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.

Pulmonary hypertension concurrent with pericardial effusion and superior vena cava syndrome: who is the initiator?

The diagnosis of pulmonary hypertension(PH) should be made by combining clinical manifestations and echocardiographic probability.[1] Following the confirmation of PH, the classification should begin with the more common groups [group 2(PH due to left heart disease) and group 3(PH due to lung diseases and/or hypoxia)], then group 4(chronic thromboembolic PH and other pulmonary artery obstructions) and finally group 1(pulmonary arterial hypertension) and group 5(PH with unclear and/or multifactorial mechanisms).[1] In this case, we demonstrate a rare scenario of obstruction-caused group 4 PH.

Numerical Study of Two Opposing Weak Polyelectrolyte Brushes by the Self-consistent Field Theory

The self-consistent field theory(SCFT)was employed to numerically study the interaction and interpenetration between two opposing weak polyelectrolyte(PE)brushes formed by grafting weak PE chains onto the surfaces of two long and parallel columns with rectangularshaped cross-section immersed in a salty aqueous solution.The dependences of the brush heights and the average degree of ionization on various system parameters were also investigated.When the brush separation is relatively large compared with the unperturbed brush height,the degree of interpenetration between the two opposing PE brushes was found to increase with increasing grafting density and bulk degree of ionization.The degree of interpenetration also increases with the bulk salt concentration in the osmotic brush regime.Numerical results further revealed that,at a brush separation comparable to the unperturbed brush height,the degree of interpenetration does not increase further with increasing bulk degree of ionization,bulk salt concentration in the osmotic regime and grafting density.The saturation of the degree of interpenetration with these system parameters indicates that the grafted PE chains in the gap between the two columns retract and tilt in order to reduce the unfavorable electrostatic and steric repulsions between the two opposing PE brushes.Based on salt ion concentrations at the midpoint between the two opposing brushes,a quantitative criterion in terms of the unperturbed brush height and Debye screening length was established to determine the threshold value of the brush separation beyond which they are truly independent from each other.