Prevalence trends and related factors of hypertension patients complicating with dyslipidemia in community of Guandong province between 2013 and 2018 / 中华心血管病杂志

Objective: To analyze the prevalence trends and related factors of hypertension patients complicating with dyslipidemia in community. Methods: This was a cross-sectional survey, patients with hypertension were selected from the different communities of Guangdong province in 2013 and 2018 respectively. General clinical characteristics, including demographic information, past history, family history, and medication history, were collected. Dyslipidemia was defined as follows: at least 1 item elevation of total cholesterol (TC)≥5.2 mmol/L, triglyceride (TG) ≥1.7 mmol/L, low-density lipoprotein cholesterol (LDL-C)≥3.4 mmol/L, or reduced high-density lipoprotein cholesterol (HDL-C)<1.0 mmol/L. The incidence of dyslipidemia was standardized based on the 2010 China Census data, and further subgroup analysis was performed according to age (<50, 50-60, ≥60 years old) and sex (male, female). Multivariate logistic regression was used to analyze the related factors of dyslipidemia. Results: In 2013 and 2018, 7 866 (4 148 (52.7%) females, with the age of (62.4±13.6) years) and 11 611 (6 692 (57.6%) females, with the age of (58.2±9.3)years) patients with hypertension were enrolled for data analysis, respectively. In 2013, the total prevalence rate of dyslipidemia in patients with hypertension in the community of Guangdong province was 56.3%, among which the prevalence rates of hypercholesterolemia, hypertriglyceridemia, high LDL-Cemia, and low HDL-Cemia were 17.1. %, 21.3%, 2.3% and 24.4%, respectively. The total prevalence of dyslipidemia in patients with hypertension in the community of Guangdong in 2018 was 47.3%, prevalence of hypercholesterolemia, hypertriglyceridemia, high LDL-Cemia and low HDL-Cemia was 14.1%, 20.3%, 12.0% and 19.4%, respectively. Subgroup analysis showed that the total prevalence of dyslipidemia in male patients with hypertension in the community of Guangdong in 2013 and 2018 was 59.0% and 50.7%, respectively, among which hypercholesterolemia was 13.8% and 8.0%, and hypertriglyceridemia was 22.3%, 20.9%, high LDL-Cemia was 1.7%, 8.1%, low HDL-Cemia was 32.9%, 30.3%, respectively. In 2013 and 2018, the total prevalence of dyslipidemia in female patients with hypertension in the community of Guangdong province was 53.9% and 44.8%, among which prevalence of hypercholesterolemia was 20.5% and 18.5%, hypertriglyceridemia was 20.4% and 19.8%, and high LDL-Cemia was 2.7% and 14.9%, and hypo-HDL-Cemia was 16.8% and 11.3%, respectively. Age subgroup analysis showed that the prevalence of dyslipidemia among hypertensive patients aged<50, 50-60, and ≥60 years in Guangdong community in 2013 were 60.1%, 60.6%, and 53.7%, respectively; and 46.2%, 49.3% and 46.5% in 2018, respectively. Multivariate logistic regression analysis showed that women (OR=0.860,95%CI 0.761-0.973,P=0.017), obese (OR=2.295,95%CI 2.007-2.624,P<0.001), diabetes (OR=1.314,95%CI 1.090-1.583,P=0.004), stroke (OR=1.894,95%CI 1.227-2.924,P=0.004) and the level of fasting blood glucose (OR=1.105,95%CI 1.066-1.146,P<0.001) were independently related with the occurrence of dyslipidemia. Conclusions: The prevalence of dyslipidemia in patients with hypertension in the communities of Guangdong province is relatively high, and the prevalence differs in sex and age. Between 2013 and 2018, the total prevalence of dyslipidemia, hyper-TCemia, and hypo-HDL-Cemia in hypertensive patients shows a downward trend. The prevalence of hyper-TGemia remains unchanged, but the prevalence of high LDL-C shows an upward trend. Several factors are related to the prevalence of dislipidemia in hypertension patients in Guandong community.

Association between Contrast Media Volume and 1-Year Clinical Outcomes in Patients Undergoing Coronary Angiography / 中华医学杂志(英文版)

<p><b>Background</b>The excess volume of contrast media (CM) is a marker of a more severe coronary culprit lesion and longer intervention duration in patients undergoing cardiac procedures. However, it is unclear whether the contrast volume is directly correlated with worse clinical outcomes. The aim of this study was to investigate the association between contrast dose and the incidence of 1-year major adverse cardiac and cerebrovascular events (MACCE) and all-cause bleeding events in patients undergoing cardiac catheterization and coronary angiography (CAG).</p><p><b>Methods</b>We prospectively enrolled 10,961 consecutive patients diagnosed with coronary heart disease expecting CAG from 2012 to 2013. The study population was pursued with a follow-up duration of 1 year. The predictive value of contrast volume, divided into quartiles, for the risk of MACCE and all-cause bleeding events was assessed using logistic regression analysis.</p><p><b>Results</b>The cumulative incidence of 1-year MACCE was 8.65%, which was directly associated with increasing contrast volume. In particular, MACCE was observed in 7.16%, 7.89%, 9.31%, and 11.73% of cases in the contrast volume quartile Q1 (≤100 ml), Q2 (101-140 ml), Q3 (141-200 ml), and Q4 (>200 ml), respectively (P < 0.001). Moreover, the incidence of 1-year all-cause bleeding events was noted in 4.70%, 5.93%, 7.28%, and 8.21% of patients in Q1, Q2, Q3, and Q4, respectively (P < 0.001). The survival analysis showed that the 1-year MACCE rate was higher in patients using greater CM volume during the CAG. CM volume used >140 ml was associated with the occurrence of 1-year MACCE, and the incidence was dramatically elevated in patients exceeding a contrast volume of 200 ml (P = 0.007).</p><p><b>Conclusion</b>Our data suggested that higher contrast volume was significantly correlated with an increased risk of MACCE and all-cause bleeding events in patients undergoing cardiac catheterization.</p><p><b>Trial Registration</b>ClinicalTrials.gov, NCT01735305; https://clinicaltrials.gov/ct2/show/NCT01735305?id=NCT017353057rank=1.</p>

Genetic and epigenetic predispositions underlying cardiovascular outcomes among patients treated with clopidogrel and aspirin / 中国药理学与毒理学杂志

Coronary artery disease (CAD)is a major cause of death and disability worldwide, and consumes a considerable amount of medical resources every year.Clopidogrel is a first-line antiplate-let therapy for CHD, butit is associated with substantial variability in PK and pharmacodynamics re-sponse. To date, gene variants explain only a smallproportion of the variability.The study aimed to identify new genetic loci-modifying antiplatelet response to clopidogrel in Chinese patients with CAD by a systematic analysis combining antiplatelet effects and PK, and further to investigate the PON1 gene promoter DNA methylation and genetic variations possibly influencing clinical outcomes in pa-tients undergoing PCI. We identified novel variants in two transporter genes (SLC14A2rs12456693, ATP-binding cassette [ABC]A1 rs2487032) and in N6AMT1 (rs2254638) associated with P2Y12 reac-tion unit (PRU) and plasma active metabolite (H4) concentration. These new variants dramatically im-proved the predictability of PRU variability to 37.7％. The associations between these loci and PK pa-rameters of clopidogrel and H4 were observed in additional patients, and its function on the activation of clopidogrel was validated in liver S9 fractions (P<0.05). Rs2254638 was further identified to exert a marginal risk effect formajor adverse cardiac events in an independent cohort.Multivariate logistic regression analysis indicated that PON1methylation level at CpG site-161 (OR=0.95; 95％ CI=0.92–0.98;P<0.01)and the use of angiotensin converting enzyme inhibitors(OR=0.48;95％ CI=0.26–0.89;P<0.01) were associated with decreased risk of bleeding events. In conclusion, new genetic variants were systematically identified as risk factors for the reduced efficacy of clopidogrel treatment.The ab-normal expression of DNA methylation-regulating key genes in the pharmacokinetic and pharmacody-namics pathways of clopidogrel and aspirin may modify clinical outcomes in dual antiplatelet-treated pa-tients undergoing PCI.

Effects of guideline-based hypertension management in rural areas of Guangdong Province / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite the improvement in the health care industry, the rates of undetected, untreated, and uncontrolled hypertension (HTN) are still very high, especially in rural areas of China. The aim of this study was to investigate the efficacy and efficiency of a guideline-based HTN management (novel therapy) in population of rural areas of Guangdong Province.</p><p><b>METHODS</b>Totally, 3113 patients with essential HTN in a rural area of Guangdong Province were enrolled and assigned to two groups, named traditional (n = 372) and novel therapeutic (n = 2741) groups, respectively. Patients in the traditional group were treated routinely, and patients in the novel group were treated in a novel model characterized by regular educational programs for hypertensive populations, close monitoring of blood pressure in combination with finely tuned antihypertensive medications, strict implementation of lifestyle modification and improving medical knowledge and skill of local medical staff efficiently. After 2 years of follow-up, primary endpoints including magnitude of systolic and diastolic blood pressures (SBP and DBP) decrease, treated and controlled rates, as well as secondary endpoints, were evaluated in both groups.</p><p><b>RESULTS</b>Initially, the treated rate was significantly higher in traditional group than that of novel group (71.15% vs. 64.99%, P < 0.05), while the controlled rates were comparable and insignificant difference between baseline BP in both groups (31.07% vs. 26.88%, P > 0.05). Four variables were significantly different, namely smoking rate, daily vegetable consumption (VC), and serum levels of low-density lipoprotein-cholesterol and fasting blood glucose between these two groups. After 2 years of follow-up, decreases in SBP and DBP were more prominent in the novel group (P < 0.001). Treated and controlled rates in both groups were both increased. Nevertheless, in comparison to the traditional group, controlled rate increased more significantly in the novel group (64.31% vs. 37.85%, P < 0.001). Variables indicating lifestyle modification such as high sodium consumption, percentages of alcohol abuse, daily VC were profoundly improved in the novel group.</p><p><b>CONCLUSIONS</b>The guideline-based HTN management implemented in the current study was beneficial for HTN control in rural areas of Guangdong Province.</p>

Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure.</p><p><b>METHODS</b>The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software.</p><p><b>RESULTS</b>Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P = 0.213). The aortic rupture patients are more likely to have ascending aortic diameters = 4 cm (62.5% vs. 9.0%, P = 0.032), involvement the aortic arch concavity (62% vs. 27%, P = 0.041) and have had multiple stents placed (P = 0.039).</p><p><b>CONCLUSIONS</b>Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter = 4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.</p>

Association of β-adrenergic receptor genes polymorphisms with incidence of subsequent cardiovascular events in Han Chinese patients with coronary artery disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sequence variants in the β-adrenergic receptor (ADRB) genes have a close relationship with the development of coronary artery disease (CAD) and the patient's prognosis. However, there is a lack of data on the role of the variants in ADRBs genes in Han Chinese patients with CAD. We aimed to investigate the association of genetic variants in the ADRB1 and ADRB2 genes with the incidence of major adverse cardiac event (MACE) in Han Chinese patients with CAD.</p><p><b>METHODS</b>A total of 545 Han Chinese patients with CAD undergoing percutaneous coronary intervention (PCI) were recruited to the study and followed for one year. Three variant sites in ADRB1 (rs1801253) and ADRB2 (rs1042713 and rs1042714) were genotyped. The effect of the ADRB1 and ADRB2 genotypes on MACE within one year was assessed.</p><p><b>RESULTS</b>There were 47 cases of MACE during follow-up. There was no significant difference in the incidence of MACE among patients carrying different genotypes of the three variants in ADRB1 and ADRB2 (Log-rank, all P > 0.05). Cox regression analysis showed no association between three variants in ADRB1 and ADRB2 genes and the incidence of MACE during one-year follow-up, the adjusted hazard ratios (95% confidence interval) for rs1801253, rs1042713 and rs1042714 were 1.05 (0.54-2.02), 1.24 (0.58-2.64) and 1.66 (0.81-3.42), respectively.</p><p><b>CONCLUSION</b>Our data did not support a relationship between the three polymorphisms of ADRB1 (rs1801253) and ADRB2 (rs1042713 and rs1042714) genes and risk of subsequent cardiovascular events after PCI in Han Chinese patients with CAD.</p>

Changes of cerebrospinal fluid pressure after thoracic endovascular aortic repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid (CSF) pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.</p><p><b>METHODS</b>Four hundred and nineteen patients were evaluated for the risk of spinal cord ischemia after thoracic endovascular aortic repair. Patients with identified risk factors before the procedure constituted group H and received prophylactic sequential CSF pressure measurement and CSF withdrawal. Patients who actually developed spinal cord ischemia constituted group P and received rescue CSF pressure measurements and CSF withdrawal.</p><p><b>RESULTS</b>Among the 419 patients evaluated, 17 were graded as high risk. Four patients actually developed spinal cord ischemia after endovascular repair. The incidence of spinal cord ischemia in this investigation was 0.9%. The patients who actually developed spinal cord ischemia had no identified risk factors and had elevated CSF pressure, ranging from 15.4 to 30.0 mmHg. Six of the 17 patients graded as high risk had elevated CSF pressure: >20 mmHg in two patients and >15 mmHg in four patients. Sequential CSF pressure measurements and provisional withdrawal successfully decrease CSF pressure and prevented symptomatic spinal cord ischemia in high-risk patients. However, these measurements could only successfully reverse the neurologic deficit in two of the patients who actually developed spinal cord ischemia.</p><p><b>CONCLUSIONS</b>Cerebrospinal fluid pressure was elevated in patients with spinal cord ischemia after thoracic endovascular aortic repair. Sequential measurements of CSF pressure and provisional withdrawal of CSF decreased CSF pressure effectively in high risk patients and provided effective prevention of spinal cord ischemia. Risk factor identification and prophylactic measurements play the key role in prevention of spinal cord ischemia after thoracic endovascular aortic repair.</p>

Analysis of coronary rotational atherectomy related complications / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analysis the complications of coronary rotational atherectomy and evaluate the safety of this procedure.</p><p><b>METHOD</b>A total of 250 rotational atherectomy cases from April 1994 to February 2012 were screened retrospectively and 22 cases patients (8.8%) with rotational atherectomy-related complications were included in this analysis.</p><p><b>RESULTS</b>Among these 22 patients, all lesions were either type B2 or C calcified lesions as evidenced by coronary angiography. After the rotation procedure, there were seven cases (2.8%) with slow reflow and two (0.8%) cases with no reflow. Seven cases (2.8%) developed severe coronary spasm and two cases (0.8%) had sinus bradycardia. Coronary dissection occurred in two cases (0.8%), while one case (0.4%) had coronary perforation and cardiac tamponade. Burr entrapment happened in one case (0.4%). There was no malignant arrhythmia, acute myocardial infarction, emergent coronary artery bypass graft or device related death during and post procedure. Comparison with baseline data, the concentration of CK-MB elevated significantly after the rotational atherectomy [(31.2 ± 4.8) mmol/L vs. (11.4 ± 6.5) mmol/L, P < 0.05].</p><p><b>CONCLUSION</b>Coronary rotational atherectomy is safe and procedure-related complications are rare.</p>

Increased platelet-leukocyte aggregates in patients with acute coronary syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the platelet-leukocyte-aggregates (PLAs) level among patients with acute coronary syndrome (ACS) and stable angina pectoris (SAP).</p><p><b>METHODS</b>Hospitalized patients were divided into three groups [ACS group (n=86), SAP group (n=54), the control group with 46 patients without coronary artery disease]. PLAs were measured by flow cytometry at admission before coronary angiography. ACS patients were further divided into low-risk group (0-108 points) and high-risk group (>109 points) according to GRACE scores at admission. PLA, platelet-monocyte aggregations (PMA), platelet-neutrophil aggregations (PNA), platelet-lymphocyte aggregations (PlyA) and hs-CRP values were compared among groups.</p><p><b>RESULTS</b>PLA (4.40%±3.08%), PMA (33.6%±21.5%), PNA (3.76%±5.06%), PLyA (2.03%±1.27%) and hs-CRP [5.75 (3.49, 9.15)] levels in ACS group were significantly higher than those in SAP and control groups (all P<0.05). PLA was also significantly higher in high-risk group than in the low-risk group (44.8%±18.0% vs. 13.0%±6.3%, P<0.01). Spearman correlation analysis showed that hs-CRP was positively correlated with PMA (r=0.547, P<0.01) and GRACE score is positively correlated with PMA, PLA, PNA and PlyA (r=0.746, 0.652, 0.460, respectively, all P<0.01).</p><p><b>CONCLUSION</b>PLAs is increased in ACS patients and higher PMA level is related with the unstable coronary syndrome in ACS patients. Increased PMA, PLA, PNA and PlyA levels is associated with higher GRACE score in ACS patients.</p>

Transradial artery intervention: an alternative approach for renal artery stent implantation? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transfemoral artery access is the main approach for the interventional treatment of renal artery stenosis (RAS). This study aimed to investigate the technical feasibility of a transradial interventional (TRI) treatment of renal artery stenosis.</p><p><b>METHODS</b>A series of 23 patients who underwent transradial renal artery stenting from October 2010 to October 2011 were studied. Radial sheath system (Terumo, Japan) was used to get access to the radial artery. Radial tourniquet (Terumo) was used to stop bleeding. A 5Fr MPA (COOK, USA) was used to perform selective renal arteriography. Percutaneous renal artery stent systems were used to perform renal artery stenting.</p><p><b>RESULTS</b>Renal artery angiography showed that 15 patients had unilateral renal artery stenosis and eight patients had bilateral renal artery stenosis. The descending aorta could not be catheterized in one patient because of the type III aortic arch. Twenty-two patients successfully underwent transradial renal artery angiography and the technical success rate was 95.7%. There was no puncture site hematoma or pseudoaneurysm. Mean procedure time was (38.4 ± 7.2) minutes, the mean amount of contrast agent used was (93.2 ± 6.3) ml, and the mean postprocedure bleeding time was (3.2 ± 1.9) minutes.</p><p><b>CONCLUSION</b>Transradial renal artery intervention is technically reliable with less invasion, rapid recovery, fewer complications and may become an alternative intervention approach for the treatment of renal artery stenosis.</p>

Progress in genetic and epigenetic research on in-stent restenosis after percutaneous coronary interventions / 中华医学遗传学杂志

Coronary heart disease is one of the most important causes of death in human, and consumes vast medical resources. Percutaneous coronary intervention (PCI) has been a significant breakthrough for its treatment. However, clinical application has been hampered by in-stent restenosis (ISR). Although drug eluting stent (DES) has reduced the occurrence of restenosis, incidence of ISR is still about 5% to 10%. The main reasons for restenosis after PCI are hyperplasia of vascular endothelial cells and smooth muscle cell migration. The exact mechanism of personalized differences in restenosis is not clear yet, but there may be a variety of risk factors. In addition to aging, smoking and diabetes, an increasing number of studies have found that genetic and epigenetic factors play an important role in ISR. In this article, authors have reviewed genetic and epigenetic factors on the progression of ISR, which may help to determine the genetic risk factors in patients with ISR after PCI.

Incidence and risk factors of coronary artery disease in elderly patients with abdominal aortic aneurysm / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the prevalence of coronary artery disease and risk factors in patients with abdominal aortic aneurysm (AAA).</p><p><b>METHODS</b>Coronary angiography was performed immediately after abdominal angiography in 70 elderly (> 50 years) consecutive patients with AAA. Medical history and imaging characteristics were evaluated.</p><p><b>RESULTS</b>CAD was diagnosed in 63 patients (90.0%) by coronary angiography: 20 (28.6%) patients with single-vessel disease (SVD), 15(21.4%) with 2VD, 22 (31.4%) with 3VD and 6 (8.6%) with left main disease + 3VD. Multi-variance logistic analysis showed that peripheral disease was the strongest predictor for CAD in AAA patients.</p><p><b>CONCLUSION</b>Coronary angiography should be performed in elderly AAA patients due to the high prevalence of CAD in this patient cohort.</p>

Vulnerable plaque burden post pharmacological and interventional treatments in patients with acute coronary syndrome and borderline lesion: intravascular ultrasound follow up results / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety between the interventional and conservative treatment options for borderline vulnerable plaque lesion in acute coronary syndrome (ACS) patients by intravascular ultrasound (IVUS).</p><p><b>METHODS</b>A total of 100 ACS patients [78 male, age 43 - 74 (60.4 ± 14.1) years] undergoing coronary angiography (CAG) with borderline lesion (coronary artery stenosis between 50% - 70%) were enrolled in May 2007 to February 2009, who were randomly divided into PCI group (50 patients) and conservative therapy group (50 patients). According to minimal lumen area (MLA) detected by IVUS, patients were further divided into MLA ≥ 4.0 mm(2) sub-group and MLA < 4.0 mm(2) sub-groups. Outcomes during hospitalization and after 10 - 12 month follow-up were compared.</p><p><b>RESULTS</b>IVUS was performed in 40 patients at 10 - 12 months post PCI, there was no in-stent thrombosis and the extent of stent neointimal hyperplasia was comparable as at the time of immediately post PCI. IVUS was performed in 35 patients at 10 - 12 months post conservative therapy, IVUS results showed that MLA increased significantly [(7.32 ± 1.42) mm(2) vs. (4.98 ± 0.89) mm(2), P < 0.01], while plaque area [(7.70 ± 2.09) mm(2) vs. (10.01 ± 2.55) mm(2), P < 0.05], plaque burden [(55.94 ± 8.36)% vs. (67.97 ± 9.36)%] and low echo area [(4.08 ± 0.80) mm(2) vs. (2.27 ± 0.79) mm(2)] were significantly decreased at follow up compared to those as baseline (all P < 0.01). There was one patient in PCI group with MLA ≥ 4.0 mm(2) developed acute in-stent thrombosis in left anterior descending artery two days after the procedure and 9 patients in conservative therapy and MLA < 4.0 mm(2) group received PCI due to recurrent angina pectoris during follow-up.</p><p><b>CONCLUSIONS</b>For the borderline lesion with MLA ≥ 4.0 mm(2) detected by IVUS, adequate medication could effectively attenuate and or reverse the plaque progression and stabilize plaque.</p>

A prospective multicenter parallel-controlled trial of TIVOLI biodegradable-polymer-based sirolimus-eluting stent compared to ENDEAVOR zotarolimus-eluting stent for the treatment of coronary artery disease: 8-month angiographic and 2-year clinical follow-up results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Available drug-eluting stents (DES) have achieved great success in reducing restenosis rates. Recently, investigators have demonstrated that the durable polymer carrier plays a significant role in DES-related hypersensitive reaction and delays vessel healing. TIVOLI stent is a novel sirolimus-eluting coronary stent with biodegradable coating containing sirolimus and polylactic-co-glycolic acid (PLGA) polymer. The present study sought to evaluate the effectiveness and safety of the TIVOLI biodegradable-polymer-based sirolimus-eluting stent in treating patients with coronary artery disease.</p><p><b>METHODS</b>A prospective, multicenter clinical trial comparing TIVOLI biodegradable coated sirolimus-eluting stent with ENDEAVOR zotarolimus-eluting stent was conducted in 324 patients (TIVOLI group: 168 patients; ENDEAVOR group: 156 patients) at 12 centers in China to demonstrate the non-inferiority of in-stent late loss with TIVOLI stent compared to ENDEAVOR stent in subjects with a maximum of two de novo native coronary artery lesions (lesion length ≤ 40 mm, reference vessel diameter 2.25-4.00 mm). The primary end point was angiographic in-stent late loss at 8-month. The secondary end points were clinical outcomes at 2 years, including major adverse cardiac events (cardiac death, myocardial infarction, or target-lesion revascularization) and stent thrombosis.</p><p><b>RESULTS</b>Angiographic late lumen loss at 8 months in the TIVOLI group was superior to the ENDEAVOR group (in-stent (0.25 ± 0.33) mm vs. (0.57 ± 0.55) mm, diff (95%CI) -0.23 (-0.32, -0.14), P < 0.0001; in-segment (0.25 ± 0.33) mm vs. (0.42 ± 0.55) mm, diff (95%CI) -0.13 (-0.23, -0.02), P = 0.0083). The rate of in-stent binary restenosis at 8 months was reduced from 8.6% in the ENDEAVOR group to 2.9% in the TIVOLI group (P = 0.0229). Compared to ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in target-lesion revascularization (4.2% vs. 9.6%, P = 0.0495) at 2 years. The two-year major adverse cardiac events (MACE) rate was lower for the TIVOLI group, but not significantly different (6.6% vs. 10.9%, P = 0.1630).</p><p><b>CONCLUSIONS</b>TIVOLI was superior to ENDEAVOR stent with respect to late lumen loss at 8 months, and it yielded both lower rates of angiographic binary restenosis at 8 months and target lesion revascularization (TLR) at 2 years. The MACE rate at 2 years was comparable in both groups.</p>

Totally percutaneous thoracic endovascular aortic repair with the preclosing technique: a case-control study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The conventional thoracic endovascular aortic repair (TEVAR) involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous approach is desirable. In this study, we describe a Preclosing technique and investigate its safety and efficacy for femoral access sites management, and evaluate its advantages as compared to those of traditional surgical cutdown approaches.</p><p><b>METHODS</b>The Preclosing technique involves two or multiple 6 F Perclose Proglide devices deployed in the femoral artery before upsizing to a 20-25 F sheath. The sutures were secured to close the arteriotomy at the end of the procedure. The medical records of patients who underwent thoracic endovascular aortic repairs using the Preclosing technique between December 2009 and November 2010 (group A) were compared with those using surgical femoral cutdown from January 2008 to November 2009 (group B). Outcome measures included rates of technical success, early complications, anesthesia method, procedure time, cardiac care unit (CCU) stay, time from procedure to discharge, hospital stay, procedure expense, hospital cost.</p><p><b>RESULTS</b>Between the two groups, there were no significant differences in baseline characteristics, in the endograft models or profiles. The technical success rate was 100.0% (85/85) in group A vs. 97.4% (147/151) in group B (P < 0.05). There was no access-related mortality in both groups. Compared with group B, the incidence of early complications were fewer in group A, 9.4% (8/85) vs. 22.5% (34/151) (P < 0.01). Local anesthesia with conscious sedation was used more often in group A, 68.2% (58/85) vs. 51.7% (78/151) in group B (P < 0.01). The procedure duration was shorter, (96 ± 33) minutes in group A vs. (127 ± 41) minutes in group B (P < 0.01). The length of the CCU stay, the duration from procedure to discharge, and the hospital stay were both reduced in group A, (117.3 ± 88.3) hours, (7.5 ± 5.3) days and (15.3 ± 6.8) days vs. (132.7 ± 115.5) hours, (10.5 ± 5.0) days and (19.5 ± 7.8) days in group B (P < 0.01). The procedure cost was RMB (109,000 ± 30,000) Yuan in group A vs. RMB (108,000 ± 25,000) Yuan in group B (P = NS). The hospital cost was RMB (130,000 ± 35,000) Yuan in group A vs. RMB (128,000 ± 33,000) Yuan in group B (P = NS).</p><p><b>CONCLUSIONS</b>Total percutaneous TEAVR with the Preclosing technique is safe and effective with meticulous technique and appropriate patient selection. The Preclosing technique decreases access-related complications, depends less on general anesthesia and the surgeon's cooperation, saves procedure time and shortens the CCU/hospital stay. With these advantages, the use of two percutaneous closure devices increases the hospital cost only slightly.</p>

Non-drug treatment for hypertrophic obstructive cardiomyopathy in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To retrospectively summarize the effect of non-medical therapies for pediatric patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>METHODS</b>From Nov. 2008 to Jun. 2010, 4 children with drug-refractory HOCM were admitted to our hospital. Their ages were 14, 7, 9 and 6 years old, respectively. Their body weights were 38, 17, 21.5 and 17 kg, respectively. Before operation, the pressure gradients over left ventricular outflow tract (LVOTG) were 60, 147, 58 and 114 mm Hg (1 mm Hg = 0.133 kPa), respectively. And mitral regurgitation (MR) areas were 2.2, 7.3 cm(2) and 2.9 cm(2), respectively, except that it was trivial in one case. Percutaneous transluminal septal myocardial ablation (PTSMA) was performed in case 1 and 2. Septal myectomy (SM) was performed in case 3 and 4. Follow-up was first performed right after operation or before discharge, then 1 month, 3 months, 6 months, and 12 months after operation, and then once a year. The follow-up period was 1 - 18 (9.3 ± 8.1) months.</p><p><b>RESULTS</b>All patients experienced relieved symptoms. Three of them had their NYHA functional class improved except case 2. Echocardiography revealed that LVOTGs right after operations were 38, 79, 20 and 0 mm Hg, respectively, suggesting significant improvement of left ventricular outflow tract obstruction (LVOTO) in all patients. During follow-up, case 2 suffered from recurrence of LVOTO, while the other 3 cases showed sustained relief. In the last follow-up, the LVOTGs of the four patients were 19, 168, 16 and 0 mm Hg, respectively. Echocardiography also revealed that MRs of all patients were significantly reduced, even in case 2 whose LVOTG rebounded, with no recurrence during follow-up. Severe complications were absent, such as ventricular septum perforation, cardiac tamponade, ventricular tachycardia or ventricular fibrillation. No one suffered from complete heart block. Transient complete right bundle branch block (CRBBB) was observed in case 1 after PTSMA and converted to intraventricular block after 1 month. Complete left bundle branch block (CLBBB) was present in both case 3 and 4, who received SM. In case 4, it converted to intraventricular block after 1 month while in case 3 CLBBB persisted.</p><p><b>CONCLUSIONS</b>The initial experience showed that PTSMA and SM were safe and effective for drug-refractory symptomatic HOCM children, with satisfactory short-term results. Further studies are needed to evaluate the long-term results and complications.</p>

Real world clinical performance of the zotarolimus eluting coronary stent system in Chinese patients: a prospective, multicenter registry study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Early clinical trials with the Endeavor zotarolimus eluting stent (ZES) in western populations demonstrated low rates of target lesion revascularization with a favorable safety profile including low late stent thrombosis with up to 5 years of follow-up. The aim of this clinical registry study was to evaluate real world clinical performance of the ZES coronary system in Chinese patients.</p><p><b>METHODS</b>The China Endeavor Registry is a prospective, multicenter registry assessing the safety of the ZES system in a real world patient population. It was conducted at 46 centers in China in routine treatment of patients with coronary artery stenosis, including patients with clinical characteristics or lesion types that are often excluded from randomized controlled trials. The registry included 2210 adult patients who underwent single-vessel or multi-vessel percutaneous coronary intervention. The primary end point was the rate of major adverse cardiac events (MACE) at 12 months.</p><p><b>RESULTS</b>The 12-month rate of MACE for all patients in the registry was 3.03%. Cardiac death or myocardial infarction rate was 1.28% and target lesion revascularization rate was 1.66%, non-target lesion target vessel revascularization (TVR) was 0.52%, TVR was 2.18%, and target vessel failure was 3.22%. There was only one case of emergent cardiac bypass surgery. The 12-month overall incidence of all Academic Research Consortium (ARC)-defined stent thrombosis was 0.43%.</p><p><b>CONCLUSION</b>Mid-term results from the real-world China Endeavor Registry suggest that Endeavor ZES was safe and effective in Chinese patients.</p>

Clinical application of anticoagulation treatment with warfarin after prosthetic heart valve replacement: a single center-based survey / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical application of anticoagulation treatment with warfarin after prosthetic heart valve replacement and compare the effect and safety of different anticoagulant intensities.</p><p><b>METHODS</b>A total of 845 Chinese patients receiving oral warfarin for anticoagulant treatment after prosthetic heart valve replacement in Guangdong General Hospital between 2000 and 2008 were enrolled in this survey. The general data, clinical data, medications, international normalized ratio (INR) and results of echocardiogram of these patients were followed up to observe the incidence of complication of thrombo-embolism and such adverse effect as hemorrhage.</p><p><b>RESULTS</b>All the patients were of Han nationality, and Cantonese accounted for 88.04%. The daily mean maintenance dose of warfarin was 2.92∓0.88 mg in these patients with a median INR of 2.09∓0.39. Of these patients, 44.62% received low-intensity anticoagulant treatment with warfarin with the INR maintained between 1.5 and 2.0, and 56.45% had standard anticoagulant intensity with the INR maintained between 2.0 and 3.0. The total incidence of thrombo-embolism was 4.14%. Severe hemorrhage occurred in 14 cases (1.66%), most frequently in the alimentary tract. The events of hemorrhage were correlated to the type of prosthetic heart valve replacement, occurring more frequently in patients with mechanical prosthetic heart valve replacement than in those with biological ones. No significant difference was found in the incidence of thrombo-embolism and server hemorrhage between the two groups receiving low and standard intensity therapy anticoagulant.</p><p><b>CONCLUSION</b>The effect and safety of low-intensity anticoagulant treatment are comparable to that of standard intensity treatment in Chinese Han patients, and anticoagulation treatment with warfarin is effective and safe to maintain the INR between 1.8-3.0.</p>

Correlation of microalbuminuria and fibrinogen to the severity of coronary artery lesions in patients with metabolic syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the correlation of microalbuminuria (MA) and fibrinogen (Fib) to the severity of coronary artery lesions in patients with metabolic syndrome (MS).</p><p><b>METHODS</b>Eighty-five patients with MS undergoing coronary artery angiography were divided, according to the number of vessels involved, into multivessel disease group and non-multivessel disease group, and also according to the modified Gensini score, into severe lesion (Gensini score>20) and non-severe lesion group. The correlations of MA and Fib to the number of involved vessels and the severity of the lesions were analyzed.</p><p><b>RESULTS</b>The urinary albumin to creatinine ratio (ACR) and Fib were significantly different between the multivessel and non-multivessel disease groups (P<0.05), and were found to be positively correlated to the number of coronary artery lesion (r=0.378, P=0.000; r=0.327, P=0.002). ACR, Fib, sex, smoking history and HDL-C differed significantly between severe lesion and non-severe lesion groups (P<0.05), and ACR and Fib showed positive correlations to the Gensini score (r=0.337, P=0.002; r=0.286, P=0.008). Logistic regression analysis identified ACR as an independent predictor of multivessel disease (B=2.655, P=0.000) and Gensini score (B=1.803, P=0.009), independent of sex, age, body mass index, smoking history, diabetes mellitus, LDL-C and HDL-C.</p><p><b>CONCLUSION</b>MA and Fib are positively correlated to the severity of coronary artery lesion, and MA is an independent predictor of multivessel disease and Gensini score in patients with MS.</p>

Intravascular ultrasound-guided interventional therapy for borderline lesions in patients with acute coronary syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the efficacy and safety of intravascular ultrasound (IVUS)-guided interventional therapy for borderline lesions in patients with acute coronary syndrome (ASC).</p><p><b>METHODS</b>Thirty-one ASC patients with borderline lesions (coronary artery stenosis between 40%-70% confirmed by coronary arteriography [CAG]) and a minimal lumen area (MLA) of the infarction related artery(IRA) < or =4.0 mm(2) shown by IVUS underwent percutaneous coronary intervention (PCI). Another 31 PCI cases without IVUS were also enrolled as the control group. The minimal luminal diameter, cross section luminal area, total cross section, plaque area and area stenosis rate were measured before and after stent deployment at a conventional or higher pressure in the IVUS group. All the patients were followed up for 10-12 months and clinically evaluated 1, 3, 6 month and 12 months after the procedure to collect the data of angina recurrence, myocardial infarction and revascularization.</p><p><b>RESULTS</b>All the 31 cases were successfully stented with satisfied CAG results (with residual stenosis <0, TIMI flow grade III) and without dissection or any related complications. Among the 32 stents, 28 showed insufficient adherence or underexpansion (stent malapposition) to require 18-20 atm dilation or another high pressure balloon to attain the adequate IVUS results. CAG and IVUS were repeated in 22 patients (70.97%) of the IVUS group during the 10 to 12 months of follow up. No stent restenosis occurred with the in-stent diameter late loss >50%, nor was in-stent thrombus found by IVUS. Endomembrane proliferation was found but without any significant difference. Minimal stent lumen area were not significantly different from the immediate results after PCI (10.12-/+1.15 mm(2) vs 8.98-/+2.12 mm(2), P>0.05). The 31 patients in the control group were successfully stented with satisactory CAG results, but 3 suffered angina at 3-6 months who showed stent restenosis and insufficient stent adherence.</p><p><b>CONCLUSION</b>IVUS can more effectively guide the interventional therapy for ACS borderline lesions and assess the immediate efficacy of therapy than CAG. Post-dilation with higher pressure (16-20 atm) guided by IVUS can further improve the procedural results. IVUS-guided PCI for ACS borderline lesions ensures high immediate and long-term success rate.</p>