Preoperative evaluation profile of patients undergoing arterial vascular surgery in a tertiary hospital

ABSTRACT Background: Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them. The aim of this study was to compare the preoperative evaluation conducted by general practitioners with those performed by cardiologists. Methods: This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients' clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others. Results: 281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001). Conclusion: The increased request for exams didn't have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources.

Determining the Association between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients with Acute Myocardial Infarction: A Prospective Study

Acute myocardial infarction (AMI) is a challenging cardiovascular disease leading to a high rate of mortality. Some cardiomyocytes in AMI were affected by ischemia and necrosis, resulting in a decrease in myocardial contractility, an acute proinflammatory response, and an increase in sympathetic tone. In the meantime, proinflammation and endothelial dysfunction are induced by high blood pressure variability (BPV), which increases left ventricular workload, heart rate, and myocardial oxygen demand. As a result, a high BPV and the pathological effects it causes are likely to affect the onset of acute cardiac complications in AMI and the physiological function of the heart [1]. Patients Pulse changeability (BPV) has been fundamentally concentrated on through the crystal of congestive cardiovascular breakdown (CHF) and hypertension, yet not in that frame of mind of an intense coronary condition (ACS). This study means to explore the relationship between transient BPV and major unfavorable heart occasions (MACE) in AMI patients. The following order can be used to define MACEs: Death > shock > cerebrovascular stroke > heart failure > hypertensive crisis > life-threatening arrhythmias .This prospective study used the weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings to include 74 patients who were hospitalized in the cardiology department at ARRAZI hospital MOHAMED VI, MARRAKECH between September 2022 and February 2023. Results: The average systolic BPV value which was estimated as standard deviation (SD) and average real variability (ARV) was more significant in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 12,78 mmHg and 11,61 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.45 mmHg and 7,23 mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE, unlike patients who didn’t experienced MACE for whom the ARV was nearly the same for patient with and without HBP. Conclusion: MACE was higher in the group BPV of AMI patients than that of non-MACE AMI patients. There was no significant association between BPV ??and MACE during the acute phase of AMI, however the BPV was significantly more important for HBP patient who experienced MACE, which leads us to think that the screening of BPV in HBP patient may by a predictive factor for the development of MACEs.

Anti-inflammatory Therapy Progress in Major Adverse Cardiac Events after PCI: Chinese and Western Medicine / 中国结合医学杂志

Acute coronary syndrome (ACS) is one of the leading causes of death in cardiovascular disease. Percutaneous coronary intervention (PCI) is an important method for the treatment of coronary heart disease (CHD), and it has greatly reduced the mortality of ACS patients since its application. However, a series of new problems may occur after PCI, such as in-stent restenosis, no-reflow phenomenon, in-stent neoatherosclerosis, late stent thrombosis, myocardial ischemia-reperfusion injury, and malignant ventricular arrhythmias, which result in the occurrence of major adverse cardiac events (MACE) that seriously reduce the postoperative benefit for patients. The inflammatory response is a key mechanism of MACE after PCI. Therefore, examining effective anti-inflammatory therapies after PCI in patients with ACS is a current research focus to reduce the incidence of MACE. The pharmacological mechanism and clinical efficacy of routine Western medicine treatment for the anti-inflammatory treatment of CHD have been verified. Many Chinese medicine (CM) preparations have been widely used in the treatment of CHD. Basic and clinical studies showed that effectiveness of the combination of CM and Western medicine treatments in reducing incidence of MACE after PCI was better than Western medicine treatment alone. The current paper reviewed the potential mechanism of the inflammatory response and occurrence of MACE after PCI in patients with ACS and the research progress of combined Chinese and Western medicine treatments in reducing incidence of MACE. The results provide a theoretical basis for further research and clinical treatment.

Analysis of major adverse cardiac events and risk factors during perioperative period of cervical spine surgery / 中国综合临床

Objective:To understand the occurrence of major adverse cardiac events (MACE) during the perioperative period of cervical spine surgery and analyze its risk factors.Methods:A retrospective analysis of 426 cervical spine surgery patients admitted to the from March 2017 to March 2021. The basic information of the patients, including gender, age, body mass index (BMI), underlying diseases, and the Charlson comorbidity index (CCI) was calculated based on the underlying diseases.The preoperative serum cardiac troponin I(cTnI) level and the operation-related indicators were collected,including the type of cervical spine surgery, surgical procedure, approach, duration of surgery, duration of anesthesia, intraoperative bleeding, postoperative pain visual analogue scale (VAS), and electrolyte disturbances. Count data were expressed as cases (%), and comparisons between groups were made using the χ 2 test; logistic regression models were applied to perform a multifactorial analysis of the factors influencing the perioperative occurrence of MACE in patients undergoing cervical spine surgery. Results:Among the 426 patients, 54 (12.68%) experienced MACE during the perioperative period, including 4 cases of unstable angina (7.41%), 4 cases of acute myocardial infarction (7.41%), 33 cases of severe arrhythmia (61.11%), and 13 cases of acute heart failure (24.07%). The results of multivariate logistic regression analysis showed that the older the age group (50-59 years old: odds ratio=1.34, 95% confidence interval: 1.14-1.78; 60-69 years old: odds ratio=1.48, 95% confidence interval: 1.20-1.86; 70-79 years old: odds ratio=1.71, 95% confidence interval: 1.34-2.57; 80-89 years old: odds ratio=1.95, 95% confidence interval: 1.46-2.85), as well as females, CCI scores>3, and preoperative cTnI>0.04 μg/L, postoperative VAS score>5, and electrolyte disorders are all influencing factors for the occurrence of MACE in cervical spine surgery patients during the perioperative period (odds ratios of 1.84, 2.12, 2.34, 2.57, 2.20, 95% confidence intervals of 1.34-2.68, 1.50-3.41, 1.63-3.72, 1.53-4.01, 1.43-3.69, all P<0.05). Conclusions:The incidence of MACE in the perioperative period of cervical spine surgery is relatively high. Elderly age, female, high CCI score, high preoperative serum cTnI, postoperative pain and electrolyte disturbance are independent risk factors for the perioperative period of cervical spine surgery.

Exploration of critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases / 中华老年医学杂志

Objective:The purpose of this study was to explore the critical values of monitored indexes of perioperative major adverse cardiac events(MACE), so as to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function to further improve the perioperative safety of elderly patients with biliary diseases.Methods:The clinical data of 246 elderly patients with biliary diseases in our hospital from May 2016 to February 2022 were collected.According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.The differences of clinical data, the monitoring indexes of postoperative cardiac function, and the coagulation function between the two groups were compared and analyzed.Logistic regression was used to analyze the independent risk factors of perioperative MACE, the cut-off value of the receiver operating characteristic(ROC)curve was calculated, and the Logistic multivariate prediction model was established.Results:In the MACE compared with the non-MACE group, age, postoperative complications and mortality, postoperative hospital stay, and the levels of postoperative high sensitivity troponin-I(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and D-dimer(D-D)were significantly increased(all P<0.05). Multivariate Logistic regression showed that postoperative BNP and D-D were two independent risk factors for perioperative MACE, and their cut-off values in the ROC curve were 382.65 pg/mL and 0.975mg/L respectively.The Logistic multivariate prediction model established by the Logistic regression equation was P= ex/(1+ ex), X=-5.710+ 0.003X 1+ 0.811X 2, where X 1 was the postoperative BNP level and X 2 was the postoperative D-D level.The accuracy, specificity and sensitivity of this prediction model for predicting perioperative MACE were 96.3%(237/246), 100.0%(235/235), and 18.2%(2/11). Conclusions:The Logistic multivariate prediction model established in this study can effectively predict the occurrence of perioperative MACE in elderly patients.Postoperative BNP and D-D were two independent risk factors for perioperative MACE.The cut-off values of BNP and D-D in the ROC curve could be used as critical values for monitoring perioperative MACE.Therefore, it is of great clinical significance to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function, and further improve the perioperative safety of elderly patients with biliary diseases.

Prognostic value of age, creatinine, and left ventricular ejection fraction risk score in patients evaluated with fractional flow reserve: a cross-sectional study

SUMMARY OBJECTIVE: In this study, we investigated the relationship between age, creatinine, and left ventricular ejection fraction risk score and the severity of coronary lesions detected by applying fractional flow reserve in the patient group presenting with chronic coronary syndrome. Also, we presented long-term follow-up results in patients whose age, creatinine, and left ventricular ejection fraction score was evaluated by the fractional flow reserve procedure. METHODS: This study was planned retrospectively and in two centers. For this purpose, 114 patients who met the study criteria and who underwent elective fractional flow reserve between January 2014 and January 2019 were included in the study. Age, creatinine, and left ventricular ejection fraction was calculated as age/left ventricular ejection fraction +1 (if estimated glomerular filtration rate<30 mL/min). RESULTS: They were divided into two groups according to the cutoff value of the age, creatinine, and left ventricular ejection fraction score. A total of 76 patients had an age, creatinine, and left ventricular ejection fraction score of ≤1.17 (Group I) and 38 patients had an age, creatinine, and left ventricular ejection fraction score of >1.17 (Group II). The number of patients with severe lesions in fractional flow reserve was significantly higher in Group II compared with Group I (60.5 vs. 32.9%, p=0.005). According to the Kaplan-Meier analysis, a significant increase was observed in major adverse cardiac events and mortality during the follow-up period in the group with a high-risk score (Log Rank: 15.01, p<0.001 and Log Rank: 8.51, p=0.004, respectively). CONCLUSION: In light of the data we obtained from our study, we found a correlation between the severity of the lesion detected in fractional flow reserve and the age, creatinine, and left ventricular ejection fraction scores. In addition, we found that patients with high age, creatinine, and left ventricular ejection fraction scores had higher mortality and major adverse cardiac events rates during follow-up.

Preoperative Anxiety Among Cardiac Surgery Patients and Its Impact on Major Adverse Cardiac Events and Mortality– A Randomized, Parallel?Group Study

Background:Patients undergoing elective cardiac surgery often experience pre?operative anxiety. Preoperative anxiety influences surgical outcome. There are very few studies which have assessed the impact of clonidine and Gabapentin in the treatment of anxiety especially in Indian populations and its implications on major adverse cardiac events (MACE) and 30 days mortality. Materials and Methods: Adult patients aged 18 to 80 years old who were scheduled to have an elective coronary artery by?pass graft (CABG) were included in the study.Those who satisfied the inclusion criteria were given either Gabapentin (800 mg) or Clonidine (300 mcg) 90?120 minutes before the induction. State trait anxiety inventory (STAI) was used to assess anxiety in baseline and taking just before operating room. The primary endpoint was a reduction in the STAI associated with the study drug, while the secondary endpoint was the incidence of MACE in the perioperative period (30 days), which included composite episodes of non?fatal cardiac arrest, chaotic rhythm, acute myocardial infarction, congestive heart failure, cardiac arrhythmia, angina, and death. Results: A total of 75 patients were considered for the statistical analysis. The demographic and clinical features of the study participants were similar in both groups. Nearly 75?80% of participants had severe anxiety in the preoperative period while 10?20% had moderate anxiety. While both the drugs showed a reduction in the anxiety levels, the clonidine group fared better (statistically insignificant). The incidence of MACE was similar in both groups. Conclusion:The preoperative anxiety levels were high among cardiac surgery patients.Both clonidine and gabapentin were equally effective in reducing the levels of preoperative anxiety. Preoperative STAI scores in the range of 32?53 is not associated with MACE and 30?day mortality among cardiac surgery patients.

Impact of drug-eluting stent-associated coronary artery spasm on 3-year clinical outcomes: A propensity score matching analysis

Background: It has been reported that significant endothelial dysfunction or clinically evident vasospasm can be associated with drug-eluting stents (DESs). However, the impact of DES associated coronary artery spasm (CAS) on long-term clinical outcomes has not been fully elucidated as compared with those of patients with vasospastic angina. Methods: A total of 2797 consecutive patients without significant coronary artery lesion (<70%), who underwent the Acetylcholine (Ach) provocation test, were enrolled between Nov 2004 and Oct 2010. DES-associated spasm was defined as significant CAS in proximal or distal to previously implanted DES site at follow-up angiography with Ach test. Patients were divided into two groups (DES-CAS; n ¼ 108, CAS; n ¼ 1878). For adjustment, propensity score matching (PSM) was done (C-statistics ¼ 0.766, DESCAS; n ¼ 102, CAS; n ¼ 102). SPSS 20 (Inc., Chicago, Illinois) was used to analyze this data. Results: Baseline characteristics were worse in the DES-CAS group. After PSM, both baseline characteristics and the Ach test results were balanced except higher incidence of diffuse CAS and ECG change in the DES-CAS group. During Ach test, the incidence of diffuse spasm (93.1% vs. 81.3%, p ¼ 0.012) and ST-T change (10.7% vs. 1.9%, p ¼ 0.010) were higher in the DES-CAS group. At 3-year, before and after adjustment, the DES-CAS group showed a higher incidence of coronary revascularization (9.8% vs. 0.0%, p ¼ 0.001), recurrent chest pain requiring follow up coronary angiography (CAG, 24.5% vs. 7.8%, p ¼ 0.001) and major adverse cardiac events (MACEs, 9.8% vs. 0.9%, p < 0.005). Conclusion: In this study, DES associated CAS was associated with higher incidence of diffuse spasm, ST-T change and adverse 3-year clinical outcomes. Special caution should be exercised in this particular subset of patients.

Evaluation value of atherogenic index of plasma for long-term prognosis of coronary artery disease / 中国医师杂志

Objective:To determine the predictive value of atherogenic index of plasma (AIP) on the long-term prognosis of patients with coronary artery disease (CAD).Methods:A total of 2 500 patients with coronary heart disease who underwent coronary angiography in Affiliated Hospital of Jining Medical University from May 2013 to November 2015 were retrospectively analyzed. According to the AIP value, the subjects were divided into low AIP group (AIP<0.06) and high AIP group (AIP≥0.06). The incidence of major adverse cardiovascular events (MACE) was compared between the two groups. Kaplan-meier method was used to evaluate the MACE-free survival rate, and multivariate Cox survival analysis was used to evaluate the independent predictors of MACE.Results:A total of 2 427 patients were followed up, with a follow-up rate of 97.08% and a median follow-up time of 4.29 years. There were 1 123 cases in the low AIP group and 1 304 cases in the high AIP group, among which 624 patients (25.7%) had MACE. The total incidence of MACE in the high AIP group was higher than that in the low AIP group ( HR=1.43, 95% CI: 1.22-1.68, P<0.01). Kaplan-meier curves showed that the MACE-free survival rate was significantly lower in the high AIP group ( P<0.01). After adjusting for multiple confounding factors, AIP was still associated with the prognosis of CHD patients. Increased AIP (≥0.06) was an independent predictor of MACE in CHD patients within 4 years ( HR=1.34, 95% CI: 1.14-1.58, P<0.01). Conclusions:AIP (≥0.06) was an independent predictor of MACE occurrence in patients with CAD within 4 years. AIP has a certain value in the long-term prognosis of patients with CAD.

Valor pronóstico del speckle-tracking bidimensional en pacientes con sospecha de cardiopatía isquémica / Prognostic value of two-dimensional speckle-tracking echocardiography in patients with suspected ischemic heart disease

RESUMEN Introducción: El estudio ecocardiográfico mediante speckle-tracking ha emergido como un novedoso método para la evaluación cuantitativa de la función miocárdica y se ha correlacionado con la presencia de enfermedad coronaria. Objetivo: Determinar el valor pronóstico de la deformación miocárdica (strain) por speckle-tracking bidimensional en la evolución de pacientes con sospecha de cardiopatía isquémica. Método: Estudio longitudinal prospectivo analítico con 51 pacientes a los que se realizó ecocardiograma con evaluación de la deformación (strain) longitudinal global por speckle-tracking bidimensional y coronariografía en el CIMEQ entre 2016 y 2018. Se siguieron los eventos cardíacos graves (infarto de miocardio, muerte cardíaca y por otras causas, enfermedad cerebrovascular y necesidad de nueva revascularización). Resultados: El 70,6% de los enfermos resultaron ser del sexo masculino, el 81,4% mayores de 50 años y 81,4%, fumadores. El 65,0% tenía enfermedad coronaria significativa y 55,0% de los casos fueron revascularizados. Se registraron 4 muertes (7,8%) y un infarto no fatal (2,0%). Los pacientes con deformación longitudinal global ≤ -15% (en valores absolutos) tuvieron mayor frecuencia de eventos cardíacos graves (p=0,02). Conclusiones: La deformación longitudinal global medida por speckle-tracking bidimensional no pudo predecir la presencia de enfermedad coronaria, pero sí los eventos cardiovasculares graves en los enfermos con enfermedad coronaria significativa.

ABSTRACT Introduction: Two-dimensional speckle-tracking echocardiography has emerged as a novel method for the quantitative evaluation of myocardial function and it has been correlated with the presence of coronary artery disease. Objective: To determine the prognostic value of myocardial strain by two-dimensional speckle-tracking echocardiography in the evolution of patients with suspected ischemic heart disease. Method: An analytical prospective longitudinal study was carried out with 51 patients, who underwent global longitudinal strain assessment by two-dimensional speckle-tracking echocardiography, and coronary angiography at CIMEQ between 2016 and 2018. Major cardiac adverse events (myocardial infarction, cardiac and non-cardiac cause of death, cerebrovascular disease, and need for new revascularization) were followed. Results: The 70.6% of patients were male, the 81.4% were older than 50 years old, and the 81.4% were smokers. The 65.0% of patients had significant coronary artery disease and the 55.0% underwent myocardial revascularization. There were four deaths (7.8%) and one non-fatal myocardial infarction (2.0%). Patients with global longitudinal strain ≤ -15% (in absolute or modular values) had a higher frequency of major adverse cardiovascular events (p=0.02). Conclusions: Global longitudinal strain by two-dimensional speckle-tracking echocardiography could not predict the presence of coronary artery disease, but it did predict major adverse cardiovascular events in patients with significant coronary artery disease.

Clinical Outcome of Intravascular Ultrasound Guided Left Main Coronary Intervention

ntroduction: Intravascular ultrasound is a new imaging modality that facilitate the process of coronary intervention. The angiographic evaluation of left main lesions significance is always questionable, IVUSdetect the significance, guide the procedure and some studies proves a benefit in mortality.Objectives:To investigate whether intravascular ultrasound IVUS guided Left Main coronary intervention could improve clinical outcomes compared with angiographic-guided Left main coronary PCI.Patientsand Methods:This controlled study was carried out between June 2017 and June 2019, in Tanta university Hospital and San Donato Hospital, Milan, 83 patients eligible to Left Main coronary intervention divided into two groups, IVUS-guided group (n=19) and angiographic-guided group(n=64). The occurrence of major adverse cardiac events(MACE): death, non-fatal myocardial infarction, or target lesion revascularizations) were recorded 6 and18Months of follow-up Results:The IVUS-guided group had a lower rate of 18-months MACE than the control group. The incidence of target lesion revascularization was lower in the IVUS-guided group than in the control group. The incidence of TLR after 6 months was not different between both groups (1 cases in IVUS group (5.3%), 6 cases in angiography group (9.4%) (P value 0.686) while the incidence of TLR after 18 months was significantly different between both groups (1 cases in IVUS group (5.3%), 17 cases in angiography group(26.6%) (Pvalue 0.048), However, there were no differences in death, myocardial infarction, stent thrombosis and number of patients treated with CABG in the 2 groups.Conclusion:The present study demonstrates that IVUS-guided LM angioplasty can improve 18 -months MACE events especially the incidence of target lesion revascularization

Analysis of risk factors for adverse cardiac events in adults with acute myocarditis during hospitalization / 中华急诊医学杂志

Objective To analyze the risk factors of adverse cardiac events in adults with acute myocarditis during hospitalization and provide reference for clinical diagnosis and treatment.Methods A restrospective study was conducted in 80 patients (54 males and 26 females) with acute myocarditis over 18 years old admitted to our hospital between January 2007 and December 2016.Major adverse cardiac events (MACE) were defined as death,cardiac arrest,cardiogenic shock and ventricular fibrillation.According to whether MACE occurred during hospitalization,patients were divided into two groups:the MACE group and the non-MACE group.The differences between the two groups were compared,and the risk factors were analyzed by logistic regression.Results There were 12 patients in the MACE group and 68 patients in the non-MACE group.The age of patients in the two groups was similar.Compared with the non-MACE group,the proportion of female patient in the MACE group was higher (66.7％ vs 26.5％,P=0.015),and the systolic pressure (mmHg) was lower at admission (89.75±17.63 vs 112.49±16.35,P＜0.01),and the heart rate (beats/min) was faster (106.42±24.39 vs 82.66±20.92,P=0.001);ALT and creatinine levels in the MACE group were higher (P＜0.01),while the levels of TnI,CK-MB,CK and LDH were significantly higher (P＜0.05).The LVEF value of the MACE group was significantly lower at admission (45％ vs 60％,P=0.022),and the proportion of LVEF ＜ 50％ was also higher (58.3％ vs 19.1％,P=0.008) The proportion of prolonged QRS wave (＞120 ms) was significantly higher in the MACE group (75％ vs 17.6％,P＜0.01).In the MACE group,the proportion of diuretics and vasoactive drugs (dopamine,norepinephrine,and adrenaline) was higher (66.7％ vs 25％,91.7％ vs 4.4％,66.7％ vs 0,75％ vs 0％,all P＜0.01);the proportion of glucocorticoids and immunoglobulin was higher (33.3％ vs 8.8％,P=0.038;33.3％ vs 4.4％,P=0.008),and the proportion of ventilator,CRRT,ECMO and IABP were also higher (50％vs 1.5％,33.3％ vs 0,25％ vs 0％,25％ vs 0％,all P＜0.01).Logistic regression analysis showed that the OR value of MACE in female patients during hospitalization was 5.56 (95％CI:1.49-20.71,P=0.011).The OR value of MACE in patients with reduced LVEF at admission was 5.92 (95％CI:1.62-21.67,P=0.007).The OR value of MACE in patients with prolonged QRS wave was 14.00 (95％CI:3.29-59.55,P＜0.01).Conclusions Female patients,LVEF＜50％ at admission,and prolonged QRS wave (QRS＞120 ms) are independent risk factors for MACE in adult patients with acute myocarditis during hospitalization.

Predictors of major adverse cardiac events following elective stenting of large coronary arteries

Objective Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. Methods We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. Results Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5 mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio = 5.23, P = 0.030) and use of DES (odds ratio = 0.048, P = 0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. Conclusion This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.

Platelet Function Analyzer-200 P2Y Results Are Predictive of the Risk of Major Adverse Cardiac Events in Korean Patients Receiving Clopidogrel Therapy Following Acute Coronary Syndrome

BACKGROUND: Clopidogrel is one of the most commonly used anti-platelet agents in cardiovascular diseases. We analyzed the relationship between the platelet function analyzer (PFA)-200 P2Y (INNOVANCE PFA-200 System, Siemens Healthcare, Germany) results and occurrence of major adverse cardiac events (MACEs) in Korean patients with recent-onset acute coronary syndrome (ACS) taking clopidogrel. METHODS: Between August 2013 and June 2016, we prospectively enrolled 106 patients with recent-onset ACS who had been treated with clopidogrel. We obtained blood samples and measured closure time (CT) using the PFA-200 P2Y test. Patients were divided into two groups on the basis of a CT cut-off value of 106 seconds. We compared patient characteristics and various MACEs that occurred during the follow-up period. RESULTS: The CTs for 78 patients exceeded the cut-off value. At the time of these analyses, 11 patients had been diagnosed with MACEs. In the time-to-event analysis, there was a difference between the two groups (P<0.001). After adjusting other variables associated with MACE occurrence, CT value was the strongest predictor of MACEs, with a 7.30-fold occurrence risk (P=0.002). CONCLUSIONS: We found a strong relationship between CT and MACE risk in Korean patients with recent-onset ACS taking clopidogrel. Accordingly, PFA-200 P2Y results could be used as a predictive marker for MACE risk in such patients.

The comparison of clinical outcomes of the first and the second-generation drug-eluting stents implanted in vein grafts after coronary artery bypass graft / 天津医药

@#Objective To compare the clinical outcomes of the first and the second-generation drug-eluting stents (DES) implanted in saphenous vein grafts (SVG) in patients after coronary artery bypass graft (CABG). Methods A total of 108 patients with coronary angiography and DES implanting in SVG due to ischemia symptoms after CABG were collected in this study, including 69 patients with the first-generation of DES (drug-eluting: sirolimus) and 39 patients with the secondgeneration of DES (drug-eluting: zotarolimus or everolimus). The success rate of stents and mortality in hospital were compared between two groups of patients. The major adverse cardiac events (MACE), such as all-cause death, target vessel revascularization (TVR) and acute myocardial infarction (AMI) in 2-year follow-up were also compared between the two groups of patients. The survival curve was drawn by Kaplan-Meier method, and the MACE free survival rates of two groups of patients were compared. Cox regression analysis was used to evaluate the risk factors for MACE in patients with SVG stent implantation. Results There were no significant differences in the success rate of stents and mortality in hospital between the two groups. In average 2-year follow-up, a total of 37 cases of MACE were performed. There was no statistical difference in the incidence of MACE between the two groups (34.8% vs. 33.3%, P＞0.05). The proportion of TVR was significantly lower in the second-generation group than that of the first-generation group (13.0% vs. 2.6%, P＜0.05). Kaplan-Meier survival analysis showed that there were no statistically differences in the survival rates of no-cumulative events between the two groups (81.2% vs. 79.5%, Log-rank χ2=0.029, P＞0.05). COX regression analysis showed that diabetes (HR=2.530, 95% CI: 1.008-6.345, P=0.041) and stent diameter (HR=1.143, 95% CI: 1.043-1.253, P=0.004) were independent predictors for the MACE in patients implanted stents in SVG. Conclusion There are no significant differences in mortality in hospital and the MACE in 2-year follow-up between the patients of two generations of DES implanting in the SVG after coronary artery bypass grafting. The proportion of TVR is lower in the second-generation DES group. Patients with diabetes and large diameter stents have a poor prognosis.

Relationship between preoperative abnormal echocardiography and occurrence of postoperative major adverse cardiac events in non-cardiac surgery patients: A nested case-control study / 解放军医学杂志

Objective To investigate the relationship between preoperative abnormal transthoracic echocardiogram (TTE) and postoperative major adverse cardiac events (MACE) in patients undergoing non-cardiac surgery.Methods This study was a nested case control study.Patients who underwent elective non-cardiac surgery in Peking University First Hospital from November 15,2012 to January 15,2013 were enrolled.We screened patients who received preoperative TTE examination from electrical medical record.The primary outcome of this study was the incidence of postoperative MACEs.The patients were divided into MACE group and control group depending on if they suffered MACE.For each patient in MACE group,4 patients without MACE events were selected for control group in term of two criteria:same revised cardiac risk index and same type of surgery.Related perioperative data were collected.Multivariate logistic analysis was used for screening potential risk factors related to MACE.Results During the study period,a total of 2975 patients undergoing elective surgery,2081 met the inclusion criteria.Amongst these patients,530 patients received preoperative TTE examinations and 25 suffered postoperative MACEs.Overall incidence of TTE abnormalities was 91.9％(487/530).25 patients with MACE and 100 patients without MACE (as control group) were selected for case control analysis.The incidence of TTE abnormality was about 92.0％ (23/25) in MACE group and 93.0％(93/100) in control group (OR=0.866,95％CI 0.169-4.446,P=1.000).Multivariate logistic analysis showed that left ventricular hypertrophy was an independent risk of MACE (OR=4.324,95％CI 1.320-14.160,P=0.016),female(OR=4.782,95％CI 1.636-13.980,P=0.005) and history of chronic renal failure (OR=21.952,95％CI 1.547-311.475,P=0.016) were also related with MACE.The predictive value of preoperative TTE abnormality against MACE was very low in ROC analysis (AUC=0.501,P=0.992).Conclusions Left ventricular hypertrophy is related to increased risk of postoperative MACE.However,further studies are needed to confirm the value of TTE examination as a routine examination for cardiac evaluation before surgery.

Serum Copeptin Levels Predict Clinical Outcomes After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

BACKGROUND: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. METHODS: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. RESULTS: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P=0.005). CONCLUSIONS: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

Safflower yellow treats the myocardial injury in patients with severe sepsis / 中成药

AIM To investigate the effects of safflower yellow on myocardial injury in patients with severe sepsis.METHODS Using prospective research methods,ninety-two patients with severe sepsis treated in our hospital from Jan.2013 to Mar.2016 were divided equally into two groups:control group (routine treatment) and observation group (routine treatment + safflower yellow).In addition,6 and 72 hours after the treatment,heart-type fatty acid binding protein (H-FABP),creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) of patients were detected,and the changes of left ventricular ejection fraction (LVEF) and sequential organ failure assessment (SOFA) scores were observed;length of ICU stay,cumulative incidence of major adverse cardiac events (MACE) and 28-day survival also were recorded at the same time.RESULTS In admission,there were no differences in the levels of H-FABP,CK,CK-MB and LVEF,SOFA scores between the two groups.After 6 hours treatment,the levels of H-FABP,CK,CK-MB and SOFA score in the observation group were lower than those in the control group;the two groups had higher levels of H-FABP,CK and CK-MB than those before the treatment,SOFA score was lower than that before the treatment;After 72 hours treatment,H-FABP,CK,CK-MB and SOFA score were lower than those after 6 hours treatment;SOFA score in the observation group was lower than that in the control group;there were no differences in H-FABP,CK and CK-MB between the two groups.The observation group had a lower cumulative incidence of MACE than the control group.There was no statistical difference in LVEF and length of ICU stay after the treatment between the two groups.The observation group had a higher 28-day survival than the control group,the difference was statistically significant (76.08％,35/46 vs 54.35％,25/46;x2 =4.529,P =0.033).The level of serum H-FABP in severe sepsis patients was negatively correlated with LVEF (r =-0.270,P =0.009).CONCLUSION Therapeutic effects of safflower yellow on myocardial injury in patients with severe sepsis is superior to routine treatment with the improvement of the prognosis of patients to a certain extent.

Effects of Intensive Atorvastatin Therapy on Postoperative Related Indexes in Non-ST Segment Elevation Myocardial Infarction Patients before PCI / 中国药房

OBJECTIVE:To investigate the effects of intensive atorvastatin therapy on postoperative blood lipid,inflammation reaction and major adverse cardiac events (MACE) in non-ST segment elevation myocardial infarction (NSTEMI) patients before PCI.METHODS:A total of 120 NSTEMI patients underwent selective PCI were randomly divided into control group (60 cases) and observation group (60 cases).Both groups were given Aspirin enteric-coated tablet 0.3 g orally,once a day+Clopidogrel sulfate tablet 300 mg orally,once a day,immediately after admission.After operation,they were given medicine continuously for consecutive 12 weeks.Control group was given Atorvastatin calcium tablet 80 mg orally,immediately after operation,and then was given 40 mg,once a day,for consecutive 12 weeks.Observation group was additionally given Atorvastatin calcium tablet 40 mg orally 6 h before operation on the basis of control group.The levels of TG,TC,HDL-C,LDL-C,hs-CRP,TNF-αt and IL-10 before and after PCI,the incidence of postoperative MACE,postoperative re-hospitalization rate and the occurrence of ADR were observed in 2 groups.RESULTS:There was no statistical significance in the levels of TG,TC,HDL-C or LDL-C between 2 groups before and after operation (P＜0.05).After operation,the levels of hs-CRP,TNF-α and IL-10 in 2 groups were significantly higher than before operation,and the observation group was significantly lower than the control group,with statistical significance (P＜ 0.05).There was no statistical significance in the incidence of postoperative MACE,postoperative re-hospitalization rate or the incidence of ADR between 2 groups (P＞0.05).CONCLUSIONS:Intensive atorvastatin therapy before PCI can effectively reduce the levels of inflammatory response in NSTEMI patients,but have no significant changes in blood lipid levels and MACE risk,without increasing the incidence of ADR.

Effects of Shuxuening Injection on Lac, Presepsin and NOS levels in sepsis patients / 中成药

AIM To investigate the effects of Shuxuening Injection (Ginkgo biloba leaf extract) on serum lactic acid (Lac),soluble CD14-st (Presepsin) and nitric oxide synthase (NOS) levels in sepsis patients.METHODS One hundred and eight patients with sepsis treated by routine treatment in our hospital from Jan.2014 to Oct.2016 were randomly divided into two groups,control group and Shuxuening group (therapy group).Two weeks were one therapeutic course.Before the treatment (the onset of patients within 3 hours),at 6 hours and 5 days after the treatment,Lac and Presepsin levels were detected,and the changes of nitric oxide (NO),NOS,inducible nitric oxide synthase (iNOS) and sequential organ failure assessment (SOFA) score were observed.Incidence of major adverse cardiac events (MACE) and 28-day survival were recorded at the same time.RESULTS Before the treatment,there were no significant differences in SOFA score and the levels of Lac,Presepsin,NO,NOS and iNOS between the two groups (P ＞ 0.05).Six hours after the treatment,the levels of Lac and Presepsin in the therapy group were lower than those in the control group (P ＜ 0.05),both the two groups had lower levels of Lac and Presepsin than those before the treatment (P ＜ 0.05);five days after the treatment,the levels of Lac and Presepsin in the two groups were lower than those at 6 hours after the treatment (P ＜ 0.05),the levels of Lac and Presepsin in the therapy group were lower than those in the control group (P ＜ 0.05).The SOFA score,NO,NOS and iNOS levels after the treatment in the therapy group were lower than those in the control group (P ＜ 0.05).The levels of Lac and Presepsin in sepsis patients were positively correlated with SOFA score (r =0.245,0.261,P =0.011,0.006).The patients in the therapy group had lower incidence of MACE and 28-day mortality rate than those in the control group (P ＜ 0.05).CONCLUSION The therapeutic effect of Shuxuening Injection combined with routine treatment on sepsis patients is superior to that of routine treatment,which can improve the prognosis of patients to a certain extent.