Effect of CYP2C19 genotyping to clopidogrel high reactivity / 中国医师杂志

Percutaneous coronary intervention is an important method for the treatment of coronary heart disease. Postoperative dual antiplatelet therapy is an important prerequisite to ensure the safety of surgery. Antiplatelet therapy with clopidogrel still has a high risk of thrombosis, which may be related to CYP2C19 genotyping. Therefore, a brief review of the impact of CYP2C19 genotyping on clopidogrel hyperresponsiveness is made.

Changes of Peripheral Leukocyte’s Telomere Length in Patients of Premature Coronary Artery Disease With Influencing Factors / 中国循环杂志

Objective: To explore the changes of peripheral leukocyte’s telomere length (LTL) in patients of premature coronary artery disease (PCAD) with inlfuencing factors. Methods: Our research was conducted in 2 sets of groups, by coronary artery condition: PCAD group,n=128 including 88 patients with ACS, 40 with SCAD and Non-CAD group,n=128 subjects; by age status: the age≤30 years, 31-40 years, 41-50 years, 51-60 years had 2, 14, 65, 47 patients in each group respectively. Peripheral LTL was detected by lfuorescent quantitative analysis, the relationship between LTL and PCAD with inlfuencing factors were studied by Spearman correlation analysis. Results: In PCAD group, compared with SCAD patients, ACS patients had more male gender, higher Gensini score, lower T/S ratio and shorter LTL, allP<0.05. Compared with Non-CAD group, PCAD group had decreased T/S ratio (0.88 ± 0.86) vs (1.10 ± 0.57),P<0.05. T/S ratio was negatively related to age in both PCAD group (r=-0.275,P=0.002) and Non-CAD group (r=-0.316,P=0.000). Spearman correlation study presented that in PCAD group, LTL was negatively related to hyperlipidemia (r=-0.415,P=0.049) and diabetes (r=-0.472,P=0.036); multi linear regression analysis indicated that in PCAD group, LTL was negatively related to age (B=-0.023,P=0.038) and in Non-CAD group, LTL was negatively related to age (B=-0.027,P=0.000), smoking (B=-0.278,P=0.012), HDL-C (B=-0.297,P=0.046). Conclusion: PCAD had more male ACS patients with shorter LTL and severer coronary lesions; LTL was negatively related to hyperlipidemia and diabetes, age was an important inlfuencing factor for LTL shortening.

Influence of gender on 30-day outcomes of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the impact of gender on early outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI) as their reperfusion strategy.</p><p><b>METHODS</b>The present study included consecutive patients with STEMI treated with primary PCI in our hospital from November 2003 to December 2012. Gender difference and predictors of 30 day all-cause death were examined among 957 patients, 197 of whom were women (20.6%). The impact of gender on 30 all-cause death was further evaluated by a propensity-matched analysis to adjust the differences in baseline characteristics between men and women.</p><p><b>RESULTS</b>Compared with men, women were older ((69.4±10.2) years old vs. (60.6±12.6) years old, P<0.001), more likely to have hypertension (72.1% (142/197) vs. 54.6% (415/760), P<0.001) and diabetes (45.2% (89/197) vs. 32.4% (246/760), P = 0.001), but less likely to be treated with β-blockers (85.3% (168/197) vs. 92.0% (699/760), P = 0.006) and angiotensin converting-enzyme inhibitors/angiotensin-receptor blockers (82.2% (162/197) vs. 88.4% (672/760), P = 0.024). Symptom-to-balloon time was longer in women than in men (330 (240, 600) minutes vs. 270 (180, 450) minutes, P < 0.001). Multivariate linear regression analysis of log-transformed symptom-to-balloon time revealed that female gender was an independent predictor of longer symptom-to-balloon time (β = 0.141, 95% confidence interval (CI) 0.053-0.228, P = 0.002). Women with STEMI had higher unadjusted 30 day all-cause death (12.6% vs. 4.2%, P < 0.001) than men. Female gender independently predicted 30 day all-cause mortality both with (hazard ratio (HR) = 3.497, 95% CI 1.485-8.234, P = 0.004) and without (HR = 2.495, 95% CI 1.170-5.323, P = 0.018) the adjustment for baseline characteristics by propensity-matched analysis.</p><p><b>CONCLUSIONS</b>Even with primary PCI as their reperfusion strategy, women with STEMI had higher 30 day all-cause death than men. Aggressive control of cardiovascular risk factors, adequate medical treatment and shortening of delay in reperfusion therapy might further improve the outcomes of female STEMI patients undergoing primary PCI.</p>

Activated clotting time post therapeutic anticoagulation with unfractionated heparin in patients undergoing elective percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the activated clotting time (ACT) level after administration of guideline-recommended dose of unfractionated heparin (UFH) and to confirm the importance of ACT monitoring in percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>We performed a retrospective study on 1 062 patients undergoing elective PCI in Peking Union Medical College Hospital from May 1, 2011 to December 31, 2012. All patients were administrated weight-adjusted UFH (70-100 U/kg) based on PCI guideline of ACCF/AHA/SCAI. Patients were divided into 3 groups: ACT < 300 s (598 cases), ACT 300-350 s (183 cases) and ACT > 350 s (281 cases). ACT level and factors that may affect UFH anticoagulation were analyzed.</p><p><b>RESULTS</b>(1) The mean age was (63.0 ± 10.6) years and 751 (70.7%) patients were men. The mean weight was (70.5 ± 11.7) kg, and the mean UFH dose used was (100.7 ± 9.1) U/kg. (2) The median ACT was 285 (240-352) s after the UFH use. Pre-defined ACT target (300-350 s) was achieved only in 17.2% (183/1 062) patients. (3) Age, gender, height, weight, UFH/weight and the risk factors of coronary heart disease were similar among 3 groups (all P > 0.05). Multifactor linear correlation analysis showed that UFH/weight was related to ACT level (r = 0.07, P < 0.01), but other factors were not related to ACT level (all P > 0.05). (4) Among 598 patients with ACT < 300 s, 444 (74.2%) patients received additional UFH. No major bleeding events were observed in 1 062 patients. The incidence of minor bleeding and ischemic complications within 48 h after procedure were similar among 4 groups of ACT < 300 s with additional UFH, ACT < 300 s without additional UFH, ACT 300-350 s and ACT > 350 s (all P > 0.05).</p><p><b>CONCLUSIONS</b>In this single-center study, only a small proportion of patients reached the ACT target after administration of weight-adjusted UFH. Our results supported the recommendation of ACT monitoring in current PCI guideline to improve efficacy and safety of UFH anticoagulation therapy.</p>

Clinical features of patients with premature acute coronary syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical features of patients with premature acute coronary syndrome(ACS).</p><p><b>METHODS</b>Three hundreds and forty seven patients with ACS who underwent coronary angiography from January 2011 to June 2013 in our department were included in this study. Eligible patients were divided into premature group (pre-group, male < 55 years old, female < 65 years old, n = 140) and non-premature group(N-pre group, male ≥ 55 years old, female ≥ 65 years old, n = 207). The cardiovascular risk factors, coronary angiography (CAG) features, complications and in-hospital mortality were analyzed.</p><p><b>RESULTS</b>Compared to N-pre group, the pre-group had a significantly higher rate of smoking [56.4% (79/140) vs. 44.4% (92/207), P < 0.05], dyslipidemia [61.4% (86/140) vs. 50.2% (104/207), P < 0.05] and positive family history of coronary artery disease [39.3% (55/140) vs. 24.6% (51/207), P < 0.01]. However, other traditional cardiovascular risk factors were less (3.03 ± 1.28 vs. 3.91 ± 1.30, P < 0.01). CAG identified higher incidence of one-vessel and double-vessel diseases (63.6%, 89/140) in pre-group, but the incidence of multi-vessel diseases (57.0%, 118/207) was more frequent in N-pre group . Moreover, the pre-group had a higher rate of coronary artery occlusion [45.7% (64/140) vs. 34.8% (72/207), P < 0.05]. Compared with N-pre group, the pre-group had a lower Gensini Score of CAG (46.2 ± 33.2 vs. 60.4 ± 37.5, P < 0.01) and a lower rate of heart failure[4.3% (6/140) vs. 11.1% (23/207), P < 0.05] during hospitalization. In-hospital mortality rate was similar between the two groups [0 vs. 1.9% (4/207), P > 0.05].</p><p><b>CONCLUSION</b>Smoking, dyslipidemia and family history of coronary artery disease are major risk factors for patients with premature ACS, these patients are more likely to have milder coronary artery stenosis and a lower incidence of heart failure compared to N-pre group.</p>

Predictors of in-hospital heart failure in patients undergoing successful primary percutaneous coronary intervention for acute myocardial infarction / 中国介入心脏病学杂志

Objectives We sought to determine the factors that predicted in-hospital heart failure(HF)in patients undergoing successful primary percutaneous coronary intervention(PCI)for ST-segment elevation myocardial infarction(STEMI). Methods The clinical and angiographic data were retrospectively reviewed in patients undergoing successful primary PCI for their ifrst STEMI. According to the occurrence of in-hospital HF, patients were divided into HF group and non-HF group. The incidence and predictors of in-hospital HF and its impact on prognosis were determined. Results A total of 834 patients were included, among them 94 patients (11.3%) were in the HF group and 740 patients(88.7%) were in the non-HF group. The mean age was (62.9±12.9) years and 662 patients (79.4%) were male. All-cause mortality at 30 days was signiifcantly higher in the HF group than in the non-HF group (24.5%vs. 1.5%, P<0.001). In Cox regression analysis, left anterior descending artery (LAD) as the culprit vessel (HR 2.173, 95% CI 1.12~4.212, P=0.022), ln 24 h NT-proBNP (HR 1.904, 95%CI 1.479~2.452, P<0.001), 24 h hsCRP≥11.0 mg/L (median) (HR 2.901, 95%CI 1.309~6.430, P=0.009) and baseline serum glucose (HR 1.022, 95%CI 1.000 ~ 1.044, P=0.046) were independent predictors of in-hospital HF. Receiver operator characteristic analysis identiifed 24 h NT-proBNP ≥ 1171 pg/ml (c=0.883, P < 0.001) and 24 h hsCRP ≥ 13.5 mg/L (c=0.829, P < 0.001) were the best cut-off values in discriminating in-hospital HF with a sensitivity and speciifcity of 92.5%and 76.8%for 24 h NT-proBNP, 86.0%and 77.0%for 24 h hsCRP, respectively. Even among patients with LAD as the culprit vessel, the incidence of in-hospital HF was only 0.4%in patients whose 24 h NT-proBNP was<1171 pg/ml and 24 h hsCRP was<13.5 mg/L;while the incidence of in-hospital HF was up to 60.9%in patients whose 24 h NT-proBNP≥1171 pg/ml and 24 h hsCRP≥13.5 mg/L (P<0.001). Conclusions The incidence of in-hospital HF was still high in STEMI patients even after successful primary PCI. Patients with in-hospital HF had poor prognosis. LAD as the culprit vessel, hsCRP, NT-proBNP and baseline serum glucose were independent predictors of in-hospital HF. Assessment and combined use of different serum biomarkers were effective methods to estimate the risk of in-hospital HF in STEMI patients undergoing primary PCI.

The relationship between thyroid dysfunction and coronary artery disease--A respective analysis and literature review / 中国综合临床

Objective To study the relationship between the thyroid dysfunction and coronary artery disease (CAD). Methods Two thousands and twelve patients,diagnosed as CAD by coronary angiography from January 2003 to February 2010 in Peking Union Hospital,were enrolled into this study and divided into normal thyroid function, hyperthyroidism, and hypothyroidism groups. The thyroid function data and the coronary angiography findings were compared among three groups. Results The incidence rates of hypertension (40%vs. 69. 4% vs. 78.6%, x2 = 12. 331, P = 0. 01) and hyperlipemia(20. 0% vs. 67.4% vs. 85.7%, x2 =12. 331 ,P=0. 002) in hyperthyroidism patients were significantly lower than normal thyroid function patients and hypothyroidism patients, but no significant differences were found in the comparison of diabetes incidence rates among three groups (20. 0% vs. 41.6% vs. 35.7%, x2 = 2. 114,P =0. 347). According to the coronary angiography findings, we found that the incidence rate of CAD of hypothyroidism patients was higher than hyperthyroidism patients(71.0% vs. 55. 2%, x2. = 1. 804, P = 0. 179), but the difference didn' t reach statistically significant level. Two hyperthyroidism patients had coronary artery spasm and acute myocardial infarction. Conclusion Hypothyroidism had more promotion effect on coronary artery disease than hyperthyroidism,but higher serum thyroxin level increased the risk of coronary spasm and the probability of acute myocardial infarction,which could be well adjusted by medication treatment.

Clinical follow-up outcomes of drug-eluting stents versus bare-metal stents in patients receiving primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction / 中华老年医学杂志

Objective To evaluate the effects of drug-eluting stents (DES) versus bare-metal stents (BMS) on clinical outcomes in patients with acute ST-segment elevation myocardial infarction (ASTEMI) receiving primary percutaneous coronary intervention (PPCI). Methods The 217patients with ASTEMI receiving PPCI from Jan. 2005 to Dec. 2007 were enrolled in this study. And they were divided into two groups: DES group (n=92) and BMS group (n=125). The baseline characteristics including age, gender, angiographic characteristics, stents characteristics, Killip classification, cardiac troponin I(CTnI)levels, left ventricular ejection fraction(LVEF), hemoglobin levels, hypertension, diabetes, hyperlipidemia, obesity and smoking of the two groups were collected.Clinical follow-up end point were major adverse cardiac event(MACE)including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was(16.8±11.3) months (6-38 months). Results The average age (years), rate of Killip classification (class 2, 3, 4), average diameter (mm) of stent were significantly higher in BMS group than in DES group(64.6±11.9 vs. 61.2±11.8, t=2.09, P=0.037;25.9% vs. 12.2%, χ2=5.53, P=0.019;3.07±0.38 vs. 2.91±0. 40, t=2.78, P=0.006). And the average LVEF (%) was significantly lower in BMS group than in DES group (55.4±11.9 vs. 60.3±12.8, t= -2.57, P=0.011). The average length (mm) of stent, rate of stent post dilatation and diabetes were significantly higher in DES group than inBMSgroup (32.8±16.2 vs. 26.2±11.2, t=-3.54, P=0.001;45.7% vs. 21.6%, χ2=13.85, P=0. 000;28.2% vs. 16.0%, χ2=4.77, P=0.030). MACE occurred in 36 patients during clinical follow-up, 6 in DES group and 30 in BMS group. Incidence of MACE was significantly lower in DES group than in BMS group(6.5% vs. 24.0%, χ2=11.70, P＜0.01). Conclusions Using DES in ASTEMI patients is safe and may improve clinical outcomes by reducing incidence of MACE compared with BMS.