Killip Class Research Articles

VALIDITY OF MEHRAN RISK SCORE FOR PREDICTING CONTRAST INDUCED NEPHROPATHY IN MODERN PRIMARY PERCUTANEOUS CORONARY INTERVENTIONS ERA

Objectives: Contrast induced nephropathy (CIN) is a common complication and found to be associated with increased morbidity and mortality after primary percutaneous coronary intervention (PCI). The objective of this study was to validate the Mehran Risk Score (MRS) for the risk stratification of CIN in patients undergone primary PCI. Methodology: A cohort of consecutive patients undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patents history of any PCI, and chronic kidney diseases were excluded from this study. MRS was calculated at baseline and post procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN. Results: A total of 547 patients were included, of which 79.3%(434) were male. CIN after primary PCI was observed in 62(11.3%) patients. The area under the curve (AUC) for the MRS was 0.712 [0.641 to 0.783]. Cut-off value of ≥6.5 had sensitivity of 61.3% [48.1%-73.4%] with positive predictive value of 21.2% [17.5%-25.6%] and specificity of 70.9% [66.7%-74.9%] with negative predictive value of 93.5% [91.3%-95.2%]. MRS ≥6.5 was found to be an independent predictor on multivariable analysis with adjusted odds ratios (OR) of 3.86 [2.23-6.68] along with multi-vessel diseases with OR of 2.31 [1.27-4.19]. Conclusion: MRS has shown to have a good discriminating power. However low positive predictive value of the optimal cutoff value of ≥6.5 for prediction of CIN suggests need of modification to the MRS to improve its clinical utility in the modern era of primary PCI.

Comparison of Clinical Profiles, Angiographic Features and Outcomes of Young and Elderly Patients with ST-Segment Elevation Myocardial Infarction

Objective: It is to reveal the differences between clinical, angiographic, in-hospital and one-year follow-up results between young and elderly patients with acute ST-segment elevation myocardial infarction.
 Material and Methods: This study was designed retrospectively in two centers. 2891 patients were screened; 260 of which were young. 260 elderly patients were randomly selected among the patients and the differences between both groups were evaluated.
 Results: The median age of the young patients was 37 (34-39) years and the median age of the elderly patients was 65 (56-73) years, and male gender was dominant in both groups. Young patients were more likely to be admitted with Killip class 1, while older patients were more likely to be admitted with Killip class 2 (P=0.002). Single-vessel disease was more common in young patients (81.0% vs. 46.3%; P<0.001), while multi-vessel disease was more common in the elderly patients (19.0% vs. 53.7%; P<0.001). In one-year follow-up, all-cause hospitalization was lower in younger patients, but there was no significant difference in mortality between elderly and young patients.
 Conclusion: Young patients presenting with ST-segment elevation myocardial infarction were more frequent smokers, obese and dyslipidemic and although in-hospital outcomes were better than the elderly, one-year mortality was similar to those of the elderly.

Outcomes of Nonagenarians with Acute Myocardial Infarction with or without Coronary Intervention.

Percutaneous coronary intervention (PCI) is the mainstay treatment of acute myocardial infarction (AMI); however, many clinicians are reluctant to perform PCI in the elderly population. This study aimed to compare the clinical outcomes of PCI versus medical therapy in nonagenarian Korean patients with AMI. We compared the clinical outcomes of nonagenarian patients with AMI with or without PCI. From the pooled data, based on a series of Korean AMI registries during 2005–2020, 467 consecutive patients were selected and categorized into two groups: the PCI and no-PCI groups. The primary endpoint was 1-year major adverse cardiac event (MACE), a composite of all-cause death, non-fatal myocardial infarction, and any revascularization. Among the 467 participants, 68.5% received PCI. The PCI group had lower proportions of Killip classes III-IV, previous heart failure, and left ventricular ejection fraction <40%, but had higher proportions of all prescribed medications and STEMI diagnosis. The 1-year MACE and all-cause death were higher in the no-PCI group, although partially attenuated post-IPTW. Our study showed that nonagenarian patients with AMI undergoing PCI had better clinical outcomes than those without PCI. Nonetheless, further investigation is needed in the future to elucidate whether PCI is beneficial for this population.

Risk Factors for No-Reflow in Patients with ST-Elevation Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Case-Control Study.

Methods This case-control study retrospectively reviewed the medical data of patients treated with primary percutaneous coronary intervention within 12 h after STEMI onset between January 2010 and January 2013 at the Department of Cardiology of the Beijing Anzhen Hospital. Results A total of 902 patients were included in the analysis. The basic characteristics between the reflow and no-reflow groups were similar, except for time-to-hospital admission, heart rate, plasma glucose, high-sensitivity C-reactive protein (hsCRP)/prealbumin (PAB), neutrophil count, intraaortic balloon pump, and aspiration thrombectomy. The multivariable analysis showed that hsCRP/PAB (OR = 1.003, 95% CI: 1.000–1.006, P=0.022), neutrophil count (OR = 1.085, 95% CI: 1.028–1.146, P=0.003), plasma glucose levels (OR = 1.086, 95% CI: 1.036–1.138, P=0.001), diabetes mellitus (OR = 0.596, 95% CI: 0.371–0.958, P=0.033), Killip classification >1 (OR = 2.002, 95% CI: 1.273–3.148, P=0.003), intraoperative intraaortic balloon pump (IABP) use (OR = 3.257, 95% CI: 1.954–5.428, P=0.001), and aspiration thrombectomy (OR = 3.412, 95% CI: 2.259–5.152, P=0.001) were independently associated with no-reflow. Conclusion hsCRP/PAB, neutrophil count, plasma glucose levels, diabetes mellitus, Killip classification, intraoperative IABP use, and aspiration thrombectomy were independent risk factors for no-reflow in patients with STEMI.

Association of Admission Time and Mortality in STEMI Patients: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate patients with acute ST-segment elevation myocardial infarction (STEMI) who were admitted during off-hours and treated with primary angioplasty associated with an increased risk of mortality compared with those admitted during regular working hours. We performed a systematic literature search using PubMed, SCOPUS, Europe PMC, and Cochrane CENTRAL databases that was finalized on March 15, 2021. The primary outcome was mortality comprising early (in-hospital), midterm (30 days to 1 year), and long-term mortality (>1 year). A total of 384,452 patients from 56 studies were included. The overall mortality of acute STEMI patients admitted during off-hours and regular hours were 6.1 and 6.7%, respectively. Patients admitted during off-hours had similar risk of early, midterm, and long-term mortality compared to those admitted during regular working hours ([relative risk or RR = 1.07, 95% confidence interval or CI, 1.00-1.14, p = 0.06; I 2 = 45%, p = 0.0009], [RR = 1.00, 95% CI, 0.95-1.05, p = 0.92; I 2 = 13%, p = 0.26], and [RR = 0.95, 95% CI, 0.86-1.04, p = 0.26; I 2 = 0%, p = 0.76], respectively). Subgroup analyses indicated that the results were consistent across all subgroups ([women vs. men], [age >65 years vs. ≤65 years], and [Killip classification II to IV vs. Killip I]). Funnel plot was asymmetrical. However, Egger's test suggests no significance of small-study effects ( p = 0.19). This meta-analysis showed that patients with acute STEMI who were admitted during off-hours and treated with primary angioplasty had similar risk of early, midterm, and long-term mortality compared with those admitted during regular working hours.

Association of Prolonged Emergency Department Length of Stay with Adverse Events in Patients with Non-ST-Elevation Acute Coronary Syndrome.

ObjectiveTo study the association between prolonged emergency department length of stay (EDLOS) and in-hospital adverse events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).MethodsIn this retrospective cohort study, the medical records of 738 patients diagnosed with NSTE-ACS and admitted to the emergency department (ED) from 1 January 2013 to 31 December 2019 were reviewed. The patients were categorized into groups with EDLOS < 4 hours and EDLOS ≥ 4 hours, and baseline characteristics, clinical presentation, Killip classification, Global Registry of Acute Coronary Events score, investigations, use of the European Society of Cardiology (ESC) 0/1-hour and 0/3-hour algorithms, and treatments in the ED were compared between the groups. The associations of in-hospital adverse events with EDLOS were examined using univariate logistic regression.ResultsFour hundred and twenty-three (57.3%) patients had an EDLOS of ≥ 4 hours, and the median (IQR) EDLOS was 4.48 hours (3.03, 6.20 hours). EDLOS ≥ 4 h was associated with a prolonged time to receive P2Y12 inhibitors and anticoagulants (P < 0.001). However, the two groups showed no significant differences in in-hospital adverse events (congestive heart failure [CHF], shock, stroke or transient ischemic attack [TIA], major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events). Nevertheless, a non-significant trend for a higher rate of adverse events (CHF, shock, major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events) with longer EDLOS was observed in the subgroup of patients who received diuretic or antiarrhythmic drugs, ventilator or bilevel positive airway pressure support, oxygen support, or inotropic/vasopressor drugs in the ED.ConclusionProlonged EDLOS showed a significant association with longer times to receive P2Y12 inhibitors and anticoagulants. However, the EDLOS < 4 hour and EDLOS ≥ 4 hour groups of patients with NSTE-ACS showed no significant differences in the rates of in-hospital adverse events. Patients who receive cardiovascular medications in the ED or are on respiratory support should be hospitalized as soon as practically possible. Proper use of the 0/1-hour algorithm over the 0/3-hour algorithm without unnecessary repeated cardiac troponin tests in the ED could reduce the EDLOS in patients with NSTE-ACS.

Association between Platelet to Neutrophil Ratio (PNR) and Clinical Outcomes in STEMI Patients after Successful pPCI: A Secondary Analysis Based on a Cohort Study.

Purpose This study was aimed at investigating whether the platelet-to-neutrophil ratio (PNR) is independently related to the prognosis of patients with ST-elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (pPCI). Methods This was a secondary analysis of data retrieved from the DATADRYAD database, which was a prospective cohort study. A total of 464 STEMI patients who underwent successful pPCI were recruited between January 2010 and October 2014. The target-independent variable, PNR, was measured at the baseline. The dependent variable in the current study was the occurrence of major adverse cardiovascular events (MACEs) during the 30-month follow-up. Results Two patients were excluded from the final analysis because their platelet counts were unavailable. The average age of the 462 participants was 63 ± 11.92 years, and approximately 76.6% were male. After adjusting for age, sex, anterior wall myocardial infarction (MI), history of MI, apelin-12, apelin-12 change rate, left ventricular end-diastolic diameter, peak cardiac troponin I, pathological Q wave, Killip classification grade, fasting blood glucose, albumin, GENSINI score, and estimated glomerular filtration rate, a nonlinear relationship was found between the PNR and MACEs in the included cohort. The threshold value of the PNR for MACEs was 23.1. Over this cutoff value, the incidence rate of MACEs increased by 43% per 10-unit change in PNR (95% CI: 1.16–1.75, p = 0.0006). Conclusion There was a threshold relationship between PNR and MACEs in patients with STEMI who underwent successful pPCI. The incidence of MACEs was positively associated with the PNR when the PNR exceeded 23.1.

Impact of atrial fibrillation and the clinical outcomes in patients with acute myocardial infarction from the K-ACTIVE registry

BackgroundThe clinical incidence and impact of atrial fibrillation (AF) in Japanese acute myocardial infarction (AMI) patients is not fully understood. MethodsTo elucidate the clinical incidence and impact of AF on in-hospital mortality in AMI patients, we analyzed a Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry), which spans 2015 to 2019. A major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. For assessing bleeding events, Bleeding Academic Research Consortium (BARC) type 3 or 5 was used. MACE plus BARC type 3 or 5 bleeding were considered as composite events. The clinical outcomes were followed for 1 year. ResultsThe total of 5059 patients included 531 patients with AF (10.5%) and 4528 patients with sinus rhythm (SR; 89.5%). AF patients were significantly older and tended to have more comorbidities than SR patients. Oral anticoagulation therapy (OAC) was used in 44% of AF patients while single antiplatelet therapy was selected for 52% of patients with OAC. Crude in-hospital mortality was significantly greater in AF patients than in SR patients (10.4%, 5.0%, respectively, p < 0.01). The multivariate analysis was adjusted for age, sex, diabetes, hypertension, hemodialysis, smoking, previous MI, body mass index, Killip classification, out of hospital cardiac arrest, and OAC. In-hospital mortality was still significantly greater in AF patients than in SR patients in the logistic regression analysis [adjusted odds ratio 2.02 (1.31–3.14)]. AF was an independent risk factor for MACE and composite events in the Cox proportional hazards model [adjusted risk ratio (ARR) 1.91 (1.36–2.69), p < 0.01; ARR 1.72 (1.25–2.36), p < 0.01]. In contrast, AF was not an independent risk factor for bleeding [ARR 1.71 (0.79–3.71), p = 0.18]. ConclusionIn Japanese AMI patients, AF was often observed and was associated with worse MACE but not worse bleeding.

CHA2DS2 VASc score and brachial artery flow-mediated dilation as predictors for no-reflow phenomenon in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundFollowing primary percutaneous coronary intervention (PCI), no-reflow is associated with a high rate of long-term unfavorable clinical outcomes. Despite the importance of early no-reflow prediction in cardiovascular medicine, noninvasive assessment is lacking. This study aimed to evaluate the preprocedural CHA2DS2 VASc score and the brachial artery flow-mediated dilation percentage (FMD%) as predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.ResultsThis study included 150 patients who presented with acute STEMI, underwent primary PCI, and were divided into two groups according to the flow result, reflow group and a no-reflow group. The CHA2DS2 VASc score was calculated and evaluation of endothelial function by measuring the brachial artery FDM% was done for each patient before the procedure. There were 39 (26%) patients in the no-reflow group and 111 (74%) in the reflow group. The no-reflow patients were older and had significantly higher body mass index (BMI), higher frequency of diabetes mellitus, hypertension, history of heart failure, dyslipidemia, Killip class IV on admission, thrombus grade V, multiple affected vessels, conventional stenting, and multiple stents placement, longer ischemic times, higher CHA2DS VASc score, and lower brachial artery FMD% (p-values of < 0.05 for all). Moreover, there was a significant negative correlation between CHA2DS VAS score and preprocedural FMD%, with the higher the score indicating lower FMD among cases (p-value = 0.000).ConclusionsPreprocedural CHA2DS2 VASc score and the brachial artery FMD can be used as predictors for the no-reflow phenomenon in patients with STEMI, undergoing primary PCI.

Relationship between Hemoglobin Concentration at Admission with the Incidence of No-Reflow Phenomenon and In-Hospital Mortality in Acute Myocardial Infarction with Elevation of ST Segments in Patients who underwent Primary Percutaneous Coronary Intervention.

Anemia in acute ST-segment elevation myocardial infarction (STEMI) is associated with a pro-coagulant state, contributing to the incidence of no-reflow phenomenon and increased mortality following primary percutaneous coronary intervention (PPCI). However, clinical data remain contradictory. The objective of our study was to evaluate the association of admission hemoglobin (Hb) concentration and in-hospital mortality of STEMI patients' post-PPCI, as well as final thrombolysis in myocardial infarction (TIMI) flow. A cross-sectional study was performed from the database of Jakarta Acute Coronary Syndrome Registry, consisting of 3,071 STEMI patients who underwent PPCI between January 2014 and December 2019. No-reflow phenomenon was defined as final TIMI flow <3 of the infarct-related artery. Outcome measures were the occurrence of no-reflow and in-hospital mortality. Anemia criteria were based on the World Health Organization. Anemia was found in 550 patients (17.9%). Patients with anemia were older (60 ± 10 years, p < 0.001), predominantly women (20.7 vs. 11.2%, p < 0.001), TIMI risk score >4 (45.8 vs. 30.4%, p < 0.00), and Killip classification >1 (25.8 vs. 20.8%, p < 0.009). Anemia at admission was not associated with no-reflow phenomenon (odds ratio [OR] = 0.889; 95% confidence interval [CI] = 0.654-1.209, p = 0.455). Multivariate regression models showed that anemia was not associated with in-hospital mortality (OR = 0.963; 95% CI = 0.635-1.459, p = 0.857) and with no-reflow phenomenon (OR = 0.939; 95% CI = 0.361-2.437, p = 0.896). Anemia upon admission was not related to the no-reflow phenomena or in-hospital mortality in STEMI patients undergoing PPCI.

Prognostic Value of Machine Learning in Patients with Acute Myocardial Infarction.

(1) Background: Patients with acute myocardial infarction (AMI) still experience many major adverse cardiovascular events (MACEs), including myocardial infarction, heart failure, kidney failure, coronary events, cerebrovascular events, and death. This retrospective study aims to assess the prognostic value of machine learning (ML) for the prediction of MACEs. (2) Methods: Five-hundred patients diagnosed with AMI and who had undergone successful percutaneous coronary intervention were included in the study. Logistic regression (LR) analysis was used to assess the relevance of MACEs and 24 selected clinical variables. Six ML models were developed with five-fold cross-validation in the training dataset and their ability to predict MACEs was compared to LR with the testing dataset. (3) Results: The MACE rate was calculated as 30.6% after a mean follow-up of 1.42 years. Killip classification (Killip IV vs. I class, odds ratio 4.386, 95% confidence interval 1.943–9.904), drug compliance (irregular vs. regular compliance, 3.06, 1.721–5.438), age (per year, 1.025, 1.006–1.044), and creatinine (1 µmol/L, 1.007, 1.002–1.012) and cholesterol levels (1 mmol/L, 0.708, 0.556–0.903) were independent predictors of MACEs. In the training dataset, the best performing model was the random forest (RDF) model with an area under the curve of (0.749, 0.644–0.853) and accuracy of (0.734, 0.647–0.820). In the testing dataset, the RDF showed the most significant survival difference (log-rank p = 0.017) in distinguishing patients with and without MACEs. (4) Conclusions: The RDF model has been identified as superior to other models for MACE prediction in this study. ML methods can be promising for improving optimal predictor selection and clinical outcomes in patients with AMI.

Ventricular septal rupture: insights into an old disease.

Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0years IQR [66-78] and 188 patients (70.9%) were operated on. IABP was used more routinely (p < 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8days HR 2.7 IC95% [1.9-3.8] p < 0.0001, a Killip class > 2 HR 2.5 IC [1.9-3.4] p < 0.0001 and Euroscore 2 > 20 HR 2.4 IC [1.8-3.2] p < 0.0001. A "time from MI to surgery" of 8days offers the best ability to discriminate between patients with or without mortality. The ability of "Euroscore 2 and Killip" to detect the patients most likely to wait 8days for surgery was at 0.81 [0.73-0.89] p < 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8days since MI before being referred to surgery.

Machine learning to predict in-hospital mortality risk among heterogenous STEMI patients with diabetes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): TECHNOLOGY DEVELOPMENT FUND 1 Background Diabetes has become a major public health concern in Asia. In Malaysia, the prevalence of diabetes has escalated in adults above the age of 18, affecting 3.9 million individuals. Patients with diabetes and coronary heart disease have worse outcomes, compared with patients without diabetes who have coronary heart disease. Conventional Risk scores such as TIMI and GRACE were derived from a Western Caucasian cohort with limited data from Asian countries, despite Asia hosting 60% of the world’s population. Purpose It is important to recognize the significant features associated with in-hospital mortality risk that is population-specific in Asian diabetes patients with STEMI to achieve a reliable and effective clinical diagnosis and improved outcome. Electronic health records contain large amounts of information on patients’ medical history and are becoming invaluable research tools that could be applied to cardiovascular disease risk prediction through machine learning (ML) algorithms. With the current success of ML over conventional methods in STEMI mortality prediction, we aim to develop ML algorithms for in-hospital risk mortality in Asian patients diagnosed with DM that can be adopted for clinical predictions Methods We used registry data from the Malaysian National Cardiovascular Disease Database of 5783 patients diagnosed with DM from 2006 to 2016. Fifty parameters including demographics, cardiovascular risk, medications and clinical variables were considered. Four machine learning (ML) algorithms were constructed using a 70% registry dataset; Random Forest (RF), Support Vector Machine (SVM), Extreme Gradient Booster (XGB) and Logistic Regression (LR). Feature selections were done based on ML algorithms feature importance combined with Sequential Backward Selection (SBS). The area under the curve (AUC) was used as the performance evaluation metric. All algorithms were validated using a 30 % validation dataset and compared to the conventional TIMI risk score for STEMI. Results The best model SVM (AUC = 0.90) outperformed other ML algorithms (Figure 1) and TIMI risk score (AUC = 0.83). The best SVM model consists of 11 predictors which are Killip class, fasting blood glucose, age, systolic blood pressure, heart rate, ACE inhibitor, beta-blocker, total cholesterol, diastolic blood pressure, lower density lipoprotein, and diuretic (Figure 2). Common predictors of SVM and TIMI risk score are Killip class, age, systolic blood pressure, and heart rate. We have shown that the population-specific data mining approach for the prediction of diabetes patients’ mortality post-STEMI outperformed conventional TIMI risk score. Conclusion In the Asian multiethnic population, combination of ML approaches with features selection demonstrated promising outcomes in patients with DM that may be used for better patient prognostic than the conventional method. Abstract Figure 1: ML Best Model Performance Abstract Figure 2: Selected Predictors for ML

Comparative assessment of short-term prognosis in patients with ST-segment elevation acute coronary syndrome without percutaneous coronary intervention based on the GRACE, TIMI, RECORD, PREDICT scales

Aim. To conduct a comparative assessment of the short-term prognosis in patients with ST-segment elevation acute coronary syndrome (STE-ACS) without percutaneous coronary intervention (PCI) based on the Global Registry of Acute Cardiac Events (GRACE), Thrombolysis In Myocardial Infarction (TIMI), RECORD, PREdicting risk of Death In Cardiac disease Tool (PREDICT) scales and to ident ify the most significant markers of fatal and non-fatal complications.Material and methods. Eighty-two STE-ACS patients without PCI were examined. Risk assessment was carried out using the GRACE, TIMI, RECORD, and PREDICT scales. Outcomes were assessed 30 days after markers. To assess the predictive value of above scales, sensitivity (Se) and specificity (Sp), as well as relative risk with a 95% confidence interval, were calculated.Results. Comparative analysis of the prognosis of developing fatal complications in STE-ACS patients without PCI revealed the following predictive characteristics of scales: GRAСE — Se=1,000, Sp=0,54, χ2=25,763 (p&lt;0,001); PREDICT — Se=0,281, Sp=0,96, χ2=20,297 (p&lt;0,001); TIMI — Se=0,75, Sp=0,94, χ2=51,985 (p&lt;0,001); RECORD — Se=1,000, Sp=0,48, χ2=21,716 (p&lt;0,001). Regarding the development of non-fatal complications, the following data was obtained: GRACE — Se=0,680, Sp=0,760, χ2=9,970 (p&lt;0,01); PREDICT — Se=0,080, Sp=1,000, χ2=4,167 (р&gt;0,05); TIMI — Se=0,120, Sp=1,000, χ2=8,171 (р&lt;0,05); RECORD — Se=0,680, Sp=0,640, χ2=5,128 (р&lt;0,05). The most significant criteria for developing fatal and non-fatal complications were identified as follows: Killip class II acute heart failure, systolic blood pressure &lt;100 mm Hg, age &gt;65 years, stage ≥II A chronic heart failure, ST elevation ≥1 mm at admission, ejection fraction ≤&lt;40%.Conclusion. A comparative evaluation of the 30-day prognostic significance of short-term scales (GRACE, RECORD, TIMI, PREDICT) in STE-ACS patients without PCI showed an ambiguous prognosis for developing both fatal and non-fatal complications. High sensitivity rates for predicting fatal complications were revealed in the GRACE and RECORD scales (100 and 100%, respectively) relative to the TIMI and PREDICT (75 and 28,1%, respectively), as well as for non-fatal complications in the GRACE and RECORD (68% for both) scales relative to the TIMI and PREDICT (12 and 8%, respectively).

English

BACKGROUND Acute myocardial infarction is a form of ischemic heart disease in which there is an inadequate supply of blood and oxygen to a portion of the myocardium. It typically occurs when there is an imbalance between myocardial oxygen supply &amp; demand. In this study, we wanted to determine the prognostic significance of serum uric acid concentration in acute myocardial infarction. METHODS This is a cross-sectional comparative study conducted among 100 acute myocardial infarction patients admitted at VIMSAR, Burla during the study period from November 2017 to October 2019 and also 50 age and gender-matched healthy controls person who presented to the hospital OPD with other reasons. All patients were diagnosed with ST-segment elevation acute myocardial infarction based on clinical history, examination, ECG changes, and biochemical markers. Detailed general examination and detailed systemic examination of cardiovascular, neuromuscular, gastrointestinal, respiratory &amp; genitourinary system were done with routine tests: Hb%, TLC, DC, ESR, S. Urea, S. Creatinine, Fasting/RBS, Blood Sugar, Urine, R/M, Serum uric acid, Troponin I &amp; CPK-MB and ECG in all leads. Evaluation of patient was done to access the Killip class on the day of admission and once among 50 age and gender-matched healthy controls. RESULTS The mean serum uric acid level was higher in patients with acute myocardial infarction than the healthy controls. There was no significant difference in the mean serum uric acid level between males &amp; females and the mean serum uric acid level between diabetic &amp; non-diabetic patients. Patients in the higher Killip class had higher serum uric acid levels. All patients who died in the study were in the higher Killip class and had higher S.uric acid levels. CONCLUSIONS A combination of Killip class &amp; serum uric acid level after acute myocardial infarction is a good predictor of mortality. KEY WORDS Myocardial Infarction, ST Segment Elevation, CPK-MB, Serum Uric Acid.

Factors Affecting Delayed Hospital Arrival of Patients with Acute Myocardial Infarction in Kinmen.

This study explores factors related to delayed emergency medical treatment for acute myocardial infarction patients on Kinmen Island. A cross-sectional study was performed in the only hospital in Kinmen Island. The study group consisted of 116 patients diagnosed with acute myocardial infarction (AMI, ICD-10 codes: I21.9) from November 2015 to May 2019. The binary logistic regression analyses were performed for the inferential statistical analysis. The mean age of the study group was 63.0 ± 14.5 years, 39.7% of the patients arrived at the emergency medicine longer than 6 h after the onset of symptoms. The related factors for delayed arrival the hospital emergency medicine department were female sex, age over 65 years, less than nine years’ education, and Killip Class, but only Killip Class reached the significant difference of statistics (OR = 3.616, 95% C.I. = 1.574 to 8.310, p = 0.002), and patients with delayed arrival times (>6 h) were found to have a higher percentage of Killip Class ≥ II. Therefore, it is essential to remind the physicians to proceed with risk stratification for acute coronary syndrome patients. In addition, health authorities should provide effective programs to increase awareness of the symptoms and timely treatment of acute myocardial infraction to the general public, especially the elderly.

Comparison of medical resource use and total admission cost in patients with acute myocardial infarction between on-hours visit versus off-hours visit.

The medical expenses for patients with acute myocardial infarction (AMI) has become enormous burden for global healthcare system. In AMI patients, total admission cost for patients with off-hours visit may be higher than those with on-hours visit, because of additional cost for emergent care during off-hours. This study aimed to compare total medical cost in AMI patients between on-hours visit versus off-hours visit. We retrospectively included 368 AMI patients who underwent PCI to the culprit lesion, and divided them into the on-hours group (n = 173) and the off-hours group (n = 195). We compared clinical characteristics, total admission cost, and clinical outcomes between the two groups. The prevalence of Killip class 3/4 was significantly greater in the off-hours group than in the on-hours group. Length of ICU and hospital stay were significantly longer in the off-hours group than in the on-hours group. Total admission cost was significantly higher in the off-hours group [¥1,570,400 (¥1,271,550-¥2,117,090)] than in the on-hours group [¥1,356,270 (¥1,100,990-¥1,957,225)] (P < 0.001). However, multivariate analysis revealed off-hours visit itself was not associated with high total admission cost after adjusting confounding factors. In conclusion, total admission cost was higher in AMI patients with off-hours visit than in those with on-hours visit. However, multivariate logistic regression analysis revealed that the off-hours visit itself was not associated with the highest total admission cost. Off-hours visit itself did not result in higher cost, but severer conditions in AMI patients with off-hours visit resulted in higher cost.

Prognostic performance of Controlling Nutritional Status score in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

The effect of malnutrition in patients with ST segment elevation myocardial infarction (STEMI) is not fully understood. In this study, we tried to investigate the prognostic consequence of the Controlling Nutritional Status (CONUT) score in patients with STEMI. In this study, we evaluated the CONUT scores of 1,028 patients with STEMI and examined its relationship with major adverse cardiovascular events (MACE) (all-cause mortality, myocardial reinfarction, and vessel revascularization) during a period of 19.9±10.3 months. Patients with CONUT score ≥5 were defined as severely malnourished. Predictors of MACE were assessed by Cox regression analysis, and p<0.05 was considered to indicate statistical significance. MACE was observed in a total of 147 (14.3%) patients. MACE was more frequent in the group with a higher CONUT score (33.3% vs. 10.9%, p<0.001). CONUT score ≥5 was an independent predictor of MACE in the Cox regression analysis (hazard ratio=2.50, 95% confidence interval: 1.61-3.90, p<0.001). Low ejection fraction, Killip class ≥3 at presentation, thrombolysis in myocardial infarction flow grade <3 after intervention, left main artery involvement, and low hemoglobin levels were other independent predictors of MACE in the long-term follow-up. Kaplan-Meier curves showed decreased MACE free survival rates in the high CONUT score group at a mean 19.9±10.3 months' follow-up duration (log-rank p<0.01). Malnutrition was strongly associated with poor outcomes in patients with STEMI treated using primary percutaneous coronary intervention.

Development and validation of a novel risk score to predict 5-year mortality in patients with acute myocardial infarction in China: a retrospective study.

BackgroundThe disease burden from ischaemic heart disease remains heavy in the Chinese population. Traditional risk scores for estimating long-term mortality in patients with acute myocardial infarction (AMI) have been developed without sufficiently considering advances in interventional procedures and medication. The goal of this study was to develop a risk score comprising clinical parameters and intervention advances at hospital admission to assess 5-year mortality in AMI patients in a Chinese population.MethodsWe performed a retrospective observational study on 2,722 AMI patients between January 2013 and December 2017. Of these patients, 1,471 patients from Changsha city, Hunan Province, China were assigned to the development cohort, and 1,251 patients from Xiangtan city, Hunan Province, China, were assigned to the validation cohort. Forty-five candidate variables assessed at admission were screened using least absolute shrinkage and selection operator, stepwise backward regression, and Cox regression methods to construct the C2ABS2-GLPK score, which was graded and stratified using a nomogram and X-tile. The score was internally and externally validated. The C-statistic and Hosmer-Lemeshow test were used to assess discrimination and calibration, respectively.ResultsFrom the 45 candidate variables obtained at admission, 10 potential predictors, namely, including Creatinine, experience of Cardiac arrest, Age, N-terminal Pro-Brain Natriuretic Peptide, a history of Stroke, Statins therapy, fasting blood Glucose, Left ventricular end-diastolic diameter, Percutaneous coronary intervention and Killip classification were identified as having a close association with 5-year mortality in patients with AMI and collectively termed the C2ABS2-GLPK score. The score had good discrimination (C-statistic = 0.811, 95% confidence intervals (CI) [0.786–0.836]) and calibration (calibration slope = 0.988) in the development cohort. In the external validation cohort, the score performed well in both discrimination (C-statistic = 0.787, 95% CI [0.756–0.818]) and calibration (calibration slope = 0.976). The patients were stratified into low- (≤148), medium- (149 to 218) and high-risk (≥219) categories according to the C2ABS2-GLPK score. The predictive performance of the score was also validated in all subpopulations of both cohorts.ConclusionThe C2ABS2-GLPK score is a Chinese population-based risk assessment tool to predict 5-year mortality in AMI patients based on 10 variables that are routinely assessed at admission. This score can assist physicians in stratifying high-risk patients and optimizing emergency medical interventions to improve long-term survival in patients with AMI.

The Utility of Systemic Immune-Inflammation Index for Predicting Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective: The systemic immune-inflammation index (SII), derived from counts of neutrophils, platelets, and lymphocytes, has been developed to predict clinical outcomes in several cancers and cardiovascular diseases. The aim of this study was to evaluate the utility of SII to predict contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: A total of 632 patients with STEMI who underwent primary PCI were retrospectively included. The patients were divided into two groups based on the presence or absence of CIN. Baseline demographic, laboratory, and clinic characteristics were evaluated between the two groups. Logistic regression analysis was used to identify independent predictors of CIN. Results: The receiver operating characteristic curve analysis demonstrated that the optimal cutoff value of SII for predicting CIN was 1,282 with a sensitivity of 76.1% and specificity of 86.7% (AUC: 0.834; 95% CI: 0.803–0.863; p < 0.001). Multivariate analysis performed in two models (SII; as separate continuous and categorical variables) showed age, estimated glomerular filtration rate (eGFR), diabetes, left ventricular ejection fraction (LVEF), Killip class ≥2, use of an intravenous diuretic, troponin I, and SII as independent predictors of CIN in model 1. In model 2, age, eGFR, diabetes, LVEF, Killip class ≥2, use of an intravenous diuretic, troponin I, and a value of SII >1,282 (p < 0.001, OR 6.205, 95% CI: 2.301–12.552) remained as independent predictors of CIN. Conclusion: SII may be a useful and reliable indicator to predict the development of CIN in patients with STEMI undergoing primary PCI than NLR and PLR.