Abstract:Aim To investigate the related influencing factors of major adverse cardiovascular events (MACE) in coronary heart disease (CHD) patients with type 2 diabetes mellitus (T2DM) based on prognostic nutritional index (PNI), and to construct a prediction model. Methods The clinical data of 391 patients with CHD combined with T2DM who were hospitalised in the Department of Cardiovascular Medicine of Hebei Provincial Peoples Hospital from January 2022 to January 2023 were collected and followed up for 1 year, and were divided into the MACE group (n＝99) and the non-MACE group (n＝292) according to the presence or absence of the occurrence of MACE, and were divided into the training set (n＝273) and the validation set (n＝118) in a ratio of 7∶3 by using the computer-generated random number method, and the patients in the training set were divided into the MACE (n＝67) group and the non-MACE group (n＝206) according to whether they had MACE or not. Lasso regression was used to screen the relevant influencing factors and to construct the prediction model of the column-line diagram, and the prediction model was validated by plotting receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). Results Lasso regression showed that the use of angiotensin receptor neprilysin inhibitor (ARNI), fasting blood glucose (FBG), C-reactive protein (CRP), platelet to lymphocyte ratio (PLR), lipoprotein(a) (Lp(a), and PNI were the predictors of the occurrence of MACE in patients with CHD combined with T2DM. A column-line graph prediction model was constructed and validated based on the above predictors, and the area under the ROC curve (AUC) was 0.838(95%CI:0.778～0.898) in the training set and 0.872(95%CI:0.803～0.942) in the validation set, with a good discriminatory degree of the model, and the C-values of the calibration curves in the training set and the validation set were 0.838 and 0.872, respectively, with good fit. The results of the decision curve analysis and the clinical impact curve showed that the column-line graph prediction model had a higher net yield of MACE in patients with CHD combined with T2DM, with high clinical utility. Conclusion PNI is an influential factor in the occurrence of MACE in patients with CHD combined with T2DM, and the column-line graphical model constructed on the basis of predictors such as PNI is convenient for clinical use and has high predictive value in predicting the occurrence of MACE in patients with CHD combined with T2DM.

Abstract:Aim To analyze the influencing factors of adverse cardiovascular events in elderly patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish a nomogram prediction model. Methods A total of 216 elderly patients with acute STEMI who underwent PCI in Jinqiu Hospital of Liaoning Province from February 2021 to January 2023 were selected and divided into occurrence group (n＝33) and non-occurrence group (n＝183) according to the occurrence of postoperative adverse cardiovascular events. General data, laboratory indicators, imaging information, and postoperative medication data of all patients were collected.Univariate and multivariate Logistic regression analysis were used to explore independent risk factors for adverse cardiovascular events. A nomogram prediction model was constructed according to independent risk factors of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein/albumin ratio (CAR), C-reactive protein to high density lipoprotein cholesterol ratio (CHR), calibration curve was drawn to verify the nomogram model, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of the predictive model for column line diagrams. Results The levels of NLR, PLR, CAR, CHR, Gensini score, and platelet aggregation ratio (PAR) were significantly higher in occurrence group than those in non-occurrence group, left ventricular ejection fraction(LVEF) was significantly lower in occurrence group (P＜0.05). Logistic regression analysis showed that Gensini score, LVEF, PAR, NLR, PLR, CAR and CHR were independent risk factors for adverse cardiovascular events after PCI in elderly acute STEMI patients (P＜0.05). The column-line diagram model for predicting the risk of adverse cardiac events after PCI in elderly acute STEMI patients was constructed based on independent risk factors, and the calibration curve of the model was close to the ideal model, and the ROC curve showed that the area under the ROC curve for the prediction of the risk of adverse cardiovascular events in the elderly acute STEMI patients was 0.914. Conclusion NLR, PLR, CAR and CHR are independent risk factors for adverse cardiovascular events in elderly acute STEMI patients after PCI, and the nomogram model constructed based on these factors can effectively predict the risk of adverse cardiovascular events in elderly acute STEMI patients after PCI.

Abstract:Aim To investigate the relationship between systemic inflammatory immune index (SII) and systemic inflammatory response index (SIRI) and the risk of in-hospital major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). Methods Retrospective analysis was conducted on AMI patients admitted to the Second Cardiovascular Disease Area of Suining Central Hospital from February 2021 to May 2022. Based on inclusion and exclusion criteria, 246 patients were finally enrolled. According to whether MACE occurred during hospitalization, they were divided into event group and non-event group, and baseline data of the two groups were compared.All variables except SII and SIRI were included in a univariate-multivariate Logistic regression analysis to screen factors affecting the risk of MACE, and were used as significant covariates for adjustment to evaluate the relationship between SII and SIRI and the risk of MACE respectively. Results The results of multivariate Logistic regression analysis showed that emergency PCI, left ventricular ejection fraction, albumin level and age were significant factors affecting the risk of in-hospital MACE in AMI patients (OR＝0.2,5%CI:0.194～0.960, P＝0.038; OR＝0.0,5%CI:0.890～0.969, P＝0.001; OR＝0.0,5%CI:0.621～0.845, P＜0.001; OR＝1.3,5%CI:1.070～1.228, P＜0.001), and a basic model was established based on this. After adjusting for the significant covariates, SII and SIRI were both independent risk factors for in-hospital MACE (OR＝1.4,5%CI:1.001～1.008, P＝0.002; OR＝4.7,5%CI:2.597～8.142, P＜0.001). The areas under the curves of SII and SIRI were 0.658 and 0.785, respectively, and the optimal cutoff values were 434.83 and 1.03. Restricted cubic spline analysis showed that SII (Nonlinear P＝0.639) and SIRI (Nonlinear P＝0.683) were linearly related to the risk of MACE after adjusting significant covariates. Threshold effect analysis showed that when SIRI＞0.93, the risk of MACE began to increase. Conclusion Elevated levels of SII and SIRI are independent risk predictors for the occurrence of in-hospital MACE in AMI patients.

Abstract:Aim To explore the influencing factors of major adverse cardiovascular events (MACE) after drug-eluting stent (DES) implantation in young and middle-aged patients with coronary artery disease (CAD). Methods Retrospective study data from the First Affiliated Hospital of Zhengzhou University were extracted from the Dryad database, and young and middle-aged CAD patients who received DES were divided into MACE group (n＝57) and non MACE group (n＝321) according to whether MACE occurred during the follow-up period. Clinical data including age, gender etc. were compared between the two groups, and the variables with significant differences between the two groups were substituted into Logistic regression model to screen the influencing factors of MACE after DES implantation in young and middle-aged CAD patients. Value of influencing factors predicting occurrence of MACE after DES implantation in young and middle-aged CAD patients was evaluated by plotting ROC curve and calculating the area under the curve (AUC). ResultsStent diameter in MACE group was significantly smaller than that in non MACE group (P＜0.001), the number of left main coronary artery lesion in MACE group was significantly higher than that in non MACE group (P＜0.05). Multivariate Logistic regression analysis indicated that stent diameter (OR＝0.4,5%CI:0.084～0.405, P＜0.001) and left main coronary artery lesion (OR＝9.9,5%CI:2.291～37.904, P＝0.002) were the independent risk factors of MACE after DES implantation in young and middle-aged CAD patients. The risk of MACE after DES implantation in young and middle-aged CAD patients significantly decreased when the stent diameter was ＞3 mm. The AUC of stent diameter combined with left main coronary artery lesion predicting occurrence of MACE after DES implantation in young and middle-aged CAD patients was 0.700 (95%CI:0.623～0.776). Conclusion The smaller stent diameter and left main coronary artery lesion are the influencing factors of the occurrence of MACE after DES implantation in young and middle-aged patients with CAD, and should be emphasized by clinical practitioners.

Abstract:Aim To explore the risk factors of major adverse cardiovascular events(MACE) after percutaneous coronary intervention (PCI) in patients with coronary artery calcification(CAC), and to construct a nomogram prediction model for MACE in CAC patientsafter PCI. Methods Retrospective analysis of clinical data of 406 patients admitted to the Department of Cardiology of the Fourth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2019, they were diagnosed with CAC by coronary angiography (CAG) or intravascular ultrasound (IVUS) and underwent PCI. The subjects were divided into event group (60 cases) and non-event group (346 cases) according to the incidence of MACE during the follow-up period. The LASSO regression and multivariate Logistic regression analysis were used to determine the independent risk factors of MACE in CAC patients after PCI, and then a nomogram prediction model was constructed and evaluated. Results LASSO regression and multivariate Logistic regression analysis results showed that advanced age, diabetes, renal dysfunction, elevated Gensini score and rotational atherectomy were risk factors for the incidence of MACE, and enlarged minimum lumen diameter (MLD) was a protective factor for the incidence of MACE (P＜0.05). The nomogram prediction model was constructed using the above six predictive indicators. After internal validation, the AUC values of nomogram for predicting MACE in CAC patients after PCI was 0.824 (95%CI:0.767～0.875), the sensitivity was 0.771, and the specificity was 0.720, suggesting that the model had a good discrimination. The calibration curve indicated that the deviation correction curve of the nomogram prediction model had good consistency with the ideal curve. The clinical decision curve analysis (DCA) suggested that when the prediction threshold of the model was in range of 0～0.6, the patients clinical net benefit level was the highest, and the nomogram model had good clinical applicability. Conclusion The nomogram prediction model established in this study can better quantitatively assess the risk degree of MACE in CAC patients after PCI, which is helpful for clinicians to screen high-risk patients, formulate individualized targeted interventions, and improvepatients, prognosis.

Abstract:Aim To explore the relationship between fractional flow reserve (FFR) technical parameters and myocardial zymogram in patients with non-ST-segment elevation acute myocardial infarction (NSTEMI) and the predictive value of major adverse cardiovascular events (MACE). Methods A total of 136 NSTEMI patients admitted to Liaocheng Third Peoples Hospital from February 2017 to February 2020 were selected and all underwent percutaneous coronary intervention (PCI) under the guidance of FFR. According to whether MACE occurred 1 month after operation, all patients were divided into MACE group (n＝14) and non-MACE group (n＝122). The clinical data, myocardial enzyme spectrum indexes, quantitative coronary angiography (QCA) parameters, and FFR technical parameters were compared between the two groups. The correlation between FFR technical parameters and myocardial enzyme spectrum indexes and QCA parameters was analyzed. The Logistic regression equation was used to analyze MACE influencing factors. The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to analyze the myocardial zymogram indexes, QCA parameters, and FFR to predict the value of MACE. Results Compared with the non-MACE group, the proportion of patients aged ≥60 years old in the MACE group increased 0.55 times, the GRACE score increased 0.11 times, the cardiac troponin I (cTnI) level increased 0.38 times, the creatine kinase (CK) level increased 0.22 times, the creatine kinase isoenzyme-MB (CK-MB) level increased 0.24 times, and the stenosis degree increased 0.08 times, the lesion length increased 0.11 times, the FFR decreased 11.9%, and the minimum lumen area of criminal vessels decreased 12.8%, the difference was statistically significant (P＜0.05); FFR was negatively correlated with cTnI, CK, and CK-MB levels (P＜0.05); FFR was negatively correlated with stenosis and lesion length (P＜0.05); Logistic regression analysis showed that after adjusting for age, GRACE score, and culprit vessel minimum lumen area, myocardial zymogram indexes (cTnI, CK, CK-MB), QCA parameters (degree of stenosis, lesion length), and FFR were all related to the occurrence of MACE (P＜0.05); The AUC of MACE predicted by FFR was 0.885, the sensitivity was 92.86%, and the specificity was 65.88%. Conclusion There is a negative correlation between FFR and myocardial enzymes (cTnI, CK and CK-MB) levels in NSTEMI patients, and are related to the occurrence of MACE, which can predict the risk of MACE.

Abstract:Aim To systematically review the prognostic factors for major adverse cardiovascular events (MACE) in patients with chronic total occlusion (CTO) of coronary artery after percutaneous coronary intervention (PCI).Methods PubMed, EMBASE, the Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect cohort studies on the prognostic factors for MACE in patients with CTO after PCI from inception to October 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies.Then, Meta analysis was performed using R3.6.2 software. Results A total of 30 cohort studies were included, including 25 002 patients with CTO. The results of Meta analysis showed that there were 8 prognostic factors with statistical significance:age (RR＝1.6,5%CI was 1.01～1.10, P＝0.01), male (RR＝1.8,5%CI was 1.17～2.42, P＜0.01), coronary artery bypass grafting history (RR＝1.0,5%CI was 1.12～1.99, P＜0.01), diabetes history (RR＝1.1,5%CI was 1.15～1.99, P＜0.01), renal dysfunction (RR＝2.1,5%CI was 2.44～3.48, P＜0.01), in-stent CTO (RR＝2.5,5%CI was 1.08～4.31, P＝0.03), successful PCI (RR＝0.2,5%CI was 0.38～0.72, P＜0.01) and minimal lumen diameter (RR＝0.7,5%CI was 0.31～0.70, P＜0.01), respectively. Conclusions Current evidence shows that age, male, coronary artery bypass grafting history, diabetes history, renal dysfunction and in-stent CTO were the risk factors for MACE in patients with CTO after PCI. Successful PCI and minimal lumen diameter were the protective factors for MACE in patients with CTO after PCI.

Abstract:Aim To investigate the changes of lncRNA-ZFAS1/Caspase-3 axis in patients with ST-segment elevation myocardial infarction(STEMI) and its relationship with prognosis of emergency percutaneous coronary intervention(PCI). Methods STEMI patients who received emergency PCI were selected as STEMI group, and the healthy volunteers during the same period were selected as control group. The expression level of lncRNA-ZFAS1 in peripheral blood and the content of Caspase-3 in serum were detected. The occurrence of major adverse cardiovascular events(MACE) of STEMI patients within 6 months after PCI was followed up. Kaplan-Meier curve was used to analyze the difference of MACE in patients with different levels of lncRNA-ZFAS1 expression in STEMI group, ROC curve was used to analyze the predictive value of lncRNA-ZFAS1 for MACE in STEMI patients, Logistic regression model was used to analyze the influencing factors of MACE in STEMI patients. Results The expression level of lncRNA-ZFAS1 in peripheral blood and serum content of Caspase-3 in STEMI group were higher than those in the control group (P＜0.05), and lncRNA-ZFAS1 was positively correlated with Caspase-3. The cumulative incidence of MACE in patients with high lncRNA-ZFAS1 expression was higher than that in patients with low lncRNA-ZFAS1 expression in STEMI group, lncRNA-ZFAS1 expression had predictive value for MACE in STEMI group. cTnI peak value, multi vessel disease, and time from onset to PCI, Gensini score, lncRNA-ZFAS1 and Caspase-3 were the influencing factors of MACE in STEMI patients. Conclusion The lncRNA-ZFAS1/Caspase-3 axis was significantly changed in STEMI, and lncRNA-ZFAS1 expression level and Caspase-3 content were increased, which were related to MACE after PCI.

Abstract:Aim To compare the long-term effects of drug-coated balloon angioplasty and drug-eluting stent implantation for left main bifurcation(LMB)-in-stent restenosis(ISR). Methods 48 patients with LMB-ISR, who underwent percutaneous coronary intervention (PCI) between October 2014 and October 2018, were retrospectively reviewed for the present study (repeat drug eluting stent (DES) implantation (n＝24), DCB angioplasty (n＝24)). Qualitative comparative analysis (QCA) was performed before and after PCI. Thirty-nine patients (81.3%) were followed up for 18 months to perform coronary angiography(CAG) and QCA, and long-term follow-up was conducted for clinical endpoint events. Results Analysis of the baseline characteristics showed that the patients in the DCB group had a similar incidence of non-ST segment elevation myocardial infarction/ST segment elevation myocardial infarction at the index PCI (8.3% vs 25.0%, P＝0.25), higher low-density lipoprotein cholesterol level ((92.9±35.1) mg/dL vs (78.0±30.7) mg/dL, P＝0.07), and more “stent- in-stent” lesions (25.0% vs 4.2%, P＝0.05) than those in the DES group but not statistically significant. After 18 months follow up ,QCA showed there was no significant difference between the DCB group and the DES group in the late lumen loss ((1.06±1.10) mm vs (0.84±1.15) mm, P＝0.62), and no significant difference in the minimum lumen diameter of target lesions ((1.68±0.96) mm vs (2.06±1.21) mm, P＝0.37). The cumulative incidence rates of major adverse cardiovascular events (MACE) were similar between both groups (median follow-up duration was 868 days; MACE rate was 25.0% in the DCB group and 29.2% in the DES group, P＝0.75). Conclusion DES and DCB showed comparable long-term clinical results in patients with LMB-ISR lesions.

Abstract:Aim To retrospectively investigate the relationship between the severity and long-term prognosis of coronary heart disease(CHD) and chronic renal failure (CRF). Methods 776 patients with CHD undergoing coronary artery stent implantation were selected. All patients were divided into two groups with or without CRF according to their basic kidney function level, among which 535 cases were in the CRF group and 241 cases were in the CRF-free group. Clinical characteristics, coronary artery lesions and 1-year incidence of major adverse cardiovascular events (MACE) were compared between the two groups. Results Compared with the control group, the degree of coronary artery stenosis in the CRF group was significantly worse, with more coronary artery number of lesions (P＜0.001) and higher proportion of coronary artery three-vessel lesions (P＜0.001) and higher gensini scores (P＜0.001). The 1-year MACE incidence was higher in the CDK group than in the control group (P=0.014). Multivariate Cox regression analysis showed that CRF was a risk factor for 1-year MACE occurrence. Conclusion CHD patients with CRF have more severe coronary artery stenosis, and CRF is an important index to predict the prognosis of CHD.