Isolation of protoplast from callus of Populus euphratica and H^+ fluxes across plasma membrane under NaCl stress

We used callus of Populus euphratica Olive to isolate protoplasts, and IT fluxes across plasma membrane were investigated. The concentration of enzymes for protoplast isolation, e.g. cellulase, pectolyase, macerozyme, hemicellulase, and sorbitol content, incubation time were systemically studied. High yield and viability of protoplast was achieved after 6-8 hours incubation of P. euphratica callus in enzyme solution containing 1.5% （w：v） cellulase R-10, 0.1% （w：v） pectolyase Y-23, 0.2% （w：v） macerozyme R-10, 0.05% （w：v） hemicellulase and 0.75M）.80 mol·L^-1 sorbitol. Non-invasively ion selective microelectrode technique was used to access proton fluxes in the absence and presence of NaCl （20 mmol.L-1）. Salt-induced transient net IT effiux was observed in the plasma membrane ofP. euphratica cells. The shift of IT flux response to NaC1 shock and the relevance to salt tolerance were discussed.

Tumor radioimmunoimaging of chimeric antibody in nude mice with hepatoma xenograft

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Effect of NaCl on growth and ion relations in two salt-tolerant strains of Paxillus involutus

The effect of NaCl on growth, biomass and ion relations of two salt-tolerant isolates of Paxillus involutus, MAJ and NAU were investigated. The two Paxillus strains were exposed to the following concentrations of NaCl： 0, 100, 200 and 500 mmol·L^-1. Growth of MAJ and NAU was enhanced by 100 mmol·L^-1 NaCl but severely inhibited at the concentration of 500 mmol·L^-1. NAU exhibited a greater capacity to exclude Na^＋ and Cl^- under all salinity levels, whereas the salt-includer MAJ had a higher capacity in nutrient uptake under salt stress. The ratios Na^＋/K^＋, Na^＋/Ca^2＋ and Na^＋/Mg^2＋ in NaCl-treated MAJ and NAU did not increase at levels of 100 and 200 mmol·L^-1 NaCl but markedly increased at 500 mmol·L^-1. This suggests that the two strains, especially MAJ, enhanced nutrient uptake corresponding to the increased Na^＋ influx at moderate salinity. We conclude that both MAJ and NAU are able to tolerate 500 mmol·L^-1 NaCl but there are species-specific differences in retaining ionic homeostasis in the two Paxillus strains. NAU is a salt-excluder, MAJ is a salt-includer but retains a high capacity in nutrient selectivity under saline conditions. Their definite mechanisms to enhance salt tolerance of mycorrhizal hosts need further study.

Cloning of plasma membrane H^+-ATPase gene in Populus euphratica Oliv.

For this paper, the plasma membrane （PM） H^＋-ATPase gene has been cloned from Populus euphratica Oliv. through a ho- mology based strategy. The isolated 3,210 bp cDNA contains a single 2,862 bp open reading frame （ORF） which encodes a putative H^＋-ATPase protein of 953 amino acid residues, with a significant homology to plasma membrane H^＋-ATPase of Prunus persica, Phaseolus vulgaris, Sesbania rostrata and Daucus carota. The predicted protein has a molecular weight of 104,553 Da. The copy number analysis revealed multiple copies of the PM H^＋-ATPase in the P. euphratica genome after digestion of their genomic DNA by the restriction enzymes EcoRI, NdeI, FbaI and Bg/Ⅱ, and Southern blot.

Evaluation of global and regional left ventricular systolic function in patients with frequent isolated premature ventricular complexes from the right ventricular outflow tract

Background Frequent premature ventricular complexes from the right ventricular outflow tract （RVOT-PVCs） are associated with left ventricular dysfunction.This study adopted two-dimensional speckle tracking imaging to evaluate global and regional left ventricular myocardial function in patients with frequent RVOT-PVCs.Methods This study included 30 patients with frequent RVOT-PVCs and 30 healthy subjects.Aortic systolic velocity-time integral （AoVTI） and myocardium strain in circumferential （CS）,radial （RS） and longitudinal （LS） directions were evaluated by conventional echocardiography and speckle tracking imaging.All values of patients with RVOT-PVCs were recorded during sinus （PVC-S） and PVC beats （PVC-V）.Results Significant differences were demonstrated in global CS,RS and LS between the control subjects and the PVC-V （CS：（17.46±2.48）% vs.（11.52±3.28）%,RS：（48.26±10.20）% vs.（20.92±9.78）%,LS：（19.89±2.62）% vs.（11.79±3.66）%,P 〈0.01）,and in segmental RS and LS of nearly all the left ventricular segments.Statistical differences in segmental CS between the PVC-V and the control subjects were only observed in anterior,anteroseptal and septal segments （only seen in anteroseptal and septal segments at apex）.Furthermore,V/S AoVTI （AoVTI during the PVC beat divided by AoVTI during the sinus beat,then multiplied by 100%） correlated with coupling interval （r=0.67,P 〈0.001） and global strain （CS：r=0.48,P=0.007; RS：r=0.65,P 〈0.001; LS：r=0.65,P 〈0.001）.Conclusions Frequent RVOT-PVCs can induce global and regional left ventricular systolic dysfunction.The reduction of hemodynamic parameters relates to the coupling interval and the global systolic function.

Three hours continuous injection of adenosine improved left ventricular function and infarct size in patients with ST-segment elevation myocardial infarction

Background The definitive treatment for myocardial ischemia is reperfusion. However, reperfusion injury has the potential to cause additional reversible and irreversible damage to the myocardium. One likely candidate for a cardioprotection is adenosine. The present study aimed at investigating the effect of intravenous adenosine on clinical outcomes in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1：1：1 ratio to receive either adenosine 50μg-kg-1.min-1 （low-dose group, n=31）, or 70 μg.kg-1.min1 （high-dose group, n=32）, or saline 1 ml/min （control group, n=27） for three hours. Drugs were given to the patients immediately after the guide wire crossed the culprit lesion. Recurrence of no-reflow, TIMI flow grade （TFG） and TIMI myocardial perfusion grade （TMPG）, and collateral circulation were recorded. The postoperative and preoperative ST segment elevation sum of 18-lead electrocardiogram （ECG） and their ratio （STsum-post/STsum-pre） were recorded, as well as the peak time and peak value of CK-MB enzyme. Serial cardiac echo and myocardial perfusion imaging were performed at 24 hours and 6 months post-stenting. The primary endpoint was left ventricular function, and infarct size. The secondary end-point was the occurrence of cardiac and non-cardiac death, non-fatal myocardial infarction, and heart failure. Results A total of 90 STEMI patients were studied. No-reflow immediately after stent procedure was seen in 11 （35.5%） patients in the control group, significantly different from 6.3% in the low-dose group or 3.7% in the high-dose group （both P=0.001）. STsum-post/STsum-pre in the low-dose and high-dose groups was significantly different from the control group （low-dose group vs. control group, P=0.003 and high-dose group vs. control group, P=0.001）, without a dose-dependent pattern （P=0.238）. The peak value of CK-MB enzyme was significantly reduced in the high-dose group compared to the control group （P=-0.024）. Compared to the left ventricular ejection fraction （LVEF） in control group, LVEF in the low-dose group increased by 5.8% at 24 hours （P=0.012） and by 10.9% at 6 months （P=0,007）, LVEF in the high-dose group increased by 9.5% at 24 hours （P=0.001） and by 10.0% at 6 months （P=0.001）, respectively. Significant reduction of infarct size by 24.2% was detected in the high-dose group vs. low-dose or control groups （P=0.008）. There was no significant difference regarding secondary endpoints at 6 months among the treated groups. Cardiac function by NYHA classification in both the low-dose and the high-dose groups was improved significantly （P=0.013, P=0.016）. Conclusion Intravenous adenosine administration might significantly reduce the recurrence of no-reflow, with resultant improved left ventricular systolic function. High-dose adenosine was further associated with significant reduction of infarct size.

Optimized quantitative angiographic and intravascular ultrasound parameters predicting the functional significance of single de novo lesions in the left anterior descending artery

Background The correlation between angiographic or intravascular ultrasound （IVUS） variables and fractional flow reserve （FFR） in patients with single left anterior descending artery （LAD） lesion has not been studied. The current study aimed at determining the best cutoff value of angiographic and IVUS parameters for defining FFR 〈0.80 in patients with LAD lesion. Methods Quantitative coronary analysis, IVUS and FFR measurements were undergone in 169 patients with single LAD lesion, The best angiographic and IVUS cutoff value and their predictive value for FFR 〈0.80 were compared using area under the receiver-operator characteristic curve （AUC） in overall patients or in subgroups stratified by lesion sites. Results FFR 〈0.80 was found in 99 lesions （58.6%）. Minimal lumen area （MLA）, and plaque burden （PB） were two predictors of FFR 〈0.80. Lesion length had less value in predicting FFR 〈0.80. The cutoff value of PB and MLA for FFR 〈0.80 was 75.4% and 3.03 mm2. MLA and PB had similar high diagnostic value for proximal （cutoff value 3.04 mm2 and 76.5%） and distal LAD lesion （2.82 mm2 and 80.6%）. Combination of MLA （2.82 mm2） and PB （80.6%） had increased diagnostic value for distal LAD lesion. Conclusions MLA and plaque burden had equivalent diagnostic value for FFR 〈0.80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.

Mechanisms and clinical significance of quality of final kissing balloon inflation in patients with true bifurcation lesions treated by crush stenting technique

Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS. Methods Two hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation （FKBI） were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis （QCA） and intravascular ultrasound （IVUS）. Angiographic follow-up was indexed at 12 months. Results The upper group was characterized by a larger bifurcation angle of 55.53°±25.25° （P=0,030） and a longer procedural time （42.43±23.92） minutes （P=0.015）. The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group （P 〈0.001）. For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS （HR 1.652, 95% Cl 1.332-2.088, P 〈0.001） and re-wiring position （HR 2.341, 95% Cl 1.780-4.329, P 〈0.001） were two independent predictors of side branch restenosis. Re-wiring position （OR 0.458, 95%C/0.336-0.874, P=0.001） and side stent expansion （OR 3.122, 95%C/2.883-5.061, P=0.014） were factors predicting the findings of KUS. Conclusions Side wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.

Effect of coronary bifurcation angle on clinical outcomes in Chinese patients treated with crush stenting： a subgroup analysis from DKCRUSH-1 bifurcation study

Background Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high （≥60°） with low （〈60°） bifurcation angle in patients who underwent either classical or double kissing （DK） crush stenting for bifurcation lesions from the DKCRUSH-1 data base. Methods There were 212 patients with 220 lesions, some with low-angle （n=138） and some with high-angle （n=74）. Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events （MACEs）, defined as cardiac death, myocardial infarction and target lesion revascularization （TLR）. Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation （FKBI）. Results At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group （91.43%） and the low-angle group （82.39%）. In the high angle group, there was a significant difference in contrast volume used （P=0.005） but no significant difference in acute gain, minimum lumen diameter （MLD）, late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with- （n=-133） and without-FKBI （n=42）, significant side-branch late loss was seen in the group without-FKBI （（0.65±0.49） mm vs （0.47±0.62） mm, P=0.02）, with a resultant greater restenosis rate （37.68% vs 18.32%, P=0.001）. No difference was detected in the MACE free survival rate between the high and low angle groups （82.39% vs 82.36%, P=0.84）. The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference （P=0.38）. The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group （P=0.001）. Cox regression analysis showed that the independent predictors for target vessel revascularization were the side branch stent MLD post stenting （hazard ratios （HR） 1.028, 95% CI 2.357-16.233, P=0.002）, lack of FKBI （HR 4.910, 95% CI 4.706-8.459, P=0.001） and unsatisfactory kissing （HR 3.120, 95% CI2.975-5.431, P=0.001）. Conclusions Bifurcation angles do not influence the clinical outcome of crush stenting. Successful final kissing balloon inflation, regardless of bifurcation angles, can predict TLR.

DK crush technique: modified treatment of bifurcation lesions in coronary artery

Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations. Reports have demonstrated the main reason for higher incidence of ostial side branch even though drugeluting stent used in side vessel lies in that there were gaps in metal coverage and drug application. Therefore,

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion lesions in remote hospitals without on-site surgical support

Background The safety of percutaneous coronary intervention （PCI） for chronic total occlusion （CTO） lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting （CABG） support was available. Methods A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events （MACE）, defined as cardiac death, myocardial infarction and target-vessel revascularization （TVR）. Results The incidence of CTO was 7.9% in patients who underwent PCI, Successful recanalization was achieved in 132 patients （86.8%）. Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths （（42.32±22.08） mm vs （27.61±22.85） mm, P=0.023）, a higher rate of perforation （25.0% vs 0, P=0.014）, and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure （10.0%, 30.0% and 35.0%） and the success （3.0%, 12.1% and 14.4%） groups （P=0.037, 0.034 and 0.040, respectively）. These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group （P=0.031 and 0.023, respectively）. Stump was the only predictor of recanalization success （HR 0.158, 95% Cl 0.041-0.612, P=0.008）, whereas procedural failure （OR 13.023, 95% CI 6.67-13.69, P=0.002）, incomplete revascularization （OR 9.71, 95% CI 2.93-5.59, P=0.005）, and total stent length （OR 6.02, 95% Cl 1.55-11.93, P=0.027） were three independent predictors of MACE. Conclusions PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.

Safety and efficacy of polymer-free paclitaxel-eluting microporous stent in real-world practice： 1-year follow-up of the SERY-I registry

Background Polymer coating on coronary stents induces vascular inflammatory response, reduces re-endothelialization, and affects long-term outcome after percutaneous coronary intervention （PCI）. The SERY-1 registry aimed to determine whether a novel polymer-free paclitaxel-eluting microporous Yinyi stent could improve 1-year outcome after index procedure in real-world clinical practice. Methods Clinical and angiographic data and follow-up outcome were collected in 1045 patients who underwent PCI with implantation of 〉1 Yinyi stents between June 2008 and August 2009 at 27 medical centers. The primary endpoint was the cumulative rate of composite major adverse cardiac events （MACE） and the secondary endpoint was the incidence of stent thrombosis at 1 year. Results Overall, 1376 lesions were treated successfully with 1713 Yinyi stents, and 1019 （98.7%） patients received dual antiplatelet therapy for at least 12 months. During 1-year follow-up, 8 patients （0.78%） had cardiac death, 6 （0.58%） suffered non-fatal myocardial infarction, and 46 （4.46%） underwent repeat PCI due to recurrence of angina, resulting in 1-year MACE-free survival of 94.09%. Stent thrombosis occurred in 10 （0.97%） patients, and the rate of Academic Research Consortium （ARC） definite or probable stent thrombosis was 0.78%. Conclusions Polymer-free paclitaxel-eluting microporous Yinyi stent is effective and safe for interventional treatment of coronary artery disease in real-world clinical practice, without recourse to carrier polymer. Potential long-term clinical advantages of this stent deserve further investigation.

Clinical outcomes after recanalization of a chronic total occluded vessel with bifurcation lesions： results from single-center, prospective, chronic total occlusion registry study

Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion （CTO） vessel after successful recanalization remain to be unknown. Methods Between January 2001 and December 2009, 195 （41.1%） patients with 254 （47.0%） bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal （n=134） and distal （n=-120） groups, according to the location of the bifurcation lesions. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at the end of clinical follow-up, including cardiac death, myocardial infarction, or target vessel revascularization （TVR）. Results Collaterals with Rentrop class 3 were seen more in distal group （100% and 68.3%）, compared to proximal group （76.9% and 45.6%）. Two-stent technique for proximal bifurcation lesions was used in 24.6%, significantly different from the distal group （6.7%, P 〈0.001）, without significant difference in composite MACE between proximal and distal groups, or between one- and two-stent subgroups in proximal group. The composite MACE after 1-year in complete revascularization subgroup was 17.9% relative to 29.6% in the incomplete revascularization group （P=0.044）. Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow, with resultant increased in-stent restenosis, total occlusion, TVR and coronary aneurysms. Imcomplete revasculzarization （HR 2.028, P=0.049, 95% CI 1.002-4.105） and post-stenting TIMI flow （HR 6.122, P=0.020, 95% Cl 1.334-28.092） were two independent predictors of composite MACE at the 1-year follow-up. Conclusions Two-stent was more used for proximal bifurcation lesions. No significant difference was observed in MACE between proximal and distal, or between one- and two-stent subgroups in the proximal group. Placement of a safety wire was critical for proximal bifurcation lesions. Complete revascularization was mandatory to improve clinical outcomes.

Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents

Background Implantation of either bare metal stent （BMS） or drug-eluting stent （DES） has been used in every day practice for patients with unprotected left main stenosis （UPLMS）. There are still a lack of data regading the subsequent results of UPLMS in-stent restenosis （ISR）. The present study aimed at determing the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.Methods Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events （MACE）, including cardiac death, myocardial infarction （Ml）, and target vessel revascularization （TVR）.Results UPLMS ISR rate was 14.8% （n=73, 15.7% after BMS, 14.5% for DES） after average of （3.89±2.01） years （range from 1 to 10.5 years） follow-up. Angiographic follow-up between 6-8 months was available in 85.3%. Of these,repeat percutaneous coronary intervention （PCI） was used in 62 （84.9%） patients, with medicine only in 9 （12.4%） and coronary artery bypass graft （CABG） in 2 （2.7%）. Most repeat PCI patients were with unstable angina （87.0%）, and had decreased left ventricular ejection fraction （（42.58±5.12）%）, fewer focal/ostial left circumflex branch （LCX） lesions, in relative to medicine only group. After （31.9±23.3） months, the MACE, Ml, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 （1.4%） patient.Conclusions Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.

Crush stenting in treating coronary bifurcate lesions： paclitaxel eluting stents versus sirolimus eluting stents

Background Because no data regarding the comparison of crush stenting with paclitaxel （PES） or sirolimus eluting stents （SES） for coronary bifurcate lesions have been reported, we compared the clinical outcomes of these two types of stents. Methods Two hundred and thirty patients with 242 bifurcate lesions were enrolled in a prospective, nonrandomized trial Primary endpoints included myocardial infarction, cardiac death and target vessel revascularization at 8 months. Results All patients were followed up clinically and 82% angiographically at 8 months. Final kissing balloon inflation was performed in 72% in the PES and 75% in the SES groups （P〉0.05）. Compared to the SES group, PES group had a higher late loss and incidence of restenosis （P=0.04） in the prebifurcation vessel segment. The postbifurcation vessel segment in the PES group had a greater late loss （（0.7±0.6） mm vs （0.3±0.4） mm, P〈0.001） and higher restenosis in the side branch （25.5% vs 15.6%, P=0.04） when compared to the SES group. There was significant difference of insegment restenosis in the entire main vessel between PES and SES groups （P=0.004）. Target lesion revascularization was more frequently seen in the PES group as compared to the SES group （P=0.01）. There was significant difference in the accumulative MACE between these two groups （P=-0.01）. The survival rate free from target lesion revascularization was significantly higher in the SES group when compared to the PES group （P〈0.001）. Conclusion SES is superior to PES in reducing restenosis and target lesion revascularization by 8-month follow-up after crush stenting for bifurcate lesions.

Midterm outcomes of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medication

Hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. The predominant abnormal haemodynamics are caused by increased left ventricular outflow tract pressure gradient （LVOTG） and abnormal systolic anterior motion of mitral valve.

Coronary bifurcation angle from 3-D predicts clinical outcomes after stenting bifurcation lesions

Background The predictive value of bifurcation angle （BA） for worse events after stenting bifurcation lesions remains to be unknown. The present study was to investigate the dynamic change of BA and clinical relevance for patients with coronary bifurcation lesions treated by drug-eluting stent （DES）. Methods BA was calculated by 3-D quantitative coronary analysis from 347 patients in DKCRUSH-II study. Primary endpoint was the occurrence of composite major adverse cardiac events （MACE） at 12-month, including cardiac death, myocardial infarction （MI） and target vessel revascularization （TVR）. Secondary end points were the rate of binary restenosis and stent thrombosis at 12-month. Results Stenting was associated with the reduction of distal BA. The cut-off value of distal BA for predicting MACE was 60°. Distal BA in 〈60° group had less reduction after stenting （（-1.96＋13.58）°vs. （-12.12±23.58）°, P 〈0.001）; two-stent technique was associated with significant reduction of distal BA （△（-4.05±14.20）°）, compared to single stent group （4＋1.55±11.73, P=0.003）; the target lesion revascularization （TLR）, TVR and MACE rate was higher in one-stent group （16.5%, 19.0% and 21.5%）, compared to two-stent group （3.8%, P=0.002; 7.5%, P=0.016; and 9.8%, P=0.024）, respectively. Among patients in ≥60° group, there were no significant differences in distal BA, stent thrombosis （ST）, MI, MACE, death, TLR, TVR between one- and two-stent groups; after stenting procedure, there was only slight change of distal BA in left anterior descending （LAD）-Ieft circumflex （LCX） subgroup （from （88.54±21.33）° at baseline to （82.44±31.72）° post-stenting）, compared to either LAD-diagonal branch （Di）, or LCX-obtuse marginal branch （OM）, or IRCA distal （RCAd） （all P 〈0.001 ）. Conclusion Two-stent technique was associated with significant reduction of distal BA. DK crush stenting had reduced rate of MACE in patients in 〈60° group, compared to one-stent technique.

Comparison of a five-year clinical outcome between Chinese women and men with de novo coronary disease treated with implantation of a drug-eluting stent： a three-center, prospective, registry study

Background The gender-based differences in adverse events after drug-eluting stent （DES） implantation between Chinese women and men have not been fully studied. The present study aimed to compare the 5-year clinical outcome after DES implantation in Chinese women and men. Methods Chinese women （n=298） and men （n=698） with newly diagnosed de novo coronary lesions were studied after DES implantation. The primary endpoint was the occurrence of major adverse cardiac events （MACEs） over a 5-year follow-up, including myocardial infarction （MI）, cardiac death, and target vessel revascularization （TVR）. Propensity score matching （PSM） was used to compare the adjusted MACE rates between sexes. Results Women differed in body habitus and had increased fasting cholesterol. Fewer women presented with MI, and they had better cardiac function with less complex disease. The unadjusted rate of MI at 3 years （2.1%） and 5 years （5.0%） and MACE （25.2%） at 5 years in men was significantly higher than that of women （0.3%, 1.0% and 17.8%, P=0.050, P=0.032, and P=0.011, respectively）. After PSM, the adjusted adverse events between sexes were similar. The stent thrombosis rate rapidly increased after 2 years in men. Conclusions There were significant gender-based differences in baseline characteristics. Chinese men had equivalent outcomes to women after DES after adjustment by PSM. The increased rate of MI in men was attributed to an increased unadjusted rate of MACE.

Quantitative assessment of late lumen loss after biodegradable polymer and permanent polymer sirolimus-eluting stents implantation

Background Sirolimus-eluting stents （SES） are reported to be associated with reduced late lumen loss （LLL）, resulting in less frequent restenosis when compared to bare-metal stent. The current study aimed to assess the difference in LLL between SES with biodegradable and with permanent polymer. Methods From March 2010 to June 2011, 300 consecutive patients having only biodegradable polymers or permanent polymer SES for all diseased vessels were included. Serial quantitative coronary analysis was performed on both the ＂in-stent＂ and ＂segment＂ area, including the stented segment, as well as both five mm margins proximal and distal to the stent. The primary endpoint was the LLL defined as the minimal lumen diameter （MLD） post-stenting minus the MLD at nine-month after the indexed procedure. Results LLL was comparable between the two stents. Importantly, LLL for the distal segment （median 0.05 mm, interquartile 0 to 0.09 mm） was less severe compared with in-stent （median 0.13 mm, interquartile 0.08 to 0.18 mm） and proximal segment LLL （median 0.12 mm, interquartile 0.06 to 0.14 mm, all P 〈0.001 ）. In general, the LLL was associated with the post-procedure MLD （b=0.28, P=0.002）, hyperlipidemia （b=0.14, P=0.021）, and calcified lesions （b=0.58, P=-0.001）. The R2 and Radj of the multiple regression model were 0.651 and 0.625, respectively. Conclusions SES with either biodegradable or permanent polymer had lower value of LLL. The small amount of LLL at the distal segment possibly contributed to the less distal edge stenosis.

Comparison of paclitaxal vs. sirolimus eluting stents with bio-degradable polymer for the treatment of coronary bifurcation lesions： subgroup analysis from DKCRUSH-I and DKCRUSH-II studies

Background The difference in clinical outcome between paclitaxal-eluting stents （PES） and sirolimus-eluting stents with bio-degradable polymer （SES-BDP） for bifurcation lesions remains unclear. The present study aimed to investigate the one-year clinical outcome after DK crush stenting using PES （maxusTM） MS. SES-BDP （ExcelTM） from our database. Methods A total of 275 patients （90 from the DKCRUSH-I and 185 from the DKCRUSH-II study） were studied. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at 12 months; including cardiac death, myocardial infarction （MI）, or target vessel revascularization （TVR）. The rate of binary restenosis and stent thrombosis served as secondary endpoints. Results At follow-up, minimal luminal diameter （MLD） in the Taxus group was （2.11＋0.66） mm, with resultant increased target lesion revascularization （TLR） 12.2% and TVR 14.4%, significantly different from the Excel group; （2.47±0.56） mm, P 〈0.001, 3.2%, P=0.006, 4.9%, P=0.019, respectively. As a result there was a significant difference in MACE between the Taxus （20.0%） and Excel （10.3%, P=0.038） groups. Overall stent thrombosis was monitored in 11 patients （4.0%）, with five in the Excel group （2.7%） and six in the Taxus group （6.7%）. All stent thrombosis in the Excel group was classified as early, and all were defined as late in the Taxus group. Conclusion The Excel stent had lower rate of stent thrombosis, TLR, TVR, and composite MACE at 12-month after an indexed stenting procedure, compared to the Taxus stent.