scholarly journals Paradoxical Association Between Apolipoprotein B and Prognosis in Coronary Artery Disease: A 36,468 Chinese Cohort Study

2021 ◽  
Author(s):  
Huanqiang Li ◽  
Bo Wang ◽  
Ziling Mai ◽  
Sijia Yu ◽  
Ziyou Zhou ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Apolipoprotein B ◽  
Cox Regression ◽  
Regression Analyses ◽  
High Concentration ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Artery Disease

Abstract Background Apolipoprotein B (ApoB) and low-density lipoprotein cholesterol (LDL-C) was identified as the target for blood lipid management among coronary artery disease (CAD) patients. Previous studies reported an inverse correlation between baseline LDL-C concentration and clinical outcomes. However, the association between baseline ApoB concentration and long-term prognosis is unknown. Methods 36,486 CAD patients admitted to Guangdong Provincial People's Hospital in China were enrolled in this study and patients were categorized into two groups: high concentration of ApoB (≥65 mg/dL) group and low concentration of ApoB (< 65 mg/dL) group. The association between ApoB levels and long-term all-cause mortality was evaluated by the Kaplan-Meier method and Cox regression analyses. Results The overall mortality was 12.49% (n = 4,554) over a median follow-up period of 5.01 years. According to Kaplan–Meier analysis, patients with low baseline ApoB levels were paradoxically more likely to get a worse prognosis. Multivariate Cox regression analyses were performed to adjust for confounding factors such as age, gender, and comorbidity, and there was no obvious difference in long-term all-cause mortality among ApoB patients (aHR: 1.07, 95% CI: 0.99-1.16). When CONUT and total bilirubin were adjusted, the risk of long-term all-cause mortality would reduce in the low-ApoB (< 65mg/dl) group (aHR: 0.86, 95% CI: 0.78-0.96). In the fully covariable-adjusted model, patients in the ApoB < 65mg/d group had a 10.00% lower risk of long-term all-cause death when comparing to patients with ApoB≥65mg/dL (aHR: 0.90; 95% CI:0.81-0.99). Conclusion This study found a paradoxical association between baseline ApoB concentration and long-term all-cause mortality. Malnutrition and bilirubin mainly mediate the ApoB paradox.

scholarly journals Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

2020 ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Artery Disease

Abstract Background: Suppression of tumorigenesis-2 is implicated in the myocardial overload and it was long been recognized as an inflammation marker related to heart failure and acute coronary syndromes, but the data on prognostic value of suppression of tumorigenesis-2 on patients with coronary artery disease remains limited. The study ought to investigate the prognostic value of suppression of tumorigenesis-2 in patients with established coronary artery disease.Methods: In this prospective cohort study, a total of 3641 consecutive patients were included. The primary end point was major adverse cardiovascular events. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). The secondary end point was all-cause death. The association between suppression of tumorigenesis-2 and outcomes was investigated using multivariable COX regression.Results: During a median follow up of 6.4 years, there were 775 patients had the occurrence of major adverse cardiovascular events and 275 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). Multiple COX regression models showed that higher level of suppression of tumorigenesis-2 was an independent predictor in developing major adverse cardiovascular events (HR=1.36, 95% CI 1.17-1.56, p＜0.001) and all-cause death (HR=2.01, 95%CI 1.56-2.59, p＜0.001). The addition of suppression of tumorigenesis-2 to established risk factors significantly improved risk prediction of the composite outcome of major adverse cardiovascular events and all-cause death (c-statistic, net reclassification index, and integrated discrimination improvement, all p＜0.05).Conclusions: Higher level of suppression of tumorigenesis-2 is significantly associated with long-term all-cause death and major adverse cardiovascular events. Suppression of tumorigenesis-2 may provide incremental prognostic value beyond traditional risk factors.

scholarly journals Association between baseline ldl-c and prognosis among patients with coronary artery disease and advanced kidney disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Wang ◽  
J Liu ◽  
S Q Chen ◽  
Q H Luo ◽  
Y Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Cox Regression ◽  
Cardiovascular Research ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Worse Prognosis

Abstract Background Lower low-density lipoprotein cholesterol (LDL-C) is significantly associated with improved prognosis in patients with coronary artery disease (CAD). However, LDL-C reduction does not decrease all-cause mortality among CAD patients when renal function impairs. There are currently no studies examining the association of low baseline LDL-C concentration (&lt;1.8 mmol/L) with mortality among patients with CAD and advanced kidney disease (AKD). We aimed to evaluate prognostic value of low baseline LDL-C level for all-cause death in these patients. Methods In this observational study, 803 CAD patients complicated with AKD (eGFR &lt;30 mL/min/1.73 m 2) were enrolled between January 2008 to December 2018. Patients were divided into two groups (LDL-C &lt;1.8 mmol/L, n=138; LDL-C ≥1.8 mmol/L, n=665). We used Kaplan-Meier methods and Cox regression analyses to assess the association between baseline low LDL-C levels and long-term all-cause mortality. Results Among 803 participants (mean age 67.4 years; 68.5% male), there were 315 incidents of all-cause death during a median follow-up of 2.7 years. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for full 24 confounders (e.g., age, diabetes, heart failure, and dialysis, etc.), multivariate Cox regression analysis revealed that lower LDL-C level (&lt;1.8mmol/L) was significantly associated with higher risk of all-cause death (adjusted HR, 1.38; 95% CI, 1.01–1.89). Conclusions Our data demonstrated that among patients with CAD and AKD, a lower baseline LDLC level (&lt;1.8mmol/L) did not present a higher survival rate but was related to a worse prognosis, suggesting a cautiousness of too low LDL-C levels among patients with CAD and AKD. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This study was supported by the National Natural Science Foundation of China (Grant No. 81670339 and Grant No. 81970311), Cardiovascular Research Foundation Project of the Chinese Medical Doctor Association (SCRFCMDA201216) and Beijing Lisheng Cardiovascular Health Foundation (LHJJ20141751).

scholarly journals Platelet-to-hemoglobin ratio as a valuable predictor of long-term all-cause mortality in coronary artery disease patients with congestive heart failure

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kunming Bao ◽  
Haozhang Huang ◽  
Guoyong Huang ◽  
Junjie Wang ◽  
Ying Liao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Prognostic Biomarker ◽  
Kaplan Meier ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Artery Disease

Abstract Background The platelet-to-hemoglobin ratio (PHR) has emerged as a prognostic biomarker in coronary artery disease (CAD) patients after PCI but not clear in CAD complicated with congestive heart failure (CHF). Hence, we aimed to assess the association between PHR and long-term all-cause mortality among CAD patients with CHF. Methods Based on the registry at Guangdong Provincial People’s Hospital in China, we analyzed data of 2599 hospitalized patients who underwent coronary angiography (CAG) and were diagnosed with CAD complicated by CHF from January 2007 to December 2018. Low PHR was defined as ˂ 1.69 (group 1) and high PHR as ≥ 1.69 (group 2). Prognosis analysis was performed using Kaplan–Meier method. To assess the association between PHR and long-term all-cause mortality, a Cox-regression model was fitted. Results During a median follow-up of 5.2 (3.1–7.8) years, a total of 985 (37.9%) patients died. On the Kaplan–Meier analysis, patients in high PHR group had a worse prognosis than those in low PHR group (log-rank, p = 0.0011). After adjustment for confounders, high PHR was correlated with an increased risk of long-term all-cause mortality in CAD patients complicated with CHF. (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 1.13–1.52, p < 0.0001). Conclusion Elevated PHR is correlated with an increased risk of long-term all-cause mortality in CAD patients with CHF. These results indicate that PHR may be a useful prognostic biomarker for this population. Meanwhile, it is necessary to take effective preventive measures to regulate both hemoglobin levels and platelet counts in this population.

scholarly journals Platelet-to-hemoglobin ratio as a valuable predictor of long-term all-Cause mortality in coronary artery disease patients with congestive heart failure

2021 ◽  
Author(s):  
Kunming Bao ◽  
Haozhang Huang ◽  
Guoyong Huang ◽  
Junjie Wang ◽  
Ying Liao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Prognostic Biomarker ◽  
Kaplan Meier ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Artery Disease

Abstract Background The platelet-to-hemoglobin ratio (PHR) has emerged as a prognostic biomarker in coronary artery disease (CAD) patients after PCI but not clear in CAD complicated with congestive heart failure (CHF). Hence, we aimed to assess the association between PHR and long-term all-cause mortality among CAD patients with CHF. Methods Based on the registry at Guangdong Provincial People’s Hospital in China, we analyzed data of 2,599 hospitalized patients who underwent coronary angiography (CAG) and were diagnosed with CAD complicated by CHF from January 2007 to December 2018. Low PHR was defined as˂1.69 (group 1) and high PHR as ≥ 1.69 (group 2). Prognosis analysis was performed using Kaplan-Meier methods. To assess the association between PHR and long-term all-cause mortality, a Cox-regression model was fitted. Results During a median follow-up of 5.2 (3.1–7.8) years, a total of 985 (37.9%) patients died. On the Kaplan-Meier analysis, patients in high PHR group had a worse prognosis than low PHR group (log-rank, p = 0.0011). After adjustment for confounders, high PHR was correlated with an increased risk of long-term all-cause mortality in CAD patients complicated with CHF. (adjusted hazard ratio [aHR], 1.21; 95% confidence interval [CI], 1.03–1.41, p = 0.02). Conclusion Elevated PHR is correlated with an increased risk of long-term all-cause mortality in CAD patients with CHF. These results indicate that PHR may be a useful prognostic biomarker for this population. Meanwhile, it is necessary to take effective preventive measures to regulate both hemoglobin levels and platelet counts in this population.

Prognostic Impact of Red Cell Distribution Width on the Development of Contrast Induced Nephropathy, Major Adverse Cardiac Events, and Mortality in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention.

2021 ◽  
Vol 17 ◽  
Author(s):  
Azka Latif ◽  
Muhammad Junaid Ahsan ◽  
Noman Lateef ◽  
Vikas Kapoor ◽  
Hafiz Muhammad Fazeel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Distribution Width ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease

: Red cell distribution width (RDW) serves as an independent predictor towards the prognosis of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention (PCI). A systematic search of databases such as PubMed, Embase, Web of Science, and Cochrane library was performed on October 10th, 2019 to elaborate the relationship between RDW and in hospital and long term follow up all-cause and cardiovascular mortality, major adverse cardiac events (MACE) and development of contrast-induced nephropathy (CIN) in patients with CAD undergoing PCI. Twenty-one studies qualified this strict selection criteria (number of patients = 56,425): one study was prospective, and the rest were retrospective cohorts. Our analysis showed that patients undergoing PCI with high RDW had a significantly higher risk of in-hospital all-cause mortality (OR 2.41), long-term all-cause mortality (OR 2.44), cardiac mortality (OR 2.65), MACE (OR: 2.16) and odds of developing CIN (OR: 1.42) when compared to the patients with low RDW. Therefore, incorporating RDW in the predictive models for the development of CIN, MACE, and mortality can help in triage to improve the outcomes in coronary artery disease patients who undergo PCI.

Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Mandava ◽  
S Pothuru ◽  
S Adeel Hassan ◽  
D Missael Rocha Castellanos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown. Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years. Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p &lt; 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at &gt;5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p &lt; 0.00001, I2 = 0) had similar outcomes. Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes. Abstract Figure.

scholarly journals Coronary Artery Disease: Optimal Lipoprotein(a) for Survival—Lower Is Better? A Large Cohort With 43,647 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Jin Liu ◽  
Liwei Liu ◽  
Bo Wang ◽  
Shiqun Chen ◽  
Buyun Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Kidney Diseases ◽  
Plasma Lipoprotein ◽  
Large Cohort ◽  
Lipoprotein A ◽  
All Cause Mortality ◽  
Artery Disease

Background: A high level of lipoprotein(a) can lead to a high risk of cardiovascular events or mortality. However, the association of moderately elevated lipoprotein(a) levels (≥15 mg/dL) with long-term prognosis among patients with coronary artery disease (CAD) is still uncertain. Hence, we aim to systematically analyzed the relevance of baseline plasma lipoprotein(a) levels to long-term mortality in a large cohort of CAD patients.Methods: We obtained data from 43,647 patients who were diagnosed with CAD and had follow-up information from January 2007 to December 2018. The patients were divided into two groups (&lt;15 and ≥15 mg/dL). The primary endpoint was long-term all-cause death. Kaplan–Meier curve analysis and Cox proportional hazards models were used to investigate the association between moderately elevated baseline lipoprotein(a) levels (≥15 mg/dL) and long-term all-cause mortality.Results: During a median follow-up of 5.04 years, 3,941 (18.1%) patients died. We observed a linear association between lipoprotein(a) levels and long-term all-cause mortality. Compared with lipoprotein(a) concentrations &lt;15 mg/dL, lipoprotein(a) ≥15 mg/dL was associated with a significantly higher risk of all-cause mortality [adjusted hazard ratio (aHR) 1.10, 95%CI: 1.04–1.16, P-values = 0.001). Similar results were found for the subgroup analysis of non-acute myocardial infarction, non-percutaneous coronary intervention, chronic heart failure, diabetes mellitus, or non-chronic kidney diseases.Conclusion: Moderately elevated baseline plasma lipoprotein(a) levels (≥15 mg/dL) are significantly associated with higher all-cause mortality in patients with CAD. Our finding provides a rationale for testing the lipoprotein(a)-reducing hypothesis with lower targets (even &lt;15 mg/dL) in CAD outcome trials.

scholarly journals Prognostic utility of lipoprotein(a) combined with fibrinogen in patients with stable coronary artery disease: a prospective, large cohort study

2020 ◽  
Author(s):  
Yan Zhang ◽  
Jing-Lu Jin ◽  
Ye-Xuan Cao ◽  
Hui-Hui Liu ◽  
Hui-Wen Zhang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cox Regression ◽  
Stable Coronary Artery Disease ◽  
Chinese Patients ◽  
Lipoprotein A ◽  
C Statistic ◽  
Kaplan Meier ◽  
Prognostic Utility ◽  
Artery Disease

Abstract Background: Elevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD). The atherogenicity of Lp(a) can be partly due to the potentially antifibrinolytic categories. We hypothesize that patients with higher Lp(a) and Fib may have worse outcomes. Methods: In this prospective study, we consecutively enrolled 8,417 Chinese patients with stable CAD from March 2011 to March 2017. All subjects were divided into 9 groups according to Lp(a) (Lp(a)-Low, Lp(a)-Medium, Lp(a)-High) and Fib levels (Fib-Low, Fib-Medium, Fib-High) and followed up for CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan-Meier, Cox regression and C-statistic analyses were performed.Results: During a median of 37.1 months’ follow-up, 395 (4.7%) CVEs occurred. The occurrence of CVEs increased by Lp(a) (3.5% vs. 5.3% vs. 5.6%, p=0.001) and Fib (4.0% vs. 4.4% vs. 6.1%, p<0.001) categories. When further classified into 9 groups by Lp(a) and Fib levels, the CVEs were highest in the 9th (Lp(a)-High and Fib-High) compared with the 1st (Lp(a)-Low and Fib-Low) group (7.2% vs. 3.3%, p<0.001). The highest risk of subsequent CVEs was found in the 9th group (HRadjusted 2.656, 95% CI 1.628-4.333, p<0.001), which was more significant than Lp(a)-High (HRadjusted 1.786, 95% CI 1.315-2.426, p<0.001) or Fib-High (HRadjusted 1.558, 95% CI 1.162-2.089, p=0.003) group. Moreover, adding the combined Lp(a) and Fib increased the C-statistic by 0.013.Conclusion: Combining Fib and Lp(a) enhance the prognostic value for incident CVEs beyond Lp(a) or Fib alone.

Sign in / Sign up

Export Citation Format

Share Document