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Objectives: The aim of our study was to evaluate the association between the presence and severity of CAD and NAFLD. Methods: The study group consisted of 153 patients who underwent coronary angiographies. Patients were categorized into CAD and non-CAD groups. CAD severity was determined by the number of CAD-involved arteries and the vessel score multiplied by Gensini score, the latter judging CAD severity. Fatty liver was diagnosed by abdominal ultrasonography (USG), with the patients being categorized by the degree of hepatosteatosis, as Grade 0, Grade 1, and Grade 2-3. Results: Among the whole study population, 47.1% of patients (n=72) were female and 52.9% of patients (n=81) were male. Forty-three patients had normal coronary arteries; 27 patients had non-critical CAD and side branch disease; and 83 patients had clinically significant CAD (stenosis>50%). The rate of CAD and Gensini score were significantly different between Grade 0, 1 and 2-3 hepatosteatosis groups (p

Bu çalışma Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalında göğüs ağrısı nedeni ile takip edilen ve koroner anjiyografi yapılan hastalarda, koroner arter hastalığı derecesinin, aort distensibilitesi, koroner perfüzyon basıncı ve miyokardiyal blush skoru üzerine etkisini araştırmak amacıyla yapılmıştır. Retrospektif olarak 2019 yılından sonra koroner anjiyografi yapılmış olan hastalarda invazif olarak aort distensibilitesi, miyokard blush skoru ve koroner perfüzyon basınçları ölçülmüştür. Bu ölçümlerin yapılabilmesi için ventrikül ve aort basınç kayıtları mevcut olan hastalar çalışmaya dahil edilmiştir. Hastaların miyokard perfüzyonunu değerlendirmek için miyokardiyal blush skoru ölçülmüştür. Bunun için yeterli süre ile cineanjiyografi yapılmış hastalar seçilmiştir. Koroner baypas yapılmış olan hastalar çalışma dışı bırakılmıştır. Çalışmaya toplam 56 hasta alınmıştır. Gensini skorlaması koroner arter hastalığının şideti ve yaygınlığını değerlendirmek için kullanılmıştır. Koroner anjiyografisi tamamen normal olan hasta sayısı 28 olup hastaların yarısını oluşturmuştur. Hafif koroner hastalık 11 hastada, ciddi koroner arter hastalığı 17 hastada tespit edilmiştir. Bunlar çalışma gruplarını oluşturmuş ve istatiksel karşılaştırmalar bu gruplar üzerinden yapılmıştır. İstatistiksel değerlendirmede frekans dağılımı, ortalama ± standart sapma verilmiş gruplar arası karşılaştırmalarda Kruskal Wallis testi kullanılmıştır. Çalışmaya dahil edilen hastaların yaş ortalaması 61.05±9.07 bulunmuştur. Koroner arter hastalığı şiddeti ve yaygınlığı ile ortalama arter basıncı, aort sistolik basıncı, aort diyastolik basıncı ve total miyokardiyal blush skoru arasında istatistiksel olarak anlamlı ilişkili bulunmuştur. The study was conducted to investigate the effect of the degree of coronary artery disease on aortic distensibility, coronary perfusion pressure and myocardial blush score in patients who were followed up with chest pain and coronary angiography in Uludağ University Faculty of Medicine Department of Cardiology. Retrospectively, aortic distensibility and myocardial blush score and coronary perfusion pressures were measured invasively in patients who underwent coronary angiography after 2019. In order to make these measurements, patients with ventricular and aortic pressure records were included in the study. Myocardial blush score was measured to evaluate myocardial perfusion of patients. For this, patients who have undergone cineangiography for a sufficient period of time were selected. Patients who underwent coronary bypass were excluded from the study. A total of 56 patients were included in the study. Gensini scoring has been used to assess the severity and prevalence of coronary artery disease. The number of patients with completely normal coronary angiography was 28 and constituted half of the patients. Mild coronary disease was detected in 11 patients and severe coronary artery disease in 17 patients. These constituted the study groups and statistical comparisons were made through these groups. Kruskal-Wallis test was used in nonparametric comparison of groups. Again, frequencies and average ± standard deviation were used. The mean age of the patients included in the study was 61.05 ± 9.07. The severity and prevalence of coronary artery disease were associated with mean arterial pressure, aortic systolic and diastolic pressure, and total myocardial blush score.

Non-invasive detection of unstable angina (UA) patients with different severity of coronary lesions remains challenging. This study aimed to identify plasma lipoproteins (LPs) that can be used as potential biomarkers for assessing the severity of coronary lesions, determined by the Gensini score (GS), in UA patients. We collected blood plasma from 67 inpatients with angiographically normal coronary arteries (NCA) and 230 UA patients, 155 of them with lowGS (GS ≤ 25.4) and 75 with highGS (GS > 25.4), and analyzed it using proton nuclear magnetic resonance spectroscopy to quantify 112 lipoprotein variables. In a logistic regression model adjusted for four well-known risk factors (age, sex, body mass index and use of lipid-lowering drugs), we tested the association between each lipoprotein and the risk of UA. Combined with the result of LASSO and PLS-DA models, ten of them were identified as important LPs. The discrimination with the addition of selected LPs was evaluated. Compared with the basic logistic model that includes four risk factors, the addition of these ten LPs concentrations did not significantly improve UA versus NCA discrimination. However, thirty-two selected LPs showed notable discrimination power in logistic regression modeling distinguishing highGS UA patients from NCA with a 14.9% increase of the area under the receiver operating characteristics curve. Among these LPs, plasma from highGS patients was enriched with LDL and VLDL subfractions, but lacked HDL subfractions. In summary, we conclude that blood plasma lipoproteins can be used as biomarkers to distinguish UA patients with severe coronary lesions from NCA patients.

Objective To evaluate the predictive value of CHADS2 and CHA2DS2-VASc scores for coronary artery lesions and in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 524 patients who were diagnosed with STEMI from January 2016 to August 2017 were retrospectively reviewed. The correlation between CHADS2 and CHA2DS2-VASc scores with the patients’ clinical data, number of coronary lesions, Gensini scores, the target vessel and hospitalization time and in-hospital adverse events (AEs) was analyzed. Results The number of coronary lesions in STEMI patients was mainly single and double lesions. The CHADS2 and CHA2DS2-VASc scores were not meaningful for predicting the number of coronary lesions. However, for left main coronary artery lesion, CHADS2 score was significantly increased when the number increased (P 2DS2-VASc score showed no statistical difference (P > 0.05). The incidence of target lesions in STMEI patients was mainly left anterior descending coronary artery (LAD) and right coronary artery (RCA). The two scores were not meaningful for predicting target lesions (P > 0.05). For the severity of coronary lesions, there was positive correlation between CHADS2 score with Gensini score (P 2DS2-VASc score and Gensini score (P > 0.05). The stratifications of CHADS2 score and CHA2DS2-VASc score were significantly associated with hospitalization time and adverse events during hospitalization (P P Conclusion CHADS2 score had a certain value to predict the severity of coronary lesion and the presence of left main coronary artery in STEMI. The CHA2DS2-VASc score had no predictive ability to do it. There was no significant value in predicting the number of coronary lesions and the location of the target lesions in STEMI patients. However, both scores had the predictive ability for patient hospitalization and AEs during hospitalization.

Triglyceride glucose index (TyG) plays an important role in metabolic syndrome (MetS), which predisposes to the development of cardiovascular diseases (CVD). Mostly, the association between the TyG index and coronary artery disease (CAD) has been investigated in healthy individuals on long-term follow-up or in asymptomatic patients with a mild and mild-moderate cardiovascular risk profile. However, there are few studies evaluating the association of TyG index with CAD in symptomatic patients. In hence, we aimed to determine the role of the TyG index in the presence and severity of CAD in symptomatic patients with high suspicion of CAD in this study. 100 patients who underwent coronary angiography were included and the patients were divided into two groups according to the presence of CAD. TyG index was calculated by the formula Ln [fasting triglycerides (mg/dl) fasting glucose (mg/dl)/2]. The severity of CAD was assessed by angiographic risk scores GENSINI, SYNTAX I, and the number of diseased vessels. TyG index did not differ significantly between patients with and without CAD. Also, there was no significant correlation between TyG index and GENSINI, SYNTAX I, and the number of diseased vessels. (for all p>0.05) In multiple logistic regression analysis, the only independent predictor of CAD was age. (p=0.03, OR=1.048, 95% CI=1.004-1.094) In conclusion, TyG index may not be a useful marker for predicting the presence or severity of CAD. According to the results of this study, age is the only predictor of CAD independent of all causes. © 2021 Ondokuz Mayis Universitesi. All rights reserved.

Background Lipoprotein(a)[Lp(a)] has been considered as an independent risk factor for coronary artery disease (CAD). The present study aimed to evaluate the association between baseline serum Lp(a) and CAD progression determined by angiographic score. Methods A total of 814 patients who had undergone two or more coronary computed tomography angiography at least 6 months apart were consecutively enrolled and the coronary severity was determined by the Gensini score system. Patients were stratified into two groups according to Lp(a)>300 mg/L and Lp(a) ≤ 300 mg/L or classified as “progressors” and “non‐progressors” based on the Gensini score rate of change per year. The association of continuous Lp(a) and Lp(a)>300 mg/L with CAD progression were respectively assessed by logistic regression analysis. Moreover, further evaluation of those association was performed in subgroups of the study population. Results Patients in the “progressors” group had significant higher Lp(a) levels. Furthermore, the multivariate logistic regression analysis showed that elevated Lp(a) (odds ratio [OR]: 1.451, 95% confidence interval [CI]: 1.177–1.789, p300 mg/L (OR:1.642, 95% CI:1.018–2.649, p = .042) were positively associated with CAD progression after adjusting for confounding factors. In addition, those relation seemed to be more prominent in subjects with lower body mass index (OR: 1.880, 95% CI: 1.224–2.888, p for interaction = .060). Conclusions Elevated baseline serum Lp(a) is positively and independently associated with angiographic progression of CAD, particularly in participants with relatively low body mass index. Therefore, Lp(a) could be a potent risk factor for CAD progression, assisting in early risk stratification in cardiovascular patients.

BACKGROUND Coronary artery disease (CAD) is one of the leading causes of death and disease burden in China and worldwide. A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention. AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) scoring system could be used for this purpose. METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled. The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score (GS). RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS (r = 0.266, P < 0.001). In receiver operating characteristic curve analysis, the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55% with a sensitivity of 55.8% and specificity of 71.8% [area under the curve (AUC) = 0.693, 95% confidence interval: 0.681 to 0.706, P < 0.001], and 7.45% with a sensitivity of 58.8% and specificity of 67.2% (AUC = 0.680, 95% confidence interval: 0.665 to 0.694, P < 0.001), respectively. CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.

Background This study aimed to find the correlation of Gensini score with retinal vessel diameter and arteriovenous ratio in elderly patients with coronary heart disease (CHD). Methods This study included 120 senile CHD patients as the CHD group and 100 healthy individuals as the normal group (NG). Gensini score was used to evaluate the severity of coronary artery lesions. Central retinal artery equivalents (CRAE), central retinal venular equivalents (CRVE), and arteriovenous ratio (AVR) were measured. Results CHD group has lower CRAE and AVR than NG, while higher CRVE was observed in NG. CRAE and AVR in UAP (unstable angina pectoris) and AMI (acute myocardial infarction) groups showed reduction (stable angina pectoris); however, enhanced CRVE and Gensini scores in UA and AMI groups were observed as compared to the SAP group. CRAE and AVR in moderate and severe groups were reduced to a greater extent compared to the mild groups, while enhanced CRVE and Gensini scores were observed more often in the severe group than the mild group. CRAE and AVR were negatively correlated with the Gensini score; however, CRVE was positively correlated with the Gensini score. Conclusion AVR is expected to be a noninvasive index to diagnose and predict senile CHD, which has a certain evaluation value. Diabetes, smoking history, and TC are independent risk factors of senile CHD.

Background: There have been a limited number of quantitative studies on the relationship between coronary artery disease (CAD) and cardiorespiratory fitness (CRF), as measured by cardiopulmonary exercise testing (CPET). Thus, we aimed to investigate the association between CRF and the severity of coronary artery disease from the most comprehensive perspective possible, and to affirm the predictive value of CPET in the severity assessment of CAD. Methods: Our study included 280 patients with coronary angiography, who had undergone CPET in Tongji Hospital. The patients’ CRF was measured through their peak oxygen uptake (VO2@peak), their oxygen uptake at the anaerobic threshold (VO2@AT) and through other parameters of CPET on a bicycle ergometer. The severity of the coronary artery disease was assessed in the following three layers: functionally significant lesions (quantitative flow ratio [QFR] ≤ 0.8), the number of stenotic coronary arteries (SCA, stenosis ≥ 50%) and the Gensini score. The correlation analyses were carried out between the CRF and the severity of the coronary artery disease. A ROC curve was plotted, and the AUC was calculated to distinguish the severe CAD and the non-severe CAD patients, as measured by the QFR, the number of SCA, and the Gensini score. Results: The VO2@AT and VO2@peak were inversely associated with the QFR. The VO2@AT, VO2@peak and VO2/kg@peak were associated with the number of SCA. Meanwhile, the VO2@AT, VO2/kg@AT, VO2@peak and VO2/kg@peak were associated with the Gensini score. An ROC analysis proved that a combination of traditional clinical risk factors and the VO2@peak/VO2prediction is valuable in predicting CAD severity. Conclusions: Our study demonstrated a strong and inverse association between CRF and the severity of CAD. A combination of traditional clinical risk factors and CRF is valuable in predicting CAD severity.

Objective: To determine frequency of elevated serum uric acid levels in patients with coronary artery disease, association of hyperuricemia with severity of coronary artery disease, gender, age, hypertension, and diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Internal Medicine department, Combined Military Hospital Multan, from Nov 2015 to May 2016. Methodology: One hundred and fifty patients with coronary artery disease were selected consecutively and admitted for coronary angiography. Serum uric acid levels were evaluated after eight hours fasting by photometric technique having normal reference range of 3.5-6.7 mg/dL. Coronary angiography was performed and Gensini score computed. To compare mean Gensini score between normouricemic and hyperuricemic population, student’s t-test was applied. Results: A total of 150 study cases (mean age: 54.4 ± 8.5 years), 101 (67.3%) were male while 49 (32.7%) were female. Diabetes mellitus was present in 43 (28.7%) of cases and hypertension was present in 65 (43.3%). Hyperuricemia was noted in 58 (38.7%) of cases. The mean Gensini score in hyperuricemic patients was significantly higher (40.31 ± 14.64) compared to patients with normal serum uric acid levels (25.02 ± 10.94) (p

Background The atherogenic index of plasma (AIP) is calculated by logarithmic transformation of the ratio of triglyceride (TG) and high‐density lipoprotein cholesterol (HDL‐C) concentrations. Although previous studies have demonstrated that the AIP is associated with coronary artery disease, its association with chronic total occlusion (CTO) requires elucidation. Hypothesis We hypothesized that the AIP would have diagnostic value in cases of CTO and could be used to predict adverse events. Methods This study involved 1131 inpatients who underwent coronary angiography. Data on demographic and clinical characteristics, coronary artery stenosis rated by the Gensini score, and clinical assessment by the Global Registry of Acute Coronary Events and thrombolysis in myocardial infarction (TIMI) scores were collected by cardiovascular doctors. Serum AIP values were evaluated by logarithmic transformation of the ratio of TG and HDL‐C concentrations. The correlations of AIP values with clinical parameters were assessed, and receiver‐operating characteristic curves were constructed for CTO diagnosis. Results Overall, 1131 inpatients were assigned to the CTO (n = 398) and control (n = 733) groups. Compared with the control group, the CTO group showed a significantly higher AIP (p

Introduction. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different. This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately. Methods. This study protocol was registered with PROSPERO (CRD42020210948), and conducted according to PRISMA guidelines, tracing studies published in vulnerable periods from January 2010 to May 2020. The Cochrane Library, EBSCO, Medline/PubMed, ProQuest and Science Direct are sources of published studies. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis, using random effect model to account for possible study heterogeneity. Heterogeneity was assessed using I2, and the meta-analysis was performed using Comprehensive Meta-Analysis Version 3 (CMA3) software. Results. Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p

Xianjing Wei,1 Ying Zhang,1 Gaoliang Yan,2 Xiaoqing Wang1 1Department of Cardiology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, 110016, People’s Republic of China; 2Department of Cardiology, Zhongda Hospital of Southeast University Medical School, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Xianjing WeiDepartment of Cardiology, The Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Zhongshan District, Dalian City, Liaoning Province, 110016, People’s Republic of ChinaTel +86 18642668608Email weixian_jing@163.comObjective: To investigate the relationship between chronic kidney disease (CKD) and the severity and long-term prognosis of patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation.Methods: There were 814 patients, who consecutively received a DES implantation, selected for this study. They were divided into two groups, according to whether or not they suffered CKD. There were 254 cases in the CKD group (31.2%), while there were 560 cases (68.8%) in the control group. The clinical characteristics, coronary artery lesions, and major adverse cardiac and cerebrovascular events (MACCE) of the two groups were compared, and the relationship between risk factors and MACCEs was analyzed by multivariate logistic regression.Results: Compared with the control group, the CKD group had more severe coronary artery stenosis, expressed as the more diseased arteries (2.15 ± 0.82 vs 1.87 ± 0.83, p = 0.001), a high incidence of three diseased arteries (42.0% vs 28.3%, p = 0.001), and a higher Gensini score [37 (18.6, 66) vs 27.5 (12, 52.5), p = 0.009]. The one-year post-implant incidence of MACCE was higher in the CKD group compared with the control group (17.6% vs 9.9%, p = 0.006).Conclusion: CKD appears to be an important predictor for the prognosis of CAD.Keywords: chronic kidney disease, coronary artery disease, Gensini score, major adverse cardiac and cerebrovascular events

Background Although the Japan Atherosclerosis Society Guidelines 2017 recommend lower levels of low-density lipoprotein cholesterol (LDL-C, < 70 mg/dL or ≤ 100 mg/dL) to prevent secondary cardiovascular events, we cannot conclude that a low level of LDL-C prevents primary cardiovascular events in patients with suspected coronary artery disease (CAD). Methods We registered 1,016 patients who were clinically suspected to have CAD and who underwent coronary computed tomography angiography (CCTA) for screening of coronary atherosclerosis. We excluded 350 patients who were receiving anti-lipidemic therapies and finally analyzed 666 patients. The patients were divided into three groups according to the LDL-C level: < 70 mg/dL (n = 25, Low LDL-C), 70 - 99 mg/dL (n = 141, Middle LDL-C), and ≥ 100 mg/dL (n = 500, High LDL-C). A ≥ 50% coronary stenosis was initially diagnosed as CAD, and the number of significantly stenosed coronary vessels (VD), Gensini score and coronary artery calcification (CAC) score were quantified. Results There were no significant differences in age, high-density lipoprotein cholesterol, rates of hypertension, hemoglobin A1c, blood sugar or systolic blood pressure among the Low, Middle and High LDL-C groups. On the other hand, there were significant differences in rates of males, smoking, dyslipidemia and diabetes, diastolic blood pressure and triglyceride among the groups. The prevalence of CAD values in the Low, Middle and High LDL-C groups were similar, at 52%, 47%, and 46%, respectively. In addition, there were no significant differences in the number of VD, Gensini score or CAC score among the Low LDL-C, Middle LDL-C and High LDL-C groups. Conclusions We showed that the level of LDL-C was not associated with the presence or severity of CAD, which indicates that we need to screen by CCTA to prevent primary coronary events even if patients without anti-lipidemic therapies show low levels of LDL-C.

Background The association of dietary patterns (DPs) linked to the severity of coronary artery disease (CAD) is little known. Therefore, this study aims to explore the relationship between major DPs and the severity of CAD. Methods This cross-sectional study was conducted among423 newly discovered CAD patients (both genders, aged 35–65 years), who underwent coronary angiography. The severity of CAD was assessed by the Gensini score. All patients were tested using a semi-quantitative food frequency questionnaire and other related data through face-to-face interviews. Factor analysis and logistic regression were applied by using SPSS version-24. Results By principal component analysis, two major DPs were identified: “Unhealthy” DP that characterized mainly by high intakes of sugar and sweets, soft drinks, salts, cooking oils, and processed meats, and “Healthy” DP that consisting high intakes of fruits, fish, poultry, vegetables, whole grains. After adjustment for confounding variables, the odds of severe CAD was significantly higher in the third (T3) and second (T2) tertile of the unhealthy pattern by 4.79 and 2.48 times more compared to the first tertile (T1) (OR 4.79; 95%CI 2.60, 8.83; P

Background Patients with non‐ST‐elevation myocardial infarction (NSTEMI) have worse long‐term prognoses than those with ST‐elevation myocardial infarction (STEMI). Hypothesis It may be attributable to more extended coronary atherosclerotic disease burden in patients with NSTEMI. Methods This study consisted of consecutive 231 patients who underwent coronary intervention for myocardial infarction (MI). To assess the extent and severity of atherosclerotic disease burden of non‐culprit coronary arteries, two scoring systems (Gensini score and synergy between percutaneous coronary intervention with Taxus and cardiac surgery [SYNTAX] score) were modified by subtracting the score of the culprit lesion: the non‐culprit Gensini score and the non‐culprit SYNTAX score. Results Patients with NSTEMI had more multi‐vessel disease, initial thrombolysis in myocardial infarction (TIMI) flow grade 2/3, and final TIMI flow grade 3 than those with STEMI. As compared to STEMI, patients with NSTEMI had significantly higher non‐culprit Gensini score (16.3 ± 19.8 vs. 31.2 ± 25.4, p

Background Inflammation is involved in the pathogenesis and progression of coronary artery diseases (CADs), including acute coronary syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been identified as a novel marker of the pro-inflammatory state. We aimed to evaluate the predictive efficacy of the NLR for the prognosis of patients with new-onset ACS. Methods We retrospectively included consecutive patients with new-onset ACS treated with emergency coronary angiography. NLR was measured at baseline and analyzed by tertiles. The severity of coronary lesions was evaluated by the Gensini score. Correlations of NLR with the severity of CAD and the incidence of major adverse cardiovascular diseases (MACEs) during follow-up were determined. Results Overall, 737 patients were included. The NLR was positively correlated with the severity of coronary lesions as assessed by Gensini score (P P P = 0.025). Conclusions The NLR may be associated with coronary disease severity at baseline but is not associated with adverse outcomes in patients with new-onset ACS. Ethics Approval Number 2019XE0208

BACKGROUND There is enough evidence that the presence of diabetes increases the risk of clinical atherosclerotic disease from two-fold to three-fold, with coronary artery disease (CAD) as its chief sequelae. We wanted to study the type of vessels, number of vessels, severity of lesions involving coronary artery and its branches in patients with ACS and compare the involvement in diabetic and non-diabetic patients with ACS by Gensini scoring system. METHODS 144 Patients (72 diabetics and 72 nondiabetics) with acute coronary syndrome diagnosed by clinical examination, ECG and or/ cardiac enzyme levels, admitted in ICCU of KIMS Hospital, Hubli, and undergoing coronary angiography during the study period were included in the study as per the inclusion and exclusion criteria. Each patient was evaluated with history taking, clinical examination, and lab investigations (ECG, 2D-Echo, coronary angiography, HbA1c, lipid profile and renal function test). Based on angiographic findings, coronary artery disease severity was calculated using Gensini, and the data obtained was analysed by different statistical methods. RESULTS Out of 144 patients, ACS was commoner among males than females (72.9% vs. 27.1%) and age of presentation was earlier in males compared to females (53 yrs. vs. 58 yrs.). Multivessel disease was commoner in diabetics compared to nondiabetics (52.8% vs. 15.3%) and also mean Gensini score was higher in diabetics (45.2 vs. 19.2). CONCLUSIONS From this study we can conclude that diabetic patients with ACS have more severe coronary disease with respect to higher number of vessels involved, more severe occlusion and higher Gensini score and also severity increases with the duration of diabetes and poor glycaemic control.

BACKGROUND: Various risk scoring methods are available to predict the severity of coronary artery disease (CAD). However, the majority of them are complex and require advanced technologies, thus limiting its usage in primary care settings. CHA2DS2-VASc-HSF is a novel risk scoring which we develop from CHA2DS2-VASc score. AIM: We hypothesize that CHA2DS2-VASc-HSF is predictive for the risk of severe CAD, and we compare its validity with previously established CHADS2 and CHA2DS2-VASc score. MATERIALS AND METHODS: A total of 210 patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2-VASc-HSF score. Severe CAD defined as coronary artery occlusion with the Gensini score of ≥20. Statistical analyses were done using SPSS 25.0 and MedCalc 18.2.1. RESULTS: This research showed that the patient with severe CAD has significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score compared to normal and mild CAD (p < 0.001). CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF correlated significantly with the CAD severity (r = 0.315, p ≤ 0.001; r = 0.395, p ≤ 0.001; r = 0.612, p ≤ 0.001, respectively). CHA2DS2-VASc-HSF may predict the risk of severe CAD independent from other variables (odds ratio = 2.540; 95% confidence interval = 1.794–3.595; p = 0.002) with the cutoff value of ≥2.5 (sensitivity = 81.4% and specificity = 68.1%). Pairwise comparison of receiver operating characteristic curves showed that CHA2DS2-VASc-HSF was superior to predict severe CAD. CONCLUSIONS: CHA2DS2-VASc-HSF scores may predict the risk of severe CAD better than CHADS2 and CHA2DS2-VASc score. This score may easily be used in primary care physicians to predict the risk of severe CAD and provide an early referral to the cardiologist.

Aim:Vaspin is an insulin-sensitive adipokine secreted from visceral fat tissue, and belongs to the serine protease inhibitor family. The relationship between vaspin level and coronary artery disease is not known yet. We aimed to investigate the relationship between serum vaspin levels and degree of vessel involvement in coronary angiography in patients with stable angina pectoris.Methods:The patients were chosen from those who had coronary angiography with the diagnosis of stable angina pectoris. Patients with previously diagnosed chronic heart disease, chronic liver disease, renal failure, thyroid dysfunction and any systemic infectious or malignant disease, patients receiving immunosupressive treatment and those who did not give informed consent were excluded from the study. Serum vaspin measurements were performed using an East Biopharm enzyme-linked immunoassay (ELISA) kit using the sandwich ELISA method. For determination of the severity of coronary lesions, the modified Gensini score was used.Results:Eighty-eight patients [34 female (38.6%) and 54 male (91.4%)] were included in the study. Vaspin levels were similar in male (1.17±1.54 ng/L) and female (1.09±1.23 ng/L) patients (p=0.46). There was no correlation between vaspin levels and the number of vessels involved (p=0.75). Vaspin levels were similar in diabetic and nondiabetic patients.Conclusion:Vaspin may not be a sensitive marker of the degree of vascular lesions in patients with stable angina pectoris. The underlying cause is probably lack of significant changes in inflammatory cascade and oxidative stress in the involved group of patients.

Objective: Interleukin (IL) 25, also known as IL-17E, is an inflammatory cytokine and has been demonstrated to be closely related to cardiovascular diseases by regulating immunity and inflammation, including atherosclerosis. This study was aimed to evaluate the expression of IL-25 in patients with coronary artery disease (CAD). Methods: In this study, the expression of IL-25 in normal (n=6) and atherosclerotic (n=10) human coronary arteries was detected by immunofluorescent staining. In addition, the serum IL-25, IL-6, and tumor necrosis factor (TNF) α concentrations in stable angina pectoris (SAP, n=44), unstable angina pectoris (UAP, n=46), acute myocardial infarction (AMI, n=34), and non-CAD (control, n=36) were measured using enzyme-linked immunosorbent assay (ELISA) kits. Results: IL-25 was significantly increased in coronary arteries of CAD patients when compared with normal coronary arteries, with macrophages and T lymphocytes being the sources of IL-25, especially macrophages. Moreover, the serum concentrations of IL-25 were markedly elevated in CAD patients and gradually increased in SAP, UAP, and AMI groups. In addition, IL-25 levels were positively correlated with the IL-6 and TNF-α levels, and Gensini score in CAD patients. Logistic regression analysis showed that IL-25 was independently positively correlated with the occurrence of acute coronary syndrome (ACS). A receiver operator characteristic curve suggested that IL-25 presented a significant diagnosis value in ACS. Conclusion: IL-25 is increased in the coronary arteries and serum of CAD patients and is associated with the severity of coronary stenosis and the occurrence of ACS, suggesting that IL-25 may be one of the biomarkers of ACS. (Anatol J Cardiol 2020; 23: 151-9)

Background: The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker and has been shown to be significantly associated with atherosclerotic coronary artery disease (CAD). Therefore, we aimed to explore the association of PLR with in-hospital major adverse cardiovascular events (MACEs) and the severity of CAD assessed by the Gensini score (GS) in patients with acute myocardial infarction (AMI) undergoing coronary angiography. Methods: A total of 502 patients with AMI consecutively treated at the Affiliated Hospital of Qingdao University (Qingdao, China) and underwent coronary angiography from August 2017 to December 2018 were recruited in this study. The demographic, clinical, angiographic characteristics, and laboratory parameters were collected. According to the presence of in-hospital MACEs, the included patients were divided into the MACE group (n = 81) and the non-MACE group (n = 421). Further, according to tertiles of the GS, the patients were classified into three groups: the low GS group (GS ≤32 points, n = 173), medium GS group (32 points < GS ≤ 60 points, n = 169), and high GS group (60 points < GS ≤ 180 points, n = 160). The main statistical methods included Chisquared test, non-parametric Mann-Whitney U test, Kruskal-Wallis H test, logistic regression, and receiver operating characteristic curves. Results: The PLR in the MACE group was significantly higher than that in the non-MACE group (179.43 [132.84, 239.74] vs. 116.11 [87.98, 145.45], Z = -8.109, P < 0.001). Further, there were significant differences in PLR among the tertiles of GS (110.05[84.57, 139.06] vs. 119.78 [98.44, 157.98] vs. 140.00 [102.27, 191.83], H= 19.524, P < 0.001). PLR was demonstrated to be an independent risk factor of in-hospital MACEs (odds ratio [OR]: 1.012, 95% confidential interval [CI]: 1.006-1.018, P < 0.001) and severe CAD assessed by the GS (OR: 1.004, 95% CI: 1.002-1.009, P= 0.042). The cutoff value of PLR for predicting the development of in-hospital MACEs was 151.28 with a sensitivity of 66.7% and a specificity of 78.1% (area under the curve [AUC]: 0.786, 95% CI: 0.730-0.842, P < 0.001), and a PLR of 139.31 was also identified to be an effective cutoff point for detecting a high GS (

Background: Although a recent study in a Japanese cohort indicated that extremely high-density lipoprotein cholesterol (HDL-C, ? 90 mg/dL) had an adverse effect on atherosclerotic cardiovascular disease mortality, we could not conclude that high levels of HDL-C were associated with the presence or severity of coronary artery disease (CAD). Methods: We enrolled 1,016 patients who were clinically suspected to have CAD and who underwent coronary computed tomography angiography (CCTA). The number of significantly stenosed coronary vessels (vessel disease (VD), ? 50% coronary stenosis is diagnosed as CAD) and the Gensini score were quantified using CCTA, and the lipid profile was measured. The patients were divided into four groups according to the HDL-C level: < 40 mg/dL (n = 115, low), 40 - 59 mg/dL (n = 530, normal), 60 - 89 mg/dL (n = 335, high) and ? 90 mg/dL (n = 36, very-high). Results: The percentage (%) of CAD in the low, normal, high and very-high groups was 69%, 55%, 42% and 25%, respectively (P for trend < 0.01). The Gensini score in the low, normal, high and very-high groups was 20 ± 25, 12 ± 16, 8 ± 12 and 4 ± 6, respectively (P for trend < 0.01). The very-high group showed the lowest triglyceride (TG) levels among the four groups. There were no significant differences in the level of low-density lipoprotein cholesterol or % use of statin among the four groups. Finally, the presence of CAD was independently associated with a low level of HDL-C, in addition to age, male, high systolic blood pressure and hemoglobin A1c, but not TG, by a multivariate logistic regression analysis. Conclusions: High levels of HDL-C at the time of CCTA for screening were associated with a reduced presence and severity of CAD. J Clin Med Res. 2020;12(11):734-739 doi: https://doi.org/10.14740/jocmr4367

Background: Ketone bodies, including β-hydroxybutyrate, acetoacetate, and acetone, can substitute and alternate with glucose under conditions of fuel and food deficiency. Ketone body metabolism is increased in a myriad of tissue metabolism disorders. Perturbations in metabolism are major contributors to coronary artery disease (CAD). The present study aimed to investigate the association of β-hydroxybutyrate with CAD. Methods: A total of 2970 Chinese Han population were enrolled. Gensini scores were calculated for all patients with positive findings. Serum levels of β-hydroxybutyrate and other laboratory parameters were measured. Associations of serum metabolites with traditionary risk factors and CAD severity were analyzed. Results: Our results showed that β-hydroxybutyrate was associated with some CAD risk factors and CAD severity, determined by Gensini score or number of diseased regions. Moreover, β-hydroxybutyrate was associated with T3/T1 of Gensini score tertile after adjusting for traditional risk factors by multivariable logistic regression analysis. The association of β-hydroxybutyrate with CAD severity was more obvious in female. Conclusions: Taken together, circulating β-hydroxybutyrate level was independently associated with CAD severity, and the association was more pronounced in female.

CHADS2 and CHA2DS2-VASc scores have been used to assess the prognostic risk of thromboembolism in non-valvular atrial fibrillation patients. Recent studies have shown the utility of CHADS2 and CHA2DS2-VASc scores for evaluating the severity of coronary artery disease (CAD). The newly defined CHA2DS2-VASc-HSF score evaluates atherosclerosis and is associated with CAD severity. This study investigated the association between the CHA2DS2-VASc-HSF score and acute coronary syndrome (ACS) severity as assessed by the Gensini score and the number of vessels. Furthermore, this study also compared the diagnostic value of the CHADS2, CHA2 DS2-VASc, and CHA2DS2-VASc-HSF score for ACS. A total of 2367 eligible inpatients (ACS group [n = 2030]; non-CAD group [n = 337]) were consecutively enrolled in this study. Receiver operating characteristic curve diagnostic tests and logistic regression models were used to analyze the risk factors for ACS. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF scores were significantly higher in the ACS group than those in the control group. After adjusting for numerous traditional CAD risk factors, an increased CHA2DS2-VASc-HSF score was found to be an independent risk factor for patients with ACS (odds ratio 1.401, 95% confidence interval 1.044, −1.879; P

Resumo Fundamento Foi demonstrado que as subunidades de interleucina-35 (IL-35) estão fortemente expressas nas placas ateroscleróticas em humanos. Assim, considera-se que elas têm um papel na aterosclerose. Objetivos Neste estudo, os níveis de IL-35 foram comparados com o grupo controle em pacientes com doença arterial coronariana (DAC) estável, e a associação entre os níveis de IL-35 e o tipo, gravidade e extensão da lesão foram investigadas com o escore Gensini (GS) e o escore Syntax (SS) no grupo de pacientes Métodos Sessenta pacientes (18 mulheres e 42 homens) com DAC, diagnosticados por meio da angiografia coronária, que apresentaram dor no peito típica e teste de esforço não invasivo positivo, e 46 pacientes (18 mulheres e 28 homens) com luminograma normal, foram incluídos no estudo. Tanto o GS quanto o SS foram calculados para o grupo de pacientes, e esses valores foram comparados com os níveis de IL-35. Variáveis com distribuição não normal foram avaliadas com o teste U de Mann-Whitney, enquanto os parâmetros com distribuição normal foram analisados com o teste t de Student. A diferença entre as variáveis categóricas foi avaliada pelo teste de qui-quadrado ou de Fisher. Os valores de p

ObjectiveCurrently, coronary artery disease (CAD) is regarded as one of the leading global disease burdens. Evidence proved that platelet activation in dyslipidemia induced CAD, however, their interaction has not been well-established in vivo. This study aims to assess the mediation effects of mean platelet volume (MPV) in lipids and the severity of CAD.MethodsWe prospectively enrolled 5,188 consecutive subjects who underwent coronary angiography between 2015 and 2020. Participants were grouped according to their CAD events, which was defined as stenosis ≥50% in at least one coronary artery, and whose severity was evaluated by the Gensini score (GS). A lipid index was drawn by principal component analysis to weight related lipid parameters including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apolipoprotein (apo) A1 B. The interaction of lipids and MPV in atherosclerosis was evaluated by the mediation analysis.ResultsLipid index increased with elevated GS irrespective of statin status (not on statin: β = 0.100, p < 0.001; on statin: β = 0.082, p < 0.001). Multiple linear regression indicated positive correlation between MPV and GS after adjustment (β = 0.171, p < 0.001). Subjects in the highest MPV tertile had higher levels of atherogenic lipid parameters and lipid index (p < 0.001). The adjusted odds ratios were greater among individuals undergoing statin medications who had high GS and higher MPV levels by elevated lipid index tertiles [1.168 (0.893–1.528) vs. 2.068 (1.552–2.756) vs. 1.764 (1.219–2.551)]. The combination of lipid index and MPV provided better prediction for high GS than individual lipid index or MPV, as shown by receiver-operating characteristic (ROC) curves (areas under ROC curves were 0.700 and 0.673 in subjects on or not on statin treatment, respectively). Significantly, mediation analysis revealed the mediation interaction of lipid index on GS by MPV, whose effect size reached 20.71 and 20.07% in participants with or without statin medications.ConclusionThe increased risk of dyslipidemia on CAD was partly enhanced by elevated MPV levels, whose mediating effect was around 20%.

Background: It has been shown that interleukin-35 (IL-35) subunits are strongly expressed in atherosclerotic plaques in humans. Therefore, it is considered to play a role in atherosclerosis. Objectives: In this study, IL-35 levels were compared with the control group in patients with stable coronary artery disease (CAD), and the association between IL-35 levels and the lesion type, lesion severity and extension was investigated with the Gensini score (GS) and the Syntax score (SS) in the patient group. Methods: Sixty patients (18 female and 42 male) with CAD diagnosed by coronary angiography, who presented with typical chest pain and positive noninvasive cardiac stress test, and 46 patients (18 female and 28 male) with normal coronary lumenogram, were included in this study. Gensini and Syntax scores were calculated in the patient group, and these values were compared with IL-35 levels. Non-normally distributed variables were analyzed by the Mann-Whitney U test, whereas normally distributed parameters were assessed by Student’s t-test. The difference between categorical variables were evaluated by the Chi-square or Fisher test. P-values

Recent studies have shown that increased circulating concentrations of fibroblast growth factor 21 (FGF21) are associated with obesity, metabolic disorder, and atherosclerosis. However the relationship between FGF21 and coronary artery disease (CAD) is controversial This study was planned to investigate the role of FGF21 in CAD development and CAD severity.Seventy-eight patients with stable angina pectoris (SAP) (lesion positive) and 40 control patients (lesion negative) with similar cardiovascular risk factors were included in the study. Serum FGF21 levels were measured by ELISA method. CAD severity was evaluated by using SYNTAX and GENSINI risk scores.FGF21 concentrations were found significantly higher in the SAP group than in the control group. [101.18 ± 141.62 vs. 47.93 ± 58.74 pg/mL; p = 0.03], no correlation was found between the SYNTAX (r = 0.146 and p = 0.134) and GENSINI (r = 0.211 and p = 0.084) scores with serum FGF21 levels. There was a negative relationship between serum FGF21 and serum HDL-C levels in correlation analysis (r = - 0.272; p = 0.026).The serum FGF21 levels are different between SAP and control patients. FGF21 is a marker for CAD diagnosis, but not for the evaluation of CAD severity.Poslednja istraživanja su pokazala da je pove}anje koncentracija u cirkulaciji fibroblastnog faktora rasta 21 (FGF21) praćeno sa gojaznošću, metaboličkim poremećajem i aterosklerzom. Međutim, odnos između FGF21 i koro narnog arterijskog oboljenja (KAO) je kontraverzan. U ovom izučavanju je planirano da se ispita uloga FGF21 u razvoju KAO kao i težina samog oboljenja.U izučavanje je uključeno sedamdeset osam pacijenata sa stabilnom anginom pektoris (SAP) (pozitivna lezija) i 40 kontrolnih pacijenata (lezija negativna) sa sličnim faktorima rizika. Nivoi serumskog FGF21 mereni su ELISA me todom. Težina KAO procenjivana je SYNTAX i GENSI faktorima rizika.Koncentracije FGF21 bile su značajno vi{e u grupi sa SAP nego u kontrolnoj grupi. [101,18 ± 141,62 vs. 47,93 ± 58,74 pg/mL; p = 0,03]. Nije utvrđena korelacija između SYNTAX (r = 0,146 i p = 0,134) i GENSI (r = 0,211 i p = 9,084) skorova sa nivoima serumskog FGF21. Nađen je negativan odnos između serumskog FGF21 i nivoa HDL-C u serumu primenom korelacione analize (r = - 0,272; p = 0,026).Nivoi FGF21 u serumu su različiti kod SAP i kontrolnih pacijenata. FGF21 je marker za dijagnostikovanje KAO, ali ne i za procenu težine KAO.

Long non-coding RNAs (lncRNAs) have emerged as essential biomolecules with variable diagnostic and/or prognostic utility in several diseases, including coronary artery disease (CAD). We aimed for the first time to investigate the potential association of five angiogenesis-related lncRNAs (PUNISHER, SENCR, MIAT, MALAT1, and GATA6-AS) variants with CAD susceptibility and/or severity. TaqMan Real-Time genotyping for PUNISHER rs12318065A/C, SENCR rs12420823C/T, MIAT rs1061540C/T, MALAT1 rs3200401T/C, and GATA6-AS1 rs73390820A/G were run on the extracted genomic DNA from 100 unrelated patients with stable CAD undergoing diagnostic coronary angiography and from 100 controls. After adjusting covariates, the studied variants showed no association with disease susceptibility; however, MIAT*T/T genotype was associated with a more severe Gensini score. In contrast, MALAT1*T/C heterozygosity was associated with a lower score. The lipid profile, and to a lesser extent smoking status, male sex, weight, hypertension, and MALAT1 (T > C) (negative correlation), explained the variance between patients/control groups via a principal component analysis. Incorporating the principal components into a logistic regression model to predict CAD yielded a 0.92 AUC. In conclusion: MIAT rs1061540 and MALAT1 rs3200401 variants were associated with CAD severity and Gensini score in the present sample of the Egyptian population. Further large multi-center and functional analyses are needed to confirm the results and identify the underlying molecular mechanisms.

Aim: This research aims to assess the severity of coronary artery disease in patients admitted with chest pain to the emergency department and focus on how risk factors vary with gender. Methods: This is a cross-sectional study of 247 patients with a pre-diagnosis of acute coronary syndrome between August 2020 and February 2021. The severity of coronary artery disease in all patients was evaluated with the Gensini score. Independent risk factors that were found to be related to severe coronary artery patients were analyzed by logistic regression. Results: The risk of severe coronary artery disease of the 247 individuals included in the study was increased by 5% (p

Objective: It is essential to understand whether coronary artery ectasia (CAE) progresses over time because the patients might be under the risk of coronary rupture, and stent implant should be avoided if ectatic changes progress.Methods: A consecutive series of 99 CAE patients who had undergone coronary angiography at least twice were enrolled and followed up for 1–16 years until they received a second angiogram. Subjects were divided into two groups (1–5 vs. 5–16 years of follow-up), then the basic clinical characteristics and coronary artery images were compared over time.Results: (1) All CAE patients exhibited atherosclerosis, and a majority presented with acute myocardial infarction. Most baseline clinical characteristics were relatively stable. (2) Atherosclerosis (indicated by the distribution of stenosis in coronary vessels) and the Gensini scores progressed significantly. Ectasia extent showed minimal changes as indicated by blood vessel involvement, Markis type, coronary blood flow, ectasia diameter, and ectasia length. (3) Multilinear regression analysis revealed that the underlying factors related to stenosis evolution indicated by fold of Gensini score were: longer time interval, lower baseline Gensini score, and higher hypersensitive C-reactive protein concentration. (4) There was a relationship between the ectatic diameter and the extent of stenosis.Conclusions: For CAE patients with atherosclerosis followed for 1–16 years, there was minimal CAE progression, while the atherosclerosis progressed and the ectasia extent was related to degree of stenosis. The results indicate that prevention and treatment of atherosclerotic changes might have more clinical significance than addressing ectatic changes.

ObjectiveOur study aims to investigate the role of the ABO blood group in the development and severity of coronary artery disease (CAD) in end-stage renal disease (ESRD) patients with dialysis.MethodsA total of 408 ESRD patients with dialysis between January 2010 and December 2020 were enrolled including 204 patients diagnosed with CAD undergoing coronary angiography for the first time, and baseline characteristics as well as Gensini score (GS) were collected. Logistic regression analysis and linear regression analysis were performed to evaluate the relation of ABO blood types to the risk and severity of CAD, respectively.ResultsBlood group O frequency was significantly low in dialysis ESRD patients with CAD (25 vs. 38.24%) compared with the non-CAD patients and multivariable logistic regression showed blood group O was negatively associated with the risk of CAD [adjusted odds ratio (OR) = 0.33, 95% CI = 0.19–0.60, p < 0.001] as well as the GS tertiles (adjusted OR = 0.23, 95% CI = 0.11–0.49, p < 0.001) compared with A blood group. Blood group A, B, and AB were positively associated with the high Gensini tertile compared with O blood group (adjusted OR = 4.26, 95% CI = 2.03–8.93, p < 0.001; adjusted OR = 2.39, 95% CI = 1.11–5.13, p < 0.05; adjusted OR = 4.33, 95% CI = 1.40–13.35, P < 0.05). Similarly, multivariable linear regression results revealed O blood type was negatively associated with the GS (β = −26.129, 95% CI = −40.094 to −12.164, p < 0.001).ConclusionThis case-control study demonstrated that blood group O was a potential independent protective factor for the risk and severity of CAD in ESRD patients with dialysis.

Gensini score (GS) provides valuable information on severity and prognosis of coronary artery disease (CAD). To evaluate the relationship between the severity of CAD determined by the GS and relation to ST-elevation myocardial infarction, non-ST segment elevation myocardial infarction (NSTEMI), unstable angina pectoris, chest pain (suspected angina syndrome on admission) and risk-factors for CAD and predictors of severity. Observational cross-sectional study. Consecutive patients who underwent clinically-indicated coronary angiography for ST-elevation myocardial infarction, NSTEMI, unstable angina pectoris or chest pain were enrolled. Among 600 patients, 417 (average age 67.8 ± 12.2 years) had CAD–related symptoms. Mean GS was 66.7 ± 63.8. Patients presenting with NSTEMI had the highest GS (81.3 ± 42.3; P

ObjectiveGensini score is an effective tool used to evaluate the severity of coronary artery disease (CAD). Whether the Gensini score has predictive value for the clinical outcomes of patients with CAD after percutaneous coronary intervention (PCI) has not been investigated.MethodsAll patients were from the Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI (CORFCHD-PCI), a retrospective cohort study involving 5,672 patients with CAD who underwent PCI, such as 2,110 patients with diabetes and 3,562 patients without diabetes, from January 2008 to December 2017. Patients were divided into three groups according to the tertile of Gensini score: first tertile (Gensini score 38 points). The median follow-up time was 31.0 (interquartile range, IQR: 30.0) months. Compared the differences in clinical outcomes between the groups. Multivariate Cox regression analyses were performed to assess the predictive value of the Gensini score for outcomes over up to 10 years of follow-up.ResultsIn the population without diabetes, there were significant differences between the three groups in the incidences of all-cause mortality (ACM, p = 0.048), cardiac mortality (CM, p = 0.024), major adverse cardiovascular (CV) events (MACEs, p = 0.006), and major adverse cardiovascular and cerebrovascular events (MACCEs, p = 0.009). In the population with diabetes, there were significant differences between the three groups in the incidences of ACM, CM, MACEs, and MACCEs (all p < 0.001). After multivariate Cox regression analyses, in the population without diabetes, the respective risks of ACM, CM, MACEs, and MACCEs were increased 89.9% [hazard ratio (HR) = 1.899, 95% CI: 1.285–2.807, p = 0.001], 115.1% (HR = 2.151, 95% CI: 1.378–3.356, p = 0.001), 48.1% (HR = 1.481, 95% CI: 1.152–1.904, p = 0.002), and 49.8% (HR = 1.498, 95% CI: 1.176–1.907, p = 0.001) in the third tertile compared with those in the first tertile. In the population with diabetes, the respective risks of ACM, CM, MACEs, and MACCEs were increased 248.5% (HR = 3.485, 95% CI: 1.973–6.154, p < 0.001), 260.4% (HR = 3.604, 95% CI: 1.866–6.963, p < 0.001), 130.2% (HR = 2.302, 95% CI: 1.649–3.215, p < 0.001), and 119.8% (HR = 2.198, 95% CI: 1.600–3.018, p < 0.001) in the third tertile compared with those in the first tertile.ConclusionThe present study indicated that the Gensini score is an independent predictor of long-term adverse outcomes in patients with CAD who underwent PCI, and it has more predictive value in the population with diabetes.

Objective Although the levels of plasma fibrinogen and albumin have been proven to be in relation to coronary heart disease (CHD), the association between fibrinogen-to-albumin ratio (FAR) and acute coronary syndrome (ACS) has not been adequately investigated. The aim of this study is to investigate the relationship between FAR and the presence and severity of CHD in patients with ACS. Methods and results A total of 1575 individuals who received coronary angiography (CAG) were enrolled. Patients were divided into the ACS group and the control group. The severity of ACS was determined by Gensini score, number of diseased coronary artery and the presence of myocardial infarction (MI). Data showed that the level of FAR in ACS group was higher than in the control group (81.20 ± 35.45 vs. 72.89 ± 20.24, P P Conclusion The levels of FAR are independently associated with the presence and the severity of coronary artery disease in patients with ACS. Furthermore, FAR, as a more convenient and rapid biological indicator, may provide a new idea for predicting the presence and severity of ACS.

Epicardial fat thickness (EFT) reflects visceral adiposity and is associated with coronary artery disease (CAD). This study aimed to assess the correlation of echocardiographic EFT with the severity of CAD and to determine the EFT cut-off to predict CAD. EFT was measured in 503 patients undergoing coronary angiogram. Mean EFT was significantly higher in the CAD group than control group (5.55 ± 1.21 mm vs 3.25 ± 1.15 mm, p

Supplemental Digital Content is available in the text., Background The aim of this study was to evaluate the diagnostic and risk predictive value of emerging proinflammatory and anti-inflammatory adipocytokines on coronary artery disease (CAD). Patients and methods The study involved 259 inpatients suspected acute coronary syndrome who underwent coronary angiography. Demographic, clinical characteristics, and coronary artery stenosis rated by Gensini score were collected by cardiovascular doctors. The levels of serum inflammatory adipocytokines were evaluated by ELISA. The correlations of the cytokines with clinical parameters were assessed. Receiver operating characteristic curves were constructed for the diagnosis of CAD. Results The 259 inpatients were assigned to the CAD (n = 180) and control groups (n = 79). Compared with the control group, the CAD group displayed significantly higher serum levels of retinol-binding protein-4 (RBP4), pentraxin 3 (PTX3), galectin-3 (GAL-3), and plasminogen activator inhibitor (PAI-1), and significantly lower levels of netrin-1 (NTN1), interleukin-37 (IL-37), and adiponectin (ADP) (all P < 0.05). PAI-1 was significantly upregulated, and IL-37 and ADP were significantly downregulated in the three-vessels CAD subgroup compared to the one- and two-vessels CAD subgroups (P < 0.05). The RBP4, PTX3, GAL-3, PAI-1, and IL-37 inflammatory cytokines were significantly positively correlated with Gensini score, and ADP was negatively correlated (all P < 0.001). IL-37 was a more accurate anti-inflammatory biomarker than NTN1 and ADP. Combining cytokines significantly increased the sensitivity and specificity. Conclusion The inflammatory adipocytokines GAL-3, RBP4, PTX3, NTN1, and IL-37 were more effective than the classical biomarkers PAI-1 and ADP in the diagnosis and risk assessment of CAD patients.

Introduction. In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical parameters and recently-developed strain echocardiography can predict severity of stenosis. Assessment of clinical parameters, altogether with strain echocardiography is expected to make better prediction. This study aim to determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain (GLS), can predict severity of coronary artery stenosis measured with Gensini score,and to further develop a prediction model based on significant parameters. Methods. This is a cross-sectional study taken at Dr. Cipto Mangunkusumo National Central General Hospital during period March – May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi-square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. A prediction model is then developed based on significant predictors by multivariate analysis. Results. The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; CI95%:1.08-7.23), history of myocardial infartion (OR 4.04; CI95%:1.51-10.80), typical angina (OR 5.01; CI95%:1.91-13.14), and GLS ≥-18.8 (OR 30.51; CI95%:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; CI95%:1.39-14.47) and GLS ≥18.8 (OR 17.30; CI95%:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions: Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors.

Objective Complement C1q tumor necrosis factor-related proteins (CTRPs), belonging to the CTRP superfamily, are extensively involved in regulating metabolism and the immune-inflammatory response. The inflammatory process is linked to the pathogenesis of coronary artery disease (CAD). Here, we investigated the association of serum levels of CTRP1 with CAD. Methods Study participants were divided into two groups according to the results of coronary angiography: a control group (n = 63) and a CAD group (n = 76). The concentrations of serum CTRP1 and inflammatory cytokines were determined by enzyme-linked immunosorbent assay. Further analysis of CTRP1 levels in individuals with different severities of CAD was conducted. The CAD severity was assessed by Gensini score. Results Serum levels of CTRP1 were significantly higher in CAD patients than in controls (17.24 ± 1.07 versus 9.31 ± 0.56 ng/mL), and CTRP1 levels increased with increasing severity of CAD. CTRP1 levels were positively correlated with concentrations of tumor necrosis factor-α and interleukin-6. Multiple logistic regression analysis showed that CTRP1 was significantly associated with CAD. Conclusions Our data showed close associations of serum CTRP1 levels with the prevalence and severity of CAD, indicating that CTRP1 can be regarded as a novel and valuable biomarker for CAD.

Aim. To study the relationship between the epicardial fat thickness (EFT), biomarkers of inflammation and metabolic dysfunction in patients with coronary artery disease (CAD) and various severity of coronary atherosclerosis.Material and methods. The study consisted of 89 patients (47 men and 42 women) with stable CAD at the age of 62,2±6,5 years, who assessed the presence and severity of coronary atherosclerosis according to angiography with the calculation of the Gensini Score (GS). We conducted an ultrasonic evaluation of the EFT. We determined the content of glucose, lipid fractions, apoproteins, pro-inflammatory cytokines and adipokines, C-reactive protein by a highly sensitive method (hsCRP).Results. In the total sample of patients, the median GS index was 13,5 (3,5; 43) points, the median EFT was 4,93 (3,95; 6,0) mm, the median hsCRP was 2,1 (1,02; 3,65) mg/l. There were no correlation relationships between the GS index and the body mass index, waist circumference, EFT, hsCRP, lipid and carbohydrate metabolism in the general group of patients. In the course of linear regression analysis, an independent contribution of hsCRP >2,1 mg/l to the formation of the first two tertiles of a sample of GS values was established (0≤ GS ≤28, paired linear regression hsCRP at GS β=0,55, p=0,0221), whereas in patients with GS values from the third tertile (GS >28 points), the growth of this parameter had an independent association with an increase in the EFT (estimation of the coefficient of paired linear regression of the EFT on GS β=0,56, p=0,0015). The range of hsCRP changes did not affect the value of the β coefficient in paired linear regression models in patients with GS >28 points (n=29) and in the subgroup of patients with GS >28 and hsCRP >2,1 mg/l (n=18).Conclusion. The absence of an independent association between EFT and minor or moderate severity of atherosclerotic lesions of the coronary arteries (for GS ≤28 points) in patients with CAD, while an independent marker of GS index increase is higher than 2,1 mg/l. An independent contribution to the formation of a severe coronary atherosclerosis (with a GS value of >28 points) is equally made by thickening of EFT, and a moderately elevated level of hsCRP.

Amaç: Erken repolarizasyon paterni (ERP) iyi huylu birvaryant olarak kabul edilmesine rağmen, son zamanlarda yapılan çalışmalardahayatı tehdit eden aritmilerle ilişkili olduğu gösterilmiştir. Hayatı tehditeden aritmi ve koroner arter hastalığının (KAH) şiddeti arasında güçlü birilişki olduğunu gösteren farklı çalışmalar vardır. Bu çalışmada ERP'lihastalarda Gensini skoru (GS) değerlerinin ERP'siz hastalara göre daha yüksekolup olmadığını belirlemeyi amaçladık.Gereçve Yöntemler: Çalışmaya ERP'li toplam 110 hastave 90 kontrol grubu alındı. Her hasta için GS hesaplandı. p< 0.05 anlamlıkabul edildi.Bulgular: GS, ERP’li hastalarda kontrol grubuna göreanlamlı derecede yüksekti (19.5±20.2 ve 2.15±4.1; p, Objective:Although early repolarization pattern (ERP) has been recognized as a benignvariant, in recent studies have shown that it is associated withlife-threatening arrhythmias. There are different studies demonstrated thatthere is a strong relationship between life-threatening arrhythmias and theseverity of coronary artery disease (CAD). In this study, we aimed to determinewhether Gensini score (GS) values were higher in patients with ERP compared topatients without ERP.Materialsand Methods: Totally 110 patients with ERP and 90 control subjects wereenrolled to the study. GS was calculated for each patient. p values < 0.05were considered significant.Results:GS was significantly higher in the ERP patients compared with the control group(19.5±20.2 vs 2.15±4.1; p

Aim:Heart-type fatty acid binding protein (H-FABP), an early marker of cardiac necrosis, is released rapidly from myocardium as a consequence of ischemic injury. We hypothesized that more severe and extensive coronary atherosclerosis would result in more pronounced myocardial injury and necrosis in patients with acute myocardial infarction (AMI). Therefore, we sought the relationship between serum H-FABP levels and the severity and extent of coronary artery disease (CAD) assessed using the Gensini score.Materials and Methods:Fifty patients with AMI who underwent invasive coronary angiography were divided into 2 groups according to the angiographic Gensini score, namely the moderate to severe CAD group (group 1) and the mild CAD group (group 2). A point of care test and Cardiodetect Quant device were used to detect whether H-FABP was positive and the quantitative measurements. The data obtained from this study were evaluated using the PASW statistic programme.Results:Mean serum H-FABP concentration was significantly higher in group 1 when compared to that in group 2. Furthermore, a strongly positive correlation was found between the Gensini score and serum H-FABP levels.Conclusion:The findings of our study suggest that the quantity of myocardial necrosis demonstrated by serum H-FABP levels is higher in patients with AMI who have more severe and extensive CAD. H-FABP levels are also positively correlated to the Gensini score. We propose that H-FABP, an early marker of myocardial necrosis, may also provide a clue about the severity and extent of CAD, especially in the setting of AMI.

Introduction. Coronary heart disease (CHD) and obstructive sleep apnea (OSA) are common and complex clinical problems. Both have a high risk of sudden cardiac death (SCD). QT dispersion (QTd) in electrogram is a measure of heterogeneity of myocardial repolarization that can predict the occurrence of ventricular arrhythmias that cause SCD QTd is a predictor of ventricular arrhythmias and sudden cardiac death. So far, there is no publication about the severity relationship CHD with QTd in OSA patients in Indonesia. Methods. A cross-sectional study was conducted on twenty-nine CHD patients accompanied OSA in 2015 who had undergone coronary angiography and polysomnography against the QT dispersion by electrocardiography in Cipto Mangunkusumo Hospital, Jakarta. QTd obtained from maximum QTc difference with minimum QTc. The severity of CHD was assessed by the Gensini score obtained from the recording of coronary angiography in the cath lab. Results. The median value of Gensini score was 10 (range 1-112). Mean value of QTc max and QTc min were 459.76 ms (standard deviation [SD] 41.39 ms) and 386.72 ms (SD 31.61), respectively. Meanwhile, the median value of QTd was 56 ms (range 14-201 ms). The Spearman correlation test showed a weak positive correlation between Gensini score and QTd (r = 0.464; p value = 0.006). Conclusion. The severity of coronary heart disease by Gensini score is weakly correlated with QT dispersion.

Aims: Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide and one of the greatest threats to public health. Tenascin C (TNC) is an extracellular matrix glycoprotein that is found in low concentrations in normal tissues and is enhanced by a range of cardiovascular pathologies. This study aimed to evaluate the value of TNC in assessing the severity of atherosclerosis measured by the Gensini score. Methods: A total of 157 patients with chest pains who underwent selective coronary angiography for suspected coronary atherosclerosis were enrolled. The patients were divided into the CAD group and non-CAD group according to symptoms and angiography. Demographic data and laboratory analyses were collected. Results: The mean TNC level was significantly higher in the CAD group than in the non-CAD group (p < 0.001). A significant positive correlation between TNC levels and Gensini score (p < 0.01, r = 0.672) was found. ROC curve analysis demonstrated that the cutoff value for TNC at 89.48 ng/mL was well differentiated in the CAD and non-CAD groups. Furthermore, TNC was also a good predictor for a higher Gensini score (the third tertile) in the ROC curve analysis. When the cutoff was accepted as 100.91 ng/mL, the sensitivity and specificity were 82.7% and 79%, respectively. Conclusion: A significant relationship was found between the Gensini score and serum TNC level. TNC levels can be considered in risk assessments for CAD before angiography.

Atherosclerosis and chemokines are strongly related, but the role of the chemokine CXCL17 in atherogenesis is still poorly understood. We aim to investigate the serum CXCL17 levels in different stages of patients with coronary heart disease and explore whether these differences contribute to atherosclerosis. In the current prospective study, we enrolled 48 patients with unstable angina (UA), 51 patients with stable angina (SA) and 41 patients for the control group (CG). All subjects were diagnosed by coronary angiography and Gensini score was used to evaluate the severity of coronary artery disease. The CXCL17 levels were determined using ELISA, while lipid metabolism indicators and high sensitivity C-reactive protein (hs-CRP) were detected by automatic biochemical analyzer. We observed that the unstable angina group had higher CXCL17 levels compared with the stable angina and the control group. The logistic regression analysis showed that CXCL17 was an independent risk factor for unstable angina. Our results showed that CXCL17 was also statistically correlated with hs-CRP, while it was irrelevant with Gensini score. CXCL17 levels were associated with activity of inflammatory response and the instability of atherosclerotic plaques. These results suggest that CXCL17 elevation may be a potential new biomarker of unstable angina.

Background: The coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) has been identified as the main predictor of prognosis. However, the association of lipoprotein(a) [Lp(a)], a well-established proatherogenic factor, with atherosclerotic burden in patients with STEMI is unclear.Methods: In total, 1,359 patients who underwent percutaneous coronary intervention (PCI) for STEMI were included in analyses. Three prespecified models with adjustment for demographic parameters and risk factors were evaluated. Generalized additive models and restricted cubic spline analyses were used to assess the relationships of Lp(a) with Gensini scores and the no-reflow phenomenon. Kaplan–Meier curves were generated to explore the predictive value of Lp(a) for long-term all-cause mortality. Furthermore, mRNA expression levels of LPA in different groups were compared using the GEO database.Results: Patients in the highest tertile according to Lp(a) levels had an increased incidence of heart failure during hospitalization. Furthermore, patients with high levels of Lp(a) (>19.1 mg/dL) had sharply increased risks for a higher Gensini score (Pfor trend = 0.03) and no-reflow (Pfor trend = 0.002) after adjustment for demographic parameters and risk factors. During a median follow-up of 930 days, 132 deaths (9.95%) were registered. Patients with high levels of Lp(a) (>19.1 mg/dL) had the worst long-term prognosis (Pfor trend < 0.0001). In a subgroup analysis, patients with higher Lp(a) still had the highest all-cause mortality. Additionally, the mRNA expression levels of LPA in patients with STEMI with lower cardiac function were higher than those in other groups (P = 0.003). A higher coronary atherosclerotic burden was correlated with higher LPA expression (P = 0.01).Conclusion: This study provides the first evidence that Lp(a) (at both the protein and mRNA levels) is independently associated with coronary atherosclerotic lesions and prognosis in patients with STEMI treated with PCI.Clinical Trial Registration:http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028516.

Introduction In previous studies, the relationship between atherosclerosis and erectile dysfunction (ED) was examined, but the relationship and correlation between Gensini score which evaluates the extent and severity of chronic coronary syndrome (CCS), and ED severity were not investigated. Aim To evaluate the relationship between Gensini score and ED in patients with CCS. Methods We included 142 consecutive male patients with the diagnosed CCS and underwent an elective coronary angiography between January 2019 and March 2020. Main Outcome Measure Correlation analysis demonstrated that Gensini score significantly negatively correlated with the International Index Erectile Function - 5 (IIEF-5) score (r = -0.417, P < .001). Results Severe ED was present in 48 (33.8%) patients, moderate ED in 31 (21.8%) patients, and mild ED in 22 (15.5%) patients. 41(28.9%) patients did not have ED. Both the No ED and Mild ED groups were statistically significantly lower than the Severe ED group in terms of the Gensini score (P < .05). When the recommended optimal cut-off point and accuracy measurements were made for the Gensini score, the area under curve (AUC) value in predicting ED was 0.806 (95% CI: 0.732-0.880, P < .001). Multivariate logistic regression analysis demonstrated that independent predictors for ED were Gensini score and age (P < .001, and P = .026, respectively). Every 1 unit increase in Gensini score resulted in a 6% increase in the occurrence of ED (OR = 1.06, CI:1.03-1.10, P < .001). Conclusion ED can be caused by endothelial dysfunction. Patients with severe CSS and high Gensini score should be evaluted for ED. ED may be a sign of severe CCS and a high Gensini score. It is also necessary to evaluate cardiological in patients with ED.

Background Growing evidence indicates that poor sleep harms health. Early to bed and early to rise is considered as a healthy lifestyle in Chinese population. The current study aimed to examine the effects of sleep habits on acute myocardial infarction (AMI) risk and severity of coronary artery disease (CAD) in Chinese population from two centers. Methods A total of 873 patients including 314 AMI cases and 559 controls were recruited from the inpatient cardiology department of the Affiliated Jiangning Hospital and the First Affiliated Hospital of Nanjing Medical University. 559 controls included 395 CAD cases and 164 non-CAD cases. We used a 17-item sleep factors questionnaire (SFQ) to evaluate sleep habits comprehensively by face-to-face interview. The severity of CAD was assessed by Gensini score in AMI and CAD groups. The effects of sleep factors on AMI risk and Gensini score were examined by unconditional logistic regression. Results After mutually adjustment for other sleep factors and demographic characteristics, the timing of sleep (24:00 and after) and morning waking (after 7:00) and sleep duration (P P = 0.011 and OR = 2.968, P P = 0.009). In subgroup analysis by age, both late sleep timing and short sleep duration were associated with increased risk of AMI regardless of age. In subjects with age ≤ 65 years, daytime napping was related to reduced risk of AMI (OR = 0.645, P = 0.046). In subjects with age > 65 years, the frequency of night-time waking (3 times) was associated with increased risk of AMI (OR = 3.467, P = 0.035). Short sleep duration was correlated with increased risk of high Gensini score (OR = 2.374, P Conclusion Sleep insufficiency is an important risk factor both for AMI risk and CAD severity. Late sleeping is also associated with increased risk of AMI. In young and middle-aged people, regular naps may have a protective effect. Graphic abstract

AimsTo investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS).MethodsA total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed.ResultsUnivariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602).ConclusionDifferent subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.