Angina Patients Research Articles

The impact of first wave of the SARS-CoV-2 2019 pandemic in Poland on characteristics and outcomes of patients hospitalized due to stable coronary artery disease.

An investigation of baseline characteristics, treatment, and outcomes in patients with stable coronary disease after the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS- -CoV-2) pandemic may provide valuable data and is beneficial for public health strategy in upcoming years. A multi-institutional registry, including 10 cardiology departments, was searched for patients admitted from June 2020 to October 2020. The baseline characteristics (age, gender, symptoms, comorbidities), treatment (non-invasive, invasive, surgical), and hospitalization outcome (mortality, myocardial infarction, stroke, composite endpoint - major adverse cardiac and cerebrovascular events [MACCE]) were evaluated. The comparison was made to parameters presented by patients from the same timeframe in 2019 (June-October). Multivariable analysis was performed. Number of hospitalized stable patients following lockdown was lower (2498 vs. 1903; p < 0.0001). They were younger (68.0 vs. 69.0; p < 0.019), more likely to present with hypertension (88.5% vs. 77.5%; p < 0.0001), diabetes (35.7% vs. 31.5%; p = 0.003), hyperlipidemia (67.9% vs. 55.4%; p < 0.0001), obesity (35.8% vs. 31.3%; p = 0.002), and more pronounced symptoms (Canadian Cardiovascular Society [CCS] III and CCS class IV angina: 30.4% vs. 26.5%; p = 0.005). They underwent percutaneous treatment more often (35.0% vs. 25.9%; p < 0.0001) and were less likely to be referred for surgery (3.7% vs. 4.9%; p = 0.0001). There were no significant differences in hospitalization outcome. New York Heart Association (NYHA) class IV for heart failure was a risk factor for both mortality and MACCE in multivariate analysis. The SARS-CoV-2 2019 pandemic affected the characteristics and hospitalization course of stable angina patients hospitalized following the first wave. The hospitalization outcome was similar in the analyzed time intervals. The higher prevalence of comorbidities raises concern regarding upcoming years.

Prognostic role of tissue plasminogen activator in coronary artery disease with or without aortic valve sclerosis.

We sought to investigate the relationship between circulating tissue plasminogen activator (t-PA) level and long-term outcomes in stable coronary artery disease patients with or without aortic valve sclerosis (AVSc). Serum levels of t-PA were determined in 347 consecutive stable angina patients with (n=183) or without (n=164) AVSc. Outcomes were prospectively recorded as planned clinic evaluations every 6months up to 7years. The primary endpoint was a composite of cardiovascular death and rehospitalization due to heart failure. The secondary endpoint included all-cause mortality, cardiovascular death, and rehospitalization due to heart failure. Serum t-PA was significantly higher in AVSc than in non-AVSc patients (2131.22pg/mL vs. 1495.85pg/mL, P<0.001). For patients with AVSc, those with t-PA level above the median (>1840.68pg/mL) were more likely to meet the primary and secondary endpoints (all P<0.001). After adjusting for potential confounding factors, serum t-PA level remained significantly predictive for each endpoint in the Cox proportional hazard models. The prognostic value of t-PA was good, with an AUC-ROC of 0.753 (P<0.001). The combination of t-PA with traditional risk factors improved the risk reclassification of AVSc patients, with a net reclassification index of 0.857 and an integrated discrimination improvement of 0.217 (all P<0.001). However, for patients without AVSc, both primary and secondary endpoints were similar, irrespective of t-PA levels. Elevated circulating t-PA confers an increased risk for poor long-term clinical outcomes in stable coronary artery disease patients with AVSc.

Serum Nuclear Factor Erythroid-2 Related Factor-2 (NRF2) as an Indicator of Oxidative Stress is Related to Coronary in-Stent Restenosis

Objective: In the treatment of coronary artery disease, stent implantation has become the standard treatment, but development of in-stent restenosis (ISR) limits the benefit of this treatment modality. Methods: Based on the connection between oxidative stress and thiol/disulphate and NRF2, it was intended to measure NRF2 and thiol/disulphate levels. Results: Coronary angiography images of 76 stable angina pectoris patients were evaluated. Of the 51 patients with a history drug eluting stent implantation, we determined 25 patients with ISR (Group 1) and 26 patients without ISR (Group 2). Twenty-five patients with normal coronary arteries were included in the study as control group (Group 3). NRF2 level was found to be significantly higher in patients who did not develop ISR (p=0.01). Total thiol was significantly higher in group 3 (738.76 micromole/L) compared to group 1 (626.11 micromole/L) and group 2 (630.27 micromole/L) (p=0.014). Native thiol was also significantly higher in group 3 (570.53 micromole/L) compared to group 1 (483.91 micromole/L) and group 2 (501 micromole/L) (p=0.006). Conclusion: We think that total and native thiol levels might be useful as an indicator of oxidative stress in early diagnosis of coronary artery disease, and the NRF2 level can be used in predicting patients who might develop coronary ISR.

Diagnosis of acute myocardial infarction using a combination of circulating circular RNA cZNF292 and clinical information based on machine learning.

Circulating circular RNAs (circRNAs) are emerging as novel biomarkers for cardiovascular diseases (CVDs). Machine learning can provide optimal predictions on the diagnosis of diseases. Here we performed a proof-of-concept study to determine if combining circRNAs with an artificial intelligence approach works in diagnosing CVD. We used acute myocardial infarction (AMI) as a model setup to prove the claim. We determined the expression level of five hypoxia-induced circRNAs, including cZNF292, cAFF1, cDENND4C, cTHSD1, and cSRSF4, in the whole blood of coronary angiography positive AMI and negative non-AMI patients. Based on feature selection by using lasso with 10-fold cross validation, prediction model by logistic regression, and ROC curve analysis, we found that cZNF292 combined with clinical information (CM), including age, gender, body mass index, heart rate, and diastolic blood pressure, can predict AMI effectively. In a validation cohort, CM+cZNF292 can separate AMI and non-AMI patients, unstable angina and AMI patients, acute coronary syndromes (ACS), and non-ACS patients. RNA stability study demonstrated that cZNF292 was stable. Knockdown of cZNF292 in endothelial cells or cardiomyocytes showed anti-apoptosis effects in oxygen glucose deprivation/reoxygenation. Thus, we identify circulating cZNF292 as a potential biomarker for AMI and construct a prediction model "CM+cZNF292."

Effect of Coronary Sinus Reducer Implantation on Aerobic Exercise Capacity in Refractory Angina Patients—A CROSSROAD Study

Coronary sinus reducer (CSR) implantation is a new treatment option for patients with refractory angina pectoris. However, there is no evidence from a randomized trial that would show an improvement in exercise capacity after this treatment. The aim of this study was to evaluate the influence of CSR treatment on maximal oxygen consumption and compare it to a sham procedure. Twenty-five patients with refractory angina pectoris (Canadian Cardiovascular Society (CCS) class II–IV) were randomized to a CSR implantation (n = 13) or a sham procedure (n = 12). At baseline and after 6 months of follow-up, the patients underwent symptom-limited cardiopulmonary exercise testing with an adjusted ramp protocol and assessment of angina pectoris using the CCS scale and Seattle angina pectoris questionnaire (SAQ). In the CSR group, maximal oxygen consumption increased from 15.56 ± 4.05 to 18.4 ± 5.2 mL/kg/min (p = 0.03) but did not change in the sham group (p = 0.53); p for intergroup comparison was 0.03. In contrast, there was no difference in the improvement of the CCS class or SAQ domains. To conclude, in patients with refractory angina and optimized medical therapy, CSR implantation may improve oxygen consumption beyond that of optimal medical therapy.

The Relationship between the Serum NLRP1 Level and Coronary Lesions in Patients with Coronary Artery Disease.

The pathogenesis of coronary artery disease is complex, and inflammation is one of the regulatory factors. The nucleotide-binding oligomerization domain (NOD)-like receptor protein 1 (NLRP1) plays an important role in the cellular inflammatory response, cell apoptosis, cell death, and autoimmune diseases. Whether the level of NLRP1 is related to the severity of coronary artery stenosis in patients with coronary artery disease (CAD) has not been reported. To test the serum level of NLRP1 in unstable angina (UA) patients and investigate the effect of NLRP1 on coronary stenosis severity of the coronary artery disease (CAD). 307 patients hospitalized in the Department of Cardiology of the Affiliated Hospital of Xuzhou Medical University for coronary angiography from January 1, 2021, to December 31, 2022 were included. We detect the level of NLRP1 in the serum of the included patients. Patients were divided into UA group and control group according to coronary angiography results and other clinical data. We use logistic regression to screen the influencing factors of UA. Then, subgroups were divided according to the Gensini score and the number of coronary artery lesions, and the difference of serum NLRP1 level between the groups was compared. Spearman correlation analysis was used to explore the correlation between the serum NLRP1 level and Gensini score. We analyze the diagnostic value of NLRP1 for UA by drawing ROC curve. The median level of serum NLRP1 in patients with UA (n = 257) was 49.71 pg/ml, IQR 30.15, 80.21, and that in patients without UA (n = 50) was 24.75 pg/ml, IQR 13.49, 41.95. Serum NLRP1 levels were significantly different among different subgroups. The patient's Gensini score was correlated with the patient's serum NLRP1 level. The serum NLRP1 level is increased in patients with UA, which is increased with the increasing severity of coronary lesions.

CT CORONARY ANGIOGRAPHY AS THE INITIALANATOMIC IMAGING TEST FOR STABLE CHEST PAIN

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the current scenario. The recommended diagnostic protocols include either exercise treadmill testing (ETT) or noninvasive cardiac imaging tests like, stress echocardiography (SE), myocardial perfusion scintigraphy (MPS), and coronary computed tomographic angiography (CCTA) to diagnose, prognosticate risk and impact therapeutic decision making for patients with an intermediate pre-test likelihood of stable CAD. In comparison with cardiac testing without imaging, non-invasive cardiac testing with imaging has been favoured as an initial test for stable angina patients with at least intermediate pre-test likelihood of obstructive CAD, due to its superior ability to diagnose, reclassify and predict CAD events, guiding the [1] subsequent treatment

Radial Versus Femoral Access in Percutaneous Coronary Intervention in Acute Coronary Syndrome

Background: Although it safeguards patients from hemorrhagic disorders during cardiac procedures, the radial route is technically more challenging than the femoral approach. Aim: To evaluate the hypothesis that radial approach is the preferred strategy in ACS patients, and identifying independent predictors of the choice to choose radial access. Methods: Between August 2021 and January 2022, this prospective study was conducted in the interventional cardiology unit of Hayatabad Medical Complex Peshawar. The study included all ACS (unstable angina or myocardial infarction) patients who had previously had invasive diagnostic or therapeutic cardiac procedures. Patients who opted out of the trial were excluded. Results: Those in group 1 had a lower mean GRACE score (112±31 versus 127±40; p&lt;0,001), improved renal function according to cretanine level (0.9±0.3 versus 1.1±1.0; p &lt; 0.001) and a reduced prevalence of indications of left ventricular failure (6% versus 21%, p 0.003) when compared to patients in group 2. There was no difference in the groups at the time of admission for the type of ACS heart rate (69±15 Vs 75±16), systolic arterial pressure (148±31 Vs 151±33), positive troponin 59(79.7%) Vs 51(68.9%), electrocardiographic ischemia 23(31%) Vs 19(25.7%), three-vessel disease (30, 40.5%) VS 25(33.8%) Practical implication: The variables that determined the preference for radial approach reflect the clinical status and severity of the patients, demonstrating that the convenience of the approach is more valued in extremely complex patients than its antihemorrhagic effectiveness. Conclusion: The trend for radial access to be preferred over femoral access during coronary intervention was not primarily influenced by the patient population's risk of bleeding. Keywords: Angioplasty, Coronary Artery Disease, Radial Artery, Femoral Artery.

Consensus statement on cardiovascular risk stratification and aggressive management of chronic coronary syndromes

Cardiovascular diseases (CVDs) are responsible for 17.5 million deaths globally, and India is more susceptible to coronary artery disease (CAD) than its western counterparts because of certain challenges such as suboptimal management, increased healthcare costs, and physicians undermining the extent of limitation in angina patients. All of these could be resolved by employing strategies starting with accurate diagnosis to timely implementation of aggressive management techniques to contain morbidity and mortality. Pan India, experts from the field of cardiology came together in order to discuss risk stratification and aggressive management of chronic coronary syndromes (CCS). The expert consensus laid down a path of recommendations considering the prevailing healthcare service infrastructure, local evidence-based studies and key international guidelines. With the wide diversity in terms of geographical distribution in India and the risk factors presented across various divisions of the population, risk stratification is necessary for prompt identification and subsequent management of CCS. In this consensus, various risk stratification techniques such as risk stratification based on ventricular function, electrocardiogram (ECG), stress echocardiography (ECHO), the Duke treadmill score (DTS), and myocardial perfusion imaging (MPI) were discussed. After risk stratification, the consensus focused on aggressive management of CVDs with therapeutic optimization for various types of patient profiles such as revascularization for stable angina and angina with comorbidities (diabetes and renal failure), apart from emphasis on various medications and their roles in ameliorating disease symptoms.

Impaired peripheral microvascular reactivity in patients with nonobstructive coronary artery disease

This study aimed to determine whether peripheral microvascular reactivity is impaired in patients with nonobstructive coronary artery disease (NOCAD). Stable patients presenting with angina were recruited and, based on results from coronary angiography, were categorized into OCAD (coronary stenosis of ≥50%) and NOCAD (stenosis <50%) groups. A control group with no history of angina was also recruited. Forearm skin microvascular reactivity was measured using the laser Doppler blood perfusion monitor and the process of postocclusive skin reactive hyperemia (PORH). Patients were categorized into OCAD (n = 42), NOCAD (n = 40), and control (n = 39) groups. Compared with the control group, the PORH perfusion percent change (PORH% change) was significantly lower in the OCAD and NOCAD groups. No significant differences were noted between the OCAD and NOCAD groups. Additionally, the NOCAD group without any coronary obstruction takes a longer time to reach peak perfusion and had lower PORH% change compared with the nonangina control group. Angina patients with NOCAD have microvascular dysfunction as demonstrated by reduced magnitude of reperfusion with an ischemic stimulus. NOCAD patients without coronary obstruction also displayed a slower response to reperfusion.

Differentiating the effects of fine and coarse particulate air pollution on the onset of stable and unstable angina: a case-crossover study in 305 Chinese cities

Background and purpose: Associations between fine and coarse particulate matters (i.e., PM2.5 and PM2.5–10, respectively) and the onset of angina have rarely been investigated. We aimed to systematically explore the impacts of PM2.5 as well as PM2.5–10 on the onset of stable and unstable angina at the hourly timescale. Methods: We performed a time-stratified case-crossover study among 995,734 angina patients from 1,655 hospitals in 305 Chinese cities from January 2015 to December 2021. Concentrations of PM2.5 and PM2.5–10 were collected at the hourly timescale from nearby fixed-site monitoring stations. Hourly onset information of unstable and stable angina was obtained from the Chinese Cardiovascular Association Database-Chest Pain Center. We applied conditional logistic regressions combined with polynomial distributed lag models to explore the lagged exposure–response associations. Subgroup analyses were performed to explore potential effect modifiers including age, sex, season, and region. Results: Transient exposure to PM2.5 was significantly associated with elevated risk of unstable and stable angina onset. The associations occurred immediately in the concurrent hour of exposure, attenuated thereafter, and turned to null at approximately lag 12 h for unstable angina and 9 h for stable angina. Each interquartile range increase in the PM2.5 concentrations over 0 to 12 h was associated with 1.32% (95% confidence interval [95% CI]: 0.94%–1.70%) and 1.69% (95% CI: 0.99%–2.39%) increase in the onset risk of unstable and stable angina, respectively. The results remained similar after controlling for co-pollutants. Greater magnitudes of associations were found among females and during cold season. Null associations were observed between PM2.5–10 and any type of angina. Conclusion: Our study indicates that acute exposure to PM2.5, rather than PM2.5–10, was significantly associated with the onset of both unstable and stable angina, underscoring the need of continued efforts in controlling particulate matter air pollution.

TCTAP A-068 Use of FFR in Chronic Stable Angina Patients and Its Impact on PCI and In-Hospital Outcome

TCTAP A-068 Use of FFR in Chronic Stable Angina Patients and Its Impact on PCI and In-Hospital Outcome

Efficacy and safety of Shugan Jieyu Decoction in the treatment of coronary heart disease complicated with depression.

Coronary heart disease combined with depression is 1 of the 2 major diseases affecting physical and mental health. It has become a hot spot at the intersection of psychiatry and internal medicine. Most doctors call double heart medicine, which has a high incidence rate and a low diagnostic rate. Clinical research shows that Shugan Jieyu Decoction (SJD) has a better curative effect, increased safety, and fewer adverse reactions, but it lacks systematic evaluation. This study aims to integrate clinical data through network meta-analysis and provide more evidence-based medical evidence for clinical medication. We searched 8 electronic databases: China knowledge network database, Wanfang, VIP, SinoMed, PubMed, Embase, WebofScience, Cochrane Library, and selected 22 randomized controlled trials from January 2012 to January 2022. The common primary endpoint was the relief of angina pectoris and the improvement of depression. Two researchers used Endnote9.1 software to conduct literature screening and information extraction according to the developed nano-passage standard, used Cochrane collaborative tool to evaluate the bias risk in the experiment, and then used RevMan5.3 software to assess the literature and data analysis synthesis. In 1908 patients with coronary heart disease and depression, the total effective rate of SJD in the treatment of angina pectoris was 3.49 (95% confidence interval, 1.93-6.29), as well as the network meta-analysis of improving depressive symptoms, anxiety, depression scores (SAS, SDS) and quality of life scores (HAMD), and reducing the indicators related to CPR and homocysteine. The analysis of this study shows that SJD can reduce the frequency of angina pectoris in patients with coronary heart disease and depression, alleviate anxiety and depression, provide a reference basis for clinical treatment, and select more effective intervention therapy.

Expression profile of circular RNAs in patients with unstable angina.

Circular RNAs (circRNAs) are a new class of noncoding RNAs, which interfere with gene transcription by absorbing microRNAs (miRNAs). The expression profile and roles of circRNAs in unstable angina (UA) patients remains unclear. An initial screening of circRNA expression by microarray analysis was performed using blood samples from three pairs of UA patients and matched healthy individuals. The differential expression of the chosen six circRNAs from the results of the microarray analysis was validated by quantitative real-time polymerase chain reaction (qRT-PCR). The microarray results demonstrated that some circRNAs were markedly different in UA patients, when compared with matched healthy individuals. In these UA patients, 22 circRNAs were upregulated and six circRNAs were downregulated when a P-value of < 0.05 was considered as a cut-off level and the fold change was > 1.5. Among the six circRNAs chosen for further analysis, qRT-PCR identified that five of these were upregulated, and the remaining circRNA was downregulated. By comparing the outcome of the six candidate circRNAs between the circRNAs microarray assay and RT-PCR validation, it was found that four circRNAs (hsa_circ_0002229, hsa_circ_0005580, hsa_circ_0046667, and hsa_circ_0001451) had the same variation trend. The present study provided the expression profile of circRNAs in UA patients. Moreover, some circRNAs have the potential to be biomarkers for the detection of UA patients. Further studies with a larger population will focus on hsa_circ_0002229, hsa_circ_0005580, hsa_circ_0046667 and hsa_circ_0001451.

The relationship between metabolic acidosis as a predictive factor of mortality in Ludwig's Angina patients at Dr. Soetomo General Hospital, Surabaya, Indonesia

Background: Mortality in a patient with Ludwig's Angina is usually due to prolonged sepsis. When sepsis is present, acidosis and lactate independently predict mortality in critically ill patients. Patients who develop acidosis after 6 hours are at high risk of death and should be treated more aggressively than septic patients. Methods: A retrospective cohort study to determine the association between metabolic acidosis and mortality in Ludwig's Angina patient at Dr. Soetomo General Hospital Surabaya at Dr. Soetomo between January 2019 - December 2020. We retrospectively reviewed 42 medical records of patients with Ludwig's Angina. We collected patient data such as age, history, physical examination, blood gas analysis, surgical intervention, comorbidities, complications before surgery, and patient outcomes. Results: We analyze a total of 42 patients. 71.40% were male, and 38.60% were in the group of 51-60 years, with a mean age of 45.73 years. 59.50% had metabolic acidosis, and 83.30% died. Based on the comorbidities, there were 28.60% with diabetes mellitus, 21.40% with dental caries and 16.70% with hypertension. A complication of hypoalbuminemia was found in 42.90%, 23.80% with sepsis, and 21.40% with acute kidney injury. Metabolic acidosis and mortality had a significant relationship with a p-value of 0.047, OR 5.00 (95% CI, 0.933-26.785). No comorbidity or complication variables impacted patient outcomes (p &gt; 0.05 for all). Conclusion: There was a significant relationship between metabolic acidosis and mortality of Ludwig's angina patients.

Serum homocysteine relates to elevated lipid level, inflammation and major adverse cardiac event risk in acute myocardial infarction patients.

Aim: This study aimed to evaluate association of homocysteine (Hcy) with major adverse cardiac event (MACE) risk in acute myocardial infarction (AMI). Methods: Serum Hcy data from 196 AMI and 20 angina pectoris patients were retrieved from ahospital's electronic system. AMI patients attended a median of 21.2-month follow-up. Results: Hcy waselevated in AMI patients compared with angina pectoris patients (p=0.020). In AMI patients, Hcy was positively related to total cholesterol, low-density lipoprotein cholesterol, C-reactive protein, infarct size, TNF-α and IL-6, while inversely linked with IL-10 (all p<0.05). Hcy was independently associated with high MACE risk in AMI patients (p=0.024). Conclusion: Serum Hcy correlates with elevated lipid levels, inflammation, infarct size and MACE risk in AMI patients.

Serum histone deacetylase 4 longitudinal change for estimating major adverse cardiovascular events in acute coronary syndrome patients receiving percutaneous coronary intervention.

Histone deacetylase 4 (HDAC4) regulates lipid accumulation, inflammation, endothelial injury, and atherosclerosis to participate in the pathogenesis of cardiovascular diseases. This study aimed to explore the value of serum HDAC4 change before and after percutaneous coronary intervention (PCI) in predicting major adverse cardiovascular events (MACE) risk in acute coronary syndrome (ACS) patients. HDAC4 from serum was detected by enzyme-linked immunosorbent assay in 340 ACS patients at baseline, day (D)1, D3, and D7 after PCI, and from 30 healthy controls (HCs). MACE was recorded during follow-up. HDAC4 was decreased in ACS patients versus HCs (P < 0.001). In ACS patients, HDAC4 was negatively related to total cholesterol (P = 0.025), low-density lipoprotein cholesterol (P = 0.007), C-reactive protein (P < 0.001), cardiac troponin I (P < 0.001), and hyperlipidemia history (P = 0.015). Additionally, HDAC4 was lowest in ST-elevation myocardial infarction (STEMI) patients, followed by non-STEMI patients, and highest in unstable angina patients (P = 0.010). After PCI, HDAC4 was decreased from baseline to D1, then increased until D7 (P < 0.001). Furthermore, HDAC4 at baseline (P = 0.002), D1 (P < 0.001), D3 (P < 0.001), and D7 (P < 0.001) were all reduced in patients who experienced MACE versus those who did not. Meanwhile, high HDAC4 at baseline (P = 0.036), D1 (P = 0.010), D3 (P = 0.012), and D7 (P = 0.012) estimated decreased accumulating MACE risk by Kaplan-Meier curve. Multivariate logistic analysis revealed that HDAC4 at D1 was independently linked to lower MACE risk (odds ratio = 0.957, P = 0.039). Serum HDAC4 is decreased from baseline to D1, then elevated until D7, and its increased level correlates with lower MACE risk in ACS patients receiving PCI.

Prediction Model of New Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome.

Atrial fibrillation (AF) is one of the most common complications of acute coronary syndrome (ACS) patients. Possible risk factors related to new-onset AF (NOAF) in ACS patients have been reported in some studies, and several prediction models have been established. However, the predictive power of these models was modest and lacked independent validation. The aim of this study is to define risk factors of NOAF in patients with ACS during hospitalization and to develop a prediction model and nomogram for individual risk prediction. Retrospective cohort studies were conducted. A total of 1535 eligible ACS patients from one hospital were recruited for model development. External validation was performed using an external cohort of 1635 ACS patients from another hospital. The prediction model was created using multivariable logistic regression and validated in an external cohort. The discrimination, calibration, and clinical utility of the model were evaluated, and a nomogram was constructed. A subgroup analysis was performed for unstable angina (UA) patients. During hospitalization, the incidence of NOAF was 8.21% and 6.12% in the training and validation cohorts, respectively. Age, admission heart rate, left atrial diameter, right atrial diameter, heart failure, brain natriuretic peptide (BNP) level, less statin use, and no percutaneous coronary intervention (PCI) were independent predictors of NOAF. The AUC was 0.891 (95% CI: 0.863-0.920) and 0.839 (95% CI: 0.796-0.883) for the training and validation cohort, respectively, and the model passed the calibration test (P > 0.05). The clinical utility evaluation shows that the model has a clinical net benefit within a certain range of the threshold probability. A model with strong predictive power was constructed for predicting the risk of NOAF in patients with ACS during hospitalization. It might help with the identification of ACS patients at risk and early intervention of NOAF during hospitalization.

Alterations of NMR-Based Lipoprotein Profile Distinguish Unstable Angina Patients with Different Severity of Coronary Lesions.

Non-invasive detection of unstable angina (UA) patients with different severity of coronary lesions remains challenging. This study aimed to identify plasma lipoproteins (LPs) that can be used as potential biomarkers for assessing the severity of coronary lesions, determined by the Gensini score (GS), in UA patients. We collected blood plasma from 67 inpatients with angiographically normal coronary arteries (NCA) and 230 UA patients, 155 of them with lowGS (GS ≤ 25.4) and 75 with highGS (GS > 25.4), and analyzed it using proton nuclear magnetic resonance spectroscopy to quantify 112 lipoprotein variables. In a logistic regression model adjusted for four well-known risk factors (age, sex, body mass index and use of lipid-lowering drugs), we tested the association between each lipoprotein and the risk of UA. Combined with the result of LASSO and PLS-DA models, ten of them were identified as important LPs. The discrimination with the addition of selected LPs was evaluated. Compared with the basic logistic model that includes four risk factors, the addition of these ten LPs concentrations did not significantly improve UA versus NCA discrimination. However, thirty-two selected LPs showed notable discrimination power in logistic regression modeling distinguishing highGS UA patients from NCA with a 14.9% increase of the area under the receiver operating characteristics curve. Among these LPs, plasma from highGS patients was enriched with LDL and VLDL subfractions, but lacked HDL subfractions. In summary, we conclude that blood plasma lipoproteins can be used as biomarkers to distinguish UA patients with severe coronary lesions from NCA patients.

Adherence to the Mediterranean Diet Association with Serum Levels of Nitric Oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal Angina Patients and Healthy Persons.

This study aimed to assess the association between adherence to the Mediterranean diet with serum Nitric oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal angina patients and healthy persons. This case-control study was conducted among 100 Prinzmetal angina patients and 100 healthy persons referred to the Ardabil Imam Khomeini hospital between 2021 and 2022. Blood samples were obtained from all study participants for measurement of serum Nitric oxide, Prostacyclin, and Thromboxane B2. To calculate adherence to the Mediterranean diet, the ten-item screener was used. The serum Nitric oxide in patients who adhered more to the Mediterranean diet was higher than patients with less adherence (coeff. = 0.41 p = 0.04). The serum Prostacyclin level in patients with greater adherence to the Mediterranean diet was 0.34 units higher than patients with less adherence (coeff. = 0.34 p = 0.02). The level of serum Thromboxane B2 had a negative association with adherence to the Mediterranean diet (coeff. = -0.48 p = 0.04). The amount of consumption of olive oil, fruits, vegetables, and legumes in healthy people was more than Prinzmetal angina patients. In Prinzmetal angina patients, more adherence to the Mediterranean diet can decrease the serum Thromboxane B2 and increase the serum Nitric oxide and Prostacyclin.