Jiyan Chen

Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis

BACKGROUNDnQuantitative flow ratio (QFR) is a novel angiography-based method for deriving fractional flow reserve (FFR) without pressure wire or induction of hyperemia. The accuracy of QFR when assessed online in the catheterization laboratory has not been adequately examined to date.nnnOBJECTIVESnThe goal of this study was to assess the diagnostic performance of QFR for the diagnosis of hemodynamically significant coronary stenosis defined by FFRxa0≤0.80.nnnMETHODSnThis prospective, multicenter trial enrolled patients who had at least 1 lesion with a diameter stenosis of 30% to 90% and a reference diameterxa0≥2xa0mm according to visual estimation. QFR, quantitative coronary angiography (QCA), and wire-based FFR were assessed online in blinded fashion during coronary angiography and re-analyzed offline at an independent core laboratory. The primary endpoint was that QFR would improve the diagnostic accuracy of coronary angiography such that the lower boundary of the 2-sided 95% confidence interval (CI) of this estimate exceeded 75%.nnnRESULTSnBetween June and July 2017, a total of 308 patients were consecutively enrolled at 5 centers. Online QFR andxa0FFR results were both obtained in 328 of 332 interrogated vessels. Patient- and vessel-level diagnostic accuracy ofxa0QFR was 92.4% (95% CI: 88.9% to 95.1%) and 92.7% (95% CI: 89.3% to 95.3%), respectively, both of which were significantlyxa0higher than the pre-specified target value (pxa0< 0.001). Sensitivity and specificity in identifying hemodynamicallyxa0significant stenosis were significantly higher for QFR than for QCA (sensitivity: 94.6% vs. 62.5%; difference: 32.0% [pxa0<xa00.001]; specificity: 91.7% vs. 58.1%; difference: 36.1% [pxa0< 0.001]). Positive predictive value,xa0negative predictive value, positive likelihood ratio, and negative likelihood ratio for QFR were 85.5%, 97.1%, 11.4, and 0.06. Offline analysis also revealed that vessel-level QFR had a high diagnostic accuracy of 93.3% (95% CI: 90.0% toxa095.7%).nnnCONCLUSIONSnThe study met its prespecified primary performance goal for the level of diagnostic accuracy of QFR in identifying hemodynamically significant coronary stenosis. (The FAVOR [Functional Diagnostic Accuracy of Quantitative Flow Ratio in Online Assessment of Coronary Stenosis] II China study]; NCT03191708).Abstract Objectives To assess the diagnostic performance of quantitative flow ratio (QFR) for diagnosis of hemodynamically-significant coronary stenosis defined by fractional flow reserve (FFR) ≤0.80. Background QFR is a novel angiography-based method for deriving FFR without pressure wire or induction of hyperemia. The accuracy of QFR when assessed online in the catheterization laboratory has not been adequately examined to date. Methods This prospective, multicenter trial enrolled patients who had at least one lesion with diameter stenosis of 30-90% and reference diameter ≥ 2mm by visual estimation. QFR, quantitative coronary angiography (QCA), and wire-based FFR were assessed online in blinded fashion during coronary angiography and re-analyzed offline at an independent core laboratory. The primary endpoint was that QFR would improve the diagnostic accuracy of coronary angiography such that the lower boundary of the 2-sided 95% confidence interval (CI) of this estimate exceeded 75%. Results Between June and July 2017, 308 patients were consecutively enrolled at 5 centers. Online QFR and FFR results were both obtained in 328 of 332 interrogated vessels. Patient-level and vessel-level diagnostic accuracy of QFR were 92.4% (95% CI: 88.9%-95.1%) and 92.7% (95% CI: 89.3%-95.3%), that were both significantly higher than the prespecified target value (p Conclusions The study met its prespecified primary performance goal for the level of diagnostic accuracy of QFR in identifying hemodynamically-significant coronary stenosis.

Comparison of Different Risk Scores for Predicting Contrast Induced Nephropathy and Outcomes After Primary Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction.

Accurate risk stratification for contrast-induced nephropathy (CIN) is important for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We aimed to compare the prognostic value of validated risk scores for CIN. We prospectively enrolled 422 consecutive patients with STEMI undergoing PPCI. Mehran; Gao; Chen; age, serum creatinine (SCr), or glomerular filtration rate, and ejection fraction (ACEF or AGEF); and Global Registry for Acute Coronary Events risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. CIN was defined as either CIN-narrow (increase in SCr ≥0.5xa0mg/dl) or CIN broad (≥0.5xa0mg/dl and/or a ≥25% increase in baseline SCr). All risk scores had relatively high predictive values for CIN-narrow (c-statistic: 0.746 to 0.873) and performed well for prediction of in-hospital death (0.784 to 0.936), MACEs (0.685 to 0.763), and 3-year all-cause mortality (0.655 to 0.871). The ACEF and AGEF risk scores had better discrimination and calibration for CIN-narrow and in-hospital outcomes. However, all risk score exhibited low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619). In conclusion, risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in patients with STEMI undergoing PPCI. The ACEF and AGEF risk scores appear to have greater prognostic value.

Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction

To investigate whether the addition of left ventricular ejection fraction (LVEF) to the TIMI risk score enhances the prediction of in-hospital and long-term death in ST segment elevation myocardial infarction (STEMI) patients. 673 patients with STEMI were divided into three groups based on TIMI risk score for STEMI: low-risk group (TIMIxa0≤3, nxa0=xa0213), moderate-risk group (TIMI 4–6, nxa0=xa0285), and high-risk group (TIMIxa0≥7, nxa0=xa0175). The predictive value was evaluated using the receiver operating characteristic. Multivariate logistic regression was used to determine risk predictors. The rates of in-hospital death (0.5 vs 3.2 vs 10.3xa0%, pxa0<xa00.001) and major adverse cardiovascular events (14.6 vs 22.5 vs 40.6xa0%, pxa0<xa00.001) were significantly higher in high-risk group. Multivariate analysis showed that TIMI risk score (ORxa01.24, 95xa0% CI 1.04–1.48, Pxa0=xa00.015) and LVEF (ORxa03.85, 95xa0% CI 1.58–10.43, Pxa0=xa00.004) were independent predictors of in-hospital death. LVEF had good predictive value for in-hospital death (AUC: 0.838 vs 0.803, pxa0=xa00.571) or 1-year death (AUC: 0.743 vs 0.728, pxa0=xa00.775), which was similar to TIMI risk score. When compared with the TIMI risk score alone, the addition of LVEF was associated with significant improvements in predicting in-hospital (AUC: 0.854 vs 0.803, pxa0=xa00.033) or 1-year death (AUC: 0.763 vs 0.728, pxa0=xa00.016). The addition of LVEF to TIMI risk score enhanced net reclassification improvement (0.864 for in-hospital death, pxa0<xa00.001; 0.510 for 1-year death, pxa0<xa00.001). LVEF was associated with in-hospital and long-term mortality in STEMI patients and had additive prognostic value to TIMI risk score.

Novel Risk Biomarker for Infective Endocarditis Patients With Normal Left Ventricular Ejection Fraction ― Monocyte to High-Density Lipoprotein Cholesterol Ratio ―

BACKGROUNDnThe monocyte to high-density lipoprotein cholesterol ratio (MHR) appears to be a newly emerging inflammatory marker. However, its prognostic value in patients with infective endocarditis (IE) and normal left ventricular ejection fraction (LVEF) has been unclear.Methodsu2004andu2004Results:We enrolled consecutive patients with IE and normal LVEF and divided into 3 groups based on the tertiles of MHR. Of 698 included patients, 44 (6.3%) died while in hospital. The occurrence of in-hospital death (3.9%, 4.3%, and 10.8%, P=0.003) and of major adverse clinical events (MACEs) (15.6%, 20.9%, and 30.6%, P<0.001) increased from the lowest to the highest MHR tertiles, respectively. Receiver-operating characteristic analysis demonstrated that MHR had good predictive value for in-hospital death (area under the curve [AUC] 0.670, 95% confidence interval [CI] 0.58-0.76, P<0.001) and was similar to C-reactive protein (AUC 0.670 vs. 0.702, P=0.444). Furthermore, MHR >21.3 had a sensitivity of 74.4% and specificity of 57.6% for predicting in-hospital death. Multiple analysis showed that MHR >21.3 was an independent predictor of both in-hospital (odds ratio 3.98, 95% CI 1.91-8.30, P<0.001) and long-term death (hazard ratio 2.29, 95% CI 1.44-3.64, P<0.001) after adjusting for age, female, diabetes mellitus, estimated glomerular filtration rate <90 mL/min/1.73 m2, and surgical treatment. Kaplan-Meier survival curves showed that patients with MHR >21.3 had an increased rate of long-term death compared to those without (P=0.002).nnnCONCLUSIONSnElevated MHR was independently associated with in-hospital and long-term death in patients with IE and normal LVEF.

Apolipoprotein A-I: A favorable prognostic marker in infective endocarditis

BACKGROUNDnDecreased apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) are common in inflammation and sepsis. No study with a large sample size has been performed to investigate the prognostic value of apoA-I or HDL-C in infective endocarditis (IE).nnnOBJECTIVEnThe present study aimed to explore the prognostic value of apoA-I and HDL-C for adverse outcomes in IE patients.nnnMETHODSnPatients with a definite diagnosis of IE between January 2009 and July 2015 were enrolled and divided into 3 groups according to their apoA-I tertiles at admission. Univariate and multivariate analyses were performed to evaluate the relationship of apoA-I and HDL-C with clinical outcomes.nnnRESULTSnOf the 593 included patients, 40 (6.7%) died in hospital. Patients with lower apoA-I experienced markedly higher rates of in-hospital mortality (10.7%, 7.0%, and 2.5% in tertiles 1-3, respectively; Pxa0=xa0.006) and major adverse clinical events (32.5%, 24.1%, and 8.6% in tertiles 1-3, respectively; Pxa0<xa0.001). ApoA-I (area under the curve, 0.671; Pxa0<xa0.001) and HDL-C (area under the curve, 0.672; Pxa0<xa0.001) had predictive values for in-hospital death. Multivariate logistic regression showed that apoA-I <0.90xa0g/L and HDL-C <0.78xa0mmol/L were independent risk predictors for in-hospital death. A multivariate Cox proportional hazard analysis revealed that apoA-I (increments of 1xa0g/L; hazard ratio, 0.36; 95% confidence interval, 0.15-0.87; Pxa0=xa0.023) and HDL-C (increments of 1xa0mmol/L; hazard ratio, 0.38; 95% confidence interval, 0.18-0.83; Pxa0=xa0.015) were independently associated with long-term mortality.nnnCONCLUSIONSnApoA-I and HDL-C were inversely associated with adverse IE prognosis.

Risk prediction in infective endocarditis by modified MELD-XI score

The suitability of the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict adverse outcomes in infective endocarditis (IE) patients remains uncertain. This study was performed to explore the prognostic value of the MELD-XI score and modified MELD-XI score for patients with IE. A total of 858 patients with IE were consecutively enrolled and classified into two groups: MELD-XI ≤u200910 (nu2009=u2009588) and MELD-XI >u200910 (nu2009=u2009270). Multivariate analysis was performed to determine risk factors independent of MELD-XI score. Higher MELD-XI score was associated with higher in-hospital mortality (15.6 vs. 4.8%, pu2009<u20090.001) and major adverse clinical events (33.3 vs. 18.4%, pu2009<u20090.001). MELD-XI score was an independent predictor of in-hospital death (odds ratio [OR]u2009=u20091.06, 95% CI, 1.02–1.10, pu2009=u20090.005). Based on a multivariate analysis, NYHA class III or IV (3 points), C-reactive protein >u20099.5xa0mg/L (4 points), and non-surgical treatment (6 points) were added to MELD-XI score. Modified MELD-XI score produced higher predictive power than previous (AUC 0.823 vs. 0.701, pu2009<u20090.001). The cumulative incidence of long-term mortality (median 29xa0months) was significantly higher in patients with modified MELD-XI score >u200913 than those without (log-ranku2009=u200925.30, pu2009<u20090.001). Modified MELD-XI score was independently associated with long-term mortality (hazard ratiou2009=u20091.08, 95% CI, 1.04–1.12, pu2009<u20090.001). MELD-XI score could be used as a risk assessment toolxa0in IE. Furthermore, modified MELD-XI score remained simple and more effective in predicting poor prognosis.

ST-Segment elevation acute myocardial infarction prehospital thrombolytic therapy: Chinese expert consensus

Acute myocardial infarction (AMI) still seriously threatens the health of the people in our country. The situation is even more severe in the vast urban and rural areas in China. Timely treatment of AMI patients to reduce mortality and protect heart function is very important. Prehospital thrombolysis treatment has great significance in urban and rural areas outside the big cities. To this end, the Chinese Medical Doctor Associations chest pain professional committee and the Chinese Medical Rescue Associations Cardiovascular Emergency Sub-Commission organized relevant experts to formulate this consensus, aiming to help prehospital medical emergency personnel select the best treatment strategies for patients with AMI. However, the final decision on a specific patient should be made by the prehospital emergency personnel together with the patients and their family members.

TCT-473 A Randomized Comparison of Biodegradable Polymer- and Permanent Polymer-coated Platinum Chromium Everolimus-Eluting Coronary Stents in China: EVOLVE China Study

The study sought to evaluate the clinical safety and effectiveness of the SYNERGY stent for the treatment of patients in China.nnEligible patients with de novo native coronary artery lesions were randomized to receive the SYNERGY or PROMUS Element Plus stents in a 1:1 ratio. Angiographic and

PREDICTIVE VALUE OF EARLY AND LATE DEFINITION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY AFTER CORONARY ANGIOGRAPHY OR PERCUTANEOUS CORONARY INTERVENTION

It is uncertain whether early (within 24h) and late (24-48h post-procedure) increased of serum creatinine (SCr) level, as an early and late definition of contrast-induced acute kidney injury (CI-AKI), has predictive value for long-term clinical prognosis.nnWe prospectively recruited 1344 consecutive

GW24-e0608 The relationship between interval of two contrast exposure during cardiac catheterisation and contrast induced nephropathy

Objectives It is not clear that the interval of two contrast exposure duringcardiac catheterisation may affect contrast induced nephropathy. We assumed that the risk of CIN increased when two contrast exposure during cardiac catheterisation are perfumed in short interval, without enough time for recovery from the adverse effects of repeated contrast exposure. Methods We prospectively observed 137 patients undergoing second cardiac catheterisation, which were divided into two groups with the interval ≤ 7 days and > 7 days. CIN was defined as an increase in serum creatinine of ≥ 0.5 mg/dl or ≥ 25% relatively from the baseline within 48-72 h after contrast media exposure. Results Eighteen patients (13.1%) developed CIN. The patients with the interval ≤ 7 days (interval median: 3, interquartile range: 2–4) have the similar baseline creatinine and contrast volume with the patients with the interval > 7days (interval median: 59, interquartile range: 28-152) (baseline SCr:86 ± 24vs89 ± 18, p = 0.344; dose of CM: 133 ± 58 vs 102 ± 57, p = 0.067, respectively). The incidence of CIN is no significant different between two groups (14.4% vs 10.6%, p = 0.531). Conclusions Risk of CIN is not influenced by the interval of two contrast exposure during cardiac catheterisation. Our results do not support the notion of short interval may affect contrast induced nephropathy.