Background:The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines.But it has inherent defects.The present study aimed to investigate ...Background:The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines.But it has inherent defects.The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes.Methods:A total of 1093 consecutive STEMI patients were included and followed up 48.2 months.Homocysteine,hypersensitive C-reactive protein (hs-CRP),and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected.The KAMIR score and the GRACE score were calculated.The performance between the KAMIR and the GRACE was compared.The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve.Results:The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death:AUC = 0.802 vs.0.721,P<0.001;major adverse cardiovascular events (MACE):AUC = 0.683 vs.0.656,P<0.001).It showed that the biomarkers could independently predict death [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.052 (1.000–1.104),P= 0.018;NT-pro BNP:HR= 1.142 (1.004–1.280),P= 0.021] and MACE [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.012 (1.003–1.021),P= 0.020;NT-pro BNP:HR= 1.136 (1.104–1.168),P= 0.006].When they were used in combination with the KAMIR,the area under the ROC curve (AUC) significantly increased for death [homocysteine:AUC = 0.802 vs.0.890,Z = 5.982,P<0.001;hs-CRP:AUC = 0.802 vs.0.873,Z= 3.721,P<0.001;NT-pro BNP:AUC= 0.802 vs.0.871,Z = 2.187,P= 0.047;homocysteine,hs-CRP and NT-pro BNP:AUC = 0.802 vs.0.940,Z = 6.177,P<0.001] and MACE [homocysteine:AUC = 0.683 vs.0.771,Z= 6.818,P<0.001;hs-CRP:AUC= 0.683 vs.0.712,Z= 2.022,P= 0.031;NT-pro BNP:AUC= 0.683 vs.0.720,Z= 2.974,P= 0.003;homocysteine,hs-CRP and NT-pro BNP:AUC= 0.683 vs.0.789,Z= 6.900,P<0.001].Conclusion:The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients.A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.展开更多
To the Editor:A 71-year-old male was admitted to the hospital for progressive exertional dyspnea.He had a history of fibrosing mediastinitis(FM)-induced pulmonary vascular stenosis.His right interlobar pulmonary arter...To the Editor:A 71-year-old male was admitted to the hospital for progressive exertional dyspnea.He had a history of fibrosing mediastinitis(FM)-induced pulmonary vascular stenosis.His right interlobar pulmonary artery had been severely stenosed and implanted with a 6-mm diameter stent(6 mm×18 mm;PALMAZ®BLUETX1,Cordis,Shanghai,China)6 months before admission,and his left superior pulmonary vein had been implanted with a 9-mm diameter stent(9 mm×29 mm;Express1 M Vascular LD,Boston Scientific,Marlborough,MA,USA)1 month before admission.展开更多
文摘Background:The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines.But it has inherent defects.The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes.Methods:A total of 1093 consecutive STEMI patients were included and followed up 48.2 months.Homocysteine,hypersensitive C-reactive protein (hs-CRP),and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected.The KAMIR score and the GRACE score were calculated.The performance between the KAMIR and the GRACE was compared.The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve.Results:The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death:AUC = 0.802 vs.0.721,P<0.001;major adverse cardiovascular events (MACE):AUC = 0.683 vs.0.656,P<0.001).It showed that the biomarkers could independently predict death [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.052 (1.000–1.104),P= 0.018;NT-pro BNP:HR= 1.142 (1.004–1.280),P= 0.021] and MACE [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.012 (1.003–1.021),P= 0.020;NT-pro BNP:HR= 1.136 (1.104–1.168),P= 0.006].When they were used in combination with the KAMIR,the area under the ROC curve (AUC) significantly increased for death [homocysteine:AUC = 0.802 vs.0.890,Z = 5.982,P<0.001;hs-CRP:AUC = 0.802 vs.0.873,Z= 3.721,P<0.001;NT-pro BNP:AUC= 0.802 vs.0.871,Z = 2.187,P= 0.047;homocysteine,hs-CRP and NT-pro BNP:AUC = 0.802 vs.0.940,Z = 6.177,P<0.001] and MACE [homocysteine:AUC = 0.683 vs.0.771,Z= 6.818,P<0.001;hs-CRP:AUC= 0.683 vs.0.712,Z= 2.022,P= 0.031;NT-pro BNP:AUC= 0.683 vs.0.720,Z= 2.974,P= 0.003;homocysteine,hs-CRP and NT-pro BNP:AUC= 0.683 vs.0.789,Z= 6.900,P<0.001].Conclusion:The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients.A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.
基金a grant from the National Natural Science Foundation of China(Nos.81770300,81860059,81460072,82070052)Chinese Academy of Sciences“Light of West China”Program,International Joint Research Program of Gansu Province(No.18YF1WA046)+1 种基金Innovation and Entrepreneurship Program of Lanzhou City(No.2018-RC-78)the Science Foundation of Gansu Provincial Hospital(No.18GSSY5-4).
文摘To the Editor:A 71-year-old male was admitted to the hospital for progressive exertional dyspnea.He had a history of fibrosing mediastinitis(FM)-induced pulmonary vascular stenosis.His right interlobar pulmonary artery had been severely stenosed and implanted with a 6-mm diameter stent(6 mm×18 mm;PALMAZ®BLUETX1,Cordis,Shanghai,China)6 months before admission,and his left superior pulmonary vein had been implanted with a 9-mm diameter stent(9 mm×29 mm;Express1 M Vascular LD,Boston Scientific,Marlborough,MA,USA)1 month before admission.