scholarly journals Cumulative Triglyceride-glucose Index Is a Risk for CVD: A Prospective Cohort Study

2021 ◽  
Author(s):  
Haozhe Cui ◽  
Qian Liu ◽  
Yuntao Wu ◽  
Liying Cao
Keyword(s):  
Cox Regression ◽  
Reference Group ◽  
Final Analysis ◽  
Sensitivity Analyses ◽  
Tyg Index ◽  
Cox Proportional Hazard ◽  
Long Term Effect ◽  
Triglyceride Glucose Index ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Abstract Background Previous studies has shown a significant relationship between baseline triglyceride-glucose (TyG) index and cardiovascular disease (CVD). However, the long-term effect of TyG index and incident CVD remains uncertain. This study aimed to investigate the association between cumulative TyG index and the risk of CVD.Method In this study, we recruited individuals participating in Kailuan Study from 2006 to 2013 without stroke, myocardial infarction, and cancer in the four consecutive examinations. Cumulative TyG index was calculated by multiplying the average TyG index and the time between the two consecutive examinations. Cumulative TyG index levels were categorized into four quartile groups: Q1 group, ≤50.65 (as reference group), Q2 group, 50.65-53.86, Q3 group, 53.86-57.44, Q4 group, ＞57.44. The effect of Cumulative TyG index on CVD incidence was estimated by multivariable-adjusted Cox proportional hazard models.Result A total of 44,087 individuals participated in the final analysis. After a mean follow-up of 6.52±1.14 years, incident CVD, MI and stroke occurred in 2057, 395 and 1695, respectively. The multivariable-adjusted COX regression model showed the HR (95% CI) of CVD were Q2 1.25(1.08-1.44), Q3 1.22(1.05-1.40) and Q4 1.39(1.21-1.61), compared to Q1 group. Consistent results were obtained in the subgroup analyses and sensitivity analyses.Conclusion Cumulative TyG index was associated with increased risk of CVD. Maintaining a healthy level of TyG index within the desirable range and better control of cumulative TyG index is important for prevention of CVD.

scholarly journals Role of RET genetic variants in MEN2-associated pheochromocytoma

2014 ◽  
Vol 170 (6) ◽  
pp. 821-828 ◽  
Author(s):  
Débora Rodrigues Siqueira ◽  
Lucieli Ceolin ◽  
Carla Vaz Ferreira ◽  
Mírian Romitti ◽  
Silvana Cavalcante Maia ◽  
...  
Keyword(s):  
Cox Regression ◽  
Cox Regression Analysis ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Age Related ◽  
Increased Risk ◽  
Tertiary Teaching ◽  
Cox Proportional Hazard Models ◽  
Tertiary Teaching Hospital ◽  
Estimated Risk

Background: RET polymorphisms have been involved in the clinical presentation and prognosis of multiple endocrine neoplasia type 2 (MEN2)-associated medullary thyroid carcinoma.ObjectiveTo investigate the effect of RET variants on the penetrance of pheochromocytoma (PHEO) in MEN2 patients. Methods: The RET variants L769L, S836S, and G691S/S904S were evaluated in a cohort of 153 MEN2 patients attending a tertiary teaching hospital. A comparison of RET variant frequencies between patients with and without PHEO was performed. Kaplan–Meier curves and Cox regression analysis were used to estimate the effect of RET variants on the age-dependent penetrance.ResultsA total of 48 (31.4%) patients presented with MEN2-associated PHEOs. The mean age at diagnosis was 35.5±13.4 years, 60.4% of patients were women, and 92.8% had RET mutations at codon 634. The frequencies of RET polymorphisms were as follows: 20.1% L769L, 4.75% S836S, and 17.3% S904S/G691S. We did not observe any association between the frequencies of L769L, S836S, or S904S/G691S variants and PHEO development (all P>0.05). However, individuals carrying two RET polymorphic alleles had an increased estimated risk of PHEO (2.63; 95% CI, 1.4–5.0; P=0.004) and were younger at diagnosis when compared with those with one or no polymorphism (29.6±6.3 and 39.3±14.4 years respectively; P=0.006). Accordingly, additional analysis using Cox proportional hazard models demonstrated that the presence of two RET variants was associated with an increased risk for early PHEO development (hazard ratio, 5.99 (95% CI, 2.24–16.03); P<0.001).ConclusionsRET polymorphic alleles have an additive effect on the estimated risk of age-related PHEO penetrance in MEN2 patients.

scholarly journals Altered Acylcarnitine Metabolism Is Associated With an Increased Risk of Atrial Fibrillation

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Einar Smith ◽  
Celine Fernandez ◽  
Olle Melander ◽  
Filip Ottosson
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cox Regression ◽  
Beta Carotene ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Incident Cases ◽  
First Time

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, but the pathogenesis is not completely understood. The application of metabolomics could help in discovering new metabolic pathways involved in the development of the disease. Methods and Results We measured 112 baseline fasting metabolites of 3770 participants in the Malmö Diet and Cancer Study; these participants were free of prevalent AF. Incident cases of AF were ascertained through previously validated registers. The associations between baseline levels of metabolites and incident AF were investigated using Cox proportional hazard models. During 23.1 years of follow‐up, 650 cases of AF were identified (incidence rate: 8.6 per 1000 person‐years). In Cox regression models adjusted for AF risk factors, 7 medium‐ and long‐chain acylcarnitines were associated with higher risk of incident AF (hazard ratio [HR] ranging from 1.09; 95% CI, 1.00–1.18 to 1.14, 95% CI, 1.05–1.24 per 1 SD increment of acylcarnitines). Furthermore, caffeine and acisoga were also associated with an increased risk (HR, 1.17; 95% CI, 1.06–1.28 and 1.08; 95% CI, 1.00–1.18, respectively), while beta carotene was associated with a lower risk (HR, 0.90; 95% CI, 0.82–0.99). Conclusions For the first time, we show associations between altered acylcarnitine metabolism and incident AF independent of traditional AF risk factors in a general population. These findings highlight metabolic alterations that precede AF diagnosis by many years and could provide insight into the pathogenesis of AF. Future studies are needed to replicate our finding in an external cohort as well as to test whether the relationship between acylcarnitines and AF is causal.

Comparison of mortality and second primary oropharyngeal malignancies by human papilloma virus (HPV) status in patients (pts) with oropharyngeal squamous cell carcinoma (OPSCC) using an updated Surveillance, Epidemiology, and End Results (SEER) database.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17518-e17518 ◽  
Author(s):  
Ryan Holstead ◽  
Rehana Rasul ◽  
Anne Golden ◽  
Nagashree Seetharamu
Keyword(s):  
Cox Regression ◽  
Tumor Grade ◽  
High Rate ◽  
Field Cancerization ◽  
Second Primary ◽  
Seer Database ◽  
Cox Proportional Hazard ◽  
Hpv Status ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

e17518 Background: Prognosis and patterns of failure differ between HPV positive (pos) and HPV negative (neg) OPSCC. HPV neg have an increased risk of developing head, neck, and lung SPM due to field cancerization. Second primary OPSCC in HPV pos pts may be due to persistent risk for HPV-mediated carcinogenesis and compromised immune status. The rate and location of SPM in HPV pos pts is not as well described and HPV-specific surveillance guidelines are yet to be determined. Methods: Retrospective cohort study from a custom SEER database of OPSCC diagnosed from 2013-2015 was conducted. Differences in overall survival (OS) and SPM were compared by HPV status using Gray’s test. Cox proportional hazard models were performed, adjusting for age, race, sex, year of diagnosis, tumor grade, stage, and first treatment. Results: 12,895 pts were identified, with a mean age of 61.8 (SD = 9.97) years, mostly male (83.2%), and white (87.3%), with 45.0% HPV pos, 15.3% HPV neg, and 39.7% HPV unknown (unk). Proportion of HPV pos pts increased from 2013-2015 (40.7%-49.2%). HPV pos pts tended to have higher stage and grade of tumor. Most patients were treated with chemotherapy and radiation. Median duration of follow up was 13 (5-22) months. HPV pos had significantly lower unadjusted 2-year mortality compared to neg or unk (13.7% vs. 38.9% vs. 32.8%, p < 0.001). Median OS for HPV pos, HPV neg and HPV unk was 29 months (m), 25.6 m, and 24.45 m respectivey (p < 0.0001). From the multivariable Cox regression, HPV neg pts had 2.25 times the risk (95% CI: 1.99-2.54) of death compared to HPV pos pts. Incidence of OP SPM was similar (0.008-0.011%) in all three HPV cohorts (aHR = 0.87, 95% CI: 0.49-1.54). Conclusions: Our study strongly supports the prognostic value of HPV status. Incidence of OP SPM is similar in HPV pos and neg OPSCC suggesting that similar surveillance strategies should be employed for all OPSCC pts. Limitations of the study include lack of data on smoking and alcohol use, high rate of HPV unk pts, and SEER-imposed restriction to SPM occurring only in the OP region.

Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality

2021 ◽  
pp. 088307382110001
Author(s):  
Jody L. Lin ◽  
Joseph Rigdon ◽  
Keith Van Haren ◽  
MyMy Buu ◽  
Olga Saynina ◽  
...  
Keyword(s):  
Severe Pneumonia ◽  
Sensitivity Analyses ◽  
Tube Placement ◽  
Composite Outcome ◽  
Eligibility Criteria ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Neurologic Impairment ◽  
Increased Risk ◽  
The Impact

Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.

scholarly journals Stopping 5-aminosalicylates in patients with ulcerative colitis starting biologic therapy does not increase the risk of adverse clinical outcomes: analysis of two nationwide population-based cohorts

Gut ◽  
2018 ◽  
Vol 68 (6) ◽  
pp. 977-984 ◽  
Author(s):  
Ryan C Ungaro ◽  
Berkeley N Limketkai ◽  
Camilla Bjørn Jensen ◽  
Kristine Højgaard Allin ◽  
Manasi Agrawal ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
The United States ◽  
Health Claims ◽  
Sensitivity Analyses ◽  
Clinical Event ◽  
Clinical Events ◽  
Increased Risk ◽  
National Databases

ObjectiveThe benefit of continuing 5-aminosalicylate (5-ASA) in patients with ulcerative colitis (UC) who initiate anti-tumour necrosis factor-alpha (anti-TNF) biologics is unknown. We aimed to compare clinical outcomes in patients with UC already on 5-ASA who started anti-TNF and then either stopped or continued 5-ASA.DesignOur primary outcome was any adverse clinical event defined as a composite of new corticosteroid use, UC-related hospitalisation or surgery. We used two national databases: the United States (US) Truven MarketScan health claims database and the Danish health registers. Patients with UC who started anti-TNF after having been on oral 5-ASA for at least 90 days were included. Patients were classified as stopping 5-ASA if therapy was discontinued within 90 days of starting anti-TNF. We performed multivariable Cox regression models controlling for demographics, clinical factors and healthcare utilisation. Adjusted HRs (aHR) with 95% CI are reported comparing stopping 5-ASA with continuing 5-ASA.ResultsA total of 3589 patients with UC were included (2890 US and 699 Denmark). Stopping 5-ASA after initiating anti-TNF was not associated with an increased risk of adverse clinical events in the U.S. cohort (aHR 1.04; 95% CI 0.90 to 1.21, p=0.57) nor in the Danish cohort (aHR 1.09; 95% CI 0.80 to 1.49, p=0.60). Results were similar in sensitivity analyses investigating concomitant immunomodulator use and duration of 5-ASA treatment before initiating anti-TNF.ConclusionIn two national databases, stopping 5-ASA in patients with UC starting anti-TNF therapy did not increase the risk of adverse clinical events. These results should be validated in a prospective clinical trial.

scholarly journals MRI phenotypes of the brain are related to future stroke and mortality in patients with manifest arterial disease: The SMART-MR study

2018 ◽  
Vol 40 (2) ◽  
pp. 354-364 ◽  
Author(s):  
Myriam G Jaarsma-Coes ◽  
Rashid Ghaznawi ◽  
Jeroen Hendrikse ◽  
Cornelis Slump ◽  
Theo D Witkamp ◽  
...  
Keyword(s):  
Clustering Analysis ◽  
Cox Regression ◽  
Reference Group ◽  
Brain Mri ◽  
Arterial Disease ◽  
Brain Abnormalities ◽  
Accurate Representation ◽  
Increased Risk ◽  
The Brain ◽  
Mr Study

Neurodegenerative and neurovascular diseases lead to heterogeneous brain abnormalities. A combined analysis of these abnormalities by phenotypes of the brain might give a more accurate representation of the underlying aetiology. We aimed to identify different MRI phenotypes of the brain and assessed the risk of future stroke and mortality within these subgroups. In 1003 patients (59 ± 10 years) from the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study, different quantitative 1.5T brain MRI markers were used in a hierarchical clustering analysis to identify 11 distinct subgroups with a different distribution in brain MRI markers and cardiovascular risk factors, and a different risk of stroke (Cox regression: from no increased risk compared to the reference group with relatively few brain abnormalities to HR = 10.34; 95% CI 3.80↔28.12 for the multi-burden subgroup) and mortality (from no increased risk compared to the reference group to HR = 4.00; 95% CI 2.50↔6.40 for the multi-burden subgroup). In conclusion, within a group of patients with manifest arterial disease, we showed that different MRI phenotypes of the brain can be identified and that these were associated with different risks of future stroke and mortality. These MRI phenotypes can possibly classify individual patients and assess their risk of future stroke and mortality.

scholarly journals Triglyceride-Glucose Index and HOMA-IR in Young Adulthood and Risk of Incident Congestive Heart Failure: The CARDIA Study

2021 ◽  
Author(s):  
Xianghui Zeng ◽  
Haobin Zhou ◽  
Yuting Xue ◽  
Xiao Wang ◽  
Qiong Zhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Congestive Heart Failure ◽  
Young Adults ◽  
Young Adulthood ◽  
Surrogate Marker ◽  
Model Assessment ◽  
Tyg Index ◽  
Triglyceride Glucose Index ◽  
Increased Risk

Abstract Background: Triglyceride-glucose (TyG) index and homeostasis model assessment-insulin resistance (HOMA-IR) are related to insulin resistance (IR). The aim of this study was to assess the association between triglyceride-glucose index / HOMA-IR within young adults and congestive heart failure (CHF), and to explore whether triglyceride-glucose index can replace HOMA-IR as a surrogate marker for insulin resistance in predicting the risk of CHF.Methods：A total of 4992 participants between the ages of 18 and 30 were enrolled from the Coronary Artery Risk Development in Young Adults (CARDIA) investigation (from 1985 to 1986 [year 0]). Cox proportional hazard regression analysis was conducted for assessing correlations between baseline TyG index / HOMA-IR and congestive heart failure events, together with Receiver Operating Characteristic (ROC) Curve employed for scrutinizing TyG index / HOMA-IR and he risk of CHF.Results: During the 31-year follow-up period, 64 (1.3%) out of the 4992 participants developed congestive heart failure. In multivariable Cox proportional hazards models, adjusted for confounding factors for CHF, increased risk of CHF was associated with per-unit increase in TyG index (hazard ratio [HR] 2.8; 95% confidence interval [CI], 1.7-4.7) and HOMA-IR (HR 1.2; 95%CI, 1.1-1.3). Kaplan-Meier curve analysis showed that participants in the TyG index and HOMA-IR index Q4 group had a higher risk of congestive heart failure than those in the Q1 group. The area under curve (AUC) for TyG index and HOMA-IR consisted of 0.67 (95% CI, 0.6-0.742) and 0.675 (95%CI, 0.604-0.746), respectively. There were no significant differences between TyG index and HOMA-IR for AUC (P = 0.986).Conclusions: TyG index and HOMA-IR are independent risk factors for CHF. The TyG index can replace HOMA-IR in young adulthood as a surrogate marker for IR to predict the risk of CHF.

scholarly journals Colorectal cancer survival among Ministry of National Guard-Health Affairs (MNG-HA) population 2009–2017: retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mesnad Alyabsi ◽  
Fouad Sabatin ◽  
Majed Ramadan ◽  
Abdul Rahman Jazieh
Keyword(s):  
Colorectal Cancer ◽  
Distant Metastasis ◽  
Cancer Survival ◽  
National Guard ◽  
Population Based ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Abstract Background Colorectal cancer (CRC) is the most diagnosed cancer among males and third among females in Saudi Arabia, with up to two-third diagnosed at advanced stage. The objective of our study was to estimate CRC survival and determine prognostic factors. Methods Ministry of National Guard- Health Affairs (MNG-HA) registry data was utilized to identify patients diagnosed with CRC between 2009 and 2017. Cases were followed until December 30th, 2017 to assess their one-, three-, and five-year CRC-specific survivals. Kaplan-Meier method and Cox proportional hazard models were used to assess survival from CRC. Results A total of 1012 CRC patients were diagnosed during 2009–2017. Nearly, one-fourth of the patients presented with rectal tumor, 42.89% with left colon and 33.41% of the cases were diagnosed at distant metastasis stage. The overall one-, three-, and five-year survival were 83, 65 and 52.0%, respectively. The five-year survival was 79.85% for localized stage, 63.25% for regional stage and 20.31% for distant metastasis. Multivariate analyses showed that age, diagnosis period, stage, nationality, basis of diagnosis, morphology and location of tumor were associated with survival. Conclusions Findings reveal poor survival compared to Surveillance, Epidemiology, and End Results (SEER) population. Diagnoses at late stage and no surgical and/or perioperative chemotherapy were associated with increased risk of death. Population-based screening in this population should be considered.

Depression and Dementia: The Role of Cortisol and Vascular Brain Lesions. AGES-Reykjavik Study

2021 ◽  
pp. 1-11
Author(s):  
Lotte Gerritsen ◽  
Emma L. Twait ◽  
Palmi V. Jonsson ◽  
Vilmundur Gudnason ◽  
Lenore J. Launer ◽  
...  
Keyword(s):  
Brain Mri ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Diagnostic Interview ◽  
Late Life Depression ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Background: Late-life depression (LLD) is related to an increased risk of developing dementia; however, the biological mechanisms explaining this relationship remain unclear. Objective: To determine whether the relationship between LLD and dementia can be best explained by the glucocorticoid cascade or vascular hypothesis. Methods: Data are from 4,354 persons (mean age 76±5 years) without dementia at baseline from the AGES-Reykjavik Study. LLD was assessed with the MINI diagnostic interview (current and remitted major depressive disorder [MDD]) and the Geriatric Depression Scale-15. Morning and evening salivary cortisol were collected (glucocorticoid cascade hypothesis). White matter hyperintensities (WMH; vascular hypothesis) volume was assessed using 1.5T brain MRI. Using Cox proportional hazard models, we estimated the associations of LLD, cortisol levels, and WMH volume with incident all-cause dementia, AD, and non-AD dementia. Results: During 8.8±3.2 years of follow-up, 843 persons developed dementia, including 397 with AD. Current MDD was associated with an increased risk of developing all-cause dementia (HR = 2.17; 95% CI 1.66–2.67), with risks similar for AD and non-AD, while remitted MDD was not (HR = 1.02; 95% CI 0.55–1.49). Depressive symptoms were also associated with increased risk of dementia, in particular non-AD dementias. Higher levels of evening cortisol increased risk of dementia, but this was independent of MDD. WMH partially explained the relation between current MDD and dementia risk but remained increased (HR = 1.71; 95% CI 1.34–2.08). Conclusion: The current study highlights the importance of LLD in developing dementia. However, neither the glucocorticoid cascade nor the vascular hypotheses fully explained the relation between depression and dementia.

P950Synergistic impact of renal failure and left ventricular dysfunction on short- and long-term mortality in patients with STEMI undergoing primary PCI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A S Pavlovic ◽  
D Milasinovic ◽  
Z Mehmedbegovic ◽  
V Dedovic ◽  
D Jelic ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cox Regression ◽  
Negative Impact ◽  
Reference Group ◽  
Left Ventricular ◽  
Primary Pci ◽  
Catheterization Laboratory ◽  
Lv Dysfunction ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background Impaired left ventricular function (LV) and renal failure (RF) have both been separately associated with increased risk of mortality in ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Purpose Our aim was to comparatively evaluate the relative impact of LV dysfunction and renal failure (RF) on the risk of mortality in primary PCI-treated STEMI patients. Methods 5878 patients admitted for primary PCI during 2009–2015, from a prospectively kept, electronic registry of a high-volume catheterization laboratory, were included in the analysis. LV dysfunction was defined as EF<40%, and RF as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 according to Cockcroft-Gault formula. Adjusted Cox regression models were used to assess 30-day and 3-year mortality hazard, with patients with EF≥40% and normal renal function serving as the reference group. Results RF was documented in 17.1% (n=1006), whereas 36.5% had LV dysfunction (n=2141). LV dysfunction and RF were separately associated with increased crude mortality rates, whereas the concurrence of both resulted in the highest mortality rate at 30 days (0.7% if no RF and normal EF vs. 5.4% if RF alone vs. 3.9% if EF<40% alone vs. 12.6% if both RF and EF<40%; p<0.001), and at 3 years (5.7% if no RF and normal EF vs. 29.0% if RF alone vs. 19.0% if EF<40% alone vs. 47.4% if both RF and EF<40%; p<0.001). After multivariable adjustment for other significant mortality predictors, such as age, previous stroke, diabetes, hyperlipidemia, anemia and Killip≥2, RF and LV dysfunction were associated with a comparable increase in mortality risk at 30 days (HR=4.1 and HR=3.7, respectively, p<0.001 for both) and at 3 years (HR=2.8 and HR=2.7, respectively, p<0.001 for both). Importantly, the combined presence of RF and low EF was independently associated with a marked increase in both 30- day (HR=6.5, 95% CI 3.7–11.4, p<0.001), and 3-year mortality (HR=4.3, 95% CI 3.3–5.6, p<0.001). Kaplan Meier cumulative mortality curves Conclusion Apart from each being independently associated with an increased risk of mortality, the concurrence of renal failure and LV dysfunction had a synergistic negative impact on the prognosis of primary PCI-treated STEMI patients

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