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Objective: To assess the feasibility of measurement of retinal arteriovenous (AV) ratio using a smartphone, we performed a comparative evaluation with fundus camera imaging and coronary SYNTAX score. Method: Successive coronary artery disease (CAD) patients who underwent coronary angiography were recruited for smartphone retinal imaging. Following pupillary dilatation, fundus camera images and smartphone photography were performed. Video images were captured with a smartphone, edited and analysed. Retinal artery and vein size at 0.5 and 1 disc diameter (DD) were measured using DICOM software by two independent observers. Another observer calculated SYNTAX score. Results: Analysable smartphone images were available in 91 (89.2%) of 102 patients. Tobacco use was found in 26%, hypertension in 54%, diabetes in 55%, and high LDL cholesterol in 50%. Median and 25e75 interquartile range (IQR) AV ratio at 0.5 and 1.0 DD, respectively, with smartphone were 0.48 (0.45e0.52) and 0.47 (0.45e0.52) and fundus camera were 0.48 (0.44e0.53) and 0.48 (0.45e0.53) (Spearman's correlation 0.80 and 0.79, p < 0.001). Coronary single vessel disease was in 21%, double vessel in 16%, triple vessel in 55%, normal angiogram in 8%, and median SYNTAX score was 18.0 (8.0e25.0). There was an inverse correlation of SYNTAX score with smartphone-derived AV ratio at 0.5 and 1.0 DD (rho _x0001_0.27,p ¼ 0.007 and _x0001_0.26,p ¼ 0.009) as well as with fundus camera (rho _x0001_0.37 and _x0001_0.38, p < 0.001). Trend-analysis showed an inverse association of smartphone AV ratio with increasing CAD (ptrend <0.001). Conclusions: Smartphone-based retinal AV imaging is feasible and comparable to fundus-camera imaging. There is a significant inverse correlation with coronary angiographic severity
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Background: Percutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected left main coronary artery (ULMCA) disease in patients with low-toeintermediate anatomic complexity or when the patient refuses CABG even after adequate counselling by heart team. We assessed the safety, in-hospital and mid-term outcomes of ULMCA stenting with drug-eluting stents (DES) in Indian patients. Methods: Our study was a retrospective analysis of patients who had undergone ULMCA PCI at a tertiary center, between March 2011 and February 2020. Clinical characteristics, procedural data, and follow-up data were analyzed. The primary outcome was a composite of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospital stay and at follow-up. The median follow-up was 2.8 years (interquartile range: 1.5e4.1 years). Results: 661 patients (mean age, 63.5 ± 10.9 years) had undergone ULMCA PCI. The mean SYNTAX score was 27.9 ± 10.4 and the mean LVEF was 58.0 ± 11.1%. 3-vessel disease and distal lesions were noted in 54% and 70.6% patients, respectively. The incidence of in-hospital MACCE was 1.8% and the MACCE during follow-up was 11.5% (including 48 [8.4%] cardiac deaths). The overall survival rates after one, three, five, and nine years were 94%, 88%, 84%, and 82%, respectively. The multivariate analysis revealed that age >65 years and high SYNTAX scores were independent predictors of mid to long-term mortality. Conclusion: ULMCA PCI with DES is safe and has acceptable in-hospital and mid-term outcomes among patients with low-toeintermediate SYNTAX score
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Resumo Fundamento Foi demonstrado que as subunidades de interleucina-35 (IL-35) estão fortemente expressas nas placas ateroscleróticas em humanos. Assim, considera-se que elas têm um papel na aterosclerose. Objetivos Neste estudo, os níveis de IL-35 foram comparados com o grupo controle em pacientes com doença arterial coronariana (DAC) estável, e a associação entre os níveis de IL-35 e o tipo, gravidade e extensão da lesão foram investigadas com o escore Gensini (GS) e o escore Syntax (SS) no grupo de pacientes Métodos Sessenta pacientes (18 mulheres e 42 homens) com DAC, diagnosticados por meio da angiografia coronária, que apresentaram dor no peito típica e teste de esforço não invasivo positivo, e 46 pacientes (18 mulheres e 28 homens) com luminograma normal, foram incluídos no estudo. Tanto o GS quanto o SS foram calculados para o grupo de pacientes, e esses valores foram comparados com os níveis de IL-35. Variáveis com distribuição não normal foram avaliadas com o teste U de Mann-Whitney, enquanto os parâmetros com distribuição normal foram analisados com o teste t de Student. A diferença entre as variáveis categóricas foi avaliada pelo teste de qui-quadrado ou de Fisher. Os valores de p<0,05 foram considerados como estatisticamente sinificativos. Resultados Não foram observadas diferenças significativas entre pacientes e o grupo controle em termos de características demográficas e achados laboratoriais. Em comparação ao grupo controle, os níveis de IL-35 no grupo com DAC foram consideravalmente menores (36,9±63,9 ng/ml vs. 33,2±13,2 ng/ml, p<0,008). Embora não tenha sido estatisticamente significativo, os níveis de IL-35 foram maiores em pacientes com SS mais baixo do que nos com SS mais alto (33,2±13,7 vs. 31,8±8,9, p=0,51). Os valores de IL-35 em pacientes com GS alto foram significativamente mais baixos do que em pacientes com GS baixo (35±17,4 vs. 30,7±8,6, p=0,043). Conclusão Demonstrou-se que os níveis de IL-35 podem ser um novo biomarcador para a DAC estável, e que a IL-35 está associada à extensão da DAC.
Abstract Background It has been shown that interleukin-35 (IL-35) subunits are strongly expressed in atherosclerotic plaques in humans. Therefore, it is considered to play a role in atherosclerosis. Objectives In this study, IL-35 levels were compared with the control group in patients with stable coronary artery disease (CAD), and the association between IL-35 levels and the lesion type, lesion severity and extension was investigated with the Gensini score (GS) and the Syntax score (SS) in the patient group. Methods Sixty patients (18 female and 42 male) with CAD diagnosed by coronary angiography, who presented with typical chest pain and positive noninvasive cardiac stress test, and 46 patients (18 female and 28 male) with normal coronary lumenogram, were included in this study. Gensini and Syntax scores were calculated in the patient group, and these values were compared with IL-35 levels. Non-normally distributed variables were analyzed by the Mann-Whitney U test, whereas normally distributed parameters were assessed by Student's t-test. The difference between categorical variables were evaluated by the Chi-square or Fisher test. P-values<0.05 were considered as statistically significant. Results No significant differences were observed between patients and the control group in terms of demographic characteristics and laboratory findings. Compared to the control group, IL-35 levels of the CAD group were considerably lower (36.9±63.9 ng/ml vs. 33.2±13.2 ng/ml, p<0.008). Although not statistically significant, IL-35 levels were higher in patients with low SS than among those with high SS (33.2±13.7 vs. 31.8±8.9, p=0.51). The IL-35 values of the patients with high GS were significantly lower than in patients with low GS (35±17.4 vs. 30.7±8.6, p=0.043). Conclusion It has been shown that IL-35 levels can be a new biomarker for stable CAD, and IL-35 is associated with the extension of CAD.
Subject(s)
Humans , Male , Female , Coronary Artery Disease/diagnosis , Interleukins/blood , Atherosclerosis/diagnosis , Severity of Illness Index , Biomarkers , Coronary AngiographyABSTRACT
Objective:To investigate the influence of the complexity of coronary artery disease based on SYNTAX score(SS) on the effect of minimally invasive or conventional bypass surgery.Methods:From January 2017 to January 2020, the medical group of the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital received a total of 760 patients undergoing off-pump coronary artery bypass grafting(OPCABG) surgery, including 596 males and 164 females. 28-85 years old, with an average of(60.88±9.36) years old. 379 cases underwent minimally invasive coronary artery bypass grafting(MICS CABG)(minimally invasive group) and 381 cases underwent median thoracotomy CABG(conventional group). In this study, according to the SS, patients of both groups were divided into 3 levels, and then the perioperative data of the two sets of high, medium, and low score intervals were compared respectively, and a preliminary analysis of the perioperative data for patients in each SS score section was performed.Results:There was no significant difference in the SS value between the minimally invasive group and the conventional group in the three intervals. There was no statistical difference in preoperative data including age, sex ratio, body mass index, hypertension, diabetes, abnormal head CT history, lung disease, history of tobacco and alcohol. The number of minimally invasive bypasses in the three groups was significantly less than that of the conventional group. The duration of minimally invasive surgery in the SS low score group was similar to that of conventional surgery, and the duration of minimally invasive surgery in the SS medium and high score group was longer than that in the conventional group. The hospital stay in the SS low and middle score group was less than that of the conventional group. There was no statistical difference in the proportion of MACCE and auxiliary equipment implantation in the 30-day perioperative period.Conclusion:In the same grade of SS group, there is no significant difference on the perioperative clinical effect between conventional CABG or MICS CABG group. The complexity of coronary artery disease is not the decisive basis for choosing minimally invasive or conventional bypass.
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Objective:To investigate the association of time in range(TIR) with the severity of coronary artery disease and acute coronary syndrome in patients with type 2 diabetes mellitus.Methods:A total of 216 patients with type 2 diabetes mellitus and coronary heart disease were recruited and undergone anthropometric and biochemical measurements, continuous glucose monitoring, and calculation of SYNTAX score. TIR was defined as the percentage of time within the glucose range of 3.9-10.0 mmol/L during 24 h. Spearman correlation analysis and multivariate linear regression analysis were used to evaluate the correlation factors of SYNTAX score. Multivariate logistic regression analysis was used to analyze the association of TIR with the severity of coronary artery disease and acute coronary syndrome. Results:Compared with patients with mild coronary artery disease, TIR in patients with moderate to severe coronary artery disease was lower[(69.4±17.3)% vs (60.8±17.8)%, t=3.0, P=0.003], and HbA 1C of patients with moderate to severe coronary artery disease was higher [(9.6±1.7)% vs (8.8±1.6)%, t=3.3, P=0.001]. SYNTAX score was negatively correlated with TIR ( r=-0.251, P<0.01) and positively correlated with HbA 1C ( r=0.249, P<0.01). Moreover, compared with HbA 1C (standardized coefficients=0.181, P=0.007), TIR (standardized coefficients=-0.192, P=0.004) had a greater influence on SYNTAX score. Multivariate linear regression analysis showed that TIR, HbA 1C, duration of diabetes and smoking were independently correlated with SYNTAX score. Multivariate logistic regression analysis revealed that compared with TIR Q1, Q3 and Q4 were independent protective factors for moderate to severe coronary artery disease (respectively, OR=0.61 and 0.59, 95% CI 0.39-0.96 and 0.38-0.94, P=0.014 and 0.009) and acute coronary syndrome (respectively, OR=0.51 and 0.39, 95% CI 0.32-0.95 and 0.26-0.75, P=0.022 and 0.008). Conclusion:TIR was significantly and independently correlated with the severity of coronary artery disease and acute coronary syndrome in type 2 diabetes mellitus after controlling confounding factors. When TIR level was decreased, the severity of coronary artery disease was aggravated, and SYNTAX score and the risk of acute coronary syndrome was increased.
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Objective: To explore the value of three-dimensional speckle tracking imaging (3D-STI) combined with coronary artery SYNTAX scores (SS) in evaluating the left ventricular function of patients with complex coronary artery disease (CAD). Methods: Totally 78 patients with complex CAD were divided into low score subgroup (SS<23, n=26), medium score subgroup (23≤SS<33, n=25) and high score subgroup (SS≥33, n=27) according to SS. The global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global three-dimensional strain (G3DS) and longitudinal strain (LS), radial strain (RS), circumferential strain (CS) as well as three-dimensional strain (3DS) of segments were obtained with 3D-STI. Then LS, RS, CS, 3DS of basal segment, middle segment and apical segment were further calculated. The above indexes were compared among groups. Results: ①GLS, GRS, GCS and G3DS all decreased in turn among low score, medium score and high score subgroups (all P<0.05). LS, 3DS of basal segment, LS, RS, CS and 3DS of middle segment and apical segment also decreased gradually (all P<0.05). ②ROC curve showed that GLS, GRS, GCS and G3DS had a certain value in detecting degrees of complex CAD, and GLS and G3DS had larger AUC. ③GLS, GRS, GCS and G3DS were negatively correlated with SS in the group of complex CAD (r=-0.548, -0.366, -0.411, -0.556, all P<0.05). 3D-STI had good interobserver and intraobserver consistency. Conclusion: 3D-STI can reflect the complexity of coronary artery lesions, which has a certain guiding significance combined with SS in diagnosis and treatment of complex CAD.
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Coronary atherosclerotic heart disease is a heart disease caused by coronary artery stenosis or obstruction, resulting in myocardial ischemia, hypoxia or necrosis. Its examination methods include electrocardiogram, hematological examination, coronary CT, coronary angiography and intravascular imaging technology, etc. In recent years, blood Fractional Flow Reserve(FFR) has been widely used to measure the degree of coronary artery stenosis in the treatment of coronary heart disease. Based on the related literature at home and abroad, elaborated the FFR measurements of coronary artery stenosis degree background significance, basic principle and implementation method, on the basis of inductive expounds the FFR examination of clinical research and the advantages and disadvantages, at the same time a preliminary prospect on the development of technology of FFR iFR-the future instantaneous waveform ratio and the functional SYNTAX score has a broad space for development.
Subject(s)
Humans , Coronary Artery Disease , Fractional Flow Reserve, MyocardialABSTRACT
Background: The aim of this study was to analyze angiographic parameters such as bifurcation angle, diameter at the polygon of confluence (POC) and SYNTAX score in predicting the need for side branch treatment with single-stent crossover technique from distal unprotected left main coronary artery (ULMCA) to the major side branch.Methods: This was a retrospective and observational study. A total of 83 patients with distal ULMCA lesions were enrolled. Patients who underwent provisional single-stent crossover technique were compared with patients that required side branch treatment though plain old balloon angioplasty (POBA) 5 (6.0%) or stenting 7 (8.4%). Angiographic parameters, bifurcation angle, diameter at the POC and the SYNTAX score were analyzed for their ability to predict the need for side branch treatment.Results: Mean age of patients was 58.2±5.3 years. Males constituted 61 (73.5%) patients. Post main branch stenting 5 (6.0%) and 7 (8.4%) patients required side branch treatment with POBA and stent implantation, respectively. Binary regression revealed bifurcation angle (Z: 1.15, OR: 0.99, 95% CI: 0.97-1.01, p=0.25), diameter at the POC (Z: 1.1, OR: 0.82, 95% CI: 0.32-2.13, p=0.272) and SYNTAX score (Z: 1.51, OR: 1.18, 95% CI: 0.95-1.45, p=0.132) did not correctly predict the requirement of side branch treatment.Conclusion: Left main coronary artery to main branch stenting can be performed safely with single-stent crossover technique, irrespective of presence of side branch disease across a wide range of bifurcation angles, diameters at the POC and SYNTAX scores.
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The evaluation of coronary artery disease (CAD) concerning the metabolic status and body mass index (BMI) is poorlystudied. This study was designed to observe the relationship between insulin resistance (IR) and the severity of CADon the basis of the metabolic and phenotypic status in stable-angina patients. A cross-sectional study was conductedon 532 patients with stable angina and coronary angiogram was done to diagnose the CAD for all. Determination ofmetabolic obesity was done using the National Cholesterol Education Program-Adult Treatment Panel III criteria.Phenotypic obesity was defined as BMI ≥ 25 kg/m2. Homeostasis model assessment IR in correlation with the severityof CAD was measured using SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for theTreatment of Narrowed Arteries) Score. The average age of the patients was 57.58 ± 10.40 years, and 69.4% weremales. Out of 532 subjects, 51.3% were hypertensive, 14.5% were smokers, 29.1% consumed alcohol, 49.3% weremetabolically obese, and 50% were phenotypically obese. Increase in IR increased the risk of severity of CAD inmetabolically obese subjects (OR = 2.51, p = 0.048). In the phenotypically obese group, the relationship between IRand the severity of CAD was not statistically significant (OR = −2.19, p = 0.08). The study concludes that the increasedIR increases the risk of severity of CAD in metabolically obese subjects.
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Background: The specific question of whether PCI or surgical treatment offers any advantage over MT in patients with stable angina and multivessel disease remains unanswered. Objective of our research was to study various risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease.Methods: This was prospective observational study carried out in a tertiary care center from July 2014 to July 2016. A total of 98 subjects undergoing different therapeutic strategies were followed up. Risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease (CAD) were studied.Results: There was a significant difference in mean SYNTAX score (P = 0.003), urine micro albumin levels (P=0.006), and body mass index (0.046) between those who had MACE and who did not have MACE.Conclusions: The urine micro albumin >30 mg/l and highest SYNTAX score were significantly associated with MACE at 1 year in subject with severe CAD.
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Introduction: Diabetes mellitus is a complex metabolicdisorder associated with an increased risk of microvascularand macrovascular disease. Type 2 diabetes mellitus is aprevalent metabolic disorder that often leads to cardiovasculardiseases and diabetic cardiomyopathy, which may lead tochronic pressure overload and myocardial infarction. Thepresent study aimed at studying the extent and complexity ofcardiovascular lesions among diabetic patients and comparesame with non-diabetic patients.Materials and methods: The present study was a CaseControl (Analytical and Interventional) Study conductedover 18 months (October 2016 to March 2018). Case groupconsisted of 250 Diabetic patients with cardiac symptoms,with or without ECG changes, who have undergone coronaryangiography. And Controls group consisted of 250 NonDiabetic patients with cardiac symptoms, with or withoutECG changes, have undergone coronary angiography.Results: In the present study, among diabetics, there were52.8% male patients and 47.2% female patients, similarlyamong non diabetic group, 57.2% were males and 42.8%cases were females. 12.4% people were found normal, 37.6%were suffering from Single vessel disease, 28.8% people withDouble vessel disease and 21.2% people with Triple vesseldisease.Conclusions: According to the present study, among coronaryangiography diagnosis, severe forms of coronary artery lesionswere found common among diabetic patients as compared tonon diabetic patients.
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Background: Ischemic heart disease results in systolic and diastolic dysfunction (DD), but diastolic function seems to be more susceptible to ischemia than systolic function. Hence, we investigate the relationship between the extent and severity of coronary lesions and left ventricular (LV) diastolic function in patients with coronary heart disease. Objective: The objective of this study was to determine the relationship between the severity of the coronary artery disease (CAD) and LV diastolic function in patient with non‑ST‑elevation acute coronary syndrome (NSTE‑ACS). Materials and Methods: A total of 109 patients with NSTE‑ACS (NSTI myocardial infarction and unstable angina) were included in the study. All angiographic variables pertinent to SYNTAX score (SS) calculation were computed using online SS calculator. All patients underwent echocardiographic examination. Results: Echocardiographic parameters E/e’, left atrial volume index (LAVI), and mitral inflow velocity (E/A) were measured in all patients and were found that an overall significant difference (P < 0.0001) in the SS between normal, Grade 1, Grade 2, and Grade 3 DD was seen. The significance of other parameters for determining DD, E/e’, and LAVI was calculated using Spearman’s correlation which also showed significant positive correlation with SS. 45.8% and 27.5% variation in the SS is accounted for E/e’ and LAVI alone, respectively. Conclusion: The study shows a positive correlation between severity of CAD assessed using SS and E/A, E/e’, and LAVI which are various determinants of DD.
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Introduction @#The left main (LM) bifurcational stenting is coronary high risk interventional procedure (CHIP) which associated with various post procedural outcome.@*Goal@#In this study, we aimed to describe current practice of coronary left main bifurcational stenting and patient’s outcome in Mongolia. @*Materials and Methods@#We selected 50 patients who gave informed consent and treated by left main bifurcational stent. All the patients gave informed consent form which was approved by ethical committee of Mongolian National University of Medical Sciences. Coronary stenosis was evaluated by Syntax score and Medina classification. The 1 year survival rate was estimated using Kaplan-Meier estimation. @*Results @#A total of 50 patients who received LM bifurcational stent were chosen (mean age 60±11, male gender 78%). Mean syntax I score was 26.1±8.6 and mean Syntax II score was 44.7±6.2. Medina 110 type lesion was 46% (n=23), medina 111 type lesion was 36% (n=18), medina 100 type lesion was 6% (n=3), medina 011 type lesion was 4% (n=2) and medina 010 type lesion was 8% (n=4). The median degree of stenosis was 50% (IQR 30%; 90%) for LM, 90% (IQR 80%; 99%) for LAD and 0% (IQR 0%; 80%) for LCx. The final procedural success with final TIMI 3 flow was achieved in 44 patients (88%). All-cause mortality was occurred 5 patients during follow-up and survival rate at the 1 year was 82% (95% CI 66; 97).@*Conclusion @#The bifurcational stenting is acceptable treatment choice which has good survival for high risk patients with LM bifurcational disease.
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Introduction@#Erectile dysfunction (ED) has numerous links to cardiovascular disease. Numerous studies show the severity of ED is strongly associated with atherosclerosis and endothelial dysfunction implicated in the pathogenesis of coronary artery disease (CAD). These common vascular pathways have led to evidence that ED onset may be used as a marker of the severity of CAD as well as a preclinical marker of early onset-CAD. The researchers aim to determine the association of ED and CAD in terms of prevalence, clinical presentation and severity and extent of vessel involvement by SYNTAX score among CAD patients undergoing coronary angiography.@*Methods@#This is a prospective, cross sectional, analytical study design set at Perpetual Succour Hospital – Cebu Heart Institute, a private, tertiary hospital with cardiac specialty units located in Cebu City. This study includes all Filipino patients admitted at Perpetual Succour Hospital suspected to have coronary artery disease based on symptoms of angina, dyspnea or other anginal equivalent with indications to undergo coronary angiography during the period of October 1, 2014 to September 30, 2015 were included.@*Results@#A total of 160 patients were included in the study. The mean age is 57.23 years with most of the patients admitted for stable ischemic heart disease (SIHD) of 54.7%, non-ST elevation acute coronary syndromes (NSTEACS) 33.5% and ST-elevation myocardial infarction (STEMI) 11.8% with multiple cardiovascular risk factors like hypertension, diabetes mellitus, smoking and dyslipidemia. Eighty-two percent complained of ED symptoms with a mean International Index of Erectile Function (IIEF) score of 15.15. Most ED patients identified had mild to moderate ED (31.7%), mild ED (21.7%), moderate ED (17.4%) and severe ED (11.8%). There were only 17.4% of patients who had undergone coronary angiography for CAD complaints that had no ED symptoms on admission. Per clinical presentation, there was a significant association between patients presenting with severe ED, moderate ED and mild to moderate ED with those presenting with SIHD and ACS-NSTEMI on admission, moderate ED and mild to moderate ED. ED was significantly associated with obstructive CAD (p=0.001) and correlated directly with the number of vessels involved (p<0.01) and inversely related to SYNTAX scores (p<0.001). ED symptoms were noted to precede CAD diagnosis by 4.9 to 5.9 years.@*Conclusion@#In conclusion, there is a high prevalence of ED among CAD patients and its existence is significantly associated with obstructive CAD varying directly with extent and number of vessel involvement. There is a significant inverse relationship with severity of ED and SYNTAX scores. The existence of ED was present in all subsets of CAD patients, regardless of presentation of admission and preceded CAD symptoms and diagnosis by four to five years.
Subject(s)
Erectile Dysfunction , Coronary Artery DiseaseABSTRACT
Background Carotid artery lesions frequently coexist with coronary arterial disease (CAD). The aim of this study was to investigate the relation between carotid intima-media thickness (CIMT) and the extent of CAD and whether CIMT could be predictive of severity of coronary atherosclerosis. Methods Coronary angiography and carotid ultrasound evaluations of 100 consecutive patients with CAD who had undergone elective coronary angiography were reviewed. IMT was measured at both carotid arteries. CIMT and severity of CAD relationship based on SYNTAX score was assessed. The relation between CIMT and cardiovascular risk factors was determined. Results Mean overall SYNTAX score was 15.76 + 4.82. Mean right CIMT was 0.86 ± 0.29 and mean left CIMT was 0.83 ± 0.24. There were no significant correlation between the SYNTAX score and CIMT (r: 10, P: 30). There was significant relationship between hypertension,diabetes and CIMT (P: 0.01). Conclusion we found no relationship between CIMT and SYNTAX score in patients who underwent coronary angiography. Diabetes mellitus and hypertension are related to increased carotid intima-media thickness.
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Background: Coronary artery calcification (CAC) is a predictor of coronary artery disease (CAD) and closely related to the predictor of future cardiac events. Objective: To assess the prevalence of fluoroscopic calcium in patients with CAD and to determine its association with various coronary risk factors. Methods: The CAC measurement was conducted by visual identification during fluoroscopy. The study subjects were allocated into two group, according to the presence (+) or absence (-) of CAC. The Syntax score was calculated from the results of coronary angiography. Results: Out of 846 patients, 236 patients represented CAC(+). The mean±SD age of the total study patients was 61±5.8 years with a male preponderance of 415(71.2%). Systolic/diastolic blood pressure was 132±24/80±13mm Hg in CAC(+) patients. The present study finding elucidated that diabetes (Adjusted Odds Ratio [OR], 8.52, 95% confidence interval [CI], 6.2-12.5, P=0.02), hypertension (OR, 5.52, 95% CI, 3.2- 8.4, P=0.03), and Syntax score (OR, 12.40, 95% CI, 8.82-16.56; P=0.001) were more prevalent in CAC(+) group compared to CAC(-) group. Those patients with family history of CAD had significant CAC as compared to those without CAD family history (OR, 3.32, 95% CI, 2.8-5.3, P=0.04). Conclusion: The prevalence of CAD among diabetic and hypertensive patients undergoing coronary calcification is significant. Therefore, screening of CAC should be considered in such patients for the better identify of their risk of cardiovascular complications
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BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (pPCI) and is associated with high mortality and morbidity and long hospital stay in patients with ST elevation myocardial infarction (STEMI). The Syntax Score (SS) has previously been studied in STEMI patients, and it was associated with increased CIN development and long-term mortality. This study investigates a possible relationship between CIN development and Syntax Score II (SSII) and compares SS and SSII by assessing CIN risk in STEMI patients treated with pPCI. METHODS: A total of 1,234 patients who underwent pPCI were divided into 2 groups according to CIN development. Patients with CIN were further divided into 2 groups according to whether or not they required hemodialysis. Reclassification tables, net reclassification improvement, and integrated discriminative improvement methods were used to assess the additive predictive value of SSII for predicting CIN. RESULTS: In the present study, 166 patients (13.5%) had CIN. Although both SS and SSII were significantly higher in CIN patients, only SSII was an independent predictor of CIN (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.012–1.051; p < 0.001) and hemodialysis requirement (OR, 1.078; 95% CI, 1.046–1.078; p < 0.001). When comparing SSII and SS in their ability to determine CIN risk, we found SSII to have a reclassification improvement of 27.59% (p < 0.001) and an integrated discrimination improvement of 9.1% (p < 0.001). CONCLUSIONS: The combination of clinical and anatomic variables can more accurately identify patients who are at high risk for CIN after pPCI. While SSII is harder to calculate than SS, it provides better prediction for CIN and hemodialysis requirement than SS.
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Humans , Discrimination, Psychological , Length of Stay , Mortality , Myocardial Infarction , Percutaneous Coronary Intervention , Renal DialysisABSTRACT
OBJECTIVE: Fibroblast growth factor (FGF) 21 is a recently established therapeutic target for treating metabolic syndromes, which include potential precursors to cardiovascular disease, suggesting a link between FGF21 and atherosclerosis. However, the association between serum FGF21 concentrations and coronary artery disease remain controversial. The aim of this study is to evaluate the association between circulating FGF21 concentrations and coronary artery lesions and clinical severity. METHODS: We enrolled 137 subjects who underwent coronary angiography, due to suspected acute coronary syndrome (ACS), from December 2009 to July 2012. Serum FGF21 levels were measured. Coronary artery lesions and clinical severities of the subjects were evaluated using the SYNergy between percutaneous coronary intervention with (paclitaxel-eluting) TAXus stent and cardiac surgery (SYNTAX) and Global Registry of Acute Coronary Events (GRACE) scoring system, respectively. RESULTS: After adjusting for established cardiovascular disease risk factors, including age, body mass index, total cholesterol, and low-density lipoprotein cholesterol, patients with coronary artery lesions (n=112 men) had significantly higher levels of FGF21 than individuals without such lesions (n=25; men) (377.1±20.1 pg/mL vs. 267.1±43.5 pg/mL; p=0.026). However, no correlations were found between serum levels of FGF21 and either the calculated STNTAX score (r=0.117; p=0.176) or GRACE risk score, which is a risk prediction tool applicable for ACS subjects (r=0.113; p=0.193). CONCLUSION: Although serum levels of FGF21 were higher in individuals with coronary lesions than in those without such lesions, FGF21 levels were not associated with angiographic severity.
Subject(s)
Humans , Acute Coronary Syndrome , Atherosclerosis , Body Mass Index , Cardiovascular Diseases , Cholesterol , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Fibroblast Growth Factors , Lipoproteins , Percutaneous Coronary Intervention , Risk Factors , Stents , Taxus , Thoracic SurgeryABSTRACT
Objective@#To investigate the prognostic value of SYNTAX score on 1 year outcome in coronary heart disease patients underwent percutaneous coronary intervention(PCI).@*Methods@#The present study (PANDA Ⅲ trial) was a perspective, multi-center, randomized controlled trial. Between December 2013 and August 2014, 2 348 patients who underwent PCI from 46 centers were enrolled. SYNTAX score was calculated from all patients. Patients were divided into 3 groups based on SYNTAX score: lower risk group (SYNTAX score≤22, 1 777 patients), intermediate risk group (SYNTAX score 23-32, 412 patients), and higher risk group (SYNTAX score≥33, 159 patients). The patients were followed up after the procedure for one year.Primary endpoint was target lesion failure (TLF), including cardiac death, target vessel myocardial infarction,and ischemia driven target lesion revascularization. Secondary endpoints included stent thrombosis and major adverse cardiac events were defined as a composite of all-cause death, myocardial infarction and any revascularization.@*Results@#(1) A total of 1 766 (99.2%), 411 (99.8%),and 159 (100%) patients in the lower risk group, intermediate risk and higher risk group completed the 1 year follow up. (2) Incidence of TLF were 5.6%(99/1 763) in lower risk group, 8.8%(36/411) in intermediate risk group,and 8.8%(14/159) in higher risk group(P=0.03). The incidence of target vessel myocardial infarction in lower risk group was 3.9%(68/1 763), 6.6%(27/411) in intermediate risk group,and 7.5% (12/159) in higher risk group(P=0.01).Prevalence of cardiac death and ischemia driven target lesion revascularization was similar among the 3 groups(P>0.05).(3) The probable stent thrombosis events rate was 0.1% (1/1 763), 0.7% (3/411), and 0.6% (1/159) in the lower, intermediate,and higher risk groups respectively (P=0.02). The incidence of major adverse cardiac events was 8.1% (142/1 763) in lower-risk group, 11.7% (48/411) in intermediate risk group, and 14.5% (23/159) in higher risk group (P<0.01). The incidence of all-cause death was 1.7%(30/1 763) in lower-risk group, 1.7%(7/411) in intermediate risk group, and 6.3%(10/159)in higher risk group (P<0.01). The incidence of myocardial infarction was 4.2% (74/1 763) in lower-risk group, 6.6% (27/411) in intermediate risk group, and 8.2% (13/159) in higher risk group(P=0.02).Incidence of any revascularization was similar among groups(P=0.59). (4) The multivariable Cox analysis showed that age (HR=1.04, 95%CI 1.02-1.06, P<0.01), total implanted stent length (HR=1.01, 95%CI 1.00-1.02, P=0.03), and baseline SYNTAX score (HR=1.02, 95%CI 1.02-1.04, P=0.02) were independent risk factors of TLF after PCI in this patient cohort.@*Conclusion@#The SYNTAX score is a valuable tool for predicting prognosis on 1 year in coronary heart disease patients underwent PCI. Trial Registration www.clinicaltrials.gov, NCT02017275.
ABSTRACT
Objective: To observe the short- and long-term clinical outcomes of fraction flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients with SYNTAX score≥33 unsuitable for coronary artery bypass grafting (CABG). Methods: A total of 117 CAD patients admitted in our hospital from 2012-01 to 2015-06 were enrolled. Since SYNTAX score≥33, EuroSCORE>6, the patients were unsuitable for CABG and treated in 2 groups: Medication group, n=20 and PCI group, during FFR-guided PCI procedure, patients received ROTA or IVUS according to physician's experience, n=97. All patients were followed-up for at least 12 months. Meanwhile, taking "coronary stent and bypass", "CABG and PCI" as key words, we searched relevant documents in VIP Chinese science and technology journal full-text database, WanFang medical database, ChinaNet and Chinese biomedical literature database from 2012-01-01 to 2015-12-31, patients' outcomes were compared with the above references to explore the clinical benefit. Results: ① PCI group and Medication group had similar SYNTAX score and EuroSCORE, P>0.05. The common pathogenesis was LAD involvement, chronic occlusion was 31.3% (5/16) in patients with partial revascularization.②PCI group had 18.6% (18/97) incidence of major adverse cardiac and cerebral events (MACCE), 2 patients died during follow-up period and 9 received revascularization; Medication group had 60% (12/20) incidence of MACCE, 3 patients died during follow-up period; the difference between 2 groups showed statistical meaning, P<0.05.③There were 22 relevant documents retrieved as comparison; in our research, PCI group had similar incidence of MACCE to the documents, P>0.05; Medication group had increased incidence of MACCE than the documents, P<0.05. Conclusion: FFR-guided PCI could bring clinical benefit in CAD patients with SYNTAX score≥33 unsuitable for CABG.