ABSTRACT
Objective:To study the clinical prognosis and related factors affecting optimal medical therapy (OMT) compliance of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).Methods:A prospective study was conducted to select 3 818 patients who were diagnosed with CAD and successfully underwent PCI in TEDA International Cardiovascular Hospital from October 2016 to September 2017. The clinical information and application of OMT during hospitalization and 1 year later were collected for research.The patients were divided into OMT group and non OMT group according to whether they adhered to OMT during follow-up one year after discharge. After comparing the imbalance baseline data of hypertension,diabetes and hyperlipidemia with propensity score,demographic characteristics, coronary revascularization history, CAD, laboratory related laboratory examinations,and the use of OMT drugs were compared between the two groups. Cox regression model was used to analyze the relationship between long-term OMT and clinical prognosis in patients with CAD.Multivariate binary logistic regression was used to analyze the related factors affecting long-term OMT compliance.Results:A total of 3 818 cases of CAD patients were matched by propensity score and 2 596 patients were included in the study. There were 1 609 males and 987 females. The age was (62.51±9.56) years old.One year later,1298 patients (50%) insisted on OMT,including dual antiplatelet therapy(DAPT), statins, β-blockers and ACEI/ARB were 97.0% (2 517/2 596),94.5%(2 454/2 596),69.6% (1 806/2 596) and 64.2% (1 666/2 596), especially angiotensin converting enzyme inhibitors / angiotensin receptor blockers and β Receptor blockers decreased the most.Cox regression analysis showed that after adjusting for other factors, compared with non-adherence to OMT group,OMT after PCI was associated with better prognosis ( HR=0.416,95% CI 0.270-0.641, P<0.001). The prognosis of CAD patients with history of old myocardial infarction ( HR=1.804,95% CI 1.070-3.041, P=0.027),cardiac insufficiency ( HR=2.074,95% CI 1.161-3.702, P=0.014),multivessel coronary disease ( HR=2.211,95% CI 1.228-3.983, P=0.008) and BMI>24 ( HR=1.570,95% CI 1.037-2.377, P=0.033) were related to worse clinical outcomes. Multi-factor binary Logistic regression showed that OMT at hospitalization was a strong influencing factor of long-term adherence to OMT ( OR=41.278,95% CI 29.961-56.871, P<0.001). Patients with higher education,employee medical insurance and with history of PCI tend to persist in OMT. Conclusion:The medication compliance of patients with long-term OMT after PCI is still poor,while the high compliance of OMT is related to the lower incidence of adverse cardiovascular events,including death, nonfatal myocardial infarction and stroke. If there is no obvious contraindication,all patients after PCI should adhere to OMT.
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Objective:To explore the mechanism of the alternation of RR interval length in atrioventricular reentrant tachycardia (AVRT).Methods:From August 2009 to August 2016, 317 patients with AVRT were treated by radiofrequency catheter ablation in cardiology department of TEDA International Cardiovascular Hospital were analyzed retrospectively.During AVRT, 5 mg of verapamil was given slowly intravenously for 10 min.After administration, the changes of RR interval, AH interval, HV interval and VA interval were observed and the time of changes was also observed.Results:After administration of verapamil, there were 8 patients with RR interval alternation and QRS wave alternation.When RR interval alternation occurred, the difference of AH interval between adjacent heart beats was gradually extended, without AH jump, and the HV interval and VA interval were constant.This phenomenon occurred 6-17 minutes after administration, and the average cycle of tachycardia was 16-42 ms longer than before administration.In 3 patients, RR interval alternation occurred.When the phenomenon disappeared, the difference of AH interval between adjacent heart beats was gradually shortened, there was no AH jump, and the interval between HV and VA was constant until AH interval was equal, the disappearance time was 19-57 min after administration; AVRT was terminated in 5 patients after administration.Conclusion:It can be concluded that the mechanism is due to the frequency dependent decreasing conduction of AH interval in tachycardia, which can not be induced by program stimulation.
ABSTRACT
Percutaneous coronary intervention(PCI) has been widely used in the current treatment of coronary heart disease.Intraoperative or perioperative medical therapy is often emphasized, while concomitant long-term optimal medical therapy(OMT) when they have received PCI is ignored.OMT can improve the clinical symptoms of patients, reduce mortality and improve the quality of life.This article will give a review about the definition of OMT after PCI in patients with coronary heart disease, its effect on prognosis and its current application status.
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Objective To explore the characteristics of electrocardiogram(ECG) and target potential features of premature ventricular contraction (PVC) in patients with complete left/right bundle branch block (CL/RBBB) and compare with those without CL/RBBB. Methods A retrospective analysis was done in 8 outflow tract PVC patients with CL/RBBB, who successfully underwent radiofrequency ablation from August 2009 to June 2017. According to the bundle branch block chamber, patients were divided into the complete right bundle branch block (CRBBB) group (n=4) and the complete left bundle branch block (CLBBB) group (n=4). The control group were those who successfully underwent ablation at the same position as the above two groups but without CL/RBBB. The characteristics of ECG and target potential features were compared among groups. Results One case in the CRBBB group was successfully ablated in the great cardiac vein with precordial R/S>1 transition at V1 and one case in the CLBBB group was successfully ablated in the right coronary cusp with precordial R/S>1 transition at V2, while other 6 cases were all with precordial R/S>1 transition at lead V4. Precordial R/S>1 transition was not later than sinus rhythm (SR) in the CLBBB group. No statistical difference was found in the QRS complex duration between SR and PVC in the CL/RBBB patients [(134.38 ± 23.80)ms vs (156.75 ± 25.93)ms, P>0.05], while statistical difference was shown in the control group [ (92.63 ± 5.76)ms vs (140.25 ± 15.97)ms,P<0.05]. Conclusion Bundle branch block can lead to misjudgment of PVC origin with CL/RBBB during sinus rhythm, thus the origin chamber of the PVC should be determined according to the mapping and ablation result.