Risk Of Future Coronary Events Research Articles

NSTEMI mortality and hospital outcomes in patients with atrial fibrillation: A propensity score-matched analysis

BackgroundAtrial fibrillation (AF) is associated with increased cardiovascular mortality. Data regarding the relationship between coronary artery disease (CAD) and AF is mixed. It is uncertain if AF directly increases the risk for future coronary events and if such patients are appropriately evaluated for CAD. MethodsThis cross-sectional study was performed on hospitalized patients with NSTEMI and concurrent AF in 2019 using the National Inpatient Sample. In-hospital mortality, rates of diagnostic cardiac angiography, percutaneous coronary intervention, ventricular tachycardiac (VT), ventricular fibrillation (VF), cardiogenic shock, cardiac arrest, length of stay (LOS), and total hospitalization charges were studied. ResultsA total of 433,965 patients met inclusion criteria (169,725 females [39.1 %], 307,985 Caucasian [71 %], 51,570 African American [11.8 %], 37,265 Hispanic [8.6 %]; mean [SD] age, 67.9 [6.2] years). 86,200 (19.8 %) patients with NSTEMI had AF, including 32,775 (38 %) female patients before propensity matching. Patients with NSTEMI and AF had increased odds of mortality (adjusted Odds ratio, 1.32; CI, 1.21–1.43; p < 0.001). AF patients were less likely to undergo diagnostic coronary angiography and PCI and had higher odds of VT, VF, cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, increased LOS, and higher hospital charges than those without AF. ConclusionAF was independently associated with increased mortality and serious cardiac complications in patients admitted with NSTEMI.

Fractional flow reserve and fractional flow reserve gradient from coronary CT angiography for future coronary events

Abstract Background Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is per-vessel index reflecting cumulative hemodynamic burden while percutaneous coronary intervention is per-lesion treatment that relieves ischemia in a focal lesion. Purpose We sought to evaluate additive prognostic value of local gradient of FFRCT (FFRCT gradient) in addition to FFRCT to predict future coronary events. Methods The current study included 239 patients (617 vessels) who underwent CCTA within 6-36 months prior to index angiography, of which 202 vessels had future coronary events and 415 vessels did not. Future coronary events were defined as a composite of vessel-specific myocardial infarction or urgent revascularization during mean interval of 1.5 years. Preexisting disease patterns were classified according to cumulative burden and local severity of coronary atherosclerosis, expressed as FFRCT ≤0.80 and FFRCT gradient ≥0.025/mm, respectively. Results Both FFRCT (per 0.01 decrease; HR 1.039, 95% CI 1.029-1.050, P&amp;lt;0.001) and FFRCT gradient (per 0.01 increase; HR 1.140, 95% CI 1.096-1.185, P&amp;lt;0.001) were significantly associated with the risk of future coronary events. Severe local disease defined by FFRCT gradient≥0.025/mm showed significantly higher risk of future coronary events than FFRCT gradient&amp;lt;0.025/mm in both FFRCT&amp;gt;0.80 (52.2% vs. 29.4%, HR 2.212, 95% CI 1.357-3.607, P=0.001) and FFRCT≤0.80 groups (59.6% vs. 39.4%, HR 1.894, 95% CI 1.255-2.856, P=0.002). Adding FFRCT gradient into model with FFRCT alone showed significantly increased predictability for future coronary events (global chi-square 43.1 vs. 37.5, P=0.018), and physiologic classification of disease patterns integrating both FFRCT and FFRCT gradient was independent predictor of future coronary events (HR 1.325, 95% CI 1.135-1.548, P&amp;lt;0.001). Conclusions Patients with severe local disease defined by high FFRCT gradient showed significantly increased risk of future coronary events irrespective of FFRCT. Integrating both FFRCT and FFRCT gradient showed incremental predictability for future coronary events than FFRCT alone.Graphic Abstract

Abstract 14750: Performance of a Polygenic Risk Score for Coronary Artery Disease Across the Spectrum of ASCVD: An Analysis of 60k Patients From 6 TIMI Randomized Trials

Background: Coronary artery disease (CAD) polygenic risk scores (PRS) may improve risk stratification, but whether performance differs by ASCVD status remains unclear. Purpose: To compare the predictive ability of a CAD PRS for coronary events in pts with ASCVD and prior event, ASCVD without event, and without overt ASCVD. Methods: We studied genotyped pts from 6 multinational TIMI RCTs. Using a 2.3 million SNP CAD PRS, we first assigned pts to low (Q1), intermediate (Q2-4), or high (Q5) genetic risk, after which pts were grouped by ASCVD status at baseline. The primary endpoint was any coronary event, a composite of death from coronary disease, myocardial infarction, or coronary revascularization. Cox proportional hazards models were used to estimate risk of events, adjusted for ancestry (principal components 1-5), age, sex, SBP, eGFR, diabetes, smoking, and trial. Results: We included 59,905 pts (mean age 66 yrs; 71% male; 79% with prior ASCVD; 49% with diabetes), of whom 10.6% had coronary events during follow-up. Compared with low genetic risk pts, event rates were greater in intermediate (HR 1.59 [95% CI 1.47-1.71]; p&lt;0.001) and high (HR 2.08 [1.91-2.27]; p&lt;0.001) genetic risk pts. There was a significant interaction between the CAD PRS and clinical ASCVD (P interaction &lt;0.001), such that genetic risk discriminated relative risk of future coronary events more strongly in pts without overt ASCVD ( Fig 1A ). In this subgroup, high genetic risk pts had a nearly 5-fold higher hazard of events than low genetic risk pts (8.5% vs 1.6% at 3 yrs; HR 4.63 [3.46-6.21]; p&lt;0.001). Pts without clinical ASCVD and high genetic risk had event rates comparable to pts with established ASCVD and low genetic risk ( Fig 1B ). Conclusion: The gradient of relative risk prediction of coronary events from a CAD PRS depends on the presence of known ASCVD and is strongest in patients without clinical disease. Genetic risk stratification may be more useful in pts without overt ASCVD to help focus preventive measures.

Childhood Parental Incarceration and Adult-Onset Hypertension and Cardiovascular Risk

Parental incarceration is an adverse childhood experience that disproportionately affects racially minoritized individuals and has been associated with long-term health risks. Although cardiovascular disease remains the primary cause of mortality differences between Black and White individuals in the US, the association between parental incarceration and cardiovascular risk remains poorly understood. To examine the association between parental incarceration during childhood and incident cardiovascular risk in adulthood. This population-based cohort study included data from waves IV (2008-2009) and V (2016-2018) of the US National Longitudinal Study of Adolescent to Adult Health. Participants represented US adults transitioning from young adulthood to adulthood. Data were analyzed from October 28, 2021, to May 1, 2023. Parental incarceration was defined as a parent or parent-like figure going to jail or prison when participants were aged younger than 18 years. Outcome measures included self-reported diagnoses of obesity, hyperlipidemia, hypertension, diabetes, or heart disease as well as serum elevations in non-high-density lipoprotein cholesterol (≥160 mg/dL) and high-sensitivity C-reactive protein (hsCRP >3 mg/L), a marker of inflammation used to estimate risk of future coronary events. Using sampling weights, incident development of each outcome was modeled as a function of parental incarceration, adjusting for participant- and neighborhood-level characteristics. This study included 9629 participants representing 16 077 108 US adults. Approximately half of participants were women (5498 [weighted 50.3%]) and the majority (5895 [weighted 71.4%]) were White. The mean participant age was 37.8 years (95% CI, 37.5 to 38.0 years) in wave V compared with 28.9 years (95% CI, 28.6 to 29.1 years) in wave IV. In wave V, those with childhood exposure to parental incarceration had lower educational attainment (91 [weighted 8.2%] vs 245 [weighted 4.2%] completing less than high school), had higher rates of public insurance (257 [weighted 20.6%] vs 806 [weighted 11.0%]), and were disproportionately Black (374 [weighted 22.5%] vs 1488 [weighted 13.6%]). Parental incarceration was associated with 33% higher adjusted odds (95% CI, 1.05 to 1.68) of developing hypertension and 60% higher adjusted odds (95% CI, 1.03 to 2.48) of developing elevated hsCRP. Associations between childhood parental incarceration and other diagnoses (ie, obesity, hyperlipidemia, diabetes, or heart disease) and serum lipid levels were not observed. In this cohort study of US adults transitioning from young adulthood to adulthood, an increased incidence of hypertension and high-risk hsCRP, but not other cardiovascular risk factors, was observed among those exposed to parental incarceration during childhood. These findings suggest possible transgenerational health consequences of mass incarceration.

The association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques assessed by near-infrared spectroscopy.

Lipid content in coronary atheromatous plaques, measured by near-infrared spectroscopy (NIRS), can predict the risk of future coronary events. Biomarkers that reflect lipid content in coronary plaques may therefore improve coronary artery disease (CAD) risk assessment. We aimed to investigate the association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques in statin-treated patients with stable CAD undergoing percutaneous coronary intervention. 56 patients with stable CAD underwent three-vessel imaging with NIRS when feasible. The coronary artery segment with the highest lipid content, defined as themaximum lipid core burden index within any4mmlength across the entire lesion (maxLCBI4mm), was defined as target segment. Lipoprotein subfractions and Lipoprotein a (Lp(a)) were analyzed in fasting serum samples by nuclear magnetic resonance spectroscopy and by standard in-hospital procedures, respectively. Penalized linear regression analyses were used to identify the best predictors of maxLCBI4mm. The uncertainty of the lasso estimates was assessed as the percentage presence of a variable in resampled datasets by bootstrapping. Only modest evidence was found for an association between lipoprotein subfractions and maxLCBI4mm. The lipoprotein subfractions with strongest potential as predictors according to the percentage presence in resampled datasets were Lp(a) (78.1 % presence) and free cholesterol in the smallest high-density lipoprotein (HDL) subfractions (74.3 % presence). When including established cardiovascular disease (CVD) risk factors in the regression model, none of the lipoprotein subfractions were considered potential predictors of maxLCBI4mm. In this study, serum levels of Lp(a) and free cholesterol in the smallest HDL subfractions showed the strongest potential as predictors for lipid content in coronary atheromatous plaques. Although the evidence is modest, our study suggests that measurement of lipoprotein subfractions may provide additional information with respect to coronary plaque composition compared to traditional lipid measurements, but not in addition to established risk factors. Further and larger studies are needed to assess the potential of circulating lipoprotein subfractions as meaningful biomarkers both for lipid content in coronary atheromatous plaques and as CVD risk markers.

The association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques assessed by near-infrared spectroscopy

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Norwegian Health Association The Liaison Committee for education, research and innovation in Central Norway. Background Lipid content in coronary atheromatous plaques, measured by near-infrared spectroscopy (NIRS), can predict the risk of future coronary events. Biomarkers that reflect lipid content in coronary plaques may therefore improve coronary artery disease (CAD) risk assessment, and lipoprotein subfractions could potentially add value beyond traditional lipid measurements. Purpose We aimed to investigate the association between circulating lipoprotein subfractions and lipid content in coronary atheromatous plaques in statin-treated patients with stable CAD undergoing percutaneous coronary intervention. Methods 56 patients with stable CAD underwent three vessel imaging with NIRS when feasible. The coronary artery segment with the highest lipid content, defined as the maximum lipid core burden index within any 4mm length across the entire lesion (maxLCBI4mm), was selected as target segment. Lipoprotein subfractions were analyzed in fasting serum samples by nuclear magnetic resonance spectroscopy. Penalized linear regression analyses (lasso) were used to identify the best predictors of maxLCBI4mm. The uncertainty of the lasso estimates was assessed as the percentage of the resampled datasets by bootstrapping. Results Only modest evidence was found for an association with lipoprotein subfractions and maxLCBI4mm. The lipoprotein subfractions with strongest potential as predictors according to the percentage presence in resampled datasets were lipoprotein a (Lp(a)) (reg.coeff = 57.0; 78.1 % presence) and free cholesterol in the smallest high-density lipoprotein (HDL) subfractions (reg.coeff = 36.5; 74.3 % presence). When including established cardiovascular risk factors in the regression model, none of the lipoprotein subfractions was considered potential predictors of maxLCBI4mm. Conclusion In this study, Lp(a) and free cholesterol in the smallest HDL subfractions in serum showed the strongest potential as predictors for lipid content in coronary atheromatous plaques. Although the evidence is modest, our study suggests that measurements lipoprotein subfractions may provide additional information with respect to coronary plaque composition compared to traditional lipid measurements, but not in addition to established risk factors. Future studies are needed to verify our findings, and to investigate the clinical implication of lipoprotein subfractions as meaningful biomarkers for lipid-rich plaques and enhanced risk prediction in CAD.

High-quality annotations for deep learning enabled plaque analysis in SCAPIS cardiac computed tomography angiography

BackgroundPlaque analysis with coronary computed tomography angiography (CCTA) is a promising tool to identify high risk of future coronary events. The analysis process is time-consuming, and requires highly trained readers. Deep learning models have proved to excel at similar tasks, however, training these models requires large sets of expert-annotated training data. The aims of this study were to generate a large, high-quality annotated CCTA dataset derived from Swedish CArdioPulmonary BioImage Study (SCAPIS), report the reproducibility of the annotation core lab and describe the plaque characteristics and their association with established risk factors. Methods and resultsThe coronary artery tree was manually segmented using semi-automatic software by four primary and one senior secondary reader. A randomly selected sample of 469 subjects, all with coronary plaques and stratified for cardiovascular risk using the Systematic Coronary Risk Evaluation (SCORE), were analyzed. The reproducibility study (n = 78) showed an agreement for plaque detection of 0.91 (0.84–0.97). The mean percentage difference for plaque volumes was −0.6% the mean absolute percentage difference 19.4% (CV 13.7%, ICC 0.94). There was a positive correlation between SCORE and total plaque volume (rho = 0.30, p < 0.001) and total low attenuation plaque volume (rho = 0.29, p < 0.001). ConclusionsWe have generated a CCTA dataset with high-quality plaque annotations showing good reproducibility and an expected correlation between plaque features and cardiovascular risk. The stratified data sampling has enriched high-risk plaques making the data well suited as training, validation and test data for a fully automatic analysis tool based on deep learning.

Relationship of cardiovascular risk factors, pericardial fat, and carotid thickness with coronary plaque type in patients with diabetes mellitus.

There is paucity of data on the potential predictors of coronary plaque types among patients with diabetes mellitus(DM). To assess the association of cardiovascular risk factors, pericardial fat volume (PFV) assessed by multi-detector CT(MDCT)angiography, and internal carotid intima media thickness with coronary atherosclerotic plaque types in patients with type 2 DM. Patients with suspected coronary artery disease who underwent 64-slice MDCT angiography were enrolled in this retrospective study. A total of 784 patients were enrolled in this study, 198 of whom had DM and 586 of whom did not. The prevalence of calcified and mixed plaques was significantly higher in the DM group than without DM group, while no significant difference was found in the distribution of non-calcified plaque between groups. There was significant association between smoking [OR(CI) = 4(2-10),P = 0.001] and increased age[OR(CI) = 1.1(1-1.3),P = 0.023] and calcified plaque presence. Regarding mixed and non-calcified plaque, increased PFV[OR(CI) = 1.1(1-1.3),P = 0.001] and positive family history[OR(CI) = 4(2-12),P = 0.049] showed a significant association with coronary mixed plaque presence while no significant association was observed between cardiovascular risk factors, PFV, and internal carotid intima media thickness and non-calcified plaque presence in patients with DM. Increased PFV showed significant and independent association with mixed coronary plaques development, which suggests that PFV may be used as an imaging marker for early detection of increased risk for future coronary events in patients with DM.

On the Natural History of Coronary Artery Disease: A Longitudinal Nationwide Serial Angiography Study.

Background The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. Methods and Results All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angiogram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43-1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69-4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34-0.39), increasing to 8.1% and 4.01 (95% CI, 3.89-4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women. Conclusions Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.

Association of plaque calcification pattern and attenuation with instability features and coronary stenosis and calcification grade

Background and aimsCoronary computed tomography (CT) allows calculating coronary artery calcium score (CACS). However, other CT features might be more strongly related to plaque vulnerability and risk of future coronary events. This study investigated the association of plaque calcification pattern and attenuation with plaque instability features, coronary artery disease (CAD) grade and CACS. MethodsOne-hundred patients with coronary stenosis associated with calcified plaques were considered for this analysis. CACS, CAD grade, calcification pattern and attenuation, features of plaque instability, and epicardial adipose tissue (EAT) thickness and attenuation were assessed with non-contrast and contrast-enhanced CT angiography. ResultsOf 373 calcified plaques, 131 were responsible for the highest degree of coronary stenosis (1.31 ± 0.53 per patient). Participants were stratified according to the features of the highest-grade lesion(s) into patients with large (35%), spotty (52%) or mixed (13%) calcification pattern and tertiles of plaque calcification attenuation (using the mean value for multiple lesions). Patients with large calcification pattern or higher plaque calcification attenuation had higher stenosis and CACS grade (and EAT attenuation), but lower plaque instability score, whereas those with spotty calcification pattern or lower plaque calcification attenuation had lower stenosis and CACS grade (and EAT attenuation), but higher plaque instability score. Among the instability features, low attenuation and napkin-ring sign, but not positive remodeling, were associated with a spotty pattern and a lower calcification attenuation. ConclusionsBoth the pattern and attenuation of calcification should be considered, in addition to CACS, for risk stratification of heavily calcified high-risk patients with non-critical coronary stenosis.

5192Management and outcomes of patients with unstable angina with undetectable, normal, or intermediate hsTnT levels - A RAPID CPU substudy

Abstract Background Patients with unstable angina (UA) are regarded to be at low risk for future coronary events. Guidelines discourage routine coronary angiography and recommend early discharge after individualized risk stratification. The relative value of clinical risk indicators as compared to cardiac troponin (cTn) alone is unsettled in the era of high-sensitivity cardiac troponin (hsTn) assays. Purpose We aimed to investigate the clinical characteristics, therapies and outcomes of UA patients with different hsTnT concentrations. Methods During 12 months, 2,525 patients were enrolled. UA was defined as unstable symptoms and either undetectable (&lt;5 ng/L), normal (5–14 ng/L) or stable elevated hsTnT (15–51 ng/L). Follow up for 1-year mortality was available in 98.7%. Results A total of 280 patients (11.1%) received a diagnosis of UA. Mortality rates at 12 months were 0%, 1.9% and 6.9% in presence of undetectable, normal and stable elevated hsTnT. Elevated hsTnT &gt;99th percentile but not unstable symptoms carried an independent 3.25-fold (1.78–5.93) higher risk for all-cause death after adjustment for other clinical risk indicators or the GRACE score. Utilization of guideline recommended therapies was high albeit lower than for non-ST-elevation myocardial infarction (NSTEMI). Significantly fewer patients with UA received dual antiplatelet therapy (DAPT, odds ratio (OR): 0.51 [95% CI: 0.44–0.59], p&lt;0.0001), coronary angiography (CA, OR 0.79, [95% CI: 0.74–0.87], p&lt;0.0001), and percutaneous coronary intervention (PCI, OR 0.50, [95% CI: 0.40–0.61], p&lt;0.0001), compared to NSTEMI. However, prevalence of significant obstructive coronary artery disease (CAD) requiring PCI was 31.8%, even in patients with undetectable hsTnT, indicating the need for stress testing. Conclusions The current dichotomization of patients into UA and NSTEMI is no longer appropriate. Additional risk stratification seems warranted including the presence and magnitude of hsTn concentration and additional risk indicators. Acknowledgement/Funding Research Grant by Roche Diagnostics

Relationship Between Sleep Apnea and Coronary Artery Calcium in Patients With Ischemic Stroke.

Study Objectives: Coronary artery disease is considered to be the major cause of death amongst patients with ischemic stroke. The coronary artery calcium (CAC) score is related not only to sleep-disordered breathing, but also with future risk of cardiovascular mortality. We investigated the association between the severity of sleep-disordered breathing and CAC score in patients with ischemic stroke.Methods: We included 32 patients who underwent coronary multichannel computed tomography and polysomnography (within 2 years of the stroke event) amongst the patients admitted to our clinic due to acute ischemic stroke. We investigated vascular risk factors, polysomnography findings, and sleep questionnaire scores, and their relationships with the CAC score.Results: All patients were found to have sleep apnea of any degree, and 23 (72%) had severe sleep apnea. Twenty-three (72%) patients had a positive CAC score. Higher CAC scores were associated with elevated respiratory disturbance index (RDI), apnea index, oxygen desaturation index, and STOP-BANG test scores. Multivariate analysis after adjusting for potential confounding factors revealed independent relationships between the CAC score and the RDI (ß [SE] = 5.3 [2.1], p = 0.01), oxygen desaturation index (ß [SE] = 6.8 [2.8], p = 0.02), and STOP-BANG test score (ß [SE] = 90.3 [37.7], p = 0.02).Conclusion: Our findings indicate a relationship between coronary atherosclerotic burden measured by the CAC score and the severity of sleep apnea. Performing polysomnography could be useful for investigating the severity of hidden coronary artery disease among these patients.Brief SummaryCurrent Knowledge/Study Rationale: The effect of sleep apnea on coronary artery disease in patients with ischemic stroke has not been explored. We investigated the relationship between sleep apnea, its related characteristics and the coronary artery calcium score in patients with stroke.Study Impact: Our findings reveal a close relationship between the atherosclerosis-related burden measured by the coronary artery calcium score and the severity of sleep apnea that persisted after adjusting for confounding variables related to the risk of coronary artery disease. Proper detection and treatment of sleep apnea might mitigate the risk of future coronary events in patients with ischemic stroke.

Coronary risk prediction by the correlation of total cholesterol/high-density lipoprotein, triglyceride/high-density lipoprotein, low-density lipoprotein/high-density lipoprotein ratios, non-high-density lipoprotein, apolipoprotein-B, and high-sensitivity C-reactive protein with low-density lipoprotein in Indian patients under statin therapy

Background: Patients are treated with statins for the control of cholesterol; but statins control only low-density lipoprotein (LDL) and not non-high-density lipoprotein (non-HDL). Also, LDL is not a good coronary risk predictor. That creates the necessity to find a better biomarker for future coronary risk prediction. Hence, biomarkers under this territory such as total cholesterol (TC)/HDL, LDL/HDL, triglyceride (TG)/HDL ratios, non-HDL, apolipoprotein-B (apo-B), and high-sensitivity C-reactive protein (hs-CRP) were to be assessed and correlated with LDL to find the better biomarker in Indian patients. Objective: The objective was to study non-HDL, apo-B, TC/HDL, TG/HDL, LDL/HDL ratios, and hs-CRP in patients under statin therapy; and to correlate them with their LDL; to predict the risk of future coronary events; and to identify which biomarker among them is better at detecting the same. Materials and Methods: This is a cross-sectional observational study performed by systematic random sampling among 87 patients under statin therapy, and the levels of LDL, TC/HDL, LDL/HDL, TG/HDL ratios, non-HDL, apo-B, and hs-CRP were measured in such patients, and their correlation with optimized and unoptimized LDL groups were done. Continuous data were represented as mean and standard deviation, andP value was calculated using independent t-test or z-test. Results: Non-HDL, TC/HDL, and LDL/HDL ratios were found to be statistically significant – all three parameters withP Conclusion: Even though all patients in our study were under statin therapy, they are still under the risk of developing coronary events. This can be solved by targeting the control of non-HDL or TC/HDL or LDL/HDL ratios, as they are found be better biomarkers for future coronary risk prediction.

High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease

BackgroundCardiac troponin is an independent predictor of cardiovascular mortality in individuals without symptoms or signs of cardiovascular disease. The mechanisms for this association are uncertain, and a role for troponin testing in the prevention of coronary heart disease has yet to be established. ObjectivesThis study sought to determine whether troponin concentration could predict coronary events, be modified by statins, and reflect response to therapy in a primary prevention population. MethodsWOSCOPS (West of Scotland Coronary Prevention Study) randomized men with raised low-density lipoprotein cholesterol and no history of myocardial infarction to pravastatin 40 mg once daily or placebo for 5 years. Plasma cardiac troponin I concentration was measured with a high-sensitivity assay at baseline and at 1 year in 3,318 participants. ResultsBaseline troponin was an independent predictor of myocardial infarction or death from coronary heart disease (hazard ratio [HR]: 2.3; 95% confidence interval [CI]: 1.4 to 3.7) for the highest (≥5.2 ng/l) versus lowest (≤3.1 ng/l) quarter of troponin (p < 0.001). There was a 5-fold greater reduction in coronary events when troponin concentrations decreased by more than a quarter, rather than increased by more than a quarter, for both placebo (HR: 0.29; 95% CI: 0.12 to 0.72 vs. HR: 1.95; 95% CI: 1.09 to 3.49; p < 0.001 for trend) and pravastatin (HR: 0.23; 95% CI: 0.10 to 0.53 vs. HR: 1.08; 95% CI: 0.53 to 2.21; p < 0.001 for trend). Pravastatin reduced troponin concentration by 13% (10% to 15%; placebo adjusted, p < 0.001) and doubled the number of men whose troponin fell more than a quarter (p < 0.001), which identified them as having the lowest risk for future coronary events (1.4% over 5 years). ConclusionsTroponin concentration predicts coronary events, is reduced by statin therapy, and change at 1 year is associated with future coronary risk independent of cholesterol lowering. Serial troponin measurements have major potential to assess cardiovascular risk and monitor the impact of therapeutic interventions.

Genetic polymorphisms of eNOS (-786T/C, Intron 4b/4a & 894G/T) and its association with asymptomatic first degree relatives of coronary heart disease patients

BackgroundThe eNOS gene has been extensively screened for important variations in the promoter (-786T/C), Intron 4 (4b/4a) and exon 7 (894G/T) regions in multiple diseases. Prevalence of Coronary Heart Disease (CHD) is much higher in young Indians when compared to other ethnic groups and first-degree relatives (FDRS) of CHD patients are at risk correlating with earlier age-of-onset and poor prognosis. ObjectiveThe objective of this study is to understand the genetic mechanism of eNOS -786T/C, Intron 4b/4a and 894G/T polymorphisms/haplotypes in the development of CHD and to identify individuals having coronary risk factors among the FDRS of CHD patients by comparing them with the general population. Materials & methodsThe study population consisted of 300 CHD patients with angiographically documented, 100 FDRS and 300 age and sex matched healthy controls. Genotyping of eNOS -786T/C, Intron 4b/4a was carried out by Allele specific-Polymerase Chain Reaction (As-PCR) and 894G/T by PCR-restriction fragment length polymorphism (PCR-RFLP) assays. ResultsThe frequency of risk factors for CHD includes age, blood pressure, obesity, diabetes mellitus, smoking, non-vegetarian diet, family history are higher in CHD patients and FDRS compared to controls (p < 0.01). The genotype distribution, allele frequencies and haplotypes of the eNOS -786T/C, 4b/4a and 894G/T were significantly different between CHD patients, FDRS and controls.eNOS gene haplotypes GCB, TCB (G-allele of 894G/T, C-allele -786T/C, B-allele of Intron 4b/4a respectively) were associated with high nitrite/nitrate levels compared to GTB in both FDRS and CHD patients (p < 0.01). ConclusionThe study shows the importance of eNOS polymorphism in the pathogenesis of CHD and predicting the risk of future coronary events in asymptomatic healthy FDRS and suggests the use of new therapeutics and initiating the measures for prevention or delaying the progression of the disease by life style modification or treatment modalities in high-risk individuals.

CRT-200.19 Prevalence and Characteristics of Percutaneous Coronary Intervention in Fractional Flow Reserve-Determined Functionally Non-significant Coronary Lesions

Although fractional flow reserve (FFR) value >0.8 can reliably identify lesions that are at a low risk of future coronary events, discrepancies between FFR values and results of other stress testing or severity of patients’ symptoms are occasionally encountered in daily practice. Percutaneous

Additive Value of Integrated Backscatter IVUS for Detection of Vulnerable Plaque by Optical Frequency Domain Imaging: An Ex Vivo Autopsy Study of Human Coronary Arteries

ObjectivesThis study sought to evaluate the diagnostic performance of optical frequency domain imaging (OFDI) for recognition of coronary plaque morphologies and to assess additive values of integrated backscatter intravascular ultrasound (IB-IVUS) in detection of vulnerable plaque. BackgroundPrecise diagnosis of coronary lesions susceptible to plaque rupture and thrombosis may serve to stratify the risk of future coronary events and to make decisions for appropriate treatment of choice. MethodsTwenty-seven coronary arteries from 14 human autopsy hearts were interrogated ex vivo by OFDI and IB-IVUS. Imaged segments were sectioned at 3 mm intervals where a total of 360 pairs of cross-sectional images coregistered to histology were investigated. ResultsOverall, OFDI could depict various plaque components and structures such as fibrous tissue, sheet and nodular calcification, lipid, cholesterol crystals, and healed plaque rupture. OFDI could detect 14 of 18 thin-cap fibroatheroma (TCFA), however, the diagnostic accuracy was not high (positive predictive value [PPV] = 60.9%, κ = 0.664; area under the curve [AUC]: 0.88) mainly because of signal interference from macrophages. Further, we defined IB-IVUS–derived TCFA by recursive partitioning analysis as: 1) cross-sectional % lipid area >65.1%; 2) % lipid area >32.3 but <65.1% with plaque area >10.5 mm2, where TCFA detection by IB-IVUS alone was marginal (PPV = 50.0%, κ = 0.545; AUC: 0.82). However, when IB-IVUS was combined with OFDI, all pseudo OFDI-derived TCFA (non-TCFA on histology) were excluded. Accordingly, PPV of TCFAs diagnosed by both OFDI and IB-IVUS was improved to 100.0% (κ = 0.704; AUC: 0.93). ConclusionsOFDI could recognize detailed morphologies of human coronary plaque. However, diagnostic accuracy of both OFDI alone and IB-IVUS alone to identify TCFA is limited. Combination of IB-IVUS with OFDI improved the accuracy for TCFA detection, suggesting hybrid imaging or further development of novel devices will be required to identify coronary lesions responsible for future events.

High-dose atorvastatin is superior to moderate-dose simvastatin in preventing peripheral arterial disease

ObjectivesTo study whether high-dose versus usual-dose statin treatment reduces the incidence of peripheral artery disease (PAD) and what is the effect of high-dose statin treatment on cardiovascular disease (CVD) outcome...

Impact of Age on the Association Between CKD and the Risk of Future Coronary Events

Elucidation of the relationship between age, kidney function, and absolute coronary risk would facilitate efforts to promote chronic kidney disease (CKD) as a high-risk state for future vascular events and justify current recommendations for statin treatment in CKD. Population-based study. 1,268,538 people with data for estimated glomerular filtration rate and albuminuria who were treated in a single Canadian province. CKD risk groups (G1, G2, G3a, G3b, and G4 had estimated glomerular filtration rate ≥90, 60-89.9, 45-59.9, 30-44.9, and 15-29.9 mL/min/1.73 m2, respectively; A1, A2, and A3 had albuminuria with albumin-creatinine ratio [ACR]<30 mg/g or dipstick urinalysis negative, ACR of 30-300 mg/g or dipstick trace or 1+, and ACR >300 mg/g or dipstick ≥ 2+, respectively) and age (<40, 40-49, ≥50 years). Rates of coronary death or nonfatal myocardial infarction (expressed per 1,000 person-years), stratified by age, sex, and CKD stage. The first available serum creatinine value and the corresponding date were set as the index serum creatinine value and index date, respectively. ACR or dipstick urinalysis data were obtained from the periods defined by 6 months before and after the index creatinine value. Absolute rates of coronary death or nonfatal myocardial infarction were consistently greater than 10 per 1,000 person-years for people with CKD and 50 years or older, regardless of CKD stage. However, absolute rates of the composite outcome were consistently less than 10 per 1,000 person-years for those younger than 50 years. Single Canadian province, median follow-up only 4.0 years. People with CKD who are 50 years or older should be considered at the highest risk of coronary events. In contrast, consideration of other risk factors will be required when assessing future risk among people with CKD who are younger than 50 years.

ASSESSMENT OF NONCULPRIT VULNERABLE PLAQUE WITH CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY IN COMPARISON TO INTRAVASCULAR ULTRASOUND

The composition of atherosclerotic plaque has an important influence on the risk of future coronary events. Plaque with attenuation on intravascular ultrasound (IVUS) might be related to a worse long-term outcome of coronary artery disease (CAD), while coronary computed tomography angiography (CTA)