[The value of CMR high-risk attributes in predicting ventricular remodeling in ST-segment-elevation myocardial infarction patients with mildly reduced or preserved ejection fraction].

Objective: To evaluate the predictive value of a multiparametric cardiac magnetic resonance (CMR) approach for ventricular remodeling in ST-segment-elevation myocardial infarction (STEMI) patients with mildly reduced or preserved left ventricular ejection fraction (LVEF). Methods: This study is a prospective cohort study. STEMI patients with acute LVEF>40% after primary percutaneous coronary intervention (PCI) in Beijing Anzhen Hospital from October 2019 to September 2021 were enrolled. All patients received acute (3-7 days) and follow-up (3 months) CMR post-PCI. According to absence or presence of ventricular remodeling, patients were divided into ventricular remodeling group and non-ventricular remodeling group. Basic clinical characteristics and CMR indicators were analyzed and compared between the two groups. Logistic regression and receiver operating characteristic (ROC) curves were used to explore the predictive performance of CMR high-risk attributes for ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF. The predictive value of combining multiple high-risk characteristics of CMR for ventricular remodeling was analyzed and compared with the traditional clinical risk factor model. Results: A total of 123 STEMI patients were enrolled (aged (57.1±11.1) years, 102 (82.9%) males). There were 97 cases (78.9%) patients in the non-ventricular remodeling group and 26 cases (21.1%) in the ventricular remodeling group. After adjustment for clinical risk factors, stroke volume<51.6 ml, global circumferential strain>-13.7%, infarct size>39.2%, microvascular obstruction>0.5%, and myocardial salvage index<43.9 were independently associated with ventricular remodeling in STEMI patients with mildly reduced or preserved LVEF. The incidence of ventricular remodeling increased with the increasing number of CMR high-risk attributes (P<0.01). The number of CMR high-risk attributes ≥3 was an independent predictor of adverse remodeling (adjusted OR=5.95, 95 CI%: 2.25-15.72, P<0.01) in STEMI patients with mildly reduced or preserved LVEF. Furthermore, the number of CMR high-risk attributes had incremental predictive value over baseline clinical risk factors (area under curve: 0.843 vs. 0.696, P<0.01). Conclusions: In STEMI patients with mild reduced or preserved LVEF, 5 CMR characteristics are associated with ventricular remodeling. The combination of ≥3 CMR high-risk characteristics is an independent predictor of ventricular remodeling, which has incremental predictive value beyond traditional risk factors in this patient cohort.

[Multimorbidity in elderly patients with acute coronary syndrome: insights from BleeMACS registry].

Objective: To assess the prevalence, pattern and outcome of multimorbidity in elderly patients with acute coronary syndrome (ACS). Methods: Secondary analysis was performed based on the data from the BleeMACS registry, which was conducted between 2003 and 2014. We stratified elderly patients (≥65 years) according to their multimorbidity. Multimorbidity was defined as two or more chronic diseases in the same individual. Kaplan-Meier methods were used to estimate 1 year event rates for each endpoint, and comparisons between the study groups were performed using the log-rank test. The primary endpoint was net adverse clinical events (NACE), which is a composite of all-cause mortality, myocardial infarction, or bleeding. Results: Of 7 120 evaluable patients, 6 391 (89.8%) were with morbidity (1 594 with 1, 2 156 with 2, and 2 641 with ≥3 morbidity). Patients with morbidity were older, percent of female sex and non-ST-elevation acute coronary syndromes and implantation rate with drug-eluting stents and blood creatine level were higher compared to patients without morbidity. Compared with the patients without morbidity, the proportion of participants with oral anticoagulant increased in proportion to increased number of morbidities (5.8% vs. 6.4% with 1 morbidity, 7.3% with 2 morbidities, 9.0% with ≥3 morbidities, P trend<0.01) and the proportion of participants with clopidogrel prescription decreased in proportion to increased number of morbidity (91.9% vs. 89.7% with 1 morbidity, 87.9% with 2 morbidities, 88.6% with ≥3 morbidities, P trend = 0.01). During 1 year follow-up, compared with those with no morbidity, the hazard ratio (HR) and 95% confidence interval (CI) of risk of NACE for those with 1, 2, and ≥ 3 morbidities was 1.18 (0.86-1.64), 1.49 (1.10-2.02), and 2.74 (2.06-3.66), respectively (P < 0.01). Multimorbidity was not associated with an increased risk of bleeding of various organs (P>0.05). Conclusion: Multimorbidity is common in elderly patients with ACS. These patients might benefit from coordinated and integrated multimorbidity management by multidisciplinary teams.

[Impact of obstructive sleep apnea on the long-term cardiovascular outcomes in patients with acute coronary syndrome].

Objective: To investigate the impact of obstructive sleep apnea (OSA) on long-term cardiovascular outcomes in patients with acute coronary syndrome (ACS). Methods: This is a single-center, prospective cohort study. Between June 2015 to January 2020, consecutive ACS patients hospitalized at Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients underwent portable sleep breathing monitoring, and they were then divided into moderate/severe OSA group (apnea-hypopnea index (AHI)≥15 events/hour) and no/mild OSA group (AHI<15 events/hour). The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, ischemia-driven revascularization and hospital admission for unstable angina or heart failure. MACCE were compared yearly by the log-rank test. Multivariable Cox regression analyses were performed to determine the independent predictors of MACCE. Results: A total of 1 927 patients with ACS were enrolled, including 1 629 males (84.5%), aged (56.4±10.5) years. Moderate/severe OSA was present in 1 014 (52.6%) patients. Compared with no/mild OSA group, moderate/severe OSA group exhibited a higher body mass index (P<0.05). Hypertension, prior PCI were more prevalent in moderate/severe OSA group (both P<0.05). The difference of ACS category between the two groups was statistically significant (P=0.021). The rate of patients who underwent PCI and the number of stents were higher in the moderate/severe OSA group. During a 5-year follow-up (median 2.9 years (IQR 1.5-3.6 years)), the cumulative incidence of MACCE was significantly higher in the moderate/severe OSA group than in the no/mild OSA group (34.0% vs. 24.0%, HR=1.346, 95%CI 1.100-1.646, log-rank P=0.004). The cumulative incidence of MACCE remained statistically higher at 4 and 5 year in the moderate/severe OSA group as compared to the no/mild OSA group (33.3% vs. 22.9%, HR=1.397, 95%CI 1.141-1.710, log-rank P=0.001; 34.0% vs. 24.0%, HR=1.341, 95%CI 1.096-1.640, log-rank P=0.004, respectively). Multivariate analysis showed that moderate/severe OSA (HR=1.312, 95%CI 1.054-1.631, P=0.015) was an independent predictor of long-term MACCE in ACS patients. Conclusions: Moderate/severe OSA is observed in more than 52% ACS patients. Moderate/severe OSA is an independent predictor of long-term MACCE.

[Impact of iron deficiency on prognosis of heart failure patients with preserved ejection fraction].

Objective: To investigate the impact of iron deficiency (ID) on prognosis in heart failure patients with preserved ejection fraction (HFpEF). Methods: A total of 215 consecutive patients with HFpEF, who visited the cardiovascular outpatient department of Beijing Anzhen Hospital, were enrolled in this prospective study. The plasma ferritin level and transferin saturation were measured. Patients were divided into two groups: ID group and non-ID group. ID patients were further divided into absolute ID subgroup and functional ID subgroup. Patients were followed up to 1 year. The endpoints of the study were all-cause mortality and rehospitalization for heart failure (HF). The independent predictors of outcome were determined by Cox regression model. The quality of life of patients was evaluated at the end of the follow-up. Results: The age of this patient cohort was (67±8) years, 39.1% patients were male. The prevalence of ID was 54.4%. Within one year of follow-up, 37 patients (17.2%) died and 70 patients (32.6%) were rehospitalized for HF. Compared to non-ID group, patients in ID group were older, had higher heart rate, lower plasma hemoglobin level and estimated glomerular filtration rate (eGFR) value, had a higher prevalence of anemia and chronic kidney disease (P all<0.05). Kaplan-Meier curves showed that all-cause mortality and rehospitalization for HF in HFpEF patients with ID were higher than patients without ID, and prognosis was similar between patients with absolute ID and functional ID. Multivariable regression analysis showed that ID was an independent predictor for all-cause mortality and rehospitalization for HF in HFpEF patients. The of 6 minutes walking distance was shorter ((356.0±98.3)m vs. (389.2±94.3)m, P=0.023), and the value in Kansas city cardiomyopathy questionnaire was lower ((58.06±10.43) m vs. (61.51±11.64) m, P = 0.039) in patients with ID than patients without ID. Conclusion: In patients with chronic HFpEF, ID is an independent predictor for all-cause mortality and rehospitalization for HF at one year of follow-up, independent of the types of ID.

[Relationship between waist-hip ratio and sleep-disordered breathing in patients with acute coronary syndrome and its effect on long-term prognosis].

Objective: To investigate the relationship between different waist-hip ratios and sleep-disordered breathing (SDB) in patients with acute coronary syndrome (ACS) and its effect on patients' long-term prognosis. Methods: A total of 725 patients who were diagnosed with ACS in the emergency ward of Beijing An Zhen Hospital from June 2015 to May 2017 were included, and all the patients were monitored for sleep and breathing. Patients were divided into four groups according to their waist-hip ratios. The differences of SDB-related indicators among the four groups were compared, and the correlation between different waist-hip ratios and SDB was analyzed using multiple logistic regression. COX regression analysis and Kaplan-Meier curve were used to compare the prognostic differences among the four groups. Results: As the waist-hip ratio increased, the apnea hypopnea index (AHI) (P=0.004) and the proportion of sleep apnea hypopnea syndrome (OSAHS) increased (39.3% vs 46.0% vs 53.2% vs 60.0%, P=0.004). Meanwhile, the number of hypoventilation increased, and the mean and minimum arterial oxygen saturation (SaO(2)) decreased (all P<0.001). Logistic regression analysis showed that high waist-hip ratio was significantly related with OSAHS (OR=2.579, 95%CI 1.521-4.373, P<0.001). The survival curves showed the highest incidence of major cardio-cerebral vascular events (MACCE) occurred in the high waist-hip ratio group (Log Rank P=0.036). COX regression analysis showed that high waist-hip ratio was an independent risk factor for MACCE in ACS patients (HR=2.855, 95%CI 1.375-5.929, P=0.005). Conclusions: In ACS patients, central obesity is related with SDB. Patients with high waist-hip ratio have a poor prognosis. Elevated waist-hip ratio and SDB jointly impact the prognosis of ACS patients.

[Effect of moderate or severe obstructive sleep apnea on cardiac structure and function in patients with acute coronary syndrome].

Objective: To investigate the effect of obstructive sleep apnea (OSA) on cardiac structure and function in patients with acute coronary syndrome (ACS). Methods: A total of 767 patients with ACS consecutively hospitalized at the Emergency & Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017 were enrolled in this study. There were 637 males and 130 females. Patients who met the inclusion criteria according to the sleep apnea hypopnea index (AHI) were examined with portable sleep respiration monitoring. Patients were divided into moderate or severe OSA group (AHI≥15,n=389) and non or mild OSA group (AHI<15, n=78). The general information and echocar diographic results were analyzed. The data fitted normal distribution were compared between the groups with independent sample t test. Results: The body mass index [(27.8±3.6) vs (25.8±3.4) kg/m(2), t=-7.854, P<0.01], neck circumference [(41.1±4.2) vs (39.3±3.2) cm, t=-6.717, P<0.01] and waist-to-hip ratio (0.99±0.54 vs 0.97±0.53, t=-4.735, P<0.01) at admission were significantly higher in moderate or severe OSA group than those in non or mild OSA group. The left ventricular end-diastolic diameter, inter-ventricular septum thickness, left atrial diameter,right atrial diameter were all significantly higher, and the E/A peak ratio was remarkably lower in the moderate or severe OSA group (t=-2.130, 0.278, -3.045, -2.241, 2.260, all P<0.05). Conclusion: Moderate or severe OSA may aggravate cardiac remodeling and diastolic function in ACS patients.

[Risk factors and prognoses analysis of new-onset atrial fibrillation in patients with acute myocardial infarction].

Objective: To explore the risk factors and prognoses of new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI). Methods: A total of 468 patients with AMI were admitted into Beijing Anzhen Hospital for emergency pereutaneous coronary intervention (PCI). According to the NOAF occurred during hospitalization, the patients were divided into two groups: the NOAF (n=37) group and the non-NOAF (n=431) group. Parameters including general clinical conditions, coronary lesions, echocardiography, biochemical markers, C-reactive protein (CRP) , N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and myocardial markers were collected. In-hospital mortality and incidence of in-hospital main adverse cardiovascular and cerebrovascular events (MACCE) were compared between the two groups. Logistic multivariate regression analyses were performed for the association between the risk factors and NOAF. Results: The incidence of NOAF was 7.9% in AMI patients undergoing emergency PCI. There were no significant differences in door-to-balloon time, weight, platelet counts, baseline serum creatinine (SCr), postoperative SCr, triglyceride, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, uric acid, glycosylated hemoglobin A1c, preoperative medication, number of lesions, thrombus aspiration, location of myocardial infarction, and history of hypertension, diabetes, peripheral vascular disease and old myocardial infarction between the two groups. The percentage of women was in the NOAF group (32.4% vs. 16.7%, P<0.05) and subjects in this group were significantly elder than those in the non-NOAF groups [(66±10) years vs. (571±11) years, P<0.001]. Moreover, the levels of no-reflow rate (40.5% vs. 12.6%, P<0.001) , CRP [25.2 (15.43, 29.97) mg/L vs.5.21 (2.33, 16.98) mg/L, P<0.001], white blood cell counts [(11.19±3.44)×10(9) vs. (9.91±3.23)×10(9), P=0.022], NT-pro-BNP [(652.6±108.8) ng/L vs. (258.3±105.9) ng/L, P<0.001], and troponin I (TnI) [20.41(1.78, 87.89) µg/L vs.7.72(1.29, 36.39) µg/L, P=0.006] were significantly higher in the NOAF group than in the non-NOAF group, while left ventricular ejection fraction [(47.70±7.34)% vs. (53.35±8.05)%, P<0.001], and hemoglobin [137.0(125.5, 146.0) g/L vs.144.0(133.0,156.0) g/L, P=0.042] were significantly lower in the NOAF group than the non-NOAF group. Patients in the NOAF group had significantly longer hospital stay than those in the non-NOAF group [(8.7±5.6) d vs. (6.0±2.3) d, P=0.007]. The in-hospital mortality (8.1% vs 1.4% P=0.004) and the incidence of in-hospital MACCE (37.8% vs. 7.7%, P<0.001) in the NOAF group were significantly higher than those in the non-NOAF group. Logistic multivariate regression analyses showed that age (HR 1.083, 95%CI 1.028-1.141, P=0.003), CRP (HR 1.116, 95%CI 1.049-1.187, P=0.001), NT-pro-BNP (HR 1.463, 95%CI 1.001-4.064, P=0.001) and no-reflow (HR 4.388, 95%CI 1.006-19.144, P=0.049) were independent predictors of NOAF after AMI. Conclusions: Age, elevated levels of CRP, NT-pro-BNP, and the absence of no-reflow are risk factors for incident NOAF in patients with AMI in hospital.

[Prospective cohort study on the impact of moderate/severe obstructive sleep apnea on the prognosis of patients with acute myocardial infarction].

Objective: To investigate the impact of moderate/severe obstructive sleep apnea (OSA) on the prognosis of acute myocardial infarction. Methods: We prospectively selected patients with acute myocardial infarction (AMI) who were hospitalized at the Emergency Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017. Patients who met the inclusion criteria were examined with portable sleep respiration monitoring. Patients were divided into moderate/severe OSA group (apnea-hypopnea index (AHI)≥15 beats/hour) and no/mild OSA group (AHI<15 beats/hour) according to sleep AHI. The incidence of major adverse cerebrovascular events (MACCE) after discharge was compared between the two groups, and the independent risk factors of MACCE were analyzed. Results: A total of 432 patients were enrolled in this study, including 211 moderate/severe OSA patients (48.8%). Compared with no/mild OSA group,patients with moderate/severe OSA had higher body mass index ((27.17±3.22) kg/m(2) vs. (25.55±3.44) kg/m(2), t=-5.033,P<0.001), higher proportion of history of percutaneous coronary intervention (PCI) (18.5%(39/211) vs. 8.6%(19/221), χ(2)=9.076,P=0.003), and higher proportion of 3-vessel disease (31.3%(66/211) vs. 24.9%(55/221), χ(2)=10.196,P=0.017). The median follow-up time was 1.0 (0.7, 1.7) years. The incidence of MACCE in the moderate/severe OSA and no/mild group was 19.9%(42/211) and 11.3%(25/221), respectively. Kaplan-Meier analysis showed a higher cumulative risk of MACCE in patients with moderate/severe OSA (log-rank test,χ(2)=5.467, P=0.019). Multivariate Cox regression analysis showed that moderate/severe OSA (HR=1.915, 95%CI 1.016-3.611, P=0.045) and diabetes mellitus (HR=1.819, 95%CI 1.022-3.238, P=0.042) were independent risk factors for MACCE at 1 year post discharge in patients with AMI. Conclusions: Nearly half of AMI patients are complicated with moderate/severe OSA in this patient cohort. Coronary artery disease is more severe in AMI patients complicating with moderate/severe OSA. Moderate/severe OSA is an independent risk factor for MACCE at 1 year after discharge in patients with AMI. Whether the prognosis of AMI can be improved by intervention of OSA remains to be investigated. Trial Registration: Clinical Trial.gov, NCT03362385.

[Association between hypothyroidism and sleep breathing disorders in patients with coronary heart disease].

Objective: To explore the association between hypothyroidism and sleep breathing disorders in patients with coronary heart disease (CHD). Methods: A total of 784 patients with CHD were consecutively enrolled at the Emergency & Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017. According to thyroid function test results, patients were divided into hypothyroidism group (79 cases) and non-hypothyroidism group (705 cases). All patients had undergone sleep monitoring. The sleep apnea status was compared between the two groups. Multivariate logistic regression and linear regression models were used to analyze the association between hypothyroidism and sleep breathing disorders in patients with CHD. Results: The proportion of females, mean body weight and body mass index in the hypothyroidism group were higher than those in the non-hypothyroidism group [26.6% vs.16.2%, (78.6±11.6) kg vs. (75.7±12.0) kg, (27.7±3.2) kg/m(2) vs. (26.6±3.5) kg/m(2), all P<0.05]. Patients in hypothyroidism group had a decreased average oxygen saturation (SaO(2)) compared with patients in non-hypothyroidism group [ (93.2±2.9) % vs. (93.9±2.0) %, P=0.030]. In addition, events of hypoventilation in hypothyroidism group were significantly higher than those in non-hypothyroidism group[92.5 (45.8, 758.3) times vs. 68.0 (33.0, 125.0) times, P=0.013]. There were no significant differences in apnea hypopnea index, diagnosis of obstructive sleep apnea and other sleep breathing parameters between the two groups (P>0.05). A multiple linear regression analysis found that in patients with CHD, the correlation between hypothyroidism and average sleep SaO(2) was significant (ß=-0.508, 95%CI -0.989--0.026, P=0.039). Conclusions: CHD patients with hypothyroidism had a lower sleep average SaO(2), and a higher sleep hypopnea events. There is a correlation between hypothyroidism and sleep hypoxia in patients with CHD. Clinical trial registration: clinicalTrials.gov, NCT03362385.

[Development and prospective validation of an ischemic risk score for acute chest pain patients with normal high-sensitivity troponin I levels and without obvious ST-segment deviation].

Objective: To develop and prospectively validate a risk score for acute chest pain patients with normal high-sensitivity troponin I (hs-TnI) levels and without obvious ST-segment deviation in China. Methods: Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients met inclusion criteria including normal hs-TnI levels and without obvious ST-segment deviation were included. The endpoint (major adverse cardiovascular events) was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, and all-cause death within 3 months after initial presentation. Predictors were screened and used to develop the risk score model by logistic regression analysis in a retrospective cohort. Then, the risk score model was evaluated in a prospective validation cohort. Results: The study population of derivation cohort included 1 735 consecutive chest pain patients. Finally, 1 030 eligible patients were enrolled. Multivariate regression analysis defined five independent predictors: male gender (ß=0.88); history of chest pain (ß value of moderate and high suspicion of coronary heart artery was 2.70 and 3.51 respectively); electrocardiogram (ß=0.84); ≥60 years old (ß=0.51) and ≥3 risk factors (ß=0.85).The range of weighted score was set as 0-13. The area under a receiver operating characteristic (ROC) curve was 0.75 (95%CI 0.72-0.78) in the final model. Major adverse cardiovascular events rates increased in proportion to score increase (P<0.01). The internal validity used bootstrap technique showed the same predictor factors as the final model, and its area under a ROC curve was 0.75(95%CI 0.72-0.78).MACE rates in the low risk group (score 0-3), intermediate risk group (score 4-7), and high risk group (score 8-13) were 1.3% (1/77) ,19.0% (22/116) ,and 42.2% (122/289) in the prospective validation cohort, respectively (P<0.01). Conclusion: The developed ischemic risk score is feasible for risk stratification of acute chest pain patients with normal hs-TnI and without obvious ST-segment deviation, this score might be helpful to the decision making of treatment and management strategies for these patients.

[Risk factors of cardiac rupture in patients with acute myocardial infarction].

Objective: To analyze the risk factors of cardiac rupture in patients with acute myocardial infarction. Methods: Clinical data were analyzed from 10 284 acute myocardial infarction patients admitted to Beijing Anzhen Hospital from January 2012 to March 2015. Cardiac rupture occurred in 81 patients, including 67 patients of acute left ventricular free wall rupture and 14 patients of ventricular septal defect, were retrospectively analyzed. Binary logistics regression analysis was performed to analyze the risk factors of cardiac rupture. Results: Incidence of cardiac rupture was significantly higher in patients with ST-segment elevation myocardial infarction than in patients with non-ST-segment elevation myocardial infarction (1.5%(70/4 724) vs. 0.2%(11/5 560), P<0.01). Binary logistic regression analysis showed that age (OR=0.827, 95%CI 0.726-0.941, P<0.01), recurrent myocardial infarction during hospital(OR=0.001, 95%CI 0.000-0.418, P<0.05), systolic blood pressure(OR=1.114, 95%CI 1.029-1.206, P<0.01), left anterior descending artery lesion (OR=0.003, 95%CI 0.000-0.334, P<0.05), lower hemoglobin(OR=1.129, 95%CI 1.051-1.212, P<0.01), serum total protein (OR=1.453, 95%CI 1.070-1.971, P<0.05), and serum magnesium level (OR=0.000, 95%CI 0.000-0.001, P<0.01) were associated with cardiac rupture. Conclusion: Older age, recurrent myocardial infarction, lower systolic blood pressure, left anterior descending artery lesion, lower serum hemoglobin, lower serum total protein, and higher serum magnesium level are risk factors of cardiac rupture and these factors should be carefully managed to prevent the occurrence of cardiac rupture.

[Impact of concomitant use of P2Y12 inhibitors and proton pump inhibitors on ischemia events in patients with acute coronary syndrome in real world].

Objective: The study aimed to analyze the impact of concomitant administration of P2Y12 inhibitors and PPIs on ischemia events in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: We retrospectively analyzed data from a international, multi-center registry between 2003 and 2014 in patients with ACS after PCI, grouped the cohort into patients receiving PPIs or no PPIs and assessed 1-year clinical endpoint (all-cause death/re-infarction). Meanwhile, we grouped the cohort into patients receiving clopidogrel or ticagrelor, and compared the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year clinical endpoint. Results: Of 9 429 patients in the final cohort, 54.8% (n=5 165) was prescribed a PPI at discharge. Patients receiving a PPI were more likely to have comorbidities. No association was observed between PPI use and the clinical endpoint (HR 1.00, 95% CI 0.86-1.18). Meanwhile, no association was found between PPI use and the clinical endpoint in patients receiving either clopidogrel or ticagrelor. And the clinical endpoint in patients administrated of clopidogrel and PPIs had no difference with that of ticagrelor and PPIs. Conclusions: In patients with ACS following PCI, increased risk of ischemia event was not found in the concomitant use of PPIs and P2Y12 inhibitors, and especially, compared with ticagrelor, clopidogrel was found no association with ischemia events when concomitant administrated with PPIs.

Overall obesity is leveling-off while abdominal obesity continues to rise in a Chinese population experiencing rapid economic development: analysis of serial cross-sectional health survey data 2002-2010.

BACKGROUND: Obesity epidemic is related to industrialization and urbanization that have lead to changes in nutrition, lifestyle and socio-economic status. However, information on the trajectory of the obesity epidemic in populations experiencing rapid economic development is limited. We therefore investigate trends in obesity from 2002 to 2010 in a southern Chinese population experiencing world's fastest economic development. METHODS: Between 2002 and 2010 four standardized surveys were conducted in a population of 85 million residents in Guangdong, China. Multistage cluster sampling was adopted to recruit representative samples. Weight, height and waist circumference of the participants were measured in a standardized way. The analysis included residents aged between 18 and 69 years. The number of participants included in the present analysis for Surveys conducted in 2002, 2004, 2007 and 2010 were 13058, 7646, 6441 and 8575, respectively. RESULTS: From year 2002 to 2010, the age-standardized Body mass index (BMI) insignificantly changed from 21.7 kg m(-2) to 22.3 kg m(-2), and the prevalence of overweight and overall obesity from 15.8 to 16.6% (both P>0.05). The age-standardized waist circumference increased from 73.7 to 78.4 cm, and prevalence of abdominal obesity increased from 12.9 to 23.7% (both P<0.001). In urban areas, BMI and overall obesity changed little during the 8-year period (BMI increased from 22.6 to 22.7 kg m(-2) and overall obesity changed from 23.7 to 21.4%), whereas there were slight increases of the same in rural areas (BMI increased from 20.8 to 22.1 kg m(-2)and overall obesity increased from 8.2 to 13.3%). Waist circumference and abdominal obesity increased significantly in both areas, but the increase was more pronounced in rural areas (in urban area, waist circumference increased from 75.1 to 78.5 cm and abdominal obesity from 16.8 to 26.5%; in rural area, waist circumference from 72.2 to 78.3 and abdominal obesity from 8.8 to 22.0%). CONCLUSIONS: BMI and overall obesity in this population, which has experienced the world's fastest economic development over the past three decades, has been leveling-off, while waist circumference and abdominal obesity, independent predictors of cardiovascular risk, have continued to rise. Our findings suggest that obesity epidemic transition in rapidly developing populations may be much faster than what has been observed in Western countries.

The effect of pre-hospital statins therapy on incidence of in-hospital death and total MACCE in patients with PCI.

OBJECTIVE: To investigate the influence of preoperative statin therapy on rate of major adverse cardiac and cerebrovascular events (MACCE) during hospital stay after successful percutaneous coronary intervention (PCI). METHODS: Review of patients who underwent PCI between June 2003 and September 2005 (n = 3893) at Beijing Anzhen Hospital of Capital University of Medical Science. (Group I, on statins, n = 3361; group II, not on statins, n = 532). To investigate if preoperative statin therapy was independently associated with the reduction in the risk of adverse postoperative outcomes after PCI. Prognostic factors were assessed using Cox multivariate regression analysis to determine if preoperative statin therapy was independently associated with a reduction in the risk of adverse postoperative outcomes. RESULTS: Our study demonstrated that preoperative statin therapy was not associated with a reduction in risk of mortality and overall MACCE during the hospital stay (0.3% vs. 0.4%; 1.4% vs. 1.2%P > 0.05, respectively).Compared with patients not receiving statins therapy, the hazard ratio for mortality in hospital was 0.738 (95% CI, 0.499-1.211, P = 0.229). CONCLUSIONS: Preoperative statin therapy did not reduce the risk of mortality and the rates of MACCE during the hospital stay after successful PCI. Cox multivariate regression analysis showed that independent prognostic parameters for mortality were Age, LVEF<50%, Triple vessel CAD, and DM (diabetes mellitus).