Background: Secreted frizzled-related protein 5 (SFRP5) is a novel adipokine that has been found to be closely associated with metabolic and cardiovascular diseases. We investigated serum SFRP5 levels during the acute phase and their predictive value for the prognosis of acute aortic dissection (AAD). Methods: In total, 152 AAD patients and 164 controls were enrolled in this study. Serum SFRP5 levels were measured using an enzyme-linked immunosorbent assay (ELISA). AAD patients were divided into high-SFRP5 and low-SFRP5 groups based on the optimal cutoff value and followed up for prognosis. The primary endpoint was all-cause mortality, and the secondary endpoint focused on AAD-related events (including AAD-related mortality and unplanned reoperations). Results: Serum SFRP5 levels were significantly higher in AAD patients than in non-AAD controls, regardless of whether they had Stanford type A or B AD. Multivariate logistic regression analysis revealed an independent association between SFRP5 and the presence of AAD (adjusted OR 1.267, 95 % CI 1.152–1.394; p < 0.001). The receiver operating characteristic curve demonstrated that the optimal cutoff value for SFRP5 to predict the presence of AAD was 10.26 ng/mL (AUC 0.7241, sensitivity 49.34 %, specificity 87.20 %). Notably, serum SFRP5 levels of patients in the death group were significantly higher than those in the survival group. Compared with patients in the low-SFRP5 group, those in the high-SFRP5 group exhibited a significantly increased risk of all-cause mortality (HR 9.540, 95 % CI 2.803–32.473; p < 0.001) and AAD-related events (HR 6.915, 95 % CI 2.361–20.254; p < 0.001) during the follow-up period. Conclusion: Serum SFRP5 levels were significantly elevated in the acute phase of AAD, and high serum SFRP5 levels were independently associated with poor AAD prognosis. These results suggest that serum SFRP5 level during the acute phase may be an effective biomarker and therapeutic target for the prognosis of AAD.

Background The protective effect of Coenzyme Q10 (CoQ10) on the cardiovascular system has been reported, however, whether it can promote early recovery of cardiac function and alleviate cardiac remodeling after myocardial infarction (MI) remains to be elucidated. Whether CoQ10 may regulate the macrophage-mediated pro-inflammatory response after MI and its potential mechanism are worth further exploration. Methods To determine the baseline plasma levels of CoQ10 by LC-MS/MS, healthy controls and MI patients ( n = 11 each) with age- and gender-matched were randomly enrolled. Additional MI patients were consecutively enrolled and randomized into the blank control ( n = 59) or CoQ10 group ( n = 61). Follow-ups were performed at 1- and 3-month to assess cardiac function after percutaneous coronary intervention (PCI). In the animal study, mice were orally administered CoQ10/vehicle daily and were subjected to left anterior descending coronary artery (LAD) ligation or sham operation. Echocardiography and serum BNP measured by ELISA were analyzed to evaluate cardiac function. Masson staining and WGA staining were performed to analyze the myocardial fibrosis and cardiomyocyte hypertrophy, respectively. Immunofluorescence staining was performed to assess the infiltration of IL1β/ROS-positive macrophages into the ischemic myocardium. Flow cytometry was employed to analyze the recruitment of myeloid immune cells to the ischemic myocardium post-MI. The expression of inflammatory indicators was assessed through RNA-seq, qPCR, and western blotting (WB). Results Compared to controls, MI patients showed a plasma deficiency of CoQ10 (0.76 ± 0.31 vs. 0.46 ± 0.10 µg/ml). CoQ10 supplementation significantly promoted the recovery of cardiac function in MI patients at 1 and 3 months after PCI. In mice study, compared to vehicle-treated MI mice, CoQ10-treated MI mice showed a favorable trend in survival rate (42.85% vs. 61.90%), as well as significantly alleviated cardiac dysfunction, myocardial fibrosis, and cardiac hypertrophy. Notably, CoQ10 administration significantly suppressed the recruitment of pro-inflammatory CCR2 + macrophages into infarct myocardium and their mediated inflammatory response, partially by attenuating the activation of the NLR family pyrin domain containing 3 (NLRP3)/Interleukin-1 beta (IL1β) signaling pathway. Conclusions These findings suggest that CoQ10 can significantly promote early recovery of cardiac function after MI. CoQ10 may function by inhibiting the recruitment of CCR2 + macrophages and suppressing the activation of the NLRP3/IL1β pathway in macrophages. Trial registration Date of registration 09/04/2021 (number: ChiCTR2100045256).

The erythroblast transformation-specific related gene (ERG) is expressed in hematopoietic stem and progenitor cells and endothelial cells. This study aimed to investigate if ERG rs2836411 is a novel genetic locus associated with anemia and aortic dissection (AD). A case-control trial was conducted to evaluate the association between ERG rs2836411 polymorphism, anemia, and AD risk. The ERG rs2836411 polymorphism was analyzed using Sanger dideoxy chain termination sequencing on genomic DNA extracted from whole blood. Serum erythropoietin (EPO) and interleukin-6 (IL-6) concentrations were measured by enzyme-linked immunosorbent assay (ELISA). 119 preoperative AD patients and 119 healthy controls were enrolled, with age and sex matched. Anemia was found independently associated with AD presence (Odds ratio (OR) 20.82, p < 0.001). Remarkably, T carriers (CT + TT) of ERG rs2836411 were associated with anemia in AD patients (OR 2.81, p = 0.013) but not in controls. After adjusting for conventional risk factors including age, sex, smoking and hypertension status, T carriers (CT + TT) were independently associated with AD presence (OR 2.20, p = 0.015), but were not associated if anemia was further adjusted. While EPO concentration was higher in AD patients and was associated with AD presence (OR 1.09, p = 0.006), no difference in EPO levels was observed between the ERG genotypes of AD patients. T carriers (CT + TT) of ERG rs2836411 are independently associated with anemia and AD presence. The association between ERG rs2836411 polymorphism and susceptibility to AD may be mediated by anemia. Further studies are warranted to validate whether this association is causal.

目的 探究血清高敏C反应蛋白(hs-CRP)、可溶性致癌抑制因子2(sST2)水平与慢性心力衰竭患者经心脏再同步化治疗(CRT)后发生室性心律失常(VA)的关系.方法 收集2018年1月—2021年7月陆军军医大学第二附属医院心内科收治并行CRT的慢性心力衰竭患者179例为研究对象,根据CRT后1年是否发生室性心律失常将患者分为未发生VA组141例和发生VA组38例.收集2组患者临床资料,记录患者CRT后1年室性心律失常指 标[校正的QT间期(QTc)、校正后Tp-Te间期(Tp-Tec)],采用双抗体夹心—酶联免疫吸附法检测血清hs-CRP、sST2水平;采用Spearman法分析血清hs-CRP、sST2与纽约心脏病协会(NYHA)心功能分级、室性心律失常的相关性,Pear-son法分析血清hs-CRP与sST2以及二者分别与左心室射血分数(LVEF)、血红蛋白(Hb)、心肌肌钙蛋白Ⅰ(cTnⅠ)、QTc、Tp-Tec的相关性;采用受试者工作特征曲线(ROC)评价血清hs-CRP、sST2水平对慢性心力衰竭患者CRT后发生室性心律失常的预测价值;采用多因素Logistic回归分析影响慢性心力衰竭患者CRT后发生室性心律失常的危险因素.结果 发生VA组NYHA心功能分级≥ Ⅱ级人数所占比例及cTnⅠ、QTc、Tp-Tec、hs-CRP、sST2水平高于未发生VA组(x2/t=12.604、11.417、9.135、9.513、12.967、23.484,P均＜0.001),LVEF、Hb 水平低于未发生 VA 组(t/P=4.312/＜0.001、2.531/0.012).慢性心力衰竭患者血清hs-CRP与sST2水平呈正相关(r/P=0.716/＜0.001),血清hs-CRP、sST2 水平与 NYHA 心功能分级、cTnⅠ、QTc、Tp-Tec、室性心律失常呈正相关(hs-CRP:r=0.629、0.558、0.672、0.704、0.764,P 均＜0.001;sST2:r=0.657、0.542、0.618、0.693、0.782,P均＜0.001),与 LVEF、Hb 水平呈负相关(hs-CRP:r=-0.583、-0.605,P 均＜0.001;sST2:r=-0.551、-0.629,P均＜0.001).血清 hs-CRP、sST2 及两者联合预测慢性心力衰竭患者CRT后发生室性心律失常的曲线下面积(AUC)分别为0.862、0.887、0.964,两者联合预测的AUC 高于单项预测(Z/P=2.882/0.004、2.250/0.025);NYHA 心功能分级 ≥ Ⅱ 级、cTnⅠ 高、QTc 高、Tp-Tec 高、hs-CRP高、sST2高是影响慢性心力衰竭患者CRT后发生室性心律失常的独立危险因素[OR(95％CI)=1.772(1.158～2.711)、2.066(1.243～3.431)、1.488(1.120～1.977)、1.596(1.095～2.325)、2.307(1.343～3.963)、1.819(1.210～2.735)],LVEF高为其独立保护因素[OR(95％CI)=0.853(0.738～0.986)].结论 慢性心力衰竭CRT后发生室性心律失常患者血清hs-CRP、sST2水平呈高表达,两者联合对室性心律失常的发生有一定预测价值,两者升高是发生室性心律失常的危险因素.

目的 探讨早发冠心病(PCHD)的危险因素,分析Nomogram预测模型对PCHD的预测价值.方法 回顾性分析自2020年5月至2021年8月陆军军医大学第二附属医院收治的620例疑诊为冠心病患者的临床资料.根据冠状动脉造影结果,将冠心病患者纳入PCHD组(n=502),未达冠心病诊断标准的患者纳入非冠心病(NCHD)组(n=118).比较两组临床指标.采用Logistic回归分析探讨PCHD的独立危险因素.构建Nomogram预测模型,绘制受试者工作特征(ROC)曲线和校正曲线,评估该预测模型的预测效能.结果 PCHD组男性比例、吸烟比例、糖尿病比例、高血压比例、体质量指数、超声颈动脉中膜厚度、白细胞计数、中性粒细胞计数、淋巴细胞计数、单核细胞计数、甘油三酯和纤维蛋白原均高于NCHD组,高密度脂蛋白胆固醇低于NCHD组,两组比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,吸烟、超声颈动脉中膜厚度、单核细胞计数、高密度脂蛋白胆固醇和纤维蛋白原是PCHD的独立危险因素(比值比分别为1.637、43.966、10.809、0.277、1.657,P＜0.05).预测 PCHD 的 Nomogram 模型总分为 34～146 分,对应 PCHD 的概率为 30％～99％.Nomo-gram 模型预测PCHD的ROC曲线下面积为0.750(95％可信区间0.701～0.799).结论 吸烟、超声颈动脉中膜厚度、单核细胞计数、高密度脂蛋白胆固醇和纤维蛋白原是PCHD的独立危险因素,整合这些指标构建的Nomogram模型对PCHD的预测效能较好.

Objective To investigate the risk factors associated with post-implantation syndrome (PIS) in Stanford type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR) and the relationship of PIS with short-term outcomes. Methods A case-control trial was conducted on the clinical data of patients undergoing TEVAR treatment for TBAD in our department from December 2013 to December 2022. They were divided into 2 groups based on the occurrence of PIS. Independent risk factors were analyzed according to the different clinical characteristics between the 2 groups. The overall 30-day mortality following TEVAR was assessed in both groups. Kaplan-Meier survival curves were utilized to evaluate the 30-day postoperative survival. Logistic regression models were constructed to investigate the relationship between PIS and overall mortality occurring within 30 d after TEVAR. Results A total of 373 TBAD patients, with an average age of 57.9±12.1 years and a male ratio of 77.5% (289 cases), were enrolled in this study. There were 106 cases (28.4%) experiencing PIS following TEVAR. Significantly larger proportions of implanted stents ≥2, operation duration ≥2 h and implantation of polyethylene terephthalate (PET)-coverted stents were observed in the PIS group than the non-PIS group (P < 0.05). Multivariate logistic regression analysis suggested that implanted stents ≥2 (OR=1.886, 95%CI: 1.049~3.389, P=0.034), operation duration ≥2 h (OR=1.938, 95%CI: 1.147~3.275, P=0.013) and implantation of PET-coverted stents (OR=2.131, 95%CI: 1.263~3.597, P=0.005) were independent risk factors for PIS after TEVAR. Within 30 d after TEVAR, 15 (4.0%) cases dead, including 10 (9.4%) from the PIS group and 5 (1.9%) from the non-PIS group. Kaplan-Meier survival curve indicated a significantly lower survival in the PIS group (Log-rank P=0.000 7). The results of multivariate logistic regression model indicated that cystatin C (OR=1.486, 95%CI: 1.053~2.097, P=0.024) and PIS (OR=5.628, 95%CI: 1.836~17.248, P=0.002) were independent risk factors for 30-day mortality after TEVAR in TBAD patients. Conclusion Implanted stents ≥2, operation duration ≥2 h and implantation of PET-coverted stents are closely associated with the occurrence PIS in TBAD patients after TEVAR. Cystatin C level and PIS are primary risk factors for poor 30-day prognosis after TEVAR.

Objectives: To compare the short-term outcomes of branched stentgrafts for left subclavian artery (LSA) revascularization or partial LSA coverage without reconstruction in the treatment of type B aortic dissection with proximal tear close to LSA. Methods: A total of 125 type B aortic dissection patients were treated with thoracic endovascular aortic repair (TEVAR) in Xinqiao Hospital of the Army Medical University from January 2019 to March 2021. Their medical records were reviewed and the outcomes were followed up. According to the different treatment methodologies, the patients were divided into complete LSA coverage with reconstruction group (n=25) and partial LSA coverage without reconstruction group (n=100). The data of baseline characteristics, clinical outcomes, and incidence of postoperative in-hospital adverse events were collected and compared between the two groups. The adverse events during one-year follow-up were also compared between the two groups. Kaplan-Meier analysis and log-rank test were used to compare the cumulative survival rates between groups. Results: Compared with partial LSA coverage group, distance of proximal tear to LSA((8.69±2.32)mm vs. (13.77±1.71) mm) was shorter, in-hospital expenses[175 400(166 000-189 900) yuan vs. 143 700 (138 100-151 800) yuan] was higher, average length of stent [200.00 mm vs. 150.00 (150.00-150.00) mm] and operation time [155.00 (140.00-170.00) min vs. 95.00 (80.00-100.00) min] were longer, and volumes of contrast agent [300.00 (200.00-300.00) ml vs. 200.00 (200.00-300.00) ml] (P<0.05) were higher for patients in the complete LSA coverage with reconstruction group. The incidence of post-operative fever was significantly higher in complete LSA coverage with revascularization group than that in partial LSA partial coverage with reconstruction group (56% vs. 25%, P=0.003). There was no significant difference in the incidences of all-cause death, stroke, endoleak, paraplegia, and LSA branch vessel occlusion between the two groups during follow-up. Kaplan-Meier analysis showed that there was no significant difference in the cumulative survival rates between the two groups (log-rank test: P=0.572 5). Conclusion: The TEVAR with complete LSA revascularization or partial LSA coverage without reconstruction for type B aortic dissection close to LSA are safe and effective with high success rates. There is no significant difference between these two techniques in short-term outcomes.

Background: Non-valvular atrial fibrillation (NVAF) is a common type of AF, and patients with NVAF have a higher risk of ischemic stroke than non-AF patients. This study aims to investigate the goal attainment of international normalized ratio (INR) in patients with NVAF after anticoagulation therapy, and to analyze the risk factors that affect the goal attainment of INR.Methods: NVAF patients who were admitted to our hospital from December 2019 to December 2020 and received anticoagulation therapy were selected as the research subjects. The INR goal attainment of patients was assessed, the risk factors affecting INR goal attainment were analyzed, and a ROC curve was drawn to evaluate the predictive value of risk factors for INR goal attainment in NVAF patients.Results: After anticoagulation treatment, the INR of 42 cases reached the target (INR value ≥0.2, the goal attainment group), and the INR of 74 cases did not reach the target (INR value <2.0, the non-goal attainment group). The age, mean platelet volume (MPV), platelet distribution width (PDW), and large platelet ratio (P-LCR) levels of patients in the goal attainment group were significantly lower than those in the non-goal attainment group, and the platelet count (PLT) level was higher than that of the non-goal attainment group (P<0.05). The results of multivariate logistic regression analysis showed that MPV, PDW, and P-LCR were independent risk factors that affected the failure in INR goal attainment in patients with NVAF after anticoagulation therapy. The ROC curve showed that the AUC values of MPV, PDW, and P-LCR were 0.711, 0.748, 0.867, respectively, and the combined AUC was 0.876, which was higher than that of the single detection.Conclusions: MPV, PDW, and P-LCR are important factors that affect the goal attainment of INR after anticoagulant therapy in NVAF patients. For patients with risk factors, clinicians can formulate a reasonable individualized anticoagulant drug regimen based on the above-mentioned index levels.

Background More people ascend to high altitude (HA) for various activities, and some individuals are susceptible to HA illness after rapidly ascending from plains. Acute mountain sickness (AMS) is a general complaint that affects activities of daily living at HA. Although genomic association analyses suggest that single nucleotide polymorphisms (SNPs) are involved in the genesis of AMS, no major gene variants associated with AMS-related symptoms have been identified. Methods In this cross-sectional study, 604 young, healthy Chinese Han men were recruited in June and July of 2012 in Chengdu, and rapidly taken to above 3700 m by plane. Basic demographic parameters were collected at sea level, and heart rate, pulse oxygen saturation (SpO 2 ), systolic and diastolic blood pressure and AMS-related symptoms were determined within 18–24 h after arriving in Lhasa. AMS patients were identified according to the latest Lake Louise scoring system (LLSS). Potential associations between variant genotypes and AMS/AMS-related symptoms were identified by logistic regression after adjusting for potential confounders (age, body mass index and smoking status). Results In total, 320 subjects (53.0%) were diagnosed with AMS, with no cases of high-altitude pulmonary edema or high-altitude cerebral edema. SpO 2 was significantly lower in the AMS group than that in the non-AMS group ( P = 0.003). Four SNPs in hypoxia-inducible factor-related genes were found to be associated with AMS before multiple hypothesis testing correction. The rs6756667 ( EPAS1 ) was associated with mild gastrointestinal symptoms ( P = 0.013), while rs3025039 ( VEGFA ) was related to mild headache ( P = 0.0007). The combination of rs6756667 GG and rs3025039 CT/TT further increased the risk of developing AMS ( OR = 2.70, P < 0.001). Conclusions Under the latest LLSS, we find that EPAS1 and VEGFA gene variants are related to AMS susceptibility through different AMS-related symptoms in the Chinese Han population; this tool might be useful for screening susceptible populations and predicting clinical symptoms leading to AMS before an individual reaches HA. Trial registration Chinese Clinical Trial Registration, ChiCTR-RCS-12002232 . Registered 31 May 2012.

Appetite loss is a common symptom that occurs in high altitude (HA) for lowlanders. Previous studies indicated that hypoxia is the initiating vital factor of HA appetite loss. PPARA, EPAS1, EGLN1, HIF1A, HIF1AN, and NFE2L2 play important roles in hypoxic responses. We aimed to explore the association of these hypoxia-related gene polymorphisms with HA appetite loss. In this study, we enrolled 416 young men who rapidly ascended to Lhasa (3700 m) from Chengdu (<500m) by plane. PPARA, EPAS1, EGLN1, HIF1A, HIF1AN, and NFE2L2 were genotyped by MassARRAY. Appetite scores were measured to identify HA appetite loss. Logistic regression and multiple genetic models were tested to evaluate the association between the single nucleotide polymorphisms (SNPs) and risk of HA appetite loss in crude and adjusted (age and SaO(2)) analysis. Subsequently, Haploview software was used to analyze the linkage disequilibrium (LD), haplotype construction and the association of diverse haplotypes with the risk of HA appetite loss. Our results revealed that allele "A" in PPARA rs4253747 was significantly associated with the increased risk of HA appetite loss. Codominant, dominant, recessive, and log-additive models of PPARA rs4253747 showed the increased risk of HA appetite loss in the crude and adjusted analysis. However, only dominant, overdominant, and log-additive models of EPAS1 rs6756667 showed decreased risk of HA appetite loss in the crude and adjusted analysis. Moreover, the results from haplotype-based test showed that the rs7292407-rs6520015 haplotype "AC" was associated with HA appetite loss in the crude analysis rather than the adjusted analysis. In this study, we first established the association of SNPs in PPARA (rs4253747) and EPAS1 (rs6756667) genes with susceptibility to HA appetite loss in Han Chinese young men. These findings provide novel insights into understanding the mechanisms involved in HA appetite loss.

Objective To investigate the predictive value of D-dimer combined with activated partial thromboplastin time (APTT) for slow/no-reflow of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome(ACS). Methods A total of 181 ACS patients undergoing emergency PCI in our department from November 2015 to June 2018 were recruited in this study. Their plasma D-dimer level and APTT were tested before surgery. According to thrombolysis in myocardial infarction (TIMI), the patients were divided into slow/no-reflow group and normal blood flow group. The correlations of D-dimer level and APTT were analyzed with the incidence of slow/no-reflow. According to the cutoff values of the 2 indicators, the patients were assigned into high-risk group and non-high-risk group, and the incidence of slow/no-reflow was compared between the 2 groups. Results Logistics multivariate regression analysis showed preoperative D-dimer (OR=2.801, 95% CI=1.399~5.610, P=0.004) was positively, and APTT (OR=0.881, 95%CI=0.810~0.959, P=0.003) was negatively correlated with slow/no-reflow phenomenon. According to ROC curve, D-dimer AUC=0.612 (95% CI=0.537~0.683, P=0.036), APTT AUC=0.653 (95% CI=0.579~0.722, P=0.004), and AUC increased to 0.697 (95% CI=0.624~0.763, P < 0.001) when D-dimer was combined with APTT index. According to the cutoff values of D-dimer and APTT, the incidence of slow/no-reflow in high-risk and non-high-risk groups was 36.17% and 14.92%, respectively (P=0.002). Conclusion Higher preoperative D-dimer indicates higher incidence of slow/no-reflow in ACS patients after emergency PCI, while preoperative APTT is negatively correlated with the incidence. So combined detection of the 2 indicators helps predict the occurrence of slow/no-reflow in the patients.

目的 探讨反应性充血指数(RHI)对急性冠脉综合征(ACS)合并糖尿病患者行冠脉支架置入术(PCI)后1年主要心血管事件(MACE)的预测价值.方法 选取自2015年12月至2016年12月陆军军医大学新桥医院心内科收治的113例ACS合并糖尿病PCI术后患者为研究对象.根据RHI将患者分为正常内皮功能(NEF)组与内皮功能障碍(DEF)组.所有患者均接受12个月的随访调查.结果 DEF组患者MACE事件发生率显著高于NEF组,两组间比较,差异有统计学意义(P<0.05).多变量Cox危险分析提示RHI为ACS合并糖尿病患者PCI术后1年MACE事件的独立预测因子(95％可信区间1.07～9.69,P<0.05).Kaplan-Meier分析显示,DEF组累积MACE发生率高于NEF组,两组间比较,差异有统计学意义(P<0.05).结论 RHI<1.67是ACS合并糖尿病患者PCI术后1年临床预后的独立预测因子.

We aimed at identifying the predictive role of endothelial function assessed by the RH-PAT index (RHI) for future major cardiovascular events (MACEs) in acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI). We measured RHI in 308 subjects with ACS, and they were divided into the normal endothelial function (NEF) group and the endothelial dysfunction (DEF) group according to the RHI. The subjects were followed up for a mean of 16 months (interquartile range [IQR]: 14–20 months) after PCI treatment, and their MACEs were also recorded. Cumulative incidence curves were constructed for time-to-event variables with Kaplan–Meier estimates and compared using the log-rank test. The overall incidence of MACEs was 25.39% in the DEF group and 15.96% in the NEF group (P<0.05). Kaplan–Meier analysis also demonstrated a significantly higher probability of MACEs in the DEF group than in the NEF group (log-rank test: P<0.05). Multivariate Cox hazard analysis identified RHI (Model 2, adjusted by blood pressure, hazard ratio [HR]: 0.425; 95% confidence interval [CI]: 0.198–0.914; P=0.029) and SYNTAX score (HR: 1.043; 95% CI: 1.019–1.067; P<0.001) as independent predictors of future MACEs after PCI treatment in ACS patients. Endothelial function measured by reactive hyperemia-peripheral arterial tonometry (RH-PAT) is impaired in ACS subjects treated with PCI. The RHI was an independent predictor of MACEs, suggesting that RHI may be useful as a candidate biomarker in the risk stratification of patients with ACS after PCI treatment.

Objective To investigate the relationship between reactive hyperemia index (RHI) and mid-long-term cardiac adverse events (AEs) in the patients with non-obstructive acute coronary syndrome(NobACS). Methods A prospective cohort trial was carried out on 290 consecutive patients with NobACS admitted in our hospital from October 2015 to July 2017. According to their RHI, they were divided into abnormal endothelial function group (AEF, n = 166, RHI<1. 67) and normal endothelial function group(NEF, n = 124, RHI≥1. 67). The patients were averagely followed up for 14. 0 ± 4. 5 months. AEs were defined as all-cause death, ischemic stroke, non-fatal myocardial infarction and re-hospitalization for cardiovascular events. Survival analysis was performed to compare the difference in AC occurrence between the 2 groups. Results There were 10 and 7 patients lost respectively in the AEF and NEF groups during the follow-up. AEs occurred in 59 patients. The AEs incidence (P＜0.01) and re-hospitalization rate (P＜0.05) were significantly higher in the AEF group than the NEF group. But there were no differences in the incidences of all-cause death, ischemic stroke and non-fatal myocardial infarction (P＞ 0.05). Multifactor Cox proportional hazards regression model showed RHI<1. 67 (HR = 2. 20, 95％CI: 1. 24 ～ 3. 92, P＜0.01 after adjustment) was an independent prognostic factor for predicting AEs. Conclusion RHI could be used in prediction of mid-long-outcome of NobACS. RHI<1. 67 is an independent prognostic factor for NobACS.