Effect of advanced age on plasma homocysteine levels and its association with ischemic stroke in non-valvular atrial fibrillation

Background Elevated homocysteine （Hcy） has been reported to be associated with cardiovascular events in atrial fibrillation （AF） pa- tients, while the age-related expression pattern of plasma Hcy in AF remains unknown. The study was aimed to investigate the effect of ad- vanced age on plasma Hcy levels and its association with ischemic stroke in non-valvular AF patients. Methods A total of 2562 consecu- tive patients with non-valvular AF and 535 controls were enrolled and divided into six age groups. Plasma Hcy levels were analyzed among different age groups, and the effect of advanced age on Hcy was investigated. Results Plasma Hcy levels did not show any difference among groups aged below 65 years, while it increased sharply in patients aged 65-74 years and aged over 75 years （15.7 ±4.6 μmol/L, 17.1 ±4.9 μmol/L, both P 〈 0.01 compared with the first four age groups）. Hcy was much higher in AF patients than in controls at the same age group （all P 〈 0.05）. The proportion of patients with hyperhomocysteinemia increased gradually with age from 32.3%, 29.2%, 31.2%, 32.4%, 45.9%, to 51.4% in six age groups. The concentration of Hcy in AF patients with ischemic stroke increased progressively with age, and was higher than those without stroke at the same age. Logistic regression analysis demonstrated that age 65-74 years [odds ratios （OR）： 1.742, 95% confidence interval （CI）： 1.223-2.482, P = 0.002] and age ≥ 75 years （OR： 2.637, 95% CI： 1.605-4.335, P 〈 0.001） were significantly independent predictors of elevated plasma Hcy levels. Conclusions Advanced age was significantly associated with elevated Hcy levels, which may provide a possible explanation for the progressive increase in ischemic stroke especially in elderly AF patients.

Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases

Objective To assess long-term survival and late cardiovascular events in patients with atrial myxoma after surgical intervention. Methods Retrospective analysis of 403 patients undergoing resection of atrial myxoma from January 2002 to December 2016 was conducted with a median follow-up period of 4.5 (range: 0.5?15) years. Results The cross-clamp time and cardiopulmonary bypass times were 41.1 ± 21.4 and 65.2 ± 27.3 min,respectively. A diagnosis of myxoma was histopathologically confirmed in all cases. The early in-hospital mortality rate was 0.7%(n = 3). During the follow-up period,tumor recurrence occurred in six patients and cerebral infarction in nine. There were 48 (11.9%) patients with late onset atrial fibrillation (AF). By multivariate analysis,age (HR = 1.05,95% CI: 1.02–1.09,P < 0.001),left atrial diameter (HR = 1.23,95% CI: 1.08–1.36,P = 0.012),and mitral valve surgery (HR = 1.17,95% CI: 1.05–1.29,P = 0.027) were independent predictors of late onset AF. Twenty-one (5.2%) patients died during the follow-up period. Advanced age (HR = 1.07,95% CI: 1.04–1.10,P = 0.003) and multiple surgical procedures (HR = 1.18,95% CI: 1.06–1.29,P = 0.012) were significantly associated with overall mortality. Conclusions Atrial myxoma can be resected with good long-term survival. Late onset AF is common after surgery in patients with atrial myxoma. Advanced age,left atrial diameter,and mitral valve surgery were independent predictors of outcomes.

Impact of Proton-pump Inhibitors on the Pharmacodynamic Effect and Clinical Outcomes in Patients Receiving Dual Antiplatelet Therapy after Percutaneous Coronary Intervention： A Propensity Score Analysis

Background：Prior studies have reported controversial conclusions regarding the risk of adverse cardiovascular events in patients using proton-pump inhibitors （PPIs） combined with clopidogrel therapy,causing much uncertainty in clinical practice.We sought to evaluate the safety of PPIs use among high-risk cardiovascular patients who underwent percutaneous coronary intervention （PCI） in a long-term follow-up study.Methods：A total of 7868 consecutive patients who had undergone PCI and received dual antiplatelet therapy （DAPT） at a single center from January 2013 to December 2013 were enrolled.Adenosine diphosphate （ADP）-induced platelet aggregation inhibition was measured by modified thromboelastography （mTEG） in 5042 patients.Propensity score matching （PSM） was applied to control differing baseline factors.Cox proportional hazards regression was used to evaluate the 2-year major adverse cardiovascular and cerebrovascular events （MACCEs）,as well as individual events,including all-cause death,myocardial infarction,unplanned target vessel revascularization,stent thrombosis,and stroke.Results：Among the whole cohort,27.2% were prescribed PPIs.The ADP-induced platelet aggregation inhibition by mTEG was significantly lower in PPI users than that in non-PPI users （42.0 ± 30.9% vs.46.4 ± 31.4%,t =4.435,P 〈 0.001）.Concomitant PPI use was not associated with increased MACCE through 2-year follow-up （12.7% vs.12.5%,x2 =0.086,P =0.769）.Other endpoints showed no significant differences after multivariate adjustment,regardless of PSM.Conclusion：In this large cohort of real-world patients,the combination of PPIs with DAPT was not associated with increased risk of MACCE in patients who underwent PCI at up to 2 years of follow-up.

Validation of Predictive Value of Patterns of Nonadherence to Antiplatelet Regimen in Stented Patients Thrombotic Risk Score in Chinese Population Undergoing Percutaneous Coronary Intervention:A Prospective Observational Study

Background: The patterns of nonadherence to antiplatelet regimen in stented patients(PARIS) thrombotic risk score are a novel score for predicting the risk of coronary thrombotic events(CTEs) after percutaneous coronary intervention(PCI) with drug?eluting stents.However, the prognostic value of this score has not been fully evaluated in non?Euro?American PCI populations.Methods: We performed a prospective, observational study of 10,724 patients who underwent PCI in Fuwai hospital, China and evaluated the PARIS thrombotic risk score’s predictive value of CTEs in the PCI population. The area under the receiver operating characteristic curve(AUROC) was used to assess the predictive value of the PARIS score for CTE.Results: Among 9782 patients without in?hospital events, a total of 95 CTEs occurred during the 2?year follow?up. The PARIS score was significantly higher in patients with CTEs(3.38 ± 2.04) compared with patients without events(2.53 ± 1.70, P < 0.001).According to the risk stratification of the PARIS thrombotic score, the risk of CTEs in the high?risk group was 3.14 times higher than that in the low?risk group(hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.92–5.13; P < 0.001). However, the risk of CTEs in the intermediate?risk and low?risk groups was not significant(HR, 1.39; 95% CI, [0.86–2.24]; P = 0.184). The PARIS score showed prognostic value in evaluating CTEs in the overall population(AUROC, 0.621; 95% CI, 0.561–0.681), the acute coronary syndrome(ACS) population(AUROC, 0.617; 95% CI, 0.534–0.700; P = 0.003), and the non?ACS population(AUROC, 0.647; 95%CI, 0.558–0.736; P = 0.001).Conclusions: In a real?world Chinese population, the PARIS thrombotic risk score shows a modest prognostic value for CTEs in patients after PCI. This score also has a predictive value for CTEs in the ACS and non?ACS subgroup populations.

Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions

Background：There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines （CRUSADE） and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction （ACUITY-HORIZONS） scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions （PCIs） with drug-eluting stents （DES） in patients receiving dual antiplatelet therapy.We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients.Methods：We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital,China.All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center.Major bleeding was defined as Types 2,3,and 5 according to Bleeding Academic Research Consortium Definition criteria.Results：During a 2-year follow-up,245 of 9782 patients （2.5%） had major bleeding （MB）.CRUSADE （21.00 [12.00,29.75] vs.18.00 [11.00,26.00],P 〈 0.001） and ACUITY-HORIZONS （9.00 [3.00,14.00] vs.6.00 [3.00,12.00],P 〈 0.001） risk scores were both significantly higher in the MB than non-MB groups.Both scores showed a moderate predictive value for MB in the whole study cohort （area under the receiver-operating characteristics curve [AUROC],0.565;95% confidence interval [CI],0.529-0.601,P =0.001;AUROC,0.566;95% CI,0.529-0.603,P 〈 0.001,respectively） and in the acute coronary syndrome （ACS） subgroup （AUROC：0.579,95% CI：0.531-）.627,P =0.001;AUROC,0.591;95% CI,0.544-0.638,P 〈 0.001,respectively）.However,neither score was a significant predictor in the non-ACS subgroup （P 〉 0.05）.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly （P 〉 0.05） in the whole cohort,ACS subgroup,or non-ACS subgroup.Conclusions：CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly （P 〉 0.05） in the whole cohort,ACS subgroup,or non-ACS subgroup.

Evaluation of the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Bleeding Score for Predicting the Long-term Out-of-hospital Bleeding Risk in Chinese Patients after Percutaneous Coronary Intervention

Background： The Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients （PARIS） bleeding score is a novel score for predicting the out-of-hospital bleeding risk after percutaneous coronary intervention （PCI）. However, whether this score has the same value in non-European and American populations is unclear. This study aimed to assess the PARIS bleeding score＇s predictive value of bleeding in patients alter PCI in the Chinese population. Methods： We perforined a prospective, observational study of 10,724 patients who underwent PCI from January to December 2013, in Fuwai Hospital, China. We defined the primary end point as major bleeding （MB） according to Bleeding Academic Research Consortium definition criteria including Type 2, 3, or 5. The predictive value of the PARIS bleeding score was assessed with the area under the receiver operating characteristic （AUROC） curve. Results： Of 9782 patients, 245 （2.50%） MB events occurred during the 2 years of follow-up. The PAP, IS bleeding score was significantly higher in the MB group than that of non-MB group （4.00 [3.00, 5.00] vs. 3.00 [2.00, 5.00], Z=3.71, P 〈 0.001 ）. According to risk stratification of the PARIS bleeding score, the bleeding risk in the intermediate- and high-risk groups was 1.50 times （hazard ratio [HR]： 1.50; 95% confidence interval [CI]： 1.160-1.950; P=0.002） and 2.27 times higher （HR： 2.27; 95% CI： 1,320-3.900： P=0.003） than that in the low-risk group. The PARIS bleeding score showed a moderate predictive value for MB in the overall population （AUROC： 0.568, 95% CI： 0.532-0.605; P 〈 0.001 ） and acute coronary syndrome （ACS） subgroup （AUROC： 0.578, 95% CI： 0.530-0.626; P = 0.001 ） and tended to be predictive in the non-ACS subgroup （AUROC： 0.556, 95% CI： 0,501 0.611; P = 0.054）.