scholarly journals Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes

2020 ◽  
Vol 11 ◽  
pp. 204201882096029
Author(s):  
Ardwan Dakhel ◽  
Moncef Zarrouk ◽  
Jan Ekelund ◽  
Stefan Acosta ◽  
Peter Nilsson ◽  
...  
Keyword(s):  
Propensity Score ◽  
Intermittent Claudication ◽  
Cox Regression ◽  
Total Mortality ◽  
Major Amputation ◽  
Endovascular Surgery ◽  
Major Adverse Cardiovascular Events ◽  
Long Term Effects ◽  
Diabetes Registry

Background: Diabetes mellitus (DM) is an established risk factor for intermittent claudication (IC) and other manifestations of atherosclerotic peripheral arterial disease. Indications for surgery in infrainguinal IC are debated, and there are conflicting reports regarding its outcomes in patients with DM. Aims of this study were to compare both short- and long-term effects on total- and cardiovascular (CV) mortality, major adverse cardiovascular events (MACEs), acute myocardial infarction (AMI), stroke, and major amputation following infrainguinal endovascular surgery for IC in patients with and without DM. We also evaluated potential relationships between diabetic control and outcomes in patients with DM. Methods: Nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Registry. Propensity score adjusted comparison of total and CV mortality, MACE, AMI, stroke, and major amputation after elective infrainguinal endovascular surgery for IC in 626 patients with and 1112 without DM at 30 postoperative days and after median 5.2 [interquartile range (IQR) 4.2–6.3] years of follow-up for patients with DM, and 5.4 (IQR 4.3–6.5) years for those without. Results: In propensity score adjusted Cox regression after 30 postoperative days, there were no differences between groups in morbidity or mortality. At last follow-up, patients with DM showed higher rates of MACE [hazard ratio (HR) 1.26, confidence interval (CI) 1.07–1.48; p < 0.01], AMI (HR 1.48, CI 1.09–2.00; p = 0.01), and major amputation (HR 2.31, CI 1.24–4.32; p < 0.01). Among patients with DM, higher HbA1c was associated with higher total mortality during follow-up (HR 1.01, CI 1.00–1.03; p = 0.045). Conclusion: Patients with DM have higher rates of MACE, AMI, and major amputation in propensity score adjusted analysis during 5 years of follow-up after infrainguinal endovascular surgery for IC. Furthermore, HbA1c is associated with total mortality in patients with DM. Prevention and treatment of DM is important to improve cardiovascular and limb outcomes.

Higher long-term cardiovascular morbidity after open surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes – a nationwide observational cohort study

VASA ◽  
2020 ◽  
pp. 1-7
Author(s):  
Ardwan Dakhel ◽  
Moncef Zarrouk ◽  
Jan Ekelund ◽  
Stefan Acosta ◽  
Mervete Miftaraj ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Intermittent Claudication ◽  
Open Surgery ◽  
Total Mortality ◽  
Major Amputation ◽  
Observational Cohort Study ◽  
Observational Cohort

Summary: Background: Diabetes mellitus (DM) is a risk factor for peripheral arterial disease (PAD). Indications for open surgery in infrainguinal intermittent claudication (IC) are limited, and reports are lacking regarding outcomes in DM patients. Study aims were to compare short and long-term effects on major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), stroke, major amputation, and mortality after infrainguinal open surgery for IC in patients with and without DM, and to evaluate relationships between glycaemic control and outcomes. Methods: Nationwide observational cohort study of all patients registered in the Swedish Vascular Registry after planned infrainguinal open surgery for IC from January 1st 2010 to December 31st 2014. Patients registered in the National Diabetes Registry were compared with patients without diabetes by propensity score adjusted comparison of MACE, AMI, stroke, major amputation, and mortality. Results: After 30 days, there were no differences in MACE, AMI, stroke, major amputation, or mortality between patients with (n = 323, mean age 70.5 [SD 7.4] years, 92 [28.5%] females) and without (n = 679, mean age 69.7 years [SD 11.2], 234 [34.5%] females) DM. At last follow-up after median 5.2 years, patients with DM showed higher rates of MACE (Hazard ratio [HR] 1.33, confidence interval [CI] 1.08–1.62; p < 0.01), and AMI (HR 2.21, CI 1.46–3.35; p < 0.01) than patients without diabetes. Among DM patients, higher glycated haemoglobin (HbA1c) was associated with higher rates of MACE (HR 1.02, CI 1.00–1.03; p = 0.02), stroke (HR 1.05, CI 1.00–1.11; p = 0.04), and total mortality (HR 1.03, CI 1.01–1.06; p < 0.01), during follow-up, whereas duration of diabetes was associated with higher rate of major amputation (HR 1.08, CI 1.02–1.15; p < 0.01). Conclusions: DM patients showed higher rates of MACE and AMI in propensity score adjusted analysis five years after planned infrainguinal open surgery for IC. Higher HbA1c was associated with MACE, stroke, and total mortality in patients with DM, whereas longer duration of DM was associated with major amputation.

scholarly journals Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

2021 ◽  
pp. 1358863X2110082
Author(s):  
Erika Lilja ◽  
Anders Gottsäter ◽  
Mervete Miftaraj ◽  
Jan Ekelund ◽  
Björn Eliasson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Vascular Surgery ◽  
Incidence Rate ◽  
Cox Regression ◽  
Major Amputation ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Number Of Patients

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

MO129COMPARATIVE EFFECTIVENESS OF SGLT2I VERSUS DPP4I ON CARDIOVASCULAR AND RENAL OUTCOMES IN ROUTINE-CARE SETTINGS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Edouard Fu ◽  
Marco Trevisan ◽  
Vivekananda Lanka ◽  
Catherine M Clase ◽  
Yang Xu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Kidney Function ◽  
Primary Outcome ◽  
Cox Regression ◽  
Routine Care ◽  
Major Adverse Cardiovascular Events ◽  
All Cause Mortality ◽  
Kidney Function Decline ◽  
Egfr Slope

Abstract Background and Aims While clinical trials have demonstrated the efficacy of SGLT2 inhibitors on preventing cardiovascular and renal damage, few studies have expanded this evidence to routine-care settings. Method We compared clinical outcomes of adults who started SGLT2i or DPP4i therapy in Stockholm, Sweden, during 2013-2019. The primary outcome was a composite of cardiovascular (CV) death and hospitalization for heart failure (HF). Secondary outcomes included major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction, stroke), all-cause mortality and the rate of eGFR decline (eGFR slope). Propensity score weighted Cox regression was used to balance 55 variables and estimate intention-to-treat hazard ratios with 95% confidence intervals. Differences in eGFR slope were calculated with linear mixed models. Results We identified 7136 individuals starting SGLT2i and 13,618 starting DPP4i therapy. Median age was 64 years (37% women) and median eGFR 86 ml/min/1.73m2. During median follow-up of 2.1 years, 211 individuals developed the primary outcome, 269 experienced MACE and 178 died. After propensity score weighting, patients starting SGLT2i therapy were at lower risk for the composite of CV death/HF hospitalization (HR 0.71; 95% CI 0.53-0.94) compared with DPP4i, and showed a tendency towards lower MACE (0.84; 95% CI 0.67-1.04) and all-cause mortality (0.85; 95% CI 0.62-1.18). There were a median of 4 (interquartile range: 2-8) eGFR measurements during follow-up per patient to estimate their eGFR slopes. In adjusted models, new users of SGLT2i had a slower rate of kidney function decline compared with DPP4i (eGFR slope difference of 0.43 (95% CI 0.15-0.72) ml/min/1.73m2 per year). Results for the primary outcome were consistent across 7 pre-specified subgroups, including eGFR (eGFR ≥60: HR 0.79 [95% CI 0.57-1.08]; eGFR &lt;60: HR 0.62 [0.38-0.99], p-value for interaction 0.40). Conclusion In patients undergoing routine care, initiation of SGLT2i was associated with fewer cardiovascular outcomes and less rapid kidney function decline compared with DPP4i initiation.

P5714Impact on the prognosis of treatment administrated in the daily clinical practice to patients with myocardial infarction with non-obstructive coronary arteries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lopez Pais ◽  
L Alvarez Rodriguez ◽  
B Izquierdo Coronel ◽  
M Pedreira Perez ◽  
R Agra Bermejo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Coronary Arteries ◽  
Cox Regression ◽  
Beta Blockers ◽  
Total Mortality ◽  
Major Adverse Cardiovascular Events ◽  
Specific Information ◽  
Diagnostic Study

Abstract Background Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) remains a challenge in cardiology clinical practice. 2016 European Society of Cardiology Working Group position paper (ESC-WGPP) recommend to treat them as the rest of myocardial infarctions, mainly with dual antiplatelet therapy (DAT), beta blockers, Angiotensin Converter Enzyme Inhibitors (ACEI), and statins. The aim of this study is to analyse the use of optimal medical treatment (OMT) of ischemic heart disease (IHD) treatment on this group of patients and its implication in their prognosis. Methods Analytical and observational study based on a retrospective cohort of MINOCA (according to the definitions of ESC-WGPP) extracted from the myocardial infarction registries of three University Hospitals during the period from 2003–2018 (N: 9371). We analysed data about the treatment of all consecutive MINOCA. Treatment prescribed was the one considered by their responsible doctors. We recorded specific information about treatment prescribed after hospitalization. Follow up analysis based on Cox regression included death from any cause and major adverse cardiovascular events ([MACE], a composite of a recurrence of myocardial infarction, stroke or transient ischemic attack or death from any cardiovascular cause) Median follow up was 52.6±32.5 months. Results Of 9371 patients initially admitted for acute myocardial infarction, 620 were classified as MINOCA (incidence 6.6%). Median age was 64.2 years old, and 40.7% were women. Regarding cardiovascular risk factors, 25.1% were smokers, 19.0% had diabetes, 42.3 had dyslipidemia and 57.7% hypertension. At discharge, 18.2% had ventricular dysfunction. DAT was prescribed in 32.4% of MINOCA patients, beta blockers in 59.5%, ACEI in 54.8% and statins in 71.9%. Statins showed impact on MINOCAs prognosis, with a significant reduction in total mortality Hazard Ratio (HR): 0.60 (95%Confidence Interval [CI]: 0.38–0.94) p 0.03. DAT had a non-significant reduction in total mortality (HR 0.64 [CI: 0.37–1.13] p 0.12). The rest of the OMT of IHD showed no significant impact on total mortality: beta blockers (HR 0.84 [CI: 0.54–1.31] p 0.45) and ACEI (1.30 [CI: 0.83–2.03] p 0.25) None of the OMT had impact on MACE after MINOCA: DAT (HR 0.97 [CI: 0.70–1.35] p 0.87), beta blockers (HR 0.92 [CI: 0.69–1.23] p 0.57), ACEI (1.13 [CI: 0.85–1.51] p 0.40) and statins (0.94 [CI: 0.69–1.30] p 0.74). Figure 1 Conclusion This study suggests that statins may be liked with a better prognosis in MINOCA, whereas the rest of conventional IHD treatments showed no difference in the course of the illness. This could be due to the heterogeneity of physiopathological mechanisms underlying the working diagnosis of MINOCA. So, following the 2016 ESC-WGPP on MINOCA recommendations, a deep diagnostic study must be performed in order to individualize the treatment.

Shall be takotsubo tear apart from working diagnosis of myocardial infarction with non-obstructive coronary arteries?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Lopez-Pais ◽  
B Izquierdo Coronel ◽  
S Raposeiras-Roubin ◽  
L Alvarez Rodriguez ◽  
O Vedia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Cox Regression ◽  
Total Mortality ◽  
Major Adverse Cardiovascular Events ◽  
Distinct Entity ◽  
Prognostic Variables ◽  
Cardiovascular Prognosis

Abstract Aims Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCA) is still controversial. The aim of this work is to evaluate main differences between TTS and non-TTS MINOCA. Methods and results A cohort study based on two prospective registries: TTS from the RETAKO registry (N:1055) and non-TTS MINOCA patients from contemporary records of acute myocardial infarction from 5 national centres (N:1080). Definitions and management recommended by the ESC were used. Survival analysis was based on Cox regression; propensity score matching was created to adjust prognostic variables. TTS were more often women (85.9% vs. 51.9%; p&lt;0.001) and older (69.4±12.5 vs. 64.5±14.1 years; p&lt;0.001). Atrial fibrillation was more frequent in non-TTS MINOCA (10.4% vs. 14.4%; p 0.007). Psychiatric disorders were more prevalent in TTS (15.5% vs. 10.2%, p&lt;0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs 1.8%, (p 0.015) and 25.8% vs. 11.5%, (p&lt;0.001). Median follow-up was 32.4 months; TTS had less major adverse cardiovascular events (MACE): Hazard Ratio (HR) 0.59; 95% confidence interval (CI) 0.42 to 0.83. There were no differences in total mortality (HR 0.87; CI: 0.64 to 1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35 to 0.98). Conclusions TTS has a different patient's profile and a more aggressive acute phase than the rest of MINOCA. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a distinct entity with unique characteristics and prognosis. Funding Acknowledgement Type of funding source: None

Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Mustafa Umut Somuncu ◽  
Belma Kalayci ◽  
Ahmet Avci ◽  
Tunahan Akgun ◽  
Huseyin Karakurt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cox Regression ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Lower Systolic Blood Pressure ◽  
Cox Regression Analysis ◽  
Killip Class ◽  
Target Vessel Revascularization

AbstractBackgroundThe increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients.Materials and methodsIn this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure.ResultsDuring a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124–4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality.ConclusionsHigh sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

scholarly journals Association of Derived Neutrophil-To-Lymphocyte Ratio With Prognosis of Coronary Heart Disease After PCI

2021 ◽  
Vol 8 ◽  
Author(s):  
Gang-Qiong Liu ◽  
Wen-Jing Zhang ◽  
Jia-Hong Shangguan ◽  
Xiao-Dan Zhu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Major Adverse Cardiovascular Events ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
The Third

Aims: The present study aimed to investigate the prognostic role of derived neutrophil-to-lymphocyte ratio (dNLR) in patients with coronary heart disease (CHD) after PCI.Methods: A total of 3,561 post-PCI patients with CHD were retrospectively enrolled in the CORFCHD-ZZ study from January 2013 to December 2017. The patients (3,462) were divided into three groups according to dNLR tertiles: the first tertile (dNLR &lt; 1.36; n = 1,139), second tertile (1.36 ≥ dNLR &lt; 1.96; n = 1,166), and third tertile(dNLR ≥ 1.96; n = 1,157). The mean follow-up time was 37.59 ± 22.24 months. The primary endpoint was defined as mortality (including all-cause death and cardiac death), and the secondary endpoint was major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs).Results: There were 2,644 patients with acute coronary syndrome (ACS) and 838 patients with chronic coronary syndrome (CCS) in the present study. In the total population, the all-cause mortality (ACM) and cardiac mortality (CM) incidence was significantly higher in the third tertile than in the first tertile [hazard risk (HR) = 1.8 (95% CI: 1.2–2.8), p = 0.006 and HR = 2.1 (95% CI: 1.23–3.8), p = 0.009, respectively]. Multivariate Cox regression analyses suggested that compared with the patients in the first tertile than those in the third tertile, the risk of ACM was increased 1.763 times (HR = 1.763, 95% CI: 1.133–2.743, p = 0.012), and the risk of CM was increased 1.763 times (HR = 1.961, 95% CI: 1.083–3.550, p = 0.026) in the higher dNLR group during the long-term follow-up. In both ACS patients and CCS patients, there were significant differences among the three groups in the incidence of ACM in univariate analysis. We also found that the incidence of CM was significantly different among the three groups in CCS patients in both univariate analysis (HR = 3.541, 95% CI: 1.154–10.863, p = 0.027) and multivariate analysis (HR = 3.136, 95% CI: 1.015–9.690, p = 0.047).Conclusion: The present study suggested that dNLR is an independent and novel predictor of mortality in CHD patients who underwent PCI.

P4745Concomitant oral anticoagulant and antidepressant therapy in patients with atrial fibrillation and risk of stroke and bleeding: a population based cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J J Komen ◽  
P Hjemdahl ◽  
A K Mantel - Teeuwisse ◽  
O H Klungel ◽  
B Wettermark ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Score ◽  
Oral Anticoagulant ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Anticoagulant Treatment ◽  
Oral Anticoagulant Treatment ◽  
Increased Risk ◽  
Antidepressant Use

Abstract Background Anticoagulation treatment reduces the risk of stroke but increases the risk of bleeding in atrial fibrillation (AF) patients. Antidepressants use is associated with increased risk for stroke and bleeds. Objective To assess the association between antidepressant use in AF patients with oral anticoagulants and bleeding and stroke risk. Methods All AF patients newly prescribed with an oral anticoagulant in the Stockholm Healthcare database (n=2.3 million inhabitants) from July 2011 until 2016 were included and followed for one year or shorter if they stopped claiming oral anticoagulant treatment or had an outcome of interest. Outcomes were severe bleeds and strokes, requiring acute hospital care. During follow-up, patients were considered exposed to antidepressant after claiming a prescription for the duration of the prescription. With a time-varying Cox regression, we assessed the association between antidepressant use and strokes and bleeds, adjusting for confounders (i.e., age, sex, comorbidities, comedication, and year of inclusion). In addition, we performed a propensity score matched analysis to test the robustness of our findings. Results Of the 30,595 patients included after claiming a prescription for a NOAC (n=13,506) or warfarin (n=17,089), 4 303 claimed a prescription for an antidepressant during follow-up. A total of 712 severe bleeds and 551 strokes were recorded in the cohort. Concomitant oral anticoagulant and antidepressant use was associated with increased rates of severe bleeds (4.7 vs 2.7 per 100 person-years) compared to oral anticoagulant treatment without antidepressant use (aHR 1.42, 95% CI: 1.12–1.80), but not significantly associated with increased stroke rates (3.5 vs 2.1 per 100 person-years, aHR 1.23, 95% CI: 0.93–1.62). No significant differences were observed between different oral anticoagulant classes (i.e., warfarin or NOAC) or different antidepressant classes (i.e., SSRI, TCA, or other antidepressant). Additional propensity-score matched analyses yielded similar results but showed a significantly increased risk for stroke (HR: 1.47, 95% CI: 1.08–2.02). Incidence rates of strokes and bleeds Conclusion Concomitant use of an oral anticoagulant and an antidepressant, irrespective of type, is associated with an increased bleeding risk. Increased awareness and a critical consideration for the need of an antidepressant is recommended in this population. Acknowledgement/Funding Swedish Heart Lung Foundation

scholarly journals Glycemic Control Status and Long-Term Clinical Outcomes in Diabetic Chronic Total Occlusion Patients: An Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Xuehui Zhang ◽  
Maoxiao Nie ◽  
Xue Chen ◽  
Zhe Liang ◽  
Quanming Zhao
Keyword(s):  
Glycemic Control ◽  
Propensity Score ◽  
Chronic Total Occlusion ◽  
Cox Regression ◽  
Glycosylated Hemoglobin ◽  
Major Adverse Cardiovascular Events ◽  
Good Glycemic Control ◽  
Total Occlusion ◽  
Clinical Prognosis ◽  
Repeat Revascularization

Background. Whether good glycemic control can result in clinical benefits for diabetic chronic total occlusion (CTO) patients is still a matter of debate. Methods. We studied 1029 diabetic CTO patients. Based on one-year glycosylated hemoglobin A (HbA1c) levels, we assigned the patients into 2 groups: HbA1c<7% group (n = 448) and HbA1c ≥ 7% group (n = 581). We further subdivided the patients into the successful CTO revascularization (CTO-SR) and nonsuccessful CTO revascularization (CTO-NSR) groups. Kaplan–Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiovascular events (MACE) and other endpoints. Results. There were no significant differences between the groups in terms of most endpoints in the overall patients. After propensity score-matched analysis, patients with HbA1c < 7.0 tended to be superior in terms of MACE, which was mainly attributed to repeat revascularization but the other endpoints. Furthermore, the benefit of the HbA1c < 7 group was more prominent among patients with CTO-NSR in terms of MACE, repeat revascularization, and target vessel revascularization (TVR); and the improvement of the HbAc1 < 7 group was more prominent among patients without chronic heart failure (CHF) ( P = 0.027 ). Conclusions. HbA1c < 7.0 was associated with a reduced incidence of MACE, which was mainly attributed to a reduction in repeat revascularization. Good glycemic control can improve diabetic CTO patients’ clinical prognosis, especially in CTO-NSR patients.

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

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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