Stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute ST-segment elevation myocardial infarction： a multicenter random- ized clinical trial

Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction （STEMI） patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a pro- spective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute STEMI patients with single vessel disease and intermediate （40%-70%） stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban （15 pg/kg） were enrolled and were randomly assigned （h 1） to stenting group （n = 201） and non-stenting group （n = 198）. In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention （PCI） with stent implantation. In non-stenting group, pa- tients received pharmacologic therapy and PCI （thrombectomy）, but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and eerebrovascular events （MACCE）, a composite of cardiac death, non-fatal myocardial infarction （M1）, repeat re- vascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complica- tion. Median follow-up time was 12.4 ~ 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group （adjusted HR： 0.42, 95% Ch 0.19-0.89, P = 0.02）. The stenting group had lower non-fatal MI rate than non-stenting group, （1.5% vs. 5.5%, P = 0.03）. The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions Stent implantation had better efficacy and safety in reducing MACCE risks among acute STEMI patients with single vessel intermediate stenosis culprit lesions.

Prognostic value of coronary artery calcium score in patients with stable an-gina pectoris after percutaneous coronary intervention

Objectives To evaluate the prognostic value of the coronary artery calcium （CAC） score in patients with stable angina pectoris （SAP） who underwent percutaneous coronary intervention （PCI）. Methods A total of 334 consecutive patients with SAP who underwent first PCI following multi-slice computer tomography （MSCT） were enrolled from our institution between January 2007 and June 2012. The CAC score was calculated according to the standard Agatston calcium scoring algorithm. Complex PCI was defined as use of high pressure bal-loon, kissing balloon and/or rotablator. Procedure-related complications included dissection, occlusion, perforation, no/slow flow and emer-gency coronary artery bypass grafting. Main adverse cardiac events （MACE） were defined as a combined end point of death, non-fatal myo-cardial infarction, target lesion revascularization and rehospitalization for cardiac ischemic events. Results Patients with a CAC score〉300 （n=145） had significantly higher PCI complexity （13.1%vs. 5.8%, P=0.017） and rate of procedure-related complications （17.2%vs. 7.4%, P=0.005） than patients with a CAC score≤300 （n=189）. After a median follow-up of 22.5 months （4-72 months）, patients with a CAC score≤300 differ greatly than those patients with CAC score＆gt;300 in cumulative non-events survival rates （88.9 vs. 79.0%, Log rank 4.577, P=0.032）. After adjusted for other factors, the risk of MACE was significantly higher [hazard ratio （HR）：4.3, 95%confidence inter-val （95%CI）：2.4-8.2, P=0.038] in patients with a CAC score〉300 compared to patients with a lower CAC score. Conclusions The CAC score is an independent predictor for MACE in SAP patients who underwent PCI and indicates complexity of PCI and proce-dure-related complications.

Analysis of risk factors for early stent thrombosis in the Chinese population:A multicenter restrospective study

BACKGROUND:The predictive scoring systems for early stent thrombosis(EST)remains blank in China.The study aims to evaluate the risk factors and conduct a prediction model of EST in the Chinese population.METHODS:EST was defined as thrombosis that occurs within the first 30 days after primary percutaneous coronary intervention(PCI).Patients from ten Chinese hospitals diagnosed as stent thrombosis(ST)from January 2010 to December 2016 were retrospectively included as the study group.A control group(1 case:2 controls)was created by including patients without ST,major adverse cardiovascular events,or cerebrovascular events during follow-up.The present study evaluated 426 patients with single-vessel lesions and ultimately included 40 patients with EST and 80 control patients,who were included to identify factors that predicted EST and to develop a prediction scoring system.The other 171 patients without integrated 1:2 pair were used for external validation.RESULTS:EST was independently associated with a low hemoglobin concentration(adjusted odds ratio[OR]0.946,95%confi dence interval[95%CI]0.901-0.993,P=0.026),a high pre-PCI Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score(OR 1.166,95%CI 1.049-1.297,P=0.004),and a DAPT(DAPT)duration of<30 days(OR 28.033,95%CI 5.302-272.834,P<0.001).The simple EST prediction score provided an area under the curve(AUC)of 0.854(95%CI 0.777-0.932,P<0.001)with 70.0%sensitivity and 90.0%specifi city,and 0.742(95%CI 0.649-0.835,P<0.001)with 54.5%sensitivity and 81.0%specifi city for external validation dataset.CONCLUSIONS:EST may be independently associated with DAPT discontinuation within 30 days,a low hemoglobin concentration,and a high SYNTAX score.The scoring system also has a good ability to predict the risk of EST and may be useful in the clinical setting.

A case report of significant progression after FFR-guided deferred PCI

In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typically,FFR>0.80 in coronary artery indicates the lesions do not affect the coronary blood flow.

Prognostic differences of catestatin among young and elderly patients with acute myocardial infarction

BACKGROUND:Previous studies have reported inconsistent findings regarding the association between catestatin and outcomes of acute myocardial infarction(AMI).This study aims to investigate the prognostic value of catestatin for long-term outcomes in patients with AMI.METHODS:One hundred and sixty-five patients with AMI were enrolled in this series.The plasma catestatin levels at baseline and clinical data were collected.All patients were followed up for four years to investigate whether there were major adverse cardiovascular events(MACEs),including cardiovascular death,recurrent AMI,rehospitalization for heart failure,and revascularization.RESULTS:There were 24 patients who had MACEs during the follow-up period.The MACEs group had significantly lower plasma catestatin levels(0.74±0.49 ng/m L vs.1.10±0.79 ng/m L,P=0.033)and were older(59.0±11.4 years old vs.53.2±12.8 years old,P=0.036).The rate of MACEs was significantly higher in the elderly group(≥60 years old)than in the young group(<60 years old)(23.8%[15/63]vs.8.8%[9/102],P=0.008).The catestatin level was significantly lower in the MACEs group than that in the non-MACEs group(0.76±0.50 ng/m L vs.1.31±0.77 ng/m L,P=0.012),and catestatin was significantly associated with MACEs(Kaplan Meier,P=0.007)among the elderly group,but not in the young group(Kaplan Meier,P=0.893).In the Cox proportional hazards regression,high catestatin was one of the independent factors for predicting MACEs after adjustment for other risk factors(hazard ratio 0.19,95%confidence interval 0.06–0.62,P=0.006)among elderly patients.CONCLUSIONS:Elderly AMI patients with lower plasma catestatin levels are more likely to develop MACEs.Catestatin may be a novel marker for the long-term prognosis of AMI,especially in elderly patients.

Preparation and enhancement of ionic conductivity in AI-added garnet-like Li6.8La3Zr1.8Bi0.2O12 lithium ionic electrolyte

Garnet-like Li6.8La3Zr1.8Bi0.2O12 （LLZBO） ＋ x mol.% Al2O3 （x = 0, 1.25, 2.50） lithium ionic electrolytes were prepared by conventional solid state reaction method under two different sintering temperatures of 1000℃ and 1100℃. XPS, induced coupled plasma optical emission spectrometer （ICP-OES）, XRD and AC impedance spectroscopy were applied to investigate the bismuth valance, lithium concentration, phase structure and lithium ionic conductivity, respectively. Electrical measurement demonstrated that ionic conductivity of AI-added LLZBO compounds could be obviously improved when the sample sintering temperature increased from 1000℃ to 1100℃. The highest ionic conductivity 6.3×10-S/cm was obtained in the LLZBO-1.25%AI sample sintered at 1100℃, in consistent with the lowest activation energy 0.45eV for the lithium ion migration. The mechanism related with good ionic conductivity in the AI-added LLZBO sample was attributed to the lattice distortion induced by the partial AI substitution at Zr sites, which is helpful to improve the migration ability of Li ions in lattice.