Comparison of Angiographic Severity of Coronary Artery Disease between Premenopausal and Postmenopausal Women with Acute Coronary Syndrome

Background: The risk of coronary artery disease in women after menopause sharply rises in contrast to that of women before menopause because of hormonal protection against atherosclerosis. No research work has been done so far to see the angiographic pattern and severity of coronary artery disease in premenopausal women and their comparison with those of postmenopausal women. This study will help understand the pattern and severity of CAD both in premenopausal and postmenopausal women. Methods: This cross sectional analytical study was conducted over 100 ACS female patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. Among them 50 patients were premenopausal status with CAD constituted study group I and another 50 postmenopausal women with CAD constituted study group II. The main objective of the study was to compare the angiographic severity of coronary artery disease between premenopausal and postmenopausal women with acute coronary syndrome. Angiographic severity of CAD was assessed by vessel score, Gensini score and Friesinger score. Results: LAD was the common artery involved (76% vs. 56%) followed by RCA (72% vs. 36%) and LCX (62% vs. 30%) in group-II compared to group-I and involvement of individual coronary artery was statistically significant (P values were 0.03, 0.003 and 0.001 respectively). Critical stenosis (70-99%) involving the all three major epicardial vessels (LAD, LCX and RCA) were found most frequently in group-II and the percentage of lesions were 56% vs. 30%; 56% vs. 22% and 54% vs. 22% respectively (p< 0.05). The vessel score of the study patients revealed that singe vessel involvement was significantly higher in group-I (52% vs. 24%) (p=0.003) and triple vessel involvement was found significantly higher in group-II (40% vs. 12%) (p=0.001). Severity assessment by Friesinger score showed normal (0) and low (1-4) Friesinger score significantly higher in group-I patients (P=0.04 and P=0.007 respectively) and high Friesinger score (11-15) was found significantly higher in patients in group II (p=0.001). Severity assessment by Gensini score of the study patients revealed significantly higher mild Gensini score in group-I patients (P=0.002) and severe Gensini score in group II patients (p=0.002). Conclusion: Coronary artery disease is one of the major important problems not only in postmenopausal women but in premenopausal women also. Postmenopausal women suffer from more triple vessels involvement, more diffuse and severe disease. This study results point out that premenopausal women suffer from less severe coronary artery disease and there is a trend to involve mid LAD more frequently in comparison to other two major coronary arteries and LM coronary artery in comparison to postmenopausal women. Bangladesh Heart Journal 2021; 36(2): 113-123

Association of Aortic Pulse Wave Velocity with the Severity of Coronary Artery Disease in Patients with Non-ST-Segment Elevation Myocardial Infarction

Background: Noninvasive assessment of arterial stiffness with aortic pulse wave velocity (PWV) may serve as a useful adjunct to the cardiovascular risk stratification and risk management. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with non-STsegment elevation myocardial infarction (NSTEMI). Methods: This cross sectional analytical study was conducted over 100 NSTEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. PWV was assessed noninvasively using the SphygmoCor® system on the day before coronary angiogram (CAG). Study subjects were divided into two groups on the basis of PWV. In group I: PWV was ≤10 m/sec and in group II: PWV was > 10 m/sec. Fifty patients in each group. Angiographic severity of CAD was assessed by vessel score, Friesinger score and Leaman score. Results: Vessel score 2 and 3 were significantly (p<0.05) higher in group II and vessel score 0 and 1 were significantly (p<0.05) higher in group I. The mean PWV in the group with normal angiographic results was 8.21±1.8 m/sec, and in patients with single-vessel disease it was 9.88±2.02 m/sec. In those with double and triple vessel disease the mean PWV was found 11.95±2.61 m/sec and 14.37±2.96 m/sec respectively. There was a significant difference of the mean value of PWV among the vessel involvement group (p=0.001). Normal and low Friesinger score were significantly (p<0.05) higher in group I patients. Intermediate and high Friesinger score were significantly (p<0.05) higher in group II patients. Increased PWV was significantly associated with the presence and severity of CAD in NSTEMI. This association showed a positive linear relation between the values of PWV and vessel score (r=0.65, p=0.01), Friesinger score (r=0.61, p=0.01), and Leaman score (r=0.36, p=0.01). Conclusion: From this study it may be stated that arterial stiffness, as measured by the aortic PWV, is an independent predictor of the presence and extent of CAD. Measurements of aortic PWV in NSTEMI can detect high risk patients requiring an early invasive strategy over a delayed invasive strategy. Bangladesh Heart Journal 2021; 36(1) : 38-46

Association between Circulating Fibrinogen Level and Severity of Coronary Artery Disease in Type 2 Diabetic Patients with Chronic Stable Angina

Background: Prevalence of coronary artery disease (CAD) among Bangladeshi population is higher in urban than rural population. Among the conventional risk factors diabetes mellitus is a major concern for Bangladeshi population. Fibrinogen (Fg) in plasma is associated with severity of CAD in some populations with acute coronary syndrome. Objective: The aim of the study was to find out the correlation between circulating fibrinogen level and severity of coronary artery disease in patients with type 2 diabetes mellitus with chronic stable angina (CSA). Methods: The study was carried out in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka from October 2015 to March 2016.Total 132 patients with chronic stable angina (CSA) and type 2 diabetes mellitus who got admitted for coronary angiogram were included in the study and they were divided into 2 groups according to the on admission level of fibrinogen. Coronary angiogram (CAG) was performed in all patients. The severity of the CAD was assessed by angiographic vessel score and Gensini score. Results: Mean Gensini score was 27.0±22.3 vs 22.2±16.4 and mean vessel score 1.6±0.9 vs 1.2±1.0 in group I and group II respectively (p=0.03 and 0.04, respectively). There was positive correlation between Fg and CAD severity in term of vessel score (r=0.19) and Gensini score (r=0.15). Univariate and multivariate analysis revealed that dyslipidemia, smoking and elevated fibrinogen were the independently significant predictors of severe CAD in type 2 diabetic patients with CSA. Conclusion: Elevated plasma fibrinogen positively correlates with the severity of CAD in patients with diabetes mellitus having chronic stable angina. Bangladesh Heart Journal 2020; 35(2) : 106-113

Association of Haemoglobin A1c Level with the Severity of Coronary Artery Disease in Non-diabetic Patients with Non-STSegment Elevation Myocardial Infarction

Background: In nondiabetic patients with non-STsegment– elevation myocardial infarction, hyperglycemia may be associated with adverse outcome. Objective: To find out the association between HbA1c levels and the severity of coronary artery disease in non-diabetic patients with non-ST-segment elevation myocardial infarction Methods: This cross sectional analytical study was carried out at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, during the period from July, 2012 to May, 2013. This study was done with an aim to find out the association between the HbA1c level and the angiographic severity of coronary artery disease in patients with non-ST- elevation myocardial infarction without diabetes mellitus. A total of 170 patients with NSTEMI without diabetes mellitus who agreed to undergo coronary angiography were included in the study. Eighty five patients were selected having HbA1c <5.7% (Group I) and 85 patients were selected having HbA1c ranging from 5.7% to 6.4% (Group II). Severity of the Coronary Artery Disease (CAD) was assessed by angiographic vessel score, and Gensini score. Results: The mean age of the studied patients was 51.0±9.0 years ranging from 30 to 80 years and male to female ratio was 4.5:1. The incidence of hypertension and level of RBS were significantly higher in group II than group I. The HbA1c level increased in accordance with the vessel score increment. There was a significant difference of the mean value of HbA1c among the vessel involvement groups. In this study mild CAD (scored”36) was significantly higher in group I and moderate to severe CAD (score>36) was significantly higher in group II according to Gensini score. This study showed a positive correlation between HbA1c and vessel score (r=0.47, p=0.01) and also between HbA1c and Gensini score (r=0.41, p=0.01). Conclusion: Elevated HbA1c levels in non-diabetic non- ST- elevation myocardial infarction patients are associated with the severity of coronary artery disease. Bangladesh Heart Journal 2020; 35(2) : 134-139

Prothrombin Gene G20210A Variant in Angiographically Documented Patients with Coronary Artery Stenosis

Background: Studies on the association between the prothrombin G20210A variant and coronary artery disease (CAD) risk are inconclusive. This study aimed to investigate the possible association between the G20210A variant in the prothrombin gene and documented CAD and its severity. Methods: This study enrolled 1460 patients who were consecutively admitted for elective coronary angiography. Via the standard angiographic techniques, coronary angiographies were done and the presence and severity of CAD were determined through the clinical vessel score and the Gensini score. Prothrombin G20210A genotypes were identified using PCR-RFLP. Results: This cross-sectional study was performed on 953 men and 507 women at a mean age of 58.21±10.33 years. The median and the interquartile range for the Gensini score were not statistically significantly different between the wild (GG) and mutant (AA+GA) genotypes (P=0.440). The association between the G20210A polymorphism and the severity of CAD with respect to the vessel score also showed no significant linear trend of higher numbers of diseased vessels (P= 0.765 for the Mantel–Haenszel test of linear trend) in the AA+GA genotype as compared with the GG genotype. Conclusion: Our data failed to confirm the hypothesis that the G20210A variant mutation may be a significant determinant of CAD risk or its severity. J Teh Univ Heart Ctr 2019;14(4):150-155 This paper should be cited as: Pourgholi L, Goodarzynejad H, Ziaee S, Zare E, Jalali A, Boroumand M. Prothrombin Gene G20210A Variant in Angiographically Documented Patients with Coronary Artery Stenosis. J Teh Univ Heart Ctr 2019;14(4):150-155.

Association of Waist-Hip Ratio with Angiographic Severity of Coronary Artery Disease in Patients with Acute ST- Segment Elevation Myocardial Infarction

Objective: Coronary artery disease (CAD) is rising in South Asia and is taking a more malignant proportion in South Asians than in Caucasians. Having a similar socioeconomic and cultural background, the scenario is same in Bangladesh. Obesity, especially abdominal is concerned as an important and modifiable risk factor for CAD which is now also raising both in developed and under developed countries. Waist-Hip ratio (WHR) is considered as an important tool for assessing abdominal obesity. The aim of this study is to evaluate the association between WHR and the severity of CAD of acute ST-segment elevation myocardial infarction (STEMI) patients so that primary prevention, early detection and proper management strategy can be taken to reduce the disease burden, morbidity and mortality.Methods: This cross sectional observational study was carried out among 105 patients with acute STEMI who received thrombolytic and underwent coronary angiography (CAG) at National Institute of Cardiovascular Diseases (NICVD), Dhaka from May, 2016 to November, 2016. They were divided into two groups, Group I (normal WHR) = 51 and group II (increased WHR) = 54, according to WHR level. Angiographic severity of coronary artery disease was assessed by vessel score and Genseni’s score.Results: Significant positive correlation was found between WHR and vessel score (r= 0.62, p=0.003). Moderate to severe CAD patients were significantly higher in increased WHR group than in normal WHR group (77.8% vs. 29.4%, p=<0.001). Significant positive correlation was also found between WHR and Genseni’s score (r= 0.71, p=0.001). Logistic regression analysis showed that a patient with increased WHR had 2.75 times higher risk of having significant CAD compared with those with the normal WHR.Conclusions: Increased WHR group had more significant coronary artery disease in terms of vessel score and Genseni’s score and can be considered as a predictor of the severity of the CAD disease in acute STEMI patients.Bangladesh Heart Journal 2017; 32(2) : 70-76

Association between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease in Chronic Stable Angina

Background: Neutrophil to lymphocyte ratio (NLR) has been proposed as a new prognostic marker in patients with chronic stable angina (CSA). NLR is a cheap, easily available, non-invasive and routinely done procedure to predict the severity of coronary artery disease.Methods: 110 patients with stable coronary artery disease were evaluated to calculate the NLR from January, 2016 to September, 2016. The patients were divided into two groups: Group I NLR>2.38 and group II NLRd”2.38. Coronary angiogram was done during index hospitalization. The severity of the coronary artery disease was assessed by vessel score and Gensini score and was compared between the groups.Results: NLR was significantly higher in the group of high vessel score and high Gensini score. We found significant weak association between NLR and vessel score (r=0.30, p=0.004) and a moderate positive correlation between NLR and Gensini score (r =0.65, P=0.001). With the increase of NLR, vessel score and Gensini score increases demonstrating more severe coronary artery disease. Univariate logistic regression analysis of variables of interest revealed that age, hypertension, dyslipidemia, serum creatinine, total WBC count and NLR were independent predictor of severe coronary artery disease with odds ratio (OR) being 1.88, 3.93, 5.01, 5.54, 4.05 and 5.70 respectively. In multivariate logistic regression analysis, after adjustment of factors NLR remain independent predictors of severe CSA (OR = 5.73; p = 0.002).Conclusion: Increased neutrophil to lymphocyte ratio is associated with angiographically severe coronary artery disease in chronic stable angina and this association is independent of conventional cardiovascular risk factors.Cardiovasc. j. 2018; 10(2): 164-170

Comparison of the GRACE and TIMI Risk Scores in Predicting the Angiographic Severity of Coronary Artery Disease in Patients with non STelevation Myocardial Infarction

Background: The superiority of the GRACE and TIMI risk scores in predicting the angiographic severity of coronary artery disease in patients with non ST-elevation myocardial infarction (NSTEMI) has not yet been established. This study was done to compare the GRACE and TIMI risk scores in predicting the angiographic severity of coronary artery disease in this group of patients.Method: The cross sectional study done in the Department of Cardiology, NICVD, Dhaka. The patients admitted with NSTEMI were evaluated to calculate the GRACE and TIMI risk score from April, 2015 to April, 2016.Coronary angiogram was done during index hospitalization and the severity of the coronary artery disease was assessed by vessel score and Gensini score.Results: Of 115 patients assessed, a positive correlation of the vessel score and Gensini score was observed with both the GRACE and TIMI risk scores (p=<0.001) and the GRACE score (r=0.59) correlated better than the TIMI score (r=0.52). The GRACE score presented area under the Receiver Operating Characteristic (ROC) curve of 0.844(95% CI = 0.774 – 0.914) significantly superior to the area under the ROC curve of 0.752(95% CI =0.658– 0.846) of the TIMI score for the difference between the two scores.Conclusion: Both the GRACE and TIMI scores had good predictive value in predicting the severity of coronary artery disease in the patients with NSTEMI but when both the scores were compared, the GRACE score was found to be superior and correlated better with the severity of coronary artery disease.Cardiovasc. j. 2017; 10(1): 45-51