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Medranda GA, Faraz HA, Thompson JB, Zhang Y, Bharadwaj AS, Osborn EA, Abu-Much A, Lansky AJ, Basir MB, Moses JW, O’Neill WW, Grines CL, Baron SJ. Association of Preprocedural SYNTAX Score With Outcomes in Impella-Assisted High-Risk Percutaneous Coronary Intervention. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101981. [PMID: 39166169 PMCID: PMC11330901 DOI: 10.1016/j.jscai.2024.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 08/22/2024]
Abstract
Background Patients with complex coronary artery disease, as defined by high SYNTAX scores, undergoing percutaneous coronary intervention (PCI) have poorer outcomes when compared with patients with lower SYNTAX I scores. This study aimed to assess if mechanical circulatory support using Impella mitigates the effect of the SYNTAX I score on outcomes after high-risk percutaneous coronary intervention (HRPCI). Methods Using data from the PROTECT III study, patients undergoing Impella-assisted HRPCI between March 2017 and March 2020 were divided into 3 cohorts based on SYNTAX I score-low (≤22), intermediate (23-32), and high (≥33). Procedural and clinical outcomes out to 90 days were compared between groups. Multivariable regression analysis was used to assess the impact of SYNTAX I score on major adverse cardiovascular and cerebrovascular events (MACCE) at 90 days. Results A total of 850 subjects with core laboratory-adjudicated SYNTAX I scores were identified (low: n = 310; intermediate: n = 256; high: n = 284). Patients with high SYNTAX I scores were older than those with low or intermediate SYNTAX I scores (72.7 vs 69.7 vs 70.1 years, respectively; P < .01). After adjustment for covariates, high SYNTAX I score remained a significant predictor of 90-day MACCE (hazard ratio [HR], 2.14; 95% CI, 1.42-3.69; P < .01 vs low), whereas intermediate SYNTAX I score was not (HR, 0.92; 95% CI, 0.47-1.77; P = .80 vs low). These findings persisted after adjustment for post-PCI SYNTAX I score. Conclusions A high SYNTAX I score was associated with higher rates of 90-day MACCE in patients who underwent Impella-assisted HRPCI. Further research is needed to understand the patient and procedural factors driving this finding.
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Affiliation(s)
| | - Haroon A. Faraz
- Interventional Cardiology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Julia B. Thompson
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Aditya S. Bharadwaj
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Eric A. Osborn
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Arsalan Abu-Much
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Alexandra J. Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mir B. Basir
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey W. Moses
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- St. Francis Hospital & Heart Center, Roslyn, New York
| | | | - Cindy L. Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | - Suzanne J. Baron
- Interventional Cardiovascular Research, Massachusetts General Hospital, Boston, Massachusetts
- Baim Institute for Clinical Research, Boston, Massachusetts
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Xu M, Chen H, Li HW. The association between SYNTAX score and long-term outcomes in patients with unstable angina pectoris: a single-centre retrospective study. BMC Cardiovasc Disord 2022; 22:155. [PMID: 35392822 PMCID: PMC8991808 DOI: 10.1186/s12872-022-02604-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SYNTAX score affects clinical outcomes in early studies. However, the prognostic value of the SYNTAX Score for long-term outcomes and differences by SYNTAX score risk stratification in long-term prognosis between medical therapy and percutaneous coronary intervention (PCI) in patients with unstable angina pectoris (UAP) are not well known in the era of new generation drug-eluting stents and medication. METHODS In this single-centre retrospective study, a total of 2364 patients with UAP from January 2014 to June 2017 at Beijing Friendship Hospital were enrolled. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), including all-cause death, cardiac death, nonfatal myocardial infarction and stroke at least 2 years after discharge. RESULTS In this study, 1695 patients had low SYNTAX scores ([Formula: see text]), 432 patients had medium SYNTAX scores (23-32), 237 patients had high SYNTAX scores (≥ 33), 1018 received medical therapy, and 1346 patients underwent PCI. Long-term MACEs occurred in 95 patients during the 3.38 ± 0.99-year follow-up. Compared to the medical therapy group, the PCI group showed lower MACEs and cardiac death in patients with high SYNTAX scores (7.4% vs. 16.7%, P = 0.048; 3.7% vs. 14.6%, P = 0.004) but no reduction in patients with low and medium SYNTAX scores. Cox multivariate regression analysis showed that advanced age, diabetes mellitus, left ventricular ejection fraction (LVEF), hs-CRP and high SYNTAX score were independent predictors for MACEs in the medical therapy group (P < 0.05), whereas chronic kidney disease (CKD) and LVEF were predictors of MACEs in the PCI group. CONCLUSIONS Compared to medical therapy, PCI could only significantly reduce long-term MACEs and cardiac death for patients with high SYNTAX scores but not for patients with low and medium SYNTAX scores. A high SYNTAX score could predict long-term MACEs for UAP patients in the medical therapy group but not in the PCI group.
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Affiliation(s)
- Min Xu
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Rd. Yong'an, XiCheng District, Beijing, 100050, China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Rd. Yong'an, XiCheng District, Beijing, 100050, China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Rd. Yong'an, XiCheng District, Beijing, 100050, China. .,Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Bakirci EM, Degirmenci H, Duman H, Demirelli S, Hamur H, Buyuklu M, Ceyhun G, Kutlusoy E. Aortic propagation velocity in the prediction of coronary artery disease severity. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:51-56. [PMID: 33612836 DOI: 10.5507/bp.2021.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). METHODS The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). RESULTS High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P <0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. CONCLUSION APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.
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Affiliation(s)
- Eftal Murat Bakirci
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Husnu Degirmenci
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Hakan Duman
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Selami Demirelli
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Hikmet Hamur
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Mutlu Buyuklu
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Gokhan Ceyhun
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ergun Kutlusoy
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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Sun D, Ma T, Zhang Y, Zhang F, Cui B. Overexpressed miR-335-5p reduces atherosclerotic vulnerable plaque formation in acute coronary syndrome. J Clin Lab Anal 2021; 35:e23608. [PMID: 33277957 PMCID: PMC7891542 DOI: 10.1002/jcla.23608 10.18926/amo/64123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) may induce cardiovascular death. The correlation of mast cells related microRNAs (miRs) with risk of ACS has been investigated. We explored regulatory mechanism of miR-335-5p on macrophage innate immune response, atherosclerotic vulnerable plaque formation, and revascularization in ACS in relation to Notch signaling. METHODS ACS-related gene microarray was collected from Gene Expression Omnibus database. After different agomir or antagomir, or inhibitor of Notch signaling treatment, IL-6, IL-1β, TNF-α, MCP-1, ICAM-1, and VCAM-1 levels were tested in ACS mice. Additionally, Notch signaling-related genes and matrix metalloproteinases (MMPs) were measured after miR-335-5p interference. Finally, mouse atherosclerosis, lipid accumulation, and the collagen/vessel area ratio of plaque were determined. RESULTS miR-335-5p targeted JAG1 and mediated Notch signaling in ACS. miR-335-5p up-regulation and Notch signaling inhibition reduced expression of JAG1, Notch pathway-related genes, IL-6, IL-1β, TNF-α, MCP-1, ICAM-1, VCAM-1, and MMPs, but promote TIMP1 and TIMP2 expression. Additionally, vulnerable plaques were decreased and collagen fiber contents were observed to increase after miR-335-5p overexpression and Notch signaling inhibition. CONCLUSIONS Overexpression of miR-335-5p inhibited innate immune response of macrophage, reduced atherosclerotic vulnerable plaque formation, and promoted revascularization in ACS mice targeting JAG1 through Notch signaling.
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Affiliation(s)
- Dingjun Sun
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Tianyi Ma
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Yixue Zhang
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Fuwei Zhang
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Bo Cui
- Cardiology DepartmentThe First Affiliated Hospital of Hunan Normal UniversityHunan Provincial People's HospitalChangshaP.R. China
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Sun D, Ma T, Zhang Y, Zhang F, Cui B. Overexpressed miR-335-5p reduces atherosclerotic vulnerable plaque formation in acute coronary syndrome. J Clin Lab Anal 2021; 35:e23608. [PMID: 33277957 PMCID: PMC7891542 DOI: 10.1002/jcla.23608] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) may induce cardiovascular death. The correlation of mast cells related microRNAs (miRs) with risk of ACS has been investigated. We explored regulatory mechanism of miR-335-5p on macrophage innate immune response, atherosclerotic vulnerable plaque formation, and revascularization in ACS in relation to Notch signaling. METHODS ACS-related gene microarray was collected from Gene Expression Omnibus database. After different agomir or antagomir, or inhibitor of Notch signaling treatment, IL-6, IL-1β, TNF-α, MCP-1, ICAM-1, and VCAM-1 levels were tested in ACS mice. Additionally, Notch signaling-related genes and matrix metalloproteinases (MMPs) were measured after miR-335-5p interference. Finally, mouse atherosclerosis, lipid accumulation, and the collagen/vessel area ratio of plaque were determined. RESULTS miR-335-5p targeted JAG1 and mediated Notch signaling in ACS. miR-335-5p up-regulation and Notch signaling inhibition reduced expression of JAG1, Notch pathway-related genes, IL-6, IL-1β, TNF-α, MCP-1, ICAM-1, VCAM-1, and MMPs, but promote TIMP1 and TIMP2 expression. Additionally, vulnerable plaques were decreased and collagen fiber contents were observed to increase after miR-335-5p overexpression and Notch signaling inhibition. CONCLUSIONS Overexpression of miR-335-5p inhibited innate immune response of macrophage, reduced atherosclerotic vulnerable plaque formation, and promoted revascularization in ACS mice targeting JAG1 through Notch signaling.
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Affiliation(s)
- Dingjun Sun
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Tianyi Ma
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Yixue Zhang
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Fuwei Zhang
- Cardiology DepartmentCentral South University Xiangya School of Medicine Affiliated Haikou Hospital (Haikou People’s Hospital)HaikouP.R. China
| | - Bo Cui
- Cardiology DepartmentThe First Affiliated Hospital of Hunan Normal UniversityHunan Provincial People's HospitalChangshaP.R. China
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Zhang C, Liu P, Xia K, Fang H, Jiang M, Xie Q, Yu Z, Yang T. Association of Serum Prealbumin with Angiographic Severity in Patients with Acute Coronary Syndrome. Med Sci Monit 2017; 23:4041-4049. [PMID: 28827514 PMCID: PMC5574376 DOI: 10.12659/msm.902348] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Serum prealbumin (PA), which is a nutritional index, has been found to be associated with severities and prognoses of various diseases. However, there are no reports about the relationship between PA and angiographic severity of coronary artery disease. Material/Methods This cross-sectional study included 867 patients with acute coronary syndrome (ACS) who underwent coronary angiography. Patients were divided into quartiles of PA and coronary artery stenosis was determined by angiographic Gensini score, the presence of high Gensini score (Gensini score ≥120), and triple-vessel disease. Multivariate linear and logistic regression analyses were performed to explore the relationship between PA and disease severity in a coronary angiogram. Results There was a significant and independent negative correlation between PA and Gensini score in multivariate linear regression (p=0.015). Logistic regression analysis revealed that crude odds ratios of triple-vessel disease and high Gensini score were 2.47 (95% CI: 1.66–3.67) and 1.83 (95% CI: 1.50–3.49), respectively, in the first quartile of PA compared with the fourth quartile and the results remained significant for high Gensini score after adjustment for confounding factors. In addition, estimated glomerular filtration rate, liver function, and high-sensitivity C-reactive protein (hs-CRP) had no interactive relationships in the above associations. Patients with lower levels of albumin or higher levels of hs-CRP or the ratio of hs-CRP to PA (hs-CRP/PA) also had more severe coronary atherosclerosis. Conclusions PA is negatively and independently associated with angiographic severity in patients with ACS, indicating for potential use in estimating the burden of coronary atherosclerosis.
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Affiliation(s)
- Chenglong Zhang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Pei Liu
- Department of Cardiology, The 3rd Hospital of Changsha, Changsha, Hunan, China (mainland)
| | - Ke Xia
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Han Fang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Minna Jiang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Qiying Xie
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Zaixin Yu
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Tianlun Yang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
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Burlacu A, Siriopol D, Nistor I, Voroneanu L, Nedelciuc I, Statescu C, Covic A. Clinical SYNTAX Score - a good predictor for renal artery stenosis in acute myocardial infarction patients: analysis from the REN-ACS trial. Arch Med Sci 2017; 13:837-844. [PMID: 28721152 PMCID: PMC5510498 DOI: 10.5114/aoms.2016.60374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/29/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In ST-elevation myocardial infarction (STEMI) patients, multisite artery disease represents a serious issue influencing evolution, outcomes and prognosis. We evaluated for the first time the power of the Myocardial Infarction SYNTAX Score (MI SS) and Clinical SYNTAX Score (MI CSS) as predictors for renal artery stenosis (RAS) in STEMI. We also stratified the study population according to the two scores, and identified the variables correlated with the higher score. MATERIAL AND METHODS We used data from the REN-ACS study, which included 181 consecutive patients prospectively investigated for presence of RAS (through renal angiography), arterial stiffness (carotid-femoral pulse wave velocity, cf-PWV) and hydration status (bioimpedance). MI SS and CSS were computed. RESULTS Multivariate regressions indicated that the independent variables correlated with MI SS were left ventricular ejection fraction < 40%, significant RAS (> 50%, defined as RAS+), history of heart failure, and multivascular coronary disease (CAD, p < 0.03 for each), while those correlated with MI CSS were RAS+, cf-PWV, history of CAD, multivascular CAD, cholesterol, and total body water (p < 0.02 for each). In order to evaluate the ability to predict RAS+ we generated receiver operating characteristics and areas under curves, and the Youden index for MI SS and CSS. CONCLUSIONS Both scores correlated with extensive atherosclerotic disease and presence of RAS+. A lower CSS proved to be a good predictor for exclusion of RAS+, with high specificity (85%) and negative predictive value (92%), and fair sensitivity (60%). We aim to further pursue this line of research and design a better predictor for RAS, with the inclusion of a novel biomarker in order to increase sensitivity.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Dimitrie Siriopol
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
| | - Ionut Nistor
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
| | - Luminita Voroneanu
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
| | - Igor Nedelciuc
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Cristian Statescu
- Department of Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
| | - Adrian Covic
- Department of Nephrology, University of Medicine ‘Gr. T. Popa’, Iasi, Romania
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Uluganyan M, Karaca G, Ulutas TK, Ekmekci A, Tusun E, Murat A, Koroglu B, Uyarel H, Bakhshaliyev N, Eren M. The Impact of Admission Serum Creatinine Derived Estimated Glomerular Filtration Rate on Major Adverse Cardiac Events in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. J Clin Med Res 2016; 8:325-30. [PMID: 26985253 PMCID: PMC4780496 DOI: 10.14740/jocmr2482w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/15/2022] Open
Abstract
Background The impact of Cockroft-Gault (C-G) derived estimated glomerular filtration rate (eGFR) on mortality and major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was assessed. Methods A total of 884 patients were classified into four categories according to admission creatine derived eGFR: < 60, 60 - < 90, 90 - < 120, and ≥ 120 mL/min/1.73 m2. Results In-hospital and long-term MACEs were significantly higher in eGFR < 60 mL/min/1.73 m2 subgroup (P < 0.001 and P = 0.028). Multivariate analysis demonstrated 7.78-fold (95% CI: 0.91 - 66.8) higher mortality risk in eGFR < 60 mL/min/1.73 m2 subgroup. Conclusion As an easily applicable bedside method, C-G derived eGFR could be important for prediction of in-hospital and long-term mortality and MACE in STEMI patients undergoing primary PCI.
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Affiliation(s)
- Mahmut Uluganyan
- Clinic of Cardiology, Kadirli Government Hospital, Osmaniye, Turkey
| | - Gurkan Karaca
- Clinic of Cardiology, Osmancik Government Hospital, Corum, Turkey
| | | | - Ahmet Ekmekci
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Eyup Tusun
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Murat
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Bayram Koroglu
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Uyarel
- Department of Cardiology, Bezmialem Vakif University Medical Hospital, Istanbul, Turkey
| | - Nijad Bakhshaliyev
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Eren
- Clinic of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
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Karadeniz M, Duran M, Akyel A, Yarlıoğlueş M, Öcek AH, Çelik İE, Kılıç A, Yalcin AA, Ergün G, Murat SN. High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome. Int Heart J 2015; 56:377-80. [PMID: 26118590 DOI: 10.1536/ihj.14-299] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High sensitive C-reactive protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore).We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23).Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12).Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.
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Association of renal function, estimated by four equations, with coronary artery disease. Int Urol Nephrol 2015; 47:663-71. [DOI: 10.1007/s11255-015-0935-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Lin TH, Hsin HT, Wang CL, Lai WT, Li AH, Kuo CT, Hwang JJ, Chiang FT, Chang SC, Chang CJ. Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. BMC Nephrol 2014; 15:66. [PMID: 24758190 PMCID: PMC4003515 DOI: 10.1186/1471-2369-15-66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/16/2014] [Indexed: 12/14/2022] Open
Abstract
Background The optimal revascularization strategy for patients with impaired glomerular filtration rate (IGFR) has not been established in acute coronary syndrome (ACS). We investigated the prognosis and impact of IGFR and invasive strategy on the cardiovascular outcomes in the ACS population. Methods In a Taiwan national-wide registry, 3093 ACS patients were enrolled. The invasive strategy was defined as patients with ST-elevation ACS (STE-ACS) undergoing primary angioplasty or fibrinolysis or coronary angiography with intent to revascularization performed within 72 hours of symptom onset in non-ST-elevation ACS (NSTE-ACS). IGFR was defined as an estimated GFR of less than 60 ml/min per 1.73 m2. Primary endpoint was a composite of death, non-fatal myocardial infarction or stroke at one year. Results Patients with IGFR (n = 1226) had more comorbidities but received less evidence-based medications during admission than those without IGFR (n = 1867). The primary endpoint-free survival rate is lower in the IGFR patients, in the whole, STE-ACS and NSTE-ACS population (all log-rank tests p < 0.01). Cox regression analysis revealed IGFR subjects had higher primary endpoint after adjusting by age, sex, medication at discharge and traditional risk factors (all p < 0.01). Kaplan–Meier curves showed IGFR patients without invasive strategy had the worst outcome in the STE-ACS and NSTE-ACS population (both p < 0.01). The invasive strategies, either with early angiography only or angioplasty, were associated with reduced primary endpoints among IGFR patients in the NSTE-ACS population (both p ≦ 0.024). Conclusions IGFR patients suffering from ACS had poor prognosis and an invasive strategy could improve cardiovascular outcome in the NSTE-ACS population.
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Affiliation(s)
| | | | | | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No,100, Tzyou 1st Road, Kaohsiung 80708, Taiwan.
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Kim IY, Hwang IH, Lee KN, Lee DW, Lee SB, Shin MJ, Rhee H, Yang B, Song SH, Seong EY, Kwak IS. Decreased renal function is an independent predictor of severity of coronary artery disease: an application of Gensini score. J Korean Med Sci 2013; 28:1615-21. [PMID: 24265524 PMCID: PMC3835503 DOI: 10.3346/jkms.2013.28.11.1615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/05/2013] [Indexed: 12/01/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of death in patients with chronic kidney disease (CKD).Although many studies have shown a higher prevalence of CAD among these patients, the association between the spectrum of renal dysfunction and severity of CAD remains unclear. In this study, we investigate the association between renal function and the severity of CAD. We retrospectively reviewed the medical records of 1,192 patients who underwent elective coronary angiography (CAG). The severity of CAD was evaluated by Gensini score according to the degree of luminal narrowing and location(s) of obstruction in the involved main coronary artery. In all patients, the estimated glomerular filtration rate (eGFR) was independently associated with Gensini score (β=-0.27, P < 0.001) in addition to diabetes mellitus (β=0.07, P = 0.02), hypertension (β=0.12, P < 0.001), low density lipoprotein (LDL)-cholesterol (β=0.08, P = 0.003), and hemoglobin (β=-0.07, P = 0.03) after controlling for other confounding factors. The result of this study demonstrates that decreased renal function is associated not only with the prevalence, but also the severity, of CAD.
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Affiliation(s)
- Il Young Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In Hye Hwang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyung Nam Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo Bong Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min Ji Shin
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Harin Rhee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - ByeongYun Yang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
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