Chronic Coronary Syndrome: Medical Therapy or Myocardial Revascularization?

Abstract The best therapeutic strategy for chronic coronary syndrome (CCS) is still controversial. The lack of contemporaneity of medical treatment in many randomized clinical trials prior to the large-scale use of statins, antiplatelet agents, anti-diabetic drugs with cardiovascular protection, and changes in life habits with well-established goals limits the applicability of such studies in current clinical practice. Medical treatment is the only therapeutic option capable of reducing atherosclerotic damage and, therefore, of acting effectively in preventing the progression of this disease. The purpose of this brief review is to critically analyze the main contemporary studies that confront medical treatment with myocardial revascularization in CCS.

Neutrophil-to-Lymphocyte Ratio and Its Relation with Markers of Inflammation and Myocardial Necrosis in Patients with Acute Myocardial Infarction and Chronic Coronary Syndrome

Background: Inflammation has an essential role in atherosclerosis that is the leading reason for acute coronary syndrome (ACS) which includes acute myocardial infarction (AMI) and unstable angina (UA). The objective of this work was to study the existence of difference in Neutrophil to Lymphocyte ratio and its relation to inflammatory markers between cases with AMI and cases with chronic coronary syndrome. Methods: This work included sixty consecutive cases with AMI and ACS who presented to cardiovascular medicine department at Tanta university hospital. The cases were classified into two equal groups; group I: cases with AMI and group II: cases with chronic coronary syndrome. All participants were subjected to ECG, Echocardiography, color Doppler, coronary angiography and laboratory investigations as differential CBC, cardiac enzymes, troponine, CK, CK-MB, CRP, urea, creatinine and random blood sugar. Patients who didn’t meet the criteria for invasive treatment, continued on medication and further noninvasive investigations done, starting from stress ECG, stress echocardiography, or CCTA. Results: There were insignificantly different between the two groups regarding age, gender and residency (p= 1.00). There was insignificant difference between the two groups regarding hypertension (p= 0.592), DM (p= 0.795) and dyslipidemia (p= 0.504). 7 (23.3%) cases were smokers in group I and 8(26.7%) patients were smokers in group II with insignificantly different between the two groups (p= 1.00). Conclusions: NLR is a powerful marker of myocardial damage in acute myocardial cases.

Noninvasive Predictors of Coronary Slow Flow Phenomenon in Patients Presenting with Chronic Coronary Syndrome

Background: Patients with coronary slow flow phenomenon (CSFP) exhibit the following characteristics: Predominantly middle-aged males, the majority have mixed pattern angina, persistent chest pain sensations after therapy, and many have had repeated invasive and non-invasive examinations. Objectives: Our study aimed to determine the base of non-invasive predictors of coronary slow flow phenomenon in patients presenting with chronic coronary syndrome. Patients and Methods: This a case-control study included 100 participants of suspected coronary artery disease were divided into two groups matched in age and sex group I: 50 patients with primary CSFP and group II: 50 patients with normal coronary angiography. Each patient was undergoing to demographic data taking, physical investigation, good hydration, restrict fasting hours requested for coronary angiography, 12 lead-Electrocardiogram (ECG)s were obtained for each patient at rest, laboratory parameters, coronary angiography, treadmill exercise ECG, transthoracic echocardiography to assess the thickness of the left ventricle’s (LV) wall, its interior dimensions, as well as the LV’s ejection fraction (EF) using M-mood method and the aortic propagation velocity. Results: male sex and the Canadian Cardiovascular Society Angina grade’s (CCSA) class 3 were significantly decreased in group I compared to group II and male sex, Diabetes mellitus (DM), smoker and CCSA class 4 were substantially increase in group I compared to group II (P <0.05). P wave max, P Wave dispersion (PWd), corrected QT dispersion (QTcd) at resting ECG, T wave inversion and ST Waves segment depression at stress ECG were significantly increase in group I compared to group II. QTc min was significantly lower in group I compared to group II (P <0.05). LA diameter was significantly increased in group I than group II. Aortic propagation velocity was significantly decreased in group I than group II (P <0.05). Hematocrit, total leucocytic count, mean platelet volume and High-sensitivity C-reactive protein (hsCRP) were significantly increase group I compared to group II (P <0.05). Conclusions: Patients suspected of having a coronary artery disease who are diagnosed with coronary slow flow, male sex, dilated LA, CCSA class 3 or 4, elevated hematocrit value, elevated total leucocytic count, increased mean platelet volume, increased HsCRP, P max, PWd, QTcd, T wave inversion, ST segment depression, and decreased aortic propagation were statistically higher in CSFP patient compared to controls

Analysis of Pathogenesis and Treatment of Chronic Coronary Syndrome Based on Vessel-collateral Theory / 中国实验方剂学杂志

Based on the syndrome and treatment system of collateral disease， and inheriting the development of the bloodline theory of traditional Chinese medicine （TCM）， academician WU Yi-ling systematically constructed the vessel-collateral theory of TCM and proposed that its core theory was the theory of Yingwei， that is， "Ying in the vein， and Wei outside the vein" （Huangdi Neijing·Lingshu·Yingwei Shenghui）， "obstructing of Yingwei， congelation of blood" （Treatise on Febrile Diseases· Pulse Differentiation Method）， "pathogen transferring through blood vessels， obstructed by blocking" （Jinkui Yaolue·Zangfu Jingluo Xianhou Bingmaizheng First）， and "damage of the heart， adjust its Yingwei". Based on the consistency of vessel-collateral as the channel of blood circulation in TCM with the blood vessels in western medicine， and guided by the Yingwei theory of vessel-collateral theory， the diagnostic criteria of syndrome differentiation of disease of vessel-collateral and vascular system represented by coronary heart disease， arrhythmia， heart failure and others was established to guide the prevention and treatment of vascular diseases. Based on the above analysis， guided by the Yingwei theory of vessel-collateral theory， and on the basis of related researches of vessel-collateral and vascular system， this paper discussed the etiology and pathogenesis of chronic coronary syndrome （CCS） in TCM. Taking useful collateral with unblocking as the treatment principle， the representative Tongluo prescription （Tongxinluo） was constructed， the research progress of Tongxinluo from various aspects such as animal experiment research， pharmacological research and clinical evidence-based research was summarized， a comprehensive system from etiology， pathogenesis， syndrome differentiation to treatment was formed， in order to provide new ideas for the clinical treatment of CCS.