A single-center comparative study of alcohol septal ablation(SA) and surgery myectomy(SM) for refractory hyper-trophic obstructive cardiomyopathy( HOCM) / 中华胸心血管外科杂志

Objective Septal reduction therapies were recommended for drug-refractory patients with hypertrophic ob-structive cardiomyopathy(HOCM).To explore and compare the effectiveness and safety in patients with hypertrophic obstruc-tive cardiomyopathy(HOCM) treated with surgery myectomy(SM) and alcohol septal ablation(SA).Methods The clinical data of 260 patients performed SA(n=184) or SM(n=76)between September 2002 and September 2014 in our institute were retrospectively reviewed.The t-test, rank sum test and chi-square test were used to compare the differences between the two groups, and the Cox regression model was used for multivariate survival analysis.All-cause mortality, cardiac cause death(peri-operative death were included ) , heart function improvement , procedure-related complications and permanent pacemaker de-pendence( PPM) constituted the main contents of this study .Results Compared with patients treated with SM , patients un-dergone SA were poor heart function status(2.97 ±0.29 vs 2.50 ±0.56, P =0.01), more prevalence of atrial fibrillation( 15.14％ vs 6.80％, P=0.046) and longer follow-up period[(5.4 ±3.8) years vs(2.5 ±2.2) years, P =0.01)].All-cause mortality for SA and SM were 3.3％ and 14.5％ respectively(P=0.001).The fatal cardiac events of SA and SM were 1.63％ and 13.16％ respectively(P<0.001).Sudden cardiac arrest were the main cardiac cause death for both patients trea-ted with SA and SM.The cardiac death of left ventricular systolic dysfunction was main found in patients treated with SM . Heart function improvement(NYHA) after SA and SM were 1.23 ±0.61 and 0.88 ±0.64 respectively(all P <0.01).And SA had a lower procedure-related PPM implantation(1.63％ vs 4.20％, P<0.05).Conclusion Our results shown that SA have survival advantage, lower PPM and similar heart function improvement compared with SM for refractory patients with HOCM.

Long-term outcomes of patients with unprotected left main coronary artery disease post revascularization / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the long-term real-world outcomes of consecutive patients with unprotected left main coronary artery disease (ULMCA) underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>Consecutive patients with ULMCA (defined as stenosis ≥ 50%) undergoing DES implantation or CABG between January 2003 to July 2009 in Beijing Anzhen Hospital were enrolled. The follow-up period extended through August 2013. The end points of the study were death, cardiac death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization).</p><p><b>RESULTS</b>From January 2003 to July 2009, 922 ULMCA patients were enrolled in this study (465 PCI patients, and 457 CABG patients). The median follow-up was 7.1 years (interquartile range 5.3 to 8.2 years). The crude relative risk was as follows: overall death rate (13.0% (41/465) vs. 22.1% (72/457), P = 0.009), stroke rate (5.8% (11/465) vs. CABG 18.9% (46/457), P < 0.001) were significantly lower whereas the rate of repeat revascularization (32.3% (110/465) vs. CABG 19.2% (58/457), P < 0.001) was significantly higher in PCI group than in CABG group. MI rate was similar between PCI and CABG group (13.9% (33/465) vs. 6.7% (26/457), P = 0.196). MACCE rate was also similar between the 2 groups (42.9% (145/465) vs. 42.5% (142/457), P = 0.122). After multivariate adjusting, there was no significant difference in rates of death, MI and a composite of serious outcomes (cardiac death, MI, or stroke) between the 2 groups. Rates of MACCE were significantly higher in the PCI group (P = 0.009) due to increased rate of repeat revascularization (P < 0.001). However, stroke rate was still significantly higher in CABG group (P = 0.001) after multivariate adjusting.</p><p><b>CONCLUSION</b>During a follow-up up to 8.2 years, the survival rate is similar between the PCI and the CABG group in patients with ULMCA disease. The rate of repeat revascularization is significantly higher and stroke rate is significantly lower in the PCI group compared to CABG group.</p>

The value of SYNTAX score in predicting outcome patients undergoing percutaneous coronary intervention / 中华内科杂志

Objective To assess the value of SYNTAX score to predict major adverse cardiac and cerebrovascular events (MACCE) among patients with three-vessel or left-main coronary artery disease undergoing percutaneous coronary intervention.Methods 190 patients with three-vessel or left-main coronary artery disease undergoing percutaneous coronary intervention (PCI) with Cypher select drug-eluting stent were enrolled.SYNTAX score and clinical SYNTAX score were retrospectively calculated.Our clinical Endpoint focused on MACCE,a composite of death,nonfatal myocardial infarction (MI),stroke and repeat revascularization.The value of SYNTAX score and clinical SYNTAX score to predict MACCE were studied respectively.Results 29 patients were observed to suffer from MACCE,accouting 18.5％ of the overall 190 patients.MACCE rates of low ( ≤ 20.5 ),intermediate ( 21.0-31.0 ),and high ( ≥ 31.5 ) tertiles according to SYNTAX score were 9.1％,16.2％ and 30.9％ respectively.Both univariate and multivariate analysis showed that SYNTAX score was the independent predictor of MACCE.MACCE rates of low ( ≤ 19.5 ),intermediate( 19.6-29.1 ),and high( ≥29.2) tertiles according to clinical SYNTAX score were 14.9％,9.8％ and 30.6％ respectively.Both univariate and multivariate analysis showed that clinical SYNTAX score was the independent predictor of MACCE.ROC analysis showed both SYNTAX score ( AUC =0.667,P =0.004) and clinical SYNTAX score ( AUC =0.636,P =0.020) had predictive value of MACCE.Clinical SYNTAX score failed to show better predictive ability than the SYNTAX score.Conclusions Both SYNTAX score and clinical SYNTAX score could be independent risk predictors for MACCE among patients with three-vessel or left-main coronary artery disease undergoing percutaneous coronary intervention.Clinical SYNTAX score failed to show better predictive ability than the SYNTAX score in this group of patients.

The incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy / 中华内科杂志

Objective To observe the incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy (HCM).Methods 612 HCM patients were analyzed prospectively from July 1990 to November 2007.The age,sex,height,weight,medical history,main symptoms and incidence of atrial fibrillation were recorded.Results The patients'mean age was (47.8±14.9).414 patients(67.6%) were male.377 patients (61.6%)had left ventrieular outflow truer obstruction.94 patients(15.4%)and atrial fibrillation.43 patients(6.O%)had sustained and 51 patients (9.4%) had paroxysmal.The patients with atrial fibrillation were older in age and were predominantly female.Their medical history were longer,left atrial diameter(LAD)longer and plasma B-type natriuretie peptide(BNP)higher.logistic regression analysis indicated that the medical history(P=0.012),LAD(P=0.0001) and BNP (P=0.017)were the independent predictors of atrial fibrillation in HCM.Atrial fibrillation was accompanied by a decrease in functional status and an increase in risk of stroke.Conclusions The incidence of atrial fibrillation in HCM was high.The medical history.LAD and BNP were the independent predictors of its occurrence.