Novel nomogram for predicting coronary vulnerable plaque risk in patients with coronary artery disease.

Objective: To develop and validate a nomogram for predicting coronary vulnerable plaques (VPs) in coronary artery disease (CAD) patients. Methods: One hundred seventy-seven CAD patients were enrolled in the training group. Another 60 patients were included for validation. Based on the identified independent risk factors, a nomogram model was developed and then validated. Results: Type 2 diabetes, hypertension, neutrophil-to-lymphocyte ratio, low-density lipoprotein cholesterol, MCP-1 and MMP-9 were found to be independent risk factors for coronary VPs. Both internal and external validation showed this nomogram had satisfactory discrimination via receiver operating characteristic curves, calibration via calibration plots and clinical application values via decision curve analysis. Conclusion: The authors established a nomogram model predicting coronary VP risk in CAD patients with promising clinical application value.

Vulnerability to coronary atherosclerotic plaques is the important initiating cause of major adverse cardiovascular events in coronary artery disease (CAD) patients. Early detection of high-risk CAD patients with vulnerable plaques (VPs) could prevent the occurrence of major adverse cardiovascular events and improve patients' clinical outcomes. The present study aimed to investigate the risk factors for coronary VPs and then develop a model for predicting VP risk in CAD patients. The authors found that Type 2 diabetes, hypertension, neutrophil-to-lymphocyte ratio, low-density lipoprotein cholesterol, MCP-1 and MMP-9 were independently associated with coronary VPs in CAD patients. Based on these variables, the authors constructed a nomogram to estimate the individualized risk of VPs and validated the nomogram internally and externally with good accuracy and discrimination. These demonstrated that this nomogram model could achieve individualized prediction of coronary VP risk and would aid physicians in identifying high-risk patients and optimizing a timely treatment strategy with potential clinical application value.

Efficacy of Oral Nicorandil to Prevent Contrast-Induced Nephropathy in Patients with Chronic Renal Dysfunction Undergoing an Elective Coronary Procedure.

OBJECTIVES: This prospective, randomized study was to investigate the role of nicorandil in the prevention of contrast-induced nephropathy (CIN) in patients with chronic renal dysfunction undergoing an elective coronary procedure. METHODS: A total of 252 eligible patients were enrolled in this study and allocated into the control group (n = 125) or nicorandil group (n = 127). Both groups received the standard hydration treatment, and patients in the nicorandil group were orally administrated 10 mg of nicorandil (t.i.d.) beginning 2 days before and continuing for 2 days after an elective coronary procedure. Serum creatinine (SCr) and cystatin C (CysC) were measured at 24 h before and 24, 48, and 72 h after the procedure. The occurrences of CIN and adverse events within 1 year were recorded. RESULTS: The nicorandil group had relatively lower SCr and CysC levels and a higher eGFR at 24 and 48 h after the procedure than the control group (p < 0.05). The incidence of CIN was significantly decreased in the nicorandil group compared to the control group. The multivariate logistic regression model revealed that nicorandil treatment was an independent protective factor for CIN (OR 0.669, 95% CI 0.522-0.857, p = 0.001). The multivariate COX proportional hazard model showed that nicorandil treatment was an independent protective predictor for adverse events (HR 0.881, 95% CI 0.781-0.993, p = 0.037). CONCLUSIONS: Nicorandil could exhibit a protective effect against CIN in patients with chronic renal dysfunction undergoing an elective coronary procedure and reduce the adverse events within 1 year after the procedure, which is superior to hydration treatment only.

Nomogram Model to Predict Cardiorenal Syndrome Type 1 in Patients with Acute Heart Failure.

BACKGROUND/AIMS: Cardiorenal syndrome type 1(CRS1) is a serious clinical condition in patients with acute heart failure (AHF) associated with adverse clinical outcomes. Although several biomarkers for identifying CRS1 have been reported, early and accurate predicting CRS1 still remains a challenge. This study was aimed to develop and validate an individualized predictive nomogram for the risk of CRS1 in patients with AHF. METHODS: A total of 1235 AHF patients between 2013 and 2018 were included in this study. The patients were randomly classified into training set (n=823) and validation set (n=412). All data of the training set were used to screen the predictors of CRS1 via univariate and multivariate analyses. A nomogram was developed based on these predictors and validated by internal and external validation. The nomogram validation comprised discriminative ability determined by the area under the curve (AUC) of receiver-operating characteristic (ROC) curve and the predictive accuracy by calibration plots. RESULTS: The overall incidence of CRS1 was 31.7%. Multivariate logistic regression revealed that age, diabetes, NYHA class, eGFR, hs-CRP and uAGT were independently associated with CRS1. A nomogram developed based on the six variables was with the AUC 0.885 and 0.823 on internal and external validation, respectively. Calibration plots showed that the predicted and actual CRS1 probabilities were fitted well on both internal and external validation. CONCLUSION: The proposed nomogram could predict the individualized risk of CRS1 with good accuracy, high discrimination, and potential clinical applicability in patients with AHF.

Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention: a retrospective cohort study.

OBJECTIVES: This study aimed to evaluate prognostic value of the combination of monocyte-to-lymphocyte ratio (MLR) with neutrophil-to-lymphocyte ratio (NLR) for predicting long-term major adverse cardiac events (MACE) in patients with non-ST elevated myocardial infarction (NSTEMI) who underwent primary percutaneous coronary intervention (PCI). DESIGN: Retrospective cohort study. SETTING: Civil Aviation General Hospital, Beijing, China. PARTICIPANTS: 678 patients with NSTEMI undergoing primary PCI between July 2010 and July 2015 were enrolled. MAIN OUTCOME MEASURES: The main outcomes were MACE. The cumulative MACE-free survival rates were calculated by Kaplan-Meier analysis and the independent predictors of MACE were assessed by Cox regression analysis. RESULTS: According to the cut-off values of MLR 0.36 and NLR 2.15, the study population was classified into four groups: low MLR + low NLR group (n=319), low MLR + high NLR group (n=126), high MLR + low NLR group (n=102) and high MLR + high NLR group (n=131). The high MLR + high NLR group had a lower MACE-free survival rate than the other three groups (p logrank <0.001). Both MLR (HR 2.128, 95% CI 1.458 to 3.105) and NLR (HR 1.925, 95% CI 1.385 to 2.676) were independent predictors of long-term MACE. Moreover, the patients in the high MLR + high NLR group had an HR of 4.055 (95% CI 2.550 to 6.448) for long-term MACE, with the low-MLR + low NLR group as reference. Comparisons of receiver operating characteristic curves revealed that the combination of MLR with NLR achieved better performance in differentiating long-term MACE, compared with MLR, NLR, high-sensitivity C reactive protein and brain natriuretic peptide alone, and had similar performance to all other pairwise combinations of the four biomarkers. CONCLUSIONS: Elevated levels of MLR and NLR were independent predictors of long-term MACE in patients with NSTEMI. Moreover, the combination of MLR and NLR could improve the prognostic value in predicting long-term MACE.

Relationship between monocyte-to-lymphocyte ratio and coronary plaque vulnerability in patients with stable angina.

AIM: To investigate the relationship between monocyte-to-lymphocyte ratio (MLR) and plaque vulnerability assessed by virtual histology intravascular ultrasound in patients with stable angina. METHODS: 133 patients with stable angina were enrolled. RESULTS: MLR was found to be an independent risk factor of thin cap fibrous atheroma (OR: 2.61; p = 0.025). MLR could differentiate thin cap fibrous atheroma with a sensitivity of 73.7% and a specificity of 61.8%. MLR level was positively correlated with the percentage of necrotic core (NC) area at the sites of minimum lumen area and the largest NC area, and positively related to the percentage of NC volume. CONCLUSION: Circulating MLR level has potential in identifying the vulnerable plaques in the setting of stable angina.

Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment.

BACKGROUND: We aimed to explore whether monocyte to lymphocyte ratio (MLR) provides predictive value of the lesion severity in patients with coronary artery disease (CAD). METHODS: Five hundred forty-three patients undergoing coronary angiography were analyzed in this retrospective study. Patients with coronary stenosis were divided into three groups on the basis of Syntax score. The control group consisted of patients with normal coronary arteries. MLR was calculated by dividing monocytes count by lymphocytes count obtained from routine blood examination. Multivariate logistic analysis was used to assess risk factors of CAD. Ordinal logistic regression analysis was used to assess the relationship between MLR and the lesion severity of coronary arteries. RESULTS: MLR was found to be an independent risk factor of the presence of CAD (OR: 3.94, 95% CI: 1.20-12.95) and a predictor of the lesion severity (OR: 2.05, 95% CI: 1.15-3.66). Besides, MLR was positively correlated with Syntax score(r = 0.437, p < 0.001). In the receiver-operating characteristic (ROC) curve analysis, MLR, with an optimal cut-off value of 0.25, predicted the severe coronary lesion with a sensitivity of 60.26% and specificity of 78.49%. CONCLUSIONS: MLR was an independent risk factor of the presence of CAD, and a predictor of the lesion severity. Compared to neutrophil to lymphocyte ratio (NLR), MLR has better performance to reflect the severity of coronary lesion.

[Glucometabolic abnormalities survey among outpatients without previous diabetes diagnosis and with coronary artery disease and hypertension].

OBJECTIVE: To explore the status of glucometabolic abnormalities in cardiological outpatients without previous diabetes diagnosis and with coronary artery disease (CAD) and hypertension. METHODS: Patients without previous diagnosis of diabetes but with hypertension and CAD aged 18 years or above were recruited from cardiology departments of 11 general hospitals in China. Demographic data, disease diagnosis and medical history were collected. Physical examination and questionnaire survey were performed after the random blood glucose test. Oral glucose tolerance test (OGTT) examination was made for patients with fasting blood glucose ≥ 6.1 mmol/L or postprandial random glucose ≥ 7.8 mmol/L. Adjusted prevalence rates were used in the study. RESULTS: A total of 7778 patients were included in 11 centers. After preliminary screening by fasting blood glucose and random blood glucose tests, 3861 patients were required to take OGTT, and 3019 (78.2%) patients actually took the test. 1287 out of 3019 patients screened with OGTT were diagnosed with diabetes, and the adjusted diabetes prevalence rate was 18.64% (1287/6904). The prevalence rate of diabetes was 19.87% (95/478), 9.22% (352/3819) and 14.81% (153/1033) in patients with CAD, hypertension, and CAD combined with hypertension, respectively. A total of 996 patients were diagnosed with impaired glucose tolerance (IGT) and its prevalence was 14.43% (996/6904). Of the enrolled population, 153 patients with random blood glucose lower than 7.8 mmol/L were also screened with OGTT test, 26.14% (40/153) patients met the diagnostic criteria of diabetes. CONCLUSION: A high prevalence of diabetes is found in patients without previous diagnosis of diabetes and with hypertension and CAD consulting at cardiology departments. We thus suggest to perform OGTT in this patient cohort to improve the early diagnosis of IGT and diabetes, and prevent missed detection of type 2 diabetes mellitus or IGT in cardiovascular patients with normal fasting blood glucose. Our results indicate that it was feasible to use OGTT as a screening tool for detecting diabetes in these patients and the patient compliance is satisfactory.