Risk factors of major bleeding in patients undergoing off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

Objective To identify the risk factors of major bleeding in patients undergoing off-pump coronary artery by-pass grafting( OPCAB) .Methods Data on coronary artery disease patients who underwent off-pump CABG between December 2009 and December 2014 were reviewed.Baseline characteristics were compared between patients with clopidogrel discontinua-tion ≥5 days and <5 days.Univariate and multivariate logistic regression analyses were performed to investigate the risk fac-tors of perioperative major bleeding.Major bleeding was defined as the Universal Definition of Perioperative Bleeding(UDPB) class 3 -4.Results A total of 3988 patients who underwent OPCAB were included in this study.Major bleeding rate was 9.23%(n=368).Multivariable regression analysis showed that female sex(OR=1.99, 95%CI:1.57-2.52), age(OR=1. 02, 95%CI:1.00-1.03), lower BMI(BMI≤25 kg/m2)(OR=1.40,95%CI:1.12-1.75), decreased GRF(GFR<60 ml/min)(OR=1.43,95%CI:1.01-2.02), decreased preoperative Hct(Hct <0.40)(OR =1.57, 95%CI: 1.23-1.99) and clopidogrel discontinuation <5 days(OR=1.97, 95%CI:1.58-2.44) conferred a higher risk of perioperative major bleeding during OPCABG.Conclusion Female, advanced age, lower BMI, decreased GRF, decreased preoperative Hct and clopi-dogrel discontinuation<5 days are independent risk factors of perioperatice major bleeding in patients undergoing OPCAB .Pre-dicting risk of major bleeding can help sugeons to optimize perioperative management .

Impact of Anemia on Prognosis of Elder Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention / 中国循环杂志

Objective: To evaluate the impact of anemia on prognosis of elder patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: A total of 908 consecutive ACS patients elder than 60 years of age with PCI in our hospital from 2010-06 to 2012-06 were studied. According to WHO deifnition of anemia (HB Results: There were 31%of patients suffering from anemia. Anemia group had more patients with the elder age, female gender, diabetes, hypertension, chronic kidney disease, decreased LVEF, more patients with 3 vessel-disease, and higher mortality at 1 year after PCI, higher rate of MACCE than those in Non-anemia group, all P Conclusion: Anemia may increase the incidences of mortality and MACCE in elder ACS patients after PCI for a long-term.

Impact of transradial coronary procedures on radial artery.

OBJECTIVE: We evaluated the impact of transradial coronary procedures on the radial artery (RA). METHODS: A total of 355 patients who underwent the transradial coronary procedures including transradial coronary angiography (CAG) and percutaneous coronary intervention (PCI) were enrolled. The right RA (RRA) was examined by ultrasound. RESULTS: The mean RRA diameter was 2.37 +/- 0.57, 1.95 +/- 0.50, and 2.23 +/- 0.41 mm, respectively, before the procedure, 1 day, and 1 month after the procedures (P < .01 at 1 day, P < .05 at 1 month). The mean intima-media thickness of RRA was 0.25 +/- 0.12, 0.69 +/- 0.31, and 0.38 +/- 0.17 mm, respectively, before the procedure, 1 day and 1 month after the procedure (P < .01 at 1 day, P < .05 at 1 month). The incidence of RRA stenosis was 0%, 15.7%, and 7.6%, respectively; the incidence of RRA occlusion was 0%, 2.8%, and 1.7%, respectively, before the procedure,1 day and 1 month after the procedure. CONCLUSIONS: Transradial coronary procedures can lead to early RA injury, but this repairs later.

The clinical study of low-dose facilitated PCI in acute myocardial infarction / 中国实用内科杂志

Objective To evaluate the efficacy and safety of facilitated PCI(low-dose rt-PA combined with percutaneous coronary intervention)in acute myocardial infarction(AMI).Methods One hundred and sixteen patients with AMI were divided into low-dose facilitated PCI group(n=69)and direct PCI group(n=47).69 patients in low-dose facilitated PCI group were treated with an intravenous drip of 50 mg rt-PA and PCI,while 47 patients in direct PCI group were treated with PCI.The rates of recanalization before and after PCI,and the left ventricular ejection fraction(LVEF)and major hemorrhage and major adverse cardiac events(MACE)in hospital were compared in two groups.Results There was no significant difference in the interval from hospitalization to the PCI between low-dose facilitated PCI group and direct PCI group.Compared with direct PCI group,the rates of recanalization and TIMI grade 3 before PCI were significantly higher in low-dose facilitated PCI group(44.7% vs 21.7%,P

Effect of early treatment with clopidogrel in patients with non-ST-elevation acute coronary syndrome undergoing early percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To evaluate the short-term effect of early treatment with clopidogrel before elective coronary stenting in patients with NSTE-ACS,compared with treatment with clopidogrel at the time of the procedure. Methods Patients with NSTE-ACS undergoing elective coronary stenting were randomly divided into two groups: early treatment group (n=272) and control group (n=265). Patients in the early treatment group were given clopidogrel immediately since hospitalization (300 mg loading dose, then 75 mg once daily); while in the control group, patients were given clopidogrel (300 mg) after coronary angiography followed by 75 mg per day after PCI. The composite endpoints were death, recurrent angina pectoris, instent thrombosis, myocardial infarction and urgent target vessel revascularization within 30 days after coronary stenting. Results Differences in baseline characteristics among patients between the two groups were negligible. There were no significant difference in the target vessel lesions requiring stenting between the 2 groups. Compared with the control group, early administration of clopidogrel showed a lower rate of death, myocardial infarction, refractory ischaemia, instent thrombosis and revascularization within 30 days of PCI. Conclusion Compared with administration of clopidogrel at the time of coronary stenting, pre-treatment with clopidogrel in patients with NSTE-ACS could significantly reduce the odds of adverse cardiovascular event and improve clinical outcomes within 30 days of PCI.