The prognostic value of multiple electrode aggregometry and light transmittance aggregometry in stable cardiovascular patients with type 2 diabetes mellitus
Argirios Ε. TsantesMaria TaichertElias KyriakouΚ KatogiannisTheodore LytrasArgyri GialerakiEleni TzoumakidouStyliani KokorisPanagiota DouramaniAthina KypraiouAristarchos PoulisGeorgios KatsadiotisDimitrios KalantzisChristine KottaridiPetros KopteridesStefanos BonovasIgnatios Ikonomidis
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Objective To evaluate the safety and efficacy of domestic clopidogrel(Talcom) in patients with coronary artery disease and diabetes mellitus.Methods 168 patients who hospitalized for coronary artery disease and successfully received coronary stenting were divided into Talcom group(n=73) and Plavix(imported clopidogrel as control) group(n=95).The incidence of major adverse cardiac events(MACE) and bleeding between the two groups were compared in 6 months follow-up after operation.Results There were no significant difference about the incidence of MACE and bleeding between the two groups after 6 months follow-up.Conclusion The efficacy and safety of domestic clopidogrel(Talcom) is similar to that of imported clopidogrel(Plavix).
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[enter Abstract Background: Longstanding cardiovascular risk factors cause major adverse cardiovascular events (MACE). MACE prediction may improve outcomes.Aim: To evaluate the ten-year predictors of MACE in patients without angina.Method: Patients referred to Inkosi Albert Luthuli Hospital, Durban, South Africa, without typical angina from 2002 to 2008 were collected, and followed-up for MACE from 2009 to 2019. Survival time was calculated in months. Independent variables were tested with Cox proportional hazard to predict MACE-morbidity and MACE-mortality. Results: There were 525 patients; at baseline 401 (73%) were Indian, 167 (32%) had diabetes. At 10-year follow-up 157/525 (29.9%) experienced MACE-morbidity, of whom, 82/525 (15.6%) had MACE-mortality. There were 368/525 (70.1%) patients censored, of whom 195/525 (37.1%) were lost to follow-up. For MACE-morbidity, mean and longest observation times were 102.2 and 201 months, respectively. Hazards for MACE-morbidity were age [hazard ratio (HR)=1.025], diabetes [HR=1.436], Duke Risk category [HR=1.562], and Ischaemic burden category [HR=1.531] (global p=0.9074). For MACE-mortality, mean and longest observation times were 107.9 and 204 months, respectively. Hazards for MACE-mortality were age [HR=1.044], Duke Risk category [HR=1.983], echocardiography risk category [HR=2.537] and Ischaemic burden category [HR=1.780] (global p=0.8547).Conclusion: In diabetic patients without typical angina, early ischaemia on non-invasive tests, indicated microvascular disease and hyperglycaemia, and reliably predicted long-term MACE-morbidity and MACE-mortality. Diabetes was a hazard for MACE-morbidity but not for MACE-mortality; patients lost to follow-up were possibly diabetic patients with MACE-mortality at district hospitals. Indian descent patients may have higher MACE risk. Early screening for ischaemia and hyperglycaemia control may improve outcomes.
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Aim: To evaluate the 6-month recurrent major adverse cardiac events (MACE) in acute coronary syndrome (ACS) patients, in relation to region and clopidogrel treatment separately for men and women. Material and Methods: During 2016, n =1,194 consecutive ACS patients hospitalized in various Cardiology Clinics in Aegean islands and Attica region, were enrolled. Clopidogrel treatment was recorded either as original product clopidogrel hydrogen sulphate (Plavix®/Iscover®) (branded) or clopidogrel besylate formulation (generic). Six-month follow-up evaluation was performed and recurrent MACE incidence and hemorrhage event were recorded. Results: The 6-month MACE incidence was 3.9% (4.6% in Aegean islands and 3.5% in Attica area, p>0.05 ). The respective incidence in men was 4.0% and in women 3.8% ( p>0.05 ). Overall generic and branded clopidogrel use was 87% and 13%, respectively. No significant differences were observed between branded and generic clopidogrel use and 6-month MACE incidence; subgroup analysis with gender as strata, did not reveal any significant outcomes as well. Hemorrhage incidence did not exceed the 1% in the total sample. Conclusions: The low incidence of recurrent MACE in ACS patients along with the low rate of bleeding events, irrespective of type of clopidogrel used, support the clinical and safety equivalence of generic and branded clopidogrel in the cardiac rehabilitation of ACS men and women patients.
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The relationship between serum IL-38 and major adverse cardiovascular events (MACE) in patients with ST elevation myocardial infarction (STEMI) remains unclear.In the present study, 589 STEMI patients were included, the serum level of IL-38 was measured. The median follow-up time was 720 days, the STEMI patients were divided into high IL-38 (IL-38>6.49ng/mL) and low IL-38 groups (IL-38≤6.49ng/mL) to compare the probability of MACE.Plasma IL-38 levels were significantly lower in STEMI patients than in SAP patients (4.0±2.2 vs 6.9±3.2 ng/mL, P < 0.001). Ninety-three STEMI patients met the defined MACE study endpoint. The incidence of MACE was significantly lower in patients with high IL-38 group than in patients with low IL-38 group (7.8% vs 23.7%, P < 0.001). Low plasma IL-38 levels were independently associated with the occurrence of MACE (OR = 0.90, P < 0.001).We get a conclusion that low plasma levels of IL-38 are independently associated with the occurrence of MACE.
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The present study aimed to investigate the associations between high-density lipoprotein (HDL) functionality and major adverse cardiovascular events (MACE) in patients who have undergone coronary computed tomography angiography (CCTA). We performed a prospective cohort study and enrolled 151 patients who underwent CCTA and had a follow-up of up to 5 years. We measured cholesterol efflux capacity (CEC), caspase-3/7 activity and monocyte chemoattractant protein-1 (MCP-1) secretion as bioassays of HDL functionality. The patients were divided into MACE(−) (n = 138) and MACE(+) (n = 13) groups. While there was no significant difference in %CEC, caspase-3/7 activity or MCP-1 secretion between the MACE(−) and MACE(+) groups, total CEC and HDL cholesterol (HDL-C) in the MACE(+) group were significantly lower than those in the MACE(−) group. Total CEC was correlated with HDL-C. A receiver-operating characteristic curve analysis showed that there was no significant difference between the areas under the curves for total CEC and HDL-C. In conclusion, total CEC in addition to HDL-C, but not %CEC, was associated with the presence of MACE. On the other hand, HDL functionality with regard to anti-inflammatory and anti-apoptosis effects was not associated with MACE.
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Objective To investigate the significance of serum N-terminal pro-B-type natriuretic peptide(NTproBNP) for the future risk evaluation of major adverse cardiac events(MACE) in elderly patients with stable coronary artery disease(SCAD).Methods A total of 810 elderly patients with SCAD were classified into non-MACE group(468 cases) and MACE group [342 cases,including cardiogenic readmission group(200 cases),nonfatal acute myocardial infarction(AMI) group(61 cases) and death group(81 cases) ] according to disease prognosis.The 342 cases of MACE group were classified into the short-term MACE group(180 cases) and the long-term MACE group(162 cases).The serum NT-proBNP levels of 40 healthy controls and 810 elderly patients with SCAD,which were followed up in the third month,in the sixth month and in the twelfth month,were determined by bi-directional lateral flow immunoassay.The results were analyzed statistically.The MACE were followed up and observed for an average of 24 months.Results The serum NT-proBNP levels at initial admission in the MACE group and non-MACE group were significantly higher than those in the control group(P 0.01),the serum NT-proBNP levels at initial admission in the MACE group were significantly higher than those in the non-MACE group(P 0.01),the serum NT-proBNP levels at initial admission in the short-term MACE group were significantly higher than those in the long-term MACE group(P 0.05),and the serum NT-proBNP level at initial admission in the death group and nonfatal AMI group were significantly higher than those in the cardiogenic readmission group(P 0.05).The serum NT-proBNP levels at initial admission were negatively correlated with the interval time of the patients with readmission and AMI [r =-0.359(P = 0.000),r =-0.458(P = 0.026) ].The serum NT-proBNP level was higher,and the incidence rates of MACE were higher.The incidence rates of MACE in different serum NT-proBNP level groups were significantly different(P 0.01),except the NT-proBNP 6 000 ng/L group.Before MACE,the top value of serum NT-proBNP in the MACE group was significantly higher than that in the non-MACE group,and the top value of serum NT-proBNP in the death group was significantly higher than that in the other groups(P 0.05,P 0.01).In the third,sixth and twelfth months of follow-up period,the serum NT-proBNP levels in the MACE group were significantly higher than those at initial admission(P 0.01).The serum NT-proBNP levels in the non-MACE group were significantly lower than those at initial admission(P 0.01),and were significantly lower than those in MACE group(P 0.01).Kaplan-Meier curve showed that the survival rate with different serum NT-proBNP levels had statistical significance(P 0.01).The death group with various diseases had no statistical significance for the serum NT-proBNP levels(P 0.05).Conclusions The incidence rate of MACE and the interval time of the MACE in elderly patients with SCAD are closely correlated with the serum NT-proBNP level at initial admission and with the changes of serum NT-proBNP levels and the top value of serum NT-proBNP in the follow-up period.The serum NT-proBNP determination for the MACE risk evaluation in elderly patients with SCAD has an important prognostic significance.
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Objective
To evaluate the predictive value of coronary CT angiography (CCTA) combined with four-dimensional speckle tracking echocardiography (4D-STE) for major adverse cardiac events (MACE) in patients with coronary atherosclerosis.
Methods
A total of 103 patients with coronary atherosclerosis admitted to the North Area of Jiaozhou People's Hospital were examined by CCTA and 4D-STE. The incidence of MACE was counted at 1 year follow-up, and the degree of coronary stenosis and the amplitude of myocardial strains (GCS, GRS, GLS, GAS) in patients with and without MACE were analyzed.
Results
The incidence of MACE was 20.39% (21/103) in the first year of follow-up. The degree of coronary artery stenosis in the MACE group was mainly grade 3 and 4, while that in the non-MACE group was mainly grade 1 and 2. The proportions of grade 3 (52.38%) and grade 4 (38.10%) in the MACE group were higher than those in the non-MACE group (17.07% and 2.44%). The proportion of grade 1 (0.00%) and grade 2 (9.52%) in the MACE group was lower than that in MACE group (30.49% and 50.00%) (P<0.05). There was no significant difference in the amplitude of myocardial strains (GCS, GRS, GLS, GAS) between the two groups (P<0.05).
Conclusion
CCTA can accurately assess the degree of coronary artery stenosis, and 4D-STE can quantitatively assess the strain amplitude of myocardial segments. CCTA combined with 4D-STE can improve the predictive value of MACE and provide evidences for clinical prevention and treatment.
Key words:
Coronary atherosclerosis; Coronary CT angiography; Four-dimensional speckle tracking echocardiography; Major adverse cardiac events
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Background: In patients with suspected myocardial infarction (MI), we sought to validate a machine learning-driven, multibiomarker panel for prediction of incident major adverse cardiovascular events (MACE). Methodology & results: A previously described prognostic panel for MACE consisting of four biomarkers was measured in 748 patients with suspected MI. The investigated end point was incident MACE within 1 year. The prognostic value of a continuous score and an optimal cut-off was investigated. The area under the curve was 0.86 for the overall model. Using the optimal cut-off resulted in a negative predictive value of 99.4% for incident MACE. Patients with an elevated prognostic score were at high risk for MACE. Conclusion: Among patients with suspected MI, we validated a multibiomarker panel for predicting 1-year MACE. Clinical Trial Registration: NCT02355457 (ClinicalTrials.gov)
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Longstanding cardiovascular risk factors cause major adverse cardiovascular events (MACE). Major adverse cardiovascular events prediction may improve outcomes. The aim was to evaluate the ten-year predictors of MACE in patients without angina.Patients referred to Inkosi Albert Luthuli Hospital, Durban, South Africa, without typical angina from 2002 to 2008 were collected and followed up for MACE from 2009 to 2019. Survival time was calculated in months. Independent variables were tested with Cox proportional hazard models to predict MACE morbidity and MACE mortality.There were 525 patients; 401 (76.0%) were Indian, 167 (31.8%) had diabetes at baseline. At 10-year follow up 157/525 (29.9%) experienced MACE morbidity, of whom, 82/525 (15.6%) had MACE mortality. There were 368/525 (70.1%) patients censored, of whom 195/525 (37.1%) were lost to follow up. For MACE morbidity, mean and longest observation times were 102.2 and 201 months, respectively. Predictors for MACE morbidity were age (hazard ratio [HR] = 1.025), diabetes (HR = 1.436), Duke Risk category (HR = 1.562) and Ischaemic burden category (HR = 1.531). For MACE mortality, mean and longest observation times were 107.9 and 204 months, respectively. Predictors for MACE mortality were age (HR = 1.044), Duke Risk category (HR = 1.983), echocardiography risk category (HR = 2.537) and Ischaemic burden category (HR = 1.780).Among patients without typical angina, early ischaemia on noninvasive tests indicated microvascular disease and hyperglycaemia, predicting long-term MACE morbidity and MACE mortality.Contribution: Diabetes was a predictor for MACE morbidity but not for MACE mortality; patients lost to follow-up were possibly diabetic patients with MACE mortality at district hospitals. Early screening for ischaemia and hyperglycaemia control may improve outcomes.
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Unstable angina
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