1
|
Munyombwe T, Dondo TB, Hall M, Nadarajah R, Hurdus B, Aktaa S, Haris M, Keeley A, West R, Hall A, Soloveva A, Norman P, Gale CP. Cohort profile: Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) Longitudinal Cohort. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:442-446. [PMID: 37451698 PMCID: PMC10405135 DOI: 10.1093/ehjqcco/qcad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
AIMS The Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) longitudinal cohort study aims to investigate health trajectories of individuals following hospitalization for myocardial infarction (MI). METHODS AND RESULTS EMMACE is a linked multicentre prospective cohort study of 14 899 patients with MI admitted to 77 hospitals in England who participated in the EMMACE-3 and -4 studies between 1st November 2011 and 24th June 2015. Long-term follow-up of the EMMACE cohorts was conducted through the EMMACE-XL (27th September 2020 to 31st March 2022) and EMMACE-XXL (1st July 2021 to 1st July 2023) studies. EMMACE collected individual participant data for health-related quality of life (HRQoL) measured by three-level EuroQol five-dimension and visual analogy scale at admission, 1 month, 6 months, 12 months, and 10 years follow-up, as well as medications, medication adherence, beliefs about medicines, Satisfaction with Information about Medicines Scale, and illness perceptions. Participant data were deterministically linked to the Myocardial Infarction National Audit Project (MINAP) for information on baseline treatments and comorbidities, Hospital Episode Statistics Admitted Patient Care (for cause-specific hospitalization data), and the Office for National Statistics (for mortality data) up to 2020. CONCLUSION EMMACE is a nationwide prospective cohort that will provide unique insights into fatal and non-fatal outcomes, medication adherence, and HRQoL following MI.Trial registration: ClinicalTrials.gov NCT01808027 and NCT01819103.
Collapse
Affiliation(s)
- Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Tatendashe B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Ramesh Nadarajah
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Ben Hurdus
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Mohammad Haris
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Adam Keeley
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, LS2 9JT Leeds, UK
| | - Alistair Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research Centre, 2 Akkuratova street, Saint Petersburg 197341, Russian
| | - Paul Norman
- School of Geography, University of Leeds, LS2 9JT Leeds, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| |
Collapse
|
2
|
PouralijanAmiri M, Khoshkam M, Madadi R, Kamali K, Faghanzadeh Ganji G, Salek R, Ramazani A. NMR-based plasma metabolic profiling in patients with unstable angina. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2020; 23:311-320. [PMID: 32440317 PMCID: PMC7229510 DOI: 10.22038/ijbms.2020.39979.9475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/23/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Unstable angina (UA) is a form of the acute coronary syndrome (ACS) that affects more than a third of the population before age 70. Due to the limitations of diagnostic tests, appropriate identification of UA is difficult. In this study, we proceeded to investigate metabolite profiling in UA patients compared with controls to determine potential candidate biomarkers. MATERIALS AND METHODS Ninety-four plasma samples from UA and 32 samples from controls were analyzed based on 1H NMR spectroscopy. The raw data were processed, analyzed, and subjected to partial least squares-discrimination analysis (PLS-DA), a supervised classification method with a good separation of control and UA patients was observed. The most important variables (VIP) ≥1 were selected and submitted to MetaboAnalyst pathway enrichment to identify the most important ones. RESULTS We identified 17 disturbed metabolites in UA patients in comparison with the controls. These metabolites are involved in various biochemical pathways such as steroid hormone biosynthesis, aminoacyl-tRNA biosynthesis, and lysine degradation. Some of the metabolites were deoxycorticosterone, 17-hydroxyprogesterone, androstenedione, androstanedione, etiocholanolone, estradiol, 2-hydroxyestradiol, 2-hydroxyestrone, 2-methoxyestradiol, and 2-methoxyestrone. In order to determine test applicability in diagnosing UA, a diagnostic model was further created using the receiver operator characteristic (ROC) curve. The areas under the curve (AUC), sensitivity, specificity, and precision were 0.87, 90%, 65%, and 91%, respectively, for diagnosing of UA. CONCLUSION These metabolites could not only be useful for the diagnosis of UA patients but also provide more information for further deciphering of the biological processes of UA.
Collapse
Affiliation(s)
- Mohammad PouralijanAmiri
- Department of Genetics & Molecular Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maryam Khoshkam
- Chemistry Group, Faculty of Basic Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Reza Madadi
- Department of Cardiology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Koorosh Kamali
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Reza Salek
- International Agency for Research on Cancer, 150cours Albert Thomas, 69372 Lyon CEDEX 08, Lyon, France
| | - Ali Ramazani
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
- Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
3
|
Cho J, Zhang Y, Park SY, Joseph AM, Han C, Park HJ, Kalavalapalli S, Chun SK, Morgan D, Kim JS, Someya S, Mathews CE, Lee YJ, Wohlgemuth SE, Sunny NE, Lee HY, Choi CS, Shiratsuchi T, Oh SP, Terada N. Mitochondrial ATP transporter depletion protects mice against liver steatosis and insulin resistance. Nat Commun 2017; 8:14477. [PMID: 28205519 PMCID: PMC5316896 DOI: 10.1038/ncomms14477] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common metabolic disorder in obese individuals. Adenine nucleotide translocase (ANT) exchanges ADP/ATP through the mitochondrial inner membrane, and Ant2 is the predominant isoform expressed in the liver. Here we demonstrate that targeted disruption of Ant2 in mouse liver enhances uncoupled respiration without damaging mitochondrial integrity and liver functions. Interestingly, liver specific Ant2 knockout mice are leaner and resistant to hepatic steatosis, obesity and insulin resistance under a lipogenic diet. Protection against fatty liver is partially recapitulated by the systemic administration of low-dose carboxyatractyloside, a specific inhibitor of ANT. Targeted manipulation of hepatic mitochondrial metabolism, particularly through inhibition of ANT, may represent an alternative approach in NAFLD and obesity treatment. Adenine nucleotide translocase (ANT) 2 promotes ADP/ATP exchange across the mitochondrial inner membrane. Cho et al. show that liver specific Ant2 deletion increases uncoupled respiration and protects mice against fatty liver and obesity-induced insulin resistance.
Collapse
Affiliation(s)
- Joonseok Cho
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Yujian Zhang
- Otsuka Maryland Medicinal Laboratories, Rockville, Maryland 20850, USA
| | - Shi-Young Park
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea
| | - Anna-Maria Joseph
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Chul Han
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Hyo-Jin Park
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Srilaxmi Kalavalapalli
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Sung-Kook Chun
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Drake Morgan
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Jae-Sung Kim
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Shinichi Someya
- Department of Aging, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Clayton E Mathews
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Young Jae Lee
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea
| | - Stephanie E Wohlgemuth
- Department of Animal Sciences, University of Florida College of Medicine, Gainesville, Florida 32611, USA
| | - Nishanth E Sunny
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Hui-Young Lee
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea
| | - Cheol Soo Choi
- Korea Mouse Metabolic Phenotyping Center, Lee Gil Ya Cancer and Diabetes Institute, Gachon University School of Medicine, Incheon 406-840, Korea.,Endocrinology, Internal Medicine, Gachon University Gil Medical Center, Incheon 405-760, Korea
| | | | - S Paul Oh
- Department of Physiology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Naohiro Terada
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| |
Collapse
|
4
|
El Missiri A, Okasha N, Badr T. Heart-type fatty acid-binding protein detects more patients with non-ST segment elevation myocardial infarction compared to troponin-T. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
5
|
Verheugt FW. The GRACE registry: how real-life evidence contributes to acute coronary syndrome guidelines. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
6
|
Hall AS, Abdel-Rahman SEDT, Barth JH. Expedited discharge with high-sensitivity (hs) troponin. Heart 2015; 101:1000-1. [PMID: 25948422 DOI: 10.1136/heartjnl-2015-307555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Alistair S Hall
- Department of Medicine, Leeds Institute for Genetics Health and Therapeutics, Leeds, UK
| | | | - Julian H Barth
- Clinical Chemistry, Leeds Teaching Hospitals Trust, Leeds, UK
| |
Collapse
|
7
|
Effects of angiotensin-converting enzyme inhibitors and beta blockers on clinical outcomes in patients with and without coronary artery obstructions at angiography (from a Register-Based Cohort Study on Acute Coronary Syndromes). Am J Cardiol 2014; 113:1628-33. [PMID: 24698468 DOI: 10.1016/j.amjcard.2014.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/24/2014] [Accepted: 02/24/2014] [Indexed: 11/22/2022]
Abstract
We sought to determine the effectiveness of angiotensin-converting enzyme (ACE) inhibition and β-blocker treatment as a function of the degree of coronary artery disease (CAD) obstruction at angiography. The Evaluation of Methods and Management of Acute Coronary Events registry enrolled patients who had been hospitalized for an acute coronary syndrome. There were 1,602 patients who had cardiac catheterization that were used for this analysis. The main outcome measures were evidence-based therapies prescribed at discharge and 6-month incidence of all-cause mortality. The cohort consisted of 1,252 patients with obstructive CAD (>50% luminal diameter obstructed) and 350 patients with nonobstructive CAD. Multivariate logistic regression analysis adjusted for further medications and other clinical factors was performed. Patients with nonobstructive CAD had significantly (p <0.001) higher rates of β-blocker (77.8% vs 63.3%) and lower rates of ACE-inhibitor (57.7% vs 66.4%) prescriptions. In patients with nonobstructive CAD, ACE-inhibitor therapy was clearly associated with a lower 6-month mortality (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.03 to 0.78, p = 0.004). No significant association between β-blocker use and death was found. In patients with obstructive CAD, both β blockers (OR 0.47, 95% CI 0.32 to 0.67, p <0.001) and ACE inhibitors (OR 0.47, 95% CI 0.26 to 0.87, p = 0.01) were significantly associated with a reduced risk of 6-month mortality. In conclusion, ACE-inhibitor therapy seems to be an effective first-line treatment for preventing the occurrence of mortality in patients with nonobstructive CAD.
Collapse
|
8
|
Abdelmoneim HM, Hasan-Ali H, Abdulkader SS. Demographics of Acute Coronary Syndrome (ACS) Egyptian patients admitted to Assiut University Hospital: Validation of TIMI and GRACE scores. EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2014. [DOI: 10.1016/j.ejccm.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
9
|
Lewinter C, Bland JM, Crouch S, Cleland JGF, Doherty P, LeWinter MM, Køber L, Hall AS, Gale CP. Impact of aspirin and statins on long-term survival in patients hospitalized with acute myocardial infarction complicated by heart failure: an analysis of 1706 patients. Eur J Heart Fail 2013; 16:95-102. [PMID: 24453098 DOI: 10.1002/ejhf.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/06/2013] [Accepted: 10/11/2013] [Indexed: 11/12/2022] Open
Abstract
AIMS Aspirin and statins are established therapies for acute myocardial infarction (MI), but their benefits in patients with chronic heart failure (HF) remain elusive. We investigated the impact of aspirin and statins on long-term survival in patients hospitalized with acute MI complicated by HF. METHODS AND RESULTS Of 4251 patients in the Evaluation of Methods and Management of Acute Coronary Events (EMMACE)-1 and -2 observational studies, 1706 patients had HF. A propensity score-matching method estimated the average treatment effects (ATEs) of aspirin and statins on survival over 90 months. ATEs were calculated as relative risk differences in all-cause mortality comparing patients receiving aspirin and statins with controls, respectively. Moreover, combined aspirin and statins vs. none (ATE I), aspirin or statins vs. none (ATE II), and aspirin and statins vs. aspirin or statins (ATE III) were assessed. The median survival times of the ATE I, ATE II and ATE III were 25, 50, and 85 months, respectively. Regarding aspirin, the ATE was significantly improved at 6, 12, and 90 months [ATE 6 months: 10%, 95% confidence interval (CI) 3-18%], where the ATE of statins favoured survival at 1-24 months (ATE 1 month: 5%, 95% CI 0.3-10%). Mortality was lower at 1, 6, and 24 months in those who received aspirin and statins (ATE I). When the combination was compared with either treatment alone, an effect persisted between 6 and 90 months (ATE III). CONCLUSION In patients with acute MI complicated by HF, prescription of aspirin and statins either alone or together was associated with better long-term survival.
Collapse
Affiliation(s)
- Christian Lewinter
- Department of Health Sciences, University of York, Heslington, YO10 5DD, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Sun M, Gao X, Zhang D, Ke C, Hou Y, Fan L, Zhang R, Liu H, Li K, Yu B. Identification of biomarkers for unstable angina by plasma metabolomic profiling. MOLECULAR BIOSYSTEMS 2013; 9:3059-67. [DOI: 10.1039/c3mb70216b] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
11
|
Lewinter C, Bland JM, Crouch S, Doherty P, Lewin RJ, Køber L, Hall AS, Gale CP. The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003. Eur J Prev Cardiol 2012. [DOI: 10.1177/2047487312469124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - John M Bland
- Department of Health Science, University of York, UK
| | - Simon Crouch
- Department of Health Science, University of York, UK
| | - Patrick Doherty
- Faculty of Health and Life sciences, York St John University, UK
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Alistair S Hall
- Centre for Epidemiology and Biostatistics, University of Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Christopher P Gale
- Centre for Epidemiology and Biostatistics, University of Leeds, UK
- Department of Cardiology, York Teaching Hospital NHS Foundation Trust, UK
| |
Collapse
|
12
|
Lown MT, Munyombwe T, Harrison W, West RM, Hall CA, Morrell C, Jackson BM, Sapsford RJ, Kilcullen N, Pepper CB, Batin PD, Hall AS, Gale CP. Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome. Am J Cardiol 2012; 109:307-13. [PMID: 22071208 DOI: 10.1016/j.amjcard.2011.09.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 12/22/2022]
Abstract
Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle-age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.
Collapse
|
13
|
Gale CP, Metcalfe E, West RM, Das R, Kilcullen N, Morrell C, Crook R, Batin PD, Hall AS, Barth JH. An assessment of the concentration-related prognostic value of cardiac troponin I following acute coronary syndrome. Am J Cardiol 2011; 108:1259-65. [PMID: 21871592 DOI: 10.1016/j.amjcard.2011.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Abstract
In 2004 the British Cardiac Society redefined myocardial infarction by cardiac troponin I (cTnI) concentration: ≤ 0.06 μg/L (unstable angina), >0.06 to < 0.5 μg/L (myocardial necrosis), and ≥ 0.5 μg/L (myocardial infarction). We investigated the effects of this classification on all-cause mortality in 1,285 patients from the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE)-2 registry. There were 528 deaths (6.6-year all-cause mortality 41.1%). Survival was greatest in the cTnI ≤ 0.06-μg/L subgroup at 30 days (p = 0.005), 6 months (p = 0.015), 1 year (p = 0.002), and 6.6 years (p = 0.045). After adjustment there was no significant difference in survival between the cTnI >0.06- to < 0.5-μg/L and ≥ 0.5-μg/L subgroups. Increased mortality (hazard ratio, 95% confidence interval) was associated with ages 70 to 80 years (2.58, 1.17 to 3.91) and >80 years (3.30, 3.50 to 5.06), peripheral vascular disease (1.50, 1.16 to 1.94), heart failure (1.36, 1.05 to 1.83), diabetes mellitus (1.68, 1.36 to 2.07), severe left ventricular systolic dysfunction (1.50, 1.00 to 2.21), and creatinine per 10 μmol/L (1.65, 1.02 to 1.08), whereas ages 50 to 60 years (0.55, 0.32 to 0.96), β blockers (0.53, 0.44 to 0.64), aspirin (0.80 0.65 to 0.99), angiotensin-converting enzyme inhibitors (0.67, 0.56 to 0.80), statins (0.73, 0.59 to 0.90), and revascularization (0.33, 0.12 to 0.92) were associated with a lower risk of death. In conclusion, although quantitative evaluation of cTnI concentration in patients with acute coronary syndrome with cTnI > 0.06 μg/L was associated with no added prognostic information, the dichotomization of patients by cTnI status ("positive" and "negative") facilitates acute coronary syndrome risk stratification.
Collapse
|
14
|
McMahon CG, Lamont JV, Curtin E, McConnell RI, Crockard M, Kurth MJ, Crean P, Fitzgerald SP. Diagnostic accuracy of heart-type fatty acid-binding protein for the early diagnosis of acute myocardial infarction. Am J Emerg Med 2011; 30:267-74. [PMID: 21208763 DOI: 10.1016/j.ajem.2010.11.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 11/08/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic efficacy of multiple tests-heart-type fatty acid-binding protein (H-FABP), cardiac troponin I (cTnI), creatine kinase-MB, and myoglobin-for the early detection of acute myocardial infarction among patients who present to the emergency department with chest pain. METHODS A total of 1128 patients provided a total of 2924 venous blood samples. Patients with chest pain were nonselected and treated according to hospital guidelines. Additional cardiac biomarkers were assayed simultaneously at serial time points using the Cardiac Array (Randox Laboratories Ltd, Crumlin, United Kingdom). RESULTS Heart-type fatty acid-binding protein had the greatest sensitivity at 0 to 3 hours (64.3%) and 3 to 6 hours (85.3%) after chest pain onset. The combination of cTnI measurement with H-FABP increased sensitivity to 71.4% at 3 to 6 hours and 88.2% at 3 to 6 hours. Receiver operating characteristic curves demonstrated that H-FABP had the greatest diagnostic ability with area under the curve at 0 to 3 hours of 0.841 and 3 to 6 hours of 0.894. The specificity was also high for the combination of H-FABP with cTnI at these time points. Heart-type fatty acid-binding protein had the highest negative predictive values of all the individual markers: 0 to 3 hours (93%) and 3 to 6 hours (97%). Again, the combined measurement of cTnI with H-FABP increased the negative predictive values to 94% at 0 to 3 hours, 98% at 3 to 6 hours, and 99% at 6 to 12 hours. CONCLUSION Testing both H-FABP and cTnI using the Cardiac Array proved to be both a reliable diagnostic tool for the early diagnosis of myocardial infarction/acute coronary syndrome and also a valuable rule-out test for patients presenting at 3 to 6 hours after chest pain onset.
Collapse
Affiliation(s)
- C Geraldine McMahon
- Emergency Department and Chest Pain Assessment Unit, St. James's Hospital, Dublin 8, Republic of Ireland
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Sarkees ML, Bavry AA. Non ST-elevation acute coronary syndrome. BMJ CLINICAL EVIDENCE 2010; 2010:0209. [PMID: 21406132 PMCID: PMC3217799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Non ST-elevation acute coronary syndrome (NSTE-ACS, here defined as unstable angina and non ST-elevation MI) is characterised by episodes of chest pain at rest or with minimal exertion, which increase in frequency or severity, often with dynamic ECG changes. Between 9% and 19% of people with NSTE-ACS die in the first 6 months after diagnosis, with about half of these deaths occurring within 4 weeks of diagnosis. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: antiplatelet; antithrombin; anti-ischaemic; lipid-lowering; and invasive treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: aspirin, beta-blockers, calcium channel blockers, clopidogrel, direct thrombin inhibitors, glycoprotein IIb/IIIa inhibitors (oral or intravenous), heparin (low molecular weight, unfractionated), fondaparinux, nitrates, routine early cardiac catheterisation and revascularisation, statins, and warfarin.
Collapse
Affiliation(s)
- Michael L Sarkees
- Lehigh Valley Hospital, Pennsylvania State University, School of Medicine, Allentown, PA, USA
| | | |
Collapse
|
16
|
Lee DH, Jeon HK, You JH, Park MY, Lee SJ, Kim SS, Shim BJ, Choi YS, Shin WS, Lee JM, Park CS, Youn HJ, Chung WS, Kim JH. Pentraxin 3 as a novel marker predicting congestive heart failure in subjects with acute coronary syndrome. Korean Circ J 2010; 40:370-6. [PMID: 20830250 PMCID: PMC2933461 DOI: 10.4070/kcj.2010.40.8.370] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 12/22/2009] [Accepted: 02/05/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pentraxin 3 (PTX3) was shown to be elevated in the acute phase of acute myocardial infarction (AMI) and to have prognostic significance in AMI patients. The aim of this study was to estimate whether the value of PTX3 could be used as a prognostic biomarker, with the global registry of acute coronary events (GRACE) risk assessment tool, in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS Between July 2007 and June 2008, 137 patient subjects (mean age : 61±12 years, M : F=108 : 29) with ACS who underwent coronary intervention, but did not have a prior percutaneous coronary intervention (PCI) and/or follow-up coronary angiogram, were enrolled. We estimated the all-cause mortality or death/MI, in-hospital and to 6 months, using the GRACE risk scores and compared these estimates with serum PTX3 concentrations. RESULTS The serum PTX3 concentration showed a significant increase in ST segment elevation myocardial infarction (STEMI) greater than the unstable angina pectoris (UAP) group (2.4±2.1 ng/mL vs. 1.3±0.9 ng/mL, p= 0.017, respectively), but did not show a significant difference between non-ST segment elevation myocardial infarction (NSTEMI) and the UAP group (1.9±1.4 ng/mL vs. 1.3±0.9 ng/mL, p=0.083, respectively). The serum PTX3 concentration was closely related to death/MI in-hospital (r=0.242, p=0.015) and death/MI to 6 months (r=0.224, p=0.023), respectively. The serum PTX3 concentration was not related to all-cause mortality in-hospital (r=0.112, p=0.269) and to 6 months (r=0.132, p=0.191), respectively. Among the parameters determining the GRACE risk scores, the degree of Killip class in congestive heart failure (CHF) was independently associated with the supramedian PTX3 concentration [odds ratio: 2.229 (95% confidence interval: 1.038-4.787), p=0.040]. CONCLUSION The serum PTX3 level provides important information for the risk stratification of CHF among the parameters determining the GRACE risk scores in subjects with ACS.
Collapse
Affiliation(s)
- Dong-Hyeon Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Barth JH, Jackson BM, Farrin AJ, Efthymiou M, Worthy G, Copeland J, Bailey KM, Romaine SPR, Balmforth AJ, McCormack T, Whitehead A, Flather MD, Nixon J, Hall AS. Change in serum lipids after acute coronary syndromes: secondary analysis of SPACE ROCKET study data and a comparative literature review. Clin Chem 2010; 56:1592-8. [PMID: 20729301 DOI: 10.1373/clinchem.2010.145631] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It has long been an accepted belief that serum cholesterol significantly falls after myocardial infarction and that a return to pre-event levels takes approximately 3 months. The magnitude and clinical significance of this fall has recently been challenged. METHODS In the Secondary Prevention of Acute Coronary Events-Reduction Of Cholesterol to Key European Targets (SPACE ROCKET) trial, we measured serum lipids of individuals on day 1 and between days 2 and 4 after acute myocardial infarction (AMI). Second, we performed a thorough literature review and compared all studies reporting data on absolute changes in lipids immediately after AMI, using weighted means. RESULTS Of 1263 SPACE ROCKET participants, 128 had paired lipid measurements where both samples had been measured using identical methods at baseline and on days 2-4 after AMI. The mean lowering in total cholesterol between day 1 and day 2-4 was 0.71 mmol/L (95% CI 0.58-0.84; P < 0.0001) and in triglycerides was 0.10 mmol/L (-0.14-0.33; P = 0.405). A total of 25 papers showing absolute lipid changes post-AMI were identified. The combined data demonstrated a mean fall in total cholesterol of 9% to 11% from baseline over days 3-14 post-AMI, whereas for triglycerides, there was a rise of 18% from baseline to between day 9 and 12 weeks. CONCLUSIONS After a secondary analysis of SPACE ROCKET data and a comparison of previously published data, we report a 10% fall in total cholesterol after AMI-a difference that is of high clinical significance. Consequently, measurement of serum lipids in patients with AMI should be performed within the first hours after presentation.
Collapse
Affiliation(s)
- Julian H Barth
- Clinical Biochemistry, Leeds General Infirmary, Leeds, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
A randomized, controlled trial of simvastatin versus rosuvastatin in patients with acute myocardial infarction: the Secondary Prevention of Acute Coronary Events--Reduction of Cholesterol to Key European Targets Trial. ACTA ACUST UNITED AC 2010; 16:712-21. [PMID: 19745745 DOI: 10.1097/hjr.0b013e3283316ce8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS We sought to evaluate reports that rosuvastatin 10 mg is a more efficacious treatment of hyperlipidaemia than is simvastatin 40 mg, hoping to assess this issue in the previously unstudied context of acute myocardial infarction. METHODS AND RESULTS The Secondary Prevention of Acute Coronary Events - Reduction of Cholesterol to Key European Targets (SPACE ROCKET) Trial was an investigator-led, open-label, blinded-endpoint, multicentre, randomized, controlled trial assessing the proportion of patients, at 3 months, achieving European Society of Cardiology 2003 (ESC-03) lipid targets of total cholesterol (TC) less than 4.5 mmol/l (174 mg/dl) or low-density lipoprotein cholesterol (LDLc) less than 2.5 mmol/l (97 mg/dl). Of 1263 patients randomized, 77.6% simvastatin versus 79.9% rosuvastatin achieved ESC-03 targets [odds ratio (OR): 1.16; 95% confidence interval (CI): 0.88-1.53; P = 0.29]. There were statistically significant differences for simvastatin versus rosuvastatin, respectively, for mean LDLc 2.03 mmol/l (78 mg/dl) versus 1.94 mmol/l (75 mg/dl; P = 0.009) and also mean TC 3.88 mmol/l (150 mg/dl) versus 3.75 mmol/l (145 mg/dl; P = 0.005). A post-hoc analysis showed higher achievement of the new ESC, American Heart Association and American College of Cardiology optimal lipid target of LDLc less than 1.81 mmol/l (70 mg/dl) with rosuvastatin (45.0%) compared with simvastatin (37.8%; OR: 1.37; 95% CI: 1.09-1.72; P = 0.007). The proportion of patients achieving the Fourth Joint Task Force European Guidelines (2007) of TC less than 4.0 mmol/l (155 mg/dl) and LDLc less than 2.0 mmol/l (77 mg/dl) was 38.7% for simvastatin 40 mg and 47.7% for rosuvastatin 10 mg (OR: 1.48; 95% CI: 1.18-1.86; P = 0.001). CONCLUSION We observed no superiority of either treatment for the ESC-03 lipid targets. Rosuvastatin 10 mg lowered mean cholesterol more effectively than simvastatin and achieved better results for the latest, more stringent, ESC target.
Collapse
|
19
|
Sarkees ML, Bavry AA. Acute coronary syndrome (unstable angina and non-ST elevation MI). BMJ CLINICAL EVIDENCE 2009; 2009:0209. [PMID: 19445778 PMCID: PMC2907796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION In people with acute coronary syndrome (ACS) the incidence of serious adverse outcomes (such as death, acute myocardial infarction [MI], or refractory angina requiring emergency revascularisation) is 5-10% within the first 7 days and about 15% at 30 days. Between 5-14% of people with acute coronary syndrome die in the year after diagnosis, with about half of these deaths occurring within 4 weeks of diagnosis. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: antiplatelet; antithrombin; anti-ischaemic; lipid-lowering; and invasive treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: aspirin, beta-blockers, calcium channel blockers, clopidogrel, direct thrombin inhibitors, glycoprotein IIb/IIIa inhibitors (oral or intravenous), heparin (low molecular weight, unfractionated), nitrates, routine early cardiac catheterisation and revascularisation, statins, and warfarin.
Collapse
|
20
|
Cubbon RM, Abbas A, Wheatcroft SB, Kilcullen N, Das R, Morrell C, Barth JH, Kearney MT, Hall AS. Diabetes mellitus and mortality after acute coronary syndrome as a first or recurrent cardiovascular event. PLoS One 2008; 3:e3483. [PMID: 18941531 PMCID: PMC2567028 DOI: 10.1371/journal.pone.0003483] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 09/09/2008] [Indexed: 01/03/2023] Open
Abstract
Background Diabetes Mellitus (DM) is associated with adverse cardiovascular prognosis. However, the risk associated with DM may vary between individuals according to their overall cardiovascular risk burden. Therefore, we aimed to determine whether DM is associated with poor outcome in patients presenting with Acute Coronary Syndrome (ACS) according to the index episode being a first or recurrent cardiovascular event. Methods and Findings We conducted a retrospective analysis of a prospective cohort study involving 2499 consecutively admitted patients with confirmed ACS in 11 UK hospitals during 2003. Usual care was provided for all participants. Demographic factors, co-morbidity and treatment (during admission and at discharge) factors were recorded. The primary outcome was all cause mortality (median 2 year follow up), compared for cohorts with and without DM according to their prior cardiovascular disease (CVD) disease status. Adjusted analyses were performed with Cox proportional hazards regression analysis. Within the entire cohort, DM was associated with an unadjusted 45% increase in mortality. However, in patients free of a history of CVD, mortality of those with and without DM was similar (18.8% and 19.7% respectively; p = 0.74). In the group with CVD, mortality of patients with DM was significantly higher than those without DM (46.7% and 33.2% respectively; p<0.001). The age and sex adjusted interaction between DM and CVD in predicting mortality was highly significant (p = 0.002) and persisted after accounting for comorbidities and treatment factors (p = 0.006). Of patients free of CVD, DM was associated with smaller elevation of Troponin I (p<0.001). However in patients with pre-existing CVD Troponin I was similar (p = 0.992). Conclusions DM is only associated with worse outcome after ACS in patients with a pre-existing history of CVD. Differences in the severity of myocyte necrosis may account for this. Further investigation is required, though our findings suggest that aggressive primary prevention of CVD in patients with DM may have beneficially modified their first presentation with (and mortality after) ACS.
Collapse
Affiliation(s)
- Richard M. Cubbon
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, The LIGHT Laboratories, The University of Leeds, Leeds, United Kingdom
| | - Afroze Abbas
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, The LIGHT Laboratories, The University of Leeds, Leeds, United Kingdom
| | - Stephen B. Wheatcroft
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, The LIGHT Laboratories, The University of Leeds, Leeds, United Kingdom
| | - Niamh Kilcullen
- C-NET Group, Clinical Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Raj Das
- C-NET Group, Clinical Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Christine Morrell
- C-NET Group, Clinical Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Julian H. Barth
- Department of Clinical Biochemistry and Immunology, Leeds General Infirmary, Leeds, United Kingdom
| | - Mark T. Kearney
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, The LIGHT Laboratories, The University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Alistair S. Hall
- C-NET Group, Clinical Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | |
Collapse
|
21
|
Hyperglycaemia, in relation to sex, and mortality after acute coronary syndrome. ACTA ACUST UNITED AC 2008; 14:666-71. [PMID: 17925626 DOI: 10.1097/hjr.0b013e32827ab6c1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS Both diabetes mellitus (DM) and hyperglycaemia are known to predict outcome after acute coronary syndrome (ACS). Recent work has suggested women with DM have greater baseline cardiovascular risk and poorer outcome after ACS. The interaction between sex and abnormal glucose homoeostasis in patients without diabetes is unexplored; we aimed to assess this relationship. METHODS AND RESULTS Retrospective analysis of data from a prospective cohort study of 1575 patients with a confirmed ACS and no previous diagnosis of DM in 11 UK hospitals. Multivariable analysis was performed to assess the value of clinical variables, including hyperglycaemia and sex, in predicting 2 year all-cause mortality. Sex and hyperglycaemia interacted in predicting mortality. In men, mortality risk increased more steeply with incremental levels of glycaemia than in women (glucose > or =11.1 mmol/l, hazard ratio, 2.19; 95% confidence interval, 1.2-4.0). In both sex groups increasing glycaemia predicted mortality at levels currently not recommended for acute therapeutic intervention (7.8-11.0 mmol/l). CONCLUSIONS In patients not known to have diabetes, hyperglycaemia is a concentration-dependent predictor of long-term mortality after ACS; this predictive value is stronger in men than women.
Collapse
|
22
|
Cubbon RM, Gale CP, Rajwani A, Abbas A, Morrell C, Das R, Barth JH, Grant PJ, Kearney MT, Hall AS. Aspirin and mortality in patients with diabetes sustaining acute coronary syndrome. Diabetes Care 2008; 31:363-5. [PMID: 17959865 DOI: 10.2337/dc07-1745] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to compare mortality reduction associated with secondary prevention in patients with and without diabetes after acute coronary syndrome (ACS). RESEARCH DESIGN AND METHODS We conducted a cohort study involving 2,499 patients with ACS recruited from 11 U.K. hospitals. Multivariable analysis comparing all-cause mortality risk reduction associated with pharmacologic agents in patients with and without diabetes. RESULTS Aspirin was not associated with significant mortality benefit in diabetes sufferers (95% CI 0.50-1.08); nondiabetic patients derived a 48% mortality reduction (P < 0.001). The interaction between diabetes and aspirin use was statistically significant (P = 0.037), indicating that patients with diabetes experience less effective mortality reduction from aspirin use. CONCLUSIONS Aspirin, but not other secondary prevention agents, is associated with less effective mortality reduction in patients with diabetes and unstable coronary artery disease.
Collapse
Affiliation(s)
- Richard M Cubbon
- Leeds Institute of Genetics, Health & Therapeutics, LIGHT Laboratories, University of Leeds, Leeds, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kilcullen N, Viswanathan K, Das R, Morrell C, Farrin A, Barth JH, Hall AS. Heart-type fatty acid-binding protein predicts long-term mortality after acute coronary syndrome and identifies high-risk patients across the range of troponin values. J Am Coll Cardiol 2007; 50:2061-7. [PMID: 18021874 DOI: 10.1016/j.jacc.2007.08.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 07/23/2007] [Accepted: 08/21/2007] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our aim was to determine if a high-performance assay for heart-type fatty acid-binding protein (H-FABP) has a role in predicting all-cause mortality after acute coronary syndrome (ACS). BACKGROUND Heart-type fatty acid-binding protein is released into the circulation following myocardial ischemia and necrosis and therefore may be of value to physicians when caring for patients admitted to hospital with a clinical diagnosis of ACS. METHODS This was a prospective observational study with a follow-up of 12 months. The H-FABP was measured 12 to 24 h after onset of symptoms in 1,448 patients admitted to hospital with ACS. The main outcome measure was all-cause mortality 1 year after index hospital admission. Multivariable analyses were conducted using the well validated GRACE (Global Registry of Acute Coronary Events) variables together with troponin I and highly sensitive C-reactive protein (hs-CRP). RESULTS After 12 months of follow-up, 296 patients had died. Multivariable analysis demonstrated that H-FABP quartiles were strongly predictive of outcome: Q1 hazard ratio (HR) 1.0; Q2 HR 2.32 (95% confidence interval [CI] 1.25 to 4.30; p = 0.007); Q3 HR 3.17 (95% CI 1.73 to 5.82; p < 0.001); Q4 HR 4.88 (95% CI 2.67 to 8.93; p < 0.001). The crude all-cause 1-year mortality for unstable angina patients with H-FABP <5.8 microg/l was 2.1% compared with 22.9% for patients above this cutoff. The adjusted all-cause mortality HR in this group was 11.35 (95% CI 2.00 to 64.34; p = 0.006). CONCLUSIONS Heart-type fatty acid-binding protein predicts long-term mortality after ACS and identifies high-risk patients in a manner that is additive to the GRACE clinical risk factors, troponin, and hs-CRP, possibly as a result of identifying the occurrence of myocardial ischemia with or without necrosis.
Collapse
Affiliation(s)
- Niamh Kilcullen
- Coronary Artery Disease Clinical Research Network Group, Leeds Institute for Genetic, Health & Therapeutics, Leeds, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Wong P, Ramsewak A, Murray S, Robinson A, Robinson D, Rodrigues E. Effects of comorbidity and hospital care on 6-month mortality in patients with elevated cardiac troponin T. Postgrad Med J 2007; 83:332-7. [PMID: 17488864 PMCID: PMC2600074 DOI: 10.1136/pgmj.2006.053082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine the effects of comorbidity and hospital care on mortality in patients with elevated cardiac troponin T. DESIGN Observational study. SETTING A large university hospital with on-site diagnostic cardiac catheter laboratory. PATIENTS All hospitalised patients with elevated cardiac troponin T level (> or =0.01 microg/l) over an 8-week period. MAIN OUTCOME MEASURES 6-month all-cause mortality. RESULTS Among 313 patients with elevated cardiac troponin T, 195 had acute coronary syndrome and 118 had other conditions. Multivariate analysis showed that among patients with acute coronary syndrome, increasing comorbidity score (odds ratio (OR) 1.23 per point increase, 95% confidence interval (CI) 1.00 to 1.51; p = 0.048), age (OR 1.08 per year, 95% CI 1.04 to 1.13; p<0.001), raised troponin T level (OR 2.22 per 10-fold increase, 95% CI 1.27 to 3.89; p = 0.005), and ST depression (OR 3.12, 95% CI 1.38 to 7.03; p = 0.006) were independent adverse predictors, while cardiologist care (OR 0.22, 95% CI 0.09 to 0.51; p<0.001) was associated with a better survival. Increasing troponin T level (OR 3.33 per 10-fold increase, 95% CI 1.24 to 8.91; p = 0.017) was found to predict a worse prognosis among patients without acute coronary syndrome, and cardiologist care did not affect outcome in this group. Among hospital survivors with acute coronary syndrome, increasing comorbidity score, age and a lack of cardiologist care were independently associated with lesser use of effective medications. CONCLUSIONS Comorbidity was associated with a higher 6-month mortality in patients having acute coronary syndrome, and lesser use of effective medicines among hospital survivors. Cardiologist care was associated with better 6-month survival in patients with acute coronary syndrome, but not in those without acute coronary syndrome.
Collapse
Affiliation(s)
- P Wong
- Aintree Cardiac Centre, University Hospital Aintree, Liverpool, UK.
| | | | | | | | | | | |
Collapse
|