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BACKGROUND: Although a science advisory recommending 12 months of dual antiplatelet therapy after drug-eluting stents implantation was published recently, the optimal duration of dual antiplatelet therapy has not yet been precisely determined. HYPOTHESIS: Prolonged dual antiplatelet therapy can improve clinical outcomes in high-risk patients implanted with sirolimus-eluting stents. METHODS: The patients implanted with sirolimus-eluting stents were assigned into standard clopidogrel therapy group (clopidogrel 75 mg/d for 12 mo) and prolonged clopidogrel therapy group (clopidogrel 75 mg/d for 18 mo). Long-term aspirin (100 mg/d) therapy was adopted in both groups. The primary endpoint was very late stent thrombosis. RESULTS: After 12 months, 24 patients were excluded because of major adverse cardiovascular events (MACEs). Three hundred and thirty six patients surviving without MACEs were further followed up for 6 months. Between 12 and 18 months, in 160 patients with standard clopidogrel therapy, 5.6% had very late stent thrombosis. In contrast, in 176 patients with prolonged clopidogrel therapy, 1.1% had very late stent thrombosis (p<0.01, versus standard clopidogrel therapy group). CONCLUSIONS: Prolonged dual antiplatelet therapy may be beneficial to prevent very late stent thrombosis after sirolimus-eluting stents implantation in high-risk patients.
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Aspirina/administración & dosificación , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Oclusión de Injerto Vascular/prevención & control , Inmunosupresores/administración & dosificación , Inhibidores de Agregación Plaquetaria/administración & dosificación , Sirolimus/administración & dosificación , Ticlopidina/análogos & derivados , Distribución de Chi-Cuadrado , Clopidogrel , Femenino , Humanos , Masculino , Estudios Retrospectivos , Ticlopidina/administración & dosificación , Resultado del TratamientoRESUMEN
Objective@#To analyze the trends on constituent ratio of non-ST-segment-elevation (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) and related in-hospital mortality in acute myocardial infarction (AMI) patients hospitalized in Beijing Anzhen Hospital from 2004 to 2014.@*Methods@#This is a single-center, retrospective study. We reviewed all patients hospitalized for AMI in Beijing Anzhen Hospital from January 1 2004 to December 31 2014, and collected all related information including hospitalization stay, the type of AMI, revascularization and in-hospital mortality. We analyzed the trends of constituent ratio of NSTEMI and STEMI, and their in-hospital mortalities during the 11 years.@*Results@#Data from a total of 23 864 patients with AMI, including 5 539 STEMI and 18 325 NSTEMI, were analyzed. Compared with STEMI patients, NSTEMI patients were older, less likely to be male (P<0.001), had higher prevalence of hypertension, hyperlipidemia, diabetes (P<0.001), and lower prevalence of smoking (P<0.001). Additionally, patients with NSTEMI were more likely to have prior history of MI (12.6% (695/5 539) vs. 7.4% (1 354/18 325), P<0.001) and coronary artery bypass graft surgery (2.7% (152/5 539) vs. 0.7% (124/18 325), P<0.001). The constituent ratio of NSTEMI was significantly increased during the observation period, rising from 15.8% (107/802) in 2004 to 35.7% (1 273/3 583) in 2014 (P value for trend <0.001). The in-hospital mortality of NSTEMI patients was significantly lower compared with those with STEMI (1.84% (102 cases) vs. 2.74% (502 cases), P<0.001). The mortality of both STEMI and NSTEMI were significantly decreased during the 11 years (both P value for χ2 trend test <0.001). After adjusting for other risk factors, NSTEMI was independently associated with lower in-hospital mortality (OR=0.50, 95%CI 0.40-0.63, P<0.001).@*Conclusions@#In patients with AMI, the constituent ratio of NSTEMI versus STEMI is increased during the 11 years. The in-hospital mortality is decreased for both STEMI and NSTEMI patients in the past 11 years, and the in-hospital mortality rate of NSTEMI patients is lower than STEMI patients in this patient cohort during the observation period.
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Objective To investigate the synergistic effect of hyperhomocystinemia (HHcy) and smoking on the incidence of Coronary heart disease. Methods A total of 22 043 subjects were enrolled from health care center. Participants were classified into two groups: Non-coronary heart disease group (control group, n = 19 410) and coronary heart disease group(n=2 633).A questionnaire survey,physical examination and blood homocysteine (Hcy)test were carried out among the participants.Results After controlling the confounding factors,multivariable Logistic regression analysis showed that the risk of coronary heart disease in patients with smoking was 4.832 times higher than that of patients with normal waistline. The risk of coronary heart disease in patients with HHcy was 1.019 times higher than that of patients with normal Hcy (OR = 4.832,1.019,P < 0.05).Interaction analysis showed that the risk of patients with HHcy and smoking was 2.473 times higher than that of patients without HHcy and no-smoking.The synergy index between HHcy and smoking on the incidence of Coronary heart disease was 1.739. The pure attributable proportion due to the interaction was 42.9%. Conclusions HHcy and smoking are risk factors for coronary heart disease and there is a positive synergistic effect between HHcy and smoking on the incidence of coronary heart disease.
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Objective To assess the effect of revascularization on clinical outcome in elderly CHD patients with DM undergoing PCI.Methods 1055 CHD patients with DM undergoing PCI were divided into complete revascularization (CR) group (n=261),non-CR group 1 (n=385) and non-CR group 2 (n=409).The patients were followed up for 2 years during which the cardiovascular events were recorded.The SYNTAX revascularization index (SRI) was calculated according to the ROC curve and the best prognostic accuracy of revascularization was assayed.Results A significant difference was found in the incidence of MACE,angina pectoris,motality,cardiogenic death,myocardial infarction,unplanned revascularization during the 2-year follow-up period (P< 0.05,P<0.01).Logistic regression analysis showed that SRI was a protective factor for MACE,reduced 64% of MACE,and thus played a great role in predicting the incidence of MACE in elderly CHD patients with DM after 2 years of PCI (P=0.010).The area under the ROC curve showed the best prognostic accuracy of revascularization was 65%.Conclusion The incidence of cardiovascular events is low in elderly CHD patients with DM after 2 years of CR.The revascularization rate should be higher than 65% for those who cannot undergo CR in order to reduce their mortality during the long-term follow-up period.
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Metabolic syndrome (MetS) is regarded as a risk factor for coronary artery disease (CAD). However, the influence of MetS on morbidity and mortality after drug-eluting stent (DES) implantation in Chinese patients with CAD remains unknown. We evaluated the impact of MetS on the clinical outcome of 1224 patients following DES implantation. After a mean follow-up of 35.4 months, patients with MetS had a significantly higher incidence of all-cause death and major adverse cardiovascular events (MACE) compared with patients without MetS (P < .001). Analyses of individual MetS components showed that dysglycemia at the time of DES implantation predicted increased all-cause mortality, while the presence of hypertension and dysglycemia predicted increased incidence of MACE.
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Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Síndrome Metabólico/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Objective To evaluate the clinical effects of two different revascularization approaches,one via percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and the other via coronary artery bypass graft (CABG),on short-and long-term prognosis in elderly patients with diabetes and multi-vessel coronary artery disease.Methods A retrospective analysis was conducted on 254 elderly patients with diabetes and multi-vessel coronary artery disease.Based on the revascularization approach,patients were divided into the PCI group (n=93) and the CABG group (n =161).The incidence of major cardiovascular events (MACE) were observed during hospitalization and 1-year after follow-up.Results All-cause mortality and the incidence of non-fatal myocardial infarction were higher in the CABG group than in the PCI group during hospitalization [4.9% (8 cases) vs.1.1% (1 cases),5.6% (9 cases) vs.2.2% (2 cases),each P<0.05],while there was no significant difference in the incidence of MACE between the two groups1-year after follow-up (P> 0.05).The incidence of cerebrovascular events was lower in the PCI group than in the CABG group [2.2 % (2 cases) vs.6.2% (10 cases),P<0.05],while the rate of revascularization was higher in thePCI group than in the CABG group [6.5% (6 cases) vs.1.9% (3 cases),P<0.05].Cox regression analysis showed that diabetes (OR =1.65,95% CI:1.013-1.926,P =0.024) and left ventricular ejection fraction (OR =1.30,95 % CI:1.018-1.652,P =0.027) were independent risk factors for revascularization and cerebrovascular events.Conclusions MACEs during hospitalization are fewer in elderly patients with diabetes and multi-vessel coronary artery heart disease who received PCI than in those who received CABG.PCI has a similar mid-and long-term effect as CABG,bur PCI has a higher revascularization rate and lower risk of MACEs than CABG.
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Objective Excimer laser coronary atherecomy ( ELCA) has been recently used for the treatment of complex coronary lesions including calcified stenosis , chronic total occlusions and in-stent restenosis. Such complex lesions are difficult to adequately treat with balloon angioplasty and /or intracoronary stenting.The aim of this study was to introduce our early experiences in using ELCA in China . Methods Fifteen patients were enrolled through our center from March 2015 to April 2016 , and excimer laser coronary angioplasty was performed on 15 lesions.Eleven patients were previously failed cases either from uncrossable balloon ( 9 lesions ) or expandable balloon ( 6 lesions ) . The procedure and clinical endpoints were recorded .Results Laser catheter with 0.9 mm diameters were used in all 15 coronary lesions.All the lesions were successfully crossed with laser catheter and finally dilated with balloon .The procedural success rate was 100%.Drug eluting stents ( DES ) were implanted in 86.7% lesions and 2 cases were treated with drug eluting balloon .Clinical success was obtained in all patients (100%).There was no dissection , major side branch occlusion , spasm, no-reflow phenomenon nor acute vessel closure . Conclusions This study shows that laser-facilitated coronary angioplasty is a simple , safe and effective device for the management of complex coronary lesions .
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OBJECTIVE: We evaluated the impact of transradial coronary procedures on the radial artery (RA). METHODS: A total of 355 patients who underwent the transradial coronary procedures including transradial coronary angiography (CAG) and percutaneous coronary intervention (PCI) were enrolled. The right RA (RRA) was examined by ultrasound. RESULTS: The mean RRA diameter was 2.37 +/- 0.57, 1.95 +/- 0.50, and 2.23 +/- 0.41 mm, respectively, before the procedure, 1 day, and 1 month after the procedures (P < .01 at 1 day, P < .05 at 1 month). The mean intima-media thickness of RRA was 0.25 +/- 0.12, 0.69 +/- 0.31, and 0.38 +/- 0.17 mm, respectively, before the procedure, 1 day and 1 month after the procedure (P < .01 at 1 day, P < .05 at 1 month). The incidence of RRA stenosis was 0%, 15.7%, and 7.6%, respectively; the incidence of RRA occlusion was 0%, 2.8%, and 1.7%, respectively, before the procedure,1 day and 1 month after the procedure. CONCLUSIONS: Transradial coronary procedures can lead to early RA injury, but this repairs later.
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Angioplastia Coronaria con Balón/efectos adversos , Angiografía Coronaria/efectos adversos , Arteria Radial/lesiones , Angioplastia Coronaria con Balón/métodos , Angiografía Coronaria/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Radial/diagnóstico por imagen , Arteria Radial/patología , UltrasonografíaRESUMEN
Objective: To evaluate the impact of anemia on prognosis of elder patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: A total of 908 consecutive ACS patients elder than 60 years of age with PCI in our hospital from 2010-06 to 2012-06 were studied. According to WHO deifnition of anemia (HB Results: There were 31%of patients suffering from anemia. Anemia group had more patients with the elder age, female gender, diabetes, hypertension, chronic kidney disease, decreased LVEF, more patients with 3 vessel-disease, and higher mortality at 1 year after PCI, higher rate of MACCE than those in Non-anemia group, all P Conclusion: Anemia may increase the incidences of mortality and MACCE in elder ACS patients after PCI for a long-term.
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<p><b>OBJECTIVE</b>To explore the relationship between plasma microRNA126 (miR-126) level and coronary collateral circulation (CCC) formation and to determine whether the miR-126 in plasma could serve as a blood-based biomarker for CCC in patients with severely narrowed coronary arteries (CAD).</p><p><b>METHODS</b>In this prospective study, a total of 120 consecutive CAD patients with ≥ 95% stenosis in one epicardial coronary artery were enrolled. Thirty healthy people served as normal control. They were divided into two groups according to Rentrop grades: patients with grade 2 and 3 collateral development (good CCC group, n = 64) and patients with grade 0 and 1 collateral development (poor CCC group, n = 56). Plasma miR-126 was measured by RT-PCR and serum VEGF was evaluated by ELISA method.</p><p><b>RESULTS</b>Fasting plasma glucose (FPG) was significantly lower in patients with good CCC than in patients with poor CCC ((5.99 ± 1.48) mmol/L vs. (6.40 ± 2.50) mmol/L). Plasma miR-126 levels and VEGF levels were significantly lower in CAD patients than in healthy people (0.04 ± 0.01 vs. 0.07 ± 0.02, P = 0.023 and (2 110 ± 455) ng/L vs. (2 574 ± 450) ng/L, P = 0.011, respectively). miR-126 and VEGF levels were significantly higher in good CCC group than in poor CCC group (miR-126: 0.06 ± 0.02 vs. 0.03 ± 0.01, P = 0.021;VEGF:(2 549 ± 614) ng/L vs. (1 759 ± 452) ng/L, P = 0.008) . In CAD patients with good CCC, the miR-126 level was positively correlated to the VEGF expression (r = 0.712, P = 0.005) while there was no correlation between miR-126 level VEGF in CAD patients with poor CCC (r = 0.342, P = 0.483) . Multivariate analysis revealed that plasma miR-126 (OR = 2.145, 95% CI 1.691-2.988, P = 0.001) and VEGF (OR = 1.279, 95% CI 1.068-2.295, P = 0.013) were independent predictors of collateral formation in patients with severely narrowed coronary arteries. In CAD patients, the area under the miR-126 ROC curve is 0.951 (P = 0.002).</p><p><b>CONCLUSION</b>Plasma miR-126 level is positively correlated to the CCC formation and is an independent predictor of CCC development in patients with severely narrowed coronary arteries, suggesting that plasma miR-126 might be a useful new, stable blood biomarker for predicting CCC formation in patients with severely narrowed coronary arteries.</p>
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Humanos , Biomarcadores , Circulación Colateral , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Sangre , Circulación Coronaria , Enfermedad Coronaria , Corazón , MicroARNs , Sangre , Análisis Multivariante , Plasma , Estudios Prospectivos , Curva ROCRESUMEN
Aim To study the mechanism of synergistic antitumor of EBB and doxorubicin in doxorubicin-resistant MCF-7/ADR breast carcinoma cells.Methods The antitumor activity of doxorubiein alone and its combination with EBB were measured by MTT assay in MCF-7/ADR and MCF-7cells. The rate of doxorubicin-induced apoptosis and the protein and mRNA levels of P-glycoprotein(P-gp) were determined in MCF-7/ADR treated with EBB by flow cytometry (FACS), respectively.Laser scanning confocal microscopy was used to detect the intracellular accumulation of drug in EBB-treated MCF-7 and MCF-7/ADR cells.Results EBB had antitumor effects for MCF-7 and MCF-7/ADR.It could potentiate the antitumor effect of dororubicin with CDI of 0.73 and 0.49 for MCF-7 and MCF-7/ADR,respectively.EBB and doxorubicin acted synergistically in elevating apoptosis of MCF-7/ADR and downregulating the expression of P-gp in a dose-dependent manner in MCF-7/ADR.EBB restored the intracellular accumulation of doxorubicin in MCF-7/ADR cells in a dose-dependent manner.After pretreatment with EBB for 24 h and 48 h,the intracellular accumulation of doxorubicin and Rh123 was obviousely restored in MCF-7/ADR cells compared with control in a time-dependent manner.Conclusion EBB is a potential agent which has strong inhibitory effect on both multidrug resistant cells and their parental cells.EBB can significantly potentiate the antitumor effects of dororubicin in MCF-7/ADR cells by blocking the function of P-glycoprotein and inhibiting the expression of P-glycoprotein.
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OBJECTIVE To understand the condition of occupational exposure in hospital,and analyze the tendency during last four years.METHODS Occupational exposure in medical personnel were investivated through questionnaireand reviwed the survey report of quantitative detection of the five serological markers of hepatitis B,in the workers exposed in HBV.RESULTS The rate of occupational exposure had declined year by year during 2005-2008,but the result was opposite for HBV.CONCLUSIONS It′s very effective to decrease occupational exposure by strenghening standardization and putting professional protective knowledge in routine work.After setting up and developing protective system against occupational exposure,it′s more prompt in updating information,protective treatment and follow-up test in serum.It shows that this system is helpful to normalize medical personnel action of occupational exposure.In fact,vaccination is an effective way to avoid medical personnel of infecting HBV.
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Objective To investigate the effects of cytarabine(Ara-C) on expression of B7 molecules and immunogenicity of acute leukemia (AL) cells. Methods The expression of B7 molecules on fresh AL ceils and on the Ara-C exposed leukemia ceils was detected by FACS cytometer. B7 mRNA in Ara-C treated HL-60 cells were detected by reverse RT-PCR. The stimulation of proliferation of allogeneic PBMC by Ara-C treated HL-60 cells was detected by MTT method. Results B7-2 was weakly expressed in four and positive in three, whereas BT-1 was positive in only one of fourty AL patiens. Ara-C significantly enhanced B7 molecules expression on AL cells. Ara-C could induce higher expression of B7 mRNAs on HL-60 cells.Ara-C treated HL-60 cells could stimulate PBMC proliferation and promote their IFN -γ production.Conclusion Fresh AL cells express low level of B7 molecules. Ara-C enhances the B7 molecules expression on AL cells. The Ara-C treated leukemia cells can significantly stimulate the proliferation of allogeneic PBMC and induce their secretion of IFN-γ.
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Objective To investigate the effect of tirofiban on myocardial necrosis biomarker after percutaneous coronary interventions(PCI)in patients with aspirin resistance(AR).Methods 374 consecutive patients with aspirin 100 mg≥1 week,receiving no other antiplatelet therapy,scheduled for PCI were enrolled.all patients were given an loading dose of 300 mg clopidogrel at least 12 hours before PCI and an 75 mg maintenance dose per day.Patients were randomized into tirofiban group(n=38)and control group(n=45)after PCI.The levels of CKMB,TnI at 8,12,and 24 hours after PCI were measured in all patients;if the CK-MB,TnI value was above normal upper limitation,it was considered elevated.Results 83 patients were AR(22.2%)and 54.2%of them are females.The frequencies of CK-MB elevation were 15(39.5%)in tirofiban group and 19(42.2%)in control group,and TnI elevation was 18(47.4%)and 23(51.1%)in the two groups respectively.Conclusion Tirofiban can not decrease the elevation level of CK-MB and TnI in patients with AR after PCI.
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Objective To investigate the current condition of essential hypertension in the elderly aged over 60 yrs in rural and urban areas in Jinan. Methods 2 626 subjects aged over 60 years in rural and urban of Jinan were involved and were examined. The investigation was based on the unified questionnaire. The contents of questionnaire mainly included the history, treatment and control of hypertension. Results Prevalence of hypertension and rate of treatment in the male elderly in urban were 64.1% and 61.5% , respectively, and were higher than those in rural (56.9% and 38.3%, respectively). The treatment rate in female was higher in urban (60.8%) than in rural (43.1%) (P
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Objective To evaluate the efficacy and safety of facilitated PCI(low-dose rt-PA combined with percutaneous coronary intervention)in acute myocardial infarction(AMI).Methods One hundred and sixteen patients with AMI were divided into low-dose facilitated PCI group(n=69)and direct PCI group(n=47).69 patients in low-dose facilitated PCI group were treated with an intravenous drip of 50 mg rt-PA and PCI,while 47 patients in direct PCI group were treated with PCI.The rates of recanalization before and after PCI,and the left ventricular ejection fraction(LVEF)and major hemorrhage and major adverse cardiac events(MACE)in hospital were compared in two groups.Results There was no significant difference in the interval from hospitalization to the PCI between low-dose facilitated PCI group and direct PCI group.Compared with direct PCI group,the rates of recanalization and TIMI grade 3 before PCI were significantly higher in low-dose facilitated PCI group(44.7% vs 21.7%,P
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Objective To investigate the value of serum high sensitive C-reactive protein (hs-CRP) together with total cholesterol(TC)/high-density lipoprotein cholesterol (HDL-C) as a predictor risk factor for future coronary heart disease (CHD). Methods TC,HDL-C and hs-CRP were measured in 260 patients. Results The serum hs-CRP levels in patients with coronary heart disease were significantly increased than those in normal group, P
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Objective To probe into the safety and effectiveness of transcatheter coil embolization for congenital coronary artery fistula. Methods Between May 1999 and December 2002, coil embolization of coronary artery fistula was attempted in 6 patients aged 38 to 70 years (mean, 50.7 years). The fistulae connected the left coronary artery to the pulmonary artery in 2 patients, the right coronary artery to the pulmonary artery in 2, the right coronary artery to the right infra-pulmonary vein in 1, bilateral coronary artery (the left anterior descending artery and right coronary artery) to the pulmonary artery in 1. Results Complete fistula occlusion was achieved in 5 patients (83.3%); one failed to go through the tortuous fistula and gave up coil embolization. There were no operative or late deaths and complications. Follow-up evaluation by physical examination and echocardiography in 5 patients showed no evidence of recurrent or residual coronary artery fistula. Conclusion On the basis of our result, we believe that transcatheter coil embolization of coronary artery fistula is a safe, effective and convenient procedure without a thoracotomy and the use of cardio-pulmonary bypass in some cases.
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Objective To assess the efficacy and safety of two kinds of arterial suture-mediated closure devices (Angioseal and Perclose) in patients after coronary arteriography(CAG) and percutaneous coronary intervention (PCI). Methods 1?020 patients (672 male, 348 female, mean age 57.8?2.4 yr) undergoing CAG or PCI were randomized into either the Angioseal group (CAG 380, PCI 120) or the Perclose group (CAG 392, PCI 128). The procedural success rate and occurance of local complications were compared between the two groups. Results Both kinds of devices had a high success rate (Angioseal 94% vs Perclose 96%) and there was no statistical difference between them. There were five cases of hematoma and no pseudoaneurysm in the Angioseal group. On the other hand, there were four cases of hematoma and three cases of pseudoaneurysm in preclose group. There was no statistal difference in terms of local complications between the 2 groups. Conclusion Both kinds of arterial suture-mediated closure devices (Angioseal and Perclose) are feasible and safe for patients undergoing CAG and PCI.
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0.05).However,major vascular complications occurred only in the femoral group(3.9%).Conclusion Transradial LM PCI is as fast and successful as the femoral approach and results in fewer vascular complications.