Severity Of Coronary Artery Disease Research Articles

Impact of Smoking on MicroRNAs in Significant Coronary Artery Disease.

Given the importance of coronary artery disease (CAD) and the range of cardiovascular disease phenotypes in smokers, as well as the potential genetic and epigenetic factors, we were motivated to explore the impact of smoking on some selected microRNAs associated with significant CAD. A total of 60 individuals were selected in four groups including non-smoker without significant CAD (S-A-), non-smokers with significant CAD (S-A+), smokers without significant CAD (S+A-) and smokers with significant CAD (S+A+). Micro-RNA expression was investigated using real-time PCR. General linear model was used to calculate fold change (FC) considering SA- as the reference group. For mir-34a, down-regulation was observed in S+A- (FC =0.13, P =0.007) and S+A+ (FC =0.23, P =0.036) groups. For mir-126-3p, down-regulation was observed in S-A+ group (FC =0.05, P =0.024). For mir-199, up-regulation was observed for S+A- group (FC =9.38, P =0.007). The only significant interaction between pack-years of smoking and number of significantly narrowed vessels (≥75% stenosis) was for mir-199 which was in favor of down-regulation (P =0.006), while the main effects were in favor of up-regulation (P <0.05). Mir-34a expression may be affected by smoking, whereas mir-126-3p expression may be affected by atherosclerosis, the most common reason of CAD. The significant down-regulation of mir-199 for the interaction of smoking dose and severity of CAD was a notable finding showing the harmful consequence of this interaction. Further studies are needed for this micro-RNA.

Combined Coronary Artery Bypass Grafting and Orthopedic Fixation in a Patient with Multiple Comorbidities: A Case Report

Background: Coronary artery disease (CAD) is a prevalent cardiovascular condition and leading cause of morbidity and mortality worldwide. The management of orthopedic injuries requiring surgical fixation is particularly complex in patients with comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Coordinating the sequence, timing, and execution of coronary artery bypass grafting (CABG) and orthopedic fixation requires careful consideration of the patient’s overall health, surgical risks, and recovery potential. Case presentation: A 55-year-old male presented with a right distal tibial fracture following a fall. His medical history included HTN, type 2 diabetes mellitus (T2DM), and Kyrle’s skin disease. During his hospital stay, he was diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). Severe multivessel CAD was confirmed by catheterization. After interdisciplinary consultation, simultaneous CABG and open reduction and internal fixation (ORIF) of the tibial fracture were performed. He was discharged in good condition and showed positive recovery during a one-month follow-up. Discussion: This case highlights the complexities of managing patients with multiple comorbidities who require both cardiac and orthopedic surgeries. This simultaneous approach allows for efficient treatment, leading to a shorter hospital stay and recovery period. This report supports the feasibility and benefits of simultaneous surgery in complex clinical scenarios, although further studies are required to establish broader guidelines. Conclusion: Our case emphasizes the importance of a multidisciplinary approach for managing patients with multiple comorbidities who require concurrent surgical intervention. Preoperative planning and specialty coordination ensured optimal outcomes. Further research is needed to develop standardized guidelines for intraoperative care of patients undergoing simultaneous procedures.

Association between platelet-to-high-density lipoprotein cholesterol ratio and future stroke risk: a national cohort study based on CHARLS

BackgroundAccording to recent research, there is a considerable correlation between the severity of coronary artery disease and the platelet-to-high-density lipoprotein cholesterol ratio (PHR), which suggests that PHR is a potentially valuable inflammatory biomarker. However, the body of current research offers insufficiently strong evidence to clarify the connection between PHR and the incidence of stroke. Therefore, this study aims to elucidate any potential associations between PHR and stroke risk.MethodsThis study employed data from the China Health and Retirement Longitudinal Study (CHARLS) covering the period from 2011 to 2018. It included 5,872 participants who did not have a history of stroke in 2011. These patients were separated into four groups according to their baseline PHR quartiles. The main goal of the study was to focus on stroke outcomes. Stroke was defined as an occurrence of a cerebrovascular accident confirmed by a physician. We employed Cox proportional hazards regression models to investigate the association between PHR and the likelihood of experiencing a stroke. Furthermore, we conducted restricted cubic spline regression analysis and subgroup analysis.ResultsThe average follow-up period was 77.5 months, during which 390 participants experienced a stroke. In comparison to the lowest quartile group, participants in the highest quartile of PHR had a 49% increased risk of stroke (HR 1.49, 95% CI 1.13–1.96, p = 0.004). The adjusted multivariable Cox regression analysis maintained the statistical significance of this association (aHR 1.42, 95% CI 1.06–1.90, p = 0.019). After adjustment, a positive linear relationship between stroke risk and PHR was identified through restricted cubic spline regression analysis (nonlinear p &amp;gt; 0.05). Additionally, the impact of stroke was consistent across a variety of subgroups, as evidenced by subgroup analysis.ConclusionOur study indicates that higher PHR levels are significantly associated with an increased risk of stroke and that these levels can be used to identify groups that are at high risk of stroke.

Abstract 4138739: Insulin Resistance as a Marker of Multivessel Coronary Artery Diseases in Patients With Cardiovascular-Kidney-Metabolic Risk: Inshight From Invasive Coronary Angiography

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome is the concept of a combined diseases, including diabetes and chronic kidney disease (CKD), to stratify patients at cardiovascular risks. However, whether CKM components and insulin resistance differ in risk for coronary artery disease (CAD) severity is unknown. Purpose: This study aimed to investigate the association of distinct CKM risks and insulin resistance with CAD severity. Methods: In this study, we included 849 patients (74% male, 69±10 years of age) who underwent coronary angiography to assess chronic CAD. We assessed CKM risks using following components: (1) BMI ≥23 kg/m 2 , (2) diabetes, (3) hypertension and dyslipidemia, and (4) CKD. According to the number of CKM risk components, patients were categorized into four groups (Group A as having 0 or 1, Group B as 2, Group C as 3, and Group 4 as 4 risks). Insulin resistance was assessed by HOMA-IR and triglyceride-glucose index (TyG index) calculated as Ln (fasting plasma glucose × triglyceride/2). Coronary artery stenosis was categorized into single-vessel or multi-vessel CAD (MVD) per AHA classification. Gensini score was calculated to assess CAD extent. Logistic regression analysis was performed to determine independent predictors of MVD among CKM risk components. Results: MVD was diagnosed in 26.3% (n = 223) patients (mean Gensini score was 58±40 points). Among the four groups, there were significant differences in age, body mass index, hemoglobin A1c levels, TyG index, HOMA-IR, and Gensini score. Compared with Group A as reference, Group C (odds ratio [OR], 1.58; 95% confidence interval [CI] 1.03–2.42) or Group D (OR, 1.75; 95%CI, 1.06–2.89) but not Group B (OR, 1.09; 95%CI, 0.70–1.71) had higher risk for MVD (Figure). In a logistic regression model adjusting for age, male, smoker, and CRP ≥2 mg/dL, independent predictor of MVD was diabetes (OR, 2.15; 95%CI,1.55–2.99; p &lt; 0.001; model 1 in Table). In addition, when adjusting for age, male, smoker, and CRP ≥2 mg/dL, HOMA-IR&gt;2.5 was an independent predictor of MVD (model 2 in Table). Similarly, TyG index, an alternative marker of insulin resistance, remained as an independent predictor of MVD (model 3 in Table). Conclusions: In chronic CAD patients who underwent coronary angiography, subgroups stratified by the CKM risk components exhibit distinctly different insulin resistance, CAD severity and risk for MVD. Insulin resistance and diabetes were independent risks for MVD in this population.

Abstract 4136463: Novel Systemic Inflammatory Biomarkers Can Predict Significant Coronary Disease in High Risk Patients

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Chronic inflammation is a known risk factor for atherosclerosis, plaque formation, disease progression, and plaque instability. Novel inflammatory biomarkers have been recently linked to excess risk of adverse cardiovascular events, including incident myocardial infarction. Elevated inflammatory biomarkers may help identify patients at higher risk for severe CAD. Aim: This study aimed to evaluate the use of novel systemic inflammatory markers in predicting the pretest probability of severe CAD in patients referred to diagnostic coronary angiography in a single tertiary care center. Methods: This was a prospective observational cohort study enrolling consecutive patients referred to diagnostic coronary angiography in a tertiary care center. Preprocedural laboratory results were obtained from medical charts, including complete blood counts with differentials. Three novel systemic inflammatory markers were computed using existing mathematical formulas: systemic immune-inflammation index (SII = neutrophil count*platelet/lymphocyte); systemic inflammation response index (SIRI = neutrophil*monocyte/lymphocyte); and systemic immune inflammatory response index (SIIRI = neutrophil*monocyte*platelet/lymphocyte). The primary study outcome was severe CAD defined as the presence of ≥70% stenosis in one of three main coronary arteries requiring percutaneous coronary intervention). The outcome was adjudicated by an independent reviewers blinded to computations of biomarkers. Result: The sample included 264 patients (age 59.3±10.8, 47% Females). Overall, 84 patients (32%) met the primary study outcomes. In univariate analysis, those with severe CAD had significantly higher SIRI (2.9±0.7 vs. 2.6±0.6, p = 0.001) and SIIRI (8.4±0.8 vs. 8.1±0.7, p = 0.015) compared to their counterparts. In multivariate analysis adjusted for age and sex, only SIRI was an independent predictor of severe CAD. Using SIRI &gt; 20.8 (upper quartile) was associated with nearly three-fold excess risk of severe CAD (OR = 2.72, 95% CI 1.45-5.09). Conclusion: Elevated SIRI, a marker of ongoing systemic inflammatory response, could be indicative of severe CAD. As an inexpensive biomarker based exclusively on complete blood count, SIRI can be used to prioritize patients referred for diagnostic angiography and potentially expedite treatments in those at higher risk for coronary events.

Abstract 4119869: Automatic assignment of CAD-RADS categories in coronary CTA reports using large language model

Background: The effectiveness of different large language models (LLM) in extracting important information from CT angiography (CTA) radiology reports is unknown. Purpose: The Coronary Artery Disease-Reporting and Data System (CAD-RADS) is a standardized reporting system for CTA that categorizes the severity of coronary artery disease to aid in clinical decision-making. To evaluate the agreement between human readers and LLMs in assigning CAD-RADS categories based on CTA reports. Materials and Methods: This retrospective study analyzed reports from patients who underwent coronary CTA for screening or diagnosis at Johns Hopkins Hospital. Reports with CAD-RADS 0–5 findings were collected from Jan. 2020 to Oct. 2023. Initially, 6,212 CTA reports were retrieved. After excluding non-organized reports and retaining only those with CAD-RADS scores, 590 reports remained. Board-certified radiologists and three large language models (GPT-3.5, GPT-4, and Llama3) assigned CAD-RADS categories based on the original radiologists' findings. Two radiologists reviewed the CAD scores, with only one discrepancy in the 590 reports, indicating high inter-agreement. Agreement between human readers and LLMs for CAD-RADS categories was assessed using the Gwet agreement coefficient (AC1 value). Frequencies of changes in CAD-RADS category assignments that could potentially affect clinical management (CAD-RADS 0-2 vs. 3-5) were calculated and compared. Typically, CAD-RADS 0-2 indicates mild disease leading to conservative management, while CAD-RADS 3-5 denotes further testing or disease requiring aggressive intervention to prevent adverse cardiovascular events. Results: Among 590 reports, agreement between original and reviewing radiologists was almost perfect (AC1 = 0.985). Good agreement was also found between original radiologists and Llama3, GPT-3.5, and GPT-4 (AC1 = 0.861, 0.907, 0.941, respectively). Differences in CAD-RADS category upgrades/downgrades potentially affecting clinical management were observed: 0 of 590 (0%) for human readers, 56 of 590 (9.4%) for Llama3, 33 of 590 (5.5%) for GPT-3.5, and 23 of 590 (3.9%) for GPT-4 upgrading CAD-RADs; 8 of 590 (1.4%) for human readers, 19 of 590 (3.2%) for Llama3, 22 of 590 (3.7%) for GPT-3.5, and 12 of 590 (2.0%) for GPT-4 downgrading RAD-CADs. Conclusion: LLMs showed good agreement with human readers in assigning CAD-RADS categories on CTA reports. However, they were more likely to upgrade CAD-RADS category when compared to radiologists.

Abstract 4143258: Sex Differences in Health Status Outcomes: Analysis of the ISCHEMIA Randomized Clinical Trial

Background: Despite a lesser extent and severity of coronary artery disease (CAD), women had a higher burden of angina than men in the ISCHEMIA trial, suggesting that other factors may explain symptom severity in women. We aim to describe demographic and clinical characteristics, as well as differences in care patterns, associated with health status differences in women, as compared with men, in the conservative and invasive treatment groups of the ISCHEMIA trial. Methods: The ISCHEMIA trial randomized participants with moderate or severe ischemia to a routine invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with catheterization reserved for GDMT failure. Health status was a key secondary outcome. Using linear regression models we compared raw and adjusted Seattle Angina Questionnaire (SAQ) scores in women and men at baseline and at 1 year, stratified by randomized treatment strategy. Within the invasive strategy, sex differences were adjusted for completeness of revascularization among those with ≥1 coronary stenosis ≥70%. Results: Of 4,617 ISCHEMIA participants with valid SAQ data, women had lower (worse) baseline SAQ summary scores (SS) throughout follow up (Figure) after adjustment for demographics and clinical characteristics, including severity of CAD (difference 5.4 points, 95% CI 4.0-6.7). Women had lower SAQ SS after adjustment for post-randomization treatment (i.e., medical therapy, achievement of risk factor goals and, in the invasive strategy, complete revascularization), 2.4 points lower (95% CI 0.7-4.1) in the conservative group (Figure), and 1.9 points lower than in men (95% CI 0.1-3.7) in the invasive group. Findings were similar for all SAQ subscales. Conclusions: Women with chronic coronary disease in ISCHEMIA had worse health status than men at baseline and 1 year later, which was not explained by demographic or clinical characteristics, intensity of medical therapy, or completeness of revascularization.

Abstract 4138602: Effect of Left Ventricular Ejection Fraction On Computed Tomography-Derived Fractional Flow Reserve Diagnostic Accuracy For Significant Coronary Artery Disease

Background: Coronary Computed Tomography Angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR) accurately assess the severity of coronary artery disease. However, the diagnostic accuracy of CT-FFR in patients with low left ventricular ejection fraction (LVEF) is unknown. Goal: Describe the per-vessel diagnostic performance of CT-FFR to detect significant coronary disease in patients with normal and reduced LVEF by echocardiogram. Methods: This was a retrospective study of 441 patients who underwent CCTA and CT-FFR at the UMass Memorial Health System between 2020 and 2023. Those with echocardiogram and invasive coronary angiography were analyzed and divided in two groups based on two-dimensional LVEF: those with LVEF &lt; 55%, and with LVEF ≥ 55%. We excluded those with prior coronary stents, incomplete CCTA, CT-FFR data due to artifacts, or poor-quality echocardiographic images. CT-FFR ≤ 0.8 was considered abnormal. Significant coronary disease by invasive angiography (reference standard) was defined as lumen stenosis ≥ 70% (left main ≥ 50%), or abnormal physiologic characteristics by FFR, resting full-cycle ratio, or instantaneous wave-free ratio. Results: 222 coronary vessels (102 patients) were analyzed. Of 102 vessels (44%) with significant coronary artery disease, 55 (53.9%) were treated with percutaneous coronary intervention, and 25 (24.5%) with coronary artery bypass grafting. Overall, CT-FFR sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 86.7% (95%CI 78.3-92.7), 75.0% (95%CI 66.4-82.3), 73.2% (95%CI 66.6-78.9), 87.7% (95%CI 81.0-92.3), and 80.1% (95%CI 74.3-85.2), respectively. 37 vessels corresponded to patients with LVEF &lt; 55%, and 185 to those with LVEF ≥ 55%. Diagnostic accuracy in both groups is seen in table 1. Conclusions: Low-normal and reduced LVEF adversely affects the diagnostic performance of CT-FFR, by reducing sensitivity, and slightly increasing specificity.

Abstract 4135746: Assessing Coronary Artery Disease Severity: Leveraging Inflammatory Markers As a Prognostic Indicators

Introduction: Cardiovascular disease continues to be the leading cause of death and a significant cause of morbidity in the United States. In recent years, there has been increased interest in the role of inflammation in predicting and modifying the risk of coronary artery disease. Of the multitude of inflammatory markers studied subsequently, two of the most easily and widely obtained is the neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR), which can be calculated from a complete blood count with differential. Multiple retrospective studies have demonstrated that the NLR and MLR have been used to diagnose ACS, predict mortality at a year after ACS, and risk stratify patients prior to percutaneous coronary intervention. Research Question: Are the NLR/MLR useful tools in predicting the severity of coronary artery disease (CAD) in patients admitted to a tertiary medical center in Southern Nevada for ACS between 2021 and 2023? Methods: A sample of n=344 patients was used to examine the potential significance of NLR/MLR to diagnose ACS and for predicting CAD severity. Traditional diagnostic test evaluation was used for determining CAD with a ratio of NLR=3.5 + MLR=0.35 (data medians) as the cut-off value. Patient risk group status (1:low risk to 4:high risk) was used as a binary outcome to test NLR/MLR between low and high risk groups using a nonparametric MWW test of medians. Additionally, ROC analysis was used to estimate an optimized cut-off for NLR/MLR as determined by AUC. Results: Results demonstrate for predicting ACS using the median NLR, sensitivity=88.07; specificity=14.88; PPV=52.01; NPV=54.35), LR(+)=1.03 and LR(-)= 0.80, using the median MLR results showed sensitivity=87.28; specificity=14.11; PPV=50.84; NPV=52.17, LR(+)=1.01 and LR(-)= 0.90. Subpopulation analysis demonstrated a statistically significant difference in NLR between “high risk ACS” vs “Low Risk ACS” (p&lt;0.001). Examination of the ROC curve for predicting the high-risk group suggested an optimized cutoff of NLR=3.7; however, AUC was only 0.617, and sensitivity and specificity were not improved compared to using the median NLR. Conclusion: Our findings suggest that an NLR greater than 3.7 may indicate multivessel involvement or proximal/left main disease in CAD patients. However, due to its low specificity and AUC, NLR alone cannot reliably distinguish between single-vessel and multivessel CAD.

The Co-Existence of Hypovitaminosis D and Diabetes Mellitus Triples the Incidence of Severe Coronary Artery Disease in Women

Background and Aims: Hypovitaminosis D is involved in the development and progression of atherosclerosis, and it is more prevalent in women. The differential impact of hypovitaminosis D on the severity of coronary artery disease (CAD) between genders remains poorly understood. This study aims to address this literature gap. Methods: A total of 1484 consecutive patients with acute myocardial infarction (AMI) were enrolled in the study. Hypovitaminosis D was defined as vitamin D ≤ 20 ng/mL. CAD was defined as the presence of at least one coronary vessel stenosis &gt; 50%, while severe CAD was defined as left main disease and/or three-vessel disease &gt; 50%. Results: The mean age of the cohort was 66.3 (11.5) years, with a predominance of the male gender (71.8%). Vitamin D values were significantly lower in women than in men (15.7 [8.4–25.4] ng/mL vs. 17.9 [11–24.3] ng/mL, p = 0.01). A higher prevalence of severe CAD was observed in female patients with hypovitaminosis D compared to those without (33% vs. 19%, p &lt; 0.01). This finding was not observed in men. Among women, hypovitaminosis D significantly increased the risk of severe CAD (OR: 1.85, p = 0.01), together with diabetes mellitus (DM) and older age, adjusted for GFR &lt; 60 mL/min/1.73 m2, cholesterol and body mass index. Furthermore, women with both hypovitaminosis D and DM had more than three times the risk of severe CAD compared with women who lacked both (OR: 3.56, p = 0.02). Conclusions: In women, hypovitaminosis D increases the risk of severe CAD, and the co-existence of hypovitaminosis D and DM triples the incidence of severe CAD.

Abstract 4137058: Clinical Characteristics and Outcomes of South Asians Presenting with Acute Coronary Syndrome

Background: Patients of South Asian descent have a higher incidence of atherosclerotic cardiovascular disease and are affected by clinically significant coronary artery disease at an earlier age when compared to the general population. As a result, they have been shown to have a higher rate of cardiovascular events. This at-risk population has not been well studied as it pertains to acute coronary syndrome. Methods: Out of 1610 patients who presented to one of two tertiary care centers between 2021-2022 with a diagnosis of acute coronary syndrome and underwent coronary angiography, 240 patients were identified as being South Asian and were included in the study. 480 non-South Asian patients were randomly selected as controls. A retrospective analysis was conducted to study the demographics, risk factors, clinical presentation, diagnostic features, and outcomes of the two groups. Results: South Asian patients who were diagnosed with acute coronary syndrome and underwent coronary angiography were significantly younger than non-South Asian patients (61 vs 65 years, p &lt; 0.001). Though they were less likely to be smokers, they were significantly more likely to have other known risk factors including hypertension, dyslipidemia, and a history of prior myocardial infarction (p &lt; 0.001). South Asians had mean lower HDL (p = 0.02), higher triglycerides (0.006), and higher Hgb A1C (p &lt; 0.001). Surprisingly, rates of multivessel disease (defined as stenosis of 50% or greater in two or three vessels) were similar between the two groups. South Asians were more likely to be referred for CABG after initial coronary angiography most likely due to diffuse disease (p = 0.014). Clinical outcomes including pre-discharge LVEF, and 2-year mortality were similar between the groups. Conclusions: South Asians are a notoriously high-risk group when it comes to early-onset and more severe coronary artery disease. The pathophysiology behind this disproportionate manifestation of cardiovascular disease is not entirely understood, but several efforts to delineate this are ongoing. Our data demonstrate that this is at least in part, due to a higher prevalence of conventional modifiable and nonmodifiable risk factors in South Asian patients.

Abstract 4137782: Fibrinogen-to-Albumin Ratio Does Not Correlate with Comprehensively Assessed Coronary Artery Disease Severity or High-Risk Plaque Features on Coronary Computed Tomographic Angiography

Background: Fibrinogen-to-albumin ratio (FAR) has been proposed as a readily available inflammatory biomarker associated with coronary artery disease (CAD). However, its association with CAD severity and prognosis has predominantly been assessed in patients with acute coronary syndromes (ACS). The Leiden score is a validated comprehensive measure of CAD incorporating stenosis proximity, severity, and plaque type that independently predicts cardiovascular events. Whether FAR is associated with Leiden score or high-risk plaque features on coronary computed tomographic angiography (CCTA) in stable outpatients is unknown. Methods: Adult outpatients undergoing clinically indicated CCTA were enrolled (5/2021-9/2023) in a prospective study assessing the relationship of plaque to immune markers and provided same-day pre-scan peripheral venous blood samples. CCTAs were post-processed and analyzed by the consensus of two expert readers blinded to clinical data using a 17-segment model to determine coronary artery calcium (CAC), Leiden score, and high-risk plaque features. Patients were grouped by FAR (quartiles), Leiden score (&lt;5, 5-20, &gt;20), and CAC score (0, &gt;0-100, &gt;100-300, &gt;300-1000, &gt;1000). Numerical variables were compared via Wilcoxon and Kruskal-Willis tests. Spearman correlation was calculated between FAR and Leiden score. Results: Of 284 patients, 53.8% were male, 86.7% were white, and 58.8% were on a statin (Table 1). Median FAR was 70.3 mg/g, 64.0% had a non-zero CAC score, and 25.0% had at least one segment with one high-risk plaque feature. Across quartiles of FAR, there was no difference in Leiden score (5.8 (IQR: 0.0-18.5), 12.4 (3.1-20.7), 8.0 (0.0-19.9), 6.8 (0.0-21.1), p=0.50) or probability of having at least one segment with at least one (29.6%, 23.9%, 23.9%, 22.5%, p=0.69) or two (18.3%, 14.1%, 12.7%, 15.5%, p=0.66) high-risk plaque features. There was no correlation between FAR and Leiden score (R=0.03, p=0.66). There was no difference in FAR when stratified by Leiden score (Table 1, p=0.53), CAC score (Table 2, p=0.50), or number of segments with at least one high-risk plaque feature (Table 3, p=0.18). Conclusion: In a prospective cohort of adult outpatients across a wide spectrum of CAD burden with high rates of baseline statin use, FAR was not associated with CAD or presence of high-risk plaque features on CCTA. Further evaluation of its role as an inflammatory biomarker in larger populations, particularly patients without ACS, is required.

Abstract 4138473: Detailed Lipoprotein Profiling in Assessing Coronary Calcium Score Progression and Atherosclerotic Risk

Background: Coronary calcium scoring (CCS) evaluates atherosclerotic burden and cardiovascular risk, correlating with coronary artery disease (CAD) severity. Advances in Nuclear Magnetic Resonance ( 1 H-NMR) spectroscopy for lipoprotein fraction analysis highlight precise atherogenic lipid parameter estimation. Enhanced lipid testing, including sub-fractionation assays, improves risk assessment and identifies new biochemical markers for CAD burden. Hypothesis: Specific lipid fractions and subfractions are significantly associated with CCS progression, serving as biochemical markers of CAD progression. Aim: To evaluate the association between lipid fractions and subfractions with CCS progression, aiming to improve CAD risk stratification. Methods: This study used data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CCS progression was any positive change in CCS values over 5 years. High-field 1 H-NMR spectroscopy assessed lipoprotein fractions and subfractions, including plasma concentration, particle size, cholesterol, and triglyceride content. Descriptive and inferential statistics compared baseline characteristics. Multivariable binary logistic regression models, both unadjusted and propensity score-adjusted, assessed associations between plasma levels of lipoprotein fractions and CCS progression. Statistical significance was set at p &lt;0.05. Results/Data: In this study of 2,986 participants, 1,008 (33.8%) experienced CCS progression over 5 years. Significant associations were found between plasma lipoprotein fractions and CCS progression. Large, medium, and very small TRLP (89-37 and 29-24 nm) were linked to increased CCS risk, while small TRLP (36-30 nm) had an inverse association. Small cLDLP (20.4-19 nm) were directly associated with CCS progression, while medium and large cLDLP (23-20.5 nm) were inversely associated. Small cHDLP (7.4-8.0 nm) increased CCS risk, whereas medium to large cHDLP (8.1-13.0 nm) had an inverse association. Specific HDL subspecies (H7P to H3P, 12.0-8.7 nm) were inversely associated with CCS progression, while H2P and H1P (7.8-7.4 nm) increased CCS risk. TRLZ (30-100 nm) levels were positively associated with CCS progression, whereas LDLZ (19-22.5 nm) and HDLZ (7.1-13 nm) were inversely associated. Conclusion(s): Plasma levels of specific lipoprotein fractions and subfractions are associated with CCS progression, providing insights into the complexity of lipoprotein characteristics in CAD.

The Role of Glucose–Lymphocyte Ratio in Evaluating the Severity of Coronary Artery Disease

Background: Recently, a new inflammatory and prognostic marker called glucose/lymphocyte ratio (GLR) has been used in patients with coronary artery disease. In this study, we analyzed the correlation between GLR and coronary artery disease (CAD) severity in patients with chronic coronary syndrome (CCS). Methods: The study included 341 patients with CCS who underwent coronary angiography and documented coronary stenosis of 50% or more in at least one major coronary artery and 437 individuals with coronary atherosclerosis between 1% and 50% or no coronary atherosclerosis (control group). Blood samples for GLR and other laboratory parameters were obtained from all patients on admission. GLR was obtained by dividing the glucose level by the lymphocyte count. Results: There were more patients with diabetes mellitus (DM) in the critical CAD group, and glucose levels (p &lt; 0.001), neutrophil counts (p &lt; 0.001), C-reactive protein (CRP) levels (p &lt; 0.001), neutrophil/lymphocyte ratio (NLR) (p &lt; 0.001), platelet/lymphocyte ratio (PLR) (p &lt; 0.001), and GLR (p &lt; 0.001) were higher. In contrast, lymphocyte counts were lower (p &lt; 0.034). Multivariate logistic regression analysis showed that DM and high CRP were independent predictors of critical CAD (p = 0.004 and p = 0.048, respectively). However, high GLR was found to be an independent predictor of critical CAD (p &lt; 0.001). Conclusions: GLR, a simple and easily measured marker, has shown strong predictive value for CAD severity in CCS patients.

Clinical and angiographic characteristics of patients with familial hypercholesterolemia presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Familial hypercholesterolemia (FH) is a world public health problem that enhances the risk of premature coronary artery disease (CAD) with a high incidence of acute coronary syndrome. This study aimed to evaluate the clinical and angiographic characteristics of the patients with and without FH who had ST-elevation myocardial infarction (STEMI). It included 690 patients who presented with the first attack of STEMI and underwent primary percutaneous coronary interventions (PPCI). The patients were analyzed to diagnose FH according to the Dutch Lipid Clinic Network (DLCN) criteria. All angiograms were analyzed for the number of diseased vessels, Syntax score, thrombus burden grade, and final Thrombolysis in Myocardial Infarction (TIMI) flow grade. The majority of patients were male (72.6%) with a mean age of 54 ± 12 years. Based on DLCN criteria, they were classified into unlikely/possible FH (86.1%) and probable/definite FH (13.9%) groups. Probable/definite FH patients were significantly younger, and higher incidence of males < 55 years compared with unlikely/possible FH patients (p < 0.001 for each). Moreover, probable/definite FH patients had a higher frequency of three-vessel disease (p = 0.007) and Syntax score (p < 0.001) with a moderate positive correlation with the DLCN score (r = 0.592, p < 0.001). Furthermore, probable/definite FH patients showed a higher thrombus burden and final TIMI slow/no-reflow when compared to the unlikely/possible FH patients (p = 0.006 and p = 0.027, respectively). Patients with probable/definite FH and LDL-C level were independent predictors of high thrombus burden besides males < 55 years, and the number of diseased vessels. In conclusion, STEMI patients with FH were younger males and associated with severe CAD with frequent multivessel CAD, high anatomical complexity of CAD, and frequent high thrombus burden. Furthermore, FH was one of the predictors of high thrombus burden.

Systemic immune inflammatory response index (SIIRI) in acute myocardial infarction.

Different treatment approaches exist for non-ST elevation acute coronary syndrome (ACS) patients. This study assessed the systemic immune inflammatory response index (SIIRI) for its prognostic value and incremental clinical utility in determining optimal timing for percutaneous coronary intervention (PCI) in non-ST elevation myocardial infarction (NSTEMI) patients, particularly when troponin levels are initially negative. This study included 1270 ACS patients: 437 STEMI, 422 NSTEMI, and 411 unstable angina. Patients were stratified by SIIRI levels measured at admission, and coronary artery disease severity was evaluated using the SYNTAX score. The primary endpoint was major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, stroke, and revascularization. Secondary endpoints encompassed individual MACE components and heart failure hospitalisations. The mean age was 54.93 years (83% male). SIIRI levels were significantly higher in STEMI patients (6.83 ± 6.43 × 105) compared to NSTEMI (4.5 ± 5.39 × 105) and unstable angina (3.48 ± 2.83 × 105) (P < 0.001). Area under the curve for SIIRI distinguished NSTEMI and unstable angina from STEMI (0.81 and 0.80), with optimal cut-off points of 4.80 × 105 and 4.25 × 105. In NSTEMI, 24.6% presented within 2 h of symptom onset, were troponin-negative, yet had elevated SIIRI. Post-PCI, SIIRI > 4.93 × 105 correlated with increased MACE at 1 year (17.2% vs 5%). NSTEMI and unstable angina patients with SIIRI values >4.80 × 105 and 4.25 × 105 respectively, may require urgent intervention (<2 h). SIIRI can be of significant utility in patients of NSTEMI who present earlier with negative troponins. SIIRI can also aid in identifying high-risk individuals post-PCI, providing a valuable tool for early and accurate assessment.

Relationship between Myocardial Performance Index (Tei Index) and angiographic severity of coronary artery disease in patients with Acute ST Elevation Myocardial Infarction

Background: Tei index is a Doppler derived measure of combined systolic and diastolic myocardial function and a better predictor of global LV function and outcome in patients with acute STEMI. The objective of this study was to determine the relationship between the myocardial performance index of LV (Tei index) and angiographic severity of coronary artery disease as assessed by SYNTAX score in patients with acute STEMI. Methods: This was a prospective, observational single centered study conducted from March 2022 to November 2022 at Manmohan Cardiothoracic Vascular and Transplant Centre, Institute of Medicine. (MCVTC, IOM). 160 patients with acute STEMI were enrolled. LV Tei index was calculated with the help of 2D and Tissue Doppler imaging, and the lesion severity was categorized with the help of SYNTAX score after the patients underwent coronary angiography. Results: The mean age was 61.23±12.33 years with a male preponderance. 107 (67%) were male with male to female ratio of 2:1. Tei index was significantly higher among the hypertensive (0.74±0.17) and diabetic (0.78±0.18) patients. 64 (40%), 51(31.9%) and 45(28.1%) had Single vessel disease (SVD), Double vessel disease (DVD) and Triple vessel disease (TVD) respectively with the Mean Tei index values 0.57 ± 0.10, 0.76 ± 0.11, and 0.88±0.11 (p&lt;0.05). The Tei index increased when patients were divided into low, mid, and high SYNTAX score groups as 0.58±0.11, 0.61±0.73, 0.88±0.13 respectively, p-value &lt; 0.05). Moreover, the study showed a positive correlation between Tei index and SYNTAX score with increasing severity of coronary artery stenosis. (r=0.654, p-value&lt;0.001). Proximal LAD, LCx and RCA lesions had greater Tei index than the distal lesions. Conclusion: More proximally located LAD, LCx, RCA lesions had higher value of Tei index, as assessed with the SYNTAX score.

Gender-Dependent Association Between Thyroid Hormones and Severity of Coronary Artery Disease by SYNTAX Score

Thyroid function has been shown to be associated with cardiovascular diseases. Moreover, sex can influence on the association between thyroid function and other diseases. We aimed to evaluate the relationship between thyroid hormones and the severity of coronary artery disease (CAD) and outcomes. In a prospective study, patients with chest pain undergoing diagnostic coronary angiography were evaluated. Patients were categorized based on the number of involved coronary arteries. Moreover, the severity of CAD was quantitatively calculated using the Syntax score (SS). All patients were also followed up for 3-month duration. The level of TSH in 150 patients was significantly higher in females than males (3.1 [1.7, 5] versus 1.8 [1, 3.3] mU/L; P=0.002). There was significant correlation between THS and the SS among females (ρ=0.477, P&lt;0.001), but not males. Among both sexes, thyroid hormones were comparable between those with or without events during follow-up. The main predictors of high SS values included age (odds ratio [OR] 1.060, 95% confidence interval [CI] 1.018-1.104; P=0.005) and female (OR 2.941, 95% CI 1.198-7.218). The main predictors of multivessel disease were age (OR 1.077, 95% CI 1.026-1.132), female (OR 5.853, 95% CI 1.880-18.222), thyroxin (OR 0.733, 95% CI 0.547-0.981), and thyrotropin (OR 1.333, 95% CI 1.079-1.647). Thyroid hormones are associated with the presence and the severity of CAD, but it might be sex-related. However, thyroid hormone levels could not predict short-term outcomes of patients.

The Impact of Neutrophil-to-High-Density Lipoprotein Ratio and Serum 25-Hydroxyvitamin D on Ischemic Heart Disease.

Background: This study describes the complex association between the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), 25-hydroxyvitamin D (25(OH)D) levels, and cardiovascular disease (CVD), such as stable ischemic heart disease (IHD), ST elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). Methods: The serum 25(OH)D concentration and NHR values were analyzed in groups of patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS). The severity of coronary artery atherosclerosis was determined using the Coronary Artery Surgery Study (CASS) scale. Results: Significant differences in 25(OH)D and NHR concentrations were observed between CCS and (ACS)/STEMI patients (p < 0.01). Higher 25(OH)D concentrations were associated with the diagnosis of CCS, and higher NHR values with the diagnosis of ACS/STEMI. The NHR threshold for ACS was set at 0.10 (p < 0.001). Patients without significant coronary artery stenosis showed significantly higher 25(OH)D levels and lower NHR values (p < 0.01). Conclusions: The significant correlation between 25(OH)D, HDL, and the NHR suggests that vitamin D, through its influence on inflammatory processes and lipid metabolism, may play a role in the pathogenesis of chronic and acute coronary syndromes. The suggested bidirectional relationship between the NHR and 25(OH)D and the role of the NHR as a predictor of vitamin D levels require further well-designed studies.

Invasive Treatment of Left Main Coronary Artery Disease: From Anatomical Features to Mechanistic Differences.

There is debate on the best treatment for significant stenoses of the left main (LM) coronary artery. The available evidence is based on four randomized trials, which were either performed specifically to assess patients with LM disease (EXCEL, NOBLE, PRECOMBAT) or had a significant fraction of patients with this disease pattern (SYNTAX). A meta-analysis revealed no difference in periprocedural and 5-year mortality but demonstrated a significant reduction of spontaneous myocardial infarction (MI) with CABG. Furthermore, the recently published SWEDEHEART registry data have shown survival advantage and fewer MACCE with CABG for LM disease after adjustment. In general, patients with more severe coronary artery disease (CAD) appear to have a survival advantage with CABG both over PCI and medical therapy (independent of the presence or absence of LM stenosis), which is always associated with a reduction of spontaneous MI in the CABG arm. Since the nomenclature of LM disease does not automatically reflect the complexity of CAD, we review the nature of LM disease in this article. We mechanistically assess the treatment effects of PCI and CABG for patients with LM disease, which is rarely isolated, often distal, and mostly associated with varying degrees of single and multi-vessel disease. We conclude that in patients with isolated LM shaft lesions and associated diseases of low complexity, the risk of spontaneous MI is lower, and PCI may achieve similar long-term outcomes compared to CABG. Thus, heart teams are essential for selecting the best treatment option and should focus on assessing infarction risk in chronic CAD.