Factors Associated with Coronary Artery Disease in Young Population(Age≤40):Analysis with 217 Cases

Objective To investigate the relevant factors of coronary artery disease(CAD) in young people under 40 years of age.Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006,including 272 men and 20 women,with the mean age being 36.7±3.7 years.The diagnosis of CAD was made in the cases presenting ≥50% stenosis in coronary lumen in coronary angiography.Based on the diagnosis,217 patients(204 men,13 women) were assigned to CAD group,and 75(68 men,7 women) to non-CAD group.Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test,χ2 test,and multinomial logistic regression with SPSS 8.0 software.Results Most study subjects were current smokers(209/292,71.6%),and more than half had body mass index(BMI)>24 kg/m2(230/292,78.8%) and usually took high-fat diet(162/292,55.5%).The proportion of heavy smokers(smoking history ≥10 years and ≥20 cigarettes per day) were significantly higher in the CAD group than in the non-CAD group [20.7%(45/217) vs.9.3%(7/75),P=0.015)].Heavy smoking [odds ratio(OR),1.89;95% confidence interval(CI),1.74-2.05],hypertension(OR,1.56;95% CI,1.48-1.65),alcohol(OR,1.37;95% CI,1.30-1.46),type 2 diabetes mellitus(OR,1.37;95% CI,1.25-1.50),high-fat diet(OR,1.35;95% CI,1.28-1.43),and BMI>24 kg/m2(OR,1.09;95% CI,1.03-1.17) were factors related to CAD in the young patients(all P<0.05).Total cholesterol(4.56±1.46 mmol/L vs.4.09±1.00 mmol/L),low-density lipoprotein cholesterol(2.38±1.11 mmol/L vs.2.14±0.63 mmol/L),lipoprotein a(134.97±109.70 mg/L vs.101.58±58.39 mg/L),uric acid(359.89±100.09 μmol/L vs.336.75±94.36 μmol/L),erythrocyte sedimentation rate(9.98±12.19 mm/hour vs.4.89±4.92 mm/hour),high-sensitivity C-reactive protein(3.42±4.39 mg/L vs.2.80±3.77 mg/L) and Big endothelin-1(1.41±1.50 fmol/mL vs.0.77±1.13 fmol/mL) in plasma were significantly increased in the CAD group compared with the non-CAD group(all P<0.05).Conclusions Heavy smoking,hypertension,alcohol consumption,type 2 diabetes mellitus,high-fat diet and BMI>24 kg/m2 were significantly related to CAD in patients aged ≤ 40,with heavy smoking presenting the highest OR.Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.

Effect of Intracoronary Infusion of Bone Marrow Mononuclear Cells or Peripheral Endothelial Progenitor Cells on Myocardial Ischemia-reperfusion Injury in Mini-swine

Objective To simulate and assess the clinical effect of intracoronary infusion of bone marrow mononuclear cells or peripheral endothelial progenitor cells on myocardial reperfusion injury in mini-swine model.Methods Twenty-three mini-swine with myocardial reperfusion injury were used as designed in the study protocol.About(3.54±0.90)×108 bone marrow mononuclear cells(MNC group,n=9) or(1.16± 1.07)×107 endothelial progenitor cells(EPC group,n=7) was infused into the affected coronary segment of the swine.The other mini-swine were infused with phosphate buffered saline as control(n=7).Echocardio-graphy and hemodynamic studies were performed before and 4 weeks after cell infusion.Myocardium infarction size was calculated.Stem cell differentiation was analyzed under a transmission electromicroscope.Results Left ventricular ejection fraction dropped by 0% in EPC group,2% in MNC group,and 10% in the control group 4 weeks after cell infusion,respectively(P<0.05).The systolic parameters increased in MNC and EPC groups but decreased in the control group.However,the diastolic parameters demonstrated no significant change in the three groups(P>0.05).EPC decreased total infarction size more than MNC did(1.60±0.26 cm2 vs.3.71±1.38 cm2,P<0.05).Undermature endothelial cells and myocytes were found under transmission electromicroscope.Conclusions Transplantation of either MNC or EPC may be beneficial to cardiac systolic function,but might not has obvious effect on diastolic function.Intracoronary infusion of EPC might be better than MNC in controlling infarction size.Both MNC and EPC may stimulate angiogenesis,inhibit fibrogenesis,and differentiate into myocardial cells.

IMPLANTATION OF AUTOLOGOUS BONE MARROW MONONUCLEAR CELLS INTO ISCHEMIC MYOCARDIUM ENHANCES CORONARY CAPILLARIES AND SYSTOLIC FUNCTION IN MINISWINE

Objective To investigate the therapeutic effectiveness of intracoronary implantation of autologous bone marrow mononuclear cells (BM-MNC) in miniswine model of reperfused myocardial infarction. Methods Sixteen miniswine myocardial ischemic reperfusion injury models made by ligation of the distal one third segment of left anterior descending artery for 90 minutes were randomized into 2 groups. In BM-MNC group (n = 9), (3.54±0.90)×108 BM-MNC were intracoronary injected, and in the control group (n = 7), phosphate buffered saline was injected by the same way. Echocardiographic and hemodynamic results, vessel density, and myocardial infarction size were evaluated and compared before and 4 weeks after cell transplantation. Results In BM-MNC group, there were no differences between before and 4 weeks after transplantation in aspects of left ventricular ejection fraction (LVEF), interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, or +dp/dtmax. In control group, LVEF, interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, and +dp/dtmax decreased significantly 4 weeks after transplantation (P < 0.05). Left ventricular end-diastolic pressure and –dp/dtmax did not change significantly before and after cell transplantation in both groups. Capillary density in BM-MNC group was greater than that in control group [(13.39 ± 6.96)/high power field vs. (3.50 ± 1.90)/high power field, P < 0.05]. Infarction area assessed by tetrazolium red staining and the infarction percentage decreased in BM-MNC group compared with those in control group (P < 0.05). Conclusions Transplantation of BM-MNC into myocardium with ischemic reperfusion injury increases capillary density and decreases infarction area. It has significantly beneficial effect on cardiac systolic function rather than on diastolic function.

Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

Background:Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy.This study was to compare two tests,light transmittance aggregometry (LTA) and modified thrombelastography (mTEG),for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention (PCI).Methods:Prospective,observational,single-center study of 789 Chinese patients undergoing PCI was enrolled.This study was investigated the correlations between the two tests and performed receiver operating characteristic curve (ROC) analysis for major adverse cardiovascular events (MACEs) at 1-year follow-up.Results:MACEs occurred in 32 patients (4.1％).Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity (Spearman r =0.733,P ＜ 0.001).ROC-curve analysis demonstrated that LTA (area under the curve [AUC]:0.677; 95％ confidence interval [CI]:0.643-0.710; P =0.0009),and mTEG (AUC:0.684; 95％ CI:0.650-0.716; P =0.0001) had moderate ability to discriminate between patients with and without MACE.MACE occurred more frequently in patients with high on-treatment platelet reactivity (HPR) when assessed by LTA (7.4％ vs.2.7％; P ＜ 0.001),and by TEG (6.7％ vs.2.6％; P ＜ 0.001).Kaplan-Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up.Conclusions:The correlation between LTA and mTEG is relatively high in Chinese patients.HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.

Impacts of smoking status on the clinical outcomes of coronary non-target lesions in patients with coronary heart disease:a single-center angiographic study

Background:Coronary atherosclerotic plaque could go through rapid progression and induce adverse cardiac events.This study aimed to evaluate the impacts of smoking status on clinical outcomes of coronary non-target lesions.Methods:Consecutive patients with coronary heart disease who underwent two serial coronary angiographies were included.All coronary non-target lesions were recorded at first coronary angiography and analyzed using quantitative coronary angiography at both procedures.Patients were grouped into non-smokers,quitters,and smokers according to their smoking status.Clinical outcomes including rapid lesion progression,lesion re-vascularization,and myocardial infarction were recorded at second coronary angiography.Multivariable Cox regression analysis was used to investigate the association between smoking status and clinical outcomes.Results:A total of 1255 patients and 1670 lesions were included.Smokers were younger and more likely to be male compared with nonsmokers.Increase in percent diameter stenosis was significantly lower(2.7[0.6,7.1]%vs.3.5[0.9,8.9]%)and 3.4[1.1,7.7]%,P=0.020)in quitters than those in smokers and non-smokers.Quitters tended to have a decreased incidence of rapid lesions progression(15.8%[76/482]vs.21.6%[74/342]and 20.6%[89/431],P=0.062),lesion re-vascularization(13.1%[63/482]vs.15.5%[53/432]and 15.5%[67/431],P=0.448),lesion-related myocardial infarction(0.8%[4/482]vs.2.6%[9/342]and 1.4%[6/431],P=0.110)and all-cause myocardial infarction(1.9%[9/482]vs.4.1%[14/342]and 2.3%[10/431],P=0.128)compared with smokers and non-smokers.In multivariable analysis,smoking status was not an independent predictor for rapid lesion progression,lesion re-vascularization,and lesion-related myocardial infarction except that a higher risk of all-cause myocardial infarction was observed in smokers than non-smokers(hazards ratio:3.00,95%confidence interval:1.04-8.62,P=0.042).Conclusion:Smoking cessation mitigates the increase in percent diameter stenosis of coronary non-target lesions,meanwhile,smokers are associated with increased risk for all-cause myocardial infarction compared with non-smokers.

Effect of Final Kissing Balloon Dilatation after One-stent Technique at Left-main Bifurcation： A Single Center Data

Background:Whether final kissing balloon (FKB) dilatation after one-stent implantation at left-main (LM) bifurcation site remains unclear.Therefore,this large sample and long-term follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy.Methods:Total 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled; among them,790 patients treated with one drug-eluting stent crossover LM to left anterior descending (LAD) with FKB (n =230) or no FKB (n =560) were comparatively analyzed.Primary outcome was the rate of major adverse cardiovascular events,defined as a composite of death,myocardial infarction (MI) and target vessel revascularization (TVR).Results:Overall,The prevalence of true bifurcation lesions,which included Medina classification (1,1,1),(1,0,1),or (0,1,1),was similar between-groups (non-FKB:37.0％ vs.FKB:39.6％,P =0.49).At mean 4 years follow-up,rates of major adverse cardiovascular events (non-FKB:10.0％ vs.FKB:7.8％,P =0.33),death,MI and TVR were not significantly different between-groups.In multivariate propensity-matched regression analysis,FKB was not an independent predictor of adverse outcomes.Conclusions:For patients treated with one-stent crossover LM to LAD,clinical outcomes appear similar between FKB and non-FKB strategy.