BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients ...BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and II,respectively).METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6%;95%confidence interval[95%CI]:27.7%–33.8%)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I and II were 1.3%(5/399)and 1.0%(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8%(95%CI:97.2%–99.6%)and 98.7%(95%CI:97.0%–99.5%)for MACE I and 98.7%(95%CI:96.8%–99.7%)and 99.0%(95%CI:97.4%–99.6%)for MACE II,respectively.CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated lowrisk patients remained above the level acceptable for early discharge without further evaluation.展开更多
The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute pha... The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……展开更多
BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative car...BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-Ⅰ(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and Ddimer(D-D) levels were significantly increased(P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic(ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.展开更多
BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress...BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.展开更多
Acute coronary syndrome(ACS)is one of the leading causes of death in cardiovascular disease.Percutaneous coronary intervention(PCI)is an important method for the treatment of coronary heart disease(CHD),and it has gre...Acute coronary syndrome(ACS)is one of the leading causes of death in cardiovascular disease.Percutaneous coronary intervention(PCI)is an important method for the treatment of coronary heart disease(CHD),and it has greatly reduced the mortality of ACS patients since its application.However,a series of new problems may occur after PCI,such as in-stent restenosis,no-reflow phenomenon,in-stent neoatherosclerosis,late stent thrombosis,myocardial ischemia-reperfusion injury,and malignant ventricular arrhythmias,which result in the occurrence of major adverse cardiac events(MACE)that seriously reduce the postoperative benefit for patients.The inflammatory response is a key mechanism of MACE after PCI.Therefore,examining effective anti-inflammatory therapies after PCI in patients with ACS is a current research focus to reduce the incidence of MACE.The pharmacological mechanism and clinical efficacy of routine Western medicine treatment for the anti-inflammatory treatment of CHD have been verified.Many Chinese medicine(CM)preparations have been widely used in the treatment of CHD.Basic and clinical studies showed that effectiveness of the combination of CM and Western medicine treatments in reducing incidence of MACE after PCI was better than Western medicine treatment alone.The current paper reviewed the potential mechanism of the inflammatory response and occurrence of MACE after PCI in patients with ACS and the research progress of combined Chinese and Western medicine treatments in reducing incidence of MACE.The results provide a theoretical basis for further research and clinical treatment.展开更多
BACKGROUND Lipoprotein(a)[Lp(a)]is a causal risk factor for atherosclerotic cardiovascular diseases;however,its role in acute coronary syndrome(ACS)remains unclear.AIM To investigate the hypothesis that the Lp(a)level...BACKGROUND Lipoprotein(a)[Lp(a)]is a causal risk factor for atherosclerotic cardiovascular diseases;however,its role in acute coronary syndrome(ACS)remains unclear.AIM To investigate the hypothesis that the Lp(a)levels are altered by various conditions during the acute phase of ACS,resulting in subsequent cardiovascular events.METHODS From September 2009 to May 2016,377 patients with ACS who underwent emergent coronary angiography,and 249 who completed≥1000 d of follow-up were enrolled.Lp(a)levels were measured using an isoform-independent assay at each time point from before percutaneous coronary intervention(PCI)to 48 h after PCI.The primary endpoint was the occurrence of major adverse cardiac events(MACE;cardiac death,other vascular death,ACS,and non-cardiac vascular events).RESULTS The mean circulating Lp(a)level decreased significantly from pre-PCI(0 h)to 12 h after(19.0 mg/dL to 17.8 mg/dL,P<0.001),and then increased significantly up to 48 h after(19.3 mg/dL,P<0.001).The changes from 0 to 12 h[Lp(a)Δ0-12]significantly correlated with the basal levels of creatinine[Spearman’s rank correlation coefficient(SRCC):-0.181,P<0.01]and Lp(a)(SRCC:-0.306,P<0.05).Among the tertiles classified according to Lp(a)Δ0-12,MACE was significantly more frequent in the lowest Lp(a)Δ0-12 group than in the remaining two tertile groups(66.2%vs 53.6%,P=0.034).A multivariate analysis revealed that Lp(a)Δ0-12[hazard ratio(HR):0.96,95%confidence interval(95%CI):0.92-0.99]and basal creatinine(HR:1.13,95%CI:1.05-1.22)were independent determinants of subsequent MACE.CONCLUSION Circulating Lp(a)levels in patients with ACS decreased significantly after emergent PCI,and a greater decrease was independently associated with a worse prognosis.展开更多
Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role.The resultant vicious cycle which sets in culminates in a higher ather...Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role.The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event(MACCE)events.However,the same has not convincingly been verified in real-world settings.In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE,prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables.However,certain questions like the role of metformin,quantifying the risk for MACCE amongst prediabetes compared to diabetes,the positive impact of reversion to normoglycemia remain unanswered.We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(CO...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is scarce.Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.AIM To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.METHODS COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample database.Overweight and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were compared.Major adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between groups.Multivariable regression analyses adjusted for sociodemographic,hospitalization features,and comorbidities.RESULTS Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive patients.On multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese patients.Class Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not significantly.All obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight group.CONCLUSION Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly different.Morbid obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitted with COVID-19.展开更多
Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect corona...Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect coronary artery disease.However,the clinical signifi cance of these fi ndings is not fully understood.Methods:We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018.Patients were followed up for a mean of 28.9 months(range 1-69 months).The clinical features,echocardiography measurements,pathological examination fi ndings,CAG results,and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results:ADN was found in 25 patients(42.4%).The arteries feeding the ADN included the right coronary artery(n=15),the left circumfl ex coronary artery(n=7),and both arteries(n=3).The patients with ADN had a higher proportion of eosinophils(3.2%vs.2.2%,P=0.03)and higher low-density lipoprotein cholesterol level(2.7 mmol/L vs.2.2 mmol/L,P=0.02).Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96%vs.73.5%,P=0.02).No signifi cant correlation was observed between the groups in clinical manifestations,atrial arrhythmia,myxoma size,cardiac chamber size,left ventricular ejection fraction,and the prevalence of complication with coronary artery disease[16%in the ADN group(n=4)vs.20.6%in the non-ADN group(n=7),P=0.66].However,patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up(0%vs.14.7%,P=0.07).Conclusion:CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.展开更多
Background:Pregnancy in women with pulmonary arterial hypertension(PAH)is a fatal condition,despite the effectiveness of PAH-specific therapies.The coverage status and effect of specific therapies in pregnant patients...Background:Pregnancy in women with pulmonary arterial hypertension(PAH)is a fatal condition,despite the effectiveness of PAH-specific therapies.The coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain unclear.To investigate this issue,we conducted a multicenter retrospective study in northern China.Methods:The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August 2020.Maternal endpoint events included(1)maternal death and/or(2)major adverse cardiac events,both occurring during pregnancy or within 6 weeks postpartum.Results:Although the overall mortality rate was encouraging(11.8%),the number of patients receiving PAH-specific therapies was extremely low(28.2%).Moreover,only 15.3%of patients received adequate duration of PAH-specific therapy(≥4 weeks)before delivery,and this subgroup showed the lowest major adverse cardiac events rate(7.7%)compared with that in the untreated(19.7%)and short-time treated groups(<4 weeks;54.5%).Conclusion:Pregnant patients with PAH without cardiac shunts face significantly increased mortality risks.Short-term PAH-specific therapy does not guarantee favorable maternal outcomes.Prepregnancy screening,early identification,and timely intervention are expected to improve maternal outcomes in pregnant women with PAH.展开更多
The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention(PCI) with stent remain unclear.The present study was aimed to compare clinical outc...The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention(PCI) with stent remain unclear.The present study was aimed to compare clinical outcomes in such two populations.From May 1999 to December 2009,4,334 patients with acute myocardial infarction(MI),unstable angina,stable angina,or silent ischemia,who underwent PCI,were registered at our centers.Among these,3,089 were men and 1,245 were women.We compared these groups with respect to the primary outcomes of MI and secondary outcomes including a composite of major adverse cardiac events(MACE) including cardiac death,MI,target lesion revascularization,target vessel revascularization(TVR),stent thrombosis(ST),definite ST and probable ST at one-year follow-up.Chinese male patients had a higher MACE rate(13%vs.10.7%,P =0.039),mainly led by TVR(9.09%vs.6.98%,P=0.024) at one year,which was significantly different than female patients.Chinese male and female patients showed a significant difference on MACEs.However,there was no significant difference with respect to MI between these groups.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)may contribute to delayed presentations of acute myocardial infarction.Delayed presentation with late reperfusion is often associated with an increased risk of mechanical c...BACKGROUND Coronavirus disease 2019(COVID-19)may contribute to delayed presentations of acute myocardial infarction.Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes.Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19.Also,standardized personal protective equipment precautions are established for all members of the team,regardless of pending COVID-19 testing which might further add to delays.AIM To compare performance measures and clinical outcomes of all patients who presented to our facility with ST elevation myocardial infarction(STEMI)during the COVID-19 pandemic to same time cohort from 2019.METHODS All patients who presented to our facility with STEMI during the pandemic were compared to a matched cohort during the same time period in 2019.STEMI with unknown time of symptom onset and inpatient STEMI patients were excluded.Primary outcome was major adverse cardiac events(MACE)in-hospital and up to 14 d after STEMI,including death,myocardial infarction,cardiac arrest,or stroke.Significant differences among groups for continuous variables were tested through ANOVA,using SYSTAT,version 13.Chi-square tests of association were used to compare patient characteristics among groups using SYSTAT.Relative risk scores and associated tests for significance were calculated for discrete variables using MedCalc(MedCalc Software,Ostend,Belgium).RESULTS There was a significantly longer time interval from symptom onset to first medical contact(FMC)in the COVID-19 group(P<0.02).Time to first electrocardiogram,door-to-balloon time,and FMC to balloon time were not significantly affected.The right coronary artery was the most common culprit for STEMI in both the cohorts.Over 60%of patients had one or more obstructive(>50%)lesion(s)remote from the culprit site.In-hospital and 14 d MACE were more prevalent in the COVID-19 group(P<0.01 and P<0.001).CONCLUSION This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which could be translating into worse clinical outcomes.展开更多
BACKGROUND For patients with cardiovascular disease,blood pressure variability(BPV),distinct from hypertension,is an important determinant of adverse cardiac events.Whether pre-operative BPV adversely affects outcomes...BACKGROUND For patients with cardiovascular disease,blood pressure variability(BPV),distinct from hypertension,is an important determinant of adverse cardiac events.Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention(PCI)is to this point unclear.AIM To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.METHODS Patients undergoing PCI in a single state in 2017 were studied(n=647).Systolic and diastolic BPV,defined as both the largest change and standard deviation for the 3-60 mo prior to PCI was calculated and patients with more than ten blood pressure measurements in that time were included for analysis(n=471).Adverse outcomes were identified up to a year following the procedure,including major adverse cardiac events(MACE),myocardial infarction,cerebrovascular accident,death,and all-cause hospitalization.RESULTS Visit-to-visit systolic BPV,as measured by both standard deviation and largest change,was higher in patients who had myocardial infarction,were readmitted,or died within one year following PCI.Systolic BPV,as measured by largest change or standard deviation,was higher in patients who had MACE,or readmissions(P<0.05).Diastolic BPV,as measured by largest change,was higher in patients with MACE and readmissions(P<0.05).CONCLUSION As BPV is easily measured and captured in the electronic medical record,these findings describe a novel method of identifying at-risk patients who undergo PCI.Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.展开更多
BACKGROUND The EverProTM(Sahajanand Laser Technology Ltd.,India)everolimus-eluting coronary stent system(EES)is a second-generation drug-eluting stent with a biodegradable polymer.AIM To determine the safety and perfo...BACKGROUND The EverProTM(Sahajanand Laser Technology Ltd.,India)everolimus-eluting coronary stent system(EES)is a second-generation drug-eluting stent with a biodegradable polymer.AIM To determine the safety and performance of the EverProTM EES in patients with coronary artery disease(CAD)during a 1-year clinical follow-up.METHODS This observational,retrospective,single-center study enrolled patients who had been implanted with the EverProTM stent between June 1,2018 and January 31,2019,and had completed a 1-year follow-up period after the index procedure.The primary clinical endpoint was major adverse cardiac events(MACE)at 6 mo defined as the composite of cardiac death,myocardial infarction(MI),and target lesion revascularization(TLR).Secondary endpoints were the incidence of TLR at 1,6 and 12 mo follow-up,MACE at 1 and 12 mo follow-up,and stent thrombosis up to 1 year after the index procedure.RESULTS The study population comprised 77 patients(98 lesions).A total of 37(48.1%)patients had comorbid hypertension.In total,26(33.8%)patients presented with ST segment elevation MI and 10.4%patients with non-ST segment elevation MI.Treated lesions were located mainly in the left anterior descending artery(49%)followed by the right coronary artery(29.6%),left circumflex(12.2%)and obtuse marginal(9.2%)arteries.The majority of patients were with single-vessel disease(79%),22.2%of lesions had a mild to severe thrombus load,and 94.9%were American College of Cardiology/American Heart Association type B or C.De novo stenting was performed in 96.9%of patients and 3%were treated for in-stent restenosis.Procedural success was attained in all patients.In-hospital or followup MACE and stent thrombosis were not reported during the 1-year follow-up period.CONCLUSION These findings suggest that the EverProTM EES is a safe and effective treatment option with no MACE or stent thrombosis reported during the 1-year study period in patients with CAD.展开更多
BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM T...BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM To compare the 5-year effectiveness and safety of the two stent types.METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines,and PubMed/MEDLINE,Scopus,and Cochrane Central were searched from inception till August 2023.Primary outcomes were major adverse cardiac events(MACE),cardiac death,myocardial infarction(MI),cardiac death or MI,and ischemia-driven total lesion revascularization(ID-TLR).RESULTS Four randomized controlled trials(RCT),which analyzed a sum total of 3045 patients with acute coronary syndrome(ACS)after a median follow-up time of 5 years were included.Though statistically insignificant,an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs.In addition,MI,cardiac death and MI,and definite stent thrombosis(DST)were significantly decreased in the TiNOS arm.Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI(NSTEMI)as a statistically significant covariate in the outcome of MACE.CONCLUSION TiNOS was found to be superior to DES in terms of MI,cardiac death or MI,and DST outcomes,however,the effect of the two stent types on ID-TLR and MACE was not significant.A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.展开更多
Background Subclinical hypothyroidism is associated with adverse cardiovascular outcomes.But less is known about its prognostic role in patients with acute coronary syndrome(ACS).Methods 538 ACS patients with normal s...Background Subclinical hypothyroidism is associated with adverse cardiovascular outcomes.But less is known about its prognostic role in patients with acute coronary syndrome(ACS).Methods 538 ACS patients with normal serum concentrations of T3 and T4 underwent coronary angiography in our hospital from January 2015 to January 2019 were retrospectively enrolled.They were divided into normal thyroid stimulating hormone(TSH)group(0.27-4.2 uIU/mL)(n=385)and high TSH group(>4.2 uIU/mL)(n=135).The study endpoints were the major adverse cardiovascular events(MACEs).The univariate and multivariate regression analysis including significant covariables were performed to test for the association between subclinical hypothyroidism and MACEs.Results The mean concentration of TSH were 8.72(6.37-11.02)uIU/mL in the high TSH group and 1.94(1.34-2.45)uIU/mL in the normal TSH group.Multivariate logistic regression analysis found that subclinical hypothyroidism[Odds ratio(OR):1.94,95%confidence interval(CI):1.23-2.65,P=0.030]was associated independently with MACE rate in ACS patients.The area under the receiver operating characteristic curve showed that the subclinical hypothyroidism had good predictable value for MACEs in patients with ACS(area under the curve:0.713,95%CI:0.668-0.802,P<0.001).Conclusions Subclinical hypothyroidism is associated with worse clinical prognosis in ACS patients.Clinicians need to pay more attention to subclinical hypothyroidism in ACS patients.[S Chin J Cardiol 2021;22(1):1-6]展开更多
Background In acute coronary syndrome(ACS),mental disorder is associated with poorer clinical outcomes,but there are still few data.Methods This study consecutively enrolled ACS patients with anxiety/depression at our...Background In acute coronary syndrome(ACS),mental disorder is associated with poorer clinical outcomes,but there are still few data.Methods This study consecutively enrolled ACS patients with anxiety/depression at our center from January 2018 to July 2020.Patients were divided into a control group(n=271)and an experiment group(n=361)based on whether they underwent psychotherapy.Patients were followed up at 12 months.The primary endpoint event was adverse cardiovascular events(MACE),including death,myocardial infarction,re-angina and the target vessel revascularization.Results There were no statistical differences in admission Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)between the two groups.The HAMA score(9.18±2.2vs.21.26±3.9;P<0.001)and HAMD score(23.15±3.8 vs.13.28±2.7;P<0.001)were lower in the experimental group than in the control group at discharge.Multiple logistic regression analysis showed that psychological status at discharge[OR 0.20,95%CI(0.011-0.421),P=0.020]and treatment for psychological disorders[OR 0.2095%CI(0.011-0.421),P=0.020]were independent predictors of 1-year MACE.Conclusions Anxiety and depressive status at discharge were independent associated with adverse events.psychotherapy significantly reduced MACEs in ACS,particularly recurrent angina,but not myocardial infarction,revascularization or all-cause mortality.展开更多
Background Small case series have suggested an association of coronary myocardial bridge (MB) with myocardial infarction (MI).However,the relationship between MB and major adverse cardiac events (MACE) remains l...Background Small case series have suggested an association of coronary myocardial bridge (MB) with myocardial infarction (MI).However,the relationship between MB and major adverse cardiac events (MACE) remains largely unknown.The aim of this study was to assess the relationship between MB and MACE involving MI.Methods We performed a systematic search of MEDLINE,PreMEDLINE,and all EMB Reviews as well as a reference list of relevant articles according to the SPICO (Study design,Patient,Intervention,Control-intervention,and Outcome) criteria using the following keywords:myocardial bridging,myocardial bridge,intramural coronary artery,mural coronary artery,tunneled coronary artery,coronary artery overbridging,etc.Bibliographies of the retrieved publications were additionally hand searched.Studies were included for the meta-analysis if they satisfied the following criteria:(1) they evaluate the association of MB with cardiovascular endpoint event; (2) they included individuals with MB and those without MB; 3) they excluded individuals with obstructive coronary artery disease (CAD).Studies were reviewed by a predetermined protocol including quality assessment.Dates were pooled using a random effect model.Results Seven observational studies that followed 5 486 patients eligible for the enrolled criteria were included from 7 136 initially identified articles.The prevalence of MB was 24.8% (1 363/5 486).During 0.5-7.0 years of follow-up of this cohort of population,crude outcome rates were 8.0% in the MB group and 7.7% in the non-MB group.The odds ratio of overall MACE and MI were 1.34 (95% confidence interval (CI):0.57-3.17,P=0.51,n=7 studies) and 2.75 (95% CI:1.08-7.02,P <0.03,n=5 studies) respectively for subjects of MB compared to non-MB.Conclusion Relationship between MB and MI appears to be a real one,although the study did not reveal a connection of MB to MACE,suggesting whether the necessity of antiplatelet therapy needs to be further studied in a larger cohort of patients with MB prospectively.展开更多
Background:There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI).Few studies have reported on this rela...Background:There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI).Few studies have reported on this relationship in non-ST elevated AMI (NSTEMI),and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods:This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients (399 men,114 women) with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R' or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events (MACE) were recorded.Results:In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group (P =0.042).There were fewer Killip Class Ⅰ patients in the fQRS group (P =0.019),while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group (P =0.019).Left ventricular ejection fraction levels were significantly lower in the fQRS group (P =0.021).Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein (CRP),and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE (MACE,P =0.028),revascularization (P =0.005),and recurrent angina (P =0.005) were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following variables were independent predictors of fQRS:Coronary artery narrowing (P =0.035),Killip classification (P =0.026),and total cholesterol (P =0.002).The following variables were found to be independent predictors of preoperative MACE:Hemoglobin (P =0.000),gender (P =0.026),fQRS (P =0.016),and time from myocardial infarction to balloon or coronary artery bypasses grafting (P =0.013).Conclusions:The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients.The number of narrowed coronary arteries,Killip classification,and total cholesterol are all independent predictors of the fQRS complexes.展开更多
Background The safety of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year ...Background The safety of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting (CABG) support was available. Methods A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction and target-vessel revascularization (TVR). Results The incidence of CTO was 7.9% in patients who underwent PCI, Successful recanalization was achieved in 132 patients (86.8%). Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths ((42.32±22.08) mm vs (27.61±22.85) mm, P=0.023), a higher rate of perforation (25.0% vs 0, P=0.014), and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure (10.0%, 30.0% and 35.0%) and the success (3.0%, 12.1% and 14.4%) groups (P=0.037, 0.034 and 0.040, respectively). These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group (P=0.031 and 0.023, respectively). Stump was the only predictor of recanalization success (HR 0.158, 95% Cl 0.041-0.612, P=0.008), whereas procedural failure (OR 13.023, 95% CI 6.67-13.69, P=0.002), incomplete revascularization (OR 9.71, 95% CI 2.93-5.59, P=0.005), and total stent length (OR 6.02, 95% Cl 1.55-11.93, P=0.027) were three independent predictors of MACE. Conclusions PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.展开更多
基金supported by the National Research Foundation of Korea(NRF)grant funded by the Korean government Ministry of Science and ICT(NRF-2021R1G1A101056711)。
文摘BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and II,respectively).METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6%;95%confidence interval[95%CI]:27.7%–33.8%)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I and II were 1.3%(5/399)and 1.0%(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8%(95%CI:97.2%–99.6%)and 98.7%(95%CI:97.0%–99.5%)for MACE I and 98.7%(95%CI:96.8%–99.7%)and 99.0%(95%CI:97.4%–99.6%)for MACE II,respectively.CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated lowrisk patients remained above the level acceptable for early discharge without further evaluation.
文摘 The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……
基金Supported by Beijing Municipal Science&Technology Commission,No.Z171100000417056.
文摘BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-Ⅰ(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and Ddimer(D-D) levels were significantly increased(P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic(ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.
文摘BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.
基金Supported by the Applied Technology Research and Development and Demonstration Projects of Beijing Province(No.Z191100006619071)。
文摘Acute coronary syndrome(ACS)is one of the leading causes of death in cardiovascular disease.Percutaneous coronary intervention(PCI)is an important method for the treatment of coronary heart disease(CHD),and it has greatly reduced the mortality of ACS patients since its application.However,a series of new problems may occur after PCI,such as in-stent restenosis,no-reflow phenomenon,in-stent neoatherosclerosis,late stent thrombosis,myocardial ischemia-reperfusion injury,and malignant ventricular arrhythmias,which result in the occurrence of major adverse cardiac events(MACE)that seriously reduce the postoperative benefit for patients.The inflammatory response is a key mechanism of MACE after PCI.Therefore,examining effective anti-inflammatory therapies after PCI in patients with ACS is a current research focus to reduce the incidence of MACE.The pharmacological mechanism and clinical efficacy of routine Western medicine treatment for the anti-inflammatory treatment of CHD have been verified.Many Chinese medicine(CM)preparations have been widely used in the treatment of CHD.Basic and clinical studies showed that effectiveness of the combination of CM and Western medicine treatments in reducing incidence of MACE after PCI was better than Western medicine treatment alone.The current paper reviewed the potential mechanism of the inflammatory response and occurrence of MACE after PCI in patients with ACS and the research progress of combined Chinese and Western medicine treatments in reducing incidence of MACE.The results provide a theoretical basis for further research and clinical treatment.
基金the Vehicle Racing Commemorative Foundation,No.2013-2015Grant for Collaborative Research from Kanazawa Medical University,No.C2015-4and Grants-in-Aid for Scientific Research(C)from the Japan Society for the Promotion of Science to Dr.Kouji Kajinami,No.18K08051 and No.21K08139.
文摘BACKGROUND Lipoprotein(a)[Lp(a)]is a causal risk factor for atherosclerotic cardiovascular diseases;however,its role in acute coronary syndrome(ACS)remains unclear.AIM To investigate the hypothesis that the Lp(a)levels are altered by various conditions during the acute phase of ACS,resulting in subsequent cardiovascular events.METHODS From September 2009 to May 2016,377 patients with ACS who underwent emergent coronary angiography,and 249 who completed≥1000 d of follow-up were enrolled.Lp(a)levels were measured using an isoform-independent assay at each time point from before percutaneous coronary intervention(PCI)to 48 h after PCI.The primary endpoint was the occurrence of major adverse cardiac events(MACE;cardiac death,other vascular death,ACS,and non-cardiac vascular events).RESULTS The mean circulating Lp(a)level decreased significantly from pre-PCI(0 h)to 12 h after(19.0 mg/dL to 17.8 mg/dL,P<0.001),and then increased significantly up to 48 h after(19.3 mg/dL,P<0.001).The changes from 0 to 12 h[Lp(a)Δ0-12]significantly correlated with the basal levels of creatinine[Spearman’s rank correlation coefficient(SRCC):-0.181,P<0.01]and Lp(a)(SRCC:-0.306,P<0.05).Among the tertiles classified according to Lp(a)Δ0-12,MACE was significantly more frequent in the lowest Lp(a)Δ0-12 group than in the remaining two tertile groups(66.2%vs 53.6%,P=0.034).A multivariate analysis revealed that Lp(a)Δ0-12[hazard ratio(HR):0.96,95%confidence interval(95%CI):0.92-0.99]and basal creatinine(HR:1.13,95%CI:1.05-1.22)were independent determinants of subsequent MACE.CONCLUSION Circulating Lp(a)levels in patients with ACS decreased significantly after emergent PCI,and a greater decrease was independently associated with a worse prognosis.
文摘Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role.The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event(MACCE)events.However,the same has not convincingly been verified in real-world settings.In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE,prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables.However,certain questions like the role of metformin,quantifying the risk for MACCE amongst prediabetes compared to diabetes,the positive impact of reversion to normoglycemia remain unanswered.We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is scarce.Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.AIM To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.METHODS COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample database.Overweight and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were compared.Major adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between groups.Multivariable regression analyses adjusted for sociodemographic,hospitalization features,and comorbidities.RESULTS Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive patients.On multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese patients.Class Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not significantly.All obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight group.CONCLUSION Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly different.Morbid obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitted with COVID-19.
文摘Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect coronary artery disease.However,the clinical signifi cance of these fi ndings is not fully understood.Methods:We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018.Patients were followed up for a mean of 28.9 months(range 1-69 months).The clinical features,echocardiography measurements,pathological examination fi ndings,CAG results,and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results:ADN was found in 25 patients(42.4%).The arteries feeding the ADN included the right coronary artery(n=15),the left circumfl ex coronary artery(n=7),and both arteries(n=3).The patients with ADN had a higher proportion of eosinophils(3.2%vs.2.2%,P=0.03)and higher low-density lipoprotein cholesterol level(2.7 mmol/L vs.2.2 mmol/L,P=0.02).Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96%vs.73.5%,P=0.02).No signifi cant correlation was observed between the groups in clinical manifestations,atrial arrhythmia,myxoma size,cardiac chamber size,left ventricular ejection fraction,and the prevalence of complication with coronary artery disease[16%in the ADN group(n=4)vs.20.6%in the non-ADN group(n=7),P=0.66].However,patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up(0%vs.14.7%,P=0.07).Conclusion:CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.
基金supported by grants from Shandong Provincial Natural Science Foundation(ZR2021MH111 for Cui X and ZR2020MH033 for Zhang H)Doctoral Program of Shandong Provincial Natural Science Foundation(ZR2017BH047 for Lu W).
文摘Background:Pregnancy in women with pulmonary arterial hypertension(PAH)is a fatal condition,despite the effectiveness of PAH-specific therapies.The coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain unclear.To investigate this issue,we conducted a multicenter retrospective study in northern China.Methods:The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August 2020.Maternal endpoint events included(1)maternal death and/or(2)major adverse cardiac events,both occurring during pregnancy or within 6 weeks postpartum.Results:Although the overall mortality rate was encouraging(11.8%),the number of patients receiving PAH-specific therapies was extremely low(28.2%).Moreover,only 15.3%of patients received adequate duration of PAH-specific therapy(≥4 weeks)before delivery,and this subgroup showed the lowest major adverse cardiac events rate(7.7%)compared with that in the untreated(19.7%)and short-time treated groups(<4 weeks;54.5%).Conclusion:Pregnant patients with PAH without cardiac shunts face significantly increased mortality risks.Short-term PAH-specific therapy does not guarantee favorable maternal outcomes.Prepregnancy screening,early identification,and timely intervention are expected to improve maternal outcomes in pregnant women with PAH.
基金supported by the Nanjing Municipal Health Outstanding Project(2000NJMHOP-120)
文摘The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention(PCI) with stent remain unclear.The present study was aimed to compare clinical outcomes in such two populations.From May 1999 to December 2009,4,334 patients with acute myocardial infarction(MI),unstable angina,stable angina,or silent ischemia,who underwent PCI,were registered at our centers.Among these,3,089 were men and 1,245 were women.We compared these groups with respect to the primary outcomes of MI and secondary outcomes including a composite of major adverse cardiac events(MACE) including cardiac death,MI,target lesion revascularization,target vessel revascularization(TVR),stent thrombosis(ST),definite ST and probable ST at one-year follow-up.Chinese male patients had a higher MACE rate(13%vs.10.7%,P =0.039),mainly led by TVR(9.09%vs.6.98%,P=0.024) at one year,which was significantly different than female patients.Chinese male and female patients showed a significant difference on MACEs.However,there was no significant difference with respect to MI between these groups.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)may contribute to delayed presentations of acute myocardial infarction.Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes.Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19.Also,standardized personal protective equipment precautions are established for all members of the team,regardless of pending COVID-19 testing which might further add to delays.AIM To compare performance measures and clinical outcomes of all patients who presented to our facility with ST elevation myocardial infarction(STEMI)during the COVID-19 pandemic to same time cohort from 2019.METHODS All patients who presented to our facility with STEMI during the pandemic were compared to a matched cohort during the same time period in 2019.STEMI with unknown time of symptom onset and inpatient STEMI patients were excluded.Primary outcome was major adverse cardiac events(MACE)in-hospital and up to 14 d after STEMI,including death,myocardial infarction,cardiac arrest,or stroke.Significant differences among groups for continuous variables were tested through ANOVA,using SYSTAT,version 13.Chi-square tests of association were used to compare patient characteristics among groups using SYSTAT.Relative risk scores and associated tests for significance were calculated for discrete variables using MedCalc(MedCalc Software,Ostend,Belgium).RESULTS There was a significantly longer time interval from symptom onset to first medical contact(FMC)in the COVID-19 group(P<0.02).Time to first electrocardiogram,door-to-balloon time,and FMC to balloon time were not significantly affected.The right coronary artery was the most common culprit for STEMI in both the cohorts.Over 60%of patients had one or more obstructive(>50%)lesion(s)remote from the culprit site.In-hospital and 14 d MACE were more prevalent in the COVID-19 group(P<0.01 and P<0.001).CONCLUSION This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which could be translating into worse clinical outcomes.
文摘BACKGROUND For patients with cardiovascular disease,blood pressure variability(BPV),distinct from hypertension,is an important determinant of adverse cardiac events.Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention(PCI)is to this point unclear.AIM To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.METHODS Patients undergoing PCI in a single state in 2017 were studied(n=647).Systolic and diastolic BPV,defined as both the largest change and standard deviation for the 3-60 mo prior to PCI was calculated and patients with more than ten blood pressure measurements in that time were included for analysis(n=471).Adverse outcomes were identified up to a year following the procedure,including major adverse cardiac events(MACE),myocardial infarction,cerebrovascular accident,death,and all-cause hospitalization.RESULTS Visit-to-visit systolic BPV,as measured by both standard deviation and largest change,was higher in patients who had myocardial infarction,were readmitted,or died within one year following PCI.Systolic BPV,as measured by largest change or standard deviation,was higher in patients who had MACE,or readmissions(P<0.05).Diastolic BPV,as measured by largest change,was higher in patients with MACE and readmissions(P<0.05).CONCLUSION As BPV is easily measured and captured in the electronic medical record,these findings describe a novel method of identifying at-risk patients who undergo PCI.Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.
文摘BACKGROUND The EverProTM(Sahajanand Laser Technology Ltd.,India)everolimus-eluting coronary stent system(EES)is a second-generation drug-eluting stent with a biodegradable polymer.AIM To determine the safety and performance of the EverProTM EES in patients with coronary artery disease(CAD)during a 1-year clinical follow-up.METHODS This observational,retrospective,single-center study enrolled patients who had been implanted with the EverProTM stent between June 1,2018 and January 31,2019,and had completed a 1-year follow-up period after the index procedure.The primary clinical endpoint was major adverse cardiac events(MACE)at 6 mo defined as the composite of cardiac death,myocardial infarction(MI),and target lesion revascularization(TLR).Secondary endpoints were the incidence of TLR at 1,6 and 12 mo follow-up,MACE at 1 and 12 mo follow-up,and stent thrombosis up to 1 year after the index procedure.RESULTS The study population comprised 77 patients(98 lesions).A total of 37(48.1%)patients had comorbid hypertension.In total,26(33.8%)patients presented with ST segment elevation MI and 10.4%patients with non-ST segment elevation MI.Treated lesions were located mainly in the left anterior descending artery(49%)followed by the right coronary artery(29.6%),left circumflex(12.2%)and obtuse marginal(9.2%)arteries.The majority of patients were with single-vessel disease(79%),22.2%of lesions had a mild to severe thrombus load,and 94.9%were American College of Cardiology/American Heart Association type B or C.De novo stenting was performed in 96.9%of patients and 3%were treated for in-stent restenosis.Procedural success was attained in all patients.In-hospital or followup MACE and stent thrombosis were not reported during the 1-year follow-up period.CONCLUSION These findings suggest that the EverProTM EES is a safe and effective treatment option with no MACE or stent thrombosis reported during the 1-year study period in patients with CAD.
文摘BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM To compare the 5-year effectiveness and safety of the two stent types.METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines,and PubMed/MEDLINE,Scopus,and Cochrane Central were searched from inception till August 2023.Primary outcomes were major adverse cardiac events(MACE),cardiac death,myocardial infarction(MI),cardiac death or MI,and ischemia-driven total lesion revascularization(ID-TLR).RESULTS Four randomized controlled trials(RCT),which analyzed a sum total of 3045 patients with acute coronary syndrome(ACS)after a median follow-up time of 5 years were included.Though statistically insignificant,an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs.In addition,MI,cardiac death and MI,and definite stent thrombosis(DST)were significantly decreased in the TiNOS arm.Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI(NSTEMI)as a statistically significant covariate in the outcome of MACE.CONCLUSION TiNOS was found to be superior to DES in terms of MI,cardiac death or MI,and DST outcomes,however,the effect of the two stent types on ID-TLR and MACE was not significant.A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.
基金supported by The 2020 Medical and Health Science and Technology Projects in Yangjiang City(No.SF2020044)
文摘Background Subclinical hypothyroidism is associated with adverse cardiovascular outcomes.But less is known about its prognostic role in patients with acute coronary syndrome(ACS).Methods 538 ACS patients with normal serum concentrations of T3 and T4 underwent coronary angiography in our hospital from January 2015 to January 2019 were retrospectively enrolled.They were divided into normal thyroid stimulating hormone(TSH)group(0.27-4.2 uIU/mL)(n=385)and high TSH group(>4.2 uIU/mL)(n=135).The study endpoints were the major adverse cardiovascular events(MACEs).The univariate and multivariate regression analysis including significant covariables were performed to test for the association between subclinical hypothyroidism and MACEs.Results The mean concentration of TSH were 8.72(6.37-11.02)uIU/mL in the high TSH group and 1.94(1.34-2.45)uIU/mL in the normal TSH group.Multivariate logistic regression analysis found that subclinical hypothyroidism[Odds ratio(OR):1.94,95%confidence interval(CI):1.23-2.65,P=0.030]was associated independently with MACE rate in ACS patients.The area under the receiver operating characteristic curve showed that the subclinical hypothyroidism had good predictable value for MACEs in patients with ACS(area under the curve:0.713,95%CI:0.668-0.802,P<0.001).Conclusions Subclinical hypothyroidism is associated with worse clinical prognosis in ACS patients.Clinicians need to pay more attention to subclinical hypothyroidism in ACS patients.[S Chin J Cardiol 2021;22(1):1-6]
基金supported by Dongguan City Social Science and Technology Development(General)Project(No.202050715059412)
文摘Background In acute coronary syndrome(ACS),mental disorder is associated with poorer clinical outcomes,but there are still few data.Methods This study consecutively enrolled ACS patients with anxiety/depression at our center from January 2018 to July 2020.Patients were divided into a control group(n=271)and an experiment group(n=361)based on whether they underwent psychotherapy.Patients were followed up at 12 months.The primary endpoint event was adverse cardiovascular events(MACE),including death,myocardial infarction,re-angina and the target vessel revascularization.Results There were no statistical differences in admission Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)between the two groups.The HAMA score(9.18±2.2vs.21.26±3.9;P<0.001)and HAMD score(23.15±3.8 vs.13.28±2.7;P<0.001)were lower in the experimental group than in the control group at discharge.Multiple logistic regression analysis showed that psychological status at discharge[OR 0.20,95%CI(0.011-0.421),P=0.020]and treatment for psychological disorders[OR 0.2095%CI(0.011-0.421),P=0.020]were independent predictors of 1-year MACE.Conclusions Anxiety and depressive status at discharge were independent associated with adverse events.psychotherapy significantly reduced MACEs in ACS,particularly recurrent angina,but not myocardial infarction,revascularization or all-cause mortality.
基金This study was partly supported by the National Natural Scientific Foundation,the Specialized Research Fund for the Doctoral Program of Higher Education of China,the Capital Special Foundation of Clinical Application Research,the Capital Health Development Fund,the Beijing Natural Science Foundation
文摘Background Small case series have suggested an association of coronary myocardial bridge (MB) with myocardial infarction (MI).However,the relationship between MB and major adverse cardiac events (MACE) remains largely unknown.The aim of this study was to assess the relationship between MB and MACE involving MI.Methods We performed a systematic search of MEDLINE,PreMEDLINE,and all EMB Reviews as well as a reference list of relevant articles according to the SPICO (Study design,Patient,Intervention,Control-intervention,and Outcome) criteria using the following keywords:myocardial bridging,myocardial bridge,intramural coronary artery,mural coronary artery,tunneled coronary artery,coronary artery overbridging,etc.Bibliographies of the retrieved publications were additionally hand searched.Studies were included for the meta-analysis if they satisfied the following criteria:(1) they evaluate the association of MB with cardiovascular endpoint event; (2) they included individuals with MB and those without MB; 3) they excluded individuals with obstructive coronary artery disease (CAD).Studies were reviewed by a predetermined protocol including quality assessment.Dates were pooled using a random effect model.Results Seven observational studies that followed 5 486 patients eligible for the enrolled criteria were included from 7 136 initially identified articles.The prevalence of MB was 24.8% (1 363/5 486).During 0.5-7.0 years of follow-up of this cohort of population,crude outcome rates were 8.0% in the MB group and 7.7% in the non-MB group.The odds ratio of overall MACE and MI were 1.34 (95% confidence interval (CI):0.57-3.17,P=0.51,n=7 studies) and 2.75 (95% CI:1.08-7.02,P <0.03,n=5 studies) respectively for subjects of MB compared to non-MB.Conclusion Relationship between MB and MI appears to be a real one,although the study did not reveal a connection of MB to MACE,suggesting whether the necessity of antiplatelet therapy needs to be further studied in a larger cohort of patients with MB prospectively.
文摘Background:There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI).Few studies have reported on this relationship in non-ST elevated AMI (NSTEMI),and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods:This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients (399 men,114 women) with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R' or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events (MACE) were recorded.Results:In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group (P =0.042).There were fewer Killip Class Ⅰ patients in the fQRS group (P =0.019),while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group (P =0.019).Left ventricular ejection fraction levels were significantly lower in the fQRS group (P =0.021).Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein (CRP),and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE (MACE,P =0.028),revascularization (P =0.005),and recurrent angina (P =0.005) were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following variables were independent predictors of fQRS:Coronary artery narrowing (P =0.035),Killip classification (P =0.026),and total cholesterol (P =0.002).The following variables were found to be independent predictors of preoperative MACE:Hemoglobin (P =0.000),gender (P =0.026),fQRS (P =0.016),and time from myocardial infarction to balloon or coronary artery bypasses grafting (P =0.013).Conclusions:The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients.The number of narrowed coronary arteries,Killip classification,and total cholesterol are all independent predictors of the fQRS complexes.
文摘Background The safety of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting (CABG) support was available. Methods A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction and target-vessel revascularization (TVR). Results The incidence of CTO was 7.9% in patients who underwent PCI, Successful recanalization was achieved in 132 patients (86.8%). Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths ((42.32±22.08) mm vs (27.61±22.85) mm, P=0.023), a higher rate of perforation (25.0% vs 0, P=0.014), and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure (10.0%, 30.0% and 35.0%) and the success (3.0%, 12.1% and 14.4%) groups (P=0.037, 0.034 and 0.040, respectively). These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group (P=0.031 and 0.023, respectively). Stump was the only predictor of recanalization success (HR 0.158, 95% Cl 0.041-0.612, P=0.008), whereas procedural failure (OR 13.023, 95% CI 6.67-13.69, P=0.002), incomplete revascularization (OR 9.71, 95% CI 2.93-5.59, P=0.005), and total stent length (OR 6.02, 95% Cl 1.55-11.93, P=0.027) were three independent predictors of MACE. Conclusions PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.