Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome

BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types of therapies.AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups.A total of 195 patients who received agents alone comprised the medication group,156 who received medical therapy combined with stents comprised the stent group,and 35 patients who were given agents and underwent coronary artery bypass grafting(CABG)comprised the CABG group.General information was compared among the three groups.GRACE and SYNTAX scores were calculated.The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events(MACEs)was analyzed.Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS.Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores(all P<0.05).The incidence of MACE was 18.5%,36.5%,and 42.9%in the medication group,stent group,and CABG group,respectively.By comparison,the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups(all P<0.05).The incidence of MACE was 6.2%,28.0%and 40.0%in patients with a low GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 31.0%,30.3%and 42.9%in patients with a medium GRACE score in the medication group,stent group,and CABG group,respectively(P>0.05).The incidence of MACE was 16.9%,46.2%,and 43.8%in patients with a high GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 16.2%,35.4%and 60.0%in patients with a low SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 37.5%,40.9%,and 41.7%in patients with a medium SYNTAX score in the medication group,stent group,and CABG group,respectively(P>0.05).MACE incidence was 50.0%,75.0%,and 25.0%in patients with a high SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).Univariate Cox regression analyses showed that both GRACE score(hazard ratio[HR]=1.212,95%confidence interval[CI]:1.083 to 1.176;P<0.05)and SYNTAX score(HR=1.160,95%CI:1.104 to 1.192;P<0.05)were factors influencing MACE(all P<0.05).Multivariate Cox regression analyses showed that GRACE(HR=1.091,95%CI:1.015 to 1.037;P<0.05)and SYNTAX scores(HR=1.031,95%CI:1.076 to 1.143;P<0.05)were independent predictors of MACE(all P<0.05).CONCLUSION GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients,and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.

Effects of omeprazole or pantoprazole on platelet function in non-ST-segment elevation acute coronary syndrome patients receiving clopidogrel

Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patients with NSTE-ACS(n =620) from general hospital of Shenyang Military Command were randomized to the omeprazole or pantoprazole(20mg/d) group(1:1), and received routine dual antiplatelet treatment. Patients' reversion rate of adenosine diphosphate-induced platelet aggregation(ADP-PA) was assessed at baseline, 12 to 24 h after administration of medication, and after 72 h of percutaneous coronary intervention(PCI). The primary endpoint of the study was platelet reactivity assessed with ADP-PA at 30 days after PCI. Adverse events(AEs) were recorded for 30-day and 180-day follow-up periods.Results: There were no significant differences between both the groups in platelet response to clopidogrel at 12–24h after drug administration(54.09%±18.90% vs. 51.62%±19.85%, P=0.12), 72 h after PCI(52.15%±19.45% vs. 49.66%±20.05%, P=0.18), and 30 days after PCI(50.44%±14.54% vs. 48.52%±15.08%, P=0.17). The rate of AEs did not differ significantly between groups during the 30-day(15.2% vs. 14.8%, P=0.91) and 180-day(16.5% vs. 14.5%, P=0.50) follow-up periods after PCI.Conclusion: The addition of omeprazole or pantoprazole to clopidogrel did not restrict the effect of platelet aggregation by reducing the conversion of clopidogrel. Compared with clopidogrel alone, pantoprazole-clopidogrel and omeprazoleclopidogrel combinations did not increase the incidence of adverse clinical events during 30-day and 180-day follow-up periods after PCI.

Impact of invasive treatment strategy on health-related quality of life six months after non-ST-elevation acute coronary syndrome

BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）. This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up （P〈0.001）, the CABG relative to PCI group showed more significant improvements in angina frequency （P= 0.044） and quality of life （P= 0.028）. In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency （OR： 1.62, 95%CI： 1.09-4.63,P= 0.042） and quality of life （OR： 2.04, 95%CI： 1.26-6.92,P= 0.038） relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.

Acute Coronary Syndrome with Persistent ST Segment Elevation Isolated in aVR: A Case Study

A 53 years old female patient with hypertension presented with constrictive retrosternal chest pain. Initial Electrocardiogram (ECG) showed ST elevation in aVR and high level cardiac Troponin-I. Thrombolysis with streptokinase was performed and she underwent?coronary angiography who showed a long tight anterior inter ventricular lesion, occlusion of the proximal circumflex and an intermediate lesion of segment 2 of the right coronary.

Percutaneous treatment in acute coronary syndromes

Both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes (ACS) are the result of an acute thrombotic lesion obstructing blood flow in the coronary vasculature. Percutaneous treatment has shown to improve clinical outcome in this clinical setting by resolving coronary obstruction with different devices directed to restore coronary blood flow. In comparison with balloon alone angioplasty, implantation of bare metal stents reduced the rate of restenosis and cardiac events, but high rates of restenosis remained, leading to further investigations to develop drug-eluting stents with different pharma- cological coatings that reduced restenosis rates and clinical events. In this review, we discuss the current treatment of ACS, reviewing recent randomized clinical trials and advances in medical treatment, including new antiplatelet agents and recent guideline recommendations.

Comparative Study of Acute Coronary Syndrome with Persistent ST-Segment Elevation (STEMI) between Diabetics and Non-Diabetics in Dakar, Senegal

Introduction: This study aimed to compare the frequency of diabetic and non-diabetic patients admitted for ST-elevation myocardial infarction (STEMI), assess their epidemiological, clinical, and paraclinical profiles, and evaluate their therapeutic strategies and outcomes. Methodology: A descriptive, analytical, comparative study with prospective and retrospective data collection was conducted from April 1, 2020, to March 31, 2021. Diabetic and non-diabetic patients with STEMI admitted to a cardiology department were included. STEMI diagnosis was based on clinical and electrocardiographic criteria showing persistent ST-segment elevation in at least two leads. All patients included in the study signed a written, informed consent form. Data analysis was performed using SPSS, with a p-value ≤ 0.05 considered statistically significant. Results: STEMI prevalence was 15.27%, with 37.11% of patients being diabetic and 62.89% non-diabetic. Diabetic patients had a mean age of 59.2 ± 10.9 years, while non-diabetics averaged 58 ± 13.4 years. Diabetics were predominantly female (72.2%), whereas non-diabetics were mainly male (83.6%). Smoking was less frequent among diabetics (25% vs. 47.54%), but hypertension, obesity, and sedentary lifestyle were more common. Diabetics had an average of 3.5 ± 1.1 risk factors compared to 2.6 ± 1.2 in non-diabetics. Admission delay was longer for diabetics (34.8 ± 51.6 hours vs. 23.3 ± 52.3 hours). Chest pain was the main symptom in both groups. Electrocardiograms showed that anterior and inferior infarctions were most frequent. Triple vessel disease and severe complications, such as cardiogenic shock, were more common in diabetics, who also had higher mortality (5.56% vs. 3.28%). Conclusion: Diabetic STEMI patients represent a high-risk group with distinct clinical features, longer admission delays, and a greater accumulation of cardiovascular risk factors, emphasizing the need for targeted interventions.

Antithrombotic and antiplatelet therapies in relation to risk stratification in patients with non-ST elevation acute coronary syndrome： insights from the Sino-Global Registry of Acute Coronary Events

Background Antithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome （NSTEACS）, yet limited information is available about their applications from a multicenter ＂real-world＂ clinical procedure, especially in China. This study was undertaken to characterize the use of antithrombotic and antiplatelet agents in relation to the risk levels of the NSTEACS patients who were enrolled in Sino-Global Registry of Acute Coronary Events （GRACEs） registry study. Methods We analyzed the data from 618 Chinese NSTEACS patients stratified into low-（n=151）, intermediate-（n=233）, and high-risk groups （n=-234） based on GRACE risk scores. The baseline characteristics, clinical presentations, antithrombotic and antiplatelet agents were recorded and compared among the three groups. Results The administration rates of low-molecular-weight heparins （LMWHs） （86.08%） and thienopyridines （85.92%） were higher whereas the administration rate of glycoprotein Ⅱb/Ⅲa inhibitor （1.78%） was much lower than those reported previously. Meanwhile, within the first 24 hours of admission, the use of heparin/LMWHs in the high-risk group was more than that in the intermediate- and low-risk groups （73.50% vs 63.09% vs 55.63%, P=0.001）. Furthermore, the combination of antithrombotic and antiplatelet medications showed no significant differences in all groups. Conclusions In the ＂real world＂ practice of China, the antithrombotic and antiplatelet therapies on NSTEACS are well adherent to the current guidelines except for several gaps, such as the very low use of glycoprotein Ⅱb/Ⅲa inhibitor. Moreover, these antithrombotic and antiplatelet treatments usually tend to be underused for the high-risk ones.

Comparison Between Upstream Tirofiban and Downstream Tirofiban in Patients With Non-ST-segment Elevation Acute Coronary Syndromes at High-risk Undergoing Percutaneous Coronary Interventions:Efficacy and Safety

Objectives To compare the efficacy and safety of upstream tirofiban with downstream tirofiban in patients with non- ST-segment elevation acute coronary syndromes （NSTE-ACS） at high-risk undergoing percutaneous coronary intervention （PCI）. Methods Two hundred and four patients with NSTE-ACS at high-risk undergoing PCI were randomized to upstream （4 -6 hours before coronary angiography） tirofiban or downstream （with the guidewire crossing the lesion） tirofiban. We evaluated myocardial damage after PCI by qualitatively analyzing cardiac troponin I （cTnI） and MB isoenzyme of creatine kinase （CK-MB）. Platelet aggregation inhibition and thrombolysis in myocardial infarction （TIMI） flow grade were assessed. The incidences of major adverse cardiac events （MACE） at 24-hour, 90-day and 180-day after PCI were followed up. The incidences of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results There were 102 patients with NSTE-ACS randomly assigned to upstream group and downstream group respectively. The peak serum levels of cTnI within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.34 vs 0. 61 ; P 〈 0.05 ）. Post-procedural cTnI elevation within 48 hours was significantly less frequent among patients who received upstream tirofiban than downstream tirofiban （63 % vs 82%, P 〈 0. 05 ）. The peak serum levels of CK-MB as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （ 15 vs 18 and 38% vs 43% ; respectively; P 〉 0. 05 ）. ECG changes and the inhibition of platelet aggregation between two groups were similar （ P 〉 0.05 ）. Although the inci- dences of MACE at 90-day and 180-day after PCI were not statistically different, they were consistently lower with upstream tirofiban （3 % vs 6% and 6% vs 16% ; P 〉 0.05 ）. The incidences of bleeding complications and thrombocyto- penia were similar in the two groups （ 11% vs 9% ; P 〉 0.05 ）. Conclusions Among patients with NSTE-ACS at high-risk undergoing PCI, upstream tirofiban is associated with attenuated myocardial damage without increasing complications. （ S Chin J Cardiol 2009; 10（4） ： 179 -185）

Effect of Danlou Tablet(丹蒌片) on Peri-procedural Myocardial Injury among Patients undergoing Percutaneous Coronary Intervention for Non-ST Elevation Acute Coronary Syndrome:A Study Protocol of A Multicenter,Randomized,Controlled Trial

Background： It has been shown that administration of statins reduced the risk of peri-procedural myocardial damage. However, it remains unclear whether Chinese medicine Danlou Tablet （~）~）, similar to statins, may protect patients undergoing percutaneous coronary intervention （PCI） from peri-procedural myocardial damage. Objective： To demonstrate the hypothesis whether treatment with Danlou Tablet would improve clinical outcome in patients undergoing selective PCI with non-ST elevation acute coronary syndrome （NSTE-ACS） in China. Methods： Approximately 220 patients with unstable angina or non-ST-segment elevation myocardial infarction undergoing PCI will be enrolled and randomized to Danlou Tablet treatment （4.5 g/day for 2 days before intervention, with a further 4.5 g/day for 90 days thereafter） or placebo. All patients will not receive Danlou Tablet before procedure. The primary end point is to evaluate the incidence of cardiac death, myocardial infarction or unplanned re-hospitalization and revascularization after 30 days in patients undergoing selective PCI treated with Danlou Tablet compared with placebo. Secondary endpoints include the incidence of peri-procedural myocardial injury, 3-month clinical outcomes, the quality of life and Chinese medicine syndromes assessment. Conclusion： This study protocol will provide important evidence of Danlou Tablet treatment on the peri-procedural myocardial injury in patients with NSTE-ACS undergoing selective PCI, which may support a strategy of routine Danlou Tablet therapy to improve the clinical outcomes.

Prognostic value of combination of ST-segment elevation in lead aVR and positive cTnI in patients with non-ST- segment elevation acute coronary syndrome

Background Non-ST-segment elevation acute coronary syndrome （NSTE-ACS） is an acute heart disease caused by incomplete occlusion of related coronary arteries with unstable atherosclerotic plaques. Lead aVR ST- segment elevation and cTnI positive are closely correlated to the prognosis of NSTE-ACS patients. However, there are few studies applying the two predictors to early risk stratification in NSTE-ACS patients. Method Two hundred and five cases of NSTE-ACS patients followed up for 6 months after discharge were reviewed. All patients were divided into four groups： Group A-cTnI negative combined with aVR-non-ST-segment elevation group （100 cases） ; Group B-cTnI negative combined with aVR-ST-segment elevation group （31 cases） ; Group C-cTnI positive combined with aVR-non-ST-segment elevation group （43 cases） ; Group D-cTnI positive combined with aVR-ST-segment elevation group （31 cases）. There was no significant difference in gender, age, old myocardial infarction, previous PCI history, hypertension, and diabetes between aVR-ST elevation group and no aVR-ST elevation group. The morbidity of left main or three-vessel coronary artery disease as well as adverse cardiovascular events in the four groups were observed and analyzed. Results （i） The morbidity of left main or three-vessel coronary artery disease was highest in Group D （87.1%） , and was markedly higher in Group B （41.9%） than that in Group A （7%） or Group C （9.3%） ; （ii） The incidence of adverse cardiovascular events was highest in Group D （77.4%）, and was much higher in B （35.5%） as compared with that tin Group A （1%） or group C （7%）. Conclusion Electrocardiographic lead aVR ST-segment elevation combined with cTnI positive has an important clinical value in predicting the prognosis of the patients with NSTE-ACS.

Glycated hemoglobinis associated with mid-term mortality in non-ST segment elevation acute coronary syndrome undergoing percutaneous coronary intervention

Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.

The association between admission systolic blood pressure and 1-year mortality in patients with non-ST-segment elevation acute coronary syndrome

Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not fully elucidated in patients with non-ST-segment elevation ACS（NSTEACS）. Methods We enrolled 1325 patients to investigate the association between admission SBP in patients hospitalized for NSTEACS. We analyzed the association between admission SBP and 1-year mortality. Admission SBP was categorized as low（〈110 mm Hg）, normal（110-140 mm Hg）, high（141-160 mm Hg）, and very high（〉160 mm Hg）. Results Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios（HRs） for 1-year mortality of 3.03（P〈0.05）, while patients with high and very high admission SBP had no significantly increased HRs for 1-year mortality. Conclusion Low admission SBP, but not elevated admission SBP, is a strong independent predictor of 1-year mortality in patients with NSTEACS.

Benefits and Safety of Tirofiban among Older Patients With Non-ST-elevation Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention

Background Glycoprotein （GP） Ⅱb/Ⅲa antagonist has been shown its efficacy and safety in high-risk patients with acute coronary syndrome （ACS） who underwent percutaneous coronary intervention （PCI）. Whether GP Ⅱb/Ⅲa antagonist is as effective and safe in older patients （ ≥ 65 years old ） as in younger patients remains unclear. Objectives Our objective was to determine whether GP Ⅱb/Ⅲa antagonist tirofiban was effective and safe in patients aged ≥65 years who underwent PCI. Methods From September 2006 to August 2008, 622 patients with non-ST-elevation ACS （NSTE ACS） were randomized to receive either tirofiban （n = 313 ） or placebo （n = 309）. The infusion duration was 48 hours for both groups. Incidence of major adverse cardiac events （MACE） was assessed at 180 days. Incidence of bleeding was monitored through 24 hours after trial therapy was discontinued. Results The incidence of MACE for the tirofiban group versus the placebo group was 7.3% vs 12. 6% （P 〈0. 05）. Among these MACE, death rate was 2.6% vs 4. 6 % （ P = 0. 198 ）, non-fatal MI was 3.8 % vs 6.5 % （ P = 0. 150）, and target vessel revascularization was 1.3% vs 1.6% （P =0. 751 ）, in the two groups, respectively. The total bleeding rate for the tirofiban group versus the placebo group was 28.1% vs 6.8% （P 〈0. 05 ）. The TIMI major and minor bleeding rates for the tirifiban versus the placebo group were 2.2% vs 1.6% （ P 〉 0. 05 ） and 25.9% vs 5.2% （ P 〈 0. 05 ）, respectively. Conclusions Tirofiban appears to be effective and safe in older patients with ACS who underwent PCI.

ST-segment elevation myocardial infarction in Kawasaki disease:A case report and review of literature

BACKGROUND Kawasaki disease(KD)is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm(CAA).CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain.Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram.An aneurysm of the left circumflex(LCX)coronary artery was found with massive thrombi within.A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications.The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7,suggestive of a small aneurysm considering his age,sex,and body surface area.We further present a case series of 19 patients with KD,including the current patient,presenting with acute coronary syndrome(ACS).Notably,none of the cases showed Z scores;only five patients(26%)had been regularly followed up by a physician,and only one patient(5.3%)was being treated with antithrombotic therapy before ACS occurred.CONCLUSION For KD presenting with ACS,regular follow up and medical therapy may be crucial for improved outcomes.

Practice of reperfusion in patients with ST-segment elevation myocardial infarction in China:findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project

Background:Reperfusion therapy is fundamental for ST-segment elevation myocardial infarction(STEMI).However,the details of contemporary practice and factors associated with reperfusion therapy in China are largely unknown.Therefore,this study aimed to explore reperfusion practice and its associated factors among hospitalized patients with STEMI in China.Methods:Patients with STEMI who were admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project from November 2014 to December 2019.The associations of the characteristics of patients and hospitals with reperfusion were examined using hierarchical logistic regression.The associations between therapies and in-hospital major adverse cardiovascular events were examined with a mixed effects Cox regression model.Results:Among the 59,447 patients,37,485(63.1%)underwent reperfusion,including 4556(7.7%)receiving fibrinolysis and 32,929(55.4%)receiving primary percutaneous coronary intervention(PCI).The reperfusion rate varied across geographical regions(48.0%–73.5%).The overall rate increased from 60.0%to 69.7%from 2014 to 2019,mainly due to an increase in primary PCI within 12 h of symptom onset.Timely PCI,but not fibrinolysis alone,was associated with a decreased risk of inhospital major adverse cardiovascular events compared with no reperfusion,with an adjusted hazard ratio(95%confidence interval)of 0.64(0.54,0.76)for primary PCI at<12 h,0.53(0.37,0.74)for primary PCI at 12 to 24 h,0.46(0.25,0.82)for the pharmaco-invasive strategy,and 0.79(0.54,1.15)for fibrinolysis alone.Conclusions:Nationwide quality improvement initiatives should be strengthened to increase the reperfusion rate and reduce inequality in China.Trial registration:www.ClinicalTrials.gov,NCT02306616。

Latest Advancement of Non ST-segment Elevation Acute Coronary Syndrome

Further understanding of the pathphophisyology, advance of the diagnosis instrument and renovation of the risk delamination standard can offer better therapy evidence for the non-ST-segment elevation acute coronary syndrome(NSTE-ACS). Drugs, such as trigeminy antiplatelet drug, prasugrel, fondaparinux and bivalirudin, have brought great clinical effect to the high risk patients. Since the result of the ICTUS test announced and the drug eluting balloon developed, we have reached the newest recognition of how to select a chance for intervention and how to prevent and cure the restenosis of in-stent.

超声联合血清AnxA1、MMP-3对NSTE-ACS患者PCI术后冠状动脉再狭窄的预测价值

目的探讨血清膜联蛋白A1(AnxA1)、基质金属蛋白酶-3(MMP-3)联合冠状动脉血管内超声钙化特征对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者经皮冠状动脉介入治疗(PCI)术后冠状动脉再狭窄的预测价值。方法回顾性选取2019年7月至2022年5月鄂州市中心医院行PCI治疗的236例NSTE-ACS患者为研究对象,依据随访1年内冠状动脉再狭窄情况分为再狭窄组(n=24)和非狭窄组(n=212)。收集患者临床资料,对比患者血清AnxA1、MMP-3水平、血管内超声检查结果;采用Logistic多因素回归分析NSTE-ACS患者PCI术后冠状动脉再狭窄影响因素;受试者操作特征(ROC)曲线分析血清AnxA1、MMP-3水平联合钙化特征评分预测术后冠状动脉再狭窄的价值。结果再狭窄组血清AnxA1、MMP-3水平及钙化病变比例、浅表型钙化比例、钙化弧度、钙化长度、钙化特征评分分别为(2.40±0.61)μg/L、(56.49±12.31)μg/L、66.67%、70.83%、(162.18±28.43)°、(25.91±4.56)mm、(5.02±1.28)分,高于非狭窄组[(1.78±0.40)μg/L、(42.78±10.07)μg/L、22.64%、29.72%、(78.41±20.39)°、(13.72±3.68)mm、(3.47±1.02)分],差异均有统计学意义(P<0.05)。AnxA1、MMP-3、钙化特征评分是NSTE-ACS患者PCI术后冠状动脉再狭窄的独立危险因素(P<0.05)。AnxA1、MMP-3、钙化特征评分及3者联合预测NSTE-ACS患者PCI术后冠状动脉再狭窄的AUC分别为0.825、0.780、0.854、0.960。结论AnxA1、MMP-3、钙化特征评分是NSTE-ACS患者PCI术后冠状动脉再狭窄的独立危险因素,3者联合较单一指标对冠状动脉再狭窄的预测价值更高。

不同心房颤动类型与心力衰竭合并非ST段抬高型急性冠状动脉综合征预后的相关性分析

目的:探究在射血分数降低型心力衰竭(heart failure with reduced ejection fraction,HFrEF)合并非ST段抬高型急性冠状动脉综合征(on-ST elevation acute coronary syndrome,NSTEACS)人群中,不同心房颤动(atrial fibrillation,AF)类型与预后的相关性。方法:本研究为单中心回顾性队列研究,最终入选HFrEF合并NSTE-ACS行PCI治疗的患者866例。所有患者根据入院时AF的类型分为三组:无AF组(n=585),阵发性AF组(n=198)和持续性/永久性AF组(n=83)。主要终点:主要不良心血管事件(major adverse cardiovascular events,MACE)。次要终点:主要终点的组成部分,包括:心血管死亡、非致死性心肌梗死(myocardial infarction,MI)、HF再住院。随访时间为3年。采用生存分析明确不同AF类型与各结局间的关系。通过多元Cox回归分析探索不同AF类型对结局发生风险的影响。结果:持续性/永久性AF组的主要结局及次要结局的发生率明显高于无AF组及阵发性AF组(P均<0.05)。生存分析表明:持续性/永久性AF组MACE、非致死性MI及HF再住院3年复合发生率显著高于无AF组及阵发性AF组(Log-rank P均<0.05)。多元Cox回归分析表明:持续性/永久性AF组MACE发生风险显著高于无AF组(HR=2.19,95%CI:1.53~3.12,P<0.001)及阵发性AF组(HR=1.55,95%CI:1.03~2.32,P=0.035)。结论:在HFrEF合并NSTEACS行PCI的患者中,持续性/永久性AF患者MACE发生风险显著高于无AF组及阵发性AF组。

血清铁蛋白/白蛋白比值用于观察ST段抬高型急性冠脉综合征患者介入治疗短期预后

目的探讨血清铁蛋白(SF)/白蛋白(Alb)比值对ST段抬高型急性冠脉综合征(STE-ACS)患者介入治疗短期预后的评估价值。方法选取2020年6月—2022年6月北京市通州区中西医结合医院和首都医科大学附属北京潞河医院接受经皮冠状动脉介入治疗术(PCI)的STE-ACS患者121例。收集所有患者一般资料,并检测其出院前的SF、Alb水平,计算SF/Alb比值。所有患者出院后随访1年,记录随访期间不良心血管事件的发生情况,根据预后情况分为预后不良组和预后良好组。采用Logistic回归分析评估STE-ACS患者介入治疗后短期预后不良的危险因素。采用决策曲线分析SF/Alb比值预测STE-ACS患者介入治疗预后的净获益率。结果121例STE-ACS患者中有117例完成随访,其中24例(20.51%)预后不良。预后不良组糖尿病史、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA_(1c))、SF、SF/Alb比值均高于预后良好组(P<0.05),高密度脂蛋白胆固醇(HDL-C)、Alb均低于预后良好组(P<0.05);其他项目2个组之间差异均无统计学意义(P>0.05)。有糖尿病史、LDL-C升高、SF升高、SF/Alb比值升高、HbA_(1c)升高、HDL-C降低、Alb降低是STE-ACS患者介入治疗短期预后不良的危险因素(P<0.05)。阈值为0.15~0.18、0.25~0.50、0.53~0.68时,SF/Alb比值预测STE-ACS患者介入治疗短期预后的净获益率高于SF、Alb单项检测,且在高风险阈值(0.00~1.00)范围内其净获益率基本>0,净获益率最大值为0.205。结论SF/Alb比值对接受PCI的STE-ACS患者的短期预后具有良好的预测价值。

阿托伐他汀联合依折麦布对非ST段抬高型急性冠脉综合征患者PCI围手术期Lp-PLA2的影响

目的 评估强化阿托伐他汀和阿托伐他汀联合依折麦布对采用经皮冠状动脉介入治疗(PCI)的非ST段抬高型急性冠脉综合征(NSTE-ACS)患者围手术期脂蛋白相关磷脂酶A2 (Lp-PLA2)水平的影响。方法 共纳入择期行PCI的NSTE-ACS患者193例,根据降脂方案,分为阿托伐他汀20 mg组(A20组)、阿托伐他汀40 mg组(A40组)、阿托伐他汀20 mg联合依折麦布10 mg组(A20+E10组)、阿托伐他汀40 mg联合依折麦布10 mg组(A40+E10组)。观察围手术期血浆Lp-PLA2和低密度脂蛋白胆固醇(LDL-C)水平的变化,随访30 d主要心血管不良事件和他汀类药物相关不良反应的发生情况。结果 析因分析结果表明,强化阿托伐他汀和依折麦布2个因素间无交互作用(P> 0.05),强化阿托伐他汀和阿托伐他汀联合依折麦布均可显著降低术后血浆Lp-PLA2水平(P <0.05)。术前各组Lp-PLA2水平无统计学差异(P> 0.05),术后各组Lp-PLA2水平均较术前降低(P <0.001)。对4组Lp-PLA2围手术期变化值进行两两比较,A40组、A20+E10组、A40+E10组均高于A20组,A40+E10组高于A40组(P <0.05),其余2组间比较无统计学差异(P> 0.05)。术后与术前比较,各组LDL-C水平无统计学差异(P> 0.05)。围手术期Lp-PLA2变化值与LDL-C变化值无相关性(P> 0.05)。各组30 d主要心血管不良事件和他汀类药物相关不良反应的发生率无统计学差异(P>0.05)。结论 在行PCI的NSTE-ACS患者中,与中等强度阿托伐他汀(20 mg)相比,高强度阿托伐他汀(40 mg)可进一步降低术后Lp-PLA2水平。与阿托伐他汀单药相比,阿托伐他汀联合依折麦布可进一步降低术后Lp-PLA2水平。围手术期强化阿托伐他汀和阿托伐他汀联合依折麦布对Lp-PLA2水平的降低作用不依赖于LDL-C变化。