Coronary artery disease最新文献

{"title":"Controlled low-density lipoprotein cholesterol attenuates cardiovascular risk mediated by elevated lipoprotein(a) after percutaneous coronary intervention.","authors":"Ahmed K Mahmoud, Kamal Awad, Juan M Farina, Mohammed Tiseer Abbas, Nima Baba Ali, Hesham M Abdalla, Amro Badr, Muhammad A Elahi, Milagros Pereyra, Isabel G Scalia, Niloofar Javadi, Nadera N Bismee, Said Alsidawi, Steven J Lester, Chadi Ayoub, Reza Arsanjani","doi":"10.1097/MCA.0000000000001460","DOIUrl":"10.1097/MCA.0000000000001460","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] is an independent, causal risk factor for cardiovascular disease. However, it is still unclear whether controlling low-density lipoprotein cholesterol (LDL-C) to optimal levels can attenuate cardiovascular risk mediated by elevated Lp(a), especially in the setting of secondary prevention.</p><p><strong>Methods: </strong>Adult patients with a baseline Lp(a) measurement who underwent percutaneous coronary intervention (PCI) and reached their LDL-C target levels (<70 mg/dl) at Mayo Clinic sites between 2006 and 2017 were included. Primary outcomes included major adverse cardiovascular events (MACE) and all-cause mortality. Kaplan-Meier curves were created to compare the survival probabilities among patients with Lp(a) ≥ 50 mg/dl compared with Lp(a) < 50 mg/dl. Multivariable Cox regression analyses were performed to quantify the association of elevated Lp(a) with our relevant outcomes and to control for possible confounders.</p><p><strong>Results: </strong>In total, 878 patients (median age: 68 years, and 74% males) who underwent PCI were included for analysis. Of them, 29.7% had elevated Lp(a) ≥ 50 mg/dl. Kaplan-Meier curves did not reveal any significant difference in survival probabilities for elevated Lp(a) for any outcome including MACE ( P  = 0.91), all-cause mortality ( P  = 0.26), or the separate MACE components. Similarly, the multivariable analysis showed no significant association for MACE (hazard ratio: 1.07, 95% confidence interval: 0.84-1.37) or all-cause mortality (hazard ratio: 0.98, 95% confidence interval: 0.74-1.30).</p><p><strong>Conclusion: </strong>In patients who underwent PCI and have their LDL-C controlled below 70 mg/dl, no significant association was found between elevated Lp(a) ≥ 50 mg/dl and risk for MACE or all-cause mortality.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"183-189"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of PCSK9 inhibitors on major cardiac adverse events and lipoprotein-a in patients with coronary heart disease: a meta-analysis.","authors":"Enze Hu, Macao Wan","doi":"10.1097/MCA.0000000000001464","DOIUrl":"10.1097/MCA.0000000000001464","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease due to its unique apo(a) component and its association with atherosclerosis and thrombogenesis. This meta-analysis was conducted to evaluate the effects of PCSK9 inhibitors on major adverse cardiac events (MACE) and Lp(a) levels in patients with coronary heart disease.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) were systematically searched in PubMed, the Cochrane Library, and other databases. Stata 15.1 software was used for data analysis, and a random- or fixed-effects model was selected based on inter-study heterogeneity. Egger's test was applied to detect publication bias.</p><p><strong>Results: </strong>A total of 12 RCTs were included, involving 48 116 patients with a mean age of 62 years, comprising 65% males and diverse ethnic backgrounds. The results showed that compared with the control group, PCSK9 inhibitors significantly reduced low-density lipoprotein cholesterol (WMD = -1.24 mmol/L, 95% confidence interval (CI): -1.28 to -1.20), total cholesterol, triglycerides, and Lp(a) levels while increasing high-density lipoprotein cholesterol levels. In terms of safety, there was no increased risk of adverse reactions other than injection site reactions. For MACE, PCSK9 inhibitors significantly reduced the risk of nonfatal myocardial infarction, stroke, and coronary revascularization events (RR = 0.87, 95% CI: 0.84-0.89).</p><p><strong>Conclusion: </strong>PCSK9 inhibitors not only significantly improve blood lipid profiles and reduce Lp(a) levels but also reduce the risk of MACE in patients with coronary heart disease. Therefore, PCSK9 inhibitors offer an effective and safe treatment option for these patients.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"200-210"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of exercise training in patients with angina with nonobstructive coronary arteries: a systematic review and meta-analysis.","authors":"Yuan Wu, Haixiang Zhu, Qijin Xu, Yan Li, Leiwen Tang","doi":"10.1097/MCA.0000000000001440","DOIUrl":"10.1097/MCA.0000000000001440","url":null,"abstract":"<p><p>Angina with nonobstructive coronary arteries (ANOCA) is a highly prevalent heart disease. The evidence on exercise training (ET) for the treatment of ANOCA, however, is still inadequate. This meta-analysis aims to provide a comprehensive assessment of the effect of ET in patients with ANOCA. Studies were searched from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP, and WanFang from inception to 15 January 2024. The quality of included studies was assessed using the Cochrane risk of bias tool. Heterogeneity among the studies was evaluated using Cochran's Q test and I2 statistic, and subgroup analysis based on gender was performed to explore potential sources of heterogeneity. A total of 12 studies were included in this meta-analysis. The pooled results showed that ET significantly increased the peak oxygen uptake (peak VO 2 ) [weighted mean difference (WMD) = 6.11, 95% confidence interval (CI): 4.73 to 7.50], left ventricular ejection fraction (WMD = 7.66, 95% CI: 5.53 to 9.78), and 6 min walking test (WMD = 55.55; 95% CI: 16.23 to 94.87). Nitric oxide (WMD = 20.18, 95% CI: 19.16 to 21.21) and peripheral arterial tonometry (WMD = 0.16, 95% CI: 0.11 to 0.21) were higher, and matrix metalloproteinase-9 (WMD = -8.02, 95% CI: -9.21 to -6.84) was lower in ET group. In conclusion, our findings indicated that ET could improve cardiopulmonary function, exercise capacity, and endothelial function, which could be recommended for the treatment of ANOCA patients.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"252-262"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum malondialdehyde levels at admission as a predictor of inhospital mortality in patients with acute coronary syndrome.","authors":"Muammer Karakayali, Metin Ogun, Inanç Artac, Doğan Ilis, Ayca Arslan, Timor Omar, Öztürk Demir, Talha Karahan, Soner Kina, Ibrahim Rencuzogullari, Yavuz Karabag","doi":"10.1097/MCA.0000000000001469","DOIUrl":"10.1097/MCA.0000000000001469","url":null,"abstract":"<p><strong>Introduction and objective: </strong>Malondialdehyde (MDA) is a predictive marker of cardiovascular events in patients with stable angina pectoris. However, there is limited information available regarding this marker in patients with acute coronary syndrome (ACS). The aim of the study was to explore the association of MDA levels with inhospital mortality among patients with ACS.</p><p><strong>Materials and methods: </strong>The study sample consisted of 556 ACS patients. The leftover plasma samples collected in EDTA vials for troponin T estimation within 24 h of chest pain were used for analysis. Blood samples were collected into tubes for MDA, nitric oxide (NO), inducible nitric oxide synthase (i-NOS), endothelial nitric oxide synthase (e-NOS), total sialic acid (TSA), NT-proBNP, ANP, homocysteine, and cardiac troponin I (cTnI). The blood samples were centrifuged (4000 g , 4 °C) for 10 min, and the obtained serum then kept at -25 °C until the analyses were carried out. The relationship between these markers and inhospital mortality of ACS patients was investigated.</p><p><strong>Results: </strong>Univariate logistic regression analysis revealed significant correlations among sex, age, creatine, MDA, NT-proBNP, ANP, homocysteine, cTnI, NO, e-NOS, i-NOS, and TSA. Further analysis of these variables using the multivariate logistic regression analysis indicated that age, creatine, MDA, and NT-proBNP were independent predictors. Optimal MDA cutoff value of >33.1 predicted inhospital mortality with 85% sensitivity and 88.17% specificity [AUC: 0.905 (95% CI: 0.878-0.928, P  < 0.001)].</p><p><strong>Conclusion: </strong>We demonstrated that MDA levels were elevated in cases of inhospital mortality among ACS patients and the optimal MDA cutoff value of >33.1 predicted inhospital mortality with 85% sensitivity and 88.17% specificity.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"211-217"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous origin of the left circumflex coronary artery from the right coronary artery arising the noncoronary sinus.","authors":"Ramazan Orkun Onder, Serdar Aslan, Ertugrul Cakir","doi":"10.1097/MCA.0000000000001430","DOIUrl":"10.1097/MCA.0000000000001430","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"267-268"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of woven coronary bifurcation lesion with mini-crush technique.","authors":"Ahmet Yaşar Çizgici, Koray Çiloğlu, Ahmet Güner, Serkan Yazan, Berkay Serter, Cemalettin Akman, Ezgi Gültekin Güner, Hande Uysal, İbrahim Faruk Aktürk, Fatih Uzun","doi":"10.1097/MCA.0000000000001467","DOIUrl":"10.1097/MCA.0000000000001467","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"264-265"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-barrel coronary sinus: a rare anomaly unveiled during cardiac resynchronization therapy.","authors":"Aziz Inan Celik, Tahir Bezgin, Burcu Kodal, Ali Cevat Tanalp, Metin Cagdas","doi":"10.1097/MCA.0000000000001434","DOIUrl":"10.1097/MCA.0000000000001434","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"271"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative clinical and echocardiographic outcomes of coronary artery bypass grafting for nonfilling and filling chronic total occlusion in the left anterior descending artery.","authors":"Takeshi Kinoshita, Ryoma Oda, Daisuke Endo, Taira Yamamoto, Minoru Tabata","doi":"10.1097/MCA.0000000000001531","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001531","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare the clinical and echocardiographic outcomes of multivessel coronary artery bypass grafting (CABG) for nonfilling vs. filling chronic total occlusion (CTO) in the left anterior descending artery (LAD).</p><p><strong>Methods: </strong>A retrospective analysis included 257 from 2778 patients undergoing multivessel CABG at Juntendo University between 2002 and 2020. CTO lesions were assessed using coronary angiography, and collateral circulation was graded using the Rentrop classification. Nonfilling CTO was defined as grades 0 and 1 while filling CTO was defined as grades 2 and 3.</p><p><strong>Results: </strong>LAD revascularization with internal thoracic artery (ITA) grafts showed higher graft dysfunction in nonfilling CTO patients. Transit-time flow measurement revealed lower mean graft flow (23 ± 12 ml/min vs. 36 ± 13 ml/min, P = 0.01) and higher pulsatile index (4.0 ± 1.5 vs. 3.0 ± 1.4, P = 0.02) in nonfilling CTO patients. Postoperative computed tomography in the ITA grafts indicated string signs in 13.7% of nonfilling CTO and 6.1% of filling CTO patients (P = 0.04), with graft occlusion rates of 5.9 and 1.8%, respectively (P = 0.03). Although long-term survival rates showed no significant difference (P = 0.19), filling CTO patients had significant improvements in left ventricular ejection fraction (LVEF) from 39 to 47% (P = 0.01) and wall motion score index (WMSI) from 1.5 to 1.1 (P = 0.02). In contrast, nonfilling CTO patients did not show significant improvements in LVEF (P = 0.76) or WMSI (P = 0.64).</p><p><strong>Conclusion: </strong>CABG for LAD nonfilling CTO does not significantly impact long-term survival but is associated with lower graft flow, higher occlusion rates, and less improvement in cardiac function compared to filling CTO.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of patients with acute coronary syndrome who present with atypical symptoms: a systematic review, pooled analysis and meta-analysis.","authors":"Chun Shing Kwok, Sadie Bennett, Eric Holroyd, Duwarakan Satchithananda, Josip A Borovac, Maximilian Will, Konstantin Schwarz, Gregory Y H Lip","doi":"10.1097/MCA.0000000000001462","DOIUrl":"10.1097/MCA.0000000000001462","url":null,"abstract":"<p><p>How frequent and whether outcomes are worse for patients with atypical presentation in acute coronary syndrome (ACS) across the literature is not known. We conducted a systematic review of the literature on patients with ACS or acute myocardial infarction who reported whether their symptoms were atypical or typical. We determined the proportion of patients with atypical or no chest pain and used meta-analysis to evaluate predictors of atypical presentation and mortality associated with atypical presentation. A total of 43 studies were included with 1 691 401 patients (mean age: 65.4 years, 63.8% male). The proportion of patients with atypical presentation ranged from 4.6 to 74.2% while for those with no chest pain it ranged from 1.4 to 35.5%. Atypical presentation occurred in 11.6% of patients (28 studies) and no chest pain occurred in 33.6% of patients (16 studies). The three strongest factors associated with increased odds of atypical presentation or no chest pain presentation were non-ST-elevation myocardial infarction [odds ratio (OR): 2.38, 95% confidence interval (CI): 1.55-3.64], greater Killip class (OR: 2.22, 95% CI: 1.84-2.67), and prior heart failure (OR: 1.79, 95% CI: 1.76-1.82). There is a two-fold increase in odds of mortality with atypical or no chest pain presentation in ACS compared with the typical presentation (OR: 2.07, 95% CI: 1.71-2.50, I2  = 99%). Atypical presentation occurs in approximately 1 in 10 patients with ACS but can be as high as 1 in 3 in some populations. Patients who present atypically are at two-fold increased risk of mortality.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"240-251"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cooling the forearm puncture site following transradial cardiac catheterization or percutaneous coronary intervention: the hemostatic 'Cryoband' pilot study.","authors":"Guy F A Prado, Alexandre A Aquino, Fabio Conejo, Sandro M Faig, Alexandre Sposito, Diego Garcia, Pedro Gabriel Melo de Barros E Silva, Flavio L Ribichini, Expedito E Ribeiro, Henrique B Ribeiro","doi":"10.1097/MCA.0000000000001530","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001530","url":null,"abstract":"<p><strong>Background: </strong>The transradial approach in percutaneous coronary procedures has become the primary vascular access worldwide. Cryotherapy is frequently used to promote analgesia and vasoconstriction. This study aimed to evaluate the safety of forearm puncture site cooling using the novel hemostatic Cryoband protocol.</p><p><strong>Methods: </strong>The proposed protocol modifies pneumatic wristband devices by incorporating a cooling plate of frozen gel on the forearm, situated beneath the air cuff. This is a pilot, prospective, single-arm study involving 100 patients. The primary endpoints were device success and time to hemostasis. The safety secondary endpoints included (a) hematomas [early discharge after transradial stenting of coronary arteries (EASY)] and bleeding (Bleeding Academic Research Consortium); (b) radial artery patency predischarge; (c) numerical rating scale for pain; and (d) frostbite burns.</p><p><strong>Results: </strong>The study involved 106 procedures (84 for diagnosis and 22 for interventions) and demonstrated a 100% success rate for the device. The median time to hemostasis was 95 min (IQR: 90-110 min) for diagnostic procedures and 180 min (IQR: 160-210 min) for interventions. In-hospital outcomes indicated no hematomas exceeding EASY grade II, a 2% incidence of radial artery occlusion, a pain score of zero in 90% of cases, and no instances of frostbite burns. After a median follow-up of 9 days, no adverse clinical events were reported, and most patients (91.5%) did not experience bleeding.</p><p><strong>Conclusion: </strong>Cooling the forearm puncture site with the novel Cryoband protocol was safe and effective. Further randomized studies are warranted to assess its potential clinical benefit over the standard technique.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}