Severe CAD Research Articles

Abstract 4137296: Single-cell Atlas of Human Epicardial Adipose Tissue Reveals Aging IL4R + Naive B cell Contributing To Atrial Fibrillation

Background: Numerous recent evidence suggested a role of epicardial adipose tissue (EAT), the visceral fat depot of the heart, in the development of Atrial Fibrillation (AF). However, the cellular and molecular mechanisms underlying the association remain elusive. Methods: We performed single-nucleus RNA sequencing on eleven EAT samples collected from 2 groups of subjects: patients with nonvalvular AF undergoing coronary bypass surgery for severe CAD (n=7), and a control group of patients without concomitant AF (n=4). Comparative analyses were performed between the groups, including cellular compositional analysis, cell type–resolved transcriptomic changes, and functional analysis. Results: Unsupervised clustering of 92734 nuclei identified 11 clusters, encompassing all known cell types in the adipose tissue. Pseudobulk differential expression analysis between the AF and control groups revealed pronounced differences in a select subset of genes located on the X and Y chromosomes, including XIST and TSIX. Subsequent pathway analysis identified that the most significantly impacted pathways were those associated with immune cell functions. Meanwhile, differences in cellular composition and transcriptomic profiles, particularly concerning B cells, were observed between normal and AF conditions, highlighting distinct immune cell dynamics. Comparison of pathways across different B cell states revealed the enrichment of distinct pathways within each state, including those involved in cellular senescence, antigen processing and presentation, and programmed cell death signatures. Notably, aging IL4R + naive B cell and inflammatory ITGB1 + memory B cell were identified as important regulators potentially involved in functional changes of EAT and AF pathogenesis. Conclusions: We built a complete single-nucleus transcriptomic atlas of human EAT in normal and AF conditions. Our study lays the foundation for developing novel therapeutic strategies for treating AF by targeting and modifying B cell functions within EAT.

Abstract 4135655: Gender Differences in Invasive Angiography and Early Revascularization after Coronary Computed Tomography Angiography

Background: Coronary CT angiography (CCTA) has emerged as a first line tool for detecting CAD and assessing need for invasive coronary angiography (ICA). Historically, women have higher cardiovascular mortality compared to men with similar coronary plaque burden, yet remain undertreated. This study aims to investigate gender differences in ICA rates and subsequent revascularization following CCTA. Methods: This study included adults who underwent CCTA between 2013-2019 at a single institution. CCTA stenosis severity was categorized as <50%, 50-69% and ≥70%. Plaque burden was assessed by segment involvement score (SIS), defined as number of coronary segments with plaque. Outcomes included ICA and revascularization within 90 days of CCTA. Multivariable logistic regression analysis was performed after adjustment for demographic, clinical, and imaging variables. Results: Of 5,855 patients (mean age 61 years, 58% men) who underwent CCTA, 582 (9.9%) and 386 (6.6%) underwent ICA and revascularization, respectively. There was no significant difference in ICA rates between men and women with similar CCTA stenosis severity ( Figure 1A ; stenosis 50-69%: 17.9% vs. 19.2%, p=0.677; stenosis ≥70%: 53.8% vs. 58.3%: p=0.313). However, among patients with stenosis ≥70% who underwent ICA, men had significantly higher rates of revascularization ( Figure 1A . 80.1% vs. 69.2%, p=0.029). In multivariable analysis, male gender was an independent predictor of revascularization after adjustment for clinical characteristics, including CCTA stenosis severity and SIS (male gender: OR 1.58, 95% CI: 1.01-2.47, p=0.047). Of note, in patients with stenosis ≥70%, rates of revascularization in women were significantly lower in the early study period (years 2013-2015, p=0.020); however, the difference narrowed in the recent study period (years 2016-2019, p=0.309) ( Figure 1B) . Conclusion: There were comparable ICA rates between men and women. Women with severe stenosis (≥70%) by CCTA had significantly lower rates of revascularization, particularly in the early study period. These findings suggest a disparity in the management of CCTA-identified severe CAD, though it has demonstrated improvement in recent years.

Is there a gender difference in the effects of cardiovascular risk factors on the anatomical localization and severity of obstruction on coronary arteries?

Abstract Background Whether there is a gender difference in the effects of traditional cardiovascular risk factors(CVRF) on the anatomical localization(AL) and severity(AS) of obstruction on coronary arteries(CA) remains unclear. Purpose In our study, we investigated whether there is a gender difference in the relationship between CVRF and obstruction on CA . Methods We included 978 patients(49.9% women, mean age: 61+10.3) with stable chest pain undergoing invasive coronary angiography between 2019-2021 who were recruited from the database of our clinic. We examined the gender difference in hypertension(HT), diabetes mellitus(DM), smoking, hyperlipidemia, previous history of CAD(H.CAD) and family history of premature CAD(F.CAD) and their correlation with the AL and AS of obstruction on CA in both gender. Results Women were older(p<0.001) with higher rates of HT (p=0.001) and DM(p=0.026) and higher TC, LDLC and HDLC levels respectively (rs) as (p=0.001, p=0.001, p=0.001). Whereas H.CAD and smoking rates were higher in men rs as (p=0.001, p=0.009). The incidence of critical stenosis (≥70 obstruction) & intermediate lesions (50-69%) on all CA and Syntax scores were higher in men(p<0,01). In patients with HT, severe CAD was more prominent on circumflex (Cx)(p=0.029) and right coronary artery(RCA)(p=0.002) in women and on the proximal ( p=0.024) and mid portion of left anterior descending artery(LAD) (p=0.045) in men. In patients with DM a statistically significant(ss) correlation was found between the presence of DM and AS in all vessels except for left main coronary artery (LMCA) in women (LAD prox:p=0.001; LAD mid:p=0.001; diagonal artery(Dg):p=0.003; Cx:p=0.001; RCA:p=0.001 ;LMCA:p>0.05). However no such correlation was observed in men(p>0.05). In patients with H.CAD moderate/severe lesions were more common on proximal(p=0.013) and mid portions of LAD(p=0.021), on CX( p=0.006) and on RCA(p=0.016) in men and more common on the proximal portion of LAD(p=0.047), CX(p=0.014) and RCA(p=0.009) in women. For either smoking and F.CAD there was no such correlation in either gender (p>0,05). As for blood lipid levels no correlation was observed between LDLC, HDLC and triglyceride levels and AL&AS in men(p>0,05). However there was a negative, weak correlation between the HDLC levels and obstruction on LAD mid portion(r=-0.140; p=0.003); on Dg(r=-0.100; p=0.034) on CX (r=-0.154; p=0.001) and on RCA (r=-0.151; p=0.001) in women. Conclusion Major traditional CVRFs have a sex specific impact on AL and AS of obstruction on CA. In the era of precisıon medicine we need gender specific risk scoring systems taking these gender differences into account.

Angiographic findings in patients with Non-ST-elevation myocardial infarction

Background & Objective: Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment elevation myocardial infarction (STEMI), Non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (USA). Patients diagnosed with NSTEMI are either treated conservatively or early invasive strategy is adopted. In NSTEMI it is believed that either one or more vessel is transiently occluded or that the blood flow is critically reduced in a patent vessel i.e. subtotal occlusion. This study was conducted to find the angiographic characteristics of NSTEMI patients undergoing coronary angiography. Methods: This study was conducted in Department of Cardiology, Lady Reading Hospital Peshawar. It was Cross Sectional Study. Data was collected from 8th November 2022 to 8th May 2023. Consecutive non-probability sampling technique was used to collect data from the patients. Results: Total of 300 patients were studied. The mean age was 56.95 years ±1.176 standard deviation. Male patients were 201 (67%) and remaining were female. It was found that 51(17%) of total NSTEMI patients were having totally obstructed coronary artery (OCA) in one or more coronary arteries. In NSTEMI, non-obstructive CAD (<50%) were found in 81 (27%) of patients whereas 219 (73%) were having significant CAD. It was found that 40% were having single vessel CAD, 32% were having double vessel CAD and 28% were having triple vessel CAD. TVCAD was present significantly higher in advance age, Diabetes mellitus, hyperlipidemia and family history of CAD. Conclusion: Patients having NSTEMI are usually having multiple risk factors and having usually severe and multivessel CAD. doi: https://doi.org/10.12669/pjms.40.10.9499 How to cite this: Ikramullah, Ahmad F, Haq A, Khan SW. Angiographic findings in patients with Non-ST-elevation myocardial infarction. Pak J Med Sci. 2024;40(10):2228-2232. doi: https://doi.org/10.12669/pjms.40.10.9499 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Effect of Severe Coronary Calcification on Diagnostic Performance of Computed Tomography-Derived Fractional Flow Reserve Analyses in People with Coronary Artery Disease.

Negative CCTA can effectively exclude significant CAD, eliminating the need for further noninvasive or invasive testing. However, in the presence of severe CAD, the accuracy declines, thus necessitating additional testing. The aim of our study was to evaluate the diagnostic performance of noninvasive cFFR derived from CCTA, compared to ICA in detecting hemodynamically significant stenoses in participants with high CAC scores (>400). This study included 37 participants suspected of having CAD who underwent CCTA and ICA. CAC was calculated and cFFR analyses were performed using an on-site machine learning-based algorithm. Diagnostic accuracy parameters of CCTA and cFFR were calculated on a per-vessel level. The median total CAC score was 870, with an IQR of 642-1370. Regarding CCTA, sensitivity and specificity for RCA were 60% and 67% with an AUC of 0.639; a LAD of 87% and 50% with an AUC of 0.688; an LCX of 33% and 90% with an AUC of 0.617, respectively. Regarding cFFR, sensitivity and specificity for RCA were 60% and 61% with an AUC of 0.606; a LAD of 75% and 54% with an AUC of 0.647; an LCX of 50% and 77% with an AUC of 0.647. No significant differences between AUCs of coronary CTA and cFFR for each vessel were found. Our results showed poor diagnostic accuracy of CCTA and cFFR in determining significant ischemia-related lesions in participants with high CAC scores when compared to ICA. Based on our results and study limitations we cannot exclude cFFR as a method for determining significant stenoses in people with high CAC. A key issue is accurate and detailed lumen segmentation based on good-quality CCTA images.

Computed tomography angiography and coronary artery disease-reporting and data system and a 5-year prognostic major adverse cardiovascular and cerebral event outcome study in a symptomatic Southeast Asian population.

This study investigated the relationship between coronary artery disease-reporting and data system (CAD-RADS) for coronary computed tomography angiogram (CCTA) and major adverse cardiovascular and cerebral event (MACE) in a symptomatic Southeast Asian, Thai population over a 5-year period. A retrospective cohort study of Thai patients without known CAD who underwent CCTA for CAD symptoms. CCTA images and 5-year health data were reviewed for CAD-RADS and MACE. MACE consists of all-cause mortality, cardiovascular death, acute coronary syndrome, heart failure hospitalization, and stroke. In total 336 patients were evaluated. The median follow-up period was 6.4 years. The overall MACE incidence was 63 cases (18.8%). The MACE event rate was progressively increased with higher CAD-RADS categories; CAD-RADS 3 [hazard ratio (HR), 3.62; P = 0.015], CAD-RADS 4a (HR, 3.50; P = 0.024), CAD-RADS 4b & 5 (HR, 7.56; P = 0.001). The risk of MACE increased significantly in the moderate to severe CAD burden group (HR, 5.58; P = 0.01). Kaplan-Meier curve showed a significant rise in MACE with higher CAD-RADS categories ( P = 0.01). CAD-RADS classification has a significant prognostic value in Southeast Asian, Thai population with cardiac symptoms.

The Value of 2D Global Longitudinal Strain in Predicting the Severity of Coronary Artery Disease in Patients with NSTEMI and Unstable Angina and Regional Strain Value for Predicting the Culprit Artery

Background: Our study aimed to evaluate the predictive ability of resting strain to determine the severity of CAD in the absence of impaired LVEF in patients with NSTEMI and unstable angina. Additionally, the study sought to predict culprit and infracted related artery (IRA) using regional strain (SLR). Methods: The study was conducted between January 2023 and May 2023 at the cardiology department of Ibn Rochd Hospital, Morocco. We conducted a comparative analysis involving 30 patients, comprising 23 individuals with NSTEMI and 7 with unstable angina. In all cases, we assessed both GLS and RLS before proceeding to coronary angiography. Subsequently, we categorized the patients into two groups: one consisted of 18 individuals with severe coronary lesions, including left main trunk (LM) and three vessels lesions, while the other group, comprising 12 patients, served as the control group and had non-severe coronary lesions Results: At resting GLS threshold below -16,3 %, despite its subnormal nature, should raise suspicion and suggest severe coronary artery disease. RLS in the "Single-vessel" group was significantly lower in the culprit artery territories, suggesting that RLS may be a better marker for identifying the culprit artery. Both GLS and the visual analysis of segmental kinetics by WMSI (Wall Motion Score Index) at rest, were statistically significant for detecting severe coronary lesions. Conclusion: GLR and SLR are sensitive markers for early detection of myocardial ischemia and predicting its severity. A resting GLR threshold of less than -16.13% could indicate severe CAD with severe tri-truncular or LMT damage, especially when combined with abnormal WMSI scores. These 2D strain parameter changes precede subjective abnormalities in segmental kinetics, which are often considered normal at rest.

Co-existence of hypovitaminosis D and diabetes mellitus triple the incidence of severe CAD in women

Co-existence of hypovitaminosis D and diabetes mellitus triple the incidence of severe CAD in women

Coronary artery disease severity and risk stratification of patients with non ST-elevation acute coronary syndrome using CHA2DS2-VASc-HSF score

BackgroundRisk stratification assessment of patients with non-ST elevation acute coronary syndrome (NSTE ACS) plays an important role in optimal management and defines the patient’s prognosis. This study aimed to evaluate the ability of CHA2DS2-VASc-HSF score (comprising of the components of the CHA2DS2-VASc score with a male instead of female sex category, hyperlipidemia, smoking, and family history of coronary artery disease respectively) to predict the severity and complexity of CAD and its efficacy in stratification for major adverse cardiovascular events (MACE) in patients with NSTE ACS without known atrial fibrillation.MethodsThis study included 200 patients (males 72.5%, mean age 55.8 ± 10.1 years) who were admitted with NSTE ACS. CHA2DS2-VASC-HSF score was calculated on admission. Patients were classified into three groups according to their CHA2DS2-VASC-HSF score: low score group (< 2; 29 patients), intermediate score group (2–4; 83 patients), and high score group (≥ 5; 88 patients). Coronary angiography was conducted and the Syntax score (SS) was calculated. Clinical follow-up at 6 months of admission for the development of MACE was recorded.ResultsSS was significantly high in the high CHA2DS2-VASc-HSF score group compared with low and intermediate score groups. CHA2DS2-VASc-HSF score had a significant positive strong correlation with syntax score (r = 0.64, P < 0.001). Smoking, vascular disease, hyperlipidemia, and CHA2DS2-VASc-HSF score were independent predictors of high SS. For the prediction of severe and complex CAD, CHA2DS2-VASc-HSF score had a good predictive power at a cut-off value ≥ 5 with a sensitivity of 86% and specificity of 65%. Hypertension, vascular disease, high SS, and CHA2DS2-VASc-HSF score were independent predictors of MACE. CHA2DS2-VASC-HSF score ≥ 4 was identified as an effective cut-off point for the development of MACE with 94% sensitivity and 70% specificity.ConclusionsCHA2DS2-VASC-HSF score is proposed to be a simple bedside score that could be used for the prediction of the severity and complexity of CAD as well as a risk stratification tool for the development of MACE in NSTE ACS patients.

Association of testosterone with myocardial infarction and severity of coronary artery disease among male patients

BackgroundCoronary heart disease (CHD) remains a leading cause of morbidity and mortality, particularly in aging populations. Men typically exhibit higher rates of CHD compared to women, with testosterone levels inversely associated with cardiovascular risk. This study investigates the relationship between testosterone levels and angiographically confirmed CHD, disease severity, and myocardial infarction (MI) among CHD cases. MethodsA cohort of 1724 male patients undergoing diagnostic or interventional coronary angiography was examined. Demographic, clinical, and biochemical data were collected, including serum total testosterone levels. The severity of CHD was assessed using the Gensini score, and MI cases were diagnosed according to World Health Organization criteria. ResultsResults revealed significant differences in testosterone levels among CHD subtypes, particularly between MI and unstable angina/stable angina groups (p < 0.001). Testosterone levels were inversely correlated with CHD severity, as evidenced by the Gensini score (Pearson coefficient = −0.062, P = 0.004). Cross-validation random forest analysis demonstrated the significant contribution of testosterone to CHD severity discrimination (p < 0.05). ConclusionsThere is an association between testosterone and a predisposition to severe CAD indicated by Gensini score and myocardial infarction.

Association between C-Reactive Protein to Albumin Ratio and Multi-Vessel Coronary Artery Disease in Patients with Stable Coronary Artery Disease.

Multivessel coronary artery disease (MV-CAD) remains a prevalent and serious health concern despite advances in treatment. Early identification and risk stratification are crucial for optimizing treatment. The CRP-to-albumin ratio (CAR) has emerged as a promising biomarker in various inflammatory diseases. This study investigated the potential of CAR as a marker for MV-CAD. We retrospectively analyzed 1360 patients with suspected CAD. Patients were divided into three groups based on CAR tertiles. Logistic regression analyses were carried out to estimate the association between MHR and MV-CAD. Elevated CAR levels were significantly associated with an increased prevalence of CAD (p < 0.001), severe CAD (p < 0.001), and MV-CAD (p < 0.001). Patients with the highest CAR tertile had five times higher odds of MV-CAD compared to the lowest tertile (p < 0.001). CAR demonstrated moderate accuracy in predicting MV-CAD (AUC: 0.644, 95% CI: 0.615-0.674, p < 0.001). CAR holds promise as a tool for the early identification and risk stratification of multivessel CAD. Further research is warranted to validate its clinical utility and explore its potential to guide treatment decisions and improve outcomes in patients with this high-risk condition.

Association Between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease in Acute Myocardial Infarction Patients

Background: Acute myocardial infarction is one of the leading causes of death across the world. Determination of severity is important in patients with acute myocardial infraction for the therapeutic decision making. Neutrophil to Lymphocyte Ratio (NLR) has been proposed as a new prognostic marker in patients with acute MI. Several international studies have found to compare the relation between NLR and severity of coronary artery disease. In these studies, they demonstrated that the NLR is higher in severe CAD. In our country no such study has been done yet to predict the severity of coronary artery disease by estimating NLR in acute MI patients. Moreover, NLR is cheap, easily available, non-invasive and routinely done procedure. Objectives: This study was conducted to find out the association of NLR to severity of CAD in acute MI patients. Methods: This observational cross sectional analytical study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, SSMC and Mitford Hospital and NICVD, Dhaka from March 2021 to February, 2022. Patients with acute MI (STEMI and NSTEMI) were approached for this study according to inclusion and exclusion criteria. They were divided into two groups according to NLR: Group A NLR &gt;2.5 and Group B NLR ≤2.5. Coronary angiogram was done during index hospitalization. The severity of coronary artery disease was assessed by Vessel score and Gensini score. According to Gensini score was non severe (≤50) severe (&gt;50). Results: Among 70 patients in our study 30 (42.8%) were in the high NLR group (Group A) and 40 (57.14%) were in low NLR group (Group B). In group A mean NLR was 5.15 ± 2.21 and in group B mean NLR was 1.65 ± 0.35, this difference was statistically significant. Severe coronary artery disease in terms of vessel score and Gensini score was significantly higher in group A than group B (p value 0.001). We found strong positive correlation between NLR and Gensini score (r= 0.7, p= 0.001), and moderate positive correlation between NLR nad vessel score (r= 0.5, p= 0.001). With the increase of NLR, vessel score and Gensini score increases demonstrating more severe CAD. Simple logistic regression analysis of variables of interest revealed that hypertension (p=0.003), diabetes mellitus (p=0.008), dyslipidaemia (p=0.007), WBC count(p=0.034), Neutrophil count (p=0.000), Lymphocyte count (p=0.000), NLR (p=0.000), LVEF (p=0.001) were independent predictor of severe coronary artery disease with odds ratio (OR) being 5.32, 3.88, 4.42, 1.00, 1.20, 0.834, 2.28, 0.805 respectively. In multivariate logistic regression analysis, after adjustment of confounding, hypertension (p=0.028, OR=5.87) and NLR (P=0.004, OR=1.81) remain independent predictor of severe CAD. In ROC curve analysis, the AUC of NLR for predicting severity of CAD is 0.8 with p value &lt; 0.001, 95% CI (0.78-0.96) and with 75% sensitivity and 86.5% specificity. So, from this study, it is evident that NLR is directly associated with coronary artery disease severity. Conclusion: Increased NLR was associated with angiographically severe coronary artery disease in acute Myocardial Infarction patients, and this association is independent of conventional cardiovascular risk factors. Bangladesh Heart Journal 2024; 39(1): 1-9

Association Between Systemic Immune- Inflammation Index and Severity of Coronary Artery Disease in Acute Myocardial Infarction Patients

Background: Acute myocardial infarction is one of the leading causes of death across the world. Determination of severity is important in patients with acute myocardial infraction for the therapeutic decision making. Systemic immune-inflammation index (SII) has been proposed as a new prognostic marker in patients with acute MI. Several international studies have found to compare the relation between SII and severity of coronary artery disease. In these studies, they demonstrated that the SII is higher in severe CAD. In our country, no such study has been done yet to predict the severity of coronary artery disease by estimating SII in acute MI patients. Moreover, SII is cheap, easily available, non-invasive and routinely done procedure. Objectives: This study was conducted to find out the association of SII to severity of CAD in acute MI patients. Methods: This observational cross sectional analytical study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, SSMC and Mitford Hospital and NICVD, Dhaka from March 2021 to February 2022. Patients with acute MI (STEMI and NSTEMI) were approached for this study according to inclusion and exclusion criteria. Coronary angiogram was done during index hospitalization. The severity of coronary artery disease was assessed by Vessel score and Gensini score. According to Gensini score CAD severity detected as mild to moderate (≤50) , severe (&gt;50). Patients were divided into two groups according to Gensini score: Group A, severe CAD ( Gensini score &gt;50) and Group B, mild to moderate CAD( Gensini score ≤50). SII calculated from admission CBC report. Results: Among 70 patients in our study 33 (47.1%) were in the high Gensini group (Group A) and 37 (52.85%) were in low Gensini group (Group B). Mean systemic immune inflammation index was found significantly higher in group A than group B, p value 0.001. We found strong positive correlation between SII and Gensini score (r= 0.7, p= 0.001). With the increase of SII, Gensini score increases demonstrating more severe CAD. In multivariate logistic regression analysis, after adjustment of confounding, hypertension (p=0.01, OR=4.84), NLR (P=0.004, OR=1.81) and SII (P=0.011. OR=1.002) remain independent predictor of severe CAD. In ROC curve analysis, the AUC of SII for predicting severity of CAD is 0.8 with p value &lt; 0.001, 95% CI (0.71-0.91) and SII cut off value 686 can predict severe CAD with 78% sensitivity and 76% specificity. So, from this study, it is evident that SII is directly associated with coronary artery disease severity. Conclusion: Increased SII was associated with angiographically severe coronary artery disease in acute Myocardial Infarction patients and this association is independent of conventional cardiovascular risk factors. Bangladesh Heart Journal 2023; 38(2): 102-109

Effects of peripheral artery disease on long-term outcomes after percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe coronary artery disease

BackgroundThere is a scarcity of data evaluating the effect of peripheral artery disease (PAD) on long-term mortality after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in patients with severe coronary artery disease in real-world practice. MethodsAmong 14,867 consecutive patients who underwent their first coronary revascularization with PCI or isolated CABG between 2011 and 2013 in the CREDO-Kyoto PCI/CABG registry Cohort-3, the current study population consisted of 3380 patients with three-vessel coronary artery disease or left main coronary artery disease. Long-term clinical outcomes were compared between PCI and CABG stratified by the presence or absence of PAD. Median clinical follow-up was 5.9 (IQR: 5.1–6.8) years. ResultsThere were 461 patients with PAD (PCI: N = 307, CABG: N = 154), and 2919 patients without PAD (PCI: N = 1823, CABG: N = 1096). The cumulative 5-year mortality after coronary revascularization was 31.2 % in patients with PAD and 16.2 % in those without PAD (p < 0.0001). There was a higher risk of PCI relative to CABG for all-cause death in patients with and without PAD (adjusted HR, 1.59; 95%CI, 0.99–2.53; p = 0.054, and HR, 1.25; 95%CI, 1.01–1.56; p = 0.04) without interaction (p interaction p = 0.48); Nevertheless, there was no excess risk of PCI relative to CABG for cardiovascular death regardless of PAD. ConclusionsThe long-term mortality after coronary revascularization was significantly higher in severe CAD patients with PAD than those without PAD. There was a higher mortality risk of PCI relative to CABG in patients with and without PAD without interaction, which was mainly driven by excess non-cardiovascular deaths.

Abstract 11430: A Bad Break: Cardiogenic Shock Complicated by an Intracardiac Foreign Body

Introduction: We report a case of cardiogenic shock complicated by an intracardiac foreign body. This is a rare occurrence during a dangerous cardiovascular disease process which necessitated urgent multidisciplinary management. Case: A 54-year-old female with a history of hypertensive cardiomyopathy and breast cancer was not improving during a hospitalization for acutely decompensated CHF and atrial flutter with RVR. Right heart catheterization demonstrated cardiogenic shock, with a foreign body noted in the right atrium favored to be a fragment of the left subclavian port catheter also seen on fluoroscopy. This object was present on admission imaging but likely mistaken as external artifact. Coronary angiography revealed severe multi-vessel CAD. A multidisciplinary team discussed the timing and modality of foreign body removal, electing to prioritize hemodynamic optimization before intervention. Once stable, the patient underwent successful endovascular removal of the catheter fragment with immediate improvement of her heart rhythm. She remained in sinus rhythm until discharge home in stable condition. Discussion: This episode of cardiogenic shock may have been precipitated by an arrhythmogenic intracardiac foreign body. However, medication non-adherence and severe CAD on angiography suggested a multifactorial etiology, justifying a delay in the removal of the foreign body until shock had resolved. Additionally, the catheter fragment present on admission imaging should have been identified earlier as a contributing factor. Timely recognition and removal of the fragment may have prevented the hemodynamic decompensation of the patient. Conclusion: This case demonstrates the efficacy of delaying the removal of an intracardiac foreign body in favor of hemodynamic optimization in patients with cardiogenic shock, while obviating the need for maintaining a broad differential when determining the underlying etiology of decompensated heart failure.

Sistemik inflamatuar yanıt indeksin(SIRI) kronik total oklüzyon öngörülmesinde rolü: yararlı mı değil mi?

Aim: Inflammation is very important in the pathogenesis of atherosclerosis and CAD. Chronic total occlusion (CTO) is a chronic form of CAD and is common in patients with severe CAD. The aim of this study was to determine the association of the systemic inflammatory response index (SIRI), a marker of inflammation, with CTO. &#x0D; &#x0D; Materials and Methods: Our study was retrospective and included 100 CAD patients with CTO and 100 CAD patients without CTO. SIRI was compared between the two groups.&#x0D; &#x0D; Results: Among the basic clinical and laboratory characteristics of the patients, age, white blood cell, and neutrophil counts were statistically higher in the CTO group (p=0.044, p=0.044, p=0.036, respectively). SIRI parameters were similar between the groups, and no statistical difference was observed (p=0.111). According to the ROC analysis, the optimum cut-off value for SIRI was &gt;1040 (sensitivity 70.0% and specificity 44.0%).&#x0D; &#x0D; Conclusion: SIRI is not a useful predictor for the detection of CTO.

Hypertensive Subjects are More Likely to Develop Coronary Artery Lesions: A Study by Computerised Tomography Coronary Angiography.

Coronary Computed Tomography Angiography (CCTA) is commonly used to identify coronary artery disease. In this study, the indications for CCTA referrals are reviewed, to identify the strongest predictors of CAD, as seen on CCTA. A retrospective study, reviewing the electronic health records of consecutive patients who underwent CCTA between July and November 2020 at our Trust, was conducted. A total of 485 patient reports were reviewed. Of patients with moderate-to-severe CAD, 128 (73.6%) were hypertensive. Of those with severe CAD, 79 patients (76%) were hypertensive. Univariate analysis for comparison of patients with absent (n = 219), mild (n = 92), moderate (n = 70) and severe (n = 104) CAD revealed that hypertension (P < .001), diabetes mellitus (P < .001), gender (P < .001), dyslipidemia (P < .001) and smoking (P = .006), were each significantly associated with the presence of CAD on CCTA. However, multiple logistic regression analysis confirmed that hypertension has the strongest association with CAD (OR = 2.22, P < .001) Furthermore, the presence of typical chest pain in hypertensive patients was strongly associated with significant CAD, on CCTA. Among all risk factors, hypertension is the strongest independent predictor for the presence of CAD on CCTA. These results suggest that hypertension is a significant factor when considering referral for CCTA, particularly when associated with chest pain.

Comparing of Peak Longitudinal strain and Post Systolic Shortening in detecting ischemia at rest in stable coronary artery disease: an angiography verified study

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary artery disease is a major public health problem. Early diagnosis and treatment of coronary artery disease is crucial. There is a need for a practical, reliable and cost-effective non-invasive imaging tool. We aimed to evaluate the rest ischemia with speckle tracking echocardiography (STE) compare to the two methods in patients who were scheduled coronary angiography according to the stress tests. Methods We included fifty patients with stable angina pectoris who were scheduled for conventional coronary angiography after the stress tests in our study. Speckle tracking echocardiography was performed just before coronary angiography. The association of 2 parameters with coronary artery disease was investigated and compared. Results Among 50 patients recruited for the study, 38 of them had severe CAD (&amp;gt;50%), whereas 12 patients had non-significant CAD. Post systolic shortening (PSS) was significantly related with CAD (p&amp;lt;0.0001). The relationship of PLS with the area at risk was found to be statistically insignificant but global longitudinal strain (GLS) was significantly lower in patients with severe CAD (p = 0.011). Conclusion PSS may detect coronary ischemia in patients with stable coronary artery disease and it is more sensitive and specific in patients with stable CAD. PSS is a very useful, practical and easy applicable non invasive tool for the detection of severe coronary artery disease at rest.

Association of Serum Vitamin D Level with Angiographic Severity of Coronary Artery Disease in Patients of Acute Myocardial Infarction

Background: Besides conventional risk factors, a novel risk factor hypovitaminosis D may play unique role in the development of coronary artery disease. Evidences suggest that people with low serum vitamin D level is associated with risk of acute MI even after adjusting for the known risk factors. This study was conducted to find out the association between serum vitamin D Level and angiographic severity of coronary artery disease in patients of acute myocardial infarction. Methods: One hundred and four patients of acute myocardial infarction undergoing coronary angiography in DMCH during May 2017 to April 2018 were the study population. The population were divided into 2 groups based on their serum vitamin D level; normal vitamin D (&gt;30 ng/ml) and low vitamin D (≤30 ng/ml). Low vitamin D level again divided into 3 groups; insufficient (vitamin D 21 to 30 ng/ml), deficient (Vitamin D 10-20 ng/ml) and severely deficient having vitamin D &lt;10 ng/ml. Coronary angiogram was done during index hospitalization. The severity of the coronary artery disease was assessed by vessel score and Gensini score.After calculation of Gensini score, 36 points was chosen as an appropriate cut-off value and patients were divided into two groups; those with a Gensini score ≤36 points was considered as having absent or mild coronary artery disease and those with a Gensini score &gt;36 points was considered as having moderate to severe coronary artery disease. Association between serum vitamin D Level and angiographic severity of CAD was looked for. Results: Seventy seven (74.0%) of study population had vitamin D level ≤ 30 ng/ml, while 27(26.0%) patients had normal level. There was no significant association between common cardiovascular risk factors with vitamin D level. Double or triple-vessel CAD were more frequent in those with vitamin D levels ≤30 ng/ml as compared to those with normal vitamin D levels (&gt;30 ng/ml) (P&lt;0.05). Majority (48.1%) of patients had double vessel disease (DVD). Among them 4(8%) patients had normal serum vitamin D levels (&gt;30 ng/ml) and 46 (92%) patients had low vitamin D (≤30 ng/ml). Mean Gensini score was found 20.8±5.1 in normal vitamin D (&gt;30 ng/ml) and 48.3±13.3 in low vitamin D (≤30 ng/ml) (p&lt;0.05). Moderate to severe CAD (Gensini score &gt;36) was found in 54.1% of patients with vitamin D insufficiency (21-30 ng/dl) and 83.3% of patients with vitamin D deficiency (10-20 ng/dl) (p&lt;0.05). Moderate negative correlation (r= -0.641; p=0.001) was found between Gensini score and serum vitamin D level of patients with acute myocardial infarction. Conclusion: Low serum vitamin D level is associated with increasing severity of coronary artery disease, docsumented angiographically among patients of acute myocardial infarction. Low serum vitamin D levels may be an emerging, independent, and potentially modifiable cardiovascular risk factor. Cardiovasc j 2023; 15(2): 124-131

Association between coronary artery lesion severity in coronary computed tomography angiography and hemoglobin A1c in nondiabetic patients with chronic coronary syndrome

Objectives: In this study, we aimed to investigate whether there is a relationship between coronary artery lesion severity detected on coronary computed tomography angiography (CTA) and the hemoglobin A1c (HbA1c) value in nondiabetic patients with chronic coronary syndrome (CCS). Patients and methods: The retrospective observational study included 125 patients (64 males, 61 females; median age: 55 years; IQR, 46.5-63.0) who underwent coronary CTA with the diagnosis of CCS and applied between March 2020 and July 2022. Two groups were formed according to the severity of coronary artery lesion by coronary CTA: Group 1 (n=71), with &lt;70% coronary lesion severity, and Group 2 (n=54), with &gt;70% coronary lesion severity. Results: The two groups were similar in terms of median age, (p=0.09) and male sex ratios (47% vs. 55%, p=0.47). The HbA1c value in Group 2 was statistically significantly higher than in Group 1 [5.89 (5.43-6.15) vs. 5.42 (5.1-5.8), p=0.001]. The HbA1c cut-off value was determined as 5.66. The ideal HbA1c cut-off value, calculated by the Youden index, had a sensitivity of 64% and a specificity of 63% in predicting the severity of coronary artery lesions in nondiabetic patients with CCS. Conclusion: In nondiabetic patients with CCS, HbA1c is associated with the presence of severe CAD lesions detected in coronary CTA.