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BACKGROUND@#Limited data are available on the comparison of clinical outcomes of complete vs. incomplete percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). The study aimed to compare their clinical outcomes.@*METHODS@#A total of 558 patients with CTO and MVD were divided into the optimal medical treatment (OMT) group ( n = 86), incomplete PCI group ( n = 327), and complete PCI group ( n = 145). Propensity score matching (PSM) was performed between the complete and incomplete PCI groups as sensitivity analysis. The primary outcome was defined as the occurrence of major adverse cardiovascular events (MACEs), and unstable angina was defined as the secondary outcome.@*RESULTS@#At a median follow-up of 21 months, there were statistical differences among the OMT, incomplete PCI, and complete PCI groups in the rates of MACEs (43.0% [37/86] vs. 30.6% [100/327] vs. 20.0% [29/145], respectively, P = 0.016) and unstable angina (24.4% [21/86] vs. 19.3% [63/327] vs. 10.3% [15/145], respectively, P = 0.010). Complete PCI was associated with lower MACE compared with OMT (adjusted hazard ratio [HR] = 2.00; 95% confidence interval [CI] = 1.23-3.27; P = 0.005) or incomplete PCI (adjusted HR = 1.58; 95% CI = 1.04-2.39; P = 0.031). Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups (20.5% [25/122] vs. 32.6% [62/190], respectively; adjusted HR = 0.55; 95% CI = 0.32-0.96; P = 0.035) and unstable angina (10.7% [13/122] vs. 20.5% [39/190], respectively; adjusted HR = 0.48; 95% CI = 0.24-0.99; P = 0.046).@*CONCLUSIONS@#For treatment of CTO and MVD, complete PCI reduced the long-term risk of MACEs and unstable angina, as compared with incomplete PCI and OMT. Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.
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Humans , Treatment Outcome , Percutaneous Coronary Intervention/methods , Coronary Occlusion/surgery , Prognosis , Angina, Unstable/surgery , Chronic Disease , Risk FactorsABSTRACT
Objective:To investigate the accuracy, effectiveness and feasibility of MassARRAY genotyping assay in the diagnoses of neonatal genetic metabolic diseases.Methods:This is a retrospective study. From December 2016 to January 2020, newborns were screened by tandem mass spectrometry at the Zhejiang Newborn Screening Center, among which the data of 7 922 suspected positive cases of genetic metabolic diseases were collected. These patients were then tested for the common variants of 27 genetic metabolic diseases by MassARRAY genotyping assay, along with further testing using Sanger or next-generation sequencing used to verify and/or further search for potential variants.Results:A total of 1 408 cases were tested with MassARRAY. Among these, 307 cases were confirmed with certain genetic metabolic diseases. The detection rate of hyperphenylalaninemia was the highest, followed by primary carnitine deficiency, short acyl-coA dehydrogenase deficiency and methylmalonic acidemia. With these cases, the consistency of Sanger sequencing and MassARRAY was 100% (307/307). Another 287 cases were identified as carriers by MassARRAY with a 49.1% (141/287) consistency in reference to Sanger sequencing, mainly involving SLC22A5 and MCCC1 genes. Meanwhile, 50.8% (146/287) of these cases were found to have another variant mainly involving PAH, PTS and ACADS genes. The remaining 814 cases have no variants; 158 cases out of these patients have continuously abnormal amino acids, acyl carnitines, urine organic acid and/or other biochemical indices, and were tested by next-generation sequencing, among which 38% (60/158) were detected with two variants. In this study, a total of 513 patients with genetic metabolic disease were diagnosed, and the detection rate of MassARRAY was 59.8% (307/513). Conclusions:MassARRAY genotyping assay can be used as an early molecular screening method for neonatal genetic metabolic diseases. The detection rate is particularly high in diseases with a high concentration of hotspot variants, such as hyperphenylalaninemia and primary carnitine deficiency. The future application value of MassARRAY should be further improved by continuously optimizing its ability to identify new disease genes and potential variable sites.
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Objective: To analyze the information of patients with acute myocardial infarction (AMI) in a single center during last 6 years, and to distinguish the clinical differences of patients between TakoSTubo cardiomyopathy (TTC) and ST-segment elevation myocardial infarction (STEMI). Methods: A total of 1042 consecutive patients with primarily diagnosed acute anterior ST-segment elevation (STEMI) admitted in our hospital from 2008-01 to 2014-04 were retrospectively enrolled. The relevant patients were studied in 2 groups:TTC group, the patients with coronary angiography (CAG) and the contrast study of left ventricle corrected TTC diagnosis, n=10, and STEMI group, the patients received CAG within 6 hours of on set with conifrmed left anterior descending singlevessel disease at the same period of time as TTC patients,n=32. The basic clinical characteristics, levels of blood lipids, MI related biomarkers, the incidence rate of pathological Q wave, QTc interval and negative T wave in 12-lead ECG were compared between 2 groups. Results: The percentage of corrected TTC diagnosis in patients with primarily diagnosed STEMI was 1.06%. The female gender in TTC group and STEMI group was 100% vs 9%,P<0.01, TTC group had more patients with stress history before on set than that in STEMI group (70% vs 22%,P=0.02), lower levels of MI related biomarkers as CK (486 ± 249) U/L vs (716 ± 132) U/L, CK-MB (13.5 ± 17.1) mg/L vs (47.5 ± 21.9) mg/L, cTnI (22.8 ± 16.3) ng/mL vs (56.4 ± 24.0) ng/mL, allP<0.01. The age of morbidity, the ratios of hypertension, diabetes mellitus and blood lipids were similar between 2 groups. The frequency of abnormal Q-wave in ECG was similar between 2 groups, while the QTc interval was different in TTC group and STEMI group (630 ± 117) ms vs (540 ± 62) ms,P=0.001, the negative T waves in ECG leads II, III, aVF, aVR and V6 were as (100.00% vs 3.13%), (60.00% vs 6.25%), (90.00% vs 3.13%), (100.00% vs 21.88%), (100.00% vs 46.88%), allP<0.05. Conclusion: TTC patients with the main presentation as ST-segment elevation are usually having emotional or physical stress before on set, with obviously prolonged QTc interval and more frequency of negative T waves in ECG.
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<p><b>OBJECTIVE</b>To observe the low-density lipoprotein cholesterol (LDL-C) target goal attainment rate and related factors in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>From March 2011 to March 2012, a total of 832 ACS patients were retrospectively evaluated in the Cardiology Department of the First Affiliated Hospital of Dalian Medical University. The target goal attainment rate after PCI was defined as the percentage of patients reaching LDL-C goals recommended by The European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias (European guidelines) and Chinese guidelines on prevention and treatment of dyslipidemias in adults and Chinese guidelines on percutaneous coronary artery intervention treatment (Chinese guidelines). Multivariate logistic regression analysis was used to analyze the related factors.</p><p><b>RESULTS</b>According to the European guidelines, the overall LDL-C goal attainment rates at 1 month and 9 months after PCI were 25.2% (210/832) and 22.2% (186/832), respectively. According to the Chinese guidelines, the overall LDL-C goal attainment rates at 1 month and 9 months after PCI were 46.5% (387/832) and 42.3% (352/832), respectively. In accordance with the Chinese guidelines, the multivariate logistic regression analysis showed that gender (females/males, OR = 0.650, 95%CI: 0.442-0.956), age ( ≥ 60 years/<60 years, OR = 0.628, 95%CI:0.464-0.850), hypertension (OR = 0.737, 95%CI: 0.547-0.994), prior myocardial infarction history (OR = 0.696, 95%CI:0.511-0.948), prior PCI history (OR = 0.575, 95%CI: 0.339-0.974) and baseline LDL-C levels ( OR = 0.155, 95%CI: 0.096-0.252) were independent risk factors that affected LDL-C goal attainment at 1 month post PCI. Moreover, the following parameters were the independent risk factors for LDL-C goal attainment at 9 months after PCI: prior myocardial infarction history (OR = 0.706, 95%CI:0.521-0.958), prior PCI history (OR = 0.565, 95%CI:0.334-0.957) and baseline LDL-C levels (OR = 0.176, 95%CI:0.110-0.282).</p><p><b>CONCLUSIONS</b>Currently, the LDL-C control rate is low in patients with ACS after PCI. The cholesterol lowering therapy should be individually strengthened for patients after PCI, especially in female patients, patients with aged ≥ 60 years old, hypertension, prior myocardial infarction history, prior PCI history and higher baseline LDL-C level.</p>
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Aged , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome , Therapeutics , Cholesterol, LDL , Blood , Percutaneous Coronary Intervention , Retrospective StudiesABSTRACT
Objective To analyze the management and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) in Liaoning province.Methods The data were collected from a prospective and multicenter registry study including 8 tertiary hospitals and 12 secondary hospitals in Liaoning province.Total 1429 patients with acute STEMI admitted to hospitals from June 2009 to June 2010 were included in the study.A unified follow-up questionnaire was applied on patient discharged.Results The average age of patients was (63 ± 13)years.37.4％ of patients recognized the disease as heart disease and 39.7％ were transported by emergency ambulance with a median symptom-to-door time of 150 min.52.9％ patients underwent emergency reperfusion therapy,including fibrinolytic therapy (24.4％) and primary percutaneous coronary intervention (PCI,28.1％).The in-hospital treatment included aspirin (99.6％),clopidogrel (81.9％),statins (90.1％),low molecular weight heparin (89.5％),β-blocker (66.0％),angiotensin converting enzyme inhibitor (ACEI)/ angiotensin receptor blocker (ARB)(66.6％).The in-hospital mortality was 10.7％ ; the mortality in females was higher than that in males (18.3％ vs.7.9％,P ＜ 0.01) and the mortality in older patients (≥ 65 years) was higher than that in younger patients (＜65 years)(17.0％ vs.5.2％,P ＜0.01).The follow-up treatment included:aspirin (81.1％),clopidogrel (45.0％),statins (61.0％),β-blocker (48.3％),ACEI/ARB (42.4％).The follow-up mortality was 5.0％ after hospital discharge.Conclusions Longer pre-hospital delay is commonly seen in STEMI patients.There is still certain gap of emergency reperfusion therapy and the evidence-based medication with related clinical guidelines of STEMI management in Liaoning.
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Objective To observe the influence of insulin therapy on the short-term prognosis of patients with acute ST-elevation myocardial infarction (ASTEMI) complicated with hyperglycaemia.Methods A total of 128 patients with ASTEMI complicated with hyperglycaemia were randomized into 2 groups:treatment group and control group.There were 64 patients(50.0％ )in the treatment group and 64 patients(50.0％ ) in the control group.All of the patients were given anticoagulants,antiplatelet drugs,statins,beta-receptor blockers,nitrates and angiotensin-converting enzyme inhibitors (ACEI)or angiotensin receptor blocker (ARB) Moreover,the patients in the treatment group were given extra 50 U insulin ( Novolin R) in 50 ml saline by venous infusion.In the treatment group,Venous blood samples were obtained before and 7 days after treatment to determine the fasting blood glucose and hs-CRP in serum; the levels of fasting blood glucose and hs-CRP and short-term prognosis were compared between the 2 groups.ResultsThe levels of fasting blood glucose in the treatment group were decreased significantly after treatment ( [ 5.4 ± 0.8 ] mmol/L vs [ 11.6 ± 2.3 ] mmol/L,P ＜0.01),but there was no significant change in the control group( [ 10.7 ± 2.1 ] mmol/L vs [ 11.2 ± 2.7]mmol/L,P ＞ 0.05 ).The levels of hs-CRP in both groups were decreased significantly after treatment (P ＜0.05),but it was much more obvious in the treatment group( [ 6.2 ± 1.5 ] mg/L vs [ 8.7 ± 1.8 ] mg/L,P ＜0.05).The incidence of major adverse cardiac events(MACE) during a 3 months′ follow-up in the treatment group was significantly lower than that in the control group ( 12.50％ vs 34.38％,P ＜ 0.05 ).Conclusion Insulin therapy can improve the short-term prognosis in patients with ASTEMI complicated with hyperglycaemia.
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Objective To observe the levels of plasma high sensitive C-reactive protein (hs-CRP) and brain natriuretic peptide (BNP) in patients with ST-segment elevation myocardial infarction ( STEMI)and analyze their significance. Methods This study enrolled 80 patients who had first acute STEMI. Twenty-five patients were in the primary percutaneons coronary intervention (PCI) group, 27 patients were in the delayed PCI group and 28 patients were in the medical treatment group. The levels of hs-CRP, BNP and creatine kinase MB (CK-MB) were measured after treatment. Left ventricular function and ventricular wall thinning ratio were evaluated by echocardiography. Results The levels of plasma hs-CRP showed dynamic variation with time in all patients. The peak time of hs-CRP was significantly different among the three groups. The peak value of hs-CRP, BNP, wall motion score index ( WMSI ) and the incidence of left ventricular remodeling decreased, but the level of loft ventricular ejection fraction (LVEF) increased in the primary PCI group. Compared with the delayed PCI group and the medical lreatment group, there were significant difference. Correlational analysis showed that there were negative relationship between LVEF and hs-CRP, BNP,WMSI (r = -0.895, -0.940, -0.939,P < 0.01 ) and positive relationship between hs-CRP and BNP, CK-MB (r = 0.935,0.886, P < 0.01 ). Conclusions The associated measure of hs-CRP and BNP could preferably evaluate the inchoate prognosis of STEMI. hs-CRP might be an useful index of successful reperfusion and predict the stability of infarction related lesion.
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Objective To study the changes of T-C of apolipoprotein CⅢ (ApoCⅢ)-455C gene and to de-tect the relationship between essential hypertension (EH) and the quantity of ApoCⅢ-455C gene. Methods 606 subjects were divided into hypertension group(n=306) and non-hypertension group(n=300). And the two groups 606 were divided into subgroup A (n=90) who had hypertension companied with hypertriglyceridem, subgroup B (n=216)who had hypertension only, subgroup C (n=51) who had hypertriglyceridem only and subgroup D (n= 249) who had none of the two diseases, by the concentration of triglycerides (TG) (TG≥1.69 mmol/L). The quan-tity of ApoCⅢ-455 C was detected by Real Time PCR. TC, TG, HDL-C, LDL-C, ApeA, ApoB 100, ApoCⅢ, ApoE, blood glucose,plasma insulin and waist circumference were measured in all cases. Results There was no difference in the quantity of ApoCⅢ-455C gene between group B and the group D [(45.16±5.97) vs (46.21±6.13)] (P>0.05). The concentration of ApoCⅢ, ApoB100 and the quantity of ApoCⅢ-455C gene in group A were higher than those in group B [0.14±0.03]g/L, (95.00±15.69)g/L, (28.13±4.11) vs (0.09±0.03)g/L,(81.22± 11.87)g/L,(45.16±5.97)(P<0.01)]. It was similar in ApoE [(0.05±0.01) g/L vs (0.04±0.01)g/L] and LDL-C [(2.54±0.61)mmol/L vs (2.15±0.41)mmol/L] (P<0.05). Conclusions The quantity of ApoC Ⅲ-455C gene is not related to EH.
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Objective To observe feature of clinic and imageology in patients with unstable angina pectoris after radiation therapy to chest. Methods The study enrolled 58 patients who had unstable angina pectoris. Twenty-eight patients were in the postradiation therapy to chest group, 30 patients were in the common unstable angina pectoris group. All patients underwent multislice spiral CT(MSCT) examination and coronary angiography (CAG). After one year follow-up, the levels of brain natriuretic peptide (BNP) and ventricular wall motion score index (WMSI) were measured , the incidence of cardiovascular events were observed in all patients. Results Calcific, multi-vessel, thrombotic disease and dissection were significantly different between the two groups, when one year follow-up , the levels of BNP were higher in the postradiation therapy to chest group than those in the common unstable angina pectoris group [ (234.31 ± 121.39) ng/L vs (124.74 ±37.81) ng/L] WMST, incidence of the first heart failure, angina pectoris recurrence and revascularization were significantly different too (P< 0.05 ). Conclusions The complex lesions are major in the postradiation therapy to chest. Moreover, because radiation injures the heart valves and myocardium,these patients' long-term prognosis are worst.
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Objective To study the prognosis and pre-procedural independent risk factors for pa-tients with no-reflow (NR) phenomenon during percutaneous coronary intervention (PCI). Methods Pa-tients with or without NR phenomenon during PCI procedures from January 2000 to January 2005 were studied retrospectively. The clinical data preoperative and the incidence of major adverse cardiovascular events (MACE) between the two groups were compared. Univariate analysis and multivariate Logistic analysis were used to select the risk factors for NR phenomenon. Retrospectively was reviewed for (35.8 ± 15.3)months. Results The NR group had more significant incidence of MACE. Multivariate Logistic analysis showed that the predictive factors for NR were (1) Smoke index ≥ 300(OR = 2.81,95%CI: 1.61-4.38 ,P =0.007). (2) Fasting blood glucose level before PCI ≥ 11.1 mmol/L (OR = 3.39,95%CI: 1.51-4.89,P = 0.000 ). (3) Absence of angina pectoris attack within one month before PCI (OR = 2.39,95%CI: 1.22-3.78,P = 0.009). Conclusions The prognosis is poor for the PCI patients with NR phenomenon. Those patients whose fasting blood glucose level before PCI ≥ 11.1 mm01/L, smoke index ≥ 300 and absence of angina pec-toffs attack within one month before PCI have higher incidence of NR phenomenon.
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Objective To assess the impact of patients's sex on outcome in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI). Design: Inception cohort of 232 patients (44 women and 188 men) who were admitted with a diagonosis of AMI to CCU between June 1996 and April 2002 in Heart Center of Dalian Medical University. Results Compared with men, women were older (66?9 vs 58?11, P
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Objective To evaluate the relationship between pressure derived fractional collateral flow (Q C/Q N) and left ventricular remodeling after acute myocardial infarction(AMI) Methods The Q C/Q N was measured in 21 patients with first AMI treated with percutaneous transluminal coronary angioplasty (PTCA), being determined by simultaneous measurement of mean aorta pressure (P a), distal coronary pressure (P w) during the balloon occlusion 21 patients were divided into two groups according to the value of Q C/Q N (group A, Q C/Q N≥0 25, group B, Q C/Q N0 05) At one month follow up, the difference in EF ( P 0 05) Both ESVI and EDVI were considerably increased in two groups Conclusion Angiographic Rentrop′s classification has its limitation in assessing the collateral circulation Q C/Q N is a major determinant of left ventricular remodeling and prognosis in patients with AMI
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Objective To explore the predictive factors of death in patients with AMI after emergency PTCA Methods PTCA were performed in 43 patients with AMI from June 1996 to March 2001, including 30 males and 13 females with aged 27-80 (mean 60 5?12 6) years old 7 Patients died inhospital Results The mortality of patients with killip 3-4, cardiogenic shock (58 3%, 44 4%) is higher than that of patients without such complications Compared with the patients without total occlusion, the patients with total occlusion have higher mortality (20 6% vs 0%) The mortality of patients with acute thrombolysis during PTCA is higher than that of patients without acute thrombolysis (40 0% vs 9 1%) Conclusion Killip 3～4, cardio genic shock, total occlusion, acute thrombolysis are the predictive factors of in hospital death in patients with AMI after PTCA
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Objective The objective of this study was to evaluate the clinical significance of coronary stenting in patient aged more than 70 years old.Methods The results of coronary stenting (14 with acute myocardiac infarction) were analyzed and compared them to 36 patients aged from 50 to 60 years old. Results The clinical success rate of coronary stenting for elderly group was 96.8%. The reanginal rate during 3 to 44 (21 ? 14) months' follow up of was 23% . No significant difference in the success and reanginal rate was observed between the two groups and no death case was found in the 14 elderly patients with acute myocardiac infarction.Conclusion Our data suggest that coronary stenting is a very safe and effective method of coronary revascularization in elderly patients.