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Objective@#To estimate the correlation between red cell distribution width (RDW) level and left atrial appendage thrombogenic milieu (LAATM) in elderly patients with non-valvular atrial fibrillation (NVAF).@*Methods@#This was a retrospective case-control study. A total of 782 NVAF patients (age>60 years old) who finished transesophageal echocardiography (TEE) from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened, and diveded into LAATM group (n=65) and non LAATM group (n=717). RDW level was compared between the two groups. Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis. The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve (ROC) analysis.@*Results@#There were significant differences in age, history of heart failure, course of atrial fibrillation (AF), type of AF, NT-proBNP level, RDW level, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), left atrial diameter, CHADS2 score and CHA2DS2-VASc score between the two groups (P<0.05). RDW level in LAATM group was significant higher than non LAATM group (13.4% (12.6%, 14.1%) vs. 12.1% (11.2%,13.0%), P<0.001). Multivariate logistic regression showed that RDW level associated with LAATM (OR=4.07, 95%CI 2.09-7.91, P<0.001). In ROC analysis, area under the curve was 0.81 (95%CI 0.74-0.88, P<0.001). When RDW level was 13.1%, LAATM could be diagnosed (sensitivity was 73.1% and specificity was 80.5%).@*Conclusions@#RDW value is associated with the presence of LAATM in elderly NVAF patients. The RDW level has a certain reference value for predicting LAATM.
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Objective: To explore the impact of different atorvastatin doses on platelet function and highreactivity in patients with acute ST-elevation myocardial infarction (STEMI) after emergent percutaneouscoronary intervention (PCI) therapy. Methods:A total of 120 STEMI patients with emergent PCI therapy were randomly divided into 2 groups:Standard group, the patients received atorvastatin 20 mg/day and Intensive group, the patientsreceived atorvastatin 40 mg/day, all patients were treated for 7 days. n=60 in each group. Blood lipids and biochemistry were examined before PCI and 7 days after atorvastatin treatment respectively;platelet fibrin clot strength induced by ADP (MAADP), AA and ADP induced platelet inhibition rate were measured by thrombelastography (TEG) test. Results: With 7 days treatment, compared with Standard group, Intensive group showed decreased MAADP (38.40±17.40) mm vs (45.70±14.50) mm, P0.05. The patients were followed-up for 3 months and the end point events including unstable angina, non-fatal MI, in-stent restenosis, in-stent thrombosis, and cardiovascular death or target vessel revascularization were similar between 2 groups, P>0.05. Conclusion: Early stage and short term administration of high dose atorvastatin could obviously inhibit platelet activity in STEMI patients after emergent PCI;such intensive atorvastatin treatment had no reduction on end point events in 3 months follow-up period.
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Objective To investigate the effects of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction (STEMI) patients after emergency percutaneous coronary intervention (PCI).Methods A total of 120 patients with acute STEMI treated with emergency PCI were enrolled and randomly divided into 20 mg of atorvastatin treatment group (standard group,n =60),and 40 mg of atorvastatin treatment group (intensive group,n =60).The blood C reactive protein (CRP),blood lipid profiles,plasma endothelin (ET) were measured before atorvastatin treatment and after 7 days of treatment,respectively.The platelet fibrin clot strength induced by ADP (MAADP) was determined by thrombelastography (TEG).Results Seven days after of atorvastatin treatment,the level of plasma ET in intensive group was significantly lower than that in standard group [(0.49 ± 0.21) pmol/L vs (0.63 ± 0.58) pmol/L,P ＜ 0.05].Moreover,the MAADP in intensive group was significantly decreased compared with the standard group [(38.4 ± 17.4) mm vs (45.7 ± 14.5) mm,P ＜ 0.05].There was a positive correlation between the ET level and MAADP in intensive group after treatment (r =0.378,P ＜ 0.05).However,no significantly differences could be viewed in the CRP and LDL-C levels between the two groups (P ＞ 0.05).Conclusion In patients with acute STEMI,early administration of 40 mg atorvastatin after emergency PCI could significantly reduce the vascular endothelial injury,improve endothelial function,and reduce the residual platelet activity.
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<p><b>OBJECTIVE</b>To evaluate the safety of percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) complicating chronic kidney disease (CKD).</p><p><b>METHODS</b>We retrospectively evaluated the medical data of 335 patients hospitalized in our hospital with a diagnosis of ACS and CKD between 1 January 2011 and 30 May 2014. Patients were divided into two groups: PCI group who received PCI treatment during hospitalization (n = 135) and non-PCI group who did not receive PCI treatment (n = 200). Multivariable logistic regression analysis was performed to evaluate the connection between PCI and in-hospital death and acute renal insufficiency.</p><p><b>RESULTS</b>The median GFR level of 335 patients was 36.26 (25.09-47.65) ml · min⁻¹ · 1.73 m⁻². GFR level was similar between the two groups (P = 0.205). Multivariable logistic regression analysis showed that PCI did not increase the risk of in-hospital death (OR = 0.465, 95% CI: 0.190-1.136, P = 0.093) and in-hospital acute renal insufficiency (OR = 0.830, 95% CI: 0.375-1.836, P = 0.669). In patients of 45 ml · min⁻¹ · 1.73 m⁻² ≤ GFR < 60 ml · min⁻¹ · 1.73 m⁻², 30 ml · min⁻¹ · 1.73 m⁻² ≤ GFR < 45 ml · min⁻¹ · 1.73 m⁻² and GFR < 30 ml · min⁻¹ · 1.73 m⁻², the OR of in-hospital death in PCI group were 0.235 (95% CI: 0.024-2.301, P = 0.213), 0.640 (95% CI: 0.112-3.649, P = 0.616) and 0.919 (95% CI: 0.159-5.307, P = 0.925), and the OR of in-hospital acute renal insufficiency were 0.436 (95% CI: 0.120-1.587, P = 0.208), 2.209 (95% CI: 0.394-12.391, P = 0.368) and 0.724 (95% CI: 0.127-4.117, P = 0.716) indicating that PCI did not increase above events in ACS patients complicating CKD.</p><p><b>CONCLUSION</b>PCI does not increase the risk of in-hospital death and in-hospital acute renal insufficiency in ACS patients complicating CKD.</p>
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Humans , Acute Coronary Syndrome , Acute Kidney Injury , Hospitalization , Percutaneous Coronary Intervention , Renal Insufficiency, Chronic , Retrospective StudiesABSTRACT
<p><b>BACKGROUND</b>Large-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention (PCI) is not necessary. However, it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring. This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients.</p><p><b>METHODS</b>Acute coronary syndrome (ACS) patients (n = 384) who received high-risk, complex PCI were randomized into two groups. PCI in the two types of lesions described below was defined as high-risk, complex PCI: lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis. The patients in the conventionally treated group received standard dual antiplatelet therapy. The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography (TEG) platelet mapping: If inhibition of platelet aggregation (IPA) induced by arachidonic acid (AA) was less than 50% the aspirin dosage was raised to 200 mg/d; if IPA induced by adenosine diphosphate (ADP) was less than 30% the clopidogrel dosage was raised to 150 mg/d, for three months. The primary efficacy endpoint was a composite of myocardial infarction, emergency target vessel revascularization (eTVR), stent thrombosis, and death in six months.</p><p><b>RESULTS</b>This study included 384 patients; 191 and 193 in the conventionally treated group and platelet function monitoring guided group, respectively. No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups. In the platelet function monitoring guided group, the mean IPA induced by AA and ADP were (69.2 ± 24.5)% (range, 4.8% to 100.0%) and (51.4 ± 29.8)% (range, 0.2% to 100.0%), respectively. The AA-induced IPA of forty-three (22.2%) patients was less than 50% and the ADP-induced IPA of fifty-seven (29.5%) patients was less than 30%; therefore, their drug dosages were adjusted. The TEG was rechecked one to four weeks after PCI, and the results indicated that the IPAs had significantly improved (P < 0.01). However, no significant differences were found in the rates of the primary efficacy endpoint. Rates in the conventionally treated group and platelet function monitoring guided group were 4.7% and 5.2%, respectively (hazard ratio: 1.13; P = 0.79).</p><p><b>CONCLUSION</b>An antiplatelet therapy guided by TEG monitored platelet function could not improve clinical efficacy even in ACS patients treated with high-risk complex PCI.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome , Drug Therapy , Arachidonic Acid , Therapeutic Uses , Aspirin , Therapeutic Uses , Blood Platelets , Platelet Aggregation , Platelet Aggregation Inhibitors , Therapeutic UsesABSTRACT
<p><b>BACKGROUND</b>Blood pressure variability (BPV) is a reliable prognostic factor for cardiovascular events. Currently there is a worldwide lack of large sample size studies in visit-to-visit BPV. Based on the Kailuan Study, we analyzed the visit-to-visit BPV of patients to investigate the range and influencing factors of BPV.</p><p><b>METHODS</b>In 11 hospitals in the Kailuan Company, 4 441 patients received routine health checkups. Physical examination measured blood pressure (BP), body height, body weight, and waist circumference, and body mass index was calculated. Blood samples were analyzed for plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), and high-sensitivity c-reactive protein (hs-CRP).</p><p><b>RESULTS</b>The effect of gender on systolic BPV was investigated. The average systolic BPV was 10.35 mmHg (1 mmHg = 0.133 kPa) overall, 10.54 mmHg in males and 10.06 mmHg in females. Multivariate Logistic regression analysis revealed that the age (RR = 1.022), systolic BP (SBP, RR = 1.007), LDL-C (RR = 1.098), and history of hypertension (RR = 1.273) were significant risk factors for higher systolic BPV. We found that aging (RR = 1.022), increased SBP (RR = 1.007), and a history of hypertension (RR = 1.394) were determinants of systolic BPV in males. The risk factors for systolic BPV of females were aging (RR = 1.017), increased SBP (RR = 1.009), increased LDL (RR = 1.136), and increased TG (RR = 1.157).</p><p><b>CONCLUSION</b>Our findings indicated that the systolic BPV is closely associated with age, SBP and history of hypertension.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Blood Pressure , Physiology , C-Reactive Protein , Metabolism , China , Cities , Hypertension , Lipoproteins, HDL , Blood , Lipoproteins, LDL , Blood , Logistic Models , Triglycerides , Blood , Waist Circumference , PhysiologyABSTRACT
ObjectiveTo explore the in-hospital mortality and its determinants for very eldly (80 + years of age) patients with acute myocardial infarction (AMI).MethodsA retrospective cohort method was used.The 499 study subjects were very eldly patients with newly diagnosed AMI consecutively admitted into our department between January 1,2002 and February 22,2010.ResultsNinety-seven out of 499 patients died during hospitalization period,with total in-hospital mortality of 19.4％.Multivariable logistic regression analysis showed the independent determinants for mortality of very elderly AMI patients were cardiac Killip grades,complete A-V block,renal dysfunction,stent implant,and the type of AMI.Conclusions The independent determinants for mortality of elderly AMI patients are as following,cardiac Killip grade,complete A-V block,renal dysfunction,stent implant,and the type of MAI.Urgent PCI is safe and effective for some very elderly with AMI,which could improve their survival rate within hospitalization period.
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<p><b>OBJECTIVE</b>To explore the association between body mass index (BMI) and mortality in the middle-aged and elderly population of Beijing.</p><p><b>METHODS</b>A prospective cohort study was carried out in a natural population (aged 40 and over) in September 1991, totaling 6 209 subjects. After a baseline survey for risk factors, all the subjects were followed-up throughout December 1999. All deaths occurred during the follow-up period were registered and encoded according to ICD-9. Proportional hazard regression was used to examine the relationship between BMI (body weight in kilograms/height in square meters) and overall and cause-specific mortality.</p><p><b>RESULTS</b>During the past ten years, five leading causes of death in the middle-aged and elderly population of Beijing were cardiovascular disease (CVD), cor pulmonale, digestive malignant tumor, sudden death without definite cause and lung cancer, which accounting for 33.3%, 13.8%, 11.2%, 7.4% and 5.6% of the total deaths, respectively. The minimum overall mortality in all population and in non-smokers were seen in those with BMI of 23.6 - 26.2. Compared with those with BMI of 23.6 - 26.2, the relative risks (RR) for all-cause mortality in all population and non-smokers with BMI less than 21.2 and equal to or greater than 26.2 were 1.7, 1.3, 1.9 and 1.5, respectively after adjusted for age, gender, smoking and alcohol drinking. BMI correlated positively with death risk due to CVD in non-smokers, with an RR of 1.2 for those with BMI > 26.2 to non-smokers with BMI < 21.2 after adjusted for age, gender and alcohol drinking. A U-shaped correlationship between BMI and deaths due to other specific causes, including cor pulmonale, digestive malignant tumor, lung cancer, pneumonia and sudden death without definite causes. With the minimum cause-specific death rates all at BMI of 23.6 - 26.2. In comparison with those with BMI of 23.6 - 26.2, RRs for these five cause-specific mortality were 14.8, 1.1, 5.6, 2.4 and 2.6, respectively for non-smokers with BMI < 21.2 and 3.0, 1.9, 3.7, 2.2 and 1.5, respectively for non-smokers with BMI >/= 26.2 after adjusted for age, gender, and alcohol drinking. The proportion of deaths due to CVD was the highest in each BMI group, with a range of 28.0% - 54.8%.</p><p><b>CONCLUSIONS</b>There exists a U-shaped correlationship between BMI and overall mortality in the middle-aged and elderly population in Beijing. CVD remains the top leading cause of death in natural population, and its death risk increased with BMI.</p>