Artery Disease Severity In Patients Research Articles

Increased coronary artery disease severity in patients undergoing invasive diagnostics during the COVID-19 pandemic.

This study aimed to compare the stage of coronary heart disease in patients who underwent invasive cardiac diagnostics during the COVID-19 pandemic and before, based on the number of medical devices used and the number of complex coronary angioplasty procedures performed. A retrospective, single-center study was conducted, which included 187 successive patients with diagnosed coronary heart disease, who were divided into 2 groups: group I (N = 92, pre-COVID-19 pandemic) and group II (N = 95, during COVID-19 pandemic). Despite a comparable number of invasive procedures in both groups, stent length and contrast use per procedure were significantly higher during the COVID-19 pandemic. Similarly, a higher number of stents was used per patient in 2021, however, the difference was not statistically significant (p = 0.0817). Similarly, fluoroscopy time per procedure and procedure duration were significantly longer in the 2021 group. Among patients treated during the COVID-19 pandemic, higher glucose concentration, blood pressure parameters, low-density lipoprotein and total cholesterol were observed; however, these differences were not statistically significant. During the COVID-19 pandemic, coronary atherosclerosis progression were found, requiring a higher number of complex coronary angioplasty procedures, which contributed to a statistically significant increase in the number of medical devices used (angioplasty guidewires, angioplasty balloons) and procedures duration. Med Pr Work Health Saf. 2024;75(4):333-342.

Determination of Correlation between Diabetes Duration and Coronary Artery Disease Severity in Patients Undergoing Coronary Angiography

Background. Coronary artery disease (CAD) is caused by atherosclerotic process in coronary arteries. Due to extraordinary risk for atherosclerosis in diabetic patients, it is also counted as a vascular disease. Diabetes mellitus (DM) is a direct major associated risk factor in the development of cardiovascular disease with some studies from high income countries reporting correlation between duration of DM and severity of CAD. However, data from Pakistan is scarce. The aim. To determine the correlation between duration of DM and severity of CAD in patients undergoing coronary angiography at the tertiary care cardiac center. Materials and methods. This cross-sectional study was conducted in the Department of Cardiology, Civil Hospital Karachi, among 160 patients who were scheduled for coronary angiography with comorbid DM. Correlation between duration of DM and severity of CAD (as assessed by the modified Gensini score) was statistically measured and reported employing Pearson’s correlation coefficient (r). Results. Significant correlation between DM duration and total Gensini score was shown with r = 0.759 and p = 0.000001. With the increase in the duration of DM, the severity of CAD also increased. Conclusion. DM duration is positively associated with the modified Gensini score and the significant determinants of CAD severity tend to be relevant.

Relation between D-Dimer Level and Coronary Artery Disease Severity in Patients with ST Segment Elevation Myocardial Infarction

Relation between D-Dimer Level and Coronary Artery Disease Severity in Patients with ST Segment Elevation Myocardial Infarction

Near-infrared spectroscopy-intravascular ultrasound to improve assessment of coronary artery disease severity in patients referred for transcatheter aortic valve implantation (The IMPACTavi registry): Design and rationale

Transcatheter aortic valve implantation (TAVI) was established as a standard treatment for high-operative risk patients with severe aortic stenosis (AS). Although coronary artery disease (CAD) often co-exists with AS, clinical and angiographic evaluations of stenosis severity are unreliable in this specific setting. To provide precise risk stratification of coronary lesions, combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) was developed to integrate morphological and molecular information on plaque composition. However, there is a lack of evidence on the association between NIRS-IVUS derived findings such as maximum 4mm lipid core burden index (maxLCBI4mm) and clinical outcomes in AS patients undergoing TAVI. This registry aims to assess feasibility and safety of NIRS-IVUS imaging in the setting of routine pre-TAVI coronary angiography to improve assessment of CAD severity. The registry is designed as a non-randomized, prospective, observational, multi-center cohort registry. Patients referred for TAVI with angiographic evidence of CAD receive NIRS-IVUS imaging and are followed up to 24 months. Enrolled patients are classified as NIRS-IVUS positive and NIRS-IVUS negative, respectively, based on their maxLCBI4mm to compare their clinical outcomes. The primary endpoint of the registry is major adverse cardiovascular events over a 24-month follow-up period. Identification of patients likely or unlikely to benefit from revascularization prior to TAVI represents an important unmet clinical need. This registry is designed to investigate whether NIRS-IVUS-derived atherosclerotic plaque characteristics can identify patients and lesions at risk for future adverse cardiovascular events after TAVI, in order to refine interventional decision-making in this challenging patient population.

The Correlation between QRS Dispersion and Coronary Artery Disease Severity in Patients with Non ST Elevation Myocardial Infraction

Non ST elevation myocardial infarction (NSTEMI) has been the subject of numerous studies. Risk stratification is a fundamental element for the management of NSTEMI; therefore, several scores have been established in this direction, particularly prognostic markers derived from the ECG.
 Aims: The aim of our study is to correlate the dispersion of the QRS with the severity of coronary lesions assessed by the GENSINI score in patients admitted for NSTEMI at the University Hospital of Marrakech.
 Methods: A retrospective study was conducted in the cardiology department of Mohammed VI university hospital of Marrakech from January 01, 2022 to March 31, 2022. Data was derived from the hospitalization register, including 30 patients (16 women and 14 men). Age ranged from 56 to 74 years with an average of 64.6 ± 9.3. Data was analyzed by SPSS, the level of significance set at p <0.05.
 Results: We found, in our study, a highly significant positive correlation between QRS dispersion (considered important if >20 ms) and admission heart rate (p=0.003) as well as the level of ultrasensitive troponins (p=0.003). There is also a very significant correlation between QRS dispersion and corrected QT interval (p=0.005), Moreover, we concluded that in patients admitted for NSTEMI, the greater the dispersion of the QRS, the higher the score of GENSINI (p<0.0001).
 Conclusion: The dispersion of the QRS is a simple marker on the ECG that can have a predictive value in different clinical contexts, particularly in acute ischemic heart disease. Further studies are needed, however, to validate its usefulness in routine practice.

Using Two-Dimensional Speckle Tracking Echocardiography to Predict Coronary Artery Disease Severity in Patients with Chronic Stable Angina

Using Two-Dimensional Speckle Tracking Echocardiography to Predict Coronary Artery Disease Severity in Patients with Chronic Stable Angina

Myocardial strain analysis by 4D-speckle tracking echocardiography for prediction of coronary artery disease severity in patients with stable angina pectoris

ObjectiveWe sought to evaluate the myocardial strain by four-dimensional speckle-tracking echocardiography (4D-STE) in patients with stable angina pectoris (SAP) to determine the severity of coronary artery disease (CAD) based on the Gensini score. MethodsThe present study comprised of 150 patients with SAP. Patients with history of SAP, normal left ventricular ejection fraction, and without regional wall motion abnormalities (RWMA) were scheduled for elective coronary angiography. Based on Gensini score, there were two groups: non-critical stenosis group [Gensini score (0–19), n = 117] and critical stenosis group [Gensini score ≥20, n = 33]. Correlation between Gensini score and 4D-STE strain parameters were investigated. ResultsOut of 150 patients, critical stenosis group had significantly depressed values of all 4D-STE strain parameters than non-critical stenosis group (p < 0.001), except global radial strain (GRS) parameter. Significant positive correlation was found between Gensini score and 4D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) with Spearman's correlation coefficient (ρ) as 0.626, 0.548, and 0.631, respectively (p < 0.001), whereas significant negative correlation was found between Gensini score and GRS (ρ = −0.433, p < 0.001). A 4D GLS value of ≥ −17 had 84.9% sensitivity and 97.4% specificity, GAS ≥ −31 (90.9% sensitivity, 78.6% specificity), GCS ≥ −17 (69.7% sensitivity, 92.3% specificity), and GRS <47 (sensitivity 72.7%, specificity 76.1%) to detect critical CAD described by Gensini score ≥20. ConclusionThe 4D-STE can aid in the assessment of severe CAD stenosis with good sensitivity and specificity in the patients with SAP without RWMA on traditional echocardiography.

Development of a Novel Inflammatory Index to Predict Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome.

The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) have previously demonstrated predictive value in coronary artery disease (CAD). We developed on an expanded, novel systemic immune-inflammation response index (SIIRI), calculated as peripheral neutrophil × monocyte × platelet ÷ lymphocyte count. We assessed 240 patients with an acute coronary syndrome that subsequently underwent percutaneous coronary intervention. CAD severity was measured using the SYNTAX score. Laboratory measurements, including cell counts, were obtained on admission. On multivariate analysis, the SIIRI was an independent predictor of severe CAD with an adjusted odds ratio (OR) of 1.666 [1.376-2.017] per 105-unit increase. The SIIRI had the highest area under the receiver operator curve of .771 [.709-.833] compared to the SII, SIRI neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio. The optimal cut-off for SIIRI was 4.3 × 105, with sensitivity = 69.9% and specificity = 75.8%. Increment in model performance resulting from adding SIIRI versus other inflammatory indices was assessed using discrimination, calibration, and goodness-of-fit measures. When added to a baseline model, the SIIRI resulted in a significant increase in the c-statistic and significant net reclassification index (.808, P < .0001) and integrated discrimination index (.129, P < .0001), and a decrease in Akaike and Bayesian information criteria.

The Predictive Value of C-Reactive ProteinAlbumin Ratio in Long-Term Mortality Among Patients Undergoing Carotid Artery Stenting

Introduction: Several inflammatory biomarkers reported in previous research have been associated with the severity of carotid artery stenosis, symptomatic carotid lesions, and carotid stent restenosis. The C-reactive protein (CRP)-to-serum albumin ratio (CAR) has been shown to predict peripheral artery disease severity in patients with carotid artery disease (CAD). However, the relationship between CAR and long-term mortality in CAD patients following carotid artery stenting (CAS) remains uncertain. The goal of this study was to investigate the ability of CAR to predict long-term mortality in patients with CAS. Patients and Methods: A total of 998 CAD patients who had percutaneous carotid artery intervention were reviewed retrospectively, and 482 of them without follow-up data were excluded from this study. The study included patients who had percutaneous carotid artery intervention between 2012 and 2018. Before the procedure, serum CRP, complete blood counts, and albumin levels were measured. The relationships between patients’ characteristics, procedural details, and CAR with all-cause mortality were evaluated in the long-term follow-up after CAS. Results: Older age (HR= 1.044; 95% CI= 1.001-1.089; p= 0.046), smoking (HR= 2.636; 95% CI= 1.213- 5.728; p= 0.014), blood urea (HR= 1.017; 95% CI= 1.002-1.033; p= 0.025), albumin (HR= 0.252; 95% CI= 0.132-0.480; p&lt; 0.001), CRP levels (HR= 1.336; 95% CI= 1.055-1.691; p= 0.016) and CAR (HR= 1.012; 95% CI= 1.003-1.022; p= 0.008) were statistically associated with all-cause mortality at 55.2 ± 12.4 months follow-up after CAS in multivariate COX regression analysis. Conclusion: In patients undergoing CAS, CAR was independently related to long-term mortality. CAR could be used in this population for risk stratification to achieve closer follow-up and optimize treatment.

The Predictive Value of P Wave Peak Time for Coronary Artery Disease Severity in Patients with Acute Myocardial Infarction

The Predictive Value of P Wave Peak Time for Coronary Artery Disease Severity in Patients with Acute Myocardial Infarction

Association between HBA1C and Coronary Artery Disease Severity in patients of Diabetes Mellitus Type 2 presented as Acute Coronary Artery Syndrome and Non Diabetic

Aim: to investigate the prevalence of diabetes mellitus type 2 (T2DM) and association of HbA1c with the severity of coronary artery disease (CAD) in patients presenting at tertiary care center as acute coronary syndrome and non-diabetic. Study Design: Prospective observational study Duration and Place Study was conducted at department of general medicine Nishter Hospital, Multan from January 2021 to January 2022 in 1 year duration. Methodology: A total of 200 patients were enrolled in study. Main variables of study were BMI, smoking status, dyslipidemia, hypertension, STEMI, angina, HbA1c and treatment strategy. SPSS version 23 was used for data analysis. P value below or equal to 0.05 was taken as significant. Results: Among total 83.5% patients intervened by therapeutic, whereas 48.0% used thrombolytic drug in STEMI. 70.7% patients were thrombolysis in therapeutic intervention and 44.8% were streptokinase in thrombolytic drug. In fasting blood sugar, 53.0% patients were diabetic, whereas in HbA1c levels, 52.3% patients were diabetic. Conclusion: This study highlights the significance of testing for diabetes in individuals in poor nations who report with non-diabetic acute coronary syndrome. One of manifestations of diabetes mellitus may be the acute coronary syndrome. Keywords: Acute coronary syndrome, Coronary angiography, Diabetes, HbA1c.

The prevalence of NAFLD in CAD and it’s correlation with their severity

To study the prevalence of Non-Alcoholic Fatty Liver Disease in Coronary Artery Disease patient and the correlation of Coronary Artery Disease severity in patients of Non-Alcoholic Fatty Liver Disease Study included 124 patients of Coronary Artery Disease who underwent detailed clinical and anthropometric examination and routine blood investigations. Ultrasonography of abdomen was done and Non-Alcoholic Fatty Liver Disease grading was done. Coronary angiography was done and angiographic severity was calculated by Gensini score. Non-Alcoholic Fatty Liver Disease was found in 71% of patient. There is a significant difference of Gensini score between patients with and without Non-Alcoholic Fatty Liver Disease. All the stage of Non-Alcoholic Fatty Liver Disease had a significant difference of Gensini score among them with but there was no difference of Gensini score between stage 1 and 2. The presence of Non-Alcoholic Fatty Liver Disease Is associated with a higher Gensini score, however a higher grade of Non-Alcoholic Fatty Liver Disease doesn’t mandate a higher Gensini score.

Relation of neutrophil-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography

Background and Aims: Inflammation plays important role in atherosclerosis. Recently, neutrophil-to-lymphocyte ratio(NLR) has emerged as new inflammatory marker in identification of coronary artery disease(CAD). We aimed to evaluate correlation of NLR with CAD severity and propose suitable cut-off NLR for predicting CAD.&#x0D; Methods: This cross-sectional study included 147 patients undergoing coronary angiography for angina with ischemic ECG changes. CAD severity was assessed by SYNTAX score and categorized into low, intermediate and high SYNTAX group. Neutrophil and lymphocyte count determined by BeneSphera analyser and NLR was calculated. Statistical analysis was performed using chi-square, ANOVA, Pearson’s correlation test and logistic regression analysis.&#x0D; Results: In 147 patients [mean age 61.27±12.87year (25-86 years);68% male],NLR ranged from 1.0 to 9.66[median 2.53(1.96-3.73 IQR), mean 3.21±1.86].The NLR (mean ± SD) in low, intermediate and high SYNTAX group were 2.35±1.27, 3.04±1.54l, 4.72±2.07 respectively (p&lt;0.0001).High SYNTAX group more frequently had diabetes mellitus, dyslipidemia, smoker, alcohol consumer, were older , and had significantly high neutrophil count, NLR values and low lymphocyte count. In univariate analysis, diabetes mellitus, NLR, neutrophil and lymphocyte count were predictors of high SYNTAX score. In the multiple logistic regression analysis, NLR &gt;3[OR=17.36, 95% CI 6.7-44.5, p=0.001] was identified as independent predictor of high SYNTAX score. In ROC analysis, NLR ≥ 1.785 was best suitable cut-off to identify presence of CAD with sensitivity of 97.4% and specificity of 83.3%.&#x0D; Conclusion: NLR correlated positively with presence and severity of CAD as assessed by SYNTAX score

Does Systemic Immune-Inflammation Index Predict Coronary Artery Disease Severity in Patients with ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Does Systemic Immune-Inflammation Index Predict Coronary Artery Disease Severity in Patients with ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Relationship between C-Reactive Protein / Albumin Ratio and Coronary Artery Disease Severity in Patients with Chronic Coronary Syndromes

Background: Syntax score (SS), which is an angiographic technique used in categorizing the severity of coronary artery disease (CAD), has a significant prognosis in coronary artery disease (CAD) and explain an important information concerning selection of revascularization policy. C-reactive protein (CRP) and albumin are markers of inflammation, and high levels of them are associated with high SS. Aim of the Work: To detect whether baseline CRP to albumin ratio (CAR), an easily available and novel inflammatory indicator, is associated with SS in patients with chronic coronary syndromes. Methodology: This study was carried out on 100 patients having chronic coronary syndromes for whom, a diagnostic coronary angiography was done at Sohag University Cath. Lab unit in the period from January -July 2021. Patients were divided randomly into two equal groups:*Group I, patients having low SS (≤22). *Group II, patients having intermediate-high SS (>22).Results: C-Reactive Protein/Albumin Ratio was significantly higher in patients having intermediate-high SS group (P < .0001). In multivariate regression analysis, CAR was an independent indicator of intermediate-high SS group together with LDL. Conclusion: CAR was more intensely related to the severity of CAD than CRP and albumin alone and was detected to be an independent indicator for intermediate- high SS group.

Could Serum Copeptin Level Be an Indicator of Coronary Artery Disease Severity in Patients with Unstable Angina?

This study aimed to identify the serum copeptin levels in patients diagnosed with unstable angina (UA) and evaluate the relationship between the patients' copeptin levels and angiographic severity.A total of 200 patients who were diagnosed with UA and underwent coronary angiography were included in the study. Clinical, electrocardiographic, echocardiographic, and laboratory data (high-sensitivity cardiac troponin T and copeptin levels) as well as The Global Registry of Acute Coronary Events (GRACE) 1.0 risk score were recorded upon admission. Moreover, the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was calculated following coronary angiography.We isolated and defined two subgroups within our study population: group 1 included patients with non-significant coronary artery disease (CAD) (< 50% diameter stenosis, n = 105); group 2 included patients with significant CAD (≥ 50% diameter stenosis, n = 95). The number of cases with a GRACE score higher than 140 was significantly higher in group 2 than in group 1 (P < 0.001). The SYNTAX scores and copeptin levels were significantly higher in group 2 than in group 1 (P < 0.001 for both). A positive correlation was observed between the copeptin levels and SYNTAX scores (r = 0.683; P < 0.001), and the cut-off level of copeptin was 18.3 pmol/L (sensitivity of 74.7%, specificity of 83.8%, and area under the curve of 0.795).This study suggests that it may be beneficial to use conventional scoring systems and serum copeptin levels when identifying high-risk UA patients.

Relation of Atrial Fibrillation to Angiographic Characteristics and Coronary Artery Disease Severity in Patients Undergoing Percutaneous Coronary Intervention

Patients with atrial fibrillation (AF) have an increased risk of coronary artery disease (CAD) compared to patients without. Angiographic characteristics, clinical presentation and severity of CAD according to the presence of AF have been poorly described. We performed a retrospective study of 303 consecutive patients (mean age 69.6 ± 10.8 years; 23.1% women) with and without AF undergoing percutaneous coronary intervention. Data on (1) type of CAD presentation, (2) coronary involvement, and (3) number of diseased coronary vessels (≥70%/luminal narrowing) were collected. CHA2DS2-VASc and 2 major adverse cardiac event (MACE) scores were calculated. Presentation of CAD was ST-segment elevation myocardial infarction (STEMI) in 37.6% of patients, non-STEMI- unstable angina in 55.1%, and other in 7.3%. Non-STEMI-unstable angina was more common in AF (69.6% vs 46.6%, p <0.001), while STEMI was more in the non-AF (22.3% vs 46.6%, p <0.001) group. Left anterior descending artery (LAD) was the most common diseased vessel (70.6%) followed by right coronary artery (RCA, 56.4%) and obtuse marginal artery (36.6%). Patients with AF had a significantly lower RCA involvement (47.3% vs 61.8%, p = 0.016), with a trend for LAD (64.3% vs 74.3%, p = 0.069). At multivariable logistic regression analysis, AF remained inversely associated with RCA involvement (odds ratio [OR] 0.541, 95% confidence interval [CI] 0.335 to 0.874, p = 0.012) and with ≥3 vessel CAD (OR 0.470, 95% CI 0.272 to 0.810, p = 0.007). The 2MACE score was associated with diseased LAD (OR 1.301, 95% CI 1.103 to 1.535, p = 0.002) and with ≥3 vessel CAD (OR 1.330, 95% CI 1.330 to 1.140, p <0.001). In conclusion, patients with AF show lower RCA involvement and generally less severe CAD compared to non-AF ones. The 2MACE score was higher in LAD obstruction and identified patients with severe CAD.

Correlation Between Epicardial Fat Thickness Assessed by Echocardiography and Coronary Artery Disease Severity in Patients Attending Suez Canal University Hospital

Correlation Between Epicardial Fat Thickness Assessed by Echocardiography and Coronary Artery Disease Severity in Patients Attending Suez Canal University Hospital

The association between the fibrinogen-to-albumin ratio and coronary artery disease severity in patients with stable coronary artery disease.

Fibrinogen-to-albumin ratio (FAR) is an inexpensive and easily measurable novel inflammatory index that has been found to be associated with atherosclerosis. In this study, we aimed to investigate the association between the FAR and coronary artery disease (CAD) severity in patients with stable CAD. In total, 356 consecutive patients with CAD were classified into three groups, those with a low Synergy between percutaneous coronary intervention and the Taxus and Cardiac Surgery Study (SYNTAX) score (≤22), those with an intermediate SYNTAX score (23≥ SYNTAX score ≤32) and those with a high SYNTAX score (>32). We determined that there were significant differences in the mean age (P < 0.001), male gender (P = 0.008), serum fibrinogen (P = 0.03), low-density lipoprotein cholesterol (P < 0.001) and FAR (P < 0.001) among the SYNTAX score groups. A strong positive correlation was detected between FAR and SYNTAX score (r = 0.899; P < 0.001), and the cutoff level of FAR for high SYNTAX score was 82 (sensitivity of 82%, specificity of 88.3% and an area under the curve of 0.826). The novel inflammatory index, FAR, is significantly associated with the severity of CAD in patients with stable CAD.

Relation of interleukin-6 level with coronary artery disease severity in patients undergoing coronary angiography

Relation of interleukin-6 level with coronary artery disease severity in patients undergoing coronary angiography