BACKGROUND The recently introduced ultrasonic flow ratio(UFR),is a novel fast computational method to derive fractional flow reserve(FFR)from intravascular ultrasound(IVUS)images.In the present study,we evaluate the d...BACKGROUND The recently introduced ultrasonic flow ratio(UFR),is a novel fast computational method to derive fractional flow reserve(FFR)from intravascular ultrasound(IVUS)images.In the present study,we evaluate the diagnostic performance of UFR in patients with intermediate left main(LM)stenosis.METHODS This is a prospective,single center study enrolling consecutive patients with presence of intermediated LM lesions(diameter stenosis of 30%-80%by visual estimation)underwent IVUS and FFR measurement.An independent core laboratory assessed offline UFR and IVUS-derived minimal lumen area(MLA)in a blinded fashion.RESULTS Both UFR and FFR were successfully achieved in 41 LM patients(mean age,62.0±9.9 years,46.3%diabetes).An acceptable correlation between UFR and FFR was identified(r=0.688,P<0.0001),with an absolute numerical difference of 0.03(standard difference:0.01).The area under the curve(AUC)in diagnosis of physiologically significant coronary stenosis for UFR was 0.94(95%CI:0.87-1.01),which was significantly higher than angiographic identified stenosis>50%(AUC=0.66,P<0.001)and numerically higher than IVUS-derived MLA(AUC=0.82;P=0.09).Patient level diagnostic accuracy,sensitivity and specificity for UFR to identify FFR≤0.80 was 82.9%(95%CI:70.2-95.7),93.1%(95%CI:82.2-100.0),58.3%(95%CI:26.3-90.4),respectively.CONCLUSION In patients with intermediate LM diseases,UFR was proved to be associated with acceptable correlation and high accuracy with pressure wire-based FFR as standard reference.The present study supports the use of UFR for functional evaluation of intermediate LM stenosis.展开更多
BACKGROUND The prognostic value of coronary collateral circulation(CC)in patients undergoing chronic total occlusion(CTO)percutaneous coronary intervention(PCI)is underdetermined.The purpose of the study was to assess...BACKGROUND The prognostic value of coronary collateral circulation(CC)in patients undergoing chronic total occlusion(CTO)percutaneous coronary intervention(PCI)is underdetermined.The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.METHODS We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December2013.All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC(grade 2 vs.grade 0–1)or Rentrop(grade 3 vs.grade 0–2)grading system.The primary endpoint was 5-year cardiac death.RESULTS Of 2452 enrolled patients,the overall technical success rate was 74.1%.Well-developed collaterals were present in686 patients(28.0%)defined by Werner's CC grade 2,and in 1145 patients(46.7%)by Rentrop grade 3.According to Werner's CC grading system,patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poordeveloped collaterals(1.6%vs.3.3%,P=0.02),those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization(4.7%vs.0.8%,P=0.01)and failure patients(4.7%vs.1.6%,P=0.12).However,the similar effect was not shown in Rentrop grading system.CONCLUSIONS In patients with the single-vessel CTO underwent PCI,well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac death.Werner's CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.展开更多
OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study function...OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study functioned as the development cohort,while the China Valvular Heart Disease(China-VHD)Study was employed for external validation.We included patients aged 60 years and above receiving medical treatment for moderate or severe MR(2274 patients in the development cohort and 1929 patients in the validation cohort).Candidate predictors were chosen using Cox’s proportional hazards model and stepwise selection with Akaike’s information criterion.RESULTS Eight predictors were identified:age≥75 years,body mass index<20 kg/m^(2),NYHA class Ⅲ/Ⅳ,secondary MR,anemia,estimated glomerular filtration rate<60 mL/min per 1.73 m^(2),albumin<35 g/L,and left ventricular ejection fraction<60%.The model displayed satisfactory performance in predicting one-year mortality in both the development cohort(C-statistic=0.73,95%CI:0.69-0.77,Brier score=0.06)and the validation cohort(C-statistic=0.73,95%CI:0.68-0.78,Brier score=0.06).The Elder-MR score ranges from 0 to 15 points.At a one-year follow-up,each point increase in the Elder-MR score represents a 1.27-fold risk of death(HR=1.27,95%CI:1.21-1.34,P<0.001)in the development cohort and a 1.24-fold risk of death(HR=1.24,95%CI:1.17-1.30,P<0.001)in the validation cohort.Compared to EuroSCORE II,the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort(C-statistic=0.71 vs.0.70,net reclassification improvement=0.320,P<0.01;integrated discrimination improvement=0.029,P<0.01).CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.展开更多
Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive pa...Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.展开更多
Objective To investigate the relevant factors of coronary artery disease(CAD) in young people under 40 years of age.Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital ...Objective To investigate the relevant factors of coronary artery disease(CAD) in young people under 40 years of age.Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006,including 272 men and 20 women,with the mean age being 36.7±3.7 years.The diagnosis of CAD was made in the cases presenting ≥50% stenosis in coronary lumen in coronary angiography.Based on the diagnosis,217 patients(204 men,13 women) were assigned to CAD group,and 75(68 men,7 women) to non-CAD group.Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test,χ2 test,and multinomial logistic regression with SPSS 8.0 software.Results Most study subjects were current smokers(209/292,71.6%),and more than half had body mass index(BMI)>24 kg/m2(230/292,78.8%) and usually took high-fat diet(162/292,55.5%).The proportion of heavy smokers(smoking history ≥10 years and ≥20 cigarettes per day) were significantly higher in the CAD group than in the non-CAD group [20.7%(45/217) vs.9.3%(7/75),P=0.015)].Heavy smoking [odds ratio(OR),1.89;95% confidence interval(CI),1.74-2.05],hypertension(OR,1.56;95% CI,1.48-1.65),alcohol(OR,1.37;95% CI,1.30-1.46),type 2 diabetes mellitus(OR,1.37;95% CI,1.25-1.50),high-fat diet(OR,1.35;95% CI,1.28-1.43),and BMI>24 kg/m2(OR,1.09;95% CI,1.03-1.17) were factors related to CAD in the young patients(all P<0.05).Total cholesterol(4.56±1.46 mmol/L vs.4.09±1.00 mmol/L),low-density lipoprotein cholesterol(2.38±1.11 mmol/L vs.2.14±0.63 mmol/L),lipoprotein a(134.97±109.70 mg/L vs.101.58±58.39 mg/L),uric acid(359.89±100.09 μmol/L vs.336.75±94.36 μmol/L),erythrocyte sedimentation rate(9.98±12.19 mm/hour vs.4.89±4.92 mm/hour),high-sensitivity C-reactive protein(3.42±4.39 mg/L vs.2.80±3.77 mg/L) and Big endothelin-1(1.41±1.50 fmol/mL vs.0.77±1.13 fmol/mL) in plasma were significantly increased in the CAD group compared with the non-CAD group(all P<0.05).Conclusions Heavy smoking,hypertension,alcohol consumption,type 2 diabetes mellitus,high-fat diet and BMI>24 kg/m2 were significantly related to CAD in patients aged ≤ 40,with heavy smoking presenting the highest OR.Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.展开更多
Objective To assess the aging burden of hospitalization for heart failure in Chinese populations in Macao.Methods The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure...Objective To assess the aging burden of hospitalization for heart failure in Chinese populations in Macao.Methods The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure(AHF)at Centro Hospitalar Conde de São Januário(the only public hospital that provides medical care for the approximately 600,000 residents of Macao)from January 2014 to December 2016.First,we investigated the relationship between socioeconomic development and epidemiological characteristics of HF in Macao.Then we assessed the patients’clinical features and outcomes according to the age groups.Results A total of 967 patients were included in the final analysis.The median age at admission was 82 years old.The advanced age at the admission of HF in Macao was significantly associated with a high-income level and the aging population structure.Marked heterogeneity existed in the epidemiological characteristics,clinical features,utilization of evidence-based therapies,short-and long-term outcomes,and prognostic utility of clinical variables among the different age groups.Conclusion Rapid economic development and significantly aging populations have produced a profound impact on the epidemiological characteristics of HF in Chinese populations.Acute decompensated heart failure(ADHF)is predominantly a disease of the elderly in Macao,and a significant heterogeneity exists in the clinical features,managements,and outcomes among different age groups.Age-based risk stratification models and multidisciplinary HF teams are urgently needed to improve the management and outcomes of hospitalized heart failure(HHF)patients.展开更多
BACKGROUND Percutaneous coronary intervention(PCI)in patients with unprotected left main coronary artery disease(ULMCAD)is increasing strategy in coronary artery patients.However,there is a lack of knowledge on the im...BACKGROUND Percutaneous coronary intervention(PCI)in patients with unprotected left main coronary artery disease(ULMCAD)is increasing strategy in coronary artery patients.However,there is a lack of knowledge on the impact of sex on outcomes of patients undergoing ULMCAD PCI.METHODS From January 2004 to December 2015,there were 3,960 patients undergoing ULMCAD PCI at our institution,including 3,121(78.8%)men and 839(21.2%)women.The clinical outcome included the incidence of major adverse cardiac events(MACE)(the composite of all-cause death,myocardial infarction(MI),and revascularization),all-cause death,MI,revascularization at three years follow-up.RESULTS Compared with men,women had not significantly different MACE(14.7%vs.14.6%,P=0.89),all-cause death(3.5%vs.3.7%,P=0.76),MI(5.0%vs.4.3%,P=0.38),revascularization(9.1%vs.8.9%,P=0.86),respectively.After adjustment,rates of MACE(HR=1.49;95%CI:1.24−1.81;P<0.0001)and all-cause death(HR=1.65;95%CI:1.09−2.48;P=0.017)occurred more frequently in male patients,as well as revascularization(HR=1.46;95%CI:1.16−1.85;P=0.001).CONCLUSION In this analysis,compared to men,women undergoing ULMCAD PCI have better outcomes of MACE,allcause death,and revascularization.展开更多
Background The effective orifice area(EOA)is utilized to characterize the hemodynamic performance of the transcatheter heart valve(THV).However,there is no consensus on EOA measurement of self-expanding THV.We aimed t...Background The effective orifice area(EOA)is utilized to characterize the hemodynamic performance of the transcatheter heart valve(THV).However,there is no consensus on EOA measurement of self-expanding THV.We aimed to compare two echocardiographic methods for EOA measurement following transcatheter self-expanding aortic valve implantation.Methods EOA was calculated according to the continuity equation.Two methods were constructed.In Method 1 and Method 2,the left ventricular outflow tract diameter(LVOTd)was measured at the entry of the prosthesis(from trailing-to-leading edge)and proximal to the prosthetic valve leaflets(from trailing-toleading edge),respectively.The velocity-time integral(VTI)of the LVOT(VTILVOT)was recorded by pulsed-wave Doppler(PW)from apical windows.The region of the PW sampling should match that of the LVOTd measurement with precise localization.The mean transvalvular pressure gradient(MG)and VTI of THV was measured by Continuous wave Doppler.Results A total of 113 consecutive patients were recruited.The mean age was 77.2±5.5 years,and 72 patients(63.7%)were male.EOA1 with the use of Method 1 was larger than EOA2(1.56±0.39 cm2 vs.1.48±0.41 cm2,P=0.001).MG correlated better with the indexed EOA1(EOAI1)(r=-0.701,P<0.001)than EOAI2(r=-0.645,P<0.001).According to EOAI(EOAI≤0.65 cm2/m2,respectively),the proportion of sever prosthesis-patient mismatch with the use of EOA1 was lower than EOA2(12.4%vs.21.2%,P<0.05).Compared with EOA2,EOA1 had lower interobserver and intra-observer variability(intra:0.5%±17%vs.3.8%±22%,P<0.001;inter:1.0%±9%vs.3.5%±11%,P<0.001).Conclusions For transcatheter self-expanding valve EOA measurement,LVOTd should be measured in the entry of the prosthesis stent(from trailing-to-leading edge),and VTILVOT should match that of the LVOTd measurement with precise localization.展开更多
Background:The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis(DES-ISR)have not been fully clarified.Whether there are different outcomes among those patients being irrespective ...Background:The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis(DES-ISR)have not been fully clarified.Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap.Methods:A total of 250 patients who underwent initial stent implantation in our hospital,and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved.The patients were categorized as early ISR(<12 months;E-ISR;n=32)and late ISR(≥12 months;L-ISR;n=218).Associations between patient characteristics and clinical performance,as well as clinical outcomes after a repeated percutaneous coronary intervention(PCI)were evaluated.Primary composite endpoint of major adverse cardiac events(MACEs)included cardiac death,non-fatal myocardial infarction(MI),or target lesion revascularization(TLR).Results:Most baseline characteristics are similar in both groups,except for the period of ISR,initial pre-procedure thrombolysis in myocardial infarction,and some serum biochemical indicators.The incidence of MACE(37.5%vs.5.5%;P<0.001)and TLR(37.5%vs.5.0%;P<0.001)is higher in the E-ISR group.After multivariate analysis,E-ISR(odds ratio[OR],13.267;[95%CI 4.984-35.311];P<0.001)and left ventricular systolic dysfunction(odds ratio[OR],6.317;[95%CI 1.145-34.843];P=0.034)are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months.Conclusions:Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients.The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.展开更多
Background： Percutaneous coronary intervention （PCI） through transradial approach （TRA） has shown to be safe and effective as transfemoral approach （TFA） among unselected patients. However, very few studies hav...Background： Percutaneous coronary intervention （PCI） through transradial approach （TRA） has shown to be safe and effective as transfemoral approach （TFA） among unselected patients. However, very few studies have compared the outcomes between TRA and TFA specifically in patients with a history of coronary artery bypass grafting surgery （CABG）, Methods： A total of 404 post-CABG patients who had undergone angiography or PCI were included in the study. The primary endpoint was defined as angiographic success and procedure success. The secondary endpoint was defined as in-hospital net adverse clinical events （NACEs）, which included all cause of death, myocardial infarction （MI）, stroke, repeat revascularization, and major bleeding. Patients were followed-up for 1-year. Major adverse cardiovascular events （MACEs）, which included death, MI, and repeat revascularization, at 1-year follow-up were also compared. Results： The angiographic success was reached by 97.4% in the TRA group compared with 100% in the TFA group （P = 0.02）. The procedure success was achieved in 99.1% in the TRA group and 97.9% in the TFA group （P = 0.68）. The incidence rates of in-hospital NACE （2.7% vs. 2.7%, P = 1.00） and l-year MACE （ 11.5% vs. 12.0%, P = 0.88） were similar between TRA and TFA. Meanwhile, TRA was associated with a lower rate of Bleeding Academic Research Consortium 〉2 bleeding （P = 0.02）. In patients undergoing graft PCI, the procedure success was similar between TRA and TFA （100.0% vs. 98.7%, P = 1.00）. The procedure time （25.0 min vs. 27.5 rain, P = 0.53） was also similar. No significant difference was detected between TRA and TFA in terms of in-hospital NACE （0 vs. 0, P = 1.00） and l-year MACE （21.4% vs. 10.3%, P = 0.19）. Conclusions： Compared with TFA, TRA had lower angiographic success but had a similar procedure success in post-CABG patients. TRA was also associated with decreased bleeding and shortened hospital stay.展开更多
Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score i...Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score is a comprehensive system to evaluate the complexity of the overall lesions.We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease(CAD).Methods::In this single-center,historical control study,patients with stable CAD with coronary lesion stenosis≥50%were consecutively recruited.During the control period,SYNTAX scores were calculated by treating cardiologists.During the intervention period,SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making.The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results::A total of 3245 patients were enrolled and assigned to the control group(08/2016-03/2017,n=1525)or the intervention group(03/2017-09/2017,n=1720).For SYNTAX score tertiles,17.9%patients were overestimated and 4.3%were underestimated by cardiologists in the control group.After adjustment,inappropriate revascularization significantly decreased in the intervention group compared with the control group(adjusted odds ratio[OR]:0.83;95%confidence interval[CI]:0.73-0.95;P=0.007).Both inappropriate percutaneous coronary intervention(adjusted OR:0.82;95%CI:0.74-0.92;P<0.001)and percutaneous coronary intervention utilization(adjusted OR:0.88;95%CI:0.79-0.98;P=0.016)decreased significantly in the intervention group.There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions::Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration::Nos.NCT03068858 and NCT02880605;https://www.clinicaltrials.gov.展开更多
Background： Whether final kissing balloon （FKB） dilatation after one-stent implantation at left-main （LM） bifurcation site remains unclear, Therefore, this large sample and long-tent1 follow-up study comparativel...Background： Whether final kissing balloon （FKB） dilatation after one-stent implantation at left-main （LM） bifurcation site remains unclear, Therefore, this large sample and long-tent1 follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy. Methods： Total 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled： among them, 790 patients treated with one drug-eluting stent crossover LM to left anterior descending （LAD） with FKB （n = 230） or no FKB （n = 560） were comparatively analyzed. Primary outcome was the rate of major adverse cardiovascular events, defined as a composite of death, myocardial infarction （MI） and target vessel revascularization （TVR）. Results： Overall, The prevalence of true bifurcation lesions, which included Medina classification （1,1,1）, （1,0,1）, or （0,1,1）, was similar between-groups （non-FKB： 37.0% vs. FKB： 39.6%, P = 0.49）. At mean 4 years follow-up, rates of major adverse cardiovascular events （non-FKB： 10.0% vs. FKB： 7.8%, P = 0.33）, death, MI and TVR were not significantly different between-groups. In multivariate propensity-matched regression analysis, FKB was not an independent predictor of adverse outcomes. Conclusions： For patients treated with one-stent crossover LM to LAD, clinical outcomes appear similar between FKB and non-FKB strategy.展开更多
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 appropr...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.展开更多
基金supported by CAMS Innovation Fund for Medical Sciences(CIFMS)(2022–12M-C&TB-043).
文摘BACKGROUND The recently introduced ultrasonic flow ratio(UFR),is a novel fast computational method to derive fractional flow reserve(FFR)from intravascular ultrasound(IVUS)images.In the present study,we evaluate the diagnostic performance of UFR in patients with intermediate left main(LM)stenosis.METHODS This is a prospective,single center study enrolling consecutive patients with presence of intermediated LM lesions(diameter stenosis of 30%-80%by visual estimation)underwent IVUS and FFR measurement.An independent core laboratory assessed offline UFR and IVUS-derived minimal lumen area(MLA)in a blinded fashion.RESULTS Both UFR and FFR were successfully achieved in 41 LM patients(mean age,62.0±9.9 years,46.3%diabetes).An acceptable correlation between UFR and FFR was identified(r=0.688,P<0.0001),with an absolute numerical difference of 0.03(standard difference:0.01).The area under the curve(AUC)in diagnosis of physiologically significant coronary stenosis for UFR was 0.94(95%CI:0.87-1.01),which was significantly higher than angiographic identified stenosis>50%(AUC=0.66,P<0.001)and numerically higher than IVUS-derived MLA(AUC=0.82;P=0.09).Patient level diagnostic accuracy,sensitivity and specificity for UFR to identify FFR≤0.80 was 82.9%(95%CI:70.2-95.7),93.1%(95%CI:82.2-100.0),58.3%(95%CI:26.3-90.4),respectively.CONCLUSION In patients with intermediate LM diseases,UFR was proved to be associated with acceptable correlation and high accuracy with pressure wire-based FFR as standard reference.The present study supports the use of UFR for functional evaluation of intermediate LM stenosis.
文摘BACKGROUND The prognostic value of coronary collateral circulation(CC)in patients undergoing chronic total occlusion(CTO)percutaneous coronary intervention(PCI)is underdetermined.The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.METHODS We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December2013.All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC(grade 2 vs.grade 0–1)or Rentrop(grade 3 vs.grade 0–2)grading system.The primary endpoint was 5-year cardiac death.RESULTS Of 2452 enrolled patients,the overall technical success rate was 74.1%.Well-developed collaterals were present in686 patients(28.0%)defined by Werner's CC grade 2,and in 1145 patients(46.7%)by Rentrop grade 3.According to Werner's CC grading system,patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poordeveloped collaterals(1.6%vs.3.3%,P=0.02),those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization(4.7%vs.0.8%,P=0.01)and failure patients(4.7%vs.1.6%,P=0.12).However,the similar effect was not shown in Rentrop grading system.CONCLUSIONS In patients with the single-vessel CTO underwent PCI,well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac death.Werner's CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.
基金supported by the National Key R&D Program of China(No.2020YFC2008100).
文摘OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study functioned as the development cohort,while the China Valvular Heart Disease(China-VHD)Study was employed for external validation.We included patients aged 60 years and above receiving medical treatment for moderate or severe MR(2274 patients in the development cohort and 1929 patients in the validation cohort).Candidate predictors were chosen using Cox’s proportional hazards model and stepwise selection with Akaike’s information criterion.RESULTS Eight predictors were identified:age≥75 years,body mass index<20 kg/m^(2),NYHA class Ⅲ/Ⅳ,secondary MR,anemia,estimated glomerular filtration rate<60 mL/min per 1.73 m^(2),albumin<35 g/L,and left ventricular ejection fraction<60%.The model displayed satisfactory performance in predicting one-year mortality in both the development cohort(C-statistic=0.73,95%CI:0.69-0.77,Brier score=0.06)and the validation cohort(C-statistic=0.73,95%CI:0.68-0.78,Brier score=0.06).The Elder-MR score ranges from 0 to 15 points.At a one-year follow-up,each point increase in the Elder-MR score represents a 1.27-fold risk of death(HR=1.27,95%CI:1.21-1.34,P<0.001)in the development cohort and a 1.24-fold risk of death(HR=1.24,95%CI:1.17-1.30,P<0.001)in the validation cohort.Compared to EuroSCORE II,the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort(C-statistic=0.71 vs.0.70,net reclassification improvement=0.320,P<0.01;integrated discrimination improvement=0.029,P<0.01).CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.
文摘Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.
文摘Objective To investigate the relevant factors of coronary artery disease(CAD) in young people under 40 years of age.Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006,including 272 men and 20 women,with the mean age being 36.7±3.7 years.The diagnosis of CAD was made in the cases presenting ≥50% stenosis in coronary lumen in coronary angiography.Based on the diagnosis,217 patients(204 men,13 women) were assigned to CAD group,and 75(68 men,7 women) to non-CAD group.Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test,χ2 test,and multinomial logistic regression with SPSS 8.0 software.Results Most study subjects were current smokers(209/292,71.6%),and more than half had body mass index(BMI)>24 kg/m2(230/292,78.8%) and usually took high-fat diet(162/292,55.5%).The proportion of heavy smokers(smoking history ≥10 years and ≥20 cigarettes per day) were significantly higher in the CAD group than in the non-CAD group [20.7%(45/217) vs.9.3%(7/75),P=0.015)].Heavy smoking [odds ratio(OR),1.89;95% confidence interval(CI),1.74-2.05],hypertension(OR,1.56;95% CI,1.48-1.65),alcohol(OR,1.37;95% CI,1.30-1.46),type 2 diabetes mellitus(OR,1.37;95% CI,1.25-1.50),high-fat diet(OR,1.35;95% CI,1.28-1.43),and BMI>24 kg/m2(OR,1.09;95% CI,1.03-1.17) were factors related to CAD in the young patients(all P<0.05).Total cholesterol(4.56±1.46 mmol/L vs.4.09±1.00 mmol/L),low-density lipoprotein cholesterol(2.38±1.11 mmol/L vs.2.14±0.63 mmol/L),lipoprotein a(134.97±109.70 mg/L vs.101.58±58.39 mg/L),uric acid(359.89±100.09 μmol/L vs.336.75±94.36 μmol/L),erythrocyte sedimentation rate(9.98±12.19 mm/hour vs.4.89±4.92 mm/hour),high-sensitivity C-reactive protein(3.42±4.39 mg/L vs.2.80±3.77 mg/L) and Big endothelin-1(1.41±1.50 fmol/mL vs.0.77±1.13 fmol/mL) in plasma were significantly increased in the CAD group compared with the non-CAD group(all P<0.05).Conclusions Heavy smoking,hypertension,alcohol consumption,type 2 diabetes mellitus,high-fat diet and BMI>24 kg/m2 were significantly related to CAD in patients aged ≤ 40,with heavy smoking presenting the highest OR.Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.
文摘Objective To assess the aging burden of hospitalization for heart failure in Chinese populations in Macao.Methods The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure(AHF)at Centro Hospitalar Conde de São Januário(the only public hospital that provides medical care for the approximately 600,000 residents of Macao)from January 2014 to December 2016.First,we investigated the relationship between socioeconomic development and epidemiological characteristics of HF in Macao.Then we assessed the patients’clinical features and outcomes according to the age groups.Results A total of 967 patients were included in the final analysis.The median age at admission was 82 years old.The advanced age at the admission of HF in Macao was significantly associated with a high-income level and the aging population structure.Marked heterogeneity existed in the epidemiological characteristics,clinical features,utilization of evidence-based therapies,short-and long-term outcomes,and prognostic utility of clinical variables among the different age groups.Conclusion Rapid economic development and significantly aging populations have produced a profound impact on the epidemiological characteristics of HF in Chinese populations.Acute decompensated heart failure(ADHF)is predominantly a disease of the elderly in Macao,and a significant heterogeneity exists in the clinical features,managements,and outcomes among different age groups.Age-based risk stratification models and multidisciplinary HF teams are urgently needed to improve the management and outcomes of hospitalized heart failure(HHF)patients.
文摘BACKGROUND Percutaneous coronary intervention(PCI)in patients with unprotected left main coronary artery disease(ULMCAD)is increasing strategy in coronary artery patients.However,there is a lack of knowledge on the impact of sex on outcomes of patients undergoing ULMCAD PCI.METHODS From January 2004 to December 2015,there were 3,960 patients undergoing ULMCAD PCI at our institution,including 3,121(78.8%)men and 839(21.2%)women.The clinical outcome included the incidence of major adverse cardiac events(MACE)(the composite of all-cause death,myocardial infarction(MI),and revascularization),all-cause death,MI,revascularization at three years follow-up.RESULTS Compared with men,women had not significantly different MACE(14.7%vs.14.6%,P=0.89),all-cause death(3.5%vs.3.7%,P=0.76),MI(5.0%vs.4.3%,P=0.38),revascularization(9.1%vs.8.9%,P=0.86),respectively.After adjustment,rates of MACE(HR=1.49;95%CI:1.24−1.81;P<0.0001)and all-cause death(HR=1.65;95%CI:1.09−2.48;P=0.017)occurred more frequently in male patients,as well as revascularization(HR=1.46;95%CI:1.16−1.85;P=0.001).CONCLUSION In this analysis,compared to men,women undergoing ULMCAD PCI have better outcomes of MACE,allcause death,and revascularization.
文摘Background The effective orifice area(EOA)is utilized to characterize the hemodynamic performance of the transcatheter heart valve(THV).However,there is no consensus on EOA measurement of self-expanding THV.We aimed to compare two echocardiographic methods for EOA measurement following transcatheter self-expanding aortic valve implantation.Methods EOA was calculated according to the continuity equation.Two methods were constructed.In Method 1 and Method 2,the left ventricular outflow tract diameter(LVOTd)was measured at the entry of the prosthesis(from trailing-to-leading edge)and proximal to the prosthetic valve leaflets(from trailing-toleading edge),respectively.The velocity-time integral(VTI)of the LVOT(VTILVOT)was recorded by pulsed-wave Doppler(PW)from apical windows.The region of the PW sampling should match that of the LVOTd measurement with precise localization.The mean transvalvular pressure gradient(MG)and VTI of THV was measured by Continuous wave Doppler.Results A total of 113 consecutive patients were recruited.The mean age was 77.2±5.5 years,and 72 patients(63.7%)were male.EOA1 with the use of Method 1 was larger than EOA2(1.56±0.39 cm2 vs.1.48±0.41 cm2,P=0.001).MG correlated better with the indexed EOA1(EOAI1)(r=-0.701,P<0.001)than EOAI2(r=-0.645,P<0.001).According to EOAI(EOAI≤0.65 cm2/m2,respectively),the proportion of sever prosthesis-patient mismatch with the use of EOA1 was lower than EOA2(12.4%vs.21.2%,P<0.05).Compared with EOA2,EOA1 had lower interobserver and intra-observer variability(intra:0.5%±17%vs.3.8%±22%,P<0.001;inter:1.0%±9%vs.3.5%±11%,P<0.001).Conclusions For transcatheter self-expanding valve EOA measurement,LVOTd should be measured in the entry of the prosthesis stent(from trailing-to-leading edge),and VTILVOT should match that of the LVOTd measurement with precise localization.
基金In this study,we are grateful to the Department of Cardiology,Cardiovascular Instimte of Fuwai Hospital for its help in recruiting patients.We thank all members who contributed to the study.
文摘Background:The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis(DES-ISR)have not been fully clarified.Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap.Methods:A total of 250 patients who underwent initial stent implantation in our hospital,and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved.The patients were categorized as early ISR(<12 months;E-ISR;n=32)and late ISR(≥12 months;L-ISR;n=218).Associations between patient characteristics and clinical performance,as well as clinical outcomes after a repeated percutaneous coronary intervention(PCI)were evaluated.Primary composite endpoint of major adverse cardiac events(MACEs)included cardiac death,non-fatal myocardial infarction(MI),or target lesion revascularization(TLR).Results:Most baseline characteristics are similar in both groups,except for the period of ISR,initial pre-procedure thrombolysis in myocardial infarction,and some serum biochemical indicators.The incidence of MACE(37.5%vs.5.5%;P<0.001)and TLR(37.5%vs.5.0%;P<0.001)is higher in the E-ISR group.After multivariate analysis,E-ISR(odds ratio[OR],13.267;[95%CI 4.984-35.311];P<0.001)and left ventricular systolic dysfunction(odds ratio[OR],6.317;[95%CI 1.145-34.843];P=0.034)are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months.Conclusions:Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients.The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.
文摘Background： Percutaneous coronary intervention （PCI） through transradial approach （TRA） has shown to be safe and effective as transfemoral approach （TFA） among unselected patients. However, very few studies have compared the outcomes between TRA and TFA specifically in patients with a history of coronary artery bypass grafting surgery （CABG）, Methods： A total of 404 post-CABG patients who had undergone angiography or PCI were included in the study. The primary endpoint was defined as angiographic success and procedure success. The secondary endpoint was defined as in-hospital net adverse clinical events （NACEs）, which included all cause of death, myocardial infarction （MI）, stroke, repeat revascularization, and major bleeding. Patients were followed-up for 1-year. Major adverse cardiovascular events （MACEs）, which included death, MI, and repeat revascularization, at 1-year follow-up were also compared. Results： The angiographic success was reached by 97.4% in the TRA group compared with 100% in the TFA group （P = 0.02）. The procedure success was achieved in 99.1% in the TRA group and 97.9% in the TFA group （P = 0.68）. The incidence rates of in-hospital NACE （2.7% vs. 2.7%, P = 1.00） and l-year MACE （ 11.5% vs. 12.0%, P = 0.88） were similar between TRA and TFA. Meanwhile, TRA was associated with a lower rate of Bleeding Academic Research Consortium 〉2 bleeding （P = 0.02）. In patients undergoing graft PCI, the procedure success was similar between TRA and TFA （100.0% vs. 98.7%, P = 1.00）. The procedure time （25.0 min vs. 27.5 rain, P = 0.53） was also similar. No significant difference was detected between TRA and TFA in terms of in-hospital NACE （0 vs. 0, P = 1.00） and l-year MACE （21.4% vs. 10.3%, P = 0.19）. Conclusions： Compared with TFA, TRA had lower angiographic success but had a similar procedure success in post-CABG patients. TRA was also associated with decreased bleeding and shortened hospital stay.
基金This work was supported by grants from the Capital’S Funds for Health Improvement and Research(No.2016-1-4031)National Key Research and Development Program(No.2016YFC1302000)Beijing Municipal Commission of Science and Technology Project(No.D171100002917001).
文摘Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score is a comprehensive system to evaluate the complexity of the overall lesions.We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease(CAD).Methods::In this single-center,historical control study,patients with stable CAD with coronary lesion stenosis≥50%were consecutively recruited.During the control period,SYNTAX scores were calculated by treating cardiologists.During the intervention period,SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making.The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results::A total of 3245 patients were enrolled and assigned to the control group(08/2016-03/2017,n=1525)or the intervention group(03/2017-09/2017,n=1720).For SYNTAX score tertiles,17.9%patients were overestimated and 4.3%were underestimated by cardiologists in the control group.After adjustment,inappropriate revascularization significantly decreased in the intervention group compared with the control group(adjusted odds ratio[OR]:0.83;95%confidence interval[CI]:0.73-0.95;P=0.007).Both inappropriate percutaneous coronary intervention(adjusted OR:0.82;95%CI:0.74-0.92;P<0.001)and percutaneous coronary intervention utilization(adjusted OR:0.88;95%CI:0.79-0.98;P=0.016)decreased significantly in the intervention group.There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions::Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration::Nos.NCT03068858 and NCT02880605;https://www.clinicaltrials.gov.
文摘Background： Whether final kissing balloon （FKB） dilatation after one-stent implantation at left-main （LM） bifurcation site remains unclear, Therefore, this large sample and long-tent1 follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy. Methods： Total 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled： among them, 790 patients treated with one drug-eluting stent crossover LM to left anterior descending （LAD） with FKB （n = 230） or no FKB （n = 560） were comparatively analyzed. Primary outcome was the rate of major adverse cardiovascular events, defined as a composite of death, myocardial infarction （MI） and target vessel revascularization （TVR）. Results： Overall, The prevalence of true bifurcation lesions, which included Medina classification （1,1,1）, （1,0,1）, or （0,1,1）, was similar between-groups （non-FKB： 37.0% vs. FKB： 39.6%, P = 0.49）. At mean 4 years follow-up, rates of major adverse cardiovascular events （non-FKB： 10.0% vs. FKB： 7.8%, P = 0.33）, death, MI and TVR were not significantly different between-groups. In multivariate propensity-matched regression analysis, FKB was not an independent predictor of adverse outcomes. Conclusions： For patients treated with one-stent crossover LM to LAD, clinical outcomes appear similar between FKB and non-FKB strategy.
文摘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.
