Accuracy of death risk prediction models for acute coronary syndrome patients: a systematic review and meta-analysis.

INTRODUCTION: This study systematically evaluates the accuracy of several death risk prediction models for patients with acute coronary syndrome (ACS) through evidence-based methods. We identify the most accurate and effective ACS death risk prediction model and provide an evidence-based basis for clinical healthcare personnel to evaluate their choice of death risk prediction model for ACS patients. EVIDENCE ACQUISITION: An evidence-based approach was used to study the current death risk prediction model for ACS. First, a literature search was carried out using computer-based and manual searching. The literature databases searched include Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, WanFang Data, CNKI, VPCS, and SinoMed. The search period was limited to 2009 to 2022. Screening, quality evaluation and data extraction were carried out for the included articles. The PROBAST was used to conduct a migration risk assessment. RevMan 5.3 and Meta-DiSc 1.4 were used in combination to determine the model effect sizes. A descriptive analysis was conducted for the data that could not be meta-analyzed. EVIDENCE SYNTHESIS: A total of 8277 articles were initially included in this study. After screening, 25 articles were finally included, involving 11 different risk prediction models. A total of 306,390 patients with ACS were included of which 158,080 (51.6%) were male and 147,793 (48.4%) were female. The patients stemmed from 11 different countries (e.g., China, the USA, Spain, the UK, etc.). The total number of deaths was 23,601. The sensitivity of the GRACE risk prediction model was 0.78, with a specificity of 0.76 and an AUC value of 0.86. The sensitivity of the CAMI risk prediction model was 0.78, with a specificity of 0.70 and an AUC value of 0.85. The sensitivity of the TIMI risk prediction model was 0.51, with a specificity of 0.81, and an AUC value of 0.64. The sensitivity of the REMS risk prediction model was 0.78, with a specificity of 0.46 and an AUC value of 0.41. Eight different risk prediction models (EPICOR, CRUSADE, SAMI, GWTG, LNS, SYNTAX II, APACHE II) that could not be combined with the effect size were also included, with sensitivities ranging from 0.77-0.95, specificities ranging from 0.22-0.99, and AUC values ranging from 0.71-0.92. CONCLUSIONS: The GRACE and CAMI risk prediction models demonstrate good accuracy for evaluating the death risk of ACS patients. The accuracy of the TIMI risk prediction model is similar to that of the REMS risk prediction model. The APACHE II, SYNTAX II, EPICOR, and CAMI risk prediction models also show good accuracy for estimating the risk of death in ACS patients, although further validation is needed due to limited evidence. For improved predictive accuracy and to help advance medical interventions, the author recommends that clinical medical staff use the GRACE model to predict the death risk of ACS patients.

Targeting pro-inflammatory T cells as a novel therapeutic approach to potentially resolve atherosclerosis in humans.

Atherosclerosis (AS), a leading cause of cardio-cerebrovascular disease worldwide, is driven by the accumulation of lipid contents and chronic inflammation. Traditional strategies primarily focus on lipid reduction to control AS progression, leaving residual inflammatory risks for major adverse cardiovascular events (MACEs). While anti-inflammatory therapies targeting innate immunity have reduced MACEs, many patients continue to face significant risks. Another key component in AS progression is adaptive immunity, but its potential role in preventing AS remains unclear. To investigate this, we conducted a retrospective cohort study on tumor patients with AS plaques. We found that anti-programmed cell death protein 1 (PD-1) monoclonal antibody (mAb) significantly reduces AS plaque size. With multi-omics single-cell analyses, we comprehensively characterized AS plaque-specific PD-1+ T cells, which are activated and pro-inflammatory. We demonstrated that anti-PD-1 mAb, when captured by myeloid-expressed Fc gamma receptors (FcγRs), interacts with PD-1 expressed on T cells. This interaction turns the anti-PD-1 mAb into a substitute PD-1 ligand, suppressing T-cell functions in the PD-1 ligands-deficient context of AS plaques. Further, we conducted a prospective cohort study on tumor patients treated with anti-PD-1 mAb with or without Fc-binding capability. Our analysis shows that anti-PD-1 mAb with Fc-binding capability effectively reduces AS plaque size, while anti-PD-1 mAb without Fc-binding capability does not. Our work suggests that T cell-targeting immunotherapy can be an effective strategy to resolve AS in humans.

Association between dietary patterns and cardiovascular diseases: A review.

Cardiovascular disease (CVD), especially atherosclerosis, is the primary cause of global deaths. It accounts for millions of deaths annually. Even a small reduction in CVD through preventive treatment can have a substantial impact. Dietary patterns and substances are strongly linked to chronic diseases such as atherosclerosis, hypertension, heart failure, and type 2 diabetes. An unhealthy diet could lead to traditional risk factors such as LDL levels, TG levels, diabetes, and high blood pressure while accelerating atherosclerosis progression. Recent research has shown the potential of dietary interventions to prevent and treat cardiovascular disease, particularly through healthy dietary patterns such as the Mediterranean diet or DASH. In 2016, the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) launched a new initiative aimed at enhancing the prevention and control of cardiovascular disease (CVD) by improving the management of CVD in primary care, including the optimization of dietary patterns. Here, this review summarizes several large cohort researches about the effects of dietary patterns on atherosclerosis, refines dietary components, and outlines some typical anti-atherosclerosis dietary agents. Finally, this review discusses recent mechanisms by which dietary interventions affect atherosclerosis progression.

Analysis of Risk Factors for Complications after Percutaneous Coronary Intervention in Patients with Acute ST-segment Elevation Myocardial Infarction.

Background: Acute ST segment elevation myocardial infarction (ASTEMI) is the most common and serious type of AMI, percutaneous coronary intervention (PCI) is currently the most commonly used approach for clinical treatment of ASTEMI. After PCI, patients with ASTEMI are very prone to various complications, which will seriously threaten their health and life safety. Objective: This study aims to analyze the risk factors for complications in patients with acute ST-segment elevation myocardial infarction (ASTEMI) treated with percutaneous coronary intervention (PCI). Methods: A total of 107 patients with ASTEMI who were subjected to PCI from October 2021 to December 2022 were selected as study subjects. Patients were divided into a safety group (no complications, n = 63) and a risk group (n = 45) based on the presence of postoperative complications. Baseline data (age, sex, etc.), Killip classification, left ventricular ejection fractions (LVEF), and routine blood test results were collected from patients in both groups for Logistic regression analysis to obtain relevant factors affecting the occurrence of post-PCI complications. Results: There were no differences between the safety group and the risk group in terms of sex, age, body mass index (BMI), Killip classification, and infarct site (P > .05). Compared with the safety group, the risk group exhibited a higher proportion of patients with multiple pre-existing diseases, LVEF < 40%, and number of coronary artery lesions ≥ 1, and higher levels of hs-CRP, NT-proBNP, HbA1c and Scr (P < .05). Logistic regression analysis results showed that multiple pre-existing diseases, hs-CRP, NT-proBNP, HbA1c, and Scr were relevant factors affecting the occurrence of post-PCI complications (P < .05). Conclusion: Multiple pre-existing diseases, hs-CRP, NT-proBNP, HbA1c, and Scr were all independent risk factors for the occurrence of post-PCI complications. Future clinical attention should be paid to these indicators in patients with ASTEMI in order to prevent post-PCI complications.

Malnutrition Predicts Adverse Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

BACKGROUND: Several studies have shown that malnutrition helps to predict the occurrence of adverse outcomes after transcatheter aortic valve replacement. However, there is still controversy and uncertainty regarding the prevalence and consequences of malnutrition. We performed a systematic review and meta-analysis to assess the relationship between malnutrition and poor postoperative outcomes in transcatheter aortic valve replacement. METHODS: Observational studies were searched in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE regarding the relationship between malnutrition and adverse outcomes after transcatheter aortic valve replacement, with the primary end-point being all-cause mortality and secondary outcomes such as cardiovascular complications and readmission rates. This meta-analysis was registered in PROSPERO (number CRD42022310139). RESULTS: A total of 10 studies involving 5936 subjects were included in the systematic review and meta-analysis. The results showed that malnourished patients had an increased risk of all-cause mortality after transcatheter aortic valve replacement compared with non-malnourished patients (hazard ratios [HR] = 1.32, 95% CI [1.13, 1.53], P <.01). Subgroup analysis showed that in Asia, postoperative all-cause mortality was significantly higher in malnourished transcatheter aortic valve replacement patients than in non-malnourished transcatheter aortic valve replacement patients (P <.01), and in addition, sample size and follow-up time may have contributed to the large heterogeneity. CONCLUSION: Malnutrition increases the risk of all-cause mortality in such patients and may predict the occurrence of adverse postoperative outcomes.

Analysis of risk factors for systemic inflammatory response syndrome in patients after transcatheter aortic valve replacement.

OBJECTIVE: Our aim was to determine the risk factors of postoperative systemic inflammatory response syndrome (SIRS) in patients with transcatheter aortic valve replacement (TAVR), identify those with a high risk of SIRS, and help reduce SIRS occurrence. METHODS: A retrospective cohort study was conducted to collect the clinical data of patients who underwent TAVR from January 2014 to December 2019 at a tertiary hospital in Zhejiang Province. The study included 156 men and 94 women. Patients were divided into SIRS and non-SIRS groups. The pre-, intra-, and postoperative indices of the two groups were recorded. The data of the two groups were compared, and univariate analysis was performed. All statistically significant factors were assessed using binary logistic regression analysis to clarify the risk factors of SIRS after TAVR. RESULTS: Overall, 30 patients developed SIRS after TAVR, with an incidence rate of 12%, an odds ratio (OR) of 0.571, and a 95% confidence interval (CI) of 0.469-0.694 (p = 0.000). There was a significant correlation between SIRS and glucose (OR: 0.823, 95% CI: 0.678-1.000, p = 0.049), albumin (OR: 0.938, 95% CI: 0.881-0.998, p = 0.044), brain natriuretic peptide (OR: 1.000, 95% CI: 1.000-1.000, p = 0.010), sex (OR: 0.412, 95% CI: 0.190-0.892, p = 0.025), and history of hypertension (OR: 0.375, 95% CI: 0.169-0.819, p = 0.014). Multivariate regression analysis demonstrated that age (OR: 1.190, 95%CI: 1.073-1.319, p = 0.001) and body mass index (BMI; OR: 0.559, 95% CI: 0.447-0.698, p = 0.000) were independent risk factors for postoperative SIRS in patients with TAVR. CONCLUSION: The incidence of SIRS after TAVR was 12%. There was a significant correlation between SIRS and albumin, glucose, and hypertension. The independent risk factors for SIRS after TAVR were age and BMI.

Factors affecting ozone sensitivity of tobacco Bel-W3 seedlings.

BACKGROUND: Since 1962, the tobacco variety Nicotiana tabacum cv. Bel-W3 has been used worldwide as an ozone (O3) bio-indicator. The use of indicator plants to monitor O3 pollution has proven problematic when trying to correlate the severity of injury to ambient O3 concentration. The aim of the present study was to study factors affecting the O3 sensitivity of Nicotiana tabacum cv. Bel-W3 seedlings. RESULTS: In chronic O3 pre-exposure tests, tobacco plants were cultured from seeds in charcoal-filtered air (CF) and noncharcoal-filtered ambient air (NF) for 21 days. During these periods, the mean O3 concentrations of the CF and NF treatments were 5.5 ± 0.2 and 14.7 ± 0.4 ppb h-1, respectively (p < 0.001). At the end of the culturing period, no O3-induced foliar injury was observed in any of the plants. The O3 sensitivity of the tobacco plants was determined by exposing the plants to 150 ppb O3 for 8 hours in a fumigation chamber. The leaf injury index percentages (LII%) of indicator plants via the CF and NF treatments were 58.0 ± 3.2% and 43.1 ± 4.0%, respectively (p < 0.01). Twenty-one-day-old tobacco seedlings grown in NF air were used to test the effects of exposed leaves on O3 sensitivity. After removing the cotyledons and all true leaves, the NF seedlings with their apical buds intact were transferred to CF air. After another 7 days of culturing, the newly developed leaves were approximately 1 cm in length. After O3 treatment, the LII% values of the newly developed leaves from the untreated and defoliated seedlings were 2.5 ± 1.7% and 27.6 ± 1.3%, respectively (p < 0.001). In acute O3 exposure tests, 21-day-old seedlings grown in CF air were fumigated with 150 ppb O3 for 8 hours in one day or for 4 hours/day in two consecutive days. The LII% values for the two groups were 63.5 ± 7.4% and 20.1 ± 4.3%, respectively (p < 0.001). CONCLUSIONS: The present findings suggest that plant pre-exposure to O3 is a critical factor influencing O3 sensitivity and that exposed leaves obtain acquired tolerance against O3 injury later on.

[Study of severe hepatitis treated with a hybrid artificial liver support system].

OBJECTIVES: To evaluate the efficacy of a hybrid artificial liver support system in the treatment of chronic severe hepatitis. METHODS: The hybrid artificial liver support system (HALSS) consisted of a bioreactor containing more than 5 x 10(9) porcine hepatocytes and plasma exchange device. 15 patients with chronic severe viral hepatitis were treated with the hybrid system. RESULTS: All the patients experienced a reduction in symptoms, such as fatigue, abdominal distention or ascites. After each treatment serum total bilirubin decreased markedly (from 493.5 micromol/L+-139.8 micromol/L to 250.9 micromol/L+-91.3 micromol/L, t=8.695, P<0.001), while prothrombin activity increased (from 24.5%+-8.4% to 30.6%+-6.3%, t=3.325, P<0.01). There were 11 patients whose progress of hepatocytes necrosis stopped after HALSS treatment, and finally they recovered completely. Four patients died of their worsen conditions. No serious adverse events were noted in the 15 patients. CONCLUSION: HALSS is a reliable hepatic support device for chronic severe hepatitis.