非ST段抬高急性冠状动脉综合征患者的介入治疗

目的：分析急性冠脉综合征患者非ST段抬高时行经皮冠状动脉介入治疗术(PCI)的有效性和安全性。方法：从2001年1月至2003年10月在我院住院的72例非ST段抬高急性冠脉综合征病人，包括不稳定型心绞痛病人UAP)48例，非ST抬高急性心肌梗死(NSTEMI)病人24例，除常规内科治疗外，接受冠状动脉造影及介入治疗(PTCA和支架植入术)。造影提示单支血管病变31例(43．1％)，双支血管病变25例(34．7％)，三支血管病变16例(22．2％)，分别行PTCA和支架植入术。结果：介入治疗的成功率97．2％(70／72)，失败的两例患者主要是导丝不能通过闭塞病变所致。在70例患者中，共植入支架91枚。随访至术后30d，无症状或症状明显缓解的61例；2例发生ST段抬高急性心肌梗死；4例多支血管病变患者再次行介入治疗；3例患者转外科行CABG术；2例患者死亡。结论：经皮冠状动脉介入治疗是非ST段抬高急性冠脉综合征的有效和安全的治疗方法。     

Filmless cardiac imaging: Motion or commotion?

This study evaluated an analogue laser optical disc (MVP) as an alternative for cinefilm angiography in the visual analysis of coronary angiograms. Visual analysis was performed independently by 5 observers using cinefilm and MVP before and after PTCA (194 coronary lesions in 88 patients) and the outcomes were compared with QCA. The mean percentage diameter stenosis on cinefilm and MVP yielded similar results compared to QCA. Regression analysis showed a good correlation between the mean cinefilm and MVP values per diameter stenosis (p < 0.001). Bland-Altman plots confirmed these findings. Qualitative analysis for detection of coronary dissections after PTCA showed an incidence of 31.3% (cinefilm) and 21.8% (MVP) (p < 0.05). The results of this study indicate that the visual analysis of the coronary angiograms using the analogue laser optical disc (MVP) yields similar results compared to the cinefilm concerning coronary lesion severity, although there is an underestimation of coronary dissections.     

Beyond coronary sinus angiography: the value of coronary arteriography and identification of the pericardiophrenic vein during left ventricular lead placement

OBJECTIVE: The purpose of this study was to define the role coronary arteriography (venous phase) for improving the success of left ventricular (LV) lead implantation and to define the value of identifying the pericardiophrenic vein for optimal LV lead placement in biventricular (bi-v) device implantation. METHODS: Seventy-seven patients underwent bi-v device implantation between July 2002 and October 2003. If the coronary sinus (CS) could not be accessed, then left coronary arteriography was performed during the same procedure. CS access was guided by venous phase images of the coronary arteriogram. The pericardiophrenic vein was identified by selective cannulation or direct visualization. Patients with Cr > 1.5 had gadolinium used as the contrast agent. RESULTS: Seventy-five successful implants were performed (97%). In seven patients (9%) repeated attempts at retrograde cannulation of the CS failed (attempt time 130 +/- 20 minute, mean +/- SD). In these patients, coronary arteriography helped define the location of the CS, which was subsequently successfully cannulated. In six patients the pericardiophrenic vein was identified either during occlusion venography of the CS (postthoracotomy, veno-venous collaterals, n = 2) or during selective cannulation of the pericardiophrenic vein (using a DAIG Csl catheter, n = 4). The vein was directly visualized in three patients who underwent surgical LV lead implantation. LV leads in all these cases were implanted in areas not overlying the preidentified pericardiophrenic vein. During follow-up, none of these patients had evidence of phrenic nerve stimulation. CONCLUSIONS: Intraoperative left coronary arteriography increases the success of CS cannulation. Identification of the pericardiophrenic vein is a useful method to avoid phrenic nerve stimulation.     

Variations in the use of coronary arteriography in the UK: the RITA trial coronary arteriogram register

The Randomised Intervention Treatment of Angina (RITA) trialis comparing the effects of coronary artery bypass surgery andcoronary angioplasty. During patient recruitment, the trialparticipants maintained a register of patients investigatedby coronary arteriography. We used the register data to analysevariation in the practice and therapeutic implications of coronaryarteriography between the 17 participating centres. Of 33 359 patients undergoing coronary arteriography, 85.2%had significant coronary artery disease (range 81.3%–89.3%between centres). The planned management for patients with coronarydisease included coronary bypass surgery (43.3%), coronary angioplasty(15.7%) and RITA randomization (3.2%). The rate of referralfor myocardial revascularization varied between centres from47.6% to 83.4%. Multiple logistic regression analysis identifiedseveral correlates of myocardial revascularization, includingthe indication for investigation, extent of coronary diseaseand left ventricular function. After adjustment for these variables,the odds of revascularization at the different participatingcentres varied by a factor of 4.2. This intercentre variationin the use of revascularization procedures may reflect variationin the clinician's view of the appropriateness of myocardialrevascularization in different clinical circumstances.     

Angiographic correlations of patients with small vessel disease diagnosed by adenosine-stress cardiac magnetic resonance imaging

Cardiac magnetic resonance imaging (CMR) with adenosine-stress myocardial perfusion is gaining importance for the detection and quantification of coronary artery disease (CAD). However, there is little knowledge about patients with CMR-detected ischemia, but having no relevant stenosis as seen on coronary angiography (CA). The aims of our study were to characterize these patients by CMR and CA and evaluate correlations and potential reasons for the ischemic findings. 73 patients with an indication for CA were first scanned on a 1.5T whole-body CMR-scanner including adenosine-stress first-pass perfusion. The images were analyzed by two independent investigators for myocardial perfusion which was classified as subendocardial ischemia (n = 22), no perfusion deficit (n = 27, control 1), or more than subendocardial ischemia (n = 24, control 2). All patients underwent CA, and a highly significant correlation between the classification of CMR perfusion deficit and the degree of coronary luminal narrowing was found. For quantification of coronary blood flow, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) was evaluated for the left anterior descending (LAD), circumflex (LCX) and right coronary artery (RCA). The main result was that corrected TFC in all coronaries was significantly increased in study patients compared to both control 1 and to control 2 patients. Study patients had hypertension or diabetes more often than control 1 patients. In conclusion, patients with CMR detected subendocardial ischemia have prolonged coronary blood flow. In connection with normal resting flow values in CAD, this supports the hypothesis of underlying coronary microvascular impairment. CMR stress perfusion differentiates non-invasively between this entity and relevant CAD.     

应用超声定量组织速度成像(QTVI)技术评价冠心病患者PTCA支架置入术后局部心肌运动的临床研究

目的探讨超声定量组织速度成像（QTW）技术评价冠心病患者VIVA支架置入前后局部心肌运动速度的临床应用价值。方法26例接受左前降支（LAD）支架置入术的冠心病患者，在术前1天内、术后1周内以及3个月时分别行QTVI检查。结果与术前相比，术后一周内LAD对应节段（前间隔，前壁，室间隔中段和心尖段）的收缩期峰值速度（PSMV）、舒张早期峰值速度（PDMV）明显增高。结论成功的冠状动脉内支架置入术后左室局部室壁运动显着改善，超声QTVI技术能提供新的定量评价指标。     

心周脂肪体积联合脂蛋白α、载脂蛋白B可诊断早期冠心病:基于MSCT测量

  目的  探讨多层螺旋CT（MSCT）测量心周脂肪体积（PAT）联合脂蛋白α（Lp-α）、载脂蛋白B（Apo-B）检测在早期冠心病患者中的诊断评估价值。  方法  选取本院2020年3月~2022年4月收治的早期冠心病患者160例纳入观察组,再选取同期健康体检者110例为对照组,检测Lp-α、Apo-B水平及利用MSCT测量PAT,分析3项指标联合检测对冠心病的诊断评估价值。  结果  观察组PAT及Lp-α、水平均高于对照组（P < 0.05）;PAT及Lp-α、Apo-B水平与冠心病的发生呈正相关性（P < 0.05）;PAT及Lp-α、Apo-B水平与冠状动脉SYNTAX评分呈正相关性（P < 0.05）;ROC曲线显示:PAT及Lp-α、Apo-B联合诊断曲线下面积为0.920,高于各单项指标曲线下面积（P < 0.05）。  结论  PAT及Lp-α、Apo-B水平在冠心病早期患者中升高,与冠心病的发生和病情程度密切相关,并对冠心病具有较高的诊断价值。      

Reproducibility of coronary atherosclerotic plaque characteristics in populations with low,intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments

To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss’ Kappa (κ) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC?=?0.66, κ?=?0.73, ICC?=?0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50?%, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ?=?0.61, κ?=?0.81, ICC?=?0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ?=?0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.     

Prevalence and predictors of coronary artery disease in patients with a calcium score of zero

The absence of coronary calcification is associated with an excellent prognosis. However, a calcium score of zero does not exclude the presence of coronary artery disease (CAD) or the possibility of future cardiovascular events. Our aim was to study the prevalence and predictors of coronary artery disease in patients with a calcium score of zero. Prospective registry consisted of 3,012 consecutive patients that underwent cardiac CT (dual source CT). Stable patients referred for evaluation of possible CAD that had a calcium score of zero (n = 864) were selected for this analysis. The variables that were statistically significant were included in a multivariable logistic regression model. From 864 patients with a calcium score of zero, 107 (12.4 %) had coronary plaques on the contrast CT (10.8 %, n = 93 with nonobstructive CAD and 1.6 %, n = 14 with obstructive CAD). By logistic regression analysis, the independent predictors of CAD in this population were age >55 years [odds ratio (OR) 1.63 (1.05–2.52)], hypertension [OR 1.64 (1.05–2.56)] and dyslipidemia [OR 1.54 (1.00–2.36)]. In the presence of these 3 variables, the probability of having coronary plaques was 21 %. The absence of coronary artery calcification does not exclude the presence of coronary artery disease, but the prevalence of obstructive disease is very low. In this population, the independent predictors of CAD in the setting of a calcium score of zero were hypertension, dyslipidemia, and age above 55 years. In the presence of these 3 predictors, the probability of having CAD was almost 2 times higher than in the general population.     

The pre-procedural platelet state predicts clinical recurrence after coronary angioplasty

Percutaneous transluminal coronary angioplasty is an established therapy for coronary artery disease, but restenosis still occurs at a rate of 25%-40%. The aim of this study was to investigate the acute effect of percutaneous transluminal coronary angioplasty on platelet function and the relationship between platelet function and clinical recurrence. Spontaneous platelet aggregation was assessed before and after successful coronary angioplasty in 155 patients (120 men, 35 women). Patients were followed for a mean time of 20 months; follow-up angiography was performed only in patients with clinical recurrence. In 122 of 155 patients (79%) a significant increase in spontaneous platelet aggregation was observed immediately after coronary angioplasty. Baseline spontaneous platelet aggregation in platelet-rich plasma was significantly lower in patients with clinical recurrence than in those without (P<0.05). Kaplan-Meier event-free survival estimate showed a significant difference in clinical recurrence between patients with spontaneous platelet aggregation in platelet-rich plasma below and above the first quintile (P<0.05) with a relative risk of 2.5. In conclusion. these results indicate that percutaneous transluminal coronary angioplasty enhances spontaneous platelet aggregation and that the platelet state before coronary angioplasty affects the risk of clinical recurrence after the procedure.     

Adverse outcomes following emergency department discharge of patients with possible acute coronary syndrome

Objective: To determine the proportion of adverse events in patients discharged after ED assessment for possible acute coronary syndrome. Methods: Prospective observational cohort study enrolling consecutive patients presenting with symptoms suggestive of coronary syndrome. Main outcome was the proportion of adverse coronary events (defined a priori) within 30 days. Results: Of 2627 patients, 1819 (69%) were discharged without a diagnosis of coronary syndrome and 808 (31%) were admitted for further investigation and treatment. Of these, 385 (14.7%) were given a final diagnosis of acute coronary syndrome. On 30 day follow up, 18 of the discharged patients were diagnosed with acute coronary syndrome (0.7%; 95% confidence intervals [CI] 0.4–1.1%), 10 with unstable angina (0.4%; 95% CI 0.2–0.7%) and 8 with non‐ST elevation myocardial infarction (0.3%; 95% CI 0.2–0.6%). There were no cases of ST elevation infarction or death. The sensitivity for diagnosis of acute coronary syndromes was 95.5% (95% CI 92.9–97.3%). Average length of stay was 7 h for discharged patients. Forty‐six per cent of patients with diabetes and 47% with a past history of coronary disease were discharged. Subsequent outpatient stress testing was performed in 13.6%. Conclusions: In a large Australian ED, less than 1% of patients presenting with symptoms suggestive of coronary syndrome were discharged and subsequently had a 30 day adverse event. Reducing this proportion by admitting patients with traditional risk factors would markedly increase hospital workload. Opportunities exist to improve both the safety and efficiency of chest pain assessment in the ED.     

Dynamic real-time architecture in magnetic resonance coronary angiography--a prospective clinical trial.

OBJECTIVES: A dynamic real-time (dRT) architecture has been developed to address limitations in magnetic resonance coronary angiography (MRCA). A prospective clinical trial of 45 patients suspected of coronary artery disease was conducted to determine clinical utility of this integrated real-time system. BACKGROUND: Clinical implementation of MRCA is not performed routinely today. However, improved anatomic coverage, image quality, and scan flexibility may enhance its clinical utility. A novel real-time architecture addresses these challenges through instantaneous reconfiguration between real-time (RT) and high-resolution (HR) imaging sequences with dynamic selection of the desired element on a custom-designed receiver coil. METHODS: A total of 45 subjects were recruited consecutively to evaluate scan time, anatomic coverage, image quality, and detection of coronary lesions. Using a modern PC, the dRT switches from RT to gated HR imaging sequence in one repetition time (39 ms). Magnetic resonance imaging (MRI) scanning was performed using a custom-designed coronary coil consisting of two four-inch phase-array circular elements enabled with real-time selection of the desired coil element. RESULTS: All studies were completed in less than 45 minutes and required a mean of 12 breath holds (16 heartbeats). Of the total number of coronary segments, 91% (357/394) were visualized. Excellent or good image quality was achieved in 86% of the segments. Blinded analysis of the coronary arteries revealed sensitivity of 93% and specificity of 88% in the detection of coronary stenoses. CONCLUSIONS: The integrated environment of dRT provides a rapid and flexible scan protocol for MRCA while achieving wide anatomical coverage, high image quality, and reliable detection of coronary stenosis in short scan time.     

Direct binding and functional studies on muscarinic cholinoceptors in porcine coronary artery

The muscarinic cholinoceptors in porcine coronary artery were identified and characterized by a binding assay using (-)-[3H]quinuclidinyl benzilate (QNB) and also by pharmacological method. Specific (-)-[3H]QNB binding in the coronary artery was saturable and of high affinity (Kd = 0.08 nM), and it showed a pharmacological specificity as well as stereoselectivity which characterized muscarinic receptors. Muscarinic antagonists competed with the (-)-[3H]QNB binding in order: nonlabeled QNB greater than dexetimide greater than atropine greater than pirenzepine greater than AF-DX 116 greater than levetimide greater than gallamine. Dexetimide was approximately 2000 times as potent as levetimide. The potencies (pKi) of these muscarinic antagonists in competing for (-)-[3H]QNB binding sites in porcine coronary artery correlated well with their pharmacological potencies (pA2 for antagonistic effect of acetylcholine-induced contraction of coronary artery). The decrease in the (-)-[3H]QNB binding by atropine and pirenzepine was due to a reduction in the apparent affinity with little change in the number of maximal binding sites, suggesting a competitive antagonism. Specific (-)-[3H]QNB binding (Kd and maximal number of binding sites) in porcine coronary artery was not changed by the removal of endothelium. We conclude: 1) (-)-[3H]QNB selectively labels the physiologically relevant muscarinic receptors in porcine coronary artery and 2) the majority of these receptors is localized on vascular smooth muscles and the receptors mediate the acetylcholine-induced contractile response of coronary artery.     

Noninvasive angiography and assessment of left ventricular function using multislice computed tomography in patients with type 2 diabetes

OBJECTIVE: Early identification of coronary artery disease (CAD) in patients with diabetes is important because these patients are at increased risk for CAD and have worse outcome than nondiabetic patients after CAD is diagnosed. Recently, noninvasive coronary angiography and assessment of left ventricular function has been demonstrated with multislice computed tomography (MSCT). The purpose of the present study was to validate this approach in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: MSCT was performed in 30 patients with confirmed type 2 diabetes. From the MSCT images, coronary artery stenoses (> or =50% luminal narrowing) and left ventricular function (left ventricular ejection fraction, regional wall motion) were evaluated and compared with results of conventional angiography and two-dimensional echocardiography. RESULTS: Two hundred twenty of 256 coronary artery segments (86%) were interpretable with MSCT. In these segments, sensitivity and specificity for detection of coronary artery stenoses were 95%. Including the uninterpretable segments, sensitivity and specificity were 81 and 82%, respectively. Bland-Altman analysis in the comparison of left ventricular ejection fractions demonstrated a mean difference of -0.48 +/- 3.8% for MSCT and echocardiography, which was not significantly different from 0. Agreement between the two modalities for assessment of regional contractile function was excellent (91%, kappa statistic 0.81). CONCLUSIONS: Accurate noninvasive evaluation of both the coronary arteries and left ventricular function with MSCT is feasible in patients with type 2 diabetes. This noninvasive approach may allow optimal identification of high-risk patients.     

Investigation of elastic features of aorta and color M-mode flow propagation velocity (APV) of descending aorta in the patients with ischemic and non-ischemic dilated cardiomyopathy

Aortic flow propagation velocity (APV) is a novel echocardiographic parameter used in coronary artery disease. It has also been used for the evaluation of aortic stiffness. In the present study, APV was measured in patients with ischemic and non-ischemic dilated cardiomyopathy (DCM) and was compared with the parameters of aortic stiffness such as aortic distensibility (AD) and aortic strain (AS). A total of 140 patients who had undergone coronary angiographic imaging were included in the study. Out of these patients, 44 had ischemic DCM, 46 had non-ischemic DCM, and 50 had normal coronary angiography (control group). AS, AD, and APV were calculated echocardiographically. One-way analysis of variance (ANOVA) and the Kruskal–Wallis test were used to compare continuous variables between the groups, while the categorical variables were compared using Pearson’s Chi square test. Pearson’s correlation test was used to investigate the parameters associated with APV, AS, and AD. Ischemic DCM and non-ischemic DCM groups differed significantly. The comparison of these groups with the control group, in terms of AS, AD, and APV values (ANOVA p?<?0.001 for all) also showed a significant difference. APV was found to be significantly correlated with AS (r?=?0.645, p?<?0.001) and AD (r?=?0.604, p?<?0.001). In ROC analysis, the area under the curve (AUC) value for APV was 0.999 (p?=?0.000) for detection of patients ischemic DCM and non-ischemic DCM. APV may be considered to be a novel and a simple echocardiographic marker, for both, distinguishing ischemic from non-ischemic DCM as well as for the presence of dilated cardiomyopathy with or without critical coronary artery disease.     

Diagnosis of coronary artery disease using exercise echocardiography and positron emission tomography: comparison and analysis of discrepant results.

Both exercise echocardiography and rubidium-82 positron emission tomography are used in the detection and characterization of coronary artery disease. This study compared results of both in 74 patients with known coronary anatomy, by use of exercise echocardiography before and after treadmill exercise and positron emission tomography with intravenous dipyridamole-handgrip stress. Significant (greater than 50%) coronary stenoses were present in 70 patients; exercise echocardiography and positron emission tomography each identified 63 patients (sensitivity 90%). Significant stenoses without previous myocardial infarction were present in 34 patients; 29 (85%) were identified by exercise echocardiography and 28 by positron emission tomography (82%, p = NS). Four patients had no significant coronary disease, and were all identified as normal by both methods. Segments were classified as either normal or showing stress or resting abnormalities, and the diagnoses were compared in the territories of the three major coronary arteries. Results were concordant with respect to the presence or absence of coronary disease in 185 of 222 territories (83%). The remaining 37 regions had abnormalities by exercise echocardiography or positron emission tomography but not both. Stress defects were identified by only one of the tests in 24 areas (in 12 [50%], angiographic findings correlated with positron emission tomography). Resting defects were diagnosed by only one modality in 13 regions (angiographic findings correlated with the results of positron emission tomography in 9 [69%] of these). Both exercise echocardiography and positron emission tomography are sensitive for the identification of coronary artery disease, although on a regional basis, positron emission tomography appears to be more specific for the diagnosis of resting perfusion defects.     

The role of 64-slice multi-detector computed tomography in the detection of subclinical atherosclerosis of the coronary artery

Multi-detector computed tomography (MDCT) has been used for detecting or excluding coronary atherosclerotic stenosis in symptomatic patients. However, the role of MDCT for routine medical examination in asymptomatic, high-risk patients has not been established. We therefore conducted the present study to test the hypothesis that MDCT could be a valuable method for detecting subclinical coronary artery stenosis in asymptomatic patients. An observational, retrospective, single-centre study was conducted with a cohort of 1,529 patients (mean age, 56.4 ± 8.3 years; 1,353 males) who had undergone MDCT as part of their general medical checkups from November 2005 to April 2008. The patients who had a past history of coronary artery disease, typical chest pain, or evidence of myocardial ischemia were excluded. During clinical follow up of these patients, the incidence of subclinical coronary stenosis and the usefulness of MDCT for routine medical examination in asymptomatic patients were investigated. Of the 1,529 enrolled patients, 42.3% had hypertension, 13.5% had diabetes mellitus, 7.7% had hyperlipidemia, and 40.4% were current smokers. Abnormal MDCT findings were noted in 560 (36.6%) patients, who were classified into two groups. One group had the presence coronary calcium with a luminal diameter stenosis of the coronary artery of <50% (n = 508, 33.2%). These patients were treated with medication or clinical follow-up. The other group had a luminal diameter stenosis of the coronary artery of ≥50% with the presence or absence of coronary calcium (n = 52, 3.4%). These patients underwent a conventional coronary angiogram and intravascular ultrasound. A total of 29 of the 1,529 patients (1.9%) presented with insignificant stenosis or myocardial bridge, and 23 patients (1.5%) presented with significant stenosis. The patients with significant stenosis underwent percutaneous coronary intervention (PCI) with stent implantation. Major adverse cardiac events occurred in only 2 patients who had been treated with PCI during a mean follow-up period of 387 ± 253 days. The incidence of significant subclinical coronary stenosis as detected by MDCT in a general medical check-up was 3.4%, and the false-positive rate of MDCT for detecting significant coronary artery stenosis was 55.8% (29/52). 64-Slice MDCT can be a useful tool for noninvasive evaluation of coronary arteries in asymptomatic patients. Further study is needed to clarify the clinical implications of MDCT in general medical check-ups.     

Gelatinase B C(-1562)T polymorphism in relation to ischaemic heart disease

OBJECTIVE: Matrix metalloproteinases, such as gelatinase B, are important in connective tissue remodelling processes associated with atherogenesis and plaque rupture. The T allele of the gelatinase B C((-1562)) T polymorphism has been reported to be associated with an almost 2-fold increase in promoter activity and with the extent of coronary artery disease (CAD). The aim of this study was to analyse the relation of this gene variation to the risk and severity of CAD and the risk of myocardial infarction (MI). MATERIAL AND METHODS: This case-control study comprised 535 healthy controls and 2731 participants who had undergone coronary angiography. RESULTS: In the total sample, the gelatinase B promoter polymorphism was not associated with the risk of CAD and MI or with the extent of CAD defined either by the number of diseased coronary arteries or--in patients with coronary angiography--by a score for coronary heart disease (CHD) according to the Gensini score. However, patients with TT genotype had higher CHD scores than the other genotypes in subgroups of individuals with high apolipoprotein B levels, high lipoprotein (a) plasma concentrations and high fibrinogen levels, or with combinations of increased levels of these coronary risk factors. These observations were made in the entire sample of individuals with coronary angiography and in the population of patients with documented CHD. CONCLUSIONS: Obviously, the gelatinase B C((-1562))T gene polymorphism is not a risk indicator for CAD and MI. With respect to the extent of CHD, the impact of this gene variation may be restricted to individuals with high apolipoprotein B, lipoprotein (a) and/or fibrinogen levels.     

Association study between fibronectin and coronary heart disease.

Fibronectin is a known chemoattractant for several cell types that play a role in the wound healing process, including fibroblasts, endothelial cells and macrophages. It also generates a scaffold that allows attachment of other extracellular matrix components. Large amounts of fibronectin have been detected in atherosclerotic plaques, suggesting that it may play a role in the pathogenesis of atherosclerosis. To examine the possible involvement of fibronectin in the etiology of atherosclerotic coronary heart disease, we analyzed four polymorphisms in the human fibronectin gene and determined the plasma fibronectin levels in patients with coronary heart disease (n = 109) and age- and gender-matched controls (n = 123) in Chinese Han people. No significant positive association was observed between these polymorphisms and coronary heart disease. The levels of circulating plasma fibronectin, however, were significantly lower in patients with coronary heart disease (mean +/- SD 245 +/- 87 mg/L) compared with controls (354 +/- 88 mg/L) (p < 0.001). The odds ratio (OR) for plasma fibronectin was 0.94 in a multivariate unconditional logistic regression model (OR = 0.94, 95% CI 0.91-0.96, p < 0.001). We conclude that, in our population, the four fibronectin gene polymorphisms detected are not associated with clinical coronary heart disease. Our data suggest that low circulating fibronectin levels might be a new marker of coronary heart disease.     

High frequency of aspirin resistance in patients with acute coronary syndrome

Aspirin is widely used for secondary prevention of cardiovascular disease, but is not effective for all patients. This phenomenon is called as aspirin resistance. Although the prognosis is worse in patients who develop acute coronary syndrome (ACS) while using aspirin, the frequency of aspirin resistance in these patients has not been evaluated. We aimed to evaluate the frequency of aspirin resistance in patients with ACS and to determine its relationship with the angiographic severity and extent of the associated coronary artery disease. The present study included 104 patients with ACS (75 men, 60.4 +/- 10.8 years) who were hospitalized while using aspirin for at least last 7 days and 100 patients with stable coronary artery disease (73 men, 57.6 +/- 10.6 years), documented by coronary angiography, history of revascularization or myocardial infarction (MI), and the use of aspirin for last 7 days. The latter group had no MI or ACS for last 3 months. Platelet function was assessed with PFA-100, which simulates primary homeostasis at injured blood vessels. Coronary angiography was performed in 83 cases of the patients with ACS during hospital stay. Aspirin resistance is more prevalent in patients with ACS (40.3%) when compared with stable coronary artery disease patients (27%). The difference was statistically significant (p = 0.04). The ACS patients with aspirin resistance were older and had severe myocardial damage. However, there were no significant differences in angiographic severity and extent of coronary artery disease between aspirin-resistant and aspirin-sensitive patients. Frequency of aspirin resistance is higher in patients who develop ACS while using aspirin than that in patients with stable coronary artery disease.