Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial.

BACKGROUND: Postprocedural anticoagulation (PPA) is frequently administered after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction, although no conclusive data support this practice. METHODS: The RIGHT trial (Comparison of Anticoagulation Prolongation vs no Anticoagulation in STEMI Patients After Primary PCI) was an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted at 53 centers in China. Patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomly assigned by center to receive low-dose PPA or matching placebo for at least 48 hours. Before trial initiation, each center selected 1 of 3 PPA regimens (40 mg of enoxaparin once daily subcutaneously; 10 U·kg·h of unfractionated heparin intravenously, adjusted to maintain activated clotting time between 150 and 220 seconds; or 0.2 mg·kg·h of bivalirudin intravenously). The primary efficacy objective was to demonstrate superiority of PPA to reduce the primary efficacy end point of all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), or urgent revascularization (any vessel) within 30 days. The key secondary objective was to evaluate the effect of each specific anticoagulation regimen (enoxaparin, unfractionated heparin, or bivalirudin) on the primary efficacy end point. The primary safety end point was Bleeding Academic Research Consortium 3 to 5 bleeding at 30 days. RESULTS: Between January 10, 2019, and September 18, 2021, a total of 2989 patients were randomized. The primary efficacy end point occurred in 37 patients (2.5%) in both the PPA and placebo groups (hazard ratio, 1.00 [95% CI, 0.63 to 1.57]). The incidence of Bleeding Academic Research Consortium 3 to 5 bleeding did not differ between the PPA and placebo groups (8 [0.5%] vs 11 [0.7%] patients; hazard ratio, 0.74 [95% CI, 0.30 to 1.83]). CONCLUSIONS: Routine PPA after primary percutaneous coronary intervention was safe but did not reduce 30-day ischemic events. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03664180.

Association of sodium-glucose cotransporter 2 inhibitors with risk of major adverse cardiovascular events in type 2 diabetes patients with acute coronary syndrome: a propensity score­matched analysis.

BACKGROUND: This study aimed to investigate the association of sodium-glucose cotransporter 2 inhibitors (SGLT2i) use with cardiovascular (CV) clinical outcomes in type 2 diabetes (T2D) patients with acute coronary syndrome (ACS). METHODS: Data of T2D patients hospitalized for ACS at Civil Aviation General Hospital from January 2019 to December 2022 were collected. Based on SGLT2i use or not, patients were stratified as SGLT2i group and SGLT2i-free group. A 1:1 nearest-neighbor propensity score-matched (PSM) was performed to adjust for the confounding factors and facilitate the robust comparisons between groups. The first occurrence of major adverse cardiovascular events (MACE) with 1 year follow-up, which consisted of CV death, all cause death, non-fatal myocardial infarction or stroke, coronary revascularization or heart failure readmission, was assessed. Kaplan-Meier analysis and Cox regressions were conducted to evaluate the prognostic significance of SGLT2i use. Subgroup analyses were performed to assess the interaction between subgroups and SGLT2i use. RESULTS: A total of 925 patients were included, and the SGLT2i use increased from 9.9% in 2019 to 43.8% in 2022. 226 pairs were finally matched using the PSM model. During 1 year follow-up period, a total of 110 patients experienced MACE in the matched cohort, with a rate of 24.3%. Survival analyses showed cumulative incidence of MACE, CV death, and heart failure readmission in the SGLT2i group were significantly lower than the SGLT2i-free group. Additionally, the adjusted Cox analyses demonstrated that SGLT2i was associated with a 34.1% lower risk of MACE (HR 0.659, 95% CI 0.487-0.892, P = 0.007), which was primarily driven by a decrease in the risk of CV death by 12.0% (HR 0.880, 95% CI 0.7830.990, P = 0.033), and heart failure readmission by 45.5% (HR 0.545, 95% CI 0.332-0.893, P = 0.016). This MACE preventive benefit was consistent across different subgroups (P interaction > 0.05 for all comparisons). CONCLUSIONS: In T2D patients with ACS, there was a clear increasing trend in SGLT2i use. SGLT2i was associated with a significantly lower risk of MACE, driven by the decrease in the risk of CV death, and heart failure readmission. Our study confirmed real-world use and efficacy of SGLT2i in a general T2D population with ACS.

The Association between Dapagliflozin Use and the Risk of Post-Contrast Acute Kidney Injury in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Propensity-Matched Analysis.

INTRODUCTION: This study aimed to investigate the effect of dapagliflozin in preventing post-contrast acute kidney injury (PC-AKI) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD) who underwent an elective coronary procedure. METHODS: Data of patients with T2DM and CKD undergoing an elective coronary procedure at Civil Aviation General Hospital from October 2020 to April 2023 were collected from the electronic medical records. Based on dapagliflozin usage, patients were classified as dapagliflozin users and nonusers. 1:1 nearest-neighbor propensity matching was performed to compare dapagliflozin users with nonusers. The primary endpoint was the first PC-AKI observed. Univariate and multivariate COX regression models were used to determine the independent risk/preventive factors for PC-AKI. Thereafter, subgroup analyses were performed to evaluate the interaction between subgroup and dapagliflozin usage. Changes in the serum creatinine (SCr) and cystatin C (CysC) levels were monitored at 24 h, 48 h, and 72 h after the procedure. RESULTS: 256 pairs (256 dapagliflozin users in the dapagliflozin group and 256 dapagliflozin nonusers in the control group) were identified in the cohort. The incidence of PC-AKI in dapagliflozin group (10.9%) was lower than that in control group (22.3%). COX regression analyses showed that dapagliflozin use was associated with a lower risk of PC-AKI (HR 0.81, 95% CI: 0.69-0.95, p = 0.01) after adjustment for covariates. In the subgroup analyses, similar HRs of the dapagliflozin usage on the PC-AKI outcome were observed in patients across different patients' characteristics which revealed its consistent benefit of preventing PC-AKI. The estimated glomerular filtration rate levels at post-48 h and 72 h were significant higher in the dapagliflozin group than those in the control group, while levels of SCr (post-48 h and 72 h) and CysC (post-24 h and 48 h) in the dapagliflozin group were lower compared with the control group. CONCLUSION: Our findings suggest dapagliflozin effectively decreases PC-AKI risk and exerts reno-protective effects in patients with T2DM and CKD undergoing an elective coronary procedure.

Effect of obstructive sleep apnoea on coronary collateral vessel development in patients with ST-segment elevation myocardial infarction.

BACKGROUND AND OBJECTIVE: The impact of obstructive sleep apnoea (OSA) in the setting of acute ST-segment elevation myocardial infarction (STEMI) is complex and divergent. This study aimed to investigate the association between OSA and coronary collateral vessel (CCV) development in patients with STEMI. METHODS: The present study prospectively screened 282 STEMI patients with an overnight sleep study. OSA was defined as apnoea-hypopnoea index (AHI) ≥15 events/h. The coronary angiograms were used for the assessment of Rentrop grades representing CCVs. RESULTS: Among 119 patients enrolled, 60 patients had OSA (50.4%). The prevalence of CCV development (Rentrop grade ≥ 2) was significantly higher in OSA group than in the non-OSA group (43.3% vs. 5.1%, p < 0.001). There was a parallel increase in the Rentrop grades associated with OSA severity and worsening of hypoxaemia indicators (minimum arterial oxygen saturation [SaO2 ], mean SaO2 and time with SaO2 below 90%). After adjustment for clinical and angiographic characteristics, and pre-procedure medications that might interact with OSA, AHI as a continuous variable (OR 1.11, 95% CI 1.08-1.21, p < 0.001) and the presence of OSA (OR 11.41, 95% CI 2.70-48.15, p = 0.001) were both associated with dramatically higher incidence of CCV development. CONCLUSION: Our study demonstrated that the presence of OSA might augment CCV development in STEMI patients. The potential protective effects and mechanisms of OSA in the acute setting of STEMI should be further investigated in larger studies.

Efficacy of Oral Nicorandil to Prevent Contrast-Induced Nephropathy in Patients with Chronic Renal Dysfunction Undergoing an Elective Coronary Procedure.

OBJECTIVES: This prospective, randomized study was to investigate the role of nicorandil in the prevention of contrast-induced nephropathy (CIN) in patients with chronic renal dysfunction undergoing an elective coronary procedure. METHODS: A total of 252 eligible patients were enrolled in this study and allocated into the control group (n = 125) or nicorandil group (n = 127). Both groups received the standard hydration treatment, and patients in the nicorandil group were orally administrated 10 mg of nicorandil (t.i.d.) beginning 2 days before and continuing for 2 days after an elective coronary procedure. Serum creatinine (SCr) and cystatin C (CysC) were measured at 24 h before and 24, 48, and 72 h after the procedure. The occurrences of CIN and adverse events within 1 year were recorded. RESULTS: The nicorandil group had relatively lower SCr and CysC levels and a higher eGFR at 24 and 48 h after the procedure than the control group (p < 0.05). The incidence of CIN was significantly decreased in the nicorandil group compared to the control group. The multivariate logistic regression model revealed that nicorandil treatment was an independent protective factor for CIN (OR 0.669, 95% CI 0.522-0.857, p = 0.001). The multivariate COX proportional hazard model showed that nicorandil treatment was an independent protective predictor for adverse events (HR 0.881, 95% CI 0.781-0.993, p = 0.037). CONCLUSIONS: Nicorandil could exhibit a protective effect against CIN in patients with chronic renal dysfunction undergoing an elective coronary procedure and reduce the adverse events within 1 year after the procedure, which is superior to hydration treatment only.

Nomogram Model to Predict Cardiorenal Syndrome Type 1 in Patients with Acute Heart Failure.

BACKGROUND/AIMS: Cardiorenal syndrome type 1(CRS1) is a serious clinical condition in patients with acute heart failure (AHF) associated with adverse clinical outcomes. Although several biomarkers for identifying CRS1 have been reported, early and accurate predicting CRS1 still remains a challenge. This study was aimed to develop and validate an individualized predictive nomogram for the risk of CRS1 in patients with AHF. METHODS: A total of 1235 AHF patients between 2013 and 2018 were included in this study. The patients were randomly classified into training set (n=823) and validation set (n=412). All data of the training set were used to screen the predictors of CRS1 via univariate and multivariate analyses. A nomogram was developed based on these predictors and validated by internal and external validation. The nomogram validation comprised discriminative ability determined by the area under the curve (AUC) of receiver-operating characteristic (ROC) curve and the predictive accuracy by calibration plots. RESULTS: The overall incidence of CRS1 was 31.7%. Multivariate logistic regression revealed that age, diabetes, NYHA class, eGFR, hs-CRP and uAGT were independently associated with CRS1. A nomogram developed based on the six variables was with the AUC 0.885 and 0.823 on internal and external validation, respectively. Calibration plots showed that the predicted and actual CRS1 probabilities were fitted well on both internal and external validation. CONCLUSION: The proposed nomogram could predict the individualized risk of CRS1 with good accuracy, high discrimination, and potential clinical applicability in patients with AHF.

Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment.

BACKGROUND: We aimed to explore whether monocyte to lymphocyte ratio (MLR) provides predictive value of the lesion severity in patients with coronary artery disease (CAD). METHODS: Five hundred forty-three patients undergoing coronary angiography were analyzed in this retrospective study. Patients with coronary stenosis were divided into three groups on the basis of Syntax score. The control group consisted of patients with normal coronary arteries. MLR was calculated by dividing monocytes count by lymphocytes count obtained from routine blood examination. Multivariate logistic analysis was used to assess risk factors of CAD. Ordinal logistic regression analysis was used to assess the relationship between MLR and the lesion severity of coronary arteries. RESULTS: MLR was found to be an independent risk factor of the presence of CAD (OR: 3.94, 95% CI: 1.20-12.95) and a predictor of the lesion severity (OR: 2.05, 95% CI: 1.15-3.66). Besides, MLR was positively correlated with Syntax score(r = 0.437, p < 0.001). In the receiver-operating characteristic (ROC) curve analysis, MLR, with an optimal cut-off value of 0.25, predicted the severe coronary lesion with a sensitivity of 60.26% and specificity of 78.49%. CONCLUSIONS: MLR was an independent risk factor of the presence of CAD, and a predictor of the lesion severity. Compared to neutrophil to lymphocyte ratio (NLR), MLR has better performance to reflect the severity of coronary lesion.

Percutaneous coronary intervention vs . medical therapy in patients on dialysis with coronary artery disease in China.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION: This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.

Novel nomogram for predicting coronary vulnerable plaque risk in patients with coronary artery disease.

Objective: To develop and validate a nomogram for predicting coronary vulnerable plaques (VPs) in coronary artery disease (CAD) patients. Methods: One hundred seventy-seven CAD patients were enrolled in the training group. Another 60 patients were included for validation. Based on the identified independent risk factors, a nomogram model was developed and then validated. Results: Type 2 diabetes, hypertension, neutrophil-to-lymphocyte ratio, low-density lipoprotein cholesterol, MCP-1 and MMP-9 were found to be independent risk factors for coronary VPs. Both internal and external validation showed this nomogram had satisfactory discrimination via receiver operating characteristic curves, calibration via calibration plots and clinical application values via decision curve analysis. Conclusion: The authors established a nomogram model predicting coronary VP risk in CAD patients with promising clinical application value.

Vulnerability to coronary atherosclerotic plaques is the important initiating cause of major adverse cardiovascular events in coronary artery disease (CAD) patients. Early detection of high-risk CAD patients with vulnerable plaques (VPs) could prevent the occurrence of major adverse cardiovascular events and improve patients' clinical outcomes. The present study aimed to investigate the risk factors for coronary VPs and then develop a model for predicting VP risk in CAD patients. The authors found that Type 2 diabetes, hypertension, neutrophil-to-lymphocyte ratio, low-density lipoprotein cholesterol, MCP-1 and MMP-9 were independently associated with coronary VPs in CAD patients. Based on these variables, the authors constructed a nomogram to estimate the individualized risk of VPs and validated the nomogram internally and externally with good accuracy and discrimination. These demonstrated that this nomogram model could achieve individualized prediction of coronary VP risk and would aid physicians in identifying high-risk patients and optimizing a timely treatment strategy with potential clinical application value.

Experimental study and mechanism model on the ignition sensitivity of typical organic dust clouds in O2/N2, O2/Ar and O2/CO2 atmospheres.

To reveal and improve our understanding of the ignition behavior and mechanism, G-G furnace experiments of three typical organic dusts were performed to investigate the minimum ignition temperature (MIT) in O2/N2, O2/Ar and O2/CO2 atmospheres with oxygen mole fraction from 8.4% to 50%. The experimental results were presented in oxygen-lean and oxy-fuel atmospheres to evaluate the ignition sensitivity of dusts in different atmospheres. It was found that CO2 is the strongest in terms of lowing the ignition sensitivity of the three dusts, and the dust explosion risk increases significantly with increasing O2 mole fraction for the three dusts through a logarithmically and significantly reducing MIT. However, for different dusts, inert gases show different suppression effects. In addition, a modified steady-state homogeneous ignition model was proposed and successfully applied to oxygen-lean atmospheres, and in oxy-fuel atmospheres, this model has also been improved to estimate the ignition mechanism. This ignition mechanism model could be used to successfully predict the minimum ignition temperature of high volatile dust under different inert atmospheres controlled by homogeneous ignition, which will provide a reference for the ignition hazard assessment of dust on hot surfaces.

Prediction of train wheel diameter based on Gaussian process regression optimized using a fast simulated annealing algorithm.

An algorithm to predict train wheel diameter based on Gaussian process regression (GPR) optimized using a fast simulated annealing algorithm (FSA-GPR) is proposed in this study to address the problem of dynamic decrease in wheel diameter with increase in mileage, which affects the measurement accuracy of train speed and location, as well as the hyper-parameter problem of the GPR in the traditional conjugate gradient algorithm. The algorithm proposed as well as other popular algorithms in the field, such as the traditional GPR algorithm, and GPR algorithms optimized using the artificial bee colony algorithm (ABC-GPR) or genetic algorithm (GA-GPR), were used to predict the wheel diameter of a DF11 train in a section of a railway during a period of major repairs. The results predicted by FSA-GPR was compared with other three algorithms as well as the real measured data from RMSE, MAE, R2 and Residual value. And the comparisons showed that the predictions obtained from the GPR optimized using FSA algorithm were more accurate than those based on the others. Therefore, this algorithm can be incorporated into the vehicle-mounted speed measurement module to automatically update the value of wheel diameter, thereby substantially reducing the manual work entailed therein and improving the effectiveness of measuring the speed and position of the train.

Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention: a retrospective cohort study.

OBJECTIVES: This study aimed to evaluate prognostic value of the combination of monocyte-to-lymphocyte ratio (MLR) with neutrophil-to-lymphocyte ratio (NLR) for predicting long-term major adverse cardiac events (MACE) in patients with non-ST elevated myocardial infarction (NSTEMI) who underwent primary percutaneous coronary intervention (PCI). DESIGN: Retrospective cohort study. SETTING: Civil Aviation General Hospital, Beijing, China. PARTICIPANTS: 678 patients with NSTEMI undergoing primary PCI between July 2010 and July 2015 were enrolled. MAIN OUTCOME MEASURES: The main outcomes were MACE. The cumulative MACE-free survival rates were calculated by Kaplan-Meier analysis and the independent predictors of MACE were assessed by Cox regression analysis. RESULTS: According to the cut-off values of MLR 0.36 and NLR 2.15, the study population was classified into four groups: low MLR + low NLR group (n=319), low MLR + high NLR group (n=126), high MLR + low NLR group (n=102) and high MLR + high NLR group (n=131). The high MLR + high NLR group had a lower MACE-free survival rate than the other three groups (p logrank <0.001). Both MLR (HR 2.128, 95% CI 1.458 to 3.105) and NLR (HR 1.925, 95% CI 1.385 to 2.676) were independent predictors of long-term MACE. Moreover, the patients in the high MLR + high NLR group had an HR of 4.055 (95% CI 2.550 to 6.448) for long-term MACE, with the low-MLR + low NLR group as reference. Comparisons of receiver operating characteristic curves revealed that the combination of MLR with NLR achieved better performance in differentiating long-term MACE, compared with MLR, NLR, high-sensitivity C reactive protein and brain natriuretic peptide alone, and had similar performance to all other pairwise combinations of the four biomarkers. CONCLUSIONS: Elevated levels of MLR and NLR were independent predictors of long-term MACE in patients with NSTEMI. Moreover, the combination of MLR and NLR could improve the prognostic value in predicting long-term MACE.

Relationship between monocyte-to-lymphocyte ratio and coronary plaque vulnerability in patients with stable angina.

AIM: To investigate the relationship between monocyte-to-lymphocyte ratio (MLR) and plaque vulnerability assessed by virtual histology intravascular ultrasound in patients with stable angina. METHODS: 133 patients with stable angina were enrolled. RESULTS: MLR was found to be an independent risk factor of thin cap fibrous atheroma (OR: 2.61; p = 0.025). MLR could differentiate thin cap fibrous atheroma with a sensitivity of 73.7% and a specificity of 61.8%. MLR level was positively correlated with the percentage of necrotic core (NC) area at the sites of minimum lumen area and the largest NC area, and positively related to the percentage of NC volume. CONCLUSION: Circulating MLR level has potential in identifying the vulnerable plaques in the setting of stable angina.