HEART Score: Prospective Evaluation of Its Accuracy and Applicability.

Background: The History, Electrocardiogram, Age, Risk factors, and Troponin I (HEART) score is a simple method to risk stratify patients with chest pain according to the risk for incidence of major adverse cardiac events (MACEs). Materials and methods: A 202-patient prospective, single center study at Sri Siddhartha Medical College, Tumkur. Patients included were those who were presented to the emergency department (ED) due to non-traumatic chest pain, irrespective of age or any previous medical treatments, and were later referred to the cardiac care unit (CCU), cardiology department (CD). The end point of the study was the incidence of MACE. Results: There was a high occurrence of endpoint-myocardial infarction (MI) as MACE among patients with a high-risk HEART score (p < 0.001). About 52 patients (81.3%) who had MI had a high-risk score and 2 patients (3.1%) who had an endpoint of MI had a low-risk score. Sensitivity of HEART score to anticipate MACE was 91%, and the specificity was 80%. Conclusions: Our prospective study demonstrates the high sensitivity of the HEART score to effectively risk stratify patients and project the phenomenon of MACE. We support the use of the HEART score as a fast and accurate risk stratification tool in the ED. How to cite this article: Anwar I, Sony D. HEART Score: Prospective Evaluation of Its Accuracy and Applicability. Indian J Crit Care Med 2024;28(8):748-752.

Baseline Cardiac Parameters as Biomarkers of Radiation Cardiotoxicity in Lung Cancer: An NI-HEART Analysis.

Background: Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients. Objectives: The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying "high risk" patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT). Methods: The medical records of patients who underwent definitive RT for non-small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death. Results: Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; P = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; P = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; P = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival. Conclusions: The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.

Prognostic value of single photon emission computed tomography myocardial perfusion imaging for the prediction of MACE in pre- kidney transplant recipients: A systematic review and meta-analysis.

BACKGROUND: Kidney transplantation provides substantial benefits in extending survival and improving quality of life for patients with end-stage renal disease. The incidence of major adverse cardiac events (MACE) increases with a decline of kidney function in patients with chronic kidney disease. After kidney transplantation, the incidence of MACE remains high. The objective of this study was to assess the prognostic significance of pre-transplant single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in kidney transplant recipients. METHODS: A systematic literature search was performed between January 1st 2015 and March 26th 2024 in PubMed, EMBASE, Web of Science and The Cochrane Library to identify the prognostic value of SPECT MPI for developing MACE (primary outcome) and mortality (secondary outcome) in kidney transplant recipients (PROSPERO CRD42020188610). Risk of bias was assessed. Meta-analyses and subgroup analyses were performed using random-effects models. RESULTS: Six studies comprising 2090 SPECT MPI scans were included. Abnormal SPECT MPI scans were associated with an increased risk of MACE post-transplantation (HR 1.62, 95% CI 1.27-2.06, p < 0.001). Subgroup analyses showed consistent findings across various patient populations and methodological differences. Sensitivity analyses supported the robustness of our findings. CONCLUSIONS: Current evidence showed that pre-transplant SPECT MPI has significant prognostic value in identifying kidney transplant candidates at risk for MACE post-transplantation. Integrating SPECT MPI into preoperative assessments might enhance risk stratification and guide clinical decision-making. Prospective studies are needed to refine risk prediction models.

A systematic review and meta-analysis evaluating the association of high sensitivity troponin levels with outcomes in patients with stable coronary artery disease.

BACKGROUND: High-sensitivity cardiac troponins (Hs-cTns) are reliable indicators of myocardial injury, but their relationship with cardiovascular outcomes remains less understood. This study explored the association between adverse cardiac events and Hs-cTnT levels exceeding 14ng/L in patients with stable CAD. METHODS: Thirteen pertinent studies were identified using specific keywords from a pool of 208 articles retrieved from PubMed, Scopus, and Google Scholar, spanning 2013 to 2023. The primary outcomes included all-cause mortality (ACM), myocardial infarction (MI), cardiovascular death (CVD), rehospitalization due to decompensated heart failure (RDHF), need for revascularization, and stroke. Comprehensive meta-analysis (CMA) was employed to analyze the data for odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using I2 statistics, and both qualitative assessment (Newcastle-Ottawa Scale) and quantitative analysis (Egger's and Beggs test, funnel plots) were conducted. RESULTS: The analysis included 29,115 participants (74.72% male) with a mean age of 68.34 years. It revealed a significantly elevated risk of ACM among stable CAD patients with Hs-cTnT levels > 14ng/L compared to those with levels <14ng/L (11.2% vs. 3.3%; OR 5.46; 95% CI: [1.53, 19.54]; p = 0.009). Similarly, higher risks were observed for MI (10.9% vs 3.6%; OR 3.12;, 95% CI: [0.98, 9.95], p = 0.053, CVD (8.1% vs. 2.1%; OR 3.37; 95% CI: [1.74, 6.50]; p < 0.0001), and RDHF (6.62% vs. 0.92%; OR 9.46; 95% CI: [4.65, 19.24]; p < 0.0001). Notably, major adverse cardiovascular events (MACE) exhibited a stronger association with Hs-cTnT levels (18.2% vs 7.81%; OR of 1.89; 95% CI: [0.80, 4.43]; I2 = 97%; p = 0.14) compared to Hs-cTnI levels (20.1% vs 21.1%; OR 1.30; 95% CI: [1.03, 1.64]; I2 = <0.0001%; p = 0.03). CONCLUSION: Elevated levels of Hs-cTnT (>14ng/L) are significantly associated with increased risks of RDHF and ACM in patients with stable CAD. Further large-scale prospective studies are warranted to refine risk assessment strategies and mitigate cardiovascular mortality in this population.

Long-term Major Adverse Cardiac Event Prediction by Computed Tomography-derived Plaque Measures and Clinical Parameters Using Machine Learning.

Objectives The present study evaluated the usefulness of machine learning (ML) models with the coronary artery calcification score (CACS) and clinical parameters for predicting major adverse cardiac events (MACEs). Methods The Nationwide Gender-specific Atherosclerosis Determinants Estimation and Ischemic Cardiovascular Disease Prospective Cohort study (NADESICO) of 1,187 patients with suspected coronary artery disease (CAD) 50-74 years old was used to build a MACE prediction model. The ML random forest (RF) model was compared with a logistic regression analysis. The performance of the ML model was evaluated using the area under the curve (AUC) with the 95% confidence interval (CI). Results Among 1,178 patients from the NADESICO dataset, MACEs occurred in 103 (8.7%) patients during a median follow-up of 4.4 years. The AUC of the RF model for MACE prediction was 0.781 (95% CI: 0.670-0.870), which was significantly higher than that of the conventional logistic regression model [AUC, 0.750 (95% CI, 0.651-0.839)]. The important features in the RF model were coronary artery stenosis (CAS) at any site, CAS in the left anterior descending branch, HbA1c level, CAS in the right coronary artery, and sex. In the external validation cohort, the model accuracy of ensemble ML-RF models that were trained on and tuned using the NADESICO dataset was not similar [AUC: 0.635 (95% CI: 0.599-0.672)]. Conclusion The ML-RF model improved the long-term prediction of MACEs compared to the logistic regression model. However, the selected variables in the internal dataset were not highly predictive of the external dataset. Further investigations are required to validate the usefulness of this model.

Drug-Coated Balloon Angioplasty vs Plain Balloon Angioplasty in patients with coronary In-Stent Restenosis: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: In-stent restenosis (ISR) remains a significant challenge in interventional cardiology despite advancements in stent technology. Drug-coated balloons (DCBs), which deliver antiproliferative agents directly to the vessel wall, have emerged as a promising alternative to plain balloon angioplasty for ISR treatment. This meta-analysis evaluates the efficacy of DCBs compared to plain balloon angioplasty in patients with coronary ISR. METHODS: A comprehensive search of PubMed and Embase was conducted on June 27, 2024. The search identified randomized controlled trials comparing DCBs and plain balloon angioplasty for ISR treatment. Six trials involving 1,322 patients met the inclusion criteria. Quality was assessed with the Cochrane Risk of Bias tool. Data extraction and statistical analysis were performed using RevMan software, assessing heterogeneity with the I2 statistic and publication bias using funnel plots. RESULTS: The analysis showed that DCBs significantly reduced late in-stent and in-segment luminal loss (P < 0.001) and target lesion revascularization (P = 0.02) compared to plain balloon angioplasty. Major adverse cardiovascular events and the combined endpoint of target lesion revascularization, myocardial infarction, and death also showed highly significant improvements with DCB treatment (P < 0.00001 and P = 0.0002, respectively). However, no significant effect was observed on myocardial infarction and mortality rates. CONCLUSION: DCBs significantly reduce in-stent late luminal loss, target lesion revascularization, and major adverse cardiovascular events compared to plain balloon angioplasty.

Assessing Barriers to Primary Prevention of Cardiovascular Diseases in Low and Middle-Income Countries: A Systematic Review.

The incidence of cardiovascular diseases (CVDs) in low- and middle-income countries (LMICs) has greatly increased. Previously dominated by infectious diseases, LMICs are the new epicentre of CVDs. CVD is a common problem amongst the population in the African continent; however, many countries in LMICs lack the resources to stem the rise of CVDs. A systematic review was conducted between March and July 2023 to assess barriers to the primary prevention of CVDs in studies conducted in LMICs. Online databases, such as Embase, Cochrane, Scopus, and MEDLINE, were consulted. Keywords included primary prevention, cardiovascular diseases, diabetes, weight loss, and physical fitness, all of which focused on LMICs. To enrich the literature review, efforts were made to check other listed references and more papers were retrieved. The inclusion criteria were countries in LMICs, CVD, full-text, and peer-reviewed journals. Qualitative and quantitative studies were included. Exclusion criteria included high-income countries, secondary prevention, and research unrelated to CVDs, such as barriers in oncology or mental health. A total of 1089 papers were retrieved from the search engines. After applying the exclusion criteria for LMICs, only 186 papers were retained. A further search for quality, relevance, and duplicity reduced the qualifying number to 50 papers. Further efforts to retrieve the data and examine the quality of the studies resulted in 18 final selected studies. Three categories emerged based on the type of barriers: physician barriers, patient barriers, and health system barriers. Evidently, in several LMICs, guidelines for CVD prevention were lacking, and too much emphasis was placed on secondary prevention at the expense of primary prevention, a lack of human resources, and inadequate infrastructure. Overworked healthcare providers were unable to allocate adequate time to the patients. There was no shared decision-making process. Patient barriers included lack of motivation, no symptoms, low level of education, no insurance, long physical distances to the facilities, and inadequate medication or stock out. Some of the major barriers included closing and opening hours, poor operating space, inadequate funding from the government or donors, and lack of electronic medical services. There are many barriers to accessing primary prevention services for CVDs. These barriers can be divided into patient, physician, or health system barriers. More research needs to be conducted in LMICs to address the increasing risk factors for CVDs. Greater investment is required by national governments to provide more resources. Task shifting and shared decision-making are some of the quick wins.

Incremental Prognostic Value of Coronary Hyper-intensity Plaque on Non-contrast Cardiac Magnetic Resonance with Global Longitudinal Strain for Major Adverse Cardiac Events in Patients with Acute Coronary Syndrome.

RATIONALE AND OBJECTIVES: This study aims to determine the long-term prognostic value of coronary hyper-intensity plaques and left ventricular (LV) myocardial strain for major adverse cardiac events (MACEs). MATERIALS AND METHODS: The study prospectively recruited 71 patients with acute coronary syndrome (ACS). All patients underwent CMR before PCI to determine the plaque-to-myocardium signal intensity ratio and LV strains. The MACEs included all-cause death, reinfarction, and new congestive heart failure. Mann-Whitney U test and chi-square test to compare patients with and without MACE, Kaplan-Meier survival analysis, Cox proportional hazards regression and C-statistics to assess prognosis, Receiver-operating characteristic (ROC) curve analysis to define the cutoff value. A P value of < 0.05 was considered statistically significant. RESULTS: Cox proportional hazard analysis showed that plaque-to-myocardium signal intensity ratio and global longitudinal strain (GLS) were independently associated with MACEs (plaque-to-myocardium signal intensity ratio: hazard ratio (HR) 2.80, 95% CI, 1.25-6.26, P = 0.01; GLS: HR1.21, 95% CI, 1.07-1.38, P＜0.01). ROC showed that a plaque-to-myocardium signal intensity ratio of 1.65 and a GLS of -10% were the best cutoff values for MACEs. The C-statistic values for plaque-to-myocardium signal intensity ratio, GLS, and plaque-to-myocardium signal intensity ratio+GLS for MACEs were 0.691, 0.792, and 0.825, respectively. Compared to GLS alone, the addition of plaque-to-myocardium signal intensity ratio to GLS increased the net reclassification index by 0.664 (P = 0.017). CONCLUSION: Plaque-to-myocardium signal intensity ratio and GLS were significantly associated with MACEs. Adding plaque-to-myocardium signal intensity ratio to GLS substantially improved the prediction for MACEs. Our findings indicate that plaque-to-myocardium signal intensity ratio combined with GLS provides incremental prognostic value for MACEs.

STress computed tomogRaphy perfusion and stress cArdiac magnetic resonance for ThE manaGement of suspected or known coronarY artery disease: resources and outcomes impact.

BACKGROUND: The aim of this study is to describe resources and outcomes of coronary computed tomography angiography plus Stress CT perfusion (CCTA â€‹+ â€‹Stress-CTP) and stress cardiovascular magnetic resonance (Stress-CMR) in symptomatic patients with suspected or known CAD. METHODS: Six hundred and twenty-four consecutive symptomatic patients with intermediate to high-risk pretest likelihood for CAD or previous history of revascularization referred to our hospital for clinically indicated CCTA â€‹+ â€‹Stress-CTP or Stress-CMR were enrolled. Stress-CTP scans were performed in 223 patients while 401 patients performed Stress-CMR. Patient follow-up was performed at 1 year after index test performance. Endpoints were all cardiac events, as a combined endpoint of revascularization, non-fatal MI and death, and hard cardiac events, as combined endpoint of non-fatal MI and death. RESULTS: Twenty-nine percent of patients who underwent CCTA â€‹+ â€‹Stress-CTP received revascularization, 7% of subjects assessed with Stress-CMR were treated invasively, and a low number of non-fatal MI and death was observed with both strategies (hard events in 0.4% of patients that had CCTA â€‹+ â€‹Stress-CTP as index test, and in 3% of patients evaluated with Stress-CMR). According to the predefined endpoints, CCTA â€‹+ â€‹Stress-CTP group showed high rate of all cardiac events and low rate of hard cardiac events, respectively. The cumulative costs were 1970 â€‹± â€‹2506 Euro and 733 â€‹± â€‹1418 Euro for the CCTA â€‹+ â€‹Stress-CTP group and Stress-CMR group, respectively. CONCLUSIONS: The use of CCTA â€‹+ â€‹Stress-CTP strategy was associated with high referral to revascularization but with a favourable trend in terms of hard cardiac events and diagnostic yield in identifying individuals at lower risk of adverse events despite the presence of CAD.

Association Between Serial B-Type Natriuretic Peptide Levels, Vasoactive Drug Weaning, and Adverse Cardiovascular Outcomes in Pediatric Heart Failure.

BACKGROUND: Children hospitalized with acute decompensated heart failure (ADHF) frequently require intravenous vasoactive (IVV) support drugs and are at risk for adverse cardiovascular (ACV) outcomes. We wished to assess whether serial changes in B-type natriuretic peptide (BNP) levels are associated with successful weaning off IVV support and/or prespecified ACV outcomes in children hospitalized with ADHF. METHODS AND RESULTS: Children hospitalized with ADHF from 2005 to 2021 at our institution were assessed for serial changes in BNP, weaning off of IVV support, and ACV outcomes. Changes in BNP level were evaluated using linear mixed-effects modeling. Bonferroni correction was used to adjust for multiple hypothesis testing. In 131 hospitalizations of children with ADHF, the median age was 4.8 years, with 74% receiving IVV support. ACV outcomes occurred in 62 children. IVV support was associated with lower admission left ventricular ejection fraction (26.7% versus 32%, P=0.002), more severe left ventricular dilation (left ventricular internal diastolic dimension Z score 5.9 versus 3.1, P=0.021) moderate or more mitral regurgitation (41.3% versus 20.6%, P=0.038), and qualitative right ventricular systolic dysfunction (in 45.4% versus 11.8%, P<0.001). Decline in BNP levels was more rapid in patients who were successfully weaned from IVV support (-0.20 versus -0.03 2log pg/mL per day, P<0.001) and in the non-ACV group (-0.17 versus -0.03 2log pg/mL per day, P<0.001). Right ventricular systolic dysfunction was an independent risk factor for ACV (odds ratio, 2.49; P=0.045). CONCLUSIONS: The declining rate of serial BNP levels was associated with weaning from IVV support and no ACV outcomes in children hospitalized with ADHF. Right ventricular systolic dysfunction was associated with ACV outcomes.

Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction.

BACKGROUND: CaIMR is proposed as a novel angiographic index designed to assess microcirculation without the need for pressure wires or hyperemic agents. We aimed to investigate the impact of caIMR on predicting clinical outcomes in STEMI patients. METHODS: One hundred and forty patients with STEMI who received PCI in Putuo Hospital of Shanghai from October 2021 to September 2022 were categorized into CMD and non-CMD groups according to the caIMR value. The baseline information, patient-related examinations, and the occurrence of MACE at the 12-month follow-up were collected to investigate risk factors in patients with STEMI. RESULTS: We divided 140 patients with STEMI enrolled into two groups according to caIMR results, including 61 patients diagnosed with CMD and 79 patients diagnosed with non-CMD. A total of 21 MACE occurred during the 1 year of follow-up. Compared with non-CMD group, patients with CMD showed a significantly higher risk of MACE. A multivariate Cox regression model was conducted for the patients, and it was found thatcaIMR was a significant predictor of prognosis in STEMI patients (HR: 8.921). Patients with CMD were divided into culprit vascular CMD and non-culprit vascular CMD, and the result found that culprit vascular CMD was associated with the incidence of MACE (OR: 4.75) and heart failure (OR: 7.50). CONCLUSION: CaIMR is a strong predictor of clinical outcomes and can provide an objective risk stratification for patients with STEMI. There is a strong correlation among leukocyte index, the use of furosemide, Killips classification, and clinical outcomes.

Initial decrease in the lipoprotein(a) level is a novel prognostic biomarker in patients with acute coronary syndrome.

BACKGROUND: Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular diseases; however, its role in acute coronary syndrome (ACS) remains unclear. AIM: To investigate the hypothesis that the Lp(a) levels are altered by various conditions during the acute phase of ACS, resulting in subsequent cardiovascular events. METHODS: From September 2009 to May 2016, 377 patients with ACS who underwent emergent coronary angiography, and 249 who completed ≥ 1000 d of follow-up were enrolled. Lp(a) levels were measured using an isoform-independent assay at each time point from before percutaneous coronary intervention (PCI) to 48 h after PCI. The primary endpoint was the occurrence of major adverse cardiac events (MACE; cardiac death, other vascular death, ACS, and non-cardiac vascular events). RESULTS: The mean circulating Lp(a) level decreased significantly from pre-PCI (0 h) to 12 h after (19.0 mg/dL to 17.8 mg/dL, P < 0.001), and then increased significantly up to 48 h after (19.3 mg/dL, P < 0.001). The changes from 0 to 12 h [Lp(a)Δ0-12] significantly correlated with the basal levels of creatinine [Spearman's rank correlation coefficient (SRCC): -0.181, P < 0.01] and Lp(a) (SRCC: -0.306, P < 0.05). Among the tertiles classified according to Lp(a)Δ0-12, MACE was significantly more frequent in the lowest Lp(a)Δ0-12 group than in the remaining two tertile groups (66.2% vs 53.6%, P = 0.034). A multivariate analysis revealed that Lp(a)Δ0-12 [hazard ratio (HR): 0.96, 95% confidence interval (95%CI): 0.92-0.99] and basal creatinine (HR: 1.13, 95%CI: 1.05-1.22) were independent determinants of subsequent MACE. CONCLUSION: Circulating Lp(a) levels in patients with ACS decreased significantly after emergent PCI, and a greater decrease was independently associated with a worse prognosis.

Predicting major adverse cardiac events using radiomics nomogram of pericoronary adipose tissue based on CCTA: A multi-center study.

BACKGROUND: The evolution of coronary atherosclerotic heart disease (CAD) is intricately linked to alterations in the pericoronary adipose tissue (PCAT). In recent epochs, characteristics of the PCAT have progressively ascended as focal points of research in CAD risk stratification and individualized clinical decision-making. Harnessing radiomic methodologies allows for the meticulous extraction of imaging features from these adipose deposits. Coupled with machine learning paradigms, we endeavor to establish predictive models for the onset of major adverse cardiovascular events (MACE). PURPOSE: To appraise the predictive utility of radiomic features of PCAT derived from coronary computed tomography angiography (CCTA) in forecasting MACE. METHODS: We retrospectively incorporated data from 314 suspected or confirmed CAD patients admitted to our institution from June 2019 to December 2022. An additional cohort of 242 patients from two external institutions was encompassed for external validation. The endpoint under consideration was the occurrence of MACE after a 1-year follow-up. MACE was delineated as cardiovascular mortality, newly diagnosed myocardial infarction, hospitalization (or re-hospitalization) for heart failure, and coronary target vessel revascularization occurring more than 30 days post-CCTA examination. All enrolled patients underwent CCTA scanning. Radiomic features were meticulously extracted from the optimal diastolic phase axial slices of CCTA images. Feature reduction was achieved through a composite feature selection algorithm, laying the groundwork for the radiomic signature model. Both univariate and multivariate analyses were employed to assess clinical variables. A multifaceted logistic regression analysis facilitated the crafting of a clinical-radiological-radiomic combined model (or nomogram). Receiver operating characteristic (ROC) curves, calibration, and decision curve analyses (DCA) were delineated, with the area under the ROC curve (AUCs) computed to gauge the predictive prowess of the clinical model, radiomic model, and the synthesized ensemble. RESULTS: A total of 12 radiomic features closely associated with MACE were identified to establish the radiomic model. Multivariate logistic regression results demonstrated that smoking, age, hypertension, and dyslipidemia were significantly correlated with MACE. In the integrated nomogram, which amalgamated clinical, imaging, and radiomic parameters, the diagnostic performance was as follows: 0.970 AUC, 0.949 accuracy (ACC), 0.833 sensitivity (SEN), 0.981 specificity (SPE), 0.926 positive predictive value (PPV), and 0.955 negative predictive value (NPV). The calibration curve indicated a commendable concordance of the nomogram, and the decision curve analysis underscored its superior clinical utility. CONCLUSIONS: The integration of radiomic signatures from PCAT based on CCTA, clinical indices, and imaging parameters into a nomogram stands as a promising instrument for prognosticating MACE events.

The predictive value of cumulative atherogenic index of plasma (AIP) for cardiovascular outcomes: a prospective community-based cohort study.

BACKGROUND: Atherogenic index of plasma (AIP) has been reported as a critical predictor on the risks and clinical outcomes of cardiovascular diseases (CVDs), and we aimed to explore the potential predictive value of cumulative AIP on major adverse cardiac events (MACE), stroke, myocardial infarction (MI) and cardiovascular mortality. METHODS: A large-scale community-based prospective cohort was established from December 2011 to April 2012 and followed up in May to July 2014. The endpoint outcomes were obtained before December 31, 2021. AIP was calculated as the logarithmically transformed ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-c) and cumulative AIP was the average value of AIP in 2012 and 2014. RESULTS: An overall of 3820 participants (36.1% male) with mean (SD) age of 59.1 (8.7) years, were enrolled. Within a median follow-up of 7.5 years, a total of 371 (9.7%) participants were documented with MACE, 293 (7.7%) participants developed stroke, 68 (1.8%) suffered from MI and 65 (1.7%) experienced cardiovascular mortality. Multivariable Cox regression analysis revealed significant associations between cumulative AIP and the risk of MACE, stroke and MI. Regarding MACE, individuals with one higher unit of cumulative AIP were associated with 75% increment on the incidence of going through MACE in fully adjusted model, while categorizing participants into four groups, individuals in the highest cumulative AIP quartile were significantly associated with increased incidence of MACE (HR = 1.76, 95%CI: 1.27-2.44, p < 0.001 in fully adjusted model), stroke (HR = 1.69, 95%CI: 1.17-2.45, p = 0.005) and MI (HR = 2.82, 95%CI: 1.18-6.72, p = 0.019). But not a significant association was observed between cumulative AIP and cardiovascular mortality. In subgroup analysis, the association of cumulative AIP and the incidence of stroke was more pronounced in the elderly (HR: 0.89 vs. 2.41 for the age groups < 65 years and ≥ 65 years, p for interaction = 0.018). CONCLUSIONS: A higher cumulative AIP was significantly associated with an increased risk of MACE, stroke and MI independent of traditional cardiovascular risk factors in a community-based population, and the association of cumulative AIP and stroke was particularly pronounced in the elderly population.

Coronary Artery Bypass Graft Failure in Women: Incidence and Clinical Implications.

BACKGROUND: Women have worse outcomes after coronary artery bypass surgery (CABG) than men. OBJECTIVES: This study aimed to determine the incidence of CABG graft failure in women, its association with cardiac events, and whether it contributes to sex-related differences in outcomes. METHODS: A pooled analysis of individual patient data from randomized clinical trials with systematic imaging follow-up was performed. Multivariable logistic regression models were used to assess the association of graft failure with myocardial infarction and repeat revascularization between CABG and imaging (primary outcome) and death after imaging (secondary outcome). Mediation analysis was performed to evaluate the effect of graft failure on the association between female sex and risk of death. RESULTS: Seven randomized clinical trials (N = 4,413, 777 women) were included. At a median imaging follow-up of 1.03 years, graft failure was significantly more frequent among women than men (37.3% vs 32.9% at the patient-level and 20.5% vs 15.8% at the graft level; P = 0.02 and P < 0.001, respectively). In women, graft failure was associated with an increased risk of myocardial infarction and repeat revascularization (OR: 3.94; 95% CI: 1.79-8.67) and death (OR: 3.18; 95% CI: 1.73-5.85). Female sex was independently associated with the risk of death (direct effect, HR: 1.84; 95% CI: 1.35-2.50) but the association was not mediated by graft failure (indirect effect, HR: 1.04; 95% CI: 0.86-1.26). CONCLUSIONS: Graft failure is more frequent in women and is associated with adverse cardiac events. The excess mortality risk associated with female sex among CABG patients is not mediated by graft failure.

Preoperative evaluation profile of patients undergoing arterial vascular surgery in a tertiary hospital.

BACKGROUND: Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them. The aim of this study was to compare the preoperative evaluation conducted by general practitioners with those performed by cardiologists. METHODS: This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients' clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others. RESULTS: 281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001). CONCLUSION: The increased request for exams didn't have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources.

Mortality and cardiovascular events in diabetes mellitus patients at dialysis initiation treated with glucagon-like peptide-1 receptor agonists.

BACKGROUND: Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) have demonstrated efficacy in improving mortality and cardiovascular (CV) outcomes. However, the impact of GLP-1RAs therapy on cardiorenal outcomes of diabetic patients at the commencement of dialysis remains unexplored. PURPOSE: This study aimed to investigate the long-term benefits of GLP-1RAs in type 2 diabetic patients at dialysis commencement. METHODS: A cohort of type 2 diabetic patients initializing dialysis was identified from the TriNetX global database. Patients treated with GLP-1RAs and those treated with long-acting insulin (LAI) were matched by propensity score. We focused on all-cause mortality, four-point major adverse cardiovascular events (4p-MACE), and major adverse kidney events (MAKE). RESULTS: Among 82,041 type 2 diabetic patients initializing dialysis, 2.1% (n = 1685) patients were GLP-1RAs users (mean ages 59.3 years; 55.4% male). 1682 patients were included in the propensity-matched group, treated either with GLP-1RAs or LAI. The main causes of acute dialysis in this study were ischemic heart disease (17.2%), followed by heart failure (13.6%) and sepsis (6.5%). Following a median follow-up of 1.4 years, GLP-1RAs uses at dialysis commencement was associated with a reduced risk of mortality (hazard ratio [HR] = 0.63, p < 0.001), 4p-MACE (HR = 0.65, p < 0.001), and MAKE (HR = 0.75, p < 0.001). This association was particularly notable in long-acting GLP-1RAs users, with higher BMI, lower HbA1c, and those with eGFR > 15 ml/min/1.73m2. GLP-1RAs' new use at dialysis commencement was significantly associated with a lower risk of MACE (p = 0.047) and MAKE (p = 0.004). Additionally, GLP-1RAs use among those who could discontinue from acute dialysis or long-term RAs users was associated with a lower risk of mortality, 4p-MACE, and MAKE. CONCLUSION: Given to the limitations of this observational study, use of GLP-1RAs at the onset of dialysis was associated with a decreased risk of MACE, MAKE, and all-cause mortality. These findings show the lack of harm associated with the use of GLP-1RAs in diabetic patients at the initiation of acute dialysis.