BACKGROUND The efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China has not bee...BACKGROUND The efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China has not been evaluated. This study aims to describe the real world effectiveness of PCSK-9 inhibitors combined with statins compared with statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease(ASCVD).METHODS This is a multi-center observational study, enrolled patients from 32 hospitals who underwent percutaneous coronary intervention(PCI) from January to June in 2019. There are 453 patients treated with PCSK-9 inhibitors combined with statins in PCSK-9 inhibitor group and 2,610 patients treated with statins-based lipid lowering therapies in statins-based group. The lipid control rate and incidence of major adverse cardiovascular events(MACE) over six months were compared between two groups.A propensity score-matched(PSM) analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for MACE.RESULTS In a total of 3,063 patients, 89.91% of patients had received moderate or high-intensity statins-based therapy before PCI, but only 9.47% of patients had low-density lipoprotein cholesterol(LDL-C) levels below 1.4 mmol/L at baseline. In the PSM selected patients, LDL-C level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81%(P < 0.001) in statins-based group after six months. The proportion of LDL-C ≤ 1.0 mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins-based group, and the proportion of LDL-C ≤ 1.4 mmol/L increased from 10.36% to 47.69% in PCSK-9 inhibitor group and 2.99% to 18.43% in statins-based group(P < 0.001 for both). There was no significant difference between PCSK-9 inhibitor and statins-based treatment in reducing the risk of MACE(hazard ratio = 2.52, 95% CI: 0.49-12.97, P = 0.250).CONCLUSIONS In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL-C levels among patients with very high risk of ASCVD in China. The long-term clinical benefits for patients received PCSK-9 inhibitor to reduce the risk of MACE is still unclear and requires further study.展开更多
BACKGROUND In transradial intervention procedures,poor back-up support and noncoaxial alignment of the guide catheter(GC)may result in failure of the balloon or stent to reach the targeted lesion.Methods to provide ex...BACKGROUND In transradial intervention procedures,poor back-up support and noncoaxial alignment of the guide catheter(GC)may result in failure of the balloon or stent to reach the targeted lesion.Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications.A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.AIM To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.METHODS A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study.The clinical characteristics,indications for use of the rapid exchange extension catheter,and procedural details and results were reviewed and analyzed.All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.RESULTS The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity(37.8%),followed by heavy calcification(28.9%),long lesions(20.0%),proximal stent(6.7%),in-stent restenosis(5.2%),and coronary origin anomalies(1.5%).The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter:Multiple predilatation technique(57%),buddy wire technique(33.4%),balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extensioncatheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheterservice time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success(balloon or stent successful crossing of the target lesion with this technique) was94.8%.CONCLUSIONThe rapid exchange extension catheter technique showed acceptable safety andefficacy in the transradial coronary interventions of type B2/C nonocclusivecoronary lesions. We recommend this technique to assist in complex lesionintervention via radial access.展开更多
Objective:To explore the correlation of carotid intima media thickness with function in patients with H-type hypertension and acute cerebral infarction.Methods:A total of 150 patients with acute cerebral infarction wh...Objective:To explore the correlation of carotid intima media thickness with function in patients with H-type hypertension and acute cerebral infarction.Methods:A total of 150 patients with acute cerebral infarction who were admitted in our hospital from June, 2016 to June, 2017 were included in the study and divided into H-type hypertension group (H-type hypertension merged with acute cerebral infarction, Hcy≥10 μmol/L), non-H-type hypertension group (non- H-type hypertension merged with acute cerebral infarction, Hcy≥10 μmol/L), and the control group (no hypertension but with acute cerebral infarction) according to Hcy level and whether being suffered from hypertension or not with 50 cases in each group. Moreover, 50 healthy individuals who came for physical examinations were served as the healthy group. The morning fasting peripheral venous blood was collected at physical examination time for patients in the healthy group and after admission for patients with acute cerebral infarction. Hcy, sICAM-1, MCP-1, and YKL-40 were detected. The color Doppler ultrasound diagnostic apparatus was used to detect IMT, distensibility, and stiffness. Results: Hcy, MCP-1, sICAM-1, and YKL-40 levels in H-type hypertension group, non-H-type hypertension group, and the control group were significantly higher than those in the healthy group. Hcy, MCP-1, sICAM-1, and YKL-40 levels in H-type hypertension group and non-H-type hypertension group were significantly higher than those in the control group. Hcy, MCP-1, sICAM-1, and YKL-40 levels in H-type hypertension group were significantly higher than those in non-H-type hypertension group. IMT and stiffness in H-type hypertension group, non-H-type hypertension group, and the control group were significantly greater than those in the healthy group, while distensibility was significantly less than that in the healthy group. IMT and stiffness in H-type hypertension group and non-H-type hypertension group were significantly greater than those in the control group, while distensibility was significantly less than that in the control group. IMT and stiffness in H-type hypertension group were significantly greater than those in non-H-type hypertension group, while distensibility was significantly less than that in non-H-type hypertension group.Conclusions: Hcy can directly affect carotid AS, increase carotid IMT, and promote the occurrence of hypertension merged with acute cerebral infarction;therefore, positive monitoring of serum Hcy level and IMT thickness in patients with hypertension and acute cerebral infarction and early intervention are of great significance in reducing the occurrence of carotid AS, delaying the progression of carotid AS, and preventing hypertension and acute cerebral infarction.展开更多
Aims:Sodium-glucose cotransporter-2(SGLT2)inhibitors have been found to ameliorate major adverse cardiovascular events in patients with heart failure with preserved ejection fraction(HFpEF),but the exact mechanism is ...Aims:Sodium-glucose cotransporter-2(SGLT2)inhibitors have been found to ameliorate major adverse cardiovascular events in patients with heart failure with preserved ejection fraction(HFpEF),but the exact mechanism is unknown.Ferroptosis is a form of programmed necrosis.Herein,we verified that canagliflozin(CANA)ameliorates heart function in HFpEF rats,partly by regulating ferroptosis,which may be activated by AMPK/PGC-1α/Nrf2 signaling.Methods:An HFpEF model was established and subjected to CANA treatment.Blood pressure was monitored,and echocardiography was performed at the 12th week.Pathological examination was performed,and expression of ferroptosis-associated proteins and AMPK/PGC-1α/Nrf2 signaling related proteins was detected.Results:CANA had an antihypertensive effect and increased E/A ratios in HFpEF rats.Myocardial pathology was ameliorated,on the basis of decreased cross-sectional area and intercellular fibrosis.Acyl-CoA synthetase longchain family member 4(ACSL4)expression increased,whereas ferritin heavy chain 1(FTH1)expression decreased in HFpEF rats,which showed iron overload.CANA reversed changes in ACSL4 and FTH1,and decreased iron accumulation,but did not alter glutathione peroxidase 4(GPX4)expression.The expression of AMPK/PGC-1α/Nrf2 signaling related proteins and heme oxygenase 1(HO-1)in the HFpEF group decreased but was reverted after CANA treatment.Conclusions:CANA regulates ferroptosis,potentially via activating AMPK/PGC-1α/Nrf2 signaling in HFpEF rats.展开更多
基金supported by the China Cardiovascular Health Alliance-Advanced Fund (2019CCA-ACCESS-054)the Beijing Lisheng Cardiovascular Health Foundation Pilot Fund Key Projects。
文摘BACKGROUND The efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China has not been evaluated. This study aims to describe the real world effectiveness of PCSK-9 inhibitors combined with statins compared with statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease(ASCVD).METHODS This is a multi-center observational study, enrolled patients from 32 hospitals who underwent percutaneous coronary intervention(PCI) from January to June in 2019. There are 453 patients treated with PCSK-9 inhibitors combined with statins in PCSK-9 inhibitor group and 2,610 patients treated with statins-based lipid lowering therapies in statins-based group. The lipid control rate and incidence of major adverse cardiovascular events(MACE) over six months were compared between two groups.A propensity score-matched(PSM) analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for MACE.RESULTS In a total of 3,063 patients, 89.91% of patients had received moderate or high-intensity statins-based therapy before PCI, but only 9.47% of patients had low-density lipoprotein cholesterol(LDL-C) levels below 1.4 mmol/L at baseline. In the PSM selected patients, LDL-C level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81%(P < 0.001) in statins-based group after six months. The proportion of LDL-C ≤ 1.0 mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins-based group, and the proportion of LDL-C ≤ 1.4 mmol/L increased from 10.36% to 47.69% in PCSK-9 inhibitor group and 2.99% to 18.43% in statins-based group(P < 0.001 for both). There was no significant difference between PCSK-9 inhibitor and statins-based treatment in reducing the risk of MACE(hazard ratio = 2.52, 95% CI: 0.49-12.97, P = 0.250).CONCLUSIONS In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL-C levels among patients with very high risk of ASCVD in China. The long-term clinical benefits for patients received PCSK-9 inhibitor to reduce the risk of MACE is still unclear and requires further study.
文摘BACKGROUND In transradial intervention procedures,poor back-up support and noncoaxial alignment of the guide catheter(GC)may result in failure of the balloon or stent to reach the targeted lesion.Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications.A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.AIM To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.METHODS A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study.The clinical characteristics,indications for use of the rapid exchange extension catheter,and procedural details and results were reviewed and analyzed.All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.RESULTS The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity(37.8%),followed by heavy calcification(28.9%),long lesions(20.0%),proximal stent(6.7%),in-stent restenosis(5.2%),and coronary origin anomalies(1.5%).The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter:Multiple predilatation technique(57%),buddy wire technique(33.4%),balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extensioncatheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheterservice time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success(balloon or stent successful crossing of the target lesion with this technique) was94.8%.CONCLUSIONThe rapid exchange extension catheter technique showed acceptable safety andefficacy in the transradial coronary interventions of type B2/C nonocclusivecoronary lesions. We recommend this technique to assist in complex lesionintervention via radial access.
文摘Objective:To explore the correlation of carotid intima media thickness with function in patients with H-type hypertension and acute cerebral infarction.Methods:A total of 150 patients with acute cerebral infarction who were admitted in our hospital from June, 2016 to June, 2017 were included in the study and divided into H-type hypertension group (H-type hypertension merged with acute cerebral infarction, Hcy≥10 μmol/L), non-H-type hypertension group (non- H-type hypertension merged with acute cerebral infarction, Hcy≥10 μmol/L), and the control group (no hypertension but with acute cerebral infarction) according to Hcy level and whether being suffered from hypertension or not with 50 cases in each group. Moreover, 50 healthy individuals who came for physical examinations were served as the healthy group. The morning fasting peripheral venous blood was collected at physical examination time for patients in the healthy group and after admission for patients with acute cerebral infarction. Hcy, sICAM-1, MCP-1, and YKL-40 were detected. The color Doppler ultrasound diagnostic apparatus was used to detect IMT, distensibility, and stiffness. Results: Hcy, MCP-1, sICAM-1, and YKL-40 levels in H-type hypertension group, non-H-type hypertension group, and the control group were significantly higher than those in the healthy group. Hcy, MCP-1, sICAM-1, and YKL-40 levels in H-type hypertension group and non-H-type hypertension group were significantly higher than those in the control group. Hcy, MCP-1, sICAM-1, and YKL-40 levels in H-type hypertension group were significantly higher than those in non-H-type hypertension group. IMT and stiffness in H-type hypertension group, non-H-type hypertension group, and the control group were significantly greater than those in the healthy group, while distensibility was significantly less than that in the healthy group. IMT and stiffness in H-type hypertension group and non-H-type hypertension group were significantly greater than those in the control group, while distensibility was significantly less than that in the control group. IMT and stiffness in H-type hypertension group were significantly greater than those in non-H-type hypertension group, while distensibility was significantly less than that in non-H-type hypertension group.Conclusions: Hcy can directly affect carotid AS, increase carotid IMT, and promote the occurrence of hypertension merged with acute cerebral infarction;therefore, positive monitoring of serum Hcy level and IMT thickness in patients with hypertension and acute cerebral infarction and early intervention are of great significance in reducing the occurrence of carotid AS, delaying the progression of carotid AS, and preventing hypertension and acute cerebral infarction.
基金supported by grants from the 2019 Hebei Science and Technology Project(grant number19277787D)2019 Hebei Innovation Capability Promotion Project(grant number 199776249D).
文摘Aims:Sodium-glucose cotransporter-2(SGLT2)inhibitors have been found to ameliorate major adverse cardiovascular events in patients with heart failure with preserved ejection fraction(HFpEF),but the exact mechanism is unknown.Ferroptosis is a form of programmed necrosis.Herein,we verified that canagliflozin(CANA)ameliorates heart function in HFpEF rats,partly by regulating ferroptosis,which may be activated by AMPK/PGC-1α/Nrf2 signaling.Methods:An HFpEF model was established and subjected to CANA treatment.Blood pressure was monitored,and echocardiography was performed at the 12th week.Pathological examination was performed,and expression of ferroptosis-associated proteins and AMPK/PGC-1α/Nrf2 signaling related proteins was detected.Results:CANA had an antihypertensive effect and increased E/A ratios in HFpEF rats.Myocardial pathology was ameliorated,on the basis of decreased cross-sectional area and intercellular fibrosis.Acyl-CoA synthetase longchain family member 4(ACSL4)expression increased,whereas ferritin heavy chain 1(FTH1)expression decreased in HFpEF rats,which showed iron overload.CANA reversed changes in ACSL4 and FTH1,and decreased iron accumulation,but did not alter glutathione peroxidase 4(GPX4)expression.The expression of AMPK/PGC-1α/Nrf2 signaling related proteins and heme oxygenase 1(HO-1)in the HFpEF group decreased but was reverted after CANA treatment.Conclusions:CANA regulates ferroptosis,potentially via activating AMPK/PGC-1α/Nrf2 signaling in HFpEF rats.
