Artery Disease Patients Research Articles

Prevalence, risk factors, and clinical effect of coronary artery disease in patients with asymptomatic bilateral carotid stenosis

ObjectiveIn the present report, we have described the prevalence, risk factors, and clinical effects of coronary artery disease (CAD) for patients with asymptomatic bilateral carotid stenosis. MethodsWe conducted a single-center, retrospective cohort study of consecutive patients referred for bilateral carotid stenosis >70% (2014-2021). All the patients had undergone systematic coronary angiography. Depending on the anatomic and clinical characteristics, the patients had undergone combined carotid endarterectomy (CEA) plus coronary artery bypass grafting, coronary percutaneous intervention followed by CEA or carotid artery stenting (CAS), or staged bilateral CEA with cardiac best medical therapy. The cumulative 30-day stroke/myocardial infarction (MI) rate after cardiac and bilateral carotid interventions and long-term survival and freedom from cardiovascular mortality were assessed. ResultsA total of 167 patients with bilateral carotid stenosis >70% had undergone preoperative coronary angiography, identifying severe CAD in 108 patients (65.1%). Echocardiographic abnormalities (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.03-5.78; P = .04) and prior coronary intervention (OR, 11.94; 95% CI, 2.99-63.81; P = .001) were significantly associated with severe CAD. CAD was treatable in 91 patients (84%) and untreatable in 17 (16%). The cumulative MI rate was 4.8%; 5.6% for the patients with severe CAD and 1.7% for those without severe CAD (P = .262). The cumulative stroke rate was 1.8%; 1.8% for those with severe CAD and 1.7% for those without severe CAD (P = 1.00). The overall stroke/MI rate was 6.6%; 8.3% for those with severe CAD and 3.3% for patients without severe CAD (P = .33). Patients with severe CAD deemed untreatable for coronary bypass or percutaneous intervention had a higher risk of perioperative stroke/MI (OR, 1.24; 95% CI, 1.00-2.83; P = .04). At 10 years, overall survival was 67.1% (95% CI, 57%-79%), and freedom from cardiovascular mortality was 78.5% (95% CI, 69%-89%). Patients with untreatable CAD maintained a higher risk of 10-year mortality (hazard ratio, 5.5; 95% CI, 1.6-19.9; P < .01). ConclusionsIn the present study, the prevalence of CAD in patients with bilateral carotid stenosis was high, especially for those with abnormal echocardiographic findings. CAD was potentially treatable in 80% of patients, and staged or simultaneous CAD treatment was performed with an acceptable stroke/MI complication rate for these patients. The presence of untreatable CAD was associated with worsened early and long-term outcomes, questioning the benefit of carotid interventions for this subset of patients.

Pattern of Coronary Artery Diseases in Patients Having Age Less Than 40 Years with Acute Coronary Syndrome

Aim: To assess the pattern of coronary artery diseases in patients older than 40 years with acute coronary syndrome. Material and methods: This cross-sectional study was conducted at the cardiology department of ABC hospital. A total of 130 patients presenting with the acute coronary syndrome were enrolled. The pattern of coronary artery diseases was assessed. Categorical variables were presented as frequencies and percentages, while numerical variables were presented as mean and SD. Results: The mean age of the patients in our study was 27.96±5.48 years. Most of the patients were male, accounting for 106 (81.5%). The most common factor was smoking 55.4% followed by hypertension 51.5%. Single vessel disease was a typical pattern presented in patients 37.7%. Three vessels disease was the second typical pattern observed in 22.3%. Conclusion: Smoking and hypertension are the leading causes of coronary artery diseases. Single vessel disease is the most common pattern in coronary artery disease patients younger than 40 years. Keywords: Acute coronary syndrome, Coronary artery disease, Pattern, Risk factors

Validation of a predictive model for coronary artery disease in patients with diabetes.

No reliable model can currently be used for predicting coronary artery disease (CAD) occurrence in patients with diabetes. We developed and validated a model predicting the occurrence of CAD in these patients. We retrospectively enrolled patients with diabetes at Henan Provincial People's Hospital between 1 January 2020 and 10 June 2020, and collected data including demographics, physical examination results, laboratory test results, and diagnostic information from their medical records. The training set included patients ( n = 1152) enrolled before 15 May 2020, and the validation set included the remaining patients ( n = 238). Univariate and multivariate logistic regression analyses were performed in the training set to develop a predictive model, which were visualized using a nomogram. The model's performance was assessed by area under the receiver-operating characteristic curve (AUC) and Brier scores for both data sets. Sex, diabetes duration, low-density lipoprotein, creatinine, high-density lipoprotein, hypertension, and heart rate were CAD predictors in diabetes patients. The model's AUC and Brier score were 0.753 [95% confidence interval (CI) 0.727-0.778] and 0.152, respectively, and 0.738 (95% CI 0.678-0.793) and 0.172, respectively, in the training and validation sets, respectively. Our model demonstrated favourable performance; thus, it can effectively predict CAD occurrence in diabetes patients.

Relationship between the neutrophil to high-density lipoprotein cholesterol ratio and severity of coronary artery disease in patients with stable coronary artery disease.

To evaluate the link between the neutrophil to HDL-C ratio (NHR) and the degree of coronary stenosis in patients with stable coronary artery disease (CAD). Totally 766 individuals who attended our clinic for coronary angiography between January 2019 and January 2021 were included in this study. The participants were divided into two groups, including the CAD group and control group. Spearman correlation analysis was used to investigate the association between NHR and Gensini score and logistic regression analysis was performed to determine the influence of NHR on CAD and severe CAD. Receiver operating characteristic (ROC) curve was constructed to analyze the predictive value of NHR for severe CAD. The CAD group had a substantially higher median NHR than the control group (3.7 vs. 3.2, P < 0.01). There was a positive correlation between NHR and Gensini score, as well as the frequency of coronary artery plaques. Logistic regression demonstrated that NHR was an independent contributor for CAD and severe CAD. In ROC analysis, the area under the ROC curve (AUC) for NHR was larger than that for neutrophil, HDL-C or LDL-C/HDL-C, and the differences were statistically significant (all P < 0.05). The NHR limit that offered the most accurate prediction of severe CAD according to the greatest possible value of the Youden index, was 3.88, with a sensitivity of 62.6% and a specificity of 66.2%. NHR was not only associated with the occurrence and seriousness of CAD, but also a better predictor of severe CAD than neutrophil, HDL-C or LDL-C/HDL-C.

Clinical significance of neutrophil gelatinase-associated lipocalin and sdLDL-C for coronary artery disease in patients with type 2 diabetes mellitus aged ≥ 65 years

Background and aimsAlthough type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) share many common pathological and physiological characteristics, there are few studies assessing the predictive capacity of novel biomarkers in occurrence and development of CAD in T2DM patients aged ≥ 65 years. In addition, T2DM patients aged ≥ 65 years are prone to CAD. Therefore, it is of great significance to find novel biomarkers for the development CAD in T2DM.MethodsIn this retrospective cohort study, 579 T2DM patients aged ≥ 65 years were consecutively enrolled in this work, and 177 of whom had major adverse cardiovascular and cerebrovascular events (MACCE: cardiovascular or cerebrovascular death, acute coronary syndrome, coronary stent implantation, and stroke) during the follow up. Univariate and multivariate factors were employed to analyze the correlation between each variable and the occurrence of MACCE, and the Spearman’s rank correlation analysis was performed to assess the relationships between Neutrophil gelatinase-associated lipocalin (NGAL) and small dense low-density lipoprotein-cholesterol (LDL-C) (sdLDL-C). The receiver operating characteristic (ROC) curve was adopted to determine the predictive value of NGAL and sdLDL-C elevation for MACCE in T2DM patients aged ≥ 65 years.ResultsAfter a median 48 months follow-up [19, (10 ~ 32) ], the levels of NGAL, sdLDL-C, hemoglobin A1c (HbA1c), LDL-C, and apolipoprotein B (ApoB) were significantly higher while those of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A I (ApoA–I) were lower in MACCE positive group. NGAL correlated to body mass index (BMI) (r = 0.391, P = 0.001) and triglyceride (TG) (r = 0.228, P = 0.032), and high-sensitivity CRP (hsCRP) (r = 0.251, P = 0.007), and neutrophils (r = 0.454, P = 0.001), sdlDL–C level was found to be positively correlated with LDL-C (r = 0.413, P = 0.001), TG (r = 0.432, P = 0.001), and ApoB (r = 0.232, P = 0.002); and it was negatively correlated with HDL-C (r = -0.362, P = 0.031) and ApoA–I (r = -0.402, P = 0.001). Age-adjusted Cox regression analysis showed that NGAL (HR = 1.006, 95% confidence interval (CI): 1.005–1.008, P < 0.001) and sdLDL–C (HR = 1.052, 95% CI: 1.037–1.066, P < 0.001) were independently associated with occurrence of MACCE. ROC curve analysis showed that NGAL (area under ROC (AUC) = 0.79, 95% CI: 0.75–0.84, P < 0.001) and sdlDL–C (AUC = 0.76, 95% CI: 0.72–0.80, P < 0.001) could predict the occurrence of MACCE (area under ROC. NGAL combined with sdlDL–C could predict the occurrence of MACCE well (AUC = 0.87, 95% CI: 0.84–0.90, P < 0.001).ConclusionThe higher NGAL and sdLDL-C in T2DM patients aged ≥ 65 years were significantly and independently associated with the risk of MACCE, and showed higher clinical values than other lipid biomarkers or other chronic inflammation, so they were expected to be the most effective predictors of MACCE assessment.

Abstract 11518: Incidence of Peripheral Arterial Disease in Patients With Coronary Artery Disease Following Cardiac Catheterization: A Prospective Observational Study

Introduction: Peripheral arterial disease (PAD) is a common vascular condition affecting roughly 800,000 Canadians annually with up to 50% being asymptomatic. As such, PAD is underdiagnosed and undertreated, despite being an independent predictor of cardiovascular (CV) risk. Moreover, PAD is commonly seen in patients with coronary artery disease (CAD) due to their shared atherosclerotic pathophysiology. Our aim was to gain a better understanding of the incidence and symptomatology of PAD in patients with established CAD on coronary angiography. Methods: Prospective subjects with CAD demonstrated on coronary angiography were immediately screened for PAD at the Mazankowski Alberta Heart Institute Cardiac Catheterization Laboratory. Following consent, a bedside ankle-brachial-index (ABI) (Microlife WatchBP Office ABI) was performed and the Edinburgh Claudication Questionnaire (ECQ) (validated for PAD) was administered. PAD was defined as an ABI≤0.90. Results: We recruited 100 patients (67.5 age ± 9.5 years, 18.0% female) between June 2021 to April 2022. Eighteen subjects (18.0%) had PAD as demonstrated by an abnormal ABI. In those with diabetes (n=34), PAD was more frequent (26.5% vs. 14.1%, p=0.068). Kappa agreement between ECQ and ABI was 0.32. Conclusions: In a prospective cohort of angiographically confirmed CAD patients, one-quarter had ABI confirmed PAD (even more common in diabetics). The ECQ provided modest agreement with ABI suggesting many of these subjects are asymptomatic. ABI can be used as a simple non-invasive tool at the bedside following cardiac catheterization to screen for PAD which has implications on subsequent guideline-directed medical therapy.

Abstract 15248: Clinical Outcomes of Transcatheter Aortic Valve Replacement With and Without Percutaneous Coronary Intervention - An Updated Meta-Analysis and Systematic Review

Hypothesis: Transcatheter aortic valve replacement (TAVR) serves as a less-invasive treatment option for high-risk patients with severe aortic stenosis. Given the coexistence of obstructive coronary artery disease in patients with high-grade aortic stenosis (estimated to be 40-75%), there is inconsistent clinical data regarding potential mortality benefits of paired percutaneous coronary intervention (PCI) with TAVR procedures. Methods: We performed a literature search using PubMed, Embase, and Cochrane Library from inception through April 2022 to assess the mortality impact of preceding/concomitant PCI in patients undergoing transcatheter aortic valve replacement. The primary outcomes were 30-day all-cause mortality, 30-day cardiovascular mortality, and 6 months-1 year all-cause mortality. Secondary outcomes included 30-day myocardial infarction, stroke, major bleeding/vascular complications, and acute kidney injury. Results: 11 studies (10 retrospective cohort studies, 1 randomized control trial) involving 2791 patients were included in the meta-analysis. Compared to patients undergoing TAVR alone, the TAVR+PCI group showed no significant difference in 30-day all-cause mortality (RR 0.90, CI 0.66, 1.22, p =0.49), 30-day cardiovascular mortality (RR 0.71 CI 0.44, 1.14, p =0.16), or 6 months-1 year all-cause mortality (RR 0.94, CI 0.75, 1.18, p =0.57). Regarding secondary outcomes, 30-day myocardial infarction was higher in the TAVR+PCI group compared to the TAVR group (RR 3.09, CI 1.26, 7.57, p =0.01), while no significant differences were found in rates of 30-day stroke (RR 1.14, CI 0.56, 2.33, p =0.72), major bleeding/vascular complications (RR 1.11, CI 0.79, 1.56, p =0.55), and acute kidney injury (RR 1.07, CI 0.75, 1.54, p =0.71). Conclusion: Concomitant/preceding percutaneous coronary intervention does not confer any additional mortality benefit, and may increase the risk of 30-day myocardial infarction, in patients with high-grade aortic stenosis undergoing transcatheter aortic valve replacement. Further trials with large sample sizes are needed to confirm our findings.

Association between Retinal Microvascular Changes and Severity of Coronary Heart Disease in Hypertensive Patients

Background : The prevalence of coronary artery disease is increasing day by day. In many cases it is undiagnosed. Hypertension is one of the risk factors of coronary artery disease. Hypertension also causes some changes in retina which is easy to diagnose in clinical practice. So the aim of this study is to predict coronary artery disease by seeing hypertensive retinal changes.&#x0D; Methods: A total of 100 patients with hypertension presenting to the emergency department with ischemic chest pain who underwent coronary angiography were studied. Presence or absence of coronary artery disease was determined. Optic fundi were assessed for hypertensive retinopathy which were photographed.&#x0D; Results: Mean ± SD age of the study population was 56.23±10.76 years. There were 75 men (75%) and 25 women (25%). Prevalence of coronary artery disease and hypertensive retinopathy were 84% and 44% respectively. There was association between coronary artery disease and retinopathy (P&lt; 0.017). Age (P= 0.019), smoking (P=0.011) and dyslipidaemia (0.039) were identified as risk factors for coronary artery disease.&#x0D; Conclusion: Important observations from this study are that hypertensive retinopathy has an association with coronary artery disease. Retinal change can be used in predicting coronary artery disease in patients with hypertension which can be used as screening tool for diagnosing coronary artery disease in resource poor settings.&#x0D; University Heart Journal 2022; 18(2): 93- 97

Global longitudinal strain imaging: Predictive value in detecting significant coronary artery disease in patients with Non-ST segment elevation myocardial infarction (NSTEMI)

Global longitudinal strain imaging: Predictive value in detecting significant coronary artery disease in patients with Non-ST segment elevation myocardial infarction (NSTEMI)

Association of galectin-3 and significant atherosclerotic epicardial artery disease in patients with chronic coronary syndrome

Association of galectin-3 and significant atherosclerotic epicardial artery disease in patients with chronic coronary syndrome

Glomerular hyperfiltration: An independent risk factor and predictor of advanced coronary artery disease.

Objective: To determine frequency and patterns of coronary artery disease in patients with glomerular hyper filtration (GHF), presented with acute coronary syndrome (ACS). Study Design: Cross Sectional, Retrospective study. Setting: Tertiary Healthcare Centre, Karachi. Period: July 2018 to July 2021. Material &amp; Methods: Twelve hundred and sixty seven patients undergone Coronary angiography (CAG) for ACS having estimated glomerular filtration rate (eGFR) calculated through Cockcroft-Gault equation &gt;90ml/min were selected. They were divided into two groups on the basis of eGFR, group A with normal eGFR (90-120ml/min) and B with eGFR i-e &gt;120ml/min with glomerular hyper filtration (GHF). Variables like age, gender, BMI, Diabetes mellitus (DM), Hypertension, Smoking, history of previous cardiovascular diseases (CVD) and family history of CVD and obesity were studied. Findings of CAG results from Cath lab were also noted down. All the relevant data was analyzed through SPSS 16. Results: Out of 1267 patients 807 patients had normal eGFR and 460 had GHF. Mean age in two groups was 45± 8.5years and 45.6± 7.8years, mean eGFR 102ml/min and 146ml/min and mean B.P was 110/80 and 135/90 mmHg respectively. Association of GHF with younger age, mean B.P, BMI, and family history of obesity was significant P value &lt;0.05. Patients with GHF had significant Coronary artery disease (CAD) P-0.036. Patients with eGFR between 145-175ml/mid had worst angiographic results, 80% of those had CAD. Conclusion: GHF has strong association with CVD and is a predictor of severity of disease.

Relation of CHA2DS2 -VASc score with severity and complexity of coronary artery disease in patients with non-ST segment elevation myocardial infarction

Objectives: This study aimed to determine the correlation between CHA2DS2 -VASc score and the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) scoring system for predicting severity and complexity of coronary artery disease in patients with non-ST segment elevation myocardial infarction (NSTEMI).&#x0D; &#x0D; Methods: This is a retrospective cross-sectional study conducted in a tertiary care center. The patients admitted to the emergency department (ED) with NSTEMI and who underwent the PCI were included. The patients’ demographic, clinical and angiographic characteristics were gathered from the hospital electronic medical records. Echocardiography and angiography images were evaluated by an experienced interventional cardiologist blinded to the patients' clinical information. The CHA2DS2-VASc and SYNTAX scores were calculated. The primary outcome of this study was the correlation between the CHA2DS2-VASc and SYNTAX scores. &#x0D; &#x0D; Results: A total of 216 patients were included. The mean CHA2DS2-VASc and SYNTAX scores were 2.9±1.7 and 16.6±7.9, respectively. There were significant differences in the mean CHA2DS2-VASc scores between the low and moderate (2.8±1.7 and 3.4±1.7, respectively, p

Evaluation of Risk Factors of Premature Coronary Artery Disease in Patients From North India: A Rising Epidemic

Background: The incidence of premature coronary artery disease (PCAD) is on rising trend in low- and middle-income countries. Considering the limited reports, the current study was conducted to evaluate the prevalence, various predisposing factors, and coronary angiographic findings of PCAD in North India. Methods: Study design—hospital-based analytical cross-sectional study. Setting: Outpatient and inpatient units of a tertiary cardiac center in North India. Two hundred sequential patients (170 males and 30 females) with acute coronary syndrome were evaluated for history of risk factors, measurement of anthropometric parameters, biochemical blood examination, electrocardiogram, complete dental examination, and angiographic assessment of coronary artery lesion. Patients with acute infection or chronic inflammatory disorders were excluded. Patients were divided into PCAD (age ≤45 years) and mature CAD. Results: The prevalence of PCAD was 15% (N = 30). PCAD had higher rates of family history of CAD ( P &lt; 0.001), tobacco consumption ( P = 0.01), smoking ( P = 0.004), and single-vessel disease (SVD) ( P &lt; 0.001). Premature CAD group had significantly lower mean fasting blood glucose (105 ± 41 mg/dL vs 127 ± 45 mg/dL) levels. Conclusion: Family history of CAD, smoking, and tobacco consumption are important risk factors of PCAD. SVD is more common in PCAD. Screening the susceptible population at risk and controlling the cardiovascular risk factors will help reduce the epidemic and consequences of PCAD.

Correlation between Microalbuminuria and Coronary Angiographic Severity in Non-diabetic Myocardial Infarction patients

Background: Microalbuminuria may have an association with myocardial infarction in absence of traditional risk factors like diabetes. The present study was intended to find the association between microalbuminuria and angiographic severity of coronary artery disease in non-diabetic myocardial infarction patients. Methods: This cross sectional analytical study included 105 non-diabetic patients with myocardial infarction who underwent coronary angiography (CAG). The microalbuminuria was defined as urine albumin to creatinine ratio (ACR) of 30 -300 mg/g, while angiographic severity was measured by Gensini score with score e” 36 was taken as moderate to severe coronary artery disease (Group I) and score below 36 was termed as absent or mild coronary artery disease (Group II). Association of microalbuminuria with severity of coronary artery disease was determined. Results: Presence of microalbuminuria was found significantly higher (45%) in patients with moderate to severe coronary artery disease than that in patients with absent or mild CAD (4.6%). The Odds of having moderate to severe coronary artery disease in patients with microalbuminuria was observed to be 17 times (95% CI = 4.5 - 63) higher than that in patients without having this condition. Correlation between ACR and Gensini score was also found a significant positive relationship (r=0.702, p&lt;0.001) with 70% of variation in Gensini score being explained by ACR. Conclusion: Microalbuminuria can be considered as a predictor of the severity of coronary artery disease in non-diabetic myocardial infarction patients. Cardiovasc j 2022; 15(1): 56-62

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. The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with non ST elevation myocardial infarction (NSTEMI). Methods: This cross-sectional observational study was conducted with a total of 120 NSTEMI patients with diabetes undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization. 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 angiographic severe coronary artery disease in patient with 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. Cardiovasc j 2022; 15(1): 49-55

Cost-effectiveness analysis of screening for peripheral artery disease in patients with coronary artery disease in China: A Markov model

BackgroundThe innovative pharmacological combination of low-dose rivaroxaban plus aspirin provides clinicians with an ideal opportunity to intensify the medical treatment of patients with coronary artery disease (CAD) and comorbid peripheral artery disease (PAD). We aimed to determine the cost-effectiveness of PAD screening using the ankle-brachial index (ABI) test in patients with CAD (with rivaroxaban administered if the PAD screening was positive) compared with no-screening strategy in China. MethodsA Markov decision model using a 1-month cycle was developed to simulate the 25-year effectiveness and cost of PAD screening on 75-year-old patients with CAD in China, evaluating the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the impact of variations in the key parameters for ICERs. ResultsOur model found an incremental cost of RMB4,959 (US$740) and an incremental QALY of 0.054 after one-time ABI screening, leading to an ICER of RMB91,936 (US$13,717) per QALY gained over a 25-year period. The reduction in all-cause mortality related to rivaroxaban and its cost were the factors most affecting the ICER. The screening would become cost-effective by decreasing the monthly cost of rivaroxaban to RMB184.5 (US$27.5) or by using domestic-brand rivaroxaban according to the threshold of a willingness to pay RMB72,447 (US$10,809) per QALY gained. ConclusionsOur study demonstrated that ABI screening for PAD to decide on low-dose rivaroxaban administration was not cost-effective for patients with CAD in China. Nevertheless, policy-guided cost changes for domestic-brand rivaroxaban could easily resolve this issue.

Can we predict obstructive coronary artery disease in patients with heart failure with reduced ejection fraction?

Can we predict obstructive coronary artery disease in patients with heart failure with reduced ejection fraction?

Revascularization of significant coronary artery disease in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract Background The prevalence of coronary artery disease (CAD) in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI) is high. However, the importance of a percutaneous coronary intervention (PCI) prior to TAVI has been matter of debate. Importantly, patients undergoing TAVI are characterized by high age often accompanied by highly calcified coronary arteries, increasing the risk of severe periprocedural complications. Moreover, patients with a severe aortic valve stenosis are limited in their ability to compensate for these life-threatening complications. Together with the necessity of dual antiplatelet therapy after PCI, this may explain a possible negative effect of PCI in this patient population. However, there is still insufficient evidence regarding the importance of PCI in patients undergoing TAVI. Purpose The aim of this systematic review and meta-analysis was to assess the need for PCI in patients with significant CAD undergoing TAVI. Methods A systematic search was conducted to identify studies comparing optimal medical treatment only versus PCI in patients with significant CAD undergoing TAVI. Endpoints were all-cause mortality, cardiac death, stroke, myocardial infarction, and major bleeding which were assessed at 30 days, one year, and beyond one year following TAVI. Results A total of 14 studies was included in this meta-analysis, including 3838 patients of which 1806 patients (47.1%) underwent PCI before TAVI. All-cause mortality was not significantly different between optimal medical treatment only and PCI at 30 days (OR: 1.27; 95% CI, 0.91–1.77; p=0.17; I2=0%), at one year (OR: 0.91; 95% CI, 0.64–1.29; p=0.59; I2=45%), and beyond one year (OR 0.68; 95% CI, 0.42–1.08; p=0.10; I2=49%). Cardiac death and myocardial infarction was similar across the groups at 30 days (OR cardiac death: 1.94; 95% CI, 0.36–10.56; p=0.45; I2=28%; OR myocardial infarction: 0.50; 95% CI, 0.13–1.91; p=0.31; I2=0%), and at one year (OR cardiac death: 0.77; 95% CI, 0.19–3.13; p=0.72; I2=84%; OR myocardial infarction: 0.74; 95% CI, 0.21–2.66; p=0.64; I2=18%). Stroke did not significantly differ between PCI and optimal medical treatment groups at 30 days (OR: 0.77; 95% CI, 0.31–1.92; p=0.57; I2=0%). However, patients that underwent TAVI without preceding PCI had significantly lower risk of major bleeding at 30 days (OR: 0.66; 95% CI, 0.46–0.94; p=0.022; I2=0%). Conclusion This systematic review and meta-analysis showed no significant differences in clinical outcomes between patients with and without PCI prior to TAVI at both short- and long-term follow-up, apart from a higher risk of major bleeding within 30 days in patients undergoing PCI before TAVI. Funding Acknowledgement Type of funding sources: None.

Relative monocytosis predicts the presence and severity of coronary artery disease on CT coronary angiography in patients with stable angina symptoms

Abstract Background Monocytes, among other leucocytes, are crucially involved in the pathogenesis of atherosclerosis, but the value of peripheral blood leucocyte counts in predicting the presence or absence of atherosclerotic coronary artery disease (CAD) is unknown. Purpose Investigating whether circulating counts of monocytes, lymphocytes and neutrophils predict CAD on computed tomography coronary angiography (CTCA) in patients presenting with stable chest pain. Methods All patients investigated with CTCA in our centre in the year 2021 were screened (n=1564). Patients presenting via the Rapid Access Chest Pain clinic were retrospectively identified, and those with a Full Blood Count from the 6 months prior to clinic were included (n=330). Traditional cardiovascular risk factors were ascertained from the clinic letter. CAD was defined as any epicardial stenosis &amp;gt;25% on CTCA. Patients with CAD were further classified as having either single or multivessel disease (left main stem disease was considered multivessel), and non-obstructive or obstructive disease (any stenosis &amp;gt;70% was considered obstructive). Results Patients with CAD had significantly higher mean monocyte count than those without CAD (0.61 vs. 0.55x109/L, p=0.004), while no differences were observed between groups in lymphocyte or neutrophil count. Monocyte count increased further with more severe CAD, being higher in patients with multivessel compared to single-vessel disease (0.62 vs. 0.60x109/L; p for trend including no CAD =0.012), and in patients with obstructive compared to non-obstructive disease (0.62 vs. 0.60x109/L; p for trend including no CAD=0.012). The association between monocytes and CAD was most marked among patients with a history of hypercholesterolaemia (monocyte count in CAD vs. no CAD: 0.63 vs. 0.54x109/L, p=0.001), and was absent in those without (0.57 vs 0.56x109/L, p=0.695). In the hypercholesterolaemia subgroup (n=186), a forward conditional logistic regression model including monocyte count alongside traditional risk factors (age, sex, smoking status, diabetes mellitus, hypertension, cholesterol level and family history), showed that only increasing age (p&amp;lt;0.001), male sex (p&amp;lt;0.001) and increasing monocyte count (p=0.01) were independently predictive of CAD. Conclusion Raised monocyte count is associated with both the presence and severity of coronary artery disease in patients presenting with anginal symptoms. In patients with a history of hypercholesterolaemia, monocyte count had a more robust predictive ability than many traditional cardiovascular risk factors. Further work is needed to establish whether patients with a relative monocytosis have a higher cardiovascular risk than would be predicted by traditional risk tools. Funding Acknowledgement Type of funding sources: None.

CORRELATION OF CLINICAL RISK SCORES WITH ANGIOGRAPHIC EXTENT AND SEVERITY USING MODIFIED GENSINI SCORE IN PATIENTS WITH ST ELEVATED MYOCARDIAL INFARCTION

Cardiovascular diseases have emerged as a significant health burden and became a leading cause of mortality in developing countries like India.In cardiovascular diseases, acute coronary syndromes are the primary cause of morbidity and mortality, for which timely diagnosis and appropriate therapy are of foremost importance to improve clinical outcomes.Different scoring systems are now available based on initial clinical history, electrocardiographic and laboratory tests that enable early risk stratification on admission. The risk scores were created and recommended by national and international guidelines to identify patients with a higher probability of adverse events, recommending more intensive treatment and early angiography in this population.In this study, we considered evaluating clinical predictors and suitable risk scores GRACE and TIMI that correlate with the severity of angiographic extent of coronary artery disease in patients presenting with ST-elevation myocardial infarction using Modified GENSINI score.