scholarly journals Cysteine‐Rich Angiogenic Inducer 61 Improves Prognostic Accuracy of GRACE (Global Registry of Acute Coronary Events) 2.0 Risk Score in Patients With Acute Coronary Syndromes

2021 ◽  
Author(s):  
Roland Klingenberg ◽  
Soheila Aghlmandi ◽  
Lorenz Räber ◽  
Alexander Akhmedov ◽  
Baris Gencer ◽  
...  
Keyword(s):  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
High Sensitivity ◽  
Prognostic Accuracy ◽  
Grace Risk Score ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Coronary Events ◽  
High Sensitivity Troponin T

Background It remains unclear whether the novel biomarker cysteine‐rich angiogenic inducer 61 (CCN1) adds incremental prognostic value to the GRACE 2.0 (Global Registry of Acute Coronary Events) risk score and biomarkers high‐sensitivity Troponin T, hsCRP (high‐sensitivity C‐reactive protein), and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) in patients with acute coronary syndromes. Methods and Results Patients referred for coronary angiography with a primary diagnosis of acute coronary syndromes were enrolled in the Special Program University Medicine – Acute Coronary Syndromes and Inflammation cohort. The primary/secondary end points were 30‐day/1‐year all‐cause mortality and the composite of all‐cause mortality or myocardial infarction as used in the GRACE risk score. Associations between biomarkers and outcome were assessed using log‐transformed biomarker values and the GRACE risk score (versions 1.0 and 2.0). The incremental value of CCN1 beyond a reference model was assessed using Harrell’s C‐statistics calculated from a Cox proportional‐hazard model. The P value of the C‐statistics was derived from a likelihood ratio test. Among 2168 patients recruited, 1732 could be analyzed. CCN1 was the strongest single predictor of all‐cause mortality at 30 days (hazard ratio [HR], 1.77 [1.31, 2.40]) and 1 year (HR, 1.81 [1.47, 2.22]). Adding CCN1 alone to the GRACE 2.0 risk score improved C‐statistics for prognostic accuracy of all‐cause mortality at 30 days (0.87–0.88) and 1 year (0.81–0.82) and when combined with high‐sensitivity Troponin T, hsCRP, NT‐proBNP for 30 days (0.87–0.91), and for 1‐year follow‐up (0.81–0.84). CCN1 also increased the prognostic value for the composite of all‐cause mortality or myocardial infarction. Conclusions CCN1 predicts adverse outcomes in patients with acute coronary syndromes adding incremental information to the GRACE risk score, suggesting distinct underlying molecular mechanisms. Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01000701.

scholarly journals Trimethyllysine, a trimethylamine N-oxide precursor, provides near- and long-term prognostic value in patients presenting with acute coronary syndromes

2019 ◽  
Vol 40 (32) ◽  
pp. 2700-2709 ◽  
Author(s):  
Xinmin S Li ◽  
Slayman Obeid ◽  
Zeneng Wang ◽  
Benjamin J Hazen ◽  
Lin Li ◽  
...  
Keyword(s):  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
High Sensitivity Troponin T

AbstractAims Trimethyllysine (TML) serves as a nutrient precursor of the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) and is associated with incident cardiovascular (CV) events in stable subjects. We examined the relationship between plasma TML levels and incident CV events in patients presenting with acute coronary syndromes (ACS).Methods and results Plasma levels of TML were quantified in two independent cohorts using mass spectrometry, and its relationship with CV events was investigated. In a Cleveland Cohort (N = 530), comprised of patients presenting to the emergency department with chest pain and suspected ACS, TML was associated with major adverse cardiac events (MACE, myocardial infarction, stroke, need for revascularization, or all-cause mortality) over both 30 days [3rd tertile (T3), adjusted odds ratio (OR) 1.77, 95% confidence interval (CI) 1.04–3.01; P < 0.05] and 6 months (T3, adjusted OR 1.95, 95% CI 1.15–3.32; P < 0.05) of follow-up independent of traditional CV risk factors and indices of renal function. Elevated TML levels were also associated with incident long-term (7-year) all-cause mortality [T3, adjusted hazard ratio (HR) 2.52, 95% CI 1.50–4.24; P < 0.001], and MACE even amongst patients persistently negative for cardiac Troponin T at presentation (e.g. 30-day MACE, T3, adjusted OR 4.49, 95% CI 2.06–9.79; P < 0.001). Trimethyllysine in combination with TMAO showed additive significance for near- and long-term CV events, including patients with ‘negative’ high-sensitivity Troponin T levels. In a multicentre Swiss Cohort (N = 1683) comprised of ACS patients, similar associations between TML and incident 1-year adverse cardiac risks were observed (e.g. mortality, adjusted T3 HR 2.74, 95% CI 1.28–5.85; P < 0.05; and MACE, adjusted T3 HR 1.55, 95% CI 1.04–2.31; P < 0.05).Conclusion Plasma TML levels, alone and together with TMAO, are associated with both near- and long-term CV events in patients with chest pain and ACS.

scholarly journals High-Sensitivity Troponin T and Copeptin in Non-ST Acute Coronary Syndromes: Implications for Prognosis and Role of hsTnT and Copeptin in Non-STEACS

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Diana Hernández-Romero ◽  
José María García-Salas ◽  
Ángel López-Cuenca ◽  
Patricio Pérez-Berbel ◽  
Carmen Puche ◽  
...  
Keyword(s):  
Adverse Events ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
High Sensitivity ◽  
Healthy Controls ◽  
Invasive Approach ◽  
Coronary Syndromes ◽  
Prognostic Implications ◽  
High Sensitivity Troponin T

High-sensitivity TnT (hsTnT) has been proposed to improve the diagnosis and stratification in acute coronary syndromes. Copeptin has been proposed for a rapid and accurate rule out of acute myocardial infarction, but some doubts exist about its use out of the first hours from admission. Abnormalities of serum hsTnT and copeptin levels in non-STEACS and negative TnT, could have prognostic implications.Methods. We included 122 non-STEACS patients without raised TnT, 33 disease controls and 43 healthy controls. We measured hsTnT and copeptin levels. Clinical follow-up at 12 months was performed for adverse endpoints.Results. Non-STEACS patients had raised hsTnT compared with both control groups (P=0.036andP<0.001). Copeptin levels were higher in non-STEACS patients than healthy controls (P=0.021), without differences with disease controls. Raised levels of hs-TnT presented prognostic implications [HR 3.29 (95%CI: 1.33–7.49),P=0.010]. hs-TnT could be used for invasive approach decision, as it shows prognostic relevance in conservative approach-patients whereas remains unrelevant for catheterized-patients. Copeptin levels were not associated with adverse events.Conclusion. hsTnT levels increased in non-STEACS, were predictive of adverse events and could be important for recommending an invasive management. We cannot confirm a predictive role of copeptin out of the first hours from admission.

scholarly journals Prognostic Value of SYNTAX Score II in Patients with Acute Coronary Syndromes Referred for Invasive Management: A Subanalysis from the SPUM and COMFORTABLE AMI Cohorts

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Slayman Obeid ◽  
Antonio H. Frangieh ◽  
Lorenz Räber ◽  
Nooraldaem Yousif ◽  
Thomas Gilhofer ◽  
...  
Keyword(s):  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Prognostic Value ◽  
Syntax Score ◽  
Repeat Revascularization ◽  
Grace Risk Score ◽  
Syntax Score Ii ◽  
All Cause Mortality ◽  
Coronary Syndromes

Aims. To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention. Methods and results. SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSIILow ≤21.5 (n=245), SxSIIMid 21.5–30.6 (n=245), and SxSIIHigh ≥30.6 (n=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77–0.84, p<0.001 versus 0.67, 95% CI 0.63–0.72, p=0.007 versus 0.69, 95% CI 0.6–0.8, p=0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96–1.07), p=0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06–1.11), p<0.001). This was also true for the prediction of both secondary outcomes MACE (n=60) and MACCE (n=70) with an adjusted HR = 1.055, 95% CI (1.03–1.08), p<0.001, and HR = 1.065, 95% CI (1.04–1.09), p<0.001. Conclusion. In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.

scholarly journals Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?

2009 ◽  
Vol 11 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Ana Teresa Timóteo ◽  
Alexandra Toste ◽  
Ruben Ramos ◽  
Fernando Miranda ◽  
Maria Lurdes Ferreira ◽  
...  
Keyword(s):  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Short Term ◽  
Prognostic Accuracy ◽  
Grace Risk Score ◽  
Short Term Mortality ◽  
Coronary Syndromes
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