Prognostic Value of Admission Blood Urea Nitrogen/Creatinine Ratio in Patients with STEMI Undergoing Late Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Caijuan Dong ◽  
Yanbo Xue ◽  
Yan Fan ◽  
Ruochen Zhang ◽  
Yunfei Feng ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Blood Urea Nitrogen ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Creatinine Ratio ◽  
Cardiac Mortality ◽  
Urea Nitrogen ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Objective: Numerous patients with ST-segment elevation myocardial infarction (STEMI), especially in developing countries, undergo late percutaneous coronary intervention (PCI), defined as time of PCI > 24 hours from symptom onset. This study is aimed to identify the predictive value of admission blood urea nitrogen/creatinine ratio (BUN/Cr) on long-term all-cause mortality and cardiac mortality in STEMI patients receiving late PCI. Methods: Eligible STEMI patients who received late PCI between 2009 and 2011 were consecutively enrolled. They were classified into two groups based on the median BUN/Cr: low BUN/Cr group and high BUN/Cr group. Patients were followed up by phone or face to face interviews and medical records review. The primary endpoint was defined as all-cause mortality and cardiac mortality. Results: 780 STEMI patients were enrolled finally. The median BUN/Cr was 14.29. The median follow-up period was 41 months, with 37 all-cause deaths and 25 cardiac deaths. Compared to the low BUN/Cr group, high BUN/Cr group had higher all-cause mortality (6.4% vs. 3.1%, P=0.029), and cardiac mortality (6.3% vs. 1.5%, P<0.001). The Cox proportional hazard analysis revealed that high BUN/Cr at admission was an independent predictor of long-term cardiac mortality (P=0.003), but not of all-cause mortality (P=0.077). Conclusions: High BUN/Cr ratio at admission was an independent predictor of cardiac mortality in STEMI patients receiving late PCI. Brief Summary: In a retrospective study of STEMI patients receiving late PCI, we found that high BUN/Cr ratio (BUN/Cr>14.29) at admission was an independent predictor of long-term cardiac mortality, but not of all-cause mortality. The study showed that BUN/Cr ratio could be a potential indicator of risk stratification models for STEMI patients undergoing late PCI.

scholarly journals Plasma Trimethylamine-N-Oxide Is an Independent Predictor of Long-Term Cardiovascular Mortality in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Ceren Eyileten ◽  
Joanna Jarosz-Popek ◽  
Daniel Jakubik ◽  
Aleksandra Gasecka ◽  
Marta Wolska ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Cox Regression ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
All Cause Mortality

To investigate the association of liver metabolite trimethylamine N-oxide (TMAO) with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted seven yr in median. Adjusted Cox-regression analysis was used for prediction of mortality. ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p &lt; 0.001). The cut-off value of &gt;4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR = 11.62, 95% CI: 2.26–59.67; p = 0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3 vs. 2.6%; p = 0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low. High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS.

scholarly journals Very long-term benefits of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Padilla Escamez ◽  
M J Romero Reyes ◽  
C Otte Alba ◽  
S Rufian Andujar ◽  
F J Molano Casimiro
Keyword(s):  
Heart Failure ◽  
Percutaneous Coronary Intervention ◽  
Cardiac Rehabilitation ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Heart Failure Hospitalization ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Background Short and medium-term benefits of cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) have been well studied. However, studies on long-term benefits of such programs after percutaneous coronary intervention (PCI) are scarce. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) on very long-term mortality and morbidity after PCI. Methods We conducted a retrospective cohort study of 701 patients who underwent PCI at our hospital between 2004 and 2011. Patients were classified into two cohorts based on whether or not they participated in a CR program phase II. A follow-up was performed in May 2020. We collected the events occurring during a median follow-up of 11 years. Results 701 patients were included in our study: 291 (41.5%) participated in the CR program, whereas 410 (58.4%) refused to do it. AMI was the most frequent indication for PCI (51.9%), followed by unstable angina (42.8%). The characteristics of the cohort based on participation in the CR program are shown in the table below. Patients who participated in the CR program were younger and mostly male. However, those who refused to do it had a higher cardiovascular risk due to a higher percentage of multivessel disease, diabetes mellitus, kidney failure and history of cerebrovascular accident. Using multivariate logistic regression, CR participation was found to be associated with significantly reduced all-cause mortality (19.5 vs 48.4%; OR 0.455; IC95% 0.295–0.701; p&lt;0.001) and cardiac mortality (4.5% vs 18.0%; OR 0.361; IC95% 0.181–0.721; p 0.004). CR is also associated with a substantial decrease in heart failure hospitalization (10.0% vs 24.8%; OR 0.557; IC95% 0.331–0.937; p 0.027) and incidence of stroke (5.5% vs 10.6%; OR 0.491; IC95% 0.271–0.890; p&lt;0.017) during the follow-up. No significant differences were observed in re-AMI (20.6% vs 24.1%, p=NS). Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality, heart failure hospitalization rates and morbidity during long-term follow-up. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Impact of gender on the long-term prognosis in acute STEMI patients undergoing primary percutaneous coronary intervention: analysis of 10-year all-comers registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.B Cid Alvarez ◽  
M Juskova ◽  
P Tasende Rey ◽  
B Alvarez Alvarez ◽  
E Gonzalez Babarro ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Long Term Prognosis

Abstract Background Published data about the impact of female gender on the long-term prognosis in patients with ST–elevation -myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) have been incoherent. Much of the registries show that the gender effect diminishes after control for age and comorbidities Purpose We sought to investigate the gender dependent impact on the long-term prognosis in STEMI patients undergoing PPCI. Methods This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. Our primary objective was to assess its impact of gender in all-cause mortality and major adverse cardiovascular events (MACE; death, recurrent MI, target vessel revascularization, heart failure) during follow-up. Follow-up was performed through consultation of the electronic registries available in the autonomic community of Galicia (IANUS program); all medical evaluations and hospital registries were reviewed. Median follow-up was 3 years (interquartile range of 0.68–4.67 years). Results Of the 1965 patients with STEMI admitted for primary PCI, 464 (23,6%) were female. Women were on average 10 years older than men (71.5±13 vs. 61.5±12 yrs, p=0,000), with a higher prevalence of diabetes (25,2% vs 20,5% p=0,030) and hypertension (65,1% vs 44,5% p=0,000). With regard to system delays, the median time from first medical contact to PPCI were superior in women (116,3±83) than men (97,9±67) (p=0,000). Despite their older age women did not show differences in the extent of coronary disease (median SYNTAX score 13,60±8.0 vs. 14.33±8.7 in men, p=0,122). The GRACE score was higher for women (141.1±39 vs 120.8±35 p=0.07) and the incidence of cardiogenic shock at admission was 10.2% (7.1% in men, p=0,003). Furthermore, female patients received less guideline-directed medical therapy than men with less prescription of statins (93.6.5% vs 96.9%; p=0,003), and beta blockers (80.2% vs 85.1%; p=0.021), and having less radial access for PPCI (84.1% vs 90.1%; p=0.000). The cumulative incidence of all-cause mortality was 19.4% vs 12.6% (p=0,000), the incidence of MACE was 31.9% vs 23.4% (p=0.000) for women and men respectively (Image 1). Multivariate analysis revealed that, after correction for baseline differences, gender remained and independent predictor for all-cause mortality (HR IC 95%: 1.922 (1.396–2.696) p=0.000) Conclusions In our “real-world” registry of patients with STEMI undergoing pPCI women had longer ischemic times, higher risk profiles, and differing interventional approaches compared with men and gender results an independent predictor for all-cause mortality. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap. Image 1 Funding Acknowledgement Type of funding source: None

CLINICAL OUTCOMES OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER PERCUTANEOUS CORONARY INTERVENTION AMONG CARDIAC REHABILITATION AND NON CARDIAC REHABILITATION GROUPS-A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 25-27
Author(s):  
Saroj Mandal ◽  
Vignesh. R ◽  
Sidnath Singh
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Observational Study ◽  
Cardiac Rehabilitation ◽  
Prospective Observational Study ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Percutaneous Coronary ◽  
All Cause Mortality

OBJECTIVES To determine clinical outcome and to nd out the association between participation of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in cardiac rehabilitation programme. DESIGN A Prospective observational study. STUDY AREA : Department of Cardiology, Institute of Postgraduate Medical Education and Research,Kolkata. PARTICIPANTS: Patients aged ≥18 years who underwent PCI due to AMI. OUTCOME MEASURES The outcomes were subsequent myocardial infarction, revascularisation, all-cause readmission, cardiac readmission, all-cause mortality and cardiac mortality. RESULT: The data of 1107 patients were included and 60.07%% of them participated in CR program. The risks of revascularisation, all cause readmission and cardiac readmission among CR participants were compared. The results of those analysis were consistent and showed that the CR participants had lower allcause mortality ,cardiac mortality,all cause readmission, cardiac admission. However no effect was observed for subsequent myocardial infarction or revascularisation. CONCLUSIONS: It was suggested CR participation may reduce the risk of all-cause mortality ,cardiac mortality, all cause readmission and cardiac admission.

Abstract 15439: Lesion Complexity and Long-term Outcomes According to Mean Observed Blood Pressure After Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jong Il Park ◽  
Byung Jun Kim ◽  
Hun Tae Kim ◽  
Jung Hee Lee ◽  
Ung Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Percutaneous Coronary ◽  
Group A ◽  
Group B ◽  
Group D

Background: The guideline recommended strict blood pressure (BP) control for the patients treated with percutaneous coronary intervention (PCI). We aimed to evaluate the relationship between mean observed BP and long-term outcomes for patients with or without lesion complexity. Methods: A total of 1,470 patients who underwent PCI were investigated. We categorized the study population into four groups based on mean observed BP and lesion complexity (left main & three-vessel disease, chronic total occlusion, total stent length ≥60mm, or bifurcation two stenting): Group A (non-complex & systolic BP ≤120mmHg, n=310), Group B (non-complex & systolic BP >120mmHg, n=674), Group C (complex & systolic BP ≤120mmHg, n=131), and Group D (complex & systolic BP >120mmHg, n=355). We evaluated major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction (MI), repeat target vessel revascularization, or stroke. Results: Well-controlled BP group (Group A&C) showed significantly lower systolic BP than uncontrolled BP group (Group B&D) (114.3±6.1mmHg vs. 130.7±7.6mmHg, p<0.001). MACCEs occurred less frequently in Group A (18.9%) than Group B (23.6%), Group C (22.7%), and Group D (33.6%) (p=0.001) at 8 years. After multivariate analysis, with Group A as a reference, the adjusted hazard ratio (HR) for MACCEs was 1.382 (95% confidence interval [CI] 0.978-1.954, p=0.067) for Group B, 1.559 (95% CI 0.957-2.540, p=0.075) for Group C, and 1.872 (95% CI 1.296-2.705, p=0.001) for Group D. In Cox regression model, although lesion complexity was not associated with MACCE, systolic BP≤120mmHg was an independent predictor for reduced rate of MACCE (HR 0.667, 95% CI 0.485-0.918, p=0.013). Conclusions: Mean observed systolic BP ≤120mmHg after PCI was independent predictor for reduced MACCEs regardless of lesion complexity. Key Words: Blood Pressure; Percutaneous Coronary Intervention; Lesion Complexity; Treatment Outcome

scholarly journals Discharge Hemoglobin Association with Long-Term Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming Gao ◽  
Xinying Zhang ◽  
Ling Qin ◽  
Yang Zheng ◽  
Zhiguo Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Minor Bleeding ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Lower Discharge

Background. Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods. We analyzed records of 983 STEMI patients who were treated with primary PCI. The primary end point was all-cause mortality at 1 year and 2 years. The relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results. Overall, 16.4% of patients had bleeding events, which were classified by the Thrombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. The incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P<0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006–1.034, P=0.004) and in a confounder-adjusted model (HR per 1 g/L decrease in discharge Hb = 1.024, 95% CI: 1.011–1.037, P<0.001). The odds ratio (OR) for all-cause mortality at 2 years for participants with Hb below the twentieth percentile was 3.529 (95% CI: 1.976–6.302) and 2.968 (95% CI: 1.614–5.456) after adjustment for age and gender and 2.485 (95% CI: 1.310–4.715) after adjustment for all covariates. Conclusions. In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.

Gamma-Glutamyl Transferase-to-Platelet Ratio as a Novel Predictor of Long-Term Adverse Outcomes in Patients after Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study

2019 ◽  
Vol 119 (06) ◽  
pp. 1021-1030 ◽  
Author(s):  
Ying-Ying Zheng ◽  
Ting-Ting Wu ◽  
You Chen ◽  
Xian-Geng Hou ◽  
Yi Yang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Retrospective Cohort ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Gamma Glutamyl Transferase ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Glutamyl Transferase

Background Gamma-glutamyl transferase (GGT) has been shown to be involved in the pathogenesis of both coronary artery disease (CAD) and liver disease, and it has been reported that the GGT-to-platelet ratio (GPR) is an independent predictor for adverse outcomes from liver fibrosis and hepatic carcinoma. However, the relation between the GPR and adverse outcomes in CAD patients after percutaneous coronary intervention (PCI) has not been investigated. Methods A total of 5,636 patients enrolled in Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI, a retrospective cohort study, from January 2008 to December 2016, were divided into two groups according to GPR (GPR < 0.12, n = 2,769 and GPR ≥ 0.12, n = 2,867). The primary outcome was long-term mortality including all-cause mortality (ACM) and cardiac mortality (CM) after PCI. The average follow-up time was 35.9 ± 22.6 months. Results We found that there were significant differences between the two groups in the incidences of ACM (p = 0.011), CM (p = 0.001), major adverse cardiovascular events (MACEs, p < 0.024), major adverse cardiovascular and cerebrovascular events (MACCEs, p = 0.014) and bleeding events (p = 0.003). Multivariate Cox regression analyses showed that GPR was an independent predictor for ACM (hazard ratio [HR]: 1.536 [95% confidence interval [CI]:1.162–2.032], p = 0.003), CM (HR: 1.763 [95% CI: 1.283–2.424], p < 0.001), MACCEs (HR: 1.269 [95% CI: 1.066–1.511], p = 0.007) and MACEs (HR: 1.308 [95% CI: 1.089–1.570], p = 0.004) in stable CAD patients but that it was an independent predictor for only the incidence of bleeding events (HR: 3.104 [95% CI: 1.680–5.736], p < 0.001) in acute coronary syndrome (ACS) patients. Conclusion This study indicates that GPR is an independent and novel predictor of adverse long-term outcomes in CAD patients who underwent PCI.

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