Relationship between TyG index and the degree of coronary artery lesions in patients with H-type hypertension.

BACKGROUND: The TyG index, a prominent metric for assessing insulin resistance, has gained traction as a prognostic tool for cardiovascular disease. Nevertheless, the understanding of the prognostic significance of the extent of coronary artery stenosis in individuals afflicted with H-type hypertension remains limited. METHODS: A retrospective study was conducted at Wuhan Third Hospital, including a cohort of 320 inpatients who were diagnosed with hypertension in combination with coronary artery disease. The study period spanned from January 1, 2021, to February 1, 2023. The study cohort was stratified based on the severity of stenosis into three distinct groups: low stenosis, medium stenosis, and high stenosis, as determined by the Gensini score derived from coronary angiography findings. The present study aimed to investigate the association between the severity of coronary stenosis and the number of lesion branches, utilizing the TyG index as a testing indicator. The predictive ability of TyG for coronary lesion severity was assessed using logistic regression analysis. RESULTS: The results of our study indicate a positive correlation between elevated levels of TyG and an increased susceptibility to severe stenosis in individuals diagnosed with H-type hypertension. Upon careful consideration of potential confounding variables, it has been observed that the TyG index exhibits a robust association with the likelihood of severe stenosis in individuals with H-type hypertension (odds ratio [OR] = 4000, 95% confidence interval CI 2.411-6.635, p = 0.0001), as well as the prevalence of multivessel disease (OR = 1.862, 95% CI 1.036-3.348, p < 0.0001). The TyG index demonstrated superior predictive ability for severe coronary stenosis in patients with H-type hypertension compared to those without H-type hypertension (area under the curve [AUC] = 0.888, 95% confidence interval CI 0.838-0.939, p < 0.0001, versus AUC = 0.615, 95% CI 0.494-0.737, p < 0.05). CONCLUSION: The TyG index is an independent risk factor for the degree of coronary stenosis and a better predictor in patients with H-type hypertension combined with coronary artery disease.

Increased prevalence of high-risk coronary plaques in metabolic dysfunction associated steatotic liver disease patients: A meta-analysis.

BACKGROUND: Metabolic dysfunction associated steatotic liver disease (MASLD) is associated with an increased risk of coronary artery disease. Computed Tomography Coronary Angiography (CTCA) can assess both the extent and the features of coronary plaques. We aimed to gather evidence about the prevalence and features of coronary plaques among MASLD patients. METHODS: PubMed, Scopus, and Google Scholar databases were searched for randomized controlled trials and adjusted observational studies assessing the prevalence and features of coronary plaques by means of CTCA in MASLD patients as compared with a control group. The prevalence of coronary stenosis (defined as >30% and >50% diameter of stenosis), of increasing coronary artery calcium (CAC) score and of high-risk features (namely low-attenuation plaques, napkin ring sign, spotty calcification and positive remodelling) in MASLD patients were the endpoints of interest. RESULTS: Twenty-four observational studies were included. MASLD was associated with an increased prevalence of critical coronary stenosis compared with controls (odds ratio [OR] 1.54, 95%CI 1.23-1.93). Increased values of CAC score were observed in MASLD patients (OR 1.35, 95%CI 1.02-1.78 and OR 2.26, 95%CI 1.57-3.23 for CAC score 0-100 and >100, respectively). An increased risk of 'high-risk' coronary plaques was observed in MASLD patients (OR 2.13, 95%CI 1.42-3.19). As high-risk features plaques, a higher prevalence of positive remodelling and spotty calcification characterize MASLD patients (OR 2.92, 95%CI 1.79-4.77 and OR 2.96, 95%CI 1.22-7.20). CONCLUSIONS: Patients with MASLD are at increased risk of developing critical coronary stenosis and coronary plaques characterized by high-risk features as detected by CTCA.

Angiographic characteristics of coronary artery disease in patients undergoing diagnostic coronary angiography at a tertiary hospital in Tanzania.

BACKGROUND: Coronary artery disease (CAD) is an important cause of global burden of disease. There is a paucity of data on the burden and risk factors for CAD in sub-Saharan Africa (SSA), despite the rising trends in the shared risk factors across regions. The recent introduction of cardiac catheterization laboratory services in SSA could shed light on the burden of CAD in the region. We aimed to assess the angiographic characteristics among patients undergoing diagnostic coronary angiography (CAG) at a single tertiary care hospital in Tanzania. METHODS: This study was a retrospective chart review. A total of 728 patients  ≥ 18 years of age who underwent CAG from January 2020 to December 2022 were recruited into the study. Basic demographic variables, risk factors and clinical characteristics including CAG findings were obtained from the registry. In addition, CAG images were retrieved for assessment of angiographic features. The luminal vessel stenosis was assessed based on eyeballing and the degree of obstruction was agreed by two independent and experienced cardiologists. The coronary stenosis of ≥ 50% was considered significant for obstructive CAD. The study was approved by the local ethics committee. RESULTS: Of patients who were recruited into the study, 384 (52.23%) were female. The study participants had a mean age of 59.46 ± 10.83 standard deviation (SD) and mean body mass index (BMI) of 31.18 kg/m2. The prevalence of CAD of any degree was estimated at 24.43% (34.18% in male, 15.50% in female), while that of obstructive CAD was 18.27%. Forty six percent of those with obstructive CAD had multiple vessel disease (MVD). Nearly 77% of patients were found to have ≥ 50-70% luminal stenosis and while those with ≥ 70% luminal coronary artery stenosis constituted 56.65%. Right coronary artery (RCA) was the most commonly affected vessel, accounting for 36.84% when any vessel disease or 56% when single vessel disease were considered. Being 65 years or older and comorbidity with type 2 diabetes (T2D) were independent risk factors for developing CAD. CONCLUSION: There is a high prevalence of obstructive CAD among patients undergoing diagnostic CAG in Tanzania, with male gender preponderance and increasingly higher in older age, often with severe disease. A large, prospective study is needed to provide epidemiological and clinical data for developing a locally-relevant cardio-preventive strategy for CAD intervention in Tanzania.

Waterpipe smoking is associated with presence and severity of coronary artery disease: a propensity score-matched study.

BACKGROUND: The prevalence of waterpipe smoking (WPS) has been increasing worldwide. This trend is alarming as WPS can negatively impact cardiovascular health. In the present study, we explored the association between WPS and the presence and severity of CAD. METHODS: This study was a retrospective analysis of patients who underwent diagnostic coronary angiography at Tehran Heart Center between April 2021 and May 2022. Patients with a previous history of percutaneous coronary intervention and coronary surgery were excluded. Waterpipe smokers were matched with non-smokers based on age, gender, and cigarette smoking using a 1:4 propensity score matching model. Stenosis ≥ 50% in any coronary artery was considered a CAD diagnosis. Gensini score was also calculated to measure the severity of the CAD. RESULTS: We reviewed the medical records of 8699 patients, including 380 waterpipe smokers. After matching, 1520 non-smokers with similar propensity scores to the waterpipe smokers were selected. Waterpipe smokers were more likely to have CAD than non-smokers (OR: 1.29; 95% CI: 1.04-1.60, P = 0.021). In addition, WPS increased the natural logarithm of the Gensini score by 1.24 (95% CI: 1.04-1.48, P = 0.014) in patients with atherosclerotic coronary disease. CONCLUSION: WPS may increase the risk of CAD independent of age, gender, and cigarette smoking. In addition, among patients with any degree of atherosclerosis in coronary arteries (GS > 0), WPS may lead to higher average GS, suggesting more severe atherosclerosis.

Sex differences in the association of the uric acid to high-density lipoprotein cholesterol ratio with coronary artery disease risk among Chinese nondialysis patients with CKD stages 3-5.

BACKGROUND AND AIMS: Evidence has indicated that serum uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) are positively and negatively associated with coronary artery disease (CAD). The UA to HDL-C ratio (UHR) has recently drawn attention as a new predictor for metabolic syndrome, inflammation and atherosclerosis. However, the association between the UHR and CAD in nondialysis chronic kidney disease (CKD) patients is still unclear. METHODS AND RESULTS: We retrospectively analysed 733 nondialysis patients with CKD stage 3-5 who received their first coronary artery angiography (CAG), including 510 participants with CAD. All laboratory indicators were collected within one week before CAG. The median UHR of CAD and non-CAD patients was 15.52% and 12.29%, respectively. In multivariate analysis, female patients with a high UHR were 4.7 times more at risk of CAD than those with a lower UHR. Meanwhile, the positive association of the UHR with the severity of coronary artery stenosis (CAS) persisted significantly in female CAD subjects but not in males. In addition, receiver operating characteristic (ROC) curves were constructed for CAD and severe CAS. The area under the curve (AUC) for the UHR was higher than that for UA and HDL-C alone in female patients [UHR (AUC): 0.715 for CAD and 0.716 for severe CAS]. CONCLUSIONS: An elevated UHR was independently related to an increased CAD risk and the severity of CAS in nondialysis female patients with CKD stage 3-5, and was more predictive of the onset of CAD and the severity of CAS than UA or HDL-C alone.

Coronary artery disease as a risk factor for metabolic dysfunction-associated steatotic liver disease and liver fibrosis.

INTRODUCTION AND OBJECTIVES: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at an increased cardiovascular risk. On the contrary, non-alcoholic fatty liver disease (NAFLD) is highly prevalent in patients with coronary heart disease (CHD). However, it is not known whether patients with significant CHD show a higher frequency of liver fibrosis. This study aimed to determine the frequency of MASLD and liver fibrosis in patients with CHD and to assess whether coronary stenosis is significantly associated with MASLD and fibrosis. PATIENTS AND METHODS: This observational and analytical study included adult patients without any known liver disease who underwent coronary angiography for suspected coronary artery disease (Jul 2021-Jul 2022). The presence of significant CHD (> 50% stenosis of at least one coronary artery) was determined. Liver elastography (FibroScan®) was performed up to 6 months after the coronary angiographic study to determine liver fibrosis, a measurement of liver stiffness (> 6.5 Kpa). Fisher's test, Mann-Whitney U test, and logistic regression models were used (p < 0.05). RESULTS: The study included 113 patients (76% men, average age: 63 years [standard deviation: 9.9]), of which 72% presented with significant CHD. The prevalence rate of MASLD was 52%. Liver fibrosis was present in 12% of the patients and all patients in the significant CHD group (p = 0.007). An increase in the number of vessels with significant CHD increased the probability of liver fibrosis (odds ratio, 1.79; 95% confidence interval, 1.06-3.04; p = 0.029). CONCLUSIONS: MASLD is highly prevalent in patients with significant CHD but without known liver damage. These data suggest that MASLD and liver fibrosis should be investigated in patients with CHD. The presence of confounding variables, especially the presence of type 2 diabetes mellitus, should be evaluated in further studies.

High Prevalence of Myocardial Bridging Detected in an Indonesian Population Using Multi-Detector Computed Tomography.

Background and Objectives: Myocardial bridging (MB) is still not yet considered a significant finding in Indonesia both radiographically and clinically. Hence, this article aims to assess the prevalence of MB using multi-detector computed tomography (MDCT) and look at factors contributing to stenosis amongst patients with MB. Materials and Methods: This study is cross-sectional in a single centre, with consecutive sampling, looking at all patients who underwent a multi-detector computed tomography (MDCT) scan from February 2021 until February 2023. GraphPad Prism version 9.0.0 for Windows (GraphPad Software, Boston, MA, USA) was used to analyse the results. Results: There are 1029 patients with an MB, yielding a prevalence of 44.3% (95%CI 42.3-46.4). The left anterior descending vessel is the most commonly implicated, with 99.6%. Among those with stenosis, the middle portion of the bridging vessel is the most common site of stenosis (n = 269), followed by the proximal portion (n = 237). The severity of stenosis is more often moderate, with 30-50% (n = 238). Females (odds ratio [OR] of 1.8, 95%CI 1.4-2.3; p-value < 0.0001), older age (t-value 5.6, p-value < 0.0001), symptomatic patients (OR 1.4, 95% CI 1.1-1.9; p-value = 0.013), and higher mean coronary artery calcium score (t-value 11.3, p-value < 0.0001) are more likely to have stenosis. The degree of stenosis is significantly higher in the proximal stenosis group than in the middle stenosis group (t-value 27, p-value < 0.0001). Conclusions: Our research demonstrates that MB may prevent atheromatosis of the coronary segment distal to the MB and predispose the development of atherosclerosis in the section proximal to the bridge.

Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries.

AIM: To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA). MATERIAL AND METHODS: This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years. RESULTS: MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042). CONCLUSION: The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.

Geospatial epidemiology of coronary artery disease treated with percutaneous coronary intervention in Crete, Greece

Coronary artery disease (CAD) constitutes a leading cause of morbidity and mortality worldwide. Percutaneous coronary intervention (PCI) is indicated in a significant proportion of CAD patients, either to improve prognosis or to relieve symptoms not responding to optimal medical therapy. Thus the annual number of patients undergoing PCI in a given geographical area could serve as a surrogate marker of the total CAD burden there. The aim of this study was to analyze the potential, spatial patterns of PCItreated CAD patients in Crete. We evaluated data from all patients subjected to PCI at the island's sole reference centre for cardiac catheterization within a 4-year study period (2013-2016). The analysis focused on regional variations of yearly PCI rates, as well as on the effect of several clinical parameters on the severity of the coronary artery stenosis treated with PCI across Crete. A spatial database within the ArcGIS environment was created and an analysis carried out based on global and local regression using ordinary least squares (OLS) and geographically weighted regression (GWR), respectively. The results revealed significant inter-municipality variation in PCI rates and thus potentially CAD burden, while the degree and direction of correlation between key clinical factors to coronary stenosis severity demonstrated specific geographical patterns. These preliminary results could set the basis for future research, with the ultimate aim to facilitate efficient healthcare strategies planning.

Homocysteine modifies the association of coronary stenosis and HIV infection in an inner city African American population.

BACKGROUND AND AIMS: People with HIV (PWH) whose disease is controlled on anti-retroviral regimens remain at an increased risk for coronary artery disease (CAD). Traditional cardiovascular risk factors do not fully explain the residual risk in PWH suggesting contributions from nontraditional factors. Homocysteine (Hcy) may be one of these as prior work in adults without HIV demonstrate that Hcy may impair endothelial function by decreasing the availability of nitric oxide, promoting the development of atherosclerosis. In addition, plasma Hcy levels are higher in PWH than in individuals living without HIV. The aim of this study was to investigate whether Hcy levels influence the association between HIV and coronary stenosis in an inner city African American population. METHODS: African Americans from the Heart Study in Baltimore, with and without HIV, recruited from inner-city Baltimore between June 2004 and February 2015, were included in this analysis. Participants underwent coronary CT angiography to evaluate the presence of coronary stenosis, defined as luminal stenosis >10%. Hcy was measured from stored serum samples. RESULTS: In this analysis, the median [IQR] age of the 664 participants was 56 [50-66] years; 68.1% were living with HIV and 43.1% were women. Elevated Hcy (>15 µmol/L) was more prevalent in those with coronary stenosis (23.3%, 95% CI: 18.4%-28.2%) than in those without coronary stenosis (13.1%, 95% CI: 9.7%-16.5%) (p = 0.0007), and HIV was associated with coronary stenosis in those participants with an elevated Hcy (Prevalence Ratio: 1.94, 95% CI: 1.04-3.64, p = 0.0038) and not in those with a Hcy ≤15 µmol/L (Prevalence Ratio: 1.02, 95% CI: 0.83-1.25, p = 0.87). CONCLUSIONS: Our data suggest an association between elevated Hcy levels (>15 µmol/L) and the prevalence of coronary stenosis in PWH from this inner city African American population.

The correlation between subendocardial viability ratio and the degree of coronary artery stenosis in patients with coronary heart disease and its predictive value for the incidence of short-term cardiovascular events.

OBJECTIVES: This study aimed to analyze the ability of subendocardial viability ratio (SEVR) to predict the degree of coronary artery stenosis and the relationship between SEVR and the incidence of short-term cardiovascular endpoint events. METHOD: The indexes of 243 patients with chest pain were collected.. Binary logistic regression analyses were performed using the dichotomous outcome of high and non-high SYNTAX scores. Receiver operating characteristic curves were employed to comparatively analyze the diagnostic efficiencies of the indices and models. A survival analysis combined with the Cox regression analysis was performed using the Kaplan-Meier method to understand the relationship between the SEVR and the incidence of cardiovascular events within 1 year in patients with coronary heart disease (CHD). RESULTS: SEVR was significantly lower ( P  < 0.05) in the high-stenosis group than control and low-stenosis groups. The diagnostic efficacy of SEVR [area under the curve (AUC) = 0.861] was better than those of age (AUC = 0.745), ABI (AUC = 0.739), and AIx@HR75 (AUC = 0.659). The cutoff SEVR was 1.105. In patients with confirmed CHD who had been discharged from the hospital for 1 year, only SEVR affected survival outcomes (hazard ratio = 0.010; 95% confidence interval: 0.001-0.418; P  = 0.016). CONCLUSION: A significant decrease in SEVR predicted severe coronary artery stenosis, with a cutoff value of 1.105 and an accuracy of 0.861. In patients with CHD, the lower the SEVR, the higher was the rate of cardiovascular events at 1 year after hospital discharge.

Comparison of clinical outcomes in patients with mixed angina and pure vasospastic angina.

OBJECTIVE: This study investigated differences in clinical outcomes between mixed angina (MA) and pure vasospastic angina (PVA). METHODS: A total of 524 vasospastic angina patients who did or did not have >50% coronary artery stenosis from January 2005 to January 2021 were divided into two groups (Group 1: PVA, N  = 399; Group 2: MA, N  = 125) and then three groups [Group 1: PVA, N  = 399; Group 2: MA without percutaneous coronary intervention (PCI), N  = 67; Group 3: MA with PCI, N  = 58] for assessment. We recorded the incidence of major adverse cardiac and cerebrovascular events (MACCE: the composite of death, myocardial infarction, nonfatal stroke or rehospitalization) during 3-year clinical follow-up. RESULTS: Compared to the PVA group, there were significant differences in MACCE (20.8% vs. 11.8%, P  = 0.011) and rehospitalization (20.0% vs. 9.8%, P  = 0.002) in the MA group. Kaplan-Meier analysis showed that patients in the MA with PCI group had the highest cumulative incidence rate of MACCE during the 3-year follow-up (log-rank P  < 0.001). CONCLUSION: Compared with the PVA patients, MA patients had significantly worse clinical outcomes during long-term follow-up.

Differences in coronary angiographic findings and outcomes between men and postmenopausal women with stable chest pain.

BACKGROUND: Despite the significant increase in cardiovascular events in women after menopause, studies comparing postmenopausal women and men are scarce. METHODS: We analyzed data from a nationwide, multicenter, prospective registry and enrolled 2412 patients with stable chest pain who underwent elective coronary angiography. Binary coronary artery disease (b-CAD) was defined as the ≥50% stenosis of epicardial coronary arteries, including the left main coronary artery. RESULTS: Compared with the men, postmenopausal women were older (66.6 ±â€…8.5 vs. 59.5 ±â€…11.4 years) and had higher high-density lipoprotein cholesterol levels (49.0 ±â€…12.8 vs. 43.6 ±â€…11.6 mg/dl, P  < 0.01). The prevalence of diabetes did not differ significantly ( P  = 0.40), and smoking was more common in men than in postmenopausal women ( P  ≤ 0.01). At enrollment, b-CAD and revascularization were more common in men than in postmenopausal women (50.3% vs. 41.0% and 14.4% vs. 9.7%, respectively; both P  < 0.01). However, multivariate analyses revealed that revascularization [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.49-1.08] was not significantly related to sex and a similar result was found in age propensity-matched population (OR: 0.80; 95% CI: 0.52-1.24). During the follow-up period, the secondary composite cardiovascular outcomes were lower in postmenopausal women than in men (OR: 0.55; 95% CI: 0.31-0.98), also consistent with the result using the age propensity-mated population (OR: 0.33; 95% CI: 0.13-0.85). CONCLUSION: Postmenopausal women experienced coronary revascularization comparable to those in men at enrollment, despite the average age of postmenopausal women was 7 years older than that of men.Postmenopausal women exhibit better clinical outcomes than those of men if optimal treatment is provided.

Comentarios al pronóstico a largo plazo de pacientes con infarto agudo de miocardio sin elevación del segmento ST y arterias coronarias sin estenosis significativa / Comments on the long-term prognosis of patients with non–ST-segment elevation acute myocardial infarction and coronary arteries without significant stenosis

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Comentarios al pronóstico a largo plazo de pacientes con infarto agudo de miocardio sin elevación del segmento ST y arterias coronarias sin estenosis significativa. Respuesta / Comments on the long-term prognosis of patients with non–ST-segment elevation acute myocardial infarction and coronary arteries without significant stenosis. Response

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Pronóstico a largo plazo de pacientes con infarto agudo de miocardio sin elevación del segmento ST y arterias coronarias sin estenosis significativa / Long-term prognosis of patients with non—ST-segment elevation acute myocardial infarction and coronary arteries without significant stenosis

Introducción y objetivos: El significado pronóstico de la ausencia de lesiones coronarias significativas en pacientes con infarto agudo de miocardio sin elevación del segmento ST es motivo de controversia. Se investigó en una cohorte contemporánea el pronóstico a largo plazo de esos pacientes. Métodos: Estudio observacional retrospectivo de 5.203 pacientes con síndrome coronario agudo. Mediante propensity score matching, se obtuvieron dos grupos de 367 pacientes con infarto agudo de miocardio sin elevación del segmento ST apareados por la ausencia o presencia de lesiones coronarias significativas. En la cohorte apareada, se determinó el impacto de la ausencia de lesiones coronarias significativas en mortalidad o reingresos por síndrome coronario agudo durante 4,8 ± 2,6 años después del alta. Resultados: La mortalidad o el reingreso por síndrome coronario agudo fueron menos entre los pacientes sin lesiones significativas (el 26,4 frente al 32,7%; p = 0,09). La mortalidad en ambos grupos fue del 19,1%. En cambio, los pacientes sin lesiones significativas presentaron menor incidencia de reingreso por síndrome coronario agudo: 2,0 frente a 3,9/100 personas-año; p = 0,003). La incidencia de muerte o reingreso por síndrome coronario agudo fue similar entre los pacientes sin lesiones y enfermedad significativa de un vaso (el 26,4 frente al 27,5%; p = 0,19), aunque más baja que la observada en pacientes con afección de dos vasos (37,8%; p = 0,007) y tres vasos/tronco común izquierdo (41,1%; p = 0,002). Conclusiones: Los pacientes con infarto agudo de miocardio sin elevación del segmento ST y coronarias sin lesiones presentan similar mortalidad a largo plazo que el grupo con lesiones significativas, pero reingresan menos frecuentemente por síndrome coronario agudo. La mortalidad o reingreso por síndrome coronario agudo de pacientes sin lesiones es similar que con enfermedad de un vaso, pero menor que en la de dos o más vasos (AU)

Introduction and Objectives: There is debate regarding the prognostic significance of the absence of significant coronary lesions in patients with non—ST-segment elevation acute myocardial infarction. We investigated long-term prognosis in a contemporary cohort of these patients. Methods: Retrospective observational study of 5203 patients with acute coronary syndrome. Propensity score matching was used to create 2 groups of 367 patients with non—ST-segment elevation acute myocardial infarction matched by the absence or presence of significant coronary lesions. In the matched cohort, we determined the impact of the absence of significant coronary lesions on mortality or readmission for acute coronary syndrome for 4.8 (2.6) years after discharge. Results: Mortality or readmission for acute coronary syndrome was lower among patients without significant lesions (26.4% vs 32.7%; P = .09). Mortality in both groups was 19.1%. In contrast, patients without significant lesions had a lower incidence of readmission for acute coronary syndrome (2.0/100 vs 3.9/100 person-years; P = .003). The incidence of mortality or readmission for acute coronary syndrome was similar in patients without significant lesions and those with significant 1-vessel disease (26.4% vs 27.5%; P = .19), but lower than that in patients with 2-vessel disease (37.8%; P = .007) and 3-vessel disease or left main coronary artery disease (41.1%; P = .002). Conclusions: Patients with non—ST-segment elevation acute myocardial infarction and coronary arteries without significant lesions have similar long-term mortality but lower readmission rates for acute coronary syndrome than patients with significant lesions. Mortality or readmission for acute coronary syndrome is similar in patients without significant lesions and patients with 1-vessel disease, but lower than in patients with disease in 2 or more vessels (AU)

MTHFR, prothrombin and Factor V gene variants in Turkish patients with coronary artery stenosis

Many epidemiological studies have reported an association between hemostatic factors and risk of both coronary and peripheral artery diseases. Using polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis, we investigated the association between coronary artery disease and polymorphisms in the methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), prothrombin (G20210A), and factor V (A4070G) genes. We screened these gene variants in 174 subjects who had undergone coronary angiography - 115 patients with patent coronary artery disease (grade 3 vessel disease, i.e., significant coronary stenosis), and 59 healthy controls with grade 0 vessel disease. The analysis of our data did not show any statistically significant association between coronary artery disease (CAD) and the investigated polymorphisms.

Risk of coronary artery stenosis in Iranian type 2 diabetics: is there a role for matrix metalloproteinase-3 gene (-1612 5A/6A) polymorphism?

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To investigate the association of matrix metalloproteinase-3 (MMP-3) polymorphism with susceptibility to coronary artery stenosis (CAS) and the number of diseased vessels in patients withtype 2 diabetes mellitus (T2DM).MethodsThe study population comprised 618 unrelated Iranian individual subjects, including 305 angiographically documented CAS patients with T2DM and 313 control subjects with T2DM. MMP3genotypes were determined by polymerase chain reaction and restriction fragment length polymorphism.ResultsSignificant differences between cases and controls were observed for MMP3 genotype frequencies (p < 0.01). The 6A allele was high frequently seen in the disease group, compared with the control group (64.75 vs. 56.24%, 6A/6A + 5A/6A vs. 5A/5A, p < 0.05). The association of this polymorphism with the severity of stenosis were also evaluated which according to results distribution of MMP3genotypes were not significantly different as compared with the severity of stenosis (p > 0.05).ConclusionsFrequency of the 6A allele of the human MMP3 gene is an independent risk factor for CAS in the Iranian T2DM studied (AU)

Infarto de miocardio sin elevación del ST con coronarias normales: predictores y pronóstico / Non-ST-elevation acute myocardial infarction with normal coronary arteries: predictors and prognosis

Introducción y objetivos. El manejo invasivo del infarto agudo de miocardio sin elevación del ST (IAMSEST) detecta en ocasiones arterias coronarias sin estenosis significativas. Nuestro objetivo fue evaluar los factores asociados y el pronóstico de esta población. Métodos. Estudiamos a 504 pacientes ingresados por IAMSEST y sometidos a cateterismo cardiaco. El objetivo primario fue el hallazgo de coronarias sin estenosis significativas y el secundario, la mortalidad o el infarto a una mediana de 3 años. Para evaluar el objetivo secundario, se utilizó un grupo control de 160 pacientes ingresados por dolor torácico durante el mismo periodo con troponina normal y coronarias sin estenosis significativas. Resultados. Encontramos coronarias sin lesiones significativas en 64 (13%) pacientes. Los predictores fueron: ser mujer (odds ratio [OR] = 6,6; p = 0,0001), edad < 55 años (OR = 3,0; p = 0,001) y ausencia de diabetes (OR = 2,4; p = 0,02), tratamiento antiagregante previo (OR = 3,9; p = 0,007) o descenso del ST (OR = 2,4; p = 0,008). La variable ser mujer con al menos dos variables adicionales identificó una coronariografía sin estenosis significativas con especificidad del 85% y sensibilidad del 53%. La ausencia de estenosis coronarias significativas disminuyó la probabilidad de muerte o infarto durante el seguimiento (hazard ratio = 0,3; intervalo de confianza del 95%, 0,2-0,9; p = 0,03). En el total de pacientes sin estenosis coronarias significativas (n = 224), no hubo diferencias en la tasa de sucesos entre los pacientes con troponina elevada y normal. Conclusiones. El sexo femenino, la edad < 55 años y la ausencia de diabetes, tratamiento antiagregante previo o descenso del ST se asociaron a una coronariografía sin estenosis significativas en el IAMSEST. El pronóstico a largo plazo de esta población fue bueno (AU)

Introduction and objectives. Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute non-ST-elevation myocardial infarction (NSTEMI). The aim was to investigate predictive factors and prognosis in these patients. Methods. The study involved 504 patients admitted for NSTEMI who underwent cardiac catheterization. The primary end-point was the observation of coronary arteries without significant stenosis, and the secondary end-point was death or myocardial infarction within a median of 3 years. In evaluating the secondary end-point, a control group of 160 patients with a normal troponin level and no significant coronary artery stenosis who were admitted for chest pain during the same period was included. Results. Overall, 64 patients (13%) had coronary arteries without significant lesions. The predictors were: female sex (odds ratio [OR]=6.6; P=.0001), age <55 years or p=".03)." and the absence of diabetes previous antiplatelet treatment st-segment depression composite variable female sex plus at least two additional predictive factors had a specificity 85 sensitivity 53 for coronary angiography showing no significant stenosis artery decreased probability death myocardial infarction during follow-up hazard ratio="0.3," 95 confidence interval 0 2-0 9 among all patients without n="224)," there was difference in event rate between those with elevated normal troponin levels conclusions nstemi age <55 years and the absence of diabetes previous antiplatelet treatment or st-segment depression were all associated with coronary angiography showing no significant stenosis long-term prognosis in these patients was good (AU)