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percutaneous coronary intervention for ostial occlusion lesion of an anomalous right coronary artery

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Journal of Geriatric Cardiology 2009年第3期6卷 189-192页

作者： Shi-Wei Yang Yu-Jie Zhou Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing 100029 China

Ostial lesions present many challenges for percutaneous coronary intervention （PCI）. coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wtre technique and focused-force angloplasty（J Genatr Cardio12009, 6：189-192）.

关键词： ostial lesions high takeoff percutaneous coronary intervention buddy wire focused-force angioplasty

percutaneous coronary intervention of totally occluded coronary venous bypass grafts:An exercise in futility?

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World Journal of Cardiology 2021年第9期13卷 493-502页

作者： Evan W Nardone Brandon M Madsen Melissa M McCarey David L Fischman Nicholas J Ruggiero Paul Walinsky Alec Vishnevsky Michael P Savage Department of Medicine Thomas Jefferson UniversityPhiladelphiaPA 19107United States Department of Anesthesiology Medstar Georgetown University HospitalWashingtonDC 20007United States Jefferson Clinical Research Institue Thomas Jefferson UniversityPhiladelphiaPA 19107United States

BACKGROUND percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical *** PCI guidelines give a class III recommendation against performing PCI on chronically occluded ***,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet *** To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary *** This was a retrospective observational study conducted at a single university *** study population consisted of 35 consecutive patients undergoing PCI of totally occluded ***-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued *** outcomes were assessed at a mean follow-up of 1221±1038 *** primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft *** The study group included 29 men and 6 women with a mean age of 69±12 *** was present in 14(40%)*** patients had Canadian Heart Classification class III or IV *** presentation was an acute coronary syndrome in 34(97%)*** SVG age was 12±5 *** duration of occlusion was acute(24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 *** complications of distal embolization or no-reflow occurred in 6(17%)*** longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 *** PCI of totally occluded SVG can be performed with a high procedural success ***,its clinical utility remains limited by poor follow-up outcomes.

关键词： coronary artery bypass grafting coronary stents Chronic total occlusion percutaneous coronary intervention Restenosis Saphenous vein grafts

percutaneous coronary intervention in nonagenarians: pros and cons

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Journal of Geriatric Cardiology 2013年第1期10卷 82-90页

作者： Giuseppe Biondi Zoccai Antonio Abbate Fabrizio D'Ascenzo Davide Presutti Mariangela Peruzzi Elena Cavarretta Antonino G.M. Marullo Marzia Lotrionte Giacomo Frati Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome Corso della Repubblica 7904100 Latina Italy VCU Pauley Heart Center PO Box 980036 Richmond VA 23298 USA Divisione di Cardiologia Università di Torino Corso Bramante 88-9010126 Torino Italy Unità di Scompenso Cardiaco e Riabilitazione Cardiologica Complesso Integrato Columbus Via Moscati 3100168 Rome Italy Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome Corso della Repubblica 7904100 Latina Italy Department of Angio Cardio Neurology IRCCS Neuromed Via Atinense 1886077 Pozzilli Italy

percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.

关键词： coronary artery disease Nonagenarian percutaneous coronary intervention Stent

percutaneous coronary intervention with anomalous origin of right coronary artery: case reports and literature review

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Journal of Geriatric Cardiology 2013年第2期10卷 -页

作者： Li-Feng Hong, Division of Dyslipidemia State Key Laboratory of Cardiovascular Disease Fu Wai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Peking Union Medical College BeiLiShi Road 167 Beijing 100037 China Divison of Cardiology the Fifth Hospital of Wuhan Wuhan 430050 China

percutaneous coronary intervention (PCI) in an anomalous right coronary artery (RCA) can be technically difficult because selective cannulation of the vessel may not be easy. We thereby present two cases with unstable angina pectoris of anomalous originated RCA. The PCI were successfully performed in two patients with a special guiding wire manipulating skill which we called “gone with the flow” combined with balloon anchoring technology, providing excellent angiographic visualization and sound guide support for stent delivery throughout the procedure without severe cardiovascular adverse effects. Our primary data suggested that PCI for geriatric patients with an anomalous origin of RCA accompanied by severe atherosclerotic lesions might also be a safe, available, and feasible strategy.

关键词： coronary angiography percutaneous coronary intervention Anomalous right coronary artery Angina

Age-dependent impact of the SYNTAX-score on longer-term mortality after percutaneous coronary intervention in an all-comer population

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Journal of Geriatric Cardiology 2018年第9期15卷 559-566页

作者： Madeleine Eickhoff Stefanie Schupke Alexander Khandoga Julia Fabian Moritz Baquet David Jochheim David Grundmann Manuela Thienel Axel Bauer Hans Theiss Stefan Brunner Jorg Hausleiter Steffen Massberg Julinda Mehilli Department of Cardiology Munich University Clinic Ludwig-Maximilians University Munich Germany German Centre for Cardiovascular Research (DZHK) Partner Site Munich Heart Alliance Germany Deutsches Herzzentrum Miinchen Klinik fiir Herz- und Kreislauferkrankungen ISAResearch Center Munich Germany

Background The Synergy between percutaneous coronary intervention with TAXUS and Cardiac Surgery （SYNTAX）-score is a validated tool for risk stratification and revascularization strategy selection in patients with complex coronary artery disease. The aim of this study was to analyse its age-related prognostic value. Methods SYNTAX-score was calculated in 1331 all-comer patients undergoing percutaneous coronary intervention （PCI）： 463 patients ≥ 75 years and 868 patients 〈 75 years. Outcomes of interest were all-cause mortality at one and two years. Results A significant interaction of age and SYNTAX-score for mortality was observed at two-year （Pinteraction= 0.019） but not at one-year follow-up （Pinteraction= 0.594）. In multivariable analysis, SYNTAX-score independently predicted 1-year mortality in both age groups （〈 75 years, hazard ratio （HR）： 1.43, 95% confidence intervals （CI）： 1.03-2.00, P = 0.034; and 〉 75 years, HR： 1.37, 95% CI： 1.01-1.85, P = 0.042）, but only two-year mortality among younger patients （〈 75 years, HR： 1.33, 95% CI： 1.01-1.76, P = 0.041; and ≥ 75 years, HR： 1.11, 95% CI： 0.87-1.41, P = 0.394）. SYNTAX-score tertiles were useful to stratify 1-year mortality in both, patients 〈 75 years （SYNTAX-score 〈 9, 3.8%; 9-20, 5.3%; 〉 20, 10.3%; P = 0.004） and 〉 75 years （SYNTAX-score 〈 11, 5.7%; 11-22.5, 16.1%; 〉 22.5, 18.7%; P = 0.003）, but two-year mortality only among patients 〈 75 years （SYNTAX-score 〈 9, 6.5%; 9-20, 7.6%; ≥ 20, 15%; P 〈 0.001） and not among ≥ 75 years old patients （SYNTAX-score 〈 11, 19.4%; 11-22.5, 26.3%; _〉 22.5, 27.9%; P = 0.138）. Conclusions Age modi- fies the impact of the SYNTAX-score on longer-term mortality after PCI. Among patients 〈 75 years, the SYNTAX-score independently predicts the risk of death at one and two years after PCI, while among patients 〉 75 years its predictive role is limited to the first year after PCI. Further studies are needed to evaluate the value of SYNTAX-score for selecting the most appropriate re

关键词： Age Mortality percutaneous coronary intervention Syntax-score The elderly

Prognostic Value of NT-proBNP in Stable coronary Artery Disease in Chinese Patients after percutaneous coronary intervention in the Drug-eluting Stent Era

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Biomedical and Environmental Sciences 2018年第12期31卷 859-866页

作者： ZHAO Xue Yan LI Jian Xin TANG Xiao Fang XU Jing Jing SONG Ying JIANG Lin CHEN Jue SONG Lei GAO Li Jian GAO Zhan QIAO Shu Bin YANG Yue Jin GAO Run Lin XU Bo YUAN Jin Qing State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College

Objective The predictive value of N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with stable coronary artery disease(SCAD) in the drug-eluting stent era is not yet clear. We aimed to evaluate the prognostic value of NT-proBNP in SCAD patients after percutaneous coronary intervention(PCI). Methods We examined 4,293 consecutive SCAD patients who underwent PCI between January 2013 and December 2013 in Fuwai Hospital, China. The primary endpoint was all-cause death. NT-proBNP levels were measured before PCI using Elisa kits(Biomedica, Austria). The indication for PCI was based on the degree of coronary stenosis and evidence of ischemia. Results Among 3,187 SCAD patients with NT-proBNP data, after a 2-year follow-up, NT-proBNP levels were predictive for all-cause death in the SCAD population [area under the receiver operating characteristic curve, 0.768; 95% confidence interval(CI), 0.687-0.849; P < 0.001]. At the optimum cutoff point of 732 pg/mL, the sensitivity and specificity of death was 75.0% and 72.3%, respectively. In a multivariable Cox regression model, the death hazard ratio was 6.43(95% CI, 2.99-13.82; P < 0.001) for patients with NT-proBNP levels ≥ 732 pg/mL, compared with < 732 pg/mL. Conclusion NT-proBNP is a strong predictor of 2-year death with SCAD after PCI in the drug-eluting stent era.

关键词： NT-proBNP Stable coronary disease Death Prognosis percutaneous coronary intervention

Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly

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Journal of Geriatric Cardiology 2017年第10期14卷 624-631页

作者： Vimalraj Bogana Shanmugam Dennis T Wong Hashrul Rashid James D Cameron Yuvaraj Malaiapan Peter J Psaltis Monash Cardiovascular Research Centre Clayton Campus of Monash University Victoria Australia South Australian Health and Medical Research Institute Adelaide Australia

Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention （PCI）. Methods This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Aus- tralian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians. Results Non-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octoge- narians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin （LMWH; 1.0% vs. 5.8%; P 〈 0.001） and glycopro- tein IIb/IIIa inhibitors （2.1% vs. 9.6%; P 〈 0.001） was lower, while femoral arterial access was used more commonly than in younger patients （80.9% vs. 67.6%; P 〈 0.001）. Overall, there was a non-significant trend towards higher incidence of all bleeding events in the elderly （9.2% vs. 5.8%; P = 0.12）. There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups. Conclusions In this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.

关键词： Bleeding coronary artery disease Octogenarians percutaneous coronary intervention

Association between baseline platelet count and severe adverse outcomes following percutaneous coronary intervention

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Journal of Geriatric Cardiology 2018年第5期15卷 346-355页

作者： Wan-Jun CHENG Shi-Wei YANG Fei GAO Yong-He GUO Zhi-Jian WANG Yu-Jie ZHOU Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing lnstitute of Heart Lung and Blood Vessel Disease The Key Laboratory of Remodel- ing-related Cardiovascular Disease Ministry of Education Beijing China

Objective The aim is to evaluate the association between baseline platelet count （PC） and severe adverse outcomes following percu- taneous coronary intervention （PCI） in current real-world practice. Methods A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low （〈 150 × 1000μ.L）, normal （150-300 × 1000μL）, and high （≥ 300 × 1000μL） baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. Results In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively （P = 0.259）. Similarly, mortality rates during long-term follow-up （median 23.8 months） for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively （P = 0.079）. After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups （0.5%, 0.3%, and 0.3%, respectively; P = 0.320）. After multivariate adjustment, low or high baseline PC did not signi- ficantly increase the risk of major bleeding. Conclusion There is no significant association between baseline PC and severe adverse out- comes following PCI in current real-world practice.

关键词： Major bleeding Mortality percutaneous coronary intervention Platelet count

Proteomics analysis of coronary atherosclerotic heart disease with different Traditional Chinese Medicine syndrome types before and after percutaneous coronary intervention

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Journal of Traditional Chinese Medicine 2024年第3期44卷 554-563页

作者： WANG Zhibo LI Ying WANG Daoping MA Bo MIAO Lan REN Junguo LIU Jinghua LIU Jianxun Beijing Key Laboratory of Pharmacology of Chinese Materia Region Institute of Basic Medical SciencesXiyuan HospitalChina Academy of Chinese Medical SciencesNational Clinical Research Center of Cardiovascular Disease of Traditional Chinese MedicineBeijing 100000China the National Key Facility for Crop Gene Resources and Genetic Improvement Institute of Crop ScienceChinese Academy of Agricultural ScienceBeijing 100098China Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China

OBJECTIVE: To investigate the underlying protein molecular mechanisms of "Qi stagnation and blood stasis syndrome"(QS) and "Qi deficiency and blood stasis syndrome"(QD), as two subtypes of coronary artery disease(CAD) in Traditional Chinese Medicine(TCM),following percutaneous coronary intervention(PCI).METHODS: In this study, a total of 227 CAD patients with QS and 211 CAD patients with QD were enrolled;all participants underwent PCI. Label-free quantification proteomics were employed to analyze the changes in serum in two subtypes of CAD patients before and 6 months after PCI, aiming to elucidate the intervention mechanism of PCI in treating CAD characterized by two different TCM ***: Biochemical analysis revealed significant changes in tumor necrosis factor-α, high density lipoprotein cholesterol, blood stasis clinical symptoms observation, and Gensini levels in both patient groups post-PCI;Proteomic analysis identified 79 and 95 differentially expressed proteins in the QS and QD patient groups, respectively, compared to their control *** C8 alpha chain, complement factor H,apolipoprotein H, apolipoprotein B, plasminogen,carbonic anhydrase 2, and complement factor Ⅰ were altered in both comparison groups. Furthermore,enrichment analysis demonstrated that cell adhesion and connectivity-related processes underwent changes in QS patients post-PCI, whereas lipid metabolism-related pathways, including the peroxisome proliferator-activated receptor signaling pathway and extracellular matrix receptor interaction, underwent changes in the QD *** protein-protein interaction network analysis further enriched 52 node proteins, including apolipoprotein B,lipoprotein(a), complement C5, apolipoprotein A4,complement C8 alpha chain, complement C8 beta chain,complement C8 gamma chain, apolipoprotein H,apolipoprotein A-Ⅱ, albumin, complement C4-B,apolipoprotein C3, among others. The functional network of these proteins is posited to contribute to

关键词： percutaneous coronary intervention proteomics peptide mapping coronary atherosclerotic heart disease Traditional Chinese Medicine syndrome