Serum total bilirubin and long-term prognosis of patients with new-onset non-ST elevation myocardial infarction: a cohort study.

BACKGROUND: The potential prognostic role of total bilirubin (TBIL) in patients with new-onset non-ST elevation myocardial infarction (NSTEMI) is not fully understood. This study aims to evaluate the potential predictive value of TBIL for long-term prognosis in patients with new-onset NSTEMI. METHODS: Patients with new-onset NSTEMI that underwent emergency coronary angiography in our department from June 2015 to March 2020 were included. Baseline TBIL was measured at admission. SYNTAX scores were used to indicate the severity of coronary lesions. The association between TBIL and SYNTAX scores was analyzed using multivariate logistic regression. The patients were followed for the incidence of major adverse cardiac and cerebrovascular events (MACCEs). The association between TBIL and MACCEs was analyzed using Kaplan-Meier survival methods. RESULTS: In total 327 patients were included in this study. Patients were divided according to tertiles of TBIL (first tertile < 10.23 µmol/L, n = 109; second tertile 10.23-14.30 µmol/L, n = 109; and third tertile ≥ 14.30 µmol/L, n = 109). TBIL was independently associated with the severity of coronary lesions in patients with NSTEMI, with an adjusted odds ratio (OR) and 95% confidence interval (CI) for the third tertile and the second tertile compared with the first tertile of TBIL of 2.259 (1.197-4.263) and 2.167 (1.157-4.059), respectively (both p < 0.05). After a mean follow-up of 30.33 months, MACCE had occurred in 57 patients. TBIL was independently associated with the increased risk of MACCEs, with an adjusted hazard ratio (HR) and 95% CI for the third tertile and the second tertile compared with the first tertile of TBIL of 2.737 (1.161-6.450) and 3.272 (1.408-7.607), respectively (both p < 0.05). CONCLUSIONS: Higher myocardial infarction admission TBIL might independently predict poor prognosis in patients with NSTEMI.

Evaluation of urinary na levels as a risk factor in patients with coronary artery disease.

INTRODUCTION: Restriction of salt intake is advised in the general population to reduce cardiovascular risk. Daily higher salt intake may contribute to high coronary artery disease (CAD) prevalence in the Turkish population, although there is limited data regarding salt intake and urinary sodium (Na) extraction in patients with CAD. In this study, we aimed to assess the relationship between urine Na, potassium (K), protein and creatine levels in patients with CAD. METHODS: One hundred participants, aged 30-65, who underwent coronary angiography under elective conditions were enrolled in this study between May 2019 and August 2019. Patients who had known CAD before, acute coronary syndrome, hypertension, congestive heart failure, diabetes mellitus (DM), structural heart disease, malignancy, renal failure, and severe comorbid states were excluded from the study. Coronary angiograpy revealed CAD in 61 patients and normal coronary arteries in 39 patients who were classified as the control group. Morning urine samples were collected for analysis. The 24-hour urine sodium was calculated using the KAWASAKI method. RESULTS: Spot urinary protein extraction and spot urinary micro-protein/creatinine ratio were significantly higher in the CAD group than in the control group (p=0.035, p=0.031, respectively). Also, serum creatinine (Cr) was found to be higher while glomerular filtration rate (GFR) and Na levels were found to be lower in the CAD group than in the control group (p=0.014, p=0.012, p=0.016 respectively). The logistic regression model was statistically significant, χ2(25)=41.45, p=0.021 and GFR, Na levels, spot urinary micro-protein/creatinine, and HDL levels were assessed as predictive factors for CAD.CONCLUSION: Urinary Na and K extraction is not affected by the presence of CAD. Also, spot urinary Na/ K ratio and 24-hour sodium extraction were similar between patients with and without CAD. However, decreased GFR and increased urinary micro-protein/creatinine ratio could be risk factors for CAD. Furter studies with large samples are needed to assess this relationship (Tab. 6, Ref. 16).

Optimal timing of coronary angiograms for patients with chronic kidney disease: association between the duration of kidney dysfunction and SYNTAX scores.

BACKGROUND: Chronic kidney disease (CKD) is associated with an increased risk of the progression of coronary artery disease (CAD). However, there are few data on the relationship between CAD severity and the duration of CKD. This study assessed the predictive value of the duration of kidney dysfunction in CKD patients with CAD severity. METHODS: In 145 patients (63.4% male, n = 92; mean age, 68.8 ± 12.8 years) with CKD, severity of CAD was assessed by coronary angiography and quantified by SYNTAX scores, and duration of kidney dysfunction was either assessed by checking historical biochemical parameters of individuals or was based on enquiries. RESULTS: Patients with high SYNTAX scores (≥ 22) had a greater prevalence of cardiovascular risk factors including age, gender, history of heart failure and smoking. In CKD patients, SYNTAX scores were positively correlated to duration of CKD and serum uric acid (UA), and negatively correlated to high-density lipoprotein-cholesterol (HDL-C) and ApoA1 levels. Univariate binary logistic regression and multivariate logistic analyses showed that SYNTAX scores correlated significantly with CKD duration, UA, and HDL-C. Receiver-operating characteristic analysis was used to explore a time point when coronary angiography application was economical and effective and yielded a Youden index of 6.5 years. CONCLUSIONS: Together, our results demonstrated that the duration of kidney dysfunction was an independent correlate of the severity of CAD in patients with CKD. Our findings suggest that coronary angiography should be considered for CKD patients with renal insufficiency having lasted for more than 6.5 years.

Decreased Serum Relaxin-2 Is Correlated with Impaired Islet ß-Cell Function in Patients with Unstable Angina and Abnormal Glucose Metabolism.

Circulating relaxin (RLX) is altered in patients with diabetes mellitus (DM) or cardiovascular diseases. This study was designed to evaluate the changes of RLX in patients with unstable angina (UA) complicated with various categories of abnormal glucose metabolism.Patients who confirmed UA by angiographic and clinical standard were grouped according to the glucose metabolism status with oral glucose tolerance test (OGTT) and medical history categorized as normal, prediabetes, newly diagnosed type 2 DM (T2DM), and previously diagnosed T2DM. Serum RLX-2 was measured and islet ß-cell function was evaluated. The severity of the coronary arterial lesions was evaluated with Syntax Scores.Serum RLX-2 was significantly higher in UA patients with prediabetes (median [quartiles]: 9.87 [7.48, 32.58] pg/mL) and newly diagnosed T2DM (18.36 [9.52, 48.08] pg/mL), compared with those with normal glucose tolerance (6.24 [4.02, 7.27] pg/mL, both P < 0.05). Interestingly, UA patients with previously diagnosed T2DM exhibited lower RLX-2 levels (4.17 [3.23, 5.72] pg/mL) compared with those with normal glucose tolerance (P < 0.05). Subsequent analyses indicated that serum RLX-2 was positively associated with parameters of islet ß-cell function, C-peptide, and fasting insulin levels; however, it was negatively associated with the levels of fasting glucose, 2-hour postprandial blood glucose, HbA1c, and insulin sensitivity, suggesting a potential protective role of RLX-2 during abnormal glucose metabolism in UA patients. Serum RLX-2 was not correlated with the Syntax Scores in these patients.Serum RLX-2 is a potential marker for UA patients with early glucose metabolism abnormality, and increased RLX-2 level was correlated with preserved islet ß-cell function.

Serum total bilirubin levels and disease severity in patients with stable coronary artery disease.

AIM: Serum total bilirubin (STB), a protective cardiovascular factor, was retrospectively investigated to determine the relationship between STB levels and the severity of disease in Chinese patients with stable coronary artery disease (CAD). PATIENTS AND METHODS: A total of 347 eligible patients presenting to our department from December 2007 to December 2012 were divided into tertiles according to their Syntax scores (low, moderate, and high). To clarify the association between STB levels and major adverse cardiovascular events (MACE), all patients were divided into two groups according to the median baseline STB (greater than or less than 13.2 µmol/l), which was measured after at least 12-h fast. All participants were followed for a mean of 37.1 months for MACE, including all-cause death, recurrent nonfatal myocardial infarction, and recurrent percutaneous coronary intervention. RESULTS: The STB levels were significantly lower in the high Syntax score group than those of the other groups and were negatively correlated with the Syntax score and number of diseased vessels. Follow-up data showed a higher incidence of MACE in the low STB group compared with the high STB group. Elevated STB levels predict the long-term prognosis of patients with stable angina pectoris. Finally, Kaplan-Meier analysis showed a significantly higher event-free survival rate in the patients with high STB levels than those in the low STB group. CONCLUSIONS: STB levels were independently associated with the severity of disease in patients with stable CAD. Elevated STB is associated with cardiovascular events and may be useful as a biomarker of the severity and prognosis of stable CAD.

Effects of vitamin D supplementation as an adjuvant therapy in coronary artery disease patients.

OBJECTIVES: Low vitamin D status has been shown to be associated with coronary artery disease. We planned to research the effects of vitamin D3 supplementation on the severity of coronary artery disease. DESIGN: We investigated the effect of 0.5 µg vitamin D3 per day in a randomized, placebo-controlled, double-blind study in 90 stable coronary artery disease patients residing in Beijing. Coronary angiography was performed before and after 6 months of treatment that took place between January and June. 25-Hydroxyvitamin D was measured by chemiluminescence assay. Coronary artery disease severity was assessed by using the SYNTAX scores. RESULTS: In vitamin D supplementation group, there was a significant increase in mean 25-hydroxyvitamin D levels from baseline (19.9 ± 9.8 ng/ml) to 6 months (35.8 ± 12.1 ng/ml; p < 0.001). At 6 months, the primary end point, a difference in the fall of SYNTAX score between the groups was -2.5 (95% CI -5.1 to -0.5; p < 0.001) under intention to treat analysis. Compared with the control group, patients treated with vitamin D3 also had greater decreases in high sensitivity C-reactive protein and renin-angiotensin system activity (p < 0.05). CONCLUSIONS: Vitamin D supplementation has beneficial effects on coronary artery disease; it can be an adjuvant therapy for patients with coronary artery disease.

The effects of low vitamin D on coronary artery disease.

PURPOSE: Coronary Artery Disease (CAD) remains a major cause of morbidity and mortality in the world. Low vitamin D status has been shown to be associated with increased risk of developing cardiovascular disease, hypertension and obesity. We planned to research the association between low vitamin D status and the severity of CAD. PROCEDURES: A total of 348 consecutive patients undergoing coronary angiography for evaluation of CAD were included in this study. 25-Hydroxyvitamin D [25(OH)D] was measured by chemiluminescence assay. CAD severity was assessed by using the SYNTAX scores. The data presented are the mean levels/values and standard deviation. FINDINGS: The serum 25(OH)D level of CAD patients was 18.2 ± 10.6 ng/ml. The SYNTAX scores were 27.8 ± 8.5. In a multivariate linear regression analysis (adjusted for age, high-sensitivity C-reactive protein, SYNTAX score, parathyroid hormone, body mass index, haemoglobin and creatinine), the serum 25(OH)D level showed a negative correlation with SYNTAX score and high-sensitivity C-reactive protein (hsCRP) level. Logistic regression analysis identified 25(OH)D as an independent factor related to high SYNTAX scores. Patients whose vitamin D levels were in the lowest 25(OH)D category (<20 ng/ml) were more often in the high SYNTAX scores group, with their incidence about two-fold higher than those in the highest 25(OH)D category (>30 ng/ml). CONCLUSION: Low vitamin D is associated with the severity of coronary artery stenosis.

Residual Risk of Coronary Atherosclerotic Heart Disease and Severity of Coronary Atherosclerosis Assessed by ApoB and LDL-C in Participants With Statin Treatment: A Retrospective Cohort Study.

Background: Low-density lipoprotein cholesterol (LDL-C) is the primary target of lipid-lowering therapy on the management of hypercholesterolemia in the United States and European guidelines, while apolipoprotein B (apoB) is the secondary target. The objective was to determine if elevated levels of apoB is superior to LDL-C in assessing residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment. Methods: This study included 131 participants with statin treatment. The generalized linear model and relative risk regression (generalized linear Poisson model with robust error variance) were used to analyze the association of the levels of apoB and LDL-C with the severity of coronary atherosclerosis and residual risk of coronary atherosclerotic heart disease. Results: Categorizing apoB and LDL-C based on tertiles, higher levels of apoB were significantly associated with the severity of coronary atherosclerosis (Ptrend = 0.012), whereas no such associations were found for elevated levels of LDL-C (Ptrend = 0.585). After multivariate adjustment, higher levels of apoB were significantly associated with residual risk of coronary atherosclerotic heart disease. When compared with low-level apoB (≤0.66 g/L), the multivariate adjusted RR and 95% CI of intermediate-level apoB (0.67-0.89 g/L) and high-level apoB (≥0.90 g/L) were 1.16 (1.01, 1.33) and 1.31 (1.08, 1.60), respectively (Ptrend = 0.011). There was a 45% increased residual risk of coronary atherosclerotic heart disease per unit increment in natural log-transformed apoB (Ptrend <0.05). However, higher levels of LDL-C were not significantly associated with residual risk of coronary atherosclerotic heart disease. When compared with low-level LDL-C (≤1.56 mmol/L), the multivariate adjusted RR and 95% CI of intermediate-level LDL-C (1.57-2.30 mmol/L) and high-level LDL-C (≥2.31 mmol/L) were 0.99 (0.84, 1.15) and 1.10 (0.86, 1.42), respectively (Ptrend = 0.437). Similar results were observed in the stratified analyses and sensitivity analyses. No significant interactions were detected for both apoB and LDL-C (all Pinteraction>0.05). Conclusions: Elevated apoB are superior in assessing the residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment.

Correlation of Resting Heart Rate with the Severity and Complexity of Coronary Artery Disease: A Single-Center Retrospective Study.

BACKGROUND: We aimed to explore the association between resting heart rate (RHR) and the severity and complexity of atherosclerosis in coronary artery disease (CAD). METHODS: Clinical and laboratory data of 388 patients who underwent coronary angiography were evaluated retrospectively. SYNTAX and Gensini scores were calculated based on angiographic findings. These scores which indicate the severity of atherosclerosis was calculated for all the patients. Patients were divided into three main groups according to RHR. Group 1 composed of patients with RHR ≤70 (n = 217), group 2 composed of patients with RHR between 70 and 89 (n = 133), and group 3 composed of patients with RHR ≥90 beats per min (bpm) (n = 38). Gensini and SYNTAX score values of the three study groups were compared. Also, Gensini score was tested for whether it showed a positive correlation with RHR and SYNTAX scores. RESULTS: All patients had an average age of 61.3 years, and the mean for RHR was 72 bpm. Mean Gensini score in the general CAD population was 24.4 ± 22.5, and mean SYNTAX score was 13.6 ± 8.1 points. The Gensini and Syntax score values of the group 3 were significantly higher than that of the other two groups (59.8 ± 31.2, P < 0.001 and 26.0 ± 6.5, P < 0.001, respectively). There was a significant correlation with Gensini score and RHR, SYNTAX score, C-reactive protein (CRP), and left ventricular ejection fraction [(r = 0.725, P < 0.001), (r = 0.680, P < 0.001), (r = 0.543, P < 0.001), (r = -0.224, P < 0.001), respectively]. CONCLUSIONS: RHR is an effective easily available marker for the assessment of severity and complexity of CAD.

SYNTAX score predicts the left ventricle thrombus development in patients undergoing primary percutaneous coronary intervention for first anterior myocardial infarction.

OBJECTIVES: The aim of this study is to investigate the relationship between left ventricular thrombus (LVT) developments and the SYNTAX score (SS) in patients undergoing primary percutaneous coronary intervention (PPCI) for first anterior wall ST-segment elevation myocardial infarction (STEMI). METHODS: We enrolled 160 patients. All participants were evaluated by serial transthoracic echocardiography. Baseline clinical, echocardiographic, and procedural features of PPCI were analyzed to find predictors of LVT development. RESULTS: The LVT was detected in 32 (20%) patients. Left ventricular ejection fraction (LVEF) and SS-I were found to be independent predictors of LVT development. Receiver-operating characteristic curve analysis revealed a cutoff value >19.5 for SS-I (area under the curve: 0.697, 95% confidence interval 0.620-0.767, P < .001) with a specificity of 45.3% and a sensitivity of 84.3%. CONCLUSION: High SS which was obtained through diagnostic angiogram of PPCI may be associated with LVT development in patients with first anterior wall STEMI.