Long-term outcomes of endovascular aneurysm repair for challenging aortic necks using the Talent endograft

The aim of the present paper is to evaluate the long-term outcomes of endovascular aneurysm repair (EVAR) for challenging aortic necks. Subgroup analyses were performed on 156 patients from the prospective multicenter Talent eLPS (enhanced Low Profile Stent Graft System) trial. Patients with high-risk aortic necks (length < 15 mm or diameter ≥28 mm) were compared with the remaining patients. Patients with high-risk ( n = 86) and low-risk necks ( n = 70) had similar age and gender distribution. Despite similar prevalences of co-morbidities, the high-risk group had higher Society for Vascular Surgery scores. The high-risk group also had larger maximum aneurysm diameters (56.6 versus 53.0 mm, P < 0.02). There were lower freedoms from major adverse events (MAEs) for the high-risk group at 30 days (84.9 versus 95.7%; P < 0.04) and 365 days (73.4 versus 89.2%; P = 0.02). Effectiveness endpoints at 12 m showed no significant differences. Freedom from all-cause mortality at 30 days (96.5 versus 100%) and aneurysm-related mortality at 365 days (96.0 versus 100%) were similar. At five years, there were no differences in endoleaks or change in aneurysm diameter. All migrations occurred in the high-risk group. The five-year freedom from aneurysm-related mortality for the high- and low-risk groups was 93.2 and 100%, respectively. In conclusion, despite a higher rate of MAEs within the first year and higher migration rates at five years, EVAR in aneurysms with challenging aortic necks can be treated with acceptable long-term results.

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Abstract TP387: Abcd 2 Score Predicts The Long-term Risk Of Stroke After Transient Ischemic Attack: Fukuoka Stroke Registry

Stroke ◽

10.1161/str.44.suppl_1.atp387 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Yasuhiro Kumai ◽

Takuya Kiyohara ◽

Masahiro Kamouchi ◽

Sohei Yoshimura ◽

Hiroshi Sugimori ◽

...

Keyword(s):

High Risk ◽

Transient Ischemic Attack ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Rank Test ◽

Moderate Risk ◽

Stroke Registry ◽

Ischemic Attack

Background and Purpose— ABCD 2 score has been developed to predict the early risk of stroke after transient ischemic attack (TIA). The aim of this study was to clarify whether ABCD 2 score predicts the occurrence of stroke in the long term after TIA. Methods— Fukuoka Stroke Registry (FSR) is a multicenter epidemiological study database on acute stoke. From June 2007 to June 2011, 496 (305 males, 70 ± 13 years of age) patients who had suffered from TIA and were hospitalized in the 7 stroke centers within 7 days after the onset of TIA were enrolled in this study. The patients were divided into three groups according to the risk: low-risk (ABCD 2 score 0-3; n=72), moderate-risk (4-5; n=229) and high-risk group (6-7; n=195). They were followed up prospectively for up to 3 years. Cox proportional hazard regression model was used to elucidate whether ABCD 2 score was a predictor for stroke after TIA after adjusting for confounding factors. Results— Among three groups, there were significant differences in age, hypertension, diabetes mellitus and the decrease in estimated glomerular filtration rate (P<0.01, significantly). During a mean follow-up of 1.3 years, Kaplan-Meier analysis demonstrated that the stroke rate in TIA patients was significantly lower in low-risk group than in moderate-risk or high-risk group (log rank test, p<0.001). The adjusted hazard ratios for stroke in patients with TIA increased with moderate-risk group (Hazard ratio [HR]: 3.47, 95% CI: 1.03-21.66, P<0.05) and high-risk group (HR: 4.46, 95% CI: 1.31-27.85, P<0.05), compared to low-risk group. Conclusions— The ABCD 2 score is able to predict the long-term risk of stroke after TIA.

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Effectiveness of different combinations of DMARDs and glucocorticoid bridging in early rheumatoid arthritis: two-year results of CareRA

Rheumatology ◽

10.1093/rheumatology/kez213 ◽

2019 ◽

Vol 58 (12) ◽

pp. 2284-2294 ◽

Cited By ~ 5

Author(s):

Veerle Stouten ◽

René Westhovens ◽

Sofia Pazmino ◽

Diederik De Cock ◽

Kristien Van der Elst ◽

...

Keyword(s):

High Risk ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Avant Garde ◽

Early Ra ◽

Risk Patients ◽

Step Down ◽

N 93

AbstractObjectivesTo investigate whether MTX should be combined with an additional DMARD and bridging glucocorticoids as initial treatment for patients with early RA to induce an effective long-term response.MethodsThe Care in early RA study is a two-year investigator-initiated pragmatic multicentre randomized trial. Early RA patients, naïve to DMARDs and glucocorticoids, were stratified based on prognostic factors. High-risk patients were randomized to COBRA-Classic (n = 98): MTX, sulfasalazine, prednisone step-down from 60 mg; COBRA-Slim (n = 98): MTX, prednisone step-down from 30 mg; or COBRA-Avant-Garde (n = 93): MTX, leflunomide, prednisone step-down from 30 mg. Low-risk patients were randomized to COBRA-Slim (n = 43); or Tight Step Up (TSU) (n = 47): MTX without prednisone. Clinical/radiological outcomes at year 2, sustainability of response, safety and treatment adaptations were assessed.ResultsIn the high-risk group 71/98 (72%) patients achieved a DAS28-CRP < 2.6 with COBRA-Slim compared with 64/98 (65%) with COBRA-Classic and 69/93 (74%) with COBRA-Avant-Garde (P = 1.00). Other clinical/radiological outcomes and sustainability of response were similar. COBRA-Slim treatment resulted in less therapy-related adverse events compared with COBRA-Classic (P = 0.02) or COBRA-Avant-Garde (P = 0.005). In the low-risk group, 29/43 (67%) patients on COBRA-Slim and 34/47 (72%) on TSU achieved a DAS28-CRP < 2.6 (P = 1.00). On COBRA-Slim, low-risk patients had lower longitudinal DAS28-CRP scores over 2 years, a lower need for glucocorticoid injections and a comparable safety profile compared with TSU.ConclusionAll regimens combining DMARDs with glucocorticoids were effective for patients with early RA up to 2 years. The COBRA-Slim regimen, MTX monotherapy with glucocorticoid bridging, provided the best balance between efficacy and safety, irrespective of patients’ prognosis.Trial registrationClinicalTrials.gov, http://www.clinicaltrials.gov, NCT01172639.

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Prognosis Evaluation of Universal Acute Coronary Syndrome: The Interplay between SYNTAX Score and ApoB/ApoA1

10.21203/rs.2.16518/v4 ◽

2020 ◽

Author(s):

Xiaotong Wang ◽

Zhongyu Wang ◽

Bing Li ◽

Ping Yang

Keyword(s):

High Risk ◽

Risk Group ◽

Independent Predictor ◽

High Risk Group ◽

Low Risk ◽

Syntax Score ◽

Coronary Syndrome ◽

Medium Risk ◽

Prognosis Evaluation

Abstract Background：Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. Syntax and Syntax II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNTAX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method：396 patients with ACS undergoing percutaneous coronary intervention（PCI）and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during the next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results：①Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium/high risk group（p=0.011）. Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group（p=0.032）.② Compared with SYNTAX II low-risk group，cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group（p=0.001，p＜0.001 respectively）. ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group（p=0.019, p=0.023 respectively）. ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group（p=0.023，p=0.044 respectively）. ⑤Logistic regression analysis showed that apoB/apoA1 was an independent predictor of MACCE events in hospital and 5 years（p=0.038，p=0.016 respectively），SYNTAX score was an independent predictor of MACCE events in 1 year（medium-risk group：p=0.02；high-risk group：p=0.015）SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs(p=0.003). Conclusions：①SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.

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Prognosis Evaluation of Universal Acute Coronary Syndrome: The Interplay between SYNTAX Score and ApoB/ApoA1

10.21203/rs.2.16518/v3 ◽

2020 ◽

Author(s):

Xiaotong Wang ◽

Zhongyu Wang ◽

Bing Li(New Corresponding Author) ◽

Ping Yang(Former Corresponding Author)

Keyword(s):

High Risk ◽

Risk Group ◽

Independent Predictor ◽

High Risk Group ◽

Low Risk ◽

Syntax Score ◽

Coronary Syndrome ◽

Medium Risk ◽

Prognosis Evaluation

Abstract Background：Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. Syntax and Syntax II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNTAX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method：396 patients with ACS undergoing percutaneous coronary intervention（PCI）and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results：①Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium-high risk group（p=0.011）. Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group（p=0.032）.② Compared with SYNTAX II low-risk group，cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group（p=0.001，p＜0.001 respectively）. ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group（p=0.001）. ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group（p=0.023，p=0.044 respectively）. ⑤Logistic regression analysis showed that apoB/apoA1 was an independent predictor of MACCE events in hospital and 5 years（p=0.038，p=0.016 respectively），SYNTAX score was an independent predictor of MACCE events in 1 year（medium-risk group：p=0.02；high-risk group：p=0.015）SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs(p=0.003). Conclusions：①SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.

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Objective Assessment of Pulmonary Embolism Can Be Deferred without Increased Risk.

Blood ◽

10.1182/blood.v106.11.1628.1628 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1628-1628

Author(s):

Sergio Siragusa ◽

Alessandra Malato ◽

Antonino Giarratano ◽

Francesco Falaschi ◽

Fernando Porro ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Diagnostic Imaging ◽

Median Time ◽

Diagnostic Tests ◽

Risk Group ◽

High Risk Group ◽

Low Risk

Abstract Background. Management of patients with suspected Pulmonary Embolism (PE) is problematic if diagnostic imaging is not available. Pretest Clinical Probability (PCP) and D-dimer (D-d) assessment were shown to be useful to identify those high risk patients for whom empirical, protective anticoagulation is indicated (Siragusa S et al. Arch Intern Med2004;164:2477–82). Objective of the study. In consecutive patients with suspected PE, we evaluated whether PCP and D-d assessment, together with the use of low molecular weight heparins (LMWHs), allow objective appraisal of PE to be deferred for up to 72 hours. Methods. In case of deferment of diagnostic imaging for PE, patients identified at high-risk (those with high PCP and those with moderate PCP and a positive D-d), received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulants. All patients were scheduled to undergo objective tests for PE (ventilation/perfusion lung scanning or computed tomography lung scan) within 72 hours from the index visit (figure). Standard antithrombotic therapy was then administered when diagnostic tests confirmed Venous ThromboEmbolism (VTE). Results. 336 patients with suspected PE were included in this study. The prevalence of VTE was 6.1% (95% CI 2.7–9.3) in the “low-risk group” and 50.4% (95% CI 41.7–59.1) in the “high-risk group”. In total, VTE was confirmed in 76 (22.6%) of 336 patients (95% CI 18.2–27). Patients’ characteristics, median time for deferral test and for LMWH administration are listed in table 1. Events at the short-term (72 hours) and long-term follow-up are listed in table 2. None of the patients had major bleeding events during the follow-ups. Conclusions. When objective diagnostic assessment of PE is not immediately available, management of symptomatic PE patients can prove highly unsatisfactory. This study demonstrates that a simple and reproducible approach allows a safe deferral of diagnostic imaging for PE for up to 72 hours. patients’ characteristics Baseline features Low risk group (n. 211) High-risk group (n. 125) p value n.s.: not significant Age in years (range) 59.3 (22–91) 60.3 (23–91) n.s. Sex (F/M) 98/113 59/66 n.s. Time since onset of symptoms (days) 1.7 1.5 n.s. Co-morbidity and 16 (7.5) 25 (19.2) 0.03 Median time of deferral test (hours) 49.5 42.5 n.s. Median time of protective anticoagulation (hours) not applicable 35.5 not applicable Outcome of Short- and Long-term FU Categories of patients (n) Events at the short-term FU Events at the long -term FU* FU indicates follow-up; CI indicates Confidence Intervals. *This refers to patients in whom Pulmonary Embolism has been previously ruled out (n. 260). “Low-risk group” (211) 0 (0%) [95% CI 1.4] 0 (0%) [95% CI 1.4] “High-risk group” (125) 1 (0.8%) [95% CI 2.3] 3 (2.4%) [95% CI 3.2] Patients clinically suspected of PE without immediate availability of diagnostic tests Patients clinically suspected of PE without immediate availability of diagnostic tests

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Refined Hepatic Grading System Improves Risk Stratification of Long-Term Outcomes in the Patients Developing Chronic Gvhd

Blood ◽

10.1182/blood.v128.22.2235.2235 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2235-2235

Author(s):

Saud Alhayli ◽

Elizabeth Shin ◽

Wilson Lam ◽

Uday Deotare ◽

Fotios V. Michelis ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

Liver Enzyme ◽

Bilirubin Level ◽

Risk Group ◽

High Risk Group ◽

Grading System ◽

Long Term Outcomes ◽

Grading Systems

Abstract Background: Chronic GVHD (cGVHD) is a syndrome with diverse clinical features resembling autoimmune disorders. cGVHD affects long-term outcomes of allogeneic HCT, resulting in significant morbidity and mortality. Scoring the severity of cGVHD has been proposed with recent changes in the grading system of cGVHD based on the NIH consensus criteria (NCC) in 2015. Grading of liver GVHD is based on the severity of liver enzyme elevation both in NCC in 2005 and 2015. The cutoff of liver enzyme profiles for liver GVHD grading is arbitrarily determined but never been validated. In this study we attempted to evaluate 3 grading systems of hepatic parameters used in 1) NCC 2005, 2) NCC 2015, and 3) the common terminology criteria for adverse events (CTCAE) version 4.0. We also have adopted binary recursive partitioning (rpart) to define the optimal cut-off that provides the best risk stratification to overall survival (OS) after development of cGVHD. Methods: A retrospective review was conducted to compare the hepatic grading systems using liver enzyme parameters used in NCC 2005, NCC2015 and CTCAE v4.0. We reviewed 336 patients who developed cGVHD after allogeneic HCT performed between 2002 and 2014. Long-term outcomes including OS and non-relapse mortality (NRM) after the occurrence of cGVHD were analyzed using the 3 hepatic grading systems. Using rpart, we determined the optimal value for each component of the liver enzyme profile (i.e. AST, ALT, ALP and bilirubin level) was which could identify the best risk stratification of OS. A refined hepatic grading system was generated based on the cut off of ALP and bilirubin level proposed by rpart method, which divided the patients into three groups: low (bilirubin <14 mmol/L and ALP < 146 IU/L), intermediate (bilirubin level ≥14 mmol/L or ALP ≥ 146 IU/L) and high risk (both) . OS and NRM were also compared according to the refined hepatic grading system. Results: Out of 336 patients, 181 had liver involvement of cGVHD. The 3 year OS rate was 74.9% (66.7-81.3%) in the group developing liver GVHD, while that was 67.0% (57.7-74.7%) in the group without liver GVHD (p=0.629). There is no difference of non-relapse mortality (NRM) between patients with or without liver GVHD (14.4% vs. 17.2%; p= 0.661). In the patients developing liver GVHD, 3 hepatic grading systems were evaluated with respect to OS and NRM after onset of cGVHD. None of the 3 grading systems could stratify the patients statistically according to OS (p=0.211 for NCC 2005; p=0.423 for NCC 2015; p=0.461 for CTCAE4.0) or to NRM (p=0.615 for NCC 2005; p=0.327 for NCC 2015; p=0.941 for CTCAE v4.0). Using rpart, we found that 1) bilirubin level ≥14 mmol/L (p=0.01) and 2) ALP ≥ 146 IU/L (p=0.059) are associated with shorter OS, 2) AST and ALT levels were not associated with OS or NRM. A refined hepatic grading system was generated with assignment of a score to each risk factor. A score of 1 was assigned to bilirubin ≥14 mmol/L and ALP ≥ 146 IU/L, each. Total score was calculated with risk score 0 (n=54, 30.0%), risk score 1 (n=85, 57.2%) and risk score 2 (n=41, 22.8%). This hepatic grading system could stratify the patients according to their OS (p=0.015): 89.6% in low vs. 71.8% in intermediate vs. 58.0% in high risk group after onset of cGVHD. Then, we have applied the refined hepatic grading system into all 336 patients developing cGVHD regardless of organ involvement. As expected, the hepatic grading system can stratify 336 patients according to OS: 79.6% in low vs. 65.4% in intermediate vs. 53.9% in high risk group after onset of cGVHD (p=0.001); according to NRM: 11.9% in low vs. 17.2% in intermediate vs. 26.1% in high risk group after onset of cGVHD (p=0.089). Multivariate analysis was performed including 9 covariates including refined hepatic grading system, liver involvement of cGVHD, cGVHD subtype, cGVHD onset < 5 months, age (by decade), platelet counts, HLA match, gender mismatch, and T cell depletion, and confirmed that the refined hepatic grading system is an independent prognostic factor for OS (p=0.003, HR 0.491) in addition to cGVHD onset <5 months and HLA match. Conclusions: None of hepatic grading systems could stratify the patients according to OS/NRM after development of cGVHD. The refined hepatic grading system using bilirubin ≥14 mmol/L and ALP ≥ 146 IU/L at onset of cGVHD defined by the rpart method, could improve risk stratification of the patients developing cGVHD. Disclosures No relevant conflicts of interest to declare.

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Long-term outcomes of intensity-modulated radiation therapy combined with neoadjuvant hormonal therapy for Japanese patients with non-metastatic prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.49 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 49-49

Author(s):

Rihito Aizawa ◽

Kenji Takayama ◽

Kiyonao Nakamura ◽

Takahiro Inoue ◽

Takashi Kobayashi ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Metastatic Prostate Cancer ◽

Risk Group ◽

Intensity Modulated Radiation Therapy ◽

Japanese Patients ◽

High Risk Group ◽

Long Term Outcomes ◽

Very High

49 Background: This study aimed to evaluate long-term outcomes of intensity-modulated radiation therapy (IMRT) combined with neoadjuvant (NA) hormonal therapy (HT) in Japanese patients with non-metastatic prostate cancer (NMPC). Methods: We retrospectively analyzed the data of 485 patients with T1-T4N0M0 adenocarcinoma of the prostate treated with IMRT combined with NA-HT. Of these patients, 32, 113, 250, and 90 patients were categorized into the low-, intermediate-, high-, and very high-risk groups, respectively, according to the NCCN risk classification. NA-HT was administered over a median duration of 6 months. In principle, 74 or 78 Gy in 2 Gy per-fraction were delivered to the prostate and seminal vesicles according to the risk. We did not administer adjuvant HT (A-HT) for any patient following the completion of IMRT. Salvage HT (S-HT) commenced when prostate-specific antigen (PSA) values exceeded 4 ng/mL. Results: The median follow-up period was 103.4 months, and the median PSA value at the initiation of S-HT was 5.1 ng/mL. In the low-risk group, the 8-year biochemical relapse-free survival, prostate cancer-specific survival, overall survival, and S-HT-free (SHTF) rates were 89.7%, 100.0%, 100.0%, and 96.7%, respectively. Those were 83.7%, 100.0%, 96.0%, and 94.3% for the intermediate-risk group, 64.5%, 97.8%, 87.0%, and 79.4% for the high-risk group, and 47.7%, 96.6%, 89.7%, and 53.3% for the very high-risk group, respectively. The estimated 8-year cumulative incidence rates of late gastrointestinal and genitourinary (grades 2–3) toxicity were 7.2% and 21.8%, respectively. We observed no grade 4 or higher toxicity. Conclusions: High-dose IMRT, combined with NA-HT and without A-HT under the early S-HT policy, achieved excellent survival outcomes with acceptable morbidities for a Japanese cohort with NMPC. Moreover, especially for high, and very high-risk patients, this approach could be a viable alternative to the uniform provision of long-term A-HT because more than the half of the patients maintained SHTF status over a period of 8-year after IMRT. Prospective trials are warranted to validate the findings of this study.

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Prognosis Evaluation of Universal Coronary Heart Disease: The Interplay between SYNTAX Score and ApoB/ApoA1

10.21203/rs.2.16518/v1 ◽

2019 ◽

Author(s):

Xiaotong Wang ◽

Zhongyu Wang ◽

Bing Li ◽

Ping Yang

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

High Risk ◽

Risk Group ◽

Independent Predictor ◽

High Risk Group ◽

Low Risk ◽

Syntax Score ◽

Medium Risk

Abstract Object：To assess the prognosis value of different kinds of SYNTAX score together with apoB/apoA1 in universal coronary heart disease (Regardless of coronary lesion). Method：396 patients undergoing percutaneous coronary intervention（PCI）and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular events (MACE) and quality of life during the next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACE incidence were analyzed. Results：①Compared with SYNTAX low-risk group, MACE incidence in 1 year significantly increased in medium-high risk group（p=0.011）. Compared with SYNTAX II low-risk group, MACE incidence in 5 years significantly increased in medium and high-risk group（p=0.032）.② Compared with SYNTAX II low-risk group，cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group（p=0.001，p＜0.001 respectively）. ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group（p=0.001）. ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group（p=0.023，p=0.044 respectively）. ⑤Logistic regression analysis showed that apoB/apoA1 was an independent predictor of MACE events in hospital and 5 years（p=0.032，p=0.016 respectively），SYNTAX score was an independent predictor of MACE events in 1 year（medium-risk group：p=0.02；high-risk group：p=0.015）SYNTAX II score was an independent predictor of MACE events in 5 yeasrs(p=0.003). Conclusions：①SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.

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Prognosis Evaluation of Universal Acute Coronary Syndrome: The Interplay between SYNTAX Score and ApoB/ApoA1

10.21203/rs.2.16518/v2 ◽

2020 ◽

Author(s):

Xiaotong Wang ◽

Zhongyu Wang ◽

Bing Li ◽

Ping Yang

Keyword(s):

High Risk ◽

Risk Group ◽

Independent Predictor ◽

High Risk Group ◽

Low Risk ◽

Syntax Score ◽

Coronary Syndrome ◽

Medium Risk ◽

Prognosis Evaluation

Abstract Background：Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. Syntax and Syntax II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNTAX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method：396 patients undergoing percutaneous coronary intervention（PCI）and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during the next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results：①Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium-high risk group（p=0.011）. Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group（p=0.032）.② Compared with SYNTAX II low-risk group，cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group（p=0.001，p＜0.001 respectively）. ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group（p=0.001）. ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group（p=0.023，p=0.044 respectively）. ⑤Logistic regression analysis showed that apoB/apoA1 was an independent predictor of MACCE events in hospital and 5 years（p=0.038，p=0.016 respectively），SYNTAX score was an independent predictor of MACCE events in 1 year（medium-risk group：p=0.02；high-risk group：p=0.015）SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs(p=0.003). Conclusions：①SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.

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Early and Long-Term Outcomes of Endovascular Aortic Repair in Young and Low Surgical Risk Patients in the Global Registry for Endovascular Aortic Treatment

Journal of Endovascular Therapy ◽

10.1177/15266028211045703 ◽

2021 ◽

pp. 152660282110457

Author(s):

Michele Piazza ◽

Francesco Squizzato ◽

Velipekka Suominen ◽

Franco Grego ◽

Santi Trimarchi ◽

...

Keyword(s):

High Risk ◽

Young Patients ◽

Low Risk ◽

Long Term Outcomes ◽

Surgical Risk ◽

High Risk Patients ◽

Risk Patients ◽

Global Registry ◽

Related Mortality

Purpose: To investigate early- and long-term outcomes of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) in young and low surgical risk patients. Methods: The global registry for endovascular aortic treatment (GREAT) was queried for all patients with AAA undergoing standard EVAR; patients were excluded if had previous AAA repair or underwent concomitant procedures. Young patients were defined if age <60; surgical risk was assessed through the validated Medicare perioperative risk score (MPRS) based on age, sex, renal function, heart failure, and peripheral vascular disease. Patients were classified as low (MPRS<3), average (MPRS 3–11), or high (MPRS>11) risk. Young versus older patients and low-risk versus average/high-risk patients were compared. The primary endpoints were early (30 days) major adverse events (MAEs), 5-year freedom from overall mortality, aortic-related mortality, and freedom from device-related reinterventions. Time-to-event endpoints were calculated by Kaplan–Meier curves. Results: Of 3217 included patients, 182 (6%) were <60 years old, 956 (30%) had a low surgical risk, 1561 (49%) an average risk, 700 (22%) a high risk. Young patients had a less angulated proximal neck (27.2±18.4° vs 30.9±21.5°; p=0.05); in low-risk compared to average/high-risk patients, a longer neck length (3±1.8 vs 2.8±1.4 cm; p=0.01) and lower neck angulation (29.7±21.8° vs 33.2±22.2°; p=0.01) were present. Young age alone had no significant impact on early mortality (0% vs 0.6%; p=0.62.) and MAEs (3.9% vs 6.1%; p=0.20), while these were significantly lower in low-risk compared to average/high-risk patients (early mortality: 0.1% vs 0.7%, p=0.04; MAEs: 4.1% vs 6.7%, p=0.005). At 5 years, overall survival was significantly higher in young (88% vs 76%; p<0.001) and lower-risk (77% vs 54%; p<0.001) patients; low-risk patients also had significantly decreased aortic-related mortality (0% vs 2%; p=0.04) and reintervention rates (6% vs 11%; p=0.007). There were no statistically significant differences in mortality (0% vs 2%; p=0.42) and reintervention rate (10% vs 10%; p=1.00) between young and older patients. Conclusion: In this real-world registry, EVAR was more often offered in cases with suitable anatomy in young and low-risk patients. Low operative risk, rather than young age alone, predicted excellent early outcomes and low 5-year mortality, aortic-related mortality, and reintervention rates.

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