Predictors of Long-Term Mortality in Patients with Stable Angina Pectoris and Coronary Slow Flow
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Coronary Angiography
2.3. CSF and Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC)
2.4. Statistical Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Tambe, A.A.; Demany, M.A.; Zimmerman, H.A.; Mascarenhas, E. Angina pectoris and slow flow velocity of dye in coronary arteries—A new angiographic finding. Am. Heart J. 1972, 84, 66–71. [Google Scholar] [CrossRef]
- Chalikias, G.; Tziakas, D. Slow Coronary Flow: Pathophysiology, Clinical Implications, and Therapeutic Management. Angiology 2021, 72, 808–818. [Google Scholar] [CrossRef]
- Aparicio, A.; Cuevas, J.; Morís, C.; Martín, M. Slow Coronary Blood Flow: Pathogenesis and Clinical Implications. Eur. Cardiol. 2022, 17, e08. [Google Scholar] [CrossRef] [PubMed]
- Beltrame, J.F.; Limaye, S.B.; Horowitz, J.D. The coronary slow flow phenomenon–A new coronary microvascular disorder. Cardiology 2002, 97, 197–202. [Google Scholar] [CrossRef]
- Kapoor, A.; Goel, P.K.; Gupta, S. Slow coronary flow: A cause for angina with ST segment elevation and normal coronary arteries. A case report. Int. J. Cardiol. 1998, 67, 257–261. [Google Scholar] [CrossRef] [PubMed]
- Saya, S.; Hennebry, T.A.; Lozano, P.; Lazzara, R.; Schechter, E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: A case report and review of literature. Clin. Cardiol. 2008, 31, 352–355. [Google Scholar] [CrossRef] [PubMed]
- Zhu, Q.; Wang, S.; Huang, X.; Zhao, C.; Wang, Y.; Li, X.; Jia, D.; Ma, C. Understanding the pathogenesis of coronary slow flow: Recent advances. Trends Cardiovasc. Med. 2022, 11, S1050-1738(22)00142-6. [Google Scholar] [CrossRef]
- Kunadian, V.; Harrigan, C.; Zorkun, C.; Palmer, A.M.; Ogando, K.J.; Biller, L.H.; Lord, E.E.; Williams, S.P.; Lew, M.E.; Ciaglo, L.N.; et al. Use of the TIMI frame count in the assessment of coronary artery blood flow and microvascular function over the past 15 years. J. Thromb. Thrombolysis 2009, 27, 316–328. [Google Scholar] [CrossRef]
- Bedetti, G.; Pasanisi, E.M.; Pizzi, C.; Turchetti, G.; Loré, C. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain. Cardiovasc. Ultrasound. 2008, 6, 21. [Google Scholar] [CrossRef] [Green Version]
- Sen, T. Coronary slow flow phenomenon leads to ST elevation myocardial infarction. Korean Circ. J. 2013, 43, 196–198. [Google Scholar] [CrossRef] [Green Version]
- Amasyali, B.; Turhan, H.; Kose, S.; Celik, T.; Iyisoy, A.; Kursaklioglu, H.; Isik, E. Aborted sudden cardiac death in a 20-year-old man with slow coronary flow. Int. J. Cardiol. 2006, 109, 427–429. [Google Scholar] [CrossRef]
- Diver, D.J.; Bier, J.D.; Ferreira, P.E.; Sharaf, B.L.; McCabe, C.; Thompson, B.; Chaitman, B.; Williams, D.O.; Braunwald, E. Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). Am. J. Cardiol. 1994, 74, 531–537. [Google Scholar] [CrossRef]
- Atak, R.; Turhan, H.; Sezgin, A.T.; Yetkin, O.; Senen, K.; Ileri, M.; Sahin, O.; Karabal, O.; Yetkin, E.; Kutuk, E.; et al. Effects of slow coronary artery flow on QT interval duration and dispersion. Ann. Noninvasive Electrocardiol. 2003, 8, 107–111. [Google Scholar] [CrossRef] [PubMed]
- Li, M.; Su, H.; Jiang, M.; Zuo, Z.; Su, Z.; Hao, L.; Yang, J.; Zhang, Z.; Wang, H.; Kong, X. Predictive value of thrombolysis in myocardial infarction frame count for coronary microvascular dysfunction evaluated with an angiography-derived index of microcirculatory resistance in patients with coronary slow flow. Quant. Imaging Med. Surg. 2022, 12, 4942–4952. [Google Scholar] [CrossRef]
- Fineschi, M.; Bravi, A.; Gori, T. The “slow coronary flow” phenomenon: Evidence of preserved coronary flow reserve despite increased resting microvascular resistances. Int. J. Cardiol. 2008, 127, 358–361. [Google Scholar] [CrossRef] [PubMed]
- Beltrame, J.F.; Limaye, S.B.; Wuttke, R.D.; Horowitz, J.D. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am. Heart J. 2003, 146, 84–90. [Google Scholar] [CrossRef]
- Zhao, C.; Zong, Z.; Zhu, Q.; Wang, Y.; Li, X.; Zhang, C.; Ma, C.; Xue, Y. The lncRNA MALAT1 participates in regulating coronary slow flow endothelial dysfunction through the miR-181b-5p-MEF2A-ET-1 axis. Vascul. Pharmacol. 2021, 138, 106841. [Google Scholar] [CrossRef] [PubMed]
- Mosseri, M.; Yarom, R.; Gotsman, M.S.; Hasin, Y. Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation 1986, 74, 964–972. [Google Scholar] [CrossRef] [Green Version]
- Cin, V.G.; Pekdemir, H.; Camsar, A.; Ciçek, D.; Akkus, M.N.; Parmaksýz, T.; Katýrcýbaý, T.; Döven, O. Diffuse intimal thickening of coronary arteries in slow coronary flow. Jpn. Heart J. 2003, 44, 907–919. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pekdemir, H.; Cin, V.G.; Ciçek, D.; Camsari, A.; Akkus, N.; Döven, O.; Parmaksiz, H.T. Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol. 2004, 59, 127–133. [Google Scholar] [CrossRef] [Green Version]
- Denicolò, S.; Perco, P.; Thöni, S.; Mayer, G. Non-adherence to antidiabetic and cardiovascular drugs in type 2 diabetes mellitus and its association with renal and cardiovascular outcomes: A narrative review. J. Diabetes Complicat. 2021, 35, 107931. [Google Scholar] [CrossRef] [PubMed]
- Desai, R.; Thakkar, S.; Fong, H.K.; Varma, Y.; Ali Khan, M.Z.; Itare, V.B.; Raina, J.S.; Savani, S.; Damarlapally, N.; Doshi, R.P.; et al. Rising Trends in Medication Non-compliance and Associated Worsening Cardiovascular and Cerebrovascular Outcomes Among Hospitalized Adults Across the United States. Cureus 2019, 11, e5389. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Arnett, D.K.; Blumenthal, R.S.; Albert, M.A.; Buroker, A.B.; Goldberger, Z.D.; Hahn, E.J.; Himmelfarb, C.D.; Khera, A.; Lloyd-Jones, D.; McEvoy, J.W.; et al. ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019, 140, e596–e646. [Google Scholar] [PubMed]
- Kraus, V.B.; Ma, S.; Tourani, R.; Fillenbaum, G.G.; Burchett, B.M.; Parker, D.C.; Kraus, W.E.; Connelly, M.A.; Otvos, J.D.; Cohen, H.J.; et al. Causal analysis identifies small HDL particles and physical activity as key determinants of longevity of older adults. EBioMedicine 2022, 85, 104292. [Google Scholar] [CrossRef]
- Revelas, M.; Thalamuthu, A.; Zettergren, A.; Oldmeadow, C.; Najar, J.; Seidu, N.M.; Armstrong, N.J.; Riveros, C.; Kwok, J.B.; Schofield, P.R.; et al. High polygenic risk score for exceptional longevity is associated with a healthy metabolic profile. Geroscience 2023, 45, 399–413. [Google Scholar] [CrossRef]
- Gordon, D.J.; Probstfield, J.L.; Garrison, R.J.; Neaton, J.D.; Castelli, W.P.; Knoke, J.D.; Jacobs, D.R., Jr.; Bangdiwala, S.; Tyroler, H.A. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989, 79, 8–15. [Google Scholar] [CrossRef] [Green Version]
- Wilson, P.W.; Abbott, R.D.; Castelli, W.P. High density lipoprotein cholesterol and mortality. The Framingham Heart Study. Arteriosclerosis 1988, 8, 737–741. [Google Scholar] [CrossRef] [Green Version]
- Beazer, J.D.; Patanapirunhakit, P.; Gill, J.M.R.; Graham, D.; Karlsson, H.; Ljunggren, S.; Mulder, M.T.; Freeman, D.J. High-density lipoprotein’s vascular protective functions in metabolic and cardiovascular disease-could extracellular vesicles be at play? Clin. Sci. 2020, 134, 2977–2986. [Google Scholar] [CrossRef]
- Márquez, A.B.; Nazir, S.; van der Vorst, E.P. High-Density Lipoprotein Modifications: A Pathological Consequence or Cause of Disease Progression? Biomedicines 2020, 8, 549. [Google Scholar] [CrossRef]
- Hawkins, B.M.; Stavrakis, S.; Rousan, T.A.; Abu-Fadel, M.; Schechter, E. Coronary slow flow--prevalence and clinical correlations. Circ. J. 2012, 76, 936–942. [Google Scholar] [CrossRef] [Green Version]
- Wei, W.; Liang, Y.; Guo, D.; Xu, X.; Xu, Q.; Li, S.; Li, Y.; Liu, J.; Liu, Y.; Tu, M.; et al. Hyperglycemia newly detected by glycated hemoglobin affects all-cause mortality in coronary artery disease patients: A retrospective cohort study. Diabetes Res. Clin. Pract. 2022, 191, 110053. [Google Scholar] [CrossRef]
- Xu, W.; Song, Q.; Wang, X.; Zhao, Z.; Meng, X.; Xia, C.; Xie, Y.; Yang, C.; Guo, Y.; Zhang, Y.; et al. Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: Insights from a large cohort study. Cardiovasc. Diabetol. 2022, 21, 217. [Google Scholar] [CrossRef] [PubMed]
- Gabaldon-Perez, A.; Bonanad, C.; Garcia-Blas, S.; Marcos-Garcés, V.; D’Gregorio, J.G.; Fernandez-Cisnal, A.; Valero, E.; Minana, G.; Merenciano-González, H.; Mollar, A.; et al. Clinical Predictors and Prognosis of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) without ST-Segment Elevation in Older. Adults. J. Clin. Med. 2023, 12, 1181. [Google Scholar] [CrossRef] [PubMed]
- Yildiz, M.; Ashokprabhu, N.; Shewale, A.; Pico, M.; Henry, T.D.; Quesada, O. Myocardial infarction with non-obstructive coronary arteries (MINOCA). Front. Cardiovasc. Med. 2022, 9, 1032436. [Google Scholar] [CrossRef]
- Lindahl, B.; Baron, T.; Albertucci, M.; Prati, F. Myocardial infarction with non-obstructive coronary artery disease. EuroIntervention 2021, 17, e875–e887, Erratum in EuroIntervention 2022, 17, e1366. [Google Scholar] [CrossRef]
- Claudio, C.P.; Quesada, O.; Pepine, C.J.; Merz, C.N.B. Why names matter for women: MINOCA/INOCA (myocardial infarction/ischemia and no obstructive coronary artery disease). Clin. Cardiol. 2018, 41, 185–193. [Google Scholar] [CrossRef]
- Schmitz, T.; Freuer, D.; Harmel, E.; Heier, M.; Peters, A.; Linseisen, J.; Meisinger, C. Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction. Acta Diabetol. 2022, 59, 1019–1029. [Google Scholar] [CrossRef] [PubMed]
- Pizzi, C.; Xhyheri, B.; Costa, G.M.; Faustino, M.; Flacco, M.E.; Gualano, M.R.; Fragassi, G.; Grigioni, F.; Manzoli, L. Nonobstructive versus obstructive coronary artery disease in acute coronary syndrome: A meta-analysis. J. Am. Heart Assoc. 2016, 5, e004185. [Google Scholar] [CrossRef] [Green Version]
- Paolisso, P.; Foà, A.; Bergamaschi, L.; Angeli, F.; Fabrizio, M.; Donati, F.; Toniolo, S.; Chiti, C.; Rinaldi, A.; Stefanizzi, A.; et al. Impact of admission hyperglycemia on short and long-term prognosis in acute myocardial infarction: MINOCA versus MIOCA. Cardiovasc. Diabetol. 2021, 20, 192. [Google Scholar] [CrossRef]
Study Population (n = 137) | Alive (n = 116) | Non-Cardiovascular Mortality (n = 9) | Cardiovascular Mortality (n = 12) | p | ||
---|---|---|---|---|---|---|
Gender (Male) | 93 (67.9) | 77 (66.4) | 6 (66.7) | 10 (83.3) | 0.487 | |
Hypertension | 92 (67.2) | 73 (62.9) a | 7 (77.8) a,b | 12 (100) b | 0.026 | |
Diabetes mellitus | 43 (31.4) | 29 (25) a | 6 (66.7) b | 8 (66.7) a,b | 0.001 | |
Family History of atherosclerosis | 6 (4.4) | 5 (4.3) | 0 (0) | 1 (8.3) | 0.650 | |
Non-compliance with medical treatment | 46 (33.6) | 29 (25) a | 7 (77.8) b | 10 (83.3) a,b | <0.001 | |
Hyperlipidaemia | 51 (37.2) | 48 (41.4) | 1 (11.1) | 2 (16.7) | 0.059 | |
Smoking Status | Non-smoker | 55 (40.1) | 44 (37.9) | 6 (66.7) | 5 (41.7) | 0.136 |
Smoker | 58 (42.3) | 48 (41.4) | 3 (33.3) | 7 (58.3) | ||
Ex-smoker | 24 (17.5) | 24 (20.7) | 0 (0) | 0 (0) | ||
Recurrent Hospitalizations | None | 100 (73) | 90 (77.6) a,b | 7 (77.8) a | 3 (25) b | <0.001 |
Acute Coronary Syndrome | 31 (22.6) | 20 (17.1) | 2 (22.2) | 9 (75) | ||
Stable Angina | 10 (7.3) | 10 (8.6) | 0 (0) | 0 (0) | ||
Intervention | None | 110 (80.3) | 91 (78.4) | 9 (100) | 10 (83.3) | 0.324 |
Angiography | 17 (12.4) | 17 (14.7) | 0 (0) | 0 (0) | ||
Angiography + stenting | 8 (5.8) | 6 (5.2) | 0 (0) | 2 (16.7) | ||
Bypass surgery | 2 (1.5) | 2 (1.7) | 0 (0) | 0 (0) | ||
Age (years) | 52.2 ± 9.36 | 50.86 ± 9.04 a | 58.67 ± 8.87 b | 60.33 ± 6.83 b | <0.001 | |
Duration of smoking (pack-years) | 20.59 ± 6.54 (n = 82) | 19.31 ± 5.77 a (n = 72) | 31 ± 3.61 b (n = 3) | 29.29 ± 4.03 b (n = 7) | <0.001 | |
Total Cholesterol (mg/dL) | 204 ± 38.79 | 202.98 ± 36.21 | 220.31 ± 38.73 | 201.6 ± 59.75 | 0.427 | |
HDL-C (mg/dL) | 42.08 ± 9.44 | 43.04 ± 9.58 a | 39.33 ± 7.6 a,b | 34.83 ± 5.27 b | 0.010 | |
Triglyceride (mg/dL) | 173 ± 65.89 | 170.05 ± 70.27 | 181.56 ± 32.66 | 195.08 ± 24.16 | 0.424 | |
LDL-C (mg/dL) | 126.59 ± 35.07 | 125.07 ± 32.12 | 144.67 ± 38.74 | 127.75 ± 55.07 | 0.271 | |
Hemoglobin (g/dL) | 14.22 ± 1.33 | 14.24 ± 1.32 | 14.12 ± 0.75 | 14.16 ± 1.77 | 0.955 | |
Glucose (mg/dL) | 103.07 ± 21.96 | 101.96 ± 19.82 | 99.11 ± 10.02 | 116.75 ± 39.37 | 0.072 | |
Survival time (years) | 9.41 ± 1.74 | 10.00 ± 0.00 | 7.11 ± 2.32 | 5.42 ± 2.84 | <0.001 | |
LAD TFC * | 40.67 ± 3.66 | 40.49 ± 3.31 | 37 ± 2.92 | 45.17 ± 3.43 | <0.001 | |
CX TFC | 37.78 ± 2.33 | 37.83 ± 2.18 a | 35.33 ± 2.06 | 39.17 ± 2.72 a | 0.001 | |
RCA TFC | 35.57 ± 3.48 | 35.46 ± 3.52 | 34.22 ± 2.17 | 37.67 ± 3.28 | 0.053 | |
Mean TFC | 38.01 ± 2.4 | 37.93 ± 2.18 | 35.52 ± 1.78 | 40.67 ± 2.51 | <0.001 |
Cause of Death | p | |||
---|---|---|---|---|
Non-Cardiovascular (n = 9) | Cardiovascular (n = 12) | |||
Gender (Male) | 6 (66.7) | 10 (83.3) | 0.611 | |
Hypertension | 7 (77.8) | 12 (100) | 0.171 | |
Diabetes mellitus | 6 (66.7) | 8 (66.7) | 1.000 | |
Family Historyof atherosclerosis | 0 (0) | 1 (8.3) | 1.000 | |
Non-compliance with medical treatment | 7 (77.8) | 10 (83.3) | 1.000 | |
Hyperlipidaemia | 1 (11.1) | 2 (16.7) | 1.000 | |
Smoking Status | Non-smoker | 6 (66.7) | 5 (41.7) | 0.387 |
Smoker | 3 (33.3) | 7 (58.3) | ||
Intervention | None | 9 (100) | 10 (83.3) | 0.486 |
Angiography + stenting | 0 (0) | 2 (16.7) | ||
Age (years) | 58.67 ± 8.87 | 60.33 ± 6.83 | 0.632 | |
Duration of smoking (pack-years) | 31 ± 3.61 (n = 3) | 29.29 ± 4.03 (n = 7) | 0.545 | |
Total cholesterol (mg/dL) | 220.31 ± 38.73 | 201.6 ± 59.75 | 0.424 | |
HDL-C (mg/dL) | 39.33 ± 7.6 | 34.83 ± 5.27 | 0.125 | |
Triglyceride (mg/dL) | 181.56 ± 32.66 | 195.08 ± 24.16 | 0.288 | |
LDL-C (mg/dL) | 144.67 ± 38.74 | 127.75 ± 55.07 | 0.442 | |
Hemoglobin (g/dL) | 14.12 ± 0.75 | 14.16 ± 1.77 | 0.955 | |
Glucose (mg/dL) | 99.11 ± 10.02 | 116.75 ± 39.37 | 0.207 | |
Survival time (Years) | 7.11 ± 2.32 | 5.42 ± 2.84 | 0.161 | |
LAD Frame count * | 37 ± 2.92 | 45.17 ± 3.43 | <0.001 | |
CX Frame count | 35.33 ± 2.06 | 39.17 ± 2.72 | 0.002 | |
RCA Frame count | 34.22 ± 2.17 | 37.67 ± 3.28 | 0.013 | |
Mean Frame count | 35.52 ± 1.78 | 40.67 ± 2.51 | <0.001 |
p | OR | 95% CI for OR | |
---|---|---|---|
Age (years) | 0.001 | 1.220 | 1.085–1.371 |
HT | 0.022 | 18.253 | 1.515–219.851 |
DM | 0.056 | 5.948 | 0.953–37.143 |
Non-compliance with medical treatment | <0.001 | 75.244 | 9.671–585.460 |
HDL-C (mg/dL) | 0.019 | 0.853 | 0.747–0.975 |
Triglyceride (mg/dL) | 0.575 | 1.004 | 0.989–1.02 |
Constant | 0.072 |
p | OR | 95% CI for OR | |
---|---|---|---|
Mean Frame Counts (frames) | 0.033 | 3.318 | 1.101–10.000 |
Gender | 0.483 | 7.812 | 0.025–2451.148 |
Total cholesterol (mg/dL) | 0.287 | 0.978 | 0.938–1.019 |
Constant | 0.060 | 0.000 |
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Aksoy, S.; Öz, D.; Öz, M.; Agirbasli, M. Predictors of Long-Term Mortality in Patients with Stable Angina Pectoris and Coronary Slow Flow. Medicina 2023, 59, 763. https://doi.org/10.3390/medicina59040763
Aksoy S, Öz D, Öz M, Agirbasli M. Predictors of Long-Term Mortality in Patients with Stable Angina Pectoris and Coronary Slow Flow. Medicina. 2023; 59(4):763. https://doi.org/10.3390/medicina59040763
Chicago/Turabian StyleAksoy, Sukru, Dilaver Öz, Melih Öz, and Mehmet Agirbasli. 2023. "Predictors of Long-Term Mortality in Patients with Stable Angina Pectoris and Coronary Slow Flow" Medicina 59, no. 4: 763. https://doi.org/10.3390/medicina59040763