QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.

BACKGROUND: In hypertrophic cardiomyopathy (HCM) patients complicated with atrial fibrillation (AF), catheter ablation has been recommended as a treatment option. Meanwhile, prolongation of QTc interval has been linked to an increased AF incidence in the general population and to poor outcomes in HCM patients. However, whether QTc prolongation predicts arrhythmia recurrence after AF ablation in the HCM population remains unknown. METHODS AND RESULTS: Thirty-nine HCM patients undergoing primary AF ablation were enrolled. The ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n=27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n=12). Pre-procedural QTc was corrected by using the Bazett's formula. At a 14.8-month follow up, 23 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had longer QTc than non-recurrent patients (461.0±28.8 ms vs. 434.3±18.2 ms, P=0.002). QTc and left atrial diameter (LAD) were independent predictors of recurrence. The cut-off value of QTc 448 ms predicted arrhythmia recurrence with a sensitivity of 73.9% and a specificity of 81.2%. A combination of LAD and QTc (global chi-squared=13.209) was better than LAD alone (global chi-squared=6.888) or QTc alone (global chi-squared=8.977) in predicting arrhythmia recurrence after AF ablation in HCM patients. CONCLUSIONS: QTc prolongation is an independent predictor of arrhythmia recurrence in HCM patients undergoing AF ablation, and might be useful for identifying those patients likely to have a better outcome following the procedure.

Predictors of recurrence after a repeat ablation procedure for paroxysmal atrial fibrillation: role of left atrial enlargement.

AIMS: This study sought to explore the predictors of recurrence in patients with paroxysmal atrial fibrillation (AF) undergoing repeat catheter ablation, especially the impact of left atrial (LA) remodelling after the original procedure on the outcome of repeat procedure. METHODS AND RESULTS: Ninety-five patients undergoing repeat ablation were enrolled in this study. Repeat procedure endpoints were pulmonary vein isolation, linear block when linear ablation is performed, and non-inducibility of atrial tachyarrhythmia by burst pacing. Patients with LA enlargement between the pre-original procedure and pre-repeat procedure were categorized as Group 1 (35 patients), while individuals with no change or decrease of LA diameter were categorized as Group 2 (60 patients). The mean duration from the original procedure to the repeat procedure was 12 months (1-40 months). After 29.6 ± 20.5 (3-73) months follow-up from the repeat procedure, 33 patients experienced recurrence (34.7%). The recurrence rate was significantly higher in Group 1 than in Group 2 (51.4 VS. 25.0%, P = 0.017). In univariate analysis, LA remodelling was the only predictor of recurrence. In multivariate analysis, after adjustment for age and LA diameter, Group 1 had a greater risk of recurrence after the repeat procedure (hazard ratio = 2.22, 95% confidence interval: 1.02-4.81, P = 0.043). CONCLUSIONS: Left atrial enlargement after undergoing the original catheter ablation of paroxysmal AF was an independent risk factor of recurrence after repeat ablation.

Prior ischemic stroke is not associated with worse clinical outcomes in patients undergoing percutaneous coronary intervention.

PURPOSE: Cerebrovascular accidents (CVAs) frequently coexist with coronary artery disease (CAD) and adversely affect prognosis in patients with CAD; however, fewer studies have investigated the role of prior ischemic stroke on the outcomes of percutaneous coronary intervention (PCI). The aim of this study was to determine the safety and effectiveness of PCI in patients with a prior ischemic stroke. METHODS: A review of patients who underwent PCI between June 2003 and September 2005 (n=3893) at the Beijing Anzhen Hospital of Capital University of Medical Science, identified 295 PCI patients with a prior ischemic stroke (≥ 3 months) and 3598 patients without a prior stroke. To investigate whether prior history of an ischemic stroke was independently associated with increased risk of adverse PCI outcomes, prognostic parameters were analyzed using univariate analysis and Cox multivariate regression analysis. Propensity score analysis was then used to match the two subgroups of patients based on multiple factors known to impact cardiac outcome. RESULTS: Patients with a prior ischemic stroke had more frequent high-risk baseline characteristics (diabetes, hypertension, hyperlipidemia and prior myocardial infarction). No significant differences were found in the major adverse cardiac and cerebrovascular event (MACCEs) rates between the two groups (1.7% in the stroke group vs. 1.4% in the non-stroke group; p=0.06). Diabetes mellitus, triple vessel CAD, number of diseased vessels, chronic total occlusion and previous myocardial infarction were independent predictors of MACCE in patients with prior stroke undergoing PCI. CONCLUSIONS: This study demonstrates that, in daily clinical practice, PCI can be provided safely and with good results to patients with a prior ischemic stroke (≥ 3 months).

[Impact of diabetes on clinical outcomes following multivessel percutaneous interventions].

OBJECTIVE: To compare the rates of mortality, myocardial infarction (MI), repeat revascularization and stent thrombosis after percutaneous coronary intervention (PCI) with implantation of stents for diabetics versus nondiabetics with multivessel disease to evaluate the impact of diabetes on long-term clinical outcomes. METHODS: We consecutively recruited a total of 1985 patients with multivessel disease at our institution from July 2003 to December 2005. And they were divided into two groups of diabetes (n = 587) or non-diabetes (n = 1398). The primary endpoint was all-cause mortality at 24 months. RESULTS: After adjusting with Logistic regression, the risk of mortality in the diabetics was significantly higher than that in the nondiabetics (4.4% vs 2.0%, hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.02 to 3.67, P = 0.021). Similar outcome was also found in the adjusted risk of cardiac mortality (2.7% vs 1.1%, HR = 2.04, 95%CI 1.12 to 3.89, P = 0.032) at 24 months, although the adjusted risk of nonfatal MI and repeat revascularization was similar. However, diabetes significantly increased the risk of stent thrombosis. The major adverse cardiac event (MACE) rate was also lower in the nondiabetics (15.8% vs 11.9%, HR = 1.52, 95%CI 1.12 to 1.89, P = 0.043). CONCLUSION: In patients with multivessel disease, diabetes is correlated with increase risks of mortality, stent thrombosis and MACE at long-term follow-up compared with non-diabetes.

[The clinical outcomes of patients undergoing revascularization for acute coronary syndrome].

OBJECTIVE: To evaluate short-term and long-term prognosis of revascularization in patients with acute coronary syndrome. METHODS: A total of 6005 patients who received coronary revascularization in our institution between July 2003 and September 2005 were enrolled. The patients were followed up in clinic or by telephone after discharge between September 2006 and November 2006. The clinical and prognosis data of all-cause mortality, neo-myocardial infarction, nonfatal stroke, and re-revascularization of ST-segment elevation myocardial infarction (STEMI), non ST-segment elevation myocardial infarction (NSTEMI) and major adverse cardiovascular and cerebrovascular events (MACCE) were analyzed. RESULTS: Among 4865 acute coronary syndrome patients, 955 cases were STEMI; 263 cases were NSTEMI; and 3647 cases were unstable angina (UA) pectoris. There were no significant difference for in-hospital mortality and late mortality (18 month survival 96%, 98% and 98%) between patients with STEMI, NSTEMI and UA. Patients with UA had lower MACCE rate (18 month non-MACCE survival of STEMI, NSTEMI and UA group were 86%, 86%, and 89% respectively). CONCLUSIONS: Despite different clinical characteristics, patients with STEMI, NSTEMI and UA undergoing revascularization had similar short-term and long-term mortality. Patients with UA had lower MACCE rate.

[Comparison of percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe left ventricular dilatation].

OBJECTIVE: To compare the short- and long-term outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe left ventricular dilatation (LVD). METHODS: From July 2003 to September 2005, we enrolled 251 patients with severe LVD to undergo coronary revascularization with either PCI (n = 101) or CABG (n = 150) and analyzed the effects of different revascularization strategies on the in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS: Compared with those in the CABG group, the patients in the PCI group had lower incidence of in-hospital MACCE events [3.0% (3/101) vs 10.7% (16/150), P = 0.024], due mainly to a lower in-hospital mortality (2.0%vs 8.7%, P = 0.028). Ninety-nine (98.0%) patients in the PCI group and 136 (90.7%) patients in the CABG group were followed up for (516 ± 182) days and (515 ± 231) days, respectively. Although no difference existed in the follow-up incidence of MACCE between two groups, the PCI patients had a trend of a higher incidence of MACCE events [18.2% (18/99) vs 9.6% (13/136), P = 0.054], due mainly to a higher rate of repeat revascularization [14 (14.1%) vs (0.7%), P < 0.01]. Two patients groups had the comparable follow-up rates of mortality [4 (4.0%) vs 12 (8.8%), P = 0.151], myocardial infarction [2 (2.0%) vs 1 (0.7%), P = 0.781] and stroke [2 (2.0%) vs 0 (0.0%), P = 0.176]. CONCLUSION: For the patients with severe LVD. PCI is both safe and feasible. And it has a lower rate of in-hospital mortality, and a comparable incidence of follow-up MACCE events. However, the rate of follow-up repeat revascularization is higher.

[Status quo and factors influencing smoking cessation in cigarette smoking patients with coronary artery disease].

OBJECTIVE: To investigate the status quo of smoking cessation and analyze factors influencing smoking cessation in cigarette smoking patients with coronary artery disease (CAD). METHOD: A total of 350 smoking patients with CAD was surveyed by questionnaire, logistic regression analysis was performed to analyze factors influencing smoking cessation. RESULTS: Incidence of smoking cessation was 57.1% (200/350) in this cohort. Patients were divided into two groups, the elderly (> 65 years old, n = 111) and the young group (≤ 65 years old, n = 239). The smoking cessation rate in the elderly group is significantly higher than in the young group (71.2% vs. 50.6%, P < 0.001). Aged patients and patients with high cultural level are easier to give up smoking. Logistic analysis showed that age ≤ 65 years old (OR = 2.336, P = 0.004), low cultural level (OR = 1.310, P = 0.028), PCI (OR = 0.261, P < 0.001), coronary artery bypass graft (OR = 0.107, P = 0.004), total family income > 4000 RMB/month (OR = 1.828, P = 0.003) are risk factors for failed smoking cessation. There are 76 patients smoking again in current smokers, most due to lack of self-control (76.3%). Compared to the elderly group, there is a higher proportion of smoking again due to the need of daily communication and work in the young group. CONCLUSIONS: We still need to raise the awareness of smoking cessation for smoking patients with CAD. Following factors should be focused for tobacco control in CAD patients: younger age, lower cultural level, not treated with PCI or CABG, patients with smoking family members, higher body mass index and higher total family income.

[Metabolic syndrome may be better at predicting the prognosis of coronary artery disease than other traditional cardiovascular risk factors].

OBJECTIVE: The prevalence of cardiovascular risk factors is growing. People with metabolic syndrome (MS) plus five cardiovascular risk factors are at a higher risk of developing coronary artery disease (CAD). The effect of metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. The present study was conducted to assess the prevalence, characteristics and long-term prognosis of CAD with metabolic syndrome and to determine which factor is the most influential prognostic factor of CAD. METHODS: The DESIRE (drug-eluting stent impact on revascularization) registry represented a database of 2368 CAD patients between July 2003 and September 2004. The median long-term follow-up was 3.5 years (293 -1855 days). Metabolic syndrome was based on the modified version of Adult Treatment Panel (ATP) III Definition of Metabolic Syndrome in 2005 using body mass index (BMI) instead of waist circumference. We tested the utility of MS and its components to predict the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascularization. RESULTS: The presence of MACCE was predicted only by MS (OR = 1.319, 95% CI 1.020 - 1.706, P = 0.035) but not other cardiovascular risk factors, such as advance age, male, smoking, high LDL cholesterol and CAD family history. MS was present in 45.6% (high fasting glucose 44.5%; high triglyceride 45.0%; low HDL 50.8%; high blood pressure 61.4%; high BMI 60.7%). CONCLUSION: Among the traditional cardiovascular risk factors, only metabolic syndrome has a primary predictive ability for MACCE in CAD patients.

[Impact of overweight on clinical outcomes in patients undergoing coronary revascularization].

OBJECTIVES: To determine the impact of BMI on clinical outcome in patients with heart failure underwent coronary revascularization. METHODS: The DESIRE-plus (Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry of coronary revascularization in our institution between July 1, 2004 and September 30, 2005. We analyzed heart failure patients with the complete data of body mass index (BMI) data from the DESIRE-plus trial and grouped them by BMI (normal BMI group, BMI < 24; overweight group, BMI 24-27.9; obesity group, BMI > or = 28). Total mortality, cardiac mortality and MACCE including death, neo-myocardial infarction, stroke, re-revascularization were recorded. We evaluated risk estimates for three bodyweight groups. RESULTS: 1010 patients were included in the study (295 in normal BMI group; 495 in overweight group and 220 obesity group). Median follow-up was 542 days. Overweight and obese patients were younger (59.3 +/- 10.14 years, 58.6 +/- 10.30 years vs 62.6 +/- 9.93 years, P < 0.01) and had a significantly higher incidence of hypertension (61.2, 66.8% vs 52.5%, P = 0.017), stable angina pectoris (21.2%, 23.7% vs 17.0%, P = 0.05) and higher triglyceride [(1.90 +/- 1.05) mmol/L, (2.10 +/- 1.12) mmol/L vs (1.48 +/- 0.92) mmol/L, P < 0.01)], fasting blood glucose level [(6.07 +/- 2.09) mmol/L, (5.96 +/- 1.53) mmol/L vs (5.67 +/- 1.92) mmol/L, P = 0.021), blood creatinine (84.9 +/- 21.7) micromol/L, (90.2 +/- 30.9) micromol/L vs (82.2 +/- 25.8) micromol/L, P = 0.002] compared with normal BMI patients. Multivariate Cox regression model showed obese patients had an decreased hazard risk (HR) for total mortality (0.285, 95%CI 0.104 - 0.777) and MACCE (0.596, 95%CI 0.401 - 0.885) compared with those for patients with normal BMI, overweight patients had no increased risk for total mortality (HR 0.769, 95%CI 0.442 - 1.338) and MACCE (0.998, 95%CI 0.754 - 1.322), there was hardly any significantly difference in cardiac mortality between three groups (P = 0.223). CONCLUSION: There were more risk factors in heart failure patients with coronary heart disease complicated with obesity or overweight, but the prognosis after revascularization of them is at least no worse than the normal weight coronary heart disease patients.

[Effect of statin therapy on mortality in patients with non-ischemic dilated cardiomyopathy].

OBJECTIVE: To explore the effect of early statin therapy (atorvastatin and simvastatin) on mortality in patients with non-ischemic dilated cardiomyopathy. METHODS: A retrospective study was conducted at a single center. A total of 315 patients with non-ischemic dilated cardiomyopathy, admitted into our hospital from January 2002 to December 2008, were enrolled. The association of statin therapy at the initial hospitalization with all-cause mortality was evaluated. The median follow-up period was 45.1 months. RESULTS: By the single-factor analysis, we found that the follow-up mortality was 17.2% in statin group and it was significantly lower than 37.4% of non-statin users (P = 0.003); in patients with worsening cardiac function NYHA III - IV, the mortality of statin group was 17.2% while a much higher mortality of 47.4% was found in non-statin users (P = 0.003); in patients with NYHA I - II, no significant difference was found in mortality between two groups. By the multi-factor analysis adjusting for age, gender, history of hypertension, diabetes mellitus, current cigarette smoking, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, left ventricular ejection fraction, NYHA functional class, use of angiotensin-converting enzyme inhibitor, ß blocker, aldosterone, other diuretics, digoxin and calcium channel blocker, we found the relative risk (RR) of death in statin use was 0.352 (95%CI 0.135 - 0.920, P = 0.033). In patients with NYHA III - IV, the relative death risk of statin therapy was 0.250 (95%CI 0.081 - 0.778, P = 0.017). CONCLUSIONS: Early treatment of atorvastatin or simvastatin is closely correlated with the reduction of mortality in non-ischemic dilated cardiomyopathy patients, especially in those with severe heart failure. And the correlation is independent of the lipid-lowering effects of statins, ACEI and ß-blocker therapy.

Obstructive sleep apnoea risk profile and the risk of recurrence of atrial fibrillation after catheter ablation.

AIMS: The aim of this study was to identify the impact of obstructive sleep apnoea (OSA) on recurrence after catheter ablation of paroxysmal atrial fibrillation (AF). METHODS AND RESULTS: One hundred and seventy-eight consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. The patients were divided into high risk (HR group) and low risk (LR group) for OSA group with Berlin questionnaire. Of the 178 patients, 104 (58.4%) were in the HR group and 74 (41.6%) were in the LR group. After a mean follow-up of 344 +/- 137 (91-572) days, 44 patients (24.7%) experienced recurrence, and the recurrence rate did not differ between the HR (25.0%) and LR groups (24.3%, P = 0.855). Cox analysis revealed that PV isolation was the only independent predictor of recurrence (hazard ratio 5.11, 95% confidence interval 1.42-18.47, P = 0.013). There was no significant difference in the incidence of complications between the HR and LR groups (2.9 vs. 1.9%, P = 0.729). CONCLUSION: The recurrence rate and incidence of complications did not differ in patients with different risk profiles for OSA. The presence of OSA should not lower the decision threshold to choose an ablative procedure in paroxysmal AF.

Pre-hospital statin therapy may not reduce incidence of all-cause mortality and overall MACCE during hospital stay after coronary artery bypass graft surgery.

BACKGROUND: The available literature has not been able to demonstrate the exact association between preoperative statin therapy and the reduction in the rates of major adverse cardiac and cerebrovascular events (MACCE). The aim of this study is to explore these unanswered questions. METHODS: A review of patients having CABG surgery between June 2003 and September 2005 (n=2013) was performed at Beijing Anzhen Hospital of the Capital University of Medical Science The preoperative demographic, morbidity and co-morbidity variability and the preoperative medications were compared between two groups: group I, on statins, n=904; group II, not on statins, n=1109. A Cox proportional hazard analysis was performed to determine the independent risk-reducing association with outcome variability after CABG surgery. RESULTS: Our study demonstrated that pre-hospital statins therapy did not reduce the risk of all-cause mortality or overall MACCE during hospital stay (1.7% versus 2.4%, respectively, P > 0.05; 4.4% versus 4.5%; P > 0.05, respectively). Compared with patients not receiving statin therapy, the hazard ratio for all-cause mortality during hospital stay was 0.696 (95% CI, 0.394-1.231, P = 0.213). The significant predictors of mortality during follow-up are age, triple-vessel CAD and blood creatinine (Cr) level. CONCLUSIONS: Pre-hospital statin therapy did not reduce the risk of mortality or the rates of MACCE during in hospital stay after CABG surgery.

[Effects of chronic renal insufficiency and anemia upon long-term outcomes in patients undergoing percutaneous coronary intervention].

OBJECTIVE: To assess whether chronic renal insufficiency and anemia are significant independent and combined predictors of poor long-term outcomes after percutaneous coronary intervention (PCI). METHODS: We examined the clinical and outcome data of 3770 PCI patients based on the pre-PCI values of glomerular filtration rate (GFR) and hemoglobin (Hb). Depending on their baseline GFR and Hb, the patients were classified into six groups: normal renal function with anemia or not; mild renal impairment with combined anemia or not; severe renal insufficiency with anemia or not. The clinical features and prognosis of patients were compared. RESULTS: Significant differences were found between the groups regarding female gender, age, body mass index, prior history of hypertension, diabetes mellitus, prior stroke, acute coronary syndrome, systolic blood pressure, left ventricular ejection fraction, total serum cholesterol, LDL-C and angiographic features (P < 0. 01). When evaluated as continuous variables, GFR and Hb were independent predictors of long-term mortality after adjusting for effects of each other (GFR: HR 0.979, 95% CI 0.960-0.999, P = 0.035; Hemoglobin: HR 0.952, 95% CI 0.921-0.984, P = 0.004). Mild renal insufficiency with anemia (HR 4.123, 95% CI 1.637-10.386, P = 0.003), severe renal insufficiency without anemia (HR 5.287, 95% CI 1.627-17.183, P = 0. 006) and severe renal insufficiency with anemia (HR 7.134, 95% CI 2.180-23.342, P = 0.001) having a statistically significant decrease in survival in patients undergoing PCI . CONCLUSION: Renal insufficiency and anemia are significant independent and combined predictors of long-term mortality in patients undergoing PCI.

Comparison of contrast enhanced 64-slice computed tomography and transesophageal echocardiography in detection of left atrial thrombus in patients with atrial fibrillation.

BACKGROUND AND OBJECTIVE: Recent advances in multi-slice computed tomography (MSCT) have allowed an improved analysis of left atrial (LA) and left atrial appendage (LAA) anatomy prior to catheter ablation of atrial fibrillation (AF). However, data regarding the ability of MSCT to identify LA/LAA thrombus are limited. This prospective study compared the efficacy of 64-slice contrast-enhanced computed tomography (64CCT) with transesophageal echocardiography (TEE) of the heart in the identification of LA/LAA thrombus. MATERIALS AND METHODS: One-hundred and seventy consecutive patients scheduled for first-time catheter ablation of paroxysmal (n = 120) or persistent (n = 50) AF were enrolled for study. Each patient underwent non-gated 64CCT and TEE of the heart for exclusion of LA/LAA thrombus prior to ablation procedure. RESULTS: Fourteen cases (8.2%) of LA/LAA thrombi were interpreted by 64CCT (ten false-positive, four true positive), whereas 11 actual thrombi (6.5%) were detected by TEE (seven false-negative by 64CCT) in the same population. Maximal dimension of TEE identified thrombi did not differ between the false-negative by 64CCT group and the true-positive group (17 +/- 6 vs. 18 +/- 5 mm P = 0.677). Results indicated 64CCT sensitivity = 36.4%, specificity = 93.7%, positive predictive value = 28.6%, and negative predictive value = 95.5% in the detection of LA/LAA thrombus. The Kappa value in evaluating the agreement between 64CCT and TEE for detection of LA/LAA thrombus was 0.267. CONCLUSION: Compared to gold standard TEE, 64CCT was shown to be less reliable in the detection of LA/LAA thrombus prior to catheter ablation in patients with AF.

[Anemia as an independent predictor of poor long-term outcomes after percutaneous coronary intervention].

OBJECTIVE: To assess whether anemia is an independent predictor of poor long-term outcome after percutaneous coronary intervention (PCI). METHODS: The second drug-eluting stent impact on revascularization registry (DESIRE-2) is a single-center registry of 6005 patients undergoing coronary revascularization from July 2003 to September 2005. We examined the clinical data and outcome of 3809 PCI patients based on hemoglobin (Hb) value before the interventional procedure. Patients were classified as anemia using the World Health Organization definition (< 120 g/L in women and < 130 g/L in men). 744 of the 3809 patients were anemic. We compared the clinical features and prognosis of the patients with or without anemia. RESULTS: Anemic patients were older and had a higher percentage of comorbidities as compared with the nonanemic ones. When compared with nonanemic patients, anemic patients had higher mortality (4.7% vs 1.5%, P < 0.001) and higher major adverse event end points, including nonfatal myocardial infarction, stroke and revascularization (14.0% vs 10.8%, P = 0.014). After adjustment for comorbidities, anemia was associated with a higher risk of mortality after percutaneous coronary intervention (RR 2.216, 95% CI 1.019-4.428; P = 0.024). CONCLUSIONS: Anemia is an independent predictor of mortality after PCI. Since PCI is a common procedure and anemia is a frequent condition in the general population, strategies for the management of anemic PCI patients should be developed.

[Medical therapy in revascularized coronary artery disease patients].

OBJECTIVE: To evaluate the status of medical therapy in the revascularized coronary artery disease (CAD) patients treated in Anzhen Hospital. METHODS: 2048 CAD patients who received revascularization during July 2003 to June 2004 were registered in DESIRE database. The methods of revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] and use of medicines [aspirin, betablocker (BB), statins, angiotension converting enzyme inhibitor (ACEI) etc] during hospitalization and during the follow-up were recorded. The patients were followed up for a mean time of 587 +/- 127 days. RESULTS: The prescription rates of aspirin, BB, statins, and ACEI were 93.9%, 88.9%, 67.7%, and 62.9% respectively. 58.9% of the patients used combined aspirin, BB, and statins; and 39.7% of the patients used combined aspirin, BB, statins, and ACEI. The prescription rates of these drugs was all significantly higher in the PCI group than in the CABG group (all P < 0.001). The prescription rates of these drugs during follow-up were 90.8%, 57.4%, 43.0%, and 24.5% respectively, all significantly lower than those during hospitalization (all P < 0.001). The prescription rates of these medicines were all significantly higher in Beijing compared with in the areas other than Beijing (all P < 0.001). CONCLUSION: The CAD patients who received revascularization show a high proportion of using secondary prevention drugs during hospitalization, and the prescription rates of these drugs decrease significantly during follow-up, especially in those who received CABG and who live outside Beijing.

[Prevalence of unrecognized diabetes and risk factor control among patients with coronary heart disease and prognosis thereof].

OBJECTIVE: To evaluate the prevalence of unrecognized diabetes in patients with coronary heart disease, the control of the risk factors of CHD, and the long-term prognosis of these patients. METHODS: The clinical data of CHD patients with complete data, including clinical characters, target organ damage, percentage of controlled risk factors, and clinical results during follow up in the DESIRE (Drug-Eluting Stent Impact on REvascularization) database were analyzed. RESULTS: 3763 patients after revascularization for coronary heart disease were registered in the DESIRE database, 3683 of which had complete data recorded. 721 of the 3683 patients (19.8%) had established diabetes at admission, 303 (10.2%) without history of diabetes had fast glucose higher than the diagnostic criteria of diabetes. Another 722 patients had impaired fast glucose (IFG). 47.4% of the 3683 CHD patients had impaired glucose metabolism. The prevalence rates of systolic blood pressure>or=140 mm Hg, low density lipoprotein cholesterol>or=2.6 mmol/L, and current smoker at admission were 46.2%, 59.4%, and 48.8% respectively, all significantly higher than those of the established diabetes patients and those without (P=0.05, 0.0001, and 0.0001 respectively). The prevalence of three vessel disease was 41.6%, similar to that of the established diabetic patients (45.7%), and significantly higher than that of those without diabetic (P=0.0001). The percentage of creatinine>132 mmo/L signifying impaired renal function was 8.7% in the patients with unrecognized diabetes, significantly higher than those of the other 3 groups (all P=0.0001). 80.6% patients were followed up for a mean time of 30.0+/-12.1 months. The mortality rate of the patients with unrecognized diabetes was 5.7%, significantly higher than those of the patients with established diabetes (4.3%), those with IFG (3.6%), and those without diabetes (2.3%, all P=0.01). The rate of major adverse cardiac and cerebral events of the patients with unrecognized diabetes was 13.9%, similar to that of patients with established diabetes (14.3%), and significantly higher than that of the patients without diabetes (10.0%, P=0.01). CONCLUSION: The prevalence rate of diabetes is high in the CHD patients, the diagnosis of one third of which is missed. The target organ damages are more common and the risk factors control is poor among these patients. The prognosis of unrecognized patients after revascularization is poor in comparison with other groups.

[Prognosis of metabolic syndrome in coronary artery disease patients of different genders].

OBJECTIVE: To analyze the prevalence and characteristics of metabolic syndrome (MS) in the patients with coronary artery disease (CAD) of different genders who underwent revascularization. METHODS: The clinical data of 2596 patients in the DESIRE (Drug-eluting Stent Impact on Revascularization) study who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were analyzed and the patients were followed up till death. MS was diagnosed based on the Chinese standard (modified ATP III). RESULTS: The mean follow-up time was 828.8 +/- 373.2 days. 1139 of the 2596 patients were diagnosed as with MS. The prevalence of MS in the female patients was 50.9%, significantly higher than that in the male patients (41.8%, P < 0.0001). Complication of MS was the only predictive factor of poor prognosis in female CAD patients (OR = 2.019, 95% CI = 1.751 - 2.506, P = 0.023). Fasting blood glucose >or= 110 mg/dl was responsible for most of the increased risk associated with MS (adjusted OR 2.511, 95% CI 1.396 approximately 4.511, P = 0.002). CONCLUSION: In comparison with the male patients the female patients undergoing revascularization have a higher he prevalence of MS and worse prognosis. In the 4 elements of MS hyperglycemia is directly associated with prognosis.

[Risk factors related to mortality in old patients with coronary heart disease after revascularization].

OBJECTIVE: To evaluate the risk factors related to mortality in old patients with coronary heart disease after revascularization. METHODS: A total of 675 patients (498 males) with age >or= 70 years old who received revascularization during July 2003 to June 2004 and followed up > 30 days after discharge were included in this study. Clinical characteristics, death and major adverse cardiac and cerebral events (MACCE) during follow up were recorded. RESULTS: The patients were followed up for a mean period of (754 +/- 355) days. 27 patients (4.0%) died and MACCE developed in 50 patients (7.4%) during follow up. Female and patients with anemia took a significantly higher risk of mortality (RR = 2.750, 95% CI 1.116 - 6.779, P = 0.028, RR = 0.385 95% CI 0.164 - 0.904, P = 0.028, respectively); Creatinine level is positively related to mortality rate. When comparing patients with Cr > 115 micromol/L and Cr > 177 micromol/L with patients with Cr < 115 micromol/L, the hazard rate was 2.963 and 10.785, respectively (95% CI 1.114 - 9.952, P = 0.035 and 95% CI 2.659 - 78.097, P = 0.000) after adjustment for other risk factors. CONCLUSION: Preexisting anaemia (male Hb < 120 g/L, female Hb < 110 g/L), renal insufficiency (Cr > 115 micromol/L) and female gender were found to be independent risk factors for mortality in old patients with coronary heart disease post revascularization.

Effect of metabolic syndrome on prognosis and clinical characteristics of revascularization in patients with coronary artery disease.

BACKGROUND: People with metabolic syndrome are at higher risk for developing coronary artery disease (CAD). The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease. METHODS: The DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was (829 +/- 373) days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome, using body mass index (BMI) instead of waist circumference. RESULTS: Of 2596 patients with complete records of height, weight, and so on, 1280 (49.3%) were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid (all P < 0.0001), with higher creatinine [(10.5 +/- 4.3) mg/L vs (9.9 +/- 2.9) mg/L, P < 0.0001] and the number of white blood cells [(7.49 +/- 2.86) x 10(9)/L vs (7.19 +/- 2.62) x 10(9)/L, P = 0.008) compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations (left main artery and/or > or = 2-vessel) (73.6% vs 69.6%, P = 0.031). There were no significant differences of major adverse cardiac and cerebral events (MACCE) or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (11.8% vs 10.0%, P = 0.044). Fasting blood glucose (> or = 1000 mg/L) and triglyceride (TG, > or = 1500 mg/L) were responsible for most of the increased risk associated with the metabolic syndrome (adjusted OR 1.465, 95% CI 1.037 - 1.874, P = 0.032; OR 1.378, 95% CI 1.014 - 1.768, P = 0.044). CONCLUSIONS: The prevalence of metabolic syndrome was very high in CAD patients. The metabolic syndrome confers a higher risk of long term MACCE in patients with CAD, and dysglycaemia and hypertriglycaemia appear to be responsible for most of the associated risk.