Coronary Angiographic Characteristics Research Articles

Acute Myocardial Infarction in Women, a Study on Risk Factors, Angiographic Features and Outcomes.

Women with acute coronary syndrome are more likely to have cardiovascular disease risk factors and atypical symptoms as compared to men. In Nepal, there is a rising trend of Coronary Artery Disease and myocardial infarction in women. However, research on acute myocardial infarction in women is lacking. The aim of this study was to study the cardiac risk factors, clinical features, angiographic features, and outcome of acute myocardial infarction in Nepalese women admitted to Hospital. This was a cross sectional study done at Shahid Gangalal National Heart Center Kathmandu from September 2016 to March 2017. Female patients admitted with a diagnosis of acute ST-segment elevation myocardial infarction or non-ST segment elevation myocardial infarction, who fulfilled the inclusion criteria were included in the study. The details of the patients, demographic profile, major clinical symptoms, major coronary artery disease risk factors, angiographic features and outcomes were recorded and assessed during the study period. Coronary angiography was done in 112 patients out of 178 patients. Out of 178 patients, 85.95 % had ST-segment elevation myocardial infarction and 14.05% had non-ST segment elevation myocardial infarction. The mean patient age was 62.53 ± 12.1. 26.4% patients were of age less than 55 years. Major risk factors were central obesity (94.61%), dyslipidemia due to low HDL (78.65%). hypertension (54.49%), smoking (54.49%) and type 2 diabetes (34.83%). The most common atypical symptoms were shortness of breath (35.39 %,) , nausea and vomiting (23. 6%) and epigastric pain (6.74%), Single vessel disease was found in 36%; double vessel disease in 26.3% and triple vessel disease in 28.9% of patients. The primary outcome of in- hospital mortality was 3.37 %. Our study showed that significant number of females had Coronary Artery Disease at early age. Among women with myocardial infarction in Nepal, obesity due to high waist to hip ratio was the most common risk factor followed by dyslipidemia due to low high density lipoproteins, smoking, hypertension, and diabetes. Atypical symptoms were also common findings. Single vessel disease was the most common lesion and left anterior descending artery was the most commonly involved vessel. Mortality was seen in ST-segment elevation myocardial infarction patients only.

Severity of Coronary Artery Disease by Friesinger Score Among Women With Acute Coronary Syndrome in a Tertiary Care Hospital in Bangladesh.

The chance of coronary artery disease (CAD) is much higher in women who have gone through menopause than in those who have not, owing to hormonal defense against atherosclerosis. More advanced CADand several comorbidities were observed in postmenopausal women. Nevertheless, there is a paucity of information comparing the angiographic severity of acute coronary syndrome (ACS) in premenopausal and postmenopausal women of different ages. This research sought to determine the Friesinger score's use in evaluating the degree of CAD in premenopausal and postmenopausal women with ACS. A total of 145 female patients with ACS were included in this cross-sectional observational research. Depending on the stage of menopause, they were categorized into two groups: group I (premenopausal) and group II (postmenopausal). The study examined the differences in clinical data and the severity of coronary angiographic features based on the Friesinger score between the premenopausal and postmenopausal ACS groups. A statistically significant difference (p = 0.001) was found in the mean age of premenopausal ACS patients, which was 41.53 ± 5.45 years, and postmenopausal ACS patients, which was 57.23 ± 7.45 years. Between the premenopausal group (31.4% vs. 17.1%; p = 0.04 and 31.4% vs. 15.7%; p = 0.002) and postmenopausal group (48.6% vs. 20%; p = 0.001), there was a greater prevalence of normal coronary angiography, single-vessel disease, and triple-vessel disease. Comparing the postmenopausal group to the premenopausal group, the high to intermediate Friesinger score (11-15) was found to be considerably higher (2.9% vs. 1.4%; 72.9% vs. 50%; p = 0.003). Prior to menopause, single-vessel disease and normal coronary angiography were more common, whereas postmenopausal individuals had triple-vessel disease.The postmenopausal group's CAD was found to be more severe than the premenopausal group's according to the Friesinger score used for severity evaluation.

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

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

Coronary Angiographic Characteristic of Coronary Artery Disease of Young Adults Under Age Forty Years Compare to Those Over Age Forty

This study aimed to compare the coronary angiographic characteristics of coronary artery disease in young adults (≤40 years) and older adults (>40 years). This was a retrospective analytic study. The study was conducted at the Department of Cardiology, Rajshahi Medical College Hospital. 100 patients with coronary artery disease were included in this study. Among the 100 patients, 50% were in the ≤40 years’ group (group A) and 50% were in the >40 years’ group (group B). Coronary angiographic characteristics were analyzed for each group. Coronary artery disease was present in 72% of group A and 84% of group B. In group A, single vessel disease (SVD) was the most common pattern (38%, p=0.001), while in group B, double vessel disease (DVD) (36%, p=0.043), triple vessel disease (TVD) (26%, p=0.033), and left main vessel disease (LM) (8%, p=0.035) were more prevalent. Left ventricular dysfunction with hypokinesia was observed in the majority of patients. The left anterior descending (LAD) artery was most commonly involved in both groups, primarily in the mid and proximal segments. The right coronary artery (RCA) was the next commonly affected artery, with differences in involvement site between the two groups. This study highlights that SVD is more common among young adults, whereas DVD, TVD, and LM diseases are more prevalent in older individuals. Older age groups exhibited a higher prevalence of diabetes mellitus, while smoking, dyslipidemia, and hypertension were common risk factors for coronary artery disease in both age groups. TAJ 2023; 36: No-2: 01-09

Retracted: Intelligent Algorithm-Based Coronary Angiography Characteristics of Acute Non-ST-Segment Elevation Myocardial Infarction Patients with Different Genders.

[This retracts the article DOI: 10.1155/2022/6447472.].

Impacts of illicit drug use on coronary angiographic findings in a multicenter registry of patients with acute coronary syndrome

Abstract Background Although illicit drug use may induce acute coronary syndrome (ACS), its impacts on coronary angiographic characteristics and the coronary artery disease (CAD) burden are a matter of debate. Purpose To assess the association between illicit drugs use and coronary angiographic findings in a multicenter patients with ACS. Methods From April 7 to 22, 2021, the Addiction in Intensive Cardiac Care Unit (ADDICT-ICCU) study included prospectively 1,499 patients admitted to ICCUs with a systematic urine multidrug test in 39 ICCUs across France. This prespecified study focuses on patients admitted for ACS with an angiography analysed by an independent Angiographic Core Laboratory. Patients with history of coronary artery bypass graft surgery were excluded. We compared coronary angiographic findings between illicit drugs users and others for the following parameters: the prevalence, location, type, and severity of CAD obstruction (stenosis≥50%), SYNTAX score, residual SYNTAX score, and the characteristics of percutaneous coronary intervention (PCI). Results Among the 283 patients with ACS (62±13 years, 77% men), 38 (13.4%) had a positive test for illicit drugs (cannabis: 12%, cocaine: 1.1%, MDMA: 0.7%). Drug users were younger than other patients (51±12 vs 64±12 years, p<0.001), but there were no significant difference in sex ratio (89.5% vs 75.5%, p=0.088). There was no significant difference in the rate of STEMI (52.6% vs 45.7%, p=0.535) and NTSEMI (47.4% vs 54.3%, p=0.535) between drug users and others. Regarding the CAD burden, drug users had significantly less obstructive coronary lesions (1.6±1.1 vs 2.2±1.4, p=0.012), less multivessel obstructive CAD (31% vs 61%, p=0.001), and a trend for a lower initial SYNTAX score (8.3±7.8 vs 10.8±8.4; p=0.084) compared to others. Concerning culprit lesion, drug users had less bifurcation lesions (p=0.008), a trend for more left anterior descending (LAD) artery lesions (p=0.091), a higher thrombus burden score (p=0.057), and less lesions above 20 mm (p=0.183). Conclusion In patients with ACS, recent illicit drug use is associated with less number of significant lesions and less multivessel CAD. Concerning culprit lesions, illicit drugs use is associated with less bifurcation lesions, with a trend for more LAD lesions and a higher thrombus burden score.ACS analysed with Core LaboratoryAngiographic findings according to drug

Patterns of Rheumatic Heart Disease Among Yemeni Patients in Cardiac Center of Al-Thawra General Hospital

Background: Rheumatic heart disease (RHD) is still a major public health problem and remains the most common cardiovascular cause of death among children and young adults. The recurrent episodes of acute rheumatic heart disease may cause the rapid progressive damage of the heart valves and chronic residual deformity resulting in stenosis or regurgitation or a combination of both stenosis and regurgitation.
 Methodology: A cross sectional Study, consecutive patients with RHD were enrolled from outpatient cardiac clinics and inpatient department of cardiac center of Al-thawra hospital in Sana’a city, Yemen between January and July 2020. Demographic, clinical, echocardiographic, and coronary angiography characteristics of patients were recorded.
 Results: 261 consecutive patients with rheumatic heart disease were analyzed with mean age of 33 ± 12.65, female patients represented 62.8% (165), illiterate patients represented 63.6% (166). The majority of the patients about 79.7% (208 patient) had mitral valve disease, 63.6% (166 patient) had aortic valve disease, 10.7% (28 patient) had organic tricuspid valve disease but the Isolated Mitral valve disease 23%( 60) , Isolated Aortic valve disease 10.3% (27) and Isolated organic tricuspid valve disease represent 4.2% (11) , double valve disease (mitral & aortic ) represent 56% (146), triple valve disease (Mitral + Aortic + Tricuspid )represent 6.5% (17).A lot of complications of RHD detected in our study; CHF 36%(94) with low EF <50% in 55.0%(144) and 34% (89) had dilated LV , 33.7%(86) developed AF , 14%(37) of the patient complicated by IE , spontaneous echo contrast 11%(29) but only 7.3%(19) developed Intra cardiac thrombus and new stroke 9.5% ( 25) , pericardial effusion 5.4% (14) and Active ARF 2.3%(6). Conclusion:
 Rheumatic heart disease is a big medical problem in Yemen and it affects children and young adults of poor and illiterate patients of both genders. The most common valvular lesion reported in our study was multivalvular lesion the predominant pure lesion was Mitral regurgitation followed by Mitral stenosis, Aortic regurgitation, with high organic affection of the tricuspid valve.

Clinical and angiographic characteristics of patients with coronary ectasia in a reference hospital

To analyze the clinical and angiographic characteristics of patients with coronary ectasia found on coronary angiography.: Descriptive study of patients admitted to the cardiac catheterization laboratory of the Hospital Guillermo Almenara with coronary ectasia, during the years 2012 to 2020. The frequency of coronary ectasia, clinical, angiographic and coronary flow characteristics were determined.7504 catheterizations were reviewed, and 91 patients were found to have coronary ectasia (1.21%). Of these patients, 71 cases were male (78%), and the mean age was 67.74 ± 9.9 years. The 38.5% of cases were obese or overweight; 39.6% were hypertensive; 11% diabetic; 13.2% smoked; 3.3% had chronic kidney disease and 3.3% had polyglobulia. Sixty-one percent of cases had a diagnosis of acute coronary syndrome, and 24% of cases had high-risk stable angina. The artery most frequently involved by ectasia was the right coronary artery (70%). The average diameter of the ectatic artery was 5.7 mm. Occlusive thrombus was found in 19.8% of cases. There was a significant association between TIMI flow and diameter of the ectatic artery (p=0.000), and there was also an association between coronary ectasia and acute coronary syndrome among patients living at an altitude of more than 2500 m (p=0.000).coronary ectasia was an infrequent entity among patients who underwent coronary angiography, was predominantly male, mainly involved the right coronary artery, was associated with lower TIMI flow, and acute coronary syndrome among residents above 2500 m of altitude.

Coronary angiographic and culprit lesion characteristics in patients resuscitated from out-of-hospital cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: None. Background Emergent coronary angiography is recommended in patients with return of spontaneous circulation (ROSC) after out of hospital cardiac arrest (OHCA) of suspected cardiac origin. The aim of this study was to analyze the prevalence of coronary artery disease (CAD), characteristics of the culprit lesions in case of acute coronary syndrome (ACS) and the success of percutaneous coronary intervention (PCI) in patients resuscitated from OHCA due to a shockable rhythm, i.e. ventricular fibrillation (VF) and ventricular tachycardia (VT). Methods We analyzed the data of 150 patients in whom coronary angiography was performed in the setting of ROSC after OHCA. Patients were categorized to have non obstructive CAD or obstructive CAD. Patients with obstructive CAD were classified as acute myocardial infarction (ST-elevation myocardial infarction (STEMI), Non-ST-elevation myocardial infarction (NSTEMI)) and chronic coronary syndrome. The culprit vessel was identified by means of electrocardiographic findings, echocardiography and coronary angiography. Coronary angiograms and all clinical data were reviewed in consensus by two experienced interventional cardiologists. Successful PCI was defined as angiographic restoration of TIMI III flow. Results Significant CAD was ruled out in 27 patients (18.0%). Obstructive CAD with at least one coronary artery stenosis was found in 123 patients (82.0%). According to clinical and angiographic findings, ACS was found in 105/150 patients (70.0%). Of the 105 patients with ACS, 53 (35.3%) presented with STEMI and 52 (34.7%) presented with NSTEMI. 18/123 patients (14.6%) showed chronic coronary syndrome. Among the patients with obstructive CAD, 1-vessel CAD was found in 32 patients (26.0%), 2-vessel CAD in 44 patients (35.8%), 3-vessel CAD in 47 patients (38.2%). 41 (33.3%) of the patients with CAD showed a chronic total occlusion (CTO) of at least one vessel. In patients presenting with ACS, the most common culprit vessels were LAD (37.4%) and CX (23.6%), followed by RCA (11.4%) and LM (2.4%). In 22.8% of the patients, the culprit vessel could not be unambiguously identified. In 82.9% of the patients with ACS/CAD, PCI was performed. TIMI flow after intervention was TIMI III in 92.1%, TIMI II in 3.9%, TIMI I in 2.0% and TIMI 0 in 2.0%. Conclusion In patients resuscitated from OHCA due to VF/VT, multivessel disease is common. Most frequently, culprit lesions are located in the LAD and CX. PCI in OHCA patients can be performed at a high success rate.

Analysis on risk factors and characteristics of coronary angiography in young men with CHD

Analysis on risk factors and characteristics of coronary angiography in young men with CHD

Gender Differences in Coronary Artery Disease, Clinical Characteristics, and Angiographic Features in the Jazan Region, Saudi Arabia.

Cardiovascular disease is a major cause of death worldwide. In Saudi Arabia and the gulf area, coronary artery disease (CAD) is considered a serious problem with high mortality. Previous studies identified multiple risk factors, that include hypertension, diabetes, dyslipidemia, obesity, smoking, and low physical activity, which might be related to lifestyle changes over the last few decades. Limited data about gender differences in clinical and angiographic characteristics among CAD patients in the Jazan region are available. The aim of this study is to assess potential gender differences in CAD and its clinical characteristics and angiographic features in the Jazan region. This retrospective chart review collected data between January 2020 and March 2021 from the follow-ups of 498 patients (100 females and 398 males) aged over 18 years at the Prince Mohammed bin Nasser Hospital in the Jazan region of Saudi Arabia. The data were collected after all patients admitted to the hospital were reviewed, and cardiac catheterization was performed. Of the 498 patients withCAD, 100 (20.1%) were female and 398 (79.9%) were male. The mean age of female patients (59.44 years) was significantly higher than that of male patients (55.1 years; P=0.0002). In addition, risk factors differed significantly between genders (P=0.0210). Moreover, vessels differed significantly between genders (P=0.0002). Coronary angiogram findings showed significant correlations between gender and percutaneous coronary intervention (PCI; P=0.0001) and MEDICAL (P=0.0010). Diagnosis findings showed significant gender differences in STEMI (P<0.0010) and unstable angina (P<0.0010). CAD severity did not differ by gender, but coronary angiogram findings showed significant relationships between gender, PCI, and MEDICAL treatment with CAD.

Intelligent Algorithm-Based Coronary Angiography Characteristics of Acute Non-ST-Segment Elevation Myocardial Infarction Patients with Different Genders.

Objective This study was aimed at comparing the characteristics of coronary angiography based on intelligent algorithm in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) of different genders. Methods Eighty patients were selected to segment the coronary angiogram using the convolutional neural network (CNN) algorithm, the input layer of the CNN was used to receive the image dataset, and three-dimensional data were input during semantic segmentation to achieve automatic segmentation of the target features. Segmentation results were quantitatively assessed by accuracy (Acc), sensitivity (Se), specificity (Sp), and Dice coefficient (Dice). The characteristics of coronary angiography were compared between the two groups. Results The CNN algorithm had good segmentation effect, complete vessel extraction, and little noise, and Acc, Se, Sp, and Dice were 90.32%, 93.39%, 91.25%, and 89.75%, respectively. The proportion of diabetes mellitus was higher in female patients with NSTEMI (68.8%) than that in male patients (46.3%); the proportion of the left main coronary artery (LM) and left anterior descending artery (LAD) was lower in the female group (7.5%, 41.3%) than that in the male group (13.8%, 81.3%), and the difference between the two groups was statistically significant (P < 0.05). Conclusion The CNN algorithm achieves accurate extraction of vessels from coronary angiographic images, and women with diabetes and hyperlipidemia are more likely to have NSTEMI than men, especially the elderly.

Clinical and angiographic characteristics of patients with coronary ectasia in a reference hospital

To analyze the clinical and angiographic characteristics of patients with coronary ectasia found on coronary angiography. : Descriptive study of patients admitted to the cardiac catheterization laboratory of the Hospital Guillermo Almenara with coronary ectasia, during the years 2012 to 2020. The frequency of coronary ectasia, clinical, angiographic and coronary flow characteristics were determined. 7504 catheterizations were reviewed, and 91 patients were found to have coronary ectasia (1.21%). Of these patients, 71 cases were male (78%), and the mean age was 67.74 ± 9.9 years. The 38.5% of cases were obese or overweight; 39.6% were hypertensive; 11% diabetic; 13.2% smoked; 3.3% had chronic kidney disease and 3.3% had polyglobulia. Sixty-one percent of cases had a diagnosis of acute coronary syndrome, and 24% of cases had high-risk stable angina. The artery most frequently involved by ectasia was the right coronary artery (70%). The average diameter of the ectatic artery was 5.7 mm. Occlusive thrombus was found in 19.8% of cases. There was a significant association between TIMI flow and diameter of the ectatic artery (p=0.000), and there was also an association between coronary ectasia and acute coronary syndrome among patients living at an altitude of more than 2500 m (p=0.000). coronary ectasia was an infrequent entity among patients who underwent coronary angiography, was predominantly male, mainly involved the right coronary artery, was associated with lower TIMI flow, and acute coronary syndrome among residents above 2500 m of altitude.

Common coronary artery occlusions in patients with myocardial infarction.

coronary artery disease (CAD) is a significant cardiovascular disease (CVD) that affects people worldwide. This study aimed to determine the main occluded coronary arteries in patients with myocardial infarction in Najran, Kingdom of Saudi Arabia (KSA). a retrospective cross-sectional study conducted between March 2020 and March 2021 and involving 661 myocardial infarction patients recruited from two hospitals (King Khalid Hospital and Prince Sultan Centre for Healthcare in Najran) used sampling for enrolled patients. Patients over the age of 15 years, current residents of KSA, and diagnosed with coronary artery occlusion based on at least one identifiable coronary lesion on a coronary angiography were considered eligible. We created generalized linear mixed models to investigate patients´ clinical and coronary angiographic features and identify statistically relevant components. there were 661 CAD cases in this study: 548 (82.9%) males and 113 (17.1%) females, with a mean and standard deviation (SD) age of 4.03 ± 1.370 years. Ages of the 661 participants ranged from 15 to 85, who had been diagnosed with myocardial infarction were evaluated. It was found that most of the patients were in the 55-64 age range. The majority of cases (366 (55.4%) had ST-segment elevation myocardial infarction (STEMI), 187 (28.3%) had non-ST-segment elevation (NSTEMI), 101 (15.3%) had acute coronary syndrome-non-ST-segment elevation (ACS-NSTEMI), and 7 (1.1%) had acute coronary syndrome-ST-segment elevation (ACS-STEMI). the left anterior descending artery (LAD) is the commonest lesion found in both ST-segment elevation and non-ST-segment elevation myocardial infarction patients.

Chronic Total Occlusion Anatomy and Characteristics of Coronary Collaterals and Angiographic Features Predicting the Success of Chronic Total Occlusion Intervention

Background and Objective: Angiographic assessment of chronic total occlusion (CTO) anatomy and collateral characteristics of coronary arteries are necessary for CTO intervention. Materials and Methods: This was a hospital-based observational study of 100 coronary angiograms (CAG) with CTOs. CTO anatomy and collateral characteristics of coronary arteries were studied for predicting anterograde and retrograde CTO intervention. Results: Right coronary artery (RCA) CTO was the most common (62%), followed by left anterior descending (LAD). More than two-thirds of RCA and LAD CTO lesions were >20 mm and half were in mid-segment. Left circumflex artery (LCX) and RCA lesions were more frequently calcified. LAD CTOs often had blunt stump; LCX CTOs frequently had bending >45°. The mean J-CTO score was lowest in RCA CTOs (2.0 ± 1.19). There were 10 different types of collaterals in RCA CTOs, 8 in LAD CTOs, and only 4 in LCX CTOs. The most common RCA CTOs collateral was LAD septal to the right posterior descending artery (RPDA) (69.4%) and in LAD CTOs, the most common was septal collaterals from the RPDA to LAD (40.9%). RCA CTOs had a higher percentage of septal collaterals, less tortuosity, and favorable entry and exit angle when compared with other two arteries. Conclusion: RCA CTOs were the most common. Angiographic features in CTO lesions vary among three major coronary arteries. The RCA CTOs had lesser mean J-CTO score, more number of septal collaterals, less tortuous collaterals, and favorable entry and exit angle. RCA CTOs were better accessible for anterograde and retrograde intervention.

Interventional strategies and perioperative complications of chronic total coronary occlusion in combination with bifurcation lesions

Objective: To analyze the clinical characteristics of chronic total coronary occlusion (CTO) combined with bifurcation lesions and the features of coronary intervention and perioperative complications. Methods: This study adopted retrospective cross-sectional research methods and included 673 patients who underwent interventional therapy for chronic total occlusion in Beijing Anzhen Hospital. According to whether there were side branches (diameter ≥2 mm) within 5 mm before and after the CTO occlusion segment, patients were divided into bifurcation group (337 cases) and non-bifurcation group (336 cases). The measurement data did not conform to the normal distribution and were represented as M (Q1, Q3). The clinical risk factors, coronary angiography characteristics, interventional treatment strategies and perioperative complications were compared between the two groups. Results: The patients in the bifurcation group were 60 (51, 65) years old, and 86.6% (292 cases) were male; the patients in the non-bifurcation group were 60 (52, 66) years old, and 83.0% (279 cases) were male.Coronary artery disease in all patients was mainly multivessel disease, of which three-vessel disease accounted for 59.9% (403 cases) and double-vessel disease accounted for 25.4% (171 cases).The target vessel in the bifurcation group was predominantly left anterior descending artery (62.3%, 210 cases), and the target vessel in the non-bifurcation group was more common in the right coronary artery (56%, 188 cases). The target vessel diameter was larger in the bifurcation group (2.91(2.71, 3.24) mm vs 2.80(2.55, 3.13) mm, P<0.001). Most patients used the antegrade technique (88%, 592 cases), and the use of antegrade technique in the bifurcation group (91.9%, 307 cases) was higher than that in the non-bifurcation group (84.8%, 285 cases) (P=0.012). After CTO-PCI, 72.8% (490 cases) of patients achieved successful angiography. A total of 73 patients (10.8%) had perioperative complications, and there was no statistical difference between the two groups. However, the incidence of perioperative myocardial infarction was higher in the bifurcation group (5.9%, 20 cases) than non-bifurcation group (2.7%, 9 cases) (P=0.038). Conclusions: CTO complicated with bifurcation lesions are very common in clinical practice. Most patients with CTO have multiple coronary artery disease at the same time. The target vessel is more common in the left anterior descending artery, and the diameter of the vessel is larger. It is more common to use antergrade technique, accompanied by more perioperative myocardial infarctions.

Gender Differences in the Relationship of Waist Circumference to Coronary Artery Lesions and One-Year Re-Admission Among Coronary Artery Disease Patients with Normal Body Mass Index.

PurposeThe study explored the association of waist circumference (WC) with the severity of cardiovascular diseases and hospital readmission of coronary artery disease (CAD) patients with normal body mass index (BMI).Patients and Methods213 female and 431 male normal-BMI CAD patients were enrolled and assigned in three groups based on their gender-specific WC tertiles. Their cardiovascular risk factors and coronary angiography characteristics were analyzed in a cross-sectional study, and the gender-specific relationship between WC and one-year re-admission rate was prospectively explored.ResultsThe cross-sectional analysis showed that for male normal-BMI CAD patients, diabetes and dyslipidemia prevalence, Apo B/A1, hs-CRP, and uric acid levels triglycerides-glucose index, the incidence of left main disease, three vessel disease, calcification lesion, total occlusive lesion, and complex lesion, as well as Gensini score was in the order of WC tertile 3 > WC tertile 2 > WC tertile 1. In addition, male normal-BMI CAD patients in the highest WC tertile were at an increased risk of severe CAD (OR=2.21), and the correlation was still statistically significant even after adjusting for potential cardiovascular risk factors (OR=1.87). For female normal-BMI CAD patients, as the WC tertiles increased, uric acid level, the prevalence of three vessel disease, diffuse lesion, and complex lesion gradually increased (P <0.05), but no significant difference was found in the risk of severe CAD among different WC groups (all P >0.05). Prospective analyses showed that the higher the WC tertile was, the higher the one-year re-admission rate in men, but not in women, and after adjusting for other risk factors, men with the highest WC tertile showed more than twice the risk of patients with the lowest WC tertile.ConclusionMale but not female, normal-BMI CAD patients with increased WC had more severe CAD and a higher risk of one-year re-admission rate.

Patterns and determinants of treatment for coronary artery disease: A cross-sectional study in the Kingdom of Saudi Arabia.

Objectives:To determine the clinical and coronary angiographic characteristics of patients with coronary artery disease (CAD) and the patterns and determinants of CAD treatment in Kingdom of Saudi Arabia (KSA).Methods:We conducted a cross-sectional study including 242 patients at 3 hospitals in KSA between June 2018 and June 2019. We included all patients aged ≥18 years diagnosed with CAD on angiography. We carried out a multinomial logistic regression to ascertain the determinants of treatment patterns and treatment modalities. Covariates for this multivariate analysis were selected based on univariate regressions.Results:The study population had a mean ± standard deviation of 58.3 ± 11.8 years, and 66.1% were male. The most frequent cardiovascular risk factor was diabetes (58.7%). Lesions involving the left anterior descending were reported among 68.6%, left circumflex among 51.2%, and right coronary arteries (RCA) among 48.8% of our patients. The most common treatment was the best medical therapy (lifestyle modifications and medical management), prescribed to 69.8% of patients. Patients aged ≤60 years with the left main disease or disease of the ramus had a higher likelihood of undergoing coronary artery bypass grafting (CABG). Contrarily, patients with RCA lesions were more likely to undergo a percutaneous coronary intervention (PCI).Conclusion:Patient age and anatomical localization of coronary atherosclerotic lesions were the main determinants of treatment with CABG or PCI.

Different revascularization strategies for patients with coronary artery disease complicating reduced ejection fraction

Objectives: To explore the short and long term outcomes of coronary artery disease(CAD) patients with heart failure with reduced ejection fraction (HFrEF) after two different revascularization strategies. Methods: The CAD patients with HFrEF who had undegone successful revascularization from January 1, 2005 to December 31, 2014 in Anzhen Hospital were analyzed based on registries. The baseline characteristics, changes of left heart function and the MACCE after a mean follow-up of 3.1 years were compared. Results: A total of 1 813 CAD patients with HFrEF who had undergone successful PCI (n=687) or CABG (n=1 126) satisfied the inclusion criteria were included. The age of all patients included was (59.6±10.0) years and male patients accounted for 83.1%. For the coronary angiographic features, the CABG group showed higher SYNTAX score (27.3±10.2 vs 31.1±10.4, P<0.01) and greater left ventricular end diastolic diameter (LVEDD) [(59.8±7.2) vs (57.9±7.7)mm, P<0.001]. The LVEF before revascularization was similar in PCI and CABG group [(35.8±5.1)% vs (35.9±4.6)%, P>0.05]. At three-month, one-year or three-year follow-up after revascularization, the improvement of LVEF was similar in the two groups (P>0.05). After multivariable adjustment, three-year outcomes revealed that the risks of all-cause mortality and cardiac death were not statistically significant between CABG and PCI group (16.3% vs 14.3%, HR=1.5, 95%CI: 1.2-2.1, P=0.07; 8.5% vs 8.2%, HR=1.3, 95%CI: 1.1-1.4, P=0.20). With regards to other endpoints, CABG group had a higher rate of stroke (6.2% vs 2.9%, HR=2.9, 95%CI:2.3-3.6, P<0.01) but a lower rate of repeat revascularization (6.5% vs 15.1%, HR=0.5, 95%CI:0.3-0.7, P<0.01) compared to PCI group. And for patients with SYNTAX score≥33, PCI group showed a comparable risk of all-cause mortality or cardiac death (HR=0.8, 95%CI: 0.4-1.3, P=0.06; HR=0.7, 95%CI:0.4-1.0, P=0.90). Conclusions: In CAD patients with HFrEF who had undergone successful revascularization, PCI is not inferior to CABG for long-term survival. PCI should be taken into consideration to become an alternative strategy in patients with left ventricular dysfunction.

The incremental value of angiographic features for predicting recurrent cardiovascular events: Insights from the Duke Databank for Cardiovascular Disease

Background and aimsIdentifying patient subgroups with cardiovascular disease (CVD) at highest risk for recurrent events remains challenging. Angiographic features may provide incremental value in risk prediction beyond clinical characteristics. MethodsWe included all cardiac catheterization patients from the Duke Databank for Cardiovascular Disease with significant coronary artery disease (CAD; 07/01/2007–12/31/2012) and an outpatient follow-up visit with a primary care physician or cardiologist in the same health system within 3 months post-catheterization. Follow-up occurred for 3 years for the primary major adverse cardiovascular event endpoint (time to all-cause death, myocardial infarction [MI], or stroke). A multivariable model to predict recurrent events was developed based on clinical variables only, then adding angiographic variables from the catheterization. Next, we compared discrimination of clinical vs. clinical plus angiographic risk prediction models. ResultsAmong 3366 patients with angiographically-defined CAD, 633 (19.2%) experienced cardiovascular events (death, MI, or stroke) within 3 years. A multivariable model including 18 baseline clinical factors and initial revascularization had modest ability to predict future atherosclerotic cardiovascular disease events (c-statistic = 0.716). Among angiographic predictors, number of diseased vessels, left main stenosis, left anterior descending stenosis, and the Duke CAD Index had the highest value for secondary risk prediction; however, the clinical plus angiographic model only slightly improved discrimination (c-statistic = 0.724; delta 0.008). The net benefit for angiographic features was also small, with a relative integrated discrimination improvement of 0.05 (95% confidence interval: 0.03–0.08). ConclusionsThe inclusion of coronary angiographic features added little incremental value in secondary risk prediction beyond clinical characteristics.