Background:Coronary collateral circulation(CCC)plays a vital role in the myocardial blood supply,especially for ischemic myocardium.Evidence suggests that the visfatin and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]levels ar...Background:Coronary collateral circulation(CCC)plays a vital role in the myocardial blood supply,especially for ischemic myocardium.Evidence suggests that the visfatin and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]levels are related to the degree and incidence of vascular stenosis associated with coronary artery disease;however,few studies have evaluated the effect of visfatin and 25(OH)D_(3) on CCC development in patients with chronic total occlusion(CTO).This study aimed to evaluate the relationship between the serum visfatin and 25(OH)D_(3) levels and CCC in patients with CTO.Methods:A total of 189 patients with CTO confirmed by coronary angiography were included.CCC was graded from 0 to 3 according to the Rentrop-Cohen classification.Patients with grade 0 or grade 1 collateral development were in-cluded in the poor CCC group(n=82),whereas patients with grade 2 or grade 3 collateral development were included in the good CCC group(n=107).The serum visfatin and 25(OH)D_(3) levels were measured by ELISA.Results:The visfatin level was significantly higher in the poor CCC group than in the good CCC group,and the 25(OH)D_(3) level was significantly lower in the poor CCC group than in the good CCC group(P=0.000).Correlation analysis showed that the Rentrop grade was negatively correlated with the visfatin level(r=−0.692,P=0.000)but positively correlated with the 25(OH)D_(3) level(r=0.635,P=0.000).Logistic regression analysis showed that the vis-fatin and 25(OH)D_(3) levels were independent risk factors for CCC(odds ratio 1.597,95%confidence interval 1.300-1.961,P=0.000 and odds ratio 0.566,95%confidence interval 0.444-0.722,P=0.000,respectively).The visfatin and 25(OH)D_(3) levels can effectively predict the CCC status.Conclusion:Serum visfatin and 25(OH)D_(3) levels are related to CCC development and are independent predictors of poor CCC.展开更多
Background Outcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP).Good coronary collateral circulation (CCC) has b...Background Outcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP).Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD).We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs.4 (13%),P=0.013).Preoperative hemoglobin level (OR:0.752; 95% CI,0.571-0.991,P=0.043),chronic obstructive pulmonary disease (OR:6.731; 95% CI,1.159-39.085,P=0.034) and poor CCC grade (OR:5.750; 95% CI,1.575-20.986,P=0.008) were associated with post-CABG in-hospital mortality.Poor CCC grade (OR:4.853; 95% CI,1.124-20.952,P=0.034) and preoperative hemoglobin level (OR:0.624; 95% CI,0.476-0.954,P=0.026) were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.展开更多
Background Collaterals to occluded infarct-related coronary arteries (IRA) have been observed after the onset of acute ST-elevation myocardial infarction (STEMI).We sought to investigate the impact of early corona...Background Collaterals to occluded infarct-related coronary arteries (IRA) have been observed after the onset of acute ST-elevation myocardial infarction (STEMI).We sought to investigate the impact of early coronary collateralization,as evidenced by angiography,on myocardial reperfusion and outcomes after primary percutaneous coronary intervention (PCI).Methods Acute procedural results,ST-segment resolution (STR),enzymatic infarct size,echocardiographic left ventricular function,and major adverse cardiac events (MACE) at 6-month follow-up were assessed in 389 patients with STEMI undergoing primary PCI for occluded IRA (TIMI flow grade 0 or 1) within 12 hours of symptom-onset.Angiographic coronary collateralization to the occluded IRA at first contrast injection was graded according to the Rentrop scoring system.Results Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralization was detected in 329 and 60 patients,respectively.Patients with high collateralization more commonly had prior stable angina and right coronary artery occlusion,but less often had left anterior descending artery occlusion.At baseline,these patients presented with less extent of ST-segment elevation and lower serum levels of creatine kinase myocardial band (CK-MB) and cardiac troponin Ⅰ (cTnl).Procedural success rate,STR,corrected TIMI flame count,and area under the curve of CK-MB and cTnl measurements after the procedure were similar between patients with high collateralization and those with low collateralization (for all comparisons P>0.05).There were no differences in left ventricular ejection fraction and rates of MACE at 6 months according to baseline angiographic collaterals to occluded IRA.Conclusions In patients with acute STEMI undergoing primary PCI within 12 hours of symptom-onset,coronary collateralization to the occluded IRA was influenced by clinical and angiographic features.Early recruitment of collaterals limits infarct size at baseline,but has no significant impact on myocardial reperfusion after the procedure and subsequent left ventricular function and clinical outcomes.展开更多
基金supported by the Science Foundation of AMHT(2018-LCYL-009)the Medical and Health Research Project of China Aerospace Science and Industry Corporation Ltd.(KYLX-56).
文摘Background:Coronary collateral circulation(CCC)plays a vital role in the myocardial blood supply,especially for ischemic myocardium.Evidence suggests that the visfatin and 25-hydroxyvitamin D_(3)[25(OH)D_(3)]levels are related to the degree and incidence of vascular stenosis associated with coronary artery disease;however,few studies have evaluated the effect of visfatin and 25(OH)D_(3) on CCC development in patients with chronic total occlusion(CTO).This study aimed to evaluate the relationship between the serum visfatin and 25(OH)D_(3) levels and CCC in patients with CTO.Methods:A total of 189 patients with CTO confirmed by coronary angiography were included.CCC was graded from 0 to 3 according to the Rentrop-Cohen classification.Patients with grade 0 or grade 1 collateral development were in-cluded in the poor CCC group(n=82),whereas patients with grade 2 or grade 3 collateral development were included in the good CCC group(n=107).The serum visfatin and 25(OH)D_(3) levels were measured by ELISA.Results:The visfatin level was significantly higher in the poor CCC group than in the good CCC group,and the 25(OH)D_(3) level was significantly lower in the poor CCC group than in the good CCC group(P=0.000).Correlation analysis showed that the Rentrop grade was negatively correlated with the visfatin level(r=−0.692,P=0.000)but positively correlated with the 25(OH)D_(3) level(r=0.635,P=0.000).Logistic regression analysis showed that the vis-fatin and 25(OH)D_(3) levels were independent risk factors for CCC(odds ratio 1.597,95%confidence interval 1.300-1.961,P=0.000 and odds ratio 0.566,95%confidence interval 0.444-0.722,P=0.000,respectively).The visfatin and 25(OH)D_(3) levels can effectively predict the CCC status.Conclusion:Serum visfatin and 25(OH)D_(3) levels are related to CCC development and are independent predictors of poor CCC.
文摘Background Outcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP).Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD).We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs.4 (13%),P=0.013).Preoperative hemoglobin level (OR:0.752; 95% CI,0.571-0.991,P=0.043),chronic obstructive pulmonary disease (OR:6.731; 95% CI,1.159-39.085,P=0.034) and poor CCC grade (OR:5.750; 95% CI,1.575-20.986,P=0.008) were associated with post-CABG in-hospital mortality.Poor CCC grade (OR:4.853; 95% CI,1.124-20.952,P=0.034) and preoperative hemoglobin level (OR:0.624; 95% CI,0.476-0.954,P=0.026) were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.
基金This work was supported by grants from the Shanghai Science and Technology Foundation (No. 05DZ19503), and National Natural Science Foundation of China (No. 30900589).
文摘Background Collaterals to occluded infarct-related coronary arteries (IRA) have been observed after the onset of acute ST-elevation myocardial infarction (STEMI).We sought to investigate the impact of early coronary collateralization,as evidenced by angiography,on myocardial reperfusion and outcomes after primary percutaneous coronary intervention (PCI).Methods Acute procedural results,ST-segment resolution (STR),enzymatic infarct size,echocardiographic left ventricular function,and major adverse cardiac events (MACE) at 6-month follow-up were assessed in 389 patients with STEMI undergoing primary PCI for occluded IRA (TIMI flow grade 0 or 1) within 12 hours of symptom-onset.Angiographic coronary collateralization to the occluded IRA at first contrast injection was graded according to the Rentrop scoring system.Results Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralization was detected in 329 and 60 patients,respectively.Patients with high collateralization more commonly had prior stable angina and right coronary artery occlusion,but less often had left anterior descending artery occlusion.At baseline,these patients presented with less extent of ST-segment elevation and lower serum levels of creatine kinase myocardial band (CK-MB) and cardiac troponin Ⅰ (cTnl).Procedural success rate,STR,corrected TIMI flame count,and area under the curve of CK-MB and cTnl measurements after the procedure were similar between patients with high collateralization and those with low collateralization (for all comparisons P>0.05).There were no differences in left ventricular ejection fraction and rates of MACE at 6 months according to baseline angiographic collaterals to occluded IRA.Conclusions In patients with acute STEMI undergoing primary PCI within 12 hours of symptom-onset,coronary collateralization to the occluded IRA was influenced by clinical and angiographic features.Early recruitment of collaterals limits infarct size at baseline,but has no significant impact on myocardial reperfusion after the procedure and subsequent left ventricular function and clinical outcomes.