Association between omentin-1 expression in human epicardial adipose tissue and coronary atherosclerosis.

BACKGROUND: Omentin-1, a novel adipocytokine mainly expressed in visceral adipose tissue, has been found to inhibit the inflammatory response and improve insulin resistance as well as other obesity-related disorders. This study investigated the association between omentin-1 expression in human epicardial adipose tissue (EAT) and coronary atherosclerosis. METHODS: Serum samples, and paired biopsies from EAT and subcutaneous adipose tissue (SAT), were obtained from patients with and without coronary artery disease (CAD, n = 28 and NCAD, n = 12, respectively) during elective cardiac surgery. Coronary angiography was performed to identify CAD presence. Serum omentin-1 and adiponectin levels were measured by ELISA. mRNA expression of omentin-1 and adiponectin was detected in adipose tissue by quantitative real-time PCR, and omentin-1 protein expression was evaluated by immunohistochemistry. Correlation and multivariate linear regression analyses were performed to determine the association between omentin-1 expression and clinical risk factors. RESULTS: mRNA and protein expression of omentin-1 were higher in EAT than paired SAT in patients with CAD and NCAD. Compared with NCAD patients, CAD patients had lower omentin-1 and adiponectin mRNA levels in EAT and serum levels as well as lower omentin-1 protein levels. Among patients with CAD, omentin-1 expression was lower in EAT surrounding coronary segments with stenosis than those without stenosis, in terms of mRNA and protein, whereas adiponectin mRNA level in EAT did not seem to differ between stenotic and non-stenotic coronary segments in CAD patients. In multivariate linear regression analysis, CAD was an independent predictor of EAT omentin-1 mRNA expression (beta = -0.57, 95 % CI -0.89 to -0.24; P = 0.001) and serum omentin-1 levels (beta = -0.35, 95 % CI -0.67 to -0.03; P = 0.036). CONCLUSIONS: Circulating and EAT-derived omentin-1 levels were reduced in patients with CAD. Omentin-1 expression in patients with CAD was lower in EAT adjacent to coronary stenotic segments than non-stenotic segments.

Influence of diabetes mellitus on long-term outcomes of patients with unprotected left main coronary artery disease treated with either drug-eluting stents or coronary artery bypass grafting.

Whether the effect of diabetes on patients with unprotected left main coronary artery (ULMCA) disease differs according to different strategies of revascularization was unknown. This study was conducted to evaluate the impact of diabetes on patients with ULMCA disease treated with either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG).A total of 922 patients with ULMCA disease who received drug-eluting stent (DES) (n = 465) implantation or underwent CABG (n = 457) were retrospectively analyzed. We compared the effects of these 2 treatments on clinical outcomes (death, myocardial infarction, stroke, repeat revascularization, and the composite of death, myocardial infarction, or stroke), according to diabetic status.During the median follow-up of 7.1 years (interquartile range, 5.3 to 8.2 years), no difference was found between PCI and CABG in the adjusted occurrence of death (P = 0.112) and the composite endpoints of death, myocardial infarction, and stroke (P = 0.235). Significantly higher incidence of repeat revascularization (P < 0.001) was observed in the DES group, whereas the CABG group had a significantly higher rate of stroke (P = 0.001). These trends were consistent in both diabetic and nondiabetic patients. We did not observe significant interactions between treatment outcomes and the presence or absence of diabetes after adjustment for covariates (P(interaction) = 0.580 for the composite of death, MI and stroke, P(interaction) = 0.685 for death, P(interaction) = 0.416 for MI, P(interaction) = 0.470 for stroke, and P(interaction) = 0.502 for repeat revascularization).Presence of diabetes was not important for decision-making between CABG and PCI in patients with ULMCA disease.

[Impact of preoperative dual antiplatelet therapy on perioperative bleeding in patients undergoing off-pump coronary artery bypass grafting].

OBJECTIVE: To evaluate the impact of preoperative dual antiplatelet therapy of aspirin and clopidogrel on perioperative blood loss and blood transfusion requirements. METHODS: A total of 60 patients underwent off-pump coronary artery bypass grafting (OPCABG) performed by the same surgeons. And they were assigned to receive dual antiplatelet therapy of aspirin and clopidogrel (group AC, n = 30) and discontinue antiplatelet therapy more than 5 days before surgery (group control, n = 30). RESULTS: No significant inter-group differences existed in basic clinical characteristics (all P > 0.05). Itraoperative blood loss volume was similar for two groups (637 ± 257 vs 635 ± 196 ml, P = 0.978). No significant inter-group difference existed in 24 h chest drainage volume (522 ± 160 vs 524 ± 204 ml, P = 0.961) or total volume of chest drainage (1044 ± 337 vs 1118 ± 198 ml, P = 0.306). CONCLUSION: Preoperative dual antiplatelet therapy of aspirin and clopidogrel does not increase the total volume of postoperative chest drainage.

[Long-term outcomes of patients with unprotected left main coronary artery disease post revascularization].

OBJECTIVE: To compare the long-term real-world outcomes of consecutive patients with unprotected left main coronary artery disease (ULMCA) underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG). METHODS: Consecutive patients with ULMCA (defined as stenosis ≥ 50%) undergoing DES implantation or CABG between January 2003 to July 2009 in Beijing Anzhen Hospital were enrolled. The follow-up period extended through August 2013. The end points of the study were death, cardiac death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization). RESULTS: From January 2003 to July 2009, 922 ULMCA patients were enrolled in this study (465 PCI patients, and 457 CABG patients). The median follow-up was 7.1 years (interquartile range 5.3 to 8.2 years). The crude relative risk was as follows: overall death rate (13.0% (41/465) vs. 22.1% (72/457), P = 0.009), stroke rate (5.8% (11/465) vs. CABG 18.9% (46/457), P < 0.001) were significantly lower whereas the rate of repeat revascularization (32.3% (110/465) vs. CABG 19.2% (58/457), P < 0.001) was significantly higher in PCI group than in CABG group. MI rate was similar between PCI and CABG group (13.9% (33/465) vs. 6.7% (26/457), P = 0.196). MACCE rate was also similar between the 2 groups (42.9% (145/465) vs. 42.5% (142/457), P = 0.122). After multivariate adjusting, there was no significant difference in rates of death, MI and a composite of serious outcomes (cardiac death, MI, or stroke) between the 2 groups. Rates of MACCE were significantly higher in the PCI group (P = 0.009) due to increased rate of repeat revascularization (P < 0.001). However, stroke rate was still significantly higher in CABG group (P = 0.001) after multivariate adjusting. CONCLUSION: During a follow-up up to 8.2 years, the survival rate is similar between the PCI and the CABG group in patients with ULMCA disease. The rate of repeat revascularization is significantly higher and stroke rate is significantly lower in the PCI group compared to CABG group.

[Effects of preoperative uses of aspirin and clopidogrel on patients undergoing coronary artery bypass graft surgery].

OBJECTIVE: To analyze the effects of preoperative uses of aspirin and clopidogrel on perioperative blood loss and blood transfusion requirements and complication in patients undergoing off-pump coronary artery bypass graft (CABG). METHODS: At our hospital from October 2011 to October 2012, a total of 480 patients underwent off-pump CABG performed by the same surgical team. Among them, 198 patients continued aspirin (discontinued clopidogrel at least 5 days) through operation (aspirin group, 1), 53 had aspirin and clopidogrel until 3 days before surgery (aspirin and clopidogrel group, 2) and 229 discontinued antiplatelet therapy 5 more days before surgery (control group, 3). RESULTS: No significant difference of basic clinical characteristics existed among three groups (P > 0.05). Group 2 was associated with a greater volume of chest tube drainage than other groups (827 ± 216 vs 416 ± 135 vs 265 ± 85 ml, P < 0.05). There was no significant difference between groups 1 and 3, even though chest tube drainage volume of group 1 was greater (827 ± 216vs 265 ± 85 ml, P > 0.05). There was no instance of stroke, myocardial infarction or post-operative mortality. CONCLUSION: Preoperative clopidogrel exposure within 5 days of surgery increases perioperative blood loss. And the pre-operative use of aspirin results in no difference in postoperative perioperative blood loss and cardiovascular outcomes.

Coronary artery bypass grafting in adults with congenital heart disease.

BACKGROUND: Adults with congenital heart disease (CHD) and coronary artery disease (CAD) have unique clinical manifestation due to the coexistence of intracardiac anomalies and CAD. Case reports are rare in surgical management of CHD combined with CAD. Our goal is to study the outcome of surgical intervention of CHD and CAD concomitantly. METHODS: From February 2002 to August 2009, 29 adult patients underwent coronary artery bypass grafting (CABG) and surgical correction of CHD concomitantly. Congenital cardiac anomalies include atrial septal defect (ASD) in 21 cases, ventricular septal defect in four cases, atrioventricular septal defect in three cases, and cor triatriatum in one case. Coronary angiography demonstrated: one-vessel disease in 10 cases, two-vessel disease in 11 cases, and three-vessel disease in eight cases. Coronary revascularization and intracardiac anomalies were corrected with cardiopulmonary bypass in 23 cases. There were six patients who had off-pump coronary artery pass grafting (OPCAB) and intraoperative device closure of ASD. RESULTS: One patient died of pulmonary infection and multiorgan failure. Follow-up time was from 2 to 89 months (mean, 42 ± 25 months). One patient with recurrent angina did not need intervention of the revascularization. Six patients who acquired OPCAB and intraoperative device closure of ASD had no complications after surgery. CONCLUSIONS: Surgery for adult patients who had CHD with CAD was a safe and effective management. OPCAB with intraoperative device closure of ASD was a reasonable approach for some selective patients.

[Impact of overweight on clinical outcomes in patients undergoing coronary revascularization].

OBJECTIVES: To determine the impact of BMI on clinical outcome in patients with heart failure underwent coronary revascularization. METHODS: The DESIRE-plus (Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry of coronary revascularization in our institution between July 1, 2004 and September 30, 2005. We analyzed heart failure patients with the complete data of body mass index (BMI) data from the DESIRE-plus trial and grouped them by BMI (normal BMI group, BMI < 24; overweight group, BMI 24-27.9; obesity group, BMI > or = 28). Total mortality, cardiac mortality and MACCE including death, neo-myocardial infarction, stroke, re-revascularization were recorded. We evaluated risk estimates for three bodyweight groups. RESULTS: 1010 patients were included in the study (295 in normal BMI group; 495 in overweight group and 220 obesity group). Median follow-up was 542 days. Overweight and obese patients were younger (59.3 +/- 10.14 years, 58.6 +/- 10.30 years vs 62.6 +/- 9.93 years, P < 0.01) and had a significantly higher incidence of hypertension (61.2, 66.8% vs 52.5%, P = 0.017), stable angina pectoris (21.2%, 23.7% vs 17.0%, P = 0.05) and higher triglyceride [(1.90 +/- 1.05) mmol/L, (2.10 +/- 1.12) mmol/L vs (1.48 +/- 0.92) mmol/L, P < 0.01)], fasting blood glucose level [(6.07 +/- 2.09) mmol/L, (5.96 +/- 1.53) mmol/L vs (5.67 +/- 1.92) mmol/L, P = 0.021), blood creatinine (84.9 +/- 21.7) micromol/L, (90.2 +/- 30.9) micromol/L vs (82.2 +/- 25.8) micromol/L, P = 0.002] compared with normal BMI patients. Multivariate Cox regression model showed obese patients had an decreased hazard risk (HR) for total mortality (0.285, 95%CI 0.104 - 0.777) and MACCE (0.596, 95%CI 0.401 - 0.885) compared with those for patients with normal BMI, overweight patients had no increased risk for total mortality (HR 0.769, 95%CI 0.442 - 1.338) and MACCE (0.998, 95%CI 0.754 - 1.322), there was hardly any significantly difference in cardiac mortality between three groups (P = 0.223). CONCLUSION: There were more risk factors in heart failure patients with coronary heart disease complicated with obesity or overweight, but the prognosis after revascularization of them is at least no worse than the normal weight coronary heart disease patients.

[The early and middle-long term clinical results of surgical treatment for ventricular septal rupture].

OBJECTIVE: To explore the way of promoting the efficacy of surgical treatment for ventricular septal rupture (VSR) after acute myocardium infarction in terms of perioperative and long term survival. METHODS: The clinic data of 37 VSR cases underwent surgical treatment from October 1994 to October 2007 were analyzed retrospectively. There were 24 male and 13 female, and the age was (63.4 +/- 7.6) years old. The whole group was divided into the VSR repair plus revascularization group (group A, 26 cases) and simple VSR repair group (group B, 11 cases). RESULTS: There were 4 operative deaths in group A (15.4%), 7 deaths in group B (63.6%), P = 0.006. With the follow-up of (34.0 +/- 29.8) months ranged from 2 to 103 months of the 26 operational survivors, there were 5 late deaths, of which 2 deaths in group A and 3 deaths in group B. According to the Kaplan-Meier survival curve, the actuarial survival rate at 6 to 8 year was (64.3 +/- 21.0)% for group A and the actuarial survival rate at 4 year was (25.0 +/- 21.7)% for group B, P = 0.011. Of the 21 mid-long term survivors, 17 cases were in NYHA class I to II and 4 cases in NYHA class III to IV. There were 4 cases suffered from VSR recurrence. According to Logistic regression, the risk factors for the early death were not adoptive of revascularization, cardiogenic shock and emergency surgical procedure, while the risk factors for late death were not adoptive of revascularization and low cardiac output after the procedures. CONCLUSIONS: VSR repair plus revascularization could improve the perioperative and mid-long term survival for the surgical treatment of VSR. The appropriate timing and procedures of the surgical operation are very important to promote perioperative survival and to prevent VSR recurrence.

[Impact of chronic anemia on in-hospital clinical outcome of revascularization in patients with coronary artery disease].

OBJECTIVE: To evaluate the in-hospital clinical outcome of revascularization in patients with coronary artery disease with chronic anemia. METHODS: Between July 2002 and June 2004, 3 679 patients in Anzhen Hospital Affiliated to Capital University of Medical Sciences were subjected to revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)] during hospitalization. These patients were divided into anemia group and non-anemia group according to blood hemoglobin (Hb) level [World Health Organization (WHO) standard (male<120 g/L, female<110 g/L) as anemia]. Rates of in-hospital main adverse cardiac and cerebral events (MACCE), including all-cause death, new attack of myocardial infarction, stroke and repeated revascularization were compared between two groups. RESULTS: There were 426 anemia patients (11.6%) and 3 253 non-anemia patients (88.4%). In-hospital death in the anemia group was higher than that of the non-anemia group [10 cases (2.4%) vs. 64 cases (1.9%), P<0.05]. Rates of MACCE of the anemia group was higher than that of the non-anemia group (4.2% vs. 3.2%, P<0.05). There was no significant difference in rates of new attack of myocardial infarction (0.7% vs. 0.6%), stroke (1.2% vs. 0.4%) and repeated revascularization (0 vs. 0.2%) between two groups (all P>0.05). CONCLUSION: Compared with non-anemia patients, anemia patients with coronary artery disease has higher in-hospital MACCE rate and all-cause mortality.

[Outcome of endovascular stent graft placement in patients with acute thoracic aortic syndromes].

OBJECTIVE: To evaluate the outcome of endovascular stent graft placement in patients with acute thoracic aortic syndromes. METHODS: Emergency stent-graft implantations were performed in 57 patients with acute thoracic aortic syndromes from May 2001 to December 2005 (45 Stanford B aortic dissections, 9 acute penetrating aortic ulcers or pseudoaneurysms. 3 traumatic thoracic aneurysms). The clinical data, efficacy and follow-up results were analyzed. RESULTS: Procedures were successful in all patients. Type I endoleaks were evidenced in 5 patients and ascending aortic dissection occurred in 1 patient during operation, 5 patients with acute penetrating aortic ulcer complicating with coronary artery disease received successful PCI immediately post endovascular stent graft placement. Adynamia in extremities occurred in 1 patient and recovered two days later post anisodamine and mcnicol treatments. Left vertebral artery ischemia was found in 1 patient due to coated subclavian artery by stent-graft and the patient recovered spontaneously after two days lethargy without special treatment. The mean ICU time after surgery was 3.5 days (1 - 8 days) and the mean hospitalization time was 10 days. The mean follow-up time was 25.30 +/- 13.1 months (1 - 47 months). Two patients died within 30 days after operation, 1 patient died of rupture of the ascending aortic dissection (7 days post operation), 1 patient died of acute renal failure at the 2nd day post operation. One patient died of empsyxis 3 months after procedure, 1 patient died at the 4th month post procedure for unknown reason, 1 patient received second stent-graft implantation because of a newly formed endoleak at the proximal end of the stent-graft, 5 patients received second stent-graft implantation because of newly formed leaks at the remote end of the stent-graft. No paraplegia or stent migration or stenosis was observed during the follow up period. Total mortality during hospitalization and follow-up was 7.0%. CONCLUSION: Patients with acute thoracic aortic syndrome could be effectively and safely treated by coated stent-graft endovascular placement.

[Risk factors related to mortality in old patients with coronary heart disease after revascularization].

OBJECTIVE: To evaluate the risk factors related to mortality in old patients with coronary heart disease after revascularization. METHODS: A total of 675 patients (498 males) with age >or= 70 years old who received revascularization during July 2003 to June 2004 and followed up > 30 days after discharge were included in this study. Clinical characteristics, death and major adverse cardiac and cerebral events (MACCE) during follow up were recorded. RESULTS: The patients were followed up for a mean period of (754 +/- 355) days. 27 patients (4.0%) died and MACCE developed in 50 patients (7.4%) during follow up. Female and patients with anemia took a significantly higher risk of mortality (RR = 2.750, 95% CI 1.116 - 6.779, P = 0.028, RR = 0.385 95% CI 0.164 - 0.904, P = 0.028, respectively); Creatinine level is positively related to mortality rate. When comparing patients with Cr > 115 micromol/L and Cr > 177 micromol/L with patients with Cr < 115 micromol/L, the hazard rate was 2.963 and 10.785, respectively (95% CI 1.114 - 9.952, P = 0.035 and 95% CI 2.659 - 78.097, P = 0.000) after adjustment for other risk factors. CONCLUSION: Preexisting anaemia (male Hb < 120 g/L, female Hb < 110 g/L), renal insufficiency (Cr > 115 micromol/L) and female gender were found to be independent risk factors for mortality in old patients with coronary heart disease post revascularization.

[Profile of risk factors modification after coronary revascularization in patients with coronary artery disease].

OBJECTIVE: To elucidate the profile of risk factors modification after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with coronary artery disease in order to scale the gap between real world practice and evidence-based guidelines. METHODS: 3767 patients with at least 30 days' followed-up after discharge in the single-center DESIRE (Drug-Eluting Stent Impact on REvascularization) registry were enrolled to compare in-hospital and follow-up data including smoking, body weight, blood pressure, fasting blood sugar and lipid levels. RESULTS: Of the 3763 patients, 3017 (80.2%) were successfully followed up for at least one month with a median of 670 (35 - 1930) days. During follow-up, 18.5% (170/917) of the in-hospital current smokers continued smoking, whereas 6.1% (71/1168) of the non-current smokers during hospitalization became cigarette addict despite a marked reduction in the general rate of current smoking (43.5% vs 9.5%, P < 0.0001). At follow-up, 24.3% (264/1087) of the overweight or obese patients experienced weight gain after revascularization. In patients with diabetes mellitus, 48.3% (143/296) had higher follow-up levels of average fasting blood sugar. In patients complicated with hypertension, 33.1% (469/1419) and 31.9% (453/1419) had higher average systolic or diastolic pressures than in-hospital measurements. During follow-up, 36.4% (111/184) had lower levels of serum high-density lipoprotein cholesterol (HDL-C), whereas 54.1% (98/181) and 56.8% (121/213) patients had higher levels of serum low-density lipoprotein cholesterol (LDL-C) and triglycerlin (TG). CONCLUSION: Risk factors modification after coronary revascularization is far beyond optimal, with a high rate of continued smoking and poor control of body weight, blood sugar, blood pressure and serum lipids. Prompt and effective measures should be taken to enhance the secondary prevention and patient education to minimize the gap between clinical practice and evidence-based guidelines.

[Comparative analysis of the risk factor on the clinical information of myocardial revascularization combined with concomitant valve operations].

OBJECTIVE: To evaluate the clinic information of coronary artery bypass grafting (CABG) combined with concomitant valve operation. METHODS: Retrospectively analyze the information of morbidity and mortality of 126 cases patients who underwent combined valve and bypass procedures between December 2000 and January 2005. These patients had been divided into 2 groups according to sex. RESULTS: There were significant differences in the clinic characteristic such as weight and diabetes mellitus and mitral valve stenosis and three disease vessels of coronary artery between 2 groups (P < 0.05). The rate of the number of bypass grafts and morbidity and mortality of complication were significant differences (P < 0.05). The number of mitral valve replacement of female was more than that of male (P < 0.05). Five males died after operation, 1 case of heart failure, 1 case of high blood sugar, 2 cases of arrhythmia, 2 cases of organs failure; Seven females died after operation, one case of heart failure, one case of alimentary tract haemorrhage, three cases of arrhythmia, two cases of organs failure. CONCLUSIONS: Coronary artery bypass grafting (CABG) combined with concomitant valve operation is safe and effective. The rate of morbidity and mortality of complication of female is more than that of male. The study demonstrates that female gender is an independent risk factor for combined morbidity and mortality during and after combined valve and coronary bypass surgery. That is related to low weight and mitral valve stenosis of female.

Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency.

BACKGROUND: To assess the safety and efficacy of combined surgery for patients with concurrent lung cancer and severe coronary heart disease (CHD). METHODS: Between 2003 and 2014, 34 patients with stage I or II lung cancer and simultaneous severe CHD underwent combined off-pump coronary artery bypass (OPCAB) grafting and lung resection. Surgically, myocardial revascularization was performed first and followed by lobectomies through the same or a second incision. Video-assisted thoracoscopes were used in some cases. Five patients also received chemotherapy before or after combined surgery in an effort to improve the long-term survival. RESULTS: All patients survived the operation and no new myocardial infarctions (MIs) occurred in the perioperative period. The most frequent complications were cardiac arrhythmias (5 cases), atelectasis (4 cases), and pulmonary infections (2 cases). All patients were followed up for 5-60 months. Within this period, 6 patients (17.6%) died due to cancer recurrence. The 3- and 5-year survivals were 75% and 67% for these lung cancer patients, respectively. CONCLUSIONS: Combined OPCAB and pulmonary resection for early stage lung cancer patients with concurrent severe CHD is a relatively safe and effective treatment with satisfactory long-term survival rates, especially for those patients with three-vessel disease who are not usually candidates for percutaneous coronary intervention (PCI) before open surgery.

Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease.

BACKGROUND: There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events. METHODS: All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. RESULTS: Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3-8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group. CONCLUSIONS: During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.

[Application of bilateral internal mammary artery in coronary artery bypass grafting].

OBJECTIVE: To evaluate the effects of application of bilateral internal mammary artery grafts in coronary artery by pass grafting (CABG). METHODS: From Jan. 1998 to Mar. 2001, 51 patients with coronary arteriosclerotic cardiopathy, all males, aged 36 - 65 (average 49.9 years), underwent coronary artery bypass grafting with bilateral internal mammary artery grafts. The pathologic change involved three branches of coronary artery in 48 cases and involved the left main trunk in 3 cases. 37 patients had the history of myocardial infarction. Four cases were complicated by left ventricular aneurysm. 47 cases were operated upon on-pump and 4 off-pump. Left ventricular aneurysmectomy was done in 4 patients and coronary endarterectomy in 1 patient. The patterns of anastomosis were as follows: right internal mammary artery (RIMA) to left anterior descending artery (LAD) and left internal mammary artery (LIMA) to obtuse marginal (OM) in 39 cases, LIMA to LAD and RIMA to right coronary artery (RCA) in 9 cases, and LIMA to LAD and RIMA to OM in 3 cases. Gastroepiploic artery and left radical artery were used in other bypass grafting. The average number of grafts used for each case was 3. RESULTS: There were 3 early operative deaths, with an early operative mortality rate of 5.9%. One patient died of low output syndrome due to perioperative myocardial infection, 1 patient died of refractory arrhythmia, and 1 patient died of cerebral accident 40 days after operation. Intraaortic balloon pump was used in 4 cases post-operatively. Mediastinal infection occurred in 2 patients. The patients were followed up for 2 to 39 months (average 15.5 months). During the follow-up, no angina pectoris occurred and ultrasonography showed that the bilateral internal mammary artery grafts were unobstructed in all patients. CONCLUSION: Bilateral internal mammary artery grafts can be applied effectively in CABG with a good short-term effect, especially for young patients.

Graft occlusion after coronary artery bypass grafting and stent deformation and in-stent restenosis after succedent stenting in a patient with deep position myocardial bridging.

We present a case of deep position myocardial bridging in a patient who had early graft occlusion after coronary artery bypass grafting and had stent deformation and in-stent restonesis after succedent stenting.

Coronary stenting versus bypass surgery in heart failure patients with preserved ejection fraction.

BACKGROUND: The optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear. The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF. METHODS: From July 2003 through September 2005, a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥ 50%) underwent PCI (n = 350) or CABG (n = 570). We compared the groups with respect to the primary outcome of mortality, and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE), including death, myocardial infarction, stroke and repeat revascularization, at a median follow-up of 543 days. RESULTS: In-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs. 2.5%, adjusted P = 0.016). During follow-up, there was no significant difference in the two groups with regard to mortality rates (2.3% vs. 3.5%, adjusted P = 0.423). Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs. 4.0%, adjusted P < 0.001), mainly due to higher rate of repeat revascularization (adjusted P < 0.001). Independent predictors of mortality were age, New York Heart Association (NYHA) class and chronic total occlusion. CONCLUSION: Among patients with CAD and HFPEF, PCI was shown to be as good as CABG with respect to the mortality rate, although there was a higher rate of repeat revascularization in patients undergoing PCI.

Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease.

BACKGROUND: In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease. METHODS: From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences. RESULTS: At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points. CONCLUSIONS: Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.