Multiple Coronary Vessel Research Articles

Intra-aortic balloon pump in patients with extracorporeal cardiopulmonary resuscitation after cardiac arrest caused by acute coronary syndrome

BackgroundThis study evaluated the association between intra-aortic balloon pump (IABP) use in patients with out-of-hospital cardiac arrest (OHCA) caused by acute coronary syndrome (ACS) who received extracorporeal cardiopulmonary resuscitation (ECPR) and 30-day outcomes. MethodsThis study was a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter registry study involving 36 participating institutions in Japan. Patients with cardiac arrest caused by ACS who received ECPR were divided into two groups depending on whether or not they received IABP. The primary outcome was 30-day survival. Subgroup analysis was performed to detect what type of patients were mostly associated with improved outcomes. ResultsOf 2,157 patients registered in the SAVE-J II study, 877 patients were enrolled in this study, 702 patients in the IABP group and 175 patients in the non-IABP group. Multivariable logistic regression analysis did not reveal a significant difference in 30-day survival (OR 1.37, 95% CI 0.91–2.07, p = 0.13). In the subgroup analysis, 30-day survival among patients without percutaneous coronary intervention (PCI) and stenosis of multiple coronary vessels were associated with IABP use. ConclusionsIABP use in patients with OHCA with ACS who received ECPR is not associated with 30-day survival. The use of IABP in patients who did not have PCI and have multiple coronary vessel stenoses warrants further study.

In vivo validation of intra-coronary absolute flow measurements and comparison of reliability between different microvascular indices and the microvascular resistance reserve

Abstract Background Coronary microvascular dysfunction plays a major role in patients with cardiac ischemia without flow limiting epicardial coronary stenosis, takotsubo cardiomyopathy, aortic valve stenosis and heart failure with preserved ejection fraction. In clinical practice, the index of microvascular resistance (IMR) and coronary flow reserve (CFR), and more recently the absolute coronary blood flow (ABF), absolute coronary resistance (ACR) and the microvascular resistance reserve (MRR) are used as parameters to measure resistance and flow using continuous coronary thermodilution. Purpose Firstly, to validate ABF measured with continuous coronary thermodilution in vivo against epicardial doppler-measured flow. Secondly, to assess reliability and reproducibility in-vivo of different microvascular indices. Methods For the purpose of this study coronary measurements were conducted in two large animal models and in patients, all with the appropriate ethical committee approval. For the first part of the study, fourteen sheep underwent repeated paired measurements of ABF and ACR (with use of continuous thermodilution) with different saline infusion speeds, as well as IMR, CFR and MRR in multiple coronary vessels. Seven additional sheep underwent these measurements while having simultaneous measurements with epicardial coronary flow probes (gold standard) in an open-chest model. The epicardial flow probes were placed on the proximal left anterior descending and circumflex artery. Maximal hyperemia was induced with adenosine (CFR and IMR) or infusion of saline at a rate of 30ml/min (ABF, ACR and MRR). For the second part of the study, in 41 patients receiving routine microvascular assessment, IMR and CFR measurements were duplicated by a single operator, after re-calibration, to assess the reproducibility of the measurement. The combined animal and human data resulted in the analysis of 408 coronary measurements made in 88 coronary vessels during 65 heart catheterizations. Results In sheep, ABF measured with continuous thermodilution (with saline infusion speeds from 5ml/min to 30ml/min) was accurate when compared with epicardial flow measurements. (Table 1, Fig 1A) Notably, the continuous thermodilution measurement had the tendency to slightly overestimate ABF. (Table 1, Fig 1B) The two methods were equivalent within 15% (Two one-sided test: mean difference: -8.73%; 95% CI: -14.40 to -3.06%, p= 0.016). When comparing test-retest reproducibility between the indices, CFR performed the worst while ACR and MRR performed the best. MRR had a significantly better reproducibility than the IMR. (Table 1, Fig 1C). Conclusion ABF can accurately be determined by continuous coronary thermodilution. MRR and ACR have a significantly superior reliability and reproducibility compared to IMR and CFR. Unlike ACR, MRR is not vessel or territory-size dependent and is therefore the index of choice for future research and clinical assessment of the microcirculation.

Coronary Artery Calcium Dispersion and Cause-Specific Mortality

Coronary artery calcium (CAC) measures subclinical atherosclerosis and improves risk stratification. CAC characteristics-including vessel(s) involved, number of vessels, volume, and density-have been shown to differentially impact risk. We assessed how dispersion-either the number of calcified vessels or CAC phenotype (diffuse, normal, and concentrated)-impacted cause-specific mortality. The CAC Consortium is a retrospective cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC scoring. This study included patients with CAC >0 (n=28,147). CAC area, CAC density, and CAC phenotypes (derived from the index of diffusion=1 - [CAC in most concentrated vessel/total Agatston score]) were calculated. The associations between CAC characteristics and cause-specific mortality were assessed. The participant details included (n=28,147): mean age 58.3 years, 25% female, 89.6% White, and 66% had 2+ calcified vessels. Diabetes, hypertension, and hyperlipidemia were predictors of multivessel involvement (p <0.001). After controlling for the overall CAC score, those with 4-vessel CAC involvement had more CAC area and less dense calcifications than those with 1-vessel. There was a graded increase in all-cause and cardiovascular disease (CVD)- and CHD-specific mortality as the number of calcified vessels increased. Among those with ≥2 vessels involved (n=18,516), a diffuse phenotype was associated with a higher CVD-specific mortality and had a trend toward higher all-cause and CHD-specific mortality than a concentrated CAC phenotype. Diffuse CAC involvement was characterized by less dense calcification, more CAC area, multiple coronary vessel involvement, and presence of certain traditional risk factors. There is a graded increase in all-cause and CVD- and CHD-specific mortality with increasing CAC dispersion.

Abstract 10808: Prognostic Significance of Obstructive Coronary Artery Disease in Patients Admitted with Acute Decompensated Heart Failure: The ARIC Study Community Surveillance

Background: Coronary artery disease (CAD) is a common cause of heart failure (HF). Whether the extent of coronary artery stenosis differs by HF type or prognosis for patients admitted with acute decompensated heart failure (ADHF) is uncertain. Methods: The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of adjudicated HF in 4 US areas from 2005-2014. Medical histories were abstracted from the hospital record. Obstructive CAD was defined as &gt; 49% stenosis in the left main coronary artery or &gt;74% stenosis in the other major coronary arteries. Associations between obstructive CAD and 28-day mortality were analyzed separately for heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF), adjusting for age, race, sex, year of admission, and coronary revascularization procedures. All analyses were weighted by the inverse of the sampling probability. Results: A total of 5115 patients admitted with ADHF underwent coronary angiography during the hospital visit (mean age = 72, 45% women, 28% Black, 30% HFpEF). Obstructive CAD was more prevalent with HFrEF ( Figure 1 ), whether at the left main coronary artery (16% vs 12%), left anterior descending artery (50% vs 35%), left circumflex artery (42% vs 34%), right coronary artery (45% vs 34%), or multiple coronary vessels (47% vs 34%). A similar proportion of patients with obstructive CAD underwent revascularization, irrespective of HF type (HFrEF: 55%, HFpEF: 61%). After adjustments, obstructive CAD (in any vessel) was associated with higher 28-day mortality, both for HFrEF (OR: 3.21; CI: 1.91 - 5.97) and HFpEF (OR: 3.62; 95% CI: 1.43 - 9.18) with no significant interaction by HF type ( P -interaction = 0.9). Conclusion: Patients hospitalized with ADHF and coexisting obstructive CAD are at greater risk of short-term mortality, irrespective of the HF type, warranting the need for effective interventions as well as secondary preventive measures in this population.

Infarction-Related Cardiogenic Shock- Diagnosis, Monitoring and Therapy–A German-Austrian S3 Guideline.

The second edition of the German-Austrian S3 guideline contains updated evidence-based recommendations for the treatment of patients with infarction-related cardiogenic shock (ICS), whose mortality is several times higher than that of patients with a hemodynamically stable myocardial infarction (1). In five consensus conferences, the experts developed 95 recommendations-including two statements-and seven algorithms with concrete instructions. Recanalization of the coronary vessel whose occlusion led to the infarction is crucial for the survival of patients with ICS. The recommended method of choice is primary percutaneous coronary intervention (pPCI) with the implantation of a drug-eluting stent (DES). If multiple coronary vessels are diseased, only the infarct artery (the "culprit lesion") should be stented at first. For cardiovascular pharmacotherapy-primarily with dobutamine and norepinephrine-the recommended hemodynamic target range for mean arterial blood pressure is 65-75 mmHg, with a cardiac index (CI) above 2.2 L/min/m2. For optimal treatment in intensive care, recommendations are given regarding the type of ventilation (invasive rather than non-invasive, lungprotective), nutrition (no nutritional intake in uncontrolled shock, no glutamine supplementation), thromboembolism prophylaxis (intravenous heparin rather than subcutaneous prophylaxis), und further topics. In case of pump failure, an intra-aortic balloon pump is not recommended; temporary mechanical support systems (Impella pumps, veno-arterial extracorporeal membrane oxygenation [VA-ECMO], and others) are hemodynamically more effective, but have not yet been convincingly shown to improve survival. Combined cardiological and intensive-care treatment is crucial for the survival of patients with ICS. Coronary treatment for ICS seems to have little potential for further improvement, while intensive-care methods can still be optimized.

Abstract 13379: Cause-specific Mortality by Diffuse Coronary Artery Calcium Phenotypes: Results From the Coronary Artery Calcium Consortium

Objectives: We sought to assess characteristics of diffuse coronary artery calcium (CAC) phenotypes and their associations with cause-specific mortality. Background: CAC is a measure of subclinical atherosclerosis and improves risk stratification. CAC characteristics including vessel involvement, number of vessels, volume, and density have been shown to differentially impact risk. Less is known about clinical predictors of a diffuse CAC phenotype and its impact on cause-specific mortality. Methods: The CAC Consortium is a retrospective, multi-site cohort of 66,636 participants without CHD who underwent CAC scoring. Risk factor data were collected at enrollment or scan. Participants with CAC&gt;0 were included—CAC area, CAC density, and the CAC index of diffusion (the percentage of total CAC in the vessel with the highest CAC score) were calculated and the association between CAC characteristics and CVD- and CHD-specific mortality was assessed. Results: In 28,147 study participants (mean age 58.3 years, 25% female, and 89.6% white), ~66% had ≥2 calcified vessels. Diabetes, hypertension, and hyperlipidemia were predictors of multivessel involvement (p&lt;0.001). After controlling for CAC score, those with 4-vessel CAC had more CAC area involved with less dense calcification compared to those with 1-vessel involvement. After adjustment, those with CAC score 1-299 had a graded increase in CVD- and CHD-specific mortality with increasing vessel number compared with 1-vessel CAC. No difference was seen for individuals with CAC &gt;300. Among those with multivessel CAC involvement, all-cause survival was significantly worse in diffuse compared to other phenotypes. Conclusion: Diffuse CAC involvement was characterized by less dense calcification, more CAC area, multiple coronary vessel involvement, and presence of certain traditional risk factors. Multivessel CAC is associated with increased CVD- and CHD-specific mortality, particularly among CAC scores 1-299.

Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: An observational study.

There is limited evidence of non-ST elevation acute coronary syndrome (NSTE-ACS) in patients aged 80 or older in Vietnam. To describe the clinical characteristics of patients aged≥80 with NSTE-ACS in Vietnam, and to examine the effect of percutaneous coronary intervention (PCI) on adverse outcomes. Consecutive patients aged ≥80 with a diagnosis of NSTE-ACS admitted to two tertiary hospitals in Vietnam from 12/2018 to 06/2019 were recruited. The major outcomes were: (1) the composite of all-cause mortality, recurrent myocardial infarction and stroke, (2) re-admission rate during 3 months. Cox proportional-hazards regressions were conducted to examine the impact of PCI on the study outcomes, with results presented as hazard ratios (HR) and 95% confidence intervals (CI). There were 120 participants, mean age 84.8 ± 3.8, 50% were female. Angiography and PCI were performed in 42 participants (35.0%). Most of the participants had multimorbidity and multiple coronary vessel disease. Compared to participants who did not receive PCI, participants who received PCI had significantly lower rates of adverse events during hospitalisation and during 3 months of follow up. Cox proportional hazards models adjusted to age and GRACE score show that PCI was significantly associated with reduced the composite outcome of all-cause mortality, recurrent myocardial infarction and stroke during 3 months follow-up (adjusted HR 0.32, 95%CI 0.12-0.86). PCI was also associated with reduced re-admission. The rate of PCI was low in the very elderly patients with NSTE-ACS in this study, although PCI was significantly associated with reduced adverse outcomes.

P6603The predictive role of T786C single nucleotide polymorphism in endothelial no-synthase gene in late left ventricular remodeling after ST-segment elevation myocardial infarction

Abstract Introduction Endothelial NO-synthase (eNOS) is constitutive enzyme, which is expressed in mature endothelial cells and promotes direct vascular dilatation. Single nucleotide polymorphism (SNP) of T786C in eNOS gene may influence on adverse cardiac remodeling after ST-elevation myocardial infarction (STEMI). Purpose To investigate possible associations between SNP T786C in eNOS gene and adverse cardiac remodeling after STEMI Methods 177 acute STEMI patients treated with primary and facilitate percutaneous coronary intervention that were admitted to intensive care unit of a Therapy National Institute were enrolled in the study. Anthropometry, cardiovascular risk assay, coronary angiography, echocardiography and biomarkers' measure were performed at baseline. The DNA extraction was performed with a commercial kit using real-time polymerase chain reaction PCR. All procedures performed in the study involving human participants were in accordance with the ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and approved by the local ethics committee (Protocol No. 8, 29.08.2016). Written informed consent was obtained from each patient. Results There were correlations between 786CC polymorphism in eNOs gene and adverse cardiac remodeling (r=0.48; p=0.001), LDL cholesterol (r=0.32; p=0.012), type 2 diabetes mellitus (r=0.30; p=0.042), diastolic BP (r=−0.26; p=0.048), unstable angina prior to STEMI (r=0.25; p=0.047) and total quantity of complicated STEMI (r=0.23; p=0.042). Additionally, there were not significant relations between 786CC polymorphism in eNOs gene and multiple coronary vessel injury, STEMI localization, levels of circulating biomarkers of myocardial injury, and amount of damaged coronary arteries. Using univariate and multivariate regressive logistic analysis we found that 786CC genotype of eNOS was independent predictor for late adverse LV remodeling (β-coefficient = 1.57342; odds ratio = 4.8231; 95% confidence interval = 1.5349–15.1552; p=0.0071). Conclusions The polymorphism 786CC in eNOs gene was found as an independent predictor for late adverse cardiac remodeling after STEMI. Acknowledgement/Funding None

Structural and Functional Characterization of the Adult Giant Danio Heart

Cardiovascular diseases remain that number one cause of death in the northern hemisphere and are increasing globally in developing economies. In spite of evolutionary separation between fishes and mammalian, the use of non‐mammalian model species has significantly increased our understanding of cardiac diseases. We have recently described the growth and cardiovascular development of the Devario malabaricus, a giant danio (GD) species closely related to the zebrafish. We hypothesize that the adult GD heart can serve as a robust non‐mammalian model for in vivo studies of cardiac biology. Using immunostaining, transmission electron microscopy, scanning block‐face electron microscopy, and Doppler, we have characterized the anatomical and functional characteristics of the adult GD heart. First, we found that the adult giant danio possesses a thick and highly vascularized compact heart. Second, the GD heart possesses a junctional region populated with a fibroblasts network similar to that observed in zebrafish. Third, multiple large coronary vessels investing the compact myocardium are connected to and continuous with atrioventricular (AV) canal lumen. In addition, the AV canal and bulbus are highly innervated, suggesting complex regulation in heart function. Moreover, we demonstrate that their cardiac function can be measured using Doppler flow velocity. These studies along with previous findings support the GD as a robust model for the study of cardiac biology.Support or Funding Information1R15HD084262‐01, Buehler Family FoundationThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Biomarker-based Prognostication of Adverse Cardiac Remodeling after STEMI: the Role of Single Nucleotide Polymorphism T786C in Endothelial NO-synthase gene

Background : Endothelial NO-synthase (eNOS) is constitutive enzyme, which expresses in mature endothelial cells and promotes direct vascular dilatation. Single nucleotide polymorphism (SNP) of T786C in eNOS gene may influence on adverse cardiac remodeling after ST-elevation myocardial infarction (STEMI). Purpose of the study was to investigate possible associations between SNP Т786С in eNOS gene and adverse cardiac remodeling after STEMI. Methods: 177 acute STEMI patients treated with percutaneous coronary intervention and thrombolysis that were admitted to intensive care unit of GI “L.T.Malaya TNI NAMSU” were enrolled in the study. Anthropometry, cardiovascular risk assay, coronary angiography, echocardiography and biomarkers’ measure were performed at baseline. The DNA extraction was performed with a commercial kit using real-time polymerase chain reaction PCR. Results: There were correlations between 786СС polymorphism in eNOs gene and adverse cardiac remodeling (r=0.48; P=0.001), LDL cholesterol (r=0.32; P=0.012), type 2 diabetes mellitus (r=0.30; P=0.042), diastolic BP (r=-0.26; P=0.048), unstable angina prior to STEMI (r=0.25; P=0.047) and total quantity of complicated STEMI (r=0.23; P=0.042). Additionally, there were not significant relations between 786СС polymorphism in eNOs gene and multiple coronary vessel injury, STEMI localization, levels of circulating biomarkers of myocardial injury, and amount of damaged coronary arteries. Using univariate and multivariate regressive logistic analysis (Table 4) we found that 786СС genotype of eNOS was independent predictor for late adverse LV remodeling (β-coefficient=1.57342; odds ration =4.8231; 95% confidence interval = 1.5349 – 15.1552; P=0.0071). In conclusion, the polymorphism 786СС in eNOs gene was found as an independent predictor for late adverse cardiac remodeling after STEMI

Clinical Relevance of Functionally Insignificant Moderate Coronary Artery Stenosis Assessed by 3-Vessel Fractional Flow Reserve Measurement.

BackgroundUnderstanding of the risk conferred by functionally insignificant lesions in multiple coronary vessels is limited. We investigated the prognostic implications of coronary artery disease (CAD) based on 3‐vessel fractional flow reserve (FFR).Methods and ResultsA total of 1,136 patients underwent FFR measurement in the 3 major epicardial arteries. We defined vessels with “Moderate CAD” as vessels with FFR, 0.81 to 0.87. Patients were classified into Group 1: No apparent CAD (FFR>0.87 in all 3‐vessels); Group 2: Single‐vessel moderate CAD; Group 3: Multivessel moderate CAD; and Group 4: Functionally significant CAD (FFR≤0.80) in any vessel. The primary end point was 2‐year major adverse cardiac events, a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization. Forty‐three percent of patients had moderate CAD (Group 2: 403/1136, 35.5%; Group 3: 84/1136, 7.4%). The 2‐year risk of major adverse cardiac events was not significantly different between patients with single‐vessel moderate CAD and no apparent CAD (2.6 versus 2.6%; HR, 1.1; 95% confidence interval, 0.4%–2.8%; P=0.89). However, patients with multivessel moderate CAD were at significantly higher risk than Group 1 (7.4 versus 2.6%; hazard ratio, 3.3; 95% confidence interval, 1.1%–9.8%; P=0.03). The risk of major adverse cardiac events in patients with multivessel moderate CAD was comparable to that of patients with functionally significant CAD (hazard ratio, 1.2; 95% confidence interval, 0.5%–3.0%; P=0.67). In a multivariable regression model, multivessel moderate CAD was an independent predictor of greater risk of 2‐year major adverse cardiac events.ConclusionsGlobal physiologic assessment with FFR measurement of 3 vessels can identify multivessel moderate CAD. The prognostic implication of multivessel moderate CAD appears comparable to that of functionally significant CAD.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.

Second vs. First generation drug eluting stents in multiple vessel disease and left main stenosis: Two‐year follow‐up of the observational, prospective, controlled, and multicenter ERACI IV registry

To compare second generation drug eluting stents (2DES) with first generation (1DES) for the treatment of patients (pts) with multiple coronary vessel disease (MVD). Although 2DES improved safety and efficacy compared to 1DES, MVD remains a challenge for percutaneous coronary interventions. ERACI IV was a prospective, observational, and controlled study in pts with MVD including left main and treated with 2DES (Firebird 2, Microport). We included 225 pts in 15 sites from Argentina. Primary endpoint was the incidence of major adverse cardiovascular events (MACCE) defined as death, myocardial infarction (MI), cerebrovascular accident (CVA) and unplanned revascularization; and to compare with 225 pts from ERACI III study (1DES). PCI strategy was planned to treat lesions ≥70% in vessels ≥ 2.00 mm, introducing a modified Syntax score (SS) where severe lesions in vessels < 2.0 mm and intermediate lesions were not scored. Baseline characteristics showed that compared to ERACI III, ERACI IV pts had higher number of diabetics (P = 0.02), previous revascularization (P = 0.007), unstable angina IIb/IIIc (P < 0.001) and three vessels/left main disease (P = 0.003). Modified SS was 22.2 ± 11. At 2 years of follow-up ERACI IV group had significantly lower incidence of death+ MI + CVA, (P = 0.01) and MACCE (P = 0.001). MACCE rate was similar in diabetics, (5.8%) and nondiabetics (7.0%). After performing a matched propensity score, MACCE remain significantly lower in ERACI IV (P = 0.005). This registry showed that 2DES in MVD has a remarkable low incidence of MACCE in unadjusted and adjusted analysis. © 2016 Wiley Periodicals, Inc.

High event rate after a first percutaneous coronary intervention in patients with diabetes mellitus: results from the Swedish coronary angiography and angioplasty registry.

Patients with diabetes mellitus have reduced longevity after acute coronary syndromes and revascularization. However, knowledge of the long-term complication rates and patterns from an everyday life setting is lacking. Consecutive patients undergoing percutaneous coronary intervention included in the Swedish Coronary Angiography Angioplasty Registry (SCAAR) between 2006 and 2010 and with no previous revascularization were prospectively followed up for combined cardiovascular events (first of all-cause mortality, myocardial infarction, stroke, and heart failure) until December 31, 2010. The mean follow-up period was 920 days (SD, 530 days). Differences in background and procedural characteristics were adjusted for in a multivariate Cox regression model. Of 58 891 patients, mean age 67 years, 19% had diabetes mellitus; 27% of them were on diet treatment, 33% on oral glucose lowering, and 40% on insulin treatment. At admission, cardiovascular risk factors, multiple coronary vessel, and left main stem disease were more frequent in patients with diabetes mellitus and their revascularization was less often complete. The adjusted risk for combined cardiovascular events was higher in patients on insulin (hazard ratio [95% confidence interval], 1.63 [1.55-1.72]), on oral treatment (1.23 [1.15-1.31]), and on diet alone (1.21 [1.12-1.29]) compared with patients without diabetes mellitus. Insulin-treated patients ran an increased risk of restenosis (1.54 [1.39-1.71]) and stent thrombosis (1.56 [1.25-1.96]). The prognosis after a first percutaneous coronary intervention is more severe in patients with diabetes mellitus, in particular, in patients treated with insulin, with higher rates of mortality, cardiovascular events, and stent thrombosis over the following 5 years.

Hemorheological parameters in coronary artery disease detected by multi-slice CT

Epidemiological studies have confirmed that hemorheological parameters are primary risk factors in CAD; and their alterations in CAD have been described. We aimed to investigate both macro- and microrheological properties of blood in patients with CAD. The data of 121 patients (mean age: 58.8 ± 9.6 years) undergoing coronary CT were analyzed. Blood samples were obtained right before CT examinations. Hematocrit (Hct), plasma (PV) and apparent whole blood viscosity (WBV), red blood cell (RBC) aggregation and RBC deformability were measured. Patients were classified into four groups according to their coronary vessel state: Negative group (n = 32, mean age: 56.8 ± 11.1 years) without any coronary stenosis or atherosclerotic lesion and zero calcium-score, Non-significant group (n = 27, mean age: 59.2 ± 7.5 years) below 40% area stenosis, Singlevessel group (n = 32, mean age: 58.8 ± 8.5 years) over 40% area stenosis or history of PCI or CABG on one coronary vessel, Multi-vessel group (n = 30, mean age: 62.1 ± 8.4 years) with over 40% area stenosis or history of PCI or CABG on multiple coronary vessels. Hct was significantly (p 0.05) differences were observed in PV. RBC aggregation was significantly (p < 0.05) increased in the Multi-vessel group compared to the Negative group. RBC deformability showed a decreasing tendency with the increasing number of atherosclerotic vessels. Our results indicate that hemorheological variables are deteriorated in patients with CAD established by coronary CT, which is more pronounced in severe coronary disease.

Admission insulin resistance index in non diabetic patients with acute coronary syndrome; clinical and angiographic features

The clinical implication of insulin resistance has extended beyond diabetes mellitus to include ischemic heart disease, dyslipidemia, hypertension and features of metabolic syndrome. Non diabetic patients with acute coronary syndrome and elevated admission insulin resistance index (AIRI) may have certain clinical angiographic and therapeutic strategies. It was aimed to illustrate the value of AIRI in non diabetic patients with acute coronary syndrome (ACS) and identify the angiographic CAD severity in relation to AIRI. Cross sectional study. Includes 120 non diabetic patients presenting with acute chest pain who were admitted to the Coronary Care Unit. Admission glucose and insulin concentration were measured and the AIRI were calculated. ECG was carried out and the cases were grouped as; unstable angina (UA) (40 cases) and acute myocardial infarction (AMI) (40 cases). They were compared to 40 cases of the stable angina (SA) group and the control group (40 cases). The studied cases were examined clinically stressing on the other criteria of insulin resistance syndrome. The following laboratory tests were undertaken including random plasma glucose, HBA1-c, lipid profile, cardiac enzymes (CK-MB, LDH, troponin T). The angiographic study was carried out for patients of each diseased group and 20 cases of the stable angina group. AIRI was significantly elevated in AMI (3.9 ± 0.1) and UA (3.01 ± 0.2) when compared to the group of SA and the control group. AIRI was significantly higher in AMI when compared to the UA group. Coronary angiography revealed one coronary vessel involvement in 10%, 20%, and 10% of SA, UA and AMI, respectively. While, two vessel involvement was detected in 0%, 30%, and 60% of SA, UA and AMI, respectively. Three coronary vessel disease was not detected in SA but was evident in 5% of UA and 30% of AMI. The relation of AIRI of the studied groups by the calculated Chi-square revealed a significant elevation of AIRI in AMI and UA. Cases with three vessel affection demonstrated higher AIRI. Elevated AIRI can predict coronary artery events in non diabetic patients with acute chest pain. Multiple coronary vessel involvement is common in such cases and suitable planned invasive therapeutic strategies have to be considered.

Admission insulin resistance index in nondiabetic patients with acute coronary syndrome: clinical and angiographic features

Abstract Background The clinical implication of insulin resistance has extended beyond diabetes mellitus to include ischemic heart disease, dyslipidemia, hypertension, and features of metabolic syndrome. Nondiabetic patients with acute coronary syndrome and elevated admission insulin resistance index (AIRI) may have certain clinical angiographic and therapeutic strategies. Objectives The study aimed to illustrate the value of AIRI in nondiabetic patients with acute coronary syndrome and identify the angiographic coronary artery disease severity in relation to AIRI. Study design This study was cross-sectional in design. Patients and methods This study included 120 nondiabetic patients presenting with acute chest pain who were admitted to the coronary care unit. Admission glucose and insulin concentrations were measured and the AIRI was calculated. ECG was carried out and the patients were grouped as follows: those with unstable angina (UA) (40 cases) and those with acute myocardial infarction (AMI) (40 cases). They were compared with 40 patients with stable angina (SA) and a group of controls (40 individuals). The studied participants were examined clinically stressing on the other criteria for insulin resistance syndrome. The following laboratory tests were undertaken, including random plasma glucose, HBA1-c, lipid profile, cardiac enzymes (CK-MB, LDH), and troponin T. An angiographic study was carried out for patients from each diseased group and for 20 patients who had suffered a first attack in the SA group. Results AIRI was significantly elevated in the AMI (3.9 ± 0.1) and UA (3.01 ± 0.2) groups when compared with the SA and control groups. AIRI was significantly higher in the AMI group when compared with the UA group. Coronary angiography revealed one coronary vessel involvement in 10, 20, and 10% of patients in the SA, UA, and AMI groups, respectively, whereas two-vessel involvement was detected in 0, 30, and 60% of patients in the SA, UA, and AMI groups, respectively. Three-coronary-vessel disease was not detected in the SA group but was evident in 5% of UA and 30% of AMI patients. The relation of AIRI in the studied groups on the basis of the χ2-test revealed significant elevation of AIRI in the AMI and UA groups. Cases with three-vessel affection demonstrated higher AIRI. Conclusion Elevated AIRI can predict coronary artery events in nondiabetic patients with acute chest pain. Multiple coronary vessel involvement is common in such cases and suitable planned invasive therapeutic strategies have to be considered.

Chemerin: A Novel Link between Inflammation and Atherosclerosis?

Chemerin: A Novel Link between Inflammation and Atherosclerosis?

Role of the fractalkine receptor CX3CR1 polymorphisms V249I and T280M as risk factors for early‐onset coronary artery disease in patients with no classic risk factors

Objectives. CX3CR1 is a monocyte chemokine receptor and adhesion molecule. Two CX3CR1 mutations, V249I and T280M, reportedly decrease coronary artery disease (CAD) risk independent of established risk factors. An I249 protective effect is attributed to reducing CX3CR1 binding to fractalkine, its ligand. Material and methods. We examined the frequencies of V249I and T280M among early‐onset CAD patients (G1; n = 149; <50 years), late‐onset CAD patients (G2; n = 150; >65 years) and healthy controls (HC; n = 149, 47–93 years) without known CAD risk factors. We compared plasma total cholesterol (TC)/high density lipoprotein‐C (HDL‐C) and apolipoprotein B (APOB)/apolipoprotein AI (APOAI) ratios among the groups and mutation carriers and non‐carriers, and the prevalence of the mutations in G1 and G2 patients with multiple coronary vessel disease (MVD) and myocardial infarction (MI). Results. G1 patients had non‐significantly lower frequencies of I249 versus (vs.) G2 or controls (G1; 51 %, G2: 61 %, controls: 58 %, p = 0.19), with no difference in T280M (p = 0.8). TC/HDL‐C and APOB/APOAI ratios were significantly higher in G1 patients vs. G2 and controls (p<0.0001) independently of either mutation. More G2 patients had MVD than younger ones (p<0.0001); however, more G1 patients were homozygous for V249 compared to G2 patients, who more often had the I249 allele (p<0.02). There was no such association with T280M (p = 0.38). Although more G1 patients had MI, this was not mutation related. Conclusions. There were significantly higher lipid ratios in G1 compared to G2 and HC (G1>G2>HC), but not in mutation prevalence. I249 mutation was associated with MVD in older patients, while V249 homozygosity was associated with the early‐onset CAD. Neither allele affected MI or lipid levels.

Abstract 3347: Sirolimus Eluting Stents In Single Vessel Versus Multi-vessel Percutaneous Coronary Intervention: Results From The Matrix Registry

Background The efficacy of sirolimus eluting stents (SES) to reduce in-stent restenosis compared to bare metal stents has been studied in single coronary vessels. However, the long-term efficacy and safety of SES implantation in multiple coronary vessels has not been well studied. We compared the efficacy and safety of SES implanted in single vessel versus multi-vessel PCI. Methods The MATRIX registry prospectively evaluates the efficacy and safety of SES in a “real world” population. In this registry, SES was implanted in single vessel PCI in 1103 patients and in multi-vessel PCI in 321 patients. Dual anti-platelet therapy with aspirin and clopidogrel was recommended for at least one year. All clinical events are source-documented and adjudicated by an independent committee. Results The multi-vessel PCI group had more patients with diabetes (38.4% vs. 32.4%, p=0.04), but less patients with prior PCI (37.7% vs. 46.6%, p=0.006) and prior CABG (17% vs. 22.3%, p=0.04). The mean number of stents implanted was 1.7 ± 0.9 vs. 3.1 ± 1.1 with procedural success of 96.7% vs. 95.6% in single and multi-vessel PCI groups respectively. The two-year clinical outcomes are shown in the table . Conclusions We documented no significant differences in single vs. multi-vessel PCI with sirolimus DES. Therefore, with appropriate patient selection and PCI technique, the treatment with multi-vessel PCI appears to be as safe and effective as single vessel PCI.

The presence of metabolic syndrome is independently associated with elevated serum CD40 ligand and disease severity in patients with symptomatic coronary artery disease

Nontraditional atherosclerotic risk factors have become the focus of attention in recent years. In addition, metabolic syndrome is gaining recognition as another multiplex cardiovascular risk factor. However, to date, no studies have investigated the effect of metabolic syndrome on circulating soluble CD40 ligand (sCD40L), monocyte chemoattractant protein 1, cellular adhesion molecules, and disease severity in patients with symptomatic coronary artery diseases. This study was conducted to address this issue. Patients with stable angina who received percutaneous coronary interventions for significant (≥70% diameter stenosis) de novo lesions between January 1999 and January 2004 and had preprocedural serum samples were enrolled. Metabolic syndrome was defined by the National Cholesterol Education Program criteria with waist criterion modified into body mass index of more than 25 kg/m 2. The serum samples were thawed and analyzed for circulating sCD40L, monocyte chemoattractant protein 1, adhesion molecules, and high sensitivity C-reactive protein (hs-CRP). Coronary severity was assessed by a modified version of Gensini scoring system. A total of 313 patients, 248 males and 65 females, were studied. Among them, 222 (70.9%, 170 males and 52 females) had metabolic syndrome. Patients with metabolic syndrome had higher serum creatinine level and lower low-density lipoprotein cholesterol despite higher triglyceride concentration. In multivariate analysis, patients with metabolic syndrome had higher sCD40L (6057 ± 275 vs. 5051 ± 423 pg/mL, P = .037) and more hs-CRP in higher tertiles ( P = .005) than patients without, but similar levels of intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and P selectin. Metabolic syndrome was also significantly associated with multiple coronary vessel involvements with 70% or higher diameter stenosis (36.5% double-vessel and 14% triple-vessel diseases vs 30.8% double-vessel and 5.5% triple-vessel diseases, P = .026) and multiple coronary segment involvements with 50% or higher diameter stenosis ( P = .014) in multivariate analysis. In conclusion, the presence of metabolic syndrome is independently associated with elevated sCD40L, hs-CRP, and coronary disease severity in patients with coronary artery disease requiring interventional treatment of stable angina.