Occurrence Of Acute Coronary Syndrome Research Articles

Elevated Lp(a) and thrombophilic mutations : the experience of a general hospital

Abstract Funding Acknowledgements None. Background Thrombophilia and elevated Lp(a) levels have been studied as risk factors predisposing to cardiovascular events. There is no evidence suggesting that the common mutations causing thrombophilia or elevated Lp(a) alone could be regarded as independent risk factors for acute coronary syndromes. Purpose To compare the frequency of the simultaneous presence of thrombophilic mutations along with elevated Lp(a) levels in young patients presenting with acute coronary syndrome (ACS) compared with those without ACS. Methods We retrospectively analyzed the data from all the young patients (males<40yo, females <45yo) who were referred for thrombophilia testing to our hospital for a period of 10 years and divided them in two groups : those who presented with ACS (ACS group) and those who were referred for thrombophilia testing for other reason (non ACS group). Lp(a) level >30mg/dl was considered as elevated. We compared the frequency of elevated Lp(a) levels in patients carrying the same mutation in the two groups. P<0.01 was considered statistically significant. Results Of the 127 patients recorded in the ACS group, 25 were factor V Leiden homozygotes, 11 factor V Leiden heterozygotes, 17 PAI 4G/5G homozygotes, 8 PAI 4G/5G heterozygotes, 36 G20210A homozygotes and 12 G20210A heterozygotes. In the non ACS group, we analyzed data from 312 patients.Of them, 12 were factor V Leiden homozygotes, 29 factor V Leiden heterozygotes, 31 PAI 4G/4G homozygotes, 17 PAI 4G/5G heterozygotes, 66 G20210A homozygotes and 57 G20210A heterozygotes. Elevated Lp(a) levels were found as follows : (ACS vs non-ACS group) factor V Leiden homozygotes 14/25(56%) vs 1/12(8.33%) (p<0.01), factor V Leiden heterozygotes 7/11(8.66%) vs 2/29(6.89%), p<0.01), PAI 4G/4G homozygotes 1/17(5.88%) vs 0/31, PAI 4G/5G heterozygotes 0/8 vs 0/31), G20210A homozygotes 0/36 vs 1/66(1.51%), G20210A heterozygotes 1/12(9.44%) vs 0/57). Conclusions Lp(a) was elevated more frequently in patients carrying factor V Leiden mutation (either homozygotes or heterozygotes) who presented with ACS when compared with patients without ACS. Although it is not established, further studies are needed in order to identify any possible correlation of the combination of this mutation along with elevated Lp(a) levels with the occurrence of ACS in young patients.

Abstract P514: Association Between Glycemic Disorder and Acute Coronary Syndrome Among Patients With Stable Coronary Artery Disease: A Propensity Score Matching Analysis

Background: Type 2 diabetes mellitus is known as a major risk factor of acute coronary syndrome (ACS) as previous studies reported. However, the association between prediabetes and ACS is not fully investigated among patients with stable coronary artery disease (CAD). Furthermore, no study has examined whether there’s effect modification by sex, age and BMI in the association between glycemic disorder and ACS. Our study aimed to evaluate the role of glycemic disorder in ACS occurrence among patients CAD. Methods: In this cross-sectional study based on electronic medical records (EMR), participants with CAD after elective coronary artery angiography (CAG) during 2016-2020 were enrolled. Diagnosis of prediabetes was based on patients’ HbA1c level ranging from 5.7% to 6.4% or fasting plasma glucose (FPG) level between 5.6 - 6.9 mmol/L. The diabetes diagnosis was defined as HbA1c ≥6.5% or fasting plasma glucose (FPG) ≥7.0 mmol/L. Multivariable logistic regression models were built to evaluate the association between prediabetes, diabetes and ACS, adjusting for age, body mass index (BMI), hypertension, low density lipoprotein, triglyceride level, statin and anti-platelet medication use. Subjects with prediabetes were matched 1:1 to healthy controls using propensity score matching to test the robustness of the result. In the subgroup analysis, we examined the heterogeneity of age, sex and BMI in the association between glycemic disorders and ACS. Results: Among 1525 participants, 1158 were male and 367 were female. Compared to participants with no diabetes, those with prediabetic were not significantly associated ACS, after adjusting for potential confounders. The result persisted after 1:1 propensity score matching. There was effect modification by sex in the association between glycemic disorders and ACS (P glycemic disorder*sex = 0.012). Female participants with diabetes, compared to those without diabetes, were positively associated with ACS (OR 2.00, 95% CI 1.00 - 3.98). The association between glycemic disorders and ACS remained stable among those with severe coronary stenosis. Conclusions: Our finding suggested that the association between prediabetes and ACS did not differ from those with normal glycemic status and CAD. The association remained consistent among those with severe coronary stenosis. Besides, sex modifies the association, and female participants with diabetes should be paid attention to their higher risk of ACS.

Prognostic influence of fibroblast growth factor 23 on the course of coronary heart disease in patients with chronic kidney disease

Objective: to study the prognostic impact of the level of fibroblast growth factors 23 on coronary heart disease depending on the stage of chronic kidney disease. Materials and methods: the study included 108 patients with coronary heart disease (CHD), stable angina (stress), functional class 1–3, chronic kidney disease (CKD) C1–C4, average age was 67,62±12,51 years (55 men and 53 women). The level of fibroblast growth factor 23 was assessed using the Biomedica FGF 23 multimatrix enzyme-linked immunosorbent assay. After 12 months of follow-up, the presence of a cumulative endpoint including the occurrence of acute coronary syndrome, stroke, transient ischemic attack, heart failure and death. Differences in data and correlations between them were considered statistically significant at p<0.05. Results: the developed prognostic model to determine the likelihood of cardiovascular complications in patients with coronary artery disease and CKD found that the FGF 23 level is equal to 27.9 with a sensitivity of 62.7% and specificity of 62.5% to distinguish patients with ischemic heart disease and CKD in whom a cumulative endpoint will occur over 12 months of follow-up. Conclusions: to identify patients at high risk of cardiovascular complications in coronary artery disease and CKD, it is advisable to use determination of FGF 23 level.

Fifteen-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation.

Clinical outcomes after percutaneous coronary intervention have improved with the use of drug-eluting stents, but data beyond 10 years are limited. The purpose of this study was to evaluate the clinical outcomes of patients undergoing sirolimus-eluting stent implantation with follow-up beyond 10 years and to determine the impact of clinical and angiographic characteristics on long-term prognosis.Methods and Results: The clinical outcomes of 885 patients who had undergone sirolimus-eluting stent implantation at a single institution were retrospectively reviewed. Primary endpoints included in the analysis were clinically driven target lesion revascularization (cTLR) and target lesion revascularization (TLR). Univariate and multivariate nominal logistic regression was used for data analysis. The incidence rates of cTLR and TLR beyond 10 years after sirolimus-eluting stent implantation were 16.4% and 36.8%, respectively, with cTLR tending to decrease beyond 10 years. Acute coronary syndrome was a predominant trigger for cTLR. Age, statin use, and stent restenosis emerged as predictors of cTLR within 10 years, but no significant predictors other than age were identified beyond 10 years. Events continue to occur beyond 10 years after sirolimus-eluting stent implantation, with a trend toward an increase in acute coronary syndromes. It is important to be vigilant about the occurrence of acute coronary syndromes during long-term follow-up.

The Effect of Daylight-Saving Time on Percutaneous Coronary Intervention Outcomes in Acute Coronary Syndrome Patients-Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) in the Years 2014-2022.

Many factors related to the switch to summer/winter time interfere with biological rhythms. This study aimed to analyze the impact of time change on clinical outcomes of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Electronic data of 874,031 patients with ACS who underwent invasive procedures were collected from the Polish National Register of Interventional Cardiology Procedures (ORPKI) between 2014 and 2021. We determined the number of patients undergoing PCI and periprocedural mortality during the day of spring or autumn time change and within the first 3 and 7 days after the time change. We demonstrated the impact of time changes on the periprocedural mortality of ACS patients within 1 day and the period of 3 and 7 days from the time change. We observed that the occurrence of all ACS and NSTEMI on the first day was lower for both time changes and higher in the case of UA and spring time change. The autumn time change significantly reduced the occurrence of all types of ACS. A significant decrease in the number of invasive procedures was found after autumn transition in the period from the first day to 7 days for ACS, NSTEMI, and UA. The occurrence of ACS and the number of invasive procedures were lower for both changes over time. Autumn time change is associated with increased periprocedural mortality in ACS and a less frequent occurrence of UA and NSTEMI within 7 days.

Recurrent Kounis syndrome due to amoxicillin: A case report

Kounis syndrome is the occurrence of acute coronary syndrome during an allergic reaction. It is thought to be due to mast cell activation and degranulation leading to coronary vasospasm. A 60-year-old gentleman presented with a cutaneous allergic reaction associated with tightening left-sided chest pain. This occurred 5 minutes after taking Amoxicillin. There were dynamic ECG changes with rising Troponin I. He had a similar episode following Amoxicillin four years ago. This case report highlights the importance of identifying Kounis Syndrome as an important differential diagnosis among patients presenting with chest pain.

Are artificial intelligence derived coronary atherosclerotic characteristics associated with subsequent development of acute coronary syndrome (ACS)

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Scripps Health Krueger Wyeth Grant Background ACS results from unstable atherosclerotic plaques. Current measures to assess risk do not consider the patient’s coronary atherosclerotic composition. This was a case control study using a prospective single-center registry of patients undergoing CCTA (N=2,700) from 2017–2020 to assess the association between plaque characterization and the occurrence of ACS. Methods ACS cases were adjudicated independently by two cardiologists using data from the EMR. Patients with prior ACS prior to CCTA, were excluded. Controls were selected 1:1 by nearest neighbor propensity matching (R. v. 4.0.3.) based on age, sex, smoking, HTN, HLD, and DM. Plaque burden and stenosis features were calculated by a commercially available artificial intelligence (AI) coronary analysis (Figure 1). Results There were 21 cases and 21 controls. Mean age of 68, 43% women, 5% Hispanic, 29% smoking hx, 76% HTN, 81% HLD, 24% DM, CAD-RADS score 2.3, and CAC of 487. Median time from CT to ACS for cases was 329 days. Presence of total non-calcified plaque, calcified plaque, fibro-fatty plaque, maximum stenosis diameter percentage and total plaque were each associated with greater risk of ACS (Table 1). Conclusion AI assessment of CCTA plaque characteristics were associated with ACS. This study shows the association between AI derived coronary atherosclerotic features and development of ACS in patients undergoing CCTA and highlights the potential utility of using AI-driven plaque characterization to predict ACS.

CCTA characteristics of vulnerable plaques preceding acute coronary syndromes-a comparative analysis between STE- and NSTE-ACS

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the University of Medicine, Pharmacy, Science and Technology „George Emil Palade“ of Târgu Mureș Research Grant number 510/13/17.01.2022. Background CCTA adverse plaque features, that illustrate increased vulnerability, have been established as significant predictors for adverse events in patients with coronary artery disease. Decades of research have benchmarked the implication of vulnerable plaques (VP) in the occurrence of acute coronary syndromes (ACS). Still, there is little information concerning the interrelation between VP features and the subsequent type of ACS. Aim We sought to identify specific characteristics of future culprit vulnerable plaques, in a comparative analysis between the type of ACS they trigger, in patients undergoing CCTA and plaque analysis for stable chest pain. Material and Methods We conducted a prospective analysis, with a 3 year follow-up, on 50 subjects who underwent CCTA evaluation for stable chest pain. Coronary plaques were analyzed at baseline, for lesions that presented moderate stenosis, with at least one vulnerability marker (LAP, PR, NRS, SCs), which became culprit lesions during follow-up. Patients were initially divided into 2 groups (gr.1 – with STE-ACS, n=13) gr.2 – patients with NSTE-ACS, n=37). The secondary analysis divided the population in 3 groups gr.1-patients with UA (n=28); gr.2- with STEMI (n=13); gr.2 –with NSTEMI (n=9). Results The time to the occurrence of an ACS was higher for STE-ACS compared to NSTE-ACS (169.9±177.4, p<0.001), which was similar when comparing NSTEMI vs. UA vs. STEMI (p = 0.0001). The lowest degree of stenosis was present for VP that had triggered NSTEMI (p = 0.03). Evaluation of plaque composition revealed that the STE-ACS group presented higher non-calcified (171.6±63 vs. 130.6±80.1 mm3 p = 0.04) and lipid rich (19.9±16.7 vs. 11.42±10.5 mm3, p = 0.04) volumes, with no other differences regarding plaque composition and morphology. Plaques that had triggered STEMI during follow-up, presented highest non-calcified (p = 0.01) and lipid rich (p = 0.01) volumes. The greatest number of plaques with over 2 vulnerability markers per lesions were found in NSTEMI precursor lesions compared to UA and STEMI (77.8% vs. 53.8% ±25%, p = 0.01). Conclusions Compared to NSTE-ACS triggering lesions, vulnerable plaques that precede STEMI-ACS present a more lipid rich, non-calcified phenotype. NSTEMI precursor lesions are heterogeneous, with a low calcium volume and increased number of vulnerability markers, while VPs triggering unstable angina are calcified, with a low lipid rich volume and spotty calcifications.

Spontaneous Coronary Artery Dissection Postpartum and Recurrence during Menopause: Hormonal Involvement in Acute Coronary Syndromes

In this case report, we present a case of a 38-year-old woman with no cardiac history and no risk factors who was admitted to the hospital with a spontaneous coronary artery dissection (SCAD) after pregnancy. Twelve years later, she suffered a recurrent SCAD during her menopause. SCAD is a rare occurrence of acute coronary syndromes and recurrence is even more rare. SCAD seems to occur predominantly in females and seems to be related to hormone levels. At first presentation, the patient was 38 years old and 4 weeks postpartum. She presented with chest pain. Electrocardiogram (ECG) showed loss of r-amplitude but no ST-segment deviation. Troponins were elevated and showed significant rise and fall. She was treated with dual anti-platelet strategy and underwent coronary angiography (CAG) which showed a type 1 dissection of the distal circumflex artery. The lesion was treated conservatively. Second presentation was 12 years later, in which she again presented with chest pain this time during menopause. ECG showed marginal changes and the troponins were again elevated. She underwent CAG again which showed a new SCAD (Type 2 B) in the second marginal obtuse artery. The old SCAD lesion was healed. Renal angiography was preformed which showed an renal bead pattern typical for fibromuscular dysplasia. Again, she was treated conservatively. This case is the first case report of a patient suffering from a recurrent SCAD in a different coronary artery, both events probably related to hormonal changes, that is, postpartum and during menopause. This may emphasize careful examination of chest pain in menopause patients with a history of earlier SCAD.

The Novel Role of Noncoding RNAs in Modulating Platelet Function: Implications in Activation and Aggregation.

It is currently believed that plaque complication, with the consequent superimposed thrombosis, is a key factor in the clinical occurrence of acute coronary syndromes (ACSs). Platelets are major players in this process. Despite the considerable progress made by the new antithrombotic strategies (P2Y12 receptor inhibitors, new oral anticoagulants, thrombin direct inhibitors, etc.) in terms of a reduction in major cardiovascular events, a significant number of patients with previous ACSs treated with these drugs continue to experience events, indicating that the mechanisms of platelet remain largely unknown. In the last decade, our knowledge of platelet pathophysiology has improved. It has been reported that, in response to physiological and pathological stimuli, platelet activation is accompanied by de novo protein synthesis, through a rapid and particularly well-regulated translation of resident mRNAs of megakaryocytic derivation. Although the platelets are anucleate, they indeed contain an important fraction of mRNAs that can be quickly used for protein synthesis following their activation. A better understanding of the pathophysiology of platelet activation and the interaction with the main cellular components of the vascular wall will open up new perspectives in the treatment of the majority of thrombotic disorders, such as ACSs, stroke, and peripheral artery diseases before and after the acute event. In the present review, we will discuss the novel role of noncoding RNAs in modulating platelet function, highlighting the possible implications in activation and aggregation.

Blood Count-Derived Inflammatory Markers and Acute Complications of Ischemic Heart Disease in Elderly Women.

Coronary artery disease (CAD) in women occurs later than in men. Underlying atherosclerosis, a chronic process of lipoprotein deposition in arterial walls with a prominent inflammatory component, is influenced by several risk factors. In women, commonly used inflammatory markers are generally found to be related to the occurrence of acute coronary syndrome (ACS), as well as the development of other diseases that influence CAD. New inflammatory markers derived from total blood count-systemic inflammatory response index (SII), systemic inflammatory reaction index (SIRI), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR)-were analyzed in the group of 244 elderly, postmenopausal women with the diagnosis of ACS or stable CAD. SII, SIRI, MLR, and NLR were significantly higher in women with ACS compared to those with stable CAD (p < 0.05 for all)-the highest values were observed in women with NSTEMI. MLR from new inflammatory markers, HDL, and history of MI turned out to be significant factors associated with ACS. These results suggest that MLR as representative of blood count-derived inflammatory markers may be considered as additional CVD risk factors in women with suspected ACS.

Relation between Hypercoagulability Effect of COVID-19 and the Occurrence of Acute Coronary Syndrome

Relation between Hypercoagulability Effect of COVID-19 and the Occurrence of Acute Coronary Syndrome

Abstract 15552: Optimal Virtual Monoenergetic Settings in Spectral Ct With a Dual Layer Detector: Breakthrough in Achieving Best Contrast Between Non Calcified and Calcified Plaques and Lumen in Coronary Arteries

Introduction: Non calcified plaque (NCP) in coronary arteries on CT is correlated with occurrence of acute coronary syndromes and coronary artery calcification (CAC) may occasionally be co-existed. CAC induces a blooming artifact, which magnifies the calcification versus its actual size. The CT values of NCP and CAC are influenced by tube kilovoltage (kV). Recent spectral CT with a dual-layer detector can generate CT images at any kiloelectron voltage (keV) (range: 40-200) after ordinary acquisition using virtual monoenergetic settings (VMS). Hypothesis: Using a new spectral CT, we can determine the optimal VMS settings for achieving best contrast between NCP, CAC and the lumen in coronary arteries. Methods: We performed enhanced 128 slice Spectral CT 7500 scans using a dual-layer detector in 42 patients with NCP and CAC on CT (tube voltage: 120 kV). After scanning, VMS images at various keV values were created from the spectral-based images. We measured the mean CT values of NCP and CAC, lumen in left main artery (LMA), and fat tissue around coronary arteries within a 1.0 mm2 circle in the axial images at each keV in early phase with a contrast. Results: Lower keV values were linked to only slightly increased mean CT values of NCP, but markedly increased mean CT values of CAC. The CT values of the lumen in the LMA were markedly increased. Conversely, the CT values of fat tissue were slightly decreased. The greatest differences in mean CT values between NCP and the LMA were observed at 40 keV. However, considering blooming artifact of CAC at 40 keV, the optimal keV for achieving the best contrast between the CT values of NCP and the lumen in the LMA was influenced by age, male sex. Conclusions: The NCP in coronary arteries, CAC, lumen of the LMA, and fat tissue exhibit unique characteristics. When conventional CT rather than spectral CT is used to evaluate the occurrence of NCP, it is necessary to determine the optimal tube voltage based on the age and male sex of the patient, CAC, and lumen of the LMA.

KOUNIS SYNDROME, THE ALLERGIC HEART ATTACK

<h3>Introduction</h3> Seldom do allergic reactions progress to involve the heart. Kounis Syndrome is the occurrence of acute coronary syndrome associated with conditions of mast cell activation such as allergy hypersensitivities (1). Here, we describe a case in which an allergic reaction to injected Lidocaine and Kenalog leads to myocardial infarction. <h3>Case Description</h3> A 67-year-old female with cardiac risk factors and osteoarthritis underwent injection of her right ankle with Lidocaine and Kenalog. She developed diffuse erythematous rash with symptoms of lightheadedness, altered mentation, and chest discomfort. Upon admission, she received epinephrine. Electrocardiogram (EKG) demonstrated ST-segment elevation in inferior leads II, III, and aVF. Labs revealed serum tryptase level of 74.8 ug/L. The patient received intravenous (IV) Norepinephrine, IV diphenhydramine, IV Famotidine, IV methylprednisolone, Aspirin, and continuous IV heparin for emergent coronary angiography. The distal right coronary artery revealed occlusive thrombus burden, causing 95% stenosis. Percutaneous coronary intervention was performed with drug-eluting stent placement. Her symptoms resolved, and she was referred to an outpatient allergist. <h3>Discussion</h3> This case illustrates the type II variant of Kounis Syndrome in which inflammatory mediators from an allergic reaction induce atherosclerotic plaque destabilization and rupture in underlying coronary artery disease (CAD). Cardiovascular manifestations associated with allergic conditions are more common than initially perceived, suggesting a causal relationship between allergies and heart disease. This remains underdiagnosed by clinicians in practice (1,2). Biomarkers in allergies, such as serum tryptase, may provide a potential marker of CAD. Novel medications that stabilize mast cells and reduce inflammation known to control allergies may ultimately reduce cardiovascular events (4).

Investigation on the Association of Copper and Copper-to-Zinc-Ratio in Hair with Acute Coronary Syndrome Occurrence and Its Risk Factors.

The prevalence of coronary artery disease (CAD) increases every year; however, the impact of microelements on its underlying cause—atherosclerosis—is still unclear. Copper plays numerous regulatory roles in cardiovascular health and was suggested to influence the classic risk factors for CAD. The copper-to-zinc-ratio (Cu/Zn-ratio) reflects systemic oxidative stress–one of the factors in the complex pathogenesis of atherosclerosis. Hair incorporates metal ions during its growth; thus, it reflects the metal exposure that occurred over the last 4–8 weeks. The aim of the presented study was to verify the association between Cu and Cu/Zn-ratio content and the occurrence of acute coronary syndrome (ACS) in the hair of 133 patients who underwent coronary angiography due to suspected ACS. Additionally, association between Cu and Cu/Zn-ratio and selected risk factors for CAD was analyzed. Neither Cu nor Cu/Zn-ratio levels were associated with the occurrence of ACS, regardless of its type (UA/NSTEMI/STEMI). We did not find a significant association between Cu content in hair and risk factors for CAD. The Cu/Zn-ratio in hair was significantly correlated only with body mass index. The relationship of Cu content and Cu/Zn-ratio in hair with CAD, its risk factors and ACS appears to be complex and requires further well-designed research.

Investigation of the Associations of Novel Inflammatory Biomarkers-Systemic Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI)-With the Severity of Coronary Artery Disease and Acute Coronary Syndrome Occurrence.

Atherosclerosis, the underlying cause of coronary artery disease (CAD), has a significant inflammatory component. White blood cell count is an affordable and accessible way to assess the systemic immune response, as it comprises many subgroups with distinct and complex functions. Considering their multidirectional effect on atherosclerosis, new biomarkers integrating various leukocyte subgroups, the Systemic Inflammatory Index (SII) and the Systemic Inflammatory Response Index (SIRI), were recently devised to describe the balance between inflammation and immune reaction. This research aimed to evaluate the relationship of the intensity of inflammation measured by these biomarkers with the severity of CAD assessed with coronary angiography and with the diagnosis of acute coronary syndrome (ACS) or stable CAD in 699 patients. SIRI, but not SII, was associated with the diagnosis, having the highest values for patients with ACS (STEMI), significantly higher than in patients with stable CAD (p < 0.01). The highest SII and SIRI values were observed in patients with three-vessel CAD. SII and SIRI require further in-depth and well-designed research to evaluate their potential in a clinical setting.

Quantitative plaque characterisation and association with acute coronary syndrome on medium to long term follow up: insights from computed tomography coronary angiography.

BackgroundComputed tomography coronary angiography (CTCA) is an established imaging modality widely used for diagnosing coronary artery stenosis with expanding potential for comprehensive assessment of coronary artery disease (CAD). Lesion-based analyses of high-risk plaques (HRP) on CTCA may aid further in prognostication presenting with stable chest pain. We conduct qualitative and quantitative assessments to identify HRPs that are associated with acute coronary syndrome (ACS) on a medium to long term follow-up.MethodsRetrospective cohort study of patients who underwent CTCA for suspected CAD. Obstructive stenosis (OS) is defined as ≥50% and the presence of HRP and its constituents: positive-remodelling (PR), low-attenuation-plaque (LAP; <56 HU), very-low-attenuation-plaque (vLAP; <30 HU) and spotty-calcification (SC) were recorded. A cross-sectional quantitative analysis of HRP was performed at the site of minimum-luminal-area (MLA). The primary endpoint was fatal or non-fatal ACS on follow-up.ResultsA total of 1,257 patients were included (mean age 61±14 years old and 51% male) with a median follow-up of 7.24 years (interquartile range 5.5 to 7.7 years). The occurrence of ACS was significantly higher in HRP (+) patients compared to HRP (−) patients and patients with no plaques (20.5% vs. 1.6% vs. 0.4%, log-rank test P<0.001). ACS was more frequent in HRP (+)/OS (+) patients (20.7%) compared to HRP (+)/OS (−) patients (8.6%), HRP (−)/OS (+) patients (1.8%) and HRP (−)/OS (−) patients (1.0%). OS, cross-sectional plaque area (PA) and the presence of vLAP identified those HRP lesions that were more likely to cause future ACS. Cross-sectional LAP area (<56 HU) in HRP lesions added incremental prognostic value to OS in predicting ACS (P=0.008).ConclusionsThe presence of OS and the LAP area at the site of MLA identify the HRP lesions that have the greatest association with development of future ACS.

Evaluation of Common Factors of Periodontitis and Cardiovascular Disease in Patients with the Acute Coronary Syndrome.

Periodontitis is a multifactorial disease causing inflammatory destruction of supporting structures of the dentition and eventually leading to its loss. This study was designed to evaluate common risk factors for periodontitis and acute coronary syndrome in the study population and demonstrate the systemic impact of periodontitis on the occurrence of acute coronary syndrome. A total of 160 patients (35 female and 125 male) were enrolled in the study. Considering the age range, the largest group of patients (118 patients) was between 55 and 65 years, which accounted for 73.8% of the total study population. There were 35 patients (21.9%) in the age group of 45 to 54 years, while the youngest age group of 35 to 44 years had as many as seven patients. Medical history and physical examination, including periodontal status, were performed. API, PD, CAL, and CPITN were evaluated. Common risk factors for periodontitis and acute coronary syndrome were assessed. The study assessed risk factors such as hypertension, diabetes, dyslipidemia, general health, smoking, height, weight, and hip circumference. In light of the above-described etiopathogenesis of atherosclerotic disease and its association with periodontal disease, it is important to emphasize preventing and treating periodontitis, especially in patients in the so-called high-risk group for cardiovascular disease. Dentists’ introduction of an appropriate prophylactic and therapeutic plan may constitute both primary and secondary prevention of cardiovascular diseases.

Impact of a NDUFC2 Variant on the Occurrence of Acute Coronary Syndromes.

BackgroundAmong several potential mechanisms, mitochondrial dysfunction has been proposed to be involved in the pathogenesis of coronary artery disease (CAD). A mitochondrial complex I deficiency severely impairs cardiovascular health and contributes to CAD development. Previous evidence highlighted a key role of NDUFC2, a subunit of complex I, deficiency in the increased occurrence of renal and cerebrovascular damage in an animal model of hypertension, and of juvenile ischemic stroke occurrence in humans. Furthermore, a significant decrease of NDUFC2 mRNA was detected in peripheral blood mononuclear cells from patients experiencing acute coronary syndrome (ACS). The T allele at NDUFC2/rs23117379 variant is known to associate with reduced gene expression and mitochondrial dysfunction.ObjectiveIn the present study we tested the impact of the T/C NDUFC2/rs23117379 variant on occurrence of ACS in a prospective cohort of CAD patients (n = 260).ResultsHypertension, smoking habit, diabetes and hypercholesterolemia were present in a large proportion of patients. Non-ST-elevation myocardial infarction (NSTEMI) represented the most frequent type of ACS (44%, n = 115), followed by ST-elevation myocardial infarction (STEMI) (34%, n = 88) and unstable angina (22%, n = 57). The alleles/genotypes distribution for T/C at NDUFC2/rs23117379 revealed that the TT genotype was associated with a trend toward the development of ACS at an earlier age (TT 61 ± 12, CT 65 ± 12 and CC 66 ± 11 years; p = 0.051 after adjustment for gender, hypertension, smoking habit, diabetes and hypercholesterolemia) and with a significant predictive role for ACS recurrence (hazard ratio [HR]1.671; 95% confidence interval [CI], 1.138–2.472; p = 0.009).ConclusionsOur findings are consistent with a deleterious effect of NDUFC2 deficiency on acute coronary events predisposition and further support a role of the NDUFC2/rs23117379 variant as a genetic cardiovascular risk factor.

Diagnostic efficacy of serum ST2 in patients with ASC.

BackgroundSoluble suppression of tumorigenicity 2 (ST2) is closely related to the development of cardiovascular disease, but the level of acute coronary syndrome (ACS) and the relationship between ST2 and ACS are unclear.Patients and MethodsPatients with the acute coronary syndrome were divided into the unstable angina pectoris (USAP) group (n = 65) and non‐ST‐segment elevation myocardial infarction (NSTEMI) group (n = 58), and the healthy population, without chest pain and with normal coronary CT, was included as a control group (n = 55). Laboratory index levels were collected from each participant. The baseline information was reviewed and analyzed. The binary logistic regression was used to explore the relation of ST2 levels with the occurrence of ACS and NSTEMI, and the diagnostic performance of ST2 for diagnosing ACS or NSTEMI was evaluated using a receiver‐operating characteristic (ROC) curve.ResultsThe level of ST2 was found significantly higher in NSTEMI than in USAP and was higher in USAP than in control (p < 0.01). ST2 levels were positively correlated with ALT, AST, and BNP in the control group, were negatively correlated with HGB and TG in the USAP group, and were positively correlated with WBC, GLU, BNP, and Gensini scores in the NSTEMI group. Multivariate analysis revealed that the occurrence of ACS was associated with ST2, BNP, GLU, TC, BUN, WBC, and PLT, and the occurrence of NSTEMI was associated with AST, WBC, LDL‐C, and ST2. Meanwhile, ST2 levels achieved good performance for ACS and NSTEMI diagnostician.ConclusionST2 could be used as an auxiliary diagnostic indicator for the occurrence of ACS and NSTEMI.