Lowering of Blood Lipid Levels with a Combination of Pitavastatin and Ezetimibe in Patients with Coronary Heart Disease:A Meta-Analysis

Objectives:According to the findings of randomized controlled trials,blood lipid levels in patients with coronary heart disease(CHD)can be significantly decreased through a combination of pitavastatin and ezetimibe;however,the effects and clinical applications of this treatment remain controversial.This meta-analysis was aimed at objectively assessing the efficacy and safety of pitavastatin and ezetimibe in lowering blood lipid levels.Design:Relevant studies were retrieved from electronic databases,including PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,VIP,and WanFang Data,from database inception to June 8,2022.The lev-els of low-density lipoprotein cholesterol,total cholesterol,triglycerides,and high-density lipoprotein cholesterol in patients’serum after treatment were the primary endpoint.Results:Nine randomized controlled trials(2586 patients)met the inclusion criteria.The meta-analysis indi-cated that pitavastatin plus ezetimibe resulted in significantly lower levels of LDL-C[standardized mean difference(SMD)=−0.86,95%confidence interval(CI)(−1.15 to−0.58),P<0.01],TC[SMD=−0.84,95%CI(−1.10 to−0.59),P<0.01],and TG[SMD=−0.59,95%CI(−0.89 to−0.28),P<0.01]than pitavastatin alone.Conclusions:Pitavastatin plus ezetimibe significantly decreased serum LDL-C,TC,and TG levels in patients with CHD.

Development and Validation of a Postoperative Prognostic Nomogram to Predict Recurrence in Patients with Persistent Atrial Fibrillation:A Retrospective Cohort Study

Background:Patients with persistent atrial fibrillation(PsAF)have a high risk of recurrence after catheter radiofre-quency ablation.Nevertheless,no effective prognostic tools have been developed to identify these high-risk patients to date.This study sought to develop and validate a simple linear predictive model for predicting postoperative recurrence in patients with PsAF.Methods:From June 2013 to June 2021,patients with PsAF admitted to our hospital were enrolled in this single-center,retrospective,observational study.The characteristics substantially associated with recurrence in patients with PsAF were screened through univariate and multivariate logistic regression analysis.The receiver operating charac-teristic curve was used to assess the predictive significance of the nomogram model after nomogram development.Furthermore,to assess the clinical value of the nomogram,we performed calibration curve and decision curve analyses.Results:A total of 209 patients were included in the study,42(20.10%)of whom were monitored up to 1 year for recurrent AF.The duration of AF episodes,left atrial diameter,BMI,CKMB,and alcohol consumption were found to be independent risk factors(P<0.05)and were integrated into the nomogram model development.The area under the curve was 0.895,the sensitivity was 93.3%,and the specificity was 71.4%,thus indicating the model’s excellent predic-tive ability.The C-index of the predictive nomogram model was 0.906.Calibration curve and decision curve analyses further revealed that the model had robust prediction and strong discrimination ability.Conclusion:This simple,practical,and innovative nomogram can help clinicians in evaluation of the risk of PsAF recurrence after catheter ablation,thus facilitating preoperative evaluation,postoperative monitoring and ultimately the construction of more personalized therapeutic protocols.

The Anzhen Risk Scoring System for Acute Type A Aortic Dissection:A Prospective Observational Study Protocol

Introduction:Acute type A aortic dissection(ATAAD)is a catastrophic disease with fatal outcomes.Malperfusion syndrome(MPS)is a serious complication of ATAAD,with an incidence of 20–40%.Many studies have shown that MPS is the main risk factor for poor ATAAD prognosis.However,a risk scoring system for ATAAD based on MPS is lacking.Here,we designed a risk scoring system for ATAAD to assess mortality through quantitative assessment of relevant organ malperfusion and subsequently develop rational treatment strategies.Methods and analysis:This was a prospective observational study.Patients’perioperative clinical data were col-lected to establish a database of ATAAD(N≥3000)and determine whether these patients had malperfusion complica-tions.The Anzhen risk scoring system was established on the basis of organ malperfusion by using a random forest survival model and a logistics model.The better method was then chosen to establish a revised risk scoring system.Ethics and dissemination:This study received ethical approval from the Ethics Committees of Beijing Anzhen Hospital,Capital Medical University(KS2019034-1).Patient consent was waived because biological samples were not collected,and no patient rights were violated.Findings will be disseminated at scientific conferences and in peer-reviewed publications.

Spontaneous Heparin-Induced Thrombocytopenia Presenting as Concomitant Bilateral Cerebrovascular Infarction and Acute Coronary Syndrome

Background:Spontaneous heparin-induced thrombocytopenia is a pro-thrombotic syndrome in which anti-heparin antibodies develop without heparin exposure.Case presentation:A 78-year-old man who underwent a successful lumbar laminectomy presented to the hospital 5 days after discharge for stroke-like symptoms and was found to have acute infarcts of the bilateral frontal lobes.The patient was found to be severely thrombocytopenic and was incidentally found to have an inferior wall myocardial infarction.Further investigation led to the diagnosis of bilateral lower extremity deep vein thromboses.His overall clinical presentation prompted a detailed hematologic workup that indicated positivity for heparin-induced thrombocy-topenia despite no previous exposure to heparin products.Conclusions:This case illustrates a patient with no prior lifetime heparin exposure who underwent laminectomy with subsequent development of acute infarcts of the bilateral frontal lobes,an inferior wall myocardial infarction,and bilateral lower extremity deep vein thromboses,with concern for sequelae of spontaneous heparin-induced thrombo-cytopenia.

The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI

Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.

Machine Learning for Predicting the Development of Postoperative Acute Kidney Injury After Coronary Artery Bypass Grafting Without Extracorporeal Circulation

Background:Cardiac surgery-associated acute kidney injury(CSA-AKI)is a major complication that increases morbidity and mortality after cardiac surgery.Most established predictive models are limited to the analysis of nonlinear relationships and do not adequately consider intraoperative variables and early postoperative variables.Nonextracorporeal circulation coronary artery bypass grafting(off-pump CABG)remains the procedure of choice for most coronary surgeries,and refined CSA-AKI predictive models for off-pump CABG are notably lacking.Therefore,this study used an artificial intelligence-based machine learning approach to predict CSA-AKI from comprehensive perioperative data.Methods:In total,293 variables were analysed in the clinical data of patients undergoing off-pump CABG in the Department of Cardiac Surgery at the First Affiliated Hospital of Guangxi Medical University between 2012 and 2021.According to the KDIGO criteria,postoperative AKI was defined by an elevation of at least 50%within 7 days,or 0.3 mg/dL within 48 hours,with respect to the reference serum creatinine level.Five machine learning algorithms—a simple decision tree,random forest,support vector machine,extreme gradient boosting and gradient boosting decision tree(GBDT)—were used to construct the CSA-AKI predictive model.The performance of these models was evaluated with the area under the receiver operating characteristic curve(AUC).Shapley additive explanation(SHAP)values were used to explain the predictive model.Results:The three most influential features in the importance matrix plot were 1-day postoperative serum potassium concentration,1-day postoperative serum magnesium ion concentration,and 1-day postoperative serum creatine phos-phokinase concentration.Conclusion:GBDT exhibited the largest AUC(0.87)and can be used to predict the risk of AKI development after surgery,thus enabling clinicians to optimise treatment strategies and minimise postoperative complications.

The Effect of Home-Based Cardiac Rehabilitation on Functional Capacity,Behavior,and Risk Factors in Patients with Acute Coronary Syndrome in China

Aim:To investigate the effect of home-based cardiac rehabilitation on functional capacity,health behavior,and risk factors in patients with acute coronary syndrome in China.Methods:Eighty patients with acute coronary syndrome were enrolled in this prospective randomized controlled study.Patients in the cardiac rehabilitation group(n=52)received home-based cardiac rehabilitation with a heart manual and a home exercise video for 3 months and patients in the control group(n=28)received only routine secondary prevention.The 6-min walk distance,laboratory test results,healthy behavior(questionnaire),quality of life(12-item Short Form Health Survey),anxiety(7-item Generalized Anxiety Disorder Questionnaire),and depression(9-item Patient Health Questionnaire)were evaluated at the beginning and after treatment for 3 months.Results:Compared with baseline data,52 patients who participated in cardiac rehabilitation had longer 6-min walk distance(515.26±113.74 m vs 0.445.30±97.92 m,P<0.0002),higher proportions of“always exercise”(78.26% vs.28%,P<0.05),“always limit food with sugar”(65.22% vs 12%,P<0.05),“always eat fruits 200–400 g every day”(82.61% vs.4%,P<0.05).and“always eat vegetables 300–500 g every day”(21.74%vs.12%,P<0.06)after treatment for 3 months.The low-density lipoprotein cholesterol control rate(52.17% vs.28%,P<0.05)and the systolic blood pressure control rate(100%vs.68%,P<0.05)were also signifi cantly increased after treatment for 3 months in the cardiac rehabilitation group.No signifi cant increase was found in the control group after treatment for 3 months.No cardiac-event related to home exercise was reported in both groups.Conclusion:Home-based cardiac rehabilitation is a feasible and available cardiac rehabilitation mode in China.

The Gut Microbiota and Atherosclerosis:The State of the Art and Novel Perspectives

The human gut microbiota is composed of more than 100 trillion microbes.Most communities are dominated by species belonging to the phyla Bacteroidetes,Firmicutes,Actinobacteria,Proteobacteria,and Verrucomicrobia.Microfl ora-derived short-chain fatty acids play a pivotal role in the framework of insulin resistance,obesity,and metabolic syndrome.They are an important energy source and are involved in several pathways,with proatherogenic and antiatherogenic effects.The increased gut microbiota lipopolysaccharide levels(defi ned as“metabolic endotoxemia”)induce a state of low-grade infl ammation and are involved in atherosclerotic disease through Toll-like receptor 4.Another important infl ammatory trigger in gut microbiota–mediated atherosclerotic promotion is trimethylamine N-oxide.On the other hand,protocatechuic acid was found to promote cholesterol effl ux from macrophages,showing an antiatherogenic effect.Further studies to clarify specifi c gut composition involved in cardiometabolic syndrome and atherogenesis are needed for greater use of targeted approaches.

Clinical Utility of Amlodipine/Valsartan Fixed-Dose Combination in the Management of Hypertension in Chinese Patients

Amlodipine/valsartan(Aml/Val)single-pill combination(SPC)therapy has been widely used and studied in clinical practice in recent years.This article reviews the Chinese and English literature on the clinical use of Aml/Val SPC therapy in Chinese hypertensive patients.According to five studies concerning the efficacy and safety of this treatment,Aml/Val SPC therapy was more efficacious than monotherapy with valsartan,amlodipine,or the nifedipine gastrointestinal therapeutic system.This treatment showed greater blood pressure-lowering effects,a higher blood pressure control rate,and a higher response rate.Aml/Val SPC treatment was well tolerated,with adverse event rates similar to those of monotherapy with valsartan or amlodipine and significantly rarer adverse events compared with the nifedipine gastrointestinal therapeutic system.Aml/Val SPC is a highly efficacious and well-tolerated antihypertensive treatment in Chinese hypertensive patients.

Diagnostic Accuracy of Three-Dimensional Whole-Heart Magnetic Resonance Angiography to Detect Coronary Artery Disease with Invasive Coronary Angiography as a Reference:A Meta-Analysis

Objective:We aimed to evaluate the diagnostic performance of three-dimensional whole-heart magnetic resonance coronary angiography(MRCA)in detecting coronary artery disease(CAD)with invasive coronary angiography as the reference standard.Methods:We searched PubMed and Embase for studies evaluating the diagnostic performance of three-dimensional whole-heart MRCA for the diagnosis of CAD with invasive coronary angiography as the reference standard.The bivariate mixed-effects regression model was applied to synthesize available data.The clinical utility of whole-heart MRCA was calculated by the posttest probability based on Bayes’s theorem.Results:Eighteen studies were included,of which 16 provided data at the artery level.Patient-based analysis revealed a pooled sensitivity of 0.90(95%confi dence interval[CI]0.87–0.93)and specifi city of 0.79(95%CI 0.73–0.84),while the pooled estimates were 0.86(95%CI 0.82–0.89)and 0.89(95%CI 0.84–0.92),respectively,at the artery level.The areas under the summary receiver operating characteristic curve were 0.93(95%CI 0.90–0.95)and 0.92(95%CI 0.90–0.94)at the patient and artery levels,respectively.With a pretest probability of 50%,the patients’posttest probabilities of CAD were 81%for positive results and 11%for negative results.Conclusions:Whole-heart MRCA can be an alternative noninvasive method for diagnosis and assessment of CAD.

Associations between Vaspin Levels and Coronary Artery Disease

The relationship between serum vaspin levels and metabolic or coronary artery disease is currently of interest for researchers.Although adipokine concentrations have been shown to be increased signifi cantly in atherosclerotic lesions,the role adipokines in the atherosclerotic process remains to be elucidated.Vaspin is a new biological marker associated with obesity and impaired insulin sensitivity.Plasma vaspin concentration has been shown to correlate with the severity of coronary artery disease.Vascular infl ammation triggered by vaspin inhibits atherogenesis by suppressing macrophage foam cell formation and vascular smooth muscle cell migration and proliferation.Vaspin also contributes to plaque stabilization by increasing collagen content and reducing the intraplaque macrophage to vascular smooth muscle cell ratio.The therapeutic goal concerning vaspin is to fi ght atherosclerosis and related diseases,as well as to maintain vascular health.

Rationale and Design of the Randomized Controlled Trial of Intensive Versus Usual ECG Screening for Atrial Fibrillation in Elderly Chinese by an Automated ECG System in Community Health Centers in Shanghai(AF-CATCH)

Objective:The randomized controlled trial(ClinicalTrials.gov identifier NCT02990741)will investigate whether more frequent electrocardiographic(ECG)recordings and analyses with an automated ECG system would improve detection of atrial fibrillation compared with a single annual ECG screen in elderly Chinese in community health centers.Design:Men and women(≥65 years)will be randomized into intensive(n=3500)and usual(n=3500)screening groups,and within the intensive screening group into intensive screening(n=2625)and more intensive screening(n=875)subgroups.ECG recordings will be performed with an automated ECG analysis system(AliveCor heart monitor)at 1 year in the usual screening group,at 3,6,9,and 12 months in the intensive screening subgroup,and at 1,2,3,and 4 weeks and 3,6,9,and 12 months in the more intensive screening subgroup.The primary outcome is the detection rate of atrial fibrillation between the usual screening group and the intensive screening group.Sample size estimation was based on a projected detection rate of atrial fibrillation of 2.0% by a single ECG recording at 12 months,an improvement of 50% with more frequent ECG recordings,α=0.05,power of 80%,and a one-sided test.Conclusions:The trial will provide evidence on the clinical effectiveness of more frequent ECG recordings by a handheld automated analysis system in the detection of atrial fibrillation.

Diagnosis of Coronary Artery Disease by Acoustic Analysis of Turbulent Murmur Caused by Coronary Artery Stenosis:A Single Center Study from China

Aim:Intracoronary murmur results from turbulent flow due to coronary artery narrowing.This study evaluated the diagnostic performance of a method for acoustic analysis of turbulent murmur caused by coronary artery stenosis in coronary artery disease(CAD)in Chinese populations.Method:Patients admitted to the cardiovascular department of the Sixth Medical Center of the Chinese People’s Liberation Army General Hospital between September 2021 and June 2022 for elective coronary angiography were prospectively enrolled.A digital electronic stethoscope was used to record heart sounds before angiography.Quantitative coronary angiography(QCA)served as the“gold standard”for CAD diagnosis to evaluate the diagnostic performance of the acoustic analysis method for CAD.Results:A total of 452 patients had complete QCA and heart sound data.The final interpretation results of the acoustic analysis method indicated 310 disease cases and 142 normal results.Increasing the cut-off values of coronary artery diameter stenosis from 30%to 50%,70%,and 90%increased the sensitivity and NPV of the acoustic analysis method;the sensitivity was 75.6%,81.9%,83.3%,and 85.7%,respectively;the NPV was 33.1%,57.0%,69.7%,and 88.0%,respectively;the specificity and PPV decreased(specificity of 75.8%,70.4%,51.0%,and 37.5%,respectively;PPV of 95.2%,89.0%,69.4%,and 32.9%,respectively);and the AUC values were 0.757,0.762,0.672,and 0.616,respectively.The sensitivity of the acoustic analysis method for one-vessel disease was 86.6%when the cut-off value was 50%.The sensitivity for identifying left anterior descending coronary artery lesions was best,at 90.7%.The sensitivity for identifying isolated coronary artery branch lesions was 66.7%,whereas the sensitivity for identifying three-vessel disease in multi-vessel coronary artery lesions was better,at 82.9%.Conclusion:Acoustic analysis of turbulent murmur caused by coronary artery stenosis for diagnosis of CAD may have favorable performance in the Chinese population.This method has good performance in CAD diagnosis with a cut-off coronary artery diameter for stenosis of 50%.

Depression,Anxiety,and Cardiovascular Disease in Chinese:A Review for a Bigger Picture

Cardiovascular disease(CVD)and depression and anxiety contribute substantially to the current disease burden worldwide as well as in China.Both depression and anxiety are highly prevalent among patients with CVD.We systematically reviewed the literature to disentangle the role of depression and anxiety disorders in the onset and prognosis of CVD with an emphasis on cohort studies conducted in the Chinese population.Despite the lack of large-scale prospective studies in China,the available evidence implies that both depression and anxiety are closely associated with the onset and prognosis of CVD,including ischemic heart disease and stroke,in Chinese adults.Putative behavioral and biological mechanisms are implicated in the link between depression/anxiety and CVD.Timely screening and diagnosis followed by proper treatment should be implemented for depression and anxiety in both the general population and patients with CVD.Current standard treatments such as selective serotonin reuptake inhibitors and psychotherapies are recommended for CVD patients with depression,although their efficacy for reducing CVD morbidity and mortality remains uncertain.In conclusion,prospective studies on the link between depression/anxiety and the onset and prognosis of CVD are urgently needed in the Chinese population,and more efforts are warranted to examine the efficacy of depression and anxiety treatments for CVD patients,particularly the integrated care model of including psychiatrists in a multidisciplinary clinical group.

ACC/AHA Guidelines for Cardiovascular Disease Prevention and Cholesterol Management:Implications of New Therapeutic Agents^a

In 2014 the American College of Cardiology/American Heart Association issued four new guidelines for cardiovascular disease prevention that focused on cardiovascular risk assessment,lifestyle management,obesity management,and blood cholesterol management.The development of an atherosclerotic cardiovascular disease risk calculator formed the basis of the risk assessment guideline,and the lifestyle management guideline focused on recommending an evidence-based dietary pattern.The blood cholesterol management guideline specifi cally identifi ed four groups of patients shown to benefi t from moderate-intensity or high-intensity statin therapy from previous clinical trials and abandoned the use of specifi c low-density lipoprotein(LDL)cholesterol(LDL-C)goal levels on the basis of the lack of clinical trial evidence.The recommendations for treatment with moderate-intensity or high-intensity statin therapy are based on rigorous evidence from randomized clinical trials.Guidance has since been provided for the use of nonstatin therapies,including cholesterol absorption inhibitor and proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapy when adequate reduction of LDL-C levels is not achieved with maximally tolerated statin therapy.The recent development and application of these therapies have resulted in remarkable reductions in LDL-C levels that are well tolerated,and preliminary outcome data are promising in showing substantial atherosclerotic cardiovascular disease event reductions beyond statin therapy.

Epidemiological Study of Heart Failure in China

Heart failure(HF)is a complex clinical syndrome that results from any structural or functional impairment of ventricular fi lling or ejection of blood.HF is one of the most important and severe end stages of many cardiovascular diseases.Epidemiological studies of HF have focused mainly on the prevalence,incidence,mortality,fatality,and distribution and temporal trends of these indicators among different populations.This review highlights important epidemiological studies of HF in China.

Systemic Vasculitis:An Important and Underestimated Cause of Malignant Hypertension

Objectives:Malignant hypertension(MHT)is defi ned as severe hypertension accompanied by ischemic failure of one or more organs.The aims of this study were to evaluate the current clinical and etiologic profi les of MHT.Methods:As a retrospective study,we selected all patients admitted to our center from January 2013 to December 2016.Seventy patients with MHT were included.Results:The average age of the patients was 40 years,and more than half of the patients were male(78.57%).There were 24 patients with essential hypertension,accounting for 34.29%of the patients,and 46 with secondary hypertension,accounting for 65.71%of the patients.For secondary MHT,systemic vasculitis(25.57%)was the most common cause,followed by severe obstructive sleep apnea syndrome(15.71%),primary renal parenchymal hypertension(11.43%),primary aldosteronism(7.14%),and Cushing syndrome(1.43%)and nutcracker phenomenon(1.43%).Twenty patients with systemic vasculitis were characterized by severe hypertension accompanied by damage to two or more target organs of differing severity.The levels of white blood cells,hypersensitive C-reactive protein,serum creatinine,and 24-hour urinary protein were above their normal range.Conclusion:Systemic vasculitis may be one of the main causes of MHT,and has been underestimated in the past.In future clinical work,clinicians need to pay more attention to patients with systemic vasculitis.

Inappropriate Activation of TLR4/NF-κB is a Cause of Heart Failure

Significance:Heart failure,a disease with extremely high incidence,is closely associated with inflammation and oxidative stress.The Toll-like receptor 4(TLR4)/nuclear factor kappa-B(NF-κB)pathway plays an important role in the occurrence and development of heart failure.Recent advances:Previous studies have shown that TLR4/NF-κB causes heart failure by inducing oxidative stress and inflammation;damaging the endothelia;promoting fibrosis;and inducing myocardial hypertrophy,apoptosis,pyroptosis,and autophagy.Critical issues:Understanding the pathogenesis of heart failure is essential for the treatment of this disease.In this review,we outline the mechanisms underlying TLR4/NF-κB pathway-mediated heart failure and discuss drugs that alleviate heart failure by regulating the TLR4/NF-κB pathway.Future directions:During TLR4/NF-κB overactivation,interventions targeting specific receptor antagonists may effectively alleviate heart failure,thus providing a basis for the development of new anti-heart failure drugs.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction:Faster Treatment Speed and Better Prognosis

Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.

Development of Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy for Patients with ST-Elevation Myocardial Infarction and Assessment of Its Use in Egypt

Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome and more specifi cally with ST-elevation myocardial infarction(STEMI)can save lives.This study aims to identify the mean time(door to balloon time and fi rst contact to balloon time)to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods:A registry study of patients presenting to cardiac centers in Egypt was designed,where patients’basic characteristics,the treatment strategy,and the door to balloon time and the fi rst contact to balloon time were assessed.Results:One thousand six hundred fi fty STEMI patients with a mean age of 57 years were included in the study.Immediate transfer for primary PCI was the most used treatment strategy,representing 74.6%of all treatment strategies used.The door to balloon time and the fi rst contact to balloon time were 50 and 60 minutes,respectively,with a primary PCI success rate of 65.1%.Conclusion:The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for STEMI patients in Egypt.