Five-year Clinical Outcomes of CAD Patients Complicated with Diabetes after StentBoost-optimized Percutaneous Coronary Intervention / 中国医学科学杂志(英文版)

Objective To evaluate the instant effects and five-year clinical outcomes of coronary artery disease patients complicated with diabetes mellitus after StentBoost-optimized percutaneous coronary intervention (PCI). Methods From March 2009 to July 2010, 184 patients undergoing PCI at our hospital were found stent underexpansion or malapposition by StentBoost after stents implantation and were divided into the diabetic (=73, 39.67%) and the non-diabetic group (=111, 60.33%). All patients received StentBoost-guided post-dilatation after stent implantation. The instant procedural results were measured and clinical outcome after five-year follow-up was analyzed in each group. Between-group comparisons were performed using Chi-square test or Student's test. Multivariate logistic regression analysis was carried out to reveal the independent predictors for long-term clinical outcomes of StentBoost-optimized PCI . Results After StentBoost-guided post-dilatation, the minimum diameter (MinLD), maximum diameter (MaxLD) and average diameter in both groups increased significantly than before (<0.001), the (MaxLD-MinLD)/MaxLD ratio and the in-stent residual stenosis decreased accordingly (<0.001). The five-year follow-up showed similar mortality rate (4.92% . 2.86%, =0.67) and major adverse cardiac event rate (11.48% . 11.43%, = 1.0) between the diabetic and the non-diabetic group, whereas the recurrence of angina pectoris was higher in the diabetic group compared to the non-diabetic group (47.54% . 29.52%; =0.02). A multivariate logistic regression analysis revealed that age and left ventricular ejection fraction rather than diabetes mellitus were independent predictors for long-term clinical outcomes. Conclusions StentBoost could effectively improve instant PCI results; the long-term clinical outcomes of StentBoost-optimized PCI were similar between diabetic and non-diabetic patients. Age and left ventricular ejection fraction were the independent predictors for long-term clinical outcomes.

Therapeutic effect evaluation of single and double stent strategy on coronary bifurcation lesions / 心血管康复医学杂志

Objective :To explore therapeutic effect of single and double stent implantation on coronary bifurcation le-sions.Methods : Clinical data of 455 patients with coronary bifurcation lesions , who received drug-eluting stent (DES) implantation in General Hospital of PLA from Jan 2014 to Oct 2016 ,were retrospectively analyzed .Accord-ing to interventional strategy ,patients were divided into single stent group (n＝235) and double stent group (n＝220).The lesion distribution ,lesion features of proximal ,distal and bifurcation ,stent implantation ,surgical selec- tion ,postoperative instant blood flow ,clinical adverse events were observed and compared between two groups .Re-sults :There were no significant difference in general data ,lesion distribution suggested by coronary angiography ,le-sion feature of proximal ,distal and bifurcation between two groups , P＞0. 05 all.All patients used Cross-over tech-nique in single stent group ,while double stent group used Crush (46.81%) ,Culotte (37.73%) ,T-stent and V-stent surgery .There were no significant difference in postoperative instant TIMI blood flow grade 3 rate of main vessel and side branch between two groups , P＞0. 05 both .During hospitalization ,incidence rate of nonfatal myocardial infarction in double stent group was significantly higher than that of single stent group (7.27% vs.2.98%) , P＝0.037. During 12-month follow-up ,compared with single stent group ,there was significant reduction in restenosis rate (5.53% vs.1.36%) , and significant rise in incidence rate of nonfatal myocardial infarction (2.55% vs. 6.82%) in double stent group ,P＝0.016 ,0.030 respectively .Conclusion :The therapeutic effect between single and double stent implantation treating coronary bifurcation lesions is no significant ,but restenosis rate of double stent group significantly reduces and incidence rate of nonfatal myocardial infarction significantly rises .

Current Status of Antithrombotic Strategy for Elderly Patients With Atrial Fibrillation and Acute Coronary Syndrome After Stent Implantation in Beijing Area / 中国循环杂志

Objective: To investigate the current status of antithrombotic strategy for elderly patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) after stent implantation in Beijing area and to study the safety and efficacy of different therapeutic strategy. Methods: A total of 467 relevant patients were enrolled by re-travelling electronic medical records from 12 hospitals in Beijing area. The patients' mean age was (78.70±3.32) years and they were divided into 2 groups by antithrombotic therapy condition: Triple therapy group, n=17 (3.64％), Double therapy group, n=450 (96.36％). The incidence of major adverse cardiac and cerebral events (MACCE) including all-caused death, non-fatal myocardial infarction, stent thrombosis, target vessel revascularization (TVR), stoke and bleeding was compared between Triple therapy group and Double therapy group.Results: The medication in Double therapy group included aspirin+ticagrelor, aspirin+clopidogrel, clopidogrel+warfarin and cilostazol+clopidogrel; in Triple therapy group was aspirin+clopidogrel+warfarin. Patient with HAS-BLED score≥3 was defined as high risk of bleeding and they were all treated by double therapy; HAS-BLED<3 was defined as low risk of bleeding, only 5.03％ patients were treated by triple therapy. 3 patients in Triple therapy group and 33 in Double therapy group suffered from gastrointestinal bleeding, P=0.338; 6 patients in Triple therapy group and 128 in Double therapy group had MACCE, P=0.589; 3 and 80 patients died in Triple therapy group and Double therapy group, P=0.766. Conclusion: Triple therapy was rarely used in elderly AF and ACS patients after stent implantation, double therapy was the main strategy; the incidence of MACCE and mortality were similar between triple and double therapies; patients with triple therapy had the higher incidence of gastrointestinal bleeding.

Relationship Between Lung Ultrasound B Line and NT-proBNP, E/e' for Evaluating Pulmonary Edema in Acute Heart Failure Patients / 中国循环杂志

Objectives: To analyze the relationship between lung ultrasound B line and NT-proBNP, E/e' in order to explore the accuracy of B lines for diagnosing pulmonary edema in patients with acute heart failure (AHF). Methods: A total of 124 AHF patients admitted in out hospital from 2016-02 to 2017-02 were enrolled. According to the number of B line, patients were divided into 3 groups: Mild pulmonary edema group, patients with B line<15, Moderate pulmonary edema group, 15≤B line<30 and Severe pulmonary edema group, B line≥30. Basic clinical condition and echocardiography parameters were compared among 3 groups; relationships between B line and NT-proBNP, E/e', EF, pulmonary artery pressure were analyzed respectively; the sensitivity and specificity for B-line diagnosing NT-proBNP≥5000 pg/ml and E/e'≥14 were evaluated by ROC curve analysis. Results: Compared with Mild and Moderate pulmonary edema groups, Severe pulmonary edema group had the severer NYHA grade, more wet rale, higher NT-proBNP level and more chest X-ray of pulmonary congestion, P<0.05. Compared with Mild pulmonary edema group, Moderate and Severe pulmonary edema groups had decreased LVEF, P<0.05; Severe pulmonary edema group showed increased diastolic function such as elevated E/A, pulmonary artery pressure and E/e',P<0.05.B line was positively related to NT-proBNP,E/e'and pulmonary artery pressure,negatively related to EF.B line had the best correlation to NT-proBNP (r=0.803, P<0.001), the next was E/e'(r=0.794, P<0.001) and the worst was pulmonary artery pressure (r=0.330, P<0.001). The cutoff values of B line for diagnosing NT-proBNP≥5000pg/ml and E/e'≥14 were both 30, the AUC of ROC=0.823 and 0.768 respectively. Conclusions: Lung ultrasound B line had good correlation to NT-proBNP and E/e', which could accurately assess the pulmonary edema in AHF patients.

Glucometabolic abnormalities survey among outpatients without previous diabetes diagnosis and with coronary artery disease and hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the status of glucometabolic abnormalities in cardiological outpatients without previous diabetes diagnosis and with coronary artery disease (CAD) and hypertension.</p><p><b>METHODS</b>Patients without previous diagnosis of diabetes but with hypertension and CAD aged 18 years or above were recruited from cardiology departments of 11 general hospitals in China. Demographic data, disease diagnosis and medical history were collected. Physical examination and questionnaire survey were performed after the random blood glucose test. Oral glucose tolerance test (OGTT) examination was made for patients with fasting blood glucose ≥ 6.1 mmol/L or postprandial random glucose ≥ 7.8 mmol/L. Adjusted prevalence rates were used in the study.</p><p><b>RESULTS</b>A total of 7778 patients were included in 11 centers. After preliminary screening by fasting blood glucose and random blood glucose tests, 3861 patients were required to take OGTT, and 3019 (78.2%) patients actually took the test. 1287 out of 3019 patients screened with OGTT were diagnosed with diabetes, and the adjusted diabetes prevalence rate was 18.64% (1287/6904). The prevalence rate of diabetes was 19.87% (95/478), 9.22% (352/3819) and 14.81% (153/1033) in patients with CAD, hypertension, and CAD combined with hypertension, respectively. A total of 996 patients were diagnosed with impaired glucose tolerance (IGT) and its prevalence was 14.43% (996/6904). Of the enrolled population, 153 patients with random blood glucose lower than 7.8 mmol/L were also screened with OGTT test, 26.14% (40/153) patients met the diagnostic criteria of diabetes.</p><p><b>CONCLUSION</b>A high prevalence of diabetes is found in patients without previous diagnosis of diabetes and with hypertension and CAD consulting at cardiology departments. We thus suggest to perform OGTT in this patient cohort to improve the early diagnosis of IGT and diabetes, and prevent missed detection of type 2 diabetes mellitus or IGT in cardiovascular patients with normal fasting blood glucose. Our results indicate that it was feasible to use OGTT as a screening tool for detecting diabetes in these patients and the patient compliance is satisfactory.</p>

Prognostic value of brain natriuretic peptide in people with viral myocarditis / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the brain natriuretic peptide (BNP) on prognostic value in patients with viral myocarditis.</p><p><b>METHODS</b>A total of 48 patients with viral myocarditis and 42 healthy people were enrolled and followed up for two years. The NYHA class and LVEF were recorded and the concentration of BNP were measured.</p><p><b>RESULTS</b>The concentration of BNP were higher and EF were lower in patients with viral myocarditis (P < 0.01) than contrast people. Higher levels of plasma BNP were related to higher mortality.</p><p><b>CONCLUSION</b>Levels of brain natriuretic peptide measured in the plasma could be a useful biochemical marker for the myocarditis, and high concentration of BNP may correlate with poor prognosis in patients with myocarditis.</p>

A novel angiographic technique, StentBoost, in comparison with intravascular ultrasound to assess stent expansion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>StentBoost (SB) is a novel angiographic technique which can enhance stent visualization and improve detection of inadequate stent expansion. Studies of SB that compare it with intravascular ultrasound (IVUS), which is the current gold standard for detection of stent underexpansion, remain inadequate. This study aimed to test the correlation of IVUS and SB, and to evaluate the effect of SB guiding the stent postdilatation.</p><p><b>METHODS</b>From March 2009 to June 2010, 52 patients were analyzed using quantitative coronary angiography (QCA), IVUS, and SB. They included 37 patients (54 stents) with postdilatation and 15 patients (21 stents) without postdilatation. Correlations of stent diameter between the three modalities were determined.</p><p><b>RESULTS</b>The minimum diameter, maximum diameter and average diameter of postdilatation obtained by QCA, IVUS, SB were significantly larger than that of poststenting, and the ratio (maximum stent diameter (MaxLD)-minimum stent diameter (MinLD))/MaxLD of postdilatation was smaller. Correlations of MinLD were the highest between IVUS and SB (r = 0.979, P < 0.0001) when compared with QCA and SB (r = 0.973, P < 0.0001), and QCA and IVUS (r = 0.964, P < 0.0001).</p><p><b>CONCLUSIONS</b>SB has superior correlations for stent expansion measured by IVUS when compared with QCA. In addition, there is an important advantage for SB in guiding the stent postdilatation.</p>