Hemoglobin Level as a Predictor of Major Adverse Cardiovascular Events and Short-term Outcomes in Stemi Patient Treated with Pharmacoinvasive Strategy versus Primary PCI

Background: Anaemia is prevalent among cases with acute coronary syndrome (ACS) and has been linked to poor clinical prognosis. Guidelines for cases with ST-segment elevation myocardial infarction (STEMI) recommend timely primary percutaneous coronary intervention (pPCI) as the preferred reperfusion strategy. If timely pPCI cannot be performed, a pharmacoinvasive strategy (PI) is recommended within 12 hours of symptom onset. The aim of this work was to study and assess the impact of hemoglobin level as a predictor of MACE and short-term outcomes in cases treated with Primary PCI vs pharmacoinvasive strategy. Methods: This prospective case-control observational study was conducted on 100 cases that were divided into 2 groups. Group I consisted of 50 anaemic cases & group II consisted of 50 cases that were not anaemic. Both groups were subdivided into A subgroups that underwent revascularization by pPCI and B subgroups that underwent revascularization by pharmacoinvasive strategy. Results: There was no significant difference in LVEF, infarct site and final TIMI flow, the anaemic groups showed statistically significant more total MACE than non-anaemic groups whether revascularized by pPCI or pharmacoinvasive strategy. As expected, anaemic cases tended to have higher bleeding complications especially those undergoing pharmacoinvasive strategy. The anaemic cases also were less likely to be discharged on RAAS and beta blockers. Conclusions: Anaemic cases whether revascularized with pPCI or pharmacoinvasive strategy tend to have higher incidence of MACE and major bleeding with no significant difference in mortality. There was no significant difference between LVEF between the study groups.

Prognostic evaluating value of serum tenascin-X level in patients with acute ST-segment elevation myocardial infarction / 中国医师进修杂志

Objective:To explore the prognostic evaluating value of serum tenascin-X in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:The clinical data of 121 patients with STEMI in the Affiliated Sinopharm Dongfeng General Hospital, Hubei University of Medicine from August 2017 to August 2018 were retrospectively analyzed. The clinical data were collected, the serum tenascin-X level was measured by enzyme-linked immunosorbent assay. The patients were followed up for 3 years, the major adverse cardiovascular events (MACE) were identified as endpoint events. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum tenascin-X for MACE in patients with STEMI. The Kaplan-Meier survival curve was drawn, the rates of non-MACE survival in patients with different serum tenascin-X levels were analyzed by log-rank method. Multivariate Cox regression was used to analyze the independent risk factors of MACE in patients with STEMI.Results:Until the end of follow-up, among 121 patients with STEMI, 42 cases (34.7%) developed MACE (MACE group), and 79 cases had not MACE (non-MACE group). The left ventricular ejection fraction (LVEF) in the MACE group was significantly lower than that in the non-MACE group: (47.14 ± 6.70)% vs. (52.67 ± 4.41)%, the C-reactive protein (CRP), B-type natriuretic peptide (BNP), cardiac troponin I (cTnI) and tenascin-X were significantly higher than those in non-MACE group: (27.92 ± 8.06) mg/L vs. (8.77 ± 3.49) mg/L, (918.31 ± 315.47) μg/L vs. (220.47 ± 108.37) μg/L, (214.73 ± 80.46) μg/L vs. (81.35 ± 28.96) μg/L and (110.67 ± 42.55) μg/L vs. (65.21 ± 28.06) μg/L, and there were statistical differences ( P<0.01). ROC curve analysis result showed that the area under the curve of serum tenascin-X to predict the MACE in patients with STEMI was 0.806 (95% CI 0.724 to 0.872), and the optimal cut-off was 93.25 μg/L, the sensitivity was 69.0%, the specificity was 86.1%. Kaplan-Meier survival curve analysis result showed that the rate of non-MACE in 80 patients with low serum tenascin-X level (<93.25 μg/L) was significantly higher than that in 41 patients with high serum tenascin-X level (≥93.25 μg/L): 83.8% vs. 29.3%, and there was statistical difference ( χ2 = 42.47, P<0.01). Multivariate Cox regression analysis result showed that the CRP, BNP and tenascin-X were the independent risk factors of MACE in patients with STEMI ( HR = 1.092, 1.001 and 1.018; 95% CI 1.051 to 1.135, 1.000 to 1.002 and 1.008 to 1.027; P<0.01 or <0.05). Conclusions:The significant increase in serum tendon protein X levels in patients with STEMI has predictive value for the MACE, and it is an independent predictor of MACE within 3 years.

Risk stratification value of HEART score combined with serial cardiac troponin in emergency patients with chest pain / 中华急诊医学杂志

Objective:To explore the risk stratification value of HEART score combined with cardiac troponin (cTn) in emergency patients with chest pain.Methods:A total of 11 583 patients with chest pain who visited the Emergency Department of Zhongshan Hospital Affiliated to Fudan University from January to December 2019 were retrospectively collected. Patients who unfinished 0 h high-sensitivity cardiac troponin T (hs-cTnT) or electrocardiogram diagnosed ST-segment elevation myocardial infarction (STEMI) or lost to follow-up were excluded, and 7 057 patients were finally included. The final diagnosis of chest pain and the occurrence of major adverse cardiovascular events within 6 mon (6 m MACEs) were followed up by telephone and medical history. The HEART score of each patient was calculated by two attending physicians, and the patients were divided into the low-risk group (0-3 points), intermediate-risk group (4-6 points) and high-risk group (7-10 points) according to the final score. The risk stratification performance and safety of HEART score were observed and analyzed. A total of 1 884 patients who completed serial hs-cTnT tests were divided into groups according to HEART score (≤3 as low-risk group) and HEART score combined with serial hs-cTnT pathway (HEART score ≤3 and two hs-cTnT measurements <0.03 ng/mL as the low-risk group). The sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of each diagnostic method were calculated to compare the diagnostic performance of the two predictive values.Results:The patients were divided into 3 groups by HEART score : 2 765 (39.2%) patients in the low-risk group, 3 438 (48.7%) in the intermediate-risk group, and 854 (12.1%) in the high-risk group. The incidence of 6 m MACEs in each group was 1.2%, 18% and 55.3%, respectively. When the low-risk threshold was 2, 23.1% of patients entered the low-risk group and the incidence of 6 m MACEs was 0.9%. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive performance of the HEART score for 6 m MACEs, and the final AUC was 0.831 ( P=0.006, 95% CI: 0.819-0.843). Regarding the occurrence of NSTEMI at the time of this visit, 4 (0.8%) patients were misdiagnosed by using the HEART score alone. Combined with serial troponin detection, the diagnostic SE and NPV were both 100%; at the same time, the diagnostic SE and NPV of 6 m MACEs in patients increased from 98.1% (95% CI: 96.9%-99.1%), 97.9% (95% CI: 96.2%-99%) to 99.1% (95% CI: 97.9%-99.7%) and 98.9% (95% CI: 97.4%-99.6%), the diagnosis SE and NPV of 6 m myocardial infarction and cardiac death in patients increased from 98% (95% CI: 96%-99.2%), 98.6% (95% CI: 97%-99.4%) to 99.2% (95% CI: 97.6%-99.8%) and 99.3% (95% CI: 98.1%-99.9%). Conclusions:The HEART score can be used for risk assessment in emergency patients with chest pain, and a threshold of 2 is recommended for the low-risk group. The diagnostic performance of HEART score combined with serial cTn is better than that of HEART score alone.

Impact of statin use on major adverse cardiovascular events in patients with normal stress myocardial perfusion imaging and elevated coronary artery calcium score

INTRODUCTION@#Normal stress myocardial perfusion imaging (MPI) carries a favourable prognosis. Conversely, elevated coronary artery calcium (CAC) is associated with increased major adverse cardiovascular events (MACE). There is limited information on the prognosis and management of patients with elevated CAC and normal MPI. We aimed to assess the outcomes of patients with elevated CAC and normal MPI in relation to post-MPI statin use.@*METHODS@#A retrospective review of normal MPI with CAC score >300 was performed between 1 March 2016 and 31 January 2017 in a Singapore tertiary hospital. Patients with known atherosclerotic cardiovascular disease or left ventricular ejection fraction <50% on MPI were excluded. Patient demographics, prescriptions and MACE (cardiac death, nonfatal myocardial infarction and/or ischaemic stroke) at 24 months after MPI were traced using electronic records. Binary logistic regression was used to evaluate for independent predictors of MACE.@*RESULTS@#We included 311 patients (median age 71 years, 56.3% male), of whom 65.0% were on moderate to high-intensity statins (MHIS) after MPI. MACE was significantly lower in the post-MPI MHIS group (3.5% vs. 9.2%, P = 0.035). On univariate binary logistic regression, post-MPI MHIS use was the only significant predictor for MACE (odds ratio [OR] 0.355 [95% confidence interval (CI) 0.131-0.962], P = 0.042), even after multivariate adjustment (adjusted OR 0.363, 95% confidence interval 0.134-0.984, P = 0.046).@*CONCLUSION@#Post-MPI MHIS use is associated with lower MACE and is an independent negative predictor for 24-month MACE among patients with normal MPI and CAC >300.

Predictive values of bilirubin for in-hospital adverse events in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Abstract Purpose To investigate the association between serum bilirubin levels and in-hospital Major Adverse Cardiac Events (MACE) in patients with ST-segment Elevation Myocardial Infarction (STEMI) undergoing primary Percutaneous Coronary Intervention (PCI). Methods A total of 418 patients with STEMI who underwent primary PCI were enrolled from October 1st, 2021 to October 31st 2022. The average age of enrolled participants was 59.23 years, and 328 patients (78.50%) were male patients. Patients were divided into MACE (patients with angina pectoris after infarction, recurrent myocardial infarction, acute heart failure, cardiogenic shock, malignant arrhythmias, or death after primary PCI) (n = 98) and non-MACE (n = 320) groups. Univariate and multivariate logistic regression analyses were performed to estimate the association between different bilirubin levels including Total Bilirubin (TB), Direct Bilirubin (DB), Indirect Bilirubin (IDB), and risk of in-hospital MACE. The area under the Receiver Operating Characteristic (ROC) curve was used to determine the accuracy of bilirubin levels in predicting in-hospital MACE. Results The incidence of MACE in STEMI patients increased from the lowest to the highest bilirubin tertiles. Multivariate logistic regression analysis showed that increased total bilirubin level was an independent predictor of in-hospital MACE in patients with STEMI (p for trend = 0.02). Compared to the first TB group, the ORs for risk of MACE were 1.58 (95% CI 0.77‒3.26) and 2.28 (95% CI 1.13‒4.59) in the second and third TB groups, respectively. The ROC curve analysis showed that the areas under the curve for TB, DB and IDB in predicting in-hospital MACE were 0.642 (95% CI 0.578‒0.705, p < 0.001), 0.676 (95% CI 0.614‒0.738, p < 0.001), and 0.619 (95% CI 0.554‒0.683, p < 0.001), respectively. Conclusions The current study showed that elevated TB, DB, and IDB levels are independent predictors of in-hospital MACE in patients with STEMI after primary PCI, and that DB has a better predictive value than TB and IDB.

Short- and long-term cardiovascular outcomes in insulin-treated versus non-insulin-treated diabetes mellitus patients after percutaneous coronary intervention: A systematic review and meta-analysis

Aims: This study aims to assess differences in severity of short-term (<1 year) and long-term (_x005F_x0001_1 year) adverse CV outcomes after PCI in insulin-treated vs. non-insulin-treated diabetes mellitus (DM) patients. Methods: A systematic search on Pubmed and Embase led to the incorporation of 29 studies that compared post-percutaneous coronary interventional outcomes in insulin-treated and non-insulintreated diabetes mellitus. Diabetes mellitus (type 2) was defined as fasting blood glucose (FBG) level of >7.0 mmol/L or with an oral glucose tolerance test (OGTT) level of >11.1 mmol/L at least on two separate occasions. Adverse CV outcomes were assessed in insulin-treated and non-insulin-treated DM after the PCI procedure considered for the analyses were mortality, MACE, TLR, TVR, MI, stent thrombosis, target lesion failure (TLF), and need for-post PCI CABG. Data were pooled and analyzed using Review Manager 5.3, and risk ratios (RR) with respective 95% confidence intervals (CI) were calculated.The statistical analyses were carried out by Review Manager v.5.3, and the data were pooled using a random-effects model. Risk ratios (RRs) with 95% confidence intervals (CI) were reported along with forest plots. The chi-square test was performed to assess for differences between the subgroups. Heterogeneity across studies was evaluated using Higgins I2 statistics. Visual inspection of the funnel plot and Begg's regression test were used to assess publication bias. Results: A total of 40,527 patients (11742 in the Insulin-treated diabetes mellitus group and 28785 in the non-insulin-treated DM group) who underwent PCI were included. The pooled analysis of short-term follow up outcomes preceding PCI demonstrated a significantly higher risk of mortality (RR ¼ 1.75 [1.24,2.47]; p ¼ 0.002), MI (RR ¼ 1.81[1.14,2.87]; p ¼ 0.01], stent thrombosis (RR ¼ 1.63[1.13, 2.35]; p ¼ 0.009) and target lesion revascularization (TLR) (RR ¼ 1.29[1.02,1.63]; p ¼ 0.03) in insulin-treated DM patients. Similarly, analysis of long-term follow-up studies depicted a significantly higher risk mortality (RR ¼ 1.55 [1.22, 1.97]; p ¼ 0.0003), MI (RR ¼ 1.63 [1.35, 1.97]; p¼<0.00001), MACE (R ¼ 1.47 [1.31, 1.65]; p¼<0.00001), stent thrombosis (RR ¼ 1.54 [1.19,1.99]; p ¼ 0.001), TLR (RR ¼ 1.40 [1.18, 1.66]; p ¼ 0.0001), target vessel revascularization (TVR) (RR ¼ 1.35 [1.11, 1.64]; p ¼ 0.003) in insulin-treated DM group after PCI versus non-insulin-treated DM patients. Conclusion: Despite a tremendous technical success rate of multi-vessel stenting, people living with diabetes who were being treated with insulin had higher long-term, and short-term mortality rates, MI, TLR, TVR, and stroke compared to people living with diabetes who were being treated with means other than insulin and are more prone to detrimental cardiovascular outcomes.

Clinical study on the efficacy of domestic Firebird2 TM rapamycin eluting stent and imported Endeavor Resolute stent / 中国综合临床

Objective:To compare the safety and efficacy of domestic Firebird2 TM rapamycin eluting stent and imported Endeavor Resolute stent in the treatment of coronary heart disease patients. Methods:The clinical data of 889 patients with coronary heart disease who underwent percutaneous coronary intervention (PCI) in Wuhan Asian heart hospital from 2010 to 2015 were analyzed retrospectively A case-control study was conducted. According to the type of stent used, 550 cases were divided into domestic Firebird 2TM group and 325 cases were divided into imported endeavor resolve group The incidence of major adverse cardiovascular events (MACE) was compared between the two groups. All patients was followed up for 1 year.Results:There was no significant difference in gender, age, body mass index, medical diseases, whether it was emergency PCI, previous PCI history, coronary artery bypass grafting history and left ventricular between the two groups (all P>0.05). The success rate of PCI in the two groups was 100%. The TIMI blood flow of target vessels in the two groups was grade 3. There was no stent unloading during the operation, and balloon pretreatment and post-treatment were performed. The results of one-year follow-up showed that there was no significant difference in the incidence of mace (3.1% (17/550) and 2.2%(7/325)) and the incidence of independent end points between domestic Firebird 2 TM group and endeavor group (all P>0.05); There was no significant difference in survival without mac between the two groups ( P>0.05). Conclusion:The domestic Firebird2 TM rapamycin eluting stent has the same clinical efficacy as the imported Endeavor Resolute drug eluting stent.

Effect of antiplatelet strategy on prognosis of in patients with diabetes mellitus and acute coronary syndrome with different CYP2C19 genotype / 国际生物医学工程杂志

Objective:To investigate the effect of different P2Y12 inhibitors on the long-term prognosis of patients with diabetes mellitus (DM) and acute coronary syndrome (ACS), with or without the CYP2C19 loss-of-function (LOF) gene. Method:266 consecutive ACS patients undergoing percutaneous coronary intervention (PCI) were enrolled. According to the CYP2C19 LOF genotype, the patients were divided into rapid metabolizing-type (without the CYP2C19 LOF gene) and moderate-slow metabolizing type (with the CYP2C19 LOF gene). Each type was divided into the A group (with diabetes) and the B group (without diabetes). Each group was divided into the ticagrelor subgroup and the clopidogrel subgroup according to the type of P2Y12 platelet inhibitor. The MACE events were recorded for each subgroup over 3 years, and the prognostic impact of the CYP2C19 LOF genotype and the type of P2Y12 used were analyzed. Results:There were no significant differences in MACE, revascularization, stroke, heart failure rehospitalization, major bleeding, or all-cause mortality among subgroups of patients with rapid metabolizing type at 3 years after PCI (all P>0.05). In patients with moderate-slow metabolizing-type, the use of tegretol significantly reduced the probability of MACE events and cardiac revascularization (all P<0.01) and significantly reduced the reoccurrence of heart attack in patients with DM. Conclusions:In DM combined with ACS patients with rapid metabolizing type, the choice of different P2Y12 inhibitors after PCI had no significant effect on their prognosis. In DM combined with ACS patients with moderate-slow metabolizing type, tegretol not only significantly reduced the incidence of MACE, revascularization, and reinfarction, but also did not increase the risk of major bleeding. In terms of reducing the reoccurrence of heart attack, the benefit of using tegretol in the DM patients was greater than in the non-DM patients.

The predictive value of HEART score combined with NT-proBNP for cardiovascular adverse events in patients with non-ST-elevation acute coronary syndrome / 中华急诊医学杂志

Objective:To explore the predictive value of HEART score combined with N-terminal pro-B-type natriuretic peptides (NT-proBNP) for 3-month major adverse cardiovascular events (MACE) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).Methods:This was a retrospective cohort study. Adult patients with acute chest pain who met the diagnostic criteria for NSTE-ACS in the 5th Affiliated Hospital of Sun Yat-Sen University from January 2018 to March 2018 were enrolled. Patients with cardiac chest pain caused by diseases other than NSTE-ACS, non-cardiac chest pain, renal insufficiency, acute cerebral infarction, end-stage disease, pregnant, and incomplete data were excluded. Data of all patients’ general clinical information, first electrocardiogram (ECG), cardiac troponin I (cTnI), and NT-proBNP were collected. The correlation between NT-proBNP level and the occurrence of MACE within 3 months was analyzed. The receiver operating characteristic (ROC) curves was drawn, and the predictive value of NT-proBNP, HEART score, and their combination for 3- month MACE in patients with NSTE-ACS were evaluated.Results:A total of 151 patients were enrolled. Patients with NSTE-ACS were divided into the MACE group ( n=95) and non-MACE group ( n=56) according to whether MACE occurred within 3 months of onset. The level of NT-proBNP, the HEART score, and the cTnI level in the MACE group were significantly higher than those in the non-MACE group (all P<0.001). After risk stratification assessed by HEART score in all patients with NSTE-ACS, it was found that the level of NT-proBNP and the incidence of MACE increased as the risk score increased (all P<0.05). The area under the ROC curve of HEART score, NT-proBNP and their combination were 0.819 (95% CI:0.751-0.887), 0.821 (95% CI:0.752-0.889) and 0.858 (95% CI:0.796-0.919), respectively. Conclusions:The combination of HEART score and NT-proBNP level can improve the predictive value for 3-month MACE in patients within NSTE-ACS, and provide important information for treatment decision and improving prognosis.

Levels of plasma Quaking and cyclooxygenase-2 predict in-stent restenosis in patients with coronary artery disease after percutaneous coronary intervention / 中南大学学报(医学版)

OBJECTIVES@#Percutaneous coronary intervention (PCI) is one of the important methods for the treatment of coronary artery disease (CAD). In-sent restenosis (ISR) after PCI for patients suffered from CAD is considered to be an essential factor affecting long-term outcomes and prognosis of this disease. This study aims to investigate the correlation between plasma Quaking (QKI) and cyclooxygenase-2 (COX-2) levels and ISR in patients with CAD.@*METHODS@#A total of 218 consecutive CAD patients who underwent coronary angiography and coronary arterial stenting from September 2019 to September 2020 in the Department of Cardiology of Xiangya Hospital of Central South University were enrolled in this study, and 35 matched individuals from the physical examination center were served as a control group. After admission, clinical data of these 2 groups were collected. Plasma QKI and COX-2 levels were measured by enzyme linked immunosorbent assay (ELISA). Follow-up angiography was performed 12 months after PCI. CAD patients were divided into a NISR group (n=160) and an ISR group (n=58) according to the occurrence of ISR based on the coronary angiography. The clinical data, coronary angiography, and stent features between the NISR group and the ISR group were compared, and multivariate logistic regression was used to explore the factors influencing ISR. The occurrence of major adverse cardiovascular events (MACE) 1 year after operation was recorded. Fifty-eight patients with ISR were divided into an MACE group (n=24) and a non-MACE group (n=34), classified according to the occurrence of MACE, and the plasma levels of QKI and COX-2 were compared between the 2 groups. Receiver operating characteristic (ROC) curves were utilized to analyze the diagnostic value of plamsa levels of QKI and COX-2 for ISR and MACE occurrences in patients after PCI.@*RESULTS@#Compared with control group, plasma levels of QKI and COX-2 in the CAD group decreased significantly (all P<0.001). Compared with the NISR group, the plasma levels of QKI and COX-2 also decreased obviously in the ISR group (all P<0.001), while the levels of high sensitivity C-reactive protein (hs-CRP) and glycosylated hemoglobin (HbAlc) significantly increased (all P<0.001). The level of COX-2 was negatively correlated with hs-CRP (r=-0.385, P=0.003). Multivariate logistic regression analysis showed that high level of plasma QKI and COX-2 were protective factors for in-stent restenosis after PCI, while hs-CRP was a risk factor. ROC curve analysis showed that the sensitivity and specificity of plasma QKI for evaluating the predictive value of ISR were 77.5% and 66.5%, respectively, and the sensitivity and specificity of plasma COX-2 for evaluating the predictive value of ISR were 80.0% and 70.7%, respectively. The sensitivity and specificity of plasma QKI combined with COX-2 for evaluating the predictive value of ISR were 81.3% and 74.1%, respectively. The sensitivity and specificity of plasma QKI for evaluating the prognosis of ISR were 75.0% and 64.7%, respectively. The sensitivity and specificity of plasma COX-2 for evaluating the prognosis of ISR were 75.0% and 70.6%, respectively. The sensitivity and specificity of plasma QKI combined with COX-2 for prognostic evaluation of ISR were 81.7% and 79.4%, respectively. The sensitivity and specificity of plasma COX-2 combined with QKI for evaluating ISR and MACE occurrences in patients after PCI were better than those of COX-2 or QKI alone (P<0.001).@*CONCLUSIONS@#High level of plasma QKI and COX-2 might be a protective factor for ISR, which can also predict ISR patient's prognosis.

The Use of Lipoprotein-Associated Phospholipase A2 in a Chinese Population to Predict Cardiovascular Events / 生物医学与环境科学（英文）

Objective@#To explore associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk of cardiovascular events in a Chinese population, with a long-term follow-up.@*Methods@#A random sample of 2,031 participants (73.6% males, mean age = 60.4 years) was derived from the Asymptomatic Polyvascular Abnormalities Community study (APAC) from 2010 to 2011. Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay (ELISA). The composite endpoint was a combination of first-ever stroke, myocardial infarction (MI) or all-cause death. Lp-PLA2 associations with outcomes were assessed using Cox models.@*Results@#The median Lp-PLA2 level was 141.0 ng/mL. Over a median follow-up of 9.1 years, we identified 389 events (19.2%), including 137 stroke incidents, 43 MIs, and 244 all-cause deaths. Using multivariate Cox regression, when compared with the lowest Lp-PLA2 quartile, the hazard ratios with 95% confidence intervals for developing composite endpoints, stroke, major adverse cardiovascular events, and all-cause death were 1.77 (1.24-2.54), 1.92 (1.03-3.60), 1.69 (1.003-2.84), and 1.94 (1.18-3.18) in the highest quartile, respectively. Composite endpoints in 145 (28.6%) patients occurred in the highest quartile where Lp-PLA2 (159.0 ng/mL) was much lower than the American Association of Clinical Endocrinologists recommended cut-off point, 200 ng/mL.@*Conclusion@#Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population. The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.

The influence of age on the safety of propofol mono-sedation gastroscopy for adult patients / 中华消化内镜杂志

Objective:To assess the influence of age on the safety of propofol mono-sedation for adult patients undergoing painless gastroscopy.Methods:A retrospective study was conducted on data of 321 patients scheduled for painless gastroscopy with propofol mono-sedation. According to the age, patients were divided into youth group (116 cases, 18-44 years), middle-aged group (103 cases, 45-59 years) and elderly group (102 cases, 60-80 years). The procedure time, the total dosage of propofol, the occurrence of airway obstruction or hypoxemia, the use of airway interventions including airway opening maneuvers and facemask ventilation, lowest SpO 2, adverse cardiovascular events (including hypertension, hypotension, tachycardia, and bradycardia), and the use of ephedrine during painless gastroscopy were observed. Results:There was significant difference regarding the total dosage of propofol among youth group (173.2±47.0 mg), middle-aged group (158.8±41.3 mg) and elderly group (137.8±26.3 mg) ( F=21.761, P<0.001). The total dosage of propofol was significantly lower in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017), and that in the middle-aged group was significantly lower than that in the youth group ( P<0.017). The incidence of hypoxemia was 12.9% (15/116) in the youth group, 15.5% (16/103) in the middle-aged group and 25.5% (26/102) in the elderly group, with significant difference among three groups ( χ2=5.711, P=0.017). Moreover, the incidence of hypoxemia was significantly higher in the elderly group compared with the middle-aged group ( P<0.017) and youth group ( P<0.017). The incidences of hypotension, bradycardia and total adverse cardiovascular events were 5.2% (6/116), 4.9% (5/103) and 11.8% (12/102), 1.7% (2/116), 2.9% (3/103) and 7.8% (8/102), and 11.2% (13/116), 10.7% (11/103) and 20.6% (21/102) respectively in youth, the middle-aged and the elderly group. There were no significant differences in the above indicators among the three groups ( P>0.05). However, compared with those of the young and the middle-aged patients, the occurrence of hypotension, bradycardia and total adverse cardiovascular events in the elderly patients were on the rise. There were no significant differences among the three groups in other indices( P>0.05). Conclusion:Total dosage of propofol may need to be decreased gradually with the increase of age of patients undergoing gastroscopy with propofol mono-sedation. Compared with young and middle-aged patients, elderly patients have a significantly higher incidence of hypoxemia, with a tendancy of total adverse cardiovascular events increase, so the safety of painless gastroscopy is reduced for these patients.

Meta-analysis of effect of Qishen Yiqi Dripping Pills combined with Western medicine on adverse cardiovascular events and quality of life after percutaneous coronary intervention / 中国中药杂志

To systemically evaluate the effect of Qishen Yiqi Dripping Pills combined with Western medicine on adverse cardiovascular events and quality of life after percutaneous coronary intervention(PCI). A total of 7 Chinese and English databases including CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library and Web of Science were searched by computer to collect the randomized controlled trials(RCTs) on Qishen Yiqi Dripping Pills combined with Western medicine in the treatment of patients with coronary heart disease after PCI with the retrieval time from the database establishment to April 1, 2020. Two researchers independently conducted li-terature screening, data extraction and bias risk assessment. Then, Meta-analysis was performed by using RevMan 5.3 software. A total of 31 RCTs were included, involving 3 537 patients. The results of Meta-analysis showed that in terms of major adverse cardiovascular events(MACE) after PCI, the combination of Qishen Yiqi Dripping Pills could significantly reduce the recurrence of angina pectoris, incidence of arrhythmia, heart failure and re-revascularization, and the effect was better than that of Western medicine treatment alone. However, there was no significant difference between the two groups in the improvement of non-fatal myocardial infarction, cardiac death, stent restenosis, stroke and other adverse cardiovascular events. In terms of improving left ventricular ejection fraction(LVEF), 6 min walking test(6 MWT), high-sensitivity C-reactive protein(hs-CRP) and Seattle angina pectoris scale(SAQ), the combination of Qishen Yiqi Dripping Pills and Western medicine treatment had obvious advantages over Western medicine treatment alone in increasing LVEF, 6 MWT and SAQ, and reducing the level of hs-CRP, with statistically significant differences. There were few adverse reactions in both groups, and there was no significant difference between the two groups. The main manifestations were gastrointestinal reactions, rash, gingiva and other small bleeding, and no serious adverse reactions occurred. The above reactions could disappear after drug withdrawal or symptomatic treatment. The application of Qishen Yiqi Dripping Pills combined with Western medicine in the treatment of patients after PCI could reduce the occurrence of MACE, improve the clinical efficacy, quality of life and prognosis in a safe and reliable manner. However, due to the quantity and quality limitations of included studies, more standardized, rigo-rous and high-quality clinical studies are still needed to further verify the above conclusions.

Changes of serum NT-pro BNP and Lp (a) levels in patients with acute mocardial infarction after emergency PCI and their clincal significances / 吉林大学学报(医学版)

Objective: To investigate the changes of the levels of amino-terminal pro-brain natriuretic peptide (NT-pro BNP) and lipoprotein a [Lp (a)], and to clarify the relationships between the severity of coronary artery lesions and the prognosis in the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCD. Methods: A total of 316 AMI patients underwent emergency PCI were selected. According to the number of stenosed coronary vessels, the patients were divided into single-vessel disease group (n=135), double-vessel disease group (n= 99) and three-vessel disease group (n=82). According to the Gensini score, there were 79 cases in 83. 00 group. The patients' general data, biochemical parameters, echocardiography results, and coronary angiography findings were recorded, and the major adverse cardiovascular events (MACE) were also recorded during a 12-month folow-up. The relationships between the serum NT-pro BNP and Lp (a) levels of the AMI patients in different lesion counts and Gensini scores, and the recent Accurrence of MACE were analyzed. The receiver operating characteristic (ROC) curve was drawn to investigate the values of NT-pro BNP and Lp (a) levels on predicting the recent MACE in the patients with AMI. Results: The serum NT-pro BNP levels of the patients in three-vessel disease group and double-vessel disease group were higher than that in single-vessel disease group (P< 0.01); the serum Lp (a) level of the patients in three-vessel disease group was higher than that in single-vessel disease group (P<0.05). According to Spearman correlation analysis, there were positive correlations between the serum NT-pro BNP level, Lp (a) level of the AMI patients and the number of coronary vessels (r=0.285, P< 0.01; r=0.144, P=0.010); there were positive correlation between the serum NT-pro BNP level, Lp (a) level and Gensini score of coronary lesions (r=0.156, P=0.006; r=0.164, P=0.003). The serum NT-pro BNP and Lp (a) levels of the patients with MACE during follow-up were higher than those in the patients without MACE. The ROC curve showed that the area under the curve (AUC) of the levels of serum NT-pro BNP and Lp (a) was 0.747 (95%CI: 0.679-0.814). Conclusion: The serum NT-pro BNP and Lp (a) levels have the certain relationships with the severity of coronary artery lesions in the AMI patients after PCI. The simultaneous detection A serum NT-pro BNP and Lp (a) levels has certain predictive value for the recent Accurrence of MACE in the AMI patients underwent emergency PCI.

Predictive value of myocardial perfusion in the prognosis after coronary artery bypass grafting / 中国胸心血管外科临床杂志

@#Objective    To evaluate the value of myocardial perfusion change before and after coronary artery bypass grafting (CABG) in predicting postoperative major adverse cardiovascular events (MACE). Methods    A total of 70 CABG patients who received CABG completed by the same operator from January to November 2017 were selected, including 45 males and 25 females with an average age of 64.83±9.09 years. The patients were divided into two groups according to whether the patients had MACE after 1 year of the surgery, including a non-MACE group (group A, n=60) and a MACE group (group B, n=10). The clinical data of patients were compared. Results    There were statistical difference in the myocardial contrast echocardiography (MCE) score in the group A before and after surgery (P<0.05), and there were statistically significant differences in the left ventricular size and left ventricular ejection fraction (LVEF) value before and 1 year after surgery (P<0.001), but no statistically significant difference in the size of left atrium (P=0.075). There was no significant difference in the preoperative and postoperative MCE score, and preoperative and postoperative 1-year cardiac ultrasound score in the group B (P>0.05). Conclusion    The change of myocardial perfusion after CABG surgery is associated with postoperative MACE. The evaluation of myocardial perfusion before and after CABG surgery is of great significance for the prognosis evaluation of patients.

Effect of serum high-sensitivity C-reactive protein and tumor necrosis factor-alpha on prognosis of patients undergoing percutaneous coronary intervention / 中国综合临床

Objective@#To investigate the effects of serum high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-α) on the prognosis of patients undergoing percutaneous coronary intervention (PCI).@*Methods@#From January 2016 to December 2017, 197 patients with acute coronary syndrome (ACS) treated by PCI in our hospital were divided into MACE group (39 cases) and non-MACE group (158 cases) according to whether major adverse cardiovascular events (MACE) occurred after PCI.The serum levels of hs-CRP and TNF-α were compared between the two groups before and 48 hours after PCI.The risk factors of MACE after PCI were analyzed by logistic regression analysis.@*Results@#One year follow-up results after PCI showed that 39 of 197 ACS patients had MACE after PCI, with an incidence of 19.8% (39/197). There were 39 cases in MACE group and 158 cases in non-MACE group.The serum hs-CRP of the MACE group and the non-MACE group before PCI were (9.70±4.71), (7.50±4.61) mg/L respectively, and 48 hours after PCI were (15.37±5.01), (12.16±4.38) mg/L, respectively.There were significant differences between the two groups (all P<0.01). The serum TNF-α levels before PCI in MACE group and non-MACE group were (33.1±8.9), (25.7±8.0) ng/L, respectively, and 48 hours after PCI were (47.6±8.1), (32.4±7.6) ng/L, respectively.There were significant differences between the two groups (P<0.05 or P<0.01). The results of logistic regression analysis showed that preoperative serum hs CRP and TNF-α were the risk factors of mace in PCI patients (OR (95% CI) was 2.069 (1.715-3.358), 2.825 (1.614-4.372), P value was 0.020 and 0.027, respectively).@*Conclusion@#The serum levels of hs-CRP and TNF-α are related to the prognosis of patients with PCI.The serum levels of hs-CRP and TNF-α before PCI are risk factors for MACE, which can be used as independent predictors of MACE.

Effect of Xintong Oral Liquid in Improving Cardiac Function of Patients with Heart Failure and Syndrome of Qi Deficiency and Phlegm and Blood Stasis Caused by Acute Myocardial Infarction / 中国实验方剂学杂志

Objective:To discuss the clinical efficacy of Xintong oral liquid on heart failure with syndrome of Qi deficiency， phlegm and blood stasis caused by acute myocardial infarction （AMI） and the effect on inflammatory factors. Method:One hundred patients were randomly divided into observation group （50 cases） and control group （50 cases） by random number table. Both groups got comprehensive treatment of western medicine. Patients in control group got simulated medicine of Xintong oral liquid， 20 mL/time， 3 times/day. Patients in observation group got Xintong oral liquid， 20 mL/time， 3 times/day. The treatment lasted for 4 weeks. Before the treatment， and at the second week and forth week after treatment， levels of cardiac troponin I （cTnI）， cardiac troponin T （cTnT）， heart type fatty acid binding protein （H-FABP）， left ventricular ejection fraction （LVEF）， cardiac output （CO）， cardiac output per stroke （SV） and left ventricular end diastolic diameter （LVEDd）， N-terminal B-type natriuretic peptide （NT-proBNP）， lipoprotein phospholipase A2 （Lp-PLA2）， high sensitive C-reactive protein （hs-CRP）， interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） were detected. The 6-minute walking test was performed to record the 6-minute walking distance and the ratio of 6 min walking distance to estimated value. Scores of traditional Chinese medicine （TCM） syndromes， minnesota Heart Failure quality of life questionnaire （MLHFQ） and Killip classification of cardiac function were recorded. During the 2 months' follow-up， adverse cardiovascular events （MACE） were recorded， and the safety was evaluated. Result:At the second and fourth week， levels of cTnI， cTnT， H-FABP， NT-proBNP， Lp-PLA2， hs-CRP， IL-6 and TNF-α were lower than those in control group （P<0.01）， and levels of LVEF， CO and SV were higher than those in control group （P<0.05， P<0.01）. NT-proBNP was lower than control group （P<0.01）. The 6-minute walking distance and the ratio of 6-minute walking distance to estimated value were all more than those in control group （P<0.01）. Scores of TCM syndrome integral， MLHFQ， Killip heart function grading were lower than those in control group （P<0.05， P<0.01）. Cumulative incidence of MACE was 12.0% （6/50）， which was lower than 28.0% （14/50） in control group （χ2=4.251， P<0.05）. Levels of Lp-PLA2， hs-CRP， IL-6 and TNF-α in observation group were lower those in control group （P<0.01）.And there was no adverse reactions related to Xintong oral liquid. Conclusion:Based on the comprehensive treatment of Western medicine， Xintong oral liquid can reduce the degree of myocardial injury， protect myocardium， improve cardiac function， reduce inflammatory reaction， reduce the occurrence of mace， effectively control clinical symptoms， and improve exercise tolerance and quality of life.

Comparison of graft vessel versus native vessel strategies for late saphenous vein graft disease after coronary artery bypass grafting / 中华心血管病杂志

Objective: To compare clinical efficacy of interventional treatment with graft vessel and native coronary artery for patients with late saphenous vein grafts disease(SVGD) after coronary artery bypass grafting (CABG). Methods: A total of 1 608 patients underwent CABG in Tianjin Chest from March 2014 to December 2017 were screened. During the follow-up period, 165 hospitalized patients with recurrence of angina pectoris within one year after CABG, who had at least one narrow vein graft(≥50%) confirmed by the coronary angiography were enrolled. According to the results of angiography and surgeon's clinical experiences, the patients received interventional treatment to vein grafts(grafts group, n=53) or native coronary vessels(native group, n=112). The operation success rate, mortality and incidence of serious complications after interventional treatment in two groups at the time of hospitalization were compared.And the incidence of major adverse cardiovascular events(MACE) in two groups at one year after discharge were also compared. Kaplan-Meier survival curve was used to compare the cumulative event-free survival rates. The risk factors for the MACE in the patients with late SVGD and treated by interventional therapy were analyzed by Cox regression analysis. Results: A total of 165 patients were included for analysis, including 98 males(59.4%). The age was (64.2±7.1) years old. The follow-up time was 12 (8, 12) months. In the grafts group, operation success rate was 90.57%(48/53), and 3 cases(5.66%) suffered from serious complications after interventional treatment, 2 cases(3.77%) died. For native group the operation success rate was 88.39%(99/112), and 7(6.25%) cases suffered from serious complications after interventional treatment, and no deaths. The operation success rate and the incidences of serious complications after interventional treatment in two groups had no statistically significant difference(both P>0.05). The mortality in hospital of native group was lower than that in grafts group(P<0.05). Within 12 months after discharge, there was no statistically significant difference in incidence of MACE of two groups (11.32%(6/53) vs. 10.71%(12/112), P>0.05). Survival analysis showed that the cumulative event-free survival rates in two groups were 73.58% (39/53) and 66.13%(74/112), and there was no statistically significant difference (P>0.05). Cox regression analysis showed acute coronary syndrome (HR=41.203, 95%CI 4.859-349.361, P<0.01), and peripheral vascular diseases (HR=2.808, 95%CI 1.067-7.393, P<0.05) were the risk factors of the MACE for the patients treated by interventional therapy with late SVGD. Conclusion: For the patients with late SVGD after CABG, the success rate of intervention with vein grafts and own coronary vessels are both high with satisfactory safety.The in-hospital mortality of interventional therapy in own coronary vessels is lower than in graft vessel. Patients with acute coronary syndrome and peripheral vascular disease have a poor prognosis.

Correlation between low serum albumin and major adverse cardiovascular events in patients with stable coronary heart disease / 中国医师进修杂志

Objective@#To investigate the correlation between low serum albumin level and major adverse cardiovascular events in patients with stable coronary heart disease.@*Methods@#A total of 367 consecutive patients with stable coronary heart disease from April 2013 to April 2015 in the Central Hospital of Nanchong City Sichuan Province were selected, and 328 cases completed follow-up. The follow-up time was (15.3 ± 8.1) months. The patients were divided into normal albumin group (serum albumin ≥ 35 g/L, 244 cases) and low serum albumin group (serum albumin < 35 g/L, 84 cases); then according to the happening of the major adverse cardiovascular events (MACE), the patients were divided into MACE group (53 cases) and non-MACE group (275 cases). The general clinical data were collected, including the gender, age, basic diseases (diabetes, hypertension), smoking history, body mass index (BMI), number of blood vessel lesion, drug treatment history. The serum albumin, hemoglobin, creatine, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triacylglycerol (TG), high sensitivity C reactive protein (hs-CRP) were detected. The estimated glomerular filtration rate (eGFR) was calculated by modification of diet in renal disease (MDRD) formula; the left ventricular ejection fraction (LVEF) was detected by color Doppler echocardiography. The Kaplan-Meier curve and receiver operating characteristics (ROC) curve were analyzed respectively, and the prognosis was analyzed by Cox regression.@*Results@#The age, diabetes rate, TG and hs-CRP in low serum albumin group were significantly higher than those in normal albumin group: (66.99 ± 9.40) years vs. (61.65 ± 9.36) years, 46.43% (39/84) vs. 34.02% (83/244), (2.36 ± 0.10) mmol/L vs. (2.15 ± 0.05) mmol/L and (4.10 ± 0.35) g/L vs. (3.83 ± 0.39) g/L, the albumin, hemoglobin, LVEF and eGFR were significantly lower than those in normal albumin group: (30.36 ± 3.09) g/L vs. (42.95 ± 4.86) g/L, (126.42 ± 18.45) g/L vs. (142.35 ± 16.53) g/L, (50.71 ± 5.60)% vs. (56.66 ± 8.01)% and (68.25 ± 12.47) ml/(min·1.73 m2) vs. (84.42 ± 14.48) ml/(min·1.73 m2), and there were statistical differences (P < 0.01 or <0.05); there were no statistical differences in gender composition, hypertension rate, smoking history, drug treatment history, BMI, number of blood vessel lesion, creatine, TC, LDL-C and HDL-C between 2 groups (P>0.05). The albumin in MACE group was significantly lower than that in non-MACE group: (34.09 ± 6.87) g/L vs. (40.81 ± 6.90) g/L, the TG was significantly higher than that in non-MACE group: (2.24 ± 0.11) mmol/L vs. (2.20 ± 0.11) mmol/L, and there were statistical differences (P<0.01); there were no statistical difference in gender composition, age, basic diseases, smoking history, drug treatment history, BMI, number of blood vessel lesion, hemoglobin, LVEF, eGFR, creatine, TC, LDL-C, HDL-C and hs-CRP between 2 groups (P>0.05). Cox regression analysis result showed that the hemoglobin, eGFR and albumin were the independent risk factors of MACE in patients with stable coronary heart disease (RR = 1.020, 1.040 and 0.787; 95% CI 1.001 to 1.040, 1.016 to 1.064 and 0.733 to 0.846; P < 0.05 or <0.01). Kaplan-Meier curve result showed that the lower the level of serum albumin, the higher the incidence of MACE in patients with stable coronary heart disease (log-rank χ2 = 6.244, P = 0.012). ROC curve analysis result showed that the cut-off value of serum albumin was 39.8 g/L, the area under curve was 0.769 (95% CI 0.719 to 0.813), with a sensitivity of 90.6%, a specificity of 60.4%.@*Conclusions@#There is close correlation between low serum albumin and recent MACE in patients with stable coronary heart disease, and it can be used as a index for the poor prognosis of patients.

Impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis / 中华心血管病杂志

Objective@#To determine the impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis.@*Methods@#The study population consisted of 134 consecutive patients admitted between January 2002 and March 2018 with diagnoses of acute viral myocarditis (onset of symptoms<1 month,patients were divided into low serum free triiodothyronine (FT3, n=20) group and normal FT3 (n=114) group. General information, clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed. Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine (TT3), normal or decreased free thyroxine (FT4) and total thyroxine (TT4) as well as normal thyroid stimulating hormone (TSH). Composite adverse cardiovascular events included death, persistent ventricular tachycardia (VT) or ventricular fibrillation (VF) and cardiac arrest. Risk factors related with composite adverse cardiovascular events in adult patients with acute viral myocarditis were analyzed by logistic regression analysis.@*Results@#Systolic blood pressure was significantly lower (P<0.01),while heart rate (P=0.004) and the prevalence of VT/VF were significantly higher (P=0.017) in low T3 group than in the normal T3 group. Level of white blood cell,C response protein,fasting glucose (all P<0.01) as well as creatinine (P=0.035) were significantly higher, while level of FT3 and left ventricular ejection fraction (LVEF) were significantly lower (both P<0.01) in low T3 group than in normal T3 group. Multivariate logistic regression analysis revealed that LVEF at admission less than 40% (OR=6.615,95%CI 1.186-36.907, P=0.031) and FT3 level less than 1.79 ng/L (OR=9.131, 95%CI 1.577-52.857, P=0.014) were independent risk factors of increased composite adverse cardiovascular events in patients with acute viral myocarditis.@*Conclusion@#Low FT3 increases the risk of adverse cardiovascular events in adult patients with acute viral myocarditis.