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Cardiovascular disease (CVD) is a major global health threat, particularly affecting low- and middle-income countries, where it accounts for a significant number of premature deaths. Risk factors such as smoking, unhealthy diet, and sedentary lifestyles contribute to its prevalence. Clinical scoring systems like TIMI, GRACE, and HEART scores, alongside biomarker assessments, aid in the early identification of high-risk individuals, facilitating timely interventions to prevent adverse outcomes. Those with advanced age, prior myocardial infarction (MI), and impaired left ventricular function are at increased risk and may benefit from invasive procedures like coronary artery bypass grafting (CABG). Early detection and management of CVD risk factors are pivotal for effective prevention and treatment strategies. This study analyzes angiographic characteristics and evaluates the clinical effectiveness of TIMI and GRACE scores in guiding treatment and predicting outcomes for patients with NSTEMI and Unstable Angina. This was conducted at a tertiary hospital in Ahmedabad over one year. The study population comprised inpatient cases diagnosed with Non-ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina. The majority of NSTEMI patients had double vessel disease with left anterior descending artery involvement, while UA patients predominantly had single vessel disease with similar artery involvement. NSTEMI patients had a significantly higher mortality rate (14.55%) compared to UA patients (4.44%). Mortality was higher in males (15.52%) compared to females (2.38%). Male gender and higher TIMI and GRACE scores are associated with increased mortality and decreased discharge rates. Revascularization may be necessary for patients with higher TIMI risk scores to reduce mortality risk. [ABSTRACT FROM AUTHOR]

Objective: To determine the causes of normal blood flow in coronary arteries in patients presenting with STEMI and receiving pPCI. Study Design: Observational study conducted retrospectively. Setting: National Institute of Cardiovascular Disease (NICVD) Karachi, Cath Lab. Period: August 17 2020 to November 2020. Material & Methods: Data was obtained from patients presented to the emergency department with STEMI and experienced primary PCI in last two years from January 2016 to Decemebr 2018.Social Sciences (SPSS) version 19 was used analyze these data. Th in those patients who had suboptimal coronary blood flow. Young patients <40 years of age had more (14%) normal coronary blood flow as compared to elders i.e >40 years. Diabetes mellitus, Hypertension, and smoking had no significant impact on coronary blood flow in these patients. Conclusion: In this study, it was found that most of the coronary arteries had abnormal blood flow during primary PCI. Multiple factors are affecting the blood flow in coronaries. The onset of symptoms and the time presented in the hospital was the main factors. Further studies are required to find more reasons for having normal blood flow in coronaries in STEMI. [ABSTRACT FROM AUTHOR]

Introduction. Cardiovascular disease is a leading cause of death worldwide. Three-quarters of these deaths occur in lowand middle-income countries among individuals in their productive years. ST-segment elevation myocardial infarction (STEMI) is a dangerous manifestation of coronary artery disease (CAD) and can lead to sudden death. Smoking and a family history of early CAD are major risk factors for STEMI cases. However, their role in any risk stratification system for patients has not been clearly established. The most widely used score in assessing the prognosis of STEMI patients is the TIMI score, but its accuracy in the young patient population is still unknown. The objectives of this study were to determine the proportion of mortality in young STEMI patients at RSCM, validate the TIMI score in young patients, and develop a risk stratification system for young STEMI patients. Methods. This research is a retrospective cohort study using medical record data from the Dr. Cipto Mangunkusumo National General Hospital (RSCM) on patients aged ≤50 years who were treated for ST-elevation myocardial infarction (STEMI) from 2018 to 2022. Univariate analysis was conducted to obtain subject characteristics and the 30-day mortality proportion of young STEMI patients. Bivariate Cox regression analysis was performed to examine the relationship between smoking and a family history of early coronary artery disease (CAD) with 30-day mortality. The TIMI score was validated in the study subjects of young patients. Multivariate analysis was conducted to obtain a new prediction model, and the model’s discriminatory performance was assessed using the area under the ROC curve (AUC), and model calibration was modified using the Hosmer-Lemeshow test. Results. A total of 164 study subjects were included. There were 107 patients (65.2%) with a smoking risk factor, while 39 patients (23.9%) had a family history of early CAD. The proportion of 30-day mortality among young patients was 7.9% (13 individuals). Statistical analysis showed that there was no correlation between 30-day mortality in young STEMI patients and a history of smoking (HR 0.0441 (95% CI 0.148-1.312)) or a family history of early CAD (HR 0.567 (95% CI 0.126- 2.559)). The TIMI score showed good predictive ability for 30-day mortality in young STEMI patients, with an AUC value of 0.836 (95% CI 0.717- 0.956). The combination of the TIMI score with the smoking history variable demonstrated good discriminatory performance in predicting 30-day mortality among young STEMI patients, with an AUC value of 0.875. However, when comparing the AUC values between the TIMI score and the TIMI score with the addition of the smoking history factor, no significant increase in accuracy was observed (p-value=0.215). Conclusions. The TIMI score demonstrates good discrimination and calibration in predicting 30-day mortality among young STEMI patients. The TIMI score, when combined with the smoking history factor, shows improved discriminatory performance and calibration in predicting 30-day mortality among young STEMI patients compared to the pure TIMI score but does not significantly enhance the accuracy.

Background. Acute coronary syndrome (ACS) is one of the significant causes of death in the adult population globally, and mortality risk assessment is essential to improve prevention strategies. This study aimed to determine the performance of the TIMI and GRACE predictive models in identifying the risk of death from acute coronary syndrome (ACS) in patients with chest pain at a public hospital in Tumbes, Peru. Methods. We designed a retrospective cross-sectional study of medical records of patients with ACS treated at the José Alfredo Mendoza Olavarría Regional Hospital in Tumbes, Peru, from May to December 2022. The performance of the scores TIMI and GRACE for risk of death from ACS was evaluated using the receiver operating characteristic (ROC) curve analysis and calculating the area under the ROC curve (AUC) value with its 95% confidence interval. The AUC values of both scores were compared using Pearson's chi-square test. Results. Data from 106 patients were analyzed. The average age of the patients was 65 years (interquartile range [IQR]: 55-73), with 63.2% being male. The AUC values for the TIMI and GRACE scores were 95.1% (CI95: 90.9-99.2%) and 95.2% (85.7-100.0%), respectively, p=0.982. Conclusion. No difference was found in using the TIMI and GRACE scores to assess the risk of death in patients with ACS who attend a hospital for chest pain. Hence, either of the two scores would be helpful for the prognosis of death in patients with ACS.

Objectives: To describe the clinical characteristics and angiographic features of COVID-19 patients presenting with acute coronary syndrome (ACS) and to compare with non-COVID-19 ACS patients presenting simultaneously. Methodology: In a case control design, data were extracted from a prospectively collected COVID-19 and NCDR registry. All ACS patients who underwent cardiac catheterization from April 2020 to May 2021 were included. All of the patients were taken to the Cath lab for diagnostic coronary angiography and possible percutaneous intervention. Demographic and clinical characteristics, angiographic features, and in-hospital outcomes were compared between ACS patients with and without COVID-19. Results: A total of 4027 COVID-19 negative patients, and 80 COVID-19 positive were included. Total of 83% in COVID-19 and 88% in non-COVID-19 group had ST elevation myocardial infarction. Majority of the COVID-19 positive patients had sub-optimal TIMI flow grade (

Background: Currently, no pharmacological or device-based intervention has been fully proven to reverse the no-reflow phenomenon. Objectives: To assess the efficacy and safety of intracoronary (IC) epinephrine in the management of no-reflow phenomenon following percutaneous coronary intervention (PCI), either as first-line treatment or after the failure of conventional agents. Design: Systematic review. Data sources and methods: PubMed and Scopus databases were systematically searched up to 28 May 2022, with additional manual search on the Google Scholar and review of the reference lists of the relevant studies to identify all published studies. Cohort studies, case series, and interventional studies written in English which evaluated the efficacy and safety of IC epinephrine in patients with no-flow phenomenon were included in our review. Results: Six of the 646 articles identified in the initial search met our inclusion criteria. IC epinephrine was used either as a first-line treatment [two randomized clinical trials (RCTs)] or after the failure of conventional agents (two cohort studies and two case series) for restoring the coronary flow, mainly after primary PCI. As first-line therapy, IC epinephrine successfully restored coronary flow in over 90% of patients in both RCTs, which significantly outperformed IC adenosine (78%) but lagged behind combination of verapamil and tirofiban (100%) in this regard. In the refractory no-flow phenomenon, successful reperfusion [thrombolysis in myocardial infarction (TIMI) flow grade = 3] was achieved in three out of four patients after the administration of IC epinephrine based on the results from both case series. Their findings were confirmed by a recent cohort study that further compared IC epinephrine with IC adenosine and found significant differences between them in terms of efficacy [% TIMI flow grade 3: (69.1% versus 52.7%, respectively; p value = 0.04)] and 1-year major adverse cardiac event (MACE) outcomes (11.3% versus 26.7%, respectively; p value ⩽ 0.01). Overall, malignant ventricular arrhythmias were reported in none of the patients treated with IC epinephrine. Conclusion: Results from available evidence suggest that IC epinephrine might be an effective and safe agent in managing the no-reflow phenomenon. [ABSTRACT FROM AUTHOR]

Abstract Background Risk stratification in non-ST segment elevation myocardial infarction (NSTEMI) determines the intervention time. Limited study compared two risk scores, the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores in the current East Asian NSTEMI patients. Methods This retrospective observational study consecutively collected patients in a large academic hospital between 01/01 and 11/01/2017 and followed for 4 years. Patients were scored by TIMI and GRACE scores on hospital admission. In-hospital endpoints were defined as the in-hospital composite event, including mortality, re-infarction, heart failure, stroke, cardiac shock, or resuscitation. Long-term outcomes were all-cause mortality and cardiac mortality in 4-year follow-up. Results A total of 232 patients were included (female 29.7%, median age 67 years), with a median follow-up of 3.7 years. GRACE score grouped most patients (45.7%) into high risk, while TIMI grouped the majority (61.2%) into medium risk. Further subgrouping the TIMI medium group showed that half (53.5%) of the TIMI medium risk population was GRACE high risk (≥ 140). Compared to TIMI medium group + GRACE

Aim: A paradigm shift demonstrating the feasibility of using the radial artery for primary angioplasty and the evaluation of high-risk subgroups. Materials and methods: The nature of the research may be described as prospective, observational, and descriptive. Patients who presented with acute ST-segment elevation myocardial infarction (STEMI) and were treated with PCI via RA at the cardiology department of a tertiary care centre were included in the study. The interventionist was given complete autonomy in deciding whether to use a RA or FA strategy. Patients who had PCI performed through the femoral artery were not allowed to participate in this research. Patients were hospitalized and underwent evaluation for baseline features such clinical history, physical examination, and investigations such as electrocardiogram, two-dimensional echo, and normal laboratory investigation. After that, patients were separated into two groups for the subgroup analysis: HRG patients and non-HRG patients. Patients with unfavourable characteristics were included in the HRG. These characteristics included age (greater than 80 years), cardiogenic shock, severe left ventricular systolic dysfunction, high degree AV block, low body surface area (BSA), multi-vessel percutaneous coronary intervention (PCI), diabetes mellitus, and low body mass index (BMI). Patients who did not have these characteristics were included in the non-HRG. Results: Males made up 83.33% of the total study population of 150 patients, with 24.67% of those patients being under the age of 50 and 6.67% of those patients being above the age of 80. The body mass index (BMI) was determined, and the results showed that 16.67% of people had a BMI of less than 19 kg/m2, whereas 30% had a BMI of more than 25 kg/m2. The majority of patients had one or more risk factors for Coronary Artery Disease (CAD), with diabetes mellitus in 33.33%, systemic hypertension in 30% and smoking in 16.67%. At presentation, patients average systolic BP was 141.8 ± 24.6 mmHg and diastolic BP was 84.4 ± 12.1 mmHg. Total is chaemic time was found to be 6.55 ± 2.69 hrs for the whole study group. ECG analysis revealed AWMI spectrum in fifty percent of patients, QRBBB pattern in five percent, IWMI spectrum in fifty percent of patients, and RVMI in five percent. According to the results of the echocardiogram, 20% of the patients had a good left ventricular function (LVEF >50%), 40% had mild LV systolic dysfunction (LVEF 40-50%), 20% had moderate LV systolic dysfunction (LVEF 30-40%), and 20% had severe LV systolic dysfunction (LVEF30%). Prior to intervention, coronary angiography revealed the presence of SVD in 40% of patients, DVD in 30%, TVD in 25%, and LMCA involvement in 5% of patients. To treat the other patients, thrombo-suction, bare metal stents (BMS), plain old balloon angioplasty (POBA), and drug-eluting stents (DES) were utilized respectively. Drug- eluting stents were used in the majority of patients (85%). After the operation, TIMI 3 flow was attained in 84.67 percent of cases, TIMI 2 flow in 13.33 percent of cases, and TIMI 1 flow in just 2 percent of cases. The majority of patients, or 89.33%, had fluoroscopy times that were less than 10 minutes during the surgery. The amount of contrast that was administered during the operation was less than 100 ml in 85.33 percent of patients, between 100 and 150 ml in 6 percent of patients, and more than 150 ml in the remaining patients. Conclusion: The purpose of the trial was to investigate the viability of RA in primary angioplasty for patients who had one or more risk factors, the most prevalent of which were diabetes, hypertension, and smoking. Patients who were younger than 50 years had a higher incidence of having a family history of early CAD. When compared to NON-HRG, HRG had a significantly higher incidence of problems; however, this difference was not statistically significant (p value > 0.05). [ABSTRACT FROM AUTHOR]

Objective. To compare the long-term (5 year) prognostic values of commonly used risk scores on major adverse cardiovascular events (MACE) in a cohort of patients who underwent primary PCI for STEMI. Design. We created a composite endpoint of MACE, defined as the occurrence of any of the following events within 5 years: ischemic or hemorrhagic stroke, target vessel revascularization, nonfatal myocardial infarction, cardiovascular death. We dichotomized risk scores into high risk and not high risk according to the literature's pre-existing cutoffs as follows: GRACE score >127 = high risk, SYNTAX I score ≥33 = high risk, SYNTAX II ≥32 high risk, TIMI >8 = high risk. We utilized the area under the receiver operating characteristic curve (AUC) as the metric for predictive ability. Results. There were 768 patients in this study and 416 (54.2%), 209 (27.2%), 511 (66.5%), and 74 (9.6%) were at high risk according to the GRACE, SYNTAX I, SYNTAX II, and TIMI scores, respectively. The AUCs for 5-year MACE were 0.54 (95% confidence interval (CI): 0.49–0.59, p =.0947), 0.79 (95% CI: 0.75–0.83, p <.0001), 0.58 (95% CI: 0.54–0.62, p =.0004), and 0.5 (95% CI: 0.48–0.53, p =.7259), respectively. Conclusion. SYNTAX I score was superior in predicting MACE in patients with STEMI and a high burden of CAD. Utilizing the basal SYNTAX I score in STEMI patients with significant non-culprit CAD may improve risk stratification, decision-making, and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Our primary objective was to describe the risk of major adverse cardiac events (MACE) at 1, 6, and 12 months after a negative coronary computed tomography angiogram (cCTA), electrocardiogram (ECG) stress test, stress echocardiography, and myocardial perfusion scintigraphy (MPS) in low‐ to intermediate‐risk patients. Methods: Initially, 952 articles were identified for screening, 81 met criteria for full‐text review, and once risk of bias was assessed, 33 articles were included in this meta‐analysis. We utilized a random‐effects model to assess pooled MACE event proportion for patients undergoing evaluation of acute coronary syndrome (ACS) when risk stratified to a low‐ to intermediate‐risk category after undergoing standard testing. Heterogeneity analysis was performed using Cochrane's Q‐test and I2 statistic. Results: Twenty‐one studies evaluated follow‐up at 1 month with cCTA having a 0.09% (95% confidence interval [CI] = 0.03% to 0.26%) pooled MACE compared to 0.23% (95% CI = 0.01% to 5.8%) of the exercise stress testing (p = 1). MPS and cCTA had an overall event rate of 0.15% (95% CI = 0.06% to 0.41%) at 6 months (I2 = 0%). At 12 months, a subgroup analysis found a pooled cCTA MACE of 0.16% (95% CI = 0.04% to 0.65%) compared to 1.68% (95% CI = 0.01% to 2.6%) for stress echocardiography with low within‐group heterogeneity (I2 = 0%). Subgroup analysis of cCTA with no disease versus nonobstructive disease (<50% stenosis) did not find statistical difference in the MACE at both 1 month (0.17% [95% CI = 0.04% to 0.67%] vs. 0.06% [95% CI = 0.01% to 0.34%]) and 12 months (0.44% [95% CI = 0.09% to 2.2% vs. 0.54% [95% CI = 0.19% to 1.5%]). Conclusions: Patients presenting with chest pain who have a coronary CTA showing < 50% stenosis, negative ECG stress test, stress echocardiography, or stress myocardial perfusion scan in the past 12 months can be discharged without any further risk stratification if their ECG and troponin are reassuring given low MACE. [ABSTRACT FROM AUTHOR]

Objective: To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad, a city in western India. Methods: A prospective study was conducted on chest pain patients from January to December 2019. All adult patients with non-traumatic chest pain presenting to the emergency department were included, and their HEART and TIMI scores were evaluated. The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death. The receiver-operating characteristics (ROC) curve was used to determine the value of HEART and TIMI scores in predicting MACEs. Besides, the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of the two scores were assessed and compared. Results: A total of 350 patients were evaluated [mean age (55.03±16.6) years, 56.6% of males]. HEART score had the highest predictive value of MACEs with an area under the curve (AUC) of 0.98, followed by the TIMI score with an AUC of 0.92. HEART score had the highest specificity of 98.0% (95% CI: 96.4%-99.6%), the sensitivity of 75.0% (95% CI: 70.7%-79.3%), and PPV of 97.0% (95% CI: 94.1%-99.9%) and NPV of 82.5% (95% CI: 74.6%-90.4%) for low-risk patients. TIMI score had a specificity of 95.0% (95% CI: 92.4%-97.6%), sensitivity of 75.0% (95% CI: 69.4%-80.6%), PPV of 92.3% (95% CI: 88.1%-96.5%) and NPV of 82.3% (95% CI: 73.8%-90.8%) for low-risk patients. Conclusions: HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score. Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.

Background: Risk stratification in non-ST segment elevation myocardial infarction (NSTEMI) determines the intervention time. Limited study compared two risk scores, the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores in the current East Asian NSTEMI patients.Methods: This retrospective observational study consecutively collected patients in a large academic hospital between 01/01 and 11/01/2017 and followed for 4 years. Patients were scored by TIMI and GRACE scores on hospital admission. In-hospital endpoints were defined as the in-hospital composite event, including mortality, re-infarction, heart failure, stroke, cardiac shock, or resuscitation. Long-term outcomes were all-cause mortality and cardiac mortality in 4-year follow-up.Results: A total of 232 patients were included (female 29.7%, median age 67 years), with a median follow-up of 3.7 years. GRACE score grouped most patients (45.7%) into high risk, while TIMI grouped the majority (61.2%) into medium risk. Further subgrouping the TIMI medium group showed that half (53.5%) of the TIMI medium risk population was GRACE high risk (≥ 140). Compared to TIMI medium group + GRACE < 140 subgroup, the TIMI medium + GRACE high-risk (≥ 140) subgroup had a significantly higher in-hospital events (39.5% vs. 9.1%, p < 0.05), long-term all-cause mortality (22.2% vs. 0% p < 0.001) and cardiac death (11.1% vs. 0% p = 0.045) in 4-year follow-up. GRACE risk scores showed a better predictive ability than TIMI risk scores both for in-hospital and long-term outcomes. (AUC of GRACE vs. TIMI, In-hospital: 0.82 vs. 0.62; long-term mortality: 0.89 vs. 0.68; long-term cardiac mortality: 0.91 vs. 0.67, all p < 0.05). Combined use of the two risk scores reserved both the convenience of scoring and the predictive accuracy.Conclusion: GRACE showed better predictive accuracy than TIMI in East Asian NSTEMI patients in both in-hospital and long-term outcomes. The sequential use of TIMI and GRACE scores provide an easy and promising discriminative tool in predicting outcomes in NSTEMI East Asian patients. [ABSTRACT FROM AUTHOR]

Abstract Background The Global Registry of Acute Coronary Events (GRACE) score is recommended for stratifying chest pain. However, there are six formulas used to calculate the GRACE score for different outcomes of acute coronary syndrome (ACS), including death (Dth) or composite of death and myocardial infarction (MI), while in hospital (IH), within 6 months after discharge (OH6m) or from admission to 6 months later (IH6m). We aimed to perform the first comprehensive evaluation and comparison of six GRACE models to predict 30-day major adverse cardiac events (MACEs) in patients with acute chest pain in the emergency department (ED). Methods Patients with acute chest pain were consecutively recruited from August 24, 2015 to September 30, 2017 from the EDs of two public hospitals in China. The 30-day MACEs included death, acute myocardial infarction (AMI), emergency revascularization, cardiac arrest and cardiogenic shock. The correlation, calibration, discrimination, reclassification and diagnostic accuracy at certain cutoff values of six GRACE models were evaluated. Comparisons with the History, ECG, Age, Risk Factors, and Troponin (HEART) and Thrombolysis in Myocardial Infarction (TIMI) scores were conducted. Results A total of 2886 patients were analyzed, with 590 (20.4%) patients experiencing outcomes. The GRACE (IHDthMI), GRACE (IH6mDthMI), GRACE (IHDth), GRACE (IH6mDth), GRACE (OH6mDth) and GRACE (OH6mDthMI) showed positive linear correlations with the actual MACE rates (r ≥ 0.568, P 186 and GRACE (IH6mDthMI) > 161 could recognize 12% and 11% patients as high risk, which were greater than other GRACEs, HEART ≥8(9%) and TIMI ≥5(8%). Conclusions In this Chinese setting, certain strengths of GRACE models beyond HEART and TIMI scores were still noteworthy for stratifying chest pain patients. The validation and reasonable application of appropriate GRACE models in the evaluation of undifferentiated chest pain should be recommended.

Background: Few studies have characterized electrocardiography (ECG) patterns correlated with left ventricular (LV) systolic dysfunction in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS).Objectives: This study aims to develop ECG pattern-derived scores to predict LV systolic dysfunction in NSTE-ACS patients.Methods: A total of 466 patients with NSTE-ACS were retrospectively enrolled. LV ejection fraction (LVEF) was assessed by echocardiography within 72 h after the first triage ECG acquisition; there was no coronary intervention in between. ECG score was developed to predict LVEF < 40%. Performance of LVEF, the Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI) and ECG scores to predict 24-month all-cause mortality were analyzed. Subgroups with varying LVEF, GRACE and TIMI scores were stratified by ECG score to identify patients at high risk of mortality.Results: LVEF < 40% was present in 20% of patients. We developed the PQRST score by multivariate logistic regression, including poor R wave progression, QRS duration > 110 ms, heart rate > 100 beats per min, and ST-segment depression ≥ 1 mm in ≥ 2 contiguous leads, ranging from 0 to 6.5. The score had an area under the curve (AUC) of 0.824 in the derivation cohort and 0.899 in the validation cohort for discriminating LVEF < 40%. A PQRST score ≥ 3 could stratify high-risk patients with LVEF ≥ 40%, GRACE score > 140, or TIMI score ≥ 3 regarding 24-month all-cause mortality.Conclusions: The PQRST score could predict LVEF < 40% in NSTE-ACS patients and identify patients at high risk of mortality in the subgroups of patients with LVEF ≥ 40%, GRACE score > 140 or TIMI score ≥ 3.

Background: Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well. Methods: We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up. Results: 524 patients had PD

Background and purposeAngiographic revascularization grading after intra-arterial stroke therapy is limited by poor standardization, making it unclear which scale is optimal for predicting outcome. Using recently standardized criteria, we sought to compare the prognostic performance of 2 commonly used reperfusion scales.MethodsInclusion criteria for this multicenter retrospective study were acute ischemic stroke attributable to middle cerebral artery M1 occlusion, intra-arterial therapy, and 90-day modified Rankin scale score. Post-intra-arterial therapy reperfusion was graded using the Thrombolysis in Myocardial Infarction (TIMI) and Modified Thrombolysis in Cerebral Infarction (mTICI) scales. The scales were compared for prediction of clinical outcome using receiver-operating characteristic analysis.ResultsOf 308 patients, mean age was 65 years, and median National Institutes of Health Stroke Scale score was 17. The mean time from stroke onset to groin puncture was 305 minutes. There was no difference in the time to treatment between patients grouped by final TIMI (ie, 0 versus 1 versus 2 versus 3) or mTICI grades (ie, 0 versus 1 versus 2a versus 2b versus 3). Good outcome (modified Rankin scale, 0-2) was achieved in 32.5% of patients, and mortality rate was 25.3% at 90 days. There was a 6.3% rate of parenchymal hematoma type 2. In receiver-operating characteristic analysis, mTICI was superior to TIMI for predicting 90-day modified Rankin scale 0 to 2 (c-statistic: 0.74 versus 0.68; P

Background: The Global Registry of Acute Coronary Events (GRACE) score is recommended for stratifying chest pain. However, there are six formulas used to calculate the GRACE score for different outcomes of acute coronary syndrome (ACS), including death (Dth) or composite of death and myocardial infarction (MI), while in hospital (IH), within 6 months after discharge (OH6m) or from admission to 6 months later (IH6m). We aimed to perform the first comprehensive evaluation and comparison of six GRACE models to predict 30-day major adverse cardiac events (MACEs) in patients with acute chest pain in the emergency department (ED).Methods: Patients with acute chest pain were consecutively recruited from August 24, 2015 to September 30, 2017 from the EDs of two public hospitals in China. The 30-day MACEs included death, acute myocardial infarction (AMI), emergency revascularization, cardiac arrest and cardiogenic shock. The correlation, calibration, discrimination, reclassification and diagnostic accuracy at certain cutoff values of six GRACE models were evaluated. Comparisons with the History, ECG, Age, Risk Factors, and Troponin (HEART) and Thrombolysis in Myocardial Infarction (TIMI) scores were conducted.Results: A total of 2886 patients were analyzed, with 590 (20.4%) patients experiencing outcomes. The GRACE (IHDthMI), GRACE (IH6mDthMI), GRACE (IHDth), GRACE (IH6mDth), GRACE (OH6mDth) and GRACE (OH6mDthMI) showed positive linear correlations with the actual MACE rates (r ≥ 0.568, P < 0.001). All these models had good calibration (Hosmer-Lemeshow test, P ≥ 0.073) except GRACE (IHDthMI) (P < 0.001). The corresponding C-statistics were 0.83(0.81,0.84), 0.82(0.81,0.83), 0.75(0.73,0.76), 0.73(0.72,0.75), 0.72(0.70,0.73) and 0.70(0.68,0.71), respectively, first two of which were comparable to HEART (0.82, 0.80-0.83) and superior to TIMI (0.71, 0.69-0.73). With a sensitivity ≥95%, GRACE (IHDthMI) ≤81 and GRACE (IH6mDthMI) ≤79 identified 868(30%) and 821(28%) patients as low risk, respectively, which were significantly better than other GRACEs and HEART ≤3(22%). With a specificity ≥95%, GRACE (IHDthMI) > 186 and GRACE (IH6mDthMI) > 161 could recognize 12% and 11% patients as high risk, which were greater than other GRACEs, HEART ≥8(9%) and TIMI ≥5(8%).Conclusions: In this Chinese setting, certain strengths of GRACE models beyond HEART and TIMI scores were still noteworthy for stratifying chest pain patients. The validation and reasonable application of appropriate GRACE models in the evaluation of undifferentiated chest pain should be recommended. [ABSTRACT FROM AUTHOR]

To investigate the effect of ticagrelor on thrombolysis risk score (TIMI), TIMI myocardial perfusion score (TMPG), TIMI frame number (CTFC), major adverse cardiovascular events (MACE) and cardiac function in patients with acute ST elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) treatment. Methods: This study included 124 STEMI patients who were treated with PCI in our hospital from June 2017 to December 2018. They were randomly divided into two groups: Xinweining group and ticagrelor group, 62 cases in each group. The patients in Xinweining group were given intravenous injection of Xinweining during the operation; the load was 0.4 μ/kg ⋅ min-1, and the maintenance dose was 0.1 μ/kg ⋅ min-1. The intravenous drip continued for 36 hours after the operation. The patients in ticagrelor group were given 300mg aspirin enteric-coated tablets and 180mg ticagrelor for 3 times /d, 30 minutes before the operation, and 100mg aspirin enteric-coated tablets and 90mg ticagrelor for 2 times/d after the operation. The changes of implantation time, average length of stent, average diameter of stent, TIMI, TMPG, CTFC, MACE, incidence of adverse reactions, myocardial enzyme spectrum index and cardiac function [maximum mitral flow rate in early diastole phase/ maximum mitral flow rate in atrial systole period (E/A value), left ventricular end diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF)] were compared before and after the operation. There was no significant difference in implantation time, average stent length and average stent diameter between ticagrelor group and Xinweining group (P > 0.05). Compared with the Xinweining group, the specific value of TIMI-3 and TMPG-3 in ticagrelor group rose significantly, and the incidence of CTFC and no reflow/slow flow significantly lowered (P < 0.05). Compared with the incidence of Xinweining group (40.32%), the incidence of MACE in ticagrelor group (9.68%) significantly decreased (P < 0.05). Compared with pre-treatment, the E/A, LVEDD and LVEF of the two groups significantly increased after the treatment; compared with the Xinweining group, the E/A, LVEDD and LVEF of the ticagrelor group significantly rose (P < 0.05). After the treatment, compared with Xinweining group, the ST segment depression in ticagrelor group significantly rose (P < 0.05). Compared with 14.52% in Xinweining group, 4.84% in ticagrelor group was significantly lower (P < 0.05). Ticagrelor can significantly alleviate myocardial perfusion in STEMI patients after PCI treatment, improve cardiac function, reduce the incidence of MACE, and lower the risk of angina pectoris and recurrent myocardial infarction. [ABSTRACT FROM AUTHOR]

Aim: Rapid evaluation of patients with acute coronary syndrome (ACS) attending the emergency service under emergency room conditions and using appropriate risk scoring would improve treatment success. Calcium levels accumulate in the tissue in people with coronary artery disease and this has been found to correlate with osteopontin levels in some studies. It is predicted that osteopontin level could be used as a biomarker to detect coronary artery calcification. In this study, we aimed to evaluate the use of osteopontin levels in the differential diagnosis of ACS in conjunction with cardiac troponin I (cTnI) levels, and HEART (history, ECG, age, risk factors, troponin) and thrombolysis in myocardial infarction (TIMI) scores in patients with chest pain who attended the emergency service., Methods: This study was conducted as a prospective observational clinical study in the Department of Emergency Medicine, Faculty of Medicine, Ataturk University. There was a total of 90 participants, including 60 patients and 30 healthy individuals in the control group. All participants' demographic information, electrocardiography (ECG) findings, cTnI level, TIMI and HEART score, and osteopontin level were evaluated., Results: The patients' mean age was 51.61 ± 17.56 years and 63.3% ( n = 57) were male. The body mass index (BMI) of the patients was 25.63 ± 4.67 kg/m 2 . Patients with chest pain [CP(+)] and high cardiac troponin I levels [cTnl(+)] were found to be older and to have higher HEART and TIMI scores than individuals with CP(+) and normal cardiac troponin I levels [cTnl(-)] and the healthy control group ( p < 0.001). While the HEART score was zero in 22 (24.4%) of the patients, the TIMI score was zero in 42 (46.7%). In terms of gender distribution, vital signs and serum osteopontin levels, there was no significant difference between the patient groups ( p > 0.05). It was found that patients with CP(+) and cTnl(+) had a higher rate of ECG abnormalities than the CP(+) and cTnl (-) group and the healthy control group ( p = 0.13 and p < 0.001, respectively). In 65 (72.2%) of the patients, the ECG results were normal. ST-segment elevation was detected in 13 (14.4%) patients. In our study, cTnl levels were found to be positively correlated with age ( r = 0.624), BMI ( r = 0.291), HEART score ( r = 0.794) and TIMI score ( r = 0.805) ( p = 0.001, p = 0.005, p = 0.001 and p = 0.001, respectively). In our study, we discovered that osteopontin levels could not reach the differential diagnostic level for ST-elevation myocardial infarction or non-ST-elevation myocardial infarction. No statistically significant difference was found in osteopontin levels between the groups ( p > 0.05)., Conclusions: While very positive results were obtained in this approach to the ACS diagnosis using HEART and TIMI scores in patients with chest pain who attended the emergency service and were diagnosed with ACS, no significant results could be obtained regarding the use of osteopontin levels as a biomarker. More comprehensive, multicentre studies involving a large number of appropriately selected patients are considered to be necessary.

Although guidelines recommend early aspirin administration after diagnosis of ST-elevation myocardial infarction (STEMI), the decision of pretransfer aspirin administration is at the discretion of the primary physicians. Therefore, this study aimed to determine whether pretransfer aspirin administration was associated with better angiographical outcomes in patients with STEMI. This study compared the angiographic findings of thrombolysis in myocardial infarction (TIMI) flow grade in the infarct-related artery before percutaneous coronary intervention (PCI) between patients who received pretransfer aspirin and those who did not. In total, 28 patients (11.2%) were administered aspirin before transfer and 219 (88.8%) were administered aspirin upon arrival at the hospital. Propensity score matching yielded 135 patients [27 patients (20%) who were administered aspirin before transfer and 108 patients (80%) who were administered aspirin upon arrival at the hospital]. Patients who received pretransfer aspirin had a higher rate of TIMI-3 flow before PCI compared to those who did not receive pretransfer aspirin [8 (28.6%) versus 15 (6.8%), P < 0.01, in all study patients; 8 (26.6%) versus 7 (6.5%), P < 0.01, in propensity-score-matched patients]. Multivariable logistic regression analysis revealed that pretransfer aspirin administration was significantly associated with the presence of TIMI-3 flow before PCI, independent of age, gender, transfer time, and statin use (OR: 5.43, 95% CI: 1.94-15.2, P < 0.01, in all study patients; OR: 6.17, 95% CI: 1.86-20.46, P < 0.01, in propensity-score-matched patients). Pretransfer aspirin administration could lead to the early restoration of coronary blood flow in patients with STEMI, supporting its active use in STEMI care.

Objective: To determine the correlation of Global Registry for Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores with Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) to predict the extent and severity of coronary artery disease (CAD) in patients presented with first onset STE levation Myocardial Infarction (STEMI) undergoing Primary Percutaneous Coronary Intervention (PPCI). Study Design: Descriptive cross-sectional study. Place and Duration of Study: Inpatient departments of Armed Forces Institute of Cardiology/ National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from Jan 2019 to Jun 2019. Methodology: Ethical approval was taken from Institutional Ethical Review Board (IERB), AFIC/NIHD. Patients of any age and both genders who presented with chest pain and satisfied criteria for Type 1 Myocardial Infarction (MI), as stated in 4th Universal Definition of MI, were included in study by non-probability consecutive sampling technique. Patients with a previous history of ischemic heart disease, Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG) surgery were excluded. Both TIMI and GRACE scores for STEMI were calculated at time of admission. The extent and severity of CAD were assessed by the SS-I. Each coronary lesion with a diameter stenosis of at least 50%, in vessels of at least 1.5 mm, were scored. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Results: Out of 376 patients, 327 (86.9%) were male and 49 (13.1%) were female. Anterior wall MI was the most common presentation 164 (43.6%). Among risk factors for CAD, hypertension was the most common one 215 (57.2%). A positive correlation was found between SS and GRACE low, intermediate and high-risk groups (0.145). Conclusion: Patients having high GRACE and TIMI scores were more likely to have severe CAD. In comparison with TIMI score, GRACE score was found to have better correlation with SS, but degree of that association was not strong enough to make it a reliable and sole predictor of CAD severity. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship of serum LDL-C and HDL-C levels with Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) Scores to predict all-cause 30 days mortality following first onset Acute Coronary Syndrome (ACS). Study Design: Descriptive cross-sectional study. Place and Duration of Study: Inpatient departments of Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from Jan 2019 to Jun 2019. Methodology: Ethical approval was taken from Institutional Ethical Review Board (IERB), AFIC/NIHD. Patients of any age and both genders who presented with chest pain and satisfied criteria for type 1 Myocardial Infarction (MI), as stated in 4th Universal Definition of MI, were included in study by non-probability consecutive sampling technique. Patients with a previous history of ischemic heart disease, Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG) surgery and patients taking lipids lowering medications over at least 3 months prior to admission were excluded. Both TIMI and GRACE scores for ST Elevation MI (STEMI) and Non-ST Elevation MI (NSTEMI) were calculated at time of admission. One non fasting blood sample was drawn for serum lipid levels from each patient within 24 hours of hospital admission and was analyzed using ROCHE cobas 6000 c501 analyzer. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Results: Out of 236 patients, 210 were male and 26 were female. Minimum recorded age was 25 years and maximum 90 years. Subjects presented with NSTEMI seem older (65.5 ± 7.3 years) than the ones presented with STEMI (59.7 ± 12.5 years). Anterior wall MI was the most common presentation (35%). Hypertension was the most common (57.6%) risk factor noted for Coronary Artery Disease (CAD). Serum lipids had a higher trend among STEMI subjects than NSTEMI and a lower trend among deceased subjects, as compared to survivors, in both STEMI and NSTEMI groups. Negative correlations were recorded between LDL-C and GRACE score in STEMI group (-0.277) and between HDL-C and both GRACE and TIMI scores (-0.349 and -0.299, respectively) in NSTEMI group. Conclusion: A significant paradoxical lower levels of serum lipids were found in deceased subjects who presented with ACS. [ABSTRACT FROM AUTHOR]