Abstract:Aim To explore the relationship between fractional flow reserve (FFR) technical parameters and myocardial zymogram in patients with non-ST-segment elevation acute myocardial infarction (NSTEMI) and the predictive value of major adverse cardiovascular events (MACE). Methods A total of 136 NSTEMI patients admitted to Liaocheng Third Peoples Hospital from February 2017 to February 2020 were selected and all underwent percutaneous coronary intervention (PCI) under the guidance of FFR. According to whether MACE occurred 1 month after operation, all patients were divided into MACE group (n＝14) and non-MACE group (n＝122). The clinical data, myocardial enzyme spectrum indexes, quantitative coronary angiography (QCA) parameters, and FFR technical parameters were compared between the two groups. The correlation between FFR technical parameters and myocardial enzyme spectrum indexes and QCA parameters was analyzed. The Logistic regression equation was used to analyze MACE influencing factors. The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to analyze the myocardial zymogram indexes, QCA parameters, and FFR to predict the value of MACE. Results Compared with the non-MACE group, the proportion of patients aged ≥60 years old in the MACE group increased 0.55 times, the GRACE score increased 0.11 times, the cardiac troponin I (cTnI) level increased 0.38 times, the creatine kinase (CK) level increased 0.22 times, the creatine kinase isoenzyme-MB (CK-MB) level increased 0.24 times, and the stenosis degree increased 0.08 times, the lesion length increased 0.11 times, the FFR decreased 11.9%, and the minimum lumen area of criminal vessels decreased 12.8%, the difference was statistically significant (P＜0.05); FFR was negatively correlated with cTnI, CK, and CK-MB levels (P＜0.05); FFR was negatively correlated with stenosis and lesion length (P＜0.05); Logistic regression analysis showed that after adjusting for age, GRACE score, and culprit vessel minimum lumen area, myocardial zymogram indexes (cTnI, CK, CK-MB), QCA parameters (degree of stenosis, lesion length), and FFR were all related to the occurrence of MACE (P＜0.05); The AUC of MACE predicted by FFR was 0.885, the sensitivity was 92.86%, and the specificity was 65.88%. Conclusion There is a negative correlation between FFR and myocardial enzymes (cTnI, CK and CK-MB) levels in NSTEMI patients, and are related to the occurrence of MACE, which can predict the risk of MACE.

Abstract:Aim To evaluate the safety and effectiveness of percutaneous coronary intervention via distal transradial artery access. Methods Pubmed, Embase, Web of Science, Cochrane Library, China Biomedical Service System (Sinomed), China Knowledge Network (CNKI), Wanfang Data Knowledge Service Platform (Wanfang Data), VIP and other databases were searched by computer. The search time limit was from Janurary 2017 to May 2020. Two researchers conducted a Meta-analysis after analyzing and evaluating according to the Cochrance bias risk assessment tool.Results A total of 1 617 articles were obtained in various databases and other channels according to a predetermined search strategy, excluding unreasonable research design, no control group or control group as other parts of blood vessels (such as femoral artery, etc.), animal experiments, reviews, systematic reviews, and case reports were excluded. 10 articles were finally selected, Meta analysis results showed that there was no significant difference in the success rate of coronary puncture, the radial artery spasticity, and local hematoma (P＞0.05). However, the the radial artery occlusion was lower (OR＝0.4,5%CI(0.8,0.69),Z＝3.56,P＜0.05) in the distal radial artery path than in the traditional radial artery pathology. Conclusion Distal transradial artery access is safer and more effective than traditional radial artery access for coronary artery intervention. It can reduce radial artery occlusion and can be used as an alternative branch of the traditional route.

Abstract:Aim To investigate the effect of renin-angiotensin system inhibitor (RASI) on long-term prognosis in patients with coronary heart disease (CHD) after contrast-associated acute kidney injury (CA-AKI). Methods A total of 1 526 patients with CHD diagnosed by coronary angiography and postoperative CA-AKI in Guangdong Provincial Peoples Hospital from January 2008 to December 2018 were included in this study. They were divided into RASI group (n＝984) and non-RASI group (n＝542) according to whether they took RASI or not. The primary end point was long-term all-cause death. Baseline clinical data were compared between the two groups. Kaplan-Meier method and COX regression analysis were used to evaluate the effect of RASI on long-term prognosis. Results The proportion of β-receptor blockers and statins used in the RASI group was higher than that in the non-RASI group (P＜0.01). During the median follow-up period of 4.75 years (quartile 2.82 years, 6.67 years), 332 patients died, and the all-cause mortality was 21.76%. Kaplan-Meier survival analysis showed that the mortality of RASI group was lower than that of non-RASI group (P＝0.001). Univariate and multivariate COX regression analysis showed that RASI treatment after discharge was significantly negatively correlated with all-cause death (P＝0.001, P＝0.034), and RASI was an independent protective factor for long-term all-cause death. Conclusions RASI is an independent protective factor for the long-term prognosis of CHD patients after CA-AKI. Long-term use of RASI therapy can reduce the all-cause death in patients with CHD and CA-AKI.

Abstract:Aim To research the connection between the changes of plasma platelet-derived growth factor C (PDGF-C) concentration and coronary heart disease and the degree of coronary artery disease. Methods The research includes 52 patients with acute coronary syndrome (ACS), 52 patients with stable angina pectoris (SAP), and 50 patients with normal angiography as the control group. Among patients with coronary heart disease (ACS and SAP), there were 60 cases of coronary artery multivessel disease, 25 cases of double vessel disease, and 19 cases of single vessel disease. The enzyme-linked immunosorbent assay (ELISA) method was used to determine the plasma PDGF-C concentration in each group of patients. The plasma PDGF-C concentration levels were compared between groups, and Spearman correlation analysis, Logistic regression analysis, and ROC curve were drawn. Results The concentration of PDGF-C in the ACS group and the SAP group was higher than that in the control group(P<0.05). The plasma PDGF-C concentration in the multivessel and double disease groups was higher than that in the single disease group(P<0.05). The results of Spearman correlation analysis indicated that there was a correlation between plasma PDGF-C concentration and Gensini score(r=0.163, P<0.05). Logistic regression analysis found that patients with high concentration of PDGF-C had a higher risk of coronary heart disease than patients with low concentration of PDGF-C (OR=1.6,5%CI 1.002~1.011). The area under the ROC curve of plasma PDGF-C concentration was 0.645, and the sensitivity was 77.88%.Conclusion High-concentration plasma PDGF-C may be a risk factor for coronary heart disease and may be related to the severity of coronary artery disease.

Abstract:Aim To explore the value of intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) in the interventional therapy of borderline coronary lesions. Methods 60 patients with borderline coronary lesions(coronary artery stenosis between 40％～70％ confirmed by coronary angiography (CAG)) were enrolled. They were divided into QCA group(n=30, received QCA examination after CAG) and IVUS group (n=30, received IVUS detection after CAG). QCA and IVUS quantitative analysis were used to measure difference in reference vessel diameter, minimal lumen diameter, minimal lumen area, stenotic rates of diameter and area between two groups, and qualitative analysis was used to detect coronary plaques imaging morphology with IVUS. Finally, all the patients were followed up for 12 months. Incidence rate of major adverse cardiovascular events (MACE) during admission and follow-up were compared between two groups. Results Compared with QCA group, the ratio of lumen diameter stenosis ((57.80％±8.18％) vs (51.73%±7.91%)) and area stenosis ((67.01％±10.41％) vs (57.07%±10.71%)) were increased, while the ratio of minimum lumen area ((3.90±0.79) mm2 vs (4.14±0.60) mm2) was decreased in IVUS group (P＜0.05). Meanwhile there was no MACE during admission in two groups, but the incidence rate of MACE was significantly lower in IVUS group than that in QCA group since one month after follow-up started(P＜0.05). Conclusion Compared with QCA, IVUS can detect more severe stenosis rate of angiographical borderline lesions, more effectively detect “unstable” lesions, guide percutaneous coronary intervention of borderline lesion, reduce the occurrence of cardiovascular events, and improve the prognosis.

Abstract:Aim To examine myocardial bridge-mural coronary artery (MB-MCA) by using coronary CT angiography (CTA) and coronary angiography (CAG); To investigate the clinical features of MB-MCA and correlation between its imaging indexes and myocardial ischemic symptoms. Methods MB cases were retrospectively analyzed in our hospital in recent years, and 152 cases of MB were selected and diagnosed by coronary CTA and CAG. According to whether there was atherosclerosis (As), 152 cases of MB were divided into simple MB group and As with MB group. According to whether there was myocardial ischemic symptom, 152 cases of MB were divided into symptomatic group and asymptomatic group. Clinical features and imaging data were analyzed and compared in each group. Correlation was analyzed between MB-MCA imaging indexes and myocardial ischemia symptoms. Results The detection rate of coronary artery CTA for MB was 11.4%, and the detection rate of CAG for MB was 10.1%, and both were close. MB-MCA features of 152 cases:Systolic compression degree was 50.1%±10.5%, diastolic compression degree was 22.8%±10.5%; The average length was 18.2±11.5 mm mm, and the thickness was 2.7±0.8 mm; The most common MB site was in the middle part of left anterior descending coronary artery (LAD) (60.7%). Incidence of myocardial ischemic symptoms (typical chest tightness, etc.) and positive rate of treadmill exercise test in As with MB group were significantly higher than those in simple MB group (75.5% vs 58.7%, 66.0% vs 43.5%, P＜0.001). Compared with the asymptomatic group, MB was more distributed in the middle part of LAD, and more easily complicated with As in the symptomatic group (86.9% vs 68.9%, 74.8% vs 57.8%, P＜0.001). Spearman correlation analysis showed that the MB thickness, MCA systolic and diastolic compression degree were positively correlated with the myocardial ischemic symptoms. Conclusions The detection rates of coronary CTA and CAG for MB are similar. Incidence of myocardial ischemic symptoms and positive rate of treadmill exercise test in patients with MB combined with As are higher than those in patients with simple MB. Myocardial ischemic symptoms in patients with MB are closely related to MB thickness, MCA compression degree and As.

Abstract:Aim To qualitatively and quantitatively evaluate the influence of plaque calcification on the diagnostic accuracy of dual source CT (DSCT) coronary angiography for coronary stenosis assessment. Methods The retrospective analysis enrolled 224 patients. They were diagnosed as coronary artery disease by DSCT angiography, and then received selective coronary angiography. There were 375 lesions with significant coronary stenosis in 224 patients according to DSCT. Of 375 lesions, 234 lesions were with calcification. The influence of characteristics of lesions on accuracy of DSCT angiography for coronary stenosis assessment was evaluated. These characteristics included calcification degree of lesions, artery external diameter of calcified lesions, length of calcified lesions and location of calcified lesions. Results For mild to moderate calcified plaque and severe calcified plaque, DSCT overestimated coronary stenosis by 6.8% (P＝0.0028) and 18.8% (P＜0.0001) separately, and the overestimation of stenosis was more obvious in severe calcified lesions (P＝0.002). For calcified lesions with artery external diameter＜3 mm and artery external diameter≥3 mm, DSCT overestimated coronary stenosis by 7.2% (P＝0.0026) and 17.1% (P＜0.0001) separately, and the overestimation of stenosis was more obvious in calcified lesions with artery external diameter≥3 mm (P＝0.001). There was no difference in the diagnostic accuracy of DSCT for calcified plaques with different lengths (P＝0.792). Conclusion The lesion calcification makes DSCT angiography overestimate coronary stenosis. This phenomenon is more likely to occur in the severe calcified lesions and calcified lesions with artery external diameter≥3 mm.

Abstract:Aim To investigate the correlation between non-high density lipoprotein cholesterol level and severity coronary heart disease(CHD). Methods 522 cases of coronary angiography were retrospectively analyzed, according to the results of coronary angiography combined with clinical features, electrocardiogram and myocardial enzyme, which were divided into non-CHD group, angina pectoris group, myocardial infarction group. The average age is 60.00±10.02 years. Gensini score was used to evaluate the degree of coronary artery lesions in patients with coronary heart disease, the clinical data of all patients were collected, and the serum lipid levels were measured and non-high density lipoprotein cholesterol was calculated. The correlation between non-high density lipoprotein cholesterol and coronary heart disease was analyzed. Results Gensini levels had statistically significant differences in the three groups (P<0.05); In angina pectoris group, non-high density lipoprotein cholesterol level and Gensini score are positively correlated (r=0.130, P=0.022); In myocardial infarction group, non-high density lipoprotein cholesterol level and Gensini score are positively correlated (r=0.213, P=0.048); Logistic regression analysis showed that age, gender and non high density lipoprotein cholesterol level were risk factors for coronary heart disease (P<0.05). Conclusion Non-high density lipoprotein cholesterol is an important index to reflect the condition of patients with coronary heart disease.

Abstract:Aim To investigate the clinical value of color Doppler ultrasonography (CDU) for brachiocephalic trunk tortuosity in pathway selection of transradial coronary angiography (CAG). Methods 700 patients with unstable angina pectoris undergoing CAG were randomly divided into the test group (n＝362) and the control group (n＝338). According to the CDU screening with or without brachiocephalic trunk tortuosity, the test group was divided into CDU tortuosity group and CDU non-tortuosity group. According to the CAG screening with or without brachiocephalic trunk tortuosity, the control group was divided into CAG tortuosity group and CAG non-tortuosity group. Diagnostic accuracy of CDU for brachiocephalic trunk tortuosity, incidence of brachiocephalic trunk tortuosity and its effect on CAG operation success rate, operation time and complications were analyzed. Results The incidence rates of brachiocephalic trunk tortuosity in test group and control group were 9.4%, 10.7% respectively, and the difference between the two groups was not statistically significant (P＞0.05). The sensitivity of CDU diagnosis for brachiocephalic trunk tortuosity was 94.4%, the specificity was 98.7%. Compared with CDU tortuosity group, CDU non-tortuosity group and CAG non-tortuosity group, the operation success rate was decreased and operation time was increased in CAG tortuosity group (P＜0.05). The cases of radial artery spasm were 1,9, 1, and 8 respectively in CDU tortuosity group, CDU non-tortuosity group, CAG tortuosity group and CAG non-tortuosity group. 1 case of mild aortic dissection and 12 cases of catheter knotting occured in CAG tortuosity group. Conclusion CDU may provide the important reference value for interventional physicians to select more effective CAG pathway in patients with brachiocephalic trunk tortuosity.

Abstract:Aim To investigate the serum levels of 25(OH)D and analyse its correlation with the severity of coronary artery stenosis in patients with coronary heart disease. Methods 150 patients underwent coronary angiography, all selected objects in general were recorded, including gender, age, history of hypertension and diabetes and so on. Biochemical parameters were measured by immune nephelometry dialysis, including fasting glucose, low density lipoprotein cholesterol (LDLC), serum calcium (Ca2+). The serum 25(OH)D levels were measured by high performance liquid chromatography-tandem mass spectrometry in all patients. They were divided into normal control group and coronary artery lesion group according to the angiography results. The coronary artery lesion group was divided into mild, moderate and severe subgroups according to SYNTAX score. Results The serum 25(OH)D levels was 13.87±7.16 μg/L in patients with coronary heart disease and 21.67±7.38 μg/L in normal control group. The serum 25(OH)D levels in patients with coronary artery lesion was lower than that of control group (P<0.05), and gradually decreased as the severity of coronary artery lesions became more severe (P<0.05). In SYNTAX scores ≥33 group,SYNTAX scores 23～32 group and SYNTAX scores ≤22 group the serum 25(OH)D levels was significantly lower than that of normal control group (P<0.05). With the increase of SYNTAX scores, the serum 25(OH)D levels decreased obviously(P<0.05). There was a negative correlation between the serum 25(OH)D levels and the coronary artery lesions(r=－0.328,P=0.019). The levels of LDLC, blood sugar and serum calcium was 2.90±0.98 mmol/L, 5.85±1.46 mmol/L, 2.09±0.22 mmol/L. Bivariate correlation analysis of 25(OH)D level with the age, LDLC, blood sugar and serum calcium revealed no obvious correlation. Conclusion The serum 25(OH)D levels decrease significantly in patients with coronary heart disease, and its level is closely related to the degree of coronary artery lesions.