In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions

Effectiveness of visual management health education in preventing venous thromboembolism in patients with complete occlusion of chronic coronary arteries

OBJECTIVE

Exploring the effectiveness of visually managed health education in reducing the risk of venous thromboembolism in patients with complete occlusion of chronic coronary arteries.

METHODS

In this study, 100 patients with chronic total occlusion of coronary arteries and undergoing percutaneous coronary intervention (PCI) in cardiovascular medicine were included and divided into a test group and a control group with 50 patients in each group. Patients in the test group received health education based on visualization management, while patients in the control group received conventional health education. Relevant data were collected for further comparison. Statistical analysis was performed using SPSS and t-test and χ2 test were used to analyze the differences.

RESULTS

After intervention, there were higher levels of antithrombin III (AT3) and activated partial prothrombin time (APTT), while lower levels of D-dimer (D-D), fibrinogen degradation product (FDP), fibrinogen (FBG), and thrombin time (TT) in the test group than those before intervention. The control group showed decreased AT3 and APTT, while increased D-D, FDP,TT and FBG levels (P < 0.05). After intervention, the levels of AT3 and APTT in the test group were higher than those in the control group, while the levels of D-D, FDP, FBG, and TT were lower than those in the latter control group (P < 0.05). Furthermore, both groups of patients showed a decrease in Padua scores and an increase in prevention cognition scores after intervention (P < 0.05). After intervention, the Padua score of the test group was lower than that of the control group (P < 0.05). The test group had higher compliance score (P < 0.001) and satisfaction (P < 0.001).

CONCLUSION

Visual management health education can effectively improve the effect of health education, increase patients' awareness, compliance and satisfaction with VTE prevention, reduce the risk of lower limb VTE, and improve the coagulation function of CTO patients during PCI.

Managing chronic coronary syndrome: how do we achieve optimal patient outcomes?

INTRODUCTION

Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management.

AREAS COVERED

This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms.

EXPERT OPINION

CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.

[Correlation between insulin resistance and coronary collateral circulation in patients with chronic total coronary occlusion]

OBJECTIVE

To explore the impact of diabetes on collateral circulation (CC) development in patients with chronic total coronary occlusion (CTO) and the underlying regulatory mechanism.

METHODS

This study was conducted among 87 patients with coronary heart disease (CHD), who had CTO in at least one vessel as confirmed by coronary angiography. Among them 42 patients were found to have a low CC level (Cohen-Rentrop grades 0-1) and 45 had a high CC level (grades 2-3). In the 39 patients with comorbid diabetes mellitus and 48 non-diabetic patients, insulin resistance (IR) levels were compared between the subgroups with different CC levels. The steady-state mode evaluation method was employed for calculating the homeostatic model assessment for insulin resistance index (HOMA-IR) using a mathematical model. During the interventional procedures, collateral and peripheral blood samples were collected from 22 patients for comparison of the metabolites using non-targeted metabolomics analysis.

RESULTS

NT-proBNP levels and LVEF differed significantly between the patients with different CC levels (P<0.05). In non-diabetic patients, HOMA-IR was higher in low CC level group than in high CC level groups. Compared with the non-diabetic patients, the diabetic patients showed 63 upregulated and 48 downregulated metabolites in the collateral blood and 23 upregulated and 14 downregulated metabolites in the peripheral blood. The differential metabolites in the collateral blood were involved in aromatic compound degradation, fatty acid biosynthesis, and steroid degradation pathways; those in the peripheral blood were related with pentose phosphate metabolism, bacterial chemotaxis, hexanoyl-CoA degradation, glycerophospholipid metabolism, and lysine degradation pathways.

CONCLUSION

The non-diabetic patients with a low level of CC had significant insulin resistance. The degradation pathways of aromatic compounds, fatty acid biosynthesis, and steroid degradation are closely correlated with the development of CC.