Predicción de riesgo cardiovascular y periodontitis en pacientes con síndrome coronario agudo, Holguín 2020

Introducción : La predicción del riesgo cardiovascular favorece la prevención de eventos cardiovasculares. Objetivo : Estimar el riesgo cardiovascular y determinar la condición periodontal de pacientes con síndrome coronario agudo. Método : Se realizó un estudio transversal en 60 sujetos admitidos en la Unidad de Cuidados Coronarios del Hospital Provincial Vladimir Ilich Lenin, con diagnóstico de síndrome coronario agudo, que a su vez cumplieron con los criterios de inclusión. Se tuvieron en cuenta los principios de ética médica, se empleó el índice Periodontal de Russell y se determinó el riesgo cardiovascular según las Tablas de Predicción de Riesgo Cardiovascular aprobadas para Cuba. Se evaluaron las variables incluidas en dichas tablas. Resultados : El infarto agudo de miocardio se presentó en el 58,3 por ciento. El 55,0 por ciento eran del sexo masculino, 35,0 por ciento se encontraban en el grupo de edad de 55 a 64 años. En relación con la condición periodontal, el 76,7 por ciento presentó periodontitis. Según los factores de riesgo explorados la adicción tabáquica estuvo presente en el 71,7 por ciento y la hipertensión arterial en el 65,0 por ciento de los sujetos. El 25,0 por ciento de los pacientes con riesgo cardiovascular bajo presentaba periodontitis. Conclusiones : Según las tablas de predicción de riesgo cardiovascular empleadas, más de la mitad de los pacientes con síndrome coronario agudo presentaron riesgo cardiovascular bajo o moderado, sin embargo, la mayoría de estos presentaban periodontitis(AU)

Introduction : Prediction of cardiovascular risk favors prevention of cardiovascular events. Objective : To estimate cardiovascular risk and determine the periodontal condition of patients with acute coronary syndrome. Methods : A cross-sectional study was carried out with 60 subjects admitted to the coronary care unit at Hospital General Docente Vladimir Ilich Lenin, with a diagnosis of acute coronary syndrome and, in turn, meeting with the inclusion criteria. The principles of medical ethics were taken into account, the Russell's Periodontal Index was used, and cardiovascular risk was determined according to the cardiovascular risk prediction tables approved for Cuba. The variables included in these tables were evaluated. Results : Acute myocardial infarction occurred in 58.3 percent of the patients. 55.0 percent were male, and 35.0 percent were in the age group 55-64 years. Regarding their periodontal condition, 76.7 percent presented periodontitis. According to the explored risk factors, tobacco addiction was present in 71.7 percent, while arterial hypertension was present in 65.0 percent of the subjects. 25.0 percent of the patients with low cardiovascular risk had periodontitis. Conclusions : According to the used cardiovascular risk prediction tables, more than half of the patients with acute coronary syndrome presented low or moderate cardiovascular risk; however, most of these had periodontitis(AU)

Differential expression profiles analysis of DNA methylation between “disease” and “syndrome” in coronary heart disease-induced unstable angina patientswith Qi deficiency and blood stasis syndrome / 数字中医药（英文）

Objective@#To explore the differential expression profiles of DNA methylation sites/regions and potential molecular mechanisms in the peripheral blood of coronary heart disease (CHD)-induced unstable angina pectoris patients with or without Qi deficiency and blood stasis syndrome, and to provide scientific evidence for the conbination of disease and syndrome.@*Methods@#According to the pre-determined inclusion and exclusion criteria, the study subjects were enrolled and divided into two groups namely CHD-induced unstable angina group (G group) and healthy control group (J group) to conduct “disease” analysis, while G group was further divided into Qi deficiency and blood stasis syndrome group (case group) and non-Qi deficiency blood stasis syndrome group (control group) to perform “syndrome” analysis. The general data and clinical information of the study subjects were collected. The peripheral venous blood was extracted on an empty stomach, and the Illumina Infinium MethylationEPIC BeadChip (850K methylation chip) was used to detect the differential expressionprofiles of DNA methylation in each group, ChAMP software (V 2.14.0) was used for the differential methylation data analysis, with a threshold of the adjusted P value (adj.P.val) < 0.01. Gene Ontology (GO) and Kyoto Encyclopedia of Genomes (KEGG) were employed for the functional and pathway enrichment analyses of related mapped genes.@*Results@#A total of 263 differentially methylated CpG positions (DMPs) were screened out between G and J groups, including 191 hypermethylated positions such as cg05845204 and cg08906898, and 72 hypomethylated positions such as cg26919182 and cg13149459. These positions were mainly mapped to 148 genes encompassing RNA binding motif protein 39 (RBM39), acetyl-CoA acyltransferase 2 (ACAA2), protein phosphatase 1 regulatory subunit 12B (PPP1R12B), and the dual-specificity tyrosine phosphorylation-regulated kinase 2 (DYRK2). GO functional enrichment analysis revealed that the genes of the DMPs were primarily enriched in protein localization to chromosomes, regulation of cell morphogenesis, negative regulation of calcium-mediated signals, etc. KEGG pathway analysis suggested that the genes were mainly enriched in fatty acid metabolism and endocytosis pathways. In addition, a total of 23 differential methylation regions (DMRs) were identified, with overlapping genes such as transmembrane protein 232 (TMEM232), ribosomal protein large P1 (RPLP1), peroxisomal biogenesis factor 10 (PEX10), and forkhead box N3 (FOXN3) recognized. It was found that GO functions were mainly enriched in the negative regulation of Ras protein signal transduction, small GTPase-mediated signal transduction, negative regulation, etc. A total of 1 703 differential methylation sites were screened out between case and control groups, including 444 increased methylation positions such as cg05573767 and 1 259 decreased methylationpositions such as cg19938535, and cg03893872. These positions were mapped to 1 108 genes such as ribosomal protein S6 kinase A2 (RPS6KA2), leucine rich repeat containing 16A (LRRC16A), and hedgehog acyltransferase (HHAT). According to the GO functional enrichment analysis, the genes relating to the DMPs were mainly enriched in biological functions such as transmembrane receptor protein serine/threonine kinase signaling pathway and axonogenesis. The KEGG pathway enrichment analysis suggested the involvement of Rap1 signaling pathway, adenosine 5’-monophosphate-activated protein kinase (AMPK) signaling pathway, etc. A total of 21 DMRs were identified, including 22 overlapping genes such as mucin 4 (MUC4), three prime repair exonuclease 1 (TREX1), and LIM homeobox 6 (LHX6). GO analysis demonstrated that the genes primarily participated in molecular functions such as positive regulation of transmembrane transport, regulation of fatty acid metabolism, and copper ion binding.@*Conclusion@#This study reveals the methylation patterns of DMPs and DMRs in patients with Qi deficiency and blood stasis syndrome caused by CHD-induced unstable angina pectoris. Potential epigenetic regulation of fatty acid metabolism, Rap1 signaling, and other molecular functions are involved in the development of CHD between the "disease" and "syndrome".

Clinical observation of ticagrelor combined with Compound xueshuantong capsule in the treatment of unstable angina pectoris / 中国药房

OBJECTIVE To observe the efficacy and safety of ticagrelor combined with Compound xueshuantong capsules in the treatment of unstable angina pectoris. METHODS Totally 120 patients with unstable angina pectoris with deficiency of Qi and Yin combined admitted to Sanmenxia Hospital of Traditional Chinese Medicine from January 2021 to December 2022 were randomly divided into clopidogrel group （group A）， ticagrelor group （group B） and combined medication group （group C）， with 40 patients in each group. In addition to conventional treatment， group A was given clopidogrel orally； group B was given ticagrelor orally； group C was given ticagrelor and Compound xueshuantong capsule orally. After 12 weeks of treatment， the clinical efficacy， frequency of angina attacks， coagulation function indicators， cardiac function indicators， traditional Chinese medicine syndrome efficacy， and the incidence of adverse cardiovascular events and bleeding incidence were evaluated in the 3 groups. RESULTS The total effective rates of group A， group B and group C were 77.5%， 85.0% and 90.0%， respectively. The incidence of adverse cardiovascular events and bleeding events were 7.5%， 7.5% and 5.0% in the respective groups， with no statistically significant difference （P＞0.05）. The frequency of angina attacks， duration of angina attacks and duration of dyspnea were significantly reduced or shortened in all 3 groups after treatment compared to before treatment （P＜0.05）. The frequency of angina attacks in group C was significantly lower than that in groups A and B after treatment （P＜0.05）. The levels of fibrinogen （FBG） and D-dimer in all 3 groups were significantly lower after treatment compared to before treatment （P＜0.05）； group A had significantly higher levels of FBG and D-dimer compared to group B and C （P＜0.05）. The left ventricular end-diastolic diameter and left ventricular end-systolic diameter in all three groups were significantly shorter after treatment， and the left ventricular ejection fraction was significantly higher compared to before treatment （P＜0.05）， but there were no statistically significant differences among those groups （P＞0.05）. The total effective rates of traditional Chinese medicine syndrome efficacy in groups A， B and C were 67.5%， 80.0% and 87.5%， respectively， with group C being significantly higher than group A （P＜0.05）. CONCLUSIONS In addition to conventional treatment， ticagrelor combined with Compound xueguantong capsules can more significantly reduce the frequency of angina attacks in patients with unstable angina pectoris， reduce the levels of FBG and D- dimer， improve traditional Chinese medicine syndrome efficacy， and do not increase the risk of bleeding.

Classification of patients with suspected acute coronary syndrome according to the universal definition

Objective: to describe the clinical, imaging and laboratory characteristics of patients undergo ing coronary arteriography with a presumptive diagnosis of acute coronary syndrome between January 2017 and December 2019, as well as the frequencies of the types of infarction according to the universal definition. Methods: an observational, cross-sectional study of patients over the age of 18 undergoing coronary angiography at a university hospital in Bogotá. Statistical analysis was carried out using STATA software, calculating absolute frequencies, proportions, and measures of central tendency and dispersion, according to the behavior of the variables. Patients were classified according to the fourth universal definition of infarction, determining each respective frequency. Results: a total of 714 medical charts were analyzed, corresponding to 459 men and 255 women, with high blood pressure, dyslipidemia, obesity, diabetes and prior coronary disease being the most common cardiovascular risk factors. Altogether, 68.9% of the patients had an electrocardiogram with an abnormal reading, and only 43.8% of the patients had obstructive lesions, of whom 33.2% were patients with type I infarction. A 12.2% prevalence was found for type II infarction, and 17% for the MINOCA category. Inpatient mortality was 2.5%, mainly due to cardiogenic shock. Conclusions: patients with acute coronary syndrome were predominantly males with cardio vascular risk factors. In this study, most patients did not have obstructive lesions on arteriography. However, type I infarction was the most common type. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2350).

Objetivo: describir las características clínicas, imagenológicas y de laboratorio de pacientes llevados a arteriografía coronaria con diagnóstico presuntivo de síndrome coronario agudo, en el periodo comprendido entre enero de 2107 y diciembre 2019; así como las frecuencias de los tipos de infarto según la definición universal. Metodología: estudio observacional de corte transversal, de pacientes mayores de 18 años llevados a coronariografía, en un hospital universitario de Bogotá. Mediante el software STATA, se realizó el análisis estadístico, con cálculo de frecuencias absolutas, proporciones, medidas de tendencia central y dispersión según el comportamiento de las variables. Se realizó la clasificación de pacientes según la cuarta definición universal de infarto, identificando cada una de las frecuen cias respectivas. Resultados: se analizaron 714 historias clínicas, correspondientes a 459 hombres y 255 mu jeres, con hipertensión arterial, dislipidemia, obesidad, diabetes y enfermedad coronaria previa como factores de riesgo cardiovascular más frecuentes. El 68.9% de pacientes tuvo un electrocar diograma interpretado como anormal y solo 43.8% de pacientes tuvo lesiones obstructivas, de los cuales 33.2% correspondió a pacientes con infarto tipo I. Se encontró una prevalencia de 12.2% para infarto tipo II y del 17% para la categoría de MINOCA. La mortalidad intrahospitalaria fue de 2.5%, principalmente por choque cardiogénico. Conclusiones: la población masculina con factores de riesgo cardiovascular, predominó en la presentación del síndrome coronario agudo. Para este estudio, la mayoría de los pacientes no tuvo lesiones obstructivas en la arteriografía. Sin embargo, dentro de los tipos de infarto; el infarto tipo I fue el más frecuente. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2350).

CT myocardial perfusion imaging complementing coronary CT angiography in a patient with a history of unstable angina: A case report

Coronary computed tomography angiography (CCTA) could show the morphological status of coronary stenosis. Moreover, computed tomography (CT) myocardial perfusion (CTP) could provide additional information to identify hypoattenuating areas that might complement the limitation of CCTA in terms of evaluating the functional status, adding to the diagnostic performance of CCTA. We reported the imaging features of coronary artery disease in a female patient with a history of unstable angina by evaluating the anatomic and functional information through CCTA and CT myocardial perfusion in one stop modality

Is the variation in monocyte to high-density lipoprotein cholesterol ratio a predictor of major cardiovascular events after acute coronary syndrome?

In clinical practice, we need to develop new tools to identify the residual cardiovascular risk after acute coronary syndrome (ACS). This study aimed to evaluate whether the monocyte to high-density lipoprotein cholesterol ratio (MHR) variation (ΔMHR) obtained during hospital admission (MHR1) and repeated in the first outpatient evaluation (MHR2) is a predictor of major adverse cardiovascular events (MACE) after ACS. One hundred ninety-one patients admitted for ACS were prospectively included. The ΔMHR was calculated by subtracting MHR1 from MHR2. Patients were followed for 166±38 days in which the occurrence of MACE was observed. The best cutoff for ΔMHR was zero (0), and individuals were divided into two groups: ΔMHR<0 (n=113) and ΔMHR≥0 (n=78). The presence of MACE was higher in the ΔMHR≥0 (22%) than in the ΔMHR<0 (7%), with a hazard ratio (HR) of 3.96 (95% confidence interval [CI]: 1.74-8.99; P=0.0004). After adjusting for confounders, ΔMHR≥0 remained an independent MACE predictor with an adjusted HR of 3.13 (95%CI: 1.35-7.26, P=0.008). In conclusion, our study showed that ΔMHR was an independent MACE predictor after ACS. Thus, ΔMHR is a potential marker of residual cardiovascular risk after ACS.

Clinical observation of Shenxiang suhe pill in the adjuvant treatment of triple vessel lesion of coronary artery / 中国药房

OBJECTIVE To investigate the efficacy and safety of Shenxiang suhe pill in the adjuvant treatment of triple vessel lesion of coronary artery. METHODS From February 2019 to February 2021，146 patients with unstable angina pectoris and triple vessel lesion of coronary artery （chest discomfort of hanning xinmai type ）admitted to Harrison International Peace Hospital were divided into observation group and control group according to random number table ，with 73 cases in each group. Control group was given Isosorbide dinitrate tablets+Aspirin enteric-coated tablets+Clopidogrel bisulfate tablets+Atorvastatin calcium tablets+ Bisoprolol fumarate tablets for western medicine treatment. Observation group was additionally given Shenxiang suhe pill 0.7 g/time orally after meal ，twice a day ，on the basis of control group. After 2 courses of treatment （3 weeks as a course of treatment ，with an interval of 1 week for each course of treatment ），curative effect and symptoms of angina pectoris [frequency and duration of angina pectoris ，walking distance of 6-min walking test （6MWT）]，TCM syndrome score ，cardiac markers [neutrophil to lymphocyte ratio （NLR）and the contents of endothelin-1（ET-1），nitric oxide （NO），soluble suppression of tumorigenicity 2 （sST2），angiotensin Ⅱ（Ang-Ⅱ）] and quality of life [Seattle angina questionnaire （SAQ），36-item short form health survey （SF-36）] before and after treatment were compared between the two groups. Adverse drug reactions （ADR）during treatment and major adverse cardiovascular events （MACE）during follow-up were recorded. RESULTS The total response rate of the observation group was 86.30％，significantly higher than 71.23％ of the control group （P＜0.05）. Before treatment ，there was no statistical difference in the above indexes between 2 groups（P＞0.05）. After treatment ，the frequency and duration of angina pectoris ，TCM syndrome score ，NLR and the contents of sST 2，ET-1 and Ang- Ⅱ in the two groups decreased or shortened significantly ，while the walking distance of 6MWT，NO content ，scores of each dimension in SAQ and SF- 36 increased significantly ；and the above indexes in observation group were significantly better than those in control group （P＜0.05）. There was no significant difference in the inciden ce of ADR between the two groups （P＞0.05）； however，the incidence of MACE in observation group was significantly lower than that in control group （P＜0.05）. CONCLUSIONS In the treatment of adjuvant treatment of triple vessel lesion of coronary artery ，Shenxiang suhe pill can improve the symptoms of angina pectoris and vascular endothelial function ，reduce the incidence of MACE ，improve the quality of life ，and has good safety.

Effectiveness and Safety of Chinese Medicinal Injection in Treatment of Unstable Angina Pectoris Based on Network Meta-analysis / 中国实验方剂学杂志

ObjectiveTo systematically evaluate the clinical effectiveness and safety of Chinese medicinal injection （CMI） in the treatment of unstable angina pectoris （UAP）. MethodEight databases， i.e.， China National Knowledge Infrastructure （CNKI），VIP，Wanfang Data，CBM，PubMed，EMBASE，The Cochrane Library，and Web of Science were searched for randomized controlled trials （RCT） of conventional treatment combined with CMI （treatment group） versus conventional treatment （CT）（control group）in the treatment of UAP published from database inception to March 31th 2021. Stata 16.0 was used for network Meta-analysis. ResultThirty-nine RCT involving 3 407 patients were included. As revealed by the results of network Meta-analysis， in terms of the total effective rate in angina pectoris improvement， the therapeutic protocols were ranked as Tanreqing injection（TRQI）+CT>Xiangdan injection（XDI）+CT>Ciwujia injection（CWJI）+CT=Shengmai injection（SMI）+CT>Xuesaitong injection（XSTS）+CT>Breviscapine injection（BI）+CT>Shuxuetong injection（SXTI）+CT>Kudiezi injection（KDZI）+CT>Shuxuening injection（SXNI）+CT>Danshen injection （DSI）+CT>Guanxinning injection（GXNI）+CT>Dengzhanxixin injection（DZXXI）+CT>Xueshuantong injection（XSTI）+CT>Gualoupi injection（GLPI）+CT>CT；for the total effective rate in ECG improvement， SXTI+CT>XDI+CT>TRQI+CT>CWJI+CT>XSTI+CT>BI+CT>XSTI+CT>SXNI+CT>GXNI+CT>KDZI+CT>DZXXI+CT>GLPI+CT>CT>SMI+CT；for the adverse reactions， DZXXI+CT>XDI+CT>DSI+CT>BI+CT>SMI+CT>SXNI+CT>CT>GLPI+CT>GXNI+CT>SXTI+CT>KDZI+CT>CWJI+CT；for the reduction of fibrinogen （FIB）， BI+CT>SXTI+CT>XSTI+CT>CT>KDZI+CT；for the reduction of C-reactive protein （CRP）， DSI+CT>DZXXI+CT>XSTI+CT>CT；for the reduction of high-sensitivity C-reactive protein （hs-CRP）， SXNI+CT>KDZI+CT>SXTI+CT>DZXXI+CT>GLPI+CT>TRQI+CT>XSTI+CT>CT. The results of subgroup analyses were consistent with those of the overall Meta-analysis. ConclusionCMI combined with CT can improve angina pectoris and ECG，reduce adverse reactions，and also improve FIB，CRP，and hs-CRP to varying degrees. However，due to the differences in the quality and quantity of CMIs in RCTs，clinical application should be performed based on the specific conditions.

Estado periodontal de pacientes con cardiopatía isquémica / Periodontal state of patients with ischemic heart disease

Introducción: En numerosos estudios realizados en las últimas 3 décadas, se ha tratado de atribuir una relación causal a la enfermedad periodontal en la fisiopatología de la cardiopatía isquémica. Objetivo: Caracterizar el estado periodontal de pacientes con cardiopatía isquémica y algunos factores de riesgo cardiovascular. Métodos: Se realizó un estudio transversal de 50 pacientes, atendidos en la sala de cuidados coronarios del Hospital Provincial Vladimir Ilich Lenin de Holguín, desde septiembre de 2019 hasta enero de 2020. Se evaluó el estado periodontal mediante el Índice Periodontal de Russell simplificado. Se exploraron algunos factores de riesgo de la cardiopatía isquémica y se emplearon métodos teóricos, empíricos, así como la estadística descriptiva. Resultados: En la serie predominó el grupo de 60-69 años de edad (23 para 46,0 %); 56,0 % de los pacientes presentó infarto agudo de miocardio y 62,0 % periodontitis avanzada. Entre los factores de riesgo cardiovascular más frecuentes figuraron: hipertensión arterial (74,0 %) y tabaquismo (70,0 %). Conclusiones: En este estudio se halló, en gran medida, la periodontitis crónica en pacientes con cardiopatía isquémica, lo cual sirve de pauta para la toma de decisiones de médicos y estomatólogos.

Introduction: In numerous studies carried out in the last 3 decades, it has been tried to attribute a causal relationship to the periodontal disease in the pathophysiology of the ischemic heart disease. Objective: To characterize the periodontal state of patients with ischemic heart disease and some cardiovascular risk factors. Methods: A cross-sectional study of 50 patients, assisted in the Coronary Cares Service of Vladimir Ilich Lenin Provincial Hospital in Holguín, was carried out from September, 2019 to January, 2020. The periodontal state was evaluated by means of the Russell Periodontal Index simplified. Some risk factors of the ischemic heart disease were explored and theoretical, empiric methods were used, as well as the descriptive statistic. Results: In the series there was a prevalence of the 60-69 age group (23 for 46 %); 56.0 % of the patients presented acute myocardial infarction and 62.0 % presented advanced periodontitis. Among the most frequent cardiovascular risk factors we can mention: hypertension (74.0 %) and nicotine addiction (70.0 %). Conclusions: In this study it was found, in great measure, the chronic periodontitis in patients with ischemic heart disease, which serves as rule for the decisions making of doctors and dentists.

Factores asociados al síndrome de Wellens en pacientes con síndrome coronario agudo sin elevación del segmento ST / Factors associated to Wellens' syndrome in patients with acute coronary syndrome without ST-segment elevation

Introducción: El síndrome de Wellens constituye un equivalente del síndrome coronario agudo con elevación del segmento ST. Este incluye dos patrones electrocardiográficos que sugieren lesión crítica de la arteria descendente anterior. Objetivo: Evaluar probables factores asociados al síndrome de Wellens en pacientes con síndrome coronario agudo sin elevación del segmento ST y lesiones coronarias significativas en la arteria descendente anterior. Material y métodos: Se realizó un estudio observacional, analítico, transversal en pacientes con diagnóstico de síndrome coronario agudo sin elevación del ST y lesión significativa en la arteria descendente anterior, comprobada mediante coronariografía, ingresados en la unidad de cuidados coronarios intensivos del Hospital Clínico-Quirúrgico Manuel Fajardo entre el 2016 y 2019. Resultados: La edad media fue de 66 años, predominó el sexo masculino (53,9 por ciento) y el antecedente de hipertensión arterial (89,5 por ciento). Los pacientes con síndrome de Wellens tuvieron un significativo menor porcentaje de antecedente de cardiopatía isquémica (58,1 por ciento vs. 84,8 por ciento; p = 0,012). Además, el síndrome arrojó asociación estadísticamente muy significativa con la condición de fumador activo (51,2 por ciento vs. 15,2 por ciento; p < 0,01). No se encontró relación estadística significativa entre el síndrome de Wellens y el resultado angiográfico. Conclusiones: La presencia de los patrones electrocardiográficos del síndrome de Wellens se asocia con el hábito tabáquico en pacientes con síndrome coronario agudo sin elevación del segmento ST y lesiones coronarias en la arteria descendente anterior, y su ausencia se asocia con el antecedente de cardiopatía isquémica en el mismo subgrupo de individuos(AU)

Introduction: Wellens' syndrome is equivalent to acute coronary syndrome with ST-segment elevation. It includes two electrocardiographic patterns suggesting a critical lesion in the anterior descending artery. Objective: Evaluate probable factors associated to Wellens' syndrome in patients with acute coronary syndrome without ST-segment elevation and significant coronary lesions in the anterior descending artery. Methods: A cross-sectional observational analytical study was conducted of patients diagnosed with acute coronary syndrome without ST-segment elevation and significant lesion in the anterior descending artery verified by coronary arteriography, admitted to the intensive coronary care unit at Manuel Fajardo Clinical Surgical Hospital in the period 2016-2019. Results: Mean age was 66 years, with a predominance of the male sex (53.9 percent) and a history of hypertension (89.5 percent). Patients with Wellens' syndrome had a significantly lower percentage of ischemic heart disease antecedents (58.1 percent vs. 84.8 percent; p = 0.012). A very significant statistical association was observed between the syndrome and active smoking (51.2 percent vs. 15.2 percent; p < 0.01). A significant statistical relationship was not found between Wellens' syndrome and angiographic results. Conclusions: The presence of electrocardiographic patterns of Wellens' syndrome is associated to smoking in patients with acute coronary syndrome without ST-segment elevation and coronary lesions in the anterior descending artery, whereas their absence is associated to a history of ischemic heart disease in the same subgroup of individuals(AU)

Protocolo de recepción del paciente con síndrome coronario agudo en el Servicio de Urgencia / Adulto Reception protocol for patients with acute coronary syndrome in the Adult Emergency Service

El Síndrome coronario agudo (SCA) se define como la obstrucción brusca de una arteria que puede dar lugar a una isquemia miocárdica aguda que se acompaña de un síndrome clínico característico que puede ir desde una isquemia con elevación o sin elevación en el segmento ST, angina estable o inestable y muerte súbita. Dado que el SCA es considerado un problema mundial por su alta incidencia y una de las principales causas de muerte es que resulta indispensable la creación y aplicación de un protocolo de recepción del paciente con SCA donde el enfermero que recepciona al paciente con dolor torácico en un servicio de urgencia pueda realizar la valoración de forma oportuna y rápida teniendo en cuenta una secuencia de intervenciones y cuidados que se encuentren plasmados en una planilla el cual garantice la implementación de las medidas terapéuticas a tiempo, aumentando la eficacia de las mismas, reduciendo la morbimortalidad y disminuyendo los costos hospitalarios. El objetivo del protocolo es estandarizar las intervenciones y cuidados de enfermería en la atención inicial del paciente con SCA[AU]

Acute coronary syndrome (ACS) is defined as a sudden obstruction of an artery that can lead to acute myocardial ischemia that is accompanied by a characteristic clinical syndrome that can range from elevation or without elevation ischemia in the ST segment, angina stable or unstable and sudden death. Ince ACS is considered a worldwide problem due to its high incidence and one of the main causes of death, it is essential to create and apply a protocol for receiving the patient with ACS, where the nurse who receives the patient with chest pain in a The emergency service can carry out the assessment in a timely and fast way, taking into account a sequence of interventions and care that are reflected in a schedule that guarantees the implementation of therapeutic measures in time, increasing their effectiveness, reducing morbidity and mortality. and lowering hospital costs. The objective of the protocol is to standardize nursing interventions and care in the initial care of the patient with ACS[AU]

A síndrome coronariana aguda (SCA) é definida como uma obstrução repentina de uma artéria que pode levar a isquemia miocárdica aguda, acompanhada por uma síndrome clínica característica que pode variar de elevação ou sem isquemia de elevação no segmento ST, angina morte estável ou instável e repentina.Como a SCA é considerada um problema mundial devido à sua alta incidência e uma das principais causas de morte, é essencial criar e aplicar um protocolo para receber o paciente com SCA, onde a enfermeira que recebe o paciente com dor no peito O serviço de emergência pode realizar a avaliação de maneira oportuna e rápida, levando em consideração uma sequência de intervenções e cuidados que se refletem em um cronograma que garante a implementação de medidas terapêuticas no tempo, aumentando sua efetividade, reduzindo a morbimortalidade. e redução de custos hospitalares. O objetivo do protocolo é padronizar intervenções e cuidados de enfermagem nos cuidados iniciais do paciente com SCA[AU]

Combination of Activating Blood Circulation and Detoxifying Chinese Medicines Played an Anti-Inflammatory Role in Unstable Angina Patients after Percutaneous Coronary Intervention: A Multicenter, Open-Labeled, Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To investigate the combined anti-inflammatory effect of activating blood circulation and detoxifying Chinese medicines in unstable angina (UA) patients.@*METHODS@#This study was an open-labeled, randomized controlled trial conducted in 5 centers in Beijing. A total of 154 patients were randomized into two groups at a 1:1 ratio by random numbers. Based on the conventional treatment, patients in the activating blood circulation (ABC) group were treated with Guanxin Danshen Droping Pill (, 0.4 g, thrice daily), and patients in the activating blood circulation and detoxifying (ABCD) group were treated with Guanxin Danshen Droping Pill (0.4 g, thrice daily) and Andrographis tablet (0.2 g, thrice daily) for 4 weeks. The primary outcome was the serum level of high sensitive C reaction protein (hs-CRP), and the secondary outcome index included the serum levels of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), soluble CD40 ligand (sCD40L), thrombomodulin (TM), the score of angina pectoris, the score of blood stasis syndrome, and the score of Chinese medicine symptoms, observed at week 0 and week 4.@*RESULTS@#A total of 144 patients completed the trial (ABC group, n=70; ABCD group, n=74). There were no significant differences in the clinical baseline characteristics between the two groups. When compared with the ABC group, ABCD group showed better performance in reducing the level of inflammatory factors, especially hs-CRP (P<0.05), IL-6 (P<0.01) and TNF-α (P<0.01). In term of clinical symptoms, ABCD group played a better role in improving the scores of angina pectoris and blood stasis syndrome than ABC group (all P<0.05).@*CONCLUSIONS@#The combination of Guanxin Danshen Dropping Pill and Andrographis tablet exert significant anti-inflammatory effect on UA patients, which is superior to single Guanxin Danshen Dropping Pill. (Registration No. ChiCTR-TRC-13004072).

Rules of Syndrome and Treatment of Unstable Angina Pectoris Guided by Vessel-collateral Theory and Mechanism Analysis Based on Network Pharmacology / 中国实验方剂学杂志

Objective:Guided by nutrient-defense stages in the vessel-collateral theory， the modern medical cases of unstable angina pectoris（UAP） were systematically collated and analyzed to explore the rules of syndrome and treatment of UAP and the molecular mechanism of core Chinese herbal combination in the treatment of UAP based on network pharmacology. Method:All medical cases with UAP treated by Chinese medicinal compounds were retrieved from PubMed，China National Knowledge Infrastructure （CNKI），Wanfang Data， VIP， and SinoMed published between database inception and November 2020. The syndromes of medical cases were determined based on the nutrient-defense stages of the vessel-collateral theory. Rules of syndrome and treatment of UAP were investigated by data mining methods， such as frequency statistics， cluster analysis， and enhanced FP-Growth algorithm. The molecular mechanism of core Chinese herbal combination in the treatment of UAP was analyzed by network pharmacology. Result:The first four syndromes of UAP with high frequencies were deficiency and stagnation of collateral Qi， blood stasis obstructing collaterals， depression and stagnation of collateral Qi， and turbid phlegm obstructing collaterals. The Chinese herbal medicines with high frequencies included Salviae Miltiorrhizae Radix et Rhizoma， Glycyrrhizae Radix et Rhizoma， Chuanxiong Rhizoma， and Astragali Radix， which were effective in resolving stasis， dredging collaterals， replenishing Qi， consolidating defensive Qi， regulating Qi， relieving depression， and dispelling phlegm. The association analysis indicated that the core Chinese herbal combination in the treatment of UAP was Salviae Miltiorrhizae Radix Chuanxiong Rhizoma-Astragali Radix. Four Chinese herbal combinations were obtained by cluster analysis. As revealed by network pharmacology， the key components of Salviae Miltiorrhizae Radix et Rhizoma-Chuanxiong Rhizoma-Astragali Radix in the treatment of UAP included quercetin， luteolin， and tanshinone Ⅱ_A， and the key targets included serine/threonine-protein kinase 1 （Akt1）， mitogen-activated protein kinase 1 （MAPK1）， Jun， interleukin （IL）-6， and MAPK8. Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway analysis showed that phosphatidylinositol-3-kinase （PI3K）/protein kinase B （Akt） signaling pathway might serve as the main pathway for its therapeutic efficacy. Conclusion:The basic pathogenesis of UAP is deficiency/depression and stagnation of collateral qi and turbid phlegm obstructing collaterals. The treatment should follow the principles of replenishing Qi， resolving stasis， and dredging collaterals， assisted with regulating Qi and resolving phlegm. The therapeutic efficacy of Salviae Miltiorrhizae Radix-Chuanxiong Rhizoma-Astragali Radix was achieved via multi-component， multi-target， and multi-pathway. This study is expected to inspire future UAP-related studies at the molecular level based on vessel-collateral theory.

Network Meta-analysis of clinical efficacy of Chinese herbal injection in adjuvant treatment of unstable angina pectoris / 中国中药杂志

The present study evaluated the curative efficacy of Chinese herbal injection on unstable angina pectoris( UAP) by network Meta-analysis. The databases,including Pub Med,Cochrane Library,Web of Science,CNKI,CBM,VIP and Wanfang were searched for randomized controlled trial( RCT) of Chinese herbal injection in the treatment of UAP. All researchers independently screened the articles,extracted the data and evaluated the quality. Open BUGS and Stata were employed for the analysis of the trials that met the quality standards. Fifty-eight studies were finally included in this study,involving 20 intervention measures. In terms of the effective rate,16 injections such as Dengzhan Xixin Injection,Xuesaitong Injection and Danshen Injection combined with western medicine exhibited significant efficacy. In terms of ECG,Puerarin Injection,Ginkgo Leaf Extract and Dipyridamole Injection( GDI),Breviscapine Injection combined with western medicine were superior to western medicine. In terms of the reduction of the angina attack times,Sodium Tanshinone ⅡASulfonate Injection,GDI and Dazhu Hongjingtian Injection combined with western medicine showed better effects than western medicine. In terms of shortening the angina duration,Shenmai Injection combined with western medicine was superior to western medicine. As revealed by the results,Dengzhan Xixin Injection,Xuesaitong Injection,Danshen Injection,Breviscapine Injection,Danshen Ligustrazine Injection combined with western medicine displayed prominent curative efficacy,which were recommended for clinical application. Meanwhile,appropriate intervention measures should be selected according to individual conditions. Limited by the quality of the included trials,the conclusions still need to be further verified.

Network Meta-analysis of Chinese patent medicine in treatment of unstable angina pectoris / 中国中药杂志

Network Meta-analysis was used to compare the efficacy and safety of Chinese patent medicines in the treatment of unstable angina pectoris. PubMed, Cochrane Library, CNKI, Wanfang, VIP and other databases were retrieved by computers from the establishment of the databases to June 2020. Randomized controlled trials(RCTs) of Chinese patent medicines for the treatment of unstable angina pectoris were collected. Two investigators independently screened out the literatures, and extracted data according to the inclusion and exclusion criteria. The quality of the included RCTs was evaluated according to the bias risk assessment tool recommended by the Cochrane System Reviewer Manual, and the Stata 13.0 software was used for data analysis and mapping. Through screening, 28 eligible studies were finally included, with the sample size of 2 885 cases, involving 8 Chinese patent medicines. The results of the network Meta-analysis showed that in terms of total effective rate for angina symptom improvement, the order was as follows: Shenshao Capsules > Naoxintong Capsules > Ginkgo Ketone Ester Dripping Pills > Compound Danshen Dripping Pills > Ginkgo Leaf Tablets > Shexiang Baoxin Pills > Tongxinluo Capsules > Yindan Xinnaotong Soft Capsules; in terms of total effective rate for ECG curative effect, the order was as follows: Ginkgo Ketone Ester Dripping Pills>Compound Danshen Dripping Pills > Tongxinluo Capsules > Shenshao Capsules > Shexiang Baoxin Pills > Yindan Xinnaotong Soft Capsules; in terms of hypersensitivity-C-reactive protein curative effect, the order was as follows: Tongxinluo Capsules > Shenshao Capsules > Ginkgo Leaf Tablets>Compound Danshen Dropping Pills> Shexiang Baoxin Pills > Naoxintong Capsules > Yindan Xinnaotong Soft Capsules > Ginkgo Ketone Ester Dropping Pills. Chinese patent medicine combined with conventional therapy can improve the clinical efficacy of unstable angina pectoris. Due to the differences in the quantity and quality of the included studies, the order results of Chinese patent medicines need to be further verified.

Meta-analysis of Therapeutic Efficacy and Safety of Nicodil Combined with Atorvastatin Calcium in the Treatment of Unstable Angina Pectoris / 中国药房

OBJECTIVE：To systematically evaluate the effectiveness and safety of nicorandil combined with atorvastatin calcium in the treatment of unstable angina pectoris ，and to provide reference for clinical treatment. METHODS ：Retrieved from PubMed，Cochrane Library ，Embase database ，CBM，VIP，CNKI and Wanfang database ，randomized controlled trials （RCTs） about nicodil combined with atorvastatin calcium in the treatment of unstable angina pectoris were collected from the inception until Jan. 3rd，2021. The included studies were screened and evaluated with modified Jadad scale. Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：A total of 10 RCTs were included ，involving 1 123 patients. Meta-analysis results showed that compared with atorvastatin calcium group ，nitcodil combined with atorvastatin calcium group significantly increased angina response rate [OR ＝3.44，95％CI（2.35，5.04），P＜0.001]，the rate of electrocardiogram improvement [OR ＝4.93，95％CI（2.88， 8.43），P＜0.001]，and significantly reduced MMP- 9 level [SMD ＝－4.21，95％CI（－4.63，－3.80），P＜0.001]，incidence of recurrent angina pectoris [OR ＝0.30，95％CI（0.12，0.71），P＝0.006]，myocardial infarction rate [OR ＝0.27，95％CI（0.08，0.89）， P＝0.03]，the incidence of adverse cardiovascular events [OR ＝0.34，95％ CI（0.21，0.55），P＜0.001]. CONCLUSIONS ： Nicorandil combined with atorvastatin calcium shows better efficacy in the treatment of unstable angina pectoris in terms of effective rate of angina pectoris ，improvement rate of cardiogram ，MMP-9 level，incidence of recurrent angina pectoris and the incidence of myocardial infarction ，and has better safety in the incidence of adverse cardiovascular events. Due to the limitation of included studies ，it remains to be verified by RCT with large sample，multi-center and high quality.

Correlation between GPR, MHR and elderly essential hypertension with unstable angina pectoris / 中南大学学报(医学版)

OBJECTIVES@#To investigate the level and significance of serum γ-glutamyl transferase-to-platelet ratio (GPR) and monocyte count to high-density lipoprotein ratio (MHR) in patients with essential hypertension (EH) and unstable angina (UA).@*METHODS@#A total of 218 patients with coronary angiography aged ≥60 years, who were admitted to the EH hospital of the Department of Cardiac Medicine, Affiliated Hospital of Chengde Medical College, were selected from September 2018 to September 2019. They were divided into an EH+UA group (@*RESULTS@#Compared with the control group, patients in the EH+UA group and the EH group had higher body mass index (BMI), tyiglyceride (TG), GPR, and MHR, and lower high-density lipoprotein-cholesterol (HDL-C) (all @*CONCLUSIONS@#There is a correlation between GPR, MHR and EH combined with UA pectoris, and the combined detection of the two indicators has adjuvant diagnostic value for elderly EH combined with UA.

Circulating microrna expression profiles in patients with stable and unstable angina

OBJECTIVES: High incidence and case fatality of unstable angina (UA) is, to a large extent, a consequence of the lack of highly sensitive and specific non-invasive markers. Circulating microRNAs (miRNAs) have been widely recommended as potential biomarkers for numerous diseases. In the present study, we characterized distinctive miRNA expression profiles in patients with stable angina (SA), UA, and normal coronary arteries (NCA), and identified promising candidates for UA diagnosis. METHODS: Serum was collected from patients with SA, UA, and NCA who visited the Department of Cardiovascular Diseases of the Meizhou People's Hospital. Small RNA sequencing was carried out on an Illumina HiSeq 2500 platform. miRNA expression in different groups of patients was profiled and then confirmed based on that in an independent set of patients. Functions of differentially expressed miRNAs were predicted using gene ontology classification and Kyoto Encyclopedia of Genes and Genomes pathway analysis. RESULTS: Our results indicated that circulating miRNA expression profiles differed between SA, UA, and NCA patients. A total of 36 and 161 miRNAs were dysregulated in SA and UA patients, respectively. miRNA expression was validated by reverse transcription quantitative polymerase chain reaction. CONCLUSION: The results suggest that circulating miRNAs are potential biomarkers of UA.

Systematic evaluation of efficacy and safety of Xinkeshu in treatment of unstable angina pectoris / 中草药

Objective: To systematically evaluate the efficacy and safety of Xinkeshu combined with conventional western medicine in the treatment of unstable angina pectoris. Methods: The randomized controlled clinical trials of Xinkeshu combined with conventional western medicine for the treatment of unstable angina pectoris were searched from PubMed database, Viper database, CNKCN, Wanfang database and other databases from the establishment of the database to April 2020.The literatures were screened according to inclusion and exclusion criteria, and Rev Man5.3 software was used for Meta analysis. Results: A total of 1569 patients were included in 19 randomized controlled trials. Meta-analysis results showed that Xinkeshu combined with conventional western medicine reduced the frequency of angina attacks (SMD=-1.16, 95%CI [-1.75, -0.57], P=0.000 1), decreased the duration of angina (MD=-2.75, 95%CI [-3.77, -1.73], P < 0.000 01), reduced the dosage of nitroglycerin (MD=-0.67, 95%CI [-0.78, -0.56], P < 0.000 01), improved ECG efficacy (RR=1.26, 95%CI [1.18, 1.35], P < 0.000 01), angina pectoris efficacy (RR=1.26, 95%CI [1.20, 1.33], P < 0.000 01), decreased triglyceride (MD=-0.57, 95%CI [-1.02, -0.12], P=0.01), total cholesterol (MD=-0.78, 95%CI [-1.15, -0.41], P < 0.000 1), low-density lipoprotein cholesterol (MD=-0.58, 95%CI [-0.80, -0.36], P < 0.000 01), raised high-density lipoprotein cholesterol (MD=0.24, 95%CI [0.08, 0.40], P=0.004), decreased whole blood viscosity (MD=-1.32, 95%CI [-2.25, -0.39], P=0.005), and plasma viscosity (MD=-0.29, 95%CI [-0.38,-0.21], P < 0.000 01), fibrinogen (MD=-1.06, 95% CI [1.29, 0.83], P < 0.000 01), lower C-reactive protein (MD=-1.70, 95% CI [2.33, 1.06], P < 0.000 01), endothelin 1 (MD=-7.81, 95% CI [10.05, 5.57], P < 0.000 01), and homocysteine (MD=-2.35, 95% CI [2.63, 2.07], P < 0.000 01), improved the effect of nitric oxide (MD=8.74, 95%CI [7.00, 10.47], P < 0.000 01), which was better than that of the pure western medicine group, and subgroup analysis results showed that the treatment course was greater than or equal to three months with better treatment. There was no statistically significant difference in the incidence of adverse reactions (P=0.56), liver and kidney function were not abnormal in all the studies. Conclusion: Clinical application of Xinkeshu combined with conventional western medicine in the treatment of unstable angina pectoris is clear, which is recommended in clinical application.

Factores predictivos de complicaciones intrahospitalarias en el Síndrome Coronario Agudo sin elevación del segmento ST / Predictive factors of intra-hospital complications in Non-ST-segment elevation Acute Coronary Syndrome

Introducción: El espectro clínico de los Síndromes Coronarios Agudos sin elevación del segmento ST incluye tanto a pacientes asintomáticos como a los que presentan isquemia activa, inestabilidad eléctrica, hemodinámica o parada cardiaca. Objetivo: Evaluar probables factores predictivos de complicaciones intrahospitalarias no letales en pacientes con diagnóstico de Síndrome Coronario Agudo sin elevación del segmento ST. Material y Métodos: Estudio observacional, analítico, de corte transversal con un universo de 218 individuos ingresados en la Unidad de Cuidados Coronarios Intensivos del Hospital Clínico-Quirúrgico Manuel Fajardo en 2016 y 2017. Resultados: Predominó el sexo masculino (51.4 por ciento) y la edad media fue de 68 años. Prevaleció la Hipertensión Arterial como factor de riesgo coronario. La edad mostró asociación estadística significativa con la aparición de cualquier complicación (p=0.015) y con las complicaciones hemodinámicas (p=0,014). El riesgo intermedio-alto, según el score TIMI, tuvo asociación estadísticamente muy significativa con las complicaciones hemodinámicas (p<0.01). Conclusiones: La edad tuvo asociación estadística con la aparición de complicaciones intrahospitalarias no letales. El sexo no se asoció con las complicaciones ni los antecedentes estudiados tampoco. Los pacientes con un riesgo intermedio-alto al ingreso, se asociaron con las complicaciones hemodinámicas(AU)

Introduction: The clinical spectrum of Non-ST-segment elevation Acute Coronary Syndromes includes both asymptomatic patients and those with active ischemia, electrical instability, hemodynamic or cardiac arrest. Objective: To evaluate probable predictive factors of non-lethal intra-hospital complications in patients diagnosed with Non-ST-segment elevation Acute Coronary Syndrome. Material and Methods: An observational, analytical, cross-sectional study was conducted with a universe of 218 individuals admitted into the Intensive Coronary Care Unit of Manuel Fajardo Clinical and Surgical Hospital between 2016 and 2017. Results: Male sex predominated (51.4 percent) and the mean age was 68 years. Arterial Hypertension prevailed as a coronary risk factor. The age showed significant statistical association with the appearance of any complication (p = 0.015) and with hemodynamic complications (p =0,014). The intermediate-high risk, according to the TIMI score, had a statistically significant association with hemodynamic complications (p <0.01). Conclusions: Age was statistically associated with the appearance of non-lethal intra-hospital complications. Sex was not associated with complications, nor did the background studied either. Patients with an intermediate-high risk at admission were associated with hemodynamic complications(AU)