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
Objective To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction(STEMI)treated with different reperfusion strategies in Chinese county-level hospitals Methods A total of 2,514 ...Objective To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction(STEMI)treated with different reperfusion strategies in Chinese county-level hospitals Methods A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014.The success of fibrinolysis was assessed according to indirect measures of vascular recanalization.The primary outcome was 2-year mortality.Results Reperfusion therapy was used in 1,080 patients(42.9%):fibrinolysis(n=664,61.5%)and primary percutaneous coronary intervention(PCI)(n=416,38.5%).The most common reason for missing reperfusion therapy was a prehospital delay>12 h(43%).Fibrinolysis[14.5%,hazard ratio(HR):0.59,95%confidence interval(CI)0.44–0.80]and primary PCI(6.8%,HR=0.32,95%CI:0.22–0.48)were associated with lower 2-year mortality than those with no reperfusion(28.5%).Among fibrinolysistreated patients,510(76.8%)achieved successful clinical reperfusion;only 17.0%of those with failed fibrinolysis underwent rescue PCI.There was no difference in 2-year mortality between successful fibrinolysis and primary PCI(8.8%vs.6.8%,HR=1.53,95%CI:0.85–2.73).Failed fibrinolysis predicted a similar mortality(33.1%)to no reperfusion(33.1%vs.28.5%,HR=1.30,95%CI:0.93–1.81).Conclusion In Chinese county-level hospitals,only approximately 2/5 of patients with STEMI underwent reperfusion therapy,largely due to prehospital delay.Approximately 30%of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years.Quality improvement initiatives are warranted,especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.展开更多
Background:The patterns of nonadherence to antiplatelet regimen in stented patients (PARIS)thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events (CTEs)after percutaneous coronar...Background:The patterns of nonadherence to antiplatelet regimen in stented patients (PARIS)thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events (CTEs)after percutaneous coronary intervention (PCI)with drug-eluting stents. However,the prognostic value of this score has not been fully evaluated in non-Euro-American PCI populations. Methods:We performed a prospective,observational study of 10,724 patients who underwent PCI in Fuwai hospital,China and evaluated the PARIS thrombotic risk score's predictive value of CTEs in the PCI population.The area under the receiver operating characteristic curve (AUROC)was used to assess the predictive value of the PARIS score for CTE. Results:Among 9782 patients without in-hospital events,a total of 95 CTEs occurred during the 2-year follow-up.The PARIS score was significantly higher in patients with CTEs (3.384-2.04)compared with patients without events (2.53±1.70,P <0.001). According to the risk stratification of the PARIS thrombotic score,the risk of CTEs in the high-risk group was 3.14 times higher than that in the low-risk group (hazard ratio [HR],3.14;95% confidence interval [CI],1.92-5.13;P <0.001).However,the risk of CTEs in the intermediate-risk and low-risk groups was not significant (HR,1.39;95% CI,[0.86-2.24];P =0.184).The PARIS score showed prognostic value in evaluating CTEs in the overall population (AUROC,0.621;95% CI,0.561-0.681),the acute coronary syndrome (ACS)population (AUROC,0.617;95% CI,0.534-0.700;P =0.003),and the non-ACS population (AUROC,0.647;95% CI,0.558-0.736;P =0.001). Conclusions:In a real-world Chinese population,the PARIS thrombotic risk score shows a modest prognostic value for CTEs in patients after PCI.This score also has a predictive value for CTEs in the ACS and non-ACS subgroup populations.展开更多
Objective To compare the long-term outcomes in ST-elevation myocardial infarction(STEMI)patients who underwent early or late delayed percutaneous coronary intervention(PCI)using drug-eluting stents(DES).Methods This s...Objective To compare the long-term outcomes in ST-elevation myocardial infarction(STEMI)patients who underwent early or late delayed percutaneous coronary intervention(PCI)using drug-eluting stents(DES).Methods This study was a retrospective,observational and single-center study.Consecutive STEMI patients(n=977),who admitted to Fuwai Hospital in 2013 and underwent successful selective PCI using drug-eluting stents(DES)within 3 to 35 days after symptom onset were enrolled and divided into the early delayed PCI(3-14 d)group(n=495)and the late delayed PCI(15-35 d)group(n=482).展开更多
Background:Patients with ST-segment elevation myocardial infarction(STEMI)who present without typical chest pain are associated with a poor outcome.However,whether angiographic characteristics are related to a higher ...Background:Patients with ST-segment elevation myocardial infarction(STEMI)who present without typical chest pain are associated with a poor outcome.However,whether angiographic characteristics are related to a higher risk of mortality in this population is unclear.This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their"high-risk"angiographic characteristics.Methods:We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014.We compared the infarct-related artery(IRA),thrombolysis in myocardial infarction(TIMI)flow grade in the IRA,and other angiographic characteristics between patients without and those with chest pain.Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality.Results:The 2922(24.1%)patients with STEMI presented without typical chest pain.These patients had a higher TIMI flow grade(mean TIMI flow grade:1.00 vs.0.94,P=0.02)and a lower rate of IRA disease of the left anterior descending artery(44.6%vs.51.2%,χ^2=35.63,P<0.01)than did those with typical chest pain.Patients without chest pain were older,more likely to have diabetes,longer time to hospital and higher Killip classification,and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality(3.3%vs.2.2%,χ^2=10.57,P<0.01).After adjusting for multi-variables,presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI(adjusted odds ratio:1.36,95%confidence interval:1.02–1.83).Conclusions:Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction.Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment,but not angiographic lesion characteristics.Clinical trial registration:NCT01874691,https://clinicaltrials.gov.展开更多
OBJECTIVE:To investigate the protective effects of Naoxintong capsules(脑心通胶囊,NXT)on tumor necrosis factor-α(TNF-α)-induced senescence inendothelial cells and its mechanism.METHODS:Human umbilical vascular endot...OBJECTIVE:To investigate the protective effects of Naoxintong capsules(脑心通胶囊,NXT)on tumor necrosis factor-α(TNF-α)-induced senescence inendothelial cells and its mechanism.METHODS:Human umbilical vascular endothelial cells(HUVECs)were treated with TNF-α±NXT and assessed for silent information regulator 1(SIRT1)expression and signaling.Cells were stained with beta-galactosidase to assess the levels of cellular senescence.SIRT1 was silenced through siRNA transfection.RESULTS:TNF-αtreatment led to the downregulation of SIRT1,resulting in forkhead box O1(FoxO-1)acetylation,p53 acetylation and enhanced p21 expression.Following TNF-αtreatment,higher SAβ-Gal activity improved.TNF-αenhanced the migration of HUVECs and increased SIRT1 expression,both of which were attenuated by NXT treatment.The downstream targets of SIRT1 including FoxO-1/p53/p21 were also modulated,and HUVECs were protected from TNF-α-induced senescence.In contrast,the NXT-mediated protection was prevented by SIRT1 silencing.CONCLUSIONS:These findings suggest that sustained endothelial senescence can be induced by TNF-αstimulation via the SIRT1/FoxO-1/p53/p21 pathway.The protection of NXT against TNF-αwas partially mediated through its effects on SIRT1.This highlights the promise of NXT as a therapeutic for atherosclerosis.展开更多
The outcomes of patients with myocardial infarction(MI)have substantially improved given the rapid progress that has occurred in revascularization techniques and secondary prevention,and the majority of MI patients su...The outcomes of patients with myocardial infarction(MI)have substantially improved given the rapid progress that has occurred in revascularization techniques and secondary prevention,and the majority of MI patients subsequently enter a chronic stable phase.Therefore,the long-term management of patients with MI has become a core issue in daily clinical practice for cardiologists.The long-term incidence of adverse events can be further reduced using newly developed medications and therapies ranging from lipid-lowering agents(eg,proprotein convertase subtilisin/kexin type 9 inhibitors)to anti-thrombotic treatments(eg,shortened dual anti-platelet therapy).However,a considerable number of patients still experience adverse events,as some residual risk can remain despite intensive secondary prevention,such as continuously elevated cholesterol levels,chronic cardiovascular inflammation,and rapid atherosclerosis progression due to increased plaque instability.Therefore,the present review sought to summarize and discuss recent advances in several key aspects regarding the long-term management of MI patients,with the expectation of clarifying the available treatment strategies for various clinical scenarios,examining the gaps between trial evidence and clinical practice,and providing possible directions for future research.展开更多
Objective To explore the use and the effect of emergency medical services(EMS)in patients with ST elevation myocardial infarction(STEMI).Methods An observational analysis was performed in 13549 patients with STEMI,who...Objective To explore the use and the effect of emergency medical services(EMS)in patients with ST elevation myocardial infarction(STEMI).Methods An observational analysis was performed in 13549 patients with STEMI,who were documented in China Acute Myocardial Infarction(CAMI)Registry and treated in 107 hospitals between January 1st,2013 and Oct 1st,2014.According to the way of arriving at the hospital,all patients were divided into EMS group and self-transport group.Results Only 2015 patients(14.9%)were transported through EMS.Compared with self-transport,EMS-transport was associated with a higher rate of reperfusion therapy(64.9%vs 52.9%,P<0.001),shorter delays in symptom-onset-to-arrival time(median,170 min vs 240 min,P<0.0001)and door-to-needle time(median,47 min vs 53 min,P=0.003),but not significantly shorter door-to-balloon time(median,106 min vs 108 min,P=0.932).Multivariate logistic analysis revealed that the negative independent predictors of EMS transport were rural residents and symptom onset at home,while the positive independent predictors were non-anterior wall infarction,consistent chest pain,severe dyspnea or syncope,prehospital cardiac arrest,Killip>2,SBP<100 mmHg,overweight/obesity,and presentation to province-level hospital.Conclusion EMS care for STEMI is greatly underused in China.EMS transportation is associated with reduction in symptom-onset-to-arrival time and higher rate of reperfusion,but not substantial reduction in treatment delays.Targeted efforts are needed to promote EMS use when chest pain occurs and so is setting up a local STEMI network focusing on organization of care among EMS and hospitals in China.展开更多
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.
基金supported by the Twelfth Five-Year Planning Project of the Scientific and Technological Department of China [2011BAI11B02]2014 special fund for scientific research in the public interest by the National Health and Family Planning Commission of the People's Republic of China [No.201402001]CAMS Innovation Fund for Medical Sciences (CIFMS) [2020-I2M-C&T-B-050]。
文摘Objective To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction(STEMI)treated with different reperfusion strategies in Chinese county-level hospitals Methods A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014.The success of fibrinolysis was assessed according to indirect measures of vascular recanalization.The primary outcome was 2-year mortality.Results Reperfusion therapy was used in 1,080 patients(42.9%):fibrinolysis(n=664,61.5%)and primary percutaneous coronary intervention(PCI)(n=416,38.5%).The most common reason for missing reperfusion therapy was a prehospital delay>12 h(43%).Fibrinolysis[14.5%,hazard ratio(HR):0.59,95%confidence interval(CI)0.44–0.80]and primary PCI(6.8%,HR=0.32,95%CI:0.22–0.48)were associated with lower 2-year mortality than those with no reperfusion(28.5%).Among fibrinolysistreated patients,510(76.8%)achieved successful clinical reperfusion;only 17.0%of those with failed fibrinolysis underwent rescue PCI.There was no difference in 2-year mortality between successful fibrinolysis and primary PCI(8.8%vs.6.8%,HR=1.53,95%CI:0.85–2.73).Failed fibrinolysis predicted a similar mortality(33.1%)to no reperfusion(33.1%vs.28.5%,HR=1.30,95%CI:0.93–1.81).Conclusion In Chinese county-level hospitals,only approximately 2/5 of patients with STEMI underwent reperfusion therapy,largely due to prehospital delay.Approximately 30%of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years.Quality improvement initiatives are warranted,especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.
文摘Background:The patterns of nonadherence to antiplatelet regimen in stented patients (PARIS)thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events (CTEs)after percutaneous coronary intervention (PCI)with drug-eluting stents. However,the prognostic value of this score has not been fully evaluated in non-Euro-American PCI populations. Methods:We performed a prospective,observational study of 10,724 patients who underwent PCI in Fuwai hospital,China and evaluated the PARIS thrombotic risk score's predictive value of CTEs in the PCI population.The area under the receiver operating characteristic curve (AUROC)was used to assess the predictive value of the PARIS score for CTE. Results:Among 9782 patients without in-hospital events,a total of 95 CTEs occurred during the 2-year follow-up.The PARIS score was significantly higher in patients with CTEs (3.384-2.04)compared with patients without events (2.53±1.70,P <0.001). According to the risk stratification of the PARIS thrombotic score,the risk of CTEs in the high-risk group was 3.14 times higher than that in the low-risk group (hazard ratio [HR],3.14;95% confidence interval [CI],1.92-5.13;P <0.001).However,the risk of CTEs in the intermediate-risk and low-risk groups was not significant (HR,1.39;95% CI,[0.86-2.24];P =0.184).The PARIS score showed prognostic value in evaluating CTEs in the overall population (AUROC,0.621;95% CI,0.561-0.681),the acute coronary syndrome (ACS)population (AUROC,0.617;95% CI,0.534-0.700;P =0.003),and the non-ACS population (AUROC,0.647;95% CI,0.558-0.736;P =0.001). Conclusions:In a real-world Chinese population,the PARIS thrombotic risk score shows a modest prognostic value for CTEs in patients after PCI.This score also has a predictive value for CTEs in the ACS and non-ACS subgroup populations.
文摘Objective To compare the long-term outcomes in ST-elevation myocardial infarction(STEMI)patients who underwent early or late delayed percutaneous coronary intervention(PCI)using drug-eluting stents(DES).Methods This study was a retrospective,observational and single-center study.Consecutive STEMI patients(n=977),who admitted to Fuwai Hospital in 2013 and underwent successful selective PCI using drug-eluting stents(DES)within 3 to 35 days after symptom onset were enrolled and divided into the early delayed PCI(3-14 d)group(n=495)and the late delayed PCI(15-35 d)group(n=482).
文摘Background:Patients with ST-segment elevation myocardial infarction(STEMI)who present without typical chest pain are associated with a poor outcome.However,whether angiographic characteristics are related to a higher risk of mortality in this population is unclear.This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their"high-risk"angiographic characteristics.Methods:We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014.We compared the infarct-related artery(IRA),thrombolysis in myocardial infarction(TIMI)flow grade in the IRA,and other angiographic characteristics between patients without and those with chest pain.Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality.Results:The 2922(24.1%)patients with STEMI presented without typical chest pain.These patients had a higher TIMI flow grade(mean TIMI flow grade:1.00 vs.0.94,P=0.02)and a lower rate of IRA disease of the left anterior descending artery(44.6%vs.51.2%,χ^2=35.63,P<0.01)than did those with typical chest pain.Patients without chest pain were older,more likely to have diabetes,longer time to hospital and higher Killip classification,and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality(3.3%vs.2.2%,χ^2=10.57,P<0.01).After adjusting for multi-variables,presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI(adjusted odds ratio:1.36,95%confidence interval:1.02–1.83).Conclusions:Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction.Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment,but not angiographic lesion characteristics.Clinical trial registration:NCT01874691,https://clinicaltrials.gov.
基金Supported by grants from the National Natural Science Foundation of China(NSFC)81700405(a Study of FOXCUT/FOXC1 on Promoting the Occurrence and Development of Degenerative Aortic Stenosis via BMPER)。
文摘OBJECTIVE:To investigate the protective effects of Naoxintong capsules(脑心通胶囊,NXT)on tumor necrosis factor-α(TNF-α)-induced senescence inendothelial cells and its mechanism.METHODS:Human umbilical vascular endothelial cells(HUVECs)were treated with TNF-α±NXT and assessed for silent information regulator 1(SIRT1)expression and signaling.Cells were stained with beta-galactosidase to assess the levels of cellular senescence.SIRT1 was silenced through siRNA transfection.RESULTS:TNF-αtreatment led to the downregulation of SIRT1,resulting in forkhead box O1(FoxO-1)acetylation,p53 acetylation and enhanced p21 expression.Following TNF-αtreatment,higher SAβ-Gal activity improved.TNF-αenhanced the migration of HUVECs and increased SIRT1 expression,both of which were attenuated by NXT treatment.The downstream targets of SIRT1 including FoxO-1/p53/p21 were also modulated,and HUVECs were protected from TNF-α-induced senescence.In contrast,the NXT-mediated protection was prevented by SIRT1 silencing.CONCLUSIONS:These findings suggest that sustained endothelial senescence can be induced by TNF-αstimulation via the SIRT1/FoxO-1/p53/p21 pathway.The protection of NXT against TNF-αwas partially mediated through its effects on SIRT1.This highlights the promise of NXT as a therapeutic for atherosclerosis.
基金supported by the National Natural Science Foundation of China(81970308)the Fund of the“Sanming”Project of Medicine in Shenzhen(SZSM201911017)+1 种基金the Shenzhen Key Medical Discipline Construction Fund(SZXK001)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2016-I2M-1-009).
文摘The outcomes of patients with myocardial infarction(MI)have substantially improved given the rapid progress that has occurred in revascularization techniques and secondary prevention,and the majority of MI patients subsequently enter a chronic stable phase.Therefore,the long-term management of patients with MI has become a core issue in daily clinical practice for cardiologists.The long-term incidence of adverse events can be further reduced using newly developed medications and therapies ranging from lipid-lowering agents(eg,proprotein convertase subtilisin/kexin type 9 inhibitors)to anti-thrombotic treatments(eg,shortened dual anti-platelet therapy).However,a considerable number of patients still experience adverse events,as some residual risk can remain despite intensive secondary prevention,such as continuously elevated cholesterol levels,chronic cardiovascular inflammation,and rapid atherosclerosis progression due to increased plaque instability.Therefore,the present review sought to summarize and discuss recent advances in several key aspects regarding the long-term management of MI patients,with the expectation of clarifying the available treatment strategies for various clinical scenarios,examining the gaps between trial evidence and clinical practice,and providing possible directions for future research.
文摘Objective To explore the use and the effect of emergency medical services(EMS)in patients with ST elevation myocardial infarction(STEMI).Methods An observational analysis was performed in 13549 patients with STEMI,who were documented in China Acute Myocardial Infarction(CAMI)Registry and treated in 107 hospitals between January 1st,2013 and Oct 1st,2014.According to the way of arriving at the hospital,all patients were divided into EMS group and self-transport group.Results Only 2015 patients(14.9%)were transported through EMS.Compared with self-transport,EMS-transport was associated with a higher rate of reperfusion therapy(64.9%vs 52.9%,P<0.001),shorter delays in symptom-onset-to-arrival time(median,170 min vs 240 min,P<0.0001)and door-to-needle time(median,47 min vs 53 min,P=0.003),but not significantly shorter door-to-balloon time(median,106 min vs 108 min,P=0.932).Multivariate logistic analysis revealed that the negative independent predictors of EMS transport were rural residents and symptom onset at home,while the positive independent predictors were non-anterior wall infarction,consistent chest pain,severe dyspnea or syncope,prehospital cardiac arrest,Killip>2,SBP<100 mmHg,overweight/obesity,and presentation to province-level hospital.Conclusion EMS care for STEMI is greatly underused in China.EMS transportation is associated with reduction in symptom-onset-to-arrival time and higher rate of reperfusion,but not substantial reduction in treatment delays.Targeted efforts are needed to promote EMS use when chest pain occurs and so is setting up a local STEMI network focusing on organization of care among EMS and hospitals in China.
