Comparison of the predictive value of EuroSCORE,SYNTAX score,and clinical SYNTAX score for outcomes of patients undergoing percutaneous coronary intervention for unprotected left main coronary artery disease

Objectives : We aimed to assess the prognostic values of the EuroSCORE, SYNTAX score, and the novel Clinical SYNTAX score (CSS) for 30‐day and 1‐year outcomes in patients undergoing left main (LM) percutaneous coronary intervention (PCI). Background : PCI has become an alternative treatment for LM coronary artery disease, and risk scoring system might be beneficial for pre‐PCI risk stratification. Methods and Results : We enrolled 198 consecutive patients with unprotected LM disease undergoing PCI (mean age 71.5 ± 10.7 years). The CSS was calculated by multiplying the SYNTAX Score to (age/left ventricular ejection fraction +1 for each 10 mL the estimated glomerular filtration rate <60 mL/min per 1.73 m²). The endpoints were 30‐day, and 1‐year all‐cause death and major adverse cardiovascular events (MACE), which were defined as all‐cause death, nonfatal MI, and clinical‐driven target vessel revascularization. Comparing with the SYNTAX score, the predictive accuracy of CSS for 30‐day and 1‐year all‐cause death and MACE were significantly higher (c‐statistics, CSS versus SYNTAX score: P < 0.01 for 30‐day and 1‐year all‐cause death; P < 0.05 for 30‐day and 1‐year MACE, respectively). Furthermore, in the multivariate Cox regression analysis, both EuroSCORE and CSS were identified as the independent predictors of 30‐day and 1‐year all‐cause death and MACE, but the SYNTAX score was not. Conclusions : In the general practice among a high‐risk population undergoing LM PCI, EuroSCORE and CSS might be independent predictors for 30‐day and 1‐year all‐cause death and MACE. Furthermore, the CSS had a superior discriminatory ability in predicting the 30‐day and 1‐year clinical outcomes comparing with the SYNTAX score. © 2012 Wiley Periodicals, Inc.     

Left Main Coronary In‐Stent Intimal Hyperplasia and Hemodynamics as Detected by Contrast‐Enhanced Transesophageal Echocardiography

Patients and methods: In‐stent hemodynamics were studied by transesophageal echocardiography (TEE) in a group of 54 patients after left main coronary artery stenting, during a 6‐month follow‐up. TEE was performed within 24 hours after stenting and at 1‐ and 3‐month follow‐up. Pulsed wave and color Doppler signals were enhanced by IV administration of Levovist. Results: Angiographic immediate success was obtained in all patients. No in‐hospital death occurred. Ten patients (18.4%) complained of recurrent angina at the follow‐up of 4.8 ± 1.2 months. Both TEE and coronary angiography confirmed in‐stent restenosis in all. Thirty‐nine patients (68.5%) remained symptoms free. Mean late loss in these patients was 0.69 ± 0.20 mm. A linear significant positive relation between mean late loss values and diastolic coronary velocity (r: 0.89, P < 0.001) was found. After 3‐ and 6‐month follow‐up, PDV showed a significant increase in comparison with basal values (0.7 ± 0.3 and 0.6 ± 0.26 vs. 0.32 ± 0.2 cm/sec, P < 0.01). All patients with restenosis showed a significant increase of diastolic coronary velocity in comparison with basal values (2.89 ± 0.25 cm/sec, P < 0.001). Conclusion: TEE can predict the development of in‐stent intimal hyperplasia in patients with unprotected left main coronary artery stenting.     

The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction

BackgroundIn patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), Global Registry for Acute Coronary Events (GRACE) score is a valid tool for risk stratification. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score is an angiographic scoring system to guide the decision-making between coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI). The aim of the present study was to assess the accuracy of the GRACE score in predicting the severity and extent of coronary artery stenosis by SYNTAX score.MethodsA total of 330 patients with acute coronary syndrome (ACS) were enrolled in the study. For every patient, the GRACE score was calculated. All patients underwent coronary angiography within 2 days and the SYNTAX scoring system was used to evaluate the severity and extent of coronary stenotic lesions. Based on ROC curve analysis, the cut-off value of GRACE score that could predict SYNTAX score ≥ 23 was calculated.ResultsGRACE score was 107.12 ± 34.4 in patients with SYNTAX SCORE < 23 and 134.80 ± 48.3 in patients with SYNTAX score ≥ 23 (p value = 0.001). A positive correlation was observed between the GRACE score and angiographic SYNTAX score (r = 0.34 p < 0.001). We found that a GRACE score of 109 is the optimal cut-off to predict SYNTAX score ≥ 23 with a sensitivity of 73.5% and specificity of 60% (p < 0.001). Its negative predictive value was 94.0%.ConclusionGRACE score had significant but modest value to predict the severity and extent of coronary artery stenosis in patients with ACS.     

The association between increased carotid intima–media thickness and SYNTAX Score in coronary artery disease: A single center study

BackgroundCarotid artery lesions frequently coexist with coronary arterial disease (CAD). The aim of this study was to investigate the relation between carotid intima-media thickness (CIMT) and the extent of CAD and whether CIMT could be predictive of severity of coronary atherosclerosis.MethodsCoronary angiography and carotid ultrasound evaluations of 100 consecutive patients with CAD who had undergone elective coronary angiography were reviewed. IMT was measured at both carotid arteries. CIMT and severity of CAD relationship based on SYNTAX score was assessed. The relation between CIMT and cardiovascular risk factors was determined.ResultsMean overall SYNTAX score was 15.76 + 4.82. Mean right CIMT was 0.86 ± 0.29 and mean left CIMT was 0.83 ± 0.24. There were no significant correlation between the SYNTAX score and CIMT (r: 10, P: 30). There was significant relationship between hypertension,diabetes and CIMT (P: 0.01).Conclusionwe found no relationship between CIMT and SYNTAX score in patients who underwent coronary angiography. Diabetes mellitus and hypertension are related to increased carotid intima-media thickness.     

冠心病患者颈动脉内膜中层厚度及颈动脉斑块与SYNTAX评分的相关性研究

目的探讨冠心病患者颈动脉内膜中层厚度(CIMT)及颈动脉斑块与冠状动脉SYNTAX评分的关系。方法选择行冠状动脉造影的患者256例,根据冠状动脉造影结果分组:51例冠状动脉狭窄50%为对照组,余205例为冠心病组。冠心病组又根据SYNTAX评分结果分为低分组(1~22分)70例、中分组(23~32)94例、高分组(32分)41例。所有患者均采用超声检测双侧CIMT及颈动脉斑块情况。结果与对照组比较,冠心病组患者CIMT及斑块发生率明显高于对照组(P0.05)。与低分组比较,中分组和高分组CIMT及斑块发生率明显升高(P0.05)。Spearman线性回归分析结果显示冠心病患者CIMT与SYNTAX评分呈直线正相关(r=0.64,P0.01)。多因素Logistic回归分析结果显示,CIMT及颈动脉斑块是SYNTAX积分32分的独立预测因素(P0.05)。结论 CIMT及颈动脉斑块与冠心病患者SYNTAX评分密切相关,可间接预测冠状动脉病变严重程度。     

Association of Epicardial Adipose Tissue With Progression of Coronary Artery Calcification Is More Pronounced in the Early Phase of Atherosclerosis: Results From the Heinz Nixdorf Recall Study

ObjectivesThis study sought to determine whether epicardial adipose tissue (EAT) volume predicts the progression of coronary artery calcification (CAC) score in the general population.BackgroundEAT predicts coronary events and is suggested to influence the development of atherosclerosis.MethodsWe included 3,367 subjects (mean age 59 ± 8 years; 47% male) from the population-based Heinz Nixdorf Recall study without known coronary artery disease at baseline. CAC was quantified from noncontrast cardiac electron beam computed tomography at baseline and after 5 years. EAT was defined as fat volume inside the pericardial sac and was quantified from axial computed tomography images. Association of EAT volume with CAC progression (log[CAC(follow-up) + 1] − log[CAC(baseline) + 1]) was depicted as percent progression of CAC + 1 per SD of EAT.ResultsSubjects with progression of CAC above the median had higher EAT volume than subjects with less CAC change (101.1 ± 47.1 ml vs. 84.4 ± 43.4 ml; p < 0.0001). In regression analysis, 6.3% (95% confidence interval [CI]: 2.3% to 10.4%; p = 0.0019) of progression of CAC + 1 was attributable to 1 SD of EAT, which persisted after adjustment for risk factors (6.1% [95% CI: 1.2% to 11.2%]; p = 0.014). For subjects with a CAC score of >0 to ≤100, progression of CAC + 1 by 20% (95% CI: 11% to 31%; p < 0.0001) was attributable to 1 SD of EAT. Effect sizes decreased with CAC at baseline, with no relevant link for subjects with a CAC score ≥400 (0.2% [95% CI: −3.5% to 4.2%]; p = 0.9). Likewise, subjects age <55 years at baseline showed the strongest association of EAT with CAC progression (20.6% [95% CI: 9.7% to 32.5%]; p < 0.0001). Interestingly, the effect of EAT on CAC progression was more pronounced in subjects with low body mass index (BMI), and decreased with degree of adiposity (BMI ≤25 kg/m²: 19.8% [95% CI: 9.2% to 31.4%]; p = 0.0001, BMI >40 kg/m²: 0.8% [95% CI: −26.7% to 38.9%]; p = 0.96).ConclusionsEAT is associated with the progression of CAC, especially in young subjects and subjects with low CAC score, suggesting that EAT may promote early atherosclerosis development.     

急性冠脉综合征患者血清血小板源性生长因子表达的临床研究

目的：探讨急性冠脉综合征患者外周血及冠状动脉局部血清PDGF浓度与冠状动脉疾病严重程度的关系。方法：纳入2012年9月至2013年12月在南京医科大学第一附属医院心血管科行冠状动脉造影的急性冠脉综合征患者,并纳入同期因胸痛住院行冠状动脉造影且冠脉未见狭窄者最为对照组,收集各组患者临床资料,计算SYNTAX积分,通过ELSIA方法测定患者外周血及冠状动脉局部血清PDGF浓度;分析非冠心病组与冠心病ACS组、ACS患者不同亚组间血清PDGF浓度的差异,利用Pearson相关性分析血清PDGF浓度与SYNTAX积分的相关性。结果：与对照组比较,冠心病ACS组外周血PDGF浓度显著升高（723.29±679.53 vs 369.12.0±292.39,P＜0.05）;冠心病ACS组中AMI组外周血PDGF浓度较UAP组显著升高（758.36±714.56 vs 614.11±600.39,P＜0.05）。冠状动脉局部PDGF浓度较外周血PDGF浓度显著升高（911.89±735.41 vs 723.29±679.53,P<0.01）。Person相关分析显示外周血PDGF浓度与冠脉狭窄程度(SYNTAX评分)呈正相关关系(rho= 0.233,p<0.05)。随着血清PDGF浓度的升高,平均Syntax积分逐步升高,高浓度组Syntax积分高于低PDGF浓度组。结论：急性冠脉综合征患者血清PDGF浓度显著升高,尤其在冠状动脉局部PDGF呈现浓聚,血清PDGF浓度可反应冠状动脉病变的严重程度。     

Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial

ObjectivesThis study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS).BackgroundThe prognostic value of the SYNTAX score in this high-risk setting remains unclear.MethodsThe CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression.ResultsPre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes.ConclusionsIn patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.     

Smartphone-enabled retinal arteriovenous imaging and correlation with coronary SYNTAX score

ObjectiveTo assess the feasibility of measurement of retinal arteriovenous (AV) ratio using a smartphone, we performed a comparative evaluation with fundus camera imaging and coronary SYNTAX score.MethodSuccessive coronary artery disease (CAD) patients who underwent coronary angiography were recruited for smartphone retinal imaging. Following pupillary dilatation, fundus camera images and smartphone photography were performed. Video images were captured with a smartphone, edited and analysed. Retinal artery and vein size at 0.5 and 1 disc diameter (DD) were measured using DICOM software by two independent observers. Another observer calculated SYNTAX score.ResultsAnalysable smartphone images were available in 91 (89.2%) of 102 patients. Tobacco use was found in 26%, hypertension in 54%, diabetes in 55%, and high LDL cholesterol in 50%. Median and 25–75 interquartile range (IQR) AV ratio at 0.5 and 1.0 DD, respectively, with smartphone were 0.48 (0.45–0.52) and 0.47 (0.45–0.52) and fundus camera were 0.48 (0.44–0.53) and 0.48 (0.45–0.53) (Spearman's correlation 0.80 and 0.79, p < 0.001). Coronary single vessel disease was in 21%, double vessel in 16%, triple vessel in 55%, normal angiogram in 8%, and median SYNTAX score was 18.0 (8.0–25.0). There was an inverse correlation of SYNTAX score with smartphone-derived AV ratio at 0.5 and 1.0 DD (rho ?0.27,p = 0.007 and ?0.26,p = 0.009) as well as with fundus camera (rho ?0.37 and ?0.38, p < 0.001). Trend-analysis showed an inverse association of smartphone AV ratio with increasing CAD (p_trend <0.001).ConclusionsSmartphone-based retinal AV imaging is feasible and comparable to fundus-camera imaging. There is a significant inverse correlation with coronary angiographic severity.     

胆固醇代谢标志物与冠状动脉SYNTAX评分的相关性研究

目的:探讨冠心病患者胆固醇代谢标志物水平与反映冠状动脉病变严重程度的SYNTAX评分的关系。方法:回顾分析在我院接受冠状动脉造影检查的冠心病患者共103例,根据冠状动脉造影结果计算SYNTAX评分,根据评分数值分为低、中、高危组,检测所有患者接受调脂治疗前胆固醇代谢标志物的水平,分析胆固醇代谢标志物与SYNTAX评分之间的关系。结果:SYNTAX评分中危组较低危组患者的菜油固醇、谷固醇水平均显著增高(P<0.05),提示随着胆固醇吸收标志物水平的升高,冠状动脉病变严重程度加重。相关性分析显示:菜油固醇、谷固醇与SYNTAX评分呈正相关。多元线性回归分析结果显示:谷固醇(B=0.233,P=0.043)与SYNTAX评分呈正相关。结论:胆固醇吸收标志物与SYNTAX评分正相关,可作为判断冠状动脉病变严重程度的参考指标之一。     

Prognostic value of coronary artery calcium and epicardial adipose tissue assessed by non-contrast cardiac computed tomography

Objective

Epicardial adipose tissue (EAT) accumulation is believed to be associated with development of coronary atherosclerosis. We investigated whether EAT volume as assessed by computed tomography (CT) has value in prediction of future cardiac events.

Methods

We studied 722 patients without proven coronary artery disease (CAD) who underwent non-contrast cardiac CT. EAT volume and coronary artery calcium (CAC) score were measured simultaneously. Patients were followed as to the occurrence of coronary events (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and late coronary revascularization ≥3 months after CT examination).

Results

During a 3.7 ± 1.7 years follow-up period, 37 coronary events were documented. Annual event rates increased across CAC score categories (0.3%, 1.0%, 2.4%, and 4.3%, in 0, 1–99, 100–399, and ≥400, respectively, p < 0.001); these were significantly higher in the higher EAT volume group (>median; 107.2 mL, 0.7% vs., 2.1%, adjusted hazard ratio; 2.65, p = 0.0090). Cox-proportional hazard analysis demonstrated that a combination of CAC score ≥ 100 and high EAT volume had a significantly higher event rate than CAC score < 100 and low EAT volume group (adjusted hazard ratio 11.6, p < 0.0001). Using Cox regression models, incremental prognostic values were identified by adding high EAT volume to clinical risks plus CAC score ≥ 100 (global χ², 6.7; p = 0.059).

Conclusion

We suggest that high EAT volume may be an independent predictor of future coronary events and increases predictive values of CAC score in patients without proven CAD.     

Serum neutrophil gelatinase-associated lipocalin concentration reflects severity of coronary artery disease in patients without heart failure and chronic kidney disease

Serum neutrophil gelatinase-associated lipocalin (NGAL) is recognized as a useful biomarker for acute kidney injury. Recently, elevated NGAL levels were reported in patients with heart failure and cardiac events, but the association between serum NGAL and severity of coronary artery disease (CAD) has not been investigated adequately. This study aimed to evaluate the association between serum NGAL concentration and CAD severity in patients without heart failure and chronic kidney disease. Two-hundred thirteen patients [mean age: 66.2 ± 9.2 (SD)] without heart failure and chronic kidney disease (estimated glomerular filtration rate >60 mL/min/1.73 m²) who underwent coronary angiography were retrospectively analyzed using the SYNTAX score. The mean concentration of serum NGAL was 134.3 ± 111.3 ng/mL. A statistically significant correlation was observed between serum NGAL levels and the SYNTAX score (R = 0.18, P = 0.0091). Multivariable analysis also showed elevated serum NGAL as an independent risk factor for a high SYNTAX score (P < 0.01). Moreover, we evaluated the association of serum NGAL and brain natriuretic peptide (BNP) with the SYNTAX score. Patients with high levels of serum NGAL (>100 ng/mL) and high levels of BNP (>25 pg/mL) had a higher SYNTAX score (low–low vs. high–high: 13.8 ± 13.4 vs. 20.8 ± 18.9, P < 0.05). Serum NGAL levels were positively and significantly associated with CAD severity, and the evaluation of both serum NGAL and BNP was useful for predicting CAD in patients without renal dysfunction and heart failure. Serum NGAL might be a biomarker for CAD severity.     

Lipoprotein(a) levels are associated with coronary severity but not with outcomes in Chinese patients underwent percutaneous coronary intervention

Background and aimsThe association between lipoprotein(a) [Lp(a)] levels and the risk of cardiovascular disease is of great interest but still controversial. This study sought to investigate the impact of Lp(a) on coronary severity and long-term outcomes of patients who undergo percutaneous coronary intervention (PCI).Methods and ResultsA total of 6714 consecutive patients who received PCI were enrolled to analyze the association between Lp(a) and coronary severity and major adverse cardiovascular and cerebrovascular events (MACCE). Patients were divided into tertiles according to Lp(a) levels on admission. Coronary severity was evaluated by SYNTAX scoring system. The MACCE included recurrent myocardial infarction, unplanned target vessel revascularization, stent thrombosis, ischemic stroke and all-cause mortality.Significantly, Lp(a) levels were positively associated with coronary severity (p < 0.001). Multivariate logistic regression analyses showed Lp(a) was an independent predictor of intermediate to high SYNTAX score. During an average of 874 days follow-up, 755 patients presented with MACCE (11.25%) were reported. The incidence rates of MACCE, all-cause mortality, cardiac death, target vessel revascularization, recurrent myocardial infarction, stent thrombosis, stroke and bleeding were not statistically different among the Lp(a) tertile groups. Furthermore, both Kaplan–Meier and Cox regression analyses found no relationship between Lp(a) and cardiovascular outcomes (p > 0.05).ConclusionLp(a) is an independent predictor of the prevalence of more complex coronary artery lesions (SYNTAX score ≥ 23) in patients with PCI. In addition, our study has shown that Lp(a) has no relationship with long-term cardiovascular outcomes in Chinese patients with PCI.     

Systolic Papillary Muscle Dyssynchrony Predicts Recurrence of Mitral Regurgitation in Patients with Ischemic Cardiomyopathy (ICM) Undergoing Mitral Valve Repair

Objective: We investigated the impact of papillary muscle dyssynchrony (DYS‐PAP) in predicting recurrent mitral regurgitation (MR) in patients with ischemic cardiomyopathy (ICM) undergoing undersized mitral ring annuloplasty (UMRA). Methods: One hundred forty‐four ICM patients (left ventricular ejection fraction <35%) in sinus rhythm undergoing UMRA between January 2001 and December 2010 at three Institutions (University Hospital, Maastricht, The Netherlands; Careggi Hospital, Florence, Italy; Civic Hospital, Brescia, Italy) were recruited. The primary endpoint was the recurrence of MR at the latest echocardiographic study defined as insufficiency ≥2+ in patients with no/trivial MR at discharge. The assessment of DYS‐PAP was performed by applying two‐dimensional (2D) speckle‐tracking imaging. Results: In patients with MR recurrence, DYS‐PAP significantly worsened (84.1 ± 8.8 msec vs.65.4 ± 8.8 msec at baseline, P < 0.001) whereas in patients with no MR recurrence, DYS‐PAP did not vary (22.3 ± 5.3 msec vs. 25.9 ± 7.2 msec at baseline, P = 0.8). Recurrent MR was positively correlated with preoperative DYS‐PAP (P < 0.001), baseline anterior mitral leaflet tethering angle α (P < 0.001) and tethering symmetry index α/β before surgery (P < 0.001). There was no significant correlation between MR recurrence and other echocardiographic parameters. Logistic regression analysis revealed that baseline values of DYS‐PAP (OR: 5.4 [95% CI: 3.1–7.7], P < 0.001), α (OR: 5.0 [2.6–6.7], P < 0.001), and α/β (OR: 3.9 [2.5–5.7], p < 0.001) were predictors of recurrent MR. A DYS‐PAP value ≥ 58 msec predicted recurrence of MR with 100% sensitivity and 83% specificity (area under the curve [AUC]: 0.92 [0.7–1], P < 0.001). Conclusions: A DYS‐PAP cutoff value of 58 msec is useful to identify patients in whom UMRA is likely to fail. That way decision making in ischemic functional MR might be facilitated.     

稳定型冠心病患者血清低密度脂蛋白胆固醇和载脂蛋白B浓度与SYNTAX评分的关系

目的探讨稳定型冠状动脉粥样硬化性心脏病(stable coronary artery disease,SCAD)患者血清低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)和载脂蛋白B浓度与SYNTAX评分的关系。方法回顾性选择2016年1月至2017年12月在宝鸡市中心医院接受冠状动脉造影检查确诊的SCAD患者150例作为研究对象,根据SYNTAX评分结果将患者分为0~22分组(低分组,n=80)、23~32分组(中分组,n=40)和33分以上组(高分组,n=30)。SYNTAX评分与不同临床特征间的相关性采用Spearman相关性分析和多元线性回归分析。结果3组患者血小板分布宽度(platelet distribution width,PDW)、红细胞分布宽度(red cell distribution width,RDW)、纤维蛋白原、总胆固醇、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、LDL-C、脂蛋白a、载脂蛋白A1、载脂蛋白B、SYNTAX评分比较,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,SYNTAX评分与HDL-C、载脂蛋白A1呈负相关(P<0.05),与纤维蛋白原、总胆固醇、LDL-C、PDW、RDW、脂蛋白a、载脂蛋白B呈正相关(P<0.05)。多元线性回归分析结果显示,HDL-C、LDL-C、纤维蛋白原、载脂蛋白B均是影响冠状动脉病变的危险因素(P<0.05)。结论随着血清LDL-C、载脂蛋白B浓度的升高,SCAD患者SYNTAX评分升高,冠状动脉病变严重程度加重。血清LDL-C、载脂蛋白B浓度可作为判断SCAD患者冠状动脉病变严重程度的参考指标。     

Comparison of multiple risk scores in assessing medium-to long-term clinical outcomes in unstable angina / non-ST-elevation myocardial infarction patients undergoing multi vessel percutaneous coronary intervention: An observational,registry-based study in India

ObjectivePost-revascularization mortality in multivessel coronary artery disease (MVCAD) has been explored via several risk scores. Here, we assessed and compared various risk scores in predicting medium to long-term clinical outcomes in unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) patients with MVCAD undergoing percutaneous coronary intervention (PCI).MethodsWe analyzed a cohort of a tertiary care center registry enrolling patients in South India, Kerala, with MVCAD (N = 200) who had undergone PCI between 2010 and 2018. The outcomes evaluated were all-cause mortality and major adverse cardiac events (MACE). The risk scores assessed included SYNTAX score (SS), residual SYNTAX score (rSS), SYNTAX revascularization index (SRI), age, creatinine, and ejection fraction (ACEF) score, clinical SYNTAX score (cSS), and SYNTAX score II (SSII).ResultsOf the analyzed risk scores, SSII had the best predictive capability with the area under the curve (AUC) of 0.79 in c-statistics, followed by ACEF score and cSS with AUCs of 0.74 and 0.65, respectively for all-cause mortality (p < 0.01). Kaplan–Meier survival curves and multivariate analysis by Cox regression showed SSII with cut-offs of >35.15 and > 29.55 to be the only score associated with higher mortality and MACE, respectively.ConclusionsIn UA/NSTEMI patients with relatively less complex MVCAD treated by PCI, the SSII, ACEF and cSS risk scores could predict the outcomes better. The SSII showed the best predictive performance for all-cause mortality and MACE. Scores based on baseline and residual atherosclerotic burden (SS, rSS, and SRI) performed poorly in predicting the mortality and MACE.     

红细胞分布宽度与冠状动脉病变严重程度有相关性

目的 目的探讨红细胞分布宽度（RDW）与冠心病患者冠状动脉病变严重程度的关系。方法 连续入选行冠脉造影患者219例,其中不稳定型心绞痛(UAP)118例,急性心肌梗死（AMI）101例,其中包括急性ST段抬高型心肌梗死(STEMI)52例,急性非ST段抬高型心肌梗死(NSTEMI)49例。所有患者均检测RDW及 N末端脑钠肽前体（NT-proBNP）等相关指标,并对患者冠脉病变情况进行SYNTAX评分,根据SYNTAX评分将所有患者分为低积分组（评分≤32分,n=139）与高积分组（评分>32分,n=80）。通过单因素分析和Pearson相关分析确定RDW与冠状动脉严重程度的关系。结果 高积分组RDW〔（13.7±0.9）%〕显著高于低积分组〔（12.4±1.4）%〕,差异有统计学意义（P<0.05）。冠状动脉2支及以上病变患者的RDW显著高于单支病变组（P<0.05)。Pearson相关分析显示RDW与SYNTAX评分呈显著正相关（r=0.252,P<0.01）。NT-proBNP升高组比NT-proBNP正常组的RDW〔（13.4±0.8） vs.（12.5±1.0）%〕明显升高,差异有统计学意义（P<0.05）。结论 冠心病患者RDW与冠心病冠脉病变严重程度具有显著相关性。     

Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis

Objective Epicardial adipose tissue (EAT) is a part of visceral fat deposited around the heart between the pericardium and myocardium along the distribution of coronary arteries. EAT thickness is reported to be associated with coronary atherosclerosis; however, no study has measured EAT volume in patients with type 2 diabetes or investigate its association with coronary artery disease. Design A hospital‐based case control study. Patients A total of 49 patients with type 2 diabetes mellitus (T2DM) and 78 nondiabetic controls were studied. Measurements Cardiac multislice computed tomography was used to measure EAT volume, Gensini score, coronary artery calcium score and, coronary lesions. The relationships between EAT volume, markers of coronary atherosclerosis and anthropometric and biochemical parameters of metabolic syndrome (MetS) were investigated. Results EAT volume was significantly higher in patients with T2DM than in nondiabetic subjects (166·1 ± 60·6 cm³ vs. 123·4 ± 41·8 cm³, P < 0·0001). Logistic regression analysis revealed independent and significant associations between EAT and diabetic status. EAT volume was significantly associated with components of MetS (BMI, waist circumference, fasting serum glucose, total cholesterol, HDL‐cholesterol, and triglycerides levels), Gensini score, coronary lesions, coronary disease and coronary calcium scores. Univariate, multivariate and trend analyses confirmed that EAT volume was associated with MetS component clustering and the coronary atherosclerosis index. Conclusions The analytical results indicate that EAT volume is increased in T2DM patients and is associated with unfavourable components of MetS and coronary atherosclerosis. The close anatomical relationship between EAT and the coronary arteries, combined with other evidence indicating that EAT is a biologically active adipokine‐secreting tissue, suggest that EAT participates in the pathogenesis of diabetic coronary atherosclerosis.     

Increased Epicardial Adipose Tissue Thickness as a Predictor for Hypertension: A Cross‐Sectional Observational Study

The aim of the study was to determine whether epicardial adipose tissue thickness (EAT), a new cardiometabolic risk factor, is associated with essential hypertension. The sample included 127 asymptomatic patients with one or more cardiovascular risk factors consecutively referred for cardiac computed tomography angiography. Data were collected retrospectively and compared between hypertensive (n=39) and normotensive (n=88) patients. The hypertensive patients had a significantly higher mean EAT thickness than the normotensive group (2.81±1.6 mm vs 2.07±1.43 mm; P=.011) and a significantly elevated mean coronary artery calcium score (316.8±512.6 vs 108.73±215; P=.0257). The odds ratio for a patient with tissue thickness ≥2.4 mm having hypertension was 1.396 (95% confidence interval, 1.033–1.922). Factors independently associated with hypertension were body mass index, low‐density lipoprotein, and age. A model score was developed using the logistic regression coefficients for calculation of individual risk. Hypertensive patients have significantly higher than normal EAT thickness. Epicardial adipose tissue thickness may serve as a risk indicator for hypertension and cardiovascular morbidity.     

Atorvastatin Treatment Improves Myocardial and Peripheral Blood Flow in Familial Hypercholesterolemia Subjects without Evidence of Coronary Atherosclerosis

Background: Hypercholesterolemia induces early microcirculatory functional and structural alterations that are reversible by cholesterol reduction. Real time myocardial contrast echocardiography (RTMCE) and vascular ultrasound evaluate the effects of hyperlipidemia on peripheral and central blood flow reserve. This study investigated the effects of lipid‐lowering therapy on coronary and peripheral artery circulation in patients with familial hypercholesterolemia (FH). Methods: RTMCE and vascular ultrasound were performed in 10 healthy volunteers (validation group) at baseline and after 12‐week clinical observation, and in 16 age‐ and sex‐matched FH patients without obstructive coronary artery disease (CAD) by computed tomography angiography at baseline and after 12‐week atorvastatin treatment. Indexes of relative myocardial blood flow (MBF) were obtained at rest and during adenosine infusion. Results: In validation group, there was no significant difference between flow‐mediated dilation (FMD) at baseline and after 12 weeks (0.15 ± 0.02 vs. 0.14 ± 0.03; P = 0.39). Similarly, no differences were observed in MBF reserve at baseline and after 12 weeks (3.31 ± 0.63 vs. 3.48 ± 0.89; P = 0.89). FMD was blunted in FH patients, at baseline, as compared with validation group (0.08 ± 0.04 vs. 0.15 ± 0.02; P < 0.001) and became similar to that group (0.13 ± 0.05 vs. 0.14 ± 0.03; P = 0.07) after treatment. MBF reserve was blunted at baseline in FH patients in comparison with the validation group (2.78 ± 0.71 vs. 3.31 ± 0.63; P = 0.003). After treatment, MBF reserve values were no longer different (3.43 ± 0.66 and 3.48 ± 0.89; P = 0.84, respectively, for FH and validation groups). Conclusion: Patients with FH and no obstructive CAD have blunted MBF reserve and lower FMD values as compared with healthy volunteers. Both FMD and MBF reserve were normalized after atorvastatin treatment.