Homocysteine is associated with the progression of non-culprit coronary lesions in elderly acute coronary syndrome patients after percutaneous coronary intervention

Background The influence of homocysteine （Hcy） on the migration and proliferation of vascular smooth muscle cells has been well established. However, the impact of Hcy levels on the progression of non-culprit coronary lesions （NCCLs） is controversial. This study aims to evaluate whether the plasma level of Hcy is related to the progression of NCCLs after percutaneous coronary stent implantation in elderly patients with acute coronary syndrome （ACS）. Methods A total of 223 elderly patients （〉 65 years old） with ACS undergoing stent im- plantation and follow-up coronary angiography were enrolled. Laboratory determination comprised of blood sample evaluation for Hcy was carried out before baseline coronary intervention. The patients were classified into two groups according to the blood Hcy tertiles （〉 15 mmol/L or 〈 15 mmol/L）. Patients were followed up for 12.2 months. NCCL progression was assessed by three-dimensional quantitative coronary angiography. Results A significantly higher ratio of NCCL progression was observed in the group with baseline Hcy concentrations above 15 mmol/L compared to the group with concentrations below 15 mmol/L （41/127, 32.3% vs. 14/96, 14.6%, P = 0.002）. Multivariate Cox regression analysis showed that Hcy and diabetes mellitus were independent risk factors for NCCL progression. The crude haz- ard ratio （HR） of NCCL progression for Hcy level was 1.056 （95% CI： 1.01-1.104, P = 0.015）. The adjusted HR of NCCL progression for Hcy level was 1.024 （95% CI： 1.007-1.042, P = 0.007）. The adjusted HR of NCCL progression for diabetes mellitus was 1.992 （95% CI： 1.15-3.44, P = 0.013）. Conclusions Hcy is an independent risk factor for NCCL progression after 12 months of follow-up in elderly patients with ACS who has undergone percutaneous coronary stenting.

Safety and efficacy of frequency-domain optical coherence tomography in evaluating and treating intermediate coronary lesions

AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients with 2-dimensional quantitativecoronary angiography(2D-QCA) demonstrating ICL were included. OCT imaging was performed. According to predetermined OCT criteria, patients were assigned to either of 2 groups: OCT-guided percutaneous coronary intervention(PCI) or OCT-guided optimal medical therapy(OMT). The primary efficacy endpoint was to demonstrate the superiority and higher accuracy of FD-OCT compared to 2D-QCA in evaluating stenosis severity in patients with ICL. The primary safety endpoint was the incidence of 30-d major adverse cardiac events(MACE). Secondary endpoints included MACE at 12 mo and other clinical events.RESULTS Analysis of the primary efficacy endpoint demonstrates that 2D-QCA overestimates the stenosis severity of ICL in both the OCT-guided PCI and OMT groups, proving FD-OCT to be superior to and more precise than 2D-QCA in treating this subset of lesions. The primary safety endpoint was fully met with the incidence of 30-d MACE being nil in both the OCT-guided PCI and OCTguided OMT groups. Incidences of secondary endpoints were found to be low in both arms, the only exception being the relatively high incidence of recurrent episodes of angina which was, however, very similar in the 2 groups.CONCLUSION FD-OCT is safe and effective in the evaluation and treatment of ICL. Larger studies are needed to firmly establish the efficacy and safety of FD-OCT in treating ICL across all coronary artery disease population subgroups.

Rapid progression of nonculprit coronary lesions six weeks after successful primary PCI in culprit artery:a case report

We report a case of a 49-year-old man who was admitted with a 3-hour history of sudden onset of substemal chest pain. Coronary angiography revealed that the left circumflex artery （LCX） was acutely and totally occluded at the mid-portion. In addition, the proximal and mid-portion of the right coronary artery （RCA） had a 60% occlusion. We inferred that the LCX was the culprit artery and primary PCI was successfully performed. Six weeks later, the patient had an eventful course with recurrence of chest pain. Coronary angiography showed no significant ste- nosis in the previous LCX lesion, while the proximal and middle potion of the RCA had a 90% occlusion. Our case demonstrates the systemic nature of acute coronary syndromes and highlights the inherent instability of coronary artery disease.

Clinical efficacy and gene chip expression analysis of Shenzhu Guanxin recipe granules(参术冠心方颗粒) in patients with intermediate coronary lesions

OBJECTIVE: To evaluate the clinical efficacy and safety of Shenzhu Guanxin recipe granules(参术冠心颗粒, SGR) in treating patients with intermediate coronary lesions(ICL), and to investigate the potential mechanism though a transcriptome sequencing approach. METHODS: ICL patients with Qi deficiency and phlegm stasis were adopted and randomly assigned to a case group or a control by random number generator in a 1∶1 randomization ratio to evaluate the clinical efficacy. RESULTS: There was no significant difference between the two groups in coronary computed tomography angiography related indexes in the two groups before and after intervention. Through the gene chip expression analysis, it is finally concluded that there are 355 differential mRNAs(190 up-regulated genes and 165 down regulated genes) when compared the SGR group and placebo group. Through protein-protein interaction network analysis of differentially expressed genes, 10 hub genes were finally obtained: CACNA2D2, CACNA2D3, DNAJC6, FGF12, SGSM2, CACNA1G, LRP6, KIF25, OXTR, UPB1. CONCLUSIONS: SGR combined with Western Medicine can be safely used to treat ICL patients with Qi deficiency and phlegm stasis. The possible mechanism of action and relevant gene loci and pathway were proposed.

Two-Stent Strategy for Bifurcation Lesions in Percutaneous Transluminal Coronary Angioplasty: Real-World Evidence

Background: Bifurcation lesions pose a high risk for adverse events after percutaneous coronary intervention (PCI). Evidence supporting the benefits of the two-stent strategy (2SS) for treating coronary bifurcation lesions in India is limited. This study aimed to evaluate the clinical outcomes of various 2SSs for percutaneous transluminal coronary angioplasty for bifurcation lesions in India. Materials and Methods: This retrospective, observational, multicentric, real-world study included 64 patients over 8 years. Data on demographics, medical history, PCI procedures, and outcomes were recorded. Descriptive statistics were computed using the SPSS software. Results: Patients (n = 64) had an average age of 65.3 ± 11.1 years, with 78.1% males. Acute coronary syndrome was reported in 18.8%, chronic stable angina in 40.6%, and unstable angina in 34.4% of participants. Two-vessel disease was observed in 98.4% of patients, and 99.4% had true bifurcation lesions. The commonly involved vessels were the left anterior descending artery (50%), left circumflex coronary artery (34.4%), and first diagonal artery (43.8%). Mean percent diameter stenosis was 87.2% ± 10.1%. The mean number of stents used was 2.00 ± 0.34. The 2SS techniques included the T and small protrusion (TAP) (39.1%), double kissing (DK) crush (18.8%), and the culotte techniques (14.1%). Procedural and angiographic success rate was 92.18%. Major adverse cardiovascular events at 1-year follow-up occurred in 7.8% of cases. Conclusion: The 2SS for bifurcation lesions showed favorable in-hospital and follow-up outcomes. Findings can serve as a resource for bifurcation angioplasty in India. Larger real-world studies with robust methodology are needed to validate these results.

Employing a random forest model to forecast the likelihood of coronary artery lesions in Kawasaki disease: a study centered on four biomarkers

Background:Kawasaki disease is an acute immune vasculitis,which is more common in children under 5 years old.Kawasaki disease mainly affects the cardiovascular system,especially the coronary arteries.Once coronary artery damage occurs,it can significantly impact the patient’s prognosis.Therefore,in some countries and regions,Kawasaki disease has become a common acquired heart disease.Methods:First,univariate analysis was conducted on each predictive factor.Then,Least Absolute Shrinkage and Selection Operator and random forest algorithms were used to screen all predictive factors,and the prediction model was evaluated using receiver operating characteristic curve,calibration curve,and Decision Curve Analysis.Results:This study,based on data from 228 Kawasaki disease patients,utilized a random forest model to identify four predictive factors:white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count.These factors were used to construct a prediction model,which achieved an area under the curve of 0.743.Conclusions:We developed a forest plot based on white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count to effectively predict the occurrence of coronary artery lesions in Kawasaki disease.

Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient:A case report

BACKGROUND The combination of acute ST-segment elevation myocardial infarction(STEMI)and gastric ulcers poses a challenge to primary percutaneous coronary intervention(PPCI),particularly for young patients.The role of drug-coated balloons(DCBs)in the treatment of de novo coronary artery lesions in large vessels remains unclear,especially for patients with STEMI.Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24,2019.Within the first 3 minutes of the initial assessment in the emergency room,the electrocardiogram(ECG)showed significant changes.There was atrial fibrillation with ST-segment elevation.Subsequently,atrial fibrillation terminated spontaneously and reverted to sinus rhythm.Soon after,the patient experienced syncope.The ECG revealed torsades de pointes ventricular tachycardia.A few seconds later,it returned to sinus rhythm.High-sensitivity tropon in I was normal.The diagnosis was acute STEMI.Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery.Considering the patient's age and history of peptic ulcer disease,after the intracoronary injection of prourokinase,percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning,and paclitaxel drug-eluting balloon angioplasty was performed without any stents,achieving favorable outcomes.CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI,and further research is warranted.

Results of the First 10 Cases of Coronary Bypass Surgery in Senegal

This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.

Complex coronary lesions and rotational atherectomy:one hospital's experience

Objective:To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent (DES) implantation in patients with complex coronary lesions. Methods:From August 2006 to August 2012, 253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study. Results:The overall procedure success rate was 98% with the cost of two (0.8%) coronary perforations, three (1.2%) dissections, five (2.0%) slow flows or no flows, three (1.2%) peri-procedure myocardial infarctions, and two (0.8%) in hospital deaths. During follow-up (mean three years), one (0.4%) patient died, two (0.8%) patients had acute myocardial infarction, 14 (5.5%) had restenosis, and target lesion revascularization occurred in eight patients (3.2%). Conclusions:Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions, especially calcified and non-dilatable lesions.

Drug-eluting stent for the treatment of small coronary lesion:comparison between sirolimus- and paclitaxel-eluting stent

Background Patients with small coronary lesions are at increased risk for repeat interventions after coronary angioplasty and stenting. The efficacy of drug-eluting stents （DES） has been demonstrated to improve the outcomes of these patients and is a focus of interest. Currently, two platforms of DES are available （sirolimus-eluting stent （SES） and paclitaxel-eluting stent （PES））. However, it has less been known that DES, SES vs PES, is superior for the treatment of small coronary lesions. Methods In this retrospective study, 87 consecutive patients with 151 lesions underwent implantation of coronary SES （n=68） and PES （n=83）. Quantitative coronary angiography （QCA） was performed at the time of stent implantation and subsequently at 8 months post-stenting. Small vessel disease was defined as lesions in vessels with diameter 42.5 mm measured by QCA. Major adverse cardiac events （MACE） including death, thrombosis, nonfatal myocardial infarction and target lesion revascularization （TLR） were compared between the two groups. Results Baseline clinical characteristics and angiographic parameters were similar between the two groups. At clinical and angiographic follow-up, overall thrombosis rates were similar in both groups （0 vs 1.2%, P〉0.05）. The TLR and in-segment restenosis were not significantly different （19.1% vs 25.3%; 10.3% vs 10.8%, P=0.365 and P=0.913 respectively） between the two groups. The in-stent restenosis rate, however, was significantly higher in the PES group （4.4% vs 21.7%; P=0.002）. Similarly, the late loss was significantly higher in the PES group （（0.14±0.38） mm vs （0.49±0.61） mm; P〈0.001）. Conclusions In this small sample-size, non-randomized study, the data indicated that implantation of SES for the treatment of patients with small coronary lesion showed more favorable results in respect of restenosis compared with PES implantation.

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

Cut-off values of lesion and vessel quantitative flow ratio in de novo coronary lesion post-drug-coated balloon therapy predicting vessel restenosis at mid-term follow-up

Background:Drug-coated balloons(DCBs)have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions.Quantitative flow ratio(QFR)is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography(CAG),obviating the need for an invasive fractional flow reserve procedural.This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR,which predict vessel restenosis(diameter stenosis[DS]≥50%)at mid-term follow-up.Methods:The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis.From their QFR performances,which were analyzed by CAG images at follow-up,we divided them into two groups:group A,showing target vessel DS≥50%,and group B,showing target vessel DS<50%.The median follow-up time was 287 days in group A and 227 days in group B.We compared the clinical characteristics,parameters during DCB therapy,and QFR performances,which were analyzed by CAG images between the two groups,in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis.Student's t test was used for the comparison of normally distributed continuous data,Mann-Whitney U test for the comparison of non-normally distributed continuous data,and receiver operating characteristic(ROC)curves for the evaluation of QFR performance which can predict vessel restenosis(DS≥50%)at mid-term follow-up using the area under the curve(AUC).Results:A total of 112 patients with 112 target vessels were enrolled in this study.Group A had 41 patients,while group B had 71.Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy,and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS≥50%post-DCB therapy were 0.905(AUC,0.741[95%confidence interval,CI:0.645,0.837];sensitivity,0.817;specificity,0.561;P<0.001)and 0.890(AUC,0.796[95%CI:0.709,0.882];sensitivity,0.746;specificity,0.780;P<0.001).Conclusions:The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy.When lesion/vessel QFR values are<0.905/0.890 post-DCB therapy,a higher risk of vessel restenosis is potentially predicted at follow-up.

Intermediate coronary lesions: prognostic evaluation of plasma osteoprotegerin in elderly patients

<正>Objective To investigate the plasma osteoprotegerin(OPG)measurement for assessing the prognosis of intermediate coronary lesions in elderly patients.Methods We retrospectively analyzed patients meeting the inclusion criteria of suspicious chest pain or confirmed coronary artery disease(CHD),and intermediate stenosis lesions(20%~70%)in 3 main coronary arteries

Direct versus pre- dilated rotational atherectomy for treating calcified coronary lesions

Objective To compare the efficacy of direct and pre-dilated atherectomy(RA)for treating the patients with calcified coronary lesions.Methods A total of 137coronary artery disease(CAD)patients receiving RA treatment in our hospital from 2010-04 to 2014-09were retrospectively studied.The ischemic related

A Meta-analysis of the Biomarkers Associated with Coronary Artery Lesions Secondary to Kawasaki Disease in Chinese Children

The biomarkers associated with coronary artery lesions （CAL） secondary to Kawasaki disease （KD） in Chinese children were investigated by using Meta-analysis. We searched documents published from January 1997 to December 2009 from medical electronic databases. According to inclusion and exclusion criteria, eligible full-text papers were identified. We conducted a comprehensive quantitative analysis by using Stata10.0 statistical software package to assess the heterogeneity among the documents, calculated the summary effect and analyze publication bias and sensitivity. A total of 92 documents and 16 biomarkers were identified. All documents were case-control studies, and included 2398 patients in CAL group and 5932 patients in non-CAL （NCAL） group. The Meta-analysis showed that the levels of platelet count, platelet hematocrit （PCT）, neutrophils count, platelet distribution width （PDW）, mean platelet volume （MPV）, erythrocyte sedimentation rate （ESR）, cardiac troponin Ⅰ （cTnI）, and endothelin-1 （ET-1） in CAL group were significantly higher than those in NCAL group, and serum albumin （Alb） and hemoglobin （Hb） levels were significantly lower in CAL group （all P〈0.05）. White blood cell （WBC） count, serum sodium, matrix metalloproteinase 9 （MMP-9）, total cholesterol （TC）, hematocrit （HCT） and CD3＋T lymphocytes percentage had no statistically significant difference between the two groups. In conclusion, our results indicated that the 10 biomarkers including platelet count, neutrophils count, PCT, PDW, MPV, ESR, cTnI, ET-1, Alb and Hb were associated with CAL, and may be involved in the pathogenesis of CAL. The biomarkers of WBC count, serum sodium, MMP-9, TC, HCT, and CD3＋T lymphocytes percentage bore no relationship with the development of CAL among Chinese children with KD.

Excimer laser coronary atherectomy for a severe calcified coronary ostium lesion:A case report

BACKGROUND Percutaneous coronary intervention can be challenging for ostial coronary artery lesions due to calcium burden and elastic fiber content.Excimer laser coronary atherectomy(ELCA)is a less common treatment for severe calcified coronary ostium lesions.CASE SUMMARY An 81-year-old male presented to the Cardiology Department of Qingdao Municipal Hospital with a 1-year history of chest pain.Coronary angiography showed severe calcific stenosis(approximately 90%)in the right coronary artery ostium.The right coronary artery ostium was unable to be advanced using a 2.5 mm×12.0 mm balloon(NC Sprinter,Medtronic,United States)or dilated using a 2.0 mm×12.0 mm balloon(Sprinter,Medtronic,United States).The patient underwent successful ELCA and balloon dilation of the calcified coronary ostium lesion.CONCLUSION ELCA appears to be a safe and effective treatment for the management of severe calcified coronary ostium lesions.

Reevaluation of the Efficacy of Intravenous Gammaglobulin in the Prevention and Treatment of Coronary Artery Lesion in Kawasaki Disease

In order to objectively evaluate the efficacy of intravenous gammaglobulin (IVIG) in the prevention and treatment of coronary artery lesion (CAL) in Kawasaki disease (KD) and the related factors influencing the IVIG efficacy, 314 children with KD were reviewed retrospectively and comparatively and were divided into IVIG plus aspirin group and ASA group. The occurrence and restoration of CAL in these two groups as well as many laboratory and clinical indexes including average hospital stay (days), total fever duration, defervescence time, platelet count, erythrocyte sedimentation rate, C reactive protein etc. were observed. The incidence of CAL was 39.5 % in the children with KD. In the IVIG+ASA group, the incidence of CAL was 34.3 % and 56.0 % in ASA group respectively (P<0.001). The incidence of CAL was reduced in the group in which 2.0 g/kg or 1.0 g/kg IVIG was administered as compared with the group in which IVIG was administered at a dose ≤0.6 g/kg or ≥3.0 g/kg (P<0.05). CAL occurred less frequently when IVIG was administered at 3-10 days of the course than that when IVIG was administered ≤3 days or >10 days (P<0.05). About 13.4 % of the CAL treated with IVIG was not recovered at the 12 th month of the course, mostly in the groups in which only ASA was administered and IVIG treatment was started 10 days later. The hospital stay (days), defervescence time, total fever duration, platelet count, erythrocyte sedimentation rate and C reactive protein were significantly reduced in IVIG+ASA group as compared with those in the ASA group (P<0.05). IVIG treatment can remarkably shorten the course of patients with KD and decrease the incidence of CAL, but the efficacy of IVIG in the prevention and treatment of KD disease is not as expected by people, therefore, reevaluation of the practical efficacy of IVIG is required.

Relationship between plasma C-reactive protein concentration and the severity of coronary artery lesion

Objective: To explore the relationship between C-reactive protein(CRP) concentration and severity of coronary artery lesion. Methods: The plasma CRP concentration were tested in 166 cases who underwent coronary angiography(CAG),coronary heart disease(CHD) was presented in 86 patients and absent in 80 cases as normal control group, and results of the two groups and different numbers of diseased coronary vessels in CHD group were analyzed. Results: The plasma CRP concentration were 2293±198, 5126±508, 12969±1076 μg/L, respectively,for the normal control group, the stable angina group and the unstable angina group. The CRP concentration in the stable angina group and unstable angina group were significantly higher than those of the normal control group (P<0.05, P<0.01, respectively). In the CHD group, the plasma CRP concentration were 5131±513, 7024±689, 11970±2075 μg/L, respectively,for the 1-vessel-disease-group, the 2-vessel-disease-group and the 3-vessel-disease-group. The CRP concentration of the three groups were significantly higher than those of the normal control group (P<0.01). Conclusion: CRP concentration is closely associated with severity of coronary artery lesion.

A Novel guide extension assisted stenting technique for coronary bifurcation lesions

A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion(CBL)is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation lesions.Another is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation lesions.The aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter(GuideLiner).With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina,a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary bifurcation.Stent implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative figures.The technique facilitates side-branch only stenting in side-branch mono-ostial(medina 0,0,1)CBL or only the distal main segment in distal mono-ostial(medina 0,1,0)CBL without compromising the other two remaining segments when using the onestent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions(tri-ostial or medina 1,1,1).Consequently,through optimizing stent deployment,the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent restenosis.The most appropriate lesions suitable for the technique,and some other practical tips are also described.

Echocardiography in Diagnosis and Prevention of the Coronary Artery Lesions in Kawasaki Disease

Kawasaki disease (muco-cutaneous lymph node syndrome, MCLS) was first reported by Kawasaki in 1967. It was characteried by nonvascular polymorphous rash, fever, ulcer in oral mucosa, edema of hands of feet, cervix lymphadenopathy and desquamations in peripheral extremities. Because of unknown pathogens, no lab examination was available as a single easily recognized diagnostic marker; the diagnosis is