Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk for cardiac events

ObjectiveTo assess the risk of future death and cardiac events following percutaneous coronary intervention (PCI) in patients using smokeless tobacco, snus, compared with patients not using snus at admission for a first PCI.MethodsThe Swedish Coronary Angiography and Angioplasty Registry is a prospective registry on coronary diagnostic procedures and interventions. A total of 74 958 patients admitted for a first PCI were enrolled between 2009 and 2018, 6790 snus users and 68 168 not using snus. We used Cox proportional hazards regression for statistical modelling on imputed datasets as well as complete-case datasets.ResultsPatients using snus were younger (mean (SD) age 61.0 (±10.2) years) than patients not using snus (67.6 (±11.1), p<0.001) and more often male (95.4% vs 67.4%, p<0.001). After multivariable adjustment, snus use was not associated with the primary composite outcome of all-cause mortality, new coronary revascularisation or new hospitalisation for heart failure at 1 year (HR 0.98, 95% CI 0.91 to 1.05). In patients using snus at baseline who underwent a second PCI (n=1443), the duration from the index intervention was shorter for subjects who continued using snus (n=921, 63.8%) compared with subjects who had stopped (mean number of days 285 vs 406, p value=0.001).ConclusionsSnus use at admission for a first PCI was not associated with a higher occurrence of all-cause mortality, new revascularisation or heart failure hospitalisation. Discontinuing snus after a first PCI was associated with a significantly longer duration to a subsequent PCI.

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Abstract 15330: Association Between Elective Percutaneous Coronary Intervention Appropriateness and Publicly Reported Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.15330 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Vinay Kini ◽

Paul Hess ◽

Wenhui Liu ◽

Gary Grunwald ◽

Michael Ho ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Proportional Hazards ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

Veterans Administration ◽

Elective Percutaneous Coronary Intervention ◽

Percutaneous Coronary ◽

National Cohort ◽

Risk Patients ◽

Facility Level

Introduction: Public reporting of percutaneous coronary intervention (PCI) outcomes such as readmission and mortality may cause harm by adversely affecting patient selection for PCI. Little is known about the relationship between these outcomes and elective PCI appropriateness - a validated metric of PCI quality. Methods: We identified all patients in the national Veterans Administration healthcare system who underwent elective PCI for stable coronary disease between 2013 and 2015. We defined PCI appropriateness using 2012 criteria. The primary outcome was 90-day all-cause hospitalization or mortality. We used hierarchical Cox proportional hazards regression models adjusted for patient- and facility-level covariates to compare outcomes across PCI appropriateness categories, and a joint survival/logistic model to compare facility-level variation in inappropriate PCI and 90-day outcomes. Results: Among 2,561 patients (mean age 66 years, 99% men) undergoing PCI across 59 sites, 29.6% were classified as appropriate, 10.4% as inappropriate, and 60% as uncertain. The proportion of patients who were readmitted or died were 15.6%, 16.4%, and 15.3% among patients who received appropriate, inappropriate, and uncertain PCI respectively. There were no significant differences in 90-day outcomes between the groups (hazard ratio for appropriate compared to inappropriate PCI 0.82 [CI 0.57 to 1.17; p=0.28]). The site level covariance between inappropriate PCI and 90-day outcomes was -0.033 (95% CI -0.117 to 0.047), indicating no site-level correlation between appropriateness and 90-day outcomes (Figure). Conclusion: We found no association between elective PCI appropriateness and 90-day outcomes among a national cohort of Veterans. Including appropriateness in public reports may 1) characterize PCI quality more fully and 2) potentially mitigate the harms of reporting outcomes by empowering providers to perform appropriate PCI in higher-risk patients.

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Left ventricular function and clinical heart failure after myocardial infarction revascularized with percutaneous coronary intervention - comparison between STEMI and NSTEMI in modern practice

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.027 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Radhakrishnan ◽

H Sharma ◽

S Brown ◽

J May ◽

N Zia ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Left Ventricular ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

St Elevation ◽

Clinical Heart Failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Left ventricular systolic dysfunction (LVSD) is a common consequence of myocardial infarction (MI). Data from historic series identified LVSD in up to 60% of patients post-MI. However, in modern practice, with high-sensitivity cardiac biomarkers leading to early detection of MI and widespread use of early revascularization, the prevalence of LVSD in the acute phase of MI and its impact on subsequent clinical heart failure remains unknown. Purpose To ascertain the prevalence of LVSD on pre-discharge echocardiography and its impact on subsequent clinical heart failure after type 1 MI treated with percutaneous coronary intervention (PCI) in a UK tertiary cardiac centre. Methods A retrospective electronic patient records review of consecutive patients with type 1 MI treated with PCI between January 2016 - December 2017. Patients treated conservatively or with surgical revascularization were excluded. Results 1000 consecutive patients were identified and 948/1000 who had an inpatient echocardiogram prior to discharge were included in this analysis – 413 ST elevation MI (STEMI) and 535 non-ST elevation (NSTEMI). Median door to balloon time for STEMI was 42 minutes (IQR 28-79). Median time from symptom onset to intervention for NSTEMI was 3 days (IQR 1-6). LVSD was defined as left ventricular ejection fraction (LVEF) <50% on transthoracic echocardiogram carried out during the hospital episode. LVSD was significantly more prevalent in patients with STEMI compared to NSTEMI (37.4% vs 17.3%, p < 0.001). Median LVEF was significantly lower in the STEMI population (55%, IQR 45-60) compared to patients with NSTEMI (60%, IQR 54-65), p < 0.001. However, rates of clinical heart failure at index presentation with MI did not vary significantly between STEMI and NSTEMI patients (6.1% vs 4.9%, p = 0.414). In stepwise multivariate regression models: age, peak troponin and previous coronary artery bypass grafting were predictors of LVEF, whereas LVEF and previous MI were predictors of clinical heart failure Patients with LVSD on pre-discharge echocardiography had significantly higher rates of 30-day readmission with heart failure (2.9% vs 0.7%, p = 0.017), 30-day all-cause mortality (6.1% vs 2%, p = 0.001), 30-day cardiac mortality (5.7% vs 1%, p < 0.001) and 2-year all-cause mortality (5.7% vs 1.6%, p = 0.001). However, at 2-years, there was no difference in hospital readmission with heart failure (0.8% vs 0.3%, p = 0.276). There were no significant differences between STEMI and NSTEMI patients for these endpoints. Conclusions Early revascularisation with PCI has led to a reduction in the prevalence of early LVSD post-MI compared to historical data. However, the presence of LVSD remains a powerful predictor of adverse clinical outcomes. Despite lower rates of LVSD on pre-discharge echocardiography in patients with NSTEMI compared with STEMI, the incidence of subsequent clinical heart failure is similar. This however may be underestimated due to survival bias.

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Three-year outcomes of selective incomplete versus complete revascularization in heart failure patients receiving multivessel percutaneous coronary intervention

European Heart Journal ◽

10.1093/ehjci/ehaa946.1131 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Chang ◽

M Hsieh ◽

D Chen ◽

C Chen ◽

I Hsieh

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Hospital Death ◽

Complete Revascularization ◽

Funding Source ◽

Cardiac Events ◽

Recurrent Myocardial Infarction ◽

Percutaneous Coronary

Abstract Background Heart failure (HF) patients with multi-vessel disease (MVD) are often associated with comorbidities to limit the possibility to achieve complete revascularization (CR) in percutaneous coronary intervention (PCI). The planned selective incomplete revascularization (SIR) may be an alternative opinion for these patients. Purpose To investigate 3-year clinical outcomes of SIR versus CR in HF patients with MVD in a real-word registry. Methods A total of 566 HF patients with MVD receiving either SIR or CR were enrolled. SIR was planned pre-PCI based on clinical exams to avoid non-viable tissue revascularization. Major adverse cardiac events (MACEs) was a composite of in-hospital death, recurrent myocardial infarction, any revascularization, and all-cause death at 3-year follow-up. Results There was no significant differences between SIR and CR groups in in-hospital death, any revascularization, all-cause death and MACEs (24.3% vs. 24.9%, p=0.922). However, SIR had a significant lower incidence of recurrent myocardial infarction than CR (3.2% vs. 7.2%, p=0.032). Conclusion The 3-year outcomes of PCI with planned SIR were completely comparable to with CR in HF patients with MVD. Planned SIR can be an opinion for HF patients with MVD who are not suitable to achieve CR. Kaplan-Meier curve of 3-year MACEs Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Chang Gung Medical Research Program

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Very long-term benefits of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehab724.2684 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Padilla Escamez ◽

M J Romero Reyes ◽

C Otte Alba ◽

S Rufian Andujar ◽

F J Molano Casimiro

Keyword(s):

Heart Failure ◽

Percutaneous Coronary Intervention ◽

Cardiac Rehabilitation ◽

Coronary Intervention ◽

Cardiac Mortality ◽

Heart Failure Hospitalization ◽

Percutaneous Coronary ◽

All Cause Mortality

Abstract Background Short and medium-term benefits of cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) have been well studied. However, studies on long-term benefits of such programs after percutaneous coronary intervention (PCI) are scarce. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) on very long-term mortality and morbidity after PCI. Methods We conducted a retrospective cohort study of 701 patients who underwent PCI at our hospital between 2004 and 2011. Patients were classified into two cohorts based on whether or not they participated in a CR program phase II. A follow-up was performed in May 2020. We collected the events occurring during a median follow-up of 11 years. Results 701 patients were included in our study: 291 (41.5%) participated in the CR program, whereas 410 (58.4%) refused to do it. AMI was the most frequent indication for PCI (51.9%), followed by unstable angina (42.8%). The characteristics of the cohort based on participation in the CR program are shown in the table below. Patients who participated in the CR program were younger and mostly male. However, those who refused to do it had a higher cardiovascular risk due to a higher percentage of multivessel disease, diabetes mellitus, kidney failure and history of cerebrovascular accident. Using multivariate logistic regression, CR participation was found to be associated with significantly reduced all-cause mortality (19.5 vs 48.4%; OR 0.455; IC95% 0.295–0.701; p<0.001) and cardiac mortality (4.5% vs 18.0%; OR 0.361; IC95% 0.181–0.721; p 0.004). CR is also associated with a substantial decrease in heart failure hospitalization (10.0% vs 24.8%; OR 0.557; IC95% 0.331–0.937; p 0.027) and incidence of stroke (5.5% vs 10.6%; OR 0.491; IC95% 0.271–0.890; p<0.017) during the follow-up. No significant differences were observed in re-AMI (20.6% vs 24.1%, p=NS). Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality, heart failure hospitalization rates and morbidity during long-term follow-up. FUNDunding Acknowledgement Type of funding sources: None.

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The efficacy of statin administration prior to elective PCI in reducing the incidence of post-procedural myocardial infarction or all-cause mortality: a systematic review

Res Medica ◽

10.2218/resmedica.v24i1.1487 ◽

2017 ◽

Vol 24 (1) ◽

pp. 35-46

Author(s):

Aniruddh Shenoy

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Percutaneous Coronary Intervention ◽

Usual Care ◽

Coronary Intervention ◽

Cochrane Central Register ◽

Cardiac Events ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

Pre Treatment

Abstract Background: Observational studies show that statin-naïve patients presenting with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI) have significantly higher rates of myocardial infarction (MI) and mortality. We plan to review the evidence for giving statin naïve patients statins 24 hours pre-PCI, with the aim of reducing post-procedural MI and mortality. Objective: To critically evaluate and appraise primary and secondary literatures that investigate the efficacy of pre-treatment loading of a statin in improving outcome for patients with ACS undergoing percutaneous coronary intervention (PCI). Review Question: What is the efficacy of statin administration prior to elective PCI in reducing the incidence of post-MI or all-cause mortality? Methods: We searched the Cochrane Database of Systemic Reviews for systemic reviews and NICE CKS database for relevant NICE clinical guidelines. We then searched the MEDLINE database and Cochrane Central Register of Controlled Trial (CENTRAL) for relevant randomised control trials (RCTs). Our search was limited to peer reviewed papers published in the last 10 years, between 1st February 2006 to 1st February 2016. Our exclusion criteria were as follows: patients previously on statin therapy; statin administration outside 24 hours of PCI; unsuitable outcomes measured; papers not available in full and non-randomised trials. We conducted a systematic review on eligible papers acquired from this search. Results: Our literature search yielded 86 papers. After reviewing these papers, 80 papers were excluded. Six papers were included in the final review in which 2207 patients received either high-dose statin treatment (n=1111) or placebo/usual care (n=1096). The ARMYDA-ACS trial showed that short-term pre-treatment with atorvastatin reduces the incidence of major cardiac events in patients with acute coronary syndromes undergoing elective PCI (OR=0.12, CI: 0.05-0.50; p=0.004). These findings were consistent with NAPLES II Trial in which preloading with atorvastatin reduced the risk of MI (OR=0.56 CI: 0.35-0.89). On the other hand, the ALPACS trial showed atorvastatin preloading had no significant benefits over usual care. They found that preloading with atorvastatin was not statistically significant reducing for post-procedural MI (OR=0.92, CI: 0.50-1.69) or mortality (OR=1.06, CI: 0.07-17.01). Three papers reported that the use of rosuvastatin given prior to elective PCI was associated with a significant reduction in post-procedural MI in patients. These were Yun KH. et al. (OR=0.50, CI: 0.25-0.98), Wang Z. et al. (OR=0.31, CI: 0.10-0.91) and Cay S. et al. (OR=0.05, CI: 0.01-0.41). Conclusion: 5 out of the 6 studies reviewed showed supported the effectiveness of pre-procedural statins use in reducing the risk of post-procedural major cardiac events in patients undergoing elective PCI. These findings support routine use of statins in patients with ACS undergoing elective PCI.

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Long-term survival in patients with coronary artery disease undergoing percutaneous coronary intervention with or without intracoronary pressure wire guidance: a report from SCAAR

European Heart Journal ◽

10.1093/ehjci/ehaa946.2507 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Volz ◽

B Redfors ◽

C Dworeck ◽

P Petursson ◽

M Gotberg ◽

...

Keyword(s):

Stable Angina ◽

Proportional Hazards ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

Funding Source ◽

Proportional Hazards Regression ◽

Pressure Wire ◽

Percutaneous Coronary ◽

All Cause Mortality

Abstract Background Intracoronary pressure wire measurements of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) provide decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the impact of FFR/iFR on long-term clinical outcomes in patients with stable angina, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), or STEMI. Methods We used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) on all patients in Sweden undergoing PCI (with or without FFR/iFR guidance) for stable angina, UA/NSTEMI, or STEMI between January 2005 and March 2018. The primary endpoint was all-cause mortality and the secondary endpoints were stent thrombosis or restenosis and periprocedural complications. The primary model was multilevel Cox proportional-hazards regression using an instrumental variable (IV) to adjust for known and unknown confounders with treating hospital as a treatment-preference instrument. The following variables were entered into Cox proportional-hazards regression in addition to the IV: age, sex, diabetes, indication for PCI, severity of coronary disease, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, previous PCI, previous coronary artery bypass graft, type of stent. Results In total, 151,001 patients underwent PCI: 31,514 (20.9%) for stable angina, 74,982 (49.6%) for UA/NSTEMI, and 44,505 (29.5%) for STEMI. Of these, FFR/iFR guidance was used in 11,433 patients (7.6%): 5029 (44.0%) with stable angina, 5989 (52.4%) with UA/NSTEMI, and 415 (3.6%) with STEMI; iFR was used in 1156 (10.1%) of these patients. After a median follow-up of 1784 (range 1–4824) days, the FFR/iFR group had lower adjusted risk estimates for all-cause mortality [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.69–0.91; P=0.001] and stent thrombosis and restenosis (HR 0.13; 95% CI 0.09–0.19; P<0.001). The number of periprocedural complications did not differ significantly between the groups (odds ratio 0.69; 95% CI 0.30–1.55; P=0.368). There was no interaction between FFR/iFR and indication for PCI. We found no difference between FFR and iFR (HR 1.12; 95% CI 0.90–1.59; P=0.216). Conclusions In this observational study, the use of FFR/IFR was associated with a lower risk of long-term mortality in patients undergoing PCI for stable angina, UA/NSTEMI, or STEMI. Our study supports the current European and American guidelines for the use of FFR/iFR during PCI and shows that intracoronary pressure wire guidance has prognostic benefit in patients with stable angina as well as in patients with the acute coronary syndrome. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Heart and Lung Foundation, ALF Västra Götaland, Swedish Scientific Council

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Abstract MP035: The Clinical Epidemiology of Fatigue in Newly Diagnosed Heart Failure

Circulation ◽

10.1161/circ.135.suppl_1.mp035 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Brent Williams

Keyword(s):

Heart Failure ◽

Health Care Services ◽

Proportional Hazards ◽

Clinical Epidemiology ◽

Cox Proportional Hazards ◽

P Value ◽

Newly Diagnosed ◽

Volume Depletion ◽

All Cause Mortality ◽

Overall Mortality

Introduction: Fatigue is a common and distressing, but poorly understood symptom among patients with heart failure (HF). The underlying mechanisms of fatigue in HF have not been clearly elucidated, but may lie in both psychologic and physiologic factors. Whether fatigue remains associated with mortality independent of other common clinical attributes also remains unresolved. Accordingly, the current study sought to evaluate the prevalence, predictors, and prognostic value of clinically documented fatigue in newly diagnosed HF patients. Methods: This retrospective cohort study consisted of 12,285 newly diagnosed HF patients receiving health care services through the Geisinger Health System, with passive data collection through electronic medical records (EMR). Incident HF, fatigue, and other study variables were derived from coded data within EMRs. A collection of 87 candidate predictors were evaluated to ascertain the strongest independent predictors of fatigue using logistic regression. The collection of candidate variables was drawn from several domains including demographics, physical examination findings, medical history, laboratory results, and medications. Patients were followed for all-cause mortality for an average of 4.8 years. The associations between fatigue and six-month, 12-month, and overall mortality were evaluated with Cox proportional hazards regression. Results: Clinically documented fatigue was found in 4827 (39%) newly diagnosed HF patients. Among the 87 candidate predictors, 18 were independently associated with fatigue at a multivariable p-value threshold of 0.001. Depression was the strongest predictor of fatigue. Fatigue was often part of a symptom cluster, as other HF symptoms including dyspnea, chest pain, edema, syncope, and palpitations were significant predictors of fatigue. Volume depletion, low body mass index, and abnormal weight loss were also strong predictors of fatigue. Though fatigue was significantly associated with 6-month (HR=1.49, p<0.01), 12-month (HR=1.39, p<0.01), and all-cause mortality (HR=1.20, p<0.01) in unadjusted models, effect sizes were attenuated and non-significant after adjustment for clinical variables with HRs of 1.12 (p=0.16), 1.07 (p=0.26), and 1.00 (p=0.89), for 6-month, 12-month, and overall mortality, respectively. Conclusions: Fatigue is a commonly documented symptom among newly diagnosed HF patients with likely origins in both psychologic and physiologic factors. Though fatigue provided a prognostic signal in the short-term, this was largely explained by physiologic confounders.

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Association Between Radial Versus Femoral Access for Percutaneous Coronary Intervention and Long‐Term Mortality

Journal of the American Heart Association ◽

10.1161/jaha.121.021256 ◽

2021 ◽

Author(s):

Andrew Kei‐Yan Ng ◽

Pauline Yeung Ng ◽

April Ip ◽

Man‐Hong Jim ◽

Chung‐Wah Siu

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Cardiac Events ◽

Femoral Access ◽

Arterial Access ◽

Radial Access ◽

Adverse Cardiac Events ◽

Percutaneous Coronary ◽

All Cause Mortality

Background Percutaneous coronary intervention with radial arterial access has been associated with fewer occurrences of major bleeding. However, published data on the long‐term mortality and major adverse cardiac events after percutaneous coronary intervention with radial or femoral arterial access are inconclusive. Method and Results This was a territory‐wide retrospective cohort study including 26 022 patients who underwent first‐ever percutaneous coronary intervention between January 1, 2010 and December 31, 2017 in Hong Kong. Among the 14 614 patients matched by propensity score (7307 patients in each group), 558 (7.6%) and 787 (10.8%) patients died during the observation period in the radial group and femoral group, respectively, resulting in annualized all‐cause mortality rates of 2.69% and 3.87%, respectively. The radial group had a lower risk of all‐cause mortality compared with the femoral group up to 3 years after percutaneous coronary intervention (hazard ratio [HR], 0.70; 95% CI, 0.63–0.78; P <0.001). Radial access was associated with a lower risk of major adverse cardiac events (HR, 0.78; 95% CI, 0.73–0.83, P <0.001), myocardial infarction after hospital discharge (HR, 0.78; 95% CI, 0.70–0.87, P <0.001), and unplanned revascularization (HR, 0.76; 95% CI, 0.68–0.85, P <0.001). The risks of stroke were similar across the 2 groups (HR, 0.96; 95% CI, 0.82–1.13, P =0.655). Conclusions Radial access was associated with a significant reduction in all‐cause mortality at 3 years compared with femoral access. Radial access was associated with reduced risks of myocardial infarction and unplanned revascularization, but not stroke. The benefits were sustained beyond the early postoperative period.

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Persistent Renal Dysfunction After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Angiology ◽

10.1177/0003319716646680 ◽

2016 ◽

Vol 68 (2) ◽

pp. 159-167 ◽

Cited By ~ 3

Author(s):

Jeong Cheon Choe ◽

Kwang Soo Cha ◽

Jinhee Ahn ◽

Jin Sup Park ◽

Hye Won Lee ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Renal Dysfunction ◽

Old Age ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

Cardiac Events ◽

Vessel Disease ◽

Percutaneous Coronary

We determined the incidence, predictors, and outcomes of persistent renal dysfunction (PRD) following percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Among 16 264 patients enrolled in a nationwide registry, we studied patients with AMI who had their estimated glomerular filtration rate at baseline and 1 month later (n = 3606). We used multivariate regression and propensity score (PS)-matched Cox proportional hazards to evaluate the association between PRD and outcomes. Persistent renal dysfunction occurred in 1333 (37%) patients. Significant PRD contributors included old age, low body mass index (BMI), hypertension, Killip class, and the extent of vessel disease. Persistent renal dysfunction was associated with an increased 1-year major adverse cardiac events (all-cause death, myocardial infarction, or revascularization) relative to no-PRD (entire cohort: 6.2% vs 4.5%, hazard ratio[HR] 1.63, 95% confidence interval [CI] 1.18-2.25, P = .003; PS-matched cohort: 7.2% vs 4.9%, HR 1.67, 95% CI 1.08-2.58, P = .022). In conclusion, PRD occurred in approximately one-third of patients with AMI following PCI. It was associated with old age, hypertension, low BMI, initial hemodynamic instability, and extent of vessel disease and was a predictor of worse outcomes at 1 year.

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ADS Score as a Novel Predictor of Outcomes in Patients Who Underwent Percutaneous Coronary Intervention

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.720597 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wen-Jing Zhang ◽

Gang-Qiong Liu ◽

Jia-Hong Shangguan ◽

Xiao-Dan Zhu ◽

Wei Wang ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

High Group ◽

Hazards Model ◽

Percutaneous Coronary ◽

Significant Difference

Objectives: A novel AFR– albumin-derived neutrophil to lymphocyte ratio (dNLR) score (ADS) were reported to associate with clinical outcome in various malignancies, However, the relation between the ADS score and outcomes in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) has not been investigated.Methods: Three thousand five hundred and sixty-one patients were divided into two groups according to ADS score: low group (ADS score <2; n = 2,682) and high group (ADS score ≥ 2; n = 879). Overall, there were 133 all-cause mortality (ACM) during the following up. The incidence of ACM in the low group is 2.7% (72/2,682) and high group is 6.9% (61/879). The ACM incidence was significantly higher in high group compared to that in the low group (P < 0.001). Cardiac mortality (CM) occurred in 82 patients: 44(1.6%) in the low group and 38 (4.3%) in the high group. There was significant difference in the CM incidence between the low group and high group (P < 0.001). Major adverse cardiac and cerebrovascular events (MACCE) occurred in 520 patients: 366 (13.6%) in the low group and 154 (17.5%) in the high group. There was significant difference in the MACCE incidence between the low group and high group (P = 0.005). Major adverse cardiac and events (MACE) occurred in 395 patients: 281(10.5%) in the low group and 114 (13.0%) in the high group. There was significant difference in the MACE incidence between the low group and high group (P = 0.041). The multivariate Cox proportional hazards model showed that ADS score was independently correlated with the ACM [adjusted HR = 2.031 (1.357–3.039), P = 0.001]; CM [adjusted HR = 1.883 (1.127–3.147), P = 0.016]; MACCE [adjusted HR = 1.352 (1.096–1.668), P = 0.005], and MACE [adjusted HR = 1.260 (0.987–1.608), P = 0.063].Conclusion: The present study indicated that the ADS score was associated with long-term mortality, the MACCE, and the MACE in CAD patients underwent PCI.

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