OBJECTIVETo investigate the correlation between serum resistin level, cardiovascular risk factors and severity of coronary disease in acute coronary syndrome (ACS).

METHODSAfter evaluated by clinical history, electrocardiography, exercise tolerance tests, laboratory tests, and coronary angiography, 220 consecutive patients with suspected chest pain were divided into normal control group, stable angina pectoris (SAP) group, and ACS group, respectively. Baseline clinical characteristics, including height, weight, waist circumference, hip circumference, white blood cell count, high-sensitive C-reactive protein (hsCRP), total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, were compared among three groups. ELISA was used to detect serum resistin levels. Pearson's correlation coefficient analysis was used to assess association between resistin and other traditional cardiovascular risk factors. Multinomial logistic regression analyses were used to define the relationship between serum resistin level and SAP or ACS.

RESULTSSerum resistin level in ACS group (1.18+/-0.48 microg/L) was significantly higher than that in normal control and SAP groups (0.49+/-0.40 and 0.66+/-0.40 microg/L; P<0.01). Only in ACS group, increased serum resistin level was significantly correlated with hsCRP (r=0.262, P=0.004) and white blood cell count (r=0.347, P=0.001). Furthermore, serum resistin levels showed a stepwise increase with the number increase of > 50% stenosed coronary vessels. Multinomial logistic regression test demonstrated that serum resistin was a strong risk factor for ACS (OR=29.132, 95 % CI: 10.939-77.581, P<0.001).

CONCLUSIONThese findings suggested the potential role of resistin in atherosclerosis and especially its involvement in ACS.

Acute Coronary Syndrome ; blood ; pathology ; physiopathology ; Aged ; Biomarkers ; blood ; Case-Control Studies ; Coronary Disease ; blood ; pathology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Resistin ; blood ; Risk Factors

OBJECTIVETo elucidate whether the plasma concentration of NT-proBNP in patients with acute coronary syndrome (ACS) correlated with severity of the diseases and whether NT-proBNP is a reliable biochemical marker correctly indicates the severity of ACS.

METHODSEighty-nine subjects came from CCU of Cardiology Department of People's Hospital Beijing University from October 2003 to June 2004 and aged 34-85 y (66.89 +/- 11.12 y). In this study the spectrum of ACS only included unstable angina pectoris (UA) and acute myocardial infarction (AMI). Patients with UA were separated into 3 groups by Braunwald classes and those with AMI were separated into 4 groups by Killip classes when their venous blood samples were collected. Plasma concentration of NT-proBNP was measured by enzyme linked immunoabsorbent assay. Data was estimated by SPSS.

RESULTSThe concentration of NT-proBNP in patients with ACS was dramatically correlative with the severity of the diseases: with the upgrading of Braunwald classes, the concentration of NT-proBNP in patients with UA increased gradually; in patients with AMI it also raised gradually with the upgrading of killip classes; furthermore, the plasma concentration of NT-proBNP in patients with AIM increased much more than that in patients with UA when they are at the similar NYHA functional class.

CONCLUSIONPlasma concentration of NT-proBNP in patients with ACS might be a reliable biochemical marker which can objectively indicate the degree of this diseases.

Acute Coronary Syndrome ; blood ; physiopathology ; Adult ; Aged ; Aged, 80 and over ; Humans ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

OBJECTIVETo investigate the changes of neutrophil myeloperoxidase (MPO) blood concentration gradient between the systemic circulation and the coronary circulation among patients with acute coronary syndrome and its clinical value.

METHODSFifty patients underwent coronary angiography, which including 10 patients in AMI group, 20 patients in UA group, 10 patients in SA group and 10 subjects served as control. The levels of MPO and hs-CRP were measured in the serum of blood collected from femoral vein, aortic artery root and coronary sinus.

RESULTSCompared with the control, concentrations of LDL in the AMI, UA and SA groups were significantly increased, while the latter three groups did not differ from each other. In the UA patients, the in-gate percentage of MPO decreased in the coronary sinus compared with that in the root of aortic artery (P < 0.01); the in-gate percentage of MPO decreased through coronary circulation more than through systemic circulation (P < 0.001); the average fluorescent intensity of MPO and the concentrations of hs-CRP showed no difference between samples from the coronary sinus and that from the root of aortic artery. In the AMI patients, the average fluorescent intensity of MPO in the coronary sinus was weakened compared with that in the root of aortic artery (P < 0.05); it decreased through coronary circulation more than through systemic circulation (P < 0.001); neither the in-gate percentage of MPO nor the concentrations of hs-CRP showed significant difference between samples from the coronary sinus and that from the root of aortic artery. In the control and SA groups, samples from the femoral vein, the root of aortic artery, and the coronary sinus did not show differences at the serum level of MPO and hs-CRP. In the UA group, the in-gate percentage of MPO correlated positively with the concentration of hs-CRP (r = 0.78, P < 0.01), and with the level of LDL as well (r = 0.52, P < 0.05); In the AMI group, the average fluorescent intensity of MPO correlated negatively with the concentration of hs-CRP (r = -0.80, P < 0.01), and showed no correlation with the level of LDL (r = 0.22, P > 0.05).

CONCLUSIONSMPO is a better marker for inflammation of the local plaques. It may be one of the mechanisms that MPO induces the transforming from LDL to ox-LDL in plaques vulnerability.

Acute Coronary Syndrome ; blood ; metabolism ; physiopathology ; Aged ; Biomarkers ; blood ; Case-Control Studies ; Coronary Circulation ; Female ; Humans ; Male ; Middle Aged ; Neutrophils ; enzymology ; Peroxidase ; blood

BACKGROUNDPeri-strut low-intensity area (PLIA) is a typical image pattern of neointima detected by optical coherence tomography (OCT) after stent implantation. However, few studies evaluated the predictors and prognosis of the PLIA; therefore, we aimed to explore the genesis and prognosis of PLIA detected by OCT in this study.

METHODSPatients presenting neointimal hyperplasia documented by OCT reexamination after percutaneous coronary intervention were prospectively included from 2009 to 2011. Peri-strut intensity was analyzed and classified into two patterns: Low-intensity and high-intensity. Clinical characteristics were analyzed to assess their contribution to peri-strut intensity patterns. Follow-up were performed in patients who did not receive revascularization during OCT reexamination, and the prognosis of the patients was evaluated.

RESULTSThere were 128 patients underwent OCT reexamination after stent implantation included in the study. PLIA was detected in 22 (17.2%) patients. The incidence of PLIA was positively correlated with serum triglyceride (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.14-3.90, P = 0.017), low-density lipoprotein (OR: 2.61, 95% CI: 1.22-5.66, P = 0.015), history of cerebrovascular disease (OR: 101.11, 95% CI: 6.54-1562.13, P < 0.001), and initial clinical presentation of acute coronary syndrome (ACS, OR: 18.77, 95% CI: 2.73-128.83, P = 0.003) while negatively correlated with stent implantation time (OR: 0.57, 95% CI: 0.33-0.98, P = 0.043). The median follow-up was longer than 3.8 years. Major adverse cardiovascular events (MACEs) occurred in 7 (7.3%) patients while showed no correlation with PLIA. A total of 17 (17.7%) patients experienced unstable angina (UA) and showed significant correlation with PLIA (hazard ratio: 6.16, 95% CI: 1.25-30.33, P = 0.025).

CONCLUSIONSPLIA detected by OCT was positively correlated with higher serum lipid level, history of cerebrovascular disease and initial presentation of ACS, and negatively correlated with stent implantation time. Patients with PLIA were more likely to have UA than those with high-intensity while no significant difference was found in MACEs.

Acute Coronary Syndrome ; blood ; pathology ; physiopathology ; Aged ; Angina, Unstable ; blood ; pathology ; physiopathology ; Cross-Sectional Studies ; Female ; Humans ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; Neointima ; blood ; pathology ; physiopathology ; Prospective Studies ; Tomography, Optical Coherence ; methods ; Triglycerides ; blood

OBJECTIVETo compare the platelet-leukocyte-aggregates (PLAs) level among patients with acute coronary syndrome (ACS) and stable angina pectoris (SAP).

METHODSHospitalized patients were divided into three groups [ACS group (n=86), SAP group (n=54), the control group with 46 patients without coronary artery disease]. PLAs were measured by flow cytometry at admission before coronary angiography. ACS patients were further divided into low-risk group (0-108 points) and high-risk group (>109 points) according to GRACE scores at admission. PLA, platelet-monocyte aggregations (PMA), platelet-neutrophil aggregations (PNA), platelet-lymphocyte aggregations (PlyA) and hs-CRP values were compared among groups.

RESULTSPLA (4.40%±3.08%), PMA (33.6%±21.5%), PNA (3.76%±5.06%), PLyA (2.03%±1.27%) and hs-CRP [5.75 (3.49, 9.15)] levels in ACS group were significantly higher than those in SAP and control groups (all P<0.05). PLA was also significantly higher in high-risk group than in the low-risk group (44.8%±18.0% vs. 13.0%±6.3%, P<0.01). Spearman correlation analysis showed that hs-CRP was positively correlated with PMA (r=0.547, P<0.01) and GRACE score is positively correlated with PMA, PLA, PNA and PlyA (r=0.746, 0.652, 0.460, respectively, all P<0.01).

CONCLUSIONPLAs is increased in ACS patients and higher PMA level is related with the unstable coronary syndrome in ACS patients. Increased PMA, PLA, PNA and PlyA levels is associated with higher GRACE score in ACS patients.

Acute Coronary Syndrome ; blood ; diagnosis ; physiopathology ; Adolescent ; Adult ; Aged ; Female ; Humans ; Leukocytes ; metabolism ; Male ; Middle Aged ; Platelet Activation ; Platelet Aggregation ; Young Adult

OBJECTIVE: To determine the effect of Tongxinluo on the endothelial function and hypersensitive C-reactive protein (hs-CRP) in acute coronary syndrome patients undergoing percutaneous coronary intervention(PCI). METHODS: Thirty-three patients with unstable angina pectoris and 6 patients with acute myocardial infarction who underwent PCI for stenotic lesions of the coronary artery were enrolled. The patients were randomly assigned to a conventional group (n = 19) which took routine treatment or a tongxinluo group (n = 20) which took Tongxinluo(4 capsules once, 3 times per day) at the base of routine treatment after PCI. Nitric oxide synthase (NOS), nitric oxide (NO), endothelium-dependent vasodilation which was evaluated in the brachial artery flow mediated diameter(FMD) and hs-CRP were measured before the PCI and 24 hours and 3 months after the PCI. The correlation between NO and hs-CRP was analyzed. RESULTS: NOS, NO, and FMD in the 2 groups 24 hours after the PCI were significantly lower than those before the PCI(P < 0.05), but hs- CRP obviously increased (P < 0.05). NOS, NO, and FMD 3 months after the PCI in the 2 groups were significantly higher than those before the PCI (P < 0.05 or P < 0.01), but hs-CRP obviously decreased (P < 0.01).All indexes mentioned above in the Tongxinluo group showed greater changes than those of the conventional group(P < 0.05). NO was negatively correlated with hs-CRP (r = -0.3219, P<0.01). CONCLUSION Tongxinluo capsules have obvious beneficial effect on endothelial function and anti-inflammation in acute coronary syndrome patients undergoing PCI, by directly acting on the endothelium and indirectly inhibiting inflammation.
Acute Coronary Syndrome ; blood ; physiopathology ; therapy ; Aged ; Angioplasty, Balloon, Coronary ; methods ; C-Reactive Protein ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Endothelium, Vascular ; drug effects ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy

OBJECTIVETo investigate the changes of serum levels of chitinase-3-like-1 protein (YKL-40) and high-sensitivity C-reactive protein (hs-CRP) in patients with non-ST segment elevation acute coronary syndrome (ACS), to explore its correlation with its severity, and to observe the effects of Guizhi Fuling Decoction (GFD) on levels of blood lipids, YKL-40, and hs-CRP.

METHODSRecruited were 72 patients with unstable angina (UA) or non-ST segment elevation myocardial infarction (NSTEMI) at Department of Integrative Medicine, First Affiliated Hospital of Xinxiang Medical College from August 2010 to June 2011. They were randomly assigned to the treatment group (36 cases) and the control group (36 cases). All patients were treated by routine treatment, but patients in the treatment group took GFD additionally. The course of treatment was four weeks. According to the severity degree, all patients were graded to four ranks: low-risk group of UA, medium-risk group of UA, high-risk group of UA, and NSTEMI. The levels of YKL-40 and hs-CRP, and the correlation of severity degree were analyzed. Before and after treatment levels of triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were measured. Before treatment, at two weeks, and after treatment the serum levels of YKL-40 and hs-CRP were detected. The relationship of YKL-40, hs-CRP and the severity of the disease were analyzed.

RESULTSLevels of YKL-40 and hs-CRP were positively correlated with the severity of the disease respectively (r = 0.729, P < 0.05; r = 0.655, P < 0.05). The positive correlation also existed between YKL-40 and hs-CRP (r = 0.848, P < 0.05). There was no statistical difference in the levels of blood lipids, YKL-40, or hs-CRP between the two groups before treatment (P > 0.05). Compared with before treatment, the levels of YKL-40 and hs-CRP significantly decreased in both groups after two weeks of treatment (P < 0.05). The levels of TG, TC, LDL-C, YKL-40, and hs-CRP significantly decreased, while the HDL-C level increased in both groups after treatment (P < 0.05). The level of HDL-C in the treatment group was higher, while levels of YKL-40 and hs-CRP were lower after treatment, when compared with the control group (all P < 0.05).

CONCLUSIONOn the basis of anti-inflammation and adjusting blood lipids by Western medicine, GFD could further reduce the serum levels of YKL-40 and hs-CRP of ACS patients, elevate the HDL-C level, and play anti-atherosclerosis effects.

Acute Coronary Syndrome ; blood ; drug therapy ; physiopathology ; Adipokines ; blood ; Aged ; C-Reactive Protein ; metabolism ; Chitinase-3-Like Protein 1 ; Cholesterol, HDL ; blood ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Lectins ; blood ; Male ; Middle Aged ; Triglycerides ; blood

OBJECTIVETo investigate the clinical implications of relationship between myeloperoxidase and acute coronary syndromes (ACS).

METHODS176 consecutive patients who underwent coronary angiography for coronary atherosclerosis were divided into four groups according to the quartile of MPO Level. The characters and the relationship between MPO and the elements were studied in every group.

RESULTS(1) ACS rate (36.2%) in the fourth quartile group of MPO level was 6 times higher than that (5.2%) in the first quartile group of MPO level, P < 0.01. (2) Gensini score (65.6 +/- 30.3) in the fourth quartile group of MPO level was significantly higher than that (17.3 +/- 10.2) in the first quartile group (P < 0.01). WBC [(7.7 +/- 1.6) x 10(9)/L] in the fourth quartile group was also significantly higher than that [(6.6 +/- 1.8) x 10(9)/L] in the first quartile group, P < 0.05. (3) When TnI < or = 0.05 ng/ml, MPO level had a positive correlation with Gensini score (r = 0.321, P = 0.002) and WBC (r = 0.230, P = 0.025). (4) Kaplan-meier event rate curve showed that there was a significant difference of the terminus incident (death, no causing death AMI, vessel reestablish and incidence rate of CABG add up) between the groups > or = 62.9 AUU/L and < 62.9 AUU/L of MPO serum level at 6-month follow-up visit (chi(2) = 13.5, P = 0.01).

CONCLUSIONActivity level of MPO in human serum seems a good biomarker for diagnosing and predicting ACS, which may be especially helpful in predicting the risk of myocardial infarction in patients with acute chest pain during 6-month follow up.

Acute Coronary Syndrome ; diagnostic imaging ; enzymology ; physiopathology ; Adult ; Angina, Unstable ; diagnostic imaging ; enzymology ; Coronary Angiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; enzymology ; Myocardial Ischemia ; diagnostic imaging ; enzymology ; Peroxidase ; blood ; Troponin I ; metabolism

OBJECTIVETo observe the effect of Wenxin Granule (WG) on brain natriuretic peptide (BNP) and heart rate variability (HRV) of acute coronary syndrome (ACS) patients.

METHODSTotally 65 ACS patients were randomly assigned to the treatment group (35 cases) and the control group (30 cases). All patients were treated with routine therapies such as angiotensin conversing enzyme inhibitors (ACEI) and metoprolol. Those in the treatment group took WG, 9 g each time, three times daily. All were treated for 90 days. Plasma samples of BNP and HRV were determined before treatment and after treatment.

RESULTSThere was no statistical difference in pre-treatment plasma BNP (P > 0.05). Plasma BNP significantly decreased after treatment in the two groups when compared with before treatment (P < 0.05). The decrease was more obvious in the treatment group (P < 0.05). There was no statistical difference in pre-treatment HRV (P > 0.05). Compared with before treatment in the same group, RMSSD, PNN50%, and high frequency (HF) obviously increased, while low frequency (LF) and LF/HF ratio significantly decreased in the two groups, showing statistical difference (P < 0.05). The aforesaid indices were obviously better in the treatment group than in the control group (P < 0.05).

CONCLUSIONAdditional administration of WG could improve short-term clinical prognosis by down-regulating plasma BNP level (via improving myocardial ischemia) and modulating HRV.

Acute Coronary Syndrome ; blood ; drug therapy ; physiopathology ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Phytotherapy ; Prognosis

PURPOSE: Plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) binds to low-density lipoprotein. The levels of Lp-PLA2 reflect the plaque burden, and are upregulated in acute coronary syndrome (ACS). We investigated the diagnostic value of Lp-PLA2 levels and found that it might be a potential biomarker for ACS. MATERIALS AND METHODS: We classified 226 study participants into three groups: patients without significant stenosis (control group), patients with significant stenosis with stable angina (SA group), and patients with ACS (ACS group). RESULTS: Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) levels were significantly greater in the ACS group than in the SA group (p=0.044 and p=0.029, respectively). Multivariate logistic regression analysis revealed that Lp-PLA2 levels are significantly associated with ACS (odds ratio=1.047, p=0.013). The addition of Lp-PLA2 to the ACS model significantly increased the global chi2 value over traditional risk factors (28.14 to 35.602, p=0.006). The area under the receiver operating characteristic curve for Lp-PLA2 was 0.624 (p=0.004). The addition of Lp-PLA2 level to serum hs-CRP concentration yielded an integrated discrimination improvement of 0.0368 (p=0.0093, standard error: 0.0142) and improved the ability to diagnose ACS. CONCLUSION: Lp-PLA2 levels are related to plaque stability and might be a diagnostic biomarker for ACS.
1-Alkyl-2-acetylglycerophosphocholine Esterase/*blood ; Acute Coronary Syndrome/*blood/physiopathology ; Aged ; Aged, 80 and over ; Angina Pectoris ; Biological Markers/blood ; C-Reactive Protein/*metabolism ; Coronary Angiography ; Female ; Humans ; Lipoproteins, LDL/*blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Plaque, Atherosclerotic/blood ; ROC Curve ; Risk Factors