Angioplasty, Balloon, Coronary ; Chronic Disease ; Coronary Disease ; therapy ; Coronary Occlusion ; therapy ; Humans

Humans ; Hyperplasia ; etiology ; Male ; Middle Aged ; Prosthesis Failure ; Stents ; Tomography, Optical Coherence ; adverse effects ; Tunica Intima ; pathology

BACKGROUNDBoth non-alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) are closely associated with many metabolic disorders. Invasive coronary angiography (CAG) is a common approach as an intervention for CAD. However, the association between angiographic severity of coronary artery and NAFLD remains controversial. This study aimed to evaluate the relationship between NAFLD and CAD.

METHODSTotally 542 consecutive patients who planned to undergo CAG due to a suspected CAD were enrolled. Abdominal computed tomography (CT) was performed before angiography to detect NAFLD. CAD was defined as stenosis of at least 50% in at least one major coronary artery. The severity of CAD was assessed by the number of vessels affected and the vessel score multiplied by the severity score (Gensini score). Significant stenosis was defined as 70% or greater reduction in lumen diameter. A probability value of P < 0.05 was considered statistically significant.

RESULTSOf 542 patients studied, 248 (45.8%) were found to have NAFLD by abdominal CT, and 382 patients (88%) were found to have significant CAD by CAG. Age, diabetes mellitus, waist circumference, body mass index, and obesity were associated with NAFLD. According to the results of Logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG (odds ratio (OR), 95% confidence interval (CI): 7.585 (4.617-12.461); P < 0.001). NAFLD was significantly more common in patients as CAD severity increased (P < 0.001).

CONCLUSIONSThe presence of NAFLD is associated with high severity of CAD, requiring that patients with abdominal obesity be also investigated for NAFLD. Patients with NAFLD should be closely followed up for the presence and severity of CAD.

Aged ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; pathology ; Fatty Liver ; diagnostic imaging ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease

OBJECTIVEPost percutaneous coronary intervention (PCI) major cardiac event rate is high in patients with high platelet aggregability. We observed the effects of intensive antiplatelet therapy in these patients.

METHODSADP-induced platelet inhibition rates were less than 30% after 24 h treatment with Clopidogrel (300 mg) in 402 patients out of 1556 patients who underwent PCI in our institute between January 2004 to June 2006. These patients were randomly divided into control group (Clopidogrel 75 mg/d and aspirin 100 mg/d, n = 201) or treatment group (Clopidogrel 75 mg/d and aspirin 100 mg/d plus cilostazol 200 mg/d, n = 201). Major adverse cardiac events were analyzed after 6 months treatments.

RESULTSPatients with ADP-induced platelet inhibition rates < 30% were significantly lower in treatment group compared to control group after 28 days treatments (9.4% vs. 89.6%, P < 0.05). Thrombosis complication (0.5% vs. 3.0%), death (0 vs. 1.0%), non-fatal myocardial infarction (0.5% vs. 1.5%), hemorrhagic (6% vs. 4%) rates were similar between treatment and control group while target vessel revascularization rate was significantly lower in treatment group compared to control group (6.5% vs. 15.9%, P < 0.05). Total MACE rate was therefore significantly lower in treatment group than that in control group (13.5% vs. 25.4%, P < 0.05).

CONCLUSIONIntensive anti-platelet treatment could significantly reduce major cardiac event rates in patients with high platelet aggregability after percutaneous coronary intervention.

Aged ; Angioplasty, Balloon, Coronary ; Aspirin ; therapeutic use ; Coronary Artery Disease ; drug therapy ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; Platelet Aggregation Inhibitors ; therapeutic use ; Platelet Count ; Ticlopidine ; analogs & derivatives ; therapeutic use

BACKGROUNDInflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein (CRP) is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 (MMP-9) is highly over-expressed in the vulnerable regions of a plaque. Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.

METHODSPatients with newly diagnosed unstable angina pectoris from clinical presentation and ECG, who were undergoing coronary angiography from April 2007 to April 2009, were included in this study. A total of 170 subjects were enrolled in the study. Before angiography, the baseline clinical data (mainly including conventional risk factors) was collected. These patients were divided into two groups, a non-plaque group (G1) which included 55 patients with no significant stenosis or less than 20% stenosis in at least one of the major coronary artery branches, and a plaque group (G2) which included 115 patients with at least one of the major coronary artery branches unstable angina pectoris with at least 50% stenosis of one major coronary artery. The patients presenting with calcified nodules of a major coronary artery were excluded from this study. We examined the serum levels of MMP-9 for all cases by multi-effect enzyme-linked immunosorbent assay.

RESULTSThere was a significant difference in the serum levels of MMP-9 between the two groups (P < 0.001). The percentage of patients with hypertension, diabetes and current smokers were significantly different between the two groups (P = 0.034, P = 0.031, and P = 0.044 respectively). The univariate Logistic regression analyses of risk factors showed that smoking was the main risk factor for angina in the non-plaque group with the OR being 1.95 (95%CI 1.02 - 3.75). Hypertension, diabetes mellitus were negatively related with the occurrence of angina in the non-plaque group with the ORs being 0.50, and 0.36, respectively (95%CI 0.26 - 0.96 and 0.14 - 0.94). The MMP-9 level was negatively related to the occurrence of angina in the non-plaque group with an OR of 0.59 (95%CI 0.47 - 0.81).

CONCLUSIONSThere is a significantly difference in MMP-9 levels between the plaque and non-plaque groups. Current smoking has a significant influence on unstable angina patients without documented plaques. The serum MMP-9 level may be a significant biomarker which can help differentiate patients with unstable angina with plaques from those with unstable angina but without plaques.

Aged ; Angina, Unstable ; blood ; metabolism ; physiopathology ; C-Reactive Protein ; metabolism ; Coronary Angiography ; Coronary Artery Disease ; blood ; metabolism ; physiopathology ; Coronary Vessels ; metabolism ; pathology ; Female ; Humans ; Male ; Matrix Metalloproteinase 9 ; blood ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Smoking ; adverse effects

BACKGROUNDPatients with prior coronary artery bypass graft (CABG) have a poor outcome after acute myocardial infarction (AMI). Little is known about the treatment strategy and outcome of percutaneous coronary intervention (PCI) in these patients. The purpose of this study was to investigate the impact of graft versus native artery PCI on the outcomes of prior CABG patients with AMI.

METHODSBetween September 2005 and October 2011, a total of 140 consecutive patients with previous CABG undergoing PCI for the treatment of AMI were included. Clinical/procedural characteristics and long-term clinical outcomes were compared between graft and native artery PCI patients.

RESULTSThe mean time interval to prior CABG was (5.6 ± 4.2) years. Thirty patients received graft PCI, success rate being 90%. One hundred and ten patients received native artery PCI, success rate being 90.7% (P > 0.05). There were no significant differences in the basic characteristics between the two groups. All patients received drug eluting stents (DESs). Three patients died during hospitalization in the graft-PCI group (10% vs. native PCI 0, P < 0.05). After a median follow- up of two years, major adverse cardiac events (MACE) (myocardial infarction, target vessel revascularization, total death) were 20% with no significant difference between the two groups. Cox regression analysis showed that both diabetes mellitus (DM, HR 3.57, 95%CI 1.03 - 5.75, P < 0.05) and primary PCI (HR 5.932, 95%CI 1.91 - 18.4, P < 0.05) were independent predictors of MACE.

CONCLUSIONSMore patients with prior CABG underwent native artery PCI for AMI. PCI to culprit graft vessels had higher in-hospital mortality. DM and primary PCI, but not graft PCI, were predictors for adverse long-term outcome.

Aged ; Coronary Artery Bypass ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; physiopathology ; surgery ; Percutaneous Coronary Intervention ; Proportional Hazards Models ; Retrospective Studies ; Treatment Outcome

BACKGROUNDAntithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome (NSTEACS), yet limited information is available about their applications from a multicenter "real-world" clinical procedure, especially in China. This study was undertaken to characterize the use of antithrombotic and antiplatelet agents in relation to the risk levels of the NSTEACS patients who were enrolled in Sino-Global Registry of Acute Coronary Events (GRACEs) registry study.

METHODSWe analyzed the data from 618 Chinese NSTEACS patients stratified into low-(n = 151), intermediate-(n = 233), and high-risk groups (n = 234) based on GRACE risk scores. The baseline characteristics, clinical presentations, antithrombotic and antiplatelet agents were recorded and compared among the three groups.

RESULTSThe administration rates of low-molecular-weight heparins (LMWHs) (86.08%) and thienopyridines (85.92%) were higher whereas the administration rate of glycoprotein IIb/IIIa inhibitor (1.78%) was much lower than those reported previously. Meanwhile, within the first 24 hours of admission, the use of heparin/LMWHs in the high-risk group was more than that in the intermediate- and low-risk groups (73.50% vs 63.09% vs 55.63%, P = 0.001). Furthermore, the combination of antithrombotic and antiplatelet medications showed no significant differences in all groups.

CONCLUSIONSIn the "real world" practice of China, the antithrombotic and antiplatelet therapies on NSTEACS are well adherent to the current guidelines except for several gaps, such as the very low use of glycoprotein IIb/IIIa inhibitor. Moreover, these antithrombotic and antiplatelet treatments usually tend to be underused for the high-risk ones.

Acute Coronary Syndrome ; drug therapy ; Aged ; Coronary Disease ; drug therapy ; Female ; Fibrinolytic Agents ; therapeutic use ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex ; antagonists & inhibitors ; Pyridines ; therapeutic use ; Registries ; Risk Assessment

OBJECTIVETo investigate the diagnostic accuracy and clinical value of electron-beam CT (EBCT) single flow mode study (EBCTSF) in combination with EBCT coronary angiography (EBCTCA) and three dimensional reconstruction using medial axis reformation (MAR) for diagnosis of coronary in-stent stenosis.

METHODSElectrocardiogram-gated EBCT single coronary scanning (without and with contrast medium) was performed in 25 consecutive coronary heart disease (CHD) patients during a short breathhold. EBCTSF was then performed at the level nearly distal to stent. Three-dimensional coronary images were reformed using MAR. EBCT findings were compared with that of conventional coronary angiography (CAG).

RESULTSThirty-five intracoronary stents were implanted in thirty-one diseased vessel segments. EBCTSF procedure was unsuccessful in 2 patients (successful rate was 92.0%, 23/25). There was a significant decrease in flow peak value (Dp), increased value (Deltad) and area under curve (A), and a significant increase in prolonged peak time (Td) in stenosed stents compared to normal stents (P < 0.05). EBCTCA was successful for all patients. Seven stenosed stents (5 in left anterior descending branch and 2 in right coronary) were correctly evaluated with EBCT. Compared with CAG, EBCTSF in combination with EBCTCA images and MAR reconstruction images had a diagnostic sensitivity of 85.0% (6/7) and a specificity of 92.9% (26/28) for detecting significant in-stent stenosis (> 50% lumen diameter). Positive and negative predictive value were 75.0% (6/8) and 96.5% (26/27) respectively. Compared with EBCT cross-section images alone, or cross-section images and three-dimensional images, the diagnostic accuracy increased from 80.0% and 88.6% to 91.4% (32/35).

CONCLUSIONSNoninvasive EBCTSF can be used to quantitatively analyze coronary flow characteristics. This technique, used in combination with EBCTCA and three dimensional reconstruction using MAR, seems to be an effective imaging modality in identifying coronary in-stent stenosis. For stent-implanted patients with atypical and nonischemic chest pain after coronary intervention, the above-mentioned technique is of important value for evaluating therapeutic effect and follow-up results.

Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; Coronary Restenosis ; diagnostic imaging ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents ; Tomography, X-Ray Computed ; methods

BACKGROUNDVasoactive factors have been reported to correlate with vulnerable plaque and acute coronary syndrome (ACS). This study aimed to investigate the relationship between vasoactive factors and plaque morphology in patients suffering from non-ST-segment elevated ACS.

METHODSFrom April 2007 to April 2009, 124 consecutive patients suffering from non-ST-segment elevated ACS who had received coronary angiography (CAG) and intravascular ultrasound (IVUS) in the People's Liberation Army General Hospital and Beijing Anzhen Hospital were enrolled in this study. Three serum vasoactive factors, plasma soluble vascular endothelial growth factor receptor-1 (sFlt-1), placental growth factor (PLGF) and interleukin-18 (IL-18), were measured by enzyme-linked-immunosorbent serologic assay of the patients. The levels of vasoactive factors were compared between vulnerable plaque group and stable plaque group, and between unstable angina pectoris (UAP) group and non-ST-segment elevation acute myocardial infarction (NSTE-AMI) group. The relationship between the plaque morphology and levels of vasoactive factors was analyzed.

RESULTSThe levels of vasoactive factors were similar between the UAP group (69 patients) and NSTE-AMI group (55 patients). The levels of sFlt-1 and PLGF in the vulnerable plaque group were significantly higher than those in the stable plaque group. The level of IL-18 was correlated positively with plaque morphology. Multivariate Logistic regression analysis showed that the level of PLGF was an independent risk factor for vulnerable plaque (OR=2.115, 95% CI 1.415-5.758, P=0.018). Using the ROC curve, PLGF was a significant factor for the diagnosis of vulnerable plaque (the diagnostic point was 26.3 ng/L, the proportion of square area under the ROC curve was 0.799, 95%CI 0.758-0.839, P<0.001; the sensitivity of PLGF under the ROC curve was 86%, and the specificity 63%).

CONCLUSIONBoth IL-18 and PLGF are biomarkers for vulnerable plaques and helpful to predict vulnerable plaque.

Acute Coronary Syndrome ; blood ; diagnostic imaging ; Aged ; Angina Pectoris ; blood ; diagnostic imaging ; Angina, Unstable ; blood ; diagnostic imaging ; Coronary Angiography ; Female ; Humans ; Interleukin-18 ; blood ; Male ; Middle Aged ; Placenta Growth Factor ; Pregnancy Proteins ; blood ; Ultrasonography, Interventional ; Vascular Endothelial Growth Factor Receptor-1 ; blood

BACKGROUNDCathepsin S and its endogenous inhibitor cystatin C are implicated in the pathogenesis of atherosclerosis, especially in the plaque destabilization and rupture leading to acute coronary syndrome. However, whether circulating cathepsin S and cystatin C also change in association with coronary plaque morphology is unknown yet.

METHODSWe recruited 98 patients with unstable angina (UA, n = 6) or stable angina (SA, n = 2) who had a segmental stenosis resulting in > 20% and < 70% diameter reduction in one major coronary artery on coronary angiography. Thirty-one healthy subjects served as controls. Intravascular ultrasound (IVUS) was used to evaluate plaque morphology. Plasma cathepsin S and cystatin C were measured as well.

RESULTSAt the culprit lesion site, plaque area ((7.85 +/- 2.83) mm(2) vs (6.53 +/- 2.92) mm(2), P = 0.027), plaque burden ((60.92 +/- 11.04)% vs (53.87 +/- 17.52)%, P = 0.025), remodeling index (0.93 +/- 0.16 vs 0.86 +/- 0.10, P = 0.004) and eccentricity index (0.74 +/- 0.17 vs 0.66 +/- 0.21, P = 0.038) were bigger in UA group than in SA group. Plasma cathepsin S and cystatin C were significantly higher in patients than in controls (P < 0.01). Plasma cathepsin S was higher in UA group ((0.411 +/- 0.121) nmol/L) than in SA group ((0.355 +/- 0.099) nmol/L, P = 0.007), so did the plasma cystatin C ((0.95 +/- 0.23) mg/L in UA group, (0.84 +/- 0.22) mg/L in SA group; P = 0.009). Plasma cathepsin S positively correlated with remodeling index (r = 0.402, P = 0.002) and eccentricity index (r = 0.441, P = 0.001), and plasma cystatin C positively correlated with plaque area (r = 0.467, P < 0.001) and plaque burden (r = 0.395, P = 0.003) in UA group but not in SA group.

CONCLUSIONSPlasma cathepsin S and cystatin C increased significantly in UA patients. In angina patients, higher plasma cathepsin S may suggest the presence of vulnerable plaque, and higher plasma cystatin C may be a clue for larger atherosclerotic coronary plaque.

Adult ; Aged ; Aged, 80 and over ; Cathepsins ; blood ; Coronary Artery Disease ; blood ; diagnostic imaging ; pathology ; Cystatin C ; blood ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional ; methods