Analysis of follow-up results after percutaneous coronary intervention in patients with primary thrombocythemia / 中国介入心脏病学杂志

Objective To analyze the characteristics, treatment and prognosis during follow-up in patients with essential thrombocythemia(ET)after percutaneous coronary intervention(PCI). Methods A total of 9 patients with ET who had CAD and treated with PCI in our hospital from 2010-01 to 2017-07 were retrospectively studied. The basic clinical information with clinical data,data of coronary intervention,application of anti-platelet and platelet reducing drugs,and the results of long-term follow-up were recorded in all patients. Results There were 5 male and 4 female with a mean age of (60.9 ± 14.3) years The 9 patients included 3 cases of acute myocardial infaction(MI),3 cases of old MI,2 cases of unstable angina and 2 cases stable angina. Coronary angiography revealed that there were 4 cases with single vessle involved and 5 cases with two-three vessles involved. All the patients were implante with drug-eluting stents. The mean platelet counts of the patients at admission were(596±233)×109/L. In 4 patients, ET was diagnosed during current hospitalization and their mean platelet counts were(803±105)×109/L. All patients received dual anti-platelet drugs after PCI and 8 patients had hydroxyurea during follow-up. During the follow-up of (53.2±26.9) months,no cardiovascular events occurred. One case of gastrointestinal bleeding occurred during the follow-up due to gastric ulcer. Conclusions Application of platelet reducing therapy with dual anti-platelet drugs in ET patients after PCI is eff ective and safe.

The impact of fasting blood glucose on the prognosis of non-diabetic patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction / 中国介入心脏病学杂志

Objective To investigate the impact of fasting blood glucose on the prognosis of non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods We retrospectively recruited consecutive patients who underwent primary PCI in our hospital from February, 2003 to March, 2015. Patients with prior history of diabetes mellitus before the index hospitalization and those with newly diagnosed diabetes mellitus during the index hospitalization were excluded. The clinical and angiographic features, medical and interventional treatment, and 30-day outcomes were compared between patients with elevated fasting blood glucose (FBG) (>5.4 mmol/L) and those with normal FBG (≤5.4 mmol/L). Results A total of 721 patients were recruited with an age of(61.2 ± 12.8)years, of whom 601 (83.4 %) were male. As compared with patients with normal FBG,those with elevated FBG were more likely to be female(20.1 % vs.13.5 %, P=0.017),had faster heart rate on admission[(82.9 ± 17.2)bpm vs.(79.4 ± 16.7)bpm,P=0.006]and more use of intra-aortic balloon pump(3.8 % vs.1.3 %,P=0.034),and had higher rates of 30 day all-cause mortality(3.5 % vs.0.5 %,P=0.004),cardiac mortality(2.9 % vs.0.5 %,P=0.012)and heart failure(18.1 % vs. 7.4 %, P< 0.001). After adjusting baseline characteristics, FBG > 5.4 mmol/L was one of the independent predictors of 30-day all-cause mortality(HR 6.030,95 % CI 1.235-29.447,P=0.026).Other independent predictors of 30-day all-cause mortality included age(HR 1.059,95 % CI 1.002-1.120,P=0.044),heart rate on admission(HR 1.036,95 % CI 1.003-1.070,P=0.034),left descending artery as the culprit vessel(HR 6.427,95 % CI 1.389-29.728,P=0.017),and use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker(HR 0.154,95 % CI 0.051-0.461,P=0.001).Conclusions In non-diabetic patients undergoing primary PCI for STEMI, elevated FBG was one of the independent predictors of 30-day all-cause mortality.

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: outcomes of 3-year clinical follow-up / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation.</p><p><b>METHODS</b>A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n = 83) or BMS (n = 108) implantation in the infarction related artery according to physician's discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups.</p><p><b>RESULTS</b>The clinical follow-up duration was 3 years ((41.7 ± 16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P = 0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P = 0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P = 0.379) and stent thrombosis (1.20% vs. 1.85%, P = 0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P = 0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P = 0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n = 73) and paclitaxel-eluting stents (PES, n = 10) subgroups (2.74% vs. 20.00%, P > 0.05).</p><p><b>CONCLUSIONS</b>This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.</p>

Clinical and coronary features of systemic lupus erythematosus patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVES</b>To observe the clinical and coronary features of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD).</p><p><b>METHODS</b>Among 2877 SLE inpatients (age ≥ 18 years, male 363, female 2514) admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [mean age (50.7 ± 12.8) years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed.</p><p><b>RESULTS</b>The incidence of CAD was significantly higher in male SLE patients than in female patients [2.48% (9/363) vs. 0.95% (24/2514), P = 0.022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [5.76% (8/139) vs. 0.91% (25/2738), P < 0.001]. Myocardial infarction was the major form of CAD (24/33). Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi-vessel lesions was found in 75.0% (15/20) patients with SLE and CAD.</p><p><b>CONCLUSIONS</b>Male SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.</p>

Clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease.</p><p><b>METHOD</b>Fifteen patients (11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed.</p><p><b>RESULTS</b>There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39.3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32.4 ± 8.1) years vs. (47.0 ± 10.2) years], had less risk factors for atherosclerosis (1.2 ± 1.5 to 2.8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 - 7 years (average 1.6 years) to 3 - 30 years (average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by echocardiography was less than 50% in 8 patients.</p><p><b>CONCLUSION</b>Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.</p>

Value of cardiac magnetic resonance imaging for the diagnosis of cardiac amyloidosis / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the clinical features and cardiac magnetic resonance imaging (CMR) characteristics of patients with endomyocardial biopsy (EMB)-proven cardiac amyloidosis (CA).</p><p><b>METHODS</b>EMB proven CA patients underwent CMR examination from September 2006 to December 2010 were included. The findings of clinical manifestation, electrocardiogram, echocardiography and CMR were analyzed.</p><p><b>RESULTS</b>Among the 18 patients with EMB verified CA, 5 patients underwent CMR. All 5 patients had heart failure symptoms and electrocardiogram was abnormal. Echocardiogram showed concentric left ventricular hypertrophy, granular appearance of the myocardium, left atrial enlargement and moderate to severe left ventricular diastolic dysfunction. CMR revealed increased thickness of the left ventricular wall (especially at the inter-ventricular septum), enlarged bilateral auricle, restricted left ventricular filling with normal or mild to moderate reduced systolic function. Pleural and pericardial effusions were observed in 2 patients. Abnormal late gadolinium enhancement (LGE) was detected in all 5 patients. CMR revealed different patterns of LGE. Left ventricular global subendocardial delayed gadolinium enhancement or transmural delayed gadolinium enhancement were found, and patients also showed line-, granular- or patchy-like enhancement. The degree and range of LGE paralleled the disease course and were consistent with electrocardiogram changes.</p><p><b>CONCLUSIONS</b>As a noninvasive diagnostic tool, CMR is valuable in the diagnosis of CA. For patients with clinical suspicion of CA, CMR could be a helpful diagnostic tool, especially in the hospitals where EMB is not available.</p>

Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention (PCI) with prior ischemic stroke.</p><p><b>METHODS</b>A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009. End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up.</p><p><b>RESULTS</b>There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke. Compared patients without prior ischemic stroke, patients with prior ischemic stroke were older (P = 0.000), had higher hypertension morbidity (P = 0.000), higher diabetes mellitus morbidity (P = 0.005), higher incidence of multi-vessels disease (P = 0.000). During the follow-up of (35.0 ± 19.6) months, cardiac death rate (8.5% vs. 3.9%, P = 0.002) and re-cerebral infarction rate (5.8% vs. 1.4%, P = 0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. Dual antiplatelet therapy treatment time [(13.77 ± 11.33) months vs. (13.94 ± 11.33) months, P = 0.986] and major bleeding events (5.8% vs. 3.6%, P = 0.100) were similar between the two groups and cerebral hemorrhage rate (1.8% vs. 0.5%, P = 0.028) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke.</p><p><b>CONCLUSION</b>Patients with prior ischemic stroke were associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.</p>

Clinical and coronary characteristics of young patients (< 30 years old) with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and angiographic features of acute myocardial infarction in patients aged 30 years or younger.</p><p><b>METHODS</b>Data of 360 consecutive patients referred to Peking Union Medical College Hospital for evaluation of chest pain or discomfort from January 2007 to December 2009, diagnosed as acute myocardial infarction and underwent emergent coronary angiography were analyzed. Seven patients (1.9%) with age ≤ 30 years [4 male, (25 ± 5) years] were included in this study, patients were followed up for (12 ± 9) months.</p><p><b>RESULTS</b>There were 6 cases of ST-segment elevated myocardial infarction and 1 non-ST-segment elevated myocardial infarction. The culprit vessels were as follows: 5 left anterior descending artery, 1 left main and 1 right coronary artery. All 3 female patients were complicated with congenital coronary malformation or autoimmune disease, including 1 coronary artery aneurismal dilation of left anterior descending, 1 Takayasu's arteritis and 1 systemic lupus erythematosus. Three of the 4 male patients were smokers. Two patients underwent percutaneous coronary intervention. There was no death or cardiovascular re-admission during the follow-up.</p><p><b>CONCLUSIONS</b>The majority of acute myocardial infarction in patients aged 30 years or younger were presented with ST-segment elevated myocardial infarction and single vessel non-obstructive lesion. The most common culprit vessel was left anterior descending artery. All female patients were complicated with congenital coronary malformation or autoimmune disease. The short-term prognosis in patients of this cohort was good.</p>

Clinical manifestations of premenopausal women with coronary arterial disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare clinical characteristics among premenopausal women with coronary arterial disease (CAD) with or without atherosclerosis (AS) and postmenopausal women with CAD.</p><p><b>METHODS</b>The clinical and coronary angiographic data, traditional risk factors (age, smoking, blood pressure, lipid profile, blood glucose, BMI, family history) were compared among premenopause (Pre-M, n=42) and post-menopause (Post-M, n=172) women with CAD as well as Pre-M patients with non-AS CAD (non-AS CAD, n=8).</p><p><b>RESULTS</b>Compared with the Post-M patients with CAD, Pre-M CAD patients had significantly fewer traditional risk factors, such as hypertension, diabetes and hypercholesterolemia, significantly more acute coronary syndrome and fewer previous history of chest pain, significantly more single vessel lesion and lower Gessini score (all P < 0. 01). The logistic regression results showed that obesity is an independent risk factor for the development of CAD in premenopausal women (OR = 3. 655, 95% CI: 1. 5-11.59, P = 0.028). Hypertension (OR = 4.73, 95% CI: 0.991-22.589, P = 0.051) and hypercholesterolemia (OR = 4.68, 95% CI: 0.971-22.564, P = 0.055) might also contribute to the development of CAD in these patients. Clinical characteristics were similar between Pre-M and non-AS CAD patients (P > 0.05).</p><p><b>CONCLUSIONS</b>Pre-M CAD patients had less traditional risk factors and lower coronary lesion score compared to post-M CAD patients. Obesity is an independent risk factor for Pre-M CAD. Non-AS coronary artery disease is also an important reason for the development of coronary arterial events in premenopausal women.</p>

Side branch occlusion rate at sites of overlapping sirolimus- or paclitaxel-eluting stents for treating long coronary lesions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare side branch occlusion rate at sites of overlapping sirolimus- or paclitaxel-eluting stents in treating long coronary lesions.</p><p><b>METHODS</b>We retrospectively reviewed the PCI CD and medical records of PCI 141 patients with at least one stent overlapping for long coronary lesion in our institute from January 2004 to October 2007. The side branches occlusion was documented and analyzed.</p><p><b>RESULTS</b>The study population were consisted of 141 patients that there were 115 man, and 26 women, who got 297 stents. There were 154 side branch vessels been observed. Side branch occlusion rate was 24.6% in Cypher group and 31.6% in TAXUS (P > 0.05), side branch TIMI flow decrease rate on overlapping region was 26.3% in Cypher group and 68.4% in TAXUS group (P > 0.05). A logistic regression model analysis show that the significant risk factors for side branch occlusion is the diameter and ostial occlusion of side branch.</p><p><b>CONCLUSION</b>Side branch occlusion rate and TIMI flow decrease rate were similar on overlapping region in patients treated with Cypher or TAXUS stents for long coronary lesions. The significant predictors for side branch TIMI flow decrease are the diameter and ostial occlusion of side branch.</p>

Risk factors for coronary artery disease stimulate urokinase receptor expression on monocytes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effect of risk factors for coronary artery disease (CAD) on urokinase receptor (uPAR) expression on monocytes.</p><p><b>METHODS</b>A total of 106 patients were enrolled and divided into five risk-factor groups: sixteen with hypertension, twenty-four with dyslipidemia, eighteen with hypertension + obesity, eighteen with dyslipidemia + obesity and thirty with hypertension + dyslipidemia + obesity. Seventeen healthy volunteers were recruited as control group. Monocyte expression of uPAR and mean fluorescence intensity index (MFI Index) of uPAR were measured by flow cytometer (FACSCalibur).</p><p><b>RESULTS</b>No difference in monocyte uPAR expression was detected between hypertension and control group [(4.9 +/- 12.5)% vs. (7.7 +/- 10.3)%, P=0.74]. However, the uPAR expression was raised to (23.7 +/- 22.5)% in hyperlipidemia group, a 3.9- and a 2.1-fold increase compared with those in hypertension (P<0.01) and control group (P<0.05), respectively. When combined with obesity, uPAR expression was elevated further to (32.9 +/- 30.8)% in hypertension + obesity group, (37.4 +/- 31.4)% in dyslipidemia + obesity group and (23.8 +/- 20.5)% in hypertension + dyslipidemia + obesity group, all having statistical significance compared with control group or hypertension group (P<0.01). The results were the same when corrected by age, BMI and hs-CRP. uPAR MFI Index was increased from 0.78 +/- 0.86 in control group to 1.91 +/- 1.97 and 3.33 +/- 2.52 in dyslipidemia group and hypertension + obesity group, respectively, P<0.05. Linear regression analysis revealed a significant correlation between uPAR expression and FBG concentration in dyslipidemia group, r=0.72, P=0.04.</p><p><b>CONCLUSIONS</b>uPAR expression was elevated on monocytes in patients with risk factors for CAD. Dyslipidemia and obesity may contribute to the increase of uPAR expression.</p>

Serum high-sensitivity C-reactive protein level in patients with coronary heart disease complicating with or without metabolic syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the relationship between serum high-sensitivity C-reactive protein (hs-CRP) level and coronary artery lesion in patients with coronary heart disease (CHD) complicating with or without metabolic syndrome.</p><p><b>METHODS</b>CHD was confirmed in 170 out of 227 patients who were admitted into Peking union hospital because of chest pain by coronary artery angiography (CAG). Metabolic syndrome was diagnosed in 79 out of 170 CHD patients (MS group) and the relationship between serum hs-CRP level and coronary lesion was compared to CHD patients without metabolic syndrome (non-MS group).</p><p><b>RESULTS</b>The number of CHD patients who had type B and C coronary stenosis and the serum level of hs-CRP was significantly higher in MS group than those in non-MS group, especially in patients with the serum level of hs-CRP > 3.5 mmol/L.</p><p><b>CONCLUSION</b>For CHD patients complicating metabolic syndrome, hs-CRP is a reliable marker to predict the severity of coronary artery lesion.</p>

Early ST resolution after successful primary PCI is related to a favorable outcome in ST elevated AMI patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the relationship between the early ST resolution magnitude and TIMI flow, MACE and the cardiac function in ST elevated AMI (STEMI) patients after successful primary PCI.</p><p><b>METHODS</b>A total of 120 consecutive patients with STEMI underwent primary PCI within 12 hours after the onset of chest pain were enrolled in this study, the ST segment resolution was calculated and the patients were divided into group A (n = 81, Sigma STE resolved > or = 50%) and group B (n = 39, Sigma STE resolved < 50%). TIMI flow after PCI, clinical events up to 30 days post PCI and cardiac function 30 days post PCI were assessed.</p><p><b>RESULTS</b>LVEF was higher in group A than that of group B (58.6% +/- 7.1% vs. 50.5% +/- 7.1%, P < 0.05). There are fewer patients with Killip III and IV in group A than in group B (1.2% vs. 12.8%, P < 0.05). The incidence of in-hospital MACE was also significantly less in group A than in group B (0 vs. 7.7%, P < 0.001). As expected, there were more patients with TIMI 3 flow (95.1% vs. 79.5%, P < 0.05) and fewer TIMI 2 (4.9% vs. 20.5%, P < 0.05) flow post PCI in group A than in group B and all 3 patients with MACE were group B patients with TIMI 2 flow.</p><p><b>CONCLUSION</b>Early ST resolution post PCI represents improved myocardial perfusion and function and is related to a favorable clinical outcome in STEMI patients.</p>