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Objective:To investigate the effect of serum cystatin C level on the occurrence and its long-term prognosis of contrast agent-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI)in elderly patients.Methods:A total of 848 elderly patients(≥60 years)undergoing PCI in our department between Mar 2015 and Dec 2017 were enrolled in a prospective cohort.The CI-AKI was defined as the increase of serum creatinine ≥44.2 μmol/L within 48-72 h after using iodine contrast agent or more than 25 % higher than base level within 48-72 h after PCI.A receiver operating characteristic curve was used to analyze the optimal cut-off value of Cystatin C for predicting CI-AKI after PCI.Patients were divided into 2 groups based on the optimal cut-off value of Cystatin C: the high Cystatin C group(Cystatin C ≥1.3 mg/L, n=178)and the control group(Cystatin C<1.3 mg/L, n=670). The differences in the incidence of CI-AKI after PCI and major adverse cardiac events(MACE)at 1 year follow-up were compared between the two groups.The Cox regression model was further used to analyze the predictors of the long-term prognosis after PCI.Results:Of 848 patients receiving PCI, the incidence of CI-AKI was 9.4%.The incidence of MACE at 1 year after PCI was higher in the high Cystatin C group than in the control group(15.7% vs.9.3%, χ2=6.524, P=0.011). Cox regression analysis confirmed that the high baseline level of Cystatin C was the most independent predictive factor for MACE at 1 year of follow-up( HR=16.244, P<0.001). Conclusions:The high baseline level of Cystatin C(≥1.3 mg/L)is an independent risk factor for CI-AKI and is also the most important predictor for the occurrence of long-term MACE in elderly patients undergoing PCI.
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Objective To explore the impact of Enalapril-folic acid tablet on development of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in elderly patients with coronary heart diseases(CHD) complicated with mild renal insufficiency. Methods A total of 935 old patients (≥60 years) undergoing selective PCI at our hospital from January 2013 to June 2016 were enrolled in this retrospective study.Based on treatments during the perioperative phase ,the 935 patients were divided into Enalapril-folic acid tablet intervention group (n= 296 ,31.7％ ) ,and other RAS blocker control group with Angiotensin eonverting-enzyme inhibitor (ACEI) or Angiotensin Ⅱreceptor blocker (ARB) (n=639 ,68.3％ ). The levels of serum creatinine for 72 hours after operation were monitored and evaluated.Baseline data and CIN incidence were compared between two groups.The clinical events within 1 month after contrast media application were recorded.Multivariate Logistic regression analysis was used to analyze independent risk factors for CIN after PCI. Results The incidence of CIN after PCI was lower in the intervention group than in the control group with no statistical significance[7.1％ (21/296) vs.11.1％ (71/639) ,χ2 = 3.679 ,P= 0.059].Multivariate regression analysis showed that age (OR=1.103 ,P=0.001) ,hypertension (OR=3.362 ,P=0.017) , and hyper-homocysteinemia (OR=3.528 ,P=0.003) were independent risk factors ,but the treatment with Enalapril-folic acid tablet might be a protective factor for development of CIN after PCI (OR=0.443 ,P=0.042).During the 1-month follow-up ,the rate of recurrent angina pectoris was lower in the intervention group than in the control group ( P < 0.05 ) ,while there were no statistically significant differences between two groups in the rates of rehospitalization due to worsening renal dysfunction ,dialysis/hemofiltration ,acute heart failure ,and new myocardial infarction (all P>0.05). Conclusions The treatment with enalapril-folic acid tablet may prevent the occurrence of CIN after PCI in elderly patients with coronary heart disease and mild renal insufficiency.
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Objective To study the effectiveness and safety of the side-branch (SB) balloon preimbedding technique on coronary bifurcation lesions (CBLs) in elderly patients.Methods A retrospective analysis was conducted on 111 elderly patients with CBLs in our hospital from January 2011 to January 2013,of whom 59 patients received SB balloon pre-imbedding and 52 patients received SB wire protection.The immediate blood flow of the side-branch after treatment,the performance of the stent,and major adverse cardiovascular events (MACE) during hospitalization,6 and 12 months after treatment,and coronary angiography 6 months after treatment were compared between the two groups.Results There were no statistical differences between the two groups in clinical characteristics,lesion distribution,length and diameter of MB or SB,bifurcation angle,length and number of main branch(MB) stenting,or MACE during hospitalization and 6 months after treatment (each P＞0.05).There was no statistical difference in immediate postoperative angiography between patients with thrombolysis in myocardial infarction (TIMI) grade 3,coronary stenosis more than 25％ in the MB (P＞0.05).The percentages of patients with coronary stenosis more than 50 ％ in SB and patients who needed SB stenting were lower in the balloon pre-imbedding group than in the wire protectiongroup[8.5％ (5/59) vs.23.1％ (12/52),42.4％ (25/59) vs.61.5％ (32/52),each P＜0.05].After 6 months of treatment,there was no statistical difference in coronary angiography in TIMI grade 3 of MB and coronary stenosis more than 25％ in MB between the two groups (P＞0.05)Also,the percentage of patients with TIMI grade 3 in SB was higher in the balloon pre-imbedding group than in the wire protection group (37/41 vs.24/34,P＜0.05);the percentage of patients with coronary stenosis more than 50％ in SB was lower in the balloon pre-imbedding group than in the wire protection group (3/41 vs.8/34,P＜0.05);and the degree of stenosis,the late lumen loss and the incidence of stem restenosis in SB were lower in the balloon pre-imbedding group than in the wire protection group (P＜0.01).The incidence of MACE 12 months after PCI was lower in the balloon pre-imbedding group than in the wire protection group (7/59 vs.14/52,P＜0.05).The pre-balloon imbedding group had a lower cost than the wire protection group,but with no statistical significance [(55 113±968) RMB vs.(61 023±1 311) RMB,P＞0.05].Conclusions SB balloon preimbedding is safe for the treatment of CBLs in elderly patients,and its effectiveness in both short-and long-term is better than that of wire protection.
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<p><b>OBJECTIVE</b>To explore the impact of plasma homocysteinemia(Hcy) on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients.</p><p><b>METHODS</b>Consecutive 684 ACS patients undergoing first PCI in our department between January 2013 and December 2014 were prospectively enrolled.Patients were divided into 2 groups according to the pre-procedural plasma Hcy level: high-Hcy group (Hcy≥10 μmol/L, n=404) and control group (Hcy<10 μmol/L, n=280). The CIN was defined as serum creatinine ≥ 44.2 μmol/L or 25% increase compared to baseline within 48-72 h after PCI.The baseline clinical data and the ratio of CIN were compared between the 2 groups.Multivariate logistic regression analysis was used to define the independent risk factors for CIN.</p><p><b>RESULTS</b>CIN occurred in 133(19.4%) out of 684 enrolled patients, and the incidence of CIN was significantly higher in high Hcy group than in the control group (22.0%(89/404)vs. 15.7%(44/280), P=0.040). After adjusting the confounding factors, including age, acute myocardial infarction, co-morbidities(hypertension, diabetes mellitus, and old myocardial infarction), laboratory examination (level of cystatin C and uric acid), glomerular filtration rate, left ventricular ejection fraction, angiographic and procedural characteristics (3 diseased vessels, multiple stent implantation), treatment at admission (spironolactone, digoxin), multivariate logistic regression analysis showed that high Hcy was independently associated with the development of CIN (OR=1.70, 95%CI 1.60-2.64, P=0.021).</p><p><b>CONCLUSION</b>Elevated Hcy prior PCI is an independent risk factor of CIN in ACS patients undergoing first PCI.</p>
Subject(s)
Humans , Acute Coronary Syndrome , Diabetes Mellitus , Glomerular Filtration Rate , Hyperhomocysteinemia , Incidence , Kidney Diseases , Myocardial Infarction , Percutaneous Coronary Intervention , Risk Factors , Ventricular Function, LeftABSTRACT
<p><b>OBJECTIVE</b>To explore the relationship between hyperhomocysteinemia (H-Hcy) and long-term outcome of coronary artery disease (CAD) patients after drug-eluting stent (DES) implantation in a single centre.</p><p><b>METHODS</b>A total of 1 408 consecutive patients implanted with DES in our department between March 2011 and January 2013 were enrolled in this prospective study. Patients were stratified into H-Hcy (Hcy≥10 µmol/L, n=798, 56.7%) and non-H-Hcy group (Hcy<10 µmol/L, n=610, 43.3%). The clinical characteristics, coronary artery lesions, SYNTAX score and 1-year major adverse cardiac and cerebrovascular events (MACCE) were compared between the two groups.</p><p><b>RESULTS</b>Compared with non-H-Hcy group, coronary artery stenosis was severer as shown by higher diseased arteries (2.11±0.87 vs. 1.91±0.82, P<0.001), higher incidence of three diseased arteries (39.7% vs. 29.5%, P<0.001) and higher SYNTAX score (36.99±29.66 vs. 27.39±22.70, P=0.001) in H-Hcy group. The 1-year incidence of MACCE was also higher in H-Hcy group compared with non-H-Hcy group(18.4% vs. 8.9%, P<0.001). Multivariate Cox analysis showed that diabetes mellitus (OR=1.530, 95%CI 1.142-2.050, P=0.004), age (OR=1.065, 95%CI 1.038-1.093; P<0.001), and Hcy (OR=1.019, 95%CI 1.005-1.033, P=0.009) are the independent predictors for 1-year MACCE.</p><p><b>CONCLUSION</b>High Hcy level is correlated with the severity of coronary artery stenosis, and serves as an independent predictor of MACCE after stenting in CAD patients.</p>
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Humans , Coronary Artery Disease , Drug-Eluting Stents , Homocysteine , Prospective Studies , Time Factors , Treatment OutcomeABSTRACT
70%(71.4% vs 39.3%, P0.05). Conclusion Removal of thrombus burden with the Diver CE catheter before stenting leads to improvement of myocardial reperfusion and left ventricular function in patients with AMI by a reduced risk of distal embolization and improved ST-segment resolution. Diver CE thrombus aspiration before primary PCI can be used easily and safely in the patients with AMI suffering from coronary arterial thrombosis.