Burden of exposure to medical radiation following an acute coronary syndrome No abstract available

Estimates of radiation exposure and subsequent risk of malignancy due to cardiac imaging in the emergency department for evaluation of chest pain: a cohort study No abstract available

Temporal pattern of neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention No abstract available

Dissociation of coronary computed tomography and stress myocardial scintigraphy: a case of vasospasm Exercise-induced vasospastic angina (VSA) is an uncommon entity of coronary artery disease. Here, we report a case of exercise-induced VSA, which was detected by exercise stress myocardial perfusion imaging. Received 11 March 2019 Accepted 25 August 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Itsuro Morishima, MD, PhD, Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan, Tel: +81584813341; fax: +81584755715; e-mail: morishima-i@muc.biglobe.ne.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Prognostic impact of lipoprotein(a) levels during lipid management with statins after ST-elevation acute myocardial infarction The causal relationship of lipoprotein(a) with cardiovascular disease has been established. However, clinical impacts of lipoprotein(a) levels on adverse vascular events in patients with established coronary artery disease who are undergoing statin treatment have not been fully elucidated. We measured lipoprotein(a) levels of 668 consecutive patients with ST-elevated myocardial infarction upon admission and reevaluated lipoprotein(a) of 189 of these patients during statin treatment at least 6 months later than the date of index ST-elevated myocardial infarction. Changes in lipoprotein(a) and associations between lipoprotein(a) levels and the incidence of major adverse cardiac and cerebrovascular event for 3 years were examined. Lipoprotein(a) at baseline was an independent predictor of 3-year major adverse cardiac and cerebrovascular event after ST-elevated myocardial infarction. Levels of lipoprotein(a) at follow-up were slightly but significantly elevated despite improvements in other lipid parameters due to statin treatment. Furthermore, higher levels of lipoprotein(a) achieved with statin treatment were also associated with the subsequent incidence of major adverse cardiac and cerebrovascular event over 3 years, regardless of whether or not the LDL-cholesterol levels were below 100 mg/dl. In conclusion, lipoprotein(a) levels during lipid management by statin are also predictive of adverse vascular events in Japanese patients with ST-elevated myocardial infarction. Received 30 April 2019 Accepted 25 August 2019 Correspondence to Yusuke Uemura, MD, PhD, Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo 446-8602, Japan, Tel: +81 566 75 2111; fax: +81 566 76 4335; e-mail: yusuke0307@kosei.anjo.aichi.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Association of shock index with short-term and long-term prognosis after ST-segment elevation myocardial infarction Background The association of shock index with long-term mortality after ST-segment elevation myocardial infarction (STEMI) remains poorly investigated. We aimed to assess the association between shock index and eight-year mortality after STEMI. Methods The study included 1369 patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Patients were categorized into three groups: a group with shock index in the first tertile (shock index, 0.21 to 0.52; n = 458), a group with shock index in the second tertile (shock index > 0.52 to 0.67; n = 457) and a group with shock index in the third tertile (shock index > 0.67 to 2.80; n = 454). The primary outcome was eight-year mortality. Results In patients with shock index in the first to third tertiles, inhospital cardiogenic shock (n = 153) occurred in 3.5, 3.9 and 26.2% of patients, respectively [adjusted odds ratio = 1.54, 95% confidence interval (CI) 1.40 to 1.69, P < 0.001]; 30-day deaths (n = 122) occurred in 2.8, 5.5 and 18.5% of patients, respectively [adjusted hazard ratio = 1.06 (1.01–1.12); P = 0.024]; eight-year deaths (n = 300) occurred in 22.9, 21.6 and 36.1% of patients, respectively [adjusted hazard ratio = 1.06 (1.02–1.11); P = 0.007] with all risk estimates calculated per 0.1 unit increment in shock index values. From 30 days to 8 years, deaths (n = 178) occurred in 20.7, 17.0 and 21.5% of patients in the first to third shock index tertiles, respectively (the difference was nonsignificant for all intertertile comparisons). Conclusions In patients with STEMI, elevated shock index is associated with the risk of inhospital cardiogenic shock and mortality up to 8 years after PPCI. The long-term adverse prognosis was almost entirely driven by events within the first 30 days. Received 12 March 2019 Accepted 25 August 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Gjin Ndrepepa, MD, Deutsches Herzzentrum München, Lazarettstrasse 36, 80636 Munich, Germany, Tel: +49 89 12181535; fax: +49 89 12184053; e-mail: ndrepepa@dhm.mhn.de Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Silent coronary artery disease in asymptomatic patients with severe aortic stenosis and normal exercise testing Objective: There are no data about the prevalence of silent coronary artery disease in asymptomatic severe aortic stenosis patients with normal exercise testing. Importantly, unmasking significant coronary artery disease in patients with aortic stenosis could influence the choice/timing of treatment in these patients. Method: Exercise testing was performed on semi-supine ergobicycle. Cardiopulmonary analysis during exercise testing, echocardiography, and laboratory analysis at rest was done. Standard clinical/electrocardiography criteria were assessed for symptoms/signs of ischemia during/after exercise testing. In patients with normal exercise testing coronary angiography was performed using standard femoral/radial percutaneous approach. Coronary stenosis was considered significant if >70% of vessel diameter or 50%–70% with fractional flow reserve ≤0.8. Results: Total of 96 patients with normal exercise testing were included (67.6 years, 50.6% males). No patient had any complication or adverse event. The Pmean was 52.7 mmHg, mean indexed aortic valve area was 0.36 cm2/m2 and left ventricular ejection fraction, 69.5%. 19/96 patients (19.8%) had significant coronary artery disease on coronary angiography. Multivariate logistic regression analysis revealed brain natriuretic peptide and blood glucose as independent predictors of silent coronary artery disease. Brain natriuretic peptide value of 118 pg/ml had sensitivity/specificity of 63%/73% for predicting coronary artery disease (area under the curve 0.727, P = 0.006). Conclusion: Our results are the first to show that in patients with severe aortic stenosis, normal left ventricular ejection fraction,, and normal exercise testing, significant coronary artery disease is present in as many as 1/5 patients. In such patients, further prospective studies are warranted to address the diagnostic value of brain natriuretic peptide in detecting silent coronary artery disease. Received 20 March 2019 Accepted 25 August 2019 Correspondence to Marko Banovic, MD, PhD, FESC, FACC, Cardiology Department, Clinical Center of Serbia, 27 Marta 26, 11000 Belgrade, Serbia, Tel: +381638050258; fax: +381113663294; e-mail: Markobanovic71@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Low serum level of sirtuin 1 predicts coronary atherosclerosis plaques during computed tomography angiography among an asymptomatic cohort Objectives: Whether in asymptomatic populations levels of serum sirtuin 1 (Sirt1) are associated with coronary atherosclerosis plaque characteristics remains unclear. This article aims to evaluate the possibility of Sirt1 serum levels predicting high-risk coronary plaques revealed through computed tomography angiography (CTA). Methods: The current cross-sectional investigation was performed on patients from non high-risk plaque (HRP) group (control group) as well as HRP group. CTA was conducted and the Framingham Risk Score (FRS) was generated each patient. Serum Sirt1 level was determined through ELISA. Univariate analysis and receiver-operating characteristic curve were used to examine the role of Sirt1 to predict HRP. Results: Lower Sirt1 serum levels were observed in patients in the HRP group in comparison with those in the control group. Gender, hyperlipidemia, age, the total cholesterol to high-density lipoproteincholesterol (HDL-C) ratio, HDL-C, apolipoprotein B and Sirt1 displayed independent association with HRP as revealed by the univariate analysis. Area under curve of the univariate model for HRP was 0.848 (95% confidence interval: 0.798–0.899); 75.4% specificity, 75.2% sensitivity, the negative predictive value was 83.0%, and the positive predictive value was 66.2%. Conclusion: Low serum level of Sirt1 predicted HRP in individuals with low–intermediate FRS, implying that Sirt1 may play a predictive role in the plaque screening before coronary CTA. Received 21 April 2019 Accepted 24 August 2019 Correspondence to Jing Zheng, MS, Department of Diagnostic CT, Cangzhou Central Hospital, No. 16, Xinhua Road, Cangzhou 061001, Hebei, China, Tel/Fax: +86 138 3274 3310; e-mail: zhengjingct@163.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The predictive value of PRECISE-DAPT score for arrhythmic complications in patients with ST-elevation myocardial infarction Objective: To investigate the predictive value of the PRECISE-DAPT score for the development of arrhythmias in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Method: A total of 706 patients with a diagnosis of ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled to the study. The patients were divided into two groups according to the PRECISE-DAPT score (PRECISE-DAPT score ≥25 and PRECISE-DAPT score <25). The patients were compared in terms of in-hospital arrhythmia. Results: High-degree atrioventricular block (second-degree Mobitz II or third-degree atrioventricular block) (17.2% vs. 4.9%; P < 0.001), ventricular tachycardia (11.2% vs. 4.6%; P = 0.005) and atrial fibrillation (13.8% vs. 3.1%; P < 0.001) rates were statistically higher in patients with higher PRECISE-DAPT score (≥25). There was no difference between the groups in terms of ventricular fibrillation (9.5% vs. 8.3%; P = 0.678). In multivariable logistic regression analysis; PRECISE-DAPT Score was independently associated with high-degree atrioventricular block (odds ratio: 6.38, P < 0.001) and atrial fibrillation (odds ratio: 4.33, P < 0.001). Conclusion: The PRECISE-DAPT score was associated with high-degree atrioventricular block and atrial fibrillation in patients with ST-segment elevation myocardial infarction underwent percutaneous coronary intervention. Received 25 December 2018 Accepted 1 July 2019 Correspondence to Ersin Yildirim, MD, Atatürk mah, Fırat cad. 71, Ada. Gardenya 6 Sitesi. H blok, Daire 42, 34750 Ataşehir/İstanbul, Turkey, Tel: +90 5370466515; fax: +90 216 3379719; e-mail: ersinyil44@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Interaction between eNOS gene polymorphism and current smoking on susceptibility to coronary heart disease in Chinese people Objective This study aims to explore the relation between endothelial nitric oxide synthase (eNOS) single-nucleotide polymorphisms (SNPs) and the risk of coronary heart disease (CHD). Methods SNPstats (online software: http://bioinfo.iconcologia.net/SNPstats) was performed to test Hardy–Weinberg equilibrium in controls. Generalized multifactor dimensionality reduction (GMDR) was adopted to screen the preferable interaction between eNOS SNPs and smoking. Results The frequency for the rs1799983-T allele was 31.1% in CHD patients, which was significantly higher than that of 19.8% in controls (P < 0.05). The frequency for the rs891512-A allele was 28.8% in cases, which was also significantly higher than that of 20.1% in controls (P < 0.05). Logistic regression analysis showed that both rs1799983-T and rs891512-A alleles were related with increased risk of CHD, and the odds ratios (ORs) [95% confidence interval (CI)] were 1.71 (1.31–2.15) and 1.57 (1.14–2.07), respectively. High-order interactions were investigated among SNPs and environmental factors using the GMDR method. The data showed that a two-locus model (rs1799983 × smoking) had a testing accuracy of 0.60 (P = 0.001). We found that current smokers with rs1799983-GT or TT within eNOS gene have the highest CHD risk, compared to never smokers with rs1799983-GG genotype, OR (95% CI) = 2.74 (1.78–3.85), after covariates adjustment for age, gender, BMI, and alcohol drinking. Conclusion The rs1799983-T and rs891512-A alleles and interaction between rs1799983 and smoking were all risk factors of CHD. Received 14 February 2019 Accepted 20 July 2019 Correspondence to Zhongcai Fan, PhD, Department of Vasculocardiology, the Affiliated Hospital of Southwest Medical University, the Key laboratory of Medical Electrophysiology, ministry of Education, No 25 Taiping Street, Jiangyang District, Luzhou City, Sichuan Province, China, Tel/fax: +86 0830 3165311; e-mail: fanzzccai21@163.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.