Predict value of controlling nutritional score on mortality of patients with acute myocardial infarction after percutaneous coronary intervention

<正>Objective To evaluate the impact of nutritionalstates on mortality of acute myocardial infarction (AMI)patients by the controlling nutritional (CONUT) score.Methods We performed a monocentric retrospective cohort study among AMI patients after percutaneous coronary intervention(PCI) and the median follow-up was 36(33,36 interquartile range) months. The endpoint was     

Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention

Background Transradial access(TRA) has been associated with reduced access site-related bleeding complications and mortality after percutaneous coronary intervention(PCI). It is unclear, however, whether these observed benefits are influenced by baseline bleeding risk. Objectives This study investigated the relationship between baseline bleeding risk, TRA utilization, and procedure-related outcomes in patients undergoing PCI enrolled in the British Cardiovascular Intervention Society database. Methods Baseline bleeding risk was calculated by using modified Mehran bleeding risk scores in 348,689 PCI procedures performed between 2006 and 2011. Four categories for bleeding risk were defined for the modified Mehran risk score(MMRS): low( 10), moderate(10 to 14), high(15 to 19), and very high(≥20). The impact of baseline bleeding risk on 30-day mortality and its relationship with access site were studied. Results TRA was independently associated with a 35% reduction in 30-day mortality risk(odds ratio [OR]: 0.65 [95% confidence interval(CI):0.59 to 0.72]; P 0.0001), with the magnitude of mortality reduction related to baseline bleeding risk(MMRS 10, OR: 0.73 [95% CI: 0.62 to 0.86]; MMRS ≥20, OR: 0.53 [95% CI: 0.47 to 0.61]). In patients with an MMRS 10, TRA was used in 71,771(43.2%) of 166,083 PCI procedures; TRA was used in8,655(40.1%) of 21,559 PCI procedures in patients with an MMRS ≥20, illustrating that TRA was used less in those at highest risk from bleeding complications(P 0.0001). Conclusions TRA was independently associated with reduced 30-day mortality, and the magnitude of this effect was related to baseline bleeding risk; those at highest risk of bleeding complications gained the greatest benefit from adoption of TRA during PCI.     

Predicting utility of a model for end stage liver disease in alcoholic liver disease

AIM: To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term (30 d and 90 d) mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis. METHODS: Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted. RESULTS: 30- and 90-d mortality rates were reported at 5.9% (2/34) and 14.7% (5/34), respectively. Significant correlation was demonstrated for the Model for End-Stage Liver Disease (P30=0.094, P90=0.046) and the Maddrey Discriminant Function score (P30= 0.033, P90= 0.038) with 30- and 90-d mortality whereas a significant association was also established for alanine aminotrans-ferase (P = 0.057), fibrin degradation products (P= 0.048) and C-reactive protein (P = 0.067) with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 (95%CI: 0.902-1.036, P = 0.028) for the Model for End-Stage Liver Disease score and 0.984 (95%CI: 0.942-1.027, P = 0.023) for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 (sensitivity 1, specificity 0.937) and 108.68 (sensitivity 1, specificity 0.969), respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 (95%CI: 0.559-0.965, P = 0.065) for the Model for End-Stage Liver Disease score and 0.752 (95%CI: 0.465-1.038, P = 0.076) for the Maddrey Discriminant Function score with the optimal cut off point of 19 (sensitivity 0.6, specificity 0.6) and 92 (sensitivity 0.6, specificity 0.946), respectively. The observed Kaplan Meier survival rates for different score-categories were compared with log-rank tests and higher score values were correlated with a lower survival. CONCLUSION: Equivalency of the Model for End-Stage Liver Disease and the Maddrey Discriminant Function score is implied by the current study, verified by the plotted Receiver Operative Curves and the estimated survival rates. A statistically significant utility of C-reactive protein, fibrin degradation products and alanine aminotrans-ferase as independent predictors of 90-d mortality has also been verified.     

Patterns of In-Hospital Mortality and Bleeding Complications Following PCI for Very Elderly Patients: Insights from the Dartmouth Dynamic Registry

Background Very elderly patients (age ≥ 85 years) are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention (PCI). However, the relationship between bleeding and mortality in the very elderly is unknown. Methods Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission (bleeding requiring transfusion, access site hematoma > 5 cm, pseudoaneurysm, and retroperitoneal bleed) and in-hospital mortality were reported for four age groups (< 65 years, 65–74 years, 75–84 years, and ≥ 85 years). The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age < 85 years and age ≥ 85 years. Results Of 17,378 patients studied, 1019 (5.9%) experienced bleeding and 369 (2.1%) died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age (mortality: 0.94%, 2.27%, 4.24% and 4.58%; bleeding: 3.96%, 6.62%, 10.68% and 13.99% for ages < 65, 65–74, 75–84 and ≥ 85 years, respectively). On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥ 85 years [odds ratio (95% CI): age < 65 years, 3.65 (1.99–6.74); age 65–74 years, 2.83 (1.62–4.94); age 75–84 years, 3.86 (2.56–5.82), age ≥ 85 years: 1.39 (0.49–3.95)]. Conclusions Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.     

Predictive value of SYNTAX score II for clinical outcomes in octogenarian undergoing percutaneous coronary intervention

Objective To evaluate the predictive value of SYNTAX Score II (SS-II) for percutaneous coronary intervention (PCI) in octogenarian (≥ 80 years old) undergoing PCI. Methods & Results Data from three consecutive years of octogenarian undergoing PCI from Ruijin Hospital (Shanghai, China) was retrospectively collected (n = 308). Follow up clinical data at one year including all cause mortality, cardiac mortality and main adverse cardiovascular and cerebrovascular events (MACCE) were collected. Patients were stratified according to tertiles of SS-II for PCI: SS-II ≤ 26 (n = 104), SS-II: 27–31 (n = 102), SS-II > 31 (n = 102). After adjustment for confounding factors, SS-II for PCI was an independent risk factors for all cause mortality (odds ratio: 2.77, 95% CI: 1.13–8.06; P = 0.04). Kaplan-Meier curves showed higher event rates for all cause mortality and cardiac mortality in higher tertile of SS-II for PCI (Log-Rank test P = 0.002 and P = 0.001, respectively). SS-II for PCI predicted one year mortality in octogenarian population undergoing PCI. Conclusions In octogenarian, SS-II which incorporated clinical variables with angiographic anatomy variable was suitable in risk stratifying and predicting clinical outcomes at one year.     

Association between the composite measures of hospital performance and in-hospital mortality for patients with acute ST-segment elevation myocardial: infarction in China

<正>Objective To investigate the association between hospital-specific opportunity-based composite score(OBCS) and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) in     

The association between the level of serum conjugated bilirubin and mortality in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

Background Even with percutaneous coronary intervention(PCI), patients with ST-segment elevation myocardial infarction(STEMI) faced a substantial mortality. We aimed to evaluate the relationship between the level of bilirubin and mortality in patients with STEMI undergoing PCI. Methods Patients with the diagnosis of STEMI and subsequently treated with PCI was enrolled retrospectively in Guangzhou Eighth People’s Hospital, from March2013 to October 2019. The primary clinical outcome was in-hospit...     

A good prognostic predictor for liver transplan-tation recipients with benign end-stage liver cirrhosis

BACKGROUND: Post-transplant model for predicting mortality(PMPM, calculated as-5.359+1.988×ln(serum creatinine [mg/d L])+1.089×ln(total bilirubin [mg/d L])) score has been proved to be a simple and accurate model for predicting the prognosis after liver transplantation(LT) in a single center study. Here we aim to verify this model in a large cohort of patients.METHODS: A total of 2727 patients undergoing LT with endstage liver cirrhosis from January 2003 to December 2010 were included in this retrospective study. Data were collected from the China Liver Transplant Registry(CLTR). PMPM score was calculated at 24-h and 7-d following LT. According to the PMPM score at 24-h, all patients were divided into the low-risk group(PMPM score ≤-1.4, n=2509) and the high-risk group(PMPM score -1.4, n=218). The area under receiver operator characteristic curve(AUROC) was calculated for evaluating the prognostic accuracy.RESULTS: The 1-, 3-, and 5-year patient survival rates in the low-risk group were significantly higher than those in the high-risk group(90.23%, 88.01%, and 86.03% vs 63.16%, 59.62%, and 56.43%, respectively, P0.001). In the high-risk group, 131 patients had a decreased PMPM score(≤-1.4) at 7-d, and their cumulative survival rate was significantly higher than the other 87 patients with sustained high PMPM score(-1.4)(P0.001). For predicting 3-month mortality, PMPM score showed a much higher AUROC than post-transplant MELD score(P0.05).CONCLUSION: PMPM score is a simple and effective tool to predict short-term mortality after liver transplantation in patients with benign liver diseases, and an indicator for prompt salvaging treatment as well.     

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory.Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.METHODS A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric cancer.For each patient we calculated the Kattan’s score.We arbitrarily divided the study population of patients into two groups based on the nomogram score(<100 points or≥100 points).Prespecified subgroups in these analyses were defined according to age(≤65 years or>65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity.RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy.Perioperative mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer patients.The removal of more than 35 lymph nodes does not lead to an increase in mortality.     

Relation of the HAS-BLED bleeding risk score to major bleeding,cardiovascular events and mortality in anticoagulated patients with atrial fibrillation

Background Stroke risk in atrial fibrillation (AF) using oral vitamin K antagonists (VKA) is closely related to bleeding risk.The HAS-BLED bleeding score has demonstrated its usefulness in assessing major bleeding risk in AF patients.However,risk factors for warfarin associated-bleeding also predict stroke risk in AF patients.We tested the usefulness of HAS-BLED score for predicting both major bleeding and cardiovascular events in a cohort of anticoagulated AF patients.Methods and Results We recruited 965 consecutive anticoagulated outpatients with permanent or paroxysmal AF who were stabilised for at least 6 months on oral anticoagulation (OAC;INR 2.0-3.0).Medical history and HAS-BLED score were assessed.Cox regression models were used to determine the association between clinical risk factors,and bleeding episodes,adverse cardiovascular events and mortality.The median HAS-BLED score was 2 (range 0-6;29% with a score ≥3,ie.high risk).Median follow-up was 861 (718-1016) days.Independent predictors for major bleeding were age ≥75 [HR:1.74 (1.05-2.87);P=0.030],male sex [HR:1.70 (1.03-2.80);P=0.036],renal impairment [HR 2.12 (1.20-3.73);0.010],previous bleeding episode [HR 6.00 (3.73-9.67);P < 0.001],current alcoholic consumption [HR 2.28 (1.03-5.06);P=0.043] and the concomitant malignant disease [HR 2.17 (1.13-4.18);P=0.020].Independent predictors for adverse cardiovascular events were age > 75y [HR 2.20 (1.40-3.46);P=0.001],heart failure [HR 1.78 (1.20-2.86);P=0.001] and previous stroke [HR 1.85 (1.20-2.86);P < 0.001].The HAS-BLED score was highly predictive for major bleeding events [HR 2.04 (1.68-2.49);P < 0.001],and for adverse cardiovascular events [HR 1.51 (1.27-1.81);P < 0.001].The incidence of both bleeding and adverse cardiovascular events was higher as HASBLED score increased,and crude bleeding rates only exceeded thrombotic events at a HAS-BLED score > 3.The HAS-BLED score also predicted all-cause mortality [HR 1.68 (1.40-2.01);P < 0.001].Conclusions The HAS-BLED score is not only useful in assessment of bleeding risk,but it showed some predictive value for cardiovascular events and mortality in anticoagulated AF patients,consistent with the relationship between thrombosis and bleeding.Nonetheless,the HAS-BLED score has been designed for predicting bleeding risk rather than thrombotic events per se,and specific risk scores for cardiovascular events and mortality should be applied for these events.     

Development and validation of a nomogram predicting one-year mortality in patients undergoing percutaneous coronary intervention

OBJECTIVE To formulate a nomogram to predict the risk of one-year mortality after percutaneous coronary intervention(PCI)based on a large-scale real-world Asian cohort.METHODS This study cohort included consecutive patients undergoing PCI in the National Center for Cardiovascular Diseases of China. The endpoint was all-cause mortality. Least absolute shrinkage and selection operator Cox regression and backward stepwise regression were used to select potential risk factors. A nomogram based on th...     

Relation between pre-procedural glucose levels and incidence of major adverse cardiac events in chronic kidney disease patients without established diabetes undergoing percutaneous coronary intervention

Background It is well known that there was a significant link between preprocedural blood glucose levels and short-term and long-term adverse outcomes in patients undergoing elective PCI. However, the role of pre-procedural blood glucose levels as a predictor of adverse events in CKD patients who underwent PCI out of established diabetes has yet to be identified. Methods In our study, we conducted a prospective study of 331 acute coronary syndrome (ACS) patients with CKD who underwent PCI out of established diabetes. Patients were divided into two groups based on pre-procedural glucose levels (hypoglycemia < 7.0 mmol/L; hyperglycemia ≥ 7.0 mmol/L). All patients were followed up prospectively for major adverse cardiovascular events (MACEs) and mortality for 6 months. Results In our cohort, hyperglycemia patients reported a higher incidence of in-hospital mortality than hypoglycemia patients (7.5% vs. 0%, P < 0.001). Hyperglycemia patients reported a significantly higher rate of 6-month MACEs (10% vs. 2.4%, P = 0.007), all cause mortality (7.5% vs. 1.6%, P = 0.015), and cardiovascular mortality (6.2%vs 1.6%, P = 0.041) compared with hypoglycemia patients with pre-procedural glucose levels < 7.0 mmol/L. Multivariate analysis disclosed that a pre-procedural glucose level ≥7.0 mmol/L was a significant independent predictor of MACEs (OR = 2.53, 95% CI 1.68-17.15, P = 0.004), all cause mortality(OR = 4.6, 95% CI 1.10-18.84, P = 0.036), and cardiovascular mortality(OR = 6.2, 95% CI 1.53-24.94, P = 0.011) at 6 months in patients after PCI. Conclusion The study suggested that pre-procedural glucose levels are associated with short-term cardiovascular outcome CKD patients who underwent PCI without established diabetes in the setting of ACS.     

Routinely available biomarkers improve prediction of long-term mortality in stable coronary artery diseasethe Vienna and Ludwigshafen coronary artery disease(VILCAD)risk score

Aims Previous risk assessment scores for patients with coronary artery disease(CAD)have focused on primary prevention and patients with acute coronary syndrome.However,especially in stable CAD patients improved long-term risk prediction is crucial to efficiently apply measures of secondary prevention.We aimed to create a clinically applicable mortality prediction score for stable CAD patients based on routinely determined laboratory biomarkers and clinical determinants of secondary prevention.Methods and Results We prospectively included 547 patients with stable CAD and a median follow-up of 11.3 years.Independent risk factors were selected using bootstrapping based on Cox regression analysis.Age,left ventricular function,serum cholinesterase,creatinine,heart rate,and HbA1c were selected as significant mortality predictors for the final multivariable model.The Vienna and Ludwigshafen Coronary Artery Disease(VILCAD)risk score based on the aforementioned variables demonstrated an excellent discriminatory power for 10year survival with a C-statistic of 0.77(P < 0.001),which was significantly better than an established risk score based on conventional cardiovascular risk factors(C-statistic = 0.61,P < 0.001).Net reclassification confirmed a significant improvement in individual risk prediction by 34.8%(95% confidence interval21.7-48.0%)compared with the conventional risk score(P < 0.001).External validation of the risk score in 1275 participants of the Ludwigshafen Risk and Cardiovascular Health study(median follow-up of 9.8 years)achieved similar results(C-statistic = 0.73,P < 0.001).Conclusion The VILCAD score based on a routinely available set of risk factors,measures of cardiac function,and comorbidities outperforms established risk prediction algorithms and might improve the identification of high-risk patients for a more intensive treatment.     

Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding

AIM: To validate the clinical Rockall score in predicting outcomes (rebleeding, surgery and mortality) in elderly patients with acute upper gastrointestinal bleeding (AUGIB). METHODS: A retrospective analysis was undertaken in 341 patients admitted to the emergency room and Intensive Care Unit of Xuanwu Hospital of Capital Medical University with non-variceal upper gastrointestinal bleeding. The Rockall scores were calculated, and the association between clinical Rockall scores and patient outcomes (rebleeding, surgery and mortality) was assessed. Based on the Rockall scores, patients were divided into three risk categories: low risk ≤ 3, moderate risk 3-4, high risk ≥ 4, and the percentages of rebleeding/death/surgery in each risk category were compared. The area under the receiver operating characteristic (ROC) curve was calculated to assess the validity of the Rockall system in predicting rebleeding, surgery and mortality of patients with AUGIB. RESULTS: A positive linear correlation between clinical Rockall scores and patient outcomes in terms of rebleeding, surgery and mortality was observed (r =0.962, 0.955 and 0.946, respectively, P = 0.001). High clinical Rockall scores > 3 were associated with adverse outcomes (rebleeding, surgery and death). There was a significant correlation between high Rockall scores and the occurrence of rebleeding, surgery and mortality in the entire patient population (χ 2 = 49.29, 23.10 and 27.64, respectively, P = 0.001). For rebleeding, the area under the ROC curve was 0.788 (95%CI: 0.726-0.849, P = 0.001); For surgery, the area under the ROC curve was 0.752 (95%CI: 0.679-0.825, P = 0.001) and for mortality, the area under the ROC curve was 0.787 (95%CI: 0.716-0.859, P = 0.001). CONCLUSION: The Rockall score is clinically useful, rapid and accurate in predicting rebleeding, surgery and mortality outcomes in elderly patients with AUGIB.     

Comparison of interventional and conservative treatment on in-hospital outcomes in elderly patients with acute myocardial infarction

Objectives To compare the in-hospital outcomes of elderly patients with acute myocardial infarction (AMI) treated by interventional or conservative protocols. Patients and Methods One handred and seventy-six consecutive patients hospitalized for AMI were involved, including 95 patients underwent emergent percutaneous coronary intervention (PCI) within 24 h after the onset of AMI and 81 patients received conservative non-invasive therapies. Clinical characteristics and in-hospital cardiac events of these two divisions were analyzed. Results In the PCI group, success rate of procedure and lesions was 98.9% and 98.5% , respectively. Procedure related complication were occurred in 6 cases(6.3% ) and no patient died during operative procedures. PCI group had a lower in-hospital mortality (11.6% vs24.7%, P<0.05) and overall cardiac events rate (24.2%vs56.8%, P<0.01) compared with conservative group. Patients complicated by pump failure at admission in PCI group had a lower mortality compared with their counterpart in conservative group(27.3% vs60.9%, P<0.05). The average hospital duration between the two groups was no significant differences. The coronary care unit (CCU) duration of the PCI group was less than that of conservative group (4±5d vs 8±5d, P < 0.05). Conclusions In elderly patients with AMI, interventional treatment can significantly decrease the in-hospital mortality and cardiac events rate compared with conservative treatment, thus gains a better short-term outcome. (J Geriatr Cardiol 2005;2(1) :24-27. )     

Prognostic implications of creatine kinase-MB elevation after percutaneous coronary intervention results from the evaluation of drug-eluting stents and ischemic events （EVENT） registry

Background Creatine kinase-MB (CK-MB) elevation after percutaneous coronary intervention (PCI) has been associated with increased risk for mortality. Although most studies have defined periprocedural myocardial infarction (pMI) as an elevation in CK-MB > 3 × upper limit of normal (ULN), use of different CK-MB assays and variation in site-specific definitions of the ULN may limit the value of such relative thresholds. Methods and Results We used data from the multicenter Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry to examine the impact of variations in site-specific thresholds for CK-MB elevation on the incidence of pMI as well as the relationship between absolute peak levels of CK-MB after PCI and 1-year mortality. The study cohort consisted of 6347 patients who underwent nonemergent PCI and had normal CK-MB at baseline. Across the 59 study centers, the ULN for CK-MB ranged from 2.6 to 10.4 ng / mL (median, 5.0 ng / mL), and there was an inverse relationship between the site-specific ULN and the incidence of pMI (defined as CK-MB elevation > 3 × ULN). Although any postprocedure elevation of CK-MB was associated with an adverse prognosis, in categorical analyses, only CK-MB ≥50 ng / mL was independently associated with increased 1-year mortality (hazard ratio, 4.71; 95% confidence interval, 2.42 to 9.13; P < 0.001). Spline analysis using peak CK-MB as a continuous variable suggested a graded, nonlinear relationship with 1-year mortality, with an inflection point at ≈30 ng / mL. Conclusions Among unselected patients undergoing PCI, there is a graded relationship between CK-MB elevation after PCI and 1-year mortality that is particularly strong for large CK-MB elevations (>30 to 50 ng / mL). Future studies that include pMI as a clinical end point should consider using a core laboratory to assess CK-MB (to ensure consistency) and raising the threshold for defining pMI above current levels (to enhance clinical relevance).     

The SYNTAX score as a predictor of contrast-induced nephropathy patients with chronic total occlusion undergoing percutaneous coronary intervention

Background The SYNTAX score was developed to assess the severity and complexity of coronary artery disease and was determined to be effective in predicting contrast-induced nephropathy(CIN) in patients with STelevation myocardial infarction(STEMI) and non-STEMI(NSTEMI). However, the relationship between SYNTAX score and CIN of patients with CTO undergoing PCI has been unclear. Methods We retrospectively enrolled 667 patients with CTO who underwent our institution′s basic PCI protocol between January 2010 and September 2012. The patients were divided into 3 groups: a low-risk group(SYNTAX score 23; n = 231), a moderate-risk group(SYNTAX score = 23-32; n = 214), and a high-risk group(SYNTAX score32; n = 222). CIN was defined as an absolute increase in SCr of ≥ 0.5 mg/d L over baseline values within 48-72 h after administration of contrast medium. We observed the correlation between SYNTAX score and the CIN rates. Results CIN developed in 74(11.09%) of the 667 study patients. The CIN rate showed a positive trend in the 3 groups based on the SYNTAX score, the higher SYNTAX score corresponds to the higher incidence of CIN(6.93%,13.08%,13.51%P = 0.044). In the multivariate analysis, SYNTAX score was identified as an independent predictor of CIN(OR:1.956,95% CI: 1.014-3.773; P = 0.045; OR: 1.942,95% CI: 1.005-3.752; P = 0.048). The incidence of in-hospital(1.3% vs. 4, 21% vs. 5.86%, P = 0.035) and long-term MACE(4.59% vs. 7.88% vs. 11.66%, P = 0.046) rates were more frequent in the higner SYNTAX score groups. Conclusions SYNTAX score is an independent predictor of CIN among patients with CTO undergoing PCI.     

Development and validation of a stent thrombosis risk score in patients with acute coronary syndromes

Objectives This study sought to develop a practical risk score to predict the risk of stent thrombosis(ST) after percutaneous coronary intervention(PCI) for acute coronary syndromes(ACS).Background ST is a rare,yet feared complication after PCI with stent implantation.A risk score for ST after PCI in ACS can be a helpful tool to personalize risk assessment.Methods This study represents a patient-level pooled analysis of 6,139 patients undergoing PCI with stent implantation for ACS in the HORIZONS-AMI(Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY(Acute Catheterization and Urgent Intervention Triage Strategy) trials who were randomized to treatment with bivalirudin versus heparin plus a glycoprotein Ⅱb /Ⅲa inhibitor.The co hort was randomly divided into a risk score development cohort(n = 4,093) and a validation cohort(n = 2,046).Cox regression methods were used to identify clinical,angiographic,and procedural characteristics associated with Academic Research Consortium-defined definite /probable ST at 1 year.Each covariate in this model was assigned an integer score based on the regression coefficients.Results Variables included in the risk score were type of ACS(ST-segment elevation myocardial infarction,non-ST-segment elevation ACS with ST deviation,or non-ST-segment elevation ACS without ST changes),current smoking,insulin-dependent diabetes mellitus,prior PCI,baseline platelet count,absence of early(prePCI) anticoagulant therapy,aneurysmal /ulcerated lesion,baseline TIMI(Thrombolysis In Myocardial Infarction) flow grade 0 /1,final TIMI flow grade < 3,and number of treated vessels.Risk scores 1 to 6 were considered low risk,7 to 9 intermediate risk,and 10 or greater high risk for ST.Rates of ST at 1 year in low-,inter mediate-,and high-risk categories were 1.36%,3.06%,and 9.18%,respectively,in the development cohort(P for trend < 0.001),and 1.65%,2.77%,and 6.45% in the validation cohort(P for trend = 0.006).The C-statistic for this risk score was over 0.65 in both cohorts.Conclusions The individual risk of ST can be predicted using a simple risk score based on clinical,angiographic,and procedural variables.     

Predictors of mortality after transjugular portosystemic shunt

AIM:To investigate if echocardiographic and hemodynamic determinations obtained at the time of transjugular intrahepatic portosystemic shunt(TIPS)can provide prognostic information that will enhance risk stratification of patients.METHODS:We reviewed medical records of 467 patients who underwent TIPS between July 2003 and December 2011 at our institution.We recorded information regarding patient demographics,underlying liver disease,indication for TIPS,baseline laboratory values,hemodynamic determinations at the time of TIPS,and echocardiographic measurements both before and after TIPS.We recorded patient comorbidities that may affect hemodynamic and echocardiographic determinations.We also calculated Model for Endstage Liver Disease(MELD)score and Child Turcotte Pugh(CTP)class.The following pre-and post-TIPS echocardiographic determinations were recorded:Left ventricular ejection fraction,right ventricular(RV)systolic pressure,subjective RV dilation,and subjective RV function.We recorded the following hemodynamic measurements:Right atrial(RA)pressure before and after TIPS,inferior vena cava pressure before and after TIPS,free hepatic vein pressure,portal vein pressure before and after TIPS,and hepatic venous pressure gradient(HVPG).RESULTS:We reviewed 418 patients with portal hypertension undergoing TIPS.RA pressure increased by a mean ± SD of 4.8 ± 3.9 mmH g(P 0.001),HVPG decreased by 6.8 ± 3.5 mmH g(P 0.001).In multivariate linear regression analysis,a higher MELD score,lower platelet count,splenectomy and a higher portal vein pressure were independent predictors of higher RA pressure(R = 0.55).Three variables predicted 3-mo mortality after TIPS in a multivariate analysis:Age,MELD score,and CTP grade C.Change in the RA pressure after TIPS predicted long-term mortality(per 1 mm Hg change,HR = 1.03,95%CI:1.01-1.06,P 0.012).CONCLUSION:RA pressure increased immediately after TIPS particularly in patients with worse liver function,portal hypertension,emergent TIPS placement and history of splenectomy.The increase in RA pressure after TIPS was associated with increased mortality.Age,splenectomy,MELD score and CTP grade were independent predictors of long-term mortality after TIPS.     

Evaluation of prognostic factors and scoring system in colonic perforation

AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.