Events Score Research Articles

Prognostic value of CHA2DS2-VASc score for the long-term cardiovascular events after coronary artery bypass grafting

Background: This study aims to investigate the value of the CHA2DS2-VASc score in predicting long-term major cardiovascular events following coronary artery bypass grafting. Methods: Between January 2008 and January 2010, a total of 559 patients (445 males, 114 females; mean age: 62.7±9.1 years; range, 35 to 84 years) who underwent elective coronary artery bypass grafting were retrospectively analyzed. At a mean of 10.7±3.1-year follow-up, major cardiovascular events were considered as the primary endpoint. Results: The multivariate Cox hazard analysis identified the CHA2DS2-VASc score as an independent predictor of major cardiovascular events (hazard ratio: 1.615; 95% confidence interval: 1.038-2.511; p=0.034). The receiver operating characteristic curve analyses revealed that 3.5 was the most optimal cut-off value of the score predicting major cardiovascular events and the patients were divided into two groups accordingly. The Kaplan-Meier analysis demonstrated a significantly higher incidence of major cardiovascular events in proportion to a higher CHA2DS2-VASc score (p<0.001). Conclusion: CHA2DS2-VASc score ≥4, which includes many risk factors for cardiovascular events, can be used as an independent predictor of long-term major cardiovascular events after coronary artery bypass grafting.

Predictors of Adverse Outcome in High-Risk Percutaneous Coronary Interventions Patients.

Identifying high-risk percutaneous coronary intervention (PCI) patients is challenging. We aimed to evaluate which high-risk patients are prone to adverse events. We performed a retrospective study including consecutive high-risk PCIs from 2005 to 2018 in a large tertiary medical centre. Patients with unprotected left main (LM) disease, last patent coronary vessel, or 3-vessel coronary artery disease with left ventricular ejection fraction < 35% were included. A predictive 30-day major adverse cardiac events (MACE) score consisting of any myocardial infarction, all-cause death, or target-vessel revascularisation was constructed. From 2005 to 2018, a total of 1890 patients who underwent PCI met the predefined high-risk PCI criteria. Mortality rate was 8.8% at 30 days and 20.7% at 1 year, and 30-day MACE rate was 14.2% and 33.5% at 1 year. Predictors of short-term MACE were New York Heart Association functional class (NYHA) 4 (hazard ratio [HR] 6.65; P<0.001), systolic blood pressure (SBP) < 90 mm Hg (HR 4.93; P<0.001), creatinine > 1.3 mg/dL (HR 3.57; P< 0.001), hemoglobin< 11.0 g/dL (HR 3.07; P < 0.001), pulmonary artery systolic pressure> 50 mm Hg (HR 2.06; P<0.001), atrial fibrillation (HR 1.74; P<0.001), and LM disease (HR 2.04; P<0.001) or last patent vessel (HR 1.70; P= 0.002). A score constructed from these parameters reached a sensitivity of 90% and a specificity of 81% with areas under the receiver operating characteristic curve of 0.92 for MACE and 0.94 with 89% sensitivity and 87% specificity for all-cause mortality. Specific features such as LM lesion or last patent conduit, pulmonary hypertension, atrial fibrillation, anemia, and renal failure, along with low SBP and NYHA 4, aid risk stratification and consideration of further treatment measures.

Dynamic CZT-SPECT: Characterizing the Lower Values of Myocardial Blood Flow and Reserve.

CZT-SPECT myocardial perfusion enables quantification of myocardial blood flow (MBF). Normal values and thresholds have been accurately defined in PET but remain unclear in SPECT. The aim of this study was to report normal MBF and myocardial flow reserve values in very low-risk patients referred for coronary artery disease screening with dynamic SPECT, in comparison with patients experiencing coronary artery disease. Eighty-four patients (31 male) were analyzed. The mean 10 years risk of fatal cardiovascular events score was 2.7% ± 1.4%. The mean global stress MBF and myocardial flow reserve were 1.6 ± 0.6 mL/min/g and 2.7 ± 0.7.

SASE, Success and Adverse event Score in Endoscopic Retrograde Cholangiopancreatography: a Novel Grading System

BackgroundValidated, accepted grading tools for preprocedural complexity assessment in ERCP are lacking. We therefore created a grading system for ERCP based on the classification used by the American Society for Gastrointestinal Endoscopy (ASGE).MethodsData on ERCP adverse events (AE) and success were collected in a multicenter, prospective uncontrolled study. Multiple logistic regressions were applied to success and AEs in accordance with the ASGE classification. Each procedure suggested by ASGE was tested against different outcomes. Results were used to create a score and were evaluated in a control cohort.Results16,327 ERCPs were documented in 27 centers. Analysis of ASGE categorization (10,904 cases) showed that this model fails to adequately predict parameters of complexity; only for cardiopulmonary AEs and perforation was no significant variance evident. Depending on the specific clinical circumstances, probability of success of the intervention sometimes varied significantly in risk, implying a twofold score, one part for probability of success and one for risk. A split score with three levels each was designed and tested in a validation cohort (5,423 procedures). Achieving therapeutic targets / post-ERCP pancreatitis could be correctly predicted in 87.0%/95.3%.ConclusionsGrading ERCP success and AEs have to be considered independently. Onefold grading systems appear incomplete and unable to provide an adequate classification of severity. SASE (Success and Adverse Event Score in Endoscopic Retrograde Cholangiopancreatography) was created to incorporate these findings. Showing high predictive value, this score could be a potent tool for planning ERCP and training in endoscopy.

Socio-demographic correlates and psychosocial stressors among suicide attempters attending a tertiary care general hospital

Abstract Introduction: Suicide is a rapidly growing and critical public health concern in India and around the world. Interpersonal, social, familial, psychological along with genetic vulnerabilities were important risk factors for suicidal attempts. Methods: This was a hospital-based cross-sectional study done at King George Hospital, Visakhapatnam. All the suicide attempters admitted to the General Medicine department were evaluated at the psychiatric department. A total of 117 patients were included in our study with convenient sampling. Beck’s suicide intent scale, Presumptive stressful life event scale, and semi-structured proforma for socio-demographic and clinical variables were used to assess the study participants. Results: Financial struggles (19.6%) and conflict with family members (14.5%) were the stressful life events among most of the suicide attempts. Most of the study sample used pesticide consumption (20.5%) as the commonest mode of suicidal attempt. The majority of the suicide attempters (53%) had medium suicidal intent. There was a significant association between marriage and stressful life event score (p=0.001). The use of pesticides was significantly higher among men than women (p=0.002) and the use of household agents was significantly high among women than men (p=0.013). Conclusion: Psychosocial stressors also play an important role in attempting suicide and hence to prevent suicidal attempts, there is a need for the development of innovative strategies to decrease the stigma, to improve coping skills and to promote help-seeking from mental health services.

Validating the predictive ability of the 2MACE score for major adverse cardiovascular events in patients with atrial fibrillation: results from phase II/III of the GLORIA-AF registry

The 2MACE score was specifically developed as a risk-stratification tool in atrial fibrillation (AF) to predict cardiovascular outcomes. We evaluated the predictive ability of the 2MACE score in the GLORIA-AF registry. All eligible patients from phase II/III of the prospective global GLORIA-AF registry were included. Major adverse cardiac events (MACEs) were defined as the composite outcome of stroke, myocardial infarction and cardiovascular death. Cox proportional hazards were used to examine the relationship between the 2MACE score and study outcomes. Predictive capability of the 2MACE score was investigated using receiver-operating characteristic curves. A total of 25,696 patients were included (mean age 71 years, female 44.9%). Over 3 years, 1583 MACEs were recorded. Patients who had MACE were older, with more cardiovascular risk factors and were less likely to be managed using a rhythm-control strategy. The median 2MACE score in the MACE and non-MACE groups were 2 (IQR 1–3) and 1 (IQR 0–2), respectively (p < 0.001). The 2MACE score was positively associated with an increase in the risk of MACE, with a score of ≥ 2 providing the best combination of sensitivity (69.6%) and specificity (51.6%), HR 2.47 (95% CI, 2.21–2.77). The 2MACE score had modest predictive performance for MACE in patients with AF (AUC 0.655 (95% CI, 0.641–0.669)). Our analysis in this prospective global registry demonstrates that the 2MACE score can adequately predict the risk of MACE (defined as myocardial infarction, CV death and stroke) in patients with AF. Clinical trial registration:http://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007 and NCT01937377

The effects of strength of religious faith on post-traumatic growth in patients with epilepsy

AimThis study was conducted to examine the effects of strength of religious faith on post-traumatic growth in patients with epilepsy. MethodThis cross-sectional and correlational study was conducted with 112 participants who were admitted to the neurology outpatient clinic of a university hospital in eastern Turkey, who met the research criteria and agreed to participate in the study. The data were collected by using “Descriptive Information Form”, “Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ)”, and “Post-traumatic Growth Inventory (PTGI)”. Santa Clara Strength of Religious Faith Questionnaire SCRFSQ has a maximum strength of faith score of 40 points and the PGTI has a maximum growth after a traumatic event score of 105 points. ResultsMean SCSRFQ total score of the participants was found to be 31.04 ± 5.17. Mean PTGI total score was found to be 60.54 ± 16.50. As a result of the regression analysis, it was found that the independent variable affected the dependent variable PTGI total score significantly (F(1,110) = 13.999, p = 0.000). It was also found that the independent variable affected the PTGI total score positively (β = 0.336) and explained 11% of the PTGI total score (p < 0.001). ConclusionIt was found that the participants had high strength of religious faith score and moderate post-traumatic growth score. It was found that post-traumatic growth increased as strength of religious faith increased.

Trombosit Dağılım Genişliği Akut Koroner Sendrom Şiddeti ve Koroner Trombüs Yükü ile İlişkili mi?

Aim: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS), and platelet distribution width (PDW) shows the activities of platelets in circulation. The purpose of this study was to determine the association of PDW with the ACS severity and angiographic intracoronary thrombus burden and Thrombolysis In Myocardial Infarction (TIMI) flow grade.&#x0D; Materials and Methods: One hundred forty-nine consecutive patients who were diagnosed as having ACS were retrospectively evaluated. Global Registry of Acute Coronary Events (GRACE) scores were calculated from the clinical and laboratory data for ACS severity. TIMI flow grades and thrombus grades of the culprit coronary arteries were calculated for each patient. Patients were grouped into two groups according to their PDW values: high PDW and low PDW. The SPSS 17.0 software was used for statistical analysis. &#x0D; Results: PDW was found to be correlated with GRACE scores (P

A Fatal Disaster: Accompanying Aortic Dissection Obscured by Acute Coronary Syndrome.

The present study investigated the characteristics of rare but often fatal cases of acute coronary syndrome and aortic dissection and the factors affecting mortality. HEART score, aortic dissection detection risk score, and Global Registry of Acute Coronary Event (GRACE) Score were calculated by evaluating biochemical tests and symptoms/signs of the 20 patients who were admitted to our clinic with a preliminary diagnosis of acute myocardial infarction and subsequently diagnosed with aortic dissection. The assumption of normal distribution was checked with the Shapiro-Wilk test, and independent group comparisons were made with the t test or the Mann-Whitney U test. Relationships between qualitative variables were analyzed with chi-square tests. Relationships between quantitative variables were analyzed with Pearson or Spearman correlation coefficients. Patients with conditions like hypertension and diabetes are at higher risk for aortic dissection. We recommend the use of the GRACE Score with the risk parameters we have determined for the prediction of operative mortality. We suggest that the axillary region and antegrade cerebral perfusion may be preferred as the cannulation area in dissection repair. We emphasize preliminary risk assessment according to the aortic dissection detection risk score and remind physicians that ECG ST-T and troponin changes may be misleading.

Predictive value of CHA2 DS2 -VASc score for in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction undergoing primary PCI.

This study aimed to explore the predictive value of CHA2 DS2 -VASc score for in-hospital major adverse cardiac events (MACEs) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary artery intervention. A total of 746 STEMI patients were divided into four groups according to CHA2 DS2 -VASc score (1, 2-3, 4-5, >5). The predictive ability of the CHA2 DS2 -VASc score for in-hospital MACE was made. Subgroup analysis was made between gender differences. In a multivariate logistic regression analysis model including creatinine, total cholesterol, and left ventricular ejection fraction, CHA2 DS2 -VASc score was an independent predictor of MACE as a continuous variable (adjusted odds ratio: 1.43, 95% confidence interval [CI]: 1.27-1.62, p < .001). As a category variable, using the lowest CHA2 DS2 -VASc score of 1 as a reference, CHA2 DS2 -VASc score 2-3, 4-5, >5 groups for predicting MACE was 4.62 (95% CI: 1.94-11.00, p = .001), 7.74 (95% CI: 3.18-18.89, p < .001), and 11.71 (95% CI: 4.14-33.15, p < .001). The CHA2 DS2 -VASc score was also an independent risk factor for MACE in the male group, either as a continuous variable or category variable. However, CHA2 DS2 -VASc score was not a predictor of MACE in the female group. The area under the curve value of the CHA2 DS2 -VASc score for predicting MACE was 0.661 in total patients (74.1% sensitivity and 50.4% specificity [p < .001]), 0.714 in the male group (69.4% sensitivity and 63.1% specificity [p < .001]), but there was no statistical significance in the female group. CHA2 DS2 -VASc score could be considered as a potential predictor of in-hospital MACE with STEMI, especially in males.

Correlation between admission red cell distribution width and GRACE risk score as an early mortality marker in patients with acute myocardial infarction

Background: Red blood cell distribution width (RDW) is a measurement of the size variation of red blood cells in circulation. The Global Registry of Acute Coronary Events (GRACE) score is the most commonly used risk-stratification scoring system to predict mortality in acute coronary syndrome for both ST- elevated myocardial infarction (STEMI), non-ST elevated myocardial infarction (NSTEMI). The aim of this study was to assess the easily determinable red blood cell distribution width (RDW) as an early mortality marker of acute myocardial infarction (MI) mortality and the correlation of RDW-CV on admission with GRACE risk score in patients with acute myocardial infarction. Methods: This hospital-based, prospective observational study included 211 patients (mean age 58.15 +/- 12.45 years, male 176) admitted with acute MI (STEMI/NSTEMI) from January 2022 to June 2022. The study population was divided into two groups basing on the 50th percentile of the admission RDW-CV value -13.7. The GRACE score was calculated on admission to predict the GRACE in hospital mortality score within 24 hours of admission. Results: The study found that the higher RDW-CV values were associated with adverse prognostic factors in acute myocardial infarction like increased age, lower systolic blood pressure, heart failure, cardiac arrest, higher cardiac biomarker levels and higher in-hospital mortality (p = 0.049, level of significance p&lt; 0.05) and this correlated with a higher GRACE score (Pearson’s correlation coefficient R= 0.47, P&lt;0.05). Conclusion: Thus, RDW can be used as a useful parameter for predicting in-hospital mortality in acute MI patients.

Contemporary Use of Ticagrelor vs Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A GRACE Risk Score Stratification–Based Analysis in a Large-Scale, Real-World Study From China

ObjectiveTo evaluate potential gains in outcomes from ticagrelor-based strategy according to risk stratification by Global Registry of Acute Coronary Events (GRACE) score. MethodsA total of 19,704 patients discharged alive post–acute coronary syndrome who underwent percutaneous coronary intervention and received ticagrelor or clopidogrel between March 2016 and March 2019 were included in the study. The primary endpoint was ischemic events at 12 months, composed of cardiac death, myocardial infarction, and/or stroke. Secondary outcomes included all-cause mortality and Bleeding Academic Research Consortium type 2 to 5 and 3 to 5 bleeding. ResultsThe ticagrelor group comprised 6432 (32.6%) patients and the clopidogrel group comprised 13,272 (67.4%) patients. During the follow-up period, there was a significant reduction in the incidence of ischemic events in patients treated using ticagrelor who had excessive risk of bleeding. According to the GRACE score, among low-risk patients, ticagrelor use compared with clopidogrel was not associated with decreased ischemic events (HR, 0.82; 95% CI, 0.57 to 1.17; P=.27) with excessive risk of Bleeding Academic Research Consortium type 3 to 5 bleeding (HR, 1.59; 95% CI, 1.16 to 2.17; P=.004). The risk of ischemic events (HR, 0.60; 95% CI, 0.41 to 0.89; P=.01) were lower in the intermediate- to high-risk patients treated with ticagrelor without significant difference in BARC type 3 to 5 bleeding risk (HR, 1.11; 95% CI, 0.75 to 1.65; P=.61). ConclusionThere was still a gap between guideline-indicated therapy and the clinical practice in a sizable subset of patients with acute coronary syndrome who underwent percutaneous coronary intervention. The GRACE risk score could identify patients who would derive benefit from the ticagrelor-based antiplatelet strategy.

The Impact of Gender and Race When Using the GRACE ACS Score to Predict Mortality.

Acute coronary syndrome (ACS) causes significant global morbidity and mortality and requires early risk stratification. The global registry of acute coronary events (GRACE) score is a well-known, validated risk stratification system that does not include race and gender. We aimed to assess whether the addition of gender and race could add to the predictability of the GRACE score model. We performed a retrospective cohort study of 46 764 ACS patients from the files of a national healthcare system. We compared the predictability of the GRACE score in conjunction with gender and race versus the original GRACE score. Different possible associations of predictability were investigated and statistically calculated. The accuracy of the prediction models was assessed using the receiver operating characteristic curve and its respective area under the curve (AUC). We compared the AUC of the 2 models, with the significance set at a P value of less than .05. Our comparison favored the original GRACE score over the modified prediction model with gender and race added (AUC = 0.838 and 0.839 respectively, P = .008). Although the P value comparing the AUC shows that the original GRACE was superior, due to our large dataset, the actual numbers are similar and may not be clinically significant. Gender and race were significantly associated with in-hospital mortality (P < .001, P = .002, respectively). However, this relationship disappeared in the multivariate analysis. Gender significantly predicted in-hospital mortality, with females 1.167 times more likely to die (P < .001). Non-white racial groups had lower in-hospital mortality than whites (OR: 0.823, P = .03). The GRACE score was valid in its original form and its ability to predict mortality was not substantially improved by including gender and race.

Coronary Atherosclerotic Plaque Activity and Future Coronary Events

Recurrent coronary events in patients with recent myocardial infarction remain a major clinical problem. Noninvasive measures of coronary atherosclerotic disease activity have the potential to identify individuals at greatest risk. To assess whether coronary atherosclerotic plaque activity as assessed by noninvasive imaging is associated with recurrent coronary events in patients with myocardial infarction. This prospective, longitudinal, international multicenter cohort study recruited participants aged 50 years or older with multivessel coronary artery disease and recent (within 21 days) myocardial infarction between September 2015 and February 2020, with a minimum 2 years' follow-up. Coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography. Total coronary atherosclerotic plaque activity was assessed by 18F-sodium fluoride uptake. The primary end point was cardiac death or nonfatal myocardial infarction but was expanded during study conduct to include unscheduled coronary revascularization due to lower than anticipated primary event rates. Among 2684 patients screened, 995 were eligible, 712 attended for imaging, and 704 completed an interpretable scan and comprised the study population. The mean (SD) age of participants was 63.8 (8.2) years, and most were male (601 [85%]). Total coronary atherosclerotic plaque activity was identified in 421 participants (60%). After a median follow-up of 4 years (IQR, 3-5 years), 141 participants (20%) experienced the primary end point: 9 had cardiac death, 49 had nonfatal myocardial infarction, and 83 had unscheduled coronary revascularizations. Increased coronary plaque activity was not associated with the primary end point (hazard ratio [HR], 1.25; 95% CI, 0.89-1.76; P = .20) or unscheduled revascularization (HR, 0.98; 95% CI, 0.64-1.49; P = .91) but was associated with the secondary end point of cardiac death or nonfatal myocardial infarction (47 of 421 patients with high plaque activity [11.2%] vs 19 of 283 with low plaque activity [6.7%]; HR, 1.82; 95% CI, 1.07-3.10; P = .03) and all-cause mortality (30 of 421 patients with high plaque activity [7.1%] vs 9 of 283 with low plaque activity [3.2%]; HR, 2.43; 95% CI, 1.15-5.12; P = .02). After adjustment for differences in baseline clinical characteristics, coronary angiography findings, and Global Registry of Acute Coronary Events score, high coronary plaque activity was associated with cardiac death or nonfatal myocardial infarction (HR, 1.76; 95% CI, 1.00-3.10; P = .05) but not with all-cause mortality (HR, 2.01; 95% CI, 0.90-4.49; P = .09). In this cohort study of patients with recent myocardial infarction, coronary atherosclerotic plaque activity was not associated with the primary composite end point. The findings suggest that risk of cardiovascular death or myocardial infarction in patients with elevated plaque activity warrants further research to explore its incremental prognostic implications.

Physical activity based on manipulative exercise: how it affects the gross motor of children with autism for 12 years old?

This study aims to determine the effect of manipulative exercise on gross motor ability in students with grade V autism at SDLB who are 12 years old. The method and design used in this study is single-subject research using an Applied Behavior Analysis (ABA) design. Researchers use test techniques in the form of instruments that use an event score recording system by providing checks/notes on paper that have been provided for each event or behavior that occurs up to a predetermined period. Data collection is carried out by observation and documentation techniques which are then analyzed using visual analysis under conditions. The results of this study provide a conclusion that manipulative exercises have an influence on the gross motor ability of students with autism, so manipulative exercises can be used as an alternative to improving gross motor ability. This success may be influenced by several other factors that limit this study such as social, cultural, linguistic, and possibly even genetic characteristics that can be used for further study. The recommendation for further research is to conduct further research by paying attention to the limitations of this research.

Predicting arrhythmic event score in Brugada syndrome: Worldwide pooled analysis with internal and external validation

Brugada syndrome is an inherited arrhythmic disease associated with major arrhythmic events (MAE). Risk predictive scores were previously developed with various performances. The purpose of this study was to create a novel score-Predicting Arrhythmic evenT (PAT)-with internal and external validation. A systematic review was performed to identify risk factors for MAE. The odds ratios (ORs) of each factor were pooled across studies. The PAT scoring scheme was developed based on pooled ORs. The PAT score was internally validated with published 105 Asian patients (follow-up 8.0 ± 4.1 [SD] years) and externally validated with unpublished 164 multiracial patients (82.3% White, 14.6% Asian, 3.2% Black; mean follow-up 8.0 ± 6.9 years) with Brugada syndrome. Performances were assessed and compared with previous scores using receiver operating characteristic curve (ROC) analysis. Sixty-seven studies published between 2002 and 2022 from 26 countries (7358 patients) were included. Pooled ORs were estimated, indicating that 15 of 23 risk factors were significant. The PAT score was then developed accordingly. The PAT score had significantly better discrimination (ROC 0.9671) than the BRUGADA-RISK score (ROC 0.7210; P = .006), Shanghai Score System (ROC 0.7079; P = .003), and Sieira etal score (ROC 0.8174; P = .026) in an external validation cohort. PAT score ≥ 10 predicted the first MAE with 95.5% sensitivity and 89.1% specificity (ROC 0.9460) and the recurrent MAE (ROC 0.7061) with 15.4% sensitivity and 93.3% specificity. The PAT score was shown to be useful in predicting MAE for primary prevention in patients with Brugada syndrome.

Predictive value of ASCVD risk score for mortality and major adverse cardiovascular events in the year following a COVID-19 infection among US Veterans

BackgroundMorbidity and mortality following COVID-19 infection may be influenced by baseline atherosclerotic cardiovascular disease (ASCVD) risk, yet limited data are available to identify those at highest risk. We examined the association between baseline ASCVD risk with mortality and major adverse cardiovascular events (MACE) in the year following COVID-19 infection. MethodsWe evaluated a nationwide retrospective cohort of US Veterans free of ASCVD who were tested for COVID-19. The primary outcome was absolute risk of all-cause mortality in the year following a COVID-19 test among those hospitalized vs. not stratified by baseline VA-ASCVD risk scores. Secondarily, risk of MACE was examined. ResultsThere were 393,683 Veterans tested for COVID-19 and 72,840 tested positive. Mean age was 57 years, 86% were male, and 68% were white. Within 30 days following infection, hospitalized Veterans with VA-ASCVD scores >20% had an absolute risk of death of 24.6% vs. 9.7% (P ≤0.0001) for those who tested positive and negative for COVID-19 respectively. In the year following infection, risk of mortality attenuated with no difference in risk after 60 days. The absolute risk of MACE was similar for Veterans who tested positive or negative for COVID-19. ConclusionsVeterans without clinical ASCVD experienced an increased absolute risk of death within 30 days of a COVID-19 infection compared to Veterans with the same VA-ASCVD risk score who tested negative, but this risk attenuated after 60 days. Whether cardiovascular preventive medications can lower the risk of mortality and MACE in the acute period following COVID-19 infection should be evaluated.

Assessment of Predictive Value of SYNTAX-II Score for Adverse Cardiac Events and Clinical Outcomes in Patients With Acute Coronary Syndrome.

Prognostic information is important for the management of acute coronary syndrome (ACS). Our aim was to evaluate Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score-II (SSII) for predicting contrast induced nephropathy (CIN) and one-year major adverse cardiac events (MACE) in ACS patients. Coronary angiographic recordings of 1304 ACS patients were retrospectively examined. Predictive values of SYNTAX score (SS), SSII-percutaneous coronary intervention (SSII-PCI), SSII-coronary artery bypass graft (SSII-CABG) scores for CIN and MACE were assessed. Combination of CIN and MACE ratios constituted primary composite end-point. Patients with SSII-PCI scores >32.55 were compared with patients with lower scores. All of the three scoring systems predicted the composite primary end-point [SS: Area under the curve (AUC): .718, P < .001 (95% CI: .689-.747), SSII-PCI: AUC: .824, P < .001 (95% CI: .800-.849), SSII-CABG: AUC: .778, P < .001 (95% CI: .751-.805)]. Comparison of AUC of receiver operating characteristic curves showed that SSII-PCI score had better predictive value than that of SS and SSII-CABG scores. In multivariate analysis, the only predictor of the primary composite end-point was SSII-PCI score (odds ratio: 1.126, 95% CI: 1.107-1.146, P < .001). SSII-PCI score was a valuable tool for prediction of shock, CABG, myocardial infarction, stent thrombosis, development of CIN and one-year mortality.

Predictive Value of the Modified GRACE Scoring System for All-Cause Mortality in Patients with Acute Myocardial Infarction.

To establish a modified Global Registry of Acute Coronary Events (GRACE) scoring system with an improved predictive performance compared with the traditional GRACE scoring system. We identified 5512 patients who were hospitalized with a definite diagnosis of acute myocardial infarction (AMI) from January 1, 2015, to December 31, 2020, at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University through the hospital's electronic medical record system. A total of 4561 patients were enrolled after the inclusion and exclusion criteria were applied. The mean follow-up was 51.8 23.4 months. The patients were divided into dead and alive groups by endpoint events. The differences between the two groups were compared using the two-sample t test and chi-square test. Adjusted traditional risk factors as well as LogBNP (B-type natriuretic peptide precursor, BNP) and the modified GRACE scoring system were included in a multifactorial COX regression model. The predictive performance of the traditional and modified GRACE scoring systems was compared by (Receiver Operating Characteristic) ROC curves. Significant differences in age, heart rate, creatinine, uric acid, LogBNP, traditional GRACE score, and modified GRACE score were found between the dead and alive groups by the two-sample t test. Comparison of the two groups by the chi-square test revealed that the dead group had a higher incidence of males; higher cardiac function class; a previous history of hypertension, diabetes, coronary artery disease (CAD), or cerebrovascular disease; a history of smoking; the need for intra-aortic balloon pump (IABP) support; and more patients taking aspirin, clopidogrel, ticagrelor, and -blockers. The results were analyzed by a multifactorial COX regression model, and after adjusting for confounders, age, cardiac function class, history of CAD, use of aspirin and -blockers, and the modified GRACE scoring system were found to be associated with all-cause mortality (ACM) in patients with AMI. The ROC curve was used to compare the predictive performance of the conventional GRACE scoring system with that of the modified GRACE scoring system, and it was found that the modified GRACE scoring system (Area Under Curve (AUC) = 0.809, p 0.001, 95% (Confidence Interval) CI (0.789-0.829)) was significantly better than the traditional GRACE scoring system (AUC = 0.786, p 0.001, 95% CI (0.764-0.808)), the comparison between the two scores was statistically significant (p 0.001). The change in the C statistic after 10-fold crossover internal validation of the modified GRACE score was not significant, and the integrated discrimination improvement (IDI) between the old and new models was calculated with IDI = 0.019 0, suggesting that the modified GRACE score has a positive improvement on the traditional GRACE score. The modified GRACE scoring system, established by combining B-type natriuretic peptide precursor (BNP) and the traditional GRACE scoring system, was independently associated with ACM in patients with AMI, with a larger AUC and higher predictive value than the traditional GRACE scoring system. NCT02737956.

Deep learning tumor heterogeneity metric from histopathology images vs next generation sequencing-derived scores for colon cancer prognostication.

3537 Background: Tumor heterogeneity is as an important determinant of clinical behavior in many cancer types, with increased heterogeneity thought to confer inferior clinical outcome. Sequencing based assessment of colon cancer has been used to quantify tumor heterogeneity and correlate it with survival, but is sensitive to the mutation calling algorithm utilized. Digitization of histopathology slides allows application of deep learning methods for image analysis. Automated slide annotation and feature extraction provides numeric representations of underlying phenotype from which tumor heterogeneity can be estimated. Here we compare the ability of a deep-learning tumor heterogeneity score (THS) to estimate overall survival in colon cancer patients to estimates produced by bulk sequencing derived mutant-allele tumor heterogeneity (MATH) and copy number variation (CNV) event scores. Methods: Digitized whole slide images (WSIs) from The Cancer Genome Atlas (TCGA) colon adenocarcinoma dataset are processed in a computational pipeline for tissue detection, numerical feature extraction, and cell type classification. WSIs are tiled and local THS calculated from imaging features. Corresponding MATH and CNV derived heterogeneity metrics are calculated from published sequencing data. Kaplan Meier curves are used to compare patient survival stratified by tumor heterogeneity as calculated by the three independent methods. Automated regional annotation identifies intra-tumoral and tumor-stromal boundary tiles and tumor THS is correlated to distance from the boundary. Results: Images from 379 patients (209 right-sided, 152 left-sided tumors) yielded 575,762 tiles. Automated annotation resulted in 272,791 intra-tumoral and 11,340 tumor-stromal boundary tiles. Stratification by imaging derived THS provided significant separation of overall survival curves (p &lt; .01) in contrast to MATH and CNV methods (p &gt; .05 for both). THS significantly separated the curves in right- but not left-sided cancers (p = .03 and .44, respectively). Evaluating THS as a function of distance from the tumor-stromal boundary, right-sided tumors showed significant decrease in THS with increasing distance from tumor edge. Conclusions: Our novel pipeline produced spatially resolved imaging data informed by underlying tumor phenotype without need for pathologist annotation. The resultant THS correlated with outcome and outperformed sequencing-based prognostication methods. The spatial information identified higher heterogeneity at the tumor edge than interior regions of right-sided, but not left-sided tumors, capturing known but poorly understood differences in colon tumors by location. Deep learning image analysis provided reproducible and cost-effective data with great potential both in clinical biomarker discovery and as a research tool.