Relationship between the Severity of Coronary Artery Disease and Cardiovascular Risk Factors in Acute Coronary Syndrome: Based on Tehran Heart Center’s Data Registry
Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS.
Methods: This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score.
Results: Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25–88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus.
Conclusion: Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS.
2. Khaled S, Matahen R. Cardiovascular risk factors profile in patients with acute coronary syndrome with particular reference to left ventricular ejection fraction. Indian Heart J 2018;70:45-49.
3. Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A, Borges A, Severo M, Maciel MJ, Moreira I, Azevedo A. Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study. BMJ Open 2018;8:e018798.
4. World Health Organization. (2014). The selection and use of essential medicines: report of the WHO Expert Committee, 2013 (including the 18th WHO model list of essential medicines and the 4th WHO model list of essential medicines for children). World Health Organization. https://apps.who.int/iris/handle/10665/112729 (14 May 2020).
5. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J 2014;35:2950-2959.
6. Nakamura M, Nishikawa H, Mukai S, Setsuda M, Nakajima K, Tamada H, Suzuki H, Ohnishi T, Kakuta Y, Nakano T, Yeung AC. Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 2001;37:63-69.
7. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med 2016;4:256.
8. Murphy A, Hamilton G, Andrianopoulos N, Yudi MB, Farouque O, Duffy SJ, Lefkovits J, Brennan A, Reid CM, Ajani AE, Clark DJ; Melbourne Interventional Group. One-year outcomes of patients with established coronary artery disease presenting with acute coronary syndromes. Am J Cardiol 2019;123:1387-1392.
9. Fuster V, Kovacic JC. Acute coronary syndromes: pathology, diagnosis, genetics, prevention, and treatment. Circ Res 2014;114:1847-1851.
10. Barstow C, Rice M, McDivitt JD. Acute coronary syndrome: diagnostic evaluation. Am Fam Physician 2017;95:170-177.
11. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. Nat Rev Cardiol 2012;9:620-633.
12. Rodriguez F, Mahaffey KW. Management of patients with NSTE-ACS: a comparison of the recent AHA/ACC and ESC guidelines. J Am Coll Cardiol 2016;68:313-321.
13. Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003;290:898-904.
14. Neeland IJ, Patel RS, Eshtehardi P, Dhawan S, McDaniel MC, Rab ST, Vaccarino V, Zafari AM, Samady H, Quyyumi AA. Coronary angiographic scoring systems: an evaluation of their equivalence and validity. Am Heart J 2012;164:547-552.e1.
15. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407-477.
16. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Rev Esp Cardiol (Engl Ed) 2015;68:1125.
17. Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L, Neal B, Rodgers A, Ni Mhurchu C, Clark T. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens 1999;21:1009-1060.
18. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, Flack JM, Carter BL, Materson BJ, Ram CV, Cohen DL, Cadet JC, Jean-Charles RR, Taler S, Kountz D, Townsend RR, Chalmers J, Ramirez AJ, Bakris GL, Wang J, Schutte AE, Bisognano JD, Touyz RM, Sica D, Harrap SB. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich) 2014;16:14-26.
19. Alberti KGMM, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabetic medicine. 1998;15:539-553.
20. Grundy SM, Cleeman JI, Merz CN, Brewer HB, Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Jr, Stone NJ; Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol 2004;44:720-732.
21. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-3421.
22. Niedziela J, Hudzik B, Niedziela N, Gąsior M, Gierlotka M, Wasilewski J, Myrda K, Lekston A, Poloński L, Rozentryt P. The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol 2014;29:801-812.
23. Balter LJ, Good KP, Barrett SP. Smoking cue reactivity in current smokers, former smokers and never smokers. Addict Behav 2015;45:26-29.
24. Khademi H, Malekzadeh R, Pourshams A, Jafari E, Salahi R, Semnani S, Abaie B, Islami F, Nasseri-Moghaddam S, Etemadi A, Byrnes G, Abnet CC, Dawsey SM, Day NE, Pharoah PD, Boffetta P, Brennan P, Kamangar F. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50,000 adults in Iran. BMJ 2012;344:e2502.
25. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
26. Mehta RH, Bhatt DL, Steg PG, Goto S, Hirsch AT, Liau CS, Röther J, Wilson PW, Richard AJ, Eagle KA, Ohman EM; REACH Registry Investigators. Modifiable risk factors control and its relationship with 1 year outcomes after coronary artery bypass surgery: insights from the REACH registry. Eur Heart J 2008;29:3052-3060.
27. Torabipour A, Arab M, Zeraati H, Rashidian A, Sari AA, Sarzaiem MR. Multivariate analysis of factors influencing length of hospital stay after coronary artery bypass surgery in Tehran, Iran. Acta Med Iran 54:124-133.
28. Ostovan MA, Darvish N, Askarian M. The prevalence of risk factors of coronary artery disease in the patients who underwent coronary artery bypass graft, Shiraz, Iran: suggesting a model. Int Cardiovasc Res J 2014;8:139-142.
29. George J, Rapsomaniki E, Pujades-Rodriguez M, Shah AD, Denaxas S, Herrett E, Smeeth L, Timmis A, Hemingway H. How does cardiovascular disease first present in women and men? Incidence of 12 cardiovascular diseases in a contemporary cohort of 1,937,360 people. Circulation 2015;132:1320-1328.
30. Leening MJ, Ferket BS, Steyerberg EW, Kavousi M, Deckers JW, Nieboer D, Heeringa J, Portegies ML, Hofman A, Ikram MA, Hunink MG, Franco OH, Stricker BH, Witteman JC, Roos-Hesselink JW. Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ 2014;349:g5992.
31. Kodaira M, Miyata H, Numasawa Y, Ueda I, Maekawa Y, Sueyoshi K, Ishikawa S, Ohki T, Negishi K, Fukuda K, Kohsaka S. Effect of smoking status on clinical outcome and efficacy of clopidogrel in acute coronary syndrome. Circ J 2016;80:1590-1599.
32. Himbert D, Klutman M, Steg G, White K, Gulba DC; GRACE Investigators. Cigarette smoking and acute coronary syndromes: a multinational observational study. Int J Cardiol 2005;100:109-117.
33. Kennon S, Barakat K, Suliman A, MacCallum PK, Ranjadayalan K, Wilkinson P, Timmis AD. Influence of previous aspirin treatment and smoking on the electrocardiographic manifestations of injury in acute myocardial infarction. Heart 2000;84:41-45.
34. EsenZencirci A, Zencirci E, Değirmencioğlu A, Karakuş G, Ekmekçi A, Ozden K, Erdem A, Fındıkçıoğlu U, Altay S, Öz D, Erer HB, Akyol A, Eren M. The predictive value of gensini score in the clinical outcomes in patients with acute ST-Segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. JACC 62;18:Suppl C: C205.
35. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-234.
36. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA 1979;241:2035-2038.
37. Saleem T, Mohammad KH, Abdel-Fattah MM, Abbasi AH. Association of glycosylated haemoglobin level and diabetes mellitus duration with the severity of coronary artery disease. Diab Vasc Dis Res 2008;5:184-189.
38. Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS , Anton-Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch-Jacquotte A, Willett WC, Thun MJ. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010;363:2211-2219.
39. Patel N, Elsaid O, Shenoy A, Sharma A, McFarlane SI. Obesity paradox in patients undergoing coronary intervention: a review. World J Cardiol 2017;9:731-736.
40. Savage MP, Fischman DL. Percutaneous coronary intervention and the obesity paradox: fat chance. JACC Cardiovasc Interv 2018;11:77-79.
41. Kang WY, Hwang SH, Hwang SH, Kim W, Park KH, Hong YJ, Kim JH, Ahn Y, Jeong MH. Effects of weight change on clinical outcomes in overweight and obese patients with acute myocardial infarction who underwent successful percutaneous coronary intervention. Chonnam Med J 2012;48:32-38.
42. Peto R, Whitlock G, Jha P. Effects of obesity and smoking on U.S. life expectancy. N Engl J Med 2010;362:855-856.
43. Goldberg RJ, Cui J, Olendzki B, Spencer F, Yarzebski J, Lessard D, Gore J. Excess body weight, clinical profile, management practices, and hospital prognosis in men and women after acute myocardial infarction. Am Heart J 2006;151:1297-1304.
44. Diercks DB, Roe MT, Mulgund J, Pollack CV, Jr, Kirk JD, Gibler WB, Ohman EM, Smith SC, Jr, Boden WE, Peterson ED. The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J 2006;152:140-148.
45. Mobeirek AF, Al-Habib K, Al-Faleh H, Hersi A, Kashour T, Ullah A, Mimish LA, AlSaif S, Taraben A, Alnemer K, Alshamiri M. Absence of obesity paradox in Saudi patients admitted with acute coronary syndromes: insights from SPACE registry. Ann Saudi Med 2014;34:38-45.
46. Chai H, Liu W, Zhang C, Peng Y, Xu YN, Chen M, Huang DJ. Obesity paradox not observed among patients with angiographically proved coronary artery disease in southern China. J Cardiol 2014;64:508-509.
|Issue||Vol 15 No 4 (2020): J Teh Univ Heart Ctr|
|Acute coronary syndrome Coronary artery disease Myocardial infarction Risk factors|
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