Relationship Between CHA2DS2-VASc Score on Admission and In-Hospital Major Adverse Cardiovascular Events in Patients Diagnosed With ST-Elevation Myocardial Infarction.

The CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, sex) scoring system, which includes conventional risk factors of coronary artery disease, was originally created to quantify the risk of thromboembolism in patients with atrial fibrillation. This study evaluated the usefulness of this score to predict adverse outcomes in STEMI (ST-elevation myocardial infarction) patients without atrial fibrillation. Primary end points were identified as MACE (major adverse cardiovascular events) which included in-hospital death or cerebrovascular accident. MACE rate was 10% (193 patients). The CHA2DS2-VASc score was an independent predictor of MACE (95% CI, 2.31 [1.37-3.9]; P = .0016). Other independent predictors of MACE included heart rate (95% CI, 1.56 [0.97-2.50]; P = .0242), admission Killip class (95% CI, 24.19 [10.74-54.46]; P < .0001), admission creatinine level (95% CI, 1.54 [1.10-2.16]; P = .0024), peak CK-MB level (95% CI, 1.63 [0.98-2.70]; P = .0001), and no-reflow (95% CI, 2.45 [1.25-4.80]; P = .0085). A nomogram was developed to estimate the risk of in-hospital adverse outcomes for STEMI patients. The CHA2DS2-VASc score was an independent predictor of MACE in STEMI patients. Linear analysis of CHA2DS2-VASc score without dichotomization was the main difference of this study from others.

Monocyte to high-density lipoprotein ratio at hospital admission predicts intrahospital mortality in patients with Stanford type-A dissection.

BACKGROUND: Immune inflammatory mechanisms have crucial roles not only in the presence but also in the progression of aortic dissection (AD). Monocyte count to high-density lipoprotein ratio (MHR) has recently emerged as an indicator of inflammation and oxidative stress. Thus, we aimed to examine the prognostic value of MHR in patients with AD. METHODS: A total of 204 consecutive patients with Stanford type-A dissection who managed surgically were retrospectively enrolled in the present study. Recruited patients were divided into two groups according to the occurrence of intrahospital death; Group 1 consisted of 165 patients who were discharged alive, and Group 2 consisted of 39 patients who died during index hospitalization. Two groups were compared with respect to baseline clinical data and admission laboratory parameters including MHR. RESULTS: The mean age of the Group 1 was 55.2 ± 12.3 years, while the mean age of the Group 2 was 60.6 ± 10.8 years (p = .012). The patients who were discharged alive (Group 1) had significantly lower MHR than the deceased patients (Group 2) (0.02099 ± 0.00140 vs. 0.02848 ± 0.01513, p = .004). At receiver operating characteristics curve analysis, MHR = 0.020699 had 67% sensitivity and 59% specificity in predicting intrahospital mortality among patients with AD. In multivariate analysis, MHR was found to be an independent risk factor of intrahospital mortality among those (ß = 1.094, p = .011). CONCLUSION: MHR is an inexpensive and easily calculated biomarker, which is useful to predict intrahospital mortality in patients with Stanford type-A dissection who managed surgically.