Incidence Of Major Cardiac Events Research Articles

Standardized risk-stratified cardiac assessment and early posttransplant cardiovascular complications in kidney transplant recipients.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in kidney transplant recipient (KTR). There is a dearth of standardized guidelines on optimal cardiovascular evaluation of transplant candidates. This single-center cohort study aims to determine the effectiveness of our standardized risk-stratified pretransplant cardiovascular screening protocol, which includes coronary angiography (CAG), in identifying advanced CVD, the proper pretransplant management of which could lead to a reduction in the incidence of major cardiac events (MACE) in the early posttransplant period. Out of the total 776 KTR transplanted between 2017 and 2019, CAG was performed on 541 patients (69.7%), of whom 22.4% were found to have obstructive coronary artery disease (CAD). Asymptomatic obstructive CAD was observed in 70.2% of cases. In 73.6% of cases, CAG findings resulted in myocardial revascularization. MACE occurred in 5.6% (N = 44) of the 23 KTR with pretransplant CVD and 21 without pretransplant CVD. KTR with posttransplant MACE occurrence had significantly worse kidney graft function at the first year posttransplant (p = 0.00048) and worse patient survival rates (p = 0.0063) during the 3-year follow-up period compared with KTR without MACE. After adjustment, the independent significant factors for MACE were arrhythmia (HR 2.511, p = 0.02, 95% CI 1.158-5.444), pretransplant history of acute myocardial infarction (HR 0.201, p = 0.046, 95% CI 0.042-0.970), and pretransplant myocardial revascularization (HR 0.225, p = 0.045, 95% CI 0.052-0.939). Asymptomatic CVD is largely prevalent in KTR. Posttransplant MACE has a negative effect on grafts and patient outcomes. Further research is needed to assess the benefits of pretransplant myocardial revascularization in asymptomatic kidney transplant candidates.

Prognostic value of right ventricular trabecular complexity in patients with arrhythmogenic cardiomyopathy.

The present study aimed to investigate the incremental prognostic value of the right ventricular fractal dimension (FD), a novel marker of myocardial trabecular complexity by cardiac magnetic resonance (CMR) in patients with arrhythmogenic cardiomyopathy (ACM). Consecutive patients with ACM undergoing CMR were followed up for major cardiac events, including sudden cardiac death, aborted cardiac arrest, and appropriate implantable cardioverter defibrillator intervention. Prognosis prediction was compared by Cox regression analysis. We established a multivariable model supplemented with RV FD and evaluated its discrimination by Harrell's C-statistic. We compared the category-free, continuous net reclassification improvement (cNRI) and integrated discrimination index (IDI) before and after the addition of FD. A total of 105 patients were prospectively included from three centers and followed up for a median of 60 (48, 66) months; experienced 36 major cardiac events were recorded. Trabecular FD displayed a strong unadjusted association with major cardiac events (p < 0.05). In the multivariable Cox regression analysis, RV maximal apical FD maintained an independent association with major cardiac events (hazard ratio, 1.31 (1.11-1.55), p < 0.002). The Hosmer-Lemeshow goodness of fit test displayed good fit (X2 = 0.68, p = 0.99). Diagnostic performance was significantly improved after the addition of RV maximal apical FD to the multivariable baseline model, and the continuous net reclassification improvement increased 21% (p = 0.001), and the integrated discrimination index improved 16% (p = 0.045). In patients with ACM, CMR-assessed myocardial trabecular complexity was independently correlated with adverse cardiovascular events and provided incremental prognostic value. The application of FD values for assessing RV myocardial trabeculae may become an accessible and promising parameter in monitoring and early diagnosis of risk factors for adverse cardiovascular events in patients with ACM. • Ventricular trabecular morphology, a novel quantitative marker by CMR, has been explored for the first time to determine the severity of ACM. • Patients with higher maximal apical fractal dimension of RV displayed significantly higher cumulative incidence of major cardiac events. • RV maximal apical FD was independently associated with major cardiac events and provided incremental prognostic value in patients with ACM.

Association between an early revascularization strategy and major cardiac events based on left ventricular dyssynchrony in patients at intermediate risk of major cardiac events using the J-ACCESS risk model.

Objective This retrospective study aimed to investigate the association between therapeutic strategies and the development of major cardiac events (MCEs) in intermediate-risk patients by using the J-ACCESS risk model in combination with the stress phase bandwidth (SPBW), an index of left ventricular dyssynchrony. Methods Patients were followed-up for three years to confirm their prognosis. Based on the estimated propensity scores, the patients who underwent revascularization within the first 60 days after SPECT and those who did not were matched 1:1 (n = 367 per group). The composite endpoint was the occurrence of MCEs, consisting of cardiac death, non-fatal myocardial infarction, and severe heart failure. SPBW was calculated by a phase analysis using the Heart Risk View-F software program, and the MCE rate was compared between the two groups by applying the normal value of SPBW (38°). Patients The study included 2,053 patients with either known or suspected CAD who underwent electrocardiogram-gated single-photon emission computed tomography myocardial perfusion imaging and were at intermediate risk of MCE according to the J-ACCESS risk model. Results During follow-up, 54 of the 734 patients (7.4%) experienced MCEs. The overall incidence of MCE in intermediate-risk patients was not significantly different between the two groups. However, the incidence of MCE in patients with an abnormal SPBW was significantly lower in those who underwent early revascularization (4.8% vs. 11.9%, P = 0.0407). Conclusion The combination of the J-ACCESS risk model and the SPBW is thus considered to be an optimal treatment strategy for patients at intermediate risk of MCE, and early revascularization may lead to an improved prognosis in intermediate-risk patients with an abnormal SPBW.

Assess the Risk Level of Acute Coronary Syndrome (ACS) Among Patients with Chest Pain in Emergency Department

Background: Fast and accurate chest pain risk stratification in the Emergency Department (ED) is critical. The HEART score predicts the short-term incidence of major cardiac events (MACE) in this population and divides them into three risk categories. Our aim was to describe the chest pain population, to characterize the subset of patients with acute coronary syndrome (ACS), and to assess the prognostic value of the Manchester triage system and the HEART score.Chest pain is a common symptom in all health care settings and may be due to a extensive variety of disease conditions. Some of those will be because of treatable causes, including musculoskeletal problems with favorable outcomes; others will be because of probably deadly life-threatening conditions, inclusive of acute coronary syndrome. Methods: Descriptive research design was adopted to conduct the study with( n=60) samples who met the inclusion criteria at Saveetha Medical College and Hospital. Samples were selected by convenience sampling Saveetha Medical College and Hospital, Chennai. A total of 60 Samples who met the inclusion criteria is selected by using convenience sampling technique. After selecting the sample, the investigator introduced him-self and explained the purpose of the study to the participants. Informed consent was obtained from the participants after assured confidentiality. The demographic and clinical variables were collected by using multiple choice questionnaires. Assess the risk level of acute coronary syndrome (ACS) by using HEART score immediately after receiving the chest pain patients with emergency. The data were collected, and score evaluation will take 10 -15 minutes after The data were tabulated and analyzed by descriptive and inferential statistics Result: The risk level of acute coronary syndrome (ACS) among patients with chest pain in emergency department. Study finding shows that out of 60 samples in risk level of acute coronary syndrome (ACS) among patients with chest pain in emergency department by using HEART Score 36(60%) had high risk, 13(21.7%) had intermediate risk and11(18.3%)had low risk. Conclusion: The chest pain is the most associate feature of major adverse cardiac events in the conditions. Chest pain is a common presentation at the Emergency Room. Rapid identification level of risk acute coronary syndrome (ACS)isacrucial component of thetriage. HEART Score is an efficient score in triaging acute chest pain patients at the Emergency Department

High-Sensitivity Cardiac Troponin I Thresholds to Identify Myocardial Injury After Noncardiac Surgery: A Cohort Study.

Myocardial injury after noncardiac surgery (MINS) is common and associated with short- and long-term major cardiovascular events. Diagnostic criteria for MINS using Abbott high-sensitivity cardiac troponin I (hs-cTnI) are unknown. We performed a prospective cohort study of adults who had in-patient noncardiac surgery and measured hs-cTnI (Abbott Laboratories) on postoperative serum samples collected up to postoperative day 3. The objective was to determine prognostically important hs-cTnI thresholds associated with major cardiac events and death at 30 days after noncardiac surgery. Using Cox proportional iterative analyses, we determined peak postoperative hs-cTnI thresholds associated with the occurrence of the 30-day composite of major cardiac events (ie, nonfatal myocardial infarction after 3 postoperative days, cardiac arrest, and congestive heart failure) and death. Of 3953 included patients, 66 (1.7%) experienced the primary outcome at 30 days. Peak hs-cTnI values and associated incidence of major cardiac events and death were as follows: < 60 ng/L: 1.0% (95% CI 0.7-1.3); 60 to < 700 ng/L: 8.6% (5.6-13.0); and ≥ 700 ng/L: 27.3% (16.4-41.9). Compared with peak hs-cTnI < 60 ng/L, adjusted hazard ratios were 7.54 (95% CI% 4.27-13.32) for hs-cTnI values of 60 to < 700 ng/L and 26.87 (13.27-54.41) for values ≥ 700 ng/L. Hs-cTnI elevation within the first 3 days after noncardiac surgery independently predicts major cardiac events and death at 30 days. A postoperative hs-cTnI ≥ 60 ng/L was associated with a > 7-fold increase in the risk of subsequent major cardiac events and mortality at 30 days.

Comparison of In-Hospital Complications among Patients with Right Ventricular Infarction

Background: Patients with right ventricular infarction is a critical condition and may cause adverse cardiac events.&#x0D; Objective: The purpose of the present study was to compare the in-hospital complications among patients with right ventricular infarction based on TIMI risk score.&#x0D; Methodology: This prospective observational study was conducted in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2007 to April 2008 for a period of one year. All the patients who were admitted into the coronary care unit of NICVD with acute inferior myocardial infarction with or without anterior myocardial infarction were selected as study population. Inclusion Criteria were patients admitted in CCU (NICVD) with acute inferior myocardial infarction with right ventricular infarction. Patients were categorized into two groups according to the extent of TIMI risk score. Patients with low TIMI risk score (0 to 3) were included in Group I and patients with high TIMI risk-score (4 to 14) were include in group II. Patients were followed up in their hospital stay to see the incidence of major cardiac events.&#x0D; Results: A total number of 60 patients with right ventricular infarction of which 30 consecutive patients with low TIMI risk score (0 to 3) were in Group I and 30 consecutive patients with high TIMI risk score (4 to 14) were in Group II. In-hospital mortality was 18.3% in the study populations and it was significantly higher in group II (33.3%) than group (3.3%). The next most common complication is cardiogenic shock followed by complete heart block, Cardiac arrest, VT and 2nd degree heart block.&#x0D; Conclusion: In conclusion the in-hospital mortality in the study populations is significantly higher in group II than group I&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):143-146

143 ESTIMATION OF RIGHT ATRIAL PRESSURE BY ULTRASOUND-ASSESSED JUGULAR VEIN DISTENSIBILITY IN PATIENTS WITH CHRONIC ADVANCED HEART FAILURE

Abstract Aims In patients with chronic advanced heart failure (HF) signs of congestion are not always evident on clinical examination. We aim to validate the ultrasound (US)-assessed jugular vein distensibility (JVD), as a non-invasive tool to identify patients with normal right atrial pressure (RAP≤7 mmHg). Methods and Results In a single-center prospective study, we assessed chronic HF patients with a left ventricular ejection fraction (LVEF)&amp;lt;50% who underwent a pulmonary artery catheterization in the setting of advanced HF therapies workup. We first identify the JVD threshold (Valsalva/rest ratio of the vein diameter) of 1.6 that allowed the most accurate discrimination between patients with RAP≤7 vs. &amp;gt;7 mmHg (area under the curve [AUC] of 0.74; p&amp;lt;0.0001) in a calibration cohort of 100 patients (mean age 53 years, median LVEF 25%). Based on this JVD threshold, we defined patients with low JVD (≤1.6; n=58; median RAP 8 mmHg) and high JVD (&amp;gt;1.6, n=42; median RAP 4 mmHg). Then, we tested the threshold in 101 patients (validation cohort), where we found comparable results (AUC of 0.82; p&amp;lt;0.0001). The JVD threshold had 0.86 and 0.94 predictive positive values to identify patients with RAP≤7 mmHg in the calibration and validation cohorts. Finally, the low JVD vs. high JVD group had a 42.7% vs. 16.1% incidence of major cardiac events at 2 years (log-rank p=0.006), showing its prognostic value. Conclusion US-assessed JVD is an accurate diagnostic tool to identify advanced HF patients with normal RAP. This tool could be tested in the ambulatory setting to modulate diuretic/vasodilator therapies.

Allopurinol pretreatment effects on coronary blood flow and revascularization outcomes in acute STEMI patients underwent emergency percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Isfahan University of Medical Sciences, Isfahan, Iran. Introduction Todays, acute ST-segment elevation myocardial infarction (STEMI) is considered as a most important component of acute coronary syndrome. In this regards, reperfusion therapy with percutaneous coronary intervention (PCI) is the most effective treatment for establishing coronary blood flow; which despite reperfusion of ischemic myocardium, it can also induce secondary injury as myocardial ischemia-reperfusion injury. The generation of reactive oxygen species by activation of xanthine oxidase (XO) enzymatic system is one of the major causes of ischemia-reperfusion injury in the ischemic myocardium and allopurinol, a XO inhibitor, has an inhibitory role on free radical productions in STEMI patients. Purpose In this study, we aimed to assess impact of allopurinol pre-treatment on revascularization outcomes, according to Thrombolysis in Myocardial Infarction (TIMI) flow and ST segment elevation recovery as well as clinical finding and major cardiac events incidence in STEMI patients underwent emergency PCI. Methods In this randomized double blind clinical trial, we enrolled 90 patients with acute STEMI in two equal groups. Allopurinol group received 600 mg allopurinol loading dose before the emergency PCI and the control group received the same shape medication as a placebo. Both groups also received the standard pretreatment protocol for PCI in acute STEMI setting. TIMI flow, ECG changes, Troponin level and major cardiac events (MACE) occurrence including death, myocardial infarction and ischemic stroke after 1 month follow up were assessed. In case group, allopurinol 100 mg daily and matched placebo pill for control group was continued for one month in addition to standard medications. Results Finally, 81 patients with acute STEMI has completed the study. The mean age of study population was 59.52 (11.31) and 61.3 (9.25) in case and control groups respectively (p = 0.49). Troponin level 48 hour after the PCI had not significant difference between the groups (p = 0.25). ECG ST-elevation regression also had not significant difference between the groups [75.0%1 vs 67.10% in case and control groups, respectively (p = 0.21)]. TIMI flow had improved in allopurinol group rather than placebo (p = 0.02). PCI success rate was 78.6% and 61.5% in allopurinol and control group respectively (p = 0.09). MACE and other clinically outcomes in follow up period were similar between groups (p &amp;gt; 0.05). Conclusions This study indicated that allopurinol pre-treatment loading dose could improve minimally revascularization outcomes based on TIMI flow in the patients undergoing primary or rescue PCI in acute STEMI setting.

Clinical Characteristics and Risk Factors of Respiratory Failure in a Cohort of Young Patients Requiring Hospital Admission with SARS-CoV2 Infection in Spain: Results of the Multicenter SEMI-COVID-19 Registry.

BackgroundAge is a risk factor for COVID severity. Most studies performed in hospitalized patients with SARS-CoV2 infection have shown an over-representation of older patients and consequently few have properly defined COVID-19 in younger patients who require hospital admission. The aim of the present study was to analyze the clinical characteristics and risk factors for the development of respiratory failure among young (18 to 50 years) hospitalized patients with COVID-19.MethodsThis retrospective nationwide cohort study included hospitalized patients from 18 to 50 years old with confirmed COVID-19 between March 1, 2020, and July 2, 2020. All patient data were obtained from the SEMI-COVID Registry. Respiratory failure was defined as the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) ≤200 mmHg or the need for mechanical ventilation and/or high-flow nasal cannula or the presence of acute respiratory distress syndrome.ResultsDuring the recruitment period, 15,034 patients were included in the SEMI-COVID-19 Registry, of whom 2327 (15.4%) were younger than 50 years. Respiratory failure developed in 343 (14.7%), while mortality occurred in 2.3%. Patients with respiratory failure showed a higher incidence of major adverse cardiac events (44 (13%) vs 14 (0.8%), p<0.001), venous thrombosis (23 (6.7%) vs 14 (0.8%), p<0.001), mortality (43 (12.5%) vs 7 (0.4%), p<0.001), and longer hospital stay (15 (9–24) vs 6 (4–9), p<0.001), than the remaining patients. In multivariate analysis, variables associated with the development of respiratory failure were obesity (odds ratio (OR), 2.42; 95% confidence interval (95% CI), 1.71 to 3.43; p<0.0001), alcohol abuse (OR, 2.40; 95% CI, 1.26 to 4.58; p=0.0076), sleep apnea syndrome (SAHS) (OR, 2.22; 95% CI, 1.07 to 3.43; p=0.032), Charlson index ≥1 (OR, 1.77; 95% CI, 1.25 to 2.52; p=0.0013), fever (OR, 1.58; 95% CI, 1.13 to 2.22; p=0.0075), lymphocytes ≤1100 cells/μL (OR, 1.67; 95% CI, 1.18 to 2.37; p=0.0033), LDH >320 U/I (OR, 1.69; 95% CI, 1.18 to 2.42; p=0.0039), AST >35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p=0.003), sodium <135 mmol/L (OR, 2.32; 95% CI, 1.24 to 4.33; p=0.0079), and C-reactive protein >8 mg/dL (OR, 2.42; 95% CI, 1.72 to 3.41; p<0.0001).ConclusionsYoung patients with COVID-19 requiring hospital admission showed a notable incidence of respiratory failure. Obesity, SAHS, alcohol abuse, and certain laboratory parameters were independently associated with the development of this complication. Patients who suffered respiratory failure had a higher mortality and a higher incidence of major cardiac events, venous thrombosis, and hospital stay.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07066-z.

Stress Echocardiography Audit: Experience of a Tertiary Care Center

Background: Stress echocardiography is a very useful diagnostic and prognostic test in the evaluation of significant coronary artery disease (CAD) causing inducible myocardial ischemia. Stress echocardiography has higher sensitivity and specificity as compared to exercise stress electrocardiography, and therefore, the guidelines recommend opting for the former modality over the latter. There are data suggesting that the incidence of major cardiac events is &lt;1% within 12 months of a negative stress echocardiogram showing no reversible ischemia. The present audit was performed to assess the predictive accuracy of stress echocardiography at our center for major cardiac events during the first year of the test. Methods: Data for all patients referred for stress echocardiography between March 10, 2015 and December 31, 2018 were captured. All patients were contacted after 1 year to evaluate for any cardiac event (cardiac death, nonfatal myocardial infarction, need for revascularization or hospital admission related to acute coronary syndrome, and/or heart failure). Analysis was performed using the standard statistical definitions. Results: Baseline information was available for 1205 patients (mean age 59 years, 60% males). Of these, 416 (34.4%) had documented CAD; 223 (18.4%) underwent stress echocardiography for chest pain evaluation, whereas 273 (22.6%) underwent the test for preoperative assessment before a noncardiac surgery. Dobutamine stress echocardiography was the modality in 1145 (95.0%) patients; ultrasound contrast was used in 1154 (95.8%) patients. One-year event rates were available for 1024 patients. Stress echocardiography was normal in 1009 (98.5%) of these patients, eight of whom had a cardiac event during the subsequent year, yielding a negative predictive value (NPV) of 99.2%. The test was abnormal in 15 (1.5%) patients, but two of them were later found to have normal coronary arteries, yielding a positive predictive value (PPV) of 86.7%. The NPV and PPV were thus both at par or even higher than most other centers. The incidence of complications during stress echocardiography was extremely low. Conclusions: This audit shows that stress echocardiography at our center has an excellent safety as well as accuracy for predicting major adverse cardiac events during the subsequent year. Stress echocardiography could thus obviate the need for coronary angiogram and even revascularization in many patients. Our findings also reinforce the value of stress echocardiography as a greatly useful preoperative test for cardiac fitness in patients undergoing a major noncardiac surgery.

High-sensitivity troponin I predicts major cardiovascular events after noncardiac surgery

Abstract Background Myocardial injury after noncardiac surgery (MINS) is common and is associated with postoperative major cardiac events and 30-day mortality. We have previously established the diagnostic criteria for MINS with the 4th-generation cardiac troponin T assay (TnT) and 5th-generation high-sensitivity TnT assay (hsTnT) based on prognostically relevant thresholds. Little is known about diagnostic criteria for MINS using the high-sensitivity troponin I (hsTnI) assay. Purpose To determine hsTnI thresholds associated with 30-day major cardiac events and death after noncardiac surgery. Methods We performed a nested prospective biobank cohort study of 4545 patients from the VISION Study. Patients were aged ≥45 years and underwent in-patient noncardiac surgery under regional or general anesthesia. Patients had samples collected and frozen preoperatively, and on postoperative days 1, 2 and 3. We measured hsTnI on thawed preoperative and postoperative samples. We used iterative Cox proportional hazard models to determine peak postoperative hsTnI thresholds independently associated with major cardiac events (i.e., composite of death, non-fatal cardiac arrest, congestive heart failure within 30 days and non-fatal myocardial infarction from postoperative days 4–30). Results Major cardiac events occurred in 89/4545 (2.0%) patients. Peak hsTnI values of &amp;lt;75 ng/L, 75 ng/L to &amp;lt;1000 ng/L, and ≥1000 ng/L were associated with an incidence of major cardiac events of 1.2% (95% CI 0.9–1.6), 7.1% (95% CI 4.8–10.5) and 25.9% (95% CI 16.3–38.4), respectively. Compared to peak hsTnI &amp;lt;75 ng/L (reference), hsTnI values 75 ng/L to &amp;lt;1000 ng/L and ≥1000 ng/L were associated with adjusted hazard ratios (aHR) of 4.53 (95% CI 2.75–7.48) and 16.17 (95% CI 8.70–30.07), respectively. No change from preoperative hsTnI to peak postoperative hsTnI significantly improved the model when included on top of the identified thresholds. Incidence of major cardiac events was 31/343 (9%) in patients with postoperative peak hsTnI ≥75 ng/L versus 52/4178 (1%) in patients with postoperative peak hsTnI &amp;lt;75 ng/L (aHR 5.76; 95% CI 3.64–9.11). A postoperative peak hsTnI ≥75 ng/L was associated with increased risk of major cardiac events either in the presence (aHR 9.35; 95% CI 5.28–16.55) or absence (aHR 3.99; 95% CI 2.19–7.25) of clinical features of myocardial injury (e.g., chest pain, ischemic electrocardiography changes). Conclusion A hsTnI elevation within the first 3 days after noncardiac surgery independently predicts major cardiac events at 30 days. A peak postoperative hsTnI ≥75 ng/L was associated with a 6-fold increase in the risk of subsequent major cardiac events at 30 days as compared to peak postoperative hsTnI&amp;lt;75 ng/L. This hsTnI threshold can be used to diagnose MINS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Siemens Healthcare Diagnostics Inc. Canadian Institutes of Health Research

Prognostic value of the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction: A systematic review and meta-regression analysis.

In all patients with ST-segment elevation myocardial infarction, risk stratification should be performed before discharge. The measurement of therapy efficiency with magnetic resonance imaging has been proposed as part of the risk assessment, but it has not been adopted widely. This meta-analysis was conducted to summarize published data on the prognostic value of the proportion of salvaged myocardium inside previously ischemic myocardium (myocardial salvage index) measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction. Random and mixed effects models were used for analyzing the data of 10 studies with 2,697 patients. The pooled myocardial salvage index, calculated as the proportion of non-necrotic myocardium inside edematous myocardium measured by T2-weighted and T1-weighted late gadolinium enhancement MRI, was 43.0% (95% confidence interval: 37.4, 48.6). The pooled length of follow-up was 12.3 months (95% confidence interval: 7.0, 17.6). The pooled incidence of major cardiac events during follow-up, defined as cardiac death, nonfatal myocardial infarction, or admission for heart failure, was 10.6% (95% confidence interval: 5.7, 15.5). The applied mixed effects model showed an absolute decrease of 1.7% in the incidence of major cardiac events during follow-up (95% confidence interval: 1.6, 1.9) with every 1% of increase in the myocardial salvage index. The heterogeneity between studies was considerable (τ = 21.3). Analysis of aggregated follow-up data after ST-segment elevation myocardial infarction suggests that the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging provides prognostic information on the risk of major cardiac events, but considerable heterogeneity exists between studies.

Personalised eHealth intervention to increase physical activity and reduce sedentary behaviour in rehabilitation after cardiac operations: study protocol for the PACO randomised controlled trial (NCT03470246)

IntroductionPersonalized intervention to increase physical Activity and reduce sedentary behaviour in rehabilitation after Cardiac Operations (PACO) is a smartphone-based and accelerometer-based eHealth intervention to increase physical activity (PA) and reduce...

The difference of risk factors predicting cardiac events in patients with chronic kidney disease between with and without diabetes.

Chronic kidney disease (CKD) and diabetes are both associated with cardiovascular disease, but the effects of diabetes in patients with CKD remain unknown. This study aimed to compare the risk factors of cardiac events between patients with CKD accompanied and not by diabetes using myocardial perfusion imaging. We initially classified 529 patients with CKD from the Japanese Assessment of Cardiac Events and Survival Study-3 (J-ACCESS-3) study who had been assessed by gated single-photon emission-computed tomography based on whether they had diabetes (n = 220) or not (n = 309) and then separated them into four subgroups based on the ejection fraction (EF) calculated by quantitative gated SPECT. After 3-year follow-up, the incidence of major cardiac events (cardiac death, sudden death, non-fatal myocardial infarction, and heart failure requiring hospitalization), risk factors among each group, and the ability of myocardial perfusion image to predict prognosis were evaluated. Major cardiac events occurred in 12.7% and 10.3% of patients with and without diabetes (not significant), and heart failure requiring hospitalization was the most frequent (75% and 78%, respectively) in both groups. Event-free survival rates were lower in the subgroups with low EF and high summed stress scores (SSS). Independent risk factors comprised currently smoking and a higher SSS, among patients with diabetes, while higher left ventricular end diastolic volumes and serum C-reactive protein values among those without diabetes. In patients with CKD, while the risk factors of major cardiac events differ between in patients with and without diabetes, quantitation with gated MPI could be used effectively in both groups.

PR deviation as a risk marker for cardiac events in patients with Takotsubo syndrome

PR segment deviation (PRD: defined as PR elevation in aVR and PR depression in lead II/III) on electrocardiography is frequently observed in patients with acute pericarditis; however, there have been few studies that explore the occurrence of PRD in patients with Takotsubo syndrome (TTS). The clinical significance of PRD in TTS is not clearly elucidated. A total of 52 consecutive patients with TTS in sinus rhythm (73.9 ± 13.8 years, nine males) were enrolled in the study. The major cardiac events were defined as sustained ventricular tachycardia or ventricular fibrillation, Killip class 4 heart failure, and cardiac death within 30 days. PRD in the hyperacute phase (within 48 h from the onset of TTS) was observed in 15 patients (29%), and all PRDs disappeared or diminished at 1 week later. The PRD (+) group had a higher value of C-reactive protein level (median: 1.80mg/dL [0.31-3.26] vs 0.20mg/dL [0.06-0.81], P=0.013) and creatine kinase-muscle/brain isoenzyme (median: 60IU/L [28-75] vs 17IU/L [13-26], P<0.001) and a lower level of left ventricular ejection fraction (42.7 ± 7.2% vs 48.8 ± 9.4%, P=0.041) than the PRD (-) group. Multivariate analysis showed that PRD was a significant and independent predictor for major cardiac events (odds ratio=21.0, 95% confidence interval=1.18-273). TTS patients with PRD in the hyperacute phase showed a high incidence of major cardiac events. Therefore, PRD may help to identify TTS patients at high risk for cardiac event.

Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk GRACE score: Prevalence, clinical outcomes and predictors

IntroductionA low-risk GRACE score identifies patients with a lower incidence of major cardiac events, however it can erroneously classify patients with severe coronary artery disease as low-risk. We assessed the prevalence, clinical outcomes and predictors of left main and/or three-vessel disease (LM/3VD) in non-ST-elevation acute myocardial infarction (NSTEMI) patients with a GRACE score of ≤108 at admission. MethodsUsing data from the Portuguese Registry on Acute Coronary Syndromes, 1196 patients with NSTEMI and a GRACE score of ≤108 who underwent coronary angiography were studied. Independent predictors of LM/3VD and its impact on in-hospital complications and one-year mortality were retrospectively analyzed. ResultsLM/3VD was present in 18.2% of patients. Its prevalence was higher in males and associated with hypertension, diabetes, previous myocardial infarction, heart failure and peripheral arterial disease (PAD). Although there were no differences in in-hospital complications, these patients had higher mortality (0.9 vs. 0.0%) and more major adverse cardiac and cerebrovascular events (MACCE) (4.1 vs. 2.5%, p=0.172), and higher one-year mortality (2.4 vs. 0.5%, p=0.005). Independent predictors of LM/3VD were age (OR 1.03; 95% CI 1.01-1.0, p=0.003), male gender (OR 2.56; 95% CI 1.56-4.17, p<0.001), heart rate (1.02; 95% CI 1.01-1.03, p<0.001), PAD (OR 3.21; 95% CI 1.47-7.00, p<0.001) and heart failure (OR 3.38; 95% CI 1.02-11.15, p=0.046). ConclusionsLM/3VD was found in one in five patients. These patients had a tendency for higher in-hospital mortality and more MACCE, and higher one-year mortality. Simple clinical variables could help predict this severe coronary anatomy.

Cardiac Events after Radiation Therapy (RT) for Stage II-III Non-Small Cell Lung Cancer (NSCLC): Analysis of 748 Patients

Radiation therapy-associated cardiac toxicity in patients with NSCLC arises sooner and is of greater clinical significance than historically appreciated. Recent studies have been limited by inconsistent definitions and small size. This study reports major cardiac events after RT in a large cohort of patients with NSCLC using comprehensive, validated cardiac toxicity criteria and dose-volume data. Retrospective study of 748 patients with Stage II (9%) to III (91%) NSCLC treated with 3D-conformal (77%) or intensity-modulated (22%) RT (median dose, 64 Gy) and chemotherapy (61%), chemotherapy and surgery (33%), or RT alone (4%) between 1998–2014 at one institution. Hearts were re-contoured per cardiac atlas definitions. Patients without baseline coronary heart disease (CHD) or CHD risk equivalent were stratified by Framingham risk. Primary endpoint was major cardiac events, defined as any grade ≥3 Common Terminology Criteria for Adverse Events (CTCAE, v4.03) or Major Adverse Cardiac Events (MACE). Estimates of Kaplan-Meier overall survival (OS) and cumulative incidence of cardiac events (non-cardiac death as a competing risk) were calculated. Fine and Gray and Cox regressions were performed. Median follow up from RT was 1.9 years. Median mean heart dose was 12.3 Gy. Two-year OS stratified by low, moderate, or high Framingham risk group or known CHD was 62.7%, 56.0%, 47.0%, and 46.8%, respectively (P=.001). Median time to first major cardiac event was 10.4 months; cumulative incidence at 1, 2, and 5-years was 18.2%, 23.5%, and 32.4%, respectively. Two-year cumulative incidence of major cardiac events (conduction, 12.0%; heart failure, 5.7%; MACE, 4.8%; pericardial [all], 4.7%; pericardial [effusion, cytology benign], 1.8%; coronary/ischemic, 2.5%; valvular, 1.1%; and cardiopulmonary/other, 5.4%) was increased in patients with vs without baseline CHD (31.2% vs 18.9%; P<.0001) and those with mean heart dose >12 Gy vs ≤12 Gy (26.7% vs 19.3%; P=.009), respectively. On multivariable analysis (MVA), baseline CHD (hazard ratio [HR] 1.75, 95% CI 1.35–2.28; P<.0001) and mean heart dose (HR 1.09/5 Gy, 95% CI 1.02–1.16; P=.013) were significantly associated with major cardiac events. On MVA accounting for baseline CHD and known lung cancer prognostic factors, major cardiac events were significantly associated with decreased OS (HR 2.91, 95% CI 2.39–3.55; P<.0001), while mean heart dose was not (HR 1.04/5 Gy, 95% CI 0.99–1.09; P=.107). In this large cohort of patients with NSCLC, major cardiac events were common, occurred sooner than previously reported, and were associated with baseline CHD and heart dose. These results build upon recent reports, support efforts to minimize heart irradiation, and highlight the importance of pre-treatment cardiac risk assessment and development of risk mitigation strategies for high risk patients.

GW29-e0833 Therapeutic effect of early interventional therapy for high-risk patients with non-ST-segment elevation acute coronary syndrome

To compare the incidence of cardiac-related events in patients with high-risk non-ST-segment elevation acute coronary syndrome (ACS) treated by early intervention with the conservative treatment of the drug. We retrospectively reviewed the incidence of major cardiac events in 104 patients with high

The efficacy of statin administration prior to elective PCI in reducing the incidence of post-procedural myocardial infarction or all-cause mortality: a systematic review

Abstract Background: Observational studies show that statin-naïve patients presenting with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI) have significantly higher rates of myocardial infarction (MI) and mortality. We plan to review the evidence for giving statin naïve patients statins 24 hours pre-PCI, with the aim of reducing post-procedural MI and mortality. Objective: To critically evaluate and appraise primary and secondary literatures that investigate the efficacy of pre-treatment loading of a statin in improving outcome for patients with ACS undergoing percutaneous coronary intervention (PCI). Review Question: What is the efficacy of statin administration prior to elective PCI in reducing the incidence of post-MI or all-cause mortality? Methods: We searched the Cochrane Database of Systemic Reviews for systemic reviews and NICE CKS database for relevant NICE clinical guidelines. We then searched the MEDLINE database and Cochrane Central Register of Controlled Trial (CENTRAL) for relevant randomised control trials (RCTs). Our search was limited to peer reviewed papers published in the last 10 years, between 1st February 2006 to 1st February 2016. Our exclusion criteria were as follows: patients previously on statin therapy; statin administration outside 24 hours of PCI; unsuitable outcomes measured; papers not available in full and non-randomised trials. We conducted a systematic review on eligible papers acquired from this search. Results: Our literature search yielded 86 papers. After reviewing these papers, 80 papers were excluded. Six papers were included in the final review in which 2207 patients received either high-dose statin treatment (n=1111) or placebo/usual care (n=1096). The ARMYDA-ACS trial showed that short-term pre-treatment with atorvastatin reduces the incidence of major cardiac events in patients with acute coronary syndromes undergoing elective PCI (OR=0.12, CI: 0.05-0.50; p=0.004). These findings were consistent with NAPLES II Trial in which preloading with atorvastatin reduced the risk of MI (OR=0.56 CI: 0.35-0.89). On the other hand, the ALPACS trial showed atorvastatin preloading had no significant benefits over usual care. They found that preloading with atorvastatin was not statistically significant reducing for post-procedural MI (OR=0.92, CI: 0.50-1.69) or mortality (OR=1.06, CI: 0.07-17.01). Three papers reported that the use of rosuvastatin given prior to elective PCI was associated with a significant reduction in post-procedural MI in patients. These were Yun KH. et al. (OR=0.50, CI: 0.25-0.98), Wang Z. et al. (OR=0.31, CI: 0.10-0.91) and Cay S. et al. (OR=0.05, CI: 0.01-0.41). Conclusion: 5 out of the 6 studies reviewed showed supported the effectiveness of pre-procedural statins use in reducing the risk of post-procedural major cardiac events in patients undergoing elective PCI. These findings support routine use of statins in patients with ACS undergoing elective PCI.

Prognostic value of rest gated myocardial perfusion SPECT imaging in male patients with ST-segment elevation myocardial infarction

Objective To investigate the prognostic value of rest gated myocardial perfusion SPECT imaging (GMPI) in male patients with ST-segment elevation myocardial infarction (STEMI). Methods Seventy male patients with acute STEMI were collected from July 2014 to December 2014. General information including age, history of hypertension, diabetes and serum levels of NT-proBNP, cTnI, hs-CRP were recorded. CAG and rest GMPI were performed to measure the LVEDV, LVESV, LVEF, and the percentage of myocardial perfusion defect size (PMPDS) was calculated. All patients were followed at least 180 d and the major cardiac events (MACE) were recorded. According to the follow-up results, patients were assigned to MACE group and non-MACE group, the prognostic value of PMPDS and NT-proBNP for MACE was analyzed by ROC curve. According to the cut-off value of PMPDS, patients were divided into 2 groups, and Kaplan-Meier survival curve were drawn. The data were analyzed by two-sample t test, Mann-Whitney u test, χ2 test, Pearson correlation analysis and log-rank test. Results The PMPDS in STEMI patients was not correlated with cTnI, hs-CRP, LVEDV and LVESV (all P>0.05), while positively correlated with NT-proBNP(r=0.793, P 0.05). The PMPDS, NT-proBNP, and number of stenotic vessels were significantly different between the two groups (t=2.4, z values: -2.1 and -3.6; all P<0.05). ROC curve analysis showed that the AUC of PMPDS was 0.700 with cut-off value of 14.06%, which was better than that of NT-proBNP (z=2.1, P<0.05). When patients were separated according to the cut-off value of 14.06%, there were significant differences in MACE incidence rates between the two groups (P<0.01). Conclusion Compared with NT-proBNP, PMPDS has a better prognostic value for predicting the MACE risk within 180 d in male STEMI patients, and can be used for the risk stratification of STEMI patients. Key words: Myocardial infarction; Male; Prognosis; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Technetium Tc 99m sestamibi