scholarly journals Oxygen-regulated protein 150 and prognosis following myocardial infarction

2007 ◽  
Vol 112 (9) ◽  
pp. 477-484 ◽  
Author(s):  
Leong L. Ng ◽  
Russell J. O'Brien ◽  
Paulene A. Quinn ◽  
Iain B. Squire ◽  
Joan E. Davies
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Endoplasmic Reticulum ◽  
Odds Ratio ◽  
Acute Coronary Syndromes ◽  
Cox Regression ◽  
Cardiovascular Morbidity ◽  
Prognostic Information ◽  
Coronary Syndromes

ORP150 (oxygen-regulated protein 150) is a chaperonin expressed in tissues undergoing hypoxic or endoplasmic reticulum stress. In the present study, we investigated plasma levels of ORP150 in patients with AMI (acute myocardial infarction) and its relationship with prognosis, together with a known risk marker N-BNP (N-terminal pro-B-type natriuretic peptide). Plasma from 396 consecutive patients with AMI was obtained for measurement of ORP150 and N-BNP. Mortality and cardiovascular morbidity (acute coronary syndromes/heart failure) was determined during follow-up. A specific ORP150 assay detected the 150 kDa protein in plasma extracts, including 3 and 7 kDa fragments. During follow-up (median, 455 days), 43 (10.9%) patients died. Both N-BNP and ORP150 levels were higher in those who died compared with the survivors [N-BNP, 724 (14.5–28840) compared with 6167 (154.9–33884) pmol/l (P<0.0005); ORP150, 257 (5.9–870.9) compared with 331 (93.3–831.8) pmol/l (P<0.001); values are medians (range)]. In a Cox regression model for mortality prediction, both N-BNP (odds ratio, 5.06; P<0.001) and ORP150 (odds ratio, 2.39; P<0.01) added prognostic information beyond creatinine and the use of thrombolytics. A Kaplan–Meier survival analysis revealed that ORP150 added prognostic information to N-BNP, especially in those with supra-median N-BNP levels. A simplified dual-marker approach with both markers below and either above or both above their respective medians effectively stratified mortality risk (log rank statistic for trend, 32.7; P<0.00005). ORP150 levels were not predictive of other cardiovascular morbidity (acute coronary syndromes or heart failure). In conclusion, ORP150 and peptide fragments derived from it are secreted following AMI and provide independent prognostic information on mortality. High levels associated with endoplasmic reticulum/hypoxic stress predict a poor outcome.

Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Mustafa Umut Somuncu ◽  
Belma Kalayci ◽  
Ahmet Avci ◽  
Tunahan Akgun ◽  
Huseyin Karakurt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cox Regression ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Lower Systolic Blood Pressure ◽  
Cox Regression Analysis ◽  
Killip Class ◽  
Target Vessel Revascularization

AbstractBackgroundThe increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients.Materials and methodsIn this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure.ResultsDuring a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124–4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality.ConclusionsHigh sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

Abstract 013: Trajectories Of Self-rated Health After Hospitalization: A 30 Year Cohort Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Scott Mu ◽  
Caitlin W Hicks ◽  
Natalie R Daya ◽  
Randi E Foraker ◽  
Anna Kucharska-newton ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Partial Recovery ◽  
Prognostic Information ◽  
Patient Centered ◽  
Self Rated Health

Introduction: Hospitalization is a complex health exposure and the period immediately following acute-care hospitalization is a high-risk state. Self-rated health is a subjective indicator of health and the long-term trends in self-rated health after hospitalization are not well characterized. Hypotheses: 1. Self-rated health decreases after hospitalization, with only partial recovery in the following years. 2. Poor self-rated health after hospitalization is associated with increased mortality. Methods: We analyzed 13,758 participants in the Atherosclerosis Risk in Communities (ARIC) Study with at least 1 hospitalization. Self-rated health was assessed annually and rated on a 4-point scale as follows: “Over the past year, compared to other people your age, would you say that your health has been excellent(=4), good(=3), fair(=2) or poor(=1)?" Using Cox regression and Kaplan-Meier methods, we evaluated mortality after hospitalization for myocardial infarction, congestive heart failure, cerebrovascular disease, pneumonia or diabetes mellitus with complications. Results: The mean self-rated health the year prior to hospitalization was 2.82 and the nadir of self-rated health was 2.62, occurring 1 year after hospitalization (Fig 1a). As compared to “excellent” self-rated health, “poor” self-rated health after any hospitalization was strongly associated with mortality (HR 4.65, 95% CI 4.27-5.07). Corresponding HRs (95% CI) for mortality post-hospitalization were 3.12 (2.30-4.22) for acute myocardial infarction, 3.08 (2.39-3.96) for congestive heart failure, 2.15 (1.43-3.23) for acute cerebrovascular disease, 4.54 (3.39-6.09) for pneumonia, and 3.32 (2.35-4.69) for diabetes mellitus with complications (Fig 1b). Conclusion: Mean self-rated health decreases significantly after hospitalization and worse self-rated health is associated with higher mortality. Self-rated health is an easily obtained patient centered outcome with valuable prognostic information.

Treatment of ST-segment elevation acute coronary syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1255-1276
Author(s):  
Borja Ibanez ◽  
Sigrun Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Real Life ◽  
Compelling Evidence ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Over the last 50 years, the treatment of acute ST-segment elevation myocardial infarction (STEMI) has been considerably improved. The widespread implementation of reperfusion (initially pharmacological and later mechanical) resulted in a magnificent reduction in the rates of in-hospital mortality from about 25% in the 1970s to 5% in the late 2010s. Mortality in real life, however, is higher than these figures shown in clinical trials. There is compelling evidence showing the association between duration of ischaemia and mortality. This is the basis for the timely reperfusion in STEMI. All actions should be made to reduce all components of the ischaemic time. Despite these advances, STEMI survivors are still at high risk for developing repetitive events, including reinfarctions, heart failure, and sudden death. Evolving therapies beyond timely reperfusion are contributing to further reduce the morbidity associated with STEMI.

scholarly journals Prior Beta-Blocker Therapy for Hypertension and Sex-Based Differences in Heart Failure Among Patients With Incident Coronary Heart Disease

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 819-826 ◽  
Author(s):  
Raffaele Bugiardini ◽  
Jinsung Yoon ◽  
Sasko Kedev ◽  
Goran Stankovic ◽  
Zorana Vasiljevic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Odds Ratio ◽  
Acute Coronary Syndromes ◽  
Relative Risk Ratio ◽  
Blocker Therapy ◽  
Coronary Syndromes ◽  
Β Blocker ◽  
Β Blockers

The usefulness of β-blockers has been questioned for patients who have hypertension without a prior manifestation of coronary heart disease or heart failure. In addition, sex-based differences in the efficacy of β-blockers for prevention of heart failure during acute myocardial ischemia have never been evaluated. We explored whether the effect of β-blocker therapy varied according to the sex among patients with hypertension who have no prior history of cardiovascular disease. Data were drawn from the ISACS (International Survey of Acute Coronary Syndromes)-Archives. The study population consisted of 13 764 patients presenting with acute coronary syndromes. There were 2590 patients in whom hypertension was treated previously with β-blocker (954 women and 1636 men). Primary outcome measure was the incidence of heart failure according to Killip class classification. Subsidiary analyses were conducted to estimate the association between heart failure and all-cause mortality at 30 days. Outcome rates were assessed using the inverse probability of treatment weighting and logistic regression models. Estimates were compared by test of interaction on the log scale. Among patients taking β-blockers before admission, there was an absolute difference of 4.6% between women and men in the rate of heart failure (Killip ≥2) at hospital presentation (21.3% versus 16.7%; relative risk ratio, 1.35 [95% CI, 1.10–1.65]). On the opposite, the rate of heart failure was approximately similar among women and men who did not receive β-blockers (17.2% versus 16.1%; relative risk ratio, 1.09 [95% CI, 0.97–1.21]). The test of interaction identified a significant ( P =0.034) association between sex and β-blocker therapy. Heart failure was predictive of mortality at 30-day either in women (odds ratio, 7.54 [95% CI, 5.78–9.83]) or men (odds ratio, 9.62 [95% CI, 7.67–12.07]). In conclusion, β-blockers use may be an acute precipitant of heart failure in new-onset coronary heart disease among women, but not men. Heart failure increases the risk of death. Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT04008173.

scholarly journals Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254008
Author(s):  
Pishoy Gouda ◽  
Anamaria Savu ◽  
Kevin R. Bainey ◽  
Padma Kaul ◽  
Robert C. Welsh
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Residual Risk ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Estimates of the risk of recurrent cardiovascular events (residual risk) among patients with acute coronary syndromes have largely been based on clinical trial populations. Our objective was to estimate the residual risk associated with common comorbidities in a large, unselected, population-based cohort of acute coronary syndrome patients. 31,056 ACS patients (49.5%—non-ST segment elevation myocardial infarction [NSTEMI], 34.0%—ST segment elevation myocardial infarction [STEMI] and 16.5%—unstable angina [UA]) hospitalised in Alberta between April 2010 and March 2016 were included. The primary composite outcome was major adverse cardiovascular events (MACE) including: death, stroke or recurrent myocardial infarction. The secondary outcome was death from any cause. Cox-proportional hazard models were used to identify the impact of ACS type and commonly observed comorbidities (heart failure, hypertension, peripheral vascular disease, renal disease, cerebrovascular disease and diabetes). At 3.0 +/- 3.7 years, rates of MACE were highest in the NSTEMI population followed by STEMI and UA (3.58, 2.41 and 1.68 per 10,000 person years respectively). Mortality was also highest in the NSTEMI population followed by STEMI and UA (2.23, 1.38 and 0.95 per 10,000 person years respectively). Increased burden of comorbidities was associated with an increased risk of MACE, most prominently seen with heart failure (adjusted HR 1.83; 95% CI 1.73–1.93), renal disease (adjusted HR 1.52; 95% CI 1.40–1.65) and diabetes (adjusted HR 1.51; 95% CI 1.44–1.59). The cumulative presence of each of examined comorbidities was associated with an incremental increase in the rate of MACE ranging from 1.7 to 9.98 per 10,000 person years. Rates of secondary prevention medications at discharge were high including: statin (89.5%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84.1%) and beta-blockers (85.9%). Residual cardiovascular risk following an acute coronary syndrome remains high despite advances in secondary prevention. A higher burden of comorbidities is associated with increased residual risk that may benefit from aggressive or novel therapies.

scholarly journals B-type natriuretic peptide levels and its correlation with left ventricular functions and heart failure in patients of acute coronary syndromes

2021 ◽  
Vol 9 (4) ◽  
pp. 1112
Author(s):  
Rajinder Kumar ◽  
Muzaffar Majeed Khujwal ◽  
Isha Sharma ◽  
Amit Varma
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Entire Spectrum ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
Clinical Heart Failure

Background: This study was designed to measure levels of B-type natriuretic peptide (BNP) across entire spectrum of acute coronary syndrome (ACS) and to find its correlation with left ventricular functions and heart failure.Methods: We measured BNP levels at baseline in 100 consecutive patients between 24-96 hours after the onset of ischemic symptoms in patients of ACS. Echocardiography was performed in all patients between day 2-5 after the index diagnosis and stabilizing the patients.Results: The BNP levels were raised across the entire spectrum of ACS, with levels (>80 pg/ml) in 32.2% of patients with ST segment-elevation myocardial infarction (STEMI), in 24% with non-ST segment-elevation myocardial infarction (NSTEMI), and in 16.6% with unstable angina (UA) respectively. High BNP levels were associated with greater increase in LV end-systolic volumes (r=+0.545, p<0.001) (LVESV) and end-diastolic volumes (LVEDV) (r=+0.336, p<0.001). There was a negative correlation between BNP levels and left ventricular ejection fraction (LVEF) (r=-0.394, p<0.002). BNP levels were significantly raised (156.0±45.1 vs 57.7±18.3 pg/ml, p<0.02) in patients developing symptomatic clinical heart failure, irrespective of LVEF ≤40%.Conclusions: Integrated use of echocardiography and BNP levels provide powerful incremental assessment of cardiac functions, clinical status, and outcome across the entire spectrum of acute coronary syndromes (ACS). Increased BNP levels are associated with progressive ventricular dilatation, LV-dysfunction, development of clinical heart failure and is associated with poor prognosis in patients of ACS.

Ticagrelor versus Clopidogrel in high bleeding risk patients presenting with Acute Coronary Syndromes: insights from the multicenter START-ANTIPLATELET registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Gragnano ◽  
E Moscarella ◽  
P Calabro' ◽  
A Cesaro ◽  
P.C Pafundi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
P Value ◽  
Bleeding Events ◽  
P2y12 Inhibitors ◽  
Coronary Syndromes ◽  
High Bleeding Risk

Abstract Background Optimal dual antiplatelet therapy in high bleeding risk (HBR) patients with acute coronary syndromes (ACS) remains debated. Although current guidelines recommend the use of potent P2Y12 inhibitors in these patients (according to the labeled indications), clopidogrel is frequently used in clinical practice based on a perceived advantage in terms of safety in the HBR population. Purpose We sought to investigate the use of clopidogrel versus ticagrelor in consecutive HBR ACS patients and their impact on ischemic and bleeding events at 1 year. Methods ACS patients enrolled in the START-ANTIPLATELET registry with at least 1 HBR criterion were included in the present analysis and stratified according to DAPT type (clopidogrel versus ticagrelor). The primary endpoint was net adverse clinical endpoint (NACE), defined as a composite of all-cause death, myocardial infarction, stroke, and major bleeding. The secondary endpoints were major adverse cardiac and cerebral events (MACE), defined as a composite of all-cause death, myocardial infarction and stroke, each individual component of NACE and MACE, and target vessel revascularization. Results Among a total of 1,209 patients with 1-year follow-up in the registry, 383 patients were considered at HBR, of whom 174 (45.4%) were on clopidogrel and 209 (54.6%) on ticagrelor. Clopidogrel was more likely to be administered in patients at increased ischemic and bleeding risk, while ticagrelor in those undergoing percutaneous coronary intervention. Mean DAPT duration was longer in the ticagrelor group than in the clopidogrel group (10.40±4.29 versus 9.35±5.4; p-value=0.03). At 1-year follow-up, the risk of NACE and MACE events was significantly higher in the clopidogrel than in the ticagrelor group (NACE: HR 1.82; 95% CI 1.07–3.09; p-value=0.02; MACE: HR 1.83; 95% CI 1.04–3.24; p-value=0.03) (Figure). After multivariate adjustment for clinical and procedural characteristics, no difference in NACEs nor MACEs was observed between patients on clopidogrel versus ticagrelor (NACE: adjusted HR 1.27; 95% CI 0.71–2.27; p-value=0.42; MACE: adjusted HR 1.19; 95% CI 0.63–2.24; p-value=0.59) (Figure). Age, number of HBR criteria, and mean DAPT duration were independent predictors of NACEs. Conclusions In a real-world ACS registry, approximately 50% of patients are at HBR and frequently treated with clopidogrel. In HBR ACS patients, no difference was observed in ischemic and bleeding events between clopidogrel and ticagrelor after adjustment for potential confounders. Kaplan-Meier curves at 1-year follow-up. Funding Acknowledgement Type of funding source: None

scholarly journals Continuous 12-lead electrocardiographic ST monitoring adds prognostic information to the thrombolysis in myocardial infarction risk score in patients with non-ST-elevation acute coronary syndromes

2005 ◽  
Vol 28 (4) ◽  
pp. 189-192 ◽  
Author(s):  
Michael N. Zairis ◽  
Anastassios G. Lyras ◽  
Stamatis S. Makrygiannis ◽  
Demetrios J. Beldekos ◽  
Konstantinos A. Mainas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Prognostic Information ◽  
Coronary Syndromes ◽  
St Elevation
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