The systemic inflammatory response index (SIRI) is a novel inflammatory biomarker in many diseases.The aim of this study was to examine the association between SIRI and adverse events in patients w...

Background: The association of the atherogenic index of plasma (AIP), an emerging lipid index that can predict the risk for cardiovascular disease, with adverse outcomes in type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has not been determined. Therefore, the aim of this study was to investigate whether the AIP could independently predict adverse cardiovascular events in T2DM patients with ACS undergoing PCI.Methods: This study was a retrospective analysis of a single-centre prospective registry involving 826 consecutive T2DM patients who underwent primary or elective PCI for ACS from June 2016 to November 2017. This study ultimately included 798 patients (age, 61 ± 10 years; male, 72.7%). The AIP was calculated as the base 10 logarithm of the ratio of the plasma concentration of triglycerides to high-density lipoprotein-cholesterol (HDL-C). All the patients were divided into 4 groups based on the AIP quartiles. The primary endpoint was a composite of death from any cause, non-fatal spontaneous myocardial infarction (MI), non-fatal ischaemic stroke, and unplanned repeat revascularization. The key secondary endpoint was a composite of cardiovascular death, non-fatal MI, and non-fatal ischaemic stroke.Results: During a median follow-up period of 927 days, 198 patients developed at least one event. An unadjusted Kaplan-Meier analysis showed that the incidence of the primary endpoint increased gradually with rising AIP quartiles (log-rank test,P = 0.001). A multivariate Cox proportional hazards analysis revealed that compared with the lowest AIP quartile, the top AIP quartile was associated with significantly increased risk for the primary and key secondary endpoints (hazard ratio [HR]: 2.249, 95% confidence interval [CI]: 1.438 to 3.517,P < 0.001; and HR: 2.571, 95% CI: 1.027 to 6.440,P = 0.044, respectively).Conclusions: A higher AIPvalue on admission was independently and strongly associated with adverse cardiovascular events in T2DM patients with ACS undergoing PCI.

Diabetes mellitus, and even prediabetes, has been shown to be independently associated with cardiovascular disease. Our study explored whether the combination of glycosylated hemoglobin (HbA _1c ) and fasting blood glucose (FBG) can better assess the severity of coronary heart disease (CHD) in elective percutaneous coronary intervention (PCI) patients. We consecutively enrolled 1006 prediabetic patients with HbA _1c 5.7% to 6.4% who underwent elective PCI. Patients were divided into 2 groups: a normal fasting glucose (NFG) group (FBG <6.1 mmol/L) and an impaired fasting glucose (IFG) group (6.1 ≤FBG<7.0 mmol/L) with defined values. Baseline characteristics and angiography data of the 2 groups were compared. The prevalence of 3-vessel disease ( P = .002), the GENSINI (the score is named after a professor) score ( P = .002), and the SYNTAX (SYNergy between PCI with TAXUS™ and Cardiac Surgery) score ( P = .002) of the IFG group was significantly higher compared to the NFG group. After multiple regression analysis, FBG was found to be independently associated with prevalence of 3-vessel disease (adjusted odds ratio: 1.62; 95% confidence interval: 1.21-2.36; P = .013), the GENSINI score (standardized β = .138, P = .008), and the SYNTAX score (standardized β = .145, P = .005). In addition, HbA _{1 c} was independently associated with the prevalence of 3-vessel disease, the GENSINI, score, and the SYNTAX score ( P < .05). Both FBG and HbA _1c are independently correlated with the severity of CHD in prediabetic patients with HbA _1c 5.7% to 6.4%.

The effect of systemic inflammation, represented by high-sensitivity C-reactive protein (hsCRP), on triglyceride glucose (TyG) index-associated cardiovascular risk in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) has not yet been determined. This study was a retrospective analysis of a single-center prospective registry and finally included 1701 patients (age, 60 ± 10 years; male, 76.7%). The primary endpoint was defined as major adverse cardiovascular events (MACE), including cardiovascular mortality, non-fatal stroke, and non-fatal myocardial infarction. In the multivariate COX regression model that included the GRACE risk score, higher TyG index was significantly associated with a greater incidence of MACE in patients with hsCRP levels less than 2 mg/L but not 2 mg/L or more (P for interaction = 0.039). Each unit increase in the TyG index was independently associated with a 52% increased risk of MACE only in patients with hsCRP levels less than 2 mg/L (P = 0.021). After adjustment for other confounding factors, including the GRACE risk score, compared with those in the group of TyG index < 8.62 and hsCRP < 2 mg/L, patients in the group of TyG index ≥ 8.62 and hsCRP ≥ 2 mg/L had a 3.9 times higher hazard ratio for developing MACE. The addition of both TyG index and hsCRP had an incremental effect on the predictive ability of the GRACE risk score-based prognostic model for MACE (C-statistic: increased from 0.631 to 0.661; cNRI: 0.146, P = 0.012; IDI: 0.009, P < 0.001). In conclusion, there was a significant interaction between the TyG index and hsCRP for the risk of MACE, and the TyG index was reliably and independently associated with MACE only when hsCRP levels were less than 2 mg/L. Furthermore, high TyG index and high hsCRP levels synergistically increased the risk of MACE, suggesting that the prognostic value of TyG index combined with hsCRP might be promising in patients with ACS undergoing PCI.

Background: Mounting evidence indicates that rapid progression of aortic stenosis (AS) is significantly associated with poor prognosis. Whether diabetes accelerates the progression of AS remains controversial.Objectives: The purpose of the present study was to investigate whether diabetes was associated with rapid progression of AS.Methods: We retrospectively analyzed 276 AS patients who underwent transthoracic echocardiography at least twice with a maximum interval ≥ 180 days from January 2016 to June 2021. AS severity was defined by specific threshold values for peak aortic jet velocity (V_max) and/or mean pressure gradient. An increase of V_max ≥ 0.3 m/s/year was defined as rapid progression. The binary Logistic regression models were used to determine the association between diabetes and rapid progression of AS.Results: At a median echocardiographic follow-up interval of 614 days, the annual increase of V_max was 0.16 (0.00–0.41) m/s. Compared with those without rapid progression, patients with rapid progression were older and more likely to have diabetes (P = 0.040 and P = 0.010, respectively). In the univariate binary Logistic regression analysis, diabetes was associated with rapid progression of AS (OR = 2.02, P = 0.011). This association remained significant in the multivariate analysis based on model 2 and model 3 (OR = 1.93, P = 0.018; OR = 1.93, P = 0.022). After propensity score-matching according to V_max, diabetes was also associated rapid progression of AS (OR = 2.57, P = 0.045).Conclusions: Diabetes was strongly and independently associated with rapid progression of AS.

Background: Calcific aortic valve stenosis (CAVS) can lead to cardiac adverse outcomes; however, currently, no effective pharmacological interventions are available to prevent or delay disease progression. Emerging evidence has identified significant associations between CAVS and key biomarkers, including Lp(a) (lipoprotein [a]), low‐density lipoprotein cholesterol, and PCSK9 (proprotein convertase subtilisin/kexin type 9). However, robust evidence from randomized controlled trials is still lacking to substantiate these associations. Methods: The EPISODE (Effect of PCSK9 Inhibitors on Calcific Aortic Valve Stenosis) trial is a prospective, evaluator‐blinded, randomized controlled trial designed to assess the therapeutic efficacy of PCSK9 inhibitors in patients with CAVS. A total of 160 patients with mild‐to‐moderate or asymptomatic severe CAVS will be randomly assigned to receive either statin monotherapy or a combination of statins and PCSK9 inhibitors. Participants will undergo follow‐up assessments at 3‐month intervals for 24 months, including transthoracic ultrasonic cardiogram, computed tomography, and quality‐of‐life evaluations using the EuroQol‐5 Dimension‐3 Level questionnaire. The primary end point is the annualized change in peak aortic jet velocity, whereas secondary end points encompass changes in aortic valve area, calcification score, incidence of heart valve surgery, and quality of life. Safety end points include all‐cause mortality and cardiovascular events. Conclusions: The trial aims to evaluate the efficacy of PCSK9 inhibitors in modulating disease progression, reducing adverse cardiovascular events, and improving clinical outcomes in patients with CAVS. The anticipated findings are expected to provide critical insights for developing novel therapeutic strategies for early intervention in CAVS. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT04968509.