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<p><b>BACKGROUND</b>Many studies have shown that the serum uric acid (SUA) level is one of the cardiovascular risk factors. The aim of the study is to evaluate the relationship between SUA levels and the severity of coronary artery disease (CAD) assessed by angiography and the Syntax score in patients with obstructive CAD.</p><p><b>METHODS</b>Participants who visited our hospital for a coronary angiography, from December 2007 to September 2012, were eligible for this analysis. SUA and other blood parameters after at least 12-hour fast were determined. First, the patients were divided into tertiles according to their Syntax scores (low Syntax score group: Syntax score ≤ 10.0; moderate Syntax score group: 10.0 <Syntax score ≤ 18.0; high Syntax score group: Syntax score >18.0). Second, to clarify the association between SUA levels and major adverse cardiovascular events (MACEs), all patients were divided into two subgroups on the basis of SUA levels. The cutoff value of SUA was defined by diagnostic criteria of hyperuricemia. Patients were separated into normal SUA group (n = 251, with SUA <416 µmol/L for men and SUA <357 µmol/L for women) and high SUA group (n = 96, with SUA ≥ 416 µmol/L for men and SUA ≥ 357 µmol/L for women). All participants were followed for a mean of 22.0 months (1-75 months, interquartile range: 28 months) for major adverse cardiovascular events (MACEs), including all-cause death, recurrent nonfatal myocardial infarction (re-MI) and recurrent percutaneous coronary intervention (re-PCI).</p><p><b>RESULTS</b>A total of 347 patients were registered for the study. The SUA levels in the high Syntax score group were significantly higher than that of the moderate Syntax score group and the low Syntax score group ((392.3 ± 81.6) µmol/L vs. (329.9 ± 71.0) µmol/L, P < 0.001; (392.3 ± 81.6) µmol/L vs. (311.4 ± 64.7) µmol/L, P < 0.001). The SUA level was positively correlated not only with the Syntax score (r = 0.421, P < 0.001; 95% CI: 0.333-0.512), but also with the number of diseased vessels (r = 0.298, P < 0.001; 95% CI: 0.194-0.396). After multiple linear regression analysis, SUA levels were identified to be independently correlated with a high Syntax score (B = 0.033, 95% CI 0.023-0.042, P < 0.001). Compared with the normal SUA subgroup, the high SUA subgroup tended to have a higher Syntax score (19.9 ± 8.7 vs. 13.6 ± 7.5, P < 0.001) and more multi-vessel disease (70.8% vs. 46.6%, P < 0.001). Follow-up data showed a higher incidence of MACE in the high SUA subgroup (20.8% vs. 6.0%, P < 0.001). Binary Logistic regression analysis indicated that the elevated SUA can predict the long-term prognosis of patients with obstructive CAD (OR = 2.968, 95% CI 1.256-7.011, P = 0.013). Kaplan-Meier analysis showed a significantly lower event-free survival rate in patients with high SUA levels than in the normal SUA subgroup (79.2% vs. 94.0%, Log rank = 17.645, P < 0.001).</p><p><b>CONCLUSIONS</b>SUA levels were independently associated with the severity of CAD in patients with obstructive CAD. An elevated SUA is associated with cardiovascular events and may be useful as a biomarker of the severity of CAD.</p>
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Aged , Female , Humans , Male , Middle Aged , Arterial Occlusive Diseases , Blood , Mortality , Coronary Artery Disease , Blood , Mortality , Kaplan-Meier Estimate , Uric Acid , BloodABSTRACT
AIM: To investigate the role of angiopoietin-1 (Ang1) and Tie2 receptor in angiogenesis after myocardial infarction through detecting their mRNA expression in normal and infracted myocardium. METHODS: The experiment was conducted in the laboratory of Biochemistry and Molecular Biology, Medical Department of Peking University from April 2006 to April 2007. Forty male SD rats were randomly divided into acute myocardial infarction model group and sham-operation group. The myocardial infarction model was established in the rats of model group through the ligation of left anterior descending artery, while the rats in sham operation group were braided of the left anterior descending artery without ligation. Five rats in both groups were executed at 3, 7, 14, and 28 days after model establishment. RNA was extracted from the same site of left anterior wall, and the polymerase chain reaction was used to semiquantitatively analyze the Ang1 and Tie2 receptor mRNA expression with GAPDH gene as internal control; meanwhile, the immunohistochemistry was used to detect vascular density in and around infarction area. All the treatments for animals were accorded with the animal ethical standards. RESULTS: All 40 rats were included in the final analysis. Both Ang1 and Tie2 receptor were expressed in normal myocardium. In the 28 days after myocardial infarction, Ang1 expression kept at almost the same level without changing, but Tie2 receptor expression was slightly elevated at 3 days, reached peak value at 7 days, and returned to the baseline value at 14 days. The vascular density increased both infarction and peri-infarction area at 7 days after acute myocardial infarction, and did not change with time. CONCLUSION: Tie2 receptor expression is elevated and coincided with angiogenesis after myocardial infarction. It may play a role in the development and stabilization of the blood vessel after myocardial infarction.
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AIM: To observe acute coronary syndrome (ACS), including acute myocardial infarction (AMI), and unstable angina pectoris (UAP) and plasma monocyte chemoattractant protein-1 (MCP-1) in patients with restenosis after angioplasty, and compared with normal controls. METHODS: Sixty-eight patients were selected from the Department of Cardiology, Third Hospital Affiliated to Peking University between December 2005 and April 2006, including 30 patients with AMI, 20 patients with UAP and 16 patients with restenosis after angioplasty. Thirty healthy people were selected simultaneously to be the controls. All subjects knew and agreed with the items. The level of blood lipid was determined in all enrolled subjects: ① Blood sample was obtained from the elbow of patients with AMI immediately at hospitalization (2-12 hours from onset). ② Blood sample was obtained from patients of UAP group and patients of restenosis after angioplasty group immediately after the hospitalization (within 24 hours of onset). ③ Blood sample was obtained from fasting subjects of the normal control group in the morning. Blood sample was centrifuged, separated of the plasma and then frozen at -70 ℃. The level of plasma MCP-1 was determined with ELISA for statistical analysis. RESULTS: A total of 98 enrolled subjects were involved in the analysis of results, and no one withdrew from the study. Comparison in plasma MCP-1 among all groups: The plasma MCP-1 in ACS group, UAP group and restenosis after angioplasty group were (166.7?46.5,149.4?54.9,119.7?25.0,89.2?26.4) ng/L respectively, and it was significantly higher in ACS group, UAP group and restenosis after angioplasty group than that in the normal control group (F =21.27,P
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Objective To evaluate the factors influencing the 5-year all-cause death in acute myocarclial infarction with ST segment elevation.Methods Five hundred and ten patients(
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Objective:To explore the related factors of ventricular arrhythmia (VA) complicating acute phase of myocardial infarction and their effects on short term prognosis. Methods:A total of 161 subjects with acute myocardial infarction (AMI) were divided into 5 groups according to VA types: frequent single ventricular premature beat group(n=10),bigeminy or paired ventricular premature beat group (n=21),non-sus- tained ventricular tachycardia group (n=31),ventricular tachycardia and fibrillation group (n=11) and control group (n=88). The characteristics of coronary artery and left ventricular ejection fraction were determined. Results:The incidence of left main coronary occlusion was more frequent in ventricular tachycardia and fibrillation group than in control group (P
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The left ventricular apical systolic dysfunction syndrome was a rare acute cardiac syndrome.Its clinical presentation and electrocardiography were similar to acute myocardial infarction.The syndrome was characterized by transient ventricular wall-motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of obstructive epicardial coronary disease.Cardiac enzyme was normal or minor elevation.At present,the cause of the syndrome is unknown.In this paper,we describe a 56-year-old female patient.She was admitted in hospital for acute appendititis and the transient left ventricular apical ballooning syndrome.She developed acute heart failure and septic shock in the hospital.The drainage of the appendiceal abscess was done and the heart failure and septic shock recovered completely in a few days.
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Objective To investigate the significance of homocysteine (Hcy) in pathogenesis of coronary heart disease (CHD) and the relationship among serum homocysteine , age, type of CHD and the branches of coronary arteriopathy. Methods In a cross sectional test, serum Hcy levels of 166 old cases (age≥60 years) and 161 non old cases(age
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Objective To compare serum potassium concentrations in type 2 diabetic and nondiabetic patients in the early phase of acute coronary syndromes (ACS). Methods Seven hundred and forty-five consecutive patients with ACS underwent cardiac catheterization from January, 1999 to March, 2003. Patients were stratified by duration of symptoms,type2diabetes,and?-receptor blocker therapy before admission. Results Serum potassium concentration was significantly higher in type 2 diabetic patients with ACS than that in nondiabetic patients with ACS 〔(4.34?0.48)mmol/L vs (4.00?0.52)mmol/L,P
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Objective To examine the association between serum resistin levels and the severity of coronary artery lesions and cardiovascular risk factors in postmenopausal women.Methods The study population consisted of 117 postmenopausal women who underwent diagnostic coronary angiography for evaluation for suspected myocardial ischemia.Fasting serum resistin,insulin,blood glucose(BG),high-sensitive C-reactive protein(hs-CRP),fibrinogen(Fib)and lipid profile,including total cholesterol(TC),triglycerides(TG),HDL-cholesterol(HDL-C),LDL-cholesterol(LDL-C),apolipoprotein A1(Apo A1),apolipoprotein B(Apo B)and lipoprotein(a)(Lp(a))were measured in all the patients.Patients were divided into four groups according to the score of their coronary artery lesions:group Ⅰ included patients with coronary artery lesion score 0(no evidence of CAD),while group Ⅱ with score 1(mild lesion),group Ⅲ with score 2(moderate lesion),and group Ⅳ with score 3(severe lesion).Only patients with moderate to severe coronary lesions were diagnosed as coronary artery disease(CAD).Results Among the 117 patients,74 were diagnosed as CAD patients.Patients with CAD had significantly higher levels of resistin compared with controls:[4(1-10)?g/L vs 2(0-4)?g/L,median(interquartile range),P=0.002].In multiple logistic regression analysis,resistin levels were associated with CAD independent of age,BMI,metabolic syndrome,history of hypertension(HTN),diabetes(DM),dyslipidemia,smoking,SBP,DBP,hs-CRP,lipids [TC,TG,HDL-C,Apo A1,Apo B,Lp(a)],Fib,BG and insulin(OR 1.131,95%CI 1.012-1.263,P=0.030).Resistin levels correlated positively with CAD lesion severity in postmenopausal women(r=0.231,P
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Objective To study the effect of bone marrow mononuclear cells transplantation on restenosis rate and its mechanism. Methods The left anterior descending coronary arteries of swines were obstructed by balloon to create myocardial infarction models. After 3 weeks coronary stents were implanted at the middle part of the left anterior descending coronary arteries followed by the injection of bone marrow mononuclear cells into the coronary arteries. The degree of restenosis were measure by quantitative coronary angiography (QCA) after four weeks. Vascular tissue at both ends of stents were tested by HE and Sirius staining to analyse the mechanism of restenosis. Results At end of the experiment there were 8 swines in the bone marrow mononuclear cells transplantation group and 9 in the control group. After injection of bone marrow mononuclear cells the restenosis rate was similar to the control group (50% vs 44%, P=0.762). The lumen late loss was also similar between the two groups (1.50?1.45 mm vs 1.31?1.07 mm,P=0.736). Conclusion Bone marrow mononuclear cells transplantation does not increase the restenosis rate after percutaneous coronary artery intervention.
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Objective To evaluate the clinical and stenting relating risk factors on the in-stent restenosis. Methods One hundred and thirty seven patients whose data were available were enrolled in this study, and the patients were divided into the groups of in-stent restenosis and non in-stent restenosis according to the results of coronary angiograms. Then the clinical and stent relating factors affecting in-stent restenosis were analyzed. Results There were no statistical differences in age and prevalence of smoking, drinking, hypertension and diabetes mellitus between two groups. Narrowing of target coronary vessels before the procedures in the group of in-stent restenosis was more severe than that in the group of non in-stent restenosis ( vs , P=0.033). The average diameter of stents used in the group of in-stent restenosis was obviously smaller than that used in the group of non in-stent restenosis ([3.19?3.90]mm vs mm, P=0.005), the average length of stents, however, used in the group of in-stent restenosis was apparently longer than that used in the group of non in-stent restenosis ([21.91?8.98]mm vs [18.20?6.07]mm, P=0.011). The total duration of stent inflation in the group of in-stent restenosis was obviously shorter than that in the group of non in-stent restenosis ([22.74?19.56]s vs [29.12?25.72]s, P=0.026). There was no statistial difference between the two groups in the inflation times and pressure of stents implantation. Conclusion The results suggested that the rate of in-stent restenosis was not significantly influenced with age, smoking, drinking, hypertension, diabetes mellitus and inflation times and pressure of stent implantation, but the narrowing of target vessels before procedures and the lengths of the stents were positively related to in-stent restenosis, while stent diameters and total inflation durations of stent were negatively related to in-stent restenosis.
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Objective To assess the values of TIMI myocardial perfusion grade (TMP), corrected TIMI frame count (CTFC), sum-ST-segment resolution (sumSTR), max-ST-segment deviation (maxSTE) in judging myocardial perfusion and to predict their clinical outcomes. Methods In 77 patients with AMI, methods of TMP, maxSTE, sumSTR, CTFC were used to judge myocardial perfusion grade respectively immediately after PCI. Sixty-five patients underwent 99m Tc-MIBI/ 18 FDG DISA SPECT within one months after PCI, in-hospital heart faiures and cardiac events in the 6 months were recorded. Results Compared with 99m Tc-MIBI/ 18 FDG DISA SPECT, sensitivity, specificity, accuracy of TMP, CTFC, maxSTE, sumSTR was calculated. Sensitivity, specificity, accuracy of maxSTE were 80%, 85.7%, 83.1% respectively; Those of TMP were 73.3%, 80%, 76.9%, respectively. But those of CTFC (40), CTFC (30), sumSTR (30%), sumSTR (50%) were lower. By multivariate analysis of TMP0/1, maxSTE was the independent risk factor for 6-month cardiac events. Conclusion TMP, maxSTE may better assess myocardial perfusion, and accurately predict the outcome in 6-months.