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Objective: In patients with acute coronary artery disease, the TIMI risk index (TRI), the thrombolysis in myocardial infarction (TIMI) risk score, and the global registry of acute coronary events (GRACE) risk score (GRS) have all been documented. The aim of this study was to determine the relationship between no-reflow (NRF) and admission TRI, major cardiac events (MACE), and in-hospital mortality in patients undergoing primary percutaneous coronary intervention (P-PCI). Methods: Between March and December 2019, 100 consecutive patients diagnosed with STEMI and treated with PPCI at Tanta Main University Hospital in Tanta, Egypt, were included in the research population. Each patient consented following a thorough history taking, evaluation of coronary risk factors, clinical examination, and electrocardiogram analysis. Additionally, all instances were classified using the Killip method. The GRS, TRS, and TRI values were examined. Results: The GRS, TRS, and TRI scores were significantly associated with increased NRF, MACE, and hospital mortality in STEMI patients treated with P-PCI, suggesting that TRI is a straightforward indicator with fewer parameters that accurately reflects P-PCI success. Conclusion: TRI has been demonstrated to enhance the risk of in-hospital mortality and MACE. TRI uses straightforward and cost-effective ways to test patients who have experienced a STEMI. Additionally, a high TRI may assist in identifying high-risk individuals and developing suitable treatment solutions.
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Objective: To investigate the long-term incidence of coronary events and related factors in patients undergoing cardiac thoracotomy without preoperative coronary angiography (CAG). Methods: This was a retrospective study. The clinical data of patients, aged between 40 and 49 years old, who underwent cardiothoracic surgery, including heart valve surgery, congenital heart disease surgery, cardio great vessels surgery and other non-coronary artery disease (CAD) surgery, in Nanjing Drum Tower Hospital from December 2009 to May 2017, were enrolled. Patients with suspected CAD, or patients with coronary CTA defined calcified coronary arteries received CAG examination prior operation, and the rest patients did not receive routine CAG examinations. The patients who did not receive routine CAG examinations were followed up by telephone. The primary endpoints include death related to coronary arteries, coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). The secondary endpoints include the new onset angina, clinically diagnosed CAD or receiving the first and second prevention for CAD. The other outcome events included cardiac death and all-cause mortality. The primary and secondary endpoints were all regarded as coronary events. The patients without preoperative CAG were divided into two groups: the positive group and the negative group, according to the incidence of coronary events during follow-up. Clinical data were compared between the two groups. Results: A total of 952 patients were included. The age was (45.2±2.7) years old, 406(42.65%) patients were male. Preoperative CAG was performed in 73 patients, among whom 9 (12.32%) patients underwent simultaneous CABG. Among the 879 cases who did not undergo coronary angiography before the operation, 18(2.05%) died during perioperative period (hospitalization and within 30 days after discharge). The patients were followed up for (61.6±25.8) months, and 28(3.25%) patients were lost to follow up. During long-term follow up, there were no fatal cases due to severe coronary events and no cases of CABG or PCI. Only 4.41% (38/861) patients had the secondary endpoints, namely the occasional onset of atypical angina. The incidence rate of the long-term coronary events, all-cause mortality and cardiac death were 4.41% (38/861), 1.16% (10/861), 0.46% (4/861) during long-term follow-up. The prevalence of hypertension was significantly higher in positive group than negative group (34.21% (13/38) vs. 20.89% (164/785), P=0.045). Conclusions: It is feasible not to perform preoperative CAG examination for non-CAD patients aged 40-49 years who will undergo cardiac thoracotomy. However, we need to be aware the risk of coronary events in the patients complicating with risk factors of CAD, such as hypertension.
Subject(s)
Adult , Humans , Male , Middle Aged , Coronary Angiography , Coronary Artery Disease/surgery , Incidence , Percutaneous Coronary Intervention , Retrospective Studies , Thoracotomy , Treatment OutcomeABSTRACT
A third of men with type 2 diabetes (T2DM) have hypogonadotrophic hypogonadism (HH) and associated increased risk of cardiovascular and all-cause mortality. Men with HH are at increased risk of developing incident T2DM. We conducted MEDLINE, EMBASE, and COCHRANE reviews on T2DM, HH, testosterone deficiency, cardiovascular and all-cause mortality from May 2005 to October 2017, yielding 1,714 articles, 52 clinical trials and 32 randomized controlled trials (RCT). Studies with testosterone therapy suggest significant benefits in sexual function, quality of life, glycaemic control, anaemia, bone density, fat, and lean muscle mass. Meta-analyses of RCT, rather than providing clarification, have further confused the issue by including under-powered studies of inadequate duration, multiple regimes, some discontinued, and inbuilt bias in terms of studies included or excluded from analysis.
Subject(s)
Humans , Male , Bias , Bone Density , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Hypogonadism , Mortality , Quality of Life , TestosteroneABSTRACT
Objective To evaluate the association of family history with risk of major coronary events (MCE) and ischemic heart disease (IHD).Methods After excluding participants with heart disease,stroke or cancer at baseline survey,a total of 485 784 participants from the China Kadoorie Biobank,who had no missing data on critical variables,were included in the analysis.Cox regression analysis was used to estimate the hazard ratios (HR) and 95％CI.Subgroup analyses were performed according to the baseline characteristics.Results During a median of 7.2 years of follow-up,we documented 3 934 incident cases of MCE and 24 537 cases of IHD.In multivariableadjusted models,family history was significantly associated with risk of MCE and IHD.The adjusted HRs (95％CI) were 1.41 (1.19-1.65) and 1.25 (1.18-1.33),respectively.History of disease among siblings was more strongly associated with early-onset MCE than parental history (HR=2.97,95％CI:1.80-4.88).Moreover,the association of family history with MCE and IHD was stronger in persons who were overweight or obesive,and the association between family history and MEC was stronger in smokers.Conclusion This large-scale,prospective study indicated that family history was an independent risk factor for MCE and IHD in China.The intervention targeting major known lifestyle risk factors and the management of chronic diseases should be strengthened for Chinese population,especially for the individuals with family history were at high risk.
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Objective To evaluate the association of family history with risk of major coronary events (MCE) and ischemic heart disease (IHD).Methods After excluding participants with heart disease,stroke or cancer at baseline survey,a total of 485 784 participants from the China Kadoorie Biobank,who had no missing data on critical variables,were included in the analysis.Cox regression analysis was used to estimate the hazard ratios (HR) and 95％CI.Subgroup analyses were performed according to the baseline characteristics.Results During a median of 7.2 years of follow-up,we documented 3 934 incident cases of MCE and 24 537 cases of IHD.In multivariableadjusted models,family history was significantly associated with risk of MCE and IHD.The adjusted HRs (95％CI) were 1.41 (1.19-1.65) and 1.25 (1.18-1.33),respectively.History of disease among siblings was more strongly associated with early-onset MCE than parental history (HR=2.97,95％CI:1.80-4.88).Moreover,the association of family history with MCE and IHD was stronger in persons who were overweight or obesive,and the association between family history and MEC was stronger in smokers.Conclusion This large-scale,prospective study indicated that family history was an independent risk factor for MCE and IHD in China.The intervention targeting major known lifestyle risk factors and the management of chronic diseases should be strengthened for Chinese population,especially for the individuals with family history were at high risk.
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Objective To investigate the predictive value of pregnancy-associated plasmaprotein-A (PAPP-A) and GRACE risk score for death and nonfatal myocardial infarction (combined endpoint) in AMI patients.Methods All AMI patients hospitalized in our department during July 2011 to July 2015 were included consecutively in this prospective study.Plasma PAPP-A were measured at admission.GRACE risk score was acquired with the application of GRACE risk score calculator.Patients were followed up for at least 1 year for any nonfatal myocardial infarction or MACE.Kaplan Meier survival study was analysed according to PAPP-A and GRACE score risk stratification respectively.A cutoff value of 3.0 ng/ml of PAPP-A was chosen from pilot work in this cohort.Results A total of 220 patients were enrolled in the study.The death and nonfatal myocardial infarction during follow-up were significantly higher in patients with PAPP-A≥3.0 ng/ml compared to patients with PAPP-A<3.0 ng/ml (15.7% vs.6.0%, log-rank χ2=5.684, P=0.017).The area under ROC curve of PAPP-A was 0.796(95%CI 0.696-0.896, P<0.01) and the ROC curve of PAPP-A GRACE risk stratification was 0.715 (95%CI 0.567-0.863,P<0.01).Subgroup analysis showed that death and nonfatal myocardial infarction during follow-up was significantly higher in patients with PAPP-A≥3.0 ng/ml compared to patients with PAPP-A<3.0 ng/ml in intermediate and low risk group by GRACE risk stratifcation (log-rank χ2=14.63,P<0.001).Conclusions PAPP-A could predict mortality and nonfatal myocardial infarction in patients with AMI.PAPP-A combined with GRACE risk score can better predict outcome than GRACE risk score alone in intermediate and low risk patients by GRACE risk stratifcation.
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Background. Community acquired pneumonia (CAP) remains a common disease condition attributing to a significant mortality and morbidity worldwide. Acute cardiac events (ACEs) are one of the most life-threatening complications in patients with severe pneumonia. Methods. Retrospective study of burden of ACE in 105 patients admitted with CAP. Results. Twenty-five patients with (CURB-65) score ranging between 0 – 2 did not require intensive care unit (ICU) admission and were admitted in the ward and high dependency unit. Of these, 12 developed ACE and 4 required to be shifted to the ICU for further management. Eighty patients with a CURB—65 score of greater than 3 were admitted to the ICU. Of the patients admitted to the ICU, 10 with ACE died; 2 patients without ACE also died. Conclusions. Our observations suggest that ACE constitute an important cause of morbidity and mortality in patients with CAP requiring hospitalisation.
Subject(s)
Adult , Aged , Community-Acquired Infections/mortality , Female , Heart Diseases/epidemiology , Humans , Male , Middle Aged , Pneumonia/mortality , Retrospective StudiesABSTRACT
Objective To investigate the association between global registry of acute coronary events (GRACE) score,N-terminal pro brain natriuretic peptide (NT-proBNP) and heart function in patients with acute coronary syndromes(ACS).Methods One hundred and seventy-four ACS patients and 60 healthy persons were enrolled our study.Of ACS patients,96 cases were with unstable angina pectoris(UP) and 78 cases with acute myocardial infarction (AMI).The level of NT-proBNP,left ventricular ejection fraction (LVEF) and GRACE score were measured.Results The NT-pro BPN of patients with UP or AMI were 87.00(38.25,245.75) ng/L and 686.00 (169.00,1 852.75) ng/L,and GRACE score were (87.51 ± 17.69) and (134.74 ± 23.56),which were higher than that in the control group (31.50 (13.00,54.75) ng/L,(81.10 ± 15.75)).LVEF in patients with AMI (57.72 ± 9.04) ％,lower than that of the control group ((64.45 ± 6.31) ％),and there were statistically significant difference among the three groups (Z =44.111,P ＜ 0.001 ; F =172.366,18.176,P ＜0.01).There was positive correlation between serum NT-pro BNP levels and GRACE score(r =0.451,P ＜ 0.001),and negative correlation was seen between serum NT-pro BNP and LVEF (r =-0.294,P ＜ 0.001)Conclusion NT-pro BNP level increases and LVEP decreases in patients with ACS and they are related to GRACE score as well as associated with the degree of risk in patients with ACS.
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Objetivos: verificar el nivel de cumplimiento de las metas en colesterol LDL, colesterol no-HDL, triglicéridos y colesterol HDL, de acuerdo con lo indicado por la guía del NCEP-ATPIII y las recomendaciones actuales, en una población de pacientes hospitalizados por causa no cardiovascular pero con antecedente de enfermedad coronaria. Analizar, además, los hipolipemiantes que utiliza esta población, así como la prevalencia de síndrome metabólico, glucemia anormal en ayunas y diabetes mellitus tipo 2. Metodología: el porcentaje de cumplimiento de estas metas se evaluó mediante el programa de análisis estadístico STATA. Se compararon los hallazgos del perfil lipídico con la propuesta de la guía del NCEP-ATPIII y las recomendaciones actuales (punto final primario). Igualmente, se analizaron los hipolipemiantes utilizados, así como la prevalencia de glucemia anormal en ayunas, diabetes mellitus tipo 2 y síndrome metabólico (punto final secundario). Resultados: se identificaron 281 pacientes que cumplían con los criterios de inclusión. En la tabla 2 se resumen los resultados del punto final primario. De acuerdo con el NCEP-ATPIII, en el riesgo alto, el porcentaje de pacientes que cumplían con las metas en el cLDL (objetivo principal en el tratamiento de las dislipidemias), era de 57,2 y en el riesgo muy alto de 23,5%. En la actualidad, a los pacientes con enfermedad coronaria, independiente de la presencia de síndrome metabólico o diabetes mellitus, se les recomienda una meta para el cLDL menor de 70 mg/dL (Recomendación IIa), la cual se observó en 21,7% de los pacientes estudiados. La prevalencia de glucemia anormal en ayunas fue de 25,6%, la de diabetes mellitus tipo 2 de 20% y la de síndrome metabólico de 45,2%. Con respecto a los hipolipemiantes utilizados, se observó que 56% usaba lovastatina, 14% no utilizaba hipolipemiantes y ninguno tenía asociación de estos fármacos. Conclusiones: después de nueve años de la publicación de las guías del NCEP-ATPIII y de las recomendaciones posteriores sobre las metas del perfil lipídico en pacientes con enfermedad coronaria y a pesar de la divulgación de las mismas a través de conferencias, congresos y publicaciones, estas metas las cumple un porcentaje bajo de pacientes, tal como lo demuestra este estudio observacional en sujetos hospitalizados por causas diferentes a la enfermedad coronaria pero con este antecedente. Una de las explicaciones para este pobre resultado es el uso de lovastatina, estatina de baja efectividad para reducir el cLDL. Se analizan otras posibles causas y se hacen propuestas para lograr los objetivos.
Objectives: to verify the level of compliance with the targets in LDL cholesterol, non-HDL cholesterol, triglycerides, HDL cholesterol, in accordance with the recommendations of the NCEP-ATPIII guide and current recommendations in a population of patients hospitalized for non-cardiovascular causes but with a history of coronary disease. Analyze also lipid-lowering drugs used by this population as well as the prevalence of metabolic syndrome, abnormal fasting glucose and type 2 diabetes mellitus. Methodology: the percentage of fulfillment of these goals was assessed using the STATA statistical analysis program. Findings of the lipid profile were compared with the proposal from the NCEP-ATPIII guide and current recommendations (primary endpoint). Similarly, lipid-lowering drugs used were analyzed as well as the prevalence of abnormal fasting glucose, diabetes mellitus type 2 and metabolic syndrome (secondary endpoint). Results: we identified 281 patients who met the inclusion criteria. Table 2 summarizes the results of the primary endpoint. According to the NCEP-ATPIII, in high risk, the percentage of patients who met the LDL cholesterol goals (main goal in the treatment of dyslipidemias), was 57,2% and in the very high risk, 23,5%. Currently, patients with coronary heart disease independent of the presence of metabolic syndrome or diabetes mellitus, a goal for LDL cholesterol below 70 mg/dL is recommended (Recommendation IIa); this was observed in 21.7% of patients studied. The prevalence of abnormal fasting glucose was 25.6%, that of type 2 diabetes mellitus was 20% and that of metabolic syndrome 45.2%. With respect to lipid-lowering drugs used, we observed that 56% used lovastatin, 14% did not use lipid-lowering drugs and none had any association of these drugs. Conclusions: after nine years of the publication of NCEP-ATPIII guidelines and subsequent recommendations on the goals of the lipid profile in patients with coronary disease and despite the dissemination of these through lectures, conferences and publications, these goals are met by a low percentage of patients, as evidenced by this observational study in patients hospitalized for causes other than coronary heart disease but with this history. One explanation for this poor performance is the use of lovastatin, that is a low efficacy statin to reduce LDL cholesterol. Other possible causes are analyzed and proposals to achieve the objectives are made.
Subject(s)
Cholesterol, HDL , Cholesterol, LDL , Coronary DiseaseABSTRACT
Objective To explore the relationship between the level of morning blood pressure surge (MBPS) and High-sensitivity C-reactive protein( hs-CRP) in acute coronary events among old patients and to evaluate their clinical value. Methods One hundred and twenty - three patients with coronary disease were divided into two groups, each of which was old myocardial infarction(OMI, n = 55) and old myocardial infarction with acute cardiovascular syndrome (OMI + ACS, n =68). The control group includes the patients without coronary disease( n =50). The patients who have infection, malignant tumors, liver and kidney dysfunction, blood diseases, valvular heart diseases, congenital heart diseases, aortic dissection,secondary hypertension were not included. All groups were received 24 hours ambulatory blood pressure monitoring to calculate MBPS and the determination of hs-CRP in serum. Results Compared with each two groups, the levels of MBPS and hs-CRP in OMI group were significantly higher than those of the control group (0. 01 ＜ P ＜0. 05) , and had more significance in the other groups ( P ＜0.01). The levels of MBPS and hs-CRP had positive relationship in coronary events in the elderly ( r =0. 76, P ＜0. 01) . Conclusion The level of MBPS is positively correlated with serum hs-CRP which is one of key risk factors of inflammatory reactions by impairing vessels in body. The two factors both play important roles in the occurrence and the development of coronary events among old patients. They both have important clinical value in recurrent acute coronary events among old patients.
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Objetivo: Determinar la fuerza de la asociación entre el Agotamiento Vital y eventos isquémicos coronarios agudos en una muestra de pacientes argentinos internados. Método: Se midió el Agotamiento mediante el cuestionario de Maastricht en 180 pacientes de ambos sexos, 90 casos con un evento corona río agudo y 90 controles con un evento agudo cardíaco no-isquémico. Se compararon ambos grupos por edad, sexo, estado civil, y educación, Diabetes, Hipertensión Arterial, Tabaquismo, y Dislipemia. Resultados: El 63,33 por ciento, 57 de los casos estaban agotados, en cambio, el 36,66 por ciento, 33 controles estaban agotados (OR= 3.1 (1.7-5.8) p
Objective: To determine the strength of the association between the Vital exhaustion syndrome (VES) and acute coronary ischemic events in hospitalized Argentinean sample. Methods: VES was measured in 180 patients of both sexes, 90 admitted due to an acute coronary ischemic syndrome (AMI or unstable angina) and a control group of 90 admitted due to an acute non-coronary cardiac event VES was evaluated with the Maastricht questionnaire during the first week of hospitalization. Results: Dividing the sample in two categories: exhausted and non-exhausted, 57 (63,33 percent) of the coronary were exhausted, while among the non coronary group, 33 were exhausted (36, 66 percent)(OR=3.1 (1.7-5.8) p<.OO1. The exhaustion score was: control mean score: 17,1 (sd 8,96); case mean score: 21,1 (sd 10,60) p: 0.006. Dislipemia was another factor with a significant difference: control 27 (30 percent) case 44 (62 percent) OR= 2.2 (1.2-4.1) p=O.01. Logistic regression was performed, including an interaction model between DLP and exhaustion, and it did not show a significant effect. Conclusions: Our results indicate that in Argentina, among other countries as reported in the literature, VES is a psychological condition that is strongly and independent associated to acute coronary events.
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Humans , Male , Adult , Female , Middle Aged , Surveys and Questionnaires , Stress, Psychological , Acute Coronary Syndrome/etiology , Argentina , Depression/diagnosis , Dyslipidemias/complicationsABSTRACT
Percutaneous transluminal coronary angioplasty (PTCA) was done successfully in 33 patients,6 of them were associated with 8 acute coronary events. Radioimmunoassay was used for the determination of plasmaET,AII and CGRP levels. The samples were drawn successively from femoral artery just before PTCA and 0min, 15min,1h,3h,24h after the final balloon inflation. The results showed that the levels of plasma AII were higher in the complication group than those of noncomplication group before PTCA and 0min, 24h after PTCA. The differences in plasma ET levels before and after PTCA between the complication group and the non-complication group were not significant. The level of plasma CGRP was decreased at 15min and returned to basal level at 1h after PTCA in the complication group.In the patients without complication,there were no significant differences in their plasma CGRP levels before and after PTCA. All + ET/CGRP in the complication group raised more rapidly,recovered later and the peak appeared earlier than that of non-complication group. For a better understanding pathophysiologic meaning of the above changes,further studies are needed.