无保护左主干病变介入治疗近远期疗效分析

目的评价无保护左冠状动脉主干(LMCA)支架治疗的安全性和有效性。方法对126例无保护LMCA病变接受介入治疗患者进行回顾性分析。结果共植入151枚支架。所有LMCA支架植入均获完全血流重建,术中无急性心梗和死亡发生。住院期间主要不良心脏事件(MACE)3例,均为急性心肌梗死,其中行靶病变血管重建术(TLR)1例,死亡2例。随访1～43(9.86±8.46)个月,总MACE 15例(12.1%),其中TLR 12例(再次PCI 9例,冠脉搭桥术3例),死亡3例。40例术后进行冠脉造影复查,19例发生了再狭窄,术中有回旋支开口部受累者再狭窄率增加。不同病变部位、手术方式对支架内再狭窄无显著影响。结论经选择的无保护LMCA病变,PCI治疗是可行和安全的,可取得较好的近远期结果。     

Left main coronary artery rotational atherectomy and stenting

BACKGROUND: Coronary artery bypass surgery is a difficult option in patients who are not candidates for bypass surgery and high-risk patients with critical left main coronary artery (LMCA) disease. We report outcomes and short-term follow-up of patients who had LMCA rotational atherectomy and/or stenting, assess the role of these interventions in protected and unprotected significant LMCA stenosis, and review the literature. METHODS: We reviewed the cases of seven men with critical LMCA stenosis for whom coronary artery bypass surgery was considered a high risk. Five patients had rotational atherectomy, one had coronary artery stenting, and one had both. RESULTS: In all cases, angiographic success was achieved, and symptoms were relieved. Six patients were discharged from the hospital in 3 to 6 days. One patient who had cardiogenic shock, respiratory failure, and acute renal failure before the procedure died of arrhythmia 4 days afterward. Another patient had elective coronary artery bypass graft surgery 3 weeks later for recurrent angina. Cardiac catheterization was repeated in 1 month for chest pain in three patients at 4 to 7 months follow-up, and none had progression of residual stenosis in the LMCA. CONCLUSIONS: Our study suggests that LMCA rotational atherectomy and stenting are safe and effective revascularization procedures in high-risk patients and patients who are not candidates for bypass surgery.     

选择性支架置入术治疗无保护左主干病变的临床疗效分析

目的：比较选择性支架置入术、外科旁路手术以及药物保守治疗对无保护左冠状动脉主干病变患者症状改善和近期远期预后的影响。方法：选取73例无保护左主干病变患者，按治疗干预方法分为选择性支架置入组（17例）、外科旁路手术（CMY3）组（38例）和药物保守治疗组（18例），随访3～41个月，分析比较其临床造影特征、手术效果和近期中期预后。结果：3组患者在危险因素、症状、体征以及主要辅助检查均无显著差异（P〉0.05）。临床预后分析显示，选择性支架置入组和CABG组的手术成功率均为100％；3组患者的住院期间生存率：选择性支架置入组为100%，CABG组为94．7%（36／38），药物治疗组为100％，3者之间无显著差异（P〉0.05）；3年生存率：选择性支架置入组为100％，CABG组为92．1％（35／38），两者之间无显著差异（P〉0．05），药物治疗组为77．8％（14／18），与另外两组相比有显著差异（P〈0.05）；远期主要心脏不良事件发生率：选择性支架置入组为17．6％（3／17），CABG组为21．1％（8／38），两者之间无显著差异（P〉0．05），药物治疗组为44．4％（8／18），与另外两组相比有显著差异（P〈0．05）；3年无事件生存率：选择性支架置入组为69．3％，CABG组为63．6％，两者之间无显著差异（P〉0.05），药物治疗组为20．9％．与另外两组相比有显著差异（P〈0．05）。3年生存率和无事件生存率的Kaplan Meier曲线显示，选择性支架置入术与外科旁路手术相比，在改善患者预后方面无显著差异（P〉0.05），但两者均明显优于单纯药物治疗（P〈0.05）。结论：选择性支架置入术是治疗左冠状动脉主干狭窄性病变的有效治疗手段。可以显著改善患者的近期和远期预后，降低远期死亡率和主要心血管事件发生率。其治疗效果明显优于单纯药物保守治疗，与CABG相比则无明显差异。     

The prognostic value of multidetector coronary CT angiography for the prediction of major adverse cardiovascular events: a multicenter observational cohort study

To assess the prognostic value of coronary artery stenosis identification by coronary computed tomographic angiography (CCTA) for the prediction of major adverse cardiac events (MACE) in a multicenter prospective cohort study. We performed a prospective multicenter observational cohort study of symptomatic patients with suspected or known coronary artery disease (CAD) (n = 172; 57% male) undergoing CCTA in accordance to ACC/AHA Appropriateness Criteria from 4 sites in and around Paris, France, and followed for a mean duration of 22.0 ± 4.5 months (interquartile range 18–26 months). Coronary arteries by CCTA were interpreted by physicians blinded to the patient characteristics for the presence or absence obstructive (≥70% luminal diameter stenosis), as well as for plaque composition categorized as non-calcified, calcified or “mixed.” MACE was defined as death, non-fatal myocardial infarction, unstable angina or target vessel revascularization. MACE event rates were compared between patients with or without obstructive plaque and with differing plaque compositions. MACE event rates were significantly higher in patients with obstructive coronary artery stenosis by CCTA compared to those without (61.1% vs. 3.9%, P < 0.01). In patients with obstructive stenosis, mixed (83.3% vs. 25.3%, P < 0.01) and calcified (94.4% vs. 50.7%, P < 0.01) plaque presence was significantly higher than in patients without obstructive stenosis, with no differences in prevalence of non-calcified plaque (27.8% vs. 20.8%, P = NS). For MACE, the negative predictive value of no observed coronary artery plaque was 100% in the follow-up period. In this prospective multicenter study of symptomatic patients with suspected or known CAD undergoing CCTAs interpreted by imagers blinded to patient characteristics, CCTA presence of plaque severity and composition successfully identifies patients at risk for incident MACE events. Importantly, a negative CCTA portends an extremely low risk for incidence MACE.     

Silent obstruction of the coronary stenosis between diagnostic angiography and later percutaneous transluminal coronary angioplasty without myocardial infarction

Among 204 patients with severe coronary artery stenosis amenable to percutaneous transluminal coronary angioplasty (PTCA), 5 (2.5%) developed new silent total coronary occlusion of the vessel to be dilated without any chest symptom during the period between diagnostic coronary angiography and repeat coronary angiography at the time of the operation. We evaluated the clinical and angiographical characteristics of the patients with silent obstruction of the coronary artery in a short time, compared with the patients with unstable angina pectoris, who is considered to be suffering from acute myocardial infarction with severe chest symptom. None of the clinical variables studied showed a significant difference between the two groups. Among the angiographic variables, the degree of collateral was higher and impaired coronary perfusion distal to the lesion was more frequently found in unstable angina group. These results suggest that unstable angina is in a later stage of the ischemic heart disease compared with the time of the diagnostic angiography in patients with silent obstruction. Silent obstruction of high degree coronary stenosis is presumably due to the development of collateral circulation.     

急性冠状动脉综合征患者心电图和相应病变血管的关系分析

目的 确定十二导联心电图上相应ST段压低与急性左主干病变的关系。方法 选取2003-06—2006-06因左主干或左前降支病变进行PCI手术的79例患者，18例是由于急性左主干闭塞或高度狭窄引起的急性冠状动脉综合征，61例是由于左前降支冠状动脉病变引起的急性冠状动脉综合征，分析病变血管和相应心电图变化的关系。结果 急性左主干闭塞或高度狭窄患者在aVF、v2、v3、v4、v5和v6导联上相应ST段压低的发生率明显高于左前降支冠状动脉病变患者。多元线性分析表明，在aVF、V2和v4导联上ST段压低可能区分左前降支病变与左主干病变。结论 在十二导联心电图上V2、V4、aVF导联ST段压低，对急性左主干闭塞或高度狭窄是重要的预测指标。     

Whole blood choline and plasma choline in acute coronary syndromes: prognostic and pathophysiological implications

BACKGROUND: Whole blood choline (WBCHO) and plasma choline (PLCHO) concentrations increase rapidly after stimulation of phospholipase D in acute coronary syndromes (ACS). Early risk-stratification was analyzed in 217 patients with suspected ACS and a negative admission troponin T (<0.03 microg/L). METHODS: WBCHO and PLCHO were measured using high-performance-liquid-chromatography mass spectrometry. Major cardiac events (MACE) were defined as cardiac death/arrest, coronary intervention or myocardial infarction (MI). RESULTS: WBCHO (> or = 28.2 micromol/L) was predictive for MACE (hazard ratio [HR] 2.7; p<0.001), cardiac death/arrest (HR 4.2; p=0.015), heart failure (HR 2.8; p=0.003), coronary intervention (HR 2.1; p=0.01) and MI (HR 8.4; p=0.002) after 30 days. PLCHO (> or = 25.0 micromol/L) was predictive for MACE (HR 2.6; p=0.005), cardiac death/arrest (HR 15.7; p<0.001), heart failure (HR 6.0; p<0.001) but not for coronary intervention and MI. WBCHO and PLCHO were predictive for MACE in multivariate analysis (Odds ratio [OR] 2.7, p=0.009 and OR 3.3, p=0.03) independently of age, gender, prior MI, coronary risk factors and ECG. CONCLUSIONS: WBCHO and PLCHO are significant and independent predictors of major cardiac events in admission troponin T negative acute coronary syndromes. Both are predictive for events related to tissue ischemia and WBCHO is capable of detecting risks associated with coronary plaque instability.     

成纤维细胞生长因子21、脂联素、游离脂肪酸与冠心病严重程度及不良预后的相关性研究

目的探讨血浆成纤维细胞生长因子21(FGF21)、脂联素(ADPN)、游离脂肪酸(FFA)水平与冠心病(CHD)临床分型、冠状动脉狭窄程度及发生不良心血管事件(MACE)的关系。方法选择2019年8月至2020年1月在蚌埠医学院第一附属医院心内科就诊的120例CHD患者作为CHD组,并选取同期40例健康志愿者作为对照组。依据临床表现及相关检查将患者分为稳定性心绞痛(SAP)组和急性冠状动脉综合征(ACS)组;依据冠状动脉造影Gensini评分将患者分为轻度狭窄组(<20分)、中度狭窄组(≥20~50分)及重度狭窄组(>50分);依据院外6个月是否发生MACE分为预后不良组和预后良好组。比较FGF21、ADPN、FFA与CHD临床分型和Gensini评分的关系,利用受试者工作特征曲线(ROC曲线)评估三者对MACE的预测价值。结果与对照组相比,CHD组血浆FFA、FGF21、总胆固醇(TC)、三酰甘油(TG)水平升高,ADPN水平降低(P<0.05)。SAP组和ACS组间FGF21、FFA、ADPN水平差异有统计学意义(P<0.05)。FGF21水平与Gensini评分呈正相关(r=0.72,P<0.05),ADPN水平与Gensini评分呈负相关(r=-0.66,P<0.05)。FGF21、ADPN、FFA单独检测诊断MACE的ROC曲线下面积分别为0.78、0.90、0.76,三者联合检测时灵敏度为82.1%,特异度为89.6%,ROC曲线下面积为0.90。结论CHD患者血浆FGF21、ADPN、FFA水平与临床分型相关,其中FGF21、ADPN还与冠状动脉狭窄程度相关。三者联合检测可预测MACE的发生情况。     

Left main or proximal left anterior descending coronary artery disease: detection by echocardiographic evaluation of interventricular septal function during exercise

Summary. Forty patients with coronary artery disease were studied prospectively to investigate whether stenosis of the left main (LMCA) or left anterior descending coronary artery, proximal to the first septal branch (proximal LAD), could be detected by M-mode echocardiography during exertion. The interventricular septum was visualized in 30 of the patients during bicycle exercise in the semisupine position, all with simultaneous occurrence of electrocardiographic evidence of myocardial ischaemia. Fifteen of these had LMCA or proximal LAD stenosis. Systolic motion and thickening of the septum decreased significantly from rest to peak exercise in patients with LMCA or proximal LAD disease while it increased in those without. The results suggest that M-mode echocardiography during exercise in patients with coronary artery disease might identify those with LMCA or proximal LAD stenosis.     

CT血管造影联合血清同型半胱氨酸、脂蛋白(a)及B型脑钠肽在评估冠状动脉硬化狭窄中的临床价值

  目的  探讨CT血管造影联合血清同型半胱氨酸（Hcy）、脂蛋白（LP）(a) 及B型脑钠肽（BNP）在冠状动脉硬化狭窄中的评估价值。  方法  选取我院2020年12月~2021年7月收治的150例冠心病患者作为观察组,另选取86例健康体检者作为对照组,均予以CT血管造影及血清Hcy、BNP、LP(a)水平检查,分析上述血清指标与疾病类型、冠脉病变支数、冠脉狭窄程度、斑块性质及CT血管造影冠脉参数的相关性。  结果  观察组血清Hcy、BNP、LP(a)水平及斑块负荷、血管狭窄程度、重建指数（RI）较对照组更高,血管体积低于对照组（P < 0.05）;急性心肌梗死患者血清Hcy、LP(a)、BNP水平及斑块负荷均 > 不稳定型心绞痛患者 > 稳定型心绞痛患者 > 隐匿型冠心病患者（P < 0.05）;随冠脉病变支数、冠脉狭窄程度增加,冠心病患者上述血清指标升高,斑块负荷、RI值均增加（P < 0.05）;非钙化斑块者上述血清指标及斑块负荷、血管狭窄程度、RI值高于钙化斑块者（P < 0.05）;冠心病患者3项血清指标均与非钙化斑块及斑块负荷、急性心肌梗死、冠脉病变支数、冠脉狭窄程度、血管狭窄程度、RI值呈正相关（P < 0.05）;ROC曲线显示,CT血管造影联合3项血清指标诊断冠状动脉硬化重度狭窄（狭窄程度 > 75%）的敏感度、特异性、曲线下面积分别为0.81、0.82、0.878。  结论  冠心病患者血清Hcy、LP(a)、BNP水平逐渐升高,与CT血管造影参数联合可较好地诊断冠状动脉硬化狭窄程度。      

Utility of stress perfusion-cardiac magnetic resonance in follow-up of patients undergoing percutaneous coronary interventions of the left main coronary artery

To assess the accuracy of cardiac magnetic resonance (CMR) for the diagnosis of angiographic stenosis after percutaneous coronary intervention (PCI) of left main coronary artery (LMCA). Patients undergone in the last year PCI of unprotected LMCA and scheduled for conventional X-ray coronary angiography (CXA) were evaluated with stress perfusion CMR within 2 weeks before CXA. Main contraindications to CMR were exclusion criteria. Stress perfusion CMR was performed to follow a bolus of contrast Gadobutrol after 3 min of adenosine infusion. Between the 50 patients enrolled, only 1 did not finish the CMR protocol and 49 patients with median age 71 (65–75) years (38 male, 11 female) were analyzed. Between 784 coronary angiographic segments evaluated we found 75 stenosis or occlusions (prevalence 9.5%), but only 13 stenosis or occlusions in proximal segments (prevalence 6.6%). Patients with coronary stenosis (n?=?12, 24%) showed a significantly (p?=?0.002) higher prevalence of diabetes (7 of 12, 58%). At CMR examination, late gadolinium enhancement was present in 25 (51%), reversible perfusion defects in 12 (24%), and fixed perfusion defects in 6 subjects (12%). The only patient with LMCA restenosis resulted positive at perfusion CMR. The accuracy of stress perfusion CMR in diagnosis of coronary stenosis was higher when the analysis was performed only in proximal coronary arteries (95%, CI 86–99) compared to overall vessels (84%, CI 70–92). Stress perfusion CMR could strongly reduce the need for elective CXA in follow up of LMCA PCI and should be validated in further multicenter prospective studies.     

冠状动脉介入治疗时代孤立性左主干狭窄病变患者的临床特征和预后分析

目的 回顾性分析孤立性左主干(left main coronary artery,LMCA)狭窄病变患者的临床特征和预后.方法 连续入选30例孤立性LMCA狭窄病变患者并分为两组:开口病变组(n=21)和非开口病变组(n=9).随访终点为主要心脑血管不良事件(major adverse cardiac or cereb...     

血浆白介素-1β水平对ST段抬高性急性心肌梗死预后的影响

目的 研究入院时血浆白介素-1β(IL-1β)水平对行经皮冠脉介入治疗(PCI)的ST段抬高性急性心肌梗死(STEAMI)患者发生不良心脏事件是否具有预测价值.方法 单中心前瞻性连续入选2006年3月至2008年3月住院的患者为研究对象,其中STEAMI 96例(均为发病12 h以内,均行直接PCI术),稳定性心绞痛(SAP)271例以及正常冠脉对照组148例.以ELISA法分别检测其血浆IL-1β水平.然后对所有STEAMI患者进行前瞻性随访,观察住院期间主要心脏事件(MACE)(包括心源性死亡,非致死性心梗,心力衰竭、心源性休克等)的发生情况.结果 STEAMI患者血浆IL-1β水平高于稳定性心绞痛及冠脉正常对照组(P<0.05).住院期间共32例STEAMI患者发生MACE(其中男性23例,女性9例,年龄(75.44±13.45)岁.非参数分析显示PCI术后发生MACE的患者其IL-1β水平显著高于无MACE的患者(中位数[范围]26.52[12.01～155.244]pg/mL vs.2.157[0.433～83.021]pg/mL,P<0.01).Spearman's相关分析显示IL-1β与肌钙蛋白Ⅰ峰值水平呈显著正相关(r=0.353,P=0.004).多因素Logistic回归显示IL-1β≥20 pg/mL是STEAMI患者住院期间发生MACE的独立危险因素(OR 32.05,95%CI 4.28～240.15,P=0.001).结论 本研究表明ST段抬高性急性心肌梗死患者入院时血浆IL-1β水平升高,而且血浆IL-1β水平是行PCI治疗的ST段抬高性急性心肌梗死患者住院期间发生主要不良心脏事件的独立预测炎症指标.     

中性粒细胞与淋巴细胞比值联合GRACE评分对急性STEMI患者PCI术后发生院内主要不良心血管事件的预测价值

目的 探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)联合全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者接受直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)术治疗后发生院内主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法 纳入2018年9月1日-2019年12月31日就诊于河北省人民医院心血管内科行直接PCI治疗的急性STEMI患者275例。根据PCI术后是否发生院内MACE(包括全因死亡、心源性休克、院内再次血运重建、恶性心律失常及心脏骤停),分为MACE组(35例)和非MACE组(240例)。收集两组临床资料,分析STEMI患者PCI术后发生院内MACE的独立危险因素,并绘制受试者工作特征(receiver operating characteristic, ROC)曲线分析NLR、GRACE评分及二者联合对急性STEMI患者PCI术后发生院内MACE的预测价值。结果 MACE组年龄、GRACE评分、CRUSADE评分及NLR均高于非MACE组,估算的肾小球滤过率低于非MACE组(均P<0.05)。多因素Logistic回归分析提示,GRACE评分、NLR是急性STEMI患者PCI术后发生院内MACE的独立危险因素(均P<0.05)。ROC曲线提示,GRACE评分、NLR对急性STEMI患者PCI术后发生院内MACE有一定预测能力,但两者联合的曲线下面积更大,可更好地预测急性STEMI患者PCI术后是否发生院内MACE。结论 GRACE评分、NLR是急性STEMI患者PCI术后发生院内MACE的独立危险因素,两者联合对急性STEMI患者PCI术后发生院内MACE具有较好的预测价值。     

The distribution and prognosis of anomalous coronary arteries identified by cardiovascular magnetic resonance: 15?year experience from two tertiary centres

Background

Aberrant coronary arteries represent a diverse group of congenital disorders. Post-mortem studies reveal a high risk of exercise-related sudden cardiac death in those with an anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS) with an inter-arterial course. There is little documentation of lifetime history and long-term follow-up of patients with coronary artery anomalies.

Methods

Patients with anomalous coronary arteries undergoing cardiovascular magnetic resonance over a 15-year period were identified and classified by anatomy and course. Medical records were reviewed for major adverse cardiovascular events (MACE). Revascularisation or myocardial infarction counted only if occurring in the distribution of the anomalous artery.

Results

Consecutive patients with coronary artery anomalies were retrospectively identified (n = 172). Median follow-up time was 4.3 years (IQR 2.5–7.8, maximum 15.6). 116 patients had ACAOS of which 64 (55%) had an inter-arterial course (IAC) and 52 (45%) did not. During follow up 110 ACAOS patients were alive, 5 died and 1 lost to follow-up.ACAOS patients experienced 58 MACE events (5 cardiovascular deaths, 5 PCI, 24 CABG and 24 had myocardial infarction). 47 MACE events occurred in ACAOS with IAC and 11 in those without (p < 0.0001), the statistical difference driven by surgical revascularisation and myocardial infarction.

Conclusions

In life, patients with an anomalous coronary artery originating from the opposite sinus of Valsalva taking an IAC have higher rates of both myocardial infarction and surgical revascularisation during long-term follow up, compared to those without IAC.     

老年冠心病患者经皮冠状动脉介入治疗分析

目的 探讨老年与非老年冠心病患者择期经皮冠状动脉介入治疗(PCI)的特点.方法 217例冠心病患者,依年龄分为老年组(＞65岁)72例和非老年组(≤65岁)145例,冠状动脉造影(CAG)显示404处病变,相应接受了245次PCI治疗,其中有153例患者成功植入冠状动脉支架172枚,记录术中并发症以及术后住院期间主要不良心脏事件(MACE)发生情况,结合病史分析两组特点及区别.结果 老年组女性患者比例、高血压、糖尿病、不稳定型心绞痛发生率、多支病变率、手术并发症发生率、支架植入率均高于非老年组;但老年组吸烟率、合并高脂血症及单支病变率均低于非老年组;两组患者重度血管狭窄(狭窄≥90％)率及手术成功率相似(P＞0.05).结论 老年组与非老年组相比,PCI的手术成功率差异无统计学意义,但老年组手术并发症以及手术后MACE发生率高于非老年组,因此,对老年患者行PCI治疗前应权衡利弊.     

Mid-term outcome after carotid artery stenting depends on presence of coronary artery disease

BACKGROUND: Longer-term outcome of patients following carotid artery revascularization depends predominantly on cardiac events rather than neurological events. AIM: To assess the longer-term outcomes of patients with known coronary artery morphology undergoing carotid artery stenting. METHOD: In a prospective observational study including 549 consecutive patients undergoing carotid artery stenting, a coronary angiography was performed in a single session unless a recent angiogram was available. Following the intervention, patients were followed prospectively to determine neurological events as well as major adverse coronary events (MACE) during long-term follow-up. RESULTS: Coronary artery disease was present in 378 patients including 92 patients without current significant stenosis. The MACE rate was 6.4% in patients without coronary artery disease compared to 28.3% in patients with coronary artery disease (P<0.00001). Cardiac and all-cause mortality were statistically significantly higher in patients with a significant coronary stenosis than in patients without coronary artery disease (P<0.001 and P<0.01). Cardiac mortality and all-cause mortality were 2.3% and 7.6% in patients without coronary artery disease (patient group I), 7.6% and 13.0% in patients with coronary artery disease but no current significant stenosis (patient group II), and 10.5% and 16.1% in patients with significant coronary stenosis (patient group III). Neurological events, however, were distributed equally among the three patient groups. CONCLUSIONS: In the longer term, outcomes in patients undergoing carotid artery stenting depend on concomitant coronary artery disease rather than neurological events, cardiac mortality and even all-cause mortality depending on a significant coronary artery stenosis.     

Serum uric acid in patients with acute ST-elevation myocardial infarction

BACKGROUND:

Few studies investigated serum uric acid levels in patients with acute Stelevation myocardial infarction (STEMI). The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction (STEMI).

METHODS:

Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010. The level of serum lipid, echocardiographic data and in-hospital major adverse cardiovascular events (MACE) in patients with hyperuricemia (n=119) were compared with those in patients without hyperuricemia (n=383). The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed. All data were analyzed with SPSS version 17.0 software for Student’s t test, the Chi-square test and Pearson’s correlation coefficient analysis.

RESULTS:

Serum uric acid level was positively correlated with serum triglyceride level. Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients (43.7% vs. 33.7%, P=0.047), and serum triglyceride level was significantly higher in hyperuricemia patients (2.11±1.24 vs. 1.78±1.38, P=0.014). But no significant association was observed between serum uric acid level and one or more diseased vessels (P>0.05). Left ventricular end-diastolic diameter (LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients (53.52±6.19 vs. 52.18±4.89, P=0.041). The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients (36.4% vs. 15.1%, P<0.001; 68.2% vs. 55.8%, P=0.023). Also, hyperuricemia patients were more likely to have in-hospital MACE (P<0.05).

CONCLUSIONS:

Serum uric acid level is positively correlated with serum triglyceride level, but not with the severity of coronary artery disease. Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in hospital MACE.KEY WORDS: Acute ST-elevation myocardial infarction, Serum uric acid, Triglyceride, Coronary angiography, Echocardiography, Left ventricular systolic dysfunction, Left ventricular diastolic dysfunction, Major adverse cardiovascular events     

Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting

Background. Improved outcomes of percutaneous coronary interventions (PCI) with drug-eluting stents (DES) have resulted in their expanded use for left main coronary artery (LMCA) stenosis.

Aim. We compared outcomes of patients undergoing PCI for unprotected LMCA stenosis and patients treated by coronary artery bypass grafting (CABG).

Method. Between January 2005 and January 2007, 6705 patients were studied with coronary angiography in northern Finland. All subjects treated with revascularization of LMCA stenosis (n=287) were included and followed up for a mean of 12±6 months.

Results. From 287 patients, 238 underwent CABG, and 49 had PCI with DES. The incidence of 1-year mortality was 4% among the PCI-treated and 11% among CABG-treated patients (P=0.136). After the first month, mortality among PCI- or CABG-treated patients did not differ statistically significantly (2% versus 7%, P=0.133). The most significant independent predictor of mortality was reduced left ventricular systolic function (hazard ratio 14.9, 95% CI 5.5–40.0, P<0.001).

Conclusions. PCI with DES for selected LMCA disease patients results in short- and midterm outcomes comparable to results of CABG in general. PCI is a viable therapeutic option in selected patients with LMCA stenosis.     

Acceleration of tissue phase mapping by k-t BLAST: a detailed analysis of the influence of k-t-BLAST for the quantification of myocardial motion at 3T

Background

Some patients may have normal wall motion after myocardial infarction. The aim of this study was to determine the prevalence and prognosis of patients with myocardial scar in the absence of abnormal wall motion. We studied patients with suspected or known coronary artery disease (CAD) who were referred for cardiovascular magnetic resonance (CMR) for the assessment of global and regional cardiac function and late gadolinium enhancement (LGE) and had normal left ventricular wall motion. Prognostic value was determined by the occurrence of hard endpoints (cardiac death and nonfatal myocardial infarction) and major adverse cardiac events (MACE) which also included hospitalization due to unstable angina or heart failure or life threatening ventricular arrhythmia.

Results

A total 1148 patients (70.3%) were studied. LGE was detected in 104 patients (9.1%). Prevalence of LGE increased in patients with increased left ventricular mass. Average follow-up time was 955 ± 542 days. LGE was the strongest predictor for hard endpoints and MACE.

Conclusion

LGE was detected in 9.1% of patients with suspected or known CAD and normal wall motion. LGE was the strongest predictor of significant cardiac events.