The development of minimally invasive treatment over the last two decades has had a great impact on hepatitis B virus (HBV)-associated primary liver cancer. The model for end-stage liver disease (MELD) score is the optimal evaluated parameter for mortality in patients with end-stage liver disease. However, the association between MELD score and minimally invasive treatment with regard to the mortality of patients with HBV-associated hepatocellular carcinoma (HCC) with a portal vein tumor thrombus (PVTT) remains unclear. In the present study, a total of 173 patients who had been diagnosed with HBV-associated HCC and PVTT in the Beijing Ditan Hospital (Beijing, China), between January 2012 and January 2015, were screened. Follow-up was performed to observe the survival time and collect information on the demographic characteristics and associated clinical indicators present in the cohort. The patient's age, sex, laboratory parameters and the use of minimally invasive treatment were analyzed with SPSS 20.0 software. Independent risk factors for mortality were screened by Cox regression analysis. Logistic regression indicated that there was an interaction between the MELD score and minimally invasive treatment. In addition, a MELD score ≤17.85 was associated with a lower mortality rate subsequent to minimally invasive treatment.
Background: The association of atherogenic index of plasma (AIP), an emerging lipid index which can predict risk for cardiovascular (CV) disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has been undetermined. Therefore, the aim of this study was to investigate whether AIP could independently predict adverse CV events in T2DM patients with ACS undergoing PCI.Methods: This study was a retrospective analysis of a single-centre prospective registry involving 826 consecutive T2DM patients who underwent primary or elective PCI for ACS at our CV center from June 2016 to November 2017. This study eventually included 798 patients (age, 61±10 years, male, 72.7%). AIP was calculated as the base 10 logarithm of the ratio of plasma concentration of triglycerides to high density lipoprotein-cholesterol (HDL-C). All patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of all-cause death, non-fatal ischemic stroke, non-fatal myocardial infarction (MI), or unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal ischemic stroke, or non-fatal MI.Results: During a median follow-up period of 927 days, 198 patients developed at least one event. An unadjusted Kaplan–Meier analysis showed the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test, P =0.001). A multivariate Cox proportional hazards analysis revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.153; 95% confidence interval [CI]: 1.355 to 3.421; P =0.001, and HR: 2.613; 95% CI: 1.024 to 6.666; P =0.044, respectively). Inclusion of AIP quartiles in a baseline prediction model for the primary endpoint increased the Harrell’s C statistic from 0.697 to 0.707. More importantly, addition of AIP quartiles to the above model significantly improved the continuous net reclassification improvement (continuous NRI =19.1%, P <0.001).Conclusions: A higher AIP value on admission was independently and strongly associated with adverse CV events in T2DM patients with ACS undergoing PCI.
Background and Aims. Heart rate (HR) and hypertension are both important risk factors for adverse cardiovascular (CV) events in patients with established coronary artery disease (CAD). We sought to evaluate whether hypertension can modify the effect of admission HR on adverse CV events in patients with acute coronary syndrome (ACS). Methods. A total of 1056 patients with ACS undergoing percutaneous coronary intervention (PCI) were analyzed. All patients were classified into three groups according to the tertiles of admission HR (T1: ≤66 bpm, n = 369; T2: 67–73 bpm, n = 322; and T3: ≥74 bpm, n = 365). The primary endpoint was defined as major adverse CV events (MACEs), including all-cause death, stroke, myocardial infarction, or unplanned repeat revascularization. The multivariate Cox regression model was performed to evaluate the association of admission HR with MACE stratified by hypertension. Results. During the median follow-up of 30 months, a total of 232 patients developed at least one event. After adjusting for other covariates, elevated admission HR was significantly associated with an increased risk of MACE only in patients with hypertension (when T1 was taken as a reference, the adjusted HR of T2 was 1.143 [95% CI: 0.700–1.864] and that of T3 was 2.062 [95% CI: 1.300–3.270]); however, in patients without hypertension, admission HR was not associated with the risk of MACE (when T1 was taken as a reference, the adjusted HR of T2 was 0.744 [0.406–1.364] and that of T3 was 0.614 [0.342–1.101]) ( P = 0.025 for interaction). Conclusions. In patients with ACS undergoing PCI, the association of elevated admission HR with an increased risk of MACE was present in individuals with hypertension but not in those without hypertension. This finding suggests a potential benefit of HR control for ACS patients when they concomitantly have hypertension.
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