Number Of Coronary Lesions Research Articles

Abstract 331: Impact Of Concomitant Use Of Veno-arterial Extracorporeal Membrane Oxygenation And Impella Support On Short-term Mortality In Acute Coronary Syndrome Patients With Refractory Cardiogenic Shock

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is one of effective therapeutic modalities for patients with cardiogenic shock (CS) and acute coronary syndrome (ACS). While VA-ECMO maintains end-organ perfusion, it increases damaged left ventricular (LV) wall tension. Combined treatment of VA-ECMO and a micro-axial Impella pump, referred to as ECPELLA, simultaneously provides systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect on ECPELLA support further reduces mortality compared to currently available VA-ECMO+IABP support. Purpose: Investigate whether ECPELLA can reduce mortality in ACS patients with severe cardiogenic shock who required VA-ECMO. Methods: From January 2012 to May 2022, 100 consecutive patients with ACS and CS who received VA-ECMO before or after percutaneous coronary intervention were enrolled. Patients were divided into two groups; 39 patients in the ECPELLA; and 61 patients in the VA-ECMO with IABP. We assessed peak serum CPK-MB levels and 30-day mortality. Results: There were no significant differences in age, rate of male sex, coronary risk factors, ST-elevated ACS, left main trunk (LMT) lesion, multi-vessel disease (MVD), number of coronary lesions, extracorporeal cardiopulmonary resuscitation, and the time from onset to reperfusion between two groups. The ECPELLA had lower peak CPK-MB levels compared to VA-ECMO with IABP, but the difference did not reach statistical significance (p=0.056). Kaplan-Meier analysis revealed that the ECPELLA had significantly lower 30-day mortality ( p=0.0016 ). Multivariable Cox proportional hazard analysis revealed that ECPELLA (HR: 0.22 95% confidence interval:0.11-0.45; p<0.0001) was inversely and independently associated with 30-day all-cause mortality. Conclusion: ECPELLA treatment appeared to have advantage in reduction of 30-day mortality.

The relationship between the number of stenotic coronary arteries and the gut microbiome in coronary heart disease patients.

An increasing number of studies have shown that the gut microbiome plays an important role in the development of coronary heart disease (CHD). However, there are no clear studies on the relationship between the gut microbiome and the number of stenotic coronary arteries. To clarify whether the gut microbiome is associated with the number of stenotic coronary arteries in CHD, we performed the 16S rRNA gene sequencing for the V3-V4 region in the gut microbiota from 9 healthy controls (C) and 36 CHD patients, which including 25 CHD patients with multivessel (MV) lesion and 11 CHD patients with single-vessel (SV) lesion. It showed that the abundance of the genus Escherichia-Shigella was significantly increased in the MV and SV groups compared with C group, while the abundance of the genera Subdoligranulum and Collinsella was significantly decreased. Biomarkers based on three gut microbiotas (Escherichia-Shigella, Subdoligranulum, and Collinsella) and three plasma metabolites(left atrial diameter (LA), low density lipoprotein (LDL), and total bile acids (TBA)) were able to distinguish CHD patients with different numbers of stenotic coronary arteries. Functional prediction of the gut microbiome was performed based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. The results showed that the gut microbial function of MV and SV group patients was richer than C group in betaine biosynthesis and unsaturated fatty acid biosynthesis, in the contrast less than C group in sphingolipid metabolism and primary bile acid biosynthesis. In summary, our study showed that the composition and function of the gut microbiome changed significantly from healthy controls to CHD patients with different numbers of coronary lesions.

Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction.

Epidemiological evidence suggests that the incidence of acute myocardial infarction (AMI) among people under 40 years of age has an increasing trend in recent years. Smoking, hypertension, diabetes mellitus, family history, and gender (male) are considered as classic risk factors for CHD, but the pathogenesis of CHD in young people is not exactly the same. Moreover, the relationship between the pattern of coronary artery disease and risk factors in young patients with acute myocardial infarction is inconclusive. In this study, we retrospectively studied the clinical data of 150 AMI patients treated in our hospital from January 2020 to May 2021. The patients were divided into the young group and elderly group according to the difference in age. The number of coronary artery lesions, the degree of coronary artery stenosis, the distribution dominance typing, the position of the lesions, and the presence of collateral circulation were observed and compared between the two groups. Multivariate logistic regression analysis was used to investigate the risk factors affecting coronary artery lesions in young patients with AMI. The results showed that the number of coronary lesions in young patients with AMI was mainly single-vessel, and the dominant type of distribution was mainly right dominant type. The stenosis degree is lighter than that of elderly patients, and the incidence of collateral circulation is lower than that of elderly patients, but the position of the lesions has no obvious regular. Smoking, staying up late, HDL-C, and LDL-C/ApoB were independent factors affecting the number of coronary artery lesions, and the changes of HDL-C and LDL-C/ApoB had an important influence on the degree of coronary stenosis in young patients. This provides a new idea for clinical treatment.

Correlation analysis of epicardial adipose tissue volume quantified by computed tomography images and coronary heart disease under optimized reconstruction algorithm.

Objectives:This paper was aimed to explore the adoption value of low-dose computed tomography (CT) imaging based on optimized ordered subset expectation maximization (OSEM) reconstruction algorithm in the correlation analysis between epicardial adipose tissue (EAT) volume and coronary heart disease (CHD).Methods:A total of 110 patients with CHD were selected for CT angiography (CTA) and coronary arteriography (CAG) examinations from October 2017 to October 2019. The predictive value of EAT for CHD was analyzed via receiver operating characteristic (ROC) curve.Results:The results showed that the iteration time and error of the improved OSEM reconstruction algorithm were better than that of MLEM algorithm under the same number of iterations. Age, smoking, hypertension, diabetes, and EAT in control group were obviously lower in contrast to those in CHD group (P<0.05). EAT in control group was (124.50±26.72) mL, and EAT in the CHD group was (159.41±38.51) mL. EAT (B=0.023, P=0.003) was an independent risk factor for CHD, which was suggested by Multiple linear regression analysis. Moreover, EAT was a risk factor for CHD, and was positively correlated with the degree and NSCV.Conclusion:The optimized OSEM algorithm was used to improve the reconstruction quality of low-dose CT images and used in quantitative measurement of epicardial fat volume. Results showed EAT was an independent risk factor for CHD, and was positively correlated with the number of coronary lesions and Gensini score. It was of great value for the prediction of CHD.

Machine learning integration of circulating and imaging biomarkers for explainable patient-specific prediction of cardiac events: A prospective study

Background and aimsWe sought to assess the performance of a comprehensive machine learning (ML) risk score integrating circulating biomarkers and computed tomography (CT) measures for the long-term prediction of hard cardiac events in asymptomatic subjects. MethodsWe studied 1069 subjects (age 58.2 ± 8.2 years, 54.0% males) from the prospective EISNER trial who underwent coronary artery calcium (CAC) scoring CT, serum biomarker assessment, and long-term follow-up. Epicardial adipose tissue (EAT) was quantified from CT using fully automated deep learning software. Forty-eight serum biomarkers, both established and novel, were assayed. An ML algorithm (XGBoost) was trained using clinical risk factors, CT measures (CAC score, number of coronary lesions, aortic valve calcium score, EAT volume and attenuation), and circulating biomarkers, and validated using repeated 10-fold cross validation. ResultsAt 14.5 ± 2.0 years, there were 50 hard cardiac events (myocardial infarction or cardiac death). The ML risk score (area under the receiver operator characteristic curve [AUC] 0.81) outperformed the CAC score (0.75) and ASCVD risk score (0.74; both p = 0.02) for the prediction of hard cardiac events. Serum biomarkers provided incremental prognostic value beyond clinical data and CT measures in the ML model (net reclassification index 0.53 [95% CI: 0.23–0.81], p < 0.0001). Among novel biomarkers, MMP-9, pentraxin 3, PIGR, and GDF-15 had highest variable importance for ML and reflect the pathways of inflammation, extracellular matrix remodeling, and fibrosis. ConclusionsIn this prospective study, ML integration of novel circulating biomarkers and noninvasive imaging measures provided superior long-term risk prediction for cardiac events compared to current risk assessment tools.

Independent Predictors for the Severity of Coronary Artery Disease in Patients with Myocardial Infarction without St-Segment Elevation

Summary It is well known that the severity of coronary heart disease is associated with a poor prognosis. 70% of patients with NSTEMI have multivascular disease, the percentage being 40% for STEMI patients. Knowing the grade severity of the coronary artery disease has importance for the therapeutic management of the case and to establish the prognosis. However, until now, we have no possibilities to identify these patients before performing the coronarography. The objective of this study was to establish a correlation between cardiovascular risk factors, ECG changes, echocardiographic changes, GRACE score and the severity of coronary artery disease invasively detected by coronarography, in patients with myocardial infarction without ST-segment elevation. Material and methods. We performed a study on 125 patients diagnosed with NSTEMI, who performed coronarography. For each patient we noted age, sex, history of high blood pressure, dyslipidemia, chronic kidney disease, smoking habit, HS troponin T levels, LDL cholesterol, triglycerides, C-reactive protein, creatinine clearance, ejection fraction of left ventricle, number of lesions discovered on angiography, GRACE and SYNTAX score. Results. Of the 125 patients included, 86 (68.8%) were men, with a mean age of 63.66 ± 11.54. The average of the laboratory tests and the parameters studied: creatinine Cl 83.80 ± 33.862 ml / min, FEVS 46.37 ± 7.394%, troponin HS 3533.625 ± 7460.873 pg / ml, CRP 2.811 ± 5.262 mg / dl, LDL 113.618 ± 50.13 mg / dl, triglyceride ± 100.58mg / dl. The mean Syntax score in the studied group was 17, 58 ± 13.65, Grace score 118.80 ± 26.980, and the number of coronary lesions 2.19 ± 1.162 The number of coronary lesions and the SYNTAX score were significantly correlated statistics with age, Grace score, presence of diabetes and chronic kidney disease. With regard to laboratory tests, creatinine clearance proved to be the most important predictor for both the number of vessels affected (r =-0.322, p=0.000) and for the Syntax score (r = -0.323,p=0.000), the latter being influenced also by the level of triglycerides (r = -0.177, p = 0.048) and that of the high sensitive troponin (r = 0.322, p = 0.015). Conclusions. Independent predictors of multivascular disease in patients with NSTEMI are : age, diabetes, chronic kidney disease, creatinine clearance and Grace score. The severity of the coronary heart disease assessed by the Syntax score, is also correlated with age, history of diabetes and chronic kidney disease, creatinine clearance, Grace score, but also with the value of tiglycerides and high-sensitive T troponin.

Risk Factors in Peripheral Artery Disease Associated with Coronary Artery Disease

Abstract Peripheral arterial disease (PAD) is a partial or complete occlusion of one or more arteries leading to a suppression of blood flow and ischemia. In the process of stenosis, numerous processes are described, among which, the most common being atherosclerosis, affecting the arteries of the inferior and coronary limbs. In the 60 patients investigated angio-coronarographically in the Emergency County Clinical Hospital of Sibiu with PAD, the prevalence of high blood pressure (HBP) and smoking was observed, among the risk factors, and 73.3% had one or more coronary lesions. The association of diabetes mellitus (DM) with PAD has shown an increase in the number of coronary lesions. There was also a strong positive correlation between the presence of left anterior descending artery (LAD) injuries and the stage of PAD regardless of other risk factors.

Relationship between the endothelial glycocalyx and the extent of coronary atherosclerosis

To investigate the correlation between the EG and the severity of coronary atherosclerosis. A total of193 subjects were divided into two groups. A SDF video microscope with a glycocalyx thickness measurement system was used to visualize the sublingual microcirculation. The levels of HA in the peripheral circulation and coronary circulation were determined via enzyme-linked immunosorbent assay. The number of coronary artery lesions and the Gensini score were used to evaluate the severity of the coronary atherosclerosis. EG thickness in the coronary heart disease (CHD) group (242.18±10.10nm) was lower than that in the NON-CHD group (251.78±10.59nm, P<0.001). There was a negative correlation between the EG thickness and the number of coronary lesions and the Gensini score. The level of intracoronary HA in the CHD group (48.60, 126.27) was higher than that in the NON-CHD group (20.60, 34.45, P<0.001), and it was positively correlated with the number of coronary lesions and the Gensini score. EG damage was correlated with the occurrence and development of coronary atherosclerosis. The EG thickness in the capillaries of the oral submucosa and the intracoronary HA level can be used as auxiliary indexes to assess the severity of coronary atherosclerosis.

The association of serum parathyroid hormone and severity of coronary artery diseases

The serum level of parathyroid hormone (PTH) has been shown to be a predictor of cardiovascular mortality. Data on the association between PTH level and degree of atherosclerosis severity are lacking. The objective of this study was to determine the relationship of serum PTH level and number of stenotic coronary arteries. The present article is a descriptive cross-sectional study on 476 patients who had undergone coronary angiography according to documented indications and had coronary lesion more than 50% in at least one main vessel during 2010-2012. The outcome was evaluated by comparison between PTH levels and the number of stenotic coronary arteries. Demographic data of the patients, severity, and number of stenotic vessels were evaluated. Of the 476 patients included, 183 (38.4%) had PTH more than 40 pg/ml. There was a significant association between PTH level and severity and number of coronary lesion: 80% of three-vessel disease patients had PTH more than 40 pg/ml but only 7% of single-vessel disease patients had PTH more than 40 pg/ml (P<0.001). The mean levels of PTH serum in single-vessel, two-vessel, and three-vessel disease were 24.8, 35.8, and 49.8 pg/ml, respectively (P<0.001). Individuals with the higher PTH level had longer history of hypertension and lower left ventricular ejection fraction (P<0.01 and P<0.002, respectively). In this relatively small prospective study, serum PTH level is associated with the number of stenotic coronary arteries. There is a correlation between high PTH level with hypertension and low ejection fraction. A prospective study that evaluates the additional value added (by ROC analysis) by PTH to already known cardiac risk factors is recommended.

Abstract P204: Clopidogrel Overuse Beyond the Guidelines: Predictors and Financial Outcomes

Background: Clopidogrel is widely used for the treatment and prevention of atherosclerotic events. Due to high cost, overuse of clopidogrel has significant implications on health care costs. The predictors for clopidogrel overuse and it's the financial implications have not been studied. Methods: This is a retrospective chart review done at the Grady Memorial Hospital. We identified 1267 patients from the pharmacy database who had received a prescription for clopidogrel from Jan 2009 to Dec 2010. After excluding patients with atrial fibrillation (n=7) and neurological indication (n=71) for clopidogrel use, 165 charts were reviewed sequentially to determine the indication, duration, cost of the clopidogrel use and factors associated with overuse. Results: The use of Clopidogrel was determined to be appropriate in only half (83/165) patients (group A). Eighty two (50%, group B) patients did not fulfill the criteria of clopidogrel use based on ACC/AHA guidelines 2007. Patients with inappropriately extended use (group B) were significantly older (mean age 67±11 vs. 59±11 years, p&lt;0.001), predominantly female (76% vs. 55%, p&lt;0.005) compared to group A patients. Notably 76% (62/82) of the group B patients had insurance compared to only 34% (28/83) in group A of this predominantly inner city population (p&lt;0.001). Group B patients used clopidogrel for twice the duration compared to Group A (mean 608±239 vs. 300±255 days, p&lt;0.001). Insured patients were nearly four times more likely (OR 3.8, 95% CI 1.6-8.8, p =0.002) than those without insurance to be on clopidogrel for an extended period beyond the guidelines, even after controlling for age, diabetes, total number of coronary lesions and stents. The extended use of clopidogrel incurred significant cost per patient to the hospital ($161±162 vs. $63±128, p&lt;0.001) and to the health care insurance plans ($325±392 vs. $101±240, p&lt;0.001). Conclusion: Nearly 50% of patients received clopidogrel for extended duration beyond the recommended guidelines causing significant costs burden. This practice is seen significantly more often in older, female patients with insurance. Further health care practice reforms are needed to avoid clopidogrel overuse and its financial burden.

Experience of Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients with Structural Heart Disease: Comparable Clinical Outcome Despite Advanced Atrial Remodeling

Backgrounds: We hypothesized radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) in patients with structural heart disease (SHD) results in outcomes comparable to those with lone AF. Methods: We included 428 patients (age, 56.0±11.0 years; male, 77.3%; paroxysmal AF, 69.4%; persistent AF, 30.6%) who underwent RFCA of AF and compared imaging, hemodynamic, electrophysiologic parameters and clinical outcome between the patients with (n=77) and without (n=351) SHD. SHD included coronary artery disease (CAD, 57.1%), valvular heart disease (23.4%), cardiomyopathy (10.4%), heart failure (6.5%), and congenital heart disease (2.6%). Results: In patients with SHD, LA diameter (p<0.001), LA volume index (p<0.001), E/E′ (p<0.001), LA mean pressure (p=0.003), effective refractory period (ERP: p=0.027), and ANP (p=0.005) were significantly higher than those without SHD. In patients with CAD (n=44), there was no significant differences in terms of culprit vessels or number of coronary lesions. There were no significant differences of complications (2.6% vs. 3.7%) and recurrence rates after blanking period (21.1% [28.6% with anti-arrhythmic drug [AAD]] vs. 20.2% [25.9% with AAD]) during 12.7±5.9 months in SHD and no SHD groups, respectively (p=0.859). Conclusion: RFCA of AF in patients with selected SHD results in clinical outcome comparable to those with lone AF, in spite of advanced LA remodeling.

Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study

To evaluate the effect of prior duration of diabetes, glycated hemoglobin level at study entry, and microalbuminuria or macroalbuminuria on the extent and severity of coronary artery disease (CAD) and peripheral arterial disease. We studied baseline characteristics of the 2368 participants of the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) study, a randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes and angiographically documented stable CAD. Patients were enrolled from January 1, 2001, through March 31, 2005. Peripheral arterial disease was ascertained by an ankle-brachial index (ABI) of 0.9 or less, and extent of CAD was measured by presence of multivessel disease, a left ventricular ejection fraction (LVEF) of less than 50%, and myocardial jeopardy index. Duration of diabetes of 20 or more years was associated with increased risk of ABI of 0.9 or less (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.26), intermittent claudication (OR, 1.61; 95% CI, 1.10-2.35), and LVEF of less than 50% (OR, 2.03; 95% CI, 1.37-3.02). Microalbuminuria was associated with intermittent claudication (OR, 1.53; 95% CI, 1.16-2.02) and ABI of 0.9 or less (OR, 1.31; 95% CI, 0.98-1.75), whereas macroalbuminuria was associated with abnormal ABI, claudication, and LVEF of less than 50%. There was a significant association between diabetes duration and extent of CAD as manifested by number of coronary lesions, but no other significant associations were observed between duration of disease, glycated hemoglobin levels, or albumin-to-creatinine ratio and other manifestations of CAD. Duration of diabetes and microalbuminuria or macroalbuminuria are important predictors of severity of peripheral arterial disease and left ventricular dysfunction in a cohort of patients selected for the presence of CAD.

The 9p21 susceptibility locus for coronary artery disease and the severity of coronary atherosclerosis

BackgroundCase-control Genome-Wide Association Studies (GWAS) have identified single nucleotide polymorphisms (SNPs) at the 9p21 locus as risk factors for coronary artery disease (CAD). The locus does not contain a clear candidate gene. Hence, the results of GWAS have raised an intense interest in delineating the basis for the observed association. We analyzed association of 4 SNPs at the 9p21 locus with the severity and progression of coronary atherosclerosis, as determined by serial quantitative coronary angiograms (QCA) in the well-characterized Lipoprotein Coronary Atherosclerosis Study (LCAS) population. The LCAS is a randomized placebo-control longitudinal follow-up study in patients with CAD conducted to test the effects of fluvastatin on progression or regression of coronary atherosclerosis.MethodsExtensive plasma lipid levels were measured at the baseline and 2 1/2 years after randomization. Likewise serial QCA was performed at the baseline and upon completion of the study. We genotyped the population for 4 SNPs, previously identified as the susceptibility SNPs for CAD in GWAS, using fluorogenic 5' nuclease assays. We reconstructed the haplotypes using Phase 2, analyzed SNP and haplotype effects using the Thesias software as well as by the conventional statistical methods.ResultsOnly Caucasians were included since they comprised 90% of the study population (332/371 with available DNA sample). The 4 SNPs at the 9p21 locus were in tight linkage disequilibrium, leading to 3 common haplotypes in the LCAS population. We found no significant association between quantitative indices of severity of coronary atherosclerosis, such as minimal lumen diameter and number of coronary lesions or occlusions and the 9p21 SNPs and haplotypes. Likewise, there was no association between quantitative indices of progression of coronary atherosclerosis and the SNPs or haplotypes. Similarly, we found no significant SNP or haplotype effect on severity and progression of coronary atherosclerosis.ConclusionWe conclude the 4 SNPs at the 9p21 locus analyzed in this study do not impart major effects on the severity or progression of coronary atherosclerosis. The effect size may be very modest or the observed association of the CAD with SNPs at the 9p21 locus in the case-control GWAS reflect involvement of vascular mechanisms not directly related to the severity or progression of coronary atherosclerosis.

Frequency and pattern of de-novo three-vessel and left main coronary artery disease; insights from single center enrolment in the SYNTAX study☆

To characterize the current patient population regarding extent and pattern of coronary artery disease (CAD) in a routine cardiac catheterization practice with special focus on de-novo three-vessel coronary artery and/or left main disease (3-VD/LM) during enrolment in the SYNTAX study (synergy between PCI with Taxus drug-eluting stent and cardiac surgery) comparing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in 3-VD/LM. During a 4-month study enrolment period, a total of 3319 consecutive adult patients undergoing coronary angiography were prospectively recorded. Patients with de-novo 3-VD/LM were screened in the daily heart team conference by interventional cardiologists and cardiac surgeons concerning suitability for study enrolment. Complexity of CAD was quantified by the SYNTAX score. A total of 694 patients (20.9%) presented with 3-VD/LM, of which 271 had previous CABG and 232 previous PCI treatment. Of the 191 patients with de-novo 3-VD/LM, SYNTAX study exclusion criteria were present in 87 patients consisting mostly of acute myocardial infarction (n=47) or concomitant indications for additional heart surgery (n=35). A total of 104 patients (54.4% of all screened) were potentially suitable for study enrolment. Of these, 13 patients refused study participation, 10 presented with uncertain protocol adherence and 6 were already participating in other cardiovascular trials. A total of 67 patients were therefore enrolled in the SYNTAX study, representing 9.7% of 3-VD/LM and 35.1% of all screened patients. Twenty-four patients were not amenable for PCI and were therefore assigned to the CABG registry. Compared to the randomized cohort, these patients had more complex CAD (SYNTAX score 34 vs 26, p=0.003) with significantly more chronic coronary vessel occlusion (70.8% vs 22.5%, p=0.04). In the randomized cohort, CABG and PCI patients were comparable in age (PCI 69.7 years vs CABG 67.2 years), additive EuroSCORE (4.8 vs 4.4), EF (57.8% vs 52.4%), number of coronary lesions (4.5 vs 4.6), left main disease (42.9% vs 52.6%) and coronary vessel occlusion. Patients with de-novo 3-VD/LM represented a small proportion of patients undergoing coronary angiography at our center. However, SYNTAX study inclusion and randomization rates of these screened patients were high. Chronic vessel occlusion and high SYNTAX scores were more common in CABG registry patients compared to randomized patients.

Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 +/- 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 +/- 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions (> or =50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis.

Predictors of Early Postoperative Cerebral Infarction After Isolated Off-Pump Coronary Artery Bypass Grafting

Risk factors associated with cerebral infarction within 7 days after off-pump coronary artery bypass grafting require further statistical elucidation. From January 1997 to July 2006, off-pump coronary artery bypass grafting was performed in 576 patients at Toyama University Hospital. Factors including previous cerebral infarction, lesions in head and neck vessels, preoperative cerebral ischemic symptoms, intraaortic balloon pump use, number of coronary lesions, number of coronary bypasses, sites of coronary bypasses, number of proximal anastomoses in the ascending aorta, use of aortic no-touch procedure, partial aortic clamping, automatic proximal anastomosis devices, and a proximal seal system were compared retrospectively between patients with and without early cerebral infarction. Factors differing between groups were analyzed further by multivariate logistic regression. Ten patients (1.7%) had cerebral infarction within 7 days after surgery. The subjects were divided into two groups, those who had cerebral infarction after surgery (n = 10) and those who did not (n = 566). Factors showing significant intergroup differences were a previous history of cerebral infarction (p < 0.001), preoperative presence of cerebral ischemic symptoms (p < 0.001), vascular lesions in head and neck vessels (p < 0.001), use of partial aortic clamping (p = 0.002), and postoperative atrial fibrillation within 7 days after surgery (p = 0.011). Multiple logistic regression analysis indicated close relationships between previous history of cerebral infarction (odds ratio, 26.6; 95% confidence interval, 2.8 to 251.1; p = 0.004), preoperative presence of cerebral ischemic symptoms plus lesions in head and neck vessels (odds ratio, 22.8; 95% confidence interval 1.8 to 285.7; p = 0.015), and use of partial aortic clamping (odds ratio, 11.1; 95% confidence interval, 1.4 to 85.7; p = 0.021). Postoperative atrial fibrillation within 7 days after surgery (odds ratio, 3.4; 95% confidence interval, 0.7 to 16.5; p = 0.121) was suspected as a risk factor for postoperative cerebral infarction. Multivariate analysis identified independent factors strongly associated with cerebral infarction after off-pump coronary artery bypass grafting, such as partial aortic clamping, presence of cerebral ischemic symptoms plus head and neck vascular lesions, and previous cerebral infarction.

Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention with Drug‐Eluting Stent Implantation in Patients with Multivessel Coronary Disease

Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after percutaneous coronary intervention (PCI). This study compared the clinical outcomes of PCI using DES versus coronary artery bypass graft (CABG) in patients with multivessel coronary artery disease (MVD) in real-world. From January 2003 to December 2004, 466 consecutive patients with MVD underwent revascularization, 235 by PCI with DES and 231 by CABG. The study end-point was the incidence of major adverse cardiovascular events (MACEs) at the first 30 days after procedure and during follow-up. Most preoperative characteristics were similar in the two groups, but left main disease (24.7% vs 2.6%, P<0.001) and three-vessel disease (65% vs 54%, P = 0.02) were more prevalent in CABG group. The number of coronary lesions was also greater in CABG group (3.7 +/- 1.1 vs 3.3 +/- 1.1, P<0.001). Despite higher early morbidity (3.9% vs 0.8%, P = 0.03) associated with CABG, there were no significant differences in composite MACEs at the first 30 days between the two groups. During follow-up (mean 25+/-8 months), the incidence of death, myocardial infarction, or cerebrovascular event was similar in both groups (PCI 6.3% vs CABG 5.6%, P = 0.84). However, bypass surgery still afforded a lower need for repeat revascularization (2.8% vs 10.4%, p = 0.001). Consequently, overall MACE rate (14.5% vs 7.9%, P = 0.03) remained higher after PCI. PCI with DES is a safe and feasible alternative to CABG for selected patients with MVD. The reintervention gap was further narrowed in the era of DES. Aside from restenosis, progression of disease needs to receive substantial emphasis.

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.

Prognostic value of dobutamine echocardiography in patients with intermediate coronary lesions at angiography.

The prognostic value of dobutamine echocardiography (DOBU-ECHO) in patients with intermediate coronary lesions has not been described in the literature. The aim of this study was to determine the prognostic value of DOBU-ECHO in patients presenting with coronary lesions smaller than 50% at angiography. Ninety-four consecutive patients were analyzed and followed-up for 64 +/- 7 months (range: 12 to 75 months). All patients presented with coronary lesions between >or= 30% and < 50% of the luminal diameter of at least one major epicardial vessel. The patient population was divided into two groups: Those with a positive DOBU-ECHO (n = 23) and those with a negative DOBU-ECHO (n = 71). The number of coronary lesions did not differ between the two groups. The patients with a positive DOBU-ECHO result were more likely than those in the negative group to have a family history of coronary artery disease or suffer from hypertension or a dyslipidemia. During the follow-up period, 13 cardiac events occurred (1 cardiac death, 5 myocardial infarctions, 2 unstable anginas, and 5 myocardial revascularizations), 11 (47.8%) of which occurred in patients with positive DOBU-ECHO. The annual incidence for a cardiac event was 7.9% per year in the positive DOBU-ECHO group and 0.5% per year in the negative DOBU-ECHO group (P < 0.001). This incidence remained significant for spontaneous cardiac events, such as cardiac death, myocardial infarction, and unstable angina (5.8% per year vs 0.2% per year; P < 0.001). In patients with angiographically confirmed intermediate coronary lesions, a positive DOBU-ECHO is an additional risk factor for the onset of a cardiac event, whereas a negative DOBU-ECHO can be used to define patients with a low cardiac risk.

A prospective study of paraoxonase gene Q/R192 polymorphism and severity, progression and regression of coronary atherosclerosis, plasma lipid levels, clinical events and response to fluvastatin

Human serum paraoxonase (PON1) is a high-density lipoprotein (HDL)-associated enzyme that is responsible for the protective effect of HDL against oxidation of low-density lipoprotein (LDL). PON1 has a Glu to Arg polymorphism at codon 192 (CGA→CAA) which is designated R/Q192. The R/Q192 polymorphism has been associated with coronary artery disease (CAD) in several, but not all, case-control studies. We prospectively studied the association of the Q/R192 genotypes with the severity, progression and regression of CAD, plasma lipid levels, clinical events and response to treatment with fluvastatin in a well-characterized cohort. Genotypes were determined by polymerase chain reaction (PCR) and restriction mapping with AlwI enzyme in 356 subjects in the Lipoprotein and Coronary Atherosclerosis Study (LCAS). Fasting plasma lipids were measured and quantitative coronary angiograms were obtained at baseline and 2.5 years following randomization to fluvastatin or placebo. A total of 177 (50%), 142 (40%) and 37 (10%) subjects had Q/Q, Q/R and R/R genotypes, respectively. Baseline and final plasma levels of HDL, LDL, triglyceride and other lipoproteins, lesion-specific minimum lumen diameters (MLD), mean MLD, number of coronary lesions and total occlusions at baseline and follow-up and clinical event rates were not significantly different among the genotypes. There was no genotype-treatment interaction with respect to plasma lipid levels and angiographic indices of CAD. The Q/R192 variants of PON1 are not associated with severity, progression or regression of coronary atherosclerosis, plasma lipid levels, clinical events, or response to treatment with fluvastatin. Thus, the Q/R192 polymorphism is not a major risk factor in susceptibility to CAD in the LCAS population.