Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris

Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index （LAAI） has predictive value for prognosis in patients with unstable angina pectoris （UAP）. This study was aimed to assess the association between LAAI and outcomes in UAP patients. Methods We enrolled a total of 391 in-hospital patients diag- nosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of ad- verse cardiovascular （CV） events, including hospital readmission for angina pectoris, acute myocardial infarction （AMI）, congestive heart failure （CHF）, stroke and all-cause mortality. Results During a mean follow-up time of 26.3±8.6 months, 98 adverse CV events occurred （84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality）. In a multivariate Cox model, LAAI [OR： 1.140, 95% CI： 1.01±1.279, P = 0.026], diastolic blood pressure （OR： 0.976, 95% CI： 0.956-0.996, P = 0.020） and pulse pressure （OR 1.020, 95% CI： 1.007-1.034, P = 0.004） were independent predictors for adverse CV events in UAP patients. Conclusions LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

Effects of Xin Mai Tong Capsule on Vasoregulatory Peptides in the Patients of Coronary Heart Disease

In order to inquire into the therapeutic effects of Xin Mai Tong Capsule (心脉通胶囊) on coronary heart disease with myocardial ischemia, 40 patients were randomly divided into two groups (Xin Mai Tong group and the control group). The plasma endothelin (ET) levels in the two groups of patients were markedly higher than that of the healthy people (P<0.001), and the calcitonin gene related peptide (CGRP) was similar to that of the healthy people (P>0.05). After treatment, ET and symptomatic scores in the two groups decreased markedly (P<0.01), and their S-T segments were elevated obviously (P<0.01). But the decrease of ET and symptomatic scores and elevation of S-T segment in Xin Mai Tong group were superior to those of the control group (P<0.05～0.01). The CGRP level in the control group did not vary obviously post-treatment, but it increased markedly (P<0.01) with the addition of Xin Mai Tong Capsule in Xin Mai Tong group.

Concomitant acute myocardial infarction and descending thoracic aorta penetrating ulcer

Acute coronary syndrome （ACS） refers to a spectrum of clinical presentations ranging from unstable angina to non-ST-segment elevation myocardial infarction （NSTEMI） to ST-segment elevation myocardial infarction （STEMI）. Aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer （PAU） are three major acute aortic syndromes （AAS）.

Danshenchuanxiongqin injection in the treatment of unstable angina pectoris: a systematic review and Meta-analysis

OBJECTIVE:To evaluate systematically the efficacy and safety of Danshenchuanxiongqin Injection(DCI)in the treatment of unstable angina pectoris(UAP).METHODS:Randomized controlled trials(RCTs)regarding DCI used for treating UAP were searched in English and Chinese electronic databases from inception to January 2014.Two reviewers independently retrieved RCTs and extracted relevant information.The Cochrane risk of bias method was used to assess the quality of included studies,and a Meta-analysis was conducted with Review Manager5.2 software.RESULTS:Eleven RCTs involving 1034 participants were included.The methodological quality was relatively passable.The Meta-analysis indicated that the combined use of DCI and conventional treatment with Western Medicine(WM)was more efficacious in the outcomes of total effective rate[Relative Risk(RR)=1.27,95%CI(confidence interval;1.18,1.35),P<0.000 01],the total effective rate of ECG[RR=1.40,95%CI(1.18,1.66),P<0.000 01],total cholesterol[Mean difference(MD)=-0.58,95%CI(-0.83,-0.33),P<0.000 01],total triglycerides[MD=-0.36,95%CI(-0.54,-0.17),P=0.0001],and the number of ST-segment depression[MD=-0.36,95%CI(-0.54,-0.17),P=0.0001].There were two adverse drug reactions reported in one study.CONCLUSION:Based on the systematic review,DCI combined with WM appeared to be efficacious in the treatment UAP.However,the evidence of DCI for treating UAP requires large-scale and double-blind RCTs to substantiate these findings.

Clinical characteristics of acute ischemic syndrome in China

OBJECTIVE: To analyse the characteristics and therapies of patients with acute ischemic syndrome in China. METHODS: This study is part of the international multicentre registry for acute ischemic syndrome. Since April 1999, the data of patients admitted to designated hospitals with acute ischemic cardiac chest pain were collected by filling in Case Report Forms offered by the Canadian Cardiovascular Collaboration. The main clinica l characteristics and in hospital events of the patients were recorded. RESULTS: Fifteen hundred and nine cases of acute ischemic syndrome from 34 hospitals nationwide were enrolled in the registry (including unstable angina and non Q-wave myocardial infarction).The mean age of the patients was 62.3. Male dominance (62.2%) was noted. The percentages of patients with chest pain at presentation and abnormal ECG were 47.8% and 89.5%, respectively. The most common clinical diagnosis on admission was unstable angina, accounting for 91.3% of the patients and non Q-wave myocardial infarction (MI), accounting for the other 8.7%. During hospitalization, the following interventions were given: thrombolytic therapy in 50 cases (3.3%), coronary angiography in 528 cases (35.0%), percutaneous transluminal coronary angioplasty (PTCA) in 253 cases (16.8%) and coronary artery bypass graft surgery (CABG) in 62 cases (4.1%). Nitrate (oral or patch ) and anti-platelet therapy were used in 1460 cases (96.8%) and 1441 cases (95.5%), respectively. The incidence of in hospital major events was 18.8%, in cluding 18 deaths (1.2%), with the most common causes being severe arrhythmias and sudden death. CONCLUSIONS: Patients with acute ischemic syndrome in China have mostly been diagnosed as cases of unstable angina. A relatively high PTCA rate but low CABG rate was noted in China. The most common cause of in hospital death is severe arrhythmias or sudden death.

Logistic Regression Analysis of Syndrome Essential Factors in Patients with Unstable Angina Pectoris

Objective: To explore the correlation between common syndrome essential factors and the symptoms and signs of unstable angina (UA). Methods: Eight hundred and fifteen patients with UA confirmed by coronary angiography were identified from several centers. Common syndrome essential factors were selected on the basis of expert experience. The correlations between common syndrome essential factors and symptoms and signs of UA were analyzed using binary logistic regression analysis. Results: The common syndrome essential factors in unstable angina were blood stasis, qi stagnation, phlegm turbidity, heat stagnancy, qi deficiency, yin deficiency, and yang deficiency. Symptoms such as chest pain, hypochondriac distention, ecchymosis, dark orbits, dark and purplish tongue, and tongue with ecchymosis and petechiae were significant diagnostic features of "blood stasis". Aversion to cold and cool limbs, weakness in the waist and knees, and clear abundant urine were significant diagnostic features of "yang deficiency". These results were in accordance with the understanding of traditional clinical Chinese medical practice. Conclusion: This clinical study analyzed the correlations between common syndrome essential factors and the symptoms and signs of unstable angina. The results provide the basis for establishing diagnostic criteria for syndrome essential factors.

Safflower yellow injection combined with conventional therapy in treating unstable angina pectoris:a meta-analysis

OBJECTIVE： To evaluate the clinical efficacy of safflower yellow injection combined with conventional therapy in treating unstable angina pectoris.METHODS： We searched online databases： Chinese journal full-text database, China National Knowledge Infrastructure, Wanfang database, Chinese journal full-text database, Pubmed, ScienceDirect,Embase, and the Cochrane Library with manual-screening of relevant literature. Eligible randomized controlled trials（RCT） on angina pectoris were included. We conducted meta-analysis using the RevMan 5.1 software from The Cochrane Collaboration. We treated the relief rate of angina symptoms and electrocardiograph（ECG） as evaluation.RESULTS： Seven articles, including in 1134 patients, were enrolled after the evaluation. Therewas no significant heterogeneity among the studies（χ2=1.08, df=6, P=0.98, I2=0%）. The safflower yellow injection with conventional therapy has a higher effective rate than the control group in relieving the symptoms of angina pectoris [odds ratio（OR）=2.95, 95%（CI）（1.81, 4.81）] and improving ischemic ECG [OR=2.85, 95% CI（1.67, 4.86）]. The difference was statistically significant in the ＂80 mg dosage＂ and ＂100 mg dosage＂ subgroups（P0.05） for improving clinical symptoms and ECG. The funnel graphic was nearly symmetrical. Sensitivity analysis suggested that the results were stable.CONCLUSION： Safflower yellow injection as an adjunct therapy with conventional drugs shows advantages in easing the clinical symptoms of unstable angina and improving ECG over basic therapy alone. However, the conclusions should be interpreted with care until more high-quality RCTs are reported.

Clinical characteristics of acute ischemic syndrome in China The Chinese Coordinating Center of OASIS Registry

Objective To analyse the characteristics and therapies of patients with acute ischemic syndrome in China. Methods This study is part of the international multicentre registry for acute ischemic syndrome. Since April 1999, the data of patients admitted to designated hospitals with acute ischemic cardiac chest pain were collected by filling in Case Report Forms offered by the Canadian Cardiovascular Collaboration. The main clinical characteristics and in-hospital events of the patients were recorded. Results Fifteen hundred and nine cases of acute ischemic syndrome from 34 hospitals nationwide were enrolled in the registry (including unstable angina and non Q-wave myocardial infarction).The mean age of the patients was 62.3. Male dominance (62.2%) was noted. The percentages of patients with chest pain at presentation and abnormal ECG were 47.8% and 89.5%, respectively. The most common clinical diagnosis on admission was unstable angina, accounting for 91.3% of the patients and non Q-wave myocardial infarction (MI), accounting for the other 8.7%. During hospitalization, the following interventions were given: thrombolytic therapy in 50 cases (3.3%), coronary angiography in 528 cases (35.0%), percutaneous transluminal coronary angioplasty (PTCA) in 253 cases (16.8%) and coronary artery bypass graft surgery (CABG) in 62 cases (4.1%). Nitrate (oral or patch) and anti-platelet therapy were used in 1460 cases (96.8%) and 1441 cases (95.5%), respectively. The incidence of in-hospital major events was 18.8%, including 18 deaths (1.2%), with the most common causes being severe arrhythmias and sudden death.Conclusions Patients with acute ischemic syndrome in China have mostly been diagnosed as cases of unstable angina. A relatively high PTCA rate but low CABG rate was noted in China. The most common cause of in-hospital death is severe arrhythmias or sudden death.