[Effect and mechanism of recombinant hirudin on atherosclerotic plaques in apolipoprotein E knockout (ApoE(-/-)) mice].

OBJECTIVE: To explore the effect and mechanism of hirudin on atherosclerotic plaques in apolipoprotein E knockout (ApoE(-/-)) mice. METHODS: Totally 24 ApoE(-/-) mice, 7-8 weeks old were fed with high fat diets. They were randomly divided into the recombinant hirudin treatment group (drug group) and the model group according to body weight and different dens, 12 in each group. Twelve C57BL/6J mice, 7-8 weeks old fed with high fat diet were recruited as the normal control group. Recombinant hirudin (0.25 mg/kg) was intraperitoneally injected to mice in the drug group from the 10th week old once every other day for five successive weeks. Equal volume of normal saline was injected to mice in the model group. Mice in the normal control group received no treatment. All mice were sacrificed after fed with high fat diet until they were 20 weeks old. Serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), high-sensitive C-reactive protein (hs-CRP), E-selectin, interleukin-6 (IL-6), and stromal metalloproteinase-2 (MMP-2) were detected. The plaque/lumen area and extracellular lipid composition/ plaque area were analyzed by HE staining and morphometry. Changes of signaling molecules in store-operated calcium channels, including stromal interacting molecule 1 (STIM1), Orail protein, and transient receptor potential channel 1 (TRPC1) were determined by Western blot. Results Lipid plaque formed in the aorta vessel wall of 20-week old mice in the model group. Compared with the normal control group, serum levels of TC, TG and LDL increased (P<0.01), hs-CRP, E-selction, IL-6, and MMP-2 obviously increased (P<0.01, P<0.05) in the model group; expression levels of STIM1, TRPC1, and Orail significantly increased (P<0.01). Compared with the model group, the plaque/lumen area and the extracellular lipid composition/plaque area significantly decreased in the drug group (P<0.05, P<0.01); serum levels of TC and LDL, hs-CRP, E-selction, IL-6, and MMP-2 obviously decreased (P<0.05, P<0.01); expression levels of STIM1, TRPC1, and Orail were significantly down-regulated (P<0.05, P<0.01). CONCLUSION: Hirudin could significantly improve lipids and endothelial functions of ApoE(-/-) mice, down-regulate expression levels of STIM1, Orai1, and TRPC1, and thus delaying the occurrence and development of atherosclerosis.

The union of anti-CD34 antibody can improve the performance of drug-eluting stents.

OBJECTIVES: The authors investigate whether the combination of anti-CD34 antibody with DES is win-win cooperation. BACKGROUND: DES may reduce the risk of restenosis compared to bare-metal stents (BMS), but they were found to inhibit the healing process of intima. METHODS: Fifteen BMS, 17 DES, and 16 combined anti-CD34 antibody and DES were randomly implanted in the coronary arteries of 22 minipigs. Ten minipigs were followed up to 2 weeks. The stenting coronary segments were examined by histological examination and scanning electron microscopy after in vivo coronary angiography and intracoronary optical coherence tomography (OCT) examinations. The other 12 minipigs were followed up to 3 months. Coronary angiography and intracoronary OCT examination were performed in vivo and histological examination was performed on the stenting coronary segments. RESULTS: After 2 weeks, the neointimal covering level of the DES was lower than that in BMS, but the covering level of the combined stents was even better than the BMS. After 3 months, neointimal hyperplasia was significant in the BMS, but not in the other two types of stents. The in-stent late lumen loss of the combined stents even showed a decreasing tendency when compared with the DES. CONCLUSION: The combination of anti-CD34 antibody and DES can not only well offset the short-term inhibitory effect on re-endothelialization but also slightly enhance the long-term antiproliferative effect.

[Analysis of the clinical data of patients with acute coronary syndrome complicated by hemorrhage during hospitalization].

OBJECTIVE: To investigate the clinical characteristics of patients with acute coronary syndrome suffering hemorrhage during hospitalization. METHODS: The clinical symptoms, diagnostic and therapeutic characteristics and in-hospital outcome of 3807 inpatients who were recruited into SINO-GRACE study in China due to acute coronary syndrome from March, 2001 to December, 2007 were collected. Statistical methods were adopted to compare the differences in clinical data between hemorrhage group and non-hemorrhage group. RESULTS: Hemorrhage had happened in 57 out of 3807 inpatients with the incidence of 1.50%. Five patients, which accounted for 9.6% of the overall hemorrhage cases, were fatal hemorrhage. Nine patients were intracranial hemorrhage with the incidence of 0.24%. There were 155 deaths among the 3807 patients, with an overall mortality rate of 4.1%. The mortality of hemorrhage accounted for 3.2% in overall mortality. Patients with one of the following factors were more apt to hemorrhage: > 70 years old, previous hemorrhage history, renal failure history, heart failure history and clopidogrel and glycoprotein (GP) IIb/IIIa receptor antagonist administration for coronary artery bypass grafting. Patients who developed hemorrhage might need prolonged hospitalization and were liable to develop heart-related adverse events, including re-infarction and sustained ventricular tachycardia/fibrillation after they were admitted in hospital over 24 hours. CONCLUSION: Patients with acute coronary syndrome who underwent coronary artery bypass grafting, with advanced age, previous hemorrhage history, renal failure history, heart failure history or treated with clopidogrel and GP IIb/IIIa receptor antagonist are more vulnerable to hemorrhage.

[Effects of Maixuekang Capsule on the platelet aggregation rate and its long-term prognosis of patients with acute coronary syndrome under percutaneous coronary intervention].

OBJECTIVE: To study the changes of adenosine diphosphate (ADP)-induced platelet aggregation rate, and evaluate the effects of Maixuekang Capsule (MC) on the platelet aggregation rate, high-sensitive C-reactive protein (hs-CRP) and the long-term prognosis in patients with acute coronary syndrome under percutaneous coronary intervention (PCI). METHODS: Totally 236 inpatients with acute coronary syndrome under PCI, who successively received PCI from July 2008 to June 2010, were randomly assigned to the routine treatment group (RTT, 120 cases) and the MC treatment group (MKT, 116 cases). Besides routine medication, patients in the MKT group additionally took MC, 12 capsules daily for 12 successive months. The ADP-induced platelet aggregation rate and hs-CRP concentration were determined before PCI, 12 h and 30 days after PCI. In the meantime, the incidence of adverse cardio-/cerebrovascular events was recorded during the twelve-month clinical follow-up. Results Compared with before PCI, ADP-induced platelet aggregation rate and the serum hs-CRP concentration were significantly higher 12 h after PCI (P < 0.05). They were significantly reduced after 30-day treatment of MC, showing statistical difference when compared with those in the RTT group (P < 0.05). In the 12-month follow-up, the incidence of adverse cardio-/cerebrovascular events was significantly lower in the MKT group than in the RTT group (6.9% vs 12.5%, P < 0.01). CONCLUSIONS: ADP-induced platelet aggregation function was significantly elevated after PCI, which was a predictive factor of poor coronary events. MC improved the long-term prognosis of patients with acute coronary syndrome possibly through inhibiting the platelet aggregation rate and the hs-CRP concentration.

[Analysis of the risk factors of patients with acute coronary syndrome suffering hemorrhage during hospitalization].

OBJECTIVE: To analyze the risk factors related to in-hospital bleeding for patients with acute coronary syndrome (ACS). METHODS: Clinical and therapeutic data of 3807 patients who were registered with acute coronary syndrome in SINO-GRACE in China from March 2001 to December 2007 were reviewed. A total of 57 patients were grouped to bleeding group and 234 out of the remaining 3750 patients without bleeding were randomly chosen and served as non-bleeding group. Hemorrhage-related factors were screened and compared between the two groups. Unitary logistic regression analysis was performed to detect the possible factors related to hemorrhage. Factors with P < 0.1 were further analyzed by stepwise regression method and multivariate conditional logistic regression analyses. RESULTS: (1) Age, history of coronary artery bypass graft (CABG), previous hemorrhage, renal failure and heart failure as well incidence of acute coronary syndrome were significantly higher in bleeding group than in non-bleeding group (all P ≤ 0.05). Patients were more often treated with clopidogrel and glycoprotein (GP) IIb/IIIa receptor antagonist in bleeding group than in non-bleeding group. (2) Single factor logistic regression analysis showed that age > 70 years, history of previous bleeding, renal failure, heart failure, clopidogrel and GP IIb/IIIa receptor antagonists use, non-ST-segment elevation myocardial infarction, inferior wall, lateral myocardial infarction, CABG were risk factors for bleeding (all P < 0.05). (3) Multivariate logistic regression analysis showed that history of renal failure (OR = 19.77, 95%CI 4.38 - 89.18, P < 0.01) and clopidogrel (OR = 19.77, 95%CI 4.38 - 89.18, P < 0.01) and GPIIb/IIIa receptor antagonist (OR = 343.57, 95%CI 40.39 - 999.99, P < 0.01) use were the independent risk factors for bleeding. CONCLUSION: Our results show that renal failure history and clopidogrel and GPIIb/IIIa receptor antagonist use are independent risk factors for in-hospital bleeding in patients with acute coronary syndrome.

[Cause of in-hospital death among acute myocardial infarction patients undergoing primary percutaneous coronary intervention in Beijing].

OBJECTIVE: To analyze the cause of in-hospital death among acute myocardial infarction patients undergoing primary percutaneous coronary intervention (PPCI) in Beijing area to evoke better individualized preventive approach. METHODS: In-hospital mortality and causes were analyzed based on database from Beijing percutaneous coronary intervention registry study (BJPCI Registry) in 2010. RESULTS: A total of 4660 PPCI patients from 48 hospitals were included. In-hospital mortality was 2.4% (n = 110). Cardiogenic shock (39.1%, 43/110), mechanical complications (28.2%, 31/110) and intervention-related complications [28.2%, 31/110: procedure related (n = 28), drug related (n = 3)] were the leading causes of in-hospital death. Five deaths was attributed to comorbidity related reason (4.5%, 5/110). The in-hospital mortality had no significant difference among hospitals of different grade or total annual PCI (all P > 0.05). In-hospital mortality was slightly higher in hospital with annual PPCI < 300 than in hospitals with annual PPCI ≥ 300 (2.9% vs. 1.8%, P < 0.05). CONCLUSION: Cardiogenic shock, mechanical complications and intervention-related complications are the main causes of in-hospital death among acute myocardial infarction patients receiving PPCI.

[Impact of left ventricular systolic function on the outcomes of percutaneous coronary intervention for unprotected left main disease].

OBJECTIVE: To evaluate the impact of left ventricular systolic function on the outcomes of percutaneous coronary intervention (PCI) for unprotected left main (ULM) disease. METHODS: The relevant baseline and outcome data of patients undergoing PCI for ULM disease at our hospital were collected from September 2006 to August 2009. The enrolled patients were divided into two groups according to left ventricular ejection fraction (LVEF): LVEF ≥ 40% group (n = 130) and LVEF < 40% group (n = 56). The baseline and outcome data were compared between two groups. Multivariable regression analysis was performed to appraise the prognostic role of LVEF < 40% in patients undergoing PCI for ULM disease. RESULTS: There were more patients with diabetes mellitus, a previous history of myocardial infarction, previous PCI/CABG (coronary artery bypass grafting) and NSTEMI (non-ST-segment elevation myocardial infarction) in LVEF < 40% group than LVEF ≥ 40% group (P < 0.05). The major adverse cardiovascular and cerebral vascular event (MACCE) rate was higher in LVEF < 40% group than LVEF ≥ 40% group (33.9% vs 18.5%, P = 0.022). And the rates of cardiac death, all-cause death and MI were also higher in LVEF < 40% group than LVEF ≥ 40% group (7.1% vs 1.5%, P = 0.047; 10.7% vs 3.1%, P = 0.034; 14.3% vs 4.6%, P = 0.022). Female gender, diabetes mellitus, previous PCI/CABG, NSTEMI/STEMI, LVEF < 40%, multiple-vessel disease, LM distal or bifurcation lesion and multiple-stent implantation were independent predictors of MACCE in patients undergoing PCI for ULM disease. CONCLUSION: Impaired left ventricular systolic function (LVEF < 40%)affects the prognosis of ULM patients undergoing PCI. Reduced LVEF (LVEF < 40%) is the strongest predictor of adverse events in these patients.

[Stents coated with sirolimus and anti-CD34 antibody can optimize the performance of sirolimus-eluting stents].

OBJECTIVE: To investigate the impact of the stents coated with sirolimus and anti-CD34 antibody on the short-term re-endothelialization and the long-term restenosis in Chinese Minipigs. METHODS: Three different types of stents [bare-metal stent (BMS), sirolimus-eluting stent (SES) and anti-CD34 antibody and sirolimus-coated stent (ASES)] were randomly implanted in the coronary arteries of 22 Chinese Minipigs. At two weeks after stenting, coronary angiography and optical coherence tomography (OCT) were performed in 10 experimental animals. At three months after stenting, coronary angiography and OCT were performed in the remaining 12 experimental animals. Histopathologic examination was performed on the coronary artery segments containing stent after the animals were executed. RESULTS: (1) No in-stent thrombosis and parietal thrombus were found by coronary angiography, OCT and histopathologic examination at two weeks post stenting. OCT analysis showed that the covered ratio of stent struts by neointima in ASES group was higher than in SES group [(55.56 ± 35.27)% vs. (41.82 ± 23.28)%, P < 0.05]. The mean thickness of neointima in ASES group was significantly higher than in SES group [(89.0 ± 5.0) µm vs. (32.0 ± 4.9) µm, P < 0.01] and BMS group [(89.0 ± 5.0) µm vs. (44.0 ± 7.2) µm, P < 0.01]. Histopathologic and scanning electron microscopy examinations demonstrated that the covering level and quality of stent struts by neointima in BMS and ASES group were both better than in SES group. (2) At three months follow-up, quantitative coronary angiography analysis found that late in-stent lumen loss in ASES group was significantly lower than in BMS group [(0.18 ± 0.06) mm vs.(0.35 ± 0.06) mm, P < 0.05]. OCT analysis showed that the percent neointimal hyperplasia in ASES and SES group was significantly lower than in BMS group [(34.75 ± 2.64)% and (35.63 ± 2.07)% vs. (48.28 ± 3.25)%, both P < 0.01]. Histopathologic analysis demonstrated that the percent areal restenosis of ASES and SES group were both significantly lower than that of BMS group [(28.65 ± 5.64)% and (29.33 ± 6.07)% vs. (46.18 ± 8.25)%, both P < 0.05]. CONCLUSION: The stents coated with anti-CD34 antibody and sirolimus can attenuate the inhibitory effect of sirolimus on the re-endothelialization at two weeks after stenting and the anti-hyperplasia effect of sirolimus at three months after stenting.

[Evaluation on the relationship between pregnancy associated plasma protein-a and intravascular ultrasound detected culprit coronary plaque morphology in patients with unstable angina].

OBJECTIVE: To assess the relationship between pregnancy associated plasma protein-A (PAPP-A) and culprit coronary plaque morphology in patients with unstable angina (UA). METHODS: Sixty-eight UA patients undergoing diagnostic coronary angiography and intravascular ultrasound were included in this study. A sandwich enzyme-linked immunosorbent assay technique was used to assay the circulating PAPP-A. Plaque characteristics of culprit lesion were analyzed for UA patients with various PAPP-A levels. RESULTS: PAPP-A level was significantly higher in high-risk UA than in non-high-risk UA [(19.9 ± 20.1) mIU/L vs. (6.9 ± 5.7) mIU/L, P = 0.002]. Optimal threshold of PAPP-A to predict high-risk UA was determined as 11.0 mIU/L with a sensitivity of 78.6% and a specificity of 77.5%. Patients with higher PAPP-A level (≥ 11.0 mIU/L) was associated with larger external elastic membrane cross-sectional area, plaque area and more plaque burden compared with patients with lower PAPP-A level (all P < 0.01). Positive remodeling, attenuated plaque and plaque rupture were significantly more often in patients with higher PAPP-A than in patients with lower PAPP-A level (all P < 0.01). PAPP-A ≥ 11.0 mIU/L (OR = 5.921, P = 0.014) and attenuated plaque (OR = 7.541, P = 0.038) were independent risk predictors for high-risk UA. CONCLUSIONS: PAPP-A was associated with instability of culprit plaque in UA patients. PAPP-A ≥ 11.0 mIU/L and attenuated plaque were independent predictors for high-risk UA.

[Phospholamban antisense RNA transfer attenuates post-infarction remodeling and preserves cardiac functions].

OBJECTIVE: To investigate whether the gene transfer of phospholamban antisense RNA could inhibit remodeling and preserve cardiac function after myocardial infarction. METHODS: Wistar rats received a ligation of left coronary with a direct intramyocardial injection of phospholamban antisense RNA eukaryote vector PcDNA4-asPLB. The cardiac function, hemodynamics and ventricular geometry of three groups (shame, saline injection and PcDNA4-asPLB injection) were studied by echocardiography and left ventricle hemodynamic recording. The levels of phospholamban (PLB) and sarcoplasmic reticulum Ca(2+)-ATPase (SERCA2a) were analyzed by Western blot and the expressions of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) examined by RT-PCR. The histological study was performed to evaluate the collage content and cardiomyocyte fiber size. RESULTS: The PcDNA4-asPLB injection group had significantly better systolic cardiac function and diastolic function [LVEF (39.4 +/- 7.8)% vs (30.9 +/- 7.4)%, P < 0.05; dp/dt Max (1545 +/- 127) mm Hg x s(-1) vs (1172 +/- 91) mm Hg x s(-1), P < 0.05)]. Compared with saline injection, the PLB expression was inhibited by 50% in PcDNA4-asPLB injection group (PLB/beta-actin ratio, 0.28 +/- 0.07 vs 0.57 +/- 0.11, P < 0.05) and the function of SERCA2a was enhanced [(1.47 +/- 0.21) micromol x min(-1) x g(-1) protein vs (0.34 +/- 0.13) micromol x min(-1) x g(-1) protein, P < 0.05]. The expressions of ANP and BNP in the saline injection group were elevated as compared to those in the PcDNA4-asPLB injection group. Histological study also showed that the collage density and the cardiomyocyte fiber size in the saline injection group were worse than those in the PcDNA4-asPLB injection group. CONCLUSION: Intramyocardial injection of phospholamban antisense RNA eukaryote vector PcDNA4-asPLB after myocardial infarction results in PLB expression inhibition, attenuates ventricular remodeling and improves systolic and diastolic cardiac functions.

[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.

[Randomized comparative study on the lipid lowering effects of Zhikang Granule and simvastatin].

OBJECTIVE: To compare the lipid lowering effects of Zhikang Granule (ZKG) and simvastatin. METHODS: Forty-five out-patients with hyperlipemia who met the entry criteria were enrolled and randomized into two groups in the ratio of 2: 1, 30 patients in the ZKG group and 15 patients in the simvastatin group. The lipid lowering effects and safety of treatment during the 24-week therapeutic period, as well as the influence of treatment on plasma high sensitivity C reactive protein (hs-CRP) level in patients were observed. RESULTS: No significant difference between the two groups was observed in serum levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C) and triglyceride (TG) at the 4th, 8th, 12th and 24th week (P > 0.05). However, as compared with baseline, significant reduction of TC and LDL-C in both groups was shown at all the observing time points (P < 0.01), while the changes in TG and HDL-C were insignificant (P > 0.05). The control rates of LDL-C and TC in the ZKG group and the simvastatin group were 86.7% (26/30) versus 100% (15/15) at the 4th week, 80.0% (24/30) versus 100% (15/15) at the 8th week, 53.3% (16/30) versus 60.0% (9/15) at the 12th week, and 90.0% (27/30) versus 93.3% (14/15) at the 24th week, respectively, all showed insignificant difference between groups. No statistical differences were found between groups in levels of plasma transaminase, creatinine, uric acid and hs-CRP (P > 0.05). CONCLUSION: ZKG has a definite effect in lowering LDL-C and TC, and it is safe in long-term administration.

[Impact of the acute myocardial infarction guidelines on in-hospital managements and outcome of the patients in China].

OBJECTIVE: To investigate the relationship between the guidelines issued by the American College of Cardiology/American Heart Association (ACC/AHA) in 2004 and the changes in early reperfusion, drug treatment and outcome of inpatients with acute myocardial infarction (AMI) in China, and to explore what extent the guidelines are followed in the management of AMI in China, and the differences in managements and patients' outcome after its issue. METHODS: A retrospective study of clinical data of 1 278 patients with AMI admitted to 12 Chinese Hospitals from January 2002 to December 2006 was carried out. They were divided into two groups: group A included 734 patients admitted from January 2002 to August 2004, and group B comprised 544 patients admitted from August 2004 to December 2006. The baseline characteristics, early reperfusion, drug treatment, reinfarction, angina pectoris, heart failure, cardiogenic shock, bleeding and death were compared between two groups. The correlation between therapeutic measure and mortality was analyzed to estimate the difference between two groups, and relationship between the differences and the guidelines issued in 2004 was also analyzed. RESULTS: The age, sex, systolic blood pressure, history of past illness excepting old myocardial infarction of patients with AMI bore no significant difference between two groups. The incidence of Killip≥III in group B was lower significantly than that in group A (7.5% vs. 14.7%, P<0.01). Reperfusion therapy was used more often in group B than in group A (78.5% vs. 71.2%, P<0.05). And percutaneous coronary intervention (PCI) therapy was used more often in group B than in group A (71.5% vs. 61.0%, P<0.01). However, the rate of lytic treatment was lower in group B than that in group A (8.6% vs. 16.3%, P<0.01). ³ The percentage of use of antiplatelet drug and aspirin was both over 97.0%. The tidopidine was used more frequently in group A than in group B (54.9% vs. 8.3%), and the clopidogrel and glycoprotein IIIa/IIb antagonists was used more frequently in group B than in group A (83.8% vs. 27.4%, 4.8% vs. 0.7%, both P<0.01). The angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist (ACEI/ARB) were administered more frequently in group B than in group A (98.2% vs. 93.5%, P<0.01), and the increasing trend of ARB was obvious (13.6% vs. 4.4%, P<0.05), but the decreasing trend of ACEI was obvious also (84.6% vs. 89.1%, P<0.01). Heparin/low molecular heparin, ß-blocker and statin were used more often in group B than in group A (97.4% vs. 94.8%, 80.1% vs. 74.8%, 87.7% vs. 82.4%, P<0.05 or P<0.01). (4) In-hospital mortality, reinfarction, angina pectoris were lower in group B than in group A (4.6% vs. 7.6%, 2.8% vs. 4.8%, 8.4% vs. 12.4%, all P<0.05). (5) Multivariate Logistic regression analysis showed that reperfusion, antiplatelet drug, statin and heparin/low molecular heparin were associated significantly with in-hospital mortality (all P<0.05). CONCLUSION: After guideline was issued by ACC/AHA in 2004, the regime of early reperfusion and drug treatment in China had followed more closely the recommendations of the guidelines. At the same time, in-hospital mortality, reinfarctions, angina pectoris were decreased. And the changes in strategy of early reperfusion, antiplatelet drug, statin and heparin/low molecular heparin are closely related with in-hospital mortality. However, current management of AMI in China has not followed the recommendations of guidelines closely. It is essential to promote the use of ß-blocker and ACEI/ARB drug treatment in China in accordance with the guidelines.

[Percutaneous coronary intervention in mainland China in 2008: register results].

OBJECTIVE: To collect data on percutaneous coronary intervention (PCI) performed in mainland China. METHODS: Questionnaires on PCI were distributed to all hospitals capable of performing PCI through national society of cardiology. Data in calendar year 2008 were analyzed. RESULTS: (1) 182,312 PCI were performed in mainland China in 2008 (+26.02% vs. 2007), average PCI rate was 1.39 per 10,000 people. (2) PCI was performed in 1061 hospitals and 171.83 PCI was performed per hospital. Among them, there were 461 hospitals performed more than 100 PCI (+54.18% vs. 2007). (3) The number of PCI performed among provinces was positive correlated with local per capita gross domestic product (GDP, ß = 0.06, P < 0.05) and the number of the hospitals performed more than 100 PCI per year (ß = 434.23, P < 0.05), and negatively correlated with local population number (ß = 0.49, P < 0.05). There were no correlation between the ratio of the hospitals performed more than 100 PCI per year (ß = -2746.35, P > 0.05) and the ratio of people with medical insurance (ß = -855.78, P > 0.05). CONCLUSIONS: From 2005, PCI rose 23.87% per year in mainland China. There are significant differences among provinces on the development of PCI.

[Cost-utility analysis of percutaneous coronary intervention in 13 cities of China].

OBJECTIVE: To investigate the cost-utility of percutaneous coronary intervention (PCI) in China. METHODS: A total of 630 patients from 13 cities undergoing PCI during the first half year of 2006 were enrolled in this study. The 36 items derived from the short form of health survey (SF-36) were applied prospectively in these patients before and 9 months after PCI. The cost per every incremental mark of SF-36 and quality adjusted life year (QALY) were calculated. RESULTS: (1) The age was lower than 60 years old in more than 50% patients. (2) In terms of detailed costs, material costs accounted for 82.5% of the hospitalization costs, medications costs accounted for 6. 8% , and operation fee accounted for 5.9%. These 3 items comprised 95.2% of overall hospitalization costs, and 69. 8% material costs were the cost for stents. (3)The average re-admission hospitalization costs were 17 841.5 RMB in 44 patients who were rehospitalized due to occurrence of major adverse cardiac events. (4) Follow-up made at months 1, 3, 6, 9, and 12 post index procedure showed that an average cost for postoperative drug treatment was 831.50 RMB per month, and most patients spent 400.0 RMB for drug treatment per month. (5) The average quality of life score increased by 20.59 post PCI (P < 0.05 vs. pre-PCI). The cost-effective analysis indicates that the cost per every incremental mark of SF-36 was 3975.7 RMB. The cost per every QALY gained was 59 898. 3 RMB. CONCLUSION: PCI is effective for patients with coronary heart disease and the cost per QALY in China was positioned in an acceptable range.

[Efficacy of stents coated with antibody against CD105 on preventing restenosis and thrombosis in minipigs].

OBJECTIVE: Novel stents loaded with antibody against CD105 were analyzed for their potential to limit coronary neointima formation and to accelerate endothelialization by attracting activated endothelial cell. METHODS: Thirty Stents coated with antibody against CD105, thirty unloaded polymer, and thirty bare metal stents were deployed in 90 coronary arteries of 30 minipigs. Oral aspirin (300 mg before operation and 100 mg post operation) and clopidogrel (300 mg before operation and 75 mg post operation) were orally administrated. Coronary artery quantitative analysis was completed by coronary arteriography, the vascular endothelium changes were observed under scanning electron microscope and the vascular morphological changes were observed under light microscope 7 and 14 days after operation. RESULTS: Complete procedural and angiographic success was achieved in all 30 minipigs. There were no major adverse cardiac and cerebrovascular events. At 7 days, there was no difference for mean neointimal area and percent area stenosis among various groups. At 14 days, endothelialization scores were significantly higher in the CD105 antibody-loaded stents and bare metal stents group than in sirolimus-eluting stents group (1.78 ± 0.49, 1.50 ± 0.67 vs. 1.08 ± 0.29, all P < 0.05), mean percent area stenosis in the CD105 antibody-loaded stents, sirolimus-eluting stents group were less than that in bare metal stents group [(23.8 ± 4)%, (24.2 ± 2)% vs. (38.0 ± 3)%, all P < 0.05], mean angiographic late luminal loss in the CD105 antibody-loaded stents, sirolimus-eluting stents group were less than that in bare metal stents group [(0.29 ± 0.28) mm, (0.28 ± 0.02) mm vs. (0.41 ± 0.01) mm, all P < 0.05]. There was no difference for mean percent area stenosis in the CD105 antibody-loaded stents and sirolimus-eluting stents group. The mean neointimal area in the CD105 antibody-loaded stents, and sirolimus-eluting stents group were less than that in bare metal stents group [(0.88 ± 0.08) mm(2), (0.89 ± 0.12mm)(2) vs. (1.00 ± 0.14) mm(2), all P < 0.05] and there was no difference for the mean neointimal area in the CD105 antibody-loaded stents and sirolimus-eluting stents group. At 7 and 14 days, there was no difference for the injury score and the inflammation score among various groups, scanning electron microscopy evidenced enhanced endothelial coverage on CD105 antibody-loaded stents compared to sirolimus-eluting stents group. CONCLUSION: Stent coated with antibody against CD105 could effectively reduce in-stent restenosis and accelerate endothelialization in the minipigs.

[Findings from registry of percutaneous coronary intervention in inland of China].

OBJECTIVE: To collect data on percutaneous coronary intervention (PCI) performed in inland of China. METHODS: Questionnaires on PCI were distributed to all hospitals capable of performing PCI through national society of cardiology. Data from 2006 and 2007 were reported in this report. RESULTS: (1) In 2007, 144,673 PCI were performed in 870 hospitals compared to 112,580 PCI performed in 1078 hospitals in 2006. Number of PCI in 2007 increased more rapidly compared to 2006 in three provinces (Fujian 327.3%; Anhui 115.1% and Guangdong 86.9%). (2) In 2007, the number of PCI performed in ten provinces accounted for 66.7% of total PCI in inland of China (Beijing 15.4%; Guangdong 8.0%; Liaoning 6.9%; Shandong 6.9%; Shanghai 6.1%; Henan 5.8%; Zhejiang 4.7%; Jiangsu 4.4%; Shanxi 4.4% and Hebei 4.2%). (3) There were 299 (34.4%) hospitals with PCI number more than 100 in 2007 compared with 290 (29.6%) hospitals in 2006; there were 507 hospitals with PCI numbers less than 50 in 2006. (4) In 2006, there were 86,974 patients received PCI in 672 hospitals and 135,658 stents were implanted and 97.8% of implanted stents were drug eluting stents (DES). CONCLUSION: From 2006 to 2007, number of PCI increased significantly in inland of China, there were about 50% hospitals with PCI number less than 50 per year and 1.56 stents per patient were implanted and 97.8% implanted stents were DES.

[Effects of tissue factor pathway inhibitor-1 on no-reflow in a rabbit model].

OBJECTIVE: To investigate the role of plasma tissue factor (TF) and tissue factor pathway inhibitor-1 (TFPI-1) level and to observe the effect of extrinsic TFPI-1 on no-reflow (NR) in a rabbit model of ischemia/reperfusion. METHODS: Rabbits were randomized into four groups (n = 10 each): ischemic- reperfusion group (IR, subjected to 120 minutes of coronary artery occlusion and followed by 60 minutes of reperfusion); ischemic- reperfusion TFPI-1 group (100 ng/kg bolus and 1 ng x kg(-1) x min(-1) infusion during reperfusion); ischemic group (subjected to 180 minutes of coronary artery occlusion) and sham group. The NR area and ischemic area were determined by thioflavin S and Evan's blue staining in vivo. Plasma TF and TFPI-1 levels were measured before operation, before and at 120 minutes post coronary artery ligation, 10 and 60 minutes after reperfusion by ELISA. RESULTS: Plasma TF and TFPI-1 levels before and at 120 minutes post coronary artery ligation were similar among the four groups (all P > 0.05). At 10 and 60 minutes after reperfusion, the plasma TF levels in the IR group was significantly higher than those in ischemic group and sham group [10 minutes: (20.7 + or - 4.1) pg/ml vs. (13.9 + or - 2.2) pg/ml (P < 0.001), (20.7 + or - 4.1) pg/ml vs. (13.2 + or - 2.6) pg/ml (P < 0.001); 60 minutes: (15.8 + or - 2.6) pg/ml vs. (13.5 + or - 1.6) pg/ml (P < 0.05), (15.8 + or - 2.6) pg/ml vs. (12.1 + or - 0.7) pg/ml (P < 0.001)] while the plasma TFPI-1 levels were similar among IR, ischemic and sham groups at 10 minutes after reperfusion and at 60 minutes after reperfusion (all P > 0.05). TFPI-1 level [(9.7 + or - 1.6) ng/ml] was significantly lower in the IR group than in the ischemic group [(11.6 + or - 1.6) ng/ml, P < 0.05] and sham group [(10.1 + or - 1.3) ng/ml, P < 0.01]. TF mRNA expression in the NR area in IR group was significantly up-regulated compared to the ischemic group (P < 0.05) and sham group (P < 0.001) while TFPI-1 mRNA expression was similar between IR group and ischemic group (P > 0.05). NR severity in the ischemic-reperfusion TFPI-1 group was significantly attenuated compared to IR group (0.39 + or - 0.11 vs. 0.54 + or - 0.06, P < 0.01). CONCLUSION: Upregulated TF mRNA expression in the NR area and increased plasma TF level during reperfusion period, reduced plasma TFPI-1 level during reperfusion period as well as attenuated NR severity by extrinsic application of human rTFPI-1 in this model suggested an important role in the pathogenesis of the NR phenomenon.

[Value of intravascular ultrasound, 64 multi-detector computed tomography and quantitative coronary angiography on lesion of coronary artery in unstable angina pectoris patient].

OBJECTIVE: To compare the value of intravascular ultrasound (IVUS) and assess the value of quantitative coronary angiography (QCA) and 64 multi-detector computed tomography (MDCT) on unstable anginas (UAP) risk stratification. METHOD: A total of 61 UAP patients (low risk: 17, middle risk: 33 and high risk: 11) were recruited, 71 vessels were examined by MDCT, QCA and IVUS. Plaque characteristics (soft, fibrous, calcified and mixed plaques) and plaque burden at minimum area (< or = 50%, 51% - 74% and > or = 75%) were detected, calculated and analyzed. Results derived from various detection methods were compared. RESULTS: Plaque burden detection by QCA was comparable to IVUS results for low and middle risk UAP (r = 0.768 and r = 0.721, respectively; all P < 0.01) but not for high risk UAP (67% + or - 14% vs.75% + or - 16%, P < 0.01) due to significant positive vessel remodeling (remodeling index = 1.21 + or - 0.31). The high negative predict value of MDCT for stenosed coronary vessels (87.8% - 96.3%)was valuable for exclusion of coronary heart disease but MDCT was not able to identify fibrous cap (kappa = 0.235) and lipid core (kappa = 0.245). Extent of remodeling index, external elastic membrane area, minimum lumen area, plaque burden, plaque rupture and thrombosis increased in proportion to increasing risks of UAP patients. CONCLUSIONS: QCA is a suitable tool for assessing UAP patients with low and middle vessel stenosis but underestimated the stenosis degree in UAP patients with high vessel stenosis. MDCT is valuable for exclusion vessel disease but not useful for identifying soft and fibrous plaque. Soft plaque with positive remodeling index and minimum lumen area < 4 mm(2) derived from IVUS could correctly identify UAP patients with high degree of vessel stenosis.