Deciphering the fate of osmotic stress priming on enhanced microorganism acclimation for purified terephthalic acid wastewater treatment with high salinity and organic load.

Osmotic stress priming (OSP) was an effective management strategy for improving microbial acclimation to salt stress. In this study, the interaction between pollutants and microbiota, and microbial osmoregulation were investigated triggered by OSP (alternately increasing salinity and organic loading). Results showed that OSP significantly improved COD removal from 31.53 % to 67.99 % and mitigated the terephthalate inhibition produced by toluate, decreasing from 1908.08 mg/L to 837.16 mg/L compared with direct priming. Due to an increase in salinity, Pelotomaculum and Mesotoga were enriched to facilitate terephthalate degradation and syntrophic acetate oxidation (SAO). And organic load promoted acetate formation through syntrophic metabolism of Syntrophorhabdus/Pelotomaculum and SAO-dependent hydrogenotrophic methanogenesis. K+ absorbing, proline and trehalose synthesis participated in osmoregulation at 0.5 % salinity, while only ectoine alleviated intracellular osmolarity under 1.0 % salinity with OLR of 0.44 kg COD /m3. This study provided in-depth insight for microbial acclimation process of anaerobic priming of saline wastewater.

Temperature-regulated and starvation-induced refractory para-toluic acid anaerobic biotransformation.

Little research was focused on the anerobic degradation of refractory para-toluic acid at present. Thus, temperature-regulated anaerobic system of para-toluic acid fed as sole substrate was built and investigated via microbiota, metabolism intermediates, and function prediction in this study. Results showed that low methane yield was produced in para-toluic acid anaerobic system at alkaline condition. And the causes were owing to anaerobic methane oxidation and potentially H2S production at 37 °C, N2 production by denitrification before starvation and propionic acid occurrence after starvation at 27 °C, and production of N2 and free ammonia, and accumulation of acetic acid at 52 °C. Simultaneously, hydrogenotrophic methanogenesis dependent on syntrophic acetate oxidation (SAO) was predominant, facilitating the removal of para-toluic acid at 52 °C. Moreover, the key intermediate changed from phthalic acid of 37 °C and 27 °C before starvation to terephthalic acid of 52 °C. Starvation promoted removal of para-toluic acid through benzoyl-CoA pathway by Syntrophorhabdus, enrichment of syntrophic propionate degraders of Bacteroidetes and Ignavibacteriaceae, and increase of methylotrophic methanogens.

Fate and removal of antibiotic resistance genes in heavy metals and dye co-contaminated wastewater treatment system amended with ß-cyclodextrin functionalized biochar.

Biochar has been received increasing concerns regarding its environmental effect, which is promising in wastewater treatment. In this study, the performance of ß-cyclodextrin functionalized biochar (ß-BC) on the removal of antibiotic resistance genes (ARGs) in wastewater treatment under the co-stresses of heavy metals and dye is evaluated. Results show that when 20 mg/L heavy metals (HMs) and 150 mg/L methyl orange (MO) are present in daily fed influent, only 0.05 mg/L HMs residual and 96.79%-98.84% MO removal efficiency achieved in ß-BC additive group, compare to 0.16 mg/L and 87.92%-94.11% of that in control, respectively, indicating that ß-BC can benefits the performance of contaminants removal. To evaluate the role of ß-BC plays on ARGs in multi-contaminants stressed system, tet W, tet M, sul-1, sul-2, blaTEM, oxa-1, qnr-S, erm-B and intI-1 are identified. The relative abundance of all identified ARGs are decreased when ß-BC presence compared to the corresponding groups without ß-BC additive. The diversity and composition of microbial community are explored and the reduction of potential antibiotic-resistant bacteria is speculated as a driver of ARGs removal. In conclusion, our study demonstrates that ß-BC possesses the ability to promote the removal of ARGs during continuous wastewater treatment under HMs-MO co-contaminant.

Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions.

OBJECTIVES: To evaluate the very long-term safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels. METHODS: From April 2004 to October 2006, 2407 consecutive patients undergoing de novo lesion percutaneous coronary intervention with reference vessel diameter greater than or equal to 3.5 mm at Fu Wai Hospital in Beijing, China, were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We performed Cox's proportional-hazards models to assess relative risks of all the outcome measures after propensity match. RESULTS: After propensity scoring, 514 DES-treated patients were matched to 514 BMS-treated patients. The patients treated with BMS were associated with higher risk of TLR (HR: 2.55, 95%CI: 1.520-4.277, P = 0.0004) and TVR (HR: 1.889, 95%CI: 1.185-3.011, P = 0.0075), but the rates of death/MI and MACE were not statistically different. All Academic Research Consortium definition stent thrombosis at 9-year were comparable in the two groups. CONCLUSIONS: During long-term follow-up through nine years, use of DES in patients with large coronary arteries was still associated with significant reductions in the risks of TLR and TVR.

[Applicability and Microbial Community Structure of Denitrification Suspended Carriers].

In order to investigate the effects of temperature and organic loading on the bioactivity reactivation of anoxic biofilm in suspended carriers, the experiment was carried out under low organic loading, shock loading and low temperature conditions. The experimental results showed that the increase of polysaccharide in extracellular polymeric substance (EPS) was important during bioactivity reactivation process, and polysaccharide content was higher than that of protein under shock loading and low temperature conditions, and the contents of both polysaccharide and protein were much higher under low organic loading condition. Anoxic biofilm achieved excellent applicability in shock loading condition, moreover anoxic biofilm reactivated under low organic loading had lowest denitrication capacity and anoxic biofilm recovered at low temperature was in between. In addition, the relative abundance of Proteobacteria under low organic loading, shock loading and low temperature conditions increased from 72.23%, 78.66% and 76.35% to 83.17%, 84.30% and 80.46% at the end of the reactivation process (25th day), respectively. However, the relative abundance of Proteobacteria under low organic loading was lower than those of other reactors, indicating that the anoxic suspended carriers were less suitable for total nitrogen removal in wastewater treatment plant. The increase in relative abundance of Dechloromonas was significant for enhancing total nitrogen removal, and anoxic biofilm possessed comparatively rich biodiversity when the denitrification capability was recovered. The presence of Flavobacterium could promote the denitrification capacity of biofilm at low temperature.

Effectiveness of Alcohol Septal Ablation Versus Transaortic Extended Myectomy in Hypertrophic Cardiomyopathy with Midventricular Obstruction.

OBJECTIVES: Investigate the effectiveness of alcohol septal ablation (ASA) and transaortic extended myectomy (TEM) in hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO). BACKGROUND: MVO is less common than subaortic obstruction. Data on the effectiveness of ASA and TEM in MVO are lacking. METHODS: The clinical profiles of 22 patients undergoing ASA and 37 patients undergoing TEM were compared. No patient had apical aneurysm, abnormal chordae, mitral valve replacement or repair. RESULTS: Baseline midventricular pressure gradient and symptoms were comparable between the ASA and TEM groups. During follow-up, both groups demonstrated substantial reduction in pressure gradient (the ASA group: 79.7 ± 21.2 mm Hg to 43.7 ± 28.9 mm Hg, P < 0.001; the TEM group: 69.0 ± 23.9 mm Hg to 15.0 ± 16.9 mm Hg, P < 0.001). The reduction in pressure gradient was greater (78.9 ± 18.6% vs. 46.4 ± 33.4%, P < 0.001) and the residual pressure gradient was lower after TEM versus ASA (P < 0.001). Patients with New York Heart Association class III/IV dyspnea decreased from 59.1 to 18.2% (P = 0.022) in the ASA group and from 56.8 to 5.6% (P < 0.001) in the TEM group. Patients with Canadian Cardiovascular Society class III/IV angina decreased from 40.9 to 9.1% (P = 0.016) in the ASA group and from 32.4 to 0% (P < 0.001) in the TEM group. CONCLUSIONS: While ASA and TEM both improve gradients and symptoms, TEM may provide a more reliable reduction in gradients compared to ASA.

Effectiveness of Alcohol Septal Ablation in Obstructive Hypertrophic Cardiomyopathy With Versus Without Extreme Septal Hypertrophy.

AIMS: Data on the effectiveness of alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) and extreme septal hypertrophy (ESH) are lacking. This study aimed to compare the effectiveness of ASA in patients with vs without ESH. METHODS: Clinical profiles of 17 patients with ESH and 256 patients without ESH were compared. RESULTS: Baseline pressure gradient and limiting symptoms were comparable between patients with and without ESH. At median 1.1 years of follow-up after ASA, pressure gradient was 48.5 ± 40.4 mm Hg in the ESH group and 40.9 ± 35.2 mm Hg in the non-ESH (N-ESH) group (P=.33). Patients with New York Heart Association class III/IV represented 5.9% of the ESH group and 16.9% of the N-ESH group (P=.39). Patients with Canadian Cardiovascular Society class III/IV represented 5.9% of the ESH group and 10.2% of the N-ESH group (P=.87). CONCLUSION: The effectiveness of ASA seems comparable between patients with and without ESH.

Clinical and angiographic predictors of major side branch occlusion after main vessel stenting in coronary bifurcation lesions.

BACKGROUND: Major side branch (SB) occlusion is one of the most serious complications during percutaneous coronary intervention (PCI) for bifurcation lesions. We aimed to characterize the incidence and predictors of major SB occlusion during coronary bifurcation intervention. METHODS: We selected consecutive patients undergoing PCI (using one stent or provisional two stent strategy) for bifurcation lesions with major SB. All clinical characteristics, coronary angiography findings, PCI procedural factors and quantitative coronary angiographic analysis data were collected. Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion. SB occlusion after main vessel (MV) stenting was defined as no blood flow or any thrombolysis in myocardial infarction (TIMI) flow grade decrease in SB after MV stenting. RESULTS: Among all 652 bifurcation lesions, 32 (4.91%) SBs occluded. No blood flow occurred in 18 lesions and TIMI flow grade decreasing occurred in 14 lesions. In multivariate analysis, diameter ratio between MV/SB (odds ratio [OR]: 7.71, 95% confidence interval [CI]: 1.53-38.85, P = 0.01), bifurcation angle (OR: 1.03, 95% CI: 1.02-1.05, P < 0.01), diameter stenosis of SB before MV stenting (OR: 1.05, 95% CI: 1.03-1.07, P < 0.01), TIMI flow grade of SB before MV stenting (OR: 3.59, 95% CI: 1.48-8.72, P < 0.01) and left ventricular eject fraction (LVEF) (OR: 1.06, 95% CI: 1.02-1.11, P < 0.01) were independent predictors of SB occlusion. CONCLUSIONS: Among clinical and angiographic findings, diameter ratio between MV/SB, bifurcation angle, diameter stenosis of SB before MV stenting, TIMI flow grade of SB before MV stenting and LVEF were predictive of major SB occlusion after MV stenting.

Effect of final kissing balloon dilatation after one-stent technique at left-main bifurcation: a single center data.

BACKGROUND: Whether final kissing balloon (FKB) dilatation after one-stent implantation at left-main (LM) bifurcation site remains unclear. Therefore, this large sample and long-term follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy. METHODS: Total 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled; among them, 790 patients treated with one drug-eluting stent crossover LM to left anterior descending (LAD) with FKB (n = 230) or no FKB (n = 560) were comparatively analyzed. Primary outcome was the rate of major adverse cardiovascular events, defined as a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR). RESULTS: Overall, The prevalence of true bifurcation lesions, which included Medina classification (1,1,1), (1,0,1), or (0,1,1), was similar between-groups (non-FKB: 37.0% vs. FKB: 39.6%, P = 0.49). At mean 4 years follow-up, rates of major adverse cardiovascular events (non-FKB: 10.0% vs. FKB: 7.8%, P = 0.33), death, MI and TVR were not significantly different between-groups. In multivariate propensity-matched regression analysis, FKB was not an independent predictor of adverse outcomes. CONCLUSIONS: For patients treated with one-stent crossover LM to LAD, clinical outcomes appear similar between FKB and non-FKB strategy.

Pilot-scale bioelectrochemical system for efficient conversion of 4-chloronitrobenzene.

4-Chloronitrobenzene (4-CNB) is one of the highly toxic contaminants that may lead to acute, chronic or persistent physiological toxicity to ecology and environment. Conventional methods for removing 4-CNB from aquatic environment may be problematic due to inefficiency, high cost and low sustainability. This study develops a pilot-scale bioelectrochemical system (BES, effective volume of 18 L) and examines its performance of bioelectrochemical transformation of 4-CNB to 4-chloroaniline (4-CAN) under continuous operation. The results demonstrate that the initial 4-CNB concentration in the influent and hydraulic retention time (HRT) has a significant impact on 4-CNB reduction and 4-CAN formation. Compared with the conventional anaerobic process in the absence of external power supplied, the 4-CNB conversion efficiency can be enhanced with power supplied due to microbial-mediated electron transfer at the negative cathode potential. At a voltage of 0.4 V and HRT of 48 h, the 4-CNB reduction and 4-CAN formation efficiency reached 99% and 94.1%, respectively. Based on a small external voltage applied, the pilot-scale BES is effective in the conversion of 4-CNB to 4-CAN, an intermediate that is of less toxicity and higher bioavailability for subsequent treatment. This study provides a new strategy and methods for eliminating 4-CNB, making wastewater treatment more economical and more sustainable.

Improved interfacial oxygen reduction by ethylenediamine tetraacetic acid in the cathode of microbial fuel cell.

In this study, ethylenediamine tetraacetic acid (EDTA) was investigated as a new kind of non-polymeric catalyst binder to improve interfacial oxygen reduction reaction (ORR) for the cathode of microbial fuel cell (MFC). The electrochemical analysis and MFC tests show negative correlation between ORR activity and molar concentration of EDTA applied during electrode preparation. In particular, the 0.02mol/L-EDTA yields higher ORR activity than other binder materials like Nafion, water, 0.1mol/L-EDTA and 0.2mol/L-EDTA, as indicated by the strongest response of ORR current and the smallest charge-transfer resistance. Accordingly, the MFC with cathode of 0.02mol/L-EDTA produced a maximum power density of 722mW/m(2), accounting for a value approximately 42% higher than that of commercial Nafion binder (5wt%, 507mW/m(2)). The improved ORR activity should be attributed to the enhanced proton transfer from phosphate ions to EDTA-involved three-phase boundary as a result of dipole ion bonds on nitrogen atoms having unshared pair of electrons in EDTA molecule.

A novel stainless steel mesh/cobalt oxide hybrid electrode for efficient catalysis of oxygen reduction in a microbial fuel cell.

To explore efficient and cost-effective cathode material for microbial fuel cells (MFCs), the present study fabricates a new type of binder-free gas diffusion electrode made of cobalt oxide (Co3O4) micro-particles directly grown on stainless steel mesh (SSM) by using an ammonia-evaporation-induced method. In various electrochemical analyses and evaluations in batch-fed dual-chamber MFCs, the SSM/Co3O4 hybrid electrode demonstrates improved performances in terms of electrocatalytic activity, selectivity, durability and economics toward oxygen reduction reaction (ORR) in pH-neutral solution, in comparison with conventional carbon supported platinum catalyst. This study suggests a new strategy to fabricate a more effective electrode for ORR in MFCs, making it more technically and economically viable to produce electrical energy from organic materials for practical applications.

[Association study between Chinese medicine blood stasis syndrome and TIMI risk stratification of patients with unstable angina pectoris].

OBJECTIVE: To study the correlation between thrombolysis in myocardial infarction (TIMI) risk stratification and blood stasis syndrome (BSS) score in patients with unstable angina pectoris (UAP), and to analyze the relation of BBS degree and UAP clinical outcomes. METHODS: Collected were general data, demographic data, risk factors, Chinese medical symptoms and syndromes, coronary artery angiography results, relevant physical and chemical examinations from 114 UAP inpatients. Gensini score, TIMI risk score, and BSS score of these patients were calculated. RESULTS: The BBS score and Gensini score were significantly positively correlated (r = 0.78, P < 0.01). The BBS score was significantly higher in those with lesion in three branches than those with lesion in one branch or in two branches (P < 0.05). The BBS score was significantly higher in the high risk group than in the lower risk group and the medium risk group (P < 0.01). The TIMI risk score was obviously higher in the severe blood stasis group than in the moderate blood stasis group and the mild blood stasis group (P < 0. 05, P < 0.01). The BBS score and TIMI risk score was positively correlated (r = 0.23, P < 0.05). CONCLUSION: The BBS score was positively correlated with more coronary arteries involved. The more severe BBS degree, the TIMI risk score more higher, and the BBS degree more syndrome.

[Clinical outcomes of rotational atherectomy followed by drug-eluting stenting via the transradial approach for the treatment of heavily calcified coronary lesions].

OBJECTIVE: To assess the clinical outcomes of rotational atherectomy followed by drug-eluting stenting via the transradial approach for the treatment of heavily calcified coronary lesions. METHODS: From January 2009 to October 2012, 114 consecutive patients with heavily calcified coronary lesions underwent rotational atherectomy and drug-eluting stents via transradial approach in our hospital were enrolled in this retrospective study. Characteristics of heavily calcified coronary lesions, the success rates of rotational atherectomy and stenting, rates of complication during perioperative treatments, and adverse cardiovascular events during hospitalization and follow up were analyzed. RESULTS: All 114 patients were successfully treated with rotational atherectomy and drug-eluting stent placement, and totally 120 target lesions of type B or C were treated including 8 left main lesions, 93 left anterior descending and 2 circumflex, 17 right coronary lesions. No-reflow was observed in 7 patients during the procedure, there was one case of entrapped rotablator burr which was successfully retrieved together with guiding catheter without serious complication. During the 6 months (median) follow-up, angina was reported in 11 patients and revascularization was performed in 8 patients due to stent restenosis and intensified medical therapy was applied in 3 patients. There was no acute myocardial infarction and death during follow-up. CONCLUSION: Rotational atherectomy followed by drug-eluting stenting via transradial approach is feasible, effective and safe and the short-term outcome is satisfactory for patients with heavily calcified coronary lesions.

[Exercise echocardiography in the evaluation of obstructive types of hypertrophic cardiomyopathy].

OBJECTIVE: To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients. METHODS: A total of 60 patients with HCM and left ventricular outflow tract gradient (LVOTG) <50 mm Hg (1 mm Hg = 0.133 kPa) at rest were enrolled consecutively, and LVOTG at rest and exercise were measured by echocardiography. Of 51 patients with gradients <30 mm Hg at rest, 26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg, 25 were non LVOTO with exercise peak value LVOTG < 30 mm Hg, and 9 were resting obstruction with LVOTG 30-49 mm Hg. The morphological characteristics of different types of obstruction were analyzed. RESULTS: Patients with latent LVOTO were more likely to have SAM (73.1% vs 8.0%) , narrow of LVOT (46.2% vs 4.0%) , higher resting gradients [(16.9 ± 7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values <0.05). The distribution of septal hypertrophy were different in the two groups (P < 0.05). Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431, 95%CI 2.323-291.112, P = 0.002) at rest and distribution of septal hypertrophy(OR 0.011, 95% CI 0.001-0.179, P = 0.008). CONCLUSIONS: Approximately half of patients with non-obstructive HCM at rest have latent LVOTO. SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.

Combination of Chinese Herbal Medicines and Conventional Treatment versus Conventional Treatment Alone in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention (5C Trial): An Open-Label Randomized Controlled, Multicenter Study.

Aims. To evaluate the efficacy of Chinese herbal medicines (CHMs) plus conventional treatment in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods and Results. Participants (n = 808) with ACS who underwent PCI from thirteen hospitals of mainland China were randomized into two groups: CHMs plus conventional treatment group (treatment group) or conventional treatment alone group (control group). All participants received conventional treatment, and participants in treatment group additionally received CHMs for six months. The primary endpoint was the composite of cardiac death, nonfatal recurrent MI, and ischemia-driven revascularization. Secondary endpoint was the composite of readmission for ACS, stroke, or congestive heart failure. The safety endpoint involved occurrence of major bleeding events. The incidence of primary endpoint was 2.7% in treatment group versus 6.2% in control group (HR, 0.43; 95% CI, 0.21 to 0.87; P = 0.015). The incidence of secondary endpoint was 3.5% in treatment group versus 8.7% in control group (HR, 0.39; 95% CI, 0.21 to 0.72; P = 0.002). No major bleeding events were observed in any participant. Conclusion. Treatment with CHMs plus conventional treatment further reduced the occurrence of cardiovascular events in patients with ACS after PCI without increasing risk of major bleeding.

Long-term clinical outcomes of patients with unprotected left main bifurcation lesions treated with 2-stent techniques.

BACKGROUND: Currently available evidence suggests that outcomes are less favorable when left main (LM) bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique. We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients. METHODS: We enrolled 301 consecutive patients treated with drug-eluting stents (DES) implantation using 2-stent techniques for unprotected LM bifurcation lesions (MEDINA 1, 1, 1, 70.5%). The 2-stent techniques included crush technique, V stenting, T stenting, and Culottes stenting. After stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB). Clinical and angiographic data were analyzed. The primary endpoints were major adverse cardiac events (MACE), which included death, myocardial infarction, and target lesion revascularization. RESULTS: Immediate procedural success was obtained in all cases with a FKB success rate of 95.3%. Follow-up data were available for all patients. The overall incidence of angiographic in-stent restenosis (ISR) rate was 20.3% and most ISRs were of the focal type. During long-term follow-up (mean duration, (54 ± 22) months), the cumulative incidence of MACE was 11.0%, with 8 (2.7%) deaths, 7 (2.3%) myocardial infarctions, and 18 (6.0%) repeated lesion revascularization. MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles (P = 0.001). CONCLUSIONS: Although percutaneous coronary intervention (PCI) with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR, the long-term clinical follow-up is acceptable. Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI.

Can "Hybrid stent implantation" improve long-term safety without adversely affecting efficacy when treating multilesion coronary artery disease in the drug-eluting stent era?

BACKGROUND: Though drug-eluting stent (DES) almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decrease the use of DES, probably improving the long-term safety but not affecting efficacy adversely when treating multilesion coronary artery disease in the DES era. METHODS: From April 2004 to October 2006, 848 patients with multilesion disease underwent hybrid stent implantation. During the same period 5647 patients with multilesion coronary heart disease were treated by exclusive DES implantation in Fu Wai Hospital. According to propensity score matching, we chose 823 pairs of patients with multileison coronary artery disease for inclusion into our study. We obtained the 24-month clinical outcome including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We used Cox's proportional-hazard models to assess relative risks of all the outcome measures after propensity match. RESULTS: At 24 months, patients in the hybrid stent implantation group showed a significantly higher risk of TLR (8.39% vs. 3.28%, HR 2.38, 95%CI: 1.50 - 3.70), TVR (11.07% vs. 6.32%, HR 1.61, 95%CI: 1.15 - 2.27) and MACE (13.75% vs. 8.75%, HR 1.37, 95%CI: 1.02 - 1.85). No significant difference was apparent in terms of mortality (1.22% vs. 1.70%, HR 0.55, 95%CI: 0.24 - 1.25), MI (1.95% vs. 2.31%, HR 0.73, 95%CI: 0.37 - 1.42), or thrombosis (definite + probable) (0.73% vs. 1.58%, HR 0.40, 95%CI: 0.15 - 1.05). CONCLUSIONS: In patients with multilesion coronary artery disease, the exclusive DES implantation was associated with significantly lower risks of TLR, TVR and MACE, and the hybrid stent implantation did not result in any significant improvements regarding safety issues. Prospective studies are needed to confirm our results.

Impact of depressed left ventricular function on outcomes in patients with three-vessel coronary disease undergoing percutaneous coronary intervention.

BACKGROUND: Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF) represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population. METHODS: Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF < 40% (low ejection fraction (EF)) and 4144 patients had LVEF ≥ 40%. In-hospital and long-term outcomes were examined according to LVEF. RESULTS: The estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group (19.64% vs. 8.73%, Log-rank test: P < 0.01; 10.30% vs. 1.33%, Log-rank test: P < 0.01, and 10.32% vs. 2.28%, Log-rank test: P < 0.01 respectively), but there was no difference in the rates of target vessel revascularization (6.18% vs. 6.11%, Log-rank test: P = 0.96). Using the Cox proportional hazard models, LVEF < 40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events (OR (95%CI): 4.779 (2.369 - 9.637), 2.673 (1.353 - 5.282), and 1.827 (1.187 - 2.813) respectively), but was not a statistically significant risk factor for target vessel revascularization (OR (95%CI): 1.094 (0.558 - 2.147)). CONCLUSION: Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.