Brachial reactivity and extent of coronary artery disease in patients with first ST-elevation acute myocardial infarction

We examined peripheral endothelial function, as measured by brachial artery reactivity, in 49 stable patients with a first episode of acute ST-segment elevation myocardial infarction to examine the relation between extent of coronary disease and peripheral vascular reactivity. Brachial artery reactivity was assessed by ultrasound and flow-mediated dilation (FMD) was calculated as the change in brachial artery diameter after release of suprasystolic blood pressure cuff inflation. FMD was classified as abnormal in (< or =6%) 19 patients (group 1) and as normal in 30 patients (group 2). Average FMDs were 2 +/- 2% in group 1 and 11 +/- 4% in group 2. Patients in group 1 were older (62 +/- 5 vs 54 +/- 11 years, p = 0.02) and more often had a history of hypertension (n = 10, 52%, vs 6, 20%, p = 0.017). Patients with abnormal endothelial function (group 1) had a larger number of coronary obstructive (>or =50%) lesions (3.6 +/- 2.4 vs 2.0 +/- 1.7, p = 0.01) and more extensive coronary disease (1.9 +/- 0.8 vs 1.4 +/- 0.8 vessel disease, p = 0.05). In patients with 3-vessel disease, FMD was lower (4.0 +/- 1.8% vs 8.2 +/- 0.8%, p = 0.04) than in those with lesser coronary involvement. In conclusion, in patients with a first episode of ST-segment elevation myocardial infarction, there was a strong correlation between extent of coronary artery disease and brachial artery reactivity. Patients with localized coronary disease had relatively normal brachial reactivity, whereas those with diffuse coronary disease had more severe abnormal brachial artery reactivity.     

急性心肌梗死患者TyG指数与冠状动脉病变严重程度的相关性

目的]探讨急性心肌梗死(AMI)患者甘油三酯-葡萄糖(TyG)指数与冠状动脉病变严重程度的相关性。 [方法]回顾性选择2020年1月─2023年3月期间就诊于新疆医科大学第四附属医院确诊为AMI的424名患者作为研究对象,收集临床资料及冠状动脉造影(CAG)结果,Gensini评分用以定量评估冠状动脉病变程度。根据Gensini评分三分位法分为低Gensini评分组(＜45分,n＝140)、中Gensini评分组(45～86分,n＝143)和高Gensini评分组(≥87分,n＝141)。采用单因素和多因素Logistic回归模型分析TyG指数与高Gensini评分冠状动脉病变发生的关系;采用Spearman相关分析法分析TyG指数与AMI患者Gensini评分之间的相关性;采用ROC曲线分析TyG指数对冠状动脉病变严重程度的预测价值。 [结果]高Gensini评分组TyG指数较低、中Gensini评分组明显升高(P＜0.05)。Logistic回归分析显示,TyG指数为AMI患者严重冠状动脉病变发生的独立危险因素(OR＝13.327,95%CI:2.642～67.235,P＝0.002)。Spearman相关分析显示,TyG指数与冠状动脉病变严重程度呈正相关(r＝0.331,P＜0.001)。ROC曲线分析显示,TyG指数的曲线下面积为0.680(95%CI:0.630～0.731,P＜0.001)。当TyG指数临界值取1.555时,其预测AMI患者发生严重冠状动脉病变风险的效能最高,灵敏度为79.4%,特异度为50.5%。 [结论]TyG作为一种新型生物标志物,与AMI患者冠状动脉病变的严重程度显著且独立相关。     

冠心病合并2型糖尿病患者冠状动脉病变严重程度的研究

目的:探讨2型糖尿病与冠状动脉病变严重程度的关系。方法:对象为选择性冠状动脉造影确诊的冠心病患者266例,其中合并2型糖尿病者96例,无糖尿病者170例。计算冠脉病变支数和进行Gensini冠脉病变评分。结果:冠心病合并2型糖尿病患者的冠脉病变Gensini评分和三支病变者明显多于不合并2型糖尿病的冠心病患者(P<0.05);简单直线相关分析表明,甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、体重指数等与冠状动脉病变严重程度显著相关(P均<0.01)。结论:冠心病患者合并2型糖尿病将加重冠状动脉病变严重程度。     

急性心肌梗死患者纤维蛋白原含量与冠状动脉病变程度及预后有关

目的探讨纤维蛋白原（FIB）含量与急性心肌梗死（AMI）冠脉病变程度及预后的关系。方法根据AMI初期FIB含量将90例AMI分为两组,A组FIB值>4 g/L,B组FIB值≤4 g/L。将两组冠脉造影结果及预后进行比较分析。结果A组多支血管病变33例（占73%）、梗死相关血管近端病变36例（占80%）、心力衰竭10例（占22%）、严重心律失常14例（占31%）、梗死后心绞痛11例（占24%）,与B组分项比较差异显著（P<0.05）。结论FIB增多的急性AMI多为多支血管病变,梗死相关血管多为近端病变,预后不好。     

非糖尿病的冠心病患者尿微量白蛋白与冠脉病变程度的关系

目的 探讨非糖尿病的冠心病患者尿微量白蛋白(MAU)与冠脉病变程度的关系.方法 对172例可疑冠心病的非糖尿患者进行冠状动脉造影检查并检测其尿白蛋白排泄率(UAER).根据冠状动脉造影结果将患者分为对照组51例和冠心病组121例.根据病变血管的数量分为无血管病变组51例、单支病变组51例、双支病变组32例、三支及以上病变组38例,对比各组间UAER和MAU阳性率之间的差异.结果 冠心病组男性患者的比例、UAER、MAU的阳性率、高敏C反应蛋白和纤维蛋白原均高于对照组(P＜0.01).随着冠脉病变数量和程度的增加,UAER(分别为12.9 mg/L、34.4 mg/L、45.1 mg/L和60.7 mg/L)和MAU的阳性率(分别为9.8%、41.2%、56.3%和68.4%)均进行性升高(P＜0.05,P＜0.01).相关分析显示冠脉病变的Gensini评分与UAER呈正相关(r=0.959,P＜0.05).结论 非糖尿病的冠心病患者UAER水平升高,UAER与冠脉病变严重程度呈正相关.     

Left ventricular diastolic filling in patients with coronary artery disease without myocardial infarction

Left ventricular diastolic dysfunction at rest was studied in 24 patients with coronary artery disease but no evidence of previous myocardial infarction. Seven patients with normal coronary arteries were studied as control. Diastolic filling was analyzed by the serial left ventricular volume and 14 radial axes from the gravity point of the left ventricle with cine left ventriculography. There were no differences in the systolic function between coronary artery disease and the normal control. Peak filling rate was decreased significantly in the groups with left anterior descending artery disease (LAD, p less than 0.05) and multivessel disease (MVD, p less than 0.05), but not in the group with right coronary artery disease (RCA). Time to peak filling rate was prolonged in each group of LAD (p less than 0.05), RCA (p less than 0.05), and MVD (p less than 0.001), compared with controls. The time-volume curve showed disturbed rapid filling in the LAD and RCA groups, and also both depressed rapid and slow filling in the MVD group. In the LAD group, the filling fraction was decreased significantly at the time of 25% of the diastolic period (p less than 0.001) and radial distension to the anterior wall was decreased at the time of 25%, 50%, and 75% of the diastolic period, compared with controls. In the RCA group, the filling fraction (p less than 0.001) and radial distension to the posterior wall were decreased only at the time of 25% of the diastolic period. In the MVD group, filling fraction and radial distension to the most wall were decreased at 25%, 50%, and 75% of the diastolic period.(ABSTRACT TRUNCATED AT 250 WORDS)     

空腹血糖与急性心肌梗死患者冠脉病变程度及近期预后的关系

目的 探讨空腹血糖(FPG)对急性心肌梗死(AMI)患者近期预后的预测价值及其与心功能、冠脉严重程度的相关性. 方法 根据患者入院次日静脉FPG水平,将235例AMI患者分为2组:FPG正常组(n=72):FPG ＜6.1 mmol/L;FPG升高组(n=163):FPG≥6.1 mmol/L;比较2组入院时killips分级、1周左室射血分数(LVEF)、冠脉严重程度(Gensini积分)、住院30 d病死率. 结果 (1)基线情况无差异的2组入院时killip分级、1周LVEF无显著差异,FPG升高组Gensini积分显著高于FPG正常组;(2)相关分析显示FPG与LVEF呈负相关,与Gensini积分呈正相关;(3)logistic回归分析显示FPG升高对于总体住院30 d病死率及溶栓治疗住院30 d病死率均有显著预测价值. 结论 FPG升高为院内充血性心力衰竭和死亡的独立预测因子,且可反映冠脉病变严重程度.     

The extent of coronary artery disease in diabetic patients with myocardial infarction: an ECG study

In 91 non-diabetics (age 63 +/- 12, mean +/- SD, years range 31-94 years) and 85 patients with known diabetes or clearly abnormal levels of HbA1c (age 66 +/- 10 years, range 36-87 years) electrocardiograms were analysed sequentially after acute myocardial infarction (AMI). There was no significant difference in infarct site between the two groups. Generalized ischaemic change without ST elevation was seen in 33% of diabetics and 22% of non-diabetics (p greater than 0.1). In patients with transmural AMI, cardiogenic shock (CGS) was significantly commoner in diabetics (relative risk 3.1, CL 1.2-8.1) but there was no difference in the frequency of reciprocal change between the two groups. In both diabetic and non-diabetic patients the development of cardiogenic shock was more frequently associated with the presence of reciprocal change, the difference reaching significance in the diabetic group (chi 2 = 4.4, p less than 0.05). Thus cardiogenic shock in both diabetic and non-diabetic patients with AMI may be associated with the presence of extensive coronary artery disease, but differences in the prevalence of extensive disease do not explain the predisposition of diabetic patients to CGS.     

急性心肌梗塞循环内皮祖细胞与冠状动脉病变严重程度的分析

目的：研究急性心肌梗塞（AMI）患者外周血中内皮祖细胞（EPCs）的水平与冠状动脉病变程度之间的关系。方法：选取55例AMI患者,以定量冠状动脉造影评估冠状动脉的血管狭窄程度,同时选取30名冠状动脉造影阴性的患者为对照组。所有患者均在入院后即刻[AMI发病平均时间（2．5±1．5）h],第24h、48h、72h、7d、14d及一个月时采血,以CD133作为EPCs标记物,用流式细胞仪检测患者外周血中CD133标记细胞数量。结果：AMI组患者及对照组均有EPCs（CD133）的表达,AMI患者EPCs数目明显低于非冠心病患者（P〈0．05）。多支病变者较单支病变者有降低趋势,但无显著性差异（P〉0．05）。EPCs数目和Gensini评分呈明显负相关（n=55,r=-0．619,P〈0．05）。结论：急性心肌梗塞患者EPCs数目和冠状动脉病变程度有关。     

Platelet-bound cyclophilin A in patients with stable coronary artery disease and acute myocardial infarction

Objective: Recently, we reported that extracellular cyclophilin A (CyPA) is an important agonist for platelets. Whereas soluble CyPA-levels have been associated with cardiovascular risk factors, cell-bound CyPA has not been investigated yet. In this study, we analyzed for the first time platelet-bound CyPA in patients with symptomatic coronary artery disease (CAD). Methods and results: blood was obtained from 388 consecutive patients: 204 with stable CAD and 184 with acute coronary syndrome (76 with unstable angina, 78 with non ST-elevation myocardial infarction (NSTEMI), and 30 with STEMI). In vitro stimulation of platelets with classical agonists revealed an enhanced expression of CyPA on the platelet surface. In patients with stable CAD, platelet-bound CyPA correlated excellently with platelet activity measured by P-selectin exposure in flow cytometry. The analysis of classical risk factors for atherosclerosis revealed that patients with hypertension and hypercholesterolemia had significantly enhanced platelet-bound CyPA, whereas diabetes and smoking were not associated with enhanced CyPA-binding to the platelet surface. In multivariate analysis, hypercholesterolemia was the only significant predictor of enhanced platelet-bound CyPA. Interestingly, in patients with acute myocardial infarction (AMI) platelet-bound CyPA was significantly decreased compared with patients with stable CAD. Conclusions: Enhanced platelet-bound CyPA is associated with hypertension and hypercholesterolemia in stable CAD patients. In patients with AMI platelet-bound CyPA is significantly decreased.     

Mechanisms of myocardial infarction without obstructive coronary artery disease

Angiography in patients with myocardial infarction (MI) most commonly reveals one or more significantly narrowed coronary arteries, but a substantial minority of patients with spontaneous MI have no obstructive coronary artery disease (CAD) at angiography. This review summarizes evidence for the most commonly hypothesized mechanisms, including plaque disruption, plaque erosion, vasospasm, embolism, and spontaneous coronary dissection. In addition, tako-tsubo syndrome and myocarditis are discussed. The best treatment of MI without obstructive CAD is likely to differ substantially based on the underlying cause. Additional mechanistic research is needed to facilitate the design of research studies aimed at documenting the best treatments for these patients, numbering as many as 225,000 per year in the US.     

AMI患者胆红素水平与冠脉病变程度的相关性

目的 探讨急性心肌梗死患者血清胆红素水平与冠状动脉病变严重程度的相关性.方法 选取经冠状动脉造影确诊为急性心肌梗死的患者291例,测定患者血清总胆红素(TBIL)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及甘油三酯(TG)水平.以冠脉病变支数、冠脉狭窄程度及冠脉病变积分来评价冠状动脉病变的严重程...     

Relation of microalbuminuria and coronary artery disease in patients with and without diabetes mellitus

Microalbuminuria (MA) is a well-known risk factor for coronary artery disease (CAD) in diabetics and nondiabetics. It is associated with higher cardiovascular mortality, especially in diabetics. However, there are few data linking angiographic severity of CAD to microalbuminuria. We examined coronary angiograms for extent of severe CAD (luminal narrowing > or = 50%) in patients with type 2 diabetes mellitus (DM) and MA (DM+MA+, n = 101), patients with DM and without MA (DM+MA-, n = 101), patients without DM and with MA (DM-MA+, n = 64), and patients without DM and MA (DM-MA-, n = 64). We also evaluated fasting glucose levels in all patients and glycosylated hemoglobin in diabetics. Patients' mean age in the DM+MA+, DM+MA-, DM-MA+, and DM-MA- groups was similar. Gender distribution across the 4 groups was also not significantly different. There were no significant differences in the prevalence of hypertension, hypercholesterolemia, and current smoking across the 4 groups. The presence of 2- or 3-vessel CAD showed a linear increase from group DM-MA- to group DM+MA+ (p < 0.001). Diabetics with MA had higher fasting glucose and glycosylated hemoglobin levels than diabetics without MA (p < 0.001). Thus, patients with MA have more severe angiographic CAD than those without MA. This relation is independent of other risk factors and is particularly evident in patients with DM.     

Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion

The feasibility, safety and usefulness of 2-dimensional echocardiography (2-D echo) during dobutamine infusion for identifying patients with multivessel coronary artery disease (CAD) after acute myocardial infarction (AMI) were evaluated in 30 patients 5 to 10 days after AMI. Patients underwent (1) 2-D echo under basal conditions and during dobutamine infusion at each dose from 5 to a maximum of 40 μg/kg/min, (2) limited multilead submaximal bicycle exercise testing and (3) coronary and left ventricular angiography. Echocardiograms were analyzed independently by 2 observers. The test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during dobutamine infusion in vascular distributions other than the area of infarction identified during basal conditions. Exercise testing was considered positive when more than 1 mm of ST depression occurred 80 ms after the J point. Dobutamine stress testing was well tolerated; no complications and no significant arrhythmia were observed. Echocardiographic recordings were adequate in all patients during the entire test; the concordance in interpretation between the 2 observers was perfect for the prediction and location of ischemic segments during dobutamine infusion.

In 15 of 17 patients without multivessel CAD, no asynergy was observed outside the infarct zone during dobutamine infusion (specificity 88%). In 11 of 13 patients with multivessel CAD, new wall motion abnormalities were identified in the segments corresponding to the arterial lesions diagnosed by angiography (sensitivity 85%). The overall accuracy of dobutamine stress 2-D echo (87%) was higher than that of dobutamine stress electrocardiography (70%) or exercise electrocardiography (59%). Thus, dobutamine stress 2-D echo is a well tolerated, widely available and cost effective stress test for detecting multivessel CAD early after AMI.     

Comparison of white blood cell counts in acute myocardial infarction patients with significant versus insignificant coronary artery disease

The response of high-density lipoprotein cholesterol to hypolipidemic monotherapy with diet, statins, fibrates, or nicotinic acid was investigated prospectively in 801 patients with dyslipidemia. We hypothesized that the behavior of high-density lipoprotein cholesterol after treatment would depend on its baseline levels and the therapy used.     

Correlation of TIMI risk score with angiographic severity and extent of coronary artery disease in patients with non-ST-elevation acute coronary syndromes

The Thrombolysis In Myocardial Infarction (TIMI) risk score predicts adverse clinical outcomes in patients with non-ST-elevation acute coronary syndromes (NSTEACS). Whether this score correlates with the coronary anatomy is unknown. We sought to determine whether the TIMI risk score correlates with the angiographic extent and severity of coronary artery disease (CAD) in patients with NSTEACS undergoing cardiac catheterization. We conducted a retrospective review of 688 consecutive medical records of patients who underwent coronary angiography secondary to NSTEACS. Patients were classified into 3 categories according to TIMI risk score: TIMI scores 0 to 2 (n = 284), 3 to 4 (n = 301), and 5 to 7 (n = 103). One-vessel disease was found in patients with TIMI score 3 to 4 as often as in patients with TIMI score 0 to 2 (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.74 to 1.56; p = 0.66). However, 1-vessel disease was found more often in patients with TIMI score 3 to 4 than in patients with TIMI score 5 to 7 (OR 2.16, 95% CI 1.18 to 3.95; p = 0.01), and in patients with TIMI score 0 to 2 than in those with TIMI score 5 to 7 (OR 1.99, 95% CI 1.08 to 3.66; p = 0.02). Two-vessel disease was more likely found in patients with TIMI score 3 to 4 than in those with TIMI scores 0 to 2 (OR 3.96, 95% CI 2.41 to 6.53; p <0.001) and 5 to 7 (OR 2.05, 95% CI 1.12 to 3.75; p = 0.004). Three-vessel or left main disease was more likely found in patients with TIMI score 3 to 4 than in patients with TIMI score 0 to 2 (OR 3.19, 95% CI 2.00 to 5.10; p <0.001), and in patients with TIMI score 5 to 7 than in patients with TIMI score 3 to 4 (OR 6.34, 95% CI 3.88 to 10.36; p <0.001). In patients with NSTEACS undergoing cardiac catheterization, the TIMI risk score correlated with the extent and severity of CAD.     

Glycaemic variability is associated with severity of coronary artery disease in patients with poorly controlled type 2 diabetes and acute myocardial infarction

BackgroundIn patients with type 2 diabetes (T2D), glycaemic variability (GV), another component of glycaemic abnormalities, is a novel potentially aggravating factor for coronary artery disease (CAD).Objectives: The aim of our study was to identify interactions between GV and severity of CAD in diabetes patients admitted for acute myocardial infarction (AMI).MethodsAll patients with T2D admitted to our university hospital for AMI from March 2015 to February 2017 who received intravenous (IV) insulin therapy and underwent coronary angiography were included. GV was assessed by mean amplitude of blood glucose excursion (MAGE) values taken within 2 days of admission. Patients with higher GV (highest MAGE tertile) were compared with those with lower GV (first and second MAGE tertiles).ResultsA total of 204 patients were included: median age was 72 (61–81) years; 32% were female; HbA_1c was 7.3% (6.4–8.2%); diabetes duration was 10 (2–17.5) years; and MAGE value was 0.65 (0.43–0.92) g/L. Compared with those with lower GV, patients with the highest GV were more often women, treated with previous insulin, and had higher blood glucose and HbA_1c levels. In addition, patients with elevated GV had significantly higher SYNTAX scores: 17 (10–28) vs. 12 (6–22) (P = 0.009). Indeed, SYNTAX scores (OR: 1.05, 95% CI: 1.02–1.08; P = 0.001) remained independently associated with high GV beyond HbA_1c levels (OR: 1.51, 95% CI: 1.2–1.89; P < 0.001).ConclusionIn AMI patients with poorly controlled diabetes, GV is associated with CAD severity beyond chronic hyperglycaemia. Although no causality can be determined from our observational study, the results suggest that, in AMI, early evaluation of GV might contribute to the identification of those diabetes patients at high risk, and serve as a therapeutic target for both primary and secondary prevention.     

Severity of coronary artery disease among blacks with acute myocardial infarction

A growing body of evidence suggests that survival after acute myocardial infarction (AMI) is considerably worse among blacks than whites. The severity of coronary artery disease (CAD), as measured by the number of diseased vessels and the degree of left ventricular dysfunction, is the major determinant of survival after AMI. To determine whether or not the severity of CAD could explain the poor prognosis in a cohort of blacks followed at this institution, cardiac catheterization was performed in a consecutive series of 51 patients less than 70 years of age. All patients were studied within 2 weeks after AMI. The mean age of the patients was 56 +/- 8 (mean +/- standard deviation) and 71% were men. A greater than or equal to 50 narrowing in 0, 1, 2 or 3 coronary arteries was noted in 5, 24, 40 and 31%, respectively. Left main stenosis was present in 3 patients (6%) and the mean left ventricular ejection fraction was 55%. In a subgroup of 20 patients echocardiographic estimates of left ventricular mass/height yielded a mean of 196 g/m, and left ventricular hypertrophy on echocardiogram was present in 74%. These data indicate that among blacks with AMI in this series CAD was only modestly more severe than expected and suggest that other factors most likely explain the high mortality in blacks after hospital discharge.