ABSTRACT
Objectives: To investigate the predictive value of CHA2DS2-VASc score for contrast induced nephropathy (CIN) after percutaneous coronary intervention in patients with coronary heart disease. Methods: A total of 356 patients undergoing elective percutaneous coronary intervention were enrolled in this study. The patients were divided into two groups according to the CHA2DS2-VASc score: CHA2DS2-VASc score ≥ 3 (n=153) and ≤ 2 (n=203). Baseline data, incidence of CIN and major adverse cardiovascular events were analyzed and compared between the two groups. The predictive effect of CHA2DS2-VASc score was analyzed with receiver operating characteristic curve (ROC) and logistic regression analysis. Results: Left ventricular ejection fraction was significantly lower, baseline serum creatinine value was significantly higher, coronary lesions were more complex, contrast agent dosage used was significantly larger and the incidence of CIN was significantly higher in patients of the CHA2DS2-VASc score ≥ 3 group than in patients of CHA2DS2-VASc score ≤ 2 group (all Pvalues<0.05). Multivariate logistic regression analysis showed that CHA2DS2-VASc score≥3 was an independent predictor of CIN (OR=2.152, 95% CI: 1.261-3.987, P=0.032). The area under the curve of ROC of CHA2DS2-VASc score ≥ 3 for predicting CIN was 0.749 (sensitivity 76.9%, specificity 73.0%). Conclusions: CHA2DS2-VASc score could predict the CIN after percutaneous coronary intervention in patients with coronary heart disease, which could help us identify the high-risk patients of CIN and take preventive measures to reduce the incidence of CIN post percutaneous coronary intervention.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the impact of various application time of aspirin and clopidogrel on the circadian rhythm changes of platelet aggregation in patients with acute coronary syndrome.</p><p><b>METHODS</b>Patients with acute coronary syndrome were divided into day-time (8:00) and night-time (20:00) medication group (n = 15 each). After plasma concentration reached steady state, platelet aggregation was assessed at 5 time points within 24 hours with a mobile four-channel whole blood impedance aggregometer. The platelet aggregation was induced by ADP and arachidonic acid. Thereafter, the two groups were exchanged and platelet aggregation was assessed in the same way post plasma steady state.</p><p><b>RESULTS</b>Arachidonic acid-induced platelet aggregation was the highest at 10:00 Am [(7.96 +/- 3.64) ohm] and the lowest at 0:00 [(6.12 +/- 3.29) ohm, P > 0.05] in day-time group. Platelet aggregation was the highest at 20:00 [(9.40 +/- 5.39) ohm] and the lowest at 10:00 [(5.46 +/- 3.93) ohm], P < 0.05). ADP-induced platelet aggregation was the highest at 10:00 and the lowest at 16:00 in day-time group (P > 0.05) and was the highest at 20:00 and the lowest at 10:00 in night-time group (P > 0.05). Platelet aggregation induced by two inducers was significantly higher at 10:00 in day-time group compared to values in night-time group (all P < 0.05).</p><p><b>CONCLUSION</b>Taking aspirin and clopidogrel at 20:00 was superior to taking the same medications at 8:00 for inhibiting peak platelet aggregation in the morning.</p>