Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction / 医学前沿

Recent studies have shown that acute blood glucose elevation in patients with ST-segment elevation myocardial infarction (STEMI) suggests a poor prognosis. To investigate the effect of fasting blood glucose (FBG) on the risk of heart failure (HF) and left ventricular systolic dysfunction (LVSD) in non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute STEMI, we retrospectively recruited consecutive non-diabetic patients who underwent primary PCI for STEMI in our hospital from February 2003 to March 2015. The patients were divided into two groups according to the FBG level. A total of 623 patients were recruited with an age of 61.3 ± 12.9 years, of whom 514 (82.5%) were male. The HF risk (odds ratio 3.401, 95% confidence interval (CI) 2.144-5.395, P < 0.001) was significantly increased in patients with elevated FBG than those with normal FBG. Elevated FBG was also independently related to LVSD (β 1.513, 95%CI 1.282-1.785, P < 0.001) in a multiple logistics regression analysis. In conclusion, elevated FBG was independently associated with 30-day HF and LVSD risk in non-diabetic patients undergoing primary PCI for STEMI.

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.

Ethical Analysis on Hospital Website Construction / 中国医学伦理学

This paper summed up the moral characteristics of website construction of hospital, which includes:honesty, effective communication, sincere service, clearness and righteous. The problems of hospital website build-ing are excessive publicity, the lack of information and features, poor style of writing and interaction and so on and analyzed the reasons for the above problems. Put forward some countermeasures to improve the moral level of hospi-tal site, namely: public, strengthen the service consciousness; open thinking, expand information sources; con-structing system, update the information;innovation, prominent website characteristics;seek truth from facts, ac-tive promotion website recommendation.

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.

Roles of fish oil and ω-3 polyunsaturated fatty acids in patients with coronary heart disease / 中华临床营养杂志

The roles of fish oil and ω-3 polyunsaturated fatty acids in preventing coronary heart disease have been extensively explored in laboratory studies,clinical epidemiologic studies,cohort studies,and clinical multicenter randomized controlled trials.However,some recent large-scale double-blinded multicenter randomized controlled trials have yielded more controversial results.Further high-quality studies are required to confirm the clinical values of fish oil and ω-3 polyunsaturated fatty acids.

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.

Effect of Simvastatin on stent restenosis and in-stent neointimal hyperplasia / 中国介入心脏病学杂志

0 05) Conclusion Treatment of simvastatin 10 mg daily did no affect the stent restenosis and the in stent neointimal hyperplasia

One year clinical outcome following coronary artery stenting in patients with severe ischemic left ventricular dysfunction / 中国介入心脏病学杂志

Objective We evaluated the long term outcome of percutaneous transluminal coronary stenting in patients with unstable angina and severe ischemic left ventricular (LV) dysfunction inadequately controlled by medical therapy Methods We analyzed data on 69 lesions in 46 elective patients (66?12 years old, 72% male) with LV ejection fraction (LVEF)≤40% who presented between 1997 and 1999 and underwent coronary stenting Results Acute clinical success (

Restenosis after percutaneous transluminal coronary angioplasty and stent implantation / 基础医学与临床

Percutaneous transluminal coronary angioplasty (PTCA) has become one of the most important treatment method in coronary artery disease along with coronary bypass operation and medicine in recent years.Restenosis after intervention becomes the Achili's heel in our daily treatment.In some degree stenting can reduce restenosis,but the restenosis after stenting is still over 20%.The focus of the treatment of restenosis over the last 2 decades has been through the application of pharmacologically active agents and mechanical approaches using a host of different devices.But this frequent and costly complication of percutaneous revascularization techniques has proved refractory to all such therapies.This review will focus on the studies that have been done during recent years,it will cover the mechanism of restenosis after PTCA and stenting,the risk factors involved in the restenosis,and the prevention and treatment of restenosis.

Promote the Hospital Culture Construction by Hospital Celebration Activities / 中国医学伦理学

Successful celebration activities are not only important content of hospital culture construction,but also an effective way to promote the construction of hospital culture.This paper holds that hospital administrators should arouse staff's fervor of taking part in the construction of hospital culture,devote their efforts to manifesting the hospital spirit,build up the hospital image,and create a favorable external environment for the hospital development so as to push forward the hospital culture construction.

The consideration on how to spread out hospital culture / 中国医学伦理学

The hospital culture conveying is a necessary component of hospital culture construction and is a very important work. The spreading out of hospital culture must be persisted, and be sure to embody the hospital culture features, furthermore, the exact carriers should be chosen according to different hospital situation.