Characteristics and outcomes following transcatheter aortic valve replacement in China: a report from China aortic valve transcatheter replacement registry (CARRY) / 中华医学杂志(英文版)

BACKGROUND@#The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.@*METHODS@#CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.@*RESULTS@#The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).@*CONCLUSIONS@#TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.@*TRIAL REGISTRATION@#https://www.chictr.org.cn/ (No. ChiCTR2000038526).

Efficacy and safety of Shexiang Baoxin pill (MUSKARDIA) in patients with stable coronary artery disease: a multicenter, double-blind, placebo-controlled phase IV randomized clinical trial / 中华医学杂志(英文版)

BACKGROUND@#The Shexiang Baoxin Pill (MUSKARDIA) has been used for treating coronary artery disease (CAD) and angina for more than 30 years in China. Nevertheless, methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce. The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy (OMT) in patients with stable CAD.@*METHODS@#A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months. Both groups received OMT according to local tertiary hospital protocols. The primary outcome was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. Secondary outcomes included all-cause mortality, non-fatal MI, non-fatal stroke, hospitalization for unstable angina or heart failure, peripheral revascularization, angina stability and angina frequency.@*RESULTS@#In all, 99.7% of the patients were treated with aspirin and 93.0% with statin. After 2 years of treatment, the occurrence of MACEs was reduced by 26.9% in the MUSKARDIA group (MUSKARDIA: 1.9% vs. placebo: 2.6%; odds ratio = 0.80; 95% confidence interval: 0.45-1.07; P  = 0.2869). Angina frequency was significantly reduced in the MUSKARDIA group at 18 months (P = 0.0362). Other secondary endpoints were similar between the two groups. The rates of adverse events were also similar between the two groups (MUSKARDIA: 17.7% vs. placebo: 17.4%, P = 0.8785).@*CONCLUSIONS@#As an add-on to OMT, MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD. Moreover, the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD. The results suggest that MUSKARDIA can be used to manage patients with CAD.@*TRIAL REGISTRATION@#chictr.org.cn, No. ChiCTR-TRC-12003513.

Evaluation of neointimal coverage and thrombosis at 3 months and 2 years post sirolimus-eluting stent implantation by optical coherence tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the short- and long-term prevalence of persistent uncovered struts and in-stent thrombus after sirolimus-eluting stent (SES) implantation by optical coherence tomography (OCT).</p><p><b>METHODS</b>OCT was performed for 31 SES in 21 patients at 3 months and for 30 SES in 21 patients at 2 years post SES implantation. Thickness of new intima inside each strut was measured and thickness equal to 0 microm was defined as an uncovered strut. Existence of in-stent thrombus was also evaluated.</p><p><b>RESULTS</b>A total of 4545 struts and 3707 struts were evaluated at 3 months and at 2 years post SES implantation, respectively. New intima at 2 years was significantly thicker than that at 3 months [(71 +/- 93) microm vs. (29 +/- 41) microm, P < 0.01]. Percent of uncovered struts at 2 years was significantly lower than that at 3 months (5% vs. 15%, P < 0.01). Prevalence of uncovered struts was similar at 2 years and at 3 months (81% vs.95%, P > 0.05). Subclinical thrombus was recognized in 14% patients at 3 months and 2 years post SES implantation.</p><p><b>CONCLUSIONS</b>Neointimal coverage inside the SES is a continuous process and the number of uncovered struts decreased from 3 months to 2 years after SES implantation. Few uncovered struts could still be visualized in the majority of patients at 2 years post SES implantation.</p>

Effects of trimetazidine on myocardial ischemia and heart rate variability in patients with non ST-elevation acute coronary syndrome / 中国临床药理学与治疗学

AIM:To observe the effects of trimetazi- dine on myocardial ischemia and heart rate variability (HRV)in patients with non ST-elevation acute coronary syndrome(NSTEACS).METHODS:74 patients with NSTEACS were chosen and randomly assigned into two groups:one group was given conventional therapy with as- pirin,isosorbide mononitfate,fluvastatin and metoprolol, trimetazidine was added on the base of conventional thera- py in the other group.The total observation time of thera- py was 8 weeks.The heart rote,blood pressure,frequen- cy and persistence time of chest pain,numbers of times of using Nitroglycerin every day,the extent anti degree of myocardial isehemia,HRV of patients were observed be- fore and after treatment.RESULTS:The therapeutic ef- fect of trimetazidine treatment group(with the effective rate 94.4%,excellence rate 72.2%)was obviously bet- ter than that of the conventional treatment group(with the effective rate 65.8%,excellence rate 36.8%)(P

Adenosine-5'-triphosphate test for the noninvasive diagnosis of AV nodal dual pathways(AVNDP) and assessment of results of slow pathway ablation in patients with AV nodal reentrant tachycardia / 中国临床药理学与治疗学

Aim To assess the value of the administration of adenosine-5'-triphosphate (ATP) during sinus rhythm for noninvasive diagnosis of AV node dual pathways(AVNDP) and abolition or modification of the slow pathway (SP) after radiofrequency(RFCA) in patients with inducible sustained AVNRT. Methods Incremental doses of ATP were intravenously administrated during sinus rhythm to patients with spontaneous or inducible sustained AVNRT(study group, n=45)and to patients with no evidence of AVNDP or inducible AVNRT (control group, n=37) until ECG signs of AVNDP( 50 ms increase or decrease in P-R interval in two consecutive beats, or occurrence of AVNRT) or second-degree AV block were observed. Results Four patients (two in study patients and two in control patients) could not complete the trial and were excluded from analysis. AVNDP was observed by ATP in 36(84%) study patients, whereas it was diagnosed by electrophysiology criteria in 38(88%) patients. AVNDP was observed only in 1(3%) control patient. AVNDP by ATP test was disappeared in 18(90%) of 20 patients who underwent SP abolition and in 3(38%) of 8 patients who underwent SP modification. Conclusion ATP test during sinus rhythm enables noninvasive diagnosis of AVNDP in a high percentage of patients with inducible AVNRT and reliably confirms the results of RFCA of the SP.