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Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China

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Journal of Geriatric Cardiology 2019年第10期16卷 741-748页

作者： Yong-Gang SUI Si-Yong TENG Jie QIAN Yuan WU Ke-Fei DOU Yi-Da TANG Shu-Bin QIAO Yong-Jian WU Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College

Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.

关键词： Conservative strategy Death Invasive strategy Non-ST-segment elevation myocardial infarction

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Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to ST-segment elevation on electrocardiogram: an analysis of China Acute Myocardial Infarction (CAMI) registry

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Chinese Medical Journal 2019年第5期132卷 519-524页

作者： Rui Fu Chen-Xi Song Ke-Fei DOU Jin-Gang Yang Hai-Yan Xu Xiao-Jin Gao Qian-Qian Liu Han Xu Yue-Jin Yang Department of Cardiology Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

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 Pkely 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.

关键词： Non-ST segment elevation myocardial infarction Symptom assessment Time to treatment

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Development and validation of a model integrating clinical and coronary lesion-based functional assessment for longterm risk prediction in PCI patients

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Journal of Geriatric Cardiology 2024年第1期21卷 44-63页

作者： Shao-Yu WU Rui ZHANG Sheng YUAN Zhong-Xing CAI Chang-Dong GUAN Tong-Qiang ZOU Li-Hua XIE Ke-Fei DOU State key Laboratory of Cardiovascular Disease BeijingChina Cardiometabolic Medicine Center Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Catheterization Laboratories Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Cardiology Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort.RESULTS In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration(Hosmer–Lemeshow χ^(2)= 7.070;P = 0.529) for predicting 2-year patient-oriented composite endpoint(POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P < 0.01) after stratified the patients into high-risk group and low-risk group.CONCLUSIONS An improved scoring system combining clinical and coronary lesion-based functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological

关键词： patients coronary prediction

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Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions

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Journal of Geriatric Cardiology 2017年第1期14卷 35-41页

作者： Dong YIN Jia LI Yue-Jin YANG Yang WANG Yan-Yan ZHAO Shi-Jie YOU Shu-Bin QIAO Bo XU Ke-Fei DOU State key Laboratory of Cardiovascular Disease Department of Cardiology Cardiovascular Institute Fuwai Hospital and National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China

sTo 与大冠的 vessels.MethodsFrom 2004年4月为病人与赤裸金属的 stents ( BMS )相比评估 drug-eluting stents ( DES )的长期的安全和有效性到2006年10月， 2407 个连续病人经历 de novo 损害有比大或等于在在中国北京的 Fu Wai ... 详细信息

sTo 与大冠的 vessels.MethodsFrom 2004年4月为病人与赤裸金属的 stents ( BMS )相比评估 drug-eluting stents ( DES )的长期的安全和有效性到2006年10月， 2407 个连续病人经历 de novo 损害有比大或等于在在中国北京的 Fu Wai 医院的 3.5 公里的参考容器直径的经皮的冠的干预，有希望地被注册进这研究。我们包括死亡，心肌的梗塞(MI ) ，血栓，目标损害 revascularization (TLR ) ，目标容器 revascularization (TVR ) ，和主要不利心脏的事件获得了 9 年的临床的结果(向，死亡， MI，和 TVR 合成) 。我们执行了艇长比例危险的模型在倾向 match.ResultsAfter 倾向得分以后估计所有结果措施的相对风险， 514 个对待 DES 的病人被匹配到 514 个对待 BMS 的病人。与 BMS 对待的病人与 TLR 的更高的风险被联系(HR：2.55， 95%CI：1.520-4.277， P = 0.0004 ) 并且 TVR (HR：1.889， 95%CI：1.185-3.011， P = 0.0075 ) ，但是 death/MI 和向的率不是统计上不同的。所有学术研究协会定义 stent 血栓在 9 年在二 groups.ConclusionsDuring 是可比较的整个九年的长期的后续，在有大冠的动脉的病人的 DES 的使用仍然在 TLR 和 TVR 的风险与重要减小被联系。

关键词：金属支架冠状动脉介入治疗临床疗效病变洗脱药物风险模型

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Effects of Nb Addition on Charpy Impact Properties of TiVTa Refractory High‑Entropy Alloy

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Acta Metallurgica Sinica(English Letters) 2023年第3期36卷 405-416页

作者： Xue Yin Yan‑Kun dou Xin‑Fu He ke Jin Cheng‑Long Wang Ya‑Guang Dong Cun‑Yong Wang Yun‑fei Xue Wen Yang Department of Reactor Engineering Technology Research China Institute of Atomic EnergyBeijing 102413China School of Materials Science and Engineering Beijing Institute of TechnologyBeijing 100081China Advance Research Institute of Multidisciplinary Science Beijing Institute of TechnologyBeijing 100081China

In the present study,the effects of Nb addition on Charpy impact properties of TiVTa refractory high-entropy alloy with high strength-ductility trade-off were systematically studied by using the instrumented Charpy impact testing machine.The experimental results showed that the impact toughness was remarkably improved by Nb addition in TiVTa to form TiVTaNb alloy.The crack initiation energy and propagation energy of TiVTaNb were 67.3%and 24.9%higher than that of TiVTa,indicating that Nb addition simultaneously reinforced the resistance to crack initiation and propagation.The impact fracture of TiVTaNb exhibited larger bending degree of shear lips,deeper dimples and more secondary cracks which effectively dissipated more impact energy.The deformation mechanism of TiVTa alloy was dominated by dislocation activities.While in TiVTaNb,the deformation mechanism was synergized by dislocation activities and deformation twinning,which were the main contributors for the improved impact properties and the stronger crack resistance of TiVTaNb alloy under impact loading.

关键词： Refractory high-entropy alloys Nb addition Impact property Crack resistance Deformation mechanism

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Feasibility and safety of robotic PCI in China: first in man experience in Asia

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Journal of Geriatric Cardiology 2019年第5期16卷 401-405页

作者： Ke-Fei DOU Chen-Xi SONG Chao-Wei MU Wei-Xian YANG Cheng-Gang ZHU Lei FENG Jue CHEN Lei SONG Yu NING Bo XU State key Laboratory of Cardiovascular Disease Department of Cardiology Cardiovascular Institute Fuwai Hospital and National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College

Objectives To evaluate the feasibility and safety of a second generation robotic percutaneous coronary intervention(R-PCI)system in China.Background Robotic PCI has been shown to be an effective method for conducting coronary interventions.It has further benefits of more accurate lesion measurement,improved stent deployment,reduced incidence of geographic miss and reduction of operator radiation exposure.Methods This single center evaluation enrolled 10 consecutive patients who had been selected for PCI.Clinical success was defined as residual stenosiskerma dose(1932±978 vs.1007±70 mGy,P=0.31).Conclusions Second generation robotic PCI was safe,effective and there were trends toward improvements in procedural efficiency during this early experience in China.

关键词： Angioplasty Percutaneous coronary intervention Robotic assist

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Comparison of outcomes for percutaneous coronary intervention in men and women with unprotected left main disease

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Journal of Geriatric Cardiology 2021年第3期18卷 168-174页

作者： Sheng-Wen LIU Chang-Dong GUAN Feng-Huan HU Jue CHEN Ke-Fei DOU Wei-Xian YANG Yong-Jian WU Yue-Jin YANG Bo XU Shu-Bin QIAO Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical SciencesBeijingChina Catheterization Laboratories Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical SciencesBeijingChina

BACKGROUND Percutaneous coronary intervention(PCI)in patients with unprotected left main coronary artery disease(ULMCAD)is increasing strategy in coronary artery patients.However,there is a lack of knowledge on the impact of sex on outcomes of patients undergoing ULMCAD PCI.METHODS From January 2004 to December 2015,there were 3,960 patients undergoing ULMCAD PCI at our institution,including 3,121(78.8%)men and 839(21.2%)women.The clinical outcome included the incidence of major adverse cardiac events(MACE)(the composite of all-cause death,myocardial infarction(MI),and revascularization),all-cause death,MI,revascularization at three years follow-up.RESULTS Compared with men,women had not significantly different MACE(14.7%vs.14.6%,P=0.89),all-cause death(3.5%vs.3.7%,P=0.76),MI(5.0%vs.4.3%,P=0.38),revascularization(9.1%vs.8.9%,P=0.86),respectively.After adjustment,rates of MACE(HR=1.49;95%CI:1.24−1.81;P<0.0001)and all-cause death(HR=1.65;95%CI:1.09−2.48;P=0.017)occurred more frequently in male patients,as well as revascularization(HR=1.46;95%CI:1.16−1.85;P=0.001).CONCLUSION In this analysis,compared to men,women undergoing ULMCAD PCI have better outcomes of MACE,allcause death,and revascularization.

关键词： coronary outcome patients

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Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China

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Chinese Medical Journal 2020年第1期133卷 1-8页

作者： Shen Lin Heng Zhang Chen-fei Rao Si-Peng Chen Shu-Bin Qiao Hong-Bing Yan Ke-Fei DOU Yong-Jian Wu Yi-Da Tang Xin-Chun Yang Zhu-Jun Shen Jian Liu Zhe Zheng National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Cardiovascular Surgery Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Information Center Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Cardiology Beijing Chao-Yang HospitalCapital Medical UniversityBeijing 100020China Department of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Cardiology Peking University People's HospitalBeijing 100044China.

Background:The Chinese appropriate use criteria(AUC)for coronary revascularization was released in 2016 to improve the use of coronary revascularization.This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease(CAD)patients.Methods:We conducted a prospective,multi-center cohort study of stable CAD patients with coronary lesion stenosis≥50%.After the classification of appropriateness based on Chinese AUC,patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received.The primary outcome was a composite of death,myocardial infarction,stroke,repeated revascularization,and ischemic symptoms with hospital admission.Results:From August 2016 to August 2017,6085 patients were consecutively enrolled.Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events(MACCEs;hazard ratio[HR]:0.62;95%confidence interval[CI]:0.45-0.86;P=0.004)than medical therapy in patients with appropriate indications(n=1617).No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications(n=2658,HR:0.81;95%CI:0.52-1.25;P=0.338)and inappropriate indications(n=1810,HR:0.80;95%CI:0.51-1.23;P=0.308).Conclusions:In patients with appropriate indications according to Chinese AUC,coronary revascularization was associated with significantly lower risk of MACCEs at 1 year.No benefit was found in coronary revascularization in patients with inappropriate indications.Our findings provide evidence for using Chinese AUC to guide clinical decision-making.

关键词： Stable coronary artery disease Appropriate use criteria Coronary revascularization

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Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness

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Chinese Medical Journal 2020年第11期133卷 1276-1284页

作者： Shen Lin Heng Zhang Si-Peng Chen Chen-fei Rao Fan Wu Fa-Jun Zhou Yun Wang Hong-Bing Yan Ke-Fei DOU Yong-Jian Wu Yi-Da Tang Li-Hua Xie Chang-Dong Guan Bo Xu Zhe Zheng National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100032China Department of Cardiovascular Surgery Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100032China Department of Information Center Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100032China Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100032China Department of Biostatistics Harvard T.H.Chan School of Public HealthBostonMAUSA Center for Outcomes Research and Evaluation Yale-New Haven HealthNew HavenCTUSA.

Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score is a comprehensive system to evaluate the complexity of the overall lesions.We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease(CAD).Methods::In this single-center,historical control study,patients with stable CAD with coronary lesion stenosis≥50%were consecutively recruited.During the control period,SYNTAX scores were calculated by treating cardiologists.During the intervention period,SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making.The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results::A total of 3245 patients were enrolled and assigned to the control group(08/2016-03/2017,n=1525)or the intervention group(03/2017-09/2017,n=1720).For SYNTAX score tertiles,17.9%patients were overestimated and 4.3%were underestimated by cardiologists in the control group.After adjustment,inappropriate revascularization significantly decreased in the intervention group compared with the control group(adjusted odds ratio[OR]:0.83;95%confidence interval[CI]:0.73-0.95;P=0.007).Both inappropriate percutaneous coronary intervention(adjusted OR:0.82;95%CI:0.74-0.92;P<0.001)and percutaneous coronary intervention utilization(adjusted OR:0.88;95%CI:0.79-0.98;P=0.016)decreased significantly in the intervention group.There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions::Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registratio

关键词： Real-time SYNTAX score Coronary revascularization Appropriate use criteria Quality improvement

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A novel phenotype with splicing mutation identified in a Chinese family with desminopathy

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Chinese Medical Journal 2019年第2期132卷 127-134页

作者： Peng Fan Chao-Xia Lu Xue-Qi Dong Di Zhu Kun-Qi Yang ke-Qiang Liu Di Zhang Ying Zhang Xu Meng Hui-Qiong Tan Li-Tian YU Ke-Fei DOU Ya-Xin Liu Xue Zhang Xian-Liang Zhou Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China McKusick-Zhang Center for Genetic Medicine State Key Laboratory of Medical Molecular BiologyInstitute of Basic Medical SciencesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100005China Emergency and Cdtical Care Center Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Background:Desminopathy, a hereditary myofibrillar myopathy, mainly results from the desmin gene (DES) mutations.Desminopathy involves various phenotypes, mainly including different cardiomyopathies, skeletal myopathy, and arrhythmia.Combined with genotype, it helps us precisely diagnose and treat for desminopathy.Methods:Sanger sequencing was used to characterize DES variation, and then a minigene assay was used to verify the effect of splice-site mutation on pre-mRNA splicing.Phenotypes were analyzed based on clinical characteristics associated with desminopathy.Results:A splicing mutation (c.735+1G>T) in DES was detected in the proband.A minigene assay revealed skipping of the whole exon 3 and transcription of abnormal pre-mRNA lacking 32 codons.Another affected family member who carried the identical mutation, was identified with a novel phenotype of desminopathy, non-compaction of ventricular myocardium.There were 2 different phenotypes varied in cardiomyopathy and skeletal myopathy among the 2 patients, but no significant correlation between genotype and phenotype was identified.Conclusions:We reported a novel phenotype with a splicing mutation in DES, enlarging the spectrum of phenotype in desminopathy.Molecular studies of desminopathy should promote our understanding of its pathogenesis and provide a precise molecular diagnosis of this disorder, facilitating clinical prevention and treatment at an early stage.

关键词： Desminopathy Cardiomyopathy Desmin gene Splicing mutation

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