1
|
Khameneh Bagheri R, Mousavi SH, Mehrad‐Majd H, Jamili MJ, Nasimi Shad A, Baradaran Rahimi V. Evaluating the association between opium abuse, blood lead levels, and the complexity of coronary artery disease. Physiol Rep 2024; 12:e15975. [PMID: 38480374 PMCID: PMC10937294 DOI: 10.14814/phy2.15975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/02/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
Opium abuse and exposure to heavy metals elevate the risk of coronary artery disease (CAD). Therefore, we aimed to determine the association between opium abuse and blood lead levels (BLLs) and the CAD complexity. We evaluated patients with acute coronary symptoms who underwent coronary angiography, and those with >50% stenosis in at least one of the coronary arteries were included. Furthermore, Synergy between PCI with Taxus and Cardiac Surgery I (SYNTAX I) score and BLLs were measured. Based on the opium abuse, 95 patients were subdivided into opium (45) and control (50) groups. Differences in demographics and CAD risk factors were insignificant between the two groups. The median BLLs were remarkably higher in the opium group than in controls (36 (35.7) and 20.5 μg/dL (11.45), respectively, p = 0.003). We also revealed no significant differences in SYNTAX score between the two groups (15.0 (9.0) and 17.5 (14.0), respectively, p = 0.28). Additionally, we found no significant correlation between BLLs and the SYNTAX scores (p = 0.277 and r = -0.113). Opium abuse was associated with high BLLs. Neither opium abuse nor high BLLs were correlated with the complexity of CAD. Further studies are warranted to establish better the relationship between opium abuse, BLLs, and CAD.
Collapse
Affiliation(s)
- Ramin Khameneh Bagheri
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Seyed Hadi Mousavi
- Medical Toxicology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Hassan Mehrad‐Majd
- Clinical Research Development Unit, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Mohammad Javad Jamili
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Arya Nasimi Shad
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
- Pharmacological Research Center of Medicinal PlantsMashhad University of Medical SciencesMashhadIran
| |
Collapse
|
2
|
Sinha SR, Prakash P, Keshari JR, Prasad RV. The Correlation Between Serum Fibroblast Growth Factor 21 and the Severity and Occurrence of Coronary Artery Disease. Cureus 2024; 16:e51924. [PMID: 38333506 PMCID: PMC10851179 DOI: 10.7759/cureus.51924] [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] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The burden of cardiovascular diseases (CVDs) is increasing worldwide with CVD being one of the leading causes of death, including atherosclerosis, myocardial infarction, cardiomyopathy, and heart failure (HF). Fibroblast growth factor 21 (FGF21) is an endocrine hormone that regulates carbohydrate and lipid metabolism. It exerts direct effects on the cardiovascular system and can serve as an early indicator of CVDs. FGF21's therapeutic properties include reducing obesity, dyslipidaemia, and hyperglycemia, which can help treat metabolic disorders, autophagy, and apoptosis. Atherosclerosis is developed due to chronic inflammatory conditions, and the immune system's reaction to oxidized lipoproteins is mainly responsible for the development of atherosclerosis. FGF21's precise role in the pathogenesis of coronary artery disease (CAD) remains elusive. Aim: This study aimed to assess the role of FGF21 in predicting the severity and magnitude of CAD in individuals diagnosed with stable angina pectoris (SAP). MATERIALS AND METHODS A prospective cross-sectional study was conducted on 110 consecutive patients with SAP reported to the cardiology department of the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India. They were divided into two groups based on coronary angiography findings. Control groups included patients not showing any atherosclerotic lesions and case groups with atherosclerotic lesions. The SYNTAX score is a grading system that measures the location and complexity of coronary arteries using anatomical principles. The Gensini score assessment technique was employed to determine the severity of CAD. We compared serum FGF21 levels,left ventricular ejection fraction (LVEF), and inflammatory biomarker C-reactive protein (CRP) levels between the two groups. Moreover, we examined the correlation between the serum FGF21 level and the SYNTAX and Gensini scores. The statistical analysis was done using Version 23.0 of SPSS Statistics. P-values below 0.05 were considered statistically significant. RESULTS The study found that the case group had a higher average age and a higher proportion of male patients. The case group had considerably higher levels of FGF21 (166.59 ± 94.49791 pg/mL) compared to the control group (54.13 ± 48.467 pg/mL) (p=0.034). The LVEF exhibited a significant difference between the case and control groups, with mean values of 50.3056 ± 7.8242% and 56.078 ± 5.3987%, respectively (p=0.031). CRP levels were comparable in both groups. The case group had mean values of SYNTAX and Gensini scores of 23.19±7.43 and 50.03±27.30, respectively. We found that there was no statistically significant association between the risk assessments for CAD severity and the levels of serum FGF21 (correlation coefficient r=0.14070, p>0.05, and r=0.206415, p>0.05, respectively) Conclusions: FGF21 is gaining recognition as a prospective addition to the FGF family, potentially playing a significant role in cardiovascular disease, particularly atherosclerosis. A statistically significant difference was seen in the serum FGF21 levels between the case and control groups, indicating that it can help in the diagnosis of CAD. However, there was no apparent correlation found between the serum FGF21 levels and the SYNTAX and Gensini scores. The role of FGF21 in the development of atherosclerosis and whether FGF21 could serve as a reliable marker need to be studied further.
Collapse
Affiliation(s)
- Seema R Sinha
- Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Prem Prakash
- General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - J R Keshari
- Biochemistery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Ravi V Prasad
- Cardiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| |
Collapse
|
3
|
Peker T, Boyraz B. Short-Term Prognostic Value of the Culprit-SYNTAX Score in Patients with Acute Myocardial Infarction. J Cardiovasc Dev Dis 2023; 10:270. [PMID: 37504526 PMCID: PMC10380831 DOI: 10.3390/jcdd10070270] [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: 05/22/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The SYNergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score is a scoring system that helps to decide on surgery or percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI), and studies are showing the prognostic value of this scoring system in both AMI and coronary artery disease patients undergoing PCI. In acute coronary syndrome (ACS) patients, the infarct-related artery and the complexity of the lesions are also important in terms of mortality and morbidity. Our study aimed to determine the prognostic value of the culprit vessel's SYNTAX score (cul-SS) in patients presenting with MI. METHODS In our study, 1284 patients presenting with MI were analyzed retrospectively. The SYNTAX scores and cul-SS of the patients were calculated. In-hospital and 30-day deaths and major complications were accepted as primary outcomes. The SYNTAX scores and cul-SS were compared in terms of predicting primary outcomes. CONCLUSIONS Major complications were observed in 36 (2.8%) patients, death in 42 (3.3%) patients, and stent thrombosis in 24 (1.9%) patients. The area under the curves for SYNTAX and cul-SS for predicting primary outcomes is 0.64 and 0.68 (p = 0.026), respectively. Cul-SS was as successful as the SYNTAX score in predicting stent thrombosis and was superior in predicting short-term death and major complications.
Collapse
Affiliation(s)
- Tezcan Peker
- Cardiology Department, Health Sciences Faculty, Medicalpark Hospital, Mudanya University, Bursa 16200, Turkey
| | - Bedrettin Boyraz
- Cardiology Department, Health Sciences Faculty, Medicalpark Hospital, Mudanya University, Bursa 16200, Turkey
| |
Collapse
|
4
|
Relationship between the triglyceride-glucose index and the SYNTAX score 2 in patients with non-ST elevation myocardial infarction. Cardiovasc Endocrinol Metab 2023; 12:e0277. [PMID: 36699193 PMCID: PMC9829247 DOI: 10.1097/xce.0000000000000277] [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: 08/09/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023]
Abstract
We evaluated if admissiontriglyceride-glucose index (TyG index) correlated with the anatomical synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score 2 in non-ST elevation myocardial infarction (NSTEMI), nondiabetic patients. Methods SYNTAX score 2 (SSII) was retrospectively evaluated in 260 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. The TyG index was calculated using the following equation: log [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. Results The average age of the patients was 57.2 ± 10.9 years; 135 patients (52.2%) were males. The average TyG index was 8.68 ± 0.12, and SSII was 18.9 ± 9.9. A moderate correlation was found between TyG index and SSII (r = 0.347; P < 0.001) and TyG index was independent risk factors for SSII high [odds ratio (OR), 6.0; 95% CI, 2.7-17.0; P < 0.001]. Conclusion In nondiabetic patients with NSTEMI, TyG index correlated with the SSII.
Collapse
|
5
|
Boyraz B, Peker T. Comparison of SYNTAX and Gensini Scores in the Decision of Surgery or Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease. Cureus 2022; 14:e22482. [PMID: 35345715 PMCID: PMC8942066 DOI: 10.7759/cureus.22482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Many scoring systems have been developed to determine the extent of coronary artery disease (CAD) in patients with multi-vessel disease. The most widely used of these are Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and Gensini scoring. Gensini scoring system can successfully show coronary plaque burden. In our study, we aimed to test the predictive power of SYNTAX and Gensini scores for surgical or percutaneous intervention decisions made by the cardiac team in patients with three-vessel disease. Methods: A total of 476 patients without ST-elevation myocardial infarction with the three-vessel disease were included in the study. SYNTAX and Gensini scores of the patients were calculated from their coronary angiographies. Receiver operating characteristic curve (ROC-curve) analysis was performed using both scores. Results: Both the SYNTAX score and Gensini score were able to predict heart team decisions (AUC: 0.759, 0.680; p<0.001). Diabetes and smoking were more common in patients who were decided to have surgery (p<0.001). Conclusion: In the light of our study results, the decisions to be made with the SYNTAX score will be closer to the decisions of the heart team than the Gensini score.
Collapse
|
6
|
Stephan T, Thoma E, Rattka M, Felbel D, Buckert D, Rottbauer W, Gonska B, Markovic S. Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement. BMC Cardiovasc Disord 2021; 21:568. [PMID: 34847875 PMCID: PMC8638523 DOI: 10.1186/s12872-021-02374-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The aim of the study was to analyze the impact of concomitant coronary artery disease (CAD) assessed by the SYNTAX score (SS) and periprocedural percutaneous coronary intervention (PCI) on outcomes after transcatheter aortic valve replacement (TAVR). Background Due to controversial data regarding the effect of CAD on outcomes after TAVR, proper revascularization strategies remain a matter of debate. Methods 553 patients with severe aortic stenosis undergoing TAVR were included in this study. SS was calculated for each patient at baseline and after PCI. Primary outcome was one-year all-cause mortality. Results 60.2% of patients (N = 333) exhibited CAD with a mean SS of 10.8 ± 8.8. Of those, 120 patients (36.0%) received periprocedural PCI. In the treatment group, mean SS was decreased from 14.9 ± 9.1 to 6.3 ± 6.7. Patients with concomitant CAD suffered more frequently from myocardial infarction (MI) post TAVR compared to those without CAD (2.1% vs. 0.0%; P < 0.01). In the CAD cohort, MI rates were comparable between patients with and without PCI (2.2% vs. 2.5%; P = 0.71). Regarding SS, patients with a residual SS < 8 showed significant lower rates of one-year mortality (9.0% vs. 18.2%; P = 0.016) and MACCE (16.5% vs. 32.2%; P = 0.001). Besides left bundle brunch, predictors for an increased one-year mortality were a residual SS ≥ 8 in the CAD group (OR = 3.17; P = 0.011) and a EuroSCORE ≥ 4% in the entire study population (OR = 2.18; P = 0.017). Conclusion Our results suggest that a residual SS-guided revascularization strategy may improve prognosis after TAVR in patients with concomitant CAD. PCI aiming for a residual SS < 8 was associated with improved one-year clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02374-y.
Collapse
Affiliation(s)
- Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Eva Thoma
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Manuel Rattka
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Birgid Gonska
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| |
Collapse
|
7
|
Gao J, Wang J, Zhao LL, Yao TT, Chen Y, Ma J, Zhang X, Wang JX, Wang Y, Cui Z, Liu Y. Gut Lactobacillus Level Is a Predictive Marker for Coronary Atherosclerotic Lesions Progress and Prognosis in Patients With Acute Coronary Syndrome. Front Cell Infect Microbiol 2021; 11:687827. [PMID: 34557424 PMCID: PMC8452980 DOI: 10.3389/fcimb.2021.687827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Gut microbiota dysbiosis can contribute to the progression of atherosclerosis. We investigated the association of the gut microbiota and the severity of coronary artery lesions and prognosis of patients with ACS. Methods In this case-control study, 402 ACS patients and 100 controls were enrolled from June 2017 to December 2018. The number of bacterial species was determined by real-time PCR. A SYNTAX score was calculated for all ACS patients based on their coronary angiography results. Results Compared with the healthy controls, the gut microbial levels in Escherichia coli, Streptococcus, and Enterobacteriaceae were significantly increased in ACS patients, while the Lactobacillus level was significantly decreased. Lactobacillus level was as an independent predictor of disease severity on the coronary angiography [high vs. low SYNTAX score: adjusted odds ratio (aOR) = 0.024, 95% confidence interval (CI): 0.004-0.155] and myocardial necrosis [high vs. low cardiac troponin T (cTNT): aOR = 0.317, 95% CI: 0.099-0.914]. Subsequently, a higher Lactobacillus level was associated with a lower risk of an all-cause death [adjusted hazard ratio (aHR) = 0.239; 95% CI: 0.093-0.617] and major adverse cardiac events (MACE) in ACS patients (aHR = 0.208; 95% CI: 0.081-0.531). After stratifying by the type of ACS, a higher Lactobacillus level was significantly associated with the decreased risks of high SYNTAX score, all-cause death, and MACE in the STEMI subgroup but not in the NSTEMI and UAP subgroups. Conclusions Lower Lactobacillus levels may indicate a higher risk of a more severe coronary atherosclerotic lesions and myocardial necrosis and worse prognosis for patients with ACS, particularly in the STEMI subgroup.
Collapse
Affiliation(s)
- Jing Gao
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
- Chest Hospital, Tianjin University, Tianjin, China
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Jie Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Li-Li Zhao
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Ting-Ting Yao
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yang Chen
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Ma
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Xu Zhang
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Jing-Xian Wang
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yin Liu
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| |
Collapse
|
8
|
Gao J, Yang YN, Cui Z, Feng SY, Ma J, Li CP, Liu Y. Pcsk9 is associated with severity of coronary artery lesions in male patients with premature myocardial infarction. Lipids Health Dis 2021; 20:56. [PMID: 34044829 PMCID: PMC8161665 DOI: 10.1186/s12944-021-01478-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Proprotein convertase subtilisin/kexin type 9 (Pcsk9) correlated with incidence and prognosis of coronary heart disease. However, it is unclear whether Pcsk9 contributed to coronary artery lesion severity in patients with premature myocardial infarction (PMI). The present study investigated associations between Pcsk9 and coronary artery lesion severity in PMI patients who underwent coronary angiography (CAG). METHODS This prospective cohort study included young men (age ≤ 45 years, n = 332) with acute MI who underwent CAG between January 2017 and July 2019. Serum Pcsk9 levels and clinical characteristics were evaluated. SYNTAX scores (SYNergy between percutaneous coronary intervention with [paclitaxel-eluting] TAXUS stent and cardiac surgery) were calculated to quantify coronary artery lesions. RESULTS Serum Pcsk9 levels were positively associated with SYNTAX scores (r = 0.173, P < 0.05). The diagnostic cutoff value of PSCK9 level was 122.9 ng/mL, yielding an area under the curve (AUC) of 0.63, sensitivity 81%, and specificity 40%. Serum Pcsk9, LDL-C, Apob, NT-proBnp, CK level, and diabetes history were independent predictors of high SYNTAX scores (P < 0.05). After stratifying by serum LDL-C level (cutoff = 2.6 mmol/L), medium-high Pcsk9 levels had increased risk of high SYNTAX scores in patients with high LDL-C (P < 0.05), and higher serum Pcsk9 levels had increased risk of major adverse cardiac events (MACE) after adjusting for confounding factors (P < 0.05). CONCLUSION Serum Pcsk9 levels correlates with severity of coronary artery lesion in PMI patients and may serve as a biomarker for severity of coronary artery stenosis in this patient population, which may contribute to risk stratification.
Collapse
Affiliation(s)
- Jing Gao
- Chest Hospital, Tianjin University, No.92 Weijin Road Nankai District, Tianjin, 300072, P.R. China
- Thoracic Clinical College, Tianjin Medical University, No.22 Qi xiang tai Road, Heping District, Tianjin, 300070, P.R. China
- Cardiovascular Institute, Tianjin Chest Hospital, No.261 Tai erzhuang Road, Jinnan District, Tianjin, 300222, P.R. China
| | - Ya-Nan Yang
- Tianjin Medical University, No.22 Qi xiangtai Road, Heping District, Tianjin, 300070, P.R. China
| | - Zhuang Cui
- Tianjin Medical University, No.22 Qi xiangtai Road, Heping District, Tianjin, 300070, P.R. China
| | - Si-Yuan Feng
- Tianjin Medical University, No.22 Qi xiangtai Road, Heping District, Tianjin, 300070, P.R. China
| | - Jing Ma
- Cardiovascular Institute, Tianjin Chest Hospital, No.261 Tai erzhuang Road, Jinnan District, Tianjin, 300222, P.R. China
| | - Chang-Ping Li
- Tianjin Medical University, No.22 Qi xiangtai Road, Heping District, Tianjin, 300070, P.R. China.
| | - Yin Liu
- Thoracic Clinical College, Tianjin Medical University, No.22 Qi xiang tai Road, Heping District, Tianjin, 300070, P.R. China.
- Department of Cardiology, Tianjin Chest Hospital, No.261 Tai erzhuang Road, Jinnan District, Tianjin, 300222, P.R. China.
| |
Collapse
|
9
|
Kilic A, Baydar O. Relationship Between Fasting Glucose, HbA 1c Levels, and the SYNTAX Score 2 in Patients With Non-ST-Elevation Myocardial Infarction. Angiology 2021; 73:177-181. [PMID: 33960202 DOI: 10.1177/00033197211014678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We evaluated if admission glycosylated hemoglobin (HbA1c) and fasting glucose levels are correlated with the severity of coronary artery disease (CAD) in non-ST-elevation myocardial infarction (NSTEMI), nondiabetic, patients. Coronary artery disease severity, according to the anatomical synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery (SYNTAX) score 2 (SSII), was retrospectively evaluated in 359 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. Glucose intolerance was assessed by serum fasting glucose and HbA1c levels. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. The average age of the patients was 57.1 ± 10.9 years; 189 (52.1%) patients were males. The average fasting glucose was 114 ± 52 mg/dL, HbA1c was 5.8% ± 0.9%, and SSII was 18.9 ± 10.3. A stronger correlation was found between HbA1c and SSII than fasting glucose and SSII (r1 = 0.901, P < .001, r2 = 0.378, P < .001, respectively), and HbA1c level and hypertension were independent risk factors for SSII high (odds ratio [OR]: 2.2 (95% CI: 0.5-9.0, P < .001; OR: 1.1 (1.0-1.3), P = .007, respectively). In conclusion, in nondiabetic patients with NSTEMI, HbA1c levels correlated with CAD severity as measured by the SSII.
Collapse
Affiliation(s)
- Alparslan Kilic
- Department of Cardiology, 52979Koc University Hospital, Istanbul, Turkey
| | - Onur Baydar
- Department of Cardiology, 52979Koc University Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
Zhang B, Li D, Liu G, Tan W, Zhang G, Liao J. Impaired activity of circulating EPCs and endothelial function are associated with increased Syntax score in patients with coronary artery disease. Mol Med Rep 2021; 23:321. [PMID: 33760184 PMCID: PMC7974324 DOI: 10.3892/mmr.2021.11960] [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: 02/24/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
It has previously been shown that the number of endothelial progenitor cells (EPCs) is negatively correlated with Syntax score in patients with coronary artery disease (CAD). However, the association between alterations in EPC function and Syntax score is still unknown. The present study evaluated the association between the activity of EPCs as well as endothelial function and Syntax score in patients with CAD and investigated the underlying mechanisms. A total of 60 patients with CAD were enrolled in 3 groups according to Syntax score, and 20 healthy subjects were recruited as the control group. The number and migratory, proliferative and adhesive activities of circulating EPCs were studied. The endothelial function was measured by flow-mediated dilatation (FMD) and the levels of nitric oxide (NO) in plasma or secreted by EPCs were detected. The number and activity of circulating EPCs were lower in patients with a high Syntax score, which was similar to the alteration in FMD. The level of NO in plasma or secreted by EPCs also decreased as Syntax score increased. There was a negative association between FMD or circulating EPCs and Syntax score. A similar association was observed between the levels of NO in plasma or secreted by EPCs and Syntax score. Patients with CAD who had a higher Syntax score exhibited lower EPC numbers or activity and weaker endothelial function, which may be associated with attenuated NO production. These findings provide novel surrogate parameters for evaluation of the severity and complexity of CAD.
Collapse
Affiliation(s)
- Bin Zhang
- Department of Cardiovascular Disease, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat‑Sen University, Jiangmen, Guangdong 529030, P.R. China
| | - Dong Li
- Clinical Experimental Center, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat‑Sen University, Jiangmen, Guangdong 529030, P.R. China
| | - Gexiu Liu
- Institute of Hematology, Medical College, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Wenfeng Tan
- Department of Cardiovascular Disease, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat‑Sen University, Jiangmen, Guangdong 529030, P.R. China
| | - Gaoxing Zhang
- Department of Cardiovascular Disease, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat‑Sen University, Jiangmen, Guangdong 529030, P.R. China
| | - Jinli Liao
- Division of Emergency Medicine, Department of General Internal Medicine, Department of Emergency Intensive Care Unit, The First Affiliated Hospital, Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
| |
Collapse
|
11
|
Viana MS, Correia VCA, Ferreira FM, Lacerda YF, Bagano GO, Fonseca LL, Kertzman LQ, Melo MV, Noya-Rabelo MM, Correia LCL. Prognostic Contrast between Anatomical and Clinical Models Regarding Fatal and Non-Fatal Outcomes in Acute Coronary Syndromes. Arq Bras Cardiol 2020; 115:219-225. [PMID: 32876188 PMCID: PMC8384280 DOI: 10.36660/abc.20190062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Recurrent ischemic events are mediated by atherosclerotic plaque instability, whereas death after an ischemic event results from gravity of insult and ability of the organism to adapt. The distinct nature of those types of events may respond for different prediction properties of clinical and anatomical information regarding type of outcome. OBJECTIVE To identify prognostic properties of clinical and anatomical data in respect of fatal and non-fatal outcomes of patients hospitalized with acute coronary syndromes (ACS). METHODS Patients consecutively admitted with ACS who underwent coronary angiography were recruited. The SYNTAX score was utilized as an anatomic model and the GRACE score as a clinical model. The predictive capacity of those scores was separately evaluated for prediction of non-fatal ischemic outcomes (infarction and refractory angina) and cardiovascular death during hospitalization. It was considered as significant a p-value <0,05. RESULTS EAmong 365 people, cardiovascular death was observed in 4,4% and incidence of non-fatal ischemic outcomes in 11%. For cardiovascular death, SYNTAX and GRACE score presented similar C-statistic of 0,80 (95% IC: 0,70 - 0,92) and 0,89 (95% IC 0,81 - 0,96), respectively - p = 0,19. As for non-fatal ischemic outcomes, the SYNTAX score presented a moderate predictive value (C-statistic = 0,64; 95%IC 0,55 - 0,73), whereas the GRACE score did not presented association with this type of outcome (C-statistic = 0,50; 95%IC 0,40-0,61) - p = 0,027. CONCLUSION Clinical and anatomic models similarly predict cardiovascular death in ACS. However, recurrence of coronary instability is better predicted by anatomic variables than clinical data. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
Collapse
Affiliation(s)
- Mateus S Viana
- Escola Bahiana de Medicina e Saúde Pública,Salvador, BA - Brasil
| | | | | | - Yasmin F Lacerda
- Escola Bahiana de Medicina e Saúde Pública,Salvador, BA - Brasil
| | | | | | - Lara Q Kertzman
- Escola Bahiana de Medicina e Saúde Pública,Salvador, BA - Brasil
| | - Milton V Melo
- Escola Bahiana de Medicina e Saúde Pública,Salvador, BA - Brasil
| | | | - Luis C L Correia
- Escola Bahiana de Medicina e Saúde Pública,Salvador, BA - Brasil
| |
Collapse
|
12
|
Gkaliagkousi E, Gavriilaki E, Yiannaki E, Vasileiadis I, Nikolaidou B, Lazaridis A, Dolgyras P, Grigoriadis S, Triantafyllou A, Anyfanti P, Markala D, Zarifis I, Douma S. Platelet microvesicles are associated with the severity of coronary artery disease: comparison between peripheral and coronary circulation. J Thromb Thrombolysis 2020; 51:1138-1143. [PMID: 33043416 DOI: 10.1007/s11239-020-02302-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 01/13/2023]
Abstract
Microvesicles (MVs) have recently emerged as markers of thrombosis. Furthermore, there is an unexplained residual thrombotic risk is observed in patients with acute coronary syndrome (ACS) and/or stable coronary artery disease (CAD), despite treatment. We measured platelet (PMVs) and erythrocyte (ErMVs) in patients with ACS and stable CAD, both in the peripheral and coronary circulation. We studied consecutive eligible patients during a coronary angiography. Blood samples were collected from the stem of the left coronary artery and femoral artery. PMVs were significantly increased in CAD patients compared to controls. ACS patients had also increased PMVs in coronary and peripheral circulation, compared to controls. Furthermore, ACS patients exhibited increased PMVs in coronary compared to peripheral circulation. Lastly, coronary PMVs were associated with the severity of CAD based on the SYNTAX score. No significant differences were observed in the levels of ErMVs among groups. Therefore, PMVs emerge as novel markers of thrombosis in CAD, further augmenting the vicious cycle of inflammation and thrombosis during ACS. Importantly, coronary PMVs may reflect the severity of CAD in this population.
Collapse
Affiliation(s)
- E Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - E Gavriilaki
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Yiannaki
- Hematology Laboratory, Theagenion Cancer Center, Thessaloniki, Greece
| | - I Vasileiadis
- Cardiology Department, G Papanicolaou Hospital, Thessaloniki, Greece
| | - B Nikolaidou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Lazaridis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Dolgyras
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Grigoriadis
- Cardiology Department, General Hospital of Veria, Veria, Greece
| | - A Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Markala
- Hematology Laboratory, Theagenion Cancer Center, Thessaloniki, Greece
| | - I Zarifis
- Cardiology Department, G Papanicolaou Hospital, Thessaloniki, Greece
| | - S Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
13
|
Wang X, Wang Z, Li B, Yang P. Prognosis evaluation of universal acute coronary syndrome: the interplay between SYNTAX score and ApoB/ApoA1. BMC Cardiovasc Disord 2020; 20:293. [PMID: 32539722 PMCID: PMC7294645 DOI: 10.1186/s12872-020-01562-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/01/2020] [Indexed: 02/08/2023] Open
Abstract
Background Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. SYNTAX and SYNTAX II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNTAX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method Three hundred ninety-six patients with ACS undergoing percutaneous coronary intervention(PCI)and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during the next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results ① Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium/high risk group (p = 0.011). Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group (p = 0.032). ② Compared with SYNTAX II low-risk group, cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group (p = 0.001, p<0.001 respectively). ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group (p = 0.019, p = 0.023 respectively). ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group (p = 0.023, p = 0.044 respectively). ⑤ Logistic regression analysis showed that apoB/apoA1 was an independent predictor of MACCE events in hospital and 5 years (p = 0.038, p = 0.016 respectively), SYNTAX score was an independent predictor of MACCE events in 1 year (medium-risk group: p = 0.02; high-risk group: p = 0.015) SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs (p = 0.003). Conclusions ① SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.
Collapse
Affiliation(s)
- Xiaotong Wang
- Department of Cardiology, China-Japan Union hospital of Jilin university, 126 Xiantai Street, Changchun, 130031, China
| | - Zhongyu Wang
- Department of Cardiology, China-Japan Union hospital of Jilin university, 126 Xiantai Street, Changchun, 130031, China
| | - Bing Li
- Department of Cardiology, China-Japan Union hospital of Jilin university, 126 Xiantai Street, Changchun, 130031, China.
| | - Ping Yang
- Department of Cardiology, China-Japan Union hospital of Jilin university, 126 Xiantai Street, Changchun, 130031, China
| |
Collapse
|
14
|
Kul S, Konus AH, Dursun I, Turan T, Cirakoglu OF, Sahin S, Karal H, Akyuz AR. Anterior Tragal Crease Is Associated With SYNTAX Score in Non-ST-Segment Elevation Myocardial Infarction. Angiology 2020; 71:793-798. [PMID: 32347104 DOI: 10.1177/0003319720920143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The main aim of this study was to investigate the relation between anterior tragal crease (ATC) and coronary artery lesion complexity and severity assessed using the SYNTAX score (SXscore) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total of 121 patients with a first-time diagnosis of NSTEMI were consecutively enrolled. ATC was defined as ≥1 crease that was close to the tragus and descended anteriorly. SXscore was calculated using the SXscore algorithm. The SXscore was higher in the ATC-positive group than in the ATC-negative group (11.85 ± 8.20 vs 7.52 ± 6.38, P = .003). In the univariate analysis, hemoglobin (male: 11.7-17.4 g/dL, female: 11.7-16.1 g/dL; P = .006), diabetes mellitus (P = .031), current smoking (P = .022), and presence of ATC (P = .022) were significantly associated with increased SXscore. Multivariate analysis revealed ATC (95% confidence interval [CI]: 1.313-7.800, P = .011), current smoking (95% CI: 2.034-13.893, P = .001), and hemoglobin (95% CI: 0.433-0.822, P = .002) as independent determinants of increased SXscore. Anterior tragal crease is easily detected by physical examination. Presence of ATC in patients with NSTEMI may be a warning signal of complexity and severity of coronary artery disease (CAD).
Collapse
Affiliation(s)
- Selim Kul
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ali Hakan Konus
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ihsan Dursun
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Turhan Turan
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Omer Faruk Cirakoglu
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Sinan Sahin
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Huseyin Karal
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| | - Ali Riza Akyuz
- Department of Cardiology, Saglik Bilimleri Universitesi, University of Health Sciences, 420101Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Turkey
| |
Collapse
|
15
|
An investigation into hemodynamically significant coronary artery lesions predictors assessed by fractional flow reserve: A propensity score matching analysis. North Clin Istanb 2020; 7:35-39. [PMID: 32232201 PMCID: PMC7103741 DOI: 10.14744/nci.2019.79058] [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: 07/16/2018] [Accepted: 02/26/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Fractional flow reserve (FFR) provides more useful information regarding myocardial metabolism and demand-supply convenience as compared to anatomical measurements. In this study, we aimed to investigate FFR predictors after propensity score matching (PSM) analysis in patients with intermediate coronary lesions. METHODS Patients who underwent coronary angiography between January 2014 and March 2015 due to suspicion of coronary artery disease were included in this study. Patients were divided into two groups according to the FFR status and predictors of FFR before and after PSM analysis were investigated. RESULTS A total of 290 patients (a total of 310 lesions) were included in this study (61±12 years, 75.5% male). In univariate analysis, after PSM analysis, Diameter stenosis (DS) and proximal LAD lesion (PLL) were associated with lower FFR values. CONCLUSION This study indicated that the majority of traditional FFR predictors did not reach the limit of significance after PSM analysis and we suggest that DS and PLL are one step ahead of predicting lesion severity compared to other traditional risk factors.
Collapse
|
16
|
Modolo R, Chichareon P, van Klaveren D, Dressler O, Zhang Y, Sabik JF, Onuma Y, Kappetein AP, Stone GW, Serruys PW. Impact of non-respect of SYNTAX score II recommendation for surgery in patients with left main coronary artery disease treated by percutaneous coronary intervention: an EXCEL substudy. Eur J Cardiothorac Surg 2020; 57:676-683. [PMID: 31620778 DOI: 10.1093/ejcts/ezz274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The SYNTAX score II (SSII) was developed from the SYNTAX trial to predict the 4-year all-cause mortality after left main or multivessel disease revascularization and to facilitate the decision-making process. The SSII provides the following treatment recommendations: (i) coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) (equipoise risk), (ii) CABG preferred (excessive risk for PCI) or (iii) PCI preferred (excessive risk for CABG). We sought to externally validate SSII and to investigate the impact of not abiding by the SSII recommendations in the randomized EXCEL trial of PCI versus CABG for left main disease. METHODS The calibration plot of predicted versus observed 4-year mortality was constructed from individual values of SSII in EXCEL. To assess overestimation versus underestimation of predicted mortality risk, an optimal fit regression line with slope and intercept was determined. Prospective treatment recommendations based on SSII were compared with actual treatments and all-cause mortality at 4 years. RESULTS SSII variables were available from EXCEL trial in 1807/1905 (95%) patients. For the entire cohort, discrimination was possibly helpful (C statistic = 0.670). SSII-predicted all-cause mortality at 4 years overestimated the observed mortality, particularly in the highest-risk percentiles, as confirmed by the fit regression line [intercept 2.37 (1.51-3.24), P = 0.003; slope 0.67 (0.61-0.74), P < 0.001]. When the SSII-recommended treatment was CABG, randomized EXCEL patients treated with PCI had a trend towards higher mortality compared with those treated with CABG (14.1% vs 5.3%, P = 0.07) in the as-treat population. In the intention-to-treat population, patients randomized to PCI had higher mortality compared with those randomized to CABG (15.1% vs 4.1%, P = 0.02), when SSII recommended CABG. CONCLUSIONS In the EXCEL trial of patients with left main disease, the SSII-predicted 4-year mortality overestimated the 4-year observed mortality with a possibly helpful discrimination. Non-compliance with SSII CABG treatment recommendations (i.e. randomized to PCI) was associated with higher 4-year all-cause mortality.
Collapse
Affiliation(s)
- Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - David van Klaveren
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, Cleveland, OH, USA
| | - Yoshinobu Onuma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, Netherlands
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | |
Collapse
|
17
|
Landt M, Abdelghani M, Hemetsberger R, Mankerious N, Allali A, Toelg R, Richardt G, Abdel-Wahab M. Impact of Revascularization Completeness on Outcomes of Patients with Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1628378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Martin Landt
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
- The Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Ralph Toelg
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- The Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| |
Collapse
|
18
|
Esper RB, Farkouh ME, Ribeiro EE, Hueb W, Domanski M, Hamza TH, Siami FS, Godoy LC, Mathew V, French J, Fuster V. SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial. J Am Coll Cardiol 2018; 72:2826-2837. [DOI: 10.1016/j.jacc.2018.09.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
|
19
|
Prognostic Value of SYNTAX Score II in Patients with Acute Coronary Syndromes Referred for Invasive Management: A Subanalysis from the SPUM and COMFORTABLE AMI Cohorts. Cardiol Res Pract 2018; 2018:9762176. [PMID: 30356345 PMCID: PMC6176297 DOI: 10.1155/2018/9762176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/12/2018] [Indexed: 11/17/2022] Open
Abstract
Aims To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention. Methods and results SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSIILow ≤21.5 (n=245), SxSIIMid 21.5–30.6 (n=245), and SxSIIHigh ≥30.6 (n=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77–0.84, p < 0.001 versus 0.67, 95% CI 0.63–0.72, p=0.007 versus 0.69, 95% CI 0.6–0.8, p=0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96–1.07), p=0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06–1.11), p < 0.001). This was also true for the prediction of both secondary outcomes MACE (n=60) and MACCE (n=70) with an adjusted HR = 1.055, 95% CI (1.03–1.08), p < 0.001, and HR = 1.065, 95% CI (1.04–1.09), p < 0.001. Conclusion In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.
Collapse
|
20
|
Pillai AA, Gousy V S, Kottyath H, Satheesh S, Selvaraj R, Jayaraman B. Long-term outcomes following left main bifurcation stenting in Indian population-Analysis based on SYNTAX I and II scores. Indian Heart J 2018; 70:394-398. [PMID: 29961456 PMCID: PMC6034007 DOI: 10.1016/j.ihj.2017.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/18/2017] [Accepted: 08/22/2017] [Indexed: 11/26/2022] Open
Abstract
Background Syntax 1 and recently Syntax 2 (SS2) scores are validated risk prediction models in coronary disease. Objectives To find out the long term outcomes following stenting for unprotected left main bifurcation disease (LMD) and to validate and compare the performance of the SYNTAX scores 1 and 2 (SS1 and SS2 PCI) for predicting major adverse cardiac events (MACE) in Indian population. Methods Single-center, retrospective, observational study involving patients who underwent percutaneous coronary intervention (PCI) with at least one stent implanted for the LMD. Discrimination and calibration models were assessed by ROC curve and the Hosmer-Lemeshow test. Results Data of 103 patients were analyzed. The mean SS1 and SS2 scores were 27.9 and 30.7 and MACE was 16.5% at 4 years. The target lesion revascularization (TLR) rate at 4 years was 11(10.7%). There were 4 deaths (3.8%). The mean left ventricular ejection fraction (LVEF) was the only variable in SS2, which predicted cardiac events. ROC curve analysis showed both models to be accurate in predicting TLR and mortality following LM PCI. SS2 score showed a better risk prediction than SSI with AUC for TLR (SSI 0.560 and SS2PCI 0.625) and AUC for mortality (SS1 0.674 and SS2PCI 0.833). Hosmer-Lemeshow test validated the accuracy of both the risk models in predicting the events. Conclusions Both risk models were applicable for Indian patients. The SS2 score was a better predictor for mortality and TLR. In the SS2 score, the LVEF was the most useful predictor of events after LM PCI.
Collapse
|
21
|
Lin T, Wang L, Guo J, Liu P, Chen L, Wei M, Li G. Association Between Serum LDL-C and ApoB and SYNTAX Score in Patients With Stable Coronary Artery Disease. Angiology 2018; 69:724-729. [PMID: 29310455 DOI: 10.1177/0003319717748771] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine the relationship between low-density lipoprotein cholesterol (LDL-C) and apolipoprotein (Apo) B levels and the SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score (SS) in patients with stable angina pectoris. We enrolled 594 patients who were suspected to have coronary heart disease (CHD) and who underwent coronary angiography. Patients were divided into 4 groups based on the SS: normal (SS = 0, n = 154), low SS (SS ≤ 22, n = 210), intermediate SS (22 < SS < 32, n = 122), and high SS (SS ≥ 33, n = 63). Positive correlations between lipoprotein (a), LDL-C, ApoB, total cholesterol, and SS were significant ( r = 0.132, 0.632, 0.599, and 0.313, respectively; P < .01), whereas high-density lipoprotein cholesterol (HDL-C), ApoA1, and ApoA1/ApoB levels showed a significant negative correlation ( r = -0.29, -0.344, and -0.561, respectively; P < .01). Multivariate linear regression analysis revealed that LDL-C, ApoB, ApoA1/ApoB, fibrinogen (Fg), and HDL-C levels had an effect on SS (standardized regression coefficients were 0.41, 0.29, -0.12, 0.08, and -0.09, respectively; P < .05). In conclusion, LDL-C, ApoB, ApoA1/ApoB, Fg, and HDL-C levels affected the SS and were predictors of CHD complexity.
Collapse
Affiliation(s)
- Taiwu Lin
- 1 Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Luzhao Wang
- 2 Department of Cardiology, Hanzhong Central Hospital, Hanzhong, China
| | - Jingbin Guo
- 1 Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Liu
- 1 Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Liheng Chen
- 1 Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mengqiu Wei
- 1 Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Gongxin Li
- 1 Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
22
|
Park SD, Bae KH, Choi YK, Jeon JH, Seo JB, Kim N, Kim CY, Kim SW, Lee WK, Kim JG, Lee IK, Lee JH, Park KG. Relationship between Circulating FGF21 Concentrations and the Severity of Coronary Artery Damage in Subjects with Cardiovascular Disease. J Lipid Atheroscler 2018. [DOI: 10.12997/jla.2018.7.1.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sung Don Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kwi-Hyun Bae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeon-Kyung Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Han Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Beom Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Namkyun Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Chang-Yeon Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Sung Woo Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Won Kee Lee
- Biostatistics Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Guk Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - In-Kyu Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Keun-Gyu Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
23
|
Viana MDS, Lopes F, Cerqueira Junior AMDS, Suerdieck JG, Silva ABD, Silva ACBD, Souza TMBD, Carvalhal MC, Rabelo MMN, Correia LCL. Incremental Prognostic Value of the Incorporation of Clinical Data Into Coronary Anatomy Data in Acute Coronary Syndromes: SYNTAX-GRACE Score. Arq Bras Cardiol 2017; 109:527-532. [PMID: 29160388 PMCID: PMC5783433 DOI: 10.5935/abc.20170160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background When performing coronary angiography in patients with acute coronary syndrome
(ACS), the anatomical extent of coronary disease usually prevails in the
prognostic reasoning. It has not yet been proven if clinical data should be
accounted for in risk stratification together with anatomical data. Objective To test the hypothesis that clinical data increment the prognostic value of
anatomical data in patients with ACS. Methods Patients admitted with objective criteria for ACS and who underwent
angiography during hospitalization were included. Primary outcome was
defined as in-hospital cardiovascular death, and the prognostic value of the
SYNTAX Score (anatomical data) was compared to that of the SYNTAX-GRACE
Score, which resulted from the incorporation of the GRACE Score into the
SYNTAX score. The Integrated Discrimination Improvement (IDI) was calculated
to evaluate the SYNTAX-GRACE Score ability to correctly reclassify
information from the traditional SYNTAX model. Results This study assessed 365 patients (mean age, 64 ± 14 years; 58% male).
In-hospital cardiovascular mortality was 4.4%, and the SYNTAX Score was a
predictor of that outcome with a C-statistic of 0.81 (95% CI: 0.70 - 0.92; p
< 0.001). The GRACE Score was a predictor of in-hospital cardiac death
independently of the SYNTAX Score (p < 0.001, logistic regression). After
incorporation into the predictive model, the GRACE Score increased the
discrimination capacity of the SYNTAX Score from 0.81 to 0.92 (95% CI: 0.87
- 0.96; p = 0.04). Conclusion In patients with ACS, clinical data complement the prognostic value of
coronary anatomy. Risk stratification should be based on the
clinical-anatomical paradigm, rather than on angiographic data only.
Collapse
Affiliation(s)
| | - Fernanda Lopes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | | | | | | | | | | | | | | | - Luis Claudio Lemos Correia
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil.,Hospital São Rafael, Fundação Monte Tabor, Salvador, BA - Brazil
| |
Collapse
|
24
|
Relation of presystolic wave on doppler examination to syntax score in patients with acute myocardial infarction. Int J Cardiovasc Imaging 2017; 34:569-576. [DOI: 10.1007/s10554-017-1270-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/04/2017] [Indexed: 12/14/2022]
|
25
|
Bundhun PK, Bhurtu A, Huang F. Worse clinical outcomes following percutaneous coronary intervention with a high SYNTAX score: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7140. [PMID: 28614240 PMCID: PMC5478325 DOI: 10.1097/md.0000000000007140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) score is an angiographic tool which is used to determine the complexity of coronary artery disease (CAD). We aimed to compare PCI versus coronary artery bypass surgery (CABG) in patients with a high SYNTAX score in order to confirm with evidence whether the former is really association with worse clinical outcomes. METHODS The National database of medical research articles (MEDLINE/PubMed), EMBASE database, and the Cochrane library were searched for publications comparing PCI versus CABG in patients with a high SYNTAX score, respectively. Death, myocardial infarction (MI), stroke, repeated revascularization, and a combined outcome death/stroke/MI were considered as the clinical endpoints. RevMan software was used to analyze the data, whereby odds ratios (OR) with 95% confidence intervals (CI) were used as the statistical parameters. RESULTS A total number of 1074 patients were included (455 patients with a high SYNTAX score were classified in the PCI group and 619 other patients with a high SYNTAX score were classified in the CABG group). A SYNTAX score cut-off value of ≥33 was considered relevant. Compared with CABG, mortality was significantly higher with a high SYNTAX score following PCI with OR: 1.79, 95% CI: 1.18 to 2.70; P = .006, I = 0%. The combined outcome death/stroke/MI was also significantly higher following PCI with a high SYNTAX score, with OR: 1.69, 95% CI: 1.24 to 2.30; P = .0009, I = 0%. In addition, PCI was also associated with significantly higher MI and repeated revascularization when compared with CABG, with OR: 3.72, 95% CI: 1.75 to 7.89; P = .0006, I = 0% and OR: 4.33, 95% CI: 1.71 to 10.94; P = .002, I = 77%, respectively. However, stroke was not significantly different. CONCLUSIONS Compared with CABG, worse clinical outcomes were observed following PCI in patients with a high SYNTAX score, confirming with evidence, published clinical literatures. Therefore, CABG should be recommended to CAD patients who have been allotted a high SYNTAX score.
Collapse
Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University
| | - Akash Bhurtu
- Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Feng Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University
| |
Collapse
|
26
|
Melina G, Angeloni E, Refice S, Monti F, Serdoz R, Rosato S, Seccareccia F, Colivicchi F, Serdoz R, Paneni F, Sinatra R. Clinical SYNTAX score predicts outcomes of patients undergoing coronary artery bypass grafting. Am Heart J 2017; 188:118-126. [PMID: 28577667 DOI: 10.1016/j.ahj.2017.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/22/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The SYNTAX score (SS) is a determinant of outcome in patients undergoing percutaneous coronary intervention. In addition, it has been recently shown that the clinical SYNTAX score (cSS), obtained by adding clinical variables to the SS, improves the predictive power of the resulting risk model. We assessed the hypothesis that the use of the cSS may predict outcomes of patients undergoing coronary artery bypass grafting (CABG). METHODS We measured the SYNTAX score in 874 patients undergoing isolated first time on-pump CABG. The clinical SYNTAX score was calculated at the time of the study using age, creatinine clearance and ejection fraction, the modified ACEF score, and analyses performed for major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality at 3-year follow-up. RESULTS The mean age of the study population was 70.9 ± 8.1 years, and the median cSS 14.2 (range 2.1-286.5). The ROC curve analysis showed that a cSS >14.5 (81.4% sensitivity and 67.8% specificity) was a reliable tool in discrimination of patients for the occurrence of MACCE (AUC 0.78) and all-cause mortality (AUC 0.74). Kaplan-Meier survival analysis confirmed that patients belonging to higher cSS quartiles have poorer 3-year survival (P = .0001) and MACCE-free survival (P = .0001), with respect to those with lower cSS. CONCLUSIONS This observational study has shown that the clinical SYNTAX score, incorporating the lesion-based SS and clinical-based ACEF score, predicted mid-term adverse outcomes of patients undergoing CABG and may play an important role in the risk stratification of this population. Further studies are needed to confirm these findings.
Collapse
|
27
|
He C, Song Y, Wang CS, Yao Y, Tang XF, Zhao XY, Gao RL, Yang YJ, Xu B, Yuan JQ. Prognostic Value of the Clinical SYNTAX Score on 2-Year Outcomes in Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2017; 119:1493-1499. [PMID: 28341359 DOI: 10.1016/j.amjcard.2017.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
This prospective, single-center, observational study evaluated prognostic value of clinical SYNTAX score (CSS) on 2-year outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). The SYNTAX score (SS) is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. However, SS was a sole angiographic grading tool only with no consideration for clinical factors. There are few studies investigating the prognostic value of CSS in patients with ACS who underwent PCI. From January 2013 to December 2013, 6,099 consecutive patients with ACS admitted to FuWai hospital and underwent PCI were enrolled in this study. Based on CSS, patients were divided into low CSS group (CSS ≤ 6.5; 2,012 patients), mid-CSS group (6.5 < CSS < 13.8; 2,056 patients), and high CSS group (CSS ≥ 13.8; 2,031 patients). At 2-year follow-up, rates of cardiac death and major adverse cardiac events (MACE) were significantly higher in the high CSS group. Compared with baseline SS, CSS demonstrated significantly improved performance for 2-year cardiac death (receiver-operating characteristic curve C-statistic: 0.74 vs 0.62, p <0.001) but not for MACE (receiver-operating characteristic curve C-statistic: 0.60 vs 0.59, p = 0.29). By multivariable analysis, the CSS combined with PCI history and hypertension were strong predictors for cardiac death and CSS, intra-aortic balloon pump support, diabetes, and successful PCI were independent predictors for MACE. In conclusion, compared with the anatomic SS, CSS was suitable in risk stratifying and predicting 2-year clinical outcome among ACS population.
Collapse
Affiliation(s)
- Chen He
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuang-Shi Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Fang Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan Zhao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jin-Qing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
28
|
Topcu S, Aksu U, Kalkan K, Gülcü O, Kalayci Karabay A, Aksakal E, Tanboğa İH, Sevimli S. Aortic valve sclerosis is associated with the extent of coronaryartery disease in stable coronary artery disease. Turk J Med Sci 2017; 47:614-620. [PMID: 28425255 DOI: 10.3906/sag-1601-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 10/09/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Aortic valve sclerosis (AVS) is characterized by lipid deposition and calcific infiltration on the edge of aortic leaflets without significant restriction of motion. The SYNTAX Score (SS) is an important method for evaluating coronary artery disease (CAD). Many studies showed that there is an important relation between the SS and undesired cardiac outcomes. In our study, we investigated the correlation between the SS and AVS by including both ACS and stable CAD cases. MATERIALS AND METHODS We enrolled 543 patients with CAD who underwent coronary angiography into this cross-sectional study between September 2013 and September 2014. RESULTS The study population was divided into two groups according to SS values above and below 22. Diabetes mellitus (DM) incidence was greater in the group with high SS values (26.3% vs. 19.2%, P = 0.052.). Left ventricular ejection fraction (LVEF) and glomerular filtration rate were lower. Low-density lipoprotein cholesterol and triglyceride levels were lower while platelet counts were higher. In multivariate analysis, for the stable coronary artery group AVS existence, platelet count, LVEF value, and chronic obstructive pulmonary disease were found as independent predictors. CONCLUSION Our study results demonstrated that AVS is significantly associated with the complexity of CAD, especially in patients with stable CAD. This study provides new information regarding the role of AVS in CAD complexity.
Collapse
Affiliation(s)
- Selim Topcu
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Uğur Aksu
- Department of Cardiology, Kars State Hospital, Kars, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oktay Gülcü
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Arzu Kalayci Karabay
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Turkey
| | - Enbiya Aksakal
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | | | - Serdar Sevimli
- Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| |
Collapse
|
29
|
Collet C, Onuma Y, Miyazaki Y, Morel MA, Serruys PW. Integration of non-invasive functional assessments with anatomical risk stratification in complex coronary artery disease: the non-invasive functional SYNTAX score. Cardiovasc Diagn Ther 2017; 7:151-158. [PMID: 28540210 DOI: 10.21037/cdt.2017.03.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Since the early days of coronary angiography, the extension and severity of coronary artery disease (CAD) have been used for risk stratification. The SYNTAX score objectively characterizes CAD in patients with multivessel disease. Furthermore, recalculating the SYNTAX score by the incorporation of the functional component coronary stenosis (i.e., FFR) increases the discrimination for the risk of adverse events. The calculation of the SYNTAX score derived from non-invasive modalities such as coronary computed tomography angiography (CTA) has emerged as a mean to obtain the SYNTAX score before invasive cardiac catheterization. Likewise, the computation of the non-invasive fractional flow reserve CT (FFRCT) allows for the calculation of the non-invasive functional SYNTAX score. Ultimately, the combination of anatomical and functional evaluations with clinical factors further refines the identification of patients at risk and provides a recommendation for the Heart Team regarding the treatment strategy (i.e., PCI or CABG) based on the predicted 4-year mortality. The purpose of this review is to describe the integration of a novel non-invasive functional coronary assessment with the angiographic risk score in patients with multivessel CAD.
Collapse
Affiliation(s)
- Carlos Collet
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Yosuke Miyazaki
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Patrick W Serruys
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,International Centre for Circulatory Health, NHLI, Imperial College of London, London, UK
| |
Collapse
|
30
|
Andrade WS, Oliveira P, Laydner H, Ferreira EJP, Barreto-Filho JAS. Severity of erectile dysfunction is highly correlated with the syntax score in patients undergoing coronariography. Int Braz J Urol 2017; 42:123-31. [PMID: 27136478 PMCID: PMC4811237 DOI: 10.1590/s1677-5538.ibju.2015.0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 07/17/2015] [Indexed: 12/05/2022] Open
Abstract
Objective To investigate the association between the severity of erectile dysfunction (ED) and coronary artery disease (CAD) in men undergoing coronary angiography for angina or acute myocardial infarct (AMI). Material and Methods We studied 132 males who underwent coronary angiography for first time between January and November 2010. ED severity was assessed by the international index of erectile function (IIEF-5) and CAD severity was assessed by the Syntax score. Patients with CAD (cases) and without CAD (controls) had their IIEF-5 compared. In the group with CAD, their IIEF-5 scores were compared to their Syntax score results. Results We identified 86 patients with and 46 without CAD. The IIEF-5 score of the group without CAD (22.6±0.8) was significantly higher than the group with CAD (12.5±0.5; p<0.0001). In patients without ED, the Syntax score average was 6.3±3.5, while those with moderate or severe ED had a mean Syntax score of 39.0±11.1. After adjustment, ED was independently associated to CAD, with an odds ratio of 40.6 (CI 95%, 14.3-115.3, p<0.0001). The accuracy of the logistic model to correctly identify presence or absence of CAD was 87%, with 92% sensitivity and 78% specificity. The average time that ED was present in patients with CAD was 38.8±2.3 months before coronary symptoms, about twice as high as patients without CAD (18.0±5.1 months). Conclusions ED severity is strongly and independently correlated with CAD complexity, as assessed by the Syntax score in patients undergoing coronariography for evaluation of new onset coronary symptoms.
Collapse
Affiliation(s)
| | - Paulo Oliveira
- Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brasil
| | | | | | | |
Collapse
|
31
|
Paradis JM, White JM, Généreux P, Urena M, Doshi D, Nazif T, Hahn R, George I, Khalique O, Harjai K, Lasalle L, Labbé BM, DeLarochellière R, Doyle D, Dumont É, Mohammadi S, Leon MB, Rodés-Cabau J, Kodali S. Impact of Coronary Artery Disease Severity Assessed With the SYNTAX Score on Outcomes Following Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2017; 6:JAHA.116.005070. [PMID: 28219920 PMCID: PMC5523783 DOI: 10.1161/jaha.116.005070] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR. Methods and Results A total of 377 patients who underwent TAVR in 2 high‐volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0); (2) low SS (SS between 1 and 22); (3) intermediate SS (SS between 23 and 32); and (4) high SS (SS ≥33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (<8 and ≥8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all‐cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all‐cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS ≥8 versus residual SS <8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all‐cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year. Conclusions In our core laboratory–validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.
Collapse
Affiliation(s)
- Jean-Michel Paradis
- Quebec Heart and Lung Institute, Quebec, Canada.,Cardiovascular Research Foundation, New-York, NY
| | | | - Philippe Généreux
- Cardiovascular Research Foundation, New-York, NY.,Hopital du Sacre-Coeur de Montreal, Montreal, Quebec Canada.,Gagnon Cardiovascular Institute Morristown Medical Center, Morristown, New Jersey
| | | | | | - Tamim Nazif
- Cardiovascular Research Foundation, New-York, NY.,Columbia University Medical Center, New-York, NY
| | - Rebecca Hahn
- Cardiovascular Research Foundation, New-York, NY.,Columbia University Medical Center, New-York, NY
| | - Isaac George
- Columbia University Medical Center, New-York, NY
| | | | | | | | | | | | | | - Éric Dumont
- Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New-York, NY.,Columbia University Medical Center, New-York, NY
| | | | - Susheel Kodali
- Cardiovascular Research Foundation, New-York, NY .,Columbia University Medical Center, New-York, NY
| |
Collapse
|
32
|
Cherry-Picking Historical Data to Legitimize Contemporary Practice. J Am Coll Cardiol 2017; 69:404-408. [DOI: 10.1016/j.jacc.2016.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/10/2016] [Indexed: 11/19/2022]
|
33
|
Zhang JX, Dong HZ, Chen BW, Cong HL, Xu J. Characteristics of coronary arterial lesions in patients with coronary heart disease and hypertension. SPRINGERPLUS 2016; 5:1208. [PMID: 27516946 PMCID: PMC4967058 DOI: 10.1186/s40064-016-2828-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022]
Abstract
Objective
The aim of this study was to investigate the correlations between risk factors such as hypertension and the complex degrees of coronary arterial lesions (CAL). Methods We selected 462 patients with coronary heart disease (CHD) with confirmed the stenosis (≥50 %) in at least one major coronary artery on coronary angiography and divided them into the “CHD with hypertension” group (CHD-HT, n = 306) and the CHD group (n = 156). The characteristics of CAL and the occurrence of 2-year postoperative major adverse cardiac cerebrovascular events (MACCE) in the two groups were observed. Results The mean SYNTAX scores (SS) was higher in the CHD-HT group than in the CHD group (P < 0.05). The proportions of complex, calcified, and diffused long lesions in the PCI patients’ target vascular lesions, as well as the total MACCE incidence, were significantly higher in the CHD-HT group than in the CHD group (P < 0.05). Logistic multifactor regression analysis showed that age, male sex, hypertension, diabetes, hyperlipidemia, and previous history of myocardial infarction were positively correlated with the SS (P < 0.05). Conclusions The patients with CHD-HT exhibited complicated and diffused CAL, and arterial hypertension can be considered as a risk factor for the complexity of coronary lesions in patients with ischemic heart disease.
Collapse
Affiliation(s)
- Jing-Xia Zhang
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Hong-Zhi Dong
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Bing-Wei Chen
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Hong-Liang Cong
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| | - Jing Xu
- Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300222 China
| |
Collapse
|
34
|
Neisius U, Koeck T, Mischak H, Rossi SH, Olson E, Carty DM, Dymott JA, Dominiczak AF, Berry C, Oldroyd KG, Delles C. Urine proteomics in the diagnosis of stable angina. BMC Cardiovasc Disord 2016; 16:70. [PMID: 27095611 PMCID: PMC4837614 DOI: 10.1186/s12872-016-0246-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/14/2016] [Indexed: 12/15/2022] Open
Abstract
Background We have previously described a panel of 238 urinary polypeptides specific for established severe coronary artery disease (CAD). Here we studied this polypeptide panel in patients with a wider range of CAD severity. Methods We recruited 60 patients who underwent elective coronary angiography for investigation of stable angina. Patients were selected for either having angiographic evidence of CAD or not (NCA) following coronary angiography (n = 30/30; age, 55 ± 6 vs. 56 ± 7 years, P = 0.539) to cover the extremes of the CAD spectrum. A further 66 patients with severe CAD (age, 64 ± 9 years) prior to surgical coronary revascularization were added for correlation studies. The Gensini score was calculated from coronary angiograms as a measure of CAD severity. Urinary proteomic analyses were performed using capillary electrophoresis coupled online to micro time-of-flight mass spectrometry. The urinary polypeptide pattern was classified using a predefined algorithm and resulting in the CAD238 score, which expresses the pattern quantitatively. Results In the whole cohort of patients with CAD (Gensini score 60 [40; 98]) we found a close correlation between Gensini scores and CAD238 (ρ = 0.465, P < 0.001). After adjustment for age (β = 0.144; P = 0.135) the CAD238 score remained a significant predictor of the Gensini score (β =0.418; P < 0.001). In those with less severe CAD (Gensini score 40 [25; 61]), however, we could not detect a difference in CAD238 compared to patients with NCA (−0.487 ± 0.341 vs. −0.612 ± 0.269, P = 0.119). Conclusions In conclusion the urinary polypeptide CAD238 score is associated with CAD burden and has potential as a new cardiovascular biomarker. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0246-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ulf Neisius
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Thomas Koeck
- mosaiques diagnostics GmbH, Rotenburger Str. 20, 30659, Hannover, Germany
| | - Harald Mischak
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.,mosaiques diagnostics GmbH, Rotenburger Str. 20, 30659, Hannover, Germany
| | - Sabrina H Rossi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Erin Olson
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - David M Carty
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Jane A Dymott
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Anna F Dominiczak
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.,Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Keith G Oldroyd
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.,Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Christian Delles
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
| |
Collapse
|
35
|
Abstract
The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a semiquantitative angiographic score developed to prospectively characterize the disease complexity of the coronary vasculature. With more than 50 validation studies, the SYNTAX score is the most-studied risk model in the setting of percutaneous coronary intervention. In this article, the evolutionary journey of the SYNTAX score is reviewed, with emphasis on its sequential modifications and adaptations, now culminating in the development and validation of the SYNTAX score II.
Collapse
Affiliation(s)
- Davide Capodanno
- Dipartimento Cardio-Toraco-Vasculare, Ferrarotto Hospital, University of Catania, Via Citelli, 6, Catania 95124, Italy.
| |
Collapse
|
36
|
Madeira S, Raposo L, Brito J, Rodrigues R, Gonçalves P, Teles R, Gabriel H, Machado F, Almeida M, Mendes M. Potential Utility of the SYNTAX Score 2 in Patients Undergoing Left Main Angioplasty. Arq Bras Cardiol 2016; 106:270-8. [PMID: 27007223 PMCID: PMC4845699 DOI: 10.5935/abc.20160038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/06/2016] [Indexed: 12/25/2022] Open
Abstract
Background The revascularization strategy of the left main disease is determinant for
clinical outcomes. Objective We sought to 1) validate and compare the performance of the SYNTAX Score 1
and 2 for predicting major cardiovascular events at 4 years in patients who
underwent unprotected left main angioplasty and 2) evaluate the long-term
outcome according to the SYNTAX score 2-recommended revascularization
strategy. Methods We retrospectively studied 132 patients from a single-centre registry who
underwent unprotected left main angioplasty between March 1999 and December
2010. Discrimination and calibration of both models were assessed by ROC
curve analysis, calibration curves and the Hosmer-Lemeshow test. Results Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and
SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI:
0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good
overall adjustment for both models, the SYNTAX Score 2 tended to
underpredict risk. In the 47 patients (36%) who should have undergone
surgery according to the SYNTAX Score 2, event rate was numerically higher
(30% vs. 25%; p=0.54), and for those with a higher difference between the
two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary
artery by-pass graft risk estimation greater than 5.7%), event rate was
almost double (40% vs. 22%; p=0.2). Conclusion The SYNTAX Score 2 may allow a better and individualized risk stratification
of patients who need revascularization of an unprotected left main coronary
artery. Prospective studies are needed for further validation.
Collapse
Affiliation(s)
- Sérgio Madeira
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Luís Raposo
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - João Brito
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Ricardo Rodrigues
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Pedro Gonçalves
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Rui Teles
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Henrique Gabriel
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | | | - Manuel Almeida
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Miguel Mendes
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| |
Collapse
|
37
|
Im E, Kim GS, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Long-Term Clinical Outcomes of a Biodegradable Polymer-Based Biolimus-Eluting Stent. J Interv Cardiol 2016; 29:162-7. [DOI: 10.1111/joic.12283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Eui Im
- Yongin Severance Hospital; Yonsei University Health System; Yongin Korea
| | - Gwang-Sil Kim
- Yongin Severance Hospital; Yonsei University Health System; Yongin Korea
| | - Dong-Ho Shin
- Severance Cardiovascular Hospital; Yonsei University Health System; Seoul Korea
- Cardiovascular Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital; Yonsei University Health System; Seoul Korea
- Cardiovascular Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital; Yonsei University Health System; Seoul Korea
- Cardiovascular Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital; Yonsei University Health System; Seoul Korea
- Cardiovascular Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital; Yonsei University Health System; Seoul Korea
- Cardiovascular Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital; Yonsei University Health System; Seoul Korea
- Cardiovascular Research Institute; Yonsei University College of Medicine; Seoul Korea
- Severance Biomedical Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital; Yonsei University Health System; Seoul Korea
- Cardiovascular Research Institute; Yonsei University College of Medicine; Seoul Korea
- Severance Biomedical Science Institute; Yonsei University College of Medicine; Seoul Korea
| |
Collapse
|
38
|
Farooq V, Di Mario C, Serruys PW. Balancing idealism with realism to safeguard the welfare of patients: The importance of Heart Team led decision-making in patients with complex coronary artery disease. Indian Heart J 2016; 68:1-5. [PMID: 26896257 PMCID: PMC4759481 DOI: 10.1016/j.ihj.2015.10.385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Vasim Farooq
- Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester and Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom.
| | - Carlo Di Mario
- NIHR Cardiovascular BRU, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Patrick W Serruys
- Emeritus Professor of Medicine with a Chair in Interventional Cardiology at the Erasmus University, Rotterdam, The Netherlands; International Centre for Circulatory Health, NHLI, Imperial College, London, United Kingdom
| |
Collapse
|
39
|
|
40
|
Aparci M, Yalcin M, Isilak Z. Nitrate-Induced Headache May Have Confounding Factors. Med Princ Pract 2016; 25:296. [PMID: 26655653 PMCID: PMC5588383 DOI: 10.1159/000443276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/10/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mustafa Aparci
- Deparment of Cardiology and Aviation Examination Center, Kasimpasa Military Hospital, Istanbul, Turkey
- *Mustafa Aparci, Department of Cardiology and Aviation Medicine, Kasimpasa Military Hospital, Yesiyurt Istasyon Street, TR-34149, Bakirkoy, Istanbul (Turkey), E-Mail
| | - Murat Yalcin
- Department of Cardiology, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Zafer Isilak
- Department of Cardiology, Haydarpasa Training Hospital, Istanbul, Turkey
| |
Collapse
|
41
|
Bypass Grafting Versus Percutaneous Intervention-Which Is Better in Multivessel Coronary Disease: Lessons From SYNTAX and Beyond. Prog Cardiovasc Dis 2015; 58:316-34. [PMID: 26529569 DOI: 10.1016/j.pcad.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score (www.syntaxscore.com) as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II (ClinicalTrials.gov Identifier: NCT02015832) and EXCEL (ClinicalTrials.gov identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.
Collapse
|
42
|
Farooq V, Di Mario C, Serruys PW. The triad of residual ischaemia, plaque burden, and plaque vulnerability: a known known?…a known unknown?..or an unknown unknown? EUROINTERVENTION 2015; 11:611-9. [DOI: 10.4244/eijv11i6a122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
43
|
Elevated Human Endothelial Cell-Specific Molecule-1 Level and Its Association With Coronary Artery Disease in Patients With Hypertension. J Investig Med 2015. [DOI: 10.1097/jim.0000000000000219] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
44
|
Jiménez-Navarro MF, López-Jiménez F, Barsness G, Lennon RJ, Sandhu GS, Prasad A. Long-term prognosis of complete percutaneous coronary revascularisation in patients with diabetes with multivessel disease. Heart 2015; 101:1233-9. [DOI: 10.1136/heartjnl-2014-307143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/18/2015] [Indexed: 01/17/2023] Open
|
45
|
Corcoran D, Berry C, Oldroyd K. Current frontiers in the clinical research of coronary physiology. Interv Cardiol 2015. [DOI: 10.2217/ica.14.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
46
|
Gómez-Sánchez M, Soulé-Egea M, Herrera-Alarcón V, Barragán-García R. [The cardiovascular surgeon and the Syntax score]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:50-8. [PMID: 25595855 DOI: 10.1016/j.acmx.2014.09.005] [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: 12/04/2013] [Revised: 09/21/2014] [Accepted: 09/24/2014] [Indexed: 11/16/2022] Open
Abstract
The Syntax score has been established as a tool to determine the complexity of coronary artery disease and as a guide for decision-making among coronary artery bypass surgery and percutaneous coronary intervention. The purpose of this review is to systematically examine what the Syntax score is, and how the surgeon should integrate the information in the selection and treatment of patients. We reviewed the results of the SYNTAX Trial, the clinical practice guidelines, as well as the benefits and limitations of the score. Finally we discuss the future directions of the Syntax score.
Collapse
Affiliation(s)
- Mario Gómez-Sánchez
- Departamento de Cirugía Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., México.
| | - Mauricio Soulé-Egea
- Departamento de Cirugía Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., México
| | - Valentín Herrera-Alarcón
- Departamento de Cirugía Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., México
| | - Rodolfo Barragán-García
- Departamento de Cirugía Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., México
| |
Collapse
|
47
|
Demir K, Avci A, Altunkeser BB, Yilmaz A, Keles F, Ersecgin A. The relation between neutrophil-to-lymphocyte ratio and coronary chronic total occlusions. BMC Cardiovasc Disord 2014; 14:130. [PMID: 25260530 PMCID: PMC4195893 DOI: 10.1186/1471-2261-14-130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that correlates with cardiac events. This study assessed the association between NLR and the presence of chronic coronary total occlusion (CTO). METHODS The study population included 225 patients, a control group (n = 75), a coronary artery disease group (n = 75), and a CTO group (n = 75). NLR was compared in the three groups. RESULTS NLR levels were significantly higher in the CTO than in the other two groups (p < 0.001). Bivariate correlation analysis showed a positive correlation between NLR and SYNTAX Score, and multivariate logistic regression analysis found that NLR was an independent predictor of CTO. ROC analysis showed that an NLR cut-off of 2.09 could distinguish between patients with and without CTO (AUC = 0.74; 95% CI, 0.68-0.81), with a specificity of 69.3% and a sensitivity of 61%. CONCLUSION NLR may be useful as a marker of CTO.
Collapse
Affiliation(s)
- Kenan Demir
- Faculty of Medicine Cardiology Department, Selcuk University, 42075 Konya, Turkey.
| | | | | | | | | | | |
Collapse
|
48
|
Namazi MH, Saadat H, Safi M, Vakili H, Alipourparsa S, Bozorgmanesh M, Haybar H. Pentraxin 3 Is Highly Specific for Predicting Anatomical Complexity of Coronary Artery Stenosis as Determined by the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Score. Korean Circ J 2014; 44:220-6. [PMID: 25089133 PMCID: PMC4117842 DOI: 10.4070/kcj.2014.44.4.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/08/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives The aim of this study was to examine the hypothesis that pentraxin 3 (PTX3) can have a diagnostic value for predicting anatomical complexity of coronary artery stenosis as measured by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score. Subjects and Methods We investigated the association of systemic arterial PTX3 with SYNTAX score among 500 patients with ischemic heart disease assigned to medical treatment (251), percutaneous coronary intervention (PCI) (197), or coronary artery bypass graft (CABG) (52). Results The clinical judgment of the cardiologists was near-perfectly concordant with the SYNTAX score. Mean {99% confidence intervals (CIs)} SYNTAX scores were 5.8 (5.1-6.6), 18.4 (17.1-19.8), and 33.2 (32.8-33.6) in patients assigned to medical therapy, PCI, and CABG, respectively. The AROC (95% CIs) for discriminating between patients with and without a high SYNTAX score (>23) was 0.920 (0.895-0.946) for systemic arterial levels of PTX3. As the systemic arterial level of PTX3 increased, the SYNTAX scores also increased almost in a curvilinear fashion, with the value corresponding to the SYNTAX score of 23 being 0.29 ng · dL-1. This cutpoint achieved a sensitivity of 0.66 (0.57-0.74), a specificity of 0.94 (0.91-0.96), a positive predictive value of 0.79 (0.70-0.87), and a negative predictive value of 0.89 (0.85-0.92). Conclusion We observed that systemic arterial levels of PTX3 were associated with the SYNTAX score in a curvilinear fashion. The discriminatory power of systemic arterial levels of PTX3 for a high SYNTAX score was excellent. The interesting finding of this study was the near perfect concordance between the decisions made by the cardiologists based on their clinical judgment and the SYNTAX score. The systemic arterial PTX3 level of 0.29 ng · dL-1 was highly specific for diagnosing complex coronary artery stenosis.
Collapse
Affiliation(s)
- Mohammad Hasan Namazi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habibollah Saadat
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Safi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Vakili
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Alipourparsa
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Haybar
- Cardiovascular Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| |
Collapse
|
49
|
Zhang YJ, Iqbal J, Campos CM, Klaveren DV, Bourantas CV, Dawkins KD, Banning AP, Escaned J, de Vries T, Morel MA, Farooq V, Onuma Y, Garcia-Garcia HM, Stone GW, Steyerberg EW, Mohr FW, Serruys PW. Prognostic Value of Site SYNTAX Score and Rationale for Combining Anatomic and Clinical Factors in Decision Making. J Am Coll Cardiol 2014; 64:423-32. [DOI: 10.1016/j.jacc.2014.05.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/26/2022]
|