<strong>Background:</strong><span style="white-space:normal;"><span style="font-family:;" "=""><strong> </strong>The current gold standard fo...<strong>Background:</strong><span style="white-space:normal;"><span style="font-family:;" "=""><strong> </strong>The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. <b>Objective:</b> The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospital</span></span><span style="white-space:normal;"><span style="font-family:;" "="">s</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> structures in Senegal. <b>Method: </b>We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. <b>Results</b>: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years;men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%;diabetes was 34.27%;dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel;28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36;95% CI, 1.05 - 5.29;p = 0.036);male gender (OR, 1.6;95% CI, 0.72 - 3.57;p = 0.24);diabetes (OR, 2.14;95% CI, 0.96 - 4.75;p = 0.06) and necrosis Q waves (4.75;CI, 0.98 - 23.09;p = 0.05). <b>Conclusion: </b>In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.</span></span>展开更多
AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patient...AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.展开更多
To the Editor:More than half of the patients undergoing invasive coronary angiography for angina or signs of myocardial ischemia present with non-obstructive coronary arteries(NOCA,<50%diameter reduction or fractio...To the Editor:More than half of the patients undergoing invasive coronary angiography for angina or signs of myocardial ischemia present with non-obstructive coronary arteries(NOCA,<50%diameter reduction or fractional flow reserve>0.80).[1]Coronary microvascular dysfunction(CMD)is a significant pathophysiological factor in these patients and is linked to adverse outcomes.[2]Although coronary reactivity testing(CRT)remains the gold standard for diagnosing CMD,it is both invasive and costly.Stress cardiac magnetic resonance(CMR)is a non-invasive and promising alternative,providing essential perfusion parameters such as myocardial perfusion reserve index(MPRI)and myocardial perfusion reserve(MPR)to diagnose CMD.Thus,based on current literature,there is robust evidence supporting the effectiveness of stress CMR in diagnosing CMD in patients with NOCA,as defined by CRT.展开更多
文摘<strong>Background:</strong><span style="white-space:normal;"><span style="font-family:;" "=""><strong> </strong>The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. <b>Objective:</b> The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospital</span></span><span style="white-space:normal;"><span style="font-family:;" "="">s</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> structures in Senegal. <b>Method: </b>We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. <b>Results</b>: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years;men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%;diabetes was 34.27%;dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel;28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36;95% CI, 1.05 - 5.29;p = 0.036);male gender (OR, 1.6;95% CI, 0.72 - 3.57;p = 0.24);diabetes (OR, 2.14;95% CI, 0.96 - 4.75;p = 0.06) and necrosis Q waves (4.75;CI, 0.98 - 23.09;p = 0.05). <b>Conclusion: </b>In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.</span></span>
文摘AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.
基金supported by the National Key R&D Program of China(Nos.2021YFF0501400 and 2021YFF0501404)the Key Project of National Natural Science Foundation of China(No.81930044).
文摘To the Editor:More than half of the patients undergoing invasive coronary angiography for angina or signs of myocardial ischemia present with non-obstructive coronary arteries(NOCA,<50%diameter reduction or fractional flow reserve>0.80).[1]Coronary microvascular dysfunction(CMD)is a significant pathophysiological factor in these patients and is linked to adverse outcomes.[2]Although coronary reactivity testing(CRT)remains the gold standard for diagnosing CMD,it is both invasive and costly.Stress cardiac magnetic resonance(CMR)is a non-invasive and promising alternative,providing essential perfusion parameters such as myocardial perfusion reserve index(MPRI)and myocardial perfusion reserve(MPR)to diagnose CMD.Thus,based on current literature,there is robust evidence supporting the effectiveness of stress CMR in diagnosing CMD in patients with NOCA,as defined by CRT.
