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BACKGROUND: Biodegradable polymer biolimus-eluting stents (BP-BES) may be associated with better outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) compared to other current-generation limus-eluting stents (LES). AIMS: To compare BP-BES with other current-generation LES in ACS patients undergoing PCI. METHODS: We pooled individual data of Non-ST-segment elevation (NSTE)-ACS patients from two large randomized controlled trials (GLASSY and TWILIGHT). The BP-BES groups consisted mostly of GLASSY patients, while the control group (other current-generation LES) included exclusively TWILIGHT patients. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, or stent thrombosis; the key secondary outcome was target-vessel failure (TVF). To account for trial design differences, outcomes were assessed at 3 months (short-term) and between 3 and 12 months (long-term) after PCI and subsequently pooled to estimate the 12-month hazards. RESULTS: Of 7107 and 6053 NSTE-ACS patients included in the short- and long-term analysis, 32.7% and 36.5% received a BP-BES, respectively. Risk of MACE associated with BP-BES versus other LES was similar at short-term (1.1% vs 1.3%, adjusted HR 0.86, 95%CI 0.53-1.38), lower at long-term (1.7% vs 3.1%, adjusted HR 0.49, 95%CI 0.34-0.72), and lower in the entire 12-month period (pooled adjusted HR 0.61, 95%CI 0.45-0.82). The cumulative 12-month risk of TVF was reduced with BP-BES (adjusted HR 0.52, 95%CI 0.38-0.70). CONCLUSION: BP-BES was associated with lower 12-month risks of MACE and TVF compared to other current generation LES among NSTE-ACS patients treated with abbreviated or standard ticagrelor-based DAPT. These non-randomized findings are hypothesis-generating. CONDENSED ABSTRACT: Differences in clinical outcomes may exist between biodegradable polymer biolimus-eluting stents (BP-BES) and other current-generation limus-eluting stent (LES) in patients with acute coronary syndrome (ACS). We pooled individual data of about 7000 Non-ST-segment elevation ACS patients undergoing PCI and treated with ticagrelor with or without aspirin from two large randomized controlled trials (GLASSY and TWILIGHT). BP-BES patients derived very largely from GLASSY and other LES patients from TWILIGHT. In this population, BP-BES compared to other current generation LES, were associated with a lower 12-month risk of major adverse cardiovascular events and target-vessel failure.
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Síndrome Coronario Agudo , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea , Humanos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/cirugía , Síndrome Coronario Agudo/etiología , Sirolimus , Stents Liberadores de Fármacos/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , Ticagrelor , Resultado del Tratamiento , Stents , Polímeros , Implantes AbsorbiblesRESUMEN
BACKGROUND@#There are few data comparing clinical outcomes of complex percutaneous coronary intervention (CPCI) when using biodegradable polymer drug-eluting stents (BP-DES) or second-generation durable polymer drug-eluting stents (DP-DES). The purpose of this study was to investigate the safety and efficacy of BP-DES and compare that with DP-DES in patients with and without CPCI during a 5-year follow-up.@*METHODS@#Patients who exclusively underwent BP-DES or DP-DES implantation in 2013 at Fuwai Hospital were consecutively enrolled and stratified into two categories based on CPCI presence or absence. CPCI included at least one of the following features: unprotected left main lesion, ≥2 lesions treated, ≥2 stents implanted, total stent length >40 mm, moderate-to-severe calcified lesion, chronic total occlusion, or bifurcated target lesion. The primary endpoint was major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction, and total coronary revascularization (target lesion revascularization, target vessel revascularization [TVR], and non-TVR) during the 5-year follow-up. The secondary endpoint was total coronary revascularization.@*RESULTS@#Among the 7712 patients included, 4882 (63.3%) underwent CPCI. Compared with non-CPCI patients, CPCI patients had higher 2- and 5-year incidences of MACE and total coronary revascularization. Following multivariable adjustment including stent type, CPCI was an independent predictor of MACE (adjusted hazard ratio [aHR]: 1.151; 95% confidence interval [CI]: 1.017-1.303, P = 0.026) and total coronary revascularization (aHR: 1.199; 95% CI: 1.037-1.388, P = 0.014) at 5 years. The results were consistent at the 2-year endpoints. In patients with CPCI, BP-DES use was associated with significantly higher MACE rates at 5 years (aHR: 1.256; 95% CI: 1.078-1.462, P = 0.003) and total coronary revascularization (aHR: 1.257; 95% CI: 1.052-1.502, P = 0.012) compared with that of DP-DES, but there was a similar risk at 2 years. However, BP-DES had comparable safety and efficacy profiles including MACE and total coronary revascularization compared with DP-DES in patients with non-CPCI at 2 and 5 years.@*CONCLUSIONS@#Patients underwent CPCI remained at a higher risk of mid- to long-term adverse events regardless of the stent type. The effect of BP-DES compared with DP-DES on outcomes was similar in CPCI and non-CPCI patients at 2 years but had inconsistent effects at the 5-year clinical endpoints.
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Humanos , Stents Liberadores de Fármacos/efectos adversos , Infarto del Miocardio/complicaciones , Polímeros/uso terapéutico , Resultado del Tratamiento , Enfermedad de la Arteria Coronaria/complicaciones , Intervención Coronaria Percutánea/efectos adversos , Implantes Absorbibles , Diseño de PrótesisRESUMEN
OBJECTIVES: The aim of this study was to compare ticagrelor monotherapy with dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents. BACKGROUND: The role of abbreviated DAPT followed by an oral P2Y12 inhibitor after PCI remains uncertain. METHODS: Two randomized trials, including 14,628 patients undergoing PCI, comparing ticagrelor monotherapy with standard DAPT on centrally adjudicated endpoints were identified, and individual patient data were analyzed using 1-step fixed-effect models. The protocol was registered in PROSPERO (CRD42019143120). The primary outcomes were the composite of Bleeding Academic Research Consortium type 3 or 5 bleeding tested for superiority and, if met, the composite of all-cause death, myocardial infarction, or stroke at 1 year, tested for noninferiority against a margin of 1.25 on a hazard ratio (HR) scale. RESULTS: Bleeding Academic Research Consortium type 3 or 5 bleeding occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%, respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p < 0.001). The composite of all-cause death, myocardial infarction, or stroke occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%) with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority). Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI: 0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to 0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs. 2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke (0.47% vs. 0.36%; p = 0.30) were similar. CONCLUSIONS: Ticagrelor monotherapy was associated with a lower risk for major bleeding compared with standard DAPT, without a concomitant increase in ischemic events.
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Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria , Quimioterapia Combinada , Terapia Antiplaquetaria Doble , Humanos , Intervención Coronaria Percutánea/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Ticagrelor/efectos adversos , Resultado del TratamientoRESUMEN
Objective To observe the expression of FGF19 (fibroblast growth factor 19) and PEDF (pigment epithelium-derived factor) in the serum of type 2 diabetic retinopathy (DR) patients and discuss their significance.Methods Total 89 patients with type 2 diabetes were selected and divided into two groups according to whether they were combined with diabetic retinopathy:45 patients with type 2 diabetes alone (DM group) and 44 patients with type 2 diabetes mellitus combined with retinopathy (DR group).At the same time,40 healthy people were selected as the control group (NDM group).The serum levels of FGF19 and PEDF and their biochemical indexes were detected and compared in each group.The correlation between the indexes and the relationship between FGF19,PEDF and DR were analyzed.Results Compared with NDM group,serum FGF19 level in DM group and DR group decreased,while C-reactive protein (CRP) and PEDF level in DM group and DR group increased (P < 0.05);serum FGF19 level in DR group was lower than that inDMgroup,while serum PEDF level was higher than that in DM group (P <0.05).The levels of fasting blood glucose (FBG),fasting insulin levels (FINS),glycosylated hemoglobin (HbA1c),total cholesterol (TC),high density lipoprotein (HDL) and low density lipoprotein (LDL) in DM and DR groups were higher than those in NDM group (P < 0.05),but there was no significant difference between DM group and DR group (P > 0.05);the levels of Hcy,triacylglycerol (TG) and CRP in DR group were higher than those in DM and NDM group (P < 0.05),and the levels of VLDL were lower than those in DM and NDM group (P < 0.05).The level of serum FGF19 was positively correlated with HDL and CRP in patients with DR (r =0.341,0.623,P < 0.05),and negatively correlated with fasting blood glucose(r =-0.428,P <0.05);The level of serum PEDF in patients with DR were negatively correlated with FINS (r =-0.343,P <0.05).When the serum level of PEDF > 12.76 mg/L,the sensitivity and specificity of PEDF dignosing DR were 80.9% and 56.7% respectively.Conclusions In patients with DR,serum FGF19 level decreased and serum PEDF levels increased.The level of both changes is closely related to DR and may be involved in the development of DR.
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Objective@#To evaluate the long-term prognosis of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) by risk stratification with American College of Cardiology (ACC)/American Heart Association (AHA) classification of coronary lesions.@*Methods@#Data used in this study derived from the I-LOVE-IT 2 trial. I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, noninferiority study. A total of 1 255 patients in I-LOVE-IT 2 trial with only one lesion and underwent biodegradable polymer drug-eluting stent implantation were included and grouped according to ACC/AHA classification of coronary lesions, namely type A/B1 lesion group (n=184), type B2 lesion group (n=457) and type C lesion group (n=614). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, all myocardial infarction, stroke, and/or any revascularization. The secondary endpoints were target lesion failure (TLF), components of PoCE, major bleeding (bleeding academic research consortium(BARC) type 3-5) and definite/probable stent thrombosis within 48 months. The incidences of endpoint events were compared in the three groups. The multivariable Cox hazard ratio model was used to analyze the independent predictors of PoCE and TLF at 48 months.@*Results@#Incidences of PoCE at 48 months were significantly higher in patients with type C lesion compared with patients with type A/B1 (24.43%(150/614) vs. 14.13%(26/184), P<0.05) or B2 lesion (24.43%(150/614) vs. 15.97%(73/457), P<0.05). The multivariable Cox hazard ratio model showed that the type C lesion were the independent predictors of 48-month PoCE (HR=1.59, 95%CI 1.21-2.08, P<0.001) and TLF (HR=2.31, 95%CI 1.53-3.49, P<0.001). After multivariable adjustment, the HRs of PoCE for patients with type C lesion versus type A/B1 and type B2 were 1.91 (95%CI 1.25-2.92, P=0.003) and 1.64 (95%CI 1.23-2.20, P<0.001), respectively. Meanwhile, the HRs of TLF for patients with type C lesion versus type A/B1 and type B2 were 2.45 (95%CI 1.29-4.64, P=0.006) and 2.55 (95%CI 1.62-4.02, P=0.001), respectively.@*Conclusions@#The ACC/AHA classification of coronary lesions has good discrimination with long-term outcomes for CAD patients undergoing PCI. The type C lesion is associated with a worse prognosis, enough attention should be paid in these patients during routine clinical management.
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Objective@#To evaluate the efficacy and safety of low dose sublingual nifedipine dripping pills (5 mg) in treating moderate and severe hypertension in comparison with normal dose (10 mg) of sublingual nifedipine dripping pills.@*Methods@#This study was designed as a randomized, double-blind, positive drug parallel controlled, multi-center, non-inferiority clinical trial. Patients with moderate and severe hypertension were enrolled by 14 clinical trial centers, randomly divided into the trial group (sublingual 5 mg nifedipine dripping pills) and the control group (sublingual 10 mg nifedipine dripping pills). The changes in blood pressure were monitored continuously within 2 hours after the initial administration, repeated the dose in 20 minutes interval after the initial administration for up to additional 3 doses (maximum 4 doses) if the antihypertensive efficacy was not satisfactory. The efficacy of antihypertensive therapy between the two groups was evaluated by repeated administration rates and blood pressure changes at 60 minutes post the initial administration, and the safety of treatment was evaluated by recording adverse event rate of the two groups.@*Results@#The anti-hypertensive effective rates at 60 minutes after sublingual administration were 83.5% (202/242) and 86.7% (208/240) respectively between the trial group and control group (χ2=1.307, P=0.253) . On the aspect of antihypertensive effectiveness at 60 minutes after single dose of sublingual administration, the anti-hypertension effective rates of the trial group and the control group were 85.6% (154/180) and 87.2% (164/188) respectively (χ2=0.221, P=0.639). Prevalence of the repeated administration was also similar between the two groups (25.6%(62/242) in the trial group and 21.7% (52/240) in the control group, χ2=1.043, P=0.307). On the safety aspect, there was no adverse events/reactions in the trial group, but there were 15 cases of adverse events/reactions occurred in control group (6.25%, χ2=15.611, P<0.001).@*Conclusions@#In the treatment of moderate to severe hypertension, the antihypertensive efficacy of low dose nifedipine dripping pills is similar to that of conventional dosage, and the safety profile of low dose nifedipine dripping pills is better than that of the conventional dose.
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Objective@#To evaluate the long-term efficacy of a second generation biodegradable polymer sirolimus-eluting stent (EXCEL2) in treating patients with de novo coronary artery diseases.@*Methods@#CREDIT Ⅱ trial was a prospective, multicenter, randomized, controlled study, conducted at 15 Chinese cardiac centres from November 2013 to December 2014. In this analysis, eligible patients for coronary stenting (n=419) were randomized to receive either the EXCEL2 stent (n=208) or the EXCEL stent (n=211). The primary endpoint was target lesion failure (TLF) at 3 years after PCI defined as a composite endpoints of cardiac death, target vessel myocardial infarction (TVMI), or clinically indicated target lesion revascularization (CI-TLR). Secondary endpoints included patient-oriented composite endpoint (PoCE) including all-cause death, all MI, or any revascularization at 3 years and independent components, and stent thrombosis according to Academic Research Consortium′s (ARC) definition.@*Results@#Among 419 enrolled patients, 413 (98.6%) patients completed 3-year clinical follow-up. Compared with the EXCEL group, 3-year TLF (5.4%(11/204) vs. 11.5% (24/209), P=0.025) and PoCE (9.8% (20/204) vs. 20.1% (42/209), P=0.003) were significantly lower in the EXCEL2 group. The cumulative event rate of CI-TLR (2.0% (4/204) vs. 5.7% (12/209), P=0.042) and any revascularization (4.9% (10/204) vs. 14.4% (30/209), P=0.001) were statistically lower in the EXCEL2 group than in the EXCEL group. There were no significant difference between two groups in terms of all-cause death and all MI. Rates of stent thrombosis were low without significant difference between the two groups (EXCEL2 vs. EXCEL, 1.0% (2/204) vs. 2.9% (6/209), P=0.285).@*Conclusion@#3-year clinical follow-up results demonstrate that EXCEL2 stents are effective and safe in treating CAD patients with de novo coronary lesions.
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Objective@#To explore the value of SYNTAX revascularization index (SRI) on evaluating the long-term prognosis of coronary artery disease (CAD) patients implanted with biodegradable polymer drug-eluting stents (BP-DES) and define the best threshold of SRI for predicting all-cause mortality in these patients.@*Methods@#Data used in this study derived from the I-LOVE-IT 2 trial (evaluate safety and effectiveness of the Tivoli DES and the Firebird DES for treatment of coronary). I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, non-inferiority study. A total of 1 829 patients implanted with BP-DES were divided into 3 groups, namely SRI=100% group (n=963), 50%≤SRI<100% group (n=527) and SRI<50% group (n=339). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, myocardial infarction(MI), stroke, and/or any revascularization. The secondary endpoints were components of PoCE and definite/probable stent thrombosis at 48 months. The receiver operating characteristic curve was used to investigate the best cut-off point of SRI for 48-month all-cause mortality. The Cox regression analysis was used to identify independent predictors of the all-cause death and PoCE at 48 months.@*Results@#Incidence of PoCE at 48 months was significantly lower in SRI=100% group than patients with 50%≤SRI<100%(17.34% (167/963) vs. 22.20% (117/527), P<0.05) and SRI<50% (17.34% (167/963) vs. 24.78% (84/339), P<0.05). Comparing with SRI=100% group, the patients with 50%≤SRI<100% suffered higher rates of all MI (7.78% (41/527) vs. 4.26% (41/963), P<0.05) and target vessel MI (6.45% (34/527) vs. 4.26% (41/963), P<0.05); patients with SRI<50% had higher rates of all-cause mortality (5.90% (20/339) vs. 3.12% (30/963), P<0.05) and any revascularization (14.16% (48/339) vs. 3.12% (30/963), P<0.05). The receiver operating characteristic curve analysis showed that the SRI=65% was the best cut-off point to predict the all-cause mortality at 48 months (area under the curve was 0.58, sensitive was 0.47, specificity was 0.70). Meanwhile, SRI<65% was an independent predictor of 48-month all-cause mortality (HR=2.06, 95%CI 1.25-3.38) and PoCE (HR=1.34, 95%CI 1.09-1.66).@*Conclusions@#SRI serves as a good index for predicting long-term prognosis and SRI<65% is an independent predictor of 48-month PoCE and all-cause mortality for CAD patients with BP-DES implantation. Meanwhile, SRI≥65% might be a reasonable threshold of incomplete revascularization.
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Objective@#To investigate the efficacy of periprocedural use of bivalirudin for patients with chronic total occlusion(CTO) lesion undergoing percutaneous coronary intervention(PCI) therapy. @*Methods@#In this randomized controlled study, 74 patients with CTO lesions confirmed by coronary angiography or CT angiography, hospitalized in the general hospital of Shenyang military region from September 2015 to December 2016, were randomly divided into unfractionated heparin(UFH) group (n=38) and bivalirudin group (n=36) by the random number table.Patients in the UFH group were treated with injection of UFH 5 000 U through the artery sheath catheter before coronary angiography,and the UFH was intravenously administered at 100 U/kg before PCI. Patients in the bivalirudin group received intravenous injection of bivalirudin (0.75 mg/kg) before coronary angiography, followed by intravenous infusion of 1.75 mg·kg-1·h-1 until at least 2 hours after the PCI. The values of the activated coagulation time (ACT) were measured,and the value was remained at 250 to 350 seconds during the PCI. The incidence rate of adverse events including hemorrhage events, no-reflow/slow flow, and contact thrombus in perioperative period were observed in all patients. In addition, the incidence rate of the major adverse cardiovascular events (MACE) including recurrent angina, heart failure, target vessel revascularization, cardiac death, non-fatal myocardial infarction,and stroke within 1 year follow-up period were also observed in the 2 groups. @*Results@#Baseline clinical and PCI data were similar between the 2 groups (all P>0.05). During the perioperative period, the incidence of the bleeding was significantly lower in the bivalirudin group than in the UFH group(5.6% (2/36) vs. 23.7% (9/38) , P=0.028).The incidence of no-reflow/slow flow was also significantly lower in the bivalirudin group than in the UFH group(0 vs. 15.8% (6/38) , P=0.025). There was no significant difference in the incidence of contact thrombosis between bivalirudin group and UFH group(8.3% (3/36) vs. 0, P=0.110). There was no cardiac death or non-fatal myocardial infarction in the 2 groups within 1 year after PCI, and there was no significant difference in the incidence of MACE in 1 year follow-up after operation between bivalirudin group and UFH group (11.1% (4/36) vs. 21.1% (8/38) , P=0.246). @*Conclusion@#The application of the anticoagulant bivalirudin during PCI in patients with CTO lesion can reduce the incidence of perioperative bleeding and no-reflow/slow flow, and does not increase the risk of MACE within 1 year after PCI.
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Objective@#To investigate the effect of excimer laser coronary atherectomy (ELCA) in the interventional treatment of acute coronary syndrome (ACS).@*Methods@#This prospective study enrolled 31 patients with ACS who underwent ELCA treatment in our hospital from November 8, 2016 to December 13, 2017. The efficacy and complications of ELCA were observed, and patients were followed up for postoperative observation of major adverse cardiovascular and cerebrovascular events (including target vessel revascularization, stroke, stent thrombosis, coronary artery bypass grafting, and death).@*Results@#The patients were aged (65.0±10.8) years old and 25 were males (80.6%).There were 5 cases (16.1%) ST-segment elevation myocardial infarction, 3 cases (9.7%) non-ST-segment elevation myocardial infarction, and 23 cases (74.2%) unstable angina in this cohort.There were 9 cases (29.0%) in-stent restenosis, 11 cases (35.5%) saphenous vein graft, 2 cases (6.5%) chronic total occlusive disease, and 4 cases (12.9%) calcification.Two patients with chronic complete occlusive disease and 1 patient with calcified lesion were examined by intravascular ultrasound (IVUS). The other lesions were not examined with IVUS and optical correlation tomography (OCT).The ELCA success rate was 100% (31/31) and the PCI success rate was 100% (31/31).Intraoperative use of 0.9 mm diameter catheters accounted for 38.7% (12/31), 1.7 mm diameter catheters accounted for 32.3% (10/31), and 1.4 mm diameter catheters accounted for 29.0% (9/31).One patient with ST-segment elevation myocardial infarction experienced no reflow of coronary artery during operation. The other 30 patients had no complications such as perforation, small dissection, large dissection, distal occlusion, slow blood flow and collateral occlusion. One cardiac death(3.2%) occurred during the postoperative follow-up of (6.4±1.9) months.@*Conclusion@#Our preliminary study results indicate that the use of ELCA in the interventional therapy of ACS is safe and effective.
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Objective To evaluate the incidence of net adverse clinical and cerebral events (NACCE) 1 year after implantation of biodegradable polymer stents (BP-SES) in elderly patients with coronary artery disease.Methods The clinical data of patients inserted with BP-SES in I-LOVE-IT 2 Trial were retrospectively analyzed, including 1829 elderly patients admitted in the General Hospital of Shenyang Military Command from Oct. 2012 to Jun. 2013, of which 62 cases aged equal to and more than 65 years (elderly group) and 1202 cases less than 65 years (non-elderly group). The primary end-point of this research was target lesion failure (TLF) rate on 12 months and the secondary end-point was the incidence of NACCE, including all-cause death, all myocardial infarction, stroke and severe hemorrhage (BARC type ≥3), and then the multiple regression analysis was performed.Results The Baseline conditions of the two groups were significantly different (P<0.05) including BMI, diabetes, hypertension, hyperlipidemia, family history of coronary heart disease, smoking history, past stroke history, history of peripheral vascular disease and stable angina pectoris. When comparing elderly group with non-elderly group, marked differences existed on the incidence of NACCE (10.0%vs. 5.2%,P<0.01), all-cause mortality (2.7%vs. 0.7%,P<0.01), myocardial infarction (5.6%vs. 3.5%,P=0.03), stent thrombosis (1.9%vs. 0.5%,P<0.01) and stroke (2.2%vs. 0.8%,P=0.01). Multiple regression analysis revealed that elderly (age ≥65) was the independent predictive factor for NACCE (OR=1.904, 95%CI 1.304-2.781,P=0.001).ConclusionThe incidence of NACCE is increased significantly in elderly patients (age ≥65), and elderly is an independent predictive factors for 12-month NACCE in patients implanted with BP-SES
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Objective To evaluate emergency nursing methods to permanent pacemaker patients with severe complication and acute hemodynamic changes during implantation. Methods The emergency nursing methods were analyzed retrospectively in 9 of 2 027 patients over 6 years, who had serious complication occurred during the pacemaker implantation Results There were 4 patients with pneumothorax, 2 with pericardial tamponed, 1 with ventricular fibrillation and 2 with acute left ventricular failure in 9 patients (0.4%). Observed the changes of symptoms and signs carefully,found the severe complications at the first time and performed the specific nursing based on different kinds of conditions and improved the prognosis of these patients. Conclusions The serious complications during the implantation of permanent pacemaker were life-threatening, and the specific nursing scheme to different types of complications could increase the successful rate of emergency service.
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Objective To investigate whether chemokine CC motif 2 (CCL2) is involved in the high residual platelet response,and the mechanism of CCL2 being involved in the regulation of platelets.Methods Forty patients with ST elevation myocardial infarction (STEMI) were admitted.P2Y12 reaction unit (PRU) was detected by VerifyNow.Forty patients were divided into high platelet reactivity group (high reactivity group,n=24) and normal platelet reactivity group (normal reactivity group,n=16) according to the results of PRU detection.Plasma CCL2 concentration of the STEMI patients was examined by ELISA.The expressions of CCL2 and CCR2 in the platelets were detected by Western blotting.After CCL2 stimulation,the kinases of which phosphorylation was changed in the platelets were screened by ARY003B protein chips.The phosphorylation of p38MAPK and HSP27 in the platelets was tested by Western blotting after CCL2 stimulation in the presence or absence of CCR2 antagonist (RS 102895) or p38MAPK signal pathway inhibitor (SB 203580).Results The plasma CCL2 concentration of high reactivity group was markedly higher than that of normal reactivity group.Moreover,compared with normal reactivity group,the expressions of CCL2 and CCR2 in the platelets of high reactivity group significantly increased.After the platelets were stimulated by CCL2,the phosphorylation of p38α and HSP27 enhanced in the platelets by protein chips screening.When RS 102895 or SB 203580 was treated before CCL2 stimulation,the phosphorylation of p38MAPK and HSP27 decreased.Conclusions CCL2 participates in high residual platelet response in an autocrine/paracrine way.CCL2/CCR2 might affect the function ofplatelets through p38MAPKHSP27 signal pathway.
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Objective To investigate the efficacy and safety of 6-month and 12-month oral dual-antiplatelet therapy This work was supported by the National Key Technology Research and Development Program in the Twelfth Five-year Plan of China (2011BAIl1B07) and the Military Clinical Key Technology and Development Program (2010gxjs001)(DAPT) on patients implanted with biodegradable polymer-coated and drug-eluted long stents (BP-DES).Methods In the I-LOVE-IT 2 trial,574 patients implanted with biodegradable polymer-coated and sirolimus-eluted long stent (BP-SES) (total stent length ≥50mm) were randomized to accepting either 6-month (n=270) or 12-month (n=304) DAPT.The primary endpoint of present study was 12-month target lesion failure (TLF),including cardiac death,target vessel myocardial infarction and clinically indicated target lesion revascularization (CI-TLR).The major secondary endpoint was 12-month net adverse clinical events (NACE),including all-causes of death,myocardial infarction,stroke,all revascularization (CI-TLR plus clinically indicated nontarget lesion revascularization) and bleeding.Results For the patients implanted with BP-SES of total stent length≥ 50mm,the total stent length was 73.0 ± 22.5mm and 69.8 ± 19.4mm in the 6-month DAPT group and 12-month group,respectively (P=0.07).No significant difference existed in the incidence of 12-month TLF between 6-month DAPT group and 12-month DAPT group (11.1% vs.9.2%,P=0.47).The incidence of NACE was similar between the 2 groups (21.9% vs.19.7%,P=0.57).The incidence of revascularization was lower in 12-month DAPT group (5.6%) than in 6-month DAPT group (11.1%,P=0.01).Furthermore,6-month landmark analysis showed that 12-month DAPT was associated with significantly lower risk of TLF (2.6% vs.6.3%,P=0.03) at a cost of slightly increased risk of all bleeding events (1.6% vs.0.7%,Log-rank P=0.32) between 6 and 12-months compared to 6-month DAPT.Conclusions In patients treated with BP-SES of total stent length ≥ 50mm,12-month DAPT have similar impacts on 12-month clinical outcomes except for all revascularization.However,12 months DAPT decreased the incidence of TLF and total revascularization between 6 months to 12 months after PCI.
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BACKGROUND AND OBJECTIVES: To compare clinical outcomes of staged versus "one-time" percutaneous coronary intervention (PCI) in intermediate to very high-risk patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel coronary disease (MVD). SUBJECTS AND METHODS: 1531 NSTE-ACS patients with multivessel PCI and meeting the criteria of intermediate to very high risk were screened from a prospectively registered database obtained from General Hospital of Shenyang Military Region between 2008 and 2012. They were categorized into "one-time" PCI (n=859) and staged PCI (n=672) according to intervention strategy. The primary outcomes included a 3-year major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularization. RESULTS: At 3 years, no significant differences in MACE (20.8% vs. 19.7%, p=0.608) and cardiac death/MI (7.1% vs. 9.1%, p=0.129) were observed between the two groups. After propensity score matching, there was no statistical significance in MACE (18.9% vs. 21.8%, p=0.249); whereas cardiac death/MI was significantly lower in the staged PCI group (7.0% vs.11.1%, p=0.033). Ninety-day landmark analysis showed that the staged PCI group had a lower 90-day incidence of MACE (1.2% vs. 3.3%, p= 0.037) and cardiac death/MI (0.7% vs. 2.6%, p=0.031). For the 90-day to 3-year follow-up period, the incidences of MACE (17.9% vs. 19.1%, p=0.641) and cardiac death/MI (6.3% vs. 8.7%, p=0.191) were similar in both groups. CONCLUSION: In intermediate- to very high-risk NSTE-ACS patients with MVD, staged PCI is superior to "one-time" PCI in terms of cardiac death/MI.
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Humanos , Síndrome Coronario Agudo , Enfermedad de la Arteria Coronaria , Enfermedad Coronaria , Muerte , Estudios de Seguimiento , Hospitales Generales , Incidencia , Personal Militar , Infarto del Miocardio , Intervención Coronaria Percutánea , Puntaje de Propensión , Estudios ProspectivosRESUMEN
Objective To explore the nursing mode of percutaneous coronary intervention (PCI) in field minimally- invasive interventional shelter for treating closed hepatic trauma and hemorrhage. Methods 8 animal modes of closed hepatic trauma were established by beagles. Then, the animals with damaged hepatic arteries were treated by emergency angio-interventional embolic treatment. And specific nursing mode, which was different from in-hospital, was performed in perioperative period. Results All the animal modes of closed hepatic trauma and hemorrhage were rescued successfully, and no operative complications were found. Conclusions With the cooperation of specific nursing mode, the emergency angio-interventional embolic treatment of closed hepatic trauma and hemorrhage in field minimally-invasive interventional shelter under the complex outdoor environment is feasible.
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Objective To investigate the influence of high frequency electrosurgical equipment ( HFEE) application in cardiac implantable electronic device ( CIED) implantation procedure on the rate of pocket hematoma .Methods Patients who received CIED implantation in General Hospital of Shenyang Military Region were analyzed retrospectively .HFEE was applied during CIED implantation procedure in every patient who was classified into HFEE group .Other patients without HFEE application were classified as the control group . Patients with or without bleeding tendency were sub-classified into the bleeding tendency subgroup or non-bleeding tendency subgroup respectively .Bleeding tendency subgroup was further divided into heparin bridging group and direct implantation group .The occurance rate of CIED pocket hematoma was recorded in all groups .Results A total of 3884 patients were enrolled .There were 3115 patients in the HFEE group and 769 patients in the control group .The baseline data of two groups was similar.The overall rate of CIED pocket hematoma in the total patient population during perioperative period were 2.2%(86/3884), and the rate of long term pocket infection or rupture in patients with CIED pocket hematoma was 10.5%(9/8).In the HFEE group, the rate of pocket hematoma was lower than that in the control group (1.5%vs.5.2%, P<0.001).The rates of CIED pocket hematoma in respective subgroups in the HFEE group including the bleeding tendency subgroup ( 1.8% vs.11.5%, P=0.004 ) , the non-bleeding tendency subgroup ( 1.4% vs.4.7%, P<0.001 ) and the heparin bridging group ( 2.0% vs. 11.5%, P=0.046 ) were markedly decreased as compared with the corresponding subgroups in the control group.In the control group , the rate of CIED pocket hematoma in the bleeding tendency subgroup was higher than that in the non-bleeding tendency subgroup (11.5%vs.4.7%, P=0.0046).In HFEE group, there was no significant difference in the rate of CIED pocket hematoma between bleeding tendency subgroup and non-bleeding tendency subgroup; and there was also no significant difference in the rate of CIED pocket hematoma between the heparin bridging group and the direct implantation group .Conclusion Application of HFEE in CIED implantation procedure could reduce the incidence of pocket hematoma , and there was no significant difference in the incidence of pocket hematoma in patients with or without oral anticoagulation or antiplatelet agents.
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Objective To evaluate the safety and efficacy of bivalirudin in patients with acute myocardial infarction ( AMI) and diabetes undergoing primary percutaneous coronary intervention ( PCI) . Methods BRIGHT was a multicenter , randomized , controlled study which enrolled AMI patients underwent primary PCI in 83 Chinese centers between August 2012 and June 2013.All patients were randomly assigned to receive bivalirudin , heparin or heparin plus tirofiban. This study was a prespecified subgroup analysis of the BRIGHT study.A total of 465 diabetics in the BRIGHT study were included , consisted of 168 in the bivalirudin group , 137 in the heparin group and 160 in the heparin plus tirofiban group .Primary endpoint was net adverse clinical event ( NACE) at 30 days, which was defined as a composite of major adverse cardiac and cerebral events ( MACCE ) and any bleedings .Results The incidences of NACE at 30 days were significantly different among three arms ( Bivalirudin:10.1% vs.heparin:16.1% vs.Heparin plus tirofiban 20.6%, P=0.031 ) .Compared with heparin plus tirofiban , bivalirudin was associated with a significantly lower NACE rate (P0.05 ) . Conclusions The use of bivalirudin has dramatically reduced the rate of bleeding and did not increase the incidence of ischemic events compared with heparin and heparin plus tirofiban , indicating a better safety and efficacy profile of bivalirudin during primary PCI in patients with AMI and diabetes .
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Objective To analyze the clinical, imaging and interventional data of patients with chronic total occlusion (CTO) lesions without myocardial infarction (MI) and to summarize the clinical and imaging characteristics of these patients. Methods The data of 2651 patients with CTO verified by coronary angiography between January 1995 and December 2014 were analyzed retrospectively. Results There were 1466 CTO patients (55. 3%) without MI (the control group) and 1185 CTO patients (44. 7%) with MI ( the MI group). The age, percentage of female patients, unstable angina, hypertention, mean triglyceride levels, left ventricular ejection fraction ( LVEF) were lower in the MI group than in the control group ( all P﹤0. 05). The rates of heart failure and serum creatinine levels were higher in the MI group than the control group (both P﹤0. 05). The rate of multi-vessel disease was higher in the control group than in the MI group (81. 4% vs. 76. 5%, P﹤0. 05). According to the target CTO vessel location, patients in the control group had lower rates of CTO in LAD (36. 2% vs. 40. 7%, P=0. 007) and higher rates of CTO in LCX (17. 0%vs. 12. 7%, P﹤0. 001). Patients in the control group without MI had better collateral circulation than that in the control group (32. 7% vs. 27. 0%, P﹤0. 001). There were no differences in success rate of PCI and complete revascularization between the two groups. Conclusions The present study showed that the CTO patients without MI were associated with better collateral development compared with the CTO patients with MI. Age, gender, unstable angina encouraging ischemic preconditioning and hypertension may be beneficial by facilitating collateral development through endogenous cardioprotective mechanisms.