Aim
. We aimed to compare post-interventional angiographic outcomes of ticagrelor versus clopidogrel according to glycosylated hemoglobin (HbA1c) levels in patients with ST-elevation myocardial ...infarction.
Material and methods
. The study included a total of 532 patients, with 334 receiving ticagrelor (62,8%) and 198 clopidogrel (37,2%). Diabetic status of the patients was assessed with HbA1c. TIMI flow grade and TIMI frame count were calculated and compared between two groups.
Results
. TIMI flow grade 3 was higher and TFC was lower after percutaneous coronary intervention of the infarct-related artery in patients treated with ticagrelor compared to clopidogrel (89,2% vs. 73,7%; p< 0,001, 20 vs. 24; p< 0,001). There was a positive correlation between the increases in HbA1c and TFC levels in the whole group (r=0,225; p=0,004). In subgroup analysis, higher HbA1c levels did not affect TFC in patients using ticagrelor (r=-0,060; p=0,326 for patients with noreflow, r=-0,133; p=0,321 for patients with TIMI-3 flow). While level of HbA1c did not affect TFC in patients with TIMI-3 flow, the presence of post-procedural no-reflow caused worsening of TFC in patients using clopidogrel as HbA1c levels increased (r=0,374; p=0,005).
Conclusion
. Ticagrelor was found to be better in terms of angiographic parameters regardless of diabetes.
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality across the world, warranting continuous research in this field. The elucidation of the atherogenesis ...mechanism is considered one of the most relevant scientific accomplishments of the last century. This has led to the clinical development of various novel therapeutic interventions for patients with or at risk of ASCVD, in which randomized clinical trials played a crucial role. The Thrombolysis in Myocardial Infarction (TIMI) Study Group was initially established to conduct a clinical trial studying thrombolysis for treatment of myocardial infarction. However, over the years, the TIMI Study Group has expanded their research interests to include antithrombotic therapy, lipid lowering, antidiabetes, anti-obesity, and even heart failure. By leading large-scale, international, randomized, controlled trials of novel therapeutics, the TIMI Study Group has helped shape the very practice of cardiovascular medicine for over a quarter of a century, and decades of research continue to provide future promise for further advancement. Through a mutual goal to improve the care of ASCVD patients, the Japanese scientific community has become one of the important contributors to the TIMI Study Group's clinical research. In this review article, the authors aim to summarize major research lead by the TIMI Study Group in the ASCVD field.
Objetivo: Examinar la correspondencia entre la relación plaquetas-linfocitos (RPL) y los puntajes GRACE y TIMI en pacientes con síndrome coronario agudo. Materiales y método: Se incluyeron 1.000 ...pacientes con síndrome coronario agudo que fueron asignados al Departamento de Cardiología del Dustira Army Hospital. El examen del paciente y el registro médico se realizaron entre enero del 2019 y junio del 2020. Resultados: El puntaje de riesgo GRACE fue sustancialmente mayor en el grupo de RPL alta en comparación con los grupos de RPL moderada y baja 158 (144-174), 130 (114.5-149) y 124 (104-147.75), respectivamente (p < 0.000). De manera similar, el grupo de RPL alta tuvo puntajes TIMI significativamente más altos para angina inestable, infarto de miocardio sin elevación del segmento ST (IAMSEST) e infarto agudo de miocardio con elevación del segmento ST (IAMCEST) que los grupos de RPL moderada y baja 3 (3-4), 3 (3-4), 3 (3-3), p = 0.001; 5 (4-5), 4 (4-5), 4.5 (4-5), p < 0.000 y 6 (5-7), 6 (5-6), 6 (5.5-6), p = 0.003. Además, los puntajes de riesgo GRACE (r = 0,314, p < 0,000), TIMI para AI (r = 0.365, p < 0.000), TIMI para IAMSEST (r = 0.314, p = 0.001) y TIMI para IAMCEST (r = 0.227, p = 0.001) también tenían un vínculo favorable con la RPL. Conclusión: La RPL es un marcador de laboratorio económico, conveniente y reproducible en la práctica clínica habitual, que podría predecir el pronóstico en pacientes con síndrome coronario agudo.
Prognostic assessment of early cardiovascular events in patients with acute coronary syndrome (ACS) can be aided by the HEART, TIMI, and GRACE scores. However, their combined use has not been ...extensively researched.
Determining the prognostic value of in-hospital and 6-month mortality using the GRACE, TIMI, and HEART scores in patients with acute coronary syndrome.
We conducted a cross-sectional descriptive study on 68 patients with acute coronary syndrome, following them longitudinally for 6 months at Can Tho Central General Hospital, Vietnam.
The GRACE score demonstrated good prognostic value for in-hospital mortality, with an area under the curve (AUC) of 0.805. Sensitivity and specificity were 90% and 65.51%. Conversely, the TIMI risk score had a poor prognostic value for in-hospital mortality (AUC = 0.682; sensitivity = 60%, specificity = 63.79%) and 6-month mortality (AUC = 0.692; sensitivity = 60%, specificity = 66.03%). On the other hand, the HEART score had quite good prognostic value for in-hospital mortality (AUC = 0.726; sensitivity = 50%, specificity = 89.74%) and good prognostic value for 6-month mortality (AUC = 0.805; sensitivity = 57.1%, specificity = 97.14%).
The GRACE scores demonstrate greater prognostic value for in-hospital mortality in patients with acute coronary syndrome compared to the TIMI and HEART scores.
Las puntuaciones HEART, TIMI y GRACE son herramientas valiosas en la evaluación pronóstica de eventos cardiovasculares tempranos en pacientes con síndrome coronario agudo (SCA). Sin embargo, su uso combinado no ha sido exhaustivamente investigado.
Determinar el valor pronóstico de la mortalidad intrahospitalaria y a los 6 meses mediante las puntuaciones GRACE, TIMI y HEART en pacientes con SCA.
Realizamos un estudio descriptivo transversal con seguimiento longitudinal de 68 pacientes con SCA durante 6 meses en el Hospital General Central de Can Tho, Vietnam.
La puntuación GRACE demostró un buen valor pronóstico para la mortalidad hospitalaria (AUC = 0.805, sensibilidad = 90%, especificidad = 65.51%). La puntuación TIMI tuvo un valor pronóstico deficiente para la mortalidad hospitalaria (AUC = 0.682, sensibilidad = 60%, especificidad = 63.79%) y la mortalidad a los 6 meses (AUC = 0.692, sensibilidad = 60%, especificidad = 66.03%). En contraste, la puntuación HEART tuvo un buen valor pronóstico para la mortalidad hospitalaria (AUC = 0.726, sensibilidad = 50%, especificidad = 89.74%) y a los 6 meses (AUC = 0.805, sensibilidad = 57.1%, especificidad = 97.14%).
Las puntuaciones GRACE demuestran un mayor valor pronóstico para la mortalidad hospitalaria en pacientes con síndrome coronario agudo en comparación con las puntuaciones TIMI y HEART.
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Abstract
Aims
Prior studies suggested that the risks of ischaemic stroke and bleeding in patients of Asian race with atrial fibrillation (AF) may be higher than that of non-Asians. In the analysis of ...ENGAGE AF-TIMI 48 trial, we compared clinical outcomes, edoxaban concentration, and anti-factor Xa (anti-FXa) activity, between Asian and non-Asian races.
Methods and results
There were 2909 patients of Asian race and 18 195 non-Asian race in the ENGAGE AF-TIMI 48 trial. The risks of thromboembolism and bleeding events were compared for Asians and non-Asians treated with warfarin. The trough levels of edoxaban concentration and anti-FXa activity were also compared and correlated with the efficacy and safety of edoxaban vs. warfarin. Compared to non-Asian patients, the Asian population was on average 2 years younger and 20 kg lighter. In the warfarin group, the adjusted risk of ischaemic stroke did not differ significantly for patients of Asian and non-Asian race adjusted hazard ratio (aHR) = 1.12, P = 0.56). Asians treated with warfarin had a higher-adjusted risk of intracranial haemorrhage (ICH: aHR 1.71, P = 0.03) compared with non-Asians. The trough edoxaban concentration and anti-FXa activity were 20–25% lower for Asians compared with non-Asians. Compared to warfarin, higher dose edoxaban significantly reduced ICH while preserving the efficacy of stroke prevention in both Asians and non-Asians. Two of three net clinical outcomes appeared to be more favourably reduced with edoxaban in Asians compared with non-Asians (Pint = 0.063 for primary, 0.037 for secondary, and 0.032 for third net clinical outcomes, respectively).
Conclusion
Compared to warfarin, higher dose edoxaban preserved the efficacy for stroke prevention and was associated with a favourable safety profile for Asians, which may be due to the lower trough edoxaban concentration and anti-FXa activity achieved in patients of Asian race.
Introduction: Microvascular and endothelial disorders play a significant role in the pathophysiology of coronary slow flow phenomenon (CSFP). However, according to previous studies, the etiology of ...CSFP is not completely understood. As CD40 and dipeptidyl peptidase-4 (DPP-4) are reported to play an important role in atherosclerosis process as well as microvascular and the endothelial dysfunction, this study evaluated the role of these two biomarkers in the pathophysiology of CSFP. Methods: One-hundred twenty-nine volunteers who were candidates for angiography and fulfilled the inclusion criteria were selected, including 29 patients with coronary artery diseases (CADs) which had less than 50% stenosis (CAD+,<50%) and without CSF, 22 CAD+patients which had 50-90% stenosis (CAD+, 50%-90%) without CSF, 16 CAD+patients with CSF, 22 patients with CSF without stenosis in their arteries, and 40 healthy individuals as controls. The serum levels of CD40 and DPP-4 were measured by an enzyme-linked immunosorbent assay kit. Results: There was no significant correlation between the serum concentration of CD40 and the thrombosis in myocardial infarction (TIMI) frame count (P=0.571). However, the serum concentration of CD40 in CAD+patients with CSF was significantly higher than the values in patients without CSF (P=0.022). Moreover, the concentration of DPP-4 in different coronary vessels did not exhibit any significant relation with TIMI score (P=0.763). Conclusion: In the present study, no significant correlation was found between the serum concentrations of CD40 and DPP-4 and the mean corrected TIMI frame count (CTFC). Accordingly, further studies with larger population sizes are needed to investigate the correlation between CD40 and DPP-4 serum levels and CSFP.
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality across the world, warranting continuous research in this field. The elucidation of the atherogenesis ...mechanism is considered one of the most relevant scientific accomplishments of the last century. This has led to the clinical development of various novel therapeutic interventions for patients with or at risk of ASCVD, in which randomized clinical trials played a crucial role.The Thrombolysis in Myocardial Infarction (TIMI) Study Group was initially established to conduct a clinical trial studying thrombolysis for treatment of myocardial infarction. However, over the years, the TIMI Study Group has expanded their research interests to include antithrombotic therapy, lipid lowering, anti-diabetes, anti-obesity, and even heart failure. By leading large-scale, international, randomized, controlled trials of novel therapeutics, the TIMI Study Group has helped shape the very practice of cardiovascular medicine for over a quarter of a century, and decades of research continue to provide future promise for further advancement. Through a mutual goal to improve the care of ASCVD patients, the Japanese scientific community has become one of the important contributors to the TIMI Study Group's clinical research.In this review article, the authors aim to summarize major research lead by the TIMI Study Group in the ASCVD field.
Identifying which patients with acute myocardial infarction (AMI) during sepsis are at risk of poor outcome is a clinical challenge.
To evaluate Global Registry of Acute Coronary Events (GRACE) and ...Thrombolysis In Myocardial Infarction (TIMI) risk scores to predict in-hospital mortality and severe ischaemic events in this setting.
In this single-centre retrospective study conducted from 2012 to 2016, all consecutive adults hospitalized in the intensive care unit for sepsis who had a concomitant AMI (within 72hours of admission) were enrolled. AMI was defined by an elevated cardiac troponin I value associated with at least one sign (clinical, electrocardiographic or echocardiographic) suggestive of myocardial ischaemia. The primary outcome was in-hospital mortality from any cause. Secondary outcomes were in-hospital occurrence of severe ischaemic events (cardiac arrest with resuscitation, ischaemic stroke and myocardial reinfarction) and major bleeding events.
Among 856 patients hospitalized for sepsis, 120 (14.5%) had a concomitant AMI (37.5% women; median age 65 years; median Sequential Organ Failure Assessment SOFA score 8). Severe ischaemic events occurred in 15 patients (12.5%), and 39 (33%) died in hospital. Neither the GRACE score (median 192, interquartile range 154–223) nor the TIMI score (median 3, interquartile range 2–4) was associated with occurrence of severe ischaemic events. Only the GRACE score was associated with in-hospital mortality (odds ratio 1.01, 95% confidence interval 1.00–1.02 per 1 point increase). Multivariable analysis identified previous aspirin use and SOFA score as independent factors associated with in-hospital mortality.
GRACE and TIMI scores did not predict in-hospital severe ischaemic events and mortality in patients with AMI during sepsis. Among individual components of both scores, previous aspirin use was associated with poor prognosis. However, because of lack of statistical power, we cannot formally rule out the usefulness of these scores in this setting.
Parmi les patients ayant un infarctus du myocarde (IDM) au décours d’un sepsis, identifier ceux à risque de mauvais pronostic est un défi clinique.
Notre objectif est d’évaluer les scores de risque GRACE et TIMI afin de prédire la mortalité intra-hospitalière et les évènements ischémiques sévères dans ce contexte.
Dans cette étude monocentrique rétrospective conduite de 2012 à 2016, tous les patients adultes hospitalisés en unité de soins intensifs pour un sepsis et présentant un IDM concomitant (dans les 72heures de l’admission) ont été consécutivement inclus. L’IDM était défini par une élévation de la troponine cardiaque I associée à la présence d’au moins un signe clinique, électrocardiographique ou échocardiographique suggérant une ischémie myocardique. Le critère de jugement principal était la mortalité intra-hospitalière toute cause. Les critères de jugement secondaires intra-hospitaliers étaient les évènements ischémiques sévères (arrêt cardiaque avec réanimation cardiopulmonaire, accident vasculaire cérébral ischémique, infarctus du myocarde récidivant) et les évènements hémorragiques sévères.
Parmi 856 patients hospitalisés pour sepsis, 120 patients (14,5 %) ont présenté un AMI concomitant (femme, 37.5 % ; âge médian, 65 ans, score SOFA médian 8). Un évènement ischémique sévère est survenu chez 15 patients (12.5 %) et 39 patients (33 %) sont décédés à l’hôpital. Ni le score GRACE (médiane 192, IQR 154–223), ni le score TIMI (médiane 3, IQR 2–4) n’étaient associés à la survenue d’un évènement ischémique sévère. Seul le score GRACE était significativement associé à la mortalité (OR 1.01, IC 95 % 1.00–1.02 par point). En analyse multivariée, la prise d’aspirine au long court et le score SOFA étaient indépendamment associés à la mortalité intra-hospitalière.
Ni le score GRACE, ni le score TIMI ne prédisent la survenue d’évènement ischémique sévère intra-hospitalier et la mortalité intra-hospitalière chez les patients présentant un IDM au cours d’un sepsis. Parmi les composants individuels des deux scores, la prise d’aspirine au long court était associée à un plus mauvais pronostic. Cependant, en raison du manque de puissance statistique, notre étude ne peut exclure formellement l’utilité de ces scores dans ce contexte.
Background: Contrast induced nephropathy (CIN) is a common complication seen after primary percutaneous coronary intervention (PCI) which can contribute to increased morbidity and mortality in ...patients of acute ST elevation myocardial infarction (STEMI). Aim of this study was to validate the TIMI Risk Index (TRI) for the risk stratification of CIN in patients undergone primary PCI. Methods: Consecutive patients of STEMI undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patients with history of any PCI and chronic kidney diseases were excluded from this study. TRI was calculated using the formula “” and post-procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN. Results: A total of 507 patients were included in this study out of which 82.2% were males and 17.8% were females. In total 8.7% (44) patients developed CIN. In the receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) for TRI was found to be 0.717, 0.649–0.758 for the prediction of CIN. Sensitive, specificity, positive predictive value and negative predictive value of TRI >22.8 to predict the development of CIN were 59.09%, 76.69%, 19.55% and 95.19% respectively. Conclusion: TIMI risk index is and easy to calculate and readily accessible score which has good predictive value to evaluate the risk of CIN in primary PCI setting.
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