scholarly journals Shock Index-C: An Updated and Simple Risk-Stratifying Tool in ST-Segment Elevation Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
Peng Ran ◽  
Xue-biao Wei ◽  
Ying-wen Lin ◽  
Guang Li ◽  
Jie-leng Huang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Predictive Power ◽  
Area Under The Curve ◽  
Hospital Death ◽  
Shock Index ◽  
Roc Curve Analysis ◽  
Chi Square ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Shock index (heart rate/systolic blood pressure, SI) is a simple scale with prognostic value in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The present study introduces an updated version of SI that includes renal function.Methods: A total of 1,851 consecutive patients with STEMI undergoing PCI were retrospectively included at Cardiac Care Unit in Guangdong Provincial People's Hospital and divided into two groups according to their admission time: derivation database (from January 2010 to December 2013, n = 1,145) and validation database (from January 2014 to April 2016, n = 706). Shock Index-C (SIC) was calculated as (SI × 100)–estimated CCr. Calibration was evaluated using the Hosmer-Lemeshow statistic. The predictive power of SIC was evaluated using receiver operating characteristic (ROC) curve analysis.Results: The predictive value and calibration of SIC for in-hospital death was excellent in derivation [area under the curve (AUC) = 0.877, p < 0.001; Hosmer-Lemeshow chi-square = 3.95, p = 0.861] and validation cohort (AUC = 0.868, p < 0.001; Hosmer-Lemeshow chi-square = 5.01, p = 0.756). SIC exhibited better predictive power for in-hospital events than SI (AUC: 0.874 vs. 0.759 for death; 0.837 vs. 0.651 for major adverse clinical events [MACEs]; 0.707 vs. 0.577 for contrast-induced acute kidney injury [CI-AKI]; and 0.732 vs. 0.590 for bleeding, all p < 0.001). Cumulative 1-year mortality was significantly higher in the upper SIC tertile (log-rank = 131.89, p < 0.001).Conclusion: SIC was an effective predictor of poor prognosis and may have potential as a novel and simple risk stratification tool for patients with STEMI undergoing PCI.

scholarly journals Use of the Thrombolysis in Myocardial Infarction Risk Index for Elderly Patients With ST-Segment Elevation Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
Bingqi Fu ◽  
Xuebiao Wei ◽  
Qi Wang ◽  
Zhiwen Yang ◽  
Jiyan Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Assessment Tool ◽  
Risk Index ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Hospital Death ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a simple risk assessment tool for patients with ST-segment elevation myocardial infarction (STEMI). However, its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain.Methods: This was a retrospective analysis of elderly (≥60 years) patients who underwent PCI for STEMI from January 2010 to April 2016. TRI was calculated on admission using the following formula: heart rate × (age/10)2/systolic blood pressure. Discrimination and calibration of TRI for in-hospital events and 1 year mortality were analyzed.Results: Totally 1,054 patients were divided into three groups according to the tertiles of the TRI: <27 (n = 348), 27–36 (n = 360) and >36 (n = 346). The incidence of acute kidney injury (AKI; 7.8 vs. 8.6 vs. 24.0%, p < 0.001), AHF (3.5 vs. 6.6 vs. 16.2%, p < 0.001), in-hospital death (0.6 vs. 3.3 vs. 11.6%, p < 0.001) and MACEs (5.2 vs. 5.8 vs. 15.9%, p < 0.001) was significantly higher in the third tertile. TRI showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p < 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for AKI (AUC = 0.678, p < 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital MACEs (AUC = 0.669, p < 0.001; Hosmer-Lemeshow p = 0.077). Receiver-operation characteristics curve showed that TRI > 42.0 had a sensitivity of 64.8% and specificity of 82.2% for predicting in-hospital death. Kaplan-Meier analysis showed that patients with TRI > 42.0 had higher 1 year mortality (Log-rank = 79.2, p < 0.001).Conclusion: TRI is suitable for risk stratification in elderly patients with STEMI undergoing PCI, and is thus of continuing value for an aging population.

scholarly journals ST-Segment Resolution as a Marker for Myocardial Scar in ST-Segment Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Qian Dong ◽  
Xuesong Wen ◽  
Guanglei Chang ◽  
Rui Xia ◽  
Sihang Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards ◽  
Area Under The Curve ◽  
Emergency Admission ◽  
Coronary Intervention ◽  
Myocardial Scar ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Myocardial Scars

Abstract Objective: To investigate the relationship between ST-segment resolution (STR) and myocardial scar thickness after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).Methods: Forty-two STEMI patients with single-branch coronary artery stenosis or occlusion were enrolled. ST-segment elevations were measured at emergency admission and at 24 h after PCI. Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) was performed 7 days after PCI to evaluate myocardial scars. Statistical analyses were performed to assess the utility of STR to predict the development of transmural (>75%) or non-transmural (<75%) myocardial scars.Results: The sensitivity and specificity of STR for predicting transmural scars were 96% and 88%, respectively, at an STR cut-off value of 40.15%. The area under the curve was 0.92. Multivariate logistic proportional hazards regression analysis disclosed that patients with STR<40.15% had a 112.95-fold higher probability of developing transmural scars compared with patients with STR≥40.15%. STR percentage was negatively correlated with myocardial scar thickness (β=-0.838, P<0.001) and size (β=-0.714, P<0.001).Conclusion: STR<40.15% at 24 h after PCI may provide meaningful diagnostic nformation regarding the extent of myocardial scarification in STEMI patients.

scholarly journals Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation

2018 ◽  
Vol 37 (6) ◽  
pp. 481-488
Author(s):  
Glória Abreu ◽  
Pedro Azevedo ◽  
Carlos Galvão Braga ◽  
Catarina Vieira ◽  
Miguel Álvares Pereira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Assessment ◽  
Shock Index ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Clinical Index ◽  
St Segment

scholarly journals Value of C-Reactive Protein in Predicting Left Ventricular Remodelling in Patients with a First ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Iwona Swiatkiewicz ◽  
Marek Kozinski ◽  
Przemyslaw Magielski ◽  
Tomasz Fabiszak ◽  
Adam Sukiennik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
C Reactive Protein ◽  
Left Ventricular Remodelling ◽  
St Segment Elevation ◽  
Reactive Protein ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Objective. To assess the value of C-reactive protein (CRP) in predicting postinfarct left ventricular remodelling (LVR).Methods.We measured in-hospital plasma CRP concentrations in patients with a first ST-segment elevation myocardial infarction (STEMI).Results. LVR was present at 6 months in 27.8% of 198 patients. CRP concentration rose during the first 24 h, mainly in LVR group. The prevalence of LVR was higher in patients from the highest quartile of CRP concentrations at 24 h as compared to those from any other quartile (odds ratio (OR) 3.48, 95% confidence interval (95% CI) 1.76–6.88). Multivariate analysis identified CRP concentration at 24 h (OR for a 10 mg/L increase 1.29, 95% CI 1.04–1.60), B-type natriuretic peptide at discharge (OR for a 100 pg/mL increase 1.21, 95% CI 1.05–1.39), body mass index (OR for a 1 kg/m2increase 1.10, 95% CI 1.01–1.21), and left ventricular end-diastolic volume (OR for a 1 mL increase 0.98, 95% CI 0.96-0.99) as independent predictors of LVR. The ROC analysis revealed a limited discriminative value of CRP (area under the curve 0.61; 95% CI 0.54–0.68) in terms of LVR prediction.Conclusions. Measurement of CRP concentration at 24 h after admission possesses a significant but modest value in predicting LVR after a first STEMI.

scholarly journals Tocilizumab increases citrullinated histone 3 in non-ST segment elevation myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001492
Author(s):  
Ragnhild Helseth ◽  
Ola Kleveland ◽  
Thor Ueland ◽  
Rune Wiseth ◽  
Jan Kristian Damas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Placebo Group ◽  
Troponin T ◽  
Controlled Trial ◽  
Area Under The Curve ◽  
St Segment Elevation ◽  
Time Points ◽  
Segment Elevation Myocardial Infarction ◽  
Histone 3 ◽  
St Segment

ObjectiveBeyond reducing inflammation and troponin T (TnT) release, the interleukin-6 receptor antagonist tocilizumab reduces neutrophil counts in patients with non-ST segment elevation myocardial infarction (NSTEMI). It is unclear if this is related to formation of neutrophil extracellular traps (NETs), carrying inflammatory and thrombotic properties.MethodsIn a placebo-controlled trial, 117 patients with NSTEMI were randomised to a single dose of tocilizumab (n=58) or placebo (n=59) before coronary angiography. The NETs related markers double-stranded DNA (dsDNA), myloperoxidase–DNA (MPO–DNA) and citrullinated histone 3 (H3Cit) were measured at five consecutive time points during hospitalisation (days 1–3).ResultsOur major findings were: (1) H3Cit levels were significantly higher in the tocilizumab compared with the placebo group at all time points (all p<0.05), and H3Cit area under the curve (AUC) was 2.3 fold higher in the tocilizumab compared with placebo group (p<0.0001). (2) MPO–DNA and dsDNA did not differ between the groups. (3) In both treatment arms, dsDNA AUC was associated with TnT AUC. (4) Neutrophil count AUC correlated inversely to H3Cit AUC (p=0.015) in the total population.ConclusionsIn patients with NSTEMI, treatment with tocilizumab is associated with increased circulating H3Cit levels, suggesting that tocilizumab enhances NETosis. Further studies should clarify whether NETosis is a relevant side effect of tocilizumab. Regardless of tocilizumab, dsDNA associated with TnT release, indicating a link between extracellular nuclear material and myocardial injury.

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