Atherosclerosis is the pathological basis of coronary heart disease, ischemic stroke and peripheral vascular disease (atherosclerotic cardiovascular disease, ASCVD). Blood cholesterol levels are closely related to ASCVD. The preva-lence and mortality of cardiovascular disease are increasing in China, which is a difficult task. The lipid management goal is to reduce the risk of ASCVD. Atherogenic cholesterol-non-high-density lipoprotein cholesterol (non-HDL-C) and low-den-sity lipoprotein cholesterol (LDL-C) are used as the primary targets of therapy, which may be more appropriate for lipid man-agement setting dislipidaemia value applied to Chinese clinic. Lifestyle intervention is the basis of lipid management. Effec-tive prevention and treatment of ASCVD require the comprehensive intervention of risk factors.

Objective To investigate the correlation between blood routine test indicators and advanced saphenous vein graft disease (SVGD) in patients with coronary artery bypass grafting (CABG). Methods By defining SVGD as an occlusion of 50% or more of the saphenous vein graft (SVG) excluding distal anastomotic occlusion, patients were divided into SVGD group and non-SVGD group, who suffered CABG over 1 year with recurrent angina and underwent coronary angiography (CAG) operation from March 2015 to January 2016 in Tianjin Chest Hospital. Results of blood routine test data were compared between two groups. The multivariable Logistic regression was analyzed for the relationship between blood routine test indicators and advanced SVGD. Results There were 148 patients in the study, 109 patients in SVGD group and 39 patients in non-SVGD group. There were significant differences in level of red blood cell distribution width (RDW:0.123 2 ± 0.008 9 vs. 0.120 2 ± 0.005 2, P<0.05), neutrophil/lymphocyte ratio (NLR:3.40 ± 2.11 vs. 2.75 ± 0.82, P<0.05) and platelet and lymphocyte ratio (PLR:143.10 ± 54.70 vs. 124.57 ± 34.40, P<0.05) between SVGD group and non-SVGD group. Multivariable Logistic regression analysis showed that RDW>0.127 5[OR (95%CI):4.905 (1.058-22.747), P=0.042], NLR>3.34[OR(95%CI):4.013(1.466-10.987), P=0.007]were independent risk factors for advanced SVGD, as well as PCT>0.185 [OR(95%CI):2.636(1.098-6.324), P=0.030]might be risk factor for advanced SVGD. Conclusion RDW>0.127 5, NLR>3.34 could indicate advanced SVGD. We need more samples to support that PCT>0.185 is used to be risk indicators for advanced SVGD.

Objective To investigate the relationship between PCSK9 gene polymorphism with lipid metabolism and CHD risk among population within Tianjin, China. Methods Patients from Tianjin Chest Hospital were selected (n=778) and divided into coronary heart disease (CHD) group (n=502) and control group (n=276). Immediately after admission, tri?glyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), apolipoprotein A (ApoA 1) and apolipo?protein B (ApoB) were tested and genotype TT,TC and CC were determined. Results In CHD group, LDL-C level is higher in TC genotype individuals than that in TT genotype individuals with statistical significance (P<0.05). CHD group and the control group were dominated by TT genotype with no statistical difference between their allele frequency distribution nor genotype frequency distribution(P>0.05). The total population allele frequencies were T 96.1%(1 495/1 556), C 3.9%(61/1 556);genotype frequencies were TT 92.2%(717/778), TC 7.8%(61/778). Multivariate Logistic regression analysis revealed that ApoA1 and HDL-C were inversely associated with coronary heart disease, therefore are protective factors for coronary heart disease. Conclusion The study found that TC genotype is correlated with serum LDL-C increase in group CHD, and the incidence of allele C showed no obvious connection with CHD.

Objective To investigate the native vessel percutaneous coronary intervention (NV-PCI) and bridge vascu-lar interventional therapy (graft-PCI) strategies on prognosis in patients with coronary artery bypass grafting (CABG), by fol-lowing up the occurrence of major adverse cardiovascular events (MACE). Methods A total of 312 patients who relapsed chest pain after the CABG and had a successful interventional treatment were divided into two groups:215 patients for NV-PCI group and 97 patients for graft-PCI group. We observed cardiac death, acute myocardium infarction (AMI) and target vessel revascularization (TVR) after visiting the patients out of hospital for 34 months on average. The risk factors of MACE were analyzed by multivariable Logistic regression after the interventional treatment for the bridge vascular lesions. Re-sults The proportions of patients without MACE, AMI and TVR were significantly higher in NV-PCI group than those in graft-PCI group (P<0.05). There were no significant differences in death rate and survival rate between two groups (P<0.05). Multivariable Logistic regression analysis showed that age of bridge [OR(95%CI):1.011(1.002-1.020), P=0.017], diabe-tes mellitus [OR(95%CI):2.375 (1.414-3.989), P=0.001] and graft-PCI [OR(95%CI):1.873(1.090-3.219),P=0.023] were in-dependent risk factors for prognosis of impacting the bridge vascular interventional treatment. Conclusion The clinical prognosis is much better in NV-PCI group than that of graft-PCI group. The age of bridge, diabetes mellitus and graft-PCI are independent risk factors for clinical prognosis of impacting the bridge vascular interventional treatment.

Objective To investigate the diagnosis and treatment in patients with acute myocardial infarction (AMI) and complicated left ventricular wall rupture (LVWR). Methods A retrospective analysis was made on the clinical features, diagnosis and successful treatment in three AMI patients with LVWR from December 2015 to April 2016. Results Three cases were included in this study. Case 1, the mesh like cardiac rupture after AMI was diagnosed by ultrasonic Doppler. Emergency revascularization was performed due to the combined cardiac shock, and the infarct related artery was opened. The vasoactive drugs were used after revascularization to reduce ventricular pressure load and volume load in the haemodynamic monitoring, and anticoagulation, antiplatelet agents were less used or discontinued to promote local thrombus healing of ventricular rupture. Case 2 was a recurrent myocardial infarction patient. LVWR was diagnosed by ultrasonic Doppler one day after emergency operation. The ruptured ventricular wall was encapsulated by thrombus. The drug therapy was effective in hemodynamic monitoring. LVWR was further confirmed by cardiac CT after clinical stabilization. Case 3 was diagnosed LVWR by ultrasonic Doppler four days after AMI. Because the ruptured ventricular wall was limited by incompletely organized thrombus, and the haemodynamic condition was stable, selective surgical repair of rupture after coronary angiography was performed. Conclusion The effective drug therapy combined with percutaneous coronary intervention and surgical repair can reduce the risk of death in patients with LVWR after AMI.

OBJECTIVETo explore the influence of PCSK9 gene E670G polymorphism on the risk of coronary heart disease (CHD) among Chinese patients from Tianjin, and to compare the effect of atorvastatin treatment on CHD patients with various PCSK9 E670G genotypes.

METHODSSeven hundred and seventy-eight patients undergoing coronary angiography (CAG) were classified into CHD group (n = 502) and control group (n = 276). Total cholesterol (TC) and triglyceride (TG) were determined for all patients. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine the E670G genotype for each patient. For 231 CHD patients who had taken atorvastatin calcium for 12 weeks and completed the follow-up, the lipid profile was determined again.

RESULTSThe distribution of PCSK9 E670G genotype between the CHD and control groups differed significantly (P< 0.01). The frequencies of G allele were 15.99% and 9.34% in the CHD and control group, respectively, which showed a statistical significance (P< 0.01). Carriers of G allele had a higher risk of CHD than those with A allele (OR=1.847, 95%CI: 1.301-2.622, P< 0.01). Among CHD patients, those carrying G allele had higher TC and TG levels than those with AA genotype, while patients with a GG genotype had higher level of low density lipoprotein cholesterol (LDL-C) than those with a AA genotype (P< 0.05). Logistic regression analysis indicated that high density lipoprotein cholesterol (HDL-C) is a protective factor of CHD (OR=0.203, 95%CI: 0.100-0.414, P< 0.05). After treatment with atorvastatin, LDL-C level decreased more significantly in those with an AA genotype compared with AG and GG genotypes (P< 0.05).

CONCLUSIONThe E670G polymorphism of the PCSK9 gene is associated with the lipid levels and risk for CHD.

Aged ; Coronary Artery Disease ; blood ; etiology ; genetics ; Female ; Genotype ; Humans ; Lipids ; blood ; Logistic Models ; Male ; Middle Aged ; Polymorphism, Genetic ; Proprotein Convertase 9 ; genetics ; Risk