Incidence Of Adverse Cardiovascular Events Research Articles

0466 High Frequency Of PLMS Is Associated With Increased Risk Of Incident Adverse Cardiovascular Events And Death Among OSA Patients

0466 High Frequency Of PLMS Is Associated With Increased Risk Of Incident Adverse Cardiovascular Events And Death Among OSA Patients

Promoting effects of dual heart care mode on patients' health behaviors in perioperative period of coronary artery bypass surgery

Objective To evaluate the effects of dual heart care mode in perioperative period of coronary artery bypass grafting (CABG) surgery on improving health behavior in patients with coronary atherosclerotic heart disease. Methods A total of 131 patients with atherosclerotic heart disease who were treated in the Cardiac Surgery Department of Yancheng Third People's Hospital of Jiangsu Province from January 2011 to December 2016 were recruited by convenience sampling method. All the patients were divided into observation group (2014.1-2016.12, n=68) and control group (2011.1-2013.12, n=63) according to the admission date. The observation group was treated with dual heart path nursing mode, while the control group was treated with routine perioperative care. The scores of self-rating anxiety scale (SAS) , health promoting lifestyle profile (HPLP) and the incidence of adverse cardiovascular events were compared between the two groups. Results There was no significant difference in the incidence of anxiety, the scores of SAS and HPLP between the two group on admission (P>0.05) . Before surgery and 7 days after surgery, the incidence of anxiety and the score of SAS of the observation group were all lower than those of the control group, and the difference was statistically significant (P<0.05) . The score of HPLP of the observation group was higher than that of the control group before discharge, and the difference was statistically significant (P<0.05) . After surgery, there were 6 cases of adverse cardiovascular events in the observation group, and 17 cases in the control group. The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group, with statistical significant difference (P<0.05) . Conclusions Dual heart path nursing mode guides nurses to give standardized perioperative holistic nursing and psychological nursing according to predetermined care plan, so that the perioperative nursing work is more standardized, more secure and more humanized. In conclusion, it improves the quality of nursing overall. Key words: Coronary artery bypass, off-pump; Perioperative nursing; Health behavior; Dual heart path care

CYP2C19 and ABCB1 genetic polymorphisms correlate with the recurrence of ischemic cardiovascular adverse events after clopidogrel treatment.

This study was aimed to investigate the correlation between CYP2C19 and ABCB1 polymorphisms and the recurrence of ischemic cardiovascular adverse events in patients with coronary artery disease treated with clopidogrel. A total of 168 patients with coronary heart disease who underwent PCI operation and received clopidogrel treatment were enrolled. Dual antiplatelet therapy was applied to the treatment of patients for 2years. Thromboelastography was used to test the efficiency of blood coagulation. Polymerase chain reaction (PCR) was used to detect CYP2C19 and ABCB1 3435CT polymorphisms. One-year follow-up visit was carried out to record the incidence of cardiovascular adverse events after drug-eluting stent implantation was inset. Follow-up visit results suggested that the patients with high on-treatment platelet reactivity (HPR) had a higher recurrence rate of cardiovascular adverse events after PCI operation and clopidogrel treatment. Gene polymorphism testing results indicated that patients with CYP2C19*3 had a significantly higher incidence of HPR, whereas CYP2C19*2 and ABCB1 3435CT were not significantly correlated with HPR. Multivariable logistic regression analysis showed that CYP2C19*3 might be an independent predictive factor of post-PCI HPR. In addition, CYP2C19*3 as well as post-PCI HPR could function as independent predictive factors of cardiovascular adverse events. CYP2C19*3 polymorphism could be an important predictive factor of HPR and ischemic cardiovascular adverse events after clopidogrel treatment.

Administration of Clopidogrel in patients after percutaneous coronary intervention

Objective To provide supportive evidence for using Clopidogrel in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI). Methods From June 2015 to May 2016, 105 cases of CHD were admitted to the Department of Cardiology, the First Affiliated Hospital of Zhengzhou University.Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram was used to detect the rate of Clopidogrel resistance, and adverse cardiovascular events were recorded for 12 months after PCI.Moreover, multivariate Logistic regression was used to analyze risk factors of Clopidogrel resistance. Results A total of 98 cases completed genetic testing for CYP2C19 polymorphisms.Cases with the wild type allele, heterozygous mutations and homozygous mutations accounted for 35.7%, 57.1% and 7.1%, respectively.Compared that for wild type cases(49.6±18.5)%, the platelet inhibition rate was significantly reduced for hybrid mutation cases(38.4±15.2)% and homozygous mutation cases(24.8±12.9)%(t=3.142, 3.370; P=0.002, 0.001, respectively). Meanwhile, based on pharmacokinetic characteristics, the rates of Clopidogrel resistance for patients with the intermediate metabolic type(the heterozygous mutant type)and the slow metabolic type(the homozygous mutant type)were significantly higher than that for patients with the normal metabolic type(the wild type)(χ2=5.687, 6.363; P<0.05, respectively). Follow-up results showed that the incidences of adverse cardiovascular events for wild-type and heterozygous mutation patients were 2.9% and 3.6%, respectively, which were significantly lower than that for homozygous mutant patients(28.6%)(χ2=5.815, 6.540; P<0.05, respectively). Multivariate Logistic regression analysis showed that risk factors for clopidogrel resistance were glycosylated hemoglobin Alc level, total cholesterol and white blood cell count. Conclusions Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram can be used as an effective way to evaluate whether Clopidogrel should be used.It is important to measure the platelet aggregation inhibition rate for early detection of Clopidogrel resistance to insure appropriate drug use. Key words: Angioplasty, transluminal, Percutaneous Coronary; Clopidogrel

In-hospital outcomes of carotid endarterectomy depending on severity of contralateral lesion

To compare in-hospital outcomes of carotid endarterectomy (CEE) in patients with different lesion of contralateral internal carotid artery (ICA). There were 730 CEE procedures in patients with bilateral ICA lesion for the period 2011-2016. All patients were divided into 4 groups depending on contralateral ICA stenosis grade: group 1 - stenosis up to 60% (42.6%, n=311); group 2 - 60-90% (18.7%, n=137); group 3 - 90-99% (25.9%, n=189); group 4 - occlusion (12.7%, n=93). Endpoints were unfavorable cardiovascular events including death, myocardial infarction (MI), stroke/TIA, significant hemorrhage by BARC scale (Bleeding Academic Research Consortium). In-hospital mortality and incidence of MI, stroke/TIA were similar in all groups. However, there were no cardiovascular complications in patients with critical contralateral stenosis or occlusion. Bleeding followed by redo surgery was the most frequent complication. Overall incidence of adverse cardiovascular events did not exceed 1.23%. There was no correlation between contralateral ICA stenosis and incidence of in-hospital adverse events including death, MI, stroke/TIA. Currently, technique of CEE is well developed that is associated with low incidence of postoperative complications.

Роль нового биомаркера ST2 в оценке ремоделирования миокарда у больных хронической сердечной недостаточностью ишемического генеза с сохраненной фракцией выброса левого желудочка

1) To study the role of soluble ST2 (sST2) in evaluation of left ventricular (LV) myocardial remodeling and 2) to evaluate the predictive value of sST2 for development of adverse cardiovascular events (CVE) during 12 months following myocardial revascularization in patients with ischemic heart disease (IHD) and chronic heart failure (CHF) with preserved LV ejection fraction (EF). The study included 55 patients (42 men) with IHD and NYHA FC I-III CHF with LV EF 63 [59; 65] % aged 65 [58; 69] who were scheduled for myocardial revascularization. Echocardiographic evaluation of myocardial stress and myocardial remodeling indexes was performed for all patients. Content of sST2 was measured using enzyme immunoassay. Group 1 included patients with sST2 overexpression (≥35 ng/ml) (n=26; sST2-43.75 ng/ml) and group 2 - patients with the sST2 expression.

Efficacy and safety of rotational atherectomy combined with drug eluting coronary in the treatment of severe coronary artery calcified lesions

Objective To investigate the efficacy and safety of rotational atherectomy (RA) combined with drug eluting stent (DES) implantation in the treatment of severe coronary artery calcification, and analyze key operation points. Methods The clinical data of sixty-two patients (68 lesions) treated with RA combined with DES from January 2014 to December 2015 were retrospectively analyzed, including the characteristics of operation, postoperative curative effect, complications, incidence of major adverse cardiovascular events (MACE) during hospitalization and follow-up period. Results A total of 75 rotary blur were used in the 62 cases, with an average of(1.18±0.27)per case, the blur diameter/target vessel diameter was (0.54±0.07), the success rate of RA was 98.4% (61/62); A toal of 103 DES were implanted in 61 patients, with an average of(1.67±0.55)per case, average length was(44.5±11.8) mm, immediate DES success rate was 100%.After RA, target vessel diameter was (2.33±0.52) mm, target vessel narrow degree was (29.6±4.8)%, thrombolysis in myocardial infarction grade Ⅲ blood flow ratio was 66.2%, which have been significantly improved compared with preoperation ((0.75±0.21) mm, (82.5±7.2)%, 10.3%)(P<0.05), the target vascular lumen diameter and stenosis of target vessel continued to improve after DES ((3.26±0.43) mm, (8.7±2.1)%, 98.5%) (P<0.05); At 3 days after operation, the left ventricular ejection fraction was significantly higher than that before the operation ( (60.5±5.5)% vs.(56.8±4.7)%)(P<0.05). The incidence of complications associated with interventional procedures was 9.7%, in which 1 case with burr incarceration switched to coronary artery bypass grafting.The incidence of major adverse cardiovascular events incidence during hospitalization was 4.8%, the follow-up period was 9.0-22.0 months.The incidence of major adverse cardiovascular events incidence during follow-up was 8.2%. Conclusion DES implantation following RA in the treatment of severe coronary artery calcification can further improve blood flow and artery stenosis, medium-term efficacy is safe and reliable; standardized RA operation is the key to ensure the success of interventional therapy. Key words: Coronary artery calcification; Coronary rotational atherectomy; Drug eluting stent; Complication; Major adverse cardiovascular events

Increased Aortic Diameters on Multidetector Computed Tomographic Scan Are Independent Predictors of Incident Adverse Cardiovascular Events: The Framingham Heart Study.

Adverse aortic remodeling, such as dilation, is associated with multiple cardiovascular disease (CVD) risk factors. We sought to determine whether measures of enlarged aortic diameters improve prediction of incident adverse CVD events above standard CVD risk factors in a community-dwelling cohort. Participants from the Framingham Offspring and Third Generation Cohorts (n=3318; aged 48.9±10.3 years), who underwent noncontrast thoracic and abdominal multidetector computed tomography during 2002 to 2005, had complete risk factor profiles, and were free of clinical CVD, were included in this study. Diameters were measured at 4 anatomically defined locations: the ascending thoracic aorta, descending thoracic aorta, the infrarenal abdominal aorta, and lower abdominal aorta. Adverse events comprised CVD death, myocardial infarction, coronary insufficiency, index admission for heart failure, and stroke. Each aortic segment was dichotomized as enlarged (diameter ≥upper 90th percentile for age, sex, and body surface area) or not enlarged; the hazard of an adverse event for an enlarged segment was determined using multivariable-adjusted Cox proportional hazards models. Over a mean 8.8±2.0 years of follow-up, there were 177 incident adverse CVD events. In models adjusted for traditional CVD risk factors, enlarged infrarenal abdominal aorta (hazard ratio=1.57; 95% confidence interval=1.06 to 2.32) and lower abdominal aorta (hazard ratio=1.53; 95% confidence interval=1.00 to 2.34) were associated with an increased hazard of CVD events. Enlarged ascending thoracic aorta and descending thoracic aorta were not significantly associated with CVD events. Among community-dwelling adults initially free of clinical CVD, enlarged infrarenal abdominal aorta and lower abdominal aorta, on noncontrast multidetector computed tomography scans, are independent predictors of incident adverse CVD events above traditional risk factors alone.

Effects of dexmedetomidine on H-FABP, CK-MB, cTnI levels, neurological function and near-term prognosis in patients undergoing heart valve replacement.

This study investigated the effects of dexmedetomidine on heart-type fatty acid binding protein (H-FABP), creatine kinase isoenzymes (CK-MB), and troponin I (cTnI) levels, neurological function and near-term prognosis in patients undergoing heart valve replacement. Patients undergoing heart valve replacement were randomly allocated to remifentanil anesthesia (control group, n=48) or dexmedetomidine anesthesia (observation group, n=48). Hemodynamic parameters were measured before anesthesia induction (T1), 1 min after intubation (T2), 10 min after start of surgery (T3), and on completion of surgery (T4). Levels of plasma H-FABP, CK-MB and cTnI were measured 10 min before anesthesia induction (C1), 10 min after start of surgery (C2), on completion of surgery (C3), 6 h after surgery (C4), and 24 h after surgery (C5). S100β protein and serum neuron-specific enolase (NSE) were detected 10 min before anesthesia induction (C1), and 24 h after surgery (C5). Neurological and cardiac function was evaluated 24 h after surgery. Incidence of cardiovascular adverse events was recorded for 1 year of follow-up. There were no significant differences in the average heart rate between the two groups during the perioperative period. The mean arterial pressure in the observation group was significantly lower than control group (P<0.05). Levels of H-FABP, CK-MB and cTnI at C2, C3, C4 and C5, were significantly higher than C1, but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, levels of S100β and NSE in both groups were higher than those before induction (P<0.05), but significantly lower in the observation versus control group (P<0.05). Twenty-four hours after surgery, neurological function scores were better, and myocardial contractility and arrhythmia scores significantly lower in the observation versus control group (P<0.05 for all). After follow-up for 1 year, incidence of cardiovascular adverse events was significantly lower in the observation versus control group (P<0.05). Dexmedetomidine anesthesia can effectively maintain hemodynamic stability, reduce myocardial injury and the occurrence of cognitive dysfunction, and improve prognosis in patients undergoing heart valve replacement.

“Bringing on the light” in a complex clinical scenario: Optical coherence tomography–guided discontinuation of antiplatelet therapy in cancer patients with coronary artery disease (PROTECT-OCT registry)

Cancer patients with recently placed drug-eluting stents (DESs) often require premature dual antiplatelet therapy (DAPT) discontinuation for cancer-related procedures. Optical coherence tomography (OCT) can identify risk factors for stent thrombosis such as stent malapposition, incomplete strut coverage and in-stent restenosis and may help guide discontinuation of DAPT. We conducted a single-center prospective study in cancer patients with recently placed (1-12 months) DES who required premature DAPT discontinuation. Patients were evaluated with diagnostic coronary angiogram and OCT. Individuals with appropriate stent strut coverage, expansion, apposition, and absence of in-stent restenosis or intraluminal masses were considered low risk and transiently discontinued DAPT to allow optimal cancer therapy. Patients who did not meet all these criteria were considered high risk and underwent further endovascular treatment when appropriate and bridging with low-molecular weight heparin. The incidence of adverse cardiovascular events was assessed after the procedure and at 12 months. A total of 40 patients were included. Twenty-seven patients (68%) were considered low risk by OCT criteria and DAPT was transiently discontinued. Thirteen patients (32%) were considered high risk with one or more OCT findings: uncovered stent struts (4 patients, 10%); stent underexpansion (3 patients, 8%); malapposition (8 patients, 20%); in-stent restenosis (2 patients, 5%). The high-risk patients with uncovered stent struts and malapposition underwent additional stent dilatation. There were no cardiovascular events in the low-risk group. One myocardial infarction occurred in the high-risk group. Fourteen non-cardiac deaths were registered before 12 months due to cancer progression or cancer therapy. OCT imaging allows identification of low-risk cancer patients with DES placed who may safely discontinue DAPT and proceed with cancer-related surgery or procedures.

Intracoronary administration of tirofiban during percutaneous coronary intervention facilitates patients with acute coronary syndrome.

We assessed the efficacy and safety of tirofiban intracoronary versus intravenous administration during percutaneous coronary intervention for patients with acute coronary syndrome. The databases of PubMed, Web of Science, China National Knowledge Infrastructure, and WanFang Database were retrieved. A total of 437 articles were found, according to inclusive and exclusive criteria, 13 of which were finally included. Compared with subjects with intravenous administration, those with intracoronary administration were more likely to reach thrombolysis in myocardial infarction trial grade 3 flow (relative risk = 1.17, 95% confidence interval: 1.11–1.22), improve left ventricular ejection fraction (Standardized mean difference = 0.65, 95% confidence interval: 0.20–1.11). Intracoronary administration resulted in a reduced risk of major adverse cardiovascular events at 30-day follow-up (relative risk = 0.47, 95% confidence interval: 0.34–0.65). However, incidence of bleeding complications was not statistically significant between two groups (relative risk = 0.76, 95% confidence interval: 0.55–1.04). Intracoronary administration of tirofiban can be more effective in increasing coronary blood flow and microvascular perfusion, more effective in improving postoperative myocardial reperfusion, more significantly in reducing the incidence of adverse cardiovascular events at 30-day’s follow-up and improving the prognosis after percutaneous coronary intervention without increasing the risk of bleeding.

Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the \u201cPas-a-Pas\u201d community intervention trial

BackgroundPhysical activity is a major, modifiable, risk factor for cardiovascular disease (CVD) that contributes to the prevention and management of CVD.The aim of this study was to assess the short- and medium-term effectiveness of 9 months of a supervised physical activity program, including sociocultural activities, on CVD risk in adults.MethodsMulticentered, randomized, controlled community intervention involving 364 patients in four primary care centers. The participants were randomly assigned to a Control Group (CG = 104) or Intervention Group (IG = 260); mean age 65.19 years; 76.8% women. The intervention consisted of 120 min/week walking (396 METs/min/week) and sociocultural gathering once a month. Clinical history, physical activity, dietary intake, CVD risk factors (smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glycosylated hemoglobin and glucose) and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data. Incidence of adverse cardiovascular events and continued adherence to the physical activity were assessed 2 years after intervention.ResultsAt the end of the intervention period, in the IG relative to the CG group, there was a significant increase in physical activity (774.81 METs/min/week), a significant change during the intervention period in systolic blood pressure (−6.63 mmHg), total cholesterol (−10.12 mg/dL) and LDL-cholesterol (−9.05 mg/dL) even after adjustment for potential confounders. At 2 years after the intervention, in the IG, compared with the CG, tthe incidence of adverse cardiovascular events was significantly lower (2.5% vs. 10.5%) and the adherence to regular physical activity was higher (72.8% vs 27.2%) in IG compared to CG.ConclusionsThis community-based physical activity program improved cardiovascular health in the short- as well as medium-term, and promoted regular physical activity in the medium-term in older Spanish adults.Trials registrationClinicaltrials.gov ID NCT02767739. Trial registered on May 5th, 2016. Retrospectively registered

Efficacy and safety of preoperative Ticagrelor loading treatment in emergency percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

Objective To observe the safety and efficacy of preoperative Ticagrelor loading in emergency percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 213 patients with acute STEMI before undergoing emergency PCI were randomly divided into Ticagrelor group(n=105)receiving 180 mg Ticagrelor loading dose, then 90 mg twice daily and Clopidogrel group(n=108) receiving 600 mg of Clopidogrel, then 75 mg once daily.Emergency PCI postoperative coronary artery TIMI flow grade and the change of incidence of no reflow, platelet aggregation rate, incidence of bleeding events and the incidence of major adverse cardiovascular events(MACE)were compared between two groups. Results The rate of no-reflow was 7.6%(8 cases)in Ticagrelor group, and 16.7%(18 cases)in Clopidogrel group(χ2=3.26、P=0.030). Platelet aggregation rates at 1 h and 24 h after treatment were (55.6±4.3)% and(48.6±4.1)% respectively in Ticagrelor group, and (63.6±3.8)% and(57.6±3.6)% respectively in Clopidogrel group, which showed that platelet aggregation inhibition effect was better in Ticagrelor than in Clopidogrel(t=14.40、17.20, both P=0.001). Two groups had no major life-threatening bleeding events.Bleeding incidence had no statistically significant difference between two groups(χ2=0.14, P=0.710), and the incidence of cardiovascular adverse events showed no statistically significant difference(χ2=0.04, P=0.840)between the 2 groups. Conclusions Preoperativeticagrelor loading treatment in emergency PCI therapy for acute ST segment elevation myocardial infarction shows stronger antiplatelet aggregation function, significantly improve postoperative TIMI flow, and does not increase the incidence of bleeding events. Key words: Myocardial infarction; Angioplasty, transluminal, percutaneous coronary

Curative effect of benidipine hydrochloride on patients with coronary slow flow angina pectoris

Objective To investigate the curative effect of benidipine hydrochloride on patients with coronary slow flow angina pectoris(CSFA). Methods Sixty cases patients with CSFA were randomly divided into two groups of 30 patients each.In the control group patients were received aspirin(100 mg, 1 times/d) and atorvastatin(20 mg, 1 times/d) as basic treatment; in the treatment group patients were received basic treatment plus benidipine hydrochloride(4 mg, 1 times/d). Follow up for 6 mouths, the effectiveness rate of treatment(relief of angina and electrocardiogram of myocardial ischemia), the correction of thrombolysis in myocardial infarction(TIMI) frame count(CTFC) before and after the different intervention, and the incidence of adverse cardiovascular events were compared between the treatment group and the control group. Results The effectiveness rate of treatment in the treatment group(86.7%, 26/30) was significantly higher than that in the control group(63.3%(19/30); χ2=4.356, P=0.037). There were significant reductions of CTFC in both groups after the different intervention(treatment group: (28.43±3.95) frames vs.(18.40±3.73) frames, t=10.254, P=0.000; control group: (27.87±4.14) frames vs.(21.87±4.17) frames, t=5.580, P=0.000). There was more significant reductions of CTFC in the treatment group as compared to the control group(t=2.138, P=0.037). The incidence of adverse cardiovascular events in the treatment group(10.0%(3/30)) was significantly lower than that in the control group(33.3%(10/30), P=0.028). Conclusion Benidipine hydrochloride is effective in the treatment of CSFA. Key words: Benidipine hydrochloride; Coronary slow flow; Angina pectoris; Curative effect

Abstract P032: Increased Abdominal Aortic Diameters on Multidetector CT Scan Are Independent Predictors of Incident Adverse Cardiovascular Events: The Framingham Heart Study

Introduction: Adverse aortic remodeling, such as dilation, is cross-sectionally associated with multiple cardiovascular disease (CVD) risk factors. We sought to determine whether increased, though not necessarily aneurysmal, abdominal aortic diameters augment prediction of incident adverse CVD events above standard CVD risk factors in a community-dwelling cohort. This may be useful since the aorta is often incidentally visualized on computed tomography (CT) body scans performed for indications other than CVD risk stratification. Methods: Participants (N=3318, aged 50±10y, 51% M) from the Framingham Offspring and Third Generation Cohorts who were free of clinical CVD, had complete risk factor profiles (collected at the adjacent cycle exams), and had non-contrast, abdominal multidetector CT scans (MDCT) during 2002-2005 were included in this study. Anteroposterior (AP) and left-right (LR) diameters were measured in the infrarenal (IAA) and lower abdominal (LAA) aorta. The IAA was measured at 5 cm above the aortoiliac bifurcation and the LAA was measured at one slice level (2.5mm) above the bifurcation of the abdominal aorta into the common iliac arteries. For each segment, the greater of AP and LR diameters was used in the analyses. Adverse events comprised CVD death, myocardial infarction, coronary insufficiency, index admission for heart failure, and stroke. For each aortic segment, hazard of an adverse event for enlarged IAA or LAA diameter (enlarged was defined as ≥ upper 90 th percentile diameter for age, sex and BSA) was determined using multivariable (MV) adjusted Cox proportional hazards models. Results: Over a mean 8.8±2.0y of follow-up, there were 149 incident adverse CVD events. In multivariable models adjusted for traditional CVD risk factors, enlarged IAA was associated with greater hazard of an adverse CVD event (HR 1.62; 95% CI 1.07-2.46; p=0.022). However, the association of enlarged LAA with adverse CVD events was borderline (HR 1.56; 95% CI 0.99-2.46; p=0.054). Conclusion: Among community-dwelling adults initially free of clinical CVD, enlarged infrarenal abdominal (IAA) aortic diameter, as determined from noncontrast MDCT scans, augments prediction of incident adverse CVD events above traditional risk factors alone.

Comparison of the effect of ticagrelor and clopidogrel on platelet functions and inflammation factor in patients with acute coronary syndrome after PCI

Objective To compare the effect of ticagrelor and clopidogrel on platelet functions and inflammation factor in patients with acute coronary syndrome(ACS) after PCI. Methods 180 patients with ACS who taken PCI were chosen and randomly divided into the observation group and the control group(90 cases in each group). All patients of the two groups were given conventional treatment, and the control group received clopidogrel treatment on the basis of routine therapy preoperation and postoperation, while the observation group received clopidogrel treatment on the basis of the control group treatment.Before treatment and 24 h, 7 d, 28 d after treatment, the C-reactive protein(CRP), interleukin 6(IL-6), tumor necrosis factor alpha(TNF-α), myeloperoxidase(MPO), soluble CD40 receptor(sCD40L), platelet maximum aggregation rate(MPAR) and P2Y12 response unit(PRU) in the two groups were recorded and compared, as well as the main cerebrovascular events after six months follow-up. Results In the two groups before treatment, MPAR and PRU had no statistically significant differences(t=0.41, 0.19, all P>0.05).24h, 7d and 28d after operation, MPAR and PRU were significantly decreased compared with before treatment(t≥2.09, all P 0.05).24h after treatment, CRP, sCD40L, IL-6 and TNF-α in the two groups all significantly increased(all P<0.05), and then decreased.24h, 7d, 28d after treatment, DCRP, sCD40L, IL-6 and TNF-α in the observation group were all significantly lower than those in the control group (t=60.79, 50.30, 27.95, 12.98, 40.29, 16.73, 15.03, 7.30, all P<0.05). And, the incidence rate of cardiovascular adverse events of the observation group was 2.22%, which was significantly lower than 10.00% of the control group(χ2=5.714, P<0.05). Conclusion Compared with clopidogrel, using ticagrelor to treat ACS patients after PCI has better antiplatelet aggregation and inflammation effects, which can reduce the incidence of cardiovascular adverse events. Key words: Coronary artery disease; Ticagrelor; Blood platelets; Chemokines

Retinol-Binding Protein-Dependent Cholesterol Uptake Regulates Macrophage Foam Cell Formation and Promotes Atherosclerosis.

Retinol-binding protein 4 (RBP4) is an adipokine that plays decisive roles in glucose metabolism and insulin sensitivity. Elevated circulating RBP4 levels were reported to be associated with increased risk for cardiovascular disease, but the precise role of RBP4 in atherosclerotic diseases and its mechanisms of action remain elusive. Serum RBP4 levels of 1683 participants from South China were evaluated and the occurrence of major adverse cardiovascular events was followed up for 5 years. Apolipoprotein E-deficient mice infected with RBP4-overexpressing/silencing adenovirus, J774A.1 macrophages, and primary peritoneal macrophages from RBP4 transgenic mice were used for investigating the function of RBP4 in foam cell formation. Prospective cohort studies revealed that baseline serum RBP4 level was an independent predictor for incidence of adverse cardiovascular events after adjustment for traditional risk factors. Increased RBP4 expression was observed in atherosclerotic lesions of aortic specimens from both humans and apolipoprotein E-deficient mice, and RBP4 was localized to areas rich in macrophage foam cells. RBP4 inhibition attenuated whereas overexpression accelerated atherosclerosis progression in apolipoprotein E-deficient mice. Both treatment with exogenous recombinant RBP4 and overexpression of RBP4 gene promoted macrophage-derived foam cell formation through the activation of scavenger-receptor CD36-mediated cholesterol uptake, and RBP4 transcriptionally upregulated CD36 expression in a manner dependent on jun N-terminal kinase and signal transducer and activator of transcription 1. The tyrosine kinase c-Src was identified as the upstream regulator of jun N-terminal kinase-signal transducer and activator of transcription 1-mediated CD36-dependent cholesterol uptake, and RBP4 challenge was found to alter the membrane distribution of c-Src and cause c-Src to partition into lipid-raft membrane subdomains, where the kinase was activated. Lastly, Toll-like receptor 4, but not retinol or stimulated by retinoic acid 6, mediated the inductive effects of RBP4 in macrophages. Inclusion of RBP4 levels in traditional models enhances the predictive ability for the incidence of atherosclerotic events. RBP4 promotes atherogenesis by inducing macrophage-derived foam cell formation.

IMPACT OF RENAL DYSFUCNTION ON EARLY AND LONG TERM OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING

The study is aimed at the comparative assessment of the incidence of adverse cardiovascular events in the inhospital and long-term period in patients with initial renal dysfunction (RD) and without it after coronary artery bypass grafting (CABG). Material and methods : 720 patients with clinical manifestations of coronary atherosclerosis, operated on between 2011 and 2012, were included in the study. All patients underwent preoperative measurement of serum creatinine levels, the estimation of glomerular filtration rate (GFR) using the MDRD formula, and the risk scoring using the additive EuroSCORE model. Results : The cut-off value for GFR was set at 60 mL / min / 1.73 m2 in this study, suggesting significant impact on the patients’ outcomes after CABG. There were differences in the preoperative clinical status among the patients with and without RD. Patients with decreased GFR were more likely to have chronic kidney disease, lower extremity arterial disease, extracranial arterial disease, compared to patients with normal GFR. Patients with RD reported higher rates of adverse cardiovascular and renal complications in the in-hospital period. Patients with decreased GFR &lt; 60 mL / min / 1,73m2 were more likely to have recurrent angina and progression of chronic heart failure one year after CABG. The assessment of the impact of renal dysfunction, defined by the levels of GFR, on the development of adverse outcome reported that patients with RD in the moderate risk group were more likely to have combined adverse outcome, compared to patients without RD one year after CABG. Conclusion : The presence of renal dysfunction has an adverse impact on the in-hospital outcome after CABG. Renal dysfunction had no predictive value on long-term outcome, but it increased the incidence of higher angina class and chronic heart failure.

Outcomes of Middle Eastern Patients Undergoing Percutaneous Coronary Intervention: The Primary Analysis of the First Jordanian PCI Registry.

Aim:This is a prospective multicenter registry designed to evaluate the incidence of adverse cardiovascular events in Middle Eastern patients undergoing percutaneous coronary interventions (PCI). The registry was also designed to determine the predictors of poor outcomes in such patients.Methods and Results:We enrolled 2426 consecutive patients who underwent PCI at 12 tertiary care centers in Jordan between January 2013 and February 2014. A case report form was used to record data prospectively at hospital admission, discharge, and 12 months of follow-up. Mean age was 56 ± 11 years, females comprised 21% of the study patients, 62% had hypertension, 53% were diabetics, and 57% were cigarette smokers. Most patients (77%) underwent PCI for acute coronary syndrome. In-hospital and 1-year mortality rates were 0.78% and 1.94%, respectively. Definite or probable stent thrombosis occurred in 9 patients (0.37%) during hospitalization and in 47 (1.94%) at 1 year. Rates of target vessel repeat PCI and coronary artery bypass graft surgery at 1 year were 3.4% and 0.6%, respectively. The multivariate analysis revealed that cardiogenic shock, congestive heart failure, ST-segment deviation, diabetes, and major bleeding were significantly associated with higher risk of 1-year mortality.Conclusions:In this first large Jordanian registry of Middle Eastern patients undergoing PCI, patients treated were relatively young age population with low in-hospital and 1-year adverse cardiovascular events. Certain clinical features were associated with worse outcomes and may warrant aggressive therapeutic strategies.

Correlation of anthropometric indices with rate pressure product in healthy young adults

Background: Generalized and abdominal obesity is associated with increased incidence of adverse cardiovascular events. Rate pressure product (RPP) is an indicator of myocardial oxygen consumption, and higher value of RPP indicates myocardial work stress or cardiovascular risk. Thus, RPP can be correlated with anthropometric indices such as body mass index (BMI), waist circumference (WC), and waist–hip ratio (WHR) to evaluate the risk of adiposity on myocardial work stress. Materials and Methods: In this study, 104 young male college students were recruited as subjects. Height, weight, WC, and hip circumference were measured whereas BMI and WHR were derived by specific formula. Heart rate (HR) and blood pressure (BP) were recorded after allowing for 10 min rest and RPP was derived by specific formula. Subjects were distributed into different groups considering BMI, WC, and WHR. The analysis of parameters, i.e., systolic BP, HR, and RPP was done by one-way ANOVA, unpaired t-test, and Pearson correlation. Results: The major findings of this study suggested that obese and overweight subject RPP was more than normal participants. The subjects of WC >90 cm had higher RPP than the subjects of WC ≤90 cm. The subjects of WHR ≥0.90 had higher RPP than WHR <0.90. There was a significant positive correlation (P < 0.05) between RPP and anthropometric indices, i.e., BMI, WC, and WHR. Conclusion: Vital parameters of adiposity or obesity such as BMI, WC, and WHR may be used to evaluate the risk of myocardial work stress or cardiovascular events in correlation with RPP.