Major Adverse Coronary Events Research Articles

Low body mass index is associated with adverse cardiovascular outcomes following PCI in India: ACC-NCDR registry

ObjectiveRegistry-based prospective study was conducted to evaluate association of body mass index (BMI) with major adverse coronary events (MACE) following percutaneous coronary intervention (PCI). MethodsSuccessive patients undergoing PCI were enrolled from April‘19 to March’22 and classified into five BMI categories (<23.0,23.0-24.9,25.0-26.9,27.0–29.9, and ≥30.0 kg/m2). Clinical, angiographic features, interventions and outcomes were obtained by in-person or telephonic follow-up. Primary endpoints were (a) MACE(cardiovascular deaths, acute coronary syndrome or stroke, revascularization, hospitalization and all-cause deaths) and (b)cardiovascular deaths. Cox-proportionate hazard ratios(HR) and 95 % confidence intervals(CI) were calculated. ResultsThe cohort included 4045 patients. Mean age was 60.3 ± 11y, 3233(79.7 %) were men. There was high prevalence of cardiometabolic risk factors. 90 % patients had acute coronary syndrome(STEMI 39.6 %, NSTEMI/unstable angina 60.3 %), 60.0 % had impaired ejection fraction(EF) and multivessel CAD. Lower BMI groups (<23.0 kg/m2) had higher prevalence of tobacco use, reduced ejection fraction(EF), multivessel CAD, stents, and less primary PCI for STEMI. There was no difference in discharge medications and in-hospital deaths. Median follow-up was 24 months (IQR 12–36), available in 3602(89.0 %). In increasing BMI categories, respectively, MACE was in 10.9,8.9,9.5,9.1 and 6.8 % (R2 = 0.73) and CVD deaths in 5.1,4.5,4.4,5.1 and 3.5 % (R2 = 0.39). Compared to lowest BMI category, age-sex adjusted HR in successive groups for MACE were 0.89,0.87,0.79,0.69 and CVD deaths 0.98,0.87,0.95,0.75 with overlapping CI. HR attenuated following multivariate adjustments. ConclusionsLow BMI patients have higher incidence of major adverse cardiovascular events following PCI in India. These patients are older, with greater tobacco use, lower EF, multivessel CAD, delayed STEMI-PCI, and longer hospitalization.

Preventative Imaging with Coronary Computed Tomography Angiography.

Coronary computed tomography angiography (CCTA) is the diagnostic modality of choice for patients with stable chest pain. In this review, we scrutinize the evidence on the use of CCTA for the screening of asymptomatic patients. Clinical evidence suggests that CCTA imaging enhances cardiovascular risk stratification and prompts the timely initiation of preventive treatment leading to reduced risk of major adverse coronary events. Visualization of coronary plaques by CCTA also helps patients to comply with preventive medications. The presence of non-obstructive plaques and total plaque burden are prognostic for cardiovascular events. High-risk plaque features and pericoronary fat attenuation index, enrich the prognostic output of CCTA on top of anatomical information by capturing information on plaque vulnerability and coronary inflammatory burden. Timely detection of atherosclerotic disease or coronary inflammation by CCTA can assist in the deployment of targeted preventive strategies and novel therapeutics to prevent cardiovascular disease.

High consumption of dairy products and risk of major adverse coronary events and stroke in a Swedish population.

The association between the consumption of dairy products and risk of CVD has been inconsistent. There is a lack of studies in populations with high intakes of dairy products. We aimed to examine the association between intake of dairy products and risk of incident major adverse coronary events and stroke in the Swedish Malmö Diet and Cancer cohort study. We included 26190 participants without prevalent CVD or diabetes. Dietary habits were obtained from a modified diet history, and endpoint data were extracted from registers. Over an average of 19 years of follow-up, 3633 major adverse coronary events cases and 2643 stroke cases were reported. After adjusting for potential confounders, very high intakes of non-fermented milk (>1000 g/d) compared with low intakes (<200 g/d) were associated with 35 % (95 % CI (8, 69)) higher risk of major adverse coronary events. In contrast, moderate intakes of fermented milk (100-300 g/d) were associated with a lower risk of major adverse coronary events compared with no consumption. Intakes of cheese (only in women) and butter were inversely associated with the risk of major adverse coronary events. We observed no clear associations between any of the dairy products and stroke risk. These results highlight the importance of studying different dairy foods separately. Further studies in populations with high dairy consumption are warranted.

Long-Term Associations between Human Cytomegalovirus Antibody Levels with All-Cause Mortality and Cardiovascular Outcomes in an Australian Community-Based Cohort.

Human cytomegalovirus (HCMV) infection has been shown to increase the risk of cardiovascular events and all-cause death among individuals with clinically apparent cardiovascular disease (CVD). Whether this association exists in individuals with no history of CVD remains unclear. Serum levels of HCMV IgG antibody were measured using an ELISA in 2050 participants aged 40-80 years from the 1994/1995 Busselton Health Survey who did not have CVD at baseline. Outcomes were all-cause death, cardiovascular death, acute coronary syndrome (ACS) and major adverse coronary and cerebrovascular events (MACCE, composite of all-cause death, ACS, stroke and coronary artery revascularisation procedures). Cox proportional hazards regression analysis was used to investigate HCMV antibody levels as a predictor of death and cardiovascular outcomes during follow-up periods of 5, 10 and 20 years. At baseline, participants had a mean age of 56 years and 57% were female. During the 20-year follow-up, there were 448 (21.9%) deaths (including 152 from CVD), 139 (6.8%) participants had ACS and 575 (28.0%) had MACCE. In the fully adjusted model, levels of HCMV antibody at 20 years was associated with all-cause death (HR 1.04; 95% CI 1.00, 1.07, p = 0.037) but not with CVD death, ACS or MACCE. Levels of HCMV antibody are associated with all-cause death but not with cardiovascular outcomes in adults without pre-existing CVD.

Abstract 10068: High Pericoronary Adipose Tissue Attenuation on Coronary Computed Tomography Angiography Predicts Cardiovascular Events in Patients Without Obstructive Coronary Artery Disease

Introduction: Patients without obstructive coronary artery disease (CAD) have an increased risk of major adverse coronary events compared to patients with no coronary artery stenosis. However, risk stratification among patients without obstructive CAD has not been established. Hypothesis: This study was aimed to investigate whether pericoronary adipose tissue attenuation (PCATA) on coronary computed tomography angiography (CCTA), a novel imaging biomarker of pericoronary inflammation, is a useful predictor for cardiovascular events in patients without obstructive CAD. Methods: A total of 1183 patients without obstructive CAD undergoing clinically indicated CCTA in our institute from August 2011 and December 2016 were enrolled. Obstructive CAD was defined as luminal narrowing of ≧50% in any coronary artery. We also examined PCATA and high-risk plaque features on CCTA as well as coronary artery calcium score and pericardial fat volume. PCATA in Hounsfield units (HU) was assessed at proximal 40-mm segments of all 3 major coronary arteries. The outcome was composite cardiovascular events including cardiovascular death, acute coronary syndrome, and late coronary revascularization. Results: During a median follow-up of 23.0 months, 32 cardiovascular events were observed. Left anterior descending artery (LAD)-PCATA in patients with cardiovascular events was significantly higher than that in patients without (-64.0 ± 6.0 HU vs -66.9 ± 7.3 HU, p=0.012), whereas right coronary artery- and left circumflex artery-PCATA were not. High LAD-PCATA was significantly associated with cardiovascular events in a model that included traditional risk factors, coronary artery calcium score and adverse CTA findings, such as degree of stenosis and high-risk plaque (HR; 1.467, 95%CI; 1.03-2.09, p = 0.033). Finally, incremental prognostic value of PCATA was evaluated. After adding LAD-PCATA to a model including traditional risk factors and the adverse CTA findings, global chi-square values increased significantly from 33.0 to 37.5 (p = 0.032). Conclusions: High LAD-PCATA has incremental prognostic value over conventional risk factors and CTA findings in patients without obstructive CAD.

Urinary sodium concentration predicts time to major adverse coronary events and all-cause mortality in men with heart failure over a 28–33-year period: a prospective cohort study

BackgroundLower urinary sodium concentrations (UNa) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether UNa predicted major adverse coronary events (MACE) and all-cause mortality over 28–33 years.MethodsOne hundred and eighty men with chronic HF from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) were included. Baseline data was collected between 1984 and 1989. MACE and all-cause outcomes were obtained using hospital linkage data (1984–2017) with a follow-up of 28–33 years. Cox proportional hazards models were generated using 24-h UNa tertiles at baseline (1 ≤ 173 mmol/day; 2 = 173-229 mmol/day; 3 = 230-491 mmol/day) as a predictor of time-to-MACE outcomes, adjusted for relevant covariates.ResultsOverall, 63% and 83% of participants (n = 114 and n = 150) had a MACE event (median 10 years) and all-cause mortality event (median 19 years), respectively. On multivariable Cox Model, relative to the lowest UNa tertile, no significant difference was noted in MACE outcome for individuals in tertiles 2 and 3 with events rates of 28% (HR:0.72; 95% CI: 0.46–1.12) and 21% (HR 0.79; 95% CI: 0.5–1.25) respectively.. Relative to the lowest UNa tertile, those in tertile 2 and 3 were 39% (HR: 0.61; 95% CIs: 0.41, 0.91) and 10% (HR: 0.90; 95% CIs: 0.62, 1.33) less likely to experience to experience all-cause mortality. The multivariable Cox model had acceptable prediction precision (Harrell's C concordance measure 0.72).ConclusionUNa was a significant predictor of all-cause mortality but not MACE outcomes over 28–33 years with 173–229 mmol/day appearing to be the optimal level. UNa may represent an emerging long-term prognostic biomarker that warrants further investigation.

Small Coronary Vessel Size: A Great Need for a Standardized Definition

Small Coronary Vessel Size: A Great Need for a Standardized Definition

Effects of the COVID-19 pandemic on the management of ST-Segment elevation myocardial infarction in Indonesia: a cohort study.

Background: ST-segment elevation myocardial infarction (STEMI) is a form of acute coronary syndrome with high mortality rate. Management of STEMI should be performed as soon as possible to prevent further damage. With the emergence of coronavirus disease 2019 (COVID-19), it may face obstacles. To overcome those problems, some changes in policy focusing on fibrinolytic therapy in STEMI patients have been applied. This study aimed to identify the effects of COVID-19 in management of STEMI patients in Indonesia. Methods: This retrospective study was conducted in Dr. Cipto Mangunkusumo Hospital (CMH), the national referral center in Indonesia. We compared data between 2018 to 2019 and 2020 to 2021 as before and during COVID-19 pandemic period, respectively. We analyzed the effects of COVID-19 on STEMI patients' visits to hospital i.e., monthly hospital admission and symptoms-to-hospital, management of STEMI i.e., the strategies and time of reperfusion, and clinical outcomes of STEMI patients i.e., major adverse coronary event and mortality. Results: There was a significant statistically reduced mean of monthly hospital admissions from 11 to 7 (p = 0.002) and prolonged duration of symptoms-to-hospital during COVID-19 from 8 to 12 hours (p = 0.005). There was also a decrease in primary percutaneous coronary intervention (PPCI) procedures during COVID-19 (65.2% vs. 27.8%, p<0.001), which was accompanied by an increased number of fibrinolytic (1.5% vs. 9.5%, p<0.001) and conservative therapy (28.5% vs. 55.6%, p <0.01). Moreover, there was also a prolonged duration of diagnosis-to-wire-crossing time (160 vs. 186 minutes, p = 0.005), meanwhile, percentage of urgent PCI, door-to-needle time, and clinical outcomes were not statistically significant. Conclusions: During COVID-19 pandemic, the number STEMI patients declined in monthly hospital admission, delays in symptoms-to-hospital time, changes in type of reperfusion strategy, and delays in PPCI procedures in CMH. Meanwhile, fibrinolytic time and clinical outcomes were not affected.

The correlation between lipoprotein(a) elevations and the risk of recurrent cardiovascular events in CAD patients with different LDL-C levels

BackgroundLipoprotein(a) [Lp(a)] elevation is an important risk factor for coronary artery disease (CAD). However, the correlation between Lp(a) elevations and the risk of recurrent cardiovascular events in patients with established cardiovascular disease is controversial. Some studies have shown that Low-density lipoprotein cholesterol (LDL-C) levels may influence the association between Lp(a) and cardiovascular risk. Our study aims to explore the correlation between Lp(a) elevations and cardiovascular risk in patients with different LDL-C levels.MethodsWe included 516 patients who received coronary stents due to acute coronary syndrome (ACS) and followed them for three years. They were divided into low-Lp(a) group and high-Lp(a) group according to Lp(a) levels, and the incidence of major adverse cardiovascular events (MACE) and acute coronary events (ACE) was compared between the two groups. Then the patients were divided into three subgroups (S1:LDL-C ≥ 1.8 mmol/L; S2:1.4 ≤ LDL-C < 1.8 mmol/L; S3:LDL-C < 1.4 mmol/L). The correlation between Lp(a) elevations and cardiovascular risk in different subgroups was analysed by Cox proportional hazards models.ResultsThe incidence of MACE and ACE in the high-Lp(a) group was significantly higher than those in the low-Lp(a) group (P < 0.05). Lp(a) elevations had independent prognostic value from the statistical point of view (MACE: HR = 1.63, 95%CI = 1.12–2.38, P = 0.012; ACE: HR = 1.70, 95%CI = 1.03–2.81, P = 0.037). Subgroup analysis showed that Lp(a) elevations increased cardiovascular risk when LDL-C ≥ 1.4 mmol/L. However, this correlation no longer existed when LDL-C levels were very low (< 1.4 mmol/L) (MACE: HR = 0.49, 95%CI = 0.17–1.42, P = 0.186; ACE: HR = 0.68, 95%CI = 0.18–2.61, P = 0.570).ConclusionsLp(a) elevations are associated with recurrent cardiovascular events when LDL-C levels are high, but this association may change when LDL-C levels are extremely low. CAD patients with combination of LDL-C ≥ 1.4 mmol/L and Lp(a) elevations shall be considered as high-risk groups and require further medication for the reduction of their LDL-C levels.

Primary Percutaneous Coronary Intervention with High-Bolus Dose Tirofiban: The FASTER (Favorite Approach to Safe and Effective Treatment for Early Reperfusion) Multicenter Registry.

Objectives To investigate the safety and clinical efficacy of tirofiban during primary percutaneous coronary interventions (pPCI). Background Gp IIb/IIIa inhibitors (GPI) use during pPCI has declined over years, mainly for the increased hemorrhagic risk associated to their use and for the availability of potent, fast-acting oral antiplatelet drugs. However, several pharmacodynamic studies showed suboptimal platelet inhibition with P2Y12-blockers, such as prasugrel or ticagrelor. Methods Patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI were prospectively enrolled in a multicenter registry conducted in high-volume centers in Italy. All patients received intraprocedural tirofiban. The primary safety endpoint was the occurrence of in-hospital bleedings according to the Bleeding Academic Research Consortium definition. In-hospital major adverse coronary events (MACE, defined as death, reinfarction, stent thrombosis, and target vessel revascularization), final TIMI flow, myocardial blush grade, and ST-segment resolution were also evaluated. Results A total of 472 patients (mean age 61 ± 11 years, 83% males) were enrolled in 16 Italian centers from October 2015 to June 2018. Mean basal thrombus grade score was 3.47 ± 1.25. PCI was performed by transradial approach in 88% of patients. We observed a very low rate of 30 days BARC bleedings (2.1%) and MACE (0.8%). Complete (>70%) ST-segment resolution was observed in 67% of patients. Conclusions In the FASTER registry, the use of tirofiban during primary PCI, performed with a transradial approach in most cases, in patients with high thrombus burden was associated with high rates of complete ST-segment resolution and low rates of in-hospital bleeding and MACE.

Abstract 078: Mid- To Long- Term Follow-up Care Insufficiencies From A Cross-sectional School- Based Cholesterol Screening Program

Introduction: The CARDIAC project surveyed cardiometabolic risk and risk for familial hypercholesterolemia (FH) through a school-based program, demonstrating the importance of universal blood cholesterol screening in children. At most, 10% of FH is diagnosed in the United States. Hypothesis: We hypothesize a disconnect between identification of risk factors and the follow-up care received by those children and young adults. Methods: Between 1998 and 2016, 60,404 5th grade children had their LDL-C levels assessed through venipuncture lipid panels. Of the 638 children who had an LDL-C ≥ 160mg/dl, indicative of probable FH, 395 were identified through EPIC EHR, phone calls, and mail surveys. WVU IRB approved verbal consent by participants. Information on their current status was obtained including medical care for their cholesterol, lipid-lowering medications (LLM), other medications, and family history of cardiac-related events. Results: Out of the 395 children identified, 174 were male and 221 were female. We had follow-up lipid panels for 58. Eight participants on a LLM had a follow-up LDL-C that was 57.5 +/- 50.1 mg/dl lower than the 5th grade level. Fifty subjects not on a LLM had an LDL-C that was 27.2 +//- 48.0 mg/dl lower than baseline. No follow-up LDL-C data was available on 33 participants who received a LLM. While only 41 children had ever taken a LLM, 56 participants were taking oral contraceptive, and 63 a psychotropic medicine. Only 1 participant was enrolled in the FH Registry. No subject was found with major adverse coronary event. Conclusion: Follow-up after screening demonstrated improved lipid levels in several subjects without known medication. Many subjects were receiving oral contraceptive agents and psychotropic medicines associated with dyslipidemia, usually without follow-up lipid panels. Roughly one-third of participants had unknown mid-term course. Epic EHR for WVU Health System found 393 subjects. The inability to document ongoing medical care in addition to demonstrated lack of care received by those who had an LDL greater than 160mg/dl shows that there is insufficient follow-up care for young people with probable FH. In conclusion, the data points to areas to improve, including better education for patients with this cardiometabolic risk factor. Education of health care professionals, telemedicine, patient-driven advocacy groups, EHRs that cover large catchments, and patient communication portals promise to better focus ongoing care for persons with abnormal lipid profiles.

Incident cardiovascular disease and long-term exposure to source-specific air pollutants in a Swedish cohort

BackgroundAir pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain. MethodsParticipants were enrolled in the Malmö Diet and Cancer cohort in 1991–1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 μm and 2.5 μm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study period. Cox proportional hazards models adjusted for possible confounders was used to estimate associations between air pollution 1–5 years prior to outcomes of incident CHF, fatal myocardial infarction (MI), major adverse coronary events (MACE), and ischemic stroke. ResultsAir pollution exposure levels (mean annual exposures to PM2.5 of 11 μg/m3 and NOx of 26 μg/m3) within the cohort were moderate in terms of environmental standards. After adjusting for confounders, we observed statistically significant associations between NOx and CHF (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.01–1.22) and NOx and fatal MI (HR 1.10, 95%CI 1.01–1.20) per interquartile range (IQR) of 9.6 μg/m3. In fully adjusted models, the estimates were similar, but the precision worse. In stratified analyses, the associations were stronger in males, ever-smokers, older participants, and those with baseline carotid artery plaques. Locally emitted and traffic-related air pollutants generally showed positive associations with CHF and fatal MI. There were no associations between air pollution and MACE or stroke. Discussion/conclusionIn an area with low to moderate air pollution exposure, we observed significant associations of long-term residential NOx with increased risk of incident CHF and fatal MI, but not with coronary events and stroke.

Factors affecting the prognosis of patient with ST elevation myocardial infarction and massive thrombosis of infart related coronaty artery

Abstract Funding Acknowledgements Type of funding sources: None. Manual thrombaspiration (MT) is aimed at achieving optimal myocardial perfusion and improving prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions. Purpose. To study the factors influencing the prognosis of the disease in patients with STEMI and massive thrombosis of an infarction-associated artery, who underwent percutaneous coronary intervention in combination with MT. Materials and methods. 2-year dynamic follow-up of two groups of patients with STEMI: 175 patients undergoing percutaneous coronary intervention with MT and 175 patients with percutaneous coronary intervention without MT. Results. As a result of the logistic regression analysis by a step-by-step method of including factors (107 indicators in total) that affect the likelihood of developing major adverse coronary event (MACE), the parameters independently influencing the risk of their development were: age of patients over 65 years old (OR 1.9), history of coronary heart disease and MI (OR 3.35), diabetes mellitus (OR 2.54), ischemia time more than 180 minutes (OR 5.43), multivessel coronary artery disease (OR 2.16), absence of myocardial perfusion - MBG grade 0 (OR 39 , 82), the ratio of neutrophils to lymphocytes is more than 3 (OR 11.05). In addition, it was found that with LV ejection fraction at discharge ≤ 42%, the risk of developing BCCS after 48 months. follow-up in both groups was 17.7 times higher (p = 0.00001, OR: 17.7 CI 95%), and in patients in the MTA (+) group with LV EDV of more than 160 ml at discharge from the hospital, the risk of developing MACE after 48 months observation was 7.9 times higher (p = 0.006). Conclusion. A retrospective analysis of the data obtained showed that all patients with STEMI and massive thrombosis of an infarction-associated coronary artery who died of cardiac causes had predictors of unfavorable outcome, most of which were determined already in the first hours of myocardial infarction.

Clinical Relevance of Coronary Computed Tomography Angiography Beyond Coronary Artery Stenosis.

The capabilities of coronary computed tomography angiography (CCTA) have advanced significantly in the past decade. Its capacity to detect stenotic coronary arteries safely and consistently has led to a marked decline in invasive diagnostic angiography. However, CCTA can do much more than identify coronary artery stenoses. This review discusses applications of CCTA beyond coronary stenosis assessment, focusing in particular on the visual and quantitative analysis of atherosclerotic plaque. Established signs of visually assessed high-risk plaque on CT include positive remodeling, low-attenuation plaque, spotty calcification, and the napkin-ring sign, which correlate with the histological thin-cap fibroatheroma. Recently, quantification of plaque subtypes has further improved the assessment of coronary plaque on CT. Quantitatively assessed low-attenuation plaque, which correlates with the necrotic core of the thin-cap fibroatheroma, has demonstrated superiority over stenosis severity and coronary calcium score in predicting subsequent myocardial infarction. Current research aims to use radiomic and machine learning methods to further improve our understanding of high-risk atherosclerotic plaque subtypes identified on CCTA. Despite rapid technological advances in the field of coronary computed tomography angiography, there remains a significant lag in routine clinical practice where use is often limited to lumenography. We summarize some of the most promising techniques that significantly improve the diagnostic and prognostic potential of CCTA. · In addition to its ability to determine severity of luminal stenoses, CCTA provides important prognostic information by evaluating atherosclerotic plaque.. · Simple scoring systems such as the segment involved score or the CT-adapted Leaman score can provide more prognostic information on major adverse coronary events compared to traditional risk factors such as presence of hypertension or diabetes.. · CT signs of high-risk plaque, including positive remodeling, low-attenuation plaque, spotty calcification, and the napkin-ring sign, are significantly more likely to predict acute coronary syndromes.. · Quantitative plaque assessment can provide precise description of volume and burden of plaque subtypes and have been found to predict subsequent myocardial infarction better than cardiovascular risk scores, calcium scoring and severity of coronary artery stenoses.. · Machine learning techniques have the potential to automate risk stratification and enhance health economy, even though present clinical applications are limited. In this era of "big data" they are an exciting avenue for future research.. · Meah MN, Williams MC. Clinical Relevance of Coronary Computed Tomography Angiography Beyond Coronary Artery Stenosis. Fortschr Röntgenstr 2021; 193: 1162 - 1170.

INCIDENCE, CLINICAL PROFILE AND OUTCOME OF PATIENTS OF ACUTE CORONARY SYNDROME PRESENTING WITH VITAMIN D DEFICIENCY: A STUDY FROM NORTH INDIA

Background: Vitamin D insufficiency is believed to affect 50% of the population worldwide and the deficiency of this important vitamin has become a key health concern across the world today. Several cross-sectional and prospective studies have shown an association between low Vitamin D status and CVD and associated mortality. Aims and objectives: To study the incidence, clinical profile and major adverse coronary events in patients of acute coronary syndrome presenting with low vitamin D level and compare with patients of acute coronary syndrome with normal vitamin D level during hospital stay and 6 months post-discharge in a tertiary care hospital. Patients and Methods: A total of 117 patients with acute coronary syndrome admitted to ICCU were enrolled for the study. Vitamin D level was estimated in these patients and their family members/relative of the comparable age group for control. The incidence, clinical profile and major adverse coronary events (MACE) were studied during 5 days of their hospital stay and at 1, 3 and 6 months post-discharge. Results: We found high prevalence of vitamin D deficiency in patients with ACS as well as in the general population (controls). However, the incidence was much higher in the study population as compared to controls. We also found that the occurrence of MACE was much higher in the low vitamin D group, compared to the normal vitamin D group. Conclusion: Low vitamin D level in patients with ACS is associated with poorer outcomes (higher incidence of MACE) compared to patients having normal vitamin D levels.

Gender difference in lipoprotein(a) concentration as a predictor of coronary revascularization in patients with known coronary artery disease

Background and aimsWhether there is a gender difference in the impact of elevated plasma Lp(a) levels on recurrent coronary events remains unclear. We, therefore, evaluated the association between Lp(a) levels and the occurrence of major adverse coronary events in a large series of coronary patients (32% women). MethodsThis single-center prospective cohort study investigated 3034 consecutive patients admitted to the Coronary Care Unit with a diagnosis of coronary ischemia. According to the inclusion criteria, 2374 patients completed the follow-up (mean of 2 years). The end-points were non-fatal myocardial infarction (MI), revascularization and coronary deaths. ResultsElevated Lp(a) levels were significantly associated with rate of revascularization, but not with non-fatal MI and cardiac death. According to Lp(a) stratification (≤30 mg/dl, >30–50 mg/dl and ≥50 mg/dl), there was a significant rise of revascularization events in the whole sample of participants, with a trend in hazard ratio (HR) of 1.23 (95% CI 1.04–1.46) and a 6% rise for every 10 mg/dl increment in Lp(a) levels. This effect was mainly driven by women (HR 2.04, 95%CI 1.33–3.12) who showed a 14% incremental risk for every 10 mg/dl rise in Lp(a) levels. ConclusionsIn patients with coronary artery disease, elevated plasma Lp(a) levels were found to be a potentially useful predictor of the need for coronary revascularizations, especially in women.

High Cardiovascular Risk in Older Men with Poor Bone Microarchitecture-The Prospective STRAMBO Study.

Data on the association between bone microarchitecture and cardiovascular disease (CVD) in men are scarce. We studied the link of bone microarchitecture and areal bone mineral density (aBMD) with the risk of major adverse coronary event (MACE) in a cohort of men aged 60 to 87 years followed prospectively for 8 years. At baseline, aBMD was measured using a Hologic Discovery-A device. Bone microarchitecture was assessed at distal radius and tibia by high-resolution peripheral quantitative computed tomography (XtremeCT Scanco device). During the study, 53 men had incident MACE. The analyses were adjusted for confounders related to bone and CVD. In 813 men (53 MACEs), higher aBMD at the lumbar spine, hip, whole body, and radius was associated with lower risk of MACE (hazard ratio [HR]=0.44-0.71/SD, p < .025 to < .001). In 745 men having valid distal radius scan (47 MACEs), higher cortical density (Ct.BMD) and higher cortical thickness (Ct.Thd ) were associated with lower risk of MACE. This risk was higher in men in the lowest quintile of cortical measures versus the four upper quintiles combined (Ct.BMD: HR=2.12, 95% confidence interval [CI] 1.08-4.17, p < .025). Findings were similar in 779 men having valid distal tibia scan (48 MACEs). At both sites, higher estimated stiffness and higher failure load were associated with a lower risk of MACE. The risk of MACE was higher in men in the lowest quintile of the measures of bone strength versus four upper quintiles jointly (distal radius stiffness: HR=2.46, 95% CI 1.27-4.74, p < .01). Similar results were obtained in 638 men without prior fragility fracture and in 689 men without ischemic heart disease at baseline. Thus, in older men followed prospectively for 8 years, higher aBMD, preserved cortical bone status, and higher estimated bone strength were associated with lower risk of MACE after adjustment for relevant confounders. © 2021 American Society for Bone and Mineral Research (ASBMR).

The Gly82Ser polymorphism in the receptor for advanced glycation end products is associated with increased risk for coronary events in the general population

Abstract Background/Introduction Activation of the receptor for advanced glycation end products (RAGE) by AGEs and various immune mediators has pro-inflammatory and pro-atherogenic effects. RAGE also exists in a soluble form, sRAGE, that acts as a decoy receptor for RAGE ligands. Low plasma sRAGE has previously been found to be associated with a higher risk for major adverse coronary events (MACE) in the population. Purpose The purpose of our study was to examine the causality of the association, by exploring whether genetic variants that influence sRAGE are associated with atherosclerosis progression and incident MACE and mortality in the population. Methods We performed a genome-wide association study (GWAS) in 4192 individuals from a randomly selected subgroup of a population-based cohort. Subsequently, we explored the associations between the identified single nucleotide polymorphims (SNPs) associated with plasma sRAGE levels, baseline intima media thickness (IMT) and IMT progression in the common carotid artery during a median follow-up of 16.5 years. Further, we analyzed the prospective relationships between the sRAGE-associated SNPs, incident MACE and mortality in the entire population-based cohort of 29245 individuals. The median follow-up time from baseline was 21.2 years for MACE and 21.6 years for total mortality (time to event or end of follow-up). Results We found the minor alleles of two single nucleotide polymorphisms (SNPs), rs2070600 and rs204993, to be independently associated with lower plasma sRAGE. While rs204993 is a silent intronic mutation, rs2070600 is known to cause a Gly82Ser polymorphism in the ligand binding domain, enhancing RAGE propensity for activation. In Cox regression analyses, we found an association between the minor T (vs. C) allele of rs2070600 and increased risk for first-time MACE [HR 1.12 (1.02–1.23); P=0.023]. The association was independent of traditional cardiovascular risk factors, blood pressure-lowering medication and lipid-lowering medication at baseline. rs204993 was not associated with MACE. Neither SNP was associated with carotid IMT at baseline or with IMT progression. We did not identify any relationships with total mortality. Conclusions We demonstrate for the first time an independent link between a genetic RAGE determinant and the risk for MACE in the population. Despite both identified SNPs being associated with lower sRAGE levels, only the functional rs2070600 mutation was associated with MACE, suggesting that the link is probably due to the enhancement of RAGE function rather than to the sRAGE lowering effect. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): This study was supported by grants from the Swedish Research Council and the Swedish Heart and Lung foundation.

Treatment of de novo coronary artery lesions with paclitaxel drug coated balloons (DCB) in diabetic and non-diabetic patients

Abstract Background Drug-coated balloon has been widely used to treat In-Stent Restenosis as recommended by ESC/EACT coronary intervention guideline. However, trials of effectiveness of DCB in treating de novo lesions in diabetic patients are limited. This study will highlight the impact of DCB in diabetic patients with only de novo lesions against non-diabetic patients. Aim To compare the outcomes of Paclitaxel Drug Coated Balloon (DCB) in Diabetic and non-diabetic patients with only de novo coronary artery disease. Methods A retrospective, single center study was conducted from January 2016 till December 2018. All diabetic and non-diabetic patients underwent angioplasty to only de novo coronary artery lesions were included in the study. Patients' baseline characteristic, angiographic data, post procedural and 12 months follow-up outcomes including major adverse coronary artery event (MACE), target lesion revascularization (TLR) and myocardial infarction (MI) are compared. Results A total of 1257 patients (726 diabetic and 531 non-diabetic patients) with total 1385 de novo coronary artery lesions (791 lesions in diabetic group and 594 lesions in non-diabetic group) were included in this study. Mean age for non-diabetic group was 57.6±10.6 years and diabetic group was 59.6±9.6 years with male predominance (91.1% in non-diabetic group, n=484 and 79.2% in diabetic group, n=575). Majority of diabetic group has hypertension (83.7%, n=608 vs 58.6%, n+311), chronic renal failure (10.3%, n=75 vs 1.9%, n=10), documented coronary artery disease (55.6%, n=404 vs 47.5%, n=252) and previous coronary angioplasty 39.5%, n=287 vs 28.8%, n=153). Adequate pre-dilatation was done in both groups (98.5%, n=585 in non-diabetic group and 99.4%, n=786 in diabetic group; p=0.000). Mean DCB diameter and length were almost similar in both groups. Mean residual stenosis after DCB was 11.15±16.9% in non-diabetic group and 13.13±13.4% in the diabetic group (p=0.008). 74.6% of non-diabetic group (n=396) and 77.1% of diabetic group (n=560) were on double antiplatelet therapy for 12 months. 86.8% (n=461) of non-diabetic and 88.4% (n=642) of diabetic patients were available for follow up. MACE events were significantly higher (p=0.000) in diabetic group (4.3%, n=31) as compare to non-diabetic group (0.6%, n=3). Target lesion revascularization (TLR) and myocardial infarction (MI) was also significantly higher in diabetic group (TLR 1.4%, N=10 vs 0.6%, n=3, p=0.049; MI 2.6%, n=19 vs 0.4%, n=2, p=0.002). Conclusion Treating de novo coronary lesions in diabetic patients with DCB associated with significantly higher MACE events, target lesion revascularization and myocardial infarction. Diabetic patients appear to have a greater volume of atherosclerotic plaque and increased propensity for atherosclerotic plaque rupture. Funding Acknowledgement Type of funding source: None

66 Comparing Conventional and High Sensitivity Troponin in Predicting a Major Acute Coronary Event in Chest Pain Patients with Intact Renal Function

This study determined whether high sensitivity troponin outperformed its predecessor in predicting a major adverse coronary event (MACE) in intact kidney function patients. This retrospective cohort study of ED patients diagnosed with chest pain, angina, unstable angina, or myocardial infarction (ICD-10 codes R07, I20, I21) was conducted from January 1 to November 27, 2018 at a tertiary care academic ED center (annual volume 95,000). Inclusion criteria was intact renal function (eGFR > 60 ml/min/1.72m2). The Roche® 4th generation conventional troponin (cTnT) was used until June 12 with a negative troponin defined as <0.06ng/mL and positive as ≥0.06ng/mL. Then, the Roche® 5th generation high sensitivity troponin (hsTnT) was used with a negative troponin defined as ≤14ng/L and a positive as ≥52ng/L. All patients were then reviewed for a MACE, defined as cardiac-related mortality, need for a coronary stent or bypass graft, or clinically diagnosed myocardial infarction type 1 or 2 within 6 weeks of initial ED visit. 6360 ED chest pain patient records were reviewed. 5063 had normal renal function. Of these, 2,655 patients (51±15 years, 56% female) had conventional troponin drawn, of which 147 patients had a MACE (prevalence = 5.5%) (see Table). 53 patients had a positive cTnT, of which 44 patients developed a MACE (PPV = 83.0%). The remaining 2,602 patients had negative cTnT, of which 103 patients developed a MACE (NPV = 96%). The positive likelihood ratio (+LR) of an elevated cTnT detecting a MACE was very high at 83 (95% CI 42, 168). The negative likelihood ratio (-LR) of a negative cTnT excluding a MACE was moderate at 0.70 (95% CI 0.63, 0.78). 2174 patients (49±15 years, 59% female) had a positive or negative high sensitivity troponin, of which 99 patients had a MACE (prevalence = 4.6%). 77 patients had a positive hsTnT of which 51 developed a MACE (PPV = 66.2%). Of the 2097 patients with a negative hsTnT, 48 developed a MACE (NPV = 97.7%). The +LR of a positive hsTnT detecting a MACE was significant at 41 (95% CI 41, 63) but lower than that of cTnT. The -LR of a negative hsTnT excluding a MACE was more significant at 0.49 (95% CI 0.40, 0.60) than that of a negative cTnT. In patients with normal renal function, a negative high sensitivity troponin is more likely than conventional troponin to exclude a MACE event. However, this comes at a slight cost, as a positive high sensitivity troponin has a lesser chance to detect MACE than a positive conventional troponin.Tabled 1Intact Renal ED CP Pts# PtsSensSpecPPV (95% CI)NPV (95% CI)+LR [95% CI]-LR [95% CI]cTnT265529.9%99.6%83.0% (81.5-84.5%)96.0% (95.2-96.8%)83 [42, 168]0.70 [0.63, 0.78]hsTnT217451.5%98.7%66.2% (64.3-68.1%)97.7% (97.1-98.3%)41 [27, 63]0.49 [0.40, 0.60] Open table in a new tab