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Atherosclerotic cardiovascular disease (ASCAD) is recognized as a chronic subclinical systemic inflammatory condition. The platelet-albumin ratio (PAR) has shown promise in prognosticating various inflammation-related disorders. Our study aimed to assess the connection between PAR and major adverse cardiovascular events (MACE) in percutaneous coronary intervention (PCI)-treated patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). PAR, derived from platelet and albumin counts, categorized participants into four quartiles. The primary outcome was composite MACE, encompassing all-cause mortality, non-fatal myocardial infarction (MI), and ischemia-driven revascularization. Secondary outcomes comprised individual MACE components. Multivariate Cox regression evaluated PAR's independent impact on adverse events. The non-linear relationship between the PAR value and MACE was explored using a restricted cubic spline (RCS). Receiver operating characteristic (ROC) analysis was conducted and the area under the curve (AUC) was calculated. Subgroup analysis was used to determine the effect of PAR on MACE in different subgroups. Enrolling 1391 NSTE-ACS patients, high PAR quartiles were correlated with elevated MACE rates (quartile 4 vs. quartile 1: 33.5% vs. 10.2%, p < 0.001). PAR was revealed to be independently related to an increased risk of MACE (quartile 4 vs. quartile 1: HR, 2.04 [95% CI, 1.34–3.08], p = 0.001). RCS indicated a positive PAR-MACE relationship. The AUC of PAR for the 3-year MACE was 0.659 (95% CI: 0.626–0.677, P<0.001). Subgroup analysis showed no significant interactions across subsets. PAR independently predicted MACE risk in PCI-treated NSTE-ACS patients. • PAR Predicts Prognosis: PAR (Platelet-albumin ratio) predicts outcomes in NSTE-ACS (non-ST-segment elevation acute coronary syndrome) patients post-PCI (percutaneous coronary intervention), revealing its potential as a novel prognostic marker. • Higher PAR, Increased MACE Risk: Elevated PAR quartiles link to higher risk of major adverse cardiovascular events (MACE), encompassing mortality, MI (myocardial infarction), and revascularization. • PAR Informs Risk Assessment: PAR's independent association with heightened MACE risk offers a practical tool for risk assessment in NSTE-ACS patients undergoing PCI, aiding tailored interventions. [ABSTRACT FROM AUTHOR]

Abstract: Aim: In 2002 the ACC/AHA guidelines for the management of patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) were updated. We aimed to answer whether the implementation of updated guidelines was capable of influencing short- and long-term mortality in these patients. Methods: We analyzed data on 812 consecutive patients who were admitted with either UA or NSTEMI between 2001 and 2004. Patients admitted in the two years before the implementation of updated guidelines (UA01/02 group and NSTEMI01/02 group) were compared to patients admitted in the two years thereafter (UA03/04 group and NSTEMI03/04 group). Yearly follow-up concerning all-cause mortality was obtained up to four years. Results: The rate of revascularizations, the percentage of procedures performed within 48h of admission, and the administration of clopidogrel increased significantly. However, still many – especially high-risk – patients did not receive revascularization. Patients of both UA groups had an identical in-hospital mortality rate. Differences in mortality between groups gained statistical significance over time (four-year mortality; 15.1% for the UA03/04 group vs. 26.5% for the UA01/02 group, p=0.014; HR 0.49 95% CI 0.28–0.87). In patients with NSTEMI in-hospital mortality decreased from 18.4% in the NSTEMI01/02 group to 9.6% in the NSTEMI03/04 group (p=0.011; HR 0.47 95% CI 0.26–0.84), and 1-year mortality from 34.7% to 25.1% (p=0.038; HR 0.63 95% CI 0.41–0.98), respectively. Mortality rates beyond one year were still lower in the NSTEMI03/04 group as compared to the NSTEMI01/02 group but it did not reach statistical significance. Multivariate Cox-regression analysis revealed furthermore that also patients with higher age and/or renal dysfunction benefit from an early invasive strategy. Conclusion: The implementation of updated guidelines for NSTE-ACS had significant impact on short- and long-term mortality. However, an early invasive strategy is still withheld to a significant number of high-risk patients, who would benefit from an invasive treatment. [Copyright &y& Elsevier]

Abstract: Objectives: To assess the effect of renal impairment (RI) and diabetes (DM) on outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Methods: Data were pooled from 13,126 patients in five NSTE-ACS TIMI trials (TIMI 11A and B, TIMI 12, OPUS-TIMI 16, and TACTICS-TIMI 18). Patients were divided based on DM status and RI (none, mild, or moderate if the glomerular filtration rate (GFR, ml/min/1.73 m2) was ≥90, 60–89 and 30–59 respectively). Results: Patients with DM and moderate RI (n =609) were older and had more prior MI (p <0.01 for all) than other subgroups. Compared with no RI/DM (n =3,832), the 12-month adjusted risks of death, MI, and death/MI increased with advancing RI and were highest with DM and moderate RI (H.R. 1.7, (1.2–2.4), p =0.002; H.R. 2.0 (1.5–2.6), p <0.001; and H.R. 1.7 (1.3–2.2), p <0.001 respectively). These events were also increased with DM and mild RI (H.R. 1.4, (1.0–1.9), p =0.06, H.R. 1.4 (1.1–1.8), p =0.006 and H.R. 1.3 (1.1–1.7), p =0.007 respectively) but not with 1) mild or moderate RI without DM or 2) DM without RI. The interaction terms for RI and DM in their association with MI and death/MI were significant. Conclusions: In the absence of DM, RI and in the absence of RI, DM did not increase the risk of MI or death/MI. However, the combination of RI and DM was associated with a particularly high risk of MI and death/MI suggesting that attention to preserving renal function may be of particular benefit for reducing cardiovascular risk in diabetic patients. [Copyright &y& Elsevier]