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• Steatotic liver disease heightened risk for major adverse cardiac events (MACE). • Metabolic dysfunction-associated steatotic liver disease (MASLD) has recently emerged. • A machine-learning model using age and risk factors of MASLD predicts MACE risk. • Age ≥ 60 and ≥ 4 MASLD risk factors significantly predict MACE in derivation cohort. • Validation cohort confirms high MACE risk with both age and risk factor criteria. Steatotic liver disease (SLD) is associated with adverse cardiac events. Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a condition characterized by the abnormal accumulation of hepatic lipids that is closely linked to five metabolic disorders: overweight or obesity, impaired glucose regulation, hypertension, hypertriglyceridemia, and low high-density lipoprotein-cholesterol. This retrospective study aimed to stratify the risk of cardiac events in patients with MASLD. Patients diagnosed with MASLD through ultrasonography were evaluated. We implemented a machine learning-based approach using a survival classification and regression tree (CART) model to stratify patients based on age, and the number of risk scores was investigated as a predictor of adverse outcomes in the derivation cohort. The primary outcomes were major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, and revascularization due to coronary artery disease. Among 2,962 patients (median age, 62 years; men, 53.5 %), the distribution of risk factors was as follows: one (10.8 %), two (28.5 %), three (33.0 %), four (19.9 %), and five (7.8 %). Over a median follow-up period of 6.8 years, 170 (5.7 %) patients experienced MACE. In the derivation cohort of 2,073 patients, the CART model identified age ≥60 years old and risk factors ≥4 as significant predictors of MACE. These findings were corroborated in a validation cohort of 889 patients. Patients meeting both criteria exhibited the highest risk of MACE (log-rank test, p < 0.001). Patients aged ≥60 years old with risk factors ≥4 indicates at high risk of MACE in patients with MASLD. This risk stratification system provides a practical tool for identifying high-risk individuals in the MASLD population. [Display omitted] [ABSTRACT FROM AUTHOR]

Aims Pericoronary adipose tissue (PCAT) attenuation obtained by coronary computed tomography angiography (CCTA) has been associated with coronary inflammation and outcomes. Whether PCAT attenuation is predictive of major adverse cardiac events (MACE) during long-term follow-up is unknown. Methods and results Symptomatic patients with coronary artery disease (CAD) who underwent CCTA were included, and clinical outcomes were evaluated. PCAT was measured at all lesions for all three major coronary arteries using semi-automated software. A comparison between patients with and without MACE was made on both a per-lesion and a per-patient level. The predictive value of PCAT attenuation for MACE was assessed in Cox regression models. In 483 patients (63.3 ± 8.5 years, 54.9% men), 1561 lesions were analysed over a median follow-up duration of 9.5 years. The mean PCAT attenuation was not significantly different between patients with and without MACE. At a per-patient level, the adjusted hazard ratio (HR) and 95% confidence interval (CI) for MACE were 0.970 (95% CI: 0.933–1.008, P = 0.121) when the average of all lesions per patient was analysed, 0.992 (95% CI: 0.961–1.024, P = 0.622) when only the most obstructive lesion was evaluated, and 0.981 (95% CI: 0.946–1.016, P = 0.285) when only the lesion with the highest PCAT attenuation per individual was evaluated. Adjusted HRs for vessel-specific PCAT attenuation in the right coronary artery, left anterior descending artery, and left circumflex artery were 0.957 (95% CI: 0.830–1.104, P = 0.548), 0.989 (95% CI: 0.954–1.025, P = 0.550), and 0.739 (95% CI: 0.293–1.865, P = 0.522), respectively, in predicting long-term MACE. Conclusion In patients referred to CCTA for clinically suspected CAD, PCAT attenuation did not predict MACE during long-term follow-up. [ABSTRACT FROM AUTHOR]

Aim: This systematic review evaluated the impact of a chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) on clinical outcomes in acute coronary syndrome (ACS) patients and assessed the benefits of staged revascularization. Methods: We performed a comprehensive systematic review to provide further insight into the impact of a CTO in a non-IRA on clinical outcomes after ACS. Moreover, we review the currently available evidence on the clinical significance of staged revascularization for a CTO in a non-IRA patients with ACS and propose whether prophylactic CTO percutaneous coronary intervention (PCI) could improve outcomes in patients who subsequently develop an ACS. Results: Our search identified 999 studies, from which 30 were selected and ten were included in the analysis. The results showed a trend of higher all-cause mortality and major adverse cardiac event rates in the culprit-only-PCI group compared with the multivessel (MV)-PC I group in ST elevation myocardial infarction patients, with varying statistical significance across different outcomes. Conclusion: This review highlights the significant impact of non-IRA CTOs in ACS. Successful CTO revascularization may provide benefits, particularly in ST elevation myocardial infarction, but the optimal management approach remains uncertain. The presence of a non-IRA CTO, especially in cardiogenic shock, predicts worse outcomes. Further research is warranted to determine the effective strategies to improve survival. Plain Language Summary Heart attacks occur when blood flow to the heart is blocked. Some people have a long-standing complete blockage in a heart artery, called a chronic total occlusion (CTO). This review examined studies on heart attack patients, who also had a CTO in a different artery. The review found that having a CTO makes heart attacks more dangerous, increasing the risk of serious complications or death. Treating the CTO might benefit some patients, potentially reducing future heart problems. However, the optimal timing for CTO treatment remains unclear, some doctors prefer immediate treatment, while others advocate waiting. For very sick heart attack patients in cardiogenic shock, a CTO further increases risks. These patients may require specialized treatments to support heart function. Although fixing CTOs might help, more research is needed to determine their effectiveness for all patients. Currently, treatment decisions are made based on each patient's situation. In conclusion, CTOs pose a significant challenge in heart attack treatment. Further studies are necessary to establish the safest and most effective approach for managing heart attack patients with CTOs. Article highlights What we know The presence of a chronic total occlusion (CTO) is associated with higher mortality and adverse events compared with no CTO. Some studies showed the benefit of CTO revascularization on outcomes like mortality, myocardial infarction and the need for coronary artery bypass grafting. Large, randomized trials failed to demonstrate significant benefits of routine CTO percutaneous coronary intervention during index acute coronary syndrome admission. Study implications The pooled estimates failed to show statistically significant differences for most outcomes across studies except in the major adverse cardiac event aspect. Adequately powered randomized trials are still needed to determine if prophylactic CTO percutaneous coronary intervention improves long-term prognosis in acute coronary syndrome patients with concurrent CTOs. [ABSTRACT FROM AUTHOR]

Background: Safety recommendations for Janus kinase inhibitors (JAKi) issued by the European Medical Agency (EMA) in 2023 could potentially influence treatment patterns for rheumatoid arthritis (RA) drugs, but little is known about the impact of these recommendations in routine clinical care. Methods: We retrospectively analyzed the German RHADAR rheumatology database for adult patients with RA and documentation of a new therapy with a JAKi, tumor necrosis factor inhibitor (TNFi), or interleukin-6 receptor inhibitor (IL-6Ri). Data were grouped into half-yearly intervals from quarter (Q)2/2020 to Q3/2023. The period from Q4/2022 to Q1/2023 immediately followed the initial EMA endorsement of Pharmacovigilance Risk Assessment Committee (PRAC) recommendations and Q2/2023-Q3/2023 immediately followed the direct healthcare provider communication (DHPC) containing the new safety JAKi recommendations. Results: Between April 1, 2020 and September 23, 2023, 3008 newly initiated therapies for TNFi (1499 [49.8%]), JAKi (1126 [37.4%]), and IL-6Ri (383 [12.7%]) were documented by the treating physicians. JAKi were increasingly used in the first two half-year periods (from 29.7% of these therapies in Q2/2020-Q3/2020 to 46.7% in Q2/2021-Q3/2021; odds ratio [OR] 2.08; p<0.001). The proportion of initiated JAKi therapies decreased significantly after the PRAC recommendations (32.9%; OR vs peak 0.56; p=0.001) and the DHPC letter (26.1%; OR vs peak 0.40; p<0.001). JAKi were more likely to be used as >3rd-line therapy in later time periods. Conclusions: This exploratory study suggests that EMA safety recommendations for JAKi influenced treatment patterns of RA patients who received JAKi in Germany. Additional studies will be needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Patients with nonalcoholic fatty liver disease (NAFLD) have a higher risk of cardiac events. However, although the severity of liver fibrosis is related to worsening prognosis in patients with NAFLD, it is unclear whether the noninvasive liver fibrosis score has a predictive value for cardiac events. We evaluated 4071 patients with NAFLD diagnosed using ultrasonography. Liver fibrosis was assessed and divided into three groups based on the Fibrosis-4 (FIB4) index and NAFLD fibrosis score (NFS). The primary outcome of this study was major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and revascularization due to coronary artery disease. The median age of the evaluated patients was 61 (52–69) years, and 2201 (54.1%) were male. During the median follow-up period of 6.6 years, 179 (4.4%) patients experienced MACE. Kaplan–Meier survival analysis demonstrated that MACE increased progressively with the FIB4 index (log-rank, p < 0.001) and NFS (log-rank, p < 0.001). Multivariable analysis showed that the higher the FIB4 index, the higher the risk for MACE (low group as reference vs. intermediate group, hazard ratio [HR]: 1.860 [95% confidence interval (CI), 1.326–2.610; p < 0.001]; vs. high group, HR:3.325 [95% CI, 2.017–5.479; p < 0.001]), as well as NFS (low NFS group as reference vs. intermediate group, HR: 1.938 [95% CI, 1.391–2.699; p < 0.001]; vs. high group, HR: 3.492 [95% CI, 1.997–6.105; p < 0.001]). The FIB4 index and NFS are associated with the probability of MACE in patients with NAFLD. The study design was approved by the ethics review board of Ogaki Municipal Hospital (approval number: 20221124–12, registration date: November 28th, 2022). https://www.ogaki-mh.jp/chiken/kenkyu.html. [Display omitted] • In patients with NAFLD, liver fibrosis status was associated with cardiac events. • The Fibrosis-4 index and NAFLD fibrosis score are both noninvasive liver fibrosis scoring indices. • These scores had significant prognostic values for the occurrence of MACE in patients with NAFLD. • Physicians should closely follow up on patients with a high liver fibrosis score. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG). Method: A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up. Results: About 66.6 % patients were treated on the native vessel, and 24.2 % on grafts vessel. In all, 360 stents [83.3 % drug-eluting stent (DES) and 16.6 % bare metal stent (BMS)] were implanted. Diabetes mellitus (p = 0.03), LVEF50 years (p = 0.04), stent type [BMS (p = 0.03) and DES (p

OBJECTIVE: The study aimed to evaluate the effect of the SYNTAX score (SS) calculated before percutaneous intervention on survival in a group of young patients with acute coronary syndrome (ACS). PATIENTS AND METHODS: Our study is a retrospective study. Patients between the ages of 18 and 45 who applied to Private Yalova Atakent Hospital Cardiology Clinic with ACS and underwent percutaneous coronary intervention between 01.01.2017 and 01.12.2023 were included in the study. Patients aged 45 and under who presented with acute syndrome and underwent coronary angiography were evaluated. Patients' history of major cardiac adverse events (MACE) was evaluated. Demographic characteristics, laboratory findings, echocardiographic parameters, and SS of the patients were recorded. SS was calculated from the coronary angiography images of the patients. RESULTS: 140 patients were included in the study. 70.0% (n=98) of the cases were diagnosed with ST-elevation myocardial infarction (STE-MI), 28.6% (n=40) with non-ST-elevation myocardial infarction (NSTE-MI)-unstable angina pectoris (USAP), and 1.4% with cardiac arrest (n=2). 28.6% (n=40) of the patients had MACE. There was a statistically significant correlation between SS and MACE (r=0.525 p=0.001). An SS value of 23.15 had 77.5% sensitivity and 60.8% specificity in predicting MACE. There was a statistically significant negative correlation between SS and ejection fraction (EF) (r=-0.584, p=0.001). EF<40.5 predicted mortality with 77.7% sensitivity and 69.4% specificity (AUC 0.710, p=0.01, 95% CI 0.615-0.825). CONCLUSIONS: SYNTAX Score and EF have predictive value in predicting MACE and mortality in young ACS patients. Different scoring systems are needed to predict MACE and mortality after ACS in young patients. [ABSTRACT FROM AUTHOR]

Chest pain (CP), a common presentation in the emergency department (ED) setting, is associated with significant morbidity and mortality if emergency clinicians miss the diagnosis of acute coronary syndrome (ACS). The HEART (History, Electrocardiogram, Age, Risk Factors, Troponin) score had been validated for risk-stratification patients who are at high risk for ACS and major adverse cardiac events (MACE). However, the use of cocaine as a risk factor of the HEART score was controversial. We hypothesized that patients with cocaine-positive (COP) would not be associated with higher risk of 30-day MACE than cocaine-negative (CON) patients. This retrospective study included adult patients who presented to 13 EDs of a University's Medical System between August 7, 2017 to August 19, 2021. Patients who had CP and prospectively calculated HEART scores and urine toxicology tests as part of their clinical evaluation were eligible. Areas Under The Receiver Operating Curve (AUROC) were calculated for the performance of HEART score and 30-day MACE for each group. This study analyzed 46,210 patients' charts, 663 (1.4%) were COP patients. Mean age was statistically similar between groups but there were fewer females in the COP group (26.2% vs 53.2%, p < 0.001). Mean (+/− SD) HEART score was 3.7 (1.4) comparing to 3.1 (1.8, p < 0.001) between COP vs CON groups, respectively. Although more COP patients (54%) had moderate HEART scores (4–6) vs. CON group (35.2%, p < 0.001), rates of 30-day MACE were 1.1% for both groups. HEART score's AUROC was 0.72 for COP and 0.78 for CON groups. AUROC for the Risk Factor among COP patients, which includes cocaine, was poor (0.54). This study, which utilized prospective calculated HEART scores, demonstrated that overall performance of the HEART score was reasonable. Specifically, our analysis showed that the rate of 30-day MACE was not affected by cocaine use as a risk factor. We would recommend clinicians to consider the HEART score for this patient group. [ABSTRACT FROM AUTHOR]

Background: Left ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end‐stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear. Purpose: To investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD. Study Type: Prospective. Population: One hundred fifty‐eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis. Filed Strength/Sequence: 3.0 T, balanced steady‐state free precession (bSSFP) cine and modified Look‐Locker inversion recovery (MOLLI) sequences. Assessment: LV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median. Statistical Tests: Cox proportional hazard regression and log‐rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C‐statistics and DeLong tests. A P value <0.05 was considered statistically significant. Results: Thirty‐four MACE occurred during the median follow‐up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C‐statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%). Data Conclusion: LVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS. Evidence Level: 2 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Background: We introduced an adapted Lyman normal-tissue complication probability (NTCP) model, incorporating clinical risk factors and censored time-to-event data, to estimate the risk of major adverse cardiac events (MACE) following left breast cancer radiotherapy (RT). Materials and methods: Clinical characteristics and MACE data of 1100 women with left-side breast cancer receiving postoperative RT from 2005 to 2017 were retrospectively collected. A modified generalized Lyman NTCP model based on the individual left ventricle (LV) equivalent uniform dose (EUD), accounting for clinical risk factors and censored data, was developed using maximum likelihood estimation. Subgroup analysis was performed for low-comorbidity and high-comorbidity groups. Results: Over a median follow-up 7.8 years, 64 patients experienced MACE, with higher mean LV dose in affected individuals (4.1 Gy vs. 2.9 Gy). The full model accounting for clinical factors identified D50 = 43.3 Gy, m = 0.59, and n = 0.78 as the best-fit parameters. The threshold dose causing a 50 % probability of MACE was lower in the high-comorbidity group (D50 = 30 Gy) compared to the low-comorbidity group (D50 = 45 Gy). Predictions indicated that restricting LV EUD below 5 Gy yielded a 10-year relative MACE risk less than 1.3 and 1.5 for high-comorbidity and low-comorbidity groups, respectively. Conclusion: Patients with comorbidities are more susceptible to cardiac events following breast RT. The proposed modified generalized Lyman model considers nondosimetric risk factors and addresses incomplete follow-up for late complications, offering comprehensive and individualized MACE risk estimates post-RT.

Abstract Background The value of counting inflammatory cells and especially their counting ratio in predicting adverse clinical outcomes in patients with acute coronary syndrome (ACS) undergoing revascularization has been shown, but the results of studies have been very diverse and paradoxical. The aim of the current study was to systematically review the studies that investigated the role of increased neutrophil-to-lymphocyte ratio (NLR) in predicting long-term clinical outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods Data abstraction was independently performed by both un-blinded reviewers on deeply assessing Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials and using the relevant keywords. The risk of bias for each study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the QUADAS-2 tool. Statistical analysis was performed using the Stata software. Overall, 14 articles published between 2010 and 2021 were eligible for the final analysis. Results A total of 20,846 ACS patients undergoing PCI were included. Higher values of NLR were associated with higher numbers of involved coronaries (RR: 1.175, 95%CI 1.021–1.353, P = 0.024). Increasing the value of NLR was associated with a 3.4 times increase in long-term death (RR: 3.424, 95%CI 2.325–5.025, P = 0.001). Similarly, higher values of NLR were significantly associated with a higher likelihood of long-term MACE (RR: 2.604, 95%CI 1.736–3.906, P = 0.001). Conclusions NLR has a high value in predicting both the severity of coronary artery involvement and long-term adverse clinical outcomes following the PCI procedure.

BACKGROUND: The accelerated diagnostic protocol (ADP) using the Emergency Department Assessment of Chest pain Score (EDACS-ADP), a tool to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department, was developed using a contemporary troponin assay. This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina (MACE I and II, respectively). METHODS: A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed. The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS: Of the 1,304 patients prospectively enrolled, 399 (30.6%; 95% confidence interval [95% CI]: 27.7%-33.8%) were considered low-risk using the EDACS-ADP. Among them, the rates of MACE I and II were 1.3% (5/399) and 1.0% (4/399), respectively. The EDACS-ADP showed sensitivities and negative predictive values of 98.8% (95% CI: 97.2%--99.6%) and 98.7% (95% CI: 97.0%--99.5%) for MACE I and 98.7% (95% CI: 96.8%--99.7%) and 99.0% (95% CI: 97.4%--99.6%) for MACE II, respectively. CONCLUSION: EDACS-ADP could help identify patients as safe for early discharge. However, when unstable angina was added to the outcome, the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation. [ABSTRACT FROM AUTHOR]

Cell division cycle 42 (CDC42) regulates cholesterol efflux, chronic inflammation, and reendothelialization in various atherosclerotic diseases. This study aimed to investigate the correlation of serum CDC42 with myocardial injury indicators and major adverse cardiac event (MACE) in ST-elevation myocardial infarction (STEMI) patients who were treated with percutaneous coronary intervention (PCI). In 250 STEMI patients about to receive PCI, serum samples were collected at enrollment before PCI treatment, and the serum samples were also obtained from 100 healthy controls (HCs) at enrollment. Serum CDC42 was detected by enzyme-linked immunosorbent assay. Serum CDC42 was decreased (versus HCs, P < 0.001) and negatively correlated with diabetes mellitus (P = 0.017), multivessel disease (P = 0.016), cardiac troponin I (P < 0.001), creatine kinase MB (P = 0.012), stent diameter ≥ 3.5 mm (P = 0.039), white blood cell (P < 0.001), low-density lipoprotein cholesterol (P = 0.049), and C-reactive protein (P < 0.001) in STEMI patients. Besides, 29 (11.6%) STEMI patients experienced MACE. The 1-year, 2-year, and 3-year accumulating MACE rates were 7.5%, 17.3%, and 19.3%, accordingly. Serum CDC42 was reduced in STEMI patients who experienced MACE compared to those who did not (P = 0.001). Serum CDC42 ≥ 250 pg/mL, ≥ 400 pg/mL, ≥ 700 pg/mL (cut by near integer value of 1/4th quartile, median, and 3/4th quartile) were associated with decreased accumulating MACE rates in STEMI patients (all P < 0.050). Notably, serum CDC42 ≥ 250 pg/mL (hazard ratio = 0.435, P = 0.031) was independently related to reduced accumulating MACE risk in STEMI patients. A serum CDC42 level of ≥ 250 pg/mL well predicts decreased MACE risk in STEMI patients who are treated with PCI. [ABSTRACT FROM AUTHOR]

Context: The postacute heart failure (AHF) rehospitalization rate is attributed to persistent hemodynamic congestion despite clinical improvement. Peak atrial longitudinal strain (PALS), utilizing speckle tracking echocardiography technology, shows potential in post‑AHF prognosis. Meanwhile, N‑terminal pro‑hormone brain natriuretic peptide (NT‑proBNP) remains a known biomarker of intracardiac congestion. Aims: This study aimed to determine the relationship between predischarge PALS and NT‑proBNP as predictors of major adverse cardiac event (MACE) in patients after AHF hospitalization. Settings and Design: This study is a prospective cohort study, conducted in Prof. Dr. I G.N.G Ngoerah Hospital, Bali, Indonesia. Subjects and Methods: The study included hospitalized AHF patients, collecting demographic data, comorbidities, therapies, and echocardiographic measures before discharge. Predischarge PALS and NT‑proBNP were taken within 24 h before discharge. The main outcome was MACE, defined as rehospitalization and cardiovascular mortality within 90 days. Statistical Analysis Used: Comparative statistical analyses was done using independent t‑test for continuous variables (Mann–Whitney U test for variables with abnormal distribution) and Chi‑squared tests. Receiver operating characteristic (ROC) used in determining optimal threshold values of predischarge PALS and NT‑proBNP as a predictor of MACE. Kaplan–Meier curves were employed to gauge event‑free survival differences between these cohorts. Then, independent Cox regression was used to identify the predictors of MACE. Results: The study enrolled 67 patients with varying ejection fraction (EF) (16 – heart failure with preserved ejection fraction, 10 – heart failure with mildly reduced ejection fraction, and 41 – heart failure with reduced ejection fraction; mean age: 56.88 ± 14.57 years). Over the 90‑day follow‑up, 21 patients (31.3%) encountered MACE. Both PALS (area under the curve [AUC] 0.816) and NT‑proBNP (AUC 0.856) before discharge served as predictors of MACE. There was no significant AUC difference between ROC curves (area difference: 0.039, P = 0.553). The regression model highlighted that PALS and NT‑proBNP level before discharge acted as independent predictors of MACE, irrespective of EF, average E/e’, or estimated predischarge pulmonary capillary wedge pressure. Conclusions: Predischarge PALS is comparable to NT‑proBNP levels as independent predictors of short‑term MACE after AHF hospitalization. [ABSTRACT FROM AUTHOR]

Background: The value of counting inflammatory cells and especially their counting ratio in predicting adverse clinical outcomes in patients with acute coronary syndrome (ACS) undergoing revascularization has been shown, but the results of studies have been very diverse and paradoxical. The aim of the current study was to systematically review the studies that investigated the role of increased neutrophil-to-lymphocyte ratio (NLR) in predicting long-term clinical outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods: Data abstraction was independently performed by both un-blinded reviewers on deeply assessing Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials and using the relevant keywords. The risk of bias for each study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the QUADAS-2 tool. Statistical analysis was performed using the Stata software. Overall, 14 articles published between 2010 and 2021 were eligible for the final analysis. Results: A total of 20,846 ACS patients undergoing PCI were included. Higher values of NLR were associated with higher numbers of involved coronaries (RR: 1.175, 95%CI 1.021–1.353, P = 0.024). Increasing the value of NLR was associated with a 3.4 times increase in long-term death (RR: 3.424, 95%CI 2.325–5.025, P = 0.001). Similarly, higher values of NLR were significantly associated with a higher likelihood of long-term MACE (RR: 2.604, 95%CI 1.736–3.906, P = 0.001). Conclusions: NLR has a high value in predicting both the severity of coronary artery involvement and long-term adverse clinical outcomes following the PCI procedure. [ABSTRACT FROM AUTHOR]

Background: Data on the effect of cardiac arrest (CA), cardiogenic shock (CS), and their combination on the prognosis of Chinese patients with ST-segment elevation myocardial infarction (STEMI) are limited. The present study sought to evaluate the clinical outcomes of STEMI complicated by CA and CS, and to identify the risk factors for CA or CS. Methods: This study included 7468 consecutive patients with STEMI in China. The patients were divided into 4 groups (CA + CS, CA only, CS only, and No CA or CS). The endpoints were 30-day all-cause death and major adverse cardiovascular events. A Cox proportional hazards regression analysis was performed. Results: CA, CS, and their combination were noted in 332 (4.4 %), 377 (5.0 %), and 117 (1.6 %) among all patients. During the 30-day follow-up, 817 (10.9 %) all-cause deaths and 964 (12.9 %) major adverse cardiovascular events occurred, and the incidence of all-cause mortality (3.6 %, 62.3 %, 74.1 %, 83.3 %) and major adverse cardiovascular events (5.4 %, 67.1 %, 75.0 %, and 87.2 %) significantly increased in the No CA or CS, CS only, CA only, and CA + CS groups, respectively. In the multivariate Cox regression models, compared with the No CA or CS group, the CA + CS, CA, and CS-only groups were associated with an increased risk of all-cause death and major adverse cardiovascular events. Patients with CA + CS had the highest risk of all-cause death (hazard ratio [HR], 25.259 [95 % confidence interval (CI) 19.221–33.195]) and major adverse cardiovascular events (HR 19.098, 95%CI 14.797–24.648). Conclusions: CA, CS, and their combination were observed in approximately 11 % of Chinese patients with STEMI, and were associated with increased risk for 30-day mortality and major adverse cardiovascular events in Chinese patients with STEMI.

Abstract While the relationship between circulating osteoprotegerin (OPG) and cardiovascular events is well-established in the general population, its association with cardiovascular risks in chronic kidney disease (CKD) patients remains less robust. This study hypothesized that elevated circulating OPG levels might be associated with an increased risk of major adverse cardiac events (MACE) in CKD patients, a total of 2,109 patients with CKD stages 1 through pre-dialysis 5 from the KNOW-CKD cohort were categorized into quartiles based on serum OPG levels. The primary outcome of the study was 3-point MACE, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, or cardiac death. The median follow-up duration was 7.9 years. The cumulative incidence of 3-point MACE significantly varied across serum OPG levels in Kaplan–Meier curve analysis (P

Background Heart rate variability (HRV) is commonly used to evaluate the short-term prognosis of coronary artery diseaseas a well-known non-invasive indicator of cardiac autonomic function. Percutaneous coronary intervention (PCI) is a commonly usedsuigical treatment of coronary artery disease, however, major adverse cardiac event (MACE) such as malignant arrhythmias and recurrent myocardial infarction are common after suigical treatment. Although dual antiplatelet therapy (DAPT) can reduce the occurrence of MACE to a certain extent, it is prone to be complicated with gastrointestinal bleeding, and unable to consistently improve the prognosis of PCI. Ocular acupuncture can effectively reduce the duration and frequency of chest pain, and exercise therapy can enhance the function of heart and blood vessels. The application of ocular acupuncture and exercise combination therapy (OAECT) after PCI remains to be explored. Objective To investigate the effect of OAECT on postoperative heart rate variability and prognosis of patients treated with PCI. Methods A total of 32 CHD patients after PCI with moderate and low risk attending Hospital of Chengdu University of Traditional Chinese Medicine were selected and randomly divided into the OAECT group and drug treatment group in a 1∶1 allocation ratio. Patients in the OAECT group received OAECT in addition to DAPT, patients in the drug treatment group received DAPT alone, patients in both 2 groups completed the 2-week intervention. The data of patients was collectedas follows: (1) Baseline indicators: gender, age, height, weight, blood pressure, respiratory rate, interval between onset and intervention, education level, occupation, severity of coronary artery disease, and number of underlying diseases. (2) Main indicators: HRV within 24 h after PCI and on the day of the end of 2-week intervention, including the standard deviation of all normal to normal RR intervals (SDNN) , standard deviation of all 5-minute RR intervals (SDANN) , mean of the standard deviation of all NN intervals for all 5-min segment of 24 hours (SDNN index) , root mean square of difference between adjacent NN intervals (rMSSD) , percent of NN50 in the total number of NN intervals (PNN50) , high frequency (HF) , low frequency (LF) low frequency/high frequency (LF/HF) values. Prognosis at 2, 4, and 8 weeks after the intervention assessed by MACE, including cardiac or all-cause deaths, malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation, severe heart failure, recurrent myocardial infarction, repeat PCI and chest pain recorded by telephone and outpatient consultations. (3) Secondary indicators: C-reactive protein (CRP) , N-terminal pro B type natriuretic peptide (NT-proBNP) , creatine kinase isoenzyme (CK-MB) , high-sensitivity troponin I (hs-TnI) . (4) Safety indicators: the occurrence of complications after PCI such as subcutaneous hematoma, skin lesions, muscle soreness, respiratory abnormalities and stroke, all the outcome indicators were measured within 24 hours after PCI and on the day of the end of 2-week intervention. Results There was no significant difference in LF/HF, SDNN, SDANN, SDNN index, LF, HF, RMSSD and PNN50 between the 2 groups (P>0.05) . There were significant differences in LF/HF, SDNN and SDANN (P0.05) . The incidence rates of MACE and adverse reactions in the OAECT group were lower than DAPT group (P

While the relationship between circulating osteoprotegerin (OPG) and cardiovascular events is well-established in the general population, its association with cardiovascular risks in chronic kidney disease (CKD) patients remains less robust. This study hypothesized that elevated circulating OPG levels might be associated with an increased risk of major adverse cardiac events (MACE) in CKD patients, a total of 2,109 patients with CKD stages 1 through pre-dialysis 5 from the KNOW-CKD cohort were categorized into quartiles based on serum OPG levels. The primary outcome of the study was 3-point MACE, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, or cardiac death. The median follow-up duration was 7.9 years. The cumulative incidence of 3-point MACE significantly varied across serum OPG levels in Kaplan–Meier curve analysis (P < 0.001, log-rank test), with the highest incidence observed in the 4th quartile. Cox regression analysis indicated that, relative to the 1st quartile, the risk of 3-point MACE was significantly higher in the 3rd (adjusted hazard ratio 2.901, 95% confidence interval 1.009 to 8.341) and the 4th quartiles (adjusted hazard ratio 4.347, 95% confidence interval 1.410 to 13.395). In conclusion, elevated circulating OPG levels are associated with adverse cardiovascular outcomes in pre-dialysis CKD patients. [ABSTRACT FROM AUTHOR]

Introduction: The main aim of this study was to investigate the impact of isolated coronary microvascular disease (CMD) as diagnosed via various modalities on prognosis. Methods: A systematic literature review of PubMed, Embase, and Cochrane Library databases was conducted to identify relevant studies published up to March 2023. Included studies were required to measure coronary microvascular function and report outcomes in patients without obstructive coronary artery disease (CAD) or any other cardiac pathological characteristics. The primary endpoint was all-cause mortality, and the secondary endpoint was a major adverse cardiac event (MACE). Pooled effects were calculated using random effects models. Results: A total of 27 studies comprising 18,204 subjects were included in the meta-analysis. Indices of coronary microvascular function measurement included coronary angiography-derived index of microcirculatory resistance (caIMR), hyperemic microcirculatory resistance (HMR), coronary flow reserve (CFR), and so on. Patients with isolated CMD exhibited a significantly higher risk of mortality (OR: 2.97, 95% CI, 1.91–4.60, p < 0.0001; HR: 3.38, 95% CI, 1.77–6.47, p = 0.0002) and MACE (OR: 5.82, 95% CI, 3.65–9.29, p < 0.00001; HR: 4.01, 95% CI, 2.59–6.20, p < 0.00001) compared to those without CMD. Subgroup analysis by measurement modality demonstrated consistent and robust pooled effect estimates in various subgroups. Conclusion: CMD is significantly associated with an elevated risk of mortality and MACE in patients without obstructive CAD or any other identifiable cardiac pathologies. The utilization of various measurement techniques may have potential advantages in the management of isolated CMD. [ABSTRACT FROM AUTHOR]

At the emergency department (ED), it is important to quickly and accurately determine which patients are likely to have a major adverse cardiac event (MACE). Machine learning (ML) models can be used to aid physicians in detecting MACE, and improving the performance of such models is an active area of research. In this study, we sought to determine if ML models can be improved by including a prior electrocardiogram (ECG) from each patient. To that end, we trained several models to predict MACE within 30 days, both with and without prior ECGs, using data collected from 19,499 consecutive patients with chest pain, from five EDs in southern Sweden, between the years 2017 and 2018. Our results indicate no improvement in AUC from prior ECGs. This was consistent across models, both with and without additional clinical input variables, for different patient subgroups, and for different subsets of the outcome. While contradicting current best practices for manual ECG analysis, the results are positive in the sense that ML models with fewer inputs are more easily and widely applicable in practice. [ABSTRACT FROM AUTHOR]

Background: Dilated cardiomyopathy (DCM) has a poor prognosis and high mortality. The relationship between the deformation capacity of the biatrial and biventricular regions in patients with DCM remains unclear. Methods: This retrospective study used cardiovascular magnetic resonance (CMR) to assess patient enrollment between September 2020 to May 2022. Feature tracking (FT) was used to evaluate biventricular global radial strain (GRS), global circumferential strain (GCS) and global longitudinal strain (GLS). Fast long-axis method was used to evaluate biatrial GLS by analyzing balanced steady-state free precession cine images. The median followup period was 362 days (interquartile range: 234 to 500 days). DCM patients were divided into two groups based on the occurrence or non-occurrence of major adverse cardiac event (MACE). The primary endpoint was defined as all-cause death, heart transplantation, and adverse ventricular arrhythmia. The secondary end point included hospitalizations due to heart failure. Cox regression analysis was utilized for variables and Kaplan-Meier survival was utilized for clinical outcomes. Results: There were 124 DCM patients (52.82 ± 12.59 years, 67.74% male) and 53 healthy volunteers (53.17 ± 14.67 years, 52.83% male) recruited in this study. Biventricular GRS, GCS, GLS, and biatrial GLS were significantly impaired in the DCM group compared with the healthy group. In receiver-operating characteristic curve, biatrial GLS and biventricular GRS, GCS, and GLS showed significant prognostic value in predicting MACEs (all p < 0.05). In multivariate Cox regression analysis, left ventricular (LV) GLS offered a significant and independent prognostic value surpassing other CMR parameters in predicting MACE. In Kaplan-Meier analysis, patients with a LV GLS >-4.81% had a significantly higher rate of MACE (Log-rank p < 0.001). Conclusions: LV GLS was independently associated with MACEs in DCM patients by using FT and fast long-axis method derived from CMR. Comprehensive CMR examination including biatrial and biventricular functions should be systematically performed, to understand disease characteristics, as well as improve the risk stratification and therapeutic management for patients with DCM. [ABSTRACT FROM AUTHOR]

IntroductionCardiovascular disease (CVD) is the leading cause of morbidity and mortality in kidney transplant recipient (KTR). There is a dearth of standardized guidelines on optimal cardiovascular evaluation of transplant candidates.MethodsThis single-center cohort study aims to determine the effectiveness of our standardized risk-stratified pretransplant cardiovascular screening protocol, which includes coronary angiography (CAG), in identifying advanced CVD, the proper pretransplant management of which could lead to a reduction in the incidence of major cardiac events (MACE) in the early posttransplant period.ResultsOut of the total 776 KTR transplanted between 2017 and 2019, CAG was performed on 541 patients (69.7%), of whom 22.4% were found to have obstructive coronary artery disease (CAD). Asymptomatic obstructive CAD was observed in 70.2% of cases. In 73.6% of cases, CAG findings resulted in myocardial revascularization. MACE occurred in 5.6% (N = 44) of the 23 KTR with pretransplant CVD and 21 without pretransplant CVD. KTR with posttransplant MACE occurrence had significantly worse kidney graft function at the first year posttransplant (p = 0.00048) and worse patient survival rates (p = 0.0063) during the 3-year follow-up period compared with KTR without MACE. After adjustment, the independent significant factors for MACE were arrhythmia (HR 2.511, p = 0.02, 95% CI 1.158–5.444), pretransplant history of acute myocardial infarction (HR 0.201, p = 0.046, 95% CI 0.042–0.970), and pretransplant myocardial revascularization (HR 0.225, p = 0.045, 95% CI 0.052–0.939).ConclusionAsymptomatic CVD is largely prevalent in KTR. Posttransplant MACE has a negative effect on grafts and patient outcomes. Further research is needed to assess the benefits of pretransplant myocardial revascularization in asymptomatic kidney transplant candidates.

Nirmeen Fayed,1,2 Sally Waheed Elkhadry,3 Andreas Garling,1 Richard K Ellerkmann1,4 1Anethesia and Critical Care Department, Klinikum Dortmund, Dortmund, Germany; 2Anesthesia and Critical Care Department, National Liver Institute Menoufia University, Shebin-Alkoom, Egypt; 3Epidemiology and Preventive Medicine Institute, National Liver Institute, Menoufia University, Shebin-Alkoom, Egypt; 4Anesthesia and Critical Care Department, Bonn University, Bonn, GermanyCorrespondence: Nirmeen Fayed, Anesthesia Department Klinikum Dortmund, Germany, Mollwitzer Straße 4, Dortmund, 44141, Germany, Tel +49 17647154842, Email drnirmeena@yahoo.comBackground: The Revised Cardiac Risk Index (RCRI) and the Geriatric Sensitive Cardiac Risk Index (GSCRI) estimate the risk of postoperative major adverse cardiac events (MACE) regardless of the type of anesthesia and without specifying the oldest old patients. Since spinal anesthesia (SA) is a preferred technique in geriatrics, we aimed to test the external validity of these indices in patients ≥ 80 years old who underwent surgery under SA and tried to identify other potential risk factors for postoperative MACE.Methods: The performance of both indices to estimate postoperative in-hospital MACE risk was tested through discrimination, calibration, and clinical utility. We also investigated the correlation between both indices and postoperative ICU admission and length of hospital stay (LOS).Results: The MACE incidence was 7.5%. Both indices had limited discriminative (AUC for RCRI and GSCRI were 0.69 and 0.68, respectively) and predictive abilities. The regression analysis showed that patients with atrial fibrillation (AF) were 3.77 and those with trauma surgery were 2.03 times more likely to exhibit MACE, and the odds of MACE increased by 9% for each additional year above 80. Introducing these factors into both indices (multivariable models) increased the discriminative ability (AUC reached 0.798 and 0.777 for RCRI and GSCRI, respectively). Bootstrap analysis showed that the predictive ability of the multivariate GSCRI but not the multivariate RCRI improved. Decision curve analysis (DCA) showed that multivariate GSCRI had superior clinical utility when compared with multivariate RCRI. Both indices correlated poorly with postoperative ICU admission and LOS.Conclusion: Both indices had limited predictive and discriminative ability to estimate postoperative in-hospital MACE risk and correlated poorly with postoperative ICU admission and LOS, following surgery under SA in the oldest-old patients. Updated versions by introducing age, AF, and trauma surgery improved the GSCRI performance but not the RCRI.Keywords: geriatric, anesthetic techniques, subarachnoid, risk, major adverse cardiac event

Background: Heart failure (HF) is associated with a high bleeding risk after percutaneous coronary intervention (PCI). Additionally, major bleeding events increase the risk of subsequent major adverse cardiac events (MACE). However, whether brain natriuretic peptide (BNP) levels and major bleeding events following PCI are associated with MACE and all-cause death remains unknown. This study aimed to investigate the impact of HF severity or bleeding on subsequent MACE and all-cause death. Methods: The Clinical Deep Data Accumulation System (CLIDAS), a multicenter database involving seven hospitals in Japan, was developed to collect data from electronic medical records. This retrospective analysis included 7160 patients who underwent PCI between April 2014 and March 2020 and completed a three-year follow-up. Patients were divided according to the presence of HF with high BNP (HFhBNP) (>100 pg/ml) and major bleeding events within 30 days post-PCI (30-day bleeding): HFhBNP with bleeding (n = 14), HFhBNP without bleeding (n = 370), non-HFhBNP with bleeding (n = 74), and non-HFhBNP without bleeding (n = 6702). Results: In patients without 30-day bleeding, HFhBNP was a risk factor for MACE (hazard ratio, 2.19; 95% confidence interval, 1.56–3.07) and all-cause death (hazard ratio, 1.60; 95% confidence interval, 1.60–2.23). Among HFhBNP patients, MACE incidence was higher in patients with 30-day bleeding than in those without bleeding, but the difference was not significant (p = 0.075). The incidence of all-cause death was higher in patients with bleeding (p = 0.001). Conclusions: HF with high BNP and bleeding events in the early stage after PCI might be associated with subsequent MACE and all-cause death.

The relationship between 24-h urinary phosphorus excretion (24 h UPE) and cardiovascular disease in patients with pre-dialysis chronic kidney disease (CKD) has rarely been studied, despite the fact that the relationship between serum phosphorus level and the risk of a cardiovascular event is well established. A total of 1701 patients with pre-dialysis CKD were finally included for the analyses and were divided into tertiles by 24 h UPE (first tertile (T1, 349.557 (mean) ± 88.413 (standard deviation)), second tertile (T2, 557.530 ± 50.738), and third tertile (T3, 851.695 ± 171.593). The study outcome was a six-point major adverse cardiac event (MACE). The median follow-up duration was 7.992 years. Kaplan–Meier curve analysis visualized that the cumulative incidences of a six-point MACE (p = 0.029) significantly differed from 24 h UPE levels, as the incidence rate of the study outcomes was highest in T1 and lowest in T3. Cox proportional hazard models unveiled that, compared to T1, the risk of a six-point MACE was significantly decreased in T3 (adjusted hazard ratio (HR) 0.376, 95% confidence interval (CI) 0.207 to 0.683). The restricted cubic spline curve analysis visualized an inverted S-shaped association between 24 h UPE level and the risk of a six-point MACE, indicating a significantly increased risk of a six-point MACE in patients with a low 24 h UPE level. In conclusion, low 24 h UPE is associated with adverse cardiovascular outcomes in patients with CKD. Our finding emphasizes that low 24 h UPE should not be a reliable marker for dietary restriction of phosphorus that essentially leads to better outcomes in patients with CKD. [ABSTRACT FROM AUTHOR]

BackgroundThere are insufficient studies on the effect of dietary salt intake on cardiovascular (CV) outcomes in chronic kidney disease (CKD) patients, and there is no consensus on the sodium (Na) intake level that increases the risk of CV disease in CKD patients. Therefore, we investigated the association between dietary salt intake and CV outcomes in CKD patients.MethodsIn the Korean cohort study for Outcome in patients with CKD (KNOW-CKD), 1,937 patients were eligible for the study, and their dietary Na intake was estimated using measured 24h urinary Na excretion. The primary outcome was a composite of CV events and/or all-cause death. The secondary outcome was a major adverse cardiac event (MACE).ResultsAmong 1,937 subjects, there were 205 (10.5%) events for the composite outcome and 110 (5.6%) events for MACE. Compared to the reference group (urinary Na excretion< 2.0g/day), the group with the highest measured 24h urinary Na excretion (urinary Na excretion ≥ 8.0g/day) was associated with increased risk of both the composite outcome (hazard ratio 3.29 [95% confidence interval 1.00-10.81]; P = 0.049) and MACE (hazard ratio 6.28 [95% confidence interval 1.45-27.20]; P = 0.013) in a cause-specific hazard model. Subgroup analysis also showed a pronounced association between dietary salt intake and the composite outcome in subgroups of patients with abdominal obesity, female, lower estimated glomerular filtration rate (< 60 ml/min per 1.73m2), no overt proteinuria, or a lower urinary potassium-to-creatinine ratio (< 46 mmol/g).ConclusionA high-salt diet is associated with CV outcomes in non-dialysis CKD patients.

APOB, APOC3, and APOE and apolipoprotein-defined lipoprotein subclasses (ADLSs; based on qualitative apolipoprotein complement) have been associated with dyslipidemia and CVD. Our main objective was to define associations of serum apolipoproteins and ADLSs with "any CVD" and "major atherosclerotic cardiovascular events" (MACEs) in a prospective study of T1D. Serum apolipoproteins and ADLSs (14 biomarkers in total) were measured in sera (obtained between 1997 and 2000) from a subset (n = 465) of the Epidemiology of Diabetes Interventions and Complications cohort. Prospective associations of "any CVD" (myocardial infarction, stroke, confirmed angina, silent myocardial infarction, revascularization, or congestive heart failure) and MACEs (fatal or nonfatal myocardial infarction or stroke), over 5,943 and 6,180 patient-years follow-up, respectively, were investigated using Cox proportional hazards models that were unadjusted and adjusted for risk factors. During 15 years of follow-up, 50 "any CVD" events and 24 MACEs occurred. Nominally significant positive univariate associations with "any CVD" were APOB, APOC3 and its subfractions [heparin precipitate, heparin-soluble (HS)], and ADLS-defined Lp-B. In adjusted analyses, APOC3-HS remained nominally significant. Nominally significant positive univariate associations with MACEs were APOC3 and its subfractions and Lp-B:C; those with total APOC3 and APOC3-HS persisted in adjusted analyses. However, these associations did not reach significance after adjusting for multiple testing. There were no significant associations of APOA1, APOA2, APOE, or other ADLSs with either "any CVD" or MACEs. These hypothesis-generating data suggest that total serum APOC3 and APOC3 in HDL are potentially important predictive biomarkers for any CVD and MACEs in adults with T1D.

Abstract Background Several studies have reported that NFKB1 gene rs28362491 polymorphism was associated with susceptibility to coronary heart disease in populations of different genetic backgrounds. To date, there have been no studies on the association between NFKB1 gene rs28362491 polymorphism and the occurrence of major adverse cardiac and cerebrovascular event (MACCE). The present study was to explore the relationship between NFKB1 gene rs28362491 polymorphism and MACCEs to investigate whether identifying NFKB1 gene polymorphism is beneficial to evaluating MACCE risks and patients’ prognoses. Methods We recruited 257 high-risk of cardiovascular disease patients with chest pain or precordial discomfort. The SNPscan™ were used to analyze the NFKB1 gene rs28362491 polymorphism. All patients were followed up in the clinic or by telephone interview for MACCEs. Results During the followed-up time (mean: 30.1 months) 49 patients had MACCEs (19.1%). Patients with the different genotypes of NFKB1 rs28362491 had different incidence rate of MACCE. The incidence of MACCE in patients carried II, ID and DD genotype was 16.5%, 15.9%, 32.6%, respectively. Log-rank analysis showed that the survival rate in patients with NFKB1 rs28362491 DD genotype was much lower than that in II or ID genotype carriers (P = 0.034). After excluding the influence of traditional risk factors of MACCEs, Cox regression showed that the DD genotype carriers had 2.294-fold relative risk of MACCEs comparing with patients carried II or ID genotype. Conclusion The NFKB1 gene rs28362491 mutant was an independent predictor of worse long-term prognosis for MACCEs. Therefore, identifying NFKB1 gene rs28362491 mutant may be used as a good way for guiding the standardized management of patients with high-risk of cardiovascular diseases.

Introduction: The modified accelerated diagnostic protocol (ADP) to assess patients with chest pain symptoms using troponin as the only biomarker (mADAPT), the History, ECG, Age, Risk factors, and Troponin (HEART) pathway, and the Emergency Department Assessment of Chest Pain Rule (EDACS)-ADP, are the three most well-known ADPs for patients with chest pain. These ADPs define major adverse cardiac event (MACE) as components of acute myocardial infarction, revascularization, and death; unstable angina is not included as an endpoint.Methods: We performed a single-center prospective observational study comparing the performance of these 3 ADPs for patients with 30-day MACE with and without unstable angina. We hypothesized that these ADPs will have high sensitivities for MACE without unstable angina, a definition used for score derivation studies. However, when unstable angina is included in the MACE, their performances would be lower than the acceptable rate of >99% sensitivity.Results: A total of 1,214 patients were included in the analysis. When unstable angina was not included in the endpoint, sensitivities for MACE were 99.1% (95% confidence interval [CI]: 96.7-99.9%), 99.5% (95% CI: 97.4-100%), and 100% (95% CI: 98.3-100%) for mADAPT, EDACS-ADP, and HEART pathway, respectively. The HEART pathway had the highest proportion of patients classified as low risk (39.2%, 95% CI: 35.8-42.9%), followed by EDACS-ADP (31.3%, 95% CI: 28.2-34.6%) and mADAPT (29.3%, 95% CI: 26.4-32.5%). However, when unstable angina was included in the MACE, sensitivities were 96.6% (95% CI: 94.4-98.1%) for mADAPT, 97.3% (95% CI: 95.3-98.6%) for EDACS-ADP, and 97.3% (95% CI: 95.3-98.6%) for the HEART pathway, respectively. There were 15 false-negative cases with mADAPT, and 12 false-negative cases each for EDACS-ADP and HEART pathway.Conclusion: All three ADPs-mADAPT, EDACS-ADP, and HEART pathway-were similarly accurate in their discriminatory performance for the risk stratification of ED patients presenting with possible ACS when unstable angina was not included in the endpoint. The HEART pathway showed the best combination of sensitivity and proportion of patients that can be classified as safe for early discharge. However, when unstable angina was added to the endpoint, all three ADPs did not show appropriate safety levels and their performances were lower than the acceptable risk of MACE. [ABSTRACT FROM AUTHOR]

Objective To investigate the changes of short-time heart rate variability (HRV) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), and to discuss the value of HRV indexes in predicting their short-term prognosis. Methods We selected 76 patients who had undergone PCI therapy. They were grouped by the presence or absence of major adverse cardiac events (MACE) within 6 months after PCI. Those patients without MACE were classified into the control group (55 cases) while those with MACE were set as the research group (21 cases). HRV linear indexes of SDNN, rMSSD, LF and HF, and HRV nonlinear indexes of approximate entropy (ApEn), sample entropy (SampEn) and Poincaré scatterplot indexes of SD1 and SD2 were compared between the two groups after PCI. Changes of HRV indexes before and after PCI were compared. Coronary artery Gensini scoring was performed in all the patients. Correlation analysis was made between coronary artery Gensini score and HRV indexes after PCI. Following up for half a year, we explored the risk factors of MACE by binary Logistic linear regression of the incidence of MACE and HRV indexes. Results In the research group SDNN, LF and SD2 are significantly increased compared with those in the control group (P < 0. 05) while rMSSD and SD1 are significantly decreased ( P < 0. 05 ); HF, ApEn and SampEn do not vary sig nificantly from those in the control group (P > 0. 05). The indexes of SDNN, rMSSD, LF, HF, SD1 and SD2 after PCI are all significantly lower than those before PCI (P < 0. 05) while ApEn and SampEn show no significant difference before and after PCI (P > 0. 05). Pearson correlation analysis shows that coronary artery Gensini score of patients is unrelated to SDNN, rMSSD, LF, HF, SD1, SD2 and ApEn (P > 0. 05). Binary Logistic regression analysis reveals that LF and SD2 are risk factors of MACE (P < 0. 05). Conclusion Autonomic modulation is improved in ACS patients after PCI. HRV indexes of LF and SD2 could effectively reflect the short-term prognosis after operation. [ABSTRACT FROM AUTHOR]

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Abstract Background COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes. Methods We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January–February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January–February 2020; Group 2, n = 124). Results For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p

We introduced an adapted Lyman normal-tissue complication probability (NTCP) model, incorporating clinical risk factors and censored time-to-event data, to estimate the risk of major adverse cardiac events (MACE) following left breast cancer radiotherapy (RT). Clinical characteristics and MACE data of 1100 women with left-side breast cancer receiving postoperative RT from 2005 to 2017 were retrospectively collected. A modified generalized Lyman NTCP model based on the individual left ventricle (LV) equivalent uniform dose (EUD), accounting for clinical risk factors and censored data, was developed using maximum likelihood estimation. Subgroup analysis was performed for low-comorbidity and high-comorbidity groups. Over a median follow-up 7.8 years, 64 patients experienced MACE, with higher mean LV dose in affected individuals (4.1 Gy vs. 2.9 Gy). The full model accounting for clinical factors identified D 50 = 43.3 Gy, m = 0.59, and n = 0.78 as the best-fit parameters. The threshold dose causing a 50 % probability of MACE was lower in the high-comorbidity group (D 50 = 30 Gy) compared to the low-comorbidity group (D 50 = 45 Gy). Predictions indicated that restricting LV EUD below 5 Gy yielded a 10-year relative MACE risk less than 1.3 and 1.5 for high-comorbidity and low-comorbidity groups, respectively. Patients with comorbidities are more susceptible to cardiac events following breast RT. The proposed modified generalized Lyman model considers nondosimetric risk factors and addresses incomplete follow-up for late complications, offering comprehensive and individualized MACE risk estimates post-RT. • We retrospectively investigated major adverse cardiac events (MACE) for left breast cancer patients post-RT. • A total of 64 MACE developed in 1100 patients with median follow-up 7.8 years. • We proposed a Lyman NTCP model based on patient's left ventricle DVH, incorporating clinical risk factors and time-to-event data. • The best-fit values for the proposed Lyman NTCP model parameters are D 50 = 43.3 Gy, m = 0.59, and n = 0.78. • Patients with comorbidities are more susceptible to cardiac injury following breast RT. [ABSTRACT FROM AUTHOR]

This is an observational, retrospective, single-center study aimed to determine whether the free triiodothyronine (FT3) to free thyroxine (FT4) ratio was related to acute myocardial infarction (AMI) prognosis in individuals with type 2 diabetes mellitus (T2DM). A total of 294 euthyroid T2DM patients with new-onset AMI were enrolled. FT3/FT4 ratio tertiles were used to categorize patients into Group 1 (FT3/FT4 ≥ 4.3), Group 2 (3.5 ≤ FT3/FT4 < 4.3), and Group 3 (FT3/FT4 < 3.5). Major adverse cardiac events (MACE), including nonfatal myocardial infarction, target vessel revascularization (TVR), and cardiac mortality, served as the primary endpoint. Group 3 demonstrated a considerably higher incidence of MACE than the other two groups over the average follow-up duration of 21 ± 6.5 months (all p < 0.001). Multivariable Cox regression analysis showed that a low FT3/FT4 ratio was an independent risk factor for MACE after AMI (Group 1 as a reference; Group 2: hazard ratio [HR] 1.275, 95% confidence interval [CI]: 0.563–2.889, p = 0.561; Group 3: HR 2.456, 95% CI: 1.105–5.459, p = 0.027). Moreover, the area under the receiver-operating characteristic curve (AUC) indicates a good predictive value of FT3/FT4 ratio for MACE (AUC = 0.70). Therefore, in T2DM patients with AMI, a low FT3/FT4 ratio was strongly linked to poor prognosis. [ABSTRACT FROM AUTHOR]

Cardiac screening using coronary computed tomography angiography (CCTA) in kidney transplant candidates before transplantation yields both diagnostic and prognostic information. Whether CT-derived fractional flow reserve (FFR CT) analysis provides prognostic information is unknown. This study aimed to assess the prognostic value of FFR CT for predicting major adverse cardiac events (MACE) and all-cause mortality in kidney transplant candidates. Among 553 consecutive kidney transplant candidates, 340 CCTA scans (61%) were evaluated with FFR CT analysis. Patients were categorized into groups based on lowest distal FFR CT ; normal >0.80, intermediate 0.80–0.76, and low ≤0.75. In patients with ≥50% stenosis, a lesion-specific FFR CT was defined as; normal >0.80 and abnormal ≤0.80. The primary endpoint was MACE (cardiac death, resuscitated cardiac arrest, myocardial infarction or revascularization). The secondary endpoint was all-cause mortality. Median follow-up was 3.3 years [2.0–5.1]. MACE occurred in 28 patients (8.2%), 29 patients (8.5%) died. When adjusting for risk factors and transplantation during follow-up, MACE occurred more frequently in patients with distal FFR CT ≤0.75 compared to patients with distal FFR CT >0.80: Hazard Ratio (HR): 3.8 (95%CI: 1.5–9.7), p ​< ​0.01. In the lesion-specific analysis with <50% stenosis as reference, patients with lesion-specific FFR CT >0.80 had a HR for MACE of 1.5 (95%CI: 0.4–4.8), p ​= ​0.55 while patients with lesion-specific FFR CT ≤0.80 had a HR of 6.0 (95%CI: 2.5–14.4), p ​< ​0.01. Abnormal FFR CT values were not associated with increased mortality. In kidney transplant candidates, abnormal FFR CT values were associated with increased MACE but not mortality. Use of FFR CT may improve cardiac evaluation prior to transplantation. [Display omitted] [ABSTRACT FROM AUTHOR]

Aims: Pericoronary adipose tissue (PCAT) attenuation obtained by coronary computed tomography angiography (CCTA) has been associated with coronary inflammation and outcomes. Whether PCAT attenuation is predictive of major adverse cardiac events (MACE) during long-term follow-up is unknown., Methods and Results: Symptomatic patients with coronary artery disease (CAD) who underwent CCTA were included, and clinical outcomes were evaluated. PCAT was measured at all lesions for all three major coronary arteries using semi-automated software. A comparison between patients with and without MACE was made on both a per-lesion and a per-patient level. The predictive value of PCAT attenuation for MACE was assessed in Cox regression models. In 483 patients (63.3 ± 8.5 years, 54.9% men), 1561 lesions were analysed over a median follow-up duration of 9.5 years. The mean PCAT attenuation was not significantly different between patients with and without MACE. At a per-patient level, the adjusted hazard ratio (HR) and 95% confidence interval (CI) for MACE were 0.970 (95% CI: 0.933-1.008, P = 0.121) when the average of all lesions per patient was analysed, 0.992 (95% CI: 0.961-1.024, P = 0.622) when only the most obstructive lesion was evaluated, and 0.981 (95% CI: 0.946-1.016, P = 0.285) when only the lesion with the highest PCAT attenuation per individual was evaluated. Adjusted HRs for vessel-specific PCAT attenuation in the right coronary artery, left anterior descending artery, and left circumflex artery were 0.957 (95% CI: 0.830-1.104, P = 0.548), 0.989 (95% CI: 0.954-1.025, P = 0.550), and 0.739 (95% CI: 0.293-1.865, P = 0.522), respectively, in predicting long-term MACE., Conclusion: In patients referred to CCTA for clinically suspected CAD, PCAT attenuation did not predict MACE during long-term follow-up., Competing Interests: Conflict of interest: The Department of Cardiology of Leiden University Medical Center received research grants from Abbott Vascular, Bayer, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. J.J.B. received speaker fees from Abbott Vascular, Edwards Lifesciences, and Omron. J.W.J. received research grants from and/or was speaker (with or without lecture fees) on a.o.(CME accredited) meetings sponsored by Amarin, Amgen, Athera, Biotronik, Boston Scientific, Dalcor, Daiichi Sankyo, Lilly, Medtronic, Merck-Schering-Plough, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi Aventis, the Netherlands Heart Foundation, CardioVascular Research the Netherlands (CVON), the Netherlands Heart Institute, and the European Community Framework KP7 Programme. J.K. received consultancy fees from GE Healthcare and Synektik Pharma and speaker fees from GE Healthcare, Bayer, Lundbeck, Boehringer-Ingelheim, Pfizer, and Merck, outside of the submitted work. A.S. received consultancy fees from Astra Zeneca and Pfizer and speaker fees from Abbott, Astra Zeneca, BMS, Janssen, Novartis, and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background Acute coronary syndrome (ACS) is a result of the interplay between genetic and environmental risk factors. A unique cytokine macrophage migration inhibitory factor (MIF), expressed by inflammatory cells, acts via a cluster of differentiation 74 (CD74) and a cluster of differentiation 44 (CD44) receptors, leading to the recruitment of mononuclear neutrophils and lymphocytes. This cascade results in exaggerated inflammation and atherosclerosis. MIF's distinctive characteristics and functions make it an essential target for achieving therapeutic atherosclerosis regression, setting it apart from other cytokines. Hence, this study aims to detect the MIF gene polymorphism in ACS patients and to assess the incidence of in-hospital major adverse cardiac events (MACE). Methodology This study was conducted in a tertiary care hospital. A total of 90 patients who had ACS were enrolled, of which 83 were included, and seven patients were excluded based on exclusion criteria (four cases of old myocardial infarction, two cases of valvular heart disease, and one case of dilated cardiomyopathy). After detailed clinical examination, laboratory evaluation, and genetic test, patients were divided into two groups based on MIF gene mutation. Five patients who had positive MIF gene mutation were termed as group A (n=5), and 78 patients with negative MIF gene mutation were termed as group B (n=78). The statistical analysis for the collected data was done using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, USA). Results Out of the 83 patients in this study, the male gender was predominant; there were three male patients in group A (n=3; 60%) and 48 male patients in group B (n=48; 61.5%). The most common age group was between 60 and 69 years; two of five patients (n=2; 40%) in group A and 30 out of 78 patients (n=30; 38.4%) in group B belonged to this age group. The common symptom was chest pain present in five patients in group A (n=5; 100%) and 76 patients (n=76; 97.5%) in group B. A common risk factor in group A patients was tobacco chewing, seen in three patients (n=3; 60%), and group B smoking was the most common risk factor seen in 30 patients (n=30; 38.5%). The most common ECG finding in group A was ST-elevation myocardial infarction (STEMI), seen in three patients (n=3; 60%), and in group B, the commonest ECG finding was non-ST-elevation myocardial infarction (NSTEMI) seen in 23 patients (n=23; 29.5%). The most common MACE was heart failure seen in two patients in group A (n=2; 40%) and in 50 patients in group B (n=50; 64.1%), followed by arrhythmias seen in one patient in group A (n=1; 20%), and eight patients in group B (n=8; 10.3%). Conclusion This study demonstrated a significant positive association between MIF gene polymorphism and the occurrence of cardiovascular events like myocardial infarction, with a statistically significant p-value (p=0.001). This study showed the presence of the disease in young age groups and individuals without conventional risk factors, underscoring the importance of genetic studies. Genetic risk factors independently contribute to the pathophysiology of coronary artery disease; hence, understanding the mechanisms of these genes and incorporating genetic testing into standard clinical practice can help future research to develop therapeutic agents that can specifically target these genes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee BLDE (Deemed to Be University) issued approval BLDE(DU)/IEC/748/2022-23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, M J et al.)

Objective: To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG)., Method: A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up., Results: About 66.6 % patients were treated on the native vessel, and 24.2 % on grafts vessel. In all, 360 stents [83.3 % drug-eluting stent (DES) and 16.6 % bare metal stent (BMS)] were implanted. Diabetes mellitus (p = 0.03), LVEF<55 % for PCI (p = 0.04), stent type [BMS (p < 0.001) and DES (p < 0.001)] and chronic kidney disease [(CKD) p < 0.01] were appeared to be the significant predictors of mortality. Age at CABG>50 years (p = 0.04), stent type [BMS (p = 0.03) and DES (p < 0.01)] and CKD (p < 0.01) as independent predictors for MACE. Higher event rate was reported in graft-vessel PCI group as compared to native-vessel PCI group: ISR (p < 0.01), TLR (p = 0.01), mortality (p = 0.04), MACE (p < 0.01) and MI (p = 0.05). Mortality (p < 0.001), MACE (p < 0.001) and MI (p < 0.001) were significantly lower in DES vs. BMS groups., Conclusion: Native-vessel PCI was associated with better clinical outcomes than graft-vessel PCI that also with the use of DES as the first choice in patients with a history of CABG., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier, a division of RELX India, Pvt. Ltd.)

Background: Several studies have reported that NFKB1 gene rs28362491 polymorphism was associated with susceptibility to coronary heart disease in populations of different genetic backgrounds. To date, there have been no studies on the association between NFKB1 gene rs28362491 polymorphism and the occurrence of major adverse cardiac and cerebrovascular event (MACCE). The present study was to explore the relationship between NFKB1 gene rs28362491 polymorphism and MACCEs to investigate whether identifying NFKB1 gene polymorphism is beneficial to evaluating MACCE risks and patients' prognoses.Methods: We recruited 257 high-risk of cardiovascular disease patients with chest pain or precordial discomfort. The SNPscan™ were used to analyze the NFKB1 gene rs28362491 polymorphism. All patients were followed up in the clinic or by telephone interview for MACCEs.Results: During the followed-up time (mean: 30.1 months) 49 patients had MACCEs (19.1%). Patients with the different genotypes of NFKB1 rs28362491 had different incidence rate of MACCE. The incidence of MACCE in patients carried II, ID and DD genotype was 16.5%, 15.9%, 32.6%, respectively. Log-rank analysis showed that the survival rate in patients with NFKB1 rs28362491 DD genotype was much lower than that in II or ID genotype carriers (P = 0.034). After excluding the influence of traditional risk factors of MACCEs, Cox regression showed that the DD genotype carriers had 2.294-fold relative risk of MACCEs comparing with patients carried II or ID genotype.Conclusion: The NFKB1 gene rs28362491 mutant was an independent predictor of worse long-term prognosis for MACCEs. Therefore, identifying NFKB1 gene rs28362491 mutant may be used as a good way for guiding the standardized management of patients with high-risk of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

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Background: Myocardial perfusion imaging (MPI) is the method most commonly used to assess patients with suspected coronary artery disease for the presence of myocardial ischemia and risk of subsequent adverse cardiac events. Studies are limited on the incidence of major adverse cardiac event (MACE) in patients with normal MPI results. Purpose: The aim of this study was to investigate the incidence and risk factors of MACE in patients with normal or near-normal MPI results. Method: In this single-center retrospective chart review study, patients who had received MPI tests at a nuclear medicine department of a medical center in 2017 were consecutively enrolled. All of the participants in this study were patients with normal or near-normal MPI results, and were followed for two years to assess the incidence of MACE (death, hospitalized for percutaneous coronary intervention; CABG, heart failure and stroke). Participants with or without MACE were compared to determine whether demographic, comorbidity, and MPI data were significant risk factors. Results: Of the 1,629 participants (age = 70.4 ± 11.3 years, 49.4% male) enrolled, 387 (23.8%) were classified into the normal MPI group and 1,242 (76.2%) were classified into the near-normal MPI group. Notably, 61 participants (15.8%) in the normal MPI group and 206 (16.6%) in the near-normal MPI group experienced MACE events during the twoyear follow-up. The risk factors of MACE identified in this study included being older in age, being male, and having poor myocardial perfusion parameters (i.e., ejection fraction) during MPI. Conclusions/Implications for Practice: Over the two-year study period, 15.8% of the participants with normal MPI results and 16.6% of those with near-normal MPI results experienced major adverse cardiac events. Thus, it is critical to inform patients regarding the potential risk of MACE risk and to educate them on how to mitigate this risk by actively managing their hyperlipidemia level and left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]

The relationship between 24-h urinary phosphorus excretion (24 h UPE) and cardiovascular disease in patients with pre-dialysis chronic kidney disease (CKD) has rarely been studied, despite the fact that the relationship between serum phosphorus level and the risk of a cardiovascular event is well established. A total of 1701 patients with pre-dialysis CKD were finally included for the analyses and were divided into tertiles by 24 h UPE (first tertile (T1, 349.557 (mean) ± 88.413 (standard deviation)), second tertile (T2, 557.530 ± 50.738), and third tertile (T3, 851.695 ± 171.593). The study outcome was a six-point major adverse cardiac event (MACE). The median follow-up duration was 7.992 years. Kaplan–Meier curve analysis visualized that the cumulative incidences of a six-point MACE (p = 0.029) significantly differed from 24 h UPE levels, as the incidence rate of the study outcomes was highest in T1 and lowest in T3. Cox proportional hazard models unveiled that, compared to T1, the risk of a six-point MACE was significantly decreased in T3 (adjusted hazard ratio (HR) 0.376, 95% confidence interval (CI) 0.207 to 0.683). The restricted cubic spline curve analysis visualized an inverted S-shaped association between 24 h UPE level and the risk of a six-point MACE, indicating a significantly increased risk of a six-point MACE in patients with a low 24 h UPE level. In conclusion, low 24 h UPE is associated with adverse cardiovascular outcomes in patients with CKD. Our finding emphasizes that low 24 h UPE should not be a reliable marker for dietary restriction of phosphorus that essentially leads to better outcomes in patients with CKD.

Background: COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes.Methods: We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January-February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January-February 2020; Group 2, n = 124).Results: For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p < 0.05). Primary percutaneous intervention was performed significantly more often in Group 1 patients than in Group 2 patients, whereas thrombolytic therapy was used significantly more often in Group 2 patients than in Group 1 patients (all p < 0.05). However, the rates of and all-cause 30-day mortality and major adverse cardiac event (MACE) were not significantly different in the two periods (all p > 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p < 0.05). All-cause 30-day mortality and MACE were only higher in NSTEMI patients during the COVID-19 pandemic period (p < 0.001).Conclusions: COVID-19 pandemic causes treatment delay in AMI patients and potentially leads to poor clinical outcome in NSTEMI patients. Thrombolytic therapy should be initiated without delay for STEMI when coronary intervention is not readily available; for NSTEMI patients, outcomes of invasive reperfusion were better than medical treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Due to the limited number of studies with long term follow-up of patients undergoing Percutaneous Coronary Intervention (PCI), we investigated the occurrence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) during 10 years of follow-up after coronary angioplasty using Random Survival Forest (RSF) and Cox proportional hazards models. Methods The current retrospective cohort study was performed on 220 patients (69 women and 151 men) undergoing coronary angioplasty from March 2009 to March 2012 in Farchshian Medical Center in Hamadan city, Iran. Survival time (month) as the response variable was considered from the date of angioplasty to the main endpoint or the end of the follow-up period (September 2019). To identify the factors influencing the occurrence of MACCE, the performance of Cox and RSF models were investigated in terms of C index, Integrated Brier Score (IBS) and prediction error criteria. Results Ninety-six patients (43.7%) experienced MACCE by the end of the follow-up period, and the median survival time was estimated to be 98 months. Survival decreased from 99% during the first year to 39% at 10 years' follow-up. By applying the Cox model, the predictors were identified as follows: age (HR = 1.03, 95% CI 1.01–1.05), diabetes (HR = 2.17, 95% CI 1.29–3.66), smoking (HR = 2.41, 95% CI 1.46–3.98), and stent length (HR = 1.74, 95% CI 1.11–2.75). The predictive performance was slightly better by the RSF model (IBS of 0.124 vs. 0.135, C index of 0.648 vs. 0.626 and out-of-bag error rate of 0.352 vs. 0.374 for RSF). In addition to age, diabetes, smoking, and stent length, RSF also included coronary artery disease (acute or chronic) and hyperlipidemia as the most important variables. Conclusion Machine-learning prediction models such as RSF showed better performance than the Cox proportional hazards model for the prediction of MACCE during long-term follow-up after PCI.

AbstractAims To evaluate risk factors for major adverse cardiac event (MACE) after the first acute coronary syndrome (ACS) and to examine the prevalence of risk factors in post-ACS patients.Methods We used Finnish population-based myocardial infarction register, FINAMI, data from years 1993–2011 to identify survivors of first ACS (n = 12686), who were then followed up for recurrent events and all-cause mortality for three years. Finnish FINRISK risk factor surveys were used to determine the prevalence of risk factors (smoking, hyperlipidaemia, diabetes and blood pressure) in post-ACS patients (n = 199).Results Of the first ACS survivors, 48.4% had MACE within three years of their primary event, 17.0% were fatal. Diabetes (p = 4.4 × 10−7), heart failure (HF) during the first ACS attack hospitalization (p = 6.8 × 10−15), higher Charlson index (p = 1.56 × 10−19) and older age (p = .026) were associated with elevated risk for MACE in the three-year follow-up, and revascularization (p = .0036) was associated with reduced risk. Risk factor analyses showed that 23% of ACS survivors continued smoking and cholesterol levels were still high (>5mmol/l) in 24% although 86% of the patients were taking lipid lowering medication.Conclusion Diabetes, higher Charlson index and HF are the most important risk factors of MACE after the first ACS. Cardiovascular risk factor levels were still high among survivors of first ACS.

Background: Growth Differentiation Factor-15 (GDF-15) has emerged as a biomarker that capable to predicting cardiovascular events. Recent studies suggest that GDF-15 is elevated in patients with acute myocardial infarction (AMI), but the prognostic remains incompletely defined. This study aimed to investigate the role of GDF-15 levels with major cardiac adverse events (MACE) on three months follow up in patients with AMI. Methods: This cohort study was conducted from November 2020 until May 2021 at Dr. Moewardi Hospital. GDF-15 was measured at admission, clinical data was collected and 3 months follow up events was registered. Prognostic value of GDF-15 and hazard ratio between high and low GDF-15 level were analyzed. Results: A total of 64 AMI patients were included in this study. MACE at three months follow-up occurred in 26.5% of patients. In multivariate analysis, GDF-15 was independently associated with risk of MACE at 3 months follow up (OR 1.501; p = 0.003). The cut-off point value of GDF-15 was analyzed with the ROC curve, obtained 2256 pg/mL which has a sensitivity of 94.1% and a specificity of 73.8% (area under the curve (AUC) 86.2%; 95% CI 0.768-0.956). Risk model with Kapplan Meier showed significant association between high GDF-15 levels (≥ 2256 pg/mL) and the incidence of MACE at 3 months follow up (HR 12.029; 95% CI 3.429- 42.197; p