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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 2013.Propensity score matching （PSM） was applied to control differing baseline factors.Two-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 evaluated.Results：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 PSM.Multivariate 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 PSM.Other endpoints showed no significant differences after multivariate adjustment regardless of PSM.Conclusions：G1-DES showed the same safety as G2-DES in this large Chinese cohort of real-world patients.However,G2-DES improved TLR-ffee survival of SCAD patients 2 years after PCI.The advantage was influenced by baseline clinical factors.GI-DES was associated with a trend of increase in revascularization risk and was not an independent predictor of worse medium-term prognosis compared with G2-D

关键词： Drug-etuting Stents Percutaneous coronary Intervention stable coronary artery disease

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

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

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

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

关键词： stable coronary artery disease Appropriate use criteria coronary revascularization

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Efficacy and safety of Shexiang Baoxin pill(MUSKARDIA)in patients with stable coronary artery disease:a multicenter,double-blind,placebo-controlled phase IV randomized clinical trial

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Chinese Medical Journal 2021年第2期134卷 185-192页

作者： Jun-Bo Ge Wei-Hu Fan Jing-Min Zhou Hai-Ming Shi Fu-Sui Ji Yang Wu Yu-Lan Zhao Jun Qian Yuan-Zhe Jin Ying-Wu Liu Sheng-Huang Wang Sheng-Hu He Ping Yang Jie Wu Feng Lu Zi-Shan Hou Department of Cardiology Zhongshan HospitalFudan UniversityShanghai 200032China Department of Cardiology Huashan HospitalFudan UniversityShanghai 200040China Department of Cardiology Beijing Hospital of the Ministry of HealthBeijing 100730China Department of Cardiology Dongfang Hospital Affiliated to Beijing University of Chinese MedicineBeijing 100078China Department of Cardiology The Second Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan 450000China Department of Cardiology The Center Hospital of Ma'anshanMa'anshanAnhui 243000China Department of Cardiology The Fourth Affiliated Hospital of China Medical UniversityShenyangLiaoning 110032China Department of Cardiology Tianjin Third Central HospitalTianjin 300170China Department of Cardiology Ningbo First HospitalNingboZhejiang 315010China Department of Cardiology Northern Jiangsu People’s HospitalYangzhouJiangsu 210036China Department of Cardiology China-Japan Union Hospital of Jilin UniversityChangchunJilin 130031China Department of Cardiology The First Affiliated Hospital of University of South ChinaHengyangHunan 421000China Department of Cardiology The Affiliated Hospital of Shandong University of Traditional Chinese MedicineJinanShandong 250355China Ddepartment of Cardiology Linyi People's HospitalLinyiShandong 276000China

Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce.The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy(OMT)in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months.Both groups received OMT according to local tertiary hospital protocols.The primary outcome was the occurrence of a major adverse cardiovascular event(MACE),defined as a composite of cardiovascular death,non-fatal myocardial infarction(MI),or non-fatal stroke.Secondary outcomes included all-cause mortality,non-fatal MI,non-fatal stroke,hospitalization for unstable angina or heart failure,peripheral revascularization,angina stability and angina frequency.Results:In all,99.7%of the patients were treated with aspirin and 93.0%with statin.After 2 years of treatment,the occurrence of MACEs was reduced by 26.9%in the MUSKARDIA group(MUSKARDIA:1.9%vs.placebo:2.6%;odds ratio=0.80;95%confidence interval:0.45-1.07;P=0.2869).Angina frequency was significantly reduced in the MUSKARDIA group at 18 months(P=0.0362).Other secondary endpoints were similar between the two groups.The rates of adverse events were also similar between the two groups(MUSKARDIA:17.7%vs.placebo:17.4%,P=0.8785).Conclusions:As an add-on to OMT,MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD.Moreover,the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD.The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:***,No.ChiCTR-TRC-12003513.

关键词： MUSKARDIA stable coronary artery disease Angina Major adverse cardiovascular event

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Network Pharmacology-Based Exploration of the Mechanism of Guanxinning Tablet for the Treatment of stable coronary artery disease

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World Journal of Traditional Chinese Medicine 2021年第4期7卷 456-466页

作者： Song Sheng Qiao-Ning Yang Hao-Ning Zhu Yong-Yue Xian Department of Emergency Xiyuan Hospital of China Academy of Chinese Medical SciencesBeijingChina

Objective:Network pharmacology was utilized to explore the mechanism of Guanxinning(GXN)tablet for the treatment of stable coronary artery disease(SCAD).Materials and Methods:First,active ingredients and therapeutic targets were predicted by databases and gene chip.Then,we constructed the compound-target(C-T)network and target-disease(T-D)network to screen hub compounds and therapeutic targets based on contribution index(CI),degree,closeness,betweenness,and coreness in the networks.Enrichment analysis was performed on hub therapeutic targets,and finally,the verification of hub ingredients and hub therapeutic targets was performed through molecular docking.Results:With"oral bioavailability≥30%,druglikeness≥0.18,and half-life≥4 h"as screening conditions,58 active ingredients were obtained.Seven hundred and seventeen compound targets and 636 SCAD targets were retrieved using databases and gene chip,and the intersection of both(139 targets)was defined as therapeutic targets.According to CI,degree,betweenness,closeness,and coreness,2 hub compounds and 13 hub therapeutic targets were chosen from the C-T network and T-D network,respectively.The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis indicated that GXN treated SCAD from several aspects including inflammatory reaction,oxidative stress,nutritional metabolism,blood pressure regulation,ventricular remodeling,vascular smooth muscle proliferation,angiogenesis,and platelet aggregation.Tissue enrichment analysis revealed that the therapeutic targets were enriched in multiple organs and tissues.The excellent binding force between the hub compounds and hub therapeutic targets was verified by molecular docking.Conclusions:The treatment of SCAD by GXN has the characteristics of multiple ingredients,multiple targets,and multiple approaches.Consequently,it may theoretically treat SCAD from multiple angles and levels.

关键词： Gene chip Guanxinning tablet molecular docking network pharmacology stable coronary artery disease

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