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@#Aortic stenosis (AS) is the most common primary valve lesion requiring surgery or transcatheter intervention in modern era. Its prevalence is rising rapidly as a consequence of the aging population. Transcatheter aortic valve replacement (TAVR) as a therapy option for older high-risk symptomatic severe AS patients has emerged and is currently extending its indications towards surgery intermediate- and low-risk subjects. Considering the common characteristics of frailty and high comorbidity among AS patients, cardiac rehabilitation (CR) has been proven to improve not only survival but also quality of life in previous reports. CR as a classⅠ recommendation in guidelines for the prevention and treatment of cardiovascular disease has been widely used in clinical practice. The purpose of this article is to sort out the current CR programs for TAVR patients in global medical management, and explore the CR optimization program fit for China medical model in post COVID-19 pandemic era.
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Objective To investigate the correlation between red blood cell distribution width(RDW) and in-stent restenosis(ISR)in patients with coronary heart disease after PCI.Methods A total of nine hundred and seventy-eight patients with coronary heart disease treated in Beijing Anzhen Hospital,Capital Medical University with DES stent implantation from March 2015 to March 2016 were enrolled in the study.Among them,493 patients(50.41%)underwent coronary angiography in the hospital at 6-12 months after the operation.According to the results of the angiography,the patients were divided into two groups: the ISR group and the non-ISR group.The basic data of the patients,the laboratory indexes and the coronary interventional procedures record were collected to analyze the factors that could lead to in-stent restenosis.Results 51 cases(10.34%)in the ISR group and 442 cases(89.66%)in the non-ISR group.The baseline characteristics of the two groups were similar,and there was no significant difference in gender,age, body mass index,combined with hypertension,family history of coronary heart disease,long-term administration of statin and follow-up interval(P>0.05).The proportion of patients with diabetes was significantly higher than that of the non-ISR group(37.3% vs.22.6%,P=0.021);the smoking rate was significantly higher in the ISR group(52.9% vs.35.7%,P=0.016).In terms of laboratory examination,there were no significant differences between the two groups in blood lipid levels and WBC,RBC,Hb and PLT counts between the two groups(P>0.05).The levels of serum RDW(13.4(13.00,13.80)vs.12.7(12.40,13.10),P<0.01)and hs-CRP (3.15(2.32,4.63)vs.1.33(0.63,3.16),P<0.01)were significantly increased in the patients with ISR.The stent length was longer in the ISR group((21.87 ± 5.20)mm vs.(19.14 ± 4.87)mm,P<0.01),the stent diameter was smaller((2.87±0.38)mm vs.(3.09±0.36)mm,P<0.01),the number of cases with serial stents in ISR group was higher than that in non-ISR group(45.1 % Vs 30.8%,P=0.038).Multivariate logistic regression analysis showed that RDW(OR=2.396,95%CI 1.655-3.471;P<0.01),hs-CRP(OR=1.052, 95%CI:1.001-1.105;P=0.044),DM(OR=2.029,95%CI:1.004-4.100;P=0.049),smoking(OR=2.252,95%CI:1.060-4.783;P=0.035),stent length(OR=1.149,95%CI:1.072-1.230;P<0.01),stent diameter(OR=0.210,95%CI:0.079-0.558;P=0.002)and serial stents(OR=2.306,95%CI:1.162-4.575;P=0.017)were independent risk factors for in-stent restenosis.Conclusion Red blood cell distribution width is an independent predictor of in-stent restenosis after PCI in patients with coronary heart disease.Chronic inflammation and oxidative stress may be the most important pathogenesis of ISR.
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ObjectiveTo investigate the independent risk factors of 30-day mortality of nontraumatic acute chest pain in emergency department so as to get non - traumatic acute chest pain risk score,MethodsThe clinical data of 532 patients with non - traumatic acute chest pain were reviewed.The independent risk factors of 30 - day mortality were identified after analysis of medical history,symptom and sign,laboratory findings by uuivariate analysis and logistic regression.Non- traumatic acute chest pain risk score was made as per the odds ratios of these risk factors. ResultsThe average age of the patients was (55.7 + 12.7 ) years,and 45 patients ( 8.4％ ) died after 30 days.In patients with non - traumatic acute chest pain,history of hypertension (OR:4.28; 95％ CI:1.59-11.55 ),prolonged chest pain (OR:1.1; 95％ CI:1.05-1.15),dyspnea (OR:6.61; 95％CI:2.40-18.10) and tachycardia (OR:1.02; 95％CI:1.00-1.04),high leucocyte count (OR:1.18; 95％CI:1.06-1.31) and D - Dimer ( OR:1.002; 95％ CI:1.001-1.002 ) predicted 30 - day mortality independently,whereas chest pain relieved by medicine (OR:0. 15; 95％ CI:0.04-0.65),high blood oxygen saturation (SaO2) (OR:0.89; 95％CI:0.83-0.98) and normal hematocrit (OR:0.92; 95％CI:0.86-0.99) were good markers to predict optimistic prognosis.Non - traumatic acute chest pain risk score was higher in 30 - day dead group than those in survival group significantly ( P ＜ 0.01 ),and mortality was significantly different between groups with various risk stratification (P ＜ 0. 01 ).Conclusions Clinical physician can predict 30 - day mortality and evaluate prognosis in patients with acute chest pain by using non - traumatic acute chest pain risk score quickly and effectively.
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Objective To compare the in-hospital and follow-up clinical results of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)in patients of left ventricular dysfunction with coronary artery disease.Methods 147 patients with left ventricular dysfunction were divided into PCI group(n=60)and CABG group(n=87).Clinical,angiographic and revascularization data were collected for analysis.Patients were by SPSS 13.0 software.P value of less than 0.05 was considered statistically significant.Results In-hospital MACCE rates and mortality ofthe two groups were comparable[(6.7%vs 9.2%,P＞0.05)and(1.7%vs 8.0%,P＞0.05)].Multivariate Logistic regression analysis indicated that in-hospital MACCE risk of the two groups were similar(OR≥3.03,95%CI 0.27～34.48,P＞0.05).22-month follow-up showed no signficance in MACCE rates (16.0%vs 13.8%,P＞0.05)and in repeated revaseularization rates(8.O%vs 1.7%,P＞0.05)between the two groups.Multivariate Cox regression analysis indicated that follow-up MACCE risk of the two groups were comparable (HR≥1.35,95%C/0.44～4.13,P＞0.05).Conclusion In coronary artery disease patients with left ventricular dysfunction,PCI and CABG have similar in-hospital and long-tem MACCE rates.Long-terra effect of PCI would be further increased with the wide use of drug-eluting stents.
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Objective To investigate the serum uric acid level in isolated systolic hypertension (ISH)in the elderly, and effect of Losartan potassium. Method Serum uric acid level were assessed spectrophotometrically using enzy matic methods in 85 ISH patients and 51 health controls. Serum uric acid level and blood pressue were compared respectively before and after the treatment of losartan potassium and Benzepril. Result Uric acid levelwas higher in patients with ISH than that in control group (P ＜ 0.01 ) . No significant difference was found between Losartan potassium and Benzepril group on the effect of lowering blood pressure. After antihypertensive treatment, uric acid level in Losartan group was significantly lower than that in Benzepril group(P ＜ 0. 01 ). Conclusion Uric acid level was marked higher in ISH in the elderly; Losartan prtassium has an additional benefit of some uricosuric effeets besides the antihypertensive effect.