Prognostic Values of Serum Chloride and Sodium Levels in Patients with Three-vessel Disease

Objective Identification of new risk factors is needed to improve prediction of adverse outcomes in patients with three-vessel disease(TVD). The present study aimed to evaluate the prognostic values of serum chloride and sodium levels in patients with TVD. Methods We used data from a prospective cohort of consecutive patients with angiographically confirmed TVD. The primary endpoint was all-cause death. Cox proportional hazard regression was used to analyze the relationship of serum chloride and sodium levels with long-term outcomes of TVD patients. Results A total of 8,318 participants with available serum chloride and sodium data were included in this analysis. At baseline, patients in the low tertiles group of serum chloride level(≤ 102.0 mmol/L) or serum sodium level(≤ 139.0 mmol/L) had more severe disease conditions. During a median follow-up of 7.5-year, both low serum chloride level and low serum sodium level were found to be associated with an increased risk for mortality in univariate analysis. However, when both parameters were incorporated into a multivariate model, only low serum sodium level remained to be an independent predictor of all-cause death(hazard ratio: 1.16, 95% confidence interval: 1.01-1.34, P = 0.041). Modest but significant improvement of discrimination was observed after incorporating serum sodium level into the Synergy between percutaneous coronary intervention(PCI) with Taxus and Cardiac Surgery score. Conclusion Serum sodium level is more strongly associated with long-term outcomes of TVD patients compared with serum chloride level. Low serum sodium level is an independent risk factor for mortality, but only provides modest prognostic information beyond an established risk model.

Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction

Background:The mortality of cardiovascular disease is constantly rising,and novel biomarkers help us predict residual risk.This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).Methods:The 419 consecutive patients with STEMI,treated at one medical center,from March 2010 to December 2015 were retrospectively investigated.Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay.The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups.Short- and long-term outcomes were compared,as were age-based subgroups (patients aged 60 years and younger vs.those older than 60 years).Statistical analyses were mainly conducted by Student t-test,Chi-squared test,logistic regression,and Cox proportional-hazards regression.Results:The H-HCY group had more males (84.6% vs.75.4%,P=0.018),and a lower prevalence of diabetes (20.2% vs.35.5%,P<0.001),compared with the L-HCY group.During hospitalization,there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs.4.8%,P= 0.440).During the median follow-up period of 35.8 (26.9–46.1) months,33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE)(P=0.120).History of hypertension (hazard ratio [HR]:1.881,95% confidence interval [CI]:1.178–3.005,P=0.008) and higher Killip class (HR:1.923,95% CI:1.419–2.607,P<0.001),but not HCY levels (HR:1.007,95% CI:0.987–1.027,P=0.507),were significantly associated with long-term outcomes.However,the subgroup analysis indicated that in older patients,HCY levels were significantly associated with long-term outcomes (HR:1.036,95% CI:1.011–1.062,P=0.005).Conclusion:Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI;however,among elderly patients with STEMI,this study revealed a risk profile for late outcomes that incorporated HCY level.

Independent Prognostic Value of High-sensitivity C-reactive Protein in Patients with Coronary Artery Ectasia

Background：Despite its severity,coronary artery ectasia （CAE） is still poorly understood.High-sensitivity C-reactive protein （hs-CRP） has been recognized as a prognostic factor in some cardiovascular diseases but not assessed in CAE.The aim of this observational study was to investigate the prognostic value of hs-CRP in CAE.Methods：Our analysis evaluated the effect of the baseline hs-CRP on cardiovascular events （CVs） （cardiac death and nonfetal myocardial infarction） in consecutively enrolled stable CAE patients.We used the Cox proportional hazards regression models to examine the association between baseline hs-CRP level and follow-up CVs in CAE.The net reclassification improvement and integrated discrimination improvement （IDI） of hs-CRP were also assessed.Results：We obtained the follow-up results of 540 patients over a median follow-up period of 36 （37.41 ± 15.88） months.The multivariable Cox analysis showed that the hs-CRP was a significant predictor of adverse outcomes in CAE （hazard ratio [HR]：2.99,95% confidence interval [CI]：1.31-6.81,P =0.0091）.In Kaplan-Meier analysis,the group with hs-CRP 〉3 mg/L had a lower cumulative 66-month event-free survival rate （log-rank test for trend,P =0.0235） and a higher risk ofCVs （HR =2.66,95% CI：1.22-5.77,P =0.0140） than the group with hs-CRP ≤3 mg/L.Hs-CRP added predictive information beyond that given by the baseline model comprising the classical risk factors （P value for IDI =0.0330）.Conclusions：A higher level of hs-CRP was independently associated with cardiac death and nonfatal myocardial infarction in CAE patients.The hs-CRP level may therefore provide prognostic information for the risk stratification of CAE patients.

Influence of socioeconomic status on acute myocardial infarction in the Chinese population： the INTERHEART China study

Background Many researches report that low socioeconomic status （SES） is associated with a higher risk of coronary heart disease （CHD）. This study aimed to determine whether levels of education, family income, and other SES were associated with acute myocardial infarction （AMI） in the Chinese population, and to compare the difference in this association between northern and southern regions in China. Methods We conducted a case-control study. Cases were first AMI （n=2909）. Controls （n=2947） were randomly selected and frequency matched to cases on age and sex. SES was measured using education, family income, possessions in the household, and occupation. Results Low levels of education （8 years） were more common in cases compared to controls （53.4% and 44.1%; P=0,0001）. After adjusting all risk factors, the level of education was associated with AMI risk in the Chinese population （P=-0.0005）. The odds ratio （OR） associated with education of 8 years or less, compared with more than 12 years （trade school/college/university） was 1.33 （95% CI 1.12-1.59）, and for education of 9-12 years 1.04 （95% CI 0.88-1.33）. The proportion of higher income population was more in controls than cases （39.4% and 35.3%）. Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI. The adjusted OR associated with the lower education was 2.38 （95% CI 1.67-3.39） in women, and 1.18 （95% CI 0.99-1.42） in men （P=0.0001, for heterogeneity）. The interaction between levels of education and different regions was significant （P=0.0206, for interaction）. Conclusion Several socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China, most markedly in northeast and southern area. The effect of education was stronger towards AMI in women than men.