Angina, Unstable ; physiopathology ; Angioplasty, Balloon, Coronary ; Drug-Eluting Stents ; Electrocardiography ; Humans ; Myocardial Infarction ; therapy

Acupuncture Therapy ; Adult ; Aged ; Angina, Unstable ; drug therapy ; physiopathology ; therapy ; Cardiovascular Agents ; administration & dosage ; Combined Modality Therapy ; Electrocardiography ; Female ; Heart ; physiopathology ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the relationship between thrombolysis in myocardial infarction (TIMI) risk score and efficacy of different treatment strategies in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

METHODSFrom Oct. 2001 to Oct. 2003, 545 consecutive patients with NSTE-ACS were randomly assigned to early conservative strategy (n = 284) or early invasive strategy group (n = 261). The combined cardiovascular events (a combination of cardiac death, nonfatal myocardial infarction, nonfatal heart failure and re-hospital admission due to recurrent ischemia angina) within 30 days and 6 months were analyzed and related to the TIMI risk score at admission.

RESULTSRehospitalization due to recurrent ischemia angina of 30 days and the combined cardiovascular events of 30 days and 6 months were significantly lower in early invasive strategy group (3.5%, 10.0%, 21.1%) compared with early conservative strategy group (8.1%, 16.9%, 28.2%, all P < 0.05). Subgroup analysis indicated early invasive strategy could significantly decrease the 30 d incidence of the combined end point events in patients with high TIMI risk score and the 6 months incidence of the combined end point events in patients with moderate and high TIMI risk score (all P < 0.01), but the incidence was similar between the two different strategies in patients with low TIMI risk score.

CONCLUSIONSEarly invasive strategy may significantly reduce combined cardiovascular events in NSTE-ACS patients with moderate and high TIMI risk score compared with early conservative strategy.

Aged ; Angina, Unstable ; drug therapy ; physiopathology ; Coronary Disease ; drug therapy ; physiopathology ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; Risk Assessment ; Thrombolytic Therapy

OBJECTIVETo observe the effect of Yiqi Yangyin Decoction (, YQYYD) on the quality of life (QOL) of patients with unstable angina pectoris (UAP).

METHODSA total of 108 patients with UAP of qi-yin deficiency syndrome confirmed by coronary angiography were enrolled and assigned to the treated group (treated with YQYYD and conventional therapy of Western medicine) and the control group (treated with conventional therapy of Western medicine), by the use of the PROC PLAN of the SAS 6.12 software, in a prospective, randomized, controlled design. The clinical total effective rate, symptom score, QOL scale [Seattle Angina Questionnaire (SAQ)] and incidence of important clinical events were defined as the observation indices to evaluate the interventional effect of YQYYD on the QOL of patients with UAP of the qi-yin deficiency syndrome.

RESULTSDuring the study, three cases dropped out in the treated group, one case dropped out in the control group, and 104 cases, including 51 cases in the treatment group and 53 cases in the control group, finished the trial. After four weeks of treatment, the total clinical effective rates in the treated group and the control group were 80.4% and 75.5% respectively, and there was no obvious difference between them (P>0.05). However, the symptom score of the treated group (9.31 + or - 2.02) was significantly lesser than that of the control group (11.62 + or - 3.04, P<0.05), and the total score of the QOL scale of the treated group (68.76 + or - 5.74) was significantly higher than that of the control group (61.06 + or - 3.31, P<0.01). Among those in the treated group physical limitation, angina stability, angina frequency, and treatment satisfaction were significantly ameliorated when compared with the control group after treatment (P<0.05, P<0.01). The incidence of important clinical events in the treated group (3.9%) was lower than that in the control group (5.7%) during the 8-month follow-up period, but the difference was insignificant (P>0.05).

CONCLUSIONYQYYD could improve the clinical symptoms of patients with UAP of qi-yin deficiency syndrome and greatly improve their QOL.

Adult ; Aged ; Angina Pectoris ; drug therapy ; physiopathology ; psychology ; Angina, Unstable ; drug therapy ; physiopathology ; psychology ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Quality of Life ; Research Design ; Treatment Outcome

BACKGROUNDThe clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction (STEMI) remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention (PCI). This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI.

METHODSAmong a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI (PA group) and the remaining 583 were free of anginal symptoms (non-PA group). Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups.

RESULTSDiabetes was less common (17.5% vs. 23.3%, P = 0.04) and symptom-to-door time was shortened ((191.6 ± 96.8) minutes vs. (357.2 ± 341.9) minutes, P < 0.001) in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery (TIMI flow grade 0 - 1) at initial angiography (75.0% vs. 90.7%, P < 0.001), and achieved more TIMI flow grade 3 after primary PCI (84.2% vs. 78.2%, P = 0.04). These were associated with higher rates of overall procedural success (95.9% vs. 91.8%, P = 0.02) and of complete ST-segment resolution at 90 minutes after the procedure (51.7% vs. 40.3%, P = 0.001). During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved ((53.0 ± 8.6)% vs. (51.1 ± 9.7)%, P = 0.002) and the primary endpoint of major adverse cardiac events was reduced in the PA group (7.2% vs. 12.7%, P = 0.01).

CONCLUSIONPresence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.

Acute Coronary Syndrome ; therapy ; Aged ; Angina, Unstable ; physiopathology ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Prospective Studies

OBJECTIVETo observe the clinical efficacy of Xin'anning Nasal Drop (XAND) in treating coronary heart disease with unstable angina pectoris (CHD-UAP).

METHODSSixty patients with CHD-UAP were assigned, according to the randomizing number table, to two groups, the control group treated with conventional Western medicine, and the treated group treated with conventional Western medicine plus XAND. The clinical efficacy and the changes of S-T segment in resting EKG and total ischemia burden (TIB) in 24-h dynamic EKG were observed.

RESULTSThe clinical efficacy, including the effect of angina alleviation, its initiation, and the effect of TCM syndrome score reduction, were significantly superior in the treated group to those in the control group ( P<0.05 or P<0.01). The degree and extent of myocardial ischemia were significantly improved in both groups ( P<0.01), but the improvement in the treated group was better than that in the control group ( P<0.05). Moreover, it was worth mentioning that the immediate effect in the treated group was better than that in the control group, and the reduction of TIB, the improvement in heart rate and myocardial oxygen consumption (immediately after the first administration or by the end of the therapeutic course), and systolic blood pressure after treatment in the former were all superior to those in the latter, showing significant difference (P<0.05 or P<0.01).

CONCLUSIONXAND has a quick effect in alleviating angina in patients with CHD-UAP, and it is worthy of further studies and spreading in clinical practice. unstable angina pectoris, Xin'anning Nasal Drop, clinical study

Administration, Intranasal ; Adult ; Aged ; Angina, Unstable ; drug therapy ; physiopathology ; Electrocardiography ; drug effects ; Female ; Heart Rate ; drug effects ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Systole ; drug effects

Compared with ST elevation myocardial infarction (STEMI), long-term outcomes are known to be worse in patients with unstable angina/non-STEMI (UA/NSTEMI), which might be related to the worse health status of patients with UA/STEMI. In patients with UA/NSTEMI and STEMI underwent percutaneous coronary intervention (PCI), angina-specific and general health-related quality-of-life (HRQOL) was investigated at baseline and at 30 days after PCI. Patients with UA/NSTEMI were older and had higher frequencies in female, diabetes and hypertension. After PCI, both angina-specific and general HRQOL scores were improved, but improvement was much more frequent in angina-related HRQOL of patients with UA/NSTEMI than those with STEMI (44.2% vs 36.8%, P < 0.001). Improvement was less common in general HRQOL. At 30-days after PCI, angina-specific HRQOL of the patients with UA/NSTEMI was comparable to those with STEMI (56.1 +/- 18.6 vs 56.6 +/- 18.7, P = 0.521), but general HRQOL was significantly lower (0.86 +/- 0.21 vs 0.89 +/- 0.17, P = 0.001) after adjusting baseline characteristics (P < 0.001). In conclusion, the general health status of those with UA/NSTEMI was not good even after optimal PCI. In addition to angina-specific therapy, comprehensive supportive care would be needed to improve the general health status of acute coronary syndrome survivors.
Aged ; Angina, Unstable/physiopathology/*therapy ; Asian Continental Ancestry Group ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Myocardial Infarction/physiopathology/*therapy ; Odds Ratio ; *Percutaneous Coronary Intervention ; *Quality of Life ; Registries ; Republic of Korea

OBJECTIVEThe study investigate the antioxidant probucol on endothelial function in patients with acute coronary syndrome (ACS).

METHODSA total of 49 ACS patients randomly received standard therapy plus probucol (P, n = 24) or standard therapy (C, n = 25). Plasma oxidized low-density lipoprotein (ox-LDL), nitric oxide (NO) and circulating endothelial cells (CEC) were measured. The brachial arterial hyperemia-induced flow mediated dilation (FMD) and sublingual nitroglycerin (NTG) mediated vasodilatations were measured by high resolution ultrasound. These variables were analyzed before and after 3 months therapy.

RESULTSPlasma NO and FMD was significantly increased after 3 months therapy than before therapy [(80.46 +/- 10.24) micromol/Lvs (48.46 +/- 12.24) micromol/L, P < 0.01; (13.46 +/- 1.20)% vs (7.45 +/- 1.02)%, P < 0.05, respectively], while the number of CEC and ox-LDL were significantly decreased (P < 0.01) in P group. These values were similar before and after 3 months in C group. The linear correlation analysis showed that plasma ox-LDL negatively correlated with NO (r = -0.574, P < 0.01) and FMD (r = -0.517, P < 0.01) and positively correlated with CEC (r = 0.385, P < 0.01) in patients received 3 months probucol therapy.

CONCLUSIONSChronic antioxidant probucol therapy could improve endothelial function in patients with ACS.

Adult ; Aged ; Angina, Unstable ; blood ; drug therapy ; Anticholesteremic Agents ; therapeutic use ; Endothelial Cells ; drug effects ; physiology ; Endothelium, Vascular ; drug effects ; physiopathology ; Female ; Humans ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; physiopathology ; Nitric Oxide ; blood ; Probucol ; therapeutic use

BACKGROUNDAspirin can inhibit inflammatory reactions and platelet aggregation, but little is known about the effects of the combination of aspirin plus clopidogrel, a new antiplatelet agent, on inflammation. The purpose of this study was to determine whether aspirin plus clopidogrel can further suppress inflammation in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS).

METHODSOne hundred and fifteen patients with NSTEACS were randomized into two groups: group A (aspirin alone, n =58) and group B (aspirin plus clopidogrel, n =57). Patients in group A received a loading dose of 300 mg aspirin, then 100 mg per day. The patients in group B received a loading dose of 300 mg aspirin and 300 mg clopidogrel, then 100 mg aspirin and 75 mg clopidogrel per day. Serum high sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-alpha) were measured in all patients at baseline prior to any drug treatment after admission, and at 7 and 30 days after beginning drug treatment. Thirty healthy volunteers on no medications were enrolled as controls (group C).

RESULTSBaseline levels of hs-CRP and TNF-alpha in group A and group B were significantly higher than those in group C. Seven days after administration, the levels of hs-CRP in both group A and group B decreased significantly [Group A: (6.15 +/- 1.39) mg/L vs (9.18 +/- 1.62) mg/L, P <0.01; Group B:(4.99 +/- 1.62) mg/L vs (10.29 +/- 1.47) mg/L, P <0.01]. Similarly, levels of TNF- alpha in both groups decreased at 7 days compared to baseline [Group A: (90.99 +/- 28.91) pg/ml vs (117.20 +/- 37.13) pg/ml, P <0.01; Group B: (74.32 +/- 21.83) pg/ml vs (115.27 +/- 32.11) pg/ml, P <0.01]. Thirty days after administration, the levels of hs-CRP in both group A and group B decreased further to (3.49 +/- 1.53) mg/L, and (2.40 +/- 1.17) mg/L respectively (P <0.01 for both comparisons). Levels of TNF-alpha in groups A and B also decreased significantly between 7 and 30 days, to 63.28 +/- 29.01 pg/ml (group A) and (43.95 +/- 17.10) pg/ml (group B; P <0.01 for both comparisons). Significantly lower levels of hs-CRP and TNF-alpha were observed in group B compared to Group A at thirty days after initiating drug treatment (P <0.05).

CONCLUSIONSAspirin plus clopidogrel treatment reduced levels of serum hs-CRP and TNF-alpha in patients with NSTEACS significantly more than aspirin alone. Because both aspirin and clopidogrel produce important anti-inflammatory effects, these results suggest the possibility that long-term treatment with aspirin plus clopidogrel may produce greater clinical benefits compared to treatment with aspirin alone.

Adult ; Aged ; Angina, Unstable ; blood ; physiopathology ; Aspirin ; administration & dosage ; C-Reactive Protein ; analysis ; Drug Therapy, Combination ; Electrocardiography ; Female ; Humans ; Inflammation ; drug therapy ; Male ; Middle Aged ; Myocardial Infarction ; blood ; physiopathology ; Ticlopidine ; administration & dosage ; analogs & derivatives ; Tumor Necrosis Factor-alpha ; analysis

OBJECTIVETo evaluate the effect of Tongxinluo (TXL) Capsule on function of vascular endothelium in patients with unstable angina pectoris (UAP).

METHODSForty-six UAP patients were randomly divided into two group, the 28 patients in the treated group treated by conventional therapy plus TXL and the 18 patients in the control group treated by conventional therapy alone. Changes of blood levels of endothelin (ET), nitric oxide (NO), Von Willebrand factor (vWF), soluble vascular cell adhesive molecule-1 (sVCAM-1) and soluble intracellular adhesive molecule-1 (sICAM-1) from before treatment to after two months of treatment were observed, and the flow-mediated dilatation (FMD) in brachial artery was detected at the same time using ultrasonography.

RESULTSAfter treatment, the blood level of vWF and ET obviously decreased (P < 0.01), levels of NO and FMD increased (P < 0.05 or P < 0.01) in both groups. Levels of sVCAM-1 and sICAM-1 significantly decreased in the treated group (P < 0.01), while in the control group, no marked change was found in sVCAM-1 and sICAM-1 (P > 0.05). Compared with the control group after treatment, the levels of vWF, ET, sVCAM-1 and sICAM-1 in the treated group were lower (P < 0.01), and levels of NO and FMD were higher (P < 0.01).

CONCLUSIONTXL might protect vascular endothelium, improve clinical therapeutic effect by path of decreasing blood levels of ET, vWF and partial cellular adhesive factor, and increasing the level of NO.

Aged ; Angina, Unstable ; blood ; drug therapy ; Capsules ; Drugs, Chinese Herbal ; therapeutic use ; Endothelins ; blood ; Endothelium, Vascular ; drug effects ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Nitric Oxide ; blood ; Phytotherapy ; Vascular Cell Adhesion Molecule-1 ; blood ; von Willebrand Factor ; metabolism