Multi-vessel Group Research Articles

Association of ST2 gene polymorphism with angiographic severity of coronary artery disease

Objective To investigate the relationship between ST2 gene polymorphism and the severity of coronary artery stenosis via angiography. Methods With a case-control design, 352 Hubei Han Chinese patients with coronary heart disease treated at Wuhan Union Hospital from 2008 to 2012 were enrolled in the study. Participants were divided into two groups, the myocardial infarction group and the non-myocardial infarction group, based on clinical data and coronary artery involvement on angiogram. Single Nucleotide Polymor phisms(SNPs) in the ST2 signal transduction pathways chosen from the Hapmap were subjected to analysis using the Sequenom MassArray system and Taqman probes to determine their genotype and allele frequency distribution in myocardial infarction patients and their association with varying degrees of coronary artery involvement in these patients. Results A total of nine SNPs met the inclusion criteria, of which, the frequency distribution of the genotypes TT and CC of the ST2 SNP rs12999364 was higher in the multivessel lesion group than in the single vessel lesion group (P=0.016), while the distribution frequency of the combined genotype TT+ CT was lower in the multivessel lesion group than in the single vessel lesion group (P=0.021). With adjustment for traditional risk factors, including age, gender, smoking, drinking, hypertension, diabetes mellitus, family history of CAD, body mass index, triglyceride and total cholesterol, logistic regression analysis showed that genotypes CT and TT+ CT in rs12999364 were independent protective factors for multivessel lesions not only in CAD (CT: OR=0.471, 95%CI=0.285-0.778, P=0.003; TT+ CT: OR=0.555, 95%CI: 0.347-0.888, P=0.014), but also in the myocardial infarction (MI) subgroup (CT: OR=0.393, 95%CI: 0.189-0.813, P=0.012; TT+ CT: OR=0.453, 95%CI: 0.228-0.901, P=0.024). Conclusions ST2 gene polymorphism rs12999364 is associated with angiographic severity of coronary heart disease and exhibits protective effects for CAD patients and myocardial infarction patients with multivessel lesions. Key words: Coronary artery disease; Gene polymorphism; Coronary arteriography

Left ventricular outcomes following multivessel PCI vs. infarct artery-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study

Background In the Randomised Trial of Preventive Angioplasty in Myocardial Infarction (PRAMI; ISRCTN73028481), compared with infarct-related artery (IRA)-only PCI, additional immediate multivessel PCI (MV-PCI) of non-IRA lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We studied left ventricular (LV) outcomes in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods In a single centre prospective sub-study, PRAMI participants were invited to undergo CMR at 1.5 Tesla 1 week and 1 year after primary PCI. LV volumes and function were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The statistical analyses were performed by an independent statistician. Results Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Eighty patients (17%) (mean age 60 years, 76% male) underwent CMR initially (n = 41 (51%) in the multi-vessel PCI group; n = 39 (49%) in the IRA-only group). 69 (86%) of these patients had a follow up CMR scan at 1 year (n = 7 lost to follow-up, n = 4 deceased). Mean (and SD) LVEF and volumes at 1 week post-MI and their change at 1 year from baseline were similar (Table 1). Conclusion The CMR sub-study participants represented the majority of all randomised participants in our hospital, which included one third of the PRAMI trial population. Random treatment group assignment in this CMR study was evenly balanced. LV function and volumes were similar at 1 week and 1 year post-intervention in survivors. The CMR sub-study suggests that the benefit of the preventive PCI strategy in PRAMI may not be mediated by any effects on LV function and remodelling. Funding Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.

Infarct burden following multivessel PCI vs. infarct-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study

Background: In the Preventive Angioplasty in Myocardial Infarction trial (PRAMI; ISRCTN73028481), immediate multivessel PCI (MV-PCI) of non-IRA (infarct related artery) lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We assessed infarct distribution and size in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods: In this single centre prospective sub-study, PRAMI participants were invited to undergo 1.5 Tesla CMR 1 week and 1 year after primary PCI. The CMR scans were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The presence and extent of infarction were assessed quantitatively with late gadolinium enhancement (LGE) imaging (Gadovist, 0.1 mmol/kg). The infarct was delineated as an area of myocardial enhancement (cm2) using a signal intensity threshold of >5SDs above a remote region, and expressed as a % of total LV mass. The incidence of new LGE in non-infarct related artery territories at baseline and 1 year were assessed. Data were analysed by an independent statistician. Results: Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Of these 80 patients underwent CMR 1 week post primary PCI of whom 41 (51%) were in the multi-vessel PCI group and 39 (49%) were in the IRA-only group. At 1 year, 69 (86%) patients had a follow up CMR scan. Infarct size and distribution are described in Table 1.

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.

Infarct Related Artery only Versus Multivessel Revascularization during Primary PCI for STEMI

Background: Guidelines for ST Elevation Myocardial Infarction (STEMI) recommend for multivessel disease that only the culprit vessel be treated and that other diseased vessels be addressed in another time. Methods: STEMI patients with multivessel disease undergoing primary PCIs in our center between January 2001 and April 2011 were divided into: 1- Culprit only PCI and 2- Multivessel PCI during the index procedure. Mortality rates and clinical outcomes were compared between the two groups in hospital and at 12 months. Results: 491 patients had STEMI and multivessel disease. In 341 (69.5%) immediate multivessel PCI was performed, in 150 (30.5%) patients a culprit vessel only was treated and the rest was deferred for another procedure. Multivessel PCI was associated with Shorter hospitalization (4.4 ± 1.27 versus 7.6 ± 2.1, P=0.01), reduced incidence of 12 months major adverse cardiac events (recurrent ischemia, reinfarction, acute heart failure and mortality (16.1 versus 35.3%, P=0.01). A significant lower rate of recurrent ischemic episodes (5.6% versus 11.3%, P=0.02), myocardial reinfarction (5% versus 10%, P=0.01), reintervention (9.4% versus 26%, P=0.01). Transient renal dysfunction was more common in multivessel PCI (8.5% versus 4% P=0.01). In-hospital mortality (4.1% vs 4.4% p=0.9) was similar, while 1 year mortality tended to be decreased in the multivessel group (6.9% vs 7.4%), p=0.06). Conclusion: Multivessel revascularization resulted in an improved clinical course. Our findings support that multivessel PCI during STEMI can be feasible and safe. Decisions about PCI of the non-infarct vessel(s) should be individualized. Further large, randomized trials will help us solve this dilemma.

Perfusion dephasing discriminated between coronary microvascular disease and multivessels coronary artery disease

Background Non-invasive imaging methods cannot reliably differentiate reliably between coronary microvascular dysfunction (CMD) and multi-vessel coronary artery disease (including left main coronary artery disease; CAD) as both these conditions may result in diffuse myocardial ischemia, which on visual and quantitative analysis can have a similar appearance. Consequently, patients are subjected to invasive angiography, and coronary microvascular dysfunction is diagnosed after demonstrating normal coronary arteries in patients with myocardial ischemia. We hypothesized that the spatial and temporal distribution of the first-pass perfusion of the left ventricular myocardium is fundamentally different between these conditions. The aim of this study was to evaluate the spatial and temporal distribution of perfusion (perfusion dephasing analysis) to differentiate CMD and multivessel CAD. Methods This study included a total of 52 patients. All subjects underwent adenosine-stress first-pass perfusion CMR. Patients with a visually positive perfusion cardiac magnetic resonance (CMR) and functional multivessel disease (fractional flow reserve (FFR) ≤0.8 in at least 2 vessels; n = 25) or a visually positive perfusion CMR and angiographically smooth coronary arteries (CMD Group; n = 27) were included. The datasets were analysed visually, quantified with Fermi deconvolution and assessed for perfusion dephasing (coefficient of variation of the time to peak of the myocardial signal intensity curve). Results Visual and quantitative analysis allowed a reliable diagnosis of significant CAD, but could not distinguish patients with multivessel CAD from patients with CMD as the total extent and severity of ischemia was similar between the two groups. In patients with CAD, perfusion analysis showed significant dephasing proportional to the extent and severity of the epicardial stenoses (average perfusion dephasing in the multivessel CAD group 17% ± 8%). In contrast, in patients with CMD there was very little perfusion dephasing (7% ± 2%;p 10.1% (p < 0.001; area under the ROC curve = 0.96). Conclusions In conclusion, perfusion-dephasing analysis, a novel method to measure temporal differences of myocardial perfusion, is highly accurate in distinguishing patients with functionally significant multivessel CAD from patients with CMD. Funding

Clinical application of the 3-dimensional speckle tracking imaging in coronary artery disease

To observe the 3-dimensional speckle tracking imaging (3D-STI) in clinical diagnosis of coronary artery disease by quantitatively evaluating left ventricular segmental and global systolic function. According to the selective coronary artery angiography, 150 inpatients suspected of coronary artery disease were divided into 5 groups according to the distribution of the affected coronary arteries: a left anterior descending coronary artery group (LAD, n=46), a left circumflex coronary artery group (LCX, n=25), a right coronary artery group (RCA, n=23), a multivessel group (n=26), and a normal group (n=30). Gensini score was calculated according to coronary artery angiography. Conventional echocardiography was applied in each patient and wall motion score index (WMSI) was calculated. 3D-STI was applied in each patient to evaluate the segmental and global systolic function in the left ventricle. Compared with the normal group, ejection fraction was decreased in the multi-vessel group alone (P<0.05). Peak systolic 3D strains in all segments were decreased in the multi-vessel group (P<0.01), while peak systolic 3D strains in the main blood-supply segments were decreased significantly in the rest of the groups (P<0.05). Global 3-dimensional strain (G3DS) was negatively correlated with Gensini score in patients with coronary artery disease (r= -0.76, P<0.01). Receiver operating characteristic curve analysis demonstrated that G3DS was more sensitive and accurate in clinical diagnosis of coronary artery disease. 3D-STI can quantitatively evaluate the segmental and global systolic function of the left ventricle, and reflect the extent of coronary artery stenosis in patients with coronary artery disease.

Effects of metoprolol sustained-release tablets on vessel endothelial function and survival myocardium in hypertensive patients with stable angina pectoris

Objective To explore the effect of metoprolol sustained-release tablets on vessel endothelial function and survival myocardium in hypertensive patients with stable angina pectoris.Methods 182 patients with hypertension who had received coronary angiography were involved in the study.According to the results of angiography ( coronary stenosis=50％ ),the patients were divided into three groups:single-vessel disease group ( single-vessel group,n=47 ),double-vessel disease group ( double-vessel group,n =49 ),multi-vessel disease group ( multi-vessel group,n =44 ),and control group ( no coronary stenosis or ＜ 50％,n =42 ).After a 12-month treatment with conventional drugs plus metoprolol sustained-release tablets,the clinical presentations,laboratory findings,blood pressure,clinical features,echocardiography,and radionuclide ventriculography were measured and analyzed.Results As the degree of coronary artery lesions increased,FMD at hours 1 and 4 and 99Tcm-MIBI uptake fraction were worse in hypertensive patients with stable angina pectoris.12 months after using of metoprolol sustained-release tablets,a significant improvement in FMD at hours 1 and 4 and 99Tcm-MIBI uptake fraction were observed in more increased vessel coronary disease groups ( double-vessel group and multi-vessel group ),which increased ( 2.72 ± 0.51 and 4.20 ± 1.47 ),( 2.50 ±0.65 and 4.31±1.85 )and ( 0.54 ± 0.07 and 0.68 ± 0.16 ).Conclusions For hypertensive patients with stable angina pectoris,metoprolol sustained-release tablets can effectively improve vessel endothelial function and survival myocardium. Key words: Hypertension; Angina pectoris; Brachial artery; Survival myocardium; Metoprolol sustained-release tablets

Comparison of infarct-related artery vs multivessel revascularization in ST-segment elevation myocardial infarction with multivessel disease: Analysis from Korea Acute Myocardial Infarction Registry

Many ST-segment elevation myocardial infarction (STEMI) patients have multivessel disease. There is still controversy in treatment strategy in STEMI patients with multivessel disease. We compared clinical outcomes of multivessel revascularization with infarct- related artery (IRA) revascularization in STEMI patients. The 1,644 STEMI patients with multivessel disease (1,106 in IRA group, 538 in multivessel group) who were received primary percutaneous coronary intervention (PCI) were analyzed from a nationwide Korea Acute Myocardial Infarction Registry. Primary endpoint was 12-month major adverse cardiac events (MACE, defined as death, myocardial infarction, and repeated revascularization). Secondary endpoints were 1-month MACE and each component, stent thrombosis during 12 month follow-up, and each components of the 12-month MACE. There were more patients with unfavorable baseline conditions in IRA group. 12-month MACE occurred in 165 (14.9%) patients in IRA group, 81 (15.1%) patients in multivessel group (p = 0.953). There were no statistical significance in the rate of 1-month MACE, each components of 1-month MACE, and stent thrombosis during 12 month follow-up. Each components of 12-month MACE were occurred similarly in both groups except for target lesion revascularization (2.4% in IRA group vs 5.9% in multivessel group, p < 0.0001). After adjusting for confounding factors, multivessel revascularization was not associated with reduced 12-month MACE (OR 1.096, 95% CI 0.676-1.775, p = 0.711). There were no significant differences in clinical outcomes between both groups except for high risk of target lesion revascularization in multivessel revascularization group.

Abstract 9443: Long-Term Clinical Outcomes of Infarct-Related Artery versus Multivessel Revascularization in Acute ST-Segment Elevation Myocardial Infarction with Multivessel Disease: An Analysis from Korea Acute Myocardial Infarction Registry

Many STEMI patients have multivessel disease. Guidelines recommend multiple revascularization only in cardiogenic shock. We compared clinical outcomes of multivessel revascularization with infarct-related artery(IRA) revascularization in ST-segment myocardial infarction(STEMI) patients. The 1,283 STEMI patients with multivessel disease[975 in IRA group(group I), 308 in multivessel group(group II)] received primary PCI and were analyzed from a nationwide Korea Acute Myocardial Infarction Registry. Primary outcomes were in-hospital mortality and 12-month major adverse cardiac events(MACE, defined as death, myocardial infarction, and repeated revascularization). Secondary outcomes were in-hospital complications and components of the MACE. There were more hemodynamic unstable patients in group I. In-hospital mortality was higher in group I with marginal significance(6.6% vs. 3.6%, p = 0.051). 12-month MACE occurred in 84(14.6%) in group I, 20(11.5%) in group II(p = 0.294). Each components of MACE were occurred similarly in two groups but non-target vessel revascularization(6.4% vs. 1.7%, p = 0.012). Adjusting for confounding factors, multivessel revascularization did not reduce in-hospital mortality(OR 0.935, 95% CI 0.403-2.167, p=0.875). It was same for 12-month MACE(OR 0.953, 95% CI 0.406-2.233, p = 0.911) and secondary outcomes. But multivessel revascularization reduced non-target vessel revascularization(OR 0.279, 95% CI 0.085-0.922, p = 0.036). There was no significant difference of clinical outcomes except for low risk of non-target vessel revascularization in multivessel revascularization group. Therefore, results of our study support current guidelines.

Impact of culprit vessel location in acute myocardial infarction on clinical outcome

Among 3,548 patients undergoing a percutaneous transluminal coronary angioplasty procedure, 714 had multilesion angioplasty (1,550 lesions) in a single session. Acute occlusion occurred in 22 patients (3.1%) and 29 lesions (1.9%). The patients were classified into a group undergoing multivessel angioplasty (348 patients, 785 lesions) and a group undergoing multilesion single vessel angioplasty (366 patients, 765 lesions). The rate of acute occlusion was similar in both patient groups. The multivessel angioplasty group had a 2.9% rate per patient (n = 10) and a 1.7% rate per vessel; the multilesion single vessel group had a 3.3% rate per patient (n = 12) and a 2.1 % rate per lesion.Five of the 10 patients from the multivessel group with acute occlusion, but only 1 of the 12 patients with occlusion in the single vessel multilesion group, required emergency open heart surgery. No patient in either group died as a consequence of coronary angioplasty. Occlusion occurred during angioplasty in 15 of the 22 patients, and 1 to 24 h after angioplasty in 7 of 22 patients. In the group with multivessel angioplasty, acute occlusion during the procedure was mainly linked with hypotension during the second vessel dilation, whereas in this group with delayed vessel closure and in the multilesion single vessel group, existence of intimal tearing constituted the most important factor for acute occlusion (12 of 16 patients). Closure of vessel per major coronary system was evenly distributed in the multivessel group, whereas significantly more left circumflex vessels closed in the single vessel multilesion group (6.1% versus 1.3% in the left anterior descending coronary artery and 1.1 % in the right coronary artery; p < 0.02). Maximal increase in serum creatine kinase after angioplasty was significantly lower in the single vessel multilesion group than in the multivessel group (563 versus 1,749 U/liter; p < 0.01).The multilesion angioplasty procedure is associated with acceptable risk. However, with an increasing amount of myocardium at risk, procedural risk is higher if more than one vessel system is dilated. Staged multivessel angioplasty with serial angioplasty on different vessel systems on separate days should be considered if factors predisposing to acute occlusion, such as hypotension or intimal tear, are present after the first dilation.

E0491 Association of coronary heart disease with carotid artery intima-media thickness and baPWV

ObjectiveTo investigate the association of coronary heart disease with carotid artery intima-media thickness and baPWV, by measuring carotid intimia - media thickness and baPWV.Methods160 patients who had been examined by...

E0492 Carotid intimia-media thickness and coronary artery disease

ObjectiveTo analyse the relationship of carotid atherosclerotic and coronary artery disease (CAD), by measuring Carotid intimia - media thickness.MethodsThe plaque index and intimia - media thickness (IMT) were detected by...

What is optimal revascularization strategy in patients with multivessel coronary artery disease in non-ST-elevation myocardial infarction? Multivessel or culprit-only revascularization

BackgroundIn patients with non-ST-elevation myocardial infarction (NSTEMI), current guidelines did not recommend optimal revascularization management in multivessel coronary artery disease. We compared clinical outcomes between multivessel revascularization and culprit-only revascularization in this setting. MethodsA total of 1919 patients with multivessel disease (1011 patients; multivessel revascularization group, 908 patients; culprit-only revascularization group) diagnosed as NSTEMI was enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008. The primary end-points were major adverse cardiac events (MACE), all-causes of deaths, myocardial infarction (MI), and repeated percutaneous coronary intervention (PCI) during 1-year clinical follow-up. Also, subgroup analysis was performed in patients with high TIMI (Thrombolysis In Myocardial Infarction) risk score (≥4) to find efficacy of multivessel PCI in high-risk patients. ResultsBaseline clinical characteristics and the risk factors of coronary artery disease were similar between both groups. In angiography, three-vessel lesion was more presented in the multivessel group (46.1% vs. 40.9%, p=0.024) and rates of left anterior descending and left main stem coronary artery as culprit vessel were higher in the multivessel group (p=0.003 and p=0.001 respectively). In-hospital mortality was higher in the culprit-only group (1.4% vs. 2.9%, p=0.025). Primary end-points occurred in 241 patients (15.5%) during 1-year follow-up. Multivessel revascularization reduced MACEs [hazard ratio (HR) 0.658, 95% confidence interval (CI) 0.45 to 0.96, p=0.031], death or myocardial infarction (HR 0.58, 95% CI 0.35 to 0.97, p=0.037) and non-target vessel revascularization (HR 0.44, 95% CI 0.24 to 0.81, p=0.008). There were no significant differences in target lesion revascularization (TLR; HR 1.38, 95% CI 0.51 to 3.71, p=0.529) and target vessel revascularization (TVR; HR 0.28, 95% CI 0.05 to 1.47, p=0.131). In subgroup analysis in patients with a higher TIMI risk score, similar results were presented. ConclusionMultivessel revascularization in multivessel coronary artery disease presenting with NSTEMI showed better clinical outcomes without significant in-stent restenosis and progression of diseased-vessel compared to culprit-only revascularization.

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.

Study of the correlation between blood lipid levels and the severity of coronary atherosclerosis in a Chinese population sample

Objective — To investigate the relationship between blood lipid levels with severity of coronary artery atherosclerosis in a Chinese population sample.Methods and results — According to coronary angiography results, 363patients (287men and 76women) with coronary artery atherosclerosis were divided into four groups: the single-vessel group (I, n=125), the double-vessel group (II, n=113), the triple-vessel group (III, n=107) and the multivessel group (IV, n=18).The severity of coronary artery atherosclerosis was quantified with a modified Gensini score on the basis of angiographic imaging. Serum triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high density lipoprotein cholesterol (non-HDL-C) were measured before angiography in all groups. Levels of serum TC, LDL-C and non-HDL-C of the II, III and IV group were significantly higher than those of the I group (4.78 ± 0.82mmol/L and 4.87 ± 1.50mmol/L and 4.73 ± 0.99mmol/L vs. 4.38 ± 0.93mmol/L, 2.91 ± 0.68mmol/L and 2.74 ± 1.23mmol/L and 2.64 ± 0.84mmol/L vs. 2.30 ± 0.77mmol/L, 3.58 ± 0.75mmol/L and 3.59 ± 1.41mmol/L and 3.43 ± 0.94mmol/L vs. 3.17 ± 0.91mmol/L; p < 0.05); the mean levels of TC, LDL-C and non-HDL-C associated positively with the Gensini score.Conclusion — Serum lipid levels correlate positively with the severity of coronary artery atherosclerosis in a Chinese population sample. Patients with higher levels of serum TC, LDL-C and non-HDL-C have more severe coronary atherosclerosis, compared with those with low levels of serum TC, LDL-C and non-HDL-C.

The clinical value of measuring plasma myoglobin in diagnosis and therapy of acute coronary syndrome

目的 探讨肌红蛋白(MYO)检测在急性冠状动脉综合征(ACS)发病早期诊断和溶栓再通效果监测的应用价值.方法 应用免疫比浊法检测胸痛患者入院即刻血浆中的MYO、肌钙蛋白T(cTnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)含量并比较其在不同时点的敏感度、特异度、阳性预测值、阴性预测值.对实施冠状动脉造影的病例观察其冠状动脉病变的严重程度与MYO的相关性.观察MYO在溶栓前后的变化.结果 入院即刻心梗组的MYO、cTnT、CK、CK-MB分别为(56±34)μg/L,(0.05±0.03)μg/L,(94±84)U/L,(17±13)U/L,均高于健康对照组(P＜0.05),并且Q波心梗组(263±182)μg/L明显高于非Q波心梗组(165±102)μg/L,P＜0.01.不稳定性心绞痛组的MYO(56.48±33.59)μg/L高于健康对照组(P＜0.01),不稳定性心绞痛组CK、CK-MB与健康对照组比较差异无统计学意义(P＞0.05).MYO在胸痛发作8 h时敏感度最高,特异度在发病24h内高于cTnT(P＜0.01),与CK-MB差异无统计学意义(P＞0.05).MYO和CK-MB的阳性预测值在发病24 h内均高于cTnT,阴性预测值在4 h MYO高于cTnT和CK-MB(P＜0.01).冠状动脉造影多支病变组的MYO含量(167±72)μg/L高于单支和早期病变组(P＜0.01),早期病变组与单支组差异无统计学意义(P＞0.05).MYO在溶栓术后在血浆中含量明显升高,酶峰出现在5.26 h,比CK、CK-MB明显提前(P＜0.01).结论 MYO是一个灵敏、可靠的早期诊断ACS和监测溶栓疗效的指标,联合CK、CK-MB、cTnT测定更有意义。

Haem oxygenase-1 expression and coronary heart disease – Association between levels of haem oxygenase-1 expression and angiographic morphology as well as the quantity of coronary lesions

Objective — The aim of this paper was to investigate the association between levels of HO-1 expression and angiographic morphology as well as the quantity of coronary lesions in patients with coronary heart disease (CHD).Methods — 110 patients with CHD were diagnosed by coronary angiography which contained coronary lesions in some way. Firstly, the patients were divided into 3 groups according to the angiographic morphology of their coronary lesions: type I (smooth borders) group (n1= 36), type II (irregular borders) group (n2= 48) and type III (long and irregular lesions) group (n3= 26). Secondly, the patients were split into a further 3 groups, named: single-vessel group (SV, 38 cases), double-vessel group (DV, 44 cases) and multi-vessel group (MV, 28 cases) according to the number of coronary lesions. Another 30 patients with normal coronary arteries (diagnosed by coronary angiography) were selected as the control group. The levels of HO-1 protein expression in monocytes and lymphocytes from the subjects were tested by immunohistochemistry and Western blot. A computer picture analysing system was also used to measure the levels of HO-1 protein expression. Results — HO-1 protein was located in cell plasma and the levels of HO-1 protein expression in patients with CHD were significantly higher than in those without CHD (p < 0.01).There were significant differences of HO-1 expression among patients with CHD. Patients with type III lesions had the highest levels, followed by those with type II lesions and the lowest levels were found in patients with type I lesions (p < 0.01). Also, levels of HO-1 protein expression in patients with multi-vessel disease and double-vessel disease were significantly higher than in those with single-vessel disease (p < 0.01).Conclusions — There is a higher expression of HO-1 in patients with CHD and the levels of HO-1 protein are associated with severity of CHD angiographically.

Effect of Coronary Angioplasty on QT Dispersion

Background and Objectives:The change in QT dispersion (QTd) immediately after balloon angioplasty refl- ects the immediate impact of ischemia. We intended to analyze the immediate impact of ischemia on myocardial repolarization. Subjects and Methods:Forty-six patients who underwent percutaneous coronary intervention were enrolled. The standard 12-lead electrocardiogram (ECG) was recorded just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning. QTd was determined by the difference between the maximum and mi- nimum QT interval (QTi). We then calculated the corrected QTi (QTc) using Bazett's formula. QTd and QTi were compared according to the site of the ballooned vessel, number of ballooned vessels and history of acute myocardial infarction. Results:QTd just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning were 35.21±10.36 msec, 54.56±16.89 msec, 50.91±14.20 msec, 45.52±9.6 msec and 38.56±10.89 msec, respectively. QTd increased markedly during ballooning, but after myocardial ischemia was relieved, decreased rapidly. Ten minutes after ballooning, QTd was reduced to a similar level as that of baseline. There were no signi- ficant differences between the AMI and non-myocardial infarction groups, single-vessel and multi-vessel groups, and the location of the stenosed artery. There was no significant difference in QTi according to different stenosed vessel. Conclusion:QT (QTc) dispersion increased rapidly with myocardial ischemia and reduced rapidly after the myocardial ischemia was resolved. Therefore, increased QTd can be used as an early clue of myocardial

Triglyceride and lipoprotein (a) are markers of coronary artery disease severity among postmenopausal women

Objective: After menopause, some women manifest coronary artery disease (CAD) with highly variable angiographic severity. For these women, postmenopausal appearing of some CAD risk factors may have differently influenced the CAD risk and severity. In this study, we attempt to unravel differences in the frequency or intensity of CAD risk factors among postmenopausal women with different angiographic severity. Methods: We studied 182 postmenopausal women (64±6 years) who underwent coronary angiography to investigate thoracic pain. Subjects with no detectable coronary lesions at angiography were recruited to the non-obstructive group and patients with CAD were grouped in one-vessel or multi-vessel groups. We compared clinical variables as the body mass index (BMI), age at menopause, age, hypertension, diabetes and cigarette smoking, and lipid measurements as plasma levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein (apo) A1, apo B and lipoprotein(a) (Lp(a)). Results: Comparing to the non-obstructive group, Lp(a) was twofold higher in the one-vessel group and threefold higher in the multi-vessel group and triglycerides were 34% higher in the one-vessel group and 50% higher in the multi-vessel group. No further difference was found among the three groups. After multivariate logistic regression analysis, triglyceride (odds ratio: 1.01; P=0.0013) and Lp(a) (odds ratio: 1.006; P<0.0001) were independently indicative of the presence of obstructive CAD. Conclusion: We found that both Lp(a) and triglycerides constitute useful markers of CAD severity among postmenopausal women.