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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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Practice of reperfusion in patients with ST-segment elevation myocardial infarction in China:findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project

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Chinese Medical Journal 2022年第23期135卷 2821-2828页

作者： Yiqian Yang Yongchen Hao Jun Liu Na Yang Danqing Hu Zhaoqing Sun Dong Zhao Jing Liu on behalf of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)Investigators Department of Epidemiology Beijing An Zhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China 不详

Background:Reperfusion therapy is fundamental for ST-segment elevation myocardial infarction(STEMI).However,the details of contemporary practice and factors associated with reperfusion therapy in China are largely unknown.Therefore,this study aimed to explore reperfusion practice and its associated factors among hospitalized patients with STEMI in China.Methods:Patients with STEMI who were admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project from November 2014 to December 2019.The associations of the characteristics of patients and hospitals with reperfusion were examined using hierarchical logistic regression.The associations between therapies and in-hospital major adverse cardiovascular events were examined with a mixed effects Cox regression model.Results:Among the 59,447 patients,37,485(63.1%)underwent reperfusion,including 4556(7.7%)receiving fibrinolysis and 32,929(55.4%)receiving primary percutaneous coronary intervention(PCI).The reperfusion rate varied across geographical regions(48.0%–73.5%).The overall rate increased from 60.0%to 69.7%from 2014 to 2019,mainly due to an increase in primary PCI within 12 h of symptom onset.Timely PCI,but not fibrinolysis alone,was associated with a decreased risk of inhospital major adverse cardiovascular events compared with no reperfusion,with an adjusted hazard ratio(95%confidence interval)of 0.64(0.54,0.76)for primary PCI at<12 h,0.53(0.37,0.74)for primary PCI at 12 to 24 h,0.46(0.25,0.82)for the pharmaco-invasive strategy,and 0.79(0.54,1.15)for fibrinolysis alone.Conclusions:Nationwide quality improvement initiatives should be strengthened to increase the reperfusion rate and reduce inequality in China.Trial registration:www.ClinicalTrials.gov,NCT02306616。

关键词： Acute Coronary Syndrome Cardiovascular diseases China Fibrinolysis Percutaneous coronary intervention Quality improvement Reperfusion ST elevation myocardial infarction

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Effects of high-dose glucose-insulin-potassium on Acute Coronary Syndrome patients receiving reperfusion therapy:a meta-analysis

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World Journal of Emergency Medicine 2024年第3期15卷 181-189页

作者： Zeyu Yang Huiruo Liu Dazhou Lu Shengchuan Cao Feng Xu Chuanbao Li Department of Emergency Medicine Qilu Hospital of Shandong UniversityJinan 250012China Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine Institute of Emergency and Critical Care Medicine of Shandong UniversityChest Pain CenterQilu Hospital of Shandong UniversityJinan 250012China Key Laboratory of Emergency and Critical Care Medicine of Shandong Province Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceShandong Provincial Engineering Laboratory for Emergency and Critical Care MedicineQilu Hospital of Shandong UniversityJinan 250012China Shandong Key Laboratory:Magnetic Field-free Medicine&Functional Imaging(MF) Qilu Hospital of Shandong UniversityJinan 250012China National Medical Products Administration(NMPA)Key Laboratory for Clinical Research and Evaluation of Innovative Drug Qilu Hospital of Shandong UniversityJinan 250012China

BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in Acute Coronary Syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.

关键词： Acute Coronary Syndrome High-dose Glucose-insulin-potassium treatment Reperfusion therapy Meta-analysis

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Long-term follow-up of antithrombotic management patterns in patients with Acute Coronary Syndrome in China

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Journal of Geriatric Cardiology 2020年第5期17卷 246-255,I0002-I0004页

作者： Xiao-Ning HAN Shu-Bin QIAO Jun-Bo GE Ya-Ling HAN Ji-Yan CHEN Zu-Yi YUAN Bo YU Jie JIANG Yong HUO Department of Cardiology Peking University First HospitalBeijingChina National Center for Cardiovascular Diseases Fuwai HospitalBeijingChina Department of Cardiology Zhongshan Hospital Affiliated to Fudan UniversityGuangzhouChina Department of Cardiology the General Hospital of Shenyang MilitaryShenyangChina Department of Cardiology Guangdong General HospitalGuangzhouChina Department of Cardiology the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina Department of Cardiology the Second Affiliated Hospital of Harbin Medical UniversityHarbinChina

Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with Acute Coronary Syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.

关键词： Acute Coronary Syndrome Antithrombotic agents Antithrombotic management patterns Observational study Real-world

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Is dual therapy the correct strategy in frail elderly patients with atrial fibrillation and Acute Coronary Syndrome?

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Journal of Geriatric Cardiology 2020年第1期17卷 51-57页

作者： Alessio Menditto Roberto Antonicelli Cardiology Unit Italian National Research Centre on Aging

Atrial fibrillation(AF)is a very common arrhythmia in clinical practice.Its incidence and prevalence are age-related and are growing in the last years.Age is a risk factor also for coronary artery disease(CAD),and with the evolution of preventive care,the first event(Acute Coronary Syndrome(ACS)or percutaneous coronary intervention(PCI))takes place at a later age.If elderly patients with AF and CAD undergo ACS or PCI,they have indication to assume triple therapy.Triple therapy(oral anticoagulation(OAC)plus dual antiplatelet therapy(DAPT))exposes patients to high bleeding risk.In the last 10 years,several clinical trials have tested dual therapy(OAC plus single antiplatelet therapy)in AF patients who undergo ACS or elective PCI.WOEST trial has tested warfarin+clopidogrel against triple therapy.PIONEER AF-PCI trial has tested low-dose rivaroxaban+P2Y12 inhibitor or very low-dose rivaroxaban+DAPT against standard triple therapy with warfarin.RE-DUAL PCI trial has tested two doses of dabigatran+P2Y12 inhibitor against standard triple therapy with Warfarin.AUGUSTUS trial has tested apixaban against warfarin both in dual therapy with P2Y12 inhibitor and in triple therapy with a P2Y12 inhibitor and aspirin.ENTRUST-AF PCI,last published study,has tested edoxaban+P2Y12 inhibitor against triple therapy.All these trials show dual therapy reduces significantly bleeding risk than triple therapy.In this paper,we analyze these clinical trials to understand if dual therapy results can be applied to elderly patients and what is probably the better approach in elderly AF patients undergo to ACS or PCI.

关键词： Acute Coronary Syndrome Atrial fibrillation Dual therapy Oral anticoagulation The elderly

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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 measured.RESULTS: 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 (Psyndrome.CONCLUSIONS: 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

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Effectiveness and safety of Suxiao Jiuxin pill in treating Acute Coronary Syndrome:a systematic review and Meta-analysis

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Journal of Traditional Chinese Medicine 2020年第4期40卷 518-529页

作者： Liu Chao Duan Lian Huang Mingyan Li Jun Xiong Xingjiang Chen Guang He Haoqiang Zhang Zhenpeng Wang Jie Department of Cardiology Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijing 100053China Graduate School Beijing University of Chinese MedicineBeijing 100029China

OBJECTIVE:To evaluate the effectiveness and safety of Suxiao Jiuxin pill(SX)in Acute Coronary Syndrome(ACS)treatment.METHODS:An extensive search of four English databases(Medline/PubMed,Cochrane Library,Embase,and World Health Organization International Clinical Trials Registration Platform)and four Chinese databases(Chinese National Knowledge Infrastructure,Wanfang,China Science and Technology Journal,and Chinese Biomedical Literature Service System)was performed.Randomized,controlled trials(RCTs)involving SX combined with conventional therapy versus conventional therapy were included.The extracted data included populations,interventions,outcomes,and risk of bias.The cardiovascular events served as the primary outcome.Review Manager 5.3 software was used for data analysis.Relative risks(RRs)with 95%confidence intervals(CIs)were the effect measure.RESULTS:A total of eight RCTs with 979 patients were included.There were 559 patients with unstable angina(UA)in six RCTs and 420 patients with acute myocardial infarction(AMI)in two RCTs.Our review showed that SX plus conventional therapy might reduce the incidence of the total endpoint(RR:0.34,95%CI:0.17,0.68,P=0.002),with no obvious adverse events(RR:1.29,95%CI:0.60,2.77,P=0.52)compared with conventional therapy for patients with UA.Additionally,SX plus conventional therapy also reduced the incidence of the total endpoint(RR:0.35,95%CI:0.18,0.68,P=0.002)compared with conventional therapy in patients with AMI.SX plus conventional therapy also reduced the incidence of ventricular fibrillation(RR:0.23,95%CI:0.10,0.57,P=0.001)compared with conventional therapy in patients with AMI.CONCLUSION:Our results suggest that SX is beneficial for treating patients with UA or AMI.However,our findings should be treated with caution because of the poor methodological quality of the included trials.Therefore,more multicenter,large-sample,high-quality RCTs are required to provide high-quality evidence.

关键词： Acute Coronary Syndrome Angina,unstable Myocardial infarction Endpoint Determination Meta-analysis Suxiao Jiuxin pill

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Plasma levels of Elabela are associated with coronary angiographic severity in patients with Acute Coronary Syndrome

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Journal of Geriatric Cardiology 2020年第11期17卷 674-679页

作者： Sheng-Li DU Xin-Chun YANG Jiu-Chang ZHONG Le-Feng WANG Yi-Fan FAN Heart Center and Beijing Key Laboratory of Hypertension Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina

Background Elabela(ELA) was newly discovered as a novel endogenous ligand of the apelin receptor(APJ) which has demonstrated to be crucial for cardiovascular disease such as myocardial infarction, hypertension and heart failure. Previous experiments have revealed that ELA reduced arterial pressure and exerted positive inotropic effects on the heart. However, the role of plasma ELA levels in patients with Acute Coronary Syndrome(ACS) and its relationship with severity of coronary arteries have not been investigated. Methods Two hundred and one subjects who were hospitalized for chest pain and underwent coronary angiography were recruited in this study. One hundred and seventy five patients were diagnosed with ACS and twenty-six subjects with negative coronary angiography were included in the control group. Plasma ELA levels, routine blood test, blood lipid, liver and kidney functions were measured. The number of coronary arteries and SYNTAX(Synergy Between Percutaneous coronary Intervention With Taxus and Cardiac Surgery) score of coronary lesions were used to evaluate the extent of coronary artery stenosis. Results ELA in patients with ACS was significantly higher than that in the control group(P coronary artery stenosis when the ELA levels were less than 63.47 ng/m L or higher than 85.49 ng/m L. Conclusion The present study demonstrates for the first time that plasma ELA levels are increased in patients with ACS. The rise in endogenous ELA levels was associated with severity of coronary stenosis and may be involved in the pathogenesis

关键词： Acute Coronary Syndrome coronary artery stenosis Elabela

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Non-ST elevation Acute Coronary Syndrome in the elderly

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Journal of Geriatric Cardiology 2020年第1期17卷 9-15页

作者： Pablo Díez-Villanueva César Jiménez Méndez Fernando Alfonso Cardiology Department Hospital Universitario La Princesa Universidad Autónoma de Madrid

1 Introduction Societies are ageing at an accelerated pace.This scenario is a well-known challenge for health care systems,as chronic diseases,multiple comorbidities and dependency are all entities that often converge in the elderly.Besides,there is an issue regarding a reduction in the general incidence of Acute Coronary Syndrome(ACS)together with a delayed in the age of presentation,which,in sum,lead to an increase in both incidence and prevalence of ACS with age,especially non-ST elevation myocardial infarction(NSTEMI).

关键词： Acute Coronary Syndrome Myocardial infarction The elderly

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Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with Acute Coronary Syndrome

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World Journal of Emergency Medicine 2021年第3期12卷 198-201页

作者： Kun Cui You-quan Shi Yuan-zheng Zhang Zheng-gong Li Chang-ling Li Department of Cardiology Chongqing General HospitalChongqing 400013China Department of Cardiology the Third People’s Hospital of Xinjiang Uygur Autonomous RegionUrumqi 830000China Department of Cardiology the First People’s Hospital of TianshuiTianshui 741000China Department of Cardiology the Second Affi liated Hospital of Zhejiang University School of MedicineHangzhou 310009China

BACKGROUND:Stent under-expansion is a main cause of Acute Coronary Syndrome(ACS),which can lead to serious clinical outcomes.The rotational atherectomy of underexpanded coronary stents(academically called stent ablation,SA)by intravascular ultrasound(IVUS)may provide more visual reference in the intervention.We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.METHODS:A total of 11 patients with ACS who underwent SA between April 2017 and January 2019 were analyzed.Clinical follow-ups were obtained either by telephone call or by scheduled visit.Clinical end-points included periprocedural and postprocedural myocardial infarction,stent thrombosis,target lesion revascularization,and major adverse cardiac events.RESULTS:The mean age of patients was 69.6±6.5 years,and five(45.5%)patients were males.All cases presented with unstable angina and were admitted with ACS.All patients required at least two burrs during the intervention and the size of the burr was selected based on the data of minimum lumen diameter(MLD),and the fi rst and the second burr/stent MLD ratios were 0.93(0.88-0.99)and 1.09(1.02-1.14),respectively.Nine patients were treated with drug-eluting stents and two were treated with drug-coated balloons.There were no complications including no fl ow,perforation,or burr entrapment during the intervention.No in-hospital deaths or major adverse cardiac events were documented during the follow-up period.In our study,less contrast agent and a lower dose of radiation were used during the intervention.CONCLUSIONS:SA guided by IVUS can reduce the risk of complications,assess the results of surgery,inform the selection of stent size,and decrease the required dose of radiation and contrast.

关键词： Acute Coronary Syndrome Intravascular ultrasound Rotational atherectomy Underexpanded stent

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