ABSTRACT
Objective:To establish a prediction model for major adverse cardiovascular and cerebrovascular events (MACCE) in elderly patients with emergency acute coronary syndrome (ACS) within 1 year, and to evaluate its prediction efficiency.Methods:This was a prospective cohort study. Elderly ACS patients who were admitted to the Cardiovascular Care Unit (CCU) or the Emergency Intensive Care Unit (EICU) in Beijing Bo'Ai Hospital through emergency department from January 2019 to December 2021 were successively enrolled. General data of the patients were collected within 24 h after admission, the incidence of malignant arrhythmia, complete revascularization and acute kidney injury (AKI) during hospitalization were recorded. Within 24 h, laboratory indexes such as serum creatinine (Scr), albumin (Alb), hypersensitive C-reactive protein (hs-CRP), creatine kinase isoenzyme MB (CK-MB), D-dimer, cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were measured. In addition, transthoracic echocardiography and the Frailty Screening Questionnaire (FSQ) were performed. Patients were followed up for the occurrence of MACCE within 1 year. The influencing factors of MACCE were screened by univariable and multivariable logistic regression analysis. The cut-off values of continuous variables were determined by receiver operating characteristic (ROC) curve and discretization was carried out with reference to clinical practice. Corresponding scores were set up according to the β regression coefficient of each variable to establish a clinical prediction score scale of MACCE. Finally, ROC curve was used to evaluate its prediction efficiency.Results:The study enrolled 322 elderly ACS patients, and the incidence of MACCE within 1 year was 24.5%. After preliminary screening of independent variables by univariable logistic regression analysis, the influencing factors of MACCE ( P<0.2) were as follows: ① Continuous indicators: age, body mass index (BMI), Alb, hs-CRP, D-dimer, NT-pro-BNP, ejection fraction (EF), Killip grade and FSQ score; ② Discrete indicators: ≥3 comorbidities, incomplete revascularization, and AKI. Multivariable logistic regression analysis after discretization of continuous indicators showed that age ≥84 years old [odds ratio ( OR)=4.351, 95% confidence interval (95% CI): 1.635-11.576, P=0.003], incomplete revascularization ( OR=6.580, 95% CI: 2.397-18.060, P < 0.001), combined with AKI ( OR=2.647, 95% CI: 1.085-6.457, P=0.032), EF ≤50% ( OR=2.742, 95% CI: 1.062-7.084, P=0.037), and FSQ≥3 points ( OR=9.345, 95% CI: 3.156-27.671, P < 0.001) were independent risk factors for MACCE. The total score of the clinical prediction system for MACCE was 8 points, including age ≥84 years old (2 points), incomplete revascularization (2 points), FSQ ≥3 points (2 points), EF ≤50% (1 point), and combined with AKI (1 point). The area under ROC curve (AUC) of the scoring system for predicting MACCE was 0.891, (95% CI: 0.844-0.938, P < 0.001). The optimal cut-off value was >3 points, and the sensitivity and specificity were 0.825 and 0.792, respectively. Conclusions:The prediction score scale of MACCE has a good diagnostic efficacy and has certain guiding value for clinicians to judge the prognosis of elderly ACS patients.
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Objective@#To evaluate the European Heart Surgery Risk Assessment System (EuroSCORE II), the US National Cardiovascular Registry Database Risk Score System (NCDRCathPCI Risk Score System), and the age, creatinine, and left ventricular ejection fraction (ACEF) score for major adverse cardiovascular and cerebrovascular events(MACCE) in patients after percutaneous coronary intervention (PCI).@*Methods@#A retrospective analysis of 404 consecutive patients with postoperative PCI patients scored and early prognosis. Calibration was assessed by the Hosmer-Lemeshow (H-L) test, and discrimination was assessed by the receiver operating characteristic (ROC) curve.@*Results@#There were 17 cases (4.21%) of MACCE. EuroSCORE II, NCDRCathPCI, and ACEF predicted the area under the ROC curve of elderly patients with PCI after surgery were 0.871, 0.785, and 0.744, respectively (P < 0.01); the difference between EuroSCORE II and ACEF was statistically significant (P < 0.05). The EuroSCORE II and NCDRCathPCI scoring systems predict good MACCE calibration (EuroSCORE II: 5.14, 95% CI 4.63-5.70; NCDRCathPCI: 4.71, 95% CI 4.47-4.97); and the ACEF scoring system underestimates MACCE. The number of cases (ACEF: 49.41 cases, 95% CI 19.57-124.97).@*Conclusions@#For the elderly patients with postoperative PCI, all three scores can better predict the occurrence of postoperative in-hospital MACCE, and the predictive value of EuroSCORE II is better.
ABSTRACT
Objective To evaluate the European Heart Surgery Risk Assessment System (EuroSCORE II), the US National Cardiovascular Registry Database Risk Score System (NCDRCathPCI Risk Score System), and the age, creatinine, and left ventricular ejection fraction (ACEF) score for major adverse cardiovascular and cerebrovascular events(MACCE) in patients after percutaneous coronary intervention (PCI). Methods A retrospective analysis of 404 consecutive patients with postoperative PCI patients scored and early prognosis. Calibration was assessed by the Hosmer-Lemeshow (H-L) test, and discrimination was assessed by the receiver operating characteristic (ROC) curve. ResuLts There were 17 cases (4.21%) of MACCE. EuroSCORE II, NCDRCathPCI, and ACEF predicted the area under the ROC curve of elderly patients with PCI after surgery were 0.871, 0.785, and 0.744, respectively (P < 0.01); the difference between EuroSCORE II and ACEF was statistically significant (P < 0.05). The EuroSCORE II and NCDRCathPCI scoring systems predict good MACCE calibration (EuroSCORE II: 5.14, 95% CI 4.63-5.70; NCDRCathPCI: 4.71, 95% CI 4.47-4.97); and the ACEF scoring system underestimates MACCE. The number of cases ( ACEF: 49.41 cases, 95% CI 19.57-124.97). ConcLusions For the elderly patients with postoperative PCI, all three scores can better predict the occurrence of postoperative in-hospital MACCE, and the predictive value of EuroSCORE II is better.
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Objective To evaluate the infl uence of iodixanol on Chinese patients who had chronic kidney disease(CKD) and received percutaneous coronary intervention complicated with major adverse cardiovascular and cerebrovascular events(MACCE) and contrast-induced acute kidney injury(CIAKI). Methods From 30th October 2013 to 7th October 2015, 3042 patients were enrolled in 30 centers in China. Patients were monitored in the hospital for 3 days and followed-up at 1 month. Patients were divided into chronic kidney disease group(n=105)and non chronic kidney disease group (n=2937) according to whether the patient has chronic nephropathy or not.The primary end point was the incidence rate of MACCE (re-revascularization of target lesions, stroke, stent thrombosis,cardiac death and myocardial infarction) and CIAKI in hospital 72 hours after PCI. The secondary end point was the incidence rate from 72 hours to 30 days post-PCI. Resuits (1)There were obvious differences between the two groups in baseline demographic date including age,BMI,comorbidities of hypertension,congestive heart failure, dyslipidemia,diabetes mellitus,peptic ulcer,ischemic stroke,previous use of antihypertensive drugs, diuretics,lipid-regulating drugs,hypoglycemic drugs,antiplatelet drugs and anticoagulants(all P<0.05).(2) There were obvious differences the CKD and non-CKD groups in perioperative date including operative route,preoperative hydration volume,postoperative hydration volume,total hydration volume,degree of postoporation lesion stenosis, contrast media used and machine injection rate(all P<0.05).(3)There were signifi cant diff erences between the two groups in the percentage of prescription of β-blocker,lipid-regulating drugs and antiplatelet drugs after PCI(all P<0.05).(4)There was not statistical diff erences between two groups in MACCE incidence in hospital and from 72 hours to 30 days post-PCI(P>0.05). (5)There was not statistical diff erences between two the groups in CIAKI incidence in hospital (P>0.05). Conclusions Iodixanol had no signifi cant eff ect on the incidence of MACCE and CIAKI in Chinese chronic kidney disease patients and non-CKD patients who received PCI.