Acute Coronary Events Research Articles

Addition of Tilburg frailty indicator to the classic Global Registry of Acute Coronary Events risk score improves its prognostic value in elderly patients with acute coronary syndrome.

Since the proper risk stratification in the growing population of patients with acute coronary syndrome (ACS) is challenging, the potential advantage of adding the elements of geriatric assessment to the commonly used Global Registry of Acute Coronary Events (GRACE) scale in predicting the risk of 6-month death requires investigation. The study group included 196 patients aged ≥65 years (mean age 74.4 years), hospitalized for ACS. The risk of 6-months mortality was assessed with the GRACE scale, the frailty syndrome (FS) using the Tilburg Frailty Indicator questionnaire, the cognitive impairment (CI) using the Polish adaptation of the Mini Mental State Examination and multimorbidity with the CAD specific index. After 6 months, a follow-up telephone call was performed. To enable the assessment of whether adding TFI, MMSE, CAD specific index to the GRACE scale improves its prognostic value, normalization was carried out. In relation to GRACE (AUC 0.713), combination of GRACE (norms) and TFI (norms) had higher predictive power for 6 months mortality (AUC = 0.737). The risk of death was seven times greater [RR = 7.02] in patients with >55.8 points in the test based on GRACE and TFI score. In the multivariable logistic regression analysis the model based on GRACE 2.0, TFI and MMSE (the lowest AIC value) was best-performing in risk of death prediction. Adding the FS assessment to the traditional GRACE scale improves its prognostic value in elderly with ACS.

Impact of the COVID-19 pandemic on time to treatment, treatment patterns and outcomes among patients with acute coronary syndrome in Yogyakarta, Indonesia: a retrospective cohort study

ObjectiveThis study aimed to evaluate the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Yogyakarta, Indonesia with respect to time to treatment, treatment pattern...

Myocardial Perfusion Scintigraphy in Diagnosic of Coronary Heart Disease

<i>Introduction: </i>Atherosclerosis plays a key role in the etiopathogenesis of cardiovascular diseases. Atherosclerosis is a generalized chronic inflammatory disease of the vascular wall, which results in anatomical and histological changes that, together with functional changes, lead to endothelial dysfunction, narrowing of the arterial lumen, and insufficient blood supply to the tissues. The shift in the incidence of cardiovascular diseases to younger age groups is alarming. The presence of microvascular changes in the myocardium is significant. The high incidence of cardiovascular diseases, especially ischemic heart disease, requires early diagnosis and modern treatment. <i>Aim: </i>The aim of the paper is to analyse and point out early diagnosis of coronary heart disease using nuclear medicine methods. <i>Set of examined patients and methodology: </i>Using nuclear medicine methods, we try to detect these changes in time and thus prevent the occurrence of acute coronary events. In nuclear cardiology, instead of a large-area scintillation detector, a new type of cardio-gamma camera "Discovery CZT 530c" based on the principle of semiconductor detectors began to be used. The abbreviation CZT stands for semiconductor composition (Cadmium-Zinc-Tellur). The set of respondents consisted of 4270 people examined in the years 2014-2016 by myocardial perfusion scintigraphy. There were 950 diabetic patients in the analysed group of the 4270 examined. <i>Results:</i> In the analysed group of 4270 respondents, 61% had negative findings and 39% had positive findings in terms of the presence of ischemic heart disease. In the group of diabetic patients, there was a negative finding in 28% of respondents and a positive finding in 72% of the respondents in the sense of positive ischemic heart disease. Using myocardial perfusion scintigraphy in the diagnosis of functional changes, we confirmed a great benefit in detecting early changes in coronary heart disease, including in the diagnosis of microvascular angina. <i>Conclusion:</i> Nuclear medicine methods are of great benefit for the diagnosis of small vessel disease, diabetic cardiomyopathy and cardiac autonomic neuropathy in patients with diabetes mellitus. The new type of cardio gamma camera "Discovery CZT 530c" allows more accurate assessment of myocardial perfusion abnormalities and at the same time the reduction of the radiopharmaceutical dose reduces the patient's radiation load by 50%.

Validation of machine learning-based risk stratification scores for patients with acute coronary syndrome treated with percutaneous coronary intervention

Abstract Aims This study aimed to validate the machine learning-based Global Registry of Acute Coronary Events (GRACE) 3.0 score and PRAISE (Prediction of Adverse Events following an Acute Coronary Syndrome) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) for predicting mortality. Methods and results Data of consecutive patients with ACS treated with PCI in a tertiary centre in the Netherlands between 2014 and 2021 were used for external validation. The GRACE 3.0 score for predicting in-hospital mortality was evaluated in 2759 patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) treated with PCI. The PRAISE score for predicting one-year mortality was evaluated in 4347 patients with ACS treated with PCI. Both risk scores were compared with the GRACE 2.0 score. The GRACE 3.0 score showed excellent discrimination [c-statistic 0.90 (95% CI 0.84, 0.94)] for predicting in-hospital mortality, with well-calibrated predictions (calibration-in-the large [CIL] −0.19 [95% CI −0.45, 0.07]). The PRAISE score demonstrated moderate discrimination [c-statistic 0.75 (95% CI 0.70, 0.80)] and overestimated the one-year risk of mortality [CIL −0.56 (95% CI −0.73, −0.39)]. Decision curve analysis demonstrated that the GRACE 3.0 score offered improved risk prediction compared with the GRACE 2.0 score, while the PRAISE score did not. Conclusion This study in ACS patients treated with PCI provides suggestive evidence that the GRACE 3.0 score effectively predicts in-hospital mortality beyond the GRACE 2.0 score. The PRAISE score demonstrated limited potential for predicting one-year mortality risk. Further external validation studies in larger cohorts including patients without PCI are warranted.

Cardiac ultrasomics for acute myocardial infarction risk stratification and prediction of all-cause mortality: a feasibility study

BackgroundCurrent risk stratification tools for acute myocardial infarction (AMI) have limitations, particularly in predicting mortality. This study utilizes cardiac ultrasound radiomics (i.e., ultrasomics) to risk stratify AMI patients when predicting all-cause mortality.ResultsThe study included 197 patients: (a) retrospective internal cohort (n = 155) of non-ST-elevation myocardial infarction (n = 63) and ST-elevation myocardial infarction (n = 92) patients, and (b) external cohort from the multicenter Door-To-Unload in ST-segment–elevation myocardial infarction [DTU-STEMI] Pilot Trial (n = 42). Echocardiography images of apical 2, 3, and 4-chamber were processed through an automated deep-learning pipeline to extract ultrasomic features. Unsupervised machine learning (topological data analysis) generated AMI clusters followed by a supervised classifier to generate individual predicted probabilities. Validation included assessing the incremental value of predicted probabilities over the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 to predict 1-year all-cause mortality in the internal cohort and infarct size in the external cohort. Three phenogroups were identified: Cluster A (high-risk), Cluster B (intermediate-risk), and Cluster C (low-risk). Cluster A patients had decreased LV ejection fraction (P < 0.01) and global longitudinal strain (P = 0.03) and increased mortality at 1-year (log rank P = 0.05). Ultrasomics features alone (C-Index: 0.74 vs. 0.70, P = 0.04) and combined with global longitudinal strain (C-Index: 0.81 vs. 0.70, P < 0.01) increased prediction of mortality beyond the GRACE 2.0 score. In the DTU-STEMI clinical trial, Cluster A was associated with larger infarct size (> 10% LV mass, P < 0.01), compared to remaining clusters.ConclusionsUltrasomics-based phenogroup clustering, augmented by TDA and supervised machine learning, provides a novel approach for AMI risk stratification.

Comparison of Global Registry of Acute Coronary Events and Rapid Emergency Medicine Scores in In-Hospital Mortality of Patients Admitted to the Emergency Service and Diagnosed with Non-ST-Segment Elevation Myocardial Infarction.

Although there are many scoring systems for acute coronary syndromes, there is no suitable score for early risk stratification during initial medical contact with non-ST-elevation myocardial infarction (NSTEMI) patients. The present study compared the Rapid Emergency Medicine Score (REMS), an easy-to-use scoring system in emergency departments, with the Global Registry of Acute Coronary Events (GRACE) score used for in-hospital mortality risk stratification of NSTEMI patients. The results were: (i) the REMS score outperformed the GRACE score in predicting the in-hospital mortality; (ii) in estimating in-hospital mortality, the sensitivity of the GRACE score was 88%, the specificity was 65%, while the sensitivity of the REMS score was 100% and the specificity was 76%; (iii) the AUC (Area Under Curve) value of the REMS score (AUC 0.89) was superior to the GRACE score (AUC 0.79) in the data obtained from Receiver operating characteristic (ROC) descriptive analysis, but not statistically significant (P > .05). We suggest that the REMS score can be used to predict in-hospital mortality in patients with NSTEMI.

Clinical Significance of Platelet Indices (Mean Platelet Volume and Mean Platelet Volume-to-lymphocyte Ratio) in Acute Coronary Syndrome: A Hospital-based Observational Study.

The role of platelet indices, such as mean platelet volume (MPV) and MPV-to-lymphocyte ratio (MPVLR), in diagnosing, and predicting the severity, and fatality in acute coronary syndrome (ACS) has not been extensively studied, particularly in Indian patients. Therefore, the study aimed to investigate the clinical significance of MPV and MPVLR in ACS. This hospital-based observational study was conducted from 2020 to 2022. It included 110 ACS cases and an equal number of age- and sex-matched controls with chest pain of noncardiac origin. The primary objective was to compare MPV and MPVLR in ACS patients and controls. Secondary objectives included examining the associations between MPV, MPVLR, and different ACS types, as well as their correlation with the global registry of acute coronary events (GRACE) risk score and inhospital major adverse cardiovascular events (MACE). Higher MPV and MPVLR were observed in ACS cases compared to controls [(11.1 ± 1.1 fL; 10.6 ± 1.3 fL, p < 0.01), (7.63 ± 4.9 fL/mm3; 4.74 ± 1.6 fL/mm3, p < 0.01) respectively]. Significant associations were found between platelet indices (MPV, MPVLR) and various ACS types (p < 0.01). Both indices positively correlated with the severity of heart failure, GRACE score, and inhospital MACE (p < 0.01). MPVLR showed a positive correlation with the duration of hospital stay [(r: 0.21; p = 0.03), but MPV did not (r: 0.13; p = 0.17)]. The GRACE score demonstrated the highest discriminating capacity in predicting inhospital mortality compared to platelet indices. Additionally, MPV serves as a more effective prognostic marker than MPVLR in predicting inhospital mortality. Both MPV and MPVLR are higher in ACS than in healthy individuals. Therefore, both may be used as discriminating markers for differentiating cardiac and noncardiac chest pain when cardiac biomarkers are not available. Additionally, both have good sensitivity for predicting the severity of the disease, inhospital mortality, and MACE in ACS.

Elevated carbohydrate antigen 125 (CA125) is associated with incident heart failure and mortality in acute coronary syndrome.

Carbohydrate antigen 125 (CA125), a mucin produced by serosal cells in response to mechanical and inflammatory stimuli, has emerged as an important biomarker to guide risk stratification in heart failure (HF). The prognostic value of CA125 in acute coronary syndrome (ACS) patients is less explored. In a cohort of 524 ACS patients (73% males, mean age 67±12years), we assessed the associations between CA125 and the risk for HF and death during a median follow-up period of 27.3months for incident HF and 39.5months for mortality. Plasma CA125 was measured within 24h after admission in the entire cohort and after 6weeks in a subgroup of 115 elderly patients (>75years of age). We also assessed the relationships between baseline CA125 and echocardiographic parameters of cardiac structure and function at 1year post-ACS in this subgroup. Baseline CA125 was associated with incident HF in the entire cohort in a Cox proportional hazards model adjusted for age, sex, cardiovascular (CV) risk factors (diabetes, smoking, hypertension, previous HF, previous ACS and previous stroke), renal function and revascularization {hazard ratio [HR] 1.46 [95% confidence interval (CI) 1.10-1.93] per 1-standard deviation [SD] CA125 increase; P=0.009}. In the detailed follow-up subgroup, elevated baseline CA125 predicted subsequent deterioration of left ventricular (LV) ejection fraction (LVEF), defined as a >5% absolute LVEF decrease in patients with LVEF≥50% at discharge [odds ratio (OR) 3.31 (95% CI 1.15-9.54) per 1-SD baseline CA125 increase; P=0.027]. We also found significant correlations between high baseline CA125 and larger LV volumes (LV end-diastolic volume index, Spearman's r=0.329, P<0.001; LV end-systolic volume index, r=0.391, P<0.001) and left atrial volume index (r=0.320, P<0.001) at 1year post-ACS, indicative of adverse cardiac remodelling. Elevated baseline and follow-up CA125 were associated with increased mortality, independently of age and sex [HR 1.37 (95% CI 1.09-1.71), P=0.006, per 1-SD baseline CA125; HR 1.98 (95% CI 1.06-3.67), P=0.031, per increasing 6week CA125 tertile]. The relationship between 6week CA125 and incident mortality remained significant in the fully adjusted model [HR 2.23 (95% CI 1.15-4.35) per increasing CA125 tertile; P=0.018]. We report independent associations between elevated CA125, LV dysfunction, cardiac remodelling, incident HF and mortality post-ACS. Our results warrant further evaluation of CA125 as a potential biomarker for risk stratification and management of ACS patients, both at the time of the acute coronary event and during follow-up.

Association of baseline and changes in health-related quality of life with mortality following myocardial infarction: multicentre longitudinal linked cohort study.

Health-related quality of life (HRQoL) for patients following myocardial infarction (MI) is frequently impaired. We investigated the association of baseline and changes in HRQoL with mortality following MI. Nationwide longitudinal study of 9474 patients admitted to 77 hospitals in England as part of the Evaluation of the Methods and Management of Acute Coronary Events study. Self-reported HRQoL was collected using EuroQol EQ-5D-3L during hospitalization and at 1, 6, and 12 months following discharge. The data was analysed using flexible parametric and multilevel survival models. Of 9474 individuals with MI, 2360 (25%) were women and 2135 (22.5%) died during the 9-year follow-up period. HRQoL improved over 12 months (baseline mean, mean increase: EQ-5D 0.76, 0.003 per month; EQ-VAS 69.0, 0.5 per month). At baseline, better HRQoL was inversely associated with mortality [Hazard ratio (HR) 0.55, 95% CI 0.47-0.63], and problems with self-care (HR 1.73, 1.56-1.92), mobility (1.65, 1.50-1.81), usual activities (1.34, 1.23-1.47), and pain/discomfort (1.34, 1.22-1.46) were associated with increased mortality. Deterioration in mobility, pain/discomfort, usual activities, and self-care over 12 months were associated with increased mortality (HR 1.43, 95% CI 1.31-1.58; 1.21, 1.11-1.32; 1.20, 1.10-1.32; 1.44, 1.30-1.59, respectively). After MI, poor HRQoL at baseline, its dimensions, and deterioration over time are associated with an increased risk of mortality. Measuring HRQoL in routine clinical practice after MI could identify at-risk groups for interventions to improve prognosis.

Case report of spontaneous coronary artery dissection in a 50‑year‑old man

BackgroundSpontaneous Coronary Artery Dissection (SCAD) is an acute coronary event of uncertain origin. SCAD occurs when the coronary artery wall dissects non-traumatically and non-atherosclerotically, leading to the formation of an intramural hematoma or intimal tear, ultimately compressing and restricting the true lumen, or even occluding it. The management of SCAD remains controversial despite modern imaging techniques. In addition to supportive drug therapy, percutaneous coronary intervention (PCI) is another option that can be used as an effective treatment modality.Case presentationWe describe A 50-year-old male with SCAD presented to the hospital emergency department complaining of chest pain. Coronary angiography incidentally showed spiral dissection from the proximal to distal right coronary artery (RCA). Three overlapping coroflex stents were deployed from the distal to the proximal RCA.ConclusionsTo stabilize the coronary artery in Acute Coronary Syndrome (ACS) patients due to SCAD, prompt interventions such as stenting and angioplasty are needed. However, it is necessary to pay attention to the clinical condition of patients and quick diagnosis for the recovery of patients and reduction of complications.

Risk scores and coronary artery disease in patients with suspected acute coronary syndrome and intermediate cardiac troponin concentrations

BackgroundGuidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease...

Additional analysis of red blood cell distribution width improves the predictive value of the GRACE 2.0 score for 18-month mortality in patients with acute myocardial infarction

Aim. To identify whether the addition of red blood cell distribution width (RDW) could improve the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 in patients with acute myocardial infarction (AMI).Material and methods. This prospective observational study included 577 AMI patients who underwent coronary angiography within 24 hours after symptom onset. Admission RDW was measured as part of the automated complete blood count. GRACE 2.0 score at admission was calculated. The clinical endpoint was 18-month all-cause mortality. Logistic regression analysis was used to identify predictive values of RDW. Area under the receiver-operator characteristic (ROC) curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the increment of predictive value for the combination of RDW with GRACE 2.0 score in predicting clinical adverse outcome.Results. The median age of patients was 65 (interquartile range: 56-74) years, while 60,7% were male. During 18-month follow-up, 66 patients (11,4%) died. RDW was positively correlated with GRACE 2.0 score (r=0,16, p&lt;0,001). Multivariate analysis showed that both GRACE 2.0 score and RDW were independent predictors of 18-month mortality (odds ratio 1,025; 95% confidence interval [CI] 1,013-1,037; p&lt;0,001; and 1,298; 1,087-1,551; p=0,004; respectively). The AUC for predicting 18-month mortality of GRACE 2.0 score, RDW and their combination was 0,795 (95% CI: 0,734-0,856), 0,708 (95% CI: 0,642-0,775) and 0,826 (95% CI: 0,775-0,876), respectively. Addition of RDW in the GRACE 2.0 score enhanced NRI (0,428; p=0,0009) and IDI (0,014; p=0,002).Conclusion. Baseline RDW levels at admission was associated with 18-month mortality in patients with AMI. The inclusion of RDW into GRACE 2.0 score enables more accurate prediction of long-term risk of death compared with GRACE 2.0 score alone.

The Association between Cardiac Arrest and Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock.

The impact of cardiac arrest (CA) at admission on the prognosis of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains a subject of debate. We conducted a retrospective study at West China Hospital from 2018 to 2021, enrolling 247 patients with AMI complicated by CS (AMI-CS). Patients were categorized into CA and non-CA groups based on their admission status. Univariate and multivariate Cox regression analyses were performed, with 30-day and 1-year mortality as the primary endpoints. Kaplan-Meier plots were constructed, and concordance (C)-indices of the Global Registry of Acute Coronary Event (GRACE) score, Intra-aortic Balloon Pump in Cardiogenic Shock (IABP-SHOCK) II score, and IABP-SHOCK II score with CA were calculated. Among the enrolled patients, 39 experienced CA and received cardiopulmonary resuscitation at admission. The 30-day and 1-year mortality rates were 40.9% and 47.0%, respectively. Neither univariate nor multivariate Cox regression analyses identified CA as a significant risk factor for 30-day and 1-year mortality. In C-statistics, the GRACE score exhibited a moderate effect (C-indices were 0.69 and 0.67, respectively), while the IABP-SHOCK II score had a better predictive performance (C-indices were 0.79 and 0.76, respectively) for the 30-day and 1-year mortality. Furthermore, CA did not enhance the predictive value of the IABP-SHOCK II score for 30-day (p = 0.864) and 1-year mortality (p = 0.888). Cardiac arrest at admission did not influence the survival of patients with AMI-CS. Active resuscitation should be prioritized for patients with AMI-CS, regardless of the presence of cardiac arrest.

Small vessel disease burden predicts incident stroke and all-cause death, but not acute coronary event.

Total small vessel disease (SVD) score is used to measure the burden of SVD by incorporating four established neuroimaging markers; white matter hyperintensity, lacune, cerebral microbleed, and enlarged perivascular space, ranging from 0 to 4. Whether total SVD scores predict all vascular outcomes remains unclear. This study aimed to clarify the predictive value of the total SVD score for incident stroke, mortality, and acute coronary syndrome in independent outpatients with vascular risk factors. We derived data from The Tokyo Women's Medical University Cerebrovascular Disease registry, a prospective observational registry in which 1011 patients with evidence of cerebral vessel disease on magnetic resonance imaging were enrolled. They were followed up until March 2023. The primary outcomes were stroke, all-cause death, and acute coronary syndrome (ACS). After excluding those with a modified Rankin scale score >1, Mini-mental State Examination score <24, and missing T2* images, 692 patients were included. During a median follow-up period of 4.6 years, stroke, ACS, and all-cause death occurred in 52, 24, and 45 patients, respectively. In multivariate analysis, the total SVD score was independently associated with stroke, and all-cause death but not with acute coronary syndrome. Both cutoff values of the total SVD score for stroke, and all-cause death were 1. In conclusion, the total SVD score could predict stroke and mortality but not acute coronary syndrome. Our results suggest intensive management of patients with a total SVD score ≥1 to prevent stroke and all-cause death. Patients with higher total SVD scores were significantly more likely to have a stroke (A; P = 0.012) than those with lower total SVD scores. However, no association was observed between total SVD scores and acute coronary syndrome (B, P = 0.604). For incident stroke, total SVD scores of 1 and 2 were the cutoff levels.

The Prognostic Value of Advanced Lung Cancer Inflammation Index in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

This study aimed to investigate the predictive value of advanced lung cancer inflammation index (ALI) for major adverse cardiovascular events (MACEs) in elderly patients with acute coronary syndrome (ACS).A total of 586 ACS patients undergoing percutaneous coronary intervention (PCI) over 65 years old between January 2017 and December 2018 were retrospectively collected. The patients were divided into two groups by the optimal cutoff value of ALI. Spearman rank correlation coefficient was used to evaluate the correlation between ALI and the Global Registry of Acute Coronary Events (GRACE). Time-dependent receiver operating characteristic (ROC) curves, Cox survival analysis, and Kaplan Meier curves were used to assess the predictive value of ALI for MACEs.Spearman's nonparametric test revealed a moderate correlation between ALI and the GRACE (r: -0.417, P < 0.001). Time-dependent ROC curves showed that the area under the curve for ALI was 0.751 (95% CI, 0.699-0.798) in predicting MACEs, higher than Geriatric Nutritional Risk Index (0.531, 95% CI 0.435-0.627) and Prognostic Nutritional Index (0.590, 95% CI 0.505-0.676), and for combined diagnostic models (ALI + GRACE) was 0.913, (95% CI 0.875 - 0.942, P < 0.001). Multivariate Cox analysis demonstrated that ALI (HR: 0.974, 95% CI: 0.952-0.996, P = 0.017) was an independent risk factor for MACEs. Kaplan Meier survival analysis showed that the cumulative incidence of MACEs was significantly higher in elderly ACS patients with lower ALI (log-rank test, P < 0.001).ALI could be a nutrition-inflammation indicator with independent predictive value for long-term MACEs of elderly ACS patients after PCI.

Vitamin-K antagonist versus dual antiplatelet therapy in management of isolated and non-obstructive atherosclerotic coronary artery ectasia

BackgroundTreatment of isolated and non-obstructive atherosclerotic coronary artery ectasia (CAE) is still controversial. AimTo assess the efficacy and safety of vitamin-K antagonist (VKA) versus dual antiplatelet (DAPT) therapy in management of patients with isolated and non-obstructive atherosclerotic CAE. MethodsWe prospectively enrolled 79 patients diagnosed on elective coronary angiography to have either isolated CAE or non-obstructive atherosclerotic CAE. Patients were assigned in 1:1 pattern to receive either VKA (warfarin) or DAPT (aspirin plus clopidogrel). Patients were followed-up for nine-months. The primary endpoint was the cumulative events rate including acute coronary event, target vessel intervention, or cardiac death. Analysis of cumulative events at different time intervals, its individual components, and bleeding were considered secondary endpoints. ResultsCumulative events rate was 33%, with mortality rate of 2.5%. Both treatment groups showed comparable cumulative events during the nine-months follow-up duration. Nevertheless, Kaplan-Meier analysis beyond the first 3-months of follow-up showed significantly higher event-free survival among the VKA-group. Recurrent events (≥2) were significantly higher among the DAPT-group. Both groups showed no major bleeding events. Multivariable cox-regression analysis showed that presence of significant coronary tortuosity, use of DAPT in reference to VKA, and lower percent time in therapeutic range (%TTR) among those receiving VKA were significant independent predictors of clinical adverse events beyond the first 3-months of follow-up. ConclusionCumulative adverse events were comparable among both treatment groups for isolated non-obstructive CAE. However, adverse events were significantly more frequent in the DAPT-group beyond the first three months.

A Machine Learning Model for Predicting In-Hospital Mortality in Chinese Patients With ST-Segment Elevation Myocardial Infarction: Findings From the China Myocardial Infarction Registry.

Machine learning (ML) risk prediction models, although much more accurate than traditional statistical methods, are inconvenient to use in clinical practice due to their nontransparency and requirement of a large number of input variables. We aimed to develop a precise, explainable, and flexible ML model to predict the risk of in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). This study recruited 18,744 patients enrolled in the 2013 China Acute Myocardial Infarction (CAMI) registry and 12,018 patients from the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective Acute Myocardial Infarction Study. The Extreme Gradient Boosting (XGBoost) model was derived from 9616 patients in the CAMI registry (2014, 89 variables) with 5-fold cross-validation and validated on both the 9125 patients in the CAMI registry (89 variables) and the independent China PEACE cohort (10 variables). The Shapley Additive Explanations (SHAP) approach was employed to interpret the complex relationships embedded in the proposed model. In the XGBoost model for predicting all-cause in-hospital mortality, the variables with the top 8 most important scores were age, left ventricular ejection fraction, Killip class, heart rate, creatinine, blood glucose, white blood cell count, and use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). The area under the curve (AUC) on the CAMI validation set was 0.896 (95% CI 0.884-0.909), significantly higher than the previous models. The AUC for the Global Registry of Acute Coronary Events (GRACE) model was 0.809 (95% CI 0.790-0.828), and for the TIMI model, it was 0.782 (95% CI 0.763-0.800). Despite the China PEACE validation set only having 10 available variables, the AUC reached 0.840 (0.829-0.852), showing a substantial improvement to the GRACE (0.762, 95% CI 0.748-0.776) and TIMI (0.789, 95% CI 0.776-0.803) scores. Several novel and nonlinear relationships were discovered between patients' characteristics and in-hospital mortality, including a U-shape pattern of high-density lipoprotein cholesterol (HDL-C). The proposed ML risk prediction model was highly accurate in predicting in-hospital mortality. Its flexible and explainable characteristics make the model convenient to use in clinical practice and could help guide patient management. ClinicalTrials.gov NCT01874691; https://clinicaltrials.gov/study/NCT01874691.

Enhanced predictive performance of the GRACE risk score by incorporating lipoprotein(a) for major adverse cardiac events in acute myocardial infarction patients undergoing PCI

BackgroundAs scientific research advances, the landscape of detection indicators and methodologies evolves continuously. Our current study aimed to identify some novel perioperative indicators that can enhance the predictive accuracy of the Global Registry of Acute Coronary Events (GRACE) score for the in-hospital major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction. MethodsA total of 647 adult patients with AMI admitted to the emergency department were consecutively enrolled in the retrospective research starting from June 2016 to September 2019. The endpoint was in-hospital MACE. Stepwise regression analysis and multivariate logistic regression were performed to select the indicators for the union model established by nomogram. Bootstrap with 1000 replicates was chosen as the internal validation of the union model. The area under the receiver operating curve (AUC) and calibration plot were used to evaluate the discrimination and calibration. Decision curve analysis (DCA) was performed to evaluate the clinical sufficiency of the nomogram. Akaike's information criterion (AIC) and Bayesian Information Criterion (BIC) were used to evaluate the goodness of fit. ResultsLipoprotein(a) combined with serum uric acid, fasting blood glucose, and hemoglobin could improve the GRACE risk score. The AUC of the union model was 0.86, which indicated a better discriminative ability than the GRACE risk score alone (AUC, 0.81; P < 0.05). The calibration plots of the union model showed favorable consistency between the prediction of the model and actual observations, which was better than the GRACE risk score. DCA plots suggested that the union model had better clinical applicability than the GRACE risk score. ConclusionLipoprotein(a) has shown promise in augmenting the predictive capability of the GRACE risk score, however, it may be beneficial to integrate it with other commonly used indicators.

Utilizing APACHE IV and GRACE Scores as Predictors of Mortality Compared with SAPS-3 Scores for Acute Coronary Syndrome Patients in the Cardiac Vascular Care Unit

Background: Acute coronary syndromes (ACS) frequent cause of hospitalization in the cardiovascular care unit. Positive predictive data are being developed and shown to be effective for patients with ACS; the Global Registry of Acute Coronary Events, or GRACE, has shown the most accurate outcomes. In contrast, prognostic scores derived from diverse cohorts of critically ill patients are predominantly employed by intensive care clinicians. Prominent examples of such scores include APACHE IV and SAPS 3. The objective of this research endeavor was to assess and contrast the efficacy of these three scores across an unselected sample of ACS cases.. Objective: The Cardiovascular Care Unit of RSUD Dr. Saiful Anwar Malang treats Acute Coronary Syndrome patients. This study compares SAPS 3, GRACE, and APACHE IV score parameters through calibration and discrimination tests to predict patient mortality. Material and Methods: The study included all ACS patients admitted from August 2021 to November 2023. Hospital mortality prediction was assessed using score calibration and discrimination. Result: There were 843 patients in total included. SAPS 3 could not be calibrated appropriately, whereas APACHE IV and GRACE could. Across all scores, discrimination was exceptional (area under the curve values of 0.811 for APACHE IV, 0.740 for GRACE, and 0.732 for SAPS 3). Conclusion: GRACE and APACHE IV were calibrated thoroughly in this cohort of intensive care unit-admitted ACS patients; however, SAPS 3 lacked such calibration. All three scores exhibited exceptional discrimination. GRACE and APACHE IV may be utilized to predict the risk of mortality in patients with ACS. Keyword: Acute Physiology and Chronic Health Evaluation Score, Global Registry of Acute Coronary Events, Intensive Cardiovascular Care Unit, Simplified Acute Physiology Score 3.

Correlation Between Ischemia Time and Left Ventricular Failure After Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction (STEMI) Patients.

Primary percutaneous coronary intervention (PPCI) is pivotal in treating ST-elevation myocardial infarction (STEMI) patients, yet ischemia time significantly impacts outcomes, particularly left ventricular failure (LVF). This study aimed to investigate the impact of ischemia duration and other variables associated with severe left ventricular systolic dysfunction in STEMI patients receiving PPCI treatment. This prospective cohort was carried out at Lady Reading Hospital in Peshawar, Pakistan, from January to June 2023. The study included 236 patients aged 18 to 70 with acute myocardial infarction who underwent PPCI within 12 hours of symptom onset. Patients with coronary dissection, late presenters (more than 12 hours after onset), those without stenting, and those with prior coronary artery intervention were excluded. Additionally, patients with systolic heart failure, a history of arrhythmias such as ventricular tachycardia or ventricular fibrillation, or a previous acute coronary syndrome event were excluded. Demographic information, clinical background, and ischemia duration were recorded and associated with left ventricular ejection fraction (LVEF) after PPCI. To identify predictors of severe left ventricular dysfunction, statistical analysis using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.) included multivariate regression, Pearson's correlation, and descriptive statistics. The patients' average age was 61.2 years (SD ± 12.3), with 35.59% of them being female (84 patients) and 64.41% of them being male (152 patients). Diabetes (33.05%, 78 patients) and hypertension (43.22%, 102 patients) were common comorbidities, and 14.41% (34 patients) had previously had a cardiac episode. Fifty-two patients (22.03%) of the total had ischemia within three hours, 94 patients (39.83%) had ischemia within six hours, 60 patients (25.42%) had ischemia within nine hours, and 30 patients (12.71%) had ischemia within 12 hours. Analysis of LVEF showed that 9.32% of patients (n=22) had LVEF <30% and 24.58% of patients (n=58) had LVEF 30-40%. Significant predictors of severe left ventricular systolic dysfunction were shown by multivariate regression to include ischemia duration (OR 1.45, p<0.001), age (OR 1.02, p=0.015), diabetes (OR 2.34, p=0.001), hypertension (OR 1.76, p=0.031), and previous cardiac events (OR 2.89, p=0.002); 20.33% of the patients (n=48) had LVF during the six-month follow-up, highlighting the therapeutic significance of prompt management in STEMI patients after PPCI. Prolonged ischemia, advanced age, diabetes, hypertension, and previous cardiac events that predict severe left ventricular dysfunction are associated with a greater risk of LVF following PPCI. Timely intervention and thorough therapy are essential for enhancing results for STEMI patients at high risk.