Occurrence Of Cardiovascular Events Research Articles

Impact of Duration of Diabetes Mellitus on Long-term Outcome in Type 2 Diabetic Patients With Primary Percutaneous Coronary Intervention After the First Myocardial Infarction.

Diabetes mellitus (DM) increases the risk of mortality in patients with acute myocardial infarction (AMI). The impact of the diabetes duration on the long-term outcome of those with percutaneous coronary intervention (PCI) after the first AMI is unclear. In this study, we evaluated the predictive value of diabetes duration in the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs). A total of 394 type 2 DM patients with PCI after the first AMI were enrolled and were divided into two groups by the diabetes duration. A short-DM group with diabetes duration of < 5 years and a long-DM group with a duration of ≥ 5 years. The clinical endpoint was MACCEs. Multivariate Cox regression analysis found that the diabetes duration was independently associated with increased occurrence of MACCEs [HR 1.512, 95% CI: (1.033, 2.215), p = 0.034], along with hypertension, Killip class III or IV, creatinine, multivessel disease, and continuous hypoglycemic therapy. After adjusting for the confounding variables, a nested Cox model showed that diabetes duration was still an independent risk factor of MACCEs [HR 1.963, 95% CI: (1.376, 2.801), p < 0.001]. The Kaplan-Meier survival curve illustrated a significantly high risk of MACCEs (HR 2.045, p < 0.0001) in long-duration DM patients. After propensity score matching, a longer diabetes duration was associated with an increased risk of MACCE occurrence. Long-duration diabetes was independently associated with poor clinical outcomes after PCI in patients with their first myocardial infarction, Despite the diabetes duration, continuous hypoglycemic therapy significantly improved long-term clinical outcomes.

Cardiac rehabilitation makes a difference: lipid control targets and prognosis

Abstract Funding Acknowledgements None. Introduction Cardiac rehabilitation (CR) has become a fundamental element in the recovery of patients with acute coronary syndrome, since it achieves greater therapeutic adherence and better control of cardiovascular risk factors (CVRF). Purpose We aim to describe the characteristics of patients with ST-elevation acute coronary syndrome (STEACS) included in a cardiac rehabilitation program, as well as the achievement of prevention objectives and the occurrence of mayor adverse cardiovascular events (MACE). Methods We present a prospective registry of 664 patients admitted to a Coronary Unit with a diagnosis of STEACS during the years 2017-2020. They were classified according to their participation in a CR program. We compared history, lipid-lowering treatment (prior, at discharge and titration), lipid levels at discharge and at 1-year follow-up, and degree of compliance with lipid targets. MACE were observed at 2-year follow-up. Results From 664 patients, 351 were excluded due to lack of follow-up or early mortality. From a total of 313 patients (mean age 59.9±11.2 and 81% male), 55.3% were included in the CR program, with this group presenting a lower mean age (55.46±8.7 vs 65.39±11.5 p&amp;lt;0.001), as well as a higher frequency of a history of early ischemic heart disease and smoking, and a lower frequency of arterial hypertension and diabetes (Table). Lipid-lowering treatment at discharge was similar in both groups. In patients undergoing CR there was a lower level of total cholesterol and low-density lipoprotein cholesterol (LDLc) at one year (126.2±27 vs 137.2±34, p=0.002; 57.8±23 vs 67.5±26, p&amp;lt;0.001) compared to the group without CR. A greater reduction in LDLc (41.4% vs 0.86%, p&amp;lt;0.001) was achieved even from higher initial LDLc values. Titration of lipid-lowering treatment was also greater, with the old target of LDLc &amp;lt; 70 being achieved in a greater number of cases (81.5% vs 59.3%, p&amp;lt;0.001). At 1-year follow-up, the new cholesterol reduction target (LDL &amp;lt;55 or 50% reduction) was achieved in only 26.8% of patients, with a greater reduction being obtained in the CR group (34.1% vs 17.9%; p=0.02). At 2-year follow up, in CR group we found low rates of re-infarction (3.2% vs 4.1%), new revascularization (5.8% vs 7.3%), not statistically significant, but we could observe differences in mortality from all causes (0% vs 4.8%, p&amp;lt;0.01). Conclusions Participation in a CR program is associated with better lipid control in patients admitted for STEACS. These programs represent a basic tool for achieving increasingly demanding LDLc targets. Longer follow-up is needed to detect clinically important adverse events.

Long-Term Clinical Implications of High-Risk Cardiac Computed Tomography Findings in Patients With Acute Ischemic Stroke.

Cardiac computed tomography (CT) acquired during the initial acute stroke imaging protocol (acute cardiac CT) is increasingly used to screen for cardioembolism, but information on the long-term clinical implications of its findings is lacking. We performed a prospective, single-center cohort study in which consecutive patients with ischemic stroke underwent ECG-gated acute cardiac CT and were followed up for 2 years. The primary outcome was functional outcome assessed using the modified Rankin Scale. Secondary outcomes were death and occurrence of major adverse cardiovascular events (composite of recurrent ischemic stroke, myocardial infarction, and cardiovascular death). We compared patients with and without a high-risk structural source of embolism on acute cardiac CT. Of 452 included patients, 55 (12.2%) had a high-risk source of embolism, predominantly cardiac thrombi (38 patients) and signs of endocarditis (8 patients). Follow-up at 2 years was complete for 430 (95.1%) patients. Patients with a high-risk source of embolism had a worse functional outcome (median modified Rankin Scale, 6 [IQR, 2-6] versus 2 [IQR, 1-5]; adjusted common odds ratio, 2.92 [95% CI, 1.62-5.25]), increased mortality rate (52.7% versus 23.7%; adjusted hazard ratio [HR], 3.28 [95% CI, 1.94-5.52]), and major adverse cardiovascular events (38.9% versus 17.5%; adjusted HR, 3.20 [95% CI, 1.80-5.69]). A high-risk source of embolism was not associated with recurrent ischemic stroke (11.1% versus 9.6%; adjusted HR, 1.30 [95% CI, 0.49-3.44]). Structural high-risk sources of embolism on acute cardiac CT in patients with ischemic stroke were associated with poor long-term functional outcome and occurrence of major adverse cardiovascular events but not with recurrent stroke.

A Noninvasive Arterial Stiffness Index to Estimate the Severity of Coronary Atherosclerosis in Patients Undergoing Coronary Angiography

The early diagnosis and appropriate treatment of subclinical atherosclerosis before the onset of life-threatening cardiovascular (CV) diseases are major unmet medical needs in current clinical practice. Noninvasive arterial stiffness indices, the arterial velocity–pulse index (AVI) and the arterial pressure–volume index (API) have been associated with CV risks, conventional arterial stiffness indices, and the severity of coronary atherosclerosis. However, few studies have examined the relationship between these indices and the occurrence of CV events. We measured the AVI and API in 113 consecutive patients admitted to Yokohama City University Hospital for cardiac catheterization between June 2015 and March 2016. Patients were followed until September 2022, and the occurrence of CV events was assessed. The mean age was 71.2 ± 10.7 years, and 83 patients (73.5%) were male. In total, 80 patients (70.8%) had hypertension, 87 (77.0%) had dyslipidemia, and 91 (80.5%) had a history of ischemic heart disease (IHD). The mean follow-up duration was 1752 ± 819 days. Patients who received elective percutaneous coronary intervention (PCI) based on the results of coronary angiography (CAG) at the time of enrollment had significantly higher API than those who did not (38.5 ± 12.6, n = 17 vs. 31.3 ± 7.4, n = 96, p = 0.001). The API was independently associated with the risk of elective PCI in multiple logistic regression analysis. In conclusion, the API could be a useful indicator for estimating the need for coronary interventional treatment in patients with a high CV risk.

Curcumin Equipped Nanozyme-Like Metal-Organic Framework Platform for the Targeted Atherosclerosis Treatment with Lipid Regulation and Enhanced Magnetic Resonance Imaging Capability.

Atherosclerotic cardiovascular disease (ASCVD) has become the leading cause of death worldwide, and early diagnosis and treatment of atherosclerosis (AS) are crucial for reducing the occurrence of acute cardiovascular events. However, early diagnosis of AS is challenging, and oral anti-AS drugs suffer from limitations like imprecise targeting and low bioavailability. To overcome the aforementioned shortcomings, Cur/MOF@DS is developed, a nanoplatform integrating diagnosis and treatment by loading curcumin (Cur) into metal-organic frameworks with nanozymes and magnetic resonance imaging (MRI) properties. In addition, the surface-modification of dextran sulfate (DS) enables PCN-222(Mn) effectively target scavenger receptor class A in macrophages or foam cells within the plaque region. This nanoplatform employs mechanisms that effectively scavenge excessive reactive oxygen species in the plaque microenvironment, promote macrophage autophagy and regulate macrophage polarization to realize lipid regulation. In vivo and in vitro experiments confirm that this nanoplatform has outstanding MRI performance and anti-AS effects, which may provide a new option for early diagnosis and treatment of AS.

Comparative efficacy and acceptability of different exercise patterns for reducing cardiovascular events in pre-diabetes: protocol for a systematic review and network meta-analysis of randomised controlled trials

IntroductionExercise has been used to reverse dysglycaemic states in patients with pre-diabetes. Systematic reviews show that exercise is an effective way to reduce the incidence of diabetes, but there is...

Active Arrhythmia Pattern: A Novel Predictor of ICD Shocks-A Subanalysis From the PARTITA Study.

In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure. A threshold of ATPs that might warrant an ablation procedure before ICD shocks is unknown. Our aim was to identify a threshold of ATPs and clinical features that predict the occurrence of shocks and cardiovascular events. We analyzed data from 517 patients in phase A of the PARTITA study. We used classification and regression tree analysis to develop and test a risk stratification model based on arrhythmia patterns and clinical data to predict ICD shocks. Secondary end points were worsening heart failure and cardiovascular hospitalization. Classification and regression tree classified patients into 6 leaves by increasing shock probability. Patients treated with ≥5 ATPs in 6 months (active arrhythmia pattern) had the highest risk of ICD shocks (93% and 86%, training and testing samples, respectively). Patients without ATPs had the lowest (1% and 2%). Other predictors included left ventricle ejection fraction<35%, age of <60 years, and obesity. Survival analysis revealed a higher risk of worsening heart failure (hazard ratio, 5.45 [95% CI, 1.62-18.4]; P=0.006) and cardiovascular hospitalization (hazard ratio, 7.29 [95% CI, 3.66-14.5]; P<0.001) for patients with an active arrhythmia pattern compared with those without ATPs. Patients with an active arrhythmia pattern (≥5 ATPs in 6 months) are associated with an increased risk of ICD shocks, as well as heart failure hospitalization and cardiovascular hospitalization. These data suggest that additional treatments may be helpful to this high-risk group as a preventive strategy to reduce the incidence of major events. Further prospective randomized trials are needed to confirm the benefits of early ventricular tachycardia ablation in this setting.

Estudio del índice de gravedad del síndrome metabólico como factor predictivo de un episodio cardiovascular mayor en mujeres premenopáusicas con lupus eritematoso sistémico

BackgroundPatients with systemic lupus erythematosus (SLE) have an increased risk of metabolic syndrome (MS) and cardiovascular (CV) disease. MS is evaluated binary, limiting the understanding of each component's severity individually. Therefore, severity scores for MS that evaluate them separately have been developed. This study aims to determine the prognosis between MS severity and the occurrence of major adverse cardiovascular events (MACE) in SLE patients. MethodsTen-year follow-up cohort study. Premenopausal>18-year-old women with a previous diagnosis of SLE were included. Patients with recent CV events, pregnancy, thyroid disease, and liposuction were excluded. The variables of interest were CV events; the confounding variables, and the MS severity indexes were examined. Hazard ratios and Kaplan-Meier survival curves were estimated through Cox regression. ResultsA total of 238 women were analyzed: 22 presented MACE, and 216 did not. MS prevalence, measured according to consensus and ATP-III criteria, was higher in MACE patients (50 and 40,95%, respectively). The MetSx-IMC severity index was higher within the MACE group. Cox analysis showed an increase in the MetSx-IMC associated with the risk of suffering MACE in a 1.107 ratio. ConclusionsThe MetSx-IMC severity index, contrary to the binary approaches, is recommended to evaluate MS as a predictor of MACE in SLE patients. Offering improved and more accurate prognosis in patients at risk of developing MCE.

Immune-inflammatory biomarkers for the occurrence of MACE in patients with myocardial infarction with non-obstructive coronary arteries.

Neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR), platelet-to-high-density lipoprotein cholesterol ratio (PHR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) have been identified as immune-inflammatory biomarkers associated with the prognosis of cardiovascular diseases. However, the relationship of these biomarkers with the prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) remains unclear. Patients with MINOCA who underwent coronary angiography at the 920th Hospital of Joint Logistics Support Force were included in our study. Clinical baseline characteristics and laboratory testing data were collected from the hospital record system. The patients were divided into two groups on the basis of major adverse cardiovascular events (MACE) occurrence. Multiple logistic regression analysis was conducted to assess the relationship between NHR, MHR, LHR, PHR, SII, SIRI, AISI, and MACE. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of NHR, MHR, LHR, PHR, SII, SIRI, and AISI for MACE in patients with MINOCA. The accuracy of the prediction was indicated by the area under the curve (AUC) value. The study included 335 patients with MINOCA. (81 in the MACE group and 254 in the No-MACE group). The MACE group had higher levels of NHR, MHR, LHR, PHR, SII, SIRI, and AISI than the No-MACE group. Multiple logistic regression analysis adjusted for confounding factors indicated that the higher levels of NHR, MHR, PHR, SII, SIRI, and AISI were associated with the occurrence of MACE in patients with MINOCA (P < 0.001). The AUC values for NHR, MHR, PHR, SII, SIRI, and AISI were 0.695, 0.747, 0.674, 0.673, 0.688, and 0.676, respectively. The combination of NHR, MHR, PHR, SII, SIRI, and AISI improved the accuracy of predicting MACE in patients with MINOCA (AUC = 0.804). Higher levels of NHR, MHR, PHR, SII, SIRI, and AISI were associated with the occurrence of MACE, and the combination of NHR, MHR, PHR, SII, SIRI, and AISI improved the accuracy for predicting the incidence of MACE events in patients with MINOCA.

Perioperative Risk of Noncardiac Surgery in Patients With Asymptomatic Significant Aortic Stenosis: A 10-Year Retrospective Study.

Aortic stenosis (AS) is a representative geriatric disease, and there is an anticipated rise in the number of patients requiring noncardiac surgeries in patients with AS. However, there is still a lack of research on the primary predictors of noncardiac perioperative complications in patients with asymptomatic significant AS. Among the cohort of noncardiac surgeries under general anesthesia, with an intermediate to high risk of surgery from 2011 to 2019, at Samsung Medical Center, 221 patients were identified to have asymptomatic significant AS. First, to examine the impact of significant AS on perioperative adverse events, the occurrences of major adverse cardiovascular events and perioperative adverse cardiovascular events were compared between patients with asymptomatic significant AS and the control group. Second, to identify the factors influencing the perioperative adverse events in patients with asymptomatic significant AS, a least absolute shrinkage and selection operator regression model was used. There was no significant difference between the control group and the asymptomatic significant AS group in the event rate of major adverse cardiovascular events (4.6% at control group versus 5.5% at asymptomatic significant AS group; P=0.608) and perioperative adverse cardiovascular events (13.8% at control group versus 18.3% at asymptomatic significant AS group; P=0.130). Cardiac damage stage was a significant risk factor of major adverse cardiovascular events and perioperative adverse cardiovascular events. There was no significant difference in major postoperative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant AS is an important factor in perioperative risk of noncardiac surgery.

Аналіз предикторів виникнення несприятливих серцево-судинних і цереброваскулярних подій після операції Бенталла

The aim – to analyze the risk factors for the occurrence of major adverse cardiac and cardiovascular events in the early period after the Bentall procedure.Materials and methods. The study analyzed the medical records of adult patients (aged 18 to 75 years) who underwent Bentall procedure for ascending aortic aneurysm between 2012 and 2021. Univariate and multivariate analysis (logistic regression) were used to determine prognostic risk factors.Results and discussion. In patients with MACCE grade 3 hypertension was observed by 14.4 % (p = 0.048) more often, duration of cardiopulmonary bypass was by 14.1 % (p = 0.017) longer, the cross-clamping of the aorta duration was by 16.3 % (p = 0.039) longer, and the lactate level at the end of the surgery was by 23.6 % (p = 0.036) higher compared to patients without MACCE. Further multivariate logistic regression analysis established two main predictors of the development of MACCE in the early postoperative period – the presence of the 3rd degree arterial hypertension (OD 2.030 95 % CI 0.578–7.161, p = 0.018) and the duration of aortic clamping (OD 1.102 95 % CI 0.931–2.136, p = 0.018).Conclusions. The 3rd degree arterial hypertension and the duration of aortic clamping were independent predictors of the development of MACCE in the early postoperative period.

A real-world pharmacovigilance study of amivantamab-related cardiovascular adverse events based on the FDA adverse event reporting system (FAERS) database

Amivantamab is the first dual-specificity antibody targeting EGFR and MET, which is approved for the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) with EGFR exon 20 insertion mutations. Cardiovascular toxicities related to amivantamab have not been reported in the CHRYSALIS study. However, the occurrence of cardiovascular events in the real world is unknown. To comprehensively investigate the clinical characteristics, onset times, and outcomes of cardiovascular toxicities associated with amivantamab. The Food and Drug Administration Adverse Event Reporting System (FAERS) database from 1st quarter of 2019 to the 2nd quarter of 2023 was retrospectively queried to extract reports of cardiovascular adverse events (AEs) associated with amivantamab. To perform disproportionality analysis, the reporting odds ratios (RORs) and information components (ICs) were calculated with statistical shrinkage trans-formation formulas and a lower limit of the 95% confidence interval (CI) for ROR (ROR025) > 1 or IC (IC025) > 0 with at least 3 reports was considered statistically significant. A total of 20,270,918 eligible records were identified, among which 98 records were related to cardiovascular events associated with amivantamab. 4 categories of cardiovascular events exhibited positive signals: venous thrombotic diseases, abnormal blood pressure, arrhythmia, and pericardial effusion. Venous thrombotic diseases and abnormal blood pressure were the two most common signals. The median time to onset (TTO) for cardiovascular AEs was 33 days. The cumulative incidence within 90 days was 100% for cardiac failure, 75% for stroke, 63.16% for arrhythmia, 50% for sudden death, and 44.18% for venous thrombotic diseases. Death accounted for 16.3% of all cardiovascular AEs associated with amivantamab. The mortality rates for Major Adverse Cardiovascular Events (MACE) were up to 60%. This pharmacovigilance study systematically explored the cardiovascular adverse events of amivantamab and provided new safety signals based on past safety information. Early and intensified monitoring is crucial, and attention should be directed towards high-risk signals.

Understanding the Korean dialysis cohort for mineral, vascular calcification, and fracture (ORCHESTRA) Study: Design, method, and baseline characteristics.

End-stage renal disease (ESRD) is a growing disease in Korea and worldwide and is an important condition that affects patient outcomes. In order to provide optimal management for mineral disturbance, vascular calcification, and bone disease of ESRD patients, the ORCHESTRA study (Korean dialysis cohort for mineral, vascular calcification, and fracture) was conducted and enrolled Korean dialysis patients. Sixteen university-affiliated hospitals and one Veterans Health Service Medical Center participated in this study. This prospective cohort study enrolled approximately 900 consecutive dialysis patients between May 2019 and January 2021. Enrolled subjects were evaluated at baseline for demographic information, laboratory tests, radiologic imaging, and bone mineral densitometry (BMD) scans. After enrollment, regular assessments of patients were performed and their biospecimens were collected according to the study protocol. Primary outcomes were occurrence of major adverse cardiovascular events (MACE), invasive treatment for peripheral artery disease (PAD), and osteoporotic fractures. Secondary outcomes were hospitalization for cerebro-cardiovascular disease or progression of abdominal aortic calcification (AAC). Participants will be assessed for up to three years to determine whether primary or secondary outcomes occur. From May 2019 to January 2021, all participating centers recruited 900 consecutive dialysis patients, including 786 undergoing hemodialysis (HD) and 114 undergoing peritoneal dialysis (PD). The mean age of subjects was 60.4 ± 12.3 years. Males accounted for 57.7%. The mean dialysis vintage was 6.1 ± 6.0 years. The HD group was significantly older, had a longer dialysis vintage, and more comorbidities. Overall, the severity of vascular calcification was higher and the level of BMD was lower in the HD group than in the PD group. This is a nationwide, multicenter, prospective cohort study that focuses on CKD-mineral and bone disorder (CKD-MBD) and aims to provide clinical evidence to establish optimal treatment guidelines for Asian dialysis patients.

Major cardiovascular events in patients with cardiovascular monosodium urate deposits in atherosclerotic plaques.

To determine the association of cardiovascular atherosclerotic plaque monosodium urate deposits with the occurrence of major cardiovascular events in gout and hyperuricemia patients. This retrospective cohort study included patients with clinically suspicion of gout, who performed a dual energy computed tomography of the affected limb and thorax between June 1st, 2012 and December 5th, 2019. Clinical and laboratory parameters were retrieved from patientś charts. Established cardiovascular risk factors were evaluated. Medical history review identified the presence of major adverse cardiac events with a median follow up time of 33 months (range 0-108 months) after the performed computed tomography scan. Full data sets were available for 189 patients: 131 (69.3%) gout patients, 40 (21.2%) hyperuricemia patients, and 18 (9.5%) controls. Patients with cardiovascular monosodium urate deposits (n = 85/189, 45%) revealed increased serum acute phase reactants, uric acid levels and calcium scores in computed tomography compared with patients without cardiovascular monosodium urate deposits. Major adverse cardiac events were observed in 35 patients (18.5%) with a higher prevalence in those patients revealing cardiovascular monosodium urate deposits (n = 22/85, 25.9%) compared with those without cardiovascular monosodium urate deposits (n = 13/104, 12.5%, OR 2.4, p= 0.018). This is the first study demonstrating the higher hazard of major adverse cardiac events in patients with dual energy computed tomography-verified cardiovascular monosodium urate deposits. The higher prevalence of cardiac events in patients with cardiovascular monosodium urate deposits may facilitate risk stratification of gout patients, as classical cardiovascular risk scores or laboratory markers fail in their proper identification.

Interpretable Trend Analysis Neural Networks for Longitudinal Data Analysis

Cohort study is one of the most commonly used study methods in medical and public health researches, which result in longitudinal data. Conventional statistical models and machine learning methods are not capable of modeling the evolution trend of the variables in longitudinal data. In this article, we propose a Trend Analysis Neural Networks (TANN), which models the evolution trend of the variables by adaptive feature learning. TANN was tested on dataset of Kaiuan research. The task was to predict occurrence of cardiovascular events within 2 and 5 years, with three repeated medical examinations during 2008 and 2013. For 2-year prediction, The AUC of the TANN is 0.7378, which is a significant improvement than that of conventional methods, while that of TRNS, RNN, DNN, GBDT, RF, and LR are 0.7222, 0.7034, 0.7054, 0.7136, 0.7160, and 0.7024, respectively. For 5-year prediction, TANN also shows improvement. The experimental results show that the proposed TANN achieves better prediction performance on cardiovascular events prediction than conventional models. Furthermore, by analyzing the weights of TANN, we could find out important trends of the indicators, which are ignored by conventional machine learning models. The trend discovery mechanism interprets the model well. TANN is an appropriate balance between high performance and interpretability.

Efficacy and safety of proton pump inhibitors on cardiovascular events and inflammatory factors in patients with upper gastrointestinal bleeding undergoing dual antiplatelet therapy.

This work evaluated the effects of proton pump inhibitors (PPIs) on cardiovascular events (CVEs) and inflammatory factors in patients with upper gastrointestinal bleeding (UGIB) undergoing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. Clinical data from these patients were analysis, intending to provide relevant theoretical evidence for clinical practice. Data of 166 patients who underwent percutaneous coronary intervention and developed UGIB while on DAPT at The First People' Hospital of Linping District from April 2021 to April 2023 were retrospectively analyzed. The patients were rolled into two groups: those who received PPI treatment and those who did not, namely, PPI and non-PPI group, respectively. Furthermore, occurrence of CVEs and the levels of inflammatory factors of patients in all groups were statistically analyzed. In patients with UGIB, melena is a common presentation. The incidence of CVE in the PPI group showed no statistically significant difference compared to the control group, and there was no significant variance observed in the distribution of CVE incidence among different PPIs. However, levels of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) were significantly lower in the PPI group compared to the non-PPI group (P < 0.05). Melena was the most frequent clinical manifestation in UGIB patients. The use of PPIs did not increase the risk of CVEs, and different PPI drugs did not affect the occurrence of CVEs. Furthermore, PPIs lowered CRP and TNF-α levels in serum of these patients.

Clinical and cardiac CT characteristics of congenital coronary abnormalities occasionally detected in a middle-aged population: A long-term follow-up study

IntroductionCongenital coronary artery anomalies (CCAA) represent one of the most challenging conditions as their clinical presentation may range from sudden cardiac death to a complete subclinical form. The aim of the present study was to evaluate the diagnostic and prognostic role of cardiac CT (CCT) evaluation in patients with CCAA, focusing on anomalies of origin. Material and methodsThe present is a retrospective analysis of a prospective clinical registry including a consecutive cohort of patients who underwent clinically indicated CCT from January 2007 to October 2015 for suspected but unknown coronary artery disease (CAD) and were diagnosed for having a congenital coronary abnormality compared to a control group matched for age, sex and segment stenosis score (SSS). Dedicated analysis of all CCT was performed for the present study and only coronary anomalies of origin were considered and included in the study. Two different composite end-points were identified for the present analysis: major cardiovascular events (MACE) and all-cause of death. ResultsAmong the 81 patients with CCAAs enrolled the most frequent anomaly was left main artery absence, which was identified in 41 individuals (50.6%). Forty-five subjects (55.5%) have an anomalous origin of the coronary artery from a different sinus of Valsalva and 45 subjects had also an anomalous course with the retro-aortic being the most common (32%). Eleven participants (13.6%) displayed also an intramural segment, while 10 (10.3%) had a slit-like ostial morphology. At multivariate analysis CT identification of ARCA, anomalous inter-arterial course and abnormal ostial morphology were significantly associated with MACE even when adjusted for age and SSS, without any differences in all-cause mortality between the two groups (6.2% vs 2.4% p ​= ​0.2478). ConclusionThe result of the present study is that CCT can be successfully used to define the anatomy and features of CAA. It suggested that in middle-aged patients, the identification of high risk characteristics at CT may have a prognostic value in term of cardiovascular events occurrence at follow-up even if the rate of events strictly linked to CCAA is low.

Correlation analysis between left ventricular global longitudinal strain and major adverse cardiovascular event occurrence in patients with end-stage renal disease

Correlation analysis between left ventricular global longitudinal strain and major adverse cardiovascular event occurrence in patients with end-stage renal disease

Impact of Arterial Calcification on Cardiovascular and Renal Outcomes in Kidney Transplant Patients

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Coronary artery calcification score (CACS) and abdominal aortic calcification score (AACS) are both well-established markers of vascular stiffness, and previous studies have shown that a higher CACS is a risk factor for chronic kidney disease (CKD) progression. However, the impact of pretransplant CACS and AACS on cardiovascular and renal outcomes in kidney transplant patients has not been established. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; We included 944 kidney transplant recipients from the KoreaN cohort study for Outcome in patients With Kidney Transplantation (KNOW-KT) cohort and categorized them into three groups (low, medium, and high) according to baseline CACS (0, 0 &amp;lt; and ≤100, &amp;gt;100) and AACS (0, 1–4, &amp;gt;4). The low (0), medium (0 &amp;lt; and ≤ 100), and high (&amp;gt;100) CACS groups each consisted of 462, 213, and 225 patients, respectively. Similarly, the low (0), medium (1–4), and high (&amp;gt;4) AACS groups included 638, 159, and 147 patients, respectively. The primary outcome was the occurrence of cardiovascular events. The secondary outcomes were all-cause mortality and composite kidney outcomes, which comprised of &amp;gt;50% decline in the estimated glomerular filtration rate and graft loss. Cox regression analysis was used to investigate the association between baseline CACS/AACS and outcomes. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The high CACS group (&lt;i&gt;N&lt;/i&gt; = 462) faced a significantly higher risk for cardiovascular outcomes (adjusted hazard ratio [aHR], 5.97; 95% confidence interval [CI], 2.01–17.7) and all-cause mortality (aHR, 2.74; 95% CI, 1.27–5.92) compared to the low CACS group (&lt;i&gt;N&lt;/i&gt; = 225). Similarly, the high AACS group (&lt;i&gt;N&lt;/i&gt; = 638) had an elevated risk for cardiovascular outcomes (aHR, 2.38; 95% CI, 1.16–4.88). Furthermore, the addition of CACS to prediction models improved prediction indices for cardiovascular outcomes. However, the risk of renal outcomes did not differ among CACS or AACS groups. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Pretransplant arterial calcification, characterized by high CACS or AACS, is an independent risk factor for cardiovascular outcomes and mortality in kidney transplant patients.

Rationale and Design of the IMPROVE Trial: A Multicenter, Randomized, Controlled, Open-label, Blinded-endpoint Trial Assessing the Efficacy of Remote Ischemic Conditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting.

Despite the appearance of off-pump coronary artery bypass grafting (CABG), ischemia-reperfusion injury (IRI) in the perioperative period still arouses concerns of clinicians. Remote ischemic conditioning (RIC) is the process of repeated ischemia and reperfusion in the peripheral vessels, which is proven to reduce IRI in vital organs. However, the effect of RIC in patients undergoing off-pump CABG is still unclear. This IMPROVE trial is a national, multicenter, randomized, controlled, open-label, blinded-endpoint clinical trial designed to assess whether RIC intervention can improve short-term prognosis of patients undergoing off-pump CABG. It plans to enroll 648 patients who will be randomly assigned into a RIC group or control group. Patients in the RIC group will receive four cycles of 5min of pressurization (about 200mmHg) and 5min of rest in the 3days before and 7days after the surgery. The primary outcome is the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) within the 3-month follow-up. MACCE is defined as all-cause death, myocardial infarction, stroke, and coronary revascularization surgery. NCT06141525 (ClinicalTrials.gov).