Coronary artery disease最新文献

Background: Exercise ECG testing is a widely used, noninvasive tool for detecting obstructive coronary artery disease (OCAD). However, its diagnostic performance is often limited by low specificity, leading to false-positive results and unnecessary invasive procedures.

Objective: This study aims to assess the potential of combining the Selvester QRS score with exercise ECG to enhance diagnostic specificity for OCAD in patients with suspected stable angina.

Methods: This retrospective study included 203 patients who presented with chest pain, underwent exercise ECG and were assessed for OCAD by coronary angiography or computed tomography angiography. Receiver operating characteristic analysis identified the optimal Selvester QRS score cutoff and assessed the diagnostic performance of exercise ECG and the combined model. Multivariable logistic regression was performed in the exercise ECG positive and negative groups.

Results: Of the 203 patients, 116 were diagnosed with OCAD. The optimal Selvester QRS score cutoff was ≥3, with a sensitivity of 83.6% and a specificity of 93.1%. The combination of a positive exercise ECG and a Selvester QRS score ≥3 achieved the highest specificity (98.9%). Regression analyses showed that Selvester QRS score ≥3 was an independent predictor of OCAD, even in patients with negative exercise ECG results (adjusted odds ratio: 7.018; P  < 0.001).

Conclusion: The Selvester QRS score can improve the specificity of the exercise ECG in detecting OCAD in patients with suspected stable angina. This approach has the potential to reduce false positives and unnecessary invasive procedures by improving risk stratification.

Background: Inflammation is a driver of atherosclerosis and plaque vulnerability. Epicardial adipose tissue (EAT) accumulation is associated with inflammation. The aim of this study was, therefore, to explore the association between EAT volume, compositional plaque progression, and vulnerability in nonobstructive coronary artery disease (CAD).

Methods: We identified 31 individuals [median age 58 (52, 68) years, 42% women] from the Norwegian Registry of Invasive Cardiology with nonobstructive CAD undergoing clinically indicated serial cardiac computed tomography (CT) and coronary CT angiography (CCTA). EAT volume was measured at baseline by a semiautomatic analysis software. Patients were grouped according to lower or higher than median baseline EAT (b-EAT) volume. Plaque progression was quantified by CCTA as annual change in total and compositional plaque volume. Hypodense plaques were adjudicated as vulnerable plaques.

Results: Patients with high b-EAT volume had numerically lower calcium score, coronary artery segment involvement score, total coronary plaque burden, and increased prevalence of vulnerable plaques compared with patients with low EAT volume at baseline and follow-up, even if it did not reach statistical significance. Compared with patients with low b-EAT volume, patients with high b-EAT volume tended to have an annual regression in total plaque volume, while the proportion of vulnerable hypodense plaque volume increased.

Conclusion: In nonobstructive CAD, patients with high b-EAT volume tended to have a regression of total plaque volume, but a transformation into a vulnerable plaque phenotype during follow-up. Whether lifestyle changes may improve prognosis in nonobstructive CAD needs to be confirmed in larger trials.

Background: The relationship between the urinary sodium - potassium ratio (USPR) and risk factors for heart disease has been observed over time. We evaluated the relationship between USPR and myocardial infarction (MI).

Methods: Causal relationships were estimated based on USPR and MI data from genome-wide association studies. The main analysis method for bidirectional two-sample Mendelian randomization was inverse-variance weighting (IVW), with four other supplementary methods used.

Results: The IVW method indicated a positive correlation between USPR levels and MI (IVW, odds ratio = 1.504, 95% confidence interval: 1.108-2.041, P  = 0.009). In contrast, the inverse analysis provided evidence suggesting that MI affected USPR ( P  > 0.05). The Cochran Q test showed heterogeneity, while the intercept test revealed no horizontal pleiotropy, and the leave-one-out analysis demonstrated that the analyses were reliable.

Conclusions: This study provides evidence for the causal effect of the USPR on MI; however, this was not the case in the opposite situation. It is plausible that the USPR serves as a promoting factor for MI.

Background: Although drug-eluting stents (DES) are effective, stent thrombosis (ST) remains a major concern in patients with acute myocardial infarction (AMI) who undergo DES implantation. We aimed to evaluate the incidence of late stent malapposition (SM) and uncovered struts 12 months after implantation of a bioabsorbable polymer everolimus-eluting stent (BP-EES) or a durable polymer zotarolimus-eluting stent (DP-ZES) in patients with AMI using optical coherence tomography (OCT).

Methods: Sixty-nine patients with AMI were randomly assigned 2:1 to the BP-EES (46 patients) or DP-ZES (23 patients) groups. The coprimary endpoints were the incidences of late SM and uncovered stent struts in OCT strut-level analysis at 12 months postimplantation.

Results: The 51 patients who completed the 12-month follow-up OCT (BP-EES, 36 patients, 39 lesions; DP-ZES, 15 patients, 18 lesions) showed no intergroup differences in the incidence of acute SM (BP-EES vs. DP-ZES; 12.25 ± 14.27% vs. 12.35 ± 10.55%, P  = 0.981) at the index procedure. The incidence of late SM (0.12 ± 0.42% vs. 0.14 ± 0.25%, P  = 0.873) and uncovered struts (1.69 ± 3.44% vs. 2.45 ± 3.23%, P  = 0.532) also did not differ between the two DES groups at 12-month postimplantation.

Conclusion: Twelve-month OCT measurements showed no significant differences in late SM and uncovered struts between the BP-EES and DP-ZES stents. Thus, contemporary second-generation DES show a very low rate of late SM and uncovered struts after 12 months in AMI, regardless of stent polymer type.

Trial registration: Late stent strut apposition and coverage after drug-eluting stent implantation by OCT in patients with AMI (APPOSITION AMI-II) (NCT02770651).

Neutrophil count is a risk factor for myocardial infarction (MI). Colchicine, a drug known as an anti-inflammatory, acts by selectively concentrating on neutrophils and impairing their function. Colchicine has been used successfully in the prevention of vascular events in patients with coronary artery disease (CAD), but recently the largest clinical trial carried out with colchicine in this clinical setting was unexpectedly neutral in the comparison of placebo and colchicine in patients with recent MI. Among the characteristics that distinguish patients with acute coronary syndromes (ACS) from established CAD is the dual antiplatelet therapy (DAPT), often consisting of aspirin and clopidogrel. Clopidogrel significantly reduces neutrophil count and could play a competitive role with colchicine by blunting its clinical effect.

Background: Treatment of in-stent restenosis (ISR) accounts for 10% of percutaneous coronary interventions in the USA. Paclitaxel-coated balloons (PCBs) are an alternative to uncoated balloons (UCBs) for ISR.

Methods: We systematically searched PubMed, Scopus, and Cochrane Central for studies comparing PCB with UCB in treating ISR. Outcomes included late lumen loss, binary restenosis, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE).

Results: Eight trials including 1410 patients [PCB in 865 (61%), follow-up 6 months to 10 years) were identified. Angiographic outcomes of late lumen loss [mean difference: -0.50 mm; 95% confidence interval (CI): -0.66 to -0.33; P  < 0.01] and binary restenosis [relative risk (RR): 0.22; 95% CI: 0.13-0.40; P  < 0.01] at 6-8 months were lower with PCB. TLR at 6 months (RR: 0.16; 95% CI: 0.06-0.40; P  < 0.001) and 1 year (RR: 0.45; 95% CI: 0.31-0.66; P  < 0.001), MACE at 6 months (RR: 0.25; 95% CI: 0.16-0.38; P  < 0.001), MACE at 3-5 years (RR: 0.54; 95% CI: 0.37-0.80; P  = 0.002), and TLR at 3-5 years (RR: 0.51; 95% CI: 0.29-0.90; P  = 0.021) were lower with PCB. Meta-regression revealed that ISR lesions in the left anterior descending artery were associated with lower rates of binary restenosis while the opposite was observed for left circumflex lesions.

Conclusion: Revascularization of coronary ISR with PCB is associated with reduced late lumen loss, binary restenosis, TLR, CCE, and MACE. PCB may be a preferred strategy for coronary ISR.