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Objective@#To develop and prospectively validate a risk score for acute chest pain patients with normal high-sensitivity troponin I (hs-TnI) levels and without obvious ST-segment deviation in China.@*Methods@#Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients met inclusion criteria including normal hs-TnI levels and without obvious ST-segment deviation were included. The endpoint (major adverse cardiovascular events) was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, and all-cause death within 3 months after initial presentation. Predictors were screened and used to develop the risk score model by logistic regression analysis in a retrospective cohort. Then, the risk score model was evaluated in a prospective validation cohort.@*Results@#The study population of derivation cohort included 1 735 consecutive chest pain patients. Finally, 1 030 eligible patients were enrolled. Multivariate regression analysis defined five independent predictors: male gender (β=0.88); history of chest pain (β value of moderate and high suspicion of coronary heart artery was 2.70 and 3.51 respectively); electrocardiogram (β=0.84); ≥60 years old (β=0.51) and ≥3 risk factors (β=0.85).The range of weighted score was set as 0-13. The area under a receiver operating characteristic (ROC) curve was 0.75 (95%CI 0.72-0.78) in the final model. Major adverse cardiovascular events rates increased in proportion to score increase (P<0.01). The internal validity used bootstrap technique showed the same predictor factors as the final model, and its area under a ROC curve was 0.75(95%CI 0.72-0.78).MACE rates in the low risk group (score 0-3), intermediate risk group (score 4-7), and high risk group (score 8-13) were 1.3% (1/77) ,19.0% (22/116) ,and 42.2% (122/289) in the prospective validation cohort, respectively (P<0.01).@*Conclusion@#The developed ischemic risk score is feasible for risk stratification of acute chest pain patients with normal hs-TnI and without obvious ST-segment deviation, this score might be helpful to the decision making of treatment and management strategies for these patients.
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ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.
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Objective To evaluate the accuracy of 64-slice spiral CT(64 SCT)in assessing the mild and severe stenosis of coronary artery.Methods A total of 72 patients suspected to suffer from coronary artery disease underwent orderly both 64 SCT and selective coronary angiography(SCAG).Volume rendering (VR),multi-planar reconstruction(MPR),maximum intensity projection(MIP)and transverse section wasused to analyze the 64 SCT data.The results were compared with those of SCAG to investigate the accuracy of the 64 SCT in assessing the≥50% stenosis of coronary artery.Results In the 720 SCAG segments of 72 patients.684 of them could be evaluated by 64 SCT.The evaluated rate Was 95.0%.Compared with SCAG,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate was 67.4%,92.9%,69.5%,92.3% and 88.0% respectively.Conclusion The accuracy of 64 SCT in assessing mild and severe stenosis is relatively high and it can be used for screening patients with suspected coronary artery diseases as a non-invasive method.
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Human umbilical cord stromal cells derived from Wharton's jelly bear the potential of stem cells. They share the common surface markers with mesenchymal stem cells derived from bone marrow. They have a relatively higher proliferation rate and self-renewal capacity and can be successfully differentiated into mature neurons, cardiomyocytes, endothelial, adipocytes, chondrocytes and skeletal cells. Researches have shown their promising foregrounds in regenerative therapeutic applications. This article will give a review about the separation and cultivation methods, in vitro differentiation, and in vitro and in vivo transplantation experiments of the aforementioned stromal cells.