Association of serum cystatin C level and major adverse cardiovascular events in patients with percutaneous coronary intervention.

Predictive value of GRACE score combined with BNP and glycosylated hemoglobin for in-hospital cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

Bile acids play important roles in lipid metabolism and glucose homeostasis. Limited research exist on the association between serum total bile acid (TBA) levels and major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS), particularly those with comorbid type 2 diabetes mellitus (T2DM). This study was conducted to examine the relationship between baseline serum TBA level and T2DM status in patients with ACS after percutaneous coronary intervention (PCI) and to identify the predictive value of TBA levels for a 2-year risk of MACEs. 425 ACS patients underwent PCI were recruited and divided into three groups based on baseline serum TBA concentration. An analysis of the association between the T2DM status and baseline serum TBA levels was conducted using univariate linear regression and multivariate linear regression. The predictive relevance of serum TBA levels was evaluated using the receiver operating characteristic (ROC) curve and Cox regression. Kaplan–Meier curves were employed to analyze the differences among groups in predicting MACEs over a 2-year follow-up period. Baseline serum TBA levels were higher in ACS patients who were diagnosed with T2DM (the median 3.6 µmol/L) than those without T2DM (the median 3.0 µmol/L). T2DM status in ACS patients was positively correlated with baseline serum TBA concentrations (β: 1.7, 95% confidence interval [CI] 0.3–3.0), particularly in the male (β: 2.0, 95% CI 0.3–3.6) and 50–69-year-old (β: 2.5, 95% CI 0.6–4.4) populations. The areas under the ROC curve of baseline serum TBA levels predicted MACEs in ACS and ACS-T2DM patients following PCI were 0.649 (95% CI 0.595–0.703) and 0.783 (95% CI 0.685–0.881), respectively. Furthermore, Cox regression analysis showed that baseline serum TBA level was associated with the occurrence of MACEs in patients with ACS after PCI over a 2-year follow-up period, especially in those diagnosed with T2DM, whose baseline TBA concentration was lower than 10.0 µmol/L. ACS Patients with T2DM had higher serum TBA levels. TBA level at baseline was an independent predictor of MACEs in ACS patients who underwent PCI, especially with comorbid T2DM.

Effects of Smoking on Major Adverse Cardiovascular Events in Patients With Coronary Artery Spasm: A Systematic Review and Meta-Analysis

IntroductionThe aim of the current study was to evaluate the association between lipoprotein(a) [Lp(a)] and major adverse cardiovascular events (MACEs) in patients with percutaneous coronary intervention (PCI) treatment.Material and methodsThis was a retrospective study. The demographics, prior medical histories, comorbidities and laboratory parameters were collected from the electronic health record. All participants were followed up for 1 year after the indexed PCI. Studied end points were a composite of MACEs including all-cause mortality, non-fatal myocardial infarction (MI), non-fatal ischemic stroke, transient ischemic attack and stent restenosis.ResultsDuring 1-year follow-up, 87 MACEs occurred. Compared to patients who did not have MACEs, patients who had MACEs were older, more likely to have higher body mass index, diabetes mellitus and left main lesion, and also had higher baseline low density lipoprotein cholesterol (LDL-C) and Lp(a) levels. All patients in both groups were prescribed aspirin and clopidogrel at discharge. Nearly 97.4% and 95.4% of patients in both groups were treated with statins and a higher proportion of patients in the MACE group were treated with ezetimibe (11.5% vs. 3.5%, p < 0.05). In multivariate regression analysis, diabetes mellitus, LDL-C, Lp(a) and glomerular filtration rate were independent risk factors for MACEs; statin use appeared to be a protective factor for MACEs. Patients with increased Lp(a) level had significantly higher incidence of MACEs than the normal Lp(a) level group (p = 0.001).ConclusionsBaseline serum Lp(a) can be used to predict MACEs in patients after PCI treatment, which was independent of LDL-C.

Chinese herbal medicine may reduce major adverse cardiovascular events in patients with dialysis hypotension: A taiwan nationwide cohort study

The prognostic value of triglyceride-glucose (TyG) has been well described in patients with coronary artery disease (CAD). Hyperhomocysteinemia (HHcy) promotes insulin resistance and has also been regarded as a potential risk factor for cardiovascular disease. However, the prognostic value of TyG in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and the interaction between TyG and HHcy remain unclear. A total of 1,734 ACS patients undergoing PCI were continuously enrolled between June 2016 and November 2017 at Beijing Anzhen Hospital. Patients were categorized into four groups based on HHcy status and the optimal cut-off value of TyG. The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unplanned repeat revascularization. Over a median follow-up of 927 days, 358 patients (20.6%) experienced MACE. The Kaplan-Meier curves showed significant differences in the cumulative incidence of MACE among prespecified groups (p < 0.001). Multivariable Cox regression analysis revealed that higher TyG was significantly associated with an increased risk of MACE in patients without HHcy (HR: 2.36, 95% CI: 1.53-3.64, p < 0.001), but not in patients with HHcy (HR: 1.31, 95% CI: 0.60-2.87, p = 0.503). Restricted cubic splines only demonstrated the prognostic value of TyG in patients without HHcy. A significant interaction was observed for MACE between TyG and HHcy (p for interaction = 0.01). The prognostic value of TyG was modified by HHcy in ACS patients undergoing PCI. Higher TyG was only associated with an increased risk of MACE in ACS patients without HHcy, but not in ACS patients with HHcy.

Although a few studies have reported the effects of several polymorphisms on major adverse cardiovascular events (MACE) in patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI), these genotypes account for only a small fraction of the variation and evidence is insufficient. This study aims to identify new genetic variants associated with MACE end point during the 18-month follow-up period by a two-stage large-scale sequencing data, including high-depth whole exome sequencing of 168 patients in the discovery cohort and high-depth targeted sequencing of 1793 patients in the replication cohort. We discovered eight new genotypes and their genes associated with MACE in patients with ACS, including MYOM2 (rs17064642), WDR24 (rs11640115), NECAB1 (rs74569896), EFR3A (rs4736529), AGAP3 (rs75750968), ZDHHC3 (rs3749187), ECHS1 (rs140410716), and KRTAP10-4 (rs201441480). Notably, the expressions of MYOM2 and ECHS1 are downregulated in both animal models and patients with phenotypes related to MACE. Importantly, we developed the first superior classifier for predicting 18-month MACE and achieved high predictive performance (AUC ranged between 0.92 and 0.94 for three machine-learning methods). Our findings shed light on the pathogenesis of cardiovascular outcomes and may help the clinician to make a decision on the therapeutic intervention for ACS patients.

This study aims to systematically review the risk factors for major adverse cardiovascular events (MACE) in patients with coronary heart disease who have undergone percutaneous coronary intervention (PCI). Systematic review and meta-analysis. The Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database for Chinese Technical Periodicals (VIP) were screened until December 2024. Case-control studies or cohort studies on the risk factors for MACE in patients with coronary heart disease who underwent PCI. Data extraction and synthesis: The literature review, data extraction, and quality evaluation were conducted by two independent researchers, and the meta-analysis was performed using RevMan 5.4 software. The main outcome was that MACE occurred during the follow-up period. A total of 40 articles were included. The meta-analysis erevealed that dyslipidemia (OR = 1.50; 95% CI [1.19, 1.89], p = 0.0007), diabetes mellitus (OR = 1.70; 95% CI [1.43, 2.02], p < 0.00001), hypertension (OR = 1.62; 95% CI [1.35, 1.96], p < 0.0001), history of smoking (OR = 2.08; 95% CI [1.51, 2.85], p < 0.0001), poorer ventricular function (OR = 2.39; 95% CI [2.17-2.64], p < 0.0001), impaired left ventricular ejection fraction (LVEF) (OR = 1.86; 95% CI [1.71-2.03], p < 0.0001), door to balloon (D-to-B) time (OR = 0.61; 95% CI [0.42-0.88]; p = 0.009), thrombolysis in myocardial infarction (TIMI) (OR = 1.41; 95% CI [1.17, 1.70], p = 0.0004), renal dysfunction (OR = 1.82; 95% CI [1.37, 2.43], p < 0.0001), and multi-vessel coronary artery disease (OR = 0.41; 95% CI [0.37, 0.46], p < 0.0001) were significantly associated with MACE after PCI. The independent risk factors of MACE after PCI are dyslipidemia, hypertension, diabetes mellitus, smoking history, Killip class > II, LVEF ≤40%, D-to-B time >90 min, TIMI flow grade ≤ II, renal insufficiency, and multivessel disease.

Objective:To investigate the correlation between monocyte to high-density lipoprotein ratio (MHR) and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods:In this retrospective study, 120 ACS patients who received PCI in our hospital from September 2014 to August 2019 were selected and divided into MACE group and normal discharge (ND) group. Their clinical data were collected, and MHR values were compared. Logistic regression analysis was conducted to analyze the correlations between various factors and ACS. The correlation between MHR and Gensini score was subjected to Pearson’s analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic value of MHR for MACE.Results:Hypertension degree, white cell count, Gensini score, MHR and the levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), apolipoprotein A1 (ApoA1), ApoB, lipoprotein (a) [LP(a)] and uric acid (UA) in MACE group were significantly higher than those in ND group (P<0.05). HDLC, ApoA1, TC, MHR, LDLC and ApoB were independent risk factors for MACE of ACS patients after PCI (P<0.05). There was a positive correlation between MHR and Gensini score (r=0.832, P<0.05), and the optimal cutoff value of MHR for diagnosing MACE was 9.45.Conclusion:Serum MHR is positively correlated with Gensini score in ACS patients after PCI, which can be used as an independent predictor for MACE in hospital.

Many susceptibility loci associated with coronary artery disease (CAD) have been identified using genome-wide association studies (GWAS). This study aimed to examine whether a composite of single nucleotide polymorphisms (SNPs) derived from GWAS could identify the risk of major adverse cardiovascular events (MACEs) in patients with established CAD. There were 1059 patients with CAD were included in the analysis. Of the participants, 686 were on statin treatment at the start of follow-up. A weighted genetic risk score (wGRS) was calculated as the sum of risk alleles multiplied by the hazard ratio for a particular SNP. In single variant analyses, rs579459, rs4420638, and rs2107595 were associated with an increased risk of MACE. A wGRS was further constructed to evaluate the cumulative effect of the 3 SNPs on the prognosis of CAD. The risk of MACE among patients with high and intermediate wGRS was 1.968- and 1.838-fold, respectively, higher than those with low wGRS. This effect was more evident in patients using lipid-lowering medication and with hypertension. Furthermore, the interaction analysis revealed that lipid-lowering medication and hypertension interacted with the genetic effect off wGRS on the risk of MACE in patients using lipid-lowering medication or with hypertension (Pinteraction < .001). We further analyzed the follow-up change in low-density lipoprotein cholesterol (LDL-C) level at 6 months after CAD disclosure and evaluated whether that was due to wGRS or statin use. The lowest reduction in LDL-C was observed in patients with high GRS who received statin treatment. Furthermore, LDL-C reduction of patients with intermediate wGRS was less than those with low wGRS in patients treated with statin. Taken together, a wGRS comprised of SNPs significantly predicts MACE in CAD patients receiving statin treatment and hypertension.

The objective of this study was to assess the incidence and risk factors of major adverse cardiovascular events (MACEs) in patients with systemic sclerosis (SSc). We conducted a nationwide, population-based, cohort study using Taiwan's National Health Insurance Research Database. We performed propensity score matching (PSM) using a 1:2 ratio, resulting in inclusion of 1379 patients with SSc and 2758 non-SSc individuals in the analysis. We assessed the association between SSc and MACEs, using the multivariable Cox proportional hazard regression model with adjustment of time-dependent covariates, and investigated risk factors for MACEs in patients with SSc, shown as adjusted hazard ratios (aHRs) with 95% CIs. SSc was not significantly associated with the risk of MACEs (aHR 1.04; 95% CI 0.77-1.42). Nevertheless, SSc was associated with increased risk of myocardial infarction [incidence rate ratio (IRR) 1.76; 95% CI 1.08-2.86] and peripheral arterial occlusion disease (IRR 3.67; 95% CI 2.84-4.74) but not of ischaemic stroke (IRR 0.89; 95% CI 0.61-1.29). Factors independently associated with MACEs in SSc patients included age (aHR 1.02), male gender (aHR 2.01), living in a suburban area (aHR 2.09), living in a rural area (aHR 3.00), valvular heart disease (aHR 4.26), RA (aHR 2.14), use of clopidogrel (aHR 26.65), and use of aspirin (aHR 5.31). The risk of MACEs was not significantly increased in Taiwanese patients with SSc, and our investigation effectively identified the factors independently associated with MACEs in SSc patients. Additionally, patients with SSc exhibited higher risks of myocardial infarction and peripheral arterial occlusion disease but not of ischaemic stroke.

BackgroundThe purpose of this study was to explore the prognostic significance of the lesion-specific pericoronary fat attenuation index (FAI) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM).MethodsThis study conducted a retrospective analysis of 304 patients diagnosed with T2DM who underwent coronary computed tomography angiography (CCTA) in our hospital from December 2011 to October 2021. All participants were followed for a period exceeding three years. Detailed clinical data and CCTA imaging features were carefully recorded, encompassing lesion-specific pericoronary FAI, FAI of the three prime coronary arteries, features of high-risk plaques, and the coronary artery calcium score (CACS). The MACE included in the study comprised cardiac death, acute coronary syndrome (which encompasses unstable angina pectoris and myocardial infarction), late-phase coronary revascularization procedures, and hospital admissions prompted by heart failure.ResultsWithin the three-year follow-up, 76 patients with T2DM suffered from MACE. The lesion-specific pericoronary FAI in patients who experienced MACE was notably higher compared to those without MACE (–84.87 ± 11.36 Hounsfield Units (HU) vs. –88.65 ± 11.89 HU, p = 0.016). Multivariate Cox regression analysis revealed that CACS ≥ 100 (hazard ratio [HR] = 4.071, 95% confidence interval [CI] 2.157–7.683, p < 0.001) and lesion-specific pericoronary FAI higher than − 83.5 HU (HR = 2.400, 95% CI 1.399–4.120, p = 0.001) were independently associated with heightened risk of MACE in patients with T2DM over a three-year period. Kaplan-Meier analysis showed that patients with higher lesion-specific pericoronary FAI were more likely to develop MACE (p = 0.0023). Additionally, lesions characterized by higher lesion-specific pericoronary FAI values were found to have a greater proportion of high-risk plaques (p = 0.015). Subgroup analysis indicated that lesion-specific pericoronary FAI higher than − 83.5 HU (HR = 2.017, 95% CI 1.143–3.559, p = 0.015) was independently correlated with MACE in patients with T2DM who have moderate to severe coronary calcification. Moreover, the combination of CACS ≥ 100 and lesion-specific pericoronary FAI>-83.5 HU significantly enhanced the predictive value of MACE in patients with T2DM within 3 years.ConclusionsThe elevated lesion-specific pericoronary FAI emerged as an independent prognostic factor for MACE in patients with T2DM, inclusive of those with moderate to severe coronary artery calcification. Incorporating lesion-specific pericoronary FAI with the CACS provided incremental predictive power for MACE in patients with T2DM.

Introduction/Background Chronic systemic inflammation is a recognized risk factor for cardiovascular disease. Atopic dermatitis (AD) has been associated with multiple comorbidities.1 However, risk of major adverse cardiovascular events (MACE) among patients with moderate-to-severe AD is not well understood in the US population. Objectives To characterize risk of MACE in patients with AD vs matched controls without AD (non-AD) and patients with rheumatoid arthritis (RA). To evaluate the effect of disease activity, analyses were repeated in patients with moderate-to-severe disease. Methods In this retrospective analysis of US administrative claims data from Optum's Clinformatics Data Mart, eligible patients were aged ≥18 years with diagnosed AD (≥2 claims for AD or ≥1 claim for AD or eczema with asthma and/or hay fever, food allergies, or allergic rhinitis) from 03/2017–03/2023. The date of the first qualifying disease diagnosis was defined as the cohort entry date. Comparator groups included non-AD controls (matched 1:1 by age, sex, and cohort entry) and patients diagnosed with RA (≥2 claims ≥7 days apart; diagnostic codes identified by rheumatologists). Patients were classified as having moderate-to-severe disease if they received dupilumab for AD or advanced systemic therapy for RA at any time during the follow-up period. Patients with moderate-to-severe AD were also matched to a non-AD control cohort. The crude incidence of MACE, defined as inpatient hospitalization with myocardial infarction or stroke, was quantified. Relative risk was calculated using multivariable Cox proportional hazards model adjusted for baseline demographics, comorbidities, and medication use. Results This analysis included 391,753 patients with AD (7136 with moderate-to-severe AD) and 97,445 patients with RA (35,846 with moderate-to-severe RA). The matched AD and non-AD cohorts included 381,221 patients each; the matched moderate-to-severe AD and non-AD cohorts comprised 7134 patients each. Mean (SD) age in years at cohort entry was 58.0 (18.8) for AD, 67.0 (13.6) for RA, and 58.1 (18.8) for non-AD controls. Incidence of MACE (per 100 patient-years) in patients with AD (1.78 [95% CI 1.76, 1.81]) was similar to non-AD matched controls (1.83 [1.80, 1.86]) and lower vs patients with RA (2.12 [2.07, 2.17]). Patients with moderate-to-severe AD had a lower MACE incidence (1.18 [95% CI 1.01, 1.35]) than non-AD matched controls (1.52 [1.33, 1.74]) and patients with moderate-to-severe RA (1.67 [1.59, 1.75]). The relative risk of MACE in patients with AD was lower vs non-AD controls (adjusted hazard ratio [aHR] [95% CI]: 0.91 [0.89, 0.93]) and patients with RA (0.83 [0.80, 0.85]). Among patients with moderate-to-severe AD, MACE risk was similar to non-AD matched controls (aHR [95% CI]: 0.92 [0.73, 1.14]) and lower vs moderate-to-severe RA (0.83 [0.73, 0.94]). MACE risk in AD was greater in patients who were older (per year, aHR [95% CI]: 1.05 [1.05, 1.05]), male (1.23 [1.19, 1.27]), Black vs White (1.16 [1.11, 1.21]), received systemic corticosteroids in the 3 months before diagnosis (1.10 [1.06, 1.14]), hospitalized in the year before diagnosis (1.35 [1.30, 1.41]); and had history of smoking (1.20 [1.16, 1.24]) and drug abuse (1.34 [1.25, 1.43]). History of cardiovascular disease and other comorbidities were significantly associated with increased MACE risk. Conclusions Among patients with AD, the risk of MACE was lower than the risk in non-AD matched controls and patients with RA. Among patients with moderate-to-severe AD, the risk of MACE was similar to the risk in non-AD matched controls but lower than the risk in moderate-to-severe RA. Patients with AD had an increased MACE risk if they were older, male, Black, hospitalized in the year before diagnosis; and had a history of smoking/drug abuse, cardiovascular disease, and other comorbidities. Characterizing the underlying MACE risk in AD can inform treatment benefit-risk assessments.

Current scoring systems used to predict major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) lack some key components and their predictive ability needs improvement. This study aimed to develop a more effective scoring system for predicting 3-year MACE in patients with AMI. Our statistical analyses included data for 461 patients with AMI. Eighty percent of patients (n=369) were randomly assigned to the training set and the remaining patients (n=92) to the validation set. Independent risk factors for MACE were identified in univariate and multifactorial logistic regression analyses. A nomogram was used to create the scoring system, the predictive ability of which was assessed using calibration curve, decision curve analysis, receiver-operating characteristic curve, and survival analysis. The nomogram model included the following seven variables: age, diabetes, prior myocardial infarction, Killip class, chronic kidney disease, lipoprotein(a), and percutaneous coronary intervention during hospitalization. The predicted and observed values for the nomogram model were in good agreement based on the calibration curves. Decision curve analysis showed that the clinical nomogram model had good predictive ability. The area under the curve (AUC) for the scoring system was 0.775 (95% confidence interval [CI] 0.728-0.823) in the training set and 0.789 (95% CI 0.693-0.886) in the validation set. Risk stratification based on the scoring system found that the risk of MACE was 4.51-fold higher (95% CI 3.24-6.28) in the high-risk group than in the low-risk group. Notably, this scoring system demonstrated better predictive ability than the GRACE risk score (AUC 0.776 vs 0.731; P=0.007). The scoring system developed from the nomogram in this study showed favorable performance in prediction of MACE and risk stratification of patients with AMI.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for patients with end-stage renal disease (ESRD) despite clinical guideline recommendations that the use of NSAIDs be avoided in this population. However, the relationship between NSAID use and adverse cardiovascular events remains unclear. Thus, this study investigated the association between NSAID use and major adverse cardiovascular events (MACEs) in patients with ESRD. We used the Taiwan National Health Insurance Research Database to conduct this population-based cohort study of patients with newly diagnosed ESRD requiring long-term dialysis between 1998 and 2012. Clinical outcomes were evaluated until the end of 2013. Time-dependent Cox regression models were used to investigate the association between NSAID use and MACEs in patients with ESRD. Among 2349 patients with ESRD receiving dialysis, 1923 (82%) patients used NSAIDs during the follow-up period. Multivariable analysis revealed that compared with nonusers, NSAID users exhibited an increased risk of MACEs with an adjusted hazard ratio (HR) of 1.70 (95% confidence interval [CI] 1.22-2.36). Further analysis demonstrated a significant dose-response relationship between the cumulative use of NSAIDs and MACEs. Adjusted HRs for MACEs were 1.63 (95% CI 1.16-2.30), 1.86 (95% CI 1.22-2.83), and 1.99 (95% CI 1.24-3.20) for cumulative NSAID use of 1-30 defined daily doses (DDDs), 31-90 DDDs, and > 90 DDDs, respectively. The results of this study suggest that NSAID use may increase the risk of MACEs in patients with ESRD. Clinicians and patients with ESRD should be aware of the potential cardiovascular risks associated with NSAIDs.