Comparison of Clinical Value between Right Distal Radial Artery Access and Right Radial Artery Access in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention

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.

Real-world five-year outcomes of FlexyRap®cobalt-chromium rapamycin-eluting stents with biodegradable polymer in patients with de-novo coronary artery disease

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.

Impact of baseline smoking status on long-term prognosis of patients with coronary artery disease underwent percutaneous coronary intervention:a large single-center data

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).

Lipoprotein(a)variability is associated with mean follow-up Creactive protein in patients with coronary artery disease following percutaneous coronary intervention

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.

Feasibility of percutaneous coronary intervention via transulnar artery approachin selective patients with coronary heart disease

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.

Percutaneous Coronary Interventional Treatment for Coronary Artery Disease and the Role of Antiplaplatelets Therapy: A Review of the Literature

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.

Twelve Months Clinical Outcomes after Percutaneous Coronary Intervention with Bare Metal Stents in Unselected Real-Life Patients with Coronary Artery Disease: Results from FLEXUS Study

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.

Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China： A Retrospective Analysis

在老病人比较在 transradial 干预( TRI )和 transfemoral 干预( TFI )之间的医院费用和临床的结果的目的在我们识别了的 65 years.Methods 上使在 Fuwai 医院里经历了经皮的冠的干预(一种总线标准)的在 65 年变老的 1229 个病人变老，中国北京，在1月1日和2010年12月31日之间。全部的医院费用和在里面医院结果在 TRI 和 TFI 之间被比较。一个反的概率 weighting (IPW ) 模型被介绍控制经历了 TRI 的潜在的 biases.Results 病人更年轻，不太经常女性、更可能为单个容器的损害收到一种总线标准、不太可能为 ostial 损害经历过程。TRI 与一 CNY7495 节省花费被联系(95%CI：CNY4419-10 420 ) 。如此的差别被更低的一种总线标准相关的费用主要驾驶。TRI 病人有停留的更短的长度(1.9 天， 95%CI：1.1-2.7 天) ，更短的 procedural 以后停留(0.7 天， 95%CI：0.3-1.1 天) ，并且更少主要不利心脏的事件(调整机会比率 = 0.47， 95%CI：0.31-0.73 ) 。在在 TRI 和 TFI 之间的一种总线标准以后的流血的发生没有统计意义(P > 0.05 ) 。在在病人的 TRI 的使用在 65 年变老的尖锐心肌的梗塞，急性冠的症候群，和稳定的 angina.Conclusion 的临床上相关的亚群一致的仍然是的如此的差别与显著地减少的医院费用和更多的有利临床的结果被联系。

Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single vs multivessel disease

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.

Safety and efficacy of dual antiplatelet therapy after percutaneous coronary interventions in patients with end-stage liver disease

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.

Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement？

几研究证明了冠的动脉绕过接枝外科(CABG ) 在有糖尿病和多容器疾病的病人比经皮的冠的干预(一种总线标准) 优异。在一种总线标准上的 CABG 的这个优点是否被限制到要求胰岛素的糖尿病患者，是未知的。我们考察包括 8 个队和 4,786 个病人在糖尿病患者把 CABG 与一种总线标准作比较的出版文学。为所有原因死亡有更低的率(相对风险(RR ) ：0.78， 95% 信心间隔(CI ) ：0.62-0.99 ) ，并且为主要不利心脏、脑血管的事件(MACCE， RR：0.59， 95% CI：0.47-0.75 ) 为与一种总线标准相比的 CABG。死亡的合成结果，心肌的梗塞并且司烧在 CABG 和一种总线标准之间是类似的(RR：0.87， 95% CI：0.54-1.42 ) 。森林阴谋的视觉检查证明在大多数分析， RR 的点估计在要求组和非胰岛素要求组的胰岛素之间是类似的。在元回归上，在胰岛素要求和 revascularization 策略的地位之间没有相互作用(P &#x0003e；0.05 为所有) 。FREEDOM 试用的仍然未出版的分析上的介绍数据显示出类似的结果。因此在当前的时代， CABG 比有更低的死亡和 MACCE 率的一种总线标准优异，但是胰岛素要求的状态没从二 revascularization 策略在结果上有效果。

Unfavorable Outcome of Percutaneous Coronary Intervention for Coronary Heart Disease with Rare Severe Pericoronary Fat Stranding

Background: 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. Aim: We report two rare cases of PCI-treated coronary heart disease patients with severe PCFS. Case Presentation: 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- 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. Conclusion: Coronary artery bypass grafting rather than PCI may be appropriate for coronary heart disease patients with severe PCFS.

Percutaneous Coronary Intervention in Chronic Total Occlusion of Anomalous Right Coronary Artery

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.

Relationship between red blood cell distribution width and intermediate-term mortality in elderly patients after percutaneous coronary intervention

关于在红血房间分发宽度(RDW ) 和在有冠的动脉疾病(CAD ) 的老病人的中间术语的预后之间的关系的 BackgroundLarge 规模临床的研究正在缺乏。因此，这研究在经历了选任的经皮的冠的干预(一种总线标准) 的老病人的中间术语的死亡上调查了 RDW 的效果从 1891 病人 &#x02265 的 .MethodsData；65 岁从 2009 年 7 月经历了选任的一种总线标准到 2011 年 9 月被收集。基于外科手术前的中部的 RDW (12.3%) ，病人被划分成二个组。低 RDW 组(RDW &#x0003c； &#x000a0； 12.3%) 有 899 个案例；高 RDW 组(RDW &#x02265； &#x000a0； 12.3%) 有 992 个案例。二个组的所有原因死亡率是在高 RDW 组的 compared.ResultsPatients 是更可能的与糖尿病女性、伴随，有的更低的血红素水平。吝啬的后续时期是 527 &#x000a0；天。在后续期间， 61 个病人死了(3.2%) 。高 RDW 组的手术后的死亡比低 RDW&#x000a0 的显著地高；组(4.3% 对 2.0% ， P&#x000a0； =&#x000a0； 0.004 ) 。在调整另外的因素以后， multivariate 考克斯回归分析表明外科手术前的高 RDW 显著地与手术后的所有原因死亡被联系(危险比率：2.301， 95% 信心间隔：1.106-4.785， P&#x000a0； =&#x000a0； 0.026 ).ConclusionsIncreased RDW 是在在选任的一种总线标准以后的老 CAD 病人的增加的中间术语的所有原因死亡的一个独立预言者。

Sodium nitroprusside injection immediately before balloon inflation during percutaneous coronary intervention

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.

Initial Experience on Anatomical Snuff Box Approach for Coronary Angiogram &Percutaneous Coronary Intervention in a Tertiary Care Center Nepal

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.

Congenital coronary artery anomalies silent until geriatric age： non-invasive assessment, angiography tips, and treatment

冠的动脉异例(CAA ) 可以为另外的心脏病或不太经常在正常诊断过程期间作为偶然的调查结果更经常被发现根据心肌的局部缺血的表明。心血管的专业人员可以涉及他们的 angiographic 诊断，功能的评价和最终的 endovascular 治疗。一个完全的 angiographic 定义是强制的以便理解功能的效果并且在 CAA 计划任何干预：计算断层摄影术和磁性的回声成像是有用非侵略的工具检测有连续心脏的结构的异例和它的关系的三维的形态学，而冠的动脉 X 线摄影法为一幅权威的解剖图画仍然是标准答案。可能的功能的意义的一个实际想法为决定怎么管理 CAA 是强制的：非侵略的压力测试和特别地侵略药理学强调有超声监视或没有 intravascular 的测试能正确地估计大多数 CAA 的功能的意义。最后，特别 endovascular 技术和材料的知识具有为获得技术、临床的成功的首要的重要性。CAA 代表一个复杂问题，它很少在不同层次包含心血管的专业人员。关于 CAA 的主要问题的及时实际知识在如此的实体的管理是重要的。

Risk or Beneficial Factors Associated with Unplanned Revascularization Risk Following Percutaneous Coronary Intervention: A Large Single-Center Data

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.

Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly

BackgroundOctogenarians 组成病人为经皮的冠的干预(一种总线标准).MethodsThis 学习评估了的非紧急情况介绍的一个增加的比例在里面医院程序的特征和结果，包括为非紧急情况一种总线标准在 2010 年 1 月和 2012 年 12 月之间介绍给单个大体积的 293 octogenarians 的流血事件第三级的照顾澳大利亚人中心。比较被做， 293 个连续病人，其损害与心肌的梗塞是的 octogenarians.ResultsNon 圣举起被匹配小于等于 60 年变老为在 octogenarians 的非紧急情况一种总线标准的最经常的指示。比作更年轻的队，他们有合作病态和更复杂的冠的疾病的更高的流行，包括更多的类型 C 和钙化的损害。低分子的重量肝磷脂的仙子程序的使用(LMWH；1.0% 对 5.8% ；P < 0.001 ) 并且 glycoprotein IIb/IIIa 禁止者(2.1% 对 9.6% ；P < 0.001 ) 更低，当大腿骨的动脉的存取比在更年轻的病人更通常被使用时(80.9% 对 67.6% ；P < 0.001 ) 。总的来说，向所有流血事件在的更高的发生有一个不重要的趋势老(9.2% 对 5.8% ；P = 0.12 ) 。在存取地点或非存取地点流血和专业或在二个队之间的次要的流血没有重要差别。亚分析没在由 LMWH， glycoprotein IIb/IIIa 禁止者或大腿骨的动脉的存取的使用为率放血上揭示任何重要影响。另外，处于在二 groups.ConclusionsIn 之间的在里面医院死亡，击或尖锐 stent 血栓的率没有重要差别这单个中心研究，我们没包括在经历非紧急情况一种总线标准的 octogenarians 流血的发生在不利在里面医院结果观察重要增加。

Percutaneous coronary interventions in the elderly:a 10-year experience in Northern New England

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.