Coronary artery disease最新文献

Background: The Geriatric Nutritional Risk Index (GNRI), derived from serum albumin levels and body weight relative to ideal body weight, is a novel tool for assessing nutritional status. This meta-analysis explored the association between GNRI and the clinical outcomes in patients with acute coronary syndrome (ACS).

Methods: We systematically searched PubMed, Embase, and Web of Science for studies evaluating the GNRI in patients with ACS. Inclusion criteria were observational studies reporting all-cause mortality or major adverse cardiovascular events (MACEs) among ACS patients categorized by low versus normal GNRI. Data extraction and quality assessment were independently performed by two authors, utilizing a random-effects model to account for potential heterogeneity.

Results: Eleven cohort studies, encompassing 18 616 patients with ACS, were included. A low GNRI was associated with significantly increased risks of all-cause mortality (RR, 1.95; 95% CI, 1.63-2.34; P < 0.001; I² = 32%) and MACEs (RR, 1.93; 95% CI, 1.62-2.29; P < 0.001; I² = 25%). Subgroup analyses for the all-cause mortality outcome showed consistent findings across varied study designs, patient demographics, and follow-up periods (P for subgroup differences all >0.05). Sensitivity analyses conducted by sequentially excluding individual studies confirmed the stability of these results.

Conclusion: A low GNRI at the time of admission is a significant predictor of increased all-cause mortality and MACEs in patients with ACS.

Background: Minimally invasive coronary artery bypass grafting (MICS-CABG) is frequently used for coronary revascularization, but the comparison of long-term clinical results with percutaneous coronary intervention (PCI) in left main disease (LMDs) remains unclear. The present study sought to determine the long-term outcomes of MICS-CABG and PCI in patients with LMDs.

Methods: A total of 551 consecutive patients [man: 457 (82.9%), mean age: 60.70 ± 9.54 years] who underwent PCI or MICS-CABG for LMDs were included. The primary endpoint was defined as the all-cause death during follow-up. The secondary endpoint defined as the major cardiovascular and cerebral events (MACCE) included cardiac death, myocardial infarction, target vessel revascularization, stroke, and stent thrombosis or graft occlusion. Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the long-term outcomes of MICS-CABG and PCI in patients with LMDs.

Results: The initial revascularization strategy was MICS-CABG in 269 (48.8%) cases and PCI in 282 (51.2%) patients. The SYNTAX scores (31.25 ± 4.63 vs. 26.05 ± 5.9, P < 0.001) were notably higher in the MICS-CABG group than in the PCI group. The incidence of long-term mortality (11 vs. 5.6%, P = 0.022) and MACCE (22 vs. 15.2%, P = 0.042) were notably higher in the PCI group than in the MICS-CABG group. The long-term mortality [adjusted HR (IPW) = 6.38 (95% CI, 3.00-13.57), P < 0.001] and MACCE [adjusted HR (IPW) = 4.51 (95% CI, 2.90-7.03), P < 0.001] in the overall population significantly differed between the PCI group and the MICS-CABG group.

Conclusion: The present study suggests that MICS-CABG for LMDs was associated with lower long-term mortality and MACCE rates than PCI.

Objectives: Contemporary studies assessing the importance of the systemic immune-inflammation index (SII) in older patients presenting with acute coronary syndrome (ACS) are scarce. This study investigated the impact and prognostic value of the SII regarding long-term mortality in older patients with ACS.

Methods: The study included 401 older patients aged 75 years and above admitted with ACS between May 2015 and December 2022. Predictors of mortality were determined using multivariate Cox regression analysis. Survival curves were generated using the Kaplan-Meier method.

Results: The patients' median age was 81 (77-85) years, and 197 (49.1%) were male. The median follow-up was 23 months (Q1-Q3 : 4-43, maximum: 102). All short- and long-term deaths, including in-hospital deaths, were significantly high in patients with high SII (P = 0.001). Inflammatory variables, including C-reactive protein, SII, the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio, were positively correlated with the SYNTAX score (for SII; R = 0.492, P = 0.001). Multivariate Cox regression analysis revealed that age [hazard ratio (HR): 1.082, 95% confidence interval (CI): 1.051-1.114, P = 0.001], estimated glomerular filtration rate (HR: 0.988, 95% CI: 0.982-0.994, P = 0.001), SII (HR: 1.004, 95% CI: 1.001-1.006, P = 0.001), and left ventricular ejection fraction (HR: 0.959, 95% CI: 0.947-0.97, P = 0.001) were independent predictors of mortality in older patients with ACS. Kaplan-Meier analysis also showed that patients with high SII had a significantly higher mortality rate (P = 0.001).

Conclusion: A high SII is an independent predictor of long-term mortality in older patients with ACS.

Background: Non-ST-segment elevation myocardial infarction (NSTEMI) is an entity which was defined as a type of a coronary syndrome with positive cardiac biomarker of myocardial necrosis with no ST-segment elevation in ECG. Currently, the centers for Medicare and Medicaid services (CMS) Hospital readmission reduction program assistance risk-adjusted 30-day readmission rates for five major clinical entities which includes acute myocardial infarction.

Methods: We performed this retrospective study to look into the current burden and predictors of NSTEMI readmission. Data were obtained from the Nationwide Readmission Database for the year 2020. We analyzed data on hospital readmission of 336 620 adults who were admitted for NSTEMI.

Results: The 30-day readmission rate was 13.5% with NSTEMI being the most common cause of readmission. Mortality was higher in readmitted patients compared to index admission (5.4 vs 3.6%, P  = 0.000). Higher risk of readmission was associated with female sex, higher Charlson comorbidity index, and longer length of stay. Lower risk of admission was seen in patients from smaller communities, patients who underwent percutaneous coronary intervention, and discharged to rehabilitation facilities.

Conclusion: Although we found an improvement in readmission rates compared to prior studies, about 13% of patients continue to get readmitted within 30 days causing significant cost to the healthcare system and often these patients have worse outcomes. We need continuing large-scale studies to identify quality measures to prevent readmission, improve mortality during readmission, and make better use of financial resources.

Background: The HALP score, measured based on hemoglobin, albumin, lymphocyte, and platelet levels, is regarded as a novel scoring system that indicates the status of systemic inflammation and nutritional health. Our study aimed to evaluate the relationship between HALP score and prognosis in non-ST-elevation myocardial infarction (NSTEMI) patients.

Methods: Between 1 January 2020 and 1 January 2022, 568 consecutive patients diagnosed with NSTEMI from a single center were included in the study retrospectively. The patients were divided into two equal groups according to the median HALP cutoff value of 44.05. Patients were followed for at least 1 year from the date of admission.

Results: The average age of the patients was 62.3 ± 10.6 years and 43.7% were female. In-hospital and 1-year mortality were found to be significantly higher in the group with low HALP scores (6.0 vs. 2.1%, P  = 0.019 and 22.5 vs. 9.9%, P  < 0.001, respectively). In receiver operating characteristic curve analysis, a cutoff level of 34.6 of the HALP score predicted 1-year mortality with 71% sensitivity and 65% specificity (area under the curve: 0.707, 95% confidence interval: 0.651-0.762, P  < 0.001). In Kaplan-Meier analysis, higher mortality rates were observed over time in the group with lower HALP scores (log-rank test=16.767, P  < 0.001). In Cox regression analysis, the HALP score was found to be an independent predictor of 1-year mortality (odds ratio: 0.969, 95% confidence interval: 0.958-0.981, P  < 0.001).

Conclusion: We found that a low HALP score could predict in-hospital and 1-year mortality in patients admitted to the hospital with a diagnosis of NSTEMI.

Background: Nonagenarians are a fast-growing age group among acute coronary syndrome (ACS) patients. While new therapeutic options have improved outcomes of ACS patients, data regarding very elderly ACS patients are limited. We aimed to evaluate temporal trends in the treatment and outcomes of nonagenarian ACS patients.

Methods: Included were ACS patients aged below 90 years enrolled in ACS Israeli Survey. Patients were divided into two groups according to enrolment period: early (2000-2010) and recent (2012-2021). The primary endpoints were 30-day major adverse cardiovascular events and all-cause mortality. Secondary outcomes included in-hospital and 1-year all-cause mortality.

Results: Included were 316 elderly ACS patients. Of them, 184 were enrolled in the early and 132 in recent surveys. Patients enrolled in the recent period were more commonly referred for an invasive strategy and more commonly received guideline-based medical therapy. All-cause mortality at 30 days was significantly lower in the recent group compared with the early group (12.5 and 26.1%, respectively, P  = 0.005). Rates of 30-day major adverse cardiovascular events were also significantly lower in the recent group (21.9 and 35.9%, respectively, P  = 0.012). Patients in the recent group received more aggressive medical therapy in discharge but at 30-day follow-up, no difference in medical treatment was observed in the two groups. There were no significant differences in 1-year mortality rates.

Conclusions: Treatment of nonagenarians with ACS has improved over the past decade. Treatment improvement was associated with a significant improvement in 30-day outcomes without any effect in 1 year. Nevertheless, even with contemporary treatment, nonagenarians with ACS remain a high-risk group with high mortality rates.