A Validated Prediction Model for All Forms of Acute Coronary Syndrome

Eagle, Kim A.; Lim, Michael J.; Dabbous, O.; Pieper, Karen S.; Goldberg, Robert J.; Werf, Frans Van de; Goodman, Shaun G.; Granger, Christopher B.; Steg, Philippe Gabriel; Gore, Joel M.; Budaj, Andrzej; Avezum, Álvaro; Flather, Marcus; Fox, Keith A.A.; Investigators, Grace

doi:10.1001/jama.291.22.2727

Cited by 1,387 publications

(357 citation statements)

References 23 publications

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“…In recent years, a considerable number of studies have analyzed the prognostic role of different biochemical markers in patients with AMI with the objective of identifying patients at a high risk of death or myocardial infarction [12,13]. Renal failure is known to be a sign of poor prognosis in both the short and long term for patients with ischemic heart disease [2,3].…”

Section: Discussionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate in Short-Risk Stratification in Acute Myocardial Infarction

et al. 2011

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Background/Aims: Renal dysfunction is associated with a higher risk of cardiovascular disease in patients with acute myocardial infarction (AMI). The aim of this study was to investigate the independent prognostic value of renal dysfunction and its incremental predictability risk after adjusting for well-known clinical factors in patients with AMI. Methods: 751 consecutive patients with AMI admitted to the Coronary Care Unit (CCU) were included. Patients were grouped into 2 categories according to the baseline estimated glomerular filtration rate (eGFR) on admission (eGFR <60 vs. eGFR ≧60 ml/min/1.73 m²). C-reactive protein and white blood cell count (WBC) as well as clinical prognostic variables were assessed. The endpoint was mortality during CCU stay. The discriminatory power was estimated by the C-index. Results: The patient group with an eGFR <60 ml/min/1.73 m² was older, had more cardiovascular risk factors, a lower left ventricular ejection fraction and higher cardiovascular mortality during CCU stay (13 vs. 3%). Logistic regression analysis revealed the following predictors of mortality: degree of renal impairment (eGFR <60 ml/min/1.73 m²), hazard ratio (HR) = 2.2 (95% CI 1.1–4.3; p = 0.028); WBC >11,000 × 10⁶/l, HR = 2.3 (95% CI 1.2–4.5; p = 0.017); Killip class on admission, HR = 3.8 (95% CI 1.7–8.5; p = 0.001), and New York Heart Association Functional Classification, HR = 3.6 (95% CI 1.7–7.4; p = 0.001). The adjusted C-index was 0.78 for baseline clinical variables and 0.84 for eGFR. Conclusions: In patients with AMI, decreased eGFR is an important prognostic factor for impaired cardiac function and mortality in the short-term follow-up. The eGFR may be reliably used in the risk stratification of patients with AMI.

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Section: Discussionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate in Short-Risk Stratification in Acute Myocardial Infarction

et al. 2011

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“…The risk of cardiovascular events is particularly high in patients with earlier CVD manifestations 6, 7. For example, the 3‐year cumulative incidence of major adverse cardiovascular events in patients undergoing carotid endarterectomy was 13% 8.…”

Section: Introductionmentioning

confidence: 99%

High Levels of (Un)Switched Memory B Cells Are Associated With Better Outcome in Patients With Advanced Atherosclerotic Disease

Meeuwsen

Duijvenvoorde

Gohar

et al. 2017

JAHA

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BackgroundAtherosclerosis is an inflammatory lipid disorder and the main underlying pathology of acute ischemic events. Despite a vast amount of data from murine atherosclerosis models, evidence of B‐cell involvement in human atherosclerotic disease is limited. We therefore investigated the association of circulating B‐cell subtypes with the occurrence of secondary cardiovascular events in advanced atherosclerotic disease.Methods and ResultsThis cohort study consists of 168 patients who were included in the Athero‐Express biobank between 2009 and 2011. Before surgery, peripheral blood mononuclear cells were isolated and stored in liquid nitrogen. After gentle thawing of the peripheral blood mononuclear cells, different B‐cell subtypes including naïve, (un)switched memory, and CD27+ CD43+ B1‐like B cells, were analyzed by flow cytometry. Univariable and multivariable Cox proportional hazard models were used to analyze associations between B‐cell subtypes, circulating antibodies and secondary cardiovascular manifestations during the 3‐year follow‐up period. Mean age was 70.1±9.6 years, males represented 62.8% of the population, and 54 patients had secondary manifestations during follow‐up. High numbers of unswitched memory cells were protective against secondary outcome (hazard ratio, 0.30 [95% CI, 0.13–0.69]; P<0.01). Similar results were obtained for the switched memory cells that also showed to be protective against secondary outcome (hazard ratio, 0.33 [95% CI, 0.14–0.77]; P=0.01).ConclusionsA high number of (un)switched memory B cells is associated with better outcome following carotid artery endarterectomy. These findings suggest a potential role for B‐cell subsets in prediction and prevention of secondary cardiovascular events in patients with atherosclerosis.

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“…Clinical covariates included body mass index, prior AMI (before the AMI at index hospitalization), prior CABG, prior stroke or transient ischemic attack, prior stable angina, cancer, diabetes mellitus, hypertension, hypercholesterolemia, peripheral vascular disease, chronic kidney disease, dialysis, chronic heart failure, chronic lung disease, family history of coronary artery disease, depression, and baseline health status (as measured by Seattle Angina Questionnaire angina frequency and quality of life scores8 and Short Form 12 physical and mental component summary scores9). Index hospitalization clinical covariates included initial systolic blood pressure, initial heart rate, ST‐segment elevations on ECG, left ventricular systolic dysfunction (ejection fraction <40%), Global Registry of Acute Coronary Event discharge risk score,10 and highest serum troponin level. Finally, treatment characteristics during index AMI hospitalization included in‐hospital PCI and CABG and medications at admission and at discharge, including aspirin, beta blockers, statins, angiotensin antagonists, thienopyridines, and insulin.…”

Section: Methodsmentioning

confidence: 99%

Clinical Relevance of Rehospitalizations for Unstable Angina and Unplanned Revascularization Following Acute Myocardial Infarction

Shore

Smolderen

Spertus

et al. 2016

JAHA

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BackgroundRehospitalizations following acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are often included as parts of composite end points in clinical trials. Although clearly costly, the clinical relevance of these individual components has not been described.Methods and ResultsPatients enrolled in a prospective, 24‐center, US acute myocardial infarction registry were followed for 1 year after an acute myocardial infarction for rehospitalizations, that were independently adjudicated by experienced cardiologists. Patients who did and did not experience UA or revascularization rehospitalization were propensity matched using greedy matching. Among 3283 patients with acute myocardial infarction who were included, mean age was 59 years, 33% were female, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 5.0% and 4.1%, respectively. After propensity matching, we included 2433 patients in the UA rehospitalization group and 2410 in the unplanned revascularization group. Using weighted proportional hazards Cox regression, there was no significant association between a rehospitalization for UA and 5‐year all‐cause mortality (9.6% versus 13.8%; adjusted hazard ratio 0.87, 95% CI 0.60–1.16). Patients rehospitalized for unplanned revascularization had a lower 5‐year mortality risk (7.0% versus 15.1%; hazard ratio 0.68, 95% CI 0.50–0.92) compared with those without such rehospitalizations. Nevertheless, patients with UA and unplanned revascularization had a substantially greater hazard of subsequent rehospitalizations compared with patients without such events (UA: hazard ratio 4.36, 95% CI 3.48–5.47; revascularization: hazard ratio 4.38, 95% CI 3.53–5.44).ConclusionsRehospitalizations for UA and unplanned revascularization in the year after an acute myocardial infarction are associated with higher risks of subsequent rehospitalizations but not with mortality.

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A Validated Prediction Model for All Forms of Acute Coronary Syndrome

Cited by 1,387 publications

References 23 publications

Estimated Glomerular Filtration Rate in Short-Risk Stratification in Acute Myocardial Infarction

Estimated Glomerular Filtration Rate in Short-Risk Stratification in Acute Myocardial Infarction

High Levels of (Un)Switched Memory B Cells Are Associated With Better Outcome in Patients With Advanced Atherosclerotic Disease

Clinical Relevance of Rehospitalizations for Unstable Angina and Unplanned Revascularization Following Acute Myocardial Infarction

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