Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation

Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients’quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past two decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.

Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history:a prospective propensity score-matched cohort study

BACKGROUND Patients with atrial fibrillation(AF)and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy.It is unclear whether catheter ablation(CA)has further benefits in these patients.METHODS AF patients with a previous history of stroke or systemic embolism(SE)from the prospective Chinese Atrial Fibrillation Registry study between August 2011 and December 2020 were included in the analysis.Patients were matched in a 1:1 ratio to CA or medical treatment(MT)based on propensity score.The primary outcome was a composite of all-cause death or ischemic stroke(IS)/SE.RESULTS During a total of 4.1±2.3 years of follow-up,the primary outcome occurred in 111 patients in the CA group(3.3 per 100 person-years)and in 229 patients in the MT group(5.7 per 100 person-years).The CA group had a lower risk of the primary outcome compared to the MT group[hazard ratio(HR)=0.59,95%CI:0.47–0.74,P<0.001].There was a significant decreasing risk of all-cause mortality(HR=0.43,95%CI:0.31–0.61,P<0.001),IS/SE(HR=0.73,95%CI:0.54–0.97,P=0.033),cardiovascular mortality(HR=0.32,95%CI:0.19–0.54,P<0.001)and AF recurrence(HR=0.33,95%CI:0.30–0.37,P<0.001)in the CA group compared to that in the MT group.Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants.CONCLUSIONS In AF patients with a prior stroke history,CA was associated with a lower combined risk of all-cause death or IS/SE.Further clinical trials are warranted to confirm the benefits of CA in these patients.

Long term outcomes of saphaneous vein graft intervention in elderly patients with prior coronary artery bypass graft

ObjectivesTo 为 saphaneous 调查过程特征和经皮的冠的干预(一种总线标准) 的长期的后续在到 2011 年 12 月的老 patients.MethodsFrom 2005 年 12 月的静脉接枝(SVG ) 损害， 84 接枝损害经皮地被对待。十七在近似吻合被定位， 48 在 SVG 身体被定位， 19 在远侧的吻合被定位。主要端点被定义为主要不利心血管的事件(向，心脏的死亡合成，目标容器 revascularization，尖锐心肌的梗塞).ResultsThe 接枝年龄是 6.7 &#x000b1；4.0 年。在一年以内介绍的大多数吻合损害(80.0%) 张贴冠的动脉绕过 grafting (CABG ) 。近似吻合损害与接枝身体和远侧的吻合损害相比为一种总线标准有最低的成功的率(70.6% 对 91.7% ， 79.0% ， P &#x0003c；0.05 ) 。远侧的插子的保护设备在 19.1% 病人被使用，最经常在身体接枝一种总线标准使用(29.2% ， P &#x0003c；0.01 ) 。stent 的直径在远侧的吻合组是最小的(2.9 &#x000b1；0.4 公里， P &#x0003c；0.05 ) 。最高的柱子膨胀压力在近似吻合被要求(17.8 &#x000b1；2.7 atm， P &#x0003c；0.05 ) 。病人被跟随在上面为 24.3 &#x000b1；16.9 个月。向发生在 18.57% 病人。向的发生在近似吻合一种总线标准之中是最高的(47.1% 对身体接枝一种总线标准 16.7% ，远侧的吻合一种总线标准 21.1% ；P &#x0003c；0.05 ) 。旧心肌的梗塞是为差的临床的结果的预兆的因素(P = 0.04 ) SVG 损害的 .ConclusionsPCI 与更低的成功是可行的率。ostial 接枝吻合损害的一种总线标准让最低过程成功率和最高的向与接枝身体和远侧的吻合损害相比评价。旧心肌的梗塞是差的结果的一个预兆的因素。

Atrial fibrillation and frailty

Both the prevalence of atrial fibrillation(AF)and frailty are increasing with age,and they often occur simultaneously,leading them to become the central concerns in this aging society.The incidence of frailty in patients with AF is highly variable,ranging from 4.4%to 75.4%,depending on different evaluating instruments used.Moreover,the incidence of frailty among patients with AF is on the rise,which indicated that patients with AF are more prone to frailty compared to patients without AF.The relationship between AF and frailty is complicated.Frailty elevates the risk of stroke and mortality in AF patients and is also associated with longer hospitalizations.On the other hand,it may reduce the appropriate anticoagulation in AF patients.However,the evidence of the effects of frailty on anti-arrhythmic and interventional therapy in patients with AF is scarce.Frailty affects both the management and the prognosis of AF in the geriatric population.Vice versa,AF could worsen the frail state and may represent a marker of frailty.However,there are still questions need to be resolved,for example,the impact of frailty on the interventional therapy of patients with AF.Therefore,the geriatric assessment of frailty should be considered when planning individualized management of AF in older patients.

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

Scientific statement of the Chinese Society of Cardiology(CSC) on using of renin angiotensin system blockers in patients with cardiovascular disease and COVID-19

The coronavirus disease 2019(COVID-19), which is caused by SARS-CoV-2, has become a worldwide public health crisis. Published clinical data from China and other countries have shown a much higher risk of developing COVID-19 and dying from the disease among the elderly, especially among those who had preexisting hypertension, cardiovascular diseases(CVD) and diabetes mellitus[1].

Chronic kidney disease and risks of adverse clinical events in patients with atrial fibrillation

BACKGROUND Chronic kidney disease(CKD)is highly prevalent in patients with atrial fibrillation(AF).However,the asso-ciation between CKD and clinical consequences in AF patients is still under debate.METHODS We included 19,079 nonvalvular AF patients with available estimated glomerular filtration rate(eGFR)values in the Chinese Atrial Fibrillation Registry from 2011 to 2018.Patients were classified into no CKD(eGFR≥90 mL/min per 1.73 m2),mild CKD(60≤eGFR<90 mL/min per 1.73 m2),moderate CKD(30≤eGFR<60 mL/min per 1.73 m2),and severe CKD(eGFR<30 mL/min per 1.73 m2)groups.The risks of thromboembolism,major bleeding,and cardiovascular mortality were estimated with Fine-Gray regression analysis according to CKD status.Cox regression was performed to assess the risk of all-cause mortal-ity associated with CKD.RESULTS Over a mean follow-up of 4.1±1.9 years,there were 985 thromboembolic events,414 major bleeding events,956 car-diovascular deaths,and 1,786 all-cause deaths.After multivariate adjustment,CKD was not an independent risk factor of throm-boembolic events.As compared to patients with no CKD,those with mild CKD,moderate CKD,and severe CKD had a 45%,47%,and 133%higher risk of major bleeding,respectively.There was a graded increased risk of cardiovascular mortality associated with CKD status compared with no CKD group:adjusted hazard ratio[HR]was 1.34(95%CI:1.07−1.68,P=0.011)for mild CKD group,2.17(95%CI:1.67−2.81,P<0.0001)for moderate CKD group,and 2.95(95%CI:1.97−4.41,P<0.0001)for severe CKD group,respectively.Risk of all-cause mortality also increased among patients with moderate or severe CKD.CONCLUSIONS CKD status was independently associated with progressively higher risks of major bleeding and mortality,but didn’t seem to be an independent predictor of thromboembolism in AF patients.

Geriatric cardiology and the Great Wall International Congress of Cardiology 2015

The burgeoning geriatric population worldwide has resuited in an unprecedented challenge to the cardiology community.Cardiovascular disease is the major cause of morbidity and mortality in the elderly population,but its recognition and management are characteristically confounded by substantial comorbidities,polypharmacy,and other complexities of care,not encountered in younger cardiac patients.

Association of frailty with in-hospital outcomes in elderly patients with heart failure

BACKGROUND Frailty is prevalent in elderly patients with cardiovascular diseases.However,the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection(HFrEF)remains unknown.AIM To evaluate the predictive efficacy of frailty,compared with pre-frailty,for adverse events in these patients.METHODS Elderly patients(≥60 years)with HFrEF were assessed.Frailty was evaluated with the Fried phenotype criteria,and physical performance was evaluated based on handgrip strength and the short physical performance battery(SPPB).The composite incidence of adverse events,including all-cause death,multiple organ failure,cardiac shock,and malignant arrhythmia,during hospitalization was recorded.RESULTS Overall,252 elderly individuals with HFrEF[mean age:69.4±6.7 years,male:169(67.0%)]were included.One hundred and thirty-five(53.6%)patients were frail and 93(36.9%)were pre-frail.Frail patients were older,more likely to be female,to have a lower blood pressure,and to present with left ventricular thrombosis(P all<0.05).Frail patients with HFrEF had a higher incidence of in-hospital mortality(11.9%vs 4.3%,P=0.048).Multivariate analyses showed that female gender(OR=0.422),aging(OR=1.090),poor cardiac functional class(OR=2.167),frailty(OR=2.379),and lower handgrip strength(OR=1.106)were independent predictors of in-hospital adverse events(P all<0.05).CONCLUSION Frailty may be associated with poor in-hospital outcomes for elderly patients with HFrEF.The influence of frailty on long-term prognosis in these patients deserves further investigation.

Reversal of pulmonary vein remodeling after catheter ablation of atrial fibrillation

BackgroundPulmonary 静脉(PV ) 和正厅经历电、结构在 atrial 纤维性颤动(AF ) 改变。试图决定 PV 和在为 AF 的导管脱离用胸估计了以后，改变的左 atrial (LA ) 颠倒的这研究计算了 .MethodsPV electrophysiologic 学习的断层摄影术(CT ) ，导管脱离在 63 个病人被执行(68% 男性；吝啬的 ±；SD 年龄：56 ±；10 年) 与征兆的 AF (49% 发作性， 51% 坚持) 。胸 CT 以前被执行并且在导管 ablation.ResultsAt 基线以后的 3 个月，有坚持的 AF 的病人有更大的 LA 体积(91 ±；29 厘米 3 对 66 ±；27 厘米 3 ；P = 0.003 ) 并且吝啬的 PV ostial 区域(241 ±；43 公里 2 对 212 ±；47 公里 2 ；P = 0.03 ) 比有发作性的 AF 的病人。在有效倔强的时期和左优异 PV 口的区域之间没有重要关联。在 3 月在脱离以后的后续， 48 个病人(76%) 是在上或离开 antiarrhythmic 药免费的 AF。在 LA 体积有重要减小(77 ±；31 厘米 3 到 70 ±；28 厘米 3 ；P <；0.001 ) 并且吝啬的 PV ostial 区域(224 ±；48 公里 2 到 182 ±；43 公里 2 ；P <；0.001 ) 。有坚持的 AF 的病人在 LA 体积有更多的减小(11.8 ±；12.8 厘米 3 对 4.0 ±；11.2 厘米 3 ；P = 0.04 ) 并且 PV ostial 区域(62 公里 2 对 34 公里 2 ；P = 0.04 ) 比有发作性的 AF 的那些。平均 PV ostial 区域的减小显著地与 LA 体积的减小被相关(r = 0.38， P = 0.03 ) AF 的 .ConclusionsCatheter 脱离改进 PV ostia 和左中庭的结构的改变。这发现在病人是更明显的，坚持的 AF 由导管脱离对待。

The Use of Direct Oral Anticoagulants for Prevention of Stroke and Systemic Embolic Events in East Asian Patients with Nonvalvular Atrial Fibrillation

As patients in East Asia age,the prevalence of age-related and chronic disease,including nonvalvular atrial fibrillation,may increase.Although warfarin has been the primary choice of anticoagulant for the prevention of stroke and systemic embolic events,the use of direct oral anticoagulants(DOACs)is increasing.DOACs do not require monitoring of the international normalized ratio to determine the optimal dose,and have a lower potential for food and drug interactions,improved benefi t-risk profiles,and a quicker onset and offset of action relative to warfarin.The pivotal phase 3 trials for each of the DOACs– dabigatran,rivaroxaban,apixaban,and edoxaban– included at least some East Asian patients.Additionally,several clinical trials were conducted specifically for East Asian patients.This review discusses patterns and predictors of anticoagulant use in East Asian patients with nonvalvular atrial fibrillation,summarizes current guideline recommendations for East Asian patients,details the primary results demonstrating the safety and efficacy of DOACs in East Asian patients relative to non– East Asian patients,provides real-world data supporting the phase 3 testing results,and addresses the clinical profile of DOACs in East Asian populations,including patients at high risk of stroke.

Whether Warfarin Therapy is Associated with Damage on Renal Function in Chinese Patients with Nonvalvular Atrial Fibrillation

Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF （NVAF）. The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods： From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate （eGFR） was calculated from baseline and fbllow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a 〉25% decline in eGFR （hereafter, endpoint）~ while Cox models estimated hazard ratios （HRs） and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a -〉25% decline in eGFR. Results： After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin （n = 655） and no anticoagulation groups （n = 296） and 120 （12.6%） patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups （χ2 = 0.178, log-rank P = 0.67）, but patients with systolic blood pressure （SBP） 〈140 mmHg have significant difference with patients with SBP ≥140 mmHg （χ2 = 4.903, log-rank P = 0.03）. Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion： In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.

A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation

Background:Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation(AF).Even though only 6%to 8%of AF patients die from stroke,about 90%are indicated for anticoagulants according to the current AF management guidelines.Therefore,we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events(TEs)in Chinese AF patients.Methods:From the prospective China Atrial Fibrillation Registry cohort study,we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline.We selected the most important variables by the extreme gradient boosting(XGBoost)algorithm and developed a simplified risk model for predicting 1-year TEs.The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score(excluding female sex from the CHA2DS2-VASc score).Results:Up to the follow-up of 1 year,163 TEs(ischemic stroke or systemic embolism)occurred.Using the XGBoost algorithm,we selected the three most important variables(congestive heart failure or left ventricular dysfunction,age,and prior stroke,abbreviated as CAS model)to predict 1-year TE risk.We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients.The CAS scheme classified 30.8%(2033/6601)of the patients as low risk for TE(CAS score=0),with a corresponding 1-year TE risk of 0.81%(95%confidence interval[CI]:0.41%–1.19%).In our cohort,the C-statistic of CAS model was 0.69(95%CI:0.65–0.73),higher than that of CHA2DS2-VA score(0.66,95%CI:0.62–0.70,Z=2.01,P=0.045).The overall net reclassification improvement from CHA2DS2-VA categories(low=0/high≥1)to CAS categories(low=0/high≥1)was 12.2%(95%CI:8.7%–15.7%).Conclusion:In Chinese AF patients,a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs,which could potentially improve anticoagulation decision-making.Trial Registration:www.chictr.org.cn(Unique identifier No.ChiCTR-OCH-13003729).

Improved myocardial perfusion and cardiac function by controlled-release basic fibroblast growth factor using fibrin glue in a canine infarct model

Objective: Angiogenic therapy is emerging as a potential strategy for the treatment of ischemic heart disease but is limited by a relatively short half-life of growth factors.Fibrin glue (FG) provides a reservoir for controlledrelease of growth factors.The aim of this study was to evaluate the effects of basic fibroblast growth factor (bFGF) incorporating FG on angiogenesis and cardiac performance in a canine infarct model.Methods: Acute myocardial infarction was induced by ligation of the left anterior descending coronary artery (LAD).Group I (n=6) underwent ligation of LAD alone.In Group II,transmural channels were created in the infarct area (n=6).In Group III,nontransmural channels were created to locate FG cylinders containing bFGF (n=6).Eight weeks after operation,myocardial perfusion was assessed by single photon emission computed tomography,cardiac function by echocardiography,and vascular development by immunohistochemical staining.Results: Total vascular density and the number of large vessels (internal diameter ≥50 μm) were dramatically higher in Group III than in Groups I and II at eight weeks.Only the controlled-release group exhibited an improvement in regional myocardial perfusion associated with lower defect score.Animals in Group III presented improved cardiac regional systolic and diastolic functions as well as global systolic function in comparison with the other two groups.Conclusions: Enhanced and sustained angiogenic response can be achieved by controlled-release bFGF incorporating FG within transmyocardial laser channels,thus enabling improvement in myocardial perfusion and cardiac function.

Elevated high sensitive C-reactive protein and apelin levels after percutaneous coronary intervention and drug-eluting stent implantation

Objective:Percutaneous coronary intervention(PCI) triggers an acute inflammatory response,while sirolimus is known to have anti-inflammatory properties;the inflammatory system response to PCI after sirolimus-eluting stent placement remains unclear.The purpose of this study is to determine the changes in high sensitive C-reactive protein(hs-CRP) and apelin after PCI procedure and drug-eluting stent implantation in patients with and without reduced left ventricular systolic function.Methods:Forty-eight consecutive patients undergoing PCI at the Beijing Anzhen Hospital between July and September 2006 were recruited.Sirolimus-eluting stents were employed in all patients.Blood samples were drawn immediately before and 24 h after the procedure.Plasma hs-CRP and apelin levels were determined by enzyme immunoassay.Results:Paired t-test revealed a significant increase in both hs-CRP and apelin post-procedure(P=0.006 and P<0.0001,respectively).Patients with reduced left ventricular ejection fraction(LVEF) had significantly lower baseline apelin levels compared to those with normal ventricular function [(46.8±10.8) vs.(72.0±8.4) pg/ml,P<0.001].However,apelin increased to a level similar to the level of those with normal left ventricular systolic function 24 h after the PCI procedure [(86.7±11.6) vs.(85.1±6.1) pg/ml,P=0.72].Conclusions:hs-CRP and apelin levels increased after PCI and sirolimus-eluting stent implantation.Patients with impaired left ventricular systolic function had significantly lower baseline apelin levels,which increased significantly after PCI.

Association between use of amiodarone for non-valvular atrial fibrillation and patient survival:from the prospective China Atrial Fibrillation Registry

Background:Post hoc analysis of the landmark atrial fibrillation follow-up investigation of rhythm management trial revealed that amiodarone was associated with higher risks of mortality,intensive care unit admission,and non-cardiovascular death.We aim to evaluate the association between amiodarone use and patient survival under updated medical mode and level using data from the China Atrial Fibrillation(China-AF)Registry study.Methods:Clinical data of 8161 non-valvular atrial fibrillation(NVAF)patients who were antiarrhythmic drug(AAD)-naive before enrollment into the China-AF Registry,recruited between August 2011 and February 2017,were collected.The primary outcome was all-cause mortality.A Cox proportional hazard regression model was used to evaluate the association between amiodarone use and the outcome.We also calculated the rate of sinus rhythm maintenance at the penultimate follow-up.Results:Compared with 6167 patients of non-AAD group,689 patients of the amiodarone group were younger(mean age 65.6vs.68.6 years),more frequently completed high school education,had fewer comorbidities such as chronic heart failure,prior bleeding,and stroke,and were more likely to be treated in tertiary hospitals while less hospitalization.The proportion of persistent AF was much lower among users of amiodarone,who were also less likely to be taking oral anticoagulants.The patients in the amiodarone group had a statistically insignificant lower incidence of all-cause mortality(2.44vs.3.91 per 100 person-years)over a mean follow-up duration of 300.6±77.5 days.After adjusting for potential confounders,amiodarone use was not significantly associated with a lower risk of all-cause mortality(adjusted hazard ratio,0.79;95%confidence interval,0.42-1.49).Sub-group analysis revealed the consistent results.The rate of sinus rhythm maintenance at the penultimate follow-up in the amiodarone group was significantly higher than in the non-AAD group.Conclusions:Our study indicated that amiodarone use was not significantly associated with a lower risk of 1-year all-cause mortality compared with a non-AAD strategy in"real-world"patients with NVAF.

Atrial Fibrillation Ablation： Indications, Outcomes, Complications, and Future Directions

Atrial fibrillation （AF） is the most common type of cardiac arrhythmia which affects 33 million individuals worldwide？ It is associated with many adverse outcomes, including stroke, dementia, heart failure （HF）, and mortality. Based on a growing body of evidence illustrating its efficacy and safety, catheter ablation （CA） has become an important treatment strategy for symptomatic AF. Most centers have progressively moved from performing paroxysmal AF to more complex long-standing persistent AF or patients with more comorbidities.

In-hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation

Objective: Limited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic strategies. This study aimed to provide detailed data regarding in-hospital direct costs for these pa-tients, compare the costs at different scenarios, and identify independent factors that may predict the costs. Methods: We collected data regarding in-hospital direct costs among patients with AF who were hospitalized owing to ischemic stroke (IS), transient ischemic attack (TIA), intracranial hemorrhage (ICH), or major gastrointestinal bleeding. All data were collected from 7 representative tertiary referral hospitals and 3 secondary care hospitals from December 2009 to October 2014. Results: In total, 312 eligible patients with thromboembolism and 143 patients with major bleeding were identified, and their hospital charts were reviewed. The median in-hospital direct costs were 17,857 Chinese Yuan (CNY) for IS and 16,589 CNY for TIA (equivalent to 2907 US dollars and 2701 US dollars, respectively). For patients with major bleeding, the costs were 27,924 CNY for ICH and 18,196 CNY for major gastrointestinal bleeding (equivalent to 4546 US dollars and 2962 US dollars, respec-tively). The direct costs were mainly driven by medications, which accounted for approximately 33.4%-36.1% in different groups of patients. The direct costs were highly related to the hospital level and National Institutes of Health Stroke Scale scores in patients with thromboembolism; in patients with ICH, the factors included hospital level, warfarin treatment before admission, and prior hospitalization for stroke. Conclusions: Given the high prevalence, AF-related thromboembolism and bleeding impose considerable economic burden on the Chinese society. Efforts to improve the management of AF may confer substantial economic benefits.

Unfractionated Heparin with Sequential Enoxaparin in Patients with Complex Coronary Artery Lesions during Percutaneous Coronary Intervention

Background： Unfractionated heparin （UFH）, despite its limitations, has been used as the primary anticoagulant alternative during the percutaneous coronary intervention （PCI）. Some studies indicated that intravenous enoxaparin could be an effective and safe option. Our team used enoxaparin alone at one time according to the guidelines （Class IIA） and found a little catheter thrombosis during PCI. We recommend a new anticoagulation strategy using enoxaparin in combination with UFH. Enoxaparin has a more predictable anticoagulant response with no need of repeatedly monitoring anticoagulation during PCI. This retrospective study aimed to evaluate the efficacy and safety of using enoxaparin in combination with UFH in PCI patients with complex coronary artery disease. Methods： Between January 2015 and April 2017, 600 PCI patients who received intravenous UFH at an initial dose of 3000 U plus intravenous enoxaparin at a dose of 0.75 mg/kg （observation group） and 600 PCI patients who received UFH at a dose of 100 U/kg （control group） were consecutively included in this retrospective study. The endpoints were postoperative 48-h thrombolysis in myocardial infarction （TIMI） bleeding and transfusion and 30-day and l-year major adverse cardio-cerebrovascular events （MACCE）. Results： Baseline clinical, angiographic, and procedural characteristics were similar between groups, except there was less stent implantation per patient in the observation group （2.13 vs. 2.25 in the control group, P = 0.002）. TIMI bleeding （3.3% vs. 4.7%） showed no significant difference between the observation group and control group. During the 30-day follow-up, the rate of MACCE was 0.9% in the observation group and 1.5% in the control group. There was no significant difference in the rates of MACCE, death, myocardial infarction, target vessel revascularization, cerebrovascular event, and angina within 30 days and 1 year after PC1 between groups as well as in the subgroup analysis of transfemoral approach. Conclusions： UFH with sequential enoxaparin has similar anticoagulant effect and safety as UFH in PCI of complex coronary artery disease.

Association of interleukin-18 gene polymorphisms with Takayasu arteritis in a Chinese Han population

Background:Interleukin-18(IL18)gene polymorphisms are related to many inflammatory and autoimmune diseases.However,a correlation analysis between IL18-607C/A and-137G/C gene polymorphisms and Takayasu arteritis(TA)is lacking.Methods:This study enrolled 200 patients with TA as the case group and 334 region-,age-,and sex-matched healthy subjects as the control group.We genotyped alleles and genotypes at positions-607 and-137 of the IL18 gene and analyzed the distribution frequencies.Mann-Whitney U test,t test,Chi-squared test and Hardy-Weinberg equilibrium were performed.Results:After adjusting for risk factors,the adjusted odds ratios and 95%confidence intervals at position-607C/A were 0.533,0.391 to 0.880(P=0.010);0.266,0.586 to 1.002(P=0.051);and 0.122,0.552 to 1.420(P=0.613)under the dominant,additive,and recessive models,respectively.For the-137G/C polymorphism,the adjusted odds ratios and 95%confidence intervals were 1.571,1.068 to 2.311(P=0.022);1.467,1.086 to 1.980(P=0.012);and 1.815,0.901 to 3.656(P=0.095)under the dominant,additive,and recessive models,respectively.Moreover,regardless of the model used,we found no statistical difference in distribution frequency between the active and quiescent states of TA for the-607C/A(P=0.355,0.631,and 0.705,respectively)and-137G/C polymorphisms(P=0.205,0.385,and 0.208,respectively).Conclusions:The IL18-607C/A gene polymorphism may decrease the risk of TA,and thus is a protective factor,whereas-137G/C may increase the risk of TA,and thus is a risk factor.However,neither polymorphism was related to activity(active vs.quiescent)of TA.