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Bećirović E, Bećirović M, Šegalo S, Bećirović A, Hadžić S, Ljuca K, Papić E, Ferhatbegović L, Ejubović M, Jagodić Ejubović A, Kovčić A, Šljivo A, Begagić E. Hemogram-derived ratios as prognostic markers for major adverse cardiovascular events in patients with non-ST-segment elevation myocardial infarction. World J Methodol 2025; 15:98143. [DOI: 10.5662/wjm.v15.i2.98143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/29/2024] [Accepted: 10/20/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Non-ST segment elevation myocardial infarction (NSTEMI) poses significant challenges in clinical management due to its diverse outcomes. Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.
AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events (MACE) in NSTEMI patients, potentially improving clinical outcomes.
METHODS A prospective, observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla, Bosnia and Herzegovina. The study included 170 patients with NSTEMI, who were divided into a group with MACE and a control group without MACE. Furthermore, the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis. Alongside hematological parameters, an additional 13 hematological-derived ratios (HDRs) were monitored, and their prognostic role was investigated.
RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction (NSTEMI) patients with MACE and a control group at T1 and T2. However, significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE. Notably, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were elevated in lethal outcomes. Furthermore, C-reactive protein-to-lymphocyte ratio (CRP/Ly) at T1 (> 4.737) demonstrated predictive value [odds ratio (OR): 3.690, P = 0.024]. Both NLR at T1 (> 4.076) and T2 (> 4.667) emerged as significant predictors, with NLR at T2 exhibiting the highest diagnostic performance, as indicated by an area under the curve of 0.811 (95%CI: 0.727-0.859) and OR of 4.915 (95%CI: 1.917-12.602, P = 0.001), emphasizing its important role as a prognostic marker.
CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients. During follow-up, NLR, PLR, and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.
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Affiliation(s)
- Emir Bećirović
- Department of Intensive Care, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Minela Bećirović
- Department of Nephrology, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Sabina Šegalo
- Department of Laboratory Technologies, Faculty of Health Sciences, University of Sarajevo, Sarajevo 71000, Bosnia and Herzegovina
| | - Amir Bećirović
- Department of Endocrinology, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Semir Hadžić
- Department of Endocrinology, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Kenana Ljuca
- School of Medicine, University of Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Emsel Papić
- Department of Laboratory Technologies, Faculty of Health Sciences, University of Sarajevo, Sarajevo 71000, Bosnia and Herzegovina
| | - Lamija Ferhatbegović
- Department for Internal Diseases and Hemodialysis, Canton Hospital Zenica, Zenica 72000, Bosnia and Herzegovina
| | - Malik Ejubović
- Department of Internal Medicine, Canton Hospital Zenica, Zenica 72000, Bosnia and Herzegovina
| | - Amira Jagodić Ejubović
- Department of Internal Medicine, Canton Hospital Zenica, Zenica 72000, Bosnia and Herzegovina
| | - Amila Kovčić
- Department of Radiotherapy, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
| | - Armin Šljivo
- Department of Cardiology, University Clinical Center Sarajevo, Sarajevo 72000, Bosnia and Herzegovina
| | - Emir Begagić
- Department of General Medicine, University of Zenica, School of Medicine, Zenica 72000, Bosnia and Herzegovina
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Reges O, Abu Ahmad W, Battat E, Saliba W, Wolff Sagy Y, Danon A, Lavie G. Trends in the Incidence of Cardiovascular Diagnoses and Procedures over the Years 2012-2021 in Israel: The Impact of the COVID-19 Pandemic. J Clin Med 2024; 13:476. [PMID: 38256610 PMCID: PMC10816154 DOI: 10.3390/jcm13020476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Prior studies found reduced incidences of cardiovascular diagnoses and treatments in the initial phase of the COVID-19 pandemic. However, these studies included a limited number of outcomes and did not consider pre-pandemic trends. This study aimed to describe trends in the incidence of cardiovascular diagnoses and treatments over the years 2012-2021 in Israel and to compare the two years of the COVID-19 period with the preceding 8 years. In this retrospective, population-based study, carried out within Clalit Health Services, the incidence rates of cardiovascular outcomes were calculated for individuals aged ≥ 25 (~2.7 million adults per year) during the first (Y1, 3/2020-2/2021) and second (Y2, 3/2021-2/2022) years of COVID-19 and the 8 years prior (3/2012-2/2020). Declines were observed in Y1 compared to 2019 in all diagnoses and treatments: STEMI (-16.3%; 95% CI: -16.6, -16.1), non-STEMI (-16.4%; -16.6, -16.2), AF (-14.1%; -14.2, -14.0), CHF (-7.8%; -7.9, -7.7), CVA (-5.0%; -5.0, -4.9), catheterization (-64.7%; -65.2, -64.2), CABG (-77.7%; -79.2, -76.2), ablation (-21.2%; -22.0, -20.4), pacemaker implantation (-39.3%; -40.7, -37.9), and defibrillator insertion (-12.5%; -13.1, -12.0). Compared with expected rates based on pre-pandemic trends, observed rates were within expected ranges (CHF, CVA, and ablation), less than expected (STEMI, non-STEMI, AF, catheterization, CABG, and pacemaker insertion), or more than expected (defibrillator insertion). In Y2, STEMI, catheterization, and CABG returned to expected rates; non-STEMI and AF were lower than expected; and CHF, CVA, ablation, and pacemaker and defibrillator implantations were higher than expected. Several cardiovascular diagnoses and treatment trends were interrupted by COVID-19. The long-term consequences of these changes should be considered by health policymakers.
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Affiliation(s)
- Orna Reges
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel 4077625, Israel
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
| | - Wiessam Abu Ahmad
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
- Hadassah Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Erez Battat
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa 3436212, Israel;
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel;
| | - Yael Wolff Sagy
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
| | - Asaf Danon
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel;
- Department of Cardiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Gil Lavie
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 6209804, Israel; (W.A.A.); (E.B.); (Y.W.S.); (G.L.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel;
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