BACKGROUNDAs an acute phase protein, α1-antitrypsin (AAT) has been extensively studied in acute coronary syndrome, but it is unclear whether a relationship exists between AAT and stable angina pectoris (SAP). The purpose of the present study was to investigate the association between AAT plasma levels and SAP.

METHODSOverall, 103 SAP patients diagnosed by coronary angiography and clinical manifestations and 118 control subjects matched for age and gender were enrolled in this case-control study. Plasma levels of AAT, high-sensitivity C-reactive protein (hsCRP), lipid profiles and other clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the Gensini score (GS) assessed by coronary angiography.

RESULTSPositively correlated with the GS (r = 0.564, P < 0.001), the plasma AAT level in the SAP group was significantly higher than that in the control group (142.08 ± 19.61 mg/dl vs. 125.50 ± 19.67 mg/dl, P < 0.001). The plasma AAT level was an independent predictor for both SAP (odds ratio [OR] = 1.037, 95% confidence interval [CI]: 1.020-1.054, P < 0.001) and a high GS (OR = 1.087, 95% CI: 1.051-1.124, P < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, plasma AAT level was found to have a larger area under the curve (AUC) for predicting a high GS (AUC = 0.858, 95% CI: 0.788-0.929, P < 0.001) than that of hsCRP (AUC = 0.665, 95% CI: 0.557-0.773, P = 0.006; Z = 2.9363, P < 0.001), with an optimal cut-off value of 137.85 mg/dl (sensitivity: 94.3%, specificity: 68.2%).

CONCLUSIONSPlasma AAT levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.

Adult ; Aged ; Angina Pectoris ; blood ; diagnostic imaging ; Angina, Stable ; blood ; diagnostic imaging ; Case-Control Studies ; Coronary Angiography ; Female ; Humans ; Male ; Middle Aged ; alpha 1-Antitrypsin ; blood

BACKGROUND AND OBJECTIVES: The reduction in the mean platelet component (MPC) concentration may be used to detect platelet activation. We performed this study to find the clinical usefulness of the MPC concentration in the differentiation of patients with stable angina from those with acute coronary syndrome (ACS). SUBJECTS AND METHOD: We evaluated 175 consecutive patients (57.9+/-10.4 years, 107 male) undergoing coronary angiography. The study patients were divided into two groups; patients with ACS (n=55, 57.5+/-11.8 years, 37 male) and those with stable angina (n=120, 58.1+/-9.7 years, 70 male). Venous blood samples were take into EDTA tube and immediately sent to laboratory room for measurement of the MPC concentration using the ADVIA(R) 120 hematology system. RESULTS: The MPC concentration was significantly decreased in those with ACS (27.3+/-1.2 g/dL vs. 28.6+/-0.9 g/dL, p=0.013) compared to those with stable angina, and also decreased in patients with unstable compared to stable angina (27.4+/-1.2 g/dL vs. 28.6+/-0.9 g/dL, p<0.001), but there was no difference in the MPC concentration between acute myocardial infarction and unstable angina (27.2+/-1.2 g/dL vs. 27.4+/-1.2 g/dL, p=0.939). An MPC concentration (28.05 g/dL demonstrated 74.5% sensitivity and 75.0% specificity in the differentiation of patients with ACS from the others in the Receiver Operating Curve analysis. The positive and negative predictive values were 51.6 and 86.5%, respectively, at that level. CONCLUSION: Measurement of the MPC concentration may be useful in the detection of ACS. Also, a decreased MPC concentration may be a very useful marker for the differentiation of unstable and stable angina.
Acute Coronary Syndrome* ; Angina, Stable ; Angina, Unstable ; Blood Platelets* ; Coronary Angiography ; Edetic Acid ; Hematology ; Humans ; Myocardial Infarction ; Platelet Activation ; Sensitivity and Specificity

PURPOSE: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory enzyme expressed in atherosclerotic plaques. We investigated the association of circulating Lp-PLA2 with characteristics of vulnerable coronary atherosclerotic plaques. MATERIALS AND METHODS: We recruited 113 patients with either unstable angina (UA, n=59) and stable angina (SA, n=54) by coronary angiography. Thirty-six healthy subjects served as controls. Intravascular ultrasound (IVUS) was used to evaluate the characteristics of coronary atherosclerotic plaque, and serum Lp-PLA2 concentration was measured as well. RESULTS: Lp-PLA2 concentration was significantly higher in both UA and SA patients [(396+/-36) microg/L and (321+/-39) microg/L, respectively] compared with the controls [(127+/-49) microg/L, p<0.01], and higher in UA than SA group. IVUS findings showed that remodeling index (RI) (0.91+/-0.15 vs. 0.85+/-0.11, p=0.005) and eccentricity index (EI) (0.73+/-0.16 vs. 0.65+/-0.22, p=0.039) were larger in UA than in SA group, and fibrous caps were thicker in SA than UA group [(0.91+/-0.23) mm vs. (0.63+/-0.21) mm, p=0.032]. Moreover, Lp-PLA2 correlated positively with EI (r=0.439, p<0.01) and RI (r=0.592, p<0.05) in UA group. There was an inverse relationship between Lp-PLA2 and fibrous cap thickness in both UA (r=-0.587, p<0.001) and SA (r=-0.318, p<0.05) groups. The independent risk factors in UA group were Lp-PLA2 (OR=1.055, 95% CI: 1.03-1.08, p=0.013), LDL-cholesterol (OR=0.032, 95% CI: 0.00-0.05, p=0.041) and fibrous cap thickness (OR=0.008, 95% CI: 0.00-0.45, p=0.019). Lp-PLA2 was strongly associated with both EI and fibrous cap thickness in both groups. CONCLUSION: Serum level of Lp-PLA2 is associated with both eccentricity index and fibrous cap thickness in both UA and SA groups. Elevated levels of circulating Lp-PLA2 might to be a strong risk factor and more serious for unstable angina than stable angina.
1-Alkyl-2-acetylglycerophosphocholine Esterase/*blood ; Adult ; Aged ; Aged, 80 and over ; Angina, Stable/*blood/enzymology/*pathology ; Angina, Unstable/*blood/enzymology/pathology ; Coronary Angiography ; Coronary Artery Disease/*blood/enzymology/*pathology ; Female ; Humans ; Male ; Middle Aged

BACKGROUND: Quyyumi et al described circadian variation of ischemic eletrocardio-graphic changes and heart rate in patients with and without significant coronary disease in 1985. Rocco et al also described circadian variation of transient myocaldial ischemia in patients with coronary artery disease. They also noted an increse in ischemic eletrocardiographic abnormalities in the morning hours.In recent years the important of circadian variation of cardiovascular phenomena has generated a great deal of interest. Such phonomena include the occurrence of ischemia in patients with both chronic stable angina and variant angina, myocaldial infarction, sudden cardiac death, ventricular arrhythmia and platelet aggregability. METHOD: To examine whether a significant circadain variation of transient myocardial ischemia exists and to better understand the character of such variation, 35 patients with againa pectoris(15 patients treated with nitrate and/or caclcum channel blocker and 20 patients without treatment) underwent 24 hours ambulatory monitoring of ischemic ST segment changes during daily life. RESULT: Only 21% of the episodes of ST depression were accompanied by chest pain. While 79% were asymptomatic. A significant circadian increase in ischemic activity was found with 44% of episodes and 40% of total ischemic time in not treated group, and 52% of episodes and 56% of total ischemic time in treated group, occuring between 6 A.M. to 12 P.M.(P<0.05 respectively) When the distribution of ischemic episodes was corrected for the variable time of waking, the peak ischemic activity was occuring in the 1st and 2nd hours after rising. There were no significant differences in heart rate at onset and heart rate at 1 min before onset. CONCLUSION: Is summary, transient myocardial ischemia in the absence of pain was more common and there were a significant circadian variation of transient myocardial ischemia with peak activity in the morning. In addition most of transient myocardial were not preceded by a rise in heart rate.
Angina, Stable ; Arrhythmias, Cardiac ; Blood Platelets ; Chest Pain ; Coronary Artery Disease ; Coronary Disease ; Death, Sudden, Cardiac ; Depression ; Heart Rate ; Humans ; Infarction ; Ischemia ; Monitoring, Ambulatory ; Myocardial Ischemia*

Coronary artery bypass grafting(CABG) without cardiopulmonary bypass is now an accepted technique of myocardial revasculization in terms of preventive method from various complications of cardiopulmonary bypass. Despite danger of myocardial ischemia, induced hypotension with bradycardia are sometimes necessary for the convenience of operative approach to beating heart. We report a case of induced hypotension with bradycardia during general anesthesia for CABG without cardiopulmonary bypass. After induction and maintenance of balanced anesthesia with fentanyl-midazolam-isofluranepiperocuronium for the 68 kg, 55 years old male stable angina patient, we induced controlled hypotension(systolic blood pressure: 70~80 mmHg) and bradycardia(heart rate: 50~60/min.) by bolus injections of verapamil 5 mg and esmolol 30 mg followed by continuous infusion of esmolol 0.1~0.3 mg/kg/min. during 50 minutes of main graft implantations without bypass. Any significant ischemic changes on EKG were not detected during induced hypotension and bradycardia. Patient was recovered without any signs of myocardial ischemia postoperativery and discharged 8 days after operation.
Anesthesia, General* ; Angina, Stable ; Arteries* ; Balanced Anesthesia ; Blood Pressure ; Bradycardia* ; Cardiopulmonary Bypass* ; Coronary Artery Bypass ; Electrocardiography ; Heart ; Humans ; Hypotension* ; Male ; Middle Aged ; Myocardial Ischemia ; Transplants* ; Verapamil

OBJECTIVETo observe the clinical efficacy on chronic stable angina pectoris treated with acupuncture at Neiguan (PC 6) and explore the impacts of acupuncture on peripheral blood neutrophil to lymphocyte ratio (NLR) in the patients of stable angina pectoris.

METHODSThirty patients of chronic stable angina pectoris met the inclusive criteria were randomized into an acupuncture group (15 cases) and a medication group (15 cases), and a healthy control group (15 cases of the same ages) was set up separately. In the acupuncture group, at the same time of the basic medication, acupuncture was applied to bilateral Neiguan (PC 6), once every two days, 3 days a week, totally for 4 weeks. In the medication group, the basic medication was applied, without acupuncture intervention. In the healthy control group, no any intervention was applied. The attack frequency of angina pectoris, dose of nitrogly-cerin, the evaluation of visual analogue scale (VAS), Seattle angina questionnaire (SAQ), the six-minute walking test (6MWT), the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were observed before and after treatment in the subjects. Additionally, the peripheral blood cells were detected to analyze specifically the changes in NLR before and after treatment and observe the relationship between NLR and clinical efficacy.

RESULTSCompared with the medication group, the attack frequency of angina pectoris was reduced within 30 days (P<0.01); the dose of nitroglycerin was reduced (P<0.01); VAS was reduced (P<0.01) and SAQ was increased (P<0.05) in the acupuncture group. The differences in 6 MWT, SAS and SDS were not significant between the two groups after treatment (all P>0.05). Additionally, compared with the medication group, in 30 days of acupuncture, NLR was reduced apparently in the acupuncture group (P<0.05).

CONCLUSIONAcupuncture relieves the clinical symptoms of chronic stable angina pectoris, but has not apparent effects on motor ability and psychological health. Corresponding to that before treatment, the decreased NRL in the patients of acupuncture group suggests the potential good prognosis on coronary heart disease after acupuncture.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Angina, Stable ; physiopathology ; therapy ; Blood Cell Count ; Female ; Humans ; Lymphocytes ; cytology ; Male ; Middle Aged ; Neutrophils ; cytology

To systemically evaluate the benefits and side effects of Shensong Yangxin Capsules( SYC) in the adjuvant treatment of stable angina pectoris( SAP). Chinese and English databases( PubMed,EMbase,the Cochrane Library,CBM,CNKI,VIP,Wan Fang database) were retrieved to collect the randomized controlled trials( RCTs) about therapeutic efficacy of SYC combined with routine drug( trial group) vs routine drug( control group) in the treatment of SAP. The methodological quality of the RCTs was evaluated based on the cochrane risk of bias assessment tool. The data were extracted and Meta-analyzed by Reviewer Manager 5. 3. TSA 0. 9 software was used for trial sequential analysis( TSA) of the total effective rate of symptoms improvement. A total of 15 RCTs with 1 316 participants were included. RESULTS:: of Meta-analysis showed that the total effective rate of angina symptoms improvement( RR = 1. 15,95% CI[1. 09,1. 21],P<0. 001) of trial group were significantly higher than those of control group,with statistical significance,the total effective rate of electrocardiograms( ECG) improvement( RR = 1. 10,95% CI[0. 94,1. 29],P = 0. 25) of trial group were significantly higher than those of control group,but the difference was not statistically significant. After treatment,the improvement of the total time of 24 h general ischemia( SMD =-1. 21,95%CI[-1. 97,-0. 45],P = 0. 002),the ST-segment depression amplitude( SMD =-1. 30,95%CI [-1. 52,-1. 09],P<0. 001),the duration of angina pectoris attack( SMD =-1. 16,95% CI[-1. 36,-0. 95],P< 0. 001),the angina pectoris attack every week( SMD =-0. 80,95%CI[-1. 10,-0. 50],P<0. 001),the onsumption of nitroglycerin every week( SMD=-0. 72,95%CI[-1. 05,-0. 39],P<0. 001) in the trial group were better than that of the control group,and the difference was statistically significant. Besides,the improvement of the blood lipid and high sensitivity C reactive protein( hs-CRP) in the trial group were better than those of the control group after treatment,and the difference was statistically significant( P< 0. 001). Funnel plots and Egger's linear regression showed that there was no publication bias. By sensitivity analysis,it showed that the results of this study were stable and reliable. No obvious adverse drug reactions were observed in all studies. TSA analysis showed that the evidence of Meta-analysis was reliable. SYC combined with routine Western medicine treatment for SAP can improve the total effective rate of angina pectoris,reduce 24 h total ischemia time,ST segment depression amplitude,duration of angina pectoris attack,frequency of angina pectoris attack and nitroglycerin dosage,and also can improve blood lipid and hs-CRP levels.
Adjuvants, Pharmaceutic ; Angina, Stable ; drug therapy ; C-Reactive Protein ; analysis ; Capsules ; Drugs, Chinese Herbal ; therapeutic use ; Electrocardiography ; Humans ; Lipids ; blood ; Randomized Controlled Trials as Topic

PURPOSE: We investigated correlations of coronary plaque composition determined by virtual histology (VH) intravascular ultrasound (IVUS) and blood levels of biomarkers that represent the vulnerability of coronary plaques. MATERIALS AND METHODS: Pre- and postprocedural blood levels of high sensitivity C-reactive protein, soluble CD40 ligand (sCD40L), matrix metalloproteinase-9, and neopterin were measured in 70 patients with stable angina (SA) or unstable angina (UA) who were undergoing percutaneous coronary intervention (PCI) for single lesions. We evaluated the data for correlations between these biomarkers and necrotic core contents in PCI target lesions analyzed by VH. RESULTS: Clinical characteristics, IVUS, VH, and biomarker blood levels were not different between the SA and the UA group except for more frequent previous statin use (52.3% vs. 23.1%, p=0.017) and lower remodeling index in the SA group (0.98+/-0.09 vs. 1.10+/-0.070, p<0.001). Among the biomarkers evaluated, only pre-PCI neopterin level showed a weakly significant correlation with the absolute volume of the necrotic core (r=0.320, p=0.008). Pre- and post-PCI blood levels of sCD40L (r=0.220, p=0.072; r=0.231, p=0.062) and post-PCI blood level of neopterin (r=0.238, p=0.051) showed trends toward weakly positive correlations with the absolute volume of necrotic core. CONCLUSION: We found a weakly positive correlation between the pre-PCI neopterin level and necrotic core volume in the PCI-target lesion. The clinical implications of our findings need to be investigated in further studies.
Aged ; Angina Pectoris/blood ; Angina, Stable/blood ; Angina, Unstable/blood ; Angioplasty, Balloon, Coronary ; Biological Markers/blood ; C-Reactive Protein/metabolism ; CD40 Ligand/blood ; Coronary Artery Disease/*blood/*metabolism/ultrasonography ; Female ; Humans ; Male ; Matrix Metalloproteinase 9/blood ; Middle Aged ; Neopterin/blood ; Plaque, Atherosclerotic/*blood/*metabolism/ultrasonography ; Ultrasonography, Interventional

BACKGROUND: Chronic infections, including Chlamydia pneumoniae, cytomegalovirus and Helicobacter pylori may be one of the risk factors for coronary artery disease (CAD). To document whether chronic infection may be associated with coronary artery disease, various inflammatory markers were analyzed in Korean patients with CAD. METHODS: The patients who underwent diagnostic coronary angiography (CAG) were divided into two groups according to the results of CAG: the patients with significant coronary lesions (Group I: n=126, M:F=99:27, 58.7+/-9.7 years) or the patients without coronary lesions (Group II: n=58, M:F=30:28, 55.5+/-8.9 years). Serologic assays for the immunoglobulin G (IgG) titers to C. pneumoniae, CMV, H. pylori, and for inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were performed. RESULTS: There were no significant differences in the sero-positivity of three infections between two groups, but titer of IgG antibody against H. pylori was significantly higher in Group I than that in Group II (859.3+/-342.2 vs. 474.2+/-113.2 U/mL, p=0.02). After adjustment for age, sex and other cardiovascular risk factors, high titer of IgG antibody aganist H. pylori was independently associated with coronary artery disease (p=0.05). CRP and ESR were significantly elevated in group I (2.7+/-5.1 vs. 0.6+/-0.9 mg/dL, p=0.003, 23.2+/-26.7 vs. 12.7+/-15 mm/hr, p=0.006). Angiographic parameters were not related with the titer of infectious agents or inflammatory markers. The value of CRP was significantly different according to clinical severity (3.8+/-6.0 in acute myocardial infarction, 1.5+/-3.6 in unstable angina pectoris, and 0.4+/-0.3 mg/dL in stable angina pectoris, p<0.01). The value of ESR was also significantly different according to clinical severity (29.0+/-30.2 in acute myocardial infarction, 17.1+/-19.0 in unstable angina pectoris, and 12.1+/-17.6 mm/hr in stable angina pectoris, p<0.01). CONCLUSIONS: Our results suggest that high titer of IgG antibody against H. pylori may be associated with CAD, and inflammation may play a significant role in the pathogenesis of acute coronary syndromes.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Blood Sedimentation ; C-Reactive Protein ; Chlamydophila pneumoniae ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Cytomegalovirus ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Inflammation* ; Myocardial Infarction ; Pneumonia ; Risk Factors

BACKGROUND: The immediate result of coronary balloon angioplasty was influenced by plastic and elastic changes of the vessel wall. After successful coronary angioplasty, the minimal luminal diameter of the dilated coronary artery segment was generally smaller than the diameter of the largest balloon catheter at the maximal inflation pressure. Several mechanisms could explain this phenomenon, including vasoconstriction, subintimal or intraplaque bleeding or edema and platelet or thrombus deposition. In addition, whenever balloon inflation results in overdistension of elastic components of the arterial wall, some degree of elastic recoil may occur. METHODS: To evaluate magnitude of elastic recoil after percutaneous transluminal coronary angioplasty in relation to lesion morphology and other procedure-related variables, 141 coronary lesions were selected from patients with acute myocardial infarction, stable angina, unstable angina and post myocardial infarction angina undergoing successful coronary angioplasty. Coronary angiograms were recorded before and after angioplasty, and during dilatation of balloon. The computer measuring program was used for the assessment of balloon diameters and coronary luminal diameters. RESULTS: 1) Of all 141 coronary lesions, percent diameter stenosis before angioplasty averaged 74.2% and after angioplasty averaged 22.5%. 2) Residual diameter stenosis was directly related to the degree of elastic recoil, the greater the elastic recoil the more severe the residual lesion immediately after angioplasty. The increase in elastic recoil corresponded to a increase in the balloon/artery ratio(p<0.05). 3) The residual diameter stenosis tended to decrease in segments dilated with an oversized balloon than with an undersized balloon(p<0.05). 4) The elastic recoil increased significantly in the subgroups of coronary segments dilated with an oversized balloon, of eccentric lesion, and type C lesion(p<0.05). 5) Percent residual stenosis was more sever in eccentric stenosis dilated with undersized balloon than in concentric stenosis. 6) Elastic recoil was greater in type C coronary segment dilated with an oversized balloon than with an undersized balloon(<0.05). 7) The lesion dilated with oversize non-compliant balloon showed more elastic recoil than with oversize compliant balloon(p<0.05). CONCLUSION: Factors such as oversized balloon, eccentric lesion, type C lesion, and non-compliant balloon significantly affected increase of the elastic recoil.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Blood Platelets ; Catheters ; Constriction, Pathologic ; Coronary Stenosis* ; Coronary Vessels ; Dilatation ; Edema ; Hemorrhage ; Humans ; Inflation, Economic ; Myocardial Infarction ; Phenobarbital ; Plastics ; Thrombosis ; Vasoconstriction