Occlusive Coronary Artery Disease Research Articles

Profile of Cases of Death Due to Coronary Artery Disease: An Autopsy Based Descriptive Study

Background: Most common cause of sudden cardiac death is coronary artery disease, which contributes to 75 to 90%. The present study is undertaken to describe the profile of autopsy cases of coronary artery disease. Methods:Descriptive cross-sectional study was conducted in all cases of sudden and unexpected death brought for autopsy a tertiary level centre in southern Kerala during a period of one year. Gross and microscopical examination of heart and coronary arteries were studied and in cases with coronary artery disease, associated factors like previous history of illness, personal habits, family history of illness, body mass index, abdominal circumference, horizontal earlobe crease were described in detail. Categorical variables were represented as frequency and percentage, continuous variables as mean and standard deviation and association was tested using Chi square test. Conclusions: Statistically significant association (p value = 0.001) was observed between the horizontal earlobe crease and occlusive coronary artery disease. No significant association was obtained between the obesity parameters like body mass index, waist to hip ratio and occlusive coronary artery disease. Majority of the cases with significant occlusion was observed in the left anterior descending artery.The most common site of thrombus was in the proximal third of left anterior descending artery.

Effect Of Fibroblast Growth Factor-21 Molecule On Coronary Collateral Development.

Collateral arteries provide an alternative source to myocardium resulting from ischemia due to occlusive coronary artery disease and may help preserve myocardial function in the case of coronary artery disease (CAD)[1]. Although the collateral development is so important, its pathophysiology has not been fully elucidated. Until now, there is no study investigating the relationship between Fibroblast growth factor-21(FGF-21) and coronary collateral. This study aims to investigate the pathophysiology of coronary collateral development. In our study, which we planned as a case control, 60 consecutive patients with ≥90 stenosis in at least one large coronary artery as a result of coronary angiography (CAG) and 30 patients with normal coronary angiography were included in the study cross-sectional. Demographic, echocardiographic and laboratory data were recorded. Coronary collateral circulation was evaluated using the Rentrop-Cohen method [2]. FGF-21 levels were measured in all individuals. In the analysis, no significant difference was observed between the two groups in basic biochemical parameters other than HDL (p>0.05 for all). FGF-21 level was found to be statistically significantly higher in the patient group compared to the control group (p:0.003). Also, FGF-21 level was found to be statistically significantly higher in the good collateral circulation group to the poor collateral circulation group (p:0.006). Univariate and multivariate logistic regression analysis was performed to predict the presence of collateral. We found that FGF-21(p=0.006), C-reactive protein (p=0.020) predicted the presence of collateral independently. Collateral formation and cardiac prognosis are closely related. Our study is the first to investigate the relationship between collateral formation and FGF-21. Our study showed that FGF-21 level is an independent predictor of collateral formation. In addition, there was a significant difference between bad and good collateral formation in terms of FGF-21 levels.

Retracted: The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease

Retracted: The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease

Ventricular arrhythmia without acute coronary syndrome as an indication for invasive coronary angiography

Abstract Background In the clinical setting of acute coronary syndrome, ventricular arrhythmia is a validated indication for urgent invasive coronary angiography (ICA). However, the indication for ICA in patients with ventricular arrhythmia but no acute coronary syndrome is less clear. This study aimed to determine the incidence of occlusive coronary artery disease (CAD) in such patients and to evaluate the association of arrhythmia subtypes and ICA findings with survival. Methods This study included 309 patients who underwent ICA due to documented ventricular arrhythmia but no acute coronary syndrome between January 2004 and October 2017. Subtypes of arrhythmia and findings from ICA were correlated to outcome. Results Overall, 309 patients [240 male (78%) 69 female (22%), mean age 68 ± 11 y] with the evidence of ventricular arrhythmia were included. The documented ventricular arrhythmia were sustained ventricular tachycardia [VT; N= 140 (45.3%)], non-sustained ventricular tachycardia [nsVT; N= 97 (31.4%)], ventricular extrasystoles [VES; N= 72 (23.3%)]. A history of CAD was documented in 164 (53%) patients. The ICA detected a new CAD [N= 38 (12%)] or significant progression of known CAD [N= 72 (23%)] in 110 (36%) patients. Out of these patients 91 (83%) were treated with percutaneous coronary intervention (PCI), four (4%) were treated with coronary artery bypass grafting (CABG). The other 199 (64%) patients showed no progression of a known CAD [N= 92 (30%)] or no CAD [N= 107 (34%)] without significant progression. During a median follow-up time of 42 months (IQR 18-60), 44 (14.2%) patients died. The subtype of ventricular arrhythmia was associated to prognosis (figure 1). In all subgroups (VT, nsVT, VES), the survival analysis revealed no difference between patients with new CAD or progression of CAD on the one hand and those without CAD or progression on the other (VT: p = 0.70; nsVT: p = 0.65; VES: p = 0.14). Furthermore in all subgroups (VT, nsVT, VES), the survival analysis found no difference between patients with a specific treatment of CAD (PCI or CABG) and those without (VT: p = 0.37; nsVT: p = 0.95; VES: p = 0.07). Conclusion CAD is diagnosed in a relevant proportion of patients with ventricular arrhythmia but no evidence of an acute coronary syndrome. However, neither the successful detection of a new CAD or the progression of a known CAD nor the specific treatment (PCI or CABG) of a detected significant CAD had an impact on survival outcome. This challenges ventricular arrhythmia as an indication for ICA.Figure 1:Survival Curves

Aortic root diameter, main pulmonary artery diameter/aortic root diameter and pericardial fat volume as predictors of occlusive coronary artery disease.

The clinical relevance of aortic root diameter (ARD) and main pulmonary artery diameter (MPAd) or pericardial fat volume (PFV) in the assessment of coronary artery disease (CAD) is largely unknown. We aimed to assess the relationship of pericardial fat volume (PFV), ARD, MPAd, and MPAd/ARD ratio with occlusive CAD (stenosis>50%).This cross-sectional study included patients who had chest pain suggestive of CAD and underwent a 64-multislice multi-detector CT angiography exam to exclude occlusive CAD presence. A total of 145 patients were enrolled in this study. The mean age was 54±10 years, 51% were males. The mean PFV, ARD, MPAd, and MPAd/ARD ratio in all patients were 155 cm3, 29.9 mm, 23.4 mm and 0.8, respectively. On univariate analysis, PFV (OR (CI)=1.1 (1.01-1.3), P<0.01), ARD (OR (CI)=1.2 (1.1-1.4), P<0.01), and MPAd/ARD ratio (OR (CI)= 0.2 (0.1-0.5), p=0.02) showed significant association with occlusive CAD presence. After adjusting for cardiac risk factors, only PFV (OR (CI)=1.1 (1.02-1.3), p<0.01), but not ARD (OR (CI)=0.9(0.3-2), p=0.85) or MPAd/ARD ratio (OR (CI)=0.1(0.1-2), p=0.69), was independently associated with occlusive CAD. In conclusion, increased PFV, but not ARD or MPAd/ARD ratio, showed a significant and independent association with occlusive CAD presence in patients with chest pain suggestive of CAD.

Cognitive effects of carotid revascularization in octogenarians

BackgroundCognitive impairment is the epitome of cerebrovascular diseases, causing a significant economic burden on our health care system. Growing evidence has indicated the benefits of carotid interventions in patients with severe carotid atherosclerosis. However, the neurocognitive outcome of carotid revascularization in octogenarians is not clearly understood. We aim to evaluate postintervention cognitive changes in seniors older than 80 years. MethodsWe prospectively recruited 170 patients undergoing carotid interventions. Neurocognitive testing was performed preoperatively and at 1, 6, and 12 months postoperatively. Episodic memory was assessed with Rey’s Auditory Verbal Learning Test. Other executive functions and language measures were also evaluated at individual time points. Raw test scores were converted to z-scores or scaled scores adjusted for age and education. The sample was divided into 2 groups based on age: octogenarian (≥80 years) and nonoctogenarian (<80 years old). Postoperative cognitive scores were compared to baseline within each subcohort. ResultsA total of 23 subjects (13%) were octogenarians, and 147 (87%) were younger than 80 years. Younger patients demonstrated significant cognitive improvements up to 12 months postop compared to the baseline. However, octogenarians exhibited a lack of improvement in verbal memory, measures of executive function, and language at all 3 postintervention time points. ConclusionCarotid interventions improve cognitive functions in younger patients with carotid occlusive atherosclerosis. However, no cognitive benefits were seen in male seniors older than 80 years. Further investigations are warranted to better understand the postinterventional cognitive changes in octogenarians.

Reperfusion Induced Fatal Hemorrhagic Myocardial Infarction: A Case Report

Sudden death due to coronary artery disease is the leading cause of death globally. Occlusive coronary artery disease results in ischemia of myocardial tissue and subsequent infarction. Various treatment modalities like blood thinners, percutaneous coronary intervention (PCI) etc are being employed in the treatment of acute myocardial infarction (MI). However, these modalities have their own limitations. In this case, reperfusion therapy resulted in hemorrhagic myocardial infarction (HMI) with a fatal outcome. An adult male with history of sudden collapse was brought to the emergency department, where he was declared as brought dead. He underwent reperfusion therapy and was on blood thinners, 4 days before the incident. On autopsy, we could find the features of hemorrhagic myocardial infarction grossly and the same was confirmed histopathologically. Though reperfusion injuries are commonly documented, deaths due to hemorrhagic myocardial Infarction, which is one of the rare complications of reperfusion therapy, are rarely reported. The important role of forensic pathologists in this case is to identify the rare causes, which led the patient to death during management of occlusive coronary artery disease.

Gene Therapeutic Strategies for Peripheral Artery Disease and New Opportunities Provided by Adeno-Associated Virus Vectors.

Peripheral artery disease (PAD) is a vascular disorder caused by occlusive atherosclerosis, which commonly impairs blood flow to the lower extremities. The prevalence of PAD is increasing globally with >200 million people affected. PAD remains a growing global health problem as the population continues to age and diabetes incidence grows. Many patients with PAD, most notably those with critical limb ischemia, fail attempts at surgical and percutaneous intervention to improve blood flow and are at risk of amputation. Gene therapy provides an opportunity to change the clinical course of PAD in these patients via strategies that increase vascular supply through angiogenesis and arteriogenesis improving muscle perfusion and function in ischemic legs. This article discusses gene therapy approaches in the context of PAD, both intermittent claudication and critical limb ischemia, and the promise of adeno-associated virus-based strategies delivering not just VEGFs (vascular endothelial growth factors) but a range of other mediators as potential new therapeutics. We also highlight challenges and failures in the clinical translation of gene therapy for PAD and how at least some of these obstacles may be overcome using adeno-associated virus.

Cardiovascular risk factors and pericardial fat volume as predictors of coronary atherosclerosis burden in postmenopausal women: A retrospective, single center study.

Little is known about the clinical relevance of pericardial fat volume (PFV), compared to other conventional cardiovascular risk factors, as predictors of coronary atherosclerosis severity among postmenopausal women. Our main aim was to assess the association of PFV and cardiovascular risk factors with coronary atherosclerosis burden, including occlusive coronary artery disease (CAD) (luminal stenosis >50%), coronary artery calcium score (CAC)>100, and plaque types in postmenopausal women. Patients who had chest pain of angina and referred for 64-slice multi-detector CT (MDCT) angiography examination to exclude occlusive CAD presence were enrolled in this retrospective study. A total of 241 women with absence of menses for more than 2 consecutive years and not taking hormone replacement therapy were enrolled in the present study. Increased PFV(OR[CI] = 1.1 [1-1.3],p = 0.004), age (OR [CI] = 1.1 [1-1.4],p = 0.002), and diabetes mellitus (OR [CI] = 2 [1-4],p = 0.025)were significant predictors of occlusive CAD presence. Increased PFV(OR [CI] = 1.1 [1-1.4],p = 0.017)and increased age (OR [CI] = 1.2 [1.1-1.4],p < 0.001)were better predictors of CAC>100 than other cardiovascular risk factors. Regarding coronary plaque types, increased age (OR [CI] = 1.1 [1.1-1.3],p = 0.001)showed a significant association with coronary calcified plaque presence while increased body mass index(OR [CI] = 1.2 [1-1.4],p = 0.018)showed a significant association with coronary non-calcified plaque presence. Higher PFV values showed an independent association with occlusive CAD and significant coronary calcification. This may imply that increased PFV is likely associated with the development of advanced and severe phenotype of coronary atherosclerosis among postmenopausal women with suspected CAD.

Association between estimated pulse wave velocity and silent lacunar infarct in a Korean population.

Previous studies have proposed the estimated pulse wave velocity (ePWV) as a simple and cost-effective measure of arterial stiffness. Since arterial stiffness plays a role in the progression of silent lacunar infarct (SLI), our present work aims to evaluate the association between ePWV and the presence of SLI. The present work was based on a cross-section study. Our study included 1,011 neurologically healthy Korean participants. The SLI was evaluated using brain magnetic resonance images (MRI). The ePWV was derived from a published equation using age and mean blood pressure (MBP). Logistic regression analyses were performed to investigate the association between ePWV and SLI. The linear relationship and robustness were evaluated using smooth curve fitting and subgroup analyses, respectively. The prevalence of SLI was 11.87%. After fully adjusting for covariates, per 1 m/s increase of ePWV casted 31% additional risk for SLI (P = 0.009). When dividing the ePWV into quartiles, the top quartile had 4.01 times risk compared with the bottom quartile. The increasing trend across the quartiles was statistically significant (P for trend < 0.001). Consistently, smooth curve fitting revealed that the risk of SLI elevated linearly with the increase of ePWV. Finally, subgroup analysis suggested that the association was robust in several sub-populations divided by age, sex, smoking, hypertension, diabetes mellitus (DM), coronary artery occlusive disease (CAOD), hyperlipidemia, and statin medication (all P for interaction > 0.05). The current study revealed an independent and positive association between ePWV and the presence of SLI in a neurologically healthy Korean population.

Metabolic syndrome-related factors as possible targets for lower urinary tract symptoms in Korean males

Introduction A positive association between benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and metabolic syndrome (MetS) was reported in several studies, but studies from Asia often showed conflicting results. Materials and methods Medical records were obtained from a health promotion center database between 2021 and 2022. Men without a history of treatment for LUTS were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), transrectal ultrasonography. Results Of 1345 individuals, 603 (44.8%) had MetS. Older age, higher IPSS values, higher prevalence rates of BPH and overactive bladder, higher triiodothyronine, and lower testosterone and sex-hormone binding globulin were observed in individuals with MetS than in individuals without MetS. The severity of LUTS significantly increased in the individuals with MetS (p = .002). In individuals with MetS, age, HbA1c, and cerebrovascular disease (CVD) were associated with IPSS. For OABSS, age, HbA1c, thyroid-stimulating hormone (TSH), coronary artery occlusive disease, and CVD were identified as predictors. Conclusions We confirmed the positive correlation between MetS and BPH/LUTS in Korean. Factors including TSH and atherosclerosis affected LUTS in individuals with MetS. These findings suggested a potential role of thyroid hormones and atherosclerosis in the etiology and treatment of BPH/LUTS in patients with MetS.

131: ANOMALOUS RIGHT CORONARY ARTERY WITH AN INTERARTERIAL COURSE ORIGINATING FROM THE LEFT CORONARY CUSP

Introduction: Anomalies of coronary arteries arising from the opposite sinus are extremely rare, with an estimated prevalence of anomalous right coronary arteries arising from the left coronary cusp varying between 0.026 and 0.25%. While largely incidental, symptomatic patients vary in presentation. This case describes a young patient with no cardiac history who presented with acute coronary syndrome and was found to have an anomalous origin of the right coronary artery (RCA). Methods: Data was collected during the admission and follow-up a year later. Results: A 27-year-old male with a history of recent cocaine use presented to the hospital with several hours of chest pain described as constant, substernal, pressure-like, exertional, and with radiation to both arms. Laboratory analysis on admission showed normal cardiac biomarkers but the ECG showed ST-elevations in multiple inferior leads. Emergent cardiac catheterization with coronary angiography showed no epicardial or occlusive coronary artery disease; however, it did show an abnormal origin of the RCA. Subsequent CT angiogram of the coronary arteries confirmed an anomalous origin of the RCA from the left coronary cusp with an interarterial course between the aorta and the pulmonary artery, with concerns for impingement. Troponin level trended up to 21 ng/mL; however, we were unsure whether this was secondary to cocaine-induced vasospasms, RCA impingement, or a combination of both. Echocardiogram (ECHO) showed a normal ejection fraction with no valvular or wall motion abnormalities. Patient tolerated the stress test well, tolerating 11+ METS, which revealed no significant ECG changes and minimal areas of ischemia. Following discussion with all the cardiac specialties involved, the patient decided to hold off surgery at this time and continue with conservative medical management. Cocaine abstinence was advised. The patient has had no recurrent episodes in over a year. Conclusions: Coronary anomalies should be suspected in symptomatic young patients with acute coronary syndrome. Given the rarity of this condition, many physicians may be unaware of this disease and should consider this as a differential diagnosis. While surgical intervention is considered first line treatment in many cases, medical management remains a suitable option in select patients.

Abstract 11532: Cardiac Complications in Polyarteritis Nodosa: A Case of Multi-Vessel Coronary Occlusion Treated With 4-Vessel Coronary Artery Bypass Grafting

Polyarteritis nodosa (PAN) is a necrotizing vasculitis causing intimal proliferation, luminal narrowing, thrombosis, ischemia, and even infarction. Coronary manifestations are rare, though recent evidence suggests coronary disease may progress rapidly causing significant morbidity and mortality. We report a case of multi-vessel occlusive coronary artery disease (CAD) in a patient with systemic PAN, successfully managed with 4-vessel coronary artery bypass grafting (CABG). An obese 53-year-old male with hypertension, hyperlipidemia, and tobacco use presented with episodic epigastric pain. Serial troponins and EKGs did not suggest cardiac ischemia. Cardiac MRI showed concentric LV hypertrophy with preserved systolic function without signs of infiltrative disease or fibrosis. Abdominal CT demonstrated splenic infarction, luminal narrowing of the celiac axis, and abdominal aortic and bilateral iliac artery aneurysms. MRA revealed inflammation of the celiac, splenic, and common hepatic arteries. CT angiography revealed beading of the superior mesenteric artery and celiac trunk, indicative of vasculitis. C3 and C4 levels were elevated. Polyarteritis nodosa was felt to be his unifying diagnosis. Prior to initiating cyclophosphamide, he returned with severe epigastric pain prompting admission. Endoscopy was negative. Coronary CT showed extensive calcification. Angiography revealed multi-vessel occlusive disease patterned with ectasia. He underwent 4-vessel CABG revascularization with LIMA-LAD and SVG-OM-LPDA-RPDA. After surgery, he began prednisone, dual anti-platelet, statin, beta-blocker, and angiotensin receptor blockade with rheumatology follow-up for optimal timing of cyclophosphamide initiation. For patients with systemic inflammatory conditions, recognition of atypical anginal events is crucial as typical identifiers of atherosclerosis may not be obvious. Bypass is definitive therapy, as stenting arteritic vessels may result in neo-endothelization. Clinicians must recognize increased risk of CAD while offering appropriate primary and secondary interventions such as screening imaging and knowledge of disease distribution for appropriate graft choice.

Obstrüktif Koroner Arter Hastalığı İle Serum 25-OH Vitamin D, Fetuin-A, Matrix Gla Protein Ve ADMA Düzeyleri Arasındaki İlişki

Giriş ve Amaç: Bu çalışmada ateroskleroz etyolojisinde rol oynadığı ileri sürülen 25OH-vitamin D, Matrix Gla Protein (MGP), Fetuin-A, Asimetrik Dimetil Arjinin (ADMA) belirteçleri ile koroner arter hastalığı arasındaki ilişki araştırıldı.&#x0D; Gereç ve Yöntemler: Bu amaçla çalışmaya koroner arter hastalığı ön tanısı ile koroner anjiyografi işlemi uygulanmış olan ve normal koroner arter saptanan 40 olgu ile, en az bir koroner arterinde %70 ve üzerinde darlık saptanan 40 olgu olmak üzere toplam 80 olgu dahil edildi.&#x0D; Bulgular: Kan MGP düzeyleri koroner arter hastalığı olan grupta kontrol grubuna kıyasla anlamlı olarak yüksek olarak gözlenirken (sırasıyla 2082,79±329,75 pg/ml ve 1853,42±285,82 pg/ml, p=0,001), Fetuin-A düzeylerinin kontrol grubunda, koroner arter hastalığı grubuna kıyasla anlamlı derecede düşük olduğu gözlendi (sırasıyla 60,54±28,61 ng/ml ve 78,61±20,45 ng/ml, p=0,002). Her iki gruptaki hastaların %85’inde 25OH-vitamin D seviyeleri düşük düzeylerde izlenmekle beraber, her iki grup arasında istatistiksel olarak anlamlı olarak fark saptanmadı (sırasıyla 20,27±12,65 ng/ml ve 20,64±7,32 ng/ml, p=0,875). Kan ADMA seviyeleri incelendiğinde ise yine gruplar arasında istatistiksel olarak anlamlı bir fark gözlenmedi (grup 1; 0,099±0,053 umol/l ve grup 2; 0,089±0,051 umol/l, p&gt;0,05). Sonuç olarak; 25OH-vitamin D ve ADMA değerleri ile koroner arter hastalığı arasında anlamlı bir ilişki saptanmazken, MGP ve Fetuin-A'nın tıkayıcı koroner arter hastalığında belirteç olabileceği gözlendi.&#x0D; Sonuç: Bizim çalışmamızda tıkayıcı koroner arter hastalığı tanısında MGP ve Fetuin-A biyobelirteçlerinin yol gösterici olduğu gözlenmiştir. Bu bulgular ışığında MGP ve Fetuin-A düzeylerinin koroner arter hastalığı tanısında kullanımının değerlendirilmesi için benzer altyapılı ve daha geniş popülasyonlarla yapılacak yeni çalışmalara ihtiyaç vardır.

Diabetic dyslipidemia impairs coronary collateral formation: An update.

Coronary collateralization is substantially impaired in patients with type 2 diabetes and occlusive coronary artery disease, which leads to aggravated myocardial ischemia and a more dismal prognosis. In a diabetic setting, altered serum lipid profiles and profound glycoxidative modification of lipoprotein particles induce endothelial dysfunction, blunt endothelial progenitor cell response, and severely hamper growth and maturation of collateral vessels. The impact of dyslipidemia and lipid-lowering treatments on coronary collateral formation has become a topic of heightened interest. In this review, we summarized the association of triglyceride-based integrative indexes, hypercholesterolemia, increased Lp(a) with its glycoxidative modification, as well as quantity and quality abnormalities of high-density lipoprotein with impaired collateral formation. We also analyzed the influence of innovative lipid-modifying strategies on coronary collateral development. Therefore, clinical management of diabetic dyslipidemia should take into account of its effect on coronary collateralization in patients with occlusive coronary artery disease.

The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease.

Objective By detecting the levels of external counterpulsation combined with exercise therapy on the levels of moesin, angiopoietin-like protein2 (Angptl 2), angiopoietin-like protein (Angptl 3), hypoxia inducible factor-1α (HIF-1α), and RNA-34a (miR-34a) in patients with coronary artery occlusive disease, the effect of external counterpulsation combined with exercise therapy on the establishment of occluded coronary collateral circulation was studied. Methods A retrospective analysis of 166 patients with coronary heart disease was confirmed by coronary angiography results that at least one coronary artery (anterior descending branch, circumflex branch, and right coronary artery) was completely occluded and was classified into the control group (routine medication) and the treatment group (routine drug therapy plus exercise therapy and external counterpulsation) according to the treatment plan of the patient. The serum levels of moesin, Angptl 2, Angptl 3, and HIF-1α were detected by enzyme-linked immunosorbent assay (ELISA) test. The index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) of the two groups of patients were measured before and after 2 weeks of treatment. The formation of collateral circulation was analyzed according to the Rentrop classification method. Results After treatment, the IMR levels of the two groups were significantly decreased, and the CFR levels were significantly increased. The decrease of IMR level and the increase of CFR level in the experimental group were better than those in the control group (P < 0.05). There was no significant difference in the positive detection rate of moesin antibody between the two groups, but the OD detection value of the treatment group decreased significantly (P < 0.05). The levels of Angptl 2, Angptl 3, and miR-34a in the treatment group were lower than those in the control group, while the relative expression of HIF-1α was higher than that in the control group. The difference was statistically significant (P < 0.05). External counterpulsation combined with exercise therapy improved the formation rate of collateral circulation (P < 0.05). Conclusions External counterpulsation combined with exercise therapy can reduce moesin antibody, Angptl 2, Angptl 3, and miR-34a levels increase HIF-1α levels, and promote the establishment of occluded coronary collateral circulation.

Association Between Serum Uric Acid and Intracranial Arterial Stenosis in a Korean Population: A Secondary Analysis Based on a Cross-Sectional Study

Background and purposeIntracranial arterial stenosis (ICAS) is a common cause of cerebrovascular disease. Studies have shown that the disease may be associated with elevated serum uric acid. However, the results remain inexact and controversial. To provide theoretical support for clinical practice, we assessed the relationship between uric acid and ICAS based on previous literature.Materials and MethodsA total of 1,011 samples were included in the secondary cross-sectional study we investigated. We evaluated the relationship between uric acid level and ICAS using multivariable logistic regression analysis.ResultsThe mean age of patients was 64.16 ± 9.13 years, and 35.51% (n = 359) were male in the study. One hundred and one (10%) of the included participants had ICAS. In the unadjusted model, uric acid level was positively associated with ICAS [odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.07–1.42, p < 0.01]. After adjusting for potential confounders (sex, age, diabetes mellitus, coronary artery occlusive disease, hyperlipidemia, statin medication, hypertension, and fasting glucose), a positive relationship was observed between uric acid and ICAS (OR = 1.26, 95% CI: 1.08–1.47, p < 0.05).ConclusionThere was a positive relationship between uric acid levels and ICAS in neurologically healthy Korean participants.

Advances in the Post-coronary Artery Bypass Graft Management of Occlusive Coronary Artery Disease.

Revascularisation of chronic total occlusion (CTO) represents one of the most challenging aspects of percutaneous coronary intervention, but advances in equipment and an understanding of CTO revascularisation techniques have resulted in considerable improvements in success rates. In patients with prior coronary artery bypass grafting (CABG) surgery, additional challenges are encountered. This article specifically explores these challenges, as well as antegrade methods of CTO crossing. Techniques, equipment that can be used and reference texts are highlighted with the aim of providing potential CTO operators adequate information to tackle additional complexities likely to be encountered in this cohort of patients. This review forms part of a wider series where additional aspects of patients with prior CABG should be factored into decisions and methods of revascularisation.

OR72. The relationship between diabetes mellitus and homocysteine level in peripheral arterial disease population in mataram city

Abstract Background Peripheral Arterial Disease (PAD) is partial or total blockage of blood vessel caused by occlusive atherosclerosis especially in lower extremity. Hyperhomocysteinemia had been used as a biomarker of cardiovascular disease such atherosclerosis formation process. Previous study have reported higher incidence of homocysteine level in patient with Diabetes Mellitus (DM) type 2. However, data on homocysteine level in PAD patient with DM type 2 is limited. Therefore, this study aim to investigate the comparation between DM and homocysteine level in PAD patient in Mataram City. Methods and Results This study is a cross sectional study conducted at Siti Hajar Islamic Hospital in Mataram City. The sample was patients with PAD with an ankle brachial index score &amp;lt;0.90 and DM type 2. The outcome of this study was homocysteine level on DM PAD patient and non-DM PAD patient. Data analysis using the unpaired T test. fifty-two PAD patients in this study, with 75% female (39) and average age of 57.4 years old in this research. The average homocysteine level in PAD patient with DM (5.7±0.9 µmol/L) was significantly higher than those in non-DM PAD patient (4.8±1.0 µmol/L) (p = 0.001). We found that history of hypertension was significantly higher in non-DM PAD patient and ankle brachial index score was significantly lower in DM PAD patient (p = 0.049). Conclusion There is a significant differences of homocysteine level within DM patient compared to non-DM patient.

Powody, dla których warto stosować cilostazol

Occlusive atherosclerosis of the lower limbs in the initial stage is characterized by symptoms of intermittent claudication with a variable distance depending on the severity of its changes. As a progressive disease, it may lead to the obstruction of the arteries of the lower extremities and the formation of a collateral circulation network in the form of natural by-passes of obstructed sections of the arteries. Disease development is accelerated by: older age, male sex, smoking, diabetes, dyslipidemic disorders and arterial hypertension. One of the effective forms of treatment of chronic lower limb ischemia in the course of atherosclerosis is pharmacotherapy with cilostazol.