Circulating t-PA antigen predicts major adverse coronary events in patients with stable coronary artery disease – a 13-year follow-up

2003 ◽  
Vol 90 (08) ◽  
pp. 344-350 ◽  
Author(s):  
Alexander Niessner ◽  
Senta Graf ◽  
Mariam Nikfardjam ◽  
Walter Speidl ◽  
Renate Huber-Beckmann ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Predictive Value ◽  
Odds Ratio ◽  
Coronary Events ◽  
Artery Disease ◽  
Prognostic Power

SummaryThrombus formation after rupture of an atherosclerotic plaque plays a crucial role in coronary artery disease (CAD). A decreased endogenous fibrinolytic system and prothrombotic factors are supposed to influence coronary thrombosis. It was our aim to investigate the predictive value of tissue plasmino-gen activator (t-PA) antigen, von Willebrand Factor, Lipoprotein (a) and anti-cardiolipin antibodies for major adverse coronary events in patients with stable CAD in a prospective cohort study of more than 10 years.We observed 141 patients with angiographically proven CAD for a median follow-up period of 13 years. t-PA antigen was the only marker predicting coronary events (logistic regression, p = 0.044) with a poor prognosis for patients in the 5th quintile with an odds ratio of 7.3 (compared to the 1st quintile). The odds ratio even increased to 10.0 for coronary events associated with the “natural course” of CAD excluding events due to restenosis. t-PA antigen had a slightly higher prognostic power (ROC curve; AUC = 0.69) than fasting glucose (AUC = 0.68) and cholesterol (AUC = 0.67). Triglycerides influenced plasma levels of t-PA antigen (regression, p < 0.001). The predictive value of t-PA antigen remained significant after adjustment for inflammation (logistic regression, p = 0.013) and extent of CAD (p = 0.045) but disappeared adjusting for insulin resistance (p = 0.12).In conclusion t-PA antigen predicted coronary events during a very long-term follow-up with a comparable prognostic power to established cardiovascular risk factors. Markers of insulin resistance influenced t-PA antigen and its predictive value.Part of this paper was originally presented at the joint meetings of the 16th International Congress of the International Society of Fibrinolysis and Proteolysis (ISFP) and the 17th International Fibrinogen Workshop of the International Fibrinogen Research Society (IFRS) held in Munich, Germany, September 2002.

scholarly journals The Chromosome 9p21 Variant Not Predicting Long-Term Cardiovascular Mortality in Chinese with Established Coronary Artery Disease: An Eleven-Year Follow-Up Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
I-Te Lee ◽  
Mark O. Goodarzi ◽  
Wen-Jane Lee ◽  
Jerome I. Rotter ◽  
Yii-der Ida Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Mortality ◽  
Odds Ratio ◽  
Recessive Model ◽  
Dominant Model ◽  
Chromosome 9P21 ◽  
Artery Disease

Introduction. We examined whether the variant at chromosome 9p21, rs4977574, was associated with long-term cardiovascular mortality in Han Chinese patients with coronary artery disease (CAD).Methodology. Subjects who underwent coronary angiography for chest pain were consecutively enrolled. Fasting blood samples were collected for laboratory and genotype assessments. The information was correlated with data collected from the national death database.Results. There were 925 cases with CAD and 634 without CAD enrolled in the present study. The G allele conferred a significant increase in risk of CAD (odds ratio = 1.47,P=0.003in the dominant model; odds ratio = 1.36,P=0.018in the recessive model). During a median of 11 years (inter-quartile range between 5.2 and 12.5 years) of follow-up, neither the total nor the cardiovascular mortality was different among CAD subjects with different genotypes. Using Cox regression analysis, genotypes of rs4977574 still failed to predict cardiovascular mortality (hazard ratio = 1.25,P=0.138in the dominant model; hazard ratio = 1.05,P=0.729in the recessive model).Conclusions. The rs4977574 at chromosome 9p21 is associated with presence of CAD in Han Chinese. However, rs4977574 could not predict cardiovascular mortality in these CAD subjects during the eleven-year period of the study.

TCF21 variant is a risk factor for coronary artery disease and will it be a prognostic marker?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Temtem ◽  
M Serrao ◽  
A Pereira ◽  
M Santos ◽  
F Mendonca ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Cox Regression ◽  
Multivariate Logistic Regression Analysis ◽  
Rank Test ◽  
Major Adverse Cardiovascular Events ◽  
Multivariate Logistic Regression ◽  
Artery Disease

Abstract Background TCF21 gene, encodes a basic-helix- loop- helix transcription factor, playing a critical action in the development of epicardial progenitor cells that give rise to coronary artery smooth muscle cells (SMC) and cardiac fibroblasts. Recent data suggest that TCF21 may play a role in the state of differentiation of SMC precursor cells that migrate to vascular lesions and contribute to fibrous cap. Purpose Investigate the association of TCF21 rs12190287G&gt;C variant with coronary artery disease (CAD) in a Portuguese population and its role on the prognosis. Methods Case-control study with 3120 participants, 1687 coronary patients with at least 75% obstruction of a major coronary artery and 1433 controls. Genotyping used the TaqMan technique (Applied Biosystems) and then a univariate and multivariate logistic regression analysis were performed. After a mean follow-up of 5.01±4.2 years (interquartile range 1.96–7.57), the occurrence of the combined Major Adverse Cardiovascular Events (MACE) (Cardiovascular Mortality, non-fatal Myocardial Infarction, new Revascularization, Cerebrovascular Disease and Peripheric Vascular Disease) were registered and analysed by Cox regression. Finally, Kaplan-Meier survival estimate was performed. Results In the total population, GC+CC genotype was found to be associated with CAD with an OR of 1.285; CI: 1.022–1.614; p=0.031. After multivariate logistic regression, adjusted to traditional risk factors, the association with CAD remained significant for this genotype (OR=1.340; CI: 1.042–1.723; p=0.022).After Cox regression adjusted for confounding variables (age and sex, hypertension, diabetes, smoking, dyslipidemia, eGFR, Ejection fraction &lt;55) the mutated genotype remained a significant predictor of MACE (HR=1.420; CI: 1.032–1.953; p=0.031). The individuals carrying the mutated allele (GC+CC) at the mean follow-up showed an event probability of 36.1%, whereas the wild population (GG) presented only 23.4%. The Log-Rank test showed significant differences between the two curves (p=0.019). Conclusion The mutated TCF21 variant can provide a new marker to identify patients at high cardiovascular risk and may representa potential target for gene therapy in future. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Clinical Outcomes of Mitral Annuloplasty with Flexible Bands in Ischemic Mitral Regurgitation

2018 ◽  
Vol 21 (5) ◽  
pp. E345-E351 ◽  
Author(s):  
Mehmet Adnan Celkan ◽  
Ismail Kork ◽  
Abdullah Ulucay
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Odds Ratio ◽  
Ischemic Mitral Regurgitation ◽  
Redo Surgery ◽  
Cox Regression Analysis ◽  
Artery Disease

Background: In this study, we present the outcomes of 53 patients with concomitant coronary artery disease and ischemic mitral regurgitation (IMR)who underwent coronary bypass grafting (CABG) plus mitral repair (flexible posterior band annuloplasty). Materials and Methods: A total of 53 patients with concomitant ischemic mitral regurgitation  and coronary artery disease underwent CABG plus posterior mitral band annuloplasty between June 2008 and June 2015. Flexible Duran AnCore® annuloplasty band (Medtronic) was used in all patients. Transesophageal echocardiography (TEE) was intraoperatively performed in all patients. A transthoracic (TTE) follow-up examination was performed at postoperative months 1, 3, 6, and 12. Results: The average cross-clamp and cardiopulmonary bypass times were 85.11 ± 5.79 and 105.98 ± 6.14 minutes, respectively. Postoperatively, there was an improvement in the grade of mitral regurgitation from 3.8 to 0.7 and in the NYHA class from 3.1 ± 0.5 to 0.5 ± 0.6 (both P < .001). In addition, statistically significant reductions in LVEDD, LVESD, and PAP were observed (P < .001). Ejection fraction rose from 39 ± 10% to 45 ± 8% (P < .01). Early mortality rate was 7.5% (n = 4). Mean follow-up was at 16 months. Late mortality occurred in one patient. During the follow-up period, reoperation was required in 2 patients. Only 2 parameters, redo surgery (P = .030) and IABP use (P = .021), were found related to mortality (P < .001). Cox regression analysis showed that redo surgery and postoperative bleeding increased mortality by 14.731 times (odds ratio: 14.731; 95% confidence interval [CI]: 1.530-141.852) and 23.839 times (odds ratio: 23.839; 95% CI: 1.478-348.641). Discussion: In patients with IMR, mitral band annuloplasty performed in conjunction with CABG was associated with an increase in functional capacity and ejection fraction as well as a reduction in LVEDD and LVESD. This approach represents a feasible alternative with low mortality and  prevents future development of mitral regurgitation and the need for redo surgery.

scholarly journals Insulin resistance genetic risk score and burden of coronary artery disease in patients referred for coronary angiography

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252855
Author(s):  
Regitze Skals ◽  
Maria Lukács Krogager ◽  
Emil Vincent R. Appel ◽  
Theresia M. Schnurr ◽  
Christian Theil Have ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Risk Score ◽  
Genetic Risk ◽  
Genetic Risk Score ◽  
Vessel Coronary Artery Disease ◽  
Artery Disease ◽  
Vessel Coronary Artery

Aims Insulin resistance associates with development of metabolic syndrome and risk of cardiovascular disease. The link between insulin resistance and cardiovascular disease is complex and multifactorial. Confirming the genetic link between insulin resistance, type 2 diabetes, and coronary artery disease, as well as the extent of coronary artery disease, is important and may provide better risk stratification for patients at risk. We investigated whether a genetic risk score of 53 single nucleotide polymorphisms known to be associated with insulin resistance phenotypes was associated with diabetes and burden of coronary artery disease. Methods and results We genotyped patients with a coronary angiography performed in the capital region of Denmark from 2010–2014 and constructed a genetic risk score of the 53 single nucleotide polymorphisms. Logistic regression using quartiles of the genetic risk score was performed to determine associations with diabetes and coronary artery disease. Associations with the extent of coronary artery disease, defined as one-, two- or three-vessel coronary artery disease, was determined by multinomial logistic regression. We identified 4,963 patients, of which 17% had diabetes and 55% had significant coronary artery disease. Of the latter, 27%, 14% and 14% had one, two or three-vessel coronary artery disease, respectively. No significant increased risk of diabetes was identified comparing the highest genetic risk score quartile with the lowest. An increased risk of coronary artery disease was found for patients with the highest genetic risk score quartile in both unadjusted and adjusted analyses, OR 1.21 (95% CI: 1.03, 1.42, p = 0.02) and 1.25 (95% CI 1.06, 1.48, p<0.01), respectively. In the adjusted multinomial logistic regression, patients in the highest genetic risk score quartile were more likely to develop three-vessel coronary artery disease compared with patients in the lowest genetic risk score quartile, OR 1.41 (95% CI: 1.10, 1.82, p<0.01). Conclusions Among patients referred for coronary angiography, only a strong genetic predisposition to insulin resistance was associated with risk of coronary artery disease and with a greater disease burden.

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