Management of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary stenting remains challenging, and there is a need for efficient tools to predict their risk of different types of cardiovascular events and death. Several scores exist such as the CHA2DS2-VASc score, the Global Registry of Acute Coronary Events (GRACE) score, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, the Anatomical and Clinical Syntax II Score and the Reduction of Atherothrombosis for Continued Health score. These 5 scores were investigated in patients with AF with coronary stenting with the aim of determining which was most predictive for stroke/thromboembolic (TE) events, nonlethal coronary events, all-cause mortality, and major adverse cardiac events (MACE). Among 845 patients with AF with coronary stenting seen from 2000 to 2014, 440 (52%) were admitted for acute coronary syndrome and 405 (48%) for elective percutaneous coronary intervention. The rate of cardiovascular complication was at 14.1% per year, and nonlethal coronary events were the most frequent complications with a yearly rate of 6.5%. CHA2DS2-VASc score was the best predictor of stroke/TE events with a c-statistic of 0.604 (95% CI 0.567 to 0.639) and a best cut-off point of 5. SYNTAX score was better to predict nonlethal coronary events and MACE with c-statistics of 0.634 (95% CI 0.598 to 0.669) and 0.612 (95% CI 0.575 to 0.647), respectively, with a best cut-off point of 9. GRACE score appeared to be the best to predict all-cause mortality with a c-statistic of 0.682 (95% CI 0.646 to 0.717) and a best cut-off point of 153. In conclusions, among validated scores, none is currently robust enough to simultaneously predict stroke/TE events, nonlethal coronary events, death, and MACE in patients with AF with stents. The CHA2DS2-VASc score remained the best score to assess stroke/TE risk, as was the SYNTAX score for nonlethal coronary events and MACE, and finally, the GRACE score for all-cause mortality in this study population.
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http://dx.doi.org/10.1016/j.amjcard.2016.06.018 | DOI Listing |
Curr Vasc Pharmacol
January 2025
Cardiology Department, Athens Naval Hospital, Athens, Greece.
Background: Gut microbiota-derived metabolite Trimethylamine-N-oxide (TMAO) is increasingly recognized as a potential novel prognostic biomarker for cardiovascular disease. Our research work aimed to investigate the potential utility of TMAO measurement in patients with STelevation Myocardial Infarction (STEMI).
Methods: We performed a systematic literature search in PubMed from inception to the 1st of February 2024 to identify all studies examining the association between plasma TMAO levels and disease complexity or clinical outcomes in STEMI patients.
Diabetes Obes Metab
January 2025
Sydney Medical School, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.
Aim: SGLT2 inhibitors may be underused in older adults with type 2 diabetes due to concerns about safety and tolerability. This pooled analysis of the CANVAS Program and CREDENCE trial examined the efficacy and safety of canagliflozin according to age.
Methods: Pooled individual participant data from the CANVAS Program (n = 10 142) and CREDENCE trial (n = 4401) were analysed by baseline age (<65 years, 65 to <75 years, and ≥75 years).
Eur Stroke J
January 2025
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Introduction: The efficacy and safety of statins for secondary prevention in patients who have experienced a cardioembolic stroke are not well-defined. However, previous observational data reported hyperlipidemia as a risk factor for both ischemic and bleeding complications in patients with AF and previous stroke. Based on these premises, we conducted a sub-analysis of the RAF and RAF-NOAC studies to evaluate the efficacy and safety of statins in secondary prevention in patients with acute ischemic stroke and AF.
View Article and Find Full Text PDFMed J Islam Repub Iran
September 2024
College of Medicine, University of Baghdad, Baghdad, Iraq.
Background: The involvement of inflammation in the start and advancement of atherosclerotic plaques in acute coronary syndrome has been clarified. White blood cell count and its differential are key inflammatory markers in cardiovascular disease, with the neutrophil-to-lymphocyte ratio (NLR) emerging as a marker of inflammation and a predictor of mortality in patients with acute coronary syndrome. The study aims to investigate the utility of neutrophil to lymphocyte ratio and other complete blood count parameters as a risk stratification tool and independent predictor of Global Registry for Acute Coronary Events (GRACE) risk score in Non-ST segment elevation acute coronary syndrome (NSTE-ACS).
View Article and Find Full Text PDFJ Med Life
November 2024
Epidemiology and Preventive Medicine Department, National Liver Institute (NLI), Menoufiya University, Shibin Al Kawm, Egypt.
Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. Risk factors of mortality in patients with AMI have been widely investigated, identifying older age and heart failure as common contributors. This study aimed to determine risk factors and explore predictors associated with higher mortality among patients with AMI.
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