Higher Gensini Score Research Articles

Erectile dysfunction severity as a predictor of left main and/or three-vessel disease in acute coronary syndrome patients

BackgroundCoronary artery disease (CAD) is a leading cause of morbidity and death. Early diagnosis of patients with left main and/or three-vessel disease (LM/3VD) among acute coronary syndrome (ACS) patients is beneficial. The relation between erectile dysfunction (ED) and cardiovascular diseases was previously noticed. The aim of our work was to find out if the severity of ED could predict the presence of LM/3VD in ACS patients. Patients and methodsEighty-five male patients with ACS were included in the study. Clinical assessment, estimation of international index of erectile function (IIEF) score, and coronary angiography were performed in all patients. Gensini score was calculated to assess the severity of CAD. Based on IIEF score, the patients were divided into two groups: Group 1: patients with mild or no ED (IIEF score ≥17), Group 2: patients with moderate or severe ED (IIEF score <17). ResultsPatients with IIEF score <17 had significantly higher prevalence of LM CAD (4.3% versus 18.4%, p=0.035), 3VD (17% versus 39.5%, p=0.021) and LM/3VD (21.3% versus 55.3%, p=0.0012), as well as higher mean Gensini score (23.5±10.8 versus 34.1±12.7, p=0.0001). The independent predictors of LM/3VD in order of significance were: age, heart rate, IIEF <17, Killip class >1, and ST-depression or ST-elevation in lead aVR ≥1mV. There was a significant negative correlation between IIEF score and Gensini score (r=−0.383, p=0.0003). ConclusionThe presence of moderate or severe ED in men with ACS is associated with higher Gensini score and more incidence of LM/3VD. IIEF score <17 was an independent predictor of LM/3VD.

Evaluation of the predictive value of Gensini score on determination of severity of coronary artery disease in cases with left bundle branch block

Abstract Left bundle branch block (LBBB) is one of the features which predicts severe organic heart disease. In this study, we aimed to examine the predictive role of Gensini score as marker of severity of coronary artery disease (CAD) in patients with LBBB and its relationship with other CAD risk factors and complications. We have included patients who referred to our center for selective coronary angiography with transient and or permanent LBBB on their surface electrocardiography (ECG). Cases with pacemaker rhythm and known non-CAD related causes of LBBB pattern on surface ECG were excluded from this study. Demographic variables and clinical features were studied. To determine severity of CAD, Gensini score was measured. The relationship between presence of CAD and deteriorated ejection fraction has been demonstrated by previous works, but we found no association between severity of CAD and degree of ejection fraction deterioration. This might imply to the role of non-CAD factors toward reduction of ejection fraction. In cases with hypertension in the setting of LBBB, higher Gensini scores were seen regardless of ventricular ejection fraction. Thus, earlier screening for possible CAD in cases with LBBB and hypertension seems rational. Keywords: Left bundle branch block Electrocardiography Severity of coronary artery disease Gensini score

Association between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease in Chronic Stable Angina

Background: Neutrophil to lymphocyte ratio (NLR) has been proposed as a new prognostic marker in patients with chronic stable angina (CSA). NLR is a cheap, easily available, non-invasive and routinely done procedure to predict the severity of coronary artery disease.Methods: 110 patients with stable coronary artery disease were evaluated to calculate the NLR from January, 2016 to September, 2016. The patients were divided into two groups: Group I NLR&gt;2.38 and group II NLRd”2.38. Coronary angiogram was done during index hospitalization. The severity of the coronary artery disease was assessed by vessel score and Gensini score and was compared between the groups.Results: NLR was significantly higher in the group of high vessel score and high Gensini score. We found significant weak association between NLR and vessel score (r=0.30, p=0.004) and a moderate positive correlation between NLR and Gensini score (r =0.65, P=0.001). With the increase of NLR, vessel score and Gensini score increases demonstrating more severe coronary artery disease. Univariate logistic regression analysis of variables of interest revealed that age, hypertension, dyslipidemia, serum creatinine, total WBC count and NLR were independent predictor of severe coronary artery disease with odds ratio (OR) being 1.88, 3.93, 5.01, 5.54, 4.05 and 5.70 respectively. In multivariate logistic regression analysis, after adjustment of factors NLR remain independent predictors of severe CSA (OR = 5.73; p = 0.002).Conclusion: Increased neutrophil to lymphocyte ratio is associated with angiographically severe coronary artery disease in chronic stable angina and this association is independent of conventional cardiovascular risk factors.Cardiovasc. j. 2018; 10(2): 164-170

Lipoprotein(a) level associates with coronary artery disease rather than carotid lesions in patients with familial hypercholesterolemia.

Lipoprotein(a) [Lp(a)] level is a novel risk factor for atherosclerotic cardiovascular disease in patients with familial hypercholesterolemia (FH), while its impact on the different sites of arteries remains undetermined. We aim to examine the associations of Lp(a) levels with coronary and carotid atherosclerosis in patients with heterozygous FH (HeFH). A total of 148 patients with HeFH who have received carotid ultrasonography and coronary angiography due to chest pain were enrolled. Plasma Lp(a) was measured using immunoturbidimetric method. Finally, the associations between Lp(a) and coronary as well as carotid lesions were evaluated. Patients with Lp(a)≥300mg/L had similar carotid intima-media thickness (IMT, 0.782±0.16mm vs 0.798±0.18mm, P=.579) and plaque prevalence (66.7% vs 65%, P=.833) compared to those with Lp(a)<300mg/L, but had a higher prevalence of coronary artery disease (CAD, 69.7% vs 50.0%, P=.016) and higher Gensini score (GS, median 27 vs 3, P=.006). Moreover, no correlations were found between carotid mean IMT with either Lp(a) level or Lp(a) year score, while positive relation of Lp(a) with GS did. Multivariate regression analysis revealed that Lp(a), Lp(a) year score, and Lp(a)≥300g/L were all independent predictors for the presence of CAD (OR=4.99, P=.007; OR=4.73, P=.009; OR=4.46, P=.006, respectively) but not for carotid plaques. This study suggested that Lp(a) level was associated with the presence and severity of CAD but not with carotid atherosclerosis in patients with HeFH.

Relationship between the maximum carotid plaque area and the severity of coronary atherosclerosis.

Carotid artery plaque is associated with coronary artery disease (CAD). Besides the presence of plaque, plaque characteristics is also related to the severity of CAD. So the characteristic difference of carotid plaque may affect this assessment role. However, it is unclear whether the maximum carotid plaque area can reflect the extents and severity of CAD. We enrolled 388 consecutive CAD patients and 45 controls, and 204 patients were studied after excluding 184 patients without carotid plaque or coronary angiogram. Carotid intima media thickness and carotid plaque were measured by carotid ultrasound. Coronary angiography was applied and Gensini score was calculated. Blood lipid and other parameters were also detected. The total and right maximum carotid plaque area were greater in high Gensini Score group than those in low and moderate score groups (both P<0.05) and multivessel disease patients possessed the highest maximum plaque area. The total and right maximum carotid plaque area were also higher in collateral circulation group than those in non-collateral group (P=0.036 and 0.002 respectively). Multivariate logistic regression showed that Gensini score (OR=2.458, 95% CI=1.111 to 5.439, P=0.027) was associated with increased total maximum carotid plaque area. The optimal cut-off value for predicting the severity of CAD was 46.75 mm2 for total maximum plaque area. The maximum carotid plaque area can reflect the clinical severity of CAD, and it can be used as a simple noninvasive indicator of severity of coronary atherosclerosis.

Left Atrium Volume Index and Aortic Stiffness as Predicting Factors for Severity of Coronary Artery Disease

AbstractBackground: Recently, it has been demonstrated that left atrial distension and aortic stiffness have a predictive value for cardiovascular outcomes especially in high-risk, elderly, and hypertensive adults.Aim of Study: Evaluation of predictive value of Left Atrium Volume Index (LAVI) and aortic stiffness for severity of angiographic pattern of Coronary Artery Disease (CAD).Methods: A prospective observational cohort single-center study conducted from May 2016 to May 2017, at Cardiovas-cular Medicine Department, Tanta University Hospitals in Gharbia Governorate, Egypt. The study enrolled 100 consec-utive adult patients of both genders who were diagnosed with chronic stable coronary artery disease and were candidates for invasive coronary angiography. Each patient was subjected to echocardiographic assessment for Left Atrium Volume Index (LAVI) and Aortic Stiffness Index (ASI) followed by invasive coronary angiography for assessment of severity of coronary artery disease by Gensini score. Patients were classified into 3 groups by Gensini score: Group I (gensini score equal zero), Group II (Gensini score more than 0 and less than 20) and Group III (Gensini score equal or more than 20).Results: The prevalence of severe CAD was higher among patients with high LAVI (p-value 0.002) and ASI (p-value 0.05). The significant positive relation between LAVI and Gensini score was mainly between Groups II, III (non-severe and severe coronary artery disease). ASI was more sensitive than LAVI for detection of the severity of CAD as ASI showed statistically significant positive strong correlation with the coronary angiographic score (p=0.001) while LAVI showed no significant correlation with the coronary angiographic score (p=0.061). The LAVI carried sensitivity of 67% and specificity of 49.5% in predicting CAD with cutoff value >19.5. While The ASI carried sensitivity of 66.7% and spe-cificity of 21% in predicting CAD with cutoff value >2.88.Conclusion: It was demonstrated that there is significant elevation at aortic stiffness index and left atrium volume index within the group of patient with the higher Gensini score. So ASI and LAVI could be used as promising factors for evalu-ation of the severity of coronary artery disease.

Association of a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 polymorphisms with severity of coronary stenosis in type 2 diabetes mellitus.

Background:The imbalance of von Willebrand factor (vWF) and a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 (ADAMTS13) has been associated with atherosclerosis progression. A high level of vWF which regulates thrombus formation is associated with diabetes mellitus (DM), and some ADAMTS13 and vWF polymorphisms have effects on their levels. Therefore, this study aimed to evaluate the associations of ADAMTS13 and vWF polymorphisms and their levels with DM and severity of coronary stenosis.Materials and Methods:Eighty-seven DM and 84 control individuals were recruited. vWF and ADAMTS13 activities as well as vWF antigen were measured by collagen-binding assay (CBA), residual-CBA, and in-house enzyme-linked immunosorbent assay, respectively. ADAMTS13 and vWF polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism.Results:The E and G alleles and AA genotype of ADAMTS13 Q448E, rs2073932, and rs652600, respectively, were independently associated with DM (odds ratio [OR] [95% confidence interval (CI)] = 2.5 [1.1, 5.6], 2.3 [1.0, 5.2], and 4.7 [1.2, 18.6], respectively). Moreover, E allele and AA genotype of Q448E and rs652600 were also significantly associated with multi-vessel disease (OR [95% CI] = 2.2 [1.0, 4.8] and 3.2 [1.0, 10.0], respectively), while the E and G allele of Q448E and rs2073932 were associated with high Gensini score (OR [95% CI] = 2.3 [1.1, 4.9] and 2.3 [1.1, 5.1], respectively).Conclusion:Association of ADAMTS13 polymorphisms with DM, number of vessel stenosis, and Gensini score may indicate the possible contribution of ADAMTS13 polymorphisms to atherosclerosis progression and severity of coronary stenosis in DM.

Association between haptoglobin genotype and coronary artery stenosis in patient with premature coronary artery disease

Background: Accumulating evidence implicates Haptoglobin (Hp) gene polymorphism as a potential risk predictor for Coronary Artery Disease (CAD). We explored the association of Hp polymorphism with premature CAD and its severity within 165 unrelated Chinese patients and 116 healthy controls using genotyping, biochemical parameters, and the Gensini scoring system. Levels of HP and IL-17 in plasma were determined by ELISA. Results: The frequencies of Hp genotypes and Alleles, Hp levels and IL-17 levels were significantly different between CVD group and control group, and among the three subgroups. Hp2-2 was associated with the highest Gensini score but the lowest Hp concentrations. After adjustments for confounding parameters, the OR of premature CAD associated with Hp2-2 was 0.630 (95% CI 0.449-0.884; P<0.05). The Hp2-2 genotype was associated with an increase in coronary artery stenosis especially in group C (OR=2.319; 95% CI 1.278-4.209; P<0.05). Gensini score was associated with Hp and IL-17 levels when we considered the entire patients. r-values were 0.296 and 0.140, respectively (P<0.05). Conclusions: Hp polymorphism is independently associated with increasing CAD severity. Hp and IL-17 may be biomarker of coronary artery stenosis. Further studies are warranted to study the role of Hp and IL-17 in the pathogenesis of CAD.

Epicardial fat thickness and severity of coronary heart disease in patients with diabetes mellitus type II.

BACKGROUNDClinical imaging studies have demonstrated a strong direct correlation between epicardial fat and abdominal visceral adiposity. There are several studies about positive correlation of epicardial fat and atherosclerotic coronary disease in general population. This study aimed to evaluate the association of epicardial fat thickness with atherosclerotic coronary disease in patients with diabetes mellitus type II.METHODSThis cross-sectional observational study involved 80 patients with diabetes mellitus type II. The patients were chosen using simple sampling method from patients with diabetes mellitus who were referred for angiography because of suspected coronary artery disease. The severity of coronary atherosclerotic lesions was evaluated using modified Gensini scoring system. Epicardial fat thickness was measured by transthoracic echocardiography within 90 days after coronary angiography. Multiple linear regression method was used to evaluate the association between mean epicardial fat thickness and Gensini score.RESULTSAfter adjustment for the effects of body mass index (BMI), age, angina, and sex, there was a significant association between Gensini score and epicardial fat thickness (β = 0.825; P < 0.001). Patients with higher blood pressure and higher body mass index also had a higher Gensini score (P < 0.010).CONCLUSIONIn patients with diabetes mellitus type II, there is a positive association between epicardial fat thickness and severity of coronary artery disease. So, by echocardiography evaluation of epicardial fat thickness, we could have an estimation of the severity of coronary arteries diseases before using more invasive techniques.

AGE AND SEX-RELATED FEATURES OF CORONARY ATHEROSCLEROTIC LESIONS IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE AND NO HISTORY OF MYOCARDIAL INFARCTION

The objective of this study was to determine age and sex-related features of coronary atherosclerotic lesions in patients with stable ischemic heart disease and no history of myocardial infarction. Material and methods. We performed a single-center cross-sectional study of 118 patients with stable ischemic heart disease (70 (59,3 %) men and 48 (40,7 %) women, median age – 65 years) who were divided into two groups according to sex criterion. All patients underwent complete evaluation including anthropometric/clinical assessment, laboratory tests and coronary angiography. Results. More severe atherosclerotic changes in the epicardial coronary arteries (greater number of affected vessels and higher Gensini score) were detected in men, this statement was true in both age categories: under and over 65 years. They were more likely to have multivessel disease (28,6 % vs 8,3 %, p&lt;0,01), while normal coronary arteries were more common in women (39,6 % vs 10 %, p&lt;0,001). There were no statistically significant differences among the representatives of both sexes in the topography of significant coronary stenoses: in both men and women obstruction usually occurred in the left anterior descending artery, mainly in its proximal part. Conclusion. The female pattern of stable ischemic heart disease is characterized by frequent absence of obstructive coronary lesions, agerelated gradual progression of atherosclerotic changes, but the localization of coronary stenoses does not differ in men and women.

Red cell distribution width is correlated with extensive coronary artery disease in patients with diabetes mellitus.

SummaryIntroduction:Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM).Methods:Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease wasdiagnosed in the presence of stenosis > 50% in all three coronary artery systems.Result:RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all).Conclusion:RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.

Association of Serum Prealbumin with Angiographic Severity in Patients with Acute Coronary Syndrome.

BackgroundSerum prealbumin (PA), which is a nutritional index, has been found to be associated with severities and prognoses of various diseases. However, there are no reports about the relationship between PA and angiographic severity of coronary artery disease.Material/MethodsThis cross-sectional study included 867 patients with acute coronary syndrome (ACS) who underwent coronary angiography. Patients were divided into quartiles of PA and coronary artery stenosis was determined by angiographic Gensini score, the presence of high Gensini score (Gensini score ≥120), and triple-vessel disease. Multivariate linear and logistic regression analyses were performed to explore the relationship between PA and disease severity in a coronary angiogram.ResultsThere was a significant and independent negative correlation between PA and Gensini score in multivariate linear regression (p=0.015). Logistic regression analysis revealed that crude odds ratios of triple-vessel disease and high Gensini score were 2.47 (95% CI: 1.66–3.67) and 1.83 (95% CI: 1.50–3.49), respectively, in the first quartile of PA compared with the fourth quartile and the results remained significant for high Gensini score after adjustment for confounding factors. In addition, estimated glomerular filtration rate, liver function, and high-sensitivity C-reactive protein (hs-CRP) had no interactive relationships in the above associations. Patients with lower levels of albumin or higher levels of hs-CRP or the ratio of hs-CRP to PA (hs-CRP/PA) also had more severe coronary atherosclerosis.ConclusionsPA is negatively and independently associated with angiographic severity in patients with ACS, indicating for potential use in estimating the burden of coronary atherosclerosis.

Association between fibrinogen level and the severity of coronary stenosis in 418 male patients with myocardial infarction younger than 35 years old.

Fibrinogen (Fib) is a useful marker for predicting the severity of coronary artery disease (CAD) in adult population. However, whether Fib can be a predictor for the presence and severity of CAD in very young MI patients (≤35 years old) remains to be determined. A total of 418 males from 61,863 patients with MI who were under 35 years old were sequentially recruited in our study. The patients were divided into two main groups and three subgroups according to coronary angiograph and Gensini score (GS) system: no coronary artery stenosis (group A), the results of the coronary artery stenosis (group B); low GS, intermediate GS and high GS. Data indicated that Fib, body mass index, current smoking, white blood cell count (WBCC) and GS were significantly higher in group B than those in group A (all P < 0.01). Moreover, there were significant differences in Fib, mean age, diabetes mellitus, family history of CAD, WBCC, left ventricular ejection fraction, and GS between high GS and low GS subgroups (all P < 0.01). A positive correlation between Fib levels and GS was found (r = 0.242, p < 0.001). Receiver operating characteristics curve analysis demonstrated that the best cut-off level of Fib predicting the severity of coronary stenosis was 3.475g/L (sensitivity 64%; specificity 70%) and the area under the curve was 0.656. Fib was also independently associated with high GS (OR=2.173, 95%CI 1.011–4.670, P = 0.047) after adjusting for potential confounders. In conclusion, Fib is significantly related to the presence and severity of coronary stenosis in male patients with MI under 35 years old.

Monosit Sayısı/HDL Oranı ile Koroner Arter Hastalığının Ciddiyeti ve Yaygınlığı Arasındaki İlişki

Introduction: Circulating monocyte count is predictive of new atherosclerotic plaque development. In addition, there is a strong inverse relationship between high-density lipoprotein (HDL) cholesterol and atherosclerosis. We aimed to investigate the relationship between the monocyte/HDL cholesterol ratio and severity of coronary artery disease. Patients and Methods: A total of 760 patients who underwent coronary angiography were included in the study. The severity of coronary atherosclerosis was calculated by the Gensini score, and the patients were grouped as having low ( 20) Gensini scores. Baseline characteristics and laboratory parameters were recorded and compared between patients with low and high Gensini scores. Results: Hypertension, diabetes mellitus, hyperlipidaemia, advanced age and smoking were more common in patients with a high Gensini score. Fasting blood glucose levels, creatinine levels and monocyte/HDL cholesterol ratio were significantly lower in patients with a low Gensini score than in those with a high Gensini score. Logistic regression analysis revealed that older age, fasting blood glucose levels, hyperlipidaemia, family history of coronary artery disease and male gender were independent predictors of a high Gensini score. We observed a correlation between the monocyte/HDL cholesterol ratio and Gensini score (p< 0.001). However, this correlation was weak (Spearman’s rho = 0.159). Conclusion: We observed a positive but weak correlation between the monocyte/HDL cholesterol; ratio and increased coronary atherosclerotic burden, as calculated by Gensini scoring. Further studies are required to demonstrate the relationship between the monocyte/HDL cholesterol ratio and atherosclerotic cardiovascular disease.

Novel and traditional lipid-related biomarkers and their combinations in predicting coronary severity

We investigated simultaneously traditional and novel lipid indices, alone or in combination, in predicting coronary severity assessed by Gensini score (GS) in 1605 non-lipid-lowering-drug-treated patients undergoing coronary angiography. Firstly, levels of triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), non high density lipoprotein cholesterol (non-HDL-C), apolipoprotein (apo) B, lipoprotein (a) [Lp(a)], proprotein convertase subtilisin/kexin type 9 (PCSK9), apoC3, small dense LDL (sdLDL) and large HDL were increased, while HDL-C and apoA1 levels were decreased as GS status (all p for trend <0.05). However, gender stratification analyses showed similar associations between lipids and GS in men but not in women. Secondly, multiple logistic regression analyses indicated that the 12 indices were predictive for high GS (≥24) but not for low GS (1–23) compared with normal coronary (GS = 0) except for TG (neither) and apoB (both). Finally, we found that interactions between two indices with mutually exclusive composition were positively associated with GS status except for couples of TC + apoC3, apoB/PCSK9/apoC3 + sdLDL-C. Concordant elevations in the two showed the highest predictive values for high GS (all p for trend <0.05). Therefore, lipid biomarkers were associated with coronary severity and their adverse changes in combination emerged greater risks in men but not in women.

Relationship between myocardial performance index and severity of coronary artery disease in patients with non-ST-segment elevation acute coronary syndrome.

SummaryObjectivesWe aimed to investigate the relationship between myocardial performance index (MPI) and severity of coronary artery disease, as assessed by the Gensini score (GS), in patients with non-ST-segment elevation myocardial infarction (NSTEMI).MethodsNinety patients with an initial diagnosis of NSTEMI were enrolled in our study. They were divided into tertiles according to the GS: low GS <19; mid GS > 19 and ≤ 96; and high GS > 96.ResultsThe low-, mid- and high-GS groups included 24, 38 and 28 patients, respectively. Clinical features such as gender distribution; body mass index (BMI); prevalence of diabetes mellitus, hypertension and hyperlipidaemia; and smoking status were similar in the three groups. MPI and isovolumic relaxation time were significantly higher in the high-GS group than in the low- and mid-GS groups (p < 0.001 and p = 0.005, respectively). Furthermore, the high-GS group had a significantly lower ejection fraction and ejection time (p = 0.01 and p < 0.001, respectively). MPI was positively correlated with the GS (r = 0.47, p < 0.001), and multivariate regression analysis showed that MPI was an independent predictor of the GS (β = 0.358, p < 0.001).ConclusionsPatients with NSTEMI who fall within the high-risk group may be identified by means of a simple MPI measurement.

Extent of coronary artery disease in patients undergoing angiography for stable or acute coronary syndromes

BackgroundWe aimed to investigate whether the angiographic extent of coronary artery disease (CAD) differs in patients undergoing coronary angiography for stable CAD or acute coronary syndrome (ACS) and identify predictors of CAD extent in these patients. MethodsWe enrolled 584 consecutive patients (463 with stable CAD, 121 with ACS) with angiographically established CAD (≥1 stenosis >25%). The Gensini score was used to assess the extent of coronary atherosclerosis. ResultsStable CAD patients had greater Framingham risk score and greater prevalence of hypertension, hypercholesterolemia, and diabetes (p<0.05 for all). Fasting glucose and systolic and diastolic blood pressure were higher, while high-sensitivity C-reactive protein (hsCRP) levels were lower in patients with stable CAD than in those with ACS (p<0.05 for all). No difference in Gensini score was observed between the two groups (p=0.118), but patients with ACS were more likely to have at least one significant epicardial angiographic lesion (>50% stenosis) (OR 2.0, p=0.022). Higher Gensini score was independently associated with (i) higher hsCRP and glucose levels, hypercholesterolemia, and increased age in stable CAD patients (R2 0.15, p<0001) and (ii) increased age and higher glucose and hsCRP levels in patients with ACS (R2 0.17, p<0001). ConclusionsPatients undergoing coronary angiography for ACS or stable CAD presented with a similar extent of angiographic CAD, although patients with ACS had a higher prevalence of significant lesions in the presence of a better cardiovascular risk profile and higher inflammation levels. The extent of angiographic CAD in both the groups shared common determinants such as hsCRP, age, and hyperglycemia, but these appeared to explain only a small part of the variation of coronary atherosclerosis.

Serum Cytokine Profile in Relation to the Severity of Coronary Artery Disease.

Objectives. To investigate the potential association of a set of serum cytokines with the severity of coronary artery disease (CAD). Methods. A total of 201 patients who underwent coronary angiography for chest discomfort were enrolled. The concentrations of serum IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, IL-9, and IL-17 were determined by xMAP multiplex technology. The CAD severity was assessed by Gensini score (GS). Results. The serum levels of TNF-α, IL-6, IL-9, IL-10, and IL-17 were significantly higher in high GS group (GS ≥ 38.5) than those in low GS group (GS < 38.5). Positive correlations were also found between these cytokines and the severity of CAD. After adjustment for other associated factors, three serum cytokines (IL-6, IL-9, and IL-17) and two clinical risk factors (creatinine and LDL-C) were identified as the independent predictors of increased severity of CAD. ROC curve analysis revealed that the logistic regression risk prediction model had a good performance on predicting CAD severity. Conclusions. Combinatorial analysis of serum cytokines (IL-6, IL-9, and IL-17) with clinical risk factors (creatinine and LDL-C) may contribute to the evaluation of the severity of CAD and may help guide the risk stratification of angina patients, especially in primary health facilities and in the catheter lab resource-limited settings.

Evaluation of the Relationship Between Hot Flashes and Night Sweats and Severity of Coronary Artery Disease in Postmenopausal Women

Introduction: Hot flashes (HF) and night sweats (NS) are due to vasomotor instability and could be recognized as cardiovascular risk markers. Therefore, this study aimed to evaluate the relationship between vasomotor instability and severity of coronary artery disease (CAD) in postmenopausal women. Materials and Methods: This observational cross sectional study, was performed in Chamran Hospital, Isfahan University of medical sciences, Isfahan, Iran from 2011-2012. In this study, womenwithin the age range of 45-60 years with angiography documented CAD were enrolled. Participants included 25 women with hot flashes, night sweats, or both and 17 women without these symptoms, respectively. In all participants, levels of follicular stimulating hormone/luteinizinghormone (FSH/LH) were measured. The severity of CAD was calculated using Gensini score. In order to evaluate the relationship between severity of CAD and other variables, Gensini scores lower than 50 and ≥50 were considered as low and high Gensini scores, respectively. Moreover, data analysis was performed using SPSS version 15.0.Results: Our findings demonstrated that NS and HF were not associated with severity of CAD, determined by Gensini scores (P-values>0.05). However, a significant positive relationship was observed between FSH levels and severity of CAD in all participants (P=0.048). In cases in low Gensini score group, the relationship between LH and Gensini score was negative and non-significant, while Gensini score showed a positive and non-significant relationship (P-value> 0.05).Conclusions: No significant association was observed between vasomotor symptoms of menopause and the severity of CAD. In addition, elevated FSH levels could be considered as a marker of severity of CAD.

Haemoglobin A1c as a marker predicting extent and severity of coronary artery disease in non-diabetic patients

Objective Lowering haemoglobin A1c (HbA1c) was shown to be associated with reduction of microvascular, neuropathic and possibly macrovascular complications in diabetic patients. However, in non-diabetic patients, few reports have examined the relation between HbA1c and extent of coronary artery disease. The aim of this study was to examine the relationship between HbA1c level and severity of coronary artery disease (CAD) in non-diabetic patients scheduled for elective coronary angiography.Methods We prospectively studied 408 consecutive non-diabetic patients with or without history of previous myocardial infarction who were scheduled for conventional coronary angiography. HbA1c was measured in all patients at the time of admission. Severity of CAD was assessed by the Gensini score. Gensini score > 30 was considered severe coronary atherosclerosis. Patients were divided into two groups: the high-risk group (HbA1c, 5.7-6.4%) and the low-risk group (HbA1c, < 5.7%).Results Patients in the high-risk group had a higher Gensini score (45.1 ± 36.7 vs 26.8 ± 26.0, P< 0.001). Patients with a Gensini score > 30 had higher values of HbA1c (6.0 ± 0.48 vs 5.75 ± 0.54, P< 0.001). HbA1c showed a positive correlation with the Gensini score. HbA1c value of 5.85% showed a sensitivity and specificity of 70 and 50%, respectively, for prediction of severe coronary atherosclerosis.Conclusion HbA1c is significantly associated with severe coronary atherosclerosis in non-diabetic patients.