Relationship between resistin level in serum and acute coronary syndrome or stable angina pectoris

Objective： To investigate the relationship between serum resistin level and acute coronary syndrome （ACS） or stable angina pectoris （SAP）. Methods： Sixty-five patients, with coronary artery disease, were enrolled and divided into three subgroups： acute myocardial infarction （AMI）, unstable angina pectoris （UAP） and SAP, and 26 healthy people were recruited as controls in the cross-sectional study. Serum resistin levels were determined by ELISA （enzyme-linked immunosorbent assay）, and WBC （white blood cell count）, hsCRP （high sensitive C-reaction protein）, CKmax （maximum of creatinkinase）, CK-MBmax （maximum of isozyme of creatinkinase） and cTnImax （maximum of troponin） were measured by standard laboratory methods. Results： The serum resistin levels were 4 folds higher in AMI patients, 2.43 folds in UAP patients and I. 12 folds in SAP patients than in the healthy controls （P〈0.05）. The resistin levels were also significantly different between AMI [（8.16±0.79） ng/ml], UAP [（5.59±0.75） ng/ml] and SAP [（3.45±0.56） ng/ml] groups （P〈0.01）; WBC, hsCRP, CK CK-MBmax and cTnlmax were significantly increased in AMI patients over UAP and SAP patients. Spearman analysis showed that serum resistin levels were positively correlated with WBC （r=0.412, P=0.046）, hsCRP （r=0.427,p=0.037）, CK CK-MBmax and cTnImax （r=0.731, 0.678, 0.656; P〈0.01）. Conclusion： Serum resistin levels increased with inflammatory factors and myocardial impairment. The results suggest that human resistin might play an important role in the pathogenesis of atherosclerosis and AMI as an inflammatory factor.

Core outcome set for stable angina pectoris in traditional Chinese medicine(COS-SAP-TCM)

Objective:This study aimed to develop a core outcome set(COS)for use in future studies of stable angina pectoris(SAP)in traditional Chinese medicine(TCM).Methods:Systematic literature reviews and qualitative interviews with cardiologists and patients with SAP treated using TCM were conducted to generate a set of outcomes.Outcomes were prioritized by stakeholders via two rounds of an online Delphi survey and face-to-face consensus meetings.Following the final consensus meeting,a final COS was generated.Results:An initial set of 324 outcomes was identified.A preliminary list of 65 outcomes was employed in the Delphi study.In total,223 participants from seven stakeholder groups were invited to score outcomes in the first Delphi round:87 completed round 1 and 47 completed round 2.Thirty-one participants attended the consensus meeting and agreed on a final core set of outcomes comprising six items across four domains:frequency of angina attack,duration of angina attack,Seattle angina questionnaire,total exercise duration in the exercise treadmill test,cardiovascular events,and QT interval on electrocardiography.Conclusions:The COS developed in this study provides the minimum requirements for measurement and reporting in future TCM clinical trials for the treatment of SAP.The employment of this COS may reduce heterogeneity across trials and facilitate evidencebased decision-making for stakeholders.

Highly sensitive troponin I assay in the diagnosis of coronary artery disease in patients with suspected stable angina

BACKGROUND Evaluation of suspected stable angina patients with probable coronary artery disease(CAD)in the community is challenging.In the United Kingdom,patients with suspected stable angina are referred by community physicians to be assessed by specialists within the hospital system in rapid access chest pain clinics(RACPC).The role of a highly sensitive troponin I(uscTnI)assay in the diagnosis of suspected CAD in a RACPC in a“real-life”setting in a non-academic hospital has not been explored.AIM To examine the diagnostic value of uscTnI(detection limit 0.12 ng/L,upper reference range 8.15 ng/L,and detected uscTnI in 96.8%of the reference population),in the evaluation of stable CAD in a non-selected patient group,with several co-morbidities,who presented to the RACPC.METHODS One hundred and seventy two RACPC patients were assigned to either functional or anatomical testing according to the hospital protocol.RESULTS The investigations offered to patients were exercise tolerance test 7.6%,24 h ECG 1.2%,Echocardiogram 14.5%,stress echocardiogram 8.1%,coronary computed tomography angiography(CCTA)12.8%,coronary angiogram 13.4%,17.4%were diagnosed with non-cardiac chest pain,3.5%treated as stable angina,8.2%reviewed by cardiologists,electronic medical records were not available in 10.4%.Receiver operating characteristic curves for CAD used uscTnI values measured in patients who underwent functional testing,angiogram or CCTA.Values>0.52 ng/L showed 100%sensitivity and at>11.6 ng/L showed 100%specificity.In the range>0.52-11.6 ng/L,uscTnI may not have the same diagnostic potential.In patients assigned to coronary angiogram higher concentrations of uscTnI was associated with severe CAD.Low levels of uscTnI and low pre-test probability of CAD(QRISK3)may decrease patient numbers assigned to CCTA.CONCLUSION The uscTnI diagnostic cut-off values in a RACPC will depend on patient population and their presenting co-morbidity.In the presence of clinical comorbidities and previous CAD the uscTnI needs to be used in conjunction with clinical assessment.

Coronary Angiography: Indications, Results and Cost-Effectiveness in the Diagnosis of Stable Angina Pectoris in Two Hospitals in Senegal

Background: The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. Objective: The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospitals structures in Senegal. Method: We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. Results: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years;men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%;diabetes was 34.27%;dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel;28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36;95% CI, 1.05 - 5.29;p = 0.036);male gender (OR, 1.6;95% CI, 0.72 - 3.57;p = 0.24);diabetes (OR, 2.14;95% CI, 0.96 - 4.75;p = 0.06) and necrosis Q waves (4.75;CI, 0.98 - 23.09;p = 0.05). Conclusion: In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.

Managing the treatment of the patients with stable angina like a chess player： making moves considering the next move of atherosclerosis

We read the article entitled Coronary revascularization in the elderly with stable angina with interest. In the guidelines related to stable coronary artery disease, it does not exist any age-related net proposals for the patients with stable angina pectoris.

A Meta-analysis of Ginseng combined with conventional therapy for stable angina pectoris

Objective:To evaluate the efficacy of Ginseng combined with conventional therapy for stable angina pectoris(SAP).Methods:From the Cochrane Library,Pubmed,Embase,Web of Science,CNKI(China National Knowledge Infrastructure),Wanfang Datebase,VIP(Chinese Scientific Journals Database),CBM(Chinese Biomedicine Database),we reviewed the clinical randomized controlled trial(RCT),after screening and assessing the risk of bias,used RevMan 5.3 and Stata 15.0 software to make the Meta-analysis.Results:Thirteen studies were included with 1176 cases,involving 606 cases in the experimental group and 570 in the control group.The results of Meta-analysis showed that Ginseng combined with conventional therapy significantly has obvious effect on clinical effective rate(RR=1.29,95%CI[1.21,1.36],P<0.00001);ECG effective rate(RR=1.35,95%CI[1.22,1.50],P<0.00001);number of angina attacks(MD=-1.77,95%CI[-2.64,-0.91],P<0.00001);duration of angina pectoris(MD=-2.16,95%CI[-2.54,-1.78],P<0.00001);nitroglycerin dosage(MD=-1.52,95%CI[-1.81,-1.23],P<0.00001),and it is better than using conventional therapy alone.Conclusion:Ginseng combined with conventional therapy for SAP can significantly improve clinical effective rate and ECG effective rate,reduce the number of angina attacks,shorten the duration of angina pectoris,and reduce nitroglycerin dosage.The development of ginseng-related proprietary Chinese medicines has good prospects.But due to the quality of studies is medium and low,it still needs to be confirmed by conducting high-quality RCTs.

Conservative Approach Might Be the Strategy by Default in Stable Angina Patients: A Case Report

Management of stable angina is still a matter of debate. Whether a conservative or invasive approach is better remains unclear. Even though recent large-scale randomized trials depict the conservative strategy as safe and efficient. In this report, we present a case of a 53-year-old male patient with cardiovascular risk factors of hypertension and hypercholesterolemia. He complained about typical chest pain at exertion. The coronary angiogram (CA) revealed severe stenosis of the proximal left anterior descending artery (LAD) ostium. After heart team discussion, coronary artery bypass graft (CABG) was advocated. However, due to a lack of means, the CABG was postponed. Meanwhile, he was managed with guideline-based medical therapy. In addition, he exercised regularly and adopted a healthy diet. Evolution was favorable with excellent symptoms control. A regular follow-up was organized with his cardiologist. A new CA before an eventual CABG six years later showed a significant plaque volume regression of the proximal LAD. We decided to continue conservative management. The stress echocardiogram to assess symptoms and exercise tolerance was normal. Our patient was sent to surgery on top of optimal medical therapy even though angioplasty was a good indication and was feasible. However, while he was struggling to afford the CABG procedure, he adopted a very healthy lifestyle along with medical therapy. Six years later, the result of that approach was without appeal, suggesting and reinforcing the conservative management of stable heart disease over invasive strategy. The recent ISCHEMIA trial is a major argument supporting that approach.

Chinese patent medicine for stable angina pectoris:protocol for a systematic review and network meta-analysis

Stable angina pectoris is a common condition that affects a wide group of patients with coronary artery diseases.A number of Chinese patent drugs based on classic herbal formulations are available for angina management.A network meta-analysis is proposed to assess the relative efficacy and safety of commonly used drugs for stable angina and generate a clinically meaningful ranking for each important outcome.We composed a list of 24 widely-used oral blood-quickening Chinese patent drugs from literature review and expert consultation.Three English and five Chinese electronic databases will be searched up to July 2021 for randomised clinical trials comparing between drugs on the list or with nitrates or placebo for stable angina.Unpublished data or grey literature will be sought through trial registries and correspondence to the report authors.Two reviewers independently screen literature,extract data and assess clinical and methodological features of included studies.The WinBUGS software will be used to perform network meta-analysis and the Stata 13.0 software to generate graphic demonstrations of the results.Primary outcomes are the incidence of cardiovascular events and changes in angina frequency,duration and intensity.We will use the surface under the cumulative ranking curve and the mean value for the numeric presentation of efficacy and safety ranking probabilities of multiple treatments.Heterogeneity and inconsistency will be assessed using appropriate statistical tests,and subgroup analysis and network meta-regression will be resorted when necessary.The quality of evidence for each outcome will be graded with the web-based GRADEpro GDT.

Assessment of Acute Episodes in Chronic Stable Angina: A Clinical-Laboratory Approach to the Use of the Coronary Vasodilator Propatyl Nitrate

Background/Objectives: Propatyl nitrate is a coronary vasodilator with immediate and prolonged action, indicated in the treatment and prevention of acute angina pectoris episodes. Methods: This was an open, self-paired comparative study performed at UNIFESO Medical School evaluating the clinical and laboratory results of treatment with propatyl nitrate in patients with chronic stable angina pectoris. Subjects received 10 mg of propatyl nitrate, at the dose of three sublingual tablets per day, to be taken at 8:00 A.M., 2:00 P.M., and 8:00 P.M. Subjects returned to the study center after 15 days of treatment for Visit 2 assessments, and at the end of the 30-day treatment period (Visit 3). Results: A total of 200 subjects were included in the study. There was a statistically significant reduction in blood pressure (p < 0.0001) and heart rate (p = 0.0001), but no change in respiratory rate (p = 0.23). Laboratory results did not vary throughout the treatment period. There was no significant change from pretreatment in the SAQ Physical Limitation scale (p = 0.7415). The Angina Stability, Angina Frequency, and Treatment Satisfaction, and Quality of Life scales showed a significant improvement from pretreatment (p < 0.0001). Adverse events were observed among 41 subjects at Visit 2 and 35 subjects at Visit 3. Conclusions: Propatyl nitrate was safe and effective in treating chronic stable angina pectoris over the course of the 30-day treatment period. Treatment with propatyl nitrate increased angina stability and reduced angina frequency while increasing treatment satisfaction and quality of life in the patient population evaluated.

Role of plasma C-reactive protein in predicting in-stent restenosis in patients with stable angina after coronary stenting

Background The role of plasma high sensitivity C-reactive protein （hs-CRP） in in-stent restenosis （ISR） remains controversial. We investigated plasma hs-CRP level at both admission and follow-up in patients with stable angina （SA）after successful coronary stenting in order to clarify the predictive value of hs-CRP for ISR.Methods We summarized 303 consecutive chronic SA patients with coronary drug-eluting stent （DES） implantation.The ISR was analyzed by quantitative coronary analysis （QCA） at a mean follow-up of 8 months, and the patients were divided into two groups according to the detected ISR as ISR group （n=48） and non-ISR group （n=255）. Plasma hs-CRP was examined at both admission and 8-month follow-up in all patients, standard medication continued throughout the investigation period.Results QCA presented that 48 patients （15.8%） suffered from ISR at follow-up. The basic clinical characteristics were similar between the two groups, while plasma hs-CRP was higher in ISR group than that in non-ISR group at both admission and follow-up, P 〈0.001 respectively. Multivariate regression analysis indicated that plasma hs-CRP level at either admission or follow-up could independently predict ISR occurrence （OR=5.581, 95% Cl 2.532-12.302, P〈0.001and OR=6.299, 95% CI 2.722-14.577, P 〈0.001, respectively）.Conclusions Our data indicate that plasma hs-CRP level may independently predict ISR at both admission and follow-up in SA patients with coronary DES implantation, which implies that a chronic, sustained systemic inflammatory response might be involved in ISR pathogenesis.

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Objective： Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion. Methods： Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system. Results： Low （Rentrop score of 0 or 1） and high （Rentrop score of 2 or 3） coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high coUateralization （for all comparisons, P〈0.05）. In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein （hsCRP） compared with those with high col- lateralization. Multivariate analysis revealed that age of 〉65 years, female gender, diabetes, no history of hypertension dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were inde- pendently associated with low coronary collateralization. Conclusions： Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.

Effect of Shenshao Tablet(参芍片) on the Quality of Life for Coronary Heart Disease Patients with Stable Angina Pectoris

Objective： To observe the effect of Chinese medicine Shenshao Tablet （参芍片, SST） on the quality of life in coronary heart disease （CHD） patients with stable angina pectoris （SAP）. Methods： Sixty-six patients with SAP confirmed by coronary angiography were enrolled and assigned to two groups by means of PROC PLAN using a SAS 6.12 software in a double-blinded, randomized, placebo-controlled design. Patients in the treated group were treated with SST, and the others in the control group were given placebo. The weekly angina frequency, quality of life scale [Seattle Angina Questionnaire （SAQ）] and incidence of important clinical events were observed to evaluate the intervention effect of SST on the quality of life for CHD patients with SAP. Results： During the study, one case dropped out in the treated group and two cases in the control group, respectively, and 63 cases including 32 cases in the treated group, and 31 cases in the control group completed the trial. After four weeks of treatment, the weekly angina frequency of the treated group （5.32± 2.46 times per week） was significantly less than that of the control group （7.32± 3.20 times per week, P 〈 0.05）. The total score of the quality of life in the treated group （71.30± 5.44） was obviously higher than that in the control group （63.50± 4.60, P 〈 0.01）, and the angina stability, angina frequency, and treatment satisfaction were significantly superior to those in the control group （P〈 0.01）. The incidence of important clinical events of the treated group （3.1%） was lower than that of the control group （6.5%） during the six-month follow-up period, but the difference was insignificant （P 〉 0.05）. Conclusion： SST could lower the angina frequency and greatly improve the quality of life in CHD patients with SAP.

Rules of acupoint and meridian selection in acupuncture-moxibustion for stable angina pectoris

To summarize and analyze the acupoint selection rules in acupuncture-moxibustion for stable angina pectoris. Clinical studies and literature on acupuncture-moxibustion for stable angina pectoris with definite acupoint selection were included through retrieving China National Knowledge Infrastructure（CNKI）,Wanfang Database and VIP in order to analyze the characteristics and rules of acupoint selection in acupuncture-moxibustion treatment for stable angina pectoris. It has been found that the acupoint selection of acupuncture-moxibustion prescriptions for stable angina pectoris focused on specific acupoints.The top 5 acupoints with the highest using frequency included Neiguan（内关PC 6）,Danzhdng（膻中CV17）,Xinshu（心俞BL 15）,Ziusanli（足三里ST 36） and Sanyinjiao（三阴交SP 6）. Acupuncture-moxibustion treatment of stable angina pectoris involved 12 meridians, mainly including the hand-jueyin pericardium meridian, the foot-taiyang bladder meridian, conception vessel, the foot-yangming stomach meridian, the foot-taiyin spleen meridian, and the hand-shaoyin heart meridian, etc., embodying the characteristics and rules of acupoint selection such as ＂highlighting the special treatment effect of acupoints＂ ＂selecting acupoints along the pericardium meridian, bladder meridian and conception vessel, combining the anterior and the posterior acupoints＂, ＂selecting the distal acupoints of spleen and stomach meridians, and focusing on specific acupoints＂, etc.

Effectiveness and Safety of Acupoint Application of Guan Xin Su He Pill (冠心苏合丸) for Patients with Chronic Stable Angina Pectoris: A Multi-Center, Randomized Controlled Trial

Objective To assess the clinical effectiveness of acupoint application(AP)of Guan Xin Su He Pill(冠心苏合丸,GXSHP)for patients with chronic stable angina pectoris(CSAP).Methods This study was carried out in 3 local hospitals in Chengdu,China.After baseline evaluation,eligible patients were randomly assigned to the placebo application for acupoints(PAA)group or the herbal application for acupoints(HAA)group.Patients in the HAA group underwent AP with herbal powder,which was mainly GXSHP,and patients in the PAA group underwent AP with sham drugs.For each treatment session,unilateral acupoints including Neiguan(PC 6),Danzhong(RN 17),Xinshu(BL 15)and Jueyinshu(BL 14),were stimulated for both groups.AP was performed 3 times a week with a 2-day interval for 4 weeks.The primary outcome was the frequency of angina pectoris attacks per week,while the secondary outcomes included angina pain intensity measured by the Visual Analogue Scale(VAS),dose of rescue oral drugs(nitroglycerin),scores on the Seattle Angina Questionnaire(SAQ),Self-Rating Anxiety Scale scores(SAS)and Self-Rating Depression Scale scores(SDS).Clinical outcomes were measured at week 0,4 and 8.The safety of AP of GXSHP treatment for CSAP were assessed.Results A total of 121 patients were enrolled.Baseline characteristics were comparable across the 2 groups.After treatment,the angina attack numbers in the HAA group were significantly reduced from 11.00 to 4.81(P<0.05).While,for PAA group,the angina frequency was not significantly improved(baseline 10.55;post-treatment 11.05).The HAA group had significantly fewer angina attacks than the PAA group(P<0.05).Pain intensity measured by VAS in HAA group was significantly reduced from 4.06 to 3.02(P<0.05).While,for PAA group,the VAS was significantly increased(baseline 3.62;post-treatment 3.96;P<0.05).Clinical outcomes showed better improvement after treatment in the HAA group than in the PAA group in terms of oral administration of rescue drugs,SAS,SDS and SAQ scores(P<0.05).The adverse events were also reported.Conclusion AP of GXSHP is a safe and effective treatment for CSAP patients(Registration No.NCT02029118).

Relationship between coronary artery remodeling and cumulative incidence of coronary angiographic lesions with vulnerable characteristics in patients with stable angina pectoris

ackground Development of vulnerable lesions is not limited to the target lesions, but a pan-coronary process. Such lesions are identified by positive remodeling （intravascular ultrasound （IVUS） and complex lesions （angiography））. The prevalence of lesions with vulnerable characteristics in patients with stable angina was not well known. The purpose of the present study was to evaluate the relationship between coronary artery remodeling and incidence of angiographic complex lesions and its calcification in stable angina patients.Methods One hundred and sixty-one stable angina patients （95 males, aged （68±11） years） with 161 de novo target lesions were studied using pre-interventional IVUS. Remodeling index was defined as the lesion divided by reference vessel area; positive remodeling was defined as remodeling index 〉1.05. Besides the 161 target lesions, there were 613 angiographic lesions with 〉30% diameter stenoses, classified as complex or smooth. Multiple complexes were defined as more than one complex lesion in one patient. Stenoses of at least 70% were described as tight. Calcium arc area was used as a new method to quantify coronary calcification.Results Fifty-six patients had positive remodeling target lesion, while 105 did not. The overall number of lesions with a diameter stenoses 〉30% was similar in patients with or without positive remodeling, and the frequency of angiographically complex lesions was higher in positive remodeling patients, especially at non-target site. Calcium arc area was smaller in patients with positive remodeling.Conclusions Positive remodeling on intravascular ultrasound was associated with more complex lesions angiographic findings, especially at non target site. Positive remodeling was found less calcified in patients with stable angina.

Needle-embedding therapy combined with basic treatment for stable angina pectoris

Objective： To clarify the clinical efficacy of needle-embedding therapy for stable angina pectoris. Methods： Seventy-six patients with stable angina pectoris were divided into needle-embedding therapy group （group A） and basic treatment group （group B） according to the random number table, with 38 patients in each group. Needle-embedding therapy combined with basic treatment was adopted in group A, and needle-embedding was given once every other day, the needles were retained for 24 h each time and three times of treatment were given each week. basic treatment was applied solely in group B. Four weeks of treatment which means one course were given in two groups, efficacy observation and evaluation were carried out after 1 course of treatment. Results： After treatment, the total effective rate of clinical efficacy was 89.47% in group A and 71.05% in group B （p 〈 0.05）, and the total effective rate of electrocardiograph （ECG） efficacy was 84.21% in group A and 63.16% in group B （p〈0.05）. After treatment, the score of limitation of motion, score of the sta- ble state of angina pectoris and the score of angina pectoris attack in group A increased by 0.7%, 34,5% and 16.9% respectively when compared with the scores before treatment （t= 1.623, p 〈0.0l; t=3.867, p 〈 0.01 ; t = 1.958, p 〈 0.05）, and according to the comparison of the score of satisfaction with treatment and the score of disease perception before and after treatment, the difference was not statistically significant （t=4.972, p 〉 0.05; t=0.999, p 〉 0.05）. According to the comparison of the score of limitation of motion, score of angina pectoris attack, score of satisfaction with treatment and the score of disease per- ception in group B before and after treatment, the differences were not statistically significant （t = 1.726, p 〉 0.05; t = 1.594, p 〉 0.05; t = 4.385, p 〉 0.05; t = 0.999, p 〉 0.05）. The score of： the stable state of angina pectoris increased by 4.9% （t = 1.780, p 〈 0.05）. Conclusion： Needle-embedding in acupoint therapy can effectively improve the clinical efficacy, ECG efficacy and the score of Seattle angina questionnaire （SAQ） of stable angina pectoris.

A Multicenter,Randomized,Double-blind Clinical Study on Wufuxinnaoqing Soft Capsule(五福心脑清胶囊) in Treatment of Chronic Stable Angina Patients with Blood Stasis Syndrome

Objective： To confirm the efficacy and safety of Wufuxinnaoqing Soft Capsule （五福心脑清胶囊, WSC） in the treatment of chronic stable angina （blood stasis syndrome）. Methods： A multicenter, randomized, double-blind, placebo-controlled trial with superiority test was designed. A total of 240 patients with chronic stable angina （blood stasis syndrome） from multiple centers were randomly and equally assigned to the treatment group and the control group. Based on standard treatment of Western medicine, the treatment group was given WSC, while the control group was given WSC mimetic, both for 12 weeks. Observed indicators included the efficacy in angina, the efficacy in Chinese medicine syndrome, the withdrawal or reduce rate of nitroglycerin and routine safety indices. Results： After 12-week treatment, the significant effective rate and total effective rate of the treatment group were significantly better than those of the control group （23.5% vs. 9.2%, 64.7% vs. 30.8%）, respectively, with statistically significant difference （P〈0.01）. After 12-week treatment, the decreased points and the decreased rate of angina symptom score in the treatment group were better than in the control group （5.1±4.2 points vs. 2.8± 3.5 points, 44.9% ±37.2% vs. 25.4%±30.7%） respectively, with significant difference （P〈0.01）. After 12-week treatment, the significant effective rate and total effective rate of the treatment group were better than the control group （respectively, 30.3% vs. 15.0%, 67.2% vs. 45.0%, P〈0.01）. After 8- or 12-week treatment, the decreased points and the decreased rate of Chinese medicine syndrome score in the treatment group were better than the control group （P〈0.05 or P〈0.01）. After 12-week treatment, nitroglycerin withdrawal rate and the withdrawal or reduce rate in treatment group were better than the control group （P〈0.01）. On safety evaluation, the incidence of adverse events （7.563% vs. 7.500%） and the incidence of cardiovascular events （0.840% vs. 0.000%） in the treatment group were similar with the control group, and the difference was not statistically significant （P〉0.05）. Couch=SlOB： In treatment of chronic stable angina （blood stasis syndrome）, WSC can reduce angina attacks and consumption of nitroglycerin, decrease angina severity degree, effectively relieve the blood stasis syndromes, such as chest pain, chest tightness, palpitations, dark purple tongue and other symptoms. Besides, adverse events and cardiovascular adverse events in the treatment group and the control group showed no difference. All shows that the drug is safe and effective. [This study was registered in Chinese Clinical Trial Registry （ChiCTR）, with registration number： ChiCTR-TRC-14005158.]

C-reactive protein/albumin ratio as a predictor for severe coronary artery disease in patients with stable angina pectoris

Background Syntax score(SS),an angiographic tool to grade the complexity of coronary artery disease,has prognostic importance for this disease. C-reactive protein(CRP)and albumin are indicators of inflammation.And both of them are associated with high SS. Hence,we aimed to investigate whether baseline CRP to albumin ratio(CAR)is associated with SS. Method A total of 312 consecutive patients with stable angina pectoris,who underwent coronary angiography for suspected coronary artery disease(CAD)from January 2018 to May 2019,were classified into two groups,low score group(syntax score≤22)and high score group(syntax group>22).The Multivariate logistic analysis and ROC curve were performed to detect the predictive effect of CAR for higher SS. Results There are 163 cases in the low score group while 149 cases in the high score group. CAR in the high score group was significantly higher than the other group(5.6[2.8-9.6]vs. 2.5[1.7-5.2],P<0.01). In multivariate logistic regression analysis,CAR was proved to be an independent predictor for high syntax score. ROC curve analyses reveal the good predictive values of CAR(AUC 0.731,95% CI:0.608-0.814,P<0.01)for high syntax score and statistical significant better than CRP or albumin alone. Conclusions CAR is independently associated with the complexity and severity of CAD,which has better predictive value than CRP or albumin alone.

Incidence, Clinical Presentation and Angiographic Findings among Patients with Coronary Artery Ectasia in Gaza

Background: Coronary artery ectasia (CAE) is a rare form of aneurysmal coronary heart disease. This condition increases risk of ischemia that leaded to stable angina pectoris and also acute coronary syndrome. Objective: To evaluate the incidence of CAE and to analyze clinical and angiographic characteristics among patients with symptomatic coronary artery disease. Methods: Retrospective trial of diagnostic coronary angiography which was performed at Alshifa hospital in Gaza, included all patients with coronary heart disease and underwent diagnostic coronary angiography from March 2014 to March 2023. We evaluate the incidence, clinical presentation and angiographic findings of patients with symptomatic coronary ectasia. Results: Of the 12,534 angiograms analyzed, CAE was found in 539 patients, an incidence of 4.3%. The mean age was 59.2 ± 11.7 years, and male gender predominate 81.8%. A 285 (52.9%) of patients found to have single ectatic vessel at their angiographic results. In two vessels 120 patients (22.3%), in three vessels 95 patients (17.6%) and in three vessel plus left main in 39 patients (7.2%). 70.9% angiograms showed pure ectasia without associated significant stenotic lesions in the same vessel. The right coronary artery (RCA) was the commonest affected vessel by ectasia. The most common presentation of patients is non ST segment elevation acute coronary syndrome. Conclusion: The incidence of coronary ectasia was 4.3%. Non ST segment elevation acute coronary syndrome was the most common clinical presenting. Only 30% of patients have additionally significant coronary artery stenosis. The majority of patients had single vessel involvement and right coronary artery was the most common involved vessel. Despite a dapper understanding of CAE in last years, there are still come critical issues about optimal treatment. Large multicenter randomized control trials are recommended to guide the clinician in the management of this complex sitting of patients.

High Serum Resistin Level may be an Indicator of the Severity of Coronary Disease in Acute Coronary Syndrome

Objective To investigate the correlation between serum resistin level, cardiovascular risk factors and severity of coronary disease in acute coronary syndrome （ACS）. Methods Alter evaluated by clinical history, electrocardiography, exercise tolerance tests, laboratory tests, and coronary angiography, 220 consecutive patients with suspected chest pain were divided into normal control group, stable angina pectoris （SAP） group, and ACS group, respectively. Baseline clinical characteristics, including height, weight, waist circumference, hip circumference, white blood cell count, high-sensitive C-reactive protein （hsCRP）, total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, were compared among three groups. ELISA was used to detect serum resistin levels. Pearson＇s correlation coefficient analysis was used to assess association between resistin and other traditional cardiovascular risk factors. Multinomial logistic regression analyses were used to define the relationship between serum resistin level and SAP or ACS. Results Serum resistin level in ACS group （1.18±0.48 μg/L） was significantly higher than that in normal control and SAP groups （0.49±0.40 and 0.66±0.40 μg/L; P〈0.01）. Only in ACS group, increased serum resistin level was significantly correlated with hsCRP （r=0.262, P=0.004） and white blood cell count （r=0.347, P=0.001）. Furthermore, serum resistin levels showed a stepwise increase with the number increase of 〉 50% stenosed coronary vessels. Multinomial logistic regression test demonstrated that serum resistin was a strong risk factor for ACS （OR=29.132, 95 % CI： 10.939-77.581, P〈0.001）. Conclusion These findings suggested the potential role of resistin in atherosclerosis and especially its involvement in ACS.