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Despite the known protective cardiovascular effect of aspirin, former studies identified its prior exposure to an acute coronary syndrome (ACS) as an independent risk factor for adverse events. However, those studies did not refle...
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Despite the known protective cardiovascular effect of aspirin, former studies identified its prior exposure to an acute coronary syndrome (ACS) as an independent risk factor for adverse events. However, those studies did not reflect contemporary approaches. In the current study, we determine whether patients exposed to aspirin before an ACS have a worse cardiovascular risk profile and if it predicts higher risk of recurrent cardiovascular events or mortality. A cohort of patients enrolled in a national registry of ACS was analyzed according to prior exposure to aspirin. A propensity score standardized patients according to baseline comorbidities. Multivariable COX regression analysis was performed in unmatched and matched populations for a primary endpoint (composite of all-cause mortality and/or cardiovascular rehospitalization) and two secondary endpoints (all-cause mortality and cardiovascular rehospitalization, separately) at 1-year follow-up. Among 5533 ACS patients, 1763 were previously exposed to aspirin. They were older and had more comorbidities; contemporary approaches, both coronary angiography and percutaneous coronary angioplasty were less likely to be performed. Before matching the population, prior exposure to aspirin was an independent predictor of primary composite endpoint (p = 0.002) and cardiovascular rehospitalization as the secondary endpoint (p = 0.001). There were no statistically significant differences between both groups in the multivariable model for the primary or secondary endpoints after matching. Previous exposure to aspirin identified ACS patients with worse baseline characteristics, establishing its role as a cardiovascular risk marker. However, our data do not support including aspirin pretreatment in risk stratification scores as an adverse prognostic variable.
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Background: A limited number of studies comparing the main risk scores (RS) for acute coronary syndromes (ACS) have been conducted and there is a limited number of long-term observations of unselected patient cohorts evaluated wit...
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Background: A limited number of studies comparing the main risk scores (RS) for acute coronary syndromes (ACS) have been conducted and there is a limited number of long-term observations of unselected patient cohorts evaluated with the various RS. The aim of this study was to validate 5 RS (TIMI STEMI RS, TIMI NSTEMI/UA RS, GRACE RS, SIMPLE RS and ZWOLLE RS) in a Polish population and to develop a new RS that would specifically predict 1 -year mortality in the unselected ACS patient cohort.Methods and Results: Single-center ACS registry analysis with 1-year follow-up of 931 patients and prospective comparison of 5 RS was conducted. Creation of an RS was attempted. Risk factors were evaluated in a multivariate logistic regression model. The predictive value of the model was assessed with evaluation of the area under curve (AUC) in receiver-operating characteristic analysis. Twelve independent factors influencing 1-year mortality were identified and of them, clerking, physical findings on admission, first ECG and myocardial necrosis markers demonstrated sufficiently high predictive value. All 5 RS were successfully validated in the target registry and although they all displayed high predictive value, the TIMI RS STEMI (AUC=0.84) and GRACE RS (AUC= 0.84) proved superior.Conclusions: The developed Banach score offers both high goodness-of-fit and predictive value and may be used irrespective of ACS type.
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Aims: The impact of plasma osmolality on clinical outcome in acute coronary syndrome (ACS) patients has not been investigated so far.Methods: In a retrospective analysis, we included 985 patients with ACS undergoing percutaneous c...
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Aims: The impact of plasma osmolality on clinical outcome in acute coronary syndrome (ACS) patients has not been investigated so far.Methods: In a retrospective analysis, we included 985 patients with ACS undergoing percutaneous coronary intervention (PCI). Plasma osmolality was calculated using concentrations of sodium, plasma glucose, and blood urea nitrogen at admission. Patients were stratified by quartiles (Q) of admission osmolality, clinical outcome was compared between those groups. The primary endpoints were in-hospital, 30-day, and I -year mortality.Results: Univariate analysis in the Cox proportional-hazards model revealed significantly higher rates of in-hospital death for patients with osmolality in Q4, as compared to patients with osmolality in Ql13 (HR 5.4, 95% Cl 3.3-9.0, p<0.01). After adjustment for confounding baseline variables, osmolality in Q4 was associated with 2.8-fold hazard of in-hospital death (HR 2.75, 95% Cl 1.35-5.61, p=0.005). Upon multivariate analysis, admission osmolality in Q4 vs. Q1-3 was associated with higher mortality rates after 30 days (HR 2.53, 95% Cl 1.23-5.21, p=0.012) and I year (HR 1.73, 95% Cl 1.02-2.91, p=0.04). Moreover, we performed landmark analysis in order to exclude critically ill patients, which revealed similar adjusted rates of death beyond 30 days to I year (HR 1.21, 95% Cl 0.55-2.66, p=0.642). Conclusions: Using the 4th quartile of plasma osmolality at admission as a natural cut-off point, osmolality in Q4, as compared to QI-3, was significantly predictive of short term but not long-term outcome in ACS patients undergoing coronary stenting. Our data suggest osmolality to be an independent, feasible, and cost-effective tool for rapid risk stratification in ACS patients.
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Both intensive antithrombotic therapy and an early* invasive strategy reduce the incidence of ischemic events in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS), at the expense of increasing the rate of ...
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Both intensive antithrombotic therapy and an early* invasive strategy reduce the incidence of ischemic events in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS), at the expense of increasing the rate of bleeding complications. Current recommendations [1] emphasize the use of an early invasive strategy in patients at higher risk. However, most registries show a more conservative management in these patients [2].Most of the predictors of ischemic events in patients with NSTE-ACS are also predictors of bleeding complications. These variables are part, both of bleeding risk scores and ischemic risk scores [3-7]. We hypothesized that due to similarities in the composition of both types of scores a close linear relationship between them might exist and, therefore, this can make the selective prediction of bleeding or ischemic comDlications in this clinical scenario difficult.
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PURPOSE: Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-...
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PURPOSE: Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality.
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BACKGROUND Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome ...
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BACKGROUND Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at tow risk (<1%) for major adverse cardiac events (MACE).
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To assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS).
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Objective: The Thrombolysis in Myocardial Infarction (TIMI) score is a validated tool for risk stratification of acute coronary syndrome. We hypothesized that the TIMI risk score would be able to risk stratify patients in observat...
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Objective: The Thrombolysis in Myocardial Infarction (TIMI) score is a validated tool for risk stratification of acute coronary syndrome. We hypothesized that the TIMI risk score would be able to risk stratify patients in observation unit for acute coronary syndrome. Methods: Study design: Retrospective cohort study of consecutive adult patients placed in an urban academic hospital emergency department observation unit with an average annual census of 65,000 between 2004 and 2007. Exclusion criteria included elevated initial cardiac biomarkers, ST segment changes on ECG, unstable vital signs, or unstable arrhythmias. A composite of significant coronary artery disease (CAD) indicators, including diagnosis of myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, or death within 30 days and 1 year, were abstracted via chart review and financial record query. The entire cohort was stratified by TIMI risk scores (0-7) and composite event rates with 95% confidence interval were calculated. Results: In total 2228 patients were analyzed. Average age was 54.5 years, 42.0% were male. The overall median TIMI risk score was 1. Eighty (3.6%) patients had 30-day and 119 (5.3%) had 1-year CAD indicators. There was a trend toward increasing rate of composite CAD indicators at 30 days and 1 year with increasing TIMI score, ranging from a 1.2% event rate at 30 days and 1.9% at 1 year for TIMI score of 0 and 12.5% at 30 days and 21.4% at 1 year for TIMI >=4. Conclusions: In an observation unit cohort, the TIMI risk score is able to risk stratify patients into low-, moderate-, and high-risk groups.
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