Muerte Súbita Post Infarto: ¿Cuándo Implantar un Desfibrilador Automático? Breve revisión a propósito de un caso / Sudden Death After Infarction: when To Implant An Automatic Defibrillator? Brief review about a case

Sudden death is the most serious complication of acute coronary syndromes. The highest percentage occurs at home with a very low survival rate. The highest risk group are patients with ejection fraction under 40% after an acute myocardial infarction. So far the indication of the clinical practice guides are the implantation of ICD as a secondary prevention, and as a primary prevention when the systolic function is severely diminished, however there is an interval of 40 days in which the implant has not managed to demonstrate benefits. In this critical period patients should be managed with beta-blockers. So far, the absolute benefit of using portable cardioverter-defibrillators as a prophylactic bridge to the ICD implant has not been demonstrated. The following revision is based on the most relevant clinical practice guides in the field carried out in relation to a clinical case

Análise da Custo-Efetividade da Angiotomografia Coronariana no SUS, em Comparação com Outros Métodos Não Invasivos na Suspeita de DAC Estável / Cost-Effectiveness Analysis of CCTA in SUS, as Compared to Other Non-Invasive Imaging Modalities in Suspected Obstructive CAD

Resumo Fundamento Atualmente o sistema de saúde público brasileiro (SUS) não contempla a angiotomografia de coronárias. Objetivos Ranquear sob a perspectiva do SUS, a custo-efetividade de estratégias diagnósticas combinando teste ergométrico, cintilografia miocárdica, ecocardiograma por estresse e angiotomografia de coronárias para o diagnóstico de doença arterial coronariana em uma coorte hipotética de pacientes com probabilidade pré-teste intermediária. Métodos Análise de custo-efetividade por meio de árvore de decisão. Foram analisados a relação de custo-efetividade incremental e o benefício líquido em saúde das estratégias diagnósticas, com a adoção de múltiplos limiares de disposição a pagar entre 0,05 e 1 PIB per capita por diagnóstico correto. Nos casos de testes sequenciais, um segundo teste confirmatório era realizado quando o primeiro fosse positivo. Resultados Após exclusão das estratégias diagnósticas dominadas ou com dominância estendida, a fronteira de eficiência foi composta por três estratégias: teste ergométrico, teste ergométrico seguido de ecocardiograma de estresse, e ecocardiograma de estresse seguido de angiotomografia de coronárias, sendo esta última a estratégia mais custo-efetiva. Pelo critério do benefício líquido, o ranqueamento das estratégias mais custo-efetivas variou conforme a disposição a pagar. Conclusão Utilizando conceitos atuais de avaliação de tecnologias em saúde, este estudo fornece um ranqueamento para a tomada de decisão sobre qual estratégia diagnóstica utilizar, em uma população com risco pré-teste intermediário para DAC. Com estimativa factível de custos para a ATC, o impacto da inclusão desta ao rol do arsenal diagnóstico representaria uma estratégia custo-efetiva na maioria dos cenários avaliados nas variações de disposição a pagar.

Abstract Background The Brazilian public health system does not include computed tomography angiography (CTA). Objective Rank, according to the Brazilian public health system, the cost-effectiveness of different strategies for the diagnosis of coronary artery disease (CAD), combining exercise tests (ET), myocardial scintigraphy (MS), stress echocardiography (SE), and CTA in a hypothetical intermediate pre-test probability cohort of patients. Methods This study implemented a cost-effectiveness analysis through a decision tree. The incremental cost-effectiveness ratio (ICER) and net benefit were analyzed by adopting multiple thresholds of willingness to pay, from 0.05 to 1 GDP per capita per correct diagnosis. In sequential tests, a second confirmatory test was performed only when the first was positive. Results After excluding dominated or extended dominance diagnostic strategies, the efficiency frontier consisted of three strategies: ET, ET followed by SE, and SE followed by CTA, the last being the most cost-effective strategy. Through the net benefit, the ranking of the most cost-effective strategies varied according to willingness to pay. Conclusions Using current concepts of health technology assessment, this study provides a ranking for decision-making concerning which diagnostic strategy to use in a population with an intermediate pre-test risk for CAD. With a feasible cost estimate adopted for CTA, the impact of including this to the list of the diagnostic arsenal would represent a cost-effective strategy in most of the evaluated scenarios with broad variations in the willingness to pay.

Fatores que Impactam a Decisão de Realizar Ventriculografia Esquerda em Doença Arterial Coronariana / Factors That Impact the Decision to Perform Left Ventriculography in Coronary Artery Disease

Resumo Fundamento A ventriculografia esquerda é um método invasivo para avaliar a função sistólica do ventrículo esquerdo. Depois do advento de métodos não invasivos, o seu uso tem sido questionado por resultar em algum risco para o paciente. Objetivos Avaliar quais fatores associam-se independentemente com a decisão de realizar ventriculografia em pacientes com doença arterial coronariana. Métodos Tratou-se de um estudo analítico, retrospectivo, avaliando prontuários eletrônicos e banco de dados e comparando 21 variáveis de interesse pré-definidas entre pacientes submetidos a cineangiocoronariografia. Foi considerado significante p < 0,05. Resultados Avaliamos 600 pacientes consecutivos, e a ventriculografia esquerda foi realizada na maioria dos pacientes submetidos a uma cineangiocoronariografia (54%). Depois da análise multivariada, os pacientes com síndromes coronarianas crônicas ( odds ratio [OR] 1,72; intervalo de confiança de 95% [IC 95%]: 1,20-2,46; p < 0,01) tiveram maior chance de serem submetidos ao procedimento. Os pacientes com função ventricular conhecida (OR = 0,58; IC 95%: 0,40-0,85; p < 0,01), os revascularizados (OR 0,31; IC 95% 0,14-0,69; p < 0,01), os hipertensos (OR 0,58; IC 95%: 0,36-0,94; p = 0,02) e aqueles com maiores valores de creatinina (OR 0,42; IC 95% 0,26-0,69; p < 0,01) tiveram maior chance de não realizar ventriculografia. Conclusões Nos pacientes submetidos a cineangiocoronariografia, o diagnóstico de síndrome coronariana crônica associou-se de modo independente com uma maior realização da técnica, enquanto ter a função ventricular previamente conhecida, ser hipertenso, ter sido submetido a revascularização cirúrgica prévia e ter valores de creatinina mais elevados associaram-se a uma maior chance de não realizar o método.

Abstract Background Left ventriculography is an invasive method for assessment of left ventricular systolic function. Since the advent of noninvasive methods, its use has been questioned, as it carries some risk to the patient. Objective To assess which factors are independently associated with the decision to perform ventriculography in patients with coronary artery disease. Methods Analytical, retrospective, database review study of electronic medical records comparing 21 predefined variables of interest among patients undergoing coronary angiography. P-values <0.05 were considered significant. Results We evaluated 600 consecutive patients undergoing coronary angiography. Left ventriculography was performed in the majority of cases (54%). After multivariate analysis, patients with chronic coronary syndrome (OR 1.72; 95% CI: 1.20-2.46; p < 0.01) were more likely to undergo the procedure. Patients with known ventricular function (OR 0.58; 95% CI: 0.40-0.85; p < 0.01); those with a history of CABG (OR 0.31; 95% CI: 0.14-0.69; p < 0.01) or hypertension (OR 0.58; 95% CI: 0.36-0.94; p = 0.02); and those with higher creatinine levels (OR 0.42; 95% CI: 0.26-0.69; p < 0.01) had greater odds of not undergoing ventriculography. Conclusions In patients undergoing coronary angiography, a diagnosis of chronic coronary syndrome was independently associated with greater likelihood of left ventriculography, while having previously determined ventricular function, a history of hypertension or CABG, and higher creatinine levels were associated with a decreased likelihood of undergoing this procedure.

Aneurisma de arteria coronaria derecha y elevación del segmento ST en cara inferior. Reporte de caso y revisión de la literatura / Right Coronary Artery Aneurysm and inferior ST segment elevation. Case Report and Literature Review / Aneurisma de artéria coronária direita e elevação do segmento ST na cara inferior. Reporte de caso e revisão da literatura

Los aneurismas de las arterias coronarias (AAC) son poco comunes, con una incidencia de 0.3-5.3%. Se definen como una dilatación 1.5 veces mayor al diámetro interno de la arteria normal adyacente. La arteria coronaria derecha es la más comúnmente afectada. Su fisiopatología es poco clara, pero se cree que una de sus principales causas es la aterosclerosis. Los AAC son generalmente asintomáticos o pueden estar asociados a isquemia miocárdica. Su tratamiento aún no está bien establecido, debido al desconocimiento general sobre su historia natural, e incluye desde un manejo conservador hasta el tratamiento quirúrgico. A continuación, se reporta el caso de un paciente con infarto agudo de miocardio y elevación del segmento ST, llevado a coronariografía que evidenció aneurisma de la coronaria derecha, que requirió trombectomía, angioplastia y manejo médico vitalicio ambulatorio.

Coronary artery aneurysms (CAA) are a rare entity with an incidence of 0.3-5.3%. They are dilations of 1.5 times larger than normal adjacent artery, with the right coronary artery as the most affected vessel. Its pathophysiology is unclear but atherosclerosis is believed to be the main cause. CAA are generally asymptomatic but can cause coronary ischemia. Its treatment is yet to be established due to general ignorance about its nature. It ranges from conservative management to surgery. In the following text, we report a case of a patient with acute myocardial infarction presenting ST-segment elevation, who showed a right coronary artery aneurysm in coronary angiography. The patient required thrombectomy, angioplasty and subsequent lifetime outpatient medical management.

Os aneurismas das artérias coronárias (AAC) são pouco comuns, com uma incidência de 0.3-5.3%. Se definem como uma dilatação 1.5 vezes maior ao diâmetro interno da artéria normal adjacente. A artéria coronária direita é a mais comumente afetada. Sua fisiopatologia é pouco clara, mas se crê que uma das suas principais causas é a aterosclerose. Os AAC são geralmente assintomáticos ou podem estar associados a isquemia miocárdica. Seu tratamento ainda não está bem estabelecido, devido ao desconhecimento geral sobre sua história natural, e inclui desde um manejo conservador até o tratamento cirúrgico. A continuação, se reporta o caso de um paciente com infarto agudo de miocárdio e elevação do segmento ST, levado a coronariografia que evidenciou aneurisma da coronária direita, que requereu trombectomia, angioplastia e manejo médico vitalício ambulatório.

Aterosclerosis en puente venoso aorto-coronario: hallazgos del OFDI: caso clínico / Findings of optical coherence tomography in saphenous grafts failure: report of one case

Atherosclerosis is the main cause of late saphenous vein graft (SVG) failure. Intracoronary images using optical coherence tomography (OCT) in addition to angiography allow a detailed analysis of the lesion beyond the degree of stenosis. We report a 67 years old diabetic male who underwent coronary surgery in 2009, consulting for an acute coronary syndrome. Angiography showed two different lesions on one aortocoronary venous grafts. OCT demonstrates atherosclerosis in different stages identifying the culprit lesion. Stent placement were successfully carried out.

Níveis de Interleucina-35 em Pacientes com Doença Arterial Coronariana Estável / Interleukin-35 Levels in Patients with Stable Coronary Artery Disease

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.

Associação entre a Gravidade da Doença Arterial Coronariana e Câncer de Pulmão: Um Estudo Piloto Transversal / Association between the Severity of Coronary Artery Disease and Lung Cancer: A Pilot Cross-Sectional Study

Resumo Fundamento A relação direta entre a doença arterial coronariana (DAC) e o câncer de pulmão não é bem conhecida. Objetivo Investigar a associação entre a gravidade anatômica da DAC e do câncer de pulmão. Métodos Trezentos pacientes, incluindo 75 recém-diagnosticados com câncer de pulmão e 225 pacientes correspondentes sem câncer, foram submetidos à angiografia coronária durante a internação, sem intervenção coronária percutânea (ICP) prévia nem enxerto de bypass da artéria coronária (CABG). O escore SYNTAX foi utilizado para avaliar a gravidade da DAC. Uma pontuação alta no escore foi definida como > 15 (o maior quartil do escore SYNTAX). O teste de tendência de Cochran-Armitage foi utilizado para verificar a distribuição dos escores dos pacientes. Uma análise de regressão logística foi utilizada para avaliar a associação entre a gravidade da DAC e o câncer de pulmão. Os valores de p foram estabelecidos quando o nível de significância era 5%. Resultados A tendência de distribuição dos escores SYNTAX dos pacientes por quartis foi diferente entre aqueles com câncer de pulmão e controles (do quartil mais baixo ao mais alto: 20,0%; 20,0%; 24,0%; 36,0% vs. 26,7%; 26,2%; 25,8%; 21,3%; p=0,022). A pontuação no escore SYNTAX foi mais alta em pacientes com câncer do que nos pacientes controle (36,0% vs. 21,3%, p=0,011).O maior quartil do escore demonstrou mais riscos de desenvolver câncer de pulmão em comparação ao quartil mais baixo (OR: 2.250, IC95%: 1.077 a 4.699 ; P -trend= 0,016). Após ajustes, os pacientes no maior quartil do escore SYNTAX tinham mais risco de desenvolver câncer de pulmão (OR: 2.1o49, IC95%: 1.008 a 4.584; P -trend= 0,028). Pacientes com escores SYNTAX alto (> 15) tinham 1.985 mais chances de ter câncer de pulmão (IC95%: 1.105-3.563, P= 0,022). Conclusão A gravidade anatômica da DAC está associada ao risco de câncer de pulmão, o que indica que um rastreamento completo deste tipo de câncer possa ser mais significativo entre pacientes com DAC.

Abstract Background The direct relationship between coronary artery disease (CAD) and lung cancer is not well known. Objective To investigate the association between the anatomical severity of CAD and lung cancer. Methods Three-hundred study patients, including 75 recently diagnosed lung cancer patients and 225 matched non-cancer patients, underwent coronary angiography during hospitalization without previous percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The SYNTAX score (SXscore) was used to assess the severity of CAD. A high SXscore (SXhigh) grade was defined as SXscore > 15 (the highest quartile of the SXscore). The Cochran-Armitage test for trend was used to assess the distribution of patients' SXscores. Logistic regression analysis was used to assess the association between the severity of CAD and lung cancer. P-values were set when significance level was 5%. Results The distribution trend of patients' SXscore by quartiles was different between lung cancer patients and control patients (from the lowest to the highest quartile: 20.0%, 20.0%, 24.0%, 36.0% vs. 26.7%, 26.2%, 25.8%, 21.3%, p=0.022). The SX high rate was higher in lung cancer patients than in control patients (36.0% vs. 21.3%, p=0.011).The highest quartile of the SXscore showed higher risk of lung cancer in comparison to the lowest quartile (OR: 2,250, 95%CI: 1,077 to 4,699 ; P-trend= 0.016). After adjustment, patients in the highest quartile of the SXscore had higher risk of lung cancer (OR: 2,149, 95%CI: 1,008 to 4,584; P-trend= 0.028). Patients with high SXscore (> 15) had 1,985 times more chances of having lung cancer (95%CI: 1,105-3,563, P= 0.022). Conclusions The anatomical severity of CAD is associated with the risk of lung cancer, which indicates that a thorough lung cancer screening may be significant among severe CAD patients.

Diagnostic efficiency and incremental value of myocardial blood flow quantification by CZT SPECT for patients with coronary artery disease / 中华心血管病杂志

Objective: To investigate the diagnostic efficiency and incremental value of quantitative myocardial blood flow measurements by Cadmium-Zine-Telluride (CZT) single photon emission computed tomography (SPECT) dynamic myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) compared with traditional semi-quantitative measurements by MPI. Methods: This is a retrospective, cross-sectional study. We retrospectively analyzed clinical data of patients with suspected or known CAD, who underwent the dynamic MPI quantitative blood flow measurement of CZT SPECT in TEDA International Cardiovascular Hospital from October 2018 to December 2020. Clinical data, semi-quantitative parameters (stress score (SS), rest score (RS) and different score (DS)) and myocardial quantitative blood flow parameters (rest myocardial blood flow (rMBF), stress myocardial blood flow (sMBF) and myocardial flow reserve (MFR)) were analyzed. According to the results of coronary angiography, patients were divided into the stenosis group and the control group with coronary artery stenosis ≥50% or ≥75% as the diagnosis criteria. The differences of quantitative and semi-quantitative parameters between the two groups were compared, and the diagnostic efficacy was compared by receiver operating characteristic(ROC) curve. Results: A total of 98 patients with a mean age of (62.1±8.7) years were included in the study, including 66 males (67%). At the patient level, with the positive standard of coronary artery stenosis≥50%, the left ventricle (LV) stress MBF (LV-sMBF) ((1.36±0.45) ml·min-1·g-1) and LV-MFR (1.45±0.43) of the stenosis group were lower than the LV-sMBF ((2.09±0.64) ml·min-1·g-1) and LV-MFR (2.17±0.54) of control group; summed SS and summed DS were higher than control group (all P<0.05). With the positive standard of coronary artery stenosis ≥75%, the LV-sMBF ((1.19±0.34) ml·min-1·g-1) and LV-MFR (1.34±0.35) of stenosis group were lower than the LV-sMBF ((1.94±0.63) ml·min-1·g-1) and MFR (2.00±0.58) of control group; all semi-quantitative parameters were higher than control group (all P<0.05). At the vascular level, with coronary artery stenosis ≥50% as the diagnosis criteria, the sMBF ((1.26±0.49) ml·min-1·g-1) and MFR (1.35±0.46) of stenosis group were lower than the sMBF ((1.95±0.70) ml·min-1·g-1) and MFR (2.05±0.65) of control group; SS and DS were higher than control group (all P<0.05). With coronary artery stenosis≥75% as the diagnosis criteria, the sMBF ((1.12±0.41) ml·min-1·g-1) and MFR (1.25±0.38) of stenosis group were lower than the sMBF ((1.84±0.70) ml·min-1·g-1) and MFR (1.93±0.66) of control group; all semi-quantitative parameters were higher than control group (all P<0.05). With coronary artery stenosis≥50% as the diagnosis criteria and CAG as the reference standard, the AUC and 95%CI of myocardial quantitative blood flow parameters indicated by ROC curve for diagnosis of CAD were 0.830 (0.783-0.877). The sensitivity (86.1% vs. 61.5%), specificity (82.6% vs. 73.8%), positive predictive value (77.8% vs. 62.5%), negative predictive value (89.3% vs. 73.0%) and accuracy (84.0% vs. 68.7%) were all higher than the semi-quantitative parameters (all P<0.05). With coronary artery stenosis≥75% as the diagnosis criteria, the AUC and 95%CI of myocardial quantitative blood flow parameters indicated by ROC curve for diagnosis of CAD were 0.832(0.785-0.879). The sensitivity (89.2% vs. 67.6%), negative predictive value (95.5% vs. 86.2%) and accuracy (80.6% vs. 68.0%) were all higher than semi-quantitative parameters (all P<0.05). Conclusion: Compared with traditional SPECT MPI derived semi-quantitative parameters, diagnostic efficacy for CAD is higher using CZT SPECT quantitative myocardial blood flow parameters, this strategy thus has additional diagnostic benefits and incremental value on the diagnosis of CAD.

Risk factors for potential drug-drug interactions of statins in patients with acute coronary syndrome

Abstract The aim of our study was to assess risk factors for potential drug-drug interactions (pDDIs) of statins across different phases of treatment of acute coronary syndrome (ACS) patients: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization (second phase) and at discharge from hospital (third phase). This was a post hoc analysis of the data collected during the retrospective observational cohort study conducted at the Clinic for Cardiology of the Clinical Centre Kragujevac, Serbia. Patients prescribed statins were identified from the original study population: 156, 240 and 236 patients for the first, second and third phases, respectively. At least one statin pDDI was present in 113 (72.4%), 161 (67.1%) and 139 (58.9%) patients in the first, second and third phases, respectively. Heart failure, arrhythmias after ACS, CRP, triglycerides, length of hospitalization, number of prescribed drugs, antiarrhythmic drugs, and clopidogrel seem to increase the risk of statin pDDIs in at least one treatment phase. Physicians should be vigilant to the possibility of statin pDDIs in ACS patients who have factors that may increase their rate.

Index of microcirculatory resistance: state-of-the-art and potential applications in computational simulation of coronary artery disease / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The dysfunction of coronary microcirculation is an important cause of coronary artery disease (CAD). The index of microcirculatory resistance (IMR) is a quantitative evaluation of coronary microcirculatory function, which provides a significant reference for the prediction, diagnosis, treatment, and prognosis of CAD. IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions, and is closely associated with coronary hemodynamic parameters such as flow rate, distal coronary pressure, and aortic pressure, which have been widely applied in computational studies of CAD. However, there is currently a lack of consensus across studies on the normal and pathological ranges of IMR. The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified, which limits the application of IMR in computational CAD studies. In this paper, we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD. Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.

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.

Comparação dos Resultados entre os Fenômenos de No-Reflow e Slow-Flow Coronariano em Pacientes sem IAMSSST / Comparison of the Outcomes between Coronary No-Reflow and Slow-Flow Phenomenon in Non-STEMI Patients

Resumo Fundamento: Os fenômenos de slow-flow (CSFP) e no-reflow coronariano (CNP) estão associados a um risco aumentado de eventos cardiovasculares adversos maiores (ECAM). Objetivos: Este estudo teve como objetivo avaliar e comparar os resultados do seguimento clínico de um ano entre pacientes com CNP e CSFP submetidos a intervenções coronárias percutâneas (ICP) em infarto agudo do miocárdio sem supradesnivelamento do segmento ST (IAMSSST). Métodos: Este estudo incluiu um total de 858 pacientes com diagnóstico de IAMSSST e submetidos a ICP nas 24 horas desde o início dos sintomas. Os pacientes foram divididos em dois grupos, o grupo CSFP (n = 221) e o grupo CNP (n = 25), considerando as características angiográficas do fluxo da trombólise no infarto do miocárdio (TIMI) e na artéria relacionada ao infarto. Os pacientes tiveram um seguimento de um ano. Um valor de p <0,05 foi considerado significativo. Resultados: O CNP foi observado em 2,91% e o CSFP em 25,75% dos pacientes. Os desfechos clínicos analisaram que a incidência de acidente vascular cerebral (AVC) foi significativamente maior no grupo CNP do que no grupo CSFP (6 (24%) vs. 6 (2,70%), p <0,001) e a de ECAM foi significativamente maior no grupo CNP do que no grupo CSFP (11 (44%) vs. 51 (23,10%), p = 0,022). A análise de regressão logística condicional forward demonstrou que o índice de massa corporal (IMC) (OR = 1,11, IC95%: 1,00-1,24, p = 0,038) e frequência cardíaca (FC) basal (OR = 0,923, IC 95%: 0,88-0,96, p <0,001) foram os preditores independentes de CNP no IAMSSST. Conclusões: Pacientes com CNP têm piores resultados clínicos e um maior risco de AVC em comparação com pacientes com CSFP no IAMSSST.

Abstract Background: Coronary slow-flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) are associated with increased risk of major cardiovascular adverse events (MACE). Objectives: This study aimed to evaluate and compare the one-year clinical follow-up outcomes among patients with CNP and CSFP who underwent percutaneous coronary interventions (PCI) in non-ST elevation myocardial infarction (NSTEMI). Methods: This study included a total of 858 patients who were diagnosed with NSTEMI and underwent PCI within 24 h of symptom onset. The patients were divided into two groups, the CSFP group (n=221) and the CNP group (n=25), regarding the angiographic characteristics of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery. Patients were followed for one-year. A p-value of <0.05 was considered significant. Results: CNP was observed in 2.91%, and CSFP was observed in 25.75% of the patients. Clinical endpoints analyzed that stroke was significantly higher in the CNP group than in the CSFP group (6 (24%) vs. 6 (2.70%), p<0.001) and MACE was significantly higher in the CNP group than in the CSFP group (11 (44%) vs. 51 (23.10%), p=0.022). Forward conditional logistic regression analysis demonstrated that body mass index (BMI) (OR=1.11, 95%CI: 1.00-1.24, p=0.038) and baseline heart rate (HR) (OR=0.923, 95%CI: 0.88-0.96, p<0.001) were the independent predictors of CNP in NSTEMI. Conclusion: CNP patients have worse clinical outcomes and a higher risk of stroke compared with CSFP patients in NSTEMI. (Arq Bras Cardiol. 2021; 116(5):856-864)

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries - Stratifying the Risk of a "new" Clinical Entity using an "Old" Tool

Abstract Background Some of the patients admitted for acute myocardial infarction have non-obstructive coronary artery disease (MINOCA). Their prognosis is not always benign, making it necessary the development of tools for risk stratification of these patients. Objectives To describe the characteristics of a sample of patients admitted for suspected MINOCA and to evaluate the prognostic value of GRACE score in this population. Methods This was a retrospective, observational, single-center, cohort study involving 56 consecutive patients with MINOCA. During one-year follow-up, patients were assessed for mortality and major adverse cardiovascular events (MACE) - a composite of all-cause mortality and hospitalization due to acute myocardial infarction, heart failure, ischemic stroke, and acute limb ischemia. Statistical analysis was performed using a non-parametric approach, with the Mann-Whitney U test for quantitative variables and ROC curves for assessing the discriminatory power of the Grace score in predicting cardiovascular events. The level of significance was set at 5%. Results Of the 56 MINOCA patients included in the study (median age 67 years), 55.4% were female. During the one-year follow-up, mortality rate was 5.5% and 9.1% of patients had MACE. A higher GRACE score was associated with mortality (p = 0.019; AUC 0.907; 95%CI 0.812-1.000; cut off 138) and MACE (p =0.034; AUC 0.790; 95%CI 0.632-0.948; cutoff 114). Conclusion The definition of MINOCA includes various diagnoses and prognoses, and the GRACE score is useful for risk stratification of patients with this condition.

Incidental lung findings in coronary computed tomography angiography

SUMMARY OBJECTIVE: In coronary computed tomography angiography, a part of the lung parenchyma also enters the image area which is called the field of view. The aim of this study was to evaluate the rate of pulmonary abnormalities and document their association with demographic features in subjects undergoing multislice coronary computed tomography angiography obtained for the assessment of coronary artery disease. METHODS: This was a retrospective observational study evaluating the coronary computed tomography angiography scans of 1,050 patients (58.5% males and 47.3% smokers) with a mean age of 52.2±11.2 years, obtained between January 2018 and March 2020. Pulmonary abnormalities were reported as nodules, focal consolidations, ground-glass opacities, consolidations, emphysema, cysts, bronchiectasis, atelectasis, and miscellaneous. RESULTS: In total, 274 pulmonary abnormalities were detected in 266 patients (25.3%). The distribution of incidental lung findings was as follows: pulmonary nodules: 36.4%, emphysema: 15.6%, bronchiectasis: 11%, ground-glass opacities: 7.2%, atelectasis 7.2%, focal consolidations: 5%, cysts: 6%, consolidations: 2.5%, and miscellaneous: 9.1%. The patients with pulmonary pathology were older (55.5±11.4 versus 51.0±10.9 years), and the percentage of smokers was higher (60.1 versus 43.2%). The possibility of the presence of any incidental lung findings in field of view of coronary computed tomography angiography increases significantly over the age of 40.5 years (p<0.001, AUC 0.612, 95%CI 0.573-0.651). CONCLUSION: Multislice coronary computed tomography angiography can give important clues regarding pulmonary diseases. It is essential for the reporting radiologist to review the entire scan for pulmonary pathological findings especially in patients with smoking history and over the age of 40.5 years.