Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
Objective To explore the risk factors of major adverse cardiovascular events(MACEs)in immune checkpoint inhibitor(ICI)related myocarditissand establish a predictive model.Methods This was a retrospective case-control ...Objective To explore the risk factors of major adverse cardiovascular events(MACEs)in immune checkpoint inhibitor(ICI)related myocarditissand establish a predictive model.Methods This was a retrospective case-control study.Tumor patients diagnosed with ICI related myocarditis in the First Affiliated Hospital of Guangzhou Medical University from May 2019 to August 2023 were selected and divided into non-MACE group and MACE group based on whether MACE occurred.Clinical and imaging data of the two groups were collected.Univariate and multivariate logistic regression models were used to analyze the risk factors for MACE in patients with ICI related myocarditis.According to the results of multivariate logistic regression analysis,R 4.1.0O software was used to construct the MACE risk prediction model for these patients and draw a nomogram.The receiver operating characteristic curve was used to evaluate the prediction ability of the prediction model.Results A total of 35 patients with ICI related myocarditis,aged(63.9±8.2)years,were included,including 28 males(80%).There were 18 patients in the non-MACE group and 17 patients in the MACE group.Multivariate logistic regression analysis showed that elevated neutrophil to lymphocyte ratio(OR=1.115,95%CI 1.007-1.235,P=0.036)and ST-T segment changes(0R=24.942,95%CI 1.239-502.194,P=0.036)were risk factors for MACE in patients with ICI related myocarditis.The receiver operating characteristic curve indicated that the area under the curve of the prediction model was 0.967(95%CI 0.916-1.000,P<0.001),with a sensitivity of 88.2%and specificity of 100%,demonstrating good predictive ability.Conclusion Elevated neutrophil to lymphocyte ratio and ST-T segment change are independent risk factors for MACE in patients with ICI related myocarditis.Risk prediction model based on the above two indicators can assist in the early identification and individualized intervention of ICI related myocarditis patients.展开更多
Objective To compare the application value of coronary computed tomography angiography(CCTA)based plaque characteristics and computed tomography(CT)derived parameters in predicting future major adverse cardiovascular ...Objective To compare the application value of coronary computed tomography angiography(CCTA)based plaque characteristics and computed tomography(CT)derived parameters in predicting future major adverse cardiovascular events(MACE)between patients with and without diabetes mellitus.Methods A total of 425 patients who underwent CCTA in Shunde Hospital Affiliated to Southern Medical University from June 2016 to November 2016 were retrospectively analyzed.Patients were divided into DM group(n=120)and non-DM group(n=305)for follow-up.According to the occurrence of MACE during follow-up,patients were divided into DM group(n=81),DM+MACE group(n=39),non-DM group(n=39),non-DM group(n=244)and non-DM+MACE group(n=61).The differences in general characteristics,biochemical index and parameters in imaging were compared among the four groups.Cox proportional hazards regression analysis was used to analyze the influencing factors for MACE in the two populations.The receiver operating characteristic(ROC)curve was used to analyze the difference in the predictive value of different plaque characteristics and CT-derived parameters for MACE.Results The levels of coronary artery calcification score(CACS),and the proportion of low-attenuation plaque(LAP)were higher in the DM+MACE group than in the DM group(P<0.05).The levels of positive reconstruction(PR),the proportionof antihypertensive drugs,CAD-RADS,CACS,residual cholesterol and apolipoprotein B were higher in the non-DM+MACE group than in the non-DM group(P<0.05).Cox proportional hazards regression analysis showed that CACS≥100(HR 2.151,95%CI 1.128-4.102,P=0.020)and LAP(HR 2.337,95%CI1.032-5.290,P=0.042)were the influencing factors for MACE in patients withDM.PR(HR 124.305,95%CI42.883-360.326,P<0.001)was the influencing factor for MACE in patients without DM.ROC curve analysis showed that the AUC of CACS combined with LAP were 0.606,0.609 and 0.660 for predicting MACE in DM patients within 1,3 and 5 years respectively.The AUC of PR for predicting MACE were 0.862,0.927,and 0.806 in the non-DM population within 1,3,and 5 years respectively.The predictive value of CACS and LAP for MACE in the DM patients was stable during the 5 years,while the predictive value of PR for MACE in the non-DM population decreased significantly after 4 years.Conclusion The predictive values of different plaque characteristics and CT derived parameters for future MACE are different between population with and without diabetes.The combination of CACS andlow-attenuationnplaques can effectively evaluate the risk of MACE in diabetic patients,while PR has a higher predictive value for MACE in non-diabetic patients.展开更多
Coronary heart disease(CHD)is a chronic,systemic disease and the primary global cause of death,affecting more than 100 million individuals worldwide.[1]It is associated with various symptoms,a deterioration in clinica...Coronary heart disease(CHD)is a chronic,systemic disease and the primary global cause of death,affecting more than 100 million individuals worldwide.[1]It is associated with various symptoms,a deterioration in clinical outcomes,and increasing healthcare expenditures.[2]Patients with CHD are at elevated long-term risk of major adverse cardiovascular events(MACEs),which typically include new-onset or recurrent myocardial infarction,stroke,and cardiovascular mortality.展开更多
Objective To investigate the impact of receptorinteracting protein kinase 3(RIPK3)on major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(P...Objective To investigate the impact of receptorinteracting protein kinase 3(RIPK3)on major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),as well as the predictive performance of RIPK3 combined with traditional cardiovascular risk factors.MethodsThisstudyywasasingle-center prospective cohort study.It included patients with AMI who underwent PCI at Peking Union Medical College Hospital between September 2017 and November 2017.Baseline clinical data were collected,and plasma samples were obtained 6 hours after PCI to measure RIPK3 levels.Follow-up was conducted via outpatient visits or phone calls to record the occurrence of MACE,including cardiovascular death,hospitalization for heart failure,and vascular events(recurrent AMI or stroke).The predictiveperformance of RIPK3,traditional cardiovascular risk factors and their combination for MACE was compared using receiveroperating characteristic(ROC)curves.Patients were divided into low-and high-RIPK3 level groups based on the optimal cutoff value of RIPK3.Multivariate Cox proportional hazards regression analysis was used to assess the impact of RIPK3 levels on MACE after PCI in AMI patients.Kaplan-Meier survival curves were plotted,and the logrank test was used to compare MACE incidence between the low-and high-RIPK3 groups.Results A total of 103 AMI patients who underwent PCI were included,aged 63.0(56.0,69.0)years,and 83(80.6%)were male.The follow-up time was 5.17(2.81,5.17)years,during which 44 patients(42.7%)experienced MACE.The ROC curve analysis showed that the area under the curve(AUC)for traditional cardiovascular risk factors was 0.68(95%CI:0.58-0.78),while the AUC for plasma RIPK3 was 0.72(95%CI:0.62-0.82).The combined AUC for traditional risk factors and RIPK3 was 0.75(95%CI:0.65-0.85).MultivariateeCox proportional hazards regression analysis indicate1d that plasma RIPK3 level is greater than or equal to the optimal cutoff value of 440.9μg/L(HR=3.31,95%CI:1.53-8.30,P=0.005)was an independent risk factor for MACE in AMI patients after PCI.Kaplan-Meier survival analysis demonstrated that the high-RIPK3 group had a significantly higher risk of MACE after PCI compared to the low-RIPK3 group(log-rank P=0.006).Conclusion Elevated plasmaRIPK3level is an independent risk factor for MACE in AMI patients after PCI.Plasma RIPK3 combined with traditional cardiovascular risk factors can more effectively predict the occurrence of MACE in AMI patients after PCI.AMI patients with RIPK3≥440.9μg/L have a higher risk of MACE after PCI.展开更多
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
文摘Objective To explore the risk factors of major adverse cardiovascular events(MACEs)in immune checkpoint inhibitor(ICI)related myocarditissand establish a predictive model.Methods This was a retrospective case-control study.Tumor patients diagnosed with ICI related myocarditis in the First Affiliated Hospital of Guangzhou Medical University from May 2019 to August 2023 were selected and divided into non-MACE group and MACE group based on whether MACE occurred.Clinical and imaging data of the two groups were collected.Univariate and multivariate logistic regression models were used to analyze the risk factors for MACE in patients with ICI related myocarditis.According to the results of multivariate logistic regression analysis,R 4.1.0O software was used to construct the MACE risk prediction model for these patients and draw a nomogram.The receiver operating characteristic curve was used to evaluate the prediction ability of the prediction model.Results A total of 35 patients with ICI related myocarditis,aged(63.9±8.2)years,were included,including 28 males(80%).There were 18 patients in the non-MACE group and 17 patients in the MACE group.Multivariate logistic regression analysis showed that elevated neutrophil to lymphocyte ratio(OR=1.115,95%CI 1.007-1.235,P=0.036)and ST-T segment changes(0R=24.942,95%CI 1.239-502.194,P=0.036)were risk factors for MACE in patients with ICI related myocarditis.The receiver operating characteristic curve indicated that the area under the curve of the prediction model was 0.967(95%CI 0.916-1.000,P<0.001),with a sensitivity of 88.2%and specificity of 100%,demonstrating good predictive ability.Conclusion Elevated neutrophil to lymphocyte ratio and ST-T segment change are independent risk factors for MACE in patients with ICI related myocarditis.Risk prediction model based on the above two indicators can assist in the early identification and individualized intervention of ICI related myocarditis patients.
文摘Objective To compare the application value of coronary computed tomography angiography(CCTA)based plaque characteristics and computed tomography(CT)derived parameters in predicting future major adverse cardiovascular events(MACE)between patients with and without diabetes mellitus.Methods A total of 425 patients who underwent CCTA in Shunde Hospital Affiliated to Southern Medical University from June 2016 to November 2016 were retrospectively analyzed.Patients were divided into DM group(n=120)and non-DM group(n=305)for follow-up.According to the occurrence of MACE during follow-up,patients were divided into DM group(n=81),DM+MACE group(n=39),non-DM group(n=39),non-DM group(n=244)and non-DM+MACE group(n=61).The differences in general characteristics,biochemical index and parameters in imaging were compared among the four groups.Cox proportional hazards regression analysis was used to analyze the influencing factors for MACE in the two populations.The receiver operating characteristic(ROC)curve was used to analyze the difference in the predictive value of different plaque characteristics and CT-derived parameters for MACE.Results The levels of coronary artery calcification score(CACS),and the proportion of low-attenuation plaque(LAP)were higher in the DM+MACE group than in the DM group(P<0.05).The levels of positive reconstruction(PR),the proportionof antihypertensive drugs,CAD-RADS,CACS,residual cholesterol and apolipoprotein B were higher in the non-DM+MACE group than in the non-DM group(P<0.05).Cox proportional hazards regression analysis showed that CACS≥100(HR 2.151,95%CI 1.128-4.102,P=0.020)and LAP(HR 2.337,95%CI1.032-5.290,P=0.042)were the influencing factors for MACE in patients withDM.PR(HR 124.305,95%CI42.883-360.326,P<0.001)was the influencing factor for MACE in patients without DM.ROC curve analysis showed that the AUC of CACS combined with LAP were 0.606,0.609 and 0.660 for predicting MACE in DM patients within 1,3 and 5 years respectively.The AUC of PR for predicting MACE were 0.862,0.927,and 0.806 in the non-DM population within 1,3,and 5 years respectively.The predictive value of CACS and LAP for MACE in the DM patients was stable during the 5 years,while the predictive value of PR for MACE in the non-DM population decreased significantly after 4 years.Conclusion The predictive values of different plaque characteristics and CT derived parameters for future MACE are different between population with and without diabetes.The combination of CACS andlow-attenuationnplaques can effectively evaluate the risk of MACE in diabetic patients,while PR has a higher predictive value for MACE in non-diabetic patients.
文摘Coronary heart disease(CHD)is a chronic,systemic disease and the primary global cause of death,affecting more than 100 million individuals worldwide.[1]It is associated with various symptoms,a deterioration in clinical outcomes,and increasing healthcare expenditures.[2]Patients with CHD are at elevated long-term risk of major adverse cardiovascular events(MACEs),which typically include new-onset or recurrent myocardial infarction,stroke,and cardiovascular mortality.
文摘Objective To investigate the impact of receptorinteracting protein kinase 3(RIPK3)on major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),as well as the predictive performance of RIPK3 combined with traditional cardiovascular risk factors.MethodsThisstudyywasasingle-center prospective cohort study.It included patients with AMI who underwent PCI at Peking Union Medical College Hospital between September 2017 and November 2017.Baseline clinical data were collected,and plasma samples were obtained 6 hours after PCI to measure RIPK3 levels.Follow-up was conducted via outpatient visits or phone calls to record the occurrence of MACE,including cardiovascular death,hospitalization for heart failure,and vascular events(recurrent AMI or stroke).The predictiveperformance of RIPK3,traditional cardiovascular risk factors and their combination for MACE was compared using receiveroperating characteristic(ROC)curves.Patients were divided into low-and high-RIPK3 level groups based on the optimal cutoff value of RIPK3.Multivariate Cox proportional hazards regression analysis was used to assess the impact of RIPK3 levels on MACE after PCI in AMI patients.Kaplan-Meier survival curves were plotted,and the logrank test was used to compare MACE incidence between the low-and high-RIPK3 groups.Results A total of 103 AMI patients who underwent PCI were included,aged 63.0(56.0,69.0)years,and 83(80.6%)were male.The follow-up time was 5.17(2.81,5.17)years,during which 44 patients(42.7%)experienced MACE.The ROC curve analysis showed that the area under the curve(AUC)for traditional cardiovascular risk factors was 0.68(95%CI:0.58-0.78),while the AUC for plasma RIPK3 was 0.72(95%CI:0.62-0.82).The combined AUC for traditional risk factors and RIPK3 was 0.75(95%CI:0.65-0.85).MultivariateeCox proportional hazards regression analysis indicate1d that plasma RIPK3 level is greater than or equal to the optimal cutoff value of 440.9μg/L(HR=3.31,95%CI:1.53-8.30,P=0.005)was an independent risk factor for MACE in AMI patients after PCI.Kaplan-Meier survival analysis demonstrated that the high-RIPK3 group had a significantly higher risk of MACE after PCI compared to the low-RIPK3 group(log-rank P=0.006).Conclusion Elevated plasmaRIPK3level is an independent risk factor for MACE in AMI patients after PCI.Plasma RIPK3 combined with traditional cardiovascular risk factors can more effectively predict the occurrence of MACE in AMI patients after PCI.AMI patients with RIPK3≥440.9μg/L have a higher risk of MACE after PCI.
