The GRACE risk score predicts no-reflow and MACE in patients with STEMI undergoing PCI / 西安交通大学学报(医学版)

【Objective】 Coronary no-reflow during percutaneous conranary intervention (PCI) often results in the failure of ischemic myocardial reperfusion and major adverse cardiovascular events (MACE). The present study sought to evaluate whether the GRACE risk score can predict coronary no-reflow in STEMI patients undergoing PCI. 【Methods】 We consecutively recruited 1 118 patients with STEMI who were admitted to Gansu Provincial People’s Hospital and The First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2011. Main demographic data, cardiovascular risk factors, blood lipid and other biochemical indicators were recorded. Coronary angiography was performed by a radial artery approach using the standard Judkins technique. Coronary no-reflow was evaluated by at least two independent experienced cardiologists. The GRACE risk score was calculated with a computer program. All the cases were followed up by medical records, face-to-face interviews or telephone calls. Finally, we analyzed the predictive value of the GRACE risk score for coronary non-reflow and MACE in STEMI patients undergoing PCI. 【Results】 During a median period of 36 months, 58 of the 1 118 patients (5.2%) were lost to follow-up. Of the remaining 1 060 patients, 118 (11.1%) had no-reflow and 147 (13.9%) had MACE. The GRACE score was higher in patients with no-reflow than those without no-reflow. Multivariate logistic regression established that the GRACE score was an independent predictor for coronary no-reflow (OR=1.034; P=0.002). And multivariate Cox analysis showed the GRACE score was an independent predictor of MACE. The area under the ROC curve for coronary no-reflow and MACE was 0.719 and 0.697, respectively. Kaplan-Meier analysis showed that the probability of rehospitalization for heart failure, reinfarction, all-cause death and cumulative cardiovascular events increased with the increase of the GRACE risk score. 【Conclusion】 The GRACE risk score is a readily available predictive scoring system for coronary no-reflow and MACE in STEMI patients.

The value of high-sensitivity C-reactive protein combined with high-sensitivity cardiac troponin T for prognosis of patients with acute coronary syndrome / 中国医师进修杂志

Objective To investigate the value of high-sensitivity C-reactive protein (hs-CRP) combined with high-sensitivity cardiac troponin T (hs-cTnT) for prognosis of patients with acute coronary syndrome (ACS).Methods One hundred and eighteen patients with ACS were selected from July 2011 to December 2012.According to the clinical feature,they were divided into unstable angina pectoris (UAP) group (38 cases),non ST segment elevation myocardial infarction (NSTEMI) group (38 cases) and ST segment elevation myocardial infarction (STEMI) group(42 cases).They were followed up for 3 months,and the incidence of cardiovascular events and cardiac death was observed.Twenty healthy people were selected as control group.Results The serum level of hs-CRP on admission in UAP group,STEMI group,NSTEMI group was higher than that in control group,and NSTEMI group was highest.And there was significant difference between NSTEMI group and STEMI group,and also between NSTEMI group and control group (P ＜ 0.05).The serum level of hs-cTnI was increased in STEMI group and NSTEMI group.The increased degree in STEMI group was higher than that in NSTEMI group,and there was significant difference (P ＜0.05).The incidence of cardiovascular events and cardiac death within 3 months after discharge in patients with the serum level of hs-CRP ≥ 3 mg/L on admission in UAP group and NSTEMI group,STEMI group was 6/11,40.0％ (12/30),46.4％ (13/28),which was higher than that in patients with the serum level of hs-CRP ＜ 3 mg/L[11.1％(3/27),3/8,5/14],and there was significant difference(P＜ 0.05).The incidence of cardiovascular events and cardiac death within 3 months after discharge in patients with the serum level of hs-cTnT≥ 1.0 μ g/L on admission in NSTEMI group and STEMI group was 16.7％(5/30) and 18.4％(7/38),which was higher than that in patients with the serum level of hs-cTnT ＜ 1.0 μ g/L (1/8,1/4),and there was significant difference (P ＜ 0.05).Conclusion Significantly increased hs-CRP is an important predictor of poor prognosis of ACS patients.hs-CRP combined with hs-cTnT is helpful in early identification of high-risk patients.Giving intensive treatment to these patients in time and monitoring closely after discharge can reduce the happening of cardiovascular events.

Change of cardiac mitochondrial STAT3 activity in rats with selenium deficiency and its relation with myocardial injury / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the phosphorylation activity of mitochondrial signal transducer and activator of transcription 3 (STAT3) in the myocardium of rats with selenium deficiency and its association with myocardial injury.</p><p><b>METHODS</b>Thirty-six rats were randomized into normal control group (n=18) and selenium deficiency model group (n=18) for feeding with normal and low-selenium chow, respectively, for 20, 30 and 40 weeks. The cardiac function of the rats was evaluated by carotid artery intubation, and the damage of cardiac mitochondria was observed under electron microscopy. The cardiac mitochondria were extracted for assessing succinate dehydrogenase and cytochrome C oxidase activities, and the protein expressions of phosphorylated and total STAT3 were detected.</p><p><b>RESULTS</b>Compared with the corresponding control groups, the rats in the model group showed significantly decreased cardiac function with obvious structural and functional damage of the cardiac mitochondria (P<0.05), which aggravated as the low-selenium feeding time extended (P<0.05). The rats in the model group also showed significantly decreased mitochondrial STAT3 activity (p-STAT3/STAT3) in the myocardium as the low-selenium feeding time prolonged (P<0.05). Pearson linear correlation analysis showed that the activity of cardiac mitochondrial STAT3 had positive correlations with the left ventricular systolic pressure, maximal increased rate of the left ventricular pressure, and the activities of succinate dehydrogenase and cytochrome C oxidase (P<0.01).</p><p><b>CONCLUSION</b>Selenium deficiency down-regulates the activity of mitochondrial STAT3 in rat heart to contribute to cardiac mitochondrial injury and the progression of heart failure.</p>

Positive association between global registry of acute coronary events score and plasma high-sensitivity Creactive protein and its predictive value for long-term cardiovascular events / 中华老年医学杂志

Objective To evaluate the correlation between plasma high sensitivity C reactive protein (hs-CRP) level and global registry of acute coronary events (GRACE) scores,and its predictive value for long-term (5 years) cardiovascular events in middle-aged and elderly patients with acute coronary syndrome (ACS).Methods 138 middle aged and elderly patients with ACS were divided into three groups according to GRACE scores:low risk group,middle risk group,high risk group.And based on quartiles of hs-CRP levels,subjects were segregated into 4 groups (Q1 to Q4).All subjects were followed up for about 5 years and adverse cardiovascular disease events were recorded.Results The hs-CRP level was gradually increased along with increasing risk according to GRACE risk stratification (hs-CRP low risk group,0.09 ± 0.22 ; middle risk group,0.21 ± 0.04 ;high risk group,0.43±0.23,P＜0.001).Meantime,GRACE risk scores were gradually increased along with increasing hs-CRP levels from Q1 to Q4 (Q1:133.0 ± 43.6; Q2:161.9 ± 60.2; Q3:169.3±52.6; Q4:188.4±47.5; all P＜0.001).Regression analysis showed that hs-CRP level was positively correlated with GRACE risk scores (r=0.576,P＜0.001).During a follow-up period of about 5 years,96 cardiovascular events were recorded.Receiver operating characteristic(ROC) curve analysis showed that area under the ROC curve (AUC) of hs-CRP was 0.821 (95 ％CI:0.749-0.892,P＜0.001) and AUC of GRACE risk score was 0.869 (95％CI:0.801 0.938,P＜0.001) in the evaluation of the long-term risk of incident cardiovascular events.The differences in prediction of long-term cardiovascular events in middle-aged and elderly patients with ACS were not significant (P =0.237) between GRACE risk score and hs CRP level.Conclusions Plasma hs-CRP level is positively associated with GRACE score.Both of them can predict long-term adverse cardiovascular events in middle-aged and elderly patients with acute coronary syndrome.

Endothelial dysfunction induced by high glucose is associated with decreased ATP-binding cassette transporter G1 expression / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the role of ATP-binding cassette transporter G1 (ABCG1) in endothelial dysfunction induced by high glucose.</p><p><b>METHODS</b>Human aortic endothelial cells (HAECs) were incubated in the presence of 5.6 or 30 mmol/L glucose for 24-72 h with or without a 2-h pretreatment with the LXR agonist 22(R)-hydroxycholesterol. Real-time PCR and Western blotting were used to measure the mRNA and protein expressions of ABCG1; the intracellular cholesterol efflux and endothelial nitric oxide synthase (eNOS) activity were measured by scintillation counting.</p><p><b>RESULTS</b>High glucose time-dependently suppressed ABCG1 expression and cholesterol efflux to HDL in HAECs. High glucose also decreased eNOS activity. ABCG1 down-regulation induced by high glucose, along with decreased cholesterol efflux and eNOS activity, was abolished by treatment of the cells with the LXR agonist.</p><p><b>CONCLUSION</b>Endothelial dysfunction induced by high glucose is associated with decreased ABCG1 expression.</p>