Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city i...Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.展开更多
Background:The hemoglobin glycation index(HGI)was developed to quantify glucose metabolism and individual differences and proved to be a robust measure of individual glycosylated hemoglobin(HbA1c)bias.Here,we aimed to...Background:The hemoglobin glycation index(HGI)was developed to quantify glucose metabolism and individual differences and proved to be a robust measure of individual glycosylated hemoglobin(HbA1c)bias.Here,we aimed to explore the relationship between different HGIs and the risk of 5-year major adverse cardiovascular events(MACEs)by performing a large multicenter cohort study in China.Methods:A total of 9791 subjects from the Risk Evaluation of Cancers in Chinese Diabetic Individuals:a Longitudinal Study(the REACTION study)were divided into five subgroups(Q1-Q5)with the HGI quantiles(≤5th,>5th and≤33.3th,>33.3th and≤66.7th,>66.7th and≤95th,and>95th percentile).A multivariate logistic regression model constructed by the restricted cubic spline method was used to evaluate the relationship between the HGI and the 5-year MACE risk.Subgroup analysis between the HGI and covariates were explored to detect differences among the five subgroups.Results:The total 5-year MACE rate in the nationwide cohort was 6.87%(673/9791).Restricted cubic spline analysis suggested a U-shaped correlation between the HGI values and MACE risk after adjustment for cardiovascular risk factors(x^(2)=29.5,P<0.001).After adjustment for potential confounders,subjects with HGIs≤-0.75 or>0.82 showed odds ratios(ORs)for MACE of 1.471(95%confidence interval[CI],1.027-2.069)and 2.222(95%CI,1.641-3.026)compared to subjects with HGIs of>-0.75 and≤-0.20.In the subgroup with non-coronary heart disease,the risk of MACE was significantly higher in subjects with HGIs≤-0.75(OR,1.540[1.039-2.234];P=0.027)and>0.82(OR,2.022[1.392-2.890];P<0.001)compared to those with HGIs of≤-0.75 or>0.82 after adjustment for potential confounders.Conclusions:We found a U-shaped correlation between the HGI values and the risk of 5-year MACE.Both low and high HGIs were associated with an increased risk of MACE.Therefore,the HGI may predict the 5-year MACE risk.展开更多
Objective::The purpose of this study was to determine the relationship between remnant-like particle cholesterol(RLP-C)and major adverse cardiovascular events(MACEs)in patients with different levels of proprotein conv...Objective::The purpose of this study was to determine the relationship between remnant-like particle cholesterol(RLP-C)and major adverse cardiovascular events(MACEs)in patients with different levels of proprotein convertase subtilisin/kexin 9(PCSK9).Methods::From September 2007 to January 2009,1,859 subjects in Pingguoyuan communities in Beijing were initially screened.After excluding those with bedridden status,mental illness,severe systemic diseases,and missing data,1,680 subjects were recruited for follow up.All recruited subjects were followed up from February 2013 to September 2013(181 subjects were lost to follow-up)and from June 2017 to September 2018(174 subjects were lost to follow up).Finally,1,325 subjects were included in the study.General demographic characteristics,lifestyle and behaviors,disease history and use of medication was collected.Levels of total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,fast blood glucose,RLP-C,low-density lipoprotein triglycerides and PCSK9 were measured.The levels of RLP-C(low:RLP-C≤157 mg/L;high:RLP-C>157 mg/L)and PCSK9(low:PCSK9≤135.87μg/L;high:PCSK9>135.87μg/L)were represented using quartiles.Subjects were categorized into 4 groups according to their RLP-C and PCSK9 levels:Q4,high levels of RLP-C with high levels of PCSK9;Q3,high levels of RLP-C with low levels of PCSK9;Q2,low levels of RLP-C with high levels of PCSK9;and Q1,low levels of RLP-C with low levels of PCSK9.The association of RLP-C with MACEs in subjects with different PCSK9 levels was evaluated.Results::After a median follow-up of 9.5 years,1,325 subjects were included in the study and a total of 191 MACEs had occurred.The incidence of MACEs was higher in the RLP-C>157 mg/L group than the RLP-C≤157 mg/L group(18.40%vs.10.42%).Cox proportional hazards regression model analysis showed that increased RLP-C levels were associated with an increased risk of MACEs(hazard ratio:1.405;95%confidence interval:1.005-1.964;P<0.005).The incidence of MACEs was higher in the high RLP-C/PCSK9 group vs.the low RLP-C/PCSK9 group(20.68%vs.8.76%).Cox proportional hazards regression model analysis showed that RLP-C was associated with an increased risk of MACEs in subjects with high PCSK9 levels independent of traditional risk factors(hazard ratio:1.791;95%confidence interval:1.168-2.825;P=0.001),but not in those with low PCSK9 levels.Conclusions::RLP-C was identified as a risk factor for MACEs,particularly in subjects with high PCSK9 levels.Lowering PCSK9 levels may reduce residual risk in subjects with elevated plasma RLP-C levels.展开更多
BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not be...BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.展开更多
Objective To explore associations between lipoprotein-associated phospholipase A2(Lp-PLA2)and the risk of cardiovascular events in a Chinese population,with a long-term follow-up.Methods A random sample of 2,031 parti...Objective To explore associations between lipoprotein-associated phospholipase A2(Lp-PLA2)and the risk of cardiovascular events in a Chinese population,with a long-term follow-up.Methods A random sample of 2,031 participants(73.6%males,mean age=60.4 years)was derived from the Asymptomatic Polyvascular Abnormalities Community study(APAC)from 2010 to 2011.Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay(ELISA).The composite endpoint was a combination of first-ever stroke,myocardial infarction(MI)or all-cause death.Lp-PLA2 associations with outcomes were assessed using Cox models.Results The median Lp-PLA2 level was 141.0 ng/m L.Over a median follow-up of 9.1 years,we identified 389 events(19.2%),including 137 stroke incidents,43 MIs,and 244 all-cause deaths.Using multivariate Cox regression,when compared with the lowest Lp-PLA2 quartile,the hazard ratios with95%confidence intervals for developing composite endpoints,stroke,major adverse cardiovascular events,and all-cause death were 1.77(1.24–2.54),1.92(1.03–3.60),1.69(1.003–2.84),and 1.94(1.18–3.18)in the highest quartile,respectively.Composite endpoints in 145(28.6%)patients occurred in the highest quartile where Lp-PLA2(159.0 ng/m L)was much lower than the American Association of Clinical Endocrinologists recommended cut-off point,200 ng/m L.Conclusion Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population.The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.展开更多
Objective:This study aimed to evaluate the major adverse cardiovascular and cerebrovascular events(MACCEs)and overall safety profile associated with iodixanol in Chinese patients undergoing percutaneous coronary inter...Objective:This study aimed to evaluate the major adverse cardiovascular and cerebrovascular events(MACCEs)and overall safety profile associated with iodixanol in Chinese patients undergoing percutaneous coronary intervention(PCI).Methods:Patients at 30 centers in China registered in the OpenClinic v3.6 database from October 30,2013,to October 7,2015,were included in the study.The primary endpoint was in-hospital MACCEs including target lesion revascularization(TLR),stroke,stent thrombosis,cardiac death,and PCI-related myocardial infarction(MI)within 72 h post-PCI.Secondary endpoints were MACCEs from 72 h to 30 d post-PCI and other safety events within 30 d post-PCI.Results:A total of 3,042 patients were enrolled.The incidence of MACCEs within 72 h post-PCI was 2.33%(n=71),including cardiac death(0.03%,n=1)and PCI-related MI(2.30%,n=70).The incidence of MACCEs from 72 h to 30 d post-PCI was 0.16%(n=5),including cardiac death(0.10%,n=3),PCI-related MI(0.03%,n=1),and TLR for stent thrombosis(0.03%,n=1).The incidence of composite angiographic or procedural complications was 2.86%(n=87);233(7.86%)patients had results suggesting contrast-induced acute kidney injury.Conclusions:These findings indicate that the use of iodixanol in Chinese patients undergoing PCI is associated with a low incidence of MACCEs,confirming its safety in this population.展开更多
BACKGROUND Individuals diagnosed with gastrointestinal tumors are at an increased risk of developing cardiovascular diseases.Among which,ventricular arrhythmia is a prevalent clinical concern.This suggests that ventri...BACKGROUND Individuals diagnosed with gastrointestinal tumors are at an increased risk of developing cardiovascular diseases.Among which,ventricular arrhythmia is a prevalent clinical concern.This suggests that ventricular arrhythmias may have predictive value in the prognosis of patients with gastrointestinal tumors.AIM To explore the prognostic value of ventricular arrhythmias in patients with gastrointestinal tumors receiving surgery.METHODS We retrospectively analyzed data from 130 patients undergoing gastrointestinal tumor resection.These patients were evaluated by a 24-h ambulatory electrocardiogram(ECG)at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2020.Additionally,41 general healthy age-matched and sexmatched controls were included.Patients were categorized into survival and non-survival groups.The primary endpoint was all-cause mortality,and secondary endpoints included major adverse cardiovascular events(MACEs).RESULTS Colorectal tumors comprised 90%of cases.Preoperative ambulatory ECG monitoring revealed that among the 130 patients with gastrointestinal tumors,100(76.92%)exhibited varying degrees of premature ventricular contractions(PVCs).Ten patients(7.69%)manifested non-sustained ventricular tachycardia(NSVT).The patients with gastrointestinal tumors exhibited higher PVCs compared to the healthy controls on both conventional ECG[27(21.3)vs 1(2.5),P=0.012]and 24-h ambulatory ECG[14(1.0,405)vs 1(0,6.5),P<0.001].Non-survivors had a higher PVC count than survivors[150.50(7.25,1690.50)vs 9(0,229.25),P=0.020].During the follow-up period,24 patients died and 11 patients experienced MACEs.Univariate analysis linked PVC>35/24 h to all-cause mortality,and NSVT was associated with MACE.However,neither PVC burden nor NSVT independently predicted outcomes according to multivariate analysis.CONCLUSION Patients with gastrointestinal tumors exhibited elevated PVCs.PVCs>35/24 h and NSVT detected by 24-h ambulatory ECG were prognostically significant but were not found to be independent predictors.展开更多
BACKGROUND Cardiovascular disease is a major complication of diabetes mellitus(DM).Type-2 DM(T2DM)is associated with an increased risk of cardiovascular events and mortality,while serum biomarkers may facilitate the p...BACKGROUND Cardiovascular disease is a major complication of diabetes mellitus(DM).Type-2 DM(T2DM)is associated with an increased risk of cardiovascular events and mortality,while serum biomarkers may facilitate the prediction of these outcomes.Early differential diagnosis of T2DM complicated with acute coronary syndrome(ACS)plays an important role in controlling disease progression and improving safety.AIM To investigate the correlation of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)with major adverse cardiovascular events(MACEs)in T2DM patients with ACS.METHODS The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively.According to different conditions,they were divided into the T2DM complicated with ACS group(T2DM+ACS,n=96),simple T2DM group(T2DM,n=85),and simple ACS group(ACS,n=90).The clinical data and laboratory indices were compared among the three groups,and the correlations of serum total bilirubin(TBIL)levels and serumγ-GGT levels with other indices were discussed.T2DM+ACS patients received a 90-day follow-up after discharge and were divided into event(n=15)and nonevent(n=81)groups according to the occurrence of MACEs;Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients.RESULTS The T2DM+ACS group showed higherγ-GGT,total cholesterol,low-density lipoprotein cholesterol(LDL-C)and glycosylated hemoglobin(HbA1c)and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups(P<0.05).Based on univariate analysis,the event and nonevent groups were significantly different in age(t=3.3612,P=0.0011),TBIL level(t=3.0742,P=0.0028),γ-GGT level(t=2.6887,P=0.0085),LDL-C level(t=2.0816,P=0.0401),HbA1c level(t=2.7862,P=0.0065)and left ventricular ejection fraction(LEVF)levels(t=3.2047,P=0.0018).Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs,and age andγ-GGT level were risk factors(P<0.05).CONCLUSION Serum TBIL levels are decreased andγ-GGT levels are increased in T2DM+ACS patients,and the two indices are significantly negatively correlated.TBIL andγ-GGT are independent influencing factors for MACEs in such patients.展开更多
Background:To investigate the effect of fatigue on the short-term prognosis of young and middle-aged patients with coronary heart disease(CHD).Methods:A cross-sectional,observational survey was distributed at a tertia...Background:To investigate the effect of fatigue on the short-term prognosis of young and middle-aged patients with coronary heart disease(CHD).Methods:A cross-sectional,observational survey was distributed at a tertiary hospital in Suzhou,China.Patients were assessed for fatigue and their prognosis was assessed at 3 and 6 months after discharge.General Information Questionnaire,Fatigue Scale and Seattle Angina Questionnaire(SAQ)were used for the survey.The Cox proportional hazard model was used to analyze the impact of fatigue on the occurrence of major adverse cardiac events(MACEs)at 3 and 6 months after discharge.Multiple linear regression models were used to analyze the effect of fatigue on health-related quality of life(HRQoL)at 3 and 6 months after discharge.Results:199 patients were followed up with in the end.43 patients(21.6%)with MACE three months after discharge had a total SAQ score of(399.76±39.61).The overall SAQ score was(425.14±22.66)and 52 patients(26.1%)experienced MACE six months after discharge.Fatigue was identified as a risk factor for MACE 6 months after discharge by the Cox proportional hazard model(HR=2.939,95%CI:0.177~0.655,P=0.001)and as an independent risk factor for quality of life 3 and 6 months after discharge by multiple linear regression(P<0.001).Conclusions:In individuals who are young or middle-aged and have coronary heart disease,fatigue is a risk factor for the short-term prognosis.It is advised that clinical professionals prioritize patient fatigue assessment and improve management of fatigue symptoms.展开更多
Background:High-sensitivity C-reactive protein(hs-CRP)is a major factor for predicting acute coronary syndrome(ACS).Myeloperoxidase(MPO)also plays an important role in atherosclerosis initiation and development.In the...Background:High-sensitivity C-reactive protein(hs-CRP)is a major factor for predicting acute coronary syndrome(ACS).Myeloperoxidase(MPO)also plays an important role in atherosclerosis initiation and development.In the present work,a detail comparison between MPO and hs-CRP for early warning ACS is discussed.Objective:To compare the values between MPO and hs-CRP for early warning ACS and predicting major adverse cardiovascular events(MACEs)in CHD patients.Methods:MPO,hs-CRP and ACS-related risk factors from 201 ACS and 210 non-ACS patients were tested,and data were analyzed with SPSS software.Major adverse cardiovascular events(MACEs)were investigated during the 4-year period follow-up in 285 coronary heart disease(CHD)patients.Results:The areas under receiver operating characteristic(ROC)curve for diagnosing ACS were 0.888(95%CI 0.843-0.933)for MPO,and 0.862(95%CI 0.815-0.910)for hs-CRP,respectively.Compared to hs-CRP,MPO had more correlations strongly with ACS-related risk factors of TG,HDL-C and LDL-C in ACS patients(p<0.05).Prospective study demonstrated that the incidences of MACEs associated significantly with elevated MPO baseline level(yes vs no,OR 7.383,95%CI 4.095-13.309)and high hs-CRP baseline level(yes vs no,OR 4.186,95%CI 2.469-7.097).Conclusions:MPO as inflammatory marker for early warning ACS has some advantages compared to hsCRP.Elevated baseline MPO and hs-CRP levels are both valuable predictors of MACEs in CHD patients.展开更多
BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST...BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.展开更多
BACKGROUND Although bilirubin is known to be an antioxidant,any relationship with coronary heart disease remains controversial.To the best of our knowledge,no previous study has investigated the association between bi...BACKGROUND Although bilirubin is known to be an antioxidant,any relationship with coronary heart disease remains controversial.To the best of our knowledge,no previous study has investigated the association between bilirubin and perioperative myocardial infarction(PMI),including its long-term prognosis.AIM To investigate the impact of bilirubin levels on PMI in patients undergoing percutaneous coronary intervention(PCI),and long-term prognosis in post-PMI patients.METHODS Between January 2014 and September 2018,10236 patients undergoing elective PCI were enrolled in the present study.Total bilirubin(TB)and cardiac troponin I(cTnI)levels were measured prior to PCI and cTnI at further time-points,8,16 and 24 h after PCI.Participants were stratified by pre-PCI TB levels and divided into three groups:<10.2;10.2-14.4 and>14.4μmol/L.PMI was defined as producing a post-procedural cTnI level of>5×upper limit of normal(ULN)with normal baseline cTnI.Major adverse cardiovascular events(MACEs)included cardiac death,MI,stroke and revascularization during a maximum 5-year follow-up.RESULTS PMI was detected in 526(15.3%),431(12.7%)and 424(12.5%)of patients with pre-PCI TB levels of<10.2,10.2-14.4 and>14.4μmol/L(P=0.001),respectively.Multivariate logistical analysis indicated that patients with TB 10.2-14.4 and>14.4μmol/L had a lower incidence of PMI[TB 10.2-14.4μmol/L:Odds ratio(OR):0.854;95%confidence interval(CI):0.739-0.987;P=0.032;TB>14.4μmol/L:OR:0.846;95%CI:0.735-0.975;P=0.021]compared with patients with TB<10.2μmol/L.Construction of a Kaplan-Meier curve demonstrated a higher MACE-free survival time for patients with higher TB than for those with lower TB(log-rank P=0.022).After adjustment for cardiovascular risk factors and angiographic characteristics,multivariate Cox analysis showed that a TB level>14.4μmol/L was associated with a reduced risk of MACEs compared with a TB level<10.2μmol/L(hazard ratio 0.667;95%CI:0.485-0.918;P=0.013).CONCLUSION Bilirubin was a protective factor in PMI prediction.For post-PMI patients,elevated bilirubin levels were independently associated with a reduced risk of MACEs during long-term follow-up.展开更多
Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardia...Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardial infarction(TIMI)score and clinical prognosis.Method:The study was a retrospective one-center observational study,continuous inclusion of 600 ACS patients diagnosed by coronary angiography in our hospital from October 2018 to July 2019.Collect general clinical data,laboratory examination results,imaging data and interventional treatment data of all patients.Were divided into:T2DM with ACS group(group DA)and non-T2DM with ACS(group NDA)according to whether or not they were associated with T2DM.According to the GRACE、TIMI score,the two groups were divided into high risk group,middle risk group and low risk group.All patients underwent coronary angiography to calculate the number of vascular lesions and Gensini scores.Design questionnaire,after discharge to 2 groups of patients by telephone or outpatient follow-up average of 10 months,statistics of the occurrence of MACE events.Result:Among the 600 patients included in the study,362 were male(60.3%)and 238 were female(39.7%)with mean age(64.7±10.3)years.The baseline data showed that the G、TG、UA、CR levels were higher in the DA group than in the NDA group;the proportion of men was lower than in the NDA group.The results of coronary angiography showed that the Gensini score of DA group was higher than that of NDA group,and the proportion of single lesion was lower than that of NDA group.The binary Logistic regression analysis suggested that age and CRP were independent risk factors for MACE events in patients with T2DM.GRACE risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,and there was no significant difference between low and middle risk group.TIMI risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,while the proportion of low and middle risk group was lower than that in NDA group.The ROC curve shows that the area(AUC)below the ROC curve that GRACE、TIMI score predicted the occurrence of MACE events in patients with T2DM and ACS was 0.707 and 0.586.Conclusion:Patients with T2DM and ACS had higher clinical risk stratification than without T2DM.GRACE score compared with the TIMI score had better predictive value for the occurrence of MACE events after discharge of T2DM with ACS patients.展开更多
Objective The main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antid...Objective The main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antidiabetic medications using a nationwide population-based database.Methods We conducted a retrospective cohort study to assess the efficacy of acupuncture on cardiovascular complications in diabetic patients using data from patients between 40 and 79 years of age,newly diagnosed with diabetes between 2003 and 2006,found in the National Health Insurance Service-National Sample Cohort(NHIS-NSC)in Korea.From the data,we identified 21,232 diabetic patients who were taking antidiabetic medication between 2003 and 2006.The selected patients were divided into two groups-those who received acupuncture at least three times and those who received no acupuncture(non-acupuncture)in the year following their diagnosis of diabetes.After 1:1 propensity score matching(PSM),each group had 3350 patients,and the observation ceased at the occurrence of a major adverse cardiovascular event(MACE),which was defined as either myocardial infarction,stroke,or death due to cardiovascular cause.Results After PSM,the acupuncture group had a lower incidence of MACE(hazard ratio[HR]:0.87;95%confidence interval[CI]:0.81-0.94;P=0.0003)and all-cause mortality(HR:0.77;95%CI:0.70-0.84;P<0.0001)than the non-acupuncture group;the HRs for stroke-related mortality(HR:0.75;95%CI:0.56-1.00;P=0.0485),ischemic heart disease mortality(HR:0.53;95%CI:0.34-0.84;P=0.006)and circulatory system disease mortality(HR:0.67;95%CI:0.55-0.82;P<0.0001)were lower in the acupuncture group than in the non-acupuncture group in the secondary analysis.Conclusion Our results indicate that diabetic patients receiving acupuncture treatment might have a lower risk of MACE,all-cause mortality and cardiovascular mortality.This population-based retrospective study suggests beneficial effects of acupuncture in preventing macrovascular complications associated with diabetes.These findings call for further prospective cohort or experimental studies on acupuncture treatment for cardiovascular complications of diabetes.展开更多
Background:Preliminary studies have indicated that Shexiang Baoxin Pill(MUSKARDIA)has a coronary artery dilation effect and increases the coronary blood flow,relieving the symptoms of angina.This study aimed to evalua...Background:Preliminary studies have indicated that Shexiang Baoxin Pill(MUSKARDIA)has a coronary artery dilation effect and increases the coronary blood flow,relieving the symptoms of angina.This study aimed to evaluate the benefit of MUSKARDIA on patients with stable coronary artery disease(CAD)and diabetes mellitus(DM).Methods:This was a subgroup analysis of a multicenter,randomized,placebo-controlled phase IV trial.CAD patients with a medical history of DM or baseline fasting blood glucose(FBG)≥7.0 mmol/L were grouped according to the treatment(standard therapy plus MUSKARDIA or placebo).The primary outcome was major adverse cardiovascular events(MACEs),which was the composite outcome of cardiovascular death,non-fatal myocardial infarction,and non-fatal stroke.The secondary outcome was the composite outcome of all-cause death,non-fatal myocardial infarction,non-fatal stroke,hospitalization for unstable angina or heart failure,and coronary angioplasty.Results:MACEs occurred in 2.6%(9/340)and 4.8%(18/376)of patients in the MUSKARDIA and placebo groups,respectively(P=0.192).Secondary composite outcome was significantly less frequent with MUSKARDIA than with placebo(15.3%[52/340]vs.22.6%[85/376],P=0.017).Risk of MACEs(hazard ratio[HR]=0.69,95%confidence interval[CI]:0.31-1.57)was comparable between two groups.In patients with uncontrolled DM(≥4 measurements of FBG≥7 mmol/L in five times of follow-up),the risk of secondary outcome was significantly lower with MUSKARDIA(5/83,6.0%)than with placebo(15/91,16.5%)(HR=0.35,95%CI:0.13-0.95).Conclusion:As an add-on to standard therapy,MUSKARDIA shows a trend of reduced MACEs in patients with stable CAD and DM.Furthermore,MUSKARDIA may reduce the frequency of all-cause death,hospitalization,and coronary angioplasty in this population,especially in those with uncontrolled DM.Trial Registration:ChiCTR.org.cn,ChiCTR-TRC-12003513.展开更多
Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated d...Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated during on-hours,especially those with a first medical contact-to-device(FMC-to-device)time within 90 min.We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time<90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time<90 min from 19 chest pain centers in Beijing from January 2018 to December 2018.Patients were divided into on-hours group and off-hours group based on their arrival time.Baseline characteristics,clinical data,and key time intervals during treatment were collected from the Quality Control&Improvement Center of Cardiovascular Intervention of Beijing by the 4tHeart and Brain Green Channel”app.Results:Overall,the median age of the patients was 58.8 years and 19.9%(133/670)were female.Of these,296(44.2%)patients underwent PPCI during on-hours and 374(55.8%)patients underwent PPCI during off-hours.Compared with the on-hours group,the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time<60 min(P<0.05).During the mean follow-up period of 24 months,a total of 64(9.6%)participants experienced a major adverse cardiovascular event(MACE),with 28(9.1%)in the on-hours group and 36(9.6%)in the off-hours group(P>0.05).According to the Cox regression analyses,off-hours admission was not a predictor of 2-year MACEs(P=0.788).Similarly,the Kaplan-Meier curves showed that the risks of a MACE,all-cause death,reinfarction,and target vessel revascularization were not significantly different between the two groups(P>0.05).Conclusions:This real-world,multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min,off-hours admission was safe,with no difference in the risk of 2-year MACEs compared with those with on-hours admission.展开更多
Objective:The optimal percutaneous coronary intervention(PCI)technique for bifurcation lesions remains controversial,especially considering the variability of the side branch(SB).A provisional stenting technique is cu...Objective:The optimal percutaneous coronary intervention(PCI)technique for bifurcation lesions remains controversial,especially considering the variability of the side branch(SB).A provisional stenting technique is currently recommended in most cases.This meta-analysis aimed to compare outcomes of different bifurcation PCI strategies,clarifying their scope of application.Methods:Randomized controlled trials comparing PCI strategies for coronary bifurcation lesions were systematically retrieved from PubMed,Cochrane,Web of Science,and EBSCO literature databases without limitations on published date or language.Major adverse cardiovascular events(MACEs)were stipulated as main outcomes.Secondary outcomes of interest were all-cause mortality,cardiovascular mortality,target lesion revascularization(TLR),target vessel revascularization,myocardial infarction(MI),and stent thrombosis.Both pooled analysis and sub-group analysis were performed.Results:Twenty-three randomized controlled trials with 6380 participants were included.Eighteen studies compared the provisional strategy with 2-stent approaches.No significant difference in MACEs(relative risk(RR),1.16;95%confidence interval(CI),0.90-1.48;I2=62%)was found between 1-stent and 2-stent techniques.However,when SB lesion length was used as the separation condition,the 2-stent strategy was associated with fewer MACEs(RR,1.87;95%CI,1.46-2.41;I2=70%),TLRs(RR,2.13;95%CI,1.50-3.02;I2=59%),and MIs(RR,2.17;95%CI,1.19-3.95;I2=52%)than the provisional strategy in those where SB lesions measured>10 mm long.Conclusions:In the current work,there was no significant difference between 1-stent and 2-stent techniques in terms of MACEs or secondary outcomes.However,2-stent approaches have clinical advantages over the provisional strategy in bifurcation when the SB lesion length is>10 mm due to fewer cases of TLR and MI.展开更多
Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD...Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce.The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy(OMT)in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months.Both groups received OMT according to local tertiary hospital protocols.The primary outcome was the occurrence of a major adverse cardiovascular event(MACE),defined as a composite of cardiovascular death,non-fatal myocardial infarction(MI),or non-fatal stroke.Secondary outcomes included all-cause mortality,non-fatal MI,non-fatal stroke,hospitalization for unstable angina or heart failure,peripheral revascularization,angina stability and angina frequency.Results:In all,99.7%of the patients were treated with aspirin and 93.0%with statin.After 2 years of treatment,the occurrence of MACEs was reduced by 26.9%in the MUSKARDIA group(MUSKARDIA:1.9%vs.placebo:2.6%;odds ratio=0.80;95%confidence interval:0.45-1.07;P=0.2869).Angina frequency was significantly reduced in the MUSKARDIA group at 18 months(P=0.0362).Other secondary endpoints were similar between the two groups.The rates of adverse events were also similar between the two groups(MUSKARDIA:17.7%vs.placebo:17.4%,P=0.8785).Conclusions:As an add-on to OMT,MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD.Moreover,the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD.The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:chictr.org.cn,No.ChiCTR-TRC-12003513.展开更多
文摘Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.
文摘Background:The hemoglobin glycation index(HGI)was developed to quantify glucose metabolism and individual differences and proved to be a robust measure of individual glycosylated hemoglobin(HbA1c)bias.Here,we aimed to explore the relationship between different HGIs and the risk of 5-year major adverse cardiovascular events(MACEs)by performing a large multicenter cohort study in China.Methods:A total of 9791 subjects from the Risk Evaluation of Cancers in Chinese Diabetic Individuals:a Longitudinal Study(the REACTION study)were divided into five subgroups(Q1-Q5)with the HGI quantiles(≤5th,>5th and≤33.3th,>33.3th and≤66.7th,>66.7th and≤95th,and>95th percentile).A multivariate logistic regression model constructed by the restricted cubic spline method was used to evaluate the relationship between the HGI and the 5-year MACE risk.Subgroup analysis between the HGI and covariates were explored to detect differences among the five subgroups.Results:The total 5-year MACE rate in the nationwide cohort was 6.87%(673/9791).Restricted cubic spline analysis suggested a U-shaped correlation between the HGI values and MACE risk after adjustment for cardiovascular risk factors(x^(2)=29.5,P<0.001).After adjustment for potential confounders,subjects with HGIs≤-0.75 or>0.82 showed odds ratios(ORs)for MACE of 1.471(95%confidence interval[CI],1.027-2.069)and 2.222(95%CI,1.641-3.026)compared to subjects with HGIs of>-0.75 and≤-0.20.In the subgroup with non-coronary heart disease,the risk of MACE was significantly higher in subjects with HGIs≤-0.75(OR,1.540[1.039-2.234];P=0.027)and>0.82(OR,2.022[1.392-2.890];P<0.001)compared to those with HGIs of≤-0.75 or>0.82 after adjustment for potential confounders.Conclusions:We found a U-shaped correlation between the HGI values and the risk of 5-year MACE.Both low and high HGIs were associated with an increased risk of MACE.Therefore,the HGI may predict the 5-year MACE risk.
基金supported by the National Key Research and Development Program of China (2021YFC2500604)to Li Sheng.
文摘Objective::The purpose of this study was to determine the relationship between remnant-like particle cholesterol(RLP-C)and major adverse cardiovascular events(MACEs)in patients with different levels of proprotein convertase subtilisin/kexin 9(PCSK9).Methods::From September 2007 to January 2009,1,859 subjects in Pingguoyuan communities in Beijing were initially screened.After excluding those with bedridden status,mental illness,severe systemic diseases,and missing data,1,680 subjects were recruited for follow up.All recruited subjects were followed up from February 2013 to September 2013(181 subjects were lost to follow-up)and from June 2017 to September 2018(174 subjects were lost to follow up).Finally,1,325 subjects were included in the study.General demographic characteristics,lifestyle and behaviors,disease history and use of medication was collected.Levels of total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,fast blood glucose,RLP-C,low-density lipoprotein triglycerides and PCSK9 were measured.The levels of RLP-C(low:RLP-C≤157 mg/L;high:RLP-C>157 mg/L)and PCSK9(low:PCSK9≤135.87μg/L;high:PCSK9>135.87μg/L)were represented using quartiles.Subjects were categorized into 4 groups according to their RLP-C and PCSK9 levels:Q4,high levels of RLP-C with high levels of PCSK9;Q3,high levels of RLP-C with low levels of PCSK9;Q2,low levels of RLP-C with high levels of PCSK9;and Q1,low levels of RLP-C with low levels of PCSK9.The association of RLP-C with MACEs in subjects with different PCSK9 levels was evaluated.Results::After a median follow-up of 9.5 years,1,325 subjects were included in the study and a total of 191 MACEs had occurred.The incidence of MACEs was higher in the RLP-C>157 mg/L group than the RLP-C≤157 mg/L group(18.40%vs.10.42%).Cox proportional hazards regression model analysis showed that increased RLP-C levels were associated with an increased risk of MACEs(hazard ratio:1.405;95%confidence interval:1.005-1.964;P<0.005).The incidence of MACEs was higher in the high RLP-C/PCSK9 group vs.the low RLP-C/PCSK9 group(20.68%vs.8.76%).Cox proportional hazards regression model analysis showed that RLP-C was associated with an increased risk of MACEs in subjects with high PCSK9 levels independent of traditional risk factors(hazard ratio:1.791;95%confidence interval:1.168-2.825;P=0.001),but not in those with low PCSK9 levels.Conclusions::RLP-C was identified as a risk factor for MACEs,particularly in subjects with high PCSK9 levels.Lowering PCSK9 levels may reduce residual risk in subjects with elevated plasma RLP-C levels.
文摘BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.
基金supported by the National Natural Science Foundation of China [Grant No. 81973112 and Grant No.9204930002]
文摘Objective To explore associations between lipoprotein-associated phospholipase A2(Lp-PLA2)and the risk of cardiovascular events in a Chinese population,with a long-term follow-up.Methods A random sample of 2,031 participants(73.6%males,mean age=60.4 years)was derived from the Asymptomatic Polyvascular Abnormalities Community study(APAC)from 2010 to 2011.Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay(ELISA).The composite endpoint was a combination of first-ever stroke,myocardial infarction(MI)or all-cause death.Lp-PLA2 associations with outcomes were assessed using Cox models.Results The median Lp-PLA2 level was 141.0 ng/m L.Over a median follow-up of 9.1 years,we identified 389 events(19.2%),including 137 stroke incidents,43 MIs,and 244 all-cause deaths.Using multivariate Cox regression,when compared with the lowest Lp-PLA2 quartile,the hazard ratios with95%confidence intervals for developing composite endpoints,stroke,major adverse cardiovascular events,and all-cause death were 1.77(1.24–2.54),1.92(1.03–3.60),1.69(1.003–2.84),and 1.94(1.18–3.18)in the highest quartile,respectively.Composite endpoints in 145(28.6%)patients occurred in the highest quartile where Lp-PLA2(159.0 ng/m L)was much lower than the American Association of Clinical Endocrinologists recommended cut-off point,200 ng/m L.Conclusion Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population.The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.
基金supported by the National Key Project of Research and Development Plan during the Thirteenth Five-year Plan Period(2016YFC1301300),ChinaConstruction Program of National Clinical Priority Specialty.
文摘Objective:This study aimed to evaluate the major adverse cardiovascular and cerebrovascular events(MACCEs)and overall safety profile associated with iodixanol in Chinese patients undergoing percutaneous coronary intervention(PCI).Methods:Patients at 30 centers in China registered in the OpenClinic v3.6 database from October 30,2013,to October 7,2015,were included in the study.The primary endpoint was in-hospital MACCEs including target lesion revascularization(TLR),stroke,stent thrombosis,cardiac death,and PCI-related myocardial infarction(MI)within 72 h post-PCI.Secondary endpoints were MACCEs from 72 h to 30 d post-PCI and other safety events within 30 d post-PCI.Results:A total of 3,042 patients were enrolled.The incidence of MACCEs within 72 h post-PCI was 2.33%(n=71),including cardiac death(0.03%,n=1)and PCI-related MI(2.30%,n=70).The incidence of MACCEs from 72 h to 30 d post-PCI was 0.16%(n=5),including cardiac death(0.10%,n=3),PCI-related MI(0.03%,n=1),and TLR for stent thrombosis(0.03%,n=1).The incidence of composite angiographic or procedural complications was 2.86%(n=87);233(7.86%)patients had results suggesting contrast-induced acute kidney injury.Conclusions:These findings indicate that the use of iodixanol in Chinese patients undergoing PCI is associated with a low incidence of MACCEs,confirming its safety in this population.
基金Supported by the Sixth Affiliated Hospital of Sun Yat-sen University Clinical Research-1010 Program,No.1010PY(2023)-06the National Nature Science Foundation of China,No.81400301+1 种基金the Fundamental Research Funds for the Central Universities,No.19ykpy10Guangzhou Health Science and Technology Project,No.20231A010068.
文摘BACKGROUND Individuals diagnosed with gastrointestinal tumors are at an increased risk of developing cardiovascular diseases.Among which,ventricular arrhythmia is a prevalent clinical concern.This suggests that ventricular arrhythmias may have predictive value in the prognosis of patients with gastrointestinal tumors.AIM To explore the prognostic value of ventricular arrhythmias in patients with gastrointestinal tumors receiving surgery.METHODS We retrospectively analyzed data from 130 patients undergoing gastrointestinal tumor resection.These patients were evaluated by a 24-h ambulatory electrocardiogram(ECG)at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2020.Additionally,41 general healthy age-matched and sexmatched controls were included.Patients were categorized into survival and non-survival groups.The primary endpoint was all-cause mortality,and secondary endpoints included major adverse cardiovascular events(MACEs).RESULTS Colorectal tumors comprised 90%of cases.Preoperative ambulatory ECG monitoring revealed that among the 130 patients with gastrointestinal tumors,100(76.92%)exhibited varying degrees of premature ventricular contractions(PVCs).Ten patients(7.69%)manifested non-sustained ventricular tachycardia(NSVT).The patients with gastrointestinal tumors exhibited higher PVCs compared to the healthy controls on both conventional ECG[27(21.3)vs 1(2.5),P=0.012]and 24-h ambulatory ECG[14(1.0,405)vs 1(0,6.5),P<0.001].Non-survivors had a higher PVC count than survivors[150.50(7.25,1690.50)vs 9(0,229.25),P=0.020].During the follow-up period,24 patients died and 11 patients experienced MACEs.Univariate analysis linked PVC>35/24 h to all-cause mortality,and NSVT was associated with MACE.However,neither PVC burden nor NSVT independently predicted outcomes according to multivariate analysis.CONCLUSION Patients with gastrointestinal tumors exhibited elevated PVCs.PVCs>35/24 h and NSVT detected by 24-h ambulatory ECG were prognostically significant but were not found to be independent predictors.
基金Supported by Science and Technology Major Project of Changzhou Science and Technology Bureau,No.CE20205047Natural Science Foundation of Xinjiang Uygur Autonomo us Region,No.ZD202220Changzhou A major scientific research project of the Municipal Health Commission,No.2022D01F52.
文摘BACKGROUND Cardiovascular disease is a major complication of diabetes mellitus(DM).Type-2 DM(T2DM)is associated with an increased risk of cardiovascular events and mortality,while serum biomarkers may facilitate the prediction of these outcomes.Early differential diagnosis of T2DM complicated with acute coronary syndrome(ACS)plays an important role in controlling disease progression and improving safety.AIM To investigate the correlation of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)with major adverse cardiovascular events(MACEs)in T2DM patients with ACS.METHODS The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively.According to different conditions,they were divided into the T2DM complicated with ACS group(T2DM+ACS,n=96),simple T2DM group(T2DM,n=85),and simple ACS group(ACS,n=90).The clinical data and laboratory indices were compared among the three groups,and the correlations of serum total bilirubin(TBIL)levels and serumγ-GGT levels with other indices were discussed.T2DM+ACS patients received a 90-day follow-up after discharge and were divided into event(n=15)and nonevent(n=81)groups according to the occurrence of MACEs;Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients.RESULTS The T2DM+ACS group showed higherγ-GGT,total cholesterol,low-density lipoprotein cholesterol(LDL-C)and glycosylated hemoglobin(HbA1c)and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups(P<0.05).Based on univariate analysis,the event and nonevent groups were significantly different in age(t=3.3612,P=0.0011),TBIL level(t=3.0742,P=0.0028),γ-GGT level(t=2.6887,P=0.0085),LDL-C level(t=2.0816,P=0.0401),HbA1c level(t=2.7862,P=0.0065)and left ventricular ejection fraction(LEVF)levels(t=3.2047,P=0.0018).Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs,and age andγ-GGT level were risk factors(P<0.05).CONCLUSION Serum TBIL levels are decreased andγ-GGT levels are increased in T2DM+ACS patients,and the two indices are significantly negatively correlated.TBIL andγ-GGT are independent influencing factors for MACEs in such patients.
基金supported by Suzhou Science and Technology Development Plan Project (grant number:sys2018018).
文摘Background:To investigate the effect of fatigue on the short-term prognosis of young and middle-aged patients with coronary heart disease(CHD).Methods:A cross-sectional,observational survey was distributed at a tertiary hospital in Suzhou,China.Patients were assessed for fatigue and their prognosis was assessed at 3 and 6 months after discharge.General Information Questionnaire,Fatigue Scale and Seattle Angina Questionnaire(SAQ)were used for the survey.The Cox proportional hazard model was used to analyze the impact of fatigue on the occurrence of major adverse cardiac events(MACEs)at 3 and 6 months after discharge.Multiple linear regression models were used to analyze the effect of fatigue on health-related quality of life(HRQoL)at 3 and 6 months after discharge.Results:199 patients were followed up with in the end.43 patients(21.6%)with MACE three months after discharge had a total SAQ score of(399.76±39.61).The overall SAQ score was(425.14±22.66)and 52 patients(26.1%)experienced MACE six months after discharge.Fatigue was identified as a risk factor for MACE 6 months after discharge by the Cox proportional hazard model(HR=2.939,95%CI:0.177~0.655,P=0.001)and as an independent risk factor for quality of life 3 and 6 months after discharge by multiple linear regression(P<0.001).Conclusions:In individuals who are young or middle-aged and have coronary heart disease,fatigue is a risk factor for the short-term prognosis.It is advised that clinical professionals prioritize patient fatigue assessment and improve management of fatigue symptoms.
文摘Background:High-sensitivity C-reactive protein(hs-CRP)is a major factor for predicting acute coronary syndrome(ACS).Myeloperoxidase(MPO)also plays an important role in atherosclerosis initiation and development.In the present work,a detail comparison between MPO and hs-CRP for early warning ACS is discussed.Objective:To compare the values between MPO and hs-CRP for early warning ACS and predicting major adverse cardiovascular events(MACEs)in CHD patients.Methods:MPO,hs-CRP and ACS-related risk factors from 201 ACS and 210 non-ACS patients were tested,and data were analyzed with SPSS software.Major adverse cardiovascular events(MACEs)were investigated during the 4-year period follow-up in 285 coronary heart disease(CHD)patients.Results:The areas under receiver operating characteristic(ROC)curve for diagnosing ACS were 0.888(95%CI 0.843-0.933)for MPO,and 0.862(95%CI 0.815-0.910)for hs-CRP,respectively.Compared to hs-CRP,MPO had more correlations strongly with ACS-related risk factors of TG,HDL-C and LDL-C in ACS patients(p<0.05).Prospective study demonstrated that the incidences of MACEs associated significantly with elevated MPO baseline level(yes vs no,OR 7.383,95%CI 4.095-13.309)and high hs-CRP baseline level(yes vs no,OR 4.186,95%CI 2.469-7.097).Conclusions:MPO as inflammatory marker for early warning ACS has some advantages compared to hsCRP.Elevated baseline MPO and hs-CRP levels are both valuable predictors of MACEs in CHD patients.
文摘BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.
文摘BACKGROUND Although bilirubin is known to be an antioxidant,any relationship with coronary heart disease remains controversial.To the best of our knowledge,no previous study has investigated the association between bilirubin and perioperative myocardial infarction(PMI),including its long-term prognosis.AIM To investigate the impact of bilirubin levels on PMI in patients undergoing percutaneous coronary intervention(PCI),and long-term prognosis in post-PMI patients.METHODS Between January 2014 and September 2018,10236 patients undergoing elective PCI were enrolled in the present study.Total bilirubin(TB)and cardiac troponin I(cTnI)levels were measured prior to PCI and cTnI at further time-points,8,16 and 24 h after PCI.Participants were stratified by pre-PCI TB levels and divided into three groups:<10.2;10.2-14.4 and>14.4μmol/L.PMI was defined as producing a post-procedural cTnI level of>5×upper limit of normal(ULN)with normal baseline cTnI.Major adverse cardiovascular events(MACEs)included cardiac death,MI,stroke and revascularization during a maximum 5-year follow-up.RESULTS PMI was detected in 526(15.3%),431(12.7%)and 424(12.5%)of patients with pre-PCI TB levels of<10.2,10.2-14.4 and>14.4μmol/L(P=0.001),respectively.Multivariate logistical analysis indicated that patients with TB 10.2-14.4 and>14.4μmol/L had a lower incidence of PMI[TB 10.2-14.4μmol/L:Odds ratio(OR):0.854;95%confidence interval(CI):0.739-0.987;P=0.032;TB>14.4μmol/L:OR:0.846;95%CI:0.735-0.975;P=0.021]compared with patients with TB<10.2μmol/L.Construction of a Kaplan-Meier curve demonstrated a higher MACE-free survival time for patients with higher TB than for those with lower TB(log-rank P=0.022).After adjustment for cardiovascular risk factors and angiographic characteristics,multivariate Cox analysis showed that a TB level>14.4μmol/L was associated with a reduced risk of MACEs compared with a TB level<10.2μmol/L(hazard ratio 0.667;95%CI:0.485-0.918;P=0.013).CONCLUSION Bilirubin was a protective factor in PMI prediction.For post-PMI patients,elevated bilirubin levels were independently associated with a reduced risk of MACEs during long-term follow-up.
基金512 Talent Culture Planning(No.by51201317,by51201105)Innovation Team of Basic and Clinical Application for Cardiovascular Injury and Protection(No.BYKC201906)+1 种基金Technology and Science Innovation Team of Bengbu Medical College(No.BYJC201901)Natural Science Research Key Programm of Bengbu Medical College(No.2020byzd109)。
文摘Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardial infarction(TIMI)score and clinical prognosis.Method:The study was a retrospective one-center observational study,continuous inclusion of 600 ACS patients diagnosed by coronary angiography in our hospital from October 2018 to July 2019.Collect general clinical data,laboratory examination results,imaging data and interventional treatment data of all patients.Were divided into:T2DM with ACS group(group DA)and non-T2DM with ACS(group NDA)according to whether or not they were associated with T2DM.According to the GRACE、TIMI score,the two groups were divided into high risk group,middle risk group and low risk group.All patients underwent coronary angiography to calculate the number of vascular lesions and Gensini scores.Design questionnaire,after discharge to 2 groups of patients by telephone or outpatient follow-up average of 10 months,statistics of the occurrence of MACE events.Result:Among the 600 patients included in the study,362 were male(60.3%)and 238 were female(39.7%)with mean age(64.7±10.3)years.The baseline data showed that the G、TG、UA、CR levels were higher in the DA group than in the NDA group;the proportion of men was lower than in the NDA group.The results of coronary angiography showed that the Gensini score of DA group was higher than that of NDA group,and the proportion of single lesion was lower than that of NDA group.The binary Logistic regression analysis suggested that age and CRP were independent risk factors for MACE events in patients with T2DM.GRACE risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,and there was no significant difference between low and middle risk group.TIMI risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,while the proportion of low and middle risk group was lower than that in NDA group.The ROC curve shows that the area(AUC)below the ROC curve that GRACE、TIMI score predicted the occurrence of MACE events in patients with T2DM and ACS was 0.707 and 0.586.Conclusion:Patients with T2DM and ACS had higher clinical risk stratification than without T2DM.GRACE score compared with the TIMI score had better predictive value for the occurrence of MACE events after discharge of T2DM with ACS patients.
基金supported by"Regional Innovation Strategy"through the National Research Foundation of Korea(NRF)funded by the Ministry of Education(MOE)(2022RIS-005)supported by NRF grant funded by the Ministry of Science and ICT(MSIT)(No.2020R1I1A3A04036500)。
文摘Objective The main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antidiabetic medications using a nationwide population-based database.Methods We conducted a retrospective cohort study to assess the efficacy of acupuncture on cardiovascular complications in diabetic patients using data from patients between 40 and 79 years of age,newly diagnosed with diabetes between 2003 and 2006,found in the National Health Insurance Service-National Sample Cohort(NHIS-NSC)in Korea.From the data,we identified 21,232 diabetic patients who were taking antidiabetic medication between 2003 and 2006.The selected patients were divided into two groups-those who received acupuncture at least three times and those who received no acupuncture(non-acupuncture)in the year following their diagnosis of diabetes.After 1:1 propensity score matching(PSM),each group had 3350 patients,and the observation ceased at the occurrence of a major adverse cardiovascular event(MACE),which was defined as either myocardial infarction,stroke,or death due to cardiovascular cause.Results After PSM,the acupuncture group had a lower incidence of MACE(hazard ratio[HR]:0.87;95%confidence interval[CI]:0.81-0.94;P=0.0003)and all-cause mortality(HR:0.77;95%CI:0.70-0.84;P<0.0001)than the non-acupuncture group;the HRs for stroke-related mortality(HR:0.75;95%CI:0.56-1.00;P=0.0485),ischemic heart disease mortality(HR:0.53;95%CI:0.34-0.84;P=0.006)and circulatory system disease mortality(HR:0.67;95%CI:0.55-0.82;P<0.0001)were lower in the acupuncture group than in the non-acupuncture group in the secondary analysis.Conclusion Our results indicate that diabetic patients receiving acupuncture treatment might have a lower risk of MACE,all-cause mortality and cardiovascular mortality.This population-based retrospective study suggests beneficial effects of acupuncture in preventing macrovascular complications associated with diabetes.These findings call for further prospective cohort or experimental studies on acupuncture treatment for cardiovascular complications of diabetes.
基金Shanghai Science and Technology Committee(No.09dZ1971400)
文摘Background:Preliminary studies have indicated that Shexiang Baoxin Pill(MUSKARDIA)has a coronary artery dilation effect and increases the coronary blood flow,relieving the symptoms of angina.This study aimed to evaluate the benefit of MUSKARDIA on patients with stable coronary artery disease(CAD)and diabetes mellitus(DM).Methods:This was a subgroup analysis of a multicenter,randomized,placebo-controlled phase IV trial.CAD patients with a medical history of DM or baseline fasting blood glucose(FBG)≥7.0 mmol/L were grouped according to the treatment(standard therapy plus MUSKARDIA or placebo).The primary outcome was major adverse cardiovascular events(MACEs),which was the composite outcome of cardiovascular death,non-fatal myocardial infarction,and non-fatal stroke.The secondary outcome was the composite outcome of all-cause death,non-fatal myocardial infarction,non-fatal stroke,hospitalization for unstable angina or heart failure,and coronary angioplasty.Results:MACEs occurred in 2.6%(9/340)and 4.8%(18/376)of patients in the MUSKARDIA and placebo groups,respectively(P=0.192).Secondary composite outcome was significantly less frequent with MUSKARDIA than with placebo(15.3%[52/340]vs.22.6%[85/376],P=0.017).Risk of MACEs(hazard ratio[HR]=0.69,95%confidence interval[CI]:0.31-1.57)was comparable between two groups.In patients with uncontrolled DM(≥4 measurements of FBG≥7 mmol/L in five times of follow-up),the risk of secondary outcome was significantly lower with MUSKARDIA(5/83,6.0%)than with placebo(15/91,16.5%)(HR=0.35,95%CI:0.13-0.95).Conclusion:As an add-on to standard therapy,MUSKARDIA shows a trend of reduced MACEs in patients with stable CAD and DM.Furthermore,MUSKARDIA may reduce the frequency of all-cause death,hospitalization,and coronary angioplasty in this population,especially in those with uncontrolled DM.Trial Registration:ChiCTR.org.cn,ChiCTR-TRC-12003513.
基金a grant from the National Natural Science Foundation of China(No.81670415).
文摘Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated during on-hours,especially those with a first medical contact-to-device(FMC-to-device)time within 90 min.We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time<90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time<90 min from 19 chest pain centers in Beijing from January 2018 to December 2018.Patients were divided into on-hours group and off-hours group based on their arrival time.Baseline characteristics,clinical data,and key time intervals during treatment were collected from the Quality Control&Improvement Center of Cardiovascular Intervention of Beijing by the 4tHeart and Brain Green Channel”app.Results:Overall,the median age of the patients was 58.8 years and 19.9%(133/670)were female.Of these,296(44.2%)patients underwent PPCI during on-hours and 374(55.8%)patients underwent PPCI during off-hours.Compared with the on-hours group,the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time<60 min(P<0.05).During the mean follow-up period of 24 months,a total of 64(9.6%)participants experienced a major adverse cardiovascular event(MACE),with 28(9.1%)in the on-hours group and 36(9.6%)in the off-hours group(P>0.05).According to the Cox regression analyses,off-hours admission was not a predictor of 2-year MACEs(P=0.788).Similarly,the Kaplan-Meier curves showed that the risks of a MACE,all-cause death,reinfarction,and target vessel revascularization were not significantly different between the two groups(P>0.05).Conclusions:This real-world,multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min,off-hours admission was safe,with no difference in the risk of 2-year MACEs compared with those with on-hours admission.
基金funded by grants from the Nanjing Health Science and Technology Development Special Fund Project(ZKX20034)the Jiangsu Provincial Special Program of Medical Science(BE2019615).
文摘Objective:The optimal percutaneous coronary intervention(PCI)technique for bifurcation lesions remains controversial,especially considering the variability of the side branch(SB).A provisional stenting technique is currently recommended in most cases.This meta-analysis aimed to compare outcomes of different bifurcation PCI strategies,clarifying their scope of application.Methods:Randomized controlled trials comparing PCI strategies for coronary bifurcation lesions were systematically retrieved from PubMed,Cochrane,Web of Science,and EBSCO literature databases without limitations on published date or language.Major adverse cardiovascular events(MACEs)were stipulated as main outcomes.Secondary outcomes of interest were all-cause mortality,cardiovascular mortality,target lesion revascularization(TLR),target vessel revascularization,myocardial infarction(MI),and stent thrombosis.Both pooled analysis and sub-group analysis were performed.Results:Twenty-three randomized controlled trials with 6380 participants were included.Eighteen studies compared the provisional strategy with 2-stent approaches.No significant difference in MACEs(relative risk(RR),1.16;95%confidence interval(CI),0.90-1.48;I2=62%)was found between 1-stent and 2-stent techniques.However,when SB lesion length was used as the separation condition,the 2-stent strategy was associated with fewer MACEs(RR,1.87;95%CI,1.46-2.41;I2=70%),TLRs(RR,2.13;95%CI,1.50-3.02;I2=59%),and MIs(RR,2.17;95%CI,1.19-3.95;I2=52%)than the provisional strategy in those where SB lesions measured>10 mm long.Conclusions:In the current work,there was no significant difference between 1-stent and 2-stent techniques in terms of MACEs or secondary outcomes.However,2-stent approaches have clinical advantages over the provisional strategy in bifurcation when the SB lesion length is>10 mm due to fewer cases of TLR and MI.
基金This study was funded by the Shanghai Science and Technology Committee and Shanghai Hutchison Pharmaceuticals Company.
文摘Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce.The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy(OMT)in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months.Both groups received OMT according to local tertiary hospital protocols.The primary outcome was the occurrence of a major adverse cardiovascular event(MACE),defined as a composite of cardiovascular death,non-fatal myocardial infarction(MI),or non-fatal stroke.Secondary outcomes included all-cause mortality,non-fatal MI,non-fatal stroke,hospitalization for unstable angina or heart failure,peripheral revascularization,angina stability and angina frequency.Results:In all,99.7%of the patients were treated with aspirin and 93.0%with statin.After 2 years of treatment,the occurrence of MACEs was reduced by 26.9%in the MUSKARDIA group(MUSKARDIA:1.9%vs.placebo:2.6%;odds ratio=0.80;95%confidence interval:0.45-1.07;P=0.2869).Angina frequency was significantly reduced in the MUSKARDIA group at 18 months(P=0.0362).Other secondary endpoints were similar between the two groups.The rates of adverse events were also similar between the two groups(MUSKARDIA:17.7%vs.placebo:17.4%,P=0.8785).Conclusions:As an add-on to OMT,MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD.Moreover,the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD.The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:chictr.org.cn,No.ChiCTR-TRC-12003513.
