P6601Low miR-19b-1-5p expression in ACS patients is related to aspirin resistance and major adverse cardio-cerebrovascular event (MACCE)

Abstract Aim Despite aspirin therapy, acute coronary syndrome (ACS) patients are at risk of developing re-events owing to the aspirin resistance. This study sought to explore the possibility of utilizing miR-19b-1-5p as a suitable biomarker for aspirin resistance and future major adverse cardio-cerebrovascular (MACCE) events in the ACS patients. Methods Buffy coat from ACS (n=945) patients was used to measure the miR-19b-1-5p expression by RT-qPCR and Platelets function was determined by Multiplate® aggregometry testing. Furthermore, MACCE was collected over a mean follow-up time of 1.01±0.43 years. Linear regression concerning the relationship between miR-19b-1-5p expression and Multiplate® data and cox regression concerning MACCE were used for the analysis, to be able to adjust for confounding. Results Low miR-19b-1-5p expression was found to be related to aspirin resistance as could be observed from sustained platelet aggregation in the presence of aspirin (-Log-miR-19b-1-5p, (B (95% CI); 41.51 (5.09–77.93); p<0.05), even after adjusting for several confounders. The Cox regression analysis, showed that with lower miR-19b-1-5p expression, was independently associated to a higher risk of MACCE (-Log-miR-19b-1-5p, (HR (95% CI); 2.41 (1.51–3.84); p<0.05). Furthermore, both a sustained platelet aggregation on aspirin and lower miR-19b-1-5p expression, were related to an increased leukocyte count (B (95% CI); 3.85 (0.95–6.75) for platelet aggregation and 1.44 (0.41–2.46), for -Log-miR-19b-1-5p; p<0.05). Conclusions Lower miR-19b-1-5p expression was found to be associated with sustained platelet aggregation on aspirin, an increased leucocyte count and the risk of MACCE in ACS patients. Therefore, miR-19b-1-5p could be a suitable marker for aspirin resistance and might predict future MACCE in ACS patients.

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Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Cardiology ◽

10.1159/000471845 ◽

2017 ◽

Vol 138 (1) ◽

pp. 26-33 ◽

Cited By ~ 3

Author(s):

Xili Lu ◽

Wei Wang ◽

Ling Zhu ◽

Yilu Wang ◽

Kai Sun ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

Fragmented Qrs ◽

All Cause Mortality ◽

The Relationship ◽

Cvd Mortality

Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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D-dimer daily continuous tendency predicts the short-term prognosis for COVID-19 independently: A retrospective study from Northeast China

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-201071 ◽

2021 ◽

pp. 1-9

Author(s):

Yinting Xing ◽

Wei Yang ◽

Yingyu Jin ◽

Chao Wang ◽

Xiuru Guan

Keyword(s):

Cox Regression ◽

Short Term ◽

Cox Regression Analysis ◽

Prognosis Group ◽

The Difference ◽

Group B ◽

The Relationship ◽

Worse Prognosis ◽

D Dimer

BACKGROUND AND OBJECTIVE: To study whether D-dimer daily continuous tendency could predict the short-term prognosis of COVID-19. PATIENTS AND METHODES: According to the short-term prognosis, 81 COVID-19 patients were divided into two groups, one of worse prognosis (Group W) and the other of better prognosis (Group B). The slope of D-dimer linear regression during hospitalization (SLOPE) was calculated as an indicator of D-dimer daily continuous tendency. The SLOPE difference between Group W and Group B was compared. The difference between the discharge results and the 3-month follow-up results was also compared. COX regression analysis was used to analyze the relationship between SLOPE and short-term prognosis of COVID-19. RESULTS: There were 16 patients in Group W and 65 patients in Group B. Group W had more critical proportion (p < 0.0001), indicating that the symptoms of its patients were more severe during hospitalization. ARDS, the most visible cause of worse prognosis, accounted for up to 68.75%, and many symptoms merged and resulted in worse prognosis. The D-dimer levels of Group W not only were significantly higher (p < 0.0001), but also showed an increasing trend. In addition, the D-dimer levels at discharge were significantly higher than those at follow-up (p = 0.0261), and the mean difference was as high as 0.7474. SLOPE significantly correlated with the short-term prognosis of COVID-19 independently (RR: 1.687, 95% CI: 1.345–2.116, P < 0.0001). The worst prognosis occurred most likely during the first month after COVID-19 diagnosis. CONCLUSION: Our study found that D-dimer daily continuous tendency independently correlates with worse prognosis and can be used as an independent predictor of the short-term prognosis for COVID-19.

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Prevalence and Impact of Fibrinolytic Dysregulation in Patients with Acute Coronary Syndromes

10.21203/rs.3.rs-32637/v1 ◽

2020 ◽

Author(s):

Huaibin Wan ◽

Zhihao Wu ◽

Zhenbang Lie ◽

Daqiang Li ◽

Shaohui Su

Keyword(s):

Acute Coronary Syndrome ◽

Cox Regression ◽

Coronary Thrombosis ◽

Major Adverse Cardiovascular Events ◽

Prognostic Information ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Poor Outcomes ◽

Fibrinolysis Shutdown

Abstract Background：Dual antiplatelet therapy can reduce coronary thrombosis and improve the prognosis in patients with acute coronary syndrome (ACS). However, there was limited prognostic information about fibrinolytic dysregulation in patients with ACS. This study is aimed to evaluated the prevalence and impact of fibrinolytic dysregulation in patients with acute coronary syndrome (ACS).Methods：We retrospectively analyzed coagulation and fibrinolysis related indexes of ACS in hospitalized adults with rapid thrombelastography between May 2016 and December 2018. All of the follow-up visits were ended by December 2019. The primary outcome was the occurrence of major adverse cardiovascular events (MACEs), which included unstable angina pectoris, non-fatal myocardial infarction, non-fatal cerebral infarction, heart failure and all-cause death. Results：338 patients were finally included with an average age of 62.5 ± 12.8 years old, 273 (80.5%) were males, 137(40.5%) patients were with STEMI. Fibrinolysis shutdown and hyperfibrinolysis were observed among 163 (48.2%) and 76(22.5%) patients, respectively. During a total of 603.2 person·years of follow-up period, 77 MACEs occurred (22.8%). Multivariate Cox regression analysis indicated that age [HR: 1.031 95% CI: 1.007-1.056, P = 0.012] and LY30 [HR: 1.097, 95% CI: 1.013-1.188, P = 0.023] were independently correlated with the occurrence of MACEs. The hazard ratios pertaining to MACEs in patients with LY30＜0.8% and ＞3.0% compared with those in the physiologic range(LY30: 0.8-3.0%) were 2.275 [HR: 2.275, 95% CI: 1.241-1.241, P = 0.003] and 1.196 [HR: 1.196, 95% CI: 0.679-2.109,P=0.535], respectively.Conclusions: Fibrinolytic dysregulation is very common in selected patients with ACS, and hyperfibrinolysis (HF) (LY30 >3%) is associated with poor outcomes in patients with ACS

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Malnutrition Affects Cholesterol Paradox in Coronary Artery Disease: a 41,229 Chinese Cohort Study

10.21203/rs.3.rs-266119/v1 ◽

2021 ◽

Author(s):

Bo Wang ◽

Jin Liu ◽

Shiqun Chen ◽

Ming Ying ◽

Guanzhong Chen ◽

...

Keyword(s):

Cox Regression ◽

Cox Model ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Kaplan Meier ◽

All Cause Mortality ◽

Chinese Cohort ◽

Artery Disease

Abstract Background: Several studies found that baseline low LDL-C concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which was called “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. We objected to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.Method: A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018, and divided into two groups (LDL-C < 1.8 mmol/L, n=4,863; LDL-C ≥ 1.8 mmol/L, n = 36,366). We used Kaplan-Meier method and Cox regression analyses to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result: In this real-world cohort (mean age 62.94 years; 74.94% male), there were 5257 incidents of all-cause death during a median follow-up of 5.20 years [Inter-quartile range (IQR): 3.05-7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low LDL-C level (<1.8mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment of nutritional status, risk of all-cause mortality of patients with low LDL-C level decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).Conclusion: Our results demonstrate that the cholesterol paradox persisted in CAD patients, but disappeared after accounting for the effects of malnutrition.

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P5656Heart failure clinical phenotypes and outcomes in patients with atrial fibrillation: an analysis from the eurobservational research programme in atrial fibrillation long-term general registry

European Heart Journal ◽

10.1093/eurheartj/ehz746.0599 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Proietti ◽

C Laroche ◽

A Tello-Montoliu ◽

R Lenarczyk ◽

G A Dan ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Regression Analysis ◽

Cox Regression ◽

Adverse Outcomes ◽

Cox Regression Analysis ◽

Coronary Syndrome

Abstract Introduction Heart failure (HF) is a well-known risk factor for atrial fibrillation (AF). Moreover, HF is associated with worse clinical outcomes in patients with known AF. Recently, phenotypes of HF have been redefined according to the level of ejection fraction (EF). New data are needed to understand if a differential risk for outcomes exists according to the new phenotypes' definitions. Purpose To evaluate the risk of major adverse outcomes in patients with AF and HF according to HF clinical phenotypes. Methods We performed a subgroup analysis of AF patients enrolled in the EORP-AF Long-Term General Registry with a history of HF at baseline, available EF and follow-up data. Patients were categorized as follows: i) EF<40%, i.e. HF reduced EF [HFrEF]; ii) EF 40–49%, i.e. HF mid-range EF [HFmrEF]; iii) EF ≥50%, i.e. HF preserved EF [HFpEF]. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death and all-cause death were recorded. Results A total of 3409 patients were included in this analysis: of these, 907 (26.6%) had HFrEF, 779 (22.9%) had HFmrEF and 1723 (50.5%) had HFpEF. An increasing proportion with CHA2DS2-VASc ≥2 was found across the three groups: 90.4% in HFrEF, 94.6% in HFmrEF and 97.3% in HFpEF (p<0.001), while lower proportions of HAS-BLED ≥3 were seen (28.0% in HFrEF, 26.3% in HFmrEF and 23.6% in HFpEF, p=0.035). At discharge patients with HFpEF were less likely treated with antiplatelet drugs (22.0%) compared to other classes and were less prescribed with vitamin K antagonists (VKA) (57.0%) and with any oral anticoagulant (OAC) (85.7%). No differences were found in terms of non-vitamin K antagonist oral anticoagulant use. At 1-year follow-up, a progressively lower rate for all study outcomes (all p<0.001), with an increasing cumulative survival, was found across the three groups, with patients with HFpEF having better survival (all p<0.0001 for Kaplan-Meier curves). After full adjustment, Cox regression analysis showed that compared to HFrEF, HFmrEF and HFpEF were associated with risk of all study outcomes (Table). Cox Regression Analysis HR (95% CI) Any TE/ACS/CV Death CV Death All-Cause Death HFmrEF 0.65 (0.49–0.86) 0.53 (0.38–0.74) 0.55 (0.41–0.74) HFpEF 0.50 (0.39–0.64) 0.42 (0.31–0.56) 0.45 (0.35–0.59) ACS = Acute Coronary Syndrome; CI = Confidence Interval; CV = Cardiovascular; EF = Ejection Fraction; HF = Heart Failure; HR = Hazard Ratio. Conclusions In this cohort of AF patients with HF, HFpEF was the most common phenotype, being associated with a profile related to an increased thromboembolic risk. Compared to HFrEF, both HFmrEF and HFpEF were associated with a lower risk of all major adverse outcomes in AF patients.

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Serum β-2 microglobulin predicts mortality in people with diabetes

Acta Endocrinologica ◽

10.1530/eje-13-0003 ◽

2013 ◽

Vol 169 (1) ◽

pp. 1-7 ◽

Cited By ~ 15

Author(s):

Ching-Lung Cheung ◽

Karen S L Lam ◽

Bernard M Y Cheung

Keyword(s):

Cox Regression ◽

Threshold Model ◽

Linear Increase ◽

Diabetic Patients ◽

Cox Regression Analysis ◽

Health And Nutrition ◽

Risk Of Mortality ◽

The Relationship ◽

Related Mortality

ObjectiveSerum β-2 microglobulin (B2M) level predicts mortality in chronic kidney disease. Glycation of B2M is cytotoxic and may contribute to the risk of mortality in diabetic patients. Our objective was to evaluate the relationship between B2M and mortality in diabetic patients.MethodsIn this prospective study, 896 participants of the Third National Health and Nutrition Examination Survey with diabetes were included in the analysis. Serum B2M level was used in multivariate Cox regression analysis to predict all-cause and diabetes-related mortality.ResultsDuring a median follow-up of 11.8 years (range 0.1–18.2 years) and 9220.5 person/years, 541 (42.4%) and 207 (16.8%) participants died from all causes and diabetes-related causes respectively. One natural-log unit of B2M was significantly associated with all-cause (hazard ratio (HR)=6.53, 95% CI 2.07–20.6) and diabetes mortality (HR=7.35, 95% CI 1.01–53.38) after multivariable adjustment. Similar results were obtained when B2M was analyzed as tertiles or in the threshold model (T1+T2 vs T3). Examination of regression splines suggests a linear increase in hazard for mortality with increasing B2M levels.ConclusionsSerum B2M level is a novel predictor of all-cause and diabetes-related mortality in people with diabetes regardless of renal function.

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Relationship between triglyceride levels and ischaemic stroke in elderly hypertensive patients

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136961 ◽

2019 ◽

Vol 96 (1133) ◽

pp. 128-133

Author(s):

Yu-Qing Huang ◽

Jia-Yi Huang ◽

Lin Liu ◽

Chao-Lei Chen ◽

Yu-Ling Yu ◽

...

Keyword(s):

Risk Factor ◽

Elderly Patients ◽

Ischaemic Stroke ◽

Cox Regression ◽

Interaction Analysis ◽

Interactive Effect ◽

Cox Regression Analysis ◽

Elderly Hypertensive ◽

The Relationship

BackgroundAlthough hyperlipidaemia was a well-known risk factor for ischaemic stroke, the association between triglyceride and first ischaemic stroke remains uncertain.ObjectivesThe present study attempted to explore the relationship between triglyceride and first ischaemic stroke in a Chinese community elderly patients with hypertension.Methods and resultsThis was a retrospective cohort study. We enrolled 3249 consecutive elderly patients with hypertension from a community in China between January 2010 and December 2011. Patients were divided into four groups based on the quartiles of triglyceride. Multivariate Cox regression analysis, subgroup and interaction test were performed to evaluate the relationship between triglyceride and first ischaemic stroke. There were a total of 3249 participants including 1455 male and 1794 female, with a mean age of 71.36±7.18 years. At an average follow-up of 5.5 years, 205 patients were identified to have first ischaemic stroke. After adjustment for potential confounders, using the lowest quartiles of triglyceride as the reference, multivariable HR (95% CI) for first ischaemic stroke increased in parallel with the quartiles of triglyceride (HRs were 1.56 (95% CI 1.07 to 2.51), 1.74 (95% CI 1.07 to 2.84) and 1.85 (95% CI 1.05 to 2.89)) from the second to the fourth quartiles, respectively (p=0.002 for trend). Subgroup and interaction analysis showed that there was no interactive effect on triglyceride and first ischaemic stroke.ConclusionTriglyceride was an independent risk factor for first ischaemic stroke among Chinese elderly patients with hypertension.

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Prevalence and impact of fibrinolytic dysregulation in patients with acute coronary syndromes

Thrombosis Journal ◽

10.1186/s12959-021-00288-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Huaibin Wan ◽

Xin Fan ◽

Zhihao Wu ◽

Zhenbang Lie ◽

Daqiang Li ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cox Regression ◽

Coronary Thrombosis ◽

Major Adverse Cardiovascular Events ◽

Prognostic Information ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Myocardial Infraction ◽

Fibrinolysis Shutdown

Abstract Objective Dual antiplatelet therapy can reduce coronary thrombosis and improve the prognosis in patients with acute coronary syndrome (ACS). However, there was limited prognostic information about fibrinolytic dysregulation in patients with ACS. This study is aimed to evaluated the prevalence and impact of fibrinolytic dysregulation in patients with acute coronary syndrome (ACS). Methods We retrospectively analyzed coagulation and fibrinolysis related indexes of ACS in hospitalized adults with rapid thrombelastography between May 2016 and December 2018. All of the follow-up visits were ended by December 2019. The primary outcome was the occurrence of major adverse cardiovascular events (MACEs), which included unstable angina pectoris, non-fatal myocardial infarction, non-fatal cerebral infarction, heart failure and all-cause death. Results Three hundred thirty-eight patients were finally included with an average age of 62.5 ± 12.8 years old, 273 (80.5%) were males, 137(40.5%) patients were with ST-elevation myocardial infraction. Fibrinolysis shutdown (LY30<0.8%) and hyperfibrinolysis (LY30 >3.0%) were observed among 163 (48.2%) and 76(22.5%) patients, respectively. During a total of 603.2 person·years of follow-up period, 77 MACEs occurred (22.8%). Multivariate Cox regression analysis indicated that LY30 [HR: 1.101, 95% CI: 1.010–1.200, P = 0.028] was independently correlated with the occurrence of MACEs. The hazard ratios pertaining to MACEs in patients with fibrinolysis shutdown and hyperfibrinolysis compared with those in the physiologic range (LY30: 0.8–3.0%) were 1.196 [HR: 1.196, 95% CI: 0.679–2.109,P = 0.535] and 2.275 [HR: 2.275, 95% CI: 1.241–4.172, P = 0.003], respectively. Conclusions Fibrinolytic dysregulation is very common in selected patients with ACS, and hyperfibrinolysis (LY30 > 3%) is associated with poor outcomes in patients with ACS.

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Long-term Prognostic Value of Homocysteine in Patients with Acute Coronary Syndrome Complicated with Hypertension: A Multicenter Retrospective Study

10.21203/rs.3.rs-1010885/v1 ◽

2021 ◽

Author(s):

Qiang Chen ◽

Xunshi Ding ◽

Caiyan Cui ◽

Tao Ye ◽

Lin Cai

Keyword(s):

Acute Coronary Syndrome ◽

Regression Analysis ◽

Prognostic Value ◽

Cox Regression ◽

P Value ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Kaplan Meier

Abstract Background and aims: This study investigates the long-term prognostic value of homocysteine in patients with acute coronary syndrome complicated with hypertension. Methods:The current work is a multicenter, retrospective, observational cohort study. We consecutively enrolled 1288 ACS patients hospitalized in 11 general hospitals in Chengdu, China, from June 2015 to December 2019. The patients were divided into hypertension and non-hypertension groups, and each was further classified into hyperhomocysteinemia (H-Hcy) and normal homocysteinemia (N-Hcy) groups according to the cut-off value of homocysteine predicting long-term mortality during follow-up. In both groups, we used Kaplan-Meier and multivariate Cox regression analysis to assess the relationship between homocysteine and long-term prognosis. Results: The median follow-up time was 18 months (range: 13.83-22.37). During this period, 78 (6.05%) death cases were recorded. The hypertension was further divided into H-Hcy (n=245) and N-Hcy (n=543), with an optimal cut-off value of 16.81 µmol/L. Similarly, non-hypertension was further divided into H-Hcy (n=200) and N-Hcy (n=300), with an optimal cut-off value of 14 µmol/L. Kaplan-Meier survival curves revealed that H-Hcy had a significantly lower survival probability than N-Hcy, both in hypertension and non-hypertension (P-value<0.01). After adjusting for confounding factors, multivariate Cox regression analysis revealed that H-Hcy (HR=2.1923, 95% CI: 1.213-3.9625, P＜0.01) was an independent predictor of long-term all-cause death in ACS with hypertension, but not in non-hypertension.Conclusion: Elevated homocysteine level predicts risk of all-cause mortality in ACS with hypertension, but not in those without hypertension. it should be considered when determining risk stratification for ACS, particularly those complicating hypertension.

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Arterial lactate levels and their prognostic value in patients undergoing pulmonary thromboendarterectomy

Archivos Peruanos de Cardiología y Cirugía Cardiovascular ◽

10.47487/apcyccv.v2i2.131 ◽

2021 ◽

Vol 2 (2) ◽

pp. 123-129

Author(s):

Cristhian Felipe Ramirez Ramos ◽

Clara Inés Saldarriaga-Giraldo ◽

Manuela Yepes-Calderón ◽

Gustavo Adolfo Castilla-Agudelo ◽

Mateo Aránzazu Uribe ◽

...

Keyword(s):

Cox Regression ◽

Rapid Change ◽

Area Under The Curve ◽

Pulmonary Thromboendarterectomy ◽

Arterial Lactate ◽

Cox Regression Analysis ◽

The People ◽

Lactate Levels ◽

The Relationship

Objective. Evaluate the change of lactate levels and its prognostic role in the postoperative period of patients undergoing pulmonary thromboendarterectomy. Methods. Retrospective study between 2001 and 2019. Patients older than 18 years and who underwent pulmonary thromboendarterectomy were included. The U Mann Whitney test was performed to evaluate the change between lactate levels, and Cox regression analysis to evaluate the relationship with mortality. Areas under the curve were constructed for lactate levels. Results. Seventy-three patients were operated on during the study period. Median age was 51 years, 55% female. The median lactate on days 1 was 4.65 mml/L and on day 2 it was 1.62 mml/L with a change of 2.87 mml/L. No differences were found between the levels measured on day 1 and 2 between the people who died and those who did not on day 30. In the multivariate regression of COX, no relationship with mortality was found. The area under the curve shows regular performance on both day 1 and day 2 in predicting mortality outcomes. Conclusions. The behavior of the lactate in patients undergoing pulmonary thromboendarterectomy shows a rapid change during the first hours after the procedure. No role was found as a predictor of mortality neither in-hospital nor in follow-up.

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