Cardiovascular risk factor control is insufficient in young patients with coronary artery disease

The Effect of Sleep Quality on Coronary Lesion Severity and Prognosis in the Young Acute Coronary Syndrome Population

This study aimed to explore the effect of long-term (≥1 year) sleep quality on coronary lesion complexity and cardiovascular prognosis in young acute coronary syndrome (ACS) patients. We consecutively recruited young patients aged from 18 to 44 years old with first-episode ACS and significant epicardial stenosis on coronary angiography from January 2016 to January 2017. Coronary lesion complexity was evaluated based on SYNTAX scores. Long-term sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) (PSQI ≤ 5 and PSQI > 5 groups). The primary endpoints were major adverse cardiovascular events (MACEs). A total of 466 young ACS patients (93.13% male; median age, 41 years) were included. Poor sleepers (PSQI > 5) had higher SYNTAX scores. After adjusting for confounders, PSQI scores (continuous variables, OR: 1.264; 95%CI: 1.166-1.371; p < 0.001) and PSQI grade (binary variable, OR: 3.864; 95%CI: 2.313-6.394; p = 0.001) were significantly associated with an increased risk of complex coronary lesions. During a median follow-up of 74 months, long-term poor sleep quality (PSQI > 5) was significantly associated with an increased risk of MACEs (HR: 4.266; 95%CI: 2.274-8.001; p < 0.001). Long-term poor sleep quality was a risk factor for complex coronary lesions and has adverse effects on cardiovascular prognosis in the young ACS population.

Cardiac CT findings in patients with family history of premature CAD: an observational study

INTRODUCTION

A family history of premature CAD may promote enhanced development of coronary atherosclerosis in a sibling population. Baseline CV algorithms may underestimate the risk of coronary incidents in individuals at familial risk. Cardiac CT provides high diagnostic performance for the detection of coronary plaques. There is little data on the use of this technology in the initial diagnostic approach of these patients. The prognostic value of early detection of coronary plaques by cardiac CT remains unknown in this population.

OBJECTIVES

The study aimed to estimate the global CV risk and the pre-test probability of CAD in patients with a family history of premature CAD. We investigated the potential role of cardiac CT imaging in the assessment of coronary risk in patients from high-risk families. We sought to remind the 2019 ESC guidelines for screening for CAD in asymptomatic subjects.

METHODS

Fifty siblings of patients with premature CAD were investigated. The pre-test probability of CAD was determined with the Clinical Model of the CAD consortium. The risk of CV disease was calculated and compared with three different risk algorithms (SCORE, FRS, PROCAM). All patients underwent cardiac CT with both non-contrast and contrast imaging. Coronary artery calcium (CAC) scoring was calculated and CT angiograms were analyzed. Patients with suspected CT obstructive CAD underwent coronary angiography. Clinical outcomes in terms of treatment were analyzed.

RESULTS

The pre-test probability of CAD was low: CAD consortium <10% in 60%, SCORE <5% in 100%, FRS <10% in 88%, CAC scoring <100% in 68%. However, PROCAM was <10% in 16 cases (32%). Only 12 patients (24%) presented normal CCTA findings. In patients with abnormal CCTA findings (n = 38), PROCAM was higher than FRS in 20 patients (53%). Coronary angiography was performed in 31 cases (62%) for suspected CT obstructive CAD. Most patients presented no significant lesions (55%). Revascularization was performed in 8 patients (16%), 6 of them (75%) presented CAC scoring <100, 4 of them (50%) presented CAC scoring <400. After investigation, lipid-lowering therapy was enhanced by 66%.

CONCLUSION

Coronary atherosclerotic-phenotyping using cardiac CT may provide discriminatory information allowing earlier identification of patients at familial risk of premature CAD. This diagnostic workup strategy may help to guide and improve the management of these patients. However, there is a paucity of data concerning the prognostic significance of this technology in relatives at familial risk of premature CAD. Therefore, further randomized controlled trials are needed to assess the incremental risk-predictive value of this approach in this population.

RISK FACTOR DISTRIBUTION AND LONG-TERM OUTCOMES IN YOUNG PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN MACEDONIA

The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.

Coronary arterial disease correlates with constitutions of Traditional Chinese Medicine: A cross-sectional study in a Chinese cohort

Introduction: This study aimed to explore the associations between constitutions of traditional Chinese medicine (TCM) and coronary artery disease (CAD).

Methods: A large-scale, community-based, cross-sectional study was performed to investigate the associations. A total of 3,748 participants were available for analysis in this study. The assessment of the constitution of TCM was based on recommendations by the Association for Chinese Medicine in China. In this study, a diagnosis of CAD was based on self-reported medical history. The associations were analyzed using univariate and multivariable logistic regression (MLR).

Results: Univariate analysis showed Phlegm–dampness, Qi-deficiency, Yang-deficiency and Yin-deficiency constitutions were significantly associated with CAD, respectively ([Formula: see text] for Phlegm–dampness, [Formula: see text] for Qi-deficiency, [Formula: see text] for Yang-deficiency and [Formula: see text] for Yin-deficiency). Furthermore, MLR demonstrated significant associations among the four constitutions and CAD, after controlling for potential confounding factors (Phlegm–dampness: [Formula: see text], [Formula: see text]; Qi-deficient: [Formula: see text], [Formula: see text], Yang-Deficient: [Formula: see text], [Formula: see text]; Yin-deficient: [Formula: see text], [Formula: see text]). As compared with Neutral participants, participants with the four constitutions of TCM had higher prevalence of CAD.

Conclusion: Our findings provided evidence that the four constitutions of TCM including Phlegm-dampness, Qi-deficiency, Yan-deficiency and Yin-deficiency were significantly associated with CAD, respectively. (This study was registered in clinicaltrials.gov with the ID: NCT02998944.)