Episodes Of Angina Research Articles

In hypertensive individuals, sleep time and sleep efficiency did not affect the number of angina episodes: a cross-sectional study

Previous studies have reported adverse effects of short and long sleep duration on cardiovascular health. However, how sleep time and sleep efficiency affect angina have not been studied in hypertensive individuals. This study aimed to assess the relationship of sleep with angina. Using a cross-sectional design, data from 1563 hypertensive individuals were collected from the parent Sleep Heart Health Study (SHHS). Age, alcohol use, average diastolic blood pressure (ADBP), average systolic blood pressure (ASBP), cigarette use, sleep time, sleep efficiency, percent time in stage N3 of sleep, and body mass index (BMI) were used as covariates. Multiple linear regression, the Chi-Square test, and Pearson’s correlation coefficient were used for data analysis. Unadjusted sleep efficiency, sleep time, ADBP, and age were significant (p < 0.05) predictors of the number of angina episodes (Anginan). When the covariates were adjusted, only ADBP and ASBP were significant (p < 0.05) predictors of Anginan. Sleep efficiency, BMI, ADBP, sleep time, and age had a significant (p < 0.05) correlation with Anginan. In hypertensive individuals, sleep time and sleep efficiency did not affect Anginan when adjusted for covariates. ADBP and ASBP were found to be significant predictors of Anginan when the covariates were adjusted.

Alprostadil vs. isosorbide dinitrate in ameliorating angina episodes in patients with coronary slow flow phenomenon: A randomized controlled trial.

BackgroundThe optimum therapy for coronary slow flow phenomenon (CSFP) stays debatable. This study compared the effectiveness of alprostadil with isosorbide dinitrate in alleviating angina episodes in CSFP patients.MethodsIn this prospective, randomized controlled study, 102 patients with CSFP without severe coronary artery stenosis that exhibited stable angina were allocated randomly in a ratio of 1:1 to either the alprostadil group (40 μg, three times per day, n = 51) or the isosorbide dinitrate group (5 mg, three times per day, n = 51). Frequency of angina events, intensity of suffering, and the Canadian Cardiovascular Society (CCS) grading of angina pectoris were evaluated at baseline and one month after. Additionally, the Seattle Angina Questionnaire (SAQ) was assessed.ResultsBaseline characteristics were comparable between the two groups. At 1-month follow-up, patients administered with alprostadil experienced fewer angina episodes [episodes per week, 1 (2) vs. 2 (2), P < 0.001] and less pain intensity [self-evaluated pain score, 2 (3) vs. 3 (4), P < 0.001] than those with isosorbide dinitrate. In the alprostadil group, 78.4% of patients were classified as CCS class I, significantly higher than the 47.1% seen in the isosorbide dinitrate group (P = 0.001). Furthermore, treatment of alprostadil led to a significant improvement in the SAQ score (7.09 U, 95% CI: 4.22–9.96, P < 0.001) compared to isosorbide dinitrate. Additionally, fewer patients suffered headaches when receiving alprostadil (7.8% vs. 19.6%, P = 0.084).ConclusionAlprostadil was more effective in ameliorating angina symptoms in CSFP patients than isosorbide dinitrate.Clinical trial registration[www.chictr.org.cn], identifier [ChiCTR2000033233].

Effective drug modification of risk factors in a patient with coronary artery disease: a case report

The basis of conservative treatment of stable coronary artery disease is the elimination of modifiable risk factors and complex drug therapy for hypertension, diabetes, and dyslipidemia. The rates of awareness, treatment and control of these parameters in Russia remain low. In this regard, current guidelines suggest a step-by-step personalized approach to achieve optimal risk factor control. The aim of this work was to demonstrate that the modification of therapy to achieve the targets of blood pressure, low-density lipoprotein cholesterol and glycated hemoglobin, lifestyle change with smoking cessation, increased physical activity and weight loss led to improvement of coronary circulation and elimination of angina episodes.

*A Novel ABCG8 Variant and Apo(A) Short Isoform Associated with Premature Atherosclerosis and Familial Hypercholesterolemia Phenocopy.

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis We report a patient with a rare ABCG8 mutation, that when combined with Apo(a) short isoforms may represent a familial hypercholesterolemia (FH) phenocopy. Objective/Purpose A 44-year-old African American male with prior myocardial infarction (MI) at the age 24 with subsequent coronary artery bypass graft who had rapid progression of atherosclerosis despite having a corrected LDL of zero. Methods Lp(a) was 127 mg/dL and LDL was 40 mg/dL and he had been on evolocumab and rosuvastatin. The corrected LDL accounts for the cholesterol contained in Lp(a) using the formula LDLcorr =LDL- 0.3x Lp(a) mass. Thus, his LDLcorr was zero. He underwent genetic testing with GBinsight which demonstrated he had Apo(a) short isoforms, which is associated with elevated Lp(a). He was also heterozygous for an extremely rare ABCG8 variant p.Gly212Glu (rs1318623110) which has not been previously reported. This variant is predicted to be deleterious and Gly212 is highly conserved across vertebrates. Mutations in ABCG5 or ABCG8 can be associated with increased LDL and risk for CAD. In addition, elevation of Lp(a) can be associated with 3 to 4 folds increased risk. This novel mutation, along with the elevated Lp(a) may help to explain his FH phenocopy presentation. Results We hypothesized that his premature disease progression may have been secondary to inflammation, atherogenesis or prothrombosis associated with Lp(a) with the added potentially deleterious effect of the ABCG8 mutation. His clinical course with his first MI at age 24 mimics that of FH, thus making him a phenocopy. We enrolled him in the randomized Lp(a)HORIZON trial evaluating the effect of pelacarsen in lowering Lp(a). However, he subsequently had an episode of unstable angina requiring additional intervention. Conclusions When assessing patients with suspected FH, mutations in genes other than LDLR, APOB, and PCSK9 should be evaluated. In this case, a mutation in ABCG8 gene along with Apo(a) short form isoforms may help explain the patient's disease progression and FH phenocopy presentation. In addition, ezetimibe may be beneficial in patients with ABCG5/8 mutation. His marked disease progression despite having a LDLcorr of zero highlights the importance of considering factors other than just LDL. Nothing to disclose.

The Outcome of LM PCI: A Single Center Experience of First 50 Cases without In-site IVUS Facility

Introduction: Left main disease (LMD) is related to significant morbidity and mortality. This study was done to evaluate the clinical major adverse cardiovascular event (MACE), including unstable angina, myocardial infarction, heart failure, target vessel revascularization, stroke and death in patients undergoing left main stem stenting without availability of in-site intravascular imaging (IVUS). Methods &amp; Materials: It was a prospective observational study done in National Institute of Cardiovascular Diseases &amp; Hospital (NICVD) from March 2014 to June 2019. Our study included 50 patients who underwent Percutaneous Coronary Intervention for left main disease without use of IVUS. All the patients were followed up for 1 year &amp; 2 years, one patient was lost to follow-up. Outcomes included in MACE were death, myocardial infarction, unstable angina, heart failure, stroke and target vessel revascularization (TVR). Results: Fifty patients (mean age 58.4 ± 4.1 years, 44 male, 06 female) were treated with a mean SYNTAX score of 24.8 ± 2.6. Thirty two (64%) patients had stable angina, 17 (34%) had unstable angina/non ST-elevation myocardial infarction, and 1 (02%) had ST-elevation Myocardial infarction. Among the risk factors, 21(42%) had DM, 33 (66%) were hypertensive, 22 (44%) were smoker, 19 (38%) had dyslipidemia, 09 (18%) had previous h/o MI, 11 (22%) had family h/o CAD &amp; 01 (02%) had previous h/o CVD. Preprocedural LVEF was 49.92± 6.60 % and post procedural 54.84 ± 4.55% which showed significant improvement of LVEF after PCI (p=0.003). Most of the patients presented with LM with SVD (82%). Among all patients, 39 (78%) underwent complete revascularization in compare to 11 (22%) had incomplete revascularization. Thirty eight (76%) patients received a single-stent DES and 12 (24%) received two-stents DES. Among double stent strategy, majority underwent TAP (50%). All access was femoral &amp; No reflow phenomena were found in any of the patients during the procedure. No perioperative mortalities were noted and no urgent coronary bypass graft surgery was required. One patient was lost to follow-up. After 1-year follow-up period, 1 (02%) patients had non-fatal myocardial infarction, 7 (14%) had episodes of unstable angina (UA) and 3 (06%) had heart failure (HF). After 2-years there was no new MI but 09 (18%) had UA &amp; 4 (08%) patients had HF episode in total. TLR was 2 (04%) in first year and 3 (06%) in 2nd year. Total mortality was 1(02%) in first year &amp; 3(06%) in 2nd year. The multivariable analysis showed a good prognosis in patients receiving LM PCI with a total event rate of 28% &amp; mortality 6%. A multivariate regression analysis with risk factors for coronary artery disease as predictive variables showed that high SYNTAX score (p = 0.013), incomplete revascularization (p=0.002) &amp; low post procedural LVEF (p= 0.001) was an independent predictor of MACE. Conclusion: Percutaneous coronary intervention of left main coronary disease without use of IVUS showed good prognosis after 1-year &amp; 2-years follow-up. It would not only save a procedure time for physicians but also prevent a financial burden on patients if they cannot afford intravascular imaging. Bangladesh Heart Journal 2022; 37(1): 1-9

Pre-infarction Angina: Time Interval to Onset of Myocardial Infarction and Comorbidity Predictors.

AimsAs part of efforts to identify candidates for patient education aimed at decreasing mortality from acute myocardial infarction, we investigated the prevalence of pre-infarction angina and its predictors among comorbidities in patients who were hospitalized with acute myocardial infarction (MI).MethodsWe conducted a prospective multicenter observational registry of MI patients from 1998 to 2014 (N = 12,093). The present study investigated the prevalence of pre-infarction angina and its predictors among comorbidities with a logistic regression model. Pre-infarction angina was defined as chest pain/oppression observed within 1 month before the onset of MI but which lasted <30 min.ResultsAfter excluding 976 (8.1%) patients with missing data on pre-infarction angina, 11,117 patients [66.4 ± 12.0 years, 9,096 (75.2%) male] were analyzed. Of these, 5,428 patients (48.8%) experienced pre-infarction angina before the onset of MI, while 5,689 (51.2%) experienced sudden onset of acute MI. Most patients experienced the first episode of angina >6 h before the onset of MI, while 15% did so ≤6 h before. Patients with hypertension, diabetes, dyslipidemia, or a family history of MI had a higher probability of pre-infarction angina than those without. Elderly patients and those with a history of cerebrovascular disease were less likely to experience pre-infarction angina.ConclusionsAlmost half of MI patients in our registry experienced pre-infarction angina before MI onset. Patients with hypertension, diabetes, dyslipidemia, or a family history of MI had a higher probability of experiencing pre-infarction angina than those without.

C80 SUDDEN CARDIAC ARREST IN A YOUNG FOOTBALL PLAYER DUE TO DOCUMENTED SPONTANEOUS CORONARY ARTERY DISSECTION

Abstract A 28–years–old male presented with sudden cardiac arrest (SCA) while playing soccer. He was quickly resuscitated and transported to the closest cardiology department. He had no ECG or echocardiographic alterations. Coronary angiography (CA) showed a spontaneous coronary artery dissection (SCAD), confirmed by optical coherence tomography (OCT), in the mid portion of left anterior descending artery (LADA). In light of his young age, and the lack of evidence of stenosis on angiography confirmed by an instant wave–free ratio (iFR) analysis that confirmed the absence of myocardial ischemia (value obtained 0.97), the patient was treated conservatively with aspirin, clopidogrel, a statin and a beta–blocker. The patient refused implantation of a cardioverter–defibrillator repeatedly. A repeat CA was performed 6–months later, showing same findings and angiographic images of the known lesion involving the LADA. Therefore, the patient was indicated as unsuitable to play soccer. At 1 year from the index event, the patient had an episode of angina pectoris associated with intensive effort and, because of this, another CA with OCT analysis were performed. On angiography the LADA showed a significant stenosis in the same region where spontaneous dissection was previously documented; finding of hyperreflectivity on OCT suggested fibrosis of the vessel wall, probably caused by anomalous immunity reaction mimicking an autoimmune disease; residual intimal–tear representing the entry–site of the dissection was also detected, and a minimal lumen area of 2.21 mm2 was calculated consistent with angiographic stenosis. PCI was indicated, implanting a 3.0/18 mm drug–eluting stent in the mid portion of the LADA, obtaining good final angiographic result and OCT analysis confirming optimal device expansion, without residual dissection. At 2 month post–PCI the patient had returned to playing football without limitation of physical activities. 1 year post–PCI follow–up the patient is still asymptomatic and healthy. In summary, we present a case of SCAD causing an acute coronary syndrome presenting with SCA, which limited subsequent physical activity. In young patients, mostly women, SCAD episode should be strongly considered in the setting of an acute coronary syndrome. Several articles had reported that medical therapy should be oriented on the pathophysiology of SCAD due to the absence of the classic atherosclerotic burst, limiting interventional therapy when strictly indicated.

The sham effect of invasive interventions in chronic coronary syndromes: a systematic review and meta-analysis

BackgroundSome patients with chronic coronary syndromes undergo invasive procedures but the efficacy of such interventions remains to be robustly established by randomised sham-controlled trials (RCTs).PurposeTo determine the sham effect in patients with chronic coronary syndromes enrolled in RCTs by performing a systematic review and meta-analysis.MethodsIn April 2022, we performed a literature search for published patient-blind RCTs (CENTRAL, MEDLINE®, PsycINFO, and reference lists) with sham procedures, reporting the pre-post effects in the invasive sham arm among patients with Canadian cardiovascular society (CCS) angina or angina equivalents.Results16 RCTs were included with 546 patients in the sham arm. Pooled results showed that sham interventions were associated with: improvement of 7% (95% CI 2–11%; I2 = 0%) in exercise time; decrease of 0.78 (95% CI − 1.10 to − 0.47; I2 = 75%) in CCS angina class; decrease of 53% (95% CI 24–71%; I2 = 96%) and 25% (95% CI 20–29%; I2 = 0%) in anginal episodes and nitroglycerine (NTG) use, respectively. Pooled results also showed an improvement in the physical functioning, angina frequency, treatment satisfaction, and disease perception domains of the Seattle Angina Questionnaire (SAQ).ConclusionSham interventions in patients with chronic coronary syndromes were associated with a significant decrease in anginal episodes, NTG use, and CCS angina class and increased SAQ quality of life and exercise time. These results highlight the need for previous non sham-controlled trials to be interpreted with caution, and the importance of new invasive interventions to be evaluated versus a sham procedure.

Efficacy and safety of combination of ulinastatin and meglumine cyclic adenosine monophosphate in the treatment of acute myocardial infarction, and its effect on serum levels of hs-CRP, cTnI and CK

Purpose: To determine the efficacy and safety of a combination of ulinastatin and meglumine cyclic adenosine monophosphate (cAMP) in the treatment of acute myocardial infarction (AMI), and its effect on serum levels of hypersensitive-c-reactive protein (hs-CRP), cardiac troponin I (cTnI), creatine kinase (CK).Methods: A total of 90 AMI patients admitted to The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar City, Heilongjiang Province, China from January 2019 to January 2020 were selected and randomized (in a 1:1 ration) into control group and study group. Patients in the two groups received meglumine cAMP, while those in the study group were, in addition, treated with ulinastatin. The two groups were compared with regard to clinical efficacy, cardiac function indices, serum biochemical indices, incidence of drug-related side effects, duration and number of episodes of angina pectoris, and levels of neuroendocrine hormones.Results: The study group exhibited remarkably higher treatment effectiveness and cardiac function indices compared to the control group (p &lt; 0.05). However, lower levels of serum biochemical indices, lower total incidence of drug toxicity, smaller number and shorter duration of angina pectoris, and lower levels of panel reactive antibodies (PRA) were observed in the study when compared to control group (p&lt; 0.001).Conclusion: Treatment of AMI patients with the combination of ulinastatin and meglumine cAMP significantly reduces the clinical symptoms of the patients, with remarkable efficacy and high safety. Furthermore, it down-regulates serum levels of hs-CRP, cTnI and CK. Thus, the combination treatment seems superior to the conventional therapy.

ANALYSIS OF THE OCCURRENCE OF VARIOUS CARDIOVASCULAR EVENTS IN PATIENTS WITH MYOCARDIAL INFARCTION WITHOUT ST SEGMENT ELEVATION DURING 6TH AND 12TH MONTHS

Myocardial infarction remains one of the leading causes in the structure of general and cardiovascular morbidity and mortality worldwide. Despite significant progress in the treatment of acute myocardial infarction in most developed countries, the emergence and prevention of early and late complications is of great interest. Existing unified methods of diagnosis and treatment of NSTEMI significantly avoid adverse events in the rehabilitation period of the disease, however, the long-term prognosis of this category of patients remains unfavorable due to the development of myocardial dysfunction after postinfarction remodeling and prognostic adverse arrhythmias. The search for opportunities to predict the development of complications, study of remodeling processes and their impact on the development of electrical instability of the myocardium, which is currently considered a promising area of non-invasive diagnosis of myocardial infarction. With regard to NSTEMI, the unfavorable long-term prognosis is primarily due to the development of myocardial dysfunction, electrical instability of the myocardium or the development of recurrent coronary events.&#x0D; Aim. To analyze the probability of occurrence of various cardiovascular events in patients with myocardial infarction without ST-segment elevation during 6 and 12 months of follow-up.&#x0D; Materials and methods. We conducted a comprehensive study of 200 patients with acute myocardial infarction without ST-segment elevation aged 38 to 80 (mean 62.0 ± 0.71, median 62 and interquartile range 55 and 70). A retrospective analysis of patients' condition during 6 and 12 months of follow-up was performed. Surveillance of patients was carried out in the mode of telephone contact with patients, assessment of the condition on scheduled visits (1st, 3rd, 6th and 12th month after hospitalization of patients with acute myocardial infarction) and recording of unscheduled and urgent requests of patients for medical help. We conducted a retrospective analysis of the condition of NSTEMI patients during 6 and 12 months of follow-up. Surveillance of patients was carried out in the mode of telephone contact with patients, assessment of the condition on scheduled visits (1st, 3rd, 6th and 12th month after hospitalization of patients with acute myocardial infarction) and recording of unscheduled and urgent requests of patients for medical help. During the observation of patients we recorded the cardiovascular events, such as cardiovascular death, myocardial infarction, stroke, heart decompensation, heart rhythm disorders.&#x0D; Results. Analysis of cardiovascular events observed during the year in the examined group of patients revealed that during the first year after an acute coronary event the most common complications were the development of acute decompensation of chronic heart failure, acute heart failure de novo and atrial fibrillation paroxysms de novo. To a lesser extent, events such as episodes of unstable angina, non-fatal myocardial infarction and strokes, and sudden cardiac death have been reported. Time dependence was demonstrated only for the first two, namely an increase in the frequency of complications at a later date – from the 6th to the 12th month compared to the first 6 months of follow-up.&#x0D; Conclusions. Manifestations of cardiac decompensation and arrhythmia in the delayed period of the disease are associated with manifestations of structural remodeling and electrical instability of the myocardium, while the reduction of fatal complications is a consequence of early invasive treatment strategy.

Target Vessel Versus Complete Revascularization in Non-ST Elevation Myocardial Infarction Without Cardiogenic Shock.

IntroductionThe role of complete revascularization (CR) vs target vessel revascularization (TVR) in non-ST-elevation myocardial infarction (NSTEMI) in patients without cardiogenic shock is still not established. In this study, we compared outcomes at one and six months among patients with NSTEMI with multivessel disease (MVD) undergoing CR vs TVR.MethodsIt was a prospective, observational study carried out among 60 NSTEMI patients with MVD (30 undergoing TVR and 30 CR) from October 2018 to November 2019. They were assessed at one and six months for primary and secondary outcomes.ResultsThe mean age of the patients was 56.13 ± 9.23 years and both the groups were well matched with respect to age, gender, risk factors, and comorbidities. In the majority of patients, the target vessel was left anterior descending (LAD) followed by right coronary artery (RCA) and left circumflex (LCX) in both groups. The primary outcomes of death from any cause, non-fatal myocardial infarction, and the need for revascularization of the ischemia-driven vessel showed no significant difference at one and six months follow-up between the CR and TVR groups. However, the secondary outcomes of heart failure hospitalizations and angina episodes were significantly more in the TVR group than CR group at one month (6 vs 1, P=0.044), (8 vs 2, P=0.038) and six months (8 vs 2, P=0.038), (9 vs 2, P=0.02), respectively.ConclusionCR was associated with no difference in death from all-cause or future revascularization but significantly lesser secondary outcomes of heart failure hospitalizations and angina episodes as compared to TVR in NSTEMI without cardiogenic shock.

Data Mining-Based Analysis of Modern Chinese Medicine for the Treatment of Stable Angina Pectoris in Coronary Heart Disease.

The aim of this study is to explore the clinical effects of Chinese medicine in the treatment of stable angina pectoris in coronary heart disease. Chinese medicine has multitarget, multilevel, and multilink effects in the treatment of coronary angina, which can significantly improve patients' symptoms. Its mechanism of action involves multiple levels such as regulating lipid metabolism, improving platelet function, antioxidant, and protecting endothelial function. The design was based on data mining to analyse the dosing pattern of modern Chinese medicine for the treatment of stable angina pectoris in coronary heart disease. The number of episodes of angina pectoris, the duration of the episodes, and the changes in the electrocardiogram before and after taking the medicine were observed and compared between the two groups. The number and duration of angina attacks ((2.23 ± 0.77) per week and (1.31 ± 0.34) min/time, respectively) in the study group were found to be significantly better than those in the control group ((3.86 ± 1.03) per week and (2.46 ± 1.21) min/time, respectively).

61-Year-Old Man With Nausea and Vomiting

61-Year-Old Man With Nausea and Vomiting

Safety and effectiveness of enhanced external counterpulsation (EECP) in refractory angina patients: A systematic reviews and meta-analysis.

Enhanced external counterpulsation (EECP) is believed to be a non-invasive treatment for coronary artery disease and angina. The aim of this study was to determine the safety and effectiveness of EECP in refractory angina patients through a systematic reviews and meta-analysis. We conducted a comprehensive search of the literature published on PubMed, Cochrane library, Scopus, ScienceDirect, Trip Database and Google Scholar databases using appropriate keywords and specific strategy with no time limit. Having selected and screened the studies based on the defined inclusion and exclusion criteria and evaluating their quality based on the Cochrane checklist. For the meta-analysis,the Mantel-Haenszel method or the generic Inverse Variance was used. Analyses were done with Review Manager 5.2 software. A number of 299 studies were initially reviewed and finally, seventeen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Also, thirteen outcomes were analyzed and the results of meta-analysis in twelve outcomes including (Systolic Blood Pressure (7 studies), Diastolic Blood Pressure (7 studies), Pulse Pressure (4 studies), Mean Arterial Pressures (4 studies), Heart Rate (6 studies), Angina episodes (7 studies), Walking distance (2 studies),Canadian Cardiovascular Society classification (6 studies), Flow-Mediated Dilation (3 studies), Daily Nitrate Usage (4 studies), Exercise Treadmill Test-Time (2 studies), ST-segment depression (2 studies)demonstrated a significant clinical advantage in the EECP treatment effectiveness in patients with angina. No significant difference was observed regarding EECP usefulness (P = 0.18) in the outcome of brachial artery diameter (2 studies). Based on the meta-analysis, the results indicate the safety and effectiveness of EECP in patients with angina pectoris and indicate the usefulness of this treatment in these patients. In general, the authors believe that the general conclusion in this regard requires some studies with a large sample size and a control group assignment.

Heart rate reduction using ivabradine protects against periprocedural myocardial injury and angina symptoms in patients with stable coronary disease undergoing coronary intervention

Purpose: There are no data demonstrating that a decrease in heart rate reduces periprocedural myocardial injury (PMI) in patients undergoing elective percutaneous coronary intervention (PCI). Ivabradine is an established anti-ischemic drug that reduces heart rate (HR) and subsequently alleviates symptoms of angina. The present study sought to determine whether HR reduction via ivabradine attenuates PMI.Methods: Forty patients with stable angina and a resting HR of &gt;70 bpm were administered 5 mg of ivabradine twice daily. The control group consisted of 40 patients with a resting HR of &gt;70 bpm. All patients were monitored for one month before the scheduled intervention. After admission, troponin I levels were measured before and 24 h after the procedure. Data on any change in symptoms were also collected in both groups.Results: There were no significant differences between the groups. A significant reduction in HR and angina episodes per week was noted in the ivabradine group (62.3±7.1 bpm vs.79±10.2 bpm; P&lt;0.05 and 0.5±0.1 vs. 2.4±2.1; P&lt;0.05). The mean troponin I levels after the procedure were significantly lower in the ivabradine group compared to the control group (0.12±0.03 ng/mL vs. 0.44±0.08 ng/mL; P&lt;0.05). When analyzing patients after coronary intervention, heart rate of &lt;70 bpm(OR 7.0; CI 1.2 to 41.7; P=0.03) and number of deployed stents (OR 4.4; 95% CI 1.1 to 17.3; P=0.03) were the only significant predictors of PMI after adjustment for potential confounders in a multivariable logistic model. Conclusion: HR reduction achieved by ivabradine reduces PMI in patients undergoing elective PCI.

The Preventive Value of Acupoint Sensitization for Patients with Stable Angina Pectoris: A Randomized, Double-Blind, Positive-Controlled, Multicentre Trial.

Background Acupoint sensitization is considered an important factor in the efficacy of acupoint therapy. This study aimed to evaluate the efficacy of acupressure in the prevention of stable angina pectoris using acupoints with different pressure-pain sensitivities. Methods A total of 202 patients were enrolled and randomly assigned to a high-sensitivity group (HSG) (n = 109) in which patients received acupressure at the five acupoints with the highest sensitivity to pain and a low-sensitivity group (LSG) (n = 93) in which patients received acupressure at the five acupoints with the lowest sensitivity to pain. The duration of acupressure treatment was 4 weeks, and the patients were evaluated at baseline, week 4, and week 8. The primary outcome was a change in the frequency of angina attacks from baseline. The secondary outcomes included nitroglycerin consumption, the Canadian Cardiovascular Society classification, and the Seattle Angina Questionnaire score. Adverse events such as bleeding and subcutaneous haemorrhage were recorded in both groups. Results The effect of acupressure compared with baseline on the prevention of angina pectoris in HSG was better than that in LSG at week 4 (incidence rate ratio (IRR): 0.691 and 95% confidence interval (CI): [0.569, 0.839]) and week 8 (IRR: 0.692 and 95% CI: [0.569, 0.839]). No significant difference between groups was found in the frequency of nitroglycerin consumption at week 4 (odds ratio (OR) = 0.863 and 95% CI: [0.147, 5.077]) or week 8 (OR = 1.426 and 95% CI: [0.211, 9.661]). Two themes in the questionnaire showed significantly different changes from baseline between the two groups. Scores on the angina frequency (AF) subscale had changed more from the baseline in the HSG at week 8 than in the LSG (mean difference (MD) = 3.807 and 95% CI: [0.673, 6.942]). Scores on the treatment satisfaction (TS) subscale had also changed more in the HSG than in the LSG at week 4 (MD = 3.651 and 95% CI: [0.327, 7.327]) and week 8 (MD = 4.220 and 95% CI: [0.347, 7.346]). One patient in the LSG reported bruising at the acupoint. No unexpected safety problems arose. Conclusions This study showed that acupressure at acupoints with high sensitivity to pain may effectively reduce the frequency of stable angina pectoris episodes. This trial is registered with NCT03975140.

Incidencia de cardiopatía isquémica en el estudio HERMEX y su asociación con los factores de riesgo cardiovascular clásicos

ObjectivesKnowledge about the incidence of coronary heart disease in our country is scarce and its sources are not comparable. Our aim was to determine the incidence of ischemic heart disease in a population cohort in a 7 years of follow-up, as well as the risk associated with the different classical cardiovascular risk factors. MethodsCohort study with a population sample of 2833 subjects, selected by the simple random method in a population between 25 and 79, from the Don Benito – Villanueva de la Serena (Badajoz) health area, response rate was 80.5%.All episodes of angina pectoris, lethal and non-lethal myocardial infarction were collected in individuals with no previous history of cardiovascular disease. Cumulative incidences and incidence rates adjusted per 100,000 person-years by sex and overall were calculated. ResultsFrom 2833 initial cohort participants, 103 were excluded due to a history of cardiovascular disease and 61 for losses, 2669 completed the follow-up (94.2%). The median follow-up was 6.9 years (IR 6.5–7.5), 56.4% women; 59 events were recorded. The overall incidence rate of ischemic heart disease was 327 cases/100,000 person-years, corresponding to 470 cases/100,000 for men and 211 cases/100,000 people-years for women. The classical cardiovascular risk factors that were associated with a higher risk of presenting events in the follow-up were dyslipidemia and arterial hypertension, in addition to male sex and age. ConclusionsThe incidence of ischemic heart disease in the urban–rural population of Extremadura is high. The classical cardiovascular risk factors most strongly associated with events were dyslipidemia, and arterial hypertension.

ACS mortality prediction in Asian in-hospital patients with deep learning using machine learning feature selection

Abstract Background Thrombolysis in Myocardial infarction (TIMI) is used in predicting the mortality rate of the acute coronary syndrome (ACS) patients. TIMI was developed based on the Western cohort with limited data on the Asian cohort. There are separate TIMI scores for STEMI and NSTEMI. Deep learning (DL) and machine learning (ML) algorithms such as support vector machine (SVM) in population-specific dataset resulted in a higher area under the curve (AUC) to TIMI. The limitation of DL is selected features by the algorithm is unknown compared to ML algorithms. Purpose To construct a single in-hospital mortality risk scoring system that combines SVM feature importance and the DL algorithm in ASIAN patients with ACS that is applicable for both STEMI and NSTEMI patients. To investigate DL performance constructed using predictors selected from SVM feature extraction and DL using complete features and compare with TIMI risk score for STEMI and NSTEMI patients. Methods We constructed four algorithms: i) DL and SVM algorithm with feature selected from SVM variable importance, ii) DL and SVM algorithm without feature selection. SVM feature importance with the backward elimination method is used to select and rank important variables. We used registry data from the National Cardiovascular Disease Database of 13190 patient's data. Fifty-four parameters including demographics, cardiovascular risk, medications and clinical variables were considered. AUC was used as the performance evaluation metric. All algorithms were validated using validation dataset and compared to the conventional TIMI for STEMI and NSTEMI. Results Validation results in Figure 1 are by STEMI and NTEMI patients. Both DL algorithms outperformed ML and TIMI score on validation data. Similar performance is observed for DL and SVM algorithms using all predictors (54 predictors) with DL and SVM algorithm using selected predictors (14 predictors). Predictors selected by the SVM feature selection are: age, heart rate, Killip class, fasting blood glucose, ST-elevation, CABG, cardiac catheterization, angina episode, HDLC, LDC, other lipid-lowering agents, statin, anti-arrhythmic agent, oralhypogly. CABG and pharmacotherapy drugs as selected predictors improve mortality prediction compared to TIMI score. In DL, 25.87% of STEMI patients and 19.71% of NSTEMI patients are estimated as high risk (risk probabilities of &amp;gt;50%). TIMI underestimated the risk of mortality of high-risk patients (≥5 risk scores) with 13.08% from STEMI patients and 4.65% from NSTEMI patients (Figure 2). Conclusions In the ASIAN multi-ethnicity population, patients with ACS can be better classified using one single algorithm compared to the conventional method like TIMI which requires two different scores. Combining ML feature selection with DL allows the identification of distinct factors related to in-hospital mortality of ACS patients in a unique ASIAN population for better mortality prediction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Technology Development Fund 1 Figure 1. Performance resultsFigure 2. Analysis on the validation set

Perfuração crônica de enxerto de veia safena após implante de stent: uma condição raramente relatada

A 69-year-old male with hypertension, dyslipidemia, and coronary artery disease (CAD) was admitted to the emergency room in December 2020 reporting chronic angina, with slight limitation to ordinary activities (Canadian Cardiovascular Society angina grade II) and described worsening of symptoms in the past 20 days, with episodes of prolonged angina (over 20 minutes) and mild dyspnea. An initial 12-lead electrocardiogram showed no signs of acute ischemia, and the cardiac biomarkers were negative for myocardial infarction (troponin 9ng/L; upper limit of [...]

EFFECT OF YOGIC LIFESTYLE MODIFICATION ON ANGINAL EPISODES IN CAD PATIENTS

BACKGROUND: There has been an alarming increase in the prevalence of Coronary Artery Disease (CAD) worldwide and is a leading cause of mortality in India. Yoga is emerging as a signicant tool in managing the disease. OBJECTIVES:The study was conducted to nd out the effect of yogic lifestyle modication on anginal episodes in CAD patients. METHODS: This prospective, controlled study included the CAD patients between the ages 30 to 70 years who were randomised to yoga group (group A, n=51) and control group (group B, n=51). They were assessed clinically on the basis of number of anginal episodes per week. The yoga group patients were prescribed a family based yoga programme in addition to the conventional drug treatment for CAD. The control group received conventional drug therapy alone. The patients were assessed at baseline and thereafter, at the end of 6 months. RESULTS: The number of anginal episodes per week reduced signicantly by 25.40% in the yoga group vis-à-vis the control group at the end of six months (independent t-test p-value&lt;0.01). It was also inferred from the study that while at baseline, there was no statistically signicant difference between the yoga and control groups (independent t-test p-value&gt;0.05), the difference became signicant at the end of six months (independent t-test p-value&lt;0.05). CONCLUSIONS: In the present study, we witnessed a substantial and signicant effect of yogic lifestyle intervention in decreasing the number of anginal episodes per week in CAD patients thereby reducing the morbidity associated with the disease considerably