BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients ...BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and II,respectively).METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6%;95%confidence interval[95%CI]:27.7%–33.8%)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I and II were 1.3%(5/399)and 1.0%(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8%(95%CI:97.2%–99.6%)and 98.7%(95%CI:97.0%–99.5%)for MACE I and 98.7%(95%CI:96.8%–99.7%)and 99.0%(95%CI:97.4%–99.6%)for MACE II,respectively.CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated lowrisk patients remained above the level acceptable for early discharge without further evaluation.展开更多
BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress...BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.展开更多
BACKGROUND Cannabis use has increased among young individuals in recent years.Although dependent cannabis use disorder(CUD)has been associated with various cardiac events,its effects on young adults without concurrent...BACKGROUND Cannabis use has increased among young individuals in recent years.Although dependent cannabis use disorder(CUD)has been associated with various cardiac events,its effects on young adults without concurrent substance use remain understudied.AIM To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events(MACCE)in this cohort.METHODSWe used the National Inpatient Sample(2016-2019)to identify hospitalized young individuals(18-44 years),excluding those with concurrent substance usage(tobacco,alcohol,and cocaine).They were divided into CUD+and CUD-.Using International Classification of Diseases-10 codes,we examined the trends in MACCE hospitalizations,including all-cause mortality(ACM),acute myocardial infarction(AMI),cardiac arrest(CA),and acuteischemic stroke(AIS).RESULTSOf 27.4 million hospitalizations among young adults without concurrent substance abuse,4.2%(1.1 million)hadco-existent CUD.In CUD+group,hospitalization rates for MACCE(1.71%vs 1.35%),AMI(0.86%vs 0.54%),CA(0.27%vs 0.24%),and AIS(0.49%vs 0.35%)were higher than in CUD-group(P<0.001).However,rate of ACMhospitalizations was lower in CUD+group(0.30%vs 0.44%).From 2016 to 2019,CUD+group experienced arelative rise of 5%in MACCE and 20%in AMI hospitalizations,compared to 22%and 36%increases in CUDgroup(P<0.05).The CUD+group had a 13%relative decrease in ACM hospitalizations,compared to a 10%relative rise in CUD-group(P<0.05).However,when adjusted for confounders,MACCE odds among CUD+cohort remain comparable between 2016 and 2019.CONCLUSIONThe CUD+group had higher rates of MACCE,but the rising trends were more apparent in the CUD-group overtime.Interestingly,the CUD+group had lower ACM rates than the CUD-group.展开更多
Resistin is a member of the family of cysteine-rich secretary proteins called resistin-like molecules (RELMs). It is suggested to be involved in inflammatory conditions and atherosclerosis. We have established a signi...Resistin is a member of the family of cysteine-rich secretary proteins called resistin-like molecules (RELMs). It is suggested to be involved in inflammatory conditions and atherosclerosis. We have established a significant correlation between serum resistin levels and coronary artery disease (CAD) in a study was performed between 2011 and 2012 in our institute in two hundred fourteen patients (164 CAD patients and 50 controls). Then the CAD patients were followed up to investigate the relationship between increased serum resistin levels and major adverse cardiac events (MACE) between 2012 and 2016. One hundred fifty-five of 164 patients (95%) were followed up and 9 patients lost to follow up. There were 39 MACE (25%) in four years of follow-up.?There were 16 in-hospital deaths due to cardiac causes, 8 revascularization procedures, and 15 re-hospitalization due to acute coronary syndrome (ACS) or heart failure (HF). The patients with MACE had similar serum resistin level (median: 71.37 pg/ml) compared to patients without MACE (median: 80.23 pg/ml) (p > 0.05).展开更多
The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute pha... The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……展开更多
Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city i...Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.展开更多
BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative car...BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-Ⅰ(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and Ddimer(D-D) levels were significantly increased(P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic(ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.展开更多
Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE...Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE)in patients with congenital long QT syndrome(LQT)remains controversial.Methods:A systematic electronic search of PubMed,Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS.Sub-group analysis evaluated the association between microvolt TWA(MTWA)and ACE in different monitoring models and ECGlead numbers.Results:A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE(OR 3.16,95%CI 1.86–5.37,P<0.001).Advanced analysis showed that macroscopic TWA was significantly related to ACE(OR 6.01,95%CI 2.96–12.21,P<0.001),while MTWA did not(OR 0.92,95%CI 0.37–2.30,P=0.85).Sub-group analysis showed that MTWA recorded in 24 h continuous ECG(OR 6.79,95%CI 0.80–57.75,P=0.08)might have a stronger association with ACE than recorded in stress ECG(OR 0.28,95%CI 0.07–1.10,P=0.07).No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads(P=0.15).Conclusions:Macroscopic TWA was significantly related to ACE in patients with LQTS.In terms of MTWA,MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG,but still deserves further evaluation.展开更多
Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with ...Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.展开更多
基金supported by the National Research Foundation of Korea(NRF)grant funded by the Korean government Ministry of Science and ICT(NRF-2021R1G1A101056711)。
文摘BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and II,respectively).METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6%;95%confidence interval[95%CI]:27.7%–33.8%)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I and II were 1.3%(5/399)and 1.0%(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8%(95%CI:97.2%–99.6%)and 98.7%(95%CI:97.0%–99.5%)for MACE I and 98.7%(95%CI:96.8%–99.7%)and 99.0%(95%CI:97.4%–99.6%)for MACE II,respectively.CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated lowrisk patients remained above the level acceptable for early discharge without further evaluation.
文摘BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.
文摘BACKGROUND Cannabis use has increased among young individuals in recent years.Although dependent cannabis use disorder(CUD)has been associated with various cardiac events,its effects on young adults without concurrent substance use remain understudied.AIM To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events(MACCE)in this cohort.METHODSWe used the National Inpatient Sample(2016-2019)to identify hospitalized young individuals(18-44 years),excluding those with concurrent substance usage(tobacco,alcohol,and cocaine).They were divided into CUD+and CUD-.Using International Classification of Diseases-10 codes,we examined the trends in MACCE hospitalizations,including all-cause mortality(ACM),acute myocardial infarction(AMI),cardiac arrest(CA),and acuteischemic stroke(AIS).RESULTSOf 27.4 million hospitalizations among young adults without concurrent substance abuse,4.2%(1.1 million)hadco-existent CUD.In CUD+group,hospitalization rates for MACCE(1.71%vs 1.35%),AMI(0.86%vs 0.54%),CA(0.27%vs 0.24%),and AIS(0.49%vs 0.35%)were higher than in CUD-group(P<0.001).However,rate of ACMhospitalizations was lower in CUD+group(0.30%vs 0.44%).From 2016 to 2019,CUD+group experienced arelative rise of 5%in MACCE and 20%in AMI hospitalizations,compared to 22%and 36%increases in CUDgroup(P<0.05).The CUD+group had a 13%relative decrease in ACM hospitalizations,compared to a 10%relative rise in CUD-group(P<0.05).However,when adjusted for confounders,MACCE odds among CUD+cohort remain comparable between 2016 and 2019.CONCLUSIONThe CUD+group had higher rates of MACCE,but the rising trends were more apparent in the CUD-group overtime.Interestingly,the CUD+group had lower ACM rates than the CUD-group.
文摘Resistin is a member of the family of cysteine-rich secretary proteins called resistin-like molecules (RELMs). It is suggested to be involved in inflammatory conditions and atherosclerosis. We have established a significant correlation between serum resistin levels and coronary artery disease (CAD) in a study was performed between 2011 and 2012 in our institute in two hundred fourteen patients (164 CAD patients and 50 controls). Then the CAD patients were followed up to investigate the relationship between increased serum resistin levels and major adverse cardiac events (MACE) between 2012 and 2016. One hundred fifty-five of 164 patients (95%) were followed up and 9 patients lost to follow up. There were 39 MACE (25%) in four years of follow-up.?There were 16 in-hospital deaths due to cardiac causes, 8 revascularization procedures, and 15 re-hospitalization due to acute coronary syndrome (ACS) or heart failure (HF). The patients with MACE had similar serum resistin level (median: 71.37 pg/ml) compared to patients without MACE (median: 80.23 pg/ml) (p > 0.05).
文摘 The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……
文摘Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.
基金Supported by Beijing Municipal Science&Technology Commission,No.Z171100000417056.
文摘BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-Ⅰ(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and Ddimer(D-D) levels were significantly increased(P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic(ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.
基金This work was supported by Beijing Municipal Science&Technology Commission(No.Z191100006619007)Beijing Municipal Administration of Hospitals’Ascent Plan(DFL20190902)of Professor Ping Zhang.
文摘Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE)in patients with congenital long QT syndrome(LQT)remains controversial.Methods:A systematic electronic search of PubMed,Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS.Sub-group analysis evaluated the association between microvolt TWA(MTWA)and ACE in different monitoring models and ECGlead numbers.Results:A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE(OR 3.16,95%CI 1.86–5.37,P<0.001).Advanced analysis showed that macroscopic TWA was significantly related to ACE(OR 6.01,95%CI 2.96–12.21,P<0.001),while MTWA did not(OR 0.92,95%CI 0.37–2.30,P=0.85).Sub-group analysis showed that MTWA recorded in 24 h continuous ECG(OR 6.79,95%CI 0.80–57.75,P=0.08)might have a stronger association with ACE than recorded in stress ECG(OR 0.28,95%CI 0.07–1.10,P=0.07).No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads(P=0.15).Conclusions:Macroscopic TWA was significantly related to ACE in patients with LQTS.In terms of MTWA,MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG,but still deserves further evaluation.
文摘Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.
