Comparison of temporal changes in established cardiovascular biomarkers after acute coronary syndrome between Caucasian and Chinese patients with diabetes mellitus

Abstract

Background: Population means of conventional cardiovascular biomarkers are known to differ between ethnic groups. In this study we performed detailed comparisons in the temporal pattern of these biomarkers between Caucasian and Chinese diabetic patients with acute coronary syndrome (ACS).

Methods: We studied differences in temporal changes of established cardiovascular biomarkers, including high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, cardiac Troponin T (TnT), NT-proBNP and C-reactive protein (CRP), in 48 Chinese and 48 clinically matched Caucasian patients with type 2 diabetes mellitus who were admitted for ACS. Blood samples were collected at regular time intervals during 30?days to 1?year after the index ACS.

Results: In the >30?day post ACS period, mean serum levels of LDL (2.16 vs. 1.47?mmol/L; p-value <0.001), total cholesterol (4.08 vs. 3.11?mmol/L; p-value <0.001), TnT (11.0 vs. 7.76?ng/L; p-value 0.010) and CRP (2.0 vs. 0.78?mg/L; p-value <0.001) were systematically higher in Caucasian than in Chinese patients. HDL and NT-proBNP levels were similar.

Conclusions: Our study showed clinically relevant differences in levels of established cardiovascular biomarkers between Caucasian and Chinese post ACS patients. Further cross-ethnic studies are warranted to determine secondary prevention treatment biomarker targets in specific populations.     

Immediate versus staged revascularisation of non-culprit arteries in patients with acute coronary syndrome: a systematic review and meta-analysis

Although there is robust evidence that revascularisation of non-culprit vessels should be pursued in patients presenting with an acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD), the optimal timing of complete revascularisation remains disputed. In this systematic review and meta-analysis our results suggest that outcomes are comparable for immediate and staged complete revascularisation in patients with ACS and MVD. However, evidence from randomised controlled trials remains scarce and cautious interpretation of these results is recommended. More non-biased evidence is necessary to aid future decision making on the optimal timing of complete revascularisation.Supplementary InformationThe online version of this article (10.1007/s12471-022-01687-7) contains supplementary material, which is available to authorized users.     

The relationship between trace elements and cardiac markers in acute coronary syndromes

Previous studies have demonstrated increased serum copper and iron levels and decreased selenium and zinc levels in patients with myocardial infarction. Furthermore, the prognostic value of the levels of trace elements in myocardial infarction has been stressed. We examined serum levels of Cu, Fe, Zn and Se, as well as glutathione peroxidase (GPx), a selenoenzyme with antioxidant properties, and C-reactive protein (CRP), a marker of inflammation, in acute coronary syndromes (ACS) regarding their relationship to cardiac troponins and creatine kinase-MB mass (CK-MBm), important prognostic markers. Serum trace elements, GPx activity and CRP were determined in 70 patients with ACS who were admitted within 12 h after the onset. Differences in these parameters were evaluated in three groups of patients divided according to the levels of cardiac markers: group III consisted of patients with high increases in cTnT, cTnI and CK-MBm (> or =0.9 ng/mL, > or =1.0 ng/mL, > or =30 ng/mL, respectively), patients with milder increases in these markers were included in groups II and I consisted of patients with values just above the upper reference limits. Serum Fe levels increased significantly in group II and even more prominently in group III compared to group I (p = 0.04, 0.002, respectively). There was no significant difference between groups II and III. The increase in serum Cu was significant in group III compared to both groups II and I (p = 0.04, 0.001, respectively). There was no significant difference between groups I and II regarding Cu and Zn. The decrease in serum Se and GPx levels was significant only between groups III and I (p = 0.004 for Se and p = 0.0001 for GPx). CRP levels showed a significant increase in group III compared to groups II and I (p = 0.03 and 0.001). CRP showed a significant positive and GPx a significant negative correlation to the cardiac markers cTnT, cTnI and CK-MBm. Cu was positively correlated to all cardiac markers, while the positive correlation between Fe and cardiac markers was significant only for cTnI. Both Zn and Se were negatively correlated to cTnT, and Se was also to cTnI. In conclusion, the increase in serum levels of Cu and Fe and the decrease in serum levels of Zn and Se in patients with higher levels of troponins and CK-MBm imply that trace element levels are related to the degree of myocardial damage and thus may play a role in the pathogenesis of ischemic heart disease. The strong correlations between cardiac markers and both CRP and GPx suggest that these parameters are promising prognostic factors in acute coronary syndromes.     

Adoption of prasugrel into routine practice: rationale and design of the Rijnmond Collective Cardiology Research (CCR) study in percutaneous coronary intervention for acute coronary syndromes

Background

Platelet inhibition is crucial in reducing both short- and long-term atherothrombotic risks in patients with acute coronary syndromes (ACS) managed with percutaneous coronary intervention (PCI). Based on randomised trials, recent recommendations in the current guidelines include the endorsement of prasugrel as a first-choice adenosine diphosphate receptor inhibitor. Yet, there is limited experience with the use of prasugrel in routine practice.

Methods

The Rijnmond Collective Cardiology Research (CCR) registry is a prospective, observational study that will follow-up 4000 PCI-treated ACS patients in the larger region of Rotterdam, the Netherlands. Based on recently implemented hospital protocols, all patients will receive prasugrel as first-choice antiplatelet agent, unless contraindicated, in accordance with European guidelines, and will be followed for up to 1 year post-discharge for longitudinal assessment of outcomes and bleeding events. This registry exemplifies a collaborative study design that employs a regional PCI registry platform and provides feedback to participating sites regarding their practice patterns, thereby supporting and promoting improvement of quality of care.

Conclusion

The CCR registry will evaluate the adoption of prasugrel into routine clinical practice and thus, will provide important evidence with regard to the benefits and risks of real-world utilisation of prasugrel as antiplatelet therapy in PCI-treated ACS patients.     

Prognostic implications of changes in cardiac troponin I levels in patients with non-ST elevation acute coronary syndrome

Abstract

Objective: Information is limited on the prognostic implications of cardiac troponin I (cTnI) changes during the first days of non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods: High-sensitivity cTnI levels were measured at study inclusion and after 48?h in 1615 conservatively managed NSTE-ACS patients from the Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO) IV trial.

Results: Patients with moderately increased cTnI levels and without a relevant decrease over time had a significantly raised mortality at 30 days and 1 year. No relevant associations between cTnI changes and recurrent myocardial infarction were seen.

Conclusion: The cTnI change is predictive for subsequent mortality in selected conservatively managed NSTE-ACS patients.     

Levels of zinc and lipid peroxidation in acute coronary syndrome

The present study was carried out on 20 female patients diagnosed with acute coronary syndrome (ACS). The control group was composed of 20 healthy female volunteers. Plasma malondialdehyde (MDA) levels and serum zinc (Zn), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and VLDL-cholesterol, Lp(a), Apo-A₁, and Apo-B were determined in all patients and controls. Plasma MDA levels were determined to be significantly high in patients with ACS compared to the controls (1.75±0.27 vs 0.8±0.43 nmol/mL; p<0.05). On the other hand, Zn levels in patients with ACS were determined to be significantly low compared to the control group (67.9±14.8 vs 101.8±22.4 mg/dL; p<0.05). There was a statistically significant negative correlation between MDA and Zn levels in patients with ACS (r=−0.678, p<0.05). Other lipid parameters were significantly altered in patients with ACS compared to the controls (p<0.05). In conclusion, Zn and lipid peroxidation levels are important in patients with ACS and they must be monitored during diagnosis and treatment of these patients.     

Association between endothelin-1 and collagen deposition in db/db diabetic mouse kidneys

Endothelin-1 has been implicated in diabetic kidney injury, but there are few firm data establishing the temporal and spatial expression of kidney endothelin-1 in diabetes. We performed an immunohistochemical and histopathological analysis to determine endothelin-1 peptide expression in the kidneys of diabetic db/db mice and non-diabetic db/m controls. Diabetic mice were studied at 8 weeks, before histological damage is evident, and again at 16 weeks, when significant glomerular injury has occurred. Urinary endothelin-1 was 6.2- and 3.6-fold higher in 8- and 16-week diabetic mice compared to age-matched controls (P<0.01 db/db vs. db/m). Compared to non-diabetic kidneys, immunoreactive endothelin-1 was first elevated 2.5-fold (P=0.02) in the tubulointerstitial compartment at 8-week and remained high (3.8-fold, P<0.01) at 16 weeks. In contrast, glomerular endothelin-1 was elevated 3.2-fold (P=0.03) only in 16-week diabetic mice. Glomerular and tubulointerstitial endothelin-1 were unchanged in 8- and 16-week non-diabetic mice. Elevated endothelin-1 in diabetic mice associated temporally and spatially with collagen deposition, especially in the tubulointerstitial compartment. The localization of kidney endothelin-1 is consistent with a role for this peptide in renal fibrogenesis. These results also highlight the potential role of ET-1 in the pathogenesis of early tubulointerstitial changes in diabetes.     

不同剂量普伐他汀对急性冠状动脉综合症血脂及vWF因子的影响

目的：探讨不同剂量普伐他汀对早期急性冠状动脉综合症患者血脂及血浆vWF水平的影响。方法：将120例冠状动脉综合症患者随机分为：常规治疗组（30例）和普伐他汀治疗组（90例）。常规治疗组采用阿司匹林、硝酸酯类、血管紧张素转换酶抑制剂等,普伐他汀治疗组是在常规治疗基础上加用普伐他汀,按照普伐他汀的剂量又分为：10mg/d、20mg/d和40mg/d三组,持续用药4周。检测治疗前后患者的hs-CRP、HDL-C、LDL-C、TC、TG与vWF等因子水平的变化。选取30例健康人作为对照组。结果：与正常组或常规治疗组相比,急性冠状动脉综合症患者治疗4周后,普伐他汀组中患者的hs-CRP、LDL-C、HDL-C、TC、TG与vWF因子的水平变化的差异均有统计学意义（P＆lt;0.05）。在普伐他汀使用的三个剂量中,以20mg/d治疗组的治疗效果相对最好（P＆lt;0.05）,副作用相对较小。结论：常规药物联合中等剂量的普伐他汀治疗早期急性冠状动脉综合症可获得良好的疗效,且安全性高,值得推广。     

Smoking cessation after an acute coronary syndrome: immediate quitters are successful quitters

Background

Cardiovascular disease (CVD) prevention guidelines stress the importance of smoking cessation and recommend intensive follow-up. To guide the development of such cessation support strategies, we analysed the characteristics that are associated with successful smoking cessation after an acute coronary syndrome (ACS).

Methods

We used data from the Randomised Evaluation of Secondary Prevention for ACS patients coordinated by Outpatient Nurse SpEcialists (RESPONSE) trial (n = 754). This was designed to quantify the impact of a nurse-coordinated prevention program, focusing on healthy lifestyles, traditional CVD risk factors and medication adherence. For the current analysis we included all smokers (324/754, 43 %). Successful quitters were defined as those who reported abstinence at 1 year of follow-up.

Results

The majority of successful quitters quit immediately after the ACS event and remained abstinent through 1 year of follow-up, without extra support (128/156, 82 %). Higher education level (33 vs. 15 %, p < 0.01), no history of CVD (87 vs. 74 %, p < 0.01) and being on target for LDL-cholesterol level at 1 year (78 vs. 63 %, p < 0.01) were associated with successful quitting.

Conclusion

The majority of successful quitters at 1 year stopped immediately after their ACS. Patients in this group showed that it was within their own ability to quit, and they did not relapse through 1 year of follow-up. Our study indicates that in a large group of patients who quit immediately after a life-threatening event, no relapse prevention program is needed.     

不同年龄急性冠脉综合征患者血脂代谢临床特点对比分析

目的:对比研究不同年龄急性冠脉综合征患者急性期血脂代谢特点及相关因素变化,探讨血脂代谢在不同年龄急性冠脉综合征发生过程中的作用及临床意义。方法:222例急性冠脉综合征(ACS)患者及119例稳定型心绞痛(SAP)患者共341例按照年龄分为3组,<60岁为非老年组共68人,其中ACS组33人,SAP组35人;60-74岁为普通老年组共67人,其中ACS组34人,SAP组33人;≥75岁为高龄老年组共206人,其中ACS组155人,SAP组51人。详细记录其基线资料并测定其血脂各项指标(包括TC、TG、LDL-C、HDL-C)及CRP。结果:与SAP患者比较,非老年人组及普通老年人组ACS患者LDL-C、CRP均显著升高;高龄老年人ACS患者LDL-C水平无显著升高,但HDL-C显著降低,CRP显著升高,差异均具有统计学意义(P<0.05),LDL-C虽无显著升高,但未达指南要求水平。各组之间TC、TG之间差异无统计学意义(P>0.05)。结论:脂代谢异常在不同年龄ACS患者的发生过程中均有重要作用,老年ACS患者中,除了应关注脂代谢紊乱外,还应该关注高血压、糖尿病等危险因素。     

双联抗血小板治疗急性冠脉综合征临床疗效观察

目的:探讨双联抗血小板治疗急性冠脉综合征(ACS)的临床疗效和安全性。方法:60例ACS患者随机分为治疗组和对照组。对照组给予阿司匹林单抗血小板治疗,治疗组采用阿司匹林+氯吡格雷双联抗血小板治疗,治疗3个月后评价临床疗效。结果:治疗组临床疗效总有效率为93.3%,显著高于对照组(76.7%),相比较有显著性差异(P<0.05);治疗后,两组LVEF、CO、E/A显著上升,与治疗前比较均有显著性差异(P<0.05);且治疗组与对照组比较有显著性差异(P<0.05)。结论:阿司匹林和氯吡格雷双联抗血小板药物治疗ACS,可以强化对血小板聚集的抑制,并增强抗栓效果,值得临床应用。     

急性肾盂肾炎合并尿路感染危险因素与致病微生物特点的临床分析

目的 探讨急性肾盂肾炎合并尿路感染危险因素与致病微生物的特点。方法 选择2017年4月—2018年4月在本院肾内科就诊的急性肾盂肾炎合并尿路感染患者59例,无菌操作收集患者中段尿,导管收集患者膀胱尿。2 h内送检,采用定量接种的方法,将一定量混匀未离心尿液用接种环接种于血平板或麦康凯平板进行细菌培养。相关性分析采用Pearson相关性检验。结果 糖尿病、肺部感染、尿路结石、脑血管疾病和肿瘤是常见的急性肾盂肾炎（APN）合并尿路感染的危险因素。男性中段尿检出率较高的菌种有大肠埃希菌（E. coli）、金黄色葡萄球菌（S. aureus）等;膀胱尿中检出率较高的菌种有大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）。女性中段尿和膀胱尿中检出率较高的菌种均是大肠埃希菌（E. coli）和金黄色葡萄球菌（S. aureus）。女性总住院时间≥4 d的患者比例明显高于男性。APN患者中合并糖尿病与大肠埃希菌（E. coli）和粪肠球菌（E. faecalis）存在正相关,尿路结石与大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）、屎肠球菌（E. faecium）存在正相关。结论 患者尿液中大肠埃希菌（E. coli）最常见,女性APN患者更容易并发尿路感染,住院时间长于男性患者。合并糖尿病的患者更容易患有大肠埃希菌（E. coli）和粪肠球菌（E. faecalis）感染,合并尿路结石的患者更倾向于大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）、屎肠球菌（E. faecium）感染。     

双联抗血小板治疗急性冠脉综合征临床疗效观察

目的：探讨双联抗血小板治疗急性冠脉综合征（ACS）的临床疗效和安全性。方法：60例ACS患者随机分为治疗组和对照组。对照组给予阿司匹林单抗血小板治疗,治疗组采用阿司匹林＋氯吡格雷双联抗血小板治疗,治疗3个月后评价临床疗效。结果：治疗组临床疗效总有效率为93.3%,显著高于对照组（76.7%）,相比较有显著性差异（P〈0.05）;治疗后,两组LVEF、CO、E/A显著上升,与治疗前比较均有显著性差异（P〈0.05）;且治疗组与对照组比较有显著性差异（P〈0.05）。结论：阿司匹林和氯吡格雷双联抗血小板药物治疗ACS,可以强化对血小板聚集的抑制,并增强抗栓效果,值得临床应用。     

Secretion of Immunoreactive endothelin-1 by capillary and microvascular endothelium of human brain

Modulation of immunoreactive endothelin-1 (IR-ET-1) production by vasoactive substances was investigated in cultured endothelial cells (EC) derived from capillaries and microvessels of human brain. Peptides, catecholamines, thrombin, protein kinase C-activating phorbol ester, and calcium ionophore enhanced the secretion of IR-ET-1. The known vasoconstrictive peptides, angiotensin II (Ang II) and arginine-vasopressin (AVP) dose-dependently stimulated the endothelial secretion of IR-ET-1. The angiotensin and vasopressin-inducible production of IR-ET-1 was completely inhibited by their respective receptor antagonists [Sar¹, Ala⁸]-angiotensin II and [1–6 (-mercapto-,-cyclopentamethylene propionic acid), 2-O-methyl-tyrosine]. The results indicate that the peptide-stimulated secretion of IR-ET-1 is receptor-mediated in EC which have specific angiotensin II and arginine-vasopressin receptors. These findings represent the first demonstration of IR-ET-1 production by capillary and microvascular endothelium of human brain.     

Current discharge management of acute coronary syndromes: data from the Rijnmond Collective Cardiology Research (CCR) study

Background

Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge.

Methods

The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guideline-recommended pharmacotherapy at hospital discharge.

Results

At discharge, 94 % of patients received aspirin, 100 % thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. ST-segment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age.

Conclusion

Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation.     

血肌酐与非ST段抬高急性冠脉综合征冠脉病变程度及其预后

目的:研究血清肌酐(serum creatinine,SCr)与非ST段抬高急性冠脉综合征(non-ST-elevation acute coronary syndrome,NSTE-ACS)患者冠脉病变程度及其预后的关系。方法:对293例患者进行回顾性分析,依据冠脉造影结果分为NSTE-ACS组和非冠心病组。根据Gensini积分系统,评价NSTE-ACS患者冠脉病变程度,并将患者分为轻度病变组、中度病变组和重度病变组。检测患者SCr水平,应用SPSS16.0分析SCr与NSTE-ACS患者冠脉病变程度及其预后关系。结果:(1)与非冠心病组相比,NSTE-ACS患者SCr较高(P0.05);其中,重度冠脉病变NSTE-ACS患者SCr水平尤高(P0.001)。(2)SCr是NSTE-ACS冠脉病变的危险因子;SCr与NSTE-ACS冠脉病变程度呈正相关(r=0.263,P0.000);SCr与NSTE-ACS主要心血管不良事件(Major Adverse Cardiovascular Events,MACE)呈正相关(r=0.183,P0.01)。结论:SCr是NSTE-ACS患者冠脉病变的独立危险因子,且与NSTE-ACS患者预后相关。SCr对于NSTE-ACS的诊疗有潜在临床价值。     

Short-term effects of air pollution,markers of endothelial activation,and coagulation to predict major adverse cardiovascular events in patients with acute coronary syndrome: insights from AIRACOS study

The aim of this study was to determine whether markers of inflammation and coagulation are associated with short-term particulate matter exposure and predict major adverse cardiovascular events at 360 d in patients with acute coronary syndrome (ACS). We included 307 consecutive patients, and assessed the average concentrations of data on atmospheric pollution in ambient air and meteorological variables from 1?d up to 7 d prior to admission. In patients with ACS, the markers of endothelial activation and coagulation, but not black carbon exposure, are associated with major adverse cardiovascular events at one-year follow-up.