The effect of fasting plasma glucose on in-hospital mortality after acute myocardial infarction in patients with and without diabetes:findings from a prospective,nationwide,and multicenter registry

OBJECTIVES To evaluate the predictive value of fasting plasma glucose(FPG)for in-hospital mortality in patients with acute myocardial infarction(AMI)with different glucose metabolism status.METHODS We selected 5,308 participants with AMI from the prospective,nationwide,multicenter CAMI registry,of which 2,081 were diabetic and 3,227 were nondiabetic.Patients were divided into high FPG and low FPG groups according to the optim-al cutoff values of FPG to predict in-hospital mortality for diabetic and nondiabetic cohorts,respectively.The primary endpoint was in-hospital mortality.RESULTS Overall,94 diabetic patients(4.5%)and 131 nondiabetic patients(4.1%)died during hospitalization,and the optimal FPG thresholds for predicting in-hospital death of the two cohorts were 13.2 mmol/L and 6.4 mmol/L,respectively.Compared with individuals who had low FPG,those with high FPG were significantly associated with higher in-hospital mortality in diabet-ic cohort(10.1%vs.2.8%;odds ratio[OR]=3.862,95%confidence interval[CI]:2.542-5.869)and nondiabetic cohort(7.4%vs.1.7%;HR=4.542,95%CI:3.041-6.782).After adjusting the potential confounders,this significant association was not changed.Further-more,FPG as a continuous variable was positively associated with in-hospital mortality in single-variable and multivariable models regardless of diabetic status.Adding FPG to the original model showed a significant improvement in C-statistic and net reclassification in diabetic and nondiabetic cohorts.CONCLUSIONS This large-scale registry indicated that there is a strong positive association between FPG and in-hospital mor-tality in AMI patients with and without diabetes.FPG might be useful to stratify patients with AMI.

Triglyceride glucose index predicts in-hospital mortality in patients with ST-segment elevation myocardial infarction who underwent primary angiography

OBJECTIVES To assess the correlation between triglyceride glucose(TyG)index and in-hospital mortality in patients with ST-segment elevation myocardial infarction(STEMI).METHODS A total of 2190 patients with STEMI who underwent primary angiography within 12 h from symptom onset were selected from the prospective,nationwide,multicenter CAMI registry.TyG index was calculated with the formula:Ln[fasting triglycerides(mmol/L)×fasting glucose(mmol/L)/2].Patients were divided into three groups according to the tertiles of TyG index.The primary endpoint was in-hospital mortality.RESULTS Overall,46 patients died during hospitalization,in-hospital mortality was 1.5%,2.2%,2.6%for tertile 1,tertile 2,and tertile 3,respectively.However,TyG index was not significantly correlated with in-hospital mortality in single-variable logistic regression analysis.Nonetheless,after adjusting for age and sex,TyG index was significantly associated with higher mortality when regarded as a continuous variable(adjusted OR=1.75,95%CI:1.16-2.63)or categorical variable(tertile 3 vs.tertile 1:adjus-ted OR=2.50,95%CI:1.14-5.49).Furthermore,TyG index,either as a continuous variable(adjusted OR=2.54,95%CI:1.42-4.54)or categorical variable(tertile 3 vs.tertile 1:adjusted OR=3.57,95%CI:1.24-10.29),was an independent predictor of in-hospital mortality after adjusting for multiple confounders in multivariable logistic regression analysis.In subgroup analysis,the pro-gnostic effect of high TyG index was more significant in patients with body mass index<18.5 kg/m2(P interaction=0.006).CONCLUSIONS This study showed that TyG index was positively correlated with in-hospital mortality in STEMI patients who underwent primary angiography,especially in underweight patients.

Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions

sTo 与大冠的 vessels.MethodsFrom 2004年4月为病人与赤裸金属的 stents ( BMS )相比评估 drug-eluting stents ( DES )的长期的安全和有效性到2006年10月， 2407 个连续病人经历 de novo 损害有比大或等于在在中国北京的 Fu Wai 医院的 3.5 公里的参考容器直径的经皮的冠的干预，有希望地被注册进这研究。我们包括死亡，心肌的梗塞(MI ) ，血栓，目标损害 revascularization (TLR ) ，目标容器 revascularization (TVR ) ，和主要不利心脏的事件获得了 9 年的临床的结果(向，死亡， MI，和 TVR 合成) 。我们执行了艇长比例危险的模型在倾向 match.ResultsAfter 倾向得分以后估计所有结果措施的相对风险， 514 个对待 DES 的病人被匹配到 514 个对待 BMS 的病人。与 BMS 对待的病人与 TLR 的更高的风险被联系(HR：2.55， 95%CI：1.520-4.277， P = 0.0004 ) 并且 TVR (HR：1.889， 95%CI：1.185-3.011， P = 0.0075 ) ，但是 death/MI 和向的率不是统计上不同的。所有学术研究协会定义 stent 血栓在 9 年在二 groups.ConclusionsDuring 是可比较的整个九年的长期的后续，在有大冠的动脉的病人的 DES 的使用仍然在 TLR 和 TVR 的风险与重要减小被联系。

Prediction of relapse after antithyroid drug therapy of hyperthyroidism through assessment of peak systolic velocity of superior thyroid artery

Objective:To explore whether assessment of peak systolic velocity of superior thyroid artery can predict relapse after anti-thyroid drug therapy of hyperthyroidism.Methods:Seventy patients with hyperthyroidism were recruited and treated with antithyroid drug according to the national guideline, the thyroid and superior thyroid artery were evaluated by color Doppler ultrasound, and the blood velocity was measured and analyzed. 30 people with euthyroid were selected as control.Results: Twenty-six of 70 patients with hyperthyroidism treated with anti-thyroid drug relapse six months after remission, accounting for 37.1%. There was no significant difference between relapse patients and patients without relapse for peak systolic velocity of pretreatment. The peak systolic velocities were significant difference between remissive and relapse patients. The MV1-MV2/MV1s was significant difference between remissive and relapse patients. Area under ROC curve of peak systolic velocities of the superior thyroid arteries of relapse patients and euthyroid subjects was 0.773, the cutoff point was 40.3 cm/s, and sensitivity and specificity were 84.6% and 65.0%, respectively. Area under ROC curve of MV1-MV2/MV1s of the superior thyroid arteries of remissive patients and relapse patients was 0.870, the cutoff point was 0.525, and sensitivity and specificity were 86.4% and 69.2%, respectively.Conclusion: The determination of peak systolic velocity of superior thyroid artery and relevant parameters can help predict relapse after anti-thyroid drug therapy of hyperthyroidism.

Comparison of Long-term Outcomes in Patients with Premature Triple-vessel Coronary Disease Undergoing Three Different Treatment Strategies： A Prospective Cohort Study

Background： Patients with premature triple-vessel disease （PTVD） have a higher risk of recurrent coronary events and repeat revascularization： however, the long-term outcome of coronary artery bypass grafting （CABG）, percutaneous coronary intervention （PCI）, and medical therapy （MT） alone for PTVD patients is controversial. The aim of this study is to evaluate the long-term outcome of PTVD patients among these three treatment strategies, to find out the most appropriate treatment methods lbr these patients. Methods： One thousand seven hundred and ninety-two patients with PTVD （age： men 〈50 years and women _〈60 years） were enrolled between 2004 and 2011. The primary end point was all-cause death. The secondary end points were cardiac death, myocardial infarction, stroke, or repeat revascularization. Results： PCI, CABG, and MT alone were performed in 933 （52.1%）, 459 （25.6%）, and 400 （22.3%） patients. Both PCI and CABG were associated with lower all-cause death （4.6% vs. 4.1% vs. 15.5%, respectively, P 〈 0.01） and cardiac death （2.8% vs. 2.0% vs. 9.8%, respectively, P 〈 0.01 ） versus MT alone. The rate of repeat revascularization in the CABG group was significantly lower than those in the PCI and MT groups. After adjusting for baseline factors, PCI and CABG were still associated with similar lower risk of all-cause death and cardiac death versus MT alone （all-cause death： hazard ratio [HR]： 0.35, 95% confidence interval [CI]： 0.23-0.53, P 〈 0.01 and HR： 0.35, 95% CI： 0.18-0.70, P= 0.003, respectively, and cardiac death： HR： 0.32, 95% CI： 0.19-0.54, P〈 0.01 and HR： 0.36, 95% CI：0.14-0.93, P = 0.03, respectively）. Conclusions： PCI and CABG provided equal long-term benefits for all-cause death and cardiac death for PTVD patients. Patients undergoing MT alone had the worst long-term clinical outcomes.