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Earlier application of loading doses of aspirin and clopidogrel decreases rate of recurrent cardiovascular ischemic events for patients undergoing percutaneous coronary intervention

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Chinese Medical Journal 2012年第4期125卷 631-638页

作者： Tang Fa-kuan Lin Le-jian Hua Ning Lu Hong Qi Zhi Tang Xue-zheng Chinese Peoples Liberat Army Hosp 309 Dept Cardiol Beijing 100091 Peoples R China

Background Aspirin and clopidogrel resistance plays a significant role in the development of cardiovascular ischemic events for ninety patients undergoing percutaneous coronary *** studies have indicated that increasing the dose of antiplatelet drugs maybe a potent method to improve the inhibition of platelet *** Thrombelastograph （TEG） determinations were used to evaluate the effect of antiplatelet *** to the results,90 patients were divided into three groups and given different doses of aspirin and *** patients with both an inhibition rate of aspirin 〉50% and an inhibition rate of clopidogrel 〉50% were defined as the control *** patients with an inhibition rate for aspirin 〈50% and an inhibition rate for clopidogrel 〈50% were defined as the resistance *** in resistance group were randomly assigned to be given a routine dose （100 mg aspirin plus 75 mg clopidogrel per day,which we called a resistance plus routine dose group,R＋R） and a loading dose （200 mg aspirin and 150 mg clopidogrel per day,which we called resistance plus loading dose group,R＋L） of antiplatelet therapy.A 12-month follow-up was observed to examine the change of inhibition rate of antiplatelet therapy and to estimate the relationship between inhibition rate and the occurrence of cardiovascular ischemic *** After 6 months of antiplatelet therapy,the inhibition rate of aspirin in the R＋L group increased from （31.4±3.7）% to （68.6±7.1）%,which was significantly higher than that in R＋R group,（51.9±8.2）% （P 〈0.01）.The inhibition rate of clopidogrel in the R＋L group increased from （22.1±3.8）% to （60.2±7.4）%,which was significantly higher than in the R＋R group,（45.9±4.3）% （P 〈0.01）.The occurrence rates of cardiovascular ischemic events,stent thrombosis,recurrent unstable angina and myocardial infarction in the R＋R group were 20%,36% and 17%,*** was significantly increased compared with that in the

关键词： aspirin resistance clopidogrel resistance thrombelastograph percutaneous coronary intervention cardiovascular ischemic events

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Effect of short-term high-dose atorvastatin on systemic inflammatory response and myocardial ischemic injury in patients with unstable angina pectoris undergoing percutaneous coronary intervention

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Chinese Medical Journal 2014年第21期127卷 3732-3737页

作者： Sun Fei Yin Zhao Shi Quanxing Zhao Bei Wang Shouli Department of Cardiology the 306th Hospital of People's Liberation Army Beijing 100101 China

Background percutaneous coronary intervention （PCI） could develop periprocedural myocardial infarction and inflammatory response and statins can modify inflammatory responses *** aim of this study was to evaluate whether short-term high-dose atorvastatin therapy can reduce inflammatory response and myocardial ischemic injury elicited by *** From March 2012 to May 2014,one hundred and sixty-five statin-naive patients with unstable angina referred for PCI at Department of Cardiology of the 306th Hospital,were enrolled and randomized to 7-day pretreatment with atorvastatin 80 mg/d as high dose group （HD group,n=56） or 20 mg/d as normal dose group （ND group,n=57） or an additional single high loading dose （80 mg） followed 6-day atorvastatin 20 mg/d as loading dose group （LD group,n=52）.Plasma C-reactive protein （CRP） and interleukin-6 （IL-6） levels were determined before intervention and at 5 minutes,24 hours,48 hours,72 hours,and 7 days after *** kinase-myocardial isoenzyme （CK-MB） and cardiac troponin I （cTnl） were measured at baseline and then 24 hours following *** Plasma CRP and IL-6 levels increased from baseline after PCI in all *** reached a maximum at 48 hours and IL-6 level reached a maximum at 24 hours after *** CRP levels at 24 hours after PCI were significantly lower in the HD group （（9.14±3.02） mg/L） than in the LD group （（11.06±3.06） mg/L） and ND group （（12.36±3.08） mg/L,P ＜0.01）; this effect persisted for 72 ***-6 levels at 24 hours and 48 hours showed a statistically significant decrease in the HD group （（16.19±5.39） ng/L and （14.26±4.12） ng/L,respectively）） than in the LD group （（19.26±6.34） ng/L and （16.03±4.08） ng/L,respectively,both P ＜0.05） and ND group （（22.24±6.98） ng/L and （17.24±4.84） ng/L,respectively）.IL-6 levels at 72 hours and 7 days showed no statistically significant difference among the study *** PCI caused a significant increase in CK-MB and cTnl at 24 hours after

关键词： atorvastatin percutaneous coronary intervention C-reactive protein interleukin-6

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Predictive Ability of the SYNergy Between percutaneous coronary intervention with TAXus and Cardiac Surgery Score Ⅱ for Long-term Mortality in Patients with Three-vessel coronary Artery Disease Undergoing percutaneous coronary intervention Treated

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Chinese Medical Journal 2015年第16期128卷 2176-2182页

作者： Ji-Qiang He Xian-Peng Yu Cheng Peng Quan Li Ya-Wei Luo Yue-Chun Gao Xiao-Ling Zhang Chang-Yan Wu Hua Zhao Yu-Chen Zhang Jing-Hua Liu Shu-Zheng Lyu Fang Chen Department of Cardiology Beijing Anzhen Hospital Capital Medical University and Institution of Beijing Heart Lung and Vascular Disease Beijing 100029 China

Background：The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score Ⅱ （SS-Ⅱ） can well predict 4-year mortality in patients with complex coronary artery disease （CAD）,and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention （PCI）.However,there is lack of data regarding the utility of the SS-Ⅱ in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents （DES）.The purpose of the present study was to evaluate the ability of the SS-Ⅱ to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation ***：Totally,573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively *** to the tertiles of the SS-Ⅱ,the patients were divided into three groups：The lowest SS-Ⅱ tertile （SS-Ⅱ ≤20）,intermediate SS-Ⅱ tertile （SS-Ⅱ of 21-31）,and the highest SS-Ⅱ tertile （SS-Ⅱ ≥32）.The survival curves of the different groups were estimated by the Kaplan-Meier *** and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-Ⅱ and 5-year *** performance of the SS-Ⅱ with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic （ROC） *** predictive ability of the SS-Ⅱ for 5-year mortality was evaluated and compared with the SS ***：The overall SS-Ⅱ was 27.6 ± *** patients in the lowest,intermediate and the highest SS-Ⅱ tertiles,the 5-year rates of mortality were 1.6%,3.2%,and 8.6%,respectively （P =0.003）;the cardiac mortality rates were 0.5%,1.9%,and 5.2%,respectively （P =0.014）.By multivariable analysis,adjusting for the potential confounders,the SS-Ⅱ was an independent predictor of 5-year mortality （hazard ratio：2.45,95% confidence interval：1.38-4.36;P=0.002）.The SS-Ⅱ demonstrated a high

关键词： Mortality percutaneous coronary intervention Predictive Ability Second-generation Drug-eluting Stents SYNTAX Score II Three-vessel coronary Artery Disease

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Effect of tirofiban plus clopidogrel and aspirin on primary percutaneous coronary intervention via transradial approach in patients with acute myocardial infarction

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Chinese Medical Journal 2008年第6期121卷 522-527页

作者： FU Xiang-hua HAO Qing-qing JIA Xin-wei FAN Wei-ze GU Xin-shun WU Wei-li HAO Guo-zhen LI Shi-qiang JIANG Yun-fa GENG Wei Department of Cardiology Second Hospital of Hebei MedicalUniversity Shijiazhuang Hebei 050000 China

Background Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention （PCI）. Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction （STEMI） patients. We evaluated this on STEMI patients who underwent primary PCI （p-PCI） via transradial artery approach. Methods Consecutive patients were randomized into tirofiban group （n=-72） or placebo group （n=-78）. Angiographic analysis included initial and final thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the thrombotic vessel. Platelet aggregation rate （PAR）, creatine phosphokinase （CPK）, CPK isoenzyme MB （CPK-MB） and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events （MACE） were followed up for 6 months. Results The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group （all P 〈0.05）. Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications. Conclusions Intravenous tirofiban infusion, in addition to aspi

关键词： myocardial infarction tirofiban percutaneous coronary intervention platelet aggregation radial artery

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Unfractionated Heparin with Sequential Enoxaparin in Patients with Complex coronary Artery Lesions during percutaneous coronary intervention

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Chinese Medical Journal 2018年第20期131卷 2417-2423页

作者： Zhi-Zhong Li Ying Tao Su Wang Cheng-Qian Yin Yu-Long Gao Yu-Tong Cheng Zhao Li Chang-Sheng Ma Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

Background： Unfractionated heparin （UFH）, despite its limitations, has been used as the primary anticoagulant alternative during the percutaneous coronary intervention （PCI）. Some studies indicated that intravenous enoxaparin could be an effective and safe option. Our team used enoxaparin alone at one time according to the guidelines （Class IIA） and found a little catheter thrombosis during PCI. We recommend a new anticoagulation strategy using enoxaparin in combination with UFH. Enoxaparin has a more predictable anticoagulant response with no need of repeatedly monitoring anticoagulation during PCI. This retrospective study aimed to evaluate the efficacy and safety of using enoxaparin in combination with UFH in PCI patients with complex coronary artery disease. Methods： Between January 2015 and April 2017, 600 PCI patients who received intravenous UFH at an initial dose of 3000 U plus intravenous enoxaparin at a dose of 0.75 mg/kg （observation group） and 600 PCI patients who received UFH at a dose of 100 U/kg （control group） were consecutively included in this retrospective study. The endpoints were postoperative 48-h thrombolysis in myocardial infarction （TIMI） bleeding and transfusion and 30-day and l-year major adverse cardio-cerebrovascular events （MACCE）. Results： Baseline clinical, angiographic, and procedural characteristics were similar between groups, except there was less stent implantation per patient in the observation group （2.13 vs. 2.25 in the control group, P = 0.002）. TIMI bleeding （3.3% vs. 4.7%） showed no significant difference between the observation group and control group. During the 30-day follow-up, the rate of MACCE was 0.9% in the observation group and 1.5% in the control group. There was no significant difference in the rates of MACCE, death, myocardial infarction, target vessel revascularization, cerebrovascular event, and angina within 30 days and 1 year after PC1 between groups as well as in the subgroup analysis of transfemoral approa

关键词： Complex coronary Heart Disease Enoxaparin percutaneous coronary intervention Unfractionated Heparin

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Intensive cholesterol lowering with statin improves the outcomes of percutaneous coronary intervention in patients with acute coronary syndrome

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Chinese Medical Journal 2009年第6期122卷 659-664页

作者： JIA Xin-wei FU Xiang-hua ZHANG Jing GU Xin-shun FAN Wei-ze WU Wei-li HAO Guo-zhen LI Shi-qiang JIANG Yun-fa Department of Cardiovascular Disease Second Hospital of Hebei Medical University Shijiazhuang Hebei 050000 China

Background The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention （PCI）. This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.Methods Altogether 228 patients with acute coronary syndrome （ACS） were randomly assigned to standard statin group （SS group, n=115） and intensive statin group （IS group, n=-113）. Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the intervened vessel were recorded before and after stent deployment. Creatine kinase （CK） isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein （hs-CRP）, P-selectin and intercellular adhesion molecule （ICAM） were measured before and 24 hours after the procedure.Results The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group （all P〈0.05）. Patients with no reflow phenomenon were less in the IS group （P〈0.001）. The CTFC was lower in the IS group than in the SS group （P 〈0.001）. TMPG was also improved in the IS group than in the SS group （P=0.001）. Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group （18.74±8.41 vs 21.78±10.64, P=0.018）. Similar changes were also found in troponin I （0.99±1.07 in the IS group vs 1.47±1.54 in the SS group, P=0.006）. CK-MB elevation occurred in 27.8% （32/115） of the patients in the SS group vs 15.9% （18/113） in the IS group （P=-0.030）. Myocardial necrosis was detected in 4.4% （5/115） of the patients in the SS group, whereas 0.9% （1/113） in the IS group （P=0.341）. But no myo

关键词： simvastatin myocardium perfusion percutaneous coronary intervention acute coronary syndrome no reflow phenomenon

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Outcomes of coronary Artery Bypass Graft Surgery Versus percutaneous coronary intervention in Patients Aged 18-45 Years with Diabetes Mellitus

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Chinese Medical Journal 2017年第24期130卷 2906-2915页

作者： Yang Li Ran Dong Kun Hua Tao-Shuai Liu Shao-You Zhou Ning Zhou Hong-Jia Zhang Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Background：Debate on treatment for young patients with coronary artery disease still *** study aimed to investigate the intermediate-and long-term outcomes between coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） in patients aged 18-45 years with diabetes mellitus （DM）.Methods：Between January 2006 and March 2016,a total of 2018 DM patients aged 18-45 years including 517 cases of CABG and 1501 cases of PCI were enrolled in the *** propensity score matching （PSM）,406 patients were matched from each *** intermediate-and long-term data were *** primary end point of this study was long-term *** secondary end points included long-term major adverse cardiovascular and cerebrovascular events （MACCEs）,stroke,angina,myocardial infarction （MI）,and repeat ***：Before PSM,the in-hospital mortality was 1.2% in the CABG group and 0.1% in the PCI group,with statistically significant difference （P 〈 0.0001）.The 10-year follow-up outcomes including long-term survival rate and freedom from MACCEs were better in the CABG group than those in the PCI group （97.3% vs.94.5%,P =0.0072;93.2% vs.86.3%,P 〈 0.0001）,but CABG group was associated with lower freedom from stoke compared to PCI group （94.2% vs.97.5%,P =0.0059）.After propensity score-matched analysis,these findings at 10-year follow-up were also *** from MACCEs was higher in CABG group compared to PCI group,but no significant difference was observed （93.1% vs.89.2%,P =0.0720）.The freedom from recurrent MI was significantly higher in CABG patients compared with PCI patients （95.6% vs.92.5%,P =0.0260）.Furthermore,CABG was associated with a higher rate of long-term survival rate than PCI （97.5% vs.94.6%,P =0.0403）.There was no significant difference in the freedom from stroke between CABG and PCI groups （95.3% vs.97.3%,P =0.9385）.The hospital cost was greater for CABG （13,936 ± 4480 US dollars vs.10,926 ± 7376 US dollars,P 〈 0.000

关键词： coronary Artery Bypass Grafting: coronary Artery Disease Diabetes Mellitus percutaneous coronary intervention

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Obstructive Sleep Apnea Affecting Platelet Reactivity in Patients Undergoing percutaneous coronary intervention

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Chinese Medical Journal 2018年第9期131卷 1023-1029页

作者： Xiao-Min Jiang Xue-Song Qian Xiao-Fei Gao Zhen Ge Nai-Liang Tian Jing Kan Jun-Jie Zhang Department of Cardiology Nanjing First Hospital Nanjing Medical University Nanjing Jiangsu 210006 China Department of Cardiology Zhangjiagang First People's Hospital Zhangjiagang Jiangsu 215699 China

Background：The relationship between obstructive sleep apnea （OSA） and platelet reactivity in patients undergoing percutaneous coronary intervention （PCI） has not been *** present prospective,single-center study explored the relationship between platelet reactivity and OSA in patients with ***：A total of 242 patients were finally included in the *** was screened overnight by *** reactivity was assessed with a sequential platelet counting method,and the platelet maximum aggregation ratio （MAR） and average aggregation ratio were *** patients were assigned per apnea-hypopnea index （AHI） to non-OSA （n =128） and OSA （n =l 14） *** receiver operating characteristic curve analysis was used to evaluate the accuracy of AHI for high platelet reactivity （HPR） on aspirin and clopidogrel,and multivariable logistic regression was used to determine the independent predictors of HPR on aspirin and ***：Median AHI was significantly higher in the OSA group than in the non-OSA group （34.5 events/h vs.8.1 events/h,Z =-13.422,P 〈 0.001）.Likewise,median arachidonic acid-and adenosine diphosphate-induced maximum aggregation rate （MAR） in the OSA group was significantly higher than those in the non-OSA group （21.1% vs.17.7%,Z=-3.525,P 〈 0.001 and 45.8% vs.32.2%,Z =-5.708,P 〈 0.001,respectively）.Multivariable logistic regression showed that OSA was the only independent predictor for HPR on aspirin （odds ratio [OR]：1.055,95% confidence interval [CI]：1.033-1.077,P 〈 0.001） and clopidogrel （OR：1.036,95% CI：1.017-1.056,P 〈 0.001）.The cutoffvalue of AHI for HPR on aspirin was 45.2 events/h （sensitivity 47.1% and specificity 91.3%）,whereas cutoffvalue of AHI for HPR on clopidogrel was 21.3 events/h （sensitivity 68.3% and specificity 67.7%）.

关键词： Antiplatelet Drugs Maximum Aggregation Rate Obstructive Sleep Apnea percutaneous coronary intervention Platelet Reactivity

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Syntax score predicts clinical outcome in patients with three-vessel coronary artery disease undergoing percutaneous coronary intervention

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Chinese Medical Journal 2011年第5期124卷 704-709页

作者： HE Ji-qiang GAO Yue-chun YU Xian-peng ZHANG Xiao-ling LUO Ya-wei WU Chang-yan LI Yu ZHANG Wei-dong CHEN Fang LU Shu-zheng Department of Cardiology Beijing An Zhen Hospital Capital Medical University & Institution of Beijing Heart Lung and Vascular Disease Beijing 100029 China

Background The Syntax score was recently developed as a comprehensive, angiographic tool grading the complexity of coronary artery disease （CAD）. It aims to assist in patient selection and risk stratification of patients with extensive CAD undergoing revascularization. However, the prognostic value of the Syntax score in patients undergoing percutaneous coronary intervention （PCI） has not been validated. The aim of this study was to evaluate its role in predicting long-term incidences of major adverse cardiac and cerebrovascular events （MACCE） in patients undergoing PCI for 3-vessel *** Two hundred and three consecutive patients with de novo 3-vessel CAD undergoing PCI with sirolimus-eluting stents were studied. Their angiograms were scored according to the Syntax score. The patients were divided into tertiles according to the Syntax score： lowest Syntax score tertile （Syntax score 〈22）, intermediate Syntax score tertile （Syntax score of 23 to 32）, and the highest Syntax score tertile （Syntax score 〉33）. During the 1-year follow-up, the MACCE-free survival curves were estimated by the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relation between the Syntax score and the incidence of MACCE. Performance of the Syntax score was studied with respect to predicting the rate of MACCE by receiver operator characteristic （ROC） curves with an area under the *** The overall Syntax score ranged from 6 to 66 with mean ± standard deviation of 27.9±12.6 and a median of 26. At 1 year, the Syntax score significantly predicted the risk of MACCE （HR 1.07/U increase, 95% Cl 1.04 to 1.11, P 〈0.001）. The rate of MACCE was significantly increased among patients in the highest Syntax score tertile （17.9%） as compared with those with the lowest Syntax score tertile （1.4%, P 〈0.001） or intermediate Syntax score tertile （6.2%, P=0.041）. After the adjustment for all potential confounders, the S

关键词： Syntax score 3-vessel coronary artery disease percutaneous coronary intervention

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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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