Severe Artery Disease Research Articles

Correlation of Neutrophil to Lymphocyte Ratio with the Severity of Coronary Artery Disease on Angiography in Patients with Acute Myocardial Infarction – An Observational Study

Correlation of Neutrophil to Lymphocyte Ratio with the Severity of Coronary Artery Disease on Angiography in Patients with Acute Myocardial Infarction – An Observational Study

Correlation of Clinical Risk Scores with Angiographic Extent and Severity of Coronary Artery Disease in Patients with ST Elevation Acute Coronary Syndrome

Correlation of Clinical Risk Scores with Angiographic Extent and Severity of Coronary Artery Disease in Patients with ST Elevation Acute Coronary Syndrome

Assessment of the Reynolds Risk Score and Correlation of Levels of Inflammatory Cardiac Biomarkers with Angiographic Severity of Coronary Artery Disease in Young Adults

Assessment of the Reynolds Risk Score and Correlation of Levels of Inflammatory Cardiac Biomarkers with Angiographic Severity of Coronary Artery Disease in Young Adults

Correlation between significant asymptomatic carotid artery stenosis and severity of peripheral arterial occlusive disease in the lower limb: a retrospective study on 200 patients

BackgroundThe aim of this study was to evaluate the correlation between significant asymptomatic carotid artery stenosis (ACAS) and severity of peripheral arterial occlusive disease (PAOD) in the lower limb, and to investigate the risk factors for significant ACAS in patients with lower limb PAOD.MethodsTwo hundred patients with lower limb PAOD were retrospectively reviewed. Baseline data, medical history and potential risk factors were collected. Lower limb PAOD was classified as stage IIA, stage IIB, stage III and stage IV. The carotid artery stenosis was classified as significant ACAS and non-significant ACAS. Multiple logistic regression estimated odds ratio of the risk factors.ResultsCompared to patients with non-significant ACAS, the patients with significant ACAS were significantly older in age and had greater percentage of cigarette-smoking andalcohol beverage consumption, and higher levels of total cholesterol and fibrinogen. There was no significant difference in sex, diabetes, hypertension, coronary heart disease and triglyceride between the two groups. The prevalence rate of significant ACAS increased with the stage of lower limb PAOD and with age. Advanced age and hypercholesteremia were risk factors for significant ACAS in this cohort. The prevalence rate of stroke increased with ACAS stage.ConclusionThe results suggested that the prevalence rate of significant ACAS was positively correlated with the severity of lower limb PAOD and age. Advanced age and hypercholesteremia appeared to be potential risk factors for significant ACAS in patients with lower limb PAOD.

Relationship between Pwave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome.

Early diagnosis of non-ST elevation acute coronary syndrome (NSTE-ACS) and prediction of the severity of current coronary artery disease (CAD) play amajor role in patient prognosis. Electrocardiography has aunique value in the diagnosis and provides prognostic information on patients with NSTE-ACS. In the present study, we aimed to examine the relationship between Pwave peak time (PWPT) and the severity of CAD in patients with NSTE-ACS. Atotal of 132 consecutive patients (female: 35.6%; mean age: 60.1 ± 11.6years) who were diagnosed with NSTE-ACS were evaluated retrospectively. Gensini scores (GSs) were used to define the angiographic characteristics of the coronary atherosclerotic lesions. The patients were divided into two groups according to the GS. The PWPT was defined as the duration between the beginning and the peak of the Pwave, and Rwave peak time (RWPT) was defined as the duration between the beginning of the QRS complex and the peak of the Rwave. There were 59 (44.6%) patients in the high-GS group (GS ≥25) and 73 (55.3%) patients in the low-GS group (GS <25). Presence of diabetes mellitus, low left ventricular ejection fraction, and high RWPT and PWPT were identified as predictors of ahigh GS in the study population. There was no significant difference between the area under the curves of PWPT and RWPT for predicting the severity of CAD (0.663 vs. 0.623, respectively; p = 0.573). The present study found that both PWPT and RWPT on admission electrocardiography were associated with the severity and complexity of CAD in patients with NSTE-ACS.

P3580Impact of glucose-6-phosphate dehydrogenase deficiency on the extent and severity of coronary atherosclerosis in patients with acute coronary syndrome

Abstract Background Studies in animal models and humans suggested that glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetically inherited condition causing haemolytic anemia, may be considered a risk factor for cardiovascular disease. It is currently unknown whether enzymatic activity may impact the extent and severity of coronary atherosclerosis in patients with acute myocardial infarction. This hypothesis was tested in a cohort of acute coronary syndrome (ACS) patients undergoing invasive management from Northern Sardinia, where the population prevalence of G6PD deficiency is the highest in the Mediterranean area. Methods The study was based on a prospective single-centre registry of consecutive ACS patients undergoing coronary angiography and subsequent percutaneous revascularization between January 2017 and December 2018, in which G6PD activity has been measured quantitatively using a biochemical assay based on G6PD/6GPD ratio in erythrocytes. Subjects were defined as deficient when the ratio was &lt;0.80. The primary endpoint of the study was the severity of coronary artery disease as assessed by the SYNTAX I score at baseline angiography. Results Among the 466 enrolled patients, 41 (9%) showed G6PD deficiency. Patients with G6PD deficiency were less likely to have a history of dyslipidemia (27% vs 50%; p=0.005) or diabetes (12% vs 21%; p=0.105). As expected, at admission patients with deficiency had lower hemoglobin level (12.1 vs 13.7 g/dL; p=0.005) as compared with those without. By angiography, SYNTAX score resulted as 19±9 and 16±9 (p=0.039) in patients with and without G6PD deficiency; while the number of diseased (with &gt;50% stenosis) vessels was 1.9 vs 1.6 (p=0.089) in the 2 study groups. Left main disease was detected in 15% and 7% (p=0.06) patients, respectively. G6PD deficiency emerged as an independent predictor of high SYNTAX score (OR=2.16, 95% CI 1.1–4.5; p=0.037). Angioplasty with coronary stenting of the culprit vessel was performed in all patients, while GP IIb/IIIa inhibitors were used in 30% and 14% (p=0.009) of patients with and without G6PD deficiency. Finally, in-hospital events were similar between the 2 study groups. Conclusions An increased extent and severity of coronary artery disease was observed in ACS patients with G6PD deficiency as compared with those without, despite the lower prevalence of “classic” cardiovascular risk factors.

P3624Prevalence and severity of coronary artery disease linked to prognosis in psoriasis patients referred for coronary computed tomography angiography: A multicentre cohort study

Abstract Background Psoriasis (Pso) is a disease characterized by systemic inflammation and is associated with an increased risk of cardiovascular disease. However, the degree of coronary artery calcification in Pso and its relation to prognosis is largely unknown. Purpose The aim of this study was 1) to estimate the prevalence and severity of coronary artery disease (CAD) in this patient group and 2) to asses the risk of major adverse cardiovascular events (MACE) including revascularization and all-cause mortality after initial diagnosis and treatment in a large-scale cohort of patients who underwent coronary computed tomography angiography (CCTA) due to angina symptoms. Methods This study consists of two parts using data from the Western Denmark Heart Registry; a cross-sectional study included 40,125 patients and a follow-up study included 42,861 patients. Pso patients were identified by the National Patient Registry and verified by nationwide prescription and treatment code registers. Primary outcome in the cross-sectional study was a coronary artery calcium score (CACS) &gt;0, with a secondary outcome defined as a CACS ≥400. In the follow-up study, the primary outcome was a combined outcome including myocardial infarction, revascularization, ischemic or unspecified stroke and all-cause mortality. Events within the first 90 days after CCTA were attributed to initial treatment and consequently excluded. All outcomes were adjusted for common cardiovascular risk factors and comorbidities. Results In the cross-sectional study 1,407 (3.5%) Pso patients were identified. OR was 1.31 (95% CI; 1.15–1.49) for CACS &gt;0 and 1.33 (95% CI; 1.10–1.62) for CACS ≥400 in Pso patients compared to non-Pso patients. In the follow-up study 1,591 (3.7%) Pso patients were identified. The mean duration of follow-up after CCTA was 4.0 years (min/max 0.0/10.2). Crude HR for the combined outcome was 1.52 (95% CI; 1.24–1.87), while adjusted HR was 1.16 (95% CI; 0.95–1.43). Conclusion In this clinically relevant cohort of patients referred to CCTA for CAD rule out, coronary artery calcification was more frequent and more severe in Pso patients even compared to the control patients with several risk factors and angina symptoms, but without inflammatory diseases. An increased risk of the combined outcome of MACE including revascularization and all-cause mortality after initial treatment in Pso patients was found in the crude analysis. The increased risk seemed predominantly carried by an increase in traditional risk factors.

P4637Elevated von Willebrand factor (VWF) and factor VIII are associated with higher clinical SYNTAX score in patients with stable coronary artery disease

Abstract Background Von Willebrand factor (VWF plays) central role in thrombogenesis, and circulates in a noncovalent complex with factor VIII (FVIII), acting as a transporter protein and stabilizer. VW factor protects FVIII from proteolytic inactivation and concentrate it at site of endothelial injury. Raised plasma VWF factor is detected in case of endothelial damage and it has been considered as a useful marker of endothelial dysfunction. Increased plasma FVIII has been found in venous thromboembolism and in some clinical conditions associated with chronic inflammation. The connection between FVIII and more incidence of arterial thrombosis is, partly, due to increased platelet adhesion/aggregation, induced by VWF at sites of arterial wall damage. The correlation between VWF factor, FVIII levels and acute coronary syndrome is well documented, but there are no available dates regarding relation between plasma levels of VW factor, FVIII and the severity of coronary artery disease according to SYNTAX I (SS) and Clinical SYNTAX score (CSS). Purpose The aim of this study was to determine the association between levels of VW factor and FVIII and the severity of coronary artery disease according to SS and CSS. Methods A total of 82 patients with symptoms of stable angina underwent coronary angiography and were divided into three groups according to SS and CSS: Group I (&lt;22 points), Group II (23–32), Group III (&gt;33). We calculated Clinical SYNTAX multiplying the value of SYNTAX score with the modified ACEF score, based on the patients' left ventricular ejection fraction, age and creatinine clearance derived using the Cockcroft–Gault equation. Results There were positive association between plasma levels of VW factor and severity of CAD according to SYNTAX I (Group I: 1.16±0.59, Group II: 1.52±0.62, Group III 1.49±0.80, Kruskal Wallis p=0.040) and Clinical SYNTAX score (Group I: 1.15±0.53, Group II: 1.38±0.72, Group III 1.57±0.75, Kruskal Wallis p=0.034). VW factor levels were significantly higher in Group II and Group III compared to Group I (SS: Mann- Whitney p=0.023 and 0.071, respectively), (CSS: p=0.251 and 0.009, respectively). We also found positive association between FVIII levels and severity of CAD according to SYNTAX I (Group I: 2.25±0.75, Group II: 2.21±0.53, Group III 2.97±0.95, Kruskal Wallis p=0.007) and Clinical SYNTAX score (Group I: 2.17±0.71, Group II: 2.26±0.68, Group III 2.89±0.87, Kruskal Wallis p=0.002). This study demonstrates that FVIII levels were significantly higher in Group III compared to Group I and Group II (SS: Mann- Whitney p=0.005 and 0.005, respectively), (CSS: p=0.001 and 0.014, respectively). The correlation between plasma levels of VW factor Conclusion Patients with stable angina pectoris and higher levels of VW and factor VIII had a higher Clinical SYNTAX and SYNTAX I score. Our study revealed that concomitant elevation in both VW and FVIII factors are a significant risk factor and predictor of more severe and extended CAD.

P3632Prognostic impact of aortic valve stenosis in patients with acute myocardial infarction

Abstract Background Aortic valve stenosis (AS) is associated with the presence and severity of coronary artery disease independently of clinical risk factors, which leads to increased cardiovascular mortality. However, the prevalence of AS and its prognostic value among patients with acute myocardial infarction (AMI) remain unknown. Purpose The purpose of this study was to investigate the prevalence and prognostic impact of AS in AMI patients. Methods We studied 2,803 AMI patients using data from Mie ACS registry, a prospective and multicenter registry. Patients were divided into subgroups according to the presence and severity of AS based on maximal aortic flow rate by Doppler echocardiography before hospital discharge: non-AS &lt;2.0 m/s, 2.0 m/s≤mild AS &lt;3.0 m/s, 3.0 m/s≤moderate AS &lt;4.0m/s and severe AS≥4.0 m/s. The primary outcome was defined as 2-year all-cause mortality. Results AS was detected in 79 patients (2.8%) including 49 mild AS, 23 moderate AS and 6 severe AS. AS patients were significantly older (79.9±9.8 versus 68.3±12.6 years), and higher killip classification than non-AS patients (P&lt;0.01, respectively). However, left ventricular ejection fraction, and prevalence of primary PCI was similar between the 2 groups. During the follow-up periods (median 725 days), 333 (11.9%) patients experienced all-cause death. AS patients demonstrated the higher all-cause mortality rate compared to that of non-AS patients during follow up (47.3% versus 11.3%, P&lt;0.0001, chi square). Kaplan-Meier curves showed that the probability of all-cause mortality was significantly higher among AS patients than non-AS patients, and was highest among moderate and severe AS (See figure A and B). Cox regression analyses for all-cause mortality demonstrated that the severity of AS was the strongest and independent poor prognostic factor (HR 1.71, 95% CI 1.30–2.24, P&lt;0.001, See table). Cox hazard regression analysis Hazard ratio 95% Confidential interval P-value Severity of aortic valve stenosis 1.71 1.30–2.24 &lt;0.001 Killip classification 1.63 1.46–1.82 &lt;0.001 Age 1.07 1.06–1.09 &lt;0.001 Serum creatinine level 1.05 1.03–1.08 &lt;0.001 Max CPK level 1.00 1.00–1.01 &lt;0.001 Left ventricular ejection fraction 0.96 0.95–0.97 &lt;0.001 Primary percutaneous coronary intervention 0.67 0.47–0.96 0.03 CPK suggests creatinine phosphokinase. All cause mortality Conclusions The presence of AS of any severity contributes to worsening of patients' prognosis following AMI independently of other known risk factors. Acknowledgement/Funding None

P2248Impact of Lipoprotein (a) levels on the presence and severity of coronary artery disease in female patients: a large cross-sectional Chinese cohort study

Abstract Background Lipoprotein (a) [Lp(a)] is recently recognized as a risk factor of atherosclerosis, and the development of coronary artery disease (CAD) in women is not fully understood. Purpose The present study aimed to examine the association of Lp(a) levels with the presence and severity of (CAD) in female patients pre- and post-menopause. Methods A total of 3712 female patients who received coronary angiography were consecutively enrolled. The level of Lp(a) was measured and compared among patients with and without CAD or myocardial infarction (MI), pre- or post- menopause. The association of Lp(a) with the presence of CAD and the severity of coronary atherosclerosis assessed by Gensini Score were examined. Results The average of Lp(a) levels were elevated as age increased in female subjects. Notably, women after menopause had higher Lp(a) levels compared with that before menopause [16.8 mg/dL (IQR 7.54–41.12 mg/dL) vs. 14.7 mg/dL (IQR 6.72–30.82 mg/dL), p=0.002]. Furthermore, multiple logistic regression analysis identified that Lp(a) &gt;30mg/dL was an independent risk factor of CAD in the postmenopausal female (OR1.38, 95% CI 1.13–1.69, p=0.002). Finally, Lp(a) had a positive correlation with Gensini score (r=0.11, p&lt;0.001), and Lp(a) &gt;30mg/dL was an independent risk factor for high Gensini score (OR 1.43, 95% CI 1.14–1.79, p&lt;0.001). While such results were not observed in the premenopausal females. Baseline characteristics of all patients Before menopause (n=525) Post menopause (n=3187) P value Age, (years) 46 (42–49) 62 (58–68) &lt;0.001* Hypertension, n (%) 231 (44.00) 2097 (65.80) &lt;0.001* Diabetes mellitus, n (%) 68 (12.95) 849 (26.64) &lt;0.001* LDL-C (mmol/L) 2.73±1.05 2.77±0.99 0.366 Lp(a) (mg/dL) 14.7 (6.72–30.82) 16.8 (7.54–41.12) 0.002* Data are expressed as mean ± SD or median (interquartile range) and numbers (percentages). BMI, body mass index; TC, total cholesterol; TG, triglyceride; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein(a); HsCRP, high-sensitivity C-reactive protein. *Statistically significant differences exist between two groups. CAD, coronary artery disease. Lp(a) in pre- and post-menopausal women Conclusion The present study indicated that circulating Lp(a) levels were independently associated with the presence and severity of CAD in the postmenopausal female, suggesting that further study may be needed to examine the role of Lp(a) in the development of CAD in female individuals with different menopausal status.

P5515Circulating galectin 1 is associated with severity of coronary artery disease and adverse cardiovascular events in patients undergoing coronary angiography

Abstract Background Galectin-1, a β-galactoside-binding lectin, was reported to attenuate the cardiac inflammation and ventricular remodeling after AMI. Its role in stable CAD was not fully elaborated. This study aimed to identify the relationship between galectin-1 and severity of CAD in patients with stable angina. Methods Totally 834 subjects underwent elective CAG were enrolled. Pre-procedure galectin-1 and hsCRP concentrations were determined. Subjects were grouped into tertiles according to their galectin-1 concentrations. SYNTAX scores were calculated to evaluate the severity of CAD. All patients were followed until January 2019, or the occurrence of major adverse cardiovascular events (MACE). Results Patients with higher galectin-1 concentrations were older and had higher prevalence of hypertension, diabetes, heart failure, and with higher levels of hsCRP and STNYAX scores. Patients with the highest tertile of galectin-1 were associated with higher risk of MACE (Fig 1A), even after adjusting age, gender, hypertension, diabetes, hemoglobin, creatinine, and LVEF (aHR: 2.13, 95% CI: 1.04–4.33, p=0.038). Gelection-1 (AUC: 0.802) showed better discriminatory performance than hsCRP (AUC: 0.696) in prediction the incidence of MACE (Fig 1B). Table 1 Tertile 1 (n=278) Tertile 2 (n=278) Tertile 3 (n=278) P Age (years) 61.0 (54.8–71.0) 67.0 (60.0–75.0) 72.0 (61.0–80.3) &lt;0.001 Male, n (%) 188 (67.6) 184 (66.2) 197 (70.9) 0.479 Hypertension, n (%) 153 (55.0) 185 (66.5) 219 (78.8) &lt;0.001 Diabetes, n (%) 67 (24.1) 90 (32.4) 123 (44.2) &lt;0.001 Heart failure, n (%) 10 (3.6) 8 (2.9) 44 (15.8) &lt;0.001 Hemoglobin (g/dL) 13.5 (12.5–14.3) 13.4 (12.4–14.3) 12.3 (10.8–13.7) &lt;0.001 Creatinine (mg/dL) 0.9 (0.8–1.1) 1.0 (0.9–1.2) 1.3 (1.1–1.9) &lt;0.001 Hs-CRP (mg/dL) 0.1 (0.0–0.2) 0.1 (0.0–0.3) 0.2 (0.1–0.7) &lt;0.001 Galectin 1 (ng/mL) 13.3 (10.2–14.7) 18.7 (17.4–20.5) 29.3 (25.5–38.5) &lt;0.001 SYNTAX score 0.0 (0.0–5.0) 0.0 (0.0–7.0) 7.0 (0.0–16.1) &lt;0.001 LVEF (%) 59.0 (54.6–62.2) 58.0 (52.0–63.0) 55.9 (49.0–60.9) 0.009 MACE: revascularization, n (%) 17 (6.1) 13 (4.7) 43 (15.5) &lt;0.001 MACE: nonfatal MI, n (%) 1 (0.4) 1 (0.4) 7 (2.5) 0.018 MACE: nonfatal stroke, n (%) 0 (0.0) 1 (0.4) 2 (0.7) 0.367 MACE: death, n (%) 4 (1.4) 1 (0.4) 13 (4.7) 0.001 Conclusion Serum galectin-1 levels were associated with the severity of CAD and subsequent MACE in patients with stable angina. Acknowledgement/Funding This study was supported in part by research grants from the Taipei Veterans General Hospital and Taiwan Ministry of Science and Technology Academic E

Epicardial Fat Tissue and Severity of Coronary Artery Disease in Diabetic vs Non Diabetic Patients

Epicardial Fat Tissue and Severity of Coronary Artery Disease in Diabetic vs Non Diabetic Patients

P843Study of the CHA2DS2-VASc score in acute coronary syndrome

Abstract Background To predict outcomes, acute coronary syndrome (ACS) can be assessed using GRACE and TIMI risk scores, whereas SYNTAX score is used to assess coronary artery disease (CAD) severity and clarify the management. CHA2DS2-VASc score is used as a predictive tool for stroke prevention in non-valvular atrial fibrillation, and it was studied in ACS in terms of outcome and CAD severity Methods Between December 2016 and June 2017, 125 ACS patients (mean age: 57.78 (±9.5) years, 78.4% males) were enrolled in this observational prospective study, 89 patients had been followed-up for six months. Patients were assessed based on history, clinical examination, 12-lead ECG, and coronary angiography. Results Subjects with a CHA2DS2-VASc score ≥2 had a higher proportion of multivessel disease (3.9%), left main coronary artery lesions (9.9%), and totally occluded, bifurcational, or long coronary lesions (60%) (All p-values&lt;0.05). We found significant positive associations of the CHA2DS2-VASc score with the SYNTAX score (p&lt;0.001) and the Gensini score (p&lt;0.001). Receiver operating characteristic (ROC) curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff&gt;2; 76% sensitivity; 76.8% specificity; p&lt;0.001) in predicting coronary multivessel diseases. Subjects with a CHA2DS2-VASc score ≥2 had a higher in-hospital complications, including heart failure, cardiogenic shock, renal impairment, and AF (all p-values&lt;0.05). The CHA2DS2-VASc score showed significant positive associations with in-hospital (11.9%, p=0.21) and six-month mortality (25%, p=0.042). ROC curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff&gt;2; 88% sensitivity; 65.3% specificity; p&lt;0.001) in predicting six-month-mortality. Multivariate logistic regression analysis showed that the CHA2DS2-VASc score (p&lt;0.001 with odds ratio 2.28; 95% CI 1.47–3.53) and the GRACE score (p&lt;0.001 with odds ratio 1.07; 95% CI 1.03–1.09) were predictors of six-month mortality. Conclusion CHA2DS2-VASc score is associated with increased CAD severity and in-hospital and six-month outcomes. Acknowledgement/Funding None

P873Plasma PCSK9 levels and atherosclerosis burden in the coronary arteries of patients undergoing coronary angiography

Abstract Background Plasma PCSK9 levels, a novel and effective therapeutic target for CVD prevention, have been associated with CVD events irrespective of traditional risk factors. Whether PCSK9 levels predict coronary artery disease (CAD) burden and severity is a matter of dispute. Purpose To investigate the association between plasma PCSK9 levels and CAD characteristics, including number of major diseased vessels, severity of coronary stenosis, and the burden of coronary calcifications. Methods One hundred and one patients undergoing coronary angiography were recruited for this cross-sectional study. The number of major coronary diseased vessels was defined as the presence of ≥1 stenoses ≥50% in diameter of at least one major coronary artery. CAD severity was defined as either the absence of coronary stenosis (no-CAD), CAD&lt;50% or CAD≥50% in one or more coronary arteries. The burden of coronary calcifications was estimated by angiography visual inspection and classified as absent, mild, moderate or severe. Results Coronary angiography showed single, double and triple vessel disease in 26 (25.7%), 23 (22.8%) and 21 (20.8%) patients, respectively; 20 (19.8%) and 11 (10.9%) pts had either minimal CAD (&lt;50%) or normal angiographic findings. Also, calcifications were absent in 65 patients (64.4%), and mild, moderate and severe in 23 (22.8%), 11 (10.9%) and 2 (2%) patients, respectively. Plasma PCSK9 levels were significantly associated with age (rho=0.22, p=0.025) and SBP (rho=0.21, p=0.034), and were almost doubled in patients with chronic kidney disease (CKD) as compared to those without CKD [164.6 ng/mL (104.6–187.0) vs 94.8 ng/mL (86.8–114.9), p=0.006]. Among patients without CKD, those with CAD≥50% had higher plasma PCSK9 levels than those without [97.1 ng/mL (87.8–143.0) vs 83.2 ng/mL (73.4–102.6), p=0.04]. In the overall population, higher plasma PCSK9 levels were found in pts with triple vessel disease [165.7 ng/mL (121.3–180.5)] than in those with double/single vessel involvement [97.9 ng/mL (87.6–99.8) and 88.4 ng/mL (87.3–97.4), p&lt;0.001 for both comparisons] or without CAD [87.5 ng/mL (74.3–114.9), p&lt;0.001]. Also, a trend toward an increase of plasma PCSK9 levels was found with higher CAD severity [no-CAD: 87.5 ng/mL (74.3–114.9), CAD&lt;50%: 89.1 ng/mL (78.9–105.3), CAD≥50%: 97.6 ng/mL (87.9–155.3), p=0.051], which turned significant after exclusion of CKD patients (p=0.042). Adjustment for age, sex, plasma LDL-cholesterol levels, statin use and CKD abolished the association between PCSK9 and CAD severity but not with the number of significantly diseased vessels and the burden of coronary calcifications. Conclusions Circulating PCSK9, whose plasma levels are significantly influenced by the presence of CKD, discriminates patients with significant coronary artery stenosis from those without CAD. In addition, both the number of diseased coronary vessels and total coronary calcifications are independently predicted by an elevated plasma PCSK9 level. Acknowledgement/Funding None

The Association Between SYNTAX Score II and Carotid Artery Disease Severity in Patients Who Underwent Coronary Artery Bypass Grafting.

The SYNTAX score (SS) and SS II, which include additional clinical parameters, are widely used today for deciding revascularization following coronary angiography. We investigated the association between the presence and severity of carotid artery disease (CrAD) using the SS and SS II in 287 patients who underwent coronary artery bypass grafting. We based this investigation on the known association between coronary artery disease and CrAD. A significant association was observed between the groups with and without CrAD in terms of SS II values (28.4 ± 9.6 vs 21.4 ± 7.7, respectively; P < .001). A significant difference was also observed when stenosis was classified according to severity as <50%, 50% to 70%, and >70% (P < .001). The results indicated a positive correlation between the presence and severity of CrAD as SS II increased (r = 0.187, P = .005). According to the results of multivariate logistic regression analysis, the SS II was an independent predictor of CrAD.

A case-control study of the association between the polymorphisms of APOE and SLCO1B1 and the severity of coronary artery disease

Objective The single nucleotide polymorphisms (SNPs) of APOE and SLCO1B1 were examined to explore their association with the risk and severity of coronary heart disease(CAD). Methods A total of 1 267 cases of consecutive coronary heart disease (CAD)-suspected inpatients visiting department of Cardiology in Peking University Peoples′ Hospital from March 2017 to november were recruited into this case-control study, and then 391 CAD cases and 223 non-CAD controls were enrolled for final analysis after screening by coronary angiography and exclusion criteria. The severity of the CAD cases were evaluated according to Gensini scores. The SNPs of APOE(388T>C, 526C>T) and SLCO1B1(388A>G, 521T>C) were detected using Real-time PCR and further verified using Sanger sequencing. Environmental risk factors were collected, and the correlations between SNPs of APOE and SLCO1B1 and the risk and severity of CAD were performed by SPSS version 16.0. Results The SNPs of all the subjects included in CAD group and non-CAD group were successfully detected, with an accordance of 100% to Sanger sequencing. The distribution of APOE and SLCO1B1 gene were subjected to Hardy-Weinberg. The distributions of APOE gene e3/e3 genotypes and e3 allele were most commonly found in both CAD group and non-CAD group (e3/e3: 70.8%,73.1%;e3: 83.5%,85.2%;respectively). APOE genotypes and alleles were comparable between the CAD cases and non-CAD controls (P>0.05). The frequencies of APOE gene e4+ genotype were more likely to be found in the subgroup of CAD with Gensini score≥72 (P 0.05). Conclusion This study observed no association between SNPs of APOE, SLCO1B1 and the risk of CAD in this population. However, APOE gene e4+ genotype may increase the severity of CAD. Key words: Apolipoproteins E; Solute carrier organic anion transporter family member 1b1; Polymorphism, genetic; Coronary disease; Severity of illness index

Thrombospondin-4 increases with the severity of peripheral arterial disease and is associated with diabetes

Thrombospondin-4 (TSP-4) is an extracellular matrix protein of the vessel wall. Despite bench evidence, its significance in the clinical setting of atherosclerosis is missing. TSP-4 (ng/ml) was measured in 365 PAD patientsusing a commercially available ELISA. PAD was diagnosed by the ankle–brachial index (ABI) and clinically graded using the Fontaine classification. TSP-4 levels were significantly higher in Fontaine II vs. Fontaine I (4.78 ± 0. 42, 4.69 ± 0.42, p = 0.043). TSP-4 significantly correlated with ABI (r = − 0.141, p = 0.023, n = 259) after the exclusion of mediasclerotic patients. Binary logistic regression analysis for Fontaine I vs. II showed an OR of 1.70 (1.02–2.82) in a multivariable model adjusted for traditional risk factors. Interestingly, TSP-4 levels were higher in patients with type 2 diabetes mellitus or prediabetes (DGT) compared with normal glucose tolerance (NGT) (4.76 ± 0.42 vs. 4.66 ± 0.41, p = 0.035). ANOVA for PAD and diabetes subgroups showed a linear increase with disease burden with the highest difference between Fontaine I-NGT and Fontaine II-DGT (4.59 ± 0.40, 4.79 ± 0.43, p = 0.015). TSP-4 levels increased with PAD severity and showed a former unknown association with diabetes. Thus, TSP-4 could be a novel marker of atherosclerotic activity, especially in the major subgroup of patients with concomitant diabetes.

Correlation between level of microalbuminuria and severity of coronary artery disease in coronary heart disease patients combined with diabetes

Objective To investigate the correlation between the level of microalbuminuria and severity of coronary artery disease in elderly coronary heart disease(CHD)patients combined with diabetes. Methods A total of 176 elderly CHD patients combined with diabetes were enrolled and prospectively studied.They were randomized into observation group(n=98)with microalbuminuria and the control group(n=78)with normoalbuminuria.The correlation between level of microalbuminuria and Gensini score was analyzed. Results The level of microalbuminuria and Gensini score were higher in observation group than in control group(P<0.05). There were statistically significant differences in level of microalbunminuria(F=9.87, P=0.013)and in Gensini score(F=9.07, P=0.015)among patients with single-, double- and triple-vessel disease.There was a positive correlation between levels of microalbuminuria and Gensini scores in CHD patients with type 2 diabetes(r=0.68, P<0.01). Conclusions The level of microalbuminuria is positively correlated with the severity of coronary artery disease in elderly CHD patients with type 2 diabetes.The microalbuminuria level can reflect the severity of coronary artery disease in a certain degree.It has certain clinical significance for predicting patient's condition in elderly CHD patients with type 2 diabetes. Key words: Coronary artery disease; Diabetes, type 2; Albuminuria

Galectin-3 plasma levels and its association with the severity of coronary artery disease in chronic stable angina patients.

Galectin-3 plasma levels and its association with the severity of coronary artery disease in chronic stable angina patients.

CORRELATION BETWEEN DURATION OF DIABETES AND SEVERITY OF CORONARY ARTERY DISEASE

Objective: To determine correlation between duration of diabetes and severity ofcoronary artery disease (Gensini score) in patients, undergoing coronaryangiography at tertiary care cardiac hospital. Methodology: A cross sectional study was conducted at Department ofCardiology, Tabba Heart Institute, Karachi from 17 September 2014 to 17thMarch 2015. All type 2 diabetic patients with 5 years or more duration of eithergender with age 40 to 70 years, who had co-morbid like hypertension, smoking,and dyslipidemia been included in the study. The severity of coronary arterydisease was found determined on Modified Gensini score correlate with durationof diabetes. The data was analyzed using SPSS version 17.0. Pearsoncorrelation, univariate, and multiple linear regressions were applied. Results: Coronary artery disease was found more than double in men as inwomen. In female patients mean Gensini score was 63.43±45.25 whereas inmale it was much higher (84.40±57.26). The mean Gensini score in patients ofage ≤60 years was higher than patients' with age > 60 years. The male genderand duration of diabetics were found strong relation with the Gensini score. Conclusion: The duration of diabetic mellitus and male gender are positivelycorrelated with the Modified Gensini score and appears to be the importantdeterminants of severity of coronary artery disease (CAD). Key Words: Duration of diabetes mellitus, Severity of coronary artery disease,Gensini score, Coronary angiography.