Incidence Of Acute Coronary Events Research Articles

Risk predicting for acute coronary syndrome with conventional and unstable plaque radiomics features from serial coronary computed tomography angiography

Abstract Background Plaques with high-risk features are responsible for most acute cardiac events. However, there are still some lesions with high-risk plaque (HRP) morphology, which will not lead to cardiac events over time. It is crucial to precisely identify features of unstable plaque and to carry out individualized treatment, eventually aiming to reduce the likelihood of plaque rupture and lower the incidence of acute coronary events. Besides, the development of quantitative radiomics in recent years may further help with the diagnostic and predictive performance of coronary CTA. Purpose To establish machine learning models by combining traditional coronary CTA features of high-risk plaque and radiomics features of unstable plaque, so as to improve the efficiency of models and to predict acute cardiac events precisely. Methods A total of 133 elderly patients (407 lesions) were retrospectively enrolled in this cohort study who underwent serial CCTA with the interval ≥ 2 years between scans. The patients were divided into two groups according to the occurrence of acute coronary events within 1 year after coronary CTA scanning . We recorded anatomical characteristics, high-risk plaque characteristics, and acute coronary events of the elderly patients. Based on the coronary CTA image cohort, we applied 3D Slicer software to segment target lesions, delineate regions of interest, and extract radiomics features. After that, we used LASSO regression to reduce the dimensionality of the radiomics features, and finally screened out unstable radiomics features. Combining the HRP features with the selected radiomics features, we established a prediction model of acute cardiac events with machine learning method. The area under the receiver operating characteristic (ROC) curve (AUC) was analyzed to compare the classification ability of conventional and radiomics models in the validation set. Results 133 elderly patients were included, with an average age of 65.8 ± 5.3 years. A novel model has been established by combining HRP features and 4 selected unstable radiomics features (2 wavelet features, 1 shape feature and 1 GrayLevel feature) with SVM machine learning method. Compared with conventional HRP model, the novel model displayed a significantly improved predictive performance in the validation set (AUC 0.784 vs. 0.624, P < 0.001). Conclusions We have established a novel model by combining the traditional HRP features of coronary CTA and radiomics features of unstable plaque, assisting in better prediction of acute coronary events in elderly . Compared with traditional HRP feature model, the prediction efficiency of novel model was significantly improved.

Long-term exposure to air pollution and incidence of coronary heart diseases and stroke in the longitudinal metropolitan studies (LMS) network: the BIGEPI project

to assess the potential of using longitudinal metropolitan studies (LMS) to study the association between long-term exposure to air pollution and the incidence of acute coronary events and stroke. closed cohort. subjects aged >=30 years, who took part in the 2011 census, residents in 5 cities (Turin, Bologna, Rome, Brindisi and Taranto). Annual concentrations of particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2) and warm-season ozone (O3) (annual O3 in Taranto and Brindisi), estimated through satellite (Turin, Bologna, Rome) or photochemical models (Taranto and Brindisi) with a spatial resolution of 1 km2, were assigned to the census address. incidence of coronary heart disease (CHD) and stroke until 31.12.2018 (2019 in Bologna). Cohort-specific Hazard Ratios (HRs), estimated using Cox regression models progressively adjusting for individual and contextual covariates, were pooled with random-effect meta-analysis. there were 71,872 incident CHD cases and 43,884 incident cases of stroke in almost 18 million person-years. No association was observed between the exposures studied and incidence of CHD and stroke, except for an increase in the incidence of CHD associated with warm-season O3 exposure (HR 1.034 per 5 μg/m3 increase). Some positive associations were found in specific cities (both outcomes in Brindisi with PM10 exposure and in Taranto with NO2 exposure, stroke in Rome with both PM10 and PM2.5), although estimates were not significant in some instances. LMS are a high potential tool for the study of comparative medium- and long-term effects of air pollution. Their further development (different definitions of exposure, outcomes, characteristics of the urban areas and extension to other LMS) may make them even more valuable tools for monitoring and planning public health interventions.

Cancer-Associated Atherothrombosis: The Challenge.

The association between venous thrombosis and malignancy, having typical features of a paraneoplastic syndrome, has been established for a century. Currently, it is recognized that arterial thromboembolism (ATE) may also behave as a paraneoplastic syndrome. Recent matched cohort studies, systematic reviews, and observational studies concur in showing an increased incidence of acute coronary events, ischemic stroke, accelerated peripheral arterial disease, and in-stent thrombosis during the 6-month period before cancer diagnosis, peaking for 30 days immediately before cancer diagnosis. Cancer patients with ATE are at higher risk of in-hospital and long-term mortality as compared with noncancer patients. In the present review, we focus on the epidemiology, clinical variants and presentation, morbidity, mortality, primary and secondary prevention, and treatment of cancer-associated ATE. The awareness that cancer can be a risk factor for ATE and that cancer therapy can initiate cardiovascular complications make it mandatory to identify high-risk patients, modify preexistent cardiovascular risk factors, and adopt effective antithrombotic prophylaxis. For ATE prophylaxis, modifiable patient-related risk factors and oncology treatment-related factors are levers for intervention. Statins and platelet antiaggregants have been studied, but their efficacy for prevention of cancer-associated ATE remains to be demonstrated. Results of revascularization procedures for cancer-associated ATE are worse than for ATE in noncancer patients. It is important that a multidisciplinary approach is adopted for making informed decisions, by involving the vascular surgeon, interventional radiologist, oncologist, and palliative medicine, as well as the patients and their family.

Detection of Subclinical Coronary Artery Lesions by Framingham Risk Score, Peripheral Artery Atheromatosis and Coronary Artery Calcium Score: A Pilot Study in Asymptomatic Individuals Living with HIV.

The incidence of acute coronary events is increased among people living with HIV (PLWH), but there is no risk estimation score, nor a surrogate biomarker able to predict subclinical coronary artery disease (sCAD). We assessed the performance of: (i) Framingham risk score (FRMs), (ii) peripheral (carotid and femoral) artery atheromatosis, and (iii) coronary artery calcium (CACs) score, to detect the presence of sCAD, in PLWH. In a cohort of PLWH free of cardiovascular disease (CVD), we measured sCAD and CACs by computed tomography, calculated FRMs, and assessed carotid/femoral plaques by ultrasound. In 56 participants (age: 49 ± 10 years, men: 88%, FRMs: 7.2 ± 6.9; mean number of carotid/femoral plaques: 1.4 ± 1.5; CACs >0 present in 59%, median CACs 0.9 [IQR 0-22]): (i) minimal sCAD (stenosis 1%-24%; present in 30%) and mild sCAD (25%-49%, 25%) were effectively detected by FRMs, number of plaques, and CACs [area under the curve (AUC) of CACs was better than that of both FRM and plaques, p < .05]; (ii) moderate sCAD (stenosis 50%-69%; present in 8.9%) was detected by number of plaques and CACs, but similar AUC (0.969 vs. 0.867, respectively, p = NS); and (iii) severe sCAD (70%-99%, present in only 3 [5.4%]) was detected only by CACs. A high prevalence of sCAD in asymptomatic PLWH free of CVD was detected; CACs is a highly efficient biomarker to detect all grades of sCAD, however, the number of carotid/femoral plaques combined is also a very promising-lower cost and radiation free-surrogate biomarker. Future, larger studies are needed to verify these results.

Study of Frequency of Acute Coronary Syndromes In Patients Presenting with Chest Pain in a Primary Health Care Center (PHCC)

Background: Ischemic myocardial disease is the most common cardiovascular disease, associated with high morbidity and mortality. Objective: Study and distinguish acute heart episodes from cases of chest pain, in patients attending a PHCC located in Goura of Korinthos, Greece. Methods: Among all cases of chest pain examined during January-August 2019, 90 patients with acute coronary syndrome (ACS) were studied. Most participants were men (71%) aged 61-70 (31%). Results: A previous heart episode was mentioned by 28,6%. Among them, 22% did not comply with their medication regimen and 14.3% had been examined with coronary angiography. Percutaneous Coronary Intervention has been performed to 11.4% and 1.4% had undergone coronary-artery bypass. Risk factors were; hypertension(52.9%),smoking(37.2%), dyslipidemia (27.1%). Clinical manifestations were;chest pain 62.9%,perspiration 21.4%,numbness of extremities 18.6%, reflection of chest pain in the back 18.6% and nausea/respiratory distress 2.9%. Electrocardiographic findings consistent with STEMI were found in 32% of patients. Α new Left Bundle Branch Block was apparent in 5.7% of patients. Episodes of unstable angina with ischemic repolarization disorders were recorded in 29.4%. All patients after evaluation and initial treatment were transported to hospital. Finally, one patient (1,42%) died. Conclusion: There is a great incidence of acute coronary events in a Greek PHCC. General practitioners, following international guidelines deal with them successfully, despite lacking resources. Initial evaluation and treatment of ACS in a PHCC is of vital importance and contributes to lower morbidity and mortality rates.

Road traffic noise, mortality and incidence of cardio-cerebrovascular diseases in Rome

Background/Aim: Transportation noise is among the most important environmental exposures contributing to the burden of disease in Europe. The aim of the study is to assess whether long-term exposure to road traffic noise is associated with mortality and incidence of coronary and cerebrovascular events in the Rome Longitudinal Study.Methods: All city residents at October 21 2001, aged 30 years and over, followed up until 31 December 2015. Lden (db(A)) and NO2 (µg/m3) concentrations were estimated at each residential address (Sound Plan 8.1, Lagrangian microscale model). The association between a 10 (db(A)) increase of Lden and non-accidental mortality, incidence of acute coronary events and stroke was assessed using Cox models adjusted for individual variables, including SEP, and NO2 concentrations (HR, CI95%). We also studied the effect of Lden (low ≤48.1 dB(A), medium 48.1-54.4 dB(A), high ≥54.4 db(A)) in three categories of NO2 concentrations (≤34.4 μg/m3, 34.4-39.9 μg/m3, ≥39.9 μg/m3) Results: 1,263,712 residents were enrolled (55% women, mean age (DS) 55 (15.4), 19% low SEP). The average population exposure levels [mean (SD)] were 53.8 (8.1) dB(A) for Lden, and 41.3 (10.1) µg/m3 for NO2 (ρ=0.47). For all the outcomes, after adjustment for NO2 we failed to find a clear association with traffic noise. However, at medium and high NO2 exposure levels we found an effect at all the noise levels considered: at Lden &gt;54.4 db(A) we found an HR=1.05 (IC95% 1.03-1.07) for non-accidental mortality, HR=1.07 (IC95% 1.00-1.14) for fatal acute coronary events and HR=1.05 (IC95% 1.00-1.11) for stroke incidence. Conclusion: We found an independent effect of noise exposure especially at medium and high NO2 levels. Policies to reduce the exposure of residents and prevent harmful effects on their health are urgent.

Major acute cardiovascular events in patients with inflammatory bowel disease.

Systemic inflammation and immune-mediated diseases have been associated with ischemic heart disease in addition to traditional risk factors. In this study, we investigate associations between inflammatory bowel disease (IBD) and acute cardiovascular events. An observational study where patient data were extracted from our health system patient pool of 3 917 894. Propensity scores were calculated for all 15 292 patients (0.39%) with IBD to assemble a 1:1 matched cohort balanced for age, gender, race and known cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus and smoking (current and former). Secondary analyses were performed independently for 6658 patients with ulcerative colitis and 9406 patients with Crohn's disease. ICD-9 and ICD-10 codes were used to identify cardiovascular risk factors and outcomes. Matched patients (n = 30 584) had a mean age of 51 years, with 58% being women, and 63% Caucasian. During the median follow-up of 4.4 years, all-cause mortality was observed in 1.7 versus 1.2% of patients from IBD and non-IBD groups, respectively [hazard ratio, 1.31; 95% confidence interval (CI), 1.08-1.58; P = 0.005]. Combined outcome for myocardial infarction or cardiovascular mortality was noted in 2.3 and 2.1% from IBD and non-IBD groups, respectively (hazard ratio, 1.04; 95% CI, 0.90-1.21; P = 0.588), while hazard ratios for cardiovascular mortality, myocardial infarction and unstable angina were 1.04 (0.74-1.47; P = 0.833), 1.05 (0.89-1.23; P = 0.591) and 1.10 (0.83-1.46; P = 0.524), respectively. Among patients with IBD, incidence of acute coronary events did not show a statistically significant difference when compared to the matched cohort.

Low-level air pollution and incidence of acute coronary events: pooled analysis of 6 European cohorts in the ELAPSE project

Low-level air pollution and incidence of acute coronary events: pooled analysis of 6 European cohorts in the ELAPSE project

THE ROLE OF MYOCARDIAL REVASCULARIZATION IN THE SURVIVAL OF PATIENTS WITH ALTERED CORONARY BLOOD FLOW DETECTED BY TRANSTHORACIC ULTRASOUND

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of &lt;0.009; and a p-value for the differences compared with the Control group (р2) of &lt;0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1&lt;0.05; p2&lt;0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

THE ROLE OF MYOCARDIAL REVASCULARIZATION IN THE SURVIVAL OF PATIENTS WITH ALTERED CORONARY BLOOD FLOW DETECTED BY TRANSTHORACIC ULTRASOUND

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of &lt;0.009; and a p-value for the differences compared with the Control group (р2) of &lt;0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1&lt;0.05; p2&lt;0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

Effect of Alirocumab and Rosuvastatin or Rosuvastatin Alone on Lipid Core Plaque in Coronary Artery Disease Seen on Near-Infrared Spectroscopy Intravascular Ultrasound (ANTARES).

Background: Despite evidence of the effects of alirocumab on the incidence of acute coronary events, its impact on plaque stabilization remains uncertain. The present study will investigate the effect of alirocumab on fibroatheroma in patients who underwent recent percutaneous coronary intervention (PCI). Methods and Results: This phase IV, open-label, randomized, blinded near-infrared spectroscopy plus intravascular ultrasound (NIRS-IVUS) analysis, parallel-group, single-center study will enroll Japanese adults recently hospitalized for PCI with suboptimal low-density lipoprotein cholesterol (LDL-C) control (>70 mg/dL) despite stable statin therapy. Thirty patients will be randomized to receive either alirocumab or standard of care. The alirocumab group will receive alirocumab 75 mg every 2 weeks plus 10 mg rosuvastatin per day. The standard-of-care group will receive 10 mg rosuvastatin per day with dose adjustment to achieve LDL-C <70 mg/dL. Post-treatment NIRS-IVUS will be performed at week 36. The primary endpoint is the change in maximum lipid core burden index in 4-mm pullback compartments (maxLCBI[4 mm]) between baseline and week 36. Secondary endpoints include change in LCBI (lesion), angle of lipid core, plaque burden, and serum lipids and biomarkers related to atherosclerosis and inflammation. Conclusions: The study will clarify the effects of alirocumab on thin-cap fibroatheroma in patients who underwent recent PCI and who have suboptimal LDL-C control with stable statin therapy.

Effect of Alirocumab and Rosuvastatin or Rosuvastatin Alone on Lipid Core Plaque in Coronary Artery Disease Seen on Near-Infrared Spectroscopy Intravascular Ultrasound (ANTARES)

Background: Despite evidence of the effects of alirocumab on the incidence of acute coronary events, its impact on plaque stabilization remains uncertain. The present study will investigate the effect of alirocumab on fibroatheroma in patients who underwent recent percutaneous coronary intervention (PCI). Methods and Results: This phase IV, open-label, randomized, blinded near-infrared spectroscopy plus intravascular ultrasound (NIRS-IVUS) analysis, parallel-group, single-center study will enroll Japanese adults recently hospitalized for PCI with suboptimal low-density lipoprotein cholesterol (LDL-C) control (>70 mg/dL) despite stable statin therapy. Thirty patients will be randomized to receive either alirocumab or standard of care. The alirocumab group will receive alirocumab 75 mg every 2 weeks plus 10 mg rosuvastatin per day. The standard-of-care group will receive 10 mg rosuvastatin per day with dose adjustment to achieve LDL-C <70 mg/dL. Post-treatment NIRS-IVUS will be performed at week 36. The primary endpoint is the change in maximum lipid core burden index in 4-mm pullback compartments (maxLCBI[4 mm]) between baseline and week 36. Secondary endpoints include change in LCBI (lesion), angle of lipid core, plaque burden, and serum lipids and biomarkers related to atherosclerosis and inflammation. Conclusions: The study will clarify the effects of alirocumab on thin-cap fibroatheroma in patients who underwent recent PCI and who have suboptimal LDL-C control with stable statin therapy.

Efficacy of alirocumab for reducing plaque vulnerability: Study protocol for ALTAIR, a randomized controlled trial in Japanese patients with coronary artery disease receiving rosuvastatin

BackgroundAlthough a recent clinical trial demonstrated that alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, significantly reduces the incidence of acute coronary events, the impact of alirocumab on plaque stabilization remains uncertain. The Efficacy of ALirocumab for Thin-cap fibroatheroma in patients with coronary Artery disease estImated by optical coherence tomogRaphy (ALTAIR) study will investigate the effect of alirocumab on thin-cap fibroatheroma (TCFA) in Japanese patients who underwent recent percutaneous coronary intervention (PCI). Methods and designALTAIR is a phase IV, open-label, randomized, parallel-group, single-center study involving blinded optical coherence tomography (OCT) image analysis in Japanese adults hospitalized for PCI and having suboptimal control of low-density lipoprotein cholesterol (LDL-C) levels (>70mg/dL) despite statin therapy. Patients will be randomized (1:1) to the alirocumab arm (alirocumab 75mg every 2 weeks added to rosuvastatin 10mg/day) or the standard-of-care arm (rosuvastatin 10mg/day, with initiation and/or dose adjustment of non-statin lipid-lowering to achieve an LDL-C target of <70mg/dL). OCT imaging will be conducted at baseline and at week 36 (post-treatment). The primary objective is to compare the alirocumab and standard-of-care arms regarding the change in TCFA fibrous-cap thickness after 9 months of treatment. ConclusionThe outcomes of ALTAIR (ClinicalTrials.gov identifier: NCT03552432) will provide insights into the effect of alirocumab on plaque vulnerability following PCI in patients with suboptimal LDL-C control despite stable statin therapy.

Cardiovascular Risk Factors and Events in Iranian Immigrants Versus Other Immigrants from the Middle East.

We report the incidence of cardiovascular events, mortality and risk factors (diabetes and hypertension) in immigrants from Iran and in non-Iranian immigrants from the Middle East. Using population-based healthcare administrative data, all immigrants from the Middle East and the non-immigrant population of Ontario, Canada as of July 2012 were identified. Baseline differences in diabetes and hypertension prevalence were compared. Outcomes were ascertained through March 2016 and included the incidence of acute coronary events, ischemic heart disease mortality, all-cause mortality, and incident diabetes and hypertension. The study population included 55,539 Iranian immigrants, 106,926 non-Iranian Middle Eastern immigrants, and 6,967,132 non-immigrants. Non-immigrants had the highest crude baseline prevalence of diabetes and hypertension. Compared to non-immigrants, Iranian and non-Iranian Middle Eastern immigrants had significantly lower incidence rate of acute coronary events, ischemic heart disease mortality and all-cause mortality. Both Iranian and non-Iranian Middle Eastern immigrants had better cardiovascular health status than non-immigrants.

Profile of Acute Coronary Syndrome In Young People: A Hospital Based Observational Study in Western Nepal

Introduction: Acute coronary syndrome is associated with high mortality and morbidity. The incidence of acute coronary events in young is increasing.Objectives: This study aimed at evaluating the profile of acute coronary syndrome in young people in the western part of Nepal.Methodology: A retrospective study was designed. All patients admitted for acute coronary syndromes were taken and data of acute coronary syndrome involving patients aged less than 45 years from April 2015 through December 2017 were collected in a pre-structured proforma and analyzed.Results: There were 712 (489 males and 223 females with M:F=2.19:1) acute coronary syndrome patients admitted during the study period. Only 79 (12.9%) patients were patients &lt;45 years of age. Commonest risk factor of acute coronary syndrome was smoking (69%) followed by dyslipidemia (46.8%), hypertension (45.5%) and diabetes (14%). Out of 79 patients of young acute coronary syndrome, 37 (46.8%) presented with ST elevated myocardial infarction, 16 (20.2%) with non-ST elevated myocardial infarction and 26 (32.9%) with unstable angina. Most common finding in coronary angiography was single vessel disease (35%) –left anterior descending artery being the commonest (53% of single vessel disease), double vessel disease (17.7%), non-critical coronary artery disease (16.4%), triple vessel disease (7.6%) and left main (1.2%). Myocardial bridging was seen in 1.2% and 20% had normal coronaries. Comparison of males and females in different categories of acute coronary showed that males predominate significantly in ST elevated myocardial infarction (odds ratio: 2.99; p=0.03) but there was no significant difference between the males and females presenting either with Non ST elevated myocardial infarction or unstable angina.Conclusion: Acute coronary syndrome in young people was common (12.9%) particularly males with Non ST elevated myocardial infarction. Smoking was the commonest risk factor. Public awareness regarding stoppage of cigarette smoking should be focused to prevent such events especially in the young population. BJHS 2018;3(1)5 : 361-365

The gene polymorphism of beta1-adrenoreceptor, postinfarction myocardial remodeling and cardiovascular risk: is there any correlation?

The influence of gene polymorphisms ADRB1 (Ser49Gly), ADRB1 (Arg389Gly) on myocardial remodeling and 12-month prognosis of patients with ST-segment elevation myocardial infarction (STEMI) was studied. The gene polymorphisms ADRB1 (Ser49Gly) and ADRB1 (Arg389Gly) does not affect myocardial remodeling. Ser49 allele is associated with a greater incidence of acute coronary events, such as death from cardiovascular causes, repeated non-fatal myocardial infarction, unplanned coronary revascularization, hospitalization for progressive angina pectoris within a year after STEMI. The Gly49 allele and the Gly49Gly genotype are associated with a favorable prognosis within a year after STEMI. The gene polymorphism ADRB1 (Arg389Gly) does not affect the prognosis after STEMI.

Is the coronary artery calcium score associated with acute coronary events in breast cancer patients treated with radiotherapy?

Background and purposeThe main objective of this study was to test whether pre-treatment coronary artery calcium (CAC) was associated with the cumulative incidence of acute coronary events (ACE) among breast cancer (BC) patients treated with postoperative radiotherapy (RT). Material and methodsThe study population consisted of 939 consecutive female BC patients treated with RT. The association between CAC and ACE was tested using Cox-proportional hazard models. Known risk factors for ACE and the mean heart dose (MHD), collected from three-dimensional computed tomography planning data, were tested for confounding. ResultsCAC scores varied from 0 to 2,859 (mean 27.3). The 9-year cumulative incidence of ACE was 3.2%, this was significantly associated with the pre-treatment CAC score. After correction for confounders, age, history of ischemic heart disease, diabetes, Body Mass Index ≥30, MHD, hypercholesterolemia and hypertension, the hazard ratio for ACE for the low and the combined intermediate and high CAC score category were 1.42 (95%CI: 0.49–4.17; p = 0.519) and 4.95 (95%CI: 1.69–14.53; p = 0.004) respectively, compared to the CAC zero category. ConclusionsHigh pre-treatment CAC is associated with ACE in BC patients treated with postoperative RT, even after correction for confounding factors such as MHD.

Surveillance on the incidence of acute coronary events in the permanent residents aged 25 years and more from 2010 to 2012 in Zhejiang province

To survey the incidence of acute coronary events (nonfatal acute myocardial infarction and death from coronary heart disease), and analyze the trend and distribution characteristics in permanent residents aged 25 years and more across 30 surveillance regions of Zhejiang province from 2010 to 2012. Through databases matching and duplicate checking, this study incorporated the register module of coronary disease and the cause of death register module in Zhejiang provincial information system for chronic non-communicable diseases surveillance and management. The distribution of incidence was calculated across gender, age groups, regions and times. A total of 31 872 person-time acute coronary events were identified. The gender- and age-standardized mean annual incidence was 81.56 per 100 000 people in overall population, with 94.33 in males and 68.27 in females. Age-standardized incidence was 87.90 and 77.36 per 100 000 people in urban and rural area, respectively. Urban area had higher incidence rate than rural in each of the three years, and had obvious trend of increasing (P < 0.001) compared with rural area (P = 0.331). Incidence rate also increased significantly with age (P < 0.001).In addition, compared with women, men had higher incidence in each age group (all P < 0.001). The incidence rate increased rapidly in population older than 75 years old. The highest incidence was observed in age group ≥ 85 years old, with 2 371.67 and 1 873.92 per 100 000 in males and females, respectively. Apparent seasonal trend was observed for acute coronary events, which was low in summer and high in winter. Quantity and incidence for acute coronary events in residents aged 25 years and more of Zhejiang surveillance regions increased during 2010 to 2012. Male had higher incidence than female, and the incidence in urban areas was higher compared with rural areas. Residents older than 75 years old were high risk population of events, and winter was the high-occurrence season.

MicroRNA-19b functions as potential anti-thrombotic protector in patients with unstable angina by targeting tissue factor

The activation of a hemostatic system plays a critical role in the incidence of acute coronary events. Hemostatic proteins may be regulated by microRNAs (miRNAs). Microparticles (MPs) are the major carrier of circulating miRNAs. The aim of this study was to determine the potential role of miRNAs in regulating gene expression involved in the hemostatic system in patients with unstable angina (UA). MiRNA expression profiles in the plasma from patients with UA (UA group, n=9) compared with individuals with clinical suspicion of coronary artery disease (CAD) but negative angiography (control group, n=9) showed that among 36 differentially expressed miRNAs, miR-19b was the most obvious one. Using real-time PCR, 5 selected miRNA levels in plasma (UA group, n=20; control group, n=30) and plasma MPs (UA group n=6; control group n=6) were proved to be consistent with the miRNA array. Flow cytometry analysis indicated that the amounts of plasma endothelial microparticles (EMPs) were increased in UA patients (UA group, n=4) compared to controls (control group, n=4). In cultured endothelial cells (ECs), TNF-α increased miR-19b release and expression. Tissue factor (TF) was predicted to be the target of miR-19b by bioinformatics analysis. Luciferase reporter assays demonstrated that miR-19b binds to TF mRNA. Overexpression of miR-19b inhibited TF expression and procoagulant activity. This study indicates that in UA patients, the increase of miR-19b wrapped in EMPs due to endothelial dysfunction may partially contribute to the circulating miR-19b elevation and miR-19b may play an anti-thrombotic role by inhibiting the expression of TF in ECs.

Red cell distribution width in relation to incidence of coronary events and case fatality rates: a population-based cohort study

AimsHigh red cell distribution width (RDW) is a strong prognostic factor in patients with cardiovascular disease. We investigated the association between RDW and incidence of acute coronary events (CEs) and...