Objective:To compare the feasibility and safety between right distal radial artery access and right radial artery access in patients undergoing coronary angiography(CAG)or percutaneous coronary intervention(PCI).Metho...Objective:To compare the feasibility and safety between right distal radial artery access and right radial artery access in patients undergoing coronary angiography(CAG)or percutaneous coronary intervention(PCI).Methods:On the basis of arterial access,113 patients who underwent CAG or PCI in Kunshan Hospital of Traditional Chinese Medicine between January and October 2018 were divided into two groups:a right distal radial artery group(52 patients)and a right radial artery group(61 patients).We collected general information,the number of puncture attempts,access times,postoperative compression time,and complications.Results:The general characteristics,rate of successful radial artery puncture,and rate of successful catheter placement in the two groups were not different.The right radial artery group had fewer puncture attempts(1.26±0.44 times vs.2.19±0.53 times,P=0.001)and a shorter access time(3.23±0.86 min vs.4.77±1.49 min,P=0.001)than the right distal radial artery group.However,the postoperative compression time in the right distal radial artery group was shorter(3.44±0.9 h vs.7.16±1.21 h,P=0.001).Two cases of bleeding,four cases of hematoma,and one case of artery occlusion in the right radial artery group and one case of hematoma in the right distal artery group occurred before discharge.The rate of total complications in the right distal radial artery group was lower than in the right radial artery group(1.93%vs.11.48%,P=0.048).Conclusion:CAG or PCI through the right distal radial artery is feasible and safe.展开更多
BACKGROUND The use of biodegradable polymer drug-eluting stents(BP-DES)has been proven to minimize restenosis and stent thrombosis.The current post-marketing monitoring was observed at the 5-year clinical outcomes of ...BACKGROUND The use of biodegradable polymer drug-eluting stents(BP-DES)has been proven to minimize restenosis and stent thrombosis.The current post-marketing monitoring was observed at the 5-year clinical outcomes of individuals who had been treated with FlexyRap®DES in the real world.AIM To assess the safety and effectiveness of FlexyRap®DES at the 5-year follow-up in real-world settings.METHODS Findings from a retrospective,multi-center,observational,post-market clinical follow-up study of patients treated with FlexyRap®DES for de novo coronary artery disease(CAD)were reported.During the 12-mo follow-up,the primary endpoint was target lesion failure,which was defined as the composite of cardiovascular death, target vessel myocardial infarction(TV-MI), and clinically driven target lesion revascularization.RESULTS The data of 500 patients received with FlexyRap®DES was obtained at the completion of the surveillance timeline of 5-year.After the implantation of FlexyRap®DES,the device success rate was 100%.Adverse events that led to major bleeding,permanent disability,or death were not experienced in the patients.The major adverse cardiac event rate at 12-mo,3-year,and 5-year follow-up was 1(0.2%),0(0%),and 1(0.2%)respectively with 0(0%)cardiovascular death,2(0.4%)TV-MI,and 0(0%)TLR compositely.Furthermore,late stent thrombosis was found in 2(0.4%)patients at the follow-up of 12-mo,very late stent thrombosis was observed in 2 patients(0.4%)at 3-year follow-up.CONCLUSION FlexyRap®DES was proved to be safe and efficacious in real-world patients with de novo CAD,indicating a lowered rate of cardiac events and stent thrombosis at 5-year follow-up.展开更多
Objective This study analyzed a large single-center sample in China to explain the impact of smoking state at baseline on long-term prognosis of coronary artery disease (CAD) patients who received percutaneous coronar...Objective This study analyzed a large single-center sample in China to explain the impact of smoking state at baseline on long-term prognosis of coronary artery disease (CAD) patients who received percutaneous coronary intervention (PCI).展开更多
BACKGROUND Increased lipoprotein(a)[lp(a)]has proinflammatory effects,which increase the risk of coronary artery disease.However,the association between lp(a)variability and follow-up C-reactive protein(CRP)level in p...BACKGROUND Increased lipoprotein(a)[lp(a)]has proinflammatory effects,which increase the risk of coronary artery disease.However,the association between lp(a)variability and follow-up C-reactive protein(CRP)level in patients undergoing percutaneous coronary intervention(PCI)has not been investigated.AIM To explore the association between lp(a)variability and mean CRP levels within the 1st year post-PCI.METHODS Results of lp(a)and CRP measurements from at least three follow-up visits of patients who had received PCI were retrospectively analyzed.Standard deviation(SD),coefficient of variation(CV),and variability independent of the mean(VIM)are presented for the variability for lp(a)and linear regression analysis was conducted to correlate lp(a)variability and mean follow-up CRP level.The relationship of lp(a)variability and inflammation status was analyzed by restricted cubic spline analysis.Finally,exploratory analysis was performed to test the consistency of results in different populations.RESULTS A total of 2712 patients were enrolled.Patients with higher variability of lp(a)had a higher level of mean follow-up CRP(P<0.001).lp(a)variability was positively correlated with the mean follow-up CRP(SD:β=0.023,P<0.001;CV:β=0.929,P<0.001;VIM:β=1.648,P<0.001)by multivariable linear regression analysis.Exploratory analysis showed that the positive association remained consistent in most subpopulations.CONCLUSION Lp(a)variability correlated with mean follow-up CRP level and high variability could be considered an independent risk factor for increased post-PCI CRP level.展开更多
Objective To probe the clinic feasibility of percutaneous coronary intervention(PCI) via transulnar artery approach (PCI TRU).Methods Fourty patients with unstable ischemic manifestation(male 34,female 6;age 59.3 ...Objective To probe the clinic feasibility of percutaneous coronary intervention(PCI) via transulnar artery approach (PCI TRU).Methods Fourty patients with unstable ischemic manifestation(male 34,female 6;age 59.3 ±9.10 years)whose radial artery of right hand was thin with a weak pulse that was not suitable to transradial artery PCI while whose ulnar artery was thick with a strong pulse based on their larger diameter in ulnar artery as compared with those in radial artery ( 3.30 ±0.22mm vs 2.43 ±0.33 mm, P <0.05 ) by the investigation of vessel echography,but revesered Allen’s test for radial and ulnar artery was positive,were selected as the subjects for PCI TRU. The radio of ulnar artery versus radial artery was 1.35:1.00 and the time of Allen’s test in ulnar artery side was shorter than that in radial artery side ( 2.70 ±0.36 s vs 4.68 ±0.52s , P <0.05 ) before PCI. The efficiency of PCI TRU was evaluated. The time of manipulative duration for each procedure of PCI TRU was recorded. The time of Allen’s test, luminal diameter (mm) , cross area of vessel lumin (mm 2), blood velocity (Vs max), blood resistance (RI) in ulnar artery and radial artery and the level of blood oxygen in finger (PaO 2、SatO 2) were measured and recorded , respectively , as well were compared quantitatively before and after 1 month of procedure . Results Fourty eight lesion segments of 42 vessels in all patients were angioplasticized successfully via TRU by 6F guiding catheter including 23 segments of type B1 , 14 segments of type B2 and 11 segments of type C. PCI TRU in all of 40 patients was performed successfully. Fourty eight stents were implanted including 2 lesions of intrastent restenosis angioplasticized with cutting balloon technique before re stenting . The average time of manipulative duration of guiding catheters engaging in osicum of target coronary, crossing the vessel lesions of guidewire, dilatation and implantation of stents,and under X ray fluoroscopy were 4.30 ±0.59 min , 2.52 ±0.40min , 2.66 ±0.40 min ,and 25.9 ±0.49 min , respectively, and the total time of the whole procedure was 56.6 ±14.8 min . When the ulnar introducer was taken off, the access site in ulnar artery was suppressed by tourniquet with no bleeding in the access site and no limitation of physical activation under maintaining infusion of heparin immediately after procedure . There was no significant change in the diameter of ulnar artery and the time of Allen’s test after 1 month of PCI procedure as compared with those before procedure ( 3.22 ±0.48mm vs 3.26 ±0.22 mm , P >0.05 ; 2.96 ±0.98 s vs 2.72 ±0.47 s , P >0.05 ). No significant change was found in the parameters of blood velocity , cross area of vessel lumin, blood resistance and the level of blood oxygen in finger after 1 month of PCI procedure. The average total hospital stay was 5.21 ±0.43 days. Following up 1 month, no complications such as occlusion of ulnar artery, abnormal sensitivity and movement disability were found in right hands in all patients.Conclusions The ulnar artery might be selected as one approach of antebrachial artery for PCI in the patients with coronary heart disease whose radial artery was difficulty as access vessels of PCI, while reversed Allen’s test for radial and ulnar artery are positive and the luminal diameter of ulnar artery was larger than that of radial artery.展开更多
Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons a...Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.展开更多
Background: Though drug-eluting stent is widely used during coronary angioplasty, still there are conditions in which bare metal stents possess a priority role. Objectives: The aim of FLEXUS study is to investigate th...Background: Though drug-eluting stent is widely used during coronary angioplasty, still there are conditions in which bare metal stents possess a priority role. Objectives: The aim of FLEXUS study is to investigate the safety and efficacy of Flexinnium stent in unselected real-life patients. Methods: The FLEXUS is a single-centric, observational, non-randomized, retrospective study performed from January to August 2014 in 216 patients who received Flexinnium stent. The end-point of study included device-oriented and patient-oriented clinical outcomes as per Academic Research Consortium consensus. These end-points were observed at in-hospital stay and 12-month follow-up. Results: Of 216 patients, 174 (80.6%) patients were male;there were 76 (35.2%) and 84 (38.9%) patients of diabetes and hypertension, respectively. Type B2 and C lesions accounted for 27 (11.3%) and 122 (50.8%), respectively. A total of 241 Flexinnium stents were implanted with an average diameter and length of 2.7 ± 0.2 mm and 21.6 ± 8.0 mm, respectively. The cumulative device-oriented composite at 12-month follow-up included 2.31% cardiac death, 1.39% myocardial infarction (MI) attributed to the target vessel, and 3.70% target lesion revascularization (TLR). Conclusion: FLEXUS study gives an idea about favorable safety and efficacy of the Flexinnium in unselected real-life patients with both simple and complex coronary lesions.展开更多
BACKGROUND Even though percutaneous coronary intervention(PCI)improved the survival of patients with acute myocardial infarction,still multivessel coronary artery disease remains an important factor burdening prognosi...BACKGROUND Even though percutaneous coronary intervention(PCI)improved the survival of patients with acute myocardial infarction,still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease(SVD).AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease(MVD).METHODS The retrospective cohort of patients were divided into two groups:SVD and MVD group.The study population consisted of both male and female young(≤45 years)patients presented with ST-elevation myocardial infarction(STEMI)at the National Institute of Cardiovascular Disease,Karachi,Pakistan and undergone primary PCI from 1 st July 2017 to 31 st March 2018.Pre and postprocedure management of the patients was as per the guidelines and institutional protocols.RESULTS A total of 571 patients with STEMI,≤45 years were stratified into two groups by the number of vessels involved,342(59.9%)with SVD and 229(40.1%)with MVD.The average age of these patients was 39.04±4.86 years.A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group(25.1%vs 38%,P<0.01;11.7%vs 27.5%,P<0.001)respectively.While,smoking was more prevalent among the SVD group as compare to MVD group(36.3%vs 28.4%,P=0.05).The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group(48.8%vs 39.2%,P=0.021).Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98%vs 96.5%of the patients is SVD vs MVD group.CONCLUSION The MVD comprised of around 40%of the young patients presented with STEMI.Also,this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases,therefore,preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.展开更多
The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DA...The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this population.Before PCI and the start of DAPT,it is recommended to assess patient bleeding risk.Based on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding complications.Furthermore,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding risk.The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(<50×10^(9)/L)and elevated portal pressure.Therefore,every effort should be made to maintain thrombocyte count above>50×10^(9)/L and prevent variceal bleeding.There is no solid evidence for DAPT in patients with cirrhosis.However,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with cirrhosis.Based on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage.Finally,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT.When indicated,PCI should be performed over radial artery using contemporary DES.Complementary medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk patients.Novel approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Pericoronary fat stranding (PCFS) is a novel noninvasive imag...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Pericoronary fat stranding (PCFS) is a novel noninvasive imaging sign of coronary inflammation, and has important implications for cardiovascular risk stratification, and the outcome of percutaneous coronary intervention (PCI) for coronary heart disease patients with pericoronary fat stranding remains unknown. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">We report two rare cases of PCI-treated coronary heart disease patients with severe PCFS. </span><b><span style="font-family:Verdana;">Case Presentation: </span></b><span style="font-family:Verdana;">This is the first report of two rare cases of PCI for patients with coronary heart disease surrounded by severe PCFS. We demonstrated that the outcome in these cases is poor, and in-stent restenosis or occlusion occurs rapidly within 2</span></span><span style="font-family:;" "=""></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">6 months following PCI. However, Case 2 underwent coronary artery bypass grafting after the rapid occurrence of in-stent occlusion, and the bypass graft remained intact over the 5 years following coronary artery bypass grafting. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Coronary artery bypass grafting rather than PCI may be appropriate for coronary heart disease patients with severe PCFS.</span></span>展开更多
Chronic total occlusion of an anomalous right coronary artery arising from left coronary sinus is uncommon. We are describing a case of a 71 years old patient presented with severe chest pain along with exertional dys...Chronic total occlusion of an anomalous right coronary artery arising from left coronary sinus is uncommon. We are describing a case of a 71 years old patient presented with severe chest pain along with exertional dyspnea with an inferior wall myocardial infarction. Coronary angiography showed anomalous right coronary artery originating from left coronary sinus having chronic total occlusion in proximal portion and normal left anterior descending artery and left circumflex artery. We were successful in implanting the two stents at an occlusive region with good angiographic results.展开更多
BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whe...BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.展开更多
Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less va...Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.展开更多
Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases wit...Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.展开更多
Background There is a paucity of information available for clinical decision making applying to the elderly patient population. Therefore, data of percutaneous coronary interventions (PCI) including demographic inform...Background There is a paucity of information available for clinical decision making applying to the elderly patient population. Therefore, data of percutaneous coronary interventions (PCI) including demographic information on the elderly patients, procedural practices, and outcomes are needed. Objectives and Methods From consecutive PCIs of participating institutions, demographics data, clinical, angiographic success and adverse clinical outcomes were collected. Standard statistical methods were used to compare crude differences in patient and procedural characteristics across age groups. Results At baseline, the prevalence of comorbid conditions ( renal failure and heart failure) increased with age. Unstable angina or a non-ST elevation MI were the most common indications for PCI across all age groups. Fewer patients ≥ 80 years old were undergoing primary PCI and older patients were somewhat less likely to receive a Ⅱb/Ⅲa receptor blocker. Slightly more patients ≥ 80 years old underwent a 2-vessel PCI ( consistent with them having more multivessel disease) and these patients were more likely to have an intervention on a Type C lesion. Compared to patients < 50 years old, those aged ≥ 70 years old had a significantly increased risk of death, MI, stroke, or vascular complications at the access site. Conclusions This study suggests increasing age is associated with increasing risk for an adverse outcome following PCI. This is in part attributable to case-mix but likely, also related to the changing physiology of aging. Despite the increased risk of the procedure, the clinical success rate for PCI is quite high and makes it a reasonable alternative for the treatment of CAD in the elderly.展开更多
文摘Objective:To compare the feasibility and safety between right distal radial artery access and right radial artery access in patients undergoing coronary angiography(CAG)or percutaneous coronary intervention(PCI).Methods:On the basis of arterial access,113 patients who underwent CAG or PCI in Kunshan Hospital of Traditional Chinese Medicine between January and October 2018 were divided into two groups:a right distal radial artery group(52 patients)and a right radial artery group(61 patients).We collected general information,the number of puncture attempts,access times,postoperative compression time,and complications.Results:The general characteristics,rate of successful radial artery puncture,and rate of successful catheter placement in the two groups were not different.The right radial artery group had fewer puncture attempts(1.26±0.44 times vs.2.19±0.53 times,P=0.001)and a shorter access time(3.23±0.86 min vs.4.77±1.49 min,P=0.001)than the right distal radial artery group.However,the postoperative compression time in the right distal radial artery group was shorter(3.44±0.9 h vs.7.16±1.21 h,P=0.001).Two cases of bleeding,four cases of hematoma,and one case of artery occlusion in the right radial artery group and one case of hematoma in the right distal artery group occurred before discharge.The rate of total complications in the right distal radial artery group was lower than in the right radial artery group(1.93%vs.11.48%,P=0.048).Conclusion:CAG or PCI through the right distal radial artery is feasible and safe.
文摘BACKGROUND The use of biodegradable polymer drug-eluting stents(BP-DES)has been proven to minimize restenosis and stent thrombosis.The current post-marketing monitoring was observed at the 5-year clinical outcomes of individuals who had been treated with FlexyRap®DES in the real world.AIM To assess the safety and effectiveness of FlexyRap®DES at the 5-year follow-up in real-world settings.METHODS Findings from a retrospective,multi-center,observational,post-market clinical follow-up study of patients treated with FlexyRap®DES for de novo coronary artery disease(CAD)were reported.During the 12-mo follow-up,the primary endpoint was target lesion failure,which was defined as the composite of cardiovascular death, target vessel myocardial infarction(TV-MI), and clinically driven target lesion revascularization.RESULTS The data of 500 patients received with FlexyRap®DES was obtained at the completion of the surveillance timeline of 5-year.After the implantation of FlexyRap®DES,the device success rate was 100%.Adverse events that led to major bleeding,permanent disability,or death were not experienced in the patients.The major adverse cardiac event rate at 12-mo,3-year,and 5-year follow-up was 1(0.2%),0(0%),and 1(0.2%)respectively with 0(0%)cardiovascular death,2(0.4%)TV-MI,and 0(0%)TLR compositely.Furthermore,late stent thrombosis was found in 2(0.4%)patients at the follow-up of 12-mo,very late stent thrombosis was observed in 2 patients(0.4%)at 3-year follow-up.CONCLUSION FlexyRap®DES was proved to be safe and efficacious in real-world patients with de novo CAD,indicating a lowered rate of cardiac events and stent thrombosis at 5-year follow-up.
文摘Objective This study analyzed a large single-center sample in China to explain the impact of smoking state at baseline on long-term prognosis of coronary artery disease (CAD) patients who received percutaneous coronary intervention (PCI).
文摘BACKGROUND Increased lipoprotein(a)[lp(a)]has proinflammatory effects,which increase the risk of coronary artery disease.However,the association between lp(a)variability and follow-up C-reactive protein(CRP)level in patients undergoing percutaneous coronary intervention(PCI)has not been investigated.AIM To explore the association between lp(a)variability and mean CRP levels within the 1st year post-PCI.METHODS Results of lp(a)and CRP measurements from at least three follow-up visits of patients who had received PCI were retrospectively analyzed.Standard deviation(SD),coefficient of variation(CV),and variability independent of the mean(VIM)are presented for the variability for lp(a)and linear regression analysis was conducted to correlate lp(a)variability and mean follow-up CRP level.The relationship of lp(a)variability and inflammation status was analyzed by restricted cubic spline analysis.Finally,exploratory analysis was performed to test the consistency of results in different populations.RESULTS A total of 2712 patients were enrolled.Patients with higher variability of lp(a)had a higher level of mean follow-up CRP(P<0.001).lp(a)variability was positively correlated with the mean follow-up CRP(SD:β=0.023,P<0.001;CV:β=0.929,P<0.001;VIM:β=1.648,P<0.001)by multivariable linear regression analysis.Exploratory analysis showed that the positive association remained consistent in most subpopulations.CONCLUSION Lp(a)variability correlated with mean follow-up CRP level and high variability could be considered an independent risk factor for increased post-PCI CRP level.
文摘Objective To probe the clinic feasibility of percutaneous coronary intervention(PCI) via transulnar artery approach (PCI TRU).Methods Fourty patients with unstable ischemic manifestation(male 34,female 6;age 59.3 ±9.10 years)whose radial artery of right hand was thin with a weak pulse that was not suitable to transradial artery PCI while whose ulnar artery was thick with a strong pulse based on their larger diameter in ulnar artery as compared with those in radial artery ( 3.30 ±0.22mm vs 2.43 ±0.33 mm, P <0.05 ) by the investigation of vessel echography,but revesered Allen’s test for radial and ulnar artery was positive,were selected as the subjects for PCI TRU. The radio of ulnar artery versus radial artery was 1.35:1.00 and the time of Allen’s test in ulnar artery side was shorter than that in radial artery side ( 2.70 ±0.36 s vs 4.68 ±0.52s , P <0.05 ) before PCI. The efficiency of PCI TRU was evaluated. The time of manipulative duration for each procedure of PCI TRU was recorded. The time of Allen’s test, luminal diameter (mm) , cross area of vessel lumin (mm 2), blood velocity (Vs max), blood resistance (RI) in ulnar artery and radial artery and the level of blood oxygen in finger (PaO 2、SatO 2) were measured and recorded , respectively , as well were compared quantitatively before and after 1 month of procedure . Results Fourty eight lesion segments of 42 vessels in all patients were angioplasticized successfully via TRU by 6F guiding catheter including 23 segments of type B1 , 14 segments of type B2 and 11 segments of type C. PCI TRU in all of 40 patients was performed successfully. Fourty eight stents were implanted including 2 lesions of intrastent restenosis angioplasticized with cutting balloon technique before re stenting . The average time of manipulative duration of guiding catheters engaging in osicum of target coronary, crossing the vessel lesions of guidewire, dilatation and implantation of stents,and under X ray fluoroscopy were 4.30 ±0.59 min , 2.52 ±0.40min , 2.66 ±0.40 min ,and 25.9 ±0.49 min , respectively, and the total time of the whole procedure was 56.6 ±14.8 min . When the ulnar introducer was taken off, the access site in ulnar artery was suppressed by tourniquet with no bleeding in the access site and no limitation of physical activation under maintaining infusion of heparin immediately after procedure . There was no significant change in the diameter of ulnar artery and the time of Allen’s test after 1 month of PCI procedure as compared with those before procedure ( 3.22 ±0.48mm vs 3.26 ±0.22 mm , P >0.05 ; 2.96 ±0.98 s vs 2.72 ±0.47 s , P >0.05 ). No significant change was found in the parameters of blood velocity , cross area of vessel lumin, blood resistance and the level of blood oxygen in finger after 1 month of PCI procedure. The average total hospital stay was 5.21 ±0.43 days. Following up 1 month, no complications such as occlusion of ulnar artery, abnormal sensitivity and movement disability were found in right hands in all patients.Conclusions The ulnar artery might be selected as one approach of antebrachial artery for PCI in the patients with coronary heart disease whose radial artery was difficulty as access vessels of PCI, while reversed Allen’s test for radial and ulnar artery are positive and the luminal diameter of ulnar artery was larger than that of radial artery.
文摘Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.
文摘Background: Though drug-eluting stent is widely used during coronary angioplasty, still there are conditions in which bare metal stents possess a priority role. Objectives: The aim of FLEXUS study is to investigate the safety and efficacy of Flexinnium stent in unselected real-life patients. Methods: The FLEXUS is a single-centric, observational, non-randomized, retrospective study performed from January to August 2014 in 216 patients who received Flexinnium stent. The end-point of study included device-oriented and patient-oriented clinical outcomes as per Academic Research Consortium consensus. These end-points were observed at in-hospital stay and 12-month follow-up. Results: Of 216 patients, 174 (80.6%) patients were male;there were 76 (35.2%) and 84 (38.9%) patients of diabetes and hypertension, respectively. Type B2 and C lesions accounted for 27 (11.3%) and 122 (50.8%), respectively. A total of 241 Flexinnium stents were implanted with an average diameter and length of 2.7 ± 0.2 mm and 21.6 ± 8.0 mm, respectively. The cumulative device-oriented composite at 12-month follow-up included 2.31% cardiac death, 1.39% myocardial infarction (MI) attributed to the target vessel, and 3.70% target lesion revascularization (TLR). Conclusion: FLEXUS study gives an idea about favorable safety and efficacy of the Flexinnium in unselected real-life patients with both simple and complex coronary lesions.
基金support of the staff members of the Clinical Research Department of the National Institute of Cardiovascular Diseases(NICVD)Karachi,Pakistan.
文摘BACKGROUND Even though percutaneous coronary intervention(PCI)improved the survival of patients with acute myocardial infarction,still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease(SVD).AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease(MVD).METHODS The retrospective cohort of patients were divided into two groups:SVD and MVD group.The study population consisted of both male and female young(≤45 years)patients presented with ST-elevation myocardial infarction(STEMI)at the National Institute of Cardiovascular Disease,Karachi,Pakistan and undergone primary PCI from 1 st July 2017 to 31 st March 2018.Pre and postprocedure management of the patients was as per the guidelines and institutional protocols.RESULTS A total of 571 patients with STEMI,≤45 years were stratified into two groups by the number of vessels involved,342(59.9%)with SVD and 229(40.1%)with MVD.The average age of these patients was 39.04±4.86 years.A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group(25.1%vs 38%,P<0.01;11.7%vs 27.5%,P<0.001)respectively.While,smoking was more prevalent among the SVD group as compare to MVD group(36.3%vs 28.4%,P=0.05).The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group(48.8%vs 39.2%,P=0.021).Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98%vs 96.5%of the patients is SVD vs MVD group.CONCLUSION The MVD comprised of around 40%of the young patients presented with STEMI.Also,this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases,therefore,preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.
文摘The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this population.Before PCI and the start of DAPT,it is recommended to assess patient bleeding risk.Based on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding complications.Furthermore,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding risk.The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(<50×10^(9)/L)and elevated portal pressure.Therefore,every effort should be made to maintain thrombocyte count above>50×10^(9)/L and prevent variceal bleeding.There is no solid evidence for DAPT in patients with cirrhosis.However,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with cirrhosis.Based on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage.Finally,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT.When indicated,PCI should be performed over radial artery using contemporary DES.Complementary medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk patients.Novel approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Pericoronary fat stranding (PCFS) is a novel noninvasive imaging sign of coronary inflammation, and has important implications for cardiovascular risk stratification, and the outcome of percutaneous coronary intervention (PCI) for coronary heart disease patients with pericoronary fat stranding remains unknown. </span><b><span style="font-family:Verdana;">Aim: </span></b><span style="font-family:Verdana;">We report two rare cases of PCI-treated coronary heart disease patients with severe PCFS. </span><b><span style="font-family:Verdana;">Case Presentation: </span></b><span style="font-family:Verdana;">This is the first report of two rare cases of PCI for patients with coronary heart disease surrounded by severe PCFS. We demonstrated that the outcome in these cases is poor, and in-stent restenosis or occlusion occurs rapidly within 2</span></span><span style="font-family:;" "=""></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">6 months following PCI. However, Case 2 underwent coronary artery bypass grafting after the rapid occurrence of in-stent occlusion, and the bypass graft remained intact over the 5 years following coronary artery bypass grafting. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Coronary artery bypass grafting rather than PCI may be appropriate for coronary heart disease patients with severe PCFS.</span></span>
文摘Chronic total occlusion of an anomalous right coronary artery arising from left coronary sinus is uncommon. We are describing a case of a 71 years old patient presented with severe chest pain along with exertional dyspnea with an inferior wall myocardial infarction. Coronary angiography showed anomalous right coronary artery originating from left coronary sinus having chronic total occlusion in proximal portion and normal left anterior descending artery and left circumflex artery. We were successful in implanting the two stents at an occlusive region with good angiographic results.
基金2020 Gansu Planning Projects on Science and Technology,No.20JR10RA352.
文摘BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.
文摘Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.
基金National Natural Science Foundation of China No. 81770365National Key Research and Development Program of China No. 2016YFC1301301Beijing United Heart Foundation No. BJUHFCSOARF201901-19。
文摘Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.
文摘Background There is a paucity of information available for clinical decision making applying to the elderly patient population. Therefore, data of percutaneous coronary interventions (PCI) including demographic information on the elderly patients, procedural practices, and outcomes are needed. Objectives and Methods From consecutive PCIs of participating institutions, demographics data, clinical, angiographic success and adverse clinical outcomes were collected. Standard statistical methods were used to compare crude differences in patient and procedural characteristics across age groups. Results At baseline, the prevalence of comorbid conditions ( renal failure and heart failure) increased with age. Unstable angina or a non-ST elevation MI were the most common indications for PCI across all age groups. Fewer patients ≥ 80 years old were undergoing primary PCI and older patients were somewhat less likely to receive a Ⅱb/Ⅲa receptor blocker. Slightly more patients ≥ 80 years old underwent a 2-vessel PCI ( consistent with them having more multivessel disease) and these patients were more likely to have an intervention on a Type C lesion. Compared to patients < 50 years old, those aged ≥ 70 years old had a significantly increased risk of death, MI, stroke, or vascular complications at the access site. Conclusions This study suggests increasing age is associated with increasing risk for an adverse outcome following PCI. This is in part attributable to case-mix but likely, also related to the changing physiology of aging. Despite the increased risk of the procedure, the clinical success rate for PCI is quite high and makes it a reasonable alternative for the treatment of CAD in the elderly.