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1.
Luis Cláudio Lemos Correia Isis Vasconcelos Guilherme Garcia Felipe Kalil Felipe Ferreira André Silva Ruan Oliveira Manuela Carvalhal Caio Freitas Márcia Maria Noya-Rabelo 《Arquivos brasileiros de cardiologia》2014,102(5):449-455
Background
The incremental prognostic value of plasma levels of C-reactive protein (CRP) in relation to GRACE score has not been established in patients with acute coronary syndrome (ACS) with non-ST segment elevation.Objective
To test the hypothesis that CRP measurements at admission increases the prognostic value of GRACE score in patients with ACS.Methods
A total of 290 subjects, consecutively admitted for ACS, with plasma material obtained upon admission CRP measurement using a high-sensitivity method (nephelometry) were studied. Cardiovascular outcomes during hospitalization were defined by the combination of death, nonfatal myocardial infarction or nonfatal refractory angina.Results
The incidence of cardiovascular events during hospitalization was 15% (18 deaths, 11 myocardial infarctions, 13 angina episodes) with CRP showing C-statistics of 0.60 (95% CI = 0.51-0.70, p = 0.034) in predicting these outcomes. After adjustment for the GRACE score, elevated CRP (defined as the best cutoff point) tended to be associated with hospital events (OR = 1.89, 95% CI = 0.92 to 3.88, p = 0.08). However, the addition of the variable elevated CRP in the GRACE model did not result in significant increase in C-statistics, which ranged from 0.705 to 0.718 (p = 0.46). Similarly, there was no significant reclassification of risk with the addition of CRP in the predictor model (net reclassification = 5.7 %, p = 0.15).Conclusion
Although CRP is associated with hospital outcomes, this inflammatory marker does not increase the prognostic value of the GRACE score. 相似文献2.
Rania Hammami Jihen Jdidi Fakher Mroua Rahma Kallel Mourad Hentati Leila Abid Samir Kammoun 《Revista portuguesa de cardiologia》2018,37(1):41-49
Introduction
The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease.Methods
We analyzed 238 consecutive patients admitted for NSTE-ACS and undergoing a coronary angiogram during hospitalization. The severity of CAD was assessed using the SYNTAX score. Obstructive CAD was defined as ≥50% stenosis in the left main or ≥70% stenosis in other vessels. Severe CAD was defined as a SYNTAX score >32. The Pearson test was used to assess the correlation between scores.Results
The SYNTAX score was higher in patients at high risk (GRACE score: p<0.001 and TIMI score: p=0.001). Moreover, there was a significant positive correlation between the GRACE and SYNTAX scores (r=0.23, p<0.001) as well as between TIMI and SYNTAX (r=0.2, p=0.002). Both clinical scores can predict obstructive CAD moderately well (area under the curve [AUC] for GRACE score: 0.599, p=0.015; TIMI score: AUC 0.639, p=0.001) but not severe disease. A GRACE score of 120 and a TIMI score of 2 were predictive of obstructive CAD with, respectively, a sensitivity of 57% and 75.7% and a specificity of 61.8% and 47.9%.Conclusion
The GRACE and TIMI scores correlate moderately with the extent of coronary disease assessed by the SYNTAX score. They can predict obstructive CAD but not severe disease. 相似文献3.
Anibal P. AbelinRenato B. David MD Carlos A. GottschallAlexandre S. Quadros MD PhD 《The Canadian journal of cardiology》2014
Background
Comparisons between dedicated risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in real-world clinical practice are scarce. The aim of this study was to assess the diagnostic performance of the Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), Thrombolysis in Myocardial Infarction (TIMI), and Zwolle scores in STEMI patients undergoing pPCI in contemporary clinical practice.Methods
This was a prospective cohort study of consecutive patients with STEMI undergoing pPCI between December 2009 and November 2010 in a high-volume tertiary referral centre. The outcomes assessed were major cardiovascular events (MACEs) and death within 30 days. The diagnostic accuracy of the scores was assessed using receiver operating characteristic curves, and scores were compared using the DeLong method.Results
During the study period, 501 patients were included. Within 30 days, 62 patients (12.4%) presented a MACE and 39 individuals (7.8%) died. All scores were statistically associated with death and MACE within 30 days (P < 0.01). The c-statistic and 95% confidence intervals for 30-day mortality were: GRACE, 0.84 (0.78-0.90); TIMI, 0.81 (0.74-0.87); Zwolle, 0.80 (0.73-0.87); and PAMI, 0.75 (0.68-0.82) (P < 0.01). There was no statistically significant difference regarding the accuracy of the TIMI, GRACE, and Zwolle scores for 30-day mortality, but the GRACE score was superior to the PAMI score (P < 0.01).Conclusions
The TIMI, GRACE, and Zwolle scores performed equally well as predictors of mortality in patients who underwent pPCI in current practice. These results suggest that these scores are suitable options for risk assessment in a real-world setting. 相似文献4.
Daniel Rios Pinto Ribeiro Adriane Monserrat Ramos Pedro Lima Vieira Eduardo Menti Odemir Luiz Bordin Jr. Priscilla Azambuja Lopes de Souza Alexandre Schaan de Quadros Vera Lúcia Portal 《Arquivos brasileiros de cardiologia》2014,103(1):69-75
Background
The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial.Objective
To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.Methods
This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student''s t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant.Results
The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores.Conclusion
Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor of 30-day mortality. 相似文献5.
Introduction and Aim
The monocyte to high-density lipoprotein cholesterol ratio (MHR) has recently been proposed as a new predictor and prognostic indicator in cardiovascular disease. The TIMI risk score predicts short-term mortality in ST-elevation myocardial infarction (STEMI) patients. However, there have been no studies regarding the association between MHR and TIMI score in patients with STEMI.Methods
A total of 161 patients admitted to our hospital were prospectively enrolled between January 2014 and June 2016. Of these, 111 consecutive patients with a diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI) were selected as the STEMI group, and the remaining 50 patients, who had angiographically normal coronary arteries, were selected as the control group. The 111 STEMI patients were then divided into two subgroups based on TIMI scores.Results
MHR was significantly higher in the STEMI group than in the control group (1.71±0.47 vs. 2.21±0.98, p=0.001) and was significantly higher in the high TIMI score group than in the low TIMI score group (1.80±0.59 vs. 2.42±1.09, p=0.001). In multivariate logistic regression analysis, MHR was the only independent predictor of acute STEMI and high TIMI score. In correlation analysis, there was a significant positive correlation between MHR and TIMI score in STEMI patients (r=0.479, p<0.001). The cutoff value of MHR for high TIMI score in patients with STEMI was 2.409, with a sensitivity of 43.06% and a specificity of 87.18% (AUC 0.669; 95% CI 0.569-0.8769; p=0.003) on ROC curve analysis.Conclusion
This study indicates that MHR is independently and significantly associated with TIMI score in patients with STEMI. MHR is a novel inflammation-based marker and may be an independent predictor of future cardiovascular events in patients with STEMI. 相似文献6.
Thao Huynh James Nasmith The Minh Luong Martin Bernier Chantal Pharand Zhao Xue-Qiao Robert P Giugliano Pierre Theroux 《The Canadian journal of cardiology》2009,25(12):e417-e421
BACKGROUND:
Although the Thrombolysis In Myocardial Infarction (TIMI) score incorporates ST deviation, it does not account for characteristics of the ST deviations. In the present study, it was hypothesized that the magnitude and characteristics of ST deviation may add to the prognostic values of the TIMI risk score in acute coronary syndrome (ACS) patients, particularly in lower-risk patients with a TIMI risk score of less than 5.OBJECTIVE:
To evaluate the prognostic value of combining the TIMI risk score and characteristics of ST deviation in patients with non-ST elevation ACS and a TIMI risk score of less than 5.METHODS:
The death/myocardial infarction (MI) rates of 1296 patients enrolled in the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) angiographic substudy were examined.RESULTS:
Patients without a TIMI risk score of 5 or greater, and without an ST deviation of 1 mm or greater had the lowest six-month rate of death/MI (5%). In patients with a TIMI risk score of less than 5, the six-month death/MI rate was increased in those with ST depression of 2 mm or greater compared with patients with a similar TIMI risk score and without ST deviation of 1 mm or greater (24% versus 5%, P<0.001). The presence of ST deviation of 2 mm or greater identified an additional 15% of patients with an increased six-month death/MI rate in patients with a TIMI risk score of less than 5.CONCLUSION:
ST segment deviation of 2 mm or greater confers additional prognostic information in non-ST elevation ACS patients with a TIMI risk score of less than 5. Patients with a TIMI risk score of less than 5 and ST deviation of 2 mm or less had the lowest risk of six-month death/MI. 相似文献7.
Durmu? Y?ld?ray ?ahin Mustafa Gür Zafer Elbasan Ali Y?ld?z Zekeriya Kaya Yahya Kemal ??en Ali K?vrak Caner Türko?lu Remzi Y?lmaz Murat ?ayl? 《Experimental & Clinical Cardiology》2013,18(2):e77-e81
BACKGROUND:
Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI.OBJECTIVE:
To assess possible predictors of patency of IRA before primary PCI in patients with STEMI.METHODS:
A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients.RESULTS:
Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P<0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (β 0.673 [95% CI 0.548 to 0.826]; P<0.001), N to L ratio (β 0.783 [95% CI 0.683 to 0.897]; P<0.001) and EF (β 1.033 [95% CI 1.006 to 1.061]; P=0.016).CONCLUSION:
Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI. 相似文献8.
PETER DAMMAN M.D. PIER WOUDSTRA M.D. WICHERT J. KUIJT M.D. WOUTER J. KIKKERT M.D. TIM P. VAN DE HOEF M.D. MAIK J. GRUNDEKEN M.D. RALF E. HARSKAMP M.D. JOSE P.S. HENRIQUES M.D. Ph.D. JAN J. PIEK M.D. Ph.D. JAN G.P. TIJSSEN M.D. Ph.D. ROBBERT J. DE WINTER M.D. Ph.D. 《Journal of interventional cardiology》2013,26(1):8-13
Objectives
We investigated the short‐ and long‐term predictive value of the TIMI risk score regarding mortality for patients treated with primary percutaneous coronary intervention (PPCI) for ST‐elevation myocardial infarction (STEMI).Background
Data on the long‐term predictive value of the TIMI risk score is sparse.Methods
We used data from 3,609 STEMI patients undergoing PPCI in a high‐volume PCI center in The Netherlands. Cumulative event rates according to TIMI score variables were estimated with the Kaplan‐Meier method and compared with the log‐rank test. The original TIMI risk score was modified based on the availability of the data in the single center registry.Results
Higher TIMI scores were associated with significantly higher mortality at short‐ and long‐term follow‐up (P < 0.001 for both). Age and Killip Class IV at presentation were significant predictors for both short‐ and long‐term mortality. Patients with an anterior MI, heart frequence >100 beats per minute, or systolic blood pressure <100 mmHG had a worse short‐term prognosis compared to those who had not. However, long‐term mortality was nonsignificantly different. The presence of a history of diabetes/hypertension and weight had only long‐term prognostic value. Time to PPCI did not have any prognostic value.Conclusions
Our current report shows that the TIMI risk score has both short‐ and long‐term discriminative value. The different variables contained in the TIMI risk score predict short‐term prognosis, others predominantly long‐term mortality, whereas some are predictive for both. (J Interven Cardiol 2013;26:8–13)9.
Leonardo Sinnott Silva Paulo Ricardo Avancini Caramori Antonio Carlos Bacelar Nunes Filho Marcelo Katz Jo?o Carlos Vieira da Costa Guaragna Pedro Lemos Valter Lima Alexandre Abizaid Flavio Tarasoutchi Fabio S. de Brito Jr 《Arquivos brasileiros de cardiologia》2015,105(3):241-247
Background
Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge.Objectives
To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI.Methods
The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)].Results
The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05).Conclusions
In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required. 相似文献10.
Ilker Gul Mustafa Zungur Ahmet Cagri Aykan Teyyar Gokdeniz Ezgi Kalaycio?lu Turhan Turan Engin Hatem Faruk Boyaci 《Arquivos brasileiros de cardiologia》2016,106(3):194-200
Background
GRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI).Objective
The present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS.Methods
We evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS).Results
Systolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438).Conclusion
End-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS. 相似文献11.
Mony Shuvy Gil Beeri Eyal Klein Tal Cohen Nir Shlomo Saar Minha David Pereg 《The Canadian journal of cardiology》2018,34(12):1613-1617
Background
Global Registry of Acute Coronary Events (GRACE) score has been routinely used for risk stratification in acute coronary syndromes (ACS). We aimed to investigate whether the GRACE score has remained relevant with contemporary treatment of patients with ACS.Methods
Included were patients with ACS in the Acute Coronary Syndrome Israeli Survey (ACSIS). Patients were divided into high (> 140) and low–intermediate (≤ 140) GRACE score. Outcomes were compared for each GRACE score group among patients enrolled in early (2000 to 2006), mid (2008 to 2010) and late (2013 to 2016) surveys.Results
Included were 4931 patients. For patients with GRACE scores > 140, temporal improvements in therapy were associated with reduced 7-day all-cause mortality (5.7%, 4.1%, and 2.0% for patients in early, mid-, and late surveys, respectively, P = 0.01) and 1-year mortality rates (27.8%, 25.3%, and 21.8% for patients in early, mid-, and late surveys, respectively, P = 0.07). Among patients with GRACE scores ≤ 140, all-cause mortality rates at 1 year were lower among participants enrolled in recent surveys (5.3%, 3.5%, and 3.1% for patients in early, mid-, and late surveys, respectively, P = 0.01). No significant differences in the accuracy of the GRACE score in predicting 7-day mortality were observed, (area under the curve [AUC] = 0.83, 0.87, and 0.75 for early, mid-, and late surveys, respectively, P = NS). Similarly, for 1-year all-cause mortality, the accuracy of the GRACE score remained comparable (AUC = 0.79, 0.84, and 0.82 for early, mid-, and late surveys, respectively, P = NS).Conclusions
Our results validated the accuracy of the GRACE score for risk stratification in ACS. The discrimination of the score has not been influenced by the better outcome with latest treatment. 相似文献12.
Korhan Soylu Serkan Yuksel Okan Gulel Ali Riza Erbay Murat Meric Halit Zengin Muhtar Museyibov Erdogan Yasar Sabri Demircan 《Journal of thoracic disease》2013,5(3):258-264
Purpose
It has been known that inflammatory mechanisms play an important role in the coronary artery disease. Our aim in this study was to investigate the relationship between the neutrophil/lymphocyte (N/L) ratio and coronary flow velocity after primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI).Methods
Two hundred and ten patients who had undergone primary PCI were included. The coronary flow velocities were evaluated using the recorded PCI procedures by Thrombolysis in Myocardial Infarction (TIMI) flow grades and corrected TIMI frame counts (cTFC) values. A value of >40 for the final cTFC was accepted as an index of insufficient coronary blood flow. The white blood cell subtypes and counts were determined in the blood samples obtained at the clinics.Results
In 165 (78%) of the investigated patients, reperfusion was found to be sufficient (Group I) while in 45 (22%) of them (Group II) insufficient reperfusion was observed (Group II). In-hospital mortality was 7.2% (n=12) in Group I, whereas it was 17.7% (n=8) in Group II (P=0.033). Similarly, one-year mortality was higher in Group II (26.6%, n=12) than in Group I (13.3%, n=22) (P=0.031). N/L ratio was determined to be higher in Group I than in Group II (8.3±6.1 vs. 6.2±5.0; P=0.034). Also, N/L ratio was found as an independent predictor of severe no-reflow development (TIMI 0-1) and of one-year mortality (P=0.01 and P=0.047, respectively).Conclusions
N/L ratio has been found to be an independent indicator for no-reflow development in patients who have undergone PCI for acute STEMI. This simple and low-cost parameter can provide useful information for the relevant risk evaluation in these patients.KEY WORDS : Inflammation, acute ST-segment elevation myocardial infarction (acute STEMI), neutrophil/lymphocyte ratio (N/L ratio) 相似文献13.
Relationship between Neutrophil-To-Lymphocyte Ratio and Electrocardiographic
Ischemia Grade in STEMI
Emre Yalcinkaya Uygar Cagdas Yuksel Murat Celik Hasan Kutsi Kabul Cem Barcin Gokoglan Yalcin Erkan Yildirim Atila Iyisoy 《Arquivos brasileiros de cardiologia》2015,104(2):112-119
Background
Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI.Objective
To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification.Methods
Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I).Results
Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p < 0.001).Conclusion
We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores. 相似文献14.
Méndez-Eirín E Flores-Ríos X García-López F Pérez-Pérez AJ Estévez-Loureiro R Piñón-Esteban P Aldama-López G Salgado-Fernández J Calviño-Santos RA Vázquez Rodríguez JM Vázquez-González N Castro-Beiras A 《Revista espa?ola de cardiología》2012,65(3):227-233
Introduction and objectives
We sought to compare the predictive value of the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) scores for the outcome of ST-segment elevation acute coronary syndrome undergoing urgent percutaneous coronary intervention.Methods
We performed a retrospective analysis of a cohort composed of all consecutive patients with ST-segment elevation acute coronary syndrome treated by urgent percutaneous coronary intervention between 2006 and 2010 (n=1503). TIMI, PAMI, CADILLAC, and GRACE risk scores were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for death, reinfarction, and target-vessel revascularization at 30 days and 1 year, using the C statistic, which was obtained by means of logistic regression and ROC curves.Results
The TIMI, PAMI, CADILLAC and GRACE showed an excellent predictive value for 30-day and 1-year mortality (C statistic range, 0.8-0.9), with superiority of the TIMI, CADILLAC, and GRACE risk models. The performance of these 4 scores was poor for both reinfarction and target-vessel revascularization (C statistic, 0.5-0.6).Conclusions
The TIMI, PAMI, CADILLAC, and GRACE scores provide excellent information to stratify the risk of mortality in patients treated by percutaneous coronary intervention. The TIMI, CADILLAC, and GRACE models have higher predictive accuracy. The usefulness of these models for reinfarction and target-vessel revascularization prediction is questionable. 相似文献15.
Liping Wang Hongyun Wang Pingshuan Dong Zhuanzhen Li Yanyu Wang Nana Duan Yuwei Zhao Shaoxin Wang 《Arquivos brasileiros de cardiologia》2014,102(6):529-538
Background
Long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) remain uncertain.Objective
To investigate long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI).Methods
We performed search of MEDLINE, EMBASE, the Cochrane library, and ISI Web of Science (until February 2013) for randomized trials comparing more than 12-month efficacy or safety of DES with BMS in patients with STEMI. Pooled estimate was presented with risk ratio (RR) and its 95% confidence interval (CI) using random-effects model.Results
Ten trials with 7,592 participants with STEMI were included. The overall results showed that there was no significant difference in the incidence of all-cause death and definite/probable stent thrombosis between DES and BMS at long-term follow-up. Patients receiving DES implantation appeared to have a lower 1-year incidence of recurrent myocardial infarction than those receiving BMS (RR = 0.75, 95% CI 0.56 to 1.00, p= 0.05). Moreover, the risk of target vessel revascularization (TVR) after receiving DES was consistently lowered during long-term observation (all p< 0.01). In subgroup analysis, the use of everolimus-eluting stents (EES) was associated with reduced risk of stent thrombosis in STEMI patients (RR = 0.37, p=0.02).Conclusions
DES did not increase the risk of stent thrombosis in patients with STEMI compared with BMS. Moreover, the use of DES did lower long-term risk of repeat revascularization and might decrease the occurrence of reinfarction. 相似文献16.
José Carlos Nicolau Humberto Graner Moreira Luciano Moreira Baracioli Carlos Vicente Serrano Jr Felipe Galego Lima Marcelo Franken Roberto Rocha Giraldez Fernando Ganem Roberto Kalil Filho José Ant?nio Franchini Ramires Roxana Mehran 《Arquivos brasileiros de cardiologia》2013,101(6):511-518
Background
It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied.Objective
The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center.Methods
Out of 1,655 patients with ACS (547 with ST-elevation ACS and 1,118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1,416. Mortality information and hemorrhagic complications were also obtained.Results
Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001).Conclusions
Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction. 相似文献17.
Luis C. L. Correia Felipe Ferreira Felipe Kalil André Silva Luisa Pereira Manuela Carvalhal Maurício Cerqueira Fernanda Lopes Nicole de Sá Márcia Noya-Rabelo 《Arquivos brasileiros de cardiologia》2015,105(1):20-27
Background
The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.Objective
To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.Methods
This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).Results
Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.Conclusion
The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS. 相似文献18.
Nallamothu B Fox KA Kennelly BM Van de Werf F Gore JM Steg PG Granger CB Dabbous OH Kline-Rogers E Eagle KA;GRACE Investigators 《Heart (British Cardiac Society)》2007,93(12):1552-1555
Objective
Treatment delays may result in different clinical outcomes in patients with ST‐segment elevation myocardial infarction (STEMI) who receive fibrinolytic therapy vs primary percutaneous coronary intervention (PCI). The aim of this analysis was to examine how treatment delays relate to 6‐month mortality in reperfusion‐treated patients enrolled in the Global Registry of Acute Coronary Events (GRACE).Design
Prospective, observational cohort study.Setting
106 hospitals in 14 countries.Patients
3959 patients who presented with STEMI within 6 h of symptom onset and received reperfusion with either a fibrin‐specific fibrinolytic drug or primary PCI.Main outcome measures
6‐month mortality.Methods
Multivariable logistic regression was used to assess the relationship between outcomes and treatment delay separately in each cohort, with time modelled with a quadratic term after adjusting for covariates from the GRACE risk score.Results
A total of 1786 (45.1%) patients received fibrinolytic therapy, and 2173 (54.9%) underwent primary PCI. After multivariable adjustment, longer treatment delays were associated with a higher 6‐month mortality in both fibrinolytic therapy and primary PCI patients (p<0.001 for both cohorts). For patients who received fibrinolytic therapy, 6‐month mortality increased by 0.30% per 10‐min delay in door‐to‐needle time between 30 and 60 min compared with 0.18% per 10‐min delay in door‐to‐balloon time between 90 and 150 min for patients undergoing primary PCI.Conclusions
Treatment delays in reperfusion therapy are associated with higher 6‐month mortality, but this relationship may be even more critical in patients receiving fibrinolytic therapy.Treatment delays in the delivery of fibrinolytic therapy and primary percutaneous coronary intervention (PCI) are associated with increased rates of mortality in patients with ST‐segment elevation myocardial infarction (STEMI).1,2 However, there is controversy as to whether treatment delays in primary PCI are less important than those in fibrinolytic therapy, especially when fibrin‐specific agents are utilised.3 This is important because a differential effect of treatment delays on outcomes may influence the selection between these two reperfusion strategies.3,4,5,6,7 Accordingly, using data from the ongoing, multinational Global Registry of Acute Coronary Events (GRACE), we examined how treatment delays relate to 6‐month mortality in patients with STEMI who received fibrinolytic therapy with a fibrin‐specific agent or primary PCI. GRACE provides an ideal resource for such an investigation because it includes patients who received both types of reperfusion strategies, and the data for each strategy are collected under identical circumstances. 相似文献19.
Omar Asdrúbal Vilca Mejía Bruna La Regina Matrangolo David Provenzale Titinger Leandro Batisti de Faria Luís Roberto Palma Dallan Filomena Regina Barbosa Galas Luiz Augusto Ferreira Lisboa Luís Alberto Oliveira Dallan Fabio Biscegli Jatene 《Arquivos brasileiros de cardiologia》2015,105(5):450-456
Background
Risk scores for cardiac surgery cannot continue to be neglected.Objective
To assess the performance of “Age, Creatinine and Ejection Fraction Score” (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores.Methods
A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor’s and EuroSCORE’s performance through correlation, calibration and discrimination tests.Results
Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763).Conclusion
Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center. 相似文献20.
Sameer Mehta Estefanía Oliveros Carlos E. Alfonso Esther Falcão Faisal Shamshad Ana I. Flores Salomon Cohen 《Journal of the Saudi Heart Association》2009,21(4):229-243