SYNTAX Score Research Articles

Correlation between controlled attenuation parameter values with SYNTAX score in patients with significant coronary artery disease

Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver disease, with coronary artery disease (CAD) as the main cause of death in NAFLD patients. However, correlation between the severity of liver steatosis and coronary atherosclerosis is yet to be understood. Here we aim to explore the correlation between controlled attenuation parameter (CAP) values and SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score in adult patients with significant CAD, defined as ≥ 50% stenosis of the left main coronary artery, or ≥ 70% stenosis of the other major coronary arteries. A cross-sectional study was conducted on 124 adult patients with significant CAD who underwent coronary angiography. Transient elastography with CAP was used to assess liver steatosis severity, resulting in a mean CAP value of 256.5 ± 47.3 dB/m, with 52.5% subjects had significant steatosis (CAP value of ≥ 248 dB/m). Median SYNTAX score was 22. A statistically significant correlation was observed between CAP value and SYNTAX score (r = 0.245, p < 0.0001). The correlation was more pronounced in patients with prior history of PCI (r = 0.389, p = 0.037). Patients with high-risk SYNTAX score (> 32) had the highest CAP value (285.4 ± 42.6 dB/m), and it was significantly higher than those with low-risk SYNTAX score (0–22), with a mean difference of 38.76 dB/m (p = 0.006). Patients with significant liver steatosis should undergo periodic CAD assessment and lifestyle modification, especially those with severe liver steatosis.

Distinct circulating cytokine levels in patients with angiography-proven coronary artery disease compared to disease-free controls

BackgroundSystemic inflammation has a critical role in the development of symptomatic coronary artery disease (CAD). Identification of inflammatory pathways may provide a platform for novel therapeutic approaches. We sought to determine whether there are differences in circulating cytokine profiles between patients with CAD and disease-free controls as well as according to the severity of the disease. MethodsCase-control study's population consisted of 452 patients who underwent diagnostic invasive coronary angiography due to clinical indications. We measured the serum concentrations of 48 circulating cytokines. Extent of CAD was assessed using the SYNTAX Score in 116 patients. Cytokine differences between groups were tested using Mann-Whitney U test and associations with CAD were explored using a logistic regression model. ResultsOverall, 310 patients had angiographically verified CAD whereas 142 had no angiographically-detected coronary atherosclerosis. In multivariable logistic regression models adjusted for age, sex, hypertension, atrial fibrillation, history of smoking and treatment for diabetes and hyperlipidemia, increased levels of interleukin 9 (OR 1.359, 95%CI 1.046–1.766, p = 0.022), IL-17 (1.491, 95%CI 1.115–1.994, p = 0.007) and tumor necrosis factor alpha (TNF-α) (OR 1.440, 95%CI 1.089–1.904, p = 0.011) were independently associated with CAD. Patients with SYNTAX Score>22 had increased levels of stromal cell-derived factor 1 alfa (SDF-1α), beta-nerve growth factor (β-NGF), IL-3 and decreased level of IL-17 compared to those with score ≤22 when adjusted for smoking and use of beta-blockers. ConclusionsPatients with CAD have distinct circulating cytokine profiles compared to disease-free controls. Distinct cytokines may have pivotal roles at different stages of coronary atherosclerosis. ClinicalTrials.gov Identifier: NCT03444259 (https://clinicaltrials.gov/study/NCT03444259).

Correlation Between High-sensitive Troponin Level, Neutrophil Lymphocyte ratio and SYNTAX score in Acute Myocardial Infarction patients undergoing Coronary Angiography

Abstract Background Acute myocardial infarction is one of the leading causes of death in the developed world. The prevalence of the disease approaches three million people worldwide. Acute myocardial infarction divided into two categories, non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI). Objective To assess the value of using high sensitive troponin and the neutrophil lymphocyte ratio as marker to predict the complexity of angiographic coronary anatomy in AMI patients assessed by SYNTAX Score. Patients and Methods this study included 100 patients who presented to emergency department of Ain Shams University Hospitals and Misr University for Science and Technology (MUST) hospital, between November/2021 and May/2022 diagnosed with AMI and underwent coronary angiography with or without stent implantation. Serum sample for differential CBC count was obtained to assess NLR as will as zero point high sensitive troponin to be correlation SYNTAX score. Results The study showed that there was a significant correlation between the NLR and the complexity of coronary lesions assessed by SYNTAX score, but the study couldn’t found any correlation between the high sensitive troponin level and the complexity of coronary lesions. Also the study showed there were no correlation between NLR and either TIMI follow or MBG. The conducted patients in the study were categorized in a tripartite fashion according to their SYNTAX score (low: 0 to 22, intermediate: 23 to 32, high: &amp;gt;32). Conclusion An increased in neutrophil lymphocyte ratio on admission is a strong and independent predictor of the complexity of the coronary lesions, but there is no significant correlation between High sensitive troponin level and the complexity of coronary lesion .

Short term clinical outcomes of Complex Percutaneous Coronary Intervention in patients with intermediate to high SYNTAX score: Ain Shams complex PCI Registry

Abstract Background Risk stratification is an important and essential component in proper patient counseling when dealing with complex coronary anatomy and decision making between either coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). The SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process. Objective To develop an electronic registry for patients with complex coronary anatomy with intermediate to high SYNTAX score undergoing non-emergent PCI who were indicated for CABG but either they were rejected by the surgeons or they refused it. Patients and Methods Our registry was conducted on 193 patients presented during eight months from the first of July 2021 till the end of February 2022 to Ain Shams University Hospitals and underwent PCI. Results comparing the intermediate to high SYNTAX score groups, there is a statistically significant increase in the in hospital and short term MACE and mortality with high SYNTAX score patients, while there was no difference regarding in hospital CIN. Regarding MACE it significantly increases in patients with anemia, CKD, LV dysfunction. For multivariate analysis it is shown that both incomplete revascularization and clinical SYNTAX II are independent predictors for the occurrence of short term MACE. Conclusion Both incomplete revascularization and clinical SYNTAX II score are independent predictors of short term (6 months) occurrence of MACE.

The role of syntax score on survival in young acute coronary syndrome patients.

The study aimed to evaluate the effect of the SYNTAX score (SS) calculated before percutaneous intervention on survival in a group of young patients with acute coronary syndrome (ACS). Our study is a retrospective study. Patients between the ages of 18 and 45 who applied to Private Yalova Atakent Hospital Cardiology Clinic with ACS and underwent percutaneous coronary intervention between 01.01.2017 and 01.12.2023 were included in the study. Patients aged 45 and under who presented with acute syndrome and underwent coronary angiography were evaluated. Patients' history of major cardiac adverse events (MACE) was evaluated. Demographic characteristics, laboratory findings, echocardiographic parameters, and SS of the patients were recorded. SS was calculated from the coronary angiography images of the patients. 140 patients were included in the study. 70.0% (n=98) of the cases were diagnosed with ST-elevation myocardial infarction (STE-MI), 28.6% (n=40) with non-ST-elevation myocardial infarction (NSTE-MI)-unstable angina pectoris (USAP), and 1.4% with cardiac arrest (n=2). 28.6% (n=40) of the patients had MACE. There was a statistically significant correlation between SS and MACE (r=0.525 p=0.001). An SS value of 23.15 had 77.5% sensitivity and 60.8% specificity in predicting MACE. There was a statistically significant negative correlation between SS and ejection fraction (EF) (r=-0.584, p=0.001). EF<40.5 predicted mortality with 77.7% sensitivity and 69.4% specificity (AUC 0.710, p=0.01, 95% CI 0.615-0.825). SYNTAX Score and EF have predictive value in predicting MACE and mortality in young ACS patients. Different scoring systems are needed to predict MACE and mortality after ACS in young patients.

Вплив реваскуляризації коронарних артерій на механічну дисинхронію міокарду лівого шлуночка у хворих з коронарною хворобою серця

Introduction. Defining a treatment strategy for patients with stable coronary heart disease will require the development of personalized criteria, among which the assessment of myocardial dyssynchrony is considered promising. The aim of the study was to evaluate the effect of revascularization of coronary arteries on indicators of mechanical myocardial dyssynchrony in patients with stable coronary heart disease. Materials and methods. The study included 121 patients with coronary heart disease, who were assessed for mechanical myocardial dyssynchrony before and 2 weeks after revascularization. The main group included 48 patients with myocardial dyssynchrony, and the comparison group included 73 patients without myocardial dyssynchrony. Complete occlusion and lesions of 3 coronary arteries were found more often in the group with myocardial dyssynchrony, and the main group also had a higher SYNTAX SCORE. The results. Mechanical dyssynchrony of the myocardium was found in 39% of patients with coronary heart disease. Before revascularization, a signifiant increase in SPWMD, APEI, IVMD, and a decrease in LVFT and LVET were found in the group of patients with myocardial dyssynchrony. After revascularization in the main group, in 9 patients out of 48 (18.7%), indicators of myocardial dyssynchrony returned to normal values. LVFT in the group of patients with myocardial dyssynchrony significantly increased, as well as left ventricular ejection time (LVET) (from 318.5±9.6 ms to 344.9±23.2 ms, p&lt;0.01). Conclusions. After revascularization, the number of patients with myocardial dyssynchrony significantly decreased due to the improvement of interventricular and intraventricular dyssynchrony indicators. Key words: myocardial dyssynchrony, coronary heart disease, revascularization, coronary angiography, SYNTAX SCORE.

Вплив перкутанної тактики повної і неповної реваскуляризації міокарда при гострому коронарному синдромі з елевацією сегмента ST на динаміку лабораторних та інструментальних показників протягом госпітального періоду лікування

The aim – to identify and study the effect of percutaneous tactics of complete and incomplete myocardial revascularization on the dynamics of laboratory and instrumental indicators in patients with acute coronary syndrome (ACS) with ST-segment elevation at the hospital stage of treatment.Materials and methods. 120 patients with ACS with ST segment elevation were examined. The criteria for inclusion in the study were the presence of acute coronary syndrome with ST segment elevation and the presence of at least one lesion of the non infarct-related (non-IRA) coronary artery with stenosis of 70 % or more according to coronary angiography. Exclusion criteria were severe clinical condition of the patient (ischemic time of more than 24 hours, cardiogenic shock, clinical death at the pre-hospital stage, presence of mechanical complications of myocardial infarction), coronary artery bypass grafting, unsuitable for PCI coronary anatomy, etc. All patients were divided into a group of complete (n=60) and a group of incomplete (n=60) revascularization. The complete revascularization group included patients who received stenting of all hemodynamically significant stenoses of the coronary arteries either during primary PCI (subgroup of immediate non-IRA stenting, n=7) or during a separate planned PCI procedure (subgroup of staged stenting non-IRA, n=53).Results and discussion. According to the echocardiography before discharge from the hospital, patients who underwent a complete procedure (both one-time and staged) had a significantly higher left ventricular ejection fraction compared to patients in the incomplete revascularization group (46.3±6.41 % vs. 43.2±8.32 %, p=0.03). The anatomical complexity of the infarct-related lesion according to the SYNTAX score had a positive correlation with the duration of the primary PCI (correlation coefficient r=0.2; p&lt;0.05) and a decrease in the left ventricular ejection fraction before discharge from the hospital (r=–0.26, p&lt;0.05). An increase in the duration of PCI was associated with an increase in leukocyte count and creatinine levels in the first 48-72 hours after the intervention. However, there was no significant difference in the incidence of contrast-induced nephropathy. A positive correlation was found between the level of LDL and the deterioration of kidney function after pPCI (r=0.27, p&lt;0.05), as well as the degree of non-IRA stenosis (3.39±0.99 mmol/l in patients with with non-IRA stenoses &gt; 90 % versus 2.77±0.68 mmol/l in patients with non-IRA stenoses 70-89 %, p&lt;0.05). While the complexity of non-IRA lesions according to the SYNTAX score had a negative correlation with the level of LDL (r=–0.26, p&lt;0.05).Conclusions. Complete revascularization in ACS with ST-elevation patients was associated with higher LVEF before hospital discharge. Immediate stenting of all non-IRA during pPCI is associated with increased procedure time but has a lower total radiation burden compared with a staged PCI strategy. The complexity of the infarct-related lesion according to the SYNTAX score is an unmodified predictor of the duration of the pPCI and the reduction of LVEF in the short observation period. Increasing the duration of pPCI leads to a more pronounced inflammatory response with an increase in the level of leukocyte count and an increase of creatinine in the first 48-72 hours after pPCI. LDL is a risk factor for the deterioration of renal function after PCI and the presence of &gt; 90 % non-IRA lesions. However, these lesions have less anatomical complexity.

Cardiac computed tomography-derived coronary artery volume to myocardial mass in patients with severe coronary artery disease

BackgroundCoronary artery lumen volume (V) to myocardial mass (M) ratio (V/M) can show the mismatch between epicardial coronary arteries and the underlying myocardium. MethodsThe V, M and V/M were obtained from the coronary computed tomography angiography (CCTA) of patients in the FAST-TRACK CABG study, the first-in-human trial of coronary artery bypass grafting (CABG) guided solely by CCTA and fractional flow reserve derived from CCTA (FFRCT) in patients with complex coronary artery disease (CAD). The correlations between V/M ratios and baseline characteristics were determined and compared with those from the ADVANCE registry, an unselected cohort of historical controls with chronic CAD. ResultsThe V/M ratio was obtained in 106 of the 114 pre-CABG CCTAs. Mean age was 65.6 years and 87% of them were male. The anatomical SYNTAX score from CCTA was significantly higher than the functional SYNTAX score derived using FFRCT [43.1 (15.2) vs 41.1 (16.5), p ​< ​0.001]. Mean V, M, and V/M were 2204 ​mm3, 137 ​g, and 16.5 ​mm3/g, respectively. There were weak negative correlations between V and anatomical and functional SYNTAX scores (Pearson's r ​= ​−0.26 and −0.34). V and V/M had a strong correlation (r ​= ​0.82). The V/M ratio in the current study was significantly lower than that in the ADVANCE registry (median 16.1 vs. 24.8 [1st quartile 20.1]). ConclusionSystematically smaller V/M ratios were found in this population with severe CAD requiring CABG compared to an unselected cohort with chronic CAD. The V/M ratio could provide additional non-invasive assessment of CAD especially when combined with FFRCT.

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES.

This retrospective study aims to explore the sex disparity in dual antiplatelet therapy (DAPT) noncompliance among left main stem percutaneous coronary intervention (PCI) patients with drug-eluting stent (DES) and identify predictors associated with non-adherence. Data were collected from the medical records of 1585 patients, including 1104 males and 481 females, who underwent left main stem PCI with DES. Baseline characteristics, angiographic features, and DAPT compliance rates at 1 month and 12 months were analyzed. Univariate logistic regression was used to identify predictors of DAPT noncompliance. The overall DAPT noncompliance rate at 1 month was 8.5%, increasing to 15.5% at 12 months. Females exhibited slightly higher noncompliance rates than males at both 1 month (15.6% vs 14.5%) and 12 months (28.1% vs 19.0%), although the difference was not statistically significant. Smoking status showed a modest impact on non-adherence, with current smokers exhibiting a lower noncompliance rate (14.9% at 1 month). Prior coronary artery disease history was associated with increased noncompliance at 12 months (18.9%). Angiographic characteristics, including lesion location and Syntax score, had no consistent association with DAPT noncompliance. This study highlights sex disparity in DAPT noncompliance among patients undergoing left main stem PCI with DES. Comorbidities, socioeconomic status, smoking status, and prior coronary artery disease history were identified as predictors of non-adherence.

Systematic screening by a heart team and a machine learning approach contribute to unraveling novel risk factors in revascularization candidates with complex coronary artery disease.

The baseline characteristics affecting mortality following percutaneous or surgical revascularization in patients with left main and / or 3‑vessel coronary artery disease (CAD) observed in real‑world practice differ from those established in randomized controlled trials (RCTs) due to the constraints of inclusion / exclusion criteria. This study aimed to assess whether systematic screening enables identification of novel and registry‑specific baseline patient characteristics influencing long‑term mortality. Least absolute shrinkage and selection operator (LASSO) regression was used to screen 42 baseline patient characteristics shared by the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial and a single‑center Polish registry of 1035 consecutive patients with complex CAD who received revascularization and were followed-up for 5 years. After screening, a classic Cox regression analysis was performed to examine the suitability of a linear model for predicting 5‑year mortality, which was then compared with the mortality predicted in the same cohort using the SYNTAX score II 2020 (SS2020). The 5‑year mortality rate in the registry was 12.3%, and the strongest predictors were pulmonary hypertension, chronic obstructive pulmonary disease, and insulin‑dependent diabetes. In an internal validation, the linear model constructed after LASSO screening and combined with a classic Cox regression analysis improved the prediction of 5‑year mortality, as compared with the SS2020 (concordance index of 0.92 and 0.75, respectively). A machine learning approach improved the detection of registry‑specific risk factors in all‑comer patients amenable to surgical or percutaneous revascularization who were evaluated by a heart team. The risk factors identified in RCTs are not necessarily the same as those detected in real clinical practice when systematic screening is applied.

Predictors of Optical Coherence Tomography-Defined Calcified Nodules in Patients With Acute Coronary Syndrome - A Substudy From the TACTICS Registry.

Recent studies suggest that the presence of calcified nodules (CN) is associated with worse prognosis in patients with acute coronary syndrome (ACS). We investigated clinical predictors of optical coherence tomography (OCT)-defined CN in ACS patients in a prospective multicenter registry.Methods and Results: We investigated 695 patients enrolled in the TACTICS registry who underwent OCT assessment of the culprit lesion during primary percutaneous coronary intervention. OCT-CN was defined as calcific nodules erupting into the lumen with disruption of the fibrous cap and an underlying calcified plate. Compared with patients without OCT-CN, patients with OCT-CN (n=28) were older (mean [±SD] age 75.0±11.3 vs. 65.7±12.7 years; P<0.001), had a higher prevalence of diabetes (50.0% vs. 29.4%; P=0.034), hemodialysis (21.4% vs. 1.6%; P<0.001), and Killip Class III/IV heart failure (21.4% vs. 5.7%; P=0.003), and a higher preprocedural SYNTAX score (median [interquartile range] score 15 [11-25] vs. 11 [7-19]; P=0.003). On multivariable analysis, age (odds ratio [OR] 1.072; P<0.001), hemodialysis (OR 16.571; P<0.001), and Killip Class III/IV (OR 4.466; P=0.004) were significantly associated with the presence of OCT-CN. In non-dialysis patients (n=678), age (OR 1.081; P<0.001), diabetes (OR 3.046; P=0.014), and Killip Class III/IV (OR 4.414; P=0.009) were significantly associated with the presence of OCT-CN. The TACTICS registry shows that OCT-CN is associated with lesion severity and poor clinical background, which may worsen prognosis.

Current applications, procedural and 1-year outcomes of Rotatripsy for the treatment of calcified coronary lesions.

Intravascular lithotripsy (IVL) combined with rotational atherectomy (RA), known as Rotatripsy, is used to treat severe coronary artery calcification (CAC), though data on efficacy, midterm safety and use sequence is limited. We aimed to identify indicators for Rotatripsy use and to assess its safety and success rates, both acutely and at 1-year follow-up. Patients undergoing Rotatripsy for severe CAC across six centers from May 2019 to December 2023 were included. Demographic, clinical, procedural and follow-up data were collected. Efficacy endpoints included device success (delivery of the RA-burr and IVL-balloon across the target lesion and administration of therapy without related complications), technical success (TIMI 3 flow and residual stenosis <30% by quantitative coronary analysis) and procedural success [composite of technical success with absence of in-hospital major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). Safety endpoints comprised Rotatripsy-related complications and MACE at 1-year follow-up. A total of 114 patients (75 ± 9 years, 78% male) underwent Rotatripsy for 120 lesions. In the majority of procedures RA was followed by IVL, mostly electively (n = 68, 57%) but also for balloon underexpansion (n = 37, 31%) and stent crossing failure (n = 1, 1%). Diverse and complex target lesions were addressed with an average SYNTAX score of 24.6 ± 13.0. Device, technical and procedural success were 97%, 94% and 93%, respectively. Therapy-related complications included two (2%) coronary perforations, one (1%) coronary dissection and one (1%) burr entrapment. At 1-year follow-up(present in 77(67%) patients), MACE occurred in 7(9%) cases. Over a 1-year follow-up period, Rotatripsy was safe and effective, predominantly using RA electively before IVL.

Association of the stress hyperglycemia ratio with coronary artery disease complexity as assessed by the SYNTAX score in patients with acute coronary syndrome

BackgroundMounting evidence supports a significant correlation between the stress hyperglycemia ratio (SHR) and both short- and long-term prognoses in patients with acute coronary syndrome (ACS). Nevertheless, research examining the association between the SHR and the complexity of coronary artery disease (CAD) is scarce. Therefore, this study aimed to explore the association between the SHR and CAD complexity, as assessed by the SYNTAX score, in patients with ACS.MethodsA total of 4715 patients diagnosed with ACS were enrolled and divided into five groups according to the quintiles of the SHR. CAD complexity was assessed using the SYNTAX score and categorized as low (≤ 22) or mid/high (> 22) levels. Logistic regression was utilized to examine the association between the SHR and CAD severity (mid-/high SYNTAX score). Restricted cubic spline (RCS) curves were generated to assess the association between the SHR and CAD severity. Subgroup analyses were conducted to stratify outcomes based on age, sex, diabetes mellitus (DM) status, and clinical presentation.ResultsAmong the total ACS population, 503 (10.7%) patients had mid/high SYNTAX scores. Logistic regression analysis revealed that the SHR was an independent risk factor for mid/high SYNTAX scores in a U-shaped pattern. After adjusting for confounding variables, Q1 and Q5 demonstrated elevated odds ratios (ORs) relative to the reference category Q3, with ORs of 1.61 (95% CI: 1.19 ∼ 2.19) and 1.68 (95% CI: 1.24 ∼ 2.29), respectively. Moreover, the ORs for Q2 (1.02, 95% CI: 0.73 ∼ 1.42) and Q4 (1.18, 95% CI: 0.85 ∼ 1.63) resembled that of Q3. Compared with the merged Q2-4 group, the ORs were 1.52 (95% CI: 1.21 ∼ 1.92) for Q1 group and 1.58 (95% CI: 1.25 ∼ 2) for the Q5 group. Subgroup analysis revealed that the U-shaped association between the SHR and mid/high SYNTAX score was attenuated in DM patients (P for interaction = 0.045).ConclusionsThere were U-shaped associations between the SHR and CAD complexity in ACS patients, with an SHR ranging from 0.68 to 0.875 indicating a relatively lower OR for mid/high SYNTAX scores. Further studies are necessary to both evaluate the predictive value of the SHR in ACS patients and explore the underlying mechanisms of the observed U-shaped associations.

Impact of coronary collateralization on major adverse cardiovascular and cerebrovascular events after successful recanalization of chronic total occlusion.

This study aims to investigate the effects of coronary collateral circulation (CCC) on the prognosis of chronic total occlusion (CTO) patients with or without metabolic syndrome (MetS). The study included 342 CTO patients who underwent successful percutaneous coronary intervention at the People's Hospital of Liaoning Province between 1 February 2021 and 30 September 2023. The Rentrop score was used to assess the status of CCC. The outcome was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR), and non-fatal stroke. Univariate and multivariate logistic analyses were used to investigate the association of CCC, MetS, and MACCEs with odds ratios (ORs) and 95% confidence intervals (CIs). The effect of CCC was further investigated in different MetS, diabetes mellitus (DM), and Syntax score groups. MACCEs were more common in patients with poor CCC compared to those with good CCC (38.74% vs. 16.56%). Statistical differences were found in MACCEs (OR = 3.33, 95% CI: 1.93-5.72), MI (OR = 3.11, 95% CI: 1.73-5.58), TVR (OR = 3.06, 95% CI: 1.70-5.53), and stent thrombosis (OR = 6.14, 95% CI: 2.76-13.65) between the good and poor CCC groups. Poor CCC patients with MetS had a higher incidence of MACCEs (OR = 4.21, 95% CI: 2.05-8.65), non-fatal MI (OR = 4.44, 95% CI: 2.01-9.83), TVR (OR = 3.28, 95% CI: 1.51-7.11), and stent thrombosis (OR = 10.80, 95% CI: 3.11-37.54). Similar findings were also observed in CTO patients with DM and a Syntax score ≥23. Poor CCC could increase the risk of MACCEs in CTO patients, particularly those with MetS, DM, and a Syntax score ≥23. Further prospective, multicenter studies are needed to validate our findings and to explore potential therapeutic interventions.

Analysis of long non-coding RNA RMRP in the diagnosis and prognosis of coronary artery disease

BackgroundLong non-coding RNAs (lncRNAs) are abundant and closely related to the occurrence and development of human diseases. LncRNAs are known to play a key role in many cardiovascular diseases. The purpose of this study was to investigate the effect of the RNA component of mitochondrial RNA-processing endoribonuclease (RMRP) on the degree of coronary artery lesions and prognosis in patients with coronary artery disease (CAD).MethodsPatients who underwent coronary angiography (CAG) and dynamical-single photon emission computed tomography (D-SPECT) were selected as study subjects, and the results of CAG were reviewed, and the patients were grouped according to SYNTAX score. Evaluate the factors affecting SYNTAX scores. The follow-up analysis was conducted, and the endpoint events were major adverse cardiovascular events (MACEs). Kaplan–Meier method was used to estimate the survival rate, and multivariate Cox regression was used to analyze the relationship between RMRP and MACEs.ResultsThe expression level of serum RMRP in patients with CAD was significantly higher than that in healthy people. Multivariate Logistic regression analysis showed that age, low-density lipoprotein cholesterol (LDL-C), RMRP and rest left ventricular ejection fraction (LVEF) were independent factors that affected SYNTAX scores. There were 19 cases of MACEs in the high RMRP group and 9 cases in the low RMRP group, and there was a significant difference in the MACE free survival curve between the two groups. Multivariate Cox regression analysis showed that age, SYNTAX score, rest LVEF and RMRP were risk factors for MACEs.ConclusionsSerum RMRP is a key factor affecting the degree of coronary artery disease and prognosis in CAD patients.

Factors associated with deterioration of myocardial inotropic function in patients with coronary artery disease

Material and methods. One hundred patients with functional class III-IV CAD, stage I-IIa heart failure with LV ejection fraction (EF) &gt;40%, successful coronary artery bypass grafting, SYNTAX Score of 33. During hospitalization, echocardiography, matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), monocyte chemoattractant protein 1 (MCP-1) were studied, while systemic immune-inflammation index (SII) was estimated. After 6 months, echocardiography revealed a group of patients with a decrease in LVEF.Results. The following factors of decreased LVEF were identified: type 2 diabetes, chronic kidney disease (p&lt;0,001), &gt;4 comorbid diseases (r=-0,597, p&lt;0,001), increase in SII by 44,6% (p&lt;0,001), MMP-9 by 62% (p&lt;0,001), MCP-1 by 55,1% (p&lt;0,001), TIMP-1 by 45,8% (p&lt;0,001). An inverse relationship was found between LVEF and the level of SII (r=-0,626, p&lt;0,001), MCP-1 (r=-0,747, p&lt;0,001), MMP-9 (r=-0,718, p&lt;0,001). There were following threshold values for predicting a decrease in LVEF: SII — 356,43, MMP-9 — 318,7 ng/ml, MCP-1 — 459,6 pg/ml.Conclusion. There are following markers of decreased LVEF in patients with CAD 6 months after successful coronary artery bypass surgery: type 2 diabetes, chronic kidney disease, &gt;4 comorbid diseases, SII, MMP-9 and MCP-1 with a threshold value of 356,43, 318,7 ng/ml and 459,6 pg/ml, respectively.

Prevalence of Carotid Artery Stenosis in Patients with Acute Myocardial Infarction Admitted to a Coronary Care Unit and its Relationship with Coronary Angiographic Findings

Objectives: The prevalence and clinical significance of carotid artery stenosis (CAS) in acute myocardial infarction (AMI) patients remain uncertain. This study aims to evaluate CAS prevalence and its association with coronary artery disease (CAD) severity in AMI patients admitted to a coronary care unit (CCU). Methodology: In this cross-sectional study, 100 consecutively selected AMI patients underwent ultrasound Doppler carotid artery assessments, including measurements of carotid intima-media thickness (cIMT), identification of plaque (stenosis &gt;0%), and calculation of internal carotid artery/common carotid artery (ICA/CCA) peak systolic velocity ratio. Angiographic findings, including the number of diseased vessels and Syntax score (SS), were also recorded. Results: Among the study cohort (mean age 55.1±11.2 years, 78 males), 32 patients exhibited CAS, with 8 having cIMT&gt;1.2mm, 3 showing ICA/CCA PSV ratio&gt;2, and 25 presenting plaque. CAS prevalence did not significantly correlate with CAD severity, regardless of the number of diseased vessels or SS. Similarly, CAS rates did not significantly differ based on SS categories (low, intermediate, high). While CAS prevalence trended higher in patients with conventional atherosclerotic risk factors (diabetes, hypertension, smoking, obesity), these associations were not statistically significant. Conclusion: CAS was prevalent in approximately one-third of AMI patients, yet it did not demonstrate a significant association with CAD severity or SS. However, CAS rates tended to increase with the presence of conventional atherosclerotic risk factors. Further research is warranted to elucidate the clinical implications of CAS in AMI patients and its relationship with CAD severity.

The association between dietary meal intake habits and coronary artery stenosis and cardio-metabolic risk factors

Background and objectiveWe are not aware of studies examining the association between dietary meal intake habits (DMIH) and severity of coronary artery stenosis (CAS). This study was conducted to investigate the relationship between DMIH and the severity of CAS as well as cardiometabolic risk factors in adults undergoing coronary angiography.MethodsThis cross-sectional study was done on 720 patients undergoing coronary angiography (aged 35–75 years) who were admitted to Afshar Hospital, a referral hospital for cardiovascular diseases in Yazd, Iran. Data on DMIH were gathered by interview. Blood samples were taken for biochemical analysis. Blood pressure, anthropometric indices, and body composition were also evaluated. The relationship between DMIH and the severity of CAS [examined by angiography based on Gensini Score (GS) and Syntax Score (SS)] and cardiometabolic risk factors were assessed using logistic regression and the analysis of covariance (ANCOVA), respectively, in crude and multivariable adjusted models.ResultsAfter adjustment for all possible confounding variables, the study revealed that people who ate 3 meals/day had a lower risk of severe CAS compared to people who ate 2 or fewer meals (OR = 0.48, 95% CI: 0.26, 0.88, P-trend = 0.02). There was an inverse association between the number of snacks /day and the severity of CAS (OR = 0.43, 95% CI: 0.22, 0.87, P-trend = 0.02). There was also an inverse relationship between breakfast frequency/week and the severity of CAS based on both GS and SS (P < 0.05). Breakfast consumption, meal frequency, lunch consumption, snack frequency, and more food consumption on holidays were also associated with different cardiometabolic markers and anthropometric measures (P < 0.05).ConclusionAccording to the results of the present study, meal frequency and breakfast consumption might be inversely associated with CAS and cardiometabolic risk factors.

Validity of the Triglyceride-Glucose Indices for Predicting the Severity of Coronary Artery Disease in Patients With Nondiabetic Chronic Coronary Syndrome.

The triglyceride-glucose (TyG) index was shown to be an independent predictor of coronary artery disease (CAD) progression and prognosis. However, whether the TyG index can predict the severity of CAD in nondiabetic patients with chronic coronary syndrome remains unclear. A total of 118 individuals who underwent elective coronary angiography were classified into group A (59 with coronary lesions) and group B (59 with normal coronary arteries; as a control group) after coronary angiography and laboratory tests for fasting and the postprandial (PP) TyG index. The complexity of CAD was determined by the Synergy Between Percutaneous Coronary Intervention (SYNTAX) score (SYNTAX score >22 indicated moderate-high risk), and patients diagnosed with diabetes or prediabetes were excluded. The TyG index was not related to the SYNTAX score in groups A and B; however, in the CAD group with an low-density lipoprotein (LDL) concentration <70 mg/dL (group A1), a fasting TyG index ≥8.25 and a PP TyG index ≥11 could predict moderate-high SYNTAX risk score; in addition, the odds ratio (OR) was 4.3× higher and the relative risk (RR) was 1.8× greater (OR = 4.3, RR = 1.8, 95% confidence interval = 1.4-13.5, P < 0.05) for individuals with a higher fasting TyG index ≥8.25 to have a moderate-high SYNTAX risk score. Individuals with a higher PP TyG index ≥11 had OR of 2.6× higher and a RR of 1.4× greater to have moderate-high SYNTAX risk score. Both fasting and PP TyG levels were associated with greater coronary anatomical complexity (SYNTAX score >22) in nondiabetic chronic coronary patients with LDL <70 mg/dL. Fasting and the PP TyG indices can serve as noninvasive predictors of CAD complexity in nondiabetic patients with LDL <70 mg/dL and could change the management and therapeutic approaches.

Prognostic value of residual SYNTAX score in patients with coronary artery disease undergoing percutaneous coronary intervention-cohort study

Residual Syntax Score (RSS) is derived from Syntax Score to quantify the burden of residual coronary artery disease after percutaneous coronary intervention (PCI). As data is limited, we report predictive utility of Residual SYNTAX Score in relation to in hospital and 1 year mortality of the patients undergoing percutaneous coronary intervention (PCI).