China/epidemiology* ; Coronary Angiography ; Coronary Artery Disease/diagnosis* ; Humans ; Registries ; Risk Assessment ; Risk Factors

OBJECTIVETo study the clinical feature, coronary artery lesion specialty and Chinese medicine syndrome characteristics of coronary heart disease (CHD) in females.

METHODSThe clinical materials of 297 female patients with CHD, whose diagnosis had been confirmed by coronary angiography, were analyzed and compared with those of 772 male patients.

RESULTSCHD in females was characterized by later occurrence, frequently complicated with diabetes mellitus and blood lipid disorder, and rather serious coronary lesion, mainly the multi- or double-branch lesion, involving the anterior descend branch, right coronary artery and convolution branch; with the often encountered syndrome factors and their combinations of qi deficiency, blood stasis, yin deficiency, blood stasis due to qi deficiency,deficiency of both qi and yin,turbid phlegm, yang-deficiency, etc.; the figures of tongue and pulse were generally dark-red or dark-purple or pale-red colored corpulent tongue proper, with waterless yellow or less coating, even without coating, cyanosed varicose sublingual veins,thin-weak or thin- rapid pulse.

CONCLUSIONFemale CHD has its special clinical feature, coronary specialty and Chinese medicine syndrome characteristics. Proper treatment methods for it are supplementing qi, activating blood, nourishing yin in dominance, with dissolving phlegm and accessing yang as accessory.

Adult ; Age of Onset ; Aged ; Coronary Artery Disease ; diagnosis ; epidemiology ; Coronary Disease ; diagnosis ; epidemiology ; Diagnosis, Differential ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Sex Factors ; Yin-Yang

BACKGROUNDAngina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS), even in patients without significant coronary artery disease (CAD). However, the incidence of angina pectoris and related CAD in such patients is controversial. There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS. The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.

METHODSData from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995. Clinical and echocardiographic follow-up data were recorded into the database annually. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.

RESULTSTotally 574 patients with severe AS (mean age, (65.9±9.6) years) were enrolled in this study. Significant CAD was found in 61 patients (10.6%). Factors associated with increased likelihood of CAD were age, hypertension, diabetes mellitus, chronic renal failure, carotid disease, and aorta calcification. In Logistic regression analysis, the independent predictor of the presence of CAD was age (P = 0.011). The incidence of CAD increased significantly at 69.2 years of age. Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.

CONCLUSIONSThere was a low incidence of significant CAD in a population of Korean patients with severe AS. Therefore, coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.

Aged ; Angina Pectoris ; diagnosis ; epidemiology ; Aortic Valve ; surgery ; Aortic Valve Stenosis ; epidemiology ; surgery ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; epidemiology ; Echocardiography ; Humans ; Incidence ; Middle Aged

BACKGROUND AND OBJECTIVES: Dobutamine stress echocardiography (DSE) with 2D echocardiography (2DE) is one of the time-consuming procedures in the diagnosis of coronary artery disease (CAD). Moreover, the accuracy of DSE with 2DE depends on the operator's skill or bias during the image acquisition. This study was conducted to determine the feasibility and accuracy of DSE with real-time 3D echocardiography (RT3DE) for the diagnosis of CAD. SUBJECT AND METHODS: 62 patients (RT3DE: 36, 2DE: 26), suspected of angina pectoris and post-revascularization ischemia, underwent DSE and coronary angiography (CAG). Image acquisition was performed at the baseline, and at 4 times during the dobutamine infusion and recovery stages. The procedure time (from the baseline to the end of the peak dose stage) was recorded. Off-line analyses of the volumetric images acquired with RT3DE were performed using 3D computer software (TomTec, Co.). Digitized quad-screen images acquired with 2DE were analyzed using the 2DE review system (ProSolv 4.0). >50% luminal diameter stenosis of any coronary artery on CAG was defined as significant coronary artery stenosis. RESULTS: The procedure time of DSE with RT3DE was significantly shorter than that of DSE with 2DE (25+/-4 vs. 37+/-4 mins, p<0.001). There was no significant difference in the sensitivity (p>0.05) or specificity (p>0.05) between the two procedures. CONCLUSION: DSE with RT3DE seems to be a feasible and less time consuming diagnostic procedure, probably providing comparable sensitivity and specificity for the detection of coronary artery stenosis, than DSE with 2DE.
Angina Pectoris ; Bias (Epidemiology) ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Dobutamine* ; Echocardiography* ; Echocardiography, Stress* ; Echocardiography, Three-Dimensional* ; Humans ; Ischemia ; Phenobarbital ; Sensitivity and Specificity

OBJECTIVETo survey the incidence of acute coronary events (nonfatal acute myocardial infarction and death from coronary heart disease), and analyze the trend and distribution characteristics in permanent residents aged 25 years and more across 30 surveillance regions of Zhejiang province from 2010 to 2012.

METHODSThrough databases matching and duplicate checking, this study incorporated the register module of coronary disease and the cause of death register module in Zhejiang provincial information system for chronic non-communicable diseases surveillance and management. The distribution of incidence was calculated across gender, age groups, regions and times.

RESULTSA total of 31 872 person-time acute coronary events were identified. The gender- and age-standardized mean annual incidence was 81.56 per 100 000 people in overall population, with 94.33 in males and 68.27 in females. Age-standardized incidence was 87.90 and 77.36 per 100 000 people in urban and rural area, respectively. Urban area had higher incidence rate than rural in each of the three years, and had obvious trend of increasing (P < 0.001) compared with rural area (P = 0.331). Incidence rate also increased significantly with age (P < 0.001).In addition, compared with women, men had higher incidence in each age group (all P < 0.001). The incidence rate increased rapidly in population older than 75 years old. The highest incidence was observed in age group ≥ 85 years old, with 2 371.67 and 1 873.92 per 100 000 in males and females, respectively. Apparent seasonal trend was observed for acute coronary events, which was low in summer and high in winter.

CONCLUSIONSQuantity and incidence for acute coronary events in residents aged 25 years and more of Zhejiang surveillance regions increased during 2010 to 2012. Male had higher incidence than female, and the incidence in urban areas was higher compared with rural areas. Residents older than 75 years old were high risk population of events, and winter was the high-occurrence season.

Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anterior Wall Myocardial Infarction ; China ; epidemiology ; Chronic Disease ; Coronary Artery Disease ; Coronary Disease ; diagnosis ; epidemiology ; Disease Management ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Rural Population

Coronary artery disease remains the leading cause of early death and graft loss in renal transplant patients. The aim of this study was to identify clinical and echocardiographic parameters independently associated with the angiographically-determined severity of coronary atherosclerosis in long-term kidney transplant patients. Fifty-two kidney transplant recipients who underwent elective coronary angiography were reviewed retrospectively. Angiographic severity was evaluated using the modified Gensini index (MGI). The mean age at coronary angiography was 52.5+/-7.9 yr with a mean prior transplant duration of 118.1+/-58.8 months. Pearson correlation analysis demonstrated a positive correlation of MGI with transplant duration before coronary angiography and chronic allograft nephropathy, whereas an inverse correlation was demonstrated with ejection fraction and statin use. On subsequent multivariate linear regression analysis, transplant duration before coronary angiography, statin use, and ejection fraction were independently associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. In summary, our study demonstrates that statin use, ejection fraction, and transplant duration before coronary angiography are independent parameters associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. Further investigation is required to reduce the atherosclerotic burden in kidney transplant patients.
Adult ; Comorbidity ; Coronary Artery Disease/*diagnosis/*epidemiology ; Female ; Humans ; Incidence ; Kidney Transplantation/*statistics & numerical data ; Korea/epidemiology ; Male ; Renal Insufficiency/*epidemiology/*surgery ; Risk Assessment ; Risk Factors ; Statistics as Topic

PURPOSE: Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated. MATERIALS AND METHODS: Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD. RESULTS: We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy. CONCLUSION: In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.
Aged ; Biomarkers/*blood ; Case-Control Studies ; Coronary Angiography ; Coronary Artery Disease/blood/*diagnosis/epidemiology ; Echocardiography/*methods ; Electrocardiography/*methods ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/blood/*diagnosis/epidemiology ; Out-of-Hospital Cardiac Arrest/*diagnosis ; Sensitivity and Specificity ; Troponin T

OBJECTIVETo analyze clinical characteristics in young and aged patients with coronary artery disease (CAD).

METHODSThe clinical and coronary angiographic data were compared between young (PCAD, male < 55 years old, n = 74, female < 65 years old, n = 71) and aged (CAD, male > 55 years old, n = 106, female > 65 years old, n = 111) patients. Seventy-one patients excluded with CAD by angiography served as controls (non-CAD). The traditional risk factors (including age, smoking, blood pressure, lipid profile, blood glucose, BMI, family history), coronary angiographic changes were analyzed and compared among various groups.

RESULTS(1) Compared with CAD group, PCAD patients had significantly higher rate of smoking (50.3% vs. 38.0%, P < 0.05), significantly higher positive CAD family history rate (29.7% vs. 19.9%, P < 0.05) and significantly higher TG level [(2.13 +/- 1.89) mmol/L vs. (1.78 +/- 1.14) mmol/L, P < 0.05], while had significantly fewer traditional risk factors (2.50 +/- 1.28 vs. 2.76 +/- 1.43, P < 0.05) and lower hypertension rate (59.3% vs. 73.3%, P < 0.05). There were significantly more PCAD patients with acute coronary syndrome (66.2% vs. 42.6%, P < 0.05), more PCAD patients had single vessel lesion (51.0% vs. 30.4%, P < 0.05), lower average lesion score (4.86 +/- 2.30 vs. 5.92 +/- 2.66, P < 0.05). (2) The logistic regression results showed that positive CAD family history (P = 0.029, OR = 1.766, 95% CI 1.060 - 2.940) and smoking (P = 0.066, OR = 1.561, 95% CI 0.971 - 2.510) are important independent risk factors for the development of PCAD.

CONCLUSIONSSmoking, positive family history and the increased TG might contribute to the pathogenesis of PCAD.

Adult ; Aged ; Coronary Artery Disease ; diagnosis ; epidemiology ; prevention & control ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Smoking ; adverse effects ; Triglycerides ; blood

OBJECTIVE: Identification of new risk factors is needed to improve prediction of adverse outcomes in patients with three-vessel disease (TVD). The present study aimed to evaluate the prognostic values of serum chloride and sodium levels in patients with TVD. METHODS: We used data from a prospective cohort of consecutive patients with angiographically confirmed TVD. The primary endpoint was all-cause death. Cox proportional hazard regression was used to analyze the relationship of serum chloride and sodium levels with long-term outcomes of TVD patients. RESULTS: A total of 8,318 participants with available serum chloride and sodium data were included in this analysis. At baseline, patients in the low tertiles group of serum chloride level (⪕ 102.0 mmol/L) or serum sodium level (⪕ 139.0 mmol/L) had more severe disease conditions. During a median follow-up of 7.5-year, both low serum chloride level and low serum sodium level were found to be associated with an increased risk for mortality in univariate analysis. However, when both parameters were incorporated into a multivariate model, only low serum sodium level remained to be an independent predictor of all-cause death (hazard ratio: 1.16, 95% confidence interval: 1.01-1.34, P = 0.041). Modest but significant improvement of discrimination was observed after incorporating serum sodium level into the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery score. CONCLUSION Serum sodium level is more strongly associated with long-term outcomes of TVD patients compared with serum chloride level. Low serum sodium level is an independent risk factor for mortality, but only provides modest prognostic information beyond an established risk model.
Aged ; China ; epidemiology ; Chlorides ; blood ; Coronary Artery Disease ; blood ; diagnosis ; mortality ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Sodium ; blood

BACKGROUND: The diagnosis of coronary artery disease (CAD) is often delayed in patients with type 2 diabetes. Serum total bilirubin levels are inversely associated with CAD. However, no studies have examined whether this can be used as a biochemical marker for identifying asymptomatic diabetic patients at higher risk for having obstructive CAD. METHODS: We performed a cross-sectional study of 460 consecutive asymptomatic patients with type 2 diabetes. All patients underwent coronary computed tomographic angiography, and their serum total bilirubin levels were measured. Obstructive CAD was defined as > or =50% diameter stenosis in at least one coronary artery. RESULTS: Serum total bilirubin tertiles showed an inverse association with the prevalence of obstructive CAD. In multivariate logistic regression analysis, the odds ratio for the highest versus the lowest tertile of total bilirubin was 0.227 (95% confidence interval [CI], 0.130 to 0.398), and an increment of 1 micromol/L in serum total bilirubin level was associated with a 14.6% decrease in obstructive CAD after adjustment for confounding variables. Receiver operating characteristic curve analysis showed that the area under the curve for the Framingham Risk Score (FRS) plus serum total bilirubin level was 0.712 (95% CI, 0.668 to 0.753), which is significantly greater than that of the FRS alone (P=0.0028). CONCLUSION: Serum total bilirubin level is inversely associated with obstructive CAD and provides additive risk information over the FRS. Serum total bilirubin may be helpful for identifying asymptomatic patients with type 2 diabetes who are at higher risk for obstructive CAD.
Angiography ; Bilirubin* ; Biomarkers ; Confounding Factors (Epidemiology) ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Cross-Sectional Studies ; Diabetes Mellitus ; Diagnosis ; Humans ; Logistic Models ; Multidetector Computed Tomography ; Odds Ratio ; Prevalence ; ROC Curve