C-terminal provasopressin (copeptin) as a prognostic marker after acute non-ST elevation myocardial infarction: Leicester Acute Myocardial Infarction Peptide II (LAMP II) study

2011 ◽  
Vol 121 (2) ◽  
pp. 79-89 ◽  
Author(s):  
Hafid Narayan ◽  
Onkar S. Dhillon ◽  
Pauline A. Quinn ◽  
Joachim Struck ◽  
Iain B. Squire ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Adverse Outcomes ◽  
St Elevation Myocardial Infarction ◽  
Net Reclassification Improvement ◽  
Wide Range ◽  
All Cause Mortality ◽  
St Elevation ◽  
Grace Score

Copeptin, the 39-amino-acid C-terminal portion of provasopressin, has been shown to be an independent predictor for adverse events following STEMI (ST elevation myocardial infarction). We hypothesized that plasma copeptin was an independent predictor for adverse outcomes following acute NSTEMI (non-STEMI) and evaluated whether copeptin added prognostic information to the GRACE (Global Registry of Acute Coronary Events) score compared with NT-proBNP (N-terminal pro-B-type natriuretic peptide). Plasma copeptin and NT-proBNP were measured in 754 consecutive patients admitted to the hospital with chest pain and diagnosed as having NSTEMI in this prospective observational study. The end point was all-cause mortality at 6 months. Upper median levels of copeptin were strongly associated with all-cause mortality at 6 months. Copeptin was a significant predictor of time to mortality {HR (hazard ratio), 5.98 [95% CI (confidence interval, 3.75–9.53]; P<0.0005} in univariate analysis and remained a significant predictor in multivariate analysis [HR, 3.03 (05% CI, 1.32–6.98); P=0.009]. There were no significant differences between the area under ROC (receiver operating characteristic) curves of copeptin, NT-proBNP and the GRACE score. Copeptin improved accuracy of risk classification when used in combination with the GRACE score as determined by net reclassification improvement, whereas NT-proBNP did not. The relative utility of the GRACE score was increased more by copeptin than by NT-proBNP over a wide range of risks. Plasma copeptin is elevated after NSTEMI, and higher levels are associated with worse outcomes. Copeptin used in conjunction with the GRACE score improves risk stratification enabling more accurate identification of high-risk individuals.

Sleep duration in the first months after ST elevation myocardial infarction: an independent predictor of all-cause mortality

2014 ◽  
pp. 504-510 ◽  
Author(s):  
Filip M. Szymański ◽  
Krzysztof J. Filipiak ◽  
Anna E. Płatek ◽  
Grzegorz Karpiński ◽  
Franciszek Majstrak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sleep Duration ◽  
Independent Predictor ◽  
St Elevation Myocardial Infarction ◽  
All Cause Mortality ◽  
St Elevation

An invasive strategy is associated with improved short- and long-term outcomes in acute myocardial infarction independently of frailty status and GRACE score: a nationwide analysis of 12144 episodes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Pessoa Amorim ◽  
D Santos-Ferreira ◽  
A Azul Freitas ◽  
H Santos ◽  
A Belo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Wald Test ◽  
Invasive Procedures ◽  
Frailty Status ◽  
Frail Patients ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
St Elevation ◽  
Grace Score

Abstract Introduction Frailty is common among patients presenting with acute myocardial infarction (MI), who have conflicting risks regarding benefits and harms of invasive procedures. Purpose To assess the clinical management and prognostic impact of invasive procedures in frail MI patients in a real-world scenario. Methods We analysed 5422 episodes of ST-elevation MI (STEMI) and 6692 of Non-ST-elevation MI (NSTEMI) recorded from 2010–2019 in a nationwide registry. A validated deficit-accumulation model was used to create a frailty index (FI), comprising 22 features [BMI &gt;25kg/m2, myocardial infarction, angina, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), valvular disease, bleeding, pacemaker/implantable cardioverter defibrillator, chronic kidney disease (creatinine &gt;2.0mg/dL), dialysis/renal transplant, stroke/transient ischaemic attack, diabetes, hypertension, dyslipidaemia, smoking, peripheral vascular disease, dementia, chronic lung disease, malignancy, polymedication (&gt;3 cardiovascular drugs), admission haemoglobin &lt;10g/dL; not including age]. Episodes with missing data on any FI parameter were not included. Frailty was initially defined as FI&gt;0.25 (i.e. ≥6 features). Results Overall, 511 (9.4%) STEMI and 1763 (26.4%) NSTEMI patients were considered frail. Angiography, PCI and CABG were less frequently performed in frail patients (p&lt;0.001). Delayed angiography (&gt;72h) was more common among NSTEMI frail patients (p&lt;0.001), and radial access was less commonly used overall (p&lt;0.001). Guideline-recommended in-hospital medical therapy, including aspirin (NSTEMI), dual-antiplatelet therapy (STEMI/NSTEMI), heparin/heparin-related agents (NSTEMI), beta-blockers (STEMI) and ACEIs/ARBs (STEMI), was less commonly used in frail patients; discharge medical therapy exhibited similar patterns. Frail patients had longer hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality, as well as 1-year all-cause and CV hospitalization and all-cause mortality (p&lt;0.001). Using receiver-operator-characteristics curve analysis, FI cutoffs of 0.11 (STEMI) and 0.20 (NSTEMI) yielded the best accuracy to predict 1-year all-cause mortality (area under the curve: 0.629 and 0.702 respectively, p&lt;0.001) – these cutoffs were subsequently used to define frailty. Although frailty attenuated in-hospital risk reductions from angiography (STEMI/NSTEMI) and PCI (NSTEMI only) (Wald test p&lt;0.05), their 1-year prognostic benefit remained unaffected (Wald test p&gt;0.05). Angiography and PCI were associated with improved in-hospital and 1-year outcomes, independently of frailty status or GRACE score (p&lt;0.001). Conclusion Frail MI patients are less commonly offered standard therapy; however, angiography and PCI were associated with short- and long-term prognostic benefits regardless of frailty status or GRACE score. Increased adherence to current recommendations might improve post-MI outcomes in frail patients. Invasive strategy and 1-year outcomes Funding Acknowledgement Type of funding source: Other. Main funding source(s): Portuguese Society of Cardiology

Value of Albumin–Globulin Ratio as a Predictor of All-Cause Mortality After Non-ST Elevation Myocardial Infarction

Angiology ◽  
2012 ◽  
Vol 64 (2) ◽  
pp. 137-145 ◽  
Author(s):  
Basem Azab ◽  
John Bibawy ◽  
Kassem Harris ◽  
Georges Khoueiry ◽  
Meredith Akerman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
All Cause Mortality ◽  
St Elevation

scholarly journals NT-proBNP Level Predicts Extent of Myonecrosis and Clinical Adverse Outcomes in Patients with ST-Elevation Myocardial Infarction: A Pilot Study

2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Mohammad Mathbout ◽  
Ahmed Asfour Steve Leung ◽  
Georges Lolay ◽  
Amr Idris ◽  
Ahmed Abdel-Latif Ziada
Keyword(s):  
Myocardial Infarction ◽  
Pilot Study ◽  
Adverse Outcomes ◽  
St Elevation Myocardial Infarction ◽  
St Elevation

Abstract 15728: Machine Learning Helps Predict Short and Intermediate-term Risk for All Cause Mortality in Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Pradyumna Agasthi ◽  
Hasan Ashraf ◽  
Chieh-Ju Chao ◽  
Panwen Wang ◽  
Mohamed Allam ◽  
...  
Keyword(s):  
Machine Learning ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Machine Learning Algorithms ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
St Elevation ◽  
Clinical Records

Background: Identifying patients at a high risk of mortality post percutaneous coronary intervention (PCI) is of vital clinical importance. We investigated the utility of machine learning algorithms to predict short and intermediate-term risk of all-cause mortality in patients undergoing PCI. Methods: Patient-level demographics, clinical, electrocardiographic ,echocardiographic and angiographic data from January 2006 to December 2017 were extracted from the Mayo Clinic CathPCI registry and clinical records. For patients with multiple PCI events, data collected at the time of the index PCI was used for analysis. Patients who underwent bailout coronary artery bypass graft surgery (CABG) prior to discharge were excluded. 306 variables were incorporated into random forest machine learning model (RF) to predict all-cause mortality at 6 months and 1 year after PCI. Ten-fold cross-validation repeated five times was used to optimize the hyperparameters and estimate its external performance. The National Cardiovascular Data Registry (NCDR) based logistic regression model was used for comparison. The area under receiver operator characteristic curves (AUC) was calculated to assess the ability of the models to predict all-cause mortality. Results: A total of 17356 unique patients were included for the final analysis after excluding 165 patients who underwent CABG surgery during the index hospitalization. The mean age was 66.9 ± 12.5 years;71% were male. Indications for PCI were ST-elevation myocardial infarction (9.4%), non-ST elevation myocardial infarction (12.9%), unstable angina (17.7%), and stable angina (52.8%) in the cohort. In-hospital, 6-month & 1 year mortality rates were 1.9%,4.2% & 5.8% respectively. The RF model was superior to the NCDR model in predicting inhospital, 6-month, 1 year mortality (p<0.0001) ( Figure 1 ). Conclusion: Machine learning is superior to NCDR model in predicting short and intermediate risk of all-cause mortality post PCI.

Abstract 13193: Impact of “Off-Peak” Versus “Peak” Hour Coronary Interventions for ST-Elevation Myocardial Infarction on Adverse Outcomes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jae S Lee ◽  
Gabriel Redel-Traub ◽  
Michael Kim ◽  
Perwaiz Meraj ◽  
Christina Brennan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Adverse Outcomes ◽  
St Elevation Myocardial Infarction ◽  
Coronary Interventions ◽  
St Elevation ◽  
Peak Versus ◽  
Versus Peak ◽  
Long Term Mortality

Background: In addition to patient-dependent factors, whether the time of arrival of the patient to the hospital with ST-elevation myocardial infarction (STEMI) might play a role in subsequent adverse outcomes following primary percutaneous coronary interventions (PCI) is not well studied. Method: 856 PCI procedures for patients presenting with STEMI from two large hospitals in the health system were analyzed. Peak hours were defined as procedures performed between 7 AM and 7 PM on weekdays. Off-peak hours were defined as procedures performed between 7 PM and 7 PM on weekdays and weekends. Unadjusted and propensity score-adjusted analyses were performed to analyze the following inpatient outcomes: composite of death/MI/stroke, composite of bleeding events, composite of death/MI/stroke/bleeding endpoints, and long-term mortality. Results: Of 856 PCIs, 407 (47.5%) were performed during the peak hours. In both unadjusted and propensity score-adjusted analyses, no significant differences in adverse outcomes and long-term mortality were observed in patients who had PCIs during off-peak and peak hours (see Table). In addition, a separate analysis performed on patients who underwent primary PCIs between 7 AM-7 PM (“Morning”) versus 7 PM-7 AM (“Evening”) on all days showed no difference in the inpatient adverse outcomes and long-term mortality (Adjusted long term mortality: HR 0.79 (95% CI 0.40-1.56), p=0.49). Conclusion: Primary PCIs performed on patients presenting with STEMI during off-peak versus peak hours results in similar inpatient adverse outcomes and long-term mortality.

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