Therapeutic effect and security of triple antiplatelet with Cilostazol in the elderly after drug-eluting stent implantation / 中华老年医学杂志

Objective To evaluate the therapeutic effect and security of triple antiplatelet with cilostazol in the elderly after drug-eluting stent implantation and compare it with double antiplatelet treatment. Methods 234 elderly patients with coronary disease were randomly divided into two groups.118 cases in the triple antiplatelet group were treated with clopidogrel (300 or 600 mg/d) and aspirin(100 mg/d) in addition with cilostazol(200mg/d) from pre surgery to 6 month after surgery,then received double antiplatelet treatment.116 cases in the double antiplatelet group were treated with Aspirin(100 mg/d) and clopidogrel(300 or 600 mg/d),then clopidogrel was ceased after 1 year and used only Aspirin. The main parameters during follow up included all-cause death,major adverse cardiovascular events (MACE) and major adverse cardiac and cerebrovascular event (MACCE),the secondary parameters during follow- up were recurrence of angina pectoris,myocardial infarction,revascularization and hemorrhage within 2 years. Results The recurrence of angina pectoris and revascularization were found in 1 case (0.85％) and 1 case(0.85％) respectively in the triple antiplatelet group,while 8 cases(6.90％) and 8 cases (6.90％) in the double antiplatelet group,with significant difference between the two groups(both x2 =4.27,P＜0.05).All cause death,myocardial infarction,cerebral apoplexy and hemorrhage were not found in the triple antiplatelet group,while 1 case of death,1 case with myocardial infarction,1 case with apoplexy and no hemorrhage appeared in the double antiplatelet group,with no significant difference between the two groups(P＞0.05).Conclusions The triple antiplatelet added with cilostazol in the elderly after drug eluting stent implantation may decrease the recurrence of angina pectoris and revascularization with higher security.

The prognosis of coronary disease with different cardiovascular risk factors combined / 中华急诊医学杂志

Objective To assess the prevalence, and characteristics, and in-hospital and long-term prognosis of coronary artery disease (CAD) with metabolic syndrome, and to determine the factors affecting the prognosis of CAD most. Method The DESIRE (drug-eluting stent impact on revascularization) registry covered a database of 2368 patients with coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in a period between July 2003 and September 2004. The median long-term follow-up time was 3.5 years ranged from 293 to 1855 days. The metabolic syndrome (MS) was diagnosed on the Definition of the Metabolic Syndrome modified by the Adult Treatment Panel (ATP) Ⅲ in 2005, by using the body mass index (BMI) instead of waist circumference. The relationship between metabolic syndrome (MS) and the incidences of major adverse cardiac as well as cerebral events (MACCE) in a large cohort of patients treated for revascularization was analyzed by using logistic analysis and Cox regression with SPSS 11.0 software. Results The Ms was present in 45.6% patients (high fast glucose (FG) in 44.5% patients, high triglycerides (TG) in 45.0% patients, low high density lipoprotein (HDL) in 50.8% patients, high BP in 61.4% patients, high BMI in60.7% patients). After follow-up, the ratio of MACCE in CAD patients with metabolic syndrome increased significantly (18.9% vs. 15.6%, P <0.036). The most dangerous factors of MS were high FG, hypertension and obesity (OR=1.787, 95%CI=1.132-2.845, P =0.014). Conclusions The MS contributes the high risk factors of MACCE in CAD patients with or without diabetes. The most dangerous combination of risk factors in MS is the combination of high FG, hypertension and obesity.

Evaluation of effects of different regimen of antiplatelet drugs on major adverse cardiac events in direction of adenosine diphosphate-induced platelet aggregation index in old patients undergoing selected percutaneous coronary intervention / 中华老年医学杂志

Objective To evaluate the effect of different regimens of antiplatelet drugs on the major adverse cardiac events (MACEs) in elderly patients undergoing selected percutaneous coronary intervention (PCI) in direction of the adenosine diphosphate (ADP) -induced platelet aggregation index. Methods The 1230 cases aged 60-80 years, mean (67. 2±10. 2) years undergoing selected PCI with the drug eluting stent were enrolled. The 615 cases of the ADP guided group according to the ADP-induced platelet aggregation index. After the first loading dose of clopidogrel (300 mg) , once the decrease of ADP-induced platelet aggregation index was more than 50% as compared with the basic level, the dose of 75 mg each day would be maintained for one year. If the decrease of the index was less than 50%. the another 300 mg of clopidogrel would be given again, until up to 900 mg on the 3th day. If the decrease of the index was still not enough, the combination of clopidogrel 75 mg, cilostazol 100 mg and aspirin 100 mg each day would be suggested. The rest 615 patients in the routine dosage group took the routine dose of clopidogrel (the first loading dosage 300 mg was taken, then 75 mg each day for one year ) . The MACEs, including cardiac death, myocardium infarction, revascularization and stent thrombosis, were observed for 12 months. Results After the first 300 mg of clopidogrel, only 45% of patients reached the standards. Until reaching 900 mg, 67.5% of patients in the ADP guided group were eligible. The tailored clopidogrel loading dose in the ADP guided group yielded a better effect on the inhibition of platelet aggregation (the routine dose vs. the tailored loading dose: 45% vs. 67. 5% , P=0. 028). After one year follow up, the MACEs were less in ADP guided group than in routine dosage group (2. 8% vs. 4. 9% , P = 0. 035). All of patients had no major bleeding, and the minor bleeding and other drug adverse events in two groups had no significant differences. Conclusions The patients undergoing selected PCI should receive ADP -induced platelet aggregation test in order to assess the inhibition effect of clopidogrel on the platelet aggregation. It is safe and effective to modify the antiplatelet drugs regimen during the peri-PCI procedure in direction of ADP-induced platelet aggregation.

Percutaneous treatment with drug-eluting stent vs bypass surgery in patients suffering from chronic stable angina with multivessel disease involving significant proximal stenosis in left anterior descending artery.

BACKGROUND: The aim of the present study was to compare the effects of drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in patients suffering from chronic stable angina with multivessel disease, involving significant proximal stenosis in the left anterior descending artery (LAD). METHODS AND RESULTS: All consecutive patients suffering from chronic stable angina with multivessel disease involving significant proximal LAD stenosis underwent DES implantation (n=600) or CABG (n=709) at our institution. At 2 years, the unadjusted mortality was significantly lower in the DES group than in the CABG group (2.2% vs 5.2%, P=0.004), but the adjusted risk of death was similar (odds ratio (OR) 0.74, 95%CI 0.28-1.97, P=0.555). Furthermore, both the adjusted rate of nonfatal myocardial infarction and cerebrovascular events was also comparable. However, the unadjusted and adjusted risk of major adverse cardiac cerebrovascular events in the DES was significantly higher than in the CABG (13.3% vs 9.6%, OR 2.71, 95%CI 1.56-4.74, P<0.001), which is probably attributed to the higher subsequent revascularization rate after DES implantation. CONCLUSIONS: DES showed comparable long-term mortality for the treatment of multivessel disease involving significant proximal stenosis in LAD in comparison with CABG.

Follow-up study on application of radiofrequency ablation combined with magnetic navigation assistance system in elderly patients with atrioventricular node reentrant tachycardia / 中华老年医学杂志

Objective To explore the safety, efficacy and 1-year follow-up outcome of radiofrequency ablation combined with magnetic navigation assistance system in elderly patients with atrioventricular node reentrant tachycardia (AVNRT). Methods Forty cases of patients with AVNRT identified by the electrophysiological test were enrolled in the study. Twenty cases were ablated with magnetic navigation system. The other 20 cases underwent the conventional catheters operation. With the cardiodrive, the 8 Frablation magnetic Helios I (Stereotaxis Inc, USA) was advanced to the Koch triangle area from the inferior caval vein (IVC). With the assistance of magnetic navigation (AXIOM Artis, Siemens, Germany), the direction of tip and the advancement or retraction of the catheters were regulated. The success rate, the time of procedure, the fluoroscopy time and the 1-year follow-up outcome were analyzed, and the complications of procedure were recorded. Results Forty cases with AVNRT underwent radiofrequency ablation successfully. In magnetic navigation group, 19/20 cases underwent magnetic catheter operation. The cases who failed to finish magnetic catheter operation underwent successfully conventional catheter operation. There was no perforation complication and no significant statistic difference in the success rate between two groups. No recurring case was found in the two groups 1 year later. The total of fluoroscopy time in magnetic navigation group was more than that in standard ablation group [(16.4±2.7) min vs. (11.1±1.0)rain, P<0.01], but the decreasing trend of fluoroscopy time in magnetic navigation group was showed. The operator's fluoroscopy time in magnetic navigation group was obviously less than that in standard ablation group [(4.5±0.6) min vs. (11.1±1.0) min, P<0.01]. Conclusions The radiofrequeney ablation combining with magnetic navigation system has the similar safety and efficacy to the conventional ablation in elderly patients with AVNRT, but the operator's fluoroscopy time was significantly decreased.

Study on the prognosis of drug-eluting stent implantation in the elderly patients with coronary heart disease / 中华老年医学杂志

Objective To evaluate the prognosis of drug-during stent (DES) implantation in elderly patients versus non-elderly patients, and to determine the clinical outcome of complete revascularization strategy versus incomplete revascularization strategy in elderly patients. Methods Patients who were treated with at least 1 DES in our hospital were enrolled in the study. They were divided into 3 groups: the elderly group (aged 75～89 years), the presenium group (age 60～74years) and the non-elderly group (aged 40～59 years). The patients aged 60～89 years were further divided into complete revascularization group and incomplete revascularization group according the Percutaneous interventional the rapy (PCI) strategy. Clinical characteristics, angiographical and interventional data were collected. Results The success rate of PCI procedure was 99.3% in elderly group(n=137), 98.7% in presenium group(n= 1006), and 99.3% in non-elderly group(n= 1031).There were no significant differences among the three groups(P>0.05). The in-hospital mortality was highest in the elderly group among the three groups (1.5%, 0.4%, 0.1%, P<0.05), but the in-hospital rates of re-infarction, repeated revascularization and stroke had no significant differences among the three groups (P>0.05). During follow-up, the rates of death and stroke were highest in the elderly group(3.1%, 2.3%, 0.7%, P<0. 01;1.5% , 1.3%, 0.3%, P<0.05, respectively),but the rates of re-infarction and repeated revascularization among the three groups had no significant differences (all P>0.05). By Cox regression analysis, serum creatinine (OR= 2.961,95%CI=1. 643～5.338,P<0.01), gender (OR=2.661,95%C1=1.376～5.145 ,P<0.01), age(OR=2.687,95%CI=1.329～5.434, P<0.01), multi-vessel disease(OR= 1.735,95 %CI= 1.132～2.661, P<0.05), and old myocardial infarction (OR = 2.041 ; 95% CI = 1.026～4.061; P<0.05) were the independent predictors for all-cause death in patients aged 60～74 years. The in-hospital mortality was higher in the incomplete revascularization group than in complete revascularization group in patients aged 60～74 years (1.4% vs. 0.2%, P<0.05). Multiple logistic regression analysis revealed that the incomplete revascularization strategy was not the independent predictor of in-hospital death (OR=0.307; 95%CI=0.011～8.467; P>0.05). Conclusions Although DES implanting is successfully procedured in presenium and elderly patients, it is associated with higher in-hospital mortality, especially in patients aged ≥75 years . Presenium and elderly patients are to be more benefit from complete revascularization strategy, but the incomplete revascularization strategy does not influence the long-term outcomes.

Relationship between plasma fibrinogen and D-dimer in patients with ST-elevation myocardial infarction / 中国综合临床

Objective To study the difference in fibrinogen and D-dimer between the patients with ST-ele-vation myocardial infarction (STEMI) and those with normal angiography of coronary artery.Methods 100 patients with STEMI who underwent PCI and 100 patients with normal coronary arteriograms as controls from Jan.2005 to Dec.2007 were studied.Plasma concentrations of fibrinogen and D-dimer were compared.Results There was no significant difference in gender, age, history of hypertension and diabetes and smoking between the two groups.Plas-ma concentration of fbfinogen(Fg) was higher in control group [(2.65±0.68 )g/L ] than STEMI group [(2.38±0.91)g/L] (P<0.05).The square root of plasma concentration of D-dimer was higher in STEMI group [(13.23±5.08) μg/L] than control group [(9.40±5.03)μg/L ] (P<0.01).The square root of the rate between D-dimer and fibrinogen was higher in STEMI group (9.11±4.13 ) than control group (5.92±3.35 ) (P<0.01).Conclusion The levels of fibrinogen in patients with STEMI are significantly lower than that of control group, and D-dimer is higher in the former group than in the latter group, suggesting that fresh thrombosis and secondary fibrinolysis exit in STEMI patients at the acute stage.

Effect of anemia on long-term outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention / 中国综合临床

Objective To assess the effect of anemia on long-term outcomes in patients with acute coronary syndrome(ACS) undergoing pereutaneous coronary intervention(PCI). Methods In 3136 patients presenting with ACS,636 patients were anemic. The clinical features, mortality and major cardiocerebral events including non-fatal acute myocardial infaret,revascularization and non-fatal cerebral stroke were compared in patients with or without anemia. The average follow-up period was 550 days. Results Anemic patients were older and had a higher percentage of comorbidities compared with nonanemic cohorts. Compared with nonanemic patients, anemic patients had higher mortality (4.7% versus 1.5% ,P <0. 001) and a higher major adverse end point events,including nonfatalmyocardial infarction, stroke and revaseularization (14.2% versus 11.0%, P = 0.032). After adjustment for comorbidities, anemia was associated with a higher risk of mortality after percutaneous coronary intervention (adjusted hazard rate ratioRR2. 166 ;95% CI 1. 298-3. 612 ;P =0.003). Conclusion Anemia before PCI is an independent factor for predicting the long-term mortality of ACS.

Clinical observation on sirolimus-eluting stent implantation in left main coronary artery bifurcation lesions / 中国医师进修杂志

Objective To evaluate the acute and long-term results of stenting for left main coronary artery (LMCA) bifurcation lesions. Methods Forty consecutive patients with LMCA bifurcation lesion and normal left ventricular function were included. Sirolimus-eluting stents were performed in all patients. Results (1)The average diameter of LMCA was (0.81?0.48)mm before stenting and increased to (3.53?0.22)mm after stenting.(2)The procedural success rate was 100.0%. In-hospital events including stent thrombosis,Q-wave myocardial infarction,and emergency bypass surgery did not occur in any patients,and non-Q-wave MI in one patient (2.5%).(3)Clinical follow-up was obtained in all patients at (8.43?3.24) months. There were no death and no myocardial infarction during follow-up. The major adverse cardis events rate was 20.0%.(4)The angiographic follow-up rate was 67.5% (27 of the 40 eligible patients),and the restenosis rate was 18.5% (parent vessel only 11.1%,side branch only 3.7%,and both 3.7%).(5)Different type of operation had no influence on restenosis rate during angiographic follow-up. Conclusion Sirolimus-eluting stent implantation for LMCA bifurcation stenosis appears safe and effective with regard to acute and midterm complications.

The clinic characteristics of elderly patients with coronary ectasia / 中华老年医学杂志

Objective To investigate the clinic characteristics and treatment methods of coronary ectasia. Methods One hundred and fifty-four cases in Anzhen hospital during the last 10 years, whom with coronary aneurysm diagnosed by coronary artery angiogram and summarized the characteristics of symptom, sign, diagnosis and treatment. Results All patients were proved with coronary angiography. There were 112(72.7%)patients presenting angina, but with no specific manifestation in electrocardiogram, X-ray and echocardiogram.Thrombolysis in emergency were taken to 3 cases with acute myocardial infarction patients. One hundred and fifty-four cases were treated with aspirin or heparinizeation, and with nitroglycerin, Calcium channel blocker to dilate vessel. The followed up of 154 cases about 1-20 years, six cases were suffered with acute myocardial infarction. One of the 6 cases was reinfarction and one case was sudden death. Conclusions Angina is the main clinical manifestation and coronary angiography is the accurate diagnostic method. Long-term application with anticoagulant agent and vasodilator should be done to prevent coronary spasm and myocardial infarction. If acute myocardial infarction occurs, prompt thrombolysis should be used, if it is ineffective, coronary artery bypass grafting should be carried out.

Evaluation of varions therapies in patients with acute ST segment elevation myocardial infarction who arrived at hospitals within 12 hours from the onset of chest pain / 中国介入心脏病学杂志

75 yrs), presence of DM etc. (2) In our study, even though the door-to-ballon time was longer than the door-to-needle time, the therapentic outcome of primary PCI was better than that of thrombolysis. (3) There are improving room for guidelines application of reperfusions such as fibrinolytic and primary PCI, aspirin, ACEI, ?-blockers and cholesterol lowering agents in patients with acute ST segment elevation myocardial infarction in China.

Effects of successful percutaneous transluminal coronary angioplasty or stent implantation in the recovery period after acute myocardial infarction on QT dispersion / 中国介入心脏病学杂志

Objective To evaluate the changes of QT dispersion (QTd) after successful percutaneous transluminal coronary angioplasty (PTCA) or stent implantation during the recovery period after acute myocardial infarction (AMI).Methods We studied 57 AMI patients who underwent PTCA or stent implantation and 86 normal coronary artery subjects used as control. Maximal and minimal QT interval (QT max and QT min) and QTd (QTd=QT max-QT min) were measured using 12-lead electrocardiography within 1 d before and 1 h after PTCA and stent implantation or coronary angiography.Results QTd and corrected QT dispersion (QTcd) were significantly prolonged in patients with AMI compared with control group. There was no significant difference in QTd and QTcd between anterior AMI and inferior one. QT max, QTc max, QTd and QTcd after PTCA or stent implantation were significantly decreased.Conclusion QTd and QTcd were significantly decreased after successful PTCA or stent implantation which were performed during the recovery period of AMI, which shows it can produce beneficial effects in decreasing the risk of ventricular arrhythmia and reducing mortality in AMI patients.

Feasibility analysis of coronary angiography by transradial approach with 4 F catheter / 中国介入心脏病学杂志

Objective To assess the feasibility of coronary angiography by transradial approach with 4 F catheter.Methods The procedural details, picture quality and local complication of coronary angiography by transradial approach with 4 F catheter in 138 patients were recorded and analyzed. Results The success rate of angiography was 97.7%. Mean fluoroscopy time was 5.05?3.23 minutes with total procedural time was 20.51?3.37 minutes. The incidence of dislodgement and excessive engagement of either coronary artery was 7.8% and 9.4% repectively. The angiographic scores for left anterior descending, circumflex and right coronary arteries were 2.87?0.40, 2.88?0.39, 2.90?0.35, respectively. Vasospasm occurred in 6 cases in the radial artery and in another 2 cases in the coronary artery. There were no occlusion of radial artery found during follow up. Conclusion Four-F catheter could be utilized in selected patients for its nice maneuverability, fine images and less vascular complications during angiography.

Effect of Sirolimus-eluting stent in actual clinical practice / 中国介入心脏病学杂志

Objective To sbserve the effect of sirolimus-eluting stent in actual clinical practice. Methods The study included 263 patients who had implanted the cypher stents from December 2002 to May 2004. The incidence of MACE was followed up in all patients 8?2 months after stent implantation by means of telephone or out-patient department visit. Evaluation of the therapeutic effect was also made in the diabetes subgroup and different types of lesions, including left main, bifurcation, chronic total occlusion, diffuse disease, in-stent restenosis, littlie vessel, acute occlusion, ostial lesions, and just A-type lesions. The rate of restenosis was observed in all of the lesion. Results Among 246 patients, all patients were successfully implanted with the cypher stents, 93.5% patients had been followed up, 10 (3.8%) patients had MACE. 139 (52.6%) patient were revised by angiography. The total rate of restenosis was 10.1%, and among it 12.9% was diabetes mellitus patients, 11.1% with chronic total occlusion, 11.3% with little vessel lesion, 10.0% with diffuse lesion, 22.2% with left main lesion, 18.1% with bifurcation, 11.1 with CTO 9.1% with ostial lesions, and 8.7% with A-type lesion lesion. Conclusion Cypher stent implantion was safe and effective in actual clinical proctice. The incidence rate of MACE was low in lesions such as chronic total occlusion, diffuse disease, in-stent restenosis, littlie vessel, acute occlusion, ostial lesions, and A-type lesion. It may be beneficial for patients who had left main, bifurcation, in-stent restenosis.

Clinical evaluation of the dexamethasone coated stent in coronary small vessel disease / 中国介入心脏病学杂志

ObjectiveTo evaluate the clinical results of intracoronary implantation of the phosphorylcholine dexamethasone coated biodivysio small coronary stents. Methods Prospective analyses of long-term results of the phosphorylcholine dexamethasone coated biodivysio coronary stents, and their implantation performed on 82 coronary artery disease patients were conducted. We implanted 106 stents of which 54 were the phosphorylcholine dexamethasone coated biodivysio coronary stents, and 52 the phosphorylcholine coated biodivysio coronary stents. Results The success rate of the implantation of both groups was 100%. The major adverse cardiac events (MACE) of the 3-month follow-up in the phosphorylcholine dexamethasone coated biodivysio coronary stents group were 9.8%; and in the phosphorylcholine coated biodivysio coronary stents group were 22.0%. The restenosis rate of the 8-month follow-up in the phosphorylcholine dexamethasone coated biodivysio coronary stents group was 4.9%; and in the phosphorylcholine coated biodivysio coronary stents group was 23.0%. Conclusion The implantation of the phosphorylcholine dexamethasone coated biodivysio coronary stents is a safe and efficient interventional procedure with a high success rate and few MACE. It may reduce restenosis rate.