Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a n...Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.展开更多
Background Growth differentiation factor-15(GDF-15)is involved in multiple processes that are associated with coronary artery disease(CAD).However,little is known about the association between GDF-15 and the future is...Background Growth differentiation factor-15(GDF-15)is involved in multiple processes that are associated with coronary artery disease(CAD).However,little is known about the association between GDF-15 and the future ischemic events in patients with intermediate CAD.This study was conducted to investigate whether plasma GDF-15 constituted risk biomarkers for future cardiovascular events in patients with intermediate CAD.Methods A prospective study was performed based on 541 patients with intermediate CAD(20%–70%).GDF-15 of each patient was determined in a blinded manner.The primary endpoint was major adverse cardiac event(MACE),which was defined as a composite of all-cause death,nonfatal myocardial infarction,revascularization and readmission due to angina pectoris.Results After a median follow-up of 64 months,504 patients(93.2%)completed the follow-up.Overall,the combined endpoint of MACE appeared in 134 patients(26.6%)in the overall population:26 patients died,11 patients suffered a nonfatal myocardial infarction,51 patients underwent revascularization,and 46 patients were readmitted for angina pectoris.The plasma levels of GDF-15(median:1172.02 vs.965.25 pg/m L,P=0.014)were higher in patients with ischemic events than those without events.After adjusting for traditional risk factors,higher GDF-15 levels were significantly associated with higher incidence of the composite endpoint of MACE(HR=1.244,95%CI:1.048–1.478,Quartile 4 vs.Quartile 1,P=0.013).Conclusions The higher level of GDF-15 was an independent predictor of long-term adverse cardiovascular events in patients with intermediate CAD.展开更多
Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compare...Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent （DES）. Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. Methods： A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization （TLR） at the longest follow-up. Dichotomous variables were presented as risk ratios （RRs） with 95% confidence intervals （C/s）, while the overall RRs were estimated using the Mantel-Haenszel random-effects model. Results： Five randomized controlled trials （RCTs） and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms ofTLR （RR = 1.24, 95% CI： 0.89-1.72, P = 0.21 ）, cardiac death （RR = 1.55, 95% CI： 0.89-2.71, P= 0.12）, major adverse cardiovascular event （RR = 1.21,95% CI： 0.98-1.48, P = 0.07）, myocardial infarction （RR = 1.12, 95% CI： 0.72-1.76, P = 0.62）, and stent thrombosis （RR = 0.95, 95% CI： 0.38-2.42, P associated with higher risk of all-cause mortality than new-generation DES （RR = 1.65, 95% CI： 1.09-2.50, P = true in the real-world observational studies （RR = 1.79, 95% CI： 1.12-2.88, P = 0.02）. In RCTs, however, no found between the two treatment strategies in the risk of all-cause mortality. 0.92）. However, DEB was 0.02）. This was especially significant difference was Conclusions： The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.展开更多
Background： There are limited data on longer-term outcomes （〉5 years） for patients with unprotected left main coronary artery （ULMCA） disease who underwent percutaneous coronary intervention （PCI） in the drug-...Background： There are limited data on longer-term outcomes （〉5 years） for patients with unprotected left main coronary artery （ULMCA） disease who underwent percutaneous coronary intervention （PCI） in the drug-eluting stents （DES） era. This study aimed at comparing the long-term （〉5 years） outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting （CABG） and the predictors of adverse events. Methods： All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results： Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses （DES = 465 vs. CABG = 457）. During the median follow-up of 7.1 years （interquartile range 5.3-8.2 years）, no difference was found between PCI and CABG in the occurrence of death （P = 0.282） and the composite endpoint of cardiac death, myocardial infarction （MI） and stroke （P = 0.294）. Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group （P = 0.014） in large part because of the significantly higher rate of repeat revascularization （P 〈 0.001）. PC/was correlated with the lower occurrence of stroke （P = 0.004）. Multivariate analysis showed ejection fraction （EF） （P = 0.012）, creatinine （P = 0.016）, and prior stroke （P = 0.03 l） were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age （P = 0.026） and EF （P = 0.002） were independent predictors in the CABG group. Conclusions： During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.展开更多
基金funded by the Ministry of Science and Technology of the People’s Republic of China,State Science and Technology Support Program (No.2011BAI11B05)Beijing Lab for Cardiovascular Precision Medicine, Beijing, China (PXM2019_014226_000023)
文摘Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.
基金supported by the Beijing Municipal Science and Technology Committee(D0906006000091)the Ministry of Science and Technology of the People’s Republic of China,State Science and Technology Support Program(No.2011BAI11B05).
文摘Background Growth differentiation factor-15(GDF-15)is involved in multiple processes that are associated with coronary artery disease(CAD).However,little is known about the association between GDF-15 and the future ischemic events in patients with intermediate CAD.This study was conducted to investigate whether plasma GDF-15 constituted risk biomarkers for future cardiovascular events in patients with intermediate CAD.Methods A prospective study was performed based on 541 patients with intermediate CAD(20%–70%).GDF-15 of each patient was determined in a blinded manner.The primary endpoint was major adverse cardiac event(MACE),which was defined as a composite of all-cause death,nonfatal myocardial infarction,revascularization and readmission due to angina pectoris.Results After a median follow-up of 64 months,504 patients(93.2%)completed the follow-up.Overall,the combined endpoint of MACE appeared in 134 patients(26.6%)in the overall population:26 patients died,11 patients suffered a nonfatal myocardial infarction,51 patients underwent revascularization,and 46 patients were readmitted for angina pectoris.The plasma levels of GDF-15(median:1172.02 vs.965.25 pg/m L,P=0.014)were higher in patients with ischemic events than those without events.After adjusting for traditional risk factors,higher GDF-15 levels were significantly associated with higher incidence of the composite endpoint of MACE(HR=1.244,95%CI:1.048–1.478,Quartile 4 vs.Quartile 1,P=0.013).Conclusions The higher level of GDF-15 was an independent predictor of long-term adverse cardiovascular events in patients with intermediate CAD.
文摘Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent （DES）. Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. Methods： A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization （TLR） at the longest follow-up. Dichotomous variables were presented as risk ratios （RRs） with 95% confidence intervals （C/s）, while the overall RRs were estimated using the Mantel-Haenszel random-effects model. Results： Five randomized controlled trials （RCTs） and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms ofTLR （RR = 1.24, 95% CI： 0.89-1.72, P = 0.21 ）, cardiac death （RR = 1.55, 95% CI： 0.89-2.71, P= 0.12）, major adverse cardiovascular event （RR = 1.21,95% CI： 0.98-1.48, P = 0.07）, myocardial infarction （RR = 1.12, 95% CI： 0.72-1.76, P = 0.62）, and stent thrombosis （RR = 0.95, 95% CI： 0.38-2.42, P associated with higher risk of all-cause mortality than new-generation DES （RR = 1.65, 95% CI： 1.09-2.50, P = true in the real-world observational studies （RR = 1.79, 95% CI： 1.12-2.88, P = 0.02）. In RCTs, however, no found between the two treatment strategies in the risk of all-cause mortality. 0.92）. However, DEB was 0.02）. This was especially significant difference was Conclusions： The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.
文摘Background： There are limited data on longer-term outcomes （〉5 years） for patients with unprotected left main coronary artery （ULMCA） disease who underwent percutaneous coronary intervention （PCI） in the drug-eluting stents （DES） era. This study aimed at comparing the long-term （〉5 years） outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting （CABG） and the predictors of adverse events. Methods： All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results： Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses （DES = 465 vs. CABG = 457）. During the median follow-up of 7.1 years （interquartile range 5.3-8.2 years）, no difference was found between PCI and CABG in the occurrence of death （P = 0.282） and the composite endpoint of cardiac death, myocardial infarction （MI） and stroke （P = 0.294）. Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group （P = 0.014） in large part because of the significantly higher rate of repeat revascularization （P 〈 0.001）. PC/was correlated with the lower occurrence of stroke （P = 0.004）. Multivariate analysis showed ejection fraction （EF） （P = 0.012）, creatinine （P = 0.016）, and prior stroke （P = 0.03 l） were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age （P = 0.026） and EF （P = 0.002） were independent predictors in the CABG group. Conclusions： During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.
