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Background: The effects of glycemic status on coronary physiology have not been well evaluated. This study aimed to investigate changes in coronary physiology by using angiographic quantitative flow ratio (QFR), and their relationships with diabetes mellitus (DM) and glycemic control status. Methods: This retrospective cohort study included 530 patients who underwent serial coronary angiography (CAG) measurements between January 2016 and December 2021 at Tongji Hospital of Tongji University. Based on baseline and follow-up angiograms, 3-vessel QFR (3V-QFR) measurements were performed. Functional progression of coronary artery disease (CAD) was defined as a change in 3V-QFR (Δ3V-QFR = 3V-QFRfollow-up - 3V-QFRbaseline) ≤-0.05. Univariable and multivariable logistic regression analyses were applied to identify the independent predictors of coronary functional progression. Subgroup analysis according to diabetic status was performed. Results: During a median interval of 12.1 (10.6, 14.3) months between the two QFR measurements, functional progression was observed in 169 (31.9%) patients. Follow-up glycosylated hemoglobin (HbA1c) was predictive of coronary functional progression with an area under the curve (AUC) of 0.599 [95% confidence interval (CI): 0.546-0.651; P<0.001] in the entire population. Additionally, the Δ3V-QFR values were significantly lower in diabetic patients with HbA1c ≥7.0% compared to those with well-controlled HbA1c or non-diabetic patients [-0.03 (-0.09, 0) vs. -0.02 (-0.05, 0.01) vs. -0.02 (-0.05, 0.02); P=0.002]. In a fully adjusted multivariable logistics analysis, higher follow-up HbA1c levels were independently associated with progression in 3V-QFR [odds ratio (OR), 1.263; 95% CI: 1.078-1.479; P=0.004]. Furthermore, this association was particularly strong in diabetic patients (OR, 1.353; 95% CI: 1.082-1.693; P=0.008) compared to patients without DM. Conclusions: Among patients with established CAD, on-treatment HbA1c levels were independently associated with progression in physiological atherosclerotic burden, especially in patients with DM.

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Background: The correlation between percutaneous coronary intervention (PCI)-related microvascular dysfunction (MVD) and plaque characteristics remains unclear. To investigate this correlation and its prognosis, we assessed changes in MVD by angiographic microvascular resistance (AMR) and intracoronary ultrasound scans after PCI. Methods: We conducted a retrospective study that enrolled 250 patients with coronary artery disease between July 2016 and December 2018. We collected demographic characteristics, laboratory tests, coronary angiography (CAG) and intracoronary ultrasound findings. We calculated quantitative flow ratio (QFR) and AMR by CAG. The endpoint was vessel-oriented composite outcomes (VOCOs). Results: After 47 exclusions, we divided 203 cases into a deteriorated group (n=139) and an improved group (n=64) based on AMR change after PCI. Compared with the improved group, the deteriorated group had smaller lumen area [3.03 (interquartile range, 2.20-3.91) vs. 3.55 mm2 (interquartile range, 2.45-4.57), P=0.033], higher plaque burden [78.92% (interquartile range, 73.95-82.61%) vs. 71.93% (interquartile range, 62.70-77.51%), P<0.001], and higher proportion of lipidic components (13.86%±4.67% vs. 11.78%±4.41%, P=0.024). Of 186 patients who completed 4.81±1.55 years follow-up, 56 developed VOCOs. Receiver-operating characteristic (ROC) curve analysis showed post-PCI AMR and VOCOs correlation (area under the curve: 0.729, P<0.001). Multivariate regression analysis showed post-PCI AMR >285 mmHg·s/m correlated with adverse outcome (hazard ratio =4.350; 95% confidence interval: 1.95-9.703; P<0.001). Conclusions: Intravascular ultrasound (IVUS) imaging and AMR revealed an association of post-PCI MVD with a smaller lumen area, more severe plaque burden, and a higher percentage of lipidic components. Post-PCI MVD was an independent risk factor for poor prognosis.

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Coronary angiography (CAG) provides two-dimensional images, but a clinician who is experienced in percutaneous coronary interventions can use information from these images to interpret spatial depth and infer the three-dimensional (3D) locations of vessels. We hypothesized that CAG results were equivalent to the mirror image of a coronary artery perspective projection, and a stereo perception could be easily established when the viewpoint of the angiogram was the X-ray tube instead of the detector. To eliminate the influence of heartbeat and respiration, a 3D-printed a coronary artery model was constructed for analysis. The effects of gantry movements during digital subtraction angiography (DSA) on the image were used to identify factors that affected DSA image transformation. Then, based on these factors, DSA imaging was simulated using UG NX software with three methods: (i) a perspective projection with the detector as the viewpoint; (ii) a parallel projection; and (iii) a mirror image of the perspective projection with the X-ray tube as the viewpoint. Finally, the resulting 3D images were compared with the DSA image. Our mirror image of the coronary artery perspective projection that used the X-ray tube as the viewpoint fused precisely with the CAG results and provided exact simulations of all the effects of DSA gantry movements on the DSA image. CAG results were equivalent to the mirror image of coronary artery perspective projection, and the stereo perception was easily established using the X-ray tube as the viewpoint.

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Background: Previous studies have shown that malnutrition is very common in patients with congestive heart failure (CHF) and is closely related to the occurrence of acute kidney injury. However, the relationship between malnutrition and contrast-associated acute kidney injury (CA-AKI) is unclear. Method and results: We obtained data from 842 patients who were diagnosed with CHF following coronary angiography (CAG) or percutaneous coronary angiography (PCI) and had follow-up information from January 2013 to February 2016. The patients were divided into 3 groups according to the Controlling Nutritional Status Score before CAG or PCI procedure (Group 1: Normal; Group 2: Mild Malnutrition; Group 3: Moderate to Severe Malnutrition). The main endpoint was CA-AKI. Univariate and multivariable logistic regression analyses were performed. 556 (60.0%) patients suffered from malnutrition before CAG or PCI. During a median follow-up of 2.1 years, A total of 49 (5.82%) patients developed CA-AKI. Additionally, 5 (1.75%), 26 (6.27%) and 18 (12.77%) events were documented in patients with normal, mild and moderate or severe malnutrition, respectively (p < 0.01). In multivariable-adjusted models, patients with malnutrition showed a significantly higher incidence of CA-AKI than those in the normal group. Conclusion: Malnutrition is an independent risk factor for CA-AKI in CHF patients following CAG.

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Background: Old age and the presence of aortic stenosis are associated with the unfolding of the intrathoracic aorta. This may result in increased difficulties navigating catheters from the right compared to the left radial approach. Objective: To investigate whether increasing age or presence of severe aortic stenosis was associated with increased catheterization success rates from left (LRA) compared to right radial artery approach (RRA). Methods: We compared coronary angiography success rates of RRA and LRA according to different age groups and in a subgroup of patients with severe aortic stenosis. Results: A total of 21,259 coronary angiographies were evaluated. With increasing age, the first pass success rate from either radial access decreased significantly (p < 0.001). In patients aged <85 years, there was no difference between LRA and RRA. However, in patients aged ≥85 years, LRA was associated with significantly higher success rates compared to RRA (90.1 vs. 82.8%, p = 0.003). Patients aged ≥85 years received less contrast agent and had shorter fluoroscopy time when LRA was used [86.6 ± 41.1 vs. 99.6 ± 48.7 ml (p < 0.001) and 4.5 ± 4.1 min vs. 6.2 ± 5.7 min (p < 0.001), mean (±SD)]. In patients with severe aortic stenosis (n = 589) better first pass success rates were observed via LRA compared to the RRA route (91.9 vs. 85.1%, p = 0.037). Conclusion: LRA, compared to RRA, is associated with a higher first-pass catheter success rate for coronary artery angiography in patients aged ≥85 years and those with severe aortic stenosis.

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Background: Different definitions of contrast-associated acute kidney injury (CA-AKI) have different predictive effects on prognosis. However, few studies explored the relationship between these definitions and long-term prognosis in patients with congestive heart failure (CHF). Thus, we aimed to evaluate this association and compared the population attributable risks (PAR) of different CA-AKI definitions. Methods: This study enrolled 2,207 consecutive patients with CHF undergoing coronary angiography (CAG) in Guangdong Provincial People's Hospital. Two different definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥.5 mg/dl or > 25% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase of ≥.3 mg/dl or > 50% in SCr from baseline within 48 h after CAG. Kaplan-Meier methods and Cox regression were applied to evaluate the association between CA-AKI with long-term mortality. Population attributable risk (PAR) of different definitions for long-term prognosis was also calculated. Results: During the 3.8-year median follow-up (interquartile range 2.1-6), the overall long-term mortality was 24.9%, and the long-term mortality in patients with the definitions of CA-AKIA and CA-AKIB were 30.4% and 34.3%, respectively. We found that CA-AKIA (HR: 1.44, 95% CI 1.19-1.74) and CA-AKIB (HR: 1.48, 95% CI 1.21-1.80) were associated with long-term mortality. The PAR was higher for CA-AKIA (9.6% vs. 8%). Conclusions: Our findings suggested that CA-AKI was associated with long-term mortality in patients with CHF irrespective of its definitions. The CA-AKIA was a much better definition of CA-AKI in patients with CHF due to its higher PAR. For these patients, cardiologists should pay more attention to the presence of CA-AKI, especially CA-AKIA.

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Objective To summarize the incidence of cardiac allograft vasculopathy (CAV) after heart transplantation and the effect on the long-term survival of recipients. Methods Clinical data of 1 006 heart transplant recipients were retrospectively analyzed. Of 48 CAV patients, 4 cases were not included in this analysis due to lack of imaging evidence. A total of 1 002 recipients were divided into the CAV group (n=44) and non-CAV group (n=958) according to the incidence of CAV. The incidence of CAV was summarized. Clinical data of all patients were statistically compared between two groups. Imaging diagnosis, coronary artery disease, drug treatment and complications, postoperative survival and causes of death of CAV patients were analyzed. Results Among 1 006 heart transplant recipients, 48 cases (4.77%) developed CAV. Compared with the non-CAV group, the proportion of preoperative smoking history, preoperative hypertension history, coronary artery disease and perioperative infection was significantly higher in the CAV group (all P < 0.05). Among 44 patients diagnosed with CAV by imaging examination, 24 cases were diagnosed with CAV by coronary CT angiography (CTA), 4 cases by coronary angiography (CAG), and 16 cases by coronary CTA combined with CAG. Among 44 patients, the proportion of grade Ⅰ CAV was 45% (20/44), 30% (13/44) for grade Ⅱ CAV and 25% (11/44) for grade Ⅲ CAV, respectively. All patients received long-term use of statins after operation, and 20 patients were given with antiplatelet drugs. Among 44 CAV patients, 11 patients underwent percutaneous coronary intervention, 6 cases received repeated heart transplantation, and 8 patients died. Kaplan-Meier survival analysis demonstrated that there was no significant difference in the long-term survival rate between the CAV and non-CAV groups (P > 0.05), whereas the survival rate of patients tended to decline after the diagnosis of CAV (at postoperative 6-7 years). The long-term survival rates of patients with grade Ⅰ, grade Ⅱ and grade Ⅲ CAV showed no significant difference (P > 0.05). Even for patients with grade Ⅰ CAV, the long-term survival rate tended to decline. Conclusions CAV is a common and intractable complication following heart transplantation, and the long-term survival rate of patients after the diagnosis of CAV tended to decline. Deepening understanding of CAV, prompt prevention, diagnosis and treatment should be delivered to improve the long-term survival rate of patients after heart transplantation.

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BACKGROUND: Conventional coronary angiography (CAG) is currently the gold standard technique for the assessment of coronary arteries prior to cardiac valve surgery. Although CAG is a relatively safe procedure, however, it is still an invasive procedure, and it has potential hazards and complications. Coronary computed tomography angiography (CCTA) is a non-invasive technique that has emerged robustly as an excellent and attractive tool for delineating coronary anatomy. Therefore, we sought to evaluate the accuracy of CCTA when compared with the gold standard CAG in the evaluation of coronary arteries before valve surgery. We screened 111 consecutive patients with VHD undergoing a routine cardiac catheterization for preoperative evaluation of CAD. Fifty patients were eligible and underwent both CAG and CCTA. Significant coronary stenosis was defined as a luminal diameter decrease of ≥ 50%. Additionally, ectasia, calcifications, and congenital coronary anomalies were analyzed. Also, we compared both techniques regarding radiation dose, contrast volume, and complications. Non-evaluable segments were excluded from all levels of analysis. Sixty-one patients were excluded from the study due to various reasons. RESULTS: Among the 50 patients of the study population, 27 (54%) were males. The prevalence of significant CAD in the study population was 19.6% according to the patient-based analysis, and CAG could have been avoided in 80.4% of patients with a true-negative CCTA result. Diagnostic accuracy of CCTA for detection of significant stenosis was evaluated regarding sensitivity and specificity, positive predictive value, negative predictive value, and overall accuracy of CCTA, which was 87.5%, 99.6%,87.5%, 99.6%, and 99.2%, respectively, for segmental-based analysis; 86%, 100%, 100%, 99%, and 99%, respectively, for vessel-based analysis; and 77.8%,100%,100%, 94.9%, and 95.7%, respectively, for patient-based analysis. Fewer rates of complications were encountered with CCTA. Additional information obtained like calcifications and congenital anomalies was diagnosed better with CCTA than CAG. CONCLUSION: Owing mainly to its high negative predictive value, a well-performed CCTA exam is an excellent method to rule out coronary artery disease, specially in patients who are not at high risk of atherosclerosis.

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BACKGROUND: This study aimed to establish a non-invasive and simple screening model of coronary atherosclerosis burden based on the associations between multiple blood parameters and total plaque score (TPS), segment-stenosis score (SSS), coronary artery disease severity (CADS) in coronary artery disease (CAD) and thus reduce unnecessary coronary angiography (CAG). METHODS: A total of 1,366 patients with suspected CAD who underwent CAG were included in this study. The clinical risk factors [age, gender, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein (HDL), triglyceride (TG), low-density lipoprotein (LDL), fasting plasma glucose (FPG), and glycated hemoglobin (GHB)] were collected. The presence of plaques and lumen stenosis was assessed based on CAG imaging. The TPS, SSS, and CADS were calculated, and the distribution spectrum of atherosclerotic plaques was described. Kruskal-Wallis test for multiple comparison tests was performed to analyze the differences in groups of different risk factors. The selected independent predictors were put into a multivariate logistic model, and the variables were further screened by stepwise regression to establish a screening model. Finally, the receiver operating characteristic (ROC) curve was used to evaluate the selected model's discriminant effect. RESULTS: The distributions of TPS and SSS scores were both right-skewed. Among males, both TPS and SSS scores were higher than in females (χ2=46.7659, P<0.0001, χ2=51.6603, P<0.0001). Both TPS and SSS scores increased with age (χ2=123.4456, P<0.0001, χ2=123.4456, P<0.0001). For TPS, the most common position was proximal left anterior descending artery (P-LAD, 51.39%). In SSS, the P-LAD plaque was highest: 0: 48.61%, 1: 10.32%, 2: 9.15%, and 3: 31.92%. The TPS score >5, SSS score >5, and CAD >0 were valuable indicators for SBP, FPG, TG, HDL, and GHB. In the model, TPS score >5, SSS score >5, and CADS >0, the area under ROC curve (AUC) was 0.753 [95% confidence interval (CI): 0.713 to 0.789], 0.728 (95% CI: 0.687 to 0.766), and 0.756 (95% CI: 0.717 to 0.793), respectively. CONCLUSIONS: The most common site of lesions was P-LAD. These models can be used as non-invasive and simple initial screening tools without CAG.

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BACKGROUND: This study aimed to identify the determinant factors of survival in patients with acute myocardial infarction (AMI) and refractory cardiogenic shock (RCS) who underwent veno-arterial extracorporeal membrane oxygenation (ECMO). METHODS: Sixty-nine consecutive patients with AMI-related RCS were enrolled in the study. They were treated with ECMO and primary percutaneous coronary intervention (PCI). The clinical scores and coronary angiography (CAG) factors related to 100-day survival were evaluated. RESULTS: Thirty patients (43.5%) survived for more than 100 days. The CAG showed that 19 (27.5%) patients had left main disease (LMD). There were 17 (24.6%), 27 (39.1%), and 25 (36.3%) patients with one-vessel, two-vessel, and three-vessel disease, respectively. There were significant differences between the survivors and non-survivors in the simplified acute physiology score II (SAPSII) (65.4±17.2 vs. 83.1±13.0, P<0.001), sepsis-related organ failure assessment score (SOFA) (10.4±2.7 vs. 12.3±2.5, P=0.004), survival after veno-arterial extracorporeal membrane oxygenation score (SAVE) (-4.4±4.3 vs. -8.4±3.1, P<0.001), CPR time (15.8±16.6 vs. 30.0±29.5, P=0.048), LMD [4 (13.3%) vs. 15 (38.5%), P=0.029], and number of coronary artery disease (NCAD) (P<0.001). Multivariate logistic regression analysis showed that NCAD (OR 3.788, P=0.008) was one of the independent predictors of mortality. The ROC analysis showed that SAPSII (AUC 0.786, P<0.001), SOFA (AUC 0.715, P=0.002), and SAVE (AUC 0.766, P<0.001) equally predict mortality. The combined NCAD parameters more accurately predicted mortality and differences in the AUC values (d-AUC) between SAPSII plus NCAD vs. SAPSII (d-AUC 0.073, z=2.256, P=0.024), SOFA plus NCAD vs. SOFA (d-AUC 0.058, z=2.773, P=0.006), and SAVE plus NCAD vs. SAVE (d-AUC 0.036, z=2.332, P=0.020). CONCLUSIONS: The SAPSII, SOFA, and SAVE scores predict the prognosis of ECMO-treated AMI patients with RCS. The CAG findings reinforce the predictive power of each score.

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BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a common complication of coronary angiography (CAG), which is associated with worse prognosis. Some studies indicated ß-blockers could preserve renal function among patients with acute myocardial infarction (AMI), but the relationship between ß-blockers and CI-AKI has not been well documented among patients with AMI who were undergoing CAG or percutaneous coronary intervention (PCI). METHODS: In this prospective, observational study, 1,309 AMI patients who were undergoing CAG or PCI were consecutively recruited between January 2010 and December 2013. Patients were assigned into ß-blockers group (n=1,074) or non-ß-blockers group (n=235) according to use or non-use of ß-blockers (including metoprolol tartrate/metoprolol succinate/Bisoprolol Fumarate) within 24 hours of perioperative period. CI-AKI was defined as an absolute increase of >0.5 mg/dL from baseline serum creatinine (SCr) within 48-72 hours after contrast medium (CM) exposure. RESULTS: The overall incidence of CI-AKI was 247/1,309 (18.9%).After multivariate adjusting, a total of 10 variables were related to CI-AKI, including ß-blockers [ß-blockers group vs. non-ß-blockers group: odds ratio (OR) =0.520; 95% confidence interval (CI), 0.291-0.930; P=0.027], age, diabetes mellitus, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, left ventricular ejection fraction (LVEF) <40%, use of intra-aortic balloon pump (IABP), peri-hypotension, emergent PCI, coronary lesions and CM dose >200 mL. During the mean follow-up of 2.35±0.99 years, the ß-blockers group was significantly associated with lower rates of mortality [ß-blockers group vs. non-ß-blockers group: adjusted hazard ratio (HR) =0.43; 95% CI, 0.27-0.71; P=0.001] among patients with AMI. CONCLUSIONS: Use of ß-blockers within 24 hours of perioperative period may be associated with lower rates of CI-AKI and long-term mortality among patients with AMI who are undergoing CAG or PCI. TRIAL REGISTRATION: PRECOMIN, ClinicalTrials.gov NCT01400295.

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BACKGROUND: A few simple and pre-procedural risk models have been developed for predicting contrast-induced nephropathy (CIN), which allow for early administration of preventative strategies before coronary angiography (CAG). The study aims to develop and validate simple pre-procedure tools for predicting risk of CIN following CAG. METHODS: We retrospectively analyzed the data from 3,469 consecutive patients undergoing CAG, who were randomly assigned to a development dataset (n=2,313) and a validation dataset (n=1,156). CIN was defined as an increase in serum creatinine (SCr) ≥0.5 mg/dL from baseline within 72 hours after CAG. Multivariate logistic regression was applied to identify independent predictors of CIN to develop risk models. The possible predictors included age >75 years, hypotension, acute myocardial infarction (AMI), SCr ≥1.5 mg/dL, and congestive heart failure (CHF). RESULTS: The incidences of CIN were 3.20% and 3.55% in the training and validation dataset respectively. Compared to classical Mehran' and ACEF CIN risk score, the new score across the validation dataset exhibited similar discrimination and predictive ability on CIN (c-statistic: 0.829, 0.832, 0.812 respectively) and in-hospital mortality (c-statistic: 0.909, 0.937, 0.866 respectively) (all P>0.05). CONCLUSIONS: The easy-to-use pre-procedural prediction model only containing 5 factors had similar predictive ability on CIN and mortality.

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BACKGROUND: Coronary angiography (CAG) and fractional flow reserve (FFR) are currently used to identify the lesions and guide the treatment of unstable angina (UA) patients. This study aims to compare the two methods and investigate factors affecting FFR value. METHODS: A total of 284 UA patients (296 coronary artery lesions) were enrolled from the Emergency Department of Anzhen Hospital Affiliated to Capital Medical University from January 2017 to December 2017. CAG and FFR determination were performed in all patients, and the roles of these two methods in guiding the treatment of UA were compared and analyzed. The subjects were divided into FFR ≤0.8 group and FFR >0.8 group. The general data and laboratory findings were compared between these two groups, and the possible influential factors were analyzed. The statistical analysis of t-test or chi square test was done with SPSS 20.0 software. RESULTS: Of 296 UA lesions, 160 (54.1%) had ≥75% angiographic stenosis and 136 (45.9%) had <75% angiographic stenosis; 168 (56.8%) had an FFR value of ≤0.8 and 128 (43.2%) had an FFR value >0.8. There was no significant difference between these two examination methods (P=0.508, χ2=0.438). Further analysis showed that 43 (26.9%) of the 160 lesions with ≥75% stenosis had an FFR value of >0.8 and did not require PCI; 49 (38.3%) of the 128 lesions with 50-70% stenosis had an FFR value of ≤0.8 and needed PCI; 2 of 8 patients with <50% stenosis had an FFR value of ≤0.8 and needed PCI. If FFR was used as the "gold standard" of PCI, the sensitivity, specificity, positive predictive value, and negative predictive value of CAG in guiding PCI for UA were 69.6%, 66.4%, 73.1%, and 62.5%, respectively. Multivariate analysis with Logistic regression revealed low high-density lipoprotein (HDL) and hypertension were independent risk factors of FFR <0.8 in UA patients. CONCLUSIONS: CAG and FFR readings could be different. A combination of CAG and FFR may help to achieve more accurate and tailored treatment of UA. The history of hypertension is an independent risk factor for FFR in UA patients, and HDL is an independent protective factor.

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Objective To investigate the relationship between ischemia-modified albumin (IMA) and coronary artery stenosis in patients without myocardial infarction.Methods For this study we consecutively enrolled 345 patients who received coronary angiography (CAG).According to the results,the subjects were divided into coronary stenosis group (232 cases)and control group (113 cases)to investigate the the relationship of IMA and IMA/albumin (IMAr)with coronary stenosis.Results ① The levels of IMA and IMAr in coronary stenosis group were higher than those in control group (P＜0.001).② The IMA and IMAr were higher in single-branch and multi-branch lesion groups than in control group (P＜0.05),whereas there was no significant difference between single-branch lesion group and multi-branch lesion group (P＞0.05).③ In receiver operating characteristics curve analysis,the sensitivity of IMA and IMAr was 64.4% and 78.0%,respectively (AUC:0.653,0.705,P＜0.001)in predicting coronary stenosis.④ Multivariate logistic regression analysis showed that IMAr was an independent risk factor for coronary stenosis in patients without myocardial infarction (OR=73.05,P＜0.001).Conclusion IMA and IMAr are closely correlated with coronary stenosis and have a value in predicting coronary artery stenosis in patients without myocardial infarction.

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Objective To investigate the relationship of high sensitivity C reactive protein (hs-CRP), interleukin-6 (IL-6)and soluble IL-6 receptor (sIL-6R)with the severity of clinical symptoms and coronary artery lesions in coronary heart disease (CHD)patients.Methods A total of 522 CHD patients were recruited and divided into three groups:stable angina pectoris (SAP),unstable angina pectoris (UAP)and acute myocardial infarction (AMI)groups.Another 102 healthy individuals served as normal controls (NCs).We calculated Gensini score according to the result of coronary angiography (CAG),collected clinical data and compared the groups. Multiple linear regression analysis was used to investigate the relationship of hs-CRP,IL-6 and sIL-6 R with Gensini score.Results The plasma hs-CRP,IL-6 levels were significantly higher and sIL-6R level was signficantly lower in SAP,UAP and AMI groups than in NC group (P<0 .0 5 ).There was a positive correlation between IL-6 level and Gensini score but a negative correlation between sIL-6 R and Gensini score presented by multiple linear regression analysis (P<0.05 ).Conclusion In CHD patients,plasma hs-CRP,IL-6 and sIL-6R levels are significantly related to the severity of clinical manifestations and coronary artery stenosis.These indicators may help predict the severity of CHD.

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To compare the feasibility, efficiency and safety of coronary angiography (CAG) and interventional procedures between the radial and femoral catheterization approaches in Chinese population using systematic review and meta-analysis, we conducted a search of the studies comparing radial and femoral catheterization approaches in patients underwent either CAG or percutaneous coronary intervention (PCI) in Chinese population. Fixed-effect relative risk (RR) for the primary end points and the second end points were compared between the two approaches. A total of 27 studies (n=8,749 patients) were finally included in the analysis. The success rate of radial approach was slightly lower than that of femoral approach in patients receiving CAG (P=0.004), but similar in patients receiving a further PCI treatment (P=0.11). The risk of major adverse cardiovascular events (MACEs) was similar between two approaches (P=0.27). Radial catheterization had a significantly lower rate of puncture site complications (P<0.00001), but a lower rate of puncture success rate (P=0.02). In patients with acute myocardial infarction (AMI), there was no difference in neither the risk of MACEs nor PCI success rate between two approaches (P=0.23 and 0.45, respectively), but a board line decrease of puncture success rate was observed in radial catheterization group (P=0.04). There were no significant differences in the volumes of contrast media, X-ray exposure time and operation time between the two approaches (all P>0.05). Thus, we concluded that radial approach is a safe method for CAG or PCI compared to traditional femoral approach in Chinese population due to their similar success rate of the procedure and risk of MACEs, and a decreased risk of puncture site complications.

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BACKGROUND: Coronary stenosis is the main cause of the coronary heart disease (CHD). However, coronary arteriography (CAG), which is considered as the 'gold standard' of determining the location and severity of CHD, hardly acquires a satisfactory image for some lesions by traditional viewing angles. OBJECTIVE: We proposed a new approach to calculate the optimal viewing angles of CAG system to observe vessel segment of interest. METHODS: Firstly, the 4-D coronary arteries are segmented to obtain a dynamic vessel model. Then, a "rendering" method in computer graphics is used to calculate the optimal viewing angles of the vessel segment in the entire cardiac cycle. At last, an intersection of these angles can be regarded as the optimal ones in the whole cardiac cycle. RESULTS: Within the constraint of 2% foreshortening, the single phase data show 1% foreshortening without overlapping at the optimal angles proposed by our method, compared with 1.8% foreshortening at working angles set by clinical experts. And the multi-phase experiments also have good results. CONCLUSIONS: The new approach can provide doctors optimal viewing angles of interested vessel segment in the whole cardiac cycle.

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BACKGROUND: Kawasaki disease usually affects infants and young children. It often goes unrecognized in adults due to varying symptoms and lack of definite diagnostic criteria. OBJECTIVES: To describe the potential for acute myocardial infarction as a complication of antecedent Kawasaki Disease (KD). CASE REPORT: We describe a case of a 19-year-old man who presented to the Emergency Department (ED) with an acute myocardial infarction that was subsequently determined to be the result of previously untreated KD. CONCLUSION: Kawasaki disease can cause coronary complications in a teenager. A high level of suspicion in the ED can help in proper management of these patients.

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