Severity Of Angiographic Disease Research Articles

The Relationship between Serum Calcium Levels and Angiographic Severity of Coronary Artery Disease in Patients with Chronic Coronary Syndrome

Objectives: This study aims to investigate the relationship between serum calcium levels and the angiographic severity of coronary artery disease (CAD) in patients with chronic coronary syndrome (CCS). Methodology: We conducted an observational study at the Department of Cardiology, Hayatabad Medical Complex, from January 2022 to December 2022, including 150 patients diagnosed with CCS. Serum calcium levels were measured using a colorimetric method, and the severity of CAD was assessed using the SYNTAX score derived from coronary angiography. Statistical analyses were performed using Pearson’s correlation coefficient and multivariate logistic regression to account for potential confounding factors such as age, gender, hypertension, diabetes, and dyslipidemia. Results: The analysis revealed a low negative correlation between serum calcium levels and SYNTAX scores (correlation coefficient: -0.13). Age emerged as a significant predictor of CAD severity (p<0.001), whereas serum calcium levels did not demonstrate an independent effect on CAD severity (p=0.24). After adjusting for confounding variables, no substantial correlation between serum calcium levels and SYNTAX scores was observed. Conclusion: While serum calcium levels were not independent predictors of CAD severity after adjusting for other risk factors, a weak negative correlation was observed. Age remained a crucial factor influencing CAD severity. These findings suggest that serum calcium levels alone are insufficient for CAD risk classification but may provide additional value when used in conjunction with other diagnostic methods.

Risk Factors Associated with Angiographic Severity of Coronary Artery Disease Based on Serum Uric Acid: A Study in a Tertiary Care Hospital, Chattogram, Bangladesh

Background: Coronary Artery Disease (CAD) is a leading cause of death worldwide, identifying risk factors and severity is crucial for management and prevention. Serum Uric Acid (SUA) has been proposed as a potential marker for the severity of CAD. Elevated SUA levels are associated with endothelial dysfunction, oxidative stress, and inflammation, all of which contribute to the development and progression of atherosclerosis. This study aims to determine the association of risk factors with the severity of CAD using SUA levels. Materials and methods: This was a cross-sectional observational study conducted in the Department of Cardiology at CMCH in Chattogram over one year from October 2020 to September 2021. After case selection demographic data were collected and transthoracic echocardiography was performed on study patients. Results: The study analyzed the association between SUA level and CAD severity in 130 patients undergoing coronary angiography. The mean SUA level was 5.06 mg/dl and was significantly associated with the presence of CAD, number of vessel involvement and severity of CAD assessed by the Gensini score. The mean SUA level in cases with CAD was significantly higher (5.26 ± 1.32 mg/dl) than in cases without CAD (4.22 ± 1.03 mg/dl). Conclusion: This study concluded that demographic variables and risk factors are associated with the severity of CAD. The severity of CAD was higher in elderly and male patients. The study suggests that when assessing the risk in a CAD patient, hyperuricemia should be considered. IAHS Medical Journal Volume 6(2) December 2023; 48-52

Value of Ischemia and Coronary Anatomy in Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease.

The value of physiological ischemia versus anatomic severity of disease for prognosis and management of patients with stable coronary artery disease (CAD) is widely debated. A total of 1764 patients who had rest-stress cadmium-zinc-telluride single-photon emission computed tomography myocardial perfusion imaging and angiography (invasive or computed tomography) were prospectively enrolled and followed for cardiac death/nonfatal myocardial infarction. The CAD prognostic index (CADPI) was used to quantify the extent and severity of angiographic disease. Prognostic value was assessed using Cox models, adjusted for pretest risk, known CAD, stressor, left ventricular ejection fraction, %ischemia and infarct, CADPI, and early (90-day) revascularization. Incremental prognostic value was evaluated using net reclassification index. The mean age was 69.7±9.5 years, 24.4% were women, and 29.3% had known CAD. Significant ischemia (>10%) was present in 28.4%. Nonobstructive, single, and multivessel disease was present in 256 (14.5%), 772 (43.8%), and 736 (41.7%), respectively. Early revascularization occurred in 579 (32.8%). Cardiac death/myocardial infarction occurred in 148 (8.4%) over a 4.6-year median follow-up. Both %ischemia and CADPI provided independent and incremental prognostic value over pretest clinical risk (P<0.001). In a model containing both ischemia and anatomy, ischemia was prognostic (hazard ratio per 5% ↑, 1.35 [95% CI, 1.11-1.63]; P=0.002) but CADPI was not (hazard ratio per 10-unit ↑, 1.09 [95% CI, 0.99-1.20]; P=0.07). Early revascularization modified the risk associated with %ischemia (interaction P=0.003) but not with CADPI (interaction P=0.6). %Ischemia and single-photon emission computed tomography variables added incremental prognostic value over clinical risk and CADPI (net reclassification index, 20.3% [95% CI, 9%-32%]; P<0.05); however, CADPI was not incrementally prognostic beyond pretest risk, %ischemia, and single-photon emission computed tomography variables (net reclassification index, 3.1% [95% CI, -5% to 15%]; P=0.21). Ischemic burden provides independent and incremental prognostic value beyond CAD anatomy and identifies patients who benefit from early revascularization. The anatomic extent of disease has independent prognostic value over clinical risk factors but offers limited incremental benefit for prognosis and guiding revascularization beyond physiological severity (ischemia).

Association between Triglyceride - High Density Lipoprotein Ratio with Angiographic Severity of Coronary Artery Disease in Patients with Non-ST Segment Elevated Myocardial Infarction

Background: Non-ST Segment Elevated Myocardial infarction (NSTEMI) is a potentially life-threatening condition. Dyslipidaemia is a major contributor of coronary artery disease (CAD) and TG/HDL-C ratio can be an important marker for the prediction of the extent of CAD. This study was aimed to find out the relation between TG/HDL-C ratio with severity of coronary artery lesion in NSTEMI patients. Methods: A total of 200 NSTEMI patients were included and classified into two groups on the basis of TG/HDL-C ratio: Group-A (TG/HDL-C ratio ≤4, n=100) and Group-B (TG/HDL-C ratio &gt;4, n=100). Angiographic severity was measured by Gensini score in all the patients during the same hospital stay period. Relation between TG/HDL-C ratio and angiographic severity was evaluated. Results: Mean age of the study populations was 55.13±8.49 (years) with male predominance (75%). Hypertension, diabetes mellitus, dyslipidaemia and obesity were significantly higher in Group-B (p&lt;0.05). Gensini score in Group-B were significantly higher than Group-A (71±23 vs 30±12, p&lt;0.001). A strong positive linear relationship was found between TG/HDL-C ratio and Gensini score (r=+0.803). Multivariate logistic regression found TG/HDL-C ratio &gt;4 as the powerful independent predictor of Gensini score &gt;36 (AOR=7.98, 95% CI=4.0-15.91, p&lt;0.001). Conclusion: There is a significant positive correlation between TG/HDL-C ratio with Gensini score indicating increased severity of coronary disease in patients with NSTEMI. So early risk stratification and intensive management of NSTEMI can be done by using this cheap and easily available marker on admission. Cardiovasc j 2024; 16(2): 63-69

Serum Lipoprotein(a) and Angiographic Severity of Coronary Artery Disease in Asian Indians

Abstract Background: With the renewed interest in lipoprotein a (Lp(a)) shown by the European Atherosclerosis Society in relation to cardiovascular disease occurrence worldwide and especially in the South Asian population, its estimation once in a lifetime has been recommended (1–3). However, the role of this proatherogenic Lp(a) in regulating the severity of angiographic lesions in coronary artery disease (CAD) is poorly understood. This study aimed to correlate the serum Lp(a) level with angiographic lesion severity in subjects with CAD. Subjects and Methods: In this cross-sectional study, a total of 100 adult patients (mean age: 52.56 [±12.84] years, 84 [84%] males) with angiographically confirmed CAD were enrolled in a tertiary care hospital in Eastern India and their serum Lp(a) levels were estimated (by immunoassay method) and correlated with the SYNTAX score groups (&lt;22, 22–33, and &gt;33) and extent of disease – single-vessel disease (SVD), double-vessel disease (DVD), or triple-vessel disease (TVD). Results: Mean serum Lp(a) was elevated in the more severe disease group with SYNTAX &gt;33 (88.79 mg/dl) than in lesser severity disease groups of SYNTAX 22-33 (57.07 mg/dl) and SYNTAX &lt;22 (35.13 mg/dl), and this trend was found to be significant by analysis of variance (ANOVA) (P &lt; 0.001). Mean levels of Lp(a) were lower in patients with SVD (33.15 mg/dl) and DVD (33.93 mg/dl) than in those with the TVD group (77.71 mg/dl), and this trend was found to be significant by ANOVA (P &lt; 0.001). Conclusion: Serum Lp(a) values had a high significant positive correlation with the angiographic severity (higher SYNTAX score and Multivessel CAD) in patients of CAD in this study. Lp(a) is a known risk factor for CAD in South Asians and statins do not appear to decrease their levels; further, our study compounds the problem by correlating its level with increasing severity of CAD. This study therefore asserts the importance of the estimation of Lp(a) in South Asian individuals and proposes larger studies to confirm its correlation with the severity of CAD.

Sociodemographic, Clinical and angiographic Overview of Women with Acute Coronary Syndrome: A Current Prospective Hospital Based Study in Bangladesh

Background: Women’s life cycles are more complex than men’s, and because female sex hormone shields premenopausal women from overt atherosclerosis, their risk of coronary events is lower. Postmenopausal women experience various comorbidities and more severe cases of coronary artery disease (CAD). Nevertheless, there is a paucity of information comparing pre- and postmenopausal women with acute coronary syndrome (ACS) in terms of their sociodemographic profiles, risk factors, clinical features, and angiographic severity of coronary artery disease. The purpose of this study was to evaluate the sociodemographic, clinical and angiographic aspects of premenopausal and postmenopausal women with ACS. Methods: In this cross sectional observational study a total of 140 female patients with acute coronary syndrome were enrolled. They were divided in group-I (premenopausal) and group-II (postmenopausal) on the basis of the state of menopause. The sociodemographic profile, clinical data and coronary angiographic characteristics severity were compared between the premenopausal and postmenopausal ACS groups. Results: The mean age of ACS patients who were premenopausal was 41.53 ± 5.45 years, while that of postmenopausal patients was 57.23 ± 7.45 years. These differences were statistically significant (p= 0.001). Most of the patient among both the groups didn’t complete their secondary school certificate (42.9% vs 65.7%). Premenopausal individuals had a considerably higher family history of early CAD (50% vs. 32.9%; p=0.017) than postmenopausal individuals. In the postmenopausal group, DM and smokeless tobacco were more common (68.6% vs. 40%; p=0.001 and 20% vs. 2.9%; p=0.002). In the premenopausal group, atypical presentations were more common (30% vs. 12.9%; p=0.013). The majority of patients in both groups initially had unstable angina, then STEMI and NSTEMI. The postmenopausal group had a lower mean left ventricular ejection fraction (50.71 ± 8.38% vs. 53.74 ± 7.46%; p=0.026) and RWMA (55.7% vs 62.9%; p=0.390) than the premenopausal group. In the premenopausal group, normal coronary angiography and single vessel disease were more common (31.4% vs 17.1%; p=0.04 and 31.4% vs 15.7%; p=0.002), while triple vessel disease was more common in the postmenopausal group (48.6% vs 20%; p=0.001). The postmenopausal group’s most often affected vascular was the left anterior descending artery (95.7% vs. 85.7%; p=0.04). In the postmenopausal group, the mean Gensini score was greater than in the premenopausal group (56.1 ± 43.4 vs. 33.5 ± 36.9; p=0.001). Conclusion: Premenopausal ACS patients were more likely to have a family history of early CAD and an unusual presentation, while postmenopausal patients were more likely to have diabetes and smokeless tobacco. Both the groups didn’t complete their secondary school certificate. In the premenopausal group, normal coronary angiography and single vessel disease were more common, whereas in the postmenopausal group, triple vessel disease was more common. CAD in the postmenopausal group was more severe.

Association of Hyperuricaemia with Angiographic Severity of Coronary Artery Disease in Patients of Acute Coronary Syndrome

Background: Coronary artery disease (CAD) is a major cause of death and a global health issue that has reached pandemic proportions in both industrialized and developing countries. Coronary artery disease is primarily caused by atherosclerosis of the epicardial coronary arteries. Aim of the study: The aim of our study was to investigate the relationship between hyperuricemia and the angiographic severity of coronary artery disease in patients who have recently been diagnosed with acute coronary syndrome. Methods: This cross-sectional analytical study was conducted in the department of Cardiology, National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh, from December 2011 to November 2012. The study included 103 patients who were newly diagnosed as acute coronary syndrome. The individuals in this study were separated into two groups based on their serum uric acid levels. All acquired data was entered into a Microsoft Excel Work Sheet and analyzed using descriptive statistics in SPSS 11.5. Results: The study populations are mainly between 40 to 75 years (90.6% &amp; 92% remaining in group- I &amp; group- II respectively). It was found that majority of the study participants were male in both groups. Findings of the study shows that there is no statistically significant difference observed in respect smoking habit (p-0.86), hypertension (p-0.32), DM (p-0.53), dyslipidemia p-6.93) and family history of IHD (p-0.68) between two groups. The data of biochemical parameters reveals that HDL level is comparatively lower in group-II (38.72± 2.19) than group- I (39.64 ± 2.11) and it is statistically significant (p=0.03). This study findings reveals that the value of stenosis in Friesinger score in group-II (9.30± 3.96) is remarkably higher than that of group-I (0.77± 3.43) and it is statistically highly significant (p-0.001). Conclusion: This study reveals that hyperuricaemia may be an independent risk factor and predictor of the severity of coronary artery ......

Angiographic severity of coronary artery disease and the influence of major cardiovascular risk factors.

To determine the angiographic severity of coronary artery disease (CAD) and assess the influence of major cardiovascular risk factors (CVRF). a cross-sectional, hospital-based study. the catheterisation laboratory of the National Cardiothoracic Centre, Accra, Ghana. for 12 months, consecutive patients admitted for coronary angiography were assessed for the presence of CVRFs. Those with significant CAD after angiography were recruited into the study. The patient's angiograms were analysed, and the CAD severity was obtained using the SYNTAX scoring criteria. The lesion overall severity (SYNTAX) score and the relationship with CVRFs present. out of the 169 patients that had coronary angiography, 78 had significant CAD. The mean SYNTAX score was 20.18 (SD= 10.68), with a significantly higher value in dyslipidaemic patients (p < 0.001). Pearson's correlation between the score and BMI was weak (r= 0.256, p= 0.034). The occurrence of high SYNTAX score lesions in about 18% of the population was significantly associated with hypertension (OR= 1.304, 95% CI [1.13-1.50]; p= 0.017) dyslipidaemia (OR= 5.636, 95% CI [1.17-27.23]; p= 0.019), and obesity (OR= 3.960, 95% CI [1.18-13.34]; p= 0.021). However, after adjusting for confounding factors, only dyslipidaemia significantly influenced its occurrence (aOR= 5.256, 95% CI [1.03-26.96]; p= 0.047). Even though the most severe form of CAD was found in about one-fifth of the study population, its occurrence was strongly influenced by the presence of dyslipidaemia. None.

Myocardial Performance Index as a Predictor of Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Myocardial Performance Index as a Predictor of Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Relationship between serum interleukin-6 levels and severity of coronary artery disease undergoing percutaneous coronary intervention

BackgroundCytokines play a potential role in atherosclerosis pathogenesis and progression. We investigated the association of interleukin-6 (IL-6) with the angiographic severity of coronary artery disease (CAD).MethodsThree hundred ten angiografically diagnosed CAD patients and 210 controls were enrolled in this study. CAD patients were stratified according to IL-6 cut-off value into high levels IL-6 group (≥ 9.5 pg/mL) and low levels IL-6 group (< 9.5 pg/mL). The severity of CAD was assessed according to Gensini score (GS), artery stenosis degree and the number of vessels involved. The mean age was 60.3 ± 11.0 years.ResultsThe level of IL-6 in patients was increased compared to controls and ranged from 1.5 to 3640.0 pg/mL. High levels of IL-6 were significantly associated with high levels of GS (> 40) but not with stenosis degree and vessel score. GS levels were significantly more elevated in patients with high levels of IL-6 group than in low IL6 levels patients (60.6 ± 39.5 vs 46.7 ± 37.2; p = 0.027). The analysis of the ROC curve performed in myocardial infarction patients showed that IL-6 (AUC: 0.941 (CI 95% 0.886, 0.997; p < 0.001) could be a powerful predictor marker in evaluating the infarct size after myocardial infarction when compared to myonecrosis biomarkers.ConclusionsIL-6 levels were associated with the severity of CAD assessed by the GS. Based on the highest levels of IL-6 measured in patients with STEMI, our study strongly suggests that IL-6 could be a powerful marker in evaluating the myocardial necrosis.Trial registrationClinicalTrials.gov Number: NCT03075566 (09/03/2017).

Cardiovascular and inflammatory biomarkers for non-invasive detection of coronary artery obstruction and prediction of long-term survival in patients with suspected chronic coronary syndrome

Abstract Introduction and methods: The knowledge about diagnostic and prognostic value of cardiac and inflammatory biomarkers in patients with chronic coronary syndrome (CCS) is limited. To address this, we analyzed serum levels of selected biomarkers in 2536 patients with suspected CCS (35% female) from the Leipzig LIFE Heart Study who were admitted for coronary angiography. The median follow-up was 10 years. The following biomarkers were considered: high sensitive troponin T (hsTNT), N-terminal pro B-type natriuretic peptide (NT-proBNP), copeptin, high sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6). Patients were stratified according to the angiographic severity of coronary artery disease (CAD): CAD0 (no sclerosis), CAD1 (non-obstructive, i.e., stenosis &amp;lt; 50%), CAD2 (≥ one stenosis ≥ 50%). Group comparison (GC) included GC1: CAD0 + 1 vs. CAD2, GC2: CAD0 vs. CAD1 + 2. Using age-, sex and symptom-based pre-test probability (PTP) table for obstructive CAD (i.e. CAD 2) which was published in the current CCS guidelines, patients were further classified into the following three categories: PTP &amp;lt; 5% (n=559), PTP 5-15% (n=545) and PTP &amp;gt; 15% (n=1432). Results CAD0, CAD1, CAD2 were apparent in 999, 529, and 1008 patients, respectively. Upon adjustment for traditional risk factors (TRF) the levels of hsTNT, NT-proBNP and IL-6 showed significant difference in GC1 (hsTNT: p=2.0x10-10, NT-proBNP: p=0.049, IL6: p=0.030). In GC2 only elevated hsTNT remained significant (p=1.9x10-7). In the ROC analysis only hsTNT slightly improved the AUC for the GC1-comparison in addition to TRF (0.729 with vs 0.712 witt hsTNT, p=0.013). Within the PTP subcategories the following results were obtained: PTP &amp;lt; 5%: AUC 0.747 with vs 0.730 without hsTNT, p=0.017; PTP 5-15 %: AUC 0.636 with vs 0.670 without hsTNT, p&amp;lt;0.001; PTP &amp;gt; 15%: AUC 0.699 with vs 0.677 without hsTNT, p= 0.024). In PTP 5-15% subgroup TropT cut-off value &amp;lt; 3 pg/mL (N= 119 / 23.4%) showed sensitivity of 89.7% and specificity of 73.1% for CAD2 detection. Ten years survival in groups CAD0, CAD1, CAD2 were 88.3%, 77.3%, 72.4%, respectively. In the multivariate analysis elevated hsTNT, NT-proBNP, copeptin and IL-6 remained significant mortality predictors in CAD2 patients with hazard ratios of similar magnitude (i.e. 1.5, 1.3, 1.4 and 1.3 per unit on the log-scale of the parameters, respectively). hsCRP did not reach significance. In the model stratified into tertiles according to the effects of classical risk factors and the joint biomarker levels for except hsCRP, hazard rates were 3.13 (tertile 2 vs 1) and 11.2 (tertile 3 vs 1). Conclusions In the present study hsTNT substantially improved the detection of obstructive CAD particularly in patients with intermediate PTP 5-15%. Furthermore, the studied biomarkers enable fast and precise non-invasive prediction of mortality risk in patients with suspected CCS, allowing tailored primary and secondary CAD prevention in this high-risk group.

Abstract 13913: Value of Ischemia and Coronary Anatomy for Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease

Aims: To assess the value of ischemia versus coronary anatomy for prognosis and to guide revascularization. Methods: A total of 1764 patients who had rest-stress SPECT MPI and angiography (invasive or CT) were prospectively enrolled and followed for cardiac death/non-fatal MI. CAD prognostic index (CADPI) was used to quantify extent and severity of angiographic disease. Prognostic value was assessed using Cox models, adjusted for pre-test risk, known CAD, stressor, LVEF, %ischemia and infarct, CADPI, early (90 day) revascularization. Incremental prognostic value was evaluated using net reclassification indices (NRI). Results: Mean age was 69.7±9.5 years, 24.4% were women and 29.3% had known CAD. Ischemia was present in 90.9%; &gt;10% in 28.4%. Non-obstructive, single, and multi-vessel disease was present in 256 (14.5%), 772 (43.8%) and 736 (41.7%) respectively. Early revascularization occurred in 579 (32.8%). Cardiac death/MI occurred in 148 (8.4%) over 4.6 year median follow-up. Both % ischemia and CADPI provided incremental prognostic value over pre-test clinical risk (p&lt;0.001, Table ). In a model containing both ischemia and anatomy, ischemia was prognostic (HR per 1% ↑=1.06, 95% CI:1.02, 1.10,p=0.02), but CADPI was not (HR=1.01 (1.00, 1.02),p=0.07). Early revascularization modified the risk associated with %ischemia (interaction p=0.003, Figure ), but not with CADPI (interaction p=0.6). % Ischemia and SPECT variables added incremental prognostic value over clinical risk and CADPI (NRI=20.3%, 95%CI: 9%, 32%, p=0.01); however CADPI was not incrementally prognostic over pre-test risk, %ischemia and SPECT variables (NRI=3.1%, 95% CI: -5%, 15%, p=0.21; Table ). Conclusion: Ischemic burden provides independent and incremental prognostic value beyond CAD anatomy and identifies patients who benefit from early revascularization. Anatomic extent of disease has limited incremental benefit for prognosis and guiding revascularization beyond ischemia.

Correlation between serum uric acid level and angiographic severity of coronary artery disease in patients with acute coronary syndrome

Correlation between serum uric acid level and angiographic severity of coronary artery disease in patients with acute coronary syndrome

The relationship between the level of soluble CD40 ligand and angiographic extent and severity of coronary artery disease

The relationship between the level of soluble CD40 ligand and angiographic extent and severity of coronary artery disease

Correlation of Clinical Risk Scores for Unstable Angina with the Angiographic Extent and Severity of Coronary Artery Disease

Objective: In patients presenting with Unstable Angina the correlation of clinical risk predictors and clinical risk scores with angiographic extent of Coronary Artery Disease (CAD) is less well understood. The objective is to assess the correlation of various clinical risk scores for unstable angina and individual clinical risk factors with the extent and severity of coronary artery disease as assessed by coronary angiography. Materials and Methods: The present study was a single centre, hospital based, observational, cross-sectional, descriptive study conducted at a tertiary care teaching and research institute in South India. One hundred and fifty patients presenting with chest pain consistent with unstable angina were assessed for existence of independent clinical predictors and calculations were done for their 5 clinical risk scores. Coronary angiography was performed in all the patients leading to the generation of Modified Gensini score and its correlation with the various clinical risk scores was done. Results: Presence of dyslipidemia and diabetes were stronger predictors of Modified Gensini score. TIMI, GRACE&amp; HEART risk scores had moderate correlation with angiographic severity while FRISC and PURSUIT scoring systems had a weak correlation. Conclusion: Presence of dyslipidemia and diabetes significantly affect the extent of CAD. Thus their presence in patients presenting with unstable angina assign them to the high risk category. Angiographic extent of CAD was strongly correlated with TIMI, GRACE and HEART risk scores, thus emphasizing on their use in risk stratification and in identifying the category of patients likely to make the most out of an early invasive strategy.

Association of Waist and Hip Ratio with the Angiographicc Severity of Coronary Artery Disease in Patients with Non ST Segment Elevation Myocardial Infarction

Background: Coronary artery disease and obesity cardiomyopathy, and cardiac autonomic neuropathy are the most prevalent types of cardiac involvement in the comorbid. Obesity has a two- to fourfold greater risk of developing coronary artery disease. Stroke and other cerebrovascular occurrences fare poorly for those with obesity and diabetes. Hospital, autopsy, epidemiological, longitudinal research, and other studies have all demonstrated the increasing prevalence of cardiomyopathy in diabetes and obese individuals Objective: the objective of the study is to association of waist and hip ratio with the angiographic severity of coronary artery disease in patients with non-ST segment elevation myocardial infarction Study Design: Cross sectional observational study Study Setting: This study was conducted in the department of Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi from Ist August 2022 to 31st January 2023. Methodology: Total 120 subjects were enrolled in the study and divided in to two groups. Group I consisted of 60 patients with normal WHR, and group II consisted of 60 patients with elevated WHR. The history and anthropometric measurements were noted using a pre-designed structured form, including demographic data and a profile of potential risk factors. Three universal criteria for diagnosing myocardial infarction were used to confirm the presence of non-ST segment elevation myocardial infarction. Each participant's signed permission was obtained before any data was collected. The patient's waist and hip circumferences were measured the day before the CAG. At least two cardiologists engaged per patient's therapy or the clinical context while evaluating the angiogram results. Visual estimation (in at least two orthogonal views) was used to estimate the vessel and Gensini scores to determine the degree of coronary artery disease on angiograms. The statistical analysis was done by using SPSS version 20. Results: Patients in Group II had a considerably higher mean body mass index and anthropometric status than those in Group I. The average WHR of the participants in the study is listed in order of increasing vascular involvement. For those with normal angiogram results, the average WHR was 0.98. There was a statistically significant difference (p&lt;0.01) in the mean WHRs of those with single-vessel disease and the value of mean is gradually increased in scoring 1, 2 and 3. The WHR positively correlated with the severity of CAD as measured by vessel score (r=0.45). In addition, a positive connection (r=0.63) between WHR and CAD severity, as measured by the Gensini score. Multivariate logistic regression analysis of odds ratio (OR) for subject characteristics likely to cause coronary artery disease severity. Practical implication: In addition, there is only one local study, which provides scant information, and worldwide data is scant and conflicting about the relationship of the ratio of waist to hip with severe coronary artery disease (CAD). The incidence of obesity and coronary artery disease in Pakistan is much higher than in Western countries; thus, this study will offer more information regarding the relationship based on local data. Conclusion: The current study found that in individuals with non-ST-segment elevation myocardial infarction, increasing WHR was substantially correlated with the angiographic severity of coronary artery disease Keyword: WHR, BMI, Waist circumference, Cardiovascular disease

Association of Serum Vitamin D Level with Angiographic Severity of Coronary Artery Disease in Patients of Acute Myocardial Infarction

Background: Besides conventional risk factors, a novel risk factor hypovitaminosis D may play unique role in the development of coronary artery disease. Evidences suggest that people with low serum vitamin D level is associated with risk of acute MI even after adjusting for the known risk factors. This study was conducted to find out the association between serum vitamin D Level and angiographic severity of coronary artery disease in patients of acute myocardial infarction. Methods: One hundred and four patients of acute myocardial infarction undergoing coronary angiography in DMCH during May 2017 to April 2018 were the study population. The population were divided into 2 groups based on their serum vitamin D level; normal vitamin D (&gt;30 ng/ml) and low vitamin D (≤30 ng/ml). Low vitamin D level again divided into 3 groups; insufficient (vitamin D 21 to 30 ng/ml), deficient (Vitamin D 10-20 ng/ml) and severely deficient having vitamin D &lt;10 ng/ml. Coronary angiogram was done during index hospitalization. The severity of the coronary artery disease was assessed by vessel score and Gensini score.After calculation of Gensini score, 36 points was chosen as an appropriate cut-off value and patients were divided into two groups; those with a Gensini score ≤36 points was considered as having absent or mild coronary artery disease and those with a Gensini score &gt;36 points was considered as having moderate to severe coronary artery disease. Association between serum vitamin D Level and angiographic severity of CAD was looked for. Results: Seventy seven (74.0%) of study population had vitamin D level ≤ 30 ng/ml, while 27(26.0%) patients had normal level. There was no significant association between common cardiovascular risk factors with vitamin D level. Double or triple-vessel CAD were more frequent in those with vitamin D levels ≤30 ng/ml as compared to those with normal vitamin D levels (&gt;30 ng/ml) (P&lt;0.05). Majority (48.1%) of patients had double vessel disease (DVD). Among them 4(8%) patients had normal serum vitamin D levels (&gt;30 ng/ml) and 46 (92%) patients had low vitamin D (≤30 ng/ml). Mean Gensini score was found 20.8±5.1 in normal vitamin D (&gt;30 ng/ml) and 48.3±13.3 in low vitamin D (≤30 ng/ml) (p&lt;0.05). Moderate to severe CAD (Gensini score &gt;36) was found in 54.1% of patients with vitamin D insufficiency (21-30 ng/dl) and 83.3% of patients with vitamin D deficiency (10-20 ng/dl) (p&lt;0.05). Moderate negative correlation (r= -0.641; p=0.001) was found between Gensini score and serum vitamin D level of patients with acute myocardial infarction. Conclusion: Low serum vitamin D level is associated with increasing severity of coronary artery disease, docsumented angiographically among patients of acute myocardial infarction. Low serum vitamin D levels may be an emerging, independent, and potentially modifiable cardiovascular risk factor. Cardiovasc j 2023; 15(2): 124-131

Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non-ST Elevation Myocardial Infarction

Background: Bed side ophthalmoscopic examination is a simple measure of diagnosis of diabetic retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions including coronary artery disease (CAD). Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD). The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with NSTEMI. Methods: This cross-sectional observational study was conducted in the Department of cardiology, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh, from March 2019 to August 2020. A total of one hundred twenty DM with NSTEMI patients undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization were included in this study. Study subjects were divided into two groups on the basis of diabetic retinopathy (Group-I: NSTEMI with diabetic retinopathy ; Group- II: NSTEMI without diabetic retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between diabetic retinopathy and Gensini score was assessed. Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3,p&lt;0.001).Gensini score increased with increasing severity of diabetic retinopathy(P &lt;0.001).The risk of having severe CAD in patient with diabetic retinopathy was 13.03 (95% CI =2.410-70.419) (P&lt;0.003).A significant correlation between diabetic retinopathy and Gensini score was noted (p value &lt;0.001) Conclusion: It may be concluded that Presence and severity of diabetic retinopathy is associated with angiographically severe coronary artery disease in patient with non-ST elevation myocardial infarction (NSTEMI) and it may be considered as an independent predictor of severity of CAD.As is a bed side assessment ,so before performing coronary angiography ,it appears to be additive for risk stratification. J Inv Clin Cardiol 2023; 5(1): 7-13

Impact of novel risk factors of atherosclerosis on severity of coronary artery disease in young Indian patients suffering from Myocardial Infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Asian Indians are affected at least a decade earlier with cardiovascular diseases (CVD), in their most productive midlife years as compared to people of European ancestry. This is the first study from Indian sub-continent assessing the impact of novel risk factors of atherosclerosis on angiographic severity of coronary artery disease (CAD) in terms of SYNTAX scores in young patients (&amp;lt;40 years) suffering myocardial infarction (MI). Purpose This study was undertaken to evaluate the association of novel risk factors of atherosclerosis with severity of CAD at the index hospitalization in young MI patients. Methods In this single center observational study, 75 consecutive young MI patients were included. Patients having previous CVD, chronic kidney disease, chronic Liver disease and any bleeding diathesis were excluded. Homocysteine, highly sensitive C- reactive protein (hs-CRP) and lipoprotein- a (Lp-a) were measured and correlated with SYNTAX I and SYNTAX II. Results Smoking (85.5%) was the most common traditional risk factor for MI while other traditional risk factors did not have significant effect on severity of CAD in young patients with MI. The mean homocysteine level was 24.43± 10.02 micromole/L, hs-CRP 8.2± 1.44 mg/L and Lp(a) 59± 23.10 mg/dL. The sensitivity and specificity of hs-CRP ³8.5 mg/L for prediction of multivessel disease was 67% and 70% respectively while that of Lp(a) ³ 66.5 mg/dL was 71% and 67% respectively. On further analysis, the sensitivity and specificity of hs-CRP value ³8.5 mg/L for prediction of SYNTAX I score &amp;gt; 22 was 75% and 65% respectively while that of Lp(a) ³ 66.5 mg/dL was 75% and 60% respectively. On multivariate linear regression, hs-CRP was the significant predictor of SYNTAX I score (p=0.03) when adjusted for homocysteine and Lp (a). Conclusions hs-CRP and Lp(a) levels are significantly associated with the severity of CAD in young MI patients. hs-CRP and Lp(a) should be evaluated along with routine risk factors of atherosclerosis in young patients at risk of CAD for early detection, timely management and prevention of major cardiac events.

HOMA estimated insulin resistance as a marker for angiographic severity of coronary artery disease in non-diabetic and non-obese patients.

Insulin resistance (IR) examined by homeostasis model assessment of insulin resistance (HOMA-IR) measures increased carotid atherosclerosis risks in non-diabetic and non-obese persons. The information about the relationship between IR and coronary atherosclerosis severity among non-diabetic and non- obese population showed conflicting results. The goal of the current study was to assess the relationship that links IR and coronary artery disease (CAD) among non-diabetic and non-obese Egyptian populations. 112 non-diabetic and non-obese patients were included in this study. These patients underwent coronary angiogram (CA) either due to acute coronary syndrome (ACS) or chronic stable angina with positive exercise tests. Our study found a strong association between HOMA-IR and Gensini score (r = 0.831,with p<0.001) in general population. The HOMA-IR was the most influential independent predictor for the presence of extensive coronary atherosclerosis. Non-diabetic and non-obese people carrying the risk of developing the three-vessel disease (3VD) may be identified with a HOMA-IR score of over 5.9 according to the ROC curve analysis with a sensitivity of 67.7%. IR that developes in non-diabetic non-obese individuals coincides with more severe and more outspread CAD. In non-diabetic non-obese populations who need a CA, a single HOMA-IR value is higher than 5.9 may imply an elevated risk for clinically significant CAD. As insulin resistance is a reversible process, risk stratifications of CAD in non-diabetic non-obese populations could include HOMA-IR as one of its parameters.