PC at the time of STEMI inversely related to incident hospital readmission (HR, 0.74; 95% CI, 0.56–0.96; P = 0.024, for a 1 SD increase). Further adjustment for serum PC AA and ALA did not change the association. EPA in serum PC was found to be unrelated to 3-y total mortality. However, after including serum PC proportions of AA and ALA into the model, we observed a significantly decreased risk of mortality for ALA (HR, 0.65; 95% CI, 0.44–0.96; P = 0.030, for a 1 SD increase). Conclusions Increasing proportions of EPA and ALA in serum PC at the time of STEMI inversely relate to 3-y cardiovascular disease-hospital readmission and all-cause mortality, respectively. Dietary EPA and ALA act synergistically and are partners rather than competitors in improving prognosis in case of a STEMI. Funding Sources Instituto de Salud Carlos III, Spain; California Walnut Commission.

scholarly journals Evolutionary and prognostic implications in patient with acute coronary syndrome and dysthyroidism

2021 ◽  
Vol 16 (2) ◽  
pp. 225-233
Author(s):  
Eleonora DRĂGAN ◽  
◽  
Maria Suzana GUBERNA ◽  
Cătălina Liliana ANDREI ◽  
Crina-Julieta SINESCU ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
C Reactive Protein ◽  
St Segment Elevation ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
St Segment

Purpose. The study aims to determine the impact of dysthyroidism on the severity and type of coronary lesion, on vascular function, as well as on the morbidity and mortality of patients with acute coronary syndrome, by finding predictive markers that can be translated into preventive measures that contribute substantially to reduce the number of newly diagnosed patients with coronary heart disease. Methods. We introduced in the study 100 patients recently diagnosed with acute coronary syndrome, without history of ischemic heart disease or thyroid disease, hospitalized in the Cardiology Clinic of the “Bagdasar-Arseni“ Emergency Clinical Hospital Bucharest, for the interventional treatment of acute coronary syndrome. The studied patients were hospitalized between November 2014 and April 2015, with regular follow-up of up to 5 years (telephone or direct interview, conducted at 6 months, 12 months, 24 months, 36 months, 48 months, 60 months), with an average period follow-up of 1006 days, evaluated clinically, bio-humorally, by echocardiography, explored with coronary angiography with the calculation of the SYNTAX score and with the performance of electrocardiogram and pulse wave. The obtained data were integrated in Excel sheets and statistically processed with the Python program. Results. The mortality rate in the patient group was 7% (7 deaths). Descriptively, of the deceased, 6 patients (86%) were male, and as thyroid status 1 hyperthyroid patient (14%), 3 hypothyroid patients (43%) and 3 patients (43%) normothyroid. There were 4 deaths (8%) in the group of patients with unstable angina and 3 deaths (8%) in the group of patients with myocardial infarction without ST-segment elevation. There were no deaths in the group of patients with acute myocardial infarction with ST-segment elevation. At follow-up, 41 patients (41%) were readmitted. Re-hospitalization was influenced by elevated values of mean blood pressure, diastolic blood pressure and C-reactive protein, unicoronary atherosclerotic disease and unstable angina at admission. At follow-up, the development of noncardiac events was noted in the evolution of patients, diabetes mellitus occurring in the majority, in almost a quarter of patients (22 patients, respectively 24% developed diabetes over time), 34% (19 patients) in euthyroidism and 8% (3 patients) dysthyroidism. Discussions. Predictive factors for the readmission of the patient with acute coronary syndrome are highlighted the following: increased level of C-reactive protein (p = 0.017), tricoronary vascular damage (p = 0.01), diastolic blood pressure greater than 80 mmHg (p = 0.025), and euthyroid status (p = 0.04). The probability of death for the patient with acute coronary syndrome rises to 66% in the presence of severe systolic dysfunction of the left ventricle (p = 0.006), and to 61% in the case of elevated values of hs troponin I (p = 0.008). In our study, the presence of dysthyroidism in the patient with acute coronary syndrome has a protective role in the development of diabetes in the first 5 years (p = 0.025). Conclusion. Dysthyroidism is associated with increased morbidity and mortality from cardiovascular disease.

scholarly journals Myocardial Work and long-term prognosis in patients after ST-segment elevation acute myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Timoteo ◽  
L Moura Branco ◽  
A Galrinho ◽  
T Mano ◽  
P Rio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Global Longitudinal Strain ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Elevation Acute Myocardial Infarction

Abstract Background Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction (LVEF) in patients with ST-segment-elevation acute myocardial infarction. However, LV global longitudinal strain (GLS) does not take into consideration the effect of afterload. Myocardial work (MW) by speckle-tracking echocardiography integrates blood pressure measurements (afterload) with LV GLS and it has been recently demonstrated that Global Work Efficiency (GWE) is associated with long-term all-cause mortality. It remains to be demonstrated if MW indices are associated with hard cardiovascular endpoints. The present study aimed to investigate the prognostic value of global LV MW obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. Methods A total of 100 consecutive ST-segment-elevation myocardial infarction patients (mean age, 61±12 years; 75% men) that survived to discharge were retrospectively analysed. LVEF, GLS and all LVMW indices were measured by transthoracic echocardiography before discharge (4.6±2.0 days after admission). All patients had at least a two-year follow-up (mean follow-up of 833±172 days). Outcomes: all-cause mortality, major acute cardiovascular events (a composite of cardiovascular mortality, myocardial infarction, stroke, unplanned cardiovascular admission) and heart failure hospitalization. Results In the two-year follow-up, 6 patients died, there were 17 patients with MACE, and 3 patients were hospitalized with heart failure. We confirmed that for all-cause mortality, GWE showed higher discrimination, compared to GLS (Table 1), with a cut-off of 83% (log-rank <0,001). For MACE, the performance of all methods is suboptimal, with an AUC <0.65 for all variables, except for GLS. For heart failure admission, performance is slightly better, but GLS is still the better parameter to predict this event. Conclusions LVGWE is a better predictor of all-cause mortality compared to GLS, but MW indices failed to demonstrate a prognostic impact in long-term cardiovascular events. Prospective studies are warranted to confirm this finding. FUNDunding Acknowledgement Type of funding sources: None. Table 1

scholarly journals An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 102
Author(s):  
Mustafa Yurtdaş ◽  
Ramazan Asoğlu ◽  
Mahmut Özdemir ◽  
Emin Asoğlu
Keyword(s):  
Myocardial Infarction ◽  
Side Branch ◽  
Coronary Bifurcation ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Coronary Bifurcation Lesions ◽  
St Segment ◽  
Bifurcation Lesions

Background and Objectives: Little is known about the upfront two-stent strategy (U2SS) for true coronary bifurcation lesions (CBLs) in acute coronary syndrome (ACS). We aimed to present our two-year follow-up results on the U2SS by using different two-stent techniques for the true CBL with a large side branch (SB) in ACS patients, including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), and to identify independent predictors of the presence of major adverse cardiac events (MACEs) after intervention. Materials and Methods: The study included 201 consecutive ACS patients with true CBLs who underwent percutaneous coronary intervention (PCI) using U2SS from October 2015 to March 2018. Clinical outcomes at follow-up were assessed. MACE was defined as a composite of cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Results: 31.3% of the patients had an UA, 46.3% had an NSTEMI, and 22.4% had an STEMI. CBL was most frequently located in the left anterior descending (LAD)/diagonal artery (59.2%). In total, 71.1% of the patients had a Medina classification (1,1,1). Overall, 62.2% of cases were treated with mini-crush stenting. Clopidogrel was given in 23.9% of the patients; 71.1% of the patients received everolimus eluting stent (EES); and 11.9% received a sirolimus eluting stent (SES). Final kissing balloon inflation was carried out in all patients, with an unsatisfactory rate of 5%. A proximal optimization technique sequence was successfully carried out in all patients. The MACE incidence was 16.9% with a median follow-up period of 2.1 years. There were seven cardiac deaths (3.5%). The TLR rate was 13.4% (n = 27), with PCI treatment in 16 patients, and coronary artery bypass grafting treatment in 11 patients. After multivariate penalized logistic regression analysis (Firth logistic regression), clopidogrel use (odds ratio (OR): 2.19; 95% confidence interval (CI): 0.41–2.51; p = 0.007) and SES use (OR: 1.86; 95% CI: 0.31–2.64; p = 0.014) were independent predictors of the presence of MACE. Conclusion: U2SS is feasible and safe for the true CBLs with large and diseased SB in ACS patients, and is related to a relatively low incidence of MACE. Clopidogrel use and SES use may predict the MACE development in ACS patients treated using U2SS.

Geriatric nutritional risk index is a predictor of recurrent percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction

Kardiologiia ◽  
2021 ◽  
Vol 61 (8) ◽  
pp. 60-67
Author(s):  
Mehmet Kaplan ◽  
Ertan Vuruskan ◽  
Gökhan Altunbas ◽  
Fethi Yavuz ◽  
Gizem Ilgın Kaplan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Risk Group ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Aim To investigate the relationship between malnutrition and follow-up cardiovascular (CV) events in non-ST-segment elevation myocardial infarction (NSTEMI).Material and methods A retrospective study was performed on 298 patients with NSTEMI. The baseline geriatric nutritionalrisk index (GNRI) was calculated at the first visit. The patients were divided into three groups accordingto the GNRI: >98, no-risk; 92 to ≤98, low risk; 82 to <92, moderate to high (MTH) risk. The studyendpoint was a composite of follow-up CV events, including all-cause mortality, non-valvular atrialfibrillation (NVAF), hospitalizations, and need for repeat percutaneous coronary intervention (PCI).Results Follow-up data showed that MTH risk group had significantly higher incidence of repeat PCI and all-cause mortality compared to other groups (p<0.001). However, follow-up hospitalizations and NVAFwere similar between groups (p>0.05). The mean GNRI was 84.6 in patients needing repeat PCI and99.8 in patients who did not require repeat PCI (p<0.001). Kaplan Meier survival analysis showed thatpatients with MTH risk had significantly poorer survival (p<0.001). According to multivariate Coxregression analysis, theMTH risk group (hazard ratio=5.372) was associated with increased mortality.Conclusion GNRI value may have a potential role for the prediction of repeat PCI in patients with NSTEMI.

scholarly journals Outcomes in nonagenarians with acute coronary syndrome. Is medical treatment important?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
JULIO Echarte-Morales ◽  
ELENA Tundidor Sanz ◽  
E Martinez Gomez ◽  
PEDRO Cepas-Guillen ◽  
JAVIER Borrego Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Dual Antiplatelet Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Nonagenarians have a high rate of comorbidities and are underrepresented in studies of ischemic heart disease. It is unknown whether treatment at discharge is useful in preventing adverse events at follow up.  Purpose  The aim of this study is to evaluate the secondary prevention with medical treatment in nonagenarians with acute myocardial infarction. Methods A multicenter, observational and retrospective study was carried out in nonagenarians admitted by acute coronary syndrome (ACS) between January 2005 and December 2018. Baseline characteristics, interventional procedures, treatment at discharge and outcomes at 1 year were evaluated. Patients with type 2 acute myocardial infarction were excluded.  Results  680 patients (92,6 ± 2,4 years old) were included. Hypertension was present in 79.4% of the entire population. Percutaneous coronary intervention (PCI) was performed in 32.1% of patients, and this group had a higher GRACE score compared to the conservative treatment group (177 versus 172; p = 0.001). Patients with ST-segment elevation myocardial infarction (STEMI) were more likely to receive an invasive strategy than the non-ST segment elevation myocardial infarction (NSTEMI) (61.5% versus 41.5%; p= 0.001). 263 patients died at 1 year follow up with in-hospital mortality of 17%. In STEMI group, patients with statins and dual antiplatelet therapy at discharge had lower mortality during follow up compared to those who did not received (26.7 % versus 41.5%; p = 0.001 and 31% versus 22%; p = 0.02, respectively) (Image 1).  Conclusions Nonagenarian patients with ACS have a high prevalence of hypertension and ICP procedures are not performed frequently. They also have a high mortality rate, although statins and dual antiplatelet therapy could be an effective secondary prevention. Abstract Figure.

Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score

2016 ◽  
Vol 7 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Roland Klingenberg ◽  
Soheila Aghlmandi ◽  
Lorenz Räber ◽  
Baris Gencer ◽  
David Nanchen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Improve Risk Stratification ◽  
St Segment ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Grace Score

Background: Clinical scores and biomarkers improve risk stratification of patients with acute coronary syndromes. However, little is known about their value in patients referred for coronary angiography. Methods: Consecutive patients admitted at four Swiss university hospitals with a diagnosis of acute coronary syndrome were enrolled into the SPUM-ACS Biomarker Cohort between 2009 and 2012. Patients were followed at 30 days and 1 year with assessment of adjudicated events including all-cause mortality and the composite of all-cause mortality or non-fatal recurrent myocardial infarction. Results: Events and biomarkers were analysed in 1892 patients (52.4% with ST-segment elevation myocardial infarction, 43.3% with non-ST-segment elevation myocardial infarction and 4.3% with unstable angina). Death at 30 days occurred in 35 patients (1.9%) and at 1 year in 80 patients (4.3%). The choice of troponin assay (conventional versus high sensitivity) to calculate the Global Registry of Acute Coronary Events (GRACE) score did not affect risk prediction. The prognostic accuracy of the GRACE score was improved when combined with three individual biomarkers including high sensitivity troponin T (hsTnT), N-terminal-pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) to yield a 9% increment (C-statistic 0.73–>0.82) for the discrimination of short-term risk for all-cause mortality. In contrast, the novel biomarkers placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and the ratio sFlt-1/PlGF did not improve risk stratification. Conclusions: In patients with acute coronary syndrome referred for coronary angiography, combinations of biomarkers including hsTnT, NT-proBNP and hsCRP with the GRACE score enhanced risk discrimination. Clinical Trials Registration: NCT01000701

scholarly journals Markers of Poor Prognosis in Non-ST Segment Elevation Acute Coronary Syndromes Without Revascularization: A 3-Year Survival Analysis

2018 ◽  
Vol 2 (2) ◽  
pp. e000139
Author(s):  
Alexander Parkhomenko ◽  
Natalia Dovgan ◽  
Yaroslav Lutay ◽  
Sergey Kozhukhov
Keyword(s):  
Myocardial Infarction ◽  
Interventricular Septum ◽  
Cardiovascular Death ◽  
Silent Myocardial Ischemia ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Number Of Patients ◽  
History Of

Introduction: The non-ST elevation acute coronary syndrome (NSTE-ACS) account for more than 50% of the total number of patients with ACS. The mortality rates after NSTEMI are not significantly different when compared with patients with ST-segment elevation myocardial infarction. Aim: The aim of the present study was to investigate whether the assessment of clinical, laboratory and instrumental data during hospital stay provide any additional independent information in predicting the 3-year major cardiac events after NSTE-ACS. Methods: We observed 490 consecutive patients, who were admitted to the emergency cardiology department with NSTE-ACS. The patients' baseline characteristics, blood analysis, left ventricle (LV) and renal function data were assessed and analyzed. The median follow‑up time was 36 months. The endpoint was cardiovascular death. Results: The results of our study show that the risk of cardiovascular death during the three years follow-up after multivariate adjustment increases with older age (> 64 years), history of diabetes, prior myocardial infarction and history of angina pectoris, lower ejection fraction (<50%), degree of myocardial hypertrophy (the thickness of the interventricular septum >1.25 mm) of the LV and the degree of diastolic dysfunction (E-wave deceleration time (DT) < 150 ms), silent myocardial ischemia during first 24-hours, high pulse pressure on Day 1 (>49 mm Hg), glucose level > 7.5 mmol/l on admission and moderate kidney dysfunction (CrCl <60 ml/min). Conclusion: In patients with NSTE-ACS, we report the cardiovascular death risk factors within the 3-year follow-up period in the present study. We thus conclude that it is important to identify the patients with high risk of future cardiovascular complications.

scholarly journals Neutrophil-to-lymphocyte ratio for predictor of in-hospital mortality in ST-segment elevation myocardial infarction: a meta-analysis

2020 ◽  
Vol 29 (2) ◽  
pp. 172-82
Author(s):  
Rodry Mikhael ◽  
Evan Hindoro ◽  
Sharleen Taner ◽  
Antonia Anna Lukito
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
St Segment Elevation ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality

BACKGROUND ST-segment elevation myocardial infarction (STEMI) is the most life-threatening condition of acute coronary syndrome that carries a poor prognosis of in-hospital mortality. Multiple scoring systems have been developed to predict in-hospital mortality and other cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) is hardly used as a predictor of in-hospital mortality. This study was aimed to determine the predictive value of NLR concerning in-hospital mortality in STEMI patients. METHODS Literature search and pooled analysis related to studies on MEDLINE/PubMed, EBSCO, Science Direct, Cochrane, and ProQuest were retrieved. Inclusion criteria were met if they were cohort studies, the subjects were STEMI patient, contained pretreatment NLR cut-off, and considered in-hospital mortality, which is defined as cardiac or all-cause mortality. Quality assessment was conducted using Newcastle-Ottawa scale. Review Manager version 5.3 (The Nordic Cochrane Centre, Copenhagen) was used for meta-analysis. RESULTS We found 12 studies with a total of 7,251 STEMI subjects with median NLR cut-off value of 5.6. Elevated NLR on admission carries a high risk of in-hospital mortality (odds ratio [OR] = 3.00, 95% confidence interval [CI] = 2.46–3.67). A slightly higher risk of all-cause mortality (OR = 2.74, 95% CI = 1.99–3.77) was observed compared with cardiac-related mortality (OR = 3.20, 95% CI = 2.47–4.14). No significant heterogeneity was observed between these studies (p = 0.46, I2 = 0%). CONCLUSIONS Elevated NLR predicts a higher in-hospital mortality rate of STEMI patients.

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