Thirty-day outcomes of in-hospital multi-vessel versus culpritonly revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease

BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.After 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.

Chinese expert consensus on the non-invasive imaging examination pathways of stable coronary artery disease

1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.

Quality control of ultrasonic measurement of carotid artery intima-media thickness

Background To report quality control methods and baseline reproducibility data of the ultrasound measurements of carotid artery intima-media thickness in the project of Establishment of an Integrated System for Coronary Heart Disease Prevention and Treatment. Methods Standard ultrasound scanning and measuring protocols were established by the study group. All sonographers and readers were trained by the carotid ultrasound core lab and all digital ultrasound images were centrally read. Ten subjects were scanned twice （with 1 week interval） by 2 sonographers independently and images were read by a single reader to evaluate the sonographer variability. Twenty subjects＇ images were read twice （with 1 week interval） by a single reader to assess the reader variability and the reproducibility of IMT measured at different carotid segments. Results The intraclass correlation （ICC） of intra- and inter-sonographer and intra- reader for mean IMT measurements was 0.99, 0.98 and 0.97 respectively; while for max IMT, it was 0.97, 0.99 and 0.95 respectively. Among different carotid segments and sites, ICC for mean 1MT measurements of common carotid （CCA）, carotid artery bulb （Bulb）, internal carotid artery （ICA）, overall near wall and overall far wall was 0.97, 0.99, 0.89, 0.93 and 0.98 respectively. Conclusion The reproducibility of IMT measurements according to our protocol is acceptable, although better reproducibility is found when measuring the mean IMT than max IMT, CCA and Bulb IMT than ICA IMT, and far wall IMT than near wall IMT.

Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in China

Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.

Trends and sex differences in atrial fibrillation hospitalization and catheter ablation at tertiary hospitals in China from 2013 to 2016

BACKGROUND Catheter ablation for atrial fibrillation(AF)is commonly performed worldwide.However,the clinical charac-teristics of hospitalized patients with AF and national trends in catheter ablation at tertiary hospitals in China remain unreported.METHODS This study used the Chinese national database(Hospital Quality Monitoring System)from 2013 to 2016,which is a mandatory database that collects the front page of patients’medical records for hospital accreditation,to describe the clinical cha-racteristics of patients with AF as an overall cohort and as subgroups divided by catheter ablation and sex.RESULTS Of 597,919 AF patients first admitted,57,983 patients underwent catheter ablation[56,384 cases(97.2%)of radiofre-quency ablation and 1599 cases(2.8%)of cryoablation]at 746 tertiary hospitals.Nearly 10%of patients hospitalized with AF at ter-tiary hospitals in China underwent catheter ablation,and the percentage of patients undergoing catheter ablation was on the rise bet-ween 2013 and 2016,and the number of cases increased by 2.5 times.Compared with AF patients who did not undergo catheter ablation,those who did were younger,more frequently male,and had fewer baseline comorbidities.Although the overall CHA_(2)DS_(2)-VASc score revealed over half of the patients were high-risk,patients who underwent catheter ablation were mostly low-risk(71.2%of males and 59.1%of females).Considering in-hospital adverse events,the overall pericardial tamponade and all-cause death incidences were 0.2%(0.6%in the ablation group)and 1.2%(0.1%in the ablation group),respectively;both of which were higher in females than males.CONCLUSIONS In this study,AF patients who underwent catheter ablation were relatively young,had a low thrombosis risk,and had few comorbidities and adverse events.Females were older and experienced more complications than males.

The Safety and Tolerance of Herbal Anti-Angina Drug Compound Danshen Droplet Pill in Healthy Volunteers

Background: Compound Salvia Pellet (T89), consisting of Danshen (salvia miltiorrhiza), Sanqi (panax notoginseng), and Borneol (Cinnamomum camphora), has been used worldwide for 14 years for chronic angina treatment. Purpose: A dose escalation study to determine the maximum tolerance dose (MTD) in Chinese population to support a proposed dose regimen change. Methods: Forty-six participants (age 18 to 45 yrs, male to female ratio = 1:1) were divided into a series of 6 patients cohorts, and sequentially assigned into one of the escalating dose groups, starting from 540 mg, the clinical doses, until 4 out of 6 subjects experience clinical Adverse Events (AEs) or when the pre-defined 3510 mg dose level is reached and completed. All doses were given orally as a single dose 2 hours after breakfast. Adverse events, vital signs, 12-lead ECG, clinical and laboratory parameters and medical evaluation were conducted as outcome measures. Results: Study completed at the highest pre-defined dose level of 3510 mg dose as never had 4/6 of subject experience AEs in any dose levels studied. All participants completed the study and data were included in the safety analysis. The only moderate AE observation (muscle damage) was observed at 2970 mg dose and was recovered without any medical treatment, and all other AEs (ECG, dizziness, muscle damage) were mild and may (5 cases) or may not (9 cases) be related to testing drug and were all self-resolved within 30 min after dose. Conclusion: Given as single oral dose, Compound Salvia Pellet is safe and well-tolerated up to the 3510 mg studied. The MTD value of Compound Salvia Pellet is unknown from this trial and must be higher than 3510 mg, 13 times higher than its current clinical dose.

Effect of plateletcrit and methylenetetrahydrofolate reductase(MTHFR)C677T genotypes on folic acid efficacy in stroke prevention

Previous studies have shown that low platelet count combined with high plasma total homocysteine(tHcy)increased stroke risk and can be lowered by 73% with folic acid.However,the combined role of other platelet activation parameters and the methylenetetrahydrofolate reductase(MTHFR)C677T genotypes on stroke risk and folic acid treatment benefit remain to be examined.This study aimed to investigate if platelet activation parameters and MTHFR genotypes jointly impact folic acid treatment efficacy in first stroke prevention.Data were derived from the China Stroke Primary Prevention Trial.This study includes a total of 11,185 adult hypertensive patients with relevant platelet activation parameters and MTHFR genotype data.When simultaneously considering both platelet activation parameters(plateletcrit,platelet count,mean platelet volume,platelet distribution width)and MTHFR genotypes,patients with both low plateletcrit(Q1)and the TT genotype had the highest stroke incidence rate(5.6%)in the enalapril group.This subgroup significantly benefited from folic acid treatment,with a 66% reduction in first stroke(HR:0.34;95%CI:0.14-0.82;p=0.016).Consistently,the subgroup with low plateletcrit(Q1)and the CC/CT genotype also benefited from folic acid treatment(HR:0.40;95%CI:0.23-0.70;p=0.001).In Chinese hypertensive adults,low plateletcrit can identify those who may greatly benefit from folic acid treatment,in particular,those with the TT genotype,a subpopulation known to have the highest stroke risk.

Effect of enalapril on plasma homocysteine levels in patients with essential hypertension

Objective:To investigate the effect of enalapril on plasma homocysteine(Hcy) levels and the association of methylenetetrahydrofolate reductase(MTHFR) C677T polymorphism with the changes of Hcy levels in response to enalapril among patients with essential hypertension.Methods:A total of 130 patients with mild-to-moderate essential hypertension were enrolled and enalapril was orally administered at a dose of 10 mg/d for eight weeks.Plasma Hcy levels were measured by denaturing high-performance liquid chromatography(DHPLC) at baseline and after eight weeks of treatment.Genotyping of MTHFR C677T polymorphism was performed by TaqMan probe technique.Results:Compared with baseline,plasma Hcy levels did not change significantly after eight weeks(P=0.81).Stratified by baseline Hcy levels,a significant increase in plasma Hcy levels(P=0.02) among those with Hcy <10 μmol/L was observed,in contrast to no significant changes in plasma Hcy levels(P=0.54) among those with Hcy ≥10 μmol/L.No significant association was observed between MTHFR C677T polymorphism and changes in Hcy levels in response to enalapril.Conclusions:Enalapril may cause an increase in plasma Hcy levels among the hypertensives with low baseline Hcy levels.There was no significant association between MTHFR C677T genotypes and changes in Hcy levels in response to enalapril among subjects with essential hypertension.

2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithrombotic treatment. Despite this observation, treatment strategies in East Asian patients are mostly based on the American and European guidelines. Despite a lower platelet inhibitory response to clopidogrel, East Asian patients show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. For potent P2Y_(12) inhibitors(ticagrelor and prasugrel),East Asian patients have shown less favorable net clinical benefits compared with Caucasian patients,which may be related to differences in pharmacokinetic/pharmacodynamic profiles and therapeutic zone of antiplatelet effect. This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population. In addition, when East Asian patients are administered potent P2Y_(12) receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed.

Percutaneous Ventricular Restoration Therapy Using the Parachute Device in Chinese Patients with Ischemic Heart Failure： Three-Month Primary End-point Results of PARACHUTE China Study

Background： The primary cause of ischemic heart failure （HF） is myocardial infarction （MI） resulting in left ventricle （LV） wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device （CardioKinetix, lnc., CA, USA） in ischemic HF patients as a result of LV remodeling after anterior wall M1. Methods： Thirty-one patients with New York Heart Association （NYHA） Class I1, I11 ischemic HF, ejection traction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014. The Parachute device was implanted through femoral artery. All patients received low-dose aspirin and anticoagulation with warfarin tbr at least 12 months postdevice implantation. The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index （LVESVI） against baseline LVESVI at 3 months postdevice implantation, determined by the echocardiography and measured by echocardiography core laboratory. Quality of life was assessed using EQ-SD and visual analog scale （VAS）. For quantitative data comparison, paired t-test （normality data） and signed-rank test （abnormality data） were used： application of signed-rank test was tbr the ranked data comparison. Results： A change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ~ 20.0 ml/m-＇ to 53,1 ~ 17.0 ml/m-＂ （P 〈 0.0001 ）, The trial met its primary end-point. Of the 31 patients, the procedural success was 96.8%. Overall, NYHA HF class assessment results showed an improvement of more than halfa class at 3 months （P 〈 0.001 ）. Quality of life assessed by the VAS value increased 11.5 points （P 〈 0.01 ）, demonstrating improvement at 3 months.Conclusion： The favorable outcomes observed in the high-risk patients provide reassuring safety and efficacy data to support adoption of this technology as a therapeutic option for ischemic HF patients. Trial Registration： ClinicalTrials.gov, NCT02240940; https：// clinicaltrials.gov/ct2/show/NCT02240940.

阿卡波糖心血管评估（ACE）试验依据与设计

心血管疾病（CVD）患者和糖耐量减低（IGT）者患2型糖尿病（T2DM）的风险较高。生活方式的调整或药物干预可以延缓T2DM的进展，但没有证据表明它们能够降低该人群的心血管风险。阿卡波糖是一种α-葡萄糖苷酶抑制剂，能够降低餐后血糖；其被证明能够使T2DM风险降低25％，并有可能降低无CVD的IGT受试者的心血管风险。阿卡波糖心血管评估（ACE）试验是一项随机、安慰剂对照、双盲、二级预防试验，受试者为7500例患有冠心病（定义为既往心肌梗死、不稳定型心绞痛或当前稳定的心绞痛）并伴有IGT且年龄I〉50岁的患者。以1：1的比例将患者随机分组，分别在标准CVD治疗药物基础上服用阿卡波糖50mg，每天3次或相匹配的安慰剂。排除标准包括糖尿病病史、过去3个月内发生过心血管事件、NYHAⅢ／Ⅳ级心力衰竭、重度肝病和重度肾功能损害。本研究在中国内地和中国香港的约150家医院内进行。主要复合心血管终点是至首次发生心血管死亡、非致死性心肌梗塞或非致死性卒中的时间。次要终点包括全因死亡和新发T2DM。ACE是一项对CVD进行二级预防的研究，用于评估冠心病患者和IGT者在标准心血管治疗的基础上加用阿卡波糖的效果。CVD的治疗与干预标准包括合理使用能降低心血管风险因素的药物，例如B肾上腺素能受体阻断剂、血管紧张素转换酶抑制剂、抗血小板药物和降血脂药物。在高血糖症患者中，血糖可能是另一个可调节的风险因素。流行病学证据表明，IGT会导致CVD发病率和死亡率上升，尽管其程度低于T2DM患者。餐后高血糖是餐后血糖代谢障碍的一个指标，它是心血管事件的一个独立的预测因子，因为负荷后血糖值与心血管事件的相关性比空腹血糖值更强，即使在非糖尿病受试者中也是这样。餐后代谢障碍影响动脉粥样硬化与CVD的机制包含多种因素。体内血糖的急性上升会诱导内皮功能障碍，可能是通过氧化应激引起。急性高血糖症也与血栓形成的激活以及炎性级联反应相关。用药物治疗来降低餐后高血糖会导致CVD的替代指标下降。在之前未用药物而被随机分配接受瑞格列奈（一种短效促泌剂，主要对餐后高血糖进行控制）或格列本脲（一种长效磺脲类药物）的患者中，使用瑞格列奈的患者C反应蛋白和白细胞介素-6的下降程度较大，颈动脉内一中膜厚度指标也是如此。阿卡波糖能够通过延缓碳水化合物的消化和吸收，降低餐后高血糖，改善内皮功能障碍，降低炎性指标（包括细胞核因子．xB活化及其核转位以及C反应蛋白），减少凝血因子（纤维蛋白原和凝血素），减少低密度脂蛋白氧化，降低颈动脉内一中膜厚度。相比那格列奈，阿卡波糖餐后血流量介导的血管扩张改善更显著。它也会放大二肽基肽酶4抑制剂阿格列汀的降血糖效应。IGT者中进行的降糖药物临床试验大都集中在预防T2DM上，而对心血管结局鲜有关注。STOP．NIDDM试验（1429名IGT受试者被随机分配阿卡波糖或安慰剂）显示，在平均3．3年的随访期后，阿卡波糖降低T2DM风险25％。后续分析也显示心肌梗死风险以及预先指定的任一心血管事件风险下降，但只有47名受试者发生了CVD。一项关于阿卡波糖的荟萃分析提示，阿卡波糖能显著降低T2DM患者的心肌梗死风险和心血管死亡、卒中、外周动脉疾病、心绞痛、心力衰竭和血管重建的风险。这些数据支持了该假设：使用阿卡波糖降低餐后高血糖能够消除IGT者的高CVD风险。目前为止唯一的有关降低餐后血糖药物的前瞻性CVD结局试验NAVIGATOR显示，那格列奈对心血管结局没有影响。ORIGIN试验（增大基础胰岛素用量以降低IGT者或早期T2DM患者的空腹血糖值）结果也显示对心血管结局没有影响。ACE试验的目的是确定阿卡波糖是否能够减少冠心病患者和IGT者中的心血管事件，其次要结局是T2DM的预防情况。

Combining fragmented QRS and TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction

Acute myocardial infarction （AMI） has a high mortality rate and poor prognosis for patients. The primary causes of death are arrhythmia and heart failure. For patients admitted because of myocardial infarction, various risk evaluations are initiated to foresee possible complications. The thrombolysis in myocardial infarction （TIMI） risk score, which can be used to predict the prognosis and the need for revas-cularisation, is the most convenient and commonly used system, but is inadequate for AMI patients on admittance. Fragmented QRS （fQRS） has been shown to be a valuable electrocardiographic （ECG） index for predicting the prognosis of patients with coronary heart disease （Das et al., 2006, 2007）.

Current status and development of percutaneous coronary intervention in China

Dr. Gruntzig et al. （1979） successfully completed the world＇s first percutaneous coronary intervention （PCI）, a percutaneous transluminal coronary angioplasty （PTCA）, in 1977. The first reported PTCA in China was in 1984. With the development of PCI techniques, while more and more patients have benefited, there are ongoing challenges as well.

Prevalence and treatment of hypertension in China： impacts of 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

The definition, recommended treatment thresholds and targets of hypertension have been updated in the recent 2017 American College of Cardiology/American Heart Association(ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. However,the impacts of this guideline on Chinese population are currently unknown. In this study, we aim to provide updated data in China using criteria from the updated guideline. A multistage, stratified sampling method was used to obtain a representative sample of 50,171 adults aged 18 years and above.Hypertension was defined as an average systolic blood pressure !130 mm Hg, or an average diastolic blood pressure !80 mm Hg, or self-reported use of antihypertensive medications in past 2 weeks. The weighted prevalence of hypertension was 60.1%(95% confidence interval [CI] 59.3%–61.0%). The treatment rate and recommended treatment rate were 16.8%(95% CI 16.1%–17.6%) and 53.7%(95% CI52.6%–54.9%), respectively; the gap was more prominent among men and participants from rural areas.Hence, the adoption of the 2017 ACC/AHA guideline will lead to a substantial increase in both prevalence and number of patients needing treatment in China. The applicability of this guideline should be carefully evaluated based on evidence from Chinese population.

Factors underlying the association of body mass index with serum ALT in Chinese hypertensive adults without known hepatic diseases

Objective： High body mass index （BMI） is considered as the most important risk factor for elevated serum alanine aminotransferase （ALT） concentration. This study examined an array of factors, including waist circumference （WC） and folate deficiency, which may mediate the association of BMI with serum ALT concentration in Chinese hypertensive adults without known hepatic diseases. Methods： A multicenter, cross-sectional study was carried out. A total of 378 patients with mild or moderate hypertension and without known hepatic diseases were recruited from five hospitals in Harbin, Shanghai, Beijing, Xi＇an, and Nanjing. Results： Of the 360 hypertensive patients with complete data in our final analysis, 13.6% had high ALT concentrations （〉40 IU/L）. Factors including BMI, WC, triglycedde level, and folate concentration were associated with ALT concentration in univariate analysis. Consistently higher preva- lence rates of elevated ALT were observed in subjects with lower folate concentrations （≥12 vs. 〈12 nmol/L, 9.9% vs. 17.8%, P=-0.03）, with higher BMI （≥28 vs. 〈28 kg/m2, 21.5% vs. 11.4%, P=-0.02） or higher WC （≥90 vs. 〈90 cm, 18.5% vs. 10.0%, P=-0.02）. However, in multivariate analysis, the association between BMI and ALT concentration disap- peared （P=-0.802 in males and 0.369 in females）, while WC in females （P〈0.001） and folate concentration （P=-0.036 in males and 0.044 in females） remained as significant predictors for ALT concentration. Conclusions： This multicenter study demonstrated that WC and low folate concentration were important factors underlying the association between BMI and ALT concentrations in Chinese hypertensive adults without known hepatic diseases.

Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous coronary intervention （PCI）. Methods： 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency （PCI） from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate （eGFR） was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results： There was a significant increase in the concentrations of fibrinogen and D-Dimer （P〈0.05） and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease （CKD; eGFR〈60 ml/（min-1.73 m^2）） （P〈0.01）. CKD （eGFR〈60 ml/（min.1.73 m^2）） was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly （P=0.032, odds ratio （OR） 4.159, 95% confidence interval （CI） 1.127-15.346）. Conclusions： Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.

Contemporary characteristics,management,and outcomes of patients hospitalized for atrial fibrillation in China:results from the real-world study of Chinese atrial fibrillation registry

Atrial fibrillation(AF)is a growing public health problem in the context of the epidemiologic transition from communicable to non-communicable diseases,and a high prevalence of AF was found in Chinese patients who died in hospital.[1]Indeed,most understanding of AF is based on findings from clinical trials and observational studies performed in North America and Western Europe,[2]and some studies have described the characteristics of patients with AF in other regions.These data have highlighted the important differences in the clinical characteristics and treatment of patients with AF in these regions.[3,4]However,few studies have investigated the characteristics of patients with AF in China.Hence,the aim of this study was to investigate the clinical demographics,management,and outcomes of patients hospitalized for AF using data from a recently registered AF-specific nationwide cohort study in China,the real-world study of Chinese atrial fibrillation(RWS-CAF)registry.The RWS-CAF registry(registration number:ChiCTR1900021250)comprises a multicenter,observational,prospective cohort that includes consecutive patients requiring hospitalization with a diagnosis of AF made according to the Chinese AF guidelines,spanning from November 1,2017,to October 31,2018.All of the enrolled hospitals are grade A class three hospitals.Individual patients hospitalized with AF who were aged 18 years or older were recruited.

Case Fatality Rate of Patients with Acute Myocardial Infarction in 253 Chest Pain Centers--China,2019-2020

Summary What is already known about this topic?Acute myocardial infarction(AMI)is the most serious form of cardiovascular diseases.The case fatality rate(CFR)of AMI patients is an important index to reflect the prognosis of AMI.What is added by this report?During the study period,the overall 30-day,60-day,and 90-day CFR of AMI was 5.9%,6.9%,and 7.6%,respectively.The CFRs in gradeⅢhospitals were lower than in gradeⅡhospitals,and the in-hospital CFR was significantly lower than that in post-discharge out-of-hospital.

Twin peaks of in-hospital mortality among patients with STEMI across five phases of COVID-19 outbreak in China:a nation-wide study

Lockdown and re-opening may become cyclical due to the recurrent waves of the COVID-19 epidemic.Few studies have examined temporal trends and determinants of in-hospital mortality among patients with ST-segment elevation myocardial infarction(STEMI),a life-threatening condition that requires emergency medical care.Using nation-wide data before,during and after the Wuhan lockdown,we aimed to depict temporal patterns and major determinants of STEMI in-hospital mortality in China across five time periods of the COVID-19 epidemic.We analyzed the data of 283,661 STEMI patients who were admitted to 4,487 chest-pain-centers across China,from January 1,2019 to May 31,2020.Compared with the period before the lockdown,STEMI in-hospital mortality increased by 25%(OR 1.25,95%CI 1.16–1.34)during Early Lockdown,by 12%(OR 1.12,95%CI 1.03–1.22)during Later Lockdown,by 35%(OR 1.35,95%CI 1.21–1.50)during Early Lift,and returned to pre-COVID risk(OR 1.04,95%CI 0.95–1.14)during Later Lift.For each time-period,we observed a clear mortality gradient by timing and types of revascularization procedure.In conclusion,the COVID-19 epidemic had a significant adverse impact on STEMI in-hospital mortality,with bimodal peaks during early lockdown and early lift periods and clear mortality gradients by timing and types of revascularization procedure,independent of the time periods.

Consensus of Chinese Specialists on Diagnosis and Treatment of Resistant Hypertension

INTRODUCTION Resistant hypertension has become a challenge in the treatment of hypertension.As the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence,resistant hypertension has become an increasingly common issue in clinical practice.Failure to control blood pressure can impair target organs such as the heart,brain,and kidney,facilitating the occurrence of clinical cardiovascular events.