scholarly journals Clinical and genetic factors associated with the risk of recurrent ischemic events in patients with stable stenocardia

2021 ◽  
Vol 20 (3) ◽  
pp. 18-27
Author(s):  
T. P. Pronko ◽  
V. A. Snezhitskiy ◽  
O. V. Gorchakova ◽  
M. L. Gladkiy ◽  
A. V. Kapytski
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Cerebral Infarction ◽  
Blood Test ◽  
Genetic Factors ◽  
Polymorphic Locus ◽  
Factors Associated ◽  
Stent Restenosis ◽  
Platelet Receptor ◽  
Ischemic Events

The aim of the study was to assess the clinical and genetic factors associated with the risk of recurrent ischemic events in patients with stable stenocardia (SS). Materials and methods. A total of 100 patients with SS were examined and followed-up for 15.3±8.3 months. The patients were divided into subgroups (SG): SG1 (n=51) – persons without events, SG2 (n=49) persons with recurrent ischemic events (hospitalization due to the development of pain syndrome, re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes), SGB (n=11) – persons with «major» recurrent ischemic events (re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes) , SGG (n=89) – persons without «major» events. The obtained survey data (general clinical, aggregometry, polymor  phism of genes of platelet fibrinogen receptor ITGB3 (T1565C), platelet collagen receptor ITGA2 (C807T), ADP platelet receptor P2RY12, H1/H2 (T744C)) were analyzed using the STATISTICA 10.0 software. Results. In SG2, men predominated (χ2 =9.2; p<0.01), past MI was more common (χ2 =4.8; p<0.05), more stents were implanted (2.4±1.9 versus 1.7±1.1, p<0.05), TRAP-test values were higher (p<0.05) compared to SG1. In SGB, greater number of stents were implanted (3.1±2.2 versus 1.61±1.57, p<0.05), the carriage of the TC genotype of the ITGB3 gene was more common, (p<0.05), a combination of gene mutations ITGB3 and P2RY12 was more common, (p<0.05) compared to SGG. A logistic regression equation was constructed, including the presence of diabetes mellitus, the number of platelets in the blood test, the ASPI-test values, the carriage of the 1565C allele of the ITGB3 gene, the number of stents implanted, which makes it possible to determine the likelihood of developing «major» recurrent ischemic events with a cut-off threshold LP₀=0.0965, with sensitivity – 81.82 %, specificity – 78.48 %, overall accuracy – 78.89 %. Conclusions. The factors associated with the development of recurrent ischemic events are: male sex, previous MI, a greater number of implanted stents, and high TRAP-test values. The factors associated with the development of recurrent «major» ischemic events are: a greater number of implanted stents, carriage of the TC genotype of the ITGB3 gene, carriage of a combination of mutations of the H1/H2 polymorphic locus of the P2RY12 gene and the T1565C polymorphic locus of the ITGB3 gene, diabetes mellitus, the number of platelets in blood test, ASPI-test values.

scholarly journals Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryota Inokuchi ◽  
Xueying Jin ◽  
Masao Iwagami ◽  
Toshikazu Abe ◽  
Masatoshi Ishikawa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cerebral Infarction ◽  
Clinic Visit ◽  
Telephone Triage ◽  
Hospital Visit ◽  
Over The Counter ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
History Of ◽  
House Call

Abstract Background Prehospital telephone triage stratifies patients into five categories, “need immediate hospital visit by ambulance,” “need to visit a hospital within 1 hour,” “need to visit a hospital within 6 hours,” “need to visit a hospital within 24 hours,” and “do not need a hospital visit” in Japan. However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged. Methods We included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively. Results We identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16–64, 65–74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71–3.36], 8.57 [95% CI 4.83–15.2], and 14.9 [95% CI 9.65–23.0], respectively; reference patients aged < 15 years); those with diabetes mellitus (2.31 [95% CI 1.25–4.26]); those with dementia (2.32 [95% CI 1.05–5.10]); and those with a history of cerebral infarction (1.98 [95% CI 1.01–3.87]) as more likely to be undertriaged. Conclusions We found that older adults and patients with diabetes mellitus, dementia, or a history of cerebral infarction were at risk of undertriage in patients triaged as need to visit a hospital within 1 h and 6 h, but further studies are needed to validate these findings.

scholarly journals Risk factors associated with post-stroke dementia: a systematic review and meta-analysis

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Jesada Surawan ◽  
Suchat Areemit ◽  
Somsak Tiamkao ◽  
Theparak Sirithanawuthichai ◽  
Suprawita Saensak
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Stroke Patients ◽  
Factors Associated ◽  
Pooled Data ◽  
Ischemic Attack

This study aimed to evaluate the risk factors for prognostic of post-stroke dementia (PSD). A systematic review included case-control and/or cohort studies, we searched both published and unpublished literatures between 2000 to July 31, 2016. Two authors independently screened and selected research articles. If another one disagreed, the third author would be just along with his/her professionally. Moreover, Critical appraisal was measured by the quality (GRADE). Data collection was in the data extraction form. The Rev-Man 5.3 was used to estimate pooled data. The fixed-effect model will be used when the heterogeneity I2>50%. Result eight publications were pooled for measuring an association between risk factors and PSD by meta-analysis. There were 6 strongly PSD risk factors. The pooled relative ratio (RR) of atrial fibrillation was 1.68, previous stroke 1.59, myocardial infarction 1.40, hypertension 1.36, diabetes mellitus 1.25 and previous transient ischemic attack 1.25 respectively. Un-pooled data from 13 publications reported that the risk factors for dementia in stroke patients were i) demographic factors, ii) vascular risk factors, iii) stroke factors, iv) stroke complications, and v) abnormalities on brain imaging. Strongly risk factors associated with increasing PSD risk were atrial fibrillation, previous stroke, myocardial infarction, hypertension, diabetes mellitus, and previous transient ischemic attack. Further studies, strongly risk factors need to investigate and develop the risk score for the prediction of dementia in stroke patients.

scholarly journals Ticagrelor monotherapy after percutaneous coronary intervention in patients with concomitant diabetes mellitus and chronic kidney disease: a TWILIGHT substudy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Cao ◽  
U Baber ◽  
G Dangas ◽  
S Sartori ◽  
Z Zhongjie ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Coronary Intervention ◽  
Study Groups ◽  
Percutaneous Coronary ◽  
Risk Patients ◽  
Type 3 ◽  
Ischemic Events

Abstract Background Diabetes mellitus (DM) and chronic kidney disease (CKD) are established risk factors for cardiovascular events, with patients presenting both conditions being at extremely high risk. P2Y12 inhibitor monotherapy with ticagrelor after a short course of dual antiplatelet therapy has emerged as a bleeding avoidance strategy for high-risk patients undergoing percutaneous coronary intervention (PCI). Purpose To investigate ischemic and bleeding outcomes associated with ticagrelor monotherapy versus ticagrelor plus aspirin according to the presence or absence of CKD and DM. Methods The TWILIGHT trial enrolled patients undergoing PCI with a drug-eluting stent who fulfilled at least one clinical and one angiographic high-risk criterion. Both DM and CKD (estimated glomerular filtration rate &lt;60 mL/min/1.73m2) were clinical study entry criteria. Following 3 months of ticagrelor plus aspirin, patients who had been adherent to treatment and free from major adverse events were randomly assigned to either aspirin or placebo in addition to ticagrelor for 1 year. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarction, or stroke. Net adverse clinical events (NACE) were defined as BARC type 3 or 5 bleeding, all-cause death, myocardial infarction, or stroke. Results Of the 6273 patients included in the analysis, 8.0% had both CKD and DM (DM+/CKD+), 8.9% had CKD only (DM-/CKD+), 29.0% had DM only (DM+/CKD-), and 52.1% had neither CKD nor DM (DM-/CKD-). At 1-year follow-up, there was a progressive increase in the rates of bleeding and ischemic events according to DM and CKD status (Figure 1). Ticagrelor plus placebo reduced the primary bleeding endpoint as compared with ticagrelor plus aspirin across all study groups, including DM+/CKD+ patients (4.7% vs. 8.7%; HR 0.52, 95% CI 0.25–1.07), with no evidence of heterogeneity (p-interaction=0.68). Similar treatment effects of ticagrelor monotherapy were observed for major BARC type 3 or 5 bleeding (p-interaction=0.17), with DM+/CKD+ patients showing the greatest absolute risk reduction (0.9% vs. 5.1%; HR 0.16, 95% CI 0.04–0.72). The key secondary endpoint was not significantly different between treatment arms across study groups, with the exception of a reduced risk in DM+/CKD- patients receiving ticagrelor monotherapy (p-interaction=0.033). A similar pattern in the DM+/CKD- group was observed for NACE (p-interaction=0.030) (Figure 2). Conclusions Among high-risk patients undergoing PCI, ticagrelor monotherapy reduced the risk of clinically relevant and major bleeding without a significant increase in ischemic events as compared with ticagrelor plus aspirin, irrespective of the presence of DM and CKD. Furthermore, ticagrelor monotherapy seemed to be associated with a more favourable net benefit in patients with DM without CKD. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator-initiated grant from AstraZeneca Figure 1. Event rates according to DM/CKD status Figure 2. Effects of ticagrelor monotherapy

scholarly journals Analysis Of Risk Factors Of Mellitus Diabetes At Hospital H. Andi Sulthan Daeng Radja Bulukumba

2019 ◽  
Vol 3 (2) ◽  
pp. 43-52
Author(s):  
Hardianti ◽  
Haerani ◽  
Amirullah
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Genetic Factors ◽  
Statistical Tests ◽  
Hospital Environment ◽  
P Value ◽  
Coronary Insufficiency ◽  
Factors Associated ◽  
Cholesterol Levels ◽  
Obesity Hypertension

Diabetes Mellitus (DM) is a health disorder in the form of a collection of symptoms caused by an increase in blood sugar (glucose) levels due to insulin deficiency or resistance. DM can cause complications such as hypertension, myocardial infarction, coronary insufficiency, diabetic retinopathy, cataracts, diabetic neuropathy, and others. Factors associated with diabetes mellitus are gender, age, genetic factors, obesity, hypertension, stress, cholesterol levels, and diet. From the results of a preliminary study conducted by researchers on July 25, 2018, with as many as 80 respondents, 40 respondents who experienced DM and 40 respondents who did not experience DM. The purpose of this study was to determine the factors associated with the incidence of diabetes mellitus in H.Andi Sulthan Hospital Daeng Radja Bulukumba in 2018 This study uses analytical design with a "case-control" approach. The population in this study is 228 people. The sample of this study were 80 respondents (40 respondents with DM and 40 respondents who were not DM) with a purposive sampling method. The results of the study were carried out using statistical tests obtained that gender, age, genetic factors, obesity, hypertension, stress, cholesterol levels, and dietary patterns are risk factors for diabetes mellitus which obtained by (p-value = <0.005) so that it can be concluded that there is a relationship of gender, age, genetic factors, obesity, hypertension, stress, cholesterol levels and diet with the incidence of diabetes mellitus in H.Andi Sulthan Daeng Radja Bulukumba Hospital. It is recommended for hospitals to cooperate in promotive and preventive efforts by providing counseling or information media in the hospital environment.

scholarly journals APOA1 (-75 G>A and 83 C>T) and APOB (2488 C>T) polymorphisms and its association with Myocardial Infarction, lipids and apolipoproteins in patients with Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Fidel Casillas ◽  
Diana Martínez Fernández ◽  
Yeminia Valle ◽  
Maricela Aceves Ramírez ◽  
Brenda Parra-Reyna ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Healthy Subjects ◽  
Genotype Distribution ◽  
Dominant Model ◽  
Susceptibility Factor ◽  
Increased Risk ◽  
Ischemic Events

IntroductionThe increased risk of myocardial infarction (MI) in T2DM is well documented. Polymorphisms in APOA1 and APOB genes allow us to identify new genetic markers in Mexican population with T2DM and MI.Material and methodsWe studied 135 patients with DMT2 and MI (DI); another 85 non-infarcted diabetic individuals with DMT2 but without previous ischemic events (NID) and 242 Healthy subjects (HS), all three groups were selected with the aim to investigate the association between the polymorphisms and infarction when T2DM is present or absent.Results-75 G>A polymorphism: differences were found in genotype distribution between DI and NID individuals (OR: 2.01, CI:1.117-3.623, p= 0.019) with an increased risk for A in the dominant model (OR: 1.77, CI: 1.020-3.084, p= 0.042); also concentrations of ApoA-I for A/A were lower in comparison with G/A (p = 0.038) and LDL-C and HDL-C levels were lower in G/A respecting to G/G carriers. 83 C> T polymorphism of APOA1: for DI individuals: HDL-C was lower in T/T respecting to C/C and triglyceride levels were lower in C/T respect to C/C carriers.ConclusionsThe -75 G>A APOA1 polymorphism could be considered as a susceptibility factor for Myocardial Infarction in individuals with T2DM and 2488 C>T APOB polymorphism is associated with changes in HDL-C and LDL-C and triglycerides in the same group.roup.

scholarly journals Ischemic and Bleeding Events of Ticagrelor Monotherapy in Korean Patients With and Without Diabetes Mellitus: Insights From the TICO Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Kyeong Ho Yun ◽  
Jae Young Cho ◽  
Seung Yul Lee ◽  
Sang Jae Rhee ◽  
Byeong Keuk Kim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Academic Research ◽  
Bleeding Complications ◽  
Diabetic Patients ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
The Impact ◽  
Ischemic Events

Background: Ticagrelor monotherapy after 3 months dual antiplatelet therapy (DAPT) with aspirin and ticagrelor can reduce bleeding without increasing ischemic events after percutaneous coronary intervention (PCI). However, the impact of this approach among the patient with diabetes remains unknown.Methods: This was a sub-analysis of the Ticagrelor Monotherapy after 3 months in the Patients Treated with New Generation Sirolimus Eluting Stent for Acute Coronary Syndrome (TICO) trial. After successful PCI, the patients were randomly assigned to ticagrelor monotherapy after 3-months DPAT or to ticagrelor-based 12-months DAPT. We compared ischemic events and bleeding events between the patients with diabetes and without diabetes for 12 months. Ischemic events were defined as death, myocardial infarction, ischemic stroke, transient ischemic attack, stent thrombosis, and any revascularizations. Bleeding events were defined according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and Bleeding Academic Research Consortium (BARC) definition.Results: Between August 2015 and October 2018, 3,056 patients were enrolled in the TICO trial, of which 835 (27.3%) had diabetes mellitus. Diabetes mellitus was associated with all evaluated ischemic and bleeding events. No significant differences in any ischemic events were observed in patients with diabetes between ticagrelor monotherapy after 3-months DAPT and ticagrelor-based 12-months DAPT (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.45–1.52, p = 0.540). In patients with diabetes, the overall incidence of bleeding complications during the 12-months follow-up period did not differ between the two treatment groups (HR 0.83, 95% CI 1.48–1.43, p = 0.505). However, ticagrelor monotherapy was significantly reduced both any TIMI bleeding and BARC three or five bleeding events in diabetes patients in the 3-months landmark analysis, after 3-months DAPT period (HR 0.20, 95% CI 0.07–0.59, p = 0.003).Conclusion: In diabetic patients, ticagrelor monotherapy showed a lower incidence of bleeding complications after 3-months DAPT period, without increasing ischemic complications, compared with ticagrelor-based 12-months DAPT (ClinicalTrials.gov Identifier: NCT02494895).

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