The Role of Electrocardiogram DETERMINE Score in Prediction of Coronary Artery Disease Severity

Background: A major cause of mortality and disability on a global scale is myocardial infarction (MI). These days, the most reliable way to detect and measure MI is via cardiovascular magnetic resonance imaging (CMR). Aims and Objectives: To evaluate the effectiveness of the Electrocardiogram DETERMINE Score in predicting the severity of coronary artery disease (CAD) in patients who have experienced an Acute Myocardial Infarction (AMI) & to assess improvements in left ventricular function at 6 months following coronary artery bypass grafting (CABG). Subjects and Methods: This Observational cohort study was done at the Cardiology and Radiology department and cardiac surgery department, Al-Azhar university hospitals and Helwan University hospital. The study involved 700 cases who patients diagnosed with Acute Myocardial Infarction and fulfilled specific criteria for selection. Result: There was highly statistically significant relation between Myocardial infarction size and ECG Marker Score as mean infarct size elevated When the number of ECG markers increased. There was a highly statistically significant relation between myocardial infarct segments, myocardial infarction size and improvement of cardiac function 6 months post-CABG. Conclusion: The study found that larger myocardial infarctions corresponded with higher DETERMINE Scores. It concluded that an ECG-based score better estimates infarct size than LVEF alone. Additionally, there was a significant statistical correlation between the size and segmentation of myocardial infarction and better cardiac function six months after CABG.

Employing a random forest model to forecast the likelihood of coronary artery lesions in Kawasaki disease: a study centered on four biomarkers

Background:Kawasaki disease is an acute immune vasculitis,which is more common in children under 5 years old.Kawasaki disease mainly affects the cardiovascular system,especially the coronary arteries.Once coronary artery damage occurs,it can significantly impact the patient’s prognosis.Therefore,in some countries and regions,Kawasaki disease has become a common acquired heart disease.Methods:First,univariate analysis was conducted on each predictive factor.Then,Least Absolute Shrinkage and Selection Operator and random forest algorithms were used to screen all predictive factors,and the prediction model was evaluated using receiver operating characteristic curve,calibration curve,and Decision Curve Analysis.Results:This study,based on data from 228 Kawasaki disease patients,utilized a random forest model to identify four predictive factors:white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count.These factors were used to construct a prediction model,which achieved an area under the curve of 0.743.Conclusions:We developed a forest plot based on white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count to effectively predict the occurrence of coronary artery lesions in Kawasaki disease.

Application Effect of Blended Education Strategy Based on the Learning Pass Platform in Phase III Cardiac Rehabilitation of Patients with Coronary Artery Disease

Objective:To explore the application effect of the blended education strategy based on the Learning Pass platform in the phase III cardiac rehabilitation of patients with coronary artery disease.Methods:90 patients diagnosed with coronary artery disease in the Department of Cardiology of our hospital from January 2019 to January 2021 were selected and divided into the control group and the experimental group according to the method of randomized numerical table,with 45 cases in each group.Both the experimental group and the control group received pre-discharge cardiac rehabilitation education by conventional means.The control group received education and supervision information via WeChat after discharge,while the experimental group joined the Learning Pass platform to receive online and offline hybrid education and supervision,with online as the mainstay and offline as a supplement.The disease cognitive level,self-management skills,quality of life,medication adherence,and emotional status of the two groups were compared.Results:The disease cognitive levels in the experimental group were significantly higher than those of the control group(P<0.05);the scores of the experimental group in terms of quality of life,self-management skills,and medication adherence were significantly higher than those of the control group(P<0.05);and the scores of anxiety and depression in the experimental group were significantly lower than those of the control group(P<0.05).Conclusion:The blended education strategy based on the Learning Pass platform has a significant application effect in phase III cardiac rehabilitation of patients with coronary artery disease.It can improve patients’disease cognitive level,self-management skills,and quality of life,and provide a basis for improving patients’prognosis.

Correlation of neutrophil to lymphocyte ratio to severity of coronary artery disease and in-hospital clinical outcomes in patients with acute coronary syndrome: A prospective observational study

Objective:To explore correlation of neutrophil-to-lymphocyte ratio(NLR)to severity of coronary artery disease(CAD)and in-hospital clinical outcomes in patients with acute coronary syndrome(ACS).Methods:In this prospective and observational study,we recruited 500 patients with ACS.For all the eligible patients,demographic details were collected,and laboratory parameters were evaluated.The CAD severity was evaluated in terms of the number of involved vessels.The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed.Results:77.2%of Patients was male,and 52%of the patients aged between 55-70 years.Based on the type of ACS,396 out of 500 patients had ST-elevation myocardial infarction.An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among classⅣpatients.The mean NLR value among the non-survivors were higher compared to the survivors(9.52±5.72 vs.4.76±2.36;P<0.01).Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0%and a specificity of 77.3%.Conclusions:The NLR can be used as an independent prognostic marker in ACS.An elevated NLR value serves as a reliable predictor for short-term complications,notably in-hospital mortality.

Nε-carboxymethyl-lysine and inflammatory cytokines,markers and mediators of coronary artery disease progression in diabetes

This editorial refers to the article“Comparative analysis of Nε-carboxymethyllysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients”,published in the recent issue of the World Journal of Diabetes 2023 is based on glucose metabolism,advanced glycation end products(AGEs),inflammation and adiposity on diabetes and coronary artery disease(CAD).This study has included CAD patients who were stratified according to glycosylated hemoglobin higher than 6.5 and sex-matched.A higher prevalence of hypertension,dyslipidemia,and non-vegetarian diet were found in the diabetic group.These risk factors might influence body weight and adiposity and explain the increment of the left atrium.Although this data was not supported by the study.The diet can also explain the non-enzymatic reactions on lipids,proteins,or nucleic acids and consequently an increment of AGEs.These molecules can emit fluorescence.However,one of the non-fluorescent and most abundant AGEs is Nε-carboxymethyl-lysine(CML).Its association with coronary artery stenosis and severity in the diabetic group might suggest its role as a player in CAD progression.Thus,CML,after binding with its receptor(RAGE),can induce calcification cascade through reactive oxygen species and mitogen-activated protein kinase.Moreover,this interaction AGE-RAGE can cause activation of the transcription nuclear factor-kb and induce inflammatory cytokines.It might explain the relationship between CML and pro-inflammatory cytokines in diabetic and CAD patients.Although this is a population from one center,the determination of CML and inflammatory cytokines might improve the diagnosis of severe and progressive CAD.Future and comparative studies among glycosylated hemoglobin,CML,and other AGE levels according to diagnosis and prognosis value might modify the clinical practice.Although these molecules are irreversible,they can act through a specific receptor inducing a signal transduction that might be modulated by inhibitors,antibodies,or siRNA.Further mechanistic studies might improve the development of future preventive therapies for diabetic patients.

Early diagnostic value of carotid artery ultrasound parameters combined with epicardial adipose layer thickness in coronary heart disease

BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinflammatory factors that promote the formation of coronary atherosclerosis.Thus,the epicardial fat layer thickness(EAT)may also predict coronary heart disease.AIM To determine the role of common carotid artery ultrasound parameters and EAT in the early diagnosis of coronary artery disease.METHODS Based on coronary angiography,patients with newly suspected coronary heart disease were divided into case(n=107)and control(n=41)groups.The carotid ultrasound parameters,including vascular stiffness(β),elastic coefficient(EP),pulse wave conduction velocity(PWV-β),CIMT,and EAT were compared between the case and control groups and among patients with different lesion numbers in the case group.Pearson correlation was used to evaluate the early diagnostic value of EAT,common carotid artery elasticity,and CIMT for coronary heart disease.RESULTS EP,β,PWV-β,CIMT,and EAT were significantly higher in the case group compared with the levels in the control group(all P<0.001).In the case group,lesions were detected in one vessel in 34 patients,two vessels in 38 patients,and three vessels in 35 patients.Within the case group,β,EP,PWV-β,CIMT,and EAT levels significantly increased with an increased number of lesions(all P<0.001).EAT positively correlated withβ,EP,PWV-β,and CIMT(all P<0.01).The area under the curve for diagnosing coronary heart disease using EAT combined with CIMT and carotid elasticity was 0.893,and the sensitivity and specificity were 0.890 and 0.837.CONCLUSION EAT correlated well with changes in carotid artery elasticity and CIMT in patients with coronary heart disease.The combination of EAT,carotid artery elasticity,and CIMT facilitates the early diagnosis of coronary heart disease.

Role of lymphocyte-to-monocyte ratio as a predictive marker for diabetic coronary artery disease: A cross-sectional study

BACKGROUND The lymphocyte to monocyte ratio(LMR)is considered a marker of systemic inflammation in cardiovascular disease and acts as predictor of mortality in coronary artery disease.AIM To investigate the predictive role of LMR in diabetic coronary artery disease patients.METHODS This cross-sectional study was conducted at tertiary care super-specialty hospital at New Delhi,India.A total of 200 angiography-proven coronary artery disease(CAD)patients were enrolled and grouped into two categories:Group I[CAD patients with type 2 diabetes mellitus(T2DM)and glycated hemoglobin(HbA1c)levels≥6.5%],and Group II(CAD patients without T2DM and HbA1c levels<6.5%).Serum lipoproteins,HbA1c,and complete blood count of enrolled patients were analyzed using fully automatic analyzers.RESULTS The logistic regression analysis showed an odds ratio of 1.48(95%CI:1.28-1.72,P<0.05)for diabetic coronary artery disease patients(Group I)in unadjusted model.After adjusting for age,gender,diet,smoking,and hypertension history,the odds ratio increased to 1.49(95%CI:1.29-1.74,P<0.01)in close association with LMR.Further adjustment for high cholesterol and triglycerides yielded the same odds ratio of 1.49(95%CI:1.27-1.75,P<0.01).Receiver operating characteristic curve analysis revealed 74%sensitivity,64%specificity,and 0.74 area under the curve(95%CI:0.67-0.80,P<0.001),suggesting moderate predictive accuracy for diabetic CAD patients.CONCLUSION LMR showed positive association with diabetic coronary artery disease,with moderate predictive accuracy.These findings have implications for improving CAD management in diabetics,necessitating further research and targeted interventions.

Analysis of the Necessity of Stellate Ganglion Block after Anesthesia to Reduce the Risk of Cardiovascular Accidents in Coronary Heart Disease

Objective:To adjust the sympathetic nervous system through preoperative ultrasound-guided stellate ganglion block and to explore and analyze the situation and necessity of postanesthesia stellate ganglion block to reduce the risk of cardiovascular accidents in coronary heart disease.Methods:80 patients with cardiovascular risk factors in Songshan Hospital of Chifeng were selected,and the time span would cover from October 2022 to June 2024,with 80 cases of elective surgery and combined coronary heart disease.They will be randomly divided into blocked groups and conventional groups,40 cases each.Conventional block was performed after anesthesia in patients in the conventional group,and planetary ganglion block was performed after anesthesia in patients in the blocked group.The cardiovascular responses of patients in the two groups were observed,and the number of intraoperative cardiovascular active drugs and the occurrence of cardiovascular adverse events were recorded in patients in the two groups.Results:Analysis of the mean arterial pressure(MAP)and heart rate(HR)values of the two groups of patients at the time points before anesthesia(T0),the moment of tracheal intubation(T1),the moment of surgical skin cutting(T2),the end of the operation(T3),and the 6h postoperative period(T4)showed that the MAP and HR of the blocked group were lower than those of the conventional group at the time points of T1 to T4,and the differences in MAP and HR values of the two groups in different time points compared with the T0 time point were statistically significant(P<0.05)and the differences in cardiovascular response(P<0.05)were statistically significant(P<0.05).significance(P<0.05).The number of intraoperative cardiovascular active drugs used in the blocked group was shorter than that in the conventional group,and the incidence of cardiovascular adverse events was lower than that in the conventional group,with a statistically significant difference(P<0.05).Conclusion:By implementing preoperative ultrasound-guided stellate ganglion block in patients with cardiovascular risk factors,the frequency and degree of coronary heart disease symptoms will be reduced,thus reducing the risk of patients,which is worth promoting.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Management and risk factor control of coronary artery disease in elderly versus nonelderly： a multicenter registry

Background Coronary artery disease （CAD） is a leading cause of death in elderly because aging is the important non-modifiable risk factors of atherosclerosis and also a predictor of poor outcomes. Underuse of guideline directed therapy may contribute to suboptimal risk factor control and worse outcomes in the elderly. We aimed to explore the management of CAD, risk factors control as well as goal attain- ment in elderly compared to nonelderly CAD patients. Methods The CORE-Thailand is an ongoing multicenter, prospective, observational registry of patients with high atherosclerotic risk in Thailand. The data of 4120 CAD patients enrolled in this cohort was analyzed comparing between the elderly （age ≥ 65 years） vs. nonelderly （age 〈 65 years）. Results There were 2172 elderly and 1948 nonelderly patients. The elderly CAD patients had higher prevalence of hypertension, dyslipidemia, atrial fibrillation and chronic kidney disease. The proportion of patients who received coronary revascularization was not different between the elderly and nonelderly CAD patients. Antiplatelets were prescribed less in the elderly while statin was prescribed in the similar proportion. Goal attainments of risk factor control of glycemic control, low density lipoprotein cholesterol, and smoking cessation except the blood pressure goal were higher in the elderly CAD patients. Conclusions The CORE-Thailand registry showed the equity in the treatment of CAD between elderly and non-elderly. Elderly CAD patients had higher rate of goal attainment in risk factor control except blood pressure goal. The effects of goal attainment on cardiovascular outcomes will be demonstrated from ongoing cohort.

Quantitative assessment of myocardial blush grade in patients with coronary artery disease and in cardiac transplant recipients

Quantitative assessment of myocardial perfusion by myocardial blush grade(MBG) is an angiographic computer-assisted method to assess myocardial tissue-level reperfusion in patients with acute coronary syndromes and microvascular integrity in heart transplant recipients with suspected cardiac allograft vasculopathy. This review describes the ability of quantitative MBG as a simple, fast and cost effective modality for the prompt diagnosis of impaired microvascular integrity during routine cardiac catheterization. Herein, we summarize the existing evidence, its usefulness in the clinical routine, and compare this method to other techniques which can be used for the assessment of myocardial perfusion.

Clinical application of simultaneous detection of cystatin C,cathepsin S,and IL-1 in classification of coronary artery disease

Cystatin C,cathepsin S,and IL-1 are three important biomarkers of atherosclerosis.Previous studies emphasized the relationship between individual biomarkers in coronary artery disease（CAD） patients and severity of atherosclerostic lesions of the coronary arteries,while combined cystatin C,cathepsin S,and IL-1 have not been reported for clinical classification of CAD.We aimed to establish a link between cystatin C,cathepsin S,IL-1 and CAD in this cohort study.Totally 112 subjects were enrolled and divided into the stable angina pectoris group,the unstable angina pectoris group and the acute myocardial infarction（AMI） groups,and 50 healthy adults served as controls.The levels of the three biomarkers were detected by ELISA.The results showed that serum level of cystatin C（mg/L） was higher in CAD patients compared with those in the healthy controls（AMI vs.unstable angina pectoris vs.stable angina pectoris vs.controls：1.27±0.18 vs.1.09±0.19 vs.0.91±0.05 vs.0.78±0.07,all P〈0.01）.Cathepsin S（ng/mL） was also significantly different among the groups（AMI vs.unstable angina pectoris vs.stable angina pectoris vs.controls：67.30±8.36 vs.56.90±7.16 vs.49.8±2.72 vs.67.30±8.36,all P〈0.01）.IL-1（pg/mL） was significantly different among the groups as well（AMI vs.unstable angina pectoris vs.stable angina pectoris vs.controls：2.96±0.57 vs.2.46±0.24 vs.2.28±0.09 vs.2.02±0.13,all P〈0.01）.Spearman＇s correlation test revealed positive correlation between cystatin C,cathepsin S,IL-1 and Gensini score（r=0.451,0.491,0.397,respectively）.It is suggested that simultaneous detection of cystatin C,cathepsin S,and IL-1 in serum may be useful in clinical classification and assessment of severity of CAD.

Diagnostic Accuracy of Three-Dimensional Whole-Heart Magnetic Resonance Angiography to Detect Coronary Artery Disease with Invasive Coronary Angiography as a Reference:A Meta-Analysis

Objective:We aimed to evaluate the diagnostic performance of three-dimensional whole-heart magnetic resonance coronary angiography(MRCA)in detecting coronary artery disease(CAD)with invasive coronary angiography as the reference standard.Methods:We searched PubMed and Embase for studies evaluating the diagnostic performance of three-dimensional whole-heart MRCA for the diagnosis of CAD with invasive coronary angiography as the reference standard.The bivariate mixed-effects regression model was applied to synthesize available data.The clinical utility of whole-heart MRCA was calculated by the posttest probability based on Bayes’s theorem.Results:Eighteen studies were included,of which 16 provided data at the artery level.Patient-based analysis revealed a pooled sensitivity of 0.90(95%confi dence interval[CI]0.87–0.93)and specifi city of 0.79(95%CI 0.73–0.84),while the pooled estimates were 0.86(95%CI 0.82–0.89)and 0.89(95%CI 0.84–0.92),respectively,at the artery level.The areas under the summary receiver operating characteristic curve were 0.93(95%CI 0.90–0.95)and 0.92(95%CI 0.90–0.94)at the patient and artery levels,respectively.With a pretest probability of 50%,the patients’posttest probabilities of CAD were 81%for positive results and 11%for negative results.Conclusions:Whole-heart MRCA can be an alternative noninvasive method for diagnosis and assessment of CAD.

Serum Bilirubin as a Predictor of Coronary Artery Disease Severity in Patients Undergoing Primary Percutaneous Coronary Intervention

Introduction: Coronary artery disease (CAD) is one of the most common causes of death worldwide. In 2010, about 7 out of total 53 million deaths were due to ischemic heart disease. The aim of this study is to evaluate the relationship of serum bilirubin level with the severity and complexity of coronary artery disease (CAD) in the patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: 70 patients with STEMI who were undergoing primary PCI were included in the study. All the patients included in the study were subjected to full routine investigations and standard coronary angiographic projections. Total bilirubin level was measured and the patients were divided into two groups. Group 1 was with serum TB (and Group 2 was with serum TB (>1 mg/dl). Severity and complexity of coronary artery lesions will be assessed using Gensini score. Results: After PCI, the two studied groups were compared regarding the number of vessels affected by one and more than one vessel disease. Single vessel disease was frequent in Group 2 (71%) with significant p value (0.003). Cardiac enzymes (troponin I) was more in Group 1 (S. Bil value (0.02). Also (ALT, AST) were more in Group 1 (p value = 0.01). By comparing the 2 groups, there was a significant difference regarding (EF) between both which was less in Group 1 (S.TB 1), p value significance (0, 0001). Also GENSENI was more in Group 1 (S.TB 1) with mean (80.35 vs 34.71) and significant pvalue (0.0001). There was a highly significant negative correlation between serum bilirubin & GENSENI score (r = -0.762, p value 0.0001). Regarding the incidence of complications, incidence was more in Group 1 (S.TB 1), which means a significant difference between both groups with significant p value (0.0001). There was a significant negative correlation between serum bilirubin & incidence of complications (R = -0.38, pvalue 0.001). Also, there was a significant negative correlation between GENSINI score, complication and bilirubin among both groups (r: -0.762\-0.38) with p value (0.0001\0.001) respectively. Conclusion: In conclusion, our results suggested that the Serum Bilirubin level is inversely correlated with the severity of CAD. Also, the SB level is an independent predictor of cardiovascular events in CAD patients. Understandably, our findings need further verification by large-scale, multicenter clinical trials in the future.

Decreased plasma urotensin Ⅱ levels inversely correlate with extent and severity of coronary artery disease

Objective To determine the plasma urolensin Ⅱ(UII) levels in various types of coronary heart disease and to clarify how the plasma UII levels correlate with the clinical presentation, extent and severity of coronary artery atherosclerosis (CAD). Methods: One hundred and three aged patients undergoing elective diagnostic coronary angiography for proven or clinical suspected coronary heart disease were enrolled in this study. The extent and severity of coronary artery disease were evaluated by vessel score and Gensini score, respectively. Plasma UII levels were measured by radioimmunoassay. Results: The plasma UII levels in the patients with modest to severe coronary stenosis (3.03±0.34 pg/ml, 1.83±0.67 pg/ml) were significantly lower than that in subjects with normal coronary artery (4.80±1.11 pg/ml, P<0.001). The plasma UII levels in patients with coronary heart disease were also significantly lower than that in patients with insignificant coronary stenosis (P < 0. 001). Compared to patients with stable angina pectoris, plasma UII levels in patients with acute coronary syndrome were significantly decreased (1.89±0.51 pg/ml vs 2.42±0.77 pg/ml, P < 0.001). Plasma UII levels were found to be negatively correlated with the severity of coronary artery stenosis (r = -0.488, P<0.001), as well as the vessel score (r = -0.408, P<0.05) in the patients with CAD. Conclusion: Significant inverse correlations exist between the plasma UII levels, and the extent and severity of coronary artery stenosis. These findings suggest that plasma UII contribute to the development and progression of coronary artery stenosis, and may be a novel marker to predict clinical types, as well as the extent and severity of coronary artery disease in the patients.

Six-month results of a biodegradable polymer and rapamycin-coating stent for coronary artery disease

Objective To assess the safety and efficacy of a novel biodegradable polymer and rapamycin-coating stent, the EXCEL stent, in the treatment of coronary artery disease (CAD), as compared with the CypherTM stent. Methods In this prospective, non-randomized study, 60 consecutive patients with symptomatic CAD received either an EXCEL stent (n=32), or a CypherTM stent(n=28),according to their respective treatment intention. Follow-up angiography was performed at a mean of 180±40 days. The primary endpoint of the study was the occurrence of a major adverse cardiac event (MACE), including death, myocardial infarction, or target-vessel revascularization during the 6 months after stenting. The secondary end points included the in-stent late luminal loss (LLL), percentage of in-stent stenosis of the luminal diameter, and the rate of restenosis (luminal narrowing of 50 percent or more) at 6 months. Results There were no significant differences between the two groups in baseline characteristics, including the distribution of target vessel and lesion types. During the follow up period of 6 months, there were no occurrences of MACE in either group. Twenty-seven patients(84%) in the EXCEL group and 10 (36 %) in the CypherTM group underwent quantitative coronary angiography at 6 months. For these patients, no restenosis occurred, and there were no differences in the in-stent stenosis of the luminal diameter (5.98±5.52% vs 5.21 ±6.3%,P＞0.05) and the LLL (-0.02±0.09 mm vs -0.01±0.07 mm, P＞0.05). Conclusions Compared with the CypherTM stent, the EXCEL Stent with biodegradable polymer and rapamycin-coating showed similar efficacy in the prevention of neointimal proliferation, restenosis, and associated clinical events in CAD patients.

Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease

AIM： The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding （UGIB） with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users. METHODS： A total of 991 patients with coronary artery disease （CAD） on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB. RESULTS： UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension （OR = 4.6, 95%CI 1.5 - 14.7, P = 0.009）, history of peptic ulceration （OR = 3.1, 95%CI 1.1 - 9.0, P = 0.039）, tertiary education （OR = 3.08, 95%CI 1.1 - 9.0, P = 0.039） and higher lean body mass （P = 0.016） were independent factors associated with UGIB. Use of nitrate did not reduce UGIB. CONCLUSION： The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.

Lipoprotein(a) as a Marker for Predicting the Presence and Severity of Coronary Artery Disease in Untreated Chinese Patients Undergoing Coronary Angiography

Objective Low-density lipoprotein cholesterol（LDL-C） has been well known as the risk factor of coronary artery disease（CAD）. However, the role of lipoprotein（a） [Lp（a）] in the development of CAD is of great interest but still controversial. Thus, we aim to explore the effect of Lp（a） on predicting the presence and severity of CAD in Chinese untreated patients, especially in combination with LDL-C. Methods We consecutively recruited 1,980 non-treated patients undergoing coronary angiography, among which 1,162 patients were diagnosed with CAD. Gensini score（GS） was used to assess the severity of CAD. Lp（a） was measured by immunoturbidimetric method. Results Patients with CAD had higher level of LDL-C and Lp（a） compared with non-CAD（P 〈 0.05）. Multivariable logistic regression revealed that Lp（a） 〉 205 mg/L（highest tertile） predicted 1.437-fold risk for CAD（95% CI： 1.108-1.865, P = 0.006） and 1.480-fold risk for high GS（95% CI： 1.090-2.009, P = 0.012） respectively. Interestingly, concomitant elevated level of Lp（a） and LDL-C conferred the highest risk for both presence [OR = 1.845, 95% CI： 1.339-2.541, P 〈 0.001] and severity [OR = 1.736, 95% CI： 1.188-2.538, P = 0.004] of CAD. Conclusion Lipoprotein（a） is a useful marker for predicting the presence and severity of CAD, especially combined with LDL-C.

Acoustic cardiography to improve detection of coronary artery disease with stress testing

AIM:To assess if performance of 12-lead exercise tolerance testing(ETT) can be improved by simultaneous acoustic cardiography and to compare the diagnostic performances of electrocardiography(ECG) during ETT and acoustic cardiography for detection or exclusion of angiographically proven coronary artery disease(CAD).METHODS:We conducted an explorative study with retrospective data analysis using a convenience sample of consecutive patients(n = 59,mean age:62 years) from an outpatient clinic in Switzerland,who were referred for ETT by their general practitioner on suspicion of CAD,and in whom,coronary angiography was carried out.Measurements included sensitivity,specificity,likelihood ratios and receiver operating characteristic curves.A standard,symptom-limited,12-lead ECG exercise tolerance test was performed by independent persons with simultaneous acoustic cardiography and subsequent cardiac angiography for determination of significant CAD.RESULTS:Thirty-four of the 59 adult subjects(58%) had a final diagnosis of CAD by angiography,and in 25 subjects,CAD was excluded by angiography.Sensitivity/specificity of ST segment depression in the group was 29%/92%,whereas the most powerful acoustic cardiographic parameter was the strength of the fourth heart sound(S4),with corresponding sensitivity/specificity of 53%/92%.The disjunctive combination of the S4 and ST depression had sensitivity/specificity of 68%/84%.CONCLUSION:In this preliminary pilot study,the use of acoustic cardiography alone during ETT or disjunctively with ST depression has been shown to be a simple and convenient method for the detection of CAD,which was superior to ST depression on the standardized ECG.

ASurvey on Treatment of Hyperlipidemia inPatients with Coronary Artery Disease

A retrospective analysis was made on the lipid level and management of those patients who experienced coronary angiography for suspected coronary artery disease and those who suffered from acute myocardial infarction admitted to our department from 1994 to 1997. It revealed: ①Incidence of elevated serum lipids (especially total cholesterol) was higher in patients with CHD than those without CHD; ② No significant difference of serum lipids in patients with single or multi vessel disease was seen except higher serum lipids in patients with multi vessel disease; ③Management for elevated lipid in our cases was not active, even neglected in our clinic practice. Attention should be paid on these problems.