Comparison of aspirin and low molecular weight heparin in pulmonary lobectomy after percutaneous coronary intervention / 中华胸心血管外科杂志

Objective:To compare the clinical application of aspirin and low molecular weight heparin in pulmonary lobectomy after percutaneous coronary intervention(PCI), and to explore the effect of aspirin monotherapy in anti-platelet therapy.Methods:From January 2018 to December 2019, the clinical data of 48 patients with coronary atherosclerotic heart disease(coronary heart disease) who underwent lobectomy in the Thoracic Surgery Department of Beijing Anzhen Hospital within 12 months after PCI were retrospectively analyzed. There were 37 males and 11 females. The age ranged from 41 to 76(67.6±10.4) years. There were 22 cases with hypertension, 18 cases with diabetes and 2 cases with cerebrovascular disease. Iliac artery stents were inserted in 2 cases and vertebral artery stents in 1 case. Preoperative atrial fibrillation in 2 cases. There were 46 patients with gradeⅠand 2 patients with gradeⅡcardiac function(NYHA). According to the preoperative antiplatelet treatment, the patients were divided into aspirin group(25 cases) and low molecular weight heparin group(LMWH group, 23 cases). In the aspirin group, clopidogrel or ticagrelor was stopped 5 days before lobectomy, and aspirin single drug antiplatelet therapy was used, orally 100 mg every day until the morning of operation. In the LMWH group, aspirin, clopidogrel or ticagrelor were stopped 7 days before surgery, and 0.6 ml LMWH calcium was injected subcutaneously, once every 12 hours, and stopped 12 hours before surgery. Perioperative clinical data of the two groups were recorded and analyzed, and major adverse cardiac event(MACE) and bleeding events were observed.Results:There was no death in all groups. MACE and bleeding occurred in 1 case respectively in LMWH group. There were no significant differences between the two groups in length of hospital stay, duration of operation, diameter of lesion, total postoperative thoracic drainage and retention time of thoracic drainage tube( P>0.05). The intraoperative blood loss and chest drainage in the aspirin group were significantly lower than those in the LMWH group in the first 3 days after surgery, with statistical significance( P<0.05). Conclusion:The incidence of MACE increases after lobectomy for coronary heart disease within 12 months after PCI, and aspirin monotherapy is safe and effective in antiplatelet therapy.

Evaluation of perioperative high-sensitive cardiac troponin i as a predictive biomarker of major adverse cardiovascular events after noncardiac surgery

ABSTRACT Background: Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality. Objective: The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery. Methods: In this prospective cohort study, we included men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery. Results: In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who presented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml. Conclusions: Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery.

Usefulness of white blood cell count to mean platelet volume ratio in predicting short term, 30 days major adverse cardiac events in patients presenting with acute coronary syndrome

Background: The role of white blood cell (WBC) to mean platelet volume (MPV) ratio (WMR) in predicting short-term major adverse cardiac events (MACE) in patients presenting with acute coronary syndrome (ACS) has not been studied extensively. We aimed to determine whether WMR can predict short-term (30 days) MACE in ACS patients.Methods: This hospital-based prospective cohort study was undertaken at a tertiary-care teaching hospital in India from January 2018 to December 2018. Fifty patients presenting with ACS to undergo primary percutaneous intervention were evaluated for WMR and short-term MACE.Results: Receiver operating characteristic (ROC) curve showed cut-off value of WMR as 1059 with area under the ROC curve of 0.825 (SE=0.074; 95% CI: 0.679-0.971; p=0.001). MACE was noted in 10 patients (20%) and mortality in 4 patients (8%). WMR with cut-off value of 1059 was significant and highly accurate in predicting MACE (diagnostic accuracy: 72%, sensitivity: 80%, specificity: 70%, positive predictive value: 40%, negative predictive value: 93.33%, p=0.016, and positive likelihood ratio: 2.67, negative likelihood ratio: 0.29). Risk of short-term MACE increases with higher respiratory rate, creatine kinase and creatine kinase myocardial band, alanine aminotransferase, WBC count, neutrophils, neutrophil to lymphocyte ratio, total bilirubin, aspartate aminotransferase, lymphocytes, uric acid, lower SBP, DBP, Troponin I, red blood cell count, and ejection fraction and clinical presentation such as, palpitations, sweating, giddiness, loss of consciousness, higher Killip class, and  diagnosis of  inferior wall myocardial infarction.Conclusions: Higher WMR values on admission (≥1059) are associated with worse short-term outcomes in patients with ACS and independently predict short-term MACE.

Low major adverse cardiac event rates following bioresorbable vascular scaffold implantation: Impact of implantation technique on treatment outcomes

Background and objective Studies conducted across the world have reported that the rates of major adverse cardiac events (MACE) following the use of bioresorbable vascular scaffolds (BVS) are comparable to that noted with traditional drug eluting stents (DES). However, there is limited data on the immediate and medium-term clinical outcomes following the use of the Absorb BVS (Abbott Vascular, Santa Clara, SA) in the Indian context. This study was conducted to determine real-world evidence on the immediate and medium-term clinical outcomes in all patients undergoing percutaneous coronary intervention (PCI) with the Absorb BVS. Methods Data of all patients who were treated with Absorb BVS at our center were evaluated. Between December 2012 and October 2016, 142 patients underwent PCI with BVS. The MACE rates during hospitalization, at 30 days, 3 months, 6 months after PCI, and every 6 months thereafter were the primary endpoints evaluated with median follow up of 13 months. Results Mean age of the study participants was 53.7 ± 11.8 years. Intravascular ultrasound imaging was performed in 15.34% of patients. Predilatation and postdilatation were performed in 81.8% and 84.6% of scaffolds, respectively. There were no episodes of MACE during hospitalization. However, 1 BVS-related MACE was observed at the 1-month (0.7%) as well as at the ≥12 month (0.8%) follow up visits. At the 6- and 12-month follow up visits, 2 (1.5%) and 3 (2.5%) non-BVS-related MACEs, respectively, were recorded. Conclusion The use of Absorb BVS in this real-world experience was associated with very good immediate and medium-term clinical outcomes.

Real World Utility of Dobutamine Stress Echocardiography in Predicting Perioperative Cardiovascular Morbidity and Mortality after Orthotopic Liver Transplantation

BACKGROUND AND OBJECTIVES: Stress echocardiography is the current standard for cardiac risk stratification of patients undergoing orthotopic liver transplantation (OLT). We aim to evaluate the role of dobutamine stress echocardiography (DSE) in predicting perioperative major adverse cardiac event (MACE) in patients undergoing OLT. METHODS: This was a single-center retrospective study including 144 OLT patients. Of 144 patients, 118 had DSE. MACE included myocardial infarction (MI), heart failure (HF), cardiovascular and all-cause death 1 year after OLT. RESULTS: Our study cohort included 118 patients. The mean age was 57.3±8.2 years (range, 25–72 years). There were 85 men and 33 women, male to female ratio being 2.6:1. Of 118, 15 (13%) had positive DSE and 103 (87%) had negative DSE. Perioperative MACE incidence was 5.9% (95% confidence interval [CI], 2.6–12.3%). In predicting MACE, DSE had sensitivity of 5.6% (95% CI, 0.2–29.4%), specificity 86% (95% CI, 77.3–91.9%), positive predictive value 6.7% (95% CI, 0.3–33.4%), and negative predictive value (NPV) 83.5% (95% CI, 74.6–89.8%). Eighteen patients had MACE in first year post OLT (15%, 95% CI, 9.5–23.3%). Adverse events included cardiogenic shock (2/18), systolic HF (2/18), non-ST-elevated MI (7/18), cardiac mortality (3/18), and all-cause mortality (7/18). The overall complication rate of DSE was 17% (20/118). CONCLUSIONS: In our cohort, DSE had a low sensitivity but high NPV in predicting perioperative MACE post OLT. A similar trend was noted for DSE in predicting 1-year MACE post OLT. We reiterate the need of a better screening and risk stratification tool for OLT.

Clinical Observation of Intensive Rosuvastatin Therapy in the Treatment of Acute Coronary Syndrome / 中国药房

OBJECTIVE:To observe long-term efficacy of intensive rosuvastatin therapy in the treatment of acute coronary syn-drome (ACS) and explore its possible mechanism,so as to provide reference for clinical diagnosis and treatment. METHODS:ACS patients receiving rosuvastatin after cured in our hospital during Jan. 2013-Jan. 2015 were divided into observation group(55 cases)and control group(47 cases)according to the dose of rosuvastatin. Under same guidance of physicans,2 groups were addi-tionally given Rosuvastatin calcium tablets(20 mg for observation group,10 mg for control group,qd,po)orally on the basis of routine treatment. Both groups were treated for 1 year. The incidence of 1-year accumulative main adverse cardiac event (MACE) were compared between 2 groups as well as the levels of blood lipid and serum cytokines,the occurrence of ADR before treat-ment,after 3 months of treatment. RESULTS:The incidence of accumulative MACE in observation group was significantly lower than control group,with statistical significance (P0.05). CONCLUSIONS:Intensive rosuvastatin therapy can significantly improve the long-term prognosis for ACS patients,which may associate with lipid metabolic regulation and anti-inflammatory effect.

The effect of implementing regional cooperative rescue on patients with acute coronary syndrome / 中华急诊医学杂志

Objective To evaluated the effect of the regional cooperative rescue model implemented on the length of time from first medical contact (FMC) to balloon dilation (B),economic expense and prognosis in patients with acute coronary syndrome (ACS).Methods Patients with ACS (including ST-segment elevation and non-ST-segment elevation) selected from other hospitals within 24 hours after onset were treated with emergency percutaneous coronary intervention.Patients were divided into two groups, regional cooperative rescue group and control group without the regional cooperative rescue model approved.The lengths of FMC-to-B time and Door-to-B time (from arrival at emergency department or OPD to balloon dilation),time required for patients referred to our hospital,cardiac function,averaged hospital costs,average hospital stay,percentage of medication used and a major adverse cardiac event (MACE) were analyzed.Results Mean FMC-to-B time,Door-to-B time,referral time and time consumed to obtain informed consent were significantly shorter [(106±33) min,(31 ±8) min,(62 ±18,8 ±3) min] vs.[(231 ±35) min,(109 ±26) min,(98 ±31) min,(28 ±11) min,respectively] by implementing the regional cooperative rescue compared with control group,and LVEF was increased,and LVED was deceased inregional cooperative rescue group.The mean costs [(44 123.0 ±3 427.0) yuan vs.(51 587.0 ±5 621.0)] yuan,days of hospital stay [(8.7 ±4.1) vs.(13.2 ±6.4)] and percentage of medication used were significantly decreased in the regional cooperative rescue group.The incidence of MACE inregional cooperative rescue group was 6.2％,whereas the incidence in control group was 16.8％.Conclusions The regional cooperative rescue model can improve the prognosis and decrease the FMC-to-B time,the rate of MACE and financial burden in patients with ACS.

Effects of ischemic postconditioning on myocardial perfusion and prognosis in patients with acute myocardial infarction treated with emergency percutaneous coronary intervention / 介入放射学杂志

Objective To investigate the effects of ischemic postconditioning (IPOC) on myocardial perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) who were treated with emergency percutaneous coronary intervention (PCI). Methods A total of 203 patients with STEMI who received emergency PCI were randomly divided into IPOC group (n=103) and control group (n=100). For the patients of IPOC group the angioplasty balloon was re-inflated within one minute after the beginning of reperfusion, the procedure was repeated three times, each time the inflation of balloon lasted for 1 minute using low-pressure (4-6 atm), and the interval between the inflation procedures was one minute. For the patients of the control group , no additional intervention was employed during the first 6 minutes of reperfusion. Cardiac troponin I(cTnI) peaks, creatine kinase-MB (CK-MB) peaks, left ventricular ejection fraction (LVEF), wall motion score index (WMSI), corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC), and major adverse cardiac events (MACE) occurred during hospitalization time in both groups were recorded and the results were compared between the two groups. Results No significant differences in age, sex, risk factors, infarction-related artery, ischemia time, etc. existed between the two groups (P>0.05). The CTFC values of IPOC group were significantly faster than those of the control group, that was (25.3±7.9) vs.(29.4±8.4),(P<0.05). The CK-MB peak and cTnI peak values of IPOC group were remarkably lower than those of the control group, those were (157.3 ±83.6) U/L vs. (201.5 ±77.3) U/L and (2.5 ±1.3) ng/mL vs. (3.1 ±1.0) ng/mL respectively (P<0.05). At the time of admission, there were no significantly differences in the LVEF and WMSI values between the two groups, and three months after PCI the LVEF and WMSI values of IPOC group were significantly better than those of the control group, those were (57.4 ±8.7)% vs. (53.6 ±9.3)% and (1.19 ±0.4) vs. (1.27 ±0.3) respectively, the differences were statistically significant (P<0.05). Three months after PCI, the occurrence of MACE in IPOC group was obviously lower than that in the control group (P<0.05). Conclusion Ischemic postconditioning can improve the infarction-related artery blood flow in patients with STEMI who receive emergency PCI treatment, it can also reduce ischemia-reperfusion injury and improve the cardiac function as well as patient’s prognosis after AMI.

Percutaneous Coronary Intervention for Acute Myocardial Infarction in Elderly Patients with Renal Dysfunction: Results from the Korea Acute Myocardial Infarction Registry

This study aimed to evaluate the effects of percutaneous coronary intervention (PCI) on short- and long-term major adverse cardiac events (MACE) in elderly (>75 yr old) acute myocardial infarction (AMI) patients with renal dysfunction. As part of Korea AMI Registry (KAMIR), elderly patients with AMI and renal dysfunction (GFR<60 mL/min) received either medical (n=439) or PCI (n=1,019) therapy. Primary end point was in-hospital death. Secondary end point was MACE during a 1 month and 1 yr follow-up. PCI group showed a significantly lower incidence of in-hospital death (20.0% vs 14.3%, P=0.006). Short-term and long-term MACE rates were higher in medical therapy group (31.9% vs 19.0%; 57.7% vs 31.3%, P<0.001), and this difference was mainly attributed to cardiac death (29.3% vs 17.6%; 51.9% vs 25.0%, P<0.001). MACE-free survival time after adjustment was also higher in PCI group on short-term (hazard ratio, 0.67; confidence interval, 0.45-0.98; P=0.037) and long-term follow-up (hazard ratio, 0.61, confidence interval, 0.45-0.83; P=0.002). In elderly AMI patients with renal dysfunction, PCI therapy yields favorable in-hospital and short-term and long-term MACE-free survival.

A study to evaluate the clinical outcome of drug-eluting vs. bare-metal stents for acute coronary syndrome patients during commercial use in real setting.

Background: This study compared clinical outcome of Drug Eluting Stents (DES) versus Bare Metal Stents (BMS) in coronary arteries in patients with Acute Coronary Syndromes. Methods: A retrospective, observational study was carried out in an inpatient setting of the private tertiary care hospital. Patients with >18 years, diagnosed for Acute Coronary Syndromes (ACS), required intervention in coronary artery with implantation of Drug Eluting Stents (DES) or Bare Metal Stents (BMS) were recruited in the study. The data had been collected from file or database of the hospital. All subjects were followed for major adverse cardiac event. Results: A total of 202 patients who underwent percutaneous coronary intervention (PCI) were enrolled into DES group (n=101) and BMS group (n=101). All patients were followed up at 1 month, 3 months, 6 months & 12 months for Major Adverse Cardiac Events (MACE). Clinical outcomes during 12 months were compared between DES group & BMS group. Overall MACE rates were reported non-significantly high in BMS group patients (14.85%) compare to DES group patients (8.91%) (p=0.458). However, DES group had lower rates of death (0.99% vs 1.98%, p=0.57), rate of MI (3.96% vs 4.95% p=0.73), rate of revascularization (1.98% vs 3.96% p=0.42) & rate of sub acute thrombosis (1.98% vs 3.96% p=0.42) and higher rate of bleeding (1.98% vs 0.99% p=0.57) compare to cohort-II. Conclusions: The use of DES in the setting of Acute Coronary Syndrome is associated with lower Major Adverse Cardiac Event (MACE) rate compared to BMS without compromising the overall safety over the course of one-year follow-up. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials.

Acute and Long-term Clinical Outcomes after Coronary Stenting of CrossFlex, GFX and NIR Stents

BACKGROUND AND OBJECTIVES: New coronary stents are displacing for the broader array of lesions, but disagreement remains which device is more advantageous and whether design determines outcomes. The present study investigates the impact of stent design on early and one year outcomes. MATERIALS AND METHODS: A retrospective analysis of 350 patients with 378 lesions (60+/-10 years, 265 male), that underwent 181 CrossFlex, 95 GFX, 102 NIR coronary stentings at Chonnam National University Hospital from January 1996 to December 1999, was performed. Early procedural success rates, major adverse cardiac event (MACE) within one year and follow-up angiographic findings in 227 patients (240 lesions, follow-up duration=8.1+/-5.9 months) were compared among three groups. METHODS: 1) There were no significant differences in the baseline clinical and angiographic characteristics except the lesion length (CrossFlex: GFX: NIR=11.5+/-5.2: 14.5+/-6.7: 13.9+/-5.7 mm, p<0.05). 2) There were no significant differences in early angiographic success rates among three groups (CrossFlex: 98.9%, GFX: 100.0%, NIR: 99.0%). 3) There were no significant differences in late luminal loss (CrossFlex: GFX: NIR=1.03+/-0.69: 1.11+/-0.75: 1.09+/-0.70 mm, p=NS), restenosis rates (CrossFlex: 30.6%, GFX: 30.8%, NIR: 28.4%, p=NS) and MACE (CrossFlex: GFX: NIR=27.6%: 29.5%: 27.5%, p=NS) among three groups. CONCLUSION: Despite different lesions length, the early and late angiographic outcomes, and MACE within one year were not different among three different types of coronary stents.