D-dimer is a common measurable coagulation marker that is associated with the risk of thrombotic events in vascular diseases. However, the impact of D-dimer on long-term mortality in coronary artery disease (CAD) patients remains unclear. This study investigated the association between D-dimer and long-term all-cause, cardiac and cancer mortality in CAD patients. Continuous 1,440 patients with CAD who underwent percutaneous coronary intervention (PCI) and survived to discharge were enrolled. These patients were divided into 3 groups based on plasma D-dimer levels at admission. Baseline D-dimer levels were grouped by tertiles: first (D-dimer < 0.7 μg/mL, n = 455), second (0.7 ≤ D-dimer < 1.2, n = 453), and third (1.2 ≤ D-dimer, n = 532). In a Kaplan-Meier analysis (mean follow-up periods 1,572 days), all-cause, cardiac and cancer mortalities were significantly higher in the third tertile than others (P < 0.001, P < 0.001 and P < 0.001, respectively). In multivariable Cox proportional hazard analyses after adjusting for confounding factors, a high D-dimer level was an independent predictor of all-cause, cardiac, non-cardiac and cancer mortalities (HR 3.23, P < 0.001; HR 3.06, P = 0.008; HR 3.11, P = 0.026). In a subgroup analysis, there were no interactions except for the gender subgroup in cancer mortality. In patients with CAD after PCI, high D-dimer levels were associated with long-term all-cause, cardiac and cancer mortality.

BackgroundThe Patterns of non-Adherence to Anti-Platelet Regimen in Stented Patients (PARIS) thrombotic risk score has been proposed to estimate the risk of stent thrombotic events after percutaneous coronary intervention (PCI). However, the prognostic value of the PARIS thrombotic risk score for long term all-cause and cardiac mortalities, as well as hospitalization due to heart failure, has not yet been evaluated. Therefore, the aim of the present study was to evaluate the prognostic value of the PARIS thrombotic risk score for all-cause and cardiac mortalities and hospitalization due to heart failure following PCI.Methods and resultsConsecutive 1,061 patients who underwent PCI were divided into three groups based on PARIS thrombotic risk score; low- (n = 320), intermediate- (n = 469) and high-risk (n = 272) groups. We followed up on all three groups for all-cause mortality, cardiac mortality and hospitalization due to heart failure. Kaplan-Meier analysis showed that all outcomes were highest in the high-risk group (P < 0.001, P = 0.022 and P < 0.001, respectively). Multivariate Cox proportional hazard analysis, adjusted for confounding factors, showed that the risk of all-cause mortality and hospitalization due to heart failure of the high-risk group were higher than those of the low-risk group (hazard ratios 1.76 and 2.14, P = 0.005 and P = 0.017, respectively).ConclusionThe PARIS thrombotic risk score is a significant prognostic indicator for all-cause mortality and hospitalization due to heart failure in patients after PCI.

The Patterns of non-Adherence to Anti-Platelet Regimen in Stented Patients (PARIS) bleeding risk score has been proposed to predict the risk of bleeding events after percutaneous coronary intervention (PCI). However, the prognostic value of the PARIS bleeding risk score for long term all-cause mortality, cardiac mortality and hospitalization due to heart failure has not yet been evaluated. Therefore, the aim of the present study was to evaluate the prognostic value of the PARIS bleeding risk score for all-cause and cardiac mortalities and hospitalization due to heart failure after PCI. Consecutive 1061 patients who had undergone PCI were divided into 3 groups based on the PARIS bleeding risk score; low (n = 112), intermediate (n = 419) and high-risk groups (n = 530). We prospectively followed up the 3 groups for all-cause and cardiac mortalities and hospitalization due to heart failure. Kaplan-Meier analysis revealed that all of the outcomes were highest in the high-risk group among the 3 groups (P < 0.001, P < 0.001 and P < 0.001 respectively). Multivariable Cox proportional hazard analysis, adjusted for confounding factors, revealed that all-cause mortality of the intermediate or high-risk groups was higher than those of the low-risk group (adjusted hazard ratio 6.06 and 12.50, P = 0.013 and P < 0.001, respectively). The PARIS bleeding risk score is a significant indicator of prognosis for all-cause mortality in patients after PCI.

Background: The predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score predicts the risk of bleeding in patients treated with dual antiplatelet therapy after percutaneous coronary intervention. Although the PRECISE-DAPT score is expected to be useful beyond its original field, long-term prognostic value of this score in patients with acute myocardial infarction (AMI) remains unclear. In the current study, we aimed to investigate the performance of the PRECISE-DAPT score in predicting the long-term prognosis in patients with AMI. Methods and results: Consecutive 552 patients with AMI, who had been discharged from our institution, were enrolled. We divided the patients into three groups, based on their PRECISE-DAPT scores: the low (PRECISE-DAPT < 17), intermediate (17-24) and high (>= 25) score groups. Kaplan-Meier analysis (mean follow-up 1424 days) revealed that all-cause mortality increased most steeply in the high score group followed by the intermediate and low score groups (P < 0.001). After adjusting for possible confounding factors, mortality of the intermediate or high score groups were higher than those of low score group (HR 2.945, 95% CI 1.182-7.237, P = 0.020, and HR 5.567, 95% CI 2.644-11.721, P < 0.001, respectively). Conclusions: In patients with AMI, a high PRECISE-DAPT score was associated with higher long-term all-cause mortality. PRECISE-DAPT score is useful for predicting all-cause mortality, as well as risk stratification of bleeding. (C) 2020 The Authors. Published by Elsevier B.V.

Introduction: It has been reported that East Asian people have higher bleeding risks than Western people. The Patterns of non-Adherence to Anti-Platelet Regimen in Stented Patients (PARIS) bleeding risk score was developed to estimate the bleeding risk after percutaneous coronary intervention (PCI). However, the utility of PARIS bleeding score for predicting long-term bleeding risks has not been validated in Japanese population. Methods: Consecutive 1061 patients who underwent PCI and survived to discharge were divided into three groups based on the category of PARIS bleeding risk score: low risk group (0-3 risk points), intermediate risk group (4-7 risk points) and high risk group (8-15 risk points), then we compared patient characteristics and followed bleeding events. Results: The numbers of patients at low, intermediate and high risk groups were 113 (10.7%), 420 (39.6%) and 528 (49.8%), respectively. Clinical characteristics for three groups were as follows: atrial fibrillation (low, intermediate and high risk groups; 8.2%, 8.9% and 21.6%, P < 0.001, respectively), peripheral artery disease (3.1%, 9.1% and 22.1%, P < 0.001), coronary multi-vessel disease (38.9%, 44.3% and 54.4%, P = 0.001), use of statin (97.3%, 89.6% and 71.7%, P < 0.001) and proton-pump inhibitors (69.1%, 72.5%, and 78.9%, P = 0.02). Among 1061 patients, a total of 74 bleeding events were occurred during the follow-up period (mean of 1742 days). In the Kaplan-Meier analysis, the cumulative incidence of bleeding events significantly increased from low risk group to intermediate and high risk group (P < 0.001). The risk score showed a significant prognostic value in predicting bleeding events (area under the receiver operating characteristic curve, 0.674; 95% confidence interval, 0.615-0.733). Conclusions: The PARIS bleeding risk score successfully stratified the long-term bleeding risk in patients with coronary artery disease after PCI in Japanese population.

Background: It has been known that East Asian people, including Japanese, has a high bleeding risk (HBR) than Western. Therefore, risk stratification is important to detect HBR patients among patients who underwent percutaneous coronary intervention (PCI). The aim of the present study was to investigate the association between serum albumin level and bleeding events in patients who underwent PCI. Methods and Results: Consecutive 1027 patients who underwent PCI and had been discharged from our institution were enrolled. We divided the patients into three groups based on serum albumin levels at discharge: the first tertile (≤3.7 g/dL, n=358), second tertile (3.8-4.1 g/dL, n=308) and third tertile (≥4.2 g/dL, n=361). Clinical characteristics of three groups were as follows: mean age (the first, second and third tertile; 72.9, 69.3 and 63.4 years, P<0.001), body mass index (23.4, 24.4 and 24.9 kg/m 2 , P<0.001), prevalence of male sex (70.7%, 78.6% and 87.1%, P<0.001), chronic kidney disease (53.8%, 39.3% and 27.1%, P<0.001), anemia (27.9%, 11.3% and 7.2%, P<0.001), atrial fibrillation (21.2%, 12.0% and 11.6%, P<0.001), peripheral artery disease (16.5%, 12.5% and 8.8%, P=0.021), stroke (23.2%, 17.9% and 9.6%, P<0.001), heart failure (54.1%, 28.1% and 21.7%, P<0.001), and use of anticoagulants (17.3%, 10.0% and 10.7%, P=0.007). In contrast, combination of antiplatelets did not differ among groups. In the Kaplan-Meier analysis (mean follow-up 1742 days), accumulated bleeding events progressively increased from the third tertile to the first tertile (Figure). The multivariable Cox proportional hazard analysis revealed that the first tertile (vs. third tertile) was independently associated with bleeding events in patients who underwent PCI (hazard ratio 3.080, 95% confidence interval 1.362-6.961, P=0.007). Conclusion: In patients who underwent PCI, low serum albumin level is independently associated with long-term bleeding events.

Background: The prediction of bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score predicts the bleeding risk in patients t...

Background: Coronary revascularization is important for heart failure patients with ischemic etiology. However, long-term prognostic impact of residual stenosis after revascularization is still poo...

Patients with acute myocardial infarction (AMI) still remain at high risk of morbidity and mortality worldwide in spite of recent advances in percutaneous coronary intervention (PCI) techniques and devices. Therefore, risk stratification at the time of hospitalisation is important to predict outcomes in these patients. Several nutritional indices, such as the geriatric nutritional risk index (GNRI) and the prognostic nutritional index (PNI), have been used in various fields. Malnutrition has been recognised as an independent predictor of adverse prognosis in patients with heart failure. However, the association between nutritional status and long-term outcome in patients with AMI remains unclear. Thus, the aim of the present study was to investigate the prognostic impact of nutritional status assessed by the GNRI and PNI on long-term outcome among patients with AMI. This was a prospective observational study that enrolled 552 consecutive patients with AMI, who had been admitted to, and discharged from, Fukushima Medical University between January 2010 and September 2018. The diagnosis of AMI was based on the World Health Organization multinational monitoring of trends and determinants of cardiovascular disease (MONICA) criteria. Patients were registered within 72 hours after the onset of symptoms if their level of creatine phosphokinase increased to more than twice the normal range, as previously reported. We evaluated nutritional status at hospital discharge using the GNRI and PNI scores as previously described. Namely, lower GNRI or PNI indicate poor nutritional status. We divided these patients into three groups based on each nutritional index: GNRI (low, GNRI <92; intermediate, 92 GNRI< 98; and high, GNRI 98) and PNI (low, PNI< 35; 35 PNI <38; and PNI 38). The patients were followed up until 2019 for all-cause death. The status and/or dates of death of all patients were obtained from the patients’ medical records, attending physicians at the patients’ referring hospital, or by contacting patients by telephone. We were able to follow up on all patients. Survival time was calculated from the date of hospitalisation until the date of death or last follow-up. Written informed consent was obtained from all study subjects at discharge. The study protocol was approved by the ethics committee of Fukushima Medical University, and was carried out in accordance with the principles outlined in the Declaration of Helsinki. During the follow-up period (mean 1424 days), there were 88 all-cause deaths, including 24 cardiac deaths. In the Kaplan–Meier analysis, as shown in Figure 1, all-cause mortality progressively increased from the high-score group to the intermediate and low-score groups (P< 0.001). After adjusting for other potential confounding factors, the Cox proportional hazard analysis revealed that low GNRI (vs. high GNRI) and low PNI (vs. high PNI) were independent predictors of all-cause mortality in patients with AMI (hazard ratio (HR) 2.732, 95% confidence interval (CI) 1.487–5.019, P1⁄4 0.001; HR 3.361, 95% CI 1.759–6.422, P< 0.001, respectively). In addition, receiver operating characteristic curve analysis (Figure 2) demonstrated that a GNRI cut-off value of 92.7 predicated one-year mortality with a sensitivity of 75% and a specificity of 72% (area under the curve (AUC) 0.80, 95% CI 0.70–0.89, P< 0.001) and a PNI cut-off value of 42.5 predicated one-year mortality with a sensitivity of 63% and a specificity of 69% (AUC 0.68, 95% CI 0.57–0.78, P1⁄4 0.004). The analysis also showed that the

Background: Malnutrition has been known as a predictive factor of clinical outcome in patients with heart failure. However, the association between nutritional status and outcomes in patients with ...