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Liao R, Cheng S, Xu N. Case Report: Kounis syndrome due to cryptopteran bite. Front Cardiovasc Med 2024; 11:1339514. [PMID: 38380174 PMCID: PMC10877037 DOI: 10.3389/fcvm.2024.1339514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Background Kounis syndrome is an acute coronary syndrome (ACS) caused by allergic reactions, including coronary artery spasm (type I) caused by allergies without coronary predisposing factors, pre-existing coronary atherosclerosis, and coronary artery disease. Anaphylaxis leads to plaque rupture or erosion leading to acute myocardial infarction (type II) and acute coronary stent thrombosis (type III). Here we share a case of Kounis syndrome type I caused by an allergy caused by a Cryptopteran bite. Case presentation A 47-year-old woman was admitted to the hospital due to an insect bite for 2 days and chest distress for more than 3 h. Outside the hospital, electrocardiogram(ECG) showed sinus rhythm, ST-segment elevation in leads V1-V3, high-sensitivity troponin 2.54 ng/ml(0-0.5 ng/ml). One hour later, the ECG of the patient showed that the ST segment elevation of lead V1-V4 was 0.10-0.20 mV. Emergency coronary angiography showed coronary spasm and moderate lumen stenosis in the middle segment of left anterior descending artery (LAD). After treatment, the patient's symptoms were relieved, and the ST segment of lead V1-V4 of electrocardiogram returned to normal. Conclusion Kunis syndrome is a life-threatening condition that can also cause myocardial ischemic injury in patients with or without coronary artery disease. Timely identification and anti-allergic treatment can achieve a good prognosis.
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Affiliation(s)
| | | | - Nan Xu
- Department of Cardiology, The First People’s Hospital of Neijiang, Neijiang, China
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Chi G, AlKhalfan F, Lee JJ, Montazerin SM, Fitzgerald C, Korjian S, Omar W, Barnathan E, Plotnikov A, Gibson CM. Factors associated with early, late, and very late stent thrombosis among patients with acute coronary syndrome undergoing coronary stent placement: analysis from the ATLAS ACS 2-TIMI 51 trial. Front Cardiovasc Med 2024; 10:1269011. [PMID: 38259304 PMCID: PMC10800486 DOI: 10.3389/fcvm.2023.1269011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Background Stent thrombosis (ST) is an uncommon but serious complication of stent implantation. This study aimed to explore factors associated with early, late, and very late ST to help guide risk assessment and clinical decision-making on ST. Methods The analysis included patients who received stent placement for the index acute coronary syndrome (ACS). Cumulative incidence of ST was assessed at 30 days (early ST), 31-360 days (late ST), 361-720 days (very late ST), and up to 720 days. Cox proportional hazards models were used to assess associations between ST and various factors, including patient characteristics [i.e., age, sex, ACS presentation, history of hypertension, smoking, diabetes, prior myocardial infarction (MI), heart failure, prior ischemic stroke, and cancer], laboratory tests [i.e., positive cardiac biomarker, hemoglobin, platelet count, white blood cell (WBC) count], and treatment [i.e., drug-eluting stent (DES) vs. bare-metal stent (BMS) and anticoagulant with rivaroxaban vs. placebo]. Results Among the 8,741 stented patients, 155 ST events (2.25%) occurred by Day 720. The cumulative incidences of early, late, and very late ST were 0.80%, 0.81%, and 0.77%, respectively. After multivariable adjustment, age ≥ 75 [hazard ratio (HR) = 2.13 (95% confidence interval, CI: 1.26-3.60)], a history of prior MI [HR = 1.81 (95% CI: 1.22-2.68)], low hemoglobin level [HR = 2.34 (95% CI: 1.59-3.44)], and high WBC count [HR = 1.58 (95% CI: 1.02-2.46)] were associated with a greater risk of overall ST, whereas DES [HR = 0.56 (95% CI: 0.38-0.83)] and rivaroxaban therapy [HR = 0.63 (95% CI: 0.44-0.88)] were associated with a lower risk of overall ST up to 720 days. Low hemoglobin level and high WBC count were associated with early ST (low hemoglobin: HR = 2.35 [95% CI: 1.34-4.12]; high WBC count: HR = 2.11 [95% CI: 1.17-3.81]). Low hemoglobin level and prior MI were associated with a greater risk of late ST (low hemoglobin: HR = 2.32 [95% CI: 1.26-4.27]; prior MI: HR = 2.98 [95% CI: 1.67-5.31]), whereas DES was associated with a lower risk of late ST [HR = 0.33 (95% CI: 0.16-0.67)]. Age ≥75 years was associated with very late ST. Conclusion The study identified positive and negative associations with early, late, and very late ST. These variables may be useful in constructing risk assessment models for ST. Clinical Trial Registration http://www.clinicaltrials.gov, identifier NCT00809965.
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Affiliation(s)
- Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Fahad AlKhalfan
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Jane J. Lee
- Department of Trial Design and Development, Baim Institute for Clinical Research, Boston, MA, United States
| | - Sahar Memar Montazerin
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Clara Fitzgerald
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Serge Korjian
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Wally Omar
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Elliot Barnathan
- Cardiovascular, Metabolism, Retina and Pulmonary Hypertension, Johnson & Johnson Pharmaceutical Research and Development, Raritan, NJ, United States
| | - Alexei Plotnikov
- Cardiovascular, Metabolism, Retina and Pulmonary Hypertension, Johnson & Johnson Pharmaceutical Research and Development, Raritan, NJ, United States
| | - C. Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Tarantini G, Cardaioli F, De Iaco G, Tuccillo B, De Angelis MC, Mauro C, Boccalatte M, Trivisonno A, Ribichini F, Vadalà G, Caramanno G, Caruso M, Lombardi M, Fischetti D, Danesi A, Abbracciavento L, Lorenzoni G, Gregori D, Panza A, Nai Fovino L, Esposito G. A more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: an Italian post-maRketing study (the CAESAR registry). Front Cardiovasc Med 2024; 10:1326091. [PMID: 38299080 PMCID: PMC10828965 DOI: 10.3389/fcvm.2023.1326091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction The use of contemporary drug-eluting stents (DES) has significantly improved outcomes of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, concerns exist regarding the long-term proinflammatory effects of durable polymer coatings used in most DES, potentially leading to long-term adverse events. First-generation polymer-free stent technologies, such as sirolimus- and probucol-eluting stents (PF-SES), have shown an excellent safety and efficacy profile. The aim of this study was to evaluate the safety and efficacy of the new ultrathin Coroflex ISAR NEO PF-SES, in a more-comers PCI population. Methods The CAESAR (a more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: An Italian post-maRketing study) registry is a multicenter, prospective study conducted in Italy, enrolling more-comers CAD patients undergoing PCI with the Coroflex ISAR NEO stent. Patients with left main (LM) disease, cardiogenic shock (CS), or severely reduced left-ventricular ejection fraction (LVEF) were excluded. The primary endpoint was target-lesion revascularization (TLR) at 1 year. Results A total of 425 patients were enrolled at 13 centers (mean age 66.9 ± 11.6 years, Diabetes mellitus 29%, acute coronary syndrome 67%, chronic total occlusion 9%). Of these, 40.9% had multivessel disease (MVD) and in 3.3% cases, the target lesion was in-stent restenosis (ISR). Clinical device success was reached in 422 (99.6%) cases. At 1 year, only two (0.5%) subjects presented ischemia-driven TLR. The 1-year rates of target vessel revascularization and MACE were 0.5% and 5.1%, respectively. Major bleeding was observed in four (1.0%) patients. Conclusion In this multicenter, prospective registry, the use of a new ultrathin Coroflex ISAR NEO PF-SES in a more-comers PCI population showed good safety and efficacy at 1 year.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giuseppe De Iaco
- Department of Cardiology, Hospital “Cardinal G. Panico”, Tricase, Italy
| | | | | | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Marco Boccalatte
- Interventional Cardiology Unit, Ospedale Santa Maria Delle Grazie Pozzuoli, Napoli, Italy
| | - Antonio Trivisonno
- Department of Cardiovascular Disease, “Antonio Cardarelli” Hospital, Campobasso, Italy
| | | | - Giuseppe Vadalà
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Giuseppe Caramanno
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Marco Caruso
- Interventional Cardiology Unit, ARNAS Civico, G. Di Cristina Benfratelli, Palermo, Italy
| | - Mario Lombardi
- Interventional Cardiology Unit, A.O. Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Andrea Panza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giovanni Esposito
- Division of Cardiology, Università Degli Studi di Napoli Federico II, Napoli, Italy
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Salamanca J, Alfonso F. Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?-a narrative review. Cardiovasc Diagn Ther 2023; 13:1080-1103. [PMID: 38162098 PMCID: PMC10753233 DOI: 10.21037/cdt-23-283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Background and Objective Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress. TTS is more common in post-menopausal women, closely resembling acute coronary syndrome (ACS) in its clinical presentation, with multiple proposed underlying pathophysiological mechanisms and no evidence-based treatments. This review aims to provide a comprehensive summary of the latest research, encompassing the pathophysiology, diagnostic findings, prognosis, and treatment options for TTS patients. Methods Relevant literature from 1990 to June 2023 on TTS epidemiology, physiopathology, diagnosis, clinical manifestations, treatment, and prognosis was retrieved through PubMed research. Only English publications were included. Key Content and Findings TTS is an increasingly recognized cardiovascular disorder, a significant release of catecholamines is thought to be a key contributing element, yet its exact mechanism remains unclear. Notably, TTS poses significant short and long-term risks akin to ACS. Initial treatment should focus on ruling out ACS and providing standard care for subsequent left ventricular dysfunction and complications. Research hints at a potential role for Angiotensin-converting enzyme inhibitors and Angiotensin II receptor blockers in improving long-term prognosis in TTS patients. Conclusions Significant knowledge gaps still exist in our understanding of the pathophysiology, treatment options, and areas for improvement in diagnosing and prognosticating this intriguing condition. Further research is therefore needed.
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Affiliation(s)
- Jorge Salamanca
- Cardiology Department, La Princesa University Hospital, Princesa Institute for Health Research (IIS-IP), Autonomous University of Madrid, CIBERCV, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department, La Princesa University Hospital, Princesa Institute for Health Research (IIS-IP), Autonomous University of Madrid, CIBERCV, Madrid, Spain
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Yaylak B, Polat F, Onuk T, Akyüz Ş, Çalık AN, Çetin M, Eren S, Mollaalioğlu F, Kolak Z, Durak F, Dayı ŞÜ. The relation of polymer structure of stent used in patients with acute coronary syndrome revascularized by stent implantation with long-term cardiovascular events. Catheter Cardiovasc Interv 2023; 102:1186-1197. [PMID: 37855201 DOI: 10.1002/ccd.30881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Drug-eluting stents (DES) have revolutionized percutaneous coronary intervention (PCI) by improving event-free survival compared to older stent designs. However, early-generation DES with polymer matrixes have raised concerns regarding late stent thrombosis due to delayed vascular healing. To address these issues, biologically bioabsorbable polymer drug-eluting stents (BP-DES) and polymer-free drug-eluting stents (PF-DES) have been developed. AIM The aim of the present study is to evaluate and compare the long-term effects of different stent platforms in patients with acute coronary syndrome (ACS) undergoing PCI. MATERIAL AND METHODS We conducted a retrospective, observational study involving 1192 ACS patients who underwent urgent PCI. Patients were treated with thin- strut DP-DES, ultra-thin strut BP-DES, or thin-strut PF-DES. The primary endpoint was a composite of cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (CITLR) at 12 months and 4 years. RESULTS The baseline demographics and clinical characteristics of patients in the three stent subgroups were similar. No significant differences were observed in target lesion failure (TLF), cardiac mortality, TVMI, and stent thrombosis (ST) rates among the three subgroups at both 12 months and 4 years. However, beyond the first year, the rate of CITLR was significantly lower in the ultra-thin strut BP-DES subgroup compared to thin-strut DP-DES, suggesting potential long-term advantages of ultra-thin strut BP-DES. Additionally, both ultra-thin strut BP-DES and thin-strut PF-DES demonstrated lower ST rates after the first year compared to thin-strut DP-DES. CONCLUSION Our study highlights the potential advantages of ultra-thin strut BP-DES in reducing CITLR rates in the long term, and both ultra-thin strut BP-DES and thin-strut PF-DES demonstrate lower rates of ST beyond the first year compared to thin-strut DP-DES. However, no significant differences were observed in overall TLF, cardiac mortality and TVMI rates among the three stent subgroups at both 12 months and 4 years.
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Affiliation(s)
- Barış Yaylak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Fuat Polat
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Tolga Onuk
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Şükrü Akyüz
- Department of Cardiology, Okan University Faculty of Medicine, İstanbul, Türkiye
| | - Ali Nazmi Çalık
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Mustafa Çetin
- Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Türkiye
| | - Semih Eren
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Feyza Mollaalioğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Zeynep Kolak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Furkan Durak
- Department of Cardiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Şennur Ünal Dayı
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
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Ehrenberger R, Németh BT, Kulyassa P, Fülöp GA, Becker D, Kiss B, Zima E, Merkely B, Édes IF. Acute coronary syndrome associated cardiogenic shock in the catheterization laboratory: peripheral veno-arterial extracorporeal membrane oxygenator management and recommendations. Front Med (Lausanne) 2023; 10:1277504. [PMID: 38020166 PMCID: PMC10661940 DOI: 10.3389/fmed.2023.1277504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiogenic shock (CS) in acute coronary syndrome (ACS) is a critical disease with high mortality rates requiring complex treatment to maximize patient survival chances. Emergent coronary revascularization along with circulatory support are keys to saving lives. Mechanical circulatory support may be instigated in severe, yet still reversible instances. Of these, the peripheral veno-arterial extracorporeal membrane oxygenator (pVA-ECMO) is the most widely used system for both circulatory and respiratory support. The aim of our work is to provide a review of our current understanding of the pVA-ECMO when used in the catheterization laboratory in a CS ACS setting. We detail the workings of a Shock Team: pVA-ECMO specifics, circumstances, and timing of implantations and discuss possible complications. We place emphasis on how to select the appropriate patients for potential pVA-ECMO support and what characteristics and parameters need to be assessed. A detailed, stepwise implantation algorithm indicating crucial steps is also featured for practitioners in the catheter laboratory. To provide an overall aspect of pVA-ECMO use in CS ACS we further gave pointers including relevant human resource, infrastructure, and consumables management to build an effective Shock Team to treat CS ACS via the pVA-ECMO method.
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Affiliation(s)
| | | | | | | | | | | | | | | | - István F. Édes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Restivo A, Stanzione A, Maffeo D, Buono A. Ping-pong snaring of a totally dislodged stent across left main ostium: "All is not lost". Catheter Cardiovasc Interv 2023; 102:889-891. [PMID: 37702150 DOI: 10.1002/ccd.30833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
Undeployed stent loss is a rare but potentially serious complication of percutaneous coronary intervention. Its management is not assisted by well-defined guidelines, and it is made even more difficult when the dislodged stent is not protected by in situ guidewire. In this work, we present the case of a total stent loss with a crushed device protruding out of the left main. In this hopeless circumstance, an innovative ping-pong technique was used to contralaterally perform a successful stent retrieval.
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Affiliation(s)
- Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessio Stanzione
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
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Miklin DJ, Garcia-Bengochea Y, Meraj P. Acute coronary syndrome in an anomalous mid-LAD right coronary artery: Don't forget to look twice before turning left. Catheter Cardiovasc Interv 2023; 102:499-502. [PMID: 37554047 DOI: 10.1002/ccd.30777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 08/10/2023]
Abstract
A 68-year-old female with past medical history of hypertension, hyperlipidemia, multiple sclerosis, diverticulitis, and tobacco use presented with 1 day of atypical chest pain after a recent diverticulitis flare. Initial workup was notable for a normal electrocardiogram but elevated high sensitivity troponin T (616 ng/L). Due to persistent symptoms, the patient was given antiplatelet therapy and taken urgently to the catheterization lab where she was found to have complete occlusion of an anomalous right coronary artery branching off the mid-left anterior descending artery. Angioplasty was performed with a drug-eluting stent and her symptoms resolved. The patient recovered well and was discharged on appropriate medical therapy. This case demonstrates a case of acute coronary syndrome in an extremely rare coronary congenital abnormality. Further research is needed on when to be suspicious for coronary anomalies on patients presenting with myocardial infarction.
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Affiliation(s)
- Daniel J Miklin
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Youssef Garcia-Bengochea
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
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Velagapudi P, Kirtane AJ, Saw J. Spontaneous Coronary Artery Dissection Causing Acute Myocardial Infarction: Is Revascularization the Best Course of Action? JACC Cardiovasc Interv 2023; 16:1870-1872. [PMID: 37587594 DOI: 10.1016/j.jcin.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Medical Center, New York City, New York, USA
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Lu YY, Lee CH, Chen CC, Chen DY, Ho MY, Yeh JK, Huang YC, Chang CY, Wang CY, Chang SH, Hsieh IC, Hsieh MJ. Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention. Front Cardiovasc Med 2023; 10:1037392. [PMID: 37560115 PMCID: PMC10407654 DOI: 10.3389/fcvm.2023.1037392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The optimal revascularization strategy for elderly patients with acute coronary syndrome (ACS) remains uncertain. We evaluated the impact of complete revascularization (CR) vs. incomplete revascularization (IR) in elderly ACS patients with multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI). METHODS Using registry data from 2011 to 2019, we conducted a propensity-score matched cohort study. Elderly patients (≥75 years) with ACS and MVD who underwent PCI were divided into CR and IR groups based on angiography during index hospitalization. Major adverse cardiovascular events (MACEs), including all-cause mortality, recurrent non-fatal myocardial infarction, and any revascularization, were assessed at 3-year follow-up. RESULTS Among 1,018 enrolled patients, 496 (48.7%) underwent CR and 522 (51.3%) received IR. After 1:1 propensity-score matching, we analyzed 395 pairs. At 3-year follow-up, CR was significantly associated with lower MACE risk compared to IR (16.7% vs. 25.6%, HR = 0.65, 95% CI: 0.47-0.88, p = 0.006), driven by reduced all-cause mortality. This benefit was consistent across all pre-specified subgroups, particularly in ST segment elevation (STE)-ACS patients. In non-STE (NSTE)-ACS subgroup analysis, CR was also associated with a lower risk of cardiac mortality compared to IR (HR = 0.30, 95% CI: 0.12-0.75, p = 0.01). CONCLUSION In elderly ACS patients with MVD undergoing PCI, CR demonstrates superior long-term outcomes compared to IR, irrespective of STE- or NSTE-ACS presentation.
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Affiliation(s)
- Yu-Ying Lu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Chi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Yun Ho
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jih-Kai Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chang Huang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chieh-Yu Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Yung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Big Data Analytics and Statistics, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Jer Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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11
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Włodarczak A, Rola P, Barycki M, Furtan Ł, Łanocha M, Włodarczak S, Szudrowicz M, Kulczycki JJ, Jaroszewska-Pozorska J, Kędzierska M, Giniewicz K, Doroszko A, Lesiak M. Mid-term safety and efficacy of magnesium bioresorbable vascular scaffolds - magmaris in diabetic population. 2-Years outcome in acute coronary syndrome cohort. Diab Vasc Dis Res 2023; 20:14791641231188705. [PMID: 37439002 PMCID: PMC10345934 DOI: 10.1177/14791641231188705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Diabetes type 2 is one of the strongest risk factors affecting coronary artery disease (CAD) and is also a marker of poor short and long-term prognosis in subjects with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) with subsequent drug-eluting stent (DES) implantation. Chronic local vascular inflammation along with endothelial dysfunction is postulated to be the pathophysiological background of unfavorable results. The second generation of metallic magnesium BRS -Magmaris (Biotronik, Berlin, Germany) had been introduced to clinical practice to overcome these limitations. METHODS We evaluated 2-years clinical outcomes after Magmaris BRS implantation in NSTE-ACS diabetic (n-72) and non-diabetic (n-121) cohorts. RESULTS No significant differences between diabetic and non-diabetes cohorts were noticed in terms of Primary Outcome (cardiac death, myocardial infarction, stent thrombosis) (8.1% vs 3.3% p = 0.182) and Principal secondary outcome - TLF- target lesion failure (9.5% vs 3.3% p = 0.106) at 2-years follow-up. CONCLUSIONS 2-years outcome suggests good safety and efficacy of the magnesium BRS (Magmaris) in NSTE- ACS and concomitant DM. Nevertheless, there is a strong need for large multicenter, randomized, prospective studies for a full assessment of this novel device in diabetic patients with ACS.
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Affiliation(s)
- Adrian Włodarczak
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, Legnica, Poland
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Piotr Rola
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, Legnica, Poland
- Department of Cardiology, Provincial Specialized Hospital in Legnica, Legnica, Poland
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital in Legnica, Legnica, Poland
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital in Legnica, Legnica, Poland
| | | | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | | | | | | | | | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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12
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Seitun S, Porto I, Papafaklis MI. Editorial: Advances in predicting future adverse coronary events: the role of cardiovascular imaging and coronary physiology indices. Front Cardiovasc Med 2023; 10:1206076. [PMID: 37229226 PMCID: PMC10203547 DOI: 10.3389/fcvm.2023.1206076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Sara Seitun
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiology Unit, Cardio-Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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13
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Tsigkas G, Vakka A, Apostolos A, Bousoula E, Vythoulkas-Biotis N, Koufou EE, Vasilagkos G, Tsiafoutis I, Hamilos M, Aminian A, Davlouros P. Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:jcdd10040135. [PMID: 37103014 PMCID: PMC10144375 DOI: 10.3390/jcdd10040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/28/2023] Open
Abstract
Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Angeliki Vakka
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasios Apostolos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Eleni Bousoula
- Department of Cardiology, Tzaneio General Hospital, 185 36 Piraeus, Greece
| | | | | | - Georgios Vasilagkos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Ioannis Tsiafoutis
- First Department of Cardiology, Red Cross Hospital, 115 26 Athens, Greece
| | - Michalis Hamilos
- Department of Cardiology, Heraklion University Hospital, 715 00 Heraklion, Crete, Greece
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
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14
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Feng WH, Chang YC, Lin YH, Chen HL, Chen CY, Lin TH, Lin TC, Chang CT, Kuo HF, Chang HM, Chu CS. P2Y12 Inhibitor Monotherapy versus Conventional Dual Antiplatelet Therapy in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Meta-Analysis. Pharmaceuticals (Basel) 2023; 16:232. [PMID: 37259380 PMCID: PMC9958698 DOI: 10.3390/ph16020232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 08/08/2023] Open
Abstract
P2Y12 inhibitor monotherapy is a feasible alternative treatment for patients after percutaneous coronary intervention (PCI) in the modern era. Clinical trials have shown that it could lower the risk of bleeding complications without increased ischemic events as compared to standard dual antiplatelet therapy (DAPT). However, the efficacy and safety of this novel approach among patients with acute coronary syndrome (ACS) are controversial because they have a much higher risk for recurrent ischemic events. The purpose of this study is to evaluate the efficacy and safety of this novel approach among patients with ACS. We conducted a meta-analysis of randomized controlled trials that compared P2Y12 inhibitor monotherapy with 12-month DAPT in ACS patients who underwent PCI with stent implantation. PubMed, Embase, the Cochrane library database, ClinicalTrials.gov, and other three websites were searched for data from the earliest report to July 2022. The primary efficacy outcome was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause mortality, myocardial infarction, stent thrombosis, or stroke. The primary safety outcome was major or minor bleeding events. The secondary endpoint was net adverse clinical events (NACE), defined as a composite of major bleeding and adverse cardiac and cerebrovascular events. Five randomized controlled trials with a total of 21,034 patients were included in our meta-analysis. The quantitative analysis showed a significant reduction in major or minor bleeding events in patients treated with P2Y12 inhibitor monotherapy as compared with standard DAPT(OR: 0.59, 95% CI: 0.46-0.75, p < 0.0001) without increasing the risk of MACCE (OR: 0.98, 95% CI: 0.86-1.13, p = 0.82). The NACE was favorable in the patients treated with P2Y12 inhibitor monotherapy (OR: 0.82, 95% CI: 0.73-0.93, p = 0.002). Of note, the overall clinical benefit of P2Y12 inhibitor monotherapy was quite different between ticagrelor and clopidogrel. The incidence of NACE was significantly lower in ticagrelor monotherapy as compared with DAPT (OR: 0.79, 95% CI: 0.68-0.91), but not in clopidogrel monotherapy (OR: 1.14, 95% CI: 0.79-1.63). Both clopidogrel and ticagrelor monotherapy showed a similar reduction in bleeding complications (OR: 0.46, 95% CI: 0.22-0.94; OR: 0.60, 95% CI: 0.44-0.83, respectively). Although statistically insignificant, the incidence of MACCE was numerically higher in clopidogrel monotherapy as compared with standard DAPT (OR: 1.50, 95% CI: 0.99-2.28, p = 0.06). Based on these findings, P2Y12 inhibitor monotherapy with ticagrelor would be a better choice of medical treatment for ACS patients after PCI with stent implantation in the current era.
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Affiliation(s)
- Wen-Han Feng
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
- Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yong-Chieh Chang
- Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
| | - Yi-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsiao-Ling Chen
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chun-Yin Chen
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Tsung-Han Lin
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Tzu-Chieh Lin
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Ching-Tang Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Hsuan-Fu Kuo
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Hsiu-Mei Chang
- Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
| | - Chih-Sheng Chu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
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15
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Hu F, Yu H, Zong J, Xue J, Wen Z, Chen M, Du L, Chen T. The impact of hypertension for metabolites in patients with acute coronary syndrome. Ann Transl Med 2023; 11:50. [PMID: 36819519 PMCID: PMC9929784 DOI: 10.21037/atm-22-6409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
Background Acute coronary syndrome (ACS) is one of the leading causes of death and is often accompanied by hypertension. Methods We investigated whether hypertension affects the metabolism of patients with ACS. Serum samples were provided from healthy controls (HCs; n=26), patients with ACS (n=20), or those patients with ACS complicated with hypertension (HTN, n=21), and all were subjected to non-targeted metabolomics analyses based on gas chromatography-mass spectrometry (GC/MS). Differential metabolites were screened using principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal partial least squares discriminant analysis (OPLS-DA). Kyoto Encyclopedia of Genes and Genomes (KEGG) provided metabolic pathways related to these metabolites. Results Compared to those in the HC group, 12 metabolites were significantly upregulated and 6 significantly downregulated in the ACS group; among these, L-cystine and isocitric acid showed the most obvious differences, respectively. Compared to those in the ACS group, 3 metabolites were significantly upregulated and 2 metabolites were significantly downregulated in the ACS-HTN group, among which oleic acid and chenodeoxycholic acid showed the most marked difference, respectively. The five most prominent metabolic pathways involved in differential metabolites between the ACS and HC groups were arginine biosynthesis; oxidative phosphorylation; alanine, aspartate and glutamate metabolism; citrate cycle; and glucagon signaling pathway. The metabolic pathways between the ACS and ACS-HTN groups were steroid biosynthesis, fatty acid biosynthesis, arginine biosynthesis, primary bile acid biosynthesis, and tyrosine metabolism. Conclusions A comprehensive study of the changes in circulatory metabolomics and the influence of HTN was conducted in patients with ACS. A serum metabolomics test can be used to identify differentially metabolized molecules and allow the classification of patients with ACS or those complicated with HTN.
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Affiliation(s)
- Feng Hu
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China;,Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huajiong Yu
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China;,Department of Cardiology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Hangzhou, China
| | - Ji Zong
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Jianing Xue
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Zuoshi Wen
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Mengjia Chen
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Luping Du
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Ting Chen
- Department of Cardiology, the First Affiliated Hospital, Zhejiang University Medical School, Hangzhou, China;,Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Hangzhou, China
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16
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Darsin Singh SK, Ahmedy FB, Noor ABYA, Abdullah KL, Abidin IZ, Suhaimi AB. Changes in Perception of Illness during Cardiac Rehabilitation Programme among Patients with Acute Coronary Syndrome: A Longitudinal Study. Healthcare (Basel) 2023; 11:healthcare11030311. [PMID: 36766886 PMCID: PMC9914116 DOI: 10.3390/healthcare11030311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/21/2023] Open
Abstract
Little is known about the changes in perception of illness among patients with the acute coronary syndrome (ACS) during cardiac rehabilitation programme (CRP). The purpose of this study is to determine changes in perception of illness with ACS patients during CRP to evaluate the association of patients' characteristics with the perception of illness at the end of Phase II of CRP. A descriptive longitudinal study was conducted among 450 patients who attended 8-weeks of Phase II CRP at 2 public hospitals in Malaysia and perception of illness was assessed using Brief Illness Perception Questionnaire (BIPQ). The assessment was conducted before Phase II (T0), during the 4th session (T1), and at the end of right after the 8th session (T2). One-way repeated measures of ANOVA analysed the changes of perception at T1 and T2 while logistic regression analysis evaluated the association of patients' characteristics with the perception of illness at T2. Perception of illness changed during and after CRP from T0 to T1, and T1 to T2 (p < 0.001). The patient viewed ACS as an illness that changed from being more acute to a chronic condition as the sessions progressed. Previous history of acute myocardial infarction (OR = 2.380, 95% CI 1.46, 5.49) and angioplasty intervention were both found to be associated with the perception of illness (OR = 3.857, 95% CI 1.55, 9.61). Perception of illness changed during CRP and these changes are associated with patients' previous history of cardiac events. Phase II can be viewed as the second window of opportunity for healthcare professionals to intervene early in modifying the perception of illness.
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Affiliation(s)
- Sukhbeer Kaur Darsin Singh
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
- Department of Nursing Science, Faculty of Medicine, Universiti of Malaya, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
| | - Fatimah Binti Ahmedy
- Department of Medical Education, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
- Correspondence: (F.B.A.); (A.B.Y.A.N.)
| | - Abqariyah Binti Yahya Ahmad Noor
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti of Malaya, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
- Correspondence: (F.B.A.); (A.B.Y.A.N.)
| | - Khatijah Lim Abdullah
- Department of Nursing, School of Medical and Life Sciences, Sunway University, Subang Jaya 47500, Selangor, Malaysia
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - Imran Zainal Abidin
- Deparment of Medicine, Faculty of Medicine, Universiti of Malaya, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
| | - Anwar Bin Suhaimi
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti of Malaya, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
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Choi W, Kang HJ, Kim JW, Kim HK, Kang HC, Kim SW, Kim JC, Ahn Y, Jeong MH, Kim JM. Modifying effect of the serum level of brain-derived neurotrophic factor (BDNF) on the association between BDNF methylation and long-term cardiovascular outcomes in patients with acute coronary syndrome. Front Cardiovasc Med 2023; 9:1084834. [PMID: 36741831 PMCID: PMC9889833 DOI: 10.3389/fcvm.2022.1084834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction This study investigated the potential modifying effects of the serum brain-derived neurotrophic factor (sBDNF) level on the association between BDNF methylation status and long-term cardiovascular outcomes in acute coronary syndrome (ACS) patients. Methods From 2006 to 2012, hospitalized ACS patients were consecutively recruited. The sBDNF level and BDNF methylation status were assessed at baseline in 969 patients who were followed up for major adverse cardiac events (MACEs) over 5-12 years, until 2017 or death. Cox proportional hazards models were utilized to compare the time to first composite or individual MACEs between individuals with lower and those with higher average BDNF methylation levels in the low and high sBDNF groups, respectively. The modifying effects of the sBDNF and average BDNF methylation levels on first composite and individual MACEs were analyzed using Cox proportional hazards models after adjusting for potential covariates. Results In the low sBDNF group, a higher average BDNF methylation level was linked to an increase in composite MACEs independent of confounding variables, but not in the high sBDNF group [HR (95 percent CI) = 1.04 (0.76-1.44)]. The interaction effect between the sBDNF and average BDNF methylation levels on composite MACEs was significant after adjusting for covariates (P = 0.008). Conclusion Combining the BDNF methylation status and sBDNF levels may help identify ACS patients who are likely to have unfavorable clinical outcomes.
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Affiliation(s)
- Wonsuk Choi
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jung-Chul Kim
- Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea,*Correspondence: Jae-Min Kim ✉
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18
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Meertens MM, Tichelbäcker T, Macherey-Meyer S, Heyne S, Braumann S, Nießen SF, Baldus S, Adler C, Lee S. Meta-analysis of extracorporeal membrane oxygenation in combination with intra-aortic balloon pump vs. extracorporeal membrane oxygenation only in patients with cardiogenic shock due to acute myocardial infarction. Front Cardiovasc Med 2023; 9:1104357. [PMID: 36741852 PMCID: PMC9889933 DOI: 10.3389/fcvm.2022.1104357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
Background Incidence and mortality of cardiogenic shock (CS) in patients with acute myocardial infarction (AMI) remain high despite substantial therapy improvements in acute percutaneous coronary intervention over the last decades. Unloading the left ventricle in patients with Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be performed by using an intra-aortic balloon pumps' (IABP) afterload reduction, which might be especially beneficial in AMI patients with CS. Objective The objective of this meta-analysis was to assess the effect of VA-ECMO + IABP vs. VA-ECMO treatment on the mortality of patients with CS due to AMI. Methods A systematic literature search was performed using EMBASE, COCHRANE, and MEDLINE databases. Studies comparing the effect of VA-ECMO + IABP vs. VA-ECMO on mortality of patients with AMI were included. Meta-analyses were performed to analyze the effect of the chosen treatment on 30-day/in-hospital mortality. Results Twelve studies were identified by the literature search, including a total of 5,063 patients, 81.5% were male and the mean age was 65.9 years. One thousand one hundred and thirty-six patients received treatment with VA-ECMO in combination with IABP and 2,964 patients received VA-ECMO treatment only. The performed meta-analysis showed decreased mortality at 30-days/in-hospital after VA-ECMO + IABP compared to VA-ECMO only for patients with cardiogenic shock after AMI (OR 0.36, 95% CI 0.30-0.44, P≤0.001). Combination of VA-ECMO + IABP was associated with higher rates of weaning success (OR 0.29, 95% CI 0.16-0.53, P < 0.001) without an increase of vascular access complications (OR 0.85, 95% CI 0.35-2.08, P = 0.72). Conclusion In this meta-analysis, combination therapy of VA-ECMO + IABP was superior to VA-ECMO only therapy in patients with CS due to AMI. In the absence of randomized data, these results are hypothesis generating only.
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19
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Zhang Y, Chu C, Zhong Z, Luo YB, Ning FF, Guo N. Prolonged dual antiplatelet therapy for Chinese ACS patients undergoing emergency PCI with drug-eluting stents: Benefits and risks. Front Cardiovasc Med 2023; 10:1080673. [PMID: 36873408 PMCID: PMC9976624 DOI: 10.3389/fcvm.2023.1080673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background In patients with acute coronary syndrome (ACS), prolonged dual antiplatelet therapy (DAPT) may reduce ischemic events and increase the risks of bleeding events differently in different ethnic groups. However, whether prolonged DAPT in Chinese patients with ACS following emergency percutaneous coronary intervention (PCI) with drug-eluting stents (DES) will be beneficial or dangerous remains unclear. This study aimed to examine the potential benefits and risks of prolonged DAPT in Chinese patients with ACS who have undergone emergency PCI with DES. Methods This study included 2,249 patients with ACS who underwent emergency PCI. If DAPT was continued for 12 or 12-24 months, it was classified as the standard (n = 1,011) or prolonged (n = 1,238) DAPT group, respectively. The incidence of the following endpoint events was determined and compared between the two groups: composite bleeding event (BARC 1 or 2 types of bleeding and BARC 3 or 5 types of bleeding) and major adverse cardiovascular and cerebrovascular events (MACCEs) [ischemia-driven revascularization, non-fatal ischemia stroke, non-fatal myocardial infarction (MI), cardiac death, and all-cause death]. Results After a median period of 47 months of follow-up [47 (40, 54)], the rate of composite bleeding events was 13.2% (n = 163) in the prolonged DAPT group and 7.9% (n = 80) in the standard DAPT group [odds ratio (OR) 1.765, 95% confidence interval (CI) 1.332-2.338, p < 0.001]. The rate of MACCEs was 11.1% (n = 138) in the prolonged DAPT group and 13.2% (n = 133) in the standard DAPT group (OR 0.828, 95% CI 0.642-1.068, p = 0.146). The DAPT duration was further shown to be insignificantly correlated with MACCEs as per the multivariable Cox regression model (HR, 0.813; 95% CI, 0.638-1.036; p = 0.094). No statistically significant difference was observed between the two groups. However, the DAPT duration was a separate predictor of composite bleeding events according to the multivariable Cox regression model (HR 1.704, 95% CI 1.302-2.232, p < 0.001). Compared with the standard DAPT group, the prolonged DAPT group had substantially more BARC 3 or 5 types of bleeding events (3.0 vs. 0.9% in those with standard DAPT, OR 3.430, 95% CI 1.648-7.141, p < 0.001) and BARC 1 or 2 types of bleeding events (10.2 vs. 7.0% in those with standard DAPT, OR 1.500, 95% CI 1.107-2.032, p = 0.008). Conclusion The prolonged DAPT group had a considerably greater incidence of composite bleeding events than the standard DAPT group. No statistically significant difference was observed in the incidence of MACCEs between the two groups.
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Affiliation(s)
- Yong Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Chu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhong Zhong
- Department of Cardiovascular Medicine, Weinan Central Hospital, Weinan, Shaanxi, China
| | - Yong-Bai Luo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fei-Fei Ning
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ning Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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20
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Cesaro A, De Michele G, Gragnano F, Calabrò P. How has COVID-19 impacted the care of patients with acute coronary syndromes? Expert Rev Cardiovasc Ther 2023; 21:1-4. [PMID: 36534926 DOI: 10.1080/14779072.2023.2159809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Gianantonio De Michele
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
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21
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Nakazone MA, Issa VS, Bestetti RB. Editorial: Intensive management of cardiovascular disease patients with confirmed or suspected COVID-19 in area where Chagas disease is endemic. Front Med (Lausanne) 2023; 10:1167877. [PMID: 36936234 PMCID: PMC10020636 DOI: 10.3389/fmed.2023.1167877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Marcelo Arruda Nakazone
- Department of Cardiology and Cardiovascular Surgery, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil
- *Correspondence: Marcelo Arruda Nakazone
| | - Victor Sarli Issa
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
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22
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Hyder SA, Schoenl SA, Kesiena O, Ali SH, Davis K, Murrow JR. A 3-year analysis of the impact of COVID-19 pandemic on NSTEMI incidence, clinical characteristics, management, and outcomes. Catheter Cardiovasc Interv 2022; 101:10.1002/ccd.30530. [PMID: 36542751 PMCID: PMC9878007 DOI: 10.1002/ccd.30530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019-2022. METHODS This study included consecutive NSTEMI patients from March 14-May 9, 2019-2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia. RESULTS This study comprised 250 patients of whom 181 who were admitted during the COVID-19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door-to-angiography time from 29 h in 2019 to 19 h in 2020 [p = 0.01] and 20 h in 2021 [p = 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [p = 0.05] and 54.7% in 2021 [p < 0.01]. Median length-of-stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [p = 0.03]. There was no significant change in outcomes in COVID-19 cohorts compared to control year. CONCLUSIONS NSTEMI patients during the first 2 years of the COVID-19 pandemic were associated with reduced door-to-angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.
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Affiliation(s)
- Syed A. Hyder
- Medical College of Georgia at Augusta UniversityUniversity of Georgia Medical PartnershipAthensGeorgiaUSA
| | - Samantha A. Schoenl
- Medical College of Georgia at Augusta UniversityUniversity of Georgia Medical PartnershipAthensGeorgiaUSA
| | - Onoriode Kesiena
- Department of MedicinePiedmont Athens Regional HospitalAthensGeorgiaUSA
| | - Syed H. Ali
- Department of MedicineDell Seton Medical Center at the University of TexasAustinTexasUSA
| | - Kathryn Davis
- Department of CardiologyPiedmont Athens Regional HospitalAthensGeorgiaUSA
| | - Jonathan R. Murrow
- Department of CardiologyPiedmont Athens Regional HospitalAthensGeorgiaUSA
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23
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Su W, Zhu JG, Li WP, Chen H, Li HW. Gallstone disease and the risk of cardiac mortality in patients with acute coronary syndrome. Front Cardiovasc Med 2022; 9:1033959. [PMID: 36505391 PMCID: PMC9730328 DOI: 10.3389/fcvm.2022.1033959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Gallstone disease is a common gastrointestinal disorder, which has previously been reported to be associated with the incidence of cardiovascular disease. We aimed to investigate the association between gallstone disease and long-term outcomes in patients with acute coronary syndrome (ACS). Materials and methods A total of consecutive 13,975 ACS patients were included in this analysis. Gallstone disease in our study included both gallstones and cholecystectomy. The primary endpoint was cardiac mortality. The secondary outcome was all-cause mortality. Relative risks were estimated using Cox proportional hazards regression. Results During a median follow-up period of 2.96 years, 518 (4.2%) patients without gallstone disease and 62 (3.6%) patients in those with gallstone disease suffered cardiac death. After multivariable adjustment for established risk factors, subjects with gallstone disease had decreased risks of both cardiac mortality and all-cause mortality [hazard rate ratios (HR) = 0.72, 95% CI: 0.55-0.95 and HR = 0.75, 95% CI: 0.62-0.90, respectively]. In patients with performed cholecystectomy, the associations between gallstones and risks for cardiac mortality and all-cause mortality turned out to be non-significant. HRs varied across subgroups depending on the presence of selected established risk factors. Conclusion Presence of gallstone disease was associated with a significantly decreased risk of follow-up mortality in patients with ACS.
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Affiliation(s)
- Wen Su
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie-Gao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China,*Correspondence: Jie-Gao Zhu,
| | - Wei-Ping Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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24
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Sheiban I, Ge Z, Kan J, Zhang JJ, Santoso T, Munawar M, Ye F, Tian N, Chen SL. Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions. Front Cardiovasc Med 2022; 9:910313. [PMID: 36304537 PMCID: PMC9595024 DOI: 10.3389/fcvm.2022.910313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Provisional stenting (PS) is the main treatment for a majority of coronary bifurcation lesion and includes PS with 1-stent and PS with 2-stent. However, the treatment difference between PS with 1-stent and with 2-stent remains unclear in patients with the acute coronary syndrome (ACS) and coronary bifurcation lesions. Materials and methods Overall, 820 ACS patients with Medina 1,1,1 or 0,1,1 coronary bifurcation lesion who had completed 3-year follow-up were included and assigned to the PS with 1-stent (n = 519) or the PS with 2-stent (n = 301) according to the use of final stenting technique. The primary endpoint was the target lesion failure (TLF) at 3 years since stenting procedures. Results At 3-year follow-up, TLF occurred in 85 (16.4%) patients in the PS with 1-stent group and 69 (22.9%) in the PS with 2-stent group (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.06–2.17, p = 0.021), mainly driven by a higher rate of target lesion revascularization (TLR) in the PS with 2-stent group (13.0% vs. 8.3%, HR 1.65, 95% CI 1.04–2.61, p = 0.033). Complex bifurcations, side branch (SB) pretreatment, intravascular imaging guidance, and hyperlipidemia were the four predictors for 3-year TLF. SB pretreatment was associated with increased 3-year TLR, leading to an extremely higher 3-year TLF. Conclusion Provisional with 2-stent for patients with ACS is associated with a higher rate of 3-year TLF, mainly due to increased requirement of revascularization. SB pretreatment should be avoided for simple bifurcation lesion.
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Affiliation(s)
- Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Teguh Santoso
- Division of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
| | - Muhammad Munawar
- Division of Cardiology, Binawaluya Cardiac Center, Jakarta, Indonesia
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nailiang Tian
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China,*Correspondence: Shao-Liang Chen,
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Dziedzic EA, Tuzimek A, Gąsior JS, Paleczny J, Junka A, Kwaśny M, Dąbrowski M, Jankowski P. Investigation on the Association of Copper and Copper-to-Zinc-Ratio in Hair with Acute Coronary Syndrome Occurrence and Its Risk Factors. Nutrients 2022; 14:nu14194107. [PMID: 36235759 PMCID: PMC9571797 DOI: 10.3390/nu14194107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
The prevalence of coronary artery disease (CAD) increases every year; however, the impact of microelements on its underlying cause—atherosclerosis—is still unclear. Copper plays numerous regulatory roles in cardiovascular health and was suggested to influence the classic risk factors for CAD. The copper-to-zinc-ratio (Cu/Zn-ratio) reflects systemic oxidative stress–one of the factors in the complex pathogenesis of atherosclerosis. Hair incorporates metal ions during its growth; thus, it reflects the metal exposure that occurred over the last 4–8 weeks. The aim of the presented study was to verify the association between Cu and Cu/Zn-ratio content and the occurrence of acute coronary syndrome (ACS) in the hair of 133 patients who underwent coronary angiography due to suspected ACS. Additionally, association between Cu and Cu/Zn-ratio and selected risk factors for CAD was analyzed. Neither Cu nor Cu/Zn-ratio levels were associated with the occurrence of ACS, regardless of its type (UA/NSTEMI/STEMI). We did not find a significant association between Cu content in hair and risk factors for CAD. The Cu/Zn-ratio in hair was significantly correlated only with body mass index. The relationship of Cu content and Cu/Zn-ratio in hair with CAD, its risk factors and ACS appears to be complex and requires further well-designed research.
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Affiliation(s)
- Ewelina A. Dziedzic
- Medical Faculty, Lazarski University in Warsaw, 02-662 Warsaw, Poland
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Correspondence: ; Tel.: +48-792-207-779
| | - Agnieszka Tuzimek
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Jakub S. Gąsior
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Justyna Paleczny
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Adam Junka
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Mirosław Kwaśny
- Institute of Optoelectronics, Military University of Technology, 00-908 Warsaw, Poland
| | - Marek Dąbrowski
- Department of Cardiology, Bielanski Hospital, 01-809 Warsaw, Poland
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warszawa, Poland
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26
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Li Y, He S, Liu T, Cheng Z, Wang C, Shi Y, Liu J. Effect of high-sensitivity C-reactive protein on the relationship between haemoglobin A1c and cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a cohort study. Cardiovasc Diagn Ther 2022; 12:614-625. [PMID: 36329961 PMCID: PMC9622396 DOI: 10.21037/cdt-22-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/02/2022] [Indexed: 10/11/2023]
Abstract
BACKGROUND There are different opinions on haemoglobin A1c (HbA1c) in predicting cardiovascular events after percutaneous coronary intervention (PCI). Some factors may affect the ability of HbA1c to predict cardiovascular events, resulting in this inconsistency. Inflammation is a direct and whole-process participant in atherosclerosis. However, no one has studied the effect of inflammation on the correlation between HbA1c and cardiovascular events. Therefore, we aimed to test the hypothesis that high-sensitivity C-reactive protein (hsCRP) modulates HbA1c-related cardiovascular events in patients with the acute coronary syndrome (ACS) undergoing PCI. METHODS This was a retrospective cohort study. We enrolled patients with ACS who were hospitalized for PCI and followed up for 24 months. The primary outcome was the composite of major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unplanned repeat revascularization. We stratified the overall population by HbA1c tertiles and hsCRP median. The relationship between HbA1c, hsCRP, and cardiovascular events was analysed by the Cox proportional hazard regression model. RESULTS A total of 2,023 patients were enrolled in this study (age: 59.7±10.03 years old, 78.1% male patients). After the 24-month follow-up, 152 (7.51%) events occurred. Patients with hsCRP >1.21 mg/L had an increased cardiovascular risk compared with patients with hsCRP ≤1.21 mg/L [hazard ratio (HR) 1.58, 95% confidence interval (CI): 1.12-2.24, P=0.010]. We did not observe a significant correlation between HbA1c and cardiovascular events. Furthermore, we stratified patients by hsCRP ≤1.21 or >1.21 mg/L and found that the correlation between HbA1c and cardiovascular events was only significant in patients with hsCRP ≤1.21 mg/L (tertile 2 vs. tertile 1: HR 1.76, 95% CI: 0.79-3.90, P=0.165, tertile 3 vs. tertile 1: HR 3.03, 95% CI: 1.50-6.12, P=0.002; P=0.008 for trend) but not in patients with hsCRP >1.21 mg/L. CONCLUSIONS This study showed that hsCRP may affect the relationship between HbA1c and the risk of cardiovascular events in patients with ACS after PCI. This finding suggests that the risk of cardiovascular events may be underestimated when only HbA1c is used as a predictor of cardiovascular risk. HbA1c has a better predictive value in the absence or low levels of inflammation states represented by hsCRP as a predictor of cardiovascular events.
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Affiliation(s)
- Yingkai Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Songyuan He
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Tong Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Zichao Cheng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Cong Wang
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yuchen Shi
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Jinghua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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27
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Lin XL, Li QY, Zhao DH, Liu JH, Fan Q. Serum glycated albumin is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents: An observational study. Front Cardiovasc Med 2022; 9:943185. [PMID: 36237913 PMCID: PMC9551162 DOI: 10.3389/fcvm.2022.943185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies have confirmed the predicted value of serum glycated albumin (GA) in atherosclerotic cardiovascular disease. However, the relationship between GA and the development of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation has not been verified in patients with acute coronary syndrome (ACS). Materials and methods In this study, 797 patients diagnosed with ACS who underwent re-coronary angiography more than 6 months after the first successful DES-based percutaneous coronary intervention (PCI) were eventually included. Patients were categorized into two groups based on the median GA levels of 14.94%. Moreover, multivariate logistic regression analysis models and the net reclassification improvement and integrated differentiation improvement risk models were constructed to assess the relationship between the GA and DES-ISR in patients with ACS. Results The GA was significantly associated with an increased risk of DES-ISR, upon adjusting for confounding factors (as nominal variate: OR 1.868, 95% CI 1.191-2.932, P = 0.007; as continuous variate: OR 1.109, 95% CI 1.040-1.183, P = 0.002). The addition of GA to a baseline risk model had an incremental effect on the predictive value for DES-ISR (AUC: GA vs. baseline model, 0.714 vs. 0.692, comparison P = 0.017; category-free net reclassification improvement (NRI) 0.080, P = 0.035; integrated discrimination improvement (IDI) 0.023, P < 0.001). Conclusion GA level was significantly associated with a high risk of DES-ISR in patients with ACS treated with PCI. Moreover, the addition of the GA to a baseline risk model has an incremental effect on the predictive potential for DES-ISR.
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Affiliation(s)
| | | | | | | | - Qian Fan
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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28
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Munnur RK, Cheng K, Laggoune J, Talman A, Muthalaly R, Nerlekar N, Baey YW, Nogic J, Lin A, Cameron JD, Seneviratne S, Wong DTL. Quantitative plaque characterisation and association with acute coronary syndrome on medium to long term follow up: insights from computed tomography coronary angiography. Cardiovasc Diagn Ther 2022; 12:415-425. [PMID: 36033222 PMCID: PMC9412217 DOI: 10.21037/cdt-21-763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/25/2022] [Indexed: 11/09/2022]
Abstract
Background Computed tomography coronary angiography (CTCA) is an established imaging modality widely used for diagnosing coronary artery stenosis with expanding potential for comprehensive assessment of coronary artery disease (CAD). Lesion-based analyses of high-risk plaques (HRP) on CTCA may aid further in prognostication presenting with stable chest pain. We conduct qualitative and quantitative assessments to identify HRPs that are associated with acute coronary syndrome (ACS) on a medium to long term follow-up. Methods Retrospective cohort study of patients who underwent CTCA for suspected CAD. Obstructive stenosis (OS) is defined as ≥50% and the presence of HRP and its constituents: positive-remodelling (PR), low-attenuation-plaque (LAP; <56 HU), very-low-attenuation-plaque (vLAP; <30 HU) and spotty-calcification (SC) were recorded. A cross-sectional quantitative analysis of HRP was performed at the site of minimum-luminal-area (MLA). The primary endpoint was fatal or non-fatal ACS on follow-up. Results A total of 1,257 patients were included (mean age 61±14 years old and 51% male) with a median follow-up of 7.24 years (interquartile range 5.5 to 7.7 years). The occurrence of ACS was significantly higher in HRP (+) patients compared to HRP (−) patients and patients with no plaques (20.5% vs. 1.6% vs. 0.4%, log-rank test P<0.001). ACS was more frequent in HRP (+)/OS (+) patients (20.7%) compared to HRP (+)/OS (−) patients (8.6%), HRP (−)/OS (+) patients (1.8%) and HRP (−)/OS (−) patients (1.0%). OS, cross-sectional plaque area (PA) and the presence of vLAP identified those HRP lesions that were more likely to cause future ACS. Cross-sectional LAP area (<56 HU) in HRP lesions added incremental prognostic value to OS in predicting ACS (P=0.008). Conclusions The presence of OS and the LAP area at the site of MLA identify the HRP lesions that have the greatest association with development of future ACS.
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Affiliation(s)
- Ravi K Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jordan Laggoune
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Talman
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Rahul Muthalaly
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Yi-Wei Baey
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jason Nogic
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia.,South Australian Health Medical Research Institute (SAHMRI), Adelaide, Australia
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Bruinen AL, Frenk LDS, de Theije F, Kemper DWM, Janssen MJW, Rahel BM, Meeder JG, van 't Hof AWJ. Point-of-care high-sensitivity troponin-I analysis in capillary blood for acute coronary syndrome diagnostics point-of-care troponin-I for ACS diagnostics. Clin Chem Lab Med 2022; 60:1669-1674. [PMID: 35858956 DOI: 10.1515/cclm-2022-0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with acute coronary syndrome (ACS) should be referred promptly to the hospital to reduce mortality and morbidity. Differentiating between low-risk and high-risk patients remains a diagnostic challenge. Point-of-care testing can contribute to earlier disposition decisions for patients excluded from ACS. This study describes the validation of the Atellica® VTLi. Patient-side Immunoassay Analyzer for high-sensitivity troponin point-of-care (POC) analysis. (The Atellica VTLi is not available for sale in the USA. The products/features (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed). METHODS A total of 152 patients with acute chest pain admitted at the cardiac emergency department (ED) were included in the study. Capillary blood was compared with a whole blood and plasma sample obtained by venipuncture. All samples were analyzed using the Atellica VTLi Patient-side Immunoassay Analyzer; in addition, plasma was analyzed by a central lab immunoassay analyzer. RESULTS No significant difference was observed between venous whole blood vs. plasma analyzed by the Atellica VTLi Patient-side Immunoassay Analyzer. The difference between capillary blood and venous blood showed a constant bias of 7.1%, for which a correction factor has been implemented. No clinically relevant differences were observed for the capillary POC results compared to plasma analyzed with a standard immunoassay analyzer. CONCLUSIONS The Atellica VTLi Patient-side Immunoassay Analyzer for high-sensitivity troponin analysis shows equivalent results for all sample types, including capillary blood. No clinically relevant discordances were observed between capillary POC and central laboratory results. With additional studies, this could pave the way towards rapid testing of high-sensitivity troponin in the ambulance or the general practitioner's office without the need for hospitalization of patients with acute chest pain.
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30
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Affiliation(s)
- Yining Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhao Wang
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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31
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Chen R, Liu C, Zhou P, Li J, Zhou J, Wang Y, Zhao X, Chen Y, Yan S, Song L, Zhao H, Yan H. Prognostic Impacts of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Coronary Syndrome Patients Without Heart Failure. Front Pharmacol 2022; 13:663811. [PMID: 35479321 PMCID: PMC9037138 DOI: 10.3389/fphar.2022.663811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/03/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Despite the recommendations from mainstream guidelines, the use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) for acute coronary syndrome (ACS) patients without heart failure (HF) is controversial, as its evidence is lacking in the era of reperfusion and intensive secondary preventions. This study aimed to investigate the impacts of ACEI/ARB on outcomes of ACS patients without HF treated by percutaneous coronary intervention (PCI). Methods: A total of 2,397 non-HF ACS patients treated by PCI were retrospectively recruited. Prognostic impacts of ACEI/ARB were assessed by unadjusted analysis, followed by propensity score matching (PSM) and propensity score matching weight (PSMW) analysis to control the between-group differences. The primary outcome was a composite of all-cause death and recurrent myocardial infarction (MI). Results: Among the included patients, 1,805 (75.3%) were prescribed with ACEI/ARB at discharge. The median follow-up time was 727 (433–2016) days, with 129 (5.4%) primary endpoint events, consisting of 55 (2.3%) cases of all-cause death and 74 (3.1%) cases of recurrent MI. The use of ACEI/ARB was not associated with significant risk reduction of primary endpoint events in unadjusted analysis (hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.64–1.39, p = 0.779), PSM analysis (HR: 0.94, 95% CI: 0.60–1.47, p = 0.784), and PSMW analysis (HR: 0.91, 95% CI: 0.55–1.49, p = 0.704). Similar results were observed for secondary outcomes of all-cause death, cardiac death, and recurrent MI. Conclusion: For ACS patients without HF, the use of ACEI/ARB was not associated with lower risk of death or recurrent MI after PCI.
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Affiliation(s)
- Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shaodi Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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32
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Lupu L, Taha L, Banai A, Shmueli H, Borohovitz A, Matetzky S, Gabarin M, Shuvy M, Beigel R, Orvin K, Minha S, Shacham Y, Banai S, Glikson M, Asher E. Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients. Clin Cardiol 2022; 45:359-369. [PMID: 35266561 PMCID: PMC9019882 DOI: 10.1002/clc.23781] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background The European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation (non‐ST‐segment elevation myocardial infarction [NSTEMI]) has recommended immediate (<2 h) percutaneous coronary intervention (PCI) in very‐high risk patients and early (<24 h) PCI in high‐risk patients. Hypothesis To examine the ESC NSTEMI guidelines adherence in a nationwide survey in Israel using the Acute Coronary Syndrome Israeli Survey (ACSIS). We hypothesized that adherence to the guidlines' recommnded PCI timing in NSTEMI pateints will be inadequate, partly due to the inconsistent evidence regarding its effect on clinical outcomes. Methods All NSTEMI patients who underwent PCI during the ACSIS surveys in 2016 and 2018 were included in the analysis. Results Out of 1793 NSTEMI patients, 1643 (92%) patients underwent PCI, and door to balloon time was documented in 1078 of them. One hundred and fifty‐six (14.5%) patients and 922 (85.5%) patients were defined as very high‐risk and high‐risk NSTEMI patients, respectively. Of the very high‐risk NSTEMI patients, only 10 (6.4%) underwent immediate coronary angiography, and 50 (32.1%) underwent early coronary angiography. Acute heart failure 139 (89.1%) was the main reason for including NSTEMI patients in the very high‐risk category. Of the high‐risk patients, early coronary angiography was performed in only 405 (43.9%) patients. Patients in whom coronary angiography was postponed were older and had more comorbidities. Conclusions Despite guidelines recommendations for immediate and early PCI in very high‐risk and high‐risk NSTEMI patients, respectively, most patients do not undergo immediate or early PCI according to contemporary guidelines. Further studies are needed to better understand the reasons for guidelines' nonadherence in those high‐risk patients.
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Affiliation(s)
- Lior Lupu
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Louay Taha
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ariel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hezzy Shmueli
- Department of Cardiology, Soroka Medical Center, Beer-Sheva, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ariel Borohovitz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mustafa Gabarin
- Dep-artment of Cardiology, Meir Medical Center, Kfar Saba, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mony Shuvy
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Roy Beigel
- Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sa'ar Minha
- Department of Cardiology, Shamir Medical Center, Be'er Ya'akov, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elad Asher
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Ma XT, Shao QY, Li QX, Yang ZQ, Han KN, Liang J, Shen H, Liu XL, Zhou YJ, Wang ZJ. Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 8:773200. [PMID: 34977188 PMCID: PMC8716456 DOI: 10.3389/fcvm.2021.773200] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Malnutrition has been shown to be associated with adverse cardiovascular outcomes in many patient populations. Aims: To investigate the prognostic significance of malnutrition as defined by nutritional risk index (NRI) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and whether NRI could improve the GRACE score based prognostic models. Methods: This study applied NRI among 1,718 patients with ACS undergoing PCI. Patients were divided into three nutritional risk groups according to their baseline NRI: no nutritional risk (NRI ≥ 100), mild nutritional risk (97.5 ≤ NRI <100), and moderate-to-severe nutritional risk (NRI <97.5). The primary endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal stroke, non-fatal myocardial infarction, or unplanned repeat revascularization. Results: During a median follow-up of 927 days, 354 patients developed MACE. In the overall population, compared with normal nutritional status, malnutrition was associated with increased risk for MACE [adjusted HR for mild and moderate-to-severe nutritional risk, respectively: 1.368 (95%CI 1.004–1.871) and 1.473 (95%CI 1.064–2.041)], and NRI significantly improved the predictive ability of the GRACE score for MACE (cNRI: 0.070, P = 0.010; IDI: 0.005, P < 0.001). In the diabetes subgroup, malnutrition was associated with nearly 2-fold high adjusted risk of MACE, and the GRACE score combined with NRI appeared to have better predictive ability than that in the overall population. Conclusion: Malnutrition as defined by NRI was independently associated with MACE in ACS patients who underwent PCI, especially in individuals with diabetes, and improved the predictive ability of the GRACE score based prognostic models.
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Affiliation(s)
- Xiao-Teng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiao-Yu Shao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiu-Xuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhi-Qiang Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kang-Ning Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao-Li Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhi-Jian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Kumar S, Ali W, Mishra S, Pradhan A, Sethi R, Kushwaha R, Singh US, Perrone MA. Circulating Soluble Lectin-like Oxidized Low-Density Lipoprotein Receptor-1 (sLOX-1): A Diagnostic Indicator across the Spectrum of Acute Coronary Syndrome. J Clin Med 2021; 10:jcm10235567. [PMID: 34884269 PMCID: PMC8658522 DOI: 10.3390/jcm10235567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Cardiac troponin is the best marker to diagnose acute coronary syndrome (ACS). However, early diagnosis using markers for plaque instability may be of significance. Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) plays an important role in the pathogenesis of atherosclerosis plaque rupture and may be a potential biomarker of coronary artery disease (CAD), including ACS. The current study aims to evaluate sLOX-1 levels in the sera of patients with ACS as an independent marker of CAD with other established diagnostic markers and assess its level before and after percutaneous intervention (PCI) in predicting the risk of future recurrence of ACS. Methods: Peripheral blood was obtained from a total of 160 patients, including patients who underwent coronary angiography (n = 18, group I), patients of stable CAD who underwent percutaneous intervention (n = 50, group II), patients of the acute coronary syndrome (n = 64, group III), and healthy controls (n = 28, group IV). A serum sLOX-1 concentration was measured by the enzyme-linked immunosorbent assay (ELISA). Results: The results obtained showed a statistically significant raised level of sLOX-1 in pre/post PCI patients of stable CAD/ACS with male preponderance. The area under the curve for sLOX-1 was 0.925 for cases that are discriminated from controls with sensitivity and specificity of 87.88 and 100%, respectively. SLOX-1 showed 100% sensitivity and specificity in the discrimination of the stable CAD that underwent PCI vs. control with an AUC of 1.00. The recurrence of coronary artery disease was observed in 9 out of 132 (6.8%) cases. The post-interventional sLOX-1 level was significantly different and higher in recurrent cases (p = 0.027) of ACS/CAD. Conclusions: sLOX-1 was a useful biomarker of stable CAD/ACS and has a potential in the risk prediction of a future recurrence of coronary artery disease.
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Affiliation(s)
- Sandeep Kumar
- Department of Pathology, King George’s Medical University, Lucknow 226003, India; (S.K.); (W.A.); (R.K.); (U.S.S.)
| | - Wahid Ali
- Department of Pathology, King George’s Medical University, Lucknow 226003, India; (S.K.); (W.A.); (R.K.); (U.S.S.)
| | - Sridhar Mishra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, India;
| | - Akshyaya Pradhan
- Department of Cardiology, Lari Cardiology Centre, King George’s Medical University, Lucknow 226003, India; (A.P.); (R.S.)
| | - Rishi Sethi
- Department of Cardiology, Lari Cardiology Centre, King George’s Medical University, Lucknow 226003, India; (A.P.); (R.S.)
| | - Rashmi Kushwaha
- Department of Pathology, King George’s Medical University, Lucknow 226003, India; (S.K.); (W.A.); (R.K.); (U.S.S.)
| | - Uma Shankar Singh
- Department of Pathology, King George’s Medical University, Lucknow 226003, India; (S.K.); (W.A.); (R.K.); (U.S.S.)
| | - Marco Alfonso Perrone
- Department of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence:
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Lu G, Ye W, Ou J, Li X, Tan Z, Li T, Liu H. Coronary Computed Tomography Angiography Assessment of High-Risk Plaques in Predicting Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:743538. [PMID: 34660742 PMCID: PMC8517134 DOI: 10.3389/fcvm.2021.743538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 01/07/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is a comprehensive, non-invasive and cost-effective imaging assessment approach, which can provide the ability to identify the characteristics and morphology of high-risk atherosclerotic plaques associated with acute coronary syndrome (ACS). The development of CCTA and latest advances in emerging technologies, such as computational fluid dynamics (CFD), have made it possible not only to identify the morphological characteristics of high-risk plaques non-invasively, but also to assess the hemodynamic parameters, the environment surrounding coronaries and so on, which may help to predict the risk of ACS. In this review, we present how CCTA was used to characterize the composition and morphology of high-risk plaques prone to ACS and the current role of CCTA, including emerging CCTA technologies, advanced analysis, and characterization techniques in prognosticating the occurrence of ACS.
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Affiliation(s)
- Guanyu Lu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiehao Ou
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyun Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zekun Tan
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tingyu Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
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De Roeck F, Scott B, Convens C, Vermeersch P. Spontaneous coronary artery dissection in young female acute coronary syndrome patients: a single-centre retrospective cohort study. Acta Cardiol 2021; 76:727-731. [PMID: 32552543 DOI: 10.1080/00015385.2020.1778373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS), rapidly gaining recognition over the last decade. SCAD occurs predominantly in young, otherwise healthy women and coronary angiogram often lacks typical (atherosclerotic) features. Therefore, SCAD remains notably underdiagnosed. As optimal treatment strategy differs greatly from atherosclerotic ACS, early (differential) diagnosis is crucial. PURPOSE/METHODS In this paper, all coronary angiograms performed for ACS in women up to 50 years of age were retrospectively reviewed by three independent interventional cardiologists. RESULTS The obtained insights are comparable to recent literature. SCAD incidence was 26% in this cohort. Left anterior descending coronary artery was the main affected vessel with SCAD subtype 2B as predominant angiographic presentation. Correct diagnosis during index procedure was poor with only 33% accuracy. Nevertheless, a favourable trend over time was noted. Percutaneous coronary intervention success was 56%, as in 44% of patients initial stenting was complicated by progressive dissection. Overall, outcome was excellent with no reported fatalities. CONCLUSION SCAD remains an underdiagnosed subtype of ACS and the importance of increasing awareness amongst (interventional) cardiologists needs to be emphasised.
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Affiliation(s)
- Frederic De Roeck
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
| | - Carl Convens
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Cardiology Department, ZNA Hartcentrum – ZNA Middelheim, Antwerp, Belgium
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Włodarczak A, Rola P, Szudrowicz M, Łanocha M, Barycki M, Kulczycki JJ, Gosiewska A, Turkiewicz K, Lesiak M, Doroszko A. Sex Differences in the Clinical Features and Outcomes of Patients with Acute Coronary Syndrome Treated with Two Generations (Absorb and Magmaris) of Bioresorbable Vascular Scaffolds. J Clin Med 2021; 10:3768. [PMID: 34501216 DOI: 10.3390/jcm10173768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/15/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Despite the developments in percutaneous coronary interventions (PCI), women are still more likely than men to have unfavorable outcomes after PCI performed in Acute Coronary Syndrome (ACS). The mechanisms of this phenomena are not fully understood. Potential benefits of bioresorbable scaffolds (BRS) may be particularly expressed in the female population. Nevertheless, the data available currently are inconsistent and limited. This study evaluated the gender-related differences in the short-term clinical outcomes in ACS patients treated with implantation of two generations of BRS (first generation, Absorb; second generation, Magmaris). Methods: The study was divided into two arms. To the first one, we qualified 160 patients with ACS treated with PCI who received 210 Absorb scaffolds. The second arm was composed of 193 patients with ACS who underwent PCI with Magmaris implantation. Results: There were no significant sex-related differences in primary endpoints (cardiovascular-death, myocardial infarction, in-stent thrombosis) or principal secondary endpoints (of target-lesion failure, scaffold restenosis, death from any reason, other cardiovascular events) in either generation of BRS in a 1-year follow-up. Conclusions: Both genders tended to have a similar outcome in routine clinical practice following BRS implantation due to ACS. The magnesium bioresorbable scaffold (Magmaris) early outcome seemed to be more favorable in comparison to the Absorb scaffold.
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Włodarczak A, Łanocha M, Szudrowicz M, Barycki M, Gosiewska A, Kulczycki JJ, Lesiak M, Doroszko A, Rola P. The 1-Year Safety and Efficacy Outcomes of Magmaris, Novel Magnesium Bioresorbable Vascular Scaffolds in Diabetes Mellitus Patients with Acute Coronary Syndrome. J Clin Med 2021; 10:jcm10143166. [PMID: 34300332 PMCID: PMC8304146 DOI: 10.3390/jcm10143166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Diabetes mellitus (DM) is one of the major risk factors contributing to Acute Coronary Syndromes (ACS) and is associated with an increased risk of adverse clinical outcomes following percutaneous coronary intervention (PCI), even when the second generation of drug-eluting stents (DES) is used. In order to overcome the disadvantages of permanent caging of a vessel with metallic DES, bioresorbable scaffold (BRS) technology has been recently developed. However, the prognosis of patients with DM and ACS treated with PCI via subsequent implantation of Magmaris (Biotronik, Berlin, Germany)—a novel magnesium-bioresorbable scaffold—is poorly investigated. Methods: A total of 193 consecutive subjects with non-ST elevation acute coronary syndrome (NSTE-ACS) who, from October 2016 to March 2020, received one or more Magmaris scaffolds were enrolled in this study. The diabetic group was compared with non-diabetic subjects. Results: There were no significant differences in the occurrence of primary endpoints (cardiovascular death, myocardial infarction, and in-stent thrombosis) and principal secondary endpoints (target-lesion failure, scaffold restenosis, death from any reason, and other cardiovascular events) between the two compared groups in a 1-year follow-up period. Conclusions: The early 1-year-outcome of magnesium bioresorbable scaffold (Magmaris) seems to be favorable and suggests that this novel BRS is safe and effective in subjects with NSTE-ACS and co-existing DM.
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Affiliation(s)
- Adrian Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (M.S.); (J.J.K.)
| | | | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (M.S.); (J.J.K.)
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital in Legnica, Iwaszkiewicza Str. 5, 59-220 Legnica, Poland;
| | - Alicja Gosiewska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, 00-662 Warsaw, Poland;
| | - Jan Jakub Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (M.S.); (J.J.K.)
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-491 Poznan, Poland;
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Piotr Rola
- Department of Cardiology, Provincial Specialized Hospital in Legnica, Iwaszkiewicza Str. 5, 59-220 Legnica, Poland;
- Correspondence: ; Tel.: +48-767-211443
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van den Berg VJ, Umans VAWM, Brankovic M, Oemrawsingh RM, Asselbergs FW, van der Harst P, Hoefer IE, Kietselaer B, Crijns HJGM, Lenderink T, Oude Ophuis AJ, van Schaik RH, Kardys I, Boersma E, Akkerhuis KM. Stabilization patterns and variability of hs-CRP, NT-proBNP and ST2 during 1 year after acute coronary syndrome admission: results of the BIOMArCS study. Clin Chem Lab Med 2021; 58:2099-2106. [PMID: 32383686 DOI: 10.1515/cclm-2019-1320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/13/2020] [Indexed: 11/15/2022]
Abstract
Objectives Details of the biological variability of high-sensitivity C-reactive protein (hs-CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and ST2 are currently lacking in patients with acute coronary syndrome (ACS) but are crucial knowledge when aiming to use these biomarkers for personalized risk prediction. In the current study, we report post-ACS kinetics and the variability of the hs-CRP, NT-proBNP and ST2. Methods BIOMArCS is a prospective, observational study with high frequency blood sampling during 1 year post-ACS. Using 1507 blood samples from 191 patients that remained free from adverse cardiac events, we investigated post-ACS kinetics of hs-CRP, NT-proBNP and ST2. Biological variability was studied using the samples collected between 6 and 12 months after the index ACS, when patients were considered to have stable coronary artery disease. Results On average, hs-CRP rose peaked at day 2 and rose well above the reference value. ST2 peaked immediately after the ACS but never rose above the reference value. NT-proBNP level rose on average during the first 2 days post-ACS and slowly declined afterwards. The within-subject variation and relative change value (RCV) of ST2 were relatively small (13.8%, RCV 39.7%), while hs-CRP (41.9%, lognormal RCV 206.1/-67.3%) and NT-proBNP (39.0%, lognormal RCV 185.2/-64.9%) showed a considerable variation. Conclusions Variability of hs-CRP and NT-proBNP within asymptomatic and clinically stable post-ACS patients is considerable. In contrast, within-patient variability of ST2 is low. Given the low within-subject variation, ST2 might be the most useful biomarker for personalizing risk prediction in stable post-ACS patients.
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Affiliation(s)
- Victor J van den Berg
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Milos Brankovic
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Rohit M Oemrawsingh
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, Utrecht, The Netherlands.,University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Netherlands Heart Institute, Utrecht, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - Imo E Hoefer
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Anton J Oude Ophuis
- Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Working Group on Cardiovascular Research the Netherlands (WCN), Utrecht, The Netherlands
| | - Ron H van Schaik
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Isabella Kardys
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Eric Boersma
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands.,Erasmus MC, Department of Cardiology, Room Na 342, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
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Pradella S, Zantonelli G, Grazzini G, Cozzi D, Danti G, Acquafresca M, Miele V. The Radiologist as a Gatekeeper in Chest Pain. Int J Environ Res Public Health 2021; 18:6677. [PMID: 34205792 PMCID: PMC8296491 DOI: 10.3390/ijerph18126677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022]
Abstract
Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient's stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.
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Affiliation(s)
- Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Giulia Zantonelli
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Giulia Grazzini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Diletta Cozzi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Manlio Acquafresca
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
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Włodarczak A, Rola P, Barycki M, Kulczycki JJ, Szudrowicz M, Lesiak M, Doroszko A. Rota-Lithotripsy-A Novel Bail-Out Strategy for Calcified Coronary Lesions in Acute Coronary Syndrome. The First-in-Man Experience. J Clin Med 2021; 10:1872. [PMID: 33925916 PMCID: PMC8123389 DOI: 10.3390/jcm10091872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
Heavy calcification remains one of the greatest challenges in the treatment of coronary artery disease (CAD), especially in subjects with an acute coronary syndrome (ACS). In the present case series study of high-risk patients with ACS, including both STEMI and NSTEMI, we performed a rota-lithotripsy-a combination of rotational atherectomy with subsequent intravascular lithotripsy-as a novel bail-out strategy to facilitate stent delivery in a tortuous calcified coronary artery.
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Affiliation(s)
- Adrian Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (J.J.K.); (M.S.)
| | - Piotr Rola
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland;
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland;
| | - Jan Jakub Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (J.J.K.); (M.S.)
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (J.J.K.); (M.S.)
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-491 Poznan, Poland;
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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Salim HY, Lwin K, Khoo C, Wilson D. Management of hyperlipidaemia following acute coronary syndrome: a retrospective audit. Br J Cardiol 2021; 28:17. [PMID: 35747451 PMCID: PMC8822512 DOI: 10.5837/bjc.2021.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Control of hypercholesterolaemia is an effective way of reducing cardiovascular events in patients at elevated risk of cardiovascular disease. Repeat cholesterol measurement is a good practice, but is rarely performed, with clinicians often adopting a 'fire and forget' policy. A retrospective audit at two cardiac centres in the West Midlands was performed to evaluate performance in lipid measurement following initiation of lipid therapy, and to evaluate whether all patients with an indication for a proprotein convertase subtisilin/kexin 9 inhibitor (PCSK9i) following acute coronary syndrome (ACS) were identified according to National Institute for Health and Care Excellence (NICE) recommendations. We identified 167/7,048 patients with a total cholesterol of ≥7.2 mmol/L, of which 33 patients had previous vascular disease affecting more than one territory (polyvascular disease). Total cholesterol threshold ≥7.2 mmol/L was chosen in order to achieve a sufficient number of samples for the audit to be completed successfully. Low-density lipoprotein (LDL) level was performed in 93 patients on admission and repeated within three months in 20 patients (13%). Overall, 48 patients (30%) had any repeat LDL recorded. Of this group, 10 patients met the NICE criteria for PCSK9i. Failure to repeat LDL levels in patients following hospital discharge with a diagnosis of ACS, is likely to explain the small number of patients identified as being eligible for PCSK9i. Underreporting of comorbid vascular disease also prevents the identification of patients at very high risk. We advocate re-establishing the practice of routine repeat fasting lipids measurement following discharge from hospital in order to correctly identify patients who may be eligible for optimal lipid-lowering therapy.
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Affiliation(s)
- Handi Yuwono Salim
- Cardiology Specialist Registrar Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD
| | - Kaung Lwin
- Cardiology Specialist Registrar Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG
| | - Chee Khoo
- Consultant Cardiologist Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG
| | - David Wilson
- Consultant Cardiologist Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD
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Chen WL, Lin YB, Chang TC, Lin YR. AMBtalk: A Cardiovascular IoT Device for Ambulance Applications. Sensors (Basel) 2021; 21:2781. [PMID: 33920835 DOI: 10.3390/s21082781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
Acute Coronary Syndrome (ACS) and other heart emergency events require immediate chest pain identification in the ambulance. Specifically, early identification and triage is required so that patients with chest pain can be quickly sent to a hospital with appropriate care facilities for treatment. In the traditional approach, ambulance personnel often use symptom checklists to examine the patient and make a quick decision for the target hospital. However, not every hospital has specialist facilities to handle such emergency cases. If the result of the subsequent cardiac enzyme test performed at the target hospital strongly suggests the occurrence of myocardial infarction, the patient may need to be sent to another hospital with specialist facilities, such as Percutaneous Coronary Intervention. The standard procedure is time consuming, which may result in delayed treatment and reduce patent survival rate. To resolve this issue, we propose AMBtalk (Ambulance Talk) for accurate, early ACS identification in an ambulance. AMBtalk provides real-time connection to hospital resources, which reduces the elapsed time for treatment, and therefore, improves the patient survival rate. The key to success for AMBtalk is the development of the AllCheck® Internet of Things (IoT) device, which can accurately and quickly provide cardiovascular parameter values for early ACS identification. The interactions between the AllCheck® IoT device, the emergency medical service center, the ambulance personnel and the hospital are achieved through the AMBtalk IoT server in the cloud network. AllCheck® outperforms the existing cardiovascular IoT device solutions for ambulance applications. The testing results of the AllCheck® device show 99% correlation with the results of the hospital reports. Due to its excellent performance in quick ACS identification, the AllCheck® device was awarded the 17th Taiwan Innovators Award in 2020.
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Song N, Luo JY, Zhao Q, Zhang JY, Liu F, Li XM, Yang YN. MALAT1 gene rs600231 polymorphism positively associated with acute coronary syndrome in Chinese population: a case-control study. Cardiovasc Diagn Ther 2021; 11:435-446. [PMID: 33968621 DOI: 10.21037/cdt-20-906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been recognized as a major player in the pathogenesis of coronary artery disease (CAD). The aim of the study was to determine the association between polymorphisms of the MALAT1 gene and acute coronary syndrome (ACS) in a Chinese population in Xinjiang. Methods In the case-control study, we genotyped three nucleotide polymorphisms (rs3200401, rs4102217, rs600231) of the MALAT1 gene using SNPscanTM typing assays (1,053 controls and 929 ACS patients). Furthermore, we explored a predictive model using MALAT1 rs600231 and clinical variables to predict the risk of ACS. Finally, the relative expression of long noncoding RNA (lncRNA) MALAT1 was also measured in 92 ACS patients and 92 controls using quantitative real-time polymerase chain reaction (qRT-PCR). Results The prevalence of the GG genotype of rs600231 in ACS group was higher than that in control group (15.7% vs. 14.7%, P=0.048). The dominant model differed (AG + GG vs. AA) and the G allele of rs600231 in ACS group was higher than that in control group (for dominant model: 66.2% vs. 60.9%, P=0.014; for allele: 41.0% vs. 37.8%, P=0.042). Multivariate logistic regression analysis and the predictive nomogram model showed that the dominant model of rs600231 remained an independent risk factor for ACS [odds ratio (OR) =1.32, 95% confidence interval (CI): 1.07-1.63, P=0.009]. The area under the receiver operating characteristic (ROC) curve (AUC) for the nomogram model for the prediction of ACS was 0.738 (95% CI: 0.716-0.761). In addition, in the AG and GG phenotypes, the relative expression of lncRNA MALAT1 was significantly higher in ACS patients than in controls with the same phenotypes (P<0.05). Among ACS group, compared to other genotype carriers, the relative expression level of MALAT1 in GG genotype carriers was higher (P<0.05). Conclusions The present study suggested that the AG and GG genotype of rs600231 in MALAT1 gene was independently associated with ACS, and could be a risk genetic marker of ACS in a Chinese population in Xinjiang.
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Affiliation(s)
- Ning Song
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medicine Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun-Yi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medicine Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qian Zhao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jin-Yu Zhang
- Department of Rehabilitation, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medicine Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiao-Mei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medicine Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medicine Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Chen H, Wang J, Xie L, Shen YL, Wang HM, Zheng KL, Zhang Q. Correlation between serum cartilage oligomeric matrix protein and major adverse cardiovascular events within 30 days in patients with acute coronary syndrome. Ann Transl Med 2021; 9:353. [PMID: 33708980 PMCID: PMC7944313 DOI: 10.21037/atm-21-333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background We studied the correlation between cartilage oligomeric matrix protein (COMP) and major adverse cardiovascular events in patients with acute coronary syndrome (ACS) within 30 days. Methods This study included 170 ACS patients who were hospitalized in the Second Affiliated Hospital of Nantong University from August 2017 to April 2019. Serum COMP level was measured at baseline. The enrolled patients were followed up for 30 days and grouped according to the occurrence of major adverse cardiovascular events (MACE) during follow-up. Among the 170 patients, 23 patients had MACE during hospitalization (MACE group), and 147 patients had no MACE (no MACE group). Results The serum COMP levels in the MACE group were significantly higher than those of the non-MACE group [84.85 (51.55, 141.75) vs. 20.65 (9.11, 46.31) ng/mL, respectively, P<0.05]. The area under the receiver operating characteristic (ROC) curve for COMP in predicting the occurrence of MACE within 30 days was 0.839, with a cutoff level of 39.9 ng/mL [95% confidence interval (CI): 0.774–0.890], 86.96% sensitivity, and 72.79% specificity (P<0.0001). Multivariate logistic regression analysis showed that serum COMP could be used as an independent predictor of MACE within 30 days in ACS patients [odds ratio (OR): 1.024, 95% CI: 1.0133–1.0349, P=0.0001]. Conclusions Serum COMP is associated with the short-term prognosis of ACS patients. High serum COMP levels can be used as a predictor of MACE within 30 days in ACS patients.
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Affiliation(s)
- Hao Chen
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Jing Wang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ling Xie
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ya-Li Shen
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Hui-Min Wang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Kou-Long Zheng
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Qing Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, China
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Jamil S, Jamil G, Mesameh H, Qureshi A, AlKaabi J, Sharma C, Aziz F, Al-Shamsi AR, Yasin J. Risk factor comparison in young patients presenting with acute coronary syndrome with atherosclerotic coronary artery disease vs. angiographically normal coronaries. Int J Med Sci 2021; 18:3526-3532. [PMID: 34522179 PMCID: PMC8436094 DOI: 10.7150/ijms.60869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/07/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Acute myocardial infarction is a relatively rare phenomenon in the young population. The incidence has nevertheless increased from years past, likely due to the presence of multiple risk factors from an increasingly younger age. Regardless of whether they have atherosclerotic coronary artery disease or normal coronary angiogram, young patients with risk factors for coronary artery disease (CAD), chest pain, and positive troponin, are initially treated in a similar fashion. Our goal was to shed light on whether risk factors between these two groups differ to help guide physicians in clinically determining whether or not an atherosclerotic cardiovascular event has occurred, as well as to potentially identify young patients at risk of acute coronary syndrome (ACS) despite normal coronary arteries. Methods: A retrospective cross sectional study was undertaken over an 8 year period at Tawam Hospital. 576 patients aged 50 or under who underwent coronary angiography were selected for the study. Medical records were analyzed for the patient's demographics and CAD risk factor profile, including the following variables: family history of CAD, smoking status, Body Mass Index category, lipid profile, and diagnosis of hyperlipidemia, diabetes, or hypertension. Details of the coronary angiogram were also reviewed. Results: Statistically significant outcomes included a higher prevalence of diabetes, hyperlipidemia, and smoking history in patients with CAD compared to the patients with normal coronary angiogram. Diabetes was one of the strongest risk factors in CAD patients, with an odds ratio of 1.98 (p= 0.011), followed by hyperlipidemia at 1.85 (p= 0.021). Smoking history had an odds ratio of 2.93 (p <0.001). Conclusion: Risk factors were present in both groups, but significantly more in the CAD group. No particular risk factor stood out for the development of ACS in those with normal coronary arteries, other than mean BMI being slightly higher in this group. Based on our analysis, no single variable can accurately predict the risk for ACS in normal coronaries. To our knowledge, few studies have been done in the young population with angiographically normal coronary arteries to determine possible risk factors for development of ACS. Further research needs to be done to determine whether the risk factors that were common amongst both groups are coincidental, or a cause of ACS in those with normal coronary arteries.
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Affiliation(s)
- Sarah Jamil
- Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Gohar Jamil
- Department of Cardiology, Tawam Hospital, Al Ain, United Arab Emirates.,Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hanaa Mesameh
- Nursing, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Juma AlKaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Javed Yasin
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Radmilovic J, Di Vilio A, D'Andrea A, Pastore F, Forni A, Desiderio A, Ragni M, Quaranta G, Cimmino G, Russo V, Scherillo M, Golino P. The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome. J Clin Med 2020; 9:E3926. [PMID: 33287336 DOI: 10.3390/jcm9123926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 01/03/2023] Open
Abstract
Among acute coronary syndrome (ACS) patients, 15% have concomitant cancer, especially in the first 6 months after their diagnosis, as well as in advanced metastatic stages. Lung, gastric, and pancreatic cancers are the most frequent malignancies associated with ACS. Chemotherapy and radiotherapy exert prothrombotic, vasospastic, and proinflammatory actions. The management of cancer patients with ACS is quite challenging: percutaneous revascularization is often underused, and antiplatelet and anticoagulant pharmacological therapy should be individually tailored to the thrombotic risk and to the bleeding complications. Sometimes oncological patients also show different degrees of thrombocytopenia, which further complicates the pharmacological strategies. The aim of this review is to summarize the current evidence regarding the treatment of ACS in cancer patients and to suggest the optimal management and therapy to reduce the risk of adverse coronary events after ACS in this high-risk population.
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Gul M, Sheikh M, Chaudhry A, Gerges L, Al Halabi H, Feldman E, Chaudhry A. Role of cardiac nuclear stress perfusion exam after computed tomographic coronary angiogram for evaluation of obstructive coronary artery disease in patients with chest pain. J Thorac Dis 2020; 12:5067-5077. [PMID: 33145083 PMCID: PMC7578483 DOI: 10.21037/jtd-2019-pitd-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Clinical workup for chest pain varies among institutions. Acute coronary syndrome (ACS) is the primary diagnosis to rule out in the differential diagnosis, due to its associated mortality and morbidity. Although studies have demonstrated efficacy of coronary computed tomographic angiography (CCTA) in diagnosis obstructive coronary artery disease (CAD), there is limited evidence in the clinical value of performing cardiac nuclear stress perfusion imaging [myocardial perfusion imaging (MPI)] exam in patients with chest pain after undergoing CCTA. We aim to evaluate clinical value of follow-up nuclear cardiac MPI in patients with chest pain who have undergone recent CCTA. Methods A total of 1,000 patients were evaluated in this IRB approved retrospective study who presented with symptoms of ACS. Patients who had elevated troponin or abnormal electrocardiogram (ECG) findings at initial presentation or prior to cardiac nuclear MPI were excluded from the study. All patients who underwent 64- or 320-detector row ECG-gated CCTA as well as a follow-up nuclear MPI. Patients who had diagnostics studies limited by artifact [e.g., suboptimal intravenous (IV) contrast bolus in CCTA, motion artifact on CCTA or MPI, etc.] were excluded. Results One hundred patients met the inclusion criteria. Patient demographics include average age 64.3 [32–89] years, 59 male, 41 females. Ninety-five/100 patients had at least one vessel with 50–70% coronary artery diameter stenosis measured on CCTA. There were no focal perfusion abnormalities identified on cardiac nuclear MPI in patients with less than 70% stenosis diagnosed on CCTA. Five percent of patients were identified with coronary arterial narrowing greater than 70% on CCTA and all 5 of these patients have evidence of abnormal cardiac nuclear stress test (perfusion abnormalities, chest pain, abnormal ECG). Conclusions In low-to-intermediate risk patients with chest pain and evidence of non-critical coronary artery stenosis (i.e., less than 70% stenosis) diagnosed on CCTA, a follow-up cardiac nuclear perfusion imaging is of limited value.
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Affiliation(s)
- Maryam Gul
- Precision Rheumatology, Anaheim, CA, USA
| | - Mubashir Sheikh
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Abbas Chaudhry
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Luke Gerges
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Hadi Al Halabi
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Eric Feldman
- Department of Diagnostic and Interventional Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Ammar Chaudhry
- Department of Diagnostic and Interventional Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
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Li J, Peng H, Zhao X, You N, Wu Y, Wang J, Chen H, Tang H, Zhou X, Li X, Jiang W. Analysis of situation of acute coronary syndrome based on the date of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project: single-centre observational study. Postgrad Med J 2020; 96:742-746. [PMID: 32047103 DOI: 10.1136/postgradmedj-2019-137008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND We are currently faced with an increasing burden of cardiovascular disease in China and the inadequacy of the application of guidelines in clinical practice. In the past decade, China has been strengthening the healthcare system, but it still lacked a national performance measurement system and an appropriate quality improvement strategy. Therefore, in order to improve the implementation of guideline recommendations in clinical practice, China has learnt from the successful experience of Get With The Guidelines project in 2014. Under the guidance of the Medical and Health Hospital of the National Health and Family Planning Commission, the Chinese Society of Cardiology and the American Heart Association jointly launched the Improving Care for Cardiovascular Disease in China (CCC) project. The project team provided an analysis report on the completion of key medical quality evaluation indicators of each hospital every month, supplied guidance through education, training, experience exchange and on-site investigation for problems, and certified hospitals with outstanding performance and obvious progress. The circle pattern, including evaluation, training, improvement and re-evaluation, will boost the guidelines compliance on clinical practice in China and improve the quality of medical services. METHODS This study was conducted in a centre of the Third Xiangya Hospital of Central South University. It included patients with ACS from December 2009 to December 2011 (n=225), patients with ACS in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project coming from the Third Xiangya Hospital of Central South University (n=665), 12 hospitals in Hunan Province (n=4333) and 150 hospitals in China (n=63 641) from November 2014 to April 2017. It assessed the situation of drug therapy, hospitalisation day, mortality during hospitalisation, median of door-to-needle (D-to-N) time and median of door-to-balloon (D-to-B) time of patients with ST-segment elevation myocardial infarction (STEMI), the proportion of D-to-N within 30 min and D-to-B within 90 min, and the proportion of reperfusion therapy. Patients with ACS from the centre from November 2014 to April 2017 were divided into five groups (every 6 months as a group according to time). The study observed change trends in all the above-mentioned indexes. RESULTS Compared with before participating in the CCC project, there were increases after participating in the CCC project in the drug usage rates of aspirin, P2Y12 inhibitor (clopidogrel or ticagrelor), β-blocker, statin and angiotensin converting enzyme inhibitor (ACEI)/angiotensin-receptor blocker (ARB). Hospitalisation day and mortality during hospitalisation were shortened. D-to-N and D-to-B times of patients with STEMI were shorter. Compared with Hunan Province and China, the drug usage rates were higher; hospitalisation day and D-to-N time were shorter; D-to-B time was longer; and the proportion of reperfusion therapy was higher. The trend of drug usage rates was on the rise. There was no significant change in the hospitalisation day and D-to-N and D-to-B times. The mortality during hospitalisation showed a downward trend. The proportion of D-to-N within 90 min and reperfusion therapy showed upward trends. CONCLUSION Quality of care for patients with ACS improved over time in the CCC project, including taking medicine following the guidelines, increased use of reperfusion therapy and faster time to treatment. Although overall mortality has improved, we also should attach importance to high-risk patients. The influence of the CCC project, which is based on guidelines on prognosis of ACS in the centre, presents an important clinical implication that it is necessary to enhance adherence to the guidelines in the treatment of ACS.
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Affiliation(s)
- Jiaying Li
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Hui Peng
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Xiexiong Zhao
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Nana You
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Yuyan Wu
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Junwen Wang
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Huiling Chen
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Huiting Tang
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Xiaoyu Zhou
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Xiaogang Li
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
| | - Weihong Jiang
- Cardiology, Central South University, Third Xiangya Hospital, Changsha, Hunan, China
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Su YM, Zhang R, Xu RF, Wang HL, Geng HH, Pan M, Qu YY, Zuo WJ, Ji ZJ, Ma GS. Triglyceride to high-density lipoprotein cholesterol ratio as a risk factor of repeat revascularization among patients with acute coronary syndrome after first-time percutaneous coronary intervention. J Thorac Dis 2020; 11:5087-5095. [PMID: 32030225 DOI: 10.21037/jtd.2019.12.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background It is clinically important to identify high-risk patients with acute coronary syndrome (ACS) who may require repeat revascularization. This retrospective study identified risk factors for repeat revascularization among ACS patients after first-time successful percutaneous coronary interventions (PCIs). The predictive value of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio for repeat revascularization was also evaluated. Methods We enrolled consecutive ACS patients who had coronary angiography performed during the period from 6 to 12 months after a first-time successful PCI. The primary outcome of the study was to identify the risk factors of repeat revascularization. The subjects were stratified based on repeat PCI events. After comparing various clinical characteristics, univariate and multivariate Cox proportional hazard model analyses were adopted to evaluate the effects of risk factors on repeat revascularization. Results The patients (n=271) were divided into the event (+) group (n=101) and the event (-) group (n=170). In the event (+) group, target lesion revascularization (TLR) accounted for 20.79% and target vessel revascularization (TVR) accounted for 50.49% of the patients. In contrast, 52.47% of the patients required de novo vessel revascularization (DVR). After adjustment for confounding factors, the TG/HDL-C ratio [hazard ratio (HR) =1.206, 95% confidence interval (CI): 1.016-1.431, P=0.032 for each higher TG/HDL-C ratio unit] and the Gensini score (HR =1.012, 95% CI: 1.005-1.018, P<0.001 for each higher Gensini score unit) were independent risk factors for a repeat PCI. Subgroup analyses showed that higher TG/HDL-C ratios were associated with a significantly higher risk of repeat PCIs in the male, hypertensive, and diabetes mellitus subgroups. Conclusions The TG/HDL-C ratio and Gensini score could serve as risk factors for repeat revascularization in ACS patients after a first-time successful PCI.
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Affiliation(s)
- Ya-Min Su
- Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Rui Zhang
- Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Rong-Feng Xu
- Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Hong-Lei Wang
- Department of Cardiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471003, China
| | - Hai-Hua Geng
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Min Pan
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yang-Yang Qu
- Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Wen-Jie Zuo
- Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Zhen-Jun Ji
- Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Gen-Shan Ma
- Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China
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