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Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome:five-year results from a large cohort study

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World Journal of Emergency Medicine 2023年第1期14卷 25-30页

作者： Jing-jing Xu Si-da Jia Lin Jiang Ying Song Pei Zhu De-shan Yuan Yi Yao Xue-yan Zhao Jian-xin Li Yue-jin Yang shu-bin qiao Bo Xu Run-lin Gao Jin-qing Yuan Department of Cardiology Fuwai Hospital and Cardiovascular InstituteNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

BACKGROUND:To investigate the most appropriate dual antiplatelet therapy(DAPT)duration for patients with acute coronary syndrome(ACS)after drug-eluting stent(DES)implantation in the largest cardiovascular center of China.METHODS:We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013.Patients were divided into four groups based on DAPT duration:standard DAPT group(11-13 months,n=1,568)and prolonged DAPT groups(13-18 months[n=308],18-24 months[n=2,125],and>24 months[n=1,186]).Baseline characteristics and 5-year clinical outcomes were recorded.RESULTS:Baseline characteristics were similar across the four groups.Among the four groups,those with prolonged DAPT(18-24 months)had the lowest incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)(14.1%vs.11.7%vs.9.6%vs.24.2%,P<0.001),all-cause death(4.8%vs.3.9%vs.2.1%vs.2.6%,P<0.001),cardiac death(3.1%vs.2.6%vs.1.4%vs.1.9%,P=0.004),and myocardial infarction(MI)(3.8%vs.4.2%vs.2.5%vs.5.8%,P<0.001).The incidence of bleeding was not different among the four groups(9.9%vs.9.4%vs.11.0%vs.9.4%,P=0.449).Cox multivariable analysis showed that prolonged DAPT(18-24 months)was an independent protective factor for MACCEs(hazard ratio[HR]0.802,95%confidence interval[CI]0.729-0.882,P<0.001),all-cause death(HR 0.660,95%CI 0.547-0.795,P<0.001),cardiac death(HR 0.663,95%CI 0.526-0.835,P<0.001),MI(HR 0.796,95%CI 0.662-0.957,P=0.015),and target vessel revascularization(HR 0.867,95%CI 0.755-0.996,P=0.044).Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs.CONCLUSION:For patients with ACS after DES,appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk.

关键词： Dual antiplatelet therapy Acute coronary syndrome Drug-eluting stent implantation

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Impacts of smoking status on the clinical outcomes of coronary non-target lesions in patients with coronary heart disease:a single-center angiographic study

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Chinese Medical Journal 2020年第19期133卷 2295-2301页

作者： Hao-Bo Xu Juan Wang Ji-Lin Chen Chao Guo Jian-Song Yuan Xin Duan Feng-Huan Hu Wei-Xian Yang Xiao-Liang Luo Rong Liu Jin-Gang Cui Sheng-Wen Liu Xiao-Jin Gao Yu-Shi Chun shu-bin qiao Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical SciencesBeijing 100037China

Background:Coronary atherosclerotic plaque could go through rapid progression and induce adverse cardiac events.This study aimed to evaluate the impacts of smoking status on clinical outcomes of coronary non-target lesions.Methods:Consecutive patients with coronary heart disease who underwent two serial coronary angiographies were included.All coronary non-target lesions were recorded at first coronary angiography and analyzed using quantitative coronary angiography at both procedures.Patients were grouped into non-smokers,quitters,and smokers according to their smoking status.Clinical outcomes including rapid lesion progression,lesion re-vascularization,and myocardial infarction were recorded at second coronary angiography.Multivariable Cox regression analysis was used to investigate the association between smoking status and clinical outcomes.Results:A total of 1255 patients and 1670 lesions were included.Smokers were younger and more likely to be male compared with nonsmokers.Increase in percent diameter stenosis was significantly lower(2.7[0.6,7.1]%vs.3.5[0.9,8.9]%)and 3.4[1.1,7.7]%,P=0.020)in quitters than those in smokers and non-smokers.Quitters tended to have a decreased incidence of rapid lesions progression(15.8%[76/482]vs.21.6%[74/342]and 20.6%[89/431],P=0.062),lesion re-vascularization(13.1%[63/482]vs.15.5%[53/432]and 15.5%[67/431],P=0.448),lesion-related myocardial infarction(0.8%[4/482]vs.2.6%[9/342]and 1.4%[6/431],P=0.110)and all-cause myocardial infarction(1.9%[9/482]vs.4.1%[14/342]and 2.3%[10/431],P=0.128)compared with smokers and non-smokers.In multivariable analysis,smoking status was not an independent predictor for rapid lesion progression,lesion re-vascularization,and lesion-related myocardial infarction except that a higher risk of all-cause myocardial infarction was observed in smokers than non-smokers(hazards ratio:3.00,95%confidence interval:1.04-8.62,P=0.042).Conclusion:Smoking cessation mitigates the increase in percent diameter stenosis of coronary non-target lesions,meanwhile,smoker

关键词： Smoking status Coronary non-target lesion Rapid progression Re-vascularization Myocardial infarction

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Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

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Chinese Medical Journal 2015年第6期128卷 774-779页

作者： Xiao-Fang Tang Ya-Ling Han Jia-Hui Zhang Jing Wang Yin Zhang Bo Xu Zhan Gao shu-bin qiao Jue Chen Yuan Wu Ji-Lin Chen Run-Lin Gao Yue-Jin Yang Jin-Qing Yuan Department of Cardiology State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Centre for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Department of Cardiology Institute of Cardiovascular Research of People's Liberation Army Shenyang Northern Hospital Shenyang Liaoning 110840 China Department of Cardiology Centre for Coronary Heart Disease State Key Laboratory of Cardiovascular DiseaseFuwai Hospita/i National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background:Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy.This study was to compare two tests,light transmittance aggregometry (LTA) and modified thrombelastography (mTEG),for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention (PCI).Methods:Prospective,observational,single-center study of 789 Chinese patients undergoing PCI was enrolled.This study was investigated the correlations between the two tests and performed receiver operating characteristic curve (ROC) analysis for major adverse cardiovascular events (MACEs) at 1-year follow-up.Results:MACEs occurred in 32 patients (4.1％).Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity (Spearman r =0.733,P ＜ 0.001).ROC-curve analysis demonstrated that LTA (area under the curve [AUC]:0.677; 95％ confidence interval [CI]:0.643-0.710; P =0.0009),and mTEG (AUC:0.684; 95％ CI:0.650-0.716; P =0.0001) had moderate ability to discriminate between patients with and without MACE.MACE occurred more frequently in patients with high on-treatment platelet reactivity (HPR) when assessed by LTA (7.4％ vs.2.7％; P ＜ 0.001),and by TEG (6.7％ vs.2.6％; P ＜ 0.001).Kaplan-Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up.Conclusions:The correlation between LTA and mTEG is relatively high in Chinese patients.HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.

关键词： Clopidogrel High On-treatment Platelet Reactivity Light Transmittance Aggregometry Thrombelastography

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氧化钽催化葡萄糖制备乳酸

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现代化工 2019年第8期39卷 162-165页

作者：余开荣庄军平朱俏俏刘颖武书彬华南理工大学制浆造纸国家重点实验室

将Ta2O5作为催化剂用于葡萄糖制备乳酸,结果发现Ta2O5的催化效果比较优异。利用SEM对Ta2O5进行表征,结果表明,Ta2O5表面由许多球状颗粒堆砌形成,颗粒尺寸为200~300 nm。此外,利用正交实验分析不同反应条件对催化效果的影响程度,实验证... 详细信息

将Ta2O5作为催化剂用于葡萄糖制备乳酸,结果发现Ta2O5的催化效果比较优异。利用SEM对Ta2O5进行表征,结果表明,Ta2O5表面由许多球状颗粒堆砌形成,颗粒尺寸为200~300 nm。此外,利用正交实验分析不同反应条件对催化效果的影响程度,实验证明反应温度>底物质量浓度>反应时间>催化剂质量。最后考察了催化剂重复使用性能和不同反应条件对于催化效果的影响,结果表明,反应温度为190℃、反应时间为4 h、底物质量浓度为6 g/L、催化剂质量为0. 06 g时,催化效果最佳,葡萄糖转化率达到92. 3%,乳酸得率达到71. 9%。催化剂经重复使用5次后,乳酸得率仍有46. 7%。

关键词：葡萄糖乳酸氧化钽

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A Comparison of the Transradial and Transfemoral Approaches for the Angiography and Intervention in Patients with a History of Coronary Artery Bypass Surgery： In-hospital and 1-year Follow-up Results

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Chinese Medical Journal 2015年第6期128卷 762-767页

作者： Pei-Yuan He Yue-Jin Yang shu-bin qiao Bo Xu Min Yao Yong-Jian Wu Jin-Qing Yuan Jue Chen Hai-Bo Liu Jun Dai Xin-Ran Tang Yang Wang Wei Li Run-Lin Gao Department of Cardiology Cardiovascular Institute and Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beiiinq 100037 China Medical Research and Biometrics Center Cardiovascular Institute and Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background:Percutaneous coronary intervention (PCI) through transradial approach (TRA) has shown to be safe and effective as transfemoral approach (TFA) among unselected patients.However,very few studies have compared the outcomes between TRA and TFA specifically in patients with a history of coronary artery bypass grafting surgery (CABG).Methods:A total of 404 post-CABG patients who had undergone angiography or PCI were included in the study.The primary endpoint was defined as angiographic success and procedure success.The secondary endpoint was defined as in-hospital net adverse clinical events (NACEs),which included all cause of death,myocardial infarction (MI),stroke,repeat revascularization,and major bleeding.Patients were followed-up for 1-year.Major adverse cardiovascular events (MACEs),which included death,MI,and repeat revascularization,at 1-year follow-up were also compared.Results:The angiographic success was reached by 97.4％ in the TRA group compared with 100％ in the TFA group (P =0.02).The procedure success was achieved in 99.1％ in the TRA group and 97.9％ in the TFA group (P =0.68).The incidence rates of in-hospital NACE (2.7％ vs.2.7％,P =1.00) and 1-year MACE (11.5％ vs.12.0％,P =0.88) were similar between TRA and TFA.Meanwhile,TRA was associated with a lower rate of Bleeding Academic Research Consortium ≥2 bleeding (P =0.02).In patients undergoing graft PCI,the procedure success was similar between TRA and TFA (100.0％ vs.98.7％,P =1.00).The procedure time (25.0 min vs.27.5 min,P =0.53) was also similar.No significant difference was detected between TRA and TFA in terms of in-hospital NACE (0 vs.0,P =1.00)and 1-year MACE (21.4％ vs.10.3％,P =0.19).Conclusions:Compared with TFA,TRA had lower angiographic success but had a similar procedure success in post-CABG patients.TRA was also associated with decreased bleeding and shortened hospital stay.

关键词： Coronary Angioplasty Coronary Artery Bypass Surgery Transfemoral Transradial

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Sirolimus-eluting cobalt-chromium stents： two-year dinical results from first-in-man study on the Firebird 2^TM stent

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Chinese Medical Journal 2008年第6期121卷 492-497页

作者： XU Bo ZHANG Qi YANG Yue-jin qiao shu-bin ZHANG Rui-yan ZHANG Jian-sheng HU Jian QIN Xue-wen HONG Tao LI Jian-ping CHEN Ji-lin HUO Yong GAO Run-lin SHEN Wei-feng Department of Cardiology Cardiovascular Institute and FuwalHospital Chinese Academy of Medical Sciences and Peking UnionMedical College Beijing 100037 China Department of Cardiology Ruijin Hospital Shanghai Jiao TongUniversity School of Medicine Shanghai 200025 China Department of Cardiology Peking University First HospitalBeijing 100034 China

Background Drug-eluting stents （DES） have been shown to significantly reduce clinical events and angiographic restenosis in the treatment of coronary artery disease （CAD）. This study was conducted to assess the long-term efficacy and safety of the polymer-based sirolimus-eluting cobalt-chromium Firebird 2TM stents in the treatment of patients with CAD. Methods This first-in-man study using the Firebird 2TM stent is a prospective, historically-controlled multicenter clinical study, which enrolled 67 patients with CAD who were treated with the sirolimus-eluting cobalt-chromium stent （Firebird 2TM, Microport Shanghai, Firebird 2 group）, compared to another 49 patients treated with a bare cobalt alloy stent （Driver, Medtronic, control group）. Continued 2-year clinical follow-up was performed after getting the initial 6-month angiographic and 1-year clinical follow-up. The incidence of major adverse cardiac events （MACE） including cardiac death, reinfarction and target lesion revascularization （TLR） and stent thrombosis were compared between the two groups. Results All patients in the Firebird 2 group （100.0%） and 48 patients in the control group （98.0%） completed the 2-year clinical follow-up. At the 1-year follow-up the use of the Firebird 2 stent was highly effective, resulting in a significant 94% decrease of TLR （26.5% in the control group and 1.5% in the Firebird 2 group, P〈0.0001）. A significant difference in TLR was maintained at 2-year follow-up, Firebird 2 group 1.5% and the control group 31.3% （P〈0.0001）. Between 1- and 2-year post-stenting, no more TLR occurred in the Firebird 2 group compared with two cases in the control group （P〉0.05）. There was a 1.5% incidence of MACE at 1- and 2-year follow-up in the Firebird 2 group, compared with 26.5% and 33.3% in the control group, respectively （all P〈0.0001）. The cumulative 1- and 2-year MACE free survival rates were 98.5% in the Firebird 2 group vs 73.5% and 66.7% in the control group （log rank P〈0.0001）. No case of stent thrombosis occurred during 2-year follo

关键词： trug-eluting stents Firebird 2 stent coronary artery disease clinical outcome

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基于AHP与TRIZ的馒头机生产线设计

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食品与机械 2021年第11期37卷 81-86页

作者：付晓莉许桥杨树峰张斌中原工学院河南郑州451191

目的:采用层次分析法(AHP)与发明问题解决理论(TRIZ)结合的模糊评价方法解决馒头机生产线主要存在的人机交互程度低、造型审美不足、缺乏设计特色等问题。方法:利用AHP获取定位设计重点区域;运用TRIZ标准工程参数分析矛盾冲突并构建矛... 详细信息

目的:采用层次分析法(AHP)与发明问题解决理论(TRIZ)结合的模糊评价方法解决馒头机生产线主要存在的人机交互程度低、造型审美不足、缺乏设计特色等问题。方法:利用AHP获取定位设计重点区域;运用TRIZ标准工程参数分析矛盾冲突并构建矛盾矩阵,利用发明原理找寻设计方案最优解并引入物—场分析法解决馒头机生产线具体实际问题,运用模糊评价法对3个馒头机造型设计方案进行评分。结果:设备造型以直线、圆角和斜角为元素的A3为优选方案。结论:该方法可解决馒头机生产线设计中定性数据与定量参数的转换问题。

关键词：馒头机生产线造型设计 AHP TRIZ 模糊评价法

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Spinal Cord Stimulation Enhances Microglial Activation in the Spinal Cord of Nerve-Injured Rats

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Neuroscience Bulletin 2020年第12期36卷 1441-1453页

作者： bin shu Shao-Qiu He Yun Guan Department of Anesthesiology and Critical Care Medicine School of MedicineJohns Hopkins UniversityBaltimoreMD 21205USA Present Address:Department of Anesthesiology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Neurological Surgery School of MedicineJohns Hopkins UniversityBaltimoreMD 21205USA

Microglia can modulate spinal nociceptive transmission.Yet,their role in spinal cord stimulation(SCS)-induced pain inhibition is unclear.Here,we examined how SCS affects microglial activation in the lumbar cord of rats with chronic constriction injury(CCI)of the sciatic nerve.Male rats received conventional SCS(50 Hz,80%motor threshold,180 min,2 sessions/day)or sham stimulation on days 18-20 post-CCI.SCS transiently attenuated the mechanical hypersensitivity in the ipsilateral hind paw and increased OX-42 immunoreactivity in the bilateral dorsal horns.SCS also upregulated the mRNAs of Ml-like markers,but not M2-like markers.Inducible NOS protein expression was increased,but brain-derived neurotrophic factor was decreased after SCS.Intrathecal minocycline(1μg-100μg),which inhibits microglial activation,dosedependently attenuated the mechanical hypersensitivity.Pretreatment with low-dose minocycline(1μg,30 min)prolonged the SCS-induced pain inhibition.These findings suggest that conventional SCS may paradoxically increase spinal M1-like microglial activity and thereby compromise its own ability to inhibit pain.

关键词： Spinal cord stimulation Microglia Neuropathic pain Spinal cord Rat

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Impact of depressed left ventricular function on outcomes in patients with three-vessel coronary disease undergoing percutaneous coronary intervention

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Chinese Medical Journal 2013年第4期126卷 609-614页

作者： GAO Zhan XU Bo Ajay J. Kirtane YANG Yue-jin YUAN Jin-qing CHEN Ji-lin qiao shu-bin WU Yong-jian QIN Xue-wen YAN Hong-bin YAO Min LIU Hai-bo CHEN Jue YOU Shi-jie GAO Run-lin Cardiovascular Institute & Fu Wai Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing100037 China

Background Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction （LVEF） represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population. Methods Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF 〈40% （low ejection fraction （EF）） and 4144 patients had LVEF _〉40%. In-hospital and long-term outcomes were examined according to LVEF. Results The estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group （19.64% vs. 8.73%, Log-rank test： P 〈0.01; 10.30% vs. 1.33%, Log-rank test： P 〈0.01, and 10.32% vs. 2.28%, Log-rank test： P 〈0.01 respectively）, but there was no difference in the rates of target vessel revascularization （6.18% vs. 6.11%, Log-rank test： P=0.96）. Using the Cox proportional hazard models, LVEF 〈40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events （OR （95% CI）： 4.779 （2.369-9.637）, 2.673 （1.353-5.282）, and 1.827 （1.187-2.813） respectively）, but was not a statistically significant risk factor for target vessel revascularization （OR （95% CI）： 1.094 （0.558-2.147））. Conclusion Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.

关键词： three-vessel coronary disease left ventricular dysfunction percutaneous coronary intervention

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Sirolimus-eluting stents for treatment of drug-eluting versus bare-metal stents restenosis： 42-month clinical outcomes from a Chinese single center

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Chinese Medical Journal 2012年第19期125卷 3398-3403页

作者： YAN Rong-qiang CHEN Ji-lin GAO Li-jian YANG Yue-jin LI Jian-jun qiao shu-bin XU Bo YAO Min QIN Xue-wen LIU Hai-bo WU Yong-jian YUAN Jin-qing CHEN Jue YOU Shi-jie DAI Jun GAO Run-lin State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Background Restenosis of bare-metal stents （BMS） and drug-eluting stents （DES） has been increasingly treated with sirolimus-eluting stents （SES）, but the long-term outcomes are unknown. Methods In our study, 388 consecutive patients （144 DES restenosis and 244 BMS restenosis） with 400 lesions （147 DES restenosis and 253 BMS restenosis） treated with SES were included. The rates of target lesion revascularization （TLR） and major adverse cardiac events （MACE） at 42 months were analyzed. Results At the mean follow-up of 42 months, the rates of death （3.5% vs. 3.3%, P=1.000） and myocardial infarction （2.8% vs. 1.2%, P=0.431） in the DES group and BMS group were comparable. Compared with the BMS group, ischemia-driven TLR occurred with a higher frequency in the DES group （18.8% vs.10.7%, P=0.024）. This translated into an increased rate of MACE in the DES group （22.2% vs. 14.0%, P=0.034）. Stent thrombosis occurred with a similar frequency in both groups （2.8% vs. 1.6%, P=0.475）. Multivariate analysis showed that DES restenosis （OR=1.907, 95% Cl 1.108-3.285, P=0.020） and smoking （OR=2.069; 95% Cl 1.188-3.605; P=0.010） were independent predictors of MACE.

关键词： restenosis percutaneous coronary intervention drug-eluting stents

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