Diagonal earlobe crease and coronary artery disease in a Chinese population.

BACKGROUND: Many reports have claimed associations between diagonal earlobe crease (DELC) and coronary artery disease (CAD), but data in Chinese populations are limited. METHODS: This cohort study investigated 449 consecutive Chinese, 250 cases with CAD and 199 without CAD, who were certified by coronary artery angiography in our center. Characteristic differences and the relation of DELC to CAD were assessed by Chi-square and t tests. The multivariate regression was performed to adjust for confounders and ROCs mode were used to detect its predicting performance for CAD. RESULTS: The prevalence of DELC was 46.2% in those without CAD and 75.2% in those with CAD (P < .001). Subjects with DELC had more stenostic vessels and higher prevalence of both any and significant coronary artery stenosis than those without DELC (P < .001). The sensitivity, specificity and positive and negative predictive values for DELC to diagnose CAD in the whole population were 0.752, 0.538, 0.671 and 0.633. The higher sensitivity and positive predictive values (ppv) were found in male, the lowest sensitivity and the highest ppv in the <45 years old group, and the lowest specificity and ppv in the >75 years old group. After adjusting for other variables including age, gender and traditional risk factors, DELC remained a positive predictor for CAD (OR, 3.408; 95% CI 2.235-5.196; P < 0.001), but not for hypertension, diabetes mellitus, hypercholesterolemia and hypertriglyceridemia. ROC analysis showed the area under the curve was 0.645 (95% CI 0.593-0.697, p < 0.001). CONCLUSIONS: The study showed a significant association between DELC and CAD independent of established risk factors in Chinese.

The ratio of second to fourth digit length (2D:4D) and coronary artery disease in a Han Chinese population.

BACKGROUND: The association between index finger to ring finger length ratio (2D:4D) and cardiac disorders has been reported, however it has not been discussed in terms of coronary artery disease (CAD). We investigated whether 2D:4D could be used as a marker for predisposition to CAD as assessed by coronary angiography in Chinese men and women. METHODS: This study included 1764 persons divided into 4 groups, 441 cases with CAD and 441 persons without CAD as control in each sex of the same age. Finger lengths were measured twice for both hands using electronic calipers. Student t test was used to detect the difference of 2D:4D among groups. The receiver operator characteristic curves (ROCs) were used to detect the diagnostic effect of 2D:4D for CAD. RESULTS: There were no significant differences in age among the four groups. A significant difference of 2D:4D ratios between right and left hand were observed only in men in both control and CAD groups. On the right hand in the control group and on both hands in the CAD group, the 2D:4D ratios were higher in women than in men (all, P < 0.001). In men with CAD, mean 2D:4D was higher than mean 2D:4D in control men (right hand 0.962±0.042:0.927±0.038; left hand 0.950±0.044:0.934±0.048; both hands, P < 0.001), but this was not observed in women. No relationship was found between 2D:4D and age (all, P >0.05). The area under the curve of right hand 2D:4D in male was 0.72 (95% CI 0.683-0.753, p<0.001), while it was 0.602 (95% CI 0.565-0.639, p<0.001) in left hand. CONCLUSIONS: The present study showed an association between high 2D:4D ratio and CAD in both hands in men. There were no significant differences in mean 2D:4D between women with CAD and controls.

[Efficacy of cyclosporine A-nanoparticles emulsion combined with stem cell transplantation therapy for acute myocardial infarction].

OBJECTIVE: To evaluate the efficacy of cyclosporine A-nanoparticles emulsion (CsA-NP) combined with adipose tissue-derived stem cells (ASCs)transplantation therapy for acute myocardial infarction (AMI) in a miniswine model. METHODS: CsA-NP emulsion was prepared by the high-pressure homogenization method. Models were performed by coronary angioplasty for percutaneous balloon occlusion of left anterior descending artery (LAD). A total of 17 miniswines survived after AMI were divided into four groups: control group (n=5), CsA-NP group (n=4), ASCs group (n=4), and CsA-NP+ASCs group (n=4). ASCs or saline were delivered by intracoronary injection one week after AMI.Before cell transplantation and 8 weeks after cell transplantation, delayed-enhanced magnetic resonance imaging (DE-MRI) was performed to evaluate cardiac function and viability. The infarcted myocardium and implanted cells were histologically studied. RESULTS: Eight weeks after treatment, the left ventricular ejection fraction (LVEF)significantly increased in the CsA-NP+ASCs group when compared with the ASCs group [(53.6 ± 2.4)% vs. (48.3 ± 1.8)%, P<0.05]; meanwhile, the infarct size significantly decreased [(6.2 ± 1.7)cm(3) vs.(7.5 ± 0.6) cm(3), P<0.05] and the thickness of the ventricular wall significantly increased (P<0.05). Histology showed that the number of surviving cells increased nearly by three times in the CsA-NP+ASCs group, and the expressions of the cardiomyocyte specific markers (cTnT and α-actin) were detected. Histological samples also showed that CsA-NP+ASCs group reduced fibrotic tissue, and down-regulated the activation of Caspase-3. CONCLUSION: The CsA-NP+ASCs combination therapy can enhance the viability of ASCs by improving LVEF and preventing LV expansion, which may be explained that CsA-NP has the anti-apoptotic effect and can promote the survivals and proliferation of ASCs.

[Pretreatment with cyclosporin A nanoparticles emulsion protects apoptosis of swine adipose tissue-derived stem cells].

OBJECTIVE: To investigate the effect of cyclosporine A-nanoparticles emulsion (CsA-NP) on protecting apoptosis of swine adipose tissue-derived stem cells (ASC ) and related mechanisms. METHODS: ASC were randomized to six groups: control group,single H2O2 group,CsA or CsA-NP 0.1 mg/ml+H2O2 group,CsA or CsA-NP 1.0 mg/ml+H2O2 group, CsA or CsA-NP 5.0 mg/ml+H2O2 group,CsA or CsA-NP 10.0 mg/ml+H2O2 group. ASC apoptosis was induced by hydrogen peroxide (H2O2100 µmol/L) in vitro. The morphology of apoptotic cells was observed and the number of apoptotic cells was measured. Apoptosis of ASC was detected by flow cytometry using an apoptosis kit. Cell activity was determined by CCK-8 assay. Caspase-3 activity was detected by applying a caspase-3 assay kit. Expression of cytochrome C was investigated by Western blot. RESULTS: H2O2 induced ASC apoptosis was evidenced by morphological and biochemical changes,which could be significantly reduced by pre-treatment with CsA or CsA-NP at concentration of 0.1-10.0 mg/ml, and the best effect was observed at concentration of 5 mg/ml (apoptosis rate: CsA: 10.6% ± 2.8% vs. 25.2% ± 3.8%; CsA-NP: 6.2% ± 2.6% vs. 25.2% ± 3.6% in control group, all P < 0.01). The cell activity was significantly higher in CsA or CsA-NP pre-treated ASC at concentration of 0.1-10.0 mg/ml than in H2O2 group (P < 0.01). Pre-treatment with CsA or CsA-NP (0.1-10.0 mg/ml) significantly down -regulated caspase-3 activity. Furthermore, CsA or CsA-NP (5 mg/ml) completely inhibited the H2O2-induced release of cytochrome C. CONCLUSIONS: These results suggest that CsA-NP and CsA could protect the oxidative stress-induced ASC apoptosis through decreasing the activation of caspase-3 and inhibiting the release of cytochrome C.

[Related factor analysis of brachial-ankle pulse wave velocity in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To explore the related factors for the measurement of arterial stiffness by brachial-ankle pulse wave velocity (baPWV) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: The blood pressure and baPWV in 76 patients with OSAHS confirmed by polysomnography (PSG) were measured. Clinical data were collected, and the carotid and extremity arteries were examined by ultrasound. Arterial intima thickening, atherosclerotic plaque formation and calcification, and the morphological changes of the arterial wall were evaluated. The related factors for baPWV in patients with OSAHS were analyzed. RESULTS: The baPWV was significantly higher in the severe OSAHS group as compared to the low-moderate group (P < 0.01), as classified according to the apnea hypopnea index and the lowest oxygen saturation. Multiple regression analysis showed that the baPWV of patients with OSAHS was related to age, oxygen desaturation index and systolic blood pressure (F = 1.726 - 5.574, P < 0.05). CONCLUSIONS: Our study showed that with OSAHS exacerbations, the baPWV value increased. The baPWV of patients with OSAHS was related to age, oxygen desaturation index and systolic blood pressure. The abnormal changes of baPWV were present earlier than the morphological changes of atherosclerosis for OSAHS patients.

[The short-term prognosis for hospitalized acute myocardial infarction patients: the impact of complication by community-acquired pneumonia].

OBJECTIVE: To analyze the correlation between the complication by community-acquired pneumonia (CAP) and the short-term prognosis in hospitalized acute myocardial infarction (AMI) patients. METHODS: Five thousand five hundred and twenty-four AMI patients hospitalized in the PLA General Hospital from January 1993 to December 2009 were enrolled for clinical data, incidence of complications and 30-day mortality. The data from patients with and without CAP complications were compared. Multivariate logistic regression analysis was employed to assess the impact of CAP on the short-term prognosis of these patients. RESULTS: In all 5 524 AMI patients studied, 477 cases of CAP was found (8.6%) . In comparison with those without CAP complication, these patients had higher age (74.3 ± 6.5 vs. 67.8 ± 4.5). The incidence of comorbidities [including old myocardial infarction (20.8% vs. 11.5%), hypertension (54.3% vs. 48.9%), diabetic mellitus (32.7% vs. 22.6%), cerebral-vascular disease (8.2% vs. 3.5%), chronic renal dysfunction (10.5% vs. 3.0%)], and complications [including arrhythmia (8.8% vs. 4.6%), gastrointestinal bleeding (5.0% vs. 0.8%) and shock (8.6% vs. 3.1%)] were all significantly higher, and hyperlipidemia (18.9% vs. 30.6%) was significantly lower (P < 0.05 or P < 0.01) in CAP complicated patients. The 30-day mortality was also significantly higher (32.1% vs. 9.7%, P < 0.01). Multivariate logistic regression analysis identified CAP and chronic renal dysfunction as an independent predictor of short-term mortality [odds ratio (OR) of CAP 3.693, 95% confidence interval (95%CI) 2.340 ~ 5.829, P < 0.01; OR of chronic renal dysfunction 12.608, 95%CI 4.448 ~ 35.739, P < 0.01]. CONCLUSIONS: The incidence of CAP complication was higher in AMI patients with higher age.CAP complicated patients were more likely to develop comorbidities/complications, and had higher short-term mortality. CAP was an independent risk factor of short-term mortality.

[Fifteen-year evolving trends of etiology and prognosis in hospitalized patients with heart failure].

OBJECTIVE: To investigate the etiological and prognostic changes of hospitalized patients with chronic heart failure. METHODS: This retrospective study analyzed 7319 hospitalized patients (male 62.07%) with validated primary discharge diagnosis of chronic heart failure in Chinese PLA General Hospital in Beijing from January 1, 1993 to December 31, 2007. Etiological characteristics, comorbidities and 30-day hospitalized mortality in the following three periods: 1993 - 1997 (n = 1623), 1998 - 2002 (n = 2444), and 2003 - 2007 (n = 3252) were compared. RESULTS: (1) The patient age increased [(56.0 ± 17.5) years, (57.8 ± 17.6) years and (62.7 ± 15.5) years, P < 0.01] and hospital stay time decreased [(31.3 ± 17.4) days, (22.7 ± 14.1) days and (20.1 ± 15.2) days, P < 0.01] from 1993 to 2007. (2) The common causes of heart failure were coronary heart disease, hypertension, rheumatic valvular heart disease and diabetes mellitus. From 1993 - 1998 to 2003 - 2007, the proportion of patients with coronary heart disease, hypertension and diabetes mellitus rose from 37.2%, 23.3% and 12.3% to 46.8%, 46.7% and 21.1%, respectively (all P < 0.05). Meanwhile the proportion of patients with rheumatic valvular heart disease fell from 35.2% to 16.6% (P < 0.05). (3) The main etiologies and comorbidities were atrial fibrillation, myocardial infarction, pneumonia, chronic obstructive pulmonary disease and renal failure. From 1993 - 1998 to 2003 - 2007, atrial fibrillation was the most common cause of heart failure, and the rate of myocardial infarction, pneumonia and renal failure rose from 11.0%, 8.9% and 5.2% to 14.7%, 14.5% and 9.1%, respectively (all P < 0.05) and the rate of COPD fell from 12.9% to 8.4% (P < 0.05). (4) The 30-day hospitalized mortalities in the three periods were 7.0%, 4.5% and 5.1%, respectively, and the mortalities in the 1998 - 2002 and 2003 - 2007 periods were lower than those of in the 1993 - 1998 period (all P < 0.05). The mortality related to coronary heart disease decreased significantly from 1993 to 2007 (9.3%, 5.0% and 3.8% in the three periods, respectively, P < 0.05). CONCLUSIONS: It is demonstrated that the primary diseases causing heart failure were coronary heart disease, hypertension, diabetes mellitus and rheumatic valvular heart disease, and the former three diseases exhibited a upward trend and the later one exhibited a downward trend. Moreover, the proportion of comorbidities in patients with heart failure increased over the study period. The 30-day hospital mortality exhibited a downward trend and decreased significantly in patients with coronary heart disease or myocardial infarction.

[Influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction in the elderly patients: an analysis of 2,535 cases].

OBJECTIVE: To investigate the influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction (AMI) in 2 535 elderly patients of different age. METHODS: A total of 2,535 patients with AMI were divided into different age groups or outcome groups, and the outcome or the incidence of in-hospital complications were reviewed in different groups. RESULTS: (1)The rate of in-hospital death was higher in > or =80 years group (22.75%, 326/422) compared with that in 60-79 years group (12.26%, 1 854/2 113, chi (2)=42.15, P<0.01). (2)Compared with the survivors (1,854 cases, 27.1%, 17.4%, 7.5%, 4.5%, 4.5%, 40.3%, 9.1%), patients who died in hospital (259 cases) were more likely to have cardiogenic shock (44.0%), Killp II-III heart function (28.2%), respiratory failure (14.3%), stroke (11.2%), renal failure (11.2%), cardiac arrhythmia (49.8%), and anemia (14.7%) in 60-79 years group (all P<0.01). No difference in the rate of pulmonary infection (24.7% vs. 20.2%) and alimentary tract hemorrhage (5.8% vs. 3.9%) was found between two groups (both P>0.05). The incidence of cardiogenic shock (28.1%), Killp II-III heart function (32.3%), respiratory failure (17.7%), renal failure (16.7%), alimentary tract hemorrhage (10.4%), cardiac arrhythmia (49.0%) and anemia (21.9%) was higher in non-survival group (96 cases) than that in survival group (326 cases, 12.9%, 21.2%, 9.2%, 5.2%, 2.1%, 35.0%, 10.1%, P<0.05 or P<0.01) in patients> or =80 years. There was no difference in the incidence of stroke (11.4% vs. 5.8%) and pulmonary infection (32.3% vs. 23.3%) between two groups (both P>0.05). (3) The foremost four in-hospital complications in the non-survivors and survivors were cardiac arrhythmia, cardiogenic shock, Killp II-III heart function and pulmonary infection in 60-79 years group, but they were cardiac arrhythmia, pulmonary infection, Killp II-III heart function and cardiogenic shock in > or =80 years group. When compared the cases of in-hospital death between these two different age groups, the incidence of cardiogenic shock was significantly lower in the > or =80 years group (28.1% vs. 44.0%, P<0.01). However, the incidence of sudden death was higher in the > or =80 years group than that in 60-79 years group (22.92% vs. 7.34%, P<0.01). CONCLUSION: The number and degree of in-hospital complications in elderly patients with AMI are increased by age. Cardiac arrhythmia is the major complication in elderly patients. For the patients 60-79 years old, it is more important to prevent and treat cardiogenic shock in order to improve the outcome in the 60-70 years group. In very old people with AMI, it is important to prevent sudden death.

The role of Fas in the progression of ischemic heart failure: prohypertrophy or proapoptosis.

During myocardial ischemia, cardiomyocytes can undergo apoptosis or compensatory hypertrophy. Fas expression is upregulated in the myocardial ischemia and is coupled to both apoptosis and hypertrophy of cardiomyocytes. The role of Fas in apoptosis induction or cardiomyocyte hypertrophy during ischemic conditions is, however, still unclear. Some reports suggested that Fas might induce myocardial hypertrophy. Apoptosis of ischemic cardiomyocytes and Fas expression in the nonischemic cardiomyocytes occurs during the early stage of ischemic heart failure. Hypertrophic cardiomyocytes easily undergo apoptosis in response to ischemia, after which apoptotic cardiomyocytes are replaced by fibrous tissue. In the late stage of ischemic heart failure, hypertrophy, apoptosis, and fibrosis are thought to accelerate each other and might thus form a vicious circle that eventually results in heart failure. In this review, we summarize recent advances in the understanding of the role of Fas in remodeling ischemic myocardial tissues.

Anti­aging effects of melatonin on the myocardial mitochondria of rats and associated mechanisms.

The present study investigated the anti-aging effects of melatonin on the myocardial mitochondria of D-galactose-aged rats and associated mechanisms. A total of 30 male Sprague­Dawley (SD) rats were randomly divided into three equal groups: An accelerated aging group that received 125 mg/kg/day D­galactose; a melatonin­treated group of D­galactose­aged rats that received 10 mg/kg/day melatonin; and a control group receiving normal saline. ATP, ADP and AMP levels in the left ventricular myocardium of rats were determined by high performance liquid chromatography and the total adenylic acid number (TAN) was subsequently calculated. Bax, Bcl­2, and cytochrome c (cyt­c) protein expression levels in myocardial mitochondria and cytoplasm were quantified by western blot analysis. In the melatonin­treated group, ATP levels were significantly higher when compared with the untreated control group and the accelerated­ageing group (0.068 vs. 0.052 and 0.058; P=0.002 and P=0.045, respectively), and TAN was significantly increased in the melatonin­treated group when compared with controls (P=0.011). In addition, cyt­c levels in the cytoplasm, but not in the mitochondria, were significantly higher in the accelerated­aging group compared with the control and melatonin­treated groups (P=0.001 and P=0.002, respectively). Bcl­2 and Bax ratios were significantly higher in the control and melatonin­treated groups when compared with the accelerated­aging group (P=0.004 and P=0.032, respectively). These results suggest that melatonin exhibits a protective effect on mitochondrial function in a rat model of accelerated aging.

[Prognostic significance of early acute renal failure in patients with cardiogenic shock after acute myocardial infarction].

OBJECTIVE: To investigate the relationship between early developed acute renal failure and the prognosis of patients with cardiogenic shock after myocardial infarction. METHODS: All patients who were consecutively to the General Hospital of PLA from 1993 to 2003 admitted with the diagnosis of acute myocardial infarction or unstable angina in the state of cardiogenic shock were enrolled. In-hospital mortality was compared between patients with and without early (<24 hours after onset of shock) developed acute renal failure. Multivariate logistic regression analysis was performed to assess the impact of acute renal failure on the prognosis of these patients. RESULTS: Fifty-one(30%)of 172 patients developed acute renal failure within 24 hours after the onset of shock. In-hospital mortality in patients with and without acute renal failure were 90% (46/51 cases) and 56% (68/121 cases), respectively. Multivariate logistic regression analysis identified acute renal failure as an independent predictor of mortality (odds ratio=6.5; 95% confidence interval: 2.5-18.0; P<0.001). CONCLUSION: Acute renal failure is common in patients with cardiogenic shock and strongly associated with in-hospital mortality.

[Clinical features and treatment of cardiogenic shock complicated with acute myocardial infarction].

OBJECTIVE: To identify the clinical features and the outcome of patients with cardiogenic shock complicating acute myocardial infarction (AMI). METHODS: One hundred and eight consecutive patients with AMI were included in this retrospective analysis. The characteristics, management, and outcome of patients with AMI were compared between patients with cardiogenic shock (group A, n=11) and without cardiogenic shock (group B, n=9). RESULTS: There was no difference in the age and other characteristics including proportion of women, diabetics, prior myocardial infarction and the position of myocardial infarction. The levels of peak creatine kinase and troponin I were (31979.7+/-22271.1)nmol x s(-1) x L(-1) and (90.7+/-61.1) microg/L respectively in group A, they were higher than those in group B (17795.2+/-14979.7)nmol.s-1.L-1 and (39.9+/-52.1) microg/L, respectively (both P<0.05). The left ventricular ejection fraction was significantly lower in group A than that in group B (0.46+/-0.12 vs. 0.55+/-0.12, P<0.05). Patients in group A had a higher proportion of pump failure, arrhythmia and pneumonia (64% vs. 14%, P<0.001; 55% vs. 21 %, P<0.05; and 46% vs. 12%, P<0.01, respectively) than those in group B. In addition, in group A patients often underwent thrombolysis of urokinase, coronary angiography and intra-aortic balloon counterpulsation (46% vs. 18%, 73% vs. 26% and 36% vs. 4%, all P<0.05, respectively). There was no difference in in-hospital mortality between group A and group B (0 vs. 4%, P>0.05). CONCLUSION: Shock patients more likely have pump failure, arrhythmia, and pneumonia and more often underwent intra-aortic balloon counterpulsation. If cardiogenic shock complicating AMI is managed with rapid evaluation and prompt initiation of supportive measures and definitive therapy, outcomes can be improved.

[Analysis of risk factors of cardiogenic shock secondary to acute myocardial infarction].

OBJECTIVE: To explore risk factors for cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) patients arising from comorbidities so as to identify high risk patients earlier. METHODS: A retrospective study was conducted on 5523 patients who were hospitalized with AMI in PLA General Hospital from January 1993 to December 2009. The patients were divided into two groups based on presence or absence of CS. Logistic regression analysis was used from comorbidities to evaluate the independent risk factors for CS. RESULTS: Among 5523 hospitalized AMI patients, 197 (3.57%) developed CS. The 30-day in hospital mortality rate of CS group was significantly higher than that of non-CS group [55.33% (109/197) vs. 7.49% (399/5326), P<0.001]. On the basis of logistic regression analysis, advanced age [odds ratio (OR)=1.03, 95% confidence interval (95%CI) 1.02 - 1.05, P<0.001], previous attack of myocardial infarction (OR=1.57, 95%CI 1.13 - 2.19, P=0.007), history of stroke (OR=1.98, 95%CI 1.20 - 3.27, P=0.008), chronic renal failure (OR=1.76, 95%CI 1.23 - 2.51, P=0.002) and pneumonia (OR=1.72, 95%CI 1.17 - 2.52, P=0.006) were independent risk factors for CS. Using receiver operator characteristic curve (ROC curve) analysis, the model was shown a good quality to judge the outcome of CS patients as the area under curve equals 0.81 (95%CI 0.75 - 0.85, P<0.001). CONCLUSIONS: Advanced age and comorbidities including previous myocardial infarction, previous stroke, chronic renal failure and pneumonia were independent risk factors for CS.

Secular trends in the etiology and comorbidity of hospitalized patients with congestive heart failure: A single-center retrospective study.

OBJECTIVE: To assess the secular trends in the etiology and comorbidity of patients hospitalized with congestive heart failure (CHF). METHODS: Data of 7,319 patients (mean age 59.6 years, 62.1% male) with a primary discharge diagnosis of CHF, hospitalized from January 1, 1993 to December 31, 2007 at the Chinese People's Liberation Army (PLA) General Hospital were extracted and analyzed. These patients were divided into three groups according to hospitalization period: 1993-1997 (n = 1623), 1998-2002 (n = 2444), and 2003-2007 (n = 3252). The etiological characteristics and comorbidities were assessed. RESULTS: Over the study period, the proportion of patients with ischemic heart disease (IHD) increased from 37.2% during the period 1993-1997 to 46.8% during the period 2003-2007, while that with valvular heart disease (VHD) decreased from 35.2% during the period 1993-1997 to 16.6% during the period 2003-2007 (both P < 0.05). Atrial fibrillation (AF) was the most common comorbidity of heart failure (23.2%, 23.0% and 20.6%, respectively, in the three periods). Compared to that of the period of 1993-1997 with that of, the proportion of patients with myocardial infarction, pneumonia, renal function impairment and hepatic cirrhosis of the period of 2003-2007 increased significantly (P < 0.05) and the proportion of patients with chronic obstructive pulmonary disease and atrial fibrillation decreased significantly (P < 0.05). CONCLUSIONS: This study implies that IHD has became a more common etiology of CHF, while VHD has deceased as an etiology of CHF in Chinese patients during the last two decades.

Effect of haemoglobin concentration on the clinical outcomes in patients with acute myocardial infarction and the factors related to haemoglobin.

BACKGROUND: The impact of haemoglobin concentrations on clinical outcomes is still a controversial issue. To determine the association between haemoglobin concentrations on admission and clinical outcomes and the related factors, this study was performed in a Chinese hospital. FINDINGS: We conducted a retrospective study on 1394 Chinese patients with acute myocardial infarction. Patients were categorized according to the haemoglobin concentration on admission, and data were evaluated to determine whether there was an association between the haemoglobin concentrations on admission and 30-day in-hospital MACEs (major cardiovascular events). Patients with hemoglobin values between 141 and 150 g/L were used as the reference, the MACEs increased as hemoglobin concentrations fell below 140 g/L or rose > 150 g/L, with an adjusted OR (odds ratio) of 5.96[95% CI (confidence interval) 2.00 to 17.68, p = 0.0013], 4.39(1.37 to 14.08, p = 0.0128), 3.99(1.46 to 10.92, p = 0.0071), 3.19(1.27 to 8.05, p = 0.0139), 2.37(0.94 to 6.01, p = 0.0687), 2.11(0.66 to 6.74, p = 0.2065), 2.01(0.60 to 6.68, p = 0.2559) in patients with haemoglobin concentrations <100 g/L, 101-110 g/L, 111-120 g/L, 121-130 g/L, 131-140 g/L, 151-160 g/L, and >160 g/L respectively. Partial correlation analysis showed that age, albumin and creatinine were significantly associated with hemoglobin concentration. CONCLUSIONS: Our results demonstrated that haemoglobin concentration affected MACEs in patients with acute myocardial infarction, and that haemoglobin concentration was associated with age, albumin and creatinine.

Medical comorbidities at admission is predictive for 30-day in-hospital mortality in patients with acute myocardial infarction: analysis of 5161 cases.

BACKGROUND: The present study investigated the prognostic value of medical comorbidities at admission for 30-day in-hospital mortality in patients with acute myocardial infarction (AMI). METHODS: A total of 5161 patients with AMI were admitted in Chinese PLA General Hospital between January 1, 1993 and December 31, 2007. Medical comorbidities including hypertension, diabetes mellitus, previous myocardial infarction, valvular heart disease, chronic obstructive pulmonary disease (COPD), renal insufficiency, previous stroke, atrial fibrillation and anemia, were identified at admission. The patients were divided into 4 groups based on the number of medical comorbidities at admission (0, 1, 2, and ≥ 3). Cox regression analysis was used to calculate relative risk (RR) and 95% confidence intervals (CI), with adjustment for age, sex, heart failure and percutaneous coronary intervention (PCI). RESULTS: The mean age of the studied population was 63.9 ± 13.6 years, and 80.1% of the patients were male. In 74.6% of the patients at least one comorbidity were identified. Hypertension (50.7%), diabetes mellitus (24.0%) and previous myocardial infarction (12%) were the leading common comorbidities at admission. The 30-day in-hospital mortality in patients with 0, 1, 2, and ≥ 3 comorbidities at admission (7.2%) was 4.9%, 7.2%, 11.1%, and 20.3%, respectively. The presence of 2 or more comorbidities was associated with higher 30-day in-hospital mortality compared with patients without comorbidity (RR: 1.41, 95% CI: 1.13-1.77, P = 0.003, and RR: 1.95, 95% CI: 1.59-2.39, P = 0.000, respectively). CONCLUSIONS: Medical comorbidities were frequently found in patients with AMI. AMI patients with more comorbidities had a higher 30-day in-hospital mortality might be predictive of early poor outcome in patients with AMI.

Extremely low warfarin dose in patients with genotypes of CYP2C9*3/*3 and VKORC1-1639A/A.

BACKGROUND: Patients with the genotypes of both CYP2C9*3/*3 and VKORC1-1639 A/A are expected to require the lowest dose of warfarin, and to have a greatly increased risk of bleeding. The experience for the dosing of warfarin in such extremely rare cases has been seldom reported. METHODS: Demographic and clinical data from two cases with stable low dose of warfarin in China were studied by resequencing the corresponding gene segments in their whole blood DNA. The potential clinical value of the pharmacogenetic algorithm for them was evaluated by calculating the stable dose of warfarin in pharmacogenetic algorithm developed by International Warfarin Pharmacogenetics Consortium. RESULTS: Both cases (68-year-old female and 50-year-old male) were diagnosed as chronic nonvalvular atrial fibrillation needing warfarin treatment, with target international normalized ratio (INR) 2 to 3. Case 1 had stable warfarin dose of 0.625 mg/d and case 2 1.25 mg/d. They needed more than 1 month to stabilize their anticoagulation. Exceeding INR values were recorded for them when the dose of warfarin was no more than 2 mg/d. Hemorrhagic complication appeared in case 1 when the dose was titrated from 2.5 to 1.25 mg/d. No concomitant medicine to increase or decrease the INR value was recorded for them. Genotyping CYP2C9 and VKORC1 showed both patients were the carriers of the homozygous alleles -CYP2C9*3/*3 and VKORC1-1639 A/A. Their stable doses of warfarin calculated by the pharmacogenetic dose algorithm (0.672 mg/d for case 1 and 1.16 mg/d for case 2) were comparable with their actual stable therapeutic doses. CONCLUSIONS: Two Chinese with the rare genotypes of both CYP2C9*3/*3 and VKORC1-1639 A/A were found to require the extremely low dose of warfarin. The pharmacogenetic algorithm incorporating the variances of VKORC1 and CYP2C9 genotypes, as well as the non-genetic factors could predict their stable dose of warfarin with high accuracy.