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Objective:To investigate the predictive value of plasma high-sensitivity C-reactive protein/albumin ratio (HCRP/ALB) for the death in patients with acute coronary syndrome (ACS).Methods:The clinical data of patients with ACS [including unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI)] admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2018 to August 2020 were retrospectively analyzed. The plasma HCRP and ALB were recorded and the HCRP/ALB ratio was calculated. Patients were divided into death group and survival group according to the hospital outcome. The differences of baseline data and biochemical indexes between the two groups were compared. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of each variable to death. Logistic regression was used to analyze the risk factors of death.Results:Among the 1 722 ACS patients, 74 died in hospital. Comparison of baseline data between death group and survival group showed that the other baseline data were statistically different except for the rate of hyperlipidemia. Among them, patients in death group had higher heart rate (HR), HCRP, B-type natriuretic peptide (BNP), HCRP/ALB [HR (bpm): 89±19 vs. 73±15, HCRP (mg/L): 23.24 (9.79, 33.69) vs. 3.57 (1.03, 14.26), BNP (ng/L): 424.0 (164.3, 1 596.1) vs. 79.0 (31.0, 211.4), HCRP/ALB: 0.700 (0.289, 1.017) vs. 0.089 (0.026, 0.368), all P < 0.01], while ALB was lower (g/L: 35.37±5.16 vs. 39.97±6.43, P < 0.01). ROC curve analysis showed that area under ROC curve and 95% confidence interval [AUC (95% CI)] of BNP, HCRP and HCRP/ALB for predicting death were 0.781 (0.717-0.845), 0.790 (0.724-0.856) and 0.803 (0.738-0.869), respectively. The Youden index of HCRP/ALB was 0.559, and the corresponding HCRP/ALB was 0.246. The patients were divided into low HCRP/ALB group (HCRP/ALB≤ 0.246, 1 163 cases) and high HCRP/ALB group (HCRP/ALB > 0.246, 559 cases). Except for gender, previous smoking, hypertension and diabetes rates, the other baseline data were statistically different between the two groups. Patients in the high HCRP/ALB group had a higher mortality (10.4% vs. 1.4%, P < 0.01), higher rates of implanted intra-aortic balloon pump (IABP, 12.7% vs. 2.7%, P < 0.01), higher BNP, HCRP, HCRP/ALB [BNP (ng/L): 253.0 (82.8, 749.0) vs. 60.0 (26.0, 145.2), HCRP (mg/L): 25.42±17.47 vs. 2.62±2.43, HCRP/ALB: 0.700±0.435 vs. 0.066±0.062, all P < 0.01], while lower ALB (g/L: 36.89±4.30 vs. 41.17±6.83, P < 0.01). Logistic regression analysis showed that higher HR [odds ratio ( OR) = 1.037, 95% CI was 1.020-1.055, P = 0.000] and higher HCRP/ALB ( OR = 3.835, 95% CI was 1.612-9.125, P = 0.002) were independent risk factors for the death in ACS patients, while higher ALB could reduce the mortality in ACS patients ( OR = 0.884, 95% CI was 0.818-0.957, P = 0.002). Conclusions:The higher the HCRP/ALB, the higher the risk of death in patients with ACS. When HCRP/ALB is greater than 0.246, the patient has a higher mortality. Therefore, HCRP/ALB in patients with ACS can be used as an effective predictor for death risk.
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Objective To investigate the effects of percutaneous coronary intervention(PCI)on life quality and cardiac events in elderly patients with stable angina owing to chronic coronary total occlusion(CTO).Methods Patients with stable angina due to CTO hospitalized in Beijing Anzhen Hospital from January 2015 to January 2018 were consecutively recruited in this prospective study,and were randomly divided into the combined treatment group(n=44)and the control group (n=43).Patients in the combined treatment group were treated with PCI and optimal medical therapy,and those in the control group were treated with optimal medical therapy alone.Patients followed up for 6 months after treatment.Cardiac function,life quality(Seattle angina questionnaire,SAQ)and adverse cardiovascular events were compared before and after treatment.Results A total of 87 patients were involved,with a mean age of (69.5 ± 7.2) years.Basic characteristics,including age,sex ratio,previous history,left ventricular ejection fraction,coronary artery lesions and SAQ scores,were similar between the groups(P＞0.05).After a 6 month post treatment follow up,SAQ scores improved in all patients,compared with those before treatment(P＜0.05).Moreover,patients in the combined treatment group had higher SAQ scores on physical limitation(86.3 ± 11.6 vs.76.3 ± 21.3),angina stability(67.3 ±24.5 vs.57.3±21.2)and angina frequency(93.3±4.3 vs.86.4±8.3)than those in the control group (P ＜0.05).There was no significant difference in major adverse cardiovascular event rate between the groups[18.2％(8 cases) vs.16.3％(7 cases),X2 =0.055,P＞0.05].Conclusions Combined with optimal medical therapy,PCI can improve the life quality in elderly patients with stable angina due to CTO,but has no significant influence on the short-term major adverse cardiovascular event rate.
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Objective To evaluate the efficacy of Sacubitril/Valsartan in the treatment of chronic heart failure in elderly patients with dilated cardiomyopathy.Methods A total of 126 elderly patients with dilated cardiomyopathy induced chronic heart failure who were treated in Beijing Anzhen Hospital from January 2017 to December 2017 were enrolled and randomly divided into the experimental group(n=62)and the control group(n=64).All patients were given a standard heart failure treatment,and the experimental group underwent sacubitril/valsartan(100 mg Bid)and the control group received benazepril (10 mg Qd)additionally for 12 months.Left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP),six-minute walk test(6MWT) and major adverse cardiovascular events(mortality and readmission for heart failure)were compared between the two groups.Results Of 126 elderly patients,73 patients(57.9％)were male,and 53were female,with a mean ± SD age of (67.2 ± 5.8) years.Basic characteristics,including age,gender,clinical history of hypertension and diabetes,LVEF,NT-proBNP and 6MWT,showed no significant difference between two groups (P ＜ 0.05).After 12 months of treatment,symptomatic hypotension occurred in one cases in each group.In the control group,NT-proBNP level was decreased after treatment as compared with before treatment[(983.3± 326.1) ng/L vs.(1 779.1 ± 478.1) ng/L,P ＜0.05],and no significant difference was found in LVEF and 6MWT at post-treatment versus pretreatment(P ＞ 0.05).In the experimental group,LVEF,NT-proBNP level and 6MWT were significantly improved in post-treatment versus pre-treatment (P ＞ 0.05).And LVEF,NT-proBNP level and 6MWT were significantly better in the experimental group than in the control group[(38.5 ±3.1)％ vs.(36.9±3.0)％,(744.5±246.7) ng/L vs.(983.3±326.1) ng/L,(323.4±60.5) m vs.(283.5±45.9)m,P＜0.05].The readmission rate for heart failure was lower in the experimental group than in the control group(26.6％ or 19 cases vs.46.8％ or 30 cases,P＜0.05),while no significant difference was found in mortality between the two groups (P ＞ 0.05).Conclusions Compared with benazepril,sacubitril/valsartan can improve the left ventricular function and exercise tolerance,and reduce the readmission rate due to chronic heart failure in patients with dilated cardiomyopathy.However,more studies are needed to assess the effects of sacubitril/valsartanthe on the prognosis of advanced elderly patients(＞88 years old)who have a preserved LVEF and a chronic end-stage heart failure(NYHA Ⅳ),and start the drug administration at different time points(before or after discharge).