Stable Ischemic Heart Disease Research Articles

Determination of Left Main Coronary Artery Stenosis Through Noninvasive Testing to Guide Revascularization in Ischemic Heart Disease

Anatomically severe left main coronary artery (LMCA) stenosis (>50%) remains one of the few groups to benefit from early revascularization in stable ischemic heart disease (SIHD). Identification of these patients through widely available noninvasive testing would decrease the need for additional upfront anatomic testing, lowering the overall cost of healthcare. Patients with SIHD who underwent either percutaneous or surgical revascularization over a 7-year period at our institution were retrospectively analyzed and categorized as having LMCA stenosis versus non-LM stenosis. All preceding noninvasive testing, including resting electrocardiogram, echocardiogram, and functional testing was evaluated and compared between groups using chi-square and t test. In total, 806 patients were evaluated. Of those, 121 were identified as having significant LMCA stenosis with 685 patients in the non-LM cohort. Between LMCA versus non-LM cohorts, there were similar rates of electrocardiogram abnormalities (68.9% vs 70.8%, p >0.05), abnormal echocardiograms (72.7% vs 69.7%, p >0.05), abnormal functional testing (83.3% vs 77.4%, p >0.05), and high-risk imaging findings (5.6% vs 4.8%, p >0.05). More importantly, of those with a complete workup, there were similar rates of normal results between the LMCA (3 of 18, 16.7%) and non-LM stenosis (9 of 189, 4.8%) groups. A comprehensive noninvasive profile of patients with IHD failed to identify or exclude patients with anatomically severe LMCA stenosis, necessitating anatomic assessment.

Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-Blind Randomized Comparative Trial.

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.

Systemic inflammatory response in cardiac surgery: possibilities of using colchicine

To evaluate manifestations of systemic inflammatory response (SIR) and the effect of the colchicine therapy on SIR severity in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) with extracorporeal circulation (EC). This study included 100 patients aged 62+6.3 years with stable IHD and multivessel coronary atherosclerosis scheduled for CABG with EC. Patients of group 1 (n=50) were administered with a single dose of colchicine (Colchicum-Dispert) 500 µg 4 hours before surgery followed by 500 µg twice a day for 10 days after surgery. Patients of group 2 (n=50) received a standard treatment, including nonsteroid anti-inflammatory drugs after surgery. Severity of the inflammatory response was evaluated by measuring blood cytokines. In the postoperative period, patient of group 1 showed a tendency toward a lower incidence of pleurisy and heart rhythm disorders in the form of paroxysmal atrial fibrillation (AF) (p=0.18). Levels of the anti-inflammatory cytokines, interleukin-10 (IL-10) and interleukin-6 (IL-6), were significantly increased in both groups at 6 hours after surgery (p&lt;0.05); at the same time, in group 1, IL-10 remained increased also at 10 days after surgery (р=0.0002). No significant time-related changes in the proinflammatory cytokines, tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β), were observed. At 3 days post-CABG, there were significant increases in tissue inhibitors of matrix metalloprotease 1 (TIMP-1) (р&lt;0.0001) and matrix metalloproteinase 9 (MMP-9) (р&lt;0.001); at the same time, patients of group 1 had lower MMP-9 concentrations than patients of group 2 (p&lt;0.05). At 10 days of postoperative period, these values were comparable with the background values. Increases in neopterin compared to preoperative values were found in both groups on days 3 and 10 after surgery (р &lt;0.0001). CABG with EC is associated with the activation of SIR. The colchicine therapy at a dose of 500 µg 4 hours prior to surgery and 500 µg twice a day for 10 days after surgery reduces manifestations of SIR, which is clinically evident as a tendency to reduced incidence of pleurisy and arrhythmias, and does not result in the development of serious complications. The dynamics of matrix metalloproteinases indicates that the colchicine treatment is promising for decreasing the risk of CHF progression and myocardial remodeling in patients with IHD.

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.

The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Serum a-1 antitrypsin as a novel biomarker in chronic heart failure.

Chronic heart failure (CHF) remains a major health issue worldwide. In the present study, we aimed to identify novel circulating biomarkers for CHF using serum proteomics technology and to validate the biomarker in three independent cohorts. The isobaric tags for relative and absolute quantitation technology was utilized to identify the potential biomarkers of CHF. The validation was conducted in three independent cohort. Cohort A included 223 patients with ischaemic heart disease (IHD) and 321 patients with ischaemic heart failure (IHF) from the CORFCHD-PCI study. Cohort B recruited 817 patients with IHD and 1139 patients with IHF from the PRACTICE study. Cohort C enrolled 559 non-ischaemic heart disease patients with CHF (n=316) or without CHF (n=243). We found the expression of a-1 antitrypsin (AAT) was elevated significantly in patients with CHF compared with that in the patients with stable IHD using statistical and bioinformatics analyses. In a validation study, there was a significant difference between patients with stable IHD and patients with IHF in AAT concentration either in cohort A (1.35±0.40 vs. 1.64±0.56, P<0.001) or in cohort B (1.37±0.42 vs. 1.70±0.48, P<0.001). The area under the receiver operating characteristic curve was 0.70 [95% confidence interval (CI): 0.66 to 0.74, P<0.001] in cohort A and 0.74 (95% CI: 0.72 to 0.76, P<0.001) in cohort B. Furthermore, AAT was negative correlated with left ventricular ejection fraction (r=-0.261, P<0.001). After adjusting for confounders using a multivariate logistic regression analysis, AAT remained an independent association with CHF in both cohort A (OR=3.14, 95% CI: 1.667 to 5.90, P<0.001) and cohort B (OR=4.10, 95% CI: 2.97 to 5.65, P<0.001). This association was also validated in cohort C (OR=1.86, 95% CI: 1.02 to 3.38, P=0.043). The present study suggests that serum AAT is a reliable biomarker for CHF in a Chinese population.

Applicability of the OPTA Questionnaire for Patients with Stable Ischemic Heart Disease in Indian Clinical Practice: A Cross-sectional, Real-word Evidence Study.

Angina is the symptomatic form of stable ischemic heart disease (SIHD). The OPtimal Treatment of Angina (OPTA) questionnaire was developed and validated to overcome the lack of a standardized and accurate tool to assess patients' clinical conditions with SIHD. This study aimed to understand the applicability of OPTA in patients with SIHD in routine clinical practice in India. In this cross-sectional, single-visit study, 344 patients with SIHD were enrolled. Study endpoints were physicians' agreement on the applicability of OPTA, the usefulness of OPTA in assessing degree of impairment in daily activities of patients, and its positive predictive value (PPV). All enrolled patients completed the study. The mean [standard deviation (SD)] age was 56.6 (10.77) years, with a majority of patients being male (69.5%) and on antianginal treatment for &gt;1 year (80.4%). Physicians of all participating patients agreed that the OPTA questionnaire could accurately assess whether treatment received by patients was optimal (100% agreement rate). No or moderate degree of impairment of daily activities was reported by 93.9% and 73.0% of patients for one and two health-related questions, respectively. The PPV and sensitivity of the questionnaire were 88.97% [confidence interval (CI): 87.58%, 90.22%] and 39.33% (CI: 34.01%, 44.85%), respectively. The OPTA questionnaire showed good agreement regarding health status between physicians and patients and could be used to periodically assess and guide clinical judgment in the management of SIHD in India. Further assessment of the impact of various treatments temporally and in the long term may be warranted.

The CRE8 EVO Coronary Stent in Diabetic Patients With Stable Ischaemic Heart Disease and Acute Coronary Syndrome (Excluding ST Elevation Myocardial Infarctions): 30-Day and Six-Month Outcomes

The CRE8 EVO Coronary Stent in Diabetic Patients With Stable Ischaemic Heart Disease and Acute Coronary Syndrome (Excluding ST Elevation Myocardial Infarctions): 30-Day and Six-Month Outcomes

Characteristics and risk of coronary-related events following hospitalisation for chronic coronary disease

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Western Australian Department of Health. Background Chronic coronary heart disease (CCD) is associated with a high healthcare burden and expenditure in Western societies, yet population-level data on CCD are limited. Use of hospitalisation data to investigate CCD epidemiology has not been well explored. Our aim was to describe characteristics of patients hospitalised with CCD and to estimate the long-term risk of coronary outcomes in this cohort. Method We used Western Australian state-wide linked hospitalisation/mortality data to identify all hospitalisations for CCD, comprised stable angina (SA, ICD-10-AM I20.1-I20.9) and chronic ischaemic heart disease (IHD, I25) from 2002 – 2017. Index admissions were defined as the first SA or chronic IHD admission in the study period. 14-years of hospitalisation history data were used to identify prior medical history, including admissions for acute coronary syndromes (ACS) +/- angiography, PCI and CABG. Kaplan-Meier survival analyses were used to estimate risk of readmission for coronary outcomes and procedures using up to 15-years of follow-up from linked morbidity/mortality data. Results There were 32,557 index SA and 29,505 index chronic IHD admissions from 2002-2017. SA index case number declined by -3.9%/year while chronic IHD admissions increased steadily (+5.3%/year, age-adjusted). The mean age was 66 years for SA and chronic IHD index admissions, with women on average 3 years younger than men; median length of stay was 3 days. Women comprised a higher proportion of SA admissions (37.8%) than chronic IHD (26.9%, p&amp;lt;0.0001). SA admissions were more likely to be emergency admissions (45.6% vs 13.4%) and have comorbidities including diabetes, hypertension and stroke. Patients with a chronic IHD admission were more likely to undergo angiography only (65.3% vs 46.7%) or revascularisation (20.6% vs 12.9%) during the index admission. Around 1/3 of SA and chronic IHD patients had a prior ACS admission (n=9964 and 8291 respectively); around half of these prior ACS admissions occurred in the 1-year preceding the index SA and chronic IHD admissions (Figure), with the majority occurring in the 90 days immediately prior to the index admission. Following an index SA or chronic IHD admission, the risk of ACS within the initial year of follow-up was 9.4% in men and 8.6% in women with SA, and 5.6% in chronic IHD men and women. This risk increased to &amp;gt;20% in both groups with 15 years of follow-up. The 15-year risk of CVD mortality was 4.3% in men and 4.2% in women following a chronic IHD admission; similar long-term risks were seen following SA admissions. Conclusion The heterogeneity in clinical profile and outcomes between patients admitted for SA versus chronic IHD requires cautious interpretation of hospitalisation data to inform the epidemiology of CCD. However, while mortality risk is low, the risk of ACS readmission is high, indicating significant ongoing morbidity and healthcare burden of CCD.

Evaluation of the neutrophil-leukocyte index in patients with cardiac disorders and new coronavirus infection

Background: The neutrophil-leukocyte index (NLI) is an independent predictor of an unfavorable outcome in stable ischemic heart disease, as well as of mortality in patients with acute coronary syndromes and uncontrolled heart failure. A number of studies have shown the informative value of NLI for the prediction of severe course of COVID-19. NLI variability in COVID-19 with comorbid baseline physical diseases and cardiovascular disorders in particular, has not been studied.&#x0D; Aim: To evaluate the clinical value of NLI in hospitalized patients with COVID-19 depending on their concomitant cardiac disorders.&#x0D; Materials and methods: In this retrospective quantitative study we have analyzed the data from medical files of the patients with the diagnosis of new coronavirus infection confirmed by polymerase chain reaction, treated in a specialized in-patient department of infectious diseases in 2020 to 2022. Previously diagnosed cardiac disorders were defined as any past history of these disorders. The results of instrumental and laboratory work-up were assessed before treatment.&#x0D; Results: The analysis included 226 patients with median age of 50.0 (Q1Q3: 42.063.0) years, with 81.4% (n = 184) of them being men. Ninety four (41.6%) patients had no previously diagnosed cardiovascular disorders. Arterial hypertension by the time of admittance was present in 132 (58.4%), ischemic heart disease, in 77 (34.1%), atherosclerotic and/or post-infarct cardiosclerosis, in 82 (36.3%), and chronic heart failure, in 77 (34.1%) of the patients.&#x0D; In the total study group (n = 226) the median NLI was 2.6 (1.574.47). The larger was the volume of the lung involvement (assessed by computed tomography at admittance), the higher was NLI (p = 0.009, Kruskal-Wallis test). There was an association between the NLI value and the degree of respiratory failure (p 0.001, Kruskal-Wallis test). Median NLI in the patients with cardiac disorders (irrespective of their nosology) was significantly higher than that in the patients without any history of cardiovascular problems: 3.30 (2.095.42) versus 1.95 (1.423.62) (p 0.001, Mann-Whitney U-test). We found significant difference in the NLI values for each type of cardiac disorders, compared to that in the patients without history of cardiovascular disorders, including for the patients with arterial hypertension (p 0.001, Kruskal-Wallis test), ischemic heart disease (p 0.001, Mann-Whitney U-test), atherosclerotic cardiosclerosis (p = 0.001, Mann-Whitney U-test), and chronic heart failure (p = 0.040, Kruskal-Wallis test).&#x0D; Conclusion: We have confirmed the contribution of cardiovascular disorders to the course of COVID-19 and the clinical value of NLI as a convenient laboratory marker of the severity of infectious disease.

Osteopontin in patients with chronic obstructive pulmonary disease and coronary heart disease

Background: Osteopontin is a protein expressed by various cell types, such as endothelial and epithelial cells, osteoclasts, hepatocytes, smooth muscle cells, activated macrophages, and T-cells. Cardiomyocytes, heart fibroblasts, endothelial cells of coronary arteries express osteopontin in response to hypoxia, inflammation, toxic factors, mechanical strain, and other stimuli.&#x0D; Aim: To study osteopontin levels in patients with chronic obstructive pulmonary disease (COPD) depending on concomitant ischemic heart disease (IHD), to identify an association between osteopontin levels with severity of COPD and functional lung test parameters.&#x0D; Materials and methods: This open-label, prospective, non-randomized comparative study with parallel groups included 99 patients with COPD grades AD by GOLD, with 49 of them having confirmed comorbid stable IHD. Serum osteopontin levels were measured by immunoenzyme assay (Human Osteopontin Platinum ELISA; Bender MedSystems, Austria). The data is given as medians and quartiles (Me [Q1; Q3]). In all patients we performed functional lung tests with bronchodilation, a 6-minute walking test, BODE index assessment, as well as CAT and mMRC questionnaires were used.&#x0D; Results: In the patients with COPD and IHD, the osteopontin levels were higher than in the patients with COPD without IHD (85.55 [46.86; 110.91] vs 55.43 [20.76; 89.64] ng/mL, respectively; p = 0.027). Osteopontin levels in the patients with all COPD grades and IHD were higher than in those without IHD, but the difference was significant only in GOLD grade B patients (91.28 [73.04; 110.91] vs 37.81 [22.54; 82.95] ng/mL, respectively, р = 0.028) and GOLD grade D patients (80.79 [34.65; 111.11] vs 37.46 [13.32; 109.5] ng/mL, respectively, р = 0.027).&#x0D; Conclusion: A significant increase of osteopontin levels in comorbid patients with COPD and stable IHD found in this study has not been previously known. It is necessary to perform further studies to identify a threshold level of osteopontin predictive of the risk of COPD exacerbations or cardiovascular events. This would help to improve medical treatment of COPD patients, as well as to identify the risk groups.

E-6 | Diagnostic Yield of Invasive Coronary Function Testing Compared With Coronary Angiography Alone in Women With Stable Ischemic Heart Disease

Objective: The aim of this study was to compare the diagnostic yield of invasive coronary function testing (CFT) and coronary angiography (CA) alone in women who presented with stable ischemic heart disease (SIHD). SIHD is a leading cause of morbidity and mortality in women, and women are more likely than men to suffer from ischemia and no obstructive coronary artery disease (INOCA). Endotypes of INOCA such as coronary vasospasm and microvascular dysfunction are not identified by routine coronary angiography. As a result, many women who undergo cardiac catheterization for suspected SIHD are not given a specific diagnosis or a targeted therapeutic plan. The diagnostic yield of CFT in comparison with CA alone in women has not been well-established. We conducted a retrospective study of women who presented with symptoms of SIHD. The primary outcome was post-procedure diagnosis identified after invasive CFT or CA. Secondary outcomes included post procedure change in cardiac medications and complications. A total of 133 women were evaluated, including 61 in the CFT group and 72 in the CA group. Compared to the CA group, women in the CFT group were more likely to receive a diagnosis of microvascular dysfunction 41% (n=25) vs. 3% (n=2), vasospastic angina 20% (n=12) vs. 1% (n=1), or endothelial dysfunction (n=5, 8% vs 0%). Other diagnoses in the CFT group included elevating resting flow (n=2), myocardial bridging (n=3), or mixed syndromes (n=5). In the CA group, women most commonly received a diagnosis of normal coronary arteries (n=15, 21%), non-obstructive coronary artery disease (n=54, 75%), or other (n=2, 3%). Post-procedure medication changes were more frequent in the CFT group compared to the CA group (69% vs 43%, p<0.001). In this study of women with SIHD, CFT confirmed an underlying vasomotor disorder in 85% of cases, whereas CA only reported a diagnosis of normal coronary arteries or non-obstructive CAD. CFT was able to further categorize women as having microvascular dysfunction or vasospastic angina, resulting in a higher frequency of post-procedure medication changes compared to CA alone. These findings suggest that CFT should be considered routinely in the evaluation of women with suspected SIHD.

D-24 | Quality of Life After Revascularization versus Medical Therapy in Older Adults With Stable Ischemic Heart Disease at 5 Year Follow-up in the BARI2D Trial

D-24 | Quality of Life After Revascularization versus Medical Therapy in Older Adults With Stable Ischemic Heart Disease at 5 Year Follow-up in the BARI2D Trial

D-22 | Trajectories of Patients Treated With Beta Blockers and Calcium Channel Blockers for Stable Ischemic Heart Disease and Diabetes Mellitus (from the Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial)

D-22 | Trajectories of Patients Treated With Beta Blockers and Calcium Channel Blockers for Stable Ischemic Heart Disease and Diabetes Mellitus (from the Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial)

Chewed Versus Swallowed Ticagrelor in P2Y12 Inhibitor-Naïve Patients Undergoing Percutaneous Coronary Intervention.

Dual antiplatelet therapy is standard for patients undergoing percutaneous coronary intervention (PCI) with stents. Traditionally, patients swallow the loading dose of a P2Y12 inhibitor before or during PCI. Time to achieve adequate platelet inhibition after swallowing the loading dose varies significantly. Chewed tablets may allow more rapid inhibition of platelet aggregation. However, data for this strategy in patients with stable ischemic heart disease or non-ST-elevation acute coronary syndrome (NSTE-ACS) are less robust. In this single-center prospective trial, 112 P2Y12-naïve patients with stable ischemic heart disease or NSTE-ACS on aspirin therapy and who received ticagrelor after coronary angiography but before PCI were randomized to chewing (n=55) or swallowing (n=57) the ticagrelor loading dose (180 mg). Baseline variables were compared using 2-sample t-test and chi-squared/Fisher's exact tests as appropriate, with alpha set at 0.05. P2Y12 reaction units (PRU) were compared at baseline, 1 hour, and 4 hours using Wilcoxon rank-sum test. Patients then received standard ticagrelor dosing. After exclusions, P2Y12 PRU in the chewed and swallowed groups at baseline, 1 hour, and 4 hours after ticagrelor loading dose were 243 vs 256 (P=0.75), 143 vs 210 (P=0.09), and 28 vs 25 (P=0.89), respectively. No differences were found in major adverse cardiac events (MACE) or major bleeding at 30 days and 1 year. In patients with stable ischemic heart disease or NSTE-ACS, chewing rather than swallowing ticagrelor may lead to slightly faster inhibition of platelet aggregation at 1 hour with no increase in MACE or major bleeding.

Platelet adhesion mediated by von Willebrand factor in patients with premature coronary artery disease

Aim To study platelet adhesion mediated by von Willebrand factor (VWF) in patients with premature ischemic heart disease (IHD).Material and methods This study enrolled 58 patients with stable IHD, including 45 men younger than 55 years with the first manifestation of IHD at the age of &lt;50 years and 13 women younger than 65 years with the first manifestation of IHD at the age of &lt;60 years. The control group consisted of 33 patients, 13 men younger than 55 years and 20 women younger than 65 years without IHD. Platelet adhesion to the collagen surface at the shear rate of 1300 s-1 was studied by evaluating the intensity of scattered laser light from the collagen-coated optical substrate in a flow chamber of a microfluidic device after 15-min circulation of whole blood in the chamber. Decreases in platelet adhesion after addition to the blood of monoclonal antibodies (mAb) to platelet receptors glycoproteins Ib (GPIb) to inhibit the receptor interaction with VWF were compared for patients of both groups.Results In patients with premature IHD, the decrease in platelet adhesion following the platelet GPIb receptor inhibition was significantly less than in patients of the control group (74.8 % (55.6; 82.7) vs. 28.9 % (-9.8; 50,5), p &lt;0.001). For the entire sample, the median decrease in platelet adhesion following the GPIb receptor inhibition was 62.8 % (52.2; 71.2). With an adjustment for traditional risk factors of IHD, a decrease in platelet adhesion of &gt;62.8% after blocking GPIb receptors increased the likelihood of premature IHD (OR=9.84, 95 % CI: 2.80-34.59; p &lt;0.001).Conclusion Blocking the interaction of GPIb receptors with VWF in patients with premature IHD and increased shear rate induced a greater decrease in platelet adhesion than in patients without this disease. This suggested that an excessive interaction of VWF with platelets might contribute to the pathogenesis of premature IHD.

Correlation of Duke Treadmill Score with Coronary angiographic Findings in Patients with Stable Ischemic Heart Disease

Aim: To determine the correlation of Duke treadmill score with angiographically determined obstructive coronary artery disease (CAD) Study design: observational cross sectional study, comparative type Place and duration: The study was done at Cardiac Center Bahawalpur from August 2020 to July 2021. Methods: The patients who had stable angina and underwent exercise tolerance testing as well as coronary angiography were included in the study. The data was collected on a predesigned proforma. The difference in the prevalence of obstructive CAD with regards to Duke treadmill score (DTS), gender, diabetes mellitus, hypertension, smoking and family history was determined with Chi square test using SPSS 20; ap value of &lt; 0.05 was taken as significant. Results: Total 71 patients were enrolled for study. Mean ageof the participants was 48.25 ± 8.7 years. It was a male dominant population. A significant difference in the prevalence of obstructive CADwas noted in low, intermediate and high risk groups according to DTS. The prevalence of obstructive coronary artery disease was not significantly different with regards to gender, diabetes mellitus, hypertension, smoking and family history. However obstructive CAD was more prevalent in those who presented with typical angina as compared to those who had atypical symptoms. Conclusion: Obstructive CAD significantly differs in low, intermediate and high risk groups according to DTS. Keywords: Duke treadmill score, coronary artery disease

Comparison of Efficacy of Biliverdin vs Heparin in Patients with Stable Ischemic Heart Disease Undergoing Percutaneous Coronary Intervention

Objective: To compare the efficacy and safety of biliverdin versus heparin in preventing thrombotic complications during percutaneous coronary intervention (PCI) in patients with stable ischemic heart disease. Methods: A total of 1000 patients were enrolled in the study, with 500 patients receiving biliverdin and 500 receiving heparin. The primary endpoint was the incidence of thrombotic complications during PCI, and the secondary endpoint was the incidence of bleeding complications. Results: Biliverdin was associated with a significantly lower incidence of thrombotic complications compared to heparin (5.6% versus 9.8%, respectively; p&lt;0.05). There was no significant difference in bleeding complications between the two groups (3.8% for biliverdin versus 3.2% for heparin; p=0.63). Logistic regression analysis found that biliverdin use was independently associated with a lower risk of thrombotic complications, even after adjusting for baseline demographic and clinical characteristics. Practical Implications: This study suggests that the use of biliverdin during percutaneous coronary intervention in patients with stable ischemic heart disease may provide a more effective alternative to heparin for preventing thrombotic complications without increasing the risk of bleeding complications. Conclusion: Biliverdin may be a more effective alternative to heparin for use during PCI in patients with stable ischemic heart disease, without increasing the risk of bleeding complications. Further studies are needed to confirm these findings and determine the long-term safety and efficacy of biliverdin in larger populations and over longer periods of follow-up. Keywords: Biliverdin, heparin, percutaneous coronary intervention, stable ischemic heart disease, thrombotic complications, bleeding complications.

Management of Stable Angina in the Older Adult Population.

As society ages, the number of older adults with stable ischemic heart disease continues to rise. Older adults exhibit the greatest morbidity and mortality from stable angina. Furthermore, they suffer a higher burden of comorbidity and adverse events from treatment than younger patients. Given that older adults were excluded or underrepresented in most randomized controlled trials of stable ischemic heart disease, evidence for management is limited and hinges on subgroup analyses of trials and observational studies. This review aims to elucidate the current definitions of aging, assess the overall burden and clinical presentations of stable ischemic heart disease in older patients, weigh the available evidence for guideline-recommended treatment options including medical therapy and revascularization, and propose a framework for synthesizing complex treatment decisions in older adults with stable angina. Due to evolving goals of care in older patients, it is paramount to readdress the patient's priorities and preferences when deciding on treatment. Ultimately, the management of stable angina in older adults will need to be informed by dedicated studies in representative populations emphasizing patient-centered end points and person-centered decision-making.

Cardiac Rehabilitation for Patients With Stable Ischemic Heart Disease Without Revascularization - Rationale and Design of a Single-Arm Pilot Study.

Background: Clinical practice guidelines strongly recommend optimal medical therapy (OMT), including lifestyle modification, pharmacotherapy, and exercise-based cardiac rehabilitation (CR), in patients with stable ischemic heart disease (SIHD). However, the efficacy and safety of CR in patients with SIHD without revascularization remain unclear. Methods and Results: The Prospective Registry of STable Angina RehabiliTation (Pre-START) study is a multicenter, prospective, single-arm, open-label pilot study to evaluate the efficacy and safety of CR on health-related quality of life (HRQL), exercise capacity, and clinical outcomes in Japanese patients with SIHD without revascularization. In this study, all patients will undergo guideline-based OMT and are encouraged to have 36 outpatient CR sessions within 5 months after enrollment. The primary endpoint is the change in the Seattle Angina Questionnaire-7 summary score between baseline and the 6-month visit; an improvement of ≥5 points will be defined as a clinically important change. Secondary endpoints include changes in other HRQL scores and exercise capacity between baseline and the 6-month visit, as well as clinical outcomes between enrollment and the 6-month visit. Conclusions: The Pre-START study will provide valuable evidence to elucidate the efficacy and safety of CR in patients with SIHD and indispensable information for a subsequent randomized controlled trial. The study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (ID: UMIN000045415) on April 1, 2022.

Abstract P316: Lower Mortality From Ischemic Heart Disease Associated With Attenuation of Autonomic Dysfunction is Related to Reduction of Sensitivity to Pain at the Chest Bone

Introduction: Autonomic nervous system dysfunction (ANSD) is associated with negative prognosis of ischemic heart disease (IHD) and has been found also to be related to elevated measures of sensitivity to pain from pressure (PPS) at the sternum. Previously, we found that non-pharmacological intervention by peripheral sensory nerve stimulation, monitored by repeated home-based PPS measurements, consistently was associated with lowered PPS measures. Compared to the general Danish population, the intervention reduced the all-cause mortality in two prospective observations, one of 103 patients with IHD followed for 3 years, and one of 73 patients with stroke followed for 4.5 years. Here, we test if we can reproduce lower all-cause mortality associated with lowered PPS measures in a randomized controlled trial (RCT). Methods: Of 361 consecutively followed patients with stable IHD, 65% had elevated PPS, suggestive of ANSD. Of these, 213 participated in a randomized controlled trial (RCT) with active (n=106) or passive intervention (n=107). We compared the 5-year all-cause mortality of both groups with two corresponding subsections of approximately 35.000 members of the general population of Denmark, matching patients for gender, age, and observation period with data from Statistics Denmark, and we compared the 5-year mortality of the two RCT groups. In separate analyses, we pooled mortality data from the active group of the RCT with data from two observational studies. We registered the pooled active intervention mortality of 1.168 person-years, compared to approximately 40 million person-years of the pooled general population. Results: We observed fewer than three deaths in the active RCT group (exact number and 95% CI not available according to GDRP rules), compared to eight deaths of passive RCT group members (P=0.035). Based on the predicted mortality from the general population of eight deaths in both groups, the result is consistent with significantly reduced mortality of recipients of active intervention (P=0.011). The separate analyses of pooled data from three consecutive studies demonstrated a mean reduction of the 4.2-year all-cause mortality of 50% (P&lt;0.00005). Conclusions: The predicted attenuation of ANSD associated with lowering of elevated PPS matched the lower all-cause mortality of patients with IHD.