| Background.Associations between D-dimer and outcomes of patients with acute coronary syndromes(ACS)remain controversial.This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention(PCI).Methods.In this observational study,3972 consecutive patients with ACS treated by emergent PCI and tested for D-dimer levels were retrospectively recruited.Levels of D-dimer were measured with immunoassay turbidimetry using the peripheral vein blood samples collected right after patients had been admitted into the coronary care unit.The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications.Cox regression with multiple adjustments was used for outcome analysis.Restricted cubic spline(RCS)analysis was performed to assess the dose-response association between D-dimer and outcomes.The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores,with internal validations using bootstrapping methods.The primary outcome was all-cause death.Results.During a median follow-up of 720 days,225 deaths occurred.Based on the thresholds generated by X-tile,ACS-PCI patients with median(420-1150 ng/mL,hazard ratio[HR]:1.58,95%confidence interval[CI]:1.14-2.20,P=0.007)and high(≥1150 ng/mL,HR:1.98,95%CI:1.36-2.89,P<0.001)levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer(<420 ng/mL).RCS analysis depicted a constant relation between D-dimer and various outcomes.The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models(C-index:0.853 vs 0.845,P difference=0.021),the GRACE score(C-index:0.826 vs 0.814,P difference=0.027),and the TIMI score(C-index:0.804 vs 0.776,P difference<0.001).The predicted mortality at the median follow-up(two years)was 1.7%,5.2%,and 10.9%for patients with low,median,and high D-dimer,respectively,which was well matched with the observed mortality(low D-dimer group:1.2%,median D-dimer group:5.2%,and high D-dimer group:12.6%).Conclusions.For ACS patients treated by emergent PCI,D-dimer level was an independent predictor for adverse outcomes,and provided additional prognostic value when combined with clinical risk factors and risk scores.Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.Background:Inflammation poses dual effects after myocardial infarction,but robust evidence shows high sensitivity C-reactive protein(hsCRP),as an inflammatory marker,is constantly associated with worse outcomes.This study aimed to investigate the probable nonlinear association between post-procedural hsCRP and mortality in patients with acute coronary syndromes(ACS)treated by percutaneous coronary intervention(PCI).Methods:A total of 3940 consecutive ACS patients treated by emergent PCI with post-procedural hsCRP measurements were retrospectively recruited.Levels of hsCRP were measured with immunoturbidimetry using blood samples collected at 6 a.m.on the second morning after patients had been admitted into the coronary care unit.Patients were stratified into 5 groups according to quintiles of hsCRP.Cox regression with adjustments for multiple covariates was used for outcome analysis.Restricted cubic spline(RCS)analysis was used to allow possible nonlinear associations.The primary outcome was all-cause death.Results:During a median follow-up of 727 days,mortality occurred in 207(5.3%)patients.Adjusted hazard ratio(HR)was higher in the lowest(<2.26 mg/L,HR:1.90,95%confidence interval[CI]:1.08-3.33,P=0.025),second highest(10.16-12.56 mg/L,HR:1.86,95%CI:1.09-3.16,P=0.023)and highest quintile(>12.56 mg/L,HR:2.02,95%CI:1.21-3.36,P=0.007)of post-procedural hsCRP,compared to the second lowest quintile(2.26-4.85 mg/L).RCS analysis depieced a J-shaped association between post-procedural hsCRP and mortality(P nonlinearity=0.004).Similar association was observed between hsCRP and cardiac death(P nonlinearity=0.014),but not for non-cardiac mortality(P nonlinearity=0.228).Conclusions:Both low and high post-procedural hsCRP was associated with higher risk of death in ACS patients treated by emergent PCI.Background:Lipoxin A4(LXA4)is one of the specialized pro-resolving lipid mediators proved to suppress the progression of atherosclerosis in vivo,but its clinical impacts in atherosclerotic patients is unclear.In this study,we assessed the prognostic impacts of LXA4 in patients with acute myocardial infarction(AMI).Methods:A total of 1569 consecutive AMI patients undergoing emergent coronary angiography were prospectively recruited from March 2017 to January 2020.Plasma samples of AMI patients were isolated from blood samples collected at the beginning of coronary angiography through the artery access sheath,and LXA4 levels were determined using enzyme-linked immunosorbent assay.The primary outcome was major adverse cardiovascular event(MACE),a composite of all-cause death,recurrent MI,ischemic stroke,or ischemia-driven revascularization.Cox regression was used to assess associations between LXA4 and clinical outcomes.Results:Overall,the median level of LXA4 was 5.637(3.047-9.014)ng/mL for AMI patients.During a median follow-up of 786(726-1108)days,high LXA4(≥ 5.637 ng/mL)was associated with lower risk of MACE(hazard ratio[HR]:0.73,95%confidence interval[CI]:0.60-0.89,P=0.002),which was sustained in propensity score matching(HR:0.73,95%CI:0.60-0.90,P=0.004)and inverse probability weighting analysis(HR:0.74,95%CI:0.61-0.90,P=0.002).Combined with pro-inflammatory biomarker,patients with high levels of LXA4(≥5.637 ng/mL)but low levels of high-sensitivity C-reactive protein(<5.7 mg/L)acquired the lowest risk of MACE(HR:0.68,95%CI:0.51-0.92,P=0.012).Conclusions:High levels of LXA4 were associated with lower risk of recurrent ischemic events for AMI patients,which could serve as new therapeutic target to tackle cardiovascular inflammation.Background.The use of β-blockers for acute coronary syndrome(ACS)patients without heart failure(HF)is controversial,and lacks of evidence in the era of reperfusion and intensive secondary preventions.This study aimed to investigate the prognostic impacts of β-blockers on patients with ACS but no HF treated by percutaneous coronary intervention(PCI).Methods.A total of 2397 consecutive patients with ACS but no HF treated by emergent PCI were retrospectively recruited from January 2010 to June 2017.Uni variable Cox regression was used to assess the prognostic impacts of β-blockers,followed by adjusted analysis,one-to-one propensity score matching(PSM),and inverse probability treatment weighting(IPTW)analysis,in order to control for systemic between-group differences.The primary outcome was all-cause death.Results.Among the included patients,2060(85.9%)were prescribed with β-blockers at discharge.The median follow-up time was 727(433-2016)days,with 55(2.3%)cases of all-cause death.Unadjusted analysis showed that the use of β-blockers was associated with lower risk of death(hazard ratio[HR]:0.42,95%confidence interval[CI]:0.23-0.76,P=0.004),which was sustained in adjusted analysis(HR:0.53,95%CI:0.29-0.98,P=0.044),PSM analysis(HR:0.44,95%CI:0.20-0.96,P=0.039)and IPTW analysis(HR:0.49.95%CI:0.35-0.70,P<0.001).Risk reduction was also seen in β-blocker users for cardiac death,but not for major adverse cardiovascular events.Conclusions.The use of β-blockers was associated with reduced long-term mortality for ACS-PCI patients without HF.Background.Despite the recommendations from mainstream guidelines,the use of angiotensin-converting enzyme inhibitors(ACEI)and angiotensin Ⅱ receptor blockers(ARB)for acute coronary syndrome(ACS)patients without heart failure(HF)is controversial,as its evidence is lacking in the era of reperfusion and intensive secondary preventions.This study aimed to investigate the impacts of ACEI/ARB on outcomes of ACS patients without HF treated by percutaneous coronary intervention(PCI).Methods.A total of 2397 non-HF ACS patients treated by emergent PCI were retrospectively recruited.Prognostic impacts of ACEI/ARB were assessed by unadjusted analysis,followed by propensity score matching(PSM)and propensity score matching weight(PSMW)analysis to control the between-group differences.The primary outcome was a composite of all-cause death and recurrent myocardial infarction(MI).Results.Among the included patients,1805(75.3%)were prescribed with ACEI/ARB at discharge.The median follow-up time was 727(433-2016)days,with 129(5.4%)primary endpoint events,consisting of 55(2.3%)cases of all-cause death and 74(3.1%)cases of recurrent MI.The use of ACEI/ARB was not associated with significant risk reduction of primary endpoint events in unadjusted analysis(hazard ratio[HR]:0.95,95%confidence interval[CI]:0.64-1.39,P=0.779),PSM analysis(HR:0.94,95%CI:0.60-1.47,P=0.784),and PSMW analysis(HR:0.91,95%CI:0.55-1.49,P=0.704).Similar results were observed for secondary outcomes of all-cause death,cardiac death,and recurrent MI.Conclusions.For ACS patients without HF,the use of ACEI/ARB was not associated with lower risk of death or recurrent MI after PCI. |
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