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Contemporary management of complex higher-risk and indicated patients: perspectives from China

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Chinese Medical Journal 2019年第12期132卷 1387-1389页

作者： Hua Shen Yu Du Yu-Jie Zhou Department of Cardiology 12th WardBeijing Anzhen HospitalCapital Medical UniversityBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseBeijing 100029China

Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CHIP population is attracting much interest in the field of interventional cardiology, since it was introduced in 2016 by Kirtane et al,[1] and the optimal treatment strategies for this population were fiercely discussed in almost every interventional forum at home and abroad. First of all, a comprehensive risk assessment must be conducted to determine which patients with CAD should undergo revascularization based on clinical presentation, functional tests, and anatomic characteristics. Percutaneous coronary intervention (PCI) might be a beneficial option when complete revascularization can be achieved, especially for patients are either inoperable or at higher surgical risk.[2,3] To treat these high-risk patients safely and effectively with PCI, well-trained interventionalists exhibiting both technical and cognitive skills are needed.

关键词： Contemporary management complex higher-risk indicated patients

Impacts of smoking status on the clinical outcomes of coronary non-target lesions in patients with coronary heart disease:a single-center angiographic study

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Chinese Medical Journal 2020年第19期133卷 2295-2301页

作者： Hao-Bo Xu Juan Wang Ji-Lin Chen Chao Guo Jian-Song Yuan Xin Duan Feng-Huan Hu Wei-Xian Yang Xiao-Liang Luo Rong Liu Jin-Gang Cui Sheng-Wen Liu Xiao-Jin Gao Yu-Shi Chun Shu-Bin Qiao Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical SciencesBeijing 100037China

Background:coronary atherosclerotic plaque could go through rapid progression and induce adverse cardiac *** study aimed to evaluate the impacts of smoking status on clinical outcomes of coronary non-target ***:Consecutive patients with coronary heart disease who underwent two serial coronary angiographies were *** coronary non-target lesions were recorded at first coronary angiography and analyzed using quantitative coronary angiography at both *** were grouped into non-smokers,quitters,and smokers according to their smoking *** outcomes including rapid lesion progression,lesion re-vascularization,and myocardial infarction were recorded at second coronary *** Cox regression analysis was used to investigate the association between smoking status and clinical ***:A total of 1255 patients and 1670 lesions were *** were younger and more likely to be male compared with non*** in percent diameter stenosis was significantly lower(2.7[0.6,7.1]%vs.3.5[0.9,8.9]%)and 3.4[1.1,7.7]%,P=0.020)in quitters than those in smokers and *** tended to have a decreased incidence of rapid lesions progression(15.8%[76/482]vs.21.6%[74/342]and 20.6%[89/431],P=0.062),lesion re-vascularization(13.1%[63/482]vs.15.5%[53/432]and 15.5%[67/431],P=0.448),lesion-related myocardial infarction(0.8%[4/482]vs.2.6%[9/342]and 1.4%[6/431],P=0.110)and all-cause myocardial infarction(1.9%[9/482]vs.4.1%[14/342]and 2.3%[10/431],P=0.128)compared with smokers and *** multivariable analysis,smoking status was not an independent predictor for rapid lesion progression,lesion re-vascularization,and lesion-related myocardial infarction except that a higher risk of all-cause myocardial infarction was observed in smokers than non-smokers(hazards ratio:3.00,95%confidence interval:1.04-8.62,P=0.042).Conclusion:Smoking cessation mitigates the increase in percent diameter stenosis

关键词： Smoking status coronary non-target lesion Rapid progression Re-vascularization Myocardial infarction

Prognostic factors of pacing-induced cardiomyopathy

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Chinese Medical Journal 2020年第13期133卷 1533-1539页

作者： Hong Zhang Yu-Jie Zhou Yu-Jie Zeng Emergency and Critical Care center Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Department of Cardiology 12th WardBeijing Anzhen HospitalCapital Medical UniversityBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic DiseaseClinical Center for Coronary Heart DiseaseCapital Medical UniversityBeijing 100029China

Background:The detrimental outcomes of right ventricular pacing on left ventricular electromechanical function ultimately result in heart failure,a phenomenon termed pacing-induced cardiomyopathy(PICM)in clinical *** study aimed to validate prognostic factors that can be used to identify patients with higher susceptibility to progress to the stage of cardiomyopathy before pacemaker ***:This observational analysis enrolled 256 patients between January 2013 and June 2016,23(8.98%)of whom progressed to PICM after 1 year of follow-up.A Cox proportional hazard model was used to analyze the prognostic factors associated with ***-response analysis was used to evaluate the relationship between significant indicators in multifactor analysis and ***:The mean values of left ventricular ejection fraction before and after pacemaker implantation in 23 patients diagnosed with PICM were 62.3%and 42.7%,*** analysis showed that sex,atrio-ventricular block,paced QRS duration,and ventricular pacing percentage were significantly associated with *** the multivariate analysis,male sex(hazard ratio:1.20,95%confidence interval[CI]:1.09-1.33,P<0.005),paced QRS duration(hazard ratio:1.95 per 1 ms increase,95%CI:1.80-2.12,P<0.001),and ventricular pacing percentage(hazard ratio:1.65 per 1%increase,95%CI:1.51-1.79,P<0.001)were independent prognostic factors associated with the development of *** ventricular pacing percentage and paced QRS duration level defined by the dose-response analysis were positively associated with PICM(P<0.05).Conclusions:Our findings indicated that paced QRS duration and ventricular pacing percentage were the most sensitive prognostic factors for PICM.

关键词： Right ventricular pacing Pacing-induced cardiomyopathy heart failure

ST-elevated acute myocardial infarction happening 1 month post stent implantation： late thrombosis in-stents or new lesions？

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Chinese Medical Journal 2009年第14期122卷 1610-1614页

作者： SONG Guang-yuan YANG Yue-jin XU Bo LI Jian-jun GAO Run-lin QIAO Shu-bin YUAN Jin-qing TANG Yi-da YOU Shi-jie PEI Han-jun ZHAO Zhen-yan WANG Xi-mei WU Yong-jian center of coronary heart disease center of Interventional Therapy Cardiovascular Institute & Fuwai Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100037 China

Background ST-elevated acute myocardial infarction （STEAMI） happening in the first month post percutaneous coronary intervention （PCI） is almost related to acute thrombosis or subacute thrombosis in-stents. This study aimed to investigate the possible causes of myocardial infarction one month later. Methods Patients who had a history of successful PCI, and received coronary angiography or re-PCI due to STEAMI were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and acute results of last PCI were recorded. If the AMI-related lesion was localized in-stents or at the edge of stents （distance apart from the edge 〈5 mm）, it was defined to be late thrombosis; otherwise as a new-lesion induced AMI. Results One hundred and ninety-two patients aged 40-79 years were included in this study. New lesions, as the cause of STEAMI, were found in 144 patients （Group A, 75%）, and late thrombosis in 48 patients （Group B, 25%）. Almost all newly built thromboses were found at the sites of previous insignificant lesions （diameter stenosis 〈50%）. There was a significant difference in the average time from previous PCI to AMI （（30.1±12.4） vs （20.3±11.9） months） between the two groups. Diabetes mellitus （DM） and drug-eluting stent （DES） utilization were associated with markedly higher morbidity of late thrombosis in adjusted Logistic regression （hazard ratio （HR） 3.4, 95% confidence interval （C/） 1.1-10.9 and 5.3, 95% Cl 1.1-26.5）. Conclusions STEAMIs happening 1 month after PCI are more likely to develop from previous insignificant lesion rupture than from late thrombosis in-stents. Moreover, DM and DES are associated with the high incidence of late thrombosis, which may indicate that intensive antiplatelet therapy should be considered in patients with diabetes.

关键词： percutaneous coronary intervention acute myocardial infarction late thrombosis diabetes mellitus

Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous coronary Intervention

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Chinese Medical Journal 2017年第1期130卷 45-50页

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

Background： Previous studies of contrast-induced acute kidney injury （CI-AK1） were mostly based on selective percutaneous coronary intervention （PCI） cases, and risk factors of CI-AKI after emergency PCI are unclear. The aim of this study was to explore the risk factors of CI-AKi in a Chinese population undergoing emergency PCI. Methods： A total of 1061 consecutive patients undergoing emergency PCI during January 2013 and June 2015 were enrolled and divided into CI-AK1 and non-CI-AKl group. Univariable and multivariable analyses were used to identity the risk factors of CI-AKI in emergency PCI patients. CI-AKI was defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dl （44.2 μmol/L） above baseline within 3 days alter exposure to contrast medium. Results： The incidence of C1-AKI in patients undergoing emergency PCI was 22.7% （241/1061）. Logistic multivariable analysis showed that body surface area （BSA）（odds ratio [OR] 0.213, 95% confidence interval [CI]： 0.075-0.607, P = 0.004）, history, of myocardial infarction （MI）（OR 1.642, 95% CI. 1.079-2.499, P- 0.021 ）, left ventricular ejection fraction （LVEF）（OR 0.969, 95% CI： 0.944-0.994, P = 0.015）, hemoglobin （Hb）（OR 0.988, 95% CI. 0.976-1.000, P 1.018 1.037, P 〈 0.001 ）, left anterior descending （LAD） stented （OR 1 0.009 0.987, P- 0.049）, and diuretics use （OR 1.850, 95% CI： 1.233-2 0.045）, estimated glomerular filtration rate （OR 1.027, 95% CI： 464, 95% CI： 1.000 2.145, P 0.050）, aspirin （OR 0.097, 95%CI： .777, P - 0.003） were independent predictors of CI-AKI in patients undergoing emergency PCI. Conclusion： History of MI, low BSA, LVEF and Hb level, LAD stented, and diuretics use are associated with increased risk of CI-AK1 in patients undergoing emergency PCI.

关键词： Contrast-induced Acute Kidney Injury Emergency Percutaneous coronary Intervention Risk Factors

Angiography-derived radial wall strain predicts coronary lesion progression in non-culprit intermediate stenosis

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Journal of Geriatric Cardiology 2022年第12期19卷 937-948页

作者： Zhi-Qing WANG Bo XU Chun-Ming LI Chang-Dong GUAN Yue CHANG Li-Hua XIE Su ZHANG Jia-Yue HUANG Patrick W Serruys William Wijns Liang-Long CHEN Sheng-Xian TU Department of Cardiology Fujian Heart Medical CenterFujian Institute of Coronary Heart DiseaseFujian Medical University Union HospitalFujianChina Biomedical Instrument Institute School of Biomedical EngineeringShanghai Jiao Tong UniversityShanghaiChina Department of Cardiology National Clinical Research Center for Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina The Lambe Institute for Translational Medicine and Curam University of GalwayGalwayIreland

BACKGROUND Intermediate coronary lesions(ICLs)are highly prevalent but ported mixed *** strain has been associated with plaque vulnerability,yet its role in predicting lesion progression is largely *** purpose of this study was to determine the predictive value of angiography-derived radial wall strain(RWS)for progression of untreated non-culprit *** Post-hoc analysis was conducted in a study cohort including 603 consecutive patients with 808 ICLs identified at index procedure with angiographic follow-up of up to two *** analysis was performed on selected angiographic frames with minimal foreshortening and vessel *** progression was defined as≥20%increase in percent diameter *** Lesion progression occurred in 49 ICLs(6.1%)with a median follow-up period of 16.8 *** RWS(RWSmax),frequently located at the proximal and throat plaque regions,distinguished progressive ICLs from silent *** largest area under the curve value of 0.75(95%CI:0.67–0.82,P12.6%.According to this threshold,178 ICLs were classified as having a high strain *** to a high strain amplitude with RWS_(max)>12.6%was independently associated with an increased risk of lesion progression(adjusted HR=6.82,95%CI:3.67–12.66,Pcoronary angiography is feasible and provides independent prognostic value in patients with untreated ICLs.

关键词： coronary stenosis strain

Comparison of in-hospital and long-term outcomes between a Cypher stent and a Taxus stent in Chinese diabetic patients with coronary artery disease

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Chinese Medical Journal 2007年第21期120卷 1868-1873页

作者： YANG Yue-jin XU Bo KANG Sheng PEI Wei-dong CHEN Ji-lin QIAO Shu-bin QIN Xue-wen YAO Min CHEN Jue WU Yong-jian LIU Hai-bo YOU Shi-jie LI Jian-jun DAI Jun GAO Run-lin coronary heart disease center Department of Cardiology Cardiovascular Institute and Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background The sirolimus and paclitaxel distribution patterns and tissue residence time may be modified in atherosclerotic lesions for patients with diabetes, and the biological mechanisms of action for these agents differ significantly. Previous clinical trials have yielded discrepant results of major adverse cardiac events and restenosis between a sirolimus-eluting stent and a paclitaxel-eluting stent in coronary artery disease. Therefore, this study was conduced to compare in-hospital and long-term clinical outcomes between patients receiving sirolimus-eluting stent （Cypher or Cypher Select stent） and paclitaxel-eluting stent （Taxus Express stent） after percutaneous intervention （PCI） in Chinese patients with diabetes. Methods One hundred and sixty-four consecutive diabetic patients underwent PCI in Fuwai Hospital from April 2004 to December 2004. Of them, 101 patients received Cypher or Cypher Select stents （Cypher group, 145 stents） and 63 patients received Taxus Express stents （Taxus group, 129 stents）. Repeat coronary angiography was performed at 6-month and clinical outcomes were evaluated at 1- and 3-year follow-up. Stent thrombosis was classified according to Academic Research Consortium （ARC）. Results The two groups did not differ significantly with respect to cardiac death, recurrent myocardial infarction （re-MI）, target vessel revascularization （TVR） and occurrence of major adverse cardiac events （MACE）. And the MACE-free cumulative survival at 1- and 3-year follow-up and early, late and very late thrombosis rates were also similar in the two groups （all P〉0.05）. There was a trend favoring PES over SES with regard to reducing cardiac death （0 vs 2.0%, P=-0.524）, re-MI （0 vs 2.0%, P=-0.524）, the composite of the cardiac death and re-MI （0 vs 4.0%, P=-0.299） and very late thrombosis （0 vs 3.0%, P=-0.295） between 1-year and 3-year follow-up. Conclusion The study indicates that PCI with either Cypher or Taxus stents is associated with similar efficacy and s

关键词： diabetes percutaneous coronary intervention, stent outcomes

Pulmonary heart disease Associated Mortality—China,2014–2021

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China CDC weekly 2023年第35期5卷 779-784页

作者： Yangyang Xu Zhe Liu Jinlei Qi Lijun Wang Maigeng Zhou Peng Yin National center for Chronic and Noncommunicable disease Control and Prevention Chinese Center for Disease Control and PreventionBeijingChina

Introduction:Over the latter half of the previous century,pulmonary heart disease(PHD)emerged as a significant public health issue in ***,the current mortality rate is *** the Multiple Cause of Death database,the present study aims to investigate the current state and progression of PHD-associated death in ***:Data from the China National Mortality Surveillance System were used to analyze progression in mortality rates attributable to PHD from 2014 to *** standardize population structure for each year during the investigation period,demographic information from the 2020 census was employed as the reference *** mortality rates(ASMR)were determined based on sex,urban-rural area,and *** identify trends in ASMR,a joinpoint regression analysis was ***:The ASMR of PHD exhibited a marked decrease,falling from 61.68 per 100,000 in 2014 to 28.53 per 100,000 in *** downward trend was observable in both genders,all regions,and both urban and rural *** greatest ASMR values were documented in the western *** observations revealed a higher ASMR in rural areas versus urban ones and in males versus *** deaths predominantly occurred among older individuals,particularly those aged 80 and *** obstructive pulmonary disease(COPD)emerged as the principal underlying cause of death PHD-associated mortalities,accounting for between 87.41%and 93.42%of cases throughout the period 2014–***:There was a declining trend in PHD mortality in China from 2014 to 2021,with COPD accounting for a significant proportion of these *** the high prevalence of COPD and the escalating population aging in China,PHD remains a significant health concern that warrants further attention.

关键词： latter downward urban

Comparison of the incidence of late stent thrombosis after implantation of different drug-eluting stents in the real world coronary heart disease patients： three-year follow-up results

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Chinese Medical Journal 2010年第7期123卷 778-781页

作者： CHEN Ji-lin GAO Li-jian YANG Yue-jin LI Jian-jun QIAO Shu-bin XU Bo HUANG Jing-han YAO Min QIN Xue-wen LIU Hai-bo WU Yong-jian YUAN Jin-qing CHEN Jue YOU Shi-jie DAI Jun GAO Run-lin center for coronary heart disease Cardiovascular Institute & Fu Wai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China

Background Late stent thrombosis （LST） is still concerned by interventions cardiologists in daily clinical practice. This study aimed to compare the incidence of LST after implantation of different drug-eluting stents （DES） in coronary heart disease （CHD） patients in the real *** From December 2001 to February 2009, a total of 11 875 consecutive CHD patients undergone DES implantation were enrolled in this single-center registery study. Patients with acute ST-segment elevation myocardial infarction, mixed DES implantation, restenosis lesions, and patients who could not take dual antiplatlet medication and those who were contraindicated for coronary interventional treatment were excluded. All patients were treated with completed dual antiplatelet medications for at least 9 months after DES deployment. The follow-up was completed by outpatient visits, letter correspondence, phone calls and coronary angiography. Definite LST was diagnosed auording to the Academic Research Consortium （ARC） *** Cypher or Cypher Select stents were implanted in 4104 cases, Taxus or Taxus Liberty stents in 2271 cases and Firebird stents （Chinese rapamycin-eluting stents） in 5500 cases. One-year follow-up was completed in 9693 patients, including 3346 cases with Cypher or Cypher Select stents, 1529 cases with Taxus or Taxus Liberty stents and 4818 cases with Firebird stents. Two- and three-year follow-up results were obtained in 7133 and 4353 patients, respectively, including 2410 and 1760 cases with Cypher or Cypher Select stents, 1285 and 900 cases with Taxus or Taxus Liberty stents as well as 3438 and 1693 cases with Firebird stents. One-year follow-up results showed that the incidence of LST was 1.08% in patients with Cypher or Cypher Select stents, 1.24% in those with Taxus or Taxus Liberty stents and 0.71% in those with Firebird stents; there was no significant difference between those with Cypher or Cypher Select and Firebird stents, but there was significant

关键词： coronary heart disease drug-eluting stents late stent thrombosis