Angiology最新文献

The present study aimed to investigate the combined impact of lipoprotein (a) [Lp(a)] and low-density lipoprotein (LDL) subfractions on cardiovascular outcomes in patients with acute coronary syndrome (ACS). The study enrolled 2061 ACS patients from Tianjin Chest Hospital. Participants were categorized into 4 groups based on their Lp(a) and the concentration of the sixth component particles of LDL(LDL-P6). The primary endpoint was the occurrence of major adverse cardiovascular events (MACE). The relationship between LDL-P6, Lp(a), and MACE was evaluated. Over a mean follow-up period of 5.4 years, 456 (22.1%) patients experienced MACE. Multivariate analysis identified both LDL-P6 and Lp(a) as significant independent predictors of MACE in ACS patients. Those in the highest-risk group had a substantially higher incidence of MACE compared with the lowest-risk group (HR 5.718; 95% CI 3.703-8.829; P < .001). The area under the curve (AUC) for MACE prediction was 0.735 for Lp(a) and 0.727 for LDL-P6. Adding either biomarker to baseline models significantly improved the C-statistic and integrated discrimination improvement (all P < .001). In ACS patients, both Lp(a) and LDL-P6 independently and synergistically predicted MACE, underscoring the value of incorporating these markers into risk stratification models for more accurate patient assessment.

The coexistence of peripheral artery disease (PAD) and acute myocardial infarction (AMI) is clinically important yet not well reported in inpatient settings. We conducted a retrospective cross-sectional study using the 2018-2020 National Inpatient Sample (NIS). Adult hospitalizations with a primary diagnosis of PAD were stratified by the presence of a secondary AMI diagnosis; multivariable logistic regression was used for binary outcomes and linear regression for continuous outcomes, adjusting for demographics, comorbidities, and hospital characteristics. Among 597 195 PAD hospitalizations, 10 835 (1.8%) had coexisting AMI. Compared with PAD-only patients, AMI cases were older (70 vs 67 years), had higher comorbidity (Charlson Index 5.3 vs 3.5), and greater in-hospital mortality (15% vs 1.6%). After adjustment, AMI was associated with higher mortality (odds ratio [OR] 6.04), acute heart failure (OR 5.54), ischemic stroke (OR 2.31), acute kidney injury (OR 2.50), and limb amputation (OR 1.44), as well as longer length of stay (+4.3 days) and higher inflation-adjusted charges (+$83 821; all P < .001). Concurrent AMI in hospitalized PAD patients is linked with significantly worse clinical outcomes and higher healthcare utilization, highlighting the need for early detection and aggressive cardiovascular risk management in this high-risk population.

Silent new ipsilateral ischemic lesions (sNIIL) detected by diffusion-weighted imaging (DWI) are commonly observed after carotid artery stenting (CAS). We aimed to analyze the association of carotid plaque characteristics on Virtual Histology Intravascular Ultrasound (VH-IVUS) with sNIIL, which is not well understood. Among 128 patients who underwent CAS and VH-IVUS, 112 patients who underwent DWI within 72 h after CAS were included for analysis. VH-IVUS detected cross-sectional composition of plaques including necrotic core (NC), dense calcium (DC), fibrous (FI), and fibrofatty (FF) in each frame. Plaques with ≥3 consecutive thin-cap fibroatheroma (TCFA) or calcified thin-cap fibroatheroma (CaTCFA) frames were defined as vulnerable. Logistic regression was applied to evaluate the association between plaque characteristics and sNIIL. A total of 56 patients (50%) had sNIIL. Larger NC in the maximum NC frame (odds ratio [OR] = 1.35; 95% confidence interval [CI]: 1.03-1.75; P = .029) and defined vulnerable plaques (OR = 3.89; 95% CI: 1.68-9.01; P = .001) were associated with sNIIL. Incidence of sNIIL showed an escalating trend with the increase of quartiles of NC (P _trend = .010). The findings of this study suggest that composition and distribution characteristics of carotid plaques on VH-IVUS during CAS have potential clinical significance.

Ankle brachial index (ABI) can be unreliable in patients with non-compressible vessels. Our aim is to determine the feasibility of toe brachial index (TBI) and reporting criteria in a large population. We evaluated Doppler waveforms and segmental pressures in 26,719 limbs. TBI was obtained in 92.7%, mean TBI = 0.61 ± 0.25. TBI was obtained in 82%of limbs with unobtainable ABI. In hemodynamically normal subgroup (defined as those with normal ankle-brachial indices at rest and after exercise) the mean TBI was 0.84 ± 0.14. In severe PAD subgroup (defined as ABI < 0.5 and monophasic waveforms) the mean TBI was 0.16 ± 0.12. Limbs with a diagnosis of a PAD (ABI ≤ 0.9) had a TBI <0.8 in 99.5% of the cases, and <0.6 in 90% of the cases. A TBI of 0.8 had a negative predictive value for PAD of 0.99. A TBI cutoff of 0.6 had a positive predictive value for PAD of 0.95. Based on these results we propose defining normal TBI above 0.8, borderline between 0.8 and 0.61, abnormal TBI ≤ 0.6 and severe PAD as TBI ≤ 0.2. In conclusion TBI can be reliably measured in patients with PAD and offer valuable information when diagnosing PAD. We present our diagnostic criteria based on clinical data.

Coronavirus 2019 (COVID-19) infection has a significant mortality rate. Despite the disease's extensive effects, little is known about the prognostic indicators that can be used. We aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR) and platelet-to- lymphocyte ratio (PLR) in predicting mortality of intensive care unit (ICU) patients. Demographic data, underlying diseases, laboratory parameters were evaluated. The study included 222 cases. The mortality rate was 57.65%. No significant differences in terms of sex, age, or underlying disease were observed between the two groups with and without mortality. Obesity, oxygen therapy, invasive mechanical ventilation (IMV) rates and high SOFA (Sequential Organ Failure Assessment) scores were found to be significantly higher in the group with a mortal course. The mortality rate was significantly higher in patients with lung involvement over 50%, with a low lymphocyte count at ICU admission. In this patient group, NLR was found to be higher, and LCR was found to be lower (P = .001). Although there was no significant difference in PLR between the two groups in univariate analysis, multivariate analysis revealed that PLR was independently associated with mortality. High NLR and low LCR values at ICU admission might serve as early warning signs for healthcare providers, allowing them to identify patients at higher risk of mortality.

Atherosclerotic stenosis of the carotid artery contributes significantly to ischemic strokes. This study investigates the correlation between the C-reactive protein (CRP) to albumin ratio (CAR) and in-stent restenosis (ISR) in patients (n = 529) undergoing carotid artery stenting. Patients were categorized based on ISR occurrence. Cox regression analyses were performed to identify independent predictors of ISR. The ISR rate was 10.3%. Laboratory analysis revealed higher levels of uric acid, CRP, and CAR in the ISR group. Cox regression identified CAR as an independent predictor of ISR (Hazard ratio (HR): 1.13, 95% CI: 1.03-1.24, P = .01), along with diabetes and smoking. A CAR cut-off of 0.28 predicted ISR with 93% sensitivity and 89% specificity (Area under the curve (AUC): 0.945, 95% CI: 0.923-0.963, P < .001). This study establishes a significant association between CAR and ISR in carotid artery stenting patients. The inflammatory response, indicated by CAR, emerges as a crucial factor in ISR development. The study contributes valuable insights into predicting and preventing ISR, emphasizing the potential of CAR as a prognostic biomarker. This easily accessible and cost-effective biomarker could enhance ISR prediction and guide preventive strategies for high-risk patients.

Cardiovascular disease (CVD) is the most common cause of death worldwide, with coronary atherosclerotic heart disease (CHD) accounting for the majority of events. Evidence demonstrates that inflammation plays a vital role in the development of CHD. The association between C-reactive protein (CRP), a representative inflammatory biomarker, and atherosclerosis (AS), CHD, and inflammation has attracted attention. Therefore, we conducted an extensive search on PubMed using the aforementioned terms as search criteria and identified a total of 1246 articles published from January 2000 to April 2024. Both review and research-based articles consistently indicate CRP as a risk enhancer for CVD, contributing to the refinement of risk stratification and early identification of apparently healthy at-risk populations. Additionally, CRP reflects disease progression and predicts the prognosis of recurrent cardiovascular events. Anti-inflammatory therapeutic strategies targeting CRP also provide new treatment options for patients. This review focuses on the link between CRP and CHD, highlighting how CRP is involved in the pathological progression of AS and its potential value for clinical applications.