Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-t...Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.展开更多
BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chine...BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chinese population.This study aimed to develop and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events(MACCE)in elderly Chinese patients with ACS.METHODS A retrospective analysis was conducted using two independent cohorts of ACS patients aged≥65 years who underwent percutaneous coronary intervention:the derivation cohort(n=1674)and the validation cohort(n=2333).Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion.A final nomogram incorporating ten variables was constructed.Model performance was evaluated in terms of discrimination[concordance index(C-index)and area under the receiver operating characteristic curve(AUC)]and calibration(calibration plots).RESULTS The 2-year incidence of MACCE was 12.5%(n=210)in the derivation cohort and 15.6%(n=364)in the validation cohort.The nomogram demonstrated good discrimination,with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort,respectively;significantly outperforming the GRACE risk score(P<0.001).Calibration plots showed good agreement between the predicted and observed outcomes.Patients classified as the high-risk group by the nomogram had a significantly higher MACCE incidence compared to that of the low-risk group(log-rank P<0.001).CONCLUSIONS This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention.It outperformed the GRACE score in both discrimmination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased morta...BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.展开更多
The management of acute coronary syndrome(ACS)in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes.Bivalirudin,a direct inhibitor of thrombin,serves as an alternat...The management of acute coronary syndrome(ACS)in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes.Bivalirudin,a direct inhibitor of thrombin,serves as an alternative to traditional therapies.This drug is particularly effective in enhancing myocardial microcircu-lation and reducing adverse events after clinical interventions.The present article explores the findings of a recent study that highlighted the clinical benefits of bivalirudin by investigating its effects on myocardial microcirculation and adverse cardiac events after percutaneous coronary intervention in older patients with ACS.Compared with unfractionated heparin,bivalirudin markedly reduced the emergency response time and improved cardiac function indicators.It further mitigated the risks of cardiovascular events and recurrent myocardial infarctions.These findings suggest that bivalirudin can enhance myocardial perfusion and reduce bleeding complications,thus serving as a safe,effective anticoagulation agent for older patients with ACS.Nonetheless,further large-scale,high-quality trials are needed to establish optimal usage guidelines and assess long-term outcomes.Integrating bivalirudin into ACS treatment protocols for older patients may help optimize patient care,balancing efficacy and safety.Continual research and consensus building are necessary for the widespread clinical application of bivalirudin and the improvement of ACS outcomes in older patients.展开更多
Objective:To investigate the impact of early initiation of intensive lipid-lowering therapy on the postoperative efficacy and inflammatory factors in patients with acute coronary syndrome(ACS)undergoing percutaneous c...Objective:To investigate the impact of early initiation of intensive lipid-lowering therapy on the postoperative efficacy and inflammatory factors in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods:A total of 100 ACS patients undergoing PCI admitted to our hospital were selected as the study subjects.They were randomly divided into a control group(treated with statin combined with ezetimibe,n=41),a study group 1(initiated with statin combined with PCSK9 inhibitor immediately after surgery,n=32),and a study group 2(routinely administered oral statin and initiated with combined PCSK9 inhibitor before discharge,n=27).The therapeutic efficacy,inflammatory factor levels,and incidence of adverse events were compared and analyzed among the three groups.Results:The therapeutic regimen in study group 1 demonstrated the optimal efficacy and impact on inflammatory factors,followed by study group 2,while the control group showed relatively weaker efficacy,with statistically significant differences(p<0.05).The overall incidence of adverse reactions was 30.00%in the control group,5.00%in study group 1,and 10.00%in study group 2,with statistically significant differences among the groups(p<0.05),with the lowest incidence observed in study group 1.Conclusion:Early intensive lipid-lowering therapy can effectively improve lipid metabolism,suppress inflammatory responses,and reduce cardiovascular events in ACS patients after PCI,suggesting its pleiotropic cardiovascular protective effects.展开更多
BACKGROUND Bioresorbable scaffolds(BRS)are a promising alternative to traditional drugeluting stents(DES)for the treatment of acute coronary syndrome(ACS).They offer the potential for complete resorption,which may red...BACKGROUND Bioresorbable scaffolds(BRS)are a promising alternative to traditional drugeluting stents(DES)for the treatment of acute coronary syndrome(ACS).They offer the potential for complete resorption,which may reduce long-term complications such as stent thrombosis and late restenosis.However,the safety,compatibility,and long-term outcomes of BRS in patients with intermediate to low-risk ACS have yet to be thoroughly investigated.AIM To investigate the safety,compatibility,and long-term outcomes of BRS in patients with intermediate to low-risk ACS.METHODS Patients with intermediate to low-risk ACS who underwent percutaneous coronary intervention with either DES or BRS,and were continuously recruited from January 2019 to June 2022 at a single center,were analyzed.Baseline data and clinical follow-up were collected for patients who underwent DES implantation(control group)and BRS implantation(observation group),and the survival outcomes and complications during a maximum follow-up period of 3 years were compared.The primary clinical endpoint was device-oriented composite endpoint(DoCE),representing the occurrence of one of the following events:Cardiac death,stent thrombosis,target vessel myocardial infarction,and clinically driven target lesion revascularization.Secondary endpoints included coronary artery bypass grafting,target vessel revascularization,and non-cardiac death.RESULTS A total of 128 patients were included in this study,with an average age of 63 years.Among them,95 were male(74%).The study involved treatment of 201 blood vessels:87(43%)received BRS,and 114(57%)received DES.A total of 97 patients completed the full 3-year follow-up.During this period,5 patients(17%)in the observation group and 7 patients(16%)in the control group experienced a major cardiovascular event(DoCE).At the 1-year follow-up,7 patients(15%)in the observation group and 6 patients(10%)in the control group experienced DoCE,and this difference was statistically significant(P<0.05).At the 2-year follow-up,there was also a significant difference between the two groups in the number of patients who needed repeat treatment of the target blood vessel(P<0.05).In the observation group,18 patients(33%)underwent follow-up coronary angiography.During the follow-up period,one patient in the observation group was found to have re-narrowing in the proximal and middle segments of the left anterior descending artery,possibly due to BRS collapse.Another patient in the observation group developed chronic total occlusion in multiple vessels at the 3-year follow-up and underwent coronary artery bypass grafting.CONCLUSION In low-to intermediate-risk ACS patients,those who got BRS had their first major heart event sooner than those who got DES.BRS is more tissue-friendly,yet over three years both groups had about the same amount of problems-only a few BRS patients still saw the scaffold collapse or the vessel slowly block.展开更多
Previous studies have suggested that abnormal hepatobiliary system function may contribute to poor prognosis in patientswith acute coronary syndrome(ACS)and that abnormal hepatobiliary system function may be associate...Previous studies have suggested that abnormal hepatobiliary system function may contribute to poor prognosis in patientswith acute coronary syndrome(ACS)and that abnormal hepatobiliary system function may be associated with per-and polyfluoroalkyl substances(PFAS)exposure.However,there is limited evidence for this association in cardiovascular subpopulations,particularly in the ACS patients.Therefore,we performed this study to evaluate the association between plasma PFAS exposure and hepatobiliary system function biomarkers in patients with ACS.This study included 546 newly diagnosed ACS patients at the Second Hospital of Hebei Medical University,and data on 15 hepatobiliary system function biomarkers were obtained from medical records.Associations between single PFAS and hepatobiliary system function biomarkers were assessed using multiple linear regression models and restricted cubic spline model(RCS),and mixture effects were assessed using the Quantile g-computation model.The results showed that total bile acids(TBA)was negative associated with perfluorohexane sulfonic acid(PFHxS)(-7.69%,95%CI:-12.15%,-3.01%).According to the RCS model,linear associations were found between TBA and PFHxS(P for overall=0.003,P for non-linear=0.234).We also have observed the association between between PFAS congeners and liver enzyme such as aspartate aminotransferase(AST)and α-l-Fucosidase(AFU),but it was not statistically significant after correction.In addition,Our results also revealed an association between prealbumin(PA)and PFAS congeners as well as mixtures.Our findings have provided a piece of epidemiological evidence on associations between PFAS congeners or mixture,and serum hepatobiliary system function biomarkers in ACS patients,which could be a basis for subsequent mechanism studies.展开更多
This article reviews the characteristics of psychological disorders in young and middle-aged acute coronary syndrome(ACS)patients,the mechanisms and effects of various psychological intervention strategies,factors inf...This article reviews the characteristics of psychological disorders in young and middle-aged acute coronary syndrome(ACS)patients,the mechanisms and effects of various psychological intervention strategies,factors influencing return to work,and current research problems and development trends,to provide scientific evidence for psychological rehabilitation and social function recovery of young and middle-aged ACS patients.展开更多
OBJECTIVE:To investigate the effects of gut microbes regulation of the trimethylamine(TMA)/flavin containing monooxygenase 3(FMO3)/trimethylamine N-oxide(TMAO)pathway on platelet aggregation in acute coronary syndrome...OBJECTIVE:To investigate the effects of gut microbes regulation of the trimethylamine(TMA)/flavin containing monooxygenase 3(FMO3)/trimethylamine N-oxide(TMAO)pathway on platelet aggregation in acute coronary syndrome(ACS)rats and the intervention of Huayu Qutan formula(化瘀祛痰方).METHODS:The ACS rats with syndrome of phlegm and blood stasis rats were established.Platelet,platelet aggregation,platelet activation markers and TMA/FMO3/TMAO pathway were detected.Metagenomics technology was employed to analyze the characteristics of the gut microbiota.RESULTS:Huayu Qutan formula and gut microbes could inhibit high platelet reactivity and regulate the TMA/FMO3/TMAO pathway.The dominant bacteria in ACS rats including but not limited to the major phyla,Firmicutes,Bacteroidetes,Actinobacteria,and Proteobacteria,also including some low abundance phyla,Fusobacteria,Verrucomicrobia,Spirochaetes,and Deferribacteres.The dominant bacteria in the Huayu Qutan formula group were Synergistetes,Deferribacteres,Deferribacteraceae,Faecalibacterium and Mucispirillum.In the Huayu Qutan formula combined with fecal bacteria enema group,the dominant bacteria were Verrucomicrobia,Verrucomicrobiae,Akkermansia and Verrucomicrobium.These gut microbiota were correlated with pathways such as Riboflavin metabolism and Arachidonic acid metabolism.CONCLUSION:Huayu Qutan formula may prevent ACS by modulating gut microbes Synergistetes,Faecalibacterium and Allobaculum,regulating the iron metabolism of Deferribacteres,and driving the TMA/FMO3/TMAO pathway to regulate gut microbiota function,and improving platelet aggregation.Akkermansia may serve as a promising probiotic,which could drive TMA/FMO3/TMAO pathway to regulate Arachidonic acid metabolism to improve platelet aggregation.The findings of this study provide a theoretical basis for the theory of"the heart is connected with the small intestine".展开更多
Objective:To investigate the clinical characteristics of familial hypercholesterolemia and early-onset acute coronary syndrome(ACS),in order to improve the understanding and diagnosis and treatment of the disease.Meth...Objective:To investigate the clinical characteristics of familial hypercholesterolemia and early-onset acute coronary syndrome(ACS),in order to improve the understanding and diagnosis and treatment of the disease.Methods:We retrospectively studied the clinical data of 2 patients with familial hypercholesterolemia and premature acute coronary syndrome treated in the Department of Cardiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.All patients underwent genetic testing and coronary artery angiography.Results:Two patients were heterozygous familial hypercholesterolemia by gene test.Coronary artery angiography showed that three coronary arteries had serious lesions,which recovered well after drug and surgical treatment.Conclusion:Patients with familial hypercholesterolemia were prone to early onset of acute coronary syndrome,which should be identified,diagnosed and treated as soon as possible.展开更多
Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which f...Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome （ACS）. Methods Patients aged 〉 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease （CAD）--specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression. Results Of the 352 patients, 152 （43.18%） were considered frail according to the study instrument （5-7 on the scale）, and 93 （26.42%） were considered moderately or se- verely frail （6-7 on the scale）. Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients （P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively）. Adjusted for sex, age, severity of coro- nary artery diseases （left main coronary artery lesion or not） and co-morbidities （CAD specific index） by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes： all-canse mortality [Hazard Ratio （HR） = 5.393; 95% CI： 1.477-19.692, P = 0.011] and unscheduled return visit （HR - 2.832; 95% CI： 1.140-7.037, P = 0.025）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.展开更多
To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without persistent ST elevation （acu...To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without persistent ST elevation （acute coronary syndrome, ACS）, a total of 200 patients were randomly assigned to a heparin group and a tirofiban＋heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or refractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban＋heparin group as compared with that of heparin group （13.9% vs 29.3 %, P=0.010）. The rates of the other composite end point events in the tirofiban＋heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination （P=0.1717）. The study showed that the incidence of ischemic events in patients with ACS receiving tirofiban＋heparin was lower when compared with that of patients who received only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.展开更多
Objective To investigate the correlation between serum resistin level, cardiovascular risk factors and severity of coronary disease in acute coronary syndrome （ACS）. Methods Alter evaluated by clinical history, ele...Objective To investigate the correlation between serum resistin level, cardiovascular risk factors and severity of coronary disease in acute coronary syndrome （ACS）. Methods Alter evaluated by clinical history, electrocardiography, exercise tolerance tests, laboratory tests, and coronary angiography, 220 consecutive patients with suspected chest pain were divided into normal control group, stable angina pectoris （SAP） group, and ACS group, respectively. Baseline clinical characteristics, including height, weight, waist circumference, hip circumference, white blood cell count, high-sensitive C-reactive protein （hsCRP）, total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, were compared among three groups. ELISA was used to detect serum resistin levels. Pearson＇s correlation coefficient analysis was used to assess association between resistin and other traditional cardiovascular risk factors. Multinomial logistic regression analyses were used to define the relationship between serum resistin level and SAP or ACS. Results Serum resistin level in ACS group （1.18±0.48 μg/L） was significantly higher than that in normal control and SAP groups （0.49±0.40 and 0.66±0.40 μg/L; P〈0.01）. Only in ACS group, increased serum resistin level was significantly correlated with hsCRP （r=0.262, P=0.004） and white blood cell count （r=0.347, P=0.001）. Furthermore, serum resistin levels showed a stepwise increase with the number increase of 〉 50% stenosed coronary vessels. Multinomial logistic regression test demonstrated that serum resistin was a strong risk factor for ACS （OR=29.132, 95 % CI： 10.939-77.581, P〈0.001）. Conclusion These findings suggested the potential role of resistin in atherosclerosis and especially its involvement in ACS.展开更多
Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains ...Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.展开更多
Objective: To explore the relationship of Traditional Chinese Medicine (TCM) Syndrome type and coronary arteriography (CAG) with respect to the number and degree of stenosed branches of coronary artery (CA) and ACC/AH...Objective: To explore the relationship of Traditional Chinese Medicine (TCM) Syndrome type and coronary arteriography (CAG) with respect to the number and degree of stenosed branches of coronary artery (CA) and ACC/AHA stage of acute coronary syndrome (ACS), to provide an objective evidence for TCM Syndrome typing on ACS Methods: Ninety patients of ACS with their TCM Syndrome typing and CAG successfully conducted were enrolled in this study. They were classified into 3 Syndrome types, the blood stasis type (type I ), the phlegm stagnant with blood stasis type (type II ),and the endogenous collateral Wind type (type III) The scores of the number and severity of the stenosis branch of CA and ACC/AHA lesion stage in different Syndrome types were calculated respectively and analysed statistically by Ridit analysis. Results: The number of stenosed branches increased gradually with the Syndrome type changing from I -II-III, compared the type III with the other two types(P<0. 01). The severity of stenosis in type I and II were similar, but that of Type III, much aggravated was significantly different from that in the former two (P<0. 01) . The ACC/AHA stage of coronary lesion tended to be more complex as the Syndrome type changed, patients of TCM type I and II had mostly lesion of stage A or Bl , while lesion in majority of patients of type III belonged to stage B2 or C, comparison between the three types showed significant difference (P<0.01). Conclusion: Most ACS patients of TCM Syndrome type III with tri-branch, severe stenosed coronary arteries, belong to the complex ACC/AHA stage of B2 and C.展开更多
ObjectiveTo validate a modified HEART [History, Electrocardiograph （ECG）, Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome （NSTE-ACS...ObjectiveTo validate a modified HEART [History, Electrocardiograph （ECG）, Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome （NSTE-ACS） in the emergency department （ED）.Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events （MACE） defined as a composite of acute myocardial infarction （AMI）, percu-taneous intervention （PCI）, coronary artery bypass graft （CABG）, or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients （46.6%） had a MACE within three months： 205 patients （15.8%） were diag-nosed with AMI, 465 patients （35.8%） underwent PCI, and 119 patients （9.2%） underwent CABG. There were 10 （0.8%） deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased （P ＆lt; 0.001 byχ2 for trend）. The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups： low risk （score 0-2）, intermediate risk （score 3-4）, and high risk （score 5-10）. Event rates were 1.1%, 18.5%, and 67.0%, respectively （P ＆lt; 0.001）.ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.展开更多
Objectives To explore serum cytokines levels (including IL-1β, sIL-2R, IL-6, TNF-α, and IFN-ν) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to es...Objectives To explore serum cytokines levels (including IL-1β, sIL-2R, IL-6, TNF-α, and IFN-ν) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS. Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1β, sIL-2R, IL-6, TNF-α, and IFN-νwere measured by enzyme linked immunosorbent assay. ResultsSerum IL-1β, sIL-2R, IL-6, TNF-αwere significantly higher in AMI group or UAP group compared to the con-trol group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-νshows no signifi-cant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner’s QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤6 scores group and > 6 scores group. Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a us-eful marker reflecting disease stability.展开更多
Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make inform...Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.展开更多
Background Low responsiveness to clopidogrel （LRC） is associated with increased risk of ischemic events. This study was aimed to explore the feasibility of tailored antiplatelet therapy according to the responsivene...Background Low responsiveness to clopidogrel （LRC） is associated with increased risk of ischemic events. This study was aimed to explore the feasibility of tailored antiplatelet therapy according to the responsiveness to clopidogrel. Methods A total of 305 clopidogrel naive patients with acute coronary syndromes （ACS） undergoing coronary stenting were randomly assigned to receive standard （n = 151） or tailored （n = 154） antiplatelet therapy. The ADP-induced platelet aggregation tests by light transmission aggregometry were performed to identify LRC patients assigned to the tailored group. The standard antiplatelet regimen was dual antiplatelet therapy with aspirin and clopidogrel. The tailored antiplatelet therapy was standard regimen for non-LRC patients and an additional 6-month cilostazol treatment for LRC patients. The primary efficacy outcome was the composite of cardiovascular death, myocardial infarction or stroke at one year. Results LCR was present in 26.6% （41/154） of patients in the tailored group. The percentage platelet aggregation for LCR patients was significantly decreased at three days after adjunctive cilostazol treatment （77.5% ± 12.1% vs. 64.5% ± 12.1%, P 〈 0.001）. At one year follow-up, a non-significant 37% relative risk reduction of primary events were observed in the tailored group as compared to the standard group （5.8% vs. 9.3%, P = 0.257）. There were no differences in the rates of stent thrombosis and hemorrhagic events between the two groups. Conclusions Tailored antiplatelet therapy for ACS patients after coronary stenting according to responsiveness to clopidogrel is feasible. However, its efficacy and safety need further confirmation by clinical trials with larger sample sizes.展开更多
Objective： To investigate the relationship between serum resistin level and acute coronary syndrome （ACS） or stable angina pectoris （SAP）. Methods： Sixty-five patients, with coronary artery disease, were enrolle...Objective： To investigate the relationship between serum resistin level and acute coronary syndrome （ACS） or stable angina pectoris （SAP）. Methods： Sixty-five patients, with coronary artery disease, were enrolled and divided into three subgroups： acute myocardial infarction （AMI）, unstable angina pectoris （UAP） and SAP, and 26 healthy people were recruited as controls in the cross-sectional study. Serum resistin levels were determined by ELISA （enzyme-linked immunosorbent assay）, and WBC （white blood cell count）, hsCRP （high sensitive C-reaction protein）, CKmax （maximum of creatinkinase）, CK-MBmax （maximum of isozyme of creatinkinase） and cTnImax （maximum of troponin） were measured by standard laboratory methods. Results： The serum resistin levels were 4 folds higher in AMI patients, 2.43 folds in UAP patients and I. 12 folds in SAP patients than in the healthy controls （P〈0.05）. The resistin levels were also significantly different between AMI [（8.16±0.79） ng/ml], UAP [（5.59±0.75） ng/ml] and SAP [（3.45±0.56） ng/ml] groups （P〈0.01）; WBC, hsCRP, CK CK-MBmax and cTnlmax were significantly increased in AMI patients over UAP and SAP patients. Spearman analysis showed that serum resistin levels were positively correlated with WBC （r=0.412, P=0.046）, hsCRP （r=0.427,p=0.037）, CK CK-MBmax and cTnImax （r=0.731, 0.678, 0.656; P〈0.01）. Conclusion： Serum resistin levels increased with inflammatory factors and myocardial impairment. The results suggest that human resistin might play an important role in the pathogenesis of atherosclerosis and AMI as an inflammatory factor.展开更多
基金funded,in part,by the National Natural Science Fund (NSFC,China) under award number 81900382supported,in part,by the Yang talents Program of Beijing (QML20200302)Beijing Municipal Natural Science Foundation (7222072).
文摘Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.
基金supported by the National High Level Hospital Clinical Research Funding(2025-GSP-QN-31&2022-GSP-QN-1)the Young Talent Program of the Academician Fund(YS-2022-002)the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)(2023-I2M-1-002)。
文摘BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chinese population.This study aimed to develop and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events(MACCE)in elderly Chinese patients with ACS.METHODS A retrospective analysis was conducted using two independent cohorts of ACS patients aged≥65 years who underwent percutaneous coronary intervention:the derivation cohort(n=1674)and the validation cohort(n=2333).Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion.A final nomogram incorporating ten variables was constructed.Model performance was evaluated in terms of discrimination[concordance index(C-index)and area under the receiver operating characteristic curve(AUC)]and calibration(calibration plots).RESULTS The 2-year incidence of MACCE was 12.5%(n=210)in the derivation cohort and 15.6%(n=364)in the validation cohort.The nomogram demonstrated good discrimination,with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort,respectively;significantly outperforming the GRACE risk score(P<0.001).Calibration plots showed good agreement between the predicted and observed outcomes.Patients classified as the high-risk group by the nomogram had a significantly higher MACCE incidence compared to that of the low-risk group(log-rank P<0.001).CONCLUSIONS This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention.It outperformed the GRACE score in both discrimmination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.
文摘The management of acute coronary syndrome(ACS)in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes.Bivalirudin,a direct inhibitor of thrombin,serves as an alternative to traditional therapies.This drug is particularly effective in enhancing myocardial microcircu-lation and reducing adverse events after clinical interventions.The present article explores the findings of a recent study that highlighted the clinical benefits of bivalirudin by investigating its effects on myocardial microcirculation and adverse cardiac events after percutaneous coronary intervention in older patients with ACS.Compared with unfractionated heparin,bivalirudin markedly reduced the emergency response time and improved cardiac function indicators.It further mitigated the risks of cardiovascular events and recurrent myocardial infarctions.These findings suggest that bivalirudin can enhance myocardial perfusion and reduce bleeding complications,thus serving as a safe,effective anticoagulation agent for older patients with ACS.Nonetheless,further large-scale,high-quality trials are needed to establish optimal usage guidelines and assess long-term outcomes.Integrating bivalirudin into ACS treatment protocols for older patients may help optimize patient care,balancing efficacy and safety.Continual research and consensus building are necessary for the widespread clinical application of bivalirudin and the improvement of ACS outcomes in older patients.
文摘Objective:To investigate the impact of early initiation of intensive lipid-lowering therapy on the postoperative efficacy and inflammatory factors in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods:A total of 100 ACS patients undergoing PCI admitted to our hospital were selected as the study subjects.They were randomly divided into a control group(treated with statin combined with ezetimibe,n=41),a study group 1(initiated with statin combined with PCSK9 inhibitor immediately after surgery,n=32),and a study group 2(routinely administered oral statin and initiated with combined PCSK9 inhibitor before discharge,n=27).The therapeutic efficacy,inflammatory factor levels,and incidence of adverse events were compared and analyzed among the three groups.Results:The therapeutic regimen in study group 1 demonstrated the optimal efficacy and impact on inflammatory factors,followed by study group 2,while the control group showed relatively weaker efficacy,with statistically significant differences(p<0.05).The overall incidence of adverse reactions was 30.00%in the control group,5.00%in study group 1,and 10.00%in study group 2,with statistically significant differences among the groups(p<0.05),with the lowest incidence observed in study group 1.Conclusion:Early intensive lipid-lowering therapy can effectively improve lipid metabolism,suppress inflammatory responses,and reduce cardiovascular events in ACS patients after PCI,suggesting its pleiotropic cardiovascular protective effects.
文摘BACKGROUND Bioresorbable scaffolds(BRS)are a promising alternative to traditional drugeluting stents(DES)for the treatment of acute coronary syndrome(ACS).They offer the potential for complete resorption,which may reduce long-term complications such as stent thrombosis and late restenosis.However,the safety,compatibility,and long-term outcomes of BRS in patients with intermediate to low-risk ACS have yet to be thoroughly investigated.AIM To investigate the safety,compatibility,and long-term outcomes of BRS in patients with intermediate to low-risk ACS.METHODS Patients with intermediate to low-risk ACS who underwent percutaneous coronary intervention with either DES or BRS,and were continuously recruited from January 2019 to June 2022 at a single center,were analyzed.Baseline data and clinical follow-up were collected for patients who underwent DES implantation(control group)and BRS implantation(observation group),and the survival outcomes and complications during a maximum follow-up period of 3 years were compared.The primary clinical endpoint was device-oriented composite endpoint(DoCE),representing the occurrence of one of the following events:Cardiac death,stent thrombosis,target vessel myocardial infarction,and clinically driven target lesion revascularization.Secondary endpoints included coronary artery bypass grafting,target vessel revascularization,and non-cardiac death.RESULTS A total of 128 patients were included in this study,with an average age of 63 years.Among them,95 were male(74%).The study involved treatment of 201 blood vessels:87(43%)received BRS,and 114(57%)received DES.A total of 97 patients completed the full 3-year follow-up.During this period,5 patients(17%)in the observation group and 7 patients(16%)in the control group experienced a major cardiovascular event(DoCE).At the 1-year follow-up,7 patients(15%)in the observation group and 6 patients(10%)in the control group experienced DoCE,and this difference was statistically significant(P<0.05).At the 2-year follow-up,there was also a significant difference between the two groups in the number of patients who needed repeat treatment of the target blood vessel(P<0.05).In the observation group,18 patients(33%)underwent follow-up coronary angiography.During the follow-up period,one patient in the observation group was found to have re-narrowing in the proximal and middle segments of the left anterior descending artery,possibly due to BRS collapse.Another patient in the observation group developed chronic total occlusion in multiple vessels at the 3-year follow-up and underwent coronary artery bypass grafting.CONCLUSION In low-to intermediate-risk ACS patients,those who got BRS had their first major heart event sooner than those who got DES.BRS is more tissue-friendly,yet over three years both groups had about the same amount of problems-only a few BRS patients still saw the scaffold collapse or the vessel slowly block.
基金supported by the National Natural Science Foundation of China(No.21976050)the Science and Technology Program of Hebei Province(No.21377779D)+3 种基金the Natural Science Foundation of Hebei Province(No.B2020206008)China Postdoctoral Science Foundation(Nos.2023M730317 and 2023T160066)the Fundamental Research Funds for the Central Universities(No.3332023042)the Open Project of Hebei Key Laboratory of Environment and Human Health(No.202301).
文摘Previous studies have suggested that abnormal hepatobiliary system function may contribute to poor prognosis in patientswith acute coronary syndrome(ACS)and that abnormal hepatobiliary system function may be associated with per-and polyfluoroalkyl substances(PFAS)exposure.However,there is limited evidence for this association in cardiovascular subpopulations,particularly in the ACS patients.Therefore,we performed this study to evaluate the association between plasma PFAS exposure and hepatobiliary system function biomarkers in patients with ACS.This study included 546 newly diagnosed ACS patients at the Second Hospital of Hebei Medical University,and data on 15 hepatobiliary system function biomarkers were obtained from medical records.Associations between single PFAS and hepatobiliary system function biomarkers were assessed using multiple linear regression models and restricted cubic spline model(RCS),and mixture effects were assessed using the Quantile g-computation model.The results showed that total bile acids(TBA)was negative associated with perfluorohexane sulfonic acid(PFHxS)(-7.69%,95%CI:-12.15%,-3.01%).According to the RCS model,linear associations were found between TBA and PFHxS(P for overall=0.003,P for non-linear=0.234).We also have observed the association between between PFAS congeners and liver enzyme such as aspartate aminotransferase(AST)and α-l-Fucosidase(AFU),but it was not statistically significant after correction.In addition,Our results also revealed an association between prealbumin(PA)and PFAS congeners as well as mixtures.Our findings have provided a piece of epidemiological evidence on associations between PFAS congeners or mixture,and serum hepatobiliary system function biomarkers in ACS patients,which could be a basis for subsequent mechanism studies.
基金Supported by Humanities and Social Sciences Project of Hubei Provincial Department of Education(22Q149&19Y090).
文摘This article reviews the characteristics of psychological disorders in young and middle-aged acute coronary syndrome(ACS)patients,the mechanisms and effects of various psychological intervention strategies,factors influencing return to work,and current research problems and development trends,to provide scientific evidence for psychological rehabilitation and social function recovery of young and middle-aged ACS patients.
基金Supported by National Natural Science Foundation of China Project:based on the Theory of“the Heart is in Harmony with the Small Intestine”to Explore the Influence and Mechanism of Gut Microbes on High Platelet Reactivity of Acute Coronary Syndrome with Phlegm and Blood Stasis Syndrome(No.82104841)Education Department of Liaoning Province Young Science and Technology Talents"Seedling"Project:to Explore the Effect and Mechanism of Huayu Qutan Formula on Platelet Function in Acute Coronary Syndrome Patients with Phlegm and Blood Stasis Syndrome after Percutaneous Coronary Intervention based on Intestinal Microbiome(No.L202039)。
文摘OBJECTIVE:To investigate the effects of gut microbes regulation of the trimethylamine(TMA)/flavin containing monooxygenase 3(FMO3)/trimethylamine N-oxide(TMAO)pathway on platelet aggregation in acute coronary syndrome(ACS)rats and the intervention of Huayu Qutan formula(化瘀祛痰方).METHODS:The ACS rats with syndrome of phlegm and blood stasis rats were established.Platelet,platelet aggregation,platelet activation markers and TMA/FMO3/TMAO pathway were detected.Metagenomics technology was employed to analyze the characteristics of the gut microbiota.RESULTS:Huayu Qutan formula and gut microbes could inhibit high platelet reactivity and regulate the TMA/FMO3/TMAO pathway.The dominant bacteria in ACS rats including but not limited to the major phyla,Firmicutes,Bacteroidetes,Actinobacteria,and Proteobacteria,also including some low abundance phyla,Fusobacteria,Verrucomicrobia,Spirochaetes,and Deferribacteres.The dominant bacteria in the Huayu Qutan formula group were Synergistetes,Deferribacteres,Deferribacteraceae,Faecalibacterium and Mucispirillum.In the Huayu Qutan formula combined with fecal bacteria enema group,the dominant bacteria were Verrucomicrobia,Verrucomicrobiae,Akkermansia and Verrucomicrobium.These gut microbiota were correlated with pathways such as Riboflavin metabolism and Arachidonic acid metabolism.CONCLUSION:Huayu Qutan formula may prevent ACS by modulating gut microbes Synergistetes,Faecalibacterium and Allobaculum,regulating the iron metabolism of Deferribacteres,and driving the TMA/FMO3/TMAO pathway to regulate gut microbiota function,and improving platelet aggregation.Akkermansia may serve as a promising probiotic,which could drive TMA/FMO3/TMAO pathway to regulate Arachidonic acid metabolism to improve platelet aggregation.The findings of this study provide a theoretical basis for the theory of"the heart is connected with the small intestine".
基金National natural science foundation project(No.81873518)。
文摘Objective:To investigate the clinical characteristics of familial hypercholesterolemia and early-onset acute coronary syndrome(ACS),in order to improve the understanding and diagnosis and treatment of the disease.Methods:We retrospectively studied the clinical data of 2 patients with familial hypercholesterolemia and premature acute coronary syndrome treated in the Department of Cardiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.All patients underwent genetic testing and coronary artery angiography.Results:Two patients were heterozygous familial hypercholesterolemia by gene test.Coronary artery angiography showed that three coronary arteries had serious lesions,which recovered well after drug and surgical treatment.Conclusion:Patients with familial hypercholesterolemia were prone to early onset of acute coronary syndrome,which should be identified,diagnosed and treated as soon as possible.
文摘Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome （ACS）. Methods Patients aged 〉 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease （CAD）--specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression. Results Of the 352 patients, 152 （43.18%） were considered frail according to the study instrument （5-7 on the scale）, and 93 （26.42%） were considered moderately or se- verely frail （6-7 on the scale）. Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients （P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively）. Adjusted for sex, age, severity of coro- nary artery diseases （left main coronary artery lesion or not） and co-morbidities （CAD specific index） by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes： all-canse mortality [Hazard Ratio （HR） = 5.393; 95% CI： 1.477-19.692, P = 0.011] and unscheduled return visit （HR - 2.832; 95% CI： 1.140-7.037, P = 0.025）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.
文摘To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without persistent ST elevation （acute coronary syndrome, ACS）, a total of 200 patients were randomly assigned to a heparin group and a tirofiban＋heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or refractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban＋heparin group as compared with that of heparin group （13.9% vs 29.3 %, P=0.010）. The rates of the other composite end point events in the tirofiban＋heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination （P=0.1717）. The study showed that the incidence of ischemic events in patients with ACS receiving tirofiban＋heparin was lower when compared with that of patients who received only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.
文摘Objective To investigate the correlation between serum resistin level, cardiovascular risk factors and severity of coronary disease in acute coronary syndrome （ACS）. Methods Alter evaluated by clinical history, electrocardiography, exercise tolerance tests, laboratory tests, and coronary angiography, 220 consecutive patients with suspected chest pain were divided into normal control group, stable angina pectoris （SAP） group, and ACS group, respectively. Baseline clinical characteristics, including height, weight, waist circumference, hip circumference, white blood cell count, high-sensitive C-reactive protein （hsCRP）, total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, were compared among three groups. ELISA was used to detect serum resistin levels. Pearson＇s correlation coefficient analysis was used to assess association between resistin and other traditional cardiovascular risk factors. Multinomial logistic regression analyses were used to define the relationship between serum resistin level and SAP or ACS. Results Serum resistin level in ACS group （1.18±0.48 μg/L） was significantly higher than that in normal control and SAP groups （0.49±0.40 and 0.66±0.40 μg/L; P〈0.01）. Only in ACS group, increased serum resistin level was significantly correlated with hsCRP （r=0.262, P=0.004） and white blood cell count （r=0.347, P=0.001）. Furthermore, serum resistin levels showed a stepwise increase with the number increase of 〉 50% stenosed coronary vessels. Multinomial logistic regression test demonstrated that serum resistin was a strong risk factor for ACS （OR=29.132, 95 % CI： 10.939-77.581, P〈0.001）. Conclusion These findings suggested the potential role of resistin in atherosclerosis and especially its involvement in ACS.
文摘Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.
文摘Objective: To explore the relationship of Traditional Chinese Medicine (TCM) Syndrome type and coronary arteriography (CAG) with respect to the number and degree of stenosed branches of coronary artery (CA) and ACC/AHA stage of acute coronary syndrome (ACS), to provide an objective evidence for TCM Syndrome typing on ACS Methods: Ninety patients of ACS with their TCM Syndrome typing and CAG successfully conducted were enrolled in this study. They were classified into 3 Syndrome types, the blood stasis type (type I ), the phlegm stagnant with blood stasis type (type II ),and the endogenous collateral Wind type (type III) The scores of the number and severity of the stenosis branch of CA and ACC/AHA lesion stage in different Syndrome types were calculated respectively and analysed statistically by Ridit analysis. Results: The number of stenosed branches increased gradually with the Syndrome type changing from I -II-III, compared the type III with the other two types(P<0. 01). The severity of stenosis in type I and II were similar, but that of Type III, much aggravated was significantly different from that in the former two (P<0. 01) . The ACC/AHA stage of coronary lesion tended to be more complex as the Syndrome type changed, patients of TCM type I and II had mostly lesion of stage A or Bl , while lesion in majority of patients of type III belonged to stage B2 or C, comparison between the three types showed significant difference (P<0.01). Conclusion: Most ACS patients of TCM Syndrome type III with tri-branch, severe stenosed coronary arteries, belong to the complex ACC/AHA stage of B2 and C.
文摘ObjectiveTo validate a modified HEART [History, Electrocardiograph （ECG）, Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome （NSTE-ACS） in the emergency department （ED）.Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events （MACE） defined as a composite of acute myocardial infarction （AMI）, percu-taneous intervention （PCI）, coronary artery bypass graft （CABG）, or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients （46.6%） had a MACE within three months： 205 patients （15.8%） were diag-nosed with AMI, 465 patients （35.8%） underwent PCI, and 119 patients （9.2%） underwent CABG. There were 10 （0.8%） deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased （P ＆lt; 0.001 byχ2 for trend）. The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups： low risk （score 0-2）, intermediate risk （score 3-4）, and high risk （score 5-10）. Event rates were 1.1%, 18.5%, and 67.0%, respectively （P ＆lt; 0.001）.ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.
文摘Objectives To explore serum cytokines levels (including IL-1β, sIL-2R, IL-6, TNF-α, and IFN-ν) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS. Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1β, sIL-2R, IL-6, TNF-α, and IFN-νwere measured by enzyme linked immunosorbent assay. ResultsSerum IL-1β, sIL-2R, IL-6, TNF-αwere significantly higher in AMI group or UAP group compared to the con-trol group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-νshows no signifi-cant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner’s QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤6 scores group and > 6 scores group. Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a us-eful marker reflecting disease stability.
文摘Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.
文摘Background Low responsiveness to clopidogrel （LRC） is associated with increased risk of ischemic events. This study was aimed to explore the feasibility of tailored antiplatelet therapy according to the responsiveness to clopidogrel. Methods A total of 305 clopidogrel naive patients with acute coronary syndromes （ACS） undergoing coronary stenting were randomly assigned to receive standard （n = 151） or tailored （n = 154） antiplatelet therapy. The ADP-induced platelet aggregation tests by light transmission aggregometry were performed to identify LRC patients assigned to the tailored group. The standard antiplatelet regimen was dual antiplatelet therapy with aspirin and clopidogrel. The tailored antiplatelet therapy was standard regimen for non-LRC patients and an additional 6-month cilostazol treatment for LRC patients. The primary efficacy outcome was the composite of cardiovascular death, myocardial infarction or stroke at one year. Results LCR was present in 26.6% （41/154） of patients in the tailored group. The percentage platelet aggregation for LCR patients was significantly decreased at three days after adjunctive cilostazol treatment （77.5% ± 12.1% vs. 64.5% ± 12.1%, P 〈 0.001）. At one year follow-up, a non-significant 37% relative risk reduction of primary events were observed in the tailored group as compared to the standard group （5.8% vs. 9.3%, P = 0.257）. There were no differences in the rates of stent thrombosis and hemorrhagic events between the two groups. Conclusions Tailored antiplatelet therapy for ACS patients after coronary stenting according to responsiveness to clopidogrel is feasible. However, its efficacy and safety need further confirmation by clinical trials with larger sample sizes.
基金Project (No. 2003C33031) supported by the Science and Technology Department of Zhejiang Province, China
文摘Objective： To investigate the relationship between serum resistin level and acute coronary syndrome （ACS） or stable angina pectoris （SAP）. Methods： Sixty-five patients, with coronary artery disease, were enrolled and divided into three subgroups： acute myocardial infarction （AMI）, unstable angina pectoris （UAP） and SAP, and 26 healthy people were recruited as controls in the cross-sectional study. Serum resistin levels were determined by ELISA （enzyme-linked immunosorbent assay）, and WBC （white blood cell count）, hsCRP （high sensitive C-reaction protein）, CKmax （maximum of creatinkinase）, CK-MBmax （maximum of isozyme of creatinkinase） and cTnImax （maximum of troponin） were measured by standard laboratory methods. Results： The serum resistin levels were 4 folds higher in AMI patients, 2.43 folds in UAP patients and I. 12 folds in SAP patients than in the healthy controls （P〈0.05）. The resistin levels were also significantly different between AMI [（8.16±0.79） ng/ml], UAP [（5.59±0.75） ng/ml] and SAP [（3.45±0.56） ng/ml] groups （P〈0.01）; WBC, hsCRP, CK CK-MBmax and cTnlmax were significantly increased in AMI patients over UAP and SAP patients. Spearman analysis showed that serum resistin levels were positively correlated with WBC （r=0.412, P=0.046）, hsCRP （r=0.427,p=0.037）, CK CK-MBmax and cTnImax （r=0.731, 0.678, 0.656; P〈0.01）. Conclusion： Serum resistin levels increased with inflammatory factors and myocardial impairment. The results suggest that human resistin might play an important role in the pathogenesis of atherosclerosis and AMI as an inflammatory factor.
