scholarly journals Midregional Proadrenomedullin for Prediction of Cardiovascular Events in Coronary Artery Disease: Results from the AtheroGene Study

2012 ◽  
Vol 58 (1) ◽  
pp. 226-236 ◽  
Author(s):  
Philipp S Wild ◽  
Renate B Schnabel ◽  
Edith Lubos ◽  
Tanja Zeller ◽  
Christoph R Sinning ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Prognostic Impact ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Symptomatic Coronary Artery Disease ◽  
Artery Disease

Abstract BACKGROUND Midregional proadrenomedullin (MR-proADM) is a newly identified prognostic marker in heart failure. We evaluated the prognostic impact of MR-proADM in a cohort of patients with symptomatic coronary artery disease according to their clinical presentation. METHODS We measured baseline MR-proADM concentrations in 2240 individuals from the prospective AtheroGene study and evaluated the prognostic impact on future fatal and nonfatal cardiovascular events during a follow-up period of 3.6 (1.6) years. RESULTS The sample comprised 1355 individuals with stable angina pectoris (SAP) and 885 with acute coronary syndrome (ACS). A cardiovascular event occurred in 192 people. Individuals presenting with SAP had only slightly lower plasma MR-proADM concentrations than those with ACS (0.53 vs 0.55 nmol/L, P = 0.006). MR-proADM showed a moderate association with age, serum N-terminal pro–B-type natriuretic peptide (NT-proBNP), glomerular filtration rate, serum C-reactive protein, hypertension, diabetes, and prevalent multivessel disease (all P < 0.0005). Individuals suffering from a cardiovascular event had higher MR-proADM concentrations at baseline in both groups (SAP 0.63 vs 0.53 nmol/L and ACS 0.65 nmol/L vs 0.55 nmol/L, both P < 0.0005). Cox regression analysis incorporating various variables of cardiovascular risk and NT-proBNP revealed a hazard ratio of 1.4 (95% CI 1.2–1.6; P < 0.0005) per increment of MR-proADM by 1SD. In risk models for secondary prevention, MR-proADM provided information comparable to that of NT-proBNP. CONCLUSIONS MR-proADM is an independent predictor for future cardiovascular events in patients with symptomatic coronary artery disease, providing information comparable to NT-proBNP for secondary risk stratification.

scholarly journals Prognostic value of soluble suppression of tumorigenesis-2 (sST2) for cardiovascular events in coronary artery disease patients with and without diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Value ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cox Regression ◽  
Coronary Syndrome ◽  
End Point ◽  
Artery Disease

Abstract Background Soluble suppression of tumorigenesis-2 (sST2) is implicated in myocardial overload and has long been recognized as an inflammatory marker related to heart failure and acute coronary syndrome, but data on the prognostic value of sST2 in patients with coronary artery disease (CAD) remain limited. This study sought to investigate the prognostic value of sST2 in patients with established CAD and its predictive value in CAD patients with and without type 2 diabetes mellitus (T2DM). Methods A total of 3641 consecutive patients were included in this prospective cohort study. The primary end point was major adverse cardiovascular events (MACEs). The secondary end point was all-cause death. The association between sST2 and outcomes was investigated using multivariable Cox regression. Results During a median follow-up of 6.4 years, MACEs occurred in 775 patients, and 275 patients died. Multiple Cox regression models showed that a higher level of sST2 was an independent predictor of MACEs development (HR = 1.36, 95% CI 1.17–1.56, p < 0.001) and all-cause death (HR = 2.01, 95% CI 1.56–2.59, p < 0.001). The addition of sST2 to established risk factors significantly improved risk prediction of the composite outcome of MACEs and all-cause death (C-index, net reclassification index, and integrated discrimination improvement, all p < 0.05). In subgroup analysis depending on diabetes status, the diabetes group had a significantly higher level of sST2, which remained a significant predictor of MACEs and all-cause death in patients with and without T2DM in multivariable models. The area under the curve (AUC) of CAD patients with diabetes mellitus was significantly higher than that of those without T2DM. For MACEs, the AUC was 0.737 (patients with T2DM) vs 0.620 (patients without T2DM). For all-cause death, the AUC was 0.923 (patients with T2DM) vs 0.789 (patients without T2DM). Conclusions A higher level of sST2 is significantly associated with long-term MACEs and all-cause death in CAD patients with and without T2DM. sST2 has strong predictive value for cardiovascular adverse events in CAD patients with T2DM, and these results provide new evidence for the role of sST2.

Abstract 13973: Circulating Eicosapentaenoic Acid to Oleic Acid Ratio and Risk for Cardiovascular Events in Patients With Coronary Artery Disease; Sub-analysis of SHINANO Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hirofumi Hioki ◽  
Takashi Miura ◽  
Yusuke Miyashita ◽  
Souichirou Ebisawa ◽  
Hirohiko Motoki ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Oleic Acid ◽  
Fatty Acid ◽  
Coronary Artery ◽  
Eicosapentaenoic Acid ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Pufa Ratio ◽  
Coronary Syndrome ◽  
Artery Disease

Background: Until now, Omega-3/Omega-6 polyunsaturated fatty acid (PUFA) ratio, particularly in ratio of eicosapentaenoic acid (EPA) to arachnidonic acid (AA), has been reported to associate with the incidence of cardiovascular events. However, the clinical impact of monounsaturated fatty acid (MUFA) on cardiovascular events has not been well understood. Objective: In this study, we evaluate whether ratio of MUFA to PUFA, especially EPA/Oleic acid (OA), could predict clinical outcome in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). Methods: SHINANO registry was prospective, observational, multicenter cohort study, enrolling 1,923 consecutive patients with CAD. From this registry, we identified 182 patients who measured fatty acid on admission. We stratified according to median of EPA/OA ratio. The primary endpoint was net adverse clinical events (NACE) including cardiac death, nonfatal myocardial infarction, ischemic stroke, PCI for ACS, heart failure, and major bleeding (Bleeding Academic Research Consortium II-IV) for 1-years. Results: Mean age was 72±10 years, 24% female, and 27% was acute coronary syndrome. One-years follow-up was completed in 181 patients (99.5%). Cumulative incidence of NACE was 22 cases. In Kaplan-Meier analysis, incidence of NACE was significantly higher in patients with EPA/OA of 0.03 to 0.12 compared to 0.13 to 0.54 (16.6% vs. 6.6%, Log-rank p=0.025). After adjusting for the calculated propensity score for EPA/OA ≥ 0.13 or not, EPA/OA ≥ 0.13 was remained an independent predictor of NACE (hazard ratio, 0.36; 95% confidence interval [CI], 0.14-0.96; p-value 0.042). The ROC curve of EPA/OA for NACE demonstrated that the area under the ROC curve (ACU) was 0.73 (95% CI; 0.61-0.85). Conclusions: This study firstly demonstrated that the patients with high EPA/OA ratio would have low incidence of NACE in patients with CAD who underwent PCI.

scholarly journals Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

2020 ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Artery Disease

Abstract Background: Suppression of tumorigenesis-2 is implicated in the myocardial overload and it was long been recognized as an inflammation marker related to heart failure and acute coronary syndromes, but the data on prognostic value of suppression of tumorigenesis-2 on patients with coronary artery disease remains limited. The study ought to investigate the prognostic value of suppression of tumorigenesis-2 in patients with established coronary artery disease.Methods: In this prospective cohort study, a total of 3641 consecutive patients were included. The primary end point was major adverse cardiovascular events. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). The secondary end point was all-cause death. The association between suppression of tumorigenesis-2 and outcomes was investigated using multivariable COX regression.Results: During a median follow up of 6.4 years, there were 775 patients had the occurrence of major adverse cardiovascular events and 275 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). Multiple COX regression models showed that higher level of suppression of tumorigenesis-2 was an independent predictor in developing major adverse cardiovascular events (HR=1.36, 95% CI 1.17-1.56, p＜0.001) and all-cause death (HR=2.01, 95%CI 1.56-2.59, p＜0.001). The addition of suppression of tumorigenesis-2 to established risk factors significantly improved risk prediction of the composite outcome of major adverse cardiovascular events and all-cause death (c-statistic, net reclassification index, and integrated discrimination improvement, all p＜0.05).Conclusions: Higher level of suppression of tumorigenesis-2 is significantly associated with long-term all-cause death and major adverse cardiovascular events. Suppression of tumorigenesis-2 may provide incremental prognostic value beyond traditional risk factors.

scholarly journals Colchicine as an Adjuvant Therapy for Coronary Artery Disease: A Systematic Review

2020 ◽  
Author(s):  
Nobian Andre ◽  
Patricia Renata ◽  
Muhamad Hafiz Mahruzza ◽  
Rony Marethianto Santoso
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Infarct Size ◽  
Cardiovascular Events ◽  
Cochrane Library ◽  
Loading Dose ◽  
Coronary Syndrome ◽  
Daily Dose ◽  
Artery Disease ◽  
Stable Cad

Background:Inflammation plays a significant role in atherosclerosis at all phases. Colchicine is a pleiotropic anti-inflammatory agent that may be beneficial in various stages of coronary artery disease (CAD). Methods:We searched for literatures in PubMed, Cochrane Library, ScienceDirect, and Proquest regarding the use of colchicine on top of current optimal medical therapy for CAD. Results: Twelve studies were identified: three studies in stable CAD patients and the remaining nine assessed in acute coronary syndrome (ACS) and post-ACS patients. The majority of studies used a colchicine dose of 0.5 mg/day. Adjuvant colchicine of 0.5 mg daily reduced the risk of developing ACS, cardiac arrest, or ischemic stroke in stable CAD: HR (hazard risk) 0.33 (95% CI 0.18-0.59), p<0.001. Patients admitted with ACS who received a 2 mg loading dose of colchicine pre-percutaneous coronary intervention (PCI) showed smaller infarct size than control: 18.3 (IQR 7.6-29.9) ml/1.73 m2vs 23.2 (18.5-33.4) ml/1.73 m2(p=0.019).In post-ACS patients, adjuvant colchicine of 0.5 mg daily significantly reduced the rate of ischemic cardiovascular events: HR 0.77 (95% CI 0.61-0.96), p=0.02. Conclusion: Stable CAD patients benefit from 0.5 mg daily dose of adjuvant colchicine to reduce the incidence of future cardiovascular events. For patients presenting with ACS, a loading dose of 2 mg of colchicine pre-PCI followed by a week of 0.5 mg colchicine twice daily on top of optimal medical care can reduce infarct size. This should be followed by consumption of 0.5 mg daily dose of adjuvant colchicine post-ACS for at least 20 months to prevent future reinfarctions.

scholarly journals Prognostic value of suppression of tumorigenesis-2 (ST2) for cardiovascular events in coronary artery disease patients with and without diabetes mellitus

2020 ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cox Regression ◽  
End Point ◽  
Increased Risk ◽  
Artery Disease

Abstract Background: Suppression of tumorigenesis-2 (ST2) is implicated in myocardial overload and has long been recognized as an inflammation marker related to heart failure and acute coronary syndromes, but data on the prognostic value of ST2 in patients with coronary artery disease (CAD) remain limited. This study sought to investigate the prognostic value of ST2 in patients with established coronary artery disease and its predictive value in CAD patients with or without type 2 diabetes mellitus (T2DM).Methods: A total of 3641 consecutive patients were included in this prospective cohort study. The primary end point was major adverse cardiovascular events (MACEs). The secondary end point was all-cause death. The association between ST2 and outcomes was investigated using multivariable Cox regression.Results: During a median follow-up of 6.4 years, 775 patients had the occurrence of MACEs and 275 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p<0.001). Multiple Cox regression models showed that higher level of ST2 was an independent predictor for MACEs developments (HR=1.36, 95% CI 1.17-1.56, p<0.001) and all-cause death (HR=2.01, 95% CI 1.56-2.59, p<0.001). The addition of ST2 to established risk factors significantly improved risk prediction of the composite outcome of MACEs and all-cause death (C-statistic, net reclassification index, and integrated discrimination improvement, all p<0.05). Subgroup analyses showed that ST2 remained a significant predictor of MACEs and all-cause death in patients with and without T2DM in multivariable models.Conclusions: A higher level of ST2 is significantly associated with long-term MACEs and all-cause death in CAD patients with and without T2DM. ST2 may provide incremental prognostic value beyond traditional risk factors.

scholarly journals High-Serum Angiopoietin-Like Protein 3 Levels Associated with Cardiovascular Outcome in Patients with Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming-Chun Chen ◽  
Bang-Gee Hsu ◽  
Chung-Jen Lee ◽  
Ji-Hung Wang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cox Regression ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
Artery Disease

Background. Angiopoietin-like protein 3 (ANGPTL3) plays a pivotal role in lipid metabolism and angiogenesis, and there is growing interest regarding the association between ANGPTL3 and coronary artery disease (CAD). This study aims to investigate whether ANGPTL3 levels can be used to predict the future occurrence of major adverse cardiovascular events (MACEs) in patients with CAD. Methods. Overall, 90 patients with CAD were enrolled between January and December 2012. The study’s primary endpoint was incidence of MACEs. Patient follow-up was completed on June 30, 2017. Results. Following a median follow-up period of 54 months, 33 MACEs had occurred. Patients reporting MACEs had lower statin use (P=0.022) and higher serum C-reactive protein (P<0.001) and serum ANGPTL3 (P<0.001) levels than those without MACEs. Kaplan–Meier analysis revealed higher cumulative incidence of CV events in the high ANGPTL3 group (median ANGPTL3 level ≥ 222.37 ng/mL) than in the low ANGPTL3 group (log-rank P=0.046). Multivariable Cox regression analysis demonstrated that ANGPTL3 levels were independently associated with MACEs in patients with CAD (hazard ratio: 1.003; 95% confidence interval: 1.000–1.005; P=0.026) after adjusted for age, gender, and body mass index, classical risk factors, and potential confounders. Conclusions. Serum ANGPTL3 levels could serve as a biomarker for future occurrence of MACEs in patients with CAD.

Benefits and Harm of Treatment with P2Y12 Inhibitors beyond 12 Months in Patients with Coronary Artery Disease

2019 ◽  
Vol 46 (04) ◽  
pp. 446-456
Author(s):  
Mads Lamm Larsen ◽  
Erik Lerkevang Grove ◽  
Steen Dalby Kristensen ◽  
Anne-Mette Hvas
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
Major Cardiovascular Events ◽  
Significant Difference ◽  
Artery Disease ◽  
Stable Cad

AbstractThe trade-off between the benefits and harm of long-term (> 12 months) treatment with P2Y12 inhibitors in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains controversial. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed and Embase were searched without time restrictions to identify randomized controlled trials comparing > 12-month P2Y12 inhibition versus ≤ 12-month treatment in patients with acute coronary syndrome (ACS) or stable CAD undergoing PCI. A qualitative assessment was performed using the assessment tool from the National Heart, Lung, and Blood Institute of the National Institutes of Health. We performed a meta-analysis of the following endpoints: primary outcome (primarily major cardiovascular events), all-cause death, and major bleeding. Eight trials, comprising 40,218 patients, were included. Five studies were rated “good,” two studies “fair,” and one study “poor.” The meta-analysis showed that > 12-month P2Y12 inhibition significantly reduced the primary outcomes compared with ≤ 12-month treatment (hazard ratio [HR]: 0.85; 95% confidence interval (CI): 0.75–0.97; p = 0.01). No significant difference was demonstrated between groups in all-cause death (HR: 1.02; 95% CI: 0.76–1.36; p = 0.91) or major bleedings (HR: 1.26; 95% CI: 0.93–1.70; p = 0.14). I 2 test showed low to moderate heterogeneity among the included studies (21.6–62.3%). This systematic review and meta-analysis therefore demonstrates a reduction in major cardiovascular events during extended P2Y12-inhibitor treatment beyond 12 months compared with ≤ 12 months in patients with ACS or stable CAD undergoing PCI. There was no significant difference in all-cause death or major bleedings.

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