scholarly journals Limitations of Cox Proportional Hazards Analysis in Mortality Prediction of Patients with Acute Coronary Syndrome

2015 ◽  
Vol 43 (1) ◽  
pp. 33-48 ◽  
Author(s):  
Magdalena Babińska ◽  
Jerzy Chudek ◽  
Elżbieta Chełmecka ◽  
Małgorzata Janik ◽  
Katarzyna Klimek ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Uric Acid ◽  
Coronary Artery ◽  
Cox Regression ◽  
Proportional Hazard ◽  
Proportional Hazard Assumption ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract The aim of this study was to evaluate the possibility of incorrect assessment of mortality risk factors in a group of patients affected by acute coronary syndrome, due to the lack of hazard proportionality in the Cox regression model. One hundred and fifty consecutive patients with acute coronary syndrome (ACS) and no age limit were enrolled. Univariable and multivariable Cox proportional hazard analyses were performed. The proportional hazard assumptions were verified using Schoenfeld residuals, χ2 test and rank correlation coefficient t between residuals and time. In the total group of 150 patients, 33 (22.0%) deaths from any cause were registered in the follow-up time period of 64 months. The non-survivors were significantly older and had increased prevalence of diabetes and erythrocyturia, longer history of coronary artery disease, higher concentrations of serum creatinine, cystatin C, uric acid, glucose, C-reactive protein (CRP), homocysteine and B-type natriuretic peptide (NT-proBNP), and lower concentrations of serum sodium. No significant differences in echocardiography parameters were observed between groups. The following factors were risk of death factors and fulfilled the proportional hazard assumption in the univariable model: smoking, occurrence of diabetes and anaemia, duration of coronary artery disease, and abnormal serum concentrations of uric acid, sodium, homocysteine, cystatin C and NT-proBNP, while in the multivariable model, the risk of death factors were: smoking and elevated concentrations of homocysteine and NT-proBNP. The study has demonstrated that violation of the proportional hazard assumption in the Cox regression model may lead to creating a false model that does not include only time-independent predictive factors.

scholarly journals Level of Knowledge About Coronary Artery Disease is Poor Among Bangladeshi Hospitalized Patient Following Acute Coronary Syndrome

2014 ◽  
Vol 14 (2) ◽  
pp. 119-122
Author(s):  
Md. Motlabur Rahman ◽  
M.A. Sattar Sarker ◽  
Tania Mahbub ◽  
Shahana Khanam ◽  
Nahida Zafrin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Disease ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Level Of Knowledge ◽  
Hospitalized Patient ◽  
Artery Disease

Back ground: Coronary artery disease (CAD) is a major risk of death worldwide. Level of education about this important health problem is poor in our general population. Aims of this study was to find out simple knowledge about coronary disease, and to find the knowledge about risk factors, symptoms, complications and knowledge about prevention of coronary disease among the hospitalized patient who admitted to SSMS and Mitford Hospital and diagnosed as patients of Acute Coronary Syndrome (ACS).Method: A pre tested questionnaire regarding assessment of level of knowledge about CAD was used to studied of the patients was admitted to SSMC and Mitford Hospital with the diagnosis of acute coronary syndrome during the period April 2009 to October 2009.Result: Our study suggests that there is a lack of awareness among a sampled Bangladeshi population regarding CAD and its modifiable risk factors. We found that the low level of knowledge in the majority of patients, the rural and less educated patients had a lower level of knowledge.Conclusion: Our cardiac patients have poor knowledge regarding their disease; improvement of knowledge is needed through much education to prevent CAD.DOI: http://dx.doi.org/10.3329/jom.v14i2.19639 J Medicine 2013, 14(2): 119-122

High Levels of Serum Uric Acid Predict Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Angiology ◽  
2011 ◽  
Vol 63 (6) ◽  
pp. 448-452 ◽  
Author(s):  
Mustafa Duran ◽  
Nihat Kalay ◽  
Mahmut Akpek ◽  
Ozcan Orscelik ◽  
Deniz Elcik ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Uric Acid ◽  
Coronary Artery ◽  
Serum Uric Acid ◽  
Coronary Syndrome ◽  
Artery Disease

Association between Serum Uric Acid and Mortality among Chinese Patients with Coronary Artery Disease

Cardiology ◽  
2016 ◽  
Vol 134 (3) ◽  
pp. 347-356 ◽  
Author(s):  
Qing Li ◽  
Yuan Zhang ◽  
Ding Ding ◽  
Yunou Yang ◽  
Qian Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Uric Acid ◽  
Coronary Artery ◽  
Serum Uric Acid ◽  
Cox Regression ◽  
Chinese Patients ◽  
Risk Of Death ◽  
Increased Risk ◽  
Artery Disease ◽  
Cvd Mortality

Objectives: Several studies have investigated the association between serum uric acid (SUA) and the risks of coronary artery disease (CAD) but have yielded inconsistent results. The aim of this study was to assess whether there is an independent association of SUA with all-cause and cardiovascular disease (CVD) mortality in Chinese patients with CAD. Methods: A prospective cohort study of 1,799 patients was conducted. Cox regression models were used to estimate the association of SUA with the risk of death. Results: During a median follow-up of 3.9 years, 177 deaths were recorded and 126 of these were due to CVD. Patients in the highest SUA quartile had a 2.43-fold risk of all-cause mortality and a 2.44-fold risk of CVD mortality compared with those in the lowest quartile. In the subpopulation analysis, the association between SUA and mortality remained similar when participants were stratified by age, gender, body mass index and type of CAD. In contrast, we found a significant interaction with estimated glomerular filtration rate (eGFR). There was a stronger association between SUA and the risk of all-cause and CVD mortality among patients with an eGFR ≥60 ml/min/1.73 m2, but no significant association was found in the population with an eGFR <60 ml/min/1.73 m2. Conclusions: Elevated SUA levels were positively associated with an increased risk of all-cause and CVD mortality among CAD patients.

Study on Vitamin D deficiency in patients of diabetes mellitus presenting with Acute Coronary syndrome in a tertiary care hospital in South India

2020 ◽  
Vol 11 (5) ◽  
pp. 49-53
Author(s):  
Archana Bhat ◽  
Arunachalam Ramachandran ◽  
Pradeep Periera ◽  
Akshatha Rao Aroor
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Vitamin D ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Vitamin D Deficiency ◽  
Coronary Syndrome ◽  
Vitamin D Levels ◽  
Luminal Stenosis ◽  
Artery Disease

Background: Vitamin D, a fat-soluble vitamin has its receptor present in myriad of tissues and it modulates multiple cellular processes. Vitamin D deficiency is reported to be associated with coronary artery disease. Cardiovascular disease is the leading cause of mortality worldwide. Aims and Objective: The primary outcome was to investigate if there is a correlation of 25-OH levels with the percentage of luminal stenosis, as measured with coronary angiogram. The secondary outcome was to determine the differences in angiographically proven luminal stenosis across categories of 25-OH vitamin D levels. Materials and Methods: Thirty patients with acute coronary syndrome with diabetes mellitus were included in this cross-sectional descriptive study. All patients were tested for fasting vitamin D levels, fasting blood sugar, HbA1C and serum creatinine. Detailed history of the patients was recorded. Data was analyzed by the statistical software SPSS version 19 and p value <0.05 was considered significant. Statistical tests like Chi- square, independent t test and log regression was used. Results: In this study 30 patients undergoing coronary angiography for acute coronary syndrome, Vitamin D levels showed severe deficiency in 6.7% (2) cases while mild deficiency was seen in 50% of the cases. Patients with single vessel disease on the coronary angiogram had lower mean HbA1C (9.18) levels in our study. Patients with triple vessel disease had poorly controlled mean HbA1C levels (10.42). Conclusion: In this study we did not find any significant difference between the serum Vitamin D deficiency levels with patients with angiographic severity of the coronary artery disease. Patients with poorly controlled diabetes mellitus had more severe angiographic proven coronary artery disease.

scholarly journals Severe Coronary Artery Disease in a Person Living with HIV

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 595
Author(s):  
Mircea Bajdechi ◽  
Cosmin Mihai ◽  
Alexandru Scafa-Udriste ◽  
Ali Cherry ◽  
Diana Zamfir ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Severe Coronary Artery Disease ◽  
Atypical Symptoms ◽  
Coronary Syndrome ◽  
Severe Coronary Artery ◽  
Artery Disease ◽  
Living With Hiv ◽  
Missed Diagnoses

The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.

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