Unstable Coronary Heart Disease Research Articles

Circulatory soluble LOX-1 is a novel predictor for coronary artery disease patients.

This study investigated the biomarker effect of soluble lectin-like oxidised low-density lipoprotein (sLOX-1) levels for the evaluation of stable and unstable coronary heart disease, correlating it with aging. This case-control study was conducted at the Cardiology Department of Xiangya Hospital between June 2015 and September 2018. Stable coronary artery disease (CAD) patients were confirmed by an invasive coronary angiogram, and American College of Cardiology as well as European Cardiology Society clinical protocols were used for the diagnosis of unstable CAD subjects. Plasma sLOX-1 levels were determined from 226 stable CAD patients, 138 unstable CAD subjects and 75 healthy participants by enzyme-linked immunosorbent assay. Plasma sLOX-1 expressions were significantly elevated in stable CAD patients (4.5-fold) and unstable CAD patients (5.8-fold) above that of volunteer healthy participants. Moreover, between the stable and unstable patient groups, sLOX-1 concentrations were also statistically significantly different (p < 0.001). Levels of plasma sLOX-1 in the healthy female (30-60 years), and stable and unstable CAD female subjects (61-84 years) were markedly elevated compared with healthy male (30-60 years), as well as stable and unstable CAD male patients (61-84 years) (p < 0.001). Besides, in the female unstable CAD (61-84 years) subjects, circulatory sLOX-1 expressions were much higher than in the younger female unstable CAD (30-60 years) patients (p < 0.001). The stable CAD patients were clearly differentiated from healthy subjects with a high sensitivity of the area under the curve (AUC = 0.895). Unstable CAD patients and healthy subjects were also markedly different with a high sensitivity, as shown by AUC (0.902). Stable and unstable CAD subjects were differentiated with an AUC of 0.867. Elevated plasma sLOX-1 levels could be regarded as a novel biomarker for detecting CAD patients and there was a significant association with gender and aging.

The association of coronary non-calcified plaque loading based on coronary computed tomography angiogram and adverse cardiovascular events in patients with unstable coronary heart disease-a retrospective cohort study.

BackgroundCoronary computed tomography angiogram (CCTA) has the characteristics of non-invasive, high resolution, and can accurately determine the characteristics of tubular wall plaques. The non-calcified plaque loading of the coronary arteries is unstable and prone to shedding, leading to adverse cardiovascular events. However, few studies focused on the predictive value of non-calcified plaque loading for adverse cardiovascular events in patients with unstable coronary heart disease (CHD). The present study was conducted to investigate the association of coronary non-calcified plaque loading based on CCTA and adverse cardiovascular events in patients with unstable CHD.MethodsA total of 206 patients with unstable CHD were collected and followed up for 1 year. The patients were divided into an observation group (n=56) and a control group (n=150) according to whether adverse cardiovascular events occurred or not. We analyzed the predictive value of coronary artery non-calcified plaque loading for adverse cardiovascular events in unstable CHD using receiver operating characteristic and multivariate logistics regression analysis.ResultsCompared with the control group, the non-calcified plaque volume in the observation group was increased (160.10±44.02 vs. 128.06±42.22 mm3, P=0.000); non-calcified plaque loading increased (26.93%±7.98% vs. 21.46%±7.62%, P=0.000); carotid intima-media thickness increased (1.49±0.17 vs. 1.40%±0.18 mm, P=0.001); and left ventricular ejection fraction (LVEF) was significantly reduced (53.28%±7.39% vs. 58.02%±7.91%, P=0.000). Non-calcified plaque volume and non-calcified plaque loading have certain diagnostic value for recurrence of adverse cardiovascular events within 1 year (P<0.05). A non-calcified plaque volume >145.58 mm3 is a risk factor for recurrence of adverse cardiovascular events (P<0.05).ConclusionsIncreased non-calcified plaque volume in patients with unstable CHD is associated with the development of adverse cardiovascular events in patients with unstable CHD.

Stress level and ways of coping with stress in a group of patients with unstable coronary heart disease

Introduction. Cardiovascular diseases still remain at the forefront of society's most important health problem and are one of the leading causes of death.Purpose of research. The aim of this study is to assess the degree of coping with stress in a group of patients treated for unstable angina.Material and methods. The research was conducted on 01.09.2019 - 01.03.2020. The size of the study group was 100 people, 45% of whom were women, 55% were men. People with diagnosed unstable angina took part in the study. The following research tools were used in this work to gather the necessary information: • Self-study report - contains 12 questions in the area of sociodemographic information, current disease and available support. • Mini-COPE - Inventory for Measuring Coping With Stress. • PSS-10 - Perceived Stress Scale. The above research tools made it possible to collect information on the sociodemographic data of the respondents, the degree of coping with stress and the scale of perceived stress.Conclusions. Younger people more often than older people focused on actively coping with stress. People in relationships coped with stress to a greater extent than single people and focused on development. Patients who remain professionally active cope better with a stressful situation than those on disability or retirement. People after surgical procedures were more planning-oriented than those treated with pharmacological treatment. The support of family and friends has a positive effect on coping with stress in patients with unstable angina.

Severe obstructive sleep apnea in patients with chronic obstructive pulmonary disease is associated with an increased prevalence of mild cognitive impairment

BackgroundChronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are associated with mild cognitive impairment (MCI). However, this association is unclear. This study aimed to assess the prevalence of MCI in patients with overlap syndrome, determine whether OSA increases the risk of MCI in patients with COPD, and investigate the potential mechanisms for this association. MethodsParticipants with stable Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2–4 COPD and complaints of snoring in 2016–2018 were enrolled in this cross-sectional observational study. All were free of asthma, acute left-sided congestive heart failure, unstable coronary heart disease, uncontrolled hypertension, diabetes, encephalitis, and epilepsy. They underwent pulmonary function tests and overnight polysomnography and completed the Montreal Cognitive Assessment (MoCA). MCI was defined by an MoCA score of <23, while OSA was defined by an apnea-hypopnea index (AHI) of ≥15 per hour. The association between MCI, demographics, and comorbidities was tested by logistic regression analysis with adjustment for confounders. Sleep-disordered breathing measures were investigated as potential mechanisms underlying this relationship. ResultsMCI was significantly more common in patients with overlap syndrome than in those with COPD (40.6% [43/106] vs 24.6% [42/171]). After adjustment, severe OSA was an independent contributor to MCI (odds ratio, OR 2.27; 95% confidence interval, CI 1.12–4.62). Increased percent of night-time spent with oxygen saturation <90% (TSat90) was associated with increased odds of MCI (odds ratio 4.75, 95% CI 2.73–11.13). ConclusionsMCI is more prevalent in overlap syndrome than in COPD. OSA may contribute to MCI in COPD. The mechanism may involve TSat90.

Real-life stress is associated with sympathetic activation in healthy subjects

Psychosocial state is a widely studied prognosis factor of coronary heart disease (CHD) and sympathetic activity is linked to adverse events in chronic heart failure or unstable CHD. The aim of this work was to study associations between a real-life stress and a sympathetic activation in healthy subjects evaluated by the pupillary light reflex, blood pressure, heart rate and body temperature. Eighty-five healthy students aged between 18 and 26 participated in the study during an exam week. All subjects were screened to exclude a generalized anxiety disorder or other psychiatric disorders. Psychological state was assessed by the psychic anxiety part of the Hamilton Anxiety scale (HAM-A), with a score of 0 to 24. Assessment of heart rate, blood pressure (mmHg), body temperature (°C) was done after five minutes of sitting, in a quiet and dark room at a constant temperature. Pupillary assessment was performed with a videopupillometer. Pupillary diameters (mm) before and after stimulation were recorded, as well as the pupillary constriction velocity (mm/s) and the latency of the reflex (ms). Median age was 23 (53%, women). The median HAM-A score was 8. In univariate analysis, body temperature ( r = 0.23, P = 0.029) and post-stimulation pupillary diameter ( r = 0.22, P = 0.047) were associated to HAM-A. No correlation was observed between HAM-A and blood pressure, heart rate, pupillary diameter before stimulation or pupillary light reflex latency. In a multivariate analysis by logistic regression, we found a significant association between HAM-A and sex (men) [OR: 0.39; 95% CI (0.15–0.98), P = 0.046], post-stimulation pupillary diameter [OR: 1.69; 95% CI (1.07–2.67); P = 0.024], and body temperature [OR: 3.24; 95% CI (1.07–9.76), P = 0.037]. Real-life stress has an impact on sympathetic activity, shown by post-stimulation pupillary diameter and body temperature. The pupillary light reflex measurement might improve the prediction of CHD events.

Diagnostic Test Squatting Stress Echocardiography and Coronary Angiography in Diagnosing Coronary Heart Disease

Background: In patients with significant coronary heart disease (CHD), increased preload and afterload during a squat can cause wall motion abnormalities (WMA) which can be detected on echocardiography. This study was conducted to determine the diagnostic value of stress echocardiography squatting as a non-invasive examination of a relatively simple, inexpensive, and safe in the detection of coronary artery stenosis in stable CHD and unstable angina patients.Methods: This study was a cross-sectional design. The subjects were all patients with stable CHD and unstable angina whom were treated in Instalasi Pusat Jantung Rumah Sakit Dr. M. Djamil Padang from May to July 2016. Subjects underwent squatting stress echocardiography procedures followed by coronary angiography. Diagnostic test was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of squatting stress echocardiography.Results: The sensitivity, specificity, and accuracy of squatting echocardiography for diagnosis of CAD were 90.3%, 88.9% and 89.7%, respectively.Conclusion: Squatting stress echocardiography can be proposed as a non-invasive examination which is relatively simple, inexpensive and safe to detect coronary artery stenosis on patients with stable CHD and unstable CHD.

Serum uric acid is associated with mortality and heart failure hospitalizations in patients with complicated myocardial infarction: findings from the High-Risk Myocardial Infarction Database Initiative.

Serum uric acid (SUA) levels are associated with poorer outcomes in healthy cohorts and patients with stable and unstable coronary heart disease. We investigated the relationship between SUA and clinical outcomes in subjects with acute myocardial infarction (MI) complicated by reduced left ventricular (LV) function, heart failure (HF), or both. Univariable and multivariable Cox proportional hazards modelling was performed to study the association of baseline SUA and all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in an individual patient meta-analysis of four merged large randomized trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT). Three trials (excluding VALIANT) reported SUA, which was available in a total of 12 677 subjects. The ranges of SUA for quartiles I-IV were 45-280, 281-344, 345-420, and 420-1640 mmol/L, respectively. While almost 90% of patients in the lowest SUA quartile were alive after a mean follow-up of 23 ± 11 months, <70% were alive in the highest SUA quartile. Compared with the lowest SUA quartile as reference, hazard ratios (HRs) and 95% confidence intervals (CIs) of SUA quartiles III and IV showed an increase in all-cause mortality [HR 1.18, 95% CI 0.95-1.46, and HR 1.36, 95% CI 1.11-1.67) and CV mortality (HR 1.27, 95% 1.01-1.61, and HR 1.47, 95% CI 1.17-1.83). SUA quartiles III and IV also exhibited increased HF hospitalization (HR 1.22, 95% CI 1.09-1.36, and HR 1.28, 95% CI 1.14-1.43; P < 0.001 for all comparisons) in multivariable analyses. The addition of SUA was associated with a significant improvement in reclassification to predict CV mortality (net reclassification improvement 17.6%, 95% CI 14.9-20.5%, P < 0.001). Elevated SUA is associated with poor outcomes in patients after MI complicated by reduced LV function, HF, or both. The quantification of SUA, a low-cost routinely available biomarker, could improve risk stratification of patients with complicated MI.

Established and emerging cardiovascular magnetic resonance techniques for the assessment of stable coronary heart disease and acute coronary syndromes.

Coronary heart disease (CHD) is a leading cause of death and disability worldwide. International guidelines recommend cardiovascular magnetic resonance (CMR) as an investigative option in those presenting with chest pain to inform diagnosis, risk stratify and determine the need for revascularization. CMR offers a unique method to assess global and regional cardiac function, myocardial perfusion, myocardial viability, tissue characterisation and proximal coronary anatomy all within a single study. This results in high diagnostic accuracy for the detection of significant coronary stenoses and an established role in the management of both stable CHD and acute coronary syndromes (ACS). The growing evidence base for the prognostic value of CMR, emerging advances in acquisition techniques, improvements in hardware and the completion of current major multi-centre clinical CMR trials will further raise its prominence in international guidelines and routine cardiological practice. This article will focus on the rapidly evolving role of the multi-parametric CMR examination in the assessment of patients with stable and unstable CHD.

Advances in Percutaneous Coronary Interventions for Elderly Patients

Coronary heart disease (CHD) is one of the leading causes of morbidity and the most common cause of death in older adults. Paradoxically, elderly patients tend to be systematically excluded from randomized-controlled cardiovascular trials, which complicates decision-making in this population. Management of CHD in the elderly is frequently more difficult in virtue of chronic comorbid conditions and aging-intrinsic dynamics. Despite these challenges, the number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. Elderly patients in many registries and large clinical series exhibit even a greater benefit from interventional procedures than younger patients, but they have a higher rate of overall complications. We present an overview of the current available evidence of PCI in older adults with stable and unstable CHD, including comparisons between drug-eluting and bare-metal stents, transfemoral and transradial access, and methods of revascularization. Adjuvant antiplatelet and antithrombotic therapies are also discussed.

Simultaneous occurrence of coronary artery disease and lung cancer: what is the best surgical treatment strategy?: Table 1:

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether combined surgical procedures in one or two stages are the best surgical treatment strategy in patients with simultaneous coronary artery disease and lung cancer. Altogether, 264 papers were found using the reported search; of which, 15 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group, study type, outcomes and results of papers are tabulated. The outcomes of the reported studies provided interesting results. All the studies were retrospective. Ten papers reported the results of combined and staged operations. The operative mortality rate of combined procedures was 0-20.8% and of staged procedures was 0-10%. The reoperation rate for bleeding of combined procedures was 0-11% and of staged procedures was 0%. The survival rate of combined procedures at 1 year was 79-100%, at 5 years was 34.9-85% and at 7 years was 61%. The survival rate of staged procedures at 1 year was 72.7% and at 5 years was 53%. Five studies reported the results of off-pump coronary artery bypass grafting (OPCABG) and lung surgery versus on-pump and lung surgery. The operative mortality rate of OPCABG and lung surgery was 0-6.6%. The 2-year survival rate of OPCABG and lung surgery was 47% and the 5-year survival rate was 13-68%. The re-exploration rate for bleeding of OPCABG was 4%. Simultaneous lung surgery and CABG could be safely performed with adequate cancer-free survival in patients with Stage I or II lung cancer. Lung surgery is better performed before institution of cardiopulmonary bypass, avoiding the complications of such a technique. Long-term survival after combined treatment is mostly related to the predicted survival after lung resection. This depends on the T stage and mostly on the patient's nodal status. In certain high-risk groups (if the cardiac procedure is difficult or if the patient is unstable), separate staged procedures (CABG as the first and lung resection as the second procedure) might be the most prudent action (3-6 weeks apart). There is also another option: OPCABG and lung resection, which could be a safe and effective treatment when unstable coronary heart disease and lung cancer coexist.

Evaluation of CD25+CD4+ Regulatory T-Lymphocyte Subpopulations in Coronary Artery Diseases Patients

Background. The development of atherosclerosis may be associated with a deficiency in the regulatory T-cells, which should serve a protective function and inhibit the accumulation of lymphocytes and macrophages. The aim of this study was the analysis of the T-lymphocyte subpopulations, particularly CD4+CD25+ regulatory T-cells in patients with different form of coronary artery disease.Materials and Methods. In the study 30 patients with stable coronary heart disease and 30 patients with unstable coronary heart disease take part. Lymphocytes subpopulations were measured with flow cytometry technique. The analysis of the treated cells parameters was performed with the use of CellQuest program.Results. We have observed statistically significant increase in activated lymphocytes subpopulations in patients with unstable coronary artery disease in comparison to stable group and significant decrease in CD25+, CD25/CD3+, and CD25/CD4+ subpopulations in unstable patients comparing to stable patients group.Conclusions. A strong interest in regulatory lymphocytes is due to their possible therapeutic use as a factor in modifying the immune response in various diseases. Questions regarding the role of regulatory T-cells in the development of atherosclerosis remain unclear. Mechanisms of the regulatory T-cells impact on suppression of atherosclerosis need more experiments to be done.

Peripheral artery disease and outcomes after myocardial infarction: An individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT

To examine the prevalence of peripheral artery disease (PAD) and the relationship between PAD and cardiovascular (CV) outcomes in subjects with left ventricular systolic dysfunction, heart failure or both after acute myocardial infarction (MI). PAD is associated with poorer prognosis in patients with stable and unstable coronary heart disease but whether PAD is associated with worse outcomes following substantial acute MI is unknown. Univariate and multivariate Cox proportional hazards modelling was used to compare clinical outcomes in an individual-patient meta-analysis of 4 trials (CAPRICORN, EPHESUS, OPTIMAAL and VALIANT). Of the 28,771 patients randomized, 2357 (8.2%) had PAD. These patients were older and had more co-morbidity and were less likely to be prescribed aspirin or a beta-blocker compared to patients without PAD. Over a mean follow-up of 2.7 years, 5121 (17.8%) patients died and 15,055 (52.3%) experienced CV death or hospitalization. PAD was an independent predictor of all individual and composite CV outcomes examined (including heart failure), with the exception of stroke. In patients with PAD (compared to those without PAD), the adjusted hazard ratio (HR) for all-cause mortality was 1.25 (95% CI 1.15-1.37; p<0.001) and the HR for CV death, non-fatal MI, non-fatal stroke or heart failure hospitalization was 1.24 (1.16-1.33; p<0.001). PAD is common and is an independent predictor of worse outcomes in patients already at high risk after MI because of left ventricular systolic dysfunction, heart failure or both. These patients represent an important group for intensive application of secondary preventive therapies.

Aterektomia rotacyjna u osoby z niestabilną chorobą wieńcową i dużym ryzykiem rewaskularyzacji chirurgicznej

A case of an 85-year-old patient with unstable coronary heart disease treated with complex percutaneous coronary intervention of the left main coronary artery, left anterior descending artery and circumflex artery with rotablation and implantation of three drugeluting stents (Rota-DES technique) is presented.

Cardiovascular Risk Prediction in Patients With Stable and Unstable Coronary Heart Disease

The American Heart Association estimates that 1 in 3 American adults have cardiovascular (CV) disease, including 16.8 million individuals with ischemic heart disease, 8 million individuals with peripheral arterial disease, and 6.5 million individuals with ischemic stroke.1 In 2005, CV disease accounted for 35% of all deaths in the United States. Given the high prevalence of CV disease and its associated morbidity and mortality, prevention of recurrent events in patients with established CV disease is a major public health objective. A fundamental tenet of preventive medicine is to initiate interventions appropriate to the level of risk for the individual. Therefore, risk assessment is an inextricable component of preventive care. This review is focused on tools for risk assessment in patients with coronary heart disease (CHD). A discussion of risk assessment in patients with atherosclerosis limited to the cerebrovascular or peripheral arterial beds is beyond the scope of this review. However, many of the tools and principles discussed here apply also to patients with atherothrombosis throughout the vascular tree. This review addresses both the early phase of risk after presentation with an acute coronary syndrome (ACS) and the chronic phase in stable CHD. After ACS, the risk of CV death in community-based studies is ≈3% to 5% at 30 days and 5% to 8% at 6 months.2 Major CV events occur in 15% to 20% of patients by 6 months.3 In patients with stable CHD, the annual mortality rate is 1% to 3%, and the annual rate of major CV events is 1% to 2%. In a registry of 38 602 patients with stable CHD, the 1-year rate of CV death was 1.9% (95% confidence interval, 1.7 to 2.1) and of CV death, myocardial infarction (MI), or stroke was 4.5% (95% confidence interval, 4.2 to 4.8).4 These …

Elevated Antibodies to Oxidized Low Density Lipoprotein are Positively Related with a Severity of Coronary Artery Disease

Aim: The prognostic value of circulating antibodies to oxidized low-density lipoprotein (anti-oxLDL) in patients with coronary heart disease is not completely clear. We aimed to investigate the association between levels of anti-oxLDL in three groups of patients with different grades of severity of coronary heart disease. Patients and methods: The study included 101 patients classified into three groups: one (N=35) with acute myocardial infarction (AMI), a group (N=35) with angiographicallly proven coronary artery disease (APCAD), and a group without angiographicallly proven coronary artery disease (N=31) designated as a control group. Levels of IgG anti-oxLDL antibodies were meausured by enzyme-linked immunosorbent assay. Results: Mean anti-oxLDL value was significantly higher in patients with AMI than in patients with APCAS (1342.1±581.5 mIU/ml vs. 553.0±183.3 mIU/ml, p<0.001), as well as compared with control group (1342.1±581.5 mIU/ml vs. 246.5±114.3, p<0.001). Similarly, significant difference in anti-oxLDL levels was found between the patients with APCAS and control group (p<0.001). Conclusions: The present study showed that elevated levels of anti-oxLDL are positively related with a severity of coronary artery disease. Hence, elevated levels of anti-oxLDL may identify patients with unstable coronary heart disease. Oxidized LDL in circulating plasma could serve as a marker of cardiovascular events.

Growth-Differentiation Factor-15 for Risk Stratification in Patients With Stable and Unstable Coronary Heart Disease

Background— Growth-differentiation factor-15 (GDF-15) is a stress-responsive transforming growth factor-β-related cytokine that has emerged as a prognostic biomarker in acute coronary syndrome trial populations. Its predictive role in stable coronary heart disease (CHD) has never been assessed. Methods and Results— The circulating levels of GDF-15 were measured by immunoradiometric assay in patients with stable angina pectoris (n=1352) or acute coronary syndrome (n=877) who were followed up for a median of 3.6 years. Stable angina pectoris patients presenting with normal (&lt;1200 ng/L), moderately elevated (1200 to 1800 ng/L), or markedly elevated (&gt;1800 ng/L) GDF-15 levels had 3.6-year CHD mortality rates of 1.4%, 2.7%, and 15.0%, respectively ( P &lt;0.001). By backward stepwise Cox-regression analysis, which adjusted for age and gender, clinical variables, the number of diseased vessels, renal function, the levels of C-reactive protein, cardiac troponin I, and N-terminal pro-B-type natriuretic peptide, GDF-15 remained an independent predictor of CHD mortality ( P &lt;0.001). Addition of GDF-15 improved the prognostic accuracy of a clinical risk prediction model concerning CHD mortality (c-statistic, 0.84 versus 0.74; P =0.005). Analysis of the acute coronary syndrome part of the study population confirmed GDF-15 as an independent predictor of CHD mortality ( P &lt;0.001). The circulating levels of GDF-15 did not predict the future risk of nonfatal myocardial infarction in patients with stable angina pectoris or acute coronary syndrome. Conclusion— This study identifies GDF-15 as a strong and independent predictor of CHD mortality across the broad spectrum of patients with stable and unstable CHD.

Simultaneous Surgical Treatment of Non-small Cell Lung Cancer and Off-pump Coronary Artery bypass Grafting.

Patients with resectable lung cancer and unstable coronary heart disease are at high risks of postoperative death or severe cardioovascular complications. They always pose a therapeutic challenge for thoracic surgeons. The aim of this study is to summarize clinical experience of radical lung resection for cancer with simultaneous off-pump coronary artery bypass grafting. Seven patients who suffered from non small cell lung cancer concomitant arrhythmia, unstable angina and recent history of myocardial infarction had been carried out simultaneous radical lobectomy and off-pump coronary artery bypass grafting. Preoperative 6 patients had been confirmed to be misfit for either coronary arterioplasty or stent implanting by performing the coronary angiography. One patient had undergone stenting before the lung cancer had been diagnosed. The procedure through median sternotomy performed offpump coronary artery bypass grafting preceded lobectomy and mediastinal lymphadenectomy. Left upper lobectomy was performed in 2 patients, right upper lobectomy was performed in 1 patient, right upper and middle lobectomy was performed in one patient, video thoracoscopy assisted left lower lobectomy was performed in 1 patient, right lower lobectomy was performed in 2 patients. There was no death of patient in hospital, however, a patient died 7th month postoperatively because of cerebrovascular accident. Atrial fibrillation was observed postoperatively in 1 patient. Five patients were diagnosed as squamous cell lung cancer by pathology examination, and 2 patients were adenocarcinoma. Follow-up ranging from 2 months to 59 monthswas available for these patients postoperatively. None of the patients showed evidence of angina and myocardial infarction after surgery. In one patient, who underwent left superior lobectomy, local recurrence was found at 19 months after surgery. In selected patients, simultaneous radical lung resection and off-pump coronary artery bypass grafting is a safe and effective treatment when unstable coronary heart disease and lung cancer coexist. The therapeutic strategy may decrease the incidence of postoperative complications.

The early and late results of combined off-pump coronary artery bypass grafting and pulmonary resection in patients with concomitant lung cancer and unstable coronary heart disease☆☆☆

The aim of this study was to analyze the early and long-term results of simultaneous surgical treatment of both coronary heart disease (CHD) and lung cancer. Twenty-five patients with the diagnoses of both non-small cell lung cancer (NSCLC) and unstable angina were operated on between 2001 and 2006 in the Department of Cardiothoracic Surgery at the University of Medical Sciences in Poznań, Poland. Myocardial revascularization was performed simultaneously with the lung resection. The mean patient age was 63 years. The majority (18 patients) were male and the stage of lung cancer was predominantly AJCC II. Most of the patients were classified as stage II or III CCS and the predominant pathology was a two-vessel disease. Fifteen lobectomies, six pneumonectomies and four wedge resections were performed together with the aortocoronary graft implantation (mean: 1.9 graft per patient). There were no postoperative deaths or perioperative myocardial infarctions (MI). The most frequent complications were as follows: atrial fibrillation (24%), atelectasis (12%) and residual pneumothorax (12%). All the patients were followed up for 8-60 months. Within this period, eight patients (32%) died, mostly due to the cancer relapse. The local recurrence of lung cancer and distant metastases were the only factors statistically influencing the late survival. No patient in the entire follow-up period had a MI. In three patients, the symptoms of recurrent angina occurred and one of them underwent a coronary stent implantation. Simultaneous off-pump myocardial revascularization and lung resection is a safe and effective treatment when unstable CHD and lung cancer coexist. In selected patients, this combined procedure may be an alternative to the two-stage approach, surgical or non-surgical (cardiologic) interventions preceding the pulmonary resection. The only statistically significant factor having an impact on long-term survival is the recurrence of the cancer.

Should Cardiac Troponins be Used as a Risk Stratification Tool for Patients with Chronic Critical Limb Ischaemia?

Objectives Cardiovascular mortality in patients with chronic critical lower limb ischaemia (CCLI) is high and early risk stratification in these patients may aid clinical management improving outcomes. Cardiac troponin I (cTnI) has prognostic significance in patients with unstable angina. The aim of this study was to evaluate the prognostic significance of cardiac troponins in CCLI patients who had no clinical evidence of unstable coronary heart disease. Methods Patients (n=152) admitted with CCLI to a single vascular unit over a two-year period were included prospectively in this study. Patients with clinical evidence of unstable coronary disease were excluded from the study. Patient demographics, clinical history, co-morbidity and risk factors for peripheral vascular disease were documented. Admission cTnI levels were recorded using a threshold, 0.1 ng/ml. The primary endpoint was mortality. Results Fifty-two patients (34.2%) had an elevated cTnI, whilst 100 (65.8%) had cTnI <0.1 ng/ml. Sixty-two patients died during the follow-up period, 38 with an elevated admission cTnI. Death rate in patients with cTnI >0.1 ng/nl was 73% compared with 24% in those with levels below the threshold (p<0.0001). Patients with elevated cTnI were significantly older than those with normal level (median age 76 years vs 71 years, p<0.001). An elevated cTnI was found to independently predict disease-specific mortality on Cox regression analysis (Hazard Ratio 4.2; 95% Confidence Interval 1.3–12.7). Conclusion In this series of patients with CCLI the measurement of cTnI on admission was a significant independent predictor of survival. cTnI has potential as a prognostic test to stratify patients with a high cardiovascular risk and may enable further optimisation of these high-risk patients.

Patients with a history of stable or unstable coronary heart disease have different acute phase responses to an inflammatory stimulus

Increased levels of acute phase proteins (APP) in serum are associated with vulnerability of atherosclerotic plaques and acute manifestations of coronary heart disease (CHD). APP have been viewed as indexes of active vascular inflammation or as mediators of atherothrombosis. In the present study we tested the hypothesis that individuals who develop stable or unstable forms of CHD might have different innate responses to an inflammatory stimulus. We compared changes in plasma C-reactive protein (CRP) and serum amyloid A (SAA) concentrations 48 h after a standardized inflammatory stimulus (adjuvanted influenza vaccination) in patients with quiescent CHD that had been manifested at onset as inducible myocardial ischemia (Group 1, n = 26) or as acute coronary syndromes (ACS) (Group 2, n = 34). Selected patients were free from inflammatory or other conditions that might affect the immune response. CRP concentration increased significantly after vaccination in both groups (Group 1: 0.47 [0.21–0.86] to 0.56 [0.32–1.17] mg/L, p = 0.005; Group 2: 0.64 [0.21–1.09] to 0.75 [0.33–1.48] mg/L, p = 0.003), without significant differences between groups in absolute or percentage changes. By contrast, SAA did not change after vaccination in Group 1 (14.4 [8.9–19.5] to 14.8 [10.3–18.8] mg/L, p = 0.88) but increased significantly in Group 2 (16.9 [10.0–21.5] to 19.2 [11.3–29.1] mg/L, p = 0.002), with significant differences between the groups in absolute and percentage terms ( p = 0.015 and 0.019, respectively). Changes in CRP and SAA, both absolute and percentage, were significantly correlated in Group 2 ( r = 0.60 and 0.66, both p < 0.001). The responsiveness of plasma SAA to an inflammatory stimulus in Group 2 alone suggests a pro-inflammatory status in patients prone to acute coronary syndrome but not in those with inducible myocardial ischemia.