scholarly journals Risk of malignancy long after acute coronary syndrome in selected urban and rural areas and comparison with smoking risk: the ABC-7* study on Heart Disease

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Giuseppe Berton ◽  
Heba T. Mahmoud ◽  
Rosa Palmieri ◽  
Fiorella Cavuto ◽  
Rocco Cordiano ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cancer Risk ◽  
Rural Areas ◽  
Positive Interaction ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Urban And Rural Areas ◽  
Adjusted Model

Abstract Background Increased cancer risk has been reported in patients with acute coronary syndrome (ACS). Objectives To investigate geographic differences in risk malignancy long after ACS. Methods We enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy in this prospective study. Patient’s residency was classified into three urban and three nearby rural areas. Results All (except for 3) patients completed the follow-up (22 years or death) and 54 % were living in rural areas. Sixteen patients had pre-existing malignancy, and 106 developed the disease during follow-up. Cancer prevalence was 17 % and 24 % (p = 0.05) and incidence of malignancy was 16 and 21/1000 person-years for urban and rural areas, respectively. In unadjusted logistic regression analysis, cancer risk increased from urban to rural areas (odds ratio [OR] 3.4;95 % confidence interval [CI] 1.7–7.1; p = 0.001), with little change from north to south provinces (OR 1.5;95 % CI 1.0-2.2; p = 0.06). Yet, we found a strong positive interaction between urban-rural areas and provinces (OR 2.1;95 % CI 1.2–3.5; p = 0.003). These results kept true in the fully adjusted model. Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR 3.0;95 % CI 1.5–6.2; p = 0.02), but not among provinces (HR 1.3;95 % CI 1.0–2.0; p = 0.14). Also, we found a strong positive interaction between geographic areas (HR 2.1;95 % CI 1.3–3.5; p = 0.002), even with a fully adjusted model. Conclusions The results in unselected real-world patients demonstrate a significant geographic difference in malignancy risk in ACS patients, with the highest risk in the north-rural area.

scholarly journals Risk of Malignancy Long After Acute Coronary Syndrome in Selected Urban and Rural Areas and Comparison With Smoking Risk: The ABC-7* Study on Heart Disease. (*ABC is An Acronym for Adria, Bassano, Conegliano, and Padova Hospitals)

2020 ◽  
Author(s):  
Giuseppe Berton ◽  
Heba Talat Mahmoud ◽  
Rosa Palmieri ◽  
Fiorella Cavuto ◽  
Rocco Cordiano ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cancer Risk ◽  
Rural Areas ◽  
Positive Interaction ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Urban And Rural Areas ◽  
Adjusted Model

Abstract Background Increased cancer risk has been reported in patients with acute coronary syndrome (ACS). Objectives To investigate geographic differences in risk malignancy long after ACS. Methods We enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy in this prospective study. Patient's residency was classified into three urban and three nearby rural areas. Results All (except for 3) patients completed the follow-up (22 years or death) and 54% were living in rural areas. Sixteen patients had pre-existing malignancy, and 106 developed the disease during follow-up. Cancer prevalence was 17% and 24% (p=0.05) and incidence of malignancy was 16 and 21/1000 person-years for urban and rural areas, respectively. In unadjusted logistic regression analysis, cancer risk increased from urban to rural areas (odds ratio [OR] 3.4;95% confidence interval [CI] 1.7-7.1; p=0.001), with little change from north to south provinces (OR 1.5;95% CI 1.0-2.2; p=0.06). Yet, we found a strong positive interaction between urban-rural areas and provinces (OR 2.1;95% CI 1.2-3.5; p=0.003). These results kept true in the fully adjusted model. Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR 3.0;95% CI 1.5-6.2; p=0.02), but not among provinces (HR 1.3;95% CI 1.0-2.0; p=0.14). Also, we found a strong positive interaction between geographic areas (HR 2.1;95% CI 1.3-3.5; p=0.002), even with a fully adjusted model. Conclusion The results in unselected real-world patients demonstrate a significant geographic difference in malignancy risk in ACS patients, with the highest risk in the north-rural area.

scholarly journals Predictive efficacy of neutrophil-to-lymphocyte ratio for long-term prognosis in new onset acute coronary syndrome: a retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi Yang ◽  
Yanan Xu ◽  
Jun Wang ◽  
Xueqin Zhai ◽  
Haibing Jiang
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Gensini Score ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
Coronary Lesions ◽  
New Onset

Abstract Background Inflammation is involved in the pathogenesis and progression of coronary artery diseases (CADs), including acute coronary syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been identified as a novel marker of the pro-inflammatory state. We aimed to evaluate the predictive efficacy of the NLR for the prognosis of patients with new-onset ACS. Methods We retrospectively included consecutive patients with new-onset ACS treated with emergency coronary angiography. NLR was measured at baseline and analyzed by tertiles. The severity of coronary lesions was evaluated by the Gensini score. Correlations of NLR with the severity of CAD and the incidence of major adverse cardiovascular diseases (MACEs) during follow-up were determined. Results Overall, 737 patients were included. The NLR was positively correlated with the severity of coronary lesions as assessed by Gensini score (P < 0.05). During the follow-up period (mean, 43.49 ± 23.97 months), 65 MACEs occurred. No significant association was detected between baseline NLR and the risk of MACEs during follow-up by either Kaplan–Meier or Cox regression analysis. Multivariable logistic regression analysis showed that a higher NLR was independently associated with coronary lesion severity as measured by the Gensini score (1st tertile vs. 3rd tertile hazard ratio [HR]: 0.527, P < 0.001, and 2nd tertile vs. 3rd tertile HR: 0.474, P = 0.025). Conclusions The NLR may be associated with coronary disease severity at baseline but is not associated with adverse outcomes in patients with new-onset ACS. Ethics Approval Number 2019XE0208

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

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.

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

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.

scholarly journals Differences in Cancer Death Risk Long After ACS Among Selected Urban and Rural Areas in North Italy: The ABC-7a† Study on Heart Disease

2021 ◽  
Vol 11 ◽  
Author(s):  
Heba T. Mahmoud ◽  
Giuseppe Berton ◽  
Rocco Cordiano ◽  
Rosa Palmieri ◽  
Tobia Nardi ◽  
...  
Keyword(s):  
Rural Areas ◽  
Cox Regression ◽  
Veneto Region ◽  
Cancer Death ◽  
Positive Interaction ◽  
Death Risk ◽  
Coronary Syndrome ◽  
Urban And Rural Areas ◽  
Risk Of Cancer

BackgroundAn increased risk of cancer death has been demonstrated for patients diagnosed with acute coronary syndrome (ACS). We are investigating possible geographic risk disparities.MethodsThis prospective study included 541 ACS patients who were admitted to hospitals and discharged alive in three provinces of Italy’s Veneto region. The patients were classified as residing in urban or rural areas in each province.ResultsWith 3 exceptions, all patients completed the 22-year follow-up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre-existing malignancy was noted in 15 patients, whereas 106 patients developed cancer during the follow-up period, which represented 6232 person-years. No difference in the cancer death risk was found between the urban and rural areas or between southern and northern provinces (hazard ratio [HR] 1.1; 95% confidence interval [CI] 0.7–1.7; p = 0.59 and HR 1.1; 95% CI 0.9–1.4; p = 0.29, respectively) according to the unadjusted Cox regression analysis. Geographic areas, however, showed a strong positive interaction, with risk increasing from the urban to rural areas from southern to northern provinces (HR 1.9; 95% CI 1.1–3.0; p = 0.01). The fully adjusted Cox regression and Fine-Gray competing risk regression models provided similar results. Interestingly, these results persisted, and even strengthened, after exclusion of the 22 patients who developed malignancy and survived to the end of follow-up. We did not observe an urban/rural difference in non-neoplastic death risk or a significant interaction between the geographic areas.ConclusionOur analysis reveals that the cancer death risk among unselected ACS patients in Italy’s Veneto region significantly differs by geography. The northern rural area has the highest risk. These results highlight the importance of implementing a preventive policy based on area-specific knowledge.

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

scholarly journals Admission Proinsulin Is Associated with Mortality in Patients with Admission Hyperglycemia during Acute Coronary Syndrome: Results from a Pilot Observational Study

2011 ◽  
Vol 57 (10) ◽  
pp. 1456-1460 ◽  
Author(s):  
Serdar Farhan ◽  
Rudolf Jarai ◽  
Ioannis Tentzeris ◽  
Matthias K Freynhofer ◽  
Ivan Brozovic ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Mortality Rate ◽  
Observational Study ◽  
Cox Regression ◽  
Multivariate Regression Analysis ◽  
Specific Patient ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
All Cause Mortality

BACKGROUND Acute hyperglycemia (AHG) is associated with mortality in patients with acute coronary syndrome (ACS). The extent to which hyperproinsulinemia contributes to worse clinical outcomes for this specific patient population is unknown. METHODS We included 308 consecutive ACS patients who underwent coronary angioplasty in this pilot observational study. Patients were separated into 3 groups: patients with proven diabetes mellitus (DM group) (n =55), nondiabetic patients with a normal glucose concentration at admission (NAG group) (n =175), and nondiabetic patients with AHG at presentation (AHG group) (n =78). Blood samples for glucose, insulin, and proinsulin measurements were obtained at admission. The primary end point of the study was all-cause mortality, which was assessed at a mean follow-up of 19 months (interquartile range, 12–28 months). RESULTS Patients in the AHG and DM groups had significantly (P =0.048) higher all-cause mortality compared with the NAG group. A univariate Cox regression analysis revealed that the proinsulin concentration was significantly associated with all-cause mortality for all study participants (hazard ratio, 1.013; 95% CI, 1.002–1.024; P =0.023). AHG patients with increased proinsulin concentrations showed a mortality rate similar to that of DM patients but had a significantly higher mortality rate than patients with AHG and a low proinsulin concentration (χ2 =7.57; P =0.006) and patients with NAG (with or without increased proinsulin) [χ2 =7.66 (P =0.006) and 13.98 (P &lt; 0.001), respectively]. A multivariate regression analysis revealed that the concentrations of glucose and proinsulin at admission were significant (P =0.002) predictors of all-cause mortality. CONCLUSIONS An increased proinsulin concentration may be a marker for mortality in ACS patients with hyperglycemia at admission and without known diabetes. Further studies are needed to evaluate the role of metabolic parameters such as proinsulin.

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

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.

Abstract P069: Prognostic Impact of the Omega-3 Index in Chest Pain Patients With a Suspected Acute Coronary Syndrome and Low Dietary Intake of Omega-3

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Ricardo A Leon de la Fuente ◽  
Patrycja A Naesgaard ◽  
Stein Tore Nilsen ◽  
Torbjoern Aarsland ◽  
Leik Woie ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Death ◽  
Smoking History ◽  
Dietary Habit ◽  
Prognostic Impact ◽  
Omega 3 ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Background: Epidemiological and interventional studies suggest that omega-3 (n-3) fatty acids derived from fish oil can reduce the occurrence of cardiovascular disease. Based on these observations, the omega-3 index [eicosapantaenoic acid (EPA) + docosahexaenoic acid (DHA) content in cell red blood membranes] has been suggested as a novel risk marker for cardiac death. Objective: To assess whether the omega-3 index can predict all-cause mortality, cardiac death and sudden cardiac death (SCD) following hospitalization with an acute coronary syndrome (ACS). Material and methods: The omega-3 index was measured in 572 consecutive patients admitted with chest pain and suspected ACS in an inland Northern Argentinean city with a dietary habit essentially based on red meat and a low intake of fish. The median age of the included patients was 63 years and 59 % were males. Clinical endpoints were collected during a 5-year follow-up period, median 3.64 years, range 1 day to 5.46 years. Stepwise Cox regression analysis was employed to compare the rate of new events in the quartiles of the omega-3 index measured at inclusion. In our multivariable analysis we corrected for age, sex, arterial hypertension, diabetes, smoking history, body mass index, previous coronary heart disease, high-sensitivity C-reactive protein, brain natriuretic peptide, Troponin-T release and use of statins and beta-blockers. Results: No statistical significant differences in baseline characteristics were noted between quartiles of the omega-3 index. The median omega 3-index was 2.8%, and ranging from 1.9% in the lowest to 3.8% in the highest quartile. During the follow-up period, 100 (17.5%) patients died. Event rates were similar in all quartiles of the omega-3 index, with no statistical significant differences. Conclusions: In a population with a low intake of fish and fish oils, the omega-3 index did not predict future fatal events in patients with acute chest pain and suspected ACS, suggesting that index levels less than 4% are too low to be protective.

scholarly journals Predictive role of platelet indices on hospital admission and discharge in the long-term prognosis of acute coronary syndrome: Platelets do count

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
G Psarakis ◽  
I Farmakis ◽  
S Zafeiropoulos ◽  
C Tsolakidis ◽  
O Konstantas ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cox Regression ◽  
Minor Bleeding ◽  
Cox Regression Analysis ◽  
Platelet Indices ◽  
Coronary Syndrome ◽  
Long Term Prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Previous clinical studies have underlined the prognostic role of platelet indices in acute coronary syndrome (ACS). However, the effect of their dynamic change during hospitalization has not thoroughly been examined. Purpose: We aimed to investigate the association between platelet indices on admission, on discharge and their change during hospitalization and the long-term prognosis of patients with ACS. Methods: Data from a randomized controlled trial recruiting ACS patients were analyzed in a survival analysis. Platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) on admission and on discharge dichotomized at the median value, as well as the change between admission and discharge of each variable dichotomized at the zero value. Primary endpoints were major adverse cardiac events (MACE), defined as occurrence of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for unstable angina, while secondary endpoints were all-cause mortality, all-cause hospitalization and major or minor bleeding events. Results: The study included 252 individuals who were followed-up for a median of 39 months. In the univariate Cox regression analysis, only PC at discharge (HR 2.20, 95% CI 1.10-4.40), MPV at discharge (HR 0.48, 95% CI 0.25-0.94) and PC reduction during the hospitalization (HR 0.25, 95% CI 0.13-0.51) predicted MACE. PC reduction correlated with a lower MACE occurrence (adjusted HR 0.27, 95%CI 0.14-0.54) and lower risk of all-cause hospitalization (adjusted HR 0.36, 95%CI 0.19-0.68) in the multivariable Cox-regression analysis. Conclusion: PC change during hospitalization can be a substantial independent predictor of long-term prognosis of ACS patients. Baseline and admission characteristics Characteristic Statistic Overall, N = 252 Negative Platelet Difference, N = 98 Postive Platelet Difference, N = 154 p-value Age, years median (IQR) 60 (53, 72) 62 (55, 74) 60 (53, 72) 0.2 Hypertension n(%) 147(58.3%) 58(59.2%) 89(57.8%) &gt;0.9 Diabetes n(%) 71(28.2%) 27(27.6%) 44(28.6%) &gt;0.9 Cardiovascualr Disease (CVD) n(%) 100(39.7%) 43(43.9%) 57(37.0%) 0.3 Primary Coronary Intervention (PCI) treatment n(%) 200(79.4%) 71(72.4%) 129(83.8%) 0.045 Number of vessels n 0.6 1 n(%) 107(59.1%) 38(59.4%) 69(59.0%) ≥2 n(%) 68(37.6%) 25(39.1%) 43(36.8%) Platelets at admission, K/μL mean(SD) 257179(71031) 237020(62555) 270006(73282) 0.001 Platelets at dischage, K/μL mean(SD) 250952(70263) 279153(75159) 233006(60698) &lt;0.001 Abstract Figure. MACE univariate / multivariate analysis

Sign in / Sign up

Export Citation Format

Share Document