冠状动脉旁路移植术后左乳内动脉-左前降支桥血管转归及影响因素分析

目的探讨冠状动脉旁路移植术(CABG)后左乳内动脉-左前降支(LIMA-LAD桥血管的转归及影响因素。方法入选2002年11月至2016年12月北京安贞医院心内科因CABG术后胸闷、胸痛症状复发接受冠状动脉造影的患者共632例。收集患者基本信息、发病相关临床信息、既往病史、实验室化验指标以及CABG时长、术前LIMA管径、峰流速等资料。根据冠状动脉造影结果评价LIMA-LAD桥血管狭窄程度,将LIMA-LAD桥血管狭窄≥50%的患者归入狭窄组(139例),LIMA-LAD桥血管狭窄<50%的患者归入非狭窄组(493例)。结果 632例患者中男性518例(82.0%),平均年龄(59.78±8.70)岁;再发心绞痛582例(92.1%),急性心肌梗死50例(7.9%)。所有患者CABG距离冠状动脉造影时间为(52.14±42.77)个月。狭窄组患者外周血管疾病比例(2.9%比8.3%,P=0.025)、CABG距离造影时间[29.0(14.0,73.0)个月比42.0(18.5,79.0)个月,P=0.041]、CABG术前LIMA峰流速[64.60(54.75,80.00)cm/s比70.00(58.35,84.10)cm/s,P=0.025]均低于非狭窄组,而CABG术前LAD狭窄<75%的比例(22.3%比6.7%,P<0.001)显著大于非狭窄组,差异均有统计学意义。logistic回归分析结果显示,CABG术前LAD狭窄<75%(OR 3.796,95%CI 2.046～7.045,P<0.001)与术后LIMA-LAD桥血管狭窄存在相关性,冠心病危险因素(如高血压病、糖尿病、吸烟)以及CABG手术时长等与桥血管狭窄无明显相关性。结论 CABG术前LAD靶血管狭窄程度可能影响术后LIMA-LAD桥血管狭窄的发生,术前评估冠状动脉应考虑靶血管狭窄程度对LIMA桥血管通畅性的影响。

脱硫建筑石膏的增强研究

研究了烟气脱硫建筑石膏成型工艺条件对其制品强度的影响,并在此基础上通过添加适量外加剂,提高石膏制品强度,同时运用SEM技术分析影响机理。实验结果表明:实验所用脱硫建筑石膏成型的最佳搅拌时间为90s,搅拌速度300r/min,成型水温15℃;在最佳成型工艺的基础上,掺入0.15%羧甲基纤维素及8%硅酸盐水泥能够有效地改善其硬化强度。SEM分析结果表明,石膏成型工艺的改变会影响到石膏晶体的生长,最终会影响硬化强度;掺入硅酸盐水泥会水化生成较细钙矾石穿插在石膏晶体中提高强度。

Relationship between plasma cathepsin S and cystatin C levels and coronary plaque morphology of mild to moderate lesions： an in vivo study using intravascular ultrasound

Background Cathepsin S and its endogenous inhibitor cystatin C are implicated in the pathogenesis of atherosclerosis, especially in the plaque destabilization and rupture leading to acute coronary syndrome. However, whether circulating cathepsin S and cystatin C also change in association with coronary plaque morphology is unknown yet. Methods We recruited 98 patients with unstable angina （UA, n=56） or stable angina （SA, n=-42） who had a segmental stenosis resulting in 〉20% and 〈70% diameter reduction in one major coronary artery on coronary angiography. Thirty-one healthy subjects served as controls. Intravascular ultrasound （IVUS） was used to evaluate plaque morphology. Plasma cathepsin S and cystatin C were measured as well. Results At the culprit lesion site, plaque area （（7.85±2.83） mm^2 vs （6.53±2.92） mm^2, P=0.027）, plaque burden （（60.92±11.04）% vs （53.87±17.52）%, P=0.025）, remodeling index （0.93±0.16 vs 0.86±0.10, P=0.004） and eccentricity index （0.74±0.17 vs 0.66±0.21, P=0.038） were bigger in UA group than in SA group. Plasma cathepsin S and cystatin C were significantly higher in patients than in controls （P〈0.01）. Plasma cathepsin S was higher in UA group （（0.411±0.121） nmol/L） than in SA group （（0.355±0.099） nmol/L, P=0.007）, so did the plasma cystatin C （（0.95±0.23） mg/L in UA group, （0.84±0.22） mg/L in SA group; P=0.009）. Plasma cathepsin S positively correlated with remodeling index （r=0.402, P=0.002） and eccentricity index （r=0.441, P=0.001）, and plasma cystatin C positively correlated with plaque area （r=0.467, P 〈0.001） and plaque burden （r=0.395, P=0.003） in UA group but not in SA group. Conclusions Plasma cathepsin S and cystatin C increased significantly in UA patients. In angina patients, higher plasma cathepsin S may suggest the presence of vulnerable plaque, and higher plasma cystatin C may be a clue for larger atherosclerotic coronary plaque.

Comparision of high sensitivity C-reactive protein and matrix metalloproteinase 9 in patients with unstable angina between with and without significant coronary artery plaques

Background Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein （CRP） is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 （MMP-9） is highly over-expressed in the vulnerable regions of a plaque. Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.

Proliferation, migration and apoptosis activities of endothelial progenitor cells in acute coronary syndrome

Background There are numerous articles on the endothelial progenitor cells （EPCs） in different disease conditions. However, the functional properties of EPCs in acute coronary syndrome （ACS） are still uncertain. Here we aimed to study the number and functions of EPCs in ACS patients. Methods Patients were enrolled with admitted ACS （n=25） and another 25 gender-, age-, atherosclerotic risk factors-matched stable coronary artery disease （CAD） controls. EPCs were defined as CD34＋/CD133＋/VEGFR-2＋ and quantified by flow cytometry. Moreover, functional properties of EPCs including colony-forming unit （CFU）, proliferation, migration as well as apoptosis were evaluated and compared between the two groups. Plasma matrix metalloproteinase-9 （MMP-9） was detected in all patients as well. Results The two groups had similar medication and clinical characteristics on admission. The EPCs in ACS patients were more than 2.6 times that in stable CAD subjects （15.6±2.7 vs. 6.0±0.8 /100 000 events, P 〈0.01）. CFU was not statistically different between the two groups （10.8±2.9 vs. 8.2±1.8, number/well, P 〉0.05）. Furthermore, EPCs isolated from ACS patients were significantly impaired in their proliferation （0.498±0.035 vs. 0.895±0.067, OD value, P〈0.01） and migration capacity （20.5±3.4 vs. 30.7±4.3, number/well, P 〈0.01） compared with controls. Moreover, the apoptosis cell in cultured EPCs was drastically increased in ACS group （（18.3±2.. 1 ）% vs. （7.8±0.4）%, P 〈0.01）. Conclusions Patients with ACS exhibited apparently increased circulating EPCs as well as cultured apoptosis percentage together with a remarkable impairment of proliferation and migration activities compared with stable CAD subjects.

Evaluation of neointimal coverage of overlapping sirolimus- eluting stents by optical coherence tomography

Background Although overlapping sirolimus-eluting stents are often used in long lesions during percutaneous coronary intervention, it was not clear how intimal hyperplasia at the overlapping segments compares with that of single-layer sirolimus-eluting stents.Methods Optical coherence tomography （OCT） examinations were performed on 22 patients in whom overlapping sirolimus-eluting stents （SESs） were implanted. OCT images were analyzed off-line after the procedure. Still frames were selected and classified, and the length of overlap, lumen loss, and average neointimal thickness on the strut were measured. The stent strut was classified into well-apposed to vessel wall with apparent neointimat coverage （type A）, well-apposed to vessel wall without neointimal coverage （type B）, malapposed to the vessel wall without neointimal coveraae （tvDe C）, and strut located at a major side branch （type D）.Results Tlqere was no statistically significant difference between strut coverage types within overlapping and non-overlapping segments, but a greater percentage of type C struts were observed within the overlapping segments （5.2% vs 1.4%, P 〉0.05）. Neither neointimal thickness （（175.0±59.9） μm vs （168.3±90.2）μm, P=0.715） nor lumen loss （（1.61±0.55） mm^2 vs （1.48±0.37） mm^2, P=0.397） was statistically different between the two segments. One patient was diagnosed with suspected in-stent thrombosis at 6 months. Although no specific characteristics of thrombosis were seen on the OCT images, a greater number of malapposed struts without neointima coverage were observed.Conclusions About 90% struts were completely covered by neointimal proliferation at 12 months follow-up, and the thicknesses of neointima on overlapping and non-overlapping segments were similar. Most of type C struts at the overlapping segments were found on the inside layer stents. Delayed antiplatelet therapy was beneficial for the patients with incompletely covered struts.

Relationship among soluble CD105, hypersensitive C-reactive protein and coronary plaque morphology： an intravascular ultrasound study

Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. We investigated the relationship among soluble CD105, hypersensitive C-reactive protein （hs-CRP）, and coronary plaque morphology.Methods A clinical study from April 2004 to December 2006 was conducted in 130 patients who were divided into 3 groups： 56 patients （43.1%） in stable angina （SA） group, 52 patients （40.0%） in unstable angina （UA） group and 22 patients （16.9%） in acute myocardial infarction group. The concentrations of soluble CD105 and hs-CRP were measured in all of the patients by cardioangiography （CAG）. Plasma samples of arterial blood were collected prior to the procedure. The levels of soluble CD105 and hs-CRP were measured by enzyme-linked immunosorbent assay （ELISA）.Results Unstable and ruptured plaque was found more frequently in patients with acute myocardial infarction and UA. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in the ruptured and unstable plaque group. Positive remodeling, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in the ruptured and unstable plaque group. Remodeling index （RI） was positively correlated with the levels of soluble CD105 in the UA group （r=0.628, P〈0.01） and the acute myocardial infarction group （r=0.639, P〈0.01）. The levels of soluble CD105 and hs-CRP were higher in the ruptured plaque group. Soluble CD105 〉4.3 ng/ml was used to predict ruptured plaque with a receiver operating characteristic （ROC） curve area of 0.77 （95% confidence interval （CI）, 66.8%-87.2%）, a sensitivity of 72.8%, a specificity of 78.0% and an accuracy of 70.2% （P〈0.01）, similarly for hs-CRP 〉 5.0 mg/ml with a ROC curve area of 0.70 （95% CI, 59.2%-80.2%）, a sensitivity of 70.2%, a specificity of 76.2% and an accuracy of 67.2% （P〈0.01）.Conclusions The plaque characteristics correlate with the clinical presentation. The elevation of soluble CD105 and hs-CRP is related to the plaque instability and rupture.

Combined effect of atorvastatin and probucol on plasma cystatin C levels and severity of coronary lesion in patients with borderline coronary lesion

Background The plasma cystatin C concentration （PcyC） has been demonstrated to have prognostic value in acute coronary syndrome, but the study of PcyC in patients with borderline coronary lesions is limited. Moreover, the effects of atorvastatin and probucol on PcyC and the severity of coronary lesions are unknown. This study was to evaluate the effects of the combination of atorvastatin and probucol on PcyC and severity of coronary lesion in patients with borderline coronary lesions. Methods One hundred and thirty consecutive patients with borderline coronary lesions （40% to 60% isolated single stenosis assessed by quantitative coronary angiography） were enrolled into the borderline coronary lesion （BCL） group, and one hundred and thirty-six subjects without coronary lesions comprised the controls （CTR）. The subjects in the BCL group were randomized into routine treatment （RTT, n=60）, and combined treatment with atorvastatin 20 mg plus probucol 1.0 g daily added to routine medication （CBT, n=70）, both groups were treated for 6 months continuously. The levels of PcyC, high-sensitive C-reactive protein （hs-CRP）, total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C）, and triglycerides （TG） were determined. One hundred and four subjects in the BCL group were rechecked by coronary angiography. Results PcyC levels were significantly higher in the BCL group than in the CTR group; （2003.26＋825.73） ng/ml vs. （1897.83＋664.46） ng/ml （P 〈0.01）. Compared with patients in the RTT group, the levels of PcyC, TC, LDL-C, TG and hs-CRP were significantly lower in the CBT group （P 〈0.05）. Moreover, there was a trend towards a slight decrease in the RTT patients, （54.38＋10.67）% vs. （50.29＋9.89）% （P 〉0.05）, and a significant decrease in the CBT patients, （53.65＋9.48%） vs. （40.38＋12.93）% （P 〈0.05）, in the mean percent stenosis of borderline coronary lesions before and after six months of treatment. Conclusions Cystatin C played an important role in with the severity of coronary lesions. The combination the treatment of choice. the development of coronary artery disease, and was associated of atorvastatin and probucol decreased PcyC levels, and could be

Antithrombotic and antiplatelet therapies in relation to risk stratification in patients with non-ST elevation acute coronary syndrome： insights from the Sino-Global Registry of Acute Coronary Events

Background Antithrombotic and antiplatelet therapies have been proposed to treat non-ST elevation acute coronary syndrome （NSTEACS）, yet limited information is available about their applications from a multicenter ＂real-world＂ clinical procedure, especially in China. This study was undertaken to characterize the use of antithrombotic and antiplatelet agents in relation to the risk levels of the NSTEACS patients who were enrolled in Sino-Global Registry of Acute Coronary Events （GRACEs） registry study. Methods We analyzed the data from 618 Chinese NSTEACS patients stratified into low-（n=151）, intermediate-（n=233）, and high-risk groups （n=-234） based on GRACE risk scores. The baseline characteristics, clinical presentations, antithrombotic and antiplatelet agents were recorded and compared among the three groups. Results The administration rates of low-molecular-weight heparins （LMWHs） （86.08%） and thienopyridines （85.92%） were higher whereas the administration rate of glycoprotein Ⅱb/Ⅲa inhibitor （1.78%） was much lower than those reported previously. Meanwhile, within the first 24 hours of admission, the use of heparin/LMWHs in the high-risk group was more than that in the intermediate- and low-risk groups （73.50% vs 63.09% vs 55.63%, P=0.001）. Furthermore, the combination of antithrombotic and antiplatelet medications showed no significant differences in all groups. Conclusions In the ＂real world＂ practice of China, the antithrombotic and antiplatelet therapies on NSTEACS are well adherent to the current guidelines except for several gaps, such as the very low use of glycoprotein Ⅱb/Ⅲa inhibitor. Moreover, these antithrombotic and antiplatelet treatments usually tend to be underused for the high-risk ones.

Relevance of SYNTAX score for assessment of saphenous vein graft failure after coronary artery bypass grafting

Objective::To identify risk factors of saphenous vein graft (SVG) failure and to investigate the utility of anatomical SYNTAX score (SS) and SYNTAX score II (SS-II) in predicting SVG failure.Methods::A total of 598 patients who underwent angiography for clinical reasons after coronary artery bypass grafting (CABG) were included. Baseline data and factors related to SVG failure were analyzed at the patient and graft levels. Patients were divided in tertiles by anatomical SS and in three groups by SS-II revascularization recommendation, and SVG patency was analyzed across these groups.Results::Patency rates were similar in all SS-stratified and SS-II recommendation groups within 1, 5, and 10 years after CABG. At the patient level, fasting blood glucose (FBG) level <7.0 mmol/L was less common in SVG failure (68.0% vs. 76.2%). At the graft level, patients with SVG failure tended to have angiography later (4.0 years vs. 3.0 years), poorer FBG control (FBG <7.0 mmol/L: 68.2% vs. 74.7%), and more grafts anastomosed to the right coronary system (59.2% vs. 47.4%). Longer time interval after CABG was related to SVG failure both at the patient and graft levels, and odds ratio ( OR)/ P values ( OR/ P) were 1.282/0.029 and 1.384/0.016, respectively. Using independent graft and grafting to the right artery system as risk factors at the graft level, OR/ Ps were 3.094/0.000 and 2.524/0.000, respectively. Conclusions::Longer time interval after CABG, independent grafts, and grafting to the right artery system are associated with SVG failure. Anatomical SS or SS-II may not be reasonable tools for predicting SVG failure.

Relationship between coronary artery remodeling and cumulative incidence of coronary angiographic lesions with vulnerable characteristics in patients with stable angina pectoris

ackground Development of vulnerable lesions is not limited to the target lesions, but a pan-coronary process. Such lesions are identified by positive remodeling （intravascular ultrasound （IVUS） and complex lesions （angiography））. The prevalence of lesions with vulnerable characteristics in patients with stable angina was not well known. The purpose of the present study was to evaluate the relationship between coronary artery remodeling and incidence of angiographic complex lesions and its calcification in stable angina patients.Methods One hundred and sixty-one stable angina patients （95 males, aged （68±11） years） with 161 de novo target lesions were studied using pre-interventional IVUS. Remodeling index was defined as the lesion divided by reference vessel area; positive remodeling was defined as remodeling index 〉1.05. Besides the 161 target lesions, there were 613 angiographic lesions with 〉30% diameter stenoses, classified as complex or smooth. Multiple complexes were defined as more than one complex lesion in one patient. Stenoses of at least 70% were described as tight. Calcium arc area was used as a new method to quantify coronary calcification.Results Fifty-six patients had positive remodeling target lesion, while 105 did not. The overall number of lesions with a diameter stenoses 〉30% was similar in patients with or without positive remodeling, and the frequency of angiographically complex lesions was higher in positive remodeling patients, especially at non-target site. Calcium arc area was smaller in patients with positive remodeling.Conclusions Positive remodeling on intravascular ultrasound was associated with more complex lesions angiographic findings, especially at non target site. Positive remodeling was found less calcified in patients with stable angina.

Clinical outcomes and cost-utility after sirolimus-eluting versus bare metal stent implantation

Background Randomized studies have shown beneficial effects of drug-eluting stent （DES） in reducing the risk of repeated revascularization. Other studies have shown higher proportion of death, myocardial infarction （MI） and increased cost concerning DES. However the long term safety and effectiveness of DES have been questioned recently.Methods To compare long term clinical outcomes, health-related quality of life （HRQOL） and cost-utility after sirolimus-eluting stent （SES） and bare metal stent （BMS） implantation in angina patients in China, 1241 patients undergoing percutaneous coronary revascularization （PCl） with either SES （n=632） or BMS （n=609） were enrolled continuously in this prospective, nonrandomized, multi-center registry study.Results Totally 1570 stents were implanted for 1334 lesions. Follow-up was completed in 1205 （97.1%） patients at 12 months. Rates of MI, all causes of death were similar between the two groups. Significant differences were found at rate of cardiovascular re-hospitalization （136 （22.4%） in BMS group vs. 68 （10.8%） in SES group, P=0.001） and recurrent angina （149 （24.5%） vs. 71 （11.3%）, P=0.001）. Dramatic difference was observed when compared the baseline and 9-month HRQOL scores intra-group （P 〈0.001）. However no significant difference was found inter-group either in baseline or follow-up HRQOL. Compared with SES, the total cost in BMS was significantly lower on discharge （62 546.0 vs. 78 245.0 Yuan, P=0.001）. And follow-up expenditure was remarkably higher in the BMS group than that in the SES group （13 412.0 vs. 8 812.0 Yuan, P=0.0001）.Conclusions There were no significant differences on death, in-stent thrombosis, MI irrespective of stent type. SES was superior to BMS on improvement of life quality. SES was with higher cost-utility compared to BMS.