scholarly journals Growth differentiation factor 15 and the risk of cardiovascular events in patients with atrial fibrillation after elective percutaneous coronary intervention

2021 ◽  
Vol 26 (7) ◽  
pp. 4457
Author(s):  
E. N. Krivosheeva ◽  
E. S. Kropacheva ◽  
A. B. Dobrovolsky ◽  
E. V. Titaeva ◽  
E. P. Panchenko
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Growth Differentiation Factor 15 ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
D Dimer

Aim. To study the predictive value of growth differentiation factor 15 (GDF-15) in patients with atrial fibrillation (AF) after elective percutaneous coronary intervention (PCI).Material and methods. The study included 150 patients (men, 69,3%) with AF receiving direct oral anticoagulants in combination with two (89,3%) or one antiplatelet agent (10,7%) after elective PCI. Median age was 71,0 [interquartile range, 66,0; 77,0] years. The median follow-up was 11,5 months [interquartile range, 8,0; 12,0]. The efficacy endpoint was the sum of cardiovascular events (CVEs), including cardiovascular death, ischemic stroke, venous thromboembolism, peripheral arterial thrombosis, acute coronary syndrome, and the need for emergency PCI. The safety endpoint was considered to be BARC type 2-5 bleeding. Prior to PCI, blood plasma samples were taken from patients to determine GDF-15 and D-dimer by enzyme immunoassay.Results. The incidence of CVEs was 16%. The incidence of BARC type 2-5 bleeding was 24,7%. The median GDF-15 level was 1270,0 pg/ml [953,0; 1778,0]. According to multiple regression, the GDF-15 level is associated with D-dimer (t=3,20; p=0,0018), diabetes (t=3,97; p=0,0001) and SYNTAX score II (t=4,77; p<0,0001). In patients with single-vessel coronary artery disease, the GDF-15 level was significantly lower than in patients with three-vessel disease (p=0,0119). According to the ROC analysis, a GDF-15 >1191 pg/ml (p=0,0076) increases the likelihood of CVE (area under the curve, 0,647; confidence interval (CI), 0,5650,723). According to Kaplan-Meier survival curves, significant differences were found in terms of absence of CVEs during the follow-up period between the groups of patients with a GDF-15 >1191 and those with GDF-15 <1191 pg/ml (76% vs 94%, p=0,0032; relative risk, 4,36; CI 1,50-7,48). The relationship of GDF-15 level with BARC type 2-5 bleeding was not revealed.Conclusion. GDF-15 is a novel marker of CVE in AF patients after elective PCI.

scholarly journals LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 IN CARDIOVASCULAR RISK STRATIFICATION AFTER CORONARY ANGIOPLASTY IN PATIENTS WITH TYPE 2 DIABETES: WHICH DECISION RULE THRESHOLD TO CHOOSE?

2015 ◽  
Vol 14 (2) ◽  
pp. 47-54 ◽  
Author(s):  
A. T. Teplyakov ◽  
A. V. Kuznetsova ◽  
N. V. Protopopova ◽  
A. V. Andriyanova ◽  
T. E. Suslova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Blood Serum ◽  
Cardiovascular Events ◽  
Posterior Probability ◽  
Coronary Intervention ◽  
Separation Point ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary

The research objective is to determine the posterior probability of adverse cardiovascular events after elective coronary intervention in patients with ischemic heart disease (IHD) associated with type 2 diabetes, at high level of lipoprotein-associated phospholipase A2 (Lp-PLA2) in blood serum, as well as to find out the optimal separation point value for this predictor, which increase allows to identify high risk with accuracy.Material and methods. The 12-month cohort observational study included 60 patients (78% of men and 22% of women) with IHD associated with type 2 diabetes, aged 48–78. At the beginning of the study, along with conventional diagnostic techniques typical of a specialized cardiology clinic, the state of carbohydrate and lipid metabolism was analyzed and the proinflammatory status was evaluated (including assessment of Lp-PLA2 concentration by ELISA). At the end of the study distant results of treatment were assessed. The following events were taken into account: death of cardiovascular events, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization (surgical, endovascular) due to restricture formation of a primary implanted stent or stricture formation of native coronary arteries, angina pectoris relapses.Results and discussion. The link between adverse cardiovascular events after elective percutaneous coronary intervention in patients with IHD type 2 diabetes-associated and high concentration of Lp-PLA2 in blood serum has been identified. Variation of the decision rule threshold on the performance curve has allowed to take Lp-PLA2 concentration of 983 ng/ml as a separation point. Accuracy of twoclass classification (determination of the posterior probability of adverse cardiovascular events) after identifying such separation point was characterized by 80% sensitivity and 100% specificity.Conclusion. The increase in the Lp-PLA2 concentration in blood serum (>983 ng/ml) may be considered as a predictor of adverse cardiovascular events after elective percutaneous coronary intervention in patients with IHD associated with type 2 diabetes.

scholarly journals Prognostic Value of D-dimer in patients with acute coronary syndrome treated by percutaneous coronary intervention: a retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Runzhen Chen ◽  
Chen Liu ◽  
Peng Zhou ◽  
Yu Tan ◽  
Zhaoxue Sheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Prognostic Value ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Risk Of Death ◽  
Clinical Risk ◽  
Percutaneous Coronary ◽  
D Dimer

Abstract Background Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death. Results During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %). Conclusions For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.

scholarly journals Prognostic impact of the atherogenic index of plasma in type 2 diabetes mellitus patients with acute coronary syndrome undergoing percutaneous coronary intervention

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaoteng Ma ◽  
Yan Sun ◽  
Yujing Cheng ◽  
Hua Shen ◽  
Fei Gao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Atherogenic Index ◽  
Atherogenic Index Of Plasma ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background The association of the atherogenic index of plasma (AIP), an emerging lipid index that can predict the risk for cardiovascular disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has not been determined. Therefore, the aim of this study was to investigate whether the AIP could independently predict adverse cardiovascular events in T2DM patients with ACS undergoing PCI. Methods This study was a retrospective analysis of a single-centre prospective registry involving 826 consecutive T2DM patients who underwent primary or elective PCI for ACS from June 2016 to November 2017. This study ultimately included 798 patients (age, 61 ± 10 years; male, 72.7%). The AIP was calculated as the base 10 logarithm of the ratio of the plasma concentration of triglycerides to high-density lipoprotein-cholesterol (HDL-C). All the patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of death from any cause, non-fatal spontaneous myocardial infarction (MI), non-fatal ischaemic stroke, and unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal MI, and non-fatal ischaemic stroke. Results During a median follow-up period of 927 days, 198 patients developed at least one event. An unadjusted Kaplan-Meier analysis showed that the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test, P = 0.001). A multivariate Cox proportional hazards analysis revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.249, 95% confidence interval [CI]: 1.438 to 3.517, P < 0.001; and HR: 2.571, 95% CI: 1.027 to 6.440, P = 0.044, respectively). Conclusions A higher AIP value on admission was independently and strongly associated with adverse cardiovascular events in T2DM patients with ACS undergoing PCI.

scholarly journals Primary Percutaneous Coronary Intervention in Patients With Type 2 Diabetes With Late/Very Late Stent Thrombosis and de novo Lesions: A Single-Center Observational Cohort Study of Clinical Outcomes and Influencing Factors

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoxiao Zhao ◽  
Jun Lan ◽  
Xiaoping Yu ◽  
Jinying Zhou ◽  
Yu Tan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Coronary Intervention ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Percutaneous Coronary ◽  
Unit Increase ◽  
D Dimer

Background: This study compared differences in the risk factors and clinical outcomes of primary percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNLs) and late or very late stent thrombosis (LST/VLST).Methods: We used angiography to screen 4,151 patients with acute coronary syndrome for DNL and LST/VLST lesions. Overall, 3,941 patients were included in the analysis and were allocated to the DM (n = 1,286) or non-DM (n = 2,665) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke, within a median follow-up period of 698 days.Results: In the group with a total white blood cell count &gt;10 × 109/L (P = 0.004), a neutral granular cell count &gt;7 × 109/L (P = 0.030), and neutrophil–lymphocyte ratio &gt;1.5 (P = 0.041), revascularization was better for DNL than for LST/VLST lesions. Among DM patients with DNLs, each unit increase in age was associated with a 53.6% increase in the risk of MACEs [hazard ratio (HR): 1.536, 95% confidence interval (CI), 1.300–1.815, P &lt; 0.0001]. Older age (≥65 years) was associated with a significantly greater risk of MACEs (P &lt; 0.0001). Furthermore, each standard deviation (SD) increase in the level of peak white blood cell counts was associated with a 50.1% increase in the risk of MACEs (HR, 1.501; 95% CI, 1.208–1.864; P = 0.0002). When stratifying the DM population with DNLs according to the D-dimer baseline and peak levels &lt;0.5 vs. ≥0.5 mg/L, the high D-dimer group at baseline had a 2.066-fold higher risk of MACEs (P &lt; 0.0001), and the high peak level D-dimer group had a 1.877-fold higher risk of MACEs (P = 0.001) compared to the low-level groups. Among DM patients with LST/VLST, each unit increase in age was associated with a 75.9% increase in the risk of MACEs (HR: 1.759, 95% CI, 1.052–2.940, P = 0.032). Furthermore, for each SD increase in the peak D-dimer level, the risk of MACEs increased by 59.7% (HR, 1.597; 95% CI, 1.110–2.295; P = 0.041).Conclusion: Following successful primary PCI, the measurement of baseline and peak D-dimer values may help identify individuals at high cardiovascular risk. This suggests a potential benefit of lowering D-dimer levels among T2DM patients with DNL. Furthermore, age and the peak D-dimer values may facilitate the risk stratification of T2DM patients with LST/VLST.

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