Single-vessel Disease Group Research Articles

Predictive factors for multivessel disease in patients with acute coronary syndrome: analysis from the CCC-ACS project in China

BackgroundMultivessel disease(MVD) is linked to a poorer prognosis, increased complications, longer hospital stays, and higher in-hospital mortality when compared to single-vessel disease(SVD).The purpose of this study is to explore the clinically relevant predictors of acute cornary syndrome (ACS) combined with MVD.MethodsThis multicenter retrospective study included 68,378 ACS patients from 240 hospitals.The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the predictive factors for MVD.ResultsWhen compared to SVD group, the MVD group showed a higher incidence of Major Adverse Cardiovascular Events(MACCEs), including all-cause death, myocardial infarction, stent thrombosis, and ischemic stroke during hospitalization, These differences were found to be statistically significant (P < 0.05) .The multivariate analysis revealed that age over 75 years (OR: 1.246, 95% CI: 1.176, 1.319), LDL/HDL ratio > 1.98 (OR: 1.245, 95% CI: 1.192, 1.302), history of heart failure (OR: 1.446, 95% CI: 1.143, 1.829), hypertension (OR: 1.274, 95% CI: 1.225, 1.325), diabetes (OR: 1.341, 95% CI: 1.278, 1.406), eGFRs < 60 ml/min·1.73m2 (OR: 1.179, 95% CI: 1.112, 1.249), family history of CAD (OR: 1.236, 95% CI: 1.108, 1.379), and high homocysteine levels (OR: 1.209, 95% CI: 1.029, 1.420) are independent predictors of MVD. The incidence of multivessel disease increased from 37.7 to 58.6% with an increase in the number of predictive factors, while the incidence of single vessel disease decreased from 62.3 to 41.4%. This trend was statistically significant (P trend < 0.001).ConclusionsMVD is strongly correlated with a range of risk factors including diabetes, hypertension, LDL/HDL ratio greater than 1.98, hyperhomocysteinemia, family history of CAD, reduced glomerular filtration rate (< 60 ml/(min·1.73m2), age over 75 years, and a history of heart failure. Furthermore, as the number of predictive factors increases, the odds ratio (OR) for patients with MVD also increases, reaching 2.344 times the OR for patients without any predictive factors.

Noninvasive cardiac-specific biomarkers for the diagnosis and prevention of vascular stenosis in cardiovascular disorder.

The most frequent lesion in the blood vessels feeding the myocardium is vascular stenosis, a condition that develops slowly but can prove to be deadly in a long run. Non-invasive biomarkers could play a significant role in timely diagnosis, detection and management for vascular stenosis events associated with cardiovascular disorders. The study aimed to investigate high sensitivity troponin I (hs-TnI), cardiac troponin I (c-TnI) and high sensitivity C-reactive protein (hs-CRP) that may be used solely or in combination in detecting the extent of vascular stenosis in CVD patients. 274 patients with dyspnea/orthopnea complaints visiting the cardiologists were enrolled in this study. Angiographic study was conducted on the enrolled patients to examine the extent of stenosis in the five prominent vessels (LDA, LCX, PDA/PLV, RCA, and OM) connected to the myocardium. Samples from all the cases suspected to be having coronary artery stenosis were collected, and subjected to biochemical evaluation of certain cardiac inflammatory biomarkers (c-TnI, hsTn-I and hs-CRP) to check their sensitivity with the level of vascular stenosis. The extent of mild and culprit stenosis was detected during angiographic examination and the same was reported in the form significant (≥50% stenosis in the vessels) and non-significant (<50% stenosis in the vessels) Carotid Stenosis. Ethical Clearance for the study was provided by Dr. Ram Manohar Lohia Institute of Medical Sciences Institutional Ethical Committee. Informed consent was obtained from all the participants enrolled in the study. We observed that 85% of the total population enrolled in this study was suffering from hypertension followed by 62.40% detected with sporadic episodes of chest pain. Most of the subjects (42% of the total population) had stenosis in their LAD followed by 38% who had stenosis in their RCA. Almost 23% patients were reported to have stenosis in their LCX followed by OM (18% patients), PDA/PLV (13%) and only 10% patients had blockage problem in their diagonal. 24% of the subjects were found to have stenosis in a single vessel and hence were categorized in the Single Vessel Disease (SVD) group while 76% were having stenosis in two or more than two arteries (Multiple Vessel Disease). hs-TnI level was found to be correlated with the levels of stenosis and was higher in the MVD group as compared to the SVD group. hs-TnI could be used as a novel marker as it shows prominence in detecting the level of stenosis quite earlier as compared to c-TnI which gets detected only after a long duration in the CVD patients admitted for angiography. hs- CRP gets readily detected as inflammation marker in these patients and hence could be used in combination with hs-TnI to detect the risk of developing coronary artery disease.

Impact of multivessel coronary artery disease on early and late clinical outcome in ST-Segment elevation myocardial infarction patients who underwent percutaneous coronary intervention: insight from Indonesia

It is estimated that 15 people for every 1000 Indonesian residents suffer from cardiovascular disease (CVD) including ST-segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is often performed in patients with STEMI. Several factors affect clinical outcome after PCI procedure including multivessel coronary artery disease. This study aimed to measure the impact of multivessel coronary artery disease on the early and late outcomes of STEMI patients undergoing PCI procedures. This was a prospective cohort study on STEMI patients undergoing PCI procedures from the period of August to December 2021. Two expected cohorts were performed i.e. patients who suffered from single-vessel disease (SVD) and patients who suffered from multivessel disease (MVD). Forty six patients with STEMI were enrolled in this study consisting of 24 (52.17%) patients with MVD and 22 (47.83%) patients with SVD. No significant difference in baseline characteristics between MVD and SVD groups was observed (p &gt; 0.05). The MVD group (91.67%) used a more radial percutaneous approach compared with the SVD group (54.55%; p = 0.04). In addition, no significant difference between the SVD group and the MVD group in major adverse cardiovascular events (MACE) and echocardiographic outcome after 90-d follow up was observed (p &gt; 0.05). In conclusion, MVD has similar impacts on early and late clinical outcomes compared with SVD in STEMI patients undergoing PCI procedures.

The Regulatory Variant -108C/T in the Promoter of Paraoxonase 1 (PON1) Gene has a More Important Role in Regulating PON1 Activity Compared to rs3735590 in 3'-UTR in Patients with Coronary Artery Disease.

This study aimed to assess the serum activity of paraoxonase 1 (PON1) in patients with coronary artery disease (CAD) based on two genetic variants including the -108C/T variant in the promoter region and the rs3735590 variant in the binding site of miR-616 at the 3'-UTR of the PON1 gene. A total of 140 subjects who exhibited clinical symptoms of CAD underwent diagnostic coronary angiography. The patients with CAD were further categorized into two groups: single-vessel disease (SVD) and multi-vessel disease (MVD). The study variants were genotyped using the restriction fragment length polymorphism (RFLP) technique after polymerase chain reaction amplification. After adjusting for age, gender, body mass index, metformin, and statin usage, a significant association was observed between the -108C/T variant and PON1 activity (P < 0.001). In the sub-groups of both SVD and MVD, individuals with the TC+CC genotypes exhibited significantly higher PON1 activity compared to TT homozygotes (P = 0.001 for SVD and P = 0.01 for MVD). As for the rs3735590 variant, individuals with the A allele (GA+AA genotypes) had higher PON1 activity compared to those with the GG genotype in both the SVD and MVD groups, although the results did not reach statistical significance. Our study findings indicate a significant decrease in PON1 activity among patients with obstructive CAD. Notably, our results suggest that the -108C/T variant exerts a greater influence on PON1 activity compared to the rs3735590 variant. These findings highlight the crucial role of the -108C/T variant in modulating PON1 activity within the context of atherosclerosis.

Mortality Associated with the Number of Diseased Vessels and Therapeutic Strategies for Coronary Artery Disease: Long-Term Follow-Up

Background: The number of coronary arteries affected by atherosclerosis is believed to impact the prognosis of coronary artery disease, resulting in a higher incidence of cardiac events. However, conclusive results on the relationship between the extent of coronary atherosclerosis and outcomes are lacking. Methods: This retrospective, single-center, observational cohort study included patients with stable coronary artery disease and preserved ventricular function who had the option of any of the three therapeutic strategies (medicine, angioplasty, or surgery) included in the MASS-Trials database. Patients were stratified according to the number of diseased arteries forming single-vessel, double-vessel, and triple-vessel disease groups. The atherosclerotic burden was assessed using the SYNTAX Score. Each group was eligible for any of the three therapeutic strategies. The primary endpoint was overall mortality. Secondary endpoints included the combination of all-cause death, nonfatal myocardial infarction, and additional coronary interventions. Results: Between May 1998 and June 2009, 2,000 patients who met the inclusion criteria in the MASS-Trial database were included. The study enrolled 1,855 patients. Of these, 224(12%) had single-vessel disease (SVD), 536(29%) had double-vessel disease (2VD), and 1,095(59%) had triple-vessel disease (3VD). The entire follow-up of our sample was 5 years. Overall mortality for SVD, 2VD, and 3VD was 9(4%), 33(6.3%), and 43(3.9%), respectively (P=0.054). Pairwise comparison of mortality at 5-year follow-up showed no significant differences between SVD x 2VD, SVD x 3VD, and 2VD x 3VD (hazard ratio [HR] 1.41, 95% CI: 0.81-2.44). The secondary endpoints (combination of overall mortality, nonfatal infarction, and additional revascularization) also revealed no significant differences (P=0.2). Conclusions: Overall mortality was similar regardless of the number of diseased arteries and the degree of arterial involvement. These data suggest that optimized medical treatment as an initial strategy is safe and has a similar rate of events in any applied therapeutic option.

Impact of sex difference on clinical outcomes in acute myocardial infarction patients with single-vessel and multi-vessel disease: based on Korea Acute Myocardial Infarction Registry-National Institute of Health.

Several studies have compared clinical outcomes according to sex in patients with acute myocardial infarction (AMI). However, studies evaluating sex differences in clinical outcomes of single-vessel disease (SVD) and multi-vessel disease (MVD) in Korean patients with AMI are lacking. Therefore, this study aimed to analyze sex differences in the clinical characteristics of patients with AMI with SVD and MVD and to evaluate the impact of sex differences on the clinical outcomes in patients with AMI with SVD and MVD. A total of 11,002 AMI patients from November 2011 to June 2015 in the Korea AMI Registry, National Institute of Health, were enrolled. The current study was retrospective observational study. Patients were divided into SVD (n=5,644) and MVD (n=5,358) groups, and clinical impact of sex difference were analyzed by propensity score matching analysis and Cox proportional hazard regression model. Women were older and had poor baseline clinical characteristics than men. Propensity score-matched analysis of men and women with SVD and MVD revealed that the adjusted 3-year risk of major adverse cardiac event (MACE) (15.0% vs. 9.4%; hazard ratio, 1.86; 95% confidence interval, 1.10-3.13; P=0.020) was higher in women with SVD aged <65 years. However, the incidence and risk of MACE were similar for men and women with MVD, and those with SVD aged ≥65 years. In the present study of Korean patients with AMI, women were older and exhibited a higher prevalence of comorbidities than men. Women with SVD aged <65 years had a significantly higher risk of MACE.

Abstract 15840: Comparison of Risk Factors for Single, Double, and Multivessel Coronary Artery Disease in a Cohort Undergoing Coronary Revascularization

Introduction: Hypertension (HTN), dyslipidemia (HLD), smoking, obesity, and diabetes (DM), peripheral arterial disease (PAD) are known risk factors for coronary artery disease (CAD). However, it is not clear if one risk factor is related to causing higher plaque burden than others. We attempted to find relationship of these risk factors with number of occluded coronary arteries (&gt;50% stenosis) to assess plaque burden. Methods: Retrospective analysis of patients admitted to a tertiary care center undergoing coronary revascularization (PCI or CABG) for acute myocardial infarction (AMI) from May 2019 - May 2021. Patients were classified based on the number of occluded coronary vessels: single vessel disease (SVD), 2 vessel disease (2VD), and &gt;2 or multivessel disease (MVD). CAD risk factors were analyzed. CAD burden was assessed by number of vessels showing &gt;70% stenosis angiographically. The relationship between CAD risk factors and CAD burden was analyzed via univariate and multivariate analysis. Results: A total of 434 patients were included. Mean age was 56 ± 11 years with 61% Caucasians, 33% African Americans (AA), and 6% Hispanics. Females were 39.4%. Patients with SVD, 2VD, and MVD, were 264 (60.8%), 101 (23.3%) and 69 (16%) respectively. Smoking and diabetes were more prevalent in SVD group, while AA race was associated with higher incidence of MVD (table 1). HTN, HLD, diabetes, obesity, smoking, PAD, CKD were statistically similar with respect to CAD burden. On multivariate analysis, AAs {OR 0.13 [0.07-0.23]} and Hispanics {OR 0.22 [0.09-0.54]} had a lower prevalence of SVD compared to Caucasians. AA had higher odds of MVD {6.2 [2.9-12.9]} shown in table 2. Mortality was higher in MVD group compared to SVD (24.6% vs. 40.6%, p=0.01). Conclusions: African American patients had a higher CAD burden when presenting with AMI. HTN, HLD, diabetes, obesity, PAD, smoking and CKD were statistically similar when compared for CAD burden.

Are P-glycoprotein (ABCB1/MDR1) and endothelial nitric oxide synthase (eNOS) polymorphisms related to severity of the coronary artery disease?

Background/Aim: Atherosclerotic cardiovascular disease is one of the most common causes of morbidity and mortality in developed countries. Genetic and environmental factors are associated with atherosclerosis development. Some single nucleotide polymorphisms have also been directly related to atherosclerosis, for example, polymorphisms that reduce nitric oxide (NO) levels and/or activity have been linked to atherosclerotic diseases. However, the multidrug resistance gene 1 (MDR-1) polymorphism is related to repeated cardiovascular events. This study aimed to investigate the relationship between MDR-1 and endothelial NO synthase (e-NOS) polymorphism and severe coronary artery disease (CAD). Methods: In total, 90 patients presenting with acute coronary syndrome were included in this cross-sectional study. Patients with at least > 70% stenosis in ≥ 2 coronary vessels were defined as severe CAD (Group 1), while those with this same level of involvement in < 2 vessels were diagnosed with single-vessel disease (Group 2). MDR 3435C-T and eNOS T-786C were determined by polymerase chain reaction (PCR) amplification. Comparison of parametric and nonparametric values between the two groups was performed using the Student’s t- or Mann–Whitney U test. Categorical variables were analyzed using the χ2 test. Risk estimations for the association of severe CAD with the polymorphisms were calculated using odds ratio (OR) and 95% confidence intervals by comparing the genotypic combinations. Results: Baseline demographic parameters were similar in both groups, except for the presence of DM and glucose level. T allele of MDR was 42% and 40% in groups 1 and 2, respectively (OR = 1.12). The C allele of eNOS was 34% and 30% in groups 1 and 2, respectively (OR = 1.16). Fourteen and 15 patients (40% and 27%, respectively) had both T and C alleles in patients in groups 1 and 2, respectively (OR = 1.77). All P-values were > 0.05. Conclusion: This study is the first one that shows that MDR1 and e-NOS polymorphisms are frequent in patients with ≥ 2 vessel disease and may be associated with severe CAD.

Elevated lipoprotein(a) and genetic polymorphisms in the LPA gene may predict cardiovascular events

Elevated lipoprotein(a) [Lp(a)] is a risk factor for coronary heart disease (CHD), but there are few studies on the prediction of future cardiovascular events by Lp(a) and its LPA single nucleotide polymorphisms (SNPs). The aim of this study was to investigate whether elevated Lp(a) and its SNPs can predict cardiovascular events. We evaluated whether Lp(a) and LPA SNPs rs6415084 and rs12194138 were associated with the incidence rate and severity of CHD. All participants were followed up for 5 years. Elevated Lp(a) is an independent risk factor for the risk and severity of CHD (CHD group vs. control group: OR = 1.793, 95% CI: 1.053–2.882, p = 0.043; multiple-vessel disease group vs. single-vessel disease group: OR = 1.941, 95% CI: 1.113–3.242, p = 0.027; high GS group vs. low GS group: OR = 2.641, 95% CI: 1.102–7.436, p = 0.040). Both LPA SNPs were risk factors for CHD, and were positively associated with the severity of CHD (LPA SNPs rs6415084: CHD group vs. control group: OR = 1.577, 95% CI: 1.105–1.989, p = 0.004; multiple-vessel disease group vs. single-vessel disease group: OR = 1.613, 95% CI: 1.076–2.641, p = 0.030; high GS group vs. low GS group: OR = 1.580, 95% CI: 1.088–2.429, p = 0.024; LPA SNPs rs12194138: CHD group vs. control group: OR = 1.475, 95% CI: 1.040–3.002, p = 0.035; multiple-vessel disease group vs. single-vessel disease group: OR = 2.274, 95% CI: 1.060–5.148, p = 0.038; high GS group vs. low GS group: OR = 2.067, 95% CI: 1.101–4.647, p = 0.021). After 5 years of follow-up, elevated Lp(a) and LPA SNPs rs6415084 and rs12194138 can independently predict cardiovascular events. The increase of serum Lp(a) and LPA SNPs rs6415084 and rs12194138 are associated with increased prevalence and severity of CHD, and can independently predict cardiovascular events.

The relationship between arterial stiffness index and coronary heart disease and its severity

BackgroundArterial stiffness index (ASI) is closely related to coronary atherosclerosis. This study aims to explore whether ASI can predict coronary heart disease (CHD) and its severity.MethodsIn this study, a total of 726 patients with suspected CHD were recruited. Based on coronary angiography results, the subjects were assigned into three groups: the control group (without obvious coronary artery disease), single-vessel disease group, and multi-vessel disease group (the number of vessels diseased ≥ 2). At the same time, according to the results of angiography, myocardial enzyme spectrum, electrocardiogram, color Doppler echocardiography and clinical manifestations, these patients were divided into four groups: the control group, stable angina (SA) Group, unstable angina (UA) group, and acute myocardial infarction (AMI) group. We have compared whether there were differences in ASI and related baseline data between groups. Receiver operating curve (ROC) analysis was conducted to determine whether ASI could predict CHD and evaluate the severity.ResultsASI was positively correlated with the number of diseased branches of coronary artery. The value of ASI was increased as the number of the diseased branches increased. The ASI value in the SA group was significantly higher compared with the control group. Furthermore, the ASI value in the UA and AMI groups was remarkably increased compared with the control and SA groups. The results of ROC analysis indicated that the sensitivity and specificity of ASI was 71.0% and 85.4% in diagnosing CHD, respectively. While ASI was used in predicting the severity of CHD, the sensitivity was 72.1% and specificity 57.9%.ConclusionASI is of great value in the diagnosis of coronary heart disease and the prediction of its severity.

Association of Serum Asymmetric Dimethylarginine with the Severity of Coronary Artery Disease: A Pilot Study.

Asymmetric dimethylarginine (ADMA), an inhibitor of nitric oxide synthase (NOS), has been implicated in endothelial dysfunction and atherogenesis. Though there is much evidence linking ADMA with atherosclerosis and adverse cardiovascular events, only a few studies have established the independent relationship between elevated ADMA and the angiographic extent of coronary artery disease (CAD). The aim of the study was to analyze serum ADMA levels in patients with varied extent and severity of coronary atherosclerosis and to see whether the levels of ADMA in male and female participants vary significantly. We analyzed 40 individuals with obstructive CAD, including men and women, between the ages of 30 and 60. According to their coronary angiographic reports, the participants were divided into four groups: minor CAD, single vessel disease (SVD), double vessel disease (DVD) group and triple vessel disease (TVD). Then, serum ADMA levels was measured and compared among these groups. ADMA level was significantly higher in patients with TVD (167.74±16.69) than those in the DVD (159.46±10.40), SVD (149.54±16.39) and minor CAD (144.5± 24.16) group (p-value= 0.0001). There was no significant difference in ADMA levels between male and female participants (p= 0.534). ADMA concentration in the serum may be useful in identifying whether CAD correlates significantly to the extent and severity of coronary atherosclerosis.

Long-term survival of carotid stenting patients with regard to single- or double-vessel carotid artery disease: a propensity score matching analysis.

IntroductionThere is lack of long-term data outside of controlled clinical trials in carotid artery stenting (CAS). In this study, we compared the short-term outcome, long-term survival, and rate of re-interventions for restenosis in patients after CAS, related to the extent of carotid atherosclerosis classified as single-vessel (unilateral) or double-vessel (bilateral) carotid artery disease.Material and methodsWe retrospectively evaluated 599 patients with significant carotid artery stenosis, who underwent 763 CAS procedures, and used the propensity score to match 226 pairs (452 patients) in the single- or double-vessel carotid disease.ResultsThere was no significant difference in the occurrence of in-hospital major adverse events (3.5% vs. 3.1% of patients in the double-vessel carotid group vs. the single-vessel carotid group; p = 1) The mean follow-up was 6.1 ±4.0 years, and a total of 181 (40%) deaths occurred during 2759 patient-years, which translates into 7.8 and 5.3 deaths per 100 patient-years in the double-vessel carotid group and the single-vessel carotid group, respectively (p < 0.01). The survival in the double-vessel carotid group vs. the single-vessel carotid group at 10 years was 46% (95% CI: 38–54%) vs. 55% (95% CI: 47–63%) (p < 0.01). Twenty-four (11%) patients and 6 (3%) patients underwent re-interventions for restenosis in the double-vessel and the single-vessel carotid disease group, respectively (p < 0.01).ConclusionsPatients with CAS and significant double-vessel carotid artery disease had similar peri-procedural risk, but had a worse long-term survival, and a higher rate of re-interventions for restenosis compared to the single-vessel carotid artery disease patients.

English

BACKGROUND Reduced heart rate variability (HRV) is associated with an increased risk of cardiovascular morbidity and mortality. The aim of the study was to determine whether reduced HRV is predictive of angiographic coronary artery disease (CAD) METHODS This study was done among 71 clinically stable subjects who underwent elective coronary angiography for diagnosis or pre-operative evaluation. High frequency (HF; 0.15 – 0.40 Hz), low frequency (LF; 0.04 – 0.15 Hz), LF / HF ratio, total power ≤ 0.4 Hz were used as the conventional indices of HRV. Analysis of variance (ANOVA) and chi square test was used to assess the statistical analysis. Statistical significance analysis was carried out with International Business Machines Statistical Package for the Social Sciences (IBM SPSS) version 22. RESULTS Out of 71 subjects, only 58 were available for final analysis. 20 subjects had normal coronary arteries, 19 had single vessel disease and remaining 19 had multi vessel disease. The HF power of HRV showed decreasing trend as the severity of angiographic stenosis increased. The median values of LF power for single vessel disease and multi vessel disease were 148 ms2 and 160 ms2 respectively. The group without coronary artery disease has a median of 215 ms2 for LF power. The median HF power was lower in single vessel disease group (133 ms2 ) compared to group with normal coronaries (139 ms2 ) and it was very low in multi vessel disease (81 ms2 ) group compared to group with normal coronaries. CONCLUSIONS A weak association of HF and LF power of HRV with degree of angiographic stenosis was observed. KEYWORDS Heart Rate Variability, Coronary Angiogram, Angiographic Stenosis

Diagnostic Values of Epicardial Adipose Tissue Thickness with Right Common Carotid Artery Elasticity and Intima-Media Thickness for Middle-Aged and Elderly Patients with Coronary Heart Disease.

BackgroundCoronary heart disease (CHD) is the most common cardiovascular disease which greatly threatens the health of middle-aged and elderly people.ObjectiveTo explore the correlations of epicardial adipose tissue (EAT) thickness with right common carotid artery elasticity and intima-media thickness (IMT) in middle-aged and elderly patients with CHD by ultrasound.MethodsA total of 132 patients diagnosed with CHD by coronary angiography (CAG) from February 2019 to August 2020 were enrolled and divided into single-vessel disease group (n=38), double-vessel disease group (n=52), and three-vessel disease group (n=42), and 52 healthy subjects were selected as control group. Their general data, biochemical indices, EAT thickness, right common carotid artery elasticity indices, and IMT were compared. The correlations of EAT thickness with right common carotid artery elasticity indices and IMT were studied by Pearson’s analysis. The predictive values of EAT thickness and IMT for CHD were analyzed by receiver operating characteristic curves.ResultsWith increasing number of diseased branches, EAT thickness, stiffness parameters β (β), strain elastic modulus (Ep), pulse wave velocity β (PWV-β) and IMT increased, arterial compliance (AC) decreased (P<0.05), but argumentation index (AI) did not change significantly. EAT thickness had significant positive correlations with β, Ep, PWV-β and IMT, negative correlation with AC, and no significant correlation with AI. The areas under the curves of EAT thickness and IMT for predicting CHD were 0.806 and 0.784, respectively.ConclusionEAT thickness is significantly correlated with right common carotid artery elasticity and IMT in middle-aged and elderly patients with CHD, and EAT thickness and IMT have high predictive values. The three indices are crucial for CHD diagnosis.

Association of myeloperoxidase, homocysteine and high-sensitivity C-reactive protein with the severity of coronary artery disease and their diagnostic and prognostic value.

In the present study, the association between the severity of coronary artery disease (CAD) and myeloperoxidase (MPO), homocysteine (Hcy) and high-sensitivity C-reactive protein (hs-CRP) was assessed and their diagnostic and prognostic value was determined. A total of 112 patients with CAD [patient group (PG)] and 112 healthy participants who visited the hospital for physical examinations [control group (CG)] were enrolled in the present study. The plasma levels of MPO, Hcy and hs-CRP were compared between the two groups. According to the arteriography results, the patients were further divided into the single-vessel disease group (SVG), double-vessel disease group (DVG) and multi-vessel disease group (MVG). The Gensini scores of the three groups were evaluated according to the Gensini score standard. The correlations between the expression of MPO, Hcy or hs-CRP and the Gensini score of the PG were analyzed. The patients' major adverse cardiovascular event (MACEs) were recorded over 6 months and compared, and the predictive values of MPO, Hcy and hs-CRP regarding MACEs were determined by receiver operating characteristics analysis. The results indicated that the levels of MPO, Hcy and hs-CRP in the PG were higher than those in the CG (P<0.05). The Gensini score and the expression of MPO, Hcy and hs-CRP in the MVG were higher than those in the SVG and the DVG, and the Gensini score and the expression of MPO, Hcy and hs-CRP in the DVG were higher than those in the SVG (P<0.05). There was a positive correlation between the Gensini score and the expression of MPO (r=0.814, P<0.05), Hcy (r=0.774, P<0.05) and hs-CRP (r=0.765, P<0.05) in the PG. The total incidence of MACEs in patients with multiple lesions was significantly higher than that in patients with double and single lesions (P<0.05). The total incidence of MACEs in the MVG group was higher than that in the SVG and the DVG, and the total incidence of MACEs in the DVG was higher than that in the SVG (P<0.05). The area under the curve (AUC) and sensitivity for MPO levels to predict MACEs were higher than those of Hcy and hs-CRP (P<0.05); however, there was no significant difference in the AUC and sensitivity of Hcy and hs-CRP for predicting MACEs (P<0.05). The specificity of hs-CRP for predicting MACEs was higher than that of MPO and Hcy (P<0.05). The number of lesions, hypertension, diabetes, MPO, Hys and hs-CRP were determined to be independent risk factors for MACEs. In conclusion, for patients with CAD, elevated plasma levels of MPO, Hcy and hs-CRP were directly correlated with the severity of CAD and the risk of MACEs. Furthermore, MPO, Hcy and hs-CRP may effectively predict MACEs and are of important clinical significance in terms of judging the condition and improving the prognosis for patients with CAD.

Expression and clinical significance of serum cystatin C in patients with hypertension and coronary heart disease.

The aim of this study is to explore the potential association between cystatin C (Cys-c) and coronary heart disease (CHD) in hypertensive patients.In this study, circulating levels of Cys-c in 62 essential hypertension (EH) patients, 147 hypertension with coronary heart disease (EH + CHD) patients, and 60 healthy volunteers were investigated using immunoturbidimetry. Then, we analyzed the correlations between Cys-C and other clinical parameters.Serum Cys-C level was significantly higher in the EH and EH + CHD groups than in the control group, and higher in the EH + CHD group than in the EH group. Receiver operating characteristic curve (ROC) analysis showed that the diagnostic value of Cys-C for patients with hypertension combined CHD was 0.871(95% CI: 0.818-0.913). Serum Cys-C level was significantly higher in the double-vessel disease group and multi-vessel disease group than in the single-vessel disease group, and higher in the multi-vessel disease group than in the double-vessel disease group. Urinary albumin and CRP correlated positively with Cys-C, and HDL correlated negatively with Cys-C. Cys-C was an independent risk factor for CHD in hypertensive patients.Our results suggested that circulating Cys-C levels was up-regulated in patients with hypertension and CHD, and had correlation with the severity of coronary artery disease. As one of the important risk factors for CHD, Cys-C can predict the occurrence of CHD in patients with hypertension.

Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single vs multivessel disease

BACKGROUNDEven though percutaneous coronary intervention (PCI) improved the survival of patients with acute myocardial infarction, still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease (SVD).AIMTo compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease (MVD).METHODSThe retrospective cohort of patients were divided into two groups: SVD and MVD group. The study population consisted of both male and female young (≤ 45 years) patients presented with ST-elevation myocardial infarction (STEMI) at the National Institute of Cardiovascular Disease, Karachi, Pakistan and undergone primary PCI from 1st July 2017 to 31st March 2018. Pre and post-procedure management of the patients was as per the guidelines and institutional protocols.RESULTSA total of 571 patients with STEMI, ≤ 45 years were stratified into two groups by the number of vessels involved, 342 (59.9%) with SVD and 229 (40.1%) with MVD. The average age of these patients was 39.04 ± 4.86 years. A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group (25.1% vs 38%, P < 0.01; 11.7% vs 27.5%, P < 0.001) respectively. While, smoking was more prevalent among the SVD group as compare to MVD group (36.3% vs 28.4%, P = 0.05). The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group (48.8% vs 39.2%, P = 0.021). Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98% vs 96.5% of the patients is SVD vs MVD group.CONCLUSIONThe MVD comprised of around 40% of the young patients presented with STEMI. Also, this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases, therefore, preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.

Effect of Aggressive Lipid-Lowering Therapy in Single-Vessel vs. Multivessel Coronary Artery Disease Patients With Acute Coronary Syndrome - Heart Institute of Japan-Proper Level of Lipid Lowering With Pitavastatin and Ezetimibe in Acute Coronary Syndrome (HIJ-PROPER) Substudy.

Background: The effects of aggressive lipid-lowering therapy according to the number of diseased coronary arteries in acute coronary syndrome (ACS) are still controversial. This study investigated the efficacy of this therapy in ACS patients with multivessel disease (MVD) and single-vessel disease (SVD).Methods and Results: The subjects were derived from the HIJ-PROPER study, in which ACS patients with dyslipidemia were randomized to receive either pitavastatin+ezetimibe (targeting low-density lipoprotein cholesterol [LDL-C] <70 mg/dL) or pitavastatin monotherapy (targeting LDL-C <90 mg/dL). In this study, treatment efficacy was compared between patients with MVD and SVD. The primary endpoint was a composite of major advanced cardiovascular events (MACE; all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization). We identified 1,702 eligible patients (MVD, n=869; SVD, n=833; mean age, 65.6 years; male, 75.6%; acute revascularization, 96.2%). MACE incidence was significantly higher in the MVD group than in the SVD group (43.7% vs. 25.9%, HR, 1.95; 95% CI: 1.65–2.31, P<0.001). In the SVD group, pitavastatin+ezetimibe had significantly fewer MACE than pitavastatin monotherapy (34.6% vs. 47.4%, HR, 0.72; 95% CI: 0.55–0.94, P=0.02).Conclusions: The benefits of aggressive lipid-lowering therapy, with the addition of ezetimibe to statins, were enhanced in ACS patients with SVD, but not with MVD, in the early invasive strategy era.

P41 Correlation of doppler ultrasound assessment of carotid femoral pulse wave velocity with coronary artery disease

Abstract Funding Acknowledgements self Background Arterial stiffness is an important cardiovascular risk factor. Carotid femoral pulse wave velocity (cfPWV) is simple noninvasive method to determine aortic stiffness. Arterial stiffness measures, cfPWV in particular, have been found to be correlate with stroke and peripheral artery disease. Usually SphygmoCor or Complior are used to calculate cfPWV. Doppler ultrasound can serve as an alternative to these methods. Purpose To assess cfPWV using doppler ultrasound and study its correlation with coronary artery disease and its severity. Methods cfPWV was assessed by ultrasound Doppler in patient aged 20-70 years undergoing coronary angiography. cfPWV was measured by sequential recordings of arterial pressure waveform at the carotid and femoral arteries with a Doppler ultrasound with ECG gating and calculated as the distance between the carotid and the femoral sampling site divided by the time interval. Result Of the 358 subjects studied, 243 had coronary artery disease(CAD) (&amp;gt;50% diameter stenosis) and were further divided into single, double or triple vessel disease groups. 115 patients had mild CAD (&amp;lt; 50% stenosis) or no CAD and served as controls. Baseline characteristics were similar except diabetes (more common in CAD group)(39.09% v/s 27.82%). cfPWV was found to increase with age in all groups. cfPWV was not significantly affected by sex, diabetes, dyslipidemia, BMI, smoking or hypothyroidism. Mean cfPWV was significantly higher in patients with CAD (8.99 v/s 6.51 m/s, p &amp;lt; 0.001) and hypertensives (8.71 v/s 7.83 m/s, p &amp;lt; 0.001). Patients with triple vessel disease(TVD) had significantly higher cfPWV (10.12 m/s) than those with double(DVD)(8.84 m/s) or single vessel disease(SVD)(8.28m/s)(p &amp;lt; 0.001). Multinomial logistic regression revealed an odds ratio of 2.00, 2.375 and 3.368 respectively for SVD, DVD and TVD groups in comparison to controls (p &amp;lt; 0.001). cfPWV value &amp;gt; 7.25 m/s predicted CAD with sensitivity 78.6 % and specificity 74.8% (AUC =0.848, P &amp;lt; 0.001). Conclusion Carotid femoral pulse wave velocity can be measured noninvasively by ultrasound Doppler. cfPWV increases with age and hypertension and has strong correlation with coronary artery disease and its severity. The cfPWV can be an independent risk factor and may be utilized for cardiovascular risk prediction. Abstract P41 Figure. cfPWV in various subgroups.

P830Differences in the usefulness of aggressive lipid-lowering therapy among single-vessel and multi-vessel coronary artery disease patients: HIJ-PROPER sub-study

Abstract Background Acute coronary syndrome (ACS) patients with multi-vessel disease (MVD) are at high risk of recurrent cardiovascular events. Previous study, examining stable atherosclerotic cardiac disease, reported that aggressive lipid-lowering therapy was more beneficial in MVD patients than in single-vessel disease (SVD) patients. However, no report has investigated the effects of aggressive lipid-lowering treatment according to the number of diseased coronary arteries in ACS patients. Purpose The purpose of the present study was to elucidate the efficacy of aggressive lipid-lowering therapy in ACS patients with MVD and SVD in modern early invasive strategy era. Methods The study population was derived from the HIJ-PROPER study, in which, ACS patients with dyslipidemia were randomized to pitavastatin + ezetimibe therapy (targeting LDL-C less than 70mg/dl) or pitavastatin-monotherapy (targeting LDL-C less than 90mg/dl). In the present study, the treatment efficacy was compared between patients with MVD and SVD. The primary end point was a composite of major advanced cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia driven revascularization. Results We identified 1702 eligible patients (mean age, 65.6 years; male, 75.6%); 869 patients (51.1%) had MVD and 833 (48.9%) patients had SVD. The rate of acute revascularization was 96.2%. The incidence of MACEs was significantly higher in MVD group compared to SVD group (43.7% vs 25.9%, hazard ratio 1.95, 95% confidence interval 1.65–2.31, p&lt;0.001). In MVD group, there was no significant difference in MACEs between pitavastatin + ezetimibe therapy and pitavastatin-monotherapy group. (43.5% vs. 43.9%, 1.0, 0.82–1.23; p=0.95). However, in SVD group, pitavastatin + ezetimibe therapy showed significantly fewer MACEs than pitavastatin-monotherapy (34.6% vs. 47.4%, 0.72, 0.55–0.94, p=0.02). (Figure) Conclusion This study showed that ACS patients with SVD enjoyed significantly greater benefits from pitavastatin + ezetimibe therapy compared with pitavastatin monotherapy, whereas the patients with MVD did not. High rate of revascularization in acute phase of ACS might affect the efficacy of aggressive lipid-lowering therapy and our results in the present study suggest different treatment approach would be necessary in ACS patients with MVD in modern early invasive strategy era.