Prediction of presence and severity of coronary artery disease using prediction for atherosclerotic cardiovascular disease risk in China scoring system

BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,P<0.001).In receiver operating characteristic curve analysis,the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55%with a sensitivity of 55.8%and specificity of 71.8%[area under the curve(AUC)=0.693,95%confidence interval:0.681 to 0.706,P<0.001],and 7.45%with a sensitivity of 58.8%and specificity of 67.2%(AUC=0.680,95%confidence interval:0.665 to 0.694,P<0.001),respectively.CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.

Correlation between Neutrophil Percentage-to-albumin Ratio and Coronary Heart Disease Complicated with Diabetes Mellitus

[Objectives]This study was conducted to explore the relationship between neutrophil percentage-to-albumin ratio(NPAR)and coronary heart disease complicated with diabetes.[Methods]A total of 603 patients with coronary heart disease who underwent coronary angiography in Pingquan County Hospital from January,2023 to December,2023 and met the inclusion criteria were included as the research object.All the patients were divided into a coronary heart disease complicated with diabetes group(CAD+T2DM group)(n=298 cases)and a control group(CAD group)(n=305 cases),according to patients medical history,heart color ultrasound and biochemical test results.The clinical data,biochemical test results and coronary artery imaging data of patients were recorded,and the Gensini score was calculated.The neutrophil percentage(NEUT%)and albumin count were determined to calculate NPAR.[Results]The NPAR value of the coronary heart disease complicated with diabetes mellitus group was(1.6±0.42),which was significantly higher than that of the control group(1.47±0.49),and the difference was statistically significant(P<0.05).The area under the ROC curve was 0.619(95%CI:0.591-0.675,P<0.05),and the prediction of coronary heart disease complicated with diabetes using NPAR showed a Youden index of 0.31,a sensitivity of 60.4%,a specificity of 40.3%,and a best cut-off score of 1.4506.[Conclusions]The neutrophil percentage-to-albumin ratio(NPAR)is closely related to coronary heart disease complicated with diabetes mellitus,and NPAR has clinical application value in the diagnosis of coronary heart disease complicated with diabetes mellitus.

Correlation between serum free fatty acids levels and Gensini score in elderly patients with coronary heart disease

Objectives To investigate the relationship between serum fxee fatty acids （FFAs） levels and the severity of coronary artery lesions in elderly patients with coronary heart disease （CAD）. Methods A total of 172 elderly patients who underwent coronary angiography were divided into CAD group （n = 128） and non-CAD group （n = 44） according to the results of coronary angiography. Serum FFAs and lipid levels were measured and the Gensini score were calculated. Results No matter the differences between age, gender and the usage of stat- ins or not, there was no statistical significance in FFAs levels （P 〉 0.05）. In terms of the Gensini score, it was higher in patients aged 70-79 years than in patients 60-69 years old [15.00 （5.00, 34.00） vs. 10.00 （2.00, 24.00）, P 〈 0.05], higher in men than women [14.00 （4.00, 34.00） vs. 7.00 （2.50, 19.75）, P 〈 0.05], and higher in patients on statins [13.50 （4.25, 33.50）vs. 6.50 （2.00, 18.00）, P 〈 0.05]. The serum FFAs lev- els [449.50 （299.00, 624.75） mEq/L vs. 388.00 （258.50, 495.25） mEq/L, P 〈 0.05J and Gensini score [17.50 （8.00, 41.75） vs. 1.00 （0, 5.00）, P 〈 0.05] were higher in the CAD group than in the non-CAD group. In the CAD group, there was no statistical significance in FFAs levels among patients with different numbers of diseased coronary vessels （P 〉 0.05）. Furthermore, the FFAs levels were positively correlated with the Gensini score （r = 0.394, P = 0.005）. Regression analysis showed that the FFAs levels were related to the Gensini score independently after adjusting for the other risk factors. Conclusions The serum FFAs levels were associated with the Gensini score in elderly patients with CAD. It might indicate FFAs as a biomarker predicting the severity of coronary artery lesions.

Is the ratio of apoB/apoA-1 the best predictor for the severity of coronary artery lesions in Chinese diabetics with stable angina pectoris？ An assessment based on Gensini scores

Background There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease （CAD） in patients with diabetes mellitus. We determined the relationship between five conventional lipid ratios and the extent of coronary artery lesions in Chinese Type 2 diabetics with stable angina pectoris （SAP）. Methods A prospective cohort study within 373 type 2 diabetic patients diag- nosed with stable CAD by coronary angiography was performed. All patients were classified into three groups according to the tertiles of Gensini scores （GS, low group 〈 8 points n = 143; intermediate group 8-28 points, n = 109; high group 〉 28 points, n = 121）. Association between the ratios of apolipoprotein （apo） B and apoA-1, total cholesterol and high density lipoprotein cholesterol （TC/HDL-C）, triglycerides and HDL-C （TG/HDL-C）, low density lipoprotein cholesterol and HDL-C （LDL-C/HDL-C）, Non-HDL-C/HDL-C and GS were evaluated using the receivers operating characteristic （ROC） curves and multivariate logistic regression models. Results The ratio of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C, and Non-HDL-C/HDL-C were correlated with Gensini scores. Area under the ROC curves for predicting high Gensini scores in the ratios of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C and Non-HDL-C/HDL-C were 0.62, 0.60, 0.59 and 0.60, respec- tively （P 〈 0.005 for all）. According to multivariate logistic regression analysis after adjusted with demographic characteristic and other lipid parameters, the ratio of apoB/apoA-1 is qualified as an independent discriminator for the severity of CAD. However, after fiu-ther adjusting different baseline variables, such as left ventricular ejective fraction, hemoglobin Alc, leukocytes count and serum creatinine, none of the above lipid ratios remained. Conclusions Compared with other lipid parameters, the ratio of apoB/apoA-1 appears to be more significantly correlated with the extent of coronary artery lesions in Chinese diabetics, but it was not an independent predictor in these settings.

Free triiodothyronine in relation to coronary severity at different ages： Gensini score assessment in 4206 euthyroid patients

Objective To study whether free triiodothyronine （FT3） within normal range has effects on the presence and severity of coronary ar- tery disease （CAD） in different gender and age groups. Methods A total of 4206 euthyroid patients were consecutively enrolled and di- vided into CAD group （n = 3306） and non-CAD group （n = 900）. All patients underwent coronary angiography （CAG）. Gensini score （GS） was used to determine the severity of coronary artery stenosis. Severe CAD was defined as GS 〉 32 and mild CAD was defined as GS 〈 32. Logistic regression analysis and linear regression analysis were conducted to determine the association of FT3 with CAD in patients with different gender and ages. Results Concentration of FT3 was lower in patients with CAD than that in angiography-normal control group （P 〈 0.05）. In addition, concentration of FT3 was lower in severe CAD than that in mild CAD. After adjusting for traditional cardiovascular risk factors and potential confounders, FT3 was negatively correlated with the presence of CAD, but not in the old patients （〉 65 years old）. Mul- tivariable linear regression analysis showed that FT3 was negatively associated with GS in male and young patients with stable CAD, but not in the old patients. Conclusions Low FT3 within normal range was negatively associated with the presence and severity of CAD in young patients, but not in the old ones. Further studies are needed to confirm our findings.

NHR与心血管疾病相关性的研究现状

中性粒细胞-高密度脂蛋白胆固醇比值(neutrophil to high density lipoprotein cholesterol ratio,NHR)作为一种新兴的炎症和氧化应激指标被广泛报告,其在心血管疾病的发展中起着重要的作用。NHR不仅与冠状动脉狭窄密切相关,而且是冠状动脉严重狭窄的独立预测因子。多篇研究表明,NHR与Gensini score呈显著正相关性,NHR预测Gensini score>40的特异度高达94.2%,灵敏度为61.0%,并可作为预测心血管疾病患者主要不良心血管事件发生风险的有效指标。许多研究提供了强有力的统计学证据,表明NHR与心血管疾病的发展和预后有关。本文结合近年相关文献就NHR与心血管疾病关系的研究现状做一综述,以探讨其在心血管疾病中的应用价值,为临床决策提供帮助。

Prevalence and Predictive Factors of Severe Coronary Lesions in Algerian Patients Undergoing Coronary Angiography

Background: The severity of coronary lesions in patients with coronary artery disease (CAD) has important prognostic and therapeutic consequences. Clinical symptoms not always reflect the disease severity and this study aimed to evaluate coronary lesions in the Algerian population where these data are scarce. Methods: It was a prospective cross-sectional study conducted in consecutive patients with an age ≥20 years who underwent clinically-indicated coronary angiography in our center. The objective of the study was to determine the prevalence of severe coronary lesions assessed with the Gensini score. The predictive factors of severity were evaluated in a multivariate analysis. Results: A total of 507 patients were included (male, 79.7%;mean age, 58.8 years). Coronary angiography was prescribed most frequently for ST-segment elevation myocardial infarction (STMI) (46.9%) and non-STMI (38.1%). The prevalence of severe coronary lesions was 69.6% (95% CI 65.5 - 73.5). In multivariate analysis, the independent predictive factors of severe coronary lesions were male sex (odds ratio [OR] 2.00;p = 0.0141), diabetes (OR 1.92;p = 0.0070), left ventricular dysfunction (OR 1.81;p = 0.0059), age (OR 1.72;p = 0.0297) and no lipid-lowering treatment (OR, 0.47;p = 0.0388). Conclusions: Severe coronary lesions were present in two out three patients in this cohort of Algerian patients undergoing coronary angiography. Independent predictive factors of severe coronary lesions were male sex, diabetes, age, left ventricular dysfunction and no lipid-lowering treatment. It is important to identify these at-risk patients, as they should be explored at an asymptomatic stage before a cardiovascular event and receive prompt treatment with angioplasty or surgery.

Testosterone is negatively associated with the severity of coronary atherosclerosis in men

This study aimed to determine whether plasma testosterone is associated with the severity of coronary atherosclerosis in a group of 803 men who underwent elective coronary angiography. Testosterone levels were measured in 803 male patients who were categorized into three groups according to testosterone level tertiles. All patients underwent elective coronary angiography, and the severity of coronary artery disease （CAD） was determined by the Gensini score. Moreover, patients were classified into two groups according to Gensini scores （score ≤ 26 and score 〉26） using the median values as cutoff points. The plasma testosterone levels were measured by an ELISA kit. The level of testosterone was negatively associated with the Gensini score （r=-0. 188; P=0.000）. A multiple linear regression analysis revealed that testosterone was an independent risk factor for the Gensini score （β=-0,110; P=0.002） after adjusting for confounding covariates. In a multivariate logistic regression model, the severity of CAD was shown to be significantly lower in the third tertile （highest） of testosterone compared to the first tertile （lowest） of testosterone （odds ratio （0R）=0.465; 95% confidence interval （C1）. 0.327-0.662; P=0.000）. In this study, patients with lower testosterone levels had higher Gensini scores in a group of 803 men who underwent elective coronary angiography. Additional studies are needed to clarify the direction of causality and possible underlying mechanisms.

Nomogram for Predicting the Severity of Coronary Artery Disease in Young Adults≤45 Years of Age with Acute Coronary Syndrome

Background:A non-invasive predictive model has not been established to identify the severity of coronary lesions in young adults with acute coronary syndrome(ACS).Methods:In this retrospective study,1088 young adults(≤45 years of age)first diagnosed with ACS who underwent coronary angiography were enrolled and randomized 7:3 into training or testing datasets.To build the nomogram,we determined optimal predictors of coronary lesion severity with the Least Absolute Shrinkage and Selection Operator and Random Forest algorithm.The predictive accuracy of the nomogram was assessed with calibration plots,and performance was assessed with the receiver operating characteristic curve,decision curve analysis and the clinical impact curve.Results:Seven predictors were identified and integrated into the nomogram:age,hypertension,diabetes,body mass index,low-density lipoprotein cholesterol,mean platelet volume and C-reactive protein.Receiver operating characteristic analyses demonstrated the nomogram’s good discriminatory performance in predicting severe coronary artery disease in young patients with ACS in the training(area under the curve 0.683,95%confidence interval[0.645–0.721])and testing(area under the curve 0.670,95%confidence interval[0.611–0.729])datasets.The nomogram was also well-calibrated in both the training(P=0.961)and testing(P=0.302)datasets.Decision curve analysis and the clinical impact curve indicated the model’s good clinical utility.Conclusion:A simple and practical nomogram for predicting coronary artery disease severity in young adults≤45 years of age with ACS was established and validated.

Galectin 3 Level in Patients with Acute Coronary Syndrome and its Relation to Severity of Coronary Artery Disease

Background: Acute coronary syndrome (ACS) is a very common cause of hospitalizations worldwide each year. Despite Troponin is considered the gold standard in diagnosis of ACS. Several molecules have been investigated to identify predictive biomarkers of diagnosis. Among these, Galectin-3 has emerged as a promising diagnostic biomarker of (ACS). We aimed to evaluate galectin-3 levels in patients with acute coronary syndrome (ACS) and its relation to severity of coronary artery disease. Methods: Seventy two patients with ACS who underwent primarypercutaneous coronary intervention (PCI) and 20 age-matched healthy controls were enrolled in our study .The severity of coronary artery disease and the burden of atherosclerosis was assessed with Gensini score and with the number of affected vessels. Galectin-3 levels were measured on admission by using ELISA with a commercially kit. Result: The mean age of the observational case control study was 55.9 ± 11.9 and 68 patients (73.9%) of the study were male. Median galectin-3 levels were significantly higher in ACS patients (20.25 ng/mL [11.9 - 39.0] vs. 8.9 ng/mL [4.6 - 24.0], P = 0.001). Patients were classified into three groups according to the number of involved vessels. Median galectin-3 levels were also significantly different among groups (one vessel: 18.9 (12 - 35.2) ng/mL, two vessels: 19 (11.9 - 35) ng/mL, three vessels 32 (12 - 39) ng/mL, P = 0.007). There was a strong correlation between galectin-3 levels and Gensini score (r = 0.500, P = 0.001). Conclusion: Galectin-3 levels were elevated in patients with ACS and there was a strong correlation between galectin-3 and severity of coronary artery disease.

Correlation between Serum Level of Adiponectin and Severity of Coronary Artery Atherosclerosis

Objectives To investigate the correlation between serum level of adiponectin and severity of coronary artery atherosclerosis. Methods Coronary angiographies were performed and serum levels of adiponectin were measured in 88 patients with suspected coronary heart disease （CHD）. Patients were divided into groups according to the coronary angiographies and Gensini＇s scores of coronary artery atherosclerosis. The serum levels of adiponectin were compared in different groups, and multiple regressions were used to analyze the correlation factors of adiponectin. Results （1）Serum adiponectin concentration in CHD group [ 7. 1 mg/L （2.4 - 21.1 mg/L） ] was decreased as compared with that in control group [ 11.6 mg/L （4.4 - 28.2 mg/L ）, P 〈 0. 01 ] ; （2）The serum levels of adiponectin fell while the Gensini＇ s scores of coronary artery atherosclerosis increased （P 〈 0. 05, P 〈 0. 01 ） ; （3）Serum level of adiponectin was positively correlated with the high-density lipoprotein cholesterol, while negatively correlated with the Gensini＇ s score of coronary artery atherosclerosis and triglyceride （P 〈 0. 01 ）. Conclusions Serum adiponectin concentration was decreased in patients with CHD. Low serum levels of adiponectin reflected the severity of coronary artery atherosclerosis. Adiponectin was a protective factor of cardiovascular system.

Correlation of red cell distribution width with the severity of coronary artery disease： a large Chinese cohort study from a single center

Background It has been reported that increased red blood cell width （RDW）is a marker associated with the presence and adverse outcomes of various cardiovascular diseases. The aim of the present study was prospectively evaluate the severity of coronary artery disease （CAD） and RDW in a large Chinese cohort. Methods A total of 677 consecutive individuals who underwent coronary angiography due to the presence of angina-like chest pain and/or positive treadmill exercise test were enrolled in this study. All patients received coronary angiography and were then divided into two groups based on the results of coronary angiography （CAD group （n=499） and control group （n=178））. The clinical information including classical CAD risk factors and RDW were analyzed to identify their relationship to CAD. The severity of CAD was evaluated by Gensini score and its relationship with RDW was also analyzed. Results Patients with angiographic CAD had significantly elevated RDW levels compared with controls （（12.95±0.77）% vs. （12.73±0.83）%, P=-0.001）. There was a significant positive correlation between RDW and the Gensini score （t=0.37, P 〈0.001）. In multivariate Logistic regression analysis, RDW was demonstrated to be an independent predictor for both angiographic CAD （OR=1.34, 95% Cl 1.02-1.77, P 〈0.05） and for a higher Gensini score （〉13, OR=-2.23, 95% Cf.. 1.62-3.08, P 〈0.001）. In a receiver operating characteristic （ROC） curve analysis, an RDW value of 12.85% was identified as an effective cut-point in predicting the presence or absence of CAD with a sensitivity of 50.0% and a specificity of 65.2%. Conclusion RDW is associated with both presence of CAD and the severity of coronary stenosis, suggesting that it might be a readily available marker for the prediction of CAD and its severity.

Effects of Percutaneous Coronary Intervention on Serum Angiopoietin-2 in Patients with Coronary Heart Disease

Background： Angiopoietin-2 （Ang-2） plays a crucial role in hypoxia-induced angiogenesis and is expressed only in sites of vascular remodeling. Ang-2 expression can be regulated by hypoxia inducible factors and other regulators with exposure to hypoxia. The objective of this study was to investigate the influence of percutaneous coronary intervention （PCI） on serum Ang-2 concentrations, and analyze the correlation between serum Ang-2 and the severity of coronary artery stenosis in patients with coronary heart disease （CHD）. Methods： Sixty-four patients with CHD were selected as the study group, each undergone PC1. Thirty-two healthy subjects were selected as the control group. Pre-PCI and post-PCl serum Ang-2 were measured by enzyme-linked immunosorbent assay. The severity of coronary artery stenosis was evaluated using angiographic Gensini scores, and the coronary collateral vessels were scored according to Rentrop＇s classification. Results： Concentrations of pre-PCI serum Ang-2 in the study group were significantly higher than those in the control group （4625.06 ~ 1838.06 vs. 1945.74 ：k 1588.17 pg/ml, P 〈 0.01 ）; however, concentrations of post-PCl serum Ang-2 were significantly lower than those of pre-PCI （3042.63 ＋ 1845.33 pg/ml vs. 4625.06 .k 1838.06 pg/ml, P 〈 0.01）. Concentrations of pre-PCl serum Ang-2 were significantly correlated with Gensini scores （r= 0.488, P〈 0.01）; however, the decrease in serum Ang-2 after PC1 was not correlated with Gensini scores, coronary collateral vessel grading, or left ventricular ejection fraction. Conclusions： Serum Ang-2 concentrations significantly increased in patients with CHD, and PCI treatment significantly decreased these concentrations. Serum Ang-2 concentrations, but not the decrease in serum Ang-2 concentrations, were significantly correlated with the severity of coronary artery stenosis. These results suggested that Ang-2 may be a biomarker of myocardial ischemia and vessel remodeling.

Association of N-terminal pro-brain natriuretic peptide with the severity of coronary artery disease in patients with normal left ventricular ejection fraction

Backround N-terminal pro-brain natriuretic peptide （NT-proBNP） is a reliable predictor in acute coronary artery disease （CAD）. Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction. Methods A total of 658 consecutive patients were divided into two groups based on angiograms： CAD group （n=484） and angiographic normal control group （n=174）. The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed. Results The prevalence of risk factors such as age, male gender, diabetes mellitus （DM）, dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD （OR：1.66 （95% CI： 1.06-2.61）, P 〈0.05）. In a receiver operating characteristic （ROC）curve analysis, an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD （area under curve （AUC）=0.56, 95% CI： 0.51-0.61）. Furthermore, NT-proBNP was positively correlated with Gensini score （r=0.14, P 〈0.001） in patients with CAD. Conclusion NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.

Study on Syndrome Element Characteristics and Its Correlation with Coronary Angiography in 324 Patients with Coronary Heart Disease

Objective： Recently, a new traditional Chinese medicine differentiation theory ＂Syndrome Element（SE）＂ has been raised. In this study, the main syndrome element types and their correlations with the results of coronary angiography （CAG） in patients with coronary heart disease （CHD） were investigated. Methods： Epidemiology cross-sectional study method was employed and 324 patients with CHD were enrolled, and their syndrome element types as well as the CAG results were analyzed. The correlations among syndrome element types, Gensini score, and the number of abnormal branches were also analyzed based on the distribution characteristics of syndrome element and coronary angiography results in the 324 cases. Results：According to their occurrence frequency in 324 CHD patients, the top eight major heart syndrome elements were Xin （心） blood stasis （85.8%）, Xin qi deficiency （79.6%）, Xin heat blockage （41.1%）, Xin phlegm with turbid fluid （38.0%）, Xin qi stagnation （24.7%）, Xin yang deficiency （18.9%）, Xin yin deficiency （17.5%） and Xin cold coagulation （4.4%）, respectively, which suggested that Xin blood stasis and Xin qi deficiency were the two most common syndrome elements. Also, as coronary artery Gensini score increased, the changing trend of the syndrome element was ＂Xin yang deficiency with blood stasis＂ to ＂Xin phlegm obstruction with heat blockage＂ to ＂Xin yin deficiency with blood stasis＂ to ＂Xin qi deficiency with blood stasis＂ to ＂Xin cold coagulation with phlegm and turbid fluid, ＂Xin cold coagulation with blood stasis＂ to ＂Xin deficiency of qi, yin and yang＂. As the number of abnormal branches increased, the syndrome element changing trend was simultaneous occurrence of cold and heat syndrome＂ to ＂Xin qi and yang deficiency with blood stasis＂ to ＂Xin retention of phlegm with turbid fluid＂ to ＂Xin cold coagulation in the heart meridian＂, ＂Xin deficiency of both qi and yin＂. The result of this study shows that Xin qi deficiency and Xin blood stasis were the major syndrome elements in patients with CHD. Conclusion： As the severity and extent of coronary artery lesion increased, there were some apparent correlations among syndrome elements, Gensini score and number of abnormal coronary artery branches.

Relationship between high-sensitivity C-reactive protein level and angiographical characteristics of coronary atherosclerosis

A role for inflammation has become well established over the past decade or more in theories describing the atherosclerotic disease process. From a pathological viewpoint, all stages, ie, initiation, growth, and complication of the atherosclerotic plaque, might be considered to be an inflammatory response to injury. Several prospective studies recently showed that plasma high sensitivity C-reactive protein （hsCRP） levels, which are one of the markers of systemic inflammation, are a powerful predictor of future myocardial infarction and cardiac death among apparently healthy individuals. However, the association between the plasma hsCRP levels and the extent of coronary stenosis in subjects remains controversial. Some studies previously demonstrated such associations, whereas other could not found. Gensini＇s score assigns a severity score for a stenosed vessel depending on the degree of luminal narrowing and the importance of its location.

Urinary albumin excretion rate is correlated with severity of coronary artery disease in elderly type 2 diabetic patients

Background Coronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria. The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients. Methods A total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older, who were given coronary angiography for diagnosis of possible coronary heart disease, participated. Their urinary albumin excretion rate was measured, and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis. The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined. Results The incidence of coronary heart disease, the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal atbuminuria group （P 〈0.05）. The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients （odds ratio （OR） =1.058, P 〈0.0001,95% confidence interval （CI）： 1.036-1.080）. Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients （β=0.476, P 〈0.0001）. The best predictive value of urinary albumin excretion rate was 10.45 tJg/min for elderly type 2 diabetes mellitus patients. The area under the curve was 0.764, with a sensitivity and specificity of 70.0% and 72.2%, respectively. Conclusions The occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria, and the severity of the disease also increased in patients with microalbuminuria. In elderly type 2 diabetes mellitus patients, urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.

冠心病血管狭窄程度的影响因素

目的观察临床相关数据资料对冠脉血管狭窄严重程度的影响。方法选取2018年10月至2019年9月于郑州大学第一附属医院心血管内科收治的冠心病患者297例,入院排除相关禁忌症后均行经皮冠脉血管造影术,并根据Gensini score将血管狭窄严重程度量化并分为轻中重三组,分析Gensini score与患者的一般资料、常规、生化等结果之间的关系及轻重中三组不同病变严重程度患者之间的差异。结果Gensini score与糖尿病病史、空腹血糖(fasting blood glucose,FBG)、脑钠肽(brain natriuretic peptide,BNP)、高密度脂蛋白(High-density lipoprotein,HDLC)之间均呈不同程度的相关(P=0.038、0.005、0.000、0.030);重度组患者Gensin:score、FBG、BNP均高于中度组和轻度组(P<0.05),而HDLC均低于中度组和轻度组;且多元Logistic回归分析发现,FBG和BNP升高是冠心病患者冠脉严重程度加重的独立危险因素。结论对于冠心病患者FBG和BNP升高可能是加重冠脉狭窄严重程度的主要原因。

Relationships of coronary artery atherosclerosis severity with blood pressure variability and ankle-brachial index in hypertensive patients

Background Numerous trials showed that blood pressure variability （BPV） plays an important role in triggering acute cardiovascular and cerebrovascular events. However, few studies have clarified the relationship between the coronary artery atherosclerosis severity with BVP and ankle-brachial index （ABI）. There are few studies in which have investigated BPV, ankle-brachial index （ABI）, brachial ankle pulse wave velelocity （baPWV） and severity of coronary angiography（ CAG ） at the same time. Methods Totally 188 hypertensive patients from January 2012 to March 2015 were enrolled in this study. All the cases underwent 24h ambulatory blood pressure monitoring （ABPM）, CAG and ABI. The extent of coronary artery disease was assessed by the Gensini score system. The subjects were divided into four groups： A（ Gensini score=0）, B（Gensini score≤20）, C（ 20〈Gensini score 〈50）, D（Gensini score≥50）. Pearson correlation and stepwise multiple regression were used for analyses. Results Compared with the A and B group, most of blood pressure standard deviation and average ABI of D group were higher （P 〈 0.05）. Correlation analysis indicated that Gensini score was positively correlated with 24h systolic blood pressure standard deviation （24hsbpsd）, day systolic blood pressure standard deviation （dsbpsd） and night systolic blood pressure standard deviation（nsbpsd）; But it was reversely correlated with ABI. ABI was reversely correlated with 24hsbpsd and nsbpsd. Gensini score was positively correlated with 24hsbpsd（P=0.02） and dsbpsd（P〈0.05）, while reversely correlated with ABI（P〈0.05） by multiple linear stepwise regression analysis. Conclusion BPV and ABI are closely related to severity of coronary artery atherosclerosis. They are predictors in patients with coronary artery disease with hypertension.