Major Cardiovascular Events In Patients Research Articles

Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis

ObjectiveTo determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased risk of cardiovascular...

Effects of the Strong Hearts program after a major cardiovascular event in patients with cardiovascular disease.

Cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) are secondary prevention interventions for cardiovascular disease (CVD) with a class 1a indication yet suboptimal utilization. To date, there are only three approved ICR programs. Alternative programing should be explored to increase enrollment and adherence in these interventions. This study aims to evaluate the effectiveness of the Strong Hearts program in cardiovascular patients following a major cardiovascular event. One hundred ninety-seven (n = 197) participants were enrolled in this prospective, nonrandomized study. Patients were eligible for participation if they were referred by a physician after a major cardiovascular event, defined as any of the following: (1) acute myocardial infarction (MI) within the preceding 12 months; (2) current stable or unstable angina pectoris; (3) heart valve procedure; (4) percutaneous intervention of any kind; (5) heart transplant; (6) coronary artery bypass grafting (CABG); or (7) congestive heart failure (CHF) with reduced or preserved ejection fraction. Participants were asked to attend program visits four times per week for 9 weeks. Visits consisted of individualized exercise and intensive healthy lifestyle education. Paired t tests were utilized to compare pre- and postprogram outcome measures. One hundred twenty-eight (n = 128) participants completed the program within the 9-week time frame and their outcome measures were included in the data analysis. Among this, 35.2% participants were female and 64.8% were male. The mean age was 65 (range, 19-88). Qualifying diagnoses were percutaneous coronary intervention (PCI; 60, 46.9%), CABG (33, 25.8%), angina (24, 18.8%), valve procedures (8, 6.2%), and CHF (3, 2.3%). After implementation of the intervention, statistically significant decreases in weight (P < .001), body mass index (BMI, P < .001), waist circumference (P < .001), triglycerides (P = .01), systolic blood pressure (SBP, P <.001), diastolic blood pressure (DBP, P = .002), total fat mass (P < .001), Dartmouth Quality of Life Index P < .001), and cardiac depression scores (P = .044) were detected. In other instances, there were statistically significant increases across time for the clinical parameters of high-density lipoprotein (HDL, P = .02), Vitamin D (P = .001), metabolic equivalents (METS, P < .001), Duke activity scores (P < .001), and Rate Your Plate nutrition scores (P < .001). There were no significant changes across time for total cholesterol (P = .17), low-density lipoprotein (LDL, P = .21), A1c (P = .27), or dual-energy X-ray absorptiometry (DXA) total lean mass (P = .86). The 9-week structured program resulted in significant cardiovascular benefit to patients with CVD by reducing cardiac risk factors, increasing exercise capacity, and improving quality of life.

Risk of Major Cardiovascular Disease after Exposure to Contrast Media: A Nationwide Population-Based Cohort Study on Dialysis Patients.

Contrast associated kidney injury is caused by side effects of iodinated contrast media (ICM), including inflammation. Chronic inflammation among dialysis patient contributes to atherosclerosis, which leads to simultaneous conditions of the kidney, brain, and vasculature. Data to investigate the pathologic effects of ICM on cardiovascular complications in dialysis patients are lacking. Dialysis patients who had been exposed to ICM from computed tomography (ICM-CT) were allocated as the ICM-CT cohort (N = 3751), whereas dialysis patients without ICM exposure were randomly allocated as the non-ICM cohort (N = 17,196). Furthermore, 540 pairs were selected for analyses through propensity score-matching in terms of age, sex, comorbidities, dialysis vintage, and index date. During a median follow-up of 10.3 years, ICM-CT cohort had significantly higher risks in the following, compared with non-ICM cohort: all-cause mortality (adjusted hazard ratio [aHR], 1.36; 95% confidence interval [CI], 1.26-1.47), cardiovascular events (aHR,1.67; 95% CI, 1.39-2.01), acute coronary syndrome (adjusted HR: 2.92; 95% CI, 1.72-4.94), sudden cardiac arrest (aHR, 1.69; 95% CI, 0.90-3.18), heart failure (aHR, 1.71; 95% CI,1.28-2.27), and stroke (aHR, 1.84; 95% CI,1.45-2.35). The proinflammatory ICM is significantly associated with an increased risk of major cardiovascular events in patients on dialysis.

Impact of NSAIDs on 8-year cumulative incidence of major cardiovascular events in patients with ankylosing spondylitis: a nationwide study.

The objectives of this study were to describe the incidence of major adverse cardiovascular events (MACEs) in French patients newly benefiting from the French Long-term Illness scheme (LTI) for AS and to evaluate the effect of various treatments on the risk of MACE occurrence. This national cohort study was based on the French national medico-administrative database SNDS containing data on hospitalization, the LTI, and outpatient care consumption. All French patients newly receiving LTI benefits for AS from 2010 to 2013 were included. The final follow-up date was 31 December 2018. The occurrences of MACEs [stroke and myocardial infarction (MI)] and comorbidities were identified from algorithms previously described in the literature. Competitive risk analysis using propensity score and inverse weighting was performed to calculate cumulative incidence functions and to determine subhazard ratios (SHRs) for the various treatments of interest. Between 2010 and 2013, 22 929 patients were included [mean age 43.0 (s.d. 13.9) years, 44.9% mal]. The 8-year cumulative incidences of MACE, stroke, and MI were 1.81% (1.61-2.05), 0.97% (0.83-1.14), and 0.85% (0.71-1.04), respectively. NSAIDs [SHR: 0.39 (0.32-0.50), P < 0.001] and anti-TNF [SHR 0.61 (0.46-0.80), P < 0.001], but not anti-IL17 [2.10 (0.79-5.57)] were associated with a lower risk of MACE occurrence. MACE incidence rates at 8 years are low in patients newly benefiting from LTI for AS. Our results support the hypothesis of a protective role of NSAIDs and anti-TNF in cardiovascular risk in these patients.

Effect of clopidogrel gene on platelet reactivity and major cardiovascular events in patients with acute coronary syndrome

Effect of clopidogrel gene on platelet reactivity and major cardiovascular events in patients with acute coronary syndrome

Platelet Indices and Intracoronary Thrombus Grade as Predictors of In-Hospital Major Cardiovascular Events in Patients with ST Elevation Myocardial Infarction Post Primary Percutaneous Coronary Intervention

Background: The high mortality rate of ST Elevation Myocardial Infarction (STEMI) is caused by its complications, especially in-hospital major cardiovascular events (MACE). This study aims to determine the relationship between platelet indices and intracoronary thrombus grade as predictors of in-hospital MACE and the interaction of the combination of both predictors in patients with STEMI post-primary percutaneous coronary intervention (PCI). Methods: This prospective cohort study was conducted with STEMI patients who underwent primary PCI. Data was analyzed by SPSS 24.0.0.0 version. Results: There were 71 samples: 46 patients (64.8%) with a high platelet index and 48 patients (67.6%) with a high intracoronary thrombus grade. During in-hospital follow-up, there were found that 42 patients (59.2%) experienced MACE. The cut-off value used classifies high platelet index for PDW 11.25 fl (AUC 0.892; CI 95% 0.786-0.999; p&lt;0.001) and MPV 10.15 (AUC 0.901; CI 95% 0.812-0.990; p&lt;0.001). The Cox regression backward log-rank model showed both high platelet indices (adjusted HR 38.13; CI 95% 5.16-282.03; p&lt;0.001) and high Intracoronary Thrombus Grade (adjusted HR 31.67; CI 95% 4.28-234.54; p=0.001) played an independent role as predictors of MACE during hospitalization, regardless of the influence of coronary angiography results, Killip class, smoking and consumption of acetosal and clopidogrel. The combination of two predictors of high platelet indices and high Intracoronary Thrombus Grade based on SEM analysis showed that 95.2% experienced in-hospital MACE (Mantel-Haenzel Common Estimate 17.48; Breslow-Day Homogeneity p=0.772; Cochran’s and Mantel-Haenszel p=&lt;0.001), had better predictive ability as seen from the comparison of the respective AUC values, namely the combination, high platelet indices and high Intracoronary Thrombus Grade (0.942; 0.902; 0.873; p&lt;0.001). Conclusion: High platelet indices and high intracoronary thrombus grade can be used as additional information for risk stratification of in-hospital MACE of STEMI patients post-primary PCI, especially when both variables were combined.

Prognostic Value of Logistic Clinical Syntax Score in Coronary Bifurcation Lesions Treated with Double Stent Technique

Introduction: In this study, we aimed to investigate the relationship between the preprocedural logistic clinical SYNTAX score (Log CSS) and major cardiovascular events (MACE) in patients with true bifurcation lesions who underwent revascularization with the double stent strategy. Patients and Methods: A total of 233 non-ST elevation myocardial infarction (NSTEMI) patients who underwent revascularization with a double stent strategy were retrospectively included in the study. Anatomical SYNTAX score (SS) and log CSS were calculated. The patients were divided into two groups according to the cut-off value determined by ROC analysis. The prediction of two-year MACE with Log CSS was evaluated. Results: MACE developed in 33.9% of patients with high Log CSS and 8.5% of patients with low Log CSS (p&lt; 0.001). In the Kaplan-Meier survival analysis, the long-term survival of the high Log CSS patients was significantly lower than the low Log CSS group (Log-rank p&lt; 0.001). In multivariate COX analyses, high Log CCS (HR= 3.781; 95% CI= 1.706-8.377; p= 0.001) was the strongest independent predictor of MACE. Conclusion: Log CSS can be a simple and useful tool to predict the development of MACE in patients with true bifurcation lesions revascularized by percutaneous coronary intervention.

New opportunities of antithrombotic therapy in patients with type 2 diabetes mellitus and stable coronary heart disease for reducing the cardiovascular risk and cardiovascular complications: THEMIS, THEMIS-PCI trials

Patients with diabetes mellitus (DM) and coronary heart disease belong to a group with a very high risk of developing cardiovascular disease. In patients with coronary atherosclerosis, DM increases the risk of ischemic events by 2-4 times. Apparently, increased antithrombotic therapy has an advantage in patients with DM who have had myocardial infarction. However, until recently it was not clear there is such an advantage in patients with DM and stable coronary artery disease without prior myocardial infarction. The addition of ticagrelol to monotherapy of acetylsalicylic acid reduces the risk of major cardiovascular events in patients with type 2 DM and stable coronary artery disease undergoing percutaneous coronary intervention, if patients have a high risk of ischemic events.

Potential Roles of Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) in Nondiabetic Populations.

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been observed in several large cardiovascular outcome trials to significantly reduce the incidence of major cardiovascular event (MACE) with type 2 diabetic patients. The clinical trials of GLP-1 RAs, including lixisenatide, exenatide, liraglutide, semaglutide, albiglutide, and dulaglutide, are associated with a significantly 14% lower risk of MACE in patients with T2DM and a history of CV disease, and with a nonsignificantly 6% lower risk in patients without history of CV disease. Some of the interpretation with GLP-1 RA trials suggested the possible role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in primary prevention of cardiovascular diseases in nondiabetic individual, echoed by a recent editorial redefining the role of GLP-1 RAs being beyond glycaemic control. The narrative review provides an in-depth insight into GLP-1 RA use guideline in different countries and regions of the world and examines the safety and concern of GLP-1 RA use. The narrative review draws the comparison of GLP-1 RA use between diabetic and nondiabetic individual in terms of cardiovascular and metabolic benefits and points out the direction of future clinical trials of GLP-1 RAs in nondiabetic individuals. The focus of the review is on GLP-1 RAs' preventive roles in nondiabetic individuals with cardiovascular disease, chronic kidney diseases, obesity, dyslipidaemia, hypertension, nonalcoholic fatty liver diseases, polycystic ovarian syndrome (PCOS), and perioperative complications of bariatric surgery, albeit in small studies and subset analysis of clinical trials of diabetic patients.

Abstract 12440: Type 2 Diabetes, Chronic Kidney Disease, and Major Cardiovascular Events in Patients With Established Cardiovascular Disease

Introduction: Type 2 diabetes (T2DM) and chronic kidney disease (CKD) both confer a high risk of cardiovascular disease (CVD), and these conditions frequently coincide. The single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in patients with established cardiovascular disease are unclear. Hypothesis: We hypothesize that T2DM and CKD are independent predictors of MACE in patients with established cardiovascular disease. Methods: We prospectively investigated 1738 patients with established cardiovascular disease - angiographically proven coronary artery disease (CAD) or sonographically proven peripheral artery disease (PAD) - over 10.0±4.7 years. Results: MACE occurred more frequently in T2DM patients (n=575) than in non-diabetic subjects (42.5% vs 29.8%, p&lt;0.001) and in patients with CKD (eGFR &lt;60ml/min/1.73m 2 ; n=302) than in those who did not have CKD (52.2% vs 30.1%, p&lt;0.001). When both, T2DM and CKD were considered, 996 subjects had neither T2DM nor CKD, 440 had T2DM but not CKD, 172 did not have diabetes but had CKD, and 130 had both T2DM and CKD. Compared to the incidence of MACE among patients with neither T2DM nor CKD (26.5%), MACE occurred more frequently in patients with T2DM who did not have CKD (38.2%; p&lt;0.001) as well as in non-diabetic patients with CKD (48.0%; p&lt;0.001); the incidence of MACE was highest in patients with both, T2DM and CKD (57.8%; p&lt;0.001), in whom it was higher than in those with T2DM but not CKD (p&lt;0.001) or those without T2DM but with CKD (p=0.007); the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.040). In Cox regression analysis, T2DM (HR=1.53 [1.29-1.83]; p&lt;0.001) and CKD (HR=1.85 [1.51-2.26]; p&lt;0.001) proved to be mutually independent predictors of MACE after adjustment for age, sex, BMI, hypertension, history of smoking, LDL-C, HDL-C and HbA1c. Conclusions: We conclude that T2DM and CKD in patients with established cardiovascular disease are mutually independent predictors of MACE. Cardiovascular disease patients with both CKD and T2DM are at an extremely high risk for MACE.

Abstract 10942: The A Body Shape Index and Type 2 Diabetes Are Mutually Independent Predictors of Major Cardiovascular Events in Patients With Established Cardiovascular Disease

Introduction: The A Body Shape index (ABSI) is a validated measure of visceral adiposity that is calculated based on waist circumference, height and BMI. Hypothesis: We hypothesize that ABSI is a predictor of major cardiovascular events in patients with established cardiovascular disease (CVD). Methods: We prospectively recorded cardiovascular events in a large cohort of 1544 patients with established CVD (1297 patients with angiographically proven stable coronary artery disease and 247 patients with sonographically verified PAD) over a mean follow-up time of 10.0±4.6 years. Results: At baseline, the ABSI was higher in patients with type 2 diabetes (T2DM; n=502) than in those who did not have diabetes (8.4±0.6 vs. 8.3±0.6; p&lt;0.001). Prospectively, the ABSI significantly predicted the incidence of MACE (n=507) after adjustment for age, gender, smoking, hypertension, LDL cholesterol, HDL cholesterol, and T2DM (standardized adjusted HRs 1.14 [1.04-1.24]; p=0.004, respectively). T2DM in turn in this model also significantly predicted MACE with a HR of 1.61 [1.33-1.94]; p&lt;0.001 after adjustment for ABSI. Conclusions: We conclude that ABSI and T2DM are mutually independent risk factors for MACE in patients with established cardiovascular disease.

Abstract 12422: Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Are Mutually Independent Predictors of Major Cardiovascular Events in Patients With Established Cardiovascular Disease

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is associated with insulin resistance, type 2 diabetes (T2DM) and cardiovascular disease. However, data on NAFLD in patients with established cardiovascular disease (CVD) are scarce. Hypothesis: We hypothesize that NAFLD and T2DM are independent predictors of the incidence of major cardiovascular events (MACE). Methods: In a large series of 1517 patients with established CVD (1199 patients with angiographically proven coronary artery disease and 318 patients with sonographically proven peripheral artery disease), using the validated fatty liver index for the diagnosis of NAFLD. Results: At baseline, the prevalence of NAFLD was significantly higher in patients with T2DM than in non-diabetic subjects (61.3% vs. 39.8%; p&lt;0.001) respectively. Prospectively, we recorded 498 MACE over a mean follow-up period of 10.0±4.5 years. The risk of MACE was higher in NAFLD patients than in those who did not have NAFLD (49.5 vs. 43.5%; p=0.020) and in patients with T2DM than in non-diabetic subjects (41.4 vs. 28.1%; p&lt;0.001). Cox regression models adjusting for conventional cardiovascular risk factors proved NAFLD and T2DM to be mutually independent predictors of MACE, with adjusted hazard ratios of 1.34 [1.06-1.69] p=0.013 and 1.59 [1.32-1.92]; p&lt;0.001, respectively. Conclusions: We conclude that NAFLD and T2DM are mutually independent predictors of MACE in patients with established CVD.

The Predictive Value of Eosinophil Indices for Major Cardiovascular Events in Patients with Acute Decompensated HFrEF.

Background and Objectives: Heart failure is a chronic disease with a high risk of mortality and morbidity. In these patients, inflammatory markers have been shown to be associated with cardiovascular adverse outcomes and disease progression. To investigate the relationships between eosinophil indices and major cardiovascular events (MACE) in patients with acute decompensated heart failure (ADHF) with reduced ejection fraction. Materials and Methods: A total of 395 consecutive patients admitted to the intensive care unit (ICU) with ADHF and reduced ejection fraction between January 2017 and December 2021 were enrolled in this retrospective study. MACE was defined as the composite of death and re-hospitalization for ADHF within 6 months of index hospitalization. All-cause mortality and MACE were assessed with respect to relationships with eosinophil indices, including neutrophil-to-eosinophil ratio (NER), leukocyte-to-eosinophil ratio (LER), eosinophil-to-lymphocyte ratio (ELR), and eosinophil-to-monocyte ratio (EMR). Results: NER and LER were significantly higher in subjects with MACE. Absolute eosinophil, lymphocyte and basophil count, hemoglobin, serum Na+, albumin, and CRP, and EMR and ELR were significantly lower in subjects with MACE compared to those without. NT-proBNP (OR: 1.682, 95% CI: 1.106–2.312, p = 0.001), Na+ (OR: 0.932, 95% CI: 0.897–0.969, p < 0.001), NER (OR: 2.740, 95 % CI: 1.797–4.177, p < 0.001), LER (OR: 2.705, 95% CI: 1.752–4.176, p < 0.001), EMR (OR:1.654, 95% CI 1.123–2.436, p = 0.011), ELR (OR: 2.112, 95% CI 1.424–3.134, p < 0.001), and eosinophil count (OR: 1.833, 95% CI 1.276–2.635) were independent predictors for development of MACE. Conclusions: Patients with ADHF and reduced ejection fraction who developed MACE within the first six months of index hospitalization had lower levels of absolute eosinophil and lymphocyte counts, and EMR and ELR values, whereas NER and LER were higher compared to those without MACE. The eosinophil indices were independently associated with mortality and MACE development. The eosinophil indices may be used to estimate MACE likelihood with acceptable sensitivity and specificity.

Prognostic Nutritional Index and Major Cardiovascular Events in Patients Undergoing Invasive Coronary Angiography: A Clinical Retrospective Study.

We aimed to examine whether prognostic nutritional index (PNI) could serve as an auxiliary predictor for major cardiovascular events (MCEs) in patients undergoing invasive coronary angiography (ICA). A total of 485 participants were enrolled, divided into low-PNI (≥47.40) and high-PNI (<47.40) groups. ICA determined the stenotic vessels of coronary artery disease. The primary outcome was incidental MCEs, a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or rehospitalization of in-stent restenosis. There were 47 (9.69%) MCEs during the 3.78-years follow-up. The cumulative incidence of MCEs was significantly higher in the low-PNI patients compared with the high-PNI patients (17.07% vs. 7.18%, p = 0.001). Malnutrition risk (low PNI) was significantly and independently associated with a higher risk of MCEs (hazard ratios: 2.593, 95% confidence intervals [CI]: 1.418–4.742). Combined use of the number of stenotic vessels with malnutrition risk showed a higher capacity to predict the MCEs than the presence of stenotic vessels alone (areas under the receiver operator characteristic curve: 0.696 [95% CI, 0.618–0.775] vs. 0.550 [95% CI, 0.466–0.633], p = 0.013). In conclusion, lower PNI levels may predict a higher risk of cardiovascular events in patients undergoing ICA, which supports the necessity of the risk assessment of nutrition status and guide the clinical treatment on strengthening nutritional support before ICA is performed, as well as nutritional intervention after ICA.

Reduction of major adverse and major cardiovascular events in patients with atrial fibrillation and stent implantation treated with left atrial occlusion device vs oral anticoagulants strategy

Abstract Background Treatment of patients with Nonvalvular Atrial Fibrillation (NVAF) who need coronary stent implantation is a challenge. Although trials have shown “direct anticoagulants (DOAC) indefinitely plus clopidogrel for one year” strategy reduces bleeding events in comparison to triple therapy, especially with warfarin, many questions remain about the safety and efficacy of this strategy. Purpose This study compared the events in patients who received left atrial appendage occlusion (LAAO) and antiplatelet therapy (APT) with those who were treated with oral anticoagulants (OAC) (including DOAC) and APT. Methods 207 consecutive patients with NVAF who underwent coronary stent implantation (most of them for NSTEACS), were analysed. 146 were treated with OAC (75 with acenocoumarol, 71 with DOAC) and 61 with LAAO during a mean follow-up of 35 months. Furthermore, they received APT according to the clinical cardiologist criteria (Figure 1). Results There were no significant differences in variables like age (average 75.7 years-old) hypertension, diabetes, gender, permanent or paroximal AF or a history of stroke or thromboembolisms between groups. But there were more unfavourable characteristics in LAAO group with significant differences in the percentage of history of coronary artery disease (43.2% vs 75,4% p= &amp;lt;0.001), CHA2DS2-VASc (4.07±1.70 vs 4.56±1.53 p=0.033), history of relevant bleedings (BARC ≥2) (8.9% vs 49.2% p&amp;lt;0.001), history of high bleeding risks defined as previous bleedings or HASBLED ≥3 (19.9% vs 62.3% p&amp;lt;0.001) and HAS-BLED (1.63±1.09 vs 2.49±1.18, p&amp;lt;0.001), between OAC and LAAO groups respectively. Observed total death, stroke/TIA and relevant bleedings incidence rates (expressed per 100 patient-years) were higher in OAC- than in LAAO-group: 10.86 vs. 6.96% (HR: 1.56; p=0.183), 4.59 vs. 1.27% (HR: 3.61; p=0.084), 12.43 vs. 4.57% (HR: 2.72; p=0.014), respectively. The composite events of MAE and MCVE (defined as in Figure 1 and 2) were also significantly higher: 23.40 vs. 9.8% (HR: 2.40; p=0.002) (Figure 2, left) and 7.41 vs. 1.9% (HR: 3.90; p=0.025) (Figure 2, right), respectively. Conclusions In patients with NVAF receiving coronary stents, a LAAO strategy with APT, shows better results in MAE and MCVE than treatment with OAC (DOAC included) plus APT strategy in a long term-follow-up, despite more unfavourable variables in LAAO group. Funding Acknowledgement Type of funding sources: None.

Hyperuricemia predicts worse prognosis in patients with chronic coronary syndrome after percutaneous coronary intervention: insights from Japanese real-world database using a storage system

Abstract Background The relationship between hyperuricemia (HUA) and cardiovascular disease was observed in some epidemiological studies. However, the association between HUA and chronic coronary syndrome (CCS) after percutaneous coronary intervention (PCI) is not fully elucidated. Purpose The purpose of this study was to investigate the prognostic impact of HUA in patients with CCS after PCI. Methods This study is a retrospective, multicenter, observational study. We developed the Clinical Deep Data Accumulation System (CLIDAS), which consists of 6 university hospitals and the national cardiovascular center in Japan, directly obtains clinical data including patients background, laboratory data, echocardiogram, electrocardiogram, cardiac catheterization report, prescription, and long-term outcome from electronic medical records. A total of 9936 consecutive patients after PCI were analyzed. Of them, 5138 patients with CCS after PCI during April 2013 and March 2019 were analyzed, and divided into HUA group (patients with HUA at baseline, n=1724) and non-HUA group (patients without HUA at baseline, n=3414). HUA was defined as a serum uric acid levels ≥7.0 mg/dL for men or ≥6.0 mg/dL for women and/or taking urate-lowering drugs. The primary outcome was the major cardiovascular events (MACE) defined as being the composite of cardiovascular death, myocardial infarction, and hospitalization for heart failure. Results The median follow-up duration was 910 days (interquartile range: 307–1479 days). The proportion of male (78% vs. 78%) and age (71±11 vs. 71±10) were similar between the HUA and the non-HUA groups. The prevalence of hypertension (87% vs. 82%), atrial fibrillation (9% vs. 5%), and history of previous hospitalization for heart failure (15% vs. 6%) and baseline creatinine value (1.8±2.3 vs. 1.5±2.0 mg/dL) were significantly higher in the HUA group. In contrast, the prevalence of diabetes (43% vs. 48%) was significantly lower in the HUA group. The incidence of MACE was significantly higher in the HUA group than in the non-HUA group (13.1% vs. 6.4%, log rank P&amp;lt;0.001). Multivariate Cox regression analyses revealed that hyperuricemia was significantly associated with MACE (hazard ratio 1.50, 95% confidence interval 1.22–1.84, P&amp;lt;0.001) after controlling for other cardiovascular risk factors. Conclusion The real-world database CLIDAS revealed that hyperuricemia was significantly associated with the increase of MACE in patients with CCS after PCI. This result sheds light on the significant role of urate in prediction of prognosis, suggesting the possibility of new therapeutic approaches using urate-lowering drugs or SGLT2 inhibitors for the CCS patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jichi Medical University, Tochigi, Japan, and Kowa Co., Ltd

End-of-trial inflammatory biomarkers, lipid levels, creatine kinase and markers of renal and liver function in the LoDoCo2 trial

Abstract Background The Low-Dose Colchicine 2 (LoDoCo2) trial demonstrated that colchicine reduced major cardiovascular events in patients with chronic coronary artery disease (CAD). The effect of long-term colchicine treatment on inflammatory biomarkers and markers reflecting renal and liver function have not been investigated yet. Purpose This substudy examines levels of inflammatory biomarkers, lipid fractions, creatine kinase (CK) and markers of renal and liver function at close-out of the trial. Methods The LoDoCo2 trial randomly assigned patients with chronic CAD to colchicine 0.5 mg once daily or placebo. Blood samples were drawn during close-out visits after a median follow-up of 32.7 (interquartile range [IQR] 24.0–48.6) months. Results Assignment to colchicine was associated with lower levels of high-sensitivity C-Reactive Protein (0.94 mg/L [0.53–1.93] vs. 1.24 mg/L [0.73–2.55]; −24.2%; p&amp;lt;0.01) and interleukin-6 (2.70 ng/L [1.79–4.18] vs. 3.16 ng/L [2.07–4.95]; −14.9%; p&amp;lt;0.01), but was not associated with any differences in lipid fractions or markers of renal function. Although CK levels were higher after colchicine (123.0 U/L, [84.0–184.0] vs. 110.0 U/L, [77.0–164.0], p&amp;lt;0.01), the number of participants with marked elevations of CK (&amp;gt;5 times upper limit of normal [ULN]) was low and not different between treatment groups. Levels of alanine aminotransferase (ULN 40 U/L) and albumin (ULN 50 U/L) were higher (p&amp;lt;0.01) in the colchicine group compared to placebo (30.0 U/L [22.0–40.0] vs. 26.0 U/L [19.0–34.0] and 43.01 g/L±2.39 vs. 42.64 g/L±2.48, respectively). There were no differences in gamma-glutamyl transferase or bilirubin. Conclusion Long-term low-dose colchicine in patients with chronic CAD was associated with lower levels of hs-CRP and IL-6 but was not associated with clinically important differences in lipid fractions, CK, renal or liver function. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The National Health Medical Research Council of AustraliaThe Netherlands Organization for Health Research and Development

The predictive value of carotid artery strain and strain-rate in assessing the 3-year risk for stroke and acute coronary syndrome in patients with metabolic syndrome

Abstract Purpose The goal of this study is to see if carotid strain and strain rate can predict major cardio-vascular events (MACE) in people who have metabolic syndrome (MS) over a 3-year period of time. Methods In this prospective observational research, we enrolled 220 adult MS patients (60.7±7.5 years old, 53% male). Bilateral 2D common carotid carotid artery (CCA) speckle-tracking ultrasound was used to determine the peak circumferential strain (CS) and the peak circumferential strain rate (CSR). Clinical outcomes were assessed throughout a three-year follow-up period. Results After a 3-year follow-up period follow-up, 14 (7%) experienced MACE: Eight (4%) suffered an atherothrombotic ischemic stroke, four (2%) had acute coronary syndrome, and two (1%) were hospitalized for heart failure. Univariate regression analysis of the clinical and echocardiographic features of the MS patients found that age, systemic hypertension, diabetes mellitus, and the CCA circumferential strain and strain rate were significantly associated with the risk of MACE. Multivariate logistic regression identified two independent predictors of MACE in patients with MS, namely the CCA-related CS (%) and CSR (1/s), P&amp;lt;0.01. The ROC curve analyses of these independent predictors of MACE indicated appropriate sensitivities and specificities. CS (AUC = 0.806, sensitivity = 82.6%, specificity = 79.2%, P&amp;lt;0.0001); CSR (AUC = 0.779, sensitivity = 82.6%, specificity = 72.4%, P&amp;lt;0.0001). The cut-off values were ≤2.9% for carotid CS and ≤0.35 s–1 for carotid CSR. Using these cut-off values, we obtained Kaplan-Meier survival curves, and these showed that MACE, ischemic stroke, and ACS-free survival was significantly lower among the MS patients with lower carotid CS and CSR (P&amp;lt;0.0001). Conclusion Carotid CS and CSR were independent predictors of major cardio- and cerebrovascular events in prospectively monitored MS patients without established cardiovascular disease. Carotid deformation could be valuable as an early prognostic indicator for the cardiovascular risk in this population group. Funding Acknowledgement Type of funding sources: None.

Can carotid angioplasty stenting be better than endarterectomy or best medical treatment for patients with carotid stenosis?

Abstract Background Carotid stenosis is responsible for a considerable amount of strokes and related deaths. Carotid angioplasty stenting (CAS), endarterectomy (CEA) and best medical treatment (BMT) are important in preventing major cardiovascular (CV) events. Methods We conducted a systematic review and meta-analysis, with randomized controlled trials (RCT), to compare CAS with CEA and BMT regarding the short and long-term major periprocedural and follow-up CV events (stroke, myocardial infarction, and death) in symptomatic and asymptomatic carotid stenosis. We searched for RCT published from 2008 to 2021 in databases such as Pubmed/MEDLINE, B-On, Embase, Clinical Trials from U.S. National Library of Medicine and International Clinical Trials Registry Platform, between July of 2018 and January of 2019, and in October of 2021. Results Nine RCT were included, with a total of 9162 participants for CAS versus (vs) CEA, and 513 participants for CAS vs TMO. Compared with CEA, CAS is associated with periprocedural stroke and death in symptomatic patients (HR=1.65, 95% CI: 1.29–2.11, p=0.05, I2=62%), due to higher stroke events than deaths. That association does not occur in asymptomatic patients in which CAS is not associated with periprocedural stroke or death (CAS=8.55%, CEA=7.05%, p=0.09). During follow-up there were no significant differences between CAS and CEA in symptomatic patients regarding stroke (HR=1.51, 95% CI: 1.23–1.84, p=0.57, I2=0%) and death (HR=1.10, 95% CI: 0.93–1.30, p=0.69, I2=0%). Periprocedural myocardial infarction (MI) incidence is higher in CEA (CAS=1.1%; CEA=2.3%; p=0.03), without influence of symptomatic status. CAS is not inferior to CEA, in both symptomatic and asymptomatic patients with high surgery risk, as for periprocedural and one year CV major events (CAS=12.2%, CEA=20.1%, absolute difference = −7.9, 95% CI: −16.4–0.7, p=0.004). BMT had no significant findings vs CAS in asymptomatic patients (HR=3.5, 95% CI: 0.42–29.11, p=0.246). Conclusion CAS is not inferior to CEA as for the periprocedural and one-year major CV events in patients with normal surgery risk. However, there is a higher risk of periprocedural stroke in CAS for symptomatic patients, and of periprocedural MI in CEA with no influence of symptomatic status. CAS seams to prevent middle and long-term ipsilateral stroke in symptomatic patients. BMT has yet to prove not to be inferior to CAS in asymptomatic patients. Funding Acknowledgement Type of funding sources: None.

Low Body Mass Index without Malnutrition Is an Independent Risk Factor for Major Cardiovascular Events in Patients with Hemodialysis.

We retrospectively analyzed major cardiovascular events (MACE), a composite of cardiac death, nonfatal myocardial infarction, unplanned revascularization, heart failure leading to hospitalization, and stroke during a 3-year follow-up of patients with hemodialysis at the dialysis center of our general hospital that can treat comprehensive diseases. Moreover, we conducted an exploratory study that focuses on the risk factor for MACE in patients with hemodialysis.A total of 132 patients with hemodialysis at our dialysis center as of June 2017 were included in the study. Data on event incidence, including death and various clinical indicators, were collected in the electronic medical record for three years until June 2020. Between June 2017 and June 2020, of the 132 patients with hemodialysis, 31 patients experienced MACE (10 cardiovascular deaths, 3 nonfatal myocardial infarction, 11 unplanned revascularizations, 5 heart failure leading to hospitalization, and 2 stroke). The patients with MACE had a lower body mass index (BMI), longer duration of dialysis with more preexisting gastrointestinal (GI) bleeding, and took more aspirin compared to the MACE-free patients. Malnutrition markers (serum total protein, serum albumin, and serum total cholesterol) were similar in both groups. In a univariate analysis for MACE, the odds ratio was significantly higher for BMI < 18.5, duration of hemodialysis, and history of GI bleeding. Multivariable-adjusted odds ratios for MACE were significantly higher for BMI < 18.5.In conclusion, BMI < 18.5 without malnutrition may be an independent risk factor for MACE in patients with hemodialysis.