A Novel Reperfusion Strategy for Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction: A Prospective Case Series.

BACKGROUND: Ischemia reperfusion injury (IRI) remains a major problem in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We have developed a novel reperfusion strategy for PCI and named it "volume-controlled reperfusion (VCR)". The aim of the current study was to assess the safety and feasibility of VCR in patients with STEMI. METHODS: Consecutive patients admitted to Beijing Chaoyang Hospital with STEMI were prospectively enrolled. The feasibility endpoint was procedural success. The safety endpoints included death from all causes, major vascular complications, and major adverse cardiac event (MACE), i.e., a composite of cardiac death, myocardial reinfarction, target vessel revascularization (TVR), and heart failure. RESULTS: A total of 30 patients were finally included. Procedural success was achieved in 28 (93.3%) patients. No patients died during the study and no major vascular complications or MACE occurred during hospitalization. With the exception of one patient (3.3%) who underwent TVR three months after discharge, no patient encountered death (0.0%), major vascular complications (0.0%), or and other MACEs (0.0%) during the median follow-up of 16 months. CONCLUSION: The findings of the pilot study suggest that VCR has favorable feasibility and safety in patients with STEMI. Further larger randomized trials are required to evaluate the effectiveness of VCR in STEMI patients.

Impact of Prior Digestive System Disease on In-Hospital Gastrointestinal Bleeding in Patients with Acute Myocardial Infarction.

OBJECTIVE: Patients presenting with acute myocardial infarction (AMI) with prior digestive system disease are more likely to suffer from gastrointestinal (GI) bleeding than those without these diseases. However, few articles reported how the different conditions of the digestive tract produced different risks of GI bleeding. METHODS: A single-center study on 7464 patients admitted for AMI from December 2010 to June 2019 in the Beijing Chaoyang Heart Center was retrospectively examined. Patients with major GI bleeding (n = 165) were compared with patients without (n = 7299). Univariate and multivariate logistic regression models were constructed to test the association between GI bleeding and prior diseases of the digestive tract, including gastroesophageal reflux disease, chronic gastritis, peptic ulcer, hepatic function damage, diseases of the colon and rectum, and gastroenterological tract tumors. RESULTS: Of the 7464 patients (mean age, 63.4; women, 25.6%; STEMI, 58.6%), 165 (2.2%) experienced major GI bleeding, and 1816 (24.3%) had a history of digestive system disease. The risk of GI bleeding was significantly associated with peptic ulcer (OR = 4.19, 95% CI: 1.86-9.45) and gastroenterological tumor (OR = 2.74, 95% CI: 1.07-7.04), indicated by multivariate logistic regression analysis. CONCLUSION: Preexisting peptic ulcers and gastroenterological tract tumors rather than other digestive system diseases were indicators of gastrointestinal bleeding in patients with AMI who undergo standard antithrombotic treatment during hospitalization.

The long-term impact of a chronic total occlusion in a non-infarct-related artery on acute ST-segment elevation myocardial infarction after primary coronary intervention.

OBJECTIVES: To investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality. METHODS: The enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared. RESULTS: The rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47-10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO. CONCLUSIONS: The presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.

Two-year clinical outcomes of patients with overlapping second-generation drug-eluting stents for treatment of long coronary artery lesions: comparison of everolimus-eluting stents with resolute zotarolimus-eluting stents.

OBJECTIVE: The aim of this study was to compare the 2-year clinical outcomes of overlapping second-generation everolimus-eluting stents (EES) with those of overlapping resolute zotarolimus-eluting stents (R-ZES) in the treatment of long coronary artery lesions. MATERIALS AND METHODS: This retrospective analysis included 256 patients treated with overlapping EES (n=121) and R-ZES (n=135) for long coronary artery lesions (total stent length per lesion ≥34 mm). Study endpoints included major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction, and target-vessel revascularization (TVR), as well as target-lesion revascularization and definite stent thrombosis separately at 2 years. RESULTS: In the two groups, the mean age was older and the average number of disease vessel was higher in the R-ZES group. The mean lesion length and total stent length per lesion were longer in the R-ZES group. EES were more frequently implanted in the left anterior descending coronary artery. No significant differences in the estimated MACE (5.8% for EES vs. 8.1% for R-ZES; P=0.548) or TVR (3.4% for EES vs. 4.0% for R-ZES; P=0.806) rates were noted between the two groups at 2-year follow-up. The incidence of definite stent thrombosis was low and similar in both groups (0.83% for EES vs. 0% for R-ZES; P=0.473). No significant differences were noted with respect to MACE or TVR between the two groups following propensity score matching. CONCLUSION: Stent overlap with second-generation EES or R-ZES was associated with low rates of MACE, TVR, and stent thrombosis at 2-year follow-up. Our results suggest that the use of overlapping EES or R-ZES in long coronary lesions is associated with good long-term clinical outcomes. These results need to be validated with randomized controlled trials.

Single InAs quantum dot grown at the junction of branched gold-free GaAs nanowire.

We report a new type of single InAs quantum dot (QD) embedded at the junction of gold-free branched GaAs/AlGaAs nanowire (NW) grown on silicon substrate. The photoluminescence intensity of such QD is ~20 times stronger than that from randomly distributed QD grown on the facet of straight NW. Sharp excitonic emission is observed at 4.2 K with a line width of 101 µeV and a vanishing two-photon emission probability of g(2)(0) = 0.031(2). This new nanostructure may open new ways for designing novel quantum optoelectronic devices.

In situ accurate control of 2D-3D transition parameters for growth of low-density InAs/GaAs self-assembled quantum dots.

A method to improve the growth repeatability of low-density InAs/GaAs self-assembled quantum dots by molecular beam epitaxy is reported. A sacrificed InAs layer was deposited firstly to determine in situ the accurate parameters of two- to three-dimensional transitions by observation of reflection high-energy electron diffraction patterns, and then the InAs layer annealed immediately before the growth of the low-density InAs quantum dots (QDs). It is confirmed by micro-photoluminescence that control repeatability of low-density QD growth is improved averagely to about 80% which is much higher than that of the QD samples without using a sacrificed InAs layer.

Photoluminescence study of low density InAs quantum clusters grown by molecular beam epitaxy.

We report a systematic optical spectroscopy study of low density InAs quantum clusters (QCs) grown by molecular beam epitaxy. The photoluminescence (PL) spectra show emission features of a wetting layer (WL) which contains hybridized quantum well states. The low-energy tail of the QCs' PL profile is actually an ensemble of some sharp lines, originating from the emission of different exciton states (e.g. X, X*, XX*) in a single quasi-three-dimensional (Q3D) cluster as detailed in the micro-PL spectra. The temperature dependence of PL spectra indicates photocarrier distribution and transport in the QC-WL system. Furthermore, this small InAs Q3D cluster is integrated with a distributed Bragg reflector structure, and using optical excitation creates a single photon source with the second-order correlation function of g((2))(0) = 0.31 at 16 K.

[The relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis].

OBJECTIVE: To observe the relationship between coronary and carotid/cerebral atherosclerotic stenosis. METHODS: Carotid/aortocranial angiography and coronary angiography were performed in 34 CAD patients complicated with symptomatic cerebral ischemia. Patients were divided into 3 subgroups according to the extent of arterial stenosis determined by angiography. There were 5 light, 4 moderate and 25 severe stenosis determined by coronary angiography and there were 6 light, 6 moderate and 24 severe stenosis determined by carotid/aortocranial angiography. RESULTS: The extent of coronary artery stenosis was parallel to the carotid artery or vertebral artery stenosis. Twenty-four patients out of 25 patients with severe coronary stenosis had severe cerebrovascular stenosis (P = 0.873). The coincident rate was as high as 92% for patients with moderate or severe cerebrovascular stenosis whose Califf risk scores of coronary artery were more than or equal to 2. The follow-up study showed the incidence of cardiovascular event and cerebrovascular event increased significantly in the patients with moderate to severe coronary and cerebral arteries stenosis and 3 patients with severe stenosis found in both coronary and cerebral arteries died during follow up. CONCLUSION: The incidence and severity of coronary artery stenosis is parallel with carotid artery or vertebral artery stenosis.