Serum uric acid as an independent predictor of mortality in patients with angiographically proven coronary artery disease.

It is a matter of controversy as to whether uric acid is an independent predictor of mortality in patients with coronary artery disease (CAD) or whether it represents only an indirect marker of adverse outcome by reflecting the association between uric acid and other cardiovascular risk factors. Therefore, we studied the influence of uric acid levels on mortality in patients with CAD. In 1,017 patients with angiographically proven CAD, classic risk factors and uric acid levels were determined at enrollment. A follow-up over a median of 2.2 years (maximum 3.1) was performed. Death from all causes was defined as an end point of the study. In CAD patients with uric acid levels <303 micromol/L (5.1 mg/dl) (lowest quartile) compared with those with uric acid levels >433 micromol/L (7.1 mg/dl) (highest quartile), the mortality rate increased from 3.4% to 17.1% (fivefold increase). After adjustment for age, both sexes demonstrated an increased risk for death with increasing uric acid levels (female patients: hazard ratio [HR] 1.30, 95% confidence intervals [CI] 1.14 to 1.49, p < or = 0.001; male patients: HR 1.39 [95% CI 1.21 to 1.59], p < or = 0.001). In multivariate Cox regression analysis performed with 12 variables that influence overall mortality-including diuretic use-elevated levels of uric acid demonstrated an independent, significant positive relation to overall mortality (HR 1.23 [95% CI 1.11 to 1.36], p <0.001) in patients with CAD. Thus, uric acid is an independent predictor of mortality in patients with CAD.     

血尿酸水平与冠脉狭窄及冠心病的关系

目的探讨血尿酸（SUA）水平与冠脉狭窄和冠心病（CHD）的关系。方法选择647例行冠脉造影患者,根据其冠脉有无狭窄分为冠脉正常组和非正常组,以冠脉至少有1支狭窄≥50%分为CHD组与非CHD组。检测患者的血脂及SUA。结果在冠脉狭窄和CHD两个分组标准下,男性不同年龄组间的SUA水平无统计学差异,女性有统计学差异（P〈0.01）。男性SUA水平与冠脉狭窄或CHD发生均无相关性;女性SUA水平与CHD发生虽无统计学差异,但与冠脉狭窄发生有关（P〈0.05）,对传统风险因素校正后,多因素分析显示女性SUA水平与冠脉狭窄无统计学意义（P〉0.05）。结论 SUA存在性别差异,女性高尿酸血症与CHD发生有一定关系,与冠脉狭窄密切相关,但非发生冠脉狭窄的独立危险因素。男性SUA水平与二者均无关。     

The prognostic importance of comorbidity for mortality in patients with stable coronary artery disease

OBJECTIVES: To identify the prevalent and prognostically important coexisting illnesses among single coronary artery disease (CAD) patients. BACKGROUND: As the population ages, physicians are increasingly required to make decisions concerning patients with multiple co-existing illnesses (comorbidity). Many trials of CAD therapy have excluded patients with significant comorbidity, such that there are limited data to guide the management of those patients. METHODS: To consider the long-term prognostic importance of comorbid illness, we examined a cohort of 1471 patients with CAD who underwent cardiac catheterization between 1985 and 1989 and were followed up through 2000 in the Duke Databank for Cardiovascular Diseases. Weights were assigned to individual diseases according to their prognostic significance in Cox proportional hazards models, thus creating a new CAD-specific index. The new index was compared with the widely used Charlson index, according to prevalence of conditions, individual and overall associations with survival, and agreement. RESULTS: The Charlson index and the CAD-specific index were highly associated with long-term survival and almost equivalent to left ventricular ejection fraction. When considering the components of the Charlson index, diabetes, renal insufficiency, chronic obstructive pulmonary disease, and peripheral vascular disease had greater prognostic significance among CAD patients, whereas peptic ulcer disease, connective tissue disease, and lymphoma were less significant. Hemiplegia, leukemia, lymphoma, severe liver disease, and acquired immunodeficiency syndrome were rarely identified among patients undergoing coronary angiography. CONCLUSIONS: Comorbid disease is strongly associated with long-term survival in patients with CAD. These data suggest co-existing illnesses should be measured and considered in clinical trials, disease registries, quality comparisons, and counseling of individual patients.     

Association of anemia with clinical outcomes in stable coronary artery disease

BACKGROUND: Although anemia is pathophysiologically associated with myocardial ischemia, there are scarce data on its clinical impact in patients with stable coronary artery disease on contemporary treatment. This study aims to describe the prevalence of anemia, and its association with symptoms and outcomes in this population. METHODS: We conducted a prospective cohort study in stable documented coronary artery disease patients. Anemia criteria was hemoglobin (Hb) <12 g/dl in women and <13 g/dl in men. Hemoglobin levels were divided in quartiles (Q) adjusted for sex. Major events included acute coronary syndromes, stroke and cardiovascular deaths. Secondary outcomes were presence of angina and chronic use of nitrates. Cox regression models were used to evaluate the independent effect of anemia on clinical outcomes. RESULTS: Among 310 patients, 71 (23%) met criteria for anemia. After a mean follow-up of 44+/-23 months, hemoglobin levels had a marked association with occurrence of major events (27% in Q1, 7% in Q2, 8% in Q3 and 12% in Q4; P<0.01). In multivariate analysis, anemia was independently associated with an increased risk of death [hazard ratio (HR) 6.5, 95% confidence interval (1.7-24.2)], major events [HR 3.3 (1.7-6.5)] and revascularization procedures [HR 2.3 (1.3-4.1)]. Persistent of angina symptoms (32 vs. 18%, P=0.01) and chronic use of nitrates (35 vs. 21%, P=0.02) were also more frequent among patients with anemia at baseline. CONCLUSIONS: In patients with stable ischemic heart disease, presence of anemia, even mild, is associated with a worse prognosis. Strategies aiming at identifying reversible causes of anemia or new treatments should be evaluated in prospective clinical trials.     

代谢综合征患者血尿酸水平与冠心病的关系

将 769例不同程度代谢异常患者分为冠心病组和非冠心病组,分析血尿酸在不同代谢异常状态下与冠心病的关系。结果显示,在缺乏其他代谢因素影响时,尿酸可能与冠心病的发生有一定关联,但并非冠心病的独立危险因素。     

Prehospital statin therapy and one-year mortality in patients with stable coronary artery disease undergoing percutaneous coronary intervention

BackgroundStatins have multiple effects in patients with coronary artery disease. No studies have investigated whether chronic statin pretreatment before percutaneous coronary intervention (PCI) has an impact on long-term mortality in patients with stable angina.MethodsThe study included 8041 patients with stable angina. At the time of PCI, 5939 patients (73.8%) were receiving statins for ≥ 1 month before procedure and 2102 patients (26.2%) were not receiving statins. The primary outcome analysis was 1-year mortality.ResultsThere were 192 deaths during the follow-up: 119 deaths among patients receiving statins and 73 deaths among patients not receiving statins (Kaplan–Meier estimates of 1-year mortality 2.06% and 3.59%; unadjusted hazards ratio [HR] = 0.56, 95% confidence interval [CI] 0.42–0.75; P < 0.001). Landmark analysis showed that almost all mortality benefit occurred in the first 30-days after PCI: 10 deaths among patients receiving statins and 22 deaths among patients not receiving statins (Kaplan–Meier estimates of 30-day death, 0.17% and 1.06%, respectively; HR = 0.16, 95% CI 0.08–0.34, P < 0.001). No significant difference in mortality according to statin pretreatment between 30 days and 1 year was observed (109 deaths among patients receiving statins vs 51 deaths among patients not receiving statins; Kaplan–Meier estimates 1.89% and 2.53%; HR = 0.75, 95% CI 0.53–1.05, P = 0.095). After adjustment in the Cox proportional hazards model, statin pretreatment was associated with a 35% reduction in the adjusted risk for 1-year mortality (adjusted HR = 0.65, 95% CI 0.44–0.98, P = 0.039).ConclusionsPretreatment with statins before PCI was associated with a significant reduction of 1-year mortality in patients with stable angina.     

冠心病患者血尿酸水平与冠状动脉病变程度的相关性分析

目的:探讨血清UA水平与冠状动脉病变严重程度的关系。方法:回顾性分析2011年6月至2012年6月,在我科住院行冠状动脉造影检查者408例。根据造影结果,分为冠状动脉正常组和冠心病组,并根据SYNTAX评分,将冠心病组分为低危组(1～22分)、中危组(23～32分)及高危组(>33分)。测定空腹UA水平、空腹血脂:包括TC、TG、HDL-C及LDL-C。比较各组患者血脂、血UA水平。男性UA以<416μmol/L为正常值,女性以<357μmol/L为正常值,再将患者分为高UA组和正常UA组,比较两组SYNTAX评分,并进行相关性分析。结果:SYNTAX评分高危组、中危组与正常组比较TC、LDL-C显著增高,而正常组、低危组间差异无统计学意义(P>0.05)。SYNTAX评分高危组、中危组与同性别冠状动脉正常组比较,血UA水平显著增高。正常UA组与高UA血症组在年龄、性别、TC、TG、HDL-C及LDL-C的差异无统计学意义(P>0.05)。高UA血症组患者的冠状动脉SYNTAX评分显著高于正常血UA组。多元Logistic回归分析表明血UA水平与冠状动脉病变程度相关。结论:血UA是冠状动脉病变严重程度的相关危险因素,随着血UA水平的增高,冠状动脉病变程度增加。     

High levels of serum uric acid predict severity of coronary artery disease in patients with acute coronary syndrome

We aimed to elucidate the relation between serum uric acid (SUA) level and severity of coronary artery disease (CAD) in nondiabetic, nonhypertensive patients (n = 246) with acute coronary syndrome (ACS). Severity of CAD was assessed by the Gensini score. One, 2, and 3 or more diseased vessels were identified in 87 (35.4%), 55 (22.4%), and 104 (42.2%) patients, respectively. Patients with hyperuricemia had higher Gensini score, high number of diseased vessels, critical lesions, and total occlusion. Serum uric acid level was significantly associated with number of diseased vessels. Serum uric acid was an independent risk factor for multivessel disease by univariate analysis. High levels of SUA associated with the severity of CAD in nondiabetic, nonhypertensive patients with ACS.     

Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease

Purpose

The aim of this study was to investigate the relationship between monocyte count/high density lipoprotein cholesterol (HDL-C) ratio (MHR) and the severity of coronary atherosclerosis, as assessed by the SYNTAX score (SXscore), in patients with stable coronary artery disease (CAD) undergoing coronary angiography.

Materials and methods

A total of 428 patients were included in the study between March 2012 and February 2015. The SXscore was determined with baseline coronary angiography. An SXscore ≥?23 was regarded as severe CAD by definition, and the patients were divided into two groups: those with low SXscores (<?23) and those with high SXscores (≥?23).

Results

MHR and C-reactive protein (CRP) were significantly higher in patients with high SXscores (p?<?0.001 and p?<?0.001, respectively). Left ventricular ejection fraction (LVEF) was lower in the group with high MHR and high SXscores. The cutoff value of MHR that predicted a high SXscore was 24, with a sensitivity of 66?% and a specificity of 65.1?%.

Conclusion

To the best of our knowledge, this is the first study in the literature showing that MHR is significantly associated with SXscores. Our results suggest that MHR can be used as a prognostic marker in patients with stable CAD, since it is an easily available and inexpensive test.

     

血尿酸、血清同型半胱氨酸与冠状动脉病变程度的关系分析

目的探讨血尿酸、血清同型半胱氨酸水平与冠心病患者冠脉病变严重程度的关系。方法回顾性分析2018年11月至2019年11月于我院住院的90例冠心病患者作为试验组,纳入同时期性别、年龄相匹配的冠脉造影正常的患者50例作为对照组。根据SYNTAX评分对冠状动脉严重程度进行评分,根据结果分为低危组(<22分)、中危组(23~32分)及高危组(>33分)。记录患者一般临床资料,抽取清晨空腹血化验UA、Hcy、TC、TG、HDL-C、LDL-C,并行冠脉造影检查,比较分析各组患者血脂、UA、Hcy的差异,并进行相关性分析及Logistic回归分析。结果SYNTAX评分中危组、高危组与对照组相比较,TC、LDL-C、UA、HCy升高,差异有统计学意义(P<0.05);UA与SYNTAX评分呈正相关(r=0.487,P<0.05),Hcy与SYNTAX评分呈正相关(r=0.437,P<0.05);Logstic回归分析发现LDL-C、UA、Hcy是冠心病患者冠状动脉病变程度的独立危险因素(P<0.05)。结论血尿酸、血清同型半胱氨酸水平是冠心病患者冠状动脉病变严重程度的危险因素,且血尿酸、血清同型半胱氨酸水平越高,冠脉病变越严重。     

血尿酸与冠心病的相关分析

目的分析血清尿酸水平是否与冠心病相关。方法经冠状动脉造影确诊的冠心病患者142例和非冠心病患者92例。分别测定血清尿酸及血脂水平,同时记录性别、年龄、吸烟、高血压、糖尿病等相关因素。结果冠心病患者血清尿酸水平显著高于对照组（P<0.01）,相关分析显示血清尿酸水平与冠脉狭窄指数、年龄、高血压、糖尿病、高密度脂蛋白、胆固醇（P<0.05或P<0.01）呈正相关。多因素回归分析显示,血清尿酸与冠心病的发生和冠脉狭窄指数无明显相关。结论高尿酸血症不是冠心病的独立危险因素。     

慢性稳定性冠心病患者的管理

<正>慢性稳定性冠心病在冠心病中占绝大多数,如何管控这一患者群体,减少他们的心血管事件发生,已成为医务工作者的重要工作。为此,中华医学会于2007年发布了关于慢性稳定性冠心病的诊疗指南[1],2010年又发表了慢性稳定性冠心病管理中国共识[2],2013年欧洲心脏病学会也发表了关于稳定性冠心病的指南[3],以指导临床实践。1慢性稳定性冠心病的诊断慢性稳定性冠心病的诊断有两个要求:第一,有     

血清尿酸水平与冠心病患者冠脉狭窄程度的关系

目的：探讨冠心病患者血清尿酸(UA)水平和冠脉狭窄程度的关系。方法：166例患者纳入研究,其中经冠脉造影诊断为冠心病119例,非冠心病患者47例。纳入患者均行生化检测,同时彩超评价患者心功能。结果：与对照组相比,冠心病患者血清UA水平显著升高(P<0.01);与UA正常组相比,UA升高组患者冠状动脉病变支数增加(P<0.01),冠脉狭窄计分CASS升高(P<0.01),而心功能明显减低(P<0.01)。血清UA水平与冠脉狭窄计分CASS呈正相关(r=0.334, p<0.01),而与心功能呈负相关(r=?0.252, p< 0.01)。结论：冠心病患者血清UA水平与冠脉狭窄程度密切相关。     

血尿酸水平与冠状动脉病变及代谢综合征的关系

目的 探讨血尿酸水平变化与冠状动脉病变程度、代谢综合征及其相关组分的关系.方法 343例(男性223例,女性120例)接受冠状动脉造影检查的患者,应用冠脉狭窄指数(CSI)评价冠状动脉病变严重程度.结果 (1)女性血尿酸水平显著低于男性[(306.3±76.9对358.9±85.2)μmol/L,P＜0.01],而男女性代谢综合征及各组分的患病率未见明显差异.(2)女性≥3项代谢异常亚组血清尿酸水平显著高于1项代谢异常亚组(P＜0.01)及2项代谢异常亚组(P＜0.05),而男性尿酸水平与代谢异常数目无明显关系.(3)将男、女人群的尿酸值分为4分位数,女性位于上1/4位点者的CSI评分高于下1/4位点者[7.0(2.5～12.0)对2.0(0.0～6.0),P=0.025].女性多支病变组血尿酸水平明显高于无病变组[(327.0±81.9对284.9±78.6)μmol/L,P=0.033].(4)Logistic回归显示年龄(β=0.042,P=0.007)和血脂异常(β=0.836,P=0.037)为男性冠脉病变的独立危险因素,而女性人群中血压异常(β=1.127,P=0.039)及血脂异常(β=0.901,P=0.009)为影响冠脉病变的主要因素.结论 血尿酸水平较高的女性,代谢异常组分聚集较多,其冠状动脉病变程度较重,故尿酸水平可作为女性动脉粥样硬化的标志.

Abstract：

Objective To analyze the association of blood uric acid level with the severity of coronary artery stenotic changes, metabolic syndrome (MS), and its components. Methods A total of 343 individuals ( male 223,female 120) who underwent coronary angiography and had complete data on MS and serum uric acid were collected. The severity of coronary artery disease (CAD) was assessed by the coronary stenesis index (CSI). MS was diagnosed according to the Guideline on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults. Results (1)The mean uric acid level was significantly lower in women than in men [ ( 306.3±76.9 vs 358.9±85.2 ) μmol/L, P＜0.01 ]. The prevalence of MS and its components showed no difference between men and women. (2) The uric acid level in women with 3 components was higher than those with1( P＜0. 01 ) or 2 ( P＜0.05 ) components of metabolic disorders, but not in men. (3) Quartiles of concentration of uric acid were computed. Compared with those in the lowest quartile of uric acid, women in the highest quartile had higher CSI score [ 7.0 (2.5-12.0) vs 2. 0( 0.0-6.0), P= 0. 025 ]. Moreover, the uric acid level was higher in women with multivessel lesions than nonCAD patients [ (327.0±81.9 vs 284.9±78.6) μmol/L, P = 0.033 ]. However, no correlation was found between uric acid level and the severity of coronary artery lesion in men. (4) Logistic regression showed that age (β=0.042, P=0. 007) and dyslipidemia(β=0.836, P=0. 037 ) were the independent risk factors of CAD in men, and hypertension(β=1. 127, P=0.039) and dyslipidemia(β=0.901, P=0.009)in women. Conclusions In women with higher uric acid level, the clustering of metabolic abnormalities was increased, and the coronary artery lesion was more severe. High uric acid level might be a marker of CAD for women.     

冠状动脉粥样硬化性心脏病患者血清尿酸特点分析

目的分析冠状动脉粥样硬化性心脏病（冠心病）患者血清尿酸浓度的特点,探讨检测血清尿酸浓度在预防冠心病发生中的作用。方法选取2010年3月至2011年2月在广东省人民医院住院,怀疑冠心病的患者430例为研究对象。首先根据造影结果分为冠心病组316例,对照组114例,测定两组的血清尿酸浓度,并进行对比分析。然后,根据世界卫生组织高尿酸血症诊断标准,将患者分成高尿酸血症组和非高尿酸血症组,比较两组的冠心病患病率。最后,患者按血清尿酸浓度分为4个浓度组,比较4组冠心病的患病率。结果冠心病组血尿酸浓度高于对照组,差异有统计学意义[（374.42±98.54）μmol.L-1vs.（374.42±98.54）μmol.L-1,P〈0.05]。高尿酸组中冠心病患病率高于非高尿酸组,但差异无统计学意义（P=0.217）。不同血清尿酸浓度的4组中,血清尿酸浓度越高,冠心病患病率也越高,与浓度最低组比较,差异有统计学意义（P=0.001）。结论血清尿酸浓度可能是冠心病的危险因素之一,血清尿酸浓度高者患冠心病的可能性较大;加强血清尿酸浓度检测对预防冠心病的发生具有重要意义。     

Circulating adhesion molecules in patients with stable coronary artery disease

To evaluate platelet and endothelial function in patients with stable coronary artery disease (CAD), we investigated levels of the plasma-soluble (s) adhesion molecules E-selectin (sE-selectin), P-selectin (sP-selectin), and intercellular adhesion molecule-1 (sICAM-1) in 74 patients (mean age, 53 +/- 8 years) with angiographically documented coronary artery disease. Levels were compared to 27 matched healthy control subjects. Patients were excluded if they had recent cardiovascular events or any illness that might influence platelet and endothelial cell function. Concentrations of sP-selectin were significantly higher in patients with stable CAD (276 +/- 61 ng/mL) compared with control subjects (188 +/- 32 ng/mL) (P = .0001), whereas sE-selectin and sICAM-1 levels were similar between the 2 groups. Pooling both groups showed that sICAM-1 correlated weakly with triglycerides (r = 0.240, P = .01) and sP-selectin correlated weakly with low-density lipoprotein cholesterol (r = 0.204, P = .04). Although plasma sICAM-1 concentrations were significantly increased in hypercholesterolemic patients compared with those of normocholesterolemic patients (P = .04), sP-selectin and sE-selectin levels were similar between the 2 groups. In conclusion, significantly increased sP-selectin levels, indicating platelet activation, were found in patients with stable CAD. No other sign of endothelial cell activation in these patients could be detected. Moreover, sP-selectin levels seem to reflect the activation of platelets rather than of endothelial cells.     

Revascularization strategies for patients with stable coronary artery disease

Patients with coronary artery disease who have prognostically significant lesions or symptoms despite optimum medical therapy require mechanical revascularization with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) or both. In this review, we will evaluate the evidence‐based use of the two revascularization approaches in treating patients with coronary artery disease. CABG has been the predominant mode of revascularization for more than half a century and is the preferred strategy for patients with multivessel disease, especially those with diabetes mellitus, left ventricular systolic dysfunction or complex lesions. There have been significant technical and technological advances in PCI over recent years, and this is now the preferred revascularization modality in patients with single‐vessel or low‐risk multivessel disease. Percutaneous coronary intervention can also be considered to treat complex multivessel disease in patients with increased risk of adverse surgical outcomes including frail patients and those with chronic obstructive pulmonary disease. Improvements in both CABG (including total arterial revascularization, off‐pump CABG and ‘no‐touch’ graft harvesting) and PCI (including newer‐generation stents, adjunctive pharmacotherapy and intracoronary imaging) mean that they will continue to challenge each other in the future. A ‘heart team’ approach is strongly recommended to select an evidence‐based, yet individualized, revascularization strategy for all patients with complex coronary artery disease. Finally, optimal medical therapy is important for all patients with coronary artery disease, regardless of the mode of revascularization.