ABSTRACT
Objective To analyze the impact of high-density lipoprotein cholesterol (HDL-C) levels at hospital admission on the incidence of major adverse cardiovascular events (MACCE) in patients with acute ST segment elevation myocardial infarction (ASTEMI).Methods 1067 patients with ASTEMI who were admitted to the 20 hospitals in Liaoning region and with lipid profile tested within the 24 hours of admission from May 2009 until May 2010,were enrolled.Data on basic demographic,clinical,status on admission and method of treatment were collected.Rate on various medical use and MACCE (cardiovascular death,non-fatal myocardial infarction,revascularization and stoke) were compared between the two groups through follow-up observation.Cox proportional hazard analysis was estimation.Results The median HDL-C level was 1.27 mmol/L,with 587 patients having HDL-C below and 489 patients HDL-C above the median level.The incidence rates of non-fatal myocardial infarction and MACCE at one-year follow-up period,was higher in low HDL-C group (4.8％ vs.0.9％,P＜0.001:23.7％ vs.18.1％,P=0.03,respectively) At one month follow-up,the incidence rate of non-fatal myocardial infarction was higher in low HDL-C group (1.4％ vs.0.0％,P=0.01 ).At six month follow-up,the incidence rates of non-fatal myocardial infarction and MACCE on one-year follow-up was higher in low HDL-C group (2.8％ vs.0.4％,P=0.003; 18.3％ vs.13.7％,P=0.04,respectively).Results from Cox proportional hazards analysis indicated that age ( HR =1.02,95％ CI:1.006- 1.035,P =0.005 ),diabetes (HR =1.05,95％ CI:1.053-2.171,P=0.03 ),HDL-C level ( HR =0.56,95％CI:0.340-0.921,P=- 0.02 ) were significantly related to the incidence of MACCE.Conclusion The incidence rates of one year and six month MACCE (mainly non-fatal myocardial infarction) and one month non-fatal myocardial infarction were significant higher in patients with low than high HDL-C levels at admission while kept on the ascending along with time.Age,diabetes,HDL-C level were independent risk factors related to the incidence of MACCE.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the value of coronary CT angiography in assessment of bifurcation lesions.</p><p><b>METHODS</b>The original image of 79 established and suspected coronary artery disease patients who underwent both coronary CT angiography and conventional artery angiography (CAG) sequentially were included in this analysis. Bifurcation lesions were assessed on primary and secondary vessels with diameter ≥ 2.0 mm, bifurcation lesions were graded according to Chen's classification. CAG was used as golden standard. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. Spearman's test and Kappa test were used to evaluate the correlation and classification identity of the two methods.</p><p><b>RESULTS</b>CAG evidenced 177 bifurcation lesions out of 445 bifurcation vessels and coronary CT detected 168 bifurcation lesions out of 404 bifurcation vessels with satisfactory imaging quality and 390 bifurcation vessels could be analyzed by both CAG and coronary CT. Sensitivity, specificity, positive predictive value and negative predictive value of coronary CT angiography were 94.2%, 94.6%, 90.7%, 96.1%, respectively. The results for the lesions at LM-LAD/LCX + LAD/Mid, LAD/Diag, RCA/PDA were more satisfactory and the sensitivity and specificity were as high as: 97.1% and 94.2%, 95.7% and 89.5%, 92.3% and 98.7%, respectively. There were significant correlations for evaluating the narrow degree of the opening of the bifurcation branch with these two methods (r = 0.799 58, P < 0.01) and for identifying I, II, III type bifurcation lesions (Kappa coefficient = 0.7959, P < 0.01) as well as for identifying the subtype bifurcation lesions (Kappa coefficient = 0.6328, P < 0.01) using the two methods.</p><p><b>CONCLUSION</b>Coronary CT angiography is efficient in identifying the bifurcation lesions and offers a reasonable indication for bifurcation lesion classification.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Angiography , Methods , Coronary Artery Disease , Diagnostic Imaging , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To analyze the impact of body mass index (BMI) on the presentation,treatment,and clinical outcomes of patients with ST-segment elevated myocardial infarction (STEMI).Methods 1414 patients with STEMI who were admitted to the 20 hospitals in Liaoning region from May 2009 until May 2010 were enrolled.Patients were stratified according to the BMI levels as normal weight group (18.5 kg/m2≤BMI＜24.0 kg/m2) (n＝485),overweight (24.0 kg/m2≤BMI＜28.0 kg/m2) (n＝736),or obesity (BMI≥28.0 kg/m2) (n＝193).Presentation,treatment and mortality during hospitalization,MACCE (cardiovascular death,non-fatal myocardial infarction,revascularization and stroke) were compared between the three groups at 3-month and 1-year follow-up.Results Obesity in patients with STEMI was associated with younger age (P＜0.001),being male (P＜0.001),with diabetes (P＝0.013) or hypertension (P＜0.001) and hyperlipidmia (P＜0.001).A higher prevalence of reperfusion treatment (P ＝ 0.018),mainly percutaneous coronary intervention (PCI) (P＜0.001) was seen during the period of hospitalization.Rates of using other kinds of medicines as well as the mortalities during hospitalization,were similar among the groups with different BMI categories.At 3-month and 1-year follow-up,more use of asprin (3-months:P＝0.018; 1-year:P＝0.002) and β-receptor blockers were seen in the obesity group (3-months:P＝0.025; 1-year:P＝0.030) while the use of other drugs were not significantly different among the three groups.The incidence rates of MACCE were not significantly different among the BMI categories while the cumulative survival rate was similar between obese group and normal weight group.Results from the Cox proportional hazards analysis indicated that factors as age (HR＝1.045,95％ CI:1.028-1.062,P＜0.001),diabetes (HR＝ 1.530,95％ CI:1.107-2.301,P＝0.041),hyperlipidmia (HR＝2.127,95％ CI:1.317-3.435,P＝0.002),urgent PCI (HR＝0.473,95％CI:0.307-0.728,P＝0.001) and the use of β-receptor blockers at 3-months follow-up period (HR＝0.373,95％ CI:0.195-0.713,P＝0.003) were significantly related to the incidence of MACCE at 1-year follow-up period.Conclusion Despite the fact that patients with obesity presented with STEMI at younger age and having received active treatment of reperfusion and medicine,both the 3-month and 1-year outcomes did not show significant difference among the BMI categories.