Traditional clinical risk factors predict clopidogrel hypo-responsiveness in unselected patients undergoing non-emergent percutaneous coronary intervention

Abstract Background Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death. Results During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %). Conclusions For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.

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Prognostic value of age-adjusted d-dimer cutoff thresholds in patients with myocardial infarction treated by percutaneous coronary intervention

European Heart Journal ◽

10.1093/ehjci/ehaa946.1310 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Chen ◽

C Liu ◽

P Zhou ◽

Y Tan ◽

Z Sheng ◽

...

Keyword(s):

Risk Factors ◽

Prognostic Value ◽

Independent Predictor ◽

Coronary Intervention ◽

Clinical Risk Factors ◽

Funding Source ◽

Clinical Risk ◽

Percutaneous Coronary ◽

Grace Score ◽

D Dimer

Abstract Introduction The association between D-dimer and outcomes of patients with myocardial infarction (MI) remains controversial. Using age-adjusted D-dimer cutoff thresholds significantly improves the accuracy of diagnosis for thrombotic diseases. This study aimed to investigate the prognostic value of age-adjusted D-dimer in MI patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3614 consecutive patients with MI treated by PCI were retrospectively recruited. The baseline age-adjusted D-dimer threshold was 500 ng/mL, and was calculated as age × 10 in patients older than 50 years. Cox regression was used for outcome analysis. The primary outcome was all-cause death. Discrimination and reclassification were calculated to assess the additional prognostic value of D-dimer when combined with established clinical risk factors and the Global Registry of Acute Coronary Events (GRACE) risk score. Results During a median follow-up of 652 days, a total of 194 deaths occurred. High D-dimer level, as defined by age-adjusted thresholds, was an independent predictor for all-cause death (hazard ratio:1.67, 95% confidence interval: 1.23–2.27, P=0.001). Addition of D-dimer level (high or low) significantly improved risk classification for death when combined with established clinical risk factors (net reclassification index [NRI]: 0.601, P<0.001; integrated discrimination improvement [IDI]: 0.011, P=0.046) and GRACE score (NRI: 0.618, P<0.001; IDI: 0.015, P=0.011). Conclusions In patients with MI treated by PCI, D-dimer elevation defined by age-adjusted thresholds was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and GRACE score. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

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Relative Impact of Clinical Risk Versus Procedural Risk on Clinical Outcomes After Percutaneous Coronary Intervention

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009642 ◽

2021 ◽

Vol 14 (2) ◽

Author(s):

Jeehoon Kang ◽

Kyung Woo Park ◽

Hak Seung Lee ◽

Chengbin Zheng ◽

Tae-Min Rhee ◽

...

Keyword(s):

Risk Factors ◽

Percutaneous Coronary Intervention ◽

Clinical Outcomes ◽

Area Under The Curve ◽

Coronary Intervention ◽

Hazard Ratio ◽

Relative Impact ◽

Unique Identifier ◽

Clinical Risk ◽

Percutaneous Coronary

Background: The clinical outcome after percutaneous coronary intervention (PCI) is affected by various clinical and procedural risk factors. We investigated the relative impact of clinical and procedural risks on clinical outcomes after PCI. Methods: A total of 13 172 patients were enrolled from the Grand-DES registry. The population was grouped into tertiles (high-, intermediate-, low-risk) according to the number of prespecified clinical and procedural risk factors, respectively. The primary end point was major adverse cardiac and cerebrovascular events (MACCE) at 3 years post-PCI. Results: MACCE occurred in 1109 (8.4%) patients during the follow-up period (median duration: 1126 days). Compared with procedural risk, clinical risk showed superior predictive power (area under the curve: 0.678 versus 0.570, P <0.001, for clinical and procedural risks, respectively) and greater magnitude of effect in the multivariate analysis for MACCE (Clinical risk: hazard ratio, 1.953 [95% CI, 1.809–2.109], P <0.001; procedural risk: hazard ratio, 1.240 [95% CI, 1.154–1.331], P <0.001). In subgroup analyses within each clinical risk tertile, procedural risk had no significant impact on MACCE in the lowest clinical risk tertile. An annual landmark analysis revealed that clinical and procedural risks were both significant predictors of MACCE, which occurred within the first and second year post-PCI. However, for MACCE occurring in the third year post-PCI, only clinical risk but not procedural risk was a significant predictor of events. Conclusions: Clinical and procedural risks were both significant predictors for ischemic clinical events in patients undergoing PCI. However, clinical risk had a greater and more prolonged effect on outcomes than procedural risk. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03507205.

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Risk factors of coronary microvascular obstruction (Preprint)

10.2196/preprints.20998 ◽

2020 ◽

Author(s):

Yong Li ◽

Shuzheng Lyu

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Logistic Regression ◽

Microvascular Obstruction ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Neutrophil Percentage ◽

Percutaneous Coronary ◽

St Elevation

BACKGROUND Coronary microvascular obstruction /no-reflow(CMVO/NR) is a predictor of long-term mortality in survivors of ST elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI). OBJECTIVE To identify risk factors of CMVO/NR. METHODS Totally 2384 STEMI patients treated with PPCI were divided into two groups according to thrombolysis in myocardial infarction(TIMI) flow grade:CMVO/NR group(246cases,TIMI 0-2 grade) and control group(2138 cases,TIMI 3 grade). We used univariable and multivariable logistic regression to identify risk factors of CMVO/NR. RESULTS A frequency of CMVO/NR was 10.3%(246/2384). Logistic regression analysis showed that the differences between the two groups in age(unadjusted odds ratios [OR] 1.032; 95% CI, 1.02 to 1.045; adjusted OR 1.032; 95% CI, 1.02 to 1.046 ; P <0.001), periprocedural bradycardia (unadjusted OR 2.357 ; 95% CI, 1.752 to 3.171; adjusted OR1.818; 95% CI, 1.338 to 2.471 ; P <0.001),using thrombus aspirationdevices during operation (unadjusted OR 2.489 ; 95% CI, 1.815 to 3.414; adjusted OR1.835; 95% CI, 1.291 to 2.606 ; P =0.001),neutrophil percentage (unadjusted OR 1.028 ; 95% CI, 1.014 to 1.042; adjusted OR1.022; 95% CI, 1.008 to 1.036 ; P =0.002) , and completely block of culprit vessel (unadjusted OR 2.626; 95% CI, 1.85 to 3.728; adjusted-OR 1.656;95% CI, 1.119 to 2.45; P =0.012) were statistically significant ( P <0. 05). The area under the receiver operating characteristic curve was 0.6896 . CONCLUSIONS Age , periprocedural bradycardia, using thrombus aspirationdevices during operation, neutrophil percentage ,and completely block of culprit vessel may be independent risk factors for predicting CMVO/NR. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023213; registered date: 16 May 2019).http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4. Key Words: Coronary disease ST elevation myocardial infarction No-reflow phenomenon Percutaneous coronary intervention

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Incidence and risk factors of delirium after percutaneous coronary intervention in individuals hospitalised for acute myocardial infarction: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044564 ◽

2020 ◽

Vol 10 (12) ◽

pp. e044564

Author(s):

Kaizhuang Huang ◽

Jiaying Lu ◽

Yaoli Zhu ◽

Tao Cheng ◽

Dahao Du ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Systematic Review ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Risk Factor ◽

Meta Analysis ◽

Coronary Intervention ◽

Cochrane Library ◽

Percutaneous Coronary

IntroductionDelirium in the postoperative period is a wide-reaching problem that affects important clinical outcomes. The incidence and risk factors of delirium in individuals with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI) has not been completely determined and no relevant systematic review and meta-analysis of incidence or risk factors exists. Hence, we aim to conduct a systematic review and meta-analysis to ascertain the incidence and risk factors of delirium among AMI patients undergoing PCI.Methods and analysesWe will undertake a comprehensive literature search among PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL and Google Scholar from their inception to the search date. Prospective cohort and cross-sectional studies that described the incidence or at least one risk factor of delirium will be eligible for inclusion. The primary outcome will be the incidence of postoperative delirium. The quality of included studies will be assessed using a risk of bias tool for prevalence studies and the Cochrane guidelines. Heterogeneity of the estimates across studies will be assessed. Incidence and risk factors associated with delirium will be extracted. Incidence data will be pooled. Each risk factor reported in the included studies will be recorded together with its statistical significance; narrative and meta-analytical approaches will be employed. The systematic review and meta-analysis will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, and thus there is no requirement for ethics approval. The study will provide an up to date and accurate incidence and risk factors of delirium after PCI among patients with AMI, which is necessary for future research in this area. The findings of this study will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020184388.

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Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention

Clinical and Experimental Nephrology ◽

10.1007/s10157-021-02061-4 ◽

2021 ◽

Author(s):

Xiaoqi Wei ◽

Hanchuan Chen ◽

Zhebin You ◽

Jie Yang ◽

Haoming He ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Percutaneous Coronary Intervention ◽

Nutritional Status ◽

Elderly Patients ◽

Kidney Injury ◽

Coronary Intervention ◽

Severe Malnutrition ◽

Percutaneous Coronary ◽

Conut Score

Abstract Background This study aimed to investigate the connection between malnutrition evaluated by the Controlling Nutritional Status (CONUT) score and the risk of contrast-associated acute kidney injury (CA-AKI) in elderly patients who underwent percutaneous coronary intervention (PCI). Methods A total of 1308 patients aged over 75 years undergoing PCI was included. Based on the CONUT score, patients were assigned to normal (0–1), mild malnutrition (2–4), moderate-severe malnutrition group (≥ 5). The primary outcome was CA-AKI (an absolute increase in ≥ 0.3 mg/dL or ≥ 50% relative serum creatinine increase 48 h after contrast medium exposure). Results Overall, the incidence of CA-AKI in normal, mild, moderate-severe malnutrition group was 10.8%, 11.0%, and 27.2%, respectively (p < 0.01). Compared with moderate-severe malnutrition group, the normal group and the mild malnutrition group showed significant lower risk of CA-AKI in models adjusting for risk factors for CA-AKI and variables in univariate analysis (odds ratio [OR] = 0.48, 95% confidence interval [CI]: 0.26–0.89, p = 0.02; OR = 0.46, 95%CI: 0.26–0.82, p = 0.009, respectively). Furthermore, the relationship were consistent across the subgroups classified by risk factors for CA-AKI except anemia. The risk of CA-AKI related with CONUT score was stronger in patients with anemia. (overall interaction p by CONUT score = 0.012). Conclusion Moderate-severe malnutrition is associated with higher risk of CA-AKI in elderly patients undergoing PCI.

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