Upstroke Time Per Cardiac Cycle as A Novel Parameter for Mortality Prediction in Patients with Acute Myocardial Infarction

Abstract

Background: Acute myocardial infarction (AMI) is one of the leading causes of death in the world. How to simply predict mortality for AMI patients is important because the appropriate treatment should be done for the patients with higher risk. Recently, a novel parameter of upstroke time per cardiac cycle (UTCC) in lower extremities was reported to be a good predictor of peripheral artery disease and mortality in elderly. However, there was no literature discussing the usefulness of UTCC for prediction of cardiovascular (CV) and overall mortality in AMI patients. Methods: 184 AMI patients admitted to the cardiac care unit were enrolled. Ankle-brachial index (ABI) and UTCC were measured by an ABI-form device in the same day of admission. Results: The median follow-up to mortality was 71 months. There were 36 CV and 124 overall mortality. Higher UTCC was associated with increased CV and overall mortality after multivariable analysis (P = 0.033 and P < 0.001, respectively). However, ABI was only associated with CV mortality and overall mortality in the univariable analysis but became insignificant after the multivariable analysis. In addition, after adding UTCC into a basic model including important clinical parameters, left ventricular ejection fraction, Charlson comorbidity index, and ABI, we found the basic model + UTCC had a better predictive value for overall mortality than the basic model itself (P < 0.001). Conclusions: Our study is the first one to evaluate the usefulness of UTCC in AMI patients for prediction of long-term mortality. Our study showed UTCC was an independent predictor of long-term CV and overall mortality and had an additive predictive value for overall mortality beyond conventional parameters. Therefore, screening AMI patients by UTCC might help physicians to identify the high-risk group with increased mortality.

Usefulness of Upstroke Time per Cardiac Cycle for Cardiovascular and All-Cause Mortality Prediction in Patients with Normal Ankle-Brachial Index

“…Chang LH et al also demonstrated that UTCC was associated with CV outcomes and in patients with type 2 diabetes 22) . Furthermore, our previous study revealed that UTCC was an independent predictor of long-term CV and all-cause mortality in patients with acute myocardial infarction 18) . According to the abovementioned literature 17,21) , UT and UTCC were useful parameters for the diagnosis of PAD and could be used to evaluate the peripheral vascular function and future outcomes.…”

“…We adjusted significant variables and time to mortality using Cox regression analysis. We also calculated the improvement of global chi-square to evaluate the additive value of ABI, baPWV, LVEF, and UTCC over a basic model for long-term CV and all-cause cardiac cycle (UTCC) was reported to be a diagnostic tool of PAD and a predictor of mortality in patients with acute myocardial infarction and older population 17,18) . Therefore, our study aimed to evaluate the usefulness of UTCC for the prediction of CV and all-cause mortality in patients with normal ABI.…”

“…Because UT and UTCC were both useful parameters for the diagnosis of PAD and predictors for CV outcomes [14][15][16][17][18] , the improvement of UT or UTCC might have a good impact on future outcomes. PAD is one of the vascular bed diseases with extremely high morbidity and mortality.…”

Using CHADS2 and CHA2DS2-VASc scores for mortality prediction in patients with chronic kidney disease

“…Causes of CV mortality were defined deaths due to cerebral vascular disease, ischemic heart disease, myocardial infarction, heart failure, valvular heart disease and atherosclerotic vascular disease. The detailed method was the same as our previous published paper 18 .…”