Occurrence Of Adverse Cardiac Events Research Articles

Relationship between changes in neurological deficit severity and adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage: a retrospective cohort study

Objective To explore the relationship between changes in neurological deficit severity and the occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage. Methods Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of NIHSS scores for adverse cardiac events. Results There were significant differences between the two groups. Multivariate logistic regression analysis showed that advanced age, high NIHSS score, large intracerebral hemorrhage volume, and high CK level were independent risk factors for adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage (p < 0.05). The NIHSS scores of both groups gradually increased after admission, peaking at 48 h after admission. In Group A, this elevation persisted until 72 h after admission, while in Group B, there was a significant decrease at 72 h after admission (p < 0.05). From admission to 7 days after admission, the NIHSS scores in Group A were higher than those in Group B (p < 0.05). The area under the curve (AUC) of the NIHSS scores at 48 h after admission was 0.776, with sensitivity and specificity of 80.9% and 84.5%, respectively, which were higher than those of other indicators (p < 0.05). Conclusion The occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage is influenced by multiple factors, and as the NIHSS score increases, the risk of such events gradually increases. Clinicians should pay attention to monitoring NIHSS scores after admission, as they have value in predicting adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage.

Correlation between Left Ventricular Pressure–Strain Loop and Severity in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome and Its Application Value in Short-Term Prognosis Evaluation

Purpose To investigate the diagnostic value of nonintrusive left ventricular pressure–strain loop (LV-PSL) for assessing overall myocardial function in sufferers with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with or without coronary stenosis. The results of this research might provide insights into the diagnosis and management of NSTE-ACS. Methods All 268 sufferers with NSTE-ACS who were received by the First Affiliated Hospital of Nanchang University between June 2019 and June 2021 were enrolled. Sufferers with single or multiple extramural coronary diameter stenosis ≥70% on coronary angiography were defined as the stenosis group. All sufferers underwent noninvasive LV-PSL construction by using cuff blood pressure as the left ventricular pressure before coronary angiography, and the resulting images were imported and analysed with offline analysis software to obtain global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The correlation between severity Gensini score and myocardial work (MW) parameters was identified through Spearman analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values for predicting coronary stenosis, and logistic regression analysis was used to identify independent factors affecting left ventricular myocardial function in sufferers of NSTE-ACS. The occurrence of adverse cardiac events during the follow-up period was recorded. Results Through the comparative analysis of general clinical data, significant differences were found between the stenosis and nonstenosis groups in terms of gender, hyperlipidaemia, hypertension and smoking. However, statistical difference was observed only for hypertension (stenosis group 54.2%; p &lt; 0.05) and hypercholesterolaemia (stenosis group 53.5%; p &lt; 0.05). GLS (tz value 3.063), GCW (tz value 11.494), GWI (tz value 9.627) and GWE (tz value 12.780) reduced and GWW (tz value 11.504) increased in the stenosis group compared with those in the nonstenosis group. All differences were statistically significant (all p &lt; 0.05). Severity Gensini scores were negatively correlated with GLS, GCW, GWI and GWE but positively correlated with GWW (p &lt; 0.001). The ROC curve and univariate and multivariate logistic regression analyses revealed that GWE (odds ratio (OR) 2.881; 95% confidence internal (95% CI) 2.176–3.816; p &lt; 0.001) had the largest area under the curve and greatest sensitivity for coronary stenosis diagnosis. GWE was (OR 2.875; 95% CI 2.217–3.727; p &lt; 0.001) and (OR 2.881; 95% CI 2.176–3.816; p &lt; 0.001). During an average follow-up period of 26.7 months, 19 sufferers experienced adverse cardiac events. GWE exhibited high predictive ability for identifying such events. Conclusions Noninvasive LV-PSL can identify whether sufferers of NSTE-ACS have acute coronary stenosis regardless of the location or size of the stenosis and can detect varying degrees of left ventricular dysfunction in such sufferers. Amongst indices, GWE had the highest diagnostic efficiency for diagnosing sufferers of NSTE-ACS with coronary stenosis and highest predictive ability for adverse cardiac events.

Effect of cardiac rehabilitation care after coronary intervention on cardiac function recovery and negative mood in patients with myocardial infarction.

Cardiovascular disease, particularly myocardial infarction (MI) profound impact on patients' quality of life and places a substantial burden on the healthcare and economy systems. Developments in medical technology have led to the emergence of coronary intervention as an essential method for treating MI. To assess the effects of cardiac rehabilitation care on cardiac function recovery and negative emotions in MI after coronary intervention. This study included a total of 180 patients with MI during the period from June 2022 to July 2023. Selected patients were divided into two groups: An observation group, which receiving cardiac rehabilitation care; a control group, which receiving conventional care. By comparing multiple observation indicators such as cardiac function indicators, blood pressure, exercise tolerance, occurrence of adverse cardiac events, and negative emotion scores between the two groups of patients. All the data were analyzed and compared between two groups. There were 44 males and 46 females in the observation group with an average age of 36.26 ± 9.88 yr; there were 43 males and 47 females in the control group, with an average age of 40.87 ± 10.5 yr. After receiving the appropriate postoperative nursing measures, the results of the observation group showed significant improvement in several indicators compared with the control group. Indicators of cardiac function, such as left ventricular end-diastolic internal diameter and left ventricular ejection fraction were significantly better in the observation group than in the control group (P < 0.05). Exercise endurance assessment showed that the 6-minute walking test distance was significantly increased in the patients of the observation group (P < 0.01). In addition, the incidence of adverse cardiac events was significantly lower in the observation group, and negative mood scores were significantly reduced (P < 0.05). Cardiac rehabilitation care after coronary intervention has a significant positive impact on functional recovery. This emphasizes the importance of cardiac rehabilitation care to improve patient recovery.

Relationship between left-axis deviation and onset of cardiac adverse events in right ventricular pacing.

The electrical axis shows alterations during right ventricular pacing (RVP), including a normal axis and left axis deviation; however, it remains unknown if differences in the electrical axis affect the occurrence of cardiac adverse events. The purpose of this study was to determine whether a left axis deviation increases the incidence of adverse cardiac events compared with a normal axis. This study analysed 156 patients with RVP. The patients were divided into two groups: those with left axis deviation after RVP (LAD group) and those with a normal axis (NA group). The primary composite outcome was the new-onset of atrial fibrillation (AF) and worsening heart failure (HF). The QRS axis of the LAD (n=77) and NA (n=79) groups were-64.5±14.3° and 29.8±36.5°, respectively (P<0.001). The median follow-up was 1100days and, regarding primary composite outcomes (hazard ratio, 1.03; 95% confidence interval, 0.64 to 1.65; P=0.89), 29/77 (37.6%) and 28/79 (35.4%) patients in the LAD and NA groups, respectively, developed AF (hazard ratio, 1.07; 95% confidence interval, 0.64 to 1.81; P=0.77). Furthermore, 8/77 (10.3%) and 12/79 (15.1%) patients in the LAD and NA groups, respectively, experienced worsening HF (hazard ratio, 0.65; 95% confidence interval, 0.26 to 1.60; P=0.35). The risk of cardiac adverse events in patients with RVP (new-onset AF or worsening HF, cardiovascular death, myocardial infarction, and stroke) and overall mortality with LAD is not higher than that with NA.

The role of echocardiographic parameters in the prevention and monitoring of cardiac toxicity on antitumor treatments.

The paper presents a summary of the literature that includes the results of the research on the echocardiographic parameters for the early detection and monitoring of the cardiac toxicity of the antitumor treatment. While the left ventricular ejection fraction is currently the most widely used index to quantify cardiac function in cardio-oncology, there are a number of indices under investigation to prove their prognostic value in the occurrence of adverse cardiac events during cancer therapy. Such indices derived from the Doppler method, speckle tracking parameters, strain rate as well as parameters derived from three-dimensional echocardiography, which can provide additional sensitivity and substantial prognostic value for future cardiovascular events.

Dissecção espontânea da artéria coronária, uma doença multifatorial: perspectivas da experiência de um centro

Background: Although it is a poorly known disease, spontaneous coronary artery dissection is an important and frequently underdiagnosed cause of non-atherosclerotic acute coronary syndrome, particularly in women. The objective of this study was to characterize a consecutive sample of patients diagnosed with spontaneous coronary artery dissection with respect to predisposing and precipitating factors; clinical and angiographic presentation; management; occurrence of adverse cardiac events; recurrence; and de novo spontaneous coronary artery dissection. Methods: Longitudinal, observational, retrospective, single-centre study, including patients diagnosed with spontaneous coronary artery dissection (n=60) admitted between January 2010 and December 2020. Results: Median age was 55 years, and 83% were women. Most patients (60%) presented without any or just one cardiovascular risk factor. Non-ST-segment elevation acute myocardial infarction accounted for 67% of clinical presentations. The most frequently affected coronary artery was the left anterior descending (47%). Most lesions (77%) appeared on angiography as type 2 spontaneous coronary artery dissection. Conservative management was chosen as the initial approach in most patients (72%). The overall incidence of de novo spontaneous coronary artery dissection was not significantly different among patients initially managed with revascularization as compared to conservative treatment (p=0.953). However, spontaneous coronary artery dissection recurrence occurred in the originally involved vessel in 3 of 15 patients initially managed with revascularization, as compared to only one among 43 patients treated conservatively (p&lt;0.05). Conclusion: Spontaneous coronary artery dissection occurs more often in young women. Non- ST-segment elevation acute myocardial infarction was the most frequent clinical presentation involving mainly the left anterior descending artery. Revascularization did not protect from recurrence.

Simvastatin Combined with Resistance Training Improves Outcomes in Patients with Chronic Heart Failure by Modulating Mitochondrial Membrane Potential and the Janus Kinase/Signal Transducer and Activator of Transcription 3 Signaling Pathways.

Background Chronic heart failure (CHF) is the end stage of cardiac disease with a 5-year mortality rate reaching 50%. Simvastatin is an antioxidant with lipid-lowering effects, which is commonly used to treat CHF. Resistance training is a nondrug treatment for CHF and exerts a positive effect on both the myocardial structure and function. Objective This study is aimed at exploring the effects and outcomes of simvastatin combined with resistance training on the mitochondrial membrane potential (MMP) of peripheral blood lymphocytes and the Janus kinase/signal transducer and activator of the transcription 3 (JAK/STAT3) signaling pathway in patients with CHF. Methods One hundred and eleven patients with CHF were allocated to the control group (CNG) (n = 55) and intervention group (IG) (n = 56) using the random number table method. The CNG received simvastatin treatment only, whereas the IG received simvastatin treatment plus resistance training. Treatment efficacy, diastolic interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD), MMP fluorescence intensity, JAK mRNA and STAT3 mRNA relative expression levels, serum C-reactive protein (CRP), galectin-3, interleukin-6 (IL-6), N-terminal–probrain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and heart-type fatty acid-binding protein (H-FABP) levels were compared in both groups. Results After 6 months of treatment, diastolic IVST, LVDD, and serum levels of CRP, galectin-3, IL-6, NT-proBNP, hs-cTnT, and H-FABP decreased in both groups and were lower in the IG than in the CNG (P < 0.05), whereas LVEF, JAK and STAT3 mRNA relative expression levels, and MMP fluorescence intensity of peripheral blood lymphocytes were higher in the IG than in the CNG (P < 0.05). Conclusion Simvastatin combined with resistance training improves heart function and reduces myocardial damage as well as the occurrence of adverse cardiac events compared with simvastatin alone. The mechanism may be related to the increase of expression of MMP, JAK, and STAT3, the regulation of MMP and JAK/STAT3 signaling pathways in peripheral lymphocytes, the alleviation of mitochondrial damage, and the inhibition of inflammatory response.

Research progress on WeChat platform in continuous care for patients with coronary heart disease

This paper reviews the application of WeChat in continuous care for patients with coronary heart disease (CHD) , namely the WeChat group-based intervention, the WeChat public platform-based intervention, the combination of WeChat group and WeChat public platform, and the combination of WeChat group and other information technologies. In addition, this paper analyzes the effect of WeChat intervention, that is, its impact on disease knowledge, self-management behavior, quality of life and the occurrence of adverse cardiac events in patients with CHD, in order to provide a reference for enriching continuous care for patients with CHD, so that continuous care can be effectively combined with WeChat information technology. Key words: Review; Continuous care; Coronary heart disease; WeChat

Adverse Cardiac Events and Mortality in Patients with Critical Limb Ischemia

Both surgical and endovascular treatment in elderly patients with critical limb ischemia are associated with high mortality rates. Patients with critical limb ischemia are at increased risk of adverse cardiovascular events and subsequent cardiovascular death. Little is known about the incidence and consequences of these adverse events. The aim of this study was to investigate the effect of adverse cardiac events on mortality in patients with critical limb ischemia undergoing surgical or endovascular treatment. A retrospective cohort study including all patients with critical limb ischemia aged ≥65 undergoing surgical or endovascular treatment for critical limb ischemia between January 2013 and June 2018 was conducted. Data on adverse cardiac events were collected from medical records. The effect of an adverse cardiac event on mortality during 6months follow-up was analyzed with a multivariable cox proportional hazards model to adjust for confounders. Effects are displayed as hazard ratios (HR) with 95% confidence intervals (CI). A total number of 449 patients were included. Median age was 76years, 52.8% of patients were male. In total, 51 patients (11%) developed an adverse cardiac event, 31 patients (10%) in the surgical group and 20 patients (14%) in the endovascular group. After adjustment for confounders, adverse cardiac events were associated with an increased risk of mortality (HR 3.5 95% CI 2.1-5.9). This study showed that adverse cardiac events commonly occur in elderly patients with critical limb ischemia. Adverse cardiac events continue to occur even months after treatment and are associated with an increased mortality risk. These findings justify routine cardiac evaluation in both surgical and endovascular treatment. Additionally, frequent postdischarge cardiac follow-up in the outpatient clinic may be helpful in limiting the occurrence of adverse cardiac events.

Neutrophil extracellular traps and dsDNA predict outcomes among patients with ST-elevation myocardial infarction

Neutrophil extracellular traps (NETs) which have a potential role in noninfectious diseases, may play an important role in patients with acute coronary syndrome. The goal of this study was to investigate the association of NETs and in-hospital major adverse cardiac events among patients with ST-segment elevation myocardial infarction (STEMI). Using immunofluorescence staining, ELISA, and fluorescent enzyme standard instrument, we assessed NETs and NETs-related factors. Multivariate analyses were performed after univariate analyses to investigate which variables were independently associated with major adverse cardiac events. Compared with peripheral arteries, we observed neutrophils obtained from infarct-related artery (IRA) releasing NETs. The dsDNA levels, NET-specific marker myeloperoxidase/deoxyribonucleic acid (MPO/DNA) complexes and NETs-related factor tissue factor were significantly higher in coronary plasma samples. Multivariate analysis that white cell counts and coronary dsDNA were independently associated with in-hospital major adverse cardiac events. ROC curve for coronary dsDNA showed sensitivity of 78.0% and specificity of 53% for the cut-off value of 0.39ug/ml. Conclusion, these results provide evidences indicating NETs were associated with STIM, and occurrence of adverse cardiac events.

Correlation between myeloperoxidase levels and adverse cardiac events in patients undergoing coronary stent implantation

Objective To investigate the correlation between myeloperoxidase(MPO)levels and adverse cardiac events in patients undergoing coronary stent implantation. Methods A total of 76 patients undergoing coronary stent implantation from January 2015 to June 2016 in the cardiac surgery department of our hospital were enrolled in this study.Serum levels of MPO, high sensitivity C-reactive protein(hs-CRP), and interleukin 6(IL-6)were detected by enzyme-linked immunosorbent assays(ELISA). After a one-year follow-up, the receiver operating characteristic(ROC)curve was used to determine the predictive value of the difference in MPO before and after the operation(ΔMPO)on the long-term prognosis of patients after coronary stent implantation.The correlations of ΔMPO with the traditional risk factors for coronary heart disease and adverse cardiac events were analyzed using multi-factor Logistic regression analysis. Results Serum levels of MPO, hs-CRP and IL-6 increased in patients after coronary stent implantation, compared with those before treatment(P<0.05). The results of ROC curve analysis showed that the area under the curve(AUC)value of serum ΔMPO was 0.786, the 95% confidence interval was 0.471~1.000 and the predictive value of serum ΔMPO for adverse cardiac events was significant(P<0.05). There was a significant correlation between ΔMPO and age, and the incidence of adverse cardiac events increased with increased ΔMPO levels.Logistic regression analysis showed that serum ΔMPO levels could preliminarily diagnose the cardiovascular risk after coronary stent implantation and independently predict the occurrence of adverse cardiac events. Conclusions MPO levels in peripheral blood are notably elevated in patients after coronary stent implantation when compared with pre-treatment levels.Serum ΔMPO levels can preliminarily diagnose adverse cardiac events after coronary stent implantation and can be used as a marker to predict adverse cardiac events. Key words: Coronary disease; Stents; Peroxidase

Copeptin, myeloperoxidase and pro-adrenomedullin for acute coronary syndrome in patients with chronic kidney disease

Objectives:Copeptin, myeloperoxidase and pro-adrenomedullin have emerged as potential biomarkers for diagnosis and prognosis of acute coronary syndrome (ACS). However, their applicability in patients with chronic kidney disease (CKD) remains unknown as these patients were excluded from previous studies. Our objective was to determine the superior novel cardiac marker to predict 30-day and six-month adverse cardiac events (ACEs) defined as cardiac-related death, myocardial infarction and ventricular fibrillation.Methods:A prospective observational study was carried out. Patients were included if they presented to the emergency department with symptoms suggestive of ACS and had CKD as defined as a serum creatinine of more than 130 µmol/l. Copeptin, myeloperoxidase and pro-adrenomedulin assays were performed. Occurrence of ACE was traced from review of the patients’ case records and the registry of deaths.Results:A total of 724 patients were recruited: 60.6% were male and 68.6% were Chinese. The median age was 67 years. Among those recruited, 88.3% had CKD stages 4 and 5, with 33.5% on dialysis. The rates of ACE at 30 days and six months were 15.1% and 21.7%, respectively. All readings of the three biomarkers were not significantly different in patients with ACE compared with those without both at 30 days and six months. The areas under the curve for copeptin, myeloperoxidase and pro-adrenomedullin were 0.53, 0.50 and 0.45, respectively ( p &gt; 0.05).Conclusions:The poor performance of the biomarkers may be attributable to lack of specificity for ACS, as elevated levels could be from other causes in CKD patients. Routine testing cannot be recommended.

The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients.

Background It has been reported that harmonics of radial pulse is related to coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). It is still unclear whether or not the first harmonics of the radial pulse spectrum is an early independent predictor of silent coronary artery disease (SCAD) and adverse cardiac events (ACE). Objectives To measure the risk of SCAD in patients with T2DM and also to survey whether or not an increment of the first harmonic (C1) of the radial pulse increases ACE. Methods 1968 asymptomatic individuals with T2DM underwent radial pulse wave measurement. First harmonic of the radial pressure wave, C1, was calculated. Next, the new occurrence of ACE and the new symptoms and signs of coronary artery disease were recorded. The follow-up period lasted for 14.7 ± 3.5 months. Results Out of 1968 asymptomatic individuals with T2DM, ACE was detected in 239 (12%) of them during the follow-up period. The logrank test demonstrated that the cumulative incidence of ACE in patients with C1 above 0.96 was greater than that in those patients with C1 below 0.89 (P < 0.01). By comparing the data of patients with C1 smaller than the first quartile and the patients with C1 greater than the third quartile, the hazard ratios were listed as follows: ACE (hazard ratio, 2.29; 95% CI, 1.55–3.37), heart failure (hazard ratio, 2.22; 95% CI, 1.21–4.09), myocardial infarction (hazard ratio, 2.44; 95% CI, 1.51–3.93), left ventricular dysfunction (Hazard ratio, 2.01; 95% CI, 0.86–4.70), and new symptoms and signs for coronary artery disease (hazard ratio, 2.03; 95% CI, 1.45–2.84). As C1 increased, the risk for composite ACE (P < 0.001 for trend) and for coronary disease (P < 0.001 for trend) also increased. The hazard ratio and trend for cardiovascular-cause mortality were not significant. Conclusions This study showed that C1 of the radial pulse wave is correlated with cardiovascular events. Survival analysis showed that C1 value is an independent predictor of ACE and SCAD in asymptomatic patients with T2DM. Thus, screening for the first harmonic of the radial pulse may improve the risk stratification of cardiac events and SCAD in asymptomatic patients although they had no history of coronary artery disease or angina-related symptom.

Prognosis of anatomic coronary artery disease without myocardial ischemia: Coronary computed tomography angiography detects high-risk patients even in cases of negative single-photon emission computed tomography findings

BackgroundWhile coronary computed tomography angiography (CCTA) provides comprehensive anatomic evaluation of coronary artery disease (CAD) with prognostic implications, clinically, the focus is usually placed on presence or absence of functionally significant CAD. Herein, we aimed to suggest a new risk stratification strategy using CCTA in patients with anatomic CAD but without myocardial ischemia on single-photon emission computed tomography (SPECT). MethodsConsecutive patients (n=798) with CAD on CCTA who underwent SPECT for evaluation of myocardial ischemia were retrospectively evaluated. The primary outcome was the occurrence of adverse cardiac events, including cardiac death, nonfatal myocardial infarction, unstable angina, and late revascularization. ResultsOf the enrolled patients, 542 (68%) showed no perfusion defect (PD) on SPECT. During the follow-up (median, 22.6 months), adverse cardiac events occurred in 23 patients without PD (4.6%). Presence of plaque in ≥4 coronary segments, plaque in the left main or proximal left anterior descending coronary artery, and partially calcified plaque presence were independent predictors of adverse events. When we defined the CCTA score based on these 3 predictors (0–3 points), the annualized event rates increased with increasing CCTA scores. Patients with a CCTA score of 3 were associated with a 23-fold risk increase (adjusted HR 23.18; p=0.003) and showed unfavorable event-free survival, comparable to those with PD on SPECT (p=0.191). ConclusionAnatomic CAD patients without evidence of myocardial ischemia on SPECT but with high-risk characteristics on CCTA showed unfavorable outcomes, comparable to those with PD. CCTA allows further risk stratification even in patients with negative SPECT findings.

Percutaneous Coronary Intervention

Objective. Toevaluate therelationship between the completeness ofrevascularisation bypercutaneous coronary intervention andtheone-year occurrence ofadverse cardiac events inpatients withmultivessel disease. Patients. Patients withstable orunstable angina pectoris, orwithexercise-induced ischaemia, were enrolled intheCoronary Angioplasty versus Bypass Revascularisation Investigation (CABRI). Methods. InCABRI,patients wererandomised to coronary bypass grafting (CABG;n=513)or angioplasty (PTCA;n=541). Revascularisation in patients randomised toPTCA wasdefined as complete ifnolesions withadiameter stenosis <50%remained post-procedure. Patients with complete revascularisation weredistinguished from those withone, two,andthree ormoreremaining lesions, respectively. Differences inbaseline characteristics andintheone-year occurrence ofdeath, myocardial infarction, (re)CABG, and(re)PTCA between these subgroups wereevaluated. Comparisons weremadewithpatients randomised to CABG. Complete revascularisation wasobtained in148patients randomised toPTCA(27%). In 147(27%) cases onelesion remained, while there were122(23%) and119(22%) patients withtwo andthree ormoreremaining lesions, respectively. Five (1%)patients could notbeclassified. Theoneyearrates ofeither death orMIwere9.5%, 5.4%, 8.2%, and12.6% intherespective PTCAsubgroups (p=0.225), and6.2%inpatients randomised to CABG(comparison withthree ormoreremaining lesions after PTCA:p=0.017). Thepercentages of repeat interventions during one-year follow-up were29.7%, 29.3%, 39.3%, and51.3% (p<0.001), muchhigher thanafter CABG(3.5%; p<0.001). Conclusion. Complete revascularisation byPTCA inmultivessel coronary disease didnotresult ina lower death orMIrate compared withincomplete revascularisation. Overall thepatient's prognosis after PTCAissimilar toCABG,butpatients with three ormoreremaining lesions after PTCAhad aworseprognosis thanCABG patients. (Neth HeartJ2001;9:3-9.)

Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes: A Systematic Literature Review.

: Background: In the management of non-ST-elevation acute coronary syndrome (NST-ACS) a gap between guideline-recommended care and actual practice has been reported. A systematic overview of the actual extent of this gap, its potential impact on patient-outcomes, and influential factors is lacking.Objective: To examine the extent of guideline adherence, to study associations with the occurrence of adverse cardiac events, and to identify factors associated with guideline adherence.Method: Systematic literature review, for which PUBMED, EMBASE, CINAHL, and the Cochrane library were searched until March 2016. Further, a manual search was performed using reference lists of included studies. Two reviewers independently performed quality-assessment and data extraction of the eligible studies.Results: Adherence rates varied widely within and between 45 eligible studies, ranging from less than 5.0% to more than 95.0% for recommendations on acute and discharge pharmacological treatment, 34.3% - 93.0% for risk stratification, and 16.0% - 95.8% for performing coronary angiography. Seven studies indicated that higher adherence rates were associated with lower mortality. Several patient-related (e.g. age, gender, co-morbidities) and organization-related (e.g. teaching hospital) factors influencing adherence were identified.Conclusion: This review showed wide variation in guideline adherence, with a substantial proportion of NST-ACS patients possibly not receiving guideline-recommended care. Consequently, lower adherence might be associated with a higher risk for poor prognosis. Future research should further investigate the complex nature of guideline adherence in NST-ACS, its impact on clinical care, and factors influencing adherence. This knowledge is essential to optimize clinical management of NST-ACS patients and could guide future quality improvement initiatives.

Effects of changes of risk factors in PCI patients on the incidence of cardiac adverse events

Objective To investigate changes of risk factors in patients after percutaneous coronary intervention (PCI), and analyze the relationship between it and the risk of occurrence of adverse cardiac events. Methods Totally 868 patients after PCI in the follow-up database center of a tertiary hospital in Harbin from March to September 2012 were selected as the research object. 2 years after surgery, the changes of blood lipid, body mass index (BMI), smoking, blood pressure and other risk factors were analyzed. Results There was no significant change in BMI and systolic blood pressure 2 years after PCI compared with prior, while low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and total cholesterol (TC) significantly decreased compared with preoperative, and high-density lipoprotein cholesterol (HDL-C) increased (P<0.05). In addition, risk stratification of adverse cardiac events was in the low-risk and intermediate-risk group 2 years after PCI, and it was significantly higher compared to the previous, and percentage of high-risk group and very high-risk group decreased (P<0.05). Conclusions The change of risk factors in PCI patients leads to the reallocation of risk stratification of cardiac adverse events, which reminds that medical staff should adhere to strengthening long-term secondary prevention interventions after PCI, to improve the quality of life of patients. Key words: Risk factors; Percutaneous coronary intervention; PROCAM integral table; Quantitative assessment

Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome.

Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n=204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n=109) or usual care (UC) group (n=95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -€24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P=0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.

The Incremental Prognostic Value of Cardiac Computed Tomography in Comparison with Single-Photon Emission Computed Tomography in Patients with Suspected Coronary Artery Disease

BackgroundCoronary computed tomographic angiography (CCTA) facilitates comprehensive evaluation of coronary artery disease (CAD), including plaque characterization, and can provide additive diagnostic value to single-photon emission computed tomography (SPECT). However, data regarding the incremental prognostic value of CCTA to SPECT remain sparse. We evaluated the independent and incremental prognostic value of CCTA, as compared with clinical risk factors and SPECT.Materials and methodsA total of 1,077 patients with suspected CAD who underwent both SPECT and cardiac CT between 2004 and 2012 were enrolled retrospectively. Presence of reversible or fixed perfusion defect (PD) and summed stress score were evaluated on SPECT. Presence, extent of coronary atherosclerosis and diameter stenosis (DS) were evaluated on CCTA. Plaque composition was categorized as non-calcified, mixed, or calcified according to the volume of calcified component (>130 Hounsfield Units). Patients were followed up for the occurrence of adverse cardiac events including cardiac death, non-fatal myocardial infarction, unstable angina, and late revascularization (>90 days after imaging studies).ResultsDuring follow-up (median 23 months), adverse cardiac events were observed in 71 patients (6.6%). When adjusted for clinical risk factors and SPECT findings, the presence of any coronary plaque, any plaque in ≥3 segments, coronary artery calcium score (CACS) ≥400, a plaque ≥50% DS, presence of non-calcified plaque (NCP) or mixed plaque (MP), and NCP/MP in ≥2 segments were independent predictors of adverse cardiac events; however, the presence of calcified plaque (CP) was not. Conventional CCTA findings, including CACS ≥400 and a plaque ≥50% DS, demonstrated incremental prognostic value over clinical risk factors and SPECT (χ² 54.19 to 101.03; p <0.001). Addition of NCP/MP in ≥2 segments resulted in further significantly improved prediction (χ² 101.03 to 113.29; p <0.001).ConclusionComprehensive CCTA evaluation of coronary atherosclerosis provides independent and incremental prognostic value in relation to SPECT evaluation of myocardial ischemia. Specifically, segmentally-analyzed plaque composition with CCTA provides further risk stratification in addition to CACS and DS.

Safety and efficacy of linagliptin in patients with type 2 diabetes mellitus and coronary artery disease: Analysis of pooled events from 19 clinical trials

AimsTo examine the safety and efficacy of linagliptin in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) using pooled data from the global clinical trials program. MethodsPatient-level data were pooled from randomized, placebo-controlled clinical trials of linagliptin (5mg, monotherapy or combination therapy). Safety/efficacy analyses were conducted for patients with CAD and ≥12 and ≥24weeks of treatment, respectively. ResultsThe safety analysis included 19 trials (linagliptin, n=451; placebo, n=272) and the efficacy analysis, 12 trials (linagliptin, n=328; placebo, n=198); mean (± standard deviation) exposure to study treatment was 212 (144) days linagliptin and 245 (171) days placebo. Occurrence of cardiac adverse events (AEs) was similar for linagliptin- and placebo-treated patients (9.1% and 9.2%, respectively); exposure-adjusted incidence rates (per 100 patient-years) were 16.6 and 14.0, respectively. Overall incidence of AEs was numerically lower with linagliptin than placebo. After 24weeks, mean adjusted change (standard error) from baseline glycosylated hemoglobin was −0.64% (0.04) with linagliptin vs. –0.08% (0.05) with placebo (P<.001). ConclusionsThis comprehensive pooled analysis showed that addition of linagliptin to treatment regimens of patients with T2DM and CAD was not associated with an increased incidence of cardiac AEs, was well tolerated, and was effective.