Benefits and risks of prolonged dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent in patients with stable coronary artery disease and diabetes / 中华心血管病杂志

Objective: To compare the efficacy and safety of prolonged dual antiplatelet therapy (DAPT>1 year) in patients with stable coronary artery disease (CAD) and diabetes who were event-free at 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in a large and contemporary PCI registry. Methods: A total of 1 661 eligible patients were selected from the Fuwai PCI Registry, of which 1 193 received DAPT>1 year and 468 received DAPT ≤1 year. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE) and Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding, MACCE was defined as a composite of all-cause death, myocardial infarction or stroke. Multivariate Cox regression analysis and inverse probability of treatment weighting (IPTW) Cox regression analysis were performed. Results: After a median follow-up of 2.5 years, patients who received DAPT>1 year were associated with lower risks of MACCE (1.4% vs. 3.2%; hazard ratio (HR) 0.412, 95% confidence interval (CI) 0.205-0.827) compared with DAPT ≤1 year, which was primarily caused by the lower all-cause mortality (0.1% vs. 2.6%; HR 0.031, 95%CI 0.004-0.236). Risks of cardiac death (0.1% vs. 1.5%; HR 0.051, 95%CI 0.006-0.416) and definite/probable ST (0.3% vs. 1.1%; HR 0.218, 95%CI 0.052-0.917) were also lower in patients received DAPT>1 year than those received DAPT ≤ 1 year. No difference was found between the two groups in terms of BARC type 2, 3, or 5 bleeding (5.3% vs. 4.1%; HR 1.088, 95%CI 0.650-1.821). Conclusions: In patients with stable CAD and diabetes who were event-free at 1 year after PCI with DES, prolonged DAPT (>1 year) provides a substantial reduction in ischemic cardiovascular events, including MACCE, all-cause mortality, cardiac mortality, and definite/probable ST, without increasing the clinically relevant bleeding risk compared with ≤ 1-year DAPT. Further well-designed, large-scale randomized trials are needed to verify the beneficial effect of prolonged DAPT in this population.

Lipoprotein apheresis in patients with familial hypercholesterolemia: a single center research / 中华心血管病杂志

Objective: We evaluated the safety and efficacy of lipoprotein apheresis (LA) in patients with familial hypercholesterolemia (FH) who can't reach low-density lipoprotein cholesterol(LDL-C) target goals with the maximal tolerated dose of lipid-lowering agents. Methods: This was a retrospective cross-sectional study. Between February 2015 and November 2019, patients with FH who were admitted in Fuwai hospital and treated with LA were consecutively enrolled. Based on intensive lipid-lowering agents, these patients received LA by double filtration plasma pheresis (DFPP) method. The changes of lipid levels such as LDL-C and lipoprotein(a)[Lp(a)] were compared before and after LA treatment, and the changes of immunoglobulin (Ig) concentration and LA-related adverse effects were also discussed. Results: A total of 115 patients with FH were enrolled in this study, of which 8 cases were homozygous FH and 107 cases were heterozygous FH. The age was (43.9±12.2) years and there were 75 (65.2%) males, and 108 (93.8%) with coronary artery disease. For pre-and immediately after LA treatment, the LDL-C was (5.20±2.94) mmol/L vs. (1.83±1.08) mmol/L, Lp(a) concentration was 428.70(177.00, 829.50)mg/L vs. 148.90(75.90, 317.00) mg/L (P<0.001), with a decrease of 64.2% and 59.8% respectively. The levels of IgG and IgA measured 1 day after LA treatment were both in the normal range and IgM concentration was below the reference value, the reductions of which were 15.1%, 25.0% and 58.7% respectively (P<0.001). Six patients had mild symptoms of nausea, hypotension dyspnea and palpitation, the symptoms were relieved by symptomatic treatment. Conclusion: For patients with FH who do not achieve LDL-C target goal with the maximal tolerated lipid-lowering agents, especially those with elevated Lp(a) levels, LA, which can significantly further reduce LDL-C and Lp(a) levels, is an effective and safe option.

Lipoprotein (a) as a Marker for Predicting the Presence and Severity of Coronary Artery Disease in Untreated Chinese Patients Undergoing Coronary Angiography / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Low-density lipoprotein cholesterol (LDL-C) has been well known as the risk factor of coronary artery disease (CAD). However, the role of lipoprotein (a) [Lp(a)] in the development of CAD is of great interest but still controversial. Thus, we aim to explore the effect of Lp(a) on predicting the presence and severity of CAD in Chinese untreated patients, especially in combination with LDL-C.</p><p><b>METHODS</b>We consecutively recruited 1,980 non-treated patients undergoing coronary angiography, among which 1,162 patients were diagnosed with CAD. Gensini score (GS) was used to assess the severity of CAD. Lp(a) was measured by immunoturbidimetric method.</p><p><b>RESULTS</b>Patients with CAD had higher level of LDL-C and Lp(a) compared with non-CAD (P < 0.05). Multivariable logistic regression revealed that Lp(a) > 205 mg/L (highest tertile) predicted 1.437-fold risk for CAD (95% CI: 1.108-1.865, P = 0.006) and 1.480-fold risk for high GS (95% CI: 1.090-2.009, P = 0.012) respectively. Interestingly, concomitant elevated level of Lp(a) and LDL-C conferred the highest risk for both presence [OR = 1.845, 95% CI: 1.339-2.541, P < 0.001] and severity [OR = 1.736, 95% CI: 1.188-2.538, P = 0.004] of CAD.</p><p><b>CONCLUSION</b>Lipoprotein (a) is a useful marker for predicting the presence and severity of CAD, especially combined with LDL-C.</p>

Impact of Acquired Thrombocytopenia After Elective Percutaneous Coronary Intervention on Long-term Outcomes of Patients With Coronary Artery Disease / 中国循环杂志

Objectives: To investigate the association between acquired thrombocytopenia and long-term clinical outcome among stable coronary artery disease patients undergoing elective percutaneous coronary intervention (PCI). Methods: We analyzed clinical data of 8 271 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013. Acquired thrombocytopenia was defined as platelet count <150×109/L after PCI in patients with normal baseline platelet count value. We compared data on demographic, clinical, laboratory, and 30-month outcome between non-thrombocytopenic and thrombocytopenic patients and identified the independent predictors of acquired thrombocytopenia post PCI. Results: Acquired thrombocytopenia developed in 654 (7.91%) patients (634 [7.67%] patients had mild thrombocytopenia, 20 [0.24%] patients had moderate or severe thrombocytopenia). Patients who developed thrombocytopenia had higher 30-month rate of all cause death (2.3% vs 1.0%, P=0.0086) and cardiogenic death (1.2% vs 0.5%, P=0.0261). Moderate or severe thrombocytopenia was associated with a 13-fold increased risk for cardiogenic death, 7-fold increased risk for stent thrombosis,11-fold increased risk for myocardial infarction compared with patients without thrombocytopenia. Conclusions: Acquired thrombocytopenia after PCI is common in stable coronary artery disease patients and is independently associated with increased risk of long-term adverse outcome in these patients.

Correlation Study Between Plasma Level of Pro-protein Convertase Subtilisin Kexin Type 9 and Coronary Artery Calcification / 中国循环杂志

Objective: To investigate the relationship between plasma level of pro-protein convertase subtilisin kexin type9 (PCSK9) and coronary artery calcification (CAC). Methods: A total of 380 consecutive chest pain patients without lipid-lowering therapy were enrolled. All patients received CT scan and coronary artery calcification (CAC) score measurement and were divided into 2 groups: CAC group, n=156 patients with CAC score>0 and Non-CAC group, n=224 patients with CAC score=0. CAC group was further classified in 3 subgroups as CAC score (1-100) subgroup, n=53, CAC score (101-400) subgroup, n=64 and CAC score>400 subgroup, n=39. Clinical data was collected, plasma levels of PCSK9 were measured in all patients and the relationship between PCSK9 and CAC score was investigated. Results: Plasma PCSK9 level in CAC group was higher than Non-CAC group (260.23±69.34) ng/ml vs (205.46±53.21) ng/ml, P<0.001; alone with CAC score increasing, PCSK9 level was elevating accordingly as in CAC score (1-100) subgroup, CAC score (101-400) subgroup and CAC score>400 subgroup, PCSK9 levels were (247.38±72.68) ng/ml, (264.87±57.63) ng/ml and (295.33±69.06) ng/ml respectively, all P<0.05. With adjusted traditional cardiovascular risk factors, multivariate regression analysis confirmed that plasma PCSK9 level was independently related to CAC score (β=0.584, P=0.002). In addition, the optimal cut-off value for PCSK9 predicting CAC was 228.58 ng/ml with sensitivity at 67% and specificity at 71%. Conclusion: Plasma PCSK9 level was related to CAC in chest pain patients without lipid-lowering therapy.

Application Value of Residual SYNTAX Score in Coronary Artery Disease Patients With Percutaneous Coronary Intervention in China / 中国循环杂志

Objective: Residual SYNTAX score (rSS) can be used as the independent predictor for clinical prognosis and the tool for quantifying incomplete revascularization (IR) in coronary artery disease (CAD) patients with percutaneous coronary intervention (PCI). Our work assessed the prognostic value of rSS on large-scale PCI patients in China. Methods: A total of 10 724 CAD patients undergoing PCI in our hospital in 2013 were studied; 381 patients with previous CABG and hybrid procedure were excluded, 10 343 patients were finally enrolled. Baseline SYNTAX score (bSS) and rSS were calculated before and after PCI. Complete revascularization (CR) was defined by rSS=0 and IR was defined by rSS≥1. The patients were followed-up for 30 months. Clinical endpoint events included MACE, a composite event of all-cause death, myocardial infarction (MI) and revascularization; all-cause death, cardiac death, MI, all-cause death/MI and revascularization.Results: There were 5 050/10 343 (48.8%) patients having CR and 5 293 having IR including 1 908 (18.4%) patients with 1≤rSS≤4, 1 777 (17.2%) with 4<rSS≤9 and 1608 (15.5%) with rSS>9. Patients with the higher rSS had more clinical comorbidity and more complicated coronary lesions. Compared with CR patients, IR patients had the higher incidences of 30-month clinical endpoint events. As rSS increasing, the incidence of MACE was elevating accordingly. Multivariate regression analysis indicated that rSS was the independent predictor for MACE and all other endpoints occurrence. Conclusion: IR patients especially those with rSS>9 had the higher incidence of adverse clinical outcomes. rSS has been a good tool for quantifying revascularization and assessing prognosis in PCI patients in China.

Plasma apoCIII Levels in Relation to Inflammatory Traits and Metabolic Syndrome in Patients not Treated with Lipid-lowering Drugs Undergoing Coronary Angiography / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Assessment of the comprehensive relationship among apolipoprotein CIII (apoCIII) levels, inflammation, and metabolic disorders is rare.</p><p><b>METHODS</b>A total of 1455 consecutive patients not treated with lipid-lowering drugs and undergoing coronary angiography were enrolled in this cross-sectional study. A mediation analysis was used to detect the underlying role of apoCIII in the association of inflammation with metabolic syndrome (MetS).</p><p><b>RESULTS</b>Patients with MetS showed higher levels of apoCIII [95.1 (73.1-131.4) vs. 81.7 (58.6-112.4) μg/mL, P < 0.001] and inflammatory markers [high sensitivity C-reactive protein, 1.7 (0.8-3.4) vs. 1.1 (0.5-2.2) mg/L; white blood cell count, (6.48 ± 1.68) vs. (6.11 ± 1.67) × 109/L]. The levels of apoCIII and inflammatory markers increased with the number of metabolic risk components (all P < 0.001). Furthermore, apoCIII levels were associated with virtually all individual MetS risk factors and inflammatory markers (all P < 0.05). Importantly, the prevalence of MetS in each metabolic disorder rose as apoCIII levels increased (all P < 0.05). Mediation analysis showed that apoCIII partially mediated the effect of inflammation on MetS independently from triglycerides.</p><p><b>CONCLUSION</b>Plasma apoCIII levels were significantly associated with the development and severity of MetS, and a role of apoCIII in the effect of inflammation on the development of MetS was identified.</p>

Impact of Smoking Status on Lipoprotein Subfractions: Data from an Untreated Chinese Cohort / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Cigarette smoking is one of the established risk factors of atherosclerotic cardiovascular disease, however, its impact on lipids is not completely understood, especially in the Chinese population. Therefore, this study evaluated the impact of smoking status (non, former, and current smoking) on the distribution of lipoprotein subfractions in untreated patients with angina-like chest pain.</p><p><b>METHODS</b>A total of 877 patients were consecutively enrolled and divided into nonsmoking (n = 518), former smoking (n = 103), and current smoking (n = 256) groups. Both low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) subfractions were measured using the Quantimetrix Lipoprint System. The distributions of lipoprotein subfractions were evaluated among the groups.</p><p><b>RESULTS</b>Compared with nonsmoking subjects, the current smoking group had significantly lower large/medium HDL-C (both P < 0.001) concentration and large HDL subfraction percentage but higher small HDL-C and medium LDL-C concentrations as well as medium LDL subfraction percentage. Importantly, former smoking subjects showed elevated levels of large HDL-C concentration, large HDL particle percentage, and mean LDL particle size and attenuation in small HDL/LDL percentages and small LDL-C concentration, but these levels did not reach the optimal status compared with those of the non-smoking group (data not shown).</p><p><b>CONCLUSION</b>Smoking has an adverse impact on the lipoprotein subfractions, presented as lower large HDL particles besides higher small HDL and medium LDL particles, whereas smoking cessation could reverse these change to a certain degree.</p>

Circulating MicroRNAs as Novel Diagnostic Biomarkers for Very Early-onset (≤40 years) Coronary Artery Disease / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Very early-onset coronary artery disease (CAD) is a great challenge in cardiovascular medicine throughout the world, especially regarding its early diagnosis. This study explored whether circulating microRNAs (miRNAs) could be used as potential biomarkers for patients with very early-onset CAD.</p><p><b>METHODS</b>We performed an initial screening of miRNA expression using RNA isolated from 20 patients with angiographically documented very early-onset CAD and 20 age- and sex-matched normal controls. For further confirmation, we prospectively examined the miRNAs selected from 40 patients with very early-onset CAD and 40 angiography-normal controls.</p><p><b>RESULTS</b>A total of 22 overexpressed miRNAs and 22 underexpressed miRNAs were detected in the initial screening. RT-qPCR analysis of the miRNAs obtained from the initial screening revealed that four miRNAs including miR-196-5p, miR-3163-3p, miR-145-3p, and miR-190a-5p exhibited significantly decreased expression in patients compared with that in controls (P<0.05). The areas under the receiver operating characteristic curve for these miRNAs were 0.824 (95% CI, 0.731-0.917; P<0.001), 0.758 (95% CI, 0.651-0.864; P<0.001), 0.753 (95% CI, 0.643-0.863; P<0.001), and 0.782 (95% CI, 0.680-0.884; P<0.001), respectively, in the validation set.</p><p><b>CONCLUSION</b>To our knowledge, this is an advanced study to report about four serum miRNAs (miR-196-5p, miR-3163-3p, miR-145-3p, and miR-190a-5p) that could be used as novel biomarkers for the diagnosis of very early-onset CAD.</p>

Effects of Hedan Tablet () on lipid profile, proprotein convertase subtilisin/kexin type 9 and high-density lipoprotein subfractions in patients with hyperlipidemia: A primary study / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of Hedan Tablet () on serum lipid profile, proprotein convertase subtilisin/kexin type 9 (PSCK9) and high-density lipoprotein (HDL) subfractions in patients with hyperlipidemia.</p><p><b>METHODS</b>Thirty-seven patients with hyperlipidemia were randomized to treatment with Hedan Tablet 4.38 g/day as Hedan group (18 cases) or placebo (19 cases) as control group for 8 weeks. The lipid profile, PCSK9 and HDL subfractions were determined at day 0 and week 8 in both groups respectively.</p><p><b>RESULTS</b>Hedan treatment for 8 weeks mildly decreased serum low-density lipoprotein cholesterol (LDL-C) levels, while no changes were found in total cholesterol (TC), triglycerides (TG) and PCSK9 concentrations. Furthermore, Hedan treatment increased the concentration of large high-density lipoprotein cholesterol (HDL-C) and the percentage of large HDL subfraction, while decreased the concentration of small HDL-C and the percentage of small HDL subfraction without changing serum HDL-C levels in patients with hyperlipidemia.</p><p><b>CONCLUSION</b>Hedan treatment of 4.38 g per day for 8 weeks could confer a favorable effects on serum LDL-C concentration as well as HDL subfractions.</p>

Correlation of red cell distribution width with the severity of coronary artery disease: a large Chinese cohort study from a single center / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has been reported that increased red blood cell width (RDW) is a marker associated with the presence and adverse outcomes of various cardiovascular diseases. The aim of the present study was prospectively evaluate the severity of coronary artery disease (CAD) and RDW in a large Chinese cohort.</p><p><b>METHODS</b>A total of 677 consecutive individuals who underwent coronary angiography due to the presence of angina-like chest pain and/or positive treadmill exercise test were enrolled in this study. All patients received coronary angiography and were then divided into two groups based on the results of coronary angiography (CAD group (n = 499) and control group (n = 178)). The clinical information including classical CAD risk factors and RDW were analyzed to identify their relationship to CAD. The severity of CAD was evaluated by Gensini score and its relationship with RDW was also analyzed.</p><p><b>RESULTS</b>Patients with angiographic CAD had significantly elevated RDW levels compared with controls ((12.95 ± 0.77)% vs. (12.73 ± 0.83)%, P = 0.001). There was a significant positive correlation between RDW and the Gensini score (r = 0.37, P < 0.001). In multivariate Logistic regression analysis, RDW was demonstrated to be an independent predictor for both angiographic CAD (OR = 1.34, 95%CI: 1.02 - 1.77, P < 0.05) and for a higher Gensini score (> 13, OR = 2.23, 95%CI: 1.62 - 3.08, P < 0.001). In a receiver operating characteristic (ROC) curve analysis, an RDW value of 12.85% was identified as an effective cut-point in predicting the presence or absence of CAD with a sensitivity of 50.0% and a specificity of 65.2%.</p><p><b>CONCLUSION</b>RDW is associated with both presence of CAD and the severity of coronary stenosis, suggesting that it might be a readily available marker for the prediction of CAD and its severity.</p>

Increased plasma C-reactive protein level predicts rapid progression of non-target atherosclerotic lesions in patients with stable angina after stenting / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although the role of C-reactive protein (CRP) in predicting rapid progression of atherosclerotic lesions has been intensively studied in unstable coronary artery disease, the data from patients with stable angina (SA) are largely absent. The present study evaluated a middle-size patient cohort who underwent percutaneous coronary intervention (PCI) with stent implantation and follow-up coronary angiography (CAG) and tested the hypothesis that increased plasma level of high-sensitive CRP would indicate rapid progression of de novo non-target coronary artery lesions in Chinese patients with SA.</p><p><b>METHODS</b>The study population comprised of 311 consecutive patients with chronic SA who underwent coronary stent implantation on initial admission and angiographic follow-up ((8.5 ± 1.2) months). Rapid angiographic progression of non-target lesion was angiographically assessed and the patients were classified into two groups according to whether the progression existed or not. The relation of plasma CRP levels to the progression of atherosclerosis was investigated.</p><p><b>RESULTS</b>Baseline demographic, clinical, and angiographic data were similar in patients with and without progression. Rapid angiographic progression of non-target lesions occurred in 136 patients (43.7%) at follow-up: 77 had a ≥ 10% diameter reduction of pre-existing stenosis ≥ 50%, 26 had a ≥ 30% diameter reduction of a pre-existing stenosis < 50%, 64 developed a new lesion ≥ 30% in a previously normal segment, and 4 had progression of a lesion to total occlusion. Progression of non-target lesions was not associated with target lesion restenosis formation. High-sensitive CRP levels were markedly higher in progression patients than in non-progression ones (1.60 (0.80 - 3.46) mg/L vs. 0.96 (0.55 - 1.87) mg/L, P < 0.001). Multivariate regression analysis showed that plasma CRP independently predicted rapid angiographic progression of non-target lesions (P = 0.001). High-sensitive CRP levels above 1.32 mg/L (the cutoff value) were associated with a 3.5-fold increase in the risk of developing rapid atherosclerotic progression (OR = 3.497, 95%CI 2.045 - 5.980).</p><p><b>CONCLUSION</b>The data confirmed and extended previous studies that plasma CRP might independently predict non-target lesion progression in patients with SA after stent implantation.</p>

Role of plasma C-reactive protein in predicting in-stent restenosis in patients with stable angina after coronary stenting / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The role of plasma high sensitivity C-reactive protein (hs-CRP) in in-stent restenosis (ISR) remains controversial. We investigated plasma hs-CRP level at both admission and follow-up in patients with stable angina (SA) after successful coronary stenting in order to clarify the predictive value of hs-CRP for ISR.</p><p><b>METHODS</b>We summarized 303 consecutive chronic SA patients with coronary drug-eluting stent (DES) implantation. The ISR was analyzed by quantitative coronary analysis (QCA) at a mean follow-up of 8 months, and the patients were divided into two groups according to the detected ISR as ISR group (n = 48) and non-ISR group (n = 255). Plasma hs-CRP was examined at both admission and 8-month follow-up in all patients, standard medication continued throughout the investigation period.</p><p><b>RESULTS</b>QCA presented that 48 patients (15.8%) suffered from ISR at follow-up. The basic clinical characteristics were similar between the two groups, while plasma hs-CRP was higher in ISR group than that in non-ISR group at both admission and follow-up, P < 0.001 respectively. Multivariate regression analysis indicated that plasma hs-CRP level at either admission or follow-up could independently predict ISR occurrence (OR = 5.581, 95%CI 2.532-12.302, P < 0.001 and OR = 6.299, 95%CI 2.722-14.577, P < 0.001, respectively).</p><p><b>CONCLUSIONS</b>Our data indicate that plasma hs-CRP level may independently predict ISR at both admission and follow-up in SA patients with coronary DES implantation, which implies that a chronic, sustained systemic inflammatory response might be involved in ISR pathogenesis.</p>

Gender difference of clinical characteristics in Chinese patients with spontaneous variant angina / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Spontaneous attack of variant angina (VA) is a unique component of coronary artery disease (CAD), and associated with severe cardiac events. However, no data are available regarding sex differences in Chinese patients with spontaneous attacks of VA. Accordingly, the present retrospective study was initiated to evaluate the Clinical characteristics of Chinese female patients with spontaneous attacks of VA.</p><p><b>METHODS</b>From January 2003 to January 2008, a total of 209 patients were diagnosed to have had a spontaneous attack of VA at Fu Wai Hospital. Of them, 27 were female, and their clinical findings were collected and compared with male patients for aspects of risk factors, clinical features and angiographical findings.</p><p><b>RESULTS</b>Spontaneous attacks of VA was relatively uncommon in female (12.9%) compared with male patients. The female patients were less likely to have a history of smoking (14.8% vs. 79.7%, P < 0.001), more likely to have a family history of CAD (33.3% vs. 11.0%, P < 0.01), and to have had a greater incidence of ventricular fibrillation during attack (11.1% vs. 2.2%, P < 0.05). There were no significant differences in other characteristics between the two groups.</p><p><b>CONCLUSION</b>Chinese female patients who experienced a spontaneous attack of VA had the characteristics of less smoking history, more family history of CAD and higher occurrence of ventricular fibrillation than male patients.</p>

Coronary intervention in patients>or=75 years old with ST-elevation myocardial infarction: in-hospital and 6-month clinical outcomes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>ST-segment elevation myocardial infarction (STEMI) in elderly patients presents specific clinical characteristics. The study on percutaneous coronary intervention (PCI) in elderly patients (>or=75 years) with STEMI, however, has less been performed.</p><p><b>METHODS</b>In the present study, 522 consecutive STEMI patients undergoing PCI within 12 hours from symptom onset were investigated, and clinical characteristics and in-hospital and 6-month outcomes of 66 elderly patients (>or=75 years, group A) were compared to those of 456 younger patients (<75 years, group B).</p><p><b>RESULTS</b>Compared to younger patients, elderly ones had more females (42.4% vs. 17.8%, P<0.005), a history of cerebral vascular events (7.6% vs. 0.9%, P<0.05), higher serum creatinine level ((96.48+/-31.65) mmol/L vs. (84.87+/-19.81) mmol/L, P<0.005) and fewer smokers (28.8% vs. 45.4%, P<0.05). The elderly ones had worse Killip class (Killip I class: 69.7% vs. 85.7%, P<0.05), less drug-eluting stent implantation and lower rates of TIMI flow 3 following PCI (33.3% vs. 47.1%, and 84.8% vs. 94.7%, P<0.05 respectively). Additionally, both in-hospital mortality and myocardial infarction rate were found to be higher in elderly patients (16.7% vs. 1.5%, and 7.6% vs. 2.6%, P<0.05 respectively), which were also observed until 6-month follow-up (9.1% vs. 0, and 6.1% vs. 0, P<0.05 respectively). In multivariable Cox regression analysis, serum creatinine level, history of hypertension, left anterior descending coronary artery as infarct-related artery and Killip class were independent predictors of 6-month overall death in elderly patients.</p><p><b>CONCLUSIONS</b>The clinical characteristics of elderly patients with STEMI after PCI are different from those of younger patients. Although PCI in this population is with a low rate of PCI failure, it is still associated with a worse outcome.</p>