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1.
Artigo em Inglês | MEDLINE | ID: mdl-31922352

RESUMO

OBJECTIVES: To assess the predictive value of the Global Registry of Acute Coronary Events (GRACE) discharge score for patients with stable coronary artery disease (SCAD) after percutaneous coronary intervention (PCI). BACKGROUND: The GRACE score is widely used for predicting the mortality of acute coronary syndrome patients. However, the predictive value of SCAD has not been sufficiently studied. METHODS: We studied 4,293 consecutive patients with SCAD who underwent PCI between January 2013 and December 2013. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS: Among 3,915 patients with SCAD following PCI, there were 38 deaths and 394 MACCE during 2 years of follow-up. The GRACE discharge score was significantly higher for patients who died than for those who survived (86.97 ± 23.27 vs. 71.07 ± 19.84; p < .001). Risk stratification of the GRACE score indicated that the mortality risk of the intermediate-risk and high-risk groups were 3.23-fold (hazard ratio [HR], 3.23; range, 1.59-6.55; p = .001) and 15.31-fold higher (HR, 15.31; range, 4.43-51.62; p < .001), respectively, than that of the low-risk group. The MACCE risk for the intermediate-risk and high-risk groups were 1.28-fold (HR, 1.28; range, 1.02-1.62; p = .037) and 2.42-fold higher (HR, 2.42; range, 1.20-4.88; p = .014), respectively. The GRACE discharge score had prognostic value for mortality (area under the receiver operating characteristic curve, 0.692; p < .001). CONCLUSIONS: The GRACE discharge score is valuable for the risk stratification of death and MACCE, as well as for the prognosis to mortality for SCAD patients who have undergone PCI.

2.
Nutr Metab Cardiovasc Dis ; 30(2): 265-273, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31740238

RESUMO

BACKGROUND AND AIMS: The association between lipoprotein(a) [Lp(a)] levels and the risk of cardiovascular disease is of great interest but still controversial. This study sought to investigate the impact of Lp(a) on coronary severity and long-term outcomes of patients who undergo percutaneous coronary intervention (PCI). METHODS AND RESULTS: A total of 6714 consecutive patients who received PCI were enrolled to analyze the association between Lp(a) and coronary severity and major adverse cardiovascular and cerebrovascular events (MACCE). Patients were divided into tertiles according to Lp(a) levels on admission. Coronary severity was evaluated by SYNTAX scoring system. The MACCE included recurrent myocardial infarction, unplanned target vessel revascularization, stent thrombosis, ischemic stroke and all-cause mortality. Significantly, Lp(a) levels were positively associated with coronary severity (p < 0.001). Multivariate logistic regression analyses showed Lp(a) was an independent predictor of intermediate to high SYNTAX score. During an average of 874 days follow-up, 755 patients presented with MACCE (11.25%) were reported. The incidence rates of MACCE, all-cause mortality, cardiac death, target vessel revascularization, recurrent myocardial infarction, stent thrombosis, stroke and bleeding were not statistically different among the Lp(a) tertile groups. Furthermore, both Kaplan-Meier and Cox regression analyses found no relationship between Lp(a) and cardiovascular outcomes (p > 0.05). CONCLUSION: Lp(a) is an independent predictor of the prevalence of more complex coronary artery lesions (SYNTAX score ≥ 23) in patients with PCI. In addition, our study has shown that Lp(a) has no relationship with long-term cardiovascular outcomes in Chinese patients with PCI.

3.
J Cardiol ; 75(1): 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31416781

RESUMO

BACKGROUND: Inflammation plays a pivotal role in coronary artery disease (CAD). Few data from large-size studies are available on the association of high-sensitivity C-reactive protein (hs-CRP) and severity of CAD. Our aim was to investigate their relationship as well as their impact on long-term outcomes in patients undergoing percutaneous coronary intervention. METHODS: In 2013, 10,020 patients were consecutively included. Patients were divided into three groups based on hs-CRP on admission: 0-3mg/L (n=6978, 69.6%), 3.01-10mg/L (n=1997, 19.9%), >10mg/L (n=1045, 10.4%). Disease severity was determined by SYNTAX score (SS). Their differences were assessed in SS and major adverse cardiovascular events (MACEs, including all-cause death, myocardial infarction, revascularization, and in-stent thrombosis) among groups. RESULTS: The mean follow-up period was 874 days. Patients with elevated hs-CRP were older, had more risk factors such as hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, and cigarette smoking. Multivariate regression analysis showed that hs-CRP >10mg/L (OR 1.49, 95% confidence interval 1.21-1.84, p<0.001), age, previous myocardial infarction, serum creatinine, and left ventricular ejection fraction were independent predictors of intermediate-high SS (>22). Subgroup analysis indicated that the relation between hs-CRP and SS was also consistent in acute coronary syndrome and its subtypes. Although elevated hs-CRP was positively associated with increased rates of MACEs (11.0% versus 12.1% versus 14.3%, p=0.006), death (1.0% versus 1.3% versus 3.0%, p<0.001), and revascularization (8.6% versus 10.4% versus 10.0%, p=0.032), it did not show any prognostic effect for adverse outcomes in multivariate regression analyses (all adjusted p> 0.05). While SS>22 remained independently predictive of MACEs and revascularization after adjusting confounders, the risks of which were increased by 56% and 68%, respectively. CONCLUSION: Serum hs-CRP could be a useful biomarker for indicating CAD severity and could aid in risk stratification.

4.
Regen Med ; 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31829095

RESUMO

Aim: To determine the efficacy and safety of intracoronary infusion of autologous bone marrow mesenchymal stem cells (MSCINJ) in combination with intensive atorvastatin (ATV) treatment for patients with anterior ST-segment elevation myocardial infarction-elevation myocardial infarction. Patients & methods: The trial enrolls a total of 100 patients with anterior ST-elevation myocardial infarction. The subjects are randomly assigned (1:1:1:1) to receive routine ATV (20 mg/d) with placebo or MSCsINJ and intensive ATV (80 mg/d) with placebo or MSCsINJ. The primary end point is the absolute change of left ventricular ejection fraction within 12 months. The secondary end points include parameters in cardiac function, remodeling and regeneration, quality of life, biomarkers and clinical outcomes. Results & conclusion: The trial will implicate the essential of cardiac micro-environment improvement ('fertilizing') for cell-based therapy. Clinical Trial Registration: NCT03047772.

5.
Chin Med J (Engl) ; 132(19): 2286-2291, 2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31567475

RESUMO

BACKGROUND: Patients with ST-segment elevation myocardial infarction (STEMI) who present without typical chest pain are associated with a poor outcome. However, whether angiographic characteristics are related to a higher risk of mortality in this population is unclear. This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their "high-risk" angiographic characteristics. METHODS: We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014. We compared the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) flow grade in the IRA, and other angiographic characteristics between patients without and those with chest pain. Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality. RESULTS: The 2922 (24.1%) patients with STEMI presented without typical chest pain. These patients had a higher TIMI flow grade (mean TIMI flow grade: 1.00 vs. 0.94, P = 0.02) and a lower rate of IRA disease of the left anterior descending artery (44.6% vs. 51.2%, χ = 35.63, P < 0.01) than did those with typical chest pain. Patients without chest pain were older, more likely to have diabetes, longer time to hospital and higher Killip classification, and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality (3.3% vs. 2.2%, χ = 10.57, P < 0.01). After adjusting for multi-variables, presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI (adjusted odds ratio: 1.36, 95% confidence interval: 1.02-1.83). CONCLUSIONS: Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction. Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment, but not angiographic lesion characteristics. CLINICAL TRIAL REGISTRATION: NCT01874691, https://clinicaltrials.gov.

6.
Am J Transl Res ; 11(7): 4214-4231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31396330

RESUMO

The SDF-1/CXCR4 signaling plays a critical role in the trafficking of mesenchymal stem cells (MSCs) to the sites of tissue damage. Our recent study demonstrated that atorvastatin (ATV) treatment improved the survival of MSCs, and ATV pretreated MSCs (ATV-MSCs) exhibited enhanced engraftment to injured myocardium. In this study, we investigated whether combined treatment with ATV and ATV-MSCs enhances cardiac repair and regeneration by activating SDF-1/CXCR4 signaling in a rat model of acute myocardial infarction. Rats were randomized into eight groups: the Sham, AMI control and 6 other groups that were subjected to AMI followed by treatment with MSCs, ATV, ATV+MSCs, ATV-MSCs, ATV+ATV-MSCs, ATV+ATV-MSCs+AMD3100 (SDF-1/CXCR4 antagonist), respectively. ATV+ATV-MSCs significantly potentiated targeted recruitment of MSCs to peri-infarct myocardium and resulted in further improvements in cardiac function and reduction in scar size compared with MSCs treatment alone at 4-week after AMI. More importantly, the cardioprotective effects conferred by ATV+ATV-MSCs were almost completely abolished by AMD3100 treatment. Together, our study demonstrated that ATV+ATV-MSCs significantly enhanced the targeted recruitment and survival of transplanted MSCs, and resulted in subsequent cardiac function improvement by augmenting SDF-1/CXCR4 signaling.

7.
Stem Cells Transl Med ; 8(10): 1068-1083, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31245934

RESUMO

Our previous studies showed that the combination of atorvastatin (ATV) and single injection of ATV-pretreated mesenchymal stem cells (MSCs) (ATV -MSCs) at 1 week post-acute myocardial infarction (AMI) promoted MSC recruitment and survival. This study aimed to investigate whether the combinatorial therapy of intensive ATV with multiple injections of ATV -MSCs has greater efficacy at different stages to better define the optimal strategy for MSC therapy in AMI. In order to determine the optimal time window for MSC treatment, we first assessed stromal cell-derived factor-1 (SDF-1) dynamic expression and inflammation. Next, we compared MSC recruitment and differentiation, cardiac function, infarct size, and angiogenesis among animal groups with single, dual, and triple injections of ATV -MSCs at early (Early1, Early2, Early3), mid-term (Mid1, Mid2, Mid3), and late (Late1, Late2, Late3) stages. Compared with AMI control, intensive ATV significantly augmented SDF-1 expression 1.5∼2.6-fold in peri-infarcted region with inhibited inflammation. ATV -MSCs implantation with ATV administration further enhanced MSC recruitment rate by 3.9%∼24.0%, improved left ventricular ejection fraction (LVEF) by 2.0%∼16.2%, and reduced infarct size in all groups 6 weeks post-AMI with most prominent improvement in mid groups and still effective in late groups. Mechanistically, ATV -MSCs remarkably suppressed inflammation and apoptosis while increasing angiogenesis. Furthermore, triple injections of ATV -MSCs were much more effective than single administration during early and mid-term stages of AMI with the best effects in Mid3 group. We conclude that the optimal strategy is multiple injections of ATV -MSCs combined with intensive ATV administration at mid-term stage of AMI. The translational potential of this strategy is clinically promising. Stem Cells Translational Medicine 2019;8:1068-1083.

8.
J Geriatr Cardiol ; 16(5): 395-400, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31217792

RESUMO

Background: Diabetes is frequently associated with poor prognosis among acute myocardial infarction (AMI) patients. Patients with these comorbidities often have atypical symptoms and subsequent delay in treatment. Few studies have reported detailed AMI symptoms in patients with diabetes. This study compared AMI symptoms and presentation characteristics between diabetics and non-diabetics. Methods: We included patients from the China AMI registry diagnosed with AMI between January 2013 and September 2014. Baseline characteristics, symptomology, and delay in treatment were compared between diabetics and non-diabetics. Multivariable logistic regression analysis was used to explore independent predictors of atypical symptoms. Results: A total of 4450 (20.2%) patients had diabetes. They were older, more often women, higher in body mass index, and more likely to have non-ST segment elevation myocardial infarction. Fewer diabetic patients presented with persistent precordial chest pain (63.1% vs. 68%, P < 0.0001), diaphoresis (60.1% vs. 65.6%, P < 0.0001), fatigue (16.7% vs. 18.3%, P = 0.0123), and incontinence (0.4% vs. 0.7%, P = 0.0093). Time to hospital presentation was longer among patients with diabetes than those without. In multivariable analysis, diabetes was identified as an independent predictor of atypical symptoms (OR: 1.112, 95% CI: 1.034-1.196). Conclusions: Our study is the first large-scale study providing evidence that diabetics are less likely to present with typical chest pain and more likely to experience treatment delay when suffering from an AMI. Our results may increase clinician awareness of recognizing AMI patients rapidly to reduce diagnosis and treatment delay, particularly in the context of diabetes.

9.
J Chin Med Assoc ; 82(8): 616-622, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31135575

RESUMO

BACKGROUND: A novel risk model to predict long-term mortality in patients with acute coronary syndrome (ACS), derived from the EPICOR (long-term follow-up of antithrombotic management patterns in acute coronary syndrome patients) registry, has been released recently and its performance remains to be assessed. The objective is to evaluate the EPICOR score for 2-year mortality risk in ACS patients after percutaneous coronary intervention (PCI). METHODS: From January to December in 2013, a total of 6087 consecutive patients presenting with ACS who were scheduled for PCI were enrolled. Use online simplified EPICOR calculator to assess the expected risk of death. RESULTS: Sixty-eight patients (1.1%) died during 2-year follow-up. The areas under the receiver operating characteristics curve for mortality in the overall population, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation ACS were 0.712 (95% CI, 0.650-0.772; p < 0.001), 0.790 (95% CI, 0.676-0.903; p < 0.001), and 0.683 (95% CI, 0.615-0.751; p < 0.001), respectively. Moreover, it was noninferior to the updated Global Registry of Acute Coronary Events (GRACE) risk score. Patients were stratified into three categories: low-risk (n = 3382), medium-risk (n = 2547), and high-risk (n = 158). Kaplan-Meier curve demonstrated significant ongoing divergence in both mortality (0.6% vs 1.3% vs 9.5%; p < 0.001) and major adverse cardiovascular and cerebrovascular events (MACCEs) (11.8% vs 12.3% vs 19.6%; p = 0.014) among them. Multivariate Cox analysis revealed that medium- and high-risk groups predicted 2- and 12-fold hazards of death comparing to the lowest. Yet, it was not a significant predictor for MACCEs after adjusting confounding factors. CONCLUSION: The simplified EPICOR score showed fair discriminatory power of 2-year mortality in patients with ACS and an improved performance in the STEMI subgroup. It could aid in risk stratification of ACS patients as an independent predictor.

10.
Chin Med J (Engl) ; 132(8): 914-921, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-30958432

RESUMO

BACKGROUND: It is currently unclear if fibrinogen is a risk factor for adverse events in patients receiving percutaneous coronary intervention (PCI) or merely serves as a marker of pre-existing comorbidities and other causal factors. We therefore investigated the association between fibrinogen levels and 2-year all-cause mortality, and compared the additional predictive value of adding fibrinogen to a basic model including traditional risk factors in patients receiving contemporary PCI. METHODS: A total of 6293 patients undergoing PCI with measured baseline fibrinogen levels were enrolled from January to December 2013 in Fuwai Hospital. Patients were divided into three groups according to tertiles of baseline fibrinogen levels: low fibrinogen, <2.98 g/L; medium fibrinogen, 2.98 to 3.58 g/L; and high fibrinogen, ≥3.58 g/L. Independent predictors of 2-year clinical outcomes were determined by multivariate Cox proportional hazards regression modeling. The increased discriminative value of fibrinogen for predicting all-cause mortality was assessed using the C-statistic and integrated discrimination improvement (IDI). RESULTS: The 2-year all-cause mortality rate was 1.2%. It was significantly higher in the high fibrinogen compared with the low and medium fibrinogen groups according to Kaplan-Meier analyses (1.7% vs. 0.9% and 1.7% vs. 1.0%, respectively; log-rank, P = 0.022). Fibrinogen was significantly associated with all-cause mortality according to multivariate Cox regression (hazard ratio 1.339, 95% confidence interval: 1.109-1.763, P = 0.005), together with traditional risk factors including age, sex, diabetes mellitus, left ventricular ejection fraction, creatinine clearance, and low-density lipoprotein cholesterol. The area under the curve for all-cause mortality in the basic model including traditional risk factors was 0.776, and this value increased to 0.787 when fibrinogen was added to the model (IDI = 0.003, Z = 0.140, P = 0.889). CONCLUSIONS: Fibrinogen is associated with 2-year all-cause mortality in patients receiving PCI, but provides no additional information over a model including traditional risk factors.


Assuntos
Fibrinogênio/análise , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/terapia , Idoso , Jejum/sangue , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Fatores de Risco
11.
Front Immunol ; 10: 62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30761134

RESUMO

Type 2 immunity participates in the pathogeneses of helminth infection and allergic diseases. Emerging evidence indicates that the components of type 2 immunity are also involved in maintaining metabolic hemostasis and facilitating the healing process after tissue injury. Numerous preclinical studies have suggested regulation of type 2 immunity-related cytokines, such as interleukin-4, -13, and -33, and cell types, such as M2 macrophages, mast cells, and eosinophils, affects cardiac functions after myocardial infarction (MI), providing new insights into the importance of immune modulation in the infarcted heart. This review provides an overview of the functions of these cytokines and cells in the setting of MI as well as their potential to predict the severity and prognosis of MI.


Assuntos
Imunidade Inata , Infarto do Miocárdio/imunologia , Animais , Polaridade Celular , Colágeno/metabolismo , Modelos Animais de Doenças , Eosinófilos/imunologia , Humanos , Inflamação/imunologia , Interleucinas/biossíntese , Macrófagos/imunologia , Mastócitos/imunologia , Camundongos , Infarto do Miocárdio/patologia , Neovascularização Fisiológica/imunologia , Ratos
12.
Chin Med J (Engl) ; 132(5): 519-524, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30807351

RESUMO

BACKGROUND: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. METHODS: We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. RESULTS: Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849-2.107). CONCLUSIONS: Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction. TRIAL REGISTRATION: www.clinicaltrials.gov (No. NCT01874691).


Assuntos
Eletrocardiografia/métodos , Infarto do Miocárdio/patologia , Idoso , Arritmias Cardíacas/patologia , Arritmias Cardíacas/fisiopatologia , China , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Razão de Chances , Sistema de Registros , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
13.
Platelets ; 30(7): 901-907, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30518271

RESUMO

This study aimed to evaluate the platelet reactivity in real-world patients with different chronic kidney disease (CKD) stages after percutaneous coronary intervention (PCI), and to examine whether high residual platelet reactivity (HRPR) is associated with higher incidence of adverse cardiovascular events in a 2-year follow up. A total of 10 724 consecutive patients receiving DAPT with aspirin and clopidogrel after PCI throughout 2013 were enrolled. We applied modified thromboelastography (mTEG) in 6745 patients. Kaplan-Meier analysis and Cox proportional regression analysis were applied to illustrate end points for patients. The prevalence of HRPR for adenosine diphosphate (ADP) was higher in patients with CKD3-5 than patients with CKD1-2 (47.0% vs. 37.3%, p = 0.002), but not for arachidonic acid (AA). No significant difference was observed for MACCE between patients with or without HRPR for ADP (HR 1.004, 95%CI: 0.864-1.167, p = 0.954). Patients with HRPR for ADP was associated with less bleeding events than patients without HRPR for ADP (HR 0.795, 95%CI: 0.643-0.982, p = 0.034). In this large cohort of real-world patients after PCI, the deterioration of renal function was linked to HRPR for ADP. HRPR was not associated with MACCE in patients with CKD in a 2-year follow up. Bleeding risks were significantly lower in PCI patients with versus without HRPR for ADP.


Assuntos
Plaquetas/metabolismo , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/uso terapêutico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia , Feminino , Humanos , Masculino , Inibidores da Agregação de Plaquetas/farmacologia
14.
Catheter Cardiovasc Interv ; 93(2): E75-E80, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30421857

RESUMO

OBJECTIVES: To evaluate the effect of prior stroke on long-term outcomes in patients undergoing percutaneous coronary interventions (PCI). BACKGROUND: Patients with coronary heart disease (CHD) and prior stroke history have more serious clinical and angiographic conditions, which make the choice of treatment strategy complex. METHODS: A total of 10,724 consecutive patients who underwent PCI from January 2013 to December 2013 were enrolled. 2-Year clinical outcomes between patients with prior stroke (n = 1150) and those with no prior stroke (n =9574) were compared. RESULTS: The proportion of patients with prior stroke was 10.72%. These patients had higher clinical risks (age, sex, and cardiovascular risk factors) and more extensive coronary disease (higher pre-PCI and residual SYNTAX scores). During the 2-year follow-up, patients with prior stroke had a higher incidence of major adverse cardiac and cerebrovascular events (MACCE), all-cause death, stent thrombosis and stroke than those without prior stroke (14.3% vs. 11.8%, p = 0.02; 2.3% vs. 1.1%, p < 0.01; 1.6% vs. 0.8%, p < 0.01; 3.3% vs. 1.1%, p < 0.01, respectively). Multivariable regression analyses identified a positive association between prior stroke and risk of stroke (HR = 2.07, 95%CI: 1.35-3.19, p < 0.01). Propensity score matched analyses (962 pairs) indicated that the only primary end point that differed in incidence between the groups was stroke and prior stroke was the only independent predictor of stroke (HR = 2.31, 95%CI: 1.20-4.45, p = 0.01). CONCLUSIONS: Prior stroke history was the only predictor of risk of post-PCI stroke. The noncerebrovascular adverse events were not increased after adjusted analyses of baseline characteristics and propensity analyses.

15.
Cardiol J ; 26(2): 138-146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30009376

RESUMO

BACKGROUND: Mean platelet volume (MPV) is a marker of platelet size and activity, and is associated with a poor prognosis of cardiovascular disease. Studies have shown a relationship between diabetes mellitus (DM) and MPV. This study examined the relationship between admission MPV and 2-year cardiac mortality in patients with DM and stable coronary artery disease (SCAD) undergoing elective percutaneous coronary intervention (PCI). METHODS: A total of 1389 patients were enrolled and divided into two groups according to MPV as fol- lows: lower MPV (n = 908, MPV ≤ 10.9 fL) and higher MPV (n = 481, MPV > 10.9 fL). RESULTS: Body mass index, platelet distribution width, MPV/platelet and glycated hemoglobin (HbA1c) levels were significantly higher in the higher MPV group compared with the lower MPV group (all p < 0.05). The platelet count was significantly lower in the higher MPV group compared with the lower MPV group (p < 0.05). MPV was positively associated with HbA1c and fasting plasma glucose levels (r = 0.073 and 0.061, p = 0.007 and 0.023, respectively) in bivariate correlation analysis. The 2-year cardiac mortality rate was 0.7%, and was significantly lower in the lower MPV group than in the higher MPV group in Kaplan-Meier analysis (p = 0.019). Receiver operating characteristic analysis showed a good diagnostic value for MPV at predicting long-term cardiac mortality (area under the curve: 0.735, 95% confidence interval [CI]: 0.590-0.880, p = 0.01). Elevated MPV was a significant risk factor for 2-year cardiac mortality (hazard ratio: 2.091, 95% CI: 1.075-4.070, p = 0.030) in multivariable Cox regression analysis. CONCLUSIONS: Mean platelet volume is a strong, independent prognostic factor in PCI-treated patients with DM and SCAD.

16.
Chin Med J (Engl) ; 131(22): 2699-2704, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30425196

RESUMO

Background: The patterns of nonadherence to antiplatelet regimen in stented patients (PARIS) thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events (CTEs) after percutaneous coronary intervention (PCI) with drug-eluting stents. However, the prognostic value of this score has not been fully evaluated in non-Euro-American PCI populations. Methods: We performed a prospective, observational study of 10,724 patients who underwent PCI in Fuwai hospital, China and evaluated the PARIS thrombotic risk score's predictive value of CTEs in the PCI population. The area under the receiver operating characteristic curve (AUROC) was used to assess the predictive value of the PARIS score for CTE. Results: Among 9782 patients without in-hospital events, a total of 95 CTEs occurred during the 2-year follow-up. The PARIS score was significantly higher in patients with CTEs (3.38 ± 2.04) compared with patients without events (2.53 ± 1.70, P < 0.001). According to the risk stratification of the PARIS thrombotic score, the risk of CTEs in the high-risk group was 3.14 times higher than that in the low-risk group (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.92-5.13; P < 0.001). However, the risk of CTEs in the intermediate-risk and low-risk groups was not significant (HR, 1.39; 95% CI, [0.86-2.24]; P = 0.184). The PARIS score showed prognostic value in evaluating CTEs in the overall population (AUROC, 0.621; 95% CI, 0.561-0.681), the acute coronary syndrome (ACS) population (AUROC, 0.617; 95% CI, 0.534-0.700; P = 0.003), and the non-ACS population (AUROC, 0.647; 95% CI, 0.558-0.736; P = 0.001). Conclusions: In a real-world Chinese population, the PARIS thrombotic risk score shows a modest prognostic value for CTEs in patients after PCI. This score also has a predictive value for CTEs in the ACS and non-ACS subgroup populations.


Assuntos
Trombose Coronária/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Síndrome Coronariana Aguda/patologia , Síndrome Coronariana Aguda/prevenção & controle , Idoso , Grupo com Ancestrais do Continente Asiático , Trombose Coronária/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Prognóstico , Estudos Prospectivos , Medição de Risco , Trombose/prevenção & controle
17.
Am J Cardiol ; 122(12): 2043-2048, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30477725

RESUMO

We aimed to determine the association of plasma lipoprotein(a) (Lp[a]) with long-term clinical outcomes in patients with chronic kidney disease (CKD) after percutaneous coronary intervention (PCI) in an observational cohort study. Four hundred and twenty-seven consecutive patients with CKD who underwent PCI from January 2013 to December 2013 were included in this study. Patients were divided into 2 groups according to median levels of Lp(a). Outcomes included 2-year risk of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding according to Bleeding Academic Research Consortium definitions. Overall, median of Lp(a) in all the patients was 217.8 mg/L. The 2-year MACCE rate across the high Lp(a) and low Lp(a) group was 23.0% versus 15.4% (p = 0.047) and bleeding event rate of the two groups 8.9% versus 4.2% (p = 0.049). The Lp(a) was significantly and positively correlated with high-sensitivity C-reactive protein levels (r2 = 0.03, p < 0.001). Kaplan-Meier curves revealed that high Lp(a) had higher incidence of bleeding than low Lp(a) (p = 0.043) and had higher risk of MACCE (p = 0.049). Multivariable Cox regression analysis indicated that high Lp(a) was an independent predictor of Bleeding Academic Research Consortium bleeding compared with low Lp(a) (hazard ratios 2.29, 95% confidence intervals 1.01 to 5.15, p = 0.046). In conclusion, a high Lp(a) value may be associated with a poor prognosis after PCI for patients with CKD.


Assuntos
Doença da Artéria Coronariana/sangue , Lipoproteína(a)/sangue , Intervenção Coronária Percutânea/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Insuficiência Renal Crônica/sangue , Idoso , Biomarcadores/sangue , China/epidemiologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Hemorragia Pós-Operatória/sangue , Prognóstico , Estudos Prospectivos , Insuficiência Renal Crônica/complicações , Fatores de Risco , Fatores de Tempo
18.
Cardiovasc Diabetol ; 17(1): 114, 2018 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107794

RESUMO

BACKGROUND: To improve outcomes in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention remain an unmet clinical need. The study aimed to evaluate the efficacy and safety of G2-DESs and BP-DESs in patients with and without DM in a single center in China. METHODS: A total of 7666 consecutive patients who exclusively had G2-DES or BP-DES implantation throughout 2013 in our center were studied. The primary efficacy endpoint was any target lesion revascularization (TLR), whereas the primary safety endpoint was a composite of death or myocardial infarction (MI) at 2-year follow-up. RESULTS: G2-DESs had a similar occurrence of death, non-fatal MI, TLR, stroke, and stent thrombosis compared with BP-DESs in patients with DM (all P > 0.05). The incidence of TVR and TLR was lower for G2-DESs than for BP-DESs in patients without DM (3.2% vs. 5.1%, P = 0.002; 2.2% vs. 4.5%, P < 0.001, respectively). Kaplan-Meier analysis also showed better TVR- and TLR-free survival rates for G2-DESs than for BP-DESs in patients without DM. Multivariate analysis showed that a BP-DES was an independent risk factor for TLR (hazard ratio 1.963, 95% confidence interval 1.390-2.772, P < 0.001) in patients without DM, which was not predictive of other components of major adverse cardiac events (P > 0.05). CONCLUSIONS: G2-DESs have better efficacy, represented by a reduced risk of TLR, and similar safety compared with BP-DESs in patients without DM. G2-DESs have similar efficacy and safety compared with BP-DESs in patients with DM at 2-year follow-up.


Assuntos
Implantes Absorvíveis , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus/epidemiologia , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Polímeros/química , China/epidemiologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Humanos , Incidência , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estudos Prospectivos , Desenho de Prótese , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
19.
Chin Med J (Engl) ; 131(17): 2041-2048, 2018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-30127213

RESUMO

Background: Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI). Methods: Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed. Results: A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min-1·1.73 m-2), 26.0% (118/454) in Group 2 (120 ml·min-1·1.73 m-2> eGFR ≥90 ml·min-1·1.73m-2), 18.3% (86/469) in Group 3 (90 ml·min-1·1.73 m-2> eGFR ≥60 ml·min-1·1.73 m-2), 21.8% (26/119) in Group 4 (60 ml·min-1·1.73 m-2> eGFR ≥30 ml·min-1·1.73 m-2), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min-1·1.73 m-2), with statistical significance (χ2 = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min-1·1.73 m-2). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ2 = 16.26, P = 0.009 at 6-month follow-up, and χ2 = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients. Conclusions: High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.


Assuntos
Lesão Renal Aguda , Taxa de Filtração Glomerular , Intervenção Coronária Percutânea , Adulto , Idoso , China , Meios de Contraste , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Int Urol Nephrol ; 50(10): 1879-1886, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29948863

RESUMO

PURPOSE: To compare the nephrotoxic effects of iodixanol and iopamidol in patients undergoing peripheral angiography. METHODS: Patients scheduled for peripheral angiography were randomly assigned to the iodixanol group (n = 463) and iopamidol group (n = 458). The primary endpoint was the incidence of contrast associated acute kidney injury (CA-AKI), which was defined as an increase ≥ 25% or ≥ 44.2 µmol/l (0.5 mg/dl) in serum creatinine (SCr) from baseline within 72 h after receiving contrast media (CM). The secondary endpoints were the mean peak SCr increase within 72 h after receiving CM and major adverse renal events (SCr increased by two times after 30 days, the need for dialysis treatment, rehospitalization for acute renal failure, or kidney-related death) during hospitalization and within 30 day postdischarge. RESULTS: The incidence of CA-AKI did not differ significantly between the iodixanol group and iopamidol group (18.1% vs. 16.8%; p = 0.595). There was no significant difference in the mean peak SCr increase between the iodixanol group and iopamidol group (10.4 ± 13.0 vs. 10.6 ± 14.3 µmol/l, p = 0.919). There were four patients [1 (0.2%) patient in the iodixanol group and 1 (0.7%) patients in the iopamidol group, p = 0.609] with doubling of SCr; no other adverse renal events were observed. CONCLUSIONS: Our data showed that the nephrotoxicity of iodixanol was comparable with that of iopamidol in patients undergoing peripheral angiography.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Creatinina/sangue , Iopamidol/efeitos adversos , Ácidos Tri-Iodobenzoicos/efeitos adversos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Idoso , Angiografia/métodos , Método Duplo-Cego , Procedimentos Endovasculares , Feminino , Taxa de Filtração Glomerular , Humanos , Iopamidol/administração & dosagem , Masculino , Estudos Prospectivos , Fatores de Risco , Ácidos Tri-Iodobenzoicos/administração & dosagem
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