The impact of fasting blood glucose on the prognosis of non-diabetic patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction / 中国介入心脏病学杂志

Objective To investigate the impact of fasting blood glucose on the prognosis of non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods We retrospectively recruited consecutive patients who underwent primary PCI in our hospital from February, 2003 to March, 2015. Patients with prior history of diabetes mellitus before the index hospitalization and those with newly diagnosed diabetes mellitus during the index hospitalization were excluded. The clinical and angiographic features, medical and interventional treatment, and 30-day outcomes were compared between patients with elevated fasting blood glucose (FBG) (>5.4 mmol/L) and those with normal FBG (≤5.4 mmol/L). Results A total of 721 patients were recruited with an age of(61.2 ± 12.8)years, of whom 601 (83.4 %) were male. As compared with patients with normal FBG,those with elevated FBG were more likely to be female(20.1 % vs.13.5 %, P=0.017),had faster heart rate on admission[(82.9 ± 17.2)bpm vs.(79.4 ± 16.7)bpm,P=0.006]and more use of intra-aortic balloon pump(3.8 % vs.1.3 %,P=0.034),and had higher rates of 30 day all-cause mortality(3.5 % vs.0.5 %,P=0.004),cardiac mortality(2.9 % vs.0.5 %,P=0.012)and heart failure(18.1 % vs. 7.4 %, P< 0.001). After adjusting baseline characteristics, FBG > 5.4 mmol/L was one of the independent predictors of 30-day all-cause mortality(HR 6.030,95 % CI 1.235-29.447,P=0.026).Other independent predictors of 30-day all-cause mortality included age(HR 1.059,95 % CI 1.002-1.120,P=0.044),heart rate on admission(HR 1.036,95 % CI 1.003-1.070,P=0.034),left descending artery as the culprit vessel(HR 6.427,95 % CI 1.389-29.728,P=0.017),and use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker(HR 0.154,95 % CI 0.051-0.461,P=0.001).Conclusions In non-diabetic patients undergoing primary PCI for STEMI, elevated FBG was one of the independent predictors of 30-day all-cause mortality.

Restrictive Cardiomyopathy Resulting from a Troponin I Type 3 Mutation in a Chinese Family / 中国医学科学杂志(英文版)

Objective To identify the pathogenic variant responsible for restrictive cardiomyopathy (RCM) in a Chinese family.Methods Next generation sequencing was used for detecting the mutation and Results verified by sequencing. We used restriction enzyme digestion to test the mutation in the family members and 200 unrelated normal subjects without any cardiac inherited diseases when the mutation was identified.Results Five individuals died from cardiac diseases, two of whom suffered from sudden cardiac death. Two individuals have suffered from chronic cardiac disorders. Mutation analysis revealed a novel missense mutation in exon 7 of troponin I type 3 (TNNI3), resulting in substitution of serine (S) with proline (P) at amino acid position 150, which cosegregated with the disease in the family, which is predicted to be probably damaging using PolyPhen-2. The mutation was not detected in the 200 unrelated subjects we tested.Conclusion Using next generation sequencing, which has very recently been shown to be successful in identifying novel causative mutations of rare Mendelian disorders, we found a novel mutation of TNNI3 in a Chinese family with RCM.

Risk factors and coronary angiography characteristics of female patients with acute coronary syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the risk factors and coronary angiography characteristics of female patients with acute coronary syndrome (ACS).</p><p><b>METHODS</b>A total of consecutive 986 inpatients with ACS who had undergone coronary angiography from March 2009 to August 2010 in our hospital were enrolled in this study. There were 303 female patients and 683 male patients. Clinical data were collected by physicians and the severity of coronary artery stenosis was analyzed via the international Gensini Score system.</p><p><b>RESULTS</b>Incidence of ACS under the age of 60 years [8.6% (26/303) vs. 16.5% (113/683), P < 0.05], family history of coronary artery disease [15.8% (48/303) vs. 23.0% (157/683), P < 0.05], and smokers [19.1% (58/303) vs. 71.7% (490/683), P < 0.001] were significantly less while hypertension [81.5% (247/303) vs. 64.0% (437/536), P < 0.001] and diabetes rate [51.8% (157/303) vs. 44.0% (298/683), P < 0.05] were significantly higher in female patients than in male patients. The comorbidities of dyslipidemia, adiposity, hyper-C-reaction protein and hyperfibrinogenemia were similar between male and female patients (P > 0.05). Unstable angina and non-ST-segment elevation myocardial infarction were more often [86.1% (261/303) vs. 78.5% (536/683)], while ST-segment elevation myocardial infarction was less [13.9% (42/303) vs. 21.5% (147/683), P = 0.005] in female patients than in male patients. There were significantly more incidence of mild coronary artery stenosis [15.0% (47/303) vs. 10.0% (68/683), P = 0.012] and less severely stenotic lesions [84.2% (255/303) vs. 89.8% (613/683), P = 0.013] in female patients than in male patients. Gensini score, percutaneous intervention rate and in-hospital mortality rate were similar between male and female patients with ACS (P > 0.05).</p><p><b>CONCLUSIONS</b>Prevalence rates of diabetes mellitus and hypertension are higher while positive family history on coronary artery disease and smoking rate are lower in female patients with ACS than in male ACS patients. Female ACS patients are often presented with unstable angina or non-ST-segment elevation myocardial infarction and with mild coronary artery stenosis compared to male ACS patients.</p>

Clinical and coronary features of systemic lupus erythematosus patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVES</b>To observe the clinical and coronary features of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD).</p><p><b>METHODS</b>Among 2877 SLE inpatients (age ≥ 18 years, male 363, female 2514) admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [mean age (50.7 ± 12.8) years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed.</p><p><b>RESULTS</b>The incidence of CAD was significantly higher in male SLE patients than in female patients [2.48% (9/363) vs. 0.95% (24/2514), P = 0.022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [5.76% (8/139) vs. 0.91% (25/2738), P < 0.001]. Myocardial infarction was the major form of CAD (24/33). Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi-vessel lesions was found in 75.0% (15/20) patients with SLE and CAD.</p><p><b>CONCLUSIONS</b>Male SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.</p>

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: outcomes of 3-year clinical follow-up / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation.</p><p><b>METHODS</b>A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n = 83) or BMS (n = 108) implantation in the infarction related artery according to physician's discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups.</p><p><b>RESULTS</b>The clinical follow-up duration was 3 years ((41.7 ± 16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P = 0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P = 0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P = 0.379) and stent thrombosis (1.20% vs. 1.85%, P = 0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P = 0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P = 0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n = 73) and paclitaxel-eluting stents (PES, n = 10) subgroups (2.74% vs. 20.00%, P > 0.05).</p><p><b>CONCLUSIONS</b>This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.</p>

Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention (PCI) with prior ischemic stroke.</p><p><b>METHODS</b>A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009. End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up.</p><p><b>RESULTS</b>There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke. Compared patients without prior ischemic stroke, patients with prior ischemic stroke were older (P = 0.000), had higher hypertension morbidity (P = 0.000), higher diabetes mellitus morbidity (P = 0.005), higher incidence of multi-vessels disease (P = 0.000). During the follow-up of (35.0 ± 19.6) months, cardiac death rate (8.5% vs. 3.9%, P = 0.002) and re-cerebral infarction rate (5.8% vs. 1.4%, P = 0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. Dual antiplatelet therapy treatment time [(13.77 ± 11.33) months vs. (13.94 ± 11.33) months, P = 0.986] and major bleeding events (5.8% vs. 3.6%, P = 0.100) were similar between the two groups and cerebral hemorrhage rate (1.8% vs. 0.5%, P = 0.028) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke.</p><p><b>CONCLUSION</b>Patients with prior ischemic stroke were associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.</p>

Clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease.</p><p><b>METHOD</b>Fifteen patients (11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed.</p><p><b>RESULTS</b>There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39.3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32.4 ± 8.1) years vs. (47.0 ± 10.2) years], had less risk factors for atherosclerosis (1.2 ± 1.5 to 2.8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 - 7 years (average 1.6 years) to 3 - 30 years (average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by echocardiography was less than 50% in 8 patients.</p><p><b>CONCLUSION</b>Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.</p>

Analysis on the correlation between SF-36 and QOL-35 in patients and coronary artery disease / 中华流行病学杂志

Objective To analyze the correlation between SF-36 and QOL-35 and the consistency of the two kinds of life-quality questionnaires when evaluating the quality of life in patients with coronary heart disease. Methods 781 in-hospital-patients, who underwent coronary angiography from June 2008 to April 2009, were included in this study. Quality of life was measured by the Chinese versions of SF-36 and QOL-35. Demographic and clinical information were collected.Correlation Analysis was done between SF-36 and QOL-35 in the patients with coronary artery disease. Results The total score of SF-36 was 62.63 ± 12.47 and the QOL-35 total score was 62.70 ± 9.69. Data from the simple correlation analysis showed that SF-36 and QOL-35 total scores (r=0.725, P＜0.01 ), SF-36 physical functioning and QOL-35 independent living capacity (r=0.933, P＜0.01), SF-36 mental health and QOL-35 mental health (r=0.132, P＜0.01), SF-36 social function and QOL-35 social function score (r=0.215, P＜0.01 ) were all relevant. Canonical correlation analysis showed that there was significant correlation between SF-36 and QOL-35 (r=0.946, P＜0.01 ). Conclusion SF-36 and QOL-35 were consistent in the evaluation on the quality of life, at the overall level.

Covariance analysis on the change of quality of life affected by percutaneous coronary intervention for patients with coronary heart disease / 中华流行病学杂志

Objective To compare changes of quality of life at 3 months from baseline among patients who underwent and did not undergo percutaneous coronary intervention (PCI). Methods Sixty one patients with coronary artery disease, who were hospitalized in Cardiology Department in March 2008, were followed-up for 3 months after being discharged. SF-36 and QOL-35 were administered before PCI and at 3 months. Patients were divided into 2 groups according to whether they underwent PCI. Changes of quality of life scores between PCI and non-PCI groups were compared using analysis of covariance. Results There were 24 cases in non-PCI group and 37 in PCI group. Baseline characteristics were well balanced between PCI and non-PCI groups except gender (67.6% vs. 28.6% for male, P=0.005) , history of angina (56.8% vs. 23.8% , P=0.015) , smoking history(51.4% vs.23.8%,P=0.037) and Judkins classification of coronary artery(P=0.001). Multivariate analysis of covariance showed that the change of life quality between non-PCI group and PCI group in 3-months after discharge had statistical differences in total scores(P=0.044) and mental health scores (P=0.003) of SF-36, total scores (P=0.039) and social function scores (P=0.007) of QOL-35. Conclusion PCI can improve life quality in patients with coronary artery disease.

Clinical and coronary characteristics of young patients (< 30 years old) with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and angiographic features of acute myocardial infarction in patients aged 30 years or younger.</p><p><b>METHODS</b>Data of 360 consecutive patients referred to Peking Union Medical College Hospital for evaluation of chest pain or discomfort from January 2007 to December 2009, diagnosed as acute myocardial infarction and underwent emergent coronary angiography were analyzed. Seven patients (1.9%) with age ≤ 30 years [4 male, (25 ± 5) years] were included in this study, patients were followed up for (12 ± 9) months.</p><p><b>RESULTS</b>There were 6 cases of ST-segment elevated myocardial infarction and 1 non-ST-segment elevated myocardial infarction. The culprit vessels were as follows: 5 left anterior descending artery, 1 left main and 1 right coronary artery. All 3 female patients were complicated with congenital coronary malformation or autoimmune disease, including 1 coronary artery aneurismal dilation of left anterior descending, 1 Takayasu's arteritis and 1 systemic lupus erythematosus. Three of the 4 male patients were smokers. Two patients underwent percutaneous coronary intervention. There was no death or cardiovascular re-admission during the follow-up.</p><p><b>CONCLUSIONS</b>The majority of acute myocardial infarction in patients aged 30 years or younger were presented with ST-segment elevated myocardial infarction and single vessel non-obstructive lesion. The most common culprit vessel was left anterior descending artery. All female patients were complicated with congenital coronary malformation or autoimmune disease. The short-term prognosis in patients of this cohort was good.</p>

Factors associated with reduced renal function post primary percutaneous coronary intervention in acute myocardial infarction patients with normal baseline serum creatinine level / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze factors associated with reduced renal function post primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients with normal baseline serum creatinine level.</p><p><b>METHOD</b>The clinical and angiographic data of 216 consecutive AMI patients undergoing primary PCI with normal baseline serum creatinine level (< 1.5 mg/dl) were obtained and compared between patients with (n = 32) and without (n = 184) renal function deterioration (increase in serum creatinine > or = 25% from baseline level within 72 hours of primary PCI) post PCI.</p><p><b>RESULTS</b>The incidence of renal function deterioration was 14.8% (32/216). Patients with age > 75 years (28.1% vs. 14.1%, P = 0.047), congestive heart failure (25.0% vs. 9.2%, P = 0.017), less use of low-molecular weight heparins (84.4% vs. 95.1%, P = 0.039) and beta-blockers (75.0% vs. 95.6%, P = 0.001) as well as angiotensin converting enzyme inhibitors/angiotensin receptor blockers (81.3% vs. 93.5%, P = 0.025) and statins (84.4% vs. 97.3%, P = 0.008) were risk factors for developing renal dysfunction post PCI. Renal function deterioration post PCI was also associated with increased in-hospital mortality (25.0% vs. 2.2%, P < 0.001). Multivariate analysis showed that congestive heart failure was the single independent predictor of renal function deterioration (odds ratio = 3.275, 95% confidence interval 1.275 - 8.408, P = 0.014), while renal function deterioration was the strongest independent predictor of in-hospital death (odds ratio = 10.313, 95% confidence interval 2.569 - 41.402, P = 0.001).</p><p><b>CONCLUSION</b>Renal function deterioration is a common complication post primary PCI and is associated with higher risk of in-hospital death in AMI patients with normal baseline serum creatinine level.</p>

Early ST resolution after successful primary PCI is related to a favorable outcome in ST elevated AMI patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the relationship between the early ST resolution magnitude and TIMI flow, MACE and the cardiac function in ST elevated AMI (STEMI) patients after successful primary PCI.</p><p><b>METHODS</b>A total of 120 consecutive patients with STEMI underwent primary PCI within 12 hours after the onset of chest pain were enrolled in this study, the ST segment resolution was calculated and the patients were divided into group A (n = 81, Sigma STE resolved > or = 50%) and group B (n = 39, Sigma STE resolved < 50%). TIMI flow after PCI, clinical events up to 30 days post PCI and cardiac function 30 days post PCI were assessed.</p><p><b>RESULTS</b>LVEF was higher in group A than that of group B (58.6% +/- 7.1% vs. 50.5% +/- 7.1%, P < 0.05). There are fewer patients with Killip III and IV in group A than in group B (1.2% vs. 12.8%, P < 0.05). The incidence of in-hospital MACE was also significantly less in group A than in group B (0 vs. 7.7%, P < 0.001). As expected, there were more patients with TIMI 3 flow (95.1% vs. 79.5%, P < 0.05) and fewer TIMI 2 (4.9% vs. 20.5%, P < 0.05) flow post PCI in group A than in group B and all 3 patients with MACE were group B patients with TIMI 2 flow.</p><p><b>CONCLUSION</b>Early ST resolution post PCI represents improved myocardial perfusion and function and is related to a favorable clinical outcome in STEMI patients.</p>

Clinical significance of adenosine 99mTc-MIBI myocardial perfusion single photon emission computed tomography for patients in percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical significance of adenosine (99m)Tc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) for percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>Coronary angiography and adenosine (99m)Tc-MIBI myocardial perfusion SPECT were performed for all patients. Adenosine myocardial perfusion was performed after PCI. Adenosine was infused intravenously at a rate of 140 microg.kg(-1).min(-1) for 6 minutes, and 925MBq (99m)Tc-MIBI was injected intravenously at 3 minutes after adenosine infusion. SPECT myocardial imaging acquisition was obtained in 1.5 hours after adenosine infusion. If the result was abnormal, rest (99m)Tc-MIBI myocardial perfusion SPECT would be performed next day. There were 17 segments of left ventricle, and four degrees of myocardial perfusion.</p><p><b>RESULTS</b>There were 63 cases (63 +/- 10 years old) with CAD, in which 40 patients got PCI. Twenty eight cases after PCI.</p><p><b>CONCLUSION</b>Adenosine myocardial perfusion imaging will be useful in detecting regional myocardial perfusion abnormalities for patients with PCI.</p>