Angiology

Early menopause has been found to be associated with higher risk of cardiovascular disease. Our objective was to investigate the impact of early menopause on clinical outcomes for women undergoing percutaneous coronary intervention (PCI). We observed female patients with coronary artery disease (CAD) undergoing PCI and found that women with early menopause (≤46 years old) were more likely to have CAD risk factors and more severe coronary lesions. During the 18-month follow-up, early menopause was associated with similar risk of death and myocardial infarction but higher risk of target lesion revascularization (TLR; 7.8% vs 5.3%, P = .003) and major adverse cardiovascular events (MACEs; 11.3% vs 9.0%, P = .007). After adjustment, early menopause was an independent risk factor for 18-month MACEs (hazard ratio [HR], 1.54; 95% confidence interval [CI] 1.18-2.00) and TLR (HR 1.61; 95% CI 1.21-2.13). In conclusion, for women undergoing PCI, early menopause is associated with higher risk of MACE, which is mainly driven by risk of TLR.

Our aim was to compare direct stenting (DS) with conventional stenting (CS) in patients with acute coronary syndrome (ACS). We searched PubMed, EMBASE, and ISI web of science for eligible studies. Primary end point was major adverse cardiac events (MACEs) in short term. Secondary end points were 1-year mortality and after-procedural no-reflow phenomenon. Twelve trials in 8998 patients were included. The odds ratios (ORs) were pooled using the Mantel-Haenszel fixed effect model. Short-term MACEs were significantly reduced in the DS arm in contrast to the CS (5.00% vs 8.08%, DS vs CS, respectively, OR [95% confidence interval] = 0.61 [0.46-0.80], P = .0004). One-year mortality and after-procedural no-reflow phenomenon were significantly lower in the DS group. No heterogeneity was observed through I² test (P_het = .81, .89, and .77 for each end point, respectively). This meta-analysis demonstrated that in selected patients with ACS, DS is not only safe and feasible but also reduces short-term and 1-year mortality as well as the occurrence of after-procedural no-reflow phenomenon.

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) on in-hospital and long-term major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in a large prospective study. Patients (n = 1938) admitted with acute STEMI within 12 hours of symptom onset and who underwent pPCI between January 2010 and January 2015 were followed up for 31.6 ± 16.2 months. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, nonfatal myocardial infarction, and mortality were higher in the third PLR tertile group. A PLR in the third tertile had 2.4-fold increased risk of in-hospital MACE and 2.8-fold risk of long-term MACE. The PLR was significantly and positively correlated with peak creatine kinase MB (CK-MB) levels (r = 0.562, P < .001) and Gensini score (r = 0.408, P < .001). Kaplan-Meier analysis of long-term MACE-free survival revealed a higher occurrence of MACE in the third PLR tertile group compared to the other tertiles. In conclusion, the PLR may be a marker of inflammatory and prothrombotic status and predicted in-hospital and long-term MACE in a population with STEMI.

Screening for concomitant atherosclerotic disease is important in cardiovascular risk reduction. This study assessed the prevalence of carotid artery disease (CAD) and peripheral arterial disease (PAD) in patients with known abdominal aortic aneurysms (AAAs). All patients with AAA attending the vascular laboratory between the January 1, 2007, and December 31, 2009, were eligible for a carotid ultrasound and measurement of ankle brachial indices. A total of 389 (305 males) patients were identified on the AAA surveillance program with a mean (±standard deviation) age of 76 (±8) years. The mean age of the males was 75.4 (±7.8) years, and the mean age of the females was 77 (±11) years. A total of 332 patients were assessed for CAD, and 101 (30.4%) of those were found to have significant disease. A total of 289 patients were assessed for PAD of which 131 (45.3%) were found to have PAD at rest, and 289 patients were assessed for both and 59 (20.4%) patients had significant CAD + PAD. Patients with AAAs are at high risk of other atherosclerotic disorders, and, therefore, they should receive intensive medical optimization.

Neutrophil and leukocyte counts are laboratory parameters that reflect the systemic inflammatory response in patients with atherosclerotic diseases. Based on the means of these parameters, the derived neutrophil–lymphocyte ratio (dNLR) can be calculated. We investigated a possible association of critical limb ischemia (CLI) and the dNLR in patients with peripheral arterial disease (PAD). We performed a retrospective data analysis including 1995 patients with PAD treated at our department in the years 2005 to 2010. The cohort was divided into tertiles according to dNLR. Higher dNLR values were associated with an increased CLI rate. In the tertile with lowest dNLR, the CLI rate was 20.4%, in the second tertile the CLI rate was 26.1%, and in the third tertile the CLI rate was 36.1%. Statistical significance was shown using a Jonckheere-Terpstra test (P < .001). A high dNLR is associated with an increased rate of CLI in patients with PAD. This might be a useful parameter to highlight patients at increased risk of CLI.

We compared Turkish patients with cardiac syndrome X (CSX) and controls with respect to serum pro- and anti-inflammatory cytokine levels, as well as the single-nucleotide polymorphisms located in the promoter regions of their related genes. This study included 111 consecutive patients angiographically diagnosed with CSX and 111 healthy controls with similar demographic characteristics. Serum interleukin (IL) 6, tumor necrosis factor α (TNF-α), and IL-10 levels were measured, and the genotypes of the patients and controls were determined using standard methods. Serum IL-6 and IL-10 levels were significantly higher in the CSX group than in the control group (P < .01, respectively). Serum TNF-α level was lower in the CSX group than in the control group (P < .001). On the other hand, participants with CSX and healthy controls were not significantly different with respect to the genotype distributions of IL-6, TNF-α, and IL-10 genes. As a result of our study, both pro-inflammatory and anti-inflammatory cytokines may play a role in the pathogenesis of CSX. In contrast, the studied gene polymorphisms did not influence CSX pathogenesis.

Obstructive sleep apnea (OSA) is associated with increased cardiovascular (CV) morbidity and mortality. Endocan is a surrogate endothelial dysfunction marker that may be associated with CV risk factors. In this study, we tested whether serum endocan is a biomarker for OSA. Serum endocan levels were measured at baseline in 40 patients with OSA and 40 healthy controls and after 3 months of continuous positive airway pressure (CPAP) treatment in the patients with OSA. All participants were evaluated by full polysomnography. Flow-mediated dilatation (FMD) and carotid intima media thickness (cIMT) were measured in all participants. Endocan levels were significantly higher in patients with OSA than in healthy controls. After adjusting confounders, endocan was a good predictor of OSA. Endocan levels correlated with OSA severity (measured by the apnea–hypopnea index [AHI]). After 3 months of CPAP treatment, endocan levels significantly decreased. Endocan levels were significantly and independently correlated with cIMT and FMD after multiple adjustments. The cIMT and FMD also had significant and independent correlation with AHI. Endocan might be a useful marker for the predisposition of patients with OSA to premature vascular disease.

SYNTAX score II (SS II) uses 2 anatomical and 6 clinical variables for the prediction of mortality after coronary artery bypass graft and percutaneous coronary intervention. The aim of this study was to investigate the relationship between glycated hemoglobin (HbA_1c), fasting blood glucose (FBG), postprandial glucose (PPG), and SYNTAX Score (SS) and SS II in patients with type 2 diabetes mellitus and coronary artery disease (CAD). We enrolled 215 consecutive diabetic patients with stable angina pectoris who underwent coronary angiography. The SS II was calculated using a nomogram that was based on the findings of a previous study. There was a moderate correlation between HbA_1c and SS (r = .396, P < .001), but there was a good correlation between HbA_1c and SS II (r = .535, P < .001). There was also a weak correlation between FBG (r = .270, P = .001), PPG (r = .177, P = .027), and SS, but there was a weak–moderate correlation between FBG (r = .341, P < .001), PPG (r = .256, P = .001), and SS II. A better correlation has been detected between HbA_1c and SS II compared to the correlation between HbA_1c and SS.

Obesity is a major public health problem, with a prevalence of 10% to 20% in Western Europe. Morbid obesity, characterized by body mass index >40 kg/m², showed an increased prevalence in the last 30 years. Obesity is associated with reduced economic and social opportunities, reduced quality of life, and is a determinant of several “intermediate risk factors,” leading to an increased mortality and a loss in life expectancy. The rising prevalence of morbid obesity increased the demand for bariatric surgery, also called “metabolic surgery”: after these interventions, there is a decrease in metabolic comorbidities, cardiovascular (CV) risk, and total mortality. In this review, we update the evaluation of morbid obese patients from the physical examination to the metabolic, CV and respiratory assessments in order to correctly stratify the CV risk and provide the best treatment. To obtain these achievements, multidisciplinary work has to be carried out with a team involving several experts with different skills.