Severity Of Coronary Artery Lesions Research Articles

Association of lipoprotein (a) and in-hospital outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention

ABSTRACT Objective: The current study was to evaluate the association of Lipoprotein (a) [Lp(a)] and in-hospital outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods: ACS patients undergoing PCI were retrospectively enrolled. Based on Lp(a) level, patients were divided into low (<30 mg/dL) and high (≥30 mg/dL) Lp(a) groups. Results: Compared to those with low Lp(a), patients with high Lp(a) had larger numbers of coronary arteries ≥70% stenosis and had longer coronary artery lesion (P < 0.05). After adjustment for covariates, high Lp(a) remained associated with higher odds of having coronary artery ≥70% stenosis, type C coronary lesion and pre-PCI TIMI flow grade 1/0. Patients with high Lp(a) had a higher unadjusted odds of acute stent thrombosis (odds ratio [OR] 1.10 and 95% confidence interval [CI] 1.01–2.27), congestive heart failure (OR 1.24 and 95% CI 1.15–2.38) and composite in-hospital outcomes (OR 1.28 and 95% CI 1.18–2.42). After adjustment for covariates, patients with high Lp(a) still had a higher odds of congestive heart failure (OR 1.08 and 95% CI 1.01–1.78) and composite in-hospital outcomes (OR 1.12 and 95% CI 1.04–1.81). Conclusion: In ACS patients undergoing PCI, compared to those with low Lp(a), patients with high Lp(a) had more severe coronary artery lesion, higher risk of congestive heart failure and composite in-hospital outcomes.

Association of small dense LDL-cholesterol with disease severity, hypertension status and clinical outcome in patients with coronary artery disease.

Previous studies have demonstrated that small dense LDL-cholesterol (sdLDL-C) is related to the pathogenesis of coronary artery disease (CAD). However, its prognostic role in hypertensive patients with CAD has been undetermined. The aim of the study was to investigate the association between sdLDL-C with disease severity, hypertensive status and clinical outcome in patients with CAD. A total of 4594 patients with angiography-proven CAD were consecutively enrolled and categorized into subgroups according to blood pressure status. Serum sdLDL-C levels were measured by direct quantitative measurement using automated chemistry analyzers. The severity of coronary artery lesions were determined by Gensini score, Syntax score and the number of lesion vessels. The associations of sdLDL-C with disease severity, hypertensive status and cardiovascular events (CVEs) were evaluated. Patients with hypertension had higher sdLDL-C levels than ones without (P = 0.010). In hypertensive patients, sdLDL-C was positively associated with the severity of CAD (P < 0.05). In addition, hypertensive patients with poorly controlled hypertension had higher sdLDL-C levels than those with well controlled (P < 0.05). Moreover, 149 CVEs occurred in patients with poorly controlled hypertension and Cox regression analysis indicated that elevated sdLDL-C levels were independently associated with CVEs in hypertensive patients with poorly controlled hypertension (adjusted hazard ratio: 1.673, 95% confidence interval: 1.105-2.535, P = 0.015). The current data, for the first time, showed that serum sdLDL-C levels were correlated with hypertension control, disease severity and worse outcomes in hypertensive patients with CAD, suggesting that paying more attention on sdLDL-C in these patients were warranted.

NFKB1 gene rs28362491 ins/del variation is associated with higher susceptibility to myocardial infarction in a Chinese Han population

Myocardial infarction (MI), the leading cause of mortality and disability worldwide, is a disease in which multiple environmental and genetic factors are involved. Recently, researches suggested that insertion/deletion (ins/del) variation of NFKB1 gene rs28362491 is a functional polymorphism. In the present study, we aimed to explore the relation between variation of NFKB1 gene rs28362491 and MI by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) in 359 MI patients and 1085 control participants. Gensini score was used to evaluate the degree of coronary artery stenosis in MI patients. The plasma levels of interleukin-6 (IL-6), IL-8, malonaldehyde (MDA) and superoxide dismutase (SOD) were randomly measured by ELISA both in MI patients and control participants. We found that the detected frequencies of D allele (41.2% vs. 36.4%, P = 0.021) and DD genotype (17.5% vs. 12.0%, P = 0.022) were significantly higher in MI patients than in control participants. Compared with II or ID genotype carriers, the Gensini score in MI patients with DD genotype was 32–43% higher (both P < 0.001). Moreover, DD genotype carries had more diseased coronary arteries (P = 0.001 vs. II or ID genotype). Of note, IL-6 levels in MI patients carrying DD genotype were significantly higher than that in control participants and other genotype carriers in MI patients (both P < 0.05). In conclusion, NFKB1 gene rs28362491 DD genotype was associated with a higher risk of MI and more severe coronary artery lesion, which also had a potential influence on the level of inflammatory cytokine IL-6.

Exercise stress global longitudinal strain echocardiography can detect subclinical cardiac dysfunction and assist in risk stratification in children with Kawasaki disease: a 3-year follow-up study

Abstract Background Global longitudinal strain (GLS) echo has been regarded as a sensitive and reproducible indicator for detection of subclinical cardiac dysfunction in children with Kawasaki disease (KD), but whether it can assist in differentiating KD patients with different severity of coronary artery lesions (CALs) has been rarely reported. The purpose of this study was to determine the feasibility of GLS derived from rest and exercise stress echo in risk stratification in patients with KD. Methods 43 children with KD and 50 healthy controls were enrolled. KDs was divided into 3 groups according to the severity of CALs based on Z score, which was measured at the 3-year follow-up, G1 = KD without CALs (Z&amp;lt;2), G2 = KD with mild CALs (2≤Z&amp;lt;5), G3 = KD with severe CALs (Z≥5). Both group underwent echo at the onset of KD diagnosis and at the 3 years' follow-up, including: diameter of LA and LV, thickness of LVPW and IVS, LVFS, LVEF, and rest GLS (GLSrest). Both group also accomplished the exercise stress echo at the 3 years' follow-up, who squatted quickly to reach target heart rate and stress GLS (GLSstress) was recorded. Patients in G3 underwent a CMR examination, including LGE, to detect myocardial ischemia or infarction. Results 38 KDs and 50 HCs had normal exercise tolerance. There were 18, 8, and 12 patients in G1, G2, and G3, respectively. LA, LV, LVPW, IVS and LVEF, were not significantly different in the KDs at the onset and 3-year follow-up, and so did that between KDs and HCs (all p&amp;gt;0.05). Both GLSrest and GLSstress in the KDs were significantly decreased compared with HCs (GLSrest: −17.2±9.1% vs. −22.3±0.7%, p&amp;lt;0.01; GLSstress: −20.7±3.5% vs. −27.7±0.7%, p&amp;lt;0.01, seen in Fig.1A, B). However, there were no significant difference in GLSrest among 3 subgroups of KDs (G1: −18.0±10.0%; G2: −19.7±1.2%; G3: 14.4±10.4%; all p&amp;gt;0.05, seen in Fig.1C). GLSstress in the G3 decreased significantly compared with that in G1 and G2 (G3 vs. G1: −16.8±2.6% vs. −22.8±1.9%, p&amp;lt;0.01; G3 vs. G2: −16.8±2.6% vs. −22.1±2.5%, p&amp;lt;0.01, seen in Fig. 1D). GLSrest had no correlation with Z score (r=0.08, p=0.62), but GLSstress correlated well with Z score (r=0.70, p&amp;lt;0.01). 8 of 12 (67%) patients in the G3 underwent CMR and 6 of 8 (75%) were found endomyocardial enhancement on LGE, which indicated myocardial infarction corresponding to the territory of abnormal coronary arteries (seen in Fig. 2). Conclusions GLS derived from rest and exercise stress speckle-tracking echo can detect subclinical cardiac dysfunction in KD patients with normal LV systolic function by conventional measurements, but rest GLS could not assist in differentiating KD patients with different severity of CALs. Exercise stress GLS, which correlated well with Z score, has the potential in risk stratification in children with KD, and thus may provide prognostic value in multidisciplinary treatment strategy. Statistics and echo, CMR imaging Funding Acknowledgement Type of funding source: None

Patterns of coronary vascular involvement in patients with heart failure due to cardiac amyloidosis

Abstract Background Amyloidosis is a group of protein-folding disorders characterised by organ deposits, derived from one of several amyloidogenic precursor proteins. The involvement of coronary arteries has been previously described in amyloidosis, however the pattern of the disease in the coronaries is still unknown. Purpose The aim of this study is to characterise the pattern and severity of coronary artery lesions in cardiac amyloidosis. Methods We retrospectively compared patients with heart failure who tested positive (i.e. biopsy or gene tests – HF/CA+) against those that tested negative (HF/CA−) for cardiac amyloidosis. Groups were compared demographically and angiographically for qualitative and quantitative variables to determine patterns of involvement in the major epicardial coronary vessels. Results In total, 110 heart failure patients were included in the study, of whom 55 were HF/CA+ patients (88 lesions) and 55 were HF/CA− patients (66 lesions). Despite the advanced age in the HF/CA+, (74.53±11.02 vs 54.11±15.08; p=0.05), severe calcification was reported in HF/CA− group (4.5% vs to 0.0%; p=0.018). The HF/CA+ group also had fewer ostial lesions (3.4% vs. 15.15%, p=0.0095), reduced TIMI flow grade (83% vs 76%; p=0.21) and a higher TIMI frame count (30±12 Vs 27±11 frames; p=0.06). In the HF/CA+ group, compared to women, men had a significant number of tandem lesions (14.55% vs 0.0%, p=0.02). Men trended to have more ulcerations in comparison to women (9.09% vs 0.0%; p=0.15). Conclusion Overall, patients with HF/CA+ were older but found to have lesser calcified lesions, ostial involvement and a reduced anterograde blood flow. This is the first report outlining the coronary lesions in patients with HF/CA+. Funding Acknowledgement Type of funding source: None

Comparison of Patterns of Coronary Artery Disease in Patients With Heart Failure by Cardiac Amyloidosis Status

Background/purposeThe aim of this study is to characterize the pattern and the severity of coronary artery lesions in cardiac amyloidosis. MethodsWe retrospectively compared patients with heart failure who tested positive (i.e., biopsy or gene tests – HF/CA+) against those who tested negative (HF/CA−) for cardiac amyloidosis. Groups were compared demographically and angiographically for qualitative and quantitative variables to determine patterns of involvement in the major epicardial coronary vessels. ResultsThe study included 110 heart failure patients, of whom 55 patients (88 lesions) were in the HF/CA+ group, and 55 patients (66 lesions) were HF/CA−. Despite the advanced age of HF/CA+ patients (74.5 ± 11.0 years vs. 54.1 ± 15.0 years; p = 0.05), no severe calcification was found in the HF/CA+ group (0.0% vs. 4.5%; p = 0.018). The HF/CA+ group also had fewer ostial lesions (3.4% vs. 15.1%; p = 0.0095) and a higher, albeit not significant, Thrombolysis in Myocardial Infarction frame count (30.4 ± 12.6 vs. 26.6 ± 11 frames; p = 0.06). In the HF/CA+ group, men had a significant number of tandem lesions compared to women (14.5% vs 0.0%, p = 0.02). ConclusionsOverall, heart failure patients with cardiac amyloidosis were older but were found to have less calcified lesions, less ostial involvement, and a reduced anterograde coronary blood flow. This is the first report examining coronary lesions in heart failure patients with cardiac amyloidosis.

ASSOCIATION BETWEEN ERECTILE DYSFUNCTION AND SEVERITY OF CORONARY ARTERY DISEASE

Background: Erectile dysfunction (ED) is the most common sexual problem in men and defined as inability to attain or maintain a penile erection sufficient for successful vaginal intercourse. Erectile dysfunction is considered a primarily vascular disease in the majority of the cases. Numerous risk factors that contribute to the development and onset of ED are principal for the development of coronary artery disease (CAD). Objective: Documentation of the relation between erectile dysfunction and severity of coronary artery disease in patients presented with acute coronary syndrome focusing on the relation between onset of erectile dysfunction and onset of acute coronary ischemia. Patients and methods: This study included Egyptian patients admitted with acute coronary syndrome (ACS) with history of erectile dysfunction (ED), and underwent coronary angiography. They were subdivided into 3 groups: Group1 (control group G1, n= 30) which have a normal coronary angiography or non-atherosclerotic coronary artery disease, group 2 (G2, n= 36) which have a single coronary artery disease, group 3 (G3, n= 34) which have more than one coronary artery disease. Comparative study was done between three groups according to risk factors, comorbidities and severity of atherosclerotic coronary artery lesions according Gensini score, degree of erectile dysfunction which was assessed by international index of erectile function (IIEF) and penile artery duplex. Results: The total number of patients admitted with acute coronary syndrome (ACS) and diagnosed as erectile dysfunction patients according international index of erectile function (IIEF) was 36. The total number was 6 (20.0%) in the control group, 10 (27.8%) in the second group, 20 (58.8%) in the third group with a significant difference between groups. Comparison between results of penile artery duplex in our study groups was classified according to response to papaverine injection into either no erection, tumescence and rigidity not sufficient for intercourse, tumescence and rigidity sufficient for intercourse or full erection. There was no significant difference between groups. Conclusion: The recognition of ED was a warning sign of silent vascular disease. It has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise.

ASSOCIATION BETWEEN ERECTILE DYSFUNCTION AND SEVERITY OF CORONARY ARTERY DISEASE

Background: Erectile dysfunction (ED) is the most common sexual problem in men and defined as inability to attain or maintain a penile erection sufficient for successful vaginal intercourse. Erectile dysfunction is considered a primarily vascular disease in the majority of the cases. Numerous risk factors that contribute to the development and onset of ED are principal for the development of coronary artery disease (CAD). Objective: Documentation of the relation between erectile dysfunction and severity of coronary artery disease in patients presented with acute coronary syndrome focusing on the relation between onset of erectile dysfunction and onset of acute coronary ischemia. Patients and methods: This study included Egyptian patients admitted with acute coronary syndrome (ACS) with history of erectile dysfunction (ED), and underwent coronary angiography. They were subdivided into 3 groups: Group1 (control group G1, n= 30) which have a normal coronary angiography or non-atherosclerotic coronary artery disease, group 2 (G2, n= 36) which have a single coronary artery disease, group 3 (G3, n= 34) which have more than one coronary artery disease. Comparative study was done between three groups according to risk factors, comorbidities and severity of atherosclerotic coronary artery lesions according Gensini score, degree of erectile dysfunction which was assessed by international index of erectile function (IIEF) and penile artery duplex. Results: The total number of patients admitted with acute coronary syndrome (ACS) and diagnosed as erectile dysfunction patients according international index of erectile function (IIEF) was 36. The total number was 6 (20.0%) in the control group, 10 (27.8%) in the second group, 20 (58.8%) in the third group with a significant difference between groups. Comparison between results of penile artery duplex in our study groups was classified according to response to papaverine injection into either no erection, tumescence and rigidity not sufficient for intercourse, tumescence and rigidity sufficient for intercourse or full erection. There was no significant difference between groups. Conclusion: The recognition of ED was a warning sign of silent vascular disease. It has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise.

Uso de modelos de predicción de eventos cardiovasculares para pronóstico de lesión vascular coronaria significativa

ObjectivesTo determine the best cut-off point and the level of agreement of the Framingham, PROCAM, and Reynolds risk scales, for the diagnosis of a severe atherosclerotic coronary artery lesion by comparing the areas under the receiver operator characteristics (ROC) curves. MethodsA cross-sectional study was carried out on adults that were subjected to coronary angiography. The Framingham, PROCAM, and Reynolds were applied, with the first two adjusted to a Colombian calibration study. Data were collected concurrently in the institutions of reference in Cardiology and haemodynamics in Bogota. ResultsOf the 200 patients study, 66% were female, and 37.5% greater than 70 years-old. Hypertension was recorded in 53.2%, and overweight and obesity in 52.7%. Elevated levels of high sensitivity C-Reactive Protein (hsCRP) were observed in 61.5% of cases and 50% had at least one major coronary lesion greater than 70%. The best cut-off points according to each of the ROC curves: Adjusted Framingham, 5.8% (sensitivity, 80%, specificity, 41%), Adjusted PROCAM, 1.7% (sensitivity, 78%, specificity, 45%) and Reynolds, 3.8% (sensitivity, 68%, specificity, 45%). Additionally, the three areas under the curve (AUC) were 0.59, 0.59, and 0.57, respectively.

Anterior Tragal Crease Is Associated With SYNTAX Score in Non-ST-Segment Elevation Myocardial Infarction

The main aim of this study was to investigate the relation between anterior tragal crease (ATC) and coronary artery lesion complexity and severity assessed using the SYNTAX score (SXscore) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total of 121 patients with a first-time diagnosis of NSTEMI were consecutively enrolled. ATC was defined as ≥1 crease that was close to the tragus and descended anteriorly. SXscore was calculated using the SXscore algorithm. The SXscore was higher in the ATC-positive group than in the ATC-negative group (11.85 ± 8.20 vs 7.52 ± 6.38, P = .003). In the univariate analysis, hemoglobin (male: 11.7-17.4 g/dL, female: 11.7-16.1 g/dL; P = .006), diabetes mellitus (P = .031), current smoking (P = .022), and presence of ATC (P = .022) were significantly associated with increased SXscore. Multivariate analysis revealed ATC (95% confidence interval [CI]: 1.313-7.800, P = .011), current smoking (95% CI: 2.034-13.893, P = .001), and hemoglobin (95% CI: 0.433-0.822, P = .002) as independent determinants of increased SXscore. Anterior tragal crease is easily detected by physical examination. Presence of ATC in patients with NSTEMI may be a warning signal of complexity and severity of coronary artery disease (CAD).

Relationship between non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and coronary heart disease.

ObjectiveTo investigate the association between non–high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and degree of coronary artery stenosis proven by coronary angiography.MethodsA total of 1867 patients were enrolled into this study and analyzed retrospectively. Three hundred eighty-five non-coronary artery disease hospitalized patients were selected as control group, 1482 patients diagnosed as coronary artery disease were classified into three subgroups according to the tertiles of their SYNTAX score. We compared the level of non–high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio among the three subgroups. The Spearman correlation was used to analyze the correlation between non–high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and SYNTAX, logistic regression was used for analyzing independent predictors of coronary artery disease.ResultsThe level of non–high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio was higher in coronary artery disease group compared with non-coronary artery disease group (P < 0.01). The Spearman correlation analysis showed that non–high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were significantly correlated with SYNTAX score (r = 0.081, P < 0.001; r = 0.216, P < 0.001). In multivariate logistic regression analysis showed that non–high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were independent predictors of coronary artery disease (odds ratio = 3.645, 95% confidence interval, 1.267–10.486; OR = 2.096, 95% confidence interval, 1.438–3.054).ConclusionNon–high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were associated with the severity of coronary artery lesions, which can be used as a biomarker for the evaluation of severity of coronary artery disease.

Evaluation of coronary artery disease in patients with atrial fibrillation by cardiac computed tomography for catheter ablation: CADAF-CT trial

Almost all institutions routinely perform cardiac computed tomography (CT) before radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) to evaluate the cardiac anatomy. The ideal timing of the CT image acquisition is different between for RFCA of AF and for evaluation of coronary artery lesions (CALs). Thus, the aim of this study was to assess whether 64- or 320-line routine cardiac CT scans before RFCA of AF could evaluate both coronary artery lesions and pulmonary veins (LA-PVs) anatomy at the timing of the image acquisition of the LA-PVs in patients with AF who underwent RFCA of AF. The CALs were evaluated in 606 consecutive patients who underwent RFCA of AF assessed by the ideal timing of the CT image acquisition for RFCA of AF, and myocardial ischemia (MI) was also evaluated in patients with severe coronary stenosis (≥ 50%) and unevaluable CALs due to their severe coronary calcification and banding artifact by additional examinations combined with exercise stress testing, 201Tl scintigraphy, and/or fractionated flow reserve measurements. This study revealed that, in patients with AF who underwent RFCA of AF, (1) both 64- and 320-line cardiac CT scans for RFCA of AF could evaluate CALs in 93% of those patients, (2) the prevalence of MI was 9%, (3) significant relationships between the CHADS2 score and prevalence of MI were observed (p = 0.003), and (4) the positive predict values of MI in patients with severe coronary stenosis (≥ 50%) and unevaluable CALs also significantly increased in accordance with the CHADS2 score (p = 0.003). The evaluation of CALs and MI by routine cardiac CT for RFCA of AF combined with the additional examinations may be one of the most feasible modalities for patients with AF.

Advances in coronary artery bypass grafting for Kawasaki disease patients with severe coronary artery lesions

川崎病是儿童获得性心脏病的首要病因，主要并发症为冠状动脉扩张或冠状动脉瘤。因冠状动脉内膜增生或血栓性闭塞导致的缺血性心脏病是川崎病冠状动脉病变患儿远期死亡的主要原因。对于抗栓治疗无效的患儿，冠状动脉搭桥术是一种安全有效的治疗方式。现对合并严重冠状动脉病变的川崎病患儿应用冠状动脉搭桥术的治疗现状、手术指征、桥血管选择及预后进行综述。.

Ankle Brachial Index as Predictor of Coronary Artery Lesion Severity in Patients with Suspected Stable Coronary Artery Disease

Background: Atherosclerosis is a general process and can occur in coronary, peripheral, and aortic arteries. Traditional risk factors for atherosclerosis are gender, age, hypertension, diabetes, smoking, dyslipidemia, and family history. Atherosclerosis in the coronary arteries will develop into coronary artery disease (CAD). Angiography examination is the gold standard in CAD diagnosis. Lower extremity artery disease (LEAD) is part of peripheral artery disease (PAD) due to atherosclerosis and can be diagnosed using the ankle brachial index (ABI). The aim of this study was to predict the severity of coronary artery lesions in patients with suspected SCAD population with ABI.Method: This was a analytical observational study using cross sectional research design. Data was taken consecutively from affordable populations at the polyclinic of RSUP Dr. Sardjito for 2 periods in May 2017-August 2017 and August 2018-October 2018. Examination of ABI was performed before patients underwent angiography and ABI was divided into low ABI (≤0.90) and normal ABI (0.91-1.40). SS measurements based on video angiography were divided into severe (SS&gt; 22) and not severe (SS ≤22).Data were presented in categorical form and analyzed using SPSS 23. Confounding factors were then analyzed by bivariate test. If there was a confounding factor with a value of p &lt;0.25, it was followed by a multivariate test.Result: There were 35 subjects with low ABI and 71 subjects with severe lesions of 104 patients. The hypothesis test showed ABI increased the incidence of coronary lesion severity with PR 1.52 (1.21-1.93 with 95% CI) with a p value of 0.002. Bivariate tests show no confounding factors that increase the incidence of coronary lesion severity. Hypertension and dyslipidemia have a value of p &lt;0.25 so multivariate analysis is performed. The results of multivariate analysis were only that ABI increase the incidence of coronary lesion severity (p= 0.004).Conclusion: A low ABI value will increase the incidence of coronary atherosclerosis lesion by 1.52 times in patients with suspected SCAD

Associations between bone mineral density and coronary artery disease: a meta-analysis of cross-sectional studies

The clinical association of coronary artery disease (CAD) with bone mineral density (BMD) has been increasingly reported, but findings on the relationship between the two age-related processes are conflicting. The aim of our study was to conduct a meta-analysis to evaluate the associations between CAD and BMD. We searched PubMed, Embase, and Cochrane Library. Odds ratio (OR) and 95% confidence interval (CI) were pooled to assess the association between low BMD and the prevalence of CAD. For continuous data, standardized mean difference (SMD) with its 95% CI was pooled. Correlation coefficients of BMD and Gensini score were pooled after being transformed by Fischer z-transformation. Subgroup and meta-regression analyses were performed to explore the sources of heterogeneity. The meta-analysis involved 4170 participants from 11 studies. Pooled ORs for the incidence of CAD in patients with low BMD versus patients with normal BMD was 1.58 (95% CI 0.99-2.52, P = 0.06), and no statistical difference was found in men and women subgroups. After confounding age, the combined OR was 1.60 (95% OR 0.69-3.72, P = 0.27). Pooling data for comparing BMD of CADs and non-CADs were - 0.28 (95% CI - 0.47 to - 0.09, P = 0.004) in femoral neck and calcaneus, - 0.42 (95% CI - 0.89-0.05, P = 0.08) in lumbar spine, and - 0.25 (95% CI - 0.40 to - 0.11, P = 0.000) in the overall. A significance was detected in pooled correlation analysis between CAG Gensini score and BMD (COR = - 0.4435 [- 0.6647; - 0.1508], P = 0.004). No sources of heterogeneity were acquired, and no publication bias was identified. Low BMD was not associated with the prevalence of CAD. Without age adjustment, the BMD of CADs is significantly lower than that of non-CADs, and the patients with lower BMD are inclined to more severe coronary artery lesions.

Serum VEGF: Diagnostic Value of Acute Coronary Syndrome from Stable Angina Pectoris and Prognostic Value of Coronary Artery Disease.

Background Although the level of serum vascular endothelial growth factor (VEGF) is elevated in coronary artery disease (CAD) patients, its potential role in acute coronary syndrome (ACS) or stable angina pectoris (SAP) patients remains unclear. Objectives To evaluate diagnostic accuracy of serum VEGF in determining ACS patients from SAP and analyze the association of serum VEGF with coronary artery lesions in SAP or the GRACE score in ACS, which is involved in the poor prognosis of low serum VEGF. Methods 248 CAD patients and 48 healthy subjects were enrolled in this study. Serum VEGF levels were detected by using ELISA. The Gensini score or GRACE score was calculated among SAP or ACS patients. All the patients were followed up for a period of 12 months (mean: 10.77 months). Results VEGF serum concentrations were higher in the ACS subgroup than in the SAP subgroup (P < 0.001) with diagnostic accuracy of ACS from SAP (AUC: 0.667, sensitivity: 68.5%, specificity: 60.1%, P < 0.001). Patients with high risk of Gensini score showed reduced VEGF levels (P < 0.001) accompanied by a negative correlation (r = −0.396, P < 0.001). Patients with a higher GRACE score indicated lower VEGF levels (P < 0.001). Low serum VEGF was one of the potential risk factors with adjusted HR of 0.531 (P=0.048). Conclusion Serum VEGF exhibits efficient diagnostic value for detection of ACS from SAP with a cutoff value of 648.75 pg/mL. Low serum VEGF indicates severe coronary artery lesions and a higher GRACE score, which suggests poor clinical outcomes.

Elevated 1-h postload plasma glucose levels identify coronary heart disease patients with greater severity of coronary artery lesions and higher risk of 1-year re-admission.

Objective:To investigate the relationship of 1-h postload plasma glucose during the oral glucose tolerance test with the severity of coronary artery lesions and risk of 1-year re-admission in coronary heart disease patients with normal glucose tolerance.Methods:A total of 266 consecutive coronary heart disease patients who underwent coronary angiography and had normal glucose tolerance confirmed by oral glucose tolerance test during hospitalization were prospectively enrolled and followed in two groups according to the 1-h postload plasma glucose cut-off point (1-h postload plasma glucose <155 mg/dL, n = 149 and 1-h postload plasma glucose ⩾155 mg/dL, n = 117). Angiographic severity was assessed by number of diseased vessels, lesion morphology and Gensini score. The risk of 1-year re-admission with adverse cardiovascular events after discharge was analysed.Results:Subjects with a 1-h postload plasma glucose ⩾155 mg/dL had higher incidence of multivessel disease and complex lesions, Gensini score and risk of 1-year re-admission than subjects with a 1-h postload plasma glucose <155 mg/dL (all p < 0.05). In the stepwise multivariate regression analysis, 1-h postload plasma glucose was the major determinant of the Gensini score. Subgroup analyses by sex showed that men with a 1-h postload plasma glucose ⩾155 mg/dL had higher incidence of complex lesions and risk of 1-year re-admission than men with a 1-h postload plasma glucose <155 mg/dL (all p < 0.05).Conclusion:Coronary heart disease patients with normal glucose tolerance and elevated 1-h postload plasma glucose levels had a greater severity of coronary artery lesions and an increased risk of re-admission with adverse cardiovascular events, particularly in men.

Prognostic Value of Endothelin-1 Level in Diabetic Patients with Coronary Artery Disease

Objective: The aim of this work is to study the prognostic value of the plasma level of the new marker, endothelin-1 (ET-1), in diabetic patients with coronary artery disease. Background: Endothelin 1 (ET-1) has been demonstrated to play a role in endothelial dysfunction and inflammation, both of which are actively involved in the pathophysiology of the onset and progression of coronary artery disease (CAD). Diabetes mellitus increases the risk of CAD and has unfavorable effects on the vascular endothelium, hence the importance of assessing this plasma marker and its relation to the severity of CAD in diabetic patients. Patients & method: This is a cross sectional study in which data was collected from January 2019 to December 2019 and was carried out on patients selected from catheterization laboratory, faculty of medicine, Minoufia university hospital, Egypt. A total of seventy patients, 35 diabetics (groupI, GI) and 35 non-diabetics (groupII, GII), with coronary artery lesions of not less than 50% in at least one main coronary artery plus twenty patients with normal coronaries as a control group (groupIII, GIII) were enrolled. The severity of coronary artery lesions were assessed by GINSINI score (GS) and the relationship between ET-1 level and GS was evaluated. Results: The ET-1 levels were significantly higher in GI with higher GS values of 34.29+ 11.7 points and SYNTAX scores of 18.4+11.17 points, than in GII with lower GS values of 23.23+8.14 points and SYNTAX of scores 12.06+12.11 points (ET-1 was 187.93+146.61 ng/L in GI versus 76.30+91.83ng/L in GII, P value=0.001). ET-1 levels were significantly higher in GI than in GIII (187.93+146.61ng/L versus 26.16+7.32 ng/L, P value=0.001). ET-1 levels were significantly higher in GII than in GIII (76.30+91.83 ng/L versus 26.16+7.32 ng/L, P value=0.001). Conclusion: There is a positive correlation between DM and both ET-1 levels and the severity of coronary artery lesions, P value 0.001.

Evaluation of hyperglycemia at admission as a marker of severity of coronary lesions in non-diabetic patients with myocardial infarction

High blood glucose (HBG) at admission is a major common metabolic disorder in patients with acute myocardial infarction (MI). However, only few data have examined its predictive performance over established risk score. The aim of our study was to determine the correlation between hyperglycemia at admission in non-diabetic patients and the severity of coronary artery lesions evaluated by the Synthax score. We conducted a cross-sectional study including all the patients admitted for MI in the cardiology intensive care unit of Casablanca from june 2018 to february 2019. The population was divided into 2 groups: hyperglycemia (glycemia at admission > 1.10 g/l) and non-hyperglycemia (< 1.10 g/l) regardless of previous diabetic status. The primary composite endpoint (all-cause death and non-fatal MI) was compared between the two groups. A total of 193 patients were included. A total of 63.4% presented with hyperglycemia on admission, 89% were over 65 years. There were significant differences in baseline clinical status established by calculating CHADSVASC score (2.60 ± 1.54 vs 1.5 ± 1.05; P = 0.01). Biological status differed significantly between the 2 groups especially troponine Ic, LDL cholesterol and triglyceride which were higher in HBG patients (32.20 ± 63.93 vs. 17.64 ± 31.16 P = 0.014; 0.94 ± 0.33 vs. 0.87 ± 0,27 P = 0.015; 1.45 ± 0.67 vs. 1.16 ± 0.42 P = 0.04 respectively). SYNTAX score was higher in the hyperglycemia group 11.21 ± 8.377 vs. 7.50 ± 8.782 P = 0.03. A multivariate analysis showed that hyperglycemia on admission was an independent predictor of severity of coronary artery lesions and was significantly associated with long-term clinical outcomes. In non-diabetic patients with MI, hyperglycemia on admission was predictive of coronary artery lesions’ severity and was associated with poor long-term clinical outcomes. Further study is needed to evaluate specific therapeutic strategies to prevent cardiovascular events occurring in these patients.

冠心病患者血清ANGPTL6水平及其与冠脉病变严重程度的关系

冠心病患者血清ANGPTL6水平及其与冠脉病变严重程度的关系