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Objective@#Previous cross-sectional studies suggested that elevated levels of total cholesterol content of erythrocyte membrane (CEM) could significantly increase the risk of acute coronary syndrome (ACS). The purpose of the present study was to assess the predictive value of baseline CEM levels for the risk of clinical endpoint events in patients with ACS through prospective follow-up studies.@*Methods@#This study is a prospective follow-up study, which consisted of 859 patients with first ACS (698 patients with unstable angina pectoris and 161 patients with acute myocardial infarction), diagnosed and hospitalized in the First and Second Affiliated Hospital of Anhui Medical University. The routine blood lipid levels and CEM were measured. Patients were divided into two groups according to the median of baseline CEM: CEM≤131.56 μg/mg group (n=430) and CEM>131.56 μg/mg group (n=429). Patients were followed up at 6 months interval. The clinical endpoints were nonfatal myocardial infarction, nonfatal stroke, all-cause mortality, all-cause mortality, heart failure requiring hospitalization, and coronary artery revascularization. Kaplan-Meier curve analysis and Cox proportional hazard model were used to analyze the impact of elevated CEM on the occurrence of clinical end-point events. HR values and 95%CI of each variable were obtained. Cox regression analysis of all-cause mortality was performed according to whether patients had risk factors for coronary heart disease (hypertension, diabetes, smoking and elevated LDL-C) and whether they were treated with PCI.@*Results@#The follow-up time was 1 640 (1 380, 2 189) days. Cox analysis after adjustment showed that an elevated baseline of CEM (>131.56 μg/mg) was associated with an increased risk of all-cause mortality (HR=1.690, 95%CI 1.041-2.742, P=0.034), but had no significant predictive effect on the other clinical endpoints. Subgroup analysis showed that elevated baseline CEM levels in ACS patients with LDL-C>1.8 mmol/L (HR=1.687, 95%CI 1.026-2.774, P=0.039), receiving in-hospital PCI (HR=2.365, 95%CI 1.054-5.307, P=0.037), or male (HR=1.794, 95%CI 1.010-3.186, P=0.046) were associated with an increased risk of all-cause mortality.@*Conclusion@#The results showed that elevated CEM levels can increase the risk of all-cause mortality in ACS patients.
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Objective To investigate whether intensive atorvastatin treatment in patients after percutaneous coro-nary intervention ( PCI) could decrease the effect of contrast medium on kidney function and the incidence of con-trast-induced acute kidney injury( CI-AKI) . Methods A total of 128 patients with PCI were randomly divided into two groups:the enhanced treatment group (n=64) and the control group(n=64). The enhanced treatment group received 80 mg atorvastatin at 12~24 h before PCI and 24,48 h after PCI. The control group was given 20 mg ator-vastatin respectively before and after PCI. The primary end point was the incidence of CI-AKI. Serum creatinine (Scr), cystatin C, glomerular filtration rate(eGFR), urinary albumin and urinary β-2 microglobulin levels were observed at 24 h before PCI and 24, 48, 72 h after PCI. Results In the enhanced treatment group 3. 1 % (n=2) of patients developed CI-AKI versus 4. 7 % (n=3) in the control group, without statistical difference (P=1.00). There was no significant difference between two groups in postoperative Scr, cystatin C, eGFR, urinary al-bumin, urinary β-2 microglobulin and creatine kinase(CK). Three days after the operation, alanine aminotrans-ferase ( ALT) elevated in two groups, and aspartate aminotransferase ( AST) increased in the enhanced treatment group (P<0. 05), but they were all in the normal range. Conclusion There has been no significant difference in decreasing the incidence of CI-AKI and the damage of contrast medium on renal function between the enhanced treatment group and the control group before PCI.
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Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome (ACS).Methods A total of 552 patients with ACS were enrolled in the present study.According to the levels of estimated glomerular filtration rate (eGFR),patients were divided into two groups,normal renal function (eGFR≥90 ml · min-1 · 1.73 m-2) and mild renal insufficiency (60≤eGFR ＜90 ml · min-1 · 1.73 m-2).The primary and secondary events were collected and analyzed through the present prospective follow-up study.Results The patients in mild renal insufficiency group had a higher incidence of the primary endpoint events than normal renal function group [31 cases (12.6％) vs 15 cases (4.9％),P =0.001].There was no difference of the secondary endpoint events incidence in the two groups.The incidence rate of all-cause mortality [8.9％ (22 cases) vs 2.2％ (7 cases),P ＜0.001] and cardiac death [6.5％ (16 cases) vs 1.3％ (4 cases),P =0.001] was higher in mild renal insufficiency group,but there was no statistical difference of incidence rate of no fatal stroke and myocardial infarction in the two groups.The results of COX regression analysis showed that the incidence of primary endpoint events in patients with mild renal dysfunction was 2.265 folds (95％ CI 1.076-4.771,P=0.031) of patients with normal renal function.Further analysis indicated that the predictive value of mild renal insufficiency was only for all-cause mortality (HR 3.118,95％ CI 1.197-8.125,P =0.020),not for heart failure and revascularization.According to the Kaplan-Meier curves results,the incidences of the primary endpoint events (P =0.004) and all-cause mortality (P =0.001) were higher in mild renal insufficiency group than in normal renal function group.Conclusion Mild renal insufficiency has important predictive value for primary endpoint events in patients with ACS.
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Objective To explore the correlation between coronary lesions and homocysteine and the plasma homocysteine changes before and after coronary intervention treatment.Methods By the transmission immune method than turbidity,respectively,89 patients with acute coronary syndrome test group and 28 coronary artery of the normal group Hcy level and 70 routine coronary stents after implantation of Hcy level.Results Acute coronary syndrome group of Hcy content was significantly higher than normal coronary artery (P ＜ 0.01 ).Coronary lesions impact Hcy level,its significant difference( P ＜ 0.01 ).And coronary intervention before and after treatment Hcy no significant differences( P ＞0.05 ).Conclusion High homocysteine is cardiovascular disease of a new and important independent risk factors.Hcy close relations with ACS,positively related,testing their level of change,and can be effectively reaction to the development process of the ACS and prognosis,prevention and treatment for clinical ACS provide reliable basis.Coronary intervention treatment can reduce Hcy whether level and role of blood vessels,is yet to be studied further.
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Objective To study on transcatheter closure of membranous ventricular septal defect (VSD) with pseudoaneurysm by patent ductus arteriosus(PDA) occlusion devices in children and summarize the skill and clinical experience. Methods The study included 20 membranous VSD cases in children.According to the finding of the left ventricular angiography, various kinds of the PDA occlusion devices was implanted. The mean diameter of the waist of the occluder was ( 10.4 ± 2.6) mm. Examination by transthoracic echocardiography (TTE) immediately and left ventricular angiography after the occluder was implanted 15minutes later to evaluate the efficacy. Results In the 20 patients, one of the Ⅳ type VSD patient was quitted because of the significant residual shunts(≥2 mm). Slightly residual shunts ( ＜ 2 mm) was found in one Ⅲ type VSD patient with multi-outlet. And disappeared in 1 month after the procedure, which VSD patient was confirmed by TTE. Thirteen cases were normal by EKG examination (or the same before procedure).Incomplete right bundle branch block was found in 4 cases. First degree atrioventricular block was found in 1 case and paroxysmal junctional tachycardia was found in 1 case. All of them were recovered in 1 week.Conclusions Transcatheter interventional therapy with PDA occlusion devices for membranous VSD with pseudoaneurysm is safe and effective. The key of the procedure is to select suitable occluder and suitable position to plant them according to the membranous morphologic characteristics,size and position of the pseudoaneurysm. It is a facultative method for transcatheter therapy this kind of congenital heart disease.
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Objective To evaluate the correlation between seram interleukin-10 (IL-10) and testosterone with coronary heart disease (CHD). Methods 387 patients were divided into CHD group (n = 239) and control group ( n = 148 ) according to the results of coronary angiography. CHD patients were divided into subgroups accord-ing to the numbers, Gensini score of lesions in the coronary arteries and clinical severity ( statue of stable coronary artery disease, unstable angina or acute myocardial infarction). Serum IL-10 and testosterone levels were measured by ELASA. Logistic regression and partial correlation were used to evaluate the correlation of serum IL-10 and testoster-one with CHD. Results IL-10 was significantly lower in the CHD group than in the control group[ (39.08 ± 14.22) ng/L vs (49.27 ± 24.67)ng/L, P < 0. 001 ]. The partial correlation analysis results in subgroups showed that the correlation coefficient of IL-10 with number of lesions,gensini score and clinical severity of CHD was - 0.25, P < 0.001, -0.25 ,P <0.05 and -0.25 ,P <0.001 ,respectively. Serum testosterone had no difference in control group and CHD group (P >0.05 ). Logistic regression analysis found that only smoking (OR = 3.79,95% CI 2.09～ 6.84,P<0.01) ,diabetes mellitus (OR =2.48,95% CI 1.05 ～5.88,P <0. 05) ,apoB ( OR = 14.3,95% CI 4.29～46.61 ,P <0.01 ) and IL-10 ( OR =0.74,95%, CI 0.57～0.89 ,P <0.01 ) entered the model. Conclusions Serum IL-10 is not only significantly correlated with CHD but also with its severity. IL-10 is an independent pro-tective factor for CHD.