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.
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.
Introduction. Acute coronary syndrome (ACS), encompassing unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), is a major ...global health concern due to its high morbidity and mortality. Research highlights a link between ACS and elevated acute phase reactants like C-reactive protein, emphasizing the role of inflammation and atherosclerosis. Serum fibrinogen, crucial in thrombus formation and an inflammatory marker, is significant in the coagulation process. This study investigates the predictive value of serum fibrinogen levels and the GRACE score for 3-month mortality in ACS patients. Aim. To examine the clinical profile of ACS patients and evaluate serum fibrinogen and GRACE score as prognostic markers for 3-month mortality. Methodology. A prospective observational study was conducted on 50 patients diagnosed with ACS at Saveetha Medical College Hospital. The study included adults over 18 with ACS, excluding those with severe comorbid conditions like end-stage liver disease or malignancy. Serum fibrinogen levels were measured at presentation and at 3 months using an automated coagulation analyzer. GRACE scores were calculated, and clinical assessments including ECG, cardiac markers, and ECHO were conducted. Data analysis involved IBM SPSS Statistics, utilizing descriptive statistics, t-tests, ANOVA, and Pearson's Correlation. Results. The study group had diverse demographics and a high prevalence of cardiovascular symptoms and comorbidities. The clinical profile of ACS showed a higher incidence of STEMI. Serum fibrinogen levels varied significantly across different Killip classes at presentation and at 3 months, with the highest levels in the more severe classes. Higher serum fibrinogen was linked to recurrent heart failure admissions and higher KILIPS class. However, there was no significant difference in fibrinogen levels between patients with and without interventions. The GRACE score was higher in STEMI patients, those with LV dysfunction, and correlated with higher serum fibrinogen. Lower FACIT F scores, indicating higher fatigue, were associated with higher fibrinogen levels and readmissions for heart failure. Conclusion. Higher serum fibrinogen levels and GRACE scores at presentation and at three months are indicators of severe myocardial infarction, increased heart failure readmission rates, and greater fatigue in ACS patients. These markers are valuable for evaluating morbidity in ACS and can aid in enhancing patient management strategies.