Prognosis Of Coronary Artery Disease Research Articles

Machine learning models for assessing risk factors affecting health care costs: 12-month exercise-based cardiac rehabilitation.

Exercise-based cardiac rehabilitation (ECR) has proven to be effective and cost-effective dominant treatment option in health care. However, the contribution of well-known risk factors for prognosis of coronary artery disease (CAD) to predict health care costs is not well recognized. Since machine learning (ML) applications are rapidly giving new opportunities to assist health care professionals' work, we used selected ML tools to assess the predictive value of defined risk factors for health care costs during 12-month ECR in patients with CAD. The data for analysis was available from a total of 71 patients referred to Oulu University Hospital, Finland, due to an acute coronary syndrome (ACS) event (75% men, age 61 ± 12 years, BMI 27 ± 4 kg/m2, ejection fraction 62 ± 8, 89% have beta-blocker medication). Risk factors were assessed at the hospital immediately after the cardiac event, and health care costs for all reasons were collected from patient registers over a year. ECR was programmed in accordance with international guidelines. Risk analysis algorithms (cross-decomposition algorithms) were employed to rank risk factors based on variances in their effects. Regression analysis was used to determine the accounting value of risk factors by entering first the risk factor with the highest degree of explanation into the model. After that, the next most potent risk factor explaining costs was added to the model one by one (13 forecast models in total). The ECR group used health care services during the year at an average of 1,624 ± 2,139€ per patient. Diabetes exhibited the strongest correlation with health care expenses (r = 0.406), accounting for 16% of the total costs (p < 0.001). When the next two ranked markers (body mass index; r = 0.171 and systolic blood pressure; r = - 0.162, respectively) were added to the model, the predictive value was 18% for the costs (p = 0.004). The depression scale had the weakest independent explanation rate of all 13 risk factors (explanation value 0.1%, r = 0.029, p = 0.811). Presence of diabetes is the primary reason forecasting health care costs in 12-month ECR intervention among ACS patients. The ML tools may help decision-making when planning the optimal allocation of health care resources.

Association between pre-treatment with statin and its inhibitory effect on the onset of coronary artery disease at the time of coronary computed tomography angiography: a new look at an old medication.

Coronary artery stenosis is often advanced by the time coronary computed tomography angiography (CCTA). Statins are the most important anti-lipidemic medication for improving the prognosis of coronary artery disease (CAD) patients. Although lipid-lowering therapy using statins appears to have been established as a method for preventing CAD, there remains the problem that CAD cannot be completely suppressed. In this study, we investigated whether pre-treatment with statin could significantly inhibit the onset of CAD when patients received CCTA for screening of CAD. The subjects were 1164 patients who underwent CCTA as screening for CAD. CAD was diagnosed when 50% or more coronary stenosis was present in the coronary arteries. Patient backgrounds were investigated by age, gender, body mass index, coronary risk factors [family history of cardiovascular diseases, smoking history, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, chronic kidney disease (CKD) or metabolic sydrome] and medications. Patients were classified into two groups according to the presence or absence of statin pre-administration during CCTA [statin (-) group (n = 804) and (+) group (n = 360)]. Compared with the statin (-) group, the statin (+) group was significantly older and had higher rates of family history, HTN, and DM. The statin (+) group had a significantly higher % CAD than the statin (-) group. Serum levels of low-density lipoprotein cholesterol (LDL-C) were significantly lower in the statin (+) group than in the statin (-) group. There was no significant difference in either high-density lipoprotein cholesterol levels or triglyceride levels between the two groups. Age, male gender, HTN, DM and pre-treatment with statin were all associated with CAD (+) in all patients. In addition, factors that contributed to CAD (+) in the statin (-) group were age, male gender, and DM, and factors that contributed to CAD (+) in the statin (+) group were age, smoking, HTN and % maximum dose of statin. At the time of CCTA, the statin (+) group had a high rate of CAD and coronary artery stenosis progressed despite a reduction of LDL-C levels. To prevent the onset of CAD, in addition to strict control of other coronary risk factors (HTN etc.), further LDL cholesterol-lowering therapy may be necessary.

Machine learning in cardiac stress test interpretation: a systematic review

Abstract Coronary artery disease (CAD) is a leading health challenge worldwide. Exercise stress testing is a foundational non-invasive diagnostic tool. Nonetheless, its variable accuracy prompts the exploration of more reliable methods. Recent advancements in machine learning (ML), including deep learning and natural language processing, have shown potential in refining the interpretation of stress testing data. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of ML applications in stress electrocardiogram (ECG) and stress echocardiography for CAD prognosis. Medical Literature Analysis and Retrieval System Online, Web of Science, and the Cochrane Library were used as databases. We analysed the ML models, outcomes, and performance metrics. Overall, seven relevant studies were identified. Machine-learning applications in stress ECGs resulted in sensitivity and specificity improvements. Some models achieved rates of above 96% in both metrics and reduced false positives by up to 21%. In stress echocardiography, ML models demonstrated an increase in diagnostic precision. Some models achieved specificity and sensitivity rates of up to 92.7 and 84.4%, respectively. Natural language processing applications enabled the categorization of stress echocardiography reports, with accuracy rates nearing 98%. Limitations include a small, retrospective study pool and the exclusion of nuclear stress testing, due to its well-documented status. This review indicates the potential of artificial intelligence applications in refining CAD stress testing assessment. Further development for real-world use is warranted.

Abstract P279: Proteomic Profiling Identifies Mortality-Associated Markers in Coronary Artery Disease

Background: Coronary artery disease (CAD) is a leading global cause of mortality. Proteomics has emerged as a promising tool for understanding CAD prognosis. We explored proteomic profiles in CAD patients to identify protein markers which predict mortality. Methods: The discovery cohort included 2,072 participants from the UK Biobank (UKB) with proteomics data and prevalent CAD at enrollment, defined by the ICD-10 and OPCS-4 codes from the in-patient Hospital Episode Statistics data. All-cause mortality was ascertained based on the Death Register records. Plasma proteomic profiling of 1,463 unique proteins at enrollment was conducted using the Olink platform. The validation cohort included 91 participants from the Mental Stress Ischemia Prognosis Study (MIPS), a prospective study of CAD patients enrolled from Emory University hospitals in whom plasma proteomic profiling of 6,159 proteins was measured by the SomaScan Assay. We analyzed 1,203 common proteins in both cohorts with missing rate &lt; 20%. In the UKB, we examined the proteome-wide associations between the rank-based inverse normal transformed protein levels and mortality, using Cox proportional hazards models adjusting for race, sex, age, body mass index, diabetes, hypertension, heart attack history, frequent drinking (≥ 3 times /week), smoking history, high- and low-density lipoprotein, triglycerides, C-reactive protein and estimated glomerular filtration rate. Mortality-associated proteins at Bonferroni corrected p &lt; 0.05 were analyzed for pathway enrichment. LASSO regression was used to further select the best performing proteins in predicting mortality. Prediction performance of the proteins was evaluated using the C statistic. The mortality-associated proteins were validated in MIPS, using Cox models adjusting for race, sex, and age. Results: The UKB cohort was 69% male, 96% White, with mean age of 62 years, and there were 646 (31%) deaths during median follow-up of 13.3 years. The MIPS cohort was 79% male, 24% Black, with mean age of 64 years, and 11 (12%) died during median follow-up of 6.3 years. A total of 274 proteins were significantly associated with mortality in the UKB, representing enriched pathways such as inflammatory response. Seven proteins, including GDF15 , TNFRSF10B , PLAUR , SPON1 , CXCL17 , ANGPT2 , and ICAM5 were identified by LASSO model as key predictors. Adding these proteins to the model with traditional risk factors improved the prediction of mortality by 5.3% (75.8% vs 70.5%, 95% CI 3.7% - 6.9%). All associations except for CXCL17 were validated in the MIPS. Conclusion: The findings suggest the potential added value of plasma proteins for predicting mortality in CAD patients beyond traditional factors. The functions of mortality-associated proteins indicate underlying biological mechanisms, such as inflammation and cell growth regulation, linked to CAD progression.

Impact of Myocardial Bridging on Cardiac Function, Symptoms and Prognosis in Coronary Artery Disease; a Systematic Review

Impact of Myocardial Bridging on Cardiac Function, Symptoms and Prognosis in Coronary Artery Disease; a Systematic Review

The correlation of atherogenic index of plasma with non-obstructive CAD and unfavorable prognosis among patients diagnosed with MINOCA

BackgroundThe atherogenic index of plasma (AIP) is linked to lipid metabolism and has shown considerable prognostic value in cardiovascular disorders. However, its role in myocardial infarction with non-obstructive coronary arteries (MINOCA) has not been investigated. We assessed the relationship between AIP, the severity of coronary stenosis, and prognosis in MINOCA. MethodsWe included consecutive patients who were diagnosed with MINOCA. AIP was calculated using the base 10 logarithm of the ratio between the levels of TG and HDL-C. The patients were divided into four groups based on their AIP quartiles: Q1 (AIP<-0.145), Q2 (AIP≥-0.145and≤0.049), Q3 (AIP>0.049and≤0.253), and Q4 (AIP>0.253). All patients underwent follow-up for MACE. ResultsThe final analysis included 421 patients, with 188 having normal coronaries (0 stenosis) and 233 exhibiting non-obstructive coronary artery disease (CAD) (<50 % stenosis). In the multivariate logistic analysis, highest AIP (Q4) group was significantly associated with increased risk of non-obstructive CAD in MINOCA (OR,1.994;95 % CI:1.075–3.698; P = 0.029). During the follow-up period, MACE occurred in 22.8 % of MINOCA patients. Q4 group exhibited a significantly higher rate of MACE (P = 0.021). Furthermore, when both AIP and coronary stenosis status were considered, the results revealed individuals in the Q4 group with non-obstructive CAD had the highest risk of MACE (log-rank P = 0.027). The adjusted Cox analysis indicated that the Q4 group was associated with a 2.052-fold increase in the HR of MACE. ConclusionAIP exhibits a notable association with the incidence of MACE in MINOCA patients and serves as a substantial marker for non-obstructive CAD in this patient group.

Sex differences in the impact of body mass index on outcomes of coronary artery disease in Koreans.

Obesity is often considered a risk factor for cardiovascular disease, but recent studies have shown conflicting results regarding the effect of BMI on the prognosis of coronary artery disease (CAD). This study aimed to evaluate the relationship between BMI and clinical outcomes of CAD according to sex in a Korean population. A total of 3476 patients with a significant CAD who underwent percutaneous coronary intervention (PCI) were enrolled. Patients were classified as follows according to BMI using the Asia-Pacific cutoff points: underweight (<18.5 kg/m 2 ), normal weight (18.5-22.9 kg/m 2 ), overweight (23.0-24.9 kg/m 2 ) and obese (≥25 kg/m 2 ) patients. Underweight and normal weight patients were further categorized into the lower BMI group, whereas overweight and obese patients were categorized into the higher BMI group. The primary endpoint was all-cause mortality. Among women, the higher BMI group showed poor clinical features in the prevalence of hypertension and chest pain presentation, and among men, the higher BMI group had a significantly lower rate of chronic renal failure. At the end of the follow-up period (median 53.5 months), the all-cause mortality rate was lower in the higher BMI group in men, and cardiovascular death and stroke rates were significantly lower in the higher BMI group in women. In Korean CAD patients treated with PCI, inverse correlations were observed between the clinical outcomes and BMI, but there were differences between men and women.

Association between alkaline phosphatase to albumin ratio and mortality among patients with sepsis

The alkaline phosphatase-to-albumin ratio (APAR) is correlated to worse prognosis in coronary artery disease, cancer, and acute renal failure. However, the relationship between APAR and sepsis prognosis has received little research. The content of this research was to investigate the prognostic relationship between APAR and sepsis. And validate the stability of the correlation in 90-days and 1-year mortality. Retrospective cohort research was conducted basing MIMIC-IV database (version 2.0). The hazard ratio (HR) and 95% confidence interval (Cl) were computed using multivariate Cox regression analysis. In addition, plots of survival curves and subgroup analyzes were conducted. Receiver operating characteristic (ROC) curves were also used. 9741 participants were included in this investigation. The 90-days mortality was 32.8%, and the 1-year mortality was 42.0%. After controlling for confounders, the adjusted HRs (95% CI) for tertile 2 (2.2–3.8) and tertile 3 (> 3.8) were 1.37 (1.25–1.51) and 1.74 (1.58–1.91), respectively. The Kaplan–Meier curve analysis showed a higher probability of 90-days death in the higher APAR group. The area under the curve (AUC) of APAR was 0.674 and could reach 0.709 after combining the Oxford Acute Severity of Illness Score (OASIS). This study demonstrates that APAR is significantly related to bad clinical outcomes in sepsis.

Association of ratios of monocyte/high-density lipoprotein cholesterol and neutrophil/high-density lipoprotein cholesterol with atherosclerotic plaque type on coronary computed tomography.

The monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR) and neutrophil/HDL-C ratio (NHR) are markers for inflammation and dyslipidaemia, which are important factors in atherosclerosis. Studies have linked MHR and NHR to the prediction, severity and prognosis of coronary artery disease. However, no study has explored their connection to plaque stability, specifically its calcific or soft/mixed content. Monocyte, neutrophil and HDL-C levels were examined in 99 patients who had coronary computed tomographic angiography (CTA) between January and August 2023. They were divided into three groups: a group of 42 healthy individuals (group 0) with no coronary artery plaque and an Agatson score of 0, an unstable plaque group (group 1) with 31 patients displaying mixed and/or soft plaque on CTA, and a stable plaque group (group 2) with 26 patients showing only calcific plaque. White blood cell (WBC), monocyte and neutrophil counts were significantly higher in group 1 patients compared to group 0 patients (group 0: WBC = 6.31 ± 0.97 × 103 cells/µl, monocytes = 0.40 ± 0.09 × 10³ cells/µl, neutrophils = 3.32 ± 0.81 × 10³ cells/µl; and group 1: WBC = 7.61 ± 1.95 × 10³ cells/µl, monocytes = 0.50 ± 0.11 × 10³ cells/µl, neutrophils = 4.19 ± 1.36 10³ cells/µl; p < 0.05). MHR and NHR were significantly higher in group 1 patients compared to group 0 patients (group 0: MHR = 0.0079 ± 0.0029, NHR = 0.063 ± 0.023 and group 1: MHR = 0.0102 ± 0.003, NHR = 0.085 ± 0.036, p < 0.05). The significant differences in MHR and NHR between the three groups were due to the differences between groups 0 and 1. MHR and NHR were significantly higher in group 1 patients, although there was no statistically significant difference between groups 1 and 2.

Model for Patients with Multivessel Coronary Artery Lesions in the Highlands Region (Qinghai Province, Northwest China)

Objective: The severity and prognosis of coronary artery disease are closely associated with treatment strategy choice. To achieve timely, accurate, early selection of a suitable treatment plan and assess patients’ prognosis, we developed an effective predictive model for early identification of high-risk patients according to lesion severity. Methods: Among the 510 patients with chest pain admitted to the Qinghai Red Cross Hospital between August 2018 and October 2019, 386 had coronary artery disease detected by coronary angiography. A total of 24 demographic characteristics and serum markers were analyzed in study participants. Least absolute shrinkage and selection operator regression was used to select variables, and multivariate logistic regression was used to build predictive models by using nominal plots. The discriminatory power of the models was evaluated with the area under the receiver operating characteristic curve (AUC). Predictive models were calibrated with calibration plots and the Hosmer–Lemeshow test. Their clinical validity was evaluated via decision curve analysis. Results: Data were randomly divided (7:3) into training (358 cases) and test (152 cases) sets. The predictive model included sex, age, smoking status, heart rate, systolic blood pressure, diastolic blood pressure, albumin, urea nitrogen, creatinine, uric acid, total cholesterol, and high-density lipoprotein cholesterol as predictors. The AUCs for the training and test sets were 0.793 and 0.732, respectively. The predictive model showed a good fit, and decision curve analysis indicated the clinical validity of the predictive model. Conclusions: We developed an effective risk predictive model with good clinical value for predicting multivessel disease. Smoking cessation, lowering creatinine, and increasing HDL cholesterol concentrations might decrease the risk of developing multivessel disease, thereby avoiding severe disease.

The relationship between prognostic nutritional index and long-term mortality in patients undergoing emergency coronary artery bypass graft surgery for acute-ST elevation myocardial infarction.

Malnutrition and the prognosis of coronary artery disease (CAD) are shown to be correlated. The significance of nutritional status has been evaluated in patients with ST elevation myocardial infarction (STEMI), stable CAD, and elective coronary artery bypass graft (CABG) surgery. However, the prognostic impact of poor nutritional status on STEMI patients who underwent emergent CABG is not known. In this study, we aimed to investigate the relationship between nutritional status assessed by the prognostic nutritional index (PNI) and long-term mortality in STEMI patients who underwent emergent CABG. To the best of our knowledge, our study is the first one to evaluate the PNI effect on this specific population. 131 consecutive patients with STEMI who did not qualify for primary percutaneous coronary intervention and required emergent CABG between 2013 and 2018 were included in our study. The study population was divided into two groups: survivors and non-survivors. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3) for both groups, using the preoperative data. The optimal cut-off value was obtained by receiver operating characteristic (ROC) analysis. According to the cut-off value, we investigated the relationship between PNI and long-term mortality. The mean age of the study population was 57.0±10.6. During the median 92.7 (70.0-105.3)-month follow-up, 32 of the 131 patients (24.4%) died. Regression analysis showed a significant association between glucose levels (hazard ratio (HR), 1.007; 95% confidence interval (CI), 1.002-1.012; p=0.011) and PNI (HR, 0.850; 95% CI, 0.787-0.917; p<0.001) and long-term mortality. Accord-ing to the ROC analysis, the cut-off value for PNI to predict all-cause mortality was found to be 44.9, with a sensitivity of 81.3% and a specificity of 89.9%. In addition, age, ejection fraction, glomerular filtration rate, Killip classification, and left anterior descending-left internal mammary artery graft use are significantly associated with long-term all-cause mortality in STEMI patients undergoing emergency CABG. The PNI was significantly associated with long-term mortality in patients with STEMI who underwent emergent CABG. PNI can be used to improve the accuracy of the risk assessment of STEMI patients undergoing emergent CABG.

Comparative study of treadmill test positive patients with coronary artery profile on coronary angiography in patient presenting with chest pain in BPKIHS, Dharan, Nepal

BACKGROUND Diagnosis of Coronary artery disease by Coronary artery angiography is limited by its availability, cost and as an invasive procedure. Treadmill test is a noninvasive and easily available test for diagnosing as well as prognosis of coronary artery disease and is most commonly performed stress test for diagnosis of coronary artery disease. Treadmill test is often used as an initial assessment of patient with suspected coronary artery disease serving as a poor man’s angiogram METHODS This was a cross sectional observational study carried out over a period from 25th August 2023 to 25th November 2023 in Department of Cardiology. A total of 100 patients with positive Treadmill test underwent CAG and subsequently analyzed for the presence of CAD were enrolled in the study. TMT test was done using Bruce Protocol and results were classified as positive and negative upon ECG changes. Data about Socio demographic profiles, clinical data, major comorbidity, the presumed risk factor for CAD were entered in MS Excel and analyzed through SPSS 25. RESULTS A total of 100 patients were enrolled in the study. Males were 45(45%) and females were 55(55%). The mean age of the patient was 53.38±16.7 years and 44.27±13.8 years in male and female group respectively. Smoking (82%) was the number one risk factor in male group and Hypertension (52%) in female group.. Significant CAD was seen in 33% of cases ad normal coronaries in 45%. The most common coronary artery involved having significant disease during coronary angiogram was LAD in 25% of cases CONCLUSIONS There was a significant correlation between positive TMT Results and coronary artery disease in coronary angiography.

Elevated plasma pyruvate kinase M2 concentrations are associated with the clinical severity and prognosis of coronary artery disease.

Pyruvate kinase M2 (PKM2) was involved in the pathophysiology of atherosclerosis and coronary artery disease (CAD). We tested whether plasma PKM2 concentrations were correlated with clinical severity and major adverse cardiovascular events (MACEs) in CAD patients. A total of 2443 CAD patients and 238 controls were enrolled. The follow-up time was two years. Plasma PKM2 concentrations were detected by enzyme-linked immunosorbent assay (ELISA) kits (Cloud-Clone, Wuhan, China) using SpectraMax i3x Multi-Mode Microplate Reader (Molecular Devices, San Jose, USA). The predictors of acute coronary syndrome (ACS) were assessed by logistic regression analysis. The association between PKM2 concentration in different quartiles and MACEs was evaluated by Kaplan-Meier (KM) curves with log-rank test and Cox proportional hazard models. The predictive value of PKM2 and a cluster of conventional risk factors was determined by Receiver operating characteristic (ROC) curves. The net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) were utilized to evaluate the enhancement in risk prediction when PKM2 was added to a predictive model containing a cluster of conventional risk factors. In CAD patients, PKM2 concentration was the independent predictor of ACS (P < 0.001). Kaplan-Meier cumulative survival curves and Cox proportional hazards analyses revealed that patients with a higher PKM2 concentration had higher incidence of MACEs compared to those with a lower PKM2 concentration (P < 0.001). The addition of PKM2 to a cluster of conventional risk factors significantly increased its prognostic value of MACEs. Baseline plasma PKM2 concentrations predict the clinical severity and prognosis of CAD.

The Combined Effect of Systemic Immune-Inflammation Index and Type 2 Diabetes Mellitus on the Prognosis of Patients Undergoing Percutaneous Coronary Intervention: A Large-Scale Cohort Study.

Chronic low-grade inflammation is the common mechanism of both atherosclerosis and type 2 diabetes mellitus (T2DM), and systemic immune-inflammation index (SII) has been emerged as a novel and simple inflammatory biomarker. However, the association between SII and glycemic metabolism and their synergetic effect on the prognosis of coronary artery disease (CAD) patients remains unclear. A total of 8602 patients hospitalized for percutaneous coronary intervention (PCI) were included. The primary endpoint was major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction (MI), and target vessel revascularization. According to the optimal cut-off value of SII for MACEs, patients were grouped into higher levels of SII (SII-H) and lower levels of SII (SII-L) and further divided by the concomitance of T2DM into four groups: SII-H/T2DM, SII-H/Non-T2DM, SII-L/T2DM, SII-L/Non-T2DM. During a median 2.4-year follow-up, 522 MACEs occurred. The optimal cut-off value of SII for MACEs was 502.5. A 1-unit increase of SII (transformed by natural logarithm) was associated with a 29% increase of MACE risks in the T2DM cohort [adjusted hazard ratio (HR): 1.29, 95% confidence interval (CI): 1.03 to 1.61, P = 0.024], while had no effect in the non-T2DM cohort (HR: 1.03, 95% CI: 0.80 to 1.34, P = 0.800). Compared to those in SII-H/T2DM group, patients in SII-H/Non-T2DM, SII-L/T2DM, SII-L/Non-T2DM had significantly decreased risk of MACEs [adjusted HR: 0.77, 95% CI: 0.61 to 0.98, P = 0.036; adjusted HR: 0.66, 95% CI: 0.50 to 0.87, P = 0.003; adjusted HR: 0.58, 95% CI: 0.45 to 0.74, P < 0.001; respectively]. Multivariable Cox regression analysis also indicated the highest risk in T2DM patients with higher levels of SII than others (P for trend < 0.001). In this large-scale real-world study, diabetic patients with elevated SII levels were associated with worse clinical outcomes after PCI.

External validation of novel clinical likelihood models to predict obstructive coronary artery disease and prognosis

ObjectivesThe risk factor-weighted and coronary artery calcium score-weighted clinical likelihood (RF-CL and CACS-CL, respectively) models improve discrimination of patients with suspected obstructive coronary artery disease (CAD). However, external validation is...

Association of Malnutrition and High Bleeding Risk with Long-Term Prognosis in Patients with Acute Coronary Syndrome following Percutaneous Coronary Intervention.

Malnutrition in cardiovascular disease is associated with poor prognosis, especially in patients with heart failure and acute coronary syndrome (ACS). High bleeding risk is also linked to coronary artery disease prognosis, including ACS. However, whether the extent of malnutrition and high bleeding risk have a cumulative impact on the long-term prognosis of patients with ACS who undergo percutaneous coronary intervention remains unclear. We analyzed 275 patients with ACS treated with percutaneous coronary intervention. The Controlling Nutritional Status score and Japanese version of the Academic Research Consortium for High Bleeding Risk criteria (J-HBR) were retrospectively evaluated. The primary and secondary outcomes were adjusted using the inverse probability treatment weighting method. The prevalence of moderate or severe malnutrition in this cohort was 16%. Kaplan-Meier analysis showed a significantly higher incidence of major adverse cardiovascular and cerebrovascular events in patients who were moderately or severely malnourished than in those who were not. Notably, the incidence of these major events was similar between severely malnourished patients with J-HBR and those without. Moderate or severe malnutrition has a significant impact on the long-term prognosis of patients with ACS who undergo percutaneous coronary intervention.

Does prediabetes diagnosed by hemoglobinA1c or oral glucose tolerance test predict coronary artery disease in patients suspected of chronic coronary syndrome?

Abstract Introduction The presence of prediabetes worsens the prognosis of coronary artery disease, as patients with prediabetes are known to have an almost doubled cardiovascular mortality risk compared to normoglycemic patients. In clinical practice, HemoglobinA1c (HbA1c) has replaced the oral glucose tolerance test (OGTT) in the diagnosis of prediabetes. However, the background for the HbA1c threshold is based on the development of microvascular complications and progression to established diabetes. It remains unclear whether the substitution of OGTT with HbA1c results in an underestimation of prediabetics with a high risk of coronary artery disease, or if HbA1c is associated with macrovascular complications in prediabetic patients. Purpose We aimed to investigate whether HbA1c- or OGTT-diagnosed prediabetes could predict presence and severity of coronary artery disease in patients suspected of chronic coronary syndrome. Methods This was a descriptive cross-sectional study of 702 patients referred to a coronary CT angiography due to suspicion of chronic coronary syndrome. Coronary artery calcification (CAC)-score, presence of plaque and significant stenosis (&amp;gt;50%), and plaque characteristics were evaluated. All patients had a fasting OGTT and blood samples performed. Patients were categorized according to glycemic status by HbA1c and OGTT, and compared to their test-specific range. Results Prediabetes was detected by HbA1c 167 (24%) or OGTT 272 (39%), and an overlap in classification by both tests was seen in 98 (22%) of participants. Both classifications of prediabetes showed increased presence of plaques, significant stenosis, calcified plaques, and correspondingly, a low frequency of a CAC-score=0 compared to their test-specific normal. Additionally, the HbA1c-prediabetics had an increased frequency of a high CAC score &amp;gt;400 compared to normal HbA1c (23% vs. 10%, p&amp;lt;0.0001). In the multiple logistic regression analysis the HbA1c-prediabetics had an odds ratio (OR) of 1.5 for plaque presence (confidence interval (CI) 1.0;2.4) and OR 2.1 for a CAC-score &amp;gt;400 (CI 1.3;3.5). None of the associations for the OGTT-prediabetics were significant in the logistic regression analysis. Receiver operating characteristic curves were applied to the significant logistic associations. The HbA1c-prediabetics had an area under the curve (AUC)=0.77 for plaque presence and AUC=0.81 for CAC-score &amp;gt;400. Conclusion Prediabetes defined by HbA1c can predict presence and severity of coronary artery disease. Although OGTT identified more patients as having prediabetes, their risk of coronary artery disease was not attributable to prediabetes. Thus, our results support the replacement of OGTT with HbA1c in clinical practice.

Impact of DM on clinical outcomes in patients with CAD diagnosed by CCTA

Abstract Background/Introduction Diabetes mellitus (DM) is the most important risk factor for coronary artery disease (CAD) progression and prognosis. The DM patients with normal coronary artery on coronary CT angiography had good prognosis, however the prognosis of mild and moderate CAD was not fully elucidated. Purpose The aim of this study was to investigate the impact of DM on clinical outcomes in patients with mild and moderate CAD diagnosed by coronary CT angiography. Methods A total of 6014 patients underwent CCTA were prospectively enrolled and the 1126 patients with minimal and intermediate CAD were analyzed. Patients were categorized according to maximal severity of coronary artery stenosis: minimal CAD (31 to 50%) and intermediate CAD (51 to 70%). The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, coronary revascularization, or cardiac hospitalization. Results Nine hundred eighty-five patients had minimal CAD and 141 patients had intermediate CAD. The DM patients were 307 (31.2%) in the minimal CAD group and 52 (36.9%) in the intermediate CAD group. During the follow-up period (median 18.9 months [interquartile range: 7.8 to 34.6 months]), there is no significant difference of the risk of MACE between the non-DM and DM patients in the minimal CAD group (26.9% vs. 32.8%; adjusted hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.74-1.49; p=0.79). However, compared with the non-DM patients, the DM patients significantly increased the risk of MACE in the intermediate CAD group (36.5% vs. 63.2%; adjusted HR, 2.37; 95% CI, 1.18-4.77; p=0.02). Conclusion The prognosis of the DM patients was similar with the non-DM patients in the minimal CAD group. However, the DM patients had worse clinical outcomes compared with the non-DM patients in the intermediate CAD group.Study design and clinical outcomeKaplan-Meier curves of event rate for MA

Effect of omega-3 fatty acids supplementation on the prognosis of coronary artery disease: A meta-analysis of randomized controlled trials

AimsTo evaluate whether omega-3 fatty acids (ɷ-3 FAs) supplementation can improve cardiovascular outcomes in patients with established coronary artery disease (CAD). Data synthesisFive electronic databases were searched for randomized controlled trials that evaluated the effect of ɷ-3 FAs on cardiovascular outcomes in patients with CAD. The language was restricted to English. The risk ratio was pooled. Subgroup analyses were conducted to evaluate whether study-level variables might act as effect modifiers. A total of 12 studies involving 29913 patients were included. ɷ-3 FAs had no effects on major adverse cardiovascular events (MACEs) (RR, 0.93; 95 % CI: 0.85 to 1.01, P = 0.09). While ɷ-3 FAs reduced the incidences of all-cause death (RR, 0.90; 95 % CI: 0.83 to 0.97, P = 0.005), cardiovascular death (RR, 0.82; 95 % CI: 0.75 to 0.90, P < 0.0001), myocardial infarction (RR, 0.77; 95 % CI: 0.68 to 0.86, P < 0.0001), revascularization (RR, 0.80; 95 % CI: 0.69 to 0.93, P = 0.003), sudden cardiac death (RR, 0.67; 95 % CI: 0.52 to 0.86, P = 0.002) and hospitalization for heart failure or unstable angina pectoris (RR, 0.75; 95 % CI: 0.58 to 0.97, P = 0.03) in CAD. It did not statistically reduce the risk of stroke (RR, 0.96; 95 % CI: 0.77 to 1.21, P = 0.76). The favorable effects of ɷ-3 FAs on MACEs were significant in subgroups of intervention with EPA and baseline triglyceride ≥1.7 mmol/L. Conclusionɷ-3 FAs supplementation, especially EPA, appears to be an effective adjunct therapy for improving the prognosis of CAD. Registration numberPROSPERO CRD42022311237.

Mortality Associated with the Number of Diseased Vessels and Therapeutic Strategies for Coronary Artery Disease: Long-Term Follow-Up

Background: The number of coronary arteries affected by atherosclerosis is believed to impact the prognosis of coronary artery disease, resulting in a higher incidence of cardiac events. However, conclusive results on the relationship between the extent of coronary atherosclerosis and outcomes are lacking. Methods: This retrospective, single-center, observational cohort study included patients with stable coronary artery disease and preserved ventricular function who had the option of any of the three therapeutic strategies (medicine, angioplasty, or surgery) included in the MASS-Trials database. Patients were stratified according to the number of diseased arteries forming single-vessel, double-vessel, and triple-vessel disease groups. The atherosclerotic burden was assessed using the SYNTAX Score. Each group was eligible for any of the three therapeutic strategies. The primary endpoint was overall mortality. Secondary endpoints included the combination of all-cause death, nonfatal myocardial infarction, and additional coronary interventions. Results: Between May 1998 and June 2009, 2,000 patients who met the inclusion criteria in the MASS-Trial database were included. The study enrolled 1,855 patients. Of these, 224(12%) had single-vessel disease (SVD), 536(29%) had double-vessel disease (2VD), and 1,095(59%) had triple-vessel disease (3VD). The entire follow-up of our sample was 5 years. Overall mortality for SVD, 2VD, and 3VD was 9(4%), 33(6.3%), and 43(3.9%), respectively (P=0.054). Pairwise comparison of mortality at 5-year follow-up showed no significant differences between SVD x 2VD, SVD x 3VD, and 2VD x 3VD (hazard ratio [HR] 1.41, 95% CI: 0.81-2.44). The secondary endpoints (combination of overall mortality, nonfatal infarction, and additional revascularization) also revealed no significant differences (P=0.2). Conclusions: Overall mortality was similar regardless of the number of diseased arteries and the degree of arterial involvement. These data suggest that optimized medical treatment as an initial strategy is safe and has a similar rate of events in any applied therapeutic option.