Impact of serum lipoprotein(a) on endothelium-dependent coronary vasomotor response assessed by intracoronary acetylcholine provocation

Mashaly, Ahmed; Rha, Seung Woon; Choi, Byoung Geol; Baek, Man Jong; Ryu, Yang Gi; Choi, Se Yeon; Byun, Jae Kyeong; Abdelshafi, Kareem; Park, Yoonjee; Jang, Won Young; Kim, Woohyeun; Park, Eun Jin; Choi, Jah Yeon; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog

doi:10.1097/mca.0000000000000642

Cited by 4 publications

(5 citation statements)

References 42 publications

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“…However, all of the above studies focused on the entire CTO population. Diabetic status was associated with fast atherosclerosis progression and poor clinical outcomes [18, 29–33]. Under such a special situation, whether revascularization should be performed is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus is observed in 34–40% CTO patients [12, 13]. The coexistence of diabetes is often associated with a severe coronary situation, which is characterized by endothelial cell dysfunction, microcirculation disorders, high-grade coronary atherosclerosis, a rapid progression of atherosclerosis and poor clinical outcomes [14–18]. Previous studies demonstrated clinical benefits after successful CTO revascularization [12, 19, 20].…”

Section: Introductionmentioning

confidence: 99%

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Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Yan

Zhang

Yuan

et al. 2019

Cardiovasc Diabetol

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Background The territory of the right coronary artery (RCA) is smaller than that of the left anterior descending artery. Previous studies have reported conflicting results when considering whether stable RCA-chronic total occlusion (CTO) should be reopened. The coexistence of diabetic and coronary artery diseases represents a severe situation. Therefore, we aimed to determine if stable RCA-CTO in diabetic patients was necessary to be reopened. To our knowledge, no studies have focused on this topic to date. Methods We enrolled diabetic patients with RCA-CTO who had clinical presentations of symptomatic stable angina or silent ischemia. RCA-CTO was treated with either successful revascularization (the CTO-SR group) or medical therapy (the CTO-MT group). The primary endpoint was all-cause death. Both Cox regression and propensity score matching analyses were used. Sensitivity analysis was performed based on subgroup populations and relevant baseline variables. Results A total of 943 patients were included: 443 (46.98%) patients in the CTO-MT group and 500 (53.02%) patients in the CTO-SR group. After a mid-term follow-up (CTO-SR: 48 months; CTO-MT: 42 months), we found that CTO-SR was superior to CTO-MT in terms of all-cause death (adjusted hazard ratio [HR] [model 1]: 0.429, 95% conference interval [CI] 0.269–0.682; adjusted HR [model 2]: 0.445, 95% CI 0.278–0.714). The superiority of CTO-SR was consistent for cardiac death, possible/definite cardiac death, repeat revascularization, target vessel revascularization (TVR) and repeat nonfatal myocardial infarction. Subgroup analysis confirmed the mortality benefit of CTO-SR by percutaneous coronary intervention (the successful CTO-PCI subgroup, 309 patients in total). While CTO-SR by coronary artery bypass grafting (the CTO-CABG subgroup, 191 patients in total) offered patients more benefit from repeat revascularization and TVR than that offered by successful CTO-PCI. Conclusions For stable RCA-CTO patients with diabetes, successful revascularization offered patients more clinical benefits than medical therapy. CTO-CABG might be a more recommended way to accomplish revascularization. Trial registration This study was not registered in an open access database Electronic supplementary material The online version of this article (10.1186/s12933-019-0911-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Yan

Zhang

Yuan

et al. 2019

Cardiovasc Diabetol

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“…(Table 2 , Ref. [ 18 , 29 , 30 , 49 , 50 , 66 , 96 , 101 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 ]).…”

Section: Novel Diagnostic Approachesunclassified

“…Intriguingly, it has been suggested that the lipoprotein(a) level is related to racial and genetic backgrounds [ 159 ], which suggest it is difficult to control the lipoprotein(a) level with medications for the management of VSA in some way. However, a large-scale clinical study did not identify obvious relationship between lipoprotein(a) and the vasospastic response to the intracoronary Ach provocation test [ 157 ].…”

Section: Novel Diagnostic Approachesmentioning

confidence: 99%

Coronary Artery Spasm: Risk Factors, Pathophysiological Mechanisms and Novel Diagnostic Approaches

Lin¹,

Lin²,

Xin³

et al. 2022

Rev. Cardiovasc. Med.

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Coronary artery spasm (CAS) is a transient reversible subtotal or complete occlusion induced by coronary hypercontraction and the critical cause of myocardial ischaemia with non-obstructive coronary arteries. During the past decades, our knowledge of the risk factors and pathophysiological mechanisms of CAS have been increasingly progressed, and various diagnostic approaches, including imaging technologies and novel biomarkers, have been proposed to serve well to diagnose CAS clinically. This review aims to summarize these research progresses on the risk factors of CAS and introduce current knowledge about the mechanisms accounting for CAS, including endothelial dysfunction, vascular smooth muscle cell hyperreactivity, and adventitial and perivascular adipose tissue inflammation. We also gathered the recently evolved diagnostic approaches and analyzed their advantages/disadvantages, in purpose of enhancing the diagnostic yield on the basis of ensuring accuracy.

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“…In addition, lipoprotein (a) might play a role in the genesis of thrombotic coronary occlusion, therefore leads to the occurrence of AMI subsequent to coronary spasm [38]. However, in a recent large-scale clinical study conducted by Ahmed Mashaly, no relationship between the elevated lipoprotein (a) level and the vasospastic response to the intracoronary Ach provocation test was identified [39]. It suggested that the role of lipoprotein (a) in the pathogenesis in CAS is far from reaching a consensus.…”

Section: Lipoprotein (A)mentioning

confidence: 99%

The Biochemical Markers Associated with the Occurrence of Coronary Spasm

Jin

Xia

et al. 2019

BioMed Research International

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Coronary artery spasm (CAS) is one of the mechanisms of angina pectoris. Unlike the diagnosis of acute myocardial infarction which is based on the elevation of cardiac markers, the diagnosis of CAS is difficult and sometimes requires sophisticated and risky provocative test which is not widely accepted in China. There is no well-established biomarker for the diagnosis or prediction of CAS. However, there are some biomarkers proven to be associated with the occurrence of CAS. For example, inflammatory factors including C-reactive protein and cytokines, lipoprotein (a), and cystatin-C might be precipitating factor for CAS. Rho-kinase as a mediator involved in multiple mechanisms of CAS, serotonin, and endothelin-1 as powerful vasoconstrictors leading to vasospasm were all observed being elevated in patients with CAS. Thioredoxin and nitrotyrosine reflected the oxidative status and could be observed to be elevated after the occurrence of CAS. In some cases doubted to be CAS without the evidence of provocative test, the blood test for the biomarkers mentioned above could be useful for the diagnosis of CAS.

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Impact of serum lipoprotein(a) on endothelium-dependent coronary vasomotor response assessed by intracoronary acetylcholine provocation

Abstract: In our study, there was no relationship between the elevated Lp(a) level and the vasospastic response to the intracoronary ACh provocation test; however, higher Lp(a) levels were associated with poor clinical outcomes up to 5 years.

Cited by 4 publications

References 42 publications

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Coronary Artery Spasm: Risk Factors, Pathophysiological Mechanisms and Novel Diagnostic Approaches

The Biochemical Markers Associated with the Occurrence of Coronary Spasm

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