ABSTRACT
BACKGROUND: This study aims to estimate prognostic indicators of new onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS) through 3 to 5 years of follow-up. HYPOTHESIS: For patients with ACS, some prognostic indicators can be used to predict new onset AF. METHODS: The Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) program was launched in 2014 by a collaborative initiative of the American Heart Association and Chinese Society of Cardiology. We enrolled 866 patients with ACS in a telephone follow-up program. We inquired about each patient's general health and invited each patient to our hospital for further consultation. We also performed ambulatory electrocardiography and other relevant examinations. RESULTS: A total of 743 ACS patients were included in the study. After 3 to 5 years, 50 (0.67%) patients developed AF. In multivariable Cox models adjusting for AF risk factors in ACS patients, we found that NT-proBNP [hazard ratio (HR) 2.625, 1.654-4.166, P < .05], creatine kinase-MB (CK-MB) (HR 4.279, 1.887-9.703, P < .05), and left ventricular ejection fraction (LVEF) (HR 0.01, 0.001-0.352, P < .05) were significantly associated with AF receiver operating characteristic (ROC) curves were used to determine a cutoff level for AF screening. NT-proBNP using a cutoff of 1705 ng/L resulted in a sensitivity of 58% and a specificity of 89.8%. CK-MB using a cutoff of 142.5 ng/L resulted in a sensitivity of 73.3% and a specificity of 58.3%. CONCLUSION: For patients with ACS, NT-proBNP, CK-MB, and LVEF have a considerable prognostic value for predicting whether AF would be detected during follow-up.
Subject(s)
Acute Coronary Syndrome/complications , Atrial Fibrillation/etiology , Ventricular Function, Left/physiology , Acute Coronary Syndrome/blood , Acute Coronary Syndrome/physiopathology , Atrial Fibrillation/diagnosis , Biomarkers/blood , Creatine Kinase, MB Form/blood , Electrocardiography, Ambulatory , Female , Follow-Up Studies , Humans , Male , Middle Aged , Natriuretic Peptide, Brain , Peptide Fragments , Prognosis , Protein Precursors , ROC Curve , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
BACKGROUND AND OBJECTIVE: Whether ticagrelor is superior to prasugrel in inhibiting platelet reactivity (PR) has remained unclear, possibly because different test methods have been used to determine this. Therefore, using a different test method, we performed a meta-analysis comparing the effects of ticagrelor and prasugrel on PR. METHODS AND RESULTS: PubMed, Embase, Web of Science, and Google Scholar were searched - without language restrictions (last updated on 26 February 2017) - for randomized trials comparing the effects of prasugrel with those of ticagrelor in patients with coronary artery disease. Selected studies were chosen for pooled analysis according to the inclusion and exclusion criteria. Data are presented as mean difference (MD) and 95% confidence interval. For the loading dose, using the VerifyNow-P2Y12 (VN) test, the PR was similar for both the prasugrel and ticagrelor groups [MD=10.80 (-9.81-31.40), P=0.30]. Using the vasodilatorstimulated phosphoprotein test, the PR was also similar for both the ticagrelor and prasugrel groups [MD=-2.87 (-6.35-0.60), P=0.10]. For the maintenance dose, using the VN test, the PR was lower in the ticagrelor group than in the prasugrel group [MD=-43.37 (-60.53 to -26.21), P<0.01]. Finally, using the vasodilator-stimulated phosphoprotein test, the PR was lower in the ticagrelor group than in the prasugrel group [MD=-9.23 (-15.82 to -2.64), P<0.01]. CONCLUSION: There was no difference between ticagrelor and prasugrel in terms of PR under the loading dose, but ticagrelor had a lower degree of PR under the maintenance dose. The results were not affected by the different PR test methods.
