P5730Do hypertensive women with coronary artery disease benefit from lowering systolic blood pressure under 130 mmHg? Long-term mortality in the INternational VErapamil SR-trandolapril STudy (INVEST)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R I Sava ◽  
Y Chen ◽  
Y K Taha ◽  
Y Gong ◽  
S M Smith ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
High Risk ◽  
Risk Group ◽  
Low Risk ◽  
High Risk Women ◽  
Artery Disease ◽  
Long Term Mortality

Abstract Background Hypertension (HTN) and coronary artery disease (CAD) are a prevalent combination in women, however limited data are available to guide blood pressure (BP) management. We hypothesize older women with HTN and CAD may not derive the same prognostic benefit from systolic BP (SBP) lowering <130 mmHg. Purpose To investigate the long-term mortality implications of different achieved SBP levels in hypertensive women with CAD. Methods Long-term, all-cause mortality data were analyzed for 9216 women, stratified by risk attributable to clinical severity of CAD (women with prior myocardial infarction or revascularization considered at high, all others at low risk) and by age (50 - <65 or ≥65 yo). The prognostic impact of achieving mean in-trial SBP <130 (referent group) was compared with 130 to <140 and ≥140 mmHg using Cox proportional hazards, adjusting for demographic and clinical characteristics. Results During 108,838 person-years of follow-up, 2945 deaths occurred. High risk women (n=3011) had increased long-term mortality in comparison to low risk women (n=6205) (adjusted HR 1.38, CI 1.28–1.5, p<0.001). Within risk groups, crude mortality percentages decreased according to BP values (table). As expected, high risk women were more likely to be ≥65 yo (68.68% vs. 50.51%, p<0.0001) or have SBP ≥140 mmHg (43.08% vs. 31.18%, p<0.0001). In adjusted analyses, an SBP ≥140 mmHg was associated with worse outcomes than SBP <130 mmHg in the entire cohort (HR 1.3, CI 1.2–1.5, p<0.0001) and when stratifying by risk (low risk group, HR = 1.47, CI 1.28–1.7, p<0.0001; high risk group, HR = 1.71, CI 1.01–1.35, p=0.03). In analyses stratified by age and risk, women ≥65 years and at high risk had decreased mortality in the 130 - <140 SBP category vs. <130 mmHg (HR 0.812, 95% CI 0.689–0.957, p=0.0133; figure). Women and deaths by risk and SBP group Group SBP category Women (n) Mortality (n) Mortality (%) High risk <130 773 338 44 130–<140 941 414 44 ≥140 1297 694 54 Low risk <130 2187 390 18 130–<140 2083 451 22 ≥140 1935 658 34 SBP = systolic blood pressure; n = number; % = percent per each group. Mortality adjusted HRs Conclusion In women ≥65 yo with hypertension and prior myocardial infarction and/or coronary revascularization enrolled in INVEST, a SBP between 130 to <140 mmHg was associated with lower all-cause, long-term mortality versus SBP <130 mmHg. Acknowledgement/Funding The main INVEST (International Verapamil [SR]/Trandolapril Study) was funded by grants from BASF Pharma, Ludwigshafen, Germany; Abbott Laboratories, A

scholarly journals Association of 1-Year Blood Pressure Variability With Long-term Mortality Among Adults With Coronary Artery Disease

2021 ◽  
Vol 4 (4) ◽  
pp. e218418
Author(s):  
Osama Dasa ◽  
Steven M. Smith ◽  
George Howard ◽  
Rhonda M. Cooper-DeHoff ◽  
Yan Gong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Blood Pressure Variability ◽  
Artery Disease ◽  
Long Term Mortality

scholarly journals Good long-term survival of Icelandic women following acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.R Gardarsdottir ◽  
M.I Sigurdsson ◽  
K.K Andersen ◽  
I.J Gudmundsdottir
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Significant Risk ◽  
Female Gender ◽  
Funding Source ◽  
Term Survival ◽  
Artery Disease ◽  
Long Term Mortality

Abstract Background Mortality from coronary artery disease has decreased considerably in recent decades in Western societies, but less in women compared with men. Possible explanations for this difference include delayed medical attention, atypical presenting symptoms and also a higher incidence of myocardial infarction with non-obstructive coronary arteries in women. In addition, recent studies suggest that women with acute myocardial infarction (AMI) are less likely to receive treatment according to guidelines, which results in worse prognosis for women. Iceland is listed as one of the most gender-equal countries in the world and we hypothesised that this may reduce the gender gap in treatment and survival following AMI. Purpose The aim of this nationwide study was to compare clinical characteristics and treatment of men and women with AMI, identify independent risk factors for long-term mortality and estimate the impact of gender on relative survival. Methods This was a retrospective cohort study on all patients in Iceland with STEMI (2008–2018) and NSTEMI (2013–2018) who had obstructive coronary artery disease on coronary angiography. Information about patients and angiography results and treatment were obtained from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and electronic health records. Data for all-cause mortality was extracted through linkage with Statistics Iceland and survival was estimated with Kaplan-Meier method and Cox regression analysis used to identify significant risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and gender-matched population in Iceland in 30-day intervals. Results A total of 1345 STEMI patients (24% women) and 1249 NSTEMI patients (24% women) were evaluated. Women with both STEMI (mean age: 71±11. vs. 67±12) and NSTEMI (mean age: 69±13 vs. 62±12) were older and less likely to have a cardiovascular history. There was no gender difference in the extent of coronary artery disease or treatment. Whilst long-term survival for women following STEMI (A) was lower, female gender was not found to be an independent risk factor for mortality after adjusting for age and comorbidities (HR 0.98, 95%-CI: 0.75–1.29). The survival after NSTEMI was similar between genders (B) and female gender was a protective prognostic factor (HR 0.67, 95% CI: 0.46–0.97). There was an excess 30-day mortality following STEMI (C) and NSTEMI (D) for both women and men compared to the matched Icelandic population, but thereafter the mortality rate was similar. Conclusion Our findings indicates that women and men in Iceland receive comparable treatment for AMI, including invasive treatment. Prognosis following NSTEMI is better in women. Higher early mortality after STEMI may be caused by delays in presentation and diagnosis as well as older age of women because female gender was not a significant risk factor for mortality. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University hospital of Iceland, 4 weeks research leave

Impact on Long-Term Mortality of Presence of Obstructive Coronary Artery Disease and Classification of Myocardial Infarction

2016 ◽  
Vol 129 (4) ◽  
pp. 398-406 ◽  
Author(s):  
Tomasz Baron ◽  
Kristina Hambraeus ◽  
Johan Sundström ◽  
David Erlinge ◽  
Tomas Jernberg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease ◽  
Long Term Mortality

A multi-gene assay to predict long-term mortality in early stage lung adenocarcinoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7569-7569
Author(s):  
D. J. Raz ◽  
J. Y. Kim ◽  
M. R. Ray ◽  
D. M. Jablons
Keyword(s):  
High Risk ◽  
Lung Adenocarcinoma ◽  
Risk Group ◽  
Early Stage ◽  
Prognostic Score ◽  
Clinical Stage ◽  
Low Risk ◽  
Gene Assay ◽  
Long Term Mortality

7569 Background: The likelihood of long-term mortality for patients with early stage lung adenocarcinoma is poorly defined by clinical stage and histopathological findings. Our hypothesis was that a multigene quantitative polymerase chain reaction (PCR) assay can predict risk of mortality among patients with early stage lung adenocarcinoma. Methods: We identified 65 genes that were previously identified as prognostic for long-term mortality in early stage lung cancer in 3 published microarray studies and 2 PCR-based studies. RNA was extracted from 124 fresh-frozen tumor samples from consecutive patients with completely resected lung adenocarcinoma with at least 3 years of clinical follow-up. 80 samples were randomly assigned to a test group and the remainder assigned to a validation group. Real-time PCR of the 65 identified genes were run on the test set using Taq-man assays. A prediction model was created using a proportional hazards model of normalized gene expression levels using backwards model selection. A model score was calculated for each patient using model coefficients and individual gene expression levels. Patients were defined as high-risk if the model score was greater than the median score. Results: Adequate real-time PCR profiles were identified in all 80 patients. Eighteen genes were included in the final model. The proportion of patients identified as high-risk and low-risk was 52% and 48% percent, respectively. The Kaplan-Meier estimated five-year survival in the low-risk group was 82% and 5% in the high-risk group (P<0.001, log-rank test). Median survival was 22 months in the high-risk group and was not reached in the low-risk group. In multivariate survival analysis, the prognostic score predicted survival independent of tumor stage and size (P<0.001). Prognostic score predicted mortality better than clinical stage, based on model log-likelihood values (P<0.001). Conclusions: This multi- gene assay aids in predicting long-term mortality among patients with surgically resected early stage lung adenocarcinoma. We are currently validating this model in our test set of samples. No significant financial relationships to disclose.

scholarly journals Optimal treatment strategies for coronary artery disease in patients with advanced kidney disease: a meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232110243
Author(s):  
Jingwen Yong ◽  
Jinfan Tian ◽  
Xin Zhao ◽  
Xueyao Yang ◽  
Haoran Xing ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Kidney Disease ◽  
Low Risk ◽  
Medium Term ◽  
Short Term ◽  
Artery Disease

Background: Coronary artery disease (CAD) is the leading cause of death in advanced kidney disease. However, its best treatment has not been determined. Methods: We searched PubMed and Cochrane databases and scanned references to related articles. Studies comparing the different treatments for patients with CAD and advanced CKD (estimated glomerular filtration rate <30 ml/min/1.73 m2 or dialysis) were selected. The primary result was all-cause death, classified according to the follow-up time: short-term (<1 month), medium-term (1 month-1 year), and long-term (>1 year). Results: A total of 32 studies were selected to enroll 84,498 patients with advanced kidney disease. Compared with medical therapy (MT) alone, percutaneous coronary intervention (PCI) was associated with low risk of short-, medium-term and long-term all-cause death (more than 3 years). For AMI patients, compared with MT, PCI was not associated with low risk of short- and medium-term all-cause death. For non-AMI patients, compared with MT, PCI was associated with low risk of long-term mortality (more than 3 years). Compared with MT, coronary artery bypass surgery (CABG) had no significant advantages in each follow-up period of all-cause death. Compared with PCI, CABG was associated with a high risk of short-term death, but low risk of long-term death: 1–3 years; more than 3 years. CABG could also reduce the risk of long-term risk of cardiac death, major adverse cardiovascular events (MACEs), myocardial infarction (MI), and repeat revascularization. Conclusions: In patients with advanced kidney disease and CAD, PCI reduced the risk of short-, medium- and long- term (more than 3 years) all-cause death compared with MT. Compared with PCI, CABG was associated with a high risk of short-term death and a low risk of long-term death and adverse events.

scholarly journals Association between a Genetic Risk Score Based on Single Nucleotide Polymorphisms of Coronary Artery Disease-Related Genes and Left Main Coronary Artery Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhengxi Xu ◽  
Hanning Liu ◽  
Cheng Sun ◽  
Ke Si ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Risk Score ◽  
Genetic Risk ◽  
Risk Group ◽  
Genetic Risk Score ◽  
High Risk Group ◽  
Low Risk ◽  
Artery Disease

Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Left main coronary artery disease (LMCAD) is a severe phenotype of CAD and has a genetic component. Previous studies identified 3 inflammation-related single nucleotide polymorphisms (SNPs) contributing to the development of LMCAD. We integrated these SNPs into a genetic risk score for the prediction of LMCAD. We enrolled 1544 patients with CAD between 2007 and 2011. The individual associations of the 3 SNPs with LMCAD were assessed. We then calculated the genetic risk score for each patient and stratified patients into low-risk, intermediate-risk, and high-risk categories of genetic risk. In univariable logistic regression analysis, the odds of LMCAD for the high-risk group were 2.81 (95% confidence interval [CI]: 1.72-4.60; P = 0.02) times those of the low-risk group. After adjustment for CAD-related clinical variables, the high-risk group (adjusted OR: 2.78; 95% CI: 1.69-4.58; P = 0.02) had increased odds of LMCAD when compared with the low-risk group. Comparison of model c-statistics showed greater predictive value with regard to LMCAD for the genetic risk score model than the models including single SNPs.

scholarly journals Distinct Patterns of the Autofluorescence of Body Surface: Potential Novel Diagnostic Biomarkers for Stable Coronary Artery Disease and Myocardial Infarction

2018 ◽  
Author(s):  
Xinkai Qu ◽  
Yujia Li ◽  
Yue Tao ◽  
Mingchao Zhang ◽  
Danhong Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Body Surface ◽  
Index Finger ◽  
Risk Group ◽  
Stable Coronary Artery Disease ◽  
Low Risk ◽  
Diagnostic Biomarkers ◽  
Artery Disease

AbstractSearches for new biomarkers of stable coronary artery disease (SCAD) and myocardial infarction (MI) are critical for therapeutic efficacy of the diseases. In this study we tested our hypothesis that distinct patterns of autofluorescence (AF) of skin and fingernails may become novel diagnostic biomarkers for MI and SCAD. Our study has indicated that SCAD and MI have distinct patterns of AF of their body surface: First, the AF intensity of the MI patients is significantly higher than that of the Healthy and Low-Risk group in their right and left Centremetacarpus, Ventroforefinger, Dorsal Index Finger and Ventribrachium, while the AF intensity of the SCAD patients is significantly higher than that of the Healthy and Low-Risk group in their right and left Index Fingernails and Dorsal Antebrachium; and second, the AF asymmetry of the MI patients is significantly higher than that of the Healthy and Low-Risk group in their Centremetacarpus, Ventroforefinger, Index Fingernails and Dorsal Antebrachium, while the AF asymmetry of the SCAD patients is significantly higher than that of the Healthy and Low-Risk group in their Ventroforefinger, Dorsal Index Finger, Dorsal Centremetacarpus and Index Fingernails. Moreover, the AF pattern of acute ischemic stroke is markedly different from those of SCAD and MI. The oxidative stress in the plasma of the MI and SCAD patients may cause the increased AF by altering the AF of keratins. Collectively, our study has indicated that SCAD and MI patients have distinct patterns of AF changes, which may become novel diagnostic biomarkers for SCAD and MI.

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