scholarly journals Longitudinal high-sensitivity C-reactive protein and long-term cardiovascular outcomes in optimally-treated patients with high-risk vascular disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Dykun ◽  
D Clark ◽  
J Carlo ◽  
A M Lincoff ◽  
V Menon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Revascularization ◽  
Density Lipoprotein ◽  
Weighted Average ◽  
High Sensitivity ◽  
Cardiovascular Death ◽  
Reactive Protein ◽  
Time Weighted Average

Abstract Background High-sensitivity C-reactive protein (hsCRP) predicts major cardiovascular events (MACE) in patients with chronic atherosclerotic cardiovascular disease. The relationship between serial longitudinal hsCRP assessment and long-term MACE has not been explored. Purpose We tested the hypothesis that longitudinal follow-up hsCRP levels (repeated measures over time) would associate with 30-month MACE (cardiovascular death, myocardial infarction, cerebrovascular accident, coronary revascularization or hospitalization for unstable angina) rates. Methods We performed a post-hoc analysis of the ACCELERATE trial of optimally-treated patients with high-risk vascular disease and evaluated data from patients with available baseline and at least one follow-up hsCRP level measured at 3, 12, and 24 months. Those with a MACE event occurring before 3 months were omitted. Using multivariable Cox proportional hazard models, we determined the association of longitudinal follow-up hsCRP levels with MACE, its components, and all-cause mortality at 30-months, adjusting for age, race, sex, region, smoking status, body mass index, diabetes, baseline hsCRP, low density lipoprotein-cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, statin use, and treatment group. Results Among 8,563 patients, mean age was 64.6±9.3 years and 22.2% were women. Median baseline hsCRP was 1.49 (0.74, 3.3) mg/L. Median time-weighted average follow-up hsCRP was 1.80 (0.88, 3.9) mg/L and mean time-weighted average follow-up LDL-C was 71.7±28.0 mg/dL. At 30 months, there was a significant stepwise relationship between cumulative MACE and increasing tertiles of last prior hsCRP value before an event or censoring (KM estimates for tertiles 1–3, respectively: 8.9 vs. 12.4 vs. 15.6%, p<0.001). In multivariable analysis, higher longitudinal follow-up hsCRP levels were independently associated with MACE [HR (95% CI) per SD: 1.19 (1.10, 1.29), p<0.001], all-cause death [1.66 (1.48, 1.86), p<0.001], cardiovascular death [1.39 (1.19, 1.62), p<0.001], myocardial infarction [1.28 (1.12, 1.46), p<0.001], stroke [1.32 (1.08, 1.62), p=0.007], and coronary revascularization [1.12 (1.01, 1.24), p=0.03], but not with hospitalization for unstable angina [0.94 (0.77, 1.14), p=0.51]. Longitudinal follow-up hsCRP was significantly associated with MACE in patients with baseline hsCRP <2mg/L [1.16 (1.04, 1.30), p=0.008] and ≥2mg/L [1.25 (1.12, 1.40), p<0.001]. Conclusions In the setting of established medical therapies, longitudinal follow-up hsCRP is significantly associated with an increased risk of long-term MACE, myocardial infarction, stroke, cardiovascular mortality, coronary revascularization, and all-cause death. Longitudinal follow-up hsCRP may thus represent a novel marker of residual cardiovascular risk, supporting further work exploring the potential diagnostic and therapeutic implications of these findings. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Iryna Dykun was supported by the German Research Foundation

Acute-Phase Plasma PCSK9 Levels and Recurrent Cardiovascular Events in a Chinese Acute Myocardial Infarction Cohort

Cardiology ◽  
2018 ◽  
Vol 141 (2) ◽  
pp. 88-97 ◽  
Author(s):  
Yan Gao ◽  
Yan Qiu ◽  
Jihua Wu ◽  
Wei Diao ◽  
Haibo Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Phase ◽  
Recurrent Events ◽  
Density Lipoprotein ◽  
High Sensitivity ◽  
Female Gender ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Increased Risk

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a promising target for lowering plasma low-density lipoprotein cholesterol and preventing cardiovascular (CV) disease. Whether plasma PCSK9 measured during the acute phase predicts recurrent CV events in patients with acute myocardial infarction (AMI) remains unresolved. Methods and Results: Plasma PCSK9 levels were measured in 1,646 patients with AMI from the China PEACE-Prospective AMI Study at the acute phase. Additionally, 248 patients were resampled and measured at 1 month post-AMI. Associations of acute-phase PCSK9 tertiles with clinical characteristics and recurrent CV events within 1 year were assessed. Female gender (OR 1.94, 95% CI 1.24–3.03), premature coronary heart disease (CHD; OR 2.12, 95% CI 1.37–3.26), higher high-sensitivity C-reactive protein (OR 1.67, 95% CI 1.44–1.95), and higher triglycerides (OR 1.46, 95% CI 1.03–2.09) were associated with higher baseline PCSK9. Plasma PCSK9 levels in the highest tertile (versus lowest) did not have an increased risk of 1-year recurrent CV events in the AMI cohort (HR 0.78, 95% CI 0.52–1.16) or any subgroup. There was also no association between percentage changes in PCSK9 over the first month and 1-year recurrent events, although there was a trend of differences between patients in the upper versus lower tertiles. Conclusion: Plasma PCSK9 levels measured during the acute phase were associated with high-sensitivity C-reactive protein, triglycerides, premature CHD, and gender in patients with AMI but did not predict recurrent CV events within 1 year. Dynamic changes in PCSK9 suggested a trend yet no significance value in predicting recurrent CV events.

scholarly journals Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure

2020 ◽  
Vol 21 (3) ◽  
pp. 807 ◽  
Author(s):  
Iwona Świątkiewicz ◽  
Przemysław Magielski ◽  
Jacek Kubica ◽  
Adena Zadourian ◽  
Anthony N. DeMaria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Multivariable Analysis ◽  
High Sensitivity ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Reactive Protein

Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP24), discharge (CRPDC), and 1 month after discharge (CRP1M). LVSD at 6 months after discharge (LVSD6M) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD6M occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD6M vs. 4.9% without LVSD6M (p < 0.0001). Compared to patients without LVSD6M, the patients with LVSD6M had higher CRP24 and CRPDC and persistent CRP1M ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP24 ≥ 19.67 mg/L improved the prediction of LVSD6M with an increased odds ratio of 1.47 (p < 0.01). Patients with LVSD6M who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.

P5524Influence of bundle branch block in the long-term outcome of patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J M Garcia Acuna ◽  
A Cordero Fort ◽  
A Martinez ◽  
P Antunez ◽  
M Perez Dominguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Coronary Revascularization ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
Worse Prognosis

Abstract The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. This consideration is not taken into account in the management of patients with coronary syndrome without ST elevation (NSTEMI). We evaluate the evolution of patients with acute coronary syndrome and long-term bundle branch block. Patients and methods We included 8771 patients admitted to two tertiary hospitals between 2003 and 2017 with an acute coronary syndrome, 5673 NSTEMI (64.3%) and 3098 STEMI (35.7%). All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB). Long-term follow-up was performed (median 55 months) to assess mortality. Results A total of 8771 patients were included with a mean age of 66.1 years, 72.5% males, 4.1% (362) with LBBB and 5% (440) with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors. Medical treatment was similar but they were less often submitted to angioplasty. During the acute phase, patients with RBBB and LBBB presented a higher rate of heart failure than those without branch block (4.8% vs 9.1% vs 3.5%, p=0.0001); higher mortality (8.4% vs 10.5% vs 3.0%, p=0.0001); higher stroke rate (2.5% vs 1.4% vs 0.8%, p=0.001); higher rate of renal failure (8.2% vs 9.7% vs 3.9%, p=0.0001) and higher rate of reinfarction (3.0% vs 4.1% vs 1.7%, p=0.001). Patients who had a RBBB or an LBBB had a worse prognosis throughout the follow-up. Heart failure was present in 17.7% of the group with RBBB, 29.6% of LBBB and 11% in the group without branch block (p=0.0001). Mortality during follow-up was 31% in RBBB, 40.6% in LBBB and 18.7% without branch block (p=0.0001). In multivariate analysis of Cox, both RBBB (HR 1.55, 95% CI 1.23–1.98, p=0.0001) and LBBB (HR 1.48, 95% CI 1.22–1.53, p=0.001) were an independent predictors of all-cause mortality (adjustment for GRACE score, gender, treatment with betablockers, angiotensin conversor enzym inhibitors, statin and coronary revascularization). Cox regression model multivariate Conclusions The presence of RBBB or LBBB in the ECG of patients with an ACS is associated with a worse prognosis both during the hospital phase and in the long term. In addition, both bundle branch blocks are independent predictors of long-term mortality in patients with ACS.

6110OCT guidance during primary PCI may increase long-term risk of device oriented events: subanalysis of ROBUST study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Jakl ◽  
P Cervinka ◽  
P Kala ◽  
J Kanovsky ◽  
A Kupec ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Implantation ◽  
Statistical Power ◽  
Imaging System ◽  
Coronary Intervention ◽  
Study Groups ◽  
Cardiovascular Death ◽  
Increased Risk

Abstract Background Optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI) is expected to be safe in short and mid-term follow-up. Long term merits or risks of OCT guidance are unknown. Purpose To assess the possible merits of OCT guidance in pPCI in long-term follow-up. Methods 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. The OCT study was performed after PCI with C7-XRTM intravascular imaging system employing a non-occlusive technique. Incidence of Device-oriented Composite Endpoints (DoCE) was compared in both study groups. DoCE were defined as composite of definite or possible cardiovascular death, myocardial infarction and target vessel revascularization. The search for DoCE was performed by means of medical check-ups, repeated telephone contacts, analysis of medical records and search in national population registry. Results Mean follow-up was 6.5 (6.5–7.1 years). Of these patients, 2 (1.0%) patients died of cardiovascular reason, 4 patients (2%) suffered myocardial infarction and 7 (3.5%) patients underwent target lesion revascularization. In OCT guided group, number of stents per patient was higher (1.4 vs. 1.2, p=0.03). Risk of DoCE was significantly higher in OCT-guided group (7.6% vs. 2.1%, p=0.023). Event-free survival in study groups Conclusion Our data suggest increased risk of adverse events related to OCT guided tailoring of stent implantation performed after pPCI. These findings should be confirmed by further randomised trials with higher statistical power. Acknowledgement/Funding The work was supported by a long-term organization development plan 1011 (FMHS)

scholarly journals Peripheral Inflammatory Biomarkers for Myocardial Infarction Risk: A Prospective Community-Based Study

2017 ◽  
Vol 63 (3) ◽  
pp. 663-672 ◽  
Author(s):  
Zhijun Wu ◽  
Zhe Huang ◽  
Wei Jin ◽  
Eric B Rimm ◽  
Alice H Lichtenstein ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Repeated Measures ◽  
High Sensitivity ◽  
Community Based ◽  
Reactive Protein ◽  
Inflammatory Status ◽  
Increased Risk ◽  
Hs Crp ◽  
Wbc Count

Abstract BACKGROUND Most previous studies regarding chronic inflammation and risk of myocardial infarction (MI) have lacked repeated measures of high-sensitivity C-reactive protein (hs-CRP) and/or white blood cell (WBC) count over time. We examined whether cumulative average and longitudinal changes in these biomarkers were associated with subsequent MI risk. METHODS In this prospective, community-based study, we included 82544 Chinese participants [66796 men and 15748 women; mean (SD) age 55.1 (9.86) y] without prior cardiovascular diseases or cancer at baseline (2006–2007). hs-CRP, WBC and other clinical covariates were assessed at baseline and every 2 years during follow-up. RESULTS During 6 years of follow-up (2006–2012), we documented 714 incident MI cases. Higher baseline and cumulative average concentrations of hs-CRP and/or WBC were consistently associated with increased risk of MI (Ptrend &lt;0.001 for both). Longitudinal increase in hs-CRP (Ptrend &lt;0.001), but not WBC, was also associated with a higher future risk of MI, after adjustment for their baseline values and other covariates. Each 1-mg/L increment per year in hs-CRP was associated with a 9.3% increase in risk for future MI [hazard ratio (HR) = 1.09, 95% CI, 1.03; 1.17]. Participants with high-grade inflammatory status (hs-CRP ≥10 mg/L and WBC ≥10 × 109/L) had a higher risk of MI occurring &lt;3 months after hs-CRP/WBC assessments vs those with hs-CRP &lt;0.5 mg/L and WBC &lt;5 × 109/L (HR = 6.64; 95% CI, 1.49–29.6), as compared with MI occurring ≥4 years (HR = 2.95; 95% CI, 0.90, 9.65). CONCLUSIONS Plasma hs-CRP concentration and WBC predicted MI risk. Longitudinal increase in hs-CRP was also associated with a higher risk of MI.

Long term prognostic impact of gender in patients with stable coronary disease: an analysis of the CICCOR registry, a seventeen years, prospective, monocentric, cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Ruiz Ortiz ◽  
J.J Sanchez Fernandez ◽  
C Ogayar Luque ◽  
E Romo Penas ◽  
M Delgado Ortega ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Cardiovascular Death ◽  
Female Sex ◽  
The Impact ◽  
Overall Mortality

Abstract Purpose Women and men with stable coronary artery disease (sCAD) have different clinical features and management, but 1-year prognosis has been reported to be similar in large observational registries. The objective of the present study was to investigate the impact of female sex in the prognosis of the disease in the very long-term. Methods The CICCOR registry (“Chronic ischaemic heart disease in Cordoba”) is a prospective, monocentric, cohort study. From February 1, 2000 to January 31, 2004, all consecutive patients with sCAD attended at two outpatient cardiology clinics in a city of the south of Spain were included in the study and prospectively followed. Differential clinical features of women and men were described and the impact of female sex in long term prognosis was investigated. Results The study sample included 1268 patients, 337 women (27%) and 931 men (73% male). Women were older than men (70±9 versus 65±11 years, p&lt;0.0005), more likely to have hypertension (72% versus 49%, p&lt;0.0005) and diabetes (45% versus 26%), and less likely to be ex-smoker/active smoker (5%/2% versus 49%/9%, p&lt;0.0005). They had more frequently angina in functional class ≥II (22% versus 17%, p=0.04) and atrial fibrillation (8% versus 5%, p=0.04), but had received less frequently coronary revascularization (32% versus 44%, p&lt;0.0005). Prescription of statins (64% versus 68%, p=0.22), antiplatelets (89% versus 93%, p=0.07) and betablockers (67% versus 63%, p=0.28) at first visit was similar than men, but women received more frequently nitrates (78% versus 64%, p&lt;0.0005), angiotensin-conversing enzyme inhibitors or receptor antagonists (56% versus 47%, p=0.004) and diuretics (41% versus 22%, p&lt;0.0005). After up to 17 years of follow-up (median 11 years, IQR 4–15 years, with a total of 12612 patients-years of observation), probabilities of acute myocardial infarction (12% versus 14%, p=0.55) or stroke (14% versus 12%, p=0.40) at median follow up were similar for women and men. However, the risks of hospital admission for heart failure (22% versus 13%, p&lt;0.0005) or cardiovascular death (35% versus 24%, p&lt;0.0005) were significantly higher for women, with a non-significant trend to higher overall mortality (45% versus 39%, p=0.07). After multivariate adjustment, the risks of most events were similar for women and men (Hazard Ratios [95% confidence intervals]: 0.79 [0.55–1.14], p=0.21 for acute myocardial infarction; 0.89 [0.61–1.29], p=0.54 for stroke; 1.13 [0.82–1.57], p=0.46 for admission for heart failure; and 0.92 [0.73–1.16], p=0.48 for cardiovascular death), with a non-significant trend to lower overall mortality (0.83 [0.67–1.02], p=0.08). Conclusion Although women and men with sCAD presents a different clinical profile, and crude rates of hospital admissions for heart failure and cardiovascular death were higher in women, female sex was not an independent prognostic factor in this observational study with up to 17 years of follow-up. Funding Acknowledgement Type of funding source: None

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