Clinical Study Of Aortitis Involving Coronary Artery Disease

Section 1:Risk factors for coronary artery involvement in Takayasu arteritisBackground and objectTakayasu arteritis with coronary artery involvement(TA-CAD)is a special but not rare clinical condition for Takayasu arteritis(TA).TA-CAD is one of the leading causes of death in patients with TA.Screening of susceptible populations and risk factors for TA-CAD in patients with TA,and making early interventions in susceptible populations may reduce the incidence of TA-CAD and improve the outcomes of patients with TA.We compared the clinical characteristics of TA-CAD and TA patients in order to screen for potential risk factors for TA-CAD in patients with TA.MethodsThe data from 64 patients with TA-CAD and 73 patients with TA were retrospectively analyzed.The logistic regression analysis was built to assess the relationship between risk factors and TA-CAD.Additionally,the present patients were further grouped by age at onset and age:Group A:Age at onset ? 40&Age ? 40;Group B:Age at onset ? 40&Age>40;Group C:Age at onset>40&Age>40.All predisposing factors,features of coronary artery lesions and outcomes were further compared among the three groups.ResultsPatients with TA-CAD were older(P<0.001)with later onset of TA(P<0.001),and had higher prevalence of hypercholesterolemia(P=0.001)and diabetes mellitus(P=0.001).The multivariate logistic regression analysis showed only later onset of TA(OR=3.724,95%CI:1.289-10.763,P=0.015)was independently associated with TA-CAD.The result of subgroup analyses according to age and age at onset:compared with group A,patients in the group B were older(P<0.05),had a longer disease duration(P<0.05),higher prevalence of hypercholesterolemia(P<0.05)and diabetes mellitus(P<0.05),and higher BMI(P<0.05).Compared with group B,patients in the group C had a short disease duration(P<0.05)with later onset of TA(P<0.05),while age,prevalence of hypertension,hypercholesterolemia and diabetes mellitus,BMI,CRP,and ESR were similar between patients in the group B and C.The ostia or proximal segment lesions and single vessel disease were the most common coronary artery lesions and disease in the group A,respectively.Compared with group A,the proportion of midsegment,distal segment lesions and multivessel disease were increased in the group B.There is a trend of increased major adverse cardiovascular events(MACE)in the group C in comparison with group A and B(P=0.074).ConclusionPatients with later onset of TA have a higher risk of occurrence of TA-CAD than those with earlier onset of TA.In addition,a trend of increased MACE was found in TA-CAD patients with later onset of TA.Therefore,in order to prevent the incidence of TA-CAD and MACE,physicians should focus on the screening of risk factors for TA-CAD in TA patients with later onset of TA.Section 2:Long-term outcomes of coronary artery bypass grafting versus percutaneous coronary intervention for Takayasu arteritis with coronary artery involvementBackground and objectTakayasu arteritis with coronary artery involvement(TA-CAD)increases mortality of patients with takayasu arteritis(TA),and rational management of TA-CAD may significantly improve the outcomes of patients with TA.TA-CAD with myocardial ischemia is an indication of coronary revascularization,but the optimal revascularization strategy for this condition has not been established.We compared the long-term outcomes of patients with TA-CAD treated with coronary artery bypass grafting(CABG)and percutaneous coronary intervention with stenting(PCI)to provide some evidence for TA-CAD patients to choose appropriate coronary revascularization strategy.MethodsWe retrospectively analyzed the clinical characteristics of 46 patients with TA-CAD who received coronary revascularization in our hospital from January 2002 to December 2015.Of the 46 patients,21 received CABG and 25 received PCI.The end event is defined as major adverse cardiovascular events(MACE),including myocardial infarction,repeated revascularization,and cardiac death.ResultsAfter about 41.0 months of follow-up,MACEs occurred in 13 patients of the PCI group and 2 of the CABG group.The risk of MACE in the PCI group was significantly higher than that in the CABG group(P<0.001).A total of 26 patients with TA-CAD underwent revascularization at the stable stage of TA including 13 in the PCI group and 13 in the CABG group;while 20 patients underwent revascularization at the active stage including 12 in the PCI group and 8 in the CABG group.For patients who underwent coronary revascularization at the active stage,the risk of MACE in the PCI group was significantly higher than that in the CABG group(P = 0.001);while for patients who underwent coronary revascularization at the stable stage,no difference was found between the PCI and CABG groups in the incidence of MACE(P = 0.138).In addition,the incidence of MACE was higher in TA-CAD patients at the active stage than those at the stable stage(P<0.001).For patients at the active stage,the risk of MACE was significantly lower in patients with than those without usage of prednisone(P = 0.028);while no difference was found between patients who were stable not requiring prednisone and patients who were stable on prednisone(P = 0.525).ConclusionWith regard to MACE,CABG is superior to PCI in patients with TA-CAD.For patients at the active stage,if emergency revascularization is necessary,CABG is ideal;if not,receiving medical therapy until disease remission and then undergoing PCI may be an alternative choice of CABG.For TA-CAD patients at the stable stage,PCI is similar with CABG in prognosis,the decision to accept CABG or PCI depends on the patient's clinical condition,the features of coronary artery lesions and so on.Section 3:Study on thrombosis and fibrinolysis in patients with Takayasu arteritis:Thrombelastography assessment in patients with Takayasu arteritisBackground and objectA thrombotic tendency existed in patients with Takayasu arteritis(TA),but the mechanism was undermined.Previous studies reported that increased platelet activity existed in patients with TA,however it was controversial that whether there was abnormalities in coagulation function.Thrombelastography(TEG)provides a global assessment of haemostatic function,beginning with initial platelet-fibrin interaction,to platelet aggregation,clot strengthening and fibrin cross-linkage,and eventually clotlysis.Therefore,in order to provide more evidence for antithrombotic therapy in patients with TA,we compared the coagulation and fibrinolysis process between patients with TA and healthy controls by TEG.MethodsA total of 127 patients with TA and 55 healthy controls in Fuwai Hospital between January 2013 and December 2015 were enrolled and received TEG assessment.The clinical data,blood routine,coagulation routine and TEG parameters were analyzed retrospectively.All patients with TA were grouped depending on disease activity,and the thrombosis-related parameters were compared between the patients with different disease activities.The Spearman correlation analysis was used to assess the relationships between MA and platelet-related parameters,and ESR and thrombosis-related parameters,respectively.ResultsCompared with healthy controls,trends of increased platelets(PLT)(P=0.085)and decreased platelet-large cell ratio(P-LCR)(P=0.054),larger mean platelet volume(MPV)(P=0.035),and wider platelet volume distribution width(PDW)(P=0.046)were observed in patients with TA.Prothrombin time(PT),activated partial thromboplastin time(aPTT),and the level of fibrin(-ogen)degradation products(FPT)were similar between the patients with TA and healthy controls.In terms of TEG assessment,shorter K time(P=0.009),larger alpha angle(P=0.019),higher levels of MA(P<0.001),G(P<0.001),TPI(P<0.001)and MA(A)(P<0.001)were found in the patients with TA.The R time,TMA,EPL,LY30,and CL30 were similar between the patients with TA and healthy controls.Compared with patients at the stable stage,PLT(P=0.027)and plateletcrit(PCT)(P=0.026)were significantly higher in patients at the active stage,whereas no significant difference was observed in MPV,P-LCR,PDW,PT and the level of FDP between patients at the stable and active stages.In terms of TEG assessment,shorter K(P=0.003),short TMA(P=0.022),larger alpha angle(P=0.010)and higher levels of MA(P= 0.007),G(P=0.002),TPI(P=0.001)and MA(A)(P<0.001)were found in patients at the active stage,whereas no significant differences was observed in the R time,EPL,LY30,and CL30 between the two groups.Spearman correlation analyses indicated:MA was correlated with PLT(r=0.380,P<0.001),while no correlations existed between MA and MPV(r=0.019,P=0.835)or PDW(r=0.039,P=0.664).ESR was correlated with PLT(r=0.198,P=0.029),PCT(r=0.225,P=0.014),K(r=-0.349,P<0.001),alpha angle(r=0.325,P<0.001),MA(r=0.478,P<0.001),MA(A)(r=0.621,P<0.001),G(r=0.478,P<0.001)and TPI(r=0.450,P<0.001),while no significant correlations were found between ESR and MPV,P-LCR,PDW,PT,FDP,R,TMA,EPL,LY30,and CL30.ConclusionInflammation was associated with platelet coagulation function rather than enzymatic coagulation function in patients with TA.Physicians should focus on antiplatelet treatment for improving the outcomes of patients with TA.