Unstable Angina Group Research Articles

Analysis of the correlation and diagnostic value of serum visfatin, hs-CRP and TNF-α in patients with different types of angina pectoris

Objective To explore the correlation and diagnostic value of serum visfatin (visfatin), high sensitive C reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) in patients with different types of angina pectoris. Methods Eighty-four patients with angina pectoris who were treated in the Eighth hospital of Wuhan from January 2013 to December 2016 were selected as the research subjects, the patients were divided into stable angina pectoris (SAP) group with 39 cases and unstable angina pectoris (UAP) group with 45 cases according to the classification criteria of angina pectoris, Thirty-seven healthy volunteers in the outpatient department of the same period were selected as the control group.To compare the levels of serum visfatin, hs-CRP and TNF-alpha in three groups, analyze the correlation between the levels of serum visfatin and hs-CRP and TNF-alpha levels in patients with angina pectoris, and analyze the diagnostic value of the levels of serum visfatin, hs-CRP, TNF-α and plasma oxidized low density lipoprotein (Ox-LDL) by ROC curve. Results There were no significant differences in fasting blood glucose, uric acid, creatinine, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) among the three groups (all P>0.05). The systolic pressure (SBP) was (134.27±11.96)mmHg and diastolic pressure (DBP) was (84.23±7.15)mmHg in SAP group, the SBP was (135.98±12.33)mmHg and DBP was (84.47±7.22)mmHg in UAP group, which were all higher than SBP ((121.49±9.97)mmHg )and DBP( (77.38±6.94)mmHg) in the control group (all P 0.05). The level of visfatin in UAP group was (6.57±1.36)μg/L, which was higher than that in SAP group( (4.62±1.08)μg/L) and in control group( (4.27±1.03)μg/L) (all P 0.05). The level of serum hs-CRP, TNF-α and plasma Ox-LDL were (12.38±2.63) mg/L, (4.35±0.28) ng/L and (617.32±53.48) μg/L in UAP group, and the level of serum hs-CRP, TNF-α and plasma Ox-LDL were (8.29±1.74) mg/L, (1.82±0.34)ng/L and (418.57±43.85)μg/L in SAP group, which were higher than hs-CRP (4.06±1.52) mg/L, TNF-α (0.98±0.13)ng/L, Ox-LDL (213.64±32.83)μg/L in control group(all P 0.05). The serum visfatin level was positively correlated with serum hs-CRP, TNF-alpha level and plasma Ox-LDL level in SAP group.(r=0.687, 0.634, 0.656, all P<0.05). The serum visfatin level was positively correlated with the serum hs-CRP, TNF-a level and Ox-LDL level in UAP group (r=0.721, 0.652, 0.673, all P<0.05). ROC curve analysis showed that the levels of serum visfatin, hs-CRP, TNF-α and plasma Ox-LDL were all near 0.7, and the sensitivity and specificity were all above 0.6 identification of different types of angina pectoris. Conclusion The level of serum visfatin in patients with UAP was significantly higher than that of SAP patients, its level is related to serum hs-CRP, TNF- alpha and plasma Ox-LDL levels, the four indexes have a certain predictive value for different types of angina pectoris, and can provide reference for different types of angina. Key words: Stable angina pectoris; Unstable angina pectoris; Visfatin; High sensitive C reactive protein; Tumor necrosis factorα

Endothelial Nitric Oxide Level as a Predictor of Coronary Complexity in Patients With Unstable Angina Pectoris

BackgroundThe Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is an anatomic scoring system based on coronary angiography that quantifies lesion severity and complexity and predicts morbidity and mortality to guide decision making between coronary artery bypass graft surgery and percutaneous coronary intervention in patients with acute coronary syndrome. The present study aimed to compare nitric oxide levels with the SYNTAX score in terms of predicting coronary complexity and the treatment decision for unstable angina pectoris in the emergency department. MethodsThe study included 120 patients with unstable angina pectoris and 120 control group subjects. Nitric oxide levels were compared with the SYNTAX score and the treatment decision. The UAP group was divided into 2 subgroups, first based on SYNTAX score of ≤18, >18-27 or >27 and then on the treatment decision of coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft surgery. ResultsThe mean nitric oxide levels in the unstable angina pectoris group were lower than in the control group (P < 0.001). Nitric oxide levels were negatively correlated with the SYNTAX score and the treatment decision (r = −0.227, P = 0.013; r = −0.498, P < 0.001, respectively). The nitric oxide levels were decreased with SYNTAX score >27 compared with >18-27 and ≤18 (P = 0.04-0.003, respectively). Nitric oxide levels were decreased in coronary artery bypass graft surgery subgroup compared with the coronary angiography and percutaneous coronary intervention groups (P < 0.001-0.018 and P < 0.001, respectively). ConclusionsNitric oxide may be considered as a novel biomarker in the prediction of coronary complexity in patients with unstable angina pectoris.

Association between serum adropin level and coronary artery disease: a systematic review and meta-analysis.

Recent studies have found that adropin is associated with coronary artery disease (CAD). This meta-analysis sought to assess the relationship between serum adropin level and CAD. Online databases including the Cochrane Library, PubMed, EMbase, Ovid, CBM, CNKI, VIP and WanFang Data were electronically searched for the clinical study concerning the relationship between serum adropin levels and CAD, including acute myocardial infarction (AMI), unstable angina pectoris (UAP), and stable angina pectoris (SAP). Two reviewers independently screened literature, extracted data and assessed methodological quality of included studies. Standard mean difference (SMD) with its 95% confidence interval (CI) was used as the effect size in this study. Then meta-analysis was performed using RevMan 5.2 software. A total of seven articles involved 945 participants were included. The results indicated that serum adropin level in CAD group was lower than healthy control group (SMD =-2.44, P=0.0008). In the subgroup analysis, the levels of serum adropin in AMI group (SMD =-2.96, P<0.00001), UAP group (SMD =-2.09, P=0.0001) and SAP group (SMD =-1.23, P=0.007) were also lower than that of healthy control. Serum adropin level in patients with CAD was lower than healthy individuals, indicating that the decrease of adropin concentration might play an important role in the development of CAD.

Circulating Oxidized Low-Density Lipoprotein is a Strong Risk Factor for the Early Stage of Coronary Heart Disease.

This study aimed to detect the circulating oxidized low-density lipoprotein (ox-LDL) levels of controls and patients with stable angina pectoris (SAP), unstable angina pectoris (UAP), and acute myocardial infarction (AMI) and also to investigate the correlation with the severity of coronary heart disease (CHD). Plasma levels of circulating ox-LDL-4E6, malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), total cholesterol, high-density lipoprotein cholesterol, LDL cholesterol, apoprotein A, apoprotein B, and lipoprotein (a) (Lp(a)) were measured in 99 participants who underwent coronary angiography. The plasma ox-LDL level was significantly higher in patients with CHD than in controls (P = 0.000). However, it was lower in the UAP and AMI groups than in the SAP group (P = 0.000). The lipid peroxide level (MDA) showed a significant difference among all groups (P = 0.000). It increased significantly in patients with CHD. The Lp(a) and hs-CRP levels were significantly higher in patients with CHD (P = 0.000 and 0.000, respectively). No difference in Lp(a) was found among the SAP, UAP, and AMI groups (P = 0.296). In patients with CHD, the plasma ox-LDL correlated negatively with hs-CRP (P = 0.011), and serum MDA correlated positively with hs-CRP (P = 0.004). The plasma ox-LDL could be used as a strong risk factor for the early stage but not the advanced stage of CHD. Hs-CRP may bound and transfer ox-LDL to macrophages. © 2018 IUBMB Life, 71(1):277-282, 2019.

Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program

ObjectivesThe aim of this study was to determine predictors and outcomes associated with staged percutaneous coronary intervention (PCI) versus one-time multivessel revascularization (OTMVR) in patients with multivessel coronary artery disease. BackgroundPrior observational studies have not evaluated predictors and outcomes of staged PCI versus OTMVR in a heterogenous population of patients with multivessel coronary artery disease who undergo multivessel revascularization. MethodsData from the Veterans Affairs (VA) CART (Clinical Assessment, Reporting, and Tracking) Program were used to evaluate patients who underwent PCI of >2 vessels between October 1, 2007, and September 3, 2014. Associations between individual factors and the decision to perform staged PCI were assessed. Additionally, the impact of measured patient and procedural factors, site factors, and unmeasured site factors on the decision to perform staged PCI was compared. Cox proportional hazards models were used to determine the association between staged PCI and mortality. ResultsA total of 7,599 patients at 61 sites were included. The decision to perform staged PCI was driven by procedural characteristics and unmeasured site factors. Staged PCI was associated with lower risk-adjusted mortality compared with OTMVR (adjusted hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.72 to 0.84; p < 0.01). This mortality benefit was observed among the ST-segment elevation myocardial infarction (HR: 0.31; 95% CI: 0.21 to 0.47; p < 0.01), non–ST-segment elevation myocardial infarction (HR: 0.74; 95% CI: 0.64 to 0.87; p < 0.01), unstable angina (HR: 0.75; 95% CI: 0.64 to 0.89; p < 0.01) and stable angina (HR: 0.88; 95% CI: 0.77 to 1.00; p = 0.05) groups. ConclusionsThe decision to pursue staged PCI was driven by procedural characteristics and unmeasured site variation and was associated with lower mortality compared with OTMVR. After adjustment, there was an association between staged PCI and reduced mortality. Given the observational nature of these findings, a randomized trial comparing the 2 is needed to guide practice.

Association between the level of CD4+ T lymphocyte microRNA-155 and coronary artery disease in patients with unstable angina pectoris.

ObjectiveTo study the association between the expression of microRNA-155 (miRNA-155) in peripheral blood CD4+ T lymphocytes and the level of serum interferon-γ (IFN-γ) concentration and the severity of coronary artery disease (CAD).MethodsAfter coronary angiography, 252 patients with suspected unstable angina pectoris (UAP) were divided into the UAP group (128 patients with CAD confirmed by angiography) and the control group (124 patients without CAD confirmed by angiography). Fresh peripheral blood was extracted 16–24 h before coronary angiography, CD4+ T lymphocytes was tested using immunomagnetic beads, the expression of miRNA-155 was tested using quantitative PCR and the expression of IFN-γ was tested using enzyme-linked immunosorbent assay (ELISA). According to the results of angiography, Gensini score of coronary artery lesions was analyzed. Furthermore, we also analysis the association between the level of miRNA-155 in peripheral blood CD4+ T lymphocytes, the level of serum IFN-γ and Gensini score of coronary lesion.ResultsThe levels of miRNA-155 (0.49 ± 0.08 vs. 0.23 ± 0.09) and IFN-γ (227.58 ± 26.01 vs. 141.23 ± 17.89) in the UAP group were significantly higher than that of the control group, the difference was statistically significant. The level of miRNA-155 and IFN-γ were positively correlated with Gensini score of CAD (r = 0.534, r = 0.713, respectively, all P < 0.05). The level of miRNA-155 was positively correlated with the level of IFN-γ (r = 0.686, P < 0.05).ConclusionsThe level of miRNA-155 in peripheral blood CD4+ T lymphocytes and the level of IFN-γ are closely correlated with the severity of CAD.

Histopathological analysis of the coronary atheroma extracted during coronary artery bypass graft surgery

This study aims to evaluate the histopathological analysis as well as the effect of coronary endarterectomy with severe calcified coronary artery disease. During the year of 2015 to 2017, a total of 135 patients (56 patients of stable angina and 79 patients of unstable angina) underwent atherectomy in adjunct to off-pump coronary artery bypass graft surgery. Histopathological study of atheroma specimen demonstrates the presence of calcification, foam cell, cholesterol clefts, thrombus, smooth muscle cell, and also necrotic tissue using standard hematoxylin and eosin stain techniques. However, smooth muscle cells and foam cell were identified with plaque using the monoclonal antibodies. Thrombus was more common in unstable angina group of patients (64.4%) in comparison to the patients with stable angina (23.2%). An accelerated progression pattern of smooth muscle cell proliferation and calcification were observed which was also common and significantly higher in unstable angina group of patients. The presence of thrombus and accelerated progressive pattern of smooth muscle cell proliferation in unstable angina patients imply the episodic disruption of atheromatous plaque followed by subsequent healing and may play a vital role in the pathophysiology of underlying angina pectoris.

The changes and clinical significance of plasma lipoprotein-associated phospholipase A2, C-reactive protein and cardiac troponin I in patients with acute coronary syndrome

Objective To investigate the relationship between lipoprotein associated phospholipase A2 (Lp-PLA2) and atherosclerotic plaque instability in patients with acute coronary syndrome (ACS), and to provide theoretical basis for diagnosis and treatment of ACS. Methods From September 2015 to February 2016, 80 patients with ACS in Shidao People's Hospital of Rongcheng were selected as the study group, including 38 cases in unstable angina group(UAP group), 24 cases in non ST segment elevation myocardial infarction group (NSTEMI group), 18 cases in ST segment elevation myocardial infarction group(STEMI group). Forty patients with stable angina pectoris(SAP group) and 40 healthy subjects(healthy group) were selected as control group.Each group was collected 8 hours fasting morning blood sample, the levels of Lp-PLA2, C reactive protein(CRP), troponin I, and low density lipoprotein were detected, in order to compare the differences among the groups and the correlation between Lp-PLA2 and ACS plaque instability was analyzed. Results The levels of Lp-PLA2, CRP, troponin I and low density lipoprotein in the ACS group were (312.63±11.14)ng/mL, (21.98±7.83)mg/L, (0.720±0.490)μg/L, (174.76±30.82)mg/dL, respectively, which were significantly higher than those of the healthy group [(141.14±12.30)ng/mL, (2.38±1.68)mg/L, (0.010±0.003)μg/L, (79.24±17.80)mg/Ml], and stable angina pectoris group[(176.42±12.44)ng/mL, (4.22±3.68)mg/L, (0.010±0.004)μg/L, (96.54±19.41)mg/mL]. There were statistically significant differences among all groups(F=3.07, 1.99, 2.43, 3.25, all P<0.01). The levels of CRP, Lp-PLA2 and cTnI in ACS patients with different types of the STEMI group, NSTEMI group, UAP group had statistically significant differences, which of the STEMI group were higher than those of the NSTEMI group, which of the NSTEMI group were higher than those of the UAP group(F=5.15, 3.47, 2.43, all P<0.05). Correlation analysis showed that the level of Lp-PLA2 was positively correlated with low density lipoprotein(r=0.625, P<0.01) and lipoprotein a(r=0.532, P<0.01). logistic regression analysis showed that Lp-PLA2 and CRP were significant independent risk factors of ACS, Lp-PLA2(OR=1.613, 95%CI: 1.292-1.992, P<0.01), CRP(OR=1.452, 95%CI: 1.210-1.782, P<0.01). Conclusion Lp-PLA2 is independent risk factor of ACS.Lp-PLA2 is involved in the inflammatory reaction of ACS, and is strongly associated with the stability of atherosclerotic plaque. Key words: Acute coronary syndrome; Lipoprotein-associated phospholiase A2; C-reactive protein; cardiac troponin I; Regression analysis

Circulating microRNA expression profiling and bioinformatics analysis of dysregulated microRNAs of patients with coronary artery disease.

MicroRNs (miRNAs) are small non-coding RNAs that modulate the expression of protein-coding genes at the post-transcription level and their dysregulated expression has been implicated in cardiovascular diseases. Circulating miRNAs have been widely recommended as potential biomarkers for many diseases including coronary artery disease. In this study, the miRNA expression profiles of 6 normal coronary artery (NCA), 12 patients with coronary artery disease including 6 unstable angina (UA) patients and 6 ST-segment elevation myocardial infarction (STEMI) patients were determined by small RNA sequencing. The differential expression of miRNAs was verified via using quantitative reverse transcription polymerase chain reaction (qRT-PCR). We further performed bioinformatics analysis for the differentially expressed miRNAs. The results showed that 60 miRNAs were up-regulated and 26 miRNAs were down-regulated in the UA group and 49 miRNAs were up-regulated and 62 miRNAs were down-regulated in the UA group when compared with the NCA group. Among them, both of UA group and STEMI group shared 38 dysregulated miRNAs (28 up-regulated and 10 down-regulated) versus NCA group. ROC curves analysis showed that miR-142-3p and miR-17-5p might server as potential biomarkers for the detection and diagnosis of UA and STEMI. Bioinformatics functional predictions showed that the differential expressed miRNAs were closely related with the pathological process of coronary artery disease. We comprehensively analyzed profile expression of circulating miRNAs of patients with coronary artery disease. Our study suggested that miR-142-3p and miR-17-5p might be potential targets for follow-up research in evaluating biomarkers of coronary artery disease.

Correlation between initial left ventricular function and predischarged 6-minute walking distance in patient with acute coronary syndromes in intensive cardiac care unit

Acute Coronary Syndromes (ACS) is a spectrum of conditions compatible with acute myocardial ischemia and or infarction due to abrupt reduction in coronary blood flow. It can manifest as ST-Elevation Myocardial Infarction (STEMI), Non ST-Elevation Myocardial Infarction (NSTEMI) or Unstable Angina Pectoris (UAP). It can cause decrease function of the left ventricle, which can be measured by Ejection Fraction (EF) through Echocardiography. In CiptoMangunkusumo Hospital, phase I Cardiac Rehabilitation were given in Intensive Cardiac Care Unit (ICCU) and Six Minutes Walking Test (6MWT) were done before patients discharged to get 6 minutes walking distance (6MWD) that can be used as a prognostic tools. This study aims to find correlations between initial left ventricular function measured by ejection fraction and predischarged 6MWD in patients with ACS. This is a retrospective study. Forty-three subjects were diagnosed with ACS, admitted at ICCU on January-May 2017 were divided into 3 groups (STEMI, NSTEMI and UAP). Echocardiography were done initially on the ICCU. All patients underwent phase I rehabilitation. The 6MWT were done on the last day of hospitalization, before discharged. Twenty-one patients (49%) were diagnosed with STEMI, 8 patients (19%) with NSTEMI, and 14 patients (32%) with UAP. The mean age were 52 (± 9.6). All data were normally distributed. The mean EF were 48 (± 2.0) % in STEMI, 43 (± 3.7) in NSTEMI and 62 (± 2.5) in UAP. The mean 6MWD were 290 (± 19.4) meters in STEMI, 274 (± 27.8) in NSTEMI and 330 (± 23.0) in UAP. There were no correlations of EF and 6MWD. There are no correlations between initial left ventricular function and predischarged 6MWD in patient with ACS in ICCU settings. The mean 6MWD in STEMI and NSTEMI group were lower than 300 meters indicating worse prognosis compare to UAP group.

Monocytes of patients with unstable angina express high levels of chemokine and pattern-recognition receptors

Background and aimsMacrophages derived from monocytes play an important role in atherosclerosis progression. Subpopulations of circulating classical, intermediate, and non-classical monocytes possess distinct functions and phenotypes, and participate in the pathogenesis of disease. The aim of this study was to compare the quantity and phenotypes of circulating monocyte subpopulations in patients with established atherosclerosis and healthy control individuals. Additionally, the study aimed to provide insight into the functional activity of monocytes against a heat shock protein (HSP60). MethodsChemokine and pattern recognition receptors in monocyte subsets obtained from peripheral blood of acute and chronic coronary artery disease patients and controls were quantified by flow cytometry. Furthermore, monocytes from healthy controls were stimulated in vitro with HSP60, and the cytokines produced by them were evaluated by flow cytometry. ResultsEighteen controls (C), 34 individuals with risk factors for cardiovascular disease (RF), 32 patients with stable angina (SA), and 16 patients with unstable angina (UA) were enrolled in the study. The absolute count of intermediate monocytes was found to be increased in patients of the UA group; high frequencies of the chemokine receptors CCR2, CCR5, and CX3CR1 were also observed in this subpopulation. Moreover, the pattern recognition receptors TLR2 and TLR4 were more frequent in intermediate monocytes from the UA group. Furthermore, the intermediate monocytes from healthy individuals produced IL-12p70 after stimulation with HSP60. ConclusionsOur results show that intermediate monocytes of UA patients exhibited an enhanced expression of the receptors involved in the recognition of damage-associated molecular patterns (DAMPs) and enhancement of the migratory function. Hence, they might contribute to the propagation and progression of inflammation observed in atherosclerosis, especially in the acute setting.

Evaluation of white blood cell and neutrophil/lymphocyte ratio in acute coronary syndrome patients admitted to emergency department

Objective: Inflammatory reaction, which causes tissue damage in Acute Coronary Syndrome (ACS), leads to deterioration. White Blood Cell (WBC), Neutrophil (N), Lymphocyte (L) and Neutrophil/ Lymphocyte (N/L) ratios were used to refer to the inflammation. High neutrophil levels show us acute inflammatory situation and low lymphocyte levels show us physiological stress. That is why N/L ratio is a valuable parameter which enables us to guess patient prognosis in Emergency Department (ED). In this study, white cell and NLR relations with ACS in patients with chest pain is evaluated. Material and Method: Patients referring to ED with chest pain within 3 months were investigated retrospectively. 100 patients were included in the study. Patients' WBC count, NLR and WBC values, gender, Troponin-I and CK-MB positivity, history of Coronary Heart Disease (CHD) and additional diseases were examined according to the final diagnoses. All the patients were divided into three groups according to ACS: Unstable Angina Pectoris (USAP), Non-ST Elevated Myocardial Infarction (NSTEMI), and ST-Elevated Myocardial Infarction (STEMI). Mortality and morbidity levels in hospital and after discharge were also examined in the study. Findings: WBC values in patients with positive Troponin-I were found statistically higher than patients with negative Troponin-I (p<0.05). In STEMI group, WBC values were statistically higher than USAP group (p<0.0083). When patients' N/L ratio average distribution was examined; Troponin-I and CK-MB positive patients' NLR was found to be statistically higher than Troponin-I and CK-MB negative ones (p<0.05). Conclusion: N/L ratio, which is a marker of inflammatory process in the myocardial vascular bed, may be considered as a risk marker. For this reason, N/L ratio at admission can be used as an auxiliary parameter for predicting the diagnosis of ACS.

A Novel Coronary CT Angiography Score for Patients of ACS

Background: Coronary atherosclerosis is one of the most significant diseases in recent years. CCTA can provide a non-invasive quantitative assessment of coronary atherosclerotic plaque. Objectives: To describe a novel score with CCTA in assessment of coronary atherosclerotic plaque characteristics in patients with acute coronary syndrome (ACS). Methods: We retrospectively analyzed 213 patients from Jun 2012 to Jun 2014. All patients were classified into four groups: healthy individuals as a control group, unstable angina group (UA), non-ST-segment elevation myocardial infarction group (NSTEMI) and ST-segment elevation myocardial infarction group (STEMI). Segment involvement score (SIS), segment stenosis score (SSS) and a novel CCTA score (CCTAs) were calculated, respectively. All evaluation indicators were analyzed with SPSS 20.0 software. All images were analyzed by two experienced radiologists, they had no knowledge of clinical or angiographic results. Results: 1. Significant differences were found among all groups of age (P=0.007), SBP (P=0.013), and males (P=0.047). 2. Significant differences in SIS, SSS, CCTAs were found between the UA, NSTEMI and STEMI groups (P=0.00) 3. SBP and CCTAs were found to be independent risk factors of UA (OR=1.042, P=0.008; OR=1.211, P=0.000, respectively). CCTAs were independent risk factors of MI (OR=1.77, P=0.000). 4. With healthy group as control, for group UA, AUC of CCTAs was 0.741. For group MI, AUC of CCTAs was 0.955. The efficiency of simultaneously identifying cases (i.e., SBP and CCTAs) in group UA was 0.850. Conclusion: CCTAs are more robust than SIS, SSS scores for the diagnoses of patients with ACS.

Effect of preinfarction angina on primary percutaneous coronary intervention outcomes

Background: Preinfarction angina has been recognized as a surrogate for preconditioning episodes. This study was designed to evaluate the cardiovascular effects of preinfarction anginal episodes among acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: Of 520 patients who had undergone primary PCI, 393 patients were finally included in a prospective cohort study. Standard primary PCI procedure according to the latest guidelines was performed. The patients were divided into three groups based on previous symptoms as follows: asymptomatic (Group A), chronic stable angina (Group B) and unstable angina (Group C). Results: A total of 393 patients were evaluated. 185 (47.1%) patients were described as asymptomatic, 48 (12.2%) had stable angina and 160 (40.7%) were categorized as unstable angina. There was no significant difference among the study groups regarding pre- and post-PCI thrombolysis in myocardial infarction flow grade (P = 0.81). Median of peak post-PCI creatine-kinase-muscle/brain level of Group A (asymptomatic) was 250.5 (115.5–389), and it was significantly higher than Group C (176 [60.00–313.50]) (P = 0.03). Q wave formation was observed in 142 (88.75%), 31 (64.5%), and 96 (52.0%) patients of Group A, B, and C patients, respectively, which was significantly higher in asymptomatic patients (P = 0.002). There was no significant difference among the three groups regarding in-hospital and 6-month mortality (P = 0.36, 0.06, respectively). The composite endpoint of 6-month mortality, acute coronary events, cerebrovascular accidents, and target vessel revascularization was not significantly different between the three groups (P = 0.11). Conclusion: Preinfarction angina among AMI patients undergoing primary PCI seems to have a limited beneficial effect on infarct size, and this benefit was not translated to any clinical benefit.

The impact of acute coronary syndrome on late drug-eluting stents restenosis: Insights from optical coherence tomography.

The aim of the study was to investigate the optical coherence tomography (OCT)-identified difference of in-stent restenosis (ISR) tissue characteristics between patients with and without acute coronary syndrome (ACS) at index intervention.The retrospective study included 80 patients with 85 drug-eluting stent (DES) restenosis lesions. Subjects were classified according to clinical presentation at the time of de-novo lesion intervention, namely ACS and non-ACS. OCT was performed at 5 years follow-up. The frequency of malapposition, neointimal characteristics, thrombus, and minimal stent area (MSA) were evaluated.ACS group consisted of 48 (60%) patients. The mean duration from initial intervention to OCT study was 66.15 months. Malapposition was more frequent in the ACS group (25.5% vs 2.9%, P = .006), as well as a higher prevalence of thrombus in the ACS group (21.6% vs 0%, P = .015). MSA of ACS group was significantly less than that of non-ACS group (4.99 ± 1.80 vs 5.62 ± 2.08 mm2, P = .018). Compared with non-ACS group, only MI group was related to smaller MSA (4.37 ± 1.39 vs 5.62 ± 2.08 mm2, P = .048); The unstable angina (UA) group was not associated with a decreased MSA. The occurrence of neoatherosclerosis tended to be higher in ACS group (60.8% vs 41.2%, P = .076).In DES restenosis, an ACS presentation at initial intervention is associated with a higher incidence of malapposition, thrombus, and smaller MSA.

Blood rheology of angina pectoris patients with myocardial injury after ischemia reperfusion and its effect on thromboxane B2 levels.

This study investigated the changes in the blood rheology of patients with angina pectoris and ischemia reperfusion injury and their effect on thromboxane B2 (TXB2) levels to examine their relationship. Forty patients with unstable angina pectoris who underwent elective percutaneous coronary intervention (PCI) were selected for the unstable angina group (UA group) and forty patients deemed free of coronary heart disease by coronary angiography were selected for the control group. Venous blood samples were drawn from all participants; patients in the UA group had blood drawn 1 day before and 1 day after the PCI procedure. Blood samples were used to analyze blood rheology and examine hemodynamic parameters, at the same time radioimmunoassay was applied to measure the concentrations of serum endothelin-1 (ET-1) and TXB2, and an automatic biochemical analyzer was used to detect the content of superoxide dismutase (SOD) and malondialdehyde (MDA). Our results showed the patients in the UA group all presented hyperviscosity; however the levels were higher for the patients in the UA group (after surgery) than for those in the UA group (before surgery). Patients in the control group exhibited normal levels, and the differences among groups were significant in pairwise comparisons (P<0.05). The levels of ET-1 and TXB2 in the UA group were increased compared with those in control group and they were highest after surgery (P<0.05). For the patients in the UA group, the serum TXB2 concentration increased gradually along with the increase in risk stratification. There were significant differences in comparisons between different strata and between UA patients and those in the control group (P<0.05). The serum SOD activity levels were lowest in the UA group (after surgery), higher in the UA group (before surgery) and highest in the control group. Conversely, the MDA content was highest in the UA group (after surgery), lower in the UA group (before surgery) and smallest in the control group; there were significant differences in pairwise comparisons. Based on our findings, a hyperviscosity syndrome was manifested in the blood rheology of patients with angina pectoris and ischemia reperfusion injury. The higher than normal TXB2 levels can be used as a marker of platelet activation and a reference for clinical risk stratification, thus having great significance for the prevention and treatment of ischemia reperfusion injury and assessment of disease progression.

Hemostasis and Clotting Markers and its Significances in Unstable Angina Pectoris Patients Complicated with Diabetes Mellitus

Background: Recent studies have confirmed that patients with unstable angina pectoris (UAP) complicated with diabetes mellitus(DM) have obvious per-thrombosis state. However, it is not clear that the changes of the hemostasis and clotting markers are very clear. Therefore, this paper is to determine the hemostasis and clotting markers in patients with UAP complicated with DM and those without DM and compared with the control group. Methods: Forty patients with UAP, forty patients with UAP complicated with DM, and forty healthy participants were included in the study as UAP group, complication group, and control group, respectively. Levels of platelet membrane glycoprotein(GP), Von Willebrand (vWF), plasminogen, antithrombin III(ATIII), factor VIII-related antigen(VIII: Ag), platelet membrane glycoprotein-140(GMP-140), protein C(PC), factor II activity(FIIa), tissue plasminogen activity(t-PA), PA inhibitor(PAI), D-dimer, and thromboxane B2(TXB2) were measured in all groups. Results: Compared with a control group and UAP group, there were significant changes of GP, vWF, ATIII, VIII: Ag, GMP-140, PC, FIIa, t-PA, PAI, D-dimer, and TXB2 in complication group (P<0.05, or P <0.01). Compared with control group, there were significant changes of GP, vWF, ATIII, VIII: Ag, GMP-140, PC, FIIa, t-PA, PAI, D-dimer, and TXB2in UAP group (P <0.05, or P <0.01). Conclusions: There are significant changes of hemostasis and clotting markers in patients with UAP, especially in those complicated with DM, which may be an important reason for the poor prognosis of these patients.

Regression analysis of red cell distribution width and mean platelet volume in patients with acute myocardial infarction

To investigate clinical implications of changes in red cell distribution width (RDW) and mean platelet volume (MPV) in patients with acute myocardial infarction. A total of 127 patients (90 men and 37 women) were enrolled in this analysis, including 66 with acute myocardial infarction (AMI) and 61 with unstable angina (UA). The patients' baseline demographic and clinical data were compared between the two groups including age, hypertension, diabetes, smoking, BMI, blood biochemical profiles, cardiac functions and platelet and red blood cell parameters. The patients were further divided into subgroups according to the RDW 50% cumulative frequency, and the MPV, P-LCR, hsCRP, NT-proBNP, RBC, Dimer and MCV were compared. The correlations between platelet and erythrocyte test results were evaluated in both the AMI and UA patients. Regression analysis was performed to identify the factors affecting the RDW in the AMI group and a regression model was established. The platelet and red blood cell test results, P-LCR, MPV, and RDW differed significantly between AMI and UA groups (P<0.01 or 0.05). Correlation analysis showed a significant positive correlation between RDW and MPV in AMI group (r=0.34, P<0.01). Between the subgroups with different RDW 50% cumulative frequencies, MPV, P-LCR, hsCRP, D-Dimer, and NT-proBNP all differed significantly (P<0.05 or 0.01). In AMI group, with RDW as the dependent variable, we established a multivariate regression model of RDW=0.19MPV+10.83. RDW and MPV are closely correlated in patients with AMI. In multiple regression analysis, MPV can explain the changes in RDW in patients with AMI.

Preliminary evaluation of the relationship between the level of plasma of miR-125b-5p and the lesion degree of coronary arteryin in coronary atherosclerotic heart disease

Objective To investigate the clinical value of circulating miR-125b-5p in coronary atherosclerotic heart disease. Methods With case-control study, 80 cases of coronary atherosclerotic heart disease were recruited in Affiliated Hospital of Nantong University from February 2014 to august 2015. According to coronary angiography result they were divided into two groups: there are coronary artery stenosis group(n=49) and control group(n=31). All patients were also divided into non-ST -segment elevation myocardial infarction and ST-segment elevation myocardial infarction group (n=35), unstable angina group group (n=25), stable angina group (n=20). The level of miR-125b-5p before coronary angiograph was detected. By independent sample t test and variance analysis, the levels of miR-125b-5p were compared between the groups of coronary artery stenosis and the group with no stenosis of the coronary artery, the coronary artery lesions in each group, and between the various types of coronary atherosclerotic heart disease respectively. Results MiR-125b-5p expression level of Coronary artery stenosis group (0.35±0.10)was lower than that in group coronary artery with no stenosis(0.95±0.12), the difference was statistically significant (t=24.179, P<0.000 1). With the increase in the number of diseased coronary arteries, miR-125b-5p expression level decreased gradually. There is also statistical significance (t=8.399, P<0.000 1; t=13.067, P<0.000 1) in miR-125b-5p expression among NSTEMI+ STEMI, UA and SAP groups. miR-125b-5p expression level was negatively correlated with Gensini score (R2=0.822, P<0.05). The area under the ROC curve(AUC) of miR-125b-5p was 0.86(95% CI 0.67-0.90), and 0.66 was the optimal cut-off value with sensitivity of 81.22% and specificity of 78.62%. Conclusions With the increase of the number of stenosis, plasma miR-125b-5p expression level decreased gradually. The expression level of miR-125b-5p was negatively correlated with the Gensini score of coronary artery, which indicated that the expression level of miR-125b-5p may be a potential biomarker that can reflect the lesion degree of coronary artery.(Chin J Lab Med, 2017, 40: 396-399) Key words: Coronary disease; microRNAs; Coronary vessels; Severity of illness index; Biological markers

Reduction in CD16/CD56 and CD16/CD3/CD56 Natural Killer Cells in Coronary Artery Disease

ABSTRACTBackground: Natural killer (NK) cells are the potential modulators of inflammatory reactions that exert several unique biological effects and could lead to future adverse events of coronary artery disease (CAD).Hypothesis: The purpose of this study was to find out the possible association of modulation in NK cell, TNK cells, T cells, B cells, and tumor necrosis factor alpha (TNF-α) in CAD patients and various forms of myocardial infarction.Methods: The present study included total 190 subjects (98 confirmed CAD patients both men and women and 92 healthy control individuals). Serum concentration of TNF-α was measured by ELISA method. For the measurement of various immune cells, viz., NK cell, TNK cells, T cells, and B cells, flow-cytometric analysis was performed.Results: A significant reduction by 15% (P < 0.001) in CD16/CD56 NK cells was observed in CAD patients. Moreover, non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI), unstable angina (UA), and combined UA + NSTEMI group also showed a significant decline in NK cells compared with control individuals. CD16/CD56/CD3 TNK cells showed a significant reduction in CAD, NSTEMI, STEMI, and UA categories. However, UA + NSTEMI group did not show any significant change in TNK cells. On the other hand, the level of TNF-α was found to be significantly elevated in CAD, STEMI, and UA groups. NSTEMI and combined UA + NSTEMI group did not show any significant change in TNF-α level.Conclusion: Current study provides an insight toward the association of immune cells and inflammation with CAD.