Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atheroscle...Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.展开更多
Recent clinical trials have demonstrated a protective effect in using traditional Chinese medicine Tongxinluo(TXL)capsule to treat atherosclerosis.However,clinical evidence of the effects of TXL treatment on coronary ...Recent clinical trials have demonstrated a protective effect in using traditional Chinese medicine Tongxinluo(TXL)capsule to treat atherosclerosis.However,clinical evidence of the effects of TXL treatment on coronary plaque vulnerability is unavailable.In response,we developed this study to investigate the hypothesis that on the basis of statin therapy,treatment with TXL capsule may stabilize coronary lesions in patients with acute coronary syndrome(ACS).The TXL-CAP study was an investigator-initiated,randomized,double-blind clinical trial conducted across 18 medical centers in China.Patients with ACS aging from 18 to 80 years old who had a non-intervened coronary target lesion with a fibrous cap thickness(FCT)<100μm and lipid arc>90°as defined by optical coherence tomography(OCT)were recruited.A total of 220 patients who met the selection criteria but did not meet the exclusion criteria will be finally recruited and randomized to receive treatment with TXL(n=110)or placebo(n=110)for a duration of 12 months.The primary endpoint was the difference in the minimum FCT of the coronary target lesion between TXL and placebo groups at the end of the 12-month follow-up.Secondary endpoints included:(1)changes of the maximum lipid arc and length of the target plaque,and the percentage of lipid,fibrous,and calcified plaques at the end of the12-month period;(2)the incidence of composite cardiovascular events and coronary revascularization within the 12 months;(3)changes in the grade and scores of the angina pectoris as assessed using the Canadian Cardiovascular Society(CCS)grading system and Seattle angina questionnaire(SAQ)score,respectively;and(4)changes in hs-CRP serum levels.The results of the TXLCAP trial will provide additional clinical data for revealing whether TXL capsules stabilizes coronary vulnerable plaques in Chinese ACS patients.展开更多
BACKGROUND Giant coronary artery aneurysms(CAA),entailing thrombosis,myocardial infarction,and sudden death,are the most severe and life-threatening complications of Kawasaki disease(KD).Giant aneurysms rarely regress...BACKGROUND Giant coronary artery aneurysms(CAA),entailing thrombosis,myocardial infarction,and sudden death,are the most severe and life-threatening complications of Kawasaki disease(KD).Giant aneurysms rarely regress and can later transform into stenoses.Data on dynamic follow-up are scarce in the literature.AIM To evaluate clinical features and long-term outcomes of giant CAA in children with KD.METHODS A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region(2012-2023).CAA criteria according to the American Heart Association guidelines of 2017 were used:(1)Dilated coronary artery with diameter Z-score>2 standard deviations(SD)but<2.5 SD;(2)Small CAA with Z-score>2.5 SD but<5 SD;(3)Medium CAA with Z-score>5 SD but<10 SD;and(4)Giant CAA with Z-score>10 SD or≥8 mm.RESULTS The mean age of children with coronary dilatation/aneurysms was 2.5 years,and the male-to-female ratio was 3:1.Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate(Z-score<5 SD but>2.0 SD)coronary dilatation(62.0%vs 21.0%,P=0.019).Major cardiovascular events(myocardial infarction,coronary artery bypass grafting,acute coronary syndrome,ischemic cardiomyopathy,left ventricular aneurysm,and giant extracardiac aneurysm)occurred in 55.5%of patients who had giant CAA.At follow-up the complete regression of giant/medium CAA was observed in 58.0%and partial regression in 42.0%after a mean of 2.3 and 5.5 years,respectively.All thrombi detected by echocardiography,CT,and angiography in giant/medium CAA disappeared between 1 year and 5 years(mean:15 months).All patients survived.CONCLUSION Risk factors for giant CAA were male sex,early age,and cerebral dysfunction.Complete regression of giant coronary aneurysms occurred in 58.0%of patients after follow-up of 2.3 years.展开更多
OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicent...OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.展开更多
BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary a...BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.展开更多
Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We comp...Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.展开更多
BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships bet...BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.展开更多
Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to e...Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.展开更多
BACKGROUND Postmenopausal women face an increased risk of cardiovascular disease(CVD)due to estrogen withdrawal,which exacerbates traditional cardiovascular risk factors such as dyslipidemia,glucose intolerance,and hy...BACKGROUND Postmenopausal women face an increased risk of cardiovascular disease(CVD)due to estrogen withdrawal,which exacerbates traditional cardiovascular risk factors such as dyslipidemia,glucose intolerance,and hypertension.Coronary Artery Calcium Score(CACS),a well-established marker of subclinical atherosclerosis,has emerged as a key predictor of adverse cardiovascular events.Despite the recognized association between menopause and heightened CVD risk,there remains a paucity of literature exploring the specific role of menopause in influencing CACS and its implications for cardiovascular morbidity and morta lity.AIM To examine the interplay between menopause,CACS,and cardiovascular health by synthesizing existing literature.METHODS A comprehensive literature search was conducted using PubMed and Google Scholar,focusing on studies that analyzed CACS in postmenopausal women,including the influence of factors such as hormone therapy,Triglyceride-Glucose index,bone mineral density,lipid metabolism,and type-1 diabetes.Data extraction and synthesis emphasized key patterns,metabolic influences,and potential mechanisms driving coronary calcification in menopause.RESULTS Findings suggest that menopause contributes to increased CACS through multiple pathways,including altered lipid metabolism,insulin resistance,and arterial stiffness.Additionally,premature menopause is associated with higher CACS and elevated CVD risk.While hormone replacement therapy(HRT)appears to have a protective effect against coronary calcification,further research is needed to clarify its long-term benefits and risks.CONCLUSION We introduce a novel framework combining CACS with metabolic and hormonal markers,and discuss estrogendriven mechanisms and HRT considerations in postmenopausal cardiovascular risk.This review underscores the need for targeted cardiovascular risk assessment in postmenopausal women,integrating CACS with other metabolic markers to improve early detection and prevention of CVD in this high-risk population.展开更多
Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or ...Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or diseased coronary arteries.[1,2]The condition is typically triggered by various allergens including medications(particularly contrast media),environmental factors,or food exposures,with symptom onset usually occurring within one hour of exposure.展开更多
Minoxidil is a potent vasodilator primarily used for the treatment of severe hypertension,and androgenic alopecia.Although known adverse effects include fluid retention,tachycardia and hypertrichosis,its potential to ...Minoxidil is a potent vasodilator primarily used for the treatment of severe hypertension,and androgenic alopecia.Although known adverse effects include fluid retention,tachycardia and hypertrichosis,its potential to induce coronary vasospasm remains largely underreported.[1]Minoxidil is currently reserved for treating alopecia for various causes.展开更多
BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of periphe...BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.展开更多
BACKGROUND Listening to music has been shown to reduce pain and anxiety before,during,and after invasive coronary procedures.AIM To perform a systematic review and meta-analysis to explore the effect of therapeutic us...BACKGROUND Listening to music has been shown to reduce pain and anxiety before,during,and after invasive coronary procedures.AIM To perform a systematic review and meta-analysis to explore the effect of therapeutic use of music on both,perioperative and postoperative outcomes of invasive coronary procedures.METHODS An exhaustive literature search of 3 electronic databases(MEDLINE,Scopus,Cochrane CENTRAL)was conducted from inception until 10th December 2023.The results of our analyses are presented as standard mean difference(SMD)or weighted mean difference,with 95%CI and pooled using a random effects model.A P value<0.05 was considered significant in all cases.RESULTS From 21 studies,2141 participants were included in our analysis.The pooled analysis demonstrated that music listening significantly improves post-procedural pain(SMD=-0.78,95%CI:-1.34 to-0.23;P=0.006),anxiety(SMD=-0.86,95%CI:-1.43 to-0.29;P=0.003),heart rate[mean difference(MD)=-3.38,95%CI:-5.51 to-1.25;P=0.002],and systolic blood pressure(MD=-5.89,95%CI:-9.75 to-2.02;P=0.003).There was no significant improvement in diastolic blood pressure(MD=-3.22,95%CI:-6.58 to 0.14;P=0.06)or respiratory rate(MD=-0.97,95%CI:-1.98 to 0.03;P=0.06).CONCLUSION Music listening can be used in healthcare settings for patients undergoing invasive coronary procedures to reduce anxiety levels and improve their physiological parameters.展开更多
BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can pre...BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can predict all-cause mortality and major adverse CV events(MACE)in patients with coronary artery disease(CAD)and to determine the prognostic value of adiponectin in predicting all-cause mortality and MACE in patients with stable CAD.METHODS We conducted a systematic search on PubMed,Scopus,and Google Scholar to find relevant studies published through June 2023 evaluating the long-term prognostic role of adiponectin in patients with stable CAD.Using a random effects model with 95%CI,we estimated the odds ratio(OR)while assessing heterogeneity through I^(2)statistics.To ensure robustness,we performed a sensitivity analysis using the leave-one-out approach.RESULTS After screening,we included five prospective studies involving 3225 patients who were followed up for a median duration of 3.8 years.Within the study population,prevalent risk factors included hypertension,diabetes,hyperlipidemia,and smoking.The commonly prescribed medications were angiotensin-converting enzyme inhibitors,beta blockers,and statins.The combined adjusted OR for all-cause mortality was found to be 2.51(95%CI:1.36–4.62),showing heterogeneity(I^(2)=65.51%,P=0.03).On the other hand,the combined adjusted OR for MACE was determined to be 1.04(95%CI:1.02–1.06)with no significant heterogeneity observed(I^(2)=0%,P=0.68).Through a sensitivity analysis,it was discovered that none of the studies significantly impacted the overall results of the meta-analysis,thus indicating their robustness.CONCLUSION Higher levels of adiponectin were found to be associated with an increased risk of long-term mortality and MACE in patients with CAD,which highlights its potential as a cost-effective marker for risk assessment and guiding treatment strategies.Further research on the role of adiponectin could greatly influence decision-making and resource allocation in CV care.展开更多
Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to...Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.展开更多
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping p...BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping primary symptoms,such as chest tightness and dyspnea.This confluence frequently leads to the misdiagnosis of PE,thus precipitating treatment delays and compromising patient outcomes.Herein,we report the case of a patient with both diseases who under-went surgery and medication therapy.CASE SUMMARY A 51-year-old man with a history of hypertension for 2 years visited a local hospital because of paroxysmal chest tightness for 1 d and was diagnosed with CHD.However,he refused hospitalization.He visited our hospital for the treatment of recurring symptoms.A comprehensive examination after admission revealed elevated D-dimer levels,and computed tomography pulmonary angio-graphy was performed to confirm the diagnosis of PE.The patient successfully underwent coronary artery bypass grafting with anticoagulant and antiplatelet drugs and had a prognosis.CONCLUSION D-dimer is useful in screening for PE,whereas computed tomography pulmonary angiography is important for diagnosis.For patients with CHD and PE,coronary artery bypass grafting combined with anticoagulant and antiplatelet therapy is feasible.展开更多
BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery ...BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.展开更多
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 Coronary heart disease(CHD)is a prevalent type 2 diabetes mellitus(T2DM)complication.Further,the risk stratification before angiography may help diagnose T2DM with CHD early.However,few studies have investi...BACKGROUND Coronary heart disease(CHD)is a prevalent type 2 diabetes mellitus(T2DM)complication.Further,the risk stratification before angiography may help diagnose T2DM with CHD early.However,few studies have investigated the coronary imaging characteristics and risk factors of patients with T2DM complicated with CHD.AIM To compare the differences in coronary imaging between patients with T2DM with and without CHD,determine the risk factors of T2DM complicated with CHD,and establish a predictive tool for diagnosing CHD in T2DM.METHODS This study retrospectively analyzed 103 patients with T2DM from January 2022 to May 2024.They are categorized based on CHD occurrence into:(1)The control group,consisting of patients with T2DM without CHD;and(2)The observation group,which includes patients with T2MD with CHD.Age,sex,smoking and drinking history,CHD family history,metformin(MET)treatment pre-admission,body mass index,fasting blood glucose(FBG),triglyceride(TG),total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol(LDL-C),serum creatinine,blood urea nitrogen(BUN),alanine aminotransferase,aspartate aminotransferase,glycosylated hemoglobin(HbA1c),and coronary imaging data of both groups were collected from the medical record system.Logistic risk analysis was conducted to screen risk factors.The prediction model’s prediction efficiency was evaluated with receiver operating characteristic curves.RESULTS The control and observation groups consisted of 48 and 55 cases,respectively.The two groups were statistically different in terms of age(t=2.006,P=0.048),FBG(t=6.038,P=0.000),TG(t=2.015,P=0.047),LDL-C(t=2.017,P=0.046),and BUN(t=2.035,P=0.044).The observation group demonstrated lower proportions of patients receiving MET(χ^(2)=5.073,P=0.024)and higher proportions of patients with HbA1c of>7.0%(χ^(2)=6.980,P=0.008)than the control group.The observation group consisted of 15,17,and 23 cases of moderate stenosis,severe stenosis,and occlusion,respectively,with a greater number of coronary artery occlusion cases than the control group(χ^(2)=6.399,P=0.041).The observation group consisted significantly higher number of diffuse lesion cases at 35 compared with the control group(χ^(2)=15.420,P=0.000).The observation group demonstrated a higher right coronary artery(RCA)stenosis index(t=6.730,P=0.000),circumflex coronary artery(LCX)stenosis index(t=5.738,P=0.000),and total stenosis index(t=7.049,P=0.000)than the control group.FBG[odds ratio(OR)=1.472;95%confidence interval(CI):1.234-1.755;P=0.000]and HbA1c(OR=3.197;95%CI:1.149-8.896;P=0.026)were independent risk factors for T2DM complicated with CHD,whereas MET(OR=0.350;95%CI:0.129-0.952;P=0.040)was considered a protective factor for CHD in T2DM.CONCLUSION Coronary artery occlusion is a prevalent complication in patients with T2DM.Patients with T2MD with CHD demonstrated a higher degree of RCA and LCX stenosis than those with T2DM without CHD.FBG,HbA1c,and MET treatment history are risk factors for T2DM complicated with CHD.展开更多
文摘Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.
基金National Key Research and Development Program of China(2017YFC1700502)Ministry of Science and Technology of China。
文摘Recent clinical trials have demonstrated a protective effect in using traditional Chinese medicine Tongxinluo(TXL)capsule to treat atherosclerosis.However,clinical evidence of the effects of TXL treatment on coronary plaque vulnerability is unavailable.In response,we developed this study to investigate the hypothesis that on the basis of statin therapy,treatment with TXL capsule may stabilize coronary lesions in patients with acute coronary syndrome(ACS).The TXL-CAP study was an investigator-initiated,randomized,double-blind clinical trial conducted across 18 medical centers in China.Patients with ACS aging from 18 to 80 years old who had a non-intervened coronary target lesion with a fibrous cap thickness(FCT)<100μm and lipid arc>90°as defined by optical coherence tomography(OCT)were recruited.A total of 220 patients who met the selection criteria but did not meet the exclusion criteria will be finally recruited and randomized to receive treatment with TXL(n=110)or placebo(n=110)for a duration of 12 months.The primary endpoint was the difference in the minimum FCT of the coronary target lesion between TXL and placebo groups at the end of the 12-month follow-up.Secondary endpoints included:(1)changes of the maximum lipid arc and length of the target plaque,and the percentage of lipid,fibrous,and calcified plaques at the end of the12-month period;(2)the incidence of composite cardiovascular events and coronary revascularization within the 12 months;(3)changes in the grade and scores of the angina pectoris as assessed using the Canadian Cardiovascular Society(CCS)grading system and Seattle angina questionnaire(SAQ)score,respectively;and(4)changes in hs-CRP serum levels.The results of the TXLCAP trial will provide additional clinical data for revealing whether TXL capsules stabilizes coronary vulnerable plaques in Chinese ACS patients.
文摘BACKGROUND Giant coronary artery aneurysms(CAA),entailing thrombosis,myocardial infarction,and sudden death,are the most severe and life-threatening complications of Kawasaki disease(KD).Giant aneurysms rarely regress and can later transform into stenoses.Data on dynamic follow-up are scarce in the literature.AIM To evaluate clinical features and long-term outcomes of giant CAA in children with KD.METHODS A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region(2012-2023).CAA criteria according to the American Heart Association guidelines of 2017 were used:(1)Dilated coronary artery with diameter Z-score>2 standard deviations(SD)but<2.5 SD;(2)Small CAA with Z-score>2.5 SD but<5 SD;(3)Medium CAA with Z-score>5 SD but<10 SD;and(4)Giant CAA with Z-score>10 SD or≥8 mm.RESULTS The mean age of children with coronary dilatation/aneurysms was 2.5 years,and the male-to-female ratio was 3:1.Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate(Z-score<5 SD but>2.0 SD)coronary dilatation(62.0%vs 21.0%,P=0.019).Major cardiovascular events(myocardial infarction,coronary artery bypass grafting,acute coronary syndrome,ischemic cardiomyopathy,left ventricular aneurysm,and giant extracardiac aneurysm)occurred in 55.5%of patients who had giant CAA.At follow-up the complete regression of giant/medium CAA was observed in 58.0%and partial regression in 42.0%after a mean of 2.3 and 5.5 years,respectively.All thrombi detected by echocardiography,CT,and angiography in giant/medium CAA disappeared between 1 year and 5 years(mean:15 months).All patients survived.CONCLUSION Risk factors for giant CAA were male sex,early age,and cerebral dysfunction.Complete regression of giant coronary aneurysms occurred in 58.0%of patients after follow-up of 2.3 years.
基金supported by the National Key Research and Development Program of China(No.2022YFC3602500)Beijing High-level Public Health Technical Talents Construction Project(Discipline Leader-03-24)Beijing Hospitals Authority’s Ascent Plan(DFL20240601).
文摘OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.
文摘BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.
文摘Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.
基金supported by the National Natural Science Foundation of China(No.82173450&No.81770237).
文摘BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.
文摘Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.
文摘BACKGROUND Postmenopausal women face an increased risk of cardiovascular disease(CVD)due to estrogen withdrawal,which exacerbates traditional cardiovascular risk factors such as dyslipidemia,glucose intolerance,and hypertension.Coronary Artery Calcium Score(CACS),a well-established marker of subclinical atherosclerosis,has emerged as a key predictor of adverse cardiovascular events.Despite the recognized association between menopause and heightened CVD risk,there remains a paucity of literature exploring the specific role of menopause in influencing CACS and its implications for cardiovascular morbidity and morta lity.AIM To examine the interplay between menopause,CACS,and cardiovascular health by synthesizing existing literature.METHODS A comprehensive literature search was conducted using PubMed and Google Scholar,focusing on studies that analyzed CACS in postmenopausal women,including the influence of factors such as hormone therapy,Triglyceride-Glucose index,bone mineral density,lipid metabolism,and type-1 diabetes.Data extraction and synthesis emphasized key patterns,metabolic influences,and potential mechanisms driving coronary calcification in menopause.RESULTS Findings suggest that menopause contributes to increased CACS through multiple pathways,including altered lipid metabolism,insulin resistance,and arterial stiffness.Additionally,premature menopause is associated with higher CACS and elevated CVD risk.While hormone replacement therapy(HRT)appears to have a protective effect against coronary calcification,further research is needed to clarify its long-term benefits and risks.CONCLUSION We introduce a novel framework combining CACS with metabolic and hormonal markers,and discuss estrogendriven mechanisms and HRT considerations in postmenopausal cardiovascular risk.This review underscores the need for targeted cardiovascular risk assessment in postmenopausal women,integrating CACS with other metabolic markers to improve early detection and prevention of CVD in this high-risk population.
基金supported by the National Key Research and Development Program of China(No.2022YFB380-7300)the National Natural Science Foundation of China(No.12471455)+2 种基金the Clinical Cohort Construction Program of Peking University Third Hospital(BYSYDL2022005)the Key Clinical Projects of Peking University Third Hospital(BYSYZD2023006)the Innovation&Transfer Fund of Peking University Third Hospital(BYSYZHKC2023-109).
文摘Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or diseased coronary arteries.[1,2]The condition is typically triggered by various allergens including medications(particularly contrast media),environmental factors,or food exposures,with symptom onset usually occurring within one hour of exposure.
文摘Minoxidil is a potent vasodilator primarily used for the treatment of severe hypertension,and androgenic alopecia.Although known adverse effects include fluid retention,tachycardia and hypertrichosis,its potential to induce coronary vasospasm remains largely underreported.[1]Minoxidil is currently reserved for treating alopecia for various causes.
文摘BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.
文摘BACKGROUND Listening to music has been shown to reduce pain and anxiety before,during,and after invasive coronary procedures.AIM To perform a systematic review and meta-analysis to explore the effect of therapeutic use of music on both,perioperative and postoperative outcomes of invasive coronary procedures.METHODS An exhaustive literature search of 3 electronic databases(MEDLINE,Scopus,Cochrane CENTRAL)was conducted from inception until 10th December 2023.The results of our analyses are presented as standard mean difference(SMD)or weighted mean difference,with 95%CI and pooled using a random effects model.A P value<0.05 was considered significant in all cases.RESULTS From 21 studies,2141 participants were included in our analysis.The pooled analysis demonstrated that music listening significantly improves post-procedural pain(SMD=-0.78,95%CI:-1.34 to-0.23;P=0.006),anxiety(SMD=-0.86,95%CI:-1.43 to-0.29;P=0.003),heart rate[mean difference(MD)=-3.38,95%CI:-5.51 to-1.25;P=0.002],and systolic blood pressure(MD=-5.89,95%CI:-9.75 to-2.02;P=0.003).There was no significant improvement in diastolic blood pressure(MD=-3.22,95%CI:-6.58 to 0.14;P=0.06)or respiratory rate(MD=-0.97,95%CI:-1.98 to 0.03;P=0.06).CONCLUSION Music listening can be used in healthcare settings for patients undergoing invasive coronary procedures to reduce anxiety levels and improve their physiological parameters.
文摘BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can predict all-cause mortality and major adverse CV events(MACE)in patients with coronary artery disease(CAD)and to determine the prognostic value of adiponectin in predicting all-cause mortality and MACE in patients with stable CAD.METHODS We conducted a systematic search on PubMed,Scopus,and Google Scholar to find relevant studies published through June 2023 evaluating the long-term prognostic role of adiponectin in patients with stable CAD.Using a random effects model with 95%CI,we estimated the odds ratio(OR)while assessing heterogeneity through I^(2)statistics.To ensure robustness,we performed a sensitivity analysis using the leave-one-out approach.RESULTS After screening,we included five prospective studies involving 3225 patients who were followed up for a median duration of 3.8 years.Within the study population,prevalent risk factors included hypertension,diabetes,hyperlipidemia,and smoking.The commonly prescribed medications were angiotensin-converting enzyme inhibitors,beta blockers,and statins.The combined adjusted OR for all-cause mortality was found to be 2.51(95%CI:1.36–4.62),showing heterogeneity(I^(2)=65.51%,P=0.03).On the other hand,the combined adjusted OR for MACE was determined to be 1.04(95%CI:1.02–1.06)with no significant heterogeneity observed(I^(2)=0%,P=0.68).Through a sensitivity analysis,it was discovered that none of the studies significantly impacted the overall results of the meta-analysis,thus indicating their robustness.CONCLUSION Higher levels of adiponectin were found to be associated with an increased risk of long-term mortality and MACE in patients with CAD,which highlights its potential as a cost-effective marker for risk assessment and guiding treatment strategies.Further research on the role of adiponectin could greatly influence decision-making and resource allocation in CV care.
基金National Key Research and Development Program of China(2022YFC2503500 and 2022YFC2503504)。
文摘Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.
文摘BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
基金Supported by the National Natural Science Foundation of China,No.82200981Natural Science Foundation of Shandong Province,No.ZR2022QH358and Special Funds of Taishan Scholars Project of Shandong Province,No.tsqn202312384.
文摘BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping primary symptoms,such as chest tightness and dyspnea.This confluence frequently leads to the misdiagnosis of PE,thus precipitating treatment delays and compromising patient outcomes.Herein,we report the case of a patient with both diseases who under-went surgery and medication therapy.CASE SUMMARY A 51-year-old man with a history of hypertension for 2 years visited a local hospital because of paroxysmal chest tightness for 1 d and was diagnosed with CHD.However,he refused hospitalization.He visited our hospital for the treatment of recurring symptoms.A comprehensive examination after admission revealed elevated D-dimer levels,and computed tomography pulmonary angio-graphy was performed to confirm the diagnosis of PE.The patient successfully underwent coronary artery bypass grafting with anticoagulant and antiplatelet drugs and had a prognosis.CONCLUSION D-dimer is useful in screening for PE,whereas computed tomography pulmonary angiography is important for diagnosis.For patients with CHD and PE,coronary artery bypass grafting combined with anticoagulant and antiplatelet therapy is feasible.
基金supported by the National Nature Science Foundation of China(No.82370336&No.82330014)the Key Research and Development Plan of Heilongjiang Province(2022ZX06C23&JD2023SJ44)the Research Project of the First Affiliated Hospital of Harbin Medical University(No.2021M19).
文摘BACKGROUND Blood glucose and serum albumin have been associated with cardiovascular disease prognosis,but the impact of admission-blood-glucose-to-albumin ratio(AAR)on adverse outcomes in critical ill coronary artery disease(CAD)patients was not investigated.METHODS Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR.The primary outcome was 1-year mortality,and secondary endpoints were in-hospital mortality,acute kidney injury(AKI),and renal replacement therapy(RRT).A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients.Kaplan-Meier survival analysis determined differences in endpoints across subgroups.RESULTS A total of 8360 patients were included.There were 726 patients(8.7%)died in the hospital and 1944 patients(23%)died at 1 year.The incidence of AKI and RRT was 63%and 4.3%,respectively.High AAR was markedly associated with in-hospital mortality(HR=1.587,P=0.003),1-year mortality(HR=1.502,P<0.001),AKI incidence(HR=1.579,P<0.001),and RRT(HR=1.640,P<0.016)in CAD patients in the completely adjusted Cox proportional hazard model.Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles.Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality,1-year mortality,and adverse renal prognosis in critical CAD patients.
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 Science and Technology Major Project of Changzhou Science and Technology Bureau,No.CE20205047Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01F52Changzhou A Major Scientific Research Project of the Municipal Health Commission,No.ZD202220.
文摘BACKGROUND Coronary heart disease(CHD)is a prevalent type 2 diabetes mellitus(T2DM)complication.Further,the risk stratification before angiography may help diagnose T2DM with CHD early.However,few studies have investigated the coronary imaging characteristics and risk factors of patients with T2DM complicated with CHD.AIM To compare the differences in coronary imaging between patients with T2DM with and without CHD,determine the risk factors of T2DM complicated with CHD,and establish a predictive tool for diagnosing CHD in T2DM.METHODS This study retrospectively analyzed 103 patients with T2DM from January 2022 to May 2024.They are categorized based on CHD occurrence into:(1)The control group,consisting of patients with T2DM without CHD;and(2)The observation group,which includes patients with T2MD with CHD.Age,sex,smoking and drinking history,CHD family history,metformin(MET)treatment pre-admission,body mass index,fasting blood glucose(FBG),triglyceride(TG),total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol(LDL-C),serum creatinine,blood urea nitrogen(BUN),alanine aminotransferase,aspartate aminotransferase,glycosylated hemoglobin(HbA1c),and coronary imaging data of both groups were collected from the medical record system.Logistic risk analysis was conducted to screen risk factors.The prediction model’s prediction efficiency was evaluated with receiver operating characteristic curves.RESULTS The control and observation groups consisted of 48 and 55 cases,respectively.The two groups were statistically different in terms of age(t=2.006,P=0.048),FBG(t=6.038,P=0.000),TG(t=2.015,P=0.047),LDL-C(t=2.017,P=0.046),and BUN(t=2.035,P=0.044).The observation group demonstrated lower proportions of patients receiving MET(χ^(2)=5.073,P=0.024)and higher proportions of patients with HbA1c of>7.0%(χ^(2)=6.980,P=0.008)than the control group.The observation group consisted of 15,17,and 23 cases of moderate stenosis,severe stenosis,and occlusion,respectively,with a greater number of coronary artery occlusion cases than the control group(χ^(2)=6.399,P=0.041).The observation group consisted significantly higher number of diffuse lesion cases at 35 compared with the control group(χ^(2)=15.420,P=0.000).The observation group demonstrated a higher right coronary artery(RCA)stenosis index(t=6.730,P=0.000),circumflex coronary artery(LCX)stenosis index(t=5.738,P=0.000),and total stenosis index(t=7.049,P=0.000)than the control group.FBG[odds ratio(OR)=1.472;95%confidence interval(CI):1.234-1.755;P=0.000]and HbA1c(OR=3.197;95%CI:1.149-8.896;P=0.026)were independent risk factors for T2DM complicated with CHD,whereas MET(OR=0.350;95%CI:0.129-0.952;P=0.040)was considered a protective factor for CHD in T2DM.CONCLUSION Coronary artery occlusion is a prevalent complication in patients with T2DM.Patients with T2MD with CHD demonstrated a higher degree of RCA and LCX stenosis than those with T2DM without CHD.FBG,HbA1c,and MET treatment history are risk factors for T2DM complicated with CHD.
