Flow reserve fraction: the optimal choice in lesion assessing and interventional guiding for patient with unstable angina pectoris and intermediate lesion wrapped with myocardial bridge: a case report

Background It is difficult to choose correctly interventional strategy for coronary intermediate lesions combined with myocardial bridge. Endovascular imaging is advocated to guide treatment, but flow reserve fraction (FFR) is not recommended to guide the interventional treatment of myocardial bridge disease because of the inaccurate judgment misled by myocardial bridge. Case presentation In this study, we reported a case of a 56-year-old male patient with unstable angina pectoris (UAP). From his coronary angiography, we found diffuse stenosis near the midsection of the left anterior descending (LAD) branch and the presence of a severe myocardial bridge in the lesion area. We were sure that the LAD was culprit vessel and this lesion was culprit lesion. Both FFR and intravenous ultrasound (IVUS) were performed and the conclusions of them are different. Although stent implantation is not usually recommended in the myocardial bridge area. However, after careful examination, a stent was finally implanted under the precise guidance of FFR. And the patient recovered well up-to now. Conclusions This case illustrates that FFR functional test was complimentary to intravascular imaging test for the coronary intermediate lesion, especially the lesion wrapped with myocardial bridges, both in assessing the lesion and in guiding treatment.

Efficacy and Safety of Tongxinluo Capsule as Adjunctive Treatment for Unstable Angina Pectoris: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Tongxinluo capsule (TXLC) is a commonly used Chinese medicine for unstable angina pectoris (UA). This article aimed to clarify the safety and efficacy of TXLC as an adjunctive treatment for UA. Two reviewers searched 7 databases from inception to August 2021, and performed literature screening and information extraction independently. The meta-analysis was implemented after evaluating the methodological quality of each randomized controlled trial (RCT) by the Cochrane Risk of Bias tool. Sensitivity analyses were conducted for testing the stability of the results, and the Begg and Egger tests were performed for any potential publication bias. After eligibility assessment, 42 RCTs with a total of 5,421 participants were included. Evidence showed that TXLC reduced the rate of cardiovascular events [RR = 0.29, 95% CI (0.19, 0.45), p < 0.00001, I2 = 0%] {including cardiovascular mortality [RR = 0.16, 95% CI (0.03, 0.88), p = 0.03, I2 = 20%], the incidence of acute myocardial infarction [RR = 0.27, 95% CI (0.13, 0.57), p = 0.0006, I2 = 0%] and the occurrence of revascularization [RR = 0.28, 95% CI (0.15,0.54), p = 0.0001, I2 = 0%]}, all-cause mortality [RR = 0.25, 95% CI (0.06, 0.99), p = 0.05, I2 = 19%], recurrence of angina [RR = 0.25, 95% CI (0.11, 0.61), p = 0.002, I2 = 0%], the number of ST-segment depression [MD = −0.45, 95% CI (−0.69, −0.20), p = 0.0005, I2 = 0%], the summation of ST-segment depression [MD = −0.70, 95% CI (−1.08, −0.32), p = 0.0003, I2 = 70%] and the hypersensitive C-reactive protein level [MD = −2.86, 95% CI (−3.73, −1.99), p < 0.00001, I2 = 86%], increased the nitric oxide level [MD = 11.67, 95% CI (8.33, 15.02), p < 0.00001, I2 = 33%], improved the electrocardiogram change [RR = 1.23, 95% CI (1.16, 1.30), p < 0.00001, I2 = 0%] and the clinical efficacy in UA [RR = 1.26, 95% CI (1.21, 1.32), p < 0.00001, I2 = 24%], and relieved the symptoms of angina pectoris {including chest pain or tightness [RR = 1.13, 95% CI (0.97, 1.32), p = 0.12, I2 = 30%], palpitations [RR = 1.47, 95% CI (1.18, 1.84), p = 0.0007, I2 = 0%], shortness of breath [RR = 1.53, 95% CI (1.24, 1.88), p < 0.0001, I2 = 0%], and asthenia [RR = 1.69, 95% CI (0.83, 3.43), p = 0.15, I2 = 90%]}. The most common adverse effect was gastrointestinal symptoms which could be relieved and eliminated through dose reduction, medication time adjustment and symptomatic remedy. Collectively, TXLC was effective and considerably safe for UA. However, due to the unavoidable risk of bias, these results must be interpreted with caution and further verified by large-scale and high-quality RCTs.Systematic Review Registration:www.crd.york.ac.uk/PROSPERO/, identifier CRD42021232771.

Immature Platelet Fraction (IPF) Levels in Acute Coronary Syndrome (ACS) Patients

Background: Acute Coronary Syndrome (ACS) is a major cardiovascular problem because it causes high hospital admissions and mortality rates. Acute Coronary Syndrome is divided into 3 (three), namely: unstable angina pectoris (UAP), myocardial infarction without ST segment elevation (NSTEMI), and myocardial infarction with ST segment elevation (STEMI). In addition to changes in biomarkers of heart injury, the platelet index (IPF = immature platelet fraction) will also change the level difference between STEMI with NSTEMI/UAP. Objective: To determine the differences in IPF levels of ACS patients with STEMI and NSTEMI/UAP Method: Observational analytic with cross sectional approach. The subjects of this study were 80 patients who came to the emergency installation of integrated heart center Emergency Room Haji Adam Malik Hospital Medan from May 2019 to September 2019 and was diagnosed with ACS (STEMI or NSTEMI/UAP). The sample in the study was the patient's venous blood and put it in an EDTA tube, then immediately checked the IPF value/level using the automatic hematology analyzer. Patients with heart failure or patients with thrombocytopenia were not included in this study. Results: In this study, the demographic characteristics of the ACS patients based on gender were male 77.5% STEMI and 87.5% NSTEMI/UAP while women 22.5% STEMI and 12.5% ​​NSTEMI/UAP. The results of the STEMI patient's IPF levels Compared with NSTEMI/UAP, the median is 6.2 (3.5-16.8) VS 2.9 (0.7-12) with a p-value of 0.0001. Conclusion: The characteristics of ACS patients based on the results of sex were that there were more men with NSTEMI/UAP than those with STEMI. There was a significant difference in the IPF levels of STEMI with NSTEMI/UAP. Keywords: Immature Platelet Fraction (IPF), Acute Coronary Syndrome (ACS), ST-Segment Elevation Myocardial Infarction (STEMI), Non ST-Segment Elevation Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (UAP).

Serum Levels of Growth Differentiation Factor-15 as an Inflammatory Marker in Patients with Unstable Angina Pectoris

Background: Growth differentiation factor-15 (GDF-15), a member of transforming growth factors, is a stress-responsive marker whose levels may significantly increase in response to pathological stresses associated with inflammatory tissue injuries such as unstable angina pectoris (USAP). This study evaluated the diagnostic value of GDF-15 in patients with USAP. Methods: The present cross-sectional study recruited 39 patients with USAP criteria and 30 patients with stable angina pectoris (SAP), referred to Shahid Beheshti Hospital, Kashan, Iran. All the patients with USAP had at least 1 coronary artery stenosis (>50%) in angiography. The control group comprised 42 healthy individuals. The serum levels of GDF-15 were measured in all the participants by ELISA. Also analyzed were the relationship between GDF-15 levels and thrombolysis in myocardial infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE) risk scores in the patients with USAP to determine the severity of the disease. Result: The study population consisted of 111 subjects, 62 women and 49 men, divided into 3 groups of USAP (n=39, mean age=60.07±14.10 y), SAP (n=30, mean age=67.56±9.88 y), and control (n=42, mean age=61.21±7.76 y). The mean serum level of GDF-15 in the USAP group was significantly different from the other 2 groups (P<0.001), while no significant difference was observed in this regard between the SAP and control groups (P=0.797). No correlation was found between the mean GDF-15 serum level and the GRACE (P=0.816) and TIMI (P=0.359) risk scores in the USAP group. Conclusion: The mean serum level of GDF-15 exhibited a rise in our patients with USAP. GDF-15 may be a diagnostic biomarker of USAP and its severity.

Is the neutrophil-lymphocyte ratio a good marker for the differential diagnosis of unstable angina pectoris and non-ST elevation myocardial infarction?

Background: The aim of this study is to investigate the role of the neutrophil-lymphocyte ratio (NLR) in the differential diagnosis of non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (USAP). Material and Method: Patients who had been admitted to the emergency ward with complaints of chest pain and who were diagnosed with USAP and NSTEMI in further examination were retrospectively included in this study. The NLR level was measured for each patient both at the times of application and of discharge. The NLR was calculated by dividing the neutrophil count by the lymphocyte count. Results: WBC (8107.38±1405.5 vs 7452.46±1427.9, p: 0.020), neutrophil (5620 vs 4300, p: 0.001), and NLR (3.86 vs 2.14, p: 0.001) values were higher, whereas the lymphocyte value (1505 vs 2100, p: 0.001) was lower in the NSTEMI versus the USAP group. According to the multivariable logistic regression analysis that was done, NLR appeared to be an independent predictor of NSTEMI. The predictive value of NLR for NSTEMI diagnosis was >3.22 with 61.9% sensitivity and 86.96% specificity (74.3% positive predictive, 78.9% negative predictive) (AUC: 0.761; p< 0.001). Conclusion: As a cheap inexpensive and easy-to-calculate index that can be applied in every medical establishment within the first 20 minutes of application, it is possible to state that NLR is a good marker in distinguishing NSTEMI from USAP patients.