Artery Disease Patients Research Articles

Prognostic significance of coexistent coronary artery disease in patients undergoing transcatheter aortic valve implantation for aortic stenosis

Abstract Background The optimal management of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) is uncertain. As TAVI expands into lower risk cohorts with longer life expectancies there is increasing need to determine the prognostic significance of coexistent CAD and identify which lesions may benefit from revascularisation. Purpose To evaluate the prognostic significance of coexistent CAD in patients with AS undergoing TAVI stratified according to myocardial territories at risk. Methods Using a retrospective, single-centre, observational registry, patients undergoing TAVI for severe AS between 2015 and 2020 were included. CAD was angiographically determined using computed tomography or invasive coronary angiography. CAD was stratified into 1) low-risk: <70% stenosis in all major epicardial coronary arteries or <50% in the left main (LM); 2) intermediate-risk: ≥70% stenosis in one or two arteries, except the proximal left anterior descending (LAD) and LM; 3) high-risk: ≥70% stenosis in the proximal LAD, ≥70% stenosis in 3 arteries or LM stenosis ≥50%. Patients with previous CABG were categorised as high-risk if: ≥70% stenosis of 3 coronary grafts or graft supplying a proximally stenosed LAD; and intermediate-risk if: ≥70% stenosis of 1 or 2 non-LAD grafts. Baseline characteristics and procedural outcomes were compared between the 3 cohorts, with the impact of CAD on outcomes evaluated after adjustment for demographics and comorbidities. Results 1805 patients were included; median age 84 (79-88), 51% male sex, median logistic Euroscore 13 (8-21). 1281 (71%), 384 (21%) and 140 (8%) patients were characterised as low-, intermediate- and high-risk coronary anatomy respectively. High risk patients were older than the other groups, however, did not have the highest prevalence of comorbidities (Table 1). Other than pacemaker implantation (9% vs 12% vs 6%, p=0.04), there were no differences in procedural complications or in-hospital mortality between groups (Table 1). At a median follow-up of 3.5 (2.3-4.8) years, 920 patients (51%) died, 292 (16%) had hospitalisation for heart failure (HHF) and 565 patients (31%) had a major adverse coronary event (MACE); defined as either myocardial infarction, HHF or cardiovascular death. Coronary anatomical stratification was associated with MACE (Log rank p<0.001) (Figure 1). After multivariate adjustment, high-risk anatomy was associated with all-cause mortality (hazard ratio (HR): 1.34, 95% confidence interval (CI): 1.06-1.68, p=0.013), HHF (HR: 1.49, 95% CI: 1.01-2.21, p=0.046) and MACE (HR: 1.68, 95% CI: 1.27-2.21, p<0.001). Conclusions Whilst the presence of CAD does not impact TAVI procedural safety, untreated high-risk coronary anatomy is associated with future adverse events and may warrant intensive medical therapy and/or revascularisation.

Changes in practice of exercise advice provision following the publication of ESC 2020 guidelines on sports cardiology and exercise at a central London inherited cardiac conditions outpatient service

Abstract ESC 2005 and AHA guidelines 2015 in sports cardiology restricted individuals with hypertrophic cardiomyopathy (HCM) from moderate and high intensity exercise and limited them to low intensity sport.1,2 Perceived increased risk of sudden cardiac death (SCD) with vigorous exercise in individuals with HCM was based on early registry data from the United States.3 This enforced sedentary lifestyle has led to an increasing trend towards obesity, atrial fibrillation and atherosclerotic coronary artery disease in patients with HCM.4 Recent ESC 2020 guidelines on exercise5 has enabled clinicians to recommend safe levels of exercise for these patients. We audited how well our outpatient practice reflected the guidance set out in 2020 ESC guidelines on exercise for patients with cardiovascular disease. Electronic records of 731 patients with a clinical diagnosis of HCM seen in our outpatient service between 2008-2023 were audited to determine whether written advice on exercise was given and if this was in line with the current ESC guidelines at any encounter. 731 patients with a mean age of 62±14.5 (range 17-91 years) were seen in our specialist outpatient service. 68% were male. 51% of patients received exercise advice either at their initial visit ± a follow-up visit. A significant proportional increase (16%,P<0.001) was seen in the number of patients receiving exercise advice at their initial visit after publication of the ESC 2020 guidelines (Table 1). 43% (270/634) of those who had their initial visit pre-guidelines received updated exercise advice as per 2020 ESC guidelines during follow-up. There was an increase in the proportion of patients receiving exercise advice each year after publication of ESC guidelines (Graph 1). Immediately following the publication, a high proportion received specific advice pertaining to intensity and duration of exercise (68% in 2020) with a slight decline subsequently (43%, 36% and 47% in 2021, 2022 and 2023 respectively). 27 patients had an implantable cardioverter defibrillator (ICD) in situ at the time of initial review with a further 127 undergoing ICD insertion under our care. SCD risk was documented for 66% (468/704) of patients according to the 2014 ESC Risk-SCD Model. 63% (214/338) of low-risk patients received exercise advice, whilst 77% (40/52) and 54% (42/78) of intermediate and high-risk patients received exercise advice respectively. 22 deaths (3%) were recorded during the follow-up period with none occurring during exercise. All cases except 2 were non-cardiac related. An overall improvement was seen in our practice with a significant increase in the number of patients receiving exercise advice after publication of the new guidelines. Despite this, only 51% of our patients received any written guidance on exercise demonstrating a need for further improvement in our outpatient practice to reflect the paradigm shift in the approach to exercise in individual with HCM as set out by the ESC 2020 guidance.

The effect of transcatheter aortic valve implantation on fractional flow reserve and non-hyperemic pressure ratios

Abstract Background Coronary artery disease in patients undergoing transcatheter aortic valve implantation (TAVI) is a very frequent clinical issue. Complex coronary artery disease can negatively influence outcomes after TAVI, however, angiography-guided percutaneous coronary intervention (PCI) has not been shown to offer any prognostic benefit. Coronary pressure indices, to select which lesions need treatment, are promising but are currently underused in aortic stenosis (AS) patients due to many physiological pitfalls. Available studies are small and show conflicting results on the effect of transcatheter aortic valve implantation (TAVI) on these indices. Purpose The aims is to compare the effects of TAVI on fractional flow reserve (FFR) and Non-hyperemic pressure ratio’s (NHPRs). Both immediate and long-term effects were studied. Methods Lesion specific coronary pressure data was extracted from 6 studies resulting in 147 lesions for immediate change in FFR analysis and 105 for NHPR analysis. To investigate the long-term changes, 93 lesions for FFR analysis and 68 for NHPR analysis were found. Results Immediately after TAVI, FFR decreased significantly (-0.0130 ± 0.0406 standard deviation, p-value: 0.0002) while NHPR remained stable (0.0003 ± 0.0675, p-value: 0.9675). Long-term after TAVR, FFR decreased significantly (-0.0230 ± 0.0747, p-value:0.0038) while NHPR increased non-significantly (0.0166 ± 0.0699, p-value: 0.0543). This increase in NHPRs became significant when only borderline NHPR lesions were considered (0.0249 ± 0.0441, p-value: 0.0015). All other results were confirmed in borderline-only lesions. Conclusions TAVI caused small significant, but opposite, changes in FFR and NHPR. In AS, FFR might underestimate lesion significance while NHPRs might overestimate its significance. This is only clinically relevant in borderline lesions, clear positive or negative physiological assessments can be trusted.Figure 1Figure 2

Excluding significant coronary artery disease in patients planned for TAVR using CT: Diagnostic accuracy of newest generation dual source photon counting scanner compared to coronary angiography

Abstract Introduction Patients with significant aortic stenosis routinely undergo CT for evaluation of the aortic root prior to interventional aortic valve replacement (TAVR). Assessment of CAD is usually performed by invasive coronary angiography. We assessed the diagnostic accuracy of the latest generation dual source photon counting scanner for exclusion of relevant CAD in a contemporary TAVR cohort. Methods Patients referred for cardiac CT prior to transcatheter aortic valve implantation were screened for inclusion this analysis. All cardiac CT exams were performed by dual source photon counting scanner (NAEOTOM alpha, Siemens healthineers, Germany). CT acquisitions were performed using retrospectively triggered spiral acquisition (30-70% of the cardiac cycle) without ultra-high resolution. For each patient, several reconstructions were rendered (thin slice reconstruction with 0.4 mm slice thickness: best diastolic phase, best systolic phase, 200-350 ms folllowing R-wave in 50 ms intervals as well as 0.6 mm slice thickness multiphase reconstruction 0-90% of the cardiac cycle in 10 % increments). Assessment of significant CAD was performed in CT and invasive angiography on a per-vessel analysis and a per-patient analysis using 2 thresholds: ≥ 50% stenosis and ≥ 70% stenosis. Assessment of stenoses in CT was performed using multiplanar reconstructions (MPR) and curved MPR and only in vessels > 1.5mm diameter. Assessment of stenosis in invasive angiography was performed using the projection with the most relevant lumen reduction. Image quality in CT was assessed on a likert scale from 1 to 4 (1=excellent, 2=minor artifacts, 3=major artifacts still assessable, 4=non-assessable). Results In this analysis 31 consecutive patients were included (mean age 79.5y, 64.5% males, 35.5% females). Mean heart rate was 66.5 bpm and 19% were in atrial fibrillation during CT acquisition. Mean image quality was 1.4. 13 Patients had no relevant CAD (stenosis ≥50%) in invasive angiography and in 18 patients at least 1 vessel was deemed to have ≥ 50% stenosis in invasive angiography. On a per vessel analysis, sensitivity, specificity and accuracy of cardiac CT to exclude stenoses using 50% and 70% thresholds were 98%, 93% and 94% vs. 97%, 93% and 94%, respectively. Negative likelihood ratio was 0.02 vs. 0.03 respectively. On a per-patient level, sensitivity and specificity were 100%. Out of 31 patients, only 2 vessels in 2 patients were deemed non-assessable. 3 patients with previous PCI as well as 3 patients with previous CABG were included in this analysis. Only 1 false negative vessel was reported in a very distal LAD segment. Conclusion Using newest generation dual source CT with photon counting, CT allowed highly reliable diagnostic workup regarding the presence of CAD in this TAVR cohort. The use of CT to assess CAD in TAVR patients seems clinically feasible especially in patients without previous percutaneous revascularisation.

Prognostic impact of the extent of coronary artery disease in patients with acute transmural myocardial infarction undergoing complete percutaneous revascularization

Abstract Background The management of acute myocardial infarction has been revolutionised by the introduction of early coronary angiography and the reperfusion strategies. Recent studies support the standard of care of complete myocardial revascularization in all patients with ST-elevation myocardial infarction (STEMI) without assessing the prognostic role of the extent of coronary artery disease (CAD). Purpose To evaluate whether the extent of CAD in patients with STEMI has a prognostic impact independent of complete myocardial revascularization. Methods Observational cohort study of 365 patients with STEMI who underwent complete revascularization. For each patient the extent of CAD has been quantified using Gensini Score (GS), which takes into account both the severity and location of the lesions. The primary endpoint of the study was all-cause mortality, while cardiovascular mortality and a composite of major adverse cardiovascular events (MACE: cardiovascular mortality, recurrent acute myocardial infarction or myocardial revascularization and stroke) were defined as secondary endpoints. To assess the prognostic role of GS in predicting all-cause mortality, the area under the curve (AUC) was calculated. The best cut-off was determined as the one that maximized Youden's index (sensitivity + specificity - 1). Results Patients with a GS >80, indicating extensive coronary disease, had significantly higher rates of both cardiovascular [4 (16.7%) vs. 12 (3.5%); p = 0.002] and all-cause mortality [5 (20.8%) vs. 24 (7%); p = 0.016], than those with a GS ≤80. A GS >80 was demonstrated to be an independent predictor of all-cause mortality [hazard ratio = 5; 95% confidence interval: 1.5-16.8; p = 0.01] Conclusions The Gensini Score can identify high-risk patients with STEMI who may benefit from more intensive therapies to improve prognosis, although current guidelines do not specify treatment based on the extent of coronary disease.Long-term outcomes according to GSPrognostic value of GS

Analysis of Angiographic Patterns in Acute Coronary Syndrome Patients With Diabetes Mellitus: Correlation With HbA1c Levels.

Background The relation of diabetes mellitus with cardiovascular diseases is well-known, even acute coronary syndrome (ACS). High levels of glycated haemoglobin (HbA1c) are used is a sign oflong-term glycemic control and may be associated with severity in coronary artery disease (CAD). In this particular setting, the aim of this investigation was to examine the relationship between the HbA1c values and the angiographic patterns of patients who were admitted with an ACS diagnosis. Methodology A cross-sectional study included 120 patients diagnosed with ACS. The criteria for eligibility included patients with ST-elevation myocardial infarction, unstable angina, and non-ST elevation myocardial infarction with history of documented diabetes mellitus. Every patient had a suitable clinical examination, had their HbA1c checked, and had coronary angiography to determine the severity of their CAD. Descriptive statistics and ANOVA were performed for statistical analyses to determine the connection between angiographic patterns and HbA1c. Results Patients with elevated HbA1c levels demonstrated a strong association with severe coronary artery disease. Notably, those with HbA1c exceeding 10.5% exhibited significant triple vessel disease and Type C lesions, indicative of advanced coronary artery disease. Statistical analyses revealed a marked difference in angiographic patterns across various HbA1c categories (p < 0.05). Conclusion The findings of this study suggest that maintaining optimal HbA1c levels is essential for mitigating the severity of coronary artery disease in patients with ACS. Moreover, effective glycemic control may be protective against advanced coronary atherosclerosis and subsequent cardiovascular complications in both diabetic and non-diabetic individuals.

Association between the triglyceride-glucose index and the severity of coronary artery disease in patients with type 2 diabetes mellitus and coronary artery disease: a retrospective study

Background Type 2 diabetes mellitus (T2DM) is a primary contributor to coronary artery disease (CAD). Insulin resistance (IR) is a hallmark of T2DM and a significant risk factor for the progression of CAD. The triglyceride-glucose (TyG) index is a new alternative indicator to identify IR. We aimed to explore the association between the TyG index and severity of CAD in patients with T2DM. Methods 280 inpatients with T2DM were enrolled from November 2019 to November 2022, classified into the CAD group (n = 175) and non-CAD group (n = 105). The TyG index and SYNTAX score were calculated. According to SYNTAX score, patients were further classified into the mid-CAD group (n = 97) and moderate to severe CAD group (n = 78). Results A significant positive correlation between the TyG index and SYNTAX score was found in the CAD group (r = 0.70, p < 0.01). The TyG index predicted the presence of moderate to severe CAD significantly, and the area under the ROC curve was 0.79 (95% CI: 0.71-0.85, p < 0.01). The higher LDL-C and TyG index, the higher risk of developing moderate to severe CAD (OR = 4.40, 95% CI 1.28 − 15.16, p = 0.02; OR = 9.00, 95% CI 3.69 − 21.96, p < 0.01). Conclusions There was a significantly positive correlation between the TyG index and SYNTAX score in T2DM patients who developed CAD; the TyG index could predict a mid/high SYNTAX score (≥ 23) and increase the risk of moderate to severe CAD.

8746 Primary Prevention and Early Intervention for Cardiovascular Disease in Polyglandular Autoimmune Syndrome Type 2

Abstract Disclosure: V.N. Flores-Robles: None. Y. Fuentes-Rosa: None. M. Sanchez-Cordero: None. D.A. Lopez: None. M. Carrero-Quinones: None. Introduction: Polyglandular autoimmune syndrome type 2 (PAS-2) is an autoimmune syndrome that is known for lymphocytic infiltration causing organ-specific damage. It can include primary adrenal insufficiency (Addison's disease), type 1 diabetes mellitus (T1DM), autoimmune thyroid disease-causing Grave’s disease, or hypothyroidism, and can be diagnosed when two out of these three pathologies are present. Carpenter syndrome, a type of PAS-2, is described as the triad of Addison's disease, autoimmune thyroid disease, and T1DM. Its initial manifestation can be associated with non-endocrine and endocrine disorders as in autoimmune thyroid disease, T1DM, primary hypogonadism, and diabetes insipidus. It is well documented that uncontrolled diabetes mellitus can accelerate the progression of cardiovascular disease of co-existing coronary artery disease, but documentation that Addison’s disease may accelerate the progression is scant with only ten cases documented. On the other hand, there are no documented cases of the presence of coronary artery disease in patients with PAS-2. Case report: This case involves a 66-year-old Hispanic male with a past medical history of hypertension, and PAS-2, presenting with Addison’s disease, type 1 diabetes mellitus, and hypothyroidism. The initial presentation at the hospital was that of a complete atrioventricular block that required pacemaker placement. Cardiology services were consulted as the patient also had a positive stress test and eventually cardiac catheterization was done as further workup. Cardiac catheterization showed obstruction of the left main coronary artery of 80% and left circumflex with mild disease, that required coronary artery bypass (CABG). A 2D ECHO was done for further evaluation of cardiac function and findings were pertinent for an ejection fraction of 65-70%, mild concentric hypertrophy of the left ventricular wall, and left ventricular diastolic function with impaired relaxation pattern. The patient underwent the CABG procedure without any complications. He has been followed up outpatient and remains without any symptoms or pertinent presentation. Early intervention in this patient with PAS-2 prevented any further cardiovascular complications. Conclusion: Patients with PAS-2 may have a predisposition to developing coronary artery disease due to concomitant endocrinopathies that independently increase the risk of cardiovascular disease. This promotes further investigation into the primary prevention of cardiovascular disease in patients presenting with PAS-2. Taking into consideration the increased risk and/or progression of cardiovascular disease in these patients, early intervention and evaluation by cardiology services should be suggested as it may decrease their morbidity or mortality. Presentation: 6/2/2024

Clinical Outcomes After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease in Patients of Diverse Race/Ethnicity

Data on percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease in patients of diverse race/ethnicity is scant. The aim of the study was to assess the impact of race/ethnicity on clinical outcomes at 12-month follow-up of patients with LMCA disease undergoing PCI with drug-eluting stent implantation. All patients undergoing PCI for LMCA disease between 2010 and 2019 at a tertiary care center were prospectively enrolled. Clinical outcomes were assessed per each race/ethnic group. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months. A total of 774 consecutive patients with known race/ethnicity were prospectively enrolled, 62.1% (n=481) Caucasians, 17.2% (n=133) Hispanics, 12.7% (n=98) Asians and 8.0% (n=62) African Americans. Compared with Caucasians, the hazard rate of the primary endpoint tended to be lower in Asian patients (6.1% vs 14.2%; hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.16-1.03), and similar in African American (13.7% vs 14.2%; HR: 0.93; 95% CI: 0.40-2.16) and Hispanic patients (14.2% vs 14.2%; HR: 1.02; 95% CI: 0.58-1.78). Hazard rates of target vessel or lesion revascularization were comparable in the four groups. Cox multivariable regression adjustment confirmed consistent findings and revealed higher hazard rate of post-discharge bleeding in African Americans vs. Caucasians (HR: 5.89; 95% CI: 1.00-34.5). In conclusion, within a racially/ethnically diverse cohort of patients undergoing PCI for LMCA disease, when compared with Caucasians, Asians are at lower risk of all-cause death, MI or stroke, while African Americans are at increased risk of post-discharge bleeding.

Exercise ECG for Detection of Asymptomatic Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus

Exercise ECG for Detection of Asymptomatic Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus

Predictors of Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus

Predictors of Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus

TCT-705 Comparative Outcomes of Endovascular Intervention Versus Bypass Surgery for Peripheral Artery Disease in Patients With Atrial Fibrillation: A Retrospective Analysis of the National Inpatient Sample

TCT-705 Comparative Outcomes of Endovascular Intervention Versus Bypass Surgery for Peripheral Artery Disease in Patients With Atrial Fibrillation: A Retrospective Analysis of the National Inpatient Sample

Outcome of Peripheral Arterial Disease in Patients with ESKD on Hemodialysis

Outcome of Peripheral Arterial Disease in Patients with ESKD on Hemodialysis

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&lt;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.

Peripheral artery disease in patients with stable coronary artery disease in general practice: results from an Italian nationwide study-PAD & CAD study.

Peripheral artery disease (PAD) remains underdiagnosed in patients with coronary artery disease (CAD) and barriers persist to measure screening PADin routine clinical practice. We assessed the prevalence of PAD in patients with CAD in Italian primary care setting using an easy automatic instrument to measure ankle brachial pressure index (ABI). A multicenter, observational study was conducted with 32 General Practitioners (GPs). Prevalence of PAD was calculated dividing the number of patients with abnormal ABI value, or with symptoms associated with PAD or history of lower limb revascularization procedures, over the total number of patients included in the study. Incidence of major CV clinical events and all-cause death was also evaluated at 12months in both CAD and CAD + PAD groups. In total, 713 CAD patients were included in the study, 148 (20.8%) patients had also PAD, asymptomatic in nearly 15% of them (106). The 35.4% of patients had ABI value ≤ 0.9 and 46.0% > 1.3 ABI. A significantly higher incidence of major CV events and all-cause death was seen in patients with PAD than in those without. Over 80% of patients received the therapy for secondary CV prevention and difference was seen between groups. Our findings showed that the use of an easy automatic instrument to measure ABI, easily managed by nurses, allowed to detect PAD in a relevant proportion of CAD patients who otherwise would not have been recognized. This encourages performing PAD screening in primary care setting to optimize the management of major CV risk factors associated with PAD. NCTumber: NCT03921905.

Predictors of Severity of Coronary Artery Disease in Patients with Acute ST-elevation Myocardial Infarction

Predictors of Severity of Coronary Artery Disease in Patients with Acute ST-elevation Myocardial Infarction

Correlation Between the Neutrophil-to-Lymphocyte Ratio and the Severity of Coronary Artery Disease in Patients With Myocardial Infarction.

Background Coronary artery disease (CAD) is one of the major causes of death all over the world. Its severity evaluation through the Gensini scoring system is quite a complex process as these score systems require complex investigations and cardiologists. Therefore, this study aimed to determine the predictive capacity of neutrophil-to-lymphocyte ratio (NLR) for the severity of CAD in patients with myocardial infarction. Methods This cross-sectional study was performed on 208patients with acute myocardial infarction whose coronary angiography was performed in the Department of Cardiology of Benazir Bhutto Hospital (BBH), Rawalpindi, Pakistan during the period of one year from January 2022 to March 2023. The enrollment of patients was made through purposive sampling and established inclusion and exclusion criteria. Ethical approval and informed consent were acquired before the data collection. Data was collected through a self-structured form. Vessel score and Gensini score were applied for the assessment of the severity of CAD. Patients were divided into two groups based on the Gensini score system. Data analysis was carried out in the Statistical Package for the Social Sciences (SPSS) version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Both descriptive and inferential statistics were used to compare the study variables between the patients with non-severe CAD and patients with severe CAD. Pearson's correlation was used to determine the correlation between the NLR and the severity of CAD. A linear regression model was applied to evaluate the predictive capacity of the NLR for the severity of CAD. A p-value less than 0.05 was set as statistically significant. Results Out of 208 patients, 128 (61.53%) patients had non-severe CAD while 80 (38.47%) patients had severe CAD. Significant differences were observed in the Gensini mean scores, NLR values, and in the frequencies of hypertension, diabetes mellitus, dyslipidemia, and history of smoking, with p≤0.05 for all these variables, between the non-severe CAD group and severe CAD group. NLR was significantly correlated with the severity of CAD (p-value=0.001). Pearson's correlation coefficient was 0.71 for NLR with the Gensini scores. The simple linear regression model was valid (the p-value of the F test was <0.000), with beta coefficients of 2.60 (p=0.002) for NLR. The R2 value was 0.80 (80%). Conclusions In the current study, a significant percentage of patients had severe CAD. Furthermore, a positive and significant association was noted between the NLR with the severity of CAD. This present study suggests that NLR is a reliable predictor of CAD severity; therefore, it could be used for risk stratification of cardiac patients with CAD.

Clinical outcomes of endovascular therapy for chronic limb-threatening ischemia in renal transplant recipients.

Endovascular treatment (EVT) for peripheral artery disease in patients with chronic limb-threatening ischemia (CLTI) is a common practice in contemporary medicine and its effectiveness is widely acknowledged. However, refractory ulcers can occasionally be encountered, particularly in patients who underwent renal transplantation (RT), even after successful EVT. To date, there have been no data on prognosis reported following EVT for CLTI in RT recipients. We included all RT recipients who underwent EVT in our hospital between 2010 and 2022. We analyzed data from 43 limbs with ischemic ulcerations classified as Rutherford class 5 or 6, which were managed solely with EVT (i.e., no bypass surgery was performed). The primary and secondary outcomes of our study were the incidence of complete wound healing and major adverse limb events (MALE), including clinically driven target vessel revascularization, major amputation, and all-cause death. The median follow-up was 31months. The mean age of the study population was 64.7 ± 8.7years, with predominantly male participants (79.1%). The overall wound healing rate was 34.9%. Kaplan-Meier curve revealed that wound healing rates at 1 and 3years were 33.6% and 40.9%, respectively. The wound healing rates of RT recipients who underwent EVT for CLTI were found to be less than satisfactory.

The Significance of von Willebrand Factor Antigen Levels in Predicting the Severity of Coronary Artery Disease in Patients with ST-Segment Elevation Myocardial Infarction

Background When the endothelium of the coronary artery is damaged, it exposes the underlying structure to a series of events that can cause complete blockage and a myocardial infarction with ST-segment elevation (STEMI). One of the key factors in this process is a protein called von Willebrand factor (vWF) that helps platelets adhere to the damaged area. Our objective was to investigate the importance of measuring vWF levels in patients with STEMI to determine the severity of their coronary artery disease (CAD) on angiography. Methods The study included 30 patients who experienced their first STEMI. Patients with a history of CAD, cardiomyopathies, valvular heart disease, atrial fibrillation, anticoagulants, coagulation disorders, and pregnancy were not included in the study. After informed consent, all patients were subjected to routine blood investigations, electrocardiography, echocardiography, and coronary angiography. Blood samples were collected for vWF Ag within 24 hours of the patients’ arrival at the hospital. After the angiography, the coronary arteries were evaluated for stenosis and quantified using the modified Gensini score (mGS). The score was then correlated with vWF Ag levels using the Spearman rank correlation. Additionally, the receiver operating characteristic (ROC) curve was plotted for the value of vWF Ag levels to detect significant CAD. Results The average age of the group was (49.77 ± 10.79) years. The average levels of vWF Ag were (204.17% ± 51.99%). Patients with an mGS score of over 150 had higher levels of vWF Ag than those with a score of under 100 ( P &lt; .001). There was a positive correlation ( r2: 0.67) between the parameters. On the ROC curve, vWF Ag levels higher than 186% predicted the presence of CAD, with an area under curve indicating sensitivity and specificity. Conclusion: In patients with STEMI, higher levels of vWF Ag were found to be associated with a greater severity of CAD.

Elevated monomeric C-reactive protein levels are associated with premature coronary artery disease in patients with normal hsCRP levels

Elevated monomeric C-reactive protein levels are associated with premature coronary artery disease in patients with normal hsCRP levels