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Yoshizaki T, Nakamura T, Horikoshi T, Watanabe Y, Kobayashi T, Saito Y, Obata JE, Sawanobori T, Takano H, Umetani K, Asakawa T, Sato A. Impact of atherothrombotic risk stratification in patients with heavily calcified lesions following rotational atherectomy. J Cardiol 2024; 83:37-43. [PMID: 37524300 DOI: 10.1016/j.jjcc.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Patients who undergo percutaneous coronary intervention (PCI) with rotational atherectomy (RA) are at high risk of adverse clinical outcomes, and there are few clinical risk stratification tools for these patients. METHODS We conducted a study with 196 patients who underwent PCI with RA out of 7391 patients who underwent PCI using a multicenter, prospective cohort registry. Patients were divided into three groups according to the tertiles of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P): 65 patients in the T1 group (TRS 2°P < 3), 66 patients in the T2 group (TRS 2°P = 3), and 65 patients in the T3 group (TRS 2°P > 3). The primary endpoint was the cumulative 2-year incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of cardiac death, acute coronary syndrome, and ischemic stroke. RESULTS Cumulative 2-year MACCE occurred in 41 patients (24 %) during the follow-up period. The cumulative incidence of MACCE was significantly higher in the T3 group than in the T1 group (log-rank test, p = 0.02). Multivariate Cox analyses revealed that the T3 group was associated with an increased risk of MACCE compared to that of the T1 group (adjusted hazard ratio, 2.66; 95 % confidence interval, 1.04-6.77; p = 0.04). The addition of TRS 2°P to conventional risk factors, including male sex, number of diseased vessels, and low-density lipoprotein cholesterol levels, improved the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.39, p = 0.027; IDI 0.072, p < 0.001). CONCLUSIONS Atherothrombotic risk stratification using TRS 2°P was useful in identifying high-risk patients with heavily calcified lesions following RA.
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Affiliation(s)
- Toru Yoshizaki
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan.
| | - Takamitsu Nakamura
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Takeo Horikoshi
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Yosuke Watanabe
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Tsuyoshi Kobayashi
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Yukio Saito
- Department of Cardiology, Kofu Municipal Hospital, Kofu, Japan
| | - Jun-Ei Obata
- Department of Cardiology, Fujieda Municipal General Hospital, Fujieda, Japan
| | | | - Hajime Takano
- Department of Cardiology, Kofu Jonan Hospital, Kofu, Japan
| | - Ken Umetani
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Akira Sato
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
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Luo Z, Feng Y, Luo D, Li S, Xiao K, Shen H, Hu Q. Favorable factors for the survival of ST-segment elevation myocardial infarction patients with medium- and high-risk thrombolysis in myocardial infarction scores. BMC Cardiovasc Disord 2023; 23:614. [PMID: 38093222 PMCID: PMC10720153 DOI: 10.1186/s12872-023-03628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE ST-segment myocardial infarction (STEMI) is a time-sensitive emergency. This study screened the favorable factors for the survival of STEMI patients with medium- and high-risk thrombolysis in myocardial infarction (TIMI) scores. METHODS According to the TIMI scores at admission, 433 STEMI patients were retrospectively and consecutively selected and allocated into low-/medium-/high-risk groups, with their general information/blood routine/biochemical indicators/coagulation indicators documented. The factors influencing the in-hospital survival of STEMI patients were analyzed using univariate and multivariate logistic regression analyses. Moreover, the predictive value of favorable factors was analyzed by receiver operating characteristics (ROC) curve, and patients were assigned into high/low level groups based on the cut-off value of these factors, with their in-hospital survival rates compared. RESULTS The in-hospital survival rate of the medium-/high-risk groups was lower than that of the low-risk group. Emergency percutaneous coronary intervention (PCI), lymphocyte (LYM), total protein (TP), albumin (ALB), and sodium (Na) were independent favorable factors for in-hospital survival in the medium-/high-risk groups. Besides, LYM > 1.275 × 109/L, TP > 60.25 g/L, ALB > 34.55 g/L, and Na > 137.9 mmo1/L had auxiliary predictive value for the survival of STEMI patients with medium-/high-risk TIMI scores. Patients with high levels of LYM, TP, ALB, and Na exhibited higher in-hospital survival rates than patients with low levels. CONCLUSION For STEMI patients with medium- and high-risk TIMI scores, accepting emergency PCI and normal levels of LYM, TP, ALB, and Na were more conducive to in-hospital survival.
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Affiliation(s)
- Zhengli Luo
- Emergency Department, Panzhihua Central Hospital, No. 34 Yikang Street, Middle Section of Panzhihua Avenue, Panzhihua, 617000, China
| | - Yuan Feng
- Emergency Department, Panzhihua Central Hospital, No. 34 Yikang Street, Middle Section of Panzhihua Avenue, Panzhihua, 617000, China
| | - Dan Luo
- Emergency Department, Panzhihua Central Hospital, No. 34 Yikang Street, Middle Section of Panzhihua Avenue, Panzhihua, 617000, China
| | - Shiyang Li
- Division of Cardiology, Panzhihua Central Hospital, Panzhihua, China
| | - Kaiyi Xiao
- Emergency Department, Panzhihua Central Hospital, No. 34 Yikang Street, Middle Section of Panzhihua Avenue, Panzhihua, 617000, China
| | - Hongmei Shen
- Information Center, Panzhihua Central Hospital, Panzhihua, China
| | - Qiang Hu
- Emergency Department, Panzhihua Central Hospital, No. 34 Yikang Street, Middle Section of Panzhihua Avenue, Panzhihua, 617000, China.
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Grinberg T, Bental T, Hammer Y, Assali A, Vaknin-Assa H, Wiessman M, Perl L, Kornowski R, Eisen A. Management and outcome across the spectrum of high-risk patients with myocardial infarction according to the thrmobolysis in myocardial infarction (TIMI) risk-score for secondary prevention. Clin Cardiol 2021; 44:1535-1542. [PMID: 34469003 PMCID: PMC8571543 DOI: 10.1002/clc.23715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with myocardial infarction (MI) are at increased risk for recurrent cardiovascular events, yet some patients, such as the elderly and those with prior comorbidities, are particularly at the highest risk. Whether these patients benefit from contemporary management is not fully elucidated. Methods Included were consecutive patients with MI who underwent percutaneous coronary intervention (PCI) in a large tertiary medical center. Patients were stratified according to the thrombolysis in myocardial infarction (TIMI) risk score for secondary prevention (TRS2°P) to high (TRS2°P = 3), very high (TRS2°P = 4), or extremely high‐risk (TRS2°P = 5–9). Excluded were low and intermediate‐risk patients (TRS2°P < 3). Outcomes included 30‐day/1‐year major adverse cardiac events (MACE) and 1‐year mortality. Temporal trends were examined in the early (2004–2010) and late (2011–2016) time‐periods. Results Among 2053 patients, 50% were high‐risk, 30% very high‐risk and 20% extremely high‐risk. Extremely high‐risk patients were older (age 74 ± 10 year) and had significant comorbidities (chronic kidney disease 68%, prior CABG 40%, heart failure 78%, peripheral artery disease 29%). Drug‐eluting stents and potent antiplatelets were more commonly used over time in all risk‐strata. Over time, 30‐day MACE rates have decreased, mainly attributed to the very high (11.3% to 5.1%, p = .006) and extremely high‐risk groups (15.9% to 8.0%, p = .016), but not the high‐risk group, with similar quantitative results for 1‐year MACE. The rates of 1‐year mortality remained unchanged in either group. Conclusion Within a particularly high‐risk cohort of MI patients who underwent PCI, the implementation of guideline‐recommended therapies has improved over time, with the highest‐risk groups demonstrating the greatest benefit in outcomes.
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Affiliation(s)
- Tzlil Grinberg
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Tamir Bental
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Hammer
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Wiessman
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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