Coronary Risk Score Research Articles

Effect of serum lipid level change on 10-year coronary heart risk distribution estimated by means of seven different coronary risk scores during one-year treatment

This study was done in order to evaluate the effect of serum levels of total cholesterol, triglycerides, low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol on 10-year coronary heart disease risk distribution change. This study included 110 subjects of both genders (71 female and 39 male), aged 29 to 73, treated at the Outpatient Department of Atherosclerosis Prevention, Centre for Laboratory Medicine, Clinical Centre Vojvodina. The 10-year coronary heart disease risk was estimated on first examination and after one-year treatment by means of Framingham, PROCAM and SCORE coronary risk scores and their modifications (Framingham Adult Treatment Panel III, Framingham Weibul, PROCAM NS and PROCAM Cox Hazards). Age, gender, systolic and diastolic blood pressure, smoking, positive family history and left ventricular hypertrophy are risk factors involved in the estimation of coronary heart disease besides lipid parameters. There were no significant differences in nutritional status, smoking habits, systolic and diastolic pressure, and no development of diabetes mellitus or cardiovascular incidents during one-year follow. However, a significant reduction in cholesterol level (p < 0.001), triglycerides (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and an increase in high-density lipoprotein cholesterol (p < 0.02) was present although therapeutic target values were not achieved. In addition, a significant increase was observed in the category of low 10-year coronary heart disease risk (Framingham- p < 0.001; Framingham ATP III- p < 0.001; Framingham Weibul- p < 0.001; PROCAM- p < 0.05; PROCAM NS- p < 0.05; PROCAM Cox Hazards- p < 0.001: SCORE- p < 0.001) and a reduction in high-risk category (Framingham- p < 0.001; Framingham ATP III- p < 0.005; Framingham Weibul- p < 0.005; PROCAM- p < 0.001; PROCAM NS-p < 0.001; PROCAM Cox Hazards- p < 0.001; SCORE- p < 0.005) in comparison with the risk at the beginning of the study. Our results show that the correction of lipid level after one-year treatment leads to a significant redistribution of 10-year coronary heart disease risk estimated by means of seven different coronary risk scores. This should stimulate patients and doctors to persist in prevention measures.

Abstract 17986: Multiple Single Day Blood Pressure Measurements and Their Impact on Coronary Heart Disease, Stroke, and Heart Failure Risk Prediction: The Atherosclerosis Risk In Communities (ARIC) Study

BACKGROUND: Although systolic blood pressure (SBP) varies through the day, single SBP measures are used in all coronary heart disease (CHD), heart failure (HF) and stroke risk prediction equations. Changes in SBP clearly affect estimated risk. However, the magnitude of change in risk when different SBP measures performed within one day are used in risk equations is not known. METHODS: Same day multiple SBP measurements (sitting, standing and supine) were performed by certified technicians using a Dinamap device in 11,075 ARIC study participants (mean age 53.9 ± 5.7 years, 57% with history of smoking, 10% diabetic and 31% hypertensive). We estimated 10 year CHD, HF and stroke risks for each SBP measure and classified individuals as 0-5%, 5-10%, 10-20% and &gt;20% risk.Then, we evaluated changes in individual risks within a day. Results: (Table): Substituting mean sitting SBP for standing and supine SBP in the Framingham CHD Risk Score (FRS) reclassified 8.3% and 10.2% of the subjects, and in the ARIC Coronary Risk Score (ACRS), 7.1% and 9.6%, respectively. Similarly, when stroke and HF risks were evaluated using ARIC risk scores 11.7% and 12.3% were reclassified when standing SBP was used, and 10.7% and 11.7% were reclassified with supine SBP measures. The maximum changes in an individual’s estimated 10 year risk were 21%, 26% and 24% for CHD, stroke and HF risk, suggesting greater than one risk category (e.g.,low to high risk) change in a day. When different sitting SBP measures (taken within minutes of each other) were used, 6.7%, 6.5%, 6.5% and 8.0% of subjects were reclassified when FRS, ACRS, ARIC stroke and HF risks were estimated. CONCLUSION: SBP changes within a day can result in statistically significant changes in estimated CHD, stroke, and HF risk. Our study has implications for the use of a single SBP measure to determine an individual’s cardiovascular risk, and raises questions on the utility of current risk prediction algorithms in patient management.

Role of central obesity in risk stratification after an acute coronary event: Does central obesity add prognostic value to the Global Registry of Acute Coronary Events (GRACE) risk score in patients with acute coronary syndrome?

BackgroundAccurate risk stratification is an important step in the initial management of acute coronary syndrome (ACS), and current guidelines recommend the use of risk scores, such as the Global Registry of Acute Coronary Events risk score (GRACE RS). Recent studies have suggested that abdominal obesity is associated with cardiovascular events in patients with ACS. However, little is known about the additional value of abdominal obesity beyond risk scores. The aim of our study was thus to assess whether waist circumference, a surrogate of abdominal adiposity, adds prognostic information to the GRACE RS. MethodsThis was a retrospective cohort study of ACS patients admitted consecutively to a cardiac care unit between June 2009 and July 2010. The composite of all-cause mortality or myocardial reinfarction within six months of index hospitalization was used as the endpoint for the analysis. ResultsA total of 285 patients were studied, 96.1% admitted for myocardial infarction (with or without ST elevation) and 3.9% for unstable angina. At the end of the follow-up period, 10 patients had died and the composite endpoint had been reached in 27 patients (9.5%). More than 70% of the study population were obese or overweight, and abdominal obesity was present in 44.6%. The GRACE RS showed poor predictive accuracy (area under the curve 0.60), and most of the GRACE variables did not reach statistical significance in multivariate analysis. The addition of waist circumference to the GRACE RS did not improve its discriminatory performance. ConclusionAbdominal obesity does not add prognostic information to the GRACE RS to predict six-month mortality or myocardial reinfarction.

Role of central obesity in risk stratification after an acute coronary event: Does central obesity add prognostic value to the Global Registry of Acute Coronary Events (GRACE) risk score in patients with acute coronary syndrome?

BackgroundAccurate risk stratification is an important step in the initial management of acute coronary syndrome (ACS), and current guidelines recommend the use of risk scores, such as the Global Registry of Acute Coronary Events risk score (GRACE RS). Recent studies have suggested that abdominal obesity is associated with cardiovascular events in patients with ACS. However, little is known about the additional value of abdominal obesity beyond risk scores. The aim of our study was thus to assess whether waist circumference, a surrogate of abdominal adiposity, adds prognostic information to the GRACE RS. MethodsThis was a retrospective cohort study of ACS patients admitted consecutively to a cardiac care unit between June 2009 and July 2010. The composite of all-cause mortality or myocardial reinfarction within six months of index hospitalization was used as the endpoint for the analysis. ResultsA total of 285 patients were studied, 96.1% admitted for myocardial infarction (with or without ST elevation) and 3.9% for unstable angina. At the end of the follow-up period, 10 patients had died and the composite endpoint had been reached in 27 patients (9.5%). More than 70% of the study population were obese or overweight, and abdominal obesity was present in 44.6%. The GRACE RS showed poor predictive accuracy (area under the curve 0.60), and most of the GRACE variables did not reach statistical significance in multivariate analysis. The addition of waist circumference to the GRACE RS did not improve its discriminatory performance. ConclusionAbdominal obesity does not add prognostic information to the GRACE RS to predict six-month mortality or myocardial reinfarction.

Validity of the Global Registry of Acute Coronary Events risk score in prediction of acute myocardial infarction mortality in hospitalised Chinese patients aged 80 and over

To detect the validity of the Global Registry of Acute Coronary Events (GRACE) risk score in predicting acute myocardial infarction (AMI) mortality of Chinese inpatients aged 80 and over. Hospital mortality was defined as all-cause death rate of patients during hospitalisation. Using GRACE risk score to predict death risk, both discrimination (C statistic) and calibration (the predicted vs observed mortality based on the population with predicted risks) were evaluated. Three hundred eighty-six patients presenting with ST segment elevation AMI (STEMI) and non-STEMI were enrolled. The GRACE risk score ranged between 151 and 297, and the mortality was 23.3%. The overall discriminatory capacity of the GRACE model was high (C statistic 0.767, CI: 0.712-0.822). There was a high correlation (R(2) = 0.833) between the predicted and observed hospitalised AMI mortality. The GRACE score is a useful risk prediction model for hospital mortality of Chinese AMI patients aged 80 and over.

Pericardial fat volume measured by non-contrast tomography improves risk prediction of subclinical coronary artery disease estimated by coronary artery calcium score and Framinghan risk score

Background: Although coronary artery calcium (CAC) score has high specificity for predicting subclinical coronary artery diasease (CAD), it lacks sensitivity. Therefore, we aimed to evaluate if the measurement of pericardial fat volume (PFv) by non-contrast computed tomography (CT) in combination with CAC score would improve discrimination of coronary atherosclerotic plaques. Methods: 132 consecutive patients with suspected CAD were addressed to perform 64-slice CT both without contrast for CAC score and coronary angiography. During CT we evaluated both CAC score and PFv (in mm3); and during angiography we evaluated PFv and the presence of coronary stenosis higher than 30%. In addition, we measured visceral abdominal adipose tissue (VAT) by abdominal CT and calculated Framinghan Heart Risk (FHR) score. Results: We found a strong association between PFv measured by non-contrast CT and the presence of coronary plaques with multivariate odds of 5.24 (95% CI 1.2–22, p=0.026). On sensitivity (sn), specificity (sp) and negative predictive value (npv) analysis for discrimination of coronary plaques, CAC score<10 + PFv measured by non-contrast CT presented the best predictive capacity (sn=93.3%; sp=100%; npv=99%) in comparison to CAC score<10 + PFv by angiography (sn=92.0%; sp=100%; npv=97%) or CAC score<10 + VAT (sn=90.7%; sp=100%; npv=95%); or even CAC score = 0 alone (sn=80%; sp=98%; npv=93%) or CAC score<10 alone (sn=80%; sp=100%; npv=93%). Furthermore, while in the entire cohort CAC score alone was better than the combination of CAC and PFv, when considering only patients with CAC score < 10, CAC score alone attained an area under the curve (AUC) of 0.808 (0.64 – 0.97; p=0.001) versus 0.853 (0.74 – 0.97; p<0.001) in CAC plus PFv model. Consistently, adding PFv to FHR score was better both in the entire cohort and in patients with CAC score<10, but tended to be more accurate in lower risk patients. Conclusions: This is the first study to shown PFv evaluation by non-contrast CT in combination with CAC score improves risk prediction of subclinical coronary artery disease in comparison with CAC score alone, especially in lower risk patients, without additional costs and risks of contrast infusion of coronary angiography.

Chronic kidney disease epidemiology collaboration equations and global registry for acute coronary events risk score for the prediction of mortality in non-ST elevation acute coronary syndromes

Chronic kidney disease epidemiology collaboration equations and global registry for acute coronary events risk score for the prediction of mortality in non-ST elevation acute coronary syndromes

Could Epicardial Adipose Tissue Thickness by Echocardiography Be Correlated with Acute Coronary Syndrome Risk Scores

The aim of our study was, echocardiographic epicardial adipose tissue (EAT) thickness could show the severity and the prognosis of acute coronary syndromes (ACS). Sixty-five ACS patients (mean age 57.4±12.2years) who underwent coronary angiography were studied. EAT thickness on the free wall of right ventricle was measured at end-diastole from the parasternal long-axis views of 3 cardiac cycles. SYNTAX and Global Registry of Acute Coronary Events (GRACE) scoring considered for severity and the prognosis of ACS. The mean value of the EAT thickness were 5.5±0.5mm (range 1-12mm). EAT thickness had a positive correlation with high sensitive troponin T (r=0.712, P<0.001) and body mass index (r=0.522, P<0.001.) EAT thickness was significantly correlated patients with high SYNTAX score (r=0.690, P<0.001), but not correlated with GRACE score (r=0.224, P=0.072). Epicardial adipose tissue thickness was correlated with angiographic severity of ACS, but not correlated with clinical prognosis risk score.

Optimal In-Hospital and Discharge Medical Therapy in Acute Coronary Syndromes in Kerala

Background— In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of optimal in-hospital and discharge medical therapy in the Kerala ACS Registry of 25 718 admissions. Methods and Results— We defined optimal in-hospital ACS medical therapy as receiving the following 5 medications: aspirin, clopidogrel, heparin, β-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all of the above therapies except heparin. Comparisons by optimal versus nonoptimal ACS care were made via Student t test for continuous variables and χ 2 test for categorical variables. We created random effects logistic regression models to evaluate the association between Global Registry of Acute Coronary Events risk score variables and optimal in-hospital or discharge medical therapy. Optimal in-hospital and discharge medical care were delivered in 40% and 46% of admissions, respectively. Wide variability in both in-hospital and discharge medical care was present, with few hospitals reaching consistently high (&gt;90%) levels. Patients receiving optimal in-hospital medical therapy had an adjusted odds ratio (95% confidence interval)=0.93 (0.71, 1.22) for in-hospital death and an adjusted odds ratio (95% confidence interval)=0.79 (0.63, 0.99) for major adverse cardiovascular event rates. Patients who received optimal in-hospital medical care were far more likely to receive optimal discharge care (adjusted odds ratio [95% confidence interval] = 10.48 [9.37, 11.72]). Conclusions— Strategies to improve in-hospital and discharge medical therapy are needed to improve local process-of-care measures and ACS outcomes in Kerala.

Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial

ObjectiveTo quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared...

Care of acute myocardial infarction in the coronary care units of Piedmont in 2007

The treatment of acute myocardial infarction (AMI), both with ST-segment elevation [ST-elevation myocardial infarction (STEMI)] and non-ST-segment elevation [non-ST-elevation myocardial infarction (NSTEMI)], is evolving in Piedmont, with an increase in interventional procedures and hub-and-spoke networks. This new region-wide survey provides updated assessment of the management of STEMI and unprecedented data on NSTEMI. In 30 coronary care units in Piedmont, all patients with AMI symptoms of duration less than 48 h, between January and March 2007, were included. Of 921 patients, 447 had STEMI and 474 NSTEMI. Diabetes was present in 35% and chronic kidney disease in 38%. Hospital mortality was 4.7% [95% confidence interval (CI) 3.3-6.1]: age 75 years or older, Killip class higher than 1 and known diabetes or abnormal blood glucose on admission were multivariate predictors. Thrombolysis and primary percutaneous transluminal coronary angioplasty (pPTCA) were performed in 17.6 and 53.1% of 391 patients, respectively, with STEMI of 12 h or less, and 29.3% had no reperfusion therapy, notably 52% of patients aged 75 years or older and 51% of those reaching non-24/24 h interventional centres. Mortality after pPTCA was 2.5% and onsite door-to-balloon time was less than 90 min in 67.5%. Overall mortality after STEMI was 5.4% (95% CI 3.2-7.6). In NSTEMI, use of antithrombotic treatments was extensive, but invasive treatment within 72 h was limited to 8% of patients in centres without interventional facilities and independent of patient's risk profile. Mortality after NSTEMI was 4.0% (95% CI 2.2-5.8) and was predicted by both the Global Registry of Acute Coronary Events risk score and diabetes. There is room for improvement in the treatment of AMI in our region, with more extensive use of reperfusion therapy in STEMI, especially in the elderly, and early revascularization and optimal medical treatment in higher-risk NSTEMI.

Canada Acute Coronary Syndrome Risk Score: A new risk score for early prognostication in acute coronary syndromes

Despite the availability of several acute coronary syndrome (ACS) prognostic risk scores, there is no appropriate score for early-risk stratification at the time of the first medical contact with patients with ACS. The primary objective of this study is to develop a simple risk score that can be used for early-risk stratification of patients with ACS. We derived the risk score from the Acute Myocardial Infarction in Quebec and Canada ACS-1 registries and validated the risk score in 4 other large data sets of patients with ACS (Canada ACS-2 registry, Canada-GRACE, EFFECT-1, and the FAST-MI registries). The final risk score is named the Canada Acute Coronary Syndrome Risk Score (C-ACS) and ranged from 0 to 4, with 1 point assigned for the presence of each of these variables: age ≥75 years, Killip >1, systolic blood pressure <100 mm Hg, and heart rate >100 beats/min. The primary end points were short-term (inhospital or 30-day) and long-term (1- or 5-year) all-cause mortality. The C-ACS has good predictive values for short- and long-term mortality of patients with ST-segment elevation myocardial infarction and non-ST-segment elevation ACS. The negative predictive value of a C-ACS score ≥1 is excellent at ≥98% (95% CI 0.97-0.99) for short-term mortality and ≥93% (95% CI 0.91-0.96) for long-term mortality. In other words, a C-ACS score of 0 can potentially identify correctly ≥97% short-term survivors and ≥91% long-term survivors. The C-ACS risk score permits rapid stratification of patients with ACS. Because this risk score is simple and easy to memorize and calculate, it can be rapidly applied by health care professionals without advanced medical training.

Impact of Admission Glycemic Variability, Glucose, and Glycosylated Hemoglobin on Major Adverse Cardiac Events After Acute Myocardial Infarction

OBJECTIVEDysglycemia is associated with poorer prognosis in patients with acute myocardial infarction (AMI). Whether admission glycemic variability (GV) has important value in prognosis of AMI patients is still unknown. The aim of the study is to investigate the prognostic value of admission GV, glucose, and glycosylated hemoglobin (HbA1c) in AMI patients.RESEARCH DESIGN AND METHODSWe measured blood glucose, HbA1c, and GV on admission in 222 consecutive patients with diagnosed AMI. GV, indicated as the mean amplitude of glycemic excursions (MAGE), was determined by a continuous glucose monitoring system. MAGE was categorized as ≥3.9 or <3.9 mmol/L, admission glucose as ≥8.61 or <8.61 mmol/L, and HbA1c as ≥6.5 or <6.5%. Participants were followed up prospectively for 12 months. The relationship of admission MAGE, glucose, and HbA1c to the major adverse cardiac event (MACE) of AMI patients was analyzed.RESULTSIn 222 enrolled patients with AMI, the rate of MACE by MAGE category (<3.9 or ≥3.9 mmol/L) was 8.4 and 24.1%, respectively (P = 0.001), by admission glucose category (<8.61 or ≥8.61 mmol/L) was 10.1 and 21.6%, respectively (P = 0.020), and by HbA1c category (<6.5 vs. ≥6.5%) was 10.7 versus 18.7%, respectively (P = 0.091). In multivariate analysis, high MAGE level was significantly associated with incidence of MACE (hazard ratio 2.419 [95% CI 1.273–9.100]; P = 0.017) even after adjusting for Global Registry of Acute Coronary Events risk score, but admission glucose and HbA1c was not.CONCLUSIONSElevated admission GV appears more important than admission glucose and prior long-term abnormal glycometabolic status in predicting 1-year MACE in patients with AMI.

Abstract TP185: Framingham Score Predicts Short-Term Risk of Major Clinical Events after a Recent Stroke

Background: Identifying patients with a recent stroke at high risk for future major vascular events may provide opportunities to improve clinical outcomes. Although Framingham Coronary Risk Score (FCRS) predicts major coronary events over 10 years in the general population free of symptomatic vascular disease, few studies have examined its role as a prognosticator after stroke. We assessed the link between the baseline FCRS and major clinical events among patients with a recent stroke. Methods: We analyzed data on ischemic stroke patients enrolled in a randomized quality improvement trial of secondary stroke prevention, conducted in 14 Kaiser Permanente hospitals in Northern California between January 2004 and September 2006. Electronic records from the index hospitalization and for 6 months following hospitalization were reviewed. Framingham Risk Scores (FRS) were calculated for each patient but all patients &gt;74 years of age (the upper age limit included in the FRS) were excluded from the analysis. FRS scores were dichotomized into high (≥20%) and low (&lt;20%) risk according to gender guidelines. The primary outcome was recurrent stroke, myocardial infarction and all-cause mortality after hospital discharge; and secondary outcomes were any stroke and any MI. Analyses were adjusted for age, gender, race, BMI, serum lipid levels, and discharge prescription of antithrombotics and statins. Results: Among 1667 patients discharged alive, mean age was 62.9 (8.6), 46% were male, 58% white, 32% had high FCRS. In adjusted analyses, high FCRS scores were associated with Black race (vs. White), higher BMI, and elevated serum triglycerides. Compared to those with low FCRS, high FCRS was associated with higher odds of the composite primary outcome 1.50 (1.16-1.93, p=0.002) and any recurrent stroke 1.53 (95% CI 1.18-1.98, p=0.001), but not any MI 1.14(95% CI 0.42-3.14, p=0.79). Additionally adjusting for age slightly attenuated these results, but did not change the significance level. A low incidence of MI (12 cases) resulted in a lack of power for this outcome. Conclusions: A baseline FRCS&gt;20% predicts higher short-term risk of major clinical events in recent ischemic stroke patients.

MR-proANP and MR-proADM for risk stratification of patients with acute chest pain

ObjectiveTo evaluate mid-regional pro-adrenomedullin (MR-proADM) and mid-regional pro-atrial natriuretic peptide (MR-proANP) as prognostic biomarkers in a representative ‘real world’ cohort of patients with suspected acute coronary syndrome (ACS).DesignProspective observational multicentre...

P 5: Value of the UKPDS risk score in the screening of asymptomatic type 2 diabetic patients for coronary stenoses and artery stiffness

Rationale and aims In patients with type 2 diabetes silent coronary disease was shown to be predictive of major cardiac events. Thus, the detection of silent myocardial ischemia (SMI) and silent coronary stenoses is challenging. Artery stiffness is also associated with a worse prognosis. The aim of this study was to examine the value of the UKPDS risk score for coronary events in the algorithm of screening for SMI, coronary stenoses and artery stiffness in patients with type 2 diabetes. Patients and Methods We included 116 patients (65 women and 51 men), aged 55.4 ± 11.8 years, without known cardiovascular disease and with normal resting ECG but at high cardiovascular risk. SMI was assessed on an ECG stress test, and a coronary angiography was carried out in the patients with SMI. Significant coronary stenoses (SCS) were defined as ≥ 70% (or 50% for the main left coronary artery). The 10-year coronary risk of non fatal events was estimated using the UKPDS risk engine. Aortic pulse wave velocity (PWV) was measured (CompliorO). Results The prevalence of hypertension, obesity, dyslipidemia, nephropathy and smoking was 61.2%, 47.2%, 52.6%, 36.2 and 6%, respectively. SMI was found in 59 patients. A coronary angiography was performed in 51 of them, and 22 (15 men and 7 women) had SCS. The coronary risk score was 18.8±16.0%, and was significantly higher in men than in women (29.4±18.3% vs 10.6±6.8%, p Conclusion In this population of type 2 diabetic patients at high cardiovascular risk, an UKPDS risk score for non fatal coronary events ≥ 15% was associated with a significantly increased risk of artery stiffness and silent coronary stenoses. This score may help in screening patients who should be tested for these disorders.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Abstract 280: Mayo Clinic Percutaneous Coronary Intervention Risk Score in Octogenerians Undergoing Acute Coronary Intervention

Introduction: Octogenarians comprise an increasing proportion of patients undergoing coronary angiography and percutaneous coronary interventional (PCI). Most interventional studies have focused on patients aged 50-65 years and as such there is paucity of scientific evidence regarding interventions in octogenarians. The Mayo clinic percutaneous coronary intervention risk score (MCRS) has been used to calculate the risk of patients undergoing PCI. We sought to determine the utility of MCRS in predicting clinical events in octogenarians in a busy community health care system. Methods: We tested the integer based mayo clinic risk score (MCRS) to predict clinical outcomes of 1173 consecutive octogenarians requiring urgent coronary interventions. Urgent coronary intervention was defined as PCI within 24 hours of the admission symptom onset. The MCRS was categorized into 3 score categories (Low:0-1%), (Moderate 2-8 %) and (High risk ≥ 11% ) Patients were then followed longitudinally for cardiovascular clinical outcomes. Clinical outcomes measured include readmission, all cause and cardiovascular mortality, revascularization and emergent coronary artery bypass at 30 days and 1 year of the index event. Results: There were 1173 patients that met the inclusion criteria. The mean age was 84 +/− 4 yrs. Fifty-two percent (610) were female. Ninety Four percent (1103) presented with chest pain on admission. Eighty seven percent (1020) had hypertension while 77% (903) had hyperlipidemia. Mean body mass index was 26+/− 4(kg/m2). The expected MCRS for the low, moderate and high risk category patients were 1%, 6% and 11% respectively, while the observed event rate in the corresponding categories for the 30 day adverse event rate was 1% (p=0.001), 8% (p=0.04) and 16% (p=NS). At one year the observed event rate for each corresponding category was 3%, (p=NS), 10% (p=NS) and 19%(P=NS). Conclusion: The Mayo clinic percutaneous coronary intervention risk score correlated well with expected and observed 30-day clinical outcomes in octogenarians with low to moderate risk categorization. In the high-risk patients the 30 day and 1 year outcomes had poor correlation between expected and observed events.

Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction

Prior studies demonstrated the association between the major adverse cardiovascular outcomes and both higher platelet and lower lymphocyte counts. Our study explores the value of the platelet/lymphocyte ratio (PLR) as a marker of long-term mortality in patients presented with non-ST segment elevation myocardial infarction (NSTEMI). This is an observational study with a total 619 NSTEMI patients admitted to a tertiary center between 2004 and 2006. Patients were stratified into equal tertiles according to their admission PLR. The primary outcome, 4year all-cause mortality, was compared among the PLR tertiles. The first, second and third PLR tertiles were PLR<118.4, 118.4≤PLR≤176, and PLR>176, respectively) included 206, 206 and 207 patients, respectively. There was a significant higher 4year all-cause mortality in the higher PLR tertiles (the mortalities were 17, 23 and 42% for the first, second and third PLR tertiles respectively, p<0.0001). After exclusion of patients expired in the first 30days, patients in the first PLR tertile had a significant lower 4year mortality (33/205, 16%) versus those in the third PLR tertile (72/192, 38%), p<0.0001. After controlling for Global Registry of Acute Coronary Events risk scores and other confounders, the hazard ratio of mortality increased 2% per each 10U increase of PLR (95%CI 1.01-1.03, p<0.0001). In patients with PLR≥176, the mortality rate was statistically higher in those received mono-antiplatelet (30/60=50%) compared to those received dual antiplatelet therapy (48/149=32%), p=0.0018. However in PLR<176, the mortality was not significantly different between mono-antiplatelet group (20/94=21%) versus dual antiplatelets group (53/213=25%), p=0.56. The PLR is a significant independent predictor of long-term mortality after NSTEMI. Among patients with PLR>176, patients with dual antiplatelet therapy had lower mortality versus those with mono-platelet therapy. Further studies are needed to clarify these findings.

C-Reactive Protein and the Framingham Coronary Risk Score in Patients Newly Diagnosed With Intermittent Claudication

To investigate the relationship between serum C-reactive protein (CRP) levels and the calculated 10-year Framingham risk score (FRS) in patients newly diagnosed with intermittent claudication. Serum CRP levels were measured in 90 patients newly diagnosed with intermittent claudication over a 12-month period. In all, 76 patients (53 males [70%], mean age 63.3 ± 9.3) were included in the analysis. Log-transformed CRP levels significantly correlated with total FRS (r = .34, P = .002). Participants were divided into 4 groups according to log-CRP levels. Analysis of variance showed a statistically significant difference between the 4 groups in terms of mean FRS, P = .003. Post hoc comparisons indicated that group 1 was significantly different from group 4, P = .002. Analysis of covariance showed a significant difference between the 4 groups of log-CRP levels in terms of mean FRS, P = .008. There is an increased 10-year risk of coronary heart disease associated with increased plasma concentration of CRP in patients newly diagnosed with intermittent claudication.