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BACKGROUND AND OBJECTIVES: Over the past decades, transradial approach for percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice. Women represent a large population who will possibly benefit from PCI, but they are often under-represented in clinical studies. Therefore, the role of TRI in women remains to be further defined. This study sought to compare safety and efficacy for transradial intervention (TRI) and transfemoral intervention (TFI) in women undergoing PCI in China. METHODS: The study population consisted of 5,067 women undergoing PCI at Fuwai Hospital, Beijing, China between 2006 and 2011 (TRI: n=4,105, TFI: n=962). Incidence rates of clinical outcomes during hospitalization and at 1-year follow-up were compared between TRI and TFI. In order to minimize potential biases, a 1:1 propensity score matching (PSM) was performed. A total of 899 pairs were matched. RESULTS: Baseline and procedural characteristics were well-balanced between TRI and TFI groups after controlling for confounders using PSM. TRI was associated with reduced major post-PCI bleeding (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.54–0.76; p 0.05). CONCLUSIONS: In this propensity score-based analysis of TRI versus TFI in Chinese women, TRI showed advantages of safety and feasibility over TFI. A wider adoption of TRI in women has the potential to improve outcomes in treatment of coronary artery diseases.
Subject(s)
Female , Humans , Asian People , Beijing , Bias , China , Coronary Artery Disease , Death , Femoral Artery , Follow-Up Studies , Hemorrhage , Hospitalization , Incidence , Myocardial Infarction , Percutaneous Coronary Intervention , Propensity Score , Radial ArteryABSTRACT
BACKGROUND AND OBJECTIVES@#Over the past decades, transradial approach for percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice. Women represent a large population who will possibly benefit from PCI, but they are often under-represented in clinical studies. Therefore, the role of TRI in women remains to be further defined. This study sought to compare safety and efficacy for transradial intervention (TRI) and transfemoral intervention (TFI) in women undergoing PCI in China.@*METHODS@#The study population consisted of 5,067 women undergoing PCI at Fuwai Hospital, Beijing, China between 2006 and 2011 (TRI: n=4,105, TFI: n=962). Incidence rates of clinical outcomes during hospitalization and at 1-year follow-up were compared between TRI and TFI. In order to minimize potential biases, a 1:1 propensity score matching (PSM) was performed. A total of 899 pairs were matched.@*RESULTS@#Baseline and procedural characteristics were well-balanced between TRI and TFI groups after controlling for confounders using PSM. TRI was associated with reduced major post-PCI bleeding (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.54–0.76; p 0.05).@*CONCLUSIONS@#In this propensity score-based analysis of TRI versus TFI in Chinese women, TRI showed advantages of safety and feasibility over TFI. A wider adoption of TRI in women has the potential to improve outcomes in treatment of coronary artery diseases.
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Objective: To assess the risk factors for peri-procedural myocardial infarction (PMI) occurrence in patients after percutaneous coronary intervention (PCI) based on the new standard of US Society for cardiovascular angiography and interventions (SCAI). Methods: According to SCAI standard, a total of 3371 relevant patients with 3516 elective PCI in our hospital were enrolled. The baseline clinical features, coronary angiography (CAG) findings and PCI procedural elements were retrospectively studied, the independent risk factors for PMI occurrence were identified by multivariate Logistic regression analysis. Results: There was 108/3516 (3.1%) PMI occurred in all patients. Multivariate Logistic regression analysis presented that age (OR=1.037, 95% CI 1.016-1.058), treating multi-vessel lesions (OR=1.697, 95% CI 1.095-2.629), treating at least 1 bifurcation lesion (OR=1.869, 95% CI: 1.213-2.878) and the total length of lesion (OR=1.016, 95%CI 1.009-1.024) were the independent risk factors for PMI occurrence. Conclusions: Age, treating multi-vessel lesions, at least one bifurcation lesion and the total length of lesion were the independent risk factors for PMI occurrence in patients after elective PCI.
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Objective:To investigate the impact of bifurcation angle (BA) on side branch occlusion (SBO) during percutaneous coronary intervention (PCI) in relevant patients. Methods: A total of 1171 consecutive patients with 1200 bifurcation lesions who received one stent technique were studied. Based on the median BA of 52°, the patients were divided into 2 groups:Low angle group, n=587 patients with 600 bifurcation lesions and High angle group, n=584 patients with 600 bifurcation lesions. SBO was deifned by either side branch blood lfow disappeared or TIMI grade decreased after PCI. The occurrence rate of SBO was investigated and the impact of BA on SBO during PCI was evaluated by multivariate Logistic regression analysis. Results:SBO occurred in 88/1200 (7.33%) bifurcation lesions. The occurrence rate of SBO in High angle group was igher than Low angle group (10.5%vs 4.2%, P Conclusion:High BA was an independent predictor of SBO after the main vessel stent implantation, which should not be ignored in clinical practice.
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<p><b>BACKGROUND</b>Despite its severity, coronary artery ectasia (CAE) is still poorly understood. High-sensitivity C-reactive protein (hs-CRP) has been recognized as a prognostic factor in some cardiovascular diseases but not assessed in CAE. The aim of this observational study was to investigate the prognostic value of hs-CRP in CAE.</p><p><b>METHODS</b>Our analysis evaluated the effect of the baseline hs-CRP on cardiovascular events (CVs) (cardiac death and nonfetal myocardial infarction) in consecutively enrolled stable CAE patients. We used the Cox proportional hazards regression models to examine the association between baseline hs-CRP level and follow-up CVs in CAE. The net reclassification improvement and integrated discrimination improvement (IDI) of hs-CRP were also assessed.</p><p><b>RESULTS</b>We obtained the follow-up results of 540 patients over a median follow-up period of 36 (37.41 ± 15.88) months. The multivariable Cox analysis showed that the hs-CRP was a significant predictor of adverse outcomes in CAE (hazard ratio [HR]: 2.99, 95% confidence interval [CI]: 1.31-6.81, P = 0.0091). In Kaplan-Meier analysis, the group with hs-CRP >3 mg/L had a lower cumulative 66-month event-free survival rate (log-rank test for trend, P = 0.0235) and a higher risk of CVs (HR = 2.66, 95% CI: 1.22-5.77, P = 0.0140) than the group with hs-CRP ≤3 mg/L. Hs-CRP added predictive information beyond that given by the baseline model comprising the classical risk factors (P value for IDI = 0.0330).</p><p><b>CONCLUSIONS</b>A higher level of hs-CRP was independently associated with cardiac death and nonfatal myocardial infarction in CAE patients. The hs-CRP level may therefore provide prognostic information for the risk stratification of CAE patients.</p>
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Aged , Female , Humans , Male , Middle Aged , C-Reactive Protein , Metabolism , Coronary Artery Disease , Metabolism , Pathology , Prognosis , Proportional Hazards ModelsABSTRACT
Objective: To investigate the prognostic factor for small side branch (SB) occlusion during coronary bifurcation intervention with the incidence rate of peri-procedural myocardial injury (PMI) in relevant patients. Methods: A total of 925 consecutive patients who received coronary bifurcation intervention were enrolled and there were 949 SB lesions ≤ 2.0 mm conifrmed by quantitative coronary angiography (QCA). The patients were divided into 2 groups: SB occlusion group,n=85, including 86 bifurcation lesions and Non-SB occlusion group,n=840, including 863 bifurcation lesions. The clinical characteristics, QCA findings and PCI procedural conditions were studied by Multivariate logistic regression analyses to explore the independent predictors of SB occlusion and to compare the incidence rate of PMI. Results: The total SB occlusion rate was 9.1% (86/949). SB occlusion group had the higher incidence rate of PMI (26/83, 31.3%) vs (77/821, 9.4%) and peri-operative MI mortality(6/83, 7.2%) vs (11/821, 1.3%) than Non-SB occlusion group, both P Conclusion: Coronary bifurcation lesion patients with SB occlusion had the higher risk of PMI during the interventional procedure.
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Objective: To establish a risk prediction model and scoring system in patients with side branch (SB) occlusion during coronary bifurcation intervention. Methods: A total of 7007 consecutive patients who received percutanenous coronary intervention (PCI) in our hospital from 2012-02 to 2012-07 were recruited and 1545 patients (with 1601 bifurcation lesions) treated by single stent technique or main vessel stenting ifrst strategy were selected for our study. According to weather SB occlusion occurred during operation, the lesions were divided into 2 groups: Non-SB occlusion group,n=1431 and SB occlusion group,n=114. The data set of the ifrst 1200/1601 lesions by time sequence, was used for establishing the risk model and scoring system, the data set of rest 401 lesions was used for model validation. Results: The modeling data set presented that the relationship between pre-operative main vessel plaque and the position of branch vessel, the main blood vessel pre-stenting TIMI grade, the stenosis degree of pre-operative bifurcation nucleus, the angle of pre-operative bifurcation and the ratio of pre-senting stenosis degree of branch diameter and pre-operative main vessel to branch vessel diameter were the independent risk factors for branch occlusion. The risk model ROC=0.80, 95% CI 0.75-0.85, Hosmer-Lemeshow HLP=1.00; the scoring system ROC=0.76, 95% CI 0.71-0.82, HLP=0.12. The validation data set ROC=0.81, 95% CI 0.73-0.89, HLP=0.77; the scoring system ROC=0.77, 95% CI 0.69-0.86, HLP=0.58. The quartile integration of both data sets indicated that the patients with the integration score ≥ 10 had the higher risk for SB occlusion than those with integration score < 10 during the operation,P<0.001. Conclusion: Our research developed a simple and user-friendly system, it may distinguish the patients with high risk of SB occlusion during bifurcation intervention by quantitative stratiifcation of coronary angiographic imaging.
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Objective: To explore the correlation between antithrombotic strategy and its prognostic value in coronary artery disease (CAD) patients combining with atrial ifbrillation (AF) after percutaneous coronary intervention (PCI). Methods: A total of 570 CAD patients with AF received PCI in our hospital from 2012-01 to 2013-12 were retrospectively analyzed by CHADS2 and HAS-BLED Score system. According to CHADS2 Results: Compared with Low risk of stroke group, the patients in High risk of stroke group had the worse prognosis and higher rate of MACCE occurrence,P0.05. The major bleeding events in patients with warfarin were a little higher than those without warfarin,P>0.05. The minor bleeding events were increased in both Low risk stroke group asP Conclusion: Warfarin medication may obviously decrease the occurrence rates of MACCE and ischemic events in high risk of stroke patients, while in low risk patients, warfarin could not further decrease the occurrence of MACCE and ischemic events. Warfarin could increase the risk for minor bleeding in both low risk and high risk of stroke in CAD patients combining with AF after PCI.
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Objective To explore the value of stress dual-phase (early and delayed phases)18 FFDG myocardial PET/CT in detection of myocardial ischemia.Methods Ten swine were prepared as ischemic models and underwent 3 imaging procedures:pre-model stress (8 swine),post-model rest (8 swine)and post-model stress dual-phase imaging (10 swine).To perform stress dual-phase imaging,the tested subjects were fasted for more than 12 h and underwent early-phase PET imaging at 50 min after the intravenous injection of 18F-FDG (5 MBq/kg) for 10 mins,and followed by a dobutamine stress test,and then delayed-phase PET imaging at 50 min after the stress test for another 10 mins.The post-model rest dual-phase imaging was performed in almost the same way except that there was no dobutamine-loading.18F-FDG uptake image was qualitatively analyzed and classified into 4 levels:1 =no uptake,2 =diffuse uptake,3 =focal uptake,4=focal on diffuse uptake.Level 1 or 2 was considered as normal.If the focal uptake (level 3 or 4)was found on anterior wall or septum,ischemia was diagnosed.x2 test was used to determine the difference of the rate of ischemic myocardium between the two phases.18F-FDG uptake ratio of the anterior wall to posterior wall (K) of the left ventricle was calculated (K1 for early phase and K2 for delayed phase).Wilcoxon rank sum test was applied to determine the difference between K1 and K2.Results CAG showed LAD stenosis ＞70％ in all swine.In pre-model stress dual-phase imaging,no ischemia was detected at two phases (8/8 for level 1 or 2,0 for level 3 or 4).There was no significant difference between K1 and K2(1.08±0.10,1.11 ±0.10; Z =-1.48,P＞0.05).In post-model rest dual-phase imaging,the rate of ischemic myocardium was not significantly different between early and delayed phases (1/8,3/8 ; x2 =0.50,P＞0.05).There was no significant difference between K1 and K2(1.47±0.28,1.28±0.40; Z=-2.02,P＞0.05).In post-model stress dual-phase imaging,the rate of ischemic myocardium between the two phases was statistically different (4/10,10/10;x2=4.17,P＜0.05),and the difference between K1 and K2 was also significant (1.55±0.32,1.86±0.39; Z=-2.49,P＜0.05).Conclusion Stress dual-phase 18F-FDG myocardial PET/CT might be useful for the diagnosis of ischemia.
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Objective: To evaluate the hybrid of drug eluting stent (DES) with bare metal stent (BMS) and exclusive DES implantation for treating the patients with multi-lesion coronary disease. Methods: A total of 6495 patients with multi-lesion coronary disease received elective PCI in our hospital from 2004-04 to 2006-10 were retrospectively studied. The patients were divided into 2 groups, Hybrid group, n=848 and Exclusive DES group, n=5647. With 1:1 propensity score matching, there were 823 pair of patients were ifnally studied. The clinical outcomes included 1, 2 years post-operative all cause death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), major adverse cardiac events (MACE) and in-stent thrombosis. The relative risks of all outcomes were assessed by Cox’s proportional-hazard model after propensity match. Results: With propensity match, Cox’s proportional-hazard model analysis indicated that compared with Exclusive DES group, Hybrid group had the higher risks of TLR (HR 2.38, 95%CI 1.50-3.70), TVR (HR 1.61, 95%CI 1.15-2.27), MACE (HR 1.37, 95%CI 1.02-1.85), all P0.05. Conclusion:Compared with exclusive DES, the hybrid of DES with BMS implantation had the higher risk of TLR, TVR and MACE for treating the patients with multi-lesion coronary disease.
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<p><b>OBJECTIVE</b>The clinical features of patients with mediastinal and/or neck hematoma after transradial cardiac catheterization were reviewed and analyzed to help the clinicians to recognize this complication, and try their best to avoid the complication and treat the complication properly.</p><p><b>METHODS</b>A total of 8 patients with mediastinal and/or neck hematoma after right transradial cardiac catheterization in Fuwai hospital from January 1, 2005 to the end of 2012 were included in this study. Among these 8 patients, 1 patient underwent coronary angiography, 7 patients underwent percutaneous coronary intervention and drug eluting stents were successfully implanted in 6 patients. The clinical data of these patients were analyzed retrospectively.</p><p><b>RESULTS</b>Super slide hydrophilic guild-wire was used in all patients. These patients felt chest pain, dyspnea and neck pain and neck or throat tightness after the procedure. CT scan was performed in all 8 patients and reviewed mediastinal hematoma, 4 patients complicated with neck hematoma, and suspicious laceration on the right subclavian artery or branch of innominate artery were found in 2 patients. Post procedure hemoglobin decrease was evidenced in all 8 patients. Anti-platelet therapy was discontinued until discharge in 2 patients, dual anti-platelet drugs were transiently discontinued or underwent dosage reduction in 4 patients, protamine was administered in 2 patients to neutralize heparin. Blood transfusion was not required, there was no stent thrombosis, and surgery was not indicated for all 8 patients. No complication was reported during follow up.</p><p><b>CONCLUSIONS</b>Mediastinal and/or neck hematoma is a rare complication post transradial catheterization approach. This complication is caused by super slide guild-wire or catheter's injury of small vessels near the aortic arch or subclavian artery, especially with rough manipulation. Neck and mediastinal CT scan should be performed as early as possible for patients with suspect hematoma and prognosis is usually fine with suitable therapy.</p>