Clinical characteristics and one year outcomes in Chinese atrial fibrillation patients with stable coronary artery disease： a population-based study

Background Atrial fibrillation （AF） and coronary artery disease （CAD） often coexist, however, the clinical characteristics and the impact of stable CAD on the outcomes in Chinese patients with AF has not been well understood. Methods Consecutive AF patients in 20 hospitals in China from November 2008 to October 2011 were enrolled. The primary endpoints included 1-year all-cause mortality, stroke, non-central nervous system （non-CNS） embolism, and major bleeding. Results A total of 1947 AF patients were analyzed, of whom 40.5% had stable CAD. The mean CHADS2 scores in CAD patients were significantly higher than that of non-CAD patients （2.4 - 1.4 vs. 1.4 - 1.2, P 〈 0.001）. During follow-up period, warfarin use is low in both groups, with relatively higher proportion in non-CAD patients compared with CAD patients （22.3% vs. 10.7%, P 〈 0.001）. Compared with non-CAD patients, CAD patients had higher one-year all-cause mortality （16.8% vs. 12.9%, P = 0.017） and incidence of stroke （9.0% vs. 6.4%, P = 0.030）, while the non-CNS embolism and major bleeding rates were comparable between the two groups. After multivariate adjustment, stable CAD was independently associated with increased risk of 1-year all-cause mortality （HR = 1.35, 95% CI： 1.01-1 .80, P = 0.040）, but not associated with stroke （HR = 1.07, 95% CI： 0.72-1.58, P = 0.736）. Conclusions Stable CAD was prevalent in Chinese AF patients and was independently associated with increased risk of 1-year all-cause mortality. Chinese AF patients with stable CAD received inadequate antithrombotic therapy and this grim status of antithrombotic therapy needed to be improved urgently.

Efficacy and safety of Shexiang Baoxin pill(MUSKARDIA)in patients with stable coronary artery disease:a multicenter,double-blind,placebo-controlled phase IV randomized clinical trial

Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce.The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy(OMT)in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months.Both groups received OMT according to local tertiary hospital protocols.The primary outcome was the occurrence of a major adverse cardiovascular event(MACE),defined as a composite of cardiovascular death,non-fatal myocardial infarction(MI),or non-fatal stroke.Secondary outcomes included all-cause mortality,non-fatal MI,non-fatal stroke,hospitalization for unstable angina or heart failure,peripheral revascularization,angina stability and angina frequency.Results:In all,99.7%of the patients were treated with aspirin and 93.0%with statin.After 2 years of treatment,the occurrence of MACEs was reduced by 26.9%in the MUSKARDIA group(MUSKARDIA:1.9%vs.placebo:2.6%;odds ratio=0.80;95%confidence interval:0.45-1.07;P=0.2869).Angina frequency was significantly reduced in the MUSKARDIA group at 18 months(P=0.0362).Other secondary endpoints were similar between the two groups.The rates of adverse events were also similar between the two groups(MUSKARDIA:17.7%vs.placebo:17.4%,P=0.8785).Conclusions:As an add-on to OMT,MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD.Moreover,the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD.The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:chictr.org.cn,No.ChiCTR-TRC-12003513.

Comparison of Efficacy and Safety between First and Second Generation Drug-eluting Stents in Patients with Stable Coronary Artery Disease： A Single-center Retrospective Study

Background：Lots of trials demonstrate that second-generation drug-eluting stents （G2-DES）,with their improved properties,offer significantly superior efficacy and safety profiles compared to first generation DES （Gl-DES） for patients with coronary artery disease （CAD） receiving percutaneous coronary intervention （PCI）.This study aimed to verify the advantage of G2-DES over G1-DES in Chinese patients with stable CAD （SCAD）.Methods：For this retrospective observational analysis,2709 SCAD patients with either G1-DES （n =863） or G2-DES （n =1846） were enrolled consecutively throughout 2013.Propensity score matching （PSM） was applied to control differing baseline factors.Two-year outcomes,including major adverse coronary events as well as individual events,including target vessel-related myocardial infarction,target lesion revascularization （TLR）,target vessel revascularization,and cardiogenic death were evaluated.Results：The incidence of revascularization between G1-and G2-DES showed a trend of significant difference with a threshold P-value （8.6% vs.6.7%,x2 =2.995,P =0.084）.G2-DES significantly improved TLR-free survival compared to G1-DES （96.6% vs.97.9%,P =0.049） and revascularization-free survival curve showed a trend of improvement of G2-DES （92.0% vs.93.8%,P =0.082）.These difterences diminished after PSM.Multivariate Cox proportional hazard regression analysis showed a trend for G 1-associated increase in revascularization （hazard ratio：1.28,95% confidence interval：0.95-1.72,P =0.099） while no significance was found after PSM.Other endpoints showed no significant differences after multivariate adjustment regardless of PSM.Conclusions：G1-DES showed the same safety as G2-DES in this large Chinese cohort of real-world patients.However,G2-DES improved TLR-ffee survival of SCAD patients 2 years after PCI.The advantage was influenced by baseline clinical factors.GI-DES was associated with a trend of increase in revascularization risk and was not an independent predictor of worse medium-term prognosis compared with G2-DES.

Network Pharmacology-Based Exploration of the Mechanism of Guanxinning Tablet for the Treatment of Stable Coronary Artery Disease

Objective:Network pharmacology was utilized to explore the mechanism of Guanxinning(GXN)tablet for the treatment of stable coronary artery disease(SCAD).Materials and Methods:First,active ingredients and therapeutic targets were predicted by databases and gene chip.Then,we constructed the compound-target(C-T)network and target-disease(T-D)network to screen hub compounds and therapeutic targets based on contribution index(CI),degree,closeness,betweenness,and coreness in the networks.Enrichment analysis was performed on hub therapeutic targets,and finally,the verification of hub ingredients and hub therapeutic targets was performed through molecular docking.Results:With"oral bioavailability≥30%,druglikeness≥0.18,and half-life≥4 h"as screening conditions,58 active ingredients were obtained.Seven hundred and seventeen compound targets and 636 SCAD targets were retrieved using databases and gene chip,and the intersection of both(139 targets)was defined as therapeutic targets.According to CI,degree,betweenness,closeness,and coreness,2 hub compounds and 13 hub therapeutic targets were chosen from the C-T network and T-D network,respectively.The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis indicated that GXN treated SCAD from several aspects including inflammatory reaction,oxidative stress,nutritional metabolism,blood pressure regulation,ventricular remodeling,vascular smooth muscle proliferation,angiogenesis,and platelet aggregation.Tissue enrichment analysis revealed that the therapeutic targets were enriched in multiple organs and tissues.The excellent binding force between the hub compounds and hub therapeutic targets was verified by molecular docking.Conclusions:The treatment of SCAD by GXN has the characteristics of multiple ingredients,multiple targets,and multiple approaches.Consequently,it may theoretically treat SCAD from multiple angles and levels.

Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China

Background:The Chinese appropriate use criteria(AUC)for coronary revascularization was released in 2016 to improve the use of coronary revascularization.This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease(CAD)patients.Methods:We conducted a prospective,multi-center cohort study of stable CAD patients with coronary lesion stenosis≥50%.After the classification of appropriateness based on Chinese AUC,patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received.The primary outcome was a composite of death,myocardial infarction,stroke,repeated revascularization,and ischemic symptoms with hospital admission.Results:From August 2016 to August 2017,6085 patients were consecutively enrolled.Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events(MACCEs;hazard ratio[HR]:0.62;95%confidence interval[CI]:0.45-0.86;P=0.004)than medical therapy in patients with appropriate indications(n=1617).No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications(n=2658,HR:0.81;95%CI:0.52-1.25;P=0.338)and inappropriate indications(n=1810,HR:0.80;95%CI:0.51-1.23;P=0.308).Conclusions:In patients with appropriate indications according to Chinese AUC,coronary revascularization was associated with significantly lower risk of MACCEs at 1 year.No benefit was found in coronary revascularization in patients with inappropriate indications.Our findings provide evidence for using Chinese AUC to guide clinical decision-making.