A five-parameter score for predicting saphenous vein graft degenerative and/or occlusive disease in recurring ischemic symptoms after one year post coronary artery bypass grafting.

BACKGROUND: The recurrence rate of ischemic symptoms after coronary artery bypass grafting (CABG) is increasing in recent years. How to prevent and treat saphenous vein graft disease (SVGD [symptomatic ⩾50% stenosis in at least one Saphenous vein graft]) has been a clinical challenge to date. Different pathogenesis may exist in SVGD of different periods. There are currently few available scores for estimating the risk of SVGD after one year post CABG. OBJECTIVE: We sought to develop and validate a simple predictive clinical risk score for SVGD with recurring ischemia after one year post CABG. METHODS AND RESULTS: This was a cross-sectional study and the results were validated using bootstrap resampling on a separate cohort. A nomogram and risk scoring system were developed based on retrospective data from a training cohort of 606 consecutive patients with recurring ischemia >1 year after CABG. Logistic regression model was used to find the predictive factors and to build a nomogram. To assess the generalization, models were validated using bootstrap resampling and an external cross-sectional study of 187 consecutive patients in four other hospitals. In multivariable analysis of the primary cohort, native lesion vessel number, SVG age, recurring ischemia type, very low-density lipoprotein level, and left ventricular end-diastolic diameter were independent predictors. A summary risk score was derived from nomogram, with a cut-off value of 15. In internal and external validation, the C-index was 0.86 and 0.82, indicating good discrimination. The calibration curve for probability of SVGD showed optimal agreement between actual observations and risk score prediction. CONCLUSION: A simple-to-use risk scoring system based on five easily variables was developed and validated to predict the risk of SVGD among patients who recurring ischemia after one year post CABG. This score may be useful for providing patients with individualized estimates of SVGD risk.

A randomized comparison of two paclitaxel-coated balloons for the treatment of in-stent restenosis: The LONGTY ISR China randomized trial (LONGTY DCB vs. SeQuent Please DCB).

OBJECTIVES: This study sought to compare the efficacy and clinical safety of the LONGTY drug-coated balloon (DCB) with those of SeQuent Please DCB in patients with in-stent restenosis (ISR). BACKGROUND: Although DCB technologies have evolved, little is known about the clinical efficacy of the new-generation LONGTY DCB. METHODS: This was a prospective, multicenter, randomized, noninferiority trial comparing LONGTY DCB with SeQuent Please DCB in patients with ISR. The primary endpoint was target lesion late lumen loss at 9 months' follow-up. RESULTS: A total of 211 patients with ISR from 13 Chinese sites were included (LONGTY DCB, n = 105; SeQuent Please DCB, n = 106). Device success was achieved in all patients. At the 9 month angiographic follow-up, target lesion late lumen loss was 0.35 ± 0.42 mm with LONGTY and 0.38 ± 0.45 mm with SeQuent Please (p for noninferiority <.001). The target lesion revascularization rates at 1 year were similar in both DCB groups (15.24 vs. 13.21%; p = .673). Over an extended follow-up of 2 years, the clinical endpoints, including cardiac death, myocardial infarction, and thrombus rate, were extremely low and similar in both groups. CONCLUSIONS: In this multicenter, head-to-head, randomized trial, the new-generation LONGTY DCB was noninferior to the SeQuent Please DCB for the primary endpoint of target lesion late lumen loss at 9 months.

Optimization of GRACE Risk Stratification by N-Terminal Pro-B-type Natriuretic Peptide Combined With D-Dimer in Patients With Non-ST-Elevation Myocardial Infarction.

We aimed to explore the utility of multiple biomarkers with GRACE risk stratification for non-ST-elevation myocardial infarction (NSTEMI). A total of 1,357 patients diagnosed with NSTEMI were enrolled in this study at multiple medical centers in Tianjin, China. The outcomes were 1-year all-cause death and major adverse cardiac events (MACE: all-cause death, hospital admission for unstable angina, hospital admission for heart failure, nonfatal recurrent myocardial infarction, and stroke). C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to verify that the biomarkers improve the predictive accuracy of the GRACE score. A total of 57 participants died, while 211 participants experienced 231 MACEs during follow-up (mean: 339 days). For all-cause death, the combination of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and D-dimer improved the predictive accuracy of GRACE the most, with C-index, IDI, and NRI values of 0.88, 0.085, and 1.223, respectively. For MACE, trigeminal combination of NT-proBNP, fibrinogen, and D-dimer resulted in C-index, IDI, and NRI values of 0.80, 0.079, and 0.647, respectively. As a result, NT-proBNP, D-dimer, fibrinogen, and GRACE comprise a new scoring system for assessing 1-year clinical events. Kaplan-Meier analysis revealed a significant increase in 1-year mortality (score ≥3.85 vs <3.85, p < 0.0001) and 1-year MACE (score ≥1.72 vs <1.72, p < 0.0001) between different score groups. In conclusion, the combination of NT-proBNP and D-dimer added prognostic value to GRACE for all-cause death. Combining NT-proBNP, fibrinogen, and D-dimer increased the prognostic value of GRACE for MACE. This newly developed scoring system is strongly correlated with all-cause mortality and MACE, and can be easily utilized in clinical practice.

Evaluation of the inhibition of chlorophenols towards human cytochrome P450 3A4 and differences among various species.

Chlorophenols (CPs) are important pollutants detected frequently in the environment. This study intended to detect the inhibitory effects of fourteen CPs (2-CP, 3-CP, 4-CP, 4C2AP, 4C3MP, 2.4-DCP, 2.3.4-TCP, 2.4.5-TCP, 2.4.6-TCP, 3.4.5-TCP, 2.3.4.5-TECP, 2.3.4.6-TECP, 2.3.5.6-TECP and PCP) towards human liver cytochrome P450 3A4 (CYP3A4). Throughout the tests, testosterone was used as the probe substrate and CPs were used as inhibitors. A series of experiments (enzyme activity assays, preliminary screening tests, inhibition kinetics determination) were conducted to determine the inhibition of CPs towards human liver CYP3A4. CPs with the inhibitory effect >80% were selected for the inhibition evaluation in liver microsomes from different animal species (monkey, rat, dog, pig). The results showed that 2.3.4-TCP, 3.4.5-TCP, and 2.3.4.5-TECP inhibited the activities of CYP3A4 by 80.3%, 93.4%, 91.6%, respectively. Inhibition kinetics type were non-competitive and inhibition kinetics constant (Ki) values were 26.4 µM, 13.5 µM, and 8.8 µM for the inhibition of 2.3.4-TCP, 3.4.5-TCP, and 2.3.4.5-TECP towards human CYP3A4, respectively. Inhibition kinetics type was competitive and Ki value was 4.9 µM for the inhibition of 2.3.4-TCP towards CYP3A4 in Monkey liver microsomes (MyLMs). Inhibition kinetic types were non-competitive and Ki values were 8.1 µM and 28.7 µM for the inhibition of 3.4.5-TCP and 2.3.4.5-TECP towards CYP3A4 in MyLMs. Inhibition kinetic types were non-competitive and Ki values were 13.8 µM, 0.6 µM, and 6.1 µM for the inhibition of 2.3.4-TCP, 3.4.5-TCP, and 2.3.4.5-TECP towards CYP3A4 in Dog liver microsomes (DLMs), respectively. By comparing Ki values and inhibition kinetic types, the dog was the most suitable model to assess the inhibition of 2.3.4-TCP and 2.3.4.5-TECP towards CYP3A4, and monkey was the most suitable model to assess the inhibition of 3.4.5-TCP towards CYP3A4. In conclusion, our recent study on the inhibition of CPs towards CYP3A4 and species differences was important for further toxicological studies of CPs in human bodies.

[Pathogenic factors and prognosis of non cardiac inpatients with acute myocardial infarction].

OBJECTIVE: To collect the clinical data of non-cardiac inpatients with coronary heart disease risk factors and analyze the pathogenic factors and prognosis features of these inpatients with acute myocardial infarction. METHODS: Retrospective analyses were performed for 650 cases of consecutive non-cardiac inpatients with coronary heart disease risk factors at Tianjin Union Medical Center between January 2009 and January 2012.They were divided into non myocardial infarction (UnAMI, n = 551) and myocardial infarction groups (AMI, n = 99). Firstly the method of single factor analysis was employed to screen some significant influencing factors of acute myocardial infarction.Secondly multivariate Logistic regression analysis was performed to analyze the risk factors associated with the onset of AMI. Also the cardiovascular death event rates during hospitalization were compared between two groups. Cox regression analysis was performed to analyze independent risk factors for cardiovascular death of two group during hospitalization. RESULTS: (1) The significant influencing factors of AMI included total cholesterol (TC), low-density lipoprotein (LDL), advanced age, discontinuation of antiplatelet drug, recent episodes of angina above II grade, arrhythmia, 5 years of PCI or CABG history, blood glucose control or not, cardiac dysfunction (NYHA II-IV), dehydration, severe inflammatory response, infection, peroperative period, emergency operation and without cardiological consultation. (2) Multivariate Logistic regression analysis showed that LDL (OR (odds ratio): 2.047, 95% CI (confidence interval): 1.066-3.930, P = 0.031), discontinuation of antiplatelet drug therapy (OR:15.213, 95% CI: 5.746-40.281, P = 0.000), recent episodes of angina above II grade (OR: 1.990, 95%CI: 1.155-3.430, P = 0.013), glucose non-control (OR: 2.991, 95% CI:1.485-6.026, P = 0.002), advanced age (OR: 2.499, 95% CI: 1.299-4.808, P = 0.006), severe inflammation (OR:4.425, 95% CI: 2.984-6.561, P = 0.000), infection (OR:2.405, 95% CI: 1.058-5.464, P = 0.036), emergency operation (OR:4.365, 95% CI: 1.580-12.060, P = 0.004) were all AMI-related occurring factors. And cardiologic consultation (OR: 0.011, 95% CI:0.003-0.040, P = 0.000) was a favorable factors to reduce AMI; (3) AMI group during hospitalization for cardiovascular death event rate was higher than the UnAMI group; (4) Advanced age (ß = 0.776, OR = 0.460, 95% CI: 0.217-0.974, P = 0.042) and without consultation of cardiology department (ß = 1.366, OR = 3.918, 95% CI: 1.549-9.912, P = 0.004) were cardiovascular death independent risk factors. CONCLUSION: (1) Non cardiac inpatients during hospitalization LDL, discontinuation antiplatelet drug therapy, recent episodes of angina above II grade, blood sugar non-control, advanced age, severe inflammatory response, infection and without cardiologic consultations were significant risk factors for AMI. (2) The treatment of Department of Cardiology specialist for non cardiac inpatients with coronary heart disease risk factors to improve the prognosis of them.

[Involvement characteristics and influencing factors of anxiety and depression in patients after percutaneous coronary intervention].

OBJECTIVE: To explore the involvement characteristics and influencing factors of anxiety and depression in patients after percutaneous coronary intervention (PCI). METHODS: A total of 396 patients undergoing PCI were investigated between January 2009 and December 2010. All of them completed the Hospital Anxiety and Depression Scale (HADS) before discharge and at 12 months post-PCI. We evaluated the involvement characteristics and used Logistic regression to analyze the influencing factors of mood changes. RESULTS: The relevant factors of post-PCI anxiety were gender (P = 0.003), age (P = 0.004) and acute myocardial infarction (P = 0.009) while depression was associated with acute myocardial infarction (P < 0.001). A 12-month follow-up study showed that anxiety remained stable in 76.3% of patients while depression in 79.5%. Multi-factor analysis showed that factors of presence of adverse cardiovascular events (OR: 1.323, 95%CI: 1.026 - 1.705, P = 0.031), Seattle angina score (OR: 0.870, 95%CI: 0.772 - 0.981, P = 0.023) and anxiety scores at pre-discharge (OR: 1.228, 95%CI: 1.053 - 1.432, P = 0.009) were correlated with the deterioration degree of depression. And the factor associated with the deterioration of depression was the scores before discharge (OR: 1.287, 95%CI: 1.072 ∼ 1.545, P = 0.007). CONCLUSION: The levels of anxiety and depression remain stable in the majority of PCI patients at Month 12 post-PCI. Perioperative communication and effective control of postoperative cardiovascular events may ease a patient's negative emotions and improve their living quality.

Neointimal coverage of sirolimus-eluting stents 6 months and 12 months after implantation: evaluation by optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a new imaging modality with resolution of approximately 10 microm and can be employed to visualize intracoronary characteristics. Sirolimus-eluting stents (SES) are susceptible to late thrombosis due to delayed re-endothelialization over the stent struts, which may result in acute myocardial infarction or death. This study was designed to evaluate the re-endothelialization and neointimal coverage of SES with OCT 6 months and 12 months after implantation. METHODS: A total of 36 patients enrolled in the study underwent OCT examination 6 months (17 patients) and 12 months (19 patients) after SES implantation. The strut apposition to the vessel wall and neointimal coverage on SES struts were evaluated by OCT. RESULTS: Forty-six SES and 6561 struts were analyzed. At 6 months, 3041 struts (98.7%) were well-apposed and 39 struts (1.3%) were malapposed. At 12 months, 3434 struts (98.6%) were well-apposed and 47 struts (1.4%) were malapposed. Furthermore, only 4 SES at 6 months (18.2%) and 10 SES at 12 months (41.7%) were fully covered by neointimal growth. The average neointimal thicknesses covering the analyzed struts at 6 months and 12 months were (42+/-28) microm and (88+/-32) microm, respectively. There were 1989 struts at 6 months (72.1%) and 1461 struts at 12 months (45.6%) with neointimal thickness <100 microm. CONCLUSIONS: OCT was able to visualize the strut apposition to the vessel wall and neointimal coverage on SES struts. At 6-month and 12-month follow-up examinations most struts were covered with thin neointima, but few of the entire SES showed full coverage. To prevent late-stent thrombosis in the presence of uncovered stent struts, longer dual antiplatelet drugs therapy should be recommended.