Complexity Of Coronary Atherosclerosis Research Articles

Correlation of CRP level with intermediate and high Syntax Score in patients with acute coronary syndrome

In patients with acute coronary syndromes, inflammation has a major role in plaque rupture, which results in acute coronary artery obstruction. This vascular process is not limited only to the site of plaque destabilisation but also in the systemic level. So, it may be detected by determining plasma inflammatory markers. C-reactive protein (CRP) has been frequently studied in recent years and considered to be one of the most important markers. The SYNTAX score (SXscore) is a useful angiographic scoring system that has been developed to assess and quantify the extent, severity and complexity of coronary artery disease. In our study, we investigated whether baseline high-sensitivity CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 128 patients with ACS who underwent coronary angiography between January 2022 and November 2022. The patients were divided according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). A total of 128 patients met the inclusion criteria and was included in the study. Among those 128 patients, 98 (76%) were males and 30 (23%) were females. The mean age of patients in the intermediate-high SXScore (61 ± 12 years) group was significantly higher than the low SXScore group (57 ± 10 years) with a P-value: 0.003. Coronary risk factor frequencies such as hypertension were present in 45%, type 2 diabetes mellitus in 42% and dyslipidemia in 83% of patients with no significant difference between both groups except for diabetes with a significant P-value: 0.008. Subjects with an intermediate-high SXScore had higher values of serum glucose, creatinine, peak troponin, and uric acid levels compared to the low SXScore subjects. In addition, the intermediate-high SXScore group showed significantly higher values of high sensibility CRP than the lower SXScore (17.8 ± 6.4 mg/L versus 10.2 ± 5.3 mg/L, P < 0.001). One of the most important results in this study was that serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease.

Impact of glucose-6-phosphate dehydrogenase deficiency on the severity of coronary atherosclerosis in patients with acute coronary syndromes.

The impact of glucose-6-phosphate dehydrogenase (G6PD) deficiency on coronary atherosclerosis has not been clearly investigated so far. We aimed to assess the effects of G6PD deficiency on the extent and complexity of coronary atherosclerosis in a large unselected cohort of consecutive patients with acute coronary syndromes (ACS). We studied 623 consecutive patients presenting with ACS and undergoing coronary angiography and percutaneous coronary intervention (PCI). G6PD activity was quantitatively measured in all individuals using a biochemical assay based on the G6PD/6GPD ratio in erythrocytes. Individuals were defined as deficient when the ratio was less than 0.80. The severity and complexity of coronary atherosclerosis were assessed by SYNTAX score at baseline angiography. Fifty-six patients (9%) showed G6PD deficiency. Severe (i.e. enzymatic activity < 0.10) G6PD deficiency was detected in 33 (5.3%) individuals, mainly of male sex (n = 32). Overall, the cardiovascular risk profile was similar between patients with G6PD deficiency and controls. Patients with G6PD deficiency showed similar severity and complexity of coronary atherosclerosis as compared to control patients; accordingly, the SYNTAX score (15 vs. 14.5, P = 0.90, respectively, in G6PD-deficent patients and controls), and all its components were similar between deficient individuals and controls. The only independent predictor of a SYNTAX score of more than 22 was patients' age (odds ratio 1.035, 95% confidence interval 1.018-1.051; P < 0.001). G6PD deficiency does not impact on the extent and complexity of coronary atherosclerosis assessed by coronary angiography in patents presenting with ACS.

The Correlation of plasma fibrinogen and complexity of coronary lesions in patients with acute coronary syndrome

Elevated levels of inflammatory markers are linked to an increased rates of adverse events in patients with CAD. Fibrinogen is an indicator of pro-coagulant state and also a biomarker playing a role in inflammatory responses in variable degrees. It is suggested that a high circulating plasma fibrinogen is correlated to adverse outcome in patients with CAD. We aimed to investigate the relationship between fibrinogen levels and CAD severity, complexity assessed with SS in patients admitted for ACS. A total of 102 patients (63.1 ± 10.3 years, 65% men) with Acute coronary Syndrome, who underwent coronary angiography were enrolled. Laboratory data including fibrinogen were obtained before admission to Cath Lab for coronary angiography. Syntax scores of all patients were calculated from baseline CAG. Intermediate-high SXscore was significantly associated with older age, female gender, Diabetes Mlellitus, heart rate and inversely associated with BMI, current smoking, and LVEF.Patients with SXscore ≥ 23 had increased inflammatory bio-markers hence hs-CRP .The plasma levels of fibrinogen were higher in the patients with SXscore ≥ 23 than in the patients with SXscore ≤ 22 ( P < 0.001). In addition, it was determined that there was a correlation between fibrinogen and hs CRP levels in the whole study population ( P < 0.001).The number of diseased vessels was significantly higher in patients with intermediate-high Sxscore compared with the low SXscore so as chronic total occlusion, by this associated also to a higher Fibrinogen levels .The rate of patients who underwent stent implantation was higher in the SXscore ≤ 22 group. In conclusion, plasma fibrinogen levels are significantly associated with the extent and complexity of coronary atherosclerosis in patients with ACS. A higher fibrinogen level is an independent predictor of intermediate-high SXscore.

The relationship between serum NT-proBNP levels and severity of coronary artery disease assessed by SYNTAX score in patients with acute myocardial infarction

Background/aimIn the present study, we aimed to investigate the relationship between NT-proBNP and SYNTAX score, which is a measure of the complexity of coronary artery disease.Materials and methodsWe enrolled 405 consecutive patients with myocardial infarction who underwent coronary angiographic examination. Patients were divided into 3 groups according to their SYNTAX scores. Those with SYNTAX score ≤22 were included in the low SYNTAX score group (LSTX), those with a score of 23–32 were included in the intermediate SYNTAX score group (ISTX), and those with a score of ≥33 were included in the high SYNTAX score group (HSTX).ResultsNT-proBNP levels were found to be significantly higher in the HSTX group compared to the other groups (P < 0.001) and in the ISTX group compared to the LSTX group (P < 0.001). The NT-proBNP levels demonstrated an increase from low SYNTAX score to high SYNTAX score tertiles.ConclusionsNT-ProBNP levels in patients with myocardial infarction on admission were independently associated with extent, severity, and complexity of coronary atherosclerosis as assessed by SYNTAX score.

Highly-Sensitive C-reactive Protein Level and its Association with Intermediate and High Syntax Score in cases of Acute Coronary Syndrome

Background: Highly-Sensitive C-reactive Protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). Aim: We investigated if baseline hs-CRP levels are correlated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). Subjects and methods: We investigated 200 patients with ACS who underwent coronary angiography. The patients were divided into groups based on their SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Results: Patients in the intermediate-high SXScore group had higher serum hs-CRP levels in comparison to low SXScore group (4.61 ±1.54 mg/dL versus 2.37 ± 0.66 mg/dL, P < 0.001). The mean age of patients and prevalence of diabetes in the intermediate-high SXScore group were statistically insignificantly than in the low SXScore group. Left ventricular ejection fraction (LVEF) was significantly lower in the patients with an intermediate-high SXScore (41±9 %) compared to low SXScore tertiles (50±8 %) (P< 0.001). There was significant correlation between the hs-crp levels and the syntax score. The correlation coefficient (r) = 0.567, also p value was significant p=0.0001. Consecutively hs-CRP at a cut-off point of ≥ 2.5mg/L was highly sensitive (97%) and specific (41%) and was a strongly independent predictor of a high SXScore in patients with ACS. Where accuracy of test was (acc= 0.94). Conclusion: It is believed that serum levels of hs-CRP on admission in patients with ACS thought to be a strong predictor of the severity and complexity of coronary atherosclerosis together with multivessel disease, and LVEF.

Highly-Sensitive C-reactive Protein Level and its Association with Intermediate and High Syntax Score in cases of Acute Coronary Syndrome

Background: Highly-Sensitive C-reactive Protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). Aim: We investigated if baseline hs-CRP levels are correlated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). Subjects and methods: We investigated 200 patients with ACS who underwent coronary angiography. The patients were divided into groups based on their SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Results: Patients in the intermediate-high SXScore group had higher serum hs-CRP levels in comparison to low SXScore group (4.61 ±1.54 mg/dL versus 2.37 ± 0.66 mg/dL, P < 0.001). The mean age of patients and prevalence of diabetes in the intermediate-high SXScore group were statistically insignificantly than in the low SXScore group. Left ventricular ejection fraction (LVEF) was significantly lower in the patients with an intermediate-high SXScore (41±9 %) compared to low SXScore tertiles (50±8 %) (P< 0.001). There was significant correlation between the hs-crp levels and the syntax score. The correlation coefficient (r) = 0.567, also p value was significant p=0.0001. Consecutively hs-CRP at a cut-off point of ≥ 2.5mg/L was highly sensitive (97%) and specific (41%) and was a strongly independent predictor of a high SXScore in patients with ACS. Where accuracy of test was (acc= 0.94). Conclusion: It is believed that serum levels of hs-CRP on admission in patients with ACS thought to be a strong predictor of the severity and complexity of coronary atherosclerosis together with multivessel disease, and LVEF.

New non-invasive indexes of arterial stiffness are significantly correlated with severity and complexity of coronary atherosclerosis

ABSTRACTBackground: Endothelial dysfunction and increased arterial stiffness gradually develop before the manifestation of catastrophic cardiovascular events. Therefore, detection and assessment of vascular function are required to address pre-existing pathological conditions. However, the currently available diagnostic devices and methods are insufficient due to variability among investigators and the time-consuming nature of manual procedures. Methods: Recently, novel devices were developed for the detection of both arterial stiffness and endothelial dysfunction in a single blood pressure measurement using a cuff-oscillometric technique (AVE-1500, Shisei Datum, Japan). API (arterial pressure volume index) is defined as the reciprocal of the slope of the tangent of the brachial artery pressure-volume curve, and AVI (arterial velocity pulse index) is defined as the ratio of the difference between the ejection and reflection waves. In the present study, we performed retrospective, cross-sectional analyses of subjects (n = 102; mean age = 70.5 ± 10.4 years) with detailed coronary angiographic examinations and clinical background parameters. Results: After adjusting for various variables using multiple linear regression analyses, we found that API, but not AVI, was significantly correlated with coronary artery severity and complexity scores. Conclusions: We propose that API may be a new vascular index useful for monitoring and assessing the severity and complexity of atherosclerosis in subjects with coronary artery disease and for evaluating atherosclerotic diseases.

RETRACTED: Mean Platelet Volume-to-Lymphocyte Ratio as a Novel Marker for Severity and Complexity of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome.

RETRACTED: Mean Platelet Volume-to-Lymphocyte Ratio as a Novel Marker for Severity and Complexity of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome.

0279 : Correlation of CRP level with intermediate and high SYNTAX score in patients with acute coronary syndrome

C-reactive protein is currently considered as a prognostic marker of atherosclerotic disease. Its serum levels can help to stratify patients admitted for acute coronary syndrome (ACS). In our data, we investigated whether baseline CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). we enrolled 128 patients with ACS who underwent coronary angiography between January 2015 and November 2015. The patients were divided into tertiles according to the SXScore: low SXScore (≤22), and intermediate-high SXScore (≥23). Subjects in the intermediate-high SXScore tertile had higher serum CRP levels compare to low SXScore tertile patients (17.8±6.4 mg/L versus 10.2±5.3 mg/L, p < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (61± 12 versus 57± 10 years; p=0.003 for age, p=0.008 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum CRP levels together with multivessel disease, left ventricular ejection fraction (LVEF), and troponin levels. Serum CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis. Thus, increased serum levels of CRP were one of the strong predictors of high SXScore in ACS patients. The author hereby declares no conflict of interest

High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome.

High sensitive C-reactive protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore).We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23).Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12).Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.

Association of Platelet-to-Lymphocyte Ratio With Severity and Complexity of Coronary Artery Disease in Patients With Acute Coronary Syndromes

The SYNTAX score (SXscore) is an anatomic scoring system based on coronary angiography (CA) that not only quantifies lesion severity and complexity but also predicts poor cardiovascular outcomes, including mortality, in patients with acute coronary syndromes (ACS). Recent studies have shown that platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in many cardiovascular diseases. The aim of this study was to investigate the association of PLR with the severity and complexity of coronary atherosclerosis as assessed by the SXscore in patients with ACS who underwent urgent CA. A total of 1,016 patients with ACS who underwent urgent CA were included in the study from August 2012 to March 2014. Admission PLR values were calculated before CA was performed. The SXscore was determined from baseline CA. The patients were divided into 2 groups, those with low SXscores (≤22) and those with intermediate to high SXscores (≥23). PLRs were significantly higher in patients with intermediate to high SXscores compared with those with low SXscores (p<0.001). In-hospital mortality was significantly higher in the groups with high PLR and intermediate to high SXscores. In multivariate analysis, the independent predictors of intermediate to high SXscore were PLR (odds ratio 1.018, 95% confidence interval 1.013 to 1.023, p<0.001) together with the left ventricular ejection fraction (odds ratio 0.935, 95% confidence interval 0.910 to 0.960, p<0.001), and age (odds ratio 1.029, 95% confidence interval 1.029 to 1.054, p=0.02). A PLR≥116 had 71% sensitivity and 66% specificity in predicting intermediate to high SXscore. In conclusion, the PLR at admission is significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS. Increased PLR is an independent predictor of higher SXscore in patients with ACS who undergo urgent CA.

N-Terminal Pro-Brain Natriuretic Peptide Level is Associated With Severity and Complexity of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome.

N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are associated with short- and long-term mortality in acute coronary syndrome (ACS). We investigated whether baseline NT-proBNP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 509 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), intermediate SXScore (23-32), and high SXScore (≥ 33). The NT-proBNP levels demonstrated an increase from low SXScore tertile to high SXScore tertile. The NT-proBNP levels according to the SXScore tertiles are as follows: low and intermediate (median 635 vs 1635, P = .014), low and high (median 635 vs 4568, P < .001), and intermediate and high (median 1635 vs 4568, P < .001). In multivariate analysis, NT-proBNP remained an independent predictor of high SXScore (odds ratio: 2.688, 95% confidence interval: 1.315-5.494, P = .007) together with age (P = .002), neutrophil-lymphocyte ratio (P = .017), and presence of non-ST-segment elevation ACS (P = .002). The NT-proBNP was independently associated with burden of coronary atherosclerosis in patients with ACS.

Abstract 18512: Comparison of Carotid Intima-media Thickness, Plaque Score and Plaque Area Stenosis in Patients with Acute Myocardial Infarction with and without ST-segment Elevation

Background: Increased carotid intima-media thickness (IMT) and presence of carotid plaques are being used for estimation of subclinical atherosclerosis but their role in established coronary artery disease remains uncertain. Therefore, we aimed to evaluate whether carotid parameters are correlated with extent and complexity of coronary atherosclerosis using SYNTAX score (SS). We also sought to compare carotid parameters between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Methods: Of 1351 patients who consecutively received carotid ultrasound evaluation from Sep 2011 to May 2012, 137 patients diagnosed with STEMI (n=73) and NSTEMI (n=65) were enrolled (104 men and mean age 64.9±12.7 years). IMT, plaque score (PS) and % plaque area stenosis (AS) were compared between STEMI and NSTEMI. PS was computed according to the presence of plaque in 4 different locations. For the quantification of plaques, % AS was calculated by the ratio of the luminal stenosis area divided by the vessel area at the narrowest portion in short axis view. Clinical parameters and SS were also compared. Results: The prevalence of hypertension and diabetes was higher in NSTEMI group than STEMI group (65.6% vs. 39.7%, p=0.002 and 42.2% vs. 19.2%, p=0.003). A higher incidence of multi-vessel disease (≥2 vessels) and diffuse lesion was observed in NSTEMI group (69.6% vs. 45.1%, p=0.007 and 65.6% vs. 46.6%, p=0.038). NSTEMI group had significant higher SS (16.0±9.2 vs. 20.0±10.2, p=0.015), IMT values, PS and % AS. SS was correlated with mean IMT values and PS (r=0.182, p=0.033 and r=0.200, p=0.019). SS was higher in NSTEMI patients with increased IMT &amp; plaque than those with normal carotid artery (22.2±9.9 vs. 10.3±6.1, p=0.001). Conclusion: NSTEMI was associated with increased CIMT, higher PS and % AS reflecting atherosclerotic burden. Carotid parameters provided additional information to predict the severity of coronary atherosclerosis in patients with NSTEMI.