scholarly journals Cardiac Troponin-I And CK-MB for Risk Stratification in Acute Myocardial Infarction (First Attack): A Comparative Study

2013 ◽  
Vol 4 (1) ◽  
pp. 10-15 ◽  
Author(s):  
S Joarder ◽  
M Hoque ◽  
M Towhiduzzaman ◽  
AF Salehuddin ◽  
N Islam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
The Mean ◽  
The Difference

Myocardial infarction is associated with release of two important enzymes. The enzymatic diagnosis is mainly based on the measurement of CK-MB and troponin-I. Cardiac troponin- I(cTnI) is known to have higher specificity and analytic sensitivity than CK-MB for detection of myocardial injury & risk stratification. These are used both as diagnostic and prognostic marker. This prospective observational study included 60 patients of 40-65 years age range, diagnosed as acute myocardial infarction. The mean ages were 50± 8 years and 53±8 years respectively. Male and female patients included were 86.7% and 13.3%; BMI was 25.3±1.5. The two important cardiac markers troponin-I and CK-MB were studied in 60 patients, admitted in the hospital with acute MI. Blood samples to estimate these markers were collected from the patients after admission at 6-9 hours, 9-24 hours and after 24 hours and their mean values with ±SD were calculated, evaluated and compared between the two groups of patients with low and high risk MI. The patients with low risk MI were those who recovered early and the high risk patients improved later in comparison to low risk group. Out of 60 patients, 37 had troponin-I level>1.5 ng /ml. Among them 29 developed high risk MI and 8 recovered earlier than high risk group. 23 patients had troponin-I <1.5 ng /ml, out of whom 10 were high and 13 were low risk. The difference of troponin-I levels between high and low risk groups of patients was statistically significant (p<0.01). On the other hand CK-MB level was >7 ng /ml in 33 patients. Out of them 22 patients developed high and 11 patients were low risk but 18 patients out of 27 who had CK-MB <7 ng /ml became high and 9 patients were low risk. The difference of outcome in respect to higher and lower values of CK-MB between the two groups was not statistically significant (p>0.05). Both troponin-I and CK-MB were estimated in all 60 patients on three occasions. The mean troponin-I levels were statistically significant between the high and the low risk groups on all occasions. On the contrary, the values of CK-MB were not statistically significant on two occasions but was significant (p < 0.01) on one occasion when it was estimated at 9 - 24 hour. Serum cTnI is better and more characteristic biomarker than CK-MB for risk prediction and prognosis evaluation in AMI patients. DOI: http://dx.doi.org/10.3329/bjmb.v4i1.13776 Bangladesh J Med Biochem 2011; 4(1): 10-15

scholarly journals Role of serum cardiac Troponin-I for risk stratification in first attack in acute myocardial infarction

1970 ◽  
Vol 8 (3) ◽  
pp. 57-63
Author(s):  
Md Sahabuddin Joarder ◽  
Md Jafarullah ◽  
Ahmed Moinuddin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Outcome Evaluation ◽  
Cardiac Troponin I ◽  
The Mean ◽  
The Difference ◽  
Q Wave

Introduction: Cardiac troponin-I (cTnI) is known to have the highest specificity and analytic sensitivity for detection of myocardial injury; it is used both as diagnostic and prognostic marker. This study was aimed to confirm this idea. Subjects & methods: This prospective observational study included 60 patients of 40 to 65 years age range diagnosed as acute myocardial infarction. The mean ages were 50±8 years and 53±8 years in Q -wave AMI and non Q-wave AMI respectively. Male and female patients included were 86.7% and 13.3%; BMI was 25.3±1.5. Results: Study showed troponin-I 7.53±0.086 ng/ml in Q wave and in non Q-wave AMI was 6.38±0.64 ng/ml after 24 hours of attack of AMI without any significant difference between two groups (P>0.05). The mean troponin-I within 9 hours of attack, were 1.60±0.80 ng/ml and 2.7±1.4 ng/ml in stable and unstable group respectively and the difference found statistically significant (P<0.05). The mean troponin-I between 9-24 hours of attack were 2.90±1.20 ng/ml and 4.90±3.20 ng/ml in stable and unstable group respectively and the difference found statistically significant (P<0.01). The mean troponin-I in unstable group after 24 hours was 9.20±4.30 ng/ml which was more than between 9-24 hours and the difference was significant (P>0.001). In clinicopathological outcome evaluation 37 patients had troponin-I level >1.5 ng/ml in which 29 patients developed unstability and 8 patients were stable. Conclusion: Serum cTnI is better and more characteristic biomarker for risk prediction and prognosis evaluation in AMI patients. Key words: Cardiac Troponin-I, acute myocardial infarction, risk stratification.   DOI: 10.3329/bjms.v8i3.3984 Bangladesh Journal of Medical Sciences Vol.8(3) 2009 p57-63

Short-term risk stratification using CADILLAC risk score in patients with ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Satou ◽  
H Kitahara ◽  
K Ishikawa ◽  
T Nakayama ◽  
Y Fujimoto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Short Term ◽  
Recurrent Myocardial Infarction ◽  
St Elevation

Abstract Background The recent reperfusion therapy for ST-elevation myocardial infarction (STEMI) has made the length of hospital stay shorter without adverse events. CADILLAC risk score is reportedly one of the risk scores predicting the long-term prognosis in STEMI patients. Purpose To invenstigate the usefulness of CADILLAC risk score for predicting short-term outcomes in STEMI patients. Methods Consecutive patients admitted to our university hospital and our medical center with STEMI (excluding shock, arrest case) who underwent primary PCI between January 2012 and April 2018 (n=387) were enrolled in this study. The patients were classified into 3 groups according to the CADILLAC risk score: low risk (n=176), intermediate risk (n=87), and high risk (n=124). Data on adverse events within 30 days after hospitalization, including in-hospital death, sustained ventricular arrhythmia, recurrent myocardial infarction, heart failure requiring intravenous treatment, stroke, or clinical hemorrhage, were collected. Results In the low risk group, adverse events within 30 days were significantly less observed, compared to the intermediate and high risk groups (n=13, 7.4% vs. n=13, 14.9% vs. n=58, 46.8%, p&lt;0.001). In particular, all adverse events occurred within 3 days in the low risk group, although adverse events, such as heart failure (n=4), recurrent myocardial infarction (n=1), stroke (n=1), and gastrointestinal bleeding (n=1), were substantially observed after day 4 of hospitalization in the intermediate and high risk groups. Conclusions In STEMI patients with low CADILLAC risk score, better short-term prognosis was observed compared to the intermediate and high risk groups, and all adverse events occurred within 3 days of hospitalization, suggesting that discharge at day 4 might be safe in this study population. CADILLAC risk score may help stratify patient risk for short-term prognosis and adjust management of STEMI patients. Initial event occurrence timing Funding Acknowledgement Type of funding source: None

scholarly journals The Revised Myeloma Comorbidity Index (R-MCI) As a Promising Approach for Predicting Overall (OS)- and Progression-Free (PFS) Survival and Optimizing Therapy Strategies in Multiple Myeloma (MM) Patients (pts) - Comparative Analysis of 5 Comorbidity Indices (CI), Including Retro- and Prospective Applicability

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3474-3474
Author(s):  
Katja Schoeller ◽  
Gabriele Ihorst ◽  
Sophia Scheubeck ◽  
Max Holler ◽  
Sandra M. Woerner ◽  
...  
Keyword(s):  
High Risk ◽  
Research Funding ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Chi Square ◽  
Mayo Score ◽  
The Difference ◽  
Therapy Strategies ◽  
Group Distribution

Introduction: MM is considered an incurable disease. Due to the improvement in long-term survival of MM pts with innovative therapy strategies, the necessity of including comorbidities and biological fitness status to treatment options has significantly increased over the last years. However, elderly pts still remain to benefit to lesser extends revealing lower PFS and OS rates, show more treatment-induced side effects and a lower quality of life. Therefore, it is inevitable to include an objective frailty assessment into MM guidelines to avoid under- and overtreatment. Since no CI has been widely established yet, selection process should include the capability of assessing a retro- and prospective baseline for comparing CI results among available data sets. This analysis compared 5 internationally well-discussed CIs regarding OS and PFS prediction and tested if these CIs can be reliably assessed retro- and prospectively. Methods: This prospective study was performed for 347 consecutive pts treated at our center, analyzing OS and PFS for the R-MCI, IMWG-, CCI, Mayo- and MRP-scores: the factors that are included in each individual score are shown in Table 1. For each CI, pts were divided into 3 risk groups (low-, intermediate-, high-risk), except for the CCI with possible designation into low- and high-risk group only. Based on these risk groups, OS and PFS were estimated by Kaplan Meier Method and compared via log rank test. Additionally we compared this above mentioned prospective cohort with a prior study including 749 pts treated at our center (Haematologica 2017;102:910-21). For this cohort we now performed a retrospective analysis with 4 of the latter CIs to analyze differences in risk group distribution within these two cohorts via Chi Square tests. Since there was missing laboratory data for the UK-MRP-score in the retrospective cohort, it was excluded from the latter analysis. Results: Pts' characteristics were typical for tertiary centers with a median age of 65 years (yrs). Median Follow-up was 36 months, median OS was not reached and PFS was 34 months. All 5 CIs could divide pts into risk groups with significantly different OS (p&lt;0.05). The difference in 3yr OS for high- and low-risk group using the R-MCI was 43% and via IMWG- and Mayo-score 37% and 70% respectively. Minor distinction for OS prediction was achieved by CCI and MRP with only 25% and 20% difference. For the MRP, the 3-yr-OS rate for frail (59%) exceeded that of intermediate pts (50%), moreover, this group comprised only low numbers (n=8). In analogy, the difference in 3yr PFS amounted to 48% for the R-MCI vs. 40% and 59% for IMWG- and Mayo-scores, respectively. Here again the CCI and MPR showed lowest PFS differences with only 20% and 27% between high- and low-risk groups (Table 1). Comparing the pro- and retrospective analyses via Chi-Square tests, only the R-MCI showed comparable results for the risk group distribution in both cohorts (p=0.26) with 26% vs. 27%, 60% vs. 55% and 14% vs. 18% in low-risk, intermediate-risk and high-risk groups, respectively (Table 1). Respective results for IMWG and CCI scores showed that significantly more patients were defined as low-risk in the retrospective than in prospective cohorts with 41% vs. 30% for the IMWG and 65% vs. 47% for the CCI, respectively (p&lt;0.001). The results for the Mayo-score revealed that 13% of the retrospective cohort were classified as high-risk as compared to 8% of the prospective cohort (p=0.0209). Conclusions: To our knowledge this is the first large prospective comparative analysis of 5 internationally discussed CIs. Our results show an excellent separation into risk groups with different OS and PFS via R-MCI, IMWG and Mayo-scores, whereas via CCI and Mayo-score to a much lesser extent. The results of this analysis reinforce the multifunctionality and convenience of using one MM-CI, like the robustly tested and repeatedly validated R-MCI. Further unique features of the R-MCI are the pro- and retrospective applicability in daily clinics, a user-friendly homepage and the future perspective of extended use, e.g. for tailoring therapies, which is currently investigated and which results will be shown at the meeting. Disclosures Wäsch: Takeda: Consultancy; Pfizer: Consultancy; Amgen: Other: travel, Research Funding; Sanofi: Consultancy; Gilead: Other: travel, Research Funding; Novartis: Consultancy; Celgene: Other: travel, Research Funding; Sanofi: Other: Travel, Research Funding; Gilead: Consultancy; Jazz: Other: travel, Research Funding; Amgen: Consultancy.

Prediction of Survival in Patients with Myelodysplastic Syndrome According to WHO Classification-Based Prognostic Scoring System (WPSS).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4617-4617
Author(s):  
Jun Ho Jang ◽  
Kihyun Kim ◽  
Chul W. Jung ◽  
Keon Woo Park
Keyword(s):  
High Risk ◽  
Scoring System ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Risk Scores ◽  
The Mean ◽  
Very High

Abstract Background Based upon the classification of FAB criteria, International Prognostic Scoring System(IPSS) has been a standard prognostic model to predict survival and progression in MDS. In 2000, the WHO has formulated a new classification of myelodysplastic syndrome(MDS). The aim of this study was to evaluate the prognostic value of WHO classification-based prognostic scoring system(WPSS) in MDS. Patients and methods One hundred forty-nine patients who were diagnosed as having de novo MDS at the Division of Hematology-Oncology, Samsung medical center, Seoul, Korea, between Dec. 1994 and Feb. 2007, were evaluated retrospectively for clinical and hamatologic features at diagnosis, transfusion dependence, overall survival(OS), and progression to leukemia(LFS). Risk group stratifications in MDS patients were done according to IPSS and WPSS. Results 18 patients(12.1%), 93 patients (62.4%), 29 patients(29%) and 9 patients(6%) had IPSS risk scores of low, intermediate-1(Int-1), intermediate-2(Int-2) and high, respectively. According to WPSS risk scores, 8 patients(5.4%), 30 patients(20.1%), 41 patients(27.5%), 57 patients(38.3%) and 13 patients(8.7%) were classified to very low, low, intermediate, high and very high risk group, respectively. In IPSS, median OSs of low, Int-1, Int-2 and high subgroup were 65.2, 32.9, 14.3 and 9.1 months respectively (p<0.001). According to WPSS, median OSs of very low, low, intermediate, high and very high risk subgroup were not reached, 55.4, 27.4, 19.0 and 6.2 months respectively (p<0.001). Between subgroups classified according to WPSS, significant differences in OS were noted in low vs. intermediate risk group (p=0.047), in intermediate vs. high risk group (p=0.046) and in high vs. very high risk group(p=0.003) but statistically not significant difference in OS was observed between very low and low risk group (p=0.08). The mean and median OS of the lowest risk group(low risk) in IPSS are 65.33 and 55.43 months, respectively. The mean and median OS of the lowest risk group(very low risk) in WPSS are 102.8 months and not reached, respectively. Conclusion These data show that WPSS with five risk groups might provide more refined prognostic stratifications of MDS than IPSS with four risk groups. Especially, new prognostic system appears to discriminate a subset of patients with very low risk, who could have long term survival.

scholarly journals Sernbo score predicts survival after intracapsular hip fracture in the elderly

2013 ◽  
Vol 95 (1) ◽  
pp. 29-33 ◽  
Author(s):  
EJC Dawe ◽  
E Lindisfarne ◽  
T Singh ◽  
I McFadyen ◽  
P Stott
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Risk Group ◽  
Characteristic Curve ◽  
Social Situation ◽  
High Risk Group ◽  
Low Risk ◽  
Risk Of Death ◽  
Intracapsular Hip Fracture ◽  
The Mean

Introduction The Sernbo score uses four factors (age, social situation, mobility and mental state) to divide patients into a high-risk and a low-risk group. This study sought to assess the use of the Sernbo score in predicting mortality after an intracapsular hip fracture. Methods A total of 259 patients with displaced intracapsular hip fractures were included in the study. Data from prospectively generated databases provided 22 descriptive variables for each patient. These included operative management, blood tests and co-mobidities. Multivariate analysis was used to identify significant predictors of mortality. Results The mean patient age was 85 years and the mean follow-up duration was 1.5 years. The one-year survival rate was 92% (±0.03) in the low-risk group and 65% (±0.046) in the high-risk group. Four variables predicted mortality: Sernbo score >15 (p=0.0023), blood creatinine (p=0.0026), ASA (American Society of Anaesthesiologists) grade >3 (p=0.0038) and non-operative treatment (p=0.0377). Receiver operating characteristic curve analysis showed the Sernbo score as the only predictor of 30-day mortality (area under curve 0.71 [0.65–0.76]). The score had a sensitivity of 92% and a specificity of 51% for prediction of death at 30 days. Conclusions The Sernbo score identifies patients at high risk of death in the 30 days following injury. This very simple score could be used to direct extra early multidisciplinary input to high-risk patients on admission with an intracapsular hip fracture.

Abstract 2425: Absence of Auto-Antibodies against Cardiac Troponin I Predicts Improvement of Left Ventricular Function after Acute Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Florian Leuschner ◽  
Jin Li ◽  
Stefan Göser ◽  
Lars Reinhardt ◽  
Renate Öttl ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Stroke Volume ◽  
Antibody Titer ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Igg Antibody ◽  
Follow Up Study

Application of antibodies against cardiac troponin I (cTnI-Ab) can induce dilation and dysfunction of the heart in mice. Recently, we demonstrated that immunization with cTnI induces inflammation and fibrosis in myocardium of mice. Others have shown that autoanti-bodies to cTnI are present in patients with acute coronary syndrome. But little is known about the clinical relevance of detected cTnI-Ab. First, anti-cTnI and anti-cTnT antibody titers were measured in sera from 272 patients with dilated- (DCM) and 185 with ischemic- (ICM) cardiomyopathy. Secondly, 108 patients with acute myocardial infarction (AMI) were included for a follow-up study. Heart characteristics were determined by magnetic resonance imaging 4 days and 6 –9 months after AMI. Altogether, in 7,0% of patients with DCM and in 9,2% with ICM an anti-cTnI IgG antibody titer ≥1:160 was measured. In contrast, only in 1,7% of patients with DCM and in 0,5% with ICM an anti-cTnT IgG antibody titer ≥1:160 was detected. Ten out of 108 patients included in the follow-up study were tested positive for cTnI-Ab with IgG Ab titers ≥1:160. TnI-Ab negative patients showed a significant increase in LVEF and stroke volume 6 –9 months after AMI. In contrast, there was no significant increase in LVEF and stroke volume in TnI-Ab positive patients. We demonstrate for the first time that the prevalence of cTnI-Abs in patients with AMI has an impact on the improvement of the LVEF over a study period of 6 –9 months.

scholarly journals Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 5-12 ◽  
Author(s):  
Dominique N van Dongen ◽  
Rudolf T Tolsma ◽  
Marion J Fokkert ◽  
Erik A Badings ◽  
Aize van der Sluis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

scholarly journals Immune‐related Long Noncoding RNA Signature for Patients with Cervical Cancer

2020 ◽  
Author(s):  
Jianfeng Zheng ◽  
Jinyi Tong ◽  
Benben Cao ◽  
Xia Zhang ◽  
Zheng Niu
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Risk Score ◽  
Immune Cell ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Gene Set Enrichment Analysis ◽  
Training Set ◽  
Score Model

Abstract Background: Cervical cancer (CC) is a common gynecological malignancy for which prognostic and therapeutic biomarkers are urgently needed. The signature based on immune‐related lncRNAs(IRLs) of CC has never been reported. This study aimed to establish an IRL signature for patients with CC.Methods: The RNA-seq dataset was obtained from the TCGA, GEO, and GTEx database. The immune scores（IS）based on single-sample gene set enrichment analysis (ssGSEA) were calculated to identify the IRLs, which were then analyzed using univariate Cox regression analysis to identify significant prognostic IRLs. A risk score model was established to divide patients into low-risk and high-risk groups based on the median risk score of these IRLs. This was then validated by splitting TCGA dataset(n=304) into a training-set(n=152) and a valid-set(n=152). The fraction of 22 immune cell subpopulations was evaluated in each sample to identify the differences between low-risk and high-risk groups. Additionally, a ceRNA network associated with the IRLs was constructed.Results: A cohort of 326 CC and 21 normal tissue samples with corresponding clinical information was included in this study. Twenty-eight IRLs were collected according to the Pearson’s correlation analysis between immune score and lncRNA expression (P < 0.01). Four IRLs (BZRAP1-AS1, EMX2OS, ZNF667-AS1, and CTC-429P9.1) with the most significant prognostic values (P < 0.05) were identified which demonstrated an ability to stratify patients into low-risk and high-risk groups by developing a risk score model. It was observed that patients in the low‐risk group showed longer overall survival (OS) than those in the high‐risk group in the training-set, valid-set, and total-set. The area under the curve (AUC) of the receiver operating characteristic curve (ROC curve) for the four IRLs signature in predicting the one-, two-, and three-year survival rates were larger than 0.65. In addition, the low-risk and high-risk groups displayed different immune statuses in GSEA. These IRLs were also significantly correlated with immune cell infiltration. Conclusions: Our results showed that the IRL signature had a prognostic value for CC. Meanwhile, the specific mechanisms of the four-IRLs in the development of CC were ascertained preliminarily.

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