Major Adverse Cardiovascular Events Events Research Articles

Major Adverse Cardiac Events After Radiation Therapy in Lung Cancer

Motivation: 
 Receiving radiation to the heart has been recognized as a risk factor for the development of major adverse cardiovascular events (MACEs) for many years. However, recent data suggests that radiation dosing to substructures of the heart serve as a better surrogate for evaluating the risk of developing a MACE than whole heart radiation dose. Recent papers suggest that dosing to the left anterior descending artery (LAD) can be used as a robust marker for cardiotoxicity risk; however, this association lacks corroborative data and is currently not incorporated into clinically routine care. 
 Problem: 
 In this paper we seek to investigate the relationship between radiation dose to the LAD and risk of developing a MACE in lung cancer patients treated with curative intent radiation. 
 Approach: 
 Chart review to confirm the presence of MACE events was performed in patients who were identified based on elevated troponin values to potentially have had a MACE after receiving their last dose of radiation therapy. Patients who had multiple courses of radiation therapy separated in time (>60 days) that received greater than 0.2 Gy whole heart dose during their subsequent courses before having a MACE were excluded. Selected patients were then stratified based on presence cardiovascular co-morbidities. Contours of patient’s LADs were made after patient selection, and will be verified by an expert (e.g., cardiologist or thoracic radiologist). 
 Results: 
 Dose to the LAD will be calculated and an assessment of the correlation between radiation dose and risk of having a MACE will be made. Analysis will assess the cardiac event rate at various times as well as time to MACE. 
 Implications: 
 This paper can help set a quantifiable standard with which radiation oncologists can use to minimize their patient’s risk of developing a MACE by minimizing radiation dosing to specific cardiac substructures while maintaining tumor coverage.

785 Sodium–glucose cotransporter 2 inhibitors in real-life patients at high cardiovascular risk

Abstract Sodium-glucose cotransporter 2 inhibitors (SGLT2i), were recently approved in the USA and the EU for the treatment of adults with symptomatic heart failure with reduced ejection fraction (HFrEF). These drugs currently play a prominent role in the treatment algorithm for HFrEF [ejection fraction ≤40%], and international guidelines considered they as first-line drugs. However, data on the use of SGLT2i in real-world practice lack. We aim at providing data on SGLT2i in high cardiovascular risk patients in the real-world setting. We have retrospectively evaluated high cardiovascular risk patients treated with SGLT2i according to Italian national regulation, and collected 1-year outcomes. The primary objective of the study is to generate real-world data about clinical characteristics, major adverse cardiovascular events (MACE), hospitalizations for heart failure, and adverse event in patients receiving canagliflozin, empagliflozin, dapagliflozin, ertugliflozin from our cohort. Ninety-three patients with diabetes treated with SGLT2i were retrospectively enrolled. At 1-year follow-up, the rate of hospitalization was 10.7%, the MACE events occurred in 6.4% of patients; of these, 4.3% had a myocardial infarction, and 2.1% had a stroke/TIA, the rate of urinary tract infections was 5.3% while no major adverse event occurred. In conclusion, in a real-world study including patients with high and very high cardiovascular risk, SGLT2i showed to be safe, with no major adverse events occurring at follow-up.

Abstract 14311: Gene Guided Antiplatelet Therapy for Acute Coronary Syndrome: An Updated Meta-Analysis

Introduction: Clopidogrel has been the mainstay oral antiplatelet regimen to treat Acute Coronary syndrome (ACS) post percutaneous coronary intervention (PCI) with stents. However, there is marked inter-individual variability due to genetic polymorphisms in the hepatic cytochrome P450 (CYP) 2C19 in the antiplatelet effects of clopidogrel and a reduced response to this drug may be a risk factor for ischemic complications. There has been varied evidence in gene-guided antiplatelet therapy post PCI. An updated meta-analysis was conducted to study the effect of gene-guided antiplatelet therapy in ACS. Methods: A systematic literature review was performed in Embase, PubMed and SCOPUS for all the related articles until May 2021 yielding 180 publications. Nine studies fulfilled inclusion criteria including 8 randomized clinical trials and 1 observational study. The Mantel- Haenszel random-effects model was used to calculate odds ratio (OR) and 95% confidence intervals (CI). Outcomes analyzed were the composite major adverse cardiovascular events (MACE), stent thrombosis, myocardial infarction (MI), bleeding and cardiovascular (CV) death. Results: Gene guided antiplatelet therapy was performed in 7106 patients and conventional therapy in 3970 patients. The MACE events was significantly lower in gene-guided therapy arm (OR = 0.67, 95% CI [0.51 -0.87], P=0.003) driven by lower stent thrombosis (OR=0.47, 95% CI [0.25 -0.88], P=0.02) and lower MI in the gene guided therapy (OR=0.61, 95% CI [0.41 -0.92], P=0.02). The bleeding rates trended to be lower in the gene guided therapy as well (OR = 0.75, 95% CI [0.54-1.02], P=0.07). There is no significance difference in CV death. (OR=0.57, 95% CI [0.21-1.55]) Conclusions: Genotype guided antiplatelet therapy in ACS has lower adverse cardiovascular outcomes driven by lower stent thrombosis and MI with lower bleeding trends as well.

Abstract 6919: Comparative Effectiveness of Long-Acting Insulin Analogs and Neutral Protamine Hagedorn (nph) Insulin for the Reduction of Major Adverse Cardiovascular Events Among Patients With Type 2 Diabetes

Introduction: Although long-acting insulin analogs (glargine, detemir, and degludec) and neutral protamine Hagedorn (NPH) insulin show similar efficacy for glycemic control among patients with type 2 diabetes, their comparative effectiveness in reducing cardiovascular events is unclear. Objective: To compare the risk of major adverse cardiovascular events (MACE) with the use of long-acting insulin analogs versus NPH among patients with type 2 diabetes. Methods: We conducted a retrospective cohort study using the Clinical Practice Research Datalink, a primary care database from the United Kingdom, linked with hospitalization and vital statistics data. The cohort included adults with type 2 diabetes initiating basal insulin therapy between 2002 and 2018. Exposure was defined as time-varying where each person-month of follow-up was classified as either current use of long-acting insulin analogs or NPH; patients who discontinued insulin treatment or were exposed to both insulin analogs and NPH in the same month were censored. The primary endpoint was MACE, a composite endpoint of myocardial infarction, ischemic stroke, and cardiovascular death. We used inverse probability of treatment and censoring weighting to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI) for MACE associated with current use of long-acting insulin analogs versus NPH. We also conducted secondary analyses stratified by age, sex, history of cardiovascular disease . Results: A total of 57,334 patients entered our cohort (31,136 using a long-acting analog and 26,198 using NPH. Mean age was 63.8 years, and 44.3% of patients were female. A total of 3,494 MACE events occurred over a mean follow-up of 1.62 years. Long-acting insulin analogs were not associated with a decreased risk of MACE compared to NPH (Table). Conclusions: Current use of long-acting insulin analogs is not associated with a reduced risk of MACE compared to use of NPH insulin among patients with type 2 diabetes.

Abstract 12454: Prognostic Value of Computational Pressure-Flow Dynamics Derived Fractional Flow Reserve in Non-Culprit Vessels Among Patients Presenting With Acute Coronary Syndrome and Multivessel Disease

Introduction: Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index developed to assess the severity of myocardial ischemia in patients with coronary artery stenoses, without the requirement of invasive pressure wire and hyperemic stimulus needed in fractional flow reserve (FFR) measurement. In patients presenting with acute coronary syndrome (ACS), the non-culprit vessels are often diseased concomitantly, and the ischemia status of such vessels may affect clinical outcomes. In this study, we aimed to evaluate the prognostic value of caFFR in non-culprit vessels among ACS patients with multivessel disease. Methods: Patients presented with ACS and at least two vessels having ≥50% diameter stenosis were included, and the culprit vessel was identified for each patient. Analyses of caFFR were performed for the two non-culprit vessels of every patient. Based on the threshold of 0.8 adopted from FFR studies, patients were stratified into ischemic group if any non-culprit vessel caFFR was ≤0.8, and into non-ischemic group if none of the non-culprit vessels had caFFR≤0.8. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction, and any subsequent revascularization. Results: A total of 293 patients (mean age 65.3±13.2, male 77.5%) were included, with 113 (38.6%) presented with STEMI, 119 (40.6%) presented with NSTEMI, and 41 (14.0%) presented with unstable angina. The ischemic group patients (n=176) had more obstructive lesions compared to non-ischemic group patients (n=117) (3.8±1.5 vs. 3.2±1.1, p<0.001). The MACE event rate at 3 years was higher in ischemic group compared to non-ischemic group (28.4% vs. 15.4%; adjusted hazard ratio, 1.92; 95% confidence interval, 1.10-3.36; p=0.023). Conclusions: In ACS patients with multivessel disease, myocardial ischemia in non-culprit vessels assessed by caFFR was associated with adverse clinical outcomes in terms of MACE.

Abstract 9884: Supranormal Left Ventricular Ejection Fraction and Risk of Major Adverse Cardiovascular Events: Findings from the Multi-Ethnic Study of Atherosclerosis and Dallas Heart Study

Introduction: Left ventricular (LV) systolic dysfunction is associated with a higher risk of adverse cardiovascular (CV) outcomes. However, the prognostic implication of supranormal LV ejection fraction (LVEF), as assessed by cardiac MRI, among adults with no prior CV disease (CVD) is unknown. Methods: Participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and Dallas Heart Study (DHS) who were free of CVD at baseline and underwent cardiac MRI with LVEF above the normal MRI cutoff (≥57%) were included. The association between cohort specific LVEF categories and risk of clinically adjudicated major adverse CV events (MACE) was assessed using adjusted Cox models. The association between continuous measures of LVEF and risk of MACE was assessed in a pooled cohort analysis using cohort-specific Z-scores of LVEF. Results: There were 4,703 participants from MESA (mean age 62, 25% black, 54% women, median follow up 13.1 years) and 2,287 participants from DHS (mean age 44, 46% black, 57% women, median follow up 12 years) with 747 and 151 MACE events, respectively. In both cohorts, participants across increasing LVEF quartiles (MESA Q1 mean LVEF=63% vs. Q4 mean LVEF=78%) were older and had a higher burden of CV risk factors. Among cardiac parameters, across increasing quartiles, LV end-diastolic volume (Q1: 69.9 vs. Q4: 64.6 ml/m2) and LV mass (Q1: 79.1 vs. Q4: 74.9 gm/m2) significantly decreased (p<0.001), while LV stroke volume (Q1: 43.8 vs. Q4: 49.8 ml/m2) increased (p<0.001). In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs. Q1) in both cohorts (Figure A). Similar patterns of association were observed between continuous distribution of LVEF and risk of MACE in the pooled analysis (Figure B). Conclusions: Among community-dwelling adults without CVD, supranormal LVEF is associated with elevated risk of MACE. Future studies are needed to elucidate the mechanisms underlying risk of CVD among individuals with supranormal LVEF.

Abstract 12082: Disparities in Medical Care and Impact on Secondary Cardiovascular Complications Among Patients With Peripheral Artery Disease: A Report From the PAD Go Pro Quality Program

Introduction: Guideline-directed optimal medical treatment (OMT) is known to reduce secondary cardiovascular risk among those with peripheral artery disease (PAD). Rates of OMT have been reported lowest among minority subgroups. Hypothesis: Race and ethnic identity are associated with differences in rates of OMT and secondary cardiovascular (CV) complications among a large, metropolitan population with PAD. Methods: From a single-system quality improvement registry, we evaluated rates of OMT and major adverse CV events (MACE), including all-cause death, myocardial infarction, and stroke. OMT was defined as use of an antiplatelet agent, statin, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker if hypertensive, and tobacco abstention if smoking. Patients were stratified based on baseline OMT status, then censored for MACE events. Results: From January 1, 2016-May 31, 2021, 15,107 outpatients with PAD had a mean age of 72.5 +/- 10.9 years, 46.5 % were female, and 89.6% identified as non-Hispanic White (NHW), 8.4% as non-Hispanic Black (NHB), and 2.0% as Hispanic/Latino (H/L). OMT was provided to 28.2% of patients overall. Rates of OMT provided to NHW, AA, and H/L cohorts were 28.2%, 26.9%, 32.6%, respectively (p=0.14). Among all patients with OMT at baseline (n=4263), 5-year rates of MACE were higher among NHB compared to NHW and H/L groups (31.9% vs 23.8% vs 24.6%, p=0.004). Among NHB, those receiving OMT had a lower risk of MACE at 5 years (31.9% vs 41.2%; log-rank p=0.014). OMT was similarly associated with reductions in MACE at 5 years within the H/L cohort (24.6% vs 47.7%; log-rank p=0.032). Conclusions: Rates of OMT to reduce secondary CV risk among those with ambulatory PAD are poor overall, and lowest among NHB subgroups. Non-OMT was associated with worse outcomes among all subgroups. Additional analysis to evaluate baseline differences, particularly regarding those affecting the provision of OMT, are warranted.

Cardiac magnetic resonance imaging improves prognostic stratification of patients with ST-elevation myocardial infarction and preserved ejection fraction.

AimsTo evaluate the prognostic validity of clinical risk factors as well as infarct characterization and myocardial deformation by cardiac magnetic resonance (CMR) in ST-elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF) following primary percutaneous coronary intervention (PCI).Methods and resultsThis multicentre, individual patient-data analysis from two large CMR trials included 1247 STEMI patients. Cardiac magnetic resonance examinations were conducted 3 [interquartile range (IQR) 2–4] days after PCI. LVEF, infarct size, microvascular obstruction (MVO), and myocardial strain values were measured. Primary endpoint was defined as composite of major adverse cardiovascular events (MACE) including death, re-infarction, and congestive heart failure. A preserved LVEF (defined as LVEF ≥50%) was observed in 724 patients (=58%). In the overall cohort, 97 patients experienced a MACE event [follow-up time 12 (IQR 12–13) months], and 34 MACE events occurred in the group with preserved LVEF (5% vs. 12% incidence rate in patients with LVEF < 50%). TIMI risk score [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.02–1.59; P = 0.03] and female gender (HR 2.24, 95% CI 1.10–4.57; P = 0.03) emerged as independent clinical determinants of MACE in the patient group with preserved LVEF. Among CMR parameters, the presence of MVO (HR 2.39, 95% CI 1.05–5.46; P = 0.04) and reduced global longitudinal strain (GLS; HR 1.12, 95% CI 1.02–1.23; P = 0.02) independently predicted MACE in the LVEF-preserved population. The addition of MVO and GLS to the clinical prognostic markers (TIMI risk score, female gender) increased (P = 0.02) the prognostic validity [AUC 0.76 (95% CI 0.73–0.79)] compared to the clinical markers alone [AUC 0.65 (0.62–0.69)].ConclusionIn contemporary treated STEMI patients showing preserved LVEF, a CMR-based risk prediction approach assessing MVO and GLS provided strong prognostic value that was incremental to clinical outcome parameters.

Safety Analysis of Pacritinib in Patients with Myelofibrosis and Severe Thrombocytopenia

Safety Analysis of Pacritinib in Patients with Myelofibrosis and Severe Thrombocytopenia

LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders

Abstract Background Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF). Purpose The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up. Methods Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF &amp;lt;50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE). Results A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p&amp;lt;0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis. Conclusions Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon. Funding Acknowledgement Type of funding sources: None.

Hospital readmissions and economic burden associated with multivessel disease in the early period following acute myocardial infarction

Abstract Background There is emerging evidence that particularly high rates of major adverse cardiovascular events (MACE) occur in the 90-day period after acute myocardial infarction (AMI). Post-AMI MACE are associated with additional resource utilization and economic burden for healthcare systems, with multivessel disease (MVD) conferring a 3- to 4-fold increase in risk of recurrent MACE in the first year post AMI vs. single vessel disease. Thus, characterizing the prevalence and outcomes of patients with MVD and various comorbidities is crucial to predict and mitigate clinical risk and associated costs. Purpose To describe post-AMI readmissions and economic burden in MVD patients at 30, 90, and 365 days. Methods This was a retrospective cohort study (1st January, 2008 to 31st December, 2018). Patients with MVD were identified by a confirmed diagnosis code from a longitudinal, representative UK population health dataset comprising primary care data from the Clinical Practice Research Datalink (CPRD), which was linked to secondary care data from the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases. Patients who experienced at least one AMI after their first recorded MVD diagnosis were defined as MVD+. A MACE was defined as any one of non-fatal MI, non-fatal stroke, or cardiovascular death. Readmissions were defined as non-elective admissions with a MACE outcome diagnosis occurring up to 28 days from a previous admission with the same treatment speciality. Results The study population included 78,128 MVD+ patients (4.2% of the total patient population). In the MVD+ cohort, 3,753 (4.8%) patients were readmitted with at least one MACE event or other non-elective admission within the cardiovascular specialty: 2,394 (63.8%), 2,562 (68.3%), and 2,830 (75.4%) readmissions occurred within 30, 90, and 365 days, respectively. The mean length of hospital stay per patient, per readmission for MACE within 30, 90, and 365 days was 7.22, 7.46, and 7.74 days, respectively. The mean cost per MACE admission within 90 days of index AMI was £3,926.52. Non-fatal MI was the most common reason for readmission at all timepoints. Percutaneous transluminal balloon angioplasty and saphenous vein graft procedures (coronary artery bypass graft, CABG) were among the most common cardiac procedures in MVD+ patients, at 70,276 (22.7%) and 15,418 (5.0%), respectively. Conclusions In patients with MVD who suffer an AMI, there is high resource utilization and cost, particularly in the first 90-days post AMI; therefore, the 90-day post-AMI period represents significant economic costs to healthcare systems. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): CSL Behring

Major adverse cardiovascular events in survivors of immune-mediated thrombotic thrombocytopenic purpura.

Cardiovascular disease is a leading cause of death in survivors of immune-mediated thrombotic thrombocytopenic purpura (iTTP), but the epidemiology of major adverse cardiovascular events (MACE) in iTTP survivors is unknown. We evaluated the prevalence and risk factors for MACE, defined as the composite of non-fatal or fatal myocardial infarction (MI), stroke, and cardiac revascularization, during clinical remission in two large iTTP cohorts (Johns Hopkins University and Ohio State University). Of 181 patients followed for ≥ 3 months after recovery from acute iTTP, 28.6% had a MACE event over a median follow up of 7.6 years. Stroke was the most common type of MACE (18.2%), followed by non-fatal MI (6.6%), cardiac revascularization (4.9%) and fatal MI (0.6%). Compared to the general United States population, iTTP survivors were younger at first stroke in remission (males [56.5 years vs. 68.6 years, p=0.031], females [49.7 years vs. 72.9 years, p < 0.001]) or MI in remission (males [56.5 years vs. 65.6 years, p < 0.001] and females [53.1 years vs. 72.0 years, p < 0.001]). Age (HR 1.03 [95% CI 1.002-1.054]), race (Black/Other vs. White) (HR 2.32 [95% CI 1.12-4.82]), and diabetes mellitus (HR 2.37 [95% CI 1.09-0.03]) were associated with MACE in a Cox regression model also adjusted for sex, hypertension, obesity, hyperlipidemia, chronic kidney disease, atrial fibrillation, autoimmune disease, and relapsing iTTP. Remission ADAMTS13 activity was not significantly associated with MACE. In conclusion, iTTP survivors experience high rates of MACE and may benefit from aggressively screening for and managing cardiovascular risk factors.

Heart failure in pregnancy: what is the long-term impact of pregnancy on cardiac function? A tertiary care centre experience and systematic review

BackgroundWomen with cardiomyopathy (CM) are often advised against pregnancy due to risk for major adverse cardiovascular events (MACE). However, the impact of CM subtype on maternal MACE is not understood,...

Prognostic implications of peak early diastolic strain rate (PEDSR) by feature-tracking cardiac magnetic resonance in patients with st-elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the National Key Research and Development Program of China OnBehalf Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University Background：The prognostic value of Peak Early Diastolic Strain Rate (PEDSR) measured by Cardiac Magnetic Resonance (CMR) in ST-Elevation Myocardial Infarction (STEMI) is not clear. Methods：420 first-STEMI patients from the EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453) and 40 normal people were enrolled and followed up. The patients received timely percutaneous coronary intervention (PCI) within 12h and CMR within 1 week (median,5 days; range, 2-7 days) after infarction. LV circumferential, radial, longitudinal PEDSR and other routine CMR parameters were measured. Clinical end point was a composite major adverse cardiovascular events (MACEs) including cardiovascular death, re-infarction and re-hospitalization for heart failure. Results：During follow-up (median: 52 months, inter-quartile range: 29–78 months), 73 (17.4%) patients experienced a MACE event. Compared with normal people, STEMI patients had lower PEDSR (circumf. PEDSR 0.77 vs. 1.27%/s, P &amp;lt; 0.001). Patients who developed MACEs also had lower PEDSR than patients who didn’t (circumf. PEDSR 0.64 vs. 0.78%/s, P &amp;lt; 0.001). Circumf. PEDSR can significantly predict MACEs with an AUC of 0.659 (95%CI 0.587-0.731, P &amp;lt; 0.001) which is not inferior to LVEF (0.659 vs. 0.651, P = 0.843), LVIS (0.659 vs. 0.661, P = 0.678) and LVMVO (0.659 vs. 0.666, P = 0.600). Circumf. PEDSR ≤ 0.665%/s is the independent predictive factor of MACEs in clinical (HR 2.099 [95%CI 1.273-3.461], P = 0.004) and CMR models (HR 1.795 [95%CI 1.065-3.026], P = 0.028). In Kaplan-Meier curve, patients with impaired PEDSR are more likely to experience MACEs (P &amp;lt; 0.001). When subdivided by LVEF, PEDSR still makes a significant difference to MACEs in patients with LVEF &amp;gt; 50.28% (P = 0.003) but not in reduced LVEF patients (P = 0.204). PEDSR is also incremental to LVEF (Continuous NRI 0.515 [95%CI 0.268-0.763], P &amp;lt; 0.001), LVIS (Continuous NRI 0.576 [95%CI 0.330-0.822], P &amp;lt; 0.001), and LVMVO (Continuous NRI 0.576 [95%CI 0.330-0.822], P &amp;lt; 0.001). Finally, worse TIMI flow post-PCI (HR 3.353 [95%CI 1.603-7.016], P = 0.001) and LVEF (HR 0.920 [95%CI 0.900, 0.940], P &amp;lt; 0.001) are the risk factors for PEDSR impairment. Conclusions：CMR-derived PEDSR can significantly predict MACEs with the discriminative power not inferior to LVEF, LVIS and LVMVO. Circumf. PEDSR ≤ 0.665%/s is an independent predictive factor of MACEs and is incremental in the prognostic risk stratification of STEMI.

Ankle-Brachial Index for Risk Stratification in Patients With Symptomatic Peripheral Artery Disease With and Without Prior Lower Extremity Revascularization: Observations From the EUCLID Trial.

[Figure: see text].

Impact of brain natriuretic peptide for predicting long-term life expectancy and cardiovascular or limb events in peripheral arterial disease.

Brain natriuretic peptide (BNP) is introduced as a predictor of the degree of ventricular dysfunction and is associated with mortality. There are limited reports on the relationship of BNP with long-term all-cause death (AD) and cardiovascular or limb events in peripheral artery disease (PAD). We examined the relationship between BNP level and these events in PAD patients. We performed a prospective cohort study in 938 PAD patients. The patients were divided into four groups based on BNP levels with median (interquartile range): Q1: ≤20.4; Q2: 20.5-42.8; Q3: 42.9-103.4; and Q4: ≥103.5 pg/mL. The endpoints were AD, freedom from major adverse cardiovascular events (MACE), and MACE plus limb events (MALE). The median follow-up time was 65 months. There were 383 deaths (40.8%) during follow-up period. AD depended on BNP levels (P<0.01), with 5-year freedom from AD rates of Q1: 94%, Q2: 84%, Q3: 69%, and Q4: 55%. The Kaplan-Meier estimates of freedom from AD, MACE, and MALE had significant differences among Q1- Q4 groups (P<0.001). In multiple regression analysis, BNP had significant negative correlations with eGFR, serum albumin, and BMI and positive correlations with diabetes (P<0.05). In Cox multivariate analysis, higher BNP, age, CRP, D-dimer, lower BMI, ABI, serum albumin, and eGFR were related to AD; and higher BNP, age, lower ABI, serum albumin, CAD, and DM were related to MACE and MALE (P<0.05). Statins improved AD, MACE, and MALE (P<0.01). BNP was a promising biomarker for AD, MACE, and MALE in patients with PAD.

Impact of completeness of revascularisation on long-term outcomes in patients with multivessel disease undergoing PCI: CR versus IR outcomes in multivessel CAD.

We aimed to study long-term clinical outcomes in patients with multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI) over the last 10 years with respect to the completeness of revascularisation at a tertiary care hospital. A total of 2,960 consecutive MVD patients taken for PCI between 2008 to 2017 were enrolled in the study with baseline demographic, procedural, and follow-up details retrieved from custom-made departmental software. Of those, 2,598 patients with follow-up details constituted the study cohort. Complete revascularisation (CR) was achieved in 1,854 (71.4%) and incomplete revascularisation (IR) in 744 (28.6%) patients. Propensity matching was performed and 740 matched pairs identified in the two groups. The primary endpoint was survival free of any major adverse cardiovascular events (MACE) with each individual MACE event being a secondary endpoint. IR occurred more often in patients with acute coronary syndrome (64.1% vs 58.3%, p=0.003), complex lesion intervention (40.7% vs 29.6%, p<0.001) and in those with mean stent length ≥38 mm per vessel intervened (21.0% vs 13.5%, p<0.001). Median follow-up was 54 months (interquartile range: 31-84 months). After propensity matching, CR resulted in a better survival free of all adverse events, i.e., 86.4% vs 81.1% (HR 1.52, CI: 1.21-2.02; p<0.01). Individual MACE endpoints were, however, not statistically different between the groups. In MVD patients undergoing PCI, CR results in better survival free of all adverse events including all-cause mortality, non-fatal MI, repeat revascularisation and recurrent angina.

A systematic review and meta-analysis of the impact of GLP-1 receptor agonists and SGLT-2 inhibitors on cardiovascular outcomes in biologically healthy older adults

Background: Unintentional weight loss is a hallmark of frailty and is associated with poor outcomes in older adults with type 2 diabetes. As such, the role of pharmacological therapies that facilitate weight loss – namely, sodium- glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists – remains uncertain in fitter older adults. We performed a systematic review and meta-analysis to evaluate these agents on major adverse cardiovascular events (MACE) in older adults eligible for participation in cardiovascular outcome trials.Methods: A literature search was performed in MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL) and CNKI from inception to 29 June 2020. A class-specific meta-analysis was conducted in older adults (&gt;65 years at recruitment) and compared with the similar analysis in younger (&lt;65 years) adults.Results: Of 761 unique studies identified, nine met the criteria for inclusion, five using GLP-1 receptor agonists and four with SGLT-2 inhibitors. GLP-1 receptor agonists in older adults were associated with a 15.3% (OR 0.847 (95% CI 0.788 to 0.910)) reduction in MACE events, similar to the 16% benefit seen in younger adults. The use of SGLT-2 inhibitors reduced MACE in older participants by 16.9% (OR 0.831 (95% CI 0.699 to 0.989)), numerically superior to the impact in younger patients (OR 0.936 (95% CI 0.787 to 1.113).Conclusions: GLP-1 receptor agonists and SGLT-2 inhibitors reduced MACE outcomes in older adults who were eligible to participate in clinical trials. Whereas this is reassuring for the biologically robust, it should not be extrapolated to frail older adults without further investigation.

Can we use the CHA2DS2VASc score in Atrial Flutter?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction CHA2DS2VASc score is a well stablished prognostic score in atrial fibrillation population. However, considering patients with isolated atrial flutter no prognostic score are defined, regarding the embolic risk of this population. Purpose To evaluate the capacity of CHA2DS2VASc score to predict cardiovascular death and major adverse cardiovascular events (MACE) in flutter patients (pts). Methods Single-center retrospective study of pts submitted to CTA between 2015 and 2019, comprising two groups: I – pts with lone AFL; II – patients with AFL and prior AF. Clinical records were analyzed to determine the occurrence of MACE during the long-term follow up, defined as death (of cardiovascular or unknown cause), stroke, clinically relevant bleed or hospitalization due to heart failure or arrhythmic events. CHA2DS2VASc score was categorized into 3 groups: 0-1; 2-3; &amp;gt;4. Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses. Results A total of 476 pts (66 ± 12 years, 80% males) underwent CTA: group I – 284 pts (60%), II – 192 pts (40%). Baseline characteristics were similar between groups, except for age with group I pts being older (68 ± 12, 64 ± 11, p &amp;lt; 0.01). The mean baseline CHA2DS2VASc was 2.3 ± 1.5 and the median post-CTA follow-up was 2.8 year. Considering global population, CHA2DS2VASc score was an independent predictor of cardiovascular death (OR: 1.49 95%CI 1.09-1.79, p = 0.08) and was a predictor of MACE even after adjustment for the diagnose of prior AF (OR 1.88, 95% IC 1.094-3.249, p = 0.022). Considering only the pts in group I CHA2DS2VASc score was a predictor of MACE (OR 3.03, 95% CI 1.112-8.278, p = 0.03) after adjustment for sex and age. Regarding the different MACE components, the score was a predictor of stroke (OR 4.45, IC 1.66-13.39, p = 0.04). In flutter pts CHA2DS2VASc score did not predict cardiovascular death. Conclusions In our population CHA2DS2VASc score was able to predict MACE events and stroke in patients with isolated atrial flutter. This suggests that in the future CHA2DS2VASc score could be applied to establish embolic risk in atrial flutter. Abstract Figure.

Return to work following adverse cardiovascular events in adults with congenital heart disease

BackgroundAdults with congenital heart disease (CHD) are at increased risk for major adverse cardiovascular events (MACE), including stroke, myocardial infarctions, and heart failure. Following survival of MACE, an important metric is re-entry to the workforce. This study sought to characterize the differences in return-to-work (RTW) characteristics between MACE survivors with CHD and those in the general population. MethodsLinking Danish health and administrative registries, a cohort of adults with CHD who survived a MACE between the years of 1992–2017 were matched 10:1 by age at MACE, year of MACE, and sex to MACE survivors without CHD. Logistic regression assessed working status relative risk at three-, six-, and 12- months after the MACE event. Cox regression hazard ratio characterized time to RTW and maintained RTW. ResultsDuring the study period, 538 CHD patients survived MACE. These patients were matched to 4930 MACE survivors without CHD. The adjusted odds ratios of having returned to work were 0.91 (95% confidence interval (CI): 0.73–1.14) of employment at three months, 0.77 (95% CI: 0.61–0.96) at six months, and 0.76 (95% CI: 0.61–0.96) at 12 months. Of those who required governmental disability payments after MACE and admission for longer than one day, the adjusted hazard ratio of maintained RTW was 0.83 (95% CI: 0.69–0.99) for CHD patients compared to the general population. ConclusionsPatients with CHD who survive a MACE have evidence of impaired RTW compared to those without CHD. Further research is needed to understand and augment functional recovery in this complex population.