SYNTAX Score Research Articles

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).

Interventional treatment in elderly patients with severe aortic valve stenosis and coronary artery disease

Aortic stenosis (AS) is a valvular heart disease commonly found in the elderly patients and frequently is associated with coronary artery disease (CAD). The impact of CAD severity and of the percutaneous coronary intervention (PCI) on post-TAVI outcomes is frequently debated. Purpose. Comparison of clinical and hemodynamic outcomes, as well as the rate of major adverse cardiovascular and cerebrovascular events (MACE) in patients undergoing TAVI with PCI (patients with AS and CAD) versus isolated TAVI (patients with AS). Material and methods. Our team conducted a prospective study that included 41 patients, with an age greater than 70 years old, who were diagnosed with severe aortic valve stenosis. After performing coronary angiography, the patients were divided into two groups: 32 patients without significant coronary lesions and 9 patients with multivessel lesions with a Syntax Score &lt;22 and who subsequently underwent coronary angioplasty (PCI). Results. The TAVI procedure was performed with a 100% success rate. After the procedure, the ejection fraction increased inconsiderably in all patients, but the average pressure gradient decreased impressively, the average value being12.59 ± 5.62 mmHg vs 14.78 ± 8.73 mmHg, p&lt; 0.001. The peak velocity of the jet through the aortic valve is 2.36 ± 0.50 m/s vs 2.53 ± 0.83 m/s, p&lt; 0.001.Conclusion. The one-year post-procedural follow-up showed that both groups of patients had a similar rate of MACE, with a significant improvement in clinical-hemodynamic parameters according to transthoracic echocardiography data.

Comparative Efficacy of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in the Treatment of Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials.

Ischemic heart disease (IHD) is a major global health issue and a leading cause of death. This study compares the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the management of IHD, focusing on their impact on revascularization, myocardial infarction (MI), and post-procedural stroke. This study aimed to evaluate and compare the effectiveness of PCI and CABG in treating IHD based on an exhaustive literature review of the past 5 years, emphasizing recent advancements and outcomes in IHD management. A comprehensive literature review analyzed 32 randomized controlled trials (RCTs) retrieved from databases such as PubMed, Cochrane Library, and Google Scholar. The study specifically assessed the incidences of revascularization, stroke, and MI in patients treated with either PCI or CABG. The comparison between CABG and PCI exclusively focused on lesions with a SYNTAX score exceeding 32. Our findings highlight CABG's significant efficacy over PCI in reducing revascularization and MI. The aggregated Mantel-Haenszel (M-H) value for revascularization was 1.85 (95% confidence interval (CI): 1.65 - 2.07), signifying CABG's advantage. Additionally, CABG demonstrated superior performance in diminishing MI occurrences (M-H = 2.71, 95% CI: 1.13 - 6.53). In contrast, PCI was more effective in reducing stroke (M-H = 0.80, 95% CI: 0.60 - 1.10). The study confirms CABG's superiority in reducing revascularization and MI in IHD patients, highlighting PCI's effectiveness in reducing stroke risk. These findings underscore the importance of personalized treatment strategies in IHD management and emphasize the need for ongoing research and evidence-based guidelines to aid in treatment selection for IHD patients.

Association of Severity of Coronary Artery Disease With SYNTAX Score and Ankle Brachial Index

Association of Severity of Coronary Artery Disease With SYNTAX Score and Ankle Brachial Index

The role of the osteoprotegerin/RANKL/RANK axis and osteopontin in acute coronary syndrome.

The primary objective of this study is to ascertain the levels of osteoprotegerin (OPG) and osteopontin (OPN), alongside osteoprotegerin/RANKL ratio (ORR), and assess their association with the SYNTAX score and ascertain the potential of these molecules as predictive markers for risk, aiding in risk stratification. Eventually, they could potentially be employed even before angiography to gauge the severity of coronary lesions. Prospective study with 147 participants, 101 (69%) were men, with an average age of 60. We included three groups - (1) patients with acute coronary syndrome undergoing percutaneous coronary intervention (ACS-PCI), (2) patients without ACS who underwent coronary angiography for an indication other than ischemia and did not undergo PCI (non-ACS without), and (3) one asymptomatic subject. OPG and OPN were measured. ORR and SYNTAX scores were calculated. The association between OPG and OPN levels and important clinical variables was investigated. OPG levels in Group 1 were lower compared to Groups 2 and 3 (controls), Group 1 (490 pg/mL) versus Group 2 (829 pg/mL) versus Group 3 (845 pg/mL) (p = 0.001). OPG had lower levels in patients with coronary artery stenosis versus without stenosis. A decrease in ORR was shown in all groups and no association with the SYNTAX score. OPG and OPN (and ORR) levels are decreased in patients with ACS and show no correlation with the SYNTAX score. As an exploratory study, our work suggest that increased OPG and OPN levels in non-ACS patients may have, in fact, a protective effect. This study is one of the few with an appropriate control in ACS and reproducibility is necessary mainly with multicenter studies.

Joint Effects of Dietary Patterns and Paraoxonase1 rs662 Polymorphism on Coronary Artery Disease Severity (Gensini and SYNTAX Scores) and Its Risk Factors in adults Undergoing Angiography.

The present study aims to assess the interaction of dietary patterns (DPs) and paraoxonase1 (PON1) rs662 polymorphism on coronary artery disease (CAD) severity and its risk factors. This cross-sectional study is conducted on 425 patients undergoing angiography. The PON1 genotypes are detected by the polymerase chain reaction-restriction fragment length polymorphism (RFLP-PCR) technique. DPs are extracted by exploratory factor analysis. Two dietary patterns Western (WDP) and Traditional (TDP) are extracted. A gene-diet interaction concerning a high Gensini score is observed. Accordingly, high adherence to the WDP increases the odds of a high Gensini score in R allele carriers compared to QQ genotype carriers by 2.48 times (odds ratio [OR]: 2.48, 95% confidence interval [CI] 0.98-6.26, p = 0.05). Also, the risk of high systolic blood pressure (SBP) is higher in R allele carriers with high adherence to the WDP compared to QQ genotype carriers(OR: 3.49, 95% CI 1.38-8.82, p<0.001. No significant interaction is observed between TDP and PON1 rs662 on any cardiometabolic risk factors (p-value>0.05). The results remain significant after adjusting for confounders. The present study's findings indicate the existence of an interaction between the PON1 rs662 polymorphism and the WDP on the risk of stenosis severity and high SBP.

Circulating trimethylamine N-oxide is correlated with high coronary artery atherosclerotic burden in individuals with newly diagnosed coronary heart disease

BackgroundTrimethylamine N-oxide (TMAO) is a metabolite derived from the gut microbiota and has been reported to be correlated with cardiovascular diseases. Although TMAO is associated with the severity of coronary artery disease in subjects with coronary heart disease (CHD) history. However, the correlation between TMAO and the atherosclerotic burden in newly diagnosed cases of CHD is unknown.MethodsIn this hospital-based study, we enrolled 429 individuals newly diagnosed with CHD undergoing coronary angiography. Plasma TMAO was assessed before coronary angiography. SYNTAX score was computed during coronary angiography to estimate the coronary artery atherosclerotic burden. Both linear and logistic regression analyses were conducted to explore the correlation between plasma TMAO levels and SYNTAX score in newly diagnosed CHD population.ResultsThe TMAO in patients with SYNTAX ≥ 33 and subjects with SYNTAX < 23 were 6.10 (interquartile range [IQR]: 3.53 to 9.15) µmol/L and 4.90 [IQR: 3.25 to 7.68] µmol/L, respectively. Linear regression adjusting for traditional risk factors showed TMAO level was positively correlated with SYNTAX score (β = 0.179; p = 0.006) in CHD population. When TMAO was added to models with traditional risk factors, the predictive value improved significantly, with the receiver operating characteristic curve (AUC) increased from 0.7312 to 0.7502 (p = 0.003). Stratified analysis showed that the correlations did not hold true for subjects who were non-smoker or with histories of diabetes. None of the stratifying factors significantly altered the correlation (all p for interaction < 0.05).ConclusionsWe found a positive linear correlation between plasma TMAO and SYNTAX score among newly diagnosed CHD individuals in Chinese population.

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

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