Prognostic Value of NT-proBNP in Stable Coronary Artery Disease in Chinese Patients after Percutaneous Coronary Intervention in the Drug-eluting Stent Era

Objective The predictive value of N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with stable coronary artery disease(SCAD) in the drug-eluting stent era is not yet clear. We aimed to evaluate the prognostic value of NT-proBNP in SCAD patients after percutaneous coronary intervention(PCI). Methods We examined 4,293 consecutive SCAD patients who underwent PCI between January 2013 and December 2013 in Fuwai Hospital, China. The primary endpoint was all-cause death. NT-proBNP levels were measured before PCI using Elisa kits(Biomedica, Austria). The indication for PCI was based on the degree of coronary stenosis and evidence of ischemia. Results Among 3,187 SCAD patients with NT-proBNP data, after a 2-year follow-up, NT-proBNP levels were predictive for all-cause death in the SCAD population [area under the receiver operating characteristic curve, 0.768; 95% confidence interval(CI), 0.687-0.849; P < 0.001]. At the optimum cutoff point of 732 pg/mL, the sensitivity and specificity of death was 75.0% and 72.3%, respectively. In a multivariable Cox regression model, the death hazard ratio was 6.43(95% CI, 2.99-13.82; P < 0.001) for patients with NT-proBNP levels ≥ 732 pg/mL, compared with < 732 pg/mL. Conclusion NT-proBNP is a strong predictor of 2-year death with SCAD after PCI in the drug-eluting stent era.

Association of CDKN2B-AS1 Polymorphisms with Premature Triple-vessel Coronary Disease and Their Sex Specificity in the Chinese Population

Objective The aim of this study is to establish whether cyclin-dependent kinase inhibitor 2B antisense RNA 1(CDKN2 B-AS1) gene polymorphisms are associated with premature triple-vessel disease(PTVD). Methods Nine single-nucleotide polymorphisms(rs1063192, rs10757274, rs1333042, rs1333049, rs2285327, rs3217986, rs3217992, rs4977574, and rs9632884) were genotyped in 884 PTVD patients and 907 control subjects(males ≤ 50 years old and females ≤ 60 years old) using the improved multiplex ligase detection reaction method. Results The allele frequencies of rs10757274 G, rs1333049 C, rs4977574 G(all P < 0.001), and rs3217986 G(P = 0.040) were significantly higher in the PTVD group than in the control group, but those of rs1063192 A, rs1333042 G, and rs9632884 C(all P < 0.001) were significantly lower in the former than in the latter. Logistic regression analysis revealed that homozygote AA of rs1333042 is associated with decreased risk for PTVD(OR = 0.42, 95% CI: 0.22-0.82, P = 0.011). In addition, the allele frequencies observed differed between genders. The G allele of rs3217986 was associated with increased risk for PTVD in male patients only(OR = 2.94, 95% CI: 1.27-6.80, P = 0.012) in the dominant model, and no positively mutated allele was found in female patients. Conclusion Polymorphisms of the CDKN2 B-AS1 gene are associated with the incidence of PTVD in the Chinese population. Furthermore, the frequencies of mutated alleles differed between genders.

Risk or Beneficial Factors Associated with Unplanned Revascularization Risk Following Percutaneous Coronary Intervention: A Large Single-Center Data

Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.

Prognostic Values of Serum Chloride and Sodium Levels in Patients with Three-vessel Disease

Objective Identification of new risk factors is needed to improve prediction of adverse outcomes in patients with three-vessel disease(TVD). The present study aimed to evaluate the prognostic values of serum chloride and sodium levels in patients with TVD. Methods We used data from a prospective cohort of consecutive patients with angiographically confirmed TVD. The primary endpoint was all-cause death. Cox proportional hazard regression was used to analyze the relationship of serum chloride and sodium levels with long-term outcomes of TVD patients. Results A total of 8,318 participants with available serum chloride and sodium data were included in this analysis. At baseline, patients in the low tertiles group of serum chloride level(≤ 102.0 mmol/L) or serum sodium level(≤ 139.0 mmol/L) had more severe disease conditions. During a median follow-up of 7.5-year, both low serum chloride level and low serum sodium level were found to be associated with an increased risk for mortality in univariate analysis. However, when both parameters were incorporated into a multivariate model, only low serum sodium level remained to be an independent predictor of all-cause death(hazard ratio: 1.16, 95% confidence interval: 1.01-1.34, P = 0.041). Modest but significant improvement of discrimination was observed after incorporating serum sodium level into the Synergy between percutaneous coronary intervention(PCI) with Taxus and Cardiac Surgery score. Conclusion Serum sodium level is more strongly associated with long-term outcomes of TVD patients compared with serum chloride level. Low serum sodium level is an independent risk factor for mortality, but only provides modest prognostic information beyond an established risk model.