scholarly journals Serum lactic acid level predicts poor myocardial perfusion and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Y Liu ◽  
C F Dai ◽  
Z W Chen ◽  
J Y Qian ◽  
J B Ge
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lactic Acid ◽  
Risk Score ◽  
Acid Level ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Lactic Acid Level ◽  
Hospital Outcomes ◽  
Grace Risk Score

Abstract Background Elevated serum lactic acid level is associated with poor outcomes in patients with critical diseases like shock. However, the clinical implication of this biomarker in patients with acute myocardial infarction remains unclear. Purpose We aimed to explore the predictive power of serum lactic acid level on admission for in-hospital outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Methods Consecutive patients undergoing pPCI with available data on serum lactid acid level were evaluated for eligbility in this retrospective cohort study. The primary outcome was all-cause death during hospitalization. Enzymatic infarct size and major adverse cardiovascular events (MACE, defined as a combination of all-cause death, recurrent myocardial infarction, and unplanned repeated revascularization) were considered secondary outcomes. Independent preditors of in-hospital death were determined by multiple logisic regression analysis. Odds ratio (OR) with 95% confidence interval (CI) was used to demonstrate the association. The predictive power of serum latictic acid level for in-hospital death was evaluated through receiver operator characteristic curve, which generated C-statictic. A combination model was further constructed by adding serum latictic acid level to the Global Registry of Acute Coronary Events (GRACE) risk score (LA-GRACE risk score). The linear dependence between serum lactic acids level and othe clinical variables was analysed using Spearman rank correlation. Results Of the 302 patients enrolled in the current analysis, 15 (5.0%) died during hospitalization. Serum lactic acid level (OR=1.657, 95% CI: 1.115 to 2.463, p=0.012)and left ventricular ejection fraction (OR=0.858, 95% CI: 0.767 to 0.959, p=0.007) were the only two independent predictors of in-hospital death. The C-statistic of serum lactic acid level for predicting in-hospital death was 0.886 (95% CI: 0.793 to 0.979). The LA-GRACE risk score improved the C-statistic of the GRACE score from 0.898 to 0.911 (p=0.294), with continuous net reclassification improvement of 0.567 (p=0.023) and integrated discrimination improvement of 0.206 (p=0.003). High serum lactic acid level was also asscoiated with larger enzymatic infarct size (p=0.002) and MACE (p=0.004). Further, it significantly correlated with white blood cell counts (r=0.264, p<0.001), serum creatinine level (r=0.189, p=0.001), and systolic blood pressure (r=−0.122, p=0.034). Conclusion Serum lactic acid level on admission is asscoiated with poor myocardial perfusion and in-hospital outcomes in patients with acute myocardial infarction undergoing pPCI. It may contribute to better risk stratification in these populations. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the National Program on Key Basic Research Project of China (Grant No: 2019YFC0840601 and 2014CBA02003), National Natural Science Foundation of China (Grant No: 81870267, 81970295, 81521001, 81670318 and 81570314), Grant of Shanghai Shenkang on Key Clinical Research Project (Grant No: SHDC2020CR2015A and SHDC12019104), Grant of Shanghai Science and Technology Committee (Grant No: 19MC1910300, 18411950200 and 20JC1410800), Key Medical and Health Projects of Xiamen Province (No: 3502Z20204004), Grant of Shanghai Municipal Commission of Health and Family Planning (Grant No: 2017YQ057), Grant of Zhongshan Hospital Affiliated to Fudan University (Grant No: 2018ZSLC01), VG Funding of Clinical Trials (2017-CCA-VG-036) and Merck Funding (Xinxin-merck-fund-051). ROC of lactic acid and GRACE score

High-Sensitivity C-Reactive Protein is a Predictor of In-Hospital Cardiac Events in Acute Myocardial Infarction Independently of GRACE Risk Score

Angiology ◽  
2011 ◽  
Vol 63 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Sergio Raposeiras-Roubín ◽  
Cristina Barreiro Pardal ◽  
Bruno Rodiño Janeiro ◽  
Emad Abu-Assi ◽  
José María García-Acuña ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Score ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Hospital Outcomes ◽  
Coronary Syndrome ◽  
Grace Risk Score

High-sensitivity CRP (hsCRP) is being increasingly used as a marker for cardiac risk assessment and as a prognostic tool in acute coronary syndrome. We analyzed the relation between hsCRP values at admission and in-hospital outcomes in 98 consecutive patients with acute myocardial infarction (AMI) undergoing catheterization. Patients with cardiac events had more advanced Killip class, more proportion of depressed left ventricular ejection fraction (LVEF), higher Global Registry of Acute Coronary Events (GRACE) risk score, and higher hsCRP levels. High-sensitivity CRP and GRACE risk score showed a significant positive correlation ( r = .320, P = .002). In multivariate analysis, hsCRP resulted as a predictor of worse in-hospital outcomes independently of GRACE risk score (OR 1.122, CI95%:1.005-1.252, P = .040). The hsCRP value showing the maximum likelihood ratio for predicting cardiac events was 1.45 mg/dL. High levels of hsCRP were also associated with development of contrast-induced nephropathy but not with bleeding events.

scholarly journals Impact of nutritional status on prognosis in acute myocardial infarction patients undergoing percutaneous coronary intervention

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Daisuke Kanda ◽  
Yoshiyuki Ikeda ◽  
Takuro Takumi ◽  
Akihiro Tokushige ◽  
Takeshi Sonoda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Nutritional Status ◽  
Risk Score ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Grace Risk Score ◽  
Percutaneous Coronary

Abstract Background Malnutrition affects the prognosis of cardiovascular disease. Acute myocardial infarction (AMI) has been a major cause of death around the world. Thus, we investigated the impact of malnutrition as defined by Geriatric Nutritional Risk Index (GNRI) on mortality in AMI patients. Methods In 268 consecutive AMI patients who underwent percutaneous coronary intervention (PCI), associations between all-cause death and baseline characteristics including malnutrition (GNRI < 92.0) and Global Registry of Acute Coronary Events (GRACE) risk score were assessed. Results Thirty-three patients died after PCI. Mortality was higher in the 51 malnourished patients than in the 217 non-malnourished patients, both within 1 month after PCI (p < 0.001) and beyond 1 month after PCI (p = 0.017). Multivariate Cox proportional hazards regression modelling using age, left ventricular ejection fraction and GRACE risk score showed malnutrition correlated significantly with all-cause death within 1 month after PCI (hazard ratio [HR] 7.04; 95% confidence interval [CI] 2.30–21.51; p < 0.001) and beyond 1 month after PCI (HR 3.10; 95% CI 1.70–8.96; p = 0.037). There were no significant differences in area under the receiver-operating characteristic (ROC) curve between GRACE risk score and GNRI for predicting all-cause death within 1 month after PCI (0.90 vs. 0.81; p = 0.074) or beyond 1 month after PCI (0.69 vs. 0.71; p = 0.87). Calibration plots comparing actual and predicted mortality confirmed that GNRI (p = 0.006) was more predictive of outcome than GRACE risk score (p = 0.85) beyond 1 month after PCI. Furthermore, comparison of p-value for interaction of malnutrition and GRACE risk score for all-cause death within 1 month after PCI, beyond 1 month after PCI, and the full follow-up period after PCI were p = 0.62, p = 0.64 and p = 0.38, respectively. Conclusions GNRI may have a potential for predicting the mortality in AMI patients especially in beyond 1 month after PCI, separate from GRACE risk score. Assessment of nutritional status may help stratify the risk of AMI mortality.

Abstract 3522: Transfer Patients With Acute Myocardial Infarction Do Not Impact Hospital Quality Measurements, Despite Being Sicker Than Directly Admitted Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Creighton Don ◽  
Douglas Stewart ◽  
Susan Heckbert ◽  
Charles Maynard ◽  
Richard Goss
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blockers ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Hospital Quality ◽  
Lipid Lowering ◽  
Hospital Death ◽  
Hospital Level ◽  
Risk Of Death

BACKGROUND Studies of hospital quality and national performance measures for acute myocardial infarction (AMI) frequently exclude transfer patients. Little is known about the clinical characteristics and outcomes of patients with AMI transferred for revascularization. HYPOTHESIS Transfer patients have greater clinical comorbidity and worse hospital survival than non-transfer patients, and negatively impact hospital quality measures. METHODS A retrospective-cohort study was performed using all patients with ST-elevation myocardial infarction who underwent coronary intervention or coronary artery bypass grafting (CABG) in Washington State from 2002 – 2005. Data on clinical and procedural characteristics, medications, and complications were obtained from the Clinical Outcomes Assessment Program. Hospitals were compared by rates of death and discharge with aspirin, beta-blockers, lipid lowering agents, and ACE inhibitors. Logistic regression was used for adjusted analysis. RESULTS Of patients undergoing revascularization for AMI, 7080 were directly admitted and 2910 were transferred. Diabetes (23.4 v. 19.7%, p<0.01), hypertension (61.3 v. 55.7%, p<0.01), and thrombolysis (32.3 v. 3.4%, p <0.01) were greater among transfers. Transfers presented with a higher rate of left main and three-vessel disease, intra-aortic balloon pump use (6.4 v. 3.6%, p<0.01) and underwent CABG more frequently (15.4 v. 5.5%, p <0.01). Transfer patients had a lower risk of death (3.9 v. 4.9%, p=0.03), but no difference in discharge medication prescription. Adjusting for major risk factors, procedure, and hospital type, transfers had a similar risk for in-hospital death compared to non-transfers (OR 0.9, CI 0.5 – 1.6). Hospitals with a high percentage of transfers treated higher-risk patients, but had similar outcomes to those with few transfers. Excluding transfers from the hospital-level analysis did not appreciably change these results. CONCLUSION Transfers were higher-risk, but had similar in-hospital mortality and were equally likely to receive appropriate medication at discharge compared to directly admitted patients. Inclusion of transfers did not affect hospital-level inpatient mortality or measurements of adherence to quality guidelines.

P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Seguchi ◽  
K Sakakura ◽  
K Yamamoto ◽  
Y Taniguchi ◽  
H Wada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Very Elderly ◽  
Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

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