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Cheng MD, Zheng YY, Zhang XY, Ruzeguli T, Sureya Y, Didaer Y, Ailiman M, Zhang JY. The Simplified Thrombo-Inflammatory Score as a Novel Predictor of All-Cause Mortality in Patients with Heart Failure: A Retrospective Cohort Study. J Inflamm Res 2024; 17:1845-1855. [PMID: 38523685 PMCID: PMC10961063 DOI: 10.2147/jir.s452544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Background The simplified thrombo-inflammatory score (sTIPS) has recently emerged as a novel prognostic score. Hence, we investigated the prognostic value of sTIPS for predicting long-term mortality in patients with heart failure (HF). Methods A total of 3741 patients were analyzed in this study. The sTIPS was calculated based on the white blood cell count (WBC) and the mean platelet volume to platelet count (MPV/PC) ratio at admission. The mean follow-up time was 22.75 months. Multivariable Cox regression analyses were used to investigate the associations between the sTIPS and all-cause mortality (ACM). Results In the whole study population, multivariate Cox regression analysis showed that patients in both the sTIPS 2 and sTIPS 1 groups had significantly increased risk of ACM as compared with patients in the sTIPS 0 group (hazard ratio [HR]=1.706, 95% confidence interval [CI]: 1.405-2.072, P<0.001 and HR = 1.431, 95% CI 1.270-1.612, P<0.001). The same significant trend was observed in heart failure with preserved ejection fraction (HFpEF) patients (sTIPS1 vs sTIPS0: HR = 1.366, 95% CI 1.100-1.697, P = 0.005; sTIPS2 vs sTIPS0: HR = 1.995, 95% CI 1.460-2.725, P<0.001). However, only sTIPS 1 group had a significantly increased the risk of ACM compared to the sTIPS 0 group among patients with HFmrEF (sTIPS1 vs sTIPS0: HR = 1.648, 95% CI 1.238-2.194, P = 0.001) and HFrEF (sTIPS1 vs sTIPS0: HR = 1.322, 95% CI 1.021-1.712, P = 0.035). Conclusion sTIPS is useful in predicting risk for long-term mortality in patients with HF.
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Affiliation(s)
- Meng-Die Cheng
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - Ying-Ying Zheng
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Xing-Yan Zhang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Tuersun Ruzeguli
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Yisimayili Sureya
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Yisha Didaer
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Mahemuti Ailiman
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Jin-Ying Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
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Wang Y, Ma X, Yang Z, Li Q, Zhou Y, Gao F, Wang Z. Value of Absolute Eosinophil Count in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Int J Gen Med 2024; 17:1025-1038. [PMID: 38525068 PMCID: PMC10959244 DOI: 10.2147/ijgm.s451900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background and Aims Elevated eosinophils typically indicate hypersensitive inflammation; however, their involvement in cardiovascular events remains incompletely understood. We investigated the association between the absolute eosinophil count (AEC) and major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Additionally, we determine whether the integration of AEC with the SYNTAX II score could improve predictive ability. Methods and Results The AECs of 1711 patients with ACS undergoing PCI from June 2016 to November 2017 were analyzed on admission. All recruitments were splitted into three groups based on AEC tertiles and 101 participants underwent one or more noteworthy outcomings. The association between AEC and MACCEs (defined as a composite of cardiovascular death, myocardial infarction [MI], and stroke) was tested by Cox proportional-hazards regression analysis. After adjusting for confounders, AEC was independently associated with MACCEs (HR 11.555, 95% CI: 3.318-40.239). Patients in the lowest AEC tertile (T1) as a reference, those in the higher tertiles had an incrementally higher risk of MACCEs (T3: HR 1.848 95% CI: 1.157-2.952; P for trend=0.008). Inclusion of AEC enhanced the predictive accuracy of the SYNTAX II score for MACCEs (AUC: from 0.701 [95% CI: 0.646-0.756] to 0.728 [95% CI: 0.677-0.780]; DeLong's test, P = 0.020). Conclusion AEC is independently linked to MACCEs in ACS patients who underwent PCI, and adds incremental predictive information to the SYNTAX II score.
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Affiliation(s)
- Yufei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Zhiqiang Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- Cardio-Metabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qiuxuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
| | - Fei Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
- The Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, People’s Republic of China
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Ashine TM, Heliso AZ, Babore GO, Ezo E, Saliya SA, Birehanu Muluneh B, Alaro MG, Adeba TS, Sebro SF, Hailu AG, Abdisa EN. Incidence and Predictors of Cardiac Arrest Among Patients Admitted to the Intensive Care Units of a Comprehensive Specialized Hospital in Central Ethiopia. Patient Relat Outcome Meas 2024; 15:31-43. [PMID: 38375416 PMCID: PMC10875971 DOI: 10.2147/prom.s452338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Background Cardiac arrest (CA) is a common public health problem. Worldwide, cardiac arrest ranks highly among hospitalised patients' public health concerns, particularly in low-income nations. Data on cardiac arrest in intensive care units in low-income countries are relatively scarce. Determining the incidence and predictors of cardiac arrest among ICU patients will be a very crucial and fruitful clinical practice in resource-limited areas like Ethiopia. Methods A retrospective cohort study was conducted by reviewing charts of 422 systematically selected patients admitted to the ICU from 2018 to 2022 in Wachemo University Comprehensive Specialized Hospital. The extraction tool was used for the data collection, Epi-data version 4.6.0 for data entry, and STATA version 14 for data cleaning and analysis. Kaplan-Meier, log rank test, and life table were used to describe the data. The Cox proportional hazard regression model was used for analysis. Results The findings of this study revealed that the overall occurrence of cardiac arrest among critically ill ICU patients was 27% (95% CI: 23, 32). The incidence density rate of cardiac arrest among intensive care unit patients was 19.6 per 1000 person-days of observation. In a multivariable analysis, patients with chronic kidney disease, oxygen saturation <90%, delirium, intubation, and patients admitted to the ICU with cardiovascular disease were found to be independent predictors of cardiac arrest in the Intensive Care Unit. Conclusion The incidence density rate of cardiac arrest among intensive care unit patients was high. This study also revealed that chronic kidney disease, delirium, intubation, oxygen saturation level below 90% and patients admitted with cardiovascular disease were independent predictors of the occurrence of cardiac arrest among intensive care unit patients. Finally, we recommend that clinician pays attention to those identified as preventable risk factors for early interventions to improve the recovery process of patients in the ICU.
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Affiliation(s)
- Taye Mezgebu Ashine
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Asnakech Zekiwos Heliso
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Getachew Ossabo Babore
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Elias Ezo
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Sentayehu Admasu Saliya
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Bethelhem Birehanu Muluneh
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Michael Geletu Alaro
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Tadesse Sahle Adeba
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Sisay Foga Sebro
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Awoke Girma Hailu
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Elias Nigusu Abdisa
- Department of Psychiatry and Mental Health, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
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Kasim S, Amir Rudin PNF, Malek S, Aziz F, Wan Ahmad WA, Ibrahim KS, Muhmad Hamidi MH, Raja Shariff RE, Fong AYY, Song C. Data analytics approach for short- and long-term mortality prediction following acute non-ST-elevation myocardial infarction (NSTEMI) and Unstable Angina (UA) in Asians. PLoS One 2024; 19:e0298036. [PMID: 38358964 PMCID: PMC10868757 DOI: 10.1371/journal.pone.0298036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Traditional risk assessment tools often lack accuracy when predicting the short- and long-term mortality following a non-ST-segment elevation myocardial infarction (NSTEMI) or Unstable Angina (UA) in specific population. OBJECTIVE To employ machine learning (ML) and stacked ensemble learning (EL) methods in predicting short- and long-term mortality in Asian patients diagnosed with NSTEMI/UA and to identify the associated features, subsequently evaluating these findings against established risk scores. METHODS We analyzed data from the National Cardiovascular Disease Database for Malaysia (2006-2019), representing a diverse NSTEMI/UA Asian cohort. Algorithm development utilized in-hospital records of 9,518 patients, 30-day data from 7,133 patients, and 1-year data from 7,031 patients. This study utilized 39 features, including demographic, cardiovascular risk, medication, and clinical features. In the development of the stacked EL model, four base learner algorithms were employed: eXtreme Gradient Boosting (XGB), Support Vector Machine (SVM), Naive Bayes (NB), and Random Forest (RF), with the Generalized Linear Model (GLM) serving as the meta learner. Significant features were chosen and ranked using ML feature importance with backward elimination. The predictive performance of the algorithms was assessed using the area under the curve (AUC) as a metric. Validation of the algorithms was conducted against the TIMI for NSTEMI/UA using a separate validation dataset, and the net reclassification index (NRI) was subsequently determined. RESULTS Using both complete and reduced features, the algorithm performance achieved an AUC ranging from 0.73 to 0.89. The top-performing ML algorithm consistently surpassed the TIMI risk score for in-hospital, 30-day, and 1-year predictions (with AUC values of 0.88, 0.88, and 0.81, respectively, all p < 0.001), while the TIMI scores registered significantly lower at 0.55, 0.54, and 0.61. This suggests the TIMI score tends to underestimate patient mortality risk. The net reclassification index (NRI) of the best ML algorithm for NSTEMI/UA patients across these periods yielded an NRI between 40-60% (p < 0.001) relative to the TIMI NSTEMI/UA risk score. Key features identified for both short- and long-term mortality included age, Killip class, heart rate, and Low-Molecular-Weight Heparin (LMWH) administration. CONCLUSIONS In a broad multi-ethnic population, ML approaches outperformed conventional TIMI scoring in classifying patients with NSTEMI and UA. ML allows for the precise identification of unique characteristics within individual Asian populations, improving the accuracy of mortality predictions. Continuous development, testing, and validation of these ML algorithms holds the promise of enhanced risk stratification, thereby revolutionizing future management strategies and patient outcomes.
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Affiliation(s)
- Sazzli Kasim
- Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
| | | | - Sorayya Malek
- Faculty of Science, Institute of Biological Sciences, University Malaya, Kuala Lumpur, Malaysia
| | - Firdaus Aziz
- School of Liberal Studies, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Wan Azman Wan Ahmad
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
- Division of Cardiology, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Khairul Shafiq Ibrahim
- Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
| | - Muhammad Hanis Muhmad Hamidi
- Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
| | - Raja Ezman Raja Shariff
- Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
| | - Alan Yean Yip Fong
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
- Department of Cardiology, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Cheen Song
- Faculty of Science, Institute of Biological Sciences, University Malaya, Kuala Lumpur, Malaysia
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Pan Q, Mu Z, Li Y, Gu C, Liu T, Wang B, Kang X. The association between serum anion gap and acute kidney injury after coronary artery bypass grafting in patients with acute coronary syndrome. BMC Cardiovasc Disord 2023; 23:542. [PMID: 37940847 PMCID: PMC10634147 DOI: 10.1186/s12872-023-03588-y] [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: 01/22/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The purpose of this study was to explore the association between serum anion gap (SAG) and acute kidney injury (AKI) after coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) in the Intensive Care Unit (ICU). METHODS We retrospectively analyzed the clinical data of 2,428 ACS patients who underwent CABG in the Medical Information Mart for Intensive Care IV (Mimic-IV) database. The endpoint of this study was AKI after CABG. The baseline data of the two groups (non-AKI group vs. AKI group) was compared, and the restricted cubic spline (RCS) plot, multivariable logistic regression model, and subgroup analysis were used to explore the relationship between SAG and the risk of AKI after CABG. RESULTS In the adjusted multivariate logistic regression model, SAG was an independent predictor of AKI after CABG (OR = 1.12, 95% CI: 1.02-1.23, P = 0.015). The RCS revealed that the relationship between SAG levels and risk of AKI was J-shaped. When the SAG was ≥ 11.58 mmol/L, the risk of AKI increased by 26% for each unit increase in SAG. Additionally, we further divided the SAG into quartiles. In the fully adjusted model, compared with the first quartile of SAG, the odds ratios (ORs) and 95% confidence intervals (CIs) for AKI risk across the SAG quartiles were 0.729 (0.311, 1.600), 1.308 (0.688-2.478), and 2.221 (1.072, 4.576). CONCLUSIONS The SAG level was associated with the risk of AKI after CABG in a J-shaped curve in the ICU. However, the underlying causes of the problem need to be investigated.
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Affiliation(s)
- Qinyuan Pan
- Department of Critical Care Medicine, The First People's Hospital of Lianyungang, Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Zhifang Mu
- Department of Critical Care Medicine, The First People's Hospital of Lianyungang, Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Yong Li
- Department of Critical Care Medicine, The First People's Hospital of Lianyungang, Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Caihong Gu
- Department of Critical Care Medicine, The First People's Hospital of Lianyungang, Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Tao Liu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Bing Wang
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Xiuwen Kang
- Department of Critical Care Medicine, The First People's Hospital of Lianyungang, Zhenhua East Road, Lianyungang, 222002, Jiangsu, China.
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Wang J, Zhang F, Liu L, Gao M, Song X, Li Y, Dang Y, Qi X. Prognostic Value of GRACE Risk Score Combined With Systemic Immune-Inflammation Index in Patients With ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention. Angiology 2023:33197231213674. [PMID: 37936386 DOI: 10.1177/00033197231213674] [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: 11/09/2023]
Abstract
The Global Registry of Acute Coronary Events (GRACE) score and the systemic immune-inflammation index (SII) were used independently to predict adverse outcomes in patients with ST-elevation myocardial infarction (STEMI). In this study, 1041 patients with STEMI were divided into 4 groups based on GRACE scores and optimal cutoff values for SII. SII was positively correlated with GRACE score (r = 0.164; P < .001). SII (HR, hazard ratio: 2.051; 95%CI: 1.249-3.368; P = .005) and GRACE score (HR: 7.625; 95%CI: 3.692-15.746; P < .001) were independent risk predictors of short-term major adverse cardiovascular events (MACEs). Taking the low SII+low GRACE group as the reference group, the short-term MACE HR of the high SII+high GRACE group was 40.470 (95%CI: 5.547-295.253). Comparing the area under the curve, the combined use of SII and GRACE scores can significantly improve the prediction efficiency of short-term MACE compared with the single use of SII and GRACE scores. In conclusion, SII may be positively correlated with GRACE score, and the combination of the two accurately predicted the occurrence of short-term MACE in STEMI patients after percutaneous coronary intervention (PCI).
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Affiliation(s)
- Jiaqi Wang
- Hebei North University, Zhangjiakou, China
| | - Feifei Zhang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Litian Liu
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Man Gao
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Xuelian Song
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
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Nguyen Duy T, Dao Bui Quy Q, Nguyen Duc L, Ho Viet Le D, Le Ha K, Do Gia T, Nguyen Trung K, Nguyen Van T, Nguyen Oanh O, Le Viet T. The Ratio of Contrast Volume/Glomerular Filtration Rate and Urine NGAL Predicts the Progression of Acute Kidney Injury to Chronic Kidney Disease in Patients After Planned Percutaneous Coronary Intervention. Int J Gen Med 2023; 16:4525-4535. [PMID: 37814641 PMCID: PMC10560475 DOI: 10.2147/ijgm.s426670] [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: 07/25/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
Objective To evaluate the value of contrast volume/glomerular filtration ratio (Vc/eGFR ratio) and urine Neutrophil Gelatinase-Associated Lipocalin (uNGAL) in predicting the progression contract associated-acute kidney injury (CA-AKI) to chronic kidney disease (CKD) in planned percutaneous coronary intervention (PCI) patients. Patients and Methods We examined 387 adult patients who had undergone planned percutaneous coronary intervention (PCI). We determined acute kidney injury (AKI) and chronic kidney disease (CKD) using the criteria set by the Kidney Disease: Improving Global Outcomes (KDIGO). We calculated the estimated glomerular filtration rate (eGFR) using the CKD-EPI formula based on serum creatinine levels. To determine the Vc/eGFR ratio, we considered the contrast medium volume and eGFR for each patient. Additionally, we measured urine NGAL levels using the ELISA method. Results The percentage of CA-AKI patients who developed CKD after planned PCI was 36.36%. Within the CA-AKI to CKD group, the Vc/eGFR ratio was 2.82, and uNGAL levels were significantly higher at 72.74 ng/mL compared to 1.93 ng/mL for Vc/eGFR ratio and 46.57 ng/mL for uNGAL in the recovery CA-AKI group. This difference was statistically significant (p<0.001). Diabetic mellitus, urine NGAL concentration, and Vc/eGFR ratio were found to be independent factors in the progression of CA-AKI to CKD. The Vc/eGFR ratio and uNGAL showed predictive capabilities for progressing CA-AKI to CKD with an AUC of 0.884 and 0.878, respectively. The sensitivity was 81.3% for both, while the specificity was 89.3% for Vc/eGFR ratio and 85.7% for uNGAL. Conclusion The Vc/eGFR ratio and uNGAL were good predictors for CA-AKI to CKD in planned PCI patients.
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Affiliation(s)
- Toan Nguyen Duy
- Military Hospital 103, Hanoi, Vietnam
- Vietnam Military Medical University, Hanoi, Vietnam
| | | | | | | | - Khoa Le Ha
- Hanoi Medical University, Hanoi, Vietnam
| | | | - Kien Nguyen Trung
- Military Hospital 103, Hanoi, Vietnam
- Vietnam Military Medical University, Hanoi, Vietnam
| | - Tam Nguyen Van
- Military Hospital 103, Hanoi, Vietnam
- Vietnam Military Medical University, Hanoi, Vietnam
| | - Oanh Nguyen Oanh
- Military Hospital 103, Hanoi, Vietnam
- Vietnam Military Medical University, Hanoi, Vietnam
| | - Thang Le Viet
- Military Hospital 103, Hanoi, Vietnam
- Vietnam Military Medical University, Hanoi, Vietnam
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Toprak K, Kaplangoray M, Memioğlu T, İnanır M, Ermiş MF, Toprak İH, Acar O, Taşcanov MB, Biçer A, Demirbağ R. Comparative Evaluation of Intermountain Risk Score With Mehran Risk Score for Risk Estimation of Contrast-Induced Nephropathy and Short-Term Mortality in ST-Segment Elevation Myocardial Infarction Patients. Angiology 2023:33197231201931. [PMID: 37672723 DOI: 10.1177/00033197231201931] [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: 09/08/2023]
Abstract
Contrast-induced nephropathy (CIN) has become one of the most important causes of in-hospital acute renal failure with the increasing use of contrast-mediated imaging tools. This significantly increases the morbidity and mortality of the affected subjects and causes a financial burden on the health system. In this context, prediction of CIN is important and some risk scores have been developed to predict CIN. The most frequently used and popular among these is the Mehran Score (MS), which is based on a number of hemodynamic and metabolic parameters. The Intermountain Risk Score (IMRS) is a recently developed risk score that highly predicts short-term mortality based on common laboratory parameters, and many parameters of this risk score have been found to be closely associated with CIN. In this context, we aimed to compare MS and IMRS in terms of CIN and short-term mortality estimation. The study included 931 patients who underwent percutaneous coronary intervention. CIN developed in 21.5% of patients. Both MS and IMRS independently predicted CIN. In receiver operating characteristic analysis, IMRS was found to be non-inferior to MS in predicting CIN and IMRS was superior to MS in predicting short-term mortality. IMRS and MS were independently associated with short-term mortality.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Mustafa Kaplangoray
- Cardiology Department, Medical Faculty, Şeyh Edebali University, Bilecik, Turkey
| | - Tolga Memioğlu
- Cardiology Department, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet İnanır
- Cardiology Department, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Fatih Ermiş
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - İbrahim Halil Toprak
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Osman Acar
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | | | - Asuman Biçer
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, Harran University, Faculty of Medicine, Sanliurfa, Turkey
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Hou L, Su K, Zhao J, Li Y. Predictive Value of COPD History on In-Stent Restenosis in Coronary Arteries Following Percutaneous Coronary Intervention. Int J Gen Med 2023; 16:3977-3984. [PMID: 37670929 PMCID: PMC10476650 DOI: 10.2147/ijgm.s427425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory disease that poses a significant health risk to individuals. Patients with COPD are predisposed to a higher incidence of coronary artery disease (CAD) than the general population. This study aims to investigate the correlation between COPD and the incidence of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). Methods This study retrospectively analyzed the clinical data and laboratory test results of patients who underwent PCI at our hospital between January 2018 and December 2021 to investigate the relationship between COPD and drug-Eluting Stents (DES) postoperative ISR. We employed the best subset method to select the most suitable combination of predictive factors, utilizing the data, and verified the precision of the model by means of internal validation. We ultimately assessed the performance of the prediction model using an ROC curve. Results The research indicates that COPD is an independent risk factor for ISR after PCI (OR=2.437, 95% CI [1.336, 4.495], P=0.004). The analysis revealed an area under the receiver operating characteristic (ROC) curve of 0.783 for the training group and 0.705 for the testing group, indicating a model fitting for both groups (both > 0.5). Conclusion COPD history is a dependable predictor of stent restenosis post percutaneous coronary intervention.
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Affiliation(s)
- Ling Hou
- Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Ke Su
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, Hubei Province, People’s Republic of China
| | - Jinbo Zhao
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, Hubei Province, People’s Republic of China
| | - Yuanhong Li
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, Hubei Province, People’s Republic of China
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10
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Chen Y, Chen S, Han Y, Xu Q, Zhao X. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Important Indicators for Predicting in-Hospital Death in Elderly AMI Patients. J Inflamm Res 2023; 16:2051-2061. [PMID: 37215380 PMCID: PMC10198281 DOI: 10.2147/jir.s411086] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/06/2023] [Indexed: 05/24/2023] Open
Abstract
Aim To investigate the role of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte(PLR) in predicting the risk of in-hospital mortality in elderly acute myocardial infarction(AMI) patients. Methods This study was a single-center, retrospective and observational study. From December 2015 to December 2021, a total of 1550 elderly patients (age ≥ 60 years) with AMI with complete clinical history data were enrolled in the Second Hospital of Dalian Medical University. Routine blood tests were performed on admission, and NLR and PLR were calculated based on neutrophil, platelet, and lymphocyte counts. Outcome was defined as all-cause mortality during hospitalization. Cox regression and restricted spline cubic(RCS) models were used to evaluate the association of NLR and in-hospital mortality risk and the association of PLR with in-hospital mortality risk, respectively. Results (1) A total of 132 (8.5%) patients died during hospitalization. From the results of blood routine, the white blood cell, neutrophil, NLR and PLR in the death group were higher than those in the non-death group, while the lymphocyte was lower than that in the non-death group, and the difference was statistically significant (P < 0.05). (2) The results of receiver operating characteristic(ROC) curves analysis showed that the predictive ability of NLR (AUC = 0.790) for in-hospital death was better than that of PLR (AUC = 0.637). (3) Multivariate Cox proportional regression hazard models showed that high NLR was associated with the risk of in-hospital mortality in elderly AMI patients (HR = 3.091, 95% CI 2.097-4.557, P < 0.001), while high PLR was not. (4) RCS models showed a nonlinear dose-response relationship between NLR and in-hospital death (P for nonlinear = 0.0007). Conclusion High NLR (> 6.69) is associated with the risk of in-hospital mortality in elderly patients with AMI and can be an independent predictor of poor short-term prognosis in elderly patients with AMI.
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Affiliation(s)
- Yan Chen
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Shengyue Chen
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yuanyuan Han
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Qing Xu
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Xin Zhao
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
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11
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Guo W, Zhu J, Liu W. Stress hyperglycemia ratio: an independent predictor for in-hospital major adverse cardiovascular and cerebrovascular events in patients with st-segment elevation myocardial infarction. BMC Cardiovasc Disord 2023; 23:195. [PMID: 37061678 PMCID: PMC10105954 DOI: 10.1186/s12872-023-03219-6] [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: 11/04/2022] [Accepted: 03/31/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND To assess the predictive accuracy of the stress hyperglycemia ratio (SHR) for in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS A total of 1,944 patients were enrolled within 24 h of a new STEMI diagnosis. The SHR was obtained by dividing the blood glucose level at admission by the estimated average glucose. MACCE were defined as acute cerebral infarction, mechanical complications of myocardial infarction, cardiogenic shock, and all-cause death. Patients were then categorized into the MACCE and non-MACCE groups according to the occurrence of in-hospital MACCE. Propensity score matching was used to balance confounding factors, and logistic regression was used to identify the potential predictive factors for MACCE. RESULTS A total of 276 patients were included after 1:1 matching, and the confounding factors were balanced between the two groups. The SHR was an independent predictor of in-hospital MACCE (odds ratio = 10.06, 95% confidence interval: 4.16-27.64, P < 0.001), while blood glucose at admission was not. The SHR was also an independent predictor for in-hospital MACCE in nondiabetic patients with STEMI (odds ratio = 11.26, 95% confidence interval: 3.05-55.21, P < 0.001). CONCLUSION SHR is an independent predictor of in-hospital MACCE in patients with acute STEMI, especially in nondiabetic patients.
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Affiliation(s)
- Wen Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jiajia Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wenxian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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12
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Chen Y, Weng C, Wu J, Tang Y, Li Z, Wen Q, Sun X, Wu M, Peng Z, Luo X, Yuan H, Lu Y, Huang W, Cai J. Clinical characteristics and prognosis differences between isolated right and left ventricular myocardial infarction in the Chinese population: a retrospective study. PeerJ 2023; 11:e14959. [PMID: 36874976 PMCID: PMC9983429 DOI: 10.7717/peerj.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/05/2023] [Indexed: 03/04/2023] Open
Abstract
Background and aims Acute myocardial infarction (AMI) is divided into left ventricular myocardial infarction (LVMI) and right ventricular myocardial infarction (RVMI) according to the regions of myocardial ischemic necrosis. Clinical characteristics, treatment strategies, and prognosis differences between isolated RVMI and LVMI have not been well characterized. This study aimed to explore this difference of patients with isolated RVMI and LVMI. Methods This retrospective cohort study included 3,506 patients hospitalized with coronary angiography diagnosed type 1 myocardial infarction (MI). Characteristics of admission and treatment strategies were compared in patients with isolated RVMI and LVMI. COX proportional hazards models with and without inverse probability of treatment weighting (IPTW) adjustment were performed to estimate the difference in all-cause and cardiovascular mortality between the two groups. Results In this retrospective study, we found the frequency of isolated RVMI was significantly lower in the population than that of isolated LVMI (406 (11.6%) vs 3,100 (88.4%)). Patients with isolated RVMI have similar age, sex, and comorbidities to the patients with isolated LVMI. However, patients with isolated RVMI have lower heart rate and blood pressure, but higher rates of cardiogenic shock and atrioventricular block. It is noteworthy that patients with isolated RVMI are more likely to be complicated with the multivessel lesion. Patients with isolated RVMI have lower risk of all-cause mortality (HR 0.36; 95% CI [0.24-0.54], p < 0.001) and cardiovascular mortality (HR 0.37; 95% CI [0.22-0.62], p < 0.001) than patients with isolated LVMI. Conclusions This study showed that patients with isolated RVMI and LVMI have similar baseline characteristics. However, the clinical manifestations were different in the isolated RVMI and LVMI patients. This study revealed a better prognosis of isolated RVMI patients compared to isolated LVMI, which indicates the ischemic region could be considered in AMI risk stratification models for better assessment of risk for adverse clinical events.
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Affiliation(s)
- Yuanyuan Chen
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunyan Weng
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junru Wu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhengxin Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Wen
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuejing Sun
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Zhiliu Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Xiying Luo
- Department of Cardiology, The First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Hong Yuan
- The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Lu
- The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Huang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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13
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Association between serum calcium level and in-hospital mortality in patients with acute myocardial infarction: a retrospective cohort study. Sci Rep 2022; 12:19954. [PMID: 36402887 PMCID: PMC9675775 DOI: 10.1038/s41598-022-24566-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022] Open
Abstract
The association between serum calcium levels and the prognosis of patients with acute myocardial infarction (AMI) remains controversial. This study aimed to explore the association between serum calcium and in-hospital mortality in patients with AMI. The data of this study were extracted from the Philips eICU Collaborative Research Database. A total of 7284 patients were eventually enrolled in this study, of which 799 (10.97%) died during hospitalization. For each patient, serum calcium, corrected to albumin, was calculated and categorized into four groups: Q1 ≤ 8.5, Q2 8.5-9.5, Q3 9.5-10.5, and Q4 > 10.5 mg/dL. Multivariate analysis demonstrated that corrected sCa was an independent predictor of in-hospital death (Q2 vs. Q1, OR 0.5, 95% CI 0.4-0.7, P < 0.001; Q3 vs. Q1, OR 0.8, 95% CI 0.6-1.0, P = 0.035; Q4 vs. Q1, OR 1.6, 95% CI 1.1-2.3, P = 0.008). The association remained stable in the fully adjusted model. A significant U-shaped association between corrected serum calcium and in-hospital mortality was observed in piecewise linear regression model (Corrected sCa < 9.4 mg/dL, OR 0.8, 95% CI 0.7-0.9, P < 0.001; corrected sCa > 9.4 mg/dL, OR 1.5, 95% CI 1.3-1.8, P < 0.001). In conclusion, both decreased and increased corrected serum calcium is associated with increased in-hospital mortality in patients with AMI, and patients may have the lowest risk of in-hospital death when corrected serum calcium is 9.4 mg/dL (2.35 mmol/L).
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Chu CH, Shih HM, Yu SH, Chang SS, Sie JS, Huang FW, Hsu TY. Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective cohort study. BMC Emerg Med 2022; 22:169. [PMID: 36280807 PMCID: PMC9590157 DOI: 10.1186/s12873-022-00732-3] [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: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sudden cardiac arrest (SCA) is a critical complication of acute myocardial infarction, especially ST-segment elevation myocardial infarction (STEMI). This study identified the risk factors for SCA in patients with STEMI before receiving catheterization. Methods We retrospectively analyzed the data of patients with STEMI and cardiac arrest who presented to a tertiary care center in Taiwan between January 1, 2016, and December 31, 2019. Only patients with coronary artery disease (CAD) confirmed by coronary angiography were included in this study. We collected the patients’ demographic and clinical data, such as age, sex, medical history, estimated glomerular filtration rate (eGFR), and coronary angiographic findings. The primary outcome of this study was SCA in patients with STEMI. Continuous and nominal variables were compared using the two-sample Student's t-test and chi-squared test, respectively. The results of logistic regression were subjected to multivariate analysis with adjustment for possible confounders. Results A total of 920 patients with STEMI and coronary angiography–documented CAD and 108 patients with SCA who presented between January 1, 2016, and December 31, 2019, were included. The bivariate logistic regression analysis of patients’ demographic data revealed that patients with STEMI and SCA were slightly younger, were more likely to have diabetes mellitus, and had a lower eGFR than did the patients without SCA. The coronary angiographic findings indicated a higher prevalence of left main CAD and three-vessel disease in patients with SCA than in patients without SCA. Multivariate logistic regression revealed that left main CAD (odds ratio [OR]: 3.77; 95% confidence interval [CI], 1.84 to 7.72), a lower eGFR (OR: 0.97; 95% CI, 0.96 to 0.98), and younger age (OR: 0.98; 95% CI, 0.96 to 0.99) were the risk factors for SCA in patients with STEMI. Conclusions Left main CAD, lower eGFR, and younger age are the risk factors for cardiac arrest in patients with acute myocardial infarction.
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Affiliation(s)
- Chang-Hung Chu
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Hong-Mo Shih
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Department of Public Health, China Medical University, No.100, Section 1, Economic and Trade Rd., Taichung, 406 Taiwan
| | - Shao-Hua Yu
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan
| | - Shih-Sheng Chang
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Division of Cardiovascular Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Ji-Syuan Sie
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Fen-Wei Huang
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Tai-Yi Hsu
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Department of Public Health, China Medical University, No.100, Section 1, Economic and Trade Rd., Taichung, 406 Taiwan
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