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Salzinger B, Lundwall K, Evans M, Mörtberg J, Wallén H, Jernberg T, Kahan T, Lundman P, Tornvall P, Erlinge D, Lindahl B, Baron T, Rezeli M, Spaak J, Jacobson SH. Associations between inflammatory and angiogenic proteomic biomarkers, and cardiovascular events and mortality in relation to kidney function. Clin Kidney J 2024; 17:sfae050. [PMID: 38524235 PMCID: PMC10959071 DOI: 10.1093/ckj/sfae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Indexed: 03/26/2024] Open
Abstract
Background The links between chronic kidney disease (CKD) and the high burden of cardiovascular disease remain unclear. We aimed to explore the association between selected inflammatory and angiogenic biomarkers, kidney function and long-term outcome in patients with an acute coronary syndrome (ACS) and to test the hypothesis that CKD status modifies this association. Methods A total of 1293 ACS patients hospitalized between 2008 and 2015 were followed until 31 December 2017. Plasma was collected on days 1-3 after admission. A total of 13 biomarkers were a priori identified and analysed with two proteomic methods, proximity extension assay or multiple reaction monitoring mass spectrometry. Boxplots and multiple linear regression models were used to study associations between biomarkers and kidney function and adjusted standardized Cox regression with an interaction term for CKD was used to assess whether CKD modified the association between biomarkers and major adverse cardiovascular events and death (MACE+). Results The concentrations of nine biomarkers-endothelial cell-specific molecule-1 (ESM-1), fibroblast growth factor 23 (FGF-23), fractalkine (CX3CL1), interleukin-1 receptor antagonist (IL-1RA), interleukin-18 (IL-18), monocyte chemotactic protein-1 (MCP-1), placenta growth factor (PlGF), transmembrane immunoglobulin 1 (TIM-1) and vascular endothelial growth factor A (VEGFA)-were inversely associated with kidney function. ESM-1, FGF-23 and TIM-1 showed associations with MACE+. Only FGF23 remained independently associated after adjustment for the other biomarkers (hazard ratio per standard deviation increase 1.34; 95% Bonferroni corrected confidence interval 1.19-1.50). None of the biomarkers showed an interaction with CKD. Conclusions The concentrations of 9 of the 13 prespecified inflammatory and angiogenic proteomic biomarkers increased when kidney function declined. Only FGF-23 demonstrated an independent association with MACE+, and this association was not modified by CKD status. These findings further support FGF-23 as an independent prognostic marker in ACS patients with and without CKD.
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Affiliation(s)
- Barbara Salzinger
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Kristina Lundwall
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Marie Evans
- ME Renal Medicine, Department of Clinical Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Josefin Mörtberg
- Division of Nephrology, Department of Internal Medicine, Centre for Clinical Research, County of Vastmanland and Uppsala University, Uppsala, Sweden
| | - Håkan Wallén
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Melinda Rezeli
- Clinical Protein Science & Imaging, Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Demir M, Kahraman F, Sen T, Astarcioglu MA. The relationship of the hemoglobin to serum creatinine ratio with long-term mortality in patients with acute coronary syndrome: A retrospective study. Medicine (Baltimore) 2023; 102:e35636. [PMID: 37832061 PMCID: PMC10578685 DOI: 10.1097/md.0000000000035636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Acute coronary syndrome (ACS) is an urgent clinical condition of cardiovascular diseases. The present study evaluated the predictive efficacy of the hemoglobin to serum creatinine ratio (Hgb/Cr) on long-term mortality in patients with ACS. The ratio, representing the proportion of the 2 values, is cheap, practical, and very easy to calculate at the bedside. Our study included 475 patients who were admitted to the coronary intensive care unit with a diagnosis of ACS and who underwent coronary angiography. The Hgb/Cr ratio was calculated by dividing the admission hemoglobin by the admission serum creatinine. All patient data were collected from the electronic hospital information system, patient files, and the hospital's archive. A comparison of the patients laboratory findings revealed that the Hgb/Cr ratios differed significantly between the survivor and non-survivor group [16.6 (7.7-49) vs 13.8 (4.91-32.8), respectively; P < .001]. A univariate Cox regression analysis showed that the Hgb/Cr ratio was statistically significant in predicting long-term mortality (0.836; 95% confidence interval [CI]: 0.781-0.895; P < .001). After adjusting the model by adding clinically and statistically significant variables, the Hgb/Cr ratio was still an independent predictor of long-term mortality (0.886; 95% CI: 0.815-0.963; P = .004). The Hgb/Cr ratio's discriminant ability was tested with an receiver operating characteristic curve analysis. The Hgb/Cr ratio's area under the curve value was 0.679 (95% CI: 0.609-0.750; P < .001). A survival analysis using the Kaplan-Meier curve of the 2 Hgb/Cr ratio groups (according to cutoff value) revealed that the low-Hgb/Cr group had a significantly higher mortality rate than high-Hgb/Cr group. The Hgb/Cr ratio was found to be an independent predictor of long-term mortality in ACS patients.
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Affiliation(s)
- Mevlut Demir
- Department of Cardiology, Kutahya Health Science University, Kutahya, Turkey
| | - Fatih Kahraman
- Department of Cardiology, Kutahya Training and Research Hospital, Kutahya, Turkey
| | - Taner Sen
- Department of Cardiology, Kutahya Health Science University, Kutahya, Turkey
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Itano S, Kanda E, Nagasu H, Nangaku M, Kashihara N. eGFR slope as a surrogate endpoint for clinical study in early stage of chronic kidney disease: from The Japan Chronic Kidney Disease Database. Clin Exp Nephrol 2023; 27:847-856. [PMID: 37466813 PMCID: PMC10504220 DOI: 10.1007/s10157-023-02376-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND In clinical trials targeting early chronic kidney disease (CKD), eGFR slope has been proposed as a surrogate endpoint for predicting end-stage kidney disease (ESKD). However, it is unclear whether the eGFR slope serves as a surrogate endpoint for predicting long-term prognosis in Japanese early CKD populations. METHODS The data source was the J-CKD-Database, which contains real-world data on patients with CKD in Japan. eGFR slope was calculated from the eGFR of each period, 1-year (1-year slope), 2-year (2-year slope), and 3-year (3-year slope), for participants with a baseline eGFR ≥ 30 ml/min/1.73 m2. The outcome was ESKD (defined as dialysis initiation or incidence of CKD stage G5). The relationship between eGFR slope and the sub-distribution hazard ratio (SHR) of ESKD with death as a competing event was investigated using a Fine-Gray proportional hazard regression model. RESULTS The number of participants and mean observation periods were 7768/877 ± 491 days for 1-year slope, 6778/706 ± 346 days for 2-year slope, and 5219/495 ± 215 days for 3-year slope. As the eGFR slope decreased, a tendency toward a lower risk of ESKD was observed. Compared with the 1-year slope, there was a smaller variation in the slope values for the 2-year or 3-year slope and a greater decrease in the SHR; therefore, a calculation period of 2 or 3 years for the eGFR slope was considered appropriate. CONCLUSION Even in Japanese patients with early stage CKD, a slower eGFR slope calculated from eGFR values over 2-3 years was associated with a decreased risk of ESKD.
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Affiliation(s)
- Seiji Itano
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hajime Nagasu
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Briguori C, Roscigno G. NSTEMI in Chronic Kidney Disease Patients. JACC Cardiovasc Interv 2022; 15:1989-1991. [DOI: 10.1016/j.jcin.2022.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 01/09/2023]
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Sadre-Bafghi SA, Mohebi M, Hadi F, Parsaiyan H, Memarjafari M, Tayeb R, Ghodsi S, Sheikh-Sharbafan R, Poorhosseini H, Salarifar M, Alidoosti M, Haji-Zeinali AM, Amirzadegan A, Aghajani H, Jenab Y, Hosseini Z. Impact of Baseline Estimated Glomerular Filtration Rate Using CKD-EPI Equation on Long-term Prognosis of STEMI Patients: A Matter of Small Increments! Crit Pathw Cardiol 2022; 21:153-159. [PMID: 35994724 DOI: 10.1097/hpc.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Baseline biomarkers including glomerular filtration rate (GFR) guide the management of patients with ST-segment elevation myocardial infarction (STEMI). GFR is a tool for prediction of adverse outcomes in these patients. OBJECTIVES We aimed to determine the prognostic utility of estimated GFR using Chronic Kidney Disease Epidemiology Collaboration in a cohort of STEMI patients. METHODS A retrospective cohort was designed among 5953 patients with STEMI. Primary endpoint of the study was major adverse cardiovascular events. GFR was classified into 3 categories delineated as C1 (<60 mL/min), C2 (60-90), and C3 (≥ 90). RESULTS Mean age of the patients was 60.38 ± 5.54 years and men constituted 78.8% of the study participants. After a median of 22 months, Multivariate Cox-regression demonstrated that hazards of major averse cardiovascular event, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction were significantly lower for subjects in C3 as compared with those in C1. Corresponding hazard ratios (HRs) for mentioned outcomes regarding C3 versus C1 were (95% confidence interval) were (HR = 0.852 [0.656-0.975]; P = 0.035), (HR = 0.425 [0.250-0.725]; P = 0.002), (HR = 0.425 [0.242-0.749]; P = 0.003), and (0.885 [0.742-0.949]; P = 0.003), respectively. Normal GFR was also associated with declined in-hospital mortality with HR of C3 versus C1: 0.299 (0.178-0.504; P < 0.0001). CONCLUSIONS Baseline GFR via Chronic Kidney Disease Epidemiology Collaboration is associated with long-term cardiovascular outcomes following STEMI.
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Affiliation(s)
- Seyed-Ali Sadre-Bafghi
- From the Afshar Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehrnaz Mohebi
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadi
- Department of Obstetrics and Gynecology, Imam Hossein Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Parsaiyan
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Memarjafari
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Tayeb
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Ghodsi
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Sheikh-Sharbafan
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali-Mohammad Haji-Zeinali
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirzadegan
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Acute myocardial infarction in young adults with chronic kidney disease. Coron Artery Dis 2022; 33:553-558. [PMID: 35942623 DOI: 10.1097/mca.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the prevalence of chronic kidney disease (CKD) in young patients with acute myocardial infarction (AMI) and to report their characteristics and clinical outcomes. BACKGROUND Underlying renal dysfunction is a risk factor for poor cardiovascular outcomes in older patients. The implication of CKD in young patients with AMI is not well studied. METHODS This is a retrospective population-based cohort study of patients aged 18-50 who presented with AMI between 2006 and 2016. Medical records were reviewed to confirm diagnosis and to identify treatment and long-term outcomes. Cox regression models were used to evaluate the association of CKD with mortality. RESULTS Among 1753 young patients with type 1 AMI (median age 45 years, 85.3% male), CKD was present in 112 (6.8%) patients. A higher proportion of CKD patients had concomitant hypertension, hyperlipidemia, diabetes, and obesity. Use of statin and P2Y12 inhibitors post-AMI was lower in CKD patients. Over a median follow-up of 7.2 years, CKD was associated with higher all-cause mortality [hazard ratio (HR), 9.3; 95% CI, 6.3-13.8]. This association persisted after adjusting for demographics, comorbidities, and treatment (adjusted HR, 3.6; 95% CI, 2.2-6.0). CONCLUSION Presence of CKD was associated with 3.6-fold higher mortality over a median follow-up of 7.2 years. A lower proportion of CKD patients were treated with statin therapy and P2Y12 inhibitors. These findings highlight the need for intensive risk factor modification and optimal use of guideline-directed medical therapies in this high-risk population.
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Elbadawi A, Elgendy IY, Kumfa P. Invasive Management for Non-ST-Segment-Elevation Myocardial Infarction and Chronic Kidney Disease: Does One Size Fit All? J Am Heart Assoc 2022; 11:e026390. [PMID: 35713279 PMCID: PMC9238646 DOI: 10.1161/jaha.122.026390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ayman Elbadawi
- Section of CardiologyBaylor College of MedicineHoustonTX
- Division of CardiologyUniversity of Texas Southwestern Medical CenterDallasTX
| | - Islam Y. Elgendy
- Division of Cardiovascular MedicineGill Heart Institute, University of KentuckyLexingtonKY
| | - Paul Kumfa
- Division of CardiologyUniversity of Texas Medical BranchGalvestonTX
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Prognostic Impact of Mildly Impaired Renal Function in Patients Undergoing Multivessel Coronary Revascularization. J Am Coll Cardiol 2022; 79:1270-1284. [DOI: 10.1016/j.jacc.2022.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/02/2023]
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Zhao D, Liu Y, Chen S, Xu Z, Yang X, Shen H, Zhang S, Li Y, Zhang H, Zou C, Ma X. Predictive Value of Blood Urea Nitrogen to Albumin Ratio in Long-Term Mortality in Intensive Care Unit Patients with Acute Myocardial Infarction: A Propensity Score Matching Analysis. Int J Gen Med 2022; 15:2247-2259. [PMID: 35256854 PMCID: PMC8898044 DOI: 10.2147/ijgm.s349722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/15/2022] [Indexed: 12/22/2022] Open
Abstract
Background Blood urea nitrogen to albumin ratio (BAR) has been implicated in predicting outcomes of various inflammatory-related diseases. However, the predictive value of BAR in long-term mortality in patients with acute myocardial infarction (AMI) has not yet been evaluated. Methods In this retrospective cohort study, the patients were recruited from the Medical Information Mart for Intensive Care III (MIMIC III) database and categorized into two groups by a cutoff value of BAR. Kaplan–Meier (K-M) analysis and Cox proportional hazard model were performed to determine the predictive value of BAR in long-term mortality following AMI. In order to adjust the baseline differences, a 1:1 propensity score matching (PSM) was carried out and the results were further validated. Results A total of 1827 eligible patients were enrolled. The optimal cutoff value of BAR for four-year mortality was 7.83 mg/g. Patients in the high BAR group tended to have a longer intensive care unit (ICU) stay and a higher rate of one-, two-, three- and four-year mortality (all p<0.001) compared with those in the low BAR group. K-M curves indicated a significant difference in four-year survival (p<0.001) between low and high BAR groups. The Cox proportional hazards model showed that higher BAR (>7.83) was independently associated with increased four-year mortality in the entire cohort, with a hazard ratio (HR) of 1.478 [95% CI (1.254–1.740), p<0.001]. After PSM, the baseline characteristics of 312 pairs of patients in the high and low BAR groups were well balanced, and similar results were observed in K-M curve (p=0.003). Conclusion A higher BAR (>7.83) was associated with four-year mortality in patients with AMI. As an easily available biomarker, BAR can predict the long-term mortality in AMI patients independently.
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Affiliation(s)
- Diming Zhao
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Yilin Liu
- Department of Ophthalmology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Shanghao Chen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Zhenqiang Xu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Xiaomei Yang
- Department of Anesthesiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Hechen Shen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Shijie Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Yi Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
- Correspondence: Xiaochun Ma, Tel +8615169196737, Email
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Zhang Y, Wang J, Zhai G, Zhou Y. Development and Validation of a Predictive Model for Chronic Kidney Disease After Percutaneous Coronary Intervention in Chinese. Clin Appl Thromb Hemost 2022; 28:10760296211069998. [PMID: 35073208 PMCID: PMC8793426 DOI: 10.1177/10760296211069998] [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] [Indexed: 11/15/2022] Open
Abstract
AIM There is no model for predicting the outcomes for coronary heart disease (CHD) patients with chronic kidney disease (CKD) after percutaneous coronary intervention (PCI). To develop and validate a model to predict major adverse cardiovascular events (MACEs) in patients with comorbid CKD and CHD undergoing PCI. METHODS We enrolled 1714 consecutive CKD patients who underwent PCI from January 1, 2008 to December 31, 2017. In the development cohort, we used least absolute shrinkage and selection operator regression for data dimension reduction and feature selection. We used multivariable logistic regression analysis to develop the prediction model. Finally, we used an independent cohort to validate the model. The performance of the prediction model was evaluated with respect to discrimination, calibration, and clinical usefulness. RESULTS The predictors included a positive family history of CHD, history of revascularization, ST segment changes, anemia, hyponatremia, transradial intervention, the number of diseased vessels, dose of contrast media >200 ml, and coronary collateral circulation. In the validation cohort, the model showed good discrimination (area under the receiver operating characteristic curve, 0.612; 95% confidence interval: 0.560, 0.664) and good calibration (Hosmer-Lemeshow test, P = 0.444). Decision curve analysis demonstrated that the model was clinically useful. CONCLUSIONS We created a nomogram that predicts MACEs after PCI in CHD patients with CKD and may help improve the screening and treatment outcomes.
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Affiliation(s)
- Ying Zhang
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, 12667Capital Medical University,Beijing, China.,117914Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Jianlong Wang
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, 12667Capital Medical University,Beijing, China
| | - Guangyao Zhai
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, 12667Capital Medical University,Beijing, China
| | - Yujie Zhou
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, 12667Capital Medical University,Beijing, China
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Zietzer A, Steffen E, Niepmann S, Düsing P, Hosen MR, Liu W, Jamme P, Al-Kassou B, Goody PR, Zimmer S, Reiners KS, Pfeifer A, Böhm M, Werner N, Nickenig G, Jansen F. MicroRNA-mediated vascular intercellular communication is altered in chronic kidney disease. Cardiovasc Res 2022; 118:316-333. [PMID: 33135066 DOI: 10.1093/cvr/cvaa322] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/23/2020] [Indexed: 02/27/2024] Open
Abstract
AIMS Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease (CAD). For both, CKD and CAD, the intercellular transfer of microRNAs (miRs) through extracellular vesicles (EVs) is an important factor of disease development. Whether the combination of CAD and CKD affects endothelial function through cellular crosstalk of EV-incorporated miRs is still unknown. METHODS AND RESULTS Out of 172 screened CAD patients, 31 patients with CAD + CKD were identified and matched with 31 CAD patients without CKD. Additionally, 13 controls without CAD and CKD were included. Large EVs from CAD + CKD patients contained significantly lower levels of the vasculo-protective miR-130a-3p and miR-126-3p compared to CAD patients and controls. Flow cytometric analysis of plasma-derived EVs revealed significantly higher numbers of endothelial cell-derived EVs in CAD and CAD + CKD patients compared to controls. EVs from CAD + CKD patients impaired target human coronary artery endothelial cell (HCAEC) proliferation upon incubation in vitro. Consistent with the clinical data, treatment with the uraemia toxin indoxyl sulfate (IS)-reduced miR-130a-3p levels in HCAEC-derived EVs. EVs from IS-treated donor HCAECs-reduced proliferation and re-endothelialization in EV-recipient cells and induced an anti-angiogenic gene expression profile. In a mouse-experiment, intravenous treatment with EVs from IS-treated endothelial cells significantly impaired endothelial regeneration. On the molecular level, we found that IS leads to an up-regulation of the heterogenous nuclear ribonucleoprotein U (hnRNPU), which retains miR-130a-3p in the cell leading to reduced vesicular miR-130a-3p export and impaired EV-recipient cell proliferation. CONCLUSION Our findings suggest that EV-miR-mediated vascular intercellular communication is altered in patients with CAD and CKD, promoting CKD-induced endothelial dysfunction.
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Affiliation(s)
- Andreas Zietzer
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Eva Steffen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sven Niepmann
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philip Düsing
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Mohammed Rabiul Hosen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Weiyi Liu
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Paul Jamme
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Baravan Al-Kassou
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philipp Roger Goody
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Katrin S Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Pfeifer
- Institute of Pharmacology and Toxicology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Michael Böhm
- Medical Department III, Faculty of Medicine, Saarland University Medical Center, Saarland University, Kirrberger Straße 100, 66421 Homburg, Germany
| | - Nikos Werner
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Medical Department II, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292 Trier, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix Jansen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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12
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Gao H, Peng H, Shen A, Chen H, Li H. Predictive Effect of Renal Function on Clinical Outcomes in Older Adults With Acute Myocardial Infarction: Results From an Observational Cohort Study in China. Front Cardiovasc Med 2021; 8:772774. [PMID: 34938788 PMCID: PMC8685416 DOI: 10.3389/fcvm.2021.772774] [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: 09/08/2021] [Accepted: 11/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background: The impact of estimated glomerular filtration rate (eGFR) on the risk of death and cardiovascular events in individuals with acute myocardial infarction (AMI) is less well established, particularly in the old Chinese population. The aim of this study was to investigate the association of eGFR with clinical outcomes among older subjects with AMI. We further developed a nomogram for the prediction of 1- and 3-year survival in this population. Methods: A cohort of 2,366 AMI subjects aged over 60 years in 2013–2020 were enrolled in the Cardiovascular Center of Beijing Friendship Hospital Database (CBD) Bank. Outcomes including cardiovascular (CV) death, all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, revascularization, and cardiac rehospitalization were collected overall and by eGFR category at baseline. eGFR was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). Subjects were categorized into four groups according to quartiles of eGFR: ≤ 63.02, 63.03–78.45, 78.46–91.50, >91.51 ml/min/1.73 m2. Hazard ratios (HRs), corresponding 95% confidence intervals (CIs) as well as the nomogram were assessed using Cox regression models. Validation of the nomogram was estimated by discrimination and calibration. Results: Incidence rates and multivariable-adjusted hazard ratios of CV and all-cause death decreased significantly across quartiles of eGFR over a median follow-up time of 36.7 months. In adjusted analysis, compared with eGFR ≤ 63.02 ml/min/1.73 m2, patients with eGFR of 63.03–78.45, 78.46–91.50, >91.51 ml/min/1.73 m2 experienced decreased risks of CV death [respective HRs of 0.58 (95% CI, 0.38–0.90), 0.61 (95% CI, 0.38–0.99), and 0.48 (95% CI, 0.25–0.90); all p < 0.05] and all-cause death [respective HRs of 0.64 (95% CI, 0.47–0.88), 0.61 (95% CI, 0.42–0.88), and 0.54 (95% CI, 0.35–0.84); all p < 0.05]. Age, eGFR quartiles, BMI, glycated hemoglobin, LVEF, LM/multi-vessel disease, angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) prescribed at discharge were associated with all-cause death. The developed model predicted 1- and 3-year probability of survival, which performed well in both discrimination and calibration. Conclusion: In older patients with AMI, early identification of eGFR reduced and cardiovascular risks management may prevent poor clinical outcomes.
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Affiliation(s)
- Hui Gao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Peng
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Aidong Shen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
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13
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Yang CC, Sung PH, Chen KH, Chai HT, Chiang JY, Ko SF, Lee FY, Yip HK. Valsartan- and melatonin-supported adipose-derived mesenchymal stem cells preserve renal function in chronic kidney disease rat through upregulation of prion protein participated in promoting PI3K-Akt-mTOR signaling and cell proliferation. Biomed Pharmacother 2021; 146:112551. [PMID: 34923336 DOI: 10.1016/j.biopha.2021.112551] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
This study tested the hypothesis that valsartan (Val) and melatonin (Mel)-assisted adipose-derived mesenchymal stem cells (ADMSCs) preserved the residual renal function in chronic kidney disease (CKD) rat through promoting cellular-prior-protein (PrPC) to upregulate PI3K/Akt/mTOR signaling and cell proliferation. In vitro study demonstrated that as compared with CKD-derived-ADMSCs, Val/Mel/overexpression of PrPC-treated CKD derived-ADMSCs significantly upregulated cell proliferation and protein expressions of PrPC and phosphorylated (p)-PI3K/p-Akt/p-mTOR, and downregulated oxidative stress (all p < 0.001). Rats (n = 42) were categorized into group 1 (sham-operated-control), group 2 (CKD), group 3 (CKD + ADMSCs/1.2 ×106 cells) + Mel/20 mg/kg/day), group 4 (CKD + siRNA-PrPC-ADMSCs/1.2 ×106 cells), group 5 (CKD + ADMSCs/1.2 ×106 cells + Val/20 mg/kg/day) and group 6 (CKD + Val + Mel). By day 35, the kidney specimens were harvested and the result showed that the protein expression of PrPC was highest in group 1, lowest in groups 2/4 and significantly lower in group 6 than in groups 3/5, but it was similar in groups 3/5 (all p < 0.0001). The protein expressions of cell-stress-signaling (p-PI3K/p-Akt/p-mTOR) and cell-cycle activity (cyclin-D1/clyclin-E2/Cdk2/Cdk4) exhibited an identical pattern, whereas the protein expressions of oxidative-stress (NOX-1/NOX-2)/mitochondrial fission (PINK1/DRP1)/apoptosis (cleaved-capsase3/cleaved-PARP) and fibrosis (TFG-ß/Smad3) as well as creatinine/BUN levels, ratio of urine-protein to urine-creatine and kidney-injured score exhibited an opposite pattern of PrPC among the groups (all p < 0.0001). In conclusion, Mel/Val facilitated-ADMSCs preserved renal architecture and function in CKD rat through promoting PrPC to regulate the cell proliferation/oxidative-stress/cell-stress signalings.
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Affiliation(s)
- Chih-Chao Yang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, ROC
| | - Kuan-Hung Chen
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC; Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC
| | - Han-Tan Chai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan, ROC
| | - Sheung-Fat Ko
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC
| | - Fan-Yen Lee
- Division of thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, ROC; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, ROC; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan, ROC; Department of Nursing, Asia University, Taichung 41354, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Xiamen 361028, Fujian, China.
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14
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Tara S, Yamamoto T, Sakai S, Kimura T, Asano K, Fujimoto Y, Shiomura R, Matsuda J, Kadooka K, Takahashi K, Ko T, Sangen H, Saiki Y, Nakata J, Hosokawa Y, Takano H, Shimizu W. Clinical Characteristics, Achievement of Secondary Prevention Goals, and Outcomes of Patients with Recurrent Acute Coronary Syndrome. J NIPPON MED SCH 2021; 88:432-440. [PMID: 33692293 DOI: 10.1272/jnms.jnms.2021_88-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because development of acute coronary syndrome (ACS) worsens the prognosis of patients with coronary artery disease, preventing recurrent ACS is crucial. However, the degree to which secondary prevention treatment goals are achieved in patients with recurrent ACS is unknown. METHODS 214 consecutive ACS patients were classified as having First ACS (n=182) or Recurrent ACS (n=32), and the clinical characteristics of these groups were compared. Fifteen patients died or developed cardiovascular (CV) events during hospitalization, and the remaining 199 patients were followed from the date of hospital discharge to evaluate subsequent CV events. RESULTS Patients in the Recurrent ACS group were older than those in the First ACS group (76.8±10.8 years vs 68.8±13.4 years, p=0.002) and had a higher rate of diabetes mellitus (DM) (65.6% vs 36.8%, p=0.003). The rate of achieving a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL in the Recurrent ACS group was only 28.1%, even though 68.8% of these patients were taking statins. An HbA1c level of <7.0% was achieved in 66.7% of patients with recurrent ACS who had been diagnosed with DM. Overall, 12.5% of patients with recurrent ACS had received optimal treatment for secondary prevention. CV events after hospital discharge were noted in 37.9% of the Recurrent ACS group and 21.2% of the First ACS group (log-rank test: p=0.004). However, recurrent ACS was not an independent risk factor for CV events (adjusted hazard ratio: 2.09, 95% confidence interval: 0.95 to 4.63, p=0.068). CONCLUSION Optimal treatment for secondary prevention was not achieved in some patients with recurrent ACS, and achievement of the guideline-recommended LDL-C goal for secondary prevention was especially low in this population.
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Affiliation(s)
- Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Shin Sakai
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Tokuhiro Kimura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kazuhiro Asano
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yuhi Fujimoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Reiko Shiomura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kosuke Kadooka
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kenta Takahashi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Toshinori Ko
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hideto Sangen
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yoshiyuki Saiki
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yusuke Hosokawa
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital.,Department of Cardiovascular Medicine, Nippon Medical School
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15
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Zhang D, Song X, Raposeiras-Roubín S, Abu-Assi E, Simao Henriques JP, D'Ascenzo F, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Huczek Z, Nie S, Fujii T, Correia L, Kawashiri MA, Southern D, Kalpak O. Evaluation of optimal medical therapy in acute myocardial infarction patients with prior stroke. Ther Adv Chronic Dis 2021; 12:20406223211046999. [PMID: 34729148 PMCID: PMC8485283 DOI: 10.1177/20406223211046999] [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: 05/17/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background Treatment of acute myocardial infarction (AMI) patients with prior stroke is a common clinical dilemma. Currently, the application of optimal medical therapy (OMT) and its impact on clinical outcomes are not clear in this patient population. Methods We retrieved 765 AMI patients with prior stroke who underwent percutaneous coronary intervention (PCI) during the index hospitalization from the international multicenter BleeMACS registry. All of the subjects were divided into two groups based on the prescription they were given prior to discharge. Baseline characteristics and procedural variables were compared between the OMT and non-OMT groups. Mortality, re-AMI, major adverse cardiovascular events (MACE), and bleeding were followed-up for 1 year. Results Approximately 5% of all patients presenting with AMI were admitted to the hospital for ischemic stroke. Although the prescription rate of each OMT medication was reasonably high (73.3%-97.3%), 47.7% lacked at least one OMT medication. Patients receiving OMT showed a significantly decreased occurrence of mortality (4.5% vs 15.1%, p < 0.001), re-AMI (4.2% vs 9.3%, p = 0.004), and the composite endpoint of death/re-AMI (8.6% vs 20.5%, p < 0.001) compared to those without OMT. No significant difference was observed between the groups regarding bleeding. After adjusting for confounding factors, OMT was the independent protective factor of 1-year mortality, while age was the independent risk factors. Conclusions OMT at discharge was associated with a significantly lower 1-year mortality of patients with AMI and prior stroke in clinical practice. However, OMT was provided to just half of the eligible patients, leaving room for substantial improvement. Clinical Trial Registration NCT02466854.
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Affiliation(s)
- Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | | | - Emad Abu-Assi
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jorge Saucedo
- Department of Cardiology, North Shore University Hospital, Chicago, IL, USA
| | | | | | - Wouter J Kikkert
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Iván Nuñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Albert Ariza-Sole
- Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain
| | | | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Claudio Moretti
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Shaoping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Toshiharu Fujii
- Division of Cardiovascular Medicine, Department of Cardiology, School of Medicine, Tokai University, Tokyo, Japan
| | - Luis Correia
- Department of Cardiology, Hospital São Rafael, Salvador, Brazil
| | - Masa-Aki Kawashiri
- Department of Cardiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | | | - Oliver Kalpak
- Interventional Cardiology, University Clinic of Cardiology, Skopje, Former Yugoslav Republic of Macedonia (FYROM)
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16
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Original Research: Long-Term Prognosis After ST-Elevation Myocardial Infarction in Patients with a Prior Cancer Diagnosis. Cardiol Ther 2021; 11:81-92. [PMID: 34724192 PMCID: PMC8933597 DOI: 10.1007/s40119-021-00244-4] [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: 09/09/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction It is unknown how long-term prognosis after ST-elevation myocardial infarction (STEMI) in patients with a prior cancer diagnosis is impacted by cancer-related factors as diagnosis, stage, and treatment. We aimed to assess long-term survival trends after STEMI in this population to evaluate both cardiovascular and cancer-related drivers of prognosis over a follow-up period of 5 years. Methods In this retrospective single-center cohort study, patients with a prior cancer diagnosis admitted with STEMI between 2004 and 2014 and treated with primary percutaneous coronary intervention (PCI) were recruited from the STEMI clinical registry of our institution. Results In the 211 included patients, the cumulative incidence of all-cause death after 5 years of follow-up was 38.1% (N = 60). The cause of death was predominantly malignancy-related (N = 29, 48.3% of deaths) and nine patients (15.0%) died of a cardiovascular cause. After correcting for age and sex, a recent cancer diagnosis (< 1 year relative to > 10 years, HRadj 2.98 [95% CI: 1.39–6.41], p = 0.005) and distant metastasis at presentation (HRadj 4.02 [1.70–9.53], p = 0.002) were significant predictors of long-term mortality. While maximum levels of cardiac troponin-T and creatinine kinase showed significant association with mortality (resp. HRadj 1.34 [1.08–1.66], p = 0.008; HRadj 1.36 [1.05–1.76], p = 0.019), other known determinants of prognosis after STEMI, e.g., hypertension and renal insufficiency, were not significantly associated with survival. Conclusions Patients with a prior cancer diagnosis admitted with STEMI have a poor survival rate. However, when the STEMI is optimally treated with primary PCI and medication, cardiac mortality is low, and prognosis is mainly determined by factors related to cancer stage. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-021-00244-4.
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17
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Ng AKY, Ng PY, Ip A, Lam LT, Ling IWH, Wong ASL, Yap DYH, Siu CW. Impact of contrast-induced acute kidney injury on long-term major adverse cardiovascular events and kidney function after percutaneous coronary intervention: insights from a territory-wide cohort study in Hong Kong. Clin Kidney J 2021; 15:338-346. [PMID: 35145648 PMCID: PMC8824785 DOI: 10.1093/ckj/sfab212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background The impact of contrast-induced acute kidney injury (CI-AKI) on long-term major adverse cardiovascular events (MACE) remains controversial. Method This was a retrospective cohort study from 14 hospitals under the Hospital Authority of Hong Kong between 2004 and 2017. Severe CI-AKI was defined as an increase in serum creatinine of >50% from the baseline value, an absolute increase of >1 mg/dL (88 μmol/L) or requiring dialysis after percutaneous coronary intervention (PCI). Mild CI-AKI was defined as an increase in serum creatinine of >25% from the baseline value or an absolute increase of >0.5 mg/dL (44 μmol/L) after PCI but not fulfilling the criteria for severe CI-AKI. The primary endpoint was MACE, defined as a composite outcome of all-cause mortality, non-fatal myocardial infarction after hospital discharge, stroke or any unplanned coronary revascularization, in a time-to-first-event analysis up to 5 years after PCI. The secondary endpoints were individual components of MACE and cardiovascular mortality. Results A total of 34 576 patients were analysed. After adjustment for cardiovascular risk factors, procedural characteristics and medication use, the risk of MACE at 5 years was significantly higher with mild CI-AKI {hazard ratio [HR], 1.18 [95% confidence interval (CI) 1.12–1.26); P < 0.001} and severe CI-AKI [HR 1.92 (95% CI 1.78–2.07); P < 0.001]. Severe CI-AKI was associated with higher adjusted risks of each secondary end point and the risks monotonically accrued over time. Conclusions Among patients undergoing a first-ever PCI, CI-AKI of any severity was associated with a higher adjusted risk of MACE at 5 years. Severe CI-AKI has a stronger association with MACE and its individual components, with an excess of early and late events.
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Affiliation(s)
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - April Ip
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Lap-tin Lam
- Cardiac Medical Unit, Grantham Hospital, Hong Kong SAR, China
| | | | | | - Desmond Yat-Hin Yap
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
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18
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Impact of glomerular filtration rate estimation on cardiovascular events in elderly patients undergoing coronary angiography. Coron Artery Dis 2021; 33:161-168. [PMID: 34657095 DOI: 10.1097/mca.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Estimation of kidney function by glomerular filtration rate (eGFR) is affected by age and is important for decision making regarding treatment and prognosis of patients with cardiovascular disease. We investigated the impact of eGFR on long-term cardiovascular outcomes in an elderly population undergoing coronary angiography for evaluation or treatment of coronary artery disease. METHODS GFR was estimated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in 3690 elderly patients (aged 70-100 years) undergoing coronary angiography. Patients receiving maintenance dialysis were excluded. The association between eGFR and major adverse cardiovascular events (MACE) including myocardial infarction, ischemic stroke or death, was investigated. GFR was further calculated according to modification of diet in renal disease (MDRD) and the Cockcroft-Gault equations, and compatibility between estimations was analyzed. RESULTS Cardiovascular comorbidities were more prevalent with the reduction in kidney function as was the proportion of patients presenting with acute coronary syndromes. The adjusted hazard ratio (95% confidence interval) for MACE during a mean follow-up of 5 years was 0.95 (0.77-1.16), 1.04 (0.84-1.29), 1.56 (1.16-1.84), 2.22 (1.65-2.97) and 3.74 (2.20-6.38) in patients with eGFR 60-89, 45-59, 30-44, 15-29 and <15 ml/min/1.73m2, respectively, compared to >90 ml/min/1.73m2. Reclassification of eGFR stages by MDRD (upward 23.8%, downward 0.4%) and Cockcroft-Gault (upward 4.3%, downward 28.1%) compared to CKD-EPI estimation, was noted. However, the association between eGFR stages and MACE was similar between equations. CONCLUSIONS Kidney function, as manifested by eGFR, has a graded inverse association with the burden of cardiovascular comorbidities and long-term adverse events in elderly patients undergoing coronary angiography.
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19
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Moisi MI, Bungau SG, Vesa CM, Diaconu CC, Behl T, Stoicescu M, Toma MM, Bustea C, Sava C, Popescu MI. Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease. Diagnostics (Basel) 2021; 11:diagnostics11081518. [PMID: 34441451 PMCID: PMC8391570 DOI: 10.3390/diagnostics11081518] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
The main causes of death in patients with chronic kidney disease (CKD) are of cardiovascular nature. The interaction between traditional cardiovascular risk factors (CVRF) and non-traditional risk factors (RF) triggers various complex pathophysiological mechanisms that will lead to accelerated atherosclerosis in the context of decreased renal function. In terms of mortality, CKD should be considered equivalent to ischemic coronary artery disease (CAD) and properly monitored. Vascular calcification, endothelial dysfunction, oxidative stress, anemia, and inflammatory syndrome represents the main uremic RF triggered by accumulation of the uremic toxins in CKD subjects. Proteinuria that appears due to kidney function decline may initiate an inflammatory status and alteration of the coagulation—fibrinolysis systems, favorizing acute coronary syndromes (ACS) occurrence. All these factors represent potential targets for future therapy that may improve CKD patient’s survival and prevention of CV events. Once installed, the CAD in CKD population is associated with negative outcome and increased mortality rate, that is the reason why discovering the complex pathophysiological connections between the two conditions and a proper control of the uremic RF are crucial and may represent the solutions for influencing the prognostic. Exclusion of CKD subjects from the important trials dealing with ACS and improper use of the therapeutical options because of the declined kidney functioned are issues that need to be surpassed. New ongoing trials with CKD subjects and platelets reactivity studies offers new perspectives for a better clinical approach and the expected results will clarify many aspects.
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Affiliation(s)
- Mădălina Ioana Moisi
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.B.)
| | - Simona Gabriela Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
- Correspondence: (S.B.); (C.M.V)
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.B.)
- Correspondence: (S.B.); (C.M.V)
| | - Camelia Cristina Diaconu
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.S.); (C.S.); (M.I.P.)
| | - Mirela Mărioara Toma
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.B.)
| | - Cristian Sava
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.S.); (C.S.); (M.I.P.)
| | - Mircea Ioachim Popescu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.S.); (C.S.); (M.I.P.)
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Coyle M, Flaherty G, Jennings C. A critical review of chronic kidney disease as a risk factor for coronary artery disease. IJC HEART & VASCULATURE 2021; 35:100822. [PMID: 34179334 PMCID: PMC8213912 DOI: 10.1016/j.ijcha.2021.100822] [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: 04/03/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD). In addition to common CVD risk factors, the presence of CKD is independently associated with an elevated cardiovascular (CV) risk. We examined the association between CKD and CVD, focusing on coronary artery disease (CAD) in both primary and secondary CVD. A total of 94 articles were included for this review using search strategies on Pubmed and Google scholar. The main findings of our review included that besides sharing common risk factors, CKD induces several physiological microscopic changes leading to increased CV risk. These microscopic changes manifest macroscopically with evidence of the development of primary CAD in CKD patients, in addition to accelerating CAD in those with pre-established CV pathology, with CKD consequently being a risk factor for both primary and secondary CAD progression. Current CV guideline recommendations do not discriminate between those patients with and without CKD. Future research is needed in this area, examining if there may be a role for tighter modifiable risk factor targets in this high-risk population.
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Affiliation(s)
- Mark Coyle
- Corresponding author at: National Institute for Prevention and Cardiovascular Health, Galway, Ireland.
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21
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Petrosyan H, Hayrapetyan H, Torozyan S, Tsaturyan A, Tribunyan S. In-hospital complications in acute ST-elevation myocardial infarction depending on renal function. Herzschrittmacherther Elektrophysiol 2021; 32:359-364. [PMID: 34255141 DOI: 10.1007/s00399-021-00782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To analyze in-hospital complications in patients with acute ST-elevation myocardial infarction (STEMI) depending on renal function. DESIGN Observational study in patients with STEMI. METHODS The study included 169 patients undergoing primary percutaneous coronary intervention. In all patients glomerular filtration rate (GRF) was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation. Of these patients, 84 had a GFR ≥ 90 ml/min/1.73 m2 (Group 1) and 85 < 90 ml/min/1.73 m2 (Group 2). Other parameters in both groups were comparable. Study groups were followed to compare Killip class > 2 acute heart failure, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new onset atrial fibrillation, and high grade atrioventricular block. All patients were treated according to European Society of Cardiology (ESC) guidelines for the management of acute myocardial infarction in patients presenting with ST elevation. RESULTS Mean GFR in Group 1 was 107.6 [Formula: see text] and in Group 2 75.3 [Formula: see text] 11.2 (p < 0.0001). The incidence of atrial fibrillation was higher in Group 2: in Group 1 and Group 2 the atrial fibrillation rate was 1.12% (one of 84) vs 8.24% (seven of 85) (p = 0.031), respectively. Group 1 revealed significantly lower rates of acute heart failure (Killip class > 2): in Group 1 and Group 2 0% (0 of 84 patients) vs 5.88% (five of 85 patients) (p = 0.024), respectively. The authors found no significant differences for other complications: in Group 1 and Group 2 ventricular tachycardia or ventricular fibrillation was 4.76% (four of 84 patients) vs 5.89% (five of 85 patients) (p = 0.75), high grade atrioventricular block was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), and the in-hospital pneumonia rate was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), respectively. CONCLUSION Patients with lower GFR were more likely to suffer from in-hospital acute heart failure (Killip class > 2) and atrial fibrillation in STEMI despite primary percutaneous coronary intervention. Renal function did not affect in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation rates. The evaluation of kidney function through GFR in STEMI patients may make in-hospital complications more predictable.
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22
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Setoyama K, Sonoda S, Naka Y, Okabe H, Inoue K, Miura T, Anai R, Araki M, Fujino Y, Takeuchi M, Otsuji Y, Kataoka M. Right ventricular branch compromise after percutaneous coronary intervention and baseline chronic kidney disease: A high-risk combination associated with long-term prognoses in acute inferior myocardial infarction. J Cardiol 2021; 78:463-470. [PMID: 34226087 DOI: 10.1016/j.jjcc.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Right ventricular branch compromise (RVBC) following percutaneous coronary intervention (PCI) in patients with acute inferior myocardial infarction (AIMI) is associated with short-term adverse clinical outcomes. Chronic kidney disease (CKD) is also known to be a major risk factor after PCI in AIMI. However, little is known about the impact of RVBC and CKD on long-term prognosis. METHODS From January 2009 to January 2019, we retrospectively enrolled 90 consecutive patients with ST-elevation AIMI who had a culprit lesion in the proximal-to-mid right coronary arteries and underwent PCI in our institution. After the measurement of the Thrombolysis in Myocardial Infarction frame counts in RV branches using post-PCI angiography, we divided them into two groups (RVBC, n = 49; non-RVBC, n = 41), and investigated their long-term prognosis for 43±31 months. The primary endpoint was the incidence of major adverse cardiac events (MACEs), including all-cause death, nonfatal MI, congestive heart failure requiring hospitalization, and life-threatening arrhythmia. RESULTS Both groups showed similar clinical characteristics; however, the baseline right ventricular function after PCI was significantly worse in RVBC than in non- RVBC. Twenty-four MACEs occurred during the follow-up (RVBC vs. non-RVBC: 37% vs. 14%, p = 0.002). In the multivariate analysis, both RVBC and baseline CKD were powerful predictors of MACEs (RVBC: hazard ratio [HR] 2.85, CKD: HR 2.29). Baseline CKD showed higher hazard ratios of MACEs in RVBC (CKD: HR 7.19 vs. non-CKD: HR 0.24). CONCLUSIONS The prognoses of RVBC after primary PCI in patients with AIMI were poor. Baseline CKD and RVBC were associated with poor long-term clinical outcomes.
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Affiliation(s)
- Koshi Setoyama
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Shinjo Sonoda
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
| | - Yutaro Naka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Hiroki Okabe
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Konosuke Inoue
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Toshiya Miura
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Reo Anai
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Masaru Araki
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Yoshihisa Fujino
- The Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Masaaki Takeuchi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Yutaka Otsuji
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Masaharu Kataoka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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23
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Okina Y, Miura T, Senda K, Taki M, Kobayashi M, Kanai M, Okuma Y, Yanagisawa T, Hashizume N, Otagiri K, Shoin K, Watanabe N, Ebisawa S, Karube K, Nakajima H, Saigusa T, Miyashita Y, Kashiwagi D, Machida K, Abe N, Tachibana T, Kanzaki Y, Maruyama T, Nomi H, Sakai T, Yui H, Mochidome T, Kobayashi T, Kasai T, Ikeda U, Kuwahara K. Prognostic ability of mid-term worsening renal function after percutaneous coronary intervention: findings from the SHINANO registry. Heart Vessels 2021; 36:1496-1505. [PMID: 33825976 PMCID: PMC8379120 DOI: 10.1007/s00380-021-01837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/15/2021] [Indexed: 12/03/2022]
Abstract
Chronic kidney disease is a prognostic factor for cardiovascular disease. Worsening renal function (WRF), specifically, is an important predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). We evaluate the prognostic impact of mid-term WRF after PCI on future cardiovascular events. We examined the renal function data of 1086 patients in the first year after PCI using the SHINANO 5-year registry. Patients were divided into two groups, mid-term WRF and non-mid-term WRF, and primary outcomes were major adverse cardiovascular events (MACE) and death. Mid-term WRF was defined as an increase in creatinine (≥ 0.3 mg/dL) in the first year after PCI. Mid-term WRF was found in 101 patients (9.3%), and compared to non-mid-term WRF, it significantly increased the incidence of MACE (p < 0.001), and all-cause death (p < 0.001), myocardial infarction (p = 0.001). Furthermore, mid-term WRF patients had higher incidence of future heart failure (p < 0.001) and new-onset atrial fibrillation (p = 0.01). Patients with both mid-term WRF and chronic kidney disease had increased MACE compared to patients with either condition alone (p < 0.001). Similarly, patients with mid-term WRF and acute kidney injury had increased MACE compared to patients with either condition alone (p < 0.001). Multivariate Cox regression analysis revealed mid-term WRF as a strong predictor of MACE (hazard ratio: 2.50, 95% confidence interval 1.57–3.98, p < 0.001). Mid-term WRF after PCI negatively affects MACE, as well as future admission due to heart failure and new-onset atrial fibrillation, chronic kidney disease, and acute kidney injury.
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Affiliation(s)
- Yoshiteru Okina
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan.
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Keisuke Senda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Minami Taki
- Department of Cardiology, Shinshu Ueda Medical Center, Ueda, Japan
| | | | - Masafumi Kanai
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Yukari Okuma
- Epartment of Cardiology, Suwa Red Cross Hospital, Suwa, Japan
| | | | - Naoto Hashizume
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | | | - Kyoko Shoin
- Department of Cardiology, Aizawa Hospital, Matsumoto, Japan
| | - Noboru Watanabe
- Department of Cardiology, Hokushin General Hospital, Nagano, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Kenichi Karube
- Department of Cardiology, Okaya Municipal Hospital, Okaya, Japan
| | - Hiroyuki Nakajima
- Department of Cardiology, Matsushiro General Hospital, Nagano, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yusuke Miyashita
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Daisuke Kashiwagi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | | | - Naoyuki Abe
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Yusuke Kanzaki
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Takuya Maruyama
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Hidetomo Nomi
- Department of Cardiology, Saku Central Hospital, Saku, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Tomoaki Mochidome
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Takahiro Kobayashi
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Toshio Kasai
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Uichi Ikeda
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Relation of Adiponectin to Cardiovascular Events and Mortality in Patients With Acute Coronary Syndrome. Am J Cardiol 2021; 140:7-12. [PMID: 33144157 DOI: 10.1016/j.amjcard.2020.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
The association between serum adiponectin levels and cardiovascular events, particularly how adiponectin predicts the development of cardiovascular events and mortality in acute coronary syndrome (ACS) patients remains unresolved. Hence, we aimed to determine whether higher adiponectin levels predict cardiovascular events and mortality in these patients. Regression analyses were performed to clarify adiponectin's ability to predict cardiovascular events and mortality among 1,641 ACS patients. Subgroup analyses were performed according to gender, age, and body mass index (BMI). The primary end point was a composite of the first all-cause death, nonfatal myocardial infarction, or nonfatal stroke event. The secondary end point was all-cause death. Hazard ratios for the primary and secondary end points per 5-µg/ml increase in adiponectin levels were 1.31 (95% confidence interval [CI], 1.13 to 1.47; p = 0.0007) and 1.32 (95% CI, 1.13 to 1.51; p = 0.001), respectively. Higher adiponectin levels were associated with increased cardiovascular events in men, patients aged ≥65 years, and those with BMI <25 kg/m2. In conclusion, higher adiponectin levels were associated with increased cardiovascular events and all-cause mortality in ACS patients. Its predictive ability might be limited in women, patients aged <65 years, and patients with BMI ≥25 kg/m2.
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25
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Pan J, Sun X, Zhang P, Chen H, Lin J. Relationship between serum cystatin-c and coronary lesion severity in coronary artery disease patients with a normal glomerular filtration rate. J Int Med Res 2021; 49:300060520985639. [PMID: 33435768 PMCID: PMC7809317 DOI: 10.1177/0300060520985639] [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] [Indexed: 11/16/2022] Open
Abstract
Objective Cardiovascular disease is a major cause of death. This study evaluated the relationship between serum cystatin-c and coronary lesion severity in coronary artery disease (CAD) patients with a normal glomerular filtration rate. Methods Nine hundred and fifty-nine patients were retrospectively included and divided into non-CAD and CAD groups according to coronary angiography results. CAD patients were classified into three groups by Gensini score tertiles. Multivariable logistic regression was used to study the relationship between serum cystatin-c and coronary lesion severity. Results Serum cystatin-c levels were significantly higher in CAD patients than in non-CAD patients. Correlation analysis revealed significant correlations between serum cystatin-c levels with the Gensini score and the number of diseased vessels. The area under the receiver operating characteristic curve of serum cystatin-c was 0.544 and 0.555 for predicting a high Gensini score and three-vessel disease, respectively. Multivariate stepwise regression analysis demonstrated that the serum cystatin-c level was an independent predictor of a high Gensini score [odds ratio (OR) = 2.177, 95% confidence interval (CI) 1.140–3.930] and three-vessel disease (OR = 1.845, 95% CI 0.994–3.424) after adjusting for the conventional CAD risk factors. Conclusions Serum cystatin-c was elevated in CAD patients and may be an independent predictor of CAD severity.
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Affiliation(s)
- Junqiang Pan
- Department of Cardiology, Xi'an Central Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, College of Medicine, Xi'an, China
| | - Xifeng Sun
- Department of Nephrology, Zibo Central Hospital, Zibo City, China
| | - Pengjie Zhang
- Department of Nephrology, Shaanxi Provincial People's Hospital, The Third Affiliated Hospital of Xi'an Jiaotong University, College of Medicine, Xi'an City, China
| | - Haichao Chen
- Department of Cardiology, Shaanxi Provincial People's Hospital, The Third Affiliated Hospital of Xi'an Jiaotong University, College of Medicine, Xi'an City, China
| | - Jing Lin
- Department of Cardiology, Shaanxi Provincial People's Hospital, The Third Affiliated Hospital of Xi'an Jiaotong University, College of Medicine, Xi'an City, China
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Montarello NJ, Salehi T, Bate AP, Pisaniello AD, Clayton PA, Teo KS, Worthley MI, Coates PT. Multimodality Tachycardia-Induced Stress Testing Predicts a Low-Risk Group for Early Cardiovascular Mortality After Renal Transplantation. Kidney Int Rep 2020; 6:120-127. [PMID: 33426391 PMCID: PMC7783555 DOI: 10.1016/j.ekir.2020.10.006] [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: 07/02/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cardiovascular events remain a major cause of death in kidney transplant recipients. The optimal noninvasive workup to prevent peritransplant cardiac mortality remains contentious. Methods We conducted a retrospective analysis to assess the renal transplantation cardiovascular assessment protocol within a single-center population over a 5-year period. Asymptomatic patients aged less than 45 years with no history of cigarette smoking, without diabetes mellitus, and dialysis-dependent for less than 24 months did not undergo cardiac testing before listing. All other asymptomatic patients underwent a noninvasive, tachycardia-induced stress test, where a target heart rate of 85% predicted for age and gender was required. The primary endpoints were rates of acute myocardial infarction (AMI) and cardiovascular death at 30 days after renal transplantation. Results Between 2015 and 2019, 380 recipients underwent cardiac evaluation: 79 (20.8%) were deemed low cardiovascular risk and placed on the renal transplant waitlist without further assessment; 270 (71.1%) underwent a tachycardia-induced stress test; and 31 (8.1%) were deemed high risk and proceeded directly to invasive coronary angiography (ICA). In the 5-year follow-up, 3 patients (0.8%) experienced an AMI 30 days after renal transplantation, all of which occurred in the high-risk “direct to ICA” cohort. No events were documented in the low-risk cohort or in patients who had a negative tachycardia-induced stress test. There were no cardiovascular deaths within 30 days after transplantation. Conclusion A negative tachycardia-induced cardiac stress test, achieving 85% of predicted heart rate, was associated with a 0% AMI rate and no cardiovascular deaths at 30 days after renal transplantation.
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Affiliation(s)
| | - Tania Salehi
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
| | - Alex P. Bate
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | | | - Philip A. Clayton
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
| | - Karen S.L. Teo
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Matthew I. Worthley
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
| | - Patrick T. Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
- Correspondence: Patrick T. Coates, Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
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Mok Y, Ballew SH, Sang Y, Grams ME, Coresh J, Evans M, Barany P, Ärnlöv J, Carrero JJ, Matsushita K. Albuminuria as a Predictor of Cardiovascular Outcomes in Patients With Acute Myocardial Infarction. J Am Heart Assoc 2020; 8:e010546. [PMID: 30947615 PMCID: PMC6507197 DOI: 10.1161/jaha.118.010546] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background In patients with myocardial infarction ( MI ), reduced kidney function is recognized as an important predictor of poor prognosis, but the impact of albuminuria, a representative measure of kidney damage, has not been extensively evaluated. Methods and Results In the SCREAM (Stockholm Creatinine Measurements) project (2006-2012), we identified 2469 patients with incident MI with dipstick proteinuria measured within a year before MI (427 patients also had urine albumin to creatinine ratio [ ACR ] measured concurrently) and obtained estimates for ACR with multiple imputation in participants with data solely on dipstick proteinuria. We quantified the association of ACR with the post- MI composite and individual outcomes of all-cause mortality, cardiovascular mortality, recurrent MI , ischemic stroke, or heart failure using Cox models and then evaluated the improvement in C statistic. During a median follow-up of 1.0 year after MI , 1607 participants (65.1%) developed the post- MI composite outcome. Higher ACR levels were independently associated with all outcomes except for ischemic stroke. Per 8-fold higher ACR (eg, 40 versus 5 mg/g), the hazard ratio of composite outcome was 1.21 (95% CI , 1.08-1.35). The addition of the ACR improved the C statistic of the post- MI composite by 0.040 (95% CI, 0.030-0.051). Largely similar results were obtained regardless of diabetic status and when ACR or dipstick was separately analyzed without imputation. Conclusions In patients with MI , albuminuria was a potent predictor of subsequent outcomes, suggesting the importance of paying attention to the information on albuminuria, in addition to kidney function, in this high-risk population.
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Affiliation(s)
- Yejin Mok
- 1 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Shoshana H Ballew
- 1 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Yingying Sang
- 1 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Morgan E Grams
- 1 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Josef Coresh
- 1 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Marie Evans
- 2 Division of Renal Medicine Department of Clinical Science, Intervention and Technology Karolinska Institutet Huddinge Sweden
| | - Peter Barany
- 2 Division of Renal Medicine Department of Clinical Science, Intervention and Technology Karolinska Institutet Huddinge Sweden
| | - Johan Ärnlöv
- 3 Division of Family Medicine and Primary Care Department of Neurobiology, Care Science and Society (NVS) Karolinska Institutet Huddinge Sweden.,4 School of Health and Social Studies Dalarna University Falun Sweden
| | - Juan-Jesus Carrero
- 5 Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Kunihiro Matsushita
- 1 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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Chen W, Chen P, Ni Z, Liu Y, Guo W, Jiang L, Wei X, Chen J, Tan N, He P, Guo Y. Prognostic of different glomerular filtration rate formulas in patients receiving percutaneous coronary intervention: insights from a multicenter observational cohort. BMC Cardiovasc Disord 2020; 20:341. [PMID: 32682399 PMCID: PMC7368721 DOI: 10.1186/s12872-020-01621-y] [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: 04/12/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background The relationships of renal dysfunction (RD) and chronic kidney disease (CKD) with prognosis have been well established among non-ST elevation acute coronary syndrome (NSTE-ACS) patients who receive percutaneous coronary intervention (PCI), but the efficacy of different estimated glomerular filtration rate (eGFR) formulas for predicting the prognosis is unknown. Methods The cohort originated from a retrospective data, which consecutively enrolled 8197 patients. The eGFR was calculated by the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), CKD Epidemiology Collaboration-creatinine, CKD Epidemiology Collaboration-Cys-C, CKD Epidemiology Collaboration-Cys-C-creatinine and a modified abbreviated MDRD (c-aGFR) equations in Chinese CKD patients. Patients were excluded if the eGFR could not be obtained by one of the formulas. Patients were categorized as having normal renal function, mild RD, moderate RD, severe RD, or kidney failure to compare prognosis. The primary outcome was the in-hospital net adverse clinical events (NACE). The secondary outcomes were NACE and all-cause death during follow-up. Results In total, 2159 NSTE-ACS patients (age: 64.23 ± 10.25 years; males: 73.7%) were enrolled. 39 (1.8%) patients with in-hospital NACE were observed. During the 3.23 ± 1.55-year follow-up, 1.7% death and 4.2% NACE were observed in 1 year. The percentage of severe RD patients ranged from 15.4 to 39.2% according to different calculation formulas. A high prevalence of in-hospital NACE was observed in the severe RD groups (ranging from 8 to 14.3% for different formulas). Multiple regression analysis showed that a high eGFR is a protect factor against NACE and all-cause death regardless of the formula use. Receiver operating characteristic curves showed similar predictive performance of the c-aGFR when compared to other formulas (in-hospital NACE: AUC = 0.612, follow-up NACE: AUC = 0.622, and follow-up death: AUC = 0.711). Conclusions Severe RD results in a high prevalence of in-hospital NACE in NSTE-ACS patients after PCI regardless of the formulas use. Different formulas have a similar ability to predict in-hospital and long-term prognosis in NSTE-ACS patients. The c-aGFR formula is the simplest and a more convenient formula for use in practice.
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Affiliation(s)
- Wei Chen
- Clinical College of Fujian Provincial Hospital, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fujian Cardiovascular Institute, Fuzhou, 350001, China
| | - Pengyuan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second Hospital of Nanhai District Foshan City, Foshan, 528000, China
| | - Zhonghan Ni
- Department 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, 510100, China
| | - Yuanhui Liu
- Department 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, 510100, China
| | - Wei Guo
- Department 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, 510100, China
| | - Lei Jiang
- Department 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, 510100, China
| | - Xuebiao Wei
- Department 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, 510100, China
| | - Jiyan Chen
- Department 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, 510100, China
| | - Ning Tan
- Department 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, 510100, China
| | - Pengcheng He
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second Hospital of Nanhai District Foshan City, Foshan, 528000, China. .,Department 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, 510100, China.
| | - Yansong Guo
- Clinical College of Fujian Provincial Hospital, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fujian Cardiovascular Institute, Fuzhou, 350001, China.
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Abstract
Emergence of various highly sensitive cardiac troponin assays into clinical practice provides a new tool for clinicians diagnosing acute coronary syndrome. These assays also create a challenge for laboratories and clinicians who have yet to familiarize themselves with sex-specific cutoffs. Healthy men and women, studied across various age groups and geographic locations, have notable differences in baseline values of highly sensitive cardiac troponin I and T, leading to establishment of sex-specific upper reference limits and cutoffs. Several differences in cardiac physiology, size, and structure may account for baseline differences in highly sensitive cardiac troponins and outcomes between the sexes. The clinical utility of implementing sex-specific cutoffs for diagnosis and management of acute coronary syndrome remains unclear. Presently, the only prospective study failed to show improved outcomes for men or women with use of sex-specific cutoffs; however, a major limitation is the frequent lack of diagnostic, therapeutic, and preventive interventions prescribed to women with low-level troponin elevations. Based on the current literature, we posit that there may nonetheless be clinical value in the use of sex-specific cutoffs for evaluating suspected acute coronary syndrome, especially in select patient populations such as younger women who tend to have lower baseline values of highly sensitive cardiac troponins. Future studies should prospectively evaluate differences in diagnostic, pharmacologic, and interventional management in men and women using myocardial infarctions classified with sex-specific cutoffs of the highly sensitive cardiac troponin assays.
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Affiliation(s)
- Prerana M. Bhatia
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of CaliforniaSan Diego
| | - Lori B. Daniels
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of CaliforniaSan Diego
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30
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Yang CC, Sung PH, Cheng BC, Li YC, Chen YL, Lee MS, Yip HK. Safety and efficacy of intrarenal arterial autologous CD34+ cell transfusion in patients with chronic kidney disease: A randomized, open-label, controlled phase II clinical trial. Stem Cells Transl Med 2020; 9:827-838. [PMID: 32297703 PMCID: PMC7381811 DOI: 10.1002/sctm.19-0409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/06/2020] [Accepted: 03/22/2020] [Indexed: 12/26/2022] Open
Abstract
Background This was a randomized, open‐label, controlled phase II clinical trial to investigate the safety, efficacy, and outcomes of intrarenal artery infusion of autologous peripheral‐blood‐derived CD34+ cells for patients with chronic kidney disease (CKD; ie, stage III or IV). Materials and Methods Between October 2016 and July 2018, 52 consecutive patients with CKD at stage III or IV were randomly allocated into a treatment group (TG; 2.5 × 107 cells for each intrarenal artery; n = 26) and a control group (CG; standardized pharmacotherapy only; n = 26). The primary endpoints included safety and change of creatinine level/creatinine clearance. The secondary endpoints were 12‐month combined unfavorable clinical outcomes (defined as dialysis or death), improvement in proteinuria, and CD34+ cell‐related adverse events. Results All patients were uneventfully discharged after CD34+ cell therapy. The baseline endothelial progenitor cell (EPC) populations did not differ between TG and CG (P > .5). Flow cytometric analysis showed increases in circulating EPC (ie, CD34+KDR+CD45dim/ CD34+CD133+CD45dim/CD31+CD133+CD45dim/CD34+CD133+KDR+/CD133+) and hematopoietic stem cell (CD34+) populations after granulocyte‐colony stimulating factor treatment (all P < .001). Besides, Matrigel assay of angiogenesis was also significantly enhanced (all P < .001). Renal‐venous blood samplings (ie, at 0, 5, 10, and 30 minutes after CD34+ cell infusion) demonstrated significant progressive increases in EPC level (P for trend <.001) among the TG patients. One‐year combined unfavorable clinical outcomes were significantly lower in TG than those in CG (0% [0] vs 13.3% [4], P = .038). By 12 months after CD34+ cell therapy, circulating creatinine level, ratio of urine protein to urine creatinine, and creatinine clearance showed no difference between TG and CG (all P > .1). Conclusion CD34+ cell therapy was safe and improved 1‐year outcome.
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Affiliation(s)
- Chih-Chao Yang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
| | - Ben-Chung Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Yi-Chen Li
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.,Institute for Translational Research in Biomedicine, Kaohsiung, Taiwan, Republic of China
| | - Mel S Lee
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.,Institute for Translational Research in Biomedicine, Kaohsiung, Taiwan, Republic of China.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, Republic of China.,Department of Nursing, Asia University, Taichung, Taiwan, Republic of China.,Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Xiamen, Fujian, People's Republic of China
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31
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Zhang DW, Wang SL, Wang PL, Du JP, Gao ZY, Wang CL, Xu H, Shi DZ. The efficacy of Chinese herbal medicines on acute coronary syndrome with renal insufficiency after percutaneous coronary intervention. JOURNAL OF ETHNOPHARMACOLOGY 2020; 248:112354. [PMID: 31689480 DOI: 10.1016/j.jep.2019.112354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/22/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Fufang Chuanxiong capsule consists of Angelica sinensis radix and Chuanxiong rhizome, which are used in the traditional Chinese medicine for the treatment of coronary artery disease, and Xinyue capsule is composed of panax quinquefolius saponin extracted from leaves and stems of Panax quinquefolium L, which has the functions of anti-myocardial ischemia, improving myocardial energy metabolism and inhibiting apoptosis of cardiomyocytes. OBJECTIVE To observe the role of Chinese herbal medicines in the cardiovascular outcome among patients with acute coronary syndrome (ACS) and renal insufficiency after percutaneous coronary intervention (PCI). METHODS The subjects came from the 5C trial (chictr.org number: chictr-trc-07000021), post-PCI patients suffered from ACS with mild-to-moderate renal insufficiency (30 mL•min-1•1.73 m-2 < estimated glomerular filtration rate≤89 mL•min-1•1.73 m-2) included. The study population consisted of 215 subjects in the control group who were treated with western medicine standard therapy, and 211 subjects in the treatment group who were treated with Chinese herbal medicines (Fufang Chuanxiong Capsule and Xinyue Capsule) for 6 months on the basis of western medicine standard therapy. All were followed for 1 year. The primary endpoint included the composite of cardiac death, nonfatal recurrent myocardial infarction, and ischemia-driven revascularization. Secondary endpoint included the composite of stroke, congestive heart failure, and readmission for ACS. The serum creatinine and estimated glomerular filtration rate (eGFR) were evaluated. RESULTS After 1 year follow-up of two groups, there were 16 cases of primary endpoint in the control group and 6 cases of primary endpoint in the treatment group [absolute risk reduction (ARR): 0.046, 95%CI: 0.004-0.088; relative risk (RR): 0.38, 95%CI: 0.15-0.96, P = 0.040]. There were 15 cases of secondary endpoint in the control group and 5 cases of secondary endpoint in the treatment (ARR: 0.041, 95%CI: 0.006-0.086; RR: 0.34, 95%CI: 0.13-0.92, P = 0.033). The eGFR in the treatment group was significantly higher than that in the control group (75.19 ± 16.74 mL min-1·1.73 m-2 VS 72.03 ± 14.96 mL min-1·1.73 m-2, P < 0.05). The eGFR in the treatment group was significantly higher after the intervention with Chinese herbal medicines than that before intervention (72.27 ± 11.83 mL min-1·1.73 m-2 VS 75.19 ± 16.74 mL min-1·1.73 m-2, P < 0.05). CONCLUSION Chinese herbal medicines plus western medicine standard therapy improved clinical outcomes in patients with ACS and mild-to-moderate renal insufficiency. Additionally, this study also demonstrated Chinese herbal medicines were useful in deferring decline of renal function.
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Affiliation(s)
- Da-Wu Zhang
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Shao-Li Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Pei-Li Wang
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jian-Peng Du
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Zhu-Ye Gao
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Cheng-Long Wang
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Hao Xu
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Da-Zhuo Shi
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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32
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Brankovic M, Kardys I, van den Berg V, Oemrawsingh R, Asselbergs FW, van der Harst P, Hoefer IE, Liem A, Maas A, Ronner E, Schotborgh C, The SHK, Hoorn EJ, Boersma E, Akkerhuis KM. Evolution of renal function and predictive value of serial renal assessments among patients with acute coronary syndrome: BIOMArCS study. Int J Cardiol 2020; 299:12-19. [PMID: 31353156 DOI: 10.1016/j.ijcard.2019.07.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Impaired renal function predicts mortality in acute coronary syndrome (ACS), but its evolution immediately following index ACS and preceding next ACS has not been described in detail. We aimed to describe this evolution using serial measurements of creatinine, glomerular filtration rate [eGFRCr] and cystatin C [CysC]. METHODS From 844 ACS patients included in the BIOMArCS study, we analysed patient-specific longitudinal marker trajectories from the case-cohort of 187 patients to determine the risk of the endpoint (cardiovascular death or hospitalization for recurrent non-fatal ACS) during 1-year follow-up. Study included only patients with eGFRCr ≥ 30 ml/min/1.73 m2. Survival analyses were adjusted for GRACE risk score and based on data >30 days after the index ACS (mean of 8 sample per patient). RESULTS Mean age was 63 years, 79% were men, 43% had STEMI, and 67% were in eGFR stages 2-3. During hospitalization for index ACS (median [IQR] duration: 5 (3-7) days), CysC levels indicated deterioration of renal function earlier than creatinine did (CysC peaked on day 3, versus day 6 for creatinine), and both stabilized after two weeks. Higher CysC levels, but not creatinine, predicted the endpoint independently of the GRACE score within the first year after index ACS (adjusted HR [95% CI] per 1SD increase: 1.68 [1.03-2.74]). CONCLUSION Immediately following index ACS, plasma CysC levels deteriorate earlier than creatinine-based indices do, but neither marker stabilizes during hospitalization but on average two weeks after ACS. Serially measured CysC levels predict mortality or recurrence of ACS during 1-year follow-up independently of patients' GRACE risk score.
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Affiliation(s)
- Milos Brankovic
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Victor van den Berg
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Rohit Oemrawsingh
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, the Netherlands; Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands
| | | | - Imo E Hoefer
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, the Netherlands
| | - Anho Liem
- Sint Franciscus Gasthuis, Rotterdam, the Netherlands
| | | | - Eelko Ronner
- Reinier de Graaf Hospital, Delft, the Netherlands
| | | | - S Hong Kie The
- Treant Zorggroep, location Bethesda, Hoogeveen, the Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands.
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Shen JH, Wang HM, Zheng KL, Lu HH, Zhang Q. Correlation of the ORBIT Score With 30-Day Mortality in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2020; 26:1076029620940047. [PMID: 33079594 PMCID: PMC7791435 DOI: 10.1177/1076029620940047] [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] [Indexed: 11/17/2022] Open
Abstract
A new scoring system Outcomes Registry for Better Informed Treatment (ORBIT) score is used to assess the bleeding risk in anticoagulated patients with atrial fibrillation (AF). Our aim is to investigate the possible correlations of the ORBIT score with 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI). A total of 639 patients with STEMI were enrolled in this study. The ORBIT, HAS-BLED, and TIMI scores were recorded during admission. After 30 days' follow-up, 639 patients were divided into 2 groups: the survival group and the nonsurvival group. Different clinical parameters were compared. The predictive values of the ORBIT, HAS-BLED, and TIMI scores for 30-day mortality were assessed from receiver operating characteristic (ROC) analyses. The univariate and multivariate Cox proportional hazards analyses were applied to evaluate the relationships between variables and 30-day mortality. Sixty-seven deaths occurred after a 30-day follow-up. The ORBIT, HAS-BLED, and TIMI scores in the death group were higher than those in the survival group (P < .05). The areas under the ROC curve for the ORBIT, HAS-BLED, and TIMI scores to predict the occurrence of 30-day mortality were 0.811 (95% CI: 0.779-0.841, P < .0001), 0.717 (95% CI: 0.680-0.752, P < .0001), and 0.844 (95% CI: 0.813-0.871, P < .0001), respectively. In multivariate Cox proportional hazards modeling, the high ORBIT score was positively associated with 30-day mortality (hazard ratio: 1.309, 95% CI: 1.101-1.556, P = .013) after adjustment. A graded relation is found in the elevated ORBIT score and 30-day mortality in patients with STEMI. Thus, the ORBIT score can be an independent predictor of 30-day mortality in patients with STEMI.
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Affiliation(s)
- Jun-Hua Shen
- Emergency Department, The Second Affiliated Hospital of Nantong University, China
| | - Hui-Min Wang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
| | - Kou-Long Zheng
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
| | - Hui-He Lu
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
| | - Qing Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
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34
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Smith ER, Hewitson TD, Holt SG. Diagnostic Tests for Vascular Calcification. Adv Chronic Kidney Dis 2019; 26:445-463. [PMID: 31831123 DOI: 10.1053/j.ackd.2019.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 02/06/2023]
Abstract
Vascular calcification (VC) is the heterogeneous endpoint of multiple vascular insults, which varies by arterial bed, the layer of the arterial wall affected, and is propagated by diverse cellular and biochemical mechanisms. A variety of in vivo and ex vivo techniques have been applied to the analysis of VC in preclinical studies, but clinical examination has principally relied on a number of noninvasive and invasive imaging modalities for detection and quantitation. Most imaging methods suffer from suboptimal spatial resolution, leading to the inability to distinguish medial from intimal VC and insufficient sensitivity to detect microcalcifications that are indicative of active mineral deposition and of vulnerable plaques which may be prone to rupture. Serum biomarkers lack specificity for VC and cannot discriminate pathology. Overall, uncertainties surrounding the sensitivity and specificity of different VC testing modalities, the absence of a clear cause-effect relationship, and lack of any evidence-based diagnostic or therapeutic protocols in relation to VC testing in chronic kidney disease has yielded weak or ungraded recommendations for their use in clinical practice. While VC is recognized as a key manifestation of chronic kidney disease-mineral and bone disorder and those with an increasing burden of VC are considered to be at higher cardiovascular risk, routine screening is not currently recommended.
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35
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De Filippo O, D’Ascenzo F, Raposeiras-Roubin S, Abu-Assi E, Peyracchia M, Bocchino PP, Kinnaird T, Ariza-Solé A, Liebetrau C, Manzano-Fernández S, Boccuzzi G, Henriques JPS, Templin C, Wilton SB, Omedè P, Velicki L, Xanthopoulou I, Correia L, Cerrato E, Rognoni A, Fabrizio U, Nuñez-Gil I, Iannaccone M, Montabone A, Taha S, Fujii T, Durante A, Song X, Gili S, Magnani G, Varbella F, Kawaji T, Blanco PF, Garay A, Quadri G, Alexopoulos D, Caneiro Queija B, Huczek Z, Cobas Paz R, González Juanatey JR, Cespón Fernández M, Nie SP, Muñoz Pousa I, Kawashiri MA, Gallo D, Morbiducci U, Conrotto F, Montefusco A, Dominguez-Rodriguez A, López-Cuenca A, Cequier A, Iñiguez-Romo A, Usmiani T, Rinaldi M, De Ferrari GM. P2Y12 inhibitors in acute coronary syndrome patients with renal dysfunction: an analysis from the RENAMI and BleeMACS projects. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 6:31-42. [DOI: 10.1093/ehjcvp/pvz048] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction.
Methods and results
All consecutive patients from RENAMI (REgistry of New Antiplatelets in patients with Myocardial Infarction) and BLEEMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registries were stratified according to estimated glomerular filtration rate (eGFR) lower or greater than 60 mL/min/1.73 m2. Death and myocardial infarction (MI) were the primary efficacy endpoints. Major bleedings (MBs), defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety endpoint. A total of 19 255 patients were enrolled. Mean age was 63 ± 12; 14 892 (77.3%) were males. A total of 2490 (12.9%) patients had chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2. Mean follow-up was 13 ± 5 months. Mortality was significantly higher in CKD patients (9.4% vs. 2.6%, P < 0.0001), as well as the incidence of reinfarction (5.8% vs. 2.9%, P < 0.0001) and MB (5.7% vs. 3%, P < 0.0001). At Cox multivariable analysis, potent P2Y12 inhibitors significantly reduced the mortality rate [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.54–0.96; P = 0.006] and the risk of reinfarction (HR 0.53, 95% CI 0.30–0.95; P = 0.033) in CKD patients as compared to clopidogrel. The reduction of risk of reinfarction was confirmed in patients with preserved renal function. Potent P2Y12 inhibitors did not increase the risk of MB in CKD patients (HR 1.00, 95% CI 0.59–1.68; P = 0.985).
Conclusion
In ACS patients with CKD, prasugrel and ticagrelor are associated with lower risk of death and recurrent MI without increasing the risk of MB.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Sergio Raposeiras-Roubin
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Emad Abu-Assi
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Mattia Peyracchia
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Heath Park Way, Cardiff, UK
| | - Albert Ariza-Solé
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8 61231, Bad Nauheim, Germany
| | - Sergio Manzano-Fernández
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Giacomo Boccuzzi
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Jose Paulo Simao Henriques
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, GE64 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Lazar Velicki
- Medical Faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, and Institute of Cardiovascular Diseases Vojvodina, Put doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Ioanna Xanthopoulou
- Department of Cardiology, Patras University Hospital, Rion, 265 04 Patras, Greece
| | - Luis Correia
- Department of Cardiology, Hospital São Rafael - Avenida São Rafael, 2152 - São Marcos, 41253-196 Salvador, Bahia, Brazil
| | - Enrico Cerrato
- Interventional Cardiology Unit, Orbassano, and San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano Rivoli, Turin, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Corso Mazzini 18, Novara, Italy
| | - Ugo Fabrizio
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Iván Nuñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Mario Iannaccone
- Cardiology Department, “SS. Annunziata” Hospital, Via Ospedali, 9, Savigliano, Cuneo, Italy
| | - Andrea Montabone
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Salma Taha
- Department of Cardiology, Faculty of Medicine, Assiut University, Libraries Street, Assiut, Egypt
| | - Toshiharu Fujii
- Division of Cardiovascular Medicine, Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Japan
| | - Alessandro Durante
- U.O. Cardiologia, Ospedale Valduce, Via Dante Alighieri, 11, 22100 Como, Italy
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Giulia Magnani
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Ferdinando Varbella
- Interventional Cardiology Unit, Orbassano, and San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano Rivoli, Turin, Italy
| | - Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, Japan
| | - Pedro Flores Blanco
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Alberto Garay
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Via Rivalta, 29, Rivoli, Torino, Italy
| | | | - Berenice Caneiro Queija
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, 1 a Banacha St, Warsaw, Poland
| | - Rafael Cobas Paz
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - José Ramón González Juanatey
- Servicio de Hemodinámica, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana s/n 15706, Santiago de Compostela, A Coruña, Spain
| | - María Cespón Fernández
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Shao-Ping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Isabel Muñoz Pousa
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Masa-Aki Kawashiri
- Department of Cardiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, 920-86 Kanazawa, Japan
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Torino, Italy
| | - Umberto Morbiducci
- Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Torino, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Alberto Dominguez-Rodriguez
- Department of Cardiology, Hospital Universitario de Canarias, Carretera Cuesta Taco, 0, 38320 Cuesta ( La, Santa Cruz de Tenerife), Spain
| | - Angel López-Cuenca
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Angel Cequier
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrés Iñiguez-Romo
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Tullio Usmiani
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
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Sideris S, Archontakis S, Latsios G, Lazaros G, Toutouzas K, Tsiamis E, Vavuranakis M, Vlachopoulos C, Gatzoulis K, Tsioufis C, Tousoulis D. Biomarkers Associated with Bleeding Risk in the Setting of Atrial Fibrillation. Curr Med Chem 2019; 26:824-836. [PMID: 28721832 DOI: 10.2174/0929867324666170718124742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prevention of thromboembolic disease, mainly stroke, with oral anticoagulants remains a major therapeutic goal in patients with atrial fibrillation. Unfortunately, despite the high efficacy, anticoagulant therapy is associated with a significant risk of, frequently catastrophic, and hemorrhagic complications. Among different clinical and laboratory parameters related to an increased risk of bleeding, several biological markers have been recognized and various risk scores for bleeding have been developed. OBJECTIVES/METHODS The aim of the present study is to review current evidence regarding the different biomarkers associated with raised bleeding risk in atrial fibrillation. RESULTS Data originating from large cohorts or the recent large-scale trials of atrial fibrillation have linked numerous individual biomarkers to an increased bleeding risk. Such a relation was revealed for markers of cardiac physiology, such as troponin, BNP and NT-proBNP, markers of renal function, such as GFR and Cystatin or hepatic function, markers involving the system of coagulation, such as D-dimer and Von Willebrand factor, hematologic markers, such as low haemoglobin or low platelets, inflammatory markers, such as interleukin-6, other factors such as GDF-15 and vitamin-E and finally genetic polymorphisms. Many such biomarkers are incorporated in the bleeding risk schemata developed for the prediction of the hemorrhagic risk. CONCLUSIONS Biomarkers were introduced in clinical practice in order to better estimate the potential risk of haemorrhage in these patients and increase the prognostic impact of clinical risk scores. In the last years this concept is gaining significant importance.
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Affiliation(s)
- Skevos Sideris
- 1st Cardiology Department, Athens Medical School, Athens, Greece
| | | | - George Latsios
- 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - George Lazaros
- 1st Cardiology Department, Athens Medical School, Athens, Greece
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Influence of age on the effect of reduced renal function on outcomes in patients with coronary artery disease. BMC Public Health 2019; 19:205. [PMID: 30777040 PMCID: PMC6380002 DOI: 10.1186/s12889-019-6498-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 01/30/2019] [Indexed: 02/05/2023] Open
Abstract
Background Ageing is a risk factor for both coronary artery disease (CAD) and reduced renal function (RRF), and it is also associated with poor prognosis in patients with CAD or RRF. However, little is known about whether the impact of RRF on clinical outcomes are different in CAD patients at different age groups. This study aimed to investigate whether ageing influences the effect of RRF on long-term risk of death in patients with CAD. Methods A retrospective analysis was conducted using data from a single-center cohort study. Three thousand and two consecutive patients with CAD confirmed by coronary angiography were enrolled. RRF was defined as an estimated glomerular filtration rate (eGFR) of less than 60 ml/min. The primary endpoint in this study was all-cause mortality. Results The mean follow-up time was 29.1 ± 12.5 months and death events occurred in 275 cases (all-cause mortality: 9.2%). The correlation analysis revealed a negative correlation between eGFR and age (r = − 0.386, P < 0.001). Comparing the younger group (age ≤ 59) with the elderly one (age ≥ 70), the prevalence of RRF increased from 5.9 to 27.5%. Multivariable Cox regression revealed that RRF was independently associated with all-cause mortality in all age groups, and the relative risks in older patients were lower than those in younger ones (age ≤ 59 vs. age 60–69 vs. age ≥ 70: hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.04–6.37 vs. HR 2.00, 95% CI 1.17–3.42 vs. HR 1.46, 95% CI 1.06–2.02). There was a significant trend for HRs for all-cause mortality according to the interaction terms for RRF and age group (RRF*age [≤59] vs. RRF*age [60–69] vs. RRF*age [≥70]: HR 1.00[reference] vs. HR 0.60, 95% CI 0.23–1.54 vs. HR 0.32, 95% CI 0.14–0.75; P for trend = 0.010). Conclusions RRF may have different impacts on clinical outcomes in CAD patients at different age groups. The association of RRF with the risk of all-cause mortality was attenuated with ageing.
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Sung PH, Chen KH, Li YC, Chiang JY, Lee MS, Yip HK. Sitagliptin and shock wave-supported peripheral blood derived endothelial progenitor cell therapy effectively preserves residual renal function in chronic kidney disease in rat-role of dipeptidyl peptidase 4 inhibition. Biomed Pharmacother 2019; 111:1088-1102. [PMID: 30841422 DOI: 10.1016/j.biopha.2019.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 01/08/2023] Open
Abstract
This study tested whether sitagliptin and shock wave (SW)-assisted circulatory-derived autologous endothelial progenitor cell (EPC) therapy would effectively preserve residual renal function in chronic kidney disease (CKD) induced by 5/6 left-nephrectomy/remove right kidney plus daily feeding high-protein diet (HPD) in rat. Adult-male SD rats (n = 40) were categorized into group 1 (sham-operated control with HPD), group 2 (HPD-CKD), group 3 [HPD-CKD + EPC (1.2 × 106 cell)/intra-vessel administration by day 14 after CKD-induction], group 4 [HPD-CKD + SW (0.12 mJ/mm2/180 shorts) at days 14/21/28 after CKD-induction by ultrasound-guided application] and group 5 [HPD-CKD + SW + EPC + sitagliptin (Sita; 600 mg/kg/day since day 14 after CKD induction)]. All animals were euthanized by day 60. By day 60, renal blood flow (RBF) was highest in group 1 and progressively increased from groups 2 to 5, whereas the levels of creatinine/BUN/proteinuria exhibited an opposite pattern of RBF among the five groups (all p < 0.001). The circulating levels of GLP-1/SDF-1α and protein levels of angiogenesis (VEGF/SDF-1α/CXCR4) and GLP-1R in kidney were progressively increased from groups 1 to 5, whereas circulating DPP4 activity exhibited an opposite pattern of SDF-1α among the groups (all p < 0.0001). The protein expressions of oxidative-stress (NOX-1/NOX-2/oxidized protein), apoptosis (Bax/caspase-3/PARP), fibrosis (Smad3/TGF-ß) and inflammation (TNF-α/NF-κB/MMP-2) and kidney injury score displayed an opposite pattern, whereas the protein expressions of TMP2, endothelial-cell markers (CD31/eNOS) and podocyte integrity biomarkers (podocin/ZO-1/synaptopodin) exhibited an identical pattern of RBF among the groups (all p < 0.001). In conclusion Sita associated SW-assisted EPC effectively protected residual renal function in CKD.
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Affiliation(s)
- Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Kuan-Hung Chen
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC; Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Yi-Chen Li
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan, ROC;; Quanzhou University of Information Engineering, Quanzhou, China
| | - Mel S Lee
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC.
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402, Taiwan, ROC; Department of Nursing, Asia University, Taichung, 41354, Taiwan, ROC.
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Richter B, Sulzgruber P, Koller L, Steininger M, El-Hamid F, Rothgerber DJ, Forster S, Goliasch G, Silbert BI, Meyer EL, Hengstenberg C, Wojta J, Niessner A. Blood urea nitrogen has additive value beyond estimated glomerular filtration rate for prediction of long-term mortality in patients with acute myocardial infarction. Eur J Intern Med 2019; 59:84-90. [PMID: 30072202 DOI: 10.1016/j.ejim.2018.07.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/28/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Blood urea nitrogen (BUN) has been shown to independently predict short- and intermediate-term outcomes in patients with acute myocardial infarction (AMI). We aimed to assess the additive predictive value of BUN beyond estimated glomerular filtration rate (eGFR) in AMI patients with an 8.6-year follow-up. METHODS This retrospective, observational single-centre study included 1332 consecutive AMI patients (median age 64 years, 58.4% male). BUN, creatinine and eGFR were determined at hospital admission. RESULTS During a median follow-up of 8.6 years (interquartile range [IQR] 4.0-11.6), 408 patients (30.6%) experienced the study endpoint of cardiovascular mortality. BUN (median 17.0 mg/dL [IQR 13.5-22.7]) was a significant predictor of cardiovascular mortality in univariate Cox regression (hazard ratio (HR) per 1 standard deviation increase 2.10, 95% confidence interval [CI] 1.94-2.28, p < .001). This association remained significant after multivariable adjustment for demographics, clinical variables and eGFR (adjusted HR 1.52 [CI 1.16-2.00, p = .003]). The association between BUN and outcome was more pronounced in patients with eGFR >60 mL/min/1.73m2 (HR 2.81 [CI 2.20-3.58, p < .001]). The discriminatory abilities (Harrell's C-statistic) for BUN, eGFR and creatinine were 0.75, 0.76 and 0.67, respectively. The addition of BUN to eGFR significantly improved the C-statistic (0.78, p for comparison = 0.017), net reclassification (23.7%, p < .001) and integrated discrimination (2.9%, p < .001). CONCLUSIONS Circulating BUN on admission is an independent predictor of long-term cardiovascular mortality in AMI patients and adds predictive power beyond eGFR. BUN reflects not only kidney function, but also acute haemodynamic and neurohumoral alterations during AMI, and may help to identify high-risk patients.
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Affiliation(s)
- Bernhard Richter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Matthias Steininger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Feras El-Hamid
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - David J Rothgerber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Stefan Forster
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Benjamin I Silbert
- Department of Intensive Care Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | - Elias L Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
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Social support buffers the negative effects of stress in cardiac patients: a cross-sectional study with acute coronary syndrome patients. J Behav Med 2018; 42:469-479. [PMID: 30523503 DOI: 10.1007/s10865-018-9998-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022]
Abstract
Cardiac patients who have social support generally have better prognosis than patients who lack social support. Several theoretical mechanisms have been proposed to explain this protective effect, including the capacity of social support to buffer the negative effects of stress. We tested this buffering effect in a study of patients hospitalized for acute coronary syndrome (ACS) in Spain. Several days after the cardiac event patients answered a questionnaire measuring stressful events during their lifetime, perceived social support around the time of the cardiac event, and depression symptoms in the past week. Results showed that stressful life events were related to depressive symptoms and worse renal function post-ACS only among patients with low perceived social support. Among patients who reported enough social support, lifetime stress was not related to depressive symptoms. No similar effects were observed on other prognostic indicators such as troponin levels or the number of obstructed arteries. These results suggest that social support can buffer the negative effects of stress on the mental and physical well-being of cardiac patients.
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Price AM, Ferro CJ, Hayer MK, Steeds RP, Edwards NC, Townend JN. Premature coronary artery disease and early stage chronic kidney disease. QJM 2018; 111:683-686. [PMID: 29024966 PMCID: PMC6166385 DOI: 10.1093/qjmed/hcx179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 12/05/2022] Open
Abstract
A 30 year old asymptomatic male with stage 3 chronic kidney disease (CKD) secondary to Focal Segmental Glomerulosclerosis was found to have features of CKD associated cardiomyopathy including left ventricular hypertrophy (LVH) and focal sub-endocardial scarring on cardiac magnetic resonance imaging. There was also a significantly raised CT coronary calcium score and evidence of non-flow limiting coronary artery disease (CAD) on a CT coronary angiogram. Early stage CKD is a major risk factor for cardiovascular risk causing myocardial hypertrophy and fibrosis and coronary artery atheroma. Cardiovascular risk begins to increase from an eGFR of around 75ml/min/1.73m2. The pathophysiology of cardiovascular disease in CKD is under investigation but to date, treatment options are limited. Blood pressure control and statins have the strongest supportive evidence.
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Affiliation(s)
- A M Price
- Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
- Address correspondence to Dr Anna M. Price, Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK.
| | - C J Ferro
- Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - M K Hayer
- Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - R P Steeds
- Department of Cardiology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - N C Edwards
- Department of Cardiology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - J N Townend
- Department of Cardiology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
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Patti G, Ricottini E, Nenna A, Cavallari I, Antonucci E, Calabrò P, Cirillo P, Gresele P, Palareti G, Pengo V, Pignatelli P, Bisignani A, Marcucci R. Impact of Chronic Renal Failure on Ischemic and Bleeding Events at 1 Year in Patients With Acute Coronary Syndrome (from the Multicenter START ANTIPLATELET Registry). Am J Cardiol 2018; 122:936-943. [PMID: 30057232 DOI: 10.1016/j.amjcard.2018.05.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
Chronic renal failure (CRF) impairs prognosis in patients with acute coronary syndromes (ACS); the differential impact of CRF on ischemic and bleeding events in the setting of ACS is unclear. We explored the predictive role of CRF, identified by different equations for the glomerular filtration rate estimation, on the occurrence of the composite end point, including both ischemic cardiovascular and major bleeding (major adverse cardiovascular and bleeding events [MACBE]) at 1 year, and its components. We accessed each patients data from 718 participants in the prospective, multicenter, and START ANTIPLATELET registry, performed on patients with ACS. The ability to predict the risk of MACBE was modest and similar for Cockcroft-Gault, MDRD, and CKD-EPI equations (area under the curves: 0.55, 95% confidence interval [CI] 0.47 to 0.63; 0.53, 95% CI 0.45 to 0.61; 0.54, 95% CI 0.46 to 0.62; respectively, overall p = 0.63). The incidence of MACBE in patients with CRF was 12.6 versus 7.4 per 100 patients/year in those with preserved renal function (adjusted odds ratio [OR] 1.80, 1.02 to 3.20, p = 0.045); the absolute excess in events rate due to CRF was higher for ischemic events (3.5%) than for major bleeding (2.6%). The increased occurrence of MACBE was even greater in patients with CRF and concomitant anemia (OR 2.16) and in patients with severe CRF (OR 2.78). In conclusion, our study indicates that, in patients with ACS, CRF impairs the clinical outcome at 1 year, especially when severe and when is concomitant with anemia. CRF is associated with greater absolute increase of ischemic events than major bleeding.
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Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Elisabetta Ricottini
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Paolo Calabrò
- Division of Cardiology, Monaldi Hospital and "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, School of Medicine, "Federico II" University, Naples, Italy
| | - Paolo Gresele
- Department of Medicine, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Vittorio Pengo
- Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, La Sapienza University of Rome, Rome, Italy
| | | | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic Diseases, University of Florence, Florence, Italy
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Song H, Hu H, Liao D, Wei J, Wei C, Liao F, Zhou W, Mo Z, Jiang S, Ruan X, He Y. Left ventricular hypertrophy predicts the decline of glomerular filtration rate in patients with type 2 diabetes mellitus. Int Urol Nephrol 2018; 50:2049-2059. [DOI: 10.1007/s11255-018-1942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/14/2018] [Indexed: 12/28/2022]
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Jakimov T, Mrdović I, Filipović B, Zdravković M, Djoković A, Hinić S, Milić N, Filipović B. Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome. Croat Med J 2018; 58:406-415. [PMID: 29308832 PMCID: PMC5778677 DOI: 10.3325/cmj.2017.58.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). METHODS This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014. The GRACE, TIMI, and RISK-PCI risk scores were compared for their predictive ability. The primary endpoint was a composite 30-day major adverse cardiovascular event (MACE), which included death, urgent target-vessel revascularization (TVR), stroke, and non-fatal recurrent myocardial infarction (REMI). RESULTS The c-statistics of the tested scores for 30-day MACE or area under the receiver operating characteristic curve (AUC) with confidence intervals (CI) were as follows: RISK-PCI (AUC=0.94; 95% CI 1.790-4.353), the GRACE score on admission (AUC=0.73; 95% CI 1.013-1.045), the GRACE score on discharge (AUC=0.65; 95% CI 0.999-1.033). The RISK-PCI score was the only score that could predict TVR (AUC=0.91; 95% CI 1.392-2.882). The RISK-PCI scoring system showed an excellent discriminative potential for 30-day death (AUC=0.96; 95% CI 1.339-3.548) in comparison with the GRACE scores on admission (AUC=0.88; 95% CI 1.018-1.072) and on discharge (AUC=0.78; 95% CI 1.000-1.058). CONCLUSIONS In comparison with the GRACE and TIMI scores, RISK-PCI score showed a non-inferior ability to predict 30-day MACE and death in ACS patients. Moreover, RISK-PCI was the only scoring system that could predict recurrent ischemia requiring TVR.
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Affiliation(s)
- Tamara Jakimov
- Tamara Jakimov, Department of Cardiology, Clinical and Hospital Center "Bežanijska kosa", Autoput s/n, 11000 Belgrade, Serbia,
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Fu CM, Chang CH, Lee CC, Fan PC, Chen SW, Lee CT, Wu CH, Li LC, Chen TH. Impact of dialysis dependence on prognosis in patients with myocardial infarction: An 11-year population-based study. Medicine (Baltimore) 2018; 97:e9833. [PMID: 29419688 PMCID: PMC5944684 DOI: 10.1097/md.0000000000009833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study we aimed to directly compare the short and long-term prognosis of nondialysis patients with chronic kidney disease (CKD), dialysis patients, and patients with preserved renal function after acute myocardial infarction (AMI).AMI in patients with CKD is a catastrophic event associated with high medical expenditures and dismal survival. However, there is little research comparing post-AMI outcomes between patients with CKD who were and were not receiving dialysis.The retrospective cohort study included patients with AMI (n = 158,125) in the Taiwan's National Health Insurance Research Database who were treated March 1998 and December 2009. Patients were classified into a nondialysis CKD group (n = 6300), dialysis group (n = 5140), and a control group (n = 146,685). The clinical characteristics, in-hospital events, and long-term outcomes of these 3 groups were compared separately using a multivariable Cox proportional hazard model.The risks of in-hospital death and 2-year all-cause mortality were the highest in the dialysis group, followed by the nondialysis CKD group, and were the lowest in the control group. The 1-year risk of myocardial infarction did not differ among the 3 study groups, but the 2-year risk of myocardial infarction was higher in the dialysis group than in the control group (hazard ratio, 1.13; 95% confidence interval, 1.03-1.24; P = .010).Patients with CKD experienced adverse short- and long-term outcomes after acute myocardial infarction. Patients with CKD, especially those who are dialysis dependent, may require more intensive management to improve their post-AMI clinical outcomes.
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Affiliation(s)
- Chung-Ming Fu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Cheng-Chia Lee
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Pei-Chun Fan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chien-Hsing Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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46
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Horiuchi Y, Aoki J, Tanabe K, Nakao K, Ozaki Y, Kimura K, Ako J, Yasuda S, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Uematsu M, Hirata K, Shibata Y, Nakai M, Nishimura K, Miyamoto Y, Ishihara M. A High Level of Blood Urea Nitrogen Is a Significant Predictor for In-hospital Mortality in Patients with Acute Myocardial Infarction. Int Heart J 2018; 59:263-271. [DOI: 10.1536/ihj.17-009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Koichi Nakao
- Saiseikai Kumamoto Hospital Cardiovascular Center
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47
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Han KW, Chen SY, Weng YM, Ng CJ, Chiu TF, Hsieh IC, Chen JC. Validation of different score systems in predicting cardiac arrest occurrence of ST-elevation myocardial infarction. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917724729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Patients with ST-elevation myocardial infarction are at risk of developing cardiac arrest. A validated tool for predicting cardiac arrest would help physicians recognize these high-risk patients earlier. This study assessed the usefulness of various score systems in predicting cardiac arrest in patients hospitalized for ST-elevation myocardial infarction. Methods: Patients’ data were retrieved from the hospital’s ST-elevation myocardial infarction registry records. Patients aged 18 years or older seen at the emergency department with a diagnosis of ST-elevation myocardial infarction between 1 July 2013 and 30 June 2014 were enrolled. The Thrombolysis in Myocardial Infarction score, the 6-month Global Registry of Acute Coronary Event risk score, CHADS2 score, and HEART score were calculated and compared. Results: A total of 249 patients were recruited. The Thrombolysis in Myocardial Infarction score, 6-month Global Registry of Acute Coronary Event risk score, CHADS2 score, and HEART scores were calculated. In total, 41 (16.5%) patients had cardiac arrest at emergency department or during hospitalization and 12 (29.3%) of them survived. The 6-month Global Registry of Acute Coronary Event risk score had the biggest area under the receiver-operating characteristic curve (0.72). Conclusion: The 6-month Global Registry of Acute Coronary Event risk score is more useful in predicting cardiac arrest in patients hospitalized for ST-elevation myocardial infarction than the other three scores. It is recommended that the 6-month Global Registry of Acute Coronary Event risk score be calculated for identifying emergency department patients hospitalized for ST-elevation myocardial infarction who are at risk of cardiac arrest during their hospital stay.
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Affiliation(s)
- Ko-Wen Han
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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48
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Lee MS, Lee FY, Chen YL, Sung PH, Chiang HJ, Chen KH, Huang TH, Chen YL, Chiang JY, Yin TC, Chang HW, Yip HK. Investigated the safety of intra-renal arterial transfusion of autologous CD34+ cells and time courses of creatinine levels, endothelial dysfunction biomarkers and micro-RNAs in chronic kidney disease patients-phase I clinical trial. Oncotarget 2017; 8:17750-17762. [PMID: 28148896 PMCID: PMC5392283 DOI: 10.18632/oncotarget.14831] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/07/2017] [Indexed: 12/27/2022] Open
Abstract
This was a phase I clinical trial to investigate the safety of autologous peripheral-blood-derived CD34+ cell therapy for patients with chronic kidney disease (CKD-treatment) (i.e., at Stages III and IV). Between November 2014 and October 2015, a total of 10 study patients were prospectively enrolled into this phase I trial. Patients who failed to enroll into the trial in the initial state of eligibility assessment were served as CKD-control group (n = 9). The health-control group was composed of 10 volunteers for the purposes of comparing (1) circulation level of endothelial progenitor cells (EPCs), (2) angiogenesis ability, and (3) anti-apoptotic miRNAs between healthy subjects and CKD patients. CD34+ cells (5.0 x 107) were transfused into right-renal artery after subcutaneous G-CSF injection (5μg/kg/twice a day for 4 days). Circulating EPC number, angiogenesis capacity (i.e., Matrigel assay) and anti-apoptotic miRNAs (miR-374a-5p/miR-19a-3p/ miR-106b-5p/miR-26b-5p/ miR-20a-5p) were significantly lower in CKD patients than in healthy subjects (all p < 0.001). Flow-cytometric analysis of renal-vein blood samplings (i.e., at 0/5/10/30 mins after cell transfusion) showed the EPC level was significantly progressively increased (p < 0.001). Procedural safety was 100% with all patients uneventfully discharged and one-year survival rate was 100%. The paired-t test showed serum creatinine maintained the same level between the baseline and at the end of one-year follow-up (all p > 0.4), whereas the net increase between initial and final creatinine level was higher in CKD-control than in CKD-treatment. In conclusion, CD34+ cell therapy was safe and maintained the renal function in stationary state at the end of study period.
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Affiliation(s)
- Mel S Lee
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fan-Yen Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Hung Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tien-Hung Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Ling Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Cheng Yin
- Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsueh-Wen Chang
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Nursing, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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49
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Morici N, Savonitto S, Ponticelli C, Schrieks IC, Nozza A, Cosentino F, Stähli BE, Perrone Filardi P, Schwartz GG, Mellbin L, Lincoff AM, Tardif JC, Grobbee DE. Post-Discharge Worsening Renal Function in Patients with Type 2 Diabetes and Recent Acute Coronary Syndrome. Am J Med 2017; 130:1068-1075. [PMID: 28344139 DOI: 10.1016/j.amjmed.2017.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Worsening renal function during hospitalization for an acute coronary syndrome is strongly predictive of in-hospital and long-term outcome. However, the role of post-discharge worsening renal function has never been investigated in this setting. METHODS We considered the placebo cohort of the AleCardio trial comparing aleglitazar with standard medical therapy among patients with type 2 diabetes mellitus and a recent acute coronary syndrome. Patients who had died or had been admitted to hospital for heart failure before the 6-month follow-up, as well as patients without complete renal function data, were excluded, leaving 2776 patients for the analysis. Worsening renal function was defined as a >20% reduction in estimated glomerular filtration rate from discharge to 6 months, or progression to macroalbuminuria. The Cox regression analysis was used to determine the prognostic impact of 6-month renal deterioration on the composite of all-cause death and hospitalization for heart failure. RESULTS Worsening renal function occurred in 204 patients (7.34%). At a median follow-up of 2 years the estimated rates of death and hospitalization for heart failure per 100 person-years were 3.45 (95% confidence interval [CI], 2.46-6.36) for those with worsening renal function, versus 1.43 (95% CI, 1.14-1.79) for patients with stable renal function. At the adjusted analysis worsening renal function was associated with the composite endpoint (hazard ratio 2.65; 95% CI, 1.57-4.49; P <.001). CONCLUSIONS Post-discharge worsening renal function is not infrequent among patients with type 2 diabetes and acute coronary syndromes with normal or mildly depressed renal function, and is a strong predictor of adverse cardiovascular events.
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Affiliation(s)
- Nuccia Morici
- Unità di Terapia Intensiva Cardiologica, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milano, Italy.
| | | | - Claudio Ponticelli
- Division of Nephrology, Humanitas Clinical Research Center, Rozzano (Milano), Italy
| | - Ilse C Schrieks
- Julius Center for Health Sciences and Primary Care and Julius Clinical, Utrecht, the Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Quebec, Canada
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara E Stähli
- Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | | | - Gregory G Schwartz
- Veterans Affairs Medical Center and University of Colorado School of Medicine, Denver
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio
| | - Jean-Claude Tardif
- Montreal Health Innovations Coordinating Center, Quebec, Canada; Montreal Heart Institute, Université de Montréal, Quebec, Canada
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care and Julius Clinical, Utrecht, the Netherlands
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50
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Sánchez-Martínez M, Flores-Blanco PJ, López-Cuenca ÁA, Sánchez-Galián MJ, Gómez-Molina M, Cambronero-Sánchez F, Guerrero-Pérez E, Valdés M, Januzzi JL, Manzano-Fernández S. Evaluation of the CRUSADE Risk Score for Predicting Major Bleeding in Patients with Concomitant Kidney Dysfunction and Acute Coronary Syndromes. Cardiorenal Med 2017; 7:179-187. [PMID: 28736558 DOI: 10.1159/000455102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/05/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Kidney dysfunction (KD) has been associated with increased risk for major bleeding (MB) in patients with acute coronary syndromes (ACS) and may be in part related to an underuse of evidence-based therapies. Our aim was to assess the predictive ability of the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk score in patients with concomitant ACS and chronic kidney disease. METHODS We conducted a retrospective analysis of a prospective registry including 1,587 ACS patients. In-hospital MB was prospectively recorded according to the CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. KD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. RESULTS The predictive ability of the CRUSADE risk score was assessed by discrimination and calibration analyses. A total of 465 (29%) subjects had KD. In multivariate logistic regression analyses, we found high CRUSADE risk score values to be associated with a higher rate of in-hospital MB; however, among patients with KD, it was not associated with BARC MB. Regardless of the MB definition, the predictive ability of the CRUSADE score in patients with KD was lower: area under the curve (AUC) 0.71 versus 0.79, p = 0.03 for CRUSADE MB and AUC 0.65 versus 0.75, p = 0.02 for BARC MB. Hosmer-Lemeshow analyses showed a good calibration in all renal function subgroups for both MB definitions (all p values >0.3). CONCLUSIONS The CRUSADE risk score shows a lower accuracy for predicting in-hospital MB in KD patients compared to those without KD.
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Affiliation(s)
| | - Pedro J Flores-Blanco
- Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain
| | | | - María J Sánchez-Galián
- Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain
| | - Miriam Gómez-Molina
- Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain
| | | | - Esther Guerrero-Pérez
- Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain
| | - Mariano Valdés
- Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain.,University of Murcia, Murcia, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sergio Manzano-Fernández
- Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain.,University of Murcia, Murcia, Spain
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