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Helanova K, Littnerova S, Kubena P, Ganovska E, Pavlusova M, Kubkova L, Jarkovsky J, Pavkova Goldbergova M, Lipkova J, Gottwaldova J, Kala P, Toman O, Dastych M, Spinar J, Parenica J. Prognostic impact of neutrophil gelatinase-associated lipocalin and B-type natriuretic in patients with ST-elevation myocardial infarction treated by primary PCI: a prospective observational cohort study. BMJ Open 2015; 5:e006872. [PMID: 26438132 PMCID: PMC4606420 DOI: 10.1136/bmjopen-2014-006872] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Neutrophil gelatinase-associated lipocalin (NGAL) from a pathophysiological perspective connects various pathways that affect the prognosis after myocardial infarction. The objective was to evaluate the benefits of measuring NGAL for prognostic stratification in addition to the Thrombolysis in Myocardial Infarction (TIMI) score, and to compare it with the prognostic value of B-type natriuretic peptide (BNP). DESIGN Prospective observational cohort study. SETTING One university/tertiary centre. PARTICIPANTS A total of 673 patients with ST segment elevation myocardial infarction were treated by primary percutaneous coronary intervention. NGAL and BNP were assessed on hospital admission. PRIMARY OUTCOME 1-year mortality. SECONDARY OUTCOMES 1-year hospitalisation due to acute heart failure, unplanned revascularisation, reinfarction, stroke and combined end point of 1-year mortality and hospitalisation due to heart failure. STATISTICAL METHODS Using the c-statistic, the ability of NGAL, BNP and TIMI score to predict 1-year mortality alone and in combination with readmission for heart failure was evaluated. The addition of the predictive value of biomarkers to the score was assessed by category free net reclassification improvement (cfNRI) and the integrated discrimination index (IDI). RESULTS The NGAL level was significantly higher in non-survivors (67 vs 115 pg/mL; p<0.001). The area under the curve (AUC) values for mortality prediction for NGAL, BNP and TIMI score were 75.5, 78.7 and 74.4, respectively (all p<0.001) with optimal cut-off values of 84 pg/mL for NGAL and 150 pg/mL for BNP. The addition of NGAL and BNP to the TIMI score significantly improved risk stratification according to cfNRI and IDI. A BNP and the combination of the TIMI score with NGAL predicted the occurrence of the combined end point with an AUC of 80.6 or 82.2, respectively. NGAL alone is a simple tool to identify very high-risk patients. NGAL >110 pg/mL was associated with a 1-year mortality of 20%. CONCLUSIONS The measurement of NGAL together with the TIMI score results in a strong prognostic model for the 1-year mortality rate in patients with STEMI.
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Affiliation(s)
- Katerina Helanova
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Simona Littnerova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Petr Kubena
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Eva Ganovska
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Marie Pavlusova
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Lenka Kubkova
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | - Jolana Lipkova
- Faculty of Medicine, Institute of Pathological Physiology, Masaryk University, Brno, Czech Republic
| | - Jana Gottwaldova
- Department of Biochemistry, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Department of Laboratory Methods, Masaryk University, Brno, Czech Republic
| | - Petr Kala
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Ondrej Toman
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
- Department of Cardiovascular Disease, International Clinical Research Center –University Hospital St Anne's, Brno, Czech Republic
| | - Milan Dastych
- Department of Biochemistry, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Department of Laboratory Methods, Masaryk University, Brno, Czech Republic
| | - Jindrich Spinar
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
- Department of Cardiovascular Disease, International Clinical Research Center –University Hospital St Anne's, Brno, Czech Republic
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
- Department of Cardiovascular Disease, International Clinical Research Center –University Hospital St Anne's, Brno, Czech Republic
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Kluz K, Parenica J, Kubkova L, Littnerova S, Tomandl J, Poloczek M, Toman O, Tesak M, Cermakova Z, Gottwaldova J, Manousek J, Pavkova Goldbergova M, Spinar J, Jarkovsky J. Unstable angina pectoris prior to ST elevation myocardial infarction in patients treated with primary percutaneous coronary intervention has no influence on prognosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:251-8. [DOI: 10.5507/bp.2014.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/14/2014] [Indexed: 11/23/2022] Open
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Alkhushail A, Kohli S, Mitchel A, Smith R, Ilsely C. Prognosis of primary percutaneous coronary intervention in elderly patients with ST-elevation myocardial infarction. J Saudi Heart Assoc 2014; 27:85-90. [PMID: 25870501 PMCID: PMC4392347 DOI: 10.1016/j.jsha.2014.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/14/2014] [Accepted: 12/05/2014] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the prognosis of primary percutaneous coronary intervention (PPCI) and medical therapy (MT) in elderly patients presenting with ST-elevation myocardial infarction (STEMI). Methods A total of 238 STEMI patients aged above 80 and treated with PPCI (n = 186) and MT (n = 52) at Harefield Hospital, London were included in this study. Patients who did not have true STEMI based on non-diagnostic electrocardiogram (ECG) for STEMI and negative troponin, who presented with left bundle branch block (LBBB) and had normal coronaries were excluded from this study. Primary PCI was defined as any use of a guidewire for more than diagnostic purposes in patients with STEMI, whereas conventional MT was defined as treatment of patients with anti-platelets and anti-thrombotic medications without thrombolysis. Results The survival rate of PPCI patients was 86% (n = 160) at month 1 followed by 83.9% (n = 156) at month 6, and 81.2% (n = 151) at month 12. The survival rate of MT patients was 44.2% (n = 23) at month 1 followed by 36.5% (n = 19) at month 6, and 34.6% (n = 18) at month 12. Compared to MT, significantly fewer comorbidities were found in the PPCI group. Ventricular fibrillation (VF) (4.8%) and consequent admission to intensive care unit (7%) were the major complications of the PPCI group. Conclusion PPCI has a higher survival rate and, compared to MT, fewer comorbidities were observed in the PPCI group of elderly patients presenting with STEMI.
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Affiliation(s)
- Abdullah Alkhushail
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia ; Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Sanjay Kohli
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Andrew Mitchel
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Robert Smith
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Charles Ilsely
- Department of Cardiology, Harefield Hospital, London, United Kingdom
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Ganjehei L, Rashid UM, Payami S, Saal AK. ST elevation myocardial infarction: recent advances and updates. Future Cardiol 2014; 10:633-66. [PMID: 25354034 DOI: 10.2217/fca.14.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ST elevation myocardial infarction (STEMI) remains a leading cause of morbidity, mortality and disability worldwide. Statistically, a trend towards improvements in morbidity and mortality has been consistent over the years, which is attributed primarily to the modification of risk factors, healthier lifestyles, treatment advances and better management of door-to-balloon times via STEMI systems. However, a major challenge in the coming years will be the baby boomers (born between the years 1946 and 1964) coming into old age. The first baby boomers turned 65 in year 2011. As the baby boomers age in the coming years, the incidence of coronary heart disease is likely to increase, and so there will be a greater need to have major advances in the management of coronary heart disease in order to deal with this additional incidence. The scope of this article is to review recent advances in the management of STEMI and to provide an updated overview.
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Affiliation(s)
- Leila Ganjehei
- Department of Cardiology, University of Cincinnati, Cincinnati, OH, USA
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Kala P. European Society of Cardiology ST-segment Elevation Myocardial Infarction Guidelines in Perspective - Focused on Primary Percutaneous Coronary Intervention. Interv Cardiol 2014; 9:7-10. [PMID: 29588770 DOI: 10.15420/icr.2011.9.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients suffering acute myocardial infarction with ST-segment elevation myocardial infarction (STEMI) require full attention of the whole STEMI network to save their lives and to improve the quality of life after a heart attack. Implementation of the most recent European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) STEMI Guidelines into the practice is the holy grail of the healthcare systems and all stakeholders. In relation to this, the Stent for Life Initiative can serve as one of very successful and effective models in Europe and beyond. Although the evidence-based approach may be applied to majority of patients, the tailored and updated therapy needs to be modified in concordance with the patients´ risk profile, experience and availability of medical resources. Some 'hot topics', issues, differences between the ESC and ACC/AHA Guidelines, latest information and perspectives are discussed in this short review; focused on primary percutaneous coronary intervention (PCI) as the most effective reperfusion therapy.
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Affiliation(s)
- Petr Kala
- Internal and Cardiology Department, Masaryk University and University Hospital Brno, Brno, Czech Republic
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