Background: Acute kidney injury (AKI) is a common complication of percutaneous coronary intervention (PCI) that has been associated with high morbidity and mortality in patients with STEMI. Acute tubular damage may be reflected by serum creatinine (Scr) values that do not meet the criteria for AKI.
Methods: This analysis included 19,424 patients from the Improving Care for Cardiovascular Disease in China, Acute Coronary Syndrome Project (n = 5,221 (36.8%), patients with a small increase in Scr within 48 h of hospitalization; n = 14,203 patients with no increase in Scr). The primary outcome was the incidence of major adverse cardiovascular events (MACE). Secondary outcomes included the incidence of massive hemorrhage, in-hospital death, atrial fibrillation, heart failure, cardiogenic shock, cardiac arrest, and stroke. Logistic regression analysis was used to evaluate associations between a small increase in Scr within 48 h of hospitalization (>0.1 to <0.3 mg/dl) and MACE or massive hemorrhage during hospitalization.
Results: Patients with a small increase in Scr within 48 h of hospitalization were significantly more likely to experience MACE (11.2% vs. 9.1%; P < 0.001) or massive hemorrhage (3.2% vs. 2.2%; P < 0.001) compared to patients with no increase in Scr, but there was no significant difference in in-hospital mortality (0.8% vs. 0.9%; P=0.301). Logistic regression analysis showed that a small increase in Scr within 48 h of hospital admission was a risk factor for MACE (OR, 1.168; 95% CI, 1.044-1.306; P=0.006) or massive hemorrhage (OR, 1.413; 95% CI, 1.164-1.715; P < 0.001). Other risk factors included age ˃65 years, history of heart failure, use of glycoprotein IIb/IIIa inhibitors, aspirin or ACEI/ARB, LVEF <40%, Killip class III-IV, and increased SBP and heart rate.
Conclusion: A small increase in Scr during hospitalization in patients with STEMI undergoing primary PCI that does not meet the criteria for AKI is a risk factor for in-hospital adverse outcomes. This effect is maintained in patients with normal Scr at hospitalization. Trial Registration. Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02306616.
背景:急性肾损伤(AKI)是经皮冠状动脉介入治疗(PCI)的常见并发症,与STEMI患者的高发病率和死亡率相关。急性肾小管损伤可通过血清肌酐(Scr)值反映出来,该值不符合AKI的诊断标准。方法:本分析纳入来自中国心血管疾病改善护理项目的19424例患者(n = 5221例(36.8%)),住院48 h内Scr小幅升高的患者;n = 14203例患者,Scr未增加)。主要终点是主要不良心血管事件(MACE)的发生率。次要结局包括大出血、院内死亡、心房颤动、心力衰竭、心源性休克、心脏骤停和中风的发生率。采用Logistic回归分析评估住院48小时内Scr小幅升高(>0.1)与结果之间的关联:住院48小时内Scr小幅升高的患者发生MACE的可能性显著增加(11.2% vs. 9.1%;P < 0.001)或大出血(3.2% vs. 2.2%;P < 0.001),但住院死亡率无显著差异(0.8% vs 0.9%;P = 0.301)。Logistic回归分析显示,入院48 h内Scr的小幅升高是发生MACE的危险因素(OR, 1.168;95% ci, 1.044-1.306;P=0.006)或大出血(or, 1.413;95% ci, 1.164-1.715;P < 0.001)。其他危险因素包括年龄≤65岁、心力衰竭史、使用糖蛋白IIb/IIIa抑制剂、阿司匹林或ACEI/ARB、LVEF。结论:不符合AKI标准的STEMI患者在住院期间Scr小幅升高是院内不良结局的危险因素。这种效果在住院时Scr正常的患者中保持。试验注册。临床试验注册:网址:https://www.clinicaltrials.gov。唯一标识符:NCT02306616。
{"title":"A Small Increase in Serum Creatinine within 48 h of Hospital Admission Is an Independent Predictor of In-Hospital Adverse Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Findings from the Improving Care for Cardiovascular Disease in the China Project.","authors":"Jiajia Zhu, Wenxian Liu, Jiang Li, Changsheng Ma, Dong Zhao","doi":"10.1155/2023/1374206","DOIUrl":"https://doi.org/10.1155/2023/1374206","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common complication of percutaneous coronary intervention (PCI) that has been associated with high morbidity and mortality in patients with STEMI. Acute tubular damage may be reflected by serum creatinine (Scr) values that do not meet the criteria for AKI.</p><p><strong>Methods: </strong>This analysis included 19,424 patients from the Improving Care for Cardiovascular Disease in China, Acute Coronary Syndrome Project (<i>n</i> = 5,221 (36.8%), patients with a small increase in Scr within 48 h of hospitalization; <i>n</i> = 14,203 patients with no increase in Scr). The primary outcome was the incidence of major adverse cardiovascular events (MACE). Secondary outcomes included the incidence of massive hemorrhage, in-hospital death, atrial fibrillation, heart failure, cardiogenic shock, cardiac arrest, and stroke. Logistic regression analysis was used to evaluate associations between a small increase in Scr within 48 h of hospitalization (>0.1 to <0.3 mg/dl) and MACE or massive hemorrhage during hospitalization.</p><p><strong>Results: </strong>Patients with a small increase in Scr within 48 h of hospitalization were significantly more likely to experience MACE (11.2% vs. 9.1%; <i>P</i> < 0.001) or massive hemorrhage (3.2% vs. 2.2%; <i>P</i> < 0.001) compared to patients with no increase in Scr, but there was no significant difference in in-hospital mortality (0.8% vs. 0.9%; <i>P</i>=0.301). Logistic regression analysis showed that a small increase in Scr within 48 h of hospital admission was a risk factor for MACE (OR, 1.168; 95% CI, 1.044-1.306; <i>P</i>=0.006) or massive hemorrhage (OR, 1.413; 95% CI, 1.164-1.715; <i>P</i> < 0.001). Other risk factors included age ˃65 years, history of heart failure, use of glycoprotein IIb/IIIa inhibitors, aspirin or ACEI/ARB, LVEF <40%, Killip class III-IV, and increased SBP and heart rate.</p><p><strong>Conclusion: </strong>A small increase in Scr during hospitalization in patients with STEMI undergoing primary PCI that does not meet the criteria for AKI is a risk factor for in-hospital adverse outcomes. This effect is maintained in patients with normal Scr at hospitalization. <i>Trial Registration</i>. Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02306616.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9272007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander Makkinejad, Bailey Brown, Rana-Armaghan Ahmad, Joanna Hua, Xiaoting Wu, Shinichi Fukuhara, Karen Kim, Himanshu Patel, G Michael Deeb, Bo Yang
Background: There are many variations in valve-sparing aortic root replacement techniques. Our aim is to determine the impact of the graft on mid-term outcomes: Valsalva graft vs. two straight tubular grafts.
Methods: From 2004 to 2020, 332 patients underwent valve-sparing aortic root replacement with either a Valsalva graft (Valsalva group: n = 270) or two straight tubular grafts (two-graft group: n = 62). Data were obtained through chart review and the National Death Index. Primary outcomes were mid-term survival and freedom from reoperation.
Results: The preoperative characteristics of the groups were similar, but the two-graft group had more type A dissections (32% vs. 19%) and emergent operations (26% vs. 15%) and was younger (45 vs. 50 years). Intraoperatively, the groups were similar, but the two-graft group had longer cross-clamp (245 vs. 215 minutes) and cardiopulmonary bypass times (284 vs. 255 minutes). Postoperative complications including reoperation for bleeding, stroke, pacemaker implantation, and renal failure were slightly more frequent in the Valsalva group, but the differences were not significant. Operative mortality was similar between the Valsalva and two-graft groups (0.7% vs. 0%). Five-year survival in the two-graft group was 100% compared to 96% in the Valsalva group (p=0.56). Five-year freedom from reoperation in the two-graft group was 100% compared to 93% in the Valsalva group (p=0.29).
Conclusions: The Valsalva and two-graft techniques both have excellent short- and mid-term outcomes. The two-graft technique might have slightly better survival and freedom from reoperation, but a larger sample size and longer follow-up are needed to determine if these advantages are significant.
背景:保留瓣膜的主动脉根部置换术有很多不同的方法。我们的目的是确定移植物对中期结果的影响:Valsalva移植物与两个直管移植物。方法:2004年至2020年,332例患者采用Valsalva移植物(Valsalva组:n = 270)或两个直管移植物(两个移植物组:n = 62)进行保留瓣膜的主动脉根置换术。数据通过图表审查和国家死亡指数获得。主要结局为中期生存和免于再手术。结果:两组术前特征相似,但两组有更多的A型夹层(32%比19%)和紧急手术(26%比15%),年龄更年轻(45比50岁)。术中,两组相似,但两组的交叉钳夹时间(245分钟对215分钟)和体外循环时间(284分钟对255分钟)更长。术后并发症包括出血再手术、卒中、起搏器植入和肾功能衰竭在Valsalva组稍高,但差异不显著。Valsalva组和双移植组的手术死亡率相似(0.7% vs 0%)。双移植组的5年生存率为100%,而Valsalva组为96% (p=0.56)。两组5年再手术自由度为100%,而Valsalva组为93% (p=0.29)。结论:Valsalva技术和双瓣移植技术均具有良好的中短期疗效。双移植物技术可能有稍好的存活率和免于再次手术的自由,但需要更大的样本量和更长的随访时间来确定这些优势是否显著。
{"title":"Valve-Sparing Aortic Root Replacement Technique: Valsalva Graft versus Two Straight Tubular Grafts.","authors":"Alexander Makkinejad, Bailey Brown, Rana-Armaghan Ahmad, Joanna Hua, Xiaoting Wu, Shinichi Fukuhara, Karen Kim, Himanshu Patel, G Michael Deeb, Bo Yang","doi":"10.1155/2023/4076881","DOIUrl":"https://doi.org/10.1155/2023/4076881","url":null,"abstract":"<p><strong>Background: </strong>There are many variations in valve-sparing aortic root replacement techniques. Our aim is to determine the impact of the graft on mid-term outcomes: Valsalva graft vs. two straight tubular grafts.</p><p><strong>Methods: </strong>From 2004 to 2020, 332 patients underwent valve-sparing aortic root replacement with either a Valsalva graft (Valsalva group: <i>n</i> = 270) or two straight tubular grafts (two-graft group: <i>n</i> = 62). Data were obtained through chart review and the National Death Index. Primary outcomes were mid-term survival and freedom from reoperation.</p><p><strong>Results: </strong>The preoperative characteristics of the groups were similar, but the two-graft group had more type A dissections (32% vs. 19%) and emergent operations (26% vs. 15%) and was younger (45 vs. 50 years). Intraoperatively, the groups were similar, but the two-graft group had longer cross-clamp (245 vs. 215 minutes) and cardiopulmonary bypass times (284 vs. 255 minutes). Postoperative complications including reoperation for bleeding, stroke, pacemaker implantation, and renal failure were slightly more frequent in the Valsalva group, but the differences were not significant. Operative mortality was similar between the Valsalva and two-graft groups (0.7% vs. 0%). Five-year survival in the two-graft group was 100% compared to 96% in the Valsalva group (<i>p</i>=0.56). Five-year freedom from reoperation in the two-graft group was 100% compared to 93% in the Valsalva group (<i>p</i>=0.29).</p><p><strong>Conclusions: </strong>The Valsalva and two-graft techniques both have excellent short- and mid-term outcomes. The two-graft technique might have slightly better survival and freedom from reoperation, but a larger sample size and longer follow-up are needed to determine if these advantages are significant.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9918367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10707873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-26eCollection Date: 2022-01-01DOI: 10.1155/2022/7869356
Ratko M Lasica, Jovan P Perunicic, Dejana R Popovic, Igor B Mrdovic, Ross A Arena, Nebojsa L Radovanovic, Mina R Radosavljevic-Radovanovic, Lazar D Djukanovic, Milika R Asanin
Background/aim: Despite technological advances in diagnosis and treatment, in-hospital mortality with acute aortic dissection type B is still about 11%. The purpose of this study was to assess the risk factors for early and long-term adverse outcomes in patients with acute aortic dissection type B treated medically or with conventional open surgery.
Methods: The present study included 104 consecutive patients with acute aortic dissection type B treated in our Center from January 1st, 1998 to January 1st, 2007. Patient demographic and clinical characteristics as well as in-hospital complications were reviewed. Univariate and multivariate testing was performed to identify the predictors of in-hospital (30-day) and late (within 9 years) mortality.
Results: 92 (88.5%) patients were treated medically, while 12 (11.5%) patients with complicated acute aortic dissection type B were treated by open surgical repair. In-hospital complications occurred in 35.7% patients, the most often being acute renal failure (28%), hypotension/shock (24%), mesenteric ischemia (12%), and limb ischemia (8%). The in-hospital mortality rate was 15.7% and the 9-year mortality rate was 51.9%. Independent predictors of early mortality in patients with acute aortic dissection type B were uncontrolled hypertension (HR-20.69) and a dissecting aorta diameter >4.75 cm (HR-6.30). Independent predictors of late mortality were relapsing pain (HR-7.93), uncontrolled hypertension (HR-7.25), and a pathologic difference in arterial blood pressure (>20 mmHg) (HR-5.33).
Conclusion: Knowledge of key risk factors may help with a better choice of treatment and mortality reduction in acute aortic dissection type B patients.
背景/目的:尽管诊断和治疗技术进步,急性B型主动脉夹层的住院死亡率仍约为11%。本研究的目的是评估药物治疗或常规开放手术治疗的急性B型主动脉夹层患者早期和长期不良结局的危险因素。方法:本研究纳入1998年1月1日至2007年1月1日在我中心连续治疗的104例急性B型主动脉夹层患者。回顾了患者人口统计学和临床特征以及院内并发症。进行单因素和多因素检验以确定住院(30天)和晚期(9年内)死亡率的预测因素。结果:92例(88.5%)患者经内科治疗,12例(11.5%)合并急性B型主动脉夹层行开放性手术修复。35.7%的患者出现院内并发症,最常见的是急性肾功能衰竭(28%)、低血压/休克(24%)、肠系膜缺血(12%)和肢体缺血(8%)。住院死亡率为15.7%,9年死亡率为51.9%。急性B型主动脉夹层患者早期死亡的独立预测因子是未控制的高血压(HR-20.69)和夹层主动脉直径>4.75 cm (HR-6.30)。晚期死亡的独立预测因子是复发性疼痛(HR-7.93)、未控制的高血压(HR-7.25)和动脉血压的病理差异(>20 mmHg) (HR-5.33)。结论:了解关键危险因素有助于更好地选择治疗方法,降低急性B型主动脉夹层患者的死亡率。
{"title":"Early and Late Mortality Predictors in Patients with Acute Aortic Dissection Type B.","authors":"Ratko M Lasica, Jovan P Perunicic, Dejana R Popovic, Igor B Mrdovic, Ross A Arena, Nebojsa L Radovanovic, Mina R Radosavljevic-Radovanovic, Lazar D Djukanovic, Milika R Asanin","doi":"10.1155/2022/7869356","DOIUrl":"https://doi.org/10.1155/2022/7869356","url":null,"abstract":"<p><strong>Background/aim: </strong>Despite technological advances in diagnosis and treatment, in-hospital mortality with acute aortic dissection type B is still about 11%. The purpose of this study was to assess the risk factors for early and long-term adverse outcomes in patients with acute aortic dissection type B treated medically or with conventional open surgery.</p><p><strong>Methods: </strong>The present study included 104 consecutive patients with acute aortic dissection type B treated in our Center from January 1<sup>st</sup>, 1998 to January 1<sup>st</sup>, 2007. Patient demographic and clinical characteristics as well as in-hospital complications were reviewed. Univariate and multivariate testing was performed to identify the predictors of in-hospital (30-day) and late (within 9 years) mortality.</p><p><strong>Results: </strong>92 (88.5%) patients were treated medically, while 12 (11.5%) patients with complicated acute aortic dissection type B were treated by open surgical repair. In-hospital complications occurred in 35.7% patients, the most often being acute renal failure (28%), hypotension/shock (24%), mesenteric ischemia (12%), and limb ischemia (8%). The in-hospital mortality rate was 15.7% and the 9-year mortality rate was 51.9%. Independent predictors of early mortality in patients with acute aortic dissection type B were uncontrolled hypertension (HR-20.69) and a dissecting aorta diameter >4.75 cm (HR-6.30). Independent predictors of late mortality were relapsing pain (HR-7.93), uncontrolled hypertension (HR-7.25), and a pathologic difference in arterial blood pressure (>20 mmHg) (HR-5.33).</p><p><strong>Conclusion: </strong>Knowledge of key risk factors may help with a better choice of treatment and mortality reduction in acute aortic dissection type B patients.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9719417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35349201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-09eCollection Date: 2022-01-01DOI: 10.1155/2022/2370802
Xiangyang Wu, Jie Zhu, Yong Mao, Xinqiang Guan, Xiaofeng He, Qi Ma, Xiaopeng Zhang, Shixiong Wang, Yongnan Li
Background: Myocardial bridging (MB) is a congenital anomaly involving the myocardial tissue encasement of a segment of the coronary artery. The purpose of the present study was to assess safety and efficacy of two surgical methods used for treating MB patients at our institute.
Methods: Off-pump MB unroofing was performed in 45 adult patients between January 2016 and December 2021 by traditional surgical unroofing techniques (conventional group, n = 26) and blunt dissection techniques (blunt dissection group, n = 19). We retrospectively reviewed our patients by examining the baseline clinical characteristics, risk factors, medications, and diagnostic data for coronary artery disease. The Seattle Angina Questionnaire (SAQ) was used to assess angina symptoms both preoperatively and 6 months postsurgery.
Results: No significant difference in preoperative clinical characteristics was observed between the two groups. The blunt dissection group had shorter unroofed period (14.69 vs. 18.91 mins, P=0.001), less ventilator time (16.26 vs. 24.62 hours, P < 0.001), and a shorter hospital stay (8.74 vs. 12.89 days, P < 0.001). Although both traditional and blunt dissection techniques significantly improved postoperative SAQ scores including physical limitation due to angina, anginal stability, anginal frequency, treatment satisfaction, and quality of life (P < 0.001), no significant difference was observed between the traditional and blunt dissection techniques for SAQ. No cases of left anterior descending (LAD) injury in the blunt dissection group were observed although seven patients in the conventional group had LAD injuries.
Conclusions: In our single-center experience of MB unroofing, the blunt dissection technique is a safe, effective technique that significantly reduces surgical and ventilator time and hospital stay. MB patients with severe angina who underwent the blunt dissection for surgical unroofing experienced significant improvements in anginal symptoms and quality of life six months after the surgery.
背景:心肌桥(MB)是一种先天性异常,涉及冠状动脉的一段心肌组织包裹。本研究的目的是评估两种手术方法治疗我院MB患者的安全性和有效性。方法:2016年1月至2021年12月,对45例成人患者采用传统手术去顶技术(常规组,n = 26)和钝性夹层技术(钝性夹层组,n = 19)进行非泵式MB去顶手术。我们通过检查冠状动脉疾病的基线临床特征、危险因素、药物和诊断数据对患者进行回顾性分析。采用西雅图心绞痛问卷(SAQ)评估术前和术后6个月的心绞痛症状。结果:两组患者术前临床特征无明显差异。钝性夹层组无顶时间较短(14.69 vs 18.91 min, P=0.001),呼吸机时间较短(16.26 vs 24.62 h, P < 0.001),住院时间较短(8.74 vs 12.89 d, P < 0.001)。尽管传统和钝性夹层技术均显著提高了术后SAQ评分,包括心绞痛引起的身体限制、心绞痛稳定性、心绞痛频率、治疗满意度和生活质量(P < 0.001),但传统和钝性夹层技术在SAQ方面无显著差异。钝性夹层组无左前降(LAD)损伤,常规组有7例左前降损伤。结论:在我们的单中心经验中,钝性剥离技术是一种安全有效的技术,可显着减少手术和呼吸机时间和住院时间。合并严重心绞痛的MB患者在接受钝性剥离手术后6个月心绞痛症状和生活质量显著改善。
{"title":"Use of Novel Blunt Dissection Technique for Surgical Unroofing in Myocardial Bridging Patients.","authors":"Xiangyang Wu, Jie Zhu, Yong Mao, Xinqiang Guan, Xiaofeng He, Qi Ma, Xiaopeng Zhang, Shixiong Wang, Yongnan Li","doi":"10.1155/2022/2370802","DOIUrl":"https://doi.org/10.1155/2022/2370802","url":null,"abstract":"<p><strong>Background: </strong>Myocardial bridging (MB) is a congenital anomaly involving the myocardial tissue encasement of a segment of the coronary artery. The purpose of the present study was to assess safety and efficacy of two surgical methods used for treating MB patients at our institute.</p><p><strong>Methods: </strong>Off-pump MB unroofing was performed in 45 adult patients between January 2016 and December 2021 by traditional surgical unroofing techniques (conventional group, <i>n</i> = 26) and blunt dissection techniques (blunt dissection group, <i>n</i> = 19). We retrospectively reviewed our patients by examining the baseline clinical characteristics, risk factors, medications, and diagnostic data for coronary artery disease. The Seattle Angina Questionnaire (SAQ) was used to assess angina symptoms both preoperatively and 6 months postsurgery.</p><p><strong>Results: </strong>No significant difference in preoperative clinical characteristics was observed between the two groups. The blunt dissection group had shorter unroofed period (14.69 vs. 18.91 mins, <i>P</i>=0.001), less ventilator time (16.26 vs. 24.62 hours, <i>P</i> < 0.001), and a shorter hospital stay (8.74 vs. 12.89 days, <i>P</i> < 0.001). Although both traditional and blunt dissection techniques significantly improved postoperative SAQ scores including physical limitation due to angina, anginal stability, anginal frequency, treatment satisfaction, and quality of life (<i>P</i> < 0.001), no significant difference was observed between the traditional and blunt dissection techniques for SAQ. No cases of left anterior descending (LAD) injury in the blunt dissection group were observed although seven patients in the conventional group had LAD injuries.</p><p><strong>Conclusions: </strong>In our single-center experience of MB unroofing, the blunt dissection technique is a safe, effective technique that significantly reduces surgical and ventilator time and hospital stay. MB patients with severe angina who underwent the blunt dissection for surgical unroofing experienced significant improvements in anginal symptoms and quality of life six months after the surgery.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40504181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Methods: A total of 197 patients (102 patients with CSF; 95 patients with normal coronary flow) were included in this retrospective study. Clinical and angiographic characteristics of patients were obtained from hospital records.
Results: Patients with CSF had higher SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and high-sensitivity C-reactive protein (hsCRP) levels compared with the control group. Body mass index (p=0.022, OR 1.151, 95% CI 1.121-1.299), low-density lipoprotein (p=0.018, OR 1.028, 95% CI 1.005-1.052), hsCRP (p=0.044, OR 1.161, 95% CI 1.004-1.343), and SII (p < 0.001, OR 1.015, 95% CI 1.003-1.026) were independent predictors of CSF in the multivariable analysis. The optimal cutoff value of SII in predicting CSF was >877 in ROC curve analysis (p < 0.001, AUC = 0.892, 95% CI 0.848-0.936). This cutoff value of SII predicted the CSF with a sensitivity of 71.5% and specificity of 92.4%. Spearman correlation analysis showed a positive correlation between the mean TFC value and PLR, NLR, hsCRP, and SII.
Conclusions: SII may be used as a better indicator for the prediction of CSF than hsCRP.
方法:共197例患者(脑脊液102例;95例冠状动脉血流正常的患者被纳入回顾性研究。患者的临床和血管造影特征从医院记录中获得。结果:脑脊液患者SII、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、高敏c反应蛋白(hsCRP)水平均高于对照组。在多变量分析中,体重指数(p=0.022, OR 1.151, 95% CI 1.121-1.299)、低密度脂蛋白(p=0.018, OR 1.028, 95% CI 1.005-1.052)、hsCRP (p=0.044, OR 1.161, 95% CI 1.004-1.343)和SII (p < 0.001, OR 1.015, 95% CI 1.003-1.026)是脑脊液的独立预测因子。ROC曲线分析SII预测CSF的最佳临界值>877 (p < 0.001, AUC = 0.892, 95% CI 0.848 ~ 0.936)。SII截断值预测脑脊液的敏感性为71.5%,特异性为92.4%。Spearman相关分析显示,TFC均值与PLR、NLR、hsCRP、SII呈正相关。结论:SII比hsCRP能更好地预测脑脊液的变化。
{"title":"The Systemic Immune-Inflammation Index May Predict the Coronary Slow Flow Better Than High-Sensitivity C-Reactive Protein in Patients Undergoing Elective Coronary Angiography.","authors":"Kurtulus Karauzum, Irem Karauzum, Kaan Hanci, Dogus Gokcek, Beyzanur Gunay, Hussain Bakhshian, Tayfun Sahin, Ertan Ural","doi":"10.1155/2022/7344639","DOIUrl":"https://doi.org/10.1155/2022/7344639","url":null,"abstract":"<p><strong>Methods: </strong>A total of 197 patients (102 patients with CSF; 95 patients with normal coronary flow) were included in this retrospective study. Clinical and angiographic characteristics of patients were obtained from hospital records.</p><p><strong>Results: </strong>Patients with CSF had higher SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and high-sensitivity C-reactive protein (hsCRP) levels compared with the control group. Body mass index (<i>p</i>=0.022, OR 1.151, 95% CI 1.121-1.299), low-density lipoprotein (<i>p</i>=0.018, OR 1.028, 95% CI 1.005-1.052), hsCRP (<i>p</i>=0.044, OR 1.161, 95% CI 1.004-1.343), and SII (<i>p</i> < 0.001, OR 1.015, 95% CI 1.003-1.026) were independent predictors of CSF in the multivariable analysis. The optimal cutoff value of SII in predicting CSF was >877 in ROC curve analysis (<i>p</i> < 0.001, AUC = 0.892, 95% CI 0.848-0.936). This cutoff value of SII predicted the CSF with a sensitivity of 71.5% and specificity of 92.4%. Spearman correlation analysis showed a positive correlation between the mean TFC value and PLR, NLR, hsCRP, and SII.</p><p><strong>Conclusions: </strong>SII may be used as a better indicator for the prediction of CSF than hsCRP.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40504179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-08eCollection Date: 2022-01-01DOI: 10.1155/2022/3972829
You Peng, Bin Liao, Yan Zhou, Wei Zeng, Zhi-Yu Zeng
Background: Ferroptosis plays a key role in cardiomyopathy. Atorvastatin (ATV) has a protective effect on ischemia-reperfusion (I/R) cardiomyopathy. The purpose of this study is to elucidate the mechanism of ATV in I/R injury.
Methods: H9C2 cells and cardiomyopathy rats were induced by hypoxia/reoxygenation (H/R) and I/R to construct in vitro and in vivo models. Cell viability was determined by CCK8. Cardiac histopathology was observed by HE staining. Transmission electron microscope (TEM) was used to observe the mitochondrial morphology. The reactive oxygen species (ROS) content in cells was analyzed by the biochemical method. ELISA was conducted to calculate the concentrations of total iron/Fe2+ and hepcidin. The expression of ferroptosis and SMAD pathway-related genes were detected by qPCR. Western blot was performed to detect the expression levels of ferroptosis and SMAD pathway-related proteins.
Results: In H9C2 cells, ATV reversed the decline in cell viability, mitochondrial shrinkage, and ROS elevation induced by erastin or H/R. The concentration of total iron and Fe2+ in H/R-induced H9C2 cells increased, and the protein expression of FPN1 decreased. After ATV treatment, the concentration of total iron and Fe2+ decreased, and the protein expression of FPN1 increased. The expression of the SMAD7 gene in H/R-induced H9C2 cells decreased, and the expression of the hepcidin gene increased, which were reversed by ATV. When SMAD7 was knocked down, ATV treatment failed to produce the above effect. ATV also improved ferroptosis in I/R rat myocardium through the SMAD7/hepcidin pathway.
Conclusions: ATV reversed the decline in H9C2 cell viability, mitochondrial shrinkage, and ROS elevation, and improved the myocardium ferroptosis through the SMAD7/hepcidin pathway in I/R rat.
{"title":"Atorvastatin Inhibits Ferroptosis of H9C2 Cells by regulatingSMAD7/Hepcidin Expression to Improve Ischemia-Reperfusion Injury.","authors":"You Peng, Bin Liao, Yan Zhou, Wei Zeng, Zhi-Yu Zeng","doi":"10.1155/2022/3972829","DOIUrl":"https://doi.org/10.1155/2022/3972829","url":null,"abstract":"<p><strong>Background: </strong>Ferroptosis plays a key role in cardiomyopathy. Atorvastatin (ATV) has a protective effect on ischemia-reperfusion (I/R) cardiomyopathy. The purpose of this study is to elucidate the mechanism of ATV in I/R injury.</p><p><strong>Methods: </strong>H9C2 cells and cardiomyopathy rats were induced by hypoxia/reoxygenation (H/R) and I/R to construct <i>in vitro</i> and <i>in vivo</i> models. Cell viability was determined by CCK8. Cardiac histopathology was observed by HE staining. Transmission electron microscope (TEM) was used to observe the mitochondrial morphology. The reactive oxygen species (ROS) content in cells was analyzed by the biochemical method. ELISA was conducted to calculate the concentrations of total iron/Fe<sup>2+</sup> and hepcidin. The expression of ferroptosis and SMAD pathway-related genes were detected by qPCR. Western blot was performed to detect the expression levels of ferroptosis and SMAD pathway-related proteins.</p><p><strong>Results: </strong>In H9C2 cells, ATV reversed the decline in cell viability, mitochondrial shrinkage, and ROS elevation induced by erastin or H/R. The concentration of total iron and Fe<sup>2+</sup> in H/R-induced H9C2 cells increased, and the protein expression of FPN1 decreased. After ATV treatment, the concentration of total iron and Fe<sup>2+</sup> decreased, and the protein expression of FPN1 increased. The expression of the SMAD7 gene in H/R-induced H9C2 cells decreased, and the expression of the hepcidin gene increased, which were reversed by ATV. When SMAD7 was knocked down, ATV treatment failed to produce the above effect. ATV also improved ferroptosis in I/R rat myocardium through the SMAD7/hepcidin pathway.</p><p><strong>Conclusions: </strong>ATV reversed the decline in H9C2 cell viability, mitochondrial shrinkage, and ROS elevation, and improved the myocardium ferroptosis through the SMAD7/hepcidin pathway in I/R rat.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9666047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40498280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The study aimed to investigate the incidence and influencing factors of heart failure after 5 years of percutaneous coronary intervention (PCI) for first acute myocardial infarction.
Methods: A total of 1235 patients, diagnosed as acute myocardial infarction and treated with PCI in Beijing Anzhen Hospital, Capital Medical University, from January 1, 2014, to December 31, 2014, were enrolled. Based on the exclusion criteria, 671 patients were followed up to obtain echocardiographic results 5 years after the onset of myocardial infarction (from January 1, 2019, to December 31, 2019). Of 671 patients, 62 were lost to follow-up. Finally, 609 patients were recruited in this study. According to the results of the echocardiographic examination, patients were divided into a heart failure group (n = 97) (LVEF < 50%) and a nonheart failure group (n = 512) (LVEF ≥ 50%). The clinical characteristics were compared between the two groups, and the influencing factors of heart failure after 5 years of PCI in patients with acute myocardial infarction were analyzed using logistic regression and receiver-operating characteristic (ROC) analyses.
Results: Of 609 patients, 97 had heart failure within 5 years after PCI for first myocardial infarction, with an incidence of 15.9%. Multivariate regression analysis finally examined the predictors related to the occurrence of heart failure, including age (aOR, 1.008; 95% confidence interval (CI), 1.054-1.123; P ≤ 0.001), peak troponin I level (aOR, 1.020; 95% CI, 1.006-1.034; P = 0.004), left ventricular ejection fraction (LVEF) (during admission) (aOR, 0.908; 95% CI, 0.862-0.956; P ≤ 0.001), and left ventricular end-diastolic dimension (LVEDD) (at admission) (aOR, 1.136; 95% CI, 1.016-1.271; P = 0.025).
Conclusion: In this study, the incidence of heart failure (LVEF < 50%) in patients with acute myocardial infarction who underwent PCI was 15.9% at a five-year follow up. Age, peak troponin I level, and LVEDD (at admission) were risk factors for heart failure, while LVEF (at admission) of patients during hospitalization was a protective factor for heart failure.
{"title":"Prognostic Significance of Percutaneous Coronary Intervention for First Acute Myocardial Infarction with Heart Failure: Five-Year Follow-Up Results.","authors":"Zichao Cheng, Yuchen Shi, Hongyu Peng, Donghui Zhao, Qian Fan, Jinghua Liu","doi":"10.1155/2022/5791295","DOIUrl":"https://doi.org/10.1155/2022/5791295","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to investigate the incidence and influencing factors of heart failure after 5 years of percutaneous coronary intervention (PCI) for first acute myocardial infarction.</p><p><strong>Methods: </strong>A total of 1235 patients, diagnosed as acute myocardial infarction and treated with PCI in Beijing Anzhen Hospital, Capital Medical University, from January 1, 2014, to December 31, 2014, were enrolled. Based on the exclusion criteria, 671 patients were followed up to obtain echocardiographic results 5 years after the onset of myocardial infarction (from January 1, 2019, to December 31, 2019). Of 671 patients, 62 were lost to follow-up. Finally, 609 patients were recruited in this study. According to the results of the echocardiographic examination, patients were divided into a heart failure group (<i>n</i> = 97) (LVEF < 50%) and a nonheart failure group (<i>n</i> = 512) (LVEF ≥ 50%). The clinical characteristics were compared between the two groups, and the influencing factors of heart failure after 5 years of PCI in patients with acute myocardial infarction were analyzed using logistic regression and receiver-operating characteristic (ROC) analyses.</p><p><strong>Results: </strong>Of 609 patients, 97 had heart failure within 5 years after PCI for first myocardial infarction, with an incidence of 15.9%. Multivariate regression analysis finally examined the predictors related to the occurrence of heart failure, including age (aOR, 1.008; 95% confidence interval (CI), 1.054-1.123; <i>P</i> ≤ 0.001), peak troponin I level (aOR, 1.020; 95% CI, 1.006-1.034; <i>P</i> = 0.004), left ventricular ejection fraction (LVEF) (during admission) (aOR, 0.908; 95% CI, 0.862-0.956; <i>P</i> ≤ 0.001), and left ventricular end-diastolic dimension (LVEDD) (at admission) (aOR, 1.136; 95% CI, 1.016-1.271; <i>P</i> = 0.025).</p><p><strong>Conclusion: </strong>In this study, the incidence of heart failure (LVEF < 50%) in patients with acute myocardial infarction who underwent PCI was 15.9% at a five-year follow up. Age, peak troponin I level, and LVEDD (at admission) were risk factors for heart failure, while LVEF (at admission) of patients during hospitalization was a protective factor for heart failure.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9649329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40492163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: This study aimed to explore if supplementary lycopene tablets may help heart failure (HF) patients improve their lipid profile, BP, and the flow-mediated dilation (FMD) index for endothelial function.
Methods: Fifty patients with ischemic HF with a reduced ejection fraction (HFrEF) were randomly assigned to one of two groups: the lycopene group which received 25 mg lycopene tablets once a day for 8 weeks and the control group which received placebo tablets containing starch once a day for 8 weeks.
Results: Our results showed that after two months, the amount of triglyceride (TG) and FMD improved significantly compared to the control, TG decreased (219.27 vs. 234.24), and the mean of FMD increased (5.68 vs. 2.95). Other variables, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density cholesterol (HDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP), showed no improvement. Also, only SBP and FMD showed intragroup improvement in the intervention group. In the intervention group, only SBP and FMD exhibited intragroup improvement.
Conclusions: It can be concluded that supplementing with lycopene can enhance endothelial function and reduce the TG levels in ischemic HFrEF patients. However, it had no positive effect on BP, TC, LDL-C, or HDL-C. Trial Registration. This clinical trial was registered at the Iranian Registry of Clinical Trials with IRCT registration number: IRCT20210614051574N4.
{"title":"Effect of Lycopene Supplementation on Some Cardiovascular Risk Factors and Markers of Endothelial Function in Iranian Patients with Ischemic Heart Failure: A Randomized Clinical Trial.","authors":"Bahareh Karimian, Azam Soleimani, Ghasem Mohammadsharifi, Kiyan Heshmat-Ghahdarijani, Laila Rejali, Davood Shafie, Atefeh Amerizadeh, Masoumeh Sadeghi","doi":"10.1155/2022/2610145","DOIUrl":"https://doi.org/10.1155/2022/2610145","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore if supplementary lycopene tablets may help heart failure (HF) patients improve their lipid profile, BP, and the flow-mediated dilation (FMD) index for endothelial function.</p><p><strong>Methods: </strong>Fifty patients with ischemic HF with a reduced ejection fraction (HFrEF) were randomly assigned to one of two groups: the lycopene group which received 25 mg lycopene tablets once a day for 8 weeks and the control group which received placebo tablets containing starch once a day for 8 weeks.</p><p><strong>Results: </strong>Our results showed that after two months, the amount of triglyceride (TG) and FMD improved significantly compared to the control, TG decreased (219.27 vs. 234.24), and the mean of FMD increased (5.68 vs. 2.95). Other variables, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density cholesterol (HDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP), showed no improvement. Also, only SBP and FMD showed intragroup improvement in the intervention group. In the intervention group, only SBP and FMD exhibited intragroup improvement.</p><p><strong>Conclusions: </strong>It can be concluded that supplementing with lycopene can enhance endothelial function and reduce the TG levels in ischemic HFrEF patients. However, it had no positive effect on BP, TC, LDL-C, or HDL-C. <i>Trial Registration</i>. This clinical trial was registered at the Iranian Registry of Clinical Trials with IRCT registration number: IRCT20210614051574N4.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9635958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40456243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-18eCollection Date: 2022-01-01DOI: 10.1155/2022/6934418
Li-Hong Lu, Xue-Ya Lv, Qi-Ming Wu, Qian Dong, Zhao Wang, Su-Juan Zhang, Li Fu, Qian Wang, Yu-Qing Song
Objective: This study aims to compare the electrocardiogram (ECG) abnormalities and QT interval prolongation in 2,886 patients with viral hepatitis cirrhosis and 643 patients with alcoholic cirrhosis in order to understand the characteristics of ECG in patients with cirrhosis and provide information and evidence for clinical diagnosis and treatment.
Methods: The ECG data of patients with viral hepatitis cirrhosis and alcoholic liver cirrhosis in the outpatients and inpatients of our hospital from August 2012 to July 2018 were reviewed. The ECG data were recorded, and the ECG report was issued by ECG experts to analyze the abnormal ECG and QT interval of patients in these two groups.
Results: In the present study, 1,132 (39.22%) of the 2,886 patients with viral liver cirrhosis and 322 (50.08%) of the 643 patients with alcoholic liver cirrhosis had an abnormal ECG (P < 0.001). Among patients with QT prolongation, 388 patients had viral liver cirrhosis (13.44%) and 170 patients had alcoholic liver cirrhosis (26.44%, P < 0.001).
Conclusion: The hemodynamics and electrophysiology of the myocardium are often changed in patients with cirrhosis, and ECG changes may also occur. QT interval prolongation is one of the most common electrophysiological abnormalities in patients with cirrhosis, and QT prolongation is more common in patients with alcoholic liver cirrhosis. Prolonged QT is associated with severe arrhythmia and sudden death and can warn of malignant arrhythmia and sudden death. Therefore, the routine detection of abnormal ECG and QT interval in patients with liver cirrhosis is of significant importance for preventing malignant events.
{"title":"Comparison of Electrocardiogram and QT Interval between Viral Hepatitis Cirrhosis and Alcoholic Cirrhosis.","authors":"Li-Hong Lu, Xue-Ya Lv, Qi-Ming Wu, Qian Dong, Zhao Wang, Su-Juan Zhang, Li Fu, Qian Wang, Yu-Qing Song","doi":"10.1155/2022/6934418","DOIUrl":"10.1155/2022/6934418","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare the electrocardiogram (ECG) abnormalities and QT interval prolongation in 2,886 patients with viral hepatitis cirrhosis and 643 patients with alcoholic cirrhosis in order to understand the characteristics of ECG in patients with cirrhosis and provide information and evidence for clinical diagnosis and treatment.</p><p><strong>Methods: </strong>The ECG data of patients with viral hepatitis cirrhosis and alcoholic liver cirrhosis in the outpatients and inpatients of our hospital from August 2012 to July 2018 were reviewed. The ECG data were recorded, and the ECG report was issued by ECG experts to analyze the abnormal ECG and QT interval of patients in these two groups.</p><p><strong>Results: </strong>In the present study, 1,132 (39.22%) of the 2,886 patients with viral liver cirrhosis and 322 (50.08%) of the 643 patients with alcoholic liver cirrhosis had an abnormal ECG (<i>P</i> < 0.001). Among patients with QT prolongation, 388 patients had viral liver cirrhosis (13.44%) and 170 patients had alcoholic liver cirrhosis (26.44%, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The hemodynamics and electrophysiology of the myocardium are often changed in patients with cirrhosis, and ECG changes may also occur. QT interval prolongation is one of the most common electrophysiological abnormalities in patients with cirrhosis, and QT prolongation is more common in patients with alcoholic liver cirrhosis. Prolonged QT is associated with severe arrhythmia and sudden death and can warn of malignant arrhythmia and sudden death. Therefore, the routine detection of abnormal ECG and QT interval in patients with liver cirrhosis is of significant importance for preventing malignant events.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9596252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40653285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-14eCollection Date: 2022-01-01DOI: 10.1155/2022/8244047
Merih T Tesfazghi, Anne R Bass, Noor Al-Hammadi, Scott C Woller, Scott M Stevens, Charles S Eby, Mitchell G Scott, Lindsey Snyder, Troy S Wildes, Brian F Gage
Background Elderly patients undergoing hip or knee arthroplasty are at a risk for myocardial injury after noncardiac surgery (MINS). We evaluated the ability of five common cardiac risk scores, alone or combined with baseline high-sensitivity cardiac troponin I (hs-cTnI), in predicting MINS and postoperative day 2 (POD2) hs-cTnI levels in patients undergoing elective total hip or knee arthroplasty. Methods This study is ancillary to the Genetics-InFormatics Trial (GIFT) of Warfarin Therapy to Prevent Deep Venous Thrombosis, which enrolled patients 65 years and older undergoing elective total hip or knee arthroplasty. The five cardiac risk scores evaluated were the atherosclerotic cardiovascular disease calculator (ASCVD), the Framingham risk score (FRS), the American College of Surgeon's National Surgical Quality Improvement Program (ACS-NSQIP) calculator, the revised cardiac risk index (RCRI), and the reconstructed RCRI (R-RCRI). Results None of the scores predicted MINS in women. Among men, the ASCVD (C-statistic of 0.66; p=0.04), ACS-NSQIP (C-statistic of 0.69; p=0.01), and RCRI (C-statistic of 0.64; p=0.04) predicted MINS. Among all patients, spearman correlations (rs) of the risk scores with the POD2 hs-cTnI levels were 0.24, 0.20, 0.11, 0.11, and 0.08 for the ASCVD, Framingham, ACS-NSQIP, RCRI, and R-RCRI scores, respectively, with p values of <0.001, <0.001, <0.001, 0.006, and 0.025. Baseline hs-cTnI predicted MINS (C-statistics: 0.63 in women and 0.72 in men) and postoperative hs-cTnI (rs = 0.51, p=0.001). Conclusion In elderly patients undergoing elective hip or knee arthroplasty, several of the scores modestly predicted MINS in men and correlated with POD2 hs-cTnI.
{"title":"Predicting Postoperative Troponin in Patients Undergoing Elective Hip or Knee Arthroplasty: A Comparison of Five Cardiac Risk Prediction Tools.","authors":"Merih T Tesfazghi, Anne R Bass, Noor Al-Hammadi, Scott C Woller, Scott M Stevens, Charles S Eby, Mitchell G Scott, Lindsey Snyder, Troy S Wildes, Brian F Gage","doi":"10.1155/2022/8244047","DOIUrl":"https://doi.org/10.1155/2022/8244047","url":null,"abstract":"Background Elderly patients undergoing hip or knee arthroplasty are at a risk for myocardial injury after noncardiac surgery (MINS). We evaluated the ability of five common cardiac risk scores, alone or combined with baseline high-sensitivity cardiac troponin I (hs-cTnI), in predicting MINS and postoperative day 2 (POD2) hs-cTnI levels in patients undergoing elective total hip or knee arthroplasty. Methods This study is ancillary to the Genetics-InFormatics Trial (GIFT) of Warfarin Therapy to Prevent Deep Venous Thrombosis, which enrolled patients 65 years and older undergoing elective total hip or knee arthroplasty. The five cardiac risk scores evaluated were the atherosclerotic cardiovascular disease calculator (ASCVD), the Framingham risk score (FRS), the American College of Surgeon's National Surgical Quality Improvement Program (ACS-NSQIP) calculator, the revised cardiac risk index (RCRI), and the reconstructed RCRI (R-RCRI). Results None of the scores predicted MINS in women. Among men, the ASCVD (C-statistic of 0.66; p=0.04), ACS-NSQIP (C-statistic of 0.69; p=0.01), and RCRI (C-statistic of 0.64; p=0.04) predicted MINS. Among all patients, spearman correlations (rs) of the risk scores with the POD2 hs-cTnI levels were 0.24, 0.20, 0.11, 0.11, and 0.08 for the ASCVD, Framingham, ACS-NSQIP, RCRI, and R-RCRI scores, respectively, with p values of <0.001, <0.001, <0.001, 0.006, and 0.025. Baseline hs-cTnI predicted MINS (C-statistics: 0.63 in women and 0.72 in men) and postoperative hs-cTnI (rs = 0.51, p=0.001). Conclusion In elderly patients undergoing elective hip or knee arthroplasty, several of the scores modestly predicted MINS in men and correlated with POD2 hs-cTnI.","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9586832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40664748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}