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Objective To analyze the influence of different health-related indicators on the prognosis of elderly patients with diabetes mellitus complicated with coronary heart disease, and to provide theoretical basis for the diagnosis and treatment of diabetes mellitus complicated with coronary heart disease. Methods Among of 456 elderly patients with diabetes mellitus complicated with coronary heart disease admitted to our hospital from December 2018 to December 2020 were selected. According to the occurrence of Major adverse cardiovascular events (MACE) within 1 year after discharge, patients were divided into the control group (no MACE) and the observation group (MACE). The Clinical data of patients including age, gender, BMI, smoking, alcohol consumption, diabetes course, degree of coronary artery stenosis and number of lesions, were collected from the medical record system. Univariate analysis and logistic regression were used to analyze the influence of health indicators such as systolic blood pressure, LEVF, HbA1c, LDL-C, LDH and ALP on the occurrence of MACE in patients with diabetes and coronary heart disease. Spearman correlation analysis was used to analyze the correlation between different health-related indicators and the occurrence of MACE in elderly patients with diabetes mellitus and coronary heart disease. Results A total of 456 elderly patients with diabetes mellitus and coronary heart disease, 122 cases (26.75%) developed MACE. There were no differences in age, male proportion, BMI, smoking and drinking of diabetes course between the two groups (P>0.05). The degree and number of coronary artery stenosis in the observation group were significantly higher than those in the control group (P7.0% (OR=2.617), LDL-C>2.6 mmol/L (OR=2.976) and BUA >420μmol/L (OR=2.341) were independent risk factors for MACE in elderly patients with diabetes mellitus and coronary heart disease (P7.0%, LDL-C >2.6 mmol/L and BUA >420 μmol/L, active treatment should be conducted to improve the prognosis of patients.
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Objective:To explore the predictive value of single high-sensitivity cardiac troponin I (hs-cTnI) concentration of 30-day cardiovascular adverse events in patients with suspected acute coronary syndrome (ACS).Methods:This is a multicenter, prospective and observational clinical study. Patients with suspected ACS who were admitted into the emergency department of Fuwai Hospital, the First Affiliated Hospital of Sun Yat-sen University and Nanjing First Hospital from January 2017 to September 2020 were enrolled. hs-cTnI result at the time of visit was obtained from patients with suspected ACS. Patients were followed up for 30 days and patients were divided into no events group and events group according to the presence or absence of 30-day cardiovascular adverse events (acute myocardial infarction (including index), unplanned revascularization and cardiovascular death). The predictive value of single Hs-cTnI at different concentration thresholds on the adverse event was evaluated in terms of sensitivity, negative predictive value (NPV) and 95% confidence interval ( CI). The best threshold was defined as: missed diagnosis rate <2% and NPV >99%. Patients were sub-grouped according to the confounders of hs-cTnI (sex, age, chest pain duration, estimated glomerular filtration rate), and Chi-square test was used to compare sensitivity and NPV among various subgroups. Results:A total of 1 461 patients were included. Among them, 387 patients (26.5%) had 30-day adverse cardiovascular events and 1 074 patients (73.5%) had no adverse cardiovascular events. Mean age was (62±12) years old and 905 were males (61.9%). When the concentration of hs-cTnI was less than 2 ng/L (limit of detection), the missed diagnosis rate of 30-day cardiovascular adverse events was 0.8% (3/387), the sensitivity was 99.2% (95% CI 97.6%-99.8%), and NPV was 98.7% (95% CI 96.0%-99.7%). When hs-cTnI concentration was less than 6 ng/L, the missed diagnosis rate was 1.8%, the sensitivity was 98.2% (95% CI 96.1%-99.2%), and NPV was 99.0% (95% CI 97.9%-99.6%). Subgroup analysis showed that the sensitivity and NPV of single hs-cTnI concentration <6 ng/L for 30-day cardiovascular adverse events were lower in patients with chest pain less than 3 h than those with chest pain time>3 hours ( P<0.05). Conclusions:Single hs-cTnI concentration less than 6 ng/L can predict the risk of 30-day cardiovascular adverse events in suspected ACS patients, but continuous monitoring is recommended for patients with chest pain onset≤3 hours.
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OBJECTIVE@#To investigate the impact of postoperative serious cardiovascular adverse events (CAE) on outcomes of patients undergoing craniotomy for intracranial aneurysm clipping.@*METHODS@#This retrospective cohort study was conducted among the patients undergoing craniotomy for intracranial aneurysm clipping during the period from December, 2016 to December, 2017, who were divided into CAE group and non-CAE group according to the occurrence of Clavien-Dindo grade ≥II CAEs after the surgery. The perioperative clinical characteristics of the patients, complications and neurological functions during hospitalization, and mortality and neurological functions at 1 year postoperatively were evaluated. The primary outcome was mortality within 1 year after the surgery. The secondary outcomes were Glasgow outcome scale (GOS) score at 1 year, lengths of postoperative hospital and intensive care unit (ICU) stay, and Glasgow coma scale (GCS) score at discharge.@*RESULTS@#A total of 361 patients were enrolled in the final analysis, including 20 (5.5%) patients in CAE group and 341 in the non-CAE group. No significant differences were found in the patients' demographic characteristics, clinical history, or other postoperative adverse events between the two groups. The 1-year mortality was significantly higher in CAE group than in the non-CAE group (20.0% vs 5.6%, P=0.01). Logistics regression analysis showed that when adjusted for age, gender, emergency hospitalization, subarachnoid hemorrhage, volume of bleeding, duration of operation, aneurysm location, and preoperative history of cardiovascular disease, postoperative CAEs of Clavien-Dindo grade≥II was independently correlated with 1-year mortality rate of the patients with an adjusted odds ratio of 3.670 (95% CI: 1.037-12.992, P=0.04). The patients with CEA also had a lower GOS score at 1 year after surgery than those without CEA (P=0.002). No significant differences were found in the occurrence of other adverse events, postoperative hospital stay, ICU stay, or GCS scores at discharge between the two groups (P > 0.05).@*CONCLUSION@#Postoperative CAEs may be a risk factor for increased 1-year mortality and disability in patients undergoing craniotomy for intracranial aneurysms.
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Humans , Craniotomy/adverse effects , Intracranial Aneurysm/surgery , Postoperative Period , Retrospective Studies , Subarachnoid Hemorrhage/surgery , Treatment OutcomeABSTRACT
Objective To investigate the forecasting value of serum fibroblast growth factor 23 (FGF23) for major adverse cardiovascular adverse events (MACE) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS).Methods One hundred and five patients with ACS who underwent PCI in the First People's Hospital of Tianmen City from June 2017 to June 2019 were enrolled.According to the happening of a MACE event occurs,the patients were divided into the MACE group (32 cases) and the non-MACE group (32 cases).The differences of general data,ultrasound indicators and biochemical indicators of patients between the two groups were compared.Logistic regression analysis was used to analyze independent risk factors for MACE after PCI in patients with ACS.Receiver operating characteristic (ROC) curve analysis was used to predict the predictive value of postoperative MACE in patients with ACS.Results There were no significant difference in the comparison of general data such as age and gender between the two groups (P ＞ 0.05).The Global Registered Risk of Acute Coronary Events (GRACE) score in the MACE group was significantly higher than that in the non-MACE group [(119.18 ± 11.49) scores vs.(111.57 ± 9.31) scores,P＜0.05].Compared with the non-MACE group,the left ventricular end diastolic diameter (LVEDD),brain natriuretic peptide (BNP),C-reactive (CRP),and EGF23 in the MACE group were significantly increased,and the left ventricular ejection fraction (LVEF) was significantly decreased [(52.04 ± 3.43) mm vs.(48.57 ± 3.69) mm,(509.48 ± 52.08) ng/L vs.(474.68 ± 89.27) ng/L,(9.61 ± 2.06) mg/L vs.(7.85 ± 0.83) mg/L,(504.73 ± 82.27) ng/L vs.(331.99 ± 81.68) ng/L,(34.77 ± 2.93)％ vs.(37.80 ± 3.62)％] (P＜ 0.05).Logistic multivariate regression analysis showed that LVEF,CRP,and FGF23 were independent risk factors for MACE after PCIin patients with ACS (P ＜ 0.05).ROC curve analysis showed that AUC of LVEF that predicted for MACE after PCI in patients with ACS was 0.747,and AUC of CRP and FGF23 were 0.772 and 0.944.The AUC of FGF23 was significantly higher than that of LVEF and CRP (Z =3.867,2.698,P＜0.05).Conclusions Abnormal elevation of serum FGF23 is associated with cardiovascular adverse events after PCI in patients with ACS,which can be used as a serum indicator for early assessment of poor cardiovascular outcomes in patients.
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Objective@#To investigate the effect of early multi-dimensional cardiac rehabilitation (CR) nursing mode on patients after percutaneous coronary intervention (PCI).@*Methods@#From August 2017 to July 2018, 100 patients with coronary heart disease (CHD) underwent PCI in the Department of Cardiology, the Third Affiliated Hospital of Sun Yat-sen University were selected as subjects. According to the random number table, the patients were divided into control group and observation group, 50 in each group. The control group received routine CR nursing intervention, and the observation group was given early multi-dimensional CR nursing mode for intervention. All patients were followed up for 6 months. The incidence of major cardiovascular adverse events (MACE) was observed 1 month and 6 months of follow-up. Patients with somatization were evaluated on the 2nd day after PCI and in the first month of follow-up using the Somatic Self-rating Scale (SSS). In the first month and the 6th month of follow-up, patient compliance was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8).@*Results@#During the study period, 3 patients were detached from each group, and there were 47 patients in both groups who completed the study. The incidence of MACE in the control group in 1 month and 6 months was 8.51% (4/47) and 4.26% (2/47), respectively. The incidence of MACE in the observation group was 10.64% (5/47) and 4.26%, (2/47) respectively. There was no significant difference in the incidence of MACE between the two groups (χ2 value was 0.123, 0.000, P>0.05). In the first month of follow-up, the SSS scores of the control group (34.32±6.59) and the observation group (31.04±7.04) were lower than those of the second day after surgery (37.21±6.19, 37.43±7.29), and the difference was statistically significant (t value was 4.633, 2.660, P<0.05). The SSS scores of the observation group were lower than those of the control group, and the difference was statistically significant (t value was 2.330, P<0.05). In the first month of follow-up, there was no significant difference in MMAS-8 score between the two groups (P>0.05). In the 6th month of follow-up, the MMAS-8 score (5.72±0.62) in the control group was lower than the first month of follow-up (6.93±0.54), and the difference was statistically significant (t value was 10.028, P<0.05). The MMAS-8 score of the control group was lower than that of the observation group (6.89±0.58), and the difference was statistically significant (t value was 9.490, P<0.05). There was no significant difference in MMAS-8 score between the observation group in the first month of follow-up and the sixth month of follow-up (P>0.05).@*Conclusion@#Early multi-dimensional CR nursing mode has a limited effect on improving the incidence of MACE in patients after PCI, but it can effectively reduce the somatization symptoms of patients and maintain good medication compliance.
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Objective@#To investigate the forecasting value of serum fibroblast growth factor 23(FGF23) for major adverse cardiovascular adverse events (MACE) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS).@*Methods@#One hundred and five patients with ACS who underwent PCI in the First People′s Hospital of Tianmen City from June 2017 to June 2019 were enrolled. According to the happening of a MACE event occurs, the patients were divided into the MACE group (32 cases) and the non-MACE group (32 cases). The differences of general data, ultrasound indicators and biochemical indicators of patients between the two groups were compared. Logistic regression analysis was used to analyze independent risk factors for MACE after PCI in patients with ACS. Receiver operating characteristic (ROC) curve analysis was used to predict the predictive value of postoperative MACE in patients with ACS.@*Results@#There were no significant difference in the comparison of general data such as age and gender between the two groups (P>0.05). The Global Registered Risk of Acute Coronary Events (GRACE) score in the MACE group was significantly higher than that in the non-MACE group [(119.18 ± 11.49) scores vs. (111.57 ± 9.31) scores, P<0.05]. Compared with the non-MACE group, the left ventricular end diastolic diameter (LVEDD), brain natriuretic peptide (BNP), C-reactive (CRP), and FGF23 in the MACE group were significantly increased, and the left ventricular ejection fraction (LVEF) was significantly decreased [(52.04 ± 3.43) mm vs. (48.57 ± 3.69) mm, (509.48 ± 52.08) ng/L vs. (474.68 ± 89.27) ng/L, (9.61 ± 2.06) mg/L vs. (7.85 ± 0.83) mg/L, (504.73 ± 82.27) ng/L vs. (331.99 ± 81.68) ng/L, (34.77 ± 2.93)% vs. (37.80 ± 3.62)%] (P<0.05). Logistic multivariate regression analysis showed that LVEF, CRP, and FGF23 were independent risk factors for MACE after PCI in patients with ACS (P<0.05). ROC curve analysis showed that AUC of LVEF that predicted for MACE after PCI in patients with ACS was 0.747,and AUC of CRP and FGF23 were 0.772 and 0.944. The AUC of FGF23 was significantly higher than that of LVEF and CRP (Z = 3.867, 2.698, P<0.05).@*Conclusions@#Abnormal elevation of serum FGF23 is associated with cardiovascular adverse events after PCI in patients with ACS, which can be used as a serum indicator for early assessment of poor cardiovascular outcomes in patients.
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Objective By analyzing the pancreas islet function characteristics of initial diagnosed type 2 diabetes patients to provide guidance of selecting hypoglycemic drugs to lower the risk occurrence of main cardiovascular adverse event(MACE)in patients with coronary arterial atherosclerotic cardiac disease (coronary disease) combined with diabetes mellitus. Methods The clinical data of 769 initial diagnosed type 2 diabetic patients admitted to Tianjin Hongqiao Hospital from January 2013 to July 2018 were retrospectively analyzed. The patients were divided into a synchronous group (542 patients) and a non-synchronous group (227 patients) according to whether the insulin and C-peptide secretion peak times were synchronized or not. The pancreas islet function characteristics of the two groups were analyzed, the differences in the levels of total cholesterol (TC), triacylglycero(TG), glycosylated hemoglobin (HbA1c),oral glucose tolerance test (OGTT), serum insulin release (INS), C-peptide detection index, peak times of insulin and C-peptide, insulin resistance index of steady state model (HOMA-IR), steady-state insulin secretion index (HOMA-β) , and quantitative insulin sensitivity test index (QUICKI) were compared between the two groups; Logistic binary regression analysis was used to screen out the risk factors that could be related to the impact of whether the peak value times of insulin and C peptide being synchronous or not in initial diagnosed type 2 diabetic patients. Results The TC in the synchronous group was significantly higher than that in the non-synchronous group (mmol/L: 4.96±1.20 vs. 4.78±1.06), and the HbA1c was obviously lower than that in non-synchronous group (0.077 5±0.016 6 vs. 0.082 7±0.018 6), the differences being statistically significant (all P<0.05). The blood glucose, insulin levels of the two groups gradually increased with time and peaked at 120 minutes, and then went down, and the blood glucose level of the synchronous group was significantly lower than that of the non-synchronous group (mmol/L:15.52±3.39 vs. 16.18±3.97), while the levels of insulin in the synchronous group were significantly higher than those in the non-synchronous group (mU/L: 92.19±78.34 vs. 55.99±49.86, both P<0.05). After 120 minutes, the level of C-peptide in synchronous group was significantly higher than that in non-synchronous group (μg/L: 2.34±0.52 vs. 2.16±0.59), and lasted to 180 minutes (μg/L: 9.96±4.71 vs. 8.99±4.33). The peak time of insulin in the synchronous group was significantly delayed than that in non-synchronized group (minutes: 125.54±28.02 vs. 93.30±40.91), but the C-peptide secretion peak time was earlier (minutes: 125.54±28.07 vs. 145.11±32.61), the differences being statistically significant (all P<0.05). There were no significant differences in HOMA-IR, QUICKI between the two groups [HOMA-IR:(4.31±3.35)% vs. (4.15±3.46)%, QUICKI: 0.32±0.04 vs. 0.33±0.05, both P>0.05], and the HOMA-β of synchronous group was significantly higher than that in the non-synchronous group [(88.64±67.53)% vs. (76.59±69.41)%, P<0.05], ISI in synchronous group was significantly lower than that in non-synchronous group (3.98±0.66 vs. 4.14±0.74, P<0.05). Logistic regression analysis showed that the factors of affecting the synchronization of insulin and C-peptide release were insulin peak time and C-peptide peak time [insulin peak time: odds ratio (OR) = 1.077, 95% confidence interval (95% CI)=1.066-1.088; peak time of C peptide: OR=0.928, 95%CI=0.918-0.938]. Conclusion The degree of insulin resistance in synchronous group is higher than that in non-synchronous group; and the secretion function of pancreas islet beta cells in non-synchronous group is lower than that in synchronous group; the more stronger insulin resistance is, the more synchronous the release curve of insulin and C-peptide is.
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[Objective]To investigate the effect of GRACE scores on prediction of 30-day cardiovascular adverse events in acute chest pain patients.[Methods]A prospective,observational analysis was conducted in the patients with acute chest pain in Emergency Department(ED)from January 1,2016 through April 1,2016.Data including characteris-tics and GRACE scores were collected.All causes leading to MACE were followed up at 30th day after the onset of acute chest pain.[Results]Among a total of 209 patients presenting with acute chest pain enrolled in this study,110 were male (52.63%)and 99 were female(47.37%).The range of age was 20-98years old,and mean age was(65.28±16.85)years old.During follow-up period,12 patients had MACE,2 patients died in ED,3 patients died in hospital,6 patients died out of hospital,and 1 person was diagnosed with myocardial infarction. When compared with non-MACE group,factors including age,BMI,hospitalized patient number,and number of patients admitted in CCU as well as GRACE scores, were significantly higher in MACE group(P<0.05). The predictive ROC curve area of GRACE scores in 30-day MACE was 0.819(0.735 to 0.902). The optimal sensitivity and specificity were 0.92 and 0.65,respectively. The probability of 30-day cardiovascular adverse events in various GRACE score risk stratification was 0.95%(low-risk),6.67%(medi-um-risk),and 18.92%(high-risk),respectively.[Conclusion]The GRACE score was a useful predictor to the occur-rence of 30-day cardiovascular adverse events in acute chest pain patients.
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BACKGROUND: The application of coronary stents, especially drug-eluting stents (DESs), has made percutaneous coronary intervention (PCI) one of important therapeutic methods for CHD. DES has reduced the in-stent restenosis to 5％–9％ and signifi cantly improved the long-term prognosis of patients with CHD. The study aimed to investigate the long-term efficacy and safety of domestic drug-eluting stents (DESs) in patients with acute coronary syndrome (ACS). METHODS: All patients with ACS who had undergone successful percutaneous coronary intervention (PCI) in the First Affiliated Hospital of Zhengzhou University from July 2009 to December 2010 were included in this study. Patients were excluded from the study if they were implanted with bare metal stents or different stents (domestic and imported DESs) simultaneously. The included patients were divided into two groups according to different stents implanted: domestic DESs and imported DESs. RESULTS: In the 1683 patients of this study, 1558 (92.6％) patients were folowed up successfuly for an average of (29.1±5.9) months. 130 (8.3％) patients had major adverse cardiovascular events (MACEs), including cardiac death in 32 (2.1％) patients, recurrent myocardial infarction in 16 (1％), and revascularization in 94 (6％). The rates of cardiac death, recurrent myocardial infarction, revascularization, in-stent restenosis, stent thrombosis and other MACEs were not significantly different between the two groups (allP>0.05). Multivarite logistic regression revealed that diabetes mellitus (OR=1.75, 95％CI: 1.09–2.82,P=0.021), vascular numbers of PCI (OR=2.16, 95％CI: 1.22–3.83, P=0.09) and PCI with left main lesion (OR=9.47, 95％CI: 2.96–30.26,P=0.01) were independent prognostic factors of MACEs. The Kaplan-Meier method revealed that there was no significant difference in cumulative survival rates and survival rates free from clinical events between the two groups (allP>0.05). CONCLUSIONS: The incidences of clinical events and cumulative survival rates are not statistically different between domestic DESs and imported DESs. Domestic DES is effective and safe in the treatment of patients with ACS.
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80%.90d follow-up of 78 cases of heart patients with iatrogenic one cases of sudden cardiac death,5 cases of non-fatal myocardial infarction,11 cases of refractory angina pectoris,revascularization,as well as 12 cases of stent implantation.VEGF level is the major cardiovascular adverse events have an independent risk factor,OR value 1.017,95% CI as 1.011～1.023.Conclusion:The vascular endothelial growth factor concentrations related to coronary stenosis and the rate of major cardiovascular-related adverse events in patients with acute coronary syndrome,monitoring the concentration of vascular endothelial growth factor has important clinical significance.