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
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
OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METH...OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort.RESULTS In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration(Hosmer–Lemeshow χ^(2)= 7.070;P = 0.529) for predicting 2-year patient-oriented composite endpoint(POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P < 0.01) after stratified the patients into high-risk group and low-risk group.CONCLUSIONS An improved scoring system combining clinical and coronary lesion-based functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological index and other commonly used risk scores.展开更多
Cardiac catheterization and percutaneous coronary intervention play an important role in the management of coronary artery disease.Although the transfemoral approach has been the traditionally dominant method,there ha...Cardiac catheterization and percutaneous coronary intervention play an important role in the management of coronary artery disease.Although the transfemoral approach has been the traditionally dominant method,there has been an increased utilization of the transradial approach.Multiple observational studies and randomized clinical trials have shown fewer bleeding complications,reduced morbidity and mortality,improved quality of life,and better economic outcomes when the transradial approach is utilized when compared to the transfemoral approach.Despite its many benefits,utilization of this approach in certain countries including the United States has been less than optimal due to a lower adoption rates mostly driven by lack of training opportunities and decreased awareness of clinical benefits of the transradial approach.In this review,the history,observational trends,efficacy,and technical aspects of transradial cardiac catheterization and percutaneous coronary intervention are discussed.展开更多
Acute ST-elevation myocardial infarction(STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator,which ...Acute ST-elevation myocardial infarction(STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator,which is mostly proportional to their size and composition. Particularly,intracoronary thrombi impair both epicardial blood flow and myocardial perfusion,by occluding major coronary arteries and causing distal embolization,respectively. Thus,although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting,the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients,by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used inthe setting of STEMI to manage thrombotic lesions.展开更多
Patients on oral anticoagulation(OAC),who are referred for coronary artery stenting account for about 5% of the whole population undergoing percutaneous coronary intervention(PCI).Although relatively small,this patien...Patients on oral anticoagulation(OAC),who are referred for coronary artery stenting account for about 5% of the whole population undergoing percutaneous coronary intervention(PCI).Although relatively small,this patient subset poses particular problems owing to the need to balance carefully the risk of bleeding against the risk of stent thrombosis and thromboembolism.Triple therapy(TT) of OAC,aspirin and clopidogrel appears as the most effective for prevention of stent thrombosis and thromboembolism.However,an increased incidence of major bleeding is to be expected during follow-up.Therefore,TT should be prolonged for as short a time as possible,and implantation of drug-eluting stents avoided.Frequent monitoring of international normalized ratio is also warranted,and the intensity of OAC should be targeted at the lower limit of the therapeutic range.Gastric protection should also be considered for all patients on medium-to long-term TT,owing to the observed highest incidence of bleeding at the gastrointestinal site.Peri-procedural management is cumbersome,and a substantial incidence of inhospital major bleeding has been reported.Since this latter is more related to procedural variables than to TT itself,choice of radial access,avoidance of glycoprotein Ⅱb/Ⅲa inhibitors,and preference for not interrupting effective OAC should be implemented.However,the evidence on which the recommendations for managing this patient subset are based is limited and of relative poor quality.While waiting for the results of ongoing,large prospective studies that are aimed at conclusively determining optimal medium-to long-term antithrombotic treatment,the official recommendations issued by the Working Group on Thrombosis of the European Society of Cardiology on the management of patients on OAC undergoing PCI with stenting should followed.展开更多
BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood...BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood subject of mech-anisms and predictors for HAVB in BAV self-expandable TAVI patients.METHODS We retrospectively included 181 BAV patients for analysis.Using computed tomography data,the curvature of ascending aorta(AAo)was quantified by the angle(AAo angle)between annulus and the cross-section at 35 mm above annulus(where the stent interacts with AAo the most).The valvular anatomy and leaflet calcification were also characterized.RESULTS The 30-day HAVB rate was 16.0%(median time to HAVB was three days).Type-1 morphology was found in 79 pat-ients(43.6%)(left-and right-coronary cusps fusion comprised 79.7%).Besides implantation below membrane septum,large AAo angle[odds ratio(OR)=1.08,P=0.016]and type-1 morphology(OR=4.97,P=0.001)were found as the independent predictors for HAVB.Together with baseline right bundle branch block,these predictors showed strong predictability for HAVB with area under the cure of 0.84(sensitivity=62.1%,specificity=92.8%).Bent AAo and calcified raphe had a synergistic effect in facilita-ting high implantation,though the former is associated with at-risk deployment(device implanted above annulus+prothesis pop-out,versus straight AAo:9.9%vs.2.2%,P=0.031).CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI.For patients with bent AAo or calcified raphe,a progressive approach to implant the device above the lower edge of membrane septum is favored,though should be done cautiously to avoid pop-out.展开更多
Background Triple therapy(TT)with vitamin K-antagonists(VKA),aspirin and clopidogrel is the recommended antithrombotic treatment following percutaneous coronary intervention with stent implantation(PCI-S)in patients w...Background Triple therapy(TT)with vitamin K-antagonists(VKA),aspirin and clopidogrel is the recommended antithrombotic treatment following percutaneous coronary intervention with stent implantation(PCI-S)in patients with an indication for oral anticoagulation.TT is associated with an increased risk of bleeding,but available evidence is flawed by important limitations,including the limited size and the retrospective design of most of the studies,as well as the rare reporting of the incidence of in-hospital bleeding and the treatment which was actually ongoing at the time of bleeding.Since the perceived high bleeding risk of TT may deny patients effective strategies,the determination of the true safety profile of TT is of paramount importance.Methods All the 27 published studies where the incidence of bleeding at various time points during follow-up has been reported separately for patients on TT were reviewed,and the weakness of the data was analyzed.Results The absolute incidence of major bleeding upon discharge at in-hospital,≤1 month,6 months,12 months and≥12 months was:3.3%±1.9%,5.1%±6.7%,8.0%±5.2%,9.0%±8.0,and 6.2%±7.8%,respectively,and not substantially different from that observed in previous studies with prolonged dual antiplatelet treatment with aspirin and clopidogrel.Conclusions While waiting for the ongoing,large-scale,registries and clinical trials to clarify the few facts and to answer the many questions regarding the risk of bleeding of TT,this treatment should not be denied to patients with an indication for VKA undergoing PCI-S provided that the proper measures and cautions are implemented.展开更多
Persons aged 80 and above are the fastest growing age group in the United States population, having increased 50% since 1990 and predicted to grow another 25% by 2020.
1Introducfion Peripheral arterial disease (PAD)is the consequence of atherosclerosis in the arteries of carotid,vertebral,abdominal mesenteric,renal,and extremity arteries with a prevalence increasing with.Carotid Occ...1Introducfion Peripheral arterial disease (PAD)is the consequence of atherosclerosis in the arteries of carotid,vertebral,abdominal mesenteric,renal,and extremity arteries with a prevalence increasing with.Carotid Occlusive disease is one of the most common site for atherosclerosis development:Endoatherec- tomy and Carotid artery stenting (CAS)have been shown to achieve similar outcomes and costst[1,2]especially in high-risk patients as very often elderly patients with multiple athero- sclerotic localizations are.The performance of supraaortic diagnostic and interventional procedures via the radial artery (RA)is growing all over the world thanks to lower risk of access site complications,lower chance to embolizing de- bries by touching the aortic arch,lower costs,and increased patient comfort compared to the traditional transfemoral approach (TFA).[3,4]The aim of this paper is to describe the potentiality the TRA can offer in the peripheral interventions of supra-aortic arteries in the elderly.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
The very elderly patient population (＞80 years) represents a rapidly increasing segment of our demographics,a consequence of the longer life expectancy and aging of the 'baby boom' generation. Coronary artery...The very elderly patient population (＞80 years) represents a rapidly increasing segment of our demographics,a consequence of the longer life expectancy and aging of the 'baby boom' generation. Coronary artery disease remains a major cause of mortality and morbidity among octogenarians with an estimated 30% of them having symptomatic heart disease and 50% eventually dying from it.展开更多
Objective:This study was aimed at investigating the effects of preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse ev...Objective:This study was aimed at investigating the effects of preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in patients with ST-segment elevation myocardial infarction(STEMI).Method:Sixty-five patients with STEMI who had visited the Shanxi Cardiovascular Disease Hospital between May 2018 and May 2021 were enrolled in the study.The enrolled patients had no history of oral statins or antiplatelet therapy.The patients were divided into a combined treatment group(loading dose of statins combined with PCSK9 inhibitors,35 patients)and a routine treatment group(loading dose of statins only,30 patients).The primary endpoints were thrombolysis in myocardial infarction(TIMI)blood flow grading,corrected TIMI frame count(CTFC),and TIMI myocardial perfusion grading(TMPG),immediately after and 30 days after the operation.The secondary endpoint was a composite endpoint of cardiovascular death,nonfatal myocardial infarction,and target vessel revascularization 30 days after the operation.Results:The combined treatment group had significantly lower CTFC(14.09±8.42 vs 26±12.42,P=0.04)and better TMPG(2.74±0.61 vs 2.5±0.73,P=0.04)than the routine treatment group immediately after the operation.Similarly,the combined treatment group had a significantly lower CTFC(16.29±7.39 vs 26.23±11.53,P=0.04)and significantly better TMPG(2.94±0.24 vs 2.76±0.43,P=0.01)than the routine treatment group 1 month after the operation.Conclusion:Preoperative treatment with a loading dose of high-intensity statins combined with PCSK9 inhibitors increased coronary blood flow and myocardial perfusion after emergency thrombus aspiration in patients with STEMI.However,the treatment did not significantly decrease the incidence of cardiovascular death,nonfatal myocardial infarction,or target vessel revascularization.展开更多
OBJECTIVES: The purpose of the SCANDSTENT study was to evaluate the use of sirolimus-eluting stents(SES) in complex coronary lesions. BACKGROUND: The use of SES improves angiographic and clinical outcomes compared wit...OBJECTIVES: The purpose of the SCANDSTENT study was to evaluate the use of sirolimus-eluting stents(SES) in complex coronary lesions. BACKGROUND: The use of SES improves angiographic and clinical outcomes compared with bare-metal stents(BMS) in simple coronary artery lesions, but there is limited evidence of their safety and efficacy when implanted in complex lesions. METHODS: We randomly assigned 322 patients with symptomatic complex coronary artery disease to receive either SES or BMS. The lesions were occluded(36% ), bifurcational(34% ), ostial(22% ), or angulated(8% ) in morphology. The primary end point was the difference in minimal lumen diameter six months after stent implantation. RESULTS: The patients were well matched in terms of demographic and angiographic baseline characteristics; 18% had diabetes. The reference vessel diameter was 2.86 mm in mean, and the lesion length 18.0 mm. At follow-up, patients who received SES had a minimal lumen diameter of 2.48 mm compared with 1.65 mm in those who received BMS(p< 0.001), a diameter stenosis of 19.3% versus 43.8% (p< 0.001), and 2.0% versus 31.9% developed restenosis(p< 0.001). The rate of major adverse cardiac events was 4.3% with SES versus 29.3% with BMS(p< 0.001), and stent thrombosis was observed in 0.6% in the SES group versus 3.1% in the BMS group(p=0.15). CONCLUSIONS: The use of SES markedly reduced restenosis and the occurrence of major adverse cardiac events in patients with complex coronary artery lesions without increasing the risk of stent thrombosis.展开更多
Background: Diabetes increases the risk of developing cardiovascular disease. Patients with diabetes undergoing percutaneous coronary intervention(PCI) show poorer outcomes compared with nondiabetic patients. The aim ...Background: Diabetes increases the risk of developing cardiovascular disease. Patients with diabetes undergoing percutaneous coronary intervention(PCI) show poorer outcomes compared with nondiabetic patients. The aim of this study was to determine the clinical benefit of long-term fluvastatin in patients with diabetes who had undergone a successful PCI. Methods: This subanalysis of a prospective, multicenter, randomized, double-blind, placebo-con-trolled trial of patients who had undergone PCI and were treated with fluvastatin determined the impact of fluvastatin on the survival-free period of major adverse cardiac events(MACE)(defined as cardiac death, nonfatal myocardial infarction, and reintervention procedure[coronary artery bypass grafting, repeat PCI, PCI for a new lesion]). Patients with baseline total cholesterol levels of 135 to 270 mg/dL(3.5-7.0 mmol/L) and triglyceride levels of 400 mg/dL(4.5 mmol/L) were randomized at discharge either to fluvastatin(n=844) or to placebo(n=833); follow-up was 3 to 4 years. Among these patients, there were 202 with diabetes(120 on fluvastatin, 82 placebo) and 1475 without diabetes(724 on fluvastatin, 751 on placebo). The primary clinical outcome was survival time free of MACE and MACE excluding restenosis. Results: The presence of diabetes increased the risk of MACE by almost 2-fold in placebo-treated patients(RR 1.78, 95%CI 1.20-2,64, P=.0045). In contrast, in diabetic patients treated with fluvastatin, the risk of MACE was not significantly different from that in patients without diabetes. Fluvastatin reduced the risk of MACE in diabetic patients by 51%(P=.0088). Conclusions: Diabetes is a consistent clinical predictor of cardiovascular complications and fluvastatin reduces the increased incidence of long-term adverse complications associated with the presence of diabetes.展开更多
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 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.
基金sponsored by Sino Medical,Tianjin,Chinasupported by the Beijing Municipal Science and Technology Project[Z191100006619107 to B.X.]Capital Health Development Research Project[20201–4032 to K.D.].
文摘OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort.RESULTS In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration(Hosmer–Lemeshow χ^(2)= 7.070;P = 0.529) for predicting 2-year patient-oriented composite endpoint(POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P < 0.01) after stratified the patients into high-risk group and low-risk group.CONCLUSIONS An improved scoring system combining clinical and coronary lesion-based functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological index and other commonly used risk scores.
文摘Cardiac catheterization and percutaneous coronary intervention play an important role in the management of coronary artery disease.Although the transfemoral approach has been the traditionally dominant method,there has been an increased utilization of the transradial approach.Multiple observational studies and randomized clinical trials have shown fewer bleeding complications,reduced morbidity and mortality,improved quality of life,and better economic outcomes when the transradial approach is utilized when compared to the transfemoral approach.Despite its many benefits,utilization of this approach in certain countries including the United States has been less than optimal due to a lower adoption rates mostly driven by lack of training opportunities and decreased awareness of clinical benefits of the transradial approach.In this review,the history,observational trends,efficacy,and technical aspects of transradial cardiac catheterization and percutaneous coronary intervention are discussed.
文摘Acute ST-elevation myocardial infarction(STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator,which is mostly proportional to their size and composition. Particularly,intracoronary thrombi impair both epicardial blood flow and myocardial perfusion,by occluding major coronary arteries and causing distal embolization,respectively. Thus,although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting,the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients,by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used inthe setting of STEMI to manage thrombotic lesions.
文摘Patients on oral anticoagulation(OAC),who are referred for coronary artery stenting account for about 5% of the whole population undergoing percutaneous coronary intervention(PCI).Although relatively small,this patient subset poses particular problems owing to the need to balance carefully the risk of bleeding against the risk of stent thrombosis and thromboembolism.Triple therapy(TT) of OAC,aspirin and clopidogrel appears as the most effective for prevention of stent thrombosis and thromboembolism.However,an increased incidence of major bleeding is to be expected during follow-up.Therefore,TT should be prolonged for as short a time as possible,and implantation of drug-eluting stents avoided.Frequent monitoring of international normalized ratio is also warranted,and the intensity of OAC should be targeted at the lower limit of the therapeutic range.Gastric protection should also be considered for all patients on medium-to long-term TT,owing to the observed highest incidence of bleeding at the gastrointestinal site.Peri-procedural management is cumbersome,and a substantial incidence of inhospital major bleeding has been reported.Since this latter is more related to procedural variables than to TT itself,choice of radial access,avoidance of glycoprotein Ⅱb/Ⅲa inhibitors,and preference for not interrupting effective OAC should be implemented.However,the evidence on which the recommendations for managing this patient subset are based is limited and of relative poor quality.While waiting for the results of ongoing,large prospective studies that are aimed at conclusively determining optimal medium-to long-term antithrombotic treatment,the official recommendations issued by the Working Group on Thrombosis of the European Society of Cardiology on the management of patients on OAC undergoing PCI with stenting should followed.
基金This study was supported by the National Natural Science Foundation of China(No.81970325&No.81900348&No.81901825)the Science and Technology Support Plan of Sichuan Province(2019YFS0299&2019YFS0433)。
文摘BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood subject of mech-anisms and predictors for HAVB in BAV self-expandable TAVI patients.METHODS We retrospectively included 181 BAV patients for analysis.Using computed tomography data,the curvature of ascending aorta(AAo)was quantified by the angle(AAo angle)between annulus and the cross-section at 35 mm above annulus(where the stent interacts with AAo the most).The valvular anatomy and leaflet calcification were also characterized.RESULTS The 30-day HAVB rate was 16.0%(median time to HAVB was three days).Type-1 morphology was found in 79 pat-ients(43.6%)(left-and right-coronary cusps fusion comprised 79.7%).Besides implantation below membrane septum,large AAo angle[odds ratio(OR)=1.08,P=0.016]and type-1 morphology(OR=4.97,P=0.001)were found as the independent predictors for HAVB.Together with baseline right bundle branch block,these predictors showed strong predictability for HAVB with area under the cure of 0.84(sensitivity=62.1%,specificity=92.8%).Bent AAo and calcified raphe had a synergistic effect in facilita-ting high implantation,though the former is associated with at-risk deployment(device implanted above annulus+prothesis pop-out,versus straight AAo:9.9%vs.2.2%,P=0.031).CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI.For patients with bent AAo or calcified raphe,a progressive approach to implant the device above the lower edge of membrane septum is favored,though should be done cautiously to avoid pop-out.
文摘Background Triple therapy(TT)with vitamin K-antagonists(VKA),aspirin and clopidogrel is the recommended antithrombotic treatment following percutaneous coronary intervention with stent implantation(PCI-S)in patients with an indication for oral anticoagulation.TT is associated with an increased risk of bleeding,but available evidence is flawed by important limitations,including the limited size and the retrospective design of most of the studies,as well as the rare reporting of the incidence of in-hospital bleeding and the treatment which was actually ongoing at the time of bleeding.Since the perceived high bleeding risk of TT may deny patients effective strategies,the determination of the true safety profile of TT is of paramount importance.Methods All the 27 published studies where the incidence of bleeding at various time points during follow-up has been reported separately for patients on TT were reviewed,and the weakness of the data was analyzed.Results The absolute incidence of major bleeding upon discharge at in-hospital,≤1 month,6 months,12 months and≥12 months was:3.3%±1.9%,5.1%±6.7%,8.0%±5.2%,9.0%±8.0,and 6.2%±7.8%,respectively,and not substantially different from that observed in previous studies with prolonged dual antiplatelet treatment with aspirin and clopidogrel.Conclusions While waiting for the ongoing,large-scale,registries and clinical trials to clarify the few facts and to answer the many questions regarding the risk of bleeding of TT,this treatment should not be denied to patients with an indication for VKA undergoing PCI-S provided that the proper measures and cautions are implemented.
文摘Persons aged 80 and above are the fastest growing age group in the United States population, having increased 50% since 1990 and predicted to grow another 25% by 2020.
文摘1Introducfion Peripheral arterial disease (PAD)is the consequence of atherosclerosis in the arteries of carotid,vertebral,abdominal mesenteric,renal,and extremity arteries with a prevalence increasing with.Carotid Occlusive disease is one of the most common site for atherosclerosis development:Endoatherec- tomy and Carotid artery stenting (CAS)have been shown to achieve similar outcomes and costst[1,2]especially in high-risk patients as very often elderly patients with multiple athero- sclerotic localizations are.The performance of supraaortic diagnostic and interventional procedures via the radial artery (RA)is growing all over the world thanks to lower risk of access site complications,lower chance to embolizing de- bries by touching the aortic arch,lower costs,and increased patient comfort compared to the traditional transfemoral approach (TFA).[3,4]The aim of this paper is to describe the potentiality the TRA can offer in the peripheral interventions of supra-aortic arteries in the elderly.
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The very elderly patient population (＞80 years) represents a rapidly increasing segment of our demographics,a consequence of the longer life expectancy and aging of the 'baby boom' generation. Coronary artery disease remains a major cause of mortality and morbidity among octogenarians with an estimated 30% of them having symptomatic heart disease and 50% eventually dying from it.
文摘Objective:This study was aimed at investigating the effects of preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in patients with ST-segment elevation myocardial infarction(STEMI).Method:Sixty-five patients with STEMI who had visited the Shanxi Cardiovascular Disease Hospital between May 2018 and May 2021 were enrolled in the study.The enrolled patients had no history of oral statins or antiplatelet therapy.The patients were divided into a combined treatment group(loading dose of statins combined with PCSK9 inhibitors,35 patients)and a routine treatment group(loading dose of statins only,30 patients).The primary endpoints were thrombolysis in myocardial infarction(TIMI)blood flow grading,corrected TIMI frame count(CTFC),and TIMI myocardial perfusion grading(TMPG),immediately after and 30 days after the operation.The secondary endpoint was a composite endpoint of cardiovascular death,nonfatal myocardial infarction,and target vessel revascularization 30 days after the operation.Results:The combined treatment group had significantly lower CTFC(14.09±8.42 vs 26±12.42,P=0.04)and better TMPG(2.74±0.61 vs 2.5±0.73,P=0.04)than the routine treatment group immediately after the operation.Similarly,the combined treatment group had a significantly lower CTFC(16.29±7.39 vs 26.23±11.53,P=0.04)and significantly better TMPG(2.94±0.24 vs 2.76±0.43,P=0.01)than the routine treatment group 1 month after the operation.Conclusion:Preoperative treatment with a loading dose of high-intensity statins combined with PCSK9 inhibitors increased coronary blood flow and myocardial perfusion after emergency thrombus aspiration in patients with STEMI.However,the treatment did not significantly decrease the incidence of cardiovascular death,nonfatal myocardial infarction,or target vessel revascularization.
文摘OBJECTIVES: The purpose of the SCANDSTENT study was to evaluate the use of sirolimus-eluting stents(SES) in complex coronary lesions. BACKGROUND: The use of SES improves angiographic and clinical outcomes compared with bare-metal stents(BMS) in simple coronary artery lesions, but there is limited evidence of their safety and efficacy when implanted in complex lesions. METHODS: We randomly assigned 322 patients with symptomatic complex coronary artery disease to receive either SES or BMS. The lesions were occluded(36% ), bifurcational(34% ), ostial(22% ), or angulated(8% ) in morphology. The primary end point was the difference in minimal lumen diameter six months after stent implantation. RESULTS: The patients were well matched in terms of demographic and angiographic baseline characteristics; 18% had diabetes. The reference vessel diameter was 2.86 mm in mean, and the lesion length 18.0 mm. At follow-up, patients who received SES had a minimal lumen diameter of 2.48 mm compared with 1.65 mm in those who received BMS(p< 0.001), a diameter stenosis of 19.3% versus 43.8% (p< 0.001), and 2.0% versus 31.9% developed restenosis(p< 0.001). The rate of major adverse cardiac events was 4.3% with SES versus 29.3% with BMS(p< 0.001), and stent thrombosis was observed in 0.6% in the SES group versus 3.1% in the BMS group(p=0.15). CONCLUSIONS: The use of SES markedly reduced restenosis and the occurrence of major adverse cardiac events in patients with complex coronary artery lesions without increasing the risk of stent thrombosis.
文摘Background: Diabetes increases the risk of developing cardiovascular disease. Patients with diabetes undergoing percutaneous coronary intervention(PCI) show poorer outcomes compared with nondiabetic patients. The aim of this study was to determine the clinical benefit of long-term fluvastatin in patients with diabetes who had undergone a successful PCI. Methods: This subanalysis of a prospective, multicenter, randomized, double-blind, placebo-con-trolled trial of patients who had undergone PCI and were treated with fluvastatin determined the impact of fluvastatin on the survival-free period of major adverse cardiac events(MACE)(defined as cardiac death, nonfatal myocardial infarction, and reintervention procedure[coronary artery bypass grafting, repeat PCI, PCI for a new lesion]). Patients with baseline total cholesterol levels of 135 to 270 mg/dL(3.5-7.0 mmol/L) and triglyceride levels of 400 mg/dL(4.5 mmol/L) were randomized at discharge either to fluvastatin(n=844) or to placebo(n=833); follow-up was 3 to 4 years. Among these patients, there were 202 with diabetes(120 on fluvastatin, 82 placebo) and 1475 without diabetes(724 on fluvastatin, 751 on placebo). The primary clinical outcome was survival time free of MACE and MACE excluding restenosis. Results: The presence of diabetes increased the risk of MACE by almost 2-fold in placebo-treated patients(RR 1.78, 95%CI 1.20-2,64, P=.0045). In contrast, in diabetic patients treated with fluvastatin, the risk of MACE was not significantly different from that in patients without diabetes. Fluvastatin reduced the risk of MACE in diabetic patients by 51%(P=.0088). Conclusions: Diabetes is a consistent clinical predictor of cardiovascular complications and fluvastatin reduces the increased incidence of long-term adverse complications associated with the presence of diabetes.
