Extent Of Coronary Artery Disease Research Articles

Predicting the Severity of Coronary Artery Disease: Can the Leukocyte Glucose Index be Used?

To investigate the usability of leuko-glycemic index (LGI) at chronic coronary syndromes (CCS) class 1 for determining the extent and severity of coronary artery disease (CAD). An observational study. Department of Cardiology, University of Pamukkale University Hospital, Turkey, between September 2021 and January 2022. One hundred and thirty-four patients, whose myocardial perfusion scintigraphy (MPS) was requested due to CCS class 1, and on whom a coronary angiogram (CAG) was performed due to evidence of ischemia, were analysed. Blood samples were taken from the patients during their hospitalisation before CAG. LGI was calculated as mg/dl.mm3 by multiplying both values and dividing by a thousand. The patients were analysed in two groups according to the critical stenosis and non-critical stenosis detected in the coronary arteries. The LGI was recorded as 480 mg/dl.mm3 (407-603) vs. 572 mg/dl.mm3 (433-877), p=0.006, and the Gensini score (6 (3-10) vs 40 (23-60), p<0.001) was significantly higher in the critical CAD group. A significant relationship has detected the increase in LGI and the extensity and severity of CAD (Unadjusted; OR (95% CI); 1.003 (1.001 - 1.004) p=0.002, adjusted; OR (95% CI); 1.002 (1.001 - 1.004) p=0.004). A high LGI was a predictor of CAD severity among CCS class 1 patients and was found to correlate with the Gensini score. The use of this simple and inexpensive index, together with other non-invasive tests before CAG, may provide some knowledge about the severity of CAD. Coronary artery disease, Leukocyte glucose index, Myocardial perfusion scintigraphy.

Prevalence of carotid artery stenosis with coronary artery disease in Japanese patients: A single-center study

There are a few reports of the prevalence of extracranial internal carotid artery stenosis (ICAS) in Asian patients with coronary artery disease (CAD). This was a prospective registry study of 157 consecutive Japanese patients undergoing coronary angiography that aimed to determine the prevalence of extracranial ICAS in recent Japanese patients. The associations between ICAS and the extent or the maximal stenosis of CAD were also investigated. The 131 eligible patients with suspected CAD were prospectively analyzed. Their mean age was 69.0 ± 8.2 years, and 75.6% were males. A total of 111 patients (84.7%) were angiographically diagnosed with CAD. ICAS (area stenosis ≥50% on ultrasonography) was present in 9 patients, and the prevalence in patients with CAD was 8.1%. All patients in the ICAS group had CAD, and this group was significantly more likely to have a history of stroke (p = 0.03). Although no significant relationships were found between the severity of ICAS and the maximal stenosis of CAD, the severity of ICAS increased gradually with the extent of CAD. The prevalence of ICAS in patients with CAD treated with current medical treatment was relatively low (8.1%) compared to previous reports, and the severity of ICAS was significantly associated with the extent of CAD.

Abstract 12932: Should We Screen For Radiotherapy-Induced Heart Disease With Exercise Stress Echocardiography? Emphasis on Major Adverse Cardiac Events

Introduction: Exercise Stress Echocardiography (ESE) is recommended as a screening tool for the evaluation of Coronary Artery Disease (CAD) in patients with suspected Radiation-Induced Heart Disease (RIHD). Up to now, studies have only evaluated its association with the extent of CAD. Hypothesis Cancer survivors treated with chest Radiotherapy (RT) that undergo an ESE and have a +ESE develop more MACE than those who have -ESE. Methods: A retrospective, descriptive, cohort study was conducted. Patients who had chest RT and underwent ESE with Treadmill Bruce Stress Protocol, from 2000 to 2012, at Mayo Clinic Rochester and Mayo Clinic Health System were included. A univariate analysis was performed to characterize the population. An analysis including Kruskal Wallis and Pearson Chi-Squared tests was completed to identify variables associated with + SE (Table 1). Multivariable Cox Model for MACE was conducted and is shown in Table 2. A time-to-event curve using Kaplan-Meier estimates is shown in Figure 1. Results: We identified 113 patients, with a mean age of 67 years and a median follow-up of 15.1 years. Of those, 99% were female, 98% were breast cancer survivors, 59% had HTN, 14% DM, 11% AFib, 2% COPD, and 12% had a history of MI. All the patients received &gt;3000cGy of Photon RT, and 57% were treated with systemic cancer therapies. A +ESE was seen in 20.3% of the patients with no significant difference in METS achieved compared with patients who had a -ESE. COPD, RT dose, and systemic therapies, specifically doxorubicin, were associated with a +ESE. The cumulative incidence of MACE was higher in the group of +ESE (p=0.029). After adjustment for HTN, DM, smoking history, hyperlipidemia, and prior MI, the HR for MACE associated with a +ESE was 1.97 (1.09-3.59). Conclusion: MACE was more frequent in patients with a +ESE who received chest RT and doxorubicin versus -ESE. These results support the usefulness of ESE in cancer survivors after RT as a cardiovascular screening tool.

Abstract 14685: Predictors of Prognosis in Cardiogenic Shock Complicating Initially Acute Myocardial Infarction

Introduction: Despite modern treatment methods, cardiogenic shock mortality complicates acute myocardial infarction (CS-AMI) remains high. Hypothesis: The study of factors affecting CS-AMI outcomes is essential. Methods: Data from the all-comers' National Registry of Coronary Interventions from 2016 to 2020 were evaluated. Of 50,745 patients with AMI (STEMI/NSTEMI) 2,822 patients (5.6%) had initially CS (72.6% men, mean age 67.6 (12) yrs). The study analyzed the predictive value of such traditional cardiovascular risk factors related to the MI (sex, age, previous PCI or CABG, renal failure, localization of MI, time delay to reperfusion), comorbidities (expressed by the Deyo modification of Charlson comorbidity index), the severity of the condition on admission (mechanical ventilation, resuscitation), the extent of coronary artery disease and procedural success (the number of affected vessels, TIMI flow before and after PCI, LM disease), and such untraditional factors as season, weekday and day time. Multivariable analysis was used to identify independent predictors of prognosis in patients with CS-AMI. Results: The 30days mortality was 50.7%. As independent predictors of prognosis were identified age (older 80yrs, OR 4.97;95% CI 3.73-6.61), resuscitation (1.34; 1.07-1.67), mechanical ventilation (1.39;1.10-1.75), 3-vessel disease 1.39;1.12-1.72), left main disease (1.26; 1.01-1.57), and post-procedural TIMI flow lower 3 (1.14; 0.79-1.66). The independent predictive value of the comorbidity index was not confirmed (1.062;0.796-1.417). The numerically higher mortality rate was shown during a) autumn time (54.2%) and winter (51.8%), b) weekend (51.45%) (vs. working week (50.03%)), c) working hours (49.3%) (vs. the after-working hours (47.6%)). The multivariate analysis did not confirm the independent predictive value of these variables. Conclusions: Mortality of CS-AMI patients is significantly and independently influenced by factors confounding their circulatory instability, such as resuscitation and respiratory failure, the extent of coronary disease, and the success of reperfusion therapy. The independent impact of comorbidity and non-traditional factors on the prognosis of these patients has not been confirmed.

Biomarker-Based Prediction of Recurrent Ischemic Events in Patients With Acute Coronary Syndromes

BackgroundIn patients with acute coronary syndrome (ACS), there is residual and variable risk of recurrent ischemic events. ObjectivesThis study aimed to develop biomarker-based prediction models for 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with ACS undergoing percutaneous coronary intervention. MethodsWe included 10,713 patients from the PLATO (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome) trial in the development cohort and externally validated in 3,508 patients from the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trial. Variables contributing to risk of CV death/MI were assessed using Cox regression models, and a score was derived using subsets of variables approximating the full model. ResultsThere were 632 and 190 episodes of CV death/MI in the development and validation cohorts. The most important predictors of CV death/MI were the biomarkers, growth differentiation factor 15, and N-terminal pro–B-type natriuretic peptide, which had greater prognostic value than all candidate variables. The final model included 8 items: age (A), biomarkers (B) (growth differentiation factor 15 and N-terminal pro–B-type natriuretic peptide), and clinical variables (C) (extent of coronary artery disease, previous vascular disease, Killip class, ACS type, P2Y12 inhibitor). The model, named ABC-ACS ischemia, was well calibrated and showed good discriminatory ability for 1-year risk of CV death/MI with C-indices of 0.71 and 0.72 in the development and validation cohorts, respectively. For CV death, the score performed better, with C-indices of 0.80 and 0.84 in the development and validation cohorts, respectively. ConclusionsAn 8-item score for the prediction of CV death/MI was developed and validated for patients with ACS undergoing percutaneous coronary intervention. The ABC-ACS ischemia score showed good calibration and discrimination and might be useful for risk prediction and decision support in patients with ACS. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872; Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRACER]; NCT00527943)

Changes in the treatment strategy following intracoronary pressure wire in a contemporaneous real-life cohort of patients with intermediate coronary stenosis. Results from a nationwide registry

Abstract Background Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease. Aims To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis. Methods Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed. Results 1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0%). The extent of coronary artery disease changed in 771 patients (54.5%). Figure 1 shows extent of coronary artery disease based on coronary angiographic analysis and following intracoronary pressure wire study. Figure 2A shows the extent of coronary artery disease based on coronary angiographic analysis and its reclassification following intracoronary pressure wire study. Figure 2B shows the extent of coronary artery disease following pressure wire study and its classification when only considering the coronary angiographic analysis. Figure 2 shows change in treatment strategy following intracoronary pressure wire study. There was a change in treatment strategy in 779 patients (55.1%) (18.0% if medical treatment; 68.8% if PCI; 58.9% if surgery (p&amp;lt;0.001 for PCI vs medical treatment; p=0.041 for PCI vs CABG; p&amp;lt;0.001 for medical treatment vs CABG). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6% vs 8.2%, p=0.034). Conclusions The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The registry was endorsed by the Intracoronary Diagnostic Techniques Working Group of the Interventional Cardiology Association of the Spanish Society of Cardiology. The study was supported by an unconditional grant from Philips-Volcano, Abbott Vascular, and Boston Scientific. The sponsors did not have access to the database or the final results until the preparation of this abstract. None of them participated in the preparation or review of this abstract.

Radial artery calcification in predicting coronary calcification and atherosclerosis burden

Abstract Background Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds, however studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease. Methods and results This is a single-center, retrospective cross-sectional study based on doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC-group) and 99 without (NRC-group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (&amp;gt;100 Agatson units) or intracoronary imaging (IVUS, OCT). A significant correlation was observed between radial calcification and coronary calcification variables (67.3%, vs 32.7% – p=0.001). The correlation between risk factors such as age, smoking, chronic kidney disease and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC-group (60% vs 44%, p=0.02). RC therefore predicts the extent and severity of coronary artery disease. Conclusion RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected. Funding Acknowledgement Type of funding sources: None.

C-reactive protein to albumin ratio predicts for severity of coronary artery disease and ischemia.

Myocardial perfusion scintigraphy (MPS) has prognostic importance in demonstrating myocardial ischemia, and the Syntax score (SS) in coronary angiography has prognostic importance in demonstrating the extent of coronary artery disease (CAD). C-reactive protein (CRP) and albumin are prognostic markers for both atherosclerosis and inflammation. In this study, we aimed at investigating the relationship of CRP/albumin ratio (CAR) with the severity of myocardial ischemia and SS in patients with stable CAD. We retrospectively evaluated 355 patients between January 2018 and January 2020. Patients were divided into normal, mild-moderate, and severe ischemia groups according to MPS. SS was classified as low risk (< 32) and high risk (≥ 32) groups. The association between CAR, SS, and MPS findings were analyzed. The median CAR level was higher in the high-risk group compared to the low-risk group (20.7 vs. 13.8, p < 0.05), and higher in the low-risk group compared to the normal group (13.8 vs. 7.4, p < 0.05). The increase in CAR level was associated with increased ischemia severity (p < 0.001). Increased CAR level was found to be an independent predictor of both high-risk and severe ischemia (OR = 1.04, p = 0.006; OR = 1.05, p = 0.001, respectively). The cut-off value of CAR > 10.2 was a common point in predicting both low-risk and mild-moderate ischemia (AUC: 0.736, p < 0.001; AUC: 0.741, p < 0.001, respectively). High CAR level was an independent predictor of both the severity of ischemia and the extent of CAD. Therefore, CAR can be a potential screening tool in patients with suspected CAD and in risk stratification.

CORRELATION OF CLINICAL RISK SCORES WITH ANGIOGRAPHIC EXTENT AND SEVERITY USING MODIFIED GENSINI SCORE IN PATIENTS WITH ST ELEVATED MYOCARDIAL INFARCTION

Cardiovascular diseases have emerged as a significant health burden and became a leading cause of mortality in developing countries like India.In cardiovascular diseases, acute coronary syndromes are the primary cause of morbidity and mortality, for which timely diagnosis and appropriate therapy are of foremost importance to improve clinical outcomes.Different scoring systems are now available based on initial clinical history, electrocardiographic and laboratory tests that enable early risk stratification on admission. The risk scores were created and recommended by national and international guidelines to identify patients with a higher probability of adverse events, recommending more intensive treatment and early angiography in this population.In this study, we considered evaluating clinical predictors and suitable risk scores GRACE and TIMI that correlate with the severity of angiographic extent of coronary artery disease in patients presenting with ST-elevation myocardial infarction using Modified GENSINI score.

Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry

Background & aimsPremature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. MethodsSuccessive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. Results4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol ≥200 mg/dl [women 1.52(1.03–2.25) and 1.59(0.79–3.20); men 1.73(1.38–2.17) and 1.92(1.22–3.03)], non-HDL cholesterol ≥130 mg/dl [women 1.84(1.35–2.52) and 1.32(0.72–2.42); men 1.69(1.43–1.90) and 1.67(1.17–2.34)], LDL cholesterol [men 1.10(0.95–1.25) and 1.04(0.77–1.41)], and tobacco [women 1.40(0.84–2.35) and 2.14(0.95–4.82); men 1.63(1.34–1.98) and 1.27(0.81–1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85–1.51)] and very premature [1.29(0.75–2.22)] CAD and was significantly higher in men [1.35(1.16–1.56) and 1.79(1.29–2.49)]. Location and extent of CAD were not different. ConclusionsIn India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.

Clonal hematopoiesis in men living with HIV and association with subclinical atherosclerosis.

People with HIV (PWH) are at increased risk for premature cardiovascular disease (CVD). Clonal hematopoiesis is a common age-related condition that may be associated with increased CVD risk. The goal of this study was to determine the prevalence of clonal hematopoiesis and its association with chronic inflammation and CVD in PWH. Cross-sectional study utilizing archived specimens and data from 118 men (86 PWH and 32 HIV-uninfected) from the Baltimore-Washington DC center of the Multicenter AIDS Cohort Study (MACS) who had had coronary computed tomography angiography (CTA) and measurement of 34 serologic inflammatory biomarkers. Clonal hematopoiesis was assessed on peripheral blood mononuclear cells utilizing targeted error-corrected next generation sequencing (NGS) focused on 92 genes frequently mutated in hematologic malignancies. Clinical and laboratory data were obtained from the MACS database. Clonal hematopoiesis with a variant allele frequency (VAF) greater than 1% was significantly more common in PWH [20/86 (23.3%)] than in HIV-uninfected men [2/32 (6.3%)] ( P = 0.035). PWH with clonal hematopoiesis (VAF > 1%) were more likely to have coronary artery stenosis of at least 50% than those without clonal hematopoiesis [6/20 (30%) vs. 6/64 (9%); P = 0.021]. Presence of clonal hematopoiesis was not significantly associated with serological inflammatory markers, except for significantly lower serum leptin levels; this was not significant after adjustment for abdominal or thigh subcutaneous fat area. Clonal hematopoiesis was more common in PWH and among PWH was associated with the extent of coronary artery disease. Larger studies are needed to further examine the biological and clinical consequences of clonal hematopoiesis in PWH.

Detecting Coronary Artery Disease Using Exhaled Breath Analysis

Introduction: Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide, and there is an unmet need for a simple, inexpensive, noninvasive tool aimed at CAD detection. The aim of this pilot study was to evaluate the possible use of breath analysis in detecting the presence of CAD. Materials and Methods: In a prospective study, breath from patients with no history of CAD who presented with acute chest pain to the emergency room was sampled using a designated portable electronic nose (eNose) system. First, breath samples from 60 patients were analyzed and categorized as obstructive, nonobstructive, and no-CAD according to the actual presence and extent of CAD as was demonstrated on cardiac imaging (either computerized tomography angiography or coronary angiography). Classification models were built according to the results, and their diagnostic performance was then examined in a blinded manner on a new set of 25 patients. The data were compared with the actual results of coronary arteries evaluation. Sensitivity, specificity, and accuracy were calculated for each model. Results: Obstructive CAD was correctly distinguished from nonobstructive and no-CAD with 89% sensitivity, 31% specificity, 83% negative predictive value (NPV), 42% positive predictive value (PPV), and 52% accuracy. In another model, any extent of CAD was successfully distinguished from no-CAD with 69% sensitivity, 67% specificity, 54% NPV, 79% PPV, and 68% accuracy. Conclusion: This proof-of-concept study shows that breath analysis has the potential to be used as a novel rapid, noninvasive diagnostic tool to help identify presence of CAD in patients with acute chest pain.

Lipid Fractions and Severity of Coronary Artery Lesions in Acute Myocardial Infarction: A Retrospective Single-Center Study

The relationship between different lipid fractions and the occurrence of atherosclerotic coronary artery disease(CAD) is a well-known fact. However, knowledge of the association of different lipid fractions and the severity and extension of coronary lesions has been rarely reported in clinical studies and is often contradictory. This study aimed to evaluate the association between different lipid fractions and the severity and extent of the coronary atherosclerotic lesion in patients with ST elevated acute myocardial infarction (STEMI). We analyzed data from 50 consecutive patients with STEMI who underwent coronary angiography during hospitalization at the Clinical Hospital in Tetovo. The severity and extent of CAD were defined using the Syntax score (SXscore) algorithm stratified according to tertiles. Laboratory analysis for lipid fractions was performed. It was noticed a statistically significant association between SXscore tertiles and the mean of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL) ratio (TC/HDL), (p=0.008). Correlation test showed week but significant positive correlation between SXscore tertiles and TC/HDL ratio (r=0.339, p=0.016) and Non-HDL (r=0.309, p=0.034). In regression analysis, reduced HDL and increased TC values statistically significantly predicted SXscore (p&lt;0.05). Among all lipid variables examined, the TC/HDL ratio appeared as the most powerful indicator of severity and extension of the coronary lesion in patients with STEMI. The TC/HDL ratio should be used as an easy, non-invasive, and inexpensive method to measure the severity of CAD to determine the diagnosis strategy and treatment of patients with atherosclerotic coronary diseases at risk of acute infarction.

The prediction role of TIMI score in correlation with coronary angiogram to determine the coronary artery disease severity and extent in patients presenting with Non-ST Elevation Acute Coronary Syndrome

Background: Accurate risk stratification in patient clinically presented as a case of Non-ST Elevation acute coronary syndrome (NSTE-ACS) is important to assess the prognosis as well as to estimate the possible adverse event especially in those patient who are at high risk. Of these scoring risk; Thrombolysis In Myocardial Infarction (TIMI) risk score have been well corroborated to predict the possible prognosis for patients with NSTE-ACS. However, their value in estimation the severity of coronary artery disease (CAD) has been less studied. Objective: To determine the role of TIMI score in prediction the severity of CAD and its extent by correlate the TIMI score with coronary angiography in patients have NSTE-ACS. Patients and Methods: A cross section study, conducted on 264 successive patients admitted with Non-ST Elevation acute coronary syndrome at Ibn-Albitar cardiac center, Baghdad, Iraq, from the 1st of October 2017 to the 1st of October 2018. Patients were rearranging into three groups according to the seven standard variables of TIMI score. The extent of CAD was examined on coronary angiography; a lesion defined significant if stenosis ≥70% in any artery of three major coronary arteries or ≥50% of left main coronary artery. Results: The total number of was 246 patients, mean age was 62.5±2.3 years. There were 67 (27.2%) of them belong to group 1 (low risk group), 142 (57.7%) of them belong to group 2 (intermediate risk group), and 37 (15.1%) of them belong to group 3 (high risk group). 54.1% of patients in group 3 had significant three-vessels coronary artery disease on comparing with 17.6% of group 2 patients and only 7.5% of group 1 patients had these lesions on coronary angiography (P-value &lt;0.01). On the other hand, one-vessel coronary artery disease occurs more commonly and significant statistically (P-value &lt;0.01) in group 2 (31.7%) than in patients in group 1 (26.9%) and group 3 (10.8%). Conclusion: High TIMI risk score patients were more probably to have significant multi-vessels coronary lesions in comparison with those with TIMI risk score in intermediate or low range which lead to help in stratify the risk and possibility of early intervention. Keywords: Coronary Angiography, Non-ST Elevation Acute Coronary Syndrome, Acute Coronary Syndrome risk stratification, TIMI score.

Association of GDF-15, hs-cTnT and NT-proBNP with coronary artery disease in patients undergoing elective angiography.

Aim: This study investigated the association between plasma levels of GDF-15, hs-cTnT and NT-proBNP and the presence of coronary artery disease (CAD) in stable patients referred for elective coronary angiography. Methods: The outcome of CAD was defined as an ordinal variable with 3 levels. The association between each biomarker and the outcome was tested using the Winell and Lindbäck method. Results: In unadjusted analysis of 252 patients, GDF-15 and hs-cTnT were associated with the presence and extent of CAD. In multivariate regression analysis including traditional risk factors, this association was no longer significant. Conclusion: NT-proBNP, GDF-15 and hs-cTnT plasma levels do not seem to improve the predictive ability of traditional risk factors for CAD in stable patients referred for coronary angiography.

Correlation study of Myocardial strain imaging with angiographic findings in patients with chronic stable angina

Background: Global Longitudinal Strain (GLS) measured by 2D speckle-tracking strain echocardiography (2D-STE) can detect impaired longitudinal left ventricle (LV) function at rest which is associated with significant coronary artery stenosis. Objective: Global longitudinal strain (GLS) may be used to predict the presence, extent and severity of CAD according to coronary angiographic findings in patients with chronic stable angina. Methods: 2D-STE and coronary angiography were performed on 100 individuals with suspected stable angina pectoris who had normal resting conventional echocardiography. Global longitudinal strain were assessed and were correlated with coronary angiography for each patient. Results: Statistically significant difference was found when comparing the mean GLS among patients with normal coronaries and different degrees of coronary artery disease (CAD).Mean GLS was – 20.76±1.39, -17.66±0.65, - 16.05±0.58 and -14.22±0.65 for normal/minor, single vessel, two vessels and three vessels respectively(p&lt;0.001). Patients with significant left main (LM) stenosis had GLS of 14.41±1.27 compared with GLS of 17.1±1.91in patients without LM stenosis (p=&lt;0.001). In our study cutoff value for detection of single vessel disease was -18.300 with good sensitivity and specificity (100% and 96.6%, respectively) with AUC (Area Under the Curve) 0.996 and p value&lt; 0.001.

Ischemia Trial: Does the Cardiology Community Need to Pivot or Continue Current Practices?

Purpose of ReviewFor decades, the standard of care for stable ischemic heart disease (SIHD) has been an ischemia-centric approach based on largely observational data suggesting a survival benefit of revascularization in patients with moderate-or-severe ischemia. In this article, we will objectively review the evolution of the ischemia paradigm, the trial evidence comparing revascularization to medical therapy in SIHD, and what contemporary practice should be in 2022.Recent FindingsRandomized trials, including COURAGE and, most recently, the ISCHEMIA trial, have shown no reduction in “hard outcomes” like death and myocardial infarction (MI) in SIHD compared to medical therapy. The trial excluded high-risk patients with left main disease, low ejection fraction (EF) < 35%, and severe unacceptable angina. Irrespective of the severity of ischemia and the extent of coronary artery disease (CAD), revascularization did not offer any prognostic advantage over medical therapy. On the other hand, there was a durable improvement in symptoms. While there are many caveats to the ISCHEMIA trial, the overall strengths of the trial outweigh these limitations. The findings of ISCHEMIA are consistent with previous trials.SummaryIt is time for the cardiology community to pivot towards medical therapy as the initial step for most patients with SIHD. Physicians should have the “COURAGE” to embrace “ISCHEMIA” and be comfortable with treating ischemia medically.

Long-term survival of Icelandic women following acute myocardial infarction

Objective. To evaluate the impact of sex on treatment and survival after acute myocardial infarction (AMI) in Iceland. Methods. A retrospective, nationwide cohort study of patients with STEMI (2008–2018) and NSTEMI (2013–2018) and obstructive coronary artery disease. Patient and procedural information were obtained from a registry and electronic health records. Survival was estimated with Kaplan–Meier method and Cox regression analysis used to identify risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and sex-matched population in Iceland at 30-day interval. Results. A total of 1345 STEMI-patients (24% women) and 1249 NSTEMI-patients (24% women) were evaluated. Women with STEMI (mean age: 71 ± 11 vs. 67 ± 12) and NSTEMI (mean age: 69 ± 13 vs. 62 ± 12) were older and less likely to have previous cardiovascular disease. There was neither sex difference in the extent of coronary artery disease nor treatment. Although crude one-year post-STEMI survival was lower for women (88.7% vs. 93.4%, p = .006), female sex was not an independent risk factor after adjusting for age and co-morbidities after STEMI and was protective for NSTEMI (HR 0.67, 95% CI: 0.46–0.97). There was excess 30-day mortality in both STEMI and NSTEMI for women compared with sex-, age- and inclusion year-matched Icelandic population, but thereafter the mortality rate was similar. Conclusion. Women and men with AMI in Iceland receive comparable treatment including revascularization and long-term survival appears similar. Prognosis after NSTEMI is better in women, whereas higher early mortality after STEMI may be caused by delays in presentation and diagnosis.

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden.

Background Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease. Methods This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT). Results A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, p=0.001). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, p=0.02). RC, therefore, predicts the extent and severity of coronary artery disease. Conclusion RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.

Does pre-diabetes predict the extent of coronary artery disease?

Abstract Funding Acknowledgements Type of funding sources: None. Background Extensive coronary artery disease (CAD) is common in diabetes mellitus. This relation between the extent of CAD and prediabetes (pDM)is less well established. Purpose To explore whether non-diabetic hyperglycaemia, assessed by HbA1c, is associated with extent of angiographic CAD, independent of traditional cardiovascular risk factors. Methods Retrospective cohort analysis of consecutive patients, without known DM undergoing coronary angiography for stable angina, who were screened for hyperglycaemia over 18 months. HbA1c was measured; pre-diabetes was defined as HbA1c 5.7-6.4%.Extent of CAD was assessed using the SYNTAX score. Presence of CAD was defined as visually estimated ≥50% luminal obstruction in arteries ≥1.5 mm diameter. Age, BMI, risk factors for CAD, HbA1c, total and LDL-cholesterol were recorded. The pre-diabetes and normal groups were compared using Mann-Whitney test for continuous variables and chi-squared test for categorical variables. Multiple logistic and linear regressions were used to assess the effect variables on SYNTAX score. Spearman rank correlation was used to assess the relation between HbA1c and SYNTAX score. Results 1071 patients had angiograms done. 207 had DM, 19 had new diagnosis of DM and 181 missed the screening leaving 664 who had HbA1c measured. 51 poor quality angiograms were excluded from SYNTAX calculation. Data was analysed for 613 (306 normal, 307 pDM) patients. The patients with prediabetes were older, had higher prevalence of risk factors, BMI, fasting glucose and SYNTAX score. HbA1c (OR 2.07, 95% CI 1.32 to 3.25, p=0.002) and the presence of pDM (OR 1.89, 95% CI 1.32 to 2.69, p&amp;lt;0.001) independently predicted the presence of CAD. HbA1c (Coefficient 2.42, SE 1.09, p=0.027) and the presence of pDM (Coefficient 2.25, SE 0.92, p=0.015) independently predicted the SYNTAX score. The correlation between HbA1c and SYNTAX score was weak but significant (Spearman's coefficient 0.206, 95% CI 0.129 to 0.281, p&amp;lt;0.0001). Conclusion HbA1c predicts the extent of CAD as measured by SYNTAX score in patients without known diabetes. Presence of pre-diabetes is an independent predictor of extent of CAD.