Clinical Value of 1.5-T Non-contrast Whole-heart Magnetic Resonance Coronary Angiography in Evaluating the Severity of Coronary Stenosis / 中国医学科学院学报

Objective To evaluate the diagnostic performance of 1.5-T non-contrast free-breathing whole-heart magnetic resonance coronary angiography(MRCA)for≥50% and≥70% coronary artery stenosis in coronary artery disease(CAD).Methods Forty-one patients clinically scheduled for invasive coronary angiography(ICA)underwent 1.5-T non-contrast free-breathing whole-heart MRCA.The diagnostic performance for≥50% and≥70% stenosis was evaluated and compared using ICA as a reference standard.Results MRCA was completed in all the 41 patients with the total acquisition time of(10.1 ± 2.2)min.The sensitivity,specificity,and accuracy of MRCA for≥50% and≥70% stenosis were 100%(95%

Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China / 中华医学杂志(英文版)

BACKGROUND@#The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients.@*METHODS@#We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission.@*RESULTS@#From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45-0.86; P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52-1.25; P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51-1.23; P = 0.308).@*CONCLUSIONS@#In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making.@*CLINICAL TRIAL REGISTRATION@#NCT02880605. https://www.clinicaltrials.gov.

The impact of fasting blood glucose on the prognosis of non-diabetic patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction / 中国介入心脏病学杂志

Objective To investigate the impact of fasting blood glucose on the prognosis of non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods We retrospectively recruited consecutive patients who underwent primary PCI in our hospital from February, 2003 to March, 2015. Patients with prior history of diabetes mellitus before the index hospitalization and those with newly diagnosed diabetes mellitus during the index hospitalization were excluded. The clinical and angiographic features, medical and interventional treatment, and 30-day outcomes were compared between patients with elevated fasting blood glucose (FBG) (>5.4 mmol/L) and those with normal FBG (≤5.4 mmol/L). Results A total of 721 patients were recruited with an age of(61.2 ± 12.8)years, of whom 601 (83.4 %) were male. As compared with patients with normal FBG,those with elevated FBG were more likely to be female(20.1 % vs.13.5 %, P=0.017),had faster heart rate on admission[(82.9 ± 17.2)bpm vs.(79.4 ± 16.7)bpm,P=0.006]and more use of intra-aortic balloon pump(3.8 % vs.1.3 %,P=0.034),and had higher rates of 30 day all-cause mortality(3.5 % vs.0.5 %,P=0.004),cardiac mortality(2.9 % vs.0.5 %,P=0.012)and heart failure(18.1 % vs. 7.4 %, P< 0.001). After adjusting baseline characteristics, FBG > 5.4 mmol/L was one of the independent predictors of 30-day all-cause mortality(HR 6.030,95 % CI 1.235-29.447,P=0.026).Other independent predictors of 30-day all-cause mortality included age(HR 1.059,95 % CI 1.002-1.120,P=0.044),heart rate on admission(HR 1.036,95 % CI 1.003-1.070,P=0.034),left descending artery as the culprit vessel(HR 6.427,95 % CI 1.389-29.728,P=0.017),and use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker(HR 0.154,95 % CI 0.051-0.461,P=0.001).Conclusions In non-diabetic patients undergoing primary PCI for STEMI, elevated FBG was one of the independent predictors of 30-day all-cause mortality.

Clinical and coronary features of systemic lupus erythematosus patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVES</b>To observe the clinical and coronary features of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD).</p><p><b>METHODS</b>Among 2877 SLE inpatients (age ≥ 18 years, male 363, female 2514) admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [mean age (50.7 ± 12.8) years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed.</p><p><b>RESULTS</b>The incidence of CAD was significantly higher in male SLE patients than in female patients [2.48% (9/363) vs. 0.95% (24/2514), P = 0.022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [5.76% (8/139) vs. 0.91% (25/2738), P < 0.001]. Myocardial infarction was the major form of CAD (24/33). Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi-vessel lesions was found in 75.0% (15/20) patients with SLE and CAD.</p><p><b>CONCLUSIONS</b>Male SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.</p>

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: outcomes of 3-year clinical follow-up / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation.</p><p><b>METHODS</b>A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n = 83) or BMS (n = 108) implantation in the infarction related artery according to physician's discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups.</p><p><b>RESULTS</b>The clinical follow-up duration was 3 years ((41.7 ± 16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P = 0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P = 0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P = 0.379) and stent thrombosis (1.20% vs. 1.85%, P = 0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P = 0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P = 0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n = 73) and paclitaxel-eluting stents (PES, n = 10) subgroups (2.74% vs. 20.00%, P > 0.05).</p><p><b>CONCLUSIONS</b>This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.</p>

Clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease.</p><p><b>METHOD</b>Fifteen patients (11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed.</p><p><b>RESULTS</b>There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39.3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32.4 ± 8.1) years vs. (47.0 ± 10.2) years], had less risk factors for atherosclerosis (1.2 ± 1.5 to 2.8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 - 7 years (average 1.6 years) to 3 - 30 years (average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by echocardiography was less than 50% in 8 patients.</p><p><b>CONCLUSION</b>Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.</p>

Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention (PCI) with prior ischemic stroke.</p><p><b>METHODS</b>A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009. End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up.</p><p><b>RESULTS</b>There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke. Compared patients without prior ischemic stroke, patients with prior ischemic stroke were older (P = 0.000), had higher hypertension morbidity (P = 0.000), higher diabetes mellitus morbidity (P = 0.005), higher incidence of multi-vessels disease (P = 0.000). During the follow-up of (35.0 ± 19.6) months, cardiac death rate (8.5% vs. 3.9%, P = 0.002) and re-cerebral infarction rate (5.8% vs. 1.4%, P = 0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. Dual antiplatelet therapy treatment time [(13.77 ± 11.33) months vs. (13.94 ± 11.33) months, P = 0.986] and major bleeding events (5.8% vs. 3.6%, P = 0.100) were similar between the two groups and cerebral hemorrhage rate (1.8% vs. 0.5%, P = 0.028) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke.</p><p><b>CONCLUSION</b>Patients with prior ischemic stroke were associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.</p>

Clinical and coronary characteristics of young patients (< 30 years old) with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and angiographic features of acute myocardial infarction in patients aged 30 years or younger.</p><p><b>METHODS</b>Data of 360 consecutive patients referred to Peking Union Medical College Hospital for evaluation of chest pain or discomfort from January 2007 to December 2009, diagnosed as acute myocardial infarction and underwent emergent coronary angiography were analyzed. Seven patients (1.9%) with age ≤ 30 years [4 male, (25 ± 5) years] were included in this study, patients were followed up for (12 ± 9) months.</p><p><b>RESULTS</b>There were 6 cases of ST-segment elevated myocardial infarction and 1 non-ST-segment elevated myocardial infarction. The culprit vessels were as follows: 5 left anterior descending artery, 1 left main and 1 right coronary artery. All 3 female patients were complicated with congenital coronary malformation or autoimmune disease, including 1 coronary artery aneurismal dilation of left anterior descending, 1 Takayasu's arteritis and 1 systemic lupus erythematosus. Three of the 4 male patients were smokers. Two patients underwent percutaneous coronary intervention. There was no death or cardiovascular re-admission during the follow-up.</p><p><b>CONCLUSIONS</b>The majority of acute myocardial infarction in patients aged 30 years or younger were presented with ST-segment elevated myocardial infarction and single vessel non-obstructive lesion. The most common culprit vessel was left anterior descending artery. All female patients were complicated with congenital coronary malformation or autoimmune disease. The short-term prognosis in patients of this cohort was good.</p>

Factors associated with reduced renal function post primary percutaneous coronary intervention in acute myocardial infarction patients with normal baseline serum creatinine level / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze factors associated with reduced renal function post primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients with normal baseline serum creatinine level.</p><p><b>METHOD</b>The clinical and angiographic data of 216 consecutive AMI patients undergoing primary PCI with normal baseline serum creatinine level (< 1.5 mg/dl) were obtained and compared between patients with (n = 32) and without (n = 184) renal function deterioration (increase in serum creatinine > or = 25% from baseline level within 72 hours of primary PCI) post PCI.</p><p><b>RESULTS</b>The incidence of renal function deterioration was 14.8% (32/216). Patients with age > 75 years (28.1% vs. 14.1%, P = 0.047), congestive heart failure (25.0% vs. 9.2%, P = 0.017), less use of low-molecular weight heparins (84.4% vs. 95.1%, P = 0.039) and beta-blockers (75.0% vs. 95.6%, P = 0.001) as well as angiotensin converting enzyme inhibitors/angiotensin receptor blockers (81.3% vs. 93.5%, P = 0.025) and statins (84.4% vs. 97.3%, P = 0.008) were risk factors for developing renal dysfunction post PCI. Renal function deterioration post PCI was also associated with increased in-hospital mortality (25.0% vs. 2.2%, P < 0.001). Multivariate analysis showed that congestive heart failure was the single independent predictor of renal function deterioration (odds ratio = 3.275, 95% confidence interval 1.275 - 8.408, P = 0.014), while renal function deterioration was the strongest independent predictor of in-hospital death (odds ratio = 10.313, 95% confidence interval 2.569 - 41.402, P = 0.001).</p><p><b>CONCLUSION</b>Renal function deterioration is a common complication post primary PCI and is associated with higher risk of in-hospital death in AMI patients with normal baseline serum creatinine level.</p>

Side branch occlusion rate at sites of overlapping sirolimus- or paclitaxel-eluting stents for treating long coronary lesions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare side branch occlusion rate at sites of overlapping sirolimus- or paclitaxel-eluting stents in treating long coronary lesions.</p><p><b>METHODS</b>We retrospectively reviewed the PCI CD and medical records of PCI 141 patients with at least one stent overlapping for long coronary lesion in our institute from January 2004 to October 2007. The side branches occlusion was documented and analyzed.</p><p><b>RESULTS</b>The study population were consisted of 141 patients that there were 115 man, and 26 women, who got 297 stents. There were 154 side branch vessels been observed. Side branch occlusion rate was 24.6% in Cypher group and 31.6% in TAXUS (P > 0.05), side branch TIMI flow decrease rate on overlapping region was 26.3% in Cypher group and 68.4% in TAXUS group (P > 0.05). A logistic regression model analysis show that the significant risk factors for side branch occlusion is the diameter and ostial occlusion of side branch.</p><p><b>CONCLUSION</b>Side branch occlusion rate and TIMI flow decrease rate were similar on overlapping region in patients treated with Cypher or TAXUS stents for long coronary lesions. The significant predictors for side branch TIMI flow decrease are the diameter and ostial occlusion of side branch.</p>

Risk factors for coronary artery disease stimulate urokinase receptor expression on monocytes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effect of risk factors for coronary artery disease (CAD) on urokinase receptor (uPAR) expression on monocytes.</p><p><b>METHODS</b>A total of 106 patients were enrolled and divided into five risk-factor groups: sixteen with hypertension, twenty-four with dyslipidemia, eighteen with hypertension + obesity, eighteen with dyslipidemia + obesity and thirty with hypertension + dyslipidemia + obesity. Seventeen healthy volunteers were recruited as control group. Monocyte expression of uPAR and mean fluorescence intensity index (MFI Index) of uPAR were measured by flow cytometer (FACSCalibur).</p><p><b>RESULTS</b>No difference in monocyte uPAR expression was detected between hypertension and control group [(4.9 +/- 12.5)% vs. (7.7 +/- 10.3)%, P=0.74]. However, the uPAR expression was raised to (23.7 +/- 22.5)% in hyperlipidemia group, a 3.9- and a 2.1-fold increase compared with those in hypertension (P<0.01) and control group (P<0.05), respectively. When combined with obesity, uPAR expression was elevated further to (32.9 +/- 30.8)% in hypertension + obesity group, (37.4 +/- 31.4)% in dyslipidemia + obesity group and (23.8 +/- 20.5)% in hypertension + dyslipidemia + obesity group, all having statistical significance compared with control group or hypertension group (P<0.01). The results were the same when corrected by age, BMI and hs-CRP. uPAR MFI Index was increased from 0.78 +/- 0.86 in control group to 1.91 +/- 1.97 and 3.33 +/- 2.52 in dyslipidemia group and hypertension + obesity group, respectively, P<0.05. Linear regression analysis revealed a significant correlation between uPAR expression and FBG concentration in dyslipidemia group, r=0.72, P=0.04.</p><p><b>CONCLUSIONS</b>uPAR expression was elevated on monocytes in patients with risk factors for CAD. Dyslipidemia and obesity may contribute to the increase of uPAR expression.</p>

Early ST resolution after successful primary PCI is related to a favorable outcome in ST elevated AMI patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the relationship between the early ST resolution magnitude and TIMI flow, MACE and the cardiac function in ST elevated AMI (STEMI) patients after successful primary PCI.</p><p><b>METHODS</b>A total of 120 consecutive patients with STEMI underwent primary PCI within 12 hours after the onset of chest pain were enrolled in this study, the ST segment resolution was calculated and the patients were divided into group A (n = 81, Sigma STE resolved > or = 50%) and group B (n = 39, Sigma STE resolved < 50%). TIMI flow after PCI, clinical events up to 30 days post PCI and cardiac function 30 days post PCI were assessed.</p><p><b>RESULTS</b>LVEF was higher in group A than that of group B (58.6% +/- 7.1% vs. 50.5% +/- 7.1%, P < 0.05). There are fewer patients with Killip III and IV in group A than in group B (1.2% vs. 12.8%, P < 0.05). The incidence of in-hospital MACE was also significantly less in group A than in group B (0 vs. 7.7%, P < 0.001). As expected, there were more patients with TIMI 3 flow (95.1% vs. 79.5%, P < 0.05) and fewer TIMI 2 (4.9% vs. 20.5%, P < 0.05) flow post PCI in group A than in group B and all 3 patients with MACE were group B patients with TIMI 2 flow.</p><p><b>CONCLUSION</b>Early ST resolution post PCI represents improved myocardial perfusion and function and is related to a favorable clinical outcome in STEMI patients.</p>

Clinical significance of adenosine 99mTc-MIBI myocardial perfusion single photon emission computed tomography for patients in percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical significance of adenosine (99m)Tc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) for percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>Coronary angiography and adenosine (99m)Tc-MIBI myocardial perfusion SPECT were performed for all patients. Adenosine myocardial perfusion was performed after PCI. Adenosine was infused intravenously at a rate of 140 microg.kg(-1).min(-1) for 6 minutes, and 925MBq (99m)Tc-MIBI was injected intravenously at 3 minutes after adenosine infusion. SPECT myocardial imaging acquisition was obtained in 1.5 hours after adenosine infusion. If the result was abnormal, rest (99m)Tc-MIBI myocardial perfusion SPECT would be performed next day. There were 17 segments of left ventricle, and four degrees of myocardial perfusion.</p><p><b>RESULTS</b>There were 63 cases (63 +/- 10 years old) with CAD, in which 40 patients got PCI. Twenty eight cases after PCI.</p><p><b>CONCLUSION</b>Adenosine myocardial perfusion imaging will be useful in detecting regional myocardial perfusion abnormalities for patients with PCI.</p>

Gene polymorphisms of rennin-angiotensin system and coronary artery thrombosis disease / 中国实验血液学杂志

To investigate the distribution frequencies of angiotensin-converting enzyme (ACE), angiotensinogen (AGT), angiotensin II I type receptor (AT1R) genotypes in Chinese, to find the relationships between polymorphisms of ACE, AGT and AT1R gene, and coronary artery thrombosis disease (CATD) and to study the interactions of themselves, PCR and PCR-RFLP techniques were performed to determine the genotypes of ACE, AGT and AT1R gene in CATD group (192 cases) and control group (110 cases). The results showed that (1) genotype frequencies of the three polymorphisms in the control group were 12.2% (DD), 43.9% (ID), and 43.9% (II) for the ACE I/D polymorphism; 8.2% (MM), 36.7% (MT), and 55.1% (TT) for AGT M235T polymorphism; 91.8% (AA), 8.2% (AC) for AT1R A1166C polymorphism respectively; (2) there were no significant differences between patients in either the control group, the non-MI group, or the MI group in any genotype frequency of all these three genes (P >0.05). (3) the odds ratio for CATD in subjects carrying both AT1R-AC and AGT-TT genotype was 3.517 (95% CI 0.988 - 12.527), compared with those carrying AT1R-AA and AGT-TT genotype and was 15.000 (95% CI 1.940-115.963), compared with those carrying AT1R-AC and AGT-MM/MT genotype. In subjects with AT1R-AC genotype, there was also a great difference of ACE D allele frequency between control group and CATD group (P=0.017). It is concluded that genotype frequencies of ACE I/D polymorphism, AGT M235T polymorphism, and AT1R A1166C polymorphism were obviously different from those in western countries. Although these three polymorphisms were not independent risk factors for CATD or myocardial infarction (MI) in Chinese, AT1R-AC genotype has a significant synergistic effect with AGT-TT genotype. There is also a obvious interaction between AT1R-AC genotype and ACE D allele.