Angiology最新文献

Research has explored the relationship between inflammatory biomarkers and cardiovascular diseases, highlighting the potential prognostic significance of the high-sensitivity C-reactive protein (hs-CRP)/albumin (ALB) ratio. However, it remains unclear whether this ratio is associated with adverse prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). This retrospective cohort study included 752 STEMI patients undergoing PCI at Tianjin Chest Hospital between January 2017 and December 2018. During a median follow-up of 52 months, 183 cases (24.0%) experienced major adverse cardiovascular events (MACE) events and 75 cases (10.0%) died. Cox regression analysis demonstrated that hs-CRP/ALB was independently associated with MACE as both a continuous (hazard ratio [HR] 1.152, 95% CI 1.097-1.210, P < .001) and categorical variable (HR 1.257, 95% CI 1.084-1.458, P = .027). Similar findings were observed for all-cause mortality (HR 1.119, 95% CI 1.058-1.183, P < .001; HR 2.228, 95% CI 1.009-4.920, P = .032). The receiver operating characteristic (ROC) curve indicated that hs-CRP/ALB levels have predictive capability for overall mortality in patients (the area under the curve [AUC] = 0.68). hs-CRP/ALB levels independently correlate with poor long-term prognosis in STEMI patients with prior PCI.

Patients with autoimmune chronic inflammatory disease (CID) are at an increased risk of valvular heart disease, including aortic valve stenosis, insufficiency, or both. The impact of CID on the prognosis of surgical or transcatheter aortic valve replacement (AVR) remains unclear. This meta-analysis aims to evaluate the impact of CID on major clinical outcomes in this population. A comprehensive literature search of PubMed, Cochrane, and Embase databases was conducted to identify relevant studies. The primary endpoint was 30-day all-cause mortality between patients with CID and controls. Secondary endpoints included, long-term all-cause mortality, stroke and in-hospital infection. Statistical analysis included Risk Ratio (RR) with 95% confidence interval (CI) using the random-effects model. Five studies involving 572,351 patients were included in the meta-analysis. Patients with CID had a greater 30-day mortality (RR = 1.17, 95% CI: 1.09, 1.27; P < .001) and a higher rate of in-hospital infection (RR = 2.13, 95% CI: 1.03, 4.41; P < .001). No differences were observed in the other secondary endpoints. Patients with CID are at an increased risk of short-term all-cause mortality and in-hospital infections after AVR. Further studies are required to validate our results and define the optimal management of these patients.

Chemical adhesive closure (CAC) has comparable efficacy to thermal ablation but with faster recovery. Endovenous glue-induced thrombosis (EGIT) is a rare complication after CAC with lacking data regarding the prevalence and potential associations with deep vein thrombosis (DVT) and pulmonary embolism (PE). A retrospective chart analysis of patients treated with CAC at our institution between January 2018 and May 2022 was completed. Data collected included demographics, site and severity of chronic venous insufficiency (CVI), procedure details and outcomes at follow up visit. A comprehensive literature search of PubMed/Medline, Embase, and Cochrane was then conducted on December 2022, to include all studies that reported EGIT cases. The search generated 19 previous studies with a total of 2101 patients treated using CAC. The pooled prevalence rate of EGIT across these studies was 1.2% (95% CI: 0.3%-2.1%, I² = 61.1%). There were two reported cases of CAC-related DVT and no related cases of PE. In our patient cohort, age, treated vein size or procedure complexity were not significantly associated with increased risk of EGIT. CAC is an effective treatment for CVI with a low prevalence of EGIT. There were two reported cases of CAC-related DVT and no PE.

Obesity and pre-diabetes are metabolic disorders associated with insulin resistance (IR). Excess epicardial adipose tissue is also associated with increased IR. The triglyceride-glucose index (TyG) has been evaluated as an alternative measure of the IR in a variety of metabolic and cardiovascular disorders. However, its relationship with EAT thickness has not been studied yet. The study included 176 prediabetic and obese patients. EAT thickness was assessed using echocardiography. EAT thickness, TyG index, anthropometric obesity indices (body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR)), homeostatic model assessment (HOMA-IR), and biochemical parameters were compared. The following correlations between EAT thickness and related parameters were observed: WC (r = .529), BMI (r = .514), ALT (r = .358), TyG index (r = .338), and HOMA-IR (r = .322; P < .001 for all). Multiple regression analysis showed that WC (Beta = .428; P = .004), age (Beta = .223; P < .001), BMI (Beta = .196; P = .029), ALT (Beta = .168; P = .012), and TyG index (Beta = .128; P = .049) were the strongest independent variables correlated with EAT thickness. A model based on WC, BMI, age, TyG index, and ALT provided the best R-square (.387) for estimating EAT thickness (P < .001). The TyG index showed a significant and independent relationship with EAT, suggesting that it may be useful as an indicator of EAT thickness.

Three deficiencies of the Papa criteria (point scoring system, PSS) for thromboangiitis obliterans (TAO) were identified and updated. According to the new criteria, 185 patients with clinically diagnosed TAO in a single center using the diagnostic criteria of Shionoya were scored and re-diagnosed. The diagnostic criteria of The Japanese Ministry of Health, Labour and Welfare (JMHLW) were used as the comparative standard to compare the diagnostic value of the revised PSS (RPSS) criteria in the diagnosis of TAO. Among the 185 patients, 145 patients were possibly diagnosed with TAO by the RPSS diagnostic criteria, 40 patients were excluded from TAO diagnosis. The JMHLW standard definitively diagnosed 154 patients with TAO, and 31 patients were excluded from TAO diagnosis. Compared with the JMHLW standard, the accuracy of the RPSS diagnostic criteria was 0.90, and the Kappa value was 0.67 (Confidence interval [CI]: 0.53-0.81), which reached "substantial" agreement. The Area Under Curve (AUC) was 0.86 and >0.7, showing good diagnostic value. The RPSS criteria have good diagnostic efficacy. If this revised scoring system can be endorsed, it might improve the certainty of TAO diagnosis and research.

Non-atherosclerotic renal artery vasculopathies are rare and can be caused by heterogenous group of diseases, some of which has bad prognosis. The literature addressing this rare group of disease is scarce. A single center analysis of all adult patients evaluated for renal artery disease including dissection, aneurysm, stenosis, vasculitis, thrombosis, irregularity, and renal infarct treated at our center, from January 2000 to April 2022. Baseline data collected included demographics, comorbidities, vital signs, laboratory values, pathology, genetic testing, and imaging results/diagnoses. Additionally, treatment modality, follow-up, and symptom relief/recurrence from follow-up visits were collected if available. Out of the included 227 patients, 91 (40%) had renal infarction, 70 (31%) had renal artery dissection, 69 (30%) had aneurysm, 33 (15%) had stenosis, and 32 (14%) had thrombosis. The most common diagnoses were fibromuscular dysplasia (n = 86, 38%) and thromboembolism (n = 38, 17%). Most patients improved with conservative management, reserving endovascular or surgical interventions for symptomatic patients with more complicated presentations. To our knowledge, this is the only case study and general review in the literature that addresses the diagnosis and management of non-atherosclerotic renal arteriopathies showing good outcome for most of the underlying etiologies.

Using the SYNTAX score (SS) for decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for left main coronary artery (LMCA) revascularization is under scrutiny. This study investigated the clinical outcomes of LMCA revascularization stratified by SS. This multicenter study included 2138 patients recruited between 2015 and 2020 who underwent LMCA disease revascularization using PCI or CABG and were categorized based on their SS into three groups: low (≤22), intermediate (23-32), and high (≥33). Patients with a high SS compared with those with an intermediate SS experienced increased hospital mortality (Odds ratio: 1.99; P = .026) and Major Adverse Cardiac and Cerebrovascular Event (MACCE; OR: 2.17; P = .006). With an average follow-up of 24.7 months, no substantial differences emerged in MACCE (Hazard ratio: 1.23; P = .52) or mortality (HR: 3.26; P = .073] between patients with high and intermediate SSs. A significant interaction between the SS category (low vs intermediate) and LMCA revascularization modality was observed for hospital MACCEs, favoring PCI over CABG (OR: 0.32; P = .033). However, no noteworthy interactions between SS categories and revascularization modalities were noted concerning hospital or follow-up mortality or follow-up MACCEs. These findings raise doubts about the utility of SS alone in selecting left-main revascularization modalities for LMCA disease.

The left internal mammary (thoracic) artery (LIMA), when used as a pedicle graft at the time of coronary artery bypass grafting, is effective and durable. Data concerning the rate and causes of LIMA failure are scant. The aim of this paper is to explore the modes and frequency of sub-optimal LIMA grafts. We examined all cases of invasive graft angiography performed in our cardiothoracic center 2016-2020 and analyzed the quality of the LIMA graft. Of 551 cases, 323 had undergone isolated coronary artery bypass grafting including a LIMA since 2001; of those, 59 (18%) appeared sub-optimal; 16 (5%) being totally occluded, 26 (8%) exhibiting a "string sign" (i.e., atretic or cord-like), 12 (4%) being focally stenosed, and 5 (1.5%) being patent but placed on a diseased portion of the left anterior descending artery or other vessel. The commonest cause of failure were poor-quality left anterior descending artery target and non-flow-limiting disease. This paper highlights the low rate, and likely modes, of failure of this valuable treatment in contemporary practice.

Acute coronary syndromes (ACS) are one of the most common causes of morbidity and mortality worldwide. Primary percutaneous coronary intervention (pPCI) is the main treatment strategy to restore myocardial perfusion. However, the no-reflow phenomenon (NRP) may block coronary flow. The present study focused on assessing and contrasting predictive parameters for NRP in ACS patients. Our research is a retrospective analysis. We assessed the parameters significantly associated with NRP using Cox regression and Receiver operating characteristic (ROC) Curve analysis. The study included 5122 patients who met the criteria. The average age of the patients was 63.9 + 13.2, and 74.4% were male. It was observed that NRP developed in 1.8% of all patients. Age, hemoglobin (Hb), white blood cell (WBC), glucose and low density lipoprotein cholesterol (LDL-C) were determined to be independent predictors of NRP. The power of these parameters to predict NRP was similar, and WBC was the most predictive (Area Under Curve (AUC): 0.605 95% CI: 0.539-0.671, P = .001). We believe that the use of these simple, practical, and routinely used hematological and biochemical parameters will help us predict the risk of developing NRP before pPCI. This information should improve management.