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1.
Medicine (Baltimore) ; 99(41): e22523, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031294

RESUMO

There is scarce evidence that the erythrocyte sedimentation rate (ESR) could efficiently improve the prediction accuracy of the Global Registry of Acute Coronary Events (GRACE) risk score in cases of ST-elevation myocardial infarction (STEMI).A cohort of 1094 STEMI patients undergoing primary percutaneous coronary intervention was retrospectively recruited. Patients were categorized based on the ESR values. Final endpoints included cardiovascular death and major adverse cardiovascular event (MACE) occurrence. The predictive value of combined models with the GRACE score and ESR was assessed by receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement.During the mean follow-up of 23 months, 34 patients died and 190 experienced MACEs, of which 23 patients died in the first year; both endpoints were more frequent in the higher group. The ESR and high-sensitivity C-reactive protein (hs-CRP) were independent risk factors of 1-year cardiovascular death, together with the GRACE score (ESR: hazard ratio = 1.03, P = .006 hs-CRP: hazard ratio = 1.00, P = .001; GRACE: 1.03, P = .012). Although no statistical improvement in the area under the ROC curve was observed in either the GRACE/ESR or the GRACE/hs-CRP model (GRACE/ESR models: 0. 8073 vs GRACE: 0.7714, P = .22; GRACE/ESR models: 0. 7815 vs GRACE: 0.7714, P = .61), the GRACE score and ESR together significantly improved the NRI (0.633; P< .001) compared with the GRACE alone. Regarding the mid-term mortality, adding the ESR to the GRACE score not only improved the NRI (0.8433; P < .001), but also increased the integrated discrimination improvement (0.0509; P = .04).The ESR is an independent risk factor of cardiovascular death and MACE in STEMI patients receiving primary percutaneous coronary intervention. The ESR comparatively enhanced the predictive values of the prognostic model, including the GRACE risk score.


Assuntos
Sedimentação Sanguínea , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Biomarcadores/sangue , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
2.
Cardiovasc Ther ; 2020: 9625181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32934665

RESUMO

Background: The white blood cell count to mean platelet volume ratio (WMR) is an indicator of inflammation in patients with atherosclerotic disease. Residual SYNTAX Score (RSS) is an objective measure of degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). We investigated the relationship between WMR and clinical prognosis and RSS in patients undergoing primary percutaneous coronary intervention (P-PCI). Method: Between June 2015 and December 2018, 537 patients who underwent primary PCI were evaluated for in-hospital events, and 477 patients were evaluated for clinical events during follow-up after discharge. The endpoint of our study is major adverse cardiac events (MACEs) seen in the in-hospital and follow-up periods. Results: In our study, 537 patients were stratified into two groups according to admission median WMR. There were 268 patients in the low WMR group (WMR < 1286) and 269 patients in the high WMR group (WMR ≥ 1286). RSS (p = 0.01) value of the high WMR group was higher than that of the low WMR group. The rates of in-hospital MACE (p = 0.001), cardiac death (p < 0.001), decompansated heart failure (0.007), and ventricular tachycardia/fibrillation (p = 0.003) were higher in the high WMR group than in the low WMR group. The follow-up MACEs (p = 0.043), cardiac death (p = 0.026), and reinfarction (p = 0.031) ratio were higher in the high WMR group. In ROC analysis, cut-off values of in-hospital and follow-up MACEs were >1064 (sensitivity: 83.12%, and specificity: 36.29%) and >1130 (sensitivity: 69.15%, and specificity: 44.91%), respectively. The Kaplan-Meier analysis showed that the high WMR group had the significantly lowest MACE-free survival rate (log-rank test, p = 0.006). A moderate correlation was observed between WMR and RSS (r: 456, p = 0.002). Conclusion: A higher WMR value on admission was associated with worse outcomes in patients with P-PCI and independently predicted for follow-up MACEs. The WMR provides both a rapid and an easily obtainable parameter to identify reliably high-risk patients who underwent primary percutaneous coronary intervention due to STEMI.


Assuntos
Plaquetas , Doença da Artéria Coronariana/terapia , Leucócitos , Volume Plaquetário Médio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
3.
Am J Cardiol ; 132: 15-21, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32773226

RESUMO

Lipid-lowering therapy is necessary to reduce cardiovascular event rates in patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate the effect of intensive lipid-lowering therapy, which comprised pitavastatin and ezetimibe, on patients with STEMI. We therefore undertook a post hoc subanalysis of the HIJ-PROPER study's data that examined the clinical outcomes of the patients with dyslipidemia and STEMI (n = 880) who received pitavastatin and ezetimibe therapy (intensive lipid-lowering therapy group) or pitavastatin monotherapy (standard lipid-lowering therapy group), and we evaluated their cardiovascular events. The primary end point was a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, unstable angina, and ischemia-driven revascularization. During the median 3.4-year follow-up period, the cumulative rates of the primary end point were 31.9% and 39.7% in the intensive lipid-lowering therapy and standard lipid-lowering therapy groups, respectively (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.62 to 0.97; p = 0.02). Compared with the standard lipid-lowering therapy group, the intensive lipid-lowering therapy group had significantly lower all-cause death (6.9% vs 3.2%; HR, 0.45; 95% CI, 0.23 to 1.84; p = 0.01) and nonfatal stroke (2.9% vs 1.6%; HR, 0.77; 95% CI, 0.62 to 0.97; p = 0.02) rates. Patients with pitavastatin and ezetimibe therapy, as compared with pitavastatin monotherapy, had a lower cardiovascular event in STEMI patients. In conclusion, adding ezetimibe to statin therapy may be beneficial for patients with dyslipidemia and STEMI.


Assuntos
Ezetimiba/uso terapêutico , Quinolinas/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Anticolesterolemiantes/uso terapêutico , Biomarcadores/sangue , LDL-Colesterol/sangue , Dinamarca/epidemiologia , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Método Simples-Cego , Taxa de Sobrevida/tendências , Resultado do Tratamento
5.
PLoS One ; 15(5): e0233286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442225

RESUMO

BACKGROUND: Elevated serum transaminase or alkaline phosphatase (ALP) has been proposed as a novel prognosticator for ST-segment elevation myocardial infarction (STEMI). We evaluated the combined prognostic impact of elevated serum transaminases and ALP on admission in STEMI patients who underwent primary percutaneous coronary intervention (PCI). METHODS: A total of 1176 patients with STEMI undergoing primary PCI were retrospectively enrolled from the INTERSTELLAR registry. Hypoxic liver injury (HLI) was defined as serum transaminase > twice the upper limit of normal. The cut-off value of high ALP was set at the median level (73 IU/L). Patients were divided into four groups according to their serum transaminase and ALP levels. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization. RESULTS: Median follow-up duration was 25 months (interquartile range, 10-39 months). The rate of MACCE was highest in patients with HLI (+) and high ALP (25.9%), compared to those in the other groups (8.2% in HLI [-] and low ALP, 11.8% in HLI [-] and high ALP, and 15.0% in HLI [+] and low ALP). Each of HLI or high ALP was an independent predictor for MACCE (HR 1.807, 95% CI 1.191-2.741; HR 1.721, 95% CI 1.179-2.512, respectively). Combined HLI and high ALP was associated with the worst prognosis (HR 3.145, 95% CI 1.794-5.514). CONCLUSIONS: Combined HLI and high ALP on admission is associated with poor clinical outcomes in patients with STEMI who have undergone primary PCI.


Assuntos
Fosfatase Alcalina/sangue , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Transaminases/sangue , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Resultado do Tratamento
6.
Angiology ; 71(8): 713-720, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32372694

RESUMO

We investigated circulating levels of inflammatory biomarkers pentraxin-3 (PTX3), cyclophilin A (CypA), and heparin-binding epidermal growth factor-like growth factor (HB-EGF); oxidative stress; and antioxidant status markers in the patients with ST-segment elevation acute myocardial infarction (STEMI) to better understand a relationship between inflammation and oxidative stress. We examined the impact of oxidative stress on high values of inflammatory parameters. The study included 87 patients with STEMI and 193 controls. We observed a positive correlation between PTX3 and HB-EGF (ρ = 0.24, P = .027), CyPA, and sulfhydryl (SH) groups (ρ = 0.25, P = .026), and a negative correlation between PTX3 and SH groups (ρ = -0.35, P = .001) in patients with STEMI. To better understand the effect of the examined parameters on the occurrence of high concentrations of inflammatory parameters, we grouped them using principal component analysis. This analysis identified the 4 most contributing factors. Optimal cutoff values for discrimination of patients with STEMI from controls were calculated for PTX3 and HB-EGF. An independent predictor for PTX3 above the cutoff value was a "metabolic-oxidative stress factor" comprised of glucose and oxidative stress marker prooxidant-antioxidant balance (odds ratio = 4.449, P = .030). The results show that higher PTX3 values will occur in patients having STEMI with greater metabolic and oxidative stress status values.


Assuntos
Proteína C-Reativa/análise , Ciclofilina A/sangue , Fator de Crescimento Semelhante a EGF de Ligação à Heparina/sangue , Mediadores da Inflamação/sangue , Estresse Oxidativo , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Componente Amiloide P Sérico/análise , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
7.
Medicine (Baltimore) ; 99(16): e19724, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311962

RESUMO

D-dimer is a primary degradation product of cross-linked fibrin, and can be an effective diagnostic factor of venous thromboembolism. However, its prognostic role in patients with acute ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to investigate whether D-dimer has a predictive value for long-term prognosis in patients with STEMI.We retrospectively enrolled 872 STEMI patients treated with primary percutaneous coronary intervention. Patients were divided into quartiles according to their admission D-dimer increased multiple, with the highest quartile (G4) (n = 219) defined as increased multiple ≧1.33, and the lowest quartile (G1) (n = 215) as increased multiple ≦0.33.Compared with G1, higher in-hospital heart failure (40.2% vs 10.2%, P < .0001), malignant arrhythmia (14.2% vs 2.3%, P < .0001), and all-cause mortality (5.9% vs 0%, P < .0001) rates were observed in G4. After a follow-up period of 29 months, 84 patients had died. In the Cox multivariate analysis, a high admission D-dimer increased multiple (≧1.33) was found to be an independent predictor of all-cause mortality (hazards ratio: 2.53, 95% confidence interval: 1.02-6.26, P = .045).Thus, there was an association between a high D-dimer level and the increase in in-hospital major adverse cardiovascular events, such as heart failure, malignant arrhythmias, and death. High D-dimer level was also an independent predictor of long-term all-cause mortality.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Idoso , Angiografia , China/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem
8.
Adv Clin Exp Med ; 29(4): 453-458, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32343887

RESUMO

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality around the world. In patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), electrocardiographic measures of ST-segment resolution (STR) may give information about the myocardial perfusion and poor prognosis. OBJECTIVES: To investigate the relation of endocan and galectin-3 levels with STR in STEMI patients. MATERIAL AND METHODS: In this cross-sectional study, 98 consecutive patients undergoing PPCI for STEMI were enrolled. Synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) scores were recorded. Electrocardiograms were assessed at baseline and 60 min after PPCI. According to STR levels, patients undergoing PPCI (n = 98) were divided into complete STR group (≥70%, n = 53) and incomplete STR group (<70%, n = 45). RESULTS: Serum glucose, total cholesterol, low-density lipoprotein cholesterol, SYNTAX score, endocan and galectin-3 levels were significantly higher and ejection fraction was significantly lower in the incomplete STR (<70%) group (p < 0.05 for all). Body mass index (BMI) (p = 0.046) and galectin-3 (p = 0.037) were independently associated with the SYNTAX score. Endocan (p = 0.044) and galectin-3 (p = 0.017) were independent predictors of incomplete STR. CONCLUSIONS: In patients with STEMI, the levels of endocan and galectin-3 may be helpful in identifying patients with a higher risk of insufficient myocardial perfusion and worse clinical outcome after PPCI.


Assuntos
Galectina 3/sangue , Proteínas de Neoplasias/sangue , Intervenção Coronária Percutânea , Proteoglicanas/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Angiografia Coronária , Estudos Transversais , Eletrocardiografia , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Resultado do Tratamento
9.
Am J Med Sci ; 359(5): 281-286, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32245567

RESUMO

BACKGROUND: The monocyte to high-density lipoprotein ratio (MHR) has been used to predict adverse clinical outcomes in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the prognostic utility of MHR in patients with ACS. MATERIALS AND METHODS: We comprehensively searched for relevant studies in Pubmed, Embase, CNKI, WanFang and VIP databases until March 12, 2019. Epidemiologic studies investigating the association between MHR and major adverse cardiovascular events (MACE) or all-cause mortality in patients with ACS were included. Pooled effect was expressed as risk ratios (RR) with 95% confidence intervals (CI) for the highest versus the reference lower MHR group. RESULTS: Eight studies involving 6,480 patients with ACS were included and analyzed. Meta-analysis indicated that the highest MHR was significantly associated with higher risk of MACE (RR 1.65; 95%CI 1.36-2.02) and all-cause mortality (RR 2.61; 95%CI 1.29-4.89) after adjusting for the conventional confounders. The prognostic values of MACE with the highest MHR caused no significant changes in the in-hospital follow-up (RR 1.76; 95%CI 1.34-2.32) and >6 months follow-up (RR 1.68; 95%CI 1.08-2.62) subgroups. Furthermore, ST elevation myocardial infarction patients with the highest MHR had a 2.07-fold higher risk of in-hospital MACE (RR 2.07; 95%CI 1.52-2.80). CONCLUSIONS: Elevated MHR is independently associated with an increased risk of MACE and all-cause mortality in patients with ACS. MHR may serve as a potential prognostic indicator for ACS prognosis.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Lipoproteínas HDL/sangue , Monócitos/citologia , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Prognóstico , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
10.
Nutr Metab Cardiovasc Dis ; 30(6): 922-924, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32249141

RESUMO

Leptin is an adipose tissue-derived hormone primarily involved in the regulation of food intake. Leptine has been shown to have a much broader role than just regulating body weight and appetite in response to food intake: among the others, it has been associated with increased ROS production and inflammation, factors involved in the restoration of an effective myocardial reperfusion after myocardial revascularization. Our study, to our best knowledge, is the first showing a direct relationship between leptin serum levels, inflammatory mediators of the ischemia reperfusion damage and effective myocardial reperfusion in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Our findings suggest that leptin serum levels are directly associated with the inflammatory response during an acute myocardial infarction and may have a role in risk stratification in this clinical setting.


Assuntos
Mediadores da Inflamação/sangue , Leptina/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Humanos , Interleucina-6/sangue , Masculino , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo , Resultado do Tratamento
11.
Cardiovasc Ther ; 2020: 8647837, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32190122

RESUMO

Background: Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: We analyzed records of 983 STEMI patients who were treated with primary PCI. The primary end point was all-cause mortality at 1 year and 2 years. The relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results: Overall, 16.4% of patients had bleeding events, which were classified by the Thrombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. The incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006-1.034, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006-1.034, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006-1.034. Conclusions: In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.


Assuntos
Anemia/sangue , Hemoglobinas/metabolismo , Hemorragia/sangue , Alta do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Anemia/diagnóstico , Anemia/mortalidade , Biomarcadores/sangue , Causas de Morte , Feminino , Hemorragia/diagnóstico , Hemorragia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Resultado do Tratamento
12.
Nutr Metab Cardiovasc Dis ; 30(4): 574-580, 2020 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-32007333

RESUMO

BACKGROUND AND AIMS: The Mediterranean diet (MD) affects the risk of myocardial infarction and long-term prognosis after a coronary event. Limited data are available regarding the influence of MD on short-term prognosis. We assessed the impact of the MD adherence on in-hospital and short-term outcome in patients with first ST-elevation Myocardial Infarction (STEMI). METHODS AND RESULTS: As many as 533 European patients with STEMI and no previous history of coronary artery disease were included in this analysis. Previous dietary habits of each patient were collected with a food frequency questionnaire from which we calculated the FAMI Mediterranean Diet Score (FAMI MD Score), according to the MD adherence. A blood sample was drawn to each patient within 6 h of symptoms onset. Levels of high-sensitivity C-Reactive Protein (hsCRP), Interleukin-6 (IL-6) were measured. Clinical outcome at 180 days and myocardial reperfusion were assessed. Patients with higher FAMI MD Score had lower levels of hsCRP; there were no differences between IL-6 level among FAMI MD Score quintiles. There were no associations between adherence to MD and 180-day adverse events. Lower FAMI MD Score was associated with a higher risk of ineffective myocardial reperfusion after thrombolysis or percutaneous coronary intervention. Similar results were observed for daily consumption of ≥4 portions of fruit and vegetable. CONCLUSIONS: A positive effect of the Mediterranean diet, and fruit and vegetable intake was observed on hsCRP and the occurrence of effective myocardial reperfusion. These findings confirm the favorable impact of Mediterranean diet adherence not only in primary but also in secondary prevention.


Assuntos
Dieta Saudável , Dieta Mediterrânea , Comportamento Alimentar , Cooperação do Paciente , Intervenção Coronária Percutânea , Comportamento de Redução do Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica , Idoso , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Europa (Continente) , Feminino , Frutas , Humanos , Mediadores da Inflamação/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Verduras
13.
Cardiovasc Ther ; 2020: 9416803, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32099583

RESUMO

Objective: This study aimed to establish a clinical prognostic nomogram for predicting major adverse cardiovascular events (MACEs) after primary percutaneous coronary intervention (PCI) among patients with ST-segment elevation myocardial infarction (STEMI). Methods: Information on 464 patients with STEMI who performed PCI procedures was included. After removing patients with incomplete clinical information, a total of 460 patients followed for 2.5 years were randomly divided into evaluation (n = 324) and validation (n = 324) and validation (. Results: Apelin-12 change rate, apelin-12 level, age, pathological Q wave, myocardial infarction history, anterior wall myocardial infarction, Killip's classification > I, uric acid, total cholesterol, cTnI, and the left atrial diameter were independently associated with MACEs (all P < 0.05). After incorporating these 11 factors, the nomogram achieved good concordance indexes of 0.758 (95%CI = 0.707-0.809) and 0.763 (95%CI = 0.689-0.837) in predicting MACEs in the evaluation and validation cohorts, respectively, and had well-fitted calibration curves. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. Conclusions: We established and validated a novel nomogram that can provide individual prediction of MACEs for patients with STEMI after PCI procedures in a Chinese population. This practical prognostic nomogram may help clinicians in decision making and enable a more accurate risk assessment.


Assuntos
Técnicas de Apoio para a Decisão , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Nomogramas , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Biomarcadores/sangue , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores de Tempo , Resultado do Tratamento
14.
BMC Cardiovasc Disord ; 20(1): 95, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103724

RESUMO

BACKGROUND: We aim to find out the relationship between random blood glucose (RBG), fasting blood glucose (FBG) and in-hospital adverse events in ST-segment elevation acute myocardial infarction (STEMI) patients. We evaluate and compare the predictive value of RBG and FBG on in-hospital adverse events, and give an appropriate cut-off value of RBG and FBG. METHOD: A retrospective study enrolled 958 consecutive AMI patients undergoing emergency coronary angiography at Zhongda Hospital were enrolled from January 1, 2016, to December 31, 2018 was performed. RBG and FBG, baseline data and adverse events were recorded. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as death, nonfatal recurrent myocardial infarction and stroke. Other adverse events included malignant arrhythmia, cardiac shock and hemorrhage. Patients with RBG > 11.1 mmol/L were divided into elevated RBG group. Patients with FBG > 6.1 mmol/L were divided into elevated FBG group. The incidence of in-hospital adverse events were compared in elevated RBG/FBG group and the control group. ROC curve was used to evaluate the predictive value of RBG and FBG on in-hospital adverse events. RESULT: The incidence of death, hemorrhage, cardiac shock and malignant arrhythmia significantly increases in elevated RBG and FBG group. Binary logistic regression showed that age, hypertension, diabetes, FBG and RBG were independent risk factors for in-hospital adverse events in STEMI patients. The AUC and 95% CI of RBG and FBG in predicting death of AMI patients were 0.789, 0.759~0.816; 0.810, 0.783~0.835, respectively. The cut-off values ​were 13.82 and 7.35 mmol/L. RBG and FBG also had fine predictive value on cardiac shock and malignant arrhythmia, no statistical difference was found in the predictive value on in-hospital adverse events (P = 0.462, P = 0.570, P = 0.694). CONCLUSION: Incidence of in-hospital adverse events significantly increases in AMI patients combined with elevated RBG or FBG. Both RBG and FBG were independent risk factors for in-hospital adverse events, they had good value on predicting in-hospital adverse events and there was no statistical difference in their predictive value.


Assuntos
Glicemia/metabolismo , Jejum/sangue , Admissão do Paciente , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Idoso , Biomarcadores/sangue , China/epidemiologia , Angiografia Coronária , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo
15.
Sci Rep ; 10(1): 2639, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060329

RESUMO

Plasma trimethylamine N-oxide (TMAO) is associated with coronary atherosclerotic plaque and cardiovascular disease risk, but associations between gut microbes in acute coronary syndrome (ACS) and post-ST-segment elevation myocardial infarction (post-STEMI) events are unknown. We investigated associations between gut microbial taxa and systemic TMAO levels and the possible TMAO contribution to incident post-STEMI cardiovascular events. PATIENTS AND METHODS: A total of 60 patients, including 30 with unstable angina pectoris (UAP), 30 post-STEMI and 30 healthy controls, were enrolled from June to November 2017. Metagenomic sequencing was performed and TMAO and IL-6 were detected. RESULTS: Minimal discriminators of gut microbial taxa (top 40) distinguished ACS patients from controls. Serum TMAO levels were positively associated with increased abundance of Aerococcaceae, Ruminococcaceae_UCG.005, Ruminococcaceae_UCC.014 and X. Eubacterium_fissicatena, and decreased abundance of Lachnospiraceae_FCS020 (P < 0.05). Elevated serum TMAO levels correlated independently with ACS (P < 0.05). Risk stratification for incident major adverse cardiovascular events (MACE) improved at one year in patients with serum TMAO levels ≦2.19 µM. Serum interleukin-6 levels were not significantly increased in patients with ACS and post-STEMI MACE. CONCLUSIONS: ACS and incident post-STEMI MACE may be associated with the gut bacteria choline metabolite TMAO. The specific gut microbial taxa identified in association with serum TMAO levels may be potential predictive biomarkers for accurate diagnosis of ACS onset.


Assuntos
Síndrome Coronariana Aguda/microbiologia , Microbioma Gastrointestinal , Infarto do Miocárdio com Supradesnível do Segmento ST/microbiologia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Metilaminas/sangue , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
16.
Biomarkers ; 25(2): 137-143, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31902247

RESUMO

Background: Takotsubo cardiomyopathy (TTC) is a syndrome of acute non-coronary heart failure with similar symptoms and electrocardiograms to acute anterior ST-elevation myocardial infarction (STEMI). Little is known about the pathophysiology of TTC. We assessed admission plasma concentrations of biomarkers reflecting neuroendocrine response (copeptin, mid-regional-pro-adrenomedullin, pro-atrial-natriuretic-peptide, soluble thrombomodulin (sTM), syndecan-1) and inflammation (suppression-of-tumorigenicity 2 (ST2), high-sensitive C-reactive-protein) in TTC patients and compared to patients with acute anterior STEMI.Materials and methods: Twenty TTC patients were matched with 40 STEMI patients by age, gender and left ventricular ejection fraction. Blood was sampled upon hospital admission immediately before acute coronary angiography.Results: The groups had similar comorbidities. TTC patients had higher plasma concentrations of sTM: 7.94 (5.89;9.61) vs. 6.42 (5.50;7.82)ng/ml, p = 0.04 and ST2 (53 (32;157) vs. 45 (31;55)ng/ml, p = 0.008) and higher heart rate: 101 ([Formula: see text]33) vs. 76([Formula: see text]14)bpm, p = 0.0001, but lower concentrations of copeptin (10.4 (7.6;39) vs. 92.3 (13;197)pmol/l, p < 0.05) and troponin T (348 (98;759) vs. 1190 (261;4105)ng/l, p = 0.04).Conclusion: TTC patients had higher plasma concentrations of sTM and ST2, higher heart rate and lower copeptin and troponin T concentrations compared to acute anterior STEMI patients. This study contributes to the hypothesis that TTC patients have endothelial cell damage and are hemodynamically more stable than patients with acute anterior STEMI on admission.


Assuntos
Biomarcadores/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Idoso , Diagnóstico Diferencial , Células Endoteliais/patologia , Feminino , Glicopeptídeos/sangue , Frequência Cardíaca , Hemodinâmica , Humanos , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Cardiomiopatia de Takotsubo/sangue , Trombomodulina/sangue , Troponina T/sangue
17.
Med Sci Monit ; 26: e919300, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31949123

RESUMO

BACKGROUND The aim of the present study was to investigate the clinical predictive value of pre-infarction angina (PIA) combined with mean platelet volume to lymphocyte count ratio (MPVLR) for no-reflow phenomenon and short-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). MATERIAL AND METHODS A total of 1009 STEMI patients who had undergone PCI were enrolled and subdivided into 4 groups based on the occurrence of PIA and the presence of MPVLR above or below the cutoff value. Analysis of the predictors of the no-reflow phenomenon and 90-day mortality was conducted. Further, evaluation and comparison of the clinical predictive value of PIA, MPVLR, and their combination were done. RESULTS Both MPVLR (odds ratio [OR]=1.476, 95% confidence interval [CI]: 1.401 to 1.756, P<0.001; hazard ratio [HR]=1.430, 95% CI: 1.287 to 1.643, P<0.001) and PIA (OR=0.905, 95% CI: 0.783 to 0.986, P<0.001; HR=0.878, 95% CI: 0.796 to 0.948, P<0.001) were independent predictors of no-reflow phenomenon and 90-day mortality. Spearman's rank correlation test revealed that MPVLR (r=-0.297, P<0.001), monocyte to lymphocyte count ratio (MLR) (r=-0.211, P<0.001) and neutrophil to lymphocyte count ratio (NLR) (r=-0.389, P<0.001) in peripheral blood were significantly negatively correlated with postoperative left ventricular ejection fraction (LVEF). Upon comparing the area under curve (AUC), the MPVLR combined with PIA achieved better performance in differentiating no-reflow phenomenon (AUC=0.847, 95% CI: 0.821 to 0.874) and 90-day mortality (AUC=0.790, 95% CI: 0.725 to 0.855), than the GRACE score, MPVLR and PIA alone, and had similar performance to all other pairwise combinations of the GRACE score, MPVLR and PIA. CONCLUSIONS High MPVLR and PIA were independent predictors of the no-reflow phenomenon and 90-day mortality in patients with STEMI after PCI. Moreover, Combined application of MPVLR and PIA can effectively predict the occurrence of the no-reflow phenomenon and 90-day mortality.


Assuntos
Angina Pectoris/sangue , Volume Plaquetário Médio , Infarto do Miocárdio/sangue , Infarto do Miocárdio/cirurgia , Fenômeno de não Refluxo/sangue , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Angina Pectoris/complicações , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Contagem de Linfócitos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/fisiopatologia , Neutrófilos/patologia , Fenômeno de não Refluxo/complicações , Fenômeno de não Refluxo/fisiopatologia , Intervenção Coronária Percutânea/efeitos adversos , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Volume Sistólico
19.
Int J Cardiovasc Imaging ; 36(5): 789-796, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31919706

RESUMO

Because the phenomenon of no reflow has a poor prognosis in ST-segment elevation myocardial infarction (STEMI) patients and the atherogenic index of plasma (AIP) has been shown to be a strong predictor of coronary heart disease, we aimed to investigate the relationship between AIP and no-reflow in patients with acute STEMI who underwent primary percutaneous coronary intervention (PCI). A total of 763 consecutive STEMI patients (648 men; mean age 58 ± 12 years) who underwent primary PCI were recruited for this study. The patients were classified into a reflow group (n = 537) and a no-reflow group (n = 226) according to the postprocedural angiographic features of thrombolysis in the myocardial infarction flow of the infarct-related artery. The AIP value was significantly higher in the no-reflow group than in the reflow group [0.50 (0.38-0.65) vs. 0.39 (0.25-0.49) p < .001], and AIP was found to be an independent predictor of no-reflow development. The best cut-off value of AIP for predicting no-reflow was 0.54, with sensitivity of 46.02 and specificity of 84,73. In addition, the predictive power of AIP was greater than that of triglycerides and high-density lipoprotein cholesterol based on a receiver operator curve comparison. The AIP was independently associated with no-reflow in patients with STEMI after primary PCI. This might be a superior indicator compared to traditional lipid profiles.


Assuntos
HDL-Colesterol/sangue , Doença da Artéria Coronariana/terapia , Fenômeno de não Refluxo/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Triglicerídeos/sangue , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenômeno de não Refluxo/diagnóstico por imagem , Fenômeno de não Refluxo/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Resultado do Tratamento
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