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简介：BackgroundManypatientshavesymptomssuggestiveofcoronaryarterydisease(CAD)andareoftenevaluatedwiththeuseofdiagnostictesting,althoughtherearelimiteddatafromrandomizedtrialstoguidecare.MethodsWerandomlyassigned10,003symptomaticpatientstoastrategyofinitialanatomicaltestingwiththeuseofcoronarycomputedtomographicangiography(CTA)ortofunctionaltesting(exerciseelectrocardiography,nuclearstresstesting,orstressechocardiography).Thecompositeprimaryendpointwasdeath,myocardialinfarction,hospitalizationforunstableangina,ormajorproceduralcomplication.SecondaryendpointsincludedinvasivecardiaccatheterizationthatdidnotshowobstructiveCADandradiationexposure.ResultsThemeanageofthepatientswas60.8±8.3years,52.7%werewomen,and87.7%hadchestpainordyspneaonexertion.ThemeanpretestlikelihoodofobstructiveCADwas53.3±21.4%.Overamedianfollow-upperiodof25months,aprimaryend-pointeventoccurredin164of4996patientsintheCTAgroup(3.3%)andin151of5007(3.0%)inthefunctional-testinggroup(adjustedhazardratio,1.04;95%confidenceinterval,0.83to1.29;P=0.75).CTAwasassociatedwithfewercatheterizationsshowingnoobstructiveCADthanwasfunctionaltesting(3.4%vs.4.3%,P=0.02),althoughmorepatientsintheCTAgroupunderwentcatheterizationwithin90daysafterrandomization(12.2%vs.8.1%).ThemediancumulativeradiationexposureperpatientwaslowerintheCTAgroupthaninthefunctional-testinggroup(10.0mSvvs.11.3mSv),but32.6%ofthepatientsinthefunctional-testinggrouphadnoexposure,sotheoverallexposurewashigherintheCTAgroup(mean,12.0mSvvs.10.1mSv;P<0.001).ConclusionsInsymptomaticpatientswithsuspectedCADwhorequirednoninvasivetesting,astrategyofinitialCTA,ascomparedwithfunctionaltesting,didnotimproveclinicaloutcomesoveramedianfollow-upof2years.

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简介：Toreviewthecardiacprotectiveeffectsofwineintakeandrecommendmoderatewineconsumptionasaprimarypreventionstrategyforcoronaryarterydiseases(CAD).Systematicallyreviewformerstudiesonthewineconsumption(redwineandyellowwine)bysearchingtheMedlinedatabaseandotherrelatedcitations,andinvestigatepossibleprotectivepathways.Regularmoderatewineintakecanbenefitheartfromacutecoronarysymptom(ACS)attacking;reducetherelativeriskofmorbidityandmortalityfromCAD.Itmightnotbeimperativetoaskpeopletostopdrinking;inversely,wesuggestmoderatewineconsumptionasapreventivestrategyinCADforitsguardingcontribution.

简介：BackgroundIncreasedserumleveloflipoprotein(a)(Lp(a))isassociatedwithatherosclerosis.WhetherincreasedLp(a)levelisindependentlyassociatedwiththeseverityofcoronaryarterydisease(CAD)isunclear.MethodsSubjectswereenrolledandreceivedcoronaryangiographytoassessthenumberofstenosedcoronaryartery.ThesubjectswithCADweredividedintonon-significant(<50%stenosis),singleandmultivesselstenosis(≥50%stenosis)groups.Parametersofinterestatbaselinewerecollected.StatisticalanalyseswereperformedtoevaluatetherelationshipbetweenLp(a)levelandCADseverity.ResultsTotally745populationswereenrolledanddiagnosedasCAD(n=605)orwithoutCAD(n=140)onthebasisofangiographyexamination.AscomparedtothesubjectswithoutCAD,serumlevelsofLp(a)andCRP,andthepercentagesofsubjectswithsmokingordiabetesweresignificantlyhigherinsubjectswithCAD.Incontrast,serumlevelsofHDL-CandApo-AweresignificantlylowerinsubjectswithCADascomparedtosubjectswithoutCAD.Incomparisonofsubjectswithnon-significantstenosis(serumLp(a)level,170.0±19.7mg/dL),serumLp(a)levelwassignificantlyhigherinsubjectswithsingle(245.5±22.3mg/dL)ormultiplevesselstenoses(265.8±14.0mg/dL).Withmultivariateregressionanalyses,afteradjustedforage,gender,smoking,familyhistoryandhypertension,therewasstillsignificantassociationbetweenserumLp(a)levelandthenumberofcoronaryarterystenosis.Afteradditionaladjustmentfordiabetes,HbA1c,totalcholesterol,LDL-C,Apo-A,uricacidandCRP,Lp(a)remainedstronglyassociatedwithCADseverity.ConclusionSerumLp(a)levelwassignificantlyassociatedwiththeseverityofcoronaryarterystenosis,whichmayaddthevalueoncardiovascularriskevaluation.

简介：Sex-specificdifferencesintheepidemiologyandpathophysiologyofcoronaryarterydiseaseandischemicheartdiseasearenowwellrecognized.Womenwithanginamoreoftenhavenonobstructivecoronaryarterydisease(NOCAD)comparedwithmen.Thispatientpopulationcarriesasignificantriskoffuturecardiovasculareventsthatisnotcommonlyappreciated,oftenleadingtodelayeddiagnosisandtreatment.WhilecoronarymicrovasculardysfunctionplaysacentralroleinthepathophysiologyofNOCADinwomen,othermechanismsofmyocardialischemiaarenowrecognized.RiskfactorssuchashypertensionandobesitydisparatelyaffectwomenandarelikelytoaccountforasignificantproportionofNOCADinthecomingyears.VascularinflammationisanimportantpathophysiologicpathwayinNOCADandisapotentialtherapeutictarget.CoronaryCTangiographyprovidesacomprehensiveassessmentofcoronaryanatomyandplaquemorphologyandisareasonablescreeningtestofchoiceforNOCAD.

简介：BackgroundPreviousstudieshavesuggestedthatpatientswithlowendothelialprogenitorcell(EPC)countsandimpairedendothelialcolonyformingactivityhaveahigherincidenceforcardiovasculareventscomparedtopatientswithhighEPCcountsandfavorablecolonyformingactivity.ThepathophysiologicalbasisforthisfindingmaybeaninsufficientendothelialcellrepairbyEPC.TheobjectiveofthisstudywastodeterminewhetherthenumberofEPCsinperipheralbloodwasassociatedwiththepresenceandseverityofangiographicstenosisinpatientsofthelatephaseafteracutemyocardialinfarction(AMI).MethodsOnehundredandonepatientsundergoingcardiaccatheterizationinourhospitalwereenrolledinthestudy.ThenumberofcirculatingEPCswasmeasuredbyafluorescent-activatedcellsorter(FACS).Patientswithacutecoronarysyndromeswereexcluded.ResultsComparedwithpatientswithnormalcoronaryartery,thenumberofcirculatingEPCswassignificantlyreducedamongpatientsinthelatephaseafterAMI(P<0.01).Wealsofoundthatcomparedwiththecontrolgroup,thenumberofEPCsofsingle-vesselstenosisgroupandmulti-vesselstenosisgroupweresignificantlyreduced(P=0.005;P=0.001).ConclusionsThenumberofEPCsintheperipheralbloodisdecreasedinpatientsofthelatephaseafterAMI.TheEPCsnumbercorrelatedwithangiographicstenosisseverity,whichsuggeststhatendothelialinjuryinthedeficientcirculatingEPCsmayaffecttheseverityoftheheartdisorderandtheclinicalpresentations.

简介：Tostudytherelationshipbetweenmyeloperoxidase(MPO)-463G/Apolymorphismsandsusceptibilitytocoronaryarterydisease(CAD)inHanpeopleofnorthAnhuiprovince.MethodsThecasegroupconsistedof79patientswhohadallangiographicallyprovenCADwereretrospectivelystudied.Usedpolymerasechainreaction-restrictionfragmentlengthpolymorphism(PCR-RFLP)methodstodecidethegenotypeofallthepatients.ResultsThefrequencyofAAhomozygotictypeinHanpeopleofAnhuiprovincewas1.4%.TheriskofCADforpersoncarryingatleastoneAallelegenotype(GAandAA)was0.37timesofGGgenotype.TheseverityofcoronaryarterystenosisinCADpatientscarryingatleastoneAallelegenotypewas0.197timesofGGgenotype(P<0.05).ConclusionsThefrequencyofAAhomozygotictypeandMPO-463G/ApolymorphisminHanpeopleofAnhuiprovinceinfluencedtheriskofCAD.AallelehadprotectivefunctioninCAD.

简介：AbstractBackground:The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients.Methods:We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission.Results:From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45–0.86; P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52–1.25; P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51–1.23; P = 0.308).Conclusions:In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making.Clinical trial registration:NCT02880605. https://www.clinicaltrials.gov.

简介：ObjectivesToinvestigatethechangeandclinicalsignificanceofclopidogrelonplateletmembraneCD40Lincoronaryarterydiseasepatientsbeforeandafterpercutaneouscoronaryintervention(PCI).Methods30caseswhowerediagnosiscoronaryarterydiseases(CAD)bycoronaryangiography,meanage56±9yearsold.Allthepatientswhohadnoantiplateletaggregationcontraindication,weretreatedwithstandardantianginapectorisdrugs.BeforePCI,allthepatientstookclopidogrel75mgperday.ActivatedplateletmembraneCD40LexpressratewasmeasuredbyflowcytometrybeforeandafterPCI6hours.ResultsActivatedplateletmembraneCD40Lexpressratewere3.73±2.15and2.46±0.90,respectivelyin30patientsbeforeandafterPCI6hours.ActivatedplateletmembraneCD40LexpressratewassignificantlydecreaseafterPCI6hoursthanthatbeforePCI(P<0.01).ConclusionsClopidogrelhassignificanceeffectonplateletmembraneCD40LincoronaryarterydiseasepatientsundergoingPCI.Clopidogrelcansuppressionplateletactivationandpreventthromboembolismeventoccurrence.

简介：AbstractBackground:Angiopoietin-2 (Ang-2) is a type of endothelial growth factor involved in angiogenesis and vascular remodeling. Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease (CAD). This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD.Methods:A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study. Coronary flow reserve (CFR) was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography. The patients were divided into the following two sub-groups according to CFR: the impaired CFR group with CFR values <2.5 and the preserved CFR group with CFR values ≥2.5. Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay. Independent predictors for impaired CFR were identified by binary logistic regression analysis. The receiver-operating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR.Results:We found that age, percentage of female sex, N-terminal pro-B-type natriuretic peptide levels, Ang-2 levels (763.3 ± 264.9 vs. 579.7 ± 169.3 pg/mL, P < 0.001), and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR. Serum Ang-2 levels were negatively correlated with CFR (r = -0.386, P < 0.001). Binary logistic regression analysis showed that Ang-2 (odds ratio: 1.004, 95% confidence interval [CI]: 1.001-1.006, P = 0.003) and age (odds ratio: 1.088, 95% CI: 1.023-1.156, P = 0.007) were independently associated with impaired CFR. Furthermore, Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve (P < 0.001). The area under the curve was 0.712 (95% CI: 0.612-0.813).Conclusions:High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.

简介：Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear

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简介：IntroductionandPatientDescription,Assessmentofpatientswithanginapectorisisachallengefortheclinicalcardiologist.Myocardialischemiaandanginapectoriscanbecausedbyvariousmechanisms,suchascoronaryatherosclerosis,vasospasm,orcoronarymicrovasculardysfunction[1].Moreover,thesemechanismsmayoverlapinagivenpatient,makingitdifficulttodeterminethecauseofangina.Wereportherethecaseofa57-year-oldfemalepatientwithahistoryofanginapectoristhatstarted3monthspreviously.Hersymptomsoccurredpredominantlyatrestbutalsowitheffort.Thepatientwasanactivesmokerwhosmokedabout15cigarettesperday(~20packyears).Moreover,shehadhypertensiontreatedwithenalapril.HerLDLlevelwas75mg/dlwithoutanycholesterol-loweringtherapy.Shewassentfordiagnosticcoronaryangiographyforsuspectedstenosingcoronaryarterydisease.

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简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

简介：Inrecentyears,intravascularultrasound(IVUS)follow-upisalwaysusedintheevaluationofthedevelopmentofatherosclerosis,anditcanalsobeusedastheendpointofdrugtherapyinclinicalobservation.Since1994,thefirststatinlipid-lowering4Sexperimentresultswasreported,thefollowingstatinforlipid-loweringtestsrepresentedbyREVERSALPROVE-IT,TNT,IDEAL,ASTEROIDandJUPITERstronglyconfirmedthatfurtherreducetheefficacyoflow-densitylipoproteincholesterol(LDL-C)(toenhancethelipid-loweringtreatment)accesstoincreaseeffectofthecardiovascularprotectionandalsoreversetheplaques'progress.Butscholars'opinionsonthemeritsanddemeritsofenhancestatincholesterol-loweringtherapyhasbeenindebate.Wereviewtherecentworkonstatinsandreversalofarterialplaquesforanumberofclinicalstudies.