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Discordance analysis for apolipoprotein and lipid measures for predicting myocardial infarction in statin-treated patients with coronary artery disease:a cohort study

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Journal of Geriatric Cardiology 2023年第12期20卷 845-854页

作者： Tian-Yu LI Pei ZHU Ying SONG Xiao-Fang TANG Zhan gao run-lin gao Jin-Qing YUAN National Clinical Research Center for Cardiovascular Diseases National Center for Cardiovascular DiseasesState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

BACKGROUND The optimal apolipoprotein or lipid measures for identifying statin-treated patients with coronary artery disease(CAD)at residual cardiovascular risk remain *** study aimed to compare the predictive powers of apolipoprotein B(apoB),non-high-density lipoprotein cholesterol(non-HDL-C),low-density lipoprotein cholesterol(LDL-C),apoB/apolipoprotein A-1(apoA-1)and non-HDL-C/HDL-C for myocardial infarction(MI)in CAD patients treated with statins in the setting of secondary *** The study included 9191 statin-treated CAD patients with a five-year median *** measures were anal-yzed as continuous variables and concordance/discordance groups by *** hazard ratio(HR)with 95%CI was estimated by Cox proportional hazards *** were classified by the clinical presentation of CAD for further *** The high-apoB-low-LDL-C and the high-non-HDL-C-low-LDL-C categories yielded HR of 1.40(95%CI:1.04–1.88)and 1.51(95%CI:1.07–2.13)for MI,respectively,whereas discordant high LDL-C with low apoB or non-HDL-C was not associa-ted with the risk of *** association of MI with discordant apoB versus non-HDL-C,apoB/apoA-1 versus apoB,non-HDL-C/HDL-C versus non-HDL-C,or apoB/apoA-1 versus non-HDL-C/HDL-C was *** patterns were found in patients with acute coronary *** contrast,no association was observed between any concordance/discordance category and the risk of MI in patients with chronic coronary *** ApoB and non-HDL-C better predict MI in statin-treated CAD patients than LDL-C,especially in patients with acute coronary ***/apoA-1 and non-HDL-C/HDL-C show no superiority to apoB and non-HDL-C for predict-ing MI.

关键词： patients coronary infarction

The Efficacy and Safety of Wenxin Keli in Patients with Frequent Premature Ventricular Contractions： A Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter Trial

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Chinese Medical Journal 2015年第19期128卷 2557-2564页

作者： Wei Hua run-lin gao Bu-Chang Zhao Jing Wang Xu-Hua Chen Chi Cai Shu Zhang The Cardiac Arrhythmia Center State Key Laboratory of Cardiovascular DiseaseFuwai 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 Xi'an Cardio-cerebral Vascular Disease HospitalXi'anShaanxi 710000China

Background：Premature ventricular contractions （PVCs） are common in the general population,and frequent PVCs may result in the poor quality of life or even the damage of cardiac *** examined the efficacy and safety of a traditional Chinese medicine Wenxin Keli for the treatment of frequent PVCs among a relatively large Chinese ***：We performed a randomized,double-blind,placebo-controlled,parallel-group,multicenter trial.A total of 1200 eligible participants were randomly assigned in a ratio of 1：1 to receive Wenxin Keli or the placebo for 4 *** primary and secondary endpoint was the change of PVC numbers and PVC-related symptoms after a 4-week treatment compared with baseline,*** addition,vital signs,laboratory values,and electrocardiographic parameters were assessed in a safety ***：At the initial evaluation,no significant differences in the baseline characteristics were observed between the Wenxin Keli group and the placebo group.A smaller number of PVCs was observed after the 4-week treatment than at baseline,in both the Wenxin Keli group （5686 ± 5940 vs.15,138 ± 7597 beats/d,P ＜ 0.001） and the placebo group （10,592 ± 8009 vs.14,529 ± 5929 beats/d,P ＜ 0.001）;moreover,the Wenxin Keli group demonstrated a significantly greater reduction in the frequency of PVCs than the placebo group （P ＜ 0.001）.In a full analysis set,patients in the Wenxin Keli group exhibited significantly higher total effective responses in the reduction of PVCs compared to those in the placebo group （83.8％ vs.43.5％,P ＜ 0.001）.The per-protocol analysis yielded similar results （83.0％ vs.39.3％,P ＜ 0.001）.Treatment with Wenxin Keli also demonstrated superior performance compared to the placebo with respect to PVC-related *** severe adverse effects attributable to Wenxin Keli were ***：Wenxin Keli treatment effectively reduced the overall number of PVCs and alleviated PVC-related symptoms in patients without structural heart dis

关键词： Wenxin Keli Premature Ventricular Contractions Efficacy Safety Clinical Trial

Impact of Proton-pump Inhibitors on the Pharmacodynamic Effect and Clinical Outcomes in Patients Receiving Dual Antiplatelet Therapy after Percutaneous Coronary Intervention： A Propensity Score Analysis

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Chinese Medical Journal 2017年第24期130卷 2899-2905页

作者： Pei Zhu Zhan gao Xiao-Fang Tang Jing-Jing Xu Yin Zhang Li-Jian gao Jue Chen Shu-Bin Qiao Yue-Jin Yang run-lin gao Bo Xu Jin-Qing Yuan Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China

Background：Prior studies have reported controversial conclusions regarding the risk of adverse cardiovascular events in patients using proton-pump inhibitors （PPIs） combined with clopidogrel therapy,causing much uncertainty in clinical *** sought to evaluate the safety of PPIs use among high-risk cardiovascular patients who underwent percutaneous coronary intervention （PCI） in a long-term follow-up ***：A total of 7868 consecutive patients who had undergone PCI and received dual antiplatelet therapy （DAPT） at a single center from January 2013 to December 2013 were *** diphosphate （ADP）-induced platelet aggregation inhibition was measured by modified thromboelastography （mTEG） in 5042 *** score matching （PSM） was applied to control differing baseline *** proportional hazards regression was used to evaluate the 2-year major adverse cardiovascular and cerebrovascular events （MACCEs）,as well as individual events,including all-cause death,myocardial infarction,unplanned target vessel revascularization,stent thrombosis,and ***：Among the whole cohort,27.2% were prescribed *** ADP-induced platelet aggregation inhibition by mTEG was significantly lower in PPI users than that in non-PPI users （42.0 ± 30.9% vs.46.4 ± 31.4%,t =4.435,P 〈 0.001）.Concomitant PPI use was not associated with increased MACCE through 2-year follow-up （12.7% vs.12.5%,x2 =0.086,P =0.769）.Other endpoints showed no significant differences after multivariate adjustment,regardless of ***：In this large cohort of real-world patients,the combination of PPIs with DAPT was not associated with increased risk of MACCE in patients who underwent PCI at up to 2 years of follow-up.

关键词： Clopidogrel Drug Interactions Percutaneous Coronary Intervention Proton-pump lnhibitors

Long-term Outcomes of Primary Percutaneous Coronary Intervention with Second-generation Drug-eluting Stents in ST-elevation Myocardial Infarction Patients Caused by Very Late Stent Thrombosis

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Chinese Medical Journal 2017年第8期130卷 929-935页

作者： Chen He Yuan-Liang Ma Chuang-Shi Wang lin Jiang Jia-Hui Zhang Yi Yao Xiao-FangTang Bo Xu run-lin gao Jin-Qing Yuan State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background： The ST-segment elevation myocardial inthrction （STEMI） patients due to stent thrombosis （ST） remain a therapeutic challenge for a clinician. Till date, very few researches have been conducted regarding the safety and effectiveness of primary percutaneous coronary intervention （PCI） with second-generation drug-eluting stents （DES） for STEMI caused by very late ST （VLST）. This retrospective study evaluated the safety, efficacy, and outcomes of primary PCI with second-generation DES for STEM1 due to VLST compared with primary PCI for STEM1 due to de novo lesion. Methods： Between January 2007 and December 2013, STEMI patients with primary PCI in Fuwai Hospital had only second-generation DES implanted for de novo lesion （558 patients） and VLST （50 patients） were included in this retrospective study. The primary end points included cardiac death and reinfarction. The secondary end points included cardiac death, reinfarction, and target lesion revascularization. Continuous variables were expressed as mean （standard deviation） or median （interquartile range） and compared by Student＇s t-test or Mann-Whitney U-test as appropriate. Categorical variables were expressed as counts and percentages, and comparison of these variables was performed with Chi-square or Fisher＇s exact test. A two-tailed value of P 〈 0.05 was considered statistically significant for all comparisons. Statistical analyses were performed by SAS software （version 9.4, SAS Institute Inc., Cary, USA） for Windows. Results： In-hospital primary end point and the secondary end point were no significant differences between two groups （P = 1.000 and P = 1.000, respectively）. No significant differences between two groups were observed according to the long-term primary end point and the secondary end point. Kaplan-Meier survival curves showed no significant difference between the two groups in the primary end point and the secondary end point at 2 years （P- 0.340 and P = 0,243, respectively）. According to

关键词： Primary Percutaneous Coronary Intervention Second-generation Drug-eluting Stents ST-elevation Myocardial Infarction Stent Thrombosis

Comparison of Efficacy and Safety between First and Second Generation Drug-eluting Stents in Patients with Stable Coronary Artery Disease： A Single-center Retrospective Study

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Chinese Medical Journal 2017年第14期130卷 1654-1661页

作者： Ru Liu Fei Xiong Yuan Wen Yuan-Liang Ma Yi Yao Zhan gao Bo Xu Yue-Jin Yang Shu-Bin Qiao run-lin gao Jin-Qing Yuan Department of Cardiology Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China Department of Physiology Colleges of Pharmacy and Medicine University of Kentucky Lexington KY 40536 USA

Background：Lots of trials demonstrate that second-generation drug-eluting stents （G2-DES）,with their improved properties,offer significantly superior efficacy and safety profiles compared to first generation DES （Gl-DES） for patients with coronary artery disease （CAD） receiving percutaneous coronary intervention （PCI）.This study aimed to verify the advantage of G2-DES over G1-DES in Chinese patients with stable CAD （SCAD）.Methods：For this retrospective observational analysis,2709 SCAD patients with either G1-DES （n =863） or G2-DES （n =1846） were enrolled consecutively throughout *** score matching （PSM） was applied to control differing baseline ***-year outcomes,including major adverse coronary events as well as individual events,including target vessel-related myocardial infarction,target lesion revascularization （TLR）,target vessel revascularization,and cardiogenic death were ***：The incidence of revascularization between G1-and G2-DES showed a trend of significant difference with a threshold P-value （8.6% vs.6.7%,x2 =2.995,P =0.084）.G2-DES significantly improved TLR-free survival compared to G1-DES （96.6% vs.97.9%,P =0.049） and revascularization-free survival curve showed a trend of improvement of G2-DES （92.0% vs.93.8%,P =0.082）.These difterences diminished after *** Cox proportional hazard regression analysis showed a trend for G 1-associated increase in revascularization （hazard ratio：1.28,95% confidence interval：0.95-1.72,P =0.099） while no significance was found after *** endpoints showed no significant differences after multivariate adjustment regardless of ***：G1-DES showed the same safety as G2-DES in this large Chinese cohort of real-world ***,G2-DES improved TLR-ffee survival of SCAD patients 2 years after *** advantage was influenced by baseline clinical ***-DES was associated with a trend of increase in revascularization risk and was not an independent predictor o

关键词： Drug-etuting Stents Percutaneous Coronary Intervention Stable Coronary Artery Disease

Effects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome

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World Journal of Emergency Medicine 2021年第1期12卷 36-41页

作者： Jing-jing Xu Ying Song Ping Jiang lin Jiang Xue-yan Zhao Zhan gao Jian-xin Li Shu-bin Qiao run-lin gao Yue-jin Yang Yin Zhang Bo Xu Jin-qing Yuan Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

BACKGROUND: We aim to investigate effects of metabolic syndrome on onset age and long-termoutcomes in patients with acute coronary syndrome (ACS).METHODS: Patients with ACS (n=6,431) who underwent percutaneous coronary interventionfrom January to December 2013 were enrolled. After excluding patients with previous coronary arterydisease, 1,558 patients were diagnosed with early-onset ACS (men aged ≤50 years;women aged≤60 years) and 3,044 patients with late-onset ACS. Baseline characteristics and five-year clinicaloutcomes were ***: Body mass index, triglyceride, low-density lipoprotein cholesterol, and uric acidconcentrations were significantly higher, while the high-density lipoprotein cholesterol (HDL-C)concentration was lower in the early-onset ACS group (P<0.001). Multivariate logistic regression revealedobesity (odds ratio [OR] 1.590, 95% confi dence interval [CI] 1.345–1.881), hypertriglyceridemia (OR 1.403,95% CI 1.185–1.660), and low HDL-C (OR 1.464, 95% CI 1.231–1.742) as independent risk factorsfor early-onset ACS (all P<0.001). The fi ve-year follow-up showed that the incidences of all cause death(1.5% vs. 3.8%, P<0.001), cardiac death (1.1% vs. 2.0%, P=0.023), and recurrent stroke (2.2% vs. 4.2%,P<0.001) were lower, while bleeding events were more frequent in the early-onset ACS group. A subgroupanalysis showed higher incidences of recurrent myocardial infarction (MI) and revascularization in patientswith early-onset ACS and metabolic ***: Obesity, hypertriglyceridemia, and lower HDL-C level are independent riskfactors for early-onset ACS, recurrent MI, and revascularization. The control of metabolic syndromemay reduce the incidence of early-onset ACS and improve the long-term prognosis.

关键词： Age Coronary artery disease Acute coronary syndrome Metabolic syndrome

Validation of Predictive Value of Patterns of Nonadherence to Antiplatelet Regimen in Stented Patients Thrombotic Risk Score in Chinese Population Undergoing Percutaneous Coronary Intervention:A Prospective Observational Study

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Chinese Medical Journal 2018年第22期131卷 2699-2704页

作者： Xue-Yan Zhao Jian-Xin Li Xiao-Fang Tang Jing-Jing Xu Ying Song lin Jiang Jue Chen Lei Song Li-Jian gao Zhan gao Shu-Bin Qiao Yue-Jin Yang run-lin gao Ro Xu Jin-Qing Yuan Coronary Heart Disease Center State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Epidemiology State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Background: The patterns of nonadherence to antiplatelet regimen in stented patients(PARIS) thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events(CTEs) after percutaneous coronary intervention(PCI) with drug?eluting ***, the prognostic value of this score has not been fully evaluated in non?Euro?American PCI ***: We performed a prospective, observational study of 10,724 patients who underwent PCI in Fuwai hospital, China and evaluated the PARIS thrombotic risk score’s predictive value of CTEs in the PCI population. The area under the receiver operating characteristic curve(AUROC) was used to assess the predictive value of the PARIS score for ***: Among 9782 patients without in?hospital events, a total of 95 CTEs occurred during the 2?year follow?up. The PARIS score was significantly higher in patients with CTEs(3.38 ± 2.04) compared with patients without events(2.53 ± 1.70, P < 0.001).According to the risk stratification of the PARIS thrombotic score, the risk of CTEs in the high?risk group was 3.14 times higher than that in the low?risk group(hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.92–5.13; P < 0.001). However, the risk of CTEs in the intermediate?risk and low?risk groups was not significant(HR, 1.39; 95% CI, [0.86–2.24]; P = 0.184). The PARIS score showed prognostic value in evaluating CTEs in the overall population(AUROC, 0.621; 95% CI, 0.561–0.681), the acute coronary syndrome(ACS) population(AUROC, 0.617; 95% CI, 0.534–0.700; P = 0.003), and the non?ACS population(AUROC, 0.647; 95%CI, 0.558–0.736; P = 0.001).Conclusions: In a real?world Chinese population, the PARIS thrombotic risk score shows a modest prognostic value for CTEs in patients after PCI. This score also has a predictive value for CTEs in the ACS and non?ACS subgroup populations.

关键词： Coronary Thrombosis Percutaneous Coronary Intervention Prognosis Risk Assessment

Evaluation of the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Bleeding Score for Predicting the Long-term Out-of-hospital Bleeding Risk in Chinese Patients after Percutaneous Coronary Intervention

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Chinese Medical Journal 2018年第12期131卷 1406-1411页

作者： Xue-Yan Zhao Jian-Xin Li Xiao-Fang Tang Jing-Jing Xu Ying Song lin Jiang Jue Chen Lei Song Li-Jian gao Zhan gao Shu-Bin Qiao Yue-Jin Yang run-lin gao Bo Xu Jin-Qing Yuan Department of Cardiology State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Department of Epidemiology State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background： The Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients （PARIS） bleeding score is a novel score for predicting the out-of-hospital bleeding risk after percutaneous coronary intervention （PCI）. However, whether this score has the same value in non-European and American populations is unclear. This study aimed to assess the PARIS bleeding score＇s predictive value of bleeding in patients alter PCI in the Chinese population. Methods： We perforined a prospective, observational study of 10,724 patients who underwent PCI from January to December 2013, in Fuwai Hospital, China. We defined the primary end point as major bleeding （MB） according to Bleeding Academic Research Consortium definition criteria including Type 2, 3, or 5. The predictive value of the PARIS bleeding score was assessed with the area under the receiver operating characteristic （AUROC） curve. Results： Of 9782 patients, 245 （2.50%） MB events occurred during the 2 years of follow-up. The PAP, IS bleeding score was significantly higher in the MB group than that of non-MB group （4.00 [3.00, 5.00] vs. 3.00 [2.00, 5.00], Z=3.71, P 〈 0.001 ）. According to risk stratification of the PARIS bleeding score, the bleeding risk in the intermediate- and high-risk groups was 1.50 times （hazard ratio [HR]： 1.50; 95% confidence interval [CI]： 1.160-1.950; P=0.002） and 2.27 times higher （HR： 2.27; 95% CI： 1,320-3.900： P=0.003） than that in the low-risk group. The PARIS bleeding score showed a moderate predictive value for MB in the overall population （AUROC： 0.568, 95% CI： 0.532-0.605; P 〈 0.001 ） and acute coronary syndrome （ACS） subgroup （AUROC： 0.578, 95% CI： 0.530-0.626; P = 0.001 ） and tended to be predictive in the non-ACS subgroup （AUROC： 0.556, 95% CI： 0,501 0.611; P = 0.054）.

关键词： Bleeding: Percutaneous Coronary Intervention Prognosis

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention

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Chinese Medical Journal 2018年第17期131卷 2041-2048页

作者： Ying Yuan Hong Qiu Xiao-Ying Hu Tong Luo Xiao-Jin gao Xue-Yan Zhao Jun Zhang Yuan Wu Shu-Bin Qiao Yue-Jin Yang run-lin gao Coronary Heart Disease Center Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background： Mounts of studies have shown that low estimated glomerular filtration rate （eGFR） is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury （CI-AKI） in a Chinese population who underwent an emergency percutaneous coronary intervention （PCI）. Methods： Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint （including nonfatal myocardial infarction, revascularization, stroke, and all-cause death） at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was ***： A total of 1061 patients were included and the overall CI-AKI rate was 22.7% （241 / 1061）. The separate rates were 77.8% （7/9） in Group 1 （eGFR 〉 120 ml·min^-1 -1.73 m^-2）, 26.0% （118/454） in Group 2 （120 ml·min^-1·min^-11.73 m^-2〉 eGFR≥90 ml·min^-1 1.73^-2）, 18.3% （86/469） in Group 3 （90 ml·min^-1 1.73 m^-2〉 eGFR 〉60 ml·min^-1·min^-11.73 m^-2）, 21.8% （26/119） in Group 4 （60 ml·min^-1·1.73 m^-2〉 eGFR≥30 ml·min^-1·min^-11.73 m^-2）, and 40.0% （4/10） in Group 5 （eGFR 〈30 ml·min^-1·min^-1·min^-11.73 m^-2）, with statistical significance （χ^2 = 25.19, P 〈 0.001）. The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing （the higher the level of eGFR, the higher the CI-AKI occurrence in case ofeGFR_〉60 ml·min^-1·1.73 m^-2）. The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences （χ^2 = 16.26, P = 0.009 at 6-month follow-up, and χ^2 = 49.05, P 〈 0.001

关键词： Contrast-Induced Acute Kidney Injury Emergency Percutaneous Coronary Intervention Estimated Glomerular Filtration Rate