Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. The efficacy and safety of the preoperative prophylactic intra-aortic balloon pump (IABP) insertion is not well established. 416 consecutive patients with severe LV dysfunction (ejection fraction ≤35%) undergoing isolated OPCAB were enrolled in a retrospective observational study. 191 patients was enrolled in the IABP group; the remaining 225 patients was in control group. A total of 129 pairs of patients were propensity-score matched. No significant differences in demographic and preoperative risk factors were found between the two groups. The postoperative 30-day mortality occurred more frequently in the control group compared with the IABP group (8.5% vs. 1.6%, p = 0.02). There was a significant reduction of low cardiac output syndrome in the IABP group compared with the control group (14% vs. 6.2%, p = 0.04). Prolonged mechanical ventilation (≥48 h) occurred more frequently in the control group (34.9% vs. 20.9%, p = 0.02). IABP also decreased the postoperative length of stay. Preoperative IABP was associated with a lower 30-day mortality, suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB.
Glucose metabolism status may play a predictive role in the severity of the complications among patients with type 2 diabetes mellitus (DM). However, few studies have focused on the prognostic value of glycosylated hemoglobin (HbA1c) and Homeostatic Model Assessment 2 for Insulin Resistance (HOMA2-IR) in patients with DM, non-ST-segment elevation infarction (NSTEMI), and single concomitant chronic total occlusion (CTO) following primary percutaneous coronary intervention (PCI). Short- and long-term prognostic value of HbA1c and HOMA2-IR in patients with DM with NSTEMI and single CTO who received primary percutaneous transluminal coronary intervention (pPCI).Data from 202 patients with NSTEMI and single CTO in nonculprit vessels were included. The incidence of revascularization, cardiogenic shock, ischemic stroke, major bleeding (ie, cerebral hemorrhage or massive hemorrhage of gastrointestinal tract), and cardiac death were combined as composite end points (CEPs). HbA1c was measured on admission and at 12 and 24 weeks after discharge. HOMA2-IR was measured on admission and at 6 and 12 weeks after discharge. The mean value of HbA1c and HOMA2-IR was calculated to determine the impact on 2.5-year CEPs. All patients were assessed during hospitalization and followed for up to 2.5 years after discharge.Mean age was 62.4 ± 11.8 years and 76% were male. Previous MI, lower left ventricular ejection fraction, and higher HbA1c (hazard ratio [HR] = 1.216; 95% confidence interval [CI] = 1.023–1.445; P = .023) were independently associated with a poor prognosis at 2.5 years. Higher HbA1c and HOMA2-IR on admission was associated with CEPs during hospitalization. Mean HOMA2-IR prior to pPCI was associated with revascularization (HR = 1.129; 95% CI = 1.008–1.265; P = .036) and ischemic stroke (HR = 1.276; 95% CI = 1.044–1.560; P = .017) during the 2.5 years follow-up period.Glucose metabolism status reflected by HbA1c and HOMA2-IR may provide prognostic value to patients with NSTEMI, type 2 DM, and single concomitant CTO following PCI. Therefore, patients with NSTEMI, CTO, and poor glycemic control should be carefully evaluated prior to PCI.
Background: In this current work we aimed to find the effect of four different single Nucleotide Polymorphisms(SNPs) rs1122608(SMARCA4),rs2230806(ABCA1), rs12563308(ANGPTL3),and rs662799(APOA5 ) on coronary heart disease(CHD) in a Han Chinese population in Xinjiang region of China. Methods: This study involved 914 subjects with 493 CHD patients and 421 healthy controls. The genotype distribution of analyzed and their relations with CHD risk factors were assessed.Results: No statistical differences were found in genotype and allele distributions of above SNPs between CHD and healthy controls (P>0.05). Serum level of high-density lipoprotein cholesterol (HDL-C) was higher in in TT genotype of rs1122608 when compared with GT and GG genotypes (P< 0.01) in CHD patients ; serum triglyceride(TG) level was higher in rs662799 GG genotype than GA and AA genotypes(P <0.00); AA of rs662799 was associated with higher HDL-C level compared with other two genotypes (P < 0.01) ; rs12563308 and rs223086 were not associated with any serum lipid traits (P > 0.05 for all). Logistic regression analysis showed that the SNPs examined were not related to CHD (p > 0.05). Also no association was found between four SNPs with the angiographic severity of CHD patients (p > 0.05). Conclusions: APOA5 rs662799 GG allele is associated with elevated triglyceride and might act as a risk factor for CHD; SMARCA4 rs1122608 TT allele and APOA5 rs662799 AA allele are associated with elevated high-density lipoprotein cholesterol levels, and might play a protective role in the development of CHD.
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