Luca Cumitini, Ailia Giubertoni, Lidia Rossi, Domenico D'Amario, Leonardo Grisafi, Paola Abbiati, Fabrizio D'Ascenzo, Gaetano Maria De Ferrari, Giuseppe Patti
Background
The PRAISE (PRedicting with Artificial Intelligence riSk aftEr acute coronary syndrome) score is a machine learning-based model for predicting 1-year adverse cardiovascular or bleeding events in patients with acute coronary syndrome (ACS). Its role in predicting arrhythmic complications in ACS remains unknown.
Methods
Atrial fibrillation (AF) and ventricular arrhythmias (VA) were recorded by continuous electrocardiographic monitoring until discharge in a cohort of 365 participants with ACS prospectively enrolled. We considered two separate timeframes for VA occurrence: ≤ 48 and > 48 h. The objective was to evaluate the ability of the PRAISE score to identify ACS patients at higher risk of in-hospital arrhythmic complications.
Results
ROC curve analysis indicated a significant association between PRAISE score and risk of both AF (AUC 0.89, p = 0.0001; optimal cut-off 5.77%) and VA (AUC 0.69, p = 0.0001; optimal cut-off 2.17%). Based on these thresholds, high/low AF PRAISE score groups and high/low VA PRAISE score groups were created, respectively. Patients with a high AF PRAISE score more frequently developed in-hospital AF (19% vs. 1%). Multivariate analysis showed a high AF PRAISE score risk as an independent predictor of AF (HR 4.30, p = 0.016). Patients with high VA PRAISE scores more frequently developed in-hospital VA (25% vs. 8% for VA ≤ 48 h; 33% vs. 3% for VA > 48 h). Multivariate analysis demonstrated a high VA PRAISE score risk as an independent predictor of both VA ≤ 48 h (HR 2.48, p = 0.032) and VA > 48 h (HR 4.93, p = 0.014).
Conclusion
The PRAISE score has a comprehensive ability to identify with high specificity those patients at risk for arrhythmic events during hospitalization for ACS.
背景：PRAISE（人工智能预测急性冠脉综合征后风险）评分是一种基于机器学习的模型，用于预测急性冠脉综合征（ACS）患者1年内的不良心血管或出血事件。它在预测ACS的心律失常并发症中的作用尚不清楚。方法：前瞻性纳入365例ACS患者，通过连续心电图监测记录房颤（AF）和室性心律失常（VA）直至出院。我们考虑了两个独立的VA发生时间框架：≤48小时和bb0 48小时。目的是评估PRAISE评分识别院内心律失常并发症高风险ACS患者的能力。结果：ROC曲线分析显示，PRAISE评分与两种AF的风险均有显著相关性(AUC 0.89, p = 0.0001；最佳临界值5.77%)和VA (AUC 0.69, p = 0.0001；最佳截止点2.17%)。根据这些阈值，分别创建高/低AF PRAISE评分组和高/低VA PRAISE评分组。房颤PRAISE评分高的患者更容易发生院内房颤（19%对1%）。多因素分析显示，高AF PRAISE评分风险是AF的独立预测因子（HR 4.30, p = 0.016）。VA PRAISE评分高的患者更容易发生院内VA (25% vs. VA≤48 h的患者为8%；33% vs. 3% VA bb0（48小时）。多因素分析表明，VA PRAISE评分高的风险是VA≤48 h （HR 2.48, p = 0.032）和VA bb0 48 h （HR 4.93, p = 0.014）的独立预测因子。结论：PRAISE评分对ACS住院期间存在心律失常风险的患者具有综合、高特异性的识别能力。
{"title":"Stratification of Early Arrhythmic Risk in Patients Admitted for Acute Coronary Syndrome: The Role of the Machine Learning-Derived “PRAISE Score”","authors":"Luca Cumitini, Ailia Giubertoni, Lidia Rossi, Domenico D'Amario, Leonardo Grisafi, Paola Abbiati, Fabrizio D'Ascenzo, Gaetano Maria De Ferrari, Giuseppe Patti","doi":"10.1002/clc.70035","DOIUrl":"10.1002/clc.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The PRAISE (PRedicting with Artificial Intelligence riSk aftEr acute coronary syndrome) score is a machine learning-based model for predicting 1-year adverse cardiovascular or bleeding events in patients with acute coronary syndrome (ACS). Its role in predicting arrhythmic complications in ACS remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) and ventricular arrhythmias (VA) were recorded by continuous electrocardiographic monitoring until discharge in a cohort of 365 participants with ACS prospectively enrolled. We considered two separate timeframes for VA occurrence: ≤ 48 and > 48 h. The objective was to evaluate the ability of the PRAISE score to identify ACS patients at higher risk of in-hospital arrhythmic complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ROC curve analysis indicated a significant association between PRAISE score and risk of both AF (AUC 0.89, <i>p</i> = 0.0001; optimal cut-off 5.77%) and VA (AUC 0.69, <i>p</i> = 0.0001; optimal cut-off 2.17%). Based on these thresholds, high/low AF PRAISE score groups and high/low VA PRAISE score groups were created, respectively. Patients with a high AF PRAISE score more frequently developed in-hospital AF (19% vs. 1%). Multivariate analysis showed a high AF PRAISE score risk as an independent predictor of AF (HR 4.30, <i>p</i> = 0.016). Patients with high VA PRAISE scores more frequently developed in-hospital VA (25% vs. 8% for VA ≤ 48 h; 33% vs. 3% for VA > 48 h). Multivariate analysis demonstrated a high VA PRAISE score risk as an independent predictor of both VA ≤ 48 h (HR 2.48, <i>p</i> = 0.032) and VA > 48 h (HR 4.93, <i>p</i> = 0.014).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The PRAISE score has a comprehensive ability to identify with high specificity those patients at risk for arrhythmic events during hospitalization for ACS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ho Sung Jeon, Young Jin Youn, Jung-Hee Lee, Young Jun Park, Jung-Woo Son, Jun-Won Lee, Min-Soo Ahn, Sung Gyun Ahn, Jang-Young Kim, Byung-Su Yoo, Junghan Yoon
Background
The Orsiro and Genoss DES stents are biodegradable polymer drug-eluting stents (DESs) with ultrathin struts.
Objective
To investigate the safety and efficacy of these two ultrathin DESs in real-world practice.
Methods
From a single-center prospective registry, we included 751 and 931 patients treated with the Genoss DES and Orsiro stents, respectively. After propensity score matching, we compared 483 patients in each group with respect to a device-oriented composite outcome (DOCO), which comprised cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularization up to 2 follow-up years.
Results
After propensity score matching, there were no significant between-group differences in clinical and angiographic characteristics. During the median follow-up period of 730 days (interquartile range, 427–730 days), there was no significant between-group difference in the DOCO rate (3.1% in the Genoss DES group vs. 2.9% in the Orsiro group, log-rank p = 0.847).
Conclusions
This study demonstrated comparable safety and efficacy between the Orsiro and Genoss DES stents during a 2-year follow-up period in real-world practice. However, this result should be confirmed in a large randomized controlled trial.
Trial Registration
ClinicalTrials.gov Identifier: NCT02038127.
背景：Orsiro和geness DES支架是具有超薄支架的可生物降解聚合物药物洗脱支架（DESs）。目的：探讨两种超薄DESs在实际应用中的安全性和有效性。方法：从单中心前瞻性登记中，我们分别纳入了751例和931例接受geness DES和Orsiro支架治疗的患者。在倾向评分匹配后，我们比较了每组483例患者的器械导向复合结局（DOCO），包括心脏性死亡、靶血管心肌梗死和临床指示的靶病变血运重建术，随访时间长达2年。结果：倾向评分匹配后，两组患者的临床和血管造影特征无显著差异。在中位随访期730天（四分位间距427-730天），DOCO率组间无显著差异（geness DES组3.1% vs Orsiro组2.9%,log-rank p = 0.847）。结论：该研究在现实世界实践的2年随访期间证明Orsiro和geness DES支架的安全性和有效性相当。然而，这一结果需要在大型随机对照试验中得到证实。试验注册：ClinicalTrials.gov标识符：NCT02038127。
{"title":"Safety and Efficacy of Two Ultrathin Biodegradable Polymer Sirolimus-Eluting Stents in Real-World Practice: Genoss DES Stents Versus Orsiro Stents From a Prospective Registry","authors":"Ho Sung Jeon, Young Jin Youn, Jung-Hee Lee, Young Jun Park, Jung-Woo Son, Jun-Won Lee, Min-Soo Ahn, Sung Gyun Ahn, Jang-Young Kim, Byung-Su Yoo, Junghan Yoon","doi":"10.1002/clc.70060","DOIUrl":"10.1002/clc.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Orsiro and Genoss DES stents are biodegradable polymer drug-eluting stents (DESs) with ultrathin struts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the safety and efficacy of these two ultrathin DESs in real-world practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From a single-center prospective registry, we included 751 and 931 patients treated with the Genoss DES and Orsiro stents, respectively. After propensity score matching, we compared 483 patients in each group with respect to a device-oriented composite outcome (DOCO), which comprised cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularization up to 2 follow-up years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After propensity score matching, there were no significant between-group differences in clinical and angiographic characteristics. During the median follow-up period of 730 days (interquartile range, 427–730 days), there was no significant between-group difference in the DOCO rate (3.1% in the Genoss DES group vs. 2.9% in the Orsiro group, log-rank <i>p</i> = 0.847).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated comparable safety and efficacy between the Orsiro and Genoss DES stents during a 2-year follow-up period in real-world practice. However, this result should be confirmed in a large randomized controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov Identifier: NCT02038127.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Should we rely on anticoagulation monitoring in ECMO patients or simply flip a coin? The increasing use of anti-factor Xa activity to monitor the effect of UFH appears appropriate, given its moderate correlation with the UFH infusion rates, and it may play a role in preventing thromboembolic events. However, to avoid bleeding complications, more sophisticated tools, and careful clinical decision-making remain essential.
{"title":"Anticoagulation Monitoring During ECMO Support: Monitor or Flip a Coin?","authors":"Sasa Rajsic, Benedikt Treml","doi":"10.1002/clc.70061","DOIUrl":"10.1002/clc.70061","url":null,"abstract":"<p>Should we rely on anticoagulation monitoring in ECMO patients or simply flip a coin? The increasing use of anti-factor Xa activity to monitor the effect of UFH appears appropriate, given its moderate correlation with the UFH infusion rates, and it may play a role in preventing thromboembolic events. However, to avoid bleeding complications, more sophisticated tools, and careful clinical decision-making remain essential.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ty J. Gluckman, Shih-Ting Chiu, Deanna Rider, Pu-kai Tseng, James O. Mudd, Joshua D. Remick, Craig Granowitz, Amy Carroll, Slaven Sikirica, Mario E. Canonico, Judith Hsia, Marc P. Bonaca
Introduction
While left ventricular ejection fraction (LVEF) represents an important means by which to classify patients with heart failure (HF), relatively little is known about the distribution of LVEFs among patients hospitalized for HF based on their International Classification of Disease (ICD)-10 code.
Methods
We performed a retrospective cross-sectional analysis of patients admitted to a large integrated health system within the western US between January 1, 2018 and October 1, 2022 with a principal diagnosis of HF (defined by ICD-10 codes: I50.2, systolic HF; I50.3, diastolic HF; I50.4, combined systolic and diastolic HF; I11.0, hypertensive heart disease with HF; and I13.0 and I13.2, hypertensive heart disease with HF and chronic kidney disease).
Results
Over nearly 5 years, 61,238 HF hospitalizations occurred, of which 49,772 (81%) had a LVEF available by echocardiography within the preceding 3 months. Whereas most patients hospitalized with systolic HF (n = 2220) as well as systolic and diastolic heart failure (n = 1582) had an LVEF ≤ 40% (86.2% and 74.8%, respectively), most patients hospitalized with diastolic HF (n = 1542) had an LVEF ≥ 50% (94.0%) (Figure). A much greater range of LVEFs were noted for those with hypertensive heart disease with HF (n = 18,092) and hypertensive heart disease with HF and CKD (n = 26,336) (Figure).
Conclusion
While there was relatively good concordance between LVEF and the ICD-10 code-defined HF type for systolic HF, diastolic HF, and systolic and diastolic HF, these codes represent a small subset (~10%) of total HF hospitalizations.
{"title":"Relationship Between Left Ventricular Ejection Fraction and ICD-10 Codes Among Patients Hospitalized With Heart Failure","authors":"Ty J. Gluckman, Shih-Ting Chiu, Deanna Rider, Pu-kai Tseng, James O. Mudd, Joshua D. Remick, Craig Granowitz, Amy Carroll, Slaven Sikirica, Mario E. Canonico, Judith Hsia, Marc P. Bonaca","doi":"10.1002/clc.70055","DOIUrl":"10.1002/clc.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While left ventricular ejection fraction (LVEF) represents an important means by which to classify patients with heart failure (HF), relatively little is known about the distribution of LVEFs among patients hospitalized for HF based on their International Classification of Disease (ICD)-10 code.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cross-sectional analysis of patients admitted to a large integrated health system within the western US between January 1, 2018 and October 1, 2022 with a principal diagnosis of HF (defined by ICD-10 codes: I50.2, systolic HF; I50.3, diastolic HF; I50.4, combined systolic and diastolic HF; I11.0, hypertensive heart disease with HF; and I13.0 and I13.2, hypertensive heart disease with HF and chronic kidney disease).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over nearly 5 years, 61,238 HF hospitalizations occurred, of which 49,772 (81%) had a LVEF available by echocardiography within the preceding 3 months. Whereas most patients hospitalized with systolic HF (<i>n</i> = 2220) as well as systolic and diastolic heart failure (<i>n</i> = 1582) had an LVEF ≤ 40% (86.2% and 74.8%, respectively), most patients hospitalized with diastolic HF (<i>n</i> = 1542) had an LVEF ≥ 50% (94.0%) (Figure). A much greater range of LVEFs were noted for those with hypertensive heart disease with HF (<i>n</i> = 18,092) and hypertensive heart disease with HF and CKD (<i>n</i> = 26,336) (Figure).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While there was relatively good concordance between LVEF and the ICD-10 code-defined HF type for systolic HF, diastolic HF, and systolic and diastolic HF, these codes represent a small subset (~10%) of total HF hospitalizations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Owais Ahmad, Hanzala Ahmed Farooqi, Isra Ahmed, Adeena Jamil, Rayyan Nabi, Irfan Ullah, Abdul Wali Khan, Raheel Ahmed, Mahboob Alam, Bernardo Cortese, Mamas A. Mamas
Aims
Atrial Fibrillation (AF) is one of the most strongly associated risk factors for stroke. Our study aims to analyze changes in mortality from 1999 to 2020 in patients with AF and stroke.
Methods
Using the Centre for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER), we retrospectively analyzed annual age-adjusted mortality rates (AAMR) per million from 1999 to 2020 in stroke patients with AF. Temporal trends were analyzed, and Annual Percentage Change (APC) was calculated using the JoinPoint regression model across variations in demographics (sex, race) and regional subgroups.
Results
Around 490 000 deaths were reported between 1999 and 2020 from stroke and AF across the 25–85+ age group. AAMR initially decreased until 2008 (APC = –0.9), followed by an increase till 2020 (APC = 1.1). Women had a higher AAMR than men throughout the years. Non-Hispanic white patients had a marginally higher AAMR than all other races and ethnicities. The highest AAMR was observed in the western region. States like Vermont, Oregon, Washington, Alaska, Minnesota, and West Virginia were in the top 90th percentile, while Nevada, Louisiana, Florida, New York, New Mexico, and Arizona were in the bottom 10th percentile. Nonmetropolitan areas had consistently higher AAMRs throughout the 2 decades.
Conclusion
An overall rise in mortality has been observed in stroke and AF patients, with a greater surge in 2019. The need for healthcare policy changes, especially in areas with high mortality and awareness of healthier lifestyle factors, can be an essential preventative measure to help mitigate growing mortality rates.
{"title":"Temporal Trends in Mortality Related to Stroke and Atrial Fibrillation in the United States: A 21-Year Retrospective Analysis of CDC-WONDER Database","authors":"Owais Ahmad, Hanzala Ahmed Farooqi, Isra Ahmed, Adeena Jamil, Rayyan Nabi, Irfan Ullah, Abdul Wali Khan, Raheel Ahmed, Mahboob Alam, Bernardo Cortese, Mamas A. Mamas","doi":"10.1002/clc.70058","DOIUrl":"10.1002/clc.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Atrial Fibrillation (AF) is one of the most strongly associated risk factors for stroke. Our study aims to analyze changes in mortality from 1999 to 2020 in patients with AF and stroke.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Centre for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER), we retrospectively analyzed annual age-adjusted mortality rates (AAMR) per million from 1999 to 2020 in stroke patients with AF. Temporal trends were analyzed, and Annual Percentage Change (APC) was calculated using the JoinPoint regression model across variations in demographics (sex, race) and regional subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Around 490 000 deaths were reported between 1999 and 2020 from stroke and AF across the 25–85+ age group. AAMR initially decreased until 2008 (APC = –0.9), followed by an increase till 2020 (APC = 1.1). Women had a higher AAMR than men throughout the years. Non-Hispanic white patients had a marginally higher AAMR than all other races and ethnicities. The highest AAMR was observed in the western region. States like Vermont, Oregon, Washington, Alaska, Minnesota, and West Virginia were in the top 90th percentile, while Nevada, Louisiana, Florida, New York, New Mexico, and Arizona were in the bottom 10th percentile. Nonmetropolitan areas had consistently higher AAMRs throughout the 2 decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An overall rise in mortality has been observed in stroke and AF patients, with a greater surge in 2019. The need for healthcare policy changes, especially in areas with high mortality and awareness of healthier lifestyle factors, can be an essential preventative measure to help mitigate growing mortality rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Runda Wu, Ya Su, Jianquan Liao, Juan Shen, Yuanji Ma, Wei Gao, Zheng Dong, Yuxiang Dai, Kang Yao, Junbo Ge
Aims
Despite the tremendous improvement in therapeutic medication and intervention for coronary atherosclerotic disease (CAD), residual risks remain. Exome sequencing enables identification of rare variants and susceptibility genes for residual risks of early-onset coronary atherosclerotic disease (EOCAD) with well-controlled conventional risk factors.
Methods
We performed whole-exome sequencing of subjects who had no conventional risk factors, defined as higher body mass index, smoking, hypertension and dyslipidemia, screened from 1950 patients with EOCAD (age ≤ 45 years, at least 50% stenosis of coronary artery by angiography), and selected control subjects from 1006 elder (age ≥ 65 years) with < 30% coronary stenosis. Gene-based association analysis and clinical phenotypic comparison were conducted.
Results
Subjects without defined conventional risk factors accounted for 4.72% of young patients. Totally, 6 genes might be associated with residual risk of EOCAD, namely CABP1 (OR = 22.19, p = 0.02), HLA-E (OR = 22.19, p = 0.02), TOE1 (OR = 33.6, p = 0.002), HPSE2 (OR = 11.1, p = 0.04), CHST14 (OR = 22.19, p = 0.02) as well as KLHL8 (OR = 22.19, p = 0.02). Phenotypic analysis displayed the levels of low-density lipoprotein cholesterol in carriers of mutations from CABP1, HLA-E, TOE1, and HPSE2 were significantly elevated compared to noncarriers. Notably, extracellular matrix-associated CHST14 and fibrinogen-associated KLHL8 both displayed possible correlation with increased neutrophil proportion and decreased monocyte percentage (both p < 0.05), exerting potential effects on the residual inflammatory risks of EOCAD.
Conclusion
The study identified six genes related to dyslipidemia and inflammation pathways with potential association with residual risk of EOCAD, which will contribute to precision-based prevention in these patients.
Trial Registration
The GRAND study was registered at www.clinicaltrials.gov on July 14, 2015, and the registry number is NCT 02496858.
目的：尽管冠状动脉粥样硬化疾病（CAD）的治疗药物和干预措施有了巨大的进步，但残留的风险仍然存在。外显子组测序能够识别具有良好控制的常规危险因素的早发性冠状动脉粥样硬化疾病（EOCAD）剩余风险的罕见变异和易感基因。方法：我们从1950例EOCAD患者（年龄≤45岁，冠状动脉造影至少50%狭窄）和1006例老年人（年龄≥65岁）中筛选无常规危险因素（定义为较高体重指数、吸烟、高血压和血脂异常）的受试者进行全外显子组测序。结果：未定义常规危险因素的受试者占年轻患者的4.72%。共有6个基因可能与EOCAD残留风险相关，分别是CABP1 （OR = 22.19, p = 0.02）、HLA-E （OR = 22.19, p = 0.02）、TOE1 （OR = 33.6, p = 0.002）、HPSE2 （OR = 11.1, p = 0.04）、CHST14 （OR = 22.19, p = 0.02）和KLHL8 （OR = 22.19, p = 0.02）。表型分析显示，与非携带者相比，CABP1、HLA-E、TOE1和HPSE2突变携带者的低密度脂蛋白胆固醇水平显著升高。值得注意的是，细胞外基质相关的CHST14和纤维蛋白原相关的KLHL8都显示出可能与中性粒细胞比例增加和单核细胞百分比下降相关（均为p）。结论：该研究确定了6个与血脂异常和炎症途径相关的基因，它们与EOCAD的残留风险有潜在的关联，这将有助于这些患者的精准预防。试验注册：GRAND研究于2015年7月14日在www.Clinicaltrials: gov注册，注册号为NCT02496858。
{"title":"Exome Sequencing Identified Susceptible Genes for High Residual Risks in Early-Onset Coronary Atherosclerotic Disease","authors":"Runda Wu, Ya Su, Jianquan Liao, Juan Shen, Yuanji Ma, Wei Gao, Zheng Dong, Yuxiang Dai, Kang Yao, Junbo Ge","doi":"10.1002/clc.70066","DOIUrl":"10.1002/clc.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Despite the tremendous improvement in therapeutic medication and intervention for coronary atherosclerotic disease (CAD), residual risks remain. Exome sequencing enables identification of rare variants and susceptibility genes for residual risks of early-onset coronary atherosclerotic disease (EOCAD) with well-controlled conventional risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed whole-exome sequencing of subjects who had no conventional risk factors, defined as higher body mass index, smoking, hypertension and dyslipidemia, screened from 1950 patients with EOCAD (age ≤ 45 years, at least 50% stenosis of coronary artery by angiography), and selected control subjects from 1006 elder (age ≥ 65 years) with < 30% coronary stenosis. Gene-based association analysis and clinical phenotypic comparison were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Subjects without defined conventional risk factors accounted for 4.72% of young patients. Totally, 6 genes might be associated with residual risk of EOCAD, namely <i>CABP1</i> (OR = 22.19, <i>p</i> = 0.02), <i>HLA-E</i> (OR = 22.19, <i>p</i> = 0.02), <i>TOE1</i> (OR = 33.6, <i>p</i> = 0.002), <i>HPSE2</i> (OR = 11.1, <i>p</i> = 0.04), <i>CHST14</i> (OR = 22.19, <i>p</i> = 0.02) as well as <i>KLHL8</i> (OR = 22.19, <i>p</i> = 0.02). Phenotypic analysis displayed the levels of low-density lipoprotein cholesterol in carriers of mutations from <i>CABP1</i>, <i>HLA-E</i>, <i>TOE1</i>, and <i>HPSE2</i> were significantly elevated compared to noncarriers. Notably, extracellular matrix-associated <i>CHST14</i> and fibrinogen-associated <i>KLHL8</i> both displayed possible correlation with increased neutrophil proportion and decreased monocyte percentage (both <i>p</i> < 0.05), exerting potential effects on the residual inflammatory risks of EOCAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study identified six genes related to dyslipidemia and inflammation pathways with potential association with residual risk of EOCAD, which will contribute to precision-based prevention in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The GRAND study was registered at www.clinicaltrials.gov on July 14, 2015, and the registry number is NCT 02496858.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Gotzmann MD, Marie Lewenhardt MD, Fabienne Kreimer MD
We would like to thank Naoya Kataoka and Teruhiko Imamura for their comments on our publication. While we strongly agree with some of their comments, we would like to take the opportunity to point out some aspects of our publication that may not have been described clearly enough.
We would like to clarify that in our study not only deceased patients with previous implantable cardioverter defibrillator (ICD) therapy were defined as patients with “benefit of ICD implantation,” but also patients with adequate ICD therapy who did not die during the observation period. In fact, of the 89 patients who received adequate ICD therapy, only 21 patients died during the study period.1 We would also like to point out that the investigation period of 4.2 years on average was not short. We therefore do not believe that an extended investigation period would have changed the results of the analysis.
In principle, however, we agree with Naoya Kataoka and Teruhiko Imamura on several points. The surgical risk and the risk of infection play a significant role in the risk-benefit assessment of device therapy. In our study, however, we limited ourselves to a few endpoints and focused in particular on the major endpoint “death from any cause.”
Another important aspect is that comorbidities have a significant impact on the benefit of ICD therapy. A younger multimorbid patient may have a worse prognosis than an older patient. Nonetheless, we believe that considering age when deciding whether ICD therapy is appropriate can be a very simple but important contribution. As the benefits of ICD therapy in older patients have been repeatedly questioned in the past, this is particularly important.2-4 At the same time, in an increasingly aging society, a considerable proportion of old and very old patients are treated with an ICD. In Germany and the United States, the proportion of patients over 80 years of age who receive an ICD for primary prophylactic indications is approximately 14%, without convincing data being available. Our study revealed that the benefit of ICD therapy in this patient group remains to be critically assessed.
In other words, comorbidities are undeniably important factors for the potential benefit of ICD therapy, but also age, so taking comorbidities into account could help to make a benefit-risk assessment before ICD implantation.
{"title":"Reply to “How to consider the indication of implantable cardioverter defibrillator in the elderly patients”","authors":"Michael Gotzmann MD, Marie Lewenhardt MD, Fabienne Kreimer MD","doi":"10.1002/clc.24208","DOIUrl":"10.1002/clc.24208","url":null,"abstract":"<p>We would like to thank Naoya Kataoka and Teruhiko Imamura for their comments on our publication. While we strongly agree with some of their comments, we would like to take the opportunity to point out some aspects of our publication that may not have been described clearly enough.</p><p>We would like to clarify that in our study not only deceased patients with previous implantable cardioverter defibrillator (ICD) therapy were defined as patients with “benefit of ICD implantation,” but also patients with adequate ICD therapy who did not die during the observation period. In fact, of the 89 patients who received adequate ICD therapy, only 21 patients died during the study period.<span><sup>1</sup></span> We would also like to point out that the investigation period of 4.2 years on average was not short. We therefore do not believe that an extended investigation period would have changed the results of the analysis.</p><p>In principle, however, we agree with Naoya Kataoka and Teruhiko Imamura on several points. The surgical risk and the risk of infection play a significant role in the risk-benefit assessment of device therapy. In our study, however, we limited ourselves to a few endpoints and focused in particular on the major endpoint “death from any cause.”</p><p>Another important aspect is that comorbidities have a significant impact on the benefit of ICD therapy. A younger multimorbid patient may have a worse prognosis than an older patient. Nonetheless, we believe that considering age when deciding whether ICD therapy is appropriate can be a very simple but important contribution. As the benefits of ICD therapy in older patients have been repeatedly questioned in the past, this is particularly important.<span><sup>2-4</sup></span> At the same time, in an increasingly aging society, a considerable proportion of old and very old patients are treated with an ICD. In Germany and the United States, the proportion of patients over 80 years of age who receive an ICD for primary prophylactic indications is approximately 14%, without convincing data being available. Our study revealed that the benefit of ICD therapy in this patient group remains to be critically assessed.</p><p>In other words, comorbidities are undeniably important factors for the potential benefit of ICD therapy, but also age, so taking comorbidities into account could help to make a benefit-risk assessment before ICD implantation.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psoriasis is a systemic inflammatory disease associated with elevated cardiovascular risk due to inflammatory and oxidative stress. Two-dimensional speckle-tracking echocardiography (2D-STE) can detect both regional and global myocardial strain. Impairment of ventricular strain can assist in the early detection of myocardial dysfunction. Subclinical myocardial dysfunction in psoriasis has not yet been elucidated with inconsistent results.
Methods
A systematic literature search of various databases was conducted to identify studies comparing global longitudinal strain (GLS) and global circumferential strain (GCS) between patients with psoriasis and healthy controls. Standardized mean differences (SMD) with 95% confidence intervals (CI) were pooled using the inverse-variance random-effects model in Review Manager Software Version 5.4.1.
Results
Eleven studies with 879 participants (501 patients with psoriasis and 378 healthy controls) were included. Psoriasis was associated with a statistically significant reduction in GLS [SMD: –1.04; 95% CI: –1.45, –0.62; p < 0.00001] and GCS [SMD: –0.66; 95% CI: –1.27, –0.05; p = 0.03] compared to healthy controls.
Conclusion
This study demonstrated that patients with psoriasis are at an elevated risk of subclinical myocardial dysfunction, as shown by the reduced GLS and GCS. Early assessment of subclinical impairment in psoriasis will allow targeted intervention and may mitigate future adverse cardiovascular events. Prospective studies with larger sample sizes are warranted to validate these results.
银屑病是一种全身性炎症性疾病，与炎症和氧化应激引起的心血管风险升高相关。二维斑点跟踪超声心动图（2D-STE）可以检测局部和全局心肌应变。心室应变损伤有助于早期发现心肌功能障碍。银屑病的亚临床心肌功能障碍尚未阐明，结果不一致。方法：系统检索各数据库的文献，比较银屑病患者与健康对照组的整体纵向应变（GLS）和整体圆周应变（GCS）。采用Review Manager Software Version 5.4.1中的反方差随机效应模型对95%置信区间（CI）的标准化平均差异（SMD）进行合并。结果：纳入了11项研究，共879名参与者（501名牛皮癣患者和378名健康对照）。牛皮癣与GLS降低有统计学意义相关[SMD: -1.04；95% ci: -1.45, -0.62；p结论：本研究表明银屑病患者亚临床心肌功能障碍的风险升高，GLS和GCS降低。早期评估牛皮癣的亚临床损害将允许有针对性的干预，并可能减轻未来的不良心血管事件。需要更大样本量的前瞻性研究来验证这些结果。
{"title":"Subclinical Myocardial Dysfunction Assessment Using Speckle Tracking Echocardiography in Patients With Psoriasis: A Pilot Meta-Analysis","authors":"Hritvik Jain, Jyoti Jain, Debankur Dey, Rishika Modi, Omar Alomari, Mushood Ahmed, Jagjot Singh, Ramez M. Odat, Raheel Ahmed, Abdulqadir J. Nashwan","doi":"10.1002/clc.70047","DOIUrl":"10.1002/clc.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Psoriasis is a systemic inflammatory disease associated with elevated cardiovascular risk due to inflammatory and oxidative stress. Two-dimensional speckle-tracking echocardiography (2D-STE) can detect both regional and global myocardial strain. Impairment of ventricular strain can assist in the early detection of myocardial dysfunction. Subclinical myocardial dysfunction in psoriasis has not yet been elucidated with inconsistent results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search of various databases was conducted to identify studies comparing global longitudinal strain (GLS) and global circumferential strain (GCS) between patients with psoriasis and healthy controls. Standardized mean differences (SMD) with 95% confidence intervals (CI) were pooled using the inverse-variance random-effects model in Review Manager Software Version 5.4.1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven studies with 879 participants (501 patients with psoriasis and 378 healthy controls) were included. Psoriasis was associated with a statistically significant reduction in GLS [SMD: –1.04; 95% CI: –1.45, –0.62; <i>p</i> < 0.00001] and GCS [SMD: –0.66; 95% CI: –1.27, –0.05; <i>p</i> = 0.03] compared to healthy controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated that patients with psoriasis are at an elevated risk of subclinical myocardial dysfunction, as shown by the reduced GLS and GCS. Early assessment of subclinical impairment in psoriasis will allow targeted intervention and may mitigate future adverse cardiovascular events. Prospective studies with larger sample sizes are warranted to validate these results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dhanunjaya Lakkireddy, Dominick J. Angiolillo, Kristofer Charlton-Ouw, Brian Jefferson, Syed Peeran, Mohannad Bisharat, Luis Ortega-Paz, Ante Harxhi, Simrati Kaul, Evelyne Michaud, Stephanie Juan, Breeana Woods, CV Damaraju, Gregory Fontana, Marc P. Bonaca
Introduction
Coronary artery disease (CAD) and peripheral artery disease (PAD) increase the risks of cardiovascular events and death. Digital health technologies are rapidly expanding to improve healthcare quality and access. The Care4Today Connect (C4T CAD-PAD) mobile application is designed to help patients with CAD and/or PAD improve medication adherence, learn about their disease, make lifestyle modifications, and enhance healthcare provider (HCP) connection via an HCP-facing portal.
Hypothesis & Methods
The prospective, single-arm, multicenter, noninterventional iPACE-CVD (innovative Patient compAnion impaCting health outcomEs: a CardioVascular Digital health program) study (ClinicalTrials.gov identifier: NCT06052319) is evaluating engagement and usefulness of the application for patients with CAD and/or PAD in clinical settings. Application access is provided with a code from patients' HCPs. Key features include medication and health experience tracking. The application is available in English and Spanish and for iOS and Android devices. Engagement is defined as the proportion of patients who use the application for ≥ 10 weeks during the 3-month study period. Application use is defined as the number of patients using ≥ 1 application feature(s) each week. Usefulness is determined by the percentage of engaged patients who complete the My Feedback Matters survey with a satisfaction response score of > 2 (on a 5-point scale, where 1 = strongly disagree and 5 = strongly agree) for at least three of the six questions.
Results
A total of 271 participants were enrolled between November 29, 2023, and May 15, 2024. The study concluded on August 15, 2024.
Conclusion
This study will help enhance the application for subsequent studies. Trial Registration: NCT06052319
{"title":"Rationale and Design of a Study to Assess the Engagement and Usefulness of the Care4Today Connect Digital Health Application for Disease Management in Coronary Artery Disease and Peripheral Artery Disease (iPACE-CVD Study)","authors":"Dhanunjaya Lakkireddy, Dominick J. Angiolillo, Kristofer Charlton-Ouw, Brian Jefferson, Syed Peeran, Mohannad Bisharat, Luis Ortega-Paz, Ante Harxhi, Simrati Kaul, Evelyne Michaud, Stephanie Juan, Breeana Woods, CV Damaraju, Gregory Fontana, Marc P. Bonaca","doi":"10.1002/clc.70039","DOIUrl":"10.1002/clc.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) and peripheral artery disease (PAD) increase the risks of cardiovascular events and death. Digital health technologies are rapidly expanding to improve healthcare quality and access. The Care4Today Connect (C4T CAD-PAD) mobile application is designed to help patients with CAD and/or PAD improve medication adherence, learn about their disease, make lifestyle modifications, and enhance healthcare provider (HCP) connection via an HCP-facing portal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis & Methods</h3>\u0000 \u0000 <p>The prospective, single-arm, multicenter, noninterventional iPACE-CVD (innovative Patient compAnion impaCting health outcomEs: a CardioVascular Digital health program) study (ClinicalTrials.gov identifier: NCT06052319) is evaluating engagement and usefulness of the application for patients with CAD and/or PAD in clinical settings. Application access is provided with a code from patients' HCPs. Key features include medication and health experience tracking. The application is available in English and Spanish and for iOS and Android devices. Engagement is defined as the proportion of patients who use the application for ≥ 10 weeks during the 3-month study period. Application use is defined as the number of patients using ≥ 1 application feature(s) each week. Usefulness is determined by the percentage of engaged patients who complete the My Feedback Matters survey with a satisfaction response score of > 2 (on a 5-point scale, where 1 = <i>strongly disagree</i> and 5 = <i>strongly agree</i>) for at least three of the six questions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 271 participants were enrolled between November 29, 2023, and May 15, 2024. The study concluded on August 15, 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study will help enhance the application for subsequent studies. <b>Trial Registration:</b> NCT06052319</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rungroj Krittayaphong, Kasem Ratanasumawong, Komsing Methavigul, Chaiyasith Wongvipaporn, Gregory Y. H. Lip
Background
Specific risk predictor scores of intracranial hemorrhage (ICH) risk in Asian subjects are lacking. We determined the incidence rate and predictors of ICH in patients with non-valvular atrial fibrillation (AF).
Methods
A prospective nationwide registry of patients with AF was conducted from 27 hospitals in Thailand. The adjudicated primary outcome was the development of ICH during follow-up. Multivariable Cox proportional hazard model was performed to identify the independent predictors for ICH. A predictive model for ICH risk was developed and validated by bootstrap, calibration plot, C-statistics, and decision curve analysis using our own data.
Results
We studied a total of 3405 patients (mean age 67.8 years; 58.2% male) with an average follow-up duration of 31.8 ± 8.7 months, during which ICH developed in 70 patients (2.06%). The incidence rate of ICH was 0.78 (0.61−0.98) per 100 person-years. Predictors of ICH were chosen from the theory-driven approaches in combination with the results of the univariable analysis. The predictive risk model had a c-index of 0.717 (0.702−0.732) with good calibration, internal validation, and clinical usefulness using decision curve analysis. The probability of ICH at 3 years for an individual patient derived from the prediction model was compared with the probability derived from HAS-BLED score by using the C-statistics. The ICH probability from the COOL-AF model was superior to the HAS-BLED score in the prediction of ICH.
Conclusion
The incidence rate of ICH was 0.78 (0.61−0.98) per 100 person-years. Predictors of ICH were older age, male sex, nonsmoking, renal replacement therapy, and use of oral anticoagulants.
{"title":"Incidence Rate and Predictors of Intracranial Hemorrhage in Patients With Atrial Fibrillation: A Report From the Nationwide COOL-AF Registry","authors":"Rungroj Krittayaphong, Kasem Ratanasumawong, Komsing Methavigul, Chaiyasith Wongvipaporn, Gregory Y. H. Lip","doi":"10.1002/clc.70040","DOIUrl":"10.1002/clc.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Specific risk predictor scores of intracranial hemorrhage (ICH) risk in Asian subjects are lacking. We determined the incidence rate and predictors of ICH in patients with non-valvular atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective nationwide registry of patients with AF was conducted from 27 hospitals in Thailand. The adjudicated primary outcome was the development of ICH during follow-up. Multivariable Cox proportional hazard model was performed to identify the independent predictors for ICH. A predictive model for ICH risk was developed and validated by bootstrap, calibration plot, C-statistics, and decision curve analysis using our own data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We studied a total of 3405 patients (mean age 67.8 years; 58.2% male) with an average follow-up duration of 31.8 ± 8.7 months, during which ICH developed in 70 patients (2.06%). The incidence rate of ICH was 0.78 (0.61−0.98) per 100 person-years. Predictors of ICH were chosen from the theory-driven approaches in combination with the results of the univariable analysis. The predictive risk model had a c-index of 0.717 (0.702−0.732) with good calibration, internal validation, and clinical usefulness using decision curve analysis. The probability of ICH at 3 years for an individual patient derived from the prediction model was compared with the probability derived from HAS-BLED score by using the C-statistics. The ICH probability from the COOL-AF model was superior to the HAS-BLED score in the prediction of ICH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence rate of ICH was 0.78 (0.61−0.98) per 100 person-years. Predictors of ICH were older age, male sex, nonsmoking, renal replacement therapy, and use of oral anticoagulants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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