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Wang YW, Xu J, Ma L, Hu H, Chen HW, Hua JS, Kong XY, Li D, Li LW, Pan JY, Wu J. Safety and efficacy of PCSK9 inhibitor (evolocumab) in patients with non-ST segment elevation acute coronary syndrome and non-culprit artery critical lesions: a randomised controlled trial protocol (SPECIAL study). BMJ Open 2024; 14:e083730. [PMID: 39009458 PMCID: PMC11253731 DOI: 10.1136/bmjopen-2023-083730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) and concomitant multivessel coronary artery disease (CAD) are considered patients with extremely high-risk atherosclerotic cardiovascular disease (ASCVD), and current guidelines specify a lower low-density lipoprotein cholesterol (LDL-C) target for this population. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to effectively reduce LDL-C levels on a statin background. Additionally, several studies have confirmed the role of PCSK9 inhibitors in plaque regression and reducing residual cardiovascular risk in patients with ACS. However, those studies included coronary lesions with a degree of stenosis <50%. Whether the application of PCSK9 inhibitors in patients with NSTE-ACS with non-culprit artery critical lesions (stenosis degree between 50% and 75%) has a similar effect on plaque regression and improvement of cardiovascular outcomes remains unknown, with a lack of relevant research. This study aims to further investigate the safety and efficacy of evolocumab in patients with NSTE-ACS and concomitant multivessel CAD (non-culprit artery stenosis between 50% and 75%). METHODS AND ANALYSIS In this single-centre clinical randomised controlled trial, 122 patients with NSTE-ACS and concomitant multivessel CAD (non-culprit artery stenosis between 50% and 75%) will be randomly assigned to either the evolocumab treatment group or the standard treatment group after completing culprit vessel revascularisation. The evolocumab treatment group will receive evolocumab in addition to statin therapy, while the standard treatment group will receive standard statin therapy. At baseline and week 50, patients in the evolocumab treatment group will undergo coronary angiography and OCT imaging to visualise pre-existing non-lesional vessels. The primary end point is the absolute change in average minimum fibrous cap thickness (FCT) from baseline to week 50. Secondary end points include changes in plaque lipid arc, lipid length, macrophage grading, lipid levels and major adverse cardiovascular events during the 1-year follow-up period. ETHICS AND DISSEMINATION Ethics: this study will adhere to the principles outlined in the Helsinki Declaration and other applicable ethical guidelines. This study protocol has received approval from the Medical Research Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital), with approval number 2022-ky214. DISSEMINATION we plan to disseminate the findings of this study through various channels. This includes publication in peer-reviewed academic journals, presentation at relevant academic conferences and communication to the public, policymakers and healthcare professionals. We will also share updates on the research progress through social media and other online platforms to facilitate the exchange and application of scientific knowledge. Efforts will be made to ensure widespread dissemination of the research results and to have a positive impact on society. TRIAL REGISTRATION NUMBER ChiCTR2200066675.
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Affiliation(s)
- Yu-Wei Wang
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Jie Xu
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Likun Ma
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Hao Hu
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Hong-Wu Chen
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Jing-Sheng Hua
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Xiang-Yong Kong
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Dan Li
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Long-Wei Li
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Jian-Yuan Pan
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
| | - Jiawei Wu
- The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology, Hefei, China
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Guan Y, Zhao S, Li J, Zhang W, Guo Z, Luo Y, Jiang X, Li J, Liu J, Chen X, Zhao Z, Zhang Z. Insights from metagenomics into gut microbiome associated with acute coronary syndrome therapy. Front Microbiol 2024; 15:1369478. [PMID: 39035441 PMCID: PMC11258018 DOI: 10.3389/fmicb.2024.1369478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/14/2024] [Indexed: 07/23/2024] Open
Abstract
Acute coronary syndrome (ACS) is a predominant cause of mortality, and the prompt and precise identification of this condition is crucial to minimize its impact. Recent research indicates that gut microbiota is associated with the onset, progression, and treatment of ACS. To investigate its role, we sequenced the gut microbiota of 38 ACS patients before and after percutaneous coronary intervention and statin therapy at three time points, examining differential species and metabolic pathways. We observed a decrease in the abundance of Parabacteroides, Escherichia, and Blautia in patients after treatment and an increase in the abundance of Gemalla, Klebsiella variicola, Klebsiella pneumoniae, and others. Two pathways related to sugar degradation were more abundant in patients before treatment, possibly correlated with disorders of sugar metabolism and risk factors, such as hyperglycemia, insulin resistance, and insufficient insulin secretion. Additionally, seven pathways related to the biosynthesis of vitamin K2 and its homolog were reduced after treatment, suggesting that ACS patients may gradually recover after therapy. The gut microbiota of patients treated with different statins exhibited notable differences after treatment. Rosuvastatin appeared to promote the growth of anti-inflammatory bacteria while reducing pro-inflammatory bacteria, whereas atorvastatin may have mixed effects on pro-inflammatory and anti-inflammatory bacteria while increasing the abundance of Bacteroides. Our research will provide valuable insights and enhance comprehension of ACS, leading to better patient diagnosis and therapy.
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Affiliation(s)
- Yuee Guan
- Department of Cardiology, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
| | - Shuru Zhao
- Shenzhen Byoryn Technology Co., Ltd., Shenzhen, China
| | - Jing Li
- University of Science and Technology of China, Hefei, China
| | - Wenqian Zhang
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi'an, China
- Department of Computer Science, City University of Hong Kong, Kowloon Tong, China
| | - Zhonghao Guo
- School of Medicine, Xi’an Jiaotong University, Xi’an, China
| | - Yi Luo
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaofei Jiang
- Department of Cardiology, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
| | - Jun Li
- Department of Cardiology, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
| | - Jianxiong Liu
- Department of Cardiology, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
| | - Xi Chen
- Department of Cardiology, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
| | - Zicheng Zhao
- Shenzhen Byoryn Technology Co., Ltd., Shenzhen, China
| | - Zhe Zhang
- Department of Cardiology, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
- Department of Cardiology, The Zhuhai National Hi-tech Industrial Development District People’s Hospital (Zhuhai People’s Hospital Medical Group, High-tech Zone), Zhuhai, China
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Okda SM, El-Bassiouny NA, El Amrawy AM, Salahuddin A, Elonsy SM, Kassem AB. Impact of CYP2D6*2A, CYP2D6*4 and CYP3A5*3 genetic polymorphisms on Bisoprolol peak concentration and clinical response in acute coronary syndrome patients. Br J Clin Pharmacol 2024. [PMID: 38886107 DOI: 10.1111/bcp.16134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 04/25/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
AIMS Acute coronary syndrome (ACS) represents a major cause of death. Bisoprolol is commonly used in the management of ACS. This study aims to investigate the impact of CYP2D6*2A, CYP2D6*4 and CYP3A5*3 genetic polymorphisms on pharmacokinetics and clinical response of bisoprolol in ACS patients. METHODS This is an open-label cohort study that included 127 ACS patients and studied the effect of CYP3A5*3, CYP2D6*2A and CYP2D6*4 genotyping using real-time polymerase chain reaction on steady state bisoprolol plasma peak concentration analysed by high performance liquid chromatography-fluorescence detector. RESULTS Regarding CYP3A5*3, the mean peak bisoprolol concentration for CC, CT and TT genotypes were 4.25 ± 1.20, 3.93 ± 1.10 and 1.79 ± 0.69 ng/mL, respectively (P < .001). Higher systolic (126 ± 5.47 mmHg), diastolic blood pressure (82 ± 2.73 mmHg) and heart rate (97.80 ± 3.03 beats/min) were also observed in CYP3A5*3 TT carriers (P < .05). In CYP2D6*2A, the peak concentration of bisoprolol was lower in CC carriers (3.54 ± 1 ng/mL) compared to GG (4.38 ± 1.25 ng/mL) and GC carriers (4.07 ± 1.29 ng/mL, P = .019). In CYP2D6*4, the mean bisoprolol peak concentration in CC carriers was 3.98 ± 1.31 ng/mL, which was lower than T allele carriers (4.5 ± 0.8, P = .02). No differences in heart rate, systolic, diastolic blood pressure or bisoprolol dose were observed among CYP2D6*2A or CYP2D6*4 variants. Smokers exhibited lower bisoprolol peak concentration (3.96 ± 1.2 ng/mL) compared to nonsmokers (4.55 ± 1.34 ng/mL, P = .037). CONCLUSION There is an association between CYP3A5*3, CYP2D6*4, CYP2D6*2A variants and bisoprolol peak concentration, which may serve as a guide in the future in choosing the optimum dose of bisoprolol in ACS patients.
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Affiliation(s)
- Sherouk M Okda
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Noha A El-Bassiouny
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | | | - Ahmad Salahuddin
- Department of Biochemistry, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
- Department of Biochemistry, College of Pharmacy, Al-Ayen Iraqi University, Thi-Qar, Iraq
| | - Sohila M Elonsy
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Amira B Kassem
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
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Gurbuz DC, Varis E. Is ChatGPT knowledgeable of acute coronary syndromes and pertinent European Society of Cardiology Guidelines? Minerva Cardiol Angiol 2024; 72:299-303. [PMID: 38391252 DOI: 10.23736/s2724-5683.24.06517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Advancements in artificial intelligence are being seen in multiple fields, including medicine, and this trend is likely to continue going forward. To analyze the accuracy and reproducibility of ChatGPT answers about acute coronary syndromes (ACS). METHODS The questions asked to ChatGPT were prepared in two categories. A list of frequently asked questions (FAQs) created from inquiries asked by the public and while preparing the scientific question list, 2023 European Society of Cardiology (ESC) Guidelines for the management of ACS and ESC Clinical Practice Guidelines were used. Accuracy and reproducibility of ChatGPT responses about ACS were evaluated by two cardiologists with ten years of experience using Global Quality Score (GQS). RESULTS Eventually, 72 FAQs related to ACS met the study inclusion criteria. In total, 65 (90.3%) ChatGPT answers scored GQS 5, which indicated highest accuracy and proficiency. None of the ChatGPT responses to FAQs about ACS scored GQS 1. In addition, highest accuracy and reliability of ChatGPT answers was obtained for the prevention and lifestyle section with GQS 5 for 19 (95%) answers, and GQS 4 for 1 (5%) answer. In contrast, accuracy and proficiency of ChatGPT answers were lowest for the treatment and management section. Moreover, 68 (88.3%) ChatGPT responses for guideline based questions scored GQS 5. Reproducibility of ChatGPT answers was 94.4% for FAQs and 90.9% for ESC guidelines questions. CONCLUSIONS This study shows for the first time that ChatGPT can give accurate and sufficient responses to more than 90% of FAQs about ACS. In addition, proficiency and correctness of ChatGPT answers about questions depending on ESC guidelines was also substantial.
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Affiliation(s)
- Dogac C Gurbuz
- Department of Cardiology, Gurlife Hospital, Eskisehir, Türkiye -
| | - Eser Varis
- Department of Cardiology, Private Hospital, Istanbul, Türkiye
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Philibert R, Dogan TK, Knight S, Ahmad F, Lau S, Miles G, Knowlton KU, Dogan MV. Validation of an Integrated Genetic-Epigenetic Test for the Assessment of Coronary Heart Disease. J Am Heart Assoc 2023; 12:e030934. [PMID: 37982274 PMCID: PMC10727271 DOI: 10.1161/jaha.123.030934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/16/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) is the leading cause of death in the world. Unfortunately, many of the key diagnostic tools for CHD are insensitive, invasive, and costly; require significant specialized infrastructure investments; and do not provide information to guide postdiagnosis therapy. In prior work using data from the Framingham Heart Study, we provided in silico evidence that integrated genetic-epigenetic tools may provide a new avenue for assessing CHD. METHODS AND RESULTS In this communication, we use an improved machine learning approach and data from 2 additional cohorts, totaling 449 cases and 2067 controls, to develop a better model for ascertaining symptomatic CHD. Using the DNA from the 2 new cohorts, we translate and validate the in silico findings into an artificial intelligence-guided, clinically implementable method that uses input from 6 methylation-sensitive digital polymerase chain reaction and 10 genotyping assays. Using this method, the overall average area under the curve, sensitivity, and specificity in the 3 test cohorts is 82%, 79%, and 76%, respectively. Analysis of targeted cytosine-phospho-guanine loci shows that they map to key risk pathways involved in atherosclerosis that suggest specific therapeutic approaches. CONCLUSIONS We conclude that this scalable integrated genetic-epigenetic approach is useful for the diagnosis of symptomatic CHD, performs favorably as compared with many existing methods, and may provide personalized insight to CHD therapy. Furthermore, given the dynamic nature of DNA methylation and the ease of methylation-sensitive digital polymerase chain reaction methodologies, these findings may pave a pathway for precision epigenetic approaches for monitoring CHD treatment response.
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Affiliation(s)
- Robert Philibert
- Cardio Diagnostics IncChicagoILUSA
- Department of PsychiatryUniversity of IowaIowa CityIAUSA
- Department of Biomedical EngineeringUniversity of IowaIowa CityIAUSA
| | | | - Stacey Knight
- Intermountain Heart Institute, Intermountain HealthcareSalt Lake CityUTUSA
- Department of Internal MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Ferhaan Ahmad
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of IowaIowa CityIAUSA
| | - Stanley Lau
- Southern California Heart CentersSan GabrielCAUSA
| | - George Miles
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTXUSA
| | - Kirk U. Knowlton
- Intermountain Heart Institute, Intermountain HealthcareSalt Lake CityUTUSA
| | - Meeshanthini V. Dogan
- Cardio Diagnostics IncChicagoILUSA
- Department of Biomedical EngineeringUniversity of IowaIowa CityIAUSA
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Wenzl FA, Bruno F, Kraler S, Klingenberg R, Akhmedov A, Ministrini S, Santos K, Godly K, Godly J, Niederseer D, Manka R, Bergmann A, Camici GG, von Eckardstein A, Stähli B, Muller O, Roffi M, Räber L, Lüscher TF. Dipeptidyl peptidase 3 plasma levels predict cardiogenic shock and mortality in acute coronary syndromes. Eur Heart J 2023; 44:3859-3871. [PMID: 37632743 DOI: 10.1093/eurheartj/ehad545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND AND AIMS Dipeptidyl peptidase 3 (DPP3) is a protease involved in the degradation of angiotensin II which disturbs peripheral blood pressure regulation and compromises left ventricular function. This study examined the relationship of circulating DPP3 (cDPP3) with cardiogenic shock (CS) and mortality in patients presenting with acute coronary syndromes (ACS). METHODS Plasma cDPP3 levels were assessed at baseline and 12-24 h after presentation in patients with ACS prospectively enrolled into the multi-centre SPUM-ACS study (n = 4787). RESULTS Circulating DPP3 levels were associated with in-hospital CS when accounting for established risk factors including the ORBI risk score [per log-2 increase, hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.05-1.82, P = .021]. High cDPP3 was an independent predictor of mortality at 30 days (HR 1.87, 95% CI 1.36-2.58, P < .001) and at one year (HR 1.61, 95% CI 1.28-2.02, P < .001) after adjustment for established risk factors and the GRACE 2.0 score. Compared to values within the normal range, persistently elevated cDPP3 levels at 12-24 h were associated with 13.4-fold increased 30-day mortality risk (HR 13.42, 95% CI 4.86-37.09, P < .001) and 5.8-fold increased 1-year mortality risk (HR 5.79, 95% CI 2.70-12.42, P < .001). Results were consistent across various patient subgroups. CONCLUSIONS This study identifies cDPP3 as a novel marker of CS and increased mortality in patients with ACS. Circulating DPP3 offers prognostic information beyond established risk factors and improves early risk assessment.
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Affiliation(s)
- Florian A Wenzl
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Royal Brompton and Harefield Hospitals, London, UK
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Giessen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Alexander Akhmedov
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Stefano Ministrini
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | | | - Konstantin Godly
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Julia Godly
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Barbara Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, London, UK
- School of Cardiovascular Medicine and Sciences, Kings College London, Strand, London, UK
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Sliwicka O, Sechopoulos I, Baggiano A, Pontone G, Nijveldt R, Habets J. Dynamic myocardial CT perfusion imaging-state of the art. Eur Radiol 2023; 33:5509-5525. [PMID: 36997751 PMCID: PMC10326111 DOI: 10.1007/s00330-023-09550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 04/01/2023]
Abstract
In patients with suspected coronary artery disease (CAD), dynamic myocardial computed tomography perfusion (CTP) imaging combined with coronary CT angiography (CTA) has become a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information on myocardial blood flow, and the presence and grading of stenosis. Recently, CTP imaging has been proven to have good diagnostic accuracy for detecting myocardial ischemia, comparable to stress magnetic resonance imaging and positron emission tomography perfusion, while being superior to single photon emission computed tomography. Dynamic CTP accompanied by coronary CTA can serve as a gatekeeper for invasive workup, as it reduces unnecessary diagnostic invasive coronary angiography. Dynamic CTP also has good prognostic value for the prediction of major adverse cardiovascular events. In this article, we will provide an overview of dynamic CTP, including the basics of coronary blood flow physiology, applications and technical aspects including protocols, image acquisition and reconstruction, future perspectives, and scientific challenges. KEY POINTS: • Stress dynamic myocardial CT perfusion combined with coronary CTA is a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information. • Dynamic CTP imaging has good diagnostic accuracy for detecting myocardial ischemia comparable to stress MRI and PET perfusion. • Dynamic CTP accompanied by coronary CTA may serve as a gatekeeper for invasive workup and can guide treatment in obstructive coronary artery disease.
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Affiliation(s)
- Olga Sliwicka
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea Baggiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jesse Habets
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands
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Philibert R, Moody J, Philibert W, Dogan MV, Hoffman EA. The Reversion of the Epigenetic Signature of Coronary Heart Disease in Response to Smoking Cessation. Genes (Basel) 2023; 14:1233. [PMID: 37372412 PMCID: PMC10297911 DOI: 10.3390/genes14061233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Coronary heart disease (CHD) is the leading cause of death worldwide. However, current diagnostic tools for CHD, such as coronary computed tomography angiography (CCTA), are poorly suited for monitoring treatment response. Recently, we have introduced an artificial-intelligence-guided integrated genetic-epigenetic test for CHD whose core consists of six assays that determine methylation in pathways known to moderate the pathogenesis of CHD. However, whether methylation at these six loci is sufficiently dynamic to guide CHD treatment response is unknown. To test that hypothesis, we examined the relationship of changes in these six loci to changes in cg05575921, a generally accepted marker of smoking intensity, using DNA from a cohort of 39 subjects undergoing a 90-day smoking cessation intervention and methylation-sensitive digital PCR (MSdPCR). We found that changes in epigenetic smoking intensity were significantly associated with reversion of the CHD-associated methylation signature at five of the six MSdPCR predictor sites: cg03725309, cg12586707, cg04988978, cg17901584, and cg21161138. We conclude that methylation-based approaches could be a scalable method for assessing the clinical effectiveness of CHD interventions, and that further studies to understand the responsiveness of these epigenetic measures to other forms of CHD treatment are in order.
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Affiliation(s)
- Robert Philibert
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (J.M.); (W.P.)
- Cardio Diagnostics Inc., Chicago, IL 60642, USA;
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA;
| | - Joanna Moody
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (J.M.); (W.P.)
| | - Willem Philibert
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (J.M.); (W.P.)
| | - Meeshanthini V. Dogan
- Cardio Diagnostics Inc., Chicago, IL 60642, USA;
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA;
| | - Eric A. Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA;
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
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Sliwicka O, Swiderska-Chadaj Z, Snoeren M, Brink M, Salah K, Peters-Bax L, Stille T, van Amerongen MJ, Sechopoulos I, Habets J. Multireader image quality evaluation of dynamic myocardial computed tomography perfusion imaging with a novel four-dimensional noise reduction filter. Acta Radiol 2023; 64:999-1006. [PMID: 35765201 DOI: 10.1177/02841851221108804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dynamic myocardial computed tomography perfusion (CTP) is a novel technique able to depict cardiac ischemia. PURPOSE To evaluate the impact of a four-dimensional noise reduction filter (similarity filter [4D-SF]) on image quality in dynamic CTP imaging, allowing for substantial radiation dose reduction. MATERIAL AND METHODS Dynamic CTP datasets of 30 patients (16 women) with suspected coronary artery disease, acquired with a 320-slice CT system, were retrieved, reconstructed with the deep learning-based algorithm of the system (DLR), and filtered with the 4D-SF. For each case, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in six regions of interest (33-38mm2) were calculated before and after filtering, in four-chamber and short-axis views, and t-tested. Furthermore, six radiologists of different expertise evaluated subjective image preference by answering five visual grading analysis-type questions (regarding acceptable level of noise, absence of artifacts, natural appearance, cardiac contour sharpness, diagnostic acceptability) using a 5-point scale. The results were analyzed using visual grade characteristics (VGC) and intraclass correlation coefficient (ICC). RESULTS Mean SNR in four-chamber view (unfiltered vs. filtered) were: septum=4.1 ± 2.1 versus 7.6 ± 5.6; lateral wall=4.5 ± 2.0 versus 8.0 ± 4.9; CNRseptum=16.6 ± 8.9 versus 31.7 ± 28; lateral wall=16.2 ± 8.9 versus 31.3 ± 28.9. Similar results were obtained in short-axis view. The perceived filtered image quality indicated decreased noise (VGCAUC=0.96) and artifacts (0.65), improved natural appearance (0.59), cardiac contour sharpness (0.74), and diagnostic acceptability (0.78). The inter-observer variability was excellent (ICC=0.79). All results were statistically significant (P < 0.05). CONCLUSION Similarity filtering after DLR improves image quality, possibly enabling dose reduction in dynamic CTP imaging in patient with suspected chronic coronary syndrome.
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Affiliation(s)
- Olga Sliwicka
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Miranda Snoeren
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique Brink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Khibar Salah
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth Peters-Bax
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tip Stille
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jesse Habets
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Anagaw YK, Yeheyis MM, Ayenew W, Bizuneh GK. Treatment Outcomes of the Acute Coronary Syndrome Among Patients Attending St. Paul Hospital. Ther Clin Risk Manag 2023; 19:105-114. [PMID: 36733976 PMCID: PMC9888011 DOI: 10.2147/tcrm.s382422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Background Acute coronary syndrome (ACS) patients need intense therapy and diagnostic evaluation for improved treatment. In Ethiopia, where patient deaths and hospital stays are rising, the ACS treatment is thought to be not very effective. Methods A retrospective cross-sectional study was conducted at St. Paul Hospital. The data were collected from patients medical records using a structured data abstraction checklist from 2018 to 2020. The data was entered, analyzed, and interpreted using SPSS version 24 software. Results Of 157 ACS patients, 69 (43.9%) had a STEMI diagnosis. Age was 63.69 years on average (SD: 8.23). The typical amount of time between the onsets of ACS symptoms to hospital presentation was 79.3 hours (3.3 days). For 104 (66.2%) patients, hypertension was the main risk factor for the development of ACS. Killip class III and IV patients made up about 3.8% of the ACS patients at St. Paul hospital. An EF of less than 40% was present in 36.3% of patients. Loading doses of aspirin (90.4%), anticoagulants (14%), beta-blockers (82.8%), statins (86%), clopidogrel (7.6%), and nitrates (2.5%) are among the medications taken inside hospitals. Of 157 ACS patients, 6 (3.8%) patients with medical records examined died while receiving treatment in the hospital, while 151 (96.2%) patients were discharged alive. Conclusion STEMI was the most common diagnosis for ACS patients at St. Paul Hospital. The two main hospital events for these patients were CHF and cardiogenic shock.
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Affiliation(s)
- Yeniewa Kerie Anagaw
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Correspondence: Yeniewa Kerie Anagaw, Email
| | - Marshet Mulugeta Yeheyis
- Department of Internal Medicine St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondim Ayenew
- Department of Social & Administrative Pharmacy, School of Pharmacy, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizachew Kassahun Bizuneh
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Greco A, Brugnera A, D’Addario M, Compare A, Franzelli C, Maloberti A, Giannattasio C, Fattirolli F, Steca P. A three-year longitudinal study of healthy lifestyle behaviors and adherence to pharmacological treatments in newly diagnosed patients with acute coronary syndrome: hierarchical linear modeling analyses. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01369-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Aim
Healthy lifestyle behaviors and a good adherence to pharmacological treatments are important predictors of lower recurrence rates and better overall outcomes among patients with an established acute coronary syndrome (ACS). The present study sought to investigate the longitudinal trajectories of these behaviors years after the onset of an ACS.
Subject and methods
We recruited a sample of 275 newly diagnosed consecutive patients at their first ACS event (mean age: 57.1 ± 7.87 years; 84% males) admitted to a cardiac rehabilitation program from three large public hospitals in Northern Italy. Patients completed a battery of sociodemographic questionnaires, which evaluated healthy lifestyles (smoking status, alcohol intake, diet, and physical activity) and adherence to pharmacological treatments, at five time-points (pre-event, 6-, 12-, 24-, and 36-month follow-ups). Longitudinal trajectories were examined through hierarchical (generalized) linear models, controlling for several demographic and clinical variables.
Results
We found significant changes in all healthy lifestyles from pre-event to the 6-month follow-up, suggesting the adoption of healthier behaviors soon after the cardiac event. However, from the 6-month up to the 3-year follow-up, patients experienced small but significant declines in their self-reported levels of healthy dietary behaviors and physical activity. Further, we found that the odds of being at medium risk of non-adherence to the pharmacological treatments significantly increased over the course of 3 years.
Conclusion
Given the negative long-term trajectories in specific lifestyles and adherence to pharmacological treatments, cardiac rehabilitation programs are suggested to provide repeated psychological interventions aimed at fostering patients’ capabilities to self-regulate their habitual behaviors.
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12
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Kalkan S, Cagan Efe S, Karagöz A, Zeren G, Yılmaz MF, Şimşek B, Batgerel U, Özkalaycı F, Tanboğa İH, Oduncu V, Karabay CY, Kırma C. A New Predictor of Mortality in ST-Elevation Myocardial Infarction: The Uric Acid Albumin Ratio. Angiology 2022; 73:461-469. [DOI: 10.1177/00033197211066362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Several studies have shown that high uric acid (UA) and low serum albumin (SA) values increase the risk of cardiovascular disease and mortality in ST-elevation myocardial infarction (STEMI). We determined whether the uric acid/albumin ratio (UAR) is a predictor of mortality in STEMI patients. All patients who presented at our center with a diagnosis of STEMI and underwent percutaneous intervention from 2015 to 2020 were screened consecutively; 4599 patients were included. A Cox proportional hazards model was used to evaluate UAR, and adjusted predictors obtained from laboratory findings and clinical characteristics contributed to mortality. Also, a regression model was presented with a directed acyclic graph (DAG). The median age of the patients was 58 years (IQR [interquartile range]: 50–67); 3581 patients (77.9%) were male. The incidence of mortality in the entire patient group was 11.9%. Median follow-up duration of all groups was 42 months. Multivariate Cox proportional regression (model-1) analysis showed age (increase 50 to 67 years; HR [hazard ratio]: 1.34, 95% CI 1.18–1.52) and UAR (increase 1.15–1.73; HR: 1.33, 95% CI 1.16–1.52) were associated with mortality. UAR may be a prognostic factor for mortality in STEMI patients and an easily accessible parameter to identify high-risk patients.
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Affiliation(s)
- Sedat Kalkan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Cagan Efe
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Gönül Zeren
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Fatih Yılmaz
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
| | - Barış Şimşek
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
| | | | - Flora Özkalaycı
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - İbrahim Halil Tanboğa
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey
- Department of Cardiology, School of Health Science, Nisantası University, Istanbul, Turkey
- Department of Biostatistics, Atatürk University, Erzurum, Turkey
| | - Vecih Oduncu
- Department of Cardiology, Bahcesehir University Hospital, Istanbul, Turkey
| | - Can Yücel Karabay
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
| | - Cevat Kırma
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
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13
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Fan X, Li M, Cao J, Liang Z. Application of thrombolysis in myocardial infarction risk index in the prediction of long-term outcomes for patients with ST-elevation myocardial infarction and multiple vessel disease: A single-center prospective observational cohort study. Exp Ther Med 2021; 22:1464. [PMID: 34737804 PMCID: PMC8561768 DOI: 10.3892/etm.2021.10899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/21/2019] [Indexed: 11/05/2022] Open
Abstract
The thrombolysis in myocardial infarction (TIMI) risk index has been indicated to be a simple and useful tool for risk stratification of patients with ST-elevation myocardial infarction (STEMI). However, the predictive value of the TIMI risk index regarding the long-term outcome for patients with STEMI with multiple vessel disease has remained to be determined. In the present study, a total of 369 patients diagnosed with STEMI who received emergency percutaneous coronary intervention treatment were analyzed. A five-year follow-up was performed to record the primary endpoint of all-cause mortality, as well as the secondary endpoints of myocardial infarction, stroke, emergent revascularization and admission due to heart failure. A receiver operating characteristic (ROC) curve was used to determine the cut-off value of the TIMI risk index for predicting all-cause death, based on which the patients were divided into a high TIMI group and a low TIMI group. Kaplan-Meier survival curves were used to compare the long-term survival of the two groups and multivariate Cox regression analysis was used to evaluate the predictive value of the risk factors regarding primary and secondary endpoints. The ROC curve indicated that the TIMI risk index was associated with three-year all-cause death with a cut-off value of 30.35 (area under curve, 0.705; P=0.001). The high TIMI group (>30.35) and low TIMI group (<30.35) exhibited a significant difference in all-cause death (P=0.009) but not in any of the secondary endpoints (P=0.527). Multivariate Cox regression analysis demonstrated that a high TIMI risk index was an independent risk factor for all-cause death in patients with STEMI and multiple-vessel disease (hazard ratio=3.709, 95% CI: 1.521-9.046, P=0.004). In conclusion, the TIMI risk index was associated with long-term outcomes for patients with STEMI and multiple-vessel disease and may be of value for risk prediction.
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Affiliation(s)
- Xuefang Fan
- Department of Cardiology, Xianyang Hospital of Yan'an University, Xianyang, Shanxi 712000, P.R. China
| | - Mingliang Li
- Ward No. 2, Department of Cardiovascular Disease, People's Hospital of Hanzhong City, Hanzhong, Shanxi 723000, P.R. China
| | - Jie Cao
- Department of Cardiology, Affiliated Hospital of Yan'an University, Xiangyang, Shanxi 716000, P.R. China
| | - Zeming Liang
- Second Department of Cardiovascular Disease, Baoji Hospital of Traditional Chinese Medicine, Baoji, Shanxi 721000, P.R. China
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14
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Aspirin in Primary Prevention: What Changed? A Critical Appraisal of Current Evidence. Am J Cardiol 2021; 141:38-48. [PMID: 33221264 DOI: 10.1016/j.amjcard.2020.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
Aspirin has been the mainstay of both secondary and primary prevention of cardiovascular disease for half a century. In 2018, 3 trials showed a modest reduction in cardiovascular outcomes that appeared counterbalanced by the risk of clinically significant bleeding. The latest ACC/AHA primary prevention guidelines downgraded their recommendation for aspirin use in primary prevention to that of physician preference. Despite the consistent and robust evidence previously supporting the use of aspirin in cardiovascular disease prevention, little discussion has been given to mechanisms or analytic explanations for this revision of recommendations. In this review, we explore 3 possible mechanisms that may have contributed to the alteration of our perception of aspirin's role in primary prevention. These include changes in the population potentially using aspirin in primary prevention, changes in cardiovascular disease and its presentation, and changes in aspirin itself. Here we present a translational look at knowledge gaps that should be addressed to better guide contemporary aspirin use in primary prevention. In conclusion, based on these considerations, the current recommendations might be improved by recalibration of the cardiovascular risk threshold above which aspirin should be recommended for primary prevention, including the incorporation of newer risk assessment modalities such as calcium scoring. A second enhancement would be developing a bleeding risk calculator to support clinicians' assessment of risk vs benefit. The use of enteric-coated aspirin vs noncoated aspirin should also be reassessed.
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15
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Montoy JCC, Shen YC, Brindis RG, Krumholz HM, Hsia RY. Impact of ST-Segment-Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non-ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2021; 10:e016932. [PMID: 33470136 PMCID: PMC7955417 DOI: 10.1161/jaha.120.016932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Many communities have implemented systems of regionalized care to improve access to timely care for patients with ST-segment-elevation myocardial infarction. However, patients who are ultimately diagnosed with non-ST-segment-elevation myocardial infarctions (NSTEMIs) may also be affected, and the impact of regionalization programs on NSTEMI treatment and outcomes is unknown. We set out to determine the effects of ST-segment-elevation myocardial infarction regionalization schemes on treatment and outcomes of patients diagnosed with NSTEMIs. Methods and Results The cohort included all patients receiving care in emergency departments diagnosed with an NSTEMI at all nonfederal hospitals in California from January 1, 2005 to September 30, 2015. Data were analyzed using a difference-in-differences approach. The main outcomes were 1-year mortality and angiography within 3 days of the index admission. A total of 293 589 patients with NSTEMIs received care in regionalized and nonregionalized communities. Over the study period, rates of early angiography increased by 0.5 and mortality decreased by 0.9 percentage points per year among the overall population (95% CI, 0.4-0.6 and -1.0 to -0.8, respectively). Regionalization was not associated with early angiography (-0.5%; 95% CI, -1.1 to 0.1) or death (0.2%; 95% CI, -0.3 to 0.8). Conclusions ST-segment-elevation myocardial infarction regionalization programs were not statistically associated with changes in guideline-recommended early angiography or changes in risk of death for patients with NSTEMI. Increases in the proportion of patients with NSTEMI who underwent guideline-directed angiography and decreases in risk of mortality were accounted for by secular trends unrelated to regionalization policies.
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Affiliation(s)
| | - Yu-Chu Shen
- Graduate School of Defense Management, Naval Postgraduate School Monterey CA.,National Bureau of Economic Research Cambridge MA
| | - Ralph G Brindis
- Department of Medicine University of California, San Francisco CA.,Philip R. Lee Institute for Health Policy Studies University of California, San Francisco CA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Renee Y Hsia
- Department of Emergency Medicine University of California, San Francisco CA.,Philip R. Lee Institute for Health Policy Studies University of California, San Francisco CA
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16
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Nicolau JC, Furtado RH, Dalçóquio TF, Lara LM, Juliasz MG, Ferrari AG, Nakashima CA, Franci A, Pereira CA, Lima FG, Giraldez RR, Salsoso R, Baracioli LM, Goodman S. Factors associated with actively working in the very long-term following acute coronary syndrome. Clinics (Sao Paulo) 2021; 76:e2553. [PMID: 33503196 PMCID: PMC7811831 DOI: 10.6061/clinics/2021/e2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Returning to work after an episode of acute coronary syndrome (ACS) is challenging for many patients, and has both personal and social impacts. There are limited data regarding the working status in the very long-term after ACS. METHODS We retrospectively analyzed 1,632 patients who were working prior to hospitalization for ACS in a quaternary hospital and were followed-up for up to 17 years. Adjusted models were developed to analyze the variables independently associated with actively working at the last contact, and a prognostic predictive index for not working at follow-up was developed. RESULTS The following variables were significantly and independently associated with actively working at the last contact: age>median (hazard-ratio [HR], 0.76, p<0.001); male sex (HR, 1.52, p<0.001); government health insurance (HR, 1.36, p<0.001); history of angina (HR, 0.69, p<0.001) or myocardial infarction (MI) (HR, 0.76, p=0.005); smoking (HR, 0.81, p=0.015); ST-elevation MI (HR, 0.81, p=0.021); anterior-wall MI (HR, 0.75, p=0.001); non-primary percutaneous coronary intervention (PCI) (HR, 0.77, p=0.002); fibrinolysis (HR, 0.61, p<0.001); cardiogenic shock (HR, 0.60, p=0.023); statin (HR, 3.01, p<0.001), beta-blocker (HR, 1.26, p=0.020), angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB) (HR, 1.37, p=0.001) at hospital discharge; and MI at follow-up (HR, 0.72, p=0.001). The probability of not working at the last contact ranged from 24.2% for patients with no variables, up to 80% for patients with six or more variables. CONCLUSIONS In patients discharged after ACS, prior and in-hospital clinical variables, as well as the quality of care at discharge, have a great impact on the long-term probability of actively working.
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Affiliation(s)
- Jose C. Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Remo H.M. Furtado
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Talia F. Dalçóquio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Livia M. Lara
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcela G. Juliasz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Aline G. Ferrari
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos A.K. Nakashima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andre Franci
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cesar A.C. Pereira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Felipe G. Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Roberto R. Giraldez
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rocío Salsoso
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciano M. Baracioli
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Shaun Goodman
- Terrence Donnelly Heart Centre, St Michael’s Hospital, University of Toronto, Toronto, Canada
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Ahmed F, Khan MS, Ali Shah SD, Jalbani J, Ali Shah A, Shaikh GA. Frequency of Three-Vessel Disease Among Patients With Non-ST Segment Elevation Myocardial Infarction. Cureus 2020; 12:e11634. [PMID: 33381357 PMCID: PMC7757756 DOI: 10.7759/cureus.11634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Though the presence of three-vessel disease (3VD) among patients with non-ST Segment Elevation Myocardial Infarction (NSTEMI) is relatively common, very limited data is available regarding its clinical significance. The current study aimed to determine the frequency of 3VD among NSTEMI patients presenting at the tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi from August 15 2015 to February 15 2016 over a sample of 139 NSTEMI patients. Data regarding patients' baseline characteristics were recorded in a proforma. Coronary angiography was performed to determine the presence of 3VD. The frequency of occluded arteries and 3VD was also recorded and the collected data was then analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA). Results: A total of 139 NSTEMI patients were enrolled in the study with a mean age of 50.47 ± 12.47 years. The majority of them were males (70.5%), mostly ≥ 40 years of age (67.6%). Among the comorbidities, 50.4% of patients had diabetes mellitus (DM), 61.9% were hypertensive and 30.9% had dyslipidemia. The overall frequency of 3VD among the enrolled NSTEMI patients was 30.2%. Three major arteries were found to be occluded; 68.3% NSTEMI patients had occlusion in the left anterior descending (LAD) artery, followed by right coronary artery (RCA) among 49.6%, 40.3% had left circumflex (LCX) artery occlusion, and 50.4% had diagonal and obtuse marginal (OM) artery occlusion respectively. Among the effect modifiers, no significant impact of age, gender, and smoking habits was observed on the frequency of 3VD among NSTEMI patients (p > 0.05). Among the reported comorbidities, DM was significant among NSTEMI patients with 3VD (p < 0.05). Conclusion: Our study results indicated that a significant proportion of NSTEMI patients had 3VD, independent of the effect of age and gender.
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Kanakakis I, Stafylas P, Avramidis D, Dagre A, Latsios G, Nikas D, Patsourakos N, Pipilis A, Sanidas I, Skalidis E, Synetos A, Tziakas D, Tzikas S, Tsiafoutis I, Tsigkas G, Bamidis P. Electronic medical registry of acute coronary syndromes in Greece. (ILIAKTIS study): Rationale and study design. Hellenic J Cardiol 2020; 62:244-247. [PMID: 32673758 DOI: 10.1016/j.hjc.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ioannis Kanakakis
- Catheterization Laboratory, Alexandra General Hospital, Athens, Greece.
| | | | | | - Anna Dagre
- General Hospital of Elefsina "Thriasio", Elefsina, Greece
| | - George Latsios
- First Department of Cardiology, Hippocratio Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Nikas
- 1st Cardiology Clinic, Ioannina University Hospital, Ioannina, Greece
| | - Nikos Patsourakos
- Cardiology Department, "Tzaneio" General Hospital of Piraeus, Greece
| | | | - Ilias Sanidas
- Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Emmanouil Skalidis
- Department of Cardiology, Heraklion University Hospital, University of Crete Medical School, Heraklion, Greece
| | - Andreas Synetos
- First Department of Cardiology, Hippocratio Hospital, Athens Medical School, Athens, Greece
| | - Dimitrios Tziakas
- University Cardiology Department & Cardiac Catheterization Laboratory, Democritus University of Thrace, Greece
| | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio General Hospital, Thessaloniki, Greece
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Du X, Zheng Y, Yang P, Ma S, Yu Z, Su X, Ge J, Leonsson-Zachrisson M, Wang X, Sun J, Bai L, Ma CS. YINGLONG: A Multicenter, Prospective, Non-Interventional Study Evaluating the Safety and Tolerability of Ticagrelor in Chinese Patients with Acute Coronary Syndrome. Adv Ther 2019; 36:1595-1605. [PMID: 31119693 PMCID: PMC6822841 DOI: 10.1007/s12325-019-00972-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ticagrelor is an oral, reversible, direct-acting P2Y12 receptor inhibitor approved for the prevention of cardiovascular events in acute coronary syndrome (ACS). In China, drug intensive monitoring regulations for new drugs require additional safety data post-approval. METHODS YINGLONG, a single-arm, phase-IV, 1-year, non-interventional study, described the safety of ticagrelor 90 mg twice daily in Chinese patients (≥ 18 years) with ACS treated with ≥ 1 dose of ticagrelor. Primary outcomes were the incidence of adverse events (AEs), in particular, PLATelet inhibition and patient Outcomes (PLATO)-defined bleeding AEs, and other serious AEs during the 1-year follow-up. Key secondary outcomes were the incidence of major cardiovascular events. RESULTS Patients (n = 1041, median age 61.0 years) had started ticagrelor and had post-dose data. Median duration of ticagrelor treatment was 357 days; 577 patients (55.4%) completed 1-year ticagrelor treatment; 973 patients (93.5%) completed 1-year follow-up. Overall, 38.7% of patients reported an AE during treatment. The most common AEs were dyspnea (n = 37, 3.6%), petechiae (n = 30, 2.9%), and chest discomfort (n = 28, 2.7%). Serious AEs, excluding bleeding, were reported in 9.8% of patients during treatment. Incidence of PLATO-defined major bleeding events was 1.1% (n = 11). Of the 21 deaths that occurred during the study (8 post-treatment), 1 was a fatal bleed. Major cardiovascular events were reported in 37 patients (3.6%). CONCLUSIONS Ticagrelor was well tolerated with a low rate of PLATO-defined major bleeding events in Chinese ACS patients. Safety results were consistent with the known ticagrelor profile. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02430493. FUNDING AstraZeneca Investment (China) Co., Ltd.
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Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Zheng
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ping Yang
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Shuren Ma
- Huai'an First People's Hospital, Huai'an, Jiangsu, China
| | - Zaixin Yu
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xi Su
- Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | - Jing Sun
- Medical Affairs, AstraZeneca China, Shanghai, China
| | - Lu Bai
- Medical Affairs, AstraZeneca China, Shanghai, China
| | - Chang-Sheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Mirzaei S, Steffen A, Vuckovic K, Ryan C, Bronas U, Zegre-Hemsey J, DeVon HA. The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome. J Emerg Nurs 2019; 45:357-365. [PMID: 30738603 DOI: 10.1016/j.jen.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/30/2018] [Accepted: 01/01/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION More than 5.5 million patients present to emergency departments in the United States annually for potential acute coronary syndrome (ACS); however, diagnosing ACS remains a challenge in emergency departments. Our aim was to describe the quality of symptoms (chest discomfort/description of pain, location/radiation, and overall symptom distress) reported by women and men ruled-in and ruled-out for ACS in emergency departments. METHODS The sample consisted of 1,064 patients presenting to emergency departments with symptoms that triggered cardiac workups. Trained research staff obtained data using the ACS Patient Information Questionnaire upon patient presentation to emergency departments. RESULTS The sample (n = 1,064) included 474 (44.55%) patients ruled-in and 590 (55.45%) patients ruled-out for ACS. Symptom distress was significantly higher in patients ruled-in versus ruled-out for ACS (7.3 ± 2.6 vs. 6.8 ± 2.5; P = 0.002) and was a significant predictor for an ACS diagnosis in men (odds ratio [OR], 1.10; confidence interval [CI], 1.03-1.17; P = 0.003). Women also reported more chest pressure (51.75% vs. 44.65; P = 0.02) compared with men, and chest pressure was a significant predictor for a diagnosis of ACS (OR, 1.61; CI, 1.03-2.53; P = 0.02). DISCUSSION Higher levels of symptom distress may help ED personnel in making a decision to evaluate a patient for ACS, and the presence of chest pressure may aid in making a differential diagnosis of ACS.
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Almeida NCC, Queiroz MAF, Lima SS, Brasil Costa I, Ayin Fossa MA, Vallinoto ACR, Ishak MDOG, Ishak R. Association of Chlamydia trachomatis, C. pneumoniae, and IL-6 and IL-8 Gene Alterations With Heart Diseases. Front Immunol 2019; 10:87. [PMID: 30804931 PMCID: PMC6370681 DOI: 10.3389/fimmu.2019.00087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 01/11/2019] [Indexed: 12/02/2022] Open
Abstract
Atherosclerosis is a progressive disease characterized by chronic inflammation of the arterial walls, associated with genetic and infectious factors. The present study investigated the involvement of Chlamydia trachomatis and Chlamydia pneumoniae infections and immunological markers (C-reactive protein, CRP, TNF-α, IL-6, IL-8, and IL-10) in the process of atherosclerosis. The evaluation included 159 patients for surgical revascularization (CAD) and 71 patients for surgical heart valve disease (HVD) at three hospitals in Belém, Brazil. The control group (CG) comprised 300 healthy individuals. Blood samples collected before surgery were used for antibodies detection (enzyme immunoassay), CRP (immunoturbidimetry) and IL-6 levels (enzyme immunoassay). Tissue fragments (atheroma plaque, heart valve and ascending aorta) were collected during surgery and subjected to qPCR for detection of bacterial DNA. Promoter region polymorphisms of each marker and relative quantification of TNF-α, IL-8, and IL-10 gene expression were performed. Demography and social information were similar to the general population involved with both diseases. Antibody prevalence to C. trachomatis was 30.6, 20.3, and 36.7% (in the CAD, HVD, and CG, respectively) and to C. pneumoniae was 83.6, 84.5, and 80.3% (in the CAD, HVD, and CG, respectively). C. trachomatis cryptic plasmid DNA was detected in 7.4% of the samples. Frequency of IL6−174G>C polymorphism was higher in CAD and HVD than in CG regardless of previous exposure to Chlamydia. Previous C. trachomatis infection showed involvement in HVD and CAD. Significant association between disease and previous C. pneumoniae infection was found only among HVD. GG genotype of IL6−174G>C is apparently a risk factor for heart disease, whereas AT genotype of IL8−251A>T was mainly involved in valvulopathies, including patients with prior exposure to C. pneumoniae.
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Affiliation(s)
| | | | - Sandra Souza Lima
- Virus Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | | | | | | | | | - Ricardo Ishak
- Virus Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
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Baro R, Haseeb S, Ordoñez S, Costabel JP. High-sensitivity cardiac troponin T as a predictor of acute Total occlusion in patients with non-ST-segment elevation acute coronary syndrome. Clin Cardiol 2018; 42:222-226. [PMID: 30536892 PMCID: PMC6712308 DOI: 10.1002/clc.23128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 01/02/2023] Open
Abstract
Background A large percentage of patients with non‐ST‐segment acute coronary syndrome (NSTE‐ACS) present with acute total occlusion (TO) of some major epicardial vessel that does not generate electrocardiographic changes. Ongoing research into the methods of accurately predicting acute TO have not yielded great success. Hypothesis High‐sensitivity cardiac troponin T (hs‐cTnT) has a good predictive value for the presence of acute TO of the culprit artery in patients with NSTE‐ACS. Methods A single‐center retrospective study of 1011 patients diagnosed with NSTE‐ACS who underwent coronary angiography and hs‐cTnT measured on admission. The predictive value of hs‐cTnT in the presence of acute TO was assessed by the area under the ROC curve. Results The mean age of the population was 67.12 ± 13.18 and 74.1% were male. 7.3% of the patients presented with acute TO. The AUC for hs‐cTnT to predict acute TO was 0.95. A hs‐cTnT value of 1006 ng/L (71.8 fold of the URL) best predicted the presence of acute TO, with a sensitivity of 86% and specificity of 95% positive predictive value (PPV): 86% and negative predictive value (NPV): 94%. Conclusions Hs‐cTnT was a good predictor of acute TO in patients with NSTE‐ACS. Hs‐cTnT values greater than 1006 ng/L were highly predictive of acute TO of a major coronary vessel.
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Affiliation(s)
- Rocío Baro
- Cardiology Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Sohaib Haseeb
- Division of Cardiology, Queen's University, Kingston, Canada
| | - Santiago Ordoñez
- Cardiology Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Juan P Costabel
- Cardiology Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
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Can MG, Ulugöl H, Güneş I, Aksu U, Tosun M, Karduz G, Vardar K, Toraman F. Effects of Alprazolam and Melatonin Used for Premedication on Oxidative Stress, Glicocalyx Integrity and Neurocognitive Functions. Turk J Anaesthesiol Reanim 2018; 46:233-237. [PMID: 30140521 DOI: 10.5152/tjar.2018.65475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/02/2018] [Indexed: 01/04/2023] Open
Abstract
Objective The purpose of this investigation was to compare the effect of alprazolam and melatonin on oxidative stress, glicocalyx integrity and neurocognitive function in patients undergoing coronary artery bypass grafting (CABG). Methods Overall, 42 patients undergoing CABG were retrospectively included in this study. Blood samples which preserved at -70°C for a previous study were used for this study. The participants were divided into two groups. Patients in the Group A were administered alprazolam before the operation, whereas melatonin was used for premedication in the Group M. Blood samples were collected at three time points [T0: before anaesthesia induction, T1: admittance to intensive care unit (ICU), T2: 24 h after ICU admission], and oxidative stress parameters and glicocalyx integrity were evaluated. Furthermore, Mini-Mental State Examination was recorded to measure neurocognitive function. Results The total thiol levels which were measured as an antioxidant parameter were significantly higher, and free Hb values were significantly lower in the Group M compared to the Group A (p<0.05). No significant differences were found in order to oxidative stress parameter levels, extubation time, length of hospital stay, durations of cross-clamp, cardiopulmonary bypass and operation and Mini-Mental State Examination results between the two groups (p>0.05). Conclusion In light of positive effects on oxidatif stress parameters, melatonin may be considered as a good and safe premedication agent with its anxiolytic, antioxidant and minimal haemodynamic and respiratory effects.
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Affiliation(s)
- Meltem Güner Can
- Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Halim Ulugöl
- Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Işın Güneş
- Department of Anaesthesiology and Reanimation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Uğur Aksu
- Department of Biology, İstanbul University Faculty of Science, İstanbul, Turkey
| | - Melis Tosun
- Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Gülsüm Karduz
- Department of Biology, İstanbul University Faculty of Science, İstanbul, Turkey
| | - Kübra Vardar
- Department of Biology, İstanbul University Faculty of Science, İstanbul, Turkey
| | - Fevzi Toraman
- Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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Callaghan RC, Halliday M, Gatley J, Sykes J, Taylor L, Benny C, Kish SJ. Comparative hazards of acute myocardial infarction among hospitalized patients with methamphetamine- or cocaine-use disorders: A retrospective cohort study. Drug Alcohol Depend 2018; 188:259-265. [PMID: 29793190 DOI: 10.1016/j.drugalcdep.2018.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/20/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND It is assumed that recreational use of methamphetamine can trigger acute myocardial infarction (AMI) events, but estimates of longitudinal hazards of AMI among methamphetamine users are lacking. METHODS Retrospective cohort study: Competing-risks analysis was used to estimate time-to-AMI patterns in methamphetamine versus matched appendicitis (population-proxy) and matched cocaine (drug-control) groups. Cohorts were propensity-score-matched using demographic and clinical variables. SETTING California, 1990-2005. PARTICIPANTS Cohorts of individuals with no prior or concurrent history of AMI hospitalized with methamphetamine- (n = 73,056), cocaine- (n = 47,726), or appendicitis-related conditions (n = 330,109). MEASUREMENTS ICD-9/ICD-10 indications of AMI (ICD-9 410.X; ICD-10 I21.X) in death records or inpatient hospital data. RESULTS Patients in methamphetamine cohort were more likely to develop subsequent AMI in comparison to those in matched appendicitis cohort [Hazard ratio (HR): 1.41; 95% CI, 1.23-1.62, p < 0.0001], with increased risk most marked in young methamphetamine users (age 15-34 years; HR: 2.04; 95% CI, 1.63-2.57, p = 0. 0001). Risk was slightly increased vs. that in matched cocaine group (HR: 1.19; 95% CI, 1.02-1.39, p = 0. 029). Individuals in cocaine cohort were also more likely to experience AMI outcome vs. appendicitis cohort (HR: 1.25; 95% CI, 1.08-1.45, p = 0. 0023). CONCLUSION Our longitudinal data support results of earlier epidemiological studies suggesting that persons with methamphetamine- (or cocaine-) use disorders might have increased AMI risk. However, because of potential study limitations and the unexpectedly modest magnitude of the observed increased AMI hazard, these findings must be considered preliminary and require replication.
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Affiliation(s)
- Russell C Callaghan
- Northern Medical Program, University of Northern British Columbia (UNBC), 3333 University Way, Prince George, BC V2N 4Z9, Canada; Human Brain Laboratory, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON M5S 2S1, Canada; Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Montana Halliday
- Northern Medical Program, University of Northern British Columbia (UNBC), 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | - Jodi Gatley
- Communicable Diseases, Emergency Preparedness and Response Public Health Ontario, 480 University Ave, Suite 300, Toronto, ON M5G 1V2, Canada
| | - Jenna Sykes
- St. Michael's Hospital, 30 Bond St, Toronto, ON M5 B 1W8, Canada
| | - Lawren Taylor
- Work Stress and Health Service, Centre for Addiction and Mental Health (CAMH),455 Spadina Avenue, Suite 210, Toronto, ON M5S 2G8, Canada
| | - Claire Benny
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Stephen J Kish
- Human Brain Laboratory, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON M5S 2S1, Canada
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Shrestha R, Shrestha A, Kan J, Chen S. A review in enormity of OCT and its enduring understanding of vulnerable plaque in coronary bifurcation lesion. Int J Cardiovasc Imaging 2018; 34:1679-1684. [PMID: 29858960 DOI: 10.1007/s10554-018-1384-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/26/2018] [Indexed: 01/03/2023]
Abstract
Optical coherence tomography (OCT) has emerged as one of the most promising tools to assist the optimization of percutaneous coronary intervention (PCI). Its ability to provide unique information on the plaque at high risk for rupture, plaque composition, the thickness of the fibrous cap, the presence of macrophage and thrombi has not only assisted simple PCI but also in many complex bifurcation lesions PCI. OCT has helped to provide valuable anatomic information to optimize stent implantation and adapt PCI strategy in individual patients. This review article summarizes the current role of OCT as an imaging technology and prediction of vulnerable plaque, its site and composition at the coronary bifurcation lesions for supporting the clinical decision.
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Affiliation(s)
| | | | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Shaoliang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Blood lipid-related low-frequency variants in LDLR and PCSK9 are associated with onset age and risk of myocardial infarction in Japanese. Sci Rep 2018; 8:8107. [PMID: 29802317 PMCID: PMC5970143 DOI: 10.1038/s41598-018-26453-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 05/14/2018] [Indexed: 12/24/2022] Open
Abstract
Recent studies have revealed the importance of rare variants in myocardial infarction (MI) susceptibility in European populations. Because genetic architectures vary in different populations, we investigated how they contribute to MI susceptibility in Japanese subjects. We performed targeted sequencing of 36 coronary artery disease risk genes, identified by genome-wide association studies, in 9,956 cases and 8,373 controls. Gene-based association tests identified significant enrichment of rare variants in LDLR and PCSK9 in MI cases. We identified 52 (novel 22) LDLR variants predicted to be damaging. Carriers of these variants showed a higher risk of MI (carriers/non-carriers 89/9867 in cases, 17/8356 controls, OR = 4.4, P = 7.2 × 10−10), higher LDL-cholesterol levels and younger age of onset for MI. With respect to PCSK9, E32K carriers showed higher LDL-cholesterol levels and younger age of onset for MI, whereas R93C carriers had lower LDL-cholesterol levels. A significant correlation between LDL-cholesterol levels and onset age of MI was observed in these variant carriers. In good agreement with previous studies in patients with familial hypercholesterolaemia, our study in the Japanese general population showed that rare variants in LDLR and PCSK9 were associated with the onset age of MI by altering LDL-cholesterol levels.
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Merinopoulos I, Gunawardena T, Wickramarachchi U, Ryding A, Eccleshall S, Vassiliou VS. Percutaneous Coronary Intervention in the Elderly: Are Drug-coated Balloons the Future? Curr Cardiol Rev 2018; 14:45-52. [PMID: 29278215 PMCID: PMC5872262 DOI: 10.2174/1573403x14666171226144120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Balloon angioplasty revolutionised percutaneous treatment for coronary ar-tery disease four decades ago, but vessel-threatening dissections, elastic recoil and restenosis were major drawbacks to an otherwise successful long-lasting intervention. Subsequent advances with bare metal stents and then drug eluting stents followed, aiming to mitigate the risks of acute vessel closure and restenosis. However, stent implantation often necessitates dual antiplatelet therapy for a pro-longed period of time, which in itself can lead to adverse outcomes, especially in the frail elderly pop-ulation at higher risk of bleeding. More recently, bioabsorbable stents have been implemented in clini-cal practice enabling earlier intimal coverage of the stent and apposition. However, another addition to the armamentarium of percutaneous coronary intervention is the use of drug-coated balloons without the need for deploying any coronary stents or scaffolds. Drug-coated balloons are semi-compliant balloons coated with an antiproliferative agent that is rapidly released on contact with the vessel intima exerting an anti-restenotic effect. The absence of a metallic scaffold means that the need for antiplatelet therapy can potentially be negated in the longer term if required. In this article, we will review the history of percutaneous coronary intervention and the available evi-dence for the appropriate use of drug-coated balloons especially in the elderly population. Conclusion: We will conclude this review by demonstrating the potential use of drug-coated balloon rather percutaneous stenting through case examples.
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Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Upul Wickramarachchi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Medical School, University of East Anglia and Royal Brompton Hospital and Imperial College London, London, United Kingdom
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Gao J, Ma X, Zhang Y, Guo M, Shi D. The role of microRNAs in prethrombotic status associated with coronary artery disease. Thromb Haemost 2017; 117:429-436. [DOI: 10.1160/th16-07-0503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/05/2016] [Indexed: 12/20/2022]
Abstract
SummaryThe acute cardiovascular events following thrombus formation is a primary cause of morbidity and mortality of patients with coronary artery disease (CAD). Numerous studies have shown that a prethrombotic status, which can be defined as an imbalance between the procoagulant and anticoagulant conditions, would exist for a period of time before thrombogenesis. Therefore, early diagnosis and intervention of prethrombotic status are important for reducing acute cardiovascular events. However, none of prethrombotic indicators have been identified as golden standard for diagnosis of prethrombotic status to date. MicroRNAs (miRNAs), a class of short non-coding RNAs, have been shown to be involved in pathophysiologic processes related to prethrombotic status, such as endothelial dysfunction, platelet activation, impaired fibrinolysis and elevated procoagulant factors, etc. Owing to their multiple and fine-tuning impacts on gene expression, miRNAs raise a novel understanding in the underlying mechanism of prethrombotic status. This review aims to discuss the role of miRNAs in prethrombotic status, especially the differently expressed miRNAs in CAD, which may be meaningful for developing promising diagnostic biomarkers and therapeutic strategies for CAD patients in future.
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Nudi F, Schillaci O, Di Belardino N, Versaci F, Tomai F, Pinto A, Neri G, Procaccini E, Nudi A, Frati G, Biondi-Zoccai G. Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction. Am J Cardiol 2017; 120:1238-1244. [PMID: 28888406 DOI: 10.1016/j.amjcard.2017.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 02/08/2023]
Abstract
The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p <0.001). Yet the prevalence of severe ischemia decreased over time from 11.4% to 2.0%, with a similar trend for moderate ischemia (from 15.9% to 11.8%, p <0.001). Similarly sobering results were wound for the prevalence of severe necrosis (from 19.8% to 8.2%) and moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed at regional level and after propensity score matching. In conclusion, the outlook of stable patients with previous MI has substantially improved in the last decade, with a decrease in the severity of residual myocardial ischemia and necrosis, despite an apparent worsening in baseline features.
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Miao L, Yin RX, Huang F, Chen WX, Cao XL, Wu JZ. The effect of MVK-MMAB variants, their haplotypes and G×E interactions on serum lipid levels and the risk of coronary heart disease and ischemic stroke. Oncotarget 2017; 8:72801-72817. [PMID: 29069827 PMCID: PMC5641170 DOI: 10.18632/oncotarget.20349] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/04/2017] [Indexed: 12/27/2022] Open
Abstract
Aim This study aimed to detect the association of the mevalonate kinase (MVK) and methylmalonic aciduria (cobalamin deficiency) cblB type (MMAB) gene variants, their haplotypes, and gene-environment (G×E) interactions on serum lipid levels and the risk of coronary heart disease (CHD) and ischemic stroke (IS) in a Chinese Han population. Methods Genotyping of the rs3759387, rs7134594, rs877710 and rs9593 SNPs in 846 CHD and 869 IS patients and 847 healthy controls was performed by PCR-RFLP and Sanger sequencing. Logistic regression and factor regression were used to investigate the association of 4 MVK-MMAB SNPs and serum lipid levels and the risk of CHD and IS. Results The genotypic and allelic frequencies of the rs3759387 and rs7134594 SNPs differed between controls and patients (P < 0.0125-0.001). The rs3759387 SNP was associated with the risk of CHD and IS in different genetic models. The A-T-G-A and C-T-C-T haplotypes were associated with increased risk of CHD. The haplotype of A-T-G-A was associated with an increased risk of IS, whereas the C-T-G-A haplotype was associated with a decreased risk of IS. Interactions of C-T-C-T-smoking or C-T-C-T-age on the risk of CHD, and A-T-G-A-hypertension or A-T-G-A-age on the risk of IS were also observed. The subjects with the rs3759387AA genotype in controls had lower high-density lipoprotein cholesterol (HDL-C) levels than did the subjects with AC/CC genotypes. Several SNPs interacted with alcohol consumption and cigarette smoking to increase serum HDL-C and apolipoprotein A1 levels, but they interacted with body mass index ≥ 24 kg/m2 to decrease serum HDL-C and apolipoprotein A1 levels. Conclusion Several MVK-MMAB variants, especially the rs3759387 SNP, 4 main haplotypes, and G×E interactions were associated with serum lipid levels and the risk of CHD and IS in a Chinese Han population.
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Affiliation(s)
- Liu Miao
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China
| | - Feng Huang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China
| | - Wu-Xian Chen
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China
| | - Xiao-Li Cao
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China
| | - Jin-Zhen Wu
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China
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N-3 polyunsaturated fatty acids alleviate high glucose-mediated dysfunction of endothelial progenitor cells and prevent ischemic injuries both in vitro and in vivo. J Nutr Biochem 2017; 42:172-181. [PMID: 28189115 DOI: 10.1016/j.jnutbio.2017.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 01/07/2017] [Accepted: 01/19/2017] [Indexed: 12/17/2022]
Abstract
Hyperglycemia is associated with a reduced number of endothelial progenitor cells (EPCs) that impairs vascular function. Circulating EPCs play important roles in postnatal neovasculogenesis and the prevention of ischemic injury. Frequent consumption of fish oil (FO) that is abundant with eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) is reportedly associated with an alleviation of diabetic complications and a lowered incidence of cardiovascular disease. The aim of this study was to examine whether N-3 polyunsaturated fatty acids such as EPA and DHA would reverse the high glucose-mediated dysfunction of EPCs in vitro and thereby prevent the ischemic injury that occurs under the hyperglycemic conditions in Type 2 diabetes (T2D) db-/- mice. The results demonstrate that EPA and DHA alleviate high glucose-mediated impairment of tubular formation in EPCs through a rescue of neovasculogenic capability. The molecular mechanisms underlying the effects of EPA and DHA include the activation of the extracellular signal-regulated kinase 1/2, Akt/endothelial nitric oxide synthase (eNOS) and AMP-activated kinase (AMPK) signaling cascades as well as the phosphorylation of the downstream FOXO3a protein in EPCs. Moreover, EPA and DHA up-regulate the expression of c-kit, erythroid 2-related factor and heme oxygenase-1 proteins. Daily consumption of FO at dosages of 4% and 6% (wt/wt) significantly increased the level of bone marrow-derived and circulating EPCs, induced a recovery of blood flow and prevented ischemic injuries in a T2D db-/- mouse model. The effects of FO consumption were exerted the activation of Akt/eNOS and AMPK signaling cascades without any effect on the plasma VEGF level in vivo.
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Javanmard SH, Heshmat-Ghahdarijani K, Mirmohammad-Sadeghi M, Sonbolestan SA, Ziayi A. The effect of melatonin on endothelial dysfunction in patient undergoing coronary artery bypass grafting surgery. Adv Biomed Res 2016; 5:174. [PMID: 28028514 PMCID: PMC5156974 DOI: 10.4103/2277-9175.194801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 01/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background: In this study, we investigated the effect of melatonin administration on four markers of endothelial cell function including intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), C-reactive protein (CRP), and nitric oxide (NO) on patients with three vessels coronary disease. Materials and Methods: This double-blind, randomized, controlled trial study was conducted on 39 patients (32 men and 7 women) with three vessels coronary disease. The case group included 20 patients who received 10 mg oral melatonin 1 h before sleeping for 1 month. The control group included 19 patients who received placebo 1 h before sleeping for 1 month. The serum levels of CRP, ICAM, VCAM, and NO were compared after 1 month treatment. Results: After 1 month of melatonin treatment, the mean level of ICAM, VCAM, and CRP showed a statistically significant decrease in the case group. On the other hand, the mean level of VCAM increased significantly in the control group. The mean levels of CRP and ICAM were also increased in the control group, but the difference did not reach the significant threshold. With respect to NO, there was a statistically significant increase in the case group, while there was a statistically significant decrease in serum NO in the control group. Conclusions: The results of this study suggested that melatonin may have beneficial effects on endothelial oxidative stress even in patient with severe and advanced atherosclerosis.
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Affiliation(s)
| | - Kiyan Heshmat-Ghahdarijani
- Department of Physiology, Physiology Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Mirmohammad-Sadeghi
- Department of Cardiac Surgery, Isfahan Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Ali Sonbolestan
- Department of Physiology, Physiology Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Ziayi
- Medical Student Research Center, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Buccheri S, Capranzano P, Condorelli A, Scalia M, Tamburino C, Capodanno D. Risk stratification after ST-segment elevation myocardial infarction. Expert Rev Cardiovasc Ther 2016; 14:1349-1360. [PMID: 27817218 DOI: 10.1080/14779072.2017.1256201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Risk stratification according to the timing of assessment, treatment modality and outcome of interest is highly advisable in patients with ST-elevation myocardial infarction (STEMI) to identify optimal treatment strategies, proper length of hospital stay and correct timing of follow-up. Areas covered: This review is an overview summarizing the characteristics and performance of available risk-scoring systems for STEMI. In particular, we sought to highlight the characteristics of STEMI cohorts used for derivation and validation of the available algorithms and appraise their discrimination ability, calibration and global accuracy. Expert commentary: Applying the appropriate score, customized on patients' profile and clinical characteristics at presentation or during the hospitalization, might prove useful to improve the overall quality of care provided to STEMI patients.
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Affiliation(s)
- Sergio Buccheri
- a Cardiovascular Department, Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Piera Capranzano
- a Cardiovascular Department, Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Antonio Condorelli
- a Cardiovascular Department, Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Matteo Scalia
- a Cardiovascular Department, Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Cardiovascular Department, Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Davide Capodanno
- a Cardiovascular Department, Ferrarotto Hospital , University of Catania , Catania , Italy
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Mosley JD, van Driest SL, Wells QS, Shaffer CM, Edwards TL, Bastarache L, McCarty CA, Thompson W, Chute CG, Jarvik GP, Crosslin DR, Larson EB, Kullo IJ, Pacheco JA, Peissig PL, Brilliant MH, Linneman JG, Denny JC, Roden DM. Defining a Contemporary Ischemic Heart Disease Genetic Risk Profile Using Historical Data. ACTA ACUST UNITED AC 2016; 9:521-530. [PMID: 27780847 DOI: 10.1161/circgenetics.116.001530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/28/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Continued reductions in morbidity and mortality attributable to ischemic heart disease (IHD) require an understanding of the changing epidemiology of this disease. We hypothesized that we could use genetic correlations, which quantify the shared genetic architectures of phenotype pairs and extant risk factors from a historical prospective study to define the risk profile of a contemporary IHD phenotype. METHODS AND RESULTS We used 37 phenotypes measured in the ARIC study (Atherosclerosis Risk in Communities; n=7716, European ancestry subjects) and clinical diagnoses from an electronic health record (EHR) data set (n=19 093). All subjects had genome-wide single-nucleotide polymorphism genotyping. We measured pairwise genetic correlations (rG) between the ARIC and EHR phenotypes using linear mixed models. The genetic correlation estimates between the ARIC risk factors and the EHR IHD were modestly linearly correlated with hazards ratio estimates for incident IHD in ARIC (Pearson correlation [r]=0.62), indicating that the 2 IHD phenotypes had differing risk profiles. For comparison, this correlation was 0.80 when comparing EHR and ARIC type 2 diabetes mellitus phenotypes. The EHR IHD phenotype was most strongly correlated with ARIC metabolic phenotypes, including total:high-density lipoprotein cholesterol ratio (rG=-0.44, P=0.005), high-density lipoprotein (rG=-0.48, P=0.005), systolic blood pressure (rG=0.44, P=0.02), and triglycerides (rG=0.38, P=0.02). EHR phenotypes related to type 2 diabetes mellitus, atherosclerotic, and hypertensive diseases were also genetically correlated with these ARIC risk factors. CONCLUSIONS The EHR IHD risk profile differed from ARIC and indicates that treatment and prevention efforts in this population should target hypertensive and metabolic disease.
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Affiliation(s)
- Jonathan D Mosley
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI.
| | - Sara L van Driest
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Quinn S Wells
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Christian M Shaffer
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Todd L Edwards
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Lisa Bastarache
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Catherine A McCarty
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Will Thompson
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Christopher G Chute
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Gail P Jarvik
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - David R Crosslin
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Eric B Larson
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Iftikhar J Kullo
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Jennifer A Pacheco
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Peggy L Peissig
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Murray H Brilliant
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - James G Linneman
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Josh C Denny
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Dan M Roden
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
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Affiliation(s)
- Calum A MacRae
- From Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.A.M.); Department of Medicine, Harvard Medical School, Boston, MA (C.A.M.); Broad Institute of Harvard and MIT, Boston, MA (C.A.M.); National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.S.V.); Evans Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); and Preventive Medicine and Cardiology Sections, Boston University School of Medicine, MA (R.S.V.).
| | - Ramachandran S Vasan
- From Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.A.M.); Department of Medicine, Harvard Medical School, Boston, MA (C.A.M.); Broad Institute of Harvard and MIT, Boston, MA (C.A.M.); National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.S.V.); Evans Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); and Preventive Medicine and Cardiology Sections, Boston University School of Medicine, MA (R.S.V.)
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Galluzzo A, Gallo C, Battaglia A, Frea S, Canavosio FG, Botta M, Bergerone S, Gaita F. Prolonged QT interval in ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2016; 17:440-5. [DOI: 10.2459/jcm.0000000000000317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zhou X, Liu XL, Ji WJ, Liu JX, Guo ZZ, Ren D, Ma YQ, Zeng S, Xu ZW, Li HX, Wang PP, Zhang Z, Li YM, Benefield BC, Zawada AM, Thorp EB, Lee DC, Heine GH. The Kinetics of Circulating Monocyte Subsets and Monocyte-Platelet Aggregates in the Acute Phase of ST-Elevation Myocardial Infarction: Associations with 2-Year Cardiovascular Events. Medicine (Baltimore) 2016; 95:e3466. [PMID: 27149446 PMCID: PMC4863763 DOI: 10.1097/md.0000000000003466] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In experimental myocardial infarction (MI), a rise in cell counts of circulating monocyte subsets contributes to impaired myocardial healing and to atherosclerotic plaque destabilization. In humans, the prognostic role of monocyte subsets in patients suffering ST-elevation MI (STEMI) is still unclear. In the present study, we aimed to determine the kinetics of the 3 monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+, and nonclassical CD14+CD16++ monocytes), as well as the subset-specific monocyte-platelet aggregates (MPA), in acute STEMI followed by primary percutaneous coronary intervention (PCI), and their relationships with cardiovascular outcomes during a 2-year follow-up.Monocyte subsets and MPA were measured in 100 STEMI patients receiving primary PCI on days 1, 2, 3, 5, and 7 of symptom onset, which were compared with 60 stable coronary heart disease patients and 35 healthy volunteers. From day 1 to day 7, significant increases in the counts of CD14++CD16+ monocytes and CD14++CD16+ MPA were observed, with peak levels on day 2. During a median follow-up of 2.0 years, 28 first cardiovascular events (defined as cardiovascular death, nonfatal ischemic stroke, recurrent MI, need for emergency or repeat revascularization, and rehospitalization for heart failure) were recorded. After adjustment for confounders, CD14++CD16+ monocytosis (day 1 [HR: 3.428; 95% CI: 1.597-7.358; P = 0.002], day 2 [HR: 4.835; 95% CI: 1.106-21.13; P = 0.04], day 3 [HR: 2.734; 95% CI: 1.138-6.564; P = 0.02], and day 7 [HR: 2.647; 95% CI: 1.196-5.861; P = 0.02]), as well as increased levels of CD14++CD16+ MPA measured on all time points (days 1, 2, 3, 5, and 7), had predictive values for adverse cardiovascular events.In conclusion, our data show the expansion of the CD14++CD16+ monocyte subset during acute phase of STEMI has predictive values for 2-year adverse cardiovascular outcomes in patients treated with primary PCI. Future studies will be warranted to elucidate whether CD14++CD16+ monocytes may become a target cell population for new therapeutic strategies after STEMI.
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Affiliation(s)
- Xin Zhou
- From the Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury (XZ, X-LL, W-JJ, J-XL, Z-ZG, DR, Y-QM, SZ, Z-WX, H-XL, Y-ML), Pingjin Hospital Heart Center, Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Division of Community Health and Humanities (PPW), Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada; Department of Radiology (ZZ); Feinberg Cardiovascular Research Institute (BCB, DCL); Department of Pathology (EBT), Northwestern University Feinberg School of Medicine, Chicago, IL, USA; and Department of Internal Medicine IV (AMZ and GHH), Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany
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Jorge JDG, Santos MAA, Barreto Filho JAS, Oliveira JLM, de Melo EV, de Oliveira NA, Faro GBDA, Sousa ACS. Level of Physical Activity and In-Hospital Course of Patients with Acute Coronary Syndrome. Arq Bras Cardiol 2015; 106:33-40. [PMID: 26690692 PMCID: PMC4728593 DOI: 10.5935/abc.20160006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/04/2015] [Indexed: 11/20/2022] Open
Abstract
Background Acute coronary syndrome (ACS) is one of the main causes of morbidity and
mortality in the modern world. A sedentary lifestyle, present in 85%
of the Brazilian population, is considered a risk factor for the
development of coronary artery disease. However, the correlation of a
sedentary lifestyle with cardiovascular events (CVE) during
hospitalization for ACS is not well established. Objective To evaluate the association between physical activity level, assessed
with the International Physical Activity Questionnaire (IPAQ), with
in-hospital prognosis in patients with ACS. Methods Observational, cross-sectional, and analytical study with 215 subjects
with a diagnosis of ACS consecutively admitted to a referral hospital
for cardiac patients between July 2009 and February 2011. All
volunteers answered the short version of the IPAQ and were observed
for the occurrence of CVE during hospitalization with a standardized
assessment conducted by the researcher and corroborated by data from
medical records. Results The patients were admitted with diagnoses of unstable angina (34.4%),
acute myocardial infarction (AMI) without ST elevation (41.4%), and
AMI with ST elevation (24.2%). According to the level of physical
activity, the patients were classified as non-active (56.3%) and
active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence
of in-hospital complications was associated with the length of
hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR =
2.54), and was independent of age, systolic blood pressure, and prior
congestive heart failure. Conclusion A physically active lifestyle reduces the risk of CVE during
hospitalization in patients with ACS.
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Affiliation(s)
- Juliana de Goes Jorge
- Núcleo de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | | | | | | | - Enaldo Vieira de Melo
- Núcleo de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Norma Alves de Oliveira
- Núcleo de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brazil
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Sumner JA, Kronish IM, Pietrzak RH, Shimbo D, Shaffer JA, Parsons FE, Edmondson D. Dimensional structure and correlates of posttraumatic stress symptoms following suspected acute coronary syndrome. J Affect Disord 2015; 186:178-85. [PMID: 26241667 PMCID: PMC4565739 DOI: 10.1016/j.jad.2015.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/22/2015] [Accepted: 06/08/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a heterogeneous construct, and some have suggested that PTSD triggered by acute coronary syndrome (ACS) may differ from PTSD due to prototypical traumas. METHODS We conducted the first examination of the latent structure of PTSD symptoms after suspected ACS in 399 adults in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Using confirmatory factor analysis, we compared the 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD. RESULTS Although all models fit well, the dysphoria model was selected as the best-fitting model. Further, there was measurement invariance of the dysphoria model by sex. PTSD dimensions evidenced differential associations with indicators of threat perception during ACS evaluation and adherence to cardioprotective medication. LIMITATIONS One limitation of this investigation is the use of self-report measures. In addition, only one-third of the sample was diagnosed with ACS at discharge; the remaining participants received diagnoses such as chest pain without a cardiac diagnosis, another symptom/disease process (e.g., hypertensive chronic kidney disease), or another cardiac disease. CONCLUSIONS Findings suggest that suspected ACS-related PTSD symptoms are best-represented by a 4-factor structure distinguishing between specific (e.g., re-experiencing) and non-specific (dysphoria) symptoms of PTSD that has received support in the broader PTSD literature.
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Affiliation(s)
- Jennifer A. Sumner
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th St, New York, NY 10032, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA,Corresponding author: Jennifer A. Sumner, Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W.168th St, Room 720H, New York, NY 10032 Phone: 212-342-0401; Fax: 212-342-5168;
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St, New York NY 10032, USA
| | - Robert H. Pietrzak
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St, New York NY 10032, USA
| | - Jonathan A. Shaffer
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St, New York NY 10032, USA
| | - Faith E. Parsons
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St, New York NY 10032, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St, New York NY 10032, USA
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Kietzmann T. Myocardial infarction in elderly patients: How to assess their bleeding risk? Thromb Haemost 2015. [PMID: 26223160 DOI: 10.1160/th15-06-0507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas Kietzmann
- Thomas Kietzmann, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Aapistie 7, FI-90220 Oulu, Finland, Tel : +358 2 9448 7713,, E-mail:
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Koller L, Rothgerber DJ, Sulzgruber P, El-Hamid F, Förster S, Wojta J, Goliasch G, Maurer G, Niessner A. History of previous bleeding and C-reactive protein improve assessment of bleeding risk in elderly patients (≥ 80 years) with myocardial infarction. Thromb Haemost 2015. [PMID: 26224504 DOI: 10.1160/th15-05-0395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We aimed to assess whether the CRUSADE risk score represents a robust instrument for stratification of bleeding risk in elderly myocardial infarction (MI) patients (≥ 80 years) and further aimed to identify age-specific predictors of major bleeding events. Binary logistic regression models were applied to assess the effect of variables on the occurrence of bleeding events during hospital stay. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminatory power. Out of 387 patients in the final study cohort, 74 patients (19.1 %) experienced a major bleeding event according to the definition of the International Society on Thrombosis and Haemostasis. The CRUSADE risk score demonstrated only a weak discriminatory power to predict bleeding in this group of patients (area under the ROC curve: 0.57 [0.51-0.65]; p=0.05). In the multivariate regression analysis, history of bleeding with an adjusted hazard ratio (HR) of 3.21 (95 % confidence interval: 1.29-8.03, p=0.01) and C-reactive protein with an adjusted HR per increase of 10 mg/l of 1.05 (1.01-1.10) were independent predictors of major bleeding. Integration of both variables into the CRUSADE score demonstrated a significantly improved performance for bleeding as indicated by a significant increase in the ROC analysis (area under the curve: 0.64 vs 0.57; for comparison p< 0.045), net reclassification index (35.6 %; p=0.006) and integrated discrimination increment (0.0242; p=0.02). In conclusion, bleeding history and C-reactive protein significantly improve the modest predictive power of the CRUSADE risk score in elderly patients with MI. These results point towards a specific risk profile for bleeding events in this high-risk group of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alexander Niessner
- Alexander Niessner, MD, MSc, Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria, Tel.: +43 1 404004614, Fax: +43 1 404004216, E-mail:
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Yang Q, Yin RX, Zhou YJ, Cao XL, Guo T, Chen WX. Association of polymorphisms in the MAFB gene and the risk of coronary artery disease and ischemic stroke: a case-control study. Lipids Health Dis 2015. [PMID: 26204962 PMCID: PMC4513700 DOI: 10.1186/s12944-015-0078-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The v-maf avian musculoaponeurotic fibrosarcoma oncogene homolog B gene (MAFB) has been associated with serum lipid levels in the Eurpean population, but little is known about such association in the Chinese population or in atherosclerosis-related patients. Therefore, the purpose of the present study was to assess the association of the single nucleotide polymorphisms (SNPs) in the MAFB and serum lipid levels and the risk of coronary artery disease (CAD) and ischemic stroke (IS) in the Chinese population. METHODS A total of 1,065 unrelated patients (CAD, 525 and IS, 540) and 539 healthy controls were recruited in this study. Genotypes of the MAFB rs2902940 and rs6102059 SNPs were determined by the Snapshot technology platform. RESULTS The rs2902940AA genotype was associated with an increased risk of CAD (adjusted OR = 1.63, 95% CI = 1.07-2.48, P = 0.023) and IS (adjusted OR = 1.69, 95% CI = 1.09-2.61, P = 0.017). The rs2902940GA/AA genotypes were also associated with an increased risk of CAD (adjusted OR = 1.56, 95% CI = 1.04-2.32, P = 0.030 for GA/AA vs. GG) and IS (adjusted OR = 1.72, 95% CI = 1.14-2.60, P = 0.010 for GA/AA vs. GG). Significant interactions were observed only in those with higher body mass index (BMI), hypertension and diabetes (P < 0.05). The subjects with rs2902940GA/AA genotypes in controls had lower serum ApoAI levels than the subjects with GG genotype (P = 0.024). CONCLUSIONS The rs2902940A allele carriers in the MAFB conferred a decreased serum ApoAI level in controls and an increased risk of CAD and IS. The rs2902940GA/AA genotypes interacted with higher BMI, hypertension and diabetes to contribute the risk of CAD and IS.
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Affiliation(s)
- Qian Yang
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Yi-Jiang Zhou
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Xiao-Li Cao
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Tao Guo
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Wu-Xian Chen
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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Mahmoud A, Saad M, Elgendy IY. Simultaneous multi-vessel coronary thrombosis in patients with ST-elevation myocardial infarction: a systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:163-6. [DOI: 10.1016/j.carrev.2015.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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Husted S. Antithrombotic therapy for long-term secondary prevention of acute coronary syndrome in high-risk patients. Ther Clin Risk Manag 2015; 11:263-77. [PMID: 25733842 PMCID: PMC4337714 DOI: 10.2147/tcrm.s75024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Patients with acute coronary syndrome (ACS) represent a major clinical burden, because they tend to experience recurrent ischemic events. Acute management of patients with ACS includes combination antithrombotic therapy composed of a parenteral anticoagulant and dual-antiplatelet therapy. Dual-antiplatelet therapy is also recommended for long-term secondary prevention of ACS. Despite advances in the antithrombotic therapies available, clinical trials suggest that patients with ACS still faceã10% risk of another event within 12-15 months of the index event. Certain patient populations, such as elderly patients and those with renal impairment or heart failure, are at higher risk of recurrent ACS events, because these patients have more vascular ischemic and bleeding risk factors than most other patients. Evidence from the GRACE and CRUSADE registries suggests underuse of the guideline-recommended evidence-based therapies for the management of ACS in such patients. This review summarizes the current standard of care for patients with ACS, focusing on long-term secondary antithrombotic strategies. Registry data are used to identify high-risk patient populations; the recent antiplatelet and anticoagulant Phase III trial data are summarized to highlight any patient populations who receive greater or lesser benefit from specific long-term antithrombotic strategies. Guideline recommendations are discussed and suggestions are provided to help improve implementation of long-term secondary prevention strategies and patient prognosis after an ACS event.
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Affiliation(s)
- Steen Husted
- Department of Biomedicine, Centre for Clinical Pharmacology, Aarhus, Denmark
- Department of Medicine, Hospital Unit West, Herning, Denmark
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Kim JH, Chung HS, Antonisamy P, Lee SR, Bae H. Cardioprotective effect of rhizomes of Acorus gramineus against isoproterenol-induced cardiac damage in pigs. Cardiovasc Toxicol 2015; 14:183-92. [PMID: 24420420 DOI: 10.1007/s12012-014-9243-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present study was designed to evaluate the cardioprotective potential of water extract of rhizomes of Acorus gramineus (AGR) against isoproterenol (ISO)-induced myocardial infarction. Male pigs were orally administered with 250 or 500 mg/kg of AGR or with vehicle for 9 days, with concurrent subcutaneous injections of ISO on the 8th and 9th day. Administration of AGR significantly ameliorated ISO-induced cardiac dysfunctions as evidenced by the ventricular ST-segment interval and R-amplitude as well as the left ventricle fractional shortening and ejection fraction. Additionally, administration of AGR significantly attenuated increased cardiac injury markers, such as cardiac troponin T, tumor necrosis factor-α, and myeloperoxidase activity, and cardiac marker enzymes, and prevented the depletion of antioxidant parameters. Malondialdehyde formation was also inhibited by AGR. Based on the results, it is concluded that AGR possesses significant cardioprotective potential and may serve as an adjunct in the treatment and prophylaxis of myocardial infarction.
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Affiliation(s)
- Jong-Hoon Kim
- Department of Veterinary Physiology, Biosafety Research Institute, College of Veterinary Medicine, Chonbuk National University, 664-14, 1GA, Duckjin-Dong, Duckjin-Gu, Jeollabuk-Do, Chonju City, 561-756, Republic of Korea
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Prevalence and prognostic significance of long QT interval in patients with acute coronary syndrome: review of the literature. J Cardiovasc Nurs 2014; 29:271-9. [PMID: 23839573 DOI: 10.1097/jcn.0b013e31829bcf1a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Sympathetic hyperactivity is linked with several adverse cardiovascular events in patients with acute coronary syndrome (ACS). Sympathetic activity increases early in the process of ischemia through 2 mechanisms. One originates from the central nervous system and leads to enhanced sympathetic activity. The other mechanism originates at the infarct zone and leads to B receptor up-regulation and catecholamine supersensitivity. Nevertheless, sympathetic hyperactivity accompanied by an underlying myocardial structural damage is likely to increase the ventricular repolarization duration measured as QT interval on the body surface electrocardiogram. PURPOSE The aims of the current review of the literature were to examine the physiological processes underlying the use of long QT interval as a risk prediction tool in patients with ACS and to critically review and critique the existing evidence related to this matter. CONCLUSION The available evidence is contradictory and includes serious limitations in design and QT measurement and correction. Until accurate and reliable data are available, it is difficult to determine the additional clinical value and prognostic significance of long QT interval in patients with ACS beyond that in other patients. CLINICAL IMPLICATIONS Long QT interval is not uncommon among patients with ACS. Automated continuous QT interval monitoring is superior to manual QT interval measurement with the standard 10-second electrocardiogram. Optimum care for patients with ACS requires nurses to keep monitoring the QT interval several days after the initial event.
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McCaul M, Lourens A, Kredo T. Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction. Cochrane Database Syst Rev 2014; 2014:CD010191. [PMID: 25208209 PMCID: PMC6823254 DOI: 10.1002/14651858.cd010191.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Early thrombolysis for individuals experiencing a myocardial infarction is associated with better mortality and morbidity outcomes. While traditionally thrombolysis is given in hospital, pre-hospital thrombolysis is proposed as an effective intervention to save time and reduce mortality and morbidity in individuals with ST-elevation myocardial infarction (STEMI). Despite some evidence that pre-hospital thrombolysis may be delivered safely, there is a paucity of controlled trial data to indicate whether the timing of delivery can be effective in reducing key clinical outcomes. OBJECTIVES To assess the morbidity and mortality of pre-hospital versus in-hospital thrombolysis for STEMI. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), EMBASE (OVID), two citation indexes on Web of Science (Thomson Reuters) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for randomised controlled trials and grey literature published up to June 2014. We also searched the reference lists of articles identified, clinical trial registries and unpublished thesis sources. We did not contact pharmaceutical companies for any relevant published or unpublished articles. We applied no language, date or publication restrictions. The Cochrane Heart Group conducted the primary electronic search. SELECTION CRITERIA We included randomised controlled trials of pre-hospital versus in-hospital thrombolysis in adults with ST-elevation myocardial infarction diagnosed by a healthcare provider. DATA COLLECTION AND ANALYSIS Two authors independently screened eligible studies for inclusion and carried out data extraction and 'Risk of bias' assessments, resolving any disagreement by consulting a third author. We contacted authors of potentially suitable studies if we required missing or additional information. We collected efficacy and adverse effect data from the trials. MAIN RESULTS We included three trials involving 538 participants. We found low quality of evidence indicating uncertainty whether pre-hopsital thrombolysis reduces all-cause mortality in individuals with STEMI compared to in-hospital thrombolysis (risk ratio 0.73, 95% confidence interval 0.37 to 1.41). We found high-quality evidence (two trials, 438 participants) that pre-hospital thrombolysis reduced the time to receipt of thrombolytic treatment compared with in-hospital thrombolysis. For adverse events, we found moderate-quality evidence that the occurrence of bleeding events was similar between participants receiving in-hospital or pre-hospital thrombolysis (two trials, 438 participants), and low-quality evidence that the occurrence of ventricular fibrillation (two trials, 178 participants), stroke (one trial, 78 participants) and allergic reactions (one trial, 100 participants) was also similar between participants receiving in-hospital or pre-hospital thrombolysis. We considered the included studies to have an overall unclear/high risk of bias. AUTHORS' CONCLUSIONS Pre-hospital thrombolysis reduces time to treatment, based on studies conducted in higher income countries. In settings where it can be safely and correctly administered by trained staff, pre-hospital thrombolysis may be an appropriate intervention. Pre-hospital thrombolysis has the potential to reduce the burden of STEMI in lower- and middle-income countries, especially in individuals who have limited access to in-hospital thrombolysis or percutaneous coronary interventions. We found no randomised controlled trials evaluating the efficacy of pre-hospital thrombolysis for STEMI in lower- and middle-income countries. Large high-quality multicentre randomised controlled trials implemented in resource-constrained countries will provide additional evidence for the efficacy and safety of this intervention. Local policy makers should consider their local health infrastructure and population distribution needs. These considerations should be taken into account when developing clinical guidelines for pre-hospital thrombolysis.
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Affiliation(s)
- Michael McCaul
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesFrancie van Zyl Drive, Tygerberg, 7505, ParowCape TownSouth Africa7505
| | - Andrit Lourens
- Faculty of Medicine and Health Science, Stellenbosch UniversityDivision of Emergency Medicine, Department of Interdisciplinary Health SciencesPO Box 19063TygerbergCape TownSouth Africa7505
| | - Tamara Kredo
- South African Medical Research CouncilSouth African Cochrane CentrePO Box 19070TygerbergCape TownSouth Africa7505
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Lim KH, Cho JY, Kim B, Bae BS, Kim JH. Red ginseng (Panax ginseng) decreases isoproterenol-induced cardiac injury via antioxidant properties in porcine. J Med Food 2014; 17:111-8. [PMID: 24456361 DOI: 10.1089/jmf.2013.2768] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Red ginseng (RG, Panax ginseng) has been shown to possess various ginsenosides. These ginsenosides are widely used for treating cardiovascular diseases in Asian communities. The present study was designed to evaluate the cardioprotective potential of RG against isoproterenol (ISO)-induced myocardial infarction (MI), by assessing electrocardiographic, hemodynamic, and biochemical parameters. Male porcines were orally administered with RG (250 and 500 mg/kg) or with vehicle for 9 days, with concurrent intraperitoneal injections of ISO (20 mg/kg) on the 8th and 9th day. RG significantly attenuated ISO-induced cardiac dysfunctions as evidenced by improved ventricular hemodynamic functions and reduced ST segment and QRS complex intervals. Also, RG significantly ameliorated myocardial injury parameters such as antioxidants. Malonaldialdehyde formation was also inhibited by RG. Based on the results, it is concluded that RG possesses significant cardioprotective potential through the inhibition of oxidative stress and may serve as an adjunct in the treatment and prophylaxis of MI.
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Affiliation(s)
- Kyu Hee Lim
- 1 Department of Veterinary Physiology, College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University , Jeonju City, Jeollabuk-Do, Korea
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Hanawa K, Ito K, Aizawa K, Shindo T, Nishimiya K, Hasebe Y, Tuburaya R, Hasegawa H, Yasuda S, Kanai H, Shimokawa H. Low-intensity pulsed ultrasound induces angiogenesis and ameliorates left ventricular dysfunction in a porcine model of chronic myocardial ischemia. PLoS One 2014; 9:e104863. [PMID: 25111309 PMCID: PMC4128732 DOI: 10.1371/journal.pone.0104863] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although a significant progress has been made in the management of ischemic heart disease (IHD), the number of severe IHD patients is increasing. Thus, it is crucial to develop new, non-invasive therapeutic strategies. In the present study, we aimed to develop low-intensity pulsed ultrasound (LIPUS) therapy for the treatment of IHD. METHODS AND RESULTS We first confirmed that in cultured human endothelial cells, LIPUS significantly up-regulated mRNA expression of vascular endothelial growth factor (VEGF) with a peak at 32-cycle (P<0.05). Then, we examined the in vivo effects of LIPUS in a porcine model of chronic myocardial ischemia with reduced left ventricular ejection fraction (LVEF) (n = 28). The heart was treated with either sham (n = 14) or LIPUS (32-cycle with 193 mW/cm2 for 20 min, n = 14) at 3 different short axis levels. Four weeks after the treatment, LVEF was significantly improved in the LIPUS group (46±4 to 57±5%, P<0.05) without any adverse effects, whereas it remained unchanged in the sham group (46±5 to 47±6%, P = 0.33). Capillary density in the ischemic region was significantly increased in the LIPUS group compared with the control group (1084±175 vs. 858±151/mm2, P<0.05). Regional myocardial blood flow was also significantly improved in the LIPUS group (0.78±0.2 to 1.39±0.4 ml/min/g, P<0.05), but not in the control group (0.84±0.3 to 0.97±0.4 ml/min/g). Western blot analysis showed that VEGF, eNOS and bFGF were all significantly up-regulated only in the LIPUS group. CONCLUSIONS These results suggest that the LIPUS therapy is promising as a new, non-invasive therapy for IHD.
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Affiliation(s)
- Kenichiro Hanawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Aizawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuhi Hasebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuji Tuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideyuki Hasegawa
- Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Department of Electronic Engineering, Graduate School of Engineering, Tohoku University, Sendai, Japan
| | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Kanai
- Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Department of Electronic Engineering, Graduate School of Engineering, Tohoku University, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
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Turpie AGG. Oral anticoagulant use in addition to antiplatelet therapy for secondary prevention in acute coronary syndrome: current perspectives. Expert Rev Cardiovasc Ther 2014; 12:963-76. [PMID: 25017622 DOI: 10.1586/14779072.2014.938055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with acute coronary syndrome (ACS) are typically managed with long-term dual antiplatelet therapy of acetylsalicylic acid plus a P2Y12 platelet receptor antagonist; however, although effective, the risk of another vascular event within 12 months remains at approximately 10%. Considerable efforts have been made to find improved therapeutic approaches to secondary prevention in ACS. The ATLAS ACS 2-TIMI 51 trial demonstrated that rivaroxaban (2.5 mg twice daily) significantly reduced recurrent vascular events, increased the risk of major bleeding but not the risk of fatal bleeding, and resulted in reduced rates of death from cardiovascular causes. These results formed the basis for approval in Europe of rivaroxaban (2.5 mg twice daily) in conjunction with standard antiplatelet therapy for the secondary prevention of ACS.
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Affiliation(s)
- Alexander G G Turpie
- Hamilton Health Sciences-General Hospital, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2 Canada
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