Sex differences in the association between D-dimer and the incidence of acute kidney injury in patients admitted with ST-segment elevation myocardial infarction: a retrospective observational study.

Identifying the predictors of acute kidney injury (AKI) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains important. We aimed to investigate the predictive value of D-dimer levels for the incidence of AKI in such a population, with particular attention paid to sex differences. A total of 2668 patients with STEMI who underwent PPCI were retrospectively included in this study and divided into quartiles according to their plasma D-dimer levels upon admission (Q1: < 0.36; Q2: 0.36-0.67; Q3: 0.68-1.17; Q4: > 1.17 mg/L). The primary endpoint was the occurrence of AKI during hospitalization. AKI was observed in 503 (18.8%) patients. The mean age of the patients was 63.0 ± 13.2 years, 2155 (80.8%) of whom were men. Multivariate analysis indicated that higher D-dimer levels were associated with a significantly increased risk of AKI (Q4 vs. Q1: OR: 1.57; 95% CI 1.11-2.23; P = 0.011). However, the prognostic effect of D-dimer was only observed in male patients (Q4 vs. Q1: OR: 2.07; 95% CI 1.37-3.13; P < 0.001), not in female patients (Q4 vs. Q1: OR: 0.72; 95% CI 0.37-1.41; P = 0.342) (P for interaction = 0.003). We demonstrated a notable sex difference in the association between D-dimer level upon admission and AKI in a large STEMI patient sample. A higher D-dimer level was associated with an increased risk of AKI in male patients but not in female patients.

The interaction between hyperuricemia and low-density lipoprotein cholesterol increases the risk of 1-year post-discharge all-cause mortality in ST-segment elevation myocardial infarction patients.

BACKGROUND AND AIMS: Hyperuricemia is a known risk factor for cardiovascular diseases, but little is known on whether the association between hyperuricemia and poor outcomes in ST-segment elevation myocardial infarction (STEMI) is modified by low-density lipoprotein cholesterol (LDL-c). This study aimed to investigate the effect of the interaction between hyperuricemia and LDL-c on the risk of 1-year post-discharge all-cause mortality in STEMI patients. METHODS AND RESULTS: A total of 1396 STEMI patients were included. Cox proportional hazards models were used to determine the association between hyperuricemia and 1-year all-cause mortality in the overall population and subgroups stratified based on LDL-c levels (<3.0 mmol/L or ≥3.0 mmol/L). Multivariate analysis indicated that hyperuricemia was associated with 1-year mortality (HR: 2.66; 95% CI: 1.30-5.47; p = 0.008). However, the prognostic effect of hyperuricemia was only observed in patients with LDL-c level ≥3.0 mmol/L (HR: 12.90; 95% CI: 2.98-55.77; p < 0.001), but not in those with LDL-c level <3.0 mmol/L (HR: 0.91, 95% CI: 0.30-2.79, p = 0.875). The interaction between hyperuricemia and LDL-c levels had a significant effect on 1-year mortality. CONCLUSION: Hyperuricemia was associated with increased 1-year post-discharge mortality in patients with LDL-c level≥ 3.0 mmol/L, but not in those with LDL-c level< 3.0 mmol/L.

Clinical Outcome After Left Ventricular Thrombus Resolution: Who Needs Long-Term or Lifetime Use of Anticoagulants?

Background Patients with left ventricular thrombus (LVT) resolution can have LVT recurrence and risk for thromboembolism. However, these outcomes after LVT resolution are not well known. We aimed to assess the prevalence, risk factors, and clinical outcomes for LVT recurrence in patients with LVT resolution to inform follow-up and treatment. Methods and Results Patients with LVT resolution were identified retrospectively from a large echocardiography database between January 2009 and May 2022. Participants had echocardiograms at 3 time points, including baseline at LVT diagnosis, at LVT resolution, and a follow-up for identification of LVT recurrence. The cumulative LVT recurrence rate was estimated by the Kaplan-Meier method, and predictors of LVT recurrence were evaluated using Cox regression analysis. Among 115 patients with LVT resolution, 28 (24.3%) had LVT recurrence at a median follow-up of 1.2 (0.5-2.8) years. LV aneurysm (hazard ratio [HR], 2.59 [95% CI, 1.20-5.58], P=0.015) and anticoagulant use (HR, 0.12 [95% CI, 0.04-0.41], P=0.001) were predictors of LVT recurrence on multivariable analysis. Patients with an LV aneurysm who did not receive any anticoagulation demonstrated an LVT recurrence rate of 69.5%, whereas those without an LV aneurysm who received anticoagulation had a recurrence rate of 0%. Patients with LVT recurrence had a higher incidence of an embolic event (10.7% versus 1.1%, P=0.016). Conclusions LVT recurrence after LVT resolution is common, especially in those with an LV aneurysm, and is associated with a higher embolic risk. Continued anticoagulation is protective against LVT recurrence, although bleeding risk needs to be considered. These findings can inform follow-up and treatment of patients with documented LVT resolution.

Lactate level and lactate clearance for acute kidney injury prediction among patients admitted with ST-segment elevation myocardial infarction: A retrospective cohort study.

Background: Hyperlactatemia is a prognostic marker among patients with ST-segment elevation acute myocardial infarction (STEMI). However, the predictive value of lactate and the dynamic change associated with acute kidney injury (AKI) among patients with STEMI, remain poorly understood. We aimed to compare single lactate values at admission (Lacadm) and 12 h after admission (Lac12h) with lactate clearance (LC) 12 h after admission for AKI prediction in patients with STEMI. Methods: A total of 1,784 patients with STEMI were included. The study endpoint was AKI occurrence during hospitalization. The predictive value of lactate levels measured at admission and 12 h after admission and LC for AKI prediction was determined using multivariate logistic regression analyses and compared with receiver operator characteristic (ROC) curve analysis. Results: Overall, AKI was observed in 353 (19.8%) patients. In multivariate logistic regression analyses, Lacadm ≥ 4.3 mmol/L (OR: 1.53; 95% CI: 1.01-2.30), Lac12h ≥ 2.1 mmol/L (OR: 1.81; 95% CI: 1.36-2.42), and LC ≥ -7.5% (OR: 0.40; 95% CI: 0.30-0.53) were the independent predictive factors for AKI after adjusting for confounders. ROC curve analysis results revealed that Lac12h (0.639; 95% CI: 0.616-0.661) exhibited a significantly higher area under the curve (AUC) than those of Lacadm (0.551; 95% CI: 0.527-0.574) and LC (0.593; 95% CI: 0.570-0.616) in the prediction of AKI. LC (△AUC = 0.037, p < 0.001) and Lac12h (△AUC = 0.017, p = 0.029) enhanced the discrimination capacity of Mehran Risk Score (MRS) for AKI among patients undergoing emergency coronary angiography. Conclusion: Lac12h is more effective for AKI prediction among patients with STEMI than Lacadm and LC. Furthermore, Lac12h and LC enhance the prediction capacity of MRS for AKI among patients after emergency coronary angiography.

Interaction between Hyperuricemia and Admission Lactate Increases the Risk of Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction.

BACKGROUND AND OBJECTIVE: Acute kidney injury (AKI) is a common complication associated with adverse outcomes among patients with ST-segment elevation myocardial infarction (STEMI). This is conflicting information about the relationship between hyperuricemia and AKI in STEMI. This work aimed to investigate the effect of the interaction between hyperuricemia and lactate on the risk of AKI. METHODS: We analyzed 2,008 consecutive STEMI patients between January 2014 and January 2019. Hyperuricemia was defined as a serum uric acid level >7 mg/dL for males and >6 mg/dL for females. AKI was defined based on the Kidney Disease: Improving Global Outcomes (KDIGO). Logistic regression models were applied to establish the relationship between hyperuricemia and AKI in the overall population and subgroups stratified as per lactate levels at admission (≤2.2 mmol/L or >2.2 mmol/L). RESULTS: In total, we included 1,887 STEMI patients. Multivariate analysis showed that hyperuricemia is associated with the risk of AKI (OR: 1.34; 95% CI: 1.01-1.77; p = 0.045). Nonetheless, the predictive effect of hyperuricemia was only observed in patients with lactate level >2.2 mmol/L (OR: 2.05; 95% CI: 1.36-3.10; p < 0.001), but not in those with lactate level ≤2.2 mmol/L (OR: 0.86, 95% CI: 0.56-1.32; p = 0.493). The interaction between hyperuricemia and lactate levels demonstrated a significant effect on AKI. CONCLUSIONS: In summary, hyperuricemia increases the risk of AKI in STEMI patients with lactate levels> 2.2 mmol/L, but not in those with lactate levels ≤2.2 mmol/L.

Short-Term Postoperative Use of Rivaroxaban to Prevent Radial Artery Occlusion After Transradial Coronary Procedure: The RESTORE Randomized Trial.

BACKGROUND: Adequate procedural anticoagulation is crucial for radial artery occlusion (RAO) prevention in patients undergoing transradial access coronary catheterization, although the effect of postprocedural anticoagulation lack thorough investigation. The aim of this study was to evaluate the clinical value of short-term postoperative anticoagulation with rivaroxaban for 24 hours and 1-month RAO prevention in patients who received transradial coronary procedures. METHODS: A total of 382 patients were randomized to receive either placebo (control group) or rivaroxaban 10 mg once daily for a period of 7 days (rivaroxaban group) to evaluate the effect of the rivaroxaban in the prevention of 24 hours and 1-month RAO assessed by Doppler ultrasound. RESULTS: There was no significant difference in the incidence of 24-hour RAO (8.9% versus 11.5%; P=0.398) between the rivaroxaban group and control group (odds ratio, 0.75 [95% CI, 0.39-1.46]; P=0.399). In contrast, the 1-month RAO (3.8% versus 11.5%; P=0.011) was significantly reduced in patients who received rivaroxaban as compared with those who did placebo (odds ratio, 0.22 [95% CI, 0.08-0.65]; P=0.006). For patients with 24-hour RAO, the rivaroxaban group was associated with higher recanalization rate of the radial artery (69.2% versus 30.0%; P=0.027) compared with the control group. No significant differences can be observed between the 2 groups for access-site complications or bleeding events. CONCLUSIONS: Short-term postoperative anticoagulation with rivaroxaban did not reduce the rate of 24-hour RAO but improved 1-month RAO, because of higher recanalization of the radial artery. However, larger clinical trials are needed to prove our results. REGISTRATION: URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900026974.

Impact of Pre-Revascularization and Post-Revascularization Cardiac Arrest on Survival Prognosis in Patients With Acute Myocardial Infarction and Following Emergency Percutaneous Coronary Intervention.

Objectives: To evaluate the effects of occurrence and timing of sudden cardiac arrest (SCA) on survival in patients with acute myocardial infarction (AMI) who underwent emergency percutaneous coronary intervention (PCI). Methods: We analyzed 1,956 consecutive patients with AMI with emergency PCI from 2014 to 2018. Patients with cardiac arrest events were identified, and their medical records were reviewed. Results: Patients were divided into non-cardiac arrest group (NCA group, n = 1,724), pre-revascularization cardiac arrest (PRCA group, n = 175), and post-revascularization SCA (POCA group, n = 57) according to SCA timing. Compared to NCA group, PRCA group and POCA group presented with higher brain natriuretic polypeptide (BNP), more often Killip class 3/4, atrial fibrillation, and less often completed recovery of coronary artery perfusion (all p < 0.05). Both patients with PRCA and POCA showed increased 30-day all-cause mortality when compared to patients with NCA (8.0 and 70.2% vs. 2.9%, both p < 0.001). However, when compared to patients with NCA, patients with PRCA did not lead to higher mortality during long-term follow-up (median time 917 days) (16.3 vs. 18.6%, p = 0.441), whereas patients with POCA were associated with increased all-cause mortality (36.3 vs. 18.6%, p < 0.001). Multivariate analysis identified Killip class 3/4, atrial fibrillation, high maximum MB isoenzyme of creatine kianse, and high creatinine as predictive factors for POCA. In Cox regression analysis, POCA was found as a strong mortality-increase predictor (HR, 8.87; 95% CI, 2.26-34.72; p = 0.002) for long-term all-cause death. Conclusions: POCA appeared to be a strong life-threatening factor for 30-day and long-term all-cause mortality among patients with AMI who admitted alive and underwent emergency PCI. However, PRCA experience did not lead to a poorer long-term survival in patients with AMI surviving the first 30 days.