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Fan X, Li M, Cao J, Liang Z. Application of thrombolysis in myocardial infarction risk index in the prediction of long-term outcomes for patients with ST-elevation myocardial infarction and multiple vessel disease: A single-center prospective observational cohort study. Exp Ther Med 2021; 22:1464. [PMID: 34737804 PMCID: PMC8561768 DOI: 10.3892/etm.2021.10899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/21/2019] [Indexed: 11/05/2022] Open
Abstract
The thrombolysis in myocardial infarction (TIMI) risk index has been indicated to be a simple and useful tool for risk stratification of patients with ST-elevation myocardial infarction (STEMI). However, the predictive value of the TIMI risk index regarding the long-term outcome for patients with STEMI with multiple vessel disease has remained to be determined. In the present study, a total of 369 patients diagnosed with STEMI who received emergency percutaneous coronary intervention treatment were analyzed. A five-year follow-up was performed to record the primary endpoint of all-cause mortality, as well as the secondary endpoints of myocardial infarction, stroke, emergent revascularization and admission due to heart failure. A receiver operating characteristic (ROC) curve was used to determine the cut-off value of the TIMI risk index for predicting all-cause death, based on which the patients were divided into a high TIMI group and a low TIMI group. Kaplan-Meier survival curves were used to compare the long-term survival of the two groups and multivariate Cox regression analysis was used to evaluate the predictive value of the risk factors regarding primary and secondary endpoints. The ROC curve indicated that the TIMI risk index was associated with three-year all-cause death with a cut-off value of 30.35 (area under curve, 0.705; P=0.001). The high TIMI group (>30.35) and low TIMI group (<30.35) exhibited a significant difference in all-cause death (P=0.009) but not in any of the secondary endpoints (P=0.527). Multivariate Cox regression analysis demonstrated that a high TIMI risk index was an independent risk factor for all-cause death in patients with STEMI and multiple-vessel disease (hazard ratio=3.709, 95% CI: 1.521-9.046, P=0.004). In conclusion, the TIMI risk index was associated with long-term outcomes for patients with STEMI and multiple-vessel disease and may be of value for risk prediction.
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Affiliation(s)
- Xuefang Fan
- Department of Cardiology, Xianyang Hospital of Yan'an University, Xianyang, Shanxi 712000, P.R. China
| | - Mingliang Li
- Ward No. 2, Department of Cardiovascular Disease, People's Hospital of Hanzhong City, Hanzhong, Shanxi 723000, P.R. China
| | - Jie Cao
- Department of Cardiology, Affiliated Hospital of Yan'an University, Xiangyang, Shanxi 716000, P.R. China
| | - Zeming Liang
- Second Department of Cardiovascular Disease, Baoji Hospital of Traditional Chinese Medicine, Baoji, Shanxi 721000, P.R. China
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2
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Wang G, Wang R, Liu L, Wang J, Zhou L. Comparison of shock index-based risk indices for predicting in-hospital outcomes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. J Int Med Res 2021; 49:3000605211000506. [PMID: 33784854 PMCID: PMC8020253 DOI: 10.1177/03000605211000506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective We aimed to determine whether the prognostic value of the shock index (SI)
and its derivatives is better than that of the Thrombolysis In Myocardial
Infarction risk index (TRI) for predicting adverse outcomes in patients with
ST-segment elevation myocardial infarction (STEMI) undergoing primary
percutaneous coronary intervention (PCI). Methods A total of 257 patients with STEMI undergoing primary PCI from January 2018
to June 2019 were analyzed in a retrospective cohort study. The SI, modified
shock index (MSI), age SI (age × the SI), age MSI (age × the MSI), and TRI
at admission were calculated. Clinical endpoints were in-hospital
complications, including all-cause mortality, acute heart failure, cardiac
shock, mechanical complications, re-infarction, and life-threatening
arrhythmia. Results Multivariate analyses showed that a high SI, MSI, age SI, age MSI, and TRI at
admission were associated with a significantly higher rate of in-hospital
complications. The predictive value of the age SI and age MSI was comparable
with that of the TRI (area under the receiver operating characteristic
curve: z = 1.313 and z = 0.882, respectively) for predicting in-hospital
complications. Conclusions The age SI and age MSI appear to be similar to the TRI for predicting
in-hospital complications in patients with STEMI undergoing primary PCI.
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Affiliation(s)
- Guoyu Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province, Nanjing, China.,Department of Cardiology, Taizhou People's Hospital, Jiangsu Province, Taizhou, China
| | - Ruzhu Wang
- Department of Cardiology, Taizhou People's Hospital, Jiangsu Province, Taizhou, China
| | - Ling Liu
- Department of Cardiology, Taizhou People's Hospital, Jiangsu Province, Taizhou, China
| | - Jing Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province, Nanjing, China.,Department of Cardiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Jiangsu Province, Huaian, China
| | - Lei Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province, Nanjing, China
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Fu B, Wei X, Wang Q, Yang Z, Chen J, Yu D. Use of the Thrombolysis in Myocardial Infarction Risk Index for Elderly Patients With ST-Segment Elevation Myocardial Infarction. Front Cardiovasc Med 2021; 8:743678. [PMID: 34869648 PMCID: PMC8639686 DOI: 10.3389/fcvm.2021.743678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/28/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a simple risk assessment tool for patients with ST-segment elevation myocardial infarction (STEMI). However, its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain. Methods: This was a retrospective analysis of elderly (≥60 years) patients who underwent PCI for STEMI from January 2010 to April 2016. TRI was calculated on admission using the following formula: heart rate × (age/10)2/systolic blood pressure. Discrimination and calibration of TRI for in-hospital events and 1 year mortality were analyzed. Results: Totally 1,054 patients were divided into three groups according to the tertiles of the TRI: <27 (n = 348), 27-36 (n = 360) and >36 (n = 346). The incidence of acute kidney injury (AKI; 7.8 vs. 8.6 vs. 24.0%, p < 0.001), AHF (3.5 vs. 6.6 vs. 16.2%, p < 0.001), in-hospital death (0.6 vs. 3.3 vs. 11.6%, p < 0.001) and MACEs (5.2 vs. 5.8 vs. 15.9%, p < 0.001) was significantly higher in the third tertile. TRI showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p < 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for AKI (AUC = 0.678, p < 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital MACEs (AUC = 0.669, p < 0.001; Hosmer-Lemeshow p = 0.077). Receiver-operation characteristics curve showed that TRI > 42.0 had a sensitivity of 64.8% and specificity of 82.2% for predicting in-hospital death. Kaplan-Meier analysis showed that patients with TRI > 42.0 had higher 1 year mortality (Log-rank = 79.2, p < 0.001). Conclusion: TRI is suitable for risk stratification in elderly patients with STEMI undergoing PCI, and is thus of continuing value for an aging population.
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Affiliation(s)
- Bingqi Fu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Xuebiao Wei
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qi Wang
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Zhiwen Yang
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Jiyan Chen
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Danqing Yu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Danqing Yu
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Çınar T, Karabağ Y, Burak C, Tanık VO, Yesin M, Çağdaş M, Rencüzoğulları İ. A simple score for the prediction of stent thrombosis in patients with ST elevation myocardial infarction: TIMI risk index. J Cardiovasc Thorac Res 2019; 11:182-188. [PMID: 31579457 PMCID: PMC6759620 DOI: 10.15171/jcvtr.2019.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction: The present study aimed to evaluate the potential utility of thrombosis in myocardial infarction (TIMI) risk index (TRI) for the prediction of stent thrombosis (ST) in ST elevation myocardial infarction (STEMI) patients who were treated with primary percutaneous coronary intervention ( pPCI ). Methods: This retrospective study was related to the clinical data of 1275 consecutive STEMI patients who underwent pPCI from January 2013 to January 2018. The TRI was calculated for each patient, and the following equation was used; TRI = heart rate x [age/10]2/systolic blood pressure. For the definition of ST, the criteria as proposed by the Academic Research Consortium were applied. Results: The incidence of ST was 3.2% (n=42 patients) in the study. The median value of the TRI was significantly elevated in patients with ST compared to those without ST (22 [17-32] vs. 16 [11-21], P<0.001, respectively). In a multivariate logistic regression analysis, the TRI was an independent predictor of ST (odds ratio [OR]: 1.061; 95% CI: 1.038-1.085; P<0.001). In a receiver operating characteristic curve analysis, the optimal value of the TRI for the prediction of ST was 25.8 with a sensitivity of 45.2% and a specificity of 86.4%. Conclusion: The present study finding has demonstrated that the TRI may be an independent predictor of ST in STEMI patients who were treated with pPCI . To the best of our knowledge, this is the first study in the literature in which the TRI and its relationship with ST was evaluated in STEMI patients treated with pPCI .
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Affiliation(s)
- Tufan Çınar
- Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Yavuz Karabağ
- Kafkas University Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | - Cengiz Burak
- Kafkas University Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | - Veysel Ozan Tanık
- Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Mahmut Yesin
- Kafkas University Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | - Metin Çağdaş
- Kafkas University Faculty of Medicine, Department of Cardiology, Kars, Turkey
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A New and Simple Risk Predictor of Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention: TIMI Risk Index. Cardiol Res Pract 2018; 2018:5908215. [PMID: 30356419 PMCID: PMC6178187 DOI: 10.1155/2018/5908215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background The thrombolysis in myocardial infarction risk index (TRI) was developed to estimate prognosis at the initial contact of the healthcare provider in coronary artery disease patients without laboratory parameters. In this study, we aimed to investigate the relationship of the baseline TRI and contrast-induced nephropathy (CIN) in patients with ST-elevation myocardial infarction (STEMI). Methods A total of 963 consecutive STEMI diagnosed patients who underwent primary percutaneous intervention were included in the study. TRI was calculated using the formula “heart rate × (age/10) 2/SBP” on admission. CIN was defined as an increase in serum creatinine concentration ≥25%, 48 hours later over the baseline. Results Of the total of 963 patients, CIN was observed in 13% (n=128). TRI was significantly higher in the CIN (+) group compared with the CIN (−) group (32.9 ± 18.8 vs 19.9 ± 9.9, P < 0.001). There was a stronger correlation between CIN and age, diastolic blood pressure, heart rate, Killip class, left ventricular ejection fraction, amount of contrast media, and diabetes mellitus. The amount of contrast media (OR 1.010, 95% CI 1.007–1.012, P < 0.001) and TRI (OR 1.047, 95% CI 1.020–1.075, P=001) were independent predictors of CIN. The best threshold TRI for predicting CIN was ≥25.8, with a 67.1% sensitivity and 80.4% specificity (area under the curve (AUC): 0.740, 95% CI: 0.711–0.768, P < 0.001). Conclusion TRI is an independent predictor of CIN, and it may be used as a simple and reliable risk assessment of CIN in STEMI patients without the need for laboratory parameters.
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6
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Zaninović Jurjević T, Dvornik Š, Kovačić S, Matana Kaštelan Z, Brumini G, Matana A, Zaputović L. A simple prognostic model for assessing in-hospital mortality risk in patients with acutely decompensated heart failure. Acta Clin Belg 2018; 74:102-109. [DOI: 10.1080/17843286.2018.1483562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Štefica Dvornik
- Department for Laboratory Diagnostics, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Slavica Kovačić
- Department for Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Gordana Brumini
- Faculty of Health Studies, Department for Basic Medical Sciences University of Rijeka, Rijeka, Croatia
| | - Ante Matana
- Department for Cardiovascular Diseases, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Luka Zaputović
- Department for Cardiovascular Diseases, Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Patel N, Patel NJ, Thakkar B, Singh V, Arora S, Patel N, Savani C, Deshmukh A, Thadani U, Badheka AO, Alfonso C, Fonarow GC, Cohen MG. Management Strategies and Outcomes of ST-Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States. Clin Cardiol 2016; 39:9-18. [PMID: 26785349 DOI: 10.1002/clc.22491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/25/2015] [Indexed: 01/26/2023] Open
Abstract
Fibrinolytic therapy is still used in patients with ST-segment elevation myocardial infarction (STEMI) when the primary percutaneous coronary intervention cannot be provided in a timely fashion. Management strategies and outcomes in transferred fibrinolytic-treated STEMI patients have not been well assessed in real-world settings. Using the Nationwide Inpatient Sample from 2008 to 2012, we identified 18 814 patients with STEMI who received fibrinolytic therapy and were transferred to a different facility within 24 hours. The primary outcome was in-hospital mortality. Secondary outcomes included gastrointestinal bleeding, bleeding requiring transfusion, intracranial hemorrhage (ICH), length of stay, and cost. The patients were divided into 3 groups: those who received medical therapy alone (n = 853; 4.5%), those who underwent coronary artery angiography without revascularization (n = 2573; 13.7%), and those who underwent coronary artery angiography with revascularization (n = 15 388; 81.8%). Rates of in-hospital mortality among the groups were 20% vs 6.6% vs 2.1%, respectively (P < 0.001); ICH was 8.5% vs 1.1% vs 0.6%, respectively (P < 0.001); and gastrointestinal bleeding was 1.1% vs 0.4% vs 0.4%, respectively (P = 0.011). Multivariate analysis identified increasing age, higher Charlson Comorbidity Index score, cardiogenic shock, cardiac arrest, and ICH as the independent predictors of not performing coronary artery angiography and/or revascularization in patients with STEMI initially treated with fibrinolytic therapy. The majority of STEMI patients transferred after receiving fibrinolytic therapy undergo coronary angiography. However, notable numbers of patients do not receive revascularization, especially patients with cardiogenic shock and following a cardiac arrest.
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Affiliation(s)
- Nish Patel
- Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Nileshkumar J Patel
- Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Badal Thakkar
- Department of Internal Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Vikas Singh
- Department of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Shilpkumar Arora
- Department of Internal Medicine, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York
| | - Nilay Patel
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Chirag Savani
- Department of Internal Medicine, New York Medical College, Valhalla, New York
| | | | - Udho Thadani
- Cardiovascular Section/Internal Medicine, VA Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Apurva O Badheka
- Department of Cardiology, Heart and Vascular Center, Everett Clinic, Everett, Washington
| | - Carlos Alfonso
- Department of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Gregg C Fonarow
- Department of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, California
| | - Mauricio G Cohen
- Department of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida
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Jabre P, Roger VL, Weston SA, Adnet F, Jiang R, Vivien B, Empana JP, Jouven X. Resting heart rate in first year survivors of myocardial infarction and long-term mortality: a community study. Mayo Clin Proc 2014; 89:1655-63. [PMID: 25440890 PMCID: PMC4256107 DOI: 10.1016/j.mayocp.2014.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the long-term prognostic effect of resting heart rate (HR) at index myocardial infarction (MI) and during the first year after MI among 1-year survivors. PATIENTS AND METHODS The community-based cohort consisted of 1571 patients hospitalized with an incident MI from January 1, 1983, through December 31, 2007, in Olmsted County, Minnesota, who were in sinus rhythm at index MI and had HR measurements on electrocardiography at index and during the first year after MI. Outcomes were all-cause and cardiovascular deaths. RESULTS During a median follow-up of 7.0 years, 627 deaths and 311 cardiovascular deaths occurred. Using patients with HRs of 60/min or less as the referent, this study found that long-term all-cause mortality risk increased progressively with increasing HR at index (hazard ratio, 1.62; 95% CI, 1.25-2.09) and even more with increasing HR during the first year after MI (hazard ratio, 2.16; 95% CI, 1.64-2.84) for patients with HRs greater than 90/min, adjusting for clinical characteristics and β-blocker use. Similar results were observed for cardiovascular mortality (adjusted hazard ratio, 1.66; 95% CI, 1.14-2.42; and adjusted hazard ratio, 1.93; 95% CI, 1.27-2.94; for HR at index and within 1 year after MI, respectively). CONCLUSION These data from a large MI community cohort indicate that HR is a strong predictor of long-term all-cause and cardiovascular mortality not only at initial presentation of MI but also during the first year of follow-up.
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Affiliation(s)
- Patricia Jabre
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; INSERM, U970, Paris Cardiovascular Research Center, Paris Descartes University, Assistance Publique-Hopitaux de Paris, Paris, France; Service d'Aide Médicale Urgente de Paris, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Frédéric Adnet
- Department of Emergency Medicine, Avicenne Hospital, Paris 13 University, Assistance Publique-Hopitaux de Paris, Bobigny, France
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Benoit Vivien
- Service d'Aide Médicale Urgente de Paris, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jean-Philippe Empana
- INSERM, U970, Paris Cardiovascular Research Center, Paris Descartes University, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Xavier Jouven
- INSERM, U970, Paris Cardiovascular Research Center, Paris Descartes University, Assistance Publique-Hopitaux de Paris, Paris, France
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Bekler A, Altun B, Gazi E, Temiz A, Barutçu A, Güngör Ö, Özkan MTA, Özcan S, Gazi S, Kırılmaz B. Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome. Anatol J Cardiol 2014; 15:801-6. [PMID: 25592101 PMCID: PMC5336965 DOI: 10.5152/akd.2014.5802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients with acute coronary syndrome (ACS). Methods: Patients with ACS who were admitted to the coronary care unit of our institution were retrospectively evaluated in this study. A total of 287 patients with ACS [154 non-ST elevated ACS (NSTE-ACS), 133 ST elevated myocardial infarction (STEMI)] were included in the study. The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS<109)-, intermediate (GRS 109-140)-, and high (GRS>140)-risk groups and group 1 (TRI<17), group 2 (TRI 17-26), and group 3 (TRI>26) according to GRS and TRI scores. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS. Results: Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study. Were excluded from the study. There were significant differences in mean age (p<0.001), heart rate (p<0.001), SS (p<0.001), TRI (p<0.001), rate of NSTE-ACS (p<0.001), and STEMI (p<0.001) in all patients between the risk groups. There was a positive significant correlation between the GRS and the SS (r=0.427, p<0.001), but there were no significant correlation between the TRI and SS (r=0.121, p=0.135). The area under the ROC curve value for GRS was 0.65 (95% CI: 0.56-0.74, p=0.001) in the prediction of severity of CAD. Conclusion: The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS.
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Affiliation(s)
- Adem Bekler
- Department of Cardiology, Çanakkale Onsekiz Mart University, Faculty of Medicine; Çanakkale-Turkey.
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10
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Serum iron concentration, but not hemoglobin, correlates with TIMI risk score and 6-month left ventricular performance after primary angioplasty for acute myocardial infarction. PLoS One 2014; 9:e104495. [PMID: 25100442 PMCID: PMC4123974 DOI: 10.1371/journal.pone.0104495] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/09/2014] [Indexed: 12/15/2022] Open
Abstract
Objective Anemia is associated with high mortality and poor prognosis after acute coronary syndrome (ACS). Increased red cell distribution width (RDW) is a strong independent predictor for adverse outcomes in ACS. The common underlying mechanism for anemia and increased RDW value is iron deficiency. It is not clear whether serum iron deficiency without anemia affects left ventricular (LV) performance after primary angioplasty for acute myocardial infarction (AMI). We investigated the prognostic value of serum iron concentration on LV ejection fraction (EF) at 6 months and its relationship to thrombolysis in myocardial infarction (TIMI) risk score in post MI patients. Methods We recruited 55 patients who were scheduled to undergo primary coronary balloon angioplasty after AMI and 54 age- and sex-matched volunteers. Serum iron concentration and interleukin-6 levels were measured before primary angioplasty. LVEF was measured by echocardiography at baseline and after 6 months. TIMI risk score was calculated for risk stratification. Results Serum iron concentration was significantly lower in those in whom LVEF had not improved ≥10% from baseline (52.7±24.1 versus 80.8±50.8 µg/dl, P = 0.016) regardless of hemoglobin level, and was significantly lower in the AMI group than in the control group (62.5±37.7 versus 103.0±38.1 µg/dl, P<0.001). Trend analysis revealed that serum iron concentration decreased as TIMI risk score increased (P = 0.002). In addition, lower serum iron concentrations were associated with higher levels of inflammatory markers. Multiple linear regression showed that baseline serum iron concentration can predict LV systolic function 6 months after primary angioplasty for AMI even after adjusting for traditional prognostic factors. Conclusion Hypoferremia is not only a marker of inflammation but also a potential prognostic factor for LV systolic function after revascularization therapy for AMI, and may be a novel biomarker for therapeutic intervention.
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11
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Using oxidized low-density lipoprotein autoantibodies to predict restenosis after balloon angioplasty in patients with acute myocardial infarction. PLoS One 2013; 8:e74726. [PMID: 24098346 PMCID: PMC3789725 DOI: 10.1371/journal.pone.0074726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/05/2013] [Indexed: 12/22/2022] Open
Abstract
Objectives Oxidized low-density lipoproteins (oxLDL) and oxidized low-density lipoprotein autoantibodies (OLAB) have been detected in human plasma and atherosclerotic lesions. OLAB appear to play a role in the clearance of oxLDL from circulation. Higher levels of OLAB appear to be associated with a reduced risk of a wide range of cardiovascular diseases. We investigated the prognostic value of plasma oxLDL and OLAB in patients undergoing primary coronary balloon angioplasty for acute ST-elevation myocardial infarction (STEMI). Methods Plasma oxLDL and OLAB concentrations were measured in 56 patients with acute STEMI before primary angioplasty, and then 3 days, 7 days and 1 month after the acute event. Follow-up angiography was repeated 6 months later to detect the presence of restensosis (defined as >50% luminal diameter stenosis). The thrombolysis in myocardial infarction (TIMI) risk score was calculated to determine the relationship between OLAB/oxLDL ratio and TIMI risk scores. Results Of the 56 patients, 18 (31%) had angiographic evidence of restenosis. Plasma OLAB concentrations were significantly lower in the restenosis group before angioplasty (181±114 vs. 335±257 U/L, p = 0.003), and at day 3 (155±92 vs. 277±185 U/L, p<0.001) and day 7 (177±110 vs. 352±279 U/L, p<0.001) after the acute event. There was no difference in oxLDL concentration between the two groups. The ratio of OLAB/oxLDL positively correlated with TIMI risk scores before angioplasty (p for trend analysis, p = 0.004), at day 3 (p = 0.008) and day 7 (p<0.001) after STEMI. Significance A relative deficit of OLAB, and hence likely impaired clearance of oxLDL, is associated with the risk of arterial restenosis after primary angioplasty for acute STEMI.
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Zahid M, Phillips BE, Albers SM, Giannoukakis N, Watkins SC, Robbins PD. Identification of a cardiac specific protein transduction domain by in vivo biopanning using a M13 phage peptide display library in mice. PLoS One 2010; 5:e12252. [PMID: 20808875 PMCID: PMC2923200 DOI: 10.1371/journal.pone.0012252] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 07/09/2010] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A peptide able to transduce cardiac tissue specifically, delivering cargoes to the heart, would be of significant therapeutic potential for delivery of small molecules, proteins and nucleic acids. In order to identify peptide(s) able to transduce heart tissue, biopanning was performed in cell culture and in vivo with a M13 phage peptide display library. METHODS AND RESULTS A cardiomyoblast cell line, H9C2, was incubated with a M13 phage 12 amino acid peptide display library. Internalized phage was recovered, amplified and then subjected to a total of three rounds of in vivo biopanning where infectious phage was isolated from cardiac tissue following intravenous injection. After the third round, 60% of sequenced plaques carried the peptide sequence APWHLSSQYSRT, termed cardiac targeting peptide (CTP). We demonstrate that CTP was able to transduce cardiomyocytes functionally in culture in a concentration and cell-type dependent manner. Mice injected with CTP showed significant transduction of heart tissue with minimal uptake by lung and kidney capillaries, and no uptake in liver, skeletal muscle, spleen or brain. The level of heart transduction by CTP also was greater than with a cationic transduction domain. CONCLUSIONS Biopanning using a peptide phage display library identified a peptide able to transduce heart tissue in vivo efficiently and specifically. CTP could be used to deliver therapeutic peptides, proteins and nucleic acid specifically to the heart.
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Affiliation(s)
- Maliha Zahid
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Brett E. Phillips
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Sean M. Albers
- Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Nick Giannoukakis
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Simon C. Watkins
- Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Paul D. Robbins
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
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Abstract
The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). These high-risk manifestations of coronary atherosclerosis are important causes of the use of emergency medical care and hospitalization in the United States. A quick but thorough assessment of the patient's history and findings on physical examination, electrocardiography, radiologic studies, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification, which is essential for guiding treatment. High-risk patients with UA/NSTEMI are often treated with an early invasive strategy involving cardiac catheterization and prompt revascularization of viable myocardium at risk. Clinical outcomes can be optimized by revascularization coupled with aggressive medical therapy that includes anti-ischemic, antiplatelet, anticoagulant, and lipid-lowering drugs. Evidence-based guidelines provide recommendations for the management of ACS; however, therapeutic approaches to the management of ACS continue to evolve at a rapid pace driven by a multitude of large-scale randomized controlled trials. Thus, clinicians are frequently faced with the problem of determining which drug or therapeutic strategy will achieve the best results. This article summarizes the evidence and provides the clinician with the latest information about the pathophysiology, clinical presentation, and risk stratification of ACS and the management of UA/NSTEMI.
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Affiliation(s)
- Amit Kumar
- Department of Hospital Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Thrombolysis in Myocardial Infarction (TIMI) Risk Index predicts long-term mortality and heart failure in patients with ST-elevation myocardial infarction in the TIMI 2 clinical trial. Am Heart J 2009; 157:673-9.e1. [PMID: 19332194 DOI: 10.1016/j.ahj.2008.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 12/10/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND TIMI (Thrombolysis in Myocardial Infarction) Risk Index (TRI) is a simple bedside score that predicts 30-day mortality in patients with ST-elevation myocardial infarction (MI). We sought to evaluate whether TRI was predictive of long-term mortality and clinical events. METHODS In the TIMI 2 trial, 3,153 patients (mean age 57 +/- 10 years, 82% men) were randomized to invasive (n = 1,583) versus conservative (n = 1,570) strategy postfibrinolysis with median follow-up of 3 years. TIMI Risk Index was divided into 5 groups. The primary end point was all-cause mortality. Secondary analyses included recurrent MI, congestive heart failure (CHF), and combined end points. RESULTS When compared with group 1, mortality in group 5 was more than 5-fold higher (hazard ratio [HR] 5.83, P < .0001) and was also increased in group 4 (HR 2.80, P < .0001) and group 3 (HR 1.96, P = .002) (c statistic 0.69). No difference was seen between groups 1 and 2 (P = .74). A similar increasing gradient effect was seen across TRI strata with group 5 having the highest risk for CHF (HR 4.13, P < .0001) and the highest risk for composite death/CHF (HR 4.35, P < .0001) over group 1. There was no difference in recurrent MI between the groups (P = .22). After controlling for other risk indicators, the relationship between TRI and mortality remained significant: group 5, HR 4.11, P < .0001; group 4, HR 2.14, P = .0009; group 3, HR 1.69, P = .02. When stratified by TRI groups, no differences in mortality or composite death/MI were found between treatment strategies. CONCLUSIONS The simple TRI can predict increased long-term mortality, CHF, and composite death/CHF.
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Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Taglieri N, Baldazzi F, Dall'Ara G, Nardini P, Gianstefani S, Guastaroba P, Grilli R, Branzi A. Long-term effectiveness of early administration of glycoprotein IIb/IIIa agents to real-world patients undergoing primary percutaneous interventions: results of a registry study in an ST-elevation myocardial infarction network. Eur Heart J 2008; 30:33-43. [DOI: 10.1093/eurheartj/ehn480] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mahmarian JJ, Pratt CM. Risk stratification after acute myocardial infarction: is it time to reassess? Implications from the INSPIRE trial. J Nucl Cardiol 2007; 14:282-92. [PMID: 17556161 DOI: 10.1016/j.nuclcard.2007.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bradshaw PJ, Ko DT, Newman AM, Donovan LR, Tu JV. Validation of the Thrombolysis In Myocardial Infarction (TIMI) risk index for predicting early mortality in a population-based cohort of STEMI and non-STEMI patients. Can J Cardiol 2007; 23:51-6. [PMID: 17245483 PMCID: PMC2649172 DOI: 10.1016/s0828-282x(07)70213-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Thrombolysis In Myocardial Infarction (TIMI) risk index for the prediction of 30-day mortality was developed and validated in patients with ST-segment elevation myocardial infarction (STEMI) who were being treated with thrombolytics in randomized clinical trials. When tested in clinical registries of patients with STEMI, the index performed poorly in an older (65 years and older) Medicare population, but it was a good predictor of early death among the more representative population on the National Registry of Myocardial Infarction-3 and -4 databases. It has not been tested in a population outside the United States or among non-STEMI patients. METHODS The TIMI risk index was applied to the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study cohort of 11,510 acute MI patients from Ontario. The model's discriminatory capacity and calibration were tested in all patients and in subgroups determined by age, sex, diagnosis and reperfusion status. RESULTS The TIMI risk index was strongly associated with 30-day mortality for both STEMI and non-STEMI patients. The C statistic was 0.82 for STEMI and 0.80 for non-STEMI patients, with overlapping 95% CI. The discriminatory capacity was somewhat lower for patients older than 65 years of age (0.74). The model was well calibrated. CONCLUSIONS The TIMI risk index is a simple, valid and moderately accurate tool for the stratification of risk for early death in STEMI and non-STEMI patients in the community setting. Its routine clinical use is warranted.
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Takata J, Nishinaga M, Doi Y. [Reperfusion therapy for acute myocardial infarction in elderly patients]. Nihon Ronen Igakkai Zasshi 2007; 43:693-6. [PMID: 17233445 DOI: 10.3143/geriatrics.43.693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although there has been great progress in reperfusion therapy, the role of coronary reperfusion for elderly patients with acute myocardial infarction has not been fully investigated. In general, mean age of the subjects in major trials was about 60 years old and approximately only 10 to 15% of patients were over age 75. On the other hand, large-scale registries such as the US national registry of myocardial infarction (NRMI) showed a higher prevalence of elderly (especially women) in the clinical setting. This discrepancy may be due to the fact that elderly patients with myocardial infarction have some difficulties in the treatment such as severe multi-vessel coronary lesions, non-cardiac complications and relatively high prevalence of adverse reactions to reperfusion therapy. Here we focus on the situation of elderly patients (especially those 75 years or older) with myocardial infarction in the "real world" clinical setting, showing the clinical changes and outcome of our registry in rural Japan: the Kochi AMI (KAMI) registry.
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Affiliation(s)
- Jun Takata
- Section of Cardiology, Department of Medicine and Geriatrics, Kochi Medical School
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