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.

MODIFIED CLASSIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE HAN POPULATION

Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.

Characteristics and Risk Factors Attributed to Coronary Artery Disease in Women Attended Health Services in Gaza-Palestine Observational Study

Coronary artery disease (CAD) is the leading cause of death in both sexes worldwide, and becomes number one killer in women due to many factors including increase in traditional risk factors, delays in apparition of symptoms, under estimation of diagnosis test and treatment. Our study aims to identify risk factors for coronary artery disease among women with chest pain underwent coronary angiography during years (2010-2013) in cardiology center. The study design is an observational among 688 women-aged 32 - 96 years;the mean age of our study population is 61 years. Risk factors are abstracted from patients’ files. Women with documented coronaries disease tend to be older, have higher, systolic blood pressure, serum level of triglyceride, and impaired clearance creatinine. 59.4% of them are menopause with higher prevalence of hypertension and diabetes (58.6% and 63.6%). Significant positive association is found in women with myocardial infarction, unstable angina, stable angina and presence of obstructive coronary artery disease respectively (89.6%, 82.3%, 59.1%) in opposite women presented with atypical chest pain have high prevalence of normal coronaries (95.7%). About 57.6% have more than three risk factors, and 55.3% are obese or overweight. In addition, 42.1% of them have impaired systolic function. We conclude that cardiovascular risk factors are highly prevalent among Palestinians women in Gaza and the combination of risk factors is common. Interventions to minimize CAD in our population are needed.

Incidence &Risk Factors Associated with Carotid Disease in Patients Undergoing Coronary Artery Bypass Grafting Surgery

Objective: The purpose of this study was to evaluate the true incidence and the risk factors associated with carotid disease in the sitting of high risk patients undergoing coronary artery bypass graft (CABG) using carotid duplex scan and to find out if routine preoperative carotid duplex scan is needed among all these patients. Methods: This retrospective study included 402 consecutive patients who underwent bilateral carotid duplex scan admitted for CABG during the period from January 2006 to December 2008. We excluded patients in cardiogenic shock who were taken to operating room emergently. Results: The prevalence of associated risk factors showed diabetes mellitus recorded the highest (93.3%) whereas peripheral vascular disease the lowest (1.7%), hypertension (89.3%), dyslipidemia (72.6%), smoker (21.1%), left main disease (4.7%), and previous stroke (3%). Patients undergoing CABG has high incidence of carotid disease (68.7%) and severe stenosis is more in patients aged 60 and above (13.5%) versus (2.3%) in age 60, previous stroke and left main disease). Conclusion: This study showed that carotid screening is recommended for all patients who are undergoing CABG due to high incidence of carotid disease.

APOLIPOPROTEIN E GENE POLYMORPHISMS AND RISK FOR CORONARY ARTERY DISEASE IN CHINESE XINJIANGUYGUR AND HAN POPULATION

Objective To examine the relationship between apolipoprotein E (Apo E) gene polymorphism and risk of coronary artery disease (CAD), analyzing association of polymorphism with classical risk factors. Methods A total of 124 patients (including 84 Han population and 40 Uygur population) with angiographically verified CAD or myocardial infarction were prospectively evaluated. Data referring to hypertension, diabetes, and tobacco consump-tion were recorded. The levels of total cholesterol (TC), high density lipoprotein (HDL) cholesterol, Apo A1 and B, and triglycerides (TG) were determined. DNA was obtained from 124 patients and 70 controls. In order to determine Apo E genotypes, DNA was PCR amplified and digested with HhaI. The genetic polymorphism of Apo E is due to three common alleles, epsilon(ε) 2, ε3, ε4, at a single autosomal gene locus. These alleles determine the six phenotypes E2/2, E3/3, E4/4, E4/2, E4/3, and E3/2. Results In Uygur population, the frequency of the ε2, ε3, and ε4 was 0.155, 0.648, and 0.197 respectively. In Han po-pulation, the frequency of the ε2, ε3, and ε4 was 0.081, 0.772, and 0.146 respectively. In the patient group, the frequency of the ε2, ε3, and ε4was 0.060, 0.758, and 0.182 respectively. In the control group, the frequency of the ε2, ε3, and ε4 was 0.193, 0.671, and 0.136 respectively. ε2 frequency of Uygur’ patients and controls was 0.050 and 0.290 respectively. Serum low density lipoprotein (LDL) cholesterol, TC, and TG values tended to decrease from the Apo E-4 phenotypes to Apo E-2 phenotypes. When deletion polymorphism of ε2 was compared with the common risk factors for CAD, its risk ratio (RR) is 4.38. Conclusions These studies confirm and find that Apo E phenotype distribution in Uygur population differs significantly from that in Han population in Xinjiang. CAD patients have significantly lower ε2 allele and slightly higher ε3 or ε4 allele frequency than controls, especially in Uygur population. It shows protective effects of ε2 on CAD.

Apolipoprotein AI gene polymorphisms and risk for coronary artery disease in Chinese Xinjiang Uygur and Han population

Objective To analyze the relationship between polymorphism at the Apolipoprotein AI (Apo AI) gene and the risk for coronary artery disease. Methods A total of 107 patients (mean age 56 ±11 years) diagnosed as having stable angina pectoris (SAP) (23 cases), unstable angina pectoris (UAP) (23 cases) or myocardial infarction (MI) (61 cases) were prospectively evaluated. DNA was obtained from the 107 patients and 50 controls. In order to determine the Apo AI genotypes at two polymorphic sites (G/A at -75 bp, and C/T at+83 bp), DNA was PCR amplified and digested with MspI. Results The frequency of carriers of the rare allele at the - 75 bp site (M1-) was 0.49 in cases and 0.30 in controls (P<0. 05). The frequencies of the M1-allele among patients with SAP, UAP, MI and controls were 0. 37 (vs. controls, P > 0. 05), 0.54 (vs. controls, P < 0.05), 0.52 (vs. controls, P<0. 05) and 0. 30, respectively. The frequencies for carriers of the rare allele at the + 83bp polymorphism (M2) were observed among patients with SAP (0. 09, vs. controls, P > 0.05), UAP (0.11, vs. controls, P>0.05) or MI (0. 12, vs. controls, P>0. 05) and controls (0. 12). There was an slightly increase in the frequency of the Ml - allele in patients with SAP to UAP or MI (0. 37 vs. 0. 54 vs. 0. 52; all P>0. 05) and Ml polymorphism as a risk factor for CAD ( OR = 3. 74, P < 0. 05). In the + 83bp polymorphism there was no difference in the allelelic frequencies in cases and controls (0. 11 vs. 0. 12; P > 0. 05). There was no significantdifference in the frequency of the M2 - allele in patients with SAP to UAP or MI (0.09 vs. 0. 11 vs. 0. 12; all P>0. 05) and M2 polymorphism not as a factor for CAD (OR=0.80, P>0. 05).Plasma lipoprotein values in patients with the allele M1-and M2 - had no different levels than those homozygous for the M1+and M2+(P>0.05). Conclusion Ml polymorphism (M1 - ) may be as a risk factor for CAD and M2 polymorphism (M2 - ) not as a factor for CAD in Chinese Xinjiang Uygur and Han population.

Characteristic analysis of clinical coronary heart disease and coronary artery disease concerning young and middle-aged male patients

BACKGROUND Coronary heart disease(CHD)is a type of coronary atherosclerotic heart disease.In recent years,the incidence of CHD has been increasing annually,with an increasing number of young patients.Severe CHD may cause severe myocardial ischemia or myocardial necrosis,which in turn may cause myocardial infarction and related complications that seriously affect the life and health of the patient.AIM To examine the coronary arteries and clinical features of young and middle-aged male patients with CHD.METHODS From February 2019 to January 2020,110 male CHD patients admitted to our hospital were selected as research subjects and were divided into two groups by age:middle-aged group(n=55)and young group(n=55).The coronary arteries and clinical features of the patients were compared.RESULTS There were no significant differences in dyslipidemia,stroke history,high-density lipoprotein cholesterol,or triacylglycerol(P>0.05)between the two groups.In the young group,age,diabetes,hypertension,smoking history,body mass index,family history of CHD,drinking history,fibrinogen,low-density lipoprotein cholesterol,total cholesterol,and single-vessel disease were higher than those in the middle-aged group.Correspondingly,serum uric acid,hyperuricemia,myocardial infarction,Gensini score>50,collateral circulation,multivessel disease,double vessel disease,involvement of the right coronary artery,and involvement of the left main coronary artery were lower in the young group than in the middle-aged group.The middle-aged group mainly suffered from a high Gensini score,implicating multiple arteries,whereas the young group was mainly affected by single-vessel disease.The between-group difference was significant(P<0.05).CONCLUSION In CHD attacks,multiple coronary arteries are implicated in middle-aged male patients and single-vessel disease in young male patients.

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.

Newer perspectives of coronary artery disease in young

Coronary artery disease(CAD) occurring in less than 45 years of age is termed as young CAD.Recent studies show a prevalence of 1.2% of CAD cases in this age group.Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%.Conventional risk factors such as smoking,diabetes,hypertension,obesity and family history seems to be as important as in older CAD subjects.But the prevalence of these risk factors seems to vary in younger subjects.By far the most commonly associated risk factor is smoking in young CAD.Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein(CETP) gene,hepatic lipase gene,lipoprotein lipase gene,apo A1 gene,apo E gene and apo B.Biomarkers such as lipoprotein(a),fibrinogen,D-dimer,serum Wnt,gamma glutamyl transferase,vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies.In general CAD in young has better prognosis than older subjects.In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes.Angiographic studies shows predominance of single vessel disease in young CAD patients.Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.

Clinical Correlation between Plasma Homocysteine Level and Coronary Artery Disease in Indian Patients

Objective: The aim of this study was to evaluate correlation between plasma homocysteine and coronary artery disease (CAD) in Indian patients. Methods: This study included 150 patients, 100 subjects in study group with angiographically diagnosed CAD and 50 subjects in control group with a normal coronary angiogram. In the study group, patients were divided into three subgroups viz.: CAD only, CAD with hypertension and CAD with type 2 diabetes mellitus. Plasma homocysteine, lipid profile and other risk factors were compared. Results: Mean homocysteine levels in study group (38.34 ± 15.25 μmol/L) were significantly higher (p Conclusion: The study demonstrated that increased levels of homocysteine are independently related to CAD. However, further studies involving a larger sample size will be required to substantiate the findings of the current study.

A Nomogram to Predict Patients with Obstructive Coronary Artery Disease: Development and Validation

Objective:To develop and validate clinical prediction models for the development of a nomogram to estimate the probability of patients having coronary artery disease(CAD).Methods and Results:A total of 1,025 patients referred for coronary angiography were included in a retrospective,single-center study.Randomly,720 patients(70%)were selected as the development group and the other patients were selected as the validation group.Multivariate logistic regression analysis showed that the seven risk factors age,sex,systolic blood pressure,lipoprotein-associated phospholipase A 2,type of angina,hypertension,and diabetes were signifi cant for diagnosis of CAD,from which we established model A.We established model B with the risk factors age,sex,height,systolic blood pressure,low-density lipoprotein cholesterol,lipoprotein-associated phospholipase A 2,type of angina,hypertension,and diabetes via the Akaike information criterion.The risk factors from the original Framingham Risk Score were used for model C.From comparison of the areas under the receiver operating characteristic curve,net reclassifi cation improvement,and integrated discrimination improvement of models A,B,and C,we chose model B to develop the nomogram because of its fi tness in discrimination,calibration,and clinical effi ciency.The nomogram for diagnosis of CAD could be used easily and conveniently.Conclusion:An individualized clinical prediction model for patients with CAD allowed an accurate estimation in Chinese populations.The Akaike information criterion is a better method in screening risk factors.The net reclassifi-cation improvement and integrated discrimination improvement are better than the area under the receiver operating characteristic curve in discrimination.Decision curve analysis can be used to evaluate the effi ciency of clinical prediction models.

Correlation between SYNTAX Score and Pattern of Risk Factors in Patients Referred for Coronary Angiography in Cardiology Department, Menoufia University

Objectives: The role of SYNTAX (SX) score in assessing the complexity of coronary artery disease (CAD) is well established. In this study we investigate the relationship between conventional risk factors of CAD with its complexity using SX score. Methods: The study consisted of 52 patients with CAD who were admitted to Cardiology Department—Menoufia University Hospitals for elective coronary angiography. The overall SX score was calculated prospectively using the SX score algorithm. Then comparison was done between populations with and without each risk factor. Results: There was a statistically significant correlation between age, hypertension, diabetes mellitus, dyslipidemia and smoking with SX score results (p 0.05). In a multivariate regression analysis, including conventional risk factors of CAD as independent covariates, it revealed that aging, having diabetes mellitus and smoking were identified as significant independent risk factors for CAD complexity. Conclusion: Advanced age, having diabetes mellitus and cigarette smoking are considered to be independent risk factors for the complexity of CAD. Therefore, when these factors present, we expect that the SX score of the patient to be high indicating a complex CAD.

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.

Analysis of Ankle-Brachial Index, Waist-Hip Ratio, Ejection-Fraction, Obesity, Smoking, Alcohol Habits, Diabetes and Hypertension as Independent Predictors of Complexity and Severity of Coronary Artery Disease

Background: The present study was conducted to examine the association between various coronary risk factors and clinical parameters, with special emphasis on ankle-brachial index, in predicting the severity and complexity of coronary artery disease. Methods: Patients diagnosed with coronary artery disease at our hospital between September-2012 and December-2014 were examined in this study. Selected patients were screened for cardiovascular risk factors including diabetes, hypertension, smoking, and alcohol habits as well as for clinical parameters including body-mass index, waist-hip ratio, ankle-brachial index, and ejection fraction. All patients underwent coronary angiography and were evaluated for severity of coronary artery disease (based on number of vessels involved) and complexity of coronary angiographic lesions (measured by computer-assisted Syntax score calculator). The collected data were analyzed to determine the role of cardiovascular risk factors and clinical parameters as predictors of complexity and severity of coronary artery disease. Results: A total of 211 patients (mean age: 54.64 ± 9.9 years;81% males) with coronary artery disease were analyzed. Findings revealed that diabetes mellitus (p < 0.001), hypertension (p < 0.001), smoking habits (p = 0.036), and low ankle-brachial index (p < 0.001) were independent predictors of complex coronary artery disease as measured by Syntax score. Significant associations were also evident between severity of coronary artery disease and diabetes mellitus (p < 0.001), hypertension (p < 0.001), and ankle-brachial index (p < 0.001). Conversely, other cardiovascular risk factors including body-mass index, alcohol habits, wait-hip ratio, and ejection fraction did not exhibit significant associations with severity and complexity of coronary artery. Conclusions: The early diagnosis of coronary artery can be predicated by evaluating diabetes, hypertension, and smoking habits in patients presenting with acute coronary syndrome. In addition, ankle-brachial index can be used as an effective non-invasive bed-side tool, as an alternative to Syntax score, in predicting the severity and complexity of coronary artery disease.

Cardiac risk factors limiting survival to liver transplantation in patients with nonalcoholic fatty liver disease

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)describes the hepatic manifestations of metabolic syndrome,which is estimated to affect 25%of adults,and currently represents the second most common indication for liver transplant in the United States.Studies have shown that patients with NAFLD are at an increased risk for heart failure,arrhythmia,and coronary artery disease(CAD),which may impact outcomes of liver transplantation.However,it remains unclear whether the presence of cardiac disease affects survival prior to liver transplant.If so,this would represent an important opportunity to optimize cardiac status and improve outcomes before liver transplant.AIM To identify cardiac factors that impact survival to liver transplantation in patients with NAFLD and on the transplant waitlist.METHODS The aim of this study was to identify cardiac risk factors that limit survival to transplant in patients with NAFLD.We performed a retrospective analysis of patients with NAFLD listed for liver transplant at a tertiary academic medical center in the United States from January 2015 to January 2021,identified through United Network of Organ Sharing registry.Exclusion criteria included a concurrent etiology of liver disease and removal from the transplant list due to chemical dependency,lack of social support,improvement in liver disease,or being lost to followup.We manually reviewed patient charts including electrocardiogram,echocardiogram,and cardiac catheterization reports as well as physician notes to identify cardiac disease states(i.e.,heart failure,arrhythmia,valvular disease and CAD)and other related diagnoses.We performed a survival analysis by Cox proportional hazards regression model to analyze the association between cardiac factors at the time listed for transplant and death or clinical deterioration prior to transplant.RESULTS Between January 2015 and January 2021,265 patients with nonalcoholic fatty liver disease were listed for liver transplant at our institution.Our patient sample had a median age of 63 and an even distribution between sexes.The median Model for End-Stage Liver Disease(MELD)score was 17 and the median body mass index was 31.6.Of these 265 patients,197(74.3%)survived to transplant and 68(25.7%)died or clinically deteriorated prior to transplant.The presence of mild or moderate CAD represented a hazard ratio of 2.013(95%CI 1.078-3.759,P=0.029)for death or clinical deterioration when compared to patients without CAD,after adjustment for age,sex,and MELD.MELD represented an adjusted hazard ratio of 1.188.CONCLUSION Mild or moderate CAD represents a hazard for waitlist mortality prior to liver transplant in patients with NAFLD.Aggressive management of CAD may be needed to improve patient outcomes.

Low Cost Equipment and Short Duration Program Are Not Barriers to Good Outcomes of Cardiac Rehabilitation in Senegalese Patients with Coronary Artery Disease

Cardiac rehabilitation is still underused in Africa, despite its cost effectiveness widely demonstrated around the world. Aim: To evaluate the results of a cardiac rehabilitation program in the first Senegalese outpatient center in low resource context. Patients and Method: We carried out a prospective and interventional study. It compared on one hand a group of coronary patients at baseline and after 6 months of our rehabilitation program and on the other hand a control group of patients not enrolled in rehabilitation. Results: We included 70 patients (30 in the rehabilitation group and 40 in the control group). After rehabilitation, the functional capacity improved: 6.99 ± 2.9 Mets at M0 vs 8.8 ± 2.23 Mets at M6, p = 0.0001. Patients of intervention group significantly increased motivation to lifestyle changes and knowledge about their disease. We found better control at 6 months of hypertension (84.50% vs 33.70%, p = 0.003), diabetes (70.00% vs 26.70%, p = 0.0042), LDL cholesterol (33.00% vs 5.00%, p = 0.002) in the group “Rehabilitation”. Prevalence of psychosocial issues like anxiety and depression decreased in intervention group: 50.00% at M0 to 23.33% at M3 (p = 0.021), then 30.00% at M6 (p = 0.18). Return to work and resuming sexual activity were not significantly different. Conclusion: Comprehensive cardiac rehabilitation program, with low cost equipment in a short duration, could have real benefits in the management of coronary artery disease by reducing anxiety and depression, improving treatment compliance, control of cardiovascular risk factors, lifestyle changes and disease knowledge.

Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments

Background:Patients who undergo coronary artery bypass grafting(CABG)are known to be at a significant risk of experiencing long-term adverse events,emphasizing the importance of regular assessments.Evaluating health-related quality of life(HRQoL)serves as a direct method to gauge prognosis.Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary(PCS)and Mental Component Summary(MCS)derived from the Short-Form 36(SF-36)health survey in CABG patients.Methods:The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013.SF-36 assessments were conducted during both the hospitalization period and follow-up.The primary endpoint of the study was all-cause mortality,while the secondary outcome was a composite measure including death,myocardial infarction,stroke,and repeat revascularization.We assessed the relationships between the PCS and MCS at baseline,as well as their changes during the first 6 months after the surgery(referred to asΔPCS andΔMCS,respectively),and the observed outcomes.Results:The patients were followed for an average of 6.28 years,during which 35 individuals(35/433,8.1%)died.After adjusting for clinical variables,it was observed that baseline MCS scores(hazard ratio[HR]for a 1-standard deviation[SD]decrease,1.57;95%confidence interval[CI],1.07-2.30)andΔMCS(HR for a 1-SD decrease,1.67;95%CI,1.09-2.56)were associated with all-cause mortality.However,baseline PCS scores andΔPCS did not exhibit a significant relationship with all-cause mortality.Notably,there was a dose-response relationship observed betweenΔMCS and the likelihood of all-cause mortality(HRs for the 2nd,3rd and 4th quartiles compared to the 1st quartile,0.33,0.45 and 0.11,respectively).Conclusions:Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG.Better mental health status and recovery indicated better prognosis.

冠心病PCI术后合并睡眠障碍患者氧化应激水平的变化及其危险因素分析

目的探究因冠心病(CHD)行经皮冠状动脉介入治疗(PCI)术后并发睡眠障碍患者的氧化应激水平的变化及其危险因素。方法回顾性分析2018年6月至2023年6月期间于攀枝花市第三人民医院心内科就诊并行PCI术的128例CHD患者临床资料,采用匹兹堡睡眠质量指数量表(PSQI)评估PCI术后是否并发睡眠障碍,并依据评分结果将患者分为并发组(n=35)和未并发组(n=93)。对比分析两组血清中超氧化物歧化酶和丙二醛的表达水平,采用单因素分析对患者基本资料(性别、年龄、体重指数、腰臀比、文化程度、是否吸烟或饮酒等)和生理病理情况[合并疾病、焦虑、术后疼痛、术后用药情况、每周运动时间、纽约心脏病协会(NYHA)心功能分级、植入支架数]进行分析,采用多因素Logistic回归分析对影响CHD患者行PCI术后并发睡眠障碍的因素进行分析。结果并发组患者血清超氧化物歧化酶水平为(61.68±10.32)U/mL,低于未并发组[(78.11±15.38)U/mL],并发组丙二醛水平为(2.72±0.44)μmol/L,高于未并发组[(2.02±0.38)μmol/L],差异均有统计学意义(P<0.05)。单因素分析结果显示,年龄、腰臀比、合并高脂血症、焦虑、术后疼痛和每周运动时间是CHD患者行PCI术后并发睡眠障碍的影响因素。多因素Logistic回归分析结果显示,超氧化物歧化酶(OR=1.290,95%CI:1.145~1.454)、丙二醛(OR=1.667,95%CI:1.362~2.040)、年龄(OR=1.672,95%CI:1.348~2.074)、腰臀比(OR=1.368,95%CI:0.901~2.076)、焦虑(OR=1.470,95%CI:1.021~2.116)、术后疼痛(OR=1.844,95%CI:1.175~2.894)和每周运动时间(OR=1.261,95%CI:0.911~1.746)为影响CHD患者行PCI术后并发睡眠障碍的独立危险因素。结论CHD行PCI术后并发睡眠障碍的患者氧化应激水平显著高于未并发睡眠障碍患者;超氧化物歧化酶、丙二醛、年龄、腰臀比、焦虑、术后疼痛和每周运动时间为影响CHD患者行PCI术后并发睡眠障碍的独立危险因素。

老年高血压患者合并冠心病的危险因素分析

目的本研究旨在分析老年高血压患者合并冠心病的危险因素。方法纳入2019年1月至2023年1月济南市妇幼保健院全科门诊收治的老年高血压患者228例为研究对象,根据冠状动脉造影显示是否合并冠心病分为冠心病组(125例)和非冠心病组(103例)。冠心病组男64例,女61例,年龄67~80(75.16±1.38)岁;非冠心病组男52例,女51例,年龄60~71(64.53±1.26)岁。收集所有患者的一般资料,通过Gensini评分评估患者的冠脉病变程度;并对患者进行全天血压监测,通过舒张压和收缩压计算全天血压负荷值,通过心脏磁共振(CMR)评估心肌灌注储备(MPR);测定患者血小板参数、血脂四项、纤维蛋白原、血浆比黏度等血液流变学指标。通过超声检查比较两组患者的斑块检出率、斑块指数和冠状动脉钙化积分(CACS)。比较两组患者各项指标的差异,通过多因素logistic回归分析探讨老年高血压患者合并冠心病的危险因素,并通过Pearson相关系数分析各项指标和Gensini评分的相关性。使用独立样本t检验、χ^(2)检验。结果共纳入228例高血压患者,其中合并冠心病125例,其Gensini评分显著高于非冠心病组[(96.21±10.25)分比(21.03±3.36)分](P<0.05);多因素logistic回归分析结果显示,年龄、血压负荷情况、MPR、平均血小板体积、血液流变学指标、斑块指数、CACS均是老年高血压患者合并冠心病的影响因素(均P<0.05);Gensini评分与血压负荷情况、血浆比黏度、斑块指数和CACS均呈正相关,与MPR呈负相关(均P<0.05)。结论年龄、血压负荷情况、MPR、血小板参数、血液流变学指标、斑块指数、CACS均是老年高血压患者合并冠心病的影响因素。

冠心病患者非心脏手术围术期心血管不良事件的危险因素分析

目的分析冠心病患者非心脏手术围术期主要心血管不良事件(MACE)的危险因素。方法回顾性分析2014-01-01/2019-12-31期间在广西医科大学第一附属医院接受非心脏手术冠心病患者619例,根据是否发生MACE将患者分为事件组(n=36)和非事件组(n=583),采用多因素Logistic回归分析冠心病患者围术期MACE的独立危险因素。观察终点为麻醉开始至患者出院期间发生的MACE,包括恶性心律失常、心肌梗死、心力衰竭及心源性死亡,记录及比较2组患者临床资料。结果冠心病患者非心脏手术围术期MACE发生率为5.8%(36/619)。多因素Logistic回归分析显示,ASAⅣ级(OR=18.515)、脑血管病史(OR=3.599)、不稳定性心绞痛史(OR=5.152)、心肌梗死史(OR=5.421)、急诊手术(OR=4.551)、腹部手术(胃肠、肝胆手术)(OR=10.384)、术中出血量500~1500 mL(OR=21.055)及术中出血量≥1500 mL(OR=83.885)是冠心病患者非心脏手术围术期MACE的危险因素(P<0.05),差异有统计学意义。结论ASAⅣ级、脑血管病史、不稳定性心绞痛史、心肌梗死史、急诊手术、腹部手术(胃肠、肝胆手术)、术中出血量是冠心病患者非心脏手术围术期MACE的危险因素。