A successful team treatment for left main shock syndrome

Acute myocardial infarction complicated by cardiogenic shock and left main coronary artery disease is called left main shock syndrome. It is reported that the morbility and mortality of the syndrome is approximately 0.46%and 55%-80%, respectively. However, the best treat-ment strategy in these cases is unknown. In this article, we present a patient with LMSS who successively underwent emergency percutane-ous coronary intervention and coronary artery bypass grafting with hemodynamic support within 5 days. The patient is now on his three month uneventful out-patient follow-up.

Blood lead level in Chinese adults with and without coronary artery disease

BACKGROUND The Trial to Assess Chelation Therapy study found that edetate disodium(disodium ethylenediaminetet-raacetic acid)chelation therapy significantly reduced the incidence of cardiac events in stable post-myocardial infarction patients,and a body of epidemiological data has shown that accumulation of biologically active metals,such as lead and cadmium,is an important risk factor for cardiovascular disease.However,limited studies have focused on the relationship between angiograph-ically diagnosed coronary artery disease(CAD)and lead exposure.This study compared blood lead level(BLL)in Chinese pa-tients with and without CAD.METHODS In this prospective,observational study,450 consecutive patients admitted to Beijing Anzhen Hospital with sus-pected CAD from November 1,2018,to January 30,2019,were enrolled.All patients underwent coronary angiography,and an experienced heart team calculated the SYNTAX scores(SXscore)for all available coronary angiograms.BLLs were determined with atomic absorption spectrophotometry and compared between patients with angiographically diagnosed CAD and those without CAD.RESULTS In total,343(76%)patients had CAD,of whom 42%had low(0−22),22%had intermediate(23−32),and 36%had high(≥33)SXscore.BLLs were 36.8±16.95μg/L in patients with CAD and 31.2±15.75μg/L in those without CAD(P=0.003).When BLLs were categorized into three groups(low,middle,high),CAD prevalence increased with increasing BLLs(P<0.05).In the multivariate regression model,BLLs were associated with CAD(odds ratio(OR):1.023,95%confidence interval(CI):1.008−1.039;P=0.0017).OR in the high versus low BLL group was 2.36(95%CI:1.29−4.42,P=0.003).Furthermore,BLLs were independently associated with intermediate and high SXscore(adjusted OR:1.050,95%CI:1.036-1.066;P<0.0001).CONCLUSION BLLs were significantly associated with angiographically diagnosed CAD.Furthermore,BLLs showed excel-lent predictive value for SXscore,especially for complex coronary artery lesions.

Clinical efficacy of different treatments and their impacts on the quality of life of octogenarians with coronary artery disease

Background:Coronary artery disease(CAD)in octogenarians(age of>80 years)has a high risk of mortality and high expenses.Research shows that the prevalence of CAD is higher among octogenarians than that among younger people,but few such patients undergo percutaneous coronary intervention(PCI)or coronary artery bypass grafting(CABG).This study aimed to evaluate different treatments w让h respect to their clinical effects and impacts on quality of life of octogenarians with CAD.Methods:Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital,Capital Medical University(Beijing,China)from January 2010 to January 2016 were collected in this study.The patients were categorized into three groups based on the treatments they received:the PCI group(n=292),CABG group(n=110),and medical treatment group(n=117).The followings were recorded during follow-up:clinical data,death(all-cause and cardiovascular-related),re-hospitalization time,Seattle Angina Questionnaire(SAQ)score,and occurrence of hemorrhagic events(cerebral bleeding,gastrointestinal bleeding,and dermal ecchymosis).Results:The median follow-up duration was 25.0(25th,75th percentile:17.0,55.5)months among 417 patients.The all-cause death rates(28.2%vs.12.0%and 14.6%,respectively)and cardiovascular-related death rates(15.4%us.3.8%and 6.4%,respectively)were significantly higher in the medical treatment group than those in the PCI group and CABG group(all P<0.05).The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group(3.8%vs.12.8%and 14.9%,respectively)(x^2=8.23&P=0.018).The SAQ scores of physical limitation,angina frequency,treatment satisfaction,and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group(all P<0.05).No significant difference in the angina stability score was observed among the three groups(F=3.179,P=0.204).Conclusion:PCI and CABG result in reduced mortality and better quality of life in octogenarians with CAD.

Unfractionated Heparin with Sequential Enoxaparin in Patients with Complex Coronary Artery Lesions during Percutaneous Coronary Intervention

Background： Unfractionated heparin （UFH）, despite its limitations, has been used as the primary anticoagulant alternative during the percutaneous coronary intervention （PCI）. Some studies indicated that intravenous enoxaparin could be an effective and safe option. Our team used enoxaparin alone at one time according to the guidelines （Class IIA） and found a little catheter thrombosis during PCI. We recommend a new anticoagulation strategy using enoxaparin in combination with UFH. Enoxaparin has a more predictable anticoagulant response with no need of repeatedly monitoring anticoagulation during PCI. This retrospective study aimed to evaluate the efficacy and safety of using enoxaparin in combination with UFH in PCI patients with complex coronary artery disease. Methods： Between January 2015 and April 2017, 600 PCI patients who received intravenous UFH at an initial dose of 3000 U plus intravenous enoxaparin at a dose of 0.75 mg/kg （observation group） and 600 PCI patients who received UFH at a dose of 100 U/kg （control group） were consecutively included in this retrospective study. The endpoints were postoperative 48-h thrombolysis in myocardial infarction （TIMI） bleeding and transfusion and 30-day and l-year major adverse cardio-cerebrovascular events （MACCE）. Results： Baseline clinical, angiographic, and procedural characteristics were similar between groups, except there was less stent implantation per patient in the observation group （2.13 vs. 2.25 in the control group, P = 0.002）. TIMI bleeding （3.3% vs. 4.7%） showed no significant difference between the observation group and control group. During the 30-day follow-up, the rate of MACCE was 0.9% in the observation group and 1.5% in the control group. There was no significant difference in the rates of MACCE, death, myocardial infarction, target vessel revascularization, cerebrovascular event, and angina within 30 days and 1 year after PC1 between groups as well as in the subgroup analysis of transfemoral approach. Conclusions： UFH with sequential enoxaparin has similar anticoagulant effect and safety as UFH in PCI of complex coronary artery disease.