107 research outputs found
A prospective investigation of the prognostic value of "TIMI" and "Front Door TIMI" in Chinese patients presenting to the emergency department with undifferentiated chest pain [Abstract]
No full textStudy Objective: Chest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) and front door Thrombolysis in Myocardial Infarction risk score (FDTIMI-RS) have been proven to be useful to risk stratify chest pain patients in many Western countries, but it has not been validated in Asian countries. We hypothesised that the TIMI-RS would be a valid tool in the Hong Kong Chinese population. The aim of this study was to establish the relationship between TIMI-RS and FDTIMI-RS and the 30-day rate of major adverse cardiac outcomes (MACE) of patients with chest pain. Methods Design: Single center prospective observational cohort study. Participants: Consecutive ED patients presenting with chest pain were enrolled from July 2009 until March 2010. Data collection: patient characteristics, TIMI-RS items and past medical and medication history. Primary outcome: MACE within 30 days of ED presentation. MACE is defined as a composite outcome which is fulfilled if any of the following occurs: death (all causes), readmission with myocardial infarction (MI), acute coronary syndrome not diagnosed at initial ED presentation, and percutaneous coronary intervention. Results: 1000 patients were recruited and 30-day follow-up was completed on all patients. Patients had a mean age of 66.7±14 years and 54% were male. 169 (17%) patients had a MACE within 30 days of ED presentation. The incidence of MACE in each TIMI-RS group is as follows: TIMI-RS 0, 1/145, (0.7%); TIMI-RS 1, 21/249 (8.4%); TIMI-RS 2, 44/239, (18.4%); TIMI-RS 3, 40/179, (22.3%); TIMI-RS 4, 42/122, (34.4%), TIMI-RS 5, 14/52, (26.9%), TIMI-RS 6/7, 7/14, (50%). There was an excellent correlation between TIMI-RS and MACE (ρ=0.964, p <0.001). Increasing FDTIMI-RS was also associated with increased risk of MACE within 30 days (ρ= 1, p=0.01). Conclusion: The TIMI-RS and FDTIMI-RS may be useful tools for risk stratification of ED patients with undifferentiated chest pain. However, patients in the low risk group still had a risk of having MACE (0.7% for TIMI-RS=0 and 1.3% for FDTIMI-RS=0). Therefore, while the scores can guide patient disposition from the ED, they cannot fully replace clinical judgement
Coronary angiography for follow-up of heart transplant recipients: Insights from TIMI frame count and TIMI myocardial perfusion grade
No full textBackground: The aim of this study was to evaluate the course of Thrombolysis in Myocardial Infarction (TIMI) frame count (TIMI FC) and myocardial perfusion grade (TIMI MPG) in heart transplant recipients and whether these parameters could predict mortality. Methods: Sixty-two heart transplant recipients were enrolled in this study. All patients had coronary angiography at baseline and at I year, which were evaluated for TIMI FC and TIMI MPG. Also, 50 vessels in 35 patients were analyzed with volumetric intravascular ultrasound (IVUS) at baseline and at I year. Rejection episodes and mortality were recorded during the follow-up period. Results: The mean follow-up interval was 51.5 +/- 17.2 months (range 12.2 to 78.4 months). TIMI FCs of all three coronary arteries and global TIMI FC (gTIMI FC) significantly increased from baseline during the first year (p = 3A rejection were significantly more frequent in the stable gTIMI FC group (p = 0.03). Mortality rate was significantly higher in the group with increasing gTFC (p = 0.02). Conclusions: gTIMI FCs and TIMI FCs of coronary arteries increase, and TIMI MPG gradually deteriorates during the first year after transplantation. Mortality rate is significantly higher in patients whose gTIMI FC increases from baseline. Change in gTIMI FC is a simple quantitative predictor of long-term mortality in heart transplant recipients
An Econometric model for the evolution of the Romanian Interbank Bid Rate (ROBID) in the context of the international financial crisis
No full textThe paper presents the econometric modeling of overnight inter-banking interest rates (ROBID) in our country, the analyzed period is between 1999-2010. The international financial crises had a great impact on the level of inter-banking interest rates after 2007 and it reflects the new level of risk for the Romanian system banking. The econometric model used in modeling the interest rates is an autoregressive moving average (ARMA) model, the ARMA model is typically applied to time series data; the paper propose several ARMA models, applies econometric tests and based on them the analyzed series (the inter-banking interest rates) forecast will be made.ROBID, ARIMA model, financial crisis, forecast.
The ratio of circulating endothelin-1 to endothelin-3 associated with TIMI risk and dynamic TIMI risk score in ST elevation acute myocardial infarction
No full textIn ST segment elevation acute myocardial infarction (STEMI), the endothelin (ET) system imbalance, reflected by the circulating ET-1:ET-3 ratio has not been investigated. This study’s primary objective was to measure the circulating ET-1:ET-3 ratio and correlate it with the risk stratification for 1 year mortality of STEMI based on TIMI score. On admission, the TIMI risk score and at discharge, the dynamic TIMI risk score were calculated in 68 consecutive subjects with STEMI. Subjects with high TIMI risk score were associated with higher mean ET-1 level and ET-1:ET-3 ratio. The ET-1:ET-3 ratio more accurately predicted the high on admission TIMI risk score than the ET-1 level. Subjects with high dynamic TIMI risk score were associated with higher mean ET-1 level and ET-1:ET-3 ratio. The ET-1:ET-3 ratio more accurately predicted the high at discharge dynamic TIMI risk score than ET-1 level. From multivariable analysis, the ET-1:ET-3 ratio was not independently associated with high on admission TIMI risk score but independently predicted high at discharge dynamic TIMI risk score (odds ratio = 9.186, p = 0.018). In conclusion, combining the ET-1 and ET-3 levels into the ET-1:ET-3 ratio provided a prognostic value by independently predicting the increased risk to 1 year mortality as indicated by at discharge dynamic TIMI risk score in patients with STEMI.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
96 Validation of the TIMI Risk Score in Chinese Patients Presenting to the Emergency Department With Chest Pain
No full textThe Thrombolysis In Myocardial Infarction (TIMI) risk score is a 7 item tool which has been validated in Western medical literature to help risk stratify chest pain patients. The aim of this study is to establish the relationship between the TIMI risk score and the rate of occurrence of Major Adverse Cardiovascular Events (MACE) within 30 days in Chinese patients presenting to the emergency department (ED) with undifferentiated chest pain.
Methods
Design - single center prospective observational study of adult Chinese ED patients with undifferentiated chest pain. Setting - University hospital emergency department in Hong Kong with annual census of 140000 patients. Subjects - all adult patients presenting with undifferentiated chest pain. Data, including patient characteristics, medical history and components of the TIMI risk score was collected. All patients were followed up at 30 days, either by review of electronic medical records or telephone interview. MACE was defined as death from any cause; myocardial infarction; troponin elevated acute coronary syndrome or undergoing percutaneous coronary intervention. Rates of MACE at 30 days were examined in relation to TIMI risk score.
Results
Follow-up at 30 days was completed for a total of 315 patients. There were a further 37 patients who did not give consent to be included in the study. Median age was 69 years and 55% of the participants were male. A MACE occurred in 57 patients (18%). Rates of MACE according to TIMI risk score were: TIMI 0, 3/37 (8%); TIMI 1, 4/79 (5%); TIMI 2, 12/77 (16%); TIMI 3, 15/67 (22%); TIMI 4 13/36 (36%); TIMI 5, 5/14 (36%); TIMI 6, 5/5 (100%); TIMI 7 0/0 (p<0.005).
Conclusion
Increasing TIMI risk score is strongly associated with risk of MACE in chest pain patients. The TIMI risk score is sensitive enough to identify Chinese patients at high risk of an adverse event but not specific enough to identify patients suitable for early discharge
Újdonságok a dapagliflozinról: a DECLARE-TIMI 58 vizsgálat alcsoport-elemzései [Novel data about dapagliflozin: subgroup analyses from DECLARE-TIMI 58 randomised trial]
No full textAz utóbbi években a nemzetközi ajánlásokban az életmód-terápia kiegészítéseként a metformin a 2-es típusú cukorbetegek első vonalbeli gyógyszeres kezelésének preferált készítményeként szerepel. A metforminkezelés kiegészítésére alkalmazott SGLT-2-gátlók a vesék proximális tubulusaiban gátolják a glukóz visszaszívódását, a következményes glucosuria a HbA1c , az éhomi és a postprandialis vércukorértéket egyaránt csökkenti, mindezt az endogén inzulintermeléstől függetlenül. Az SGLT-2-gátló dapagliflozinnal elvégzett, 2018-ban publikált, randomizált, kontrollált kardiovaszkuláris kimenetelt vizsgáló DECLARE-TIMI 58 tanulmány igazolta a dapagliflozin addigi antidiabetikus kezelést kiegészítő alkalmazásának – placebóval szemben – kardiovaszkuláris biztonságosságát, teljesült a non-inferioritás kritériuma. Egyúttal a dapagliflozin szignifikánsan csökkentette a szívelégtelenség miatti kórházi felvétel szükségességét, valamint jelentősen csökkentette az előre meghatározott összetett vesevégpontokat. A jelen közleményben a DECLARE vizsgálat négy különböző alcsoport-analízisének eredményeit tekinti át a szerző, nevezetesen a dapagliflozinnak a posztinfarktusos betegekre, az előzményükben szívelégtelenségben szenvedő betegekre, a diabeteses vesebetegség progressziójára, valamint a perifériás érbetegséggel társult, illetve attól mentes cukorbetegekre gyakorolt hatásait. | In recent years, according to international guidelines, metformin is the preferred initial glucose-lowering medication for most people with type 2 diabetes. SGLT-2 inhibitors reduce glucose reabsorption in the renal proximal tubules and increases renal glucose excretion via the urine leading to reduced HbA1c , fasting and postprandial plasma glucose levels, independently from endogenous insulin secretion. DECLARE-TIMI 58 study, published in 2018 was a cardiovascular outcome trial. This study demonstrated that dapagliflozin, when added to the standard of care treatment, was non-inferior to placebo with respect primary safety endpoint of major adverse cardiovascular events. However, dapagliflozin significantly reduced rate of hospitalization for heart failure. Furthermore, dapagliflozin administration markedly reduced prespecified composite renal outcome. In this review the author summarizes the data on four subgroup analyses of DECLARE-TIMI 58 study, namely patients with previous myocardial infarction, effect of dapagliflozin on heart failure depending on history of heart failure at baseline, and development and progression of diabetic kidney disease, and in patients with and without peripheral artery disease
755-2 Current Management of ST Elevation Myocardial Infarction and Outcome of Thrombolytic Ineligible Patients: Results of the Multicenter TIMI 9 Registry
No full textDespite clear benefit of thrombolysis (Tlysis) and primary (1°) PTCA for acute MI, prior reports have indicated a low use of thrombolytic therapy in the U.S. Further, single center reports have suggested that mortality is up to 5 times higher when thrombolysis is not given. To evaluate the management and outcome of acute MI in 1994, we conducted a registry in 20 hospitals (16 with l° PTCA capability) and prospectively identified allconsecutive patients (ptsl presenting with acute MI and ST segment elevation or new LBBB. A total of 587 pts were identified, 200 were enrolled in the TIMI 9 thrombolytic trial of hirudin vs. heparin, and 387 in the TIMI 9 Registry. Tlysis was given to 356 of 587 (60.7%) pts (of whom 200/356 (56%) were enrolled in TIMI 9); l° PTCA was performed in 62/587 (10.5%) of the total population and medical therapy used in 169/587128.8%). Of the patients enrolled in the TIMI 9 Registry, those treated with l° PTCA were significantly younger, 60.7 years, vs. 64.9 for Tlysis and 66.1 for medical therapy(each p<0.05) and were less oftenwomen, 20.0%, vs. 36.2% and 36.1%, respectively, (each p<0.05). Time to presentation was significantly longer for medically treated pts: 13.8h vs. 4.4h for Tlysis and 3.3h for 1° PTCA (each p<0.001). Delay> 12 hours was the reason cited most often for pts not treated with thrombolysis. Inhospital mortality is shown. Recurrent MI was similar in the 3 groups, 4.2%.Conclusions(1) In 1994 in the U.S., reperfusion therapy was used in 71% of pts with ST elevation MI at these hospitals. (2) The potential underutilization of l° PTCA in women deserves further study. (3) Early mortality was similar for Tlysis and l° PTCA, but highest for medically treated pts, which supports further expansion of reperfusion therapy in ST elevation MI (including use of strategies to shorten patient time to presentation) and the need for improved medical therapies for thrombolytic ineligible patients
Study of flight data recorder, underwater locator beacon, data logger and flarm collision avoidance system
No full textProspective validation of Thrombolysis in Myocardial Infarction and front door Thrombolysis in Myocardial Infarction risk scores in Chinese patients presenting to the ED with chest pain
No full textChest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction (TIMI) and front door TIMI (FDTIMI) scores are used to risk stratify chest pain patients in many Western countries; they have not been validated in patients with undifferentiated chest pain in Asia. Our objective was to establish the relationship between the TIMI and FDTIMI scores and the 30 day rate of major adverse cardiac outcomes (MACE) in Chinese patients presenting to the ED with chest pain.
Methods
Prospective, single-center, observational cohort study of consecutive patients presenting with chest pain from July 2009 until March 2010 to a Hong Kong university hospital ED. Data collected included patient characteristics, TIMI items and past medical and medication history. Primary outcome was MACE within 30 days of presentation. MACE was a composite outcome of any of the following: death (all causes), readmission with myocardial infarction, acute coronary syndrome not diagnosed at initial ED presentation and coronary revascularization.
Results
One thousand patients recruited with complete 30-day follow-up. STEMI patients (n = 75) were excluded. Mean patient age 66.8 ± 13.9 years; 51.7% male. 119 (12.9%) patients had MACE within 30 days of presentation. The incidence of MACE ranged from 0 for TIMI0 to 37.5% for patients with TIMI6/7. Increasing TIMI and FDTIMI scores were associated with a higher incidence of MACE.
Conclusions
This validation suggests that the TIMI/FDTIMI scores can be employed in Hong Kong Chinese; they may be useful for risk stratificatio
Obesity and effects of dapagliflozin on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus in the DECLARE-TIMI 58 trial
No full textPublished on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected] : We investigated the associations between obesity, cardiorenal events, and benefits of dapagliflozin in patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS : DECLARE-TIMI 58 randomized patients with T2DM and either atherosclerotic cardiovascular (CV) disease or multiple risk factors to dapagliflozin vs. placebo. Patients were stratified by body mass index (BMI, kg/m2): normal (18.5 to <25), overweight (25 to <30), moderately obese (30 to <35), severely obese (35 to <40), and very-severely obese (≥40). Outcomes analysed were CV death, hospitalization for heart failure (HHF), renal-specific composite outcome, and atrial fibrillation or flutter (AF/AFL). Of 17 134 patients, 9.0% had a normal BMI, 31.5% were overweight, 32.4% were moderately, 17.2% severely, and 9.8% were very-severely obese. Higher BMI was associated with a higher adjusted risk of HHF and AF/AFL (hazard ratio 1.30 and 1.28, respectively, per 5 kg/m2; P < 0.001 for all). Dapagliflozin reduced body weight by similar relative amounts consistently across BMI categories (percent difference: -1.9 to -2.4%). Although relative risk reductions in CV and renal-specific composite outcomes with dapagliflozin did not significantly differ across the range of BMI (P for interaction ≥0.20 for all outcomes), obese patients (BMI ≥ 30 kg/m2) tended to derive greater absolute risk reduction in HHF and AF/AFL (P for interaction 0.02 and 0.09, respectively) than non-obese patients. CONCLUSIONS : In DECLARE-TIMI 58, patients with T2DM and higher BMI were more likely to have HHF and AF/AFL. Whereas relative risk reductions in CV and renal outcomes with dapagliflozin were generally consistent across the range of BMI, absolute risk reduction in obesity-related outcomes including HHF and AF/AFL tended to be larger in obese patients with T2DM. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01730534.N
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