Restrictive Cardiomyopathy Resulting from a Troponin I Type 3 Mutation in a Chinese Family.

Objective To identify the pathogenic variant responsible for restrictive cardiomyopathy (RCM) in a Chinese family.Methods Next generation sequencing was used for detecting the mutation and Results verified by sequencing. We used restriction enzyme digestion to test the mutation in the family members and 200 unrelated normal subjects without any cardiac inherited diseases when the mutation was identified.Results Five individuals died from cardiac diseases, two of whom suffered from sudden cardiac death. Two individuals have suffered from chronic cardiac disorders. Mutation analysis revealed a novel missense mutation in exon 7 of troponin I type 3 (TNNI3), resulting in substitution of serine (S) with proline (P) at amino acid position 150, which cosegregated with the disease in the family, which is predicted to be probably damaging using PolyPhen-2. The mutation was not detected in the 200 unrelated subjects we tested.Conclusion Using next generation sequencing, which has very recently been shown to be successful in identifying novel causative mutations of rare Mendelian disorders, we found a novel mutation of TNNI3 in a Chinese family with RCM.

Renal Dysfunction and hsCRP Predict Long-term Outcomes of Percutaneous Coronary Intervention in Acute Myocardial Infarction.

BACKGROUND: This study assessed the combined utility of estimated glomerular filtration rate (eGFR) and serum high-sensitivity C-reactive protein (hsCRP) levels to predict long-term mortality and cardiovascular outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Elevated CRP levels and renal dysfunction have both been shown to independently and jointly predict mortality and cardiovascular outcomes after PCI in the short term. However, long-term results in patients with acute STEMI undergoing PCI have not been reported. METHODS: A total of 262 patients with acute STEMI undergoing primary PCI were classified at admission into quartiles according to eGFR (<60, 60-70, 70-80 and ≥80 mL·min·1.73 m) and hsCRP (<3 and ≥3 mg/L). Mortality, nonfatal myocardial infarction (MI) and major adverse cardiac events (MACEs) were compared among the groups. RESULTS: During a median follow-up of 48.3 months, the composite of all-cause mortality and nonfatal MI (mortality + MI) was significantly higher (35.09%) in the group with the lowest eGFR compared with that of the other 3 eGFR groups (14.29%, 3.77% and 9.43%, respectively, P < 0.0001) and the group with elevated hsCRP (34.29%) versus that with hsCRP <3 mg/L (4.41%, P < 0.0001). A combined analysis showed an exaggerated hazard in patients with the lowest eGFR and highest hsCRP (hazard ratio: 44.658; 95% confidence interval: 5.955-111.890). CONCLUSIONS: Renal dysfunction and elevated hsCRP predict a high long-term incidence of MACE in patients with acute STEMI undergoing primary PCI, with the combination being of prognostic significance for long-term mortality and MI in these patients.

[Prevalence and risk factors of atherosclerotic renal artery stenosis].

OBJECTIVE: To explore the prevalence and risk factors of atherosclerotic renal artery stenosis (ARAS) in patients undergoing coronary angiography. METHODS: A total of 2506 patients with suspected and known coronary heart disease (CAD) at our hospital underwent simultaneous coronary and renal angiography. Renal artery stenosis was defined as at least one of renal artery stenosis ≥ 50% narrowing of luminal diameter. The prevalence of ARAS was summarized from the results of angiography. And single- and multi-variable logistic regression analysis was used to assess the relationship between clinical characteristics and ARAS. RESULTS: Among them, there were 1479 males and 1027 females with a mean age of 62.7 ± 11.4 years. ARAS was detected in 409 patients (16.3%), including 214 (8.5%) with significant stenosis (≥ 75%); Bilateral ARAS was detected in 98 patients (3.9%), including 27 (1.1%) with significant stenosis (≥ 75%). Left and right ARAS were detected in 162 patients (6.5%) and 148 patients (5.9%) respectively, including 84 patients (3.4%) with significant stenosis (≥ 75%) in left ARAS and 72 patients (2.9%) in right ARAS. Univariate analysis indicated that age, females, diabetes, hypertension, stroke, peripheral artery disease, coronary heart disease, renal insufficiency, dyslipidemia and hyperuricemia were the predictor for ARAS (P < 0.05 or 0.01). Multivariate regression analysis demonstrated that age ≥ 65 years (P = 0.025, OR = 1.358), females (P < 0.01, OR = 1.678), hypertension (P < 0.01, OR = 1.650), peripheral artery disease (P < 0.01, OR = 14.678), renal insufficiency (P < 0.01, OR = 1.835), coronary heart disease including 3-vessel (P < 0.01, OR = 1.746) and left main coronary (P < 0.01, OR = 3.416)disease were independent risk factors for ARAS. CONCLUSION: Renal angiography should be routinely performed in female patients aged ≥ 65 years with hypertension, peripheral artery disease, elevated creatinine and coronary heart disease, especially for 3-vessel and left main coronary disease to identify ARAS in time.

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: outcomes of 3-year clinical follow-up.

BACKGROUND: The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation. METHODS: A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n = 83) or BMS (n = 108) implantation in the infarction related artery according to physician's discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups. RESULTS: The clinical follow-up duration was 3 years ((41.7 ± 16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P = 0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P = 0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P = 0.379) and stent thrombosis (1.20% vs. 1.85%, P = 0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P = 0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P = 0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n = 73) and paclitaxel-eluting stents (PES, n = 10) subgroups (2.74% vs. 20.00%, P > 0.05). CONCLUSIONS: This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.

[Clinical and coronary features of systemic lupus erythematosus patients with coronary artery disease].

OBJECTIVES: To observe the clinical and coronary features of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD). METHODS: Among 2877 SLE inpatients (age ≥ 18 years, male 363, female 2514) admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [mean age (50.7 ± 12.8) years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed. RESULTS: The incidence of CAD was significantly higher in male SLE patients than in female patients [2.48% (9/363) vs. 0.95% (24/2514), P = 0.022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [5.76% (8/139) vs. 0.91% (25/2738), P < 0.001]. Myocardial infarction was the major form of CAD (24/33). Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi-vessel lesions was found in 75.0% (15/20) patients with SLE and CAD. CONCLUSIONS: Male SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.

Birth measurements, family history, and environmental factors associated with later-life hypertensive status.

BACKGROUND: This birth cohort study was conducted to investigate the contribution of prenatal and antenatal environmental exposures to later-life hypertensive status. METHODS: Two thousand five hundred and three individuals born in 1921-1954 at the Peking Union Medical College Hospital (PUMCH) were targeted; 2,081 (83.1%) participated. Clinical examinations included an interview, blood pressure (BP) measurements, and laboratory assays. Statistical analyses were performed using ordinal regression models with later-life hypertensive status as the dependent variable. Similar analyses were for subpopulations divided by family history of hypertension. RESULTS: In the 2,081 subjects, 449 were normotensive, 531 were prehypertensive, and 1,101 had hypertension. Three hundred and forty two hypertensive patients were classified as high-risk (BP ≥180/110 mm Hg, or accompanied with diabetes or three well-established cardiovascular risk factors); the other 759 patients were at mid-to-low risks. Lower birth weight (<2,500 g: odds ratio (OR) = 1.67, P = 0.02; 2,500- <3,000 g: OR = 1.64, P < 0.01; 3,000- <3,500 g, OR = 1.40, P = 0.01), family history of hypertension (OR = 1.73, P < 0.01), poor education (OR = 1.76, P < 0.01), and alcoholism (OR = 3.05, P < 0.01) significantly predicted later-life high-risk hypertension. For participants with hypertensive family history (57.7%), the association with birth weight became nonsignificant, but poor education (OR = 2.33, P < 0.01) and alcoholism (OR = 3.10, P = 0.01) remained important. For participants without hypertensive family history (42.3%), the effects of lower birth weight (<2,500 g: OR = 2.26, P = 0.02; 2,500- <3,000 g: OR = 1.91, P = 0.01; 3,000- <3,500 g, OR = 1.78, P = 0.01) and alcoholism (OR = 3.23, P < 0.01) remained significant. CONCLUSION: Low birth weight, low education, alcoholism, and hypertensive family history are linked to later-life hypertensive status. Low birth weight is also partly associated with one's genetic background; whereas the association with education and alcoholism are independent from hypertensive family history.

[Risk factors and coronary angiography characteristics of female patients with acute coronary syndrome].

OBJECTIVE: To assess the risk factors and coronary angiography characteristics of female patients with acute coronary syndrome (ACS). METHODS: A total of consecutive 986 inpatients with ACS who had undergone coronary angiography from March 2009 to August 2010 in our hospital were enrolled in this study. There were 303 female patients and 683 male patients. Clinical data were collected by physicians and the severity of coronary artery stenosis was analyzed via the international Gensini Score system. RESULTS: Incidence of ACS under the age of 60 years [8.6% (26/303) vs. 16.5% (113/683), P < 0.05], family history of coronary artery disease [15.8% (48/303) vs. 23.0% (157/683), P < 0.05], and smokers [19.1% (58/303) vs. 71.7% (490/683), P < 0.001] were significantly less while hypertension [81.5% (247/303) vs. 64.0% (437/536), P < 0.001] and diabetes rate [51.8% (157/303) vs. 44.0% (298/683), P < 0.05] were significantly higher in female patients than in male patients. The comorbidities of dyslipidemia, adiposity, hyper-C-reaction protein and hyperfibrinogenemia were similar between male and female patients (P > 0.05). Unstable angina and non-ST-segment elevation myocardial infarction were more often [86.1% (261/303) vs. 78.5% (536/683)], while ST-segment elevation myocardial infarction was less [13.9% (42/303) vs. 21.5% (147/683), P = 0.005] in female patients than in male patients. There were significantly more incidence of mild coronary artery stenosis [15.0% (47/303) vs. 10.0% (68/683), P = 0.012] and less severely stenotic lesions [84.2% (255/303) vs. 89.8% (613/683), P = 0.013] in female patients than in male patients. Gensini score, percutaneous intervention rate and in-hospital mortality rate were similar between male and female patients with ACS (P > 0.05). CONCLUSIONS: Prevalence rates of diabetes mellitus and hypertension are higher while positive family history on coronary artery disease and smoking rate are lower in female patients with ACS than in male ACS patients. Female ACS patients are often presented with unstable angina or non-ST-segment elevation myocardial infarction and with mild coronary artery stenosis compared to male ACS patients.

[Clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease].

OBJECTIVE: To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease. METHOD: Fifteen patients (11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed. RESULTS: There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39.3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32.4 ± 8.1) years vs. (47.0 ± 10.2) years], had less risk factors for atherosclerosis (1.2 ± 1.5 to 2.8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 - 7 years (average 1.6 years) to 3 - 30 years (average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by echocardiography was less than 50% in 8 patients. CONCLUSION: Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.

[Deviation of ST-segment and detection of infarction related artery in patients with acute inferior wall infarction].

OBJECTIVE: To explore the characteristics of ST-segment deviation in patients with acute ST elevation myocardial infarction(STEMI)having only one vessel lesion in either left circumflex artery (LCX) or right coronary artery (RCA). METHODS: All AMI (acute myocardial infarction) patients were admitted into Peking Union Medical College Hospital from January 1996 to March 2009. They underwent coronary angiography (CAG). And the IRA (infarction-related artery) was either LCX or RCA without other coronary artery stenosis. Their ST-segments deviations on electrocardiogram (ECG) were analyzed quantitatively. RESULTS: Among 2503 AMI cases undergoing CAG during hospitalization, 75 cases had LCX (n = 16) or RCA (n = 59)-related STEMI. The RCA group was further divided into the proximal subgroup (n = 21) and the distal subgroup (n = 38). RCA as IRA was diagnosed when ST I depression < 0, ST V(1) elevation ≥ 0 or ST I and aVL depression < 0 with the sensitivities of 55.9%, 74.6% and 54.2% and the specificities of 81.3%, 62.5% and 81.3% respectively. LCX as IRA was diagnosed when ST aVR depression ≥ 0.1 mv, ST I elevation ≥ 0 or ST V(5) and V(6) elevation ≥ 0 with the sensitivities of 68.8%, 81.3% and 31.3% and the specificities of 76.3%, 59.3% and 91.5% respectively. Proximal occlusion of RCA was diagnosed when there was no ST depression in V(1) and depression in V(2), Max precordial ST depression in V(1)-V(3) with the sensitivities of 47.6% and 52.4% and the specificities of 78.9% and 84.2%. CONCLUSION: While discriminating IRA in STEMI patients with single LCX or RCA lesion, it is necessary to assess all ST-segments deviations on ECG.

[ST segment deviation in acute myocardial infarction with isolated disease of left anterior descending artery].

OBJECTIVE: To analyze the characteristics of the electrocardiogram (ECG) of left anterior descending coronary artery (LAD) occlusion in patients with acute ST elevation myocardial infarction (STEMI). METHODS: Patients included were those diagnosed with STEMI in Peking Union Medical College Hospital from January 1996 to March 2009, and underwent coronary angiography (CAG). The infarction related artery (IRA) was LAD, and there were no significant stenosis in left circumflex artery and right coronary artery. A total of 170 cases were consecutively enrolled. They were divided into 2 groups according to occlusive sites of the LAD: LAD proximal (n = 77), LAD medius distal group (n = 93). Standard 18 leads ECG within 12 hours from the onset of STEMI were recorded and ST segment deviation was analyzed quantitatively. RESULTS: Proximal LAD occlusion as IRA was diagnosed with aVL ≥ 0.1 mV, ST aVL > aVR, sum of II, III and aVF STsegment depression ≥ 0.1 mV, in which sensitivity was 39.0%, 37.7% and 50.6%, specificity was 78.5%, 77.4% and 74.2% respectively. Statisticully significance (P < 0.05). Medius-distal LAD occlusion as IRA was diagnosed with no II ST depression, aVF ST depression and sum of II, III and aVF ST segment depression > 0.1 mV, In which sensitivity were 86.0%, 81.7% and 74.2% and the were 31.2%, 48.1% and 50.6% respectively. Statisticully significance (P < 0.05). CONCLUSION: In STEMI patients with isolated LAD occlusion, ECG can be useful to predict the occlusion site.

[Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke].

OBJECTIVE: To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention (PCI) with prior ischemic stroke. METHODS: A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009. End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up. RESULTS: There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke. Compared patients without prior ischemic stroke, patients with prior ischemic stroke were older (P = 0.000), had higher hypertension morbidity (P = 0.000), higher diabetes mellitus morbidity (P = 0.005), higher incidence of multi-vessels disease (P = 0.000). During the follow-up of (35.0 ± 19.6) months, cardiac death rate (8.5% vs. 3.9%, P = 0.002) and re-cerebral infarction rate (5.8% vs. 1.4%, P = 0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. Dual antiplatelet therapy treatment time [(13.77 ± 11.33) months vs. (13.94 ± 11.33) months, P = 0.986] and major bleeding events (5.8% vs. 3.6%, P = 0.100) were similar between the two groups and cerebral hemorrhage rate (1.8% vs. 0.5%, P = 0.028) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. CONCLUSION: Patients with prior ischemic stroke were associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.

[Effects of hemoglobin levels on long-term prognosis in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To evaluate the effects of hemoglobin (Hb) levels on long-term prognosis in the patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: A total of 150 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. They were divided into 2 groups: Hb < 120 g/L group (n = 21) and Hb ≥ 120 g/L group (n = 129). The mean clinical follow-up period was 3 years (range: 41.4 ± 16.1 months). The differences of major adverse cardiac events (MACE), including death, acute myocardial infarction, stent thrombosis & stent restenosis), were observed between two groups. RESULTS: The parameters of infarction site, infarction relative artery, 2-vessel disease, 3-vessel disease, Killip class ≥ II, drug-eluting stent, TIMI grade 3 flow, hypertension, hyperlipidemia, smoking, obesity, aspirin and clopidogrel use were not different between two groups (all P > 0.05). The rate of diabetes was significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (47.62% vs 18.60%, P = 0.0032). The mean age and symptom-onset-to balloon-time (SOTB) were significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (68.5 ± 9.2 vs 61.2 ± 12.2 years, P < 0.0001; 8.8 ± 10.5 vs 6.3 ± 5.0 h, P < 0.0001). The mean LVEF (left ventricular ejection fraction)(%) and rate of complete revascularization were significantly lower in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (51.25 ± 11.34 vs 58.79 ± 10.38, P < 0.0001; 61.9% vs 86.8%, P = 0.0045). Logistic regression analysis showed that LVEF was an independent predictor of MACE during the follow-up period (P = 0.0140). During a 3-year follow-up, MACE occurred in 16 patients. The incidence of MACE was significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (33.33% vs 6.98%, P = 0.0003); Moreover the all-cause mortality and cardiac mortality were significantly higher in Hb < 120 g/L group than those in Hb ≥ 120 g/L group (28.57% vs 3.10%, P < 0.0001; 23.81% vs 2.33%, P < 0.0001). CONCLUSION: In the patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, hemoglobin level < 120 g/L at baseline is markedly associated with adverse outcomes and an elevated incidence of MACE and mortality during the follow-up period.

[Analysis on the correlation between SF-36 and QOL-35 in patients and coronary artery disease].

OBJECTIVE: To analyze the correlation between SF-36 and QOL-35 and the consistency of the two kinds of life-quality questionnaires when evaluating the quality of life in patients with coronary heart disease. METHODS: 781 in-hospital-patients, who underwent coronary angiography from June 2008 to April 2009, were included in this study. Quality of life was measured by the Chinese versions of SF-36 and QOL-35. Demographic and clinical information were collected. Correlation Analysis was done between SF-36 and QOL-35 in the patients with coronary artery disease. RESULTS: The total score of SF-36 was 62.63 ± 12.47 and the QOL-35 total score was 62.70 ± 9.69. Data from the simple correlation analysis showed that SF-36 and QOL-35 total scores (r = 0.725, P < 0.01), SF-36 physical functioning and QOL-35 independent living capacity (r = 0.933, P < 0.01), SF-36 mental health and QOL-35 mental health(r = 0.132, P < 0.01), SF-36 social function and QOL-35 social function score (r = 0.215, P < 0.01) were all relevant. Canonical correlation analysis showed that there was significant correlation between SF-36 and QOL-35 (r = 0.946, P < 0.01). CONCLUSION: SF-36 and QOL-35 were consistent in the evaluation on the quality of life, at the overall level.

[Effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To evaluate effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: A total of 214 patients with acute myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. All patients were divided into two groups by duration of clopidogrel use: <1 year group (n=59) and > or =1 years group (n=155). Baseline characteristics [age, gender, angiographic characteristics, Killip classification, LVEF (left ventricular ejection fraction) , CK (creatine kinase), CK-MB, CTnI (cardiac troponin-I), hemoglobin levels and history of hypertension, diabetes, hyperlipidemia, obesity and smoking] of two groups were collected. Clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was 41.6 +/- 16.3 months. MACE occurred in 28 patients. RESULTS: Rates of male, infarction site, infarction relative artery, multivessel disease, Killip classification (class I), aspirin use and history of smoking, obesity, hypertension and hyperlipidemia were not different (P > 0.05) in duration of clopidogrel use <1 year group and > or =1 years group. Average LVEF, hemoglobin levels and rate of drug-eluting stents were significantly lower in duration of clopidogrel use <1 year group than that in duration of clopidogrel use > or =1 years group (P < 0.0001, P < 0.0001, P = 0.0065). Average CK, CK-MB, CTnI were significantly higher in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group (P < 0.0001). Rate of diabetes and average age were significantly higher in duration of clopidogrel use <1 year group than that in duration of clopidogrel use > or =1 years group (P = 0.0190, P < 0.0001). Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use < 1 year group (6.45% vs. 30.51%, P < 0.01). After stopping clopidogrel use, incidence of MACE in followup period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group (2.58% vs. 20. 34%, P < 0.01). CONCLUSION: Primary percutaneous coronary intervention is an effective therapeutic method. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group. Duration of clopidogrel use may influence clinical outcomes in follow-up period in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

[Covariance analysis on the change of quality of life affected by percutaneous coronary intervention for patients with coronary heart disease].

OBJECTIVE: To compare changes of quality of life at 3 months from baseline among patients who underwent and did not undergo percutaneous coronary intervention (PCI). METHODS: Sixty one patients with coronary artery disease, who were hospitalized in Cardiology Department in March 2008, were followed-up for 3 months after being discharged. SF-36 and QOL-35 were administered before PCI and at 3 months. Patients were divided into 2 groups according to whether they underwent PCI. Changes of quality of life scores between PCI and non-PCI groups were compared using analysis of covariance. RESULTS: There were 24 cases in non-PCI group and 37 in PCI group. Baseline characteristics were well balanced between PCI and non-PCI groups except gender (67.6% vs. 28.6% for male, P = 0.005), history of angina (56.8% vs. 23.8%, P = 0.015), smoking history (51.4% vs.23.8%, P = 0.037) and Judkins classification of coronary artery (P = 0.001). Multivariate analysis of covariance showed that the change of life quality between non-PCI group and PCI group in 3-months after discharge had statistical differences in total scores (P = 0.044) and mental health scores (P = 0.003) of SF-36, total scores (P = 0.039) and social function scores (P = 0.007) of QOL-35. CONCLUSION: PCI can improve life quality in patients with coronary artery disease.

[Clinical and coronary characteristics of young patients (< 30 years old) with acute myocardial infarction].

OBJECTIVE: To explore the clinical characteristics and angiographic features of acute myocardial infarction in patients aged 30 years or younger. METHODS: Data of 360 consecutive patients referred to Peking Union Medical College Hospital for evaluation of chest pain or discomfort from January 2007 to December 2009, diagnosed as acute myocardial infarction and underwent emergent coronary angiography were analyzed. Seven patients (1.9%) with age ≤ 30 years [4 male, (25 ± 5) years] were included in this study, patients were followed up for (12 ± 9) months. RESULTS: There were 6 cases of ST-segment elevated myocardial infarction and 1 non-ST-segment elevated myocardial infarction. The culprit vessels were as follows: 5 left anterior descending artery, 1 left main and 1 right coronary artery. All 3 female patients were complicated with congenital coronary malformation or autoimmune disease, including 1 coronary artery aneurismal dilation of left anterior descending, 1 Takayasu's arteritis and 1 systemic lupus erythematosus. Three of the 4 male patients were smokers. Two patients underwent percutaneous coronary intervention. There was no death or cardiovascular re-admission during the follow-up. CONCLUSIONS: The majority of acute myocardial infarction in patients aged 30 years or younger were presented with ST-segment elevated myocardial infarction and single vessel non-obstructive lesion. The most common culprit vessel was left anterior descending artery. All female patients were complicated with congenital coronary malformation or autoimmune disease. The short-term prognosis in patients of this cohort was good.

[Assessment of life quality in patients with chronic heart failure].

OBJECTIVE: Using Kansas city cardiomyopathy questionnaire (KCCQ) to evaluate the quality of life (QOL) of the patients with chronic heart failure. METHODS: A total of 271 hospitalized patients with heart failure symptoms in cardiology department, Peking Union Medical College Hospital, who undergone coronary angiography from December 2007 to December 2008, were included in this study. QOL of the subjects was measured, and their demographic and clinical data were collected. Patients were divided into 2 groups according to heart function and they were compared by QOL.Multiple linear regression analysis was conducted to identify the variables associated with the quality of life. RESULTS: KCCQ physical limitation scores of the patients of left ventricular elective fraction (LVEF) < 50% (n = 50) and LVEF > or = 50% (n = 221) were (66 +/- 22) points and (73 +/- 22) points (P < 0.05). In the patients of NYHA I/II (n = 227) vs NYHA III/IV (n = 44), KCCQ scores of physical limitation, symptoms and QOL were (74 +/- 20) vs (60 +/- 27) points, (62 +/- 22) vs (49 +/- 25) points and (61 +/- 16) vs (53 +/- 18) points (all P < 0.05). In the patients of heart failure grade A/B (n = 197) vs grade C/D (n = 74), KCCQ scores of physical limitation, symptoms and QOL were (75 +/- 19) vs (61 +/- 26) points, (63 +/- 22) vs (52 +/- 24) points, (61 +/- 16) vs (56 +/- 18) points (all P < 0.05). Multiple linear regression analysis of QOL KCCQ showed that, age, NYHA cardiac function classification, gender and Judkins score were the risk factors of patients' physical limitation (P < 0.01); gender and stages of heart failure were the risk factors of patients'symptoms (P < 0.01); gender was the risk factors of patients'social function (P < 0.01). CONCLUSION: The patients with poor cardiac function have a poor QOL. KCCQ is more sensitive for the evaluation of heart function. Age, NYHA, gender, Judkins score and stages of heart failure can change QOL for the patients with chronic heart failure.

[Assessment of quality of life in patients with coronary artery disease with Seattle angina questionnaire].

OBJECTIVE: To evaluate quality of life (QOL) of patients with different severity of coronary artery disease using Seattle angina questionnaire (SAQ). METHODS: A total of 513 hospitalized patients undergoing coronary angiography from December 2007 to December 2008 were included. QOL of these patients was measured with SAQ and their demographic and clinical data were collected. Patients were divided into 3 groups according to the severity of coronary artery disease by coronary angiography. And comparisons of traditional risk factors and QOL were made among these groups. Multiple linear regression analysis was conducted to identify the variables associated with QOL. RESULTS: The scores of physical limitation were significantly different among 3 groups according to the severity of coronary artery disease by coronary angiography (80 +/- 16, 79 +/- 19 and 71 +/- 22, P < 0.01). Multiple linear regression analysis showed that physical limitation of the patients was affected by age (P < 0.01), gender (P < 0.01) and severity of coronary artery disease (P < 0.01). Angina stability was affected by the history of myocardial infarction (P = 0.03). Angina frequency was affected by the history of myocardial infarction (P = 0.01) and gender (P = 0.04). Treatment satisfaction was affected by the severity of coronary artery disease (P = 0.03) and disease perception by the history of DM (P = 0.03). CONCLUSION: Age, gender, history of myocardial infarction, history of DM and severity of coronary artery disease are independent predictors of QOL in patients with coronary artery disease.

[Factors associated with reduced renal function post primary percutaneous coronary intervention in acute myocardial infarction patients with normal baseline serum creatinine level].

OBJECTIVE: To analyze factors associated with reduced renal function post primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients with normal baseline serum creatinine level. METHOD: The clinical and angiographic data of 216 consecutive AMI patients undergoing primary PCI with normal baseline serum creatinine level (< 1.5 mg/dl) were obtained and compared between patients with (n = 32) and without (n = 184) renal function deterioration (increase in serum creatinine > or = 25% from baseline level within 72 hours of primary PCI) post PCI. RESULTS: The incidence of renal function deterioration was 14.8% (32/216). Patients with age > 75 years (28.1% vs. 14.1%, P = 0.047), congestive heart failure (25.0% vs. 9.2%, P = 0.017), less use of low-molecular weight heparins (84.4% vs. 95.1%, P = 0.039) and beta-blockers (75.0% vs. 95.6%, P = 0.001) as well as angiotensin converting enzyme inhibitors/angiotensin receptor blockers (81.3% vs. 93.5%, P = 0.025) and statins (84.4% vs. 97.3%, P = 0.008) were risk factors for developing renal dysfunction post PCI. Renal function deterioration post PCI was also associated with increased in-hospital mortality (25.0% vs. 2.2%, P < 0.001). Multivariate analysis showed that congestive heart failure was the single independent predictor of renal function deterioration (odds ratio = 3.275, 95% confidence interval 1.275 - 8.408, P = 0.014), while renal function deterioration was the strongest independent predictor of in-hospital death (odds ratio = 10.313, 95% confidence interval 2.569 - 41.402, P = 0.001). CONCLUSION: Renal function deterioration is a common complication post primary PCI and is associated with higher risk of in-hospital death in AMI patients with normal baseline serum creatinine level.

[Characteristics of angina in patients with coronary artery disease complicated by diabetes mellitus].

OBJECTIVE: To improve the understanding of chest pain and angina pectoris in patients with diabetes mellitus (DM). METHODS: The clinical features and angina characteristics of 4873 patients undergoing coronary angiography (CAG) were recorded. The characteristics of angina pectoris of 1431 patients with coronary artery diseases (CAD) complicated by DM were analyzed. For detecting coronary artery disease, the sensitivity, specificity, positive predictive value, and negative predictive value were analyzed according to chest pain and coronary angiography. RESULTS: Of the 1431 CAD patients with DM 187 only presented non-cardiac chest pain, 492 presented atypical angina, and 752 presented typical angina. Of the CAD 2056 patients without DM 297 only presented non-cardiac chest pain, 735 presented atypical angina, and 1024 presented typical angina. In detecting coronary artery disease, no matter with what type of chest pain, the positive predictive values of the DM group were all remarkably higher than those of the non-DM group, and the negative predictive values of the DM group were all remarkably lower than those of the non-DM group, however, there were not significant differences in the sensitivity and specificity between the DM group and non-DM group. In the non-DM group the number of stenotic branches of coronary artery was closely associated with the angina characteristics (P < 0.01), however, in the DM group the number of stenotic branches of coronary artery was not associated with the angina characteristics (P = 0.333). CONCLUSION: Typical angina pectoris is a clinical manifestation with high accuracy in diagnosis of CAD. In the non-DM patients, the characteristics of chest pain reflect the severity of coronary artery stenosis.