Cumulative incidence of coronary lesions with vulnerable characteristics in patients with stable angina pectoris: an intravascular ultrasound and angiographic study

Prognostic value of the GRACE discharge score for predicting the mortality of patients with stable coronary artery disease who underwent percutaneous coronary intervention

OBJECTIVES

To assess the predictive value of the Global Registry of Acute Coronary Events (GRACE) discharge score for patients with stable coronary artery disease (SCAD) after percutaneous coronary intervention (PCI).

BACKGROUND

The GRACE score is widely used for predicting the mortality of acute coronary syndrome patients. However, the predictive value of SCAD has not been sufficiently studied.

METHODS

We studied 4,293 consecutive patients with SCAD who underwent PCI between January 2013 and December 2013. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE).

RESULTS

Among 3,915 patients with SCAD following PCI, there were 38 deaths and 394 MACCE during 2 years of follow-up. The GRACE discharge score was significantly higher for patients who died than for those who survived (86.97 ± 23.27 vs. 71.07 ± 19.84; p < .001). Risk stratification of the GRACE score indicated that the mortality risk of the intermediate-risk and high-risk groups were 3.23-fold (hazard ratio [HR], 3.23; range, 1.59-6.55; p = .001) and 15.31-fold higher (HR, 15.31; range, 4.43-51.62; p < .001), respectively, than that of the low-risk group. The MACCE risk for the intermediate-risk and high-risk groups were 1.28-fold (HR, 1.28; range, 1.02-1.62; p = .037) and 2.42-fold higher (HR, 2.42; range, 1.20-4.88; p = .014), respectively. The GRACE discharge score had prognostic value for mortality (area under the receiver operating characteristic curve, 0.692; p < .001).

CONCLUSIONS

The GRACE discharge score is valuable for the risk stratification of death and MACCE, as well as for the prognosis to mortality for SCAD patients who have undergone PCI.

The natural history of napkin-ring sign by coronary computed tomography angiography

Introduction

Despite their significance, the prevalence and the incidence of vulnerable plaques in coronary arteries, as well as their natural history, remain poorly known.

Aim

To evaluate the prevalence, incidence and evolution of napkin-ring sign (NRS), and to establish factors associated with its presence, progression, or regression, in patients with suspected coronary artery disease (CAD).

Material and methods

The study is based on a single-center prospective registry. Eighty-nine patients with suspected CAD underwent two computed tomography angiography (CTA) examinations within an interval of at least 24 months. High-risk plaque was defined by the presence of a low-attenuation area adjacent to the coronary lumen, surrounded by a ring of higher attenuation – NRS.

Results

At the baseline 53 NRS were observed in 22 (25%) patients, 7 (8%) patients had single NRS and 15 (17%) had multiple NRS. After the follow-up period, there were 68 NRS in 32 patients. In 18 patients progression was observed with 23 additional NRS. Presence of single NRS and diabetes were independent predictors of NRS progression.

Conclusions

The number of NRS plaque tends to increase over time in patients with suspected CAD. The progression may be predicted by the presence of diabetes or single NRS.

Relationship between Endothelial Nitric Oxide Synthase, Insulin Resistance and Macrovascular Disease in Patients with Acute Myocardial Infarction

OBJECTIVE: To explore the relationship between endothelial nitric oxide synthase (eNOS) activity, insulin resistance and macrovascular disease in patients with acute myocardial infarction (AMI). METHODS: AMI patients were grouped according to the presence (group A, n = 49) or absence (group B, n = 48) of macrovascular disease. A healthy control group was also recruited (group C, n = 43). eNOS activity and nitric oxide (NO), endothelin-1 (ET-1), fasting plasma glucose and fasting insulin levels were compared across groups. The homeostasis model assessment of insulin resistance (HOMA—IR) was calculated in each participant and correlations between biochemical parameters were determined. RESULTS: eNOS and NO levels were significantly lower in group A compared with the other groups. Conversely, ET-1 levels and the HOMA-IR were significantly higher in group A. eNOS activity and NO levels were significantly lower, and ET-1 levels and HOMA-IR were significantly higher, in group B compared with controls. Across the groups there were inverse correlations in AMI patients between eNOS and HOMA-IR, NO and HOMA-IR, eNOS and ET-1, and NO and ET-1, and positive correlations between eNOS and NO, regardless of whether macrovascular disease was present. CONCLUSION: There is a close relationship between eNOS activity and the development of insulin resistance and macrovascular disease in AMI patients.

Differential Characteristics of Inflammatory Responses to Stent Implantation Between De Novo and Intrastent Restenosis Lesion in Patients With Stable Angina

Mechanical plaque rupture of coronary atherosclerotic plaque during stent implantation can increase serum levels of high-sensitivity C-reactive protein (hsCRP). Patients with stable angina pectoris were divided into 2 groups: one group included 186 patients with de novo lesion who underwent stent implantation (de novo group); the other group included 40 patients with intrastent restenosis (ISR) undergoing stent implantation (ISR group). The de novo group had a significant increase in hsCRP levels post stenting, while the ISR group showed no increase in hsCRP post stenting. Intravascular ultrasound with radiofrequency data analysis showed that the de novo group had larger percentage of both necrotic core area and fibrofatty area at the target lesion than the ISR group, while the ISR group had a larger percentage of fibrous area. Differential inflammatory response to stent implantation between the de novo plaque and in ISR lesion is related to lesion morphology.