Adverse Cardiac Events In Patients Research Articles

P1578Determinants and clinical implication of post-procedural fractional flow reserve values as a predictor of major adverse cardiac events in patients with stable angina pectoris

P1578Determinants and clinical implication of post-procedural fractional flow reserve values as a predictor of major adverse cardiac events in patients with stable angina pectoris

P2330Risk of adverse cardiac events in patients undergoing surgery after coronary drug-eluting stent implantation for acute coronary syndrome and stable angina pectoris

P2330Risk of adverse cardiac events in patients undergoing surgery after coronary drug-eluting stent implantation for acute coronary syndrome and stable angina pectoris

Elevated circulating IL-32 presents a poor prognostic outcome in patients with heart failure after myocardial infarction

BackgroundInterleukin-32 (IL-32) is a newly discovered proinflammatory cytokine. However, there are limited data regarding IL-32 as a biomarker for heart failure (HF). In this study, we assessed the prognostic value of IL-32 in patients with chronic HF after myocardial infarction (MI). Methods and resultsOver a period of 1.8years, we prospectively enrolled 100 patients with chronic HF after MI. IL-32, NT-proBNP, Matrix metallopeptidase 9 (MMP-9), procollagen type I (PI) and type III (PIII) were measured at baseline. Study endpoint was adverse cardiac events. High IL-32 levels were associated with numerous factors that are related to deteriorate cardiac function and cardiac fibrosis. Strong expression of IL-32 was detected in human cardiomyocytes from HF tissue. ROC curve revealed the area under the curve of IL-32 for predicting negative outcome of HF was 0.72 (95% CI: 0.60–0.83, P<0.01). Kaplan–Meier statistics showed that the risk of adverse cardiac event was 5.75 fold (hazard ratio 5.75, 95% CI 1.53–21.58, P=0.009), which increased in the highest quartile (>296pg/mL). Cox regression analysis revealed IL-32 was an independent predictor for cardiac events (hazard ratio 2.78, 95% CI 1.02–7.57, P=0.046). Recombinant IL-32 significantly exacerbated infarct size in a mouse model of MI. IL-32 upregulated expression of MMP-9, PIII and transforming growth factor beta in rat fibroblasts. ConclusionIL-32 might be a novel predictor of adverse cardiac event in patients with HF after MI. The pro-fibrotic effect of IL-32 may contribute to adverse cardiac remodeling and progression to HF.

High-risk patients with mild-moderate left ventricular dysfunction after a previous myocardial infarction. A long-term prognostic data by cardiac magnetic resonance

BackgroundFew studies have explored prognosis in patients with previous myocardial infarction (MI) with mild-moderate (MM) left ventricular (LV) dysfunction (D).The aim of our study was to investigate whether combining LV parameters obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous MI and MM-LV-D. MethodsIn 418 consecutive patients (63.3±11.3years old, female 12.9%) with previous MI, we quantified LVEF, volumes and wall motion score index (WMSI) and measured the infarct extent by late gadolinium enhancement (LGE). According to LVEF, patients were considered with normal LVEF (>55%), MM-LV-D (LVEF>30 and ≤55%) and severe (S) LV-D (LVEF ≤30). ResultsDuring follow-up (median, 39.7months) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 17/99 of patients with S-LV-D, in 15/201 with MM-LV-D, and in only 1/118 of those with normal LV-EF.After adjustment for age, an extent of LGE >11.3%, a dilated LV (male >112ml/m2; female >92ml/m2) and a WMSI>1.59 were associated with adverse cardiac events in patients with MM-LV-D. In patients with MM-LV-D, when each of these 3 factors was observed, the prognosis was worse respect to those with 1–2 factors and no factor (p=0.035 and p=0.004, respectively). Prognosis was similar (p=0.61) between MM-LV-D patients with all 3 factors and those with S-LV-dysfunction. CONCLUSIONS. A multiparametric CMR approach, which includes LGE, dilated LV and WMSI, permits to identify post MI patients with MM-LV-D with a risk of cardiac events similar to those with S-LV-D. Further multicenter studies are needed to confirm our data.

Sex differences in coronary atherosclerosis progression and major adverse cardiac events in patients with suspected coronary artery disease

BackgroundLittle is known about the influence of coronary atherosclerosis progression on the risk of major adverse cardiac events (MACE). Similarly, differences between men and women regarding atherosclerosis progression are poorly understood. The purpose of this study was to investigate the progression of coronary atherosclerosis by coronary CT angiography (coronary CTA) in men and women, and to evaluate its prognostic value regarding MACE. MethodsThis study included 1046 patients with suspected coronary artery disease (CAD) who underwent serial coronary CTA because of new or worsening symptoms or because follow-up coronary CTA had been recommended by attending physicians. Coronary atherosclerosis was semi-quantitatively assessed as follows: three-vessel plaque score (TVPS), severe proximal plaque score (SPPS), segment stenosis score (SSS), segment involvement score (SIS), and coronary artery calcium score (CACS). Patients were followed-up regarding the occurrence of MACE, defined as cardiac death, coronary revascularization, nonfatal myocardial infarction and hospitalization due to unstable angina. Follow-up information was gathered by clinical visits or telephone contacts. ResultsFollow-up was achieved in 953 (91.1%) patients (63.8% male; mean age, 53.9 ± 9.7 years) with a mean interval of 4.9 ± 1.1 years. MACE occurred in 132 (13.9%) patients. The average interscan time was 2.1 years. Compared with women, men had significantly higher progression of SPPS, SSS and SIS (6.6% vs. 3.5%, 28.0% vs. 18.3%, 26.6% vs. 16.8%, respectively, all P < 0.005). There was a strong association between the progression of SPPS as well as SSS and MACE, both for men (SPPS, HR:2.17, P < 0.001; SSS, HR:1.28, P = 0.023) and women (SPPS, HR:2.75, P < 0.001; SSS, HR:1.19, P = 0.027). ConclusionsProgression of coronary atherosclerosis as determined by coronary CTA is higher in men than women, it is associated with the risk of future MACE.

Aspirin Before Elective Surgery-Stop or Continue?

Cessation of long-term aspirin treatment before noncardiac surgery can cause adverse cardiac events in patients at risk, particularly in those with previous percutaneous coronary interventions (PCI) with stent implantation. The factors influencing the clinical decision to stop aspirin treatment are currently unknown. In a single-center, cross-sectional study (retrospective registration: NCT03049566) carried out from February to December 2014, we took a survey among patients scheduled for noncardiac surgery who were under long-term aspirin treatment, and among their treating anesthesiologists using standardized questionnaires on preoperative aspirin use, comorbidities, and risk-benefit assessments. The main objective was to identify factors associated with the decision to stop aspirin treatment. The results of multivariable logistic regressions and intraclass correlations are presented. 805 patients were included in the study, and 636 questionnaires were returned (203 of which concerned patients with coronary stents). 46.8% of the patients stopped their long-term aspirin treatment before surgery; 38.7% of these patients stopped it too early (>10 days before surgery) or too late (≤ 3 days before surgery). A prior PCI with stent implantation lowered the probability of aspirin cessation (odds ratio [OR] = 0.47 [0.31; 0.72]; p <0.001). On the other hand, patients were more likely to stop their long-term aspirin treatment if it had already been discontinued once before (OR = 4.58 [3.06; 6.84]; p <0.001), if there was a risk of bleeding into a closed space (OR = 4.54 [2.02; 10.22]; p <0.001), if they did not know why they were supposed to take aspirin (OR = 2.12 [1.05; 4.28]; p = 0.036), or if the preoperative consultation with the anesthesiologist occurred <2 days before surgery (OR = 1.60 [1.08; 2.37]; p = 0.018). Patients often assessed the risks related to aspirin cessation lower than their physicians did. This study reveals discordance between guideline recommendations and everyday clinical practice in patients with coronary stents. The early integration of cardiologists and anesthesiologists and a more widespread use of stent implant cards could promote adherence to the guidelines.

Patients With Diabetes Without Significant Angiographic Coronary Artery Disease Have the Same Risk of Myocardial Infarction as Patients Without Diabetes in a Real-World Population Receiving Appropriate Prophylactic Treatment.

The risk of myocardial infarction (MI) in patients with diabetes is greater than for patients without diabetes. Consequently, prophylactic treatment is recommended for patients with diabetes and risk factors for ischemic heart disease. We aimed to estimate the risk of adverse cardiac events in patients with and without diabetes with and without coronary artery disease (CAD) after coronary angiography (CAG). A population-based cohort of patients registered in the Western Denmark Heart Registry who underwent CAG between 1 January 2003 and 31 December 2012 was stratified according to the presence or absence of obstructive CAD and diabetes. End points were death, cardiac death, and MI. Unadjusted and adjusted rate ratios (RRs) were calculated by using patients without diabetes and without CAD as the reference group. We included 93,866 patients of whom 12,544 (13.4%) had diabetes at the time of CAG. Median follow-up was 4.1 years. Patients with and without diabetes without obstructive CAD had the same adjusted risk of death (RR 1.03 [95% CI 0.92-1.15]), cardiac death (RR 1.21 [95% CI 0.90-1.64]), and MI (RR 0.88 [95% CI 0.65-1.17]). Patients with diabetes without CAD were more often treated with statins (75.3% vs. 46.0%) and aspirin (65.7% vs. 52.7%) than patients without diabetes and CAD. In a real-world population, patients with diabetes with high rates of statin and aspirin treatment had the same risk of cardiovascular events as patients without diabetes in the absence of angiographically significant CAD.

The HEART score for early rule out of acute coronary syndromes in the emergency department: a systematic review and meta-analysis.

The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome. For the 12 studies meeting inclusion criteria, study characteristics and diagnostic accuracy measures were systematically extracted and study quality assessed using the QUADAS-2 tool. After quality assessment, nine studies including data from 11,217 patients were combined in the meta-analysis applying a generalised linear mixed model approach with random effects assumption (Stata 13.1). In total, 15.4% of patients (range 7.3-29.1%) developed major adverse cardiac events after a mean of 6 weeks' follow-up. Among patients categorised as 'low risk' and suitable for early discharge (HEART score 0-3), the pooled incidence of 'missed' major adverse cardiac events was 1.6%. The pooled sensitivity and specificity of the HEART score for predicting major adverse cardiac events were 96.7% (95% confidence interval (CI) 94.0-98.2%) and 47.0% (95% CI 41.0-53.5%), respectively. Patients with a HEART score of 0-3 are at low risk of incident major adverse cardiac events. As 3.3% of patients with major adverse cardiac events are 'missed' by the HEART score, clinicians must ask whether this risk is acceptably low for clinical implementation.

Development of a new risk nomogram of perioperative major adverse cardiac events for Chinese patients undergoing colorectal carcinoma surgery.

The purpose of this study is to create a new risk nomogram to predict perioperative major adverse cardiac events in patients undergoing colorectal carcinoma surgery. A total of 1899 patients who underwent colorectal carcinoma surgery at a tertiary teaching hospital in China between 2007 and 2012 were recruited. Logistic regression analysis was used to define risk factors for major adverse cardiac events. A nomogram-predicting model was built based on the logistic regression model and discrimination was tested by receiver operating characteristic curves. Fifty-six (2.9%) among 1899 included patients developed at least one cardiac event. Eight risk factors were found in the multivariate logistic regression model, which included age ≥60years, smoking, a history of chronic kidney disease, coronary artery disease, congestive heart failure, hypertension, preoperative albumin levels ≤35g/L, blood transfusion ≥500mL, and intraoperative blood pressure variability. P=0.708 in the Hosmer-Lemeshow test indicated acceptable calibration power. Based on this multivariate model, we built a risk nomogram model for these cardiac events with an area under the curve (95% confidence interval) of 0.923 (0.889, 0.957), which demonstrated good discrimination of this model. When the probability cutoff was 1.9% (total score of 83), the nomogram model had the best sensitivity and specificity in predicting cardiac events. A new nomogram model for predicting perioperative major adverse cardiac events in patients who had colorectal carcinoma surgery was established in this study. When the total score is >83, patients undergoing colorectal carcinoma surgery should be considered at high risk of perioperative major adverse cardiac events.

Hyperuricemia as predictor of in-hospital major adverse cardiac events in patients with acute myocardial infarction treated at Sanglah General Hospital, Denpasar-Bali

Background: Even though hyperuricemia has been shown to have roles in the formation of atherosclerosis and increasing incidence of coronary heart disease, its role in predicting prognosis in acute myocardial infarction (AMI) patients has not been widely studied.Objective: This study aimed to investigate the role of hyperuricemia as a predictor of in-hospital major adverse cardiac events (MACE) and to determine the MACE-free survival difference between hyperuricemia and normouricemia patients with AMI who were hospitalized at Sanglah General Hospital.Methods: Prospective cohort study with consecutive sampling was conducted in AMI patients who were treated at Sanglah General Hospital from November 2016 until February 2017. Uric acid level was measured at the first admission and MACE during hospitalization was observed.Results: Eighty-seven patients were involved in this study. We found adjusted HR 1.875 (p=0.041; 95% CI 1.026-3.428) for the development of in-hospital MACE. There was a significant difference (log-rank test p=0.03) in MACE-free survival between hyperuricemia (mean survival 17.25 hours) and normouricemia (mean survival 43.389 hours) groups.Conclusion: Hyperuricemia is an independent predictor of in-hospital MACE in AMI patients hospitalized at Sanglah General Hospital. Event-free survival of hyperuricemic patients is worse compared to normouricemia patients during hospitalization.

Subsequent Major Adverse Cardiac Events in Patients With Clinical Atherosclerotic Cardiovascular Disease and Prior Statin Use

Employee of and owns stock in Amgen

Frailty Increases the Risk of Major Adverse Cardiac Events in Patients with Stable Claudication

Frailty Increases the Risk of Major Adverse Cardiac Events in Patients with Stable Claudication

Impact of T wave amplitude in lead aVR on predicting cardiac events in ischemic and nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator.

T wave amplitudes during ventricular repolarization in the lead aVR (TAaVR) are shown to be associated with adverse cardiac events in patients with several cardiovascular diseases, such as postmyocardial infarction. However, the utility of TAaVR has not been previously evaluated in patients with cardiomyopathy who have received implantable cardioverter defibrillators (ICD). Patients with ischemic or nonischemic cardiomyopathy (ICM or NICM, respectively) and who received an ICD may experience worsening of their condition due to the introduction of electric shock during treatment. This study aimed to investigate the utility of TAaVR in the prediction of cardiac events in ICM or NICM patients with ICD. Ninety-three consecutive ICM or NICM patients with ICD were retrospectively analyzed (median age: 64years; male: 77.4%; ICD for secondary prevention: 76.3%; NICM: 64.5%). The median follow-up period was 31months. The primary endpoint was defined as composite cardiac events, including cardiac death, major ventricular arrhythmic events (MVAE), or hospitalization due to heart failure (HHF). Multivariate Cox regression analysis demonstrated that less negative TAaVR (-0.1mV ≤ TAaVR <0mV and 0mV≤TAaVR) was independently associated with the primary endpoint (HR: 3.75; 95% confidence interval [CI]: 1.09-23.7; p=.04). Kaplan-Meier curve also revealed that the event free survival rate in the less negative TAaVR group was significantly lower than that in the normal TAaVR group (<-0.1mV) (p<.01). TAaVR is useful in risk stratification for cardiac events in ICM or NICM patients with ICD.

Cardiac computed tomography-derived myocardial mass at risk using the Voronoi-based segmentation algorithm: A histological validation study

BackgroundMyocardial mass at risk (MMAR) is an important predictor of adverse cardiac events in patients with ischemic heart disease. This study aims to validate the accuracy of MMAR calculated from cardiac computed tomography (CCT) data using the Voronoi-based segmentation algorithm in comparison with actual MMAR measured on ex-vivo swine hearts prepared by injecting a dye into the coronary arteries. MethodsFifteen extracted swine hearts had India ink injected into one of the major coronary arteries. Subsequently, all coronary arteries manually injected with methylcellulose-based iohexiol-370 were imaged by 16-row CT. The ventricles were cross-sectioned perpendicularly to the long axis of the left ventricle (LV). The stained area and the total LV area of individual slices were measured, and actual MMAR was calculated as the ratio of the LV volume with the disc-summation method. CT-based MMAR of each coronary artery was calculated automatically with the Voronoi-based segmentation algorithm. The results were compared using Pearson's correlation coefficient. ResultsThe median value of CT-based MMAR was 50.8% for the left anterior descending artery (LAD), 36.6% for the left circumflex artery (LCX), and 23.0% for the right coronary artery (RCA). Actual MMAR was 49.8% for LAD, 32.2% for LCX, and 25.9% for RCA. CT-based MMAR was significantly related to actual MMAR (r = 0.92, p = 0.02 for LAD; r = 0.96, p = 0.009 for LCX; r = 0.96, p = 0.009 for RCA). ConclusionCT-based MMAR obtained by Voronoi-based segmentation algorithm reliably estimates actual MMAR measured on ex-vivo swine hearts.

Usefulness of Multiple Biomarkers for Predicting Incident Major Adverse Cardiac Events in Patients Who Underwent Diagnostic Coronary Angiography (from the Catheter Sampled Blood Archive in Cardiovascular Diseases [CASABLANCA] Study)

We sought to develop a multiple biomarker approach for prediction of incident major adverse cardiac events (MACE; composite of cardiovascular death, myocardial infarction, and stroke) in patients referred for coronary angiography. In a 649-participant training cohort, predictors of MACE within 1 year were identified using least-angle regression; over 50 clinical variables and 109 biomarkers were analyzed. Predictive models were generated using least absolute shrinkage and selection operator with logistic regression. A score derived from the final model was developed and evaluated with a 278-patient validation set during a median of 3.6years follow-up. The scoring system consisted of N-terminal pro B-type natriuretic peptide (NT-proBNP), kidney injury molecule-1, osteopontin, and tissue inhibitor of metalloproteinase-1; no clinical variables were retained in the predictive model. In the validation cohort, each biomarker improved model discrimination or calibration for MACE; the final model had an area under the curve (AUC) of 0.79 (p <0.001), higher than AUC for clinical variables alone (0.75). In net reclassification improvement analyses, addition of other markers to NT-proBNP resulted in significant improvement (net reclassification improvement 0.45; p= 0.008). At the optimal score cutoff, we found 64% sensitivity, 76% specificity, 28% positive predictive value, and 93% negative predictive value for 1-year MACE. Time-to-first MACE was shorter in those with an elevated score (p <0.001); such risk extended to at least to 4years. In conclusion, in a cohort of patients who underwent coronary angiography, we describe a novel multiple biomarker score for incident MACE within 1 year (NCT00842868).

OP-115 [AJC » Percutaneous coronary interventions] Relationship Between Neutrophil-to-Lymphocyte Ratio and Major Adverse Cardiac Events In Patients With Saphenous Vein Graft Disease

OP-115 [AJC » Percutaneous coronary interventions] Relationship Between Neutrophil-to-Lymphocyte Ratio and Major Adverse Cardiac Events In Patients With Saphenous Vein Graft Disease

Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease

Introduction: Leptin is an adipose tissue-derived hormone associated with cardiovascular risk factors. We examined whether leptin predicts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.Methods: Fasting plasma leptin levels were measured in 1327 male and 619 female CAD patients. The patients were followed up for two years. The primary endpoint (MACE) was the composite of a hospitalisation for congestive heart failure (CHF) or a cardiac death. The secondary endpoint was the composite of an acute coronary syndrome (ACS) or a stroke.Results: In regression analysis including established risk variables, high leptin levels were associated with a significantly increased risk of MACE (HR 3.37; 95%CI 1.64–6.90; p = 0.001) and ACS or stroke (HR 1.95; 95%CI 1.29–2.96; p = 0.002). Adding leptin to the risk model for MACE increased the C-index from 0.78 (95%CI 0.71–0.85) to 0.81 (0.74–0.88) and improved classification (NRI 0.36; 95%CI 0.13–0.60; p = 0.002) and discrimination of the patients (IDI 0.016; 95%CI 0.001–0.030; p = 0.031).Conclusions: High plasma leptin levels predict short-term occurrence of CHF or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible harmful effects of leptin should be thoroughly investigated.Key messagesLeptin is a peptide hormone secreted mainly by adipose tissue. It has been associated with several cardiovascular risk factors.High leptin levels predict the short-term occurrence of congestive heart failure or cardiac death and ACS or stroke in patients with CAD independently of established risk factors.The possible detrimental effects of leptin on the cardiovascular system should be thoroughly investigated.

CORONARY CALCIUM CHARACTERISTICS AS PREDICTORS OF MAJOR ADVERSE CARDIAC EVENTS IN SYMPTOMATIC PATIENTS: INSIGHTS FROM THE CORE320 MULTINATIONAL STUDY

Background-—The predictive value of coronary artery calcium (CAC) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results-—A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56–68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions-—In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

Insulin-Like Growth Factor Binding Protein 4 Fragments Provide Incremental Prognostic Information on Cardiovascular Events in Patients With ST-Segment Elevation Myocardial Infarction.

BackgroundFragments of insulin‐like growth factor binding protein 4 (IGFBP‐4) are potential new biomarkers for cardiac risk assessment. The fragments are generated on specific cleavage by pregnancy‐associated plasma protein‐A, which exerts proatherogenic activity. This study investigated the prognostic value of IGFBP‐4 fragments in patients with ST‐segment elevation myocardial infarction.Methods and ResultsWe prospectively included 656 patients with ST‐segment elevation myocardial infarction treated with percutaneous coronary intervention from September 2006 to December 2008. Blood samples were drawn before percutaneous coronary intervention, and levels of intact IGFBP‐4 and N‐terminal and C‐terminal IGFBP‐4 fragments were measured by specific assays. End points were 5‐year all‐cause and cardiovascular mortality and the combined end point of major adverse cardiac events. Prognostic potential was evaluated on top of a clinical model in terms of discrimination, calibration, and reclassification analysis. During follow‐up, 166 patients experienced a major adverse cardiac event and 136 patients died, of whom 69 died from cardiovascular causes. Both IGFBP‐4 fragments were associated with all end points (P<0.001). After multivariable adjustments, both N‐terminal and C‐terminal IGFBP‐4 fragment levels remained associated with all end points, including cardiovascular mortality with hazard ratios per doubling in protein concentration of 2.54 (95% CI 1.59–4.07; P<0.001) and 2.07 (95% CI 1.41–3.04; P<0.001), respectively. Incorporation of IGFBP‐4 fragments into a clinical model with 15 risk factors improved C‐statistics and model calibration and provided incremental prognostic contribution, as assessed by net reclassification improvement and integrated discrimination improvement.Conclusions IGFBP‐4 fragments are associated with increased risk of all‐cause mortality, cardiovascular mortality, and major adverse cardiac events in patients with ST‐segment elevation myocardial infarction.

Positive T wave in lead aVR as an independent predictor for 1-year major adverse cardiac events in patients with first anterior wall ST-segment elevation myocardial infarction.

Positive T wave in lead aVR has been shown to predict an adverse in-hospital outcome in patients with anterior wall ST-segment elevation myocardial infarction (STEMI). However, the prognostic value of positive T wave in lead aVR on a long-term outcome has not been fully explored. We performed a retrospective analysis of 190 consecutive patients with first anterior wall STEMI who underwent an emergent coronary angiogram. Patients were divided into those with positive T wave>0mV and those with negative T wave≦0mV in lead aVR. Baseline and angiographic characteristics, and in-hospital revascularization procedures were recorded. In addition, in-hospital and 1-year major adverse cardiac events (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were recorded. Among 190 patients, 37 patients (19%) had positive T wave and 153 patients (81%) had negative T wave in lead aVR. Patients with positive T wave had higher rate of left main disease defined as stenosis ≥50% (11% vs. 2%, p=.028) than those with negative T wave. Patients with positive T wave had higher rate of 1-year MACE (38% vs. 13%, p<.001) driven by higher all-cause mortality (27% vs. 5%, p<.001). Positive T wave was an independent predictor for 1-year MACE (OR 2.74; 95% CI 1.04-7.15; p=.04). Positive T wave in lead aVR was an independent predictor for 1-year MACE in patients with first anterior wall STEMI.