Relationship Between NT-proBNP Levels and Left Ventricular Ejection Fraction in Patients with Unstable Angina and Diabetes Mellitus and Preserved LVEF.

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is suggested to be altered in patients with systolic heart failure or acute coronary syndrome. We explored the relationship between left ventricular ejection fraction (LVEF) and levels of NT-proBNP in patients with unstable angina and type 2 diabetes mellitus and preserved LVEF.Patients with unstable angina were divided into normal glucose tolerance (controls) and type 2 diabetes mellitus groups. The plasma NT-proBNP concentration was measured in these patients within 30 minute of admission for a comparative study. The severity of coronary arterial lesions was evaluated using Syntax scores. Results: NT-proBNP levels were not significantly different in patients with unstable angina and type 2 diabetes mellitus (median [quartiles]: 167.0 [66.1, 623.3] pg/mL) from those of controls (116.0 [69.8, 233.0], P = 0.278). Subsequent analyses indicated that ln (NT-proBNP) was positively associated with the following parameters: left ventricular end-diastolic diameter (r = 0.495, P = 0.019), left ventricular end-systolic diameter (r = 0.648, P = 0.001), and Syntax score (r = 0.567, P = 0.006); ln (NT-proBNP) was negatively associated with LVEF (r = -0.652, P = 0.001) in patients with unstable angina and type 2 diabetes mellitus. In multiple linear regression analysis, ln (NT-proBNP) levels were significantly independently correlated with the LVEF and Syntax score. However, no correlation was observed between ln (NT-proBNP) and each parameter in patients with unstable angina and normal glucose tolerance (controls).The NT-proBNP level is independently correlated with the LVEF in patients with unstable angina and type 2 diabetes mellitus and preserved LVEF.

Five-years' prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study.

Background: Most of coronary artery ectasia (CAE) patients have comorbid coronary atherosclerosis. It was lack of prognostic data for CAE patients with coronary heart disease (CHD) and for whom with acute myocardial infarction (AMI). Objective: To determine the overall prognosis for CAE patients. Materials and methods: This study was a retrospective cohort study. Fifty-one patients with CAE and comorbid AMI (CAE + AMI) and 108 patients with CAE and comorbid CHD (CAE + CHD) were enrolled and matched to non-CAE subjects at a ratio of 1:3 using a propensity score method, respectively. Controls for CAE + AMI group were 153 AMI patients, controls for CAE group were 324 CHD patients and 329 participants with relatively normal coronary arteries (CON). We followed them up to observe major cardiovascular events (MACE). Results: The Kaplan-Meier curves showed that the prognosis in CAE + AMI group was worse than in AMI group (5-year non-MACE rate: 62.70% vs. 79.70%, P = 0.010), the prognosis in CAE group was worse than in CHD and CON groups (5-year non-MACE rate: 74.10% vs. 85.80% and 96.70%, respectively, P = 0.000). The main MACEs in CAE + AMI and CAE groups were AMI reoccurrence (19.61% vs. 4.57%, P = 0.002) and re-hospitalization due to repeated angina pectoris (14.81% vs. 8.33% and 2.74%, P = 0.000), respectively. Additionally, the COX regression analysis revealed that the protective factors for preventing MACE in CAE + AMI group included antiplatelet agents (hazard ratio = 0.234, P = 0.016) and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB, hazard ratio = 0.317, P = 0.037). Whereas the main factor promoting MACE in CAE group was the degree of coronary stenosis (Gensini score, hazard ratio = 1.011, P = 0.022). Conclusion: The prognosis of patients with CAE + AMI was worse than that of those with AMI. The overall prognosis of patients with CAE was worse than that of those with CHD. CAE + AMI and CAE groups had different characteristics; the former was prone to AMI reoccurrence, and the latter was prone to repeated angina pectoris. To prevent MACE, medications, including antiplatelets and ACEI/ARBs, are indicated for patients with CAE + AMI, whereas prevention of the progression of atherosclerotic lesions is indicated for patients with CAE.

Antithrombotic treatment strategy for patients with coronary artery ectasia and acute myocardial infarction: A case report.

BACKGROUND: There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia (CAE). CASE SUMMARY: This case reports the dynamic observation of a patient for 48 mo after a diagnosis of CAE with acute myocardial infarction (AMI). The first antithrombotic agents used were aspirin (100 mg/d) and clopidogrel (75 mg/d). During the sixth month of observation, a second AMI occurred involving the same culprit vessel; therefore, antithrombotic agents were changed to aspirin (100 mg/d) and ticagrelor (90 mg twice per day). Twelve months after the second AMI, an attempt to reduce the dosage ticagrelor failed; therefore the original dose was continued. The CAE was relatively stable during the following 4 years. CONCLUSION: This case indicates that a combination of aspirin and ticagrelor may be more effective for CAE patients with AMI than aspirin and clopidogrel.

Impact of COVID-19 pandemic on STEMI undergoing primary PCI treatment in Beijing, China.

OBJECTIVE: Strict control measures under the COVID epidemic have brought an inevitable impact on ST-segment elevation myocardial infarction (STEMI)'s emergency treatment. We investigated the impact of the COVID on the treatment of patients with STEMI undergoing primary PCI. METHODS: In this single center cohort study, we selected a time frame of 6 month after declaration of COVID-19 infection (Jan 24-July 24, 2020); a group of STEMI patients in the same period of 2019 was used as control. Finally, a total of 246 STEMI patients, who were underwent primary PCI, were enrolled into the study (136 non COVID-19 outbreak periods and 110 COVID-19 outbreak periods). The impact of COVID on the time of symptom onset to the first medical contact (symptom-to-FMC) and door to balloon (D-to-B) was investigated. Moreover, the primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of cardiac death, heart failure and malignant arrhythmia. RESULTS: Compared with the same period in 2019, there was a 19% decrease in the total number of STEMI patients undergoing primary PCI at the peak of the pandemic in 2020. The delay in symptom-to-FMC was significantly longer in COVID Outbreak period (180 [68.75, 342] vs 120 [60,240] min, P = 0.003), and the D-to-B times increased significantly (148 [115-190] vs 84 [70-120] min, P < 0.001). However, among patients with STEMI, MACE was similar in both time periods (18.3% vs 25.7%, p = 0.168). On multivariable analysis, COVID was not independently associated with MACE; the history of diabetes, left main disease and age>65 years were the strongest predictors of MACE in the overall population. CONCLUSIONS: The COVID pandemic was not independently associated with MACE; suggesting that active primary PCI treatment preserved high-quality standards even when challenged by a severe epidemic. CLINICAL TRIAL REGISTRATION: URL: https://ClinicalTrials.gov Unique identifier: NCT04427735.

Is Coronary Artery Ectasia a Progressive Disease? A Self-Controlled Retrospective Cohort Study.

Objective: It is essential to understand whether coronary artery ectasia (CAE) progresses over time because the patients might be under the risk of coronary rupture, and stent implant should be avoided if ectatic changes progress. Methods: A consecutive series of 99 CAE patients who had undergone coronary angiography at least twice were enrolled and followed up for 1-16 years until they received a second angiogram. Subjects were divided into two groups (1-5 vs. 5-16 years of follow-up), then the basic clinical characteristics and coronary artery images were compared over time. Results: (1) All CAE patients exhibited atherosclerosis, and a majority presented with acute myocardial infarction. Most baseline clinical characteristics were relatively stable. (2) Atherosclerosis (indicated by the distribution of stenosis in coronary vessels) and the Gensini scores progressed significantly. Ectasia extent showed minimal changes as indicated by blood vessel involvement, Markis type, coronary blood flow, ectasia diameter, and ectasia length. (3) Multilinear regression analysis revealed that the underlying factors related to stenosis evolution indicated by fold of Gensini score were: longer time interval, lower baseline Gensini score, and higher hypersensitive C-reactive protein concentration. (4) There was a relationship between the ectatic diameter and the extent of stenosis. Conclusions: For CAE patients with atherosclerosis followed for 1-16 years, there was minimal CAE progression, while the atherosclerosis progressed and the ectasia extent was related to degree of stenosis. The results indicate that prevention and treatment of atherosclerotic changes might have more clinical significance than addressing ectatic changes.

Peripheral blood soluble elastin and elastase as auxiliary diagnostic indicators for coronary artery ectasia

Background/aim: Damage to elastin fibres in coronary media might lead to coronary artery ectasia (CAE). This study evaluated whether CAE can be distinguished by detecting circulating soluble elastin (s-elastin), which is a degradation product of elastin fibres, and elastase, which is the main enzyme of elastin fibres. Materials and methods: Fifty-eight patients with CAE, 58 with coronary heart disease (CHD) and 61 with relatively normal coronary arteries, were included. Circulating s-elastin and elastase were measured, and receiver operating characteristic curves were used to demonstrate their respective optimal cut-off values for predicting CAE. Results: The concentrations of s-elastin and elastase were higher in the CAE group than in the CHD and relatively-normal-coronary groups. Their cut-off values for screening of CAE were 13.148 ng/mL and 25.549 ng/mL, respectively; for sensitivity of CAE were 0.690 and 0.773, respectively; and for specificity of CAE were 0.862 and 0.571, respectively. A combination of s-elastin and elastase in series (one of the two higher than its cut-off value) had a better sensitivity for screening for CAE, whereas their combination in parallel (both higher than their cut-off values) had a better specificity. Conclusion: Circulating s-elastin and elastase are promising biomarkers for assisting in CAE diagnosis.

Incomplete protective effect of coronary collateral circulation for acute myocardial infarction patients.

The short-term and long-term effects of coronary collateral circulation (CCC) discovered after acute myocardial infarction (AMI) are still debatable. This retrospective cohort study aimed to explore the clinical significance of CCC for AMI patients.A consecutive series of 323 AMI patients with CCC and 1339 AMI subjects without CCC were enrolled, most of them received percutaneous coronary intervention after AMI. Comparisons between CCC subjects and non-CCC population and between CCC sub-groups were applied regarded to basic clinical characteristics, stenosis extent indicated by Gensini score, myocardial infarction size estimated by peak concentration of troponin I (TnI), and left ventricular function evaluated by peak value of N-terminal pro-brain natriuretic peptide (NT-proBNP). Multiple linear regressions for NT-proBNP and TnI, and Kaplan-Meier curves for 5-years' main cardiovascular event (MACE) were also analyzed.CCC might provide incomplete protection by preventing excessive myocardial infarction but not a poorer heart function during AMI and CCC had no obvious protective effect on 5-years' MACE for AMI patients. More attentions should be paid to heart function for CCC patients during AMI.

Underlying factors relating to acute myocardial infarction for coronary artery ectasia patients.

Coronary artery ectasia (CAE) patients were more prone to present with acute myocardial infarction (AMI), this case-control research aimed to explore the underlying factors relating AMI for them.This study investigated a serial of 119 patients who underwent coronary angiography and were diagnosed as CAE between the years 2016 and 2017 at the Beijing Friendship Hospital; 32 of the patients developed AMI and 87 did not develop AMI. The possible factors relating to AMI, including disease history, cardiovascular risk factors, thrombotic condition, inflammation status, and coronary imaging characteristics, were comprehensively compared between CAE patients with and without AMI.CAE patients with AMI had a lower antiplatelet rate, a higher blood low-density lipoprotein cholesterol level, increased neutrophil to lymphocyte (NL) ratio, higher Gensini score, and larger proportions of Markis type II. Logistic regression analysis also indicated that AMI history, lower antiplatelet rate, higher NL ratio, higher low-density lipoprotein cholesterol level and Gensini score, as well as Markis type II were associated with AMI in CAE patients.AMI history, lower antiplatelet treatment rates, poor blood lipid control and higher coronary stenosis extent, higher inflammatory response, and Markis type II were closely related to the incidence of AMI in CAE patients.

Is Coronary Artery Ectasia a Thrombotic Disease?

Coronary artery ectasia (CAE) is a rare disease and a substantial portion of patients with CAE are first diagnosed with acute myocardial infarction (AMI). The question was raised if CAE was a kind of thrombotic disease. We assessed a consecutive series of 119 patients with CAE including 32 patients with AMI (CAE + AMI group) and 87 patients without AMI (CAE group). During the same period, 90 patients with coronary heart disease, 90 patients with normal coronary arteries (control), and 120 AMI patients without CAE (AMI group) were randomly selected and evaluated. Both current and previous AMI prevalence rates in the CAE population were higher than the AMI rate for the other patients undergoing coronary angiograms; the mean platelet volume and fibrinogen were increased in the CAE + AMI and CAE groups. For patients with CAE with AMI, most of the thrombotic lesions were in the ectasia site. After dividing the patients with CAE into with and without antiplatelet treatment groups before admission, the AMI rate was lower in the antiplatelet group. Platelets may participate in the thrombotic process in CAE. Antiplatelet treatment may decrease the AMI rate of patients with CAE.

Autoimmune Diseases May Increase Adverse Cardiovascular Events After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

BACKGROUND: Outcomes of patients with autoimmune diseases after percutaneous coronary intervention (PCI), as compared to those without autoimmune disease, remain unclear. METHODS: We searched Medline, EMBASE, and the Cochrane Library from their inception to 1 April 2017. All studies comparing the following outcomes of patients with and without autoimmune diseases after PCI were included: long-term mortality, major adverse cardiovascular events (MACE), repeat revascularisation, myocardial ischaemia or myocardial infarction (MI), restenosis, and in-hospital mortality. The Newcastle-Ottawa Quality Assessment Scale (NOS) and the quality assessment form of the Agency for Healthcare Research and Quality (USA) (AHRQ) were used for assessing the risk of bias, and the certainty of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: A total of 11 studies were included in our analysis. Compared with patients without autoimmune diseases, those with autoimmune diseases carried an increased risk of MACEs (relative risk (RR): 2.24, 95% confidence interval (CI): 1.20-4.16; heterogeneity: p=0.128, I2=56.9%), repeat revascularisation (RR: 1.66, 95% CI 95%: 1.01-2.72; heterogeneity: p=0.057, I2=65.1%), ischaemia or MI (RR: 2.80, 95% CI: 1.38-5.65; heterogeneity: p=0.871, I2=0.0%), and restenosis (RR: 2.06, 95% CI: 1.39-3.07; heterogeneity: p=0.665, I2=0.0%) during the one-year follow-up after PCI, and carried an increased risk of MACEs (RR: 1.10, 95% CI: 1.04-1.17) and death (RR: 1.38, 95% CI: 1.25-1.51) during the 11-year follow-up after PCI. CONCLUSIONS: Evidence of very low quality showed that during the one-year follow-up period, patients with autoimmune diseases after PCI were more likely to experience MACEs, repeat revascularisation, myocardial ischaemia or MI, and restenosis. During the 11-year follow-up period, patients with autoimmune diseases after PCI were more likely to die. It is therefore important to watch for restenosis, repeat ischaemia or MI and other adverse events more carefully in patients with autoimmune diseases after PCI.

Oncolytic Adenovirus rAd.DCN Inhibits Breast Tumor Growth and Lung Metastasis in an Immune-Competent Orthotopic Xenograft Model.

The majority of advanced breast cancer patients develop distal metastasis, including lung and bone metastasis. However, effective therapeutic strategies to prevent metastasis are still lacking. Decorin is a natural inhibitor of transforming growth factor ß, which plays a pivotal role in tumor metastasis. An oncolytic adenovirus expressing decorin, rAd.DCN, has been developed previously. In an immune-competent breast tumor (4T1) model, intratumoral (i.t.) as well as intravenous (i.v.) delivery of rAd.DCN inhibited growth of orthotopic tumors and spontaneous lung metastasis. It was shown that i.t. delivery of rAd.DCN produced higher levels of transgene expression and evoked stronger oncolysis of the tumors compared to i.v. delivery. However, i.v. delivery resulted in higher amount of virus accumulation in the lungs and produced stronger responses to prevent tumor lung metastasis. Oncolytic adenovirus-mediated decorin expression in the tumors downregulated the decorin target genes and decreased epithelial mesenchymal transition markers. Decorin expression in lung tissues also increased Th1 cytokine expression, such as interleukin (IL)-2, IL-12, and tumor necrosis factor α, and decreased Th2 cytokines, such as transforming growth factor ß and IL-6. Moreover, rAd.DCN treatment induced strong systemic inflammatory responses and upregulated CD8+ T lymphocytes. In conclusion, rAd.DCN inhibits tumor growth and lung metastasis of breast cancer via regulating wnt/ß-catenin, vascular endothelial growth factor (VEGF), and Met pathways, and modulating the antitumor inflammatory and immune responses. Considering that i.v. delivery was much more effective in preventing lung metastasis, systemic delivery of rAd.DCN might be a promising strategy to treat breast cancer lung metastasis.

Multivessel coronary artery ectasia and severe calcification in a patient with pheochromocytoma: a case report.

Multivessel coronary artery ectasia with severe calcification is rare among patients with coronary artery disease. A 74-year-old Chinese woman suffered from acute myocardial infarction on a background of 50 years of poorly controlled hypertension secondary to pheochromocytoma, which was surgically removed in June 2012 prior to the presentation. Coronary angiography revealed total occlusion of the proximal left anterior descending artery, and multiple ectasias with severe calcification in the left main, circumflex and right coronary artery. After an aspiration thrombectomy and balloon angioplasty, grade 3 coronary flow was restored in the left descending coronary artery. No cardiac events were found in the 12-month follow-up. We conclude that multivessel coronary artery ectasia and severe calcification may be present in patients with a long-standing history of hypertension secondary to pheochromocytoma.

Transradial percutaneous coronary intervention for left main bifurcation lesions using 7.5-Fr sheathless guide catheter.

Recent studies have shown sheathless guide catheters (GCs) to be safe and effective during complex lesions such as bifurcations, chronic total occlusion (CTO), and/or calcified lesions. We investigated the feasibility and safety of using 7.5-Fr sheathless GC for transradial percutaneous coronary intervention (PCI) to treat left main bifurcation lesions.A total of 82 patients were consecutively enrolled from March 2013 to February 2016. They underwent transradial PCI for left main bifurcation lesions using the 7.5-Fr sheathless GC.The mean syntax score was 28.1 ±â€Š6.1, and the majority (n = 55, 67.1%) was intermediate scores (23∼32). The unprotected LM disease was present in 67 of 82 patients (81.7%), and true bifurcation (Medina 1, 1, 1) was present in 46 of 82 patients (56.1%). The 2-stent technique was used in 62 of 82 patients (75.6%). The 2-stent technique included 31 cases (37.8%) of "Crush," 18 cases (22.0%) of "Cullote," and 13 (15.8%) cases of "T stent and modified T stent" (T stent). Immediate angiographic success rate was 100% (82/82), and procedural success rate was 97.6% (80/82). The vascular complications occurred in 3 patients (3/82, 3.7%).The use of 7.5-Fr sheathless GC is safe and allows PCI for complex bifurcation lesions located in the distal of left main to be performed transradially with a high success rate.

Short- and Long-term Outcomes in Patients with Connective Tissue Diseases Undergoing Percutaneous Coronary Intervention.

BACKGROUND: Coronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with connective tissue diseases (CTDs). Risk factors and clinical characteristics in these patients are not equivalent to those in traditional CAD patients. The objective of this study was to report short- and long-term clinical outcomes in a consecutive series of patients with CTD who underwent percutaneous coronary intervention (PCI) with stent implantation. METHODS: The study group comprised 106 consecutive patients with CTD who underwent PCI in Beijing Friendship Hospital between January 2009 and June 2012. Medical records were analyzed retrospectively including clinical basic material, coronary angiogram data, and the incidence of major adverse cardiac events (MACEs) during the short- and long-term (median 3 years) follow-up. RESULTS: Ninety-two of the patients (86.8%) had one or more traditional CAD risk factors. Multivessel disease was present in more than 2/3 of patients (73.6%). The left anterior descending coronary artery was the most commonly affected vessel (65.1%). Five bare-metal stents and 202 drug-eluting stents were implanted. After a median follow-up period of 36 months, thirteen patients (12.3%) died from cardiac causes, the rate of stent thrombosis was 9.4%, and the rate of target vessel revascularization (TVR) was 14.2%. Multivariate analysis revealed that hypertension (hazard ratio [HR] = 3.07, 95% confidence interval [CI]: 1.30-7.24, P = 0.041), anterior myocardial infarction (HR = 2.77, 95% CI: 1.06-7.03, P = 0.04), longer duration of steroid treatment (HR = 3.60, 95% CI: 1.43-9.08, P = 0.032), and C-reactive protein level >10 mg/L (HR = 3.98, 95% CI: 1.19-12.56, P = 0.036) were independent predictors of MACEs. CONCLUSIONS: Patients with CTD and CAD may have severe coronary lesions. PCI in these patients tends to result in an increased rate of stent thrombosis and TVR during long-term follow-up, which may be influenced by traditional and nontraditional risk factors.

Impact of red blood cell distribution width on long-term mortality in patients with ST-elevation myocardial infarction.

OBJECTIVES: Recent studies have reported increased red blood cell distribution width (RDW) has been associated with adverse outcomes in heart failure and stable coronary disease. We investigated the association between RDW and risk of all-cause mortality in patients with ST-elevation myocardial infarction (STEMI) who were free of heart failure at baseline. METHODS: We enrolled 691 patients with STEMI who were free of heart failure at baseline confirmed by coronary angiography in Beijing Friendship Hospital from January 2007 to December 2008. According to the median RDW at baseline (13.0%) on admission, the patients were divided into two groups: a low-RDW group (RDW <13.0%, n = 329) and a high-RDW group (RDW ≥13.0%, n = 362). All-cause mortality rates were compared between groups. Mean duration of follow-up was 41.8 months. The relation between RDW and clinical outcomes after hospital discharge were tested using Cox regression models, adjusting for clinical variables. At the same time, the sensitivity and specificity of RDW were analyzed by ROC analysis. RESULTS: Forty-seven patients (6.8%) died during follow-up. The cumulative incidence of all-cause death was significantly higher in the high-RDW group than in the low-RDW group (log-rank p = 0.007). Multivariate analysis revealed that high RDW was associated with all-cause mortality (hazard ratio: 3.43; 95% confidence interval: 1.17-8.32; p = 0.025). The area under the ROC curve was 0.562. CONCLUSION: From the statistical point of view, increased RDW is associated with all-cause and cardiac mortality rates in patients with STEMI who were free of heart failure at baseline. But RDW is a marker with a very low prognostic accuracy that does not seem to be clinically helpful.

Remodeling of small intramyocardial coronary arteries distal to total occlusions after myocardial infarction in pigs.

OBJECTIVE: The present study was designed to investigate whether microvascular remodeling could occur in hibernating myocardium and infarction regions distal to a total occluded coronary artery after acute myocardial infarction. MATERIALS AND METHODS: Copper stents were implanted in the left descending coronary arteries of 64 pigs to induce anterior wall myocardial infarction. The pigs were assigned randomly to group A (n=8; killed at 1 week), group B (n=8; killed at 2 weeks), group C (n=16; killed at 4 weeks), group D (n=16; killed at 3 months), and group E (n=16; killed at 6 months). The control group included six pigs that were subjected to the same procedures but without implantation of copper stents. The wall area (WA) and lumen area (LA) of small intramyocardial coronary arteries (SIMCA) distal to occlusions were measured and the ratios of WA/LA and LA/total vessel area (%L) were calculated. The composition of the arterial wall was determined by Masson's trichrome stain, transmission electron microscope. RESULTS: A significant increase in WA/LA and decrease %L in SIMCA were observed in group B (P<0.05), group C (P<0.01), group D (P<0.01), and group E (P<0.01) compared with the control. There was increased area of collagen fiber in the thickened arterial wall in group C (P<0.05), group D (P<0.01), and group E (P<0.01) compared with the control group, group A, and group B. A significantly increased ratio of the synthetic phenotype vascular smooth muscle cells were found in group B (P<0.05), group C (P<0.01), group D (P<0.01), and group E (P<0.01) compared with the control group. CONCLUSION: Several weeks after occlusion of epicardial coronary, the SIMCAs distal to occlusion developed remodeling, with an increase in wall thickness and a decrease in lumen size. These structural changes may restrict blood flow to ischemic or hibernating myocardium after revascularization.

[Acute angiographic and clinical outcomes of patients with calcified chronic total occlusion underwent percutaneous coronary intervention].

OBJECTIVE: To evaluate the in-hospital outcome of patients with calcified chronic total occlusion (CTO) lesion underwent percutaneous coronary intervention (PCI). METHODS: The clinic and lesion characteristics as well as acute PCI outcome were analyzed in 726 patients with calcified CTO [624 detected by coronary angiography (CAG) and 102 detected by intravascular ultrasound (IVUS)] and received PCI therapy from June 1995 to February 2007 in our department. RESULTS: There were 728 diseased vessels with 732 lesions in these patients. Total procedure success rate (80.6% vs. 89.2%, P < 0.05) and the lesion success rate (80.2% vs. 88.2%, P < 0.05) were significantly lower in calcified CTO detected by CAG compared to that detected by IVUS. The causes of procedure failures in CAG detected patients were as follows: 87 guide failure, 21 balloon failure, 8 procedure related complications and 5 low TIMI blood flow (grade 2) at the end of PCI procedure. The causes of procedure failures in IVUS detected patients were as follows: 7 guide wire failure, 2 balloon failure, 1 procedure related complications and 1 patient with low TIMI blood flow (grade 2). The in-hospital major adverse cardiac events (MACE) rate was 1.1% in CAG detected calcified CTO and 1.0% in IVUS detected calcified CTO (P > 0.05). CONCLUSION: PCI therapy resulted in satisfactory procedure success rate and in-hospital outcome for patients with calcified CTO and IVUS is helpful for further increasing the PCI procedure success rate in patients with calcified CTO.