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

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.

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

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.

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

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.

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

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.

scholarly journals Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 5-12 ◽  
Author(s):  
Dominique N van Dongen ◽  
Rudolf T Tolsma ◽  
Marion J Fokkert ◽  
Erik A Badings ◽  
Aize van der Sluis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

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

Stroke ◽  
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.

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

Vascular ◽  
2011 ◽  
Vol 19 (3) ◽  
pp. 132-140 ◽  
Author(s):  
Jeffrey Jim ◽  
Brian G Rubin ◽  
Patrick J Geraghty ◽  
Luis A Sanchez
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Endovascular Aneurysm Repair ◽  
High Risk Group ◽  
Low Risk ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Aneurysm Repair ◽  
Related Mortality

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.

scholarly journals A genetic risk score predicts recurrent events after myocardial infarction in young patients with a low level of traditional risk factors

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Mendonca ◽  
M I Mendonca ◽  
M Temtem ◽  
M Santos ◽  
J A Sousa ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Genetic Risk ◽  
Risk Group ◽  
Low Risk ◽  
Low Level ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Traditional Risk Factors

Abstract Introduction Coronary Heart Disease (CAD) is a multifactorial disease, including environmental and genetic risk factors. Current smoking, dyslipidemia and diabetes have a significant impact in long- term mortality and morbidity. However, several genetic variants associated with CAD but not with traditional risk factors (TRFs) has been reported to improve prediction of events and extended mortality, in younger CAD people. Aim To evaluate the clinical utility of a GRS composed by variants from GWAS associated to CAD but not with TRF to predict life-long residual risk in patients under 55 years old and a low level of TRFs. Methods We conducted a prospective study with 573 consecutive patients aged &lt;55 years presenting with AMI and a low level of TRFs (without diabetes and with LDL cholesterol &gt;150 mg/ml). We analysed several biochemical markers and performed a GRS with variants not associated with TRFs (TCF21 rs12190287, CDKN2B-AS1 rs1333049, CDKN2B rs4977574, PHACTR1 rs1332844, MIA3 rs17465637, ADAMTS7 rs3825807, ZC3HC1 rs11556924, SMAD3 rs17228212 and GJA4 rs618675). We studied the GRS association with a primary composite endpoint of all-cause vascular morbidity and mortality including recurrent acute coronary syndrome (myocardial infarct and unstable angina), coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), re-hospitalization for heart failure, ischemic stroke and cardiovascular dead. Results A total of 573 patients were studied and followed up for a mean of 4.7±4.0 years. There were 169 recurrent cardiovascular events. The GRS was sub-divided into terciles, verifying that patients in the third tercile (high risk) had a higher number of risk alleles. Compared with the low-risk GRS tercile, the multivariate-adjusted HR for recurrences was 1.520 (95% CI 1.011–2.286); p=0.044 for the intermediate-risk group and was 2.051 (95% CI 1.382–3.044); p&lt;0.0001 for the high-risk group. Inclusion of the GRS in the model with TRFs alone (low risk) improved the C-statistic analysis (C-statistic = 0.030; p=0.004), cNRI (continuous net reclassification improvement) (30.8%), and the IDI (integrated discrimination improvement index) (0.022). Conclusions A multilocus GRS may identify young coronary disease patients with a low level of TRFs but at significant risk of long-term events recurrence. The genetic information may improve prediction discrimination, and reclassification over the conventional risk factors alone, providing better cost-effective therapeutic strategies. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

2017 ◽  
Vol 27 (1) ◽  
pp. 81-91 ◽  
Author(s):  
Anand Veeravagu ◽  
Amy Li ◽  
Christian Swinney ◽  
Lu Tian ◽  
Adrienne Moraff ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Stratification ◽  
Spine Surgery ◽  
Assessment Tool ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Acs Nsqip ◽  
Medium Risk

OBJECTIVEThe ability to assess the risk of adverse events based on known patient factors and comorbidities would provide more effective preoperative risk stratification. Present risk assessment in spine surgery is limited. An adverse event prediction tool was developed to predict the risk of complications after spine surgery and tested on a prospective patient cohort.METHODSThe spinal Risk Assessment Tool (RAT), a novel instrument for the assessment of risk for patients undergoing spine surgery that was developed based on an administrative claims database, was prospectively applied to 246 patients undergoing 257 spinal procedures over a 3-month period. Prospectively collected data were used to compare the RAT to the Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. Study end point was occurrence and type of complication after spine surgery.RESULTSThe authors identified 69 patients (73 procedures) who experienced a complication over the prospective study period. Cardiac complications were most common (10.2%). Receiver operating characteristic (ROC) curves were calculated to compare complication outcomes using the different assessment tools. Area under the curve (AUC) analysis showed comparable predictive accuracy between the RAT and the ACS NSQIP calculator (0.670 [95% CI 0.60–0.74] in RAT, 0.669 [95% CI 0.60–0.74] in NSQIP). The CCI was not accurate in predicting complication occurrence (0.55 [95% CI 0.48–0.62]). The RAT produced mean probabilities of 34.6% for patients who had a complication and 24% for patients who did not (p = 0.0003). The generated predicted values were stratified into low, medium, and high rates. For the RAT, the predicted complication rate was 10.1% in the low-risk group (observed rate 12.8%), 21.9% in the medium-risk group (observed 31.8%), and 49.7% in the high-risk group (observed 41.2%). The ACS NSQIP calculator consistently produced complication predictions that underestimated complication occurrence: 3.4% in the low-risk group (observed 12.6%), 5.9% in the medium-risk group (observed 34.5%), and 12.5% in the high-risk group (observed 38.8%). The RAT was more accurate than the ACS NSQIP calculator (p = 0.0018).CONCLUSIONSWhile the RAT and ACS NSQIP calculator were both able to identify patients more likely to experience complications following spine surgery, both have substantial room for improvement. Risk stratification is feasible in spine surgery procedures; currently used measures have low accuracy.

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

Rheumatology ◽  
2019 ◽  
Vol 58 (12) ◽  
pp. 2284-2294 ◽  
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.

Impact of Stratification of Comorbidities on Nutrition Indices and Survival in Patients on Continuous Ambulatory Peritoneal Dialysis

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 153-157 ◽  
Author(s):  
Narayan Prasad ◽  
Amit Gupta ◽  
Archana Sinha ◽  
Anurag Singh ◽  
Raj Kumar Sharma ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Comorbid Illness ◽  
Medium Risk ◽  
Risk Patients

Background Case-mix comorbidities and malnutrition influence outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. In the present study, we analyzed the influence of stratified comorbidities on nutrition indices and survival in CAPD patients. Patients and Methods We categorized 373 CAPD patients (197 with and 176 without diabetes) into three risk groups: low—age under 70 years and no comorbid illness; medium—age 70 – 80 years, or any age with 1 comorbid illness, or age under 70 years with diabetes; high—age over 80 years, or any age with 2 comorbid illnesses. We then compared nutrition indices and malnutrition by subjective global assessment (SGA) between the three groups. Survival was compared using Kaplan–Meier survival analysis. Results Mean daily calorie and protein intakes in the low-risk group (21 ± 6.7 Kcal/kg, 0.85 ± 0.28 g/kg) were significantly higher than in the medium- (17.6 ± 5.2 Kcal/kg, 0.79 ± 0.25 g/kg) and high-risk (17.5 ± 6.1 Kcal/kg, 0.78 ± 0.26 g/kg) groups ( p = 0.001 and p = 0.04 respectively). Relative risk (RR) of malnutrition was less in the low-risk group (103/147, 70.06%) than in the medium-risk group [135/162, 83.3%; RR: 2.0; 95% confidence interval (CI): 2.1 to 3.4; p = 0.01] or the high-risk group (54/64, 84.4%; RR: 2.3; 95% CI: 2.1 to 4.9; p = 0.03). Mean survivals of patients in the low-, medium-, and high-risk groups were 51 patient–months (95% CI: 45.6 to 56.4 patient–months), 43.3 patient–months (95% CI: 37.8 to 48.7 patient–months), and 29.7 patient–months (95% CI: 23 to 36.4 patient–months) respectively (log-rank: 35.9 patient–months; p = 0.001). The 1-, 2-, 3-, 4-, and 5-year patient survivals in the low-, medium-, and high-risk groups were 96%, 87%, 79%, 65%, and 56%; 89%, 67%, 54%, 43%, and 34%; and 76%, 48%, 31%, 30%, and 30% respectively. Conclusions Intake of calories and protein was significantly lower in the medium-risk and high-risk groups than in the low-risk group. Survival was significantly better in low-risk patients than in medium- and high-risk patients.

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