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Abstract Background The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment-elevation myocardial infarction. Objectives The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year. Methods We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%. Results A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE). Conclusions We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however.
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ABSTRACT Introduction: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. Methods: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. Results: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. Conclusion: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.
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@#Objective To retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. Methods Clinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. Results Finally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. Conclusion Iatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.
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RESUMEN Introducción y objetivos: El alta hospitalaria temprana (dentro de las primeras 48 horas) en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tratados con angioplastia coronaria primaria con stent (ATCp) ha sido adoptada en países desarrollados. Sin embargo, su implementación en Sudamérica ha sido dispar. Material y métodos: Estudio piloto de intervención no controlado, argentino, de pacientes con IAMCEST de bajo riesgo tratados con ATCp, para evaluar tasa de alta temprana y comparar la incidencia de eventos cardiovasculares adversos mayores (MACE) con la que ocurre en pacientes externados en forma no temprana. Resultados: Desde 2013 hasta 2021 se trataron con ATCp 320 pacientes con IAMCEST, de los que 158 fueron de bajo riesgo. Alta temprana en 63,9% (IC 95% 55,9-71,4%). La diabetes (OR 0,31; IC 95% 0,12-0,83) y el IAMCEST anterior (OR 0,34; IC 95% 0,16-0,69) se asociaron en forma independiente con menor probabilidad de alta temprana. Durante una mediana de seguimiento de 27,2 meses, la razón de tasas de incidencia de MACE entre los grupos de alta temprana y no temprana fue de 0,77 (IC 95 % 0,25-2,58; p = 0,61). Las variables asociadas de forma independiente con MACE fueron la revascularización completa (HR 0,18; IC 95% 0,03-0,95) y el tiempo de fluoroscopía (HR 1,02; IC 95% 1,01-1,05). No hubo diferencias significativas en las complicaciones del acceso vascular, las tasas de reingreso a 30 días y sobrevida global entre los grupos. Conclusiones: El alta temprana en pacientes con IAMCEST de bajo riesgo tratados con ATCp puede ser factible incluso en países en desarrollo, sin aumento significativo de la morbimortalidad.
ABSTRACT Background and objectives: Early discharge (within the first 48 hours) in patients with ST-segment elevation myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (PCI) with stenting is a strategy that has been adopted in developed countries. However, its implementation in South America has been uneven. Methods: We conducted an uncontrolled intervention pilot study on low-risk STEMI patients managed with primary PCI to evaluate the early discharge rate and compare the incidence of major adverse cardiovascular events (MACE) with those occurring in patients discharged later. Results: Of 320 STEMI patients managed with primary PCI from 2013 to 2021, 158 were low-risk patients and 63.9% (95% CI 55.9-71,4%) of them were discharged early. Diabetes (OR 0.31, 95% CI 0.12-0.83), and anterior wall STEMI (OR 0.34, 95% CI 0.16-0.69) were independently associated with lower probability of early discharge. During a median follow-up period of 27.2 months, the incidence rate ratio of MACE between the early discharge and non-early discharge groups was 0.77 (95% CI 0.25-2.58; p = 0.61). The variables independently associated with MACE were complete revascularization (HR 0.18, 95% CI 0.03-0.95) and fluoroscopy time (HR 1.02, 95% CI 1.01-1.05). There were no significant differences in vascular access complications, 30-day readmission rate and overall survival between groups. Conclusions: Early discharge in low-risk STEMI patients managed with primary PCI may be feasible even in developing countries, without significantly increasing morbidity and mortality.
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Background: Acute coronary syndrome patient outcomes have been improved using early invasive techniques. The aim of this study was to investigate the incidence, location, and severity of bleeding in PCI-treated cases to identify patient risk profiles and increased bleeding occurrences. Methods: This prospective observational study evaluated percutaneous coronary angiography in 80 patients with hypertension and diabetes mellitus who planned to undergo primary or elective PCI. The cases were separated into 2 groups; those who reported bleeding (n=11) and those who did not (n=69). All patients underwent physical examination, laboratory evaluation, 12-lead electrocardiography, and PCI. Results: In univariate regression analysis, age (OR: 1.09, 95% CI: 1.009 – 1.192), female gender (OR: 4.32, 95% CI: 1.157 – 16.131), history of peripheral arterial disease (OR: 7.31, 95% CI: 1.585 – 33.742), and femoral site of vascular access (OR: 9.6, 95% CI: 2.263 – 40.721) were independent predictors of major bleeding after PCI. In multivariate regression analysis, age (OR: 1.12, 95% CI:1.014 – 1.269), female gender (OR: 13.75, 95% CI: 1.983 – 161.2), history of peripheral arterial disease (OR: 43.38, 95% CI: 3.754 - 1042) and femoral site of vascular access (OR: 13.29, 95% CI: 2.233 – 128.5) were independent predictors of major bleeding after PCI. Conclusions: Patients who reported bleeding after PCI had a significantly higher age, prevalence of female sex, serum creatinine, and transfemoral intervention before and after intervention compared to patients who did not report bleeding, while haemoglobin and transradial intervention before and after intervention were significantly lower in the bleeding cases than in the non-bleeding cases.
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Abstract Background Patients with degenerated saphenous vein grafts (SVG) have a higher risk of developing no-reflow. The CHA2DS2-VASc score was established as a no-reflow predictor in patients with acute coronary syndrome (ACS). Objectives In our study, we aimed to assess the association between CHA2DS2-VASc score and no-reflow after the procedure and short-term mortality in patients with SVG who underwent elective percutaneous coronary intervention (PCI). Methods Our retrospective study comprised 118 patients who were divided into two groups according to the occurrence of the no-reflow phenomenon. The groups were compared on the basis of demographic characteristics, angiographic parameters, CHA2DS2-VASc scores, and outcome. A logistic regression analysis was additionally performed to determine the predictors of no-reflow. A p value of < 0.05 was considered statistically significant. Results Mean age of the participants was 66.4 ± 9.2 years, and 25.4% of them were female. Apart from the history of diabetes (p = 0.032), demographic data, blood parameters, ejection fraction, total stent length and diameter, medication use, median CHA2DS2-VASc score, and adverse cardiac events did not differ between the groups. In univariate logistic regression analysis, the presence of diabetes and stent length appeared to be associated with no-reflow, but not in multivariate analysis. The median CHA2DS2-VASc score was higher in non-survivors at 1-year follow-up (4.5 versus 3, p = 0.047). Conclusions In our study, we did not observe a significant relationship between no-reflow and CHA2DS2-VASc score. Larger studies are needed to reveal the indicators of improved post-intervention reperfusion in elective SVG PCI.
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Introduction: Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndromes (ACS). The aim of this study was to compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI. Methods: This retrospective multi-center study included all patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation, those indicated for urgent CABG, and patients in cardiogenic shock were excluded. Included patients were divided into two groups according to the stenting strategy either single or two stents. Six months follow up data were collected by telephone calls and by examination of medical records. Results: Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. 93 patients (59%) were treated by single stent while 65 patients (41%) were managed by two-stents strategy. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%±11.20 vs 71.88%±15.05, t= -5.39, p <0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 mins) and contrast volume (259.23± 59.45 vs 232.58± 96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However, the angiographic success rates (residual stenosis ?30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MCp=0.151). There is no significant difference in the overall incidence rate of MACE in both groups 6 months following the index procedure (13.9 % vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents. Conclusion: Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of MACE were comparable to one stent strategy, on medium-term follow up.
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The present study assessed incidence, risk factors, in-hospital and short-term outcomes associated with no-reflow in patients undergoing percutaneous coronary intervention (PCI) in STEMI, NSTEMI, unstable angina and stable angina. Out of 449 patients, 42 (9.3%) developed no-reflow. Hypertension, dyslipidemia, obesity and smoking were significant risk factors. There was significant association of no-reflow with left main disease, multiple stents, target lesion length_x0001_ 20 mm and higher thrombus grade. Interestingly, 93 patients (23.4%) of normal flow had myocardial perfusion grade (MPG) of 0/1 with mortality in 9 (10%) patients. No-reflow is associated with poor in-hospital and short-term outcomes with higher incidence of death, cardiogenic shock, heart failure and MACE. Knowledge of risk factors of no-reflow portends a more meticulous approach to improve final outcomes. MPG could be better predictor of outcomes in these patients.
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Abstract Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.
Resumen Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.
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Background: Revascularization of the coronary arteries is associated with better short term and long term prognosis in patients having multivessel coronary artery disease (MV-CAD) and chronic kidney disease (CKD). However, whether revascularization using coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) using drug eluting stents (DES) is better remains unknown. Objectives: To compare the outcomes of revascularization by multi-vessel PCI using DES versus revascularization by CABG in patients with CKD having multivessel CAD, regarding in-hospital and one-year major adverse cardiovascular and cerebrovascular events (MACCE). Methods: This was a retrospective analysis of the data of a group of patients having CKD with eGFR less than 60 ml/min with multivessel CAD who underwent revascularization by PCI or revascularization by CABG and were compared as regards in-hospital and one-year MAACE. Results: A total of 565 patients were reviewed in this study, 230 patients had multivessel PCI using DES while 335 patients had CABG. Comparing both revascularization groups regarding in-hospital MACCE, patients who had mutli-vessel PCI had significantly lower in-hospital mortality, cerebrovascular events (stroke/TIA) and lower total MACCE than patients who had CABG (P-value = 0.03 & 0.01 & 0.04 respectively). When comparing both revascularization groups regarding one-year MACCE, patients who had mutli-vessel PCI had significantly lower cerebrovascular events and total MACCE than those patients who had CABG (P-value = 0.02 & 0.03 respectively). Conclusion: This is a retrospective study to determine which strategy is better for revascularization of CKD patients having multivessel CAD; we can conclude that multi-vessel PCI using DES for CKD patients and multivessel CAD had advantages over CABG regarding in-hospital and one-year cerebrovascular accidents (TIA/stroke) and regarding total MACCE. Larger randomized controlled trials are required to confirm our findings.
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SUMMARY BACKGROUND: The simplified Selvester QRS score is a parameter for estimating myocardial damage in ST-elevation myocardial infarction. ST-elevation myocardial infarction leads to varying degrees of impairment in left ventricular systolic and diastolic function. Myocardial performance index is a single parameter that can predict combined left ventricular systolic and diastolic performance. OBJECTIVE: We investigated the relationship between Selvester score and myocardial performance index in patients undergoing primary percutaneous coronary intervention for acute anterior myocardial infarction. METHODS: The study included 58 patients who underwent primary percutaneous coronary intervention for acute anterior myocardial infarction. Selvester score of all patients was also calculated at 72 h. Patients were categorized into two groups according to the Selvester score. Those with a score <6 (low score) were considered group 1 and those with a score ≥6 (high score) were considered group 2. RESULTS: When compared with group 1, patients in group 2 were older (p=0.01) and had lower left ventricular ejection fractions (50.3±4 vs. 35.6±6.9, p=0.001), and conventional myocardial performance index (0.52±0.06 vs. 0.69±0.08, p=0.001), lateral tissue Doppler-derived myocardial performance index (0.57±0.08 vs. 0.72±0.08, p=0.001), and septal tissue Doppler-derived myocardial performance index (0.62±0.07 vs. 0.76±0.08, p=0.001) were higher. There was a high correlation between lateral tissue Doppler-derived myocardial performance index and conventional myocardial performance index and Selvester score (r=0.80, p<0.001; r=0.86, p<0.001, respectively) and a moderate correlation between septal tissue Doppler-derived myocardial performance index and Selvester score (r=0.67, p<0.001). CONCLUSIONS: The post-procedural Selvester score can predict lateral tissue Doppler-derived myocardial performance index and conventional myocardial performance index with high sensitivity and acceptable specificity in patients undergoing primary percutaneous coronary intervention for acute anterior myocardial infarction.
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With the rapid development of imaging and percutaneous coronary intervention, the application of contrast media has become more and more widespread, and contrast-associated AKI has become one of the most common causes of acute kidney injury. Contrast-associated AKI seriously threatens patients' health and brings greater economic burden to patients, so it is particularly important to prevent the contrast-associated AKI. Nicorandil is a common vasodilator drug in clinical practice, widely used in the treatment of angina pectoris, with the effects of anti-oxidative stress, anti-apoptosis, anti-inflammatory and vasodilation, and is considered to be effective in preventing contrast - associated AKI. However, there is still a lack of further research on the efficacy of nicorandil in preventing contrast-associated AKI.
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Objective:To analyze the status of in stent restenosis (ISR) in patients with acute myocardial infarction (AMI) and diabetes mellitus (DM) one year after percutaneous coronary intervention (PCI), and explore the risk factors.Methods:From December 2019 to December 2020, 158 patients with AMI and DM who were treated by PCI in Qionghai Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Hainan Medical College were selected. They were followed up for one year after surgery to calculate the incidence of ISR. The patients were divided into ISR group and non ISR group according to whether ISR occurred. The difference of clinical data between the two groups was compared. Logistic regression was used to analyze the risk factors for the occurrence of ISR in AMI patients with DM 1 year after PCI.Results:55 patients were followed up for 1 year, and the incidence of ISR was 34.81% (55/158). There were significant difference between ISR group and non ISR group in hypertension history, old myocardial infarction history, smoking, exercise ratio, preoperative low density lipoprotein cholesterol (LDL-C), total bilirubin (TBIL), blood uric acid (UA), plasma fibrinogen (FIB), glycosylated hemoglobin (HbA 1c) levels, coronary artery lesion number, stenosis degree, stent length, stent diameter (all P<0.05). Multivariate logistic regression analysis showed that hypertension history, smoking, LDL-C, FIB, HbA 1c and stent length were independent risk factors for ISR in AMI patients with DM after PCI, and exercise and appropriate increase of stent diameter were protective factors (all P<0.05). Conclusions:The incidence of ISR in AMI patients with DM at 1 year after PCI is relatively high, and its occurrence is related to many factors. In order to reduce the risk of ISR after PCI, we should encourage smoking cessation, exercise, strengthen the monitoring of biochemical indicators, and appropriately increase the diameter of stent during PCI.
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Objective:To investigate the role of serum CX3CR1 in the diagnosis of coronary artery stenosis and in the evaluation of prognosis after percutaneous coronary intervention.Methods:A total of 101 patients with coronary artery stenosis (≥ 50% stenosis) confirmed with coronary angiography (CAG) in Haiyang People's Hospital from January 2018 to May 2019 who were followed up till May 2021 were included in the observation group. Thirty-four healthy individuals who underwent physical examination during the same period were included in the control group. Patients in the observation group were divided into an in-stent restenosis group (ISR group, n = 28) and a non-ISR group ( n = 73). The expression of CX3CR1 was detected. The incidence of adverse cardiac events was calculated. The sensitivity, specificity, and area under the curve (AUC) plotted for the use of CX3CR1 to diagnose coronary artery stenosis and predict adverse cardiac events were evaluated. Results:The expression of CX3CR1 in the observation group was (3.95 ± 1.05) μg/L, which was significantly higher than (2.30 ± 0.65) μg/L in the control group ( t = 2.87, P < 0.05). The receiver operating characteristic curve analysis showed that the AUC, sensitivity, and specificity of the use of CX3CR1 in diagnosing coronary artery stenosis were 0.892, 75.2%, and 88.2%. The incidence of non-fatal myocardial infarction, angina pectoris, heart failure, and cardiac death in the ISR group was significantly higher compared with the non-ISR group ( χ2 = 8.06, 7.17, 8.06, 7.17, all P < 0.05). The receiver operating characteristic curve analysis results showed that the AUC value of CX3CR1 in predicting non-fatal myocardial infarction, angina pectoris, heart failure, and cardiac death were 0.786, 0.895, 0.997, and 0.887, respectively. Conclusion:CX3CR1 is highly expressed in coronary artery stenosis, which can provide a reference for the diagnosis and prognostic evaluation of coronary artery stenosis.
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Objective:To investigate the pathological characteristics, treatment timing, and prognosis of de Winter syndrome.Methods:Six patients with de Winter syndrome who received treatment in the Department of Cardiovascular Medicine, The First People's Hospital of Tianmen from July 2017 to September 2020 were included in this study. The clinical risk factors, characteristics of coronary artery lesions, electrocardiogram evolution, echocardiography, high-sensitivity troponin, and brain natriuretic peptide were evaluated. All patients were followed up for 12 months after discharge.Results:Among the six patients included, four patients underwent coronary angiography and percutaneous coronary intervention. Coronary angiography results showed that anterior descending artery lesions occurred in all patients, consisting of occlusion of the anterior descending artery in three patients and severe stenosis of the anterior descending artery in one patient. After surgery, TIMI3 blood flow recovered in all patients. Electrocardiogram showed anterior wall ST segment elevation in five patients, and anterior wall and inferior wall ST segment elevation in one patient. One patient refused to undergo coronary angiography and was discharged after conservative management with drugs. de Winter syndrome was not identified in time in one patient. The patient died after being admitted to the hospital through routine procedures. Five recovered patients were followed up for 12 months, consisting of one patient who was re-admitted because of heart failure, and four patients in whom no adverse events occurred.Conclusion:Identification of electrocardiogram manifestations of de Winter syndrome and implementation of coronary angiography and percutaneous coronary intervention as early as possible can substantially reduce mortality rate and improve long-term prognosis.
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Objective:To investigate the application value of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals.Methods:The clinical data of 51 patients with acute coronary syndrome who received treatment in Feng Tai People's Hospital from January 2020 to January 2022 were retrospectively analyzed. They were divided into a control group ( n = 25) and an observation group ( n = 26). The control group was given standard dual antiplatelet and statin drugs. The observation group underwent percutaneous coronary intervention and stent implantation based on conventional drug treatment. All patients were followed up for 1 year. Cardiac function indexes left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups. The number of readmissions, length of hospital stay, quality of life score, medication, the incidence of complications, and the incidence of adverse cardiovascular events were compared between the two groups. Results:Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (both P > 0.05). After treatment, LVEF was increased, and LVEDD was decreased in each group compared with before treatment. After treatment, LVEF and LVEDD in the observation group were (50.34 ± 5.97)% and (49.01 ± 5.02) mm, respectively, which were significantly superior to (45.61 ± 5.42)% and (52.12 ± 5.24) mm in the control group ( t = -2.96, 2.17, both P < 0.05). After treatment, the number of readmissions in the observation group was significantly less than that in the control group [(0.8 ± 0.1) times vs. (2.1 ± 0.3) times, t = 20.14, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.4 ± 3.1) days vs. (25.3 ± 3.9) days, t = 13.10, P < 0.001]. Quality of life score in the observation group was significantly higher than that in the control group [(85.3 ± 5.9) points vs. (72.5 ± 5.2) points, t = -8.19, P < 0.001]. After treatment, the incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group [3.9% (1/26) vs. 28.0% (7/25), χ2 = 3.94, P = 0.041). Conclusion:Use of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals is feasible. It can improve patients' cardiac function and has a remarkable clinical effect with a low incidence of adverse cardiovascular events.
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Objective:To investigate the value of CHA2DS2-VASc score for predicting percutaneous coronary intervention (PCI) prognosis in patients with coronary chronic total occlusion.Methods:The clinical data of 139 patients with coronary chronic total occlusion who underwent PCI at the Second Hospital of Anhui Medical University from January 2019 to December 2020 were retrospectively analyzed. These patients were divided into good prognosis and poor prognosis groups according to prognosis outcomes. Univariate and multivariate Cox regression analysis was performed to evaluate the influential factors of adverse events after PCI in patients with coronary chronic total occlusion. The receiver operating characteristic curves were plotted to evaluate the value of the CHA2DS2-VASc score for predicting the occurrence of adverse events in patients with coronary chronic total occlusion undergoing PCI.Results:Among the 139 patients with coronary chronic total occlusion, the average follow-up time was (19.88 ± 7.90) months, 19 (13.7%) patients had a poor prognosis, and 120 (86.3%) patients had a good prognosis. The age, uric acid, and CHA2DS2-VASc score in the poor prognosis group were 73 (65.0, 77.0) years, (383.26 ± 120.60) μmol/L, and 4 (3, 5) points, respectively, which were significantly higher than 66 (57.0, 71.8) years, (322.68 ± 91.88) μmol/L, and 3 (2, 4) points in the good prognosis group ( U = -2.74, t = 2.24, U = -3.09, all P < 0.05). However, the proportion of patients with the successful opening of the occluded coronary artery and albumin, hemoglobin, and triacylglycerol levels in the poor prognosis group were 11 (57.9%), 36.7 (34.4, 38.3) g/L, (120.26±19.74) g/L, and 1.03 (0.85, 1.49) mmol/L, respectively, which were significantly lower than 98 (81.7%)( χ2 = 4.16, P = 0.041), 39.3 (36.78, 42.1) g/L ( U = -2.85, P = 0.004), (133.62 ± 16.84) g/L ( t = 1.52, P = 0.002), and 1.52 (1.09, 2.25) mmol/L ( U =-2.13, P = 0.033) in the good prognosis group. Multivariate Cox regression analysis showed that CHA2DS2-VASc score was a risk factor for poor prognosis of patients with coronary chronic total occlusion undergoing PCI (95% CI: 1.137-2.274, P = 0.007). The receiver operating characteristic curve analysis results showed that the area under the receiver operating characteristic curve plotted for CHA2DS2-VASc score predicting poor prognosis in patients with coronary chronic total occlusion undergoing PCI was 0.716 (95% CI: 0.588-0.844, P = 0.003), with the cut-off point of 3.5, the sensitivity of 68.4%, and specificity of 66.7%, respectively. Conclusion:Compared with those with a good prognosis, patients with a poor prognosis have a higher CHA2DS2-VASc score. The CHA2DS2-VASc score has a certain application value for predicting mid- and long-term prognosis in patients with coronary chronic total occlusion who undergo PCI.
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Objective:To analyze the value of cytotoxic T lymphocyte and natural killer cell levels in prognosis evaluation of patients with ST-elevation myocardial infarction (STEMI).Methods:A total of 158 patients with STEMI who underwent percutaneous coronary intervention in The Second People's Hospital of Liaocheng from September 2020 to August 2021 were included in this study. The ratio of cytotoxic T lymphocytes to natural killer cells was measured immediately after admission and 48 hours after surgery. These patients were followed up for 1 month after treatment. They were divided into the adverse cardiovascular event group (occurrence group) and no adverse cardiovascular event group (non-occurrence group) according to the occurrence of cardiovascular adverse events. The influential factors of the prognosis of STEMI and the correlation between the influential factors and STEMI were analyzed.Results:Among 158 patients with STEMI, 27 patients had adverse cardiovascular events, accounting for 17.09%. There were significant differences in systolic blood pressure, left ventricular ejection fraction, and low-density lipoprotein levels between the occurrence and non-occurrence groups ( t = 2.82, 4.27, 2.32, all P < 0.05). At 48 hours after surgery, the levels of cytotoxic T lymphocytes [(22.75 ± 8.39)%, (29.23 ± 4.61)%] and natural killer cells [(13.73 ± 4.64)%, (20.64 ± 4.52)%] in the peripheral blood in the occurrence and non-occurrence groups were significantly decreased compared with before surgery [ t = -5.05, -83.68, -142.71, -7 084.80, all P < 0.001]. Before and 48 hours after surgery, the levels of cytotoxic T lymphocytes [(27.47 ± 3.35)%, (22.75 ± 8.39)%] and natural killer cells [(21.42 ± 4.36)%, (13.73 ± 4.64)%] in the peripheral blood in the occurrence group were significantly lower than those in the non-occurrence group ( t = 7.68, 13.10, 4.16, 5.76, all P < 0.001). Univariate analysis showed that preoperative cytotoxic T lymphocytes < 27.47%, preoperative natural killer cells < 21.42%, left ventricular ejection fraction, and low-density lipoprotein may be the risk factors that affect the prognosis of patients with STEMI ( P < 0.000, 0.012, 0.019, 0.033). Cox regression analysis showed that preoperative cytotoxic T lymphocytes < 27.47% and preoperative natural killer cells < 21.42% were independent risk factors affecting the prognosis of patients with STEMI (both P < 0.001). Conclusion:Reduced levels of baseline cytotoxic T lymphocytes and natural killer cells in patients with STEMI suggest an increased risk of poor prognosis.
ABSTRACT
This retrospective single-center registry study included all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion using drug coated-balloon (DCB)-only strategy between August 2011 and December 2018. To best of our knowledge, no previous studies of DCB-only strategy of treating de novo left main coronary artery disease, exist. The primary endpoint was major adverse cardiovascular events (MACEs) including cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). The cohort was divided into two groups depending on weather the lesion preparation was done according to the international consensus group guidelines. Sixty-six patients (mean age 75±8.6, 72% male), 52% of whom had acute coronary syndrome, underwent left main PCI with the DCB-only strategy. No procedural mortality and no acute closures of the treated left main occurred. At 12 months, MACE and TLR occurred in 24% and 6% of the whole cohort, respectively. If the lesion preparation was done according to the guidelines, the MACE and TLR rates were 21.2% and 1.9%. Left main PCI with the DCB only-strategy is safe leading to acceptable MACE and low TLR rates at one year, if the lesion preparation is done according to the guidelines.