Combination of the CYP2C19 metabolizer and the GRACE risk score better predicts the long-term major adverse cardiac events in acute coronary syndrome undergoing percutaneous coronary intervention.

INTRODUCTION: Both Global Registry of Acute Coronary Events (GRACE) risk score and CYP2C19 metabolizer status can independently predict major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We investigated whether their combination could better predict MACE occurrence in patients with ACS undergoing PCI. MATERIALS AND METHODS: This retrospective cohort study included 548 consecutive patients with ACS undergoing PCI. A cumulative MACE curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify MACE predictors. The predictive value of GRACE risk score alone and CYP2C19 metabolizer status was estimated by the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: In a median of 28.58 months, 17 patients (3%) were lost to follow-up, and 62 (11.3%) experienced MACEs. Multivariate Cox regression analysis showed that both GRACE score and CYP2C19 metabolizer status were independent MACE predictors (hazard ratio 1.019, 95% CI 1.011-1.027, p < 0.001; hazard ratio 2.383, 95% CI 1.601-3.547, p < 0.001, respectively). Kaplan-Meier analysis showed that CYP2C19 PM increased the MACE risk (log rank test = 10.848, p = 0.004). The GRACE score adjustment by CYP2C19 metabolizer status enhanced the predictive value (AUC increased from 0.682 for GRACE score alone to 0.731 for GRACE score plus CYP2C19 metabolizer). This result was further verified by IDI and NRI. CONCLUSIONS: CYP2C19 metabolizer status and GRACE score are readily available predictive approaches for MACEs, and their combination derives a more accurate long-term MACE prediction in clopidogrel-treated patients with ACS undergoing PCI.

[Seasonal Variations and Controlling Factors of the Element Contents in Drip Waters Collected from the Baojinggong Cave in Guangdong Province].

Geochemical dynamics of cave water were monitored to unveil its seasonal variation and controlling factors from December 2011 to May 2013 in Baojinggong cave, north of Guangdong Province. Concentrations of elements such as Ba, Sr, Ca and Mg of three drips in the cave were analyzed. The results showed that: (1) All these elements of three drips displayed significant seasonal variations, but the trends of seasonal variation of different elements or different drips were not the same, which reflected that each element in different drips might be controlled by different effects; (2) The low element contents of Drip1 and Drip2 during the heavy rainfall month showed that heavy rainfall could dilute the concentrations of elements; (3) Mg/Ca had a positive relationship with Sr/Ca ratio in three drips, and was higher in dry season and lower in rainy season. It implied that the two proxies might be mainly controlled by precipitation, karst water source, leaching effect and prior calcite precipitation (PCP), and reflected the climate change.

[Atmospheric deposition fluxes and seasonal variations of elements in northeast of Sichuan, central China].

Monthly atmospheric deposition was collected in Northeast of Sichuan Province from August 2011 to July 2012. Contents of Na, Mg, Ca, K, Si, Sr, Ba and Zn in weak-acid leachable fraction (with pH values of ca. 2) of the deposition were determined using ICP-MS. The results indicated that the deposition fluxes of all these elements exhibited notable seasonal variations. For example, the deposition flux of Na increased with precipitation, suggesting a dominant derivation from wet deposition; whereas the fluxes of Ca, Ba, Si, Sr and Mg displayed higher values during winter or spring season, suggesting that these elements may be closely associated with atmospheric dust activity. The annual fluxes of these elements were remarkably different in value. Na had the highest flux of 30 497 microg x (10(2) cm2 x a)(-1), more than three orders of magnitude higher than the lowest flux of Ba of 27.4 microg x (10(2) cm2 x a)(-1).