Independent Predictor Of Major Adverse Cardiovascular Events Research Articles

Lack of Incremental Prognostic Value of Pericoronary Adipose Tissue Computed Tomography Attenuation Beyond Coronary Artery Disease Reporting and Data System for Major Adverse Cardiovascular Events in Patients With Acute Chest Pain.

Pericoronary adipose tissue (PCAT) and Coronary Artery Disease Reporting and Data System (CAD-RADS) category had prognostic values for major adverse cardiovascular events (MACEs). However, little is known about the difference between CAD-RADS and PCAT computed tomography (CT) attenuation for predicting MACEs. This study was to compare the prognostic value of PCAT and CAD-RADS for MACEs in patients with acute chest pain. Between January 2010 and December 2021, all consecutive emergency patients with acute chest pain referred for coronary computed tomography angiography were enrolled in this retrospective study. MACEs included unstable angina requiring hospitalization, coronary revascularization, nonfatal myocardial infarction, and all-cause death. Patients' clinical characteristics, CAD-RADS, and PCAT CT attenuation were used to evaluate risk factors of MACEs using multivariable Cox regression analysis. A total of 1313 patients were evaluated (mean age, 57.13±12.57 years; 782 men). During a median follow-up of 38 months, 142 of the 1313 patients (10.81%) experienced MACEs. Multivariable Cox regression analysis showed that CAD-RADS categories 2, 3, 4, 5 (hazard ratio range, 2.286-8.325; all P<0.005) and right coronary artery PCAT CT attenuation (hazard ratio, 1.033; P=0.006) were independent predictors of MACEs after adjusting for clinical risk factors. The C statistics revealed that CAD-RADS improved risk stratification compared with PCAT CT alone (C-index, 0.760 versus 0.712; P=0.036). However, the benefit of right coronary artery PCAT CT attenuation combined with CAD-RADS was not significant compared with CAD-RADS alone (0.777 versus 0.760; P=0.129). Right coronary artery PCAT CT attenuation and CAD-RADS were independent predictors of MACEs. However, no incremental prognostic value of right coronary artery PCAT CT attenuation beyond CAD-RADS was detected for MACEs in patients with acute chest pain.

157-OR: Cystatin C Predicts Major Cardiovascular Events in Patients with Coronary Artery Disease Both among Patients With and among Those Without the Metabolic Syndrome

Cystatin C is an established biomarker for renal function, and, given the close association of chronic kidney disease and cardiovascular disease might indicate new-onset or deteriorating cardiovascular disease. However, evidence for cystatin C as a predictor of cardiovascular events is limited and controversial. We therefore aimed at investigating the role of cystatin C as a predictor of future major adverse cardiovascular events (MACE) in a high risk-cohort of patients with established coronary artery disease (CAD). We prospectively recorded cardiovascular events in 1481 patients with angiographically verified CAD over a mean follow-up of 10.0±5.2 years. At baseline, 684 patients had the metabolic syndrome (MetS) and 797 did not have the MetS. During follow-up, 578 (39%) of our patients suffered MACE. Cystatin C proved to be a strong and independent predictor for MACE in the total study cohort (standardized adjusted HR 1.56 [1.34-1.83], p&amp;lt;0.001). When MetS status was taken into account, cystatin C significantly predicted major cardiovascular events both in patients with the MetS (HR 1.56 [1.28-1.90], p&amp;lt;0.001) and in non-MetS patients (HR 1.44 [1.12-1.84], p=0.004). We conclude that cystatin C predicts major cardiovascular events in patients with coronary artery disease both among patients with the MetS and in non-MetS individuals. Disclosure A.Mader: None. C.H.Saely: None. M.Maechler: None. B.Larcher: None. L.Sprenger: None. A.Leiherer: None. A.Muendlein: None. A.Vonbank: None. T.Plattner: None. H.Drexel: None.

Safety and incremental prognostic value of stress CMR in patients with known chronic kidney disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is the main cause of mortality in patients with chronic kidney disease (CKD). Although several studies have demonstrated the consistently high prognostic value of stress cardiovascular magnetic resonance (CMR), its prognostic value in patients with CKD is not well established. We aimed to assess the safety and the incremental prognostic value of vasodilator stress perfusion CMR in consecutive symptomatic patients with known CKD. Methods Between 2008 and 2021, we conducted a bi-center longitudinal study with all consecutive symptomatic patients with known CKD, defined by estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/1.73 m2, referred for vasodilator stress CMR. All patients with eGFR &amp;lt;30 ml/min/1.73 m² (n=62) were excluded due the risk of nephrogenic systemic fibrosis. All patients were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent nonfatal myocardial infarction (MI). Cox regressions were used to determine the prognostic value of stress CMR parameters. Results Of 825 patients with known CKD (71.4±8.8 years, 70% men), 769 (93%) completed the CMR protocol, and among those 702 (91%) completed the follow-up (median follow-up 6.4 (4.0–8.2) years). Stress CMR was well tolerated without occurrence of death or severe adverse event related to the injection of gadolinium or nephrogenic systemic fibrosis case. The presence of inducible ischemia was associated with the occurrence of MACE (hazard ratio [HR] 12.50; 95% confidence interval [CI]: 7.50–20.8; p&amp;lt;0.001). In multivariable analysis, ischemia and late gadolinium enhancement were independent predictors of MACE (HR 15.5; 95% CI: 7.72 to 30.9; and HR:4.67 [95%CI: 2.83–7.68]; respectively, both p&amp;lt;0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI=0.477; IDI=0.049). Conclusions In patients with known CKD, stress CMR is safe and its findings have an incremental prognostic value to predict MACE over traditional risk factors.

Predictive value of diastolic function assessed by CMR feature tracking in patients with suspected myocarditis and preserved left ventricular ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Reduced left ventricular systolic function is a well established predictor for outcome in Patients with myocarditis. However, the predictive role of diastolic function in patients with suspected myocarditis and preserved ejection fraction is unknown. Purpose Assess the predicative value of diastolic left ventricular function in patients with suspected myocarditis. Methods Late and early radial, circumferential and longitudinal diastolic strain rate was assessed as using CMR feature tracking in patients with clinically suspected myocarditis being referred for cardiac magnetic resonance imaging (CMR). The primary endpoint was defined as a composite of first major adverse cardiovascular events (MACE) including all-cause mortality, sustained ventricular tachycardia and hospitalization for heart failure. Results 755 consecutive patients with suspected myocarditis and referred for CMR (277, 37% female; mean age 48 ± 16years) were included. Of those late gadolinium enhancement (LGE) was present in 417 (55.2%). 416 had a preserved ejection fraction &amp;gt;50% (55.1%). Mace was documented in 123 patients (16.3%) during a median observational time of 3.77 years. After adjustment for LVEF, LGE extend, age, and gender early circumferential strain rate (HR=0.35 95% CI 0.16–0.77, p = 0.009), early longitudinal diastolic strain rate (HR=0.40 95% CI 0.17–0.96, p = 0.042) and late diastolic strain rate (HR=0.23 95% CI 0.07–0.74, p = 0.013) remained independent predictors of MACE. Conclusion CMR feature tracking diastolic strain rate is independently associated with outcome, beyond LVEF and LGE in patients with myocarditis, and might therefore contribute to improved risk stratification in this sclinical setting.

#3785 PROPOSAL OF A NOVEL RISK PREDICTION SCORE FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS IN LUPUS NEPHRITIS

Abstract Background and Aims Patients with systemic lupus erythematosus have an increased risk of cardiovascular diseases (CVD) vastly contributing to morbidity and mortality. Besides traditional risk factors, lupus-related factors also contribute to the overall risk. Our major objective was to identify both traditional and non-traditional factors that could aid the prediction of CVD risk and major adverse cardiovascular events (MACE) in this population. MACE was defined as the composite of nonfatal myocardial infarction, hospitalization due to heart failure, coronary revascularization, stroke, and cardiovascular death. We also aimed to create a model that could be applied after a prompt assessment of lupus nephritis patients to estimate the long-term CVD risk. Method We conducted a single-center retrospective analysis on lupus nephritis patients. Demographic variables, cardiovascular events, clinical and histological data were collected from patients who underwent kidney biopsy between 2005 and 2020 (Figure 1). Chi-square, Mann-Whitney U-test, and logistic regression analyses were performed to investigate risk factors for MACE (IBM SPSS Statistics v28). Receiver Operating Characteristic (ROC) curve was used to determine optimal cut-off values. The study was approved by the Semmelweis University Regional and Institutional Committee of Science and Research Ethics (SE RKEB 225/2018). Results 91 patients were enrolled in this period. The mean age was 37.3±12.3 years, 86% females, and the mean follow-up time was 62±48 months. Fourteen patients (15.4%) suffered at least one MACE, of which 13 (14.3%) occurred after diagnosing lupus and 8 (8.8%) after the biopsy. Two patients deceased of a cardiovascular event. Out of the traditional risk factors, increased age (35.8±11.1 vs 45.5±15.1 years, p = 0.012) entailed a higher occurrence of MACE. Complete white blood cell (3.54±0.41 vs 3.25±0.87 Giga/liter, p = 0.026) and neutrophil count (2.85±0.33 vs 3.11±0.83 Giga/liter, p = 0.001) were higher, while diastolic blood pressure was lower (89.5±10.96 vs 78.43±6.9 mmHg, p&amp;lt;0.001) at the time of the biopsy in patients with MACE complication. Age, neutrophil count, and diastolic blood pressure were proven to be independent predictors of MACE (Table 1). Based on these observations, we proposed a new model (CANDE: Cardiovascular risk –based on Age, Neutrophil count, and Diastolic blood pressure– Estimation score) that is a stronger predictor of MACE and can be used to calculate MACE risk from the time of the biopsy in lupus nephritis patients (Figure 1). The higher the score was, the more often the MACE cases were present (Table 1). ROC curve analysis demonstrated that at 0.78 cut-off value the score predicts MACE occurrence at the time of the biopsy with a sensitivity of 0.75 and a specificity of 0.61. The analyses of MACE subgroups revealed that neutrophil-lymphocyte ratio was elevated in patients who were hospitalized because of heart failure (5.66±4.61 vs 9.68±6.46, p = 0.046), while neutrophil-thrombocyte ratio was higher in patients with coronary revascularization in their medical history (0.023±0.015 vs 0.06±0.028, p = 0.02). This also indicates the importance of neutrophils in CVD risk assessment. Conclusion Age, neutrophil count, and diastolic blood pressure are demonstrated to be independent risk factors of MACE in lupus nephritis. The score calculated from these parameters (CANDE) is a stronger predictor of MACE at the time of the biopsy. A larger cohort is needed to validate these promising results.

GLYCEMIC VARIABILITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: CLINICAL IMPLICATIONS AND PHARMACOLOGICAL CONSIDERATIONS

Objective: Glycemic variability (GV), independently of glycemic control, has emerged as a prognostic marker in patients with type 2 diabetes mellitus (DM). In this study, we assessed the prognostic value of GV for predicting major adverse cardiovascular events (MACE) in our local population. We also assessed its prognostic value for diabetic microvascular complications (DMC) and its relationships with antidiabetic medications. Design and method: This was a retrospective cohort study that recruited 680 patients with type 2 DM across 2015-2017. MACE were defined as: the composite of; total death, myocardial infarction (MI), stroke, hospitalization due to heart failure, revascularization. GV was calculated for two glycemic control markers: glycated hemoglobin (G-Hb) and fasting blood sugar (FBS); via 3 metrics- standard deviation (SD), coefficient of variation (CV), and variability independent from the mean (VIM). Cox proportional hazard models and Kruskal-Wallis tests were used in the statistical analysis. Results: 105 events classified as MACE were identified in 86 patients and 104 DMC in 98 patients in an average follow-up period of 78.43 months. GV was found to be an independent predictor of MACE, particularly for FBS-CV but not a predictor of DMC. FBS-CV &gt; 17.51% as compared with &lt; 17.51% was a significant and independent predictor of MACE, with HR 1.589 (95% CI; 1.022, 2.472) (P = 0.040) (Table 1 &amp; Figure 1). DMC were predicted mainly by the duration of type DM, and by the glycemic control; similarly represented by G-Hb and FBS. Patients on metformin, and dipeptidyl peptidase (DPP) 4 inhibitors, had the lowest GV, as compared with patients whose treatments included insulin/sulphonylureas (P&lt;0.001). Conclusions: In our population, GV predicted MACE: with FBS-CV superior to the “gold standard” glycemic control marker G-Hb. Further, GV may be explained, partially at least, by the choice of antidiabetic medications: this finding might contribute to the cardiovascular protection attributed to one class rather than another.

Cystatin C as a Predictor of Major Adverse Cardiovascular Event in Patients with Acute Myocardial Infarction Without Cardiogenic Shock and Renal Impairment After Coronary Intervention.

To prove that cystatin C is a predictor of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), either with ST-segment Elevation (AMI-EST) or without ST-segment elevation (AMI-NEST), without cardiogenic shock or renal impairment. This was an observational cohort study. Samples were obtained from AMI patients who underwent PCI between February 2022 and March 2022 at the Intensive Cardiovascular Care Unit. Cystatin C levels were measured before PCI. MACE were observed within 6 months. Comparisons between normally distributed continuous data were performed using the t-test; Mann-Whitney test was used for non-normally distributed data. Categorical data were compared using the chi-squared test. The cut-off point of cystatin C levels to predict MACE was analyzed using Receiver Operating Characteristics (ROC). The participants were 40 AMI patients, consisting of 32 patients (80%) with AMI-EST and eight patients (20%) diagnosed with AMI-NEST, who were evaluated for the occurrence of MACE within 6 months after PCI. Ten patients (25%) developed MACE during follow-up [(MACE (+)], and the rest were in the MACE (-) group. Cystatin C levels were significantly higher in the MACE (+) group (p=0.021). ROC analysis revealed a cystatin C level of 1.21 mg/dL; cystatin C > 1.21 is associated with MACE risk, showing a significant relationship with the odds ratio value reaching 26.00, with 95% CI (3.99-169.24). Cystatin C level is an independent predictor of MACE in patients with AMI without cardiogenic shock or renal impairment after PCI.

HEART RATE AT OFFICE VISIT AND LONG-TERM CARDIOVASCULAR EVENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: Elevated heart rate at admission or discharge is known to be associated with poor cardiovascular outcomes in patients with acute myocardial infarction (AMI). The association between averaged heart rate at office and cardiovascular outcomes in patients with AMI has been studied scarcely. We investigated the relationship of heart rate at office with long-term cardiovascular outcomes in AMI. Design and method: We analyzed a total of 7,840 patients with heart rate measured at least 3 times after hospital discharge between January 2004 and April 2015 from COREA-AMI registry. The values of heart rate measured at office visit were averaged and categorized into four groups by quartiles (&lt;68, 68-74, 74-80, and &gt;80 beats per minute). The primary end point was a composite of cardiovascular death, myocardial infarction, and ischemic stroke. Results: During a median of 5.7-year follow up, major adverse cardiovascular events (MACE) affected 1,357(17.3%) patients. The averaged heart rate of higher than 80 beat per minute (b.p.m) was associated with an increased incidence of primary outcomes compared to the averaged heart rate of 68-74 b.p.m as reference. (Adjusted hazard ratio 1.37, 95% CI 1.19-1.58, p&lt;0.0001) Increased heart rate of 1 b.p.m was an independent predictor of MACE (Adjusted hazard ratio 1.025, 95% CI 1.02-1.03, p&lt;0.001). When dichotomized into &lt; 74 or &gt; 74 b.p.m, lower averaged heart rate was not associated with incidence of primary outcomes in patients with LV systolic dysfunction in contrast to those without LV systolic dysfunction. Conclusions: Elevated averaged heart rate at office visit after AMI was associated with increased risk of cardiovascular outcomes.

Relationship of hyperglycaemic and glycaemic fluctuations to major adverse cardiovascular events in type 2 Diabetes Mellitus

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dean's funds of the University of Malta Medical School. Background Type 2 diabetes mellitus (T2DM) is a known major risk factor for cardiovascular disease. Nonetheless, tight glycaemic control has not convincingly shown to lead to improved cardiovascular outcomes in clinical trials. This could be due to the fact that the vast majority of trials did not assess the effect of hypoglycaemia and glucose fluctuations in their study population. The aim of this study was thus to investigate the effects of hyperglycaemia, hypoglycaemia and glucose variability in subjects with T2DM at a median follow-up of 6.4 years. Methods Subjects with T2DM of less than 10 years duration, and on stable anti-glycaemic treatment were recruited. At baselines, all participants underwent 72-hour continuous glucose monitoring, as well as parameters assessment. Moreover, risk factor bloods, including an HbA1c level, were taken. Patients were consequently followed up at 6.4 years (median: 2338 days, IQR: 2116-2446 days) and MACE (major adverse cardiovascular events) was assessed. This comprised a composite of all-cause mortality, non-fatal myocardial infarction (both ST-elevation myocardial infarction and non-ST elevation myocardial infarction), revascularisation (both percutaneous and coronary artery bypass grafting), non-fatal stroke and hospitilisation for heart failure. The incidence of MACE was assessed from electronic database available at the local public hospital that caters for the entire Maltese population. Univariate analysis was performed using Mann-Whitney U test for non-parametric variables and independent samples t-test for parametric variables. Variables with a p value &amp;lt;0.1 were consequently put in the multivariate Cox regression model to assess for independent predictors of MACE. Statistical analysis was performed using SPSS version 24.0 for Windows. Findings: The study population comprised 122 subjects with T2DM (89 males: 32 females). The mean age was 62.6 years and the mean DM duration was 3.7 years at baseline. At follow-up, 19 participants exhibited MACE. Variables with a p value of &amp;lt;0.1 in univariate analysis comprised fructosamine, HbA1c, mean systolic blood pressure measurements as well as duration of BG (blood glucose) &amp;lt;3.9 mmol/L and standard deviation of BG (an indicator of intra-individual blood glucose variability; the latter two were derived from 72-hour continuous glucose monitoring). Following adjustment for both age and gender, HbA1c (OR: 1.9, 95% CI: 1.32-2.73, p= 0.001) levels at baseline as well as standard deviation of BG (OR: 1.93, 95% CI: 1.68-3.16, p= 0.009) were shown to be independent predictors of MACE. Interpretation: This study demonstrates that cardiovascular disease in subjects with T2DM of relatively short duration is not only influenced by poor glycaemic control but also by fluctuations in glucose levels, as evidenced by measurements obtained from continuous glucose monitoring obtained at baseline.

Occlusion of the infarct-related coronary artery presenting as acute coronary syndrome with and without ST-elevation: impact of inflammation and outcomes in a real-world prospective cohort.

Patients with ST-segment elevation typically feature total coronary occlusion (TCO) of the infarct-related artery (IRA) on angiography, which may result in worse outcomes. Yet, relying solely on electrocardiogram (ECG) findings may be misleading and those presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) may have TCO as well. Herein, we aimed to delineate clinical characteristics and outcomes of patients with ACS stratified by IRA location. A total of 4787 ACS patients were prospectively recruited between 2009 and 2017 in SPUM-ACS (ClinicalTrials.gov Identifier: NCT01000701). The primary endpoint was major adverse cardiovascular events (MACEs), a composite of all-cause death, non-fatal myocardial infarction and non-fatal stroke at 1 year. Multivariable-adjusted survival models were fitted using backward selection. A total of 4412 ACS patients were included in this analysis, 56.0% (n=2469) ST-elevation myocardial infarction (STEMI) and 44.0% (n=1943) NSTE-ACS. The IRA was the right coronary artery (RCA) in 33.9% (n=1494), the left-anterior descending coronary artery (LAD) in 45.6% (n=2013), and the left circumflex (LCx) in 20.5% (n=905) patients. In STEMI patients, TCO (defined as TIMI 0 flow at angiography) was observed in 55% of cases with LAD, in 63% with RCA, and in 55% with LCx. In those presenting with NSTE-ACS, TCO was more frequent in those with LCx and RCA as compared to the LAD (27 and 24%, respectively, vs. 9%, P<0.001). Among patients with NSTE-ACS, occlusion of the LCx was associated with an increased risk of MACE during 1 year after the index ACS (fully adjusted hazard ratio 1.68, 95% confidence interval 1.10-2.59, P=0.02; reference: RCA and LAD). Features of patients with NSTE-ACS associated with TCO of the IRA included elevated lymphocyte and neutrophil counts, higher levels of high-sensitivity C reactive protein (hs-CRP) and high-sensitivity cardiac troponin T, lower eGFR, and notably a negative history of MI. In NSTE-ACS, both LCx and RCA involvement was associated with TCO at angiography despite the absence of ST-segment elevation. Involvement of the LCx, but not the LAD or RCA, as the IRA represented an independent predictor of MACE during 1-year follow-up. Hs-CRP, lymphocyte, and neutrophil counts were independent predictors of total IRA occlusion, suggesting a possible role of systemic inflammation in the detection of TCO irrespective of ECG presentation.

Efficacy of Primary Percutaneous Coronary Intervention (PCI) Performed Through a Transradial Approach in Patients with ST- Segment Elevation Myocardial Infarction (STEMI) at a Tertiary Care Cardiac Center

Objective of Study: The study aimed to evaluate the clinical outcomes, safety, and efficacy of primary percutaneous coronary intervention (PCI) performed through a transradial approach in patients with ST- Segment elevation myocardial infarction (STEMI) at a tertiary care cardiac center. Place of Study: The study was conducted at the National Institute of Cardiovascular Diseases, Karachi, Pakistan Duration of Study: The study was conducted over a period of six months, from April, 2022 to September, 2022. Methods: A total of 250 consecutive patients who underwent primary PCI through a transradial approach were included in the study. Demographic, clinical, procedural, and angiographic data were collected. The primary outcome measure was the incidence of major adverse cardiovascular events (MACE), including death, myocardial infarction, target vessel revascularization, and stroke at 30 days and six months' post-procedure. Secondary outcomes included procedural success, access site complications, and door-to-balloon time. Results: The mean age of participants was 58.7 ± 10.2 years, with 72.8% being male. The procedural success rate was 96.4%. The incidence of MACE at 30 days and six months was 5.6% and 8.8%, respectively. Access site complications were observed in 2.8% of patients, and the mean door-to-balloon time was 81.3 ± 25.6 minutes. Multivariate analysis identified diabetes mellitus and triple-vessel disease as independent predictors of MACE. Conclusion: Primary PCI through a transradial approach at a tertiary care cardiac center in Karachi, Pakistan, demonstrated high procedural success rates, favorable clinical outcomes, and a low incidence of access site complications. This approach may be considered a safe and effective treatment option for patients with acute coronary syndromes. Keywords: primary percutaneous coronary intervention, transradial approach, ST- segment elevation myocardial infarction, major adverse cardiovascular events, tertiary care cardiac center, access site complications, door-to-balloon time

Atrial high-rate episodes intensify R2CHA2DS2-VASc score for prognostic stratification in pacemaker patients

Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R2CHA2DS2-VASc, CHADS2, R2CHADS2 and CHA2DS2-VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate the R2CHA2DS2-VASc score in combination with AHRE ≥ 6 min for predicting MACE in patients with dual-chamber PPM but no prior atrial fibrillation (AF). We retrospectively enrolled 376 consecutive patients undergoing dual-chamber PPM implantation and no prior AF. The primary endpoint was subsequent MACE. For all patients in the cohort, CHADS2, R2CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc scores and AHRE ≥ or < 6 min were determined. AHRE was recorded as a heart rate > 175 bpm (Medtronic) or > 200 bpm (Biotronik) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine the independent predictors of MACE. ROC-AUC analysis was performed for CHADS2, R2CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores and then adding AHRE ≥ 6 min to the four scores. The median age was 77 years, and 107 patients (28.5%) developed AHRE ≥ 6 min. After a median follow-up of 32 months, 46 (12.2%) MACE occurred. Multivariate Cox regression analysis showed that R2CHA2DS2-VASc score (HR, 1.485; 95% CI, 1.212–1.818; p < 0.001) and AHRE ≥ 6 min (HR, 2.125; 95% CI, 1.162–3.887; p = 0.014) were independent predictors for MACE. The optimal R2CHA2DS2-VASc score cutoff value was 4.5 (set at ≥ 5), with the highest Youden index (AUC, 0.770; 95% CI, 0.709–0.831; p < 0.001). ROC-AUC analysis of the four risk scores separately combined with AHRE ≥ 6 min all showed better discriminatory power than the four scores alone (All Z-statistic p < 0.05). In patients with PPM who develop AHRE ≥ 6 min, it is crucial to perform risk assessment with either four scores to further stratify risk for MACE.

The value of serum Sema4D level in predicting the prognosis of patients with acute ST-segment elevation myocardial infarction and with high thrombus burden

BackgroundAcute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease. High thrombus burden is an independent risk factor for poor prognosis of acute myocardial infarction. However, there is no study on the correlation between soluble semaphorin 4D (sSema4D) level and high thrombus burden in patients with STEMI.PurposeThis study aimed to investigate the relationship between sSema4D level and the thrombus burden of STEMI and further explore its effect on the main predictive value of the occurrence of major adverse cardiovascular events (MACE).MethodsFrom October 2020 to June 2021, 100 patients with STEMI diagnosed in our hospital’s cardiology department were selected. According to the thrombolysis in myocardial infarction(TIMI)score, STEMI patients were divided into high thrombus burden groups (55 cases) and non-high thrombus burden groups (45 cases) 0.74 patients with stable coronary heart disease (CHD) were selected as stable CHD group, and 75 patients with negative coronary angiography (CAG) were selected as control group. Serum sSema4D levels were measured in 4 groups. The correlation between serum sSema4D and high-sensitivity C-reactive protein (hs-CRP) in patients with STEMI was analyzed. The relationship of serum sSema4D levels between the high and non-high thrombus burden group was evaluated. The effect of sSema4D levels on the occurrence of MACE was explored in one year after percutaneous coronary intervention.ResultsSerum sSema4D level was positively correlated with hs-CRP level in STEMI patients (P < 0.05) with a correlation coefficient of 0.493. The sSema4D level was significantly higher in the high versus non-high thrombus burden group (22.54(20.82,24.17), P < 0.05). Moreover, MACE occurred in 19 cases in high thrombus burden group and 3 cases in non-high thrombus burden group. The results of Cox regression analysis showed that sSema4D was an independent predictor of MACE (OR = 1.497,95% CI: 1.213–1.847, P < 0.001).ConclusionThe sSema4D level is associated with coronary thrombus burden and is an independent risk factor for MACE.

Prognostic Value of Angiography-Derived Index of Microcirculatory Resistance in Patients with Coronary Artery Disease Undergoing Rotational Atherectomy.

Rotational atherectomy (RA) is the major tool used to treat severely calcified lesions in patients with coronary artery disease (CAD). The relationship between coronary microvascular dysfunction and RA remains unknown. Therefore, we attempted to explore the predictive implications of the coronary angiography-derived index of microcirculatory resistance (angio-IMR) in CAD patients undergoing RA. This retrospective study included 118 patients with severe coronary calcification who underwent a successful RA from January 2018 to June 2021. The angio-IMR was calculated based on computed flow and pressure dynamic principles to assess coronary microcirculatory function. Follow-up was performed on all patients for major adverse cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, target vessel revascularization (TVR), and stroke. The mean angio-IMR for all patients was 25.58 7.93. Patients were stratified the groups based on a mean angio-IMR of 25, fifty-four (45.8%) patients had angio-IMR 25. The logistic regression analysis showed that angiography-derived fractional flow reserve was significantly associated with coronary microvascular dysfunction. After median follow-up of 21.7 (15.1-24.0) months, MACEs occurred in 30.6%, including 12.5% all-cause deaths, 6.4% non-fatal myocardial infarction, 14.5% TVR, and 0.9% stroke. Kaplan-Meier analysis demonstrated that patients with angio-IMR 25 had greater cumulative MACEs (41.6%) and TVR (20.7%) than patients with preserved angio-IMR. COX regression analysis indicated that angio-IMR 25 and reduced left ventricular ejection fraction were independent predictors of MACEs. In addition, angio-IMR 25 and lowered minimum luminal area independently predicted TVR occurrence. In CAD patients undergoing RA, angio-IMR 25 was an independent and significant predictor of MACEs and TVR. NCT05435898.

Heterogeneous plaque-lumen geometry is associated with major adverse cardiovascular events.

Prospective studies show that only a minority of plaques with higher risk features develop future major adverse cardiovascular events (MACE), indicating the need for more predictive markers. Biomechanical estimates such as plaque structural stress (PSS) improve risk prediction but require expert analysis. In contrast, complex and asymmetric coronary geometry is associated with both unstable presentation and high PSS, and can be estimated quickly from imaging. We examined whether plaque-lumen geometric heterogeneity evaluated from intravascular ultrasound affects MACE and incorporating geometric parameters enhances plaque risk stratification. We examined plaque-lumen curvature, irregularity, lumen aspect ratio (LAR), roughness, PSS, and their heterogeneity indices (HIs) in 44 non-culprit lesions (NCLs) associated with MACE and 84 propensity-matched no-MACE-NCLs from the PROSPECT study. Plaque geometry HI were increased in MACE-NCLs vs. no-MACE-NCLs across whole plaque and peri-minimal luminal area (MLA) segments (HI curvature: adjusted P = 0.024; HI irregularity: adjusted P = 0.002; HI LAR: adjusted P = 0.002; HI roughness: adjusted P = 0.004). Peri-MLA HI roughness was an independent predictor of MACE (hazard ratio: 3.21, P < 0.001). Inclusion of HI roughness significantly improved the identification of MACE-NCLs in thin-cap fibroatheromas (TCFA, P < 0.001), or with MLA ≤ 4 mm2 (P < 0.001), or plaque burden (PB) ≥ 70% (P < 0.001), and further improved the ability of PSS to identify MACE-NCLs in TCFA (P = 0.008), or with MLA ≤ 4 mm2 (P = 0.047), and PB ≥ 70% (P = 0.003) lesions. Plaque-lumen geometric heterogeneity is increased in MACE vs. no-MACE-NCLs, and inclusion of geometric heterogeneity improves the ability of imaging to predict MACE. Assessment of geometric parameters may provide a simple method of plaque risk stratification.

Association between complete revascularization of the coronary artery and clinical outcomes in peripheral artery disease: a sub-analysis of the I-PAD Nagano registry

Peripheral artery disease (PAD) is commonly caused by atherosclerosis and has an unfavorable prognosis. Complete revascularization (CR) of the coronary artery reduces the risk of major adverse cardiovascular event (MACE) in patients with coronary artery disease (CAD). However, the impact of CR in patients with PAD has not been established to date. Therefore, we evaluated the impact of CR of CAD on the five-year clinical outcomes in patients with PAD. This study was based on a prospective, multicenter, observational registry in Japan. We enrolled 366 patients with PAD undergoing endovascular treatment. The primary endpoint was MACE, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. After excluding ineligible patients, 96 and 68 patients received complete revascularization of the coronary artery (CR group) and incomplete revascularization of the coronary artery (ICR group), respectively. Freedom from MACE in the CR group was significantly higher than in the ICR group at 5 years (66.7% vs 46.0%, p < 0.01). Multivariate analysis revealed that CR emerged as an independent predictor of MACE (Hazard ratio: 0.56, 95% confidential interval: 0.34–0.94, p = 0.03). CR of CAD was significantly associated with improved clinical outcomes in patients with PAD undergoing endovascular treatment.

SGLT2-inhibitors effects on the coronary fibrous cap thickness and MACEs in diabetic patients with inducible myocardial ischemia and multi vessels non-obstructive coronary artery stenosis

BackgroundSodium–glucose transporter 2 inhibitors (SGLT2-I) could modulate atherosclerotic plaque progression, via down-regulation of inflammatory burden, and lead to reduction of major adverse cardiovascular events (MACEs) in type 2 diabetes mellitus (T2DM) patients with ischemic heart disease (IHD). T2DM patients with multivessel non-obstructive coronary stenosis (Mv-NOCS) have over-inflammation and over-lipids’ plaque accumulation. This could reduce fibrous cap thickness (FCT), favoring plaque rupture and MACEs. Despite this, there is not conclusive data about the effects of SGLT2-I on atherosclerotic plaque phenotype and MACEs in Mv-NOCS patients with T2DM. Thus, in the current study, we evaluated SGLT2-I effects on Mv-NOCS patients with T2DM in terms of FCT increase, reduction of systemic and coronary plaque inflammation, and MACEs at 1 year of follow-up.MethodsIn a multi-center study, we evaluated 369 T2DM patients with Mv-NOCS divided in 258 (69.9%) patients that did not receive the SGLT2-I therapy (Non-SGLT2-I users), and 111 (30.1%) patients that were treated with SGLT2-I therapy (SGLT2-I users) after percutaneous coronary intervention (PCI) and optical coherence tomography (OCT) evaluation. As the primary study endpoint, we evaluated the effects of SGLT2-I on FCT changes at 1 year of follow-up. As secondary endpoints, we evaluated at baseline and at 12 months follow-up the inflammatory systemic and plaque burden and rate of MACEs, and predictors of MACE through multivariable analysis.ResultsAt 6 and 12 months of follow-up, SGLT2-I users vs. Non-SGLT2-I users showed lower body mass index (BMI), glycemia, glycated hemoglobin, B-type natriuretic peptide, and inflammatory cells/molecules values (p < 0.05). SGLT2-I users vs. Non-SGLT2-I users, as evaluated by OCT, evidenced the highest values of minimum FCT, and lowest values of lipid arc degree and macrophage grade (p < 0.05). At the follow-up end, SGLT2-I users vs. Non-SGLT2-I users had a lower rate of MACEs [n 12 (10.8%) vs. n 57 (22.1%); p < 0.05]. Finally, Hb1Ac values (1.930, [CI 95%: 1.149–2.176]), macrophage grade (1.188, [CI 95%: 1.073–1.315]), and SGLT2-I therapy (0.342, [CI 95%: 0.180–0.651]) were independent predictors of MACEs at 1 year of follow-up.ConclusionsSGLT2-I therapy may reduce about 65% the risk to have MACEs at 1 year of follow-up, via ameliorative effects on glucose homeostasis, and by the reduction of systemic inflammatory burden, and local effects on the atherosclerotic plaque inflammation, lipids’ deposit, and FCT in Mv-NOCS patients with T2DM.

Coronary CT angiography-derived plaque characteristics and physiologic patterns for peri-procedural myocardial infarction and subsequent events.

Peri-procedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) has been shown to be associated with worse clinical outcomes. We aimed to investigate the value of coronary plaque characteristics and physiologic disease patterns (focal vs. diffuse) assessed by coronary computed tomography angiography (CTA) in predicting PMI and adverse events. Three hundred fifty-nine patients with normal pre-PCI high-sensitivity cardiac troponin T (hs-cTnT) underwent CTA before PCI were analysed. The high-risk plaque characteristics (HRPC) were assessed on CTA. The physiologic disease pattern was characterized using CTA fractional flow reserve-derived pullback pressure gradients (FFRCT PPG). PMI was defined as an increase in hs-cTnT to >5 times the upper limit of normal after PCI. The major adverse cardiovascular events (MACE) were a composite of cardiac death, spontaneous myocardial infarction, and target vessel revascularization. The presence of ≥3 HRPC in the target lesions [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.29-3.80, P = 0.004] and low FFRCT PPG (OR 1.23, 95% CI 1.02-1.52, P = 0.028) were independent predictors of PMI. In a four-group classification according to HRPC and FFRCT PPG, patients with ≥3 HRPC and low FFRCT PPG had the highest risk of MACE (19.3%; overall P = 0.001). Moreover, the presence of ≥3 HRPC and low FFRCT PPG was an independent predictor of MACE and showed incremental prognostic value compared with a model with clinical risk factors alone [C index = 0.78 vs. 0.60, P = 0.005, net reclassification index = 0.21 (95% CI: 0.04-0.48), P = 0.020]. Coronary CTA can evaluate plaque characteristics and physiologic disease patterns simultaneously, which plays an important role for risk stratification before PCI.

Gender Differences in Epicardial Adipose Tissue and Plaque Composition by Coronary CT Angiography: Association with Cardiovascular Outcome.

Background: To investigate gender differences in epicardial adipose tissue (EAT) and plaque composition by coronary CT angiography (CCTA) and the association with cardiovascular outcome. Methods: Data of 352 patients (64.2 ± 10.3 years, 38% female) with suspected coronary artery disease (CAD) who underwent CCTA were retrospectively analyzed. EAT volume and plaque composition from CCTA were compared between men and women. Major adverse cardiovascular events (MACE) were recorded from follow-up. Results: Men were more likely to have obstructive CAD, higher Agatston scores, and a larger total and non-calcified plaque burden. In addition, men displayed more adverse plaque characteristics and EAT volume compared to women (all p < 0.05). After a median follow-up of 5.1 years, MACE occurred in 8 women (6%) and 22 men (10%). In multivariable analysis, Agatston calcium score (HR 1.0008, p = 0.014), EAT volume (HR 1.067, p = 0.049), and low-attenuation plaque (HR 3.82, p = 0.036) were independent predictors for MACE in men, whereas only low-attenuation plaque (HR 2.42, p = 0.041) showed predictive value for events in women. Conclusion: Women demonstrated less overall plaque burden, fewer adverse plaque characteristics, and a smaller EAT volume compared to men. However, low-attenuation plaque is a predictor for MACE in both genders. Thus, a differentiated plaque analysis is warranted to understand gender differences of atherosclerosis to guide medical therapy and prevention strategies.

Correlation Between GDF11 Serum Levels, Severity of Coronary Artery Lesions, and the Prognosis of Patients with ST-segment Elevation Myocardial Infarction.

We aimed to explore the correlation among serum GDF11, the severity of coronary artery lesions, and the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). A total of 367 patients were enrolled and divided into control (n = 172) and STEMI (n = 195) groups. Serum GDF11 (P < 0.001) was an independent predictor of STEMI and was negatively correlated with SYNTAX score (P < 0.05). ROC curve analysis showed that serum GDF11 could screen patients for major adverse cardiovascular events (MACEs). KM curve analysis showed that patients with lower concentration of GDF11 had a higher incidence of MACEs, and Cox proportional hazards regression analysis showed that the serum GDF11 (P < 0.001) was an independent predictor of MACEs. Serum GDF11 was negatively correlated with the severity of coronary lesions and was also an independent prognostic indicator of MACEs in patients with STEMI.