Future Cardiovascular Events In Patients Research Articles

High Levels of Serum Adipocyte Fatty Acid-binding Protein Predict Cardiovascular Events in Coronary Artery Disease Patients.

Background: Adipocyte fatty acid-binding protein (A-FABP) is a cardiometabolic predictor of cardiovascular (CV) disease in humans. We evaluated the association between serum A-FABP levels and future CV events in patients with coronary artery disease (CAD).Methods: A total of 106 CAD patients were enrolled in this study between January and December 2012 and were followed-up until June 30, 2017. The primary endpoint was the incidence of major adverse CV events.Results: During a median follow-up period of 53 months, 44 CV events occurred. Patients with CV events presented higher systolic blood pressure (p = 0.020), total serum cholesterol (p = 0.047), and serum A-FABP levels (p < 0.001) compared with patients without CV events. Kaplan-Meier analysis showed that the cumulative incidence of CV events in the high A-FABP group (median A-FABP concentration of >17.63 ng/mL) was higher than that in the low A-FABP group (log-rank p < 0.001). Multivariate Cox analysis showed that triglycerides (hazard ratio (HR): 1.008, 95% confidence interval (CI): 1.001-1.016, p = 0.026) and serum A-FABP levels (HR: 1.027, 95% CI: 1.009-1.047, p = 0.004) were independently associated with CV events.Conclusion: Serum A-FABP level is a biomarker for future CV events in patients with CAD. Further prospective studies are needed to confirm the mechanisms underlying this association.

Comparison of a Simple Angiographic Approach With a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery Score-Based Approach for Left Main Coronary Artery Stenting: A Pooled Analysis of Serial PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) Studies.

The applicability of Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores to left main coronary artery disease (CAD) has been questioned. A simplified alternative is needed for guiding decision making. We evaluated the prognostic value of a simplified angiographic classification in comparison with a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score-based approach for patients with left main CAD undergoing drug-eluting stent implantation. The proposed approach classified left main CAD as either extensive (n=819), defined as left main bifurcation lesions with an involvement of ostial left circumflex artery or as any left main lesion plus multivessel CAD, or limited (n=453), defined as ostial/midshaft lesions or left main bifurcation lesions without an involvement of ostium of left circumflex artery, alone or plus 1-vessel disease. The databases from 4 prospective Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease studies were pooled, and the primary outcome was a major adverse cardiac event, defined as death, myocardial infarction, or repeat revascularization. During follow-up (median 38 months; interquartile range, 36-61 months), the risk for major adverse cardiac event was significantly higher with extensive than with limited left main CAD (adjusted hazard ratio, 2.13; 95% confidence interval, 1.54-2.94; P<0.001). The risk for a composite outcome of death or myocardial infarction was also higher with extensive left main CAD (adjusted hazard ratio, 1.75; 95% confidence interval, 1.08-2.85; P=0.02). However, Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score tertiles did not effectively stratify these 2 outcome measures. Compared with Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores, the simpler angiographic approach provided better discrimination for future cardiovascular events in patients with left main CAD undergoing drug-eluting stent implantation.

Atherosclerotic plaque characteristics are not associated with future cardiovascular events in patients undergoing iliofemoral endarterectomy

BackgroundPlaque characteristics such as intraplaque hemorrhage (IPH) have been associated with secondary cardiovascular events (CVE) in patients undergoing carotid endarterectomy. In addition, carotid plaques containing macrophage infiltration or a large lipid core size were associated with less restenosis. It is currently unknown whether iliofemoral plaque histopathologic characteristics are predictive for secondary CVE in patients with peripheral arterial disease undergoing iliofemoral endarterectomy. The aim of this study was to examine the association between iliofemoral atherosclerotic plaque characteristics and secondary CVE in patients undergoing iliofemoral endarterectomy. MethodsThere were 497 patients with iliofemoral atherosclerotic disease who underwent primary endarterectomy of the iliac or femoral artery from 2002 to 2013 included. All specimen were uptaken in the Athero Express biobank and 7 histologic plaque characteristics were analyzed: calcification, collagen, fat content, IPH, macrophages, smooth muscle cells, and vessel density. The composite CVE consisted of myocardial infarction, cerebrovascular accident, peripheral (re-)interventions, and cardiovascular death. Multivariate Cox regression models were used to examine the association between plaque and the composite end point during a follow-up period of 3 years. ResultsOf the 497 patients, 225 (46.4%) experienced a composite CVE within 3 years after the initial surgery. Calcified plaques were univariably associated with composite CVE (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.00-1.73; P = .049). After correction for confounders, multivariable analyses showed no association between calcified plaques and composite CVE (HR, 1.13; 95% CI, 0.85-1.50; P = .413). IPH was not predictive of secondary CVE (HR, 1.02; 95% CI, 0.79-1.33; P = .867). ConclusionsIn this cohort of patients with peripheral arterial disease undergoing iliofemoral endarterectomy, investigated atherosclerotic plaque characteristics were not independently associated with secondary CVE during follow-up.

O7-2 - Simple Screening Test for Sarcopenia Predicts Future Cardiovascular Events in Patients with Chronic Kidney Disease

Introduction: Recently, a simple screening test that can identify sarcopenia using three variables (age, grip strength and calf circumference) has been developed. However, clinical utility of sarcopenia score for predicting future cardiovascular events in patients with kidney disease remains unclear. Methods and Results: We calculated sarcopenia score of 265 chronic kidney disease (CKD) patients, and followed the patients for cardiovascular events. The endpoint of this study was a composite of total mortality and cardiovascular hospitalization, including heart failure decompensation. The patients in high sarcopenia score (greater than or equal to 105 in men and 120 in women) group showed significantly higher plasma BNP levels (median 103.1, interquartile range [46.3–310.0] vs. 46.7, [18.0–91.8]pg/mL, P < .0001) than those in low sarcopenia score group. Kaplan-Meier curve revealed that the risk of adverse cardiovascular events was significantly increased in high sarcopenia score group (log-rank test: P < .0001), even after potential confounding factors were corrected using propensity score matching. Multivariate Cox hazard analysis identified high sarcopenia score (hazard ratio: 3.00; 95% confidence interval: 1.44–6.27; P = .0003) as independent predictor of primary endpoints. Furthermore, the combination of high sarcopenia score and high BNP identified patients with significantly higher probability of future events (P < .0001). Conclusions: Simple screening score for sarcopenia could be a useful tool for estimating future adverse event risk in patients with CKD.

Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events

BackgroundAn inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. MethodsFrom 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. ResultsDuring a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, p=0.005). The receiver operating characteristic curve revealed that 5mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p<0.001). In the validation cohort, the presence of a large IAD (IAD ≥5mmHg) was significantly associated with the primary endpoint (p=0.021). ConclusionsIAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg.

GDF-15 predicts cardiovascular events in acute chest pain patients.

BackgroundTreatment of patients presenting with possible acute myocardial infarction (AMI) is based on timely diagnosis and proper risk stratification aided by biomarkers. We aimed at evaluating the predictive value of GDF-15 in patients presenting with symptoms suggestive of AMI.MethodsConsecutive patients presenting with suspected AMI were enrolled in three study centers. Cardiovascular events were assessed during a follow-up period of 6 months with a combined endpoint of death or MI.ResultsFrom the 1818 enrolled patients (m/f = 1208/610), 413 (22.7%) had an acute MI and 63 patients reached the combined endpoint. Patients with MI and patients with adverse outcome had higher GDF-15 levels compared with non-MI patients (967.1pg/mL vs. 692.2 pg/L, p<0.001) and with event-free patients (1660 pg/mL vs. 756.6 pg/L, p<0.001). GDF-15 levels were lower in patients with SYNTAX score ≤ 22 (797.3 pg/mL vs. 947.2 pg/L, p = 0.036). Increased GDF-15 levels on admission were associated with a hazard ratio of 2.1 for death or MI (95%CI: 1.67–2.65, p<0.001) in a model adjusted for age and sex and of 1.57 (1.13–2.19, p = 0.008) adjusted for the GRACE score variables. GDF-15 showed a relevant reclassification with regards to the GRACE score with an overall net reclassification index (NRI) of 12.5% and an integrated discrimination improvement (IDI) of 14.56% (p = 0.006).ConclusionGDF-15 is an independent predictor of future cardiovascular events in patients presenting with suspected MI. GDF-15 levels correlate with the severity of CAD and can identify and risk-stratify patients who need coronary revascularization.

Plaque characteristics and inflammatory markers for the prediction of major cardiovascular events in patients with ST-segment elevation myocardial infarction.

To investigate the clinical utility of culprit plaque characteristics and inflammatory markers for the prediction of future cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) with successful drug-eluting stent (DES) implantation. We evaluated 172 STEMI patients with successful primary percutaneous coronary intervention (PCI) with DES using pre-PCI high-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR) and pre-PCI intravascular ultrasound virtual histology (IVUS-VH) of culprit lesions. The incidence of major adverse cardiovascular events (MACE) including all-cause mortality, non-fatal MI, stroke and late revascularization were recorded during hospitalization and follow-up. During follow-up (median 41 months), the incidence of MACE did not significantly differ among patients with or without all 3 high-risk plaque features on IVUS-VH (15.1 vs. 16.2%; p = 0.39). In contrast, patients with elevated hs-CRP and NLR levels were at significant risk for MACE [32.7 vs. 5.8%; hazard ratio (HR) 7.85; p < 0.001 and 43.9 vs. 6.9%; HR 8.44; p < 0.001, respectively]. High-risk plaque features had no incremental usefulness to predict future MACE. However, the incorporation of hs-CRP and NLR into a model with conventional clinical and procedural risk factors significantly improved the C-statistic for the prediction of MACE (0.76-0.89; p = 0.04). High-risk plaque features identified by IVUS-VH in culprit lesions were not associated with future MACE in patients with STEMI receiving DES. However, elevated hs-CRP and NLR levels were significantly associated with poorer outcomes and had incremental predictive values over conventional risk factors.

Risk stratification in stable coronary artery disease

AbstractCoronary artery disease is a very common chronic condition affecting large numbers of people across the world. Once detected the natural history of coronary disease is very variable between individuals. Hence, the assessment of symptoms and current burden of disease is a key determinant for the recommendation of drug treatments and other interventions, for example, revascularization, with the aim of improving the quality and quantity of a patient's life. We here review our current approach to assessing the risk of future cardiovascular events in patients presenting with stable coronary artery disease.Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/5222692/Activity.aspx

Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry.

BackgroundThe extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated.Methods and ResultsIncluded were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end‐point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11–1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99–1.14, P=0.11), and total primary end‐point events (adjusted risk ratio 1.08, CI 1.01–1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06–1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21–1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13–1.34, P<0.001).ConclusionsPatients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

The alanine aminotransferase/aspartate aminotransferase ratio predicts future cardiovascular events in patients with established coronary artery disease and homa insulin resistance

Non-alcoholic fatty liver disease is an important feature of the metabolic syndrome and is characterized by an elevated alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio. The association of the ALT/AST ratio with cardiovascular events in insulin-resistant patients with established

PS 05-38 BRACHIAL-ANKLE PULSE WAVE VELOCITY AS A RISK STRATIFICATION INDEX FOR THE SHORT-TERM PROGNOSIS OF PATIENTS WITH ESTABLISHED CORONARY ARTERY DISEASE

Objective: We evaluated that brachial-ankle pulse wave velocity (baPWV) can be a risk stratification index to predict prognosis in patients with established CAD. Design and Method: We recruited the patients undergoing emergent or elective PCI for stable angina or acute coronary syndrome from Chungbuk national university hospital cathlab database. The clinical outcomes were surveilled via chart reviews and telephone call. Results: In total, 925 patients were enrolled (Male 670, 72.4%) with median follow-up of 524 days. The higher baPWV was defined as a median baPWV of 1730 cm s–1 or more. The patients were diagnosed as ST elevation MI (221, 23.0%), non ST elevation MI (221, 23.9%), unstable angina (294, 31.8%), stable angina (189, 20.4%). The composite end points of the study at follow-up of 12 months were cardiovascular death, nonfatal MI, and coronary revascularization. At a 12-month follow-up, we found 61 total ischemic events (higher PWV 7.9% vs normal PWV 5.8% (p = 0.211)), 18 cardiovascular deaths (2.0% vs 1.9% (p = 0.964)), 5 nonfatal MIs (0.8% vs 0.4% (p = 0.319)), 3 stent thrombosis (0.6% vs 0.3% (p = 0.313)) and 45 target-vessel revascularizations (5.9% vs 4.2% (p = 0.241)). In survival analysis, there was no significant difference between patients with higher baPWV and normal velocity. Multivariate analysis revealed that a higher baPWV was not significantly associated with poorer short-term prognosis (hazard ratio, 0.793; 95% confidence interval, 0.529–1.188) in established CAD patients. Conclusions: baPWV, a marker for arterial stiffness, is not a risk stratification index for short-term prognosis in patients with established CAD patients. Routine use of PWV to predicting future cardiovascular events in patients with established CAD seems to be unnecessary.

Prognostic significance of circulating leukocyte subtype counts in patients with coronary artery disease

Background and aimsThis study investigated the association of leukocyte subtype counts with vascular endothelial dysfunction and future cardiovascular events in patients with coronary artery disease (CAD). MethodsThe study included 389 consecutive CAD patients (259 male, 130 female; mean age, 70.1 ± 9.9 years). The patients underwent coronary angiography, and measurement of blood parameters, including leukocyte subtype counts. ResultsThere were 84 cardiovascular events during a mean follow-up of 586 ± 378 days. Kaplan–Meier analysis showed a higher probability of cardiovascular events in the high-monocyte group (≥360/mm3) compared with the low-monocyte group (<360/mm3) (log-rank test, p = 0.047). Multivariate Cox hazard analysis identified a high monocyte count as an independent predictor of cardiovascular events (hazard ratio: 1.63, 95% confidence interval:1.05–2.51, p = 0.028). Peripheral endothelial function in 355 of the CAD patients was assessed by reactive hyperemia peripheral arterial tonometry index (RHI) to examine the association of ln-RHI with leukocyte subtype counts. Total leukocyte, monocyte and neutrophil counts were significantly higher in CAD patients with low ln-RHI (<0.57: the mean ln-RHI value) compared with those with high ln-RHI (≥0.57). Univariate analyses revealed that ln-RHI in CAD patients was positively correlated with ln-total leukocyte (r = −0.187, p < 0.001), ln-monocyte (r = 0.316, p < 0.001), and neutrophil (r = −0.175, p = 0.001) counts. Multiple regression analysis showed that the monocyte count was a significant and independent factor associated with ln-RHI (adjusted R2 = 0.126, p < 0.001). ConclusionsA high monocyte count was an independent and incremental predictor of cardiovascular events in CAD patients. The monocyte count was also significantly correlated with peripheral endothelial dysfunction in CAD patients.

Association of Serum Bilirubin with SYNTAX Score and Future Cardiovascular Events in Patients Undergoing Coronary Intervention.

Bilirubin has emerged as an important endogenous antioxidant molecule, and increasing evidence shows that bilirubin may protect against atherosclerosis. The SYNTAX score has been developed to assess the severity and complexity of coronary artery disease. The aim of this study was to evaluate whether serum bilirubin levels are associated with SYNTAX scores and whether they could be used to predict future cardiovascular events in patients undergoing coronary intervention. Serum bilirubin levels and other blood parameters in patients with at least 12-h fasting states were determined. The primary endpoint was any composite cardiovascular event within 1 year, including death, nonfatal myocardial infarction, and target-vessel revascularization. In total, 250 consecutive patients with stable coronary artery disease (mean age 70 ± 13) who had received coronary intervention were enrolled. All study subjects were divided into two groups: group 1 was defined as high SYNTAX score (> 22), and group 2 was defined as low SYNTAX score (≤ 22). Total bilirubin levels were significantly lower in the high SYNTAX score group than in the low SYNTAX score group (0.51 ± 0.22 vs. 0.72 ± 0.29 mg/dl, p < 0.001). By multivariate analysis, serum total bilirubin levels were identified as an independent predictor for high SYNTAX score (adjusted odds ratio: 0.28, 95% confidence interval 0.04-0.42; p = 0.004). Use of the Kaplan-Meier analysis demonstrated a significant difference in 1-year cardiovascular events between high (> 0.8 mg/dl), medium (> 0.5, ≤ 0.8 mg/dl), and low (≤ 0.5 mg/dl) bilirubin levels (log-rank test p = 0.011). Serum bilirubin level is associated with SYNTAX score and predicts future cardiovascular events in patients undergoing coronary intervention.

Impact of aspirin on the prognosis in patients with coronary spasm without significant atherosclerotic stenosis

BackgroundCoronary spasm is one of the mechanisms of myocardial infarction with nonobstructive coronary arteries (MINOCA). The aim of this study was to investigate the effects of aspirin on future cardiovascular events in patients with coronary vasospastic angina (VSA) with non-significant atherosclerotic stenosis. MethodsThis was the retrospective analysis of the 640 VSA patients with non-significant atherosclerotic stenosis (≤50% stenosis) among 1,877 consecutive patients who underwent acetylcholine (ACh)-provocation testing between January 1991 and December 2010. The patients were divided into 2 groups treated with (n=137) or without (n=503) low-dose aspirin (81–100mg/day). We evaluated major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction, and unstable angina. ResultsIn the study population, 24 patients (3.8%) experienced MACE; there were 6 cases in VSA patients with aspirin and 6 in those without aspirin. Multivariate Cox hazards analysis for correlated factors of MACE indicated that use of statin (HR: 0.11; 95% CI: 0.02 to 0.84; P=0.033), ST-segment elevation during attack (HR: 5.28; 95% CI: 2.19–12.7; P<0.001), but not the use of aspirin as a significant predictor of MACE. After propensity score matching (n=112, each), Kaplan–Meier survival analysis indicated almost identical rate of 5-year survival free from MACE in those with aspirin, compared to those without aspirin in the entire and matched cohort (P=0.640 and P=0.541, respectively). ConclusionsLow-dose aspirin might not reduce future cardiovascular events in VSA patients with non-significant stenosis.

Remnant lipoproteinemia predicts cardiovascular events in patients with type 2 diabetes and chronic kidney disease

BackgroundPatients having type 2 diabetes mellitus (DM) and chronic kidney disease (CKD) are at high risk of cardiovascular events. Triglyceride-rich lipoprotein levels are synergistically increased in patients with DM and CKD. This study examined the predictive value of remnant lipoprotein levels for cardiovascular events in patients with DM and CKD. MethodsThree hundred and sixty-five patients with type 2 DM and CKD were enrolled. Serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method. All patients were followed prospectively for a period of 45±23 months or until occurrence of one of the following events: cardiac death, non-fatal myocardial infarction, unstable angina requiring unplanned coronary revascularization, or ischemic stroke. ResultsDuring the follow-up period, 59 patients had cardiovascular events. Multivariate Cox analysis revealed that high levels of RLP-C (≥4.3mg/dL; median value) were a significant risk factor for cardiovascular events, independent of traditional risk factors (HR: 1.30; 95% CI: 1.04–1.63; p=0.02). The addition of high levels of RLP-C to traditional risk factors improved net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.36, p=0.01; and IDI 0.03, p=0.02). ConclusionsRLP-C is useful for risk assessment of future cardiovascular events in patients having type 2 DM and CKD.

Cardiac Imaging and Individual Risk Assessment: Current State-of-the-Art and Economical Implications

Cardiac magnetic resonance (CMR) imaging is a widely used diagnostic tool in clinical practice. Besides diagnostic information, CMR may also provide prognostic information for future cardiovascular events in patients with a recent myocardial infarction (MI) and patients with suspected or known coronary artery disease (CAD). In this lecture, the diagnostic value of CMR findings is established and the independent prognostic association with future cardiovascular events is explored. The lecture is based on a meta-analysis and systematic review of prognostic studies identified by systematic MEDLINE and EMBASE searches on this topic. Published literature is reviewed for associations between CMR findings (left ventricular ejection fraction [LVEF], wall motion abnormalities [WMA], abnormal myocardial perfusion, microvascular obstruction, late gadolinium enhancement, edema, and intramyocardial hemorrhage) and hard events (all-cause mortality, cardiac death, cardiac transplantation, and MI) or major adverse cardiovascular events (MACE) (hard events and other cardiovascular events defined by the authors of the evaluated papers). Fifty-six studies (n = 25,497) were evaluated. For patients with recent MI, too few patients were evaluated to establish associations between CMR findings and hard events. LVEF (range of adjusted hazard ratios [HRs]: 1.03 to 1.05 per % decrease) was independently associated with MACE. In patients with suspected or known CAD, WMA (adjusted HRs: 1.87 to 2.99); inducible perfusion defects (adjusted HRs: 3.02 to 7.77); LVEF (adjusted HRs: 0.72 to 0.82 per 10% increase); and infarction (adjusted HRs: 2.82 to 9.43) were independently associated with hard events, and the presence of inducible perfusion defects was associated with MACE (adjusted HRs: 1.76 to 3.21). The independent predictor of future cardiovascular events for patients with a recent MI was LVEF, and the predictors for patients with suspected or known CAD were WMA, inducible perfusion defects, LVEF, and presence of infarction.

Can Apolipoproteins apoB and apoB/apoA1 Ratio Predict Future Cardiovascular Risk Post Acute Coronary Syndrome? A Retrospective Cohort Study

Background: Whether apolipoproteins B100 (ApoB) and ApoB/ApoA1 biomarkers can predict future cardiovascular events in patients with acute coronary syndrome (ACS) is unknown. We evaluated the association between these biomarkers and development of major adverse cardiovascular events within 12 months in patients with ACS. Methods: We used data from a prospective cohort study of 1149 patients (32% women) aged 55 years or less, hospitalized for ACS (January 2009-April 2013). Baseline ApoB and ApoA1 levels were measured within the first 4 days of hospitalization for ACS. Patients were followed for 12 months for the composite of death, recurrent ACS, need for recurrent revascularization, or re-hospitalization for cardiac causes. Results: After ACS, most patients had elevated ApoB levels (46% 0.8-1.1 g/L and 31% with >1.1 g/L). Patients with the lowest ApoB levels (<0.8 g/L) were more likely to be women, have a history of previous myocardial infarction, diabetes and to be prescribed statins compared with those with higher ApoB levels. There was no significant association with ApoB level and the risk of composite cardiovascular outcome after adjustment for age, sex, statin use, GRACE score, ACS severity and day of measurement (Hazard Ratio (HR) 0.79, 95% CI: 0.41-1.55). Increasing ApoB/ApoA1 ratio was also not associated with risk of developing composite cardiovascular events compared with lower ratios (HR 0.92 95% CI 0.45-1.87). Conclusion: ApoB level and ApoB/ApoA1 ratio do not predict future cardiovascular events post-ACS when measured in the first 4 days in patients aged less than 55 years.

Biomarkers for risk stratification in secondary cardiovascular prevention. A role of red blood cell distribution width and calcium score

BackgroundPatients with coronary artery disease (CAD) are considered as high risk in terms of secondary cardiovascular prevention. However, obviously the risk is not homogenous across the whole group. Red blood cell distribution width (RDW) has been recently related to adverse outcomes in patients with atherosclerosis. Calcium score (CaS) may be used for risk stratification in primary prevention. The value of these biomarkers for prediction of cardiovascular outcomes in patients with CAD is unknown. MethodsThe study group comprised 269 consecutive patients with significant stable CAD. The primary endpoint was a composite of death or nonfatal myocardial infarction. ResultsMedian post-discharge follow up was 43.2 months (IQR39.2–48.6). The primary outcome was observed in 27 patients including 13 deaths and 14 nonfatal myocardial infarction. According to ROC analysis the best cut-off value for RDW for prediction of the primary event was 14% [(AUC) = 0.69; 95%CI:0.63–0.75; p = 0.0002] and for CaS was 603 [(AUC) = 0.66; 95%CI:0.60–0.72; p = 0.001]. According to multivariable Cox regression analysis both RDW>14% (HR 2.6; 95%CI:1.1–5.9) and CaS>603 (HR 2.3; 95%CI:1.1–5.1) were independently correlated to the primary outcome. Subsequently, patients were categorized into three risk subgroups: LOW: CaS≤603 and RDW≤14–124(46.1%), MID: either CaS>603 or RDW>14–104(38.7%), and HIGH - CaS>603 and RDW>14–41(15.2%) patients. The respective risk of events according to Kaplan–Meier analysis were 4.03%, 9.62%, and 29.27% (p < 0.0001). ConclusionsRDW and calcium score may be predictors of future cardiovascular events in patients with significant CAD. They may be useful tools for risk stratification and may indicate patients suitable for more aggressive secondary prevention measures.

Abstract 18608: Low Appendicular Skeletal Muscle Mass Predicts the Future Cadiovascular Events in Patients With Acute Decompensated Heart Failure

Introduction: Heart failure (HF) is a clinical syndrome associated with diverse metabolic disturbances. Recent studies suggest that failing heart through secretion of soluble myostatin may induce skeletal muscle wasting in HF patients and skeletal muscle plays an important role in pathogenesis of exercise intolerance in patients with chronic HF. However, the clinical significance of skeletal muscle mass in patients with acute decompensated HF (ADHF) remains unclear. Hypothesis: We hypothesized that low appendicular skeletal muscle mass could predict the occurrence of future cardiovascular (CV) events in patients with ADHF. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 96 patients with ADHF (age 72±11, left ventricular ejection fraction (LVEF) 38±15%, B-type natriuretic peptide (BNP) levels on admission 752 [377-1398] pg/ml). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height 2 ) was defined according to the Asia Working Group for Sarcopenia criteria (&lt;7.0kg/m 2 in male, &lt;5.4kg/m 2 in female). ADHF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, or HF re-hospitalization). Results: ASMI significantly correlated with age (r=-0.51, P&lt;0.001), male sex (r=0.53, P&lt;0.001), body mass index (r=0.63, P&lt;0.001), systolic blood pressure on admission (r=0.21, P=0.04), and BNP levels on admission (r=-0.39, P=0.04). ADHF patients with low ASMI (n=54, 56%) had higher BNP levels (968 [552-1773] versus 498 [273-943], p=0.001) and higher rate of clinical scenario 2-3 (48% versus 12%, p=0.001) than those with normal ASMI. 42 patients developed CV events (median follow-up, 16months). Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the low ASMI group than those in the normal ASMI group (54% vs. 29%, log-rank test, P=0.02). Multivariate Cox hazard analysis identified low ASMI as an independent predictor of the CV events in patients with ADHF (hazard ratio 2.1, 95%-confidence interval 1.1-4.2, P=0.03). Conclusions: Low ASMI could predict the future CV events in patients with ADHF, irrespective of LV systolic function and other clinical profile.

Antiplatelet and Statin Use in US Patients With Coronary Artery Disease Categorized by Race/Ethnicity and Gender, 2003 to 2012

Antiplatelets and statins are efficacious for preventing future cardiovascular events in patients with coronary heart disease. Disparity in cardiovascular outcomes exists by race/ethnicity and gender; however, few studies have explored potential disparities in long-term antiplatelet and statin use by race/ethnicity and gender. We conducted a repeated cross-sectional analysis using the nationally representative Medical Expenditure Panel Survey from 2003 to 2012. The sample consisted of 14,334 men and women >29years with coronary heart disease. We identified antiplatelet and statin use, medical conditions, and sociodemographic characteristics. Rates of use did not change for statins or the combination of statins and antiplatelets from 2003 to 2012 but decreased for antiplatelets (p= 0.015). Of the total sample, 70.9% (95% confidence interval [CI] 69.7 to 72.1) reported use of antiplatelets, 52.5% (95% CI 51.1 to 53.8) reported statin use, and 43.1% (95% CI 41.8 to 44.4) reported the combination. Use of antiplatelets and statins were associated with one another (odds ratio 3.22; 95% CI 2.87 to 3.62). From 2009 to 2012, black and Hispanic men along with all race/ethnicities of women were less likely to report use of statins, antiplatelets, and the combination of the 2 compared with white men, even after controlling for sociodemographics. Changing the definition of a medication use, inclusion of cardiovascular risk factors, or the inclusion of warfarin in the antiplatelet category did not substantially change the results. Future practice and policy goals should focus on increasing the number of high-risk patients on appropriate preventative medications while focusing particular attention on decreasing the identified disparity.