A New Predictor of Mortality in ST-Elevation Myocardial Infarction: The Uric Acid Albumin Ratio

Several studies have shown that high uric acid (UA) and low serum albumin (SA) values increase the risk of cardiovascular disease and mortality in ST-elevation myocardial infarction (STEMI). We determined whether the uric acid/albumin ratio (UAR) is a predictor of mortality in STEMI patients. All patients who presented at our center with a diagnosis of STEMI and underwent percutaneous intervention from 2015 to 2020 were screened consecutively; 4599 patients were included. A Cox proportional hazards model was used to evaluate UAR, and adjusted predictors obtained from laboratory findings and clinical characteristics contributed to mortality. Also, a regression model was presented with a directed acyclic graph (DAG). The median age of the patients was 58 years (IQR [interquartile range]: 50–67); 3581 patients (77.9%) were male. The incidence of mortality in the entire patient group was 11.9%. Median follow-up duration of all groups was 42 months. Multivariate Cox proportional regression (model-1) analysis showed age (increase 50 to 67 years; HR [hazard ratio]: 1.34, 95% CI 1.18–1.52) and UAR (increase 1.15–1.73; HR: 1.33, 95% CI 1.16–1.52) were associated with mortality. UAR may be a prognostic factor for mortality in STEMI patients and an easily accessible parameter to identify high-risk patients.

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Prediction of Long-Term Outcomes in ST-Elevation Myocardial Infarction and Non-ST Elevation Myocardial Infarction with and without Creatinine Kinase Elevation—Post-Hoc Analysis of the J-MINUET Study

Journal of Clinical Medicine ◽

10.3390/jcm9082667 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2667 ◽

Cited By ~ 2

Author(s):

Shigeru Toyoda ◽

Masashi Sakuma ◽

Shichiro Abe ◽

Teruo Inoue ◽

Koichi Nakao ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Events ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

St Elevation Myocardial Infarction ◽

Risk Scores ◽

Long Term Outcomes ◽

St Elevation

Background: A Japanese prospective, nation-wide, multicenter registry (J-MINUET) showed that long-term outcomes were worse in non-ST elevation acute myocardial infarction (NSTEMI), diagnosed by increased cardiac troponin levels, compared to STEMI. This was observed in both non-STEMI with elevated creatine kinase (CK) (NSTEMI+CK) and non-STEMI without elevated CK (NSTEMI-CK). However, predictive factors for long-term outcomes in STEMI, NSTEMI+CK, and NSTEMI-CK have not been elucidated. Methods: Using the Cox proportional hazards model, we determined significant independent predictors of long-term outcomes from a total of 111 parameters evaluated in the J-MINUET study in each of our groups, including STEMI, NSTEMI+CK, and NSTEMI-CK. Then, we calculated the risk score using the regression coefficients for the determined independent predictors for the strict prediction of long-term outcomes. Results: Prognostic factors, as well as composite cardiovascular events and all-cause death, were different between STEMI, NSTEMI+CK, and NSTEMI-CK. Risk scores could effectively and powerfully predict both composite cardiovascular events and all-cause death in each group. Conclusions: The prediction of long-term outcomes using cored parameters of baseline demographics and clinical characteristics is feasible and could prove useful in establishing therapeutic strategies in patients with STEMI, NSTEMI+CK, and NSTEMI-CK.

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Effect of PCSK9 E670G and R46L Polymorphisms on Major Adverse Cardio-Cerebrovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

International Journal of Angiology ◽

10.1055/s-0041-1722875 ◽

2021 ◽

Author(s):

Anwar Santoso ◽

Yulianto Yulianto ◽

Hendra Simarmata ◽

Abhirama Nofandra Putra ◽

Erlin Listiyaningsih

Keyword(s):

Myocardial Infarction ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

Cerebrovascular Events ◽

St Segment ◽

Significant Difference

AbstractMajor adverse cardio-cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) are still high, although there have been advances in pharmacology and interventional procedures. Proprotein convertase subtilisin/Kexin type 9 (PCSK9) is a serine protease regulating lipid metabolism associated with inflammation in acute coronary syndrome. The MACCE is possibly related to polymorphisms in PCSK9. A prospective cohort observational study was designed to confirm the association between polymorphism of E670G and R46L in the PCSK9 gene with MACCE in STEMI. The Cox proportional hazards model and Spearman correlation were utilized in the study. The Genotyping of PCSK9 and ELISA was assayed.Sixty-five of 423 STEMI patients experienced MACCE in 6 months. The E670G polymorphism in PCSK9 was associated with MACCE (hazard ratio = 45.40; 95% confidence interval: 5.30–390.30; p = 0.00). There was a significant difference of PCSK9 plasma levels in patients with previous statin consumption (310 [220–1,220] pg/mL) versus those free of any statins (280 [190–1,520] pg/mL) (p = 0.001).E670G polymorphism of PCSK9 was associated with MACCE in STEMI within a 6-month follow-up. The plasma PCSK9 level was higher in statin users.

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Abstract MP74: It's Not Too Late to Improve Adherence: Association Between All-Cause Mortality and Statin Adherence Change After Acute Myocardial Infarction

Circulation ◽

10.1161/circ.137.suppl_1.mp74 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Ryan P Hickson ◽

Jennifer G Robinson ◽

Izabela E Annis ◽

Ley A Killeya-Jones ◽

Gang Fang

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Proportional Hazards Model ◽

Reference Group ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Administrative Claims ◽

Post Discharge ◽

All Cause Mortality ◽

Statin Adherence

Introduction: Hospitalization for acute myocardial infarction (AMI) affects medication adherence in prevalent statin users. Our objective was to estimate the association between changes in statin adherence and all-cause mortality after AMI discharge. Hypothesis: Patients who are adherent both pre- and post-AMI have the lowest risk of all-cause mortality. Methods: Medicare administrative claims were used to identify AMI hospitalizations in 2008-2010. Patients were ≥66 years old, continuously enrolled ≥360 days pre-AMI with a statin prescription claim, discharged to home/self-care, and survived ≥180 days post-AMI with continuous enrollment. Statin adherence was measured in the 180 days pre- and post-AMI hospitalization using proportion of days covered and categorized as severely nonadherent, moderately nonadherent, and adherent. The exposure was categorical change in statin adherence from pre- to post-AMI (9 categories, see Figure); adherent/adherent was the reference group. Patients were followed for all-cause mortality from 180 days post-discharge for up to 18 months. A multivariable Cox proportional hazards model estimated hazard ratios (HRs). Results: Of 101,011 eligible patients, 15% decreased, 20% increased, and 64% did not change statin adherence categories. Compared to patients who were adherent pre- and post-AMI, the adjusted HR (95% confidence intervals [CIs]) for patients who increased from severely nonadherent to adherent was 0.93 (95% CI: 0.85-1.02); other increases in adherence had similar HRs (see Figure). Compared to patients who were adherent pre- and post-AMI, the adjusted HR for patients who decreased from adherent to severely nonadherent was 1.22 (95% CI: 1.13-1.33); other decreases in adherence had similar HRs. Conclusions: Although patients with decreased statin adherence had the worst mortality outcomes, those with increased adherence had similar or better outcomes than continuously adherent patients, showing that, even after an AMI, it is not too late to improve statin adherence.

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Uric acid in the early risk stratification of ST-elevation myocardial infarction

Internal and Emergency Medicine ◽

10.1007/s11739-011-0515-9 ◽

2011 ◽

Vol 7 (1) ◽

pp. 33-39 ◽

Cited By ~ 26

Author(s):

Chiara Lazzeri ◽

Serafina Valente ◽

Marco Chiostri ◽

Claudio Picariello ◽

Gian Franco Gensini

Keyword(s):

Myocardial Infarction ◽

Uric Acid ◽

Risk Stratification ◽

St Elevation Myocardial Infarction ◽

Early Risk ◽

St Elevation

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Prognostic Efficacy of C-Reactive Protein to Albumin Ratio in Patients with St Elevation Myocardial İnfarction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.03.074 ◽

2018 ◽

Vol 121 (8) ◽

pp. e23

Author(s):

Ibrahim Rencuzogullari ◽

Yavuz Karabag

Keyword(s):

Myocardial Infarction ◽

St Elevation Myocardial Infarction ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

St Elevation

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Relationship between fibrinogen -to- albumin ratio and angiographic no-reflow in elderly patients with st-elevation myocardial infarction treated with primary percutaneous coronary intervention

The Turkish Journal of Geriatrics ◽

10.31086/tjgeri.2019.100 ◽

2019 ◽

Vol 22 (3) ◽

pp. 244-257

Author(s):

Firdevs EKİZLER ◽

Bahar TEKİN TAK ◽

Serkan ÇAY

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Elderly Patients ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Albumin Ratio ◽

No Reflow ◽

Percutaneous Coronary ◽

St Elevation

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Is Obesity a Favorable Prognostic Factor in Peritoneal Dialysis Patients?

Peritoneal Dialysis International ◽

10.1177/089686080002000623 ◽

2000 ◽

Vol 20 (6) ◽

pp. 715-721 ◽

Cited By ~ 85

Author(s):

David W. Johnson ◽

Karen A. Herzig ◽

David M. Purdie ◽

Wendy Chang ◽

Allison M. Brown ◽

...

Keyword(s):

Myocardial Infarction ◽

Peritoneal Dialysis ◽

Proportional Hazards Model ◽

Patient Survival ◽

Tertiary Care ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Adverse Cardiovascular Event ◽

Free Survival

Objective To determine the influence of an elevated body mass index (BMI) on cardiovascular outcomes and survival in peritoneal dialysis (PD) patients. Design Prospective, observational study of a prevalent PD cohort at a single center. Setting Tertiary care institutional dialysis center. Patients The study included all patients with a BMI of at least 20 who had been receiving PD for at least 1 month as of 31 January 1996 ( n = 43). Patients were classified as overweight [BMI > 27.5; mean ± standard error of mean (SEM): 32.1 ± 1.1; n = 14] or normal weight (BMI 20 – 27.5; mean ± SEM: 23.8 ± 0.4; n = 29). Outcome Measures Patient survival and adverse cardiovascular events (myocardial infarction, congestive cardiac failure, cerebrovascular accident, and symptomatic peripheral vascular disease) were recorded over a 3-year period. Results At baseline, no significant differences were seen between the groups in clinical, biochemical, nutritional, or echocardiographic parameters, except for a lower dietary protein intake (0.97 ± 0.10 g/kg/day vs 1.44 ± 0.10 g/ kg/day, p = 0.004) and a higher proportion of well-nourished patients by subjective global assessment (100% vs 72%, p < 0.05) in the overweight group. After 3 years of follow-up, 29% of overweight patients and 69% of normal-weight patients had died ( p < 0.05). Using a Cox proportional hazards model, a BMI greater than 27.5 was shown to be an independent positive predictor of patient survival, with an adjusted hazard ratio (HR) of 0.09 [95% confidence interval (CI): 0.01 – 0.85; p < 0.05]. However, being overweight did not significantly influence myocardial infarction-free survival (adjusted HR: 0.33; 95% CI: 0.07 – 1.48; p = 0.15) or combined adverse cardiovascular event-free survival (adjusted HR: 0.67; 95% CI: 0.23 – 1.93; p = 0.46). Conclusions Obesity conferred a significant survival advantage in our PD population. Obese patients should therefore not be discouraged from receiving PD purely on the basis of BMI. Moreover, maintaining a higher-than-average BMI to preserve “nutritional reserve” may help to reduce the mortality and morbidity rates associated with PD.

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Association of Acidemia With Short-Term Mortality of Acute Myocardial Infarction: A Retrospective Study Base on MIMIC-III Database

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620950837 ◽

2020 ◽

Vol 26 ◽

pp. 107602962095083

Author(s):

Tang Zhang ◽

Yao-Zong Guan ◽

Hao Liu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Short Term ◽

Hazards Model ◽

Short Term Mortality ◽

Mimic Iii

Acute myocardial infarction (AMI) is a leading cause of death and not a few of these patients are combined with acidemia. This study aimed to detect the association of acidemia with short-term mortality of AMI patients. A total of 972 AMI patients were selected from the Medical Information Mart for Intensive Care (MIMIC) III database for analysis. Propensity-score matching (PSM) was used to reduce the imbalance. Kaplan-Meier survival analysis was used to compare the mortality, and Cox-proportional hazards model was used to detect related factors associated with mortality. After PSM, a total of 345 non-acidemia patients and 345 matched acidemia patients were included. The non-acidemia patients had a significantly lower 30-day mortality (20.0% vs. 28.7%) and lower 90-day mortality (24.9% vs. 31.9%) than the acidemia patients ( P < 0.001 for all). The severe-acidemia patients (PH < 7.25) had the highest 30-day mortality (52.6%) and 90-day mortality (53.9%) than non-acidemia patients and mild-acidemia (7.25 ≤ PH < 7.35) patients ( P < 0.001). In Cox-proportional hazards model, acidemia was associated with improved 30-day mortality (HR = 1.518; 95%CI = 1.110-2.076, P = 0.009) and 90-day mortality (HR = 1.378; 95%CI = 1.034 -1.837, P = 0.029). These results suggest that severe acidemia is associated with improved 30-day mortality and 90-day mortality of AMI patients.

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A censored quantile regression approach for the analysis of time to event data

Statistical Methods in Medical Research ◽

10.1177/0962280216648724 ◽

2016 ◽

Vol 27 (3) ◽

pp. 955-965 ◽

Cited By ~ 4

Author(s):

Xiaonan Xue ◽

Xianhong Xie ◽

Howard D Strickler

Keyword(s):

Quantile Regression ◽

Regression Model ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Time To Event ◽

Censored Quantile Regression ◽

Quantile Regression Model ◽

Hazards Model

The commonly used statistical model for studying time to event data, the Cox proportional hazards model, is limited by the assumption of a constant hazard ratio over time (i.e., proportionality), and the fact that it models the hazard rate rather than the survival time directly. The censored quantile regression model, defined on the quantiles of time to event, provides an alternative that is more flexible and interpretable. However, the censored quantile regression model has not been widely adopted in clinical research, due to the complexity involved in interpreting its results properly and consequently the difficulty to appreciate its advantages over the Cox proportional hazards model, as well as the absence of adequate validation procedure. In this paper, we addressed these limitations by (1) using both simulated examples and data from National Wilms’ Tumor clinical trials to illustrate proper interpretation of the censored quantile regression model and the differences and the advantages of the model compared to the Cox proportional hazards model; and (2) developing a validation procedure for the predictive censored quantile regression model. The performance of this procedure was examined using simulation studies. Overall, we recommend the use of censored quantile regression model, which permits a more sensitive analysis of time to event data together with the Cox proportional hazards model.

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