scholarly journals Relationship between HDL-Cholesterol and Angiographic Severity of Coronary Artery Disease

2018 ◽  
Vol 33 (1) ◽  
pp. 32-38
Author(s):  
Mohammed Iqbal Ahmed ◽  
Khandker Mohammad Akhtaruzzaman ◽  
Mohammad Arifur Rahman ◽  
Mohammad Selim Mahmod ◽  
Shamsun Nahar
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Lipoprotein Cholesterol ◽  
Coronary Artery Diseases ◽  
Vessel Disease ◽  
Significant Difference ◽  
Low Hdl ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background: Dyslipidaemias is one of the major risk factor for Coronary artery diseases (CAD).There is an inverse correlation between high density lipoprotein cholesterol (HDL-C) and the risk of coronary artery disease. Understanding the angiographic characteristics of coronary artery diseases (CAD) in low and normal HDLC patients and its association with severity of CAD is very important for future intervention. Although highdensity lipoprotein cholesterol (HDL-C) is well established predictor of future cardiovascular event, little information is available regarding its correlation with the prevalence and severity of angiographically evaluated coronary artery diseases (CAD).Materials and Methods: This cross-sectional comparative study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from January 2012 to December 2013. We included 100 patients with coronary artery diseases and divided into two groups. 50 patients with low HDL-C (<40 mg/dl) were taken in study group (Group-A) and 50 patients with normal HDLC (>40 mg/dl) were taken in control group (Group-B) according to inclusion and exclusion criteria. Coronary angiography was performed via the trans-femoral approach using standard techniques. Severity of CAD was determined by vessels score and Friesinger score.Results: The age [51.1 (SD 8.7) years vs 51.4 (SD 8.2) years; p>0.05] and sex [45 (90.0%) male and 5 (10.0%) female vs 41 (82.0%) male and 9 (18.0%) female; p=0.249] were similar in group-A and group-B. The conventional risk did not show any significant difference between low and normal HDL level group such as age, sex, smoking, diabetes mellitus, hypertension, BMI, hypercholesterolaemia, high serum LDL, hypertriglyceridaemia and family history of CAD (p>0.05 each). No significant vessel disease [3 (6.0%) vs 14 (28.0%); p=0.008] and single vessel disease [11 (22.0%) vs 25 (50.0%); p=0.020] were significantly fewer in group A than that of group-B; while double vessel disease [14 (28.0%) vs 5 (10.0%); p=0.039] and triple vessels disease [22 (44.0%) vs 6 (12.0%); p=0.002] were significantly higher in group-A than that of group-B. Friesinger score 0 [3 (6.0%) vs 11 (22.0%); p=0.033] and Friesinger score 1 to 4 [6 (12.0%) vs 24 (48.0%); p=0.01] were significantly fewer in group A than that of group-B; while Friesinger score 5 to 9 [20(40.0%) vs 9 (18.0%); p=0.041] and Friesinger score 10 to 15 [21 (42.0%) vs 6 (12.0%); p<0.004] were significantly higher in group-A than that of group-B. Among all respondents conventional risk factors were not statically significant between the groups. A significant negative correlation was found between serum HDL-C (mg/dl) and number of diseased vessel (r=0.370; p<0.001) and also Friesinger score (r=0.388; p<0.001).Conclusion: It may be concluded that low HDL-C level is associated with angiographically more severe coronary artery diseases reflected by vessels score and Friesinger score as compared to normal or high HDL-C level.Bangladesh Heart Journal 2018; 33(1) : 32-38

scholarly journals Relationship between Hemoglobin A1c Level and Severity of Coronary Artery Disease Among The Hospitalized Patients with Acute Coronary Syndrome

2018 ◽  
Vol 33 (2) ◽  
pp. 80-84
Author(s):  
Syed Dawood Md Taimur ◽  
Sahela Nasrin ◽  
M Maksumul Haq ◽  
MA Rashid ◽  
Hemanta I Gomes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hemoglobin A1c ◽  
Diabetic Patients ◽  
Age Group ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS. Materials & Methods : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c>6.5%) and rest of were nondiabetics (HbA1c<6.5%) ( group-A and B). Results: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p>.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289). Conclusions: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients. Bangladesh Heart Journal 2018; 33(2) : 80-84

Abstract 11785: The Association of Guideline Adherence of Coronary Revascularization and Clinical Outcomes for Patients With Stable and Complex Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chenfei Rao ◽  
Zhe Zheng ◽  
Shengshou Hu ◽  
Heng Zhang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Research Network ◽  
Significant Difference ◽  
Group A ◽  
Artery Disease ◽  
Group B ◽  
Revascularization Procedures

Introduction: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) gained popularity in China, there are gaps in knowledge about the appropriateness of revascularization procedures and related outcomes of stable and complex coronary artery disease. Methods: Using the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) research network, this prospective study of 3-Vessel Disease (China PEACE-3VD) consecutively enrolled patients with 3-vessel and/or left-main disease diagnosed by elective coronary angiography in 24 large cardiovascular centers in China. We abstracted medical record data for patient characteristics and treatment strategies, the core lab calculated SYNTAX Scores for all patients. We classified the appropriateness of treatment for each patient using 2011 Guideline on Myocardial Revascularization published by European Society of Cardiology and European Association of Cardio-Thoracic Surgery. We compared the 1-year rates of major adverse cardiovascular and cerebral events (MACCE) between patients underwent revascularization with I/IIa and IIb/III indications. Results: We consecutively enrolled 3186 patients from participated hospitals. Among them, 20.4% (651) underwent medical therapy, 79.6% (2535) underwent revascularization procedures (PCI: 87.4%, 12.6% CABG) during the index hospitalization. For patients underwent revascularization procedures, 47.9% patients were suitable for both CABG and PCI (has I indication for CABG, and IIa indication for PCI, group A), 52.1% were only suitable for CABG (has I indication for CABG, and IIb/III for PCI, group B). In group A, 95% underwent PCI, 5% underwent CABG, the 1-year MACCE rates of CABG and PCI showed no significant difference (PCI: 4.6%, CABG: 7.7%, adjusted OR=1.21, p=0.81); In group B, 80.4% underwent PCI, 19.6% underwent CABG, the 1-year MACCE rates of CABG is significantly lower than PCI (PCI: 7.5%, CABG: 2.3%, adjusted OR=3.18, p=0.027). Conclusions: Using the Guideline on Myocardial Revascularization, we identified certain overuse of PCI for stable and complex coronary artery disease. The inappropriate use of PCI is associated with worse 1-year outcomes than CABG. (NCT01625312)

scholarly journals Intra-Femoral Sheath Time: Does it Increase a Patient's Risk for Developing a Hematoma?

2013 ◽  
Author(s):  
Colleen Planchon
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Femoral Artery ◽  
Percutaneous Coronary Interventions ◽  
Medication Therapy ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
Group A ◽  
Artery Disease ◽  
Group B

Despite advancements in technology and medication therapy, coronary artery disease continues to remain the number one cause of death. Treatment for coronary artery disease requires life style modifications, medication therapy, percutaneous coronary interventions, and sometimes coronary artery bypass surgery. Though percutaneous coronary interventions are considered safe and are commonly occurring procedures, there are still risks for complications. One of the most frequently occurring complications is hematoma of the femoral artery site. The purpose of this study was to determine if there was an increased incidence of hematomas in individuals undergoing percutaneous coronary intervention with associated sheath times of less than five hours (Group A) as compared to sheath time of greater than five hours (Group B). The study used a retrospective, two group design and was conducted at a tertiary care center that performs over 1500 PCI’s annually. Inclusion criteria included adults over the age of 18 who were hemodynamically stable, had no known bleeding disorders, and were punctured once at the femoral artery to perform the percutaneous intervention. Two hundred fifty medical records were reviewed utilizing a data collection tool designed by the researcher. Total sample size was 55, 21 in Group A and 34 in Group B. Six hematomas were documented as occurring, but were not reportable based on the ACC definition. Hematomas were documented in the medical record using the terms “small”, “medium,” and “large” versus an objective measurement. No hematomas were identified using the ACC definition, which was the measurement standard for this research hospital. Sheath times in Group A averaged 4.02 hours, and group B 7.42 hours. There was a higher incidence of descriptive hematoma that did not meet the criteria of this study in Group B. Results call for recommendations of on-going documentation of post procedure hematomas using a standardized, reliable, and valid measuring tool. APRN’s can be instrumental in implementing change in patient care , hospital policy and on the national level by assuring that hematomas are accurately and consistently documented. Further research is indicated related to sheath times and potential associated negative outcomes.

scholarly journals Ten-Year All-Cause Death According to Completeness of Revascularization in Patients with Three-Vessel Disease or Left Main Coronary Artery Disease: Insights from the SYNTAX Extended Survival Study

Circulation ◽  
2021 ◽  
Author(s):  
Kuniaki Takahashi ◽  
Patrick W. Serruys ◽  
Chao Gao ◽  
Masafumi Ono ◽  
Rutao Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Unique Identifier ◽  
Vessel Disease ◽  
Main Coronary Artery Disease ◽  
Significant Difference ◽  
Artery Disease ◽  
Extended Survival

Background: Ten-year all-cause death according to incomplete (IR) versus complete revascularization (CR) has not been fully investigated in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) undergoing percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). Methods: The SYNTAX Extended Survival Study evaluated vital status up to 10 years in patients who were originally enrolled in the SYNTAX trial. In the present sub-study, outcomes of the CABG CR group were compared with the CABG IR, PCI CR, and PCI IR groups. In addition, in the PCI cohort, the residual SYNTAX score (rSS) was used to quantify the extent of IR and to assess its association with fatal late outcome. The rSS of 0 suggests CR, whereas a rSS>0 identifies degree of IR. Results: IR was more frequently observed in patients with PCI vs. CABG (56.6% vs. 36.8%) and more common in those with 3VD than LMCAD in both PCI (58.5% vs. 53.8%) and CABG arm (42.8% vs. 27.5%). Patients undergoing PCI with CR had no significant difference in 10-year all-cause death compared with those undergoing CABG (22.2% for PCI with CR vs. 24.3% for CABG with IR vs. 23.8% for CABG with CR). In contrast, those with PCI and IR had a significantly higher risk of all-cause death at 10 years compared with CABG and CR (33.5% vs. 23.7%; adjusted hazard ratio [aHR]:1.48; 95% confidence interval [CI]:1.15-1.91). When patients with PCI were stratified according to the rSS, those with a rSS≤8 had no significant difference in all-cause death at 10 years as the other terciles (22.2% for rSS=0 vs. 23.9% for rSS>0-4 vs. 28.9% for rSS>4-8), whereas a rSS> 8 had a significantly higher risk of 10-year all-cause death as compared with those undergoing PCI with CR (50.1% vs. 22.2%; aHR:3.40; 95% CI:2.13-5.43). Conclusions: IR is common after PCI, and the degree of incompleteness was associated with 10-year mortality. If it is unlikely that complete (or nearly complete; rSS<8) revascularization can be achieved with PCI in patients with 3VD, CABG should be considered. Clinical Trial Registration: SYNTAX: https://www.clinicaltrials.gov Unique Identifier: NCT00114972. SYNTAX Extended Survival: https://www.clinicaltrials.gov Unique Identifier: NCT03417050

scholarly journals Subclinical Hypothyroidism with TSH>7 mIU/l and≤10 mIU/l and Coronary Artery Disease

2020 ◽  
Vol 52 (02) ◽  
pp. 85-88
Author(s):  
Pedro Weslley Souza Rosário ◽  
Maria Regina Calsolari
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Subclinical Hypothyroidism ◽  
Calcium Score ◽  
Thyroid Stimulating Hormone ◽  
Group A ◽  
Artery Disease ◽  
Group B ◽  
Low Cardiovascular Risk

AbstractThe association of subclinical hypothyroidism (SCH) with increased cardiovascular risk is controversial when thyroid-stimulating hormone (TSH) concentration is<10 mIU/l, as well as its association with a higher coronary artery calcium score (CACS) in individuals with low cardiovascular risk. This study evaluated coronary artery disease (CAD) by CACS in asymptomatic, low-cardiovascular risk women with SCH and TSH>7 mIU/l and≤10 mIU/l untreated for 5 years after diagnosis. The CACS was obtained for two groups of women with low cardiovascular risk. Group A consisted of 32 women with mild SCH (TSH>7 mIU/l and≤10 mIU/l) who remained untreated for 5 years, and group B consisted of 32 euthyroid women matched for age and body mass index to group A. The CACS ranged from 0 to 350 (median 0, 25–75% interval: 0–10) in group A and from 0 to 280 (median 0, 25–75% interval: 0–0) in group B. Scores>0 and≥10 were significantly more frequent in group A (40.6 vs. 12.5% and 25 vs. 3.1%, respectively). A CACS≥100 was also more frequent in group A (18.75 vs. 3.1%), but the difference was not significant (p=0.1). The results of the study suggest that long-term SCH with TSH>7 mIU/l and ≤ 10 mIU/l is associated with a higher risk of CAD in individuals≤65 years, even in those with low cardiovascular risk.

scholarly journals Relationship between triglyceride HDL-cholesterol ratio and severity of coronary artery disease in patient with acute coronary syndrome

2016 ◽  
Vol 43 (3) ◽  
pp. 157-161 ◽  
Author(s):  
Md Rasul Amin ◽  
Md Afzalur Rahman ◽  
Nur Alam ◽  
Md Nazmul Hasan ◽  
GM Sadik Hasan
Keyword(s):  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Lesion Score ◽  
Coronary Angiogram ◽  
Vessel Disease ◽  
Low Hdl ◽  
Artery Disease ◽  
Vessel Score ◽  
Cad Risk

Cardiovascular Disease (CVD) is the leading cause of death worldwide, responsible for one third of death. Coronary artery Disease (CAD) is the most common cause. Dyslipidaemia is one of the major contributors of increased CAD risk. High LDL-C, high TG and low HDL-C have all been as predictors for CAD risk. TG/HDL-C ratio could be a very important, easy, non-invasive means of predicting the presence and extent of coronary atherosclerosis. The aim of this study was to evaluate the association between TG/HDL-C ratio and the extent of CAD assessed by coronary angiogram in our setting. This cross sectional analytical study has been done in the Department of Cardiology, Sir Salimullah Medical College & Mitford Hospital. A total 118 patients with newly diagnosed ACS, undergoing coronary angiogram in were selected purposively. Previous history of PCI or CABG, patients getting lipid lowering drugs, patient with congenital heart disease or vulvular heart disease was excluded. Angiographic severity of coronary artery disease was assessed by 2 indices – vessels score’ and ‘Lesion score’. Smoking was found in highest percentage (65.3%) and half of the patient’s risk factor were hypertension (51.7%) and overweight (50.8%). The relationship between vessel score with TG/HDL-C ratio shows that among patients with triple vessel disease on coronary angiogram, 93% had high (?4) TG/HDL-C ratio whereas among double vessel disease patients, 82% patients had high (?4) TG/HDL-C ratio. The 157 association between atherosclerosis lesion score with TG/HDL-C ratio shows that with the increase level atherosclerosis TG/HDL-C ratio also increased. A subject with low HDL (<40 mg/dl for male and <50 mg/dl for female) had 4.75 times increase in odds of having coronary artery disease while a subject with high LDL (>100 mg/dl) had 2.60 (95% CI 1.55% to 14.26%) times increase in odds of having coronary artery disease. In this study high TG/HDL-C ratio (>4) was found with severity of CAD in relation to vessel score and atherosclerosis lesion score. High TG/HDL-C ratio indicates an atherogenic plaque and a significant risk for the development of coronary artery disease. In this study high TG/HDL-C ratio was found as the most powerful predictor of coronary heart disease among all the lipid variables examined. This finding can help us to find out high risk ACS patient and plan for treatment strategy of severe CAD in our population.Bangladesh Med J. 2014 Sep; 43 (3): 157-161

scholarly journals Effect of Body Mass Index on Morbidity and Mortality in Patients Undergoing Coronary Artery Bypass Grafting

2019 ◽  
Vol 1 (2) ◽  
pp. 69-74
Author(s):  
Mohamed Shawky ◽  
Yousry Elsaied Rizk ◽  
Mohammed Mohammed Mohammed Saffan ◽  
Ashraf Mostafa Elnahas Wahdan ◽  
Mohamed Ahmed Gouda Elgazzar
Keyword(s):  
Coronary Artery Disease ◽  
Body Mass Index ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Morbidity And Mortality ◽  
Bypass Grafting ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background: Obesity affects cardiovascular morbidity and mortality, and it increases the risk of coronary artery disease. Despite that, several cardiac surgery risk stratification scores do not consider the effect of obesity on the outcomes. The objective of this research is to study the impact of body mass index (BMI) on morbidity and mortality after coronary artery bypass grafting (CABG) in Egyptian patients. Methods: This prospective cohort study included 200 patients who underwent CABG for atherosclerotic coronary artery disease. Patients were divided into two groups, group A: patients with BMI ≥ 25 Kg/m2 and group B: patients with BMI < 25 Kg/m2. The mean age in group A was 56± 4.95 years vs. 54± 5.5 years in group B (p= 0.102). Male patients presented 58% of the population in group A vs 74% in group B (p= 0.017). 60% of patients were hypertensive in group A compared to 63% in group B (p= 0.66) and 62%, and 48% were diabetics in group A and B respectively (p= 0.04). Results: Postoperatively, there was a significant increase in wound infection (40% vs 8%; p< 0.001), chest infection (47% vs. 10% p< 0.001), surgical re-exploration (28% vs. 1%; p< 0.001), prolonged ICU stays (5.3 ± 2.88 vs. 3.93 ± 1.71 days; p< 0.001), ward stay (11.28 ±8.9 vs. 5.48 ± 2.45 days; p< 0.001), mediastinitis (34% vs. 6%; p< 0.001), the occurrence of sternal wound sinus within 8 months (26% vs. 7%; p< 0.001), in group A more compared to group B. There was no difference in ejection fraction (54.2 ±7.38 vs. 54.7 ± 9.1%; p= 0.69) and mortality (4% vs. 2%; p= 0.68) between groups. Conclusions: BMI 25 Kg/m2 or higher is associated with increased infectious complications and prolonged stay after CABG; however, it did not affect mortality. Optimizing body weight is recommended before elective surgery.

scholarly journals Comparison of the Reduction of LDL-C or nonHDL-C induced by Red Yeast Rice Extract, Xuezhikang, between Fasting and Postprandial States in Patients with Coronary Artery Disease

2020 ◽  
Author(s):  
Li-Yuan Zhu ◽  
Xing-Yu Wen ◽  
Qun-Yan Xiang ◽  
Li-Ling Guo ◽  
Jin Xu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Blood Lipids ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Red Yeast Rice ◽  
Red Yeast ◽  
Significant Difference ◽  
Artery Disease ◽  
Standard Breakfast

Abstract Background: Xuezhikang, an extract of red yeast rice, effectively lowers fasting and postprandial triglyceride (TG) levels. It was unknown that whether Xuezhikang could contribute the lipid management goals, low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (nonHDL-C) at fasting and postprandial states in patients with coronary artery disease (CAD).Methods: Fifty CAD patients were divided into Xuezhikang (XZK, n=25) group and control (CON, n=25) group randomly to receive red yeast rice exact, 1200mg/d Xuezhikang capsules or not for 6 weeks (6w). Blood lipids were detected repeatedly before and after 6w at 0, 2, 4 and 6 hours (h) after a standard breakfast with 800kcal.Result: When taking all patients as a whole (n=50), serum LDL-C level decreased while TG and RC levels increased significantly at 2, 4 and 6 h after breakfast (P＜0.05). Serum nonHDL-C level mildly but significantly increased at 4h and 6h after breakfast (P＜0.05). Short-term Xuezhikang treatment decreased tAUCs of TC, TG, LDL-C, nonHDL-C and RC whereas increased that of HDL-C significantly (P＜0.05). Serum LDL-C level showed a drop of 27.8%, 28.1%, 26.2%, 25.3% at 0, 2, 4 and 6 h, respectively, after breakfast. Serum nonHDL-C level showed a drop of 27.6%, 28.7%, 29.0% and 28.0% at 0, 2, 4 and 6 h, respectively. There was no significant difference in the percentages of reduction in LDL-C or nonHDL-C level among four time-points.Conclusions: Xuezhikang significantly decreased LDL-C or nonHDL-C level with similar percentages of reduction between fasting and postprandial states in patients with CAD, indicating that postprandial blood lipids detected at the same time point after a daily meal could replace fasting blood lipids to evaluate the efficacy of cholesterol-lowering therapy in CAD patients, unwilling or unable to keep a fasting state.

Promoter Polymorphism of Interleukin-18 in Angiographically Proven Coronary Artery Disease

Angiology ◽  
2008 ◽  
Vol 60 (2) ◽  
pp. 180-185 ◽  
Author(s):  
Wenwei Liu ◽  
Qizhu Tang ◽  
Hua Jiang ◽  
Xiangwu Ding ◽  
Yongsheng Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Promoter Polymorphism ◽  
Occurrence Rate ◽  
Cardiac Complications ◽  
Interleukin 18 ◽  
Chinese Han ◽  
Vessel Disease ◽  
Significant Difference ◽  
Artery Disease

Interleukin 18 (IL–18) is a pro-atherogenic cytokine associated with the occurrence of various cardiac complications. The IL–18 gene has a functional −137 G/C polymorphism (rs187238) in the promoter region. Using the ligase detection reaction-polymerase chain reaction, we genotyped a cohort of patients in Chinese Han population in Xiangfan region. Case patients of coronary artery disease and control patients were identified by coronary angiography. The plasma IL–18 concentrations were measured by ELISA. A significant increase of G allele or GG-genotype was observed in 241 case patients compared to 145 control individuals (frequency of G allele = 0.90 vs 0.83, p=0.004; frequency of GG-genotype = 0.81 vs 0.68, p = 0.005). In case patients, G allele carriers in multi-vessel disease patients had a higher occurrence rate when compared to single-vessel disease patients, but no significant difference was detected (frequency of G allele = 0.92 vs 0.88, p=0.107; frequency of GG-genotype = 0.84 vs 0.75, p = 0.089). IL–18 protein concentration of the −137GG genotype was much higher than concentration of the CG and CC genotype (case patients: 229.1±131.5 vs 122.7±73.6 pg/ml, P < 0.001; control patients: 65.9±31.6 vs 42.4±19.5 pg/ml, P < 0.001). To conclude, IL–18 promoter −137G/C polymorphism influences IL–18 levels and the occurrence of coronary artery disease, suggesting that IL–18 is causally involved in the development of atherosclerosis.

scholarly journals Complete Revascularisation is associated with Improved Survival after Out of Hospital Cardiac Arrest

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Kanyal ◽  
N Pareek ◽  
D Sarma ◽  
A Bharucha ◽  
R Dworakowski ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Final Analysis ◽  
Syntax Score ◽  
Group A ◽  
Artery Disease ◽  
Complete Revascularisation ◽  
Group B ◽  
Hospital Cardiac Arrest

Abstract Introduction Coronary artery disease (CAD) is common in patients with Out of Hospital Cardiac Arrest (OOHCA) but the clinical relevance of burden of CAD and evidence for revascularisation strategies in relation to outcomes and modes of death remains unclear. Purpose This study sought to assess the extent of CAD as defined by the SYNTAX score and prognostic value of complete compared with incomplete revascularisation by evaluating the SYNTAX revascularisation index (SRI) in patients with OOHCA. Methods 619 patients with OOHCA were admitted at our centre between 1st May 2012 and 31st December 2017. 237 were excluded for having a non-cardiac aetiology or prior neurological disability. 398 patients were included into the study and of these 272 (68.3%) had early coronary angiography (CAG) and were included in the final analysis. The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from the coronary angiograms by a cardiologist blinded to the outcome. Patients were subdivided into 4 subgroups according to quartiles of the baseline syntax score (bSS) of 0, Group A: 1–10, Group B: 11–20 and Group C: ≥21. Complete revascularisation (CR) was defined as SRI of 1 and incomplete (IR) as SRI &lt;1 where the SRI=(1-[rSS/bSS]) ×100 (Figure 1). Results Patients with a bSS of 0 were younger, had less shockable initial arrest rhythms and worse lactate and pH on arrival.Patients with bSS&gt;0 (i.e., those with coronary artery disease) had similar cardiac arrest circumstances in terms of rates of witnessed, bystander CPR and shockable rhythms. Admission metabolic status reflected by pH and lactate and rates of ST elevation/LBBB were also identical for all three groups. However, LVEF on admission decreased significantly as coronary complexity increased (P&lt;0.0001). While early angiography was more preferentially performed in those with higher coronary complexity, paradoxically, those with bSS 1–4 had highest rates of culprit lesions which was reflected in higher rates of PCI (Figure 1). 124 (45.4%) had CR compared with 54.2% with IR. CR was most likely to be achieved as the coronary complexity reduced (Group A – 71.7%, Group B – 41.1%, Group C - 23.3%). There was no difference in rates of cardiogenic shock between both groups (CR 61.1% vs. IR 69% p=ns), but patients with complete revascularisation were younger (58.8 vs 67.8, p&lt;0.0001), lower rates of hypertension and previous CABG (16.2% vs 3.2%, p≤0.0001) CR was associated with decreased mortality at 30 days (45.9% vs 34.6%, p=0.046) and 12 months (49.3% vs 35.4%, p=0.022). The lower mortality rate in CR appeared to partly be driven by lower cardiac deaths though this was not statistically significant (22% vs 7%, p=0.1) (Figure 2). Conclusions CR in a primary coronary aetiology OOHCA group is associated with reduced early and long-term mortality, which may be driven by a reduction in cardiac deaths. Prospective randomised trials in this population are warranted. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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