ObjectivesTo develop and validate a clinical diagnostic model based on optical pumped magnetometer magnetocardiography (OPM-MCG) for the detection of myocardial ischaemia in patients with borderline coronary lesions prior to invasive coronary angiography (ICA).DesignProspective observational cohort study.SettingSingle centre of the China National Clinical Research Centre for Cardiovascular Disease (NCCMRC).ParticipantsAdults with borderline coronary lesions on ICA (n=141).InterventionsUnderwent OPM-MCG before ICA and fractional flow reserve measurement.ResultsFive parameters were included in the final diagnostic model: MAgmax-TT, δDtsum-PN, δAgsum-C, δArsum-N and δArmin-N. 1000 bootstrap replications showed that the area under the receiver operating characteristic curve and 95% CI of the diagnostic model were 0.864 (0.803–0.925), with a sensitivity of 79.4%, specificity of 80.8%, positive predictive value of 79.4% and negative predictive value of 80.8%. Decision curve analysis showed a net benefit from the predictive model when the threshold probability of an ischaemic patient was >12%, suggesting the potential utility of the model in the real world.ConclusionsA nomogram based on five OPM-MCG parameters was developed to assess myocardial ischaemia in patients with borderline coronary lesions and has the potential to reduce the need for unnecessary ICA.Trial registration numberChina Clinical Trial Registry (ChiCTR2300072382).

Background Coronary artery disease and left ventricular outflow tract obstruction may overlap in symptoms in patients with hypertrophic cardiomyopathy. It has not been clear if coronary revascularization relieves exertional symptoms in patients with hypertrophic cardiomyopathy. Methods We reviewed 156 patients with hypertrophic cardiomyopathy who underwent percutaneous coronary intervention at Anzhen Hospital from 2009 to 2019. Improvement in symptoms after the percutaneous coronary intervention was investigated. Results The mean age was 60.8 ± 9.8 years, and 116 (74.4%) were men. The main symptoms of the patients were chest tightness in 115 (73.7%), chest pain in 88 (56.4%), dyspnea in 50 (32.1%), palpitation in 22 (14.1%), and presyncope/syncope in 12 (7.7%). At rest, the systolic anterior motion of the mitral valve was observed in only 36 patients. Among the 156 patients, 64 had single-vessel disease, 46 had two-vessel diseases, and the other 46 had three-vessel diseases. There was no early mortality in the present cohort. After the coronary intervention, there were significant improvements in symptoms including chest tightness (6.4%), chest pain (1.3%), dyspnea (2.6%), and palpitation (8.3%). In 93 patients with follow-up data, the overall survival was 77% at 10 years and the survival free from intervention was 60% at 10 years. Conclusions In patients with hypertrophic cardiomyopathy, coronary artery disease can be an important cause of symptoms and should be screened. Percutaneous coronary intervention is safe and effective for coronary revascularization. Cardiac symptoms can be significantly relieved and long-term outcomes are favorable.

肥厚型心肌病(hypertrophic cardiomyopathy,HCM)是全球最常见的常染色体显性遗传性心脏病,发病率为1/200～500[1-2].约70％的HCM患者合并左心室流出道梗阻(left ventricular outflow tract obstruction,LVOTO)[3].LVOTO不仅与劳力性呼吸困难、乏力、胸痛、活动耐力下降等临床症状的发生、发展有关,而且还会增加HCM患者的心源性猝死(sudden cardiac death,SCD)的风险[3].因此,肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)的治疗一直是相关研究的热点话题,本文总结HOCM的治疗最新进展,包括新兴药物、室间隔减容术(septal reduction therapy,SRT)、射频消融术以及经导管二尖瓣成形术.

Objective:To compare the prognosis of mildly or severely symptomatic patients with obstructive hypertrophic cardiomyopathy (OHCM) who underwent alcohol septal ablation (ASA).Methods:This retrospective study cohort consisted of patients with OHCM who received ASA treatment in Beijing Anzhen Hospital, Capital Medical University from March 2001 to August 2021. These patients were divided into mildly and severely symptomatic groups according to the severity of clinical symptoms. Long-term follow-up was conducted, and the following data were collected: duration of follow-up, postoperatire treatment, New York Heart Association (NYHA) classification, arrhythmia events and pacemaker implantation, echocardiographic parameters, and cause of death. Overall survival and survival free from OHCM-related death were observed, and the improvement of clinical symptoms and resting left ventricular outflow tract gradient (LVOTG) and the incidence of new-onset atrial fibrillation were evaluated. The Kaplan-Meier method and log-rank test were used to determine and compare the cumulative survival rates of the different groups. Cox regression analysis models were used to determine predictors of clinical events.Results:A total of 189 OHCM patients were included in this study, including 68 in the mildly symptomatic group and 121 in the severely symptomatic group. The median follow-up of the study was 6.0 (2.7, 10.6) years. There was no statistical difference in overall survival between the mildly symptomatic group (5-year and 10-year overall survival were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year overall survival were 94.2% and 83.9%, respectively, P=0.405); there was also no statistical difference in survival free from OHCM-related death between the mildly symptomatic group (5-year and 10-year survival free from HCM-related death were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year survival free from HCM-related death were 95.2% and 92.6%, respectively, P=0.846). In the mildly symptomatic group, NYHA classification was improved after ASA ( P<0.001), among which 37 patients (54.4%) were in NYHA class Ⅰ, and the resting left ventricular outflow tract gradient (LVOTG) decreased from 67.6 (42.7, 90.1) mmHg (1 mmHg=0.133 kPa) to 24.4 (11.7, 35.6) mmHg ( P<0.001). In severely symptomatic group, NYHA classification was also improved post ASA ( P<0.001), among which 96 patients (79.3%) improved by at least one NYHA classification, and the resting LVOTG decreased from 69.6 (38.4, 96.1) mmHg to 19.0 (10.6, 39.8) mmHg ( P<0.001). The incidence of new-onset atrial fibrillation was similar between the mildly and severely symptomatic groups (10.2% vs. 13.3%, P=0.565). Cox multivariate regression analysis showed that age was an independent predictor of all-cause mortality in OHCM patients post ASA ( HR=1.068, 95% CI 1.002-1.139, P=0.042). Conclusions:Among patients with OHCM treated with ASA, overall survival and survival free from HCM-related death were similar between mildly symptomatic group and severely symptomatic group. ASA therapy can effectively relieve resting LVOTG and improve clinical symptoms in mildly or severely symptomatic patients with OHCM. Age was an independent predictor of all-cause mortality in OHCM patients post ASA.

目的:探讨左主干病变合并慢性肾脏病(CKD)患者血运重建术的预后.方法:入选北京安贞医院行经皮冠状动脉介入术(PCI)或者冠状动脉旁路移植术(CABG)治疗的无保护左主干病变合并慢性肾脏病患者240例,其中PCI组121例,CABG组119例.研究终点为全因死亡、心肌梗死、卒中、再次血运重建.结果:随访时间中位数6.1(5.1,8.0)年,两组全因死亡发生率(PCI 29.8％vs.CABG 34.5％)、心源性死亡率(PCI 24.0％vs.CABG 21.8％)和心肌梗死发生率(PCI 15.7％vs.CABG 10.9％)两组间差异无统计学意义.PCI组卒中发生率显著低于CABG组(1.7％vs.14.3％,P＜0.05),PCI组再次血运重建发生率显著高于CABG组(24.8％vs.15.1％P=0.002).结论:左主干病变合并CKD血运重建术的预后较差,PCI和CABG全因死亡和心肌梗死发生率相当,PCI组卒中发生率显著低于CABG而再次血运重建高于CABG.

Objective: To observe the therapeutic effects of alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class Ⅱ) with hypertrophic obstructive cardiomyopathy(HOCM). Methods: This retrospective study included 150 mildly symptomatic patients with HOCM hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from March 2001 to December 2017, consisting of medical therapy group (n=102) and ASA group (n=48). Baseline clinical data were collected, patients were followed up to a mean of 6.0 (3.5, 8.1) years. Overall and HCM-related mortality events (including chronic heart failure, atrial fibrillation related stroke, sudden cardiac death) were observed in the two groups. Moreover, the improvement of NYHA function classification and left ventricular outflow tract gradient (LVOTG) were also evaluated. Survival analysis was performed by Kaplan-Meier method. Results: Age of this cohort was (52.9±14.5)years, 92 cases(61.3%) were male. In the follow-up, LVOTG was reduced from (85.8±35.4)mmHg (1 mmHg=0.133 kPa) to (27.7±19.8)mmHg (P<0.001) in the ASA group, and from (66.3±35.0)mmHg to (56.5±27.7)mmHg in medical therapy group(P<0.01). At the last clinical follow-up, there were 32 patients (66.7%) whose LVOTG were<30 mmHg, septal thickness decreased from (20.3±3.8)mm to (16.1±3.4)mm (P<0.001), NYHA classification was also remarkably improved (P<0.001). New-onset atrial fibrillation tended to be lower in the ASA group compared to medical therapy group (9.3%(4/43) vs. 20.8%(20/96),P=0.096). Eleven patients (10.8%) in the medical therapy group and 2 patients (4.2%) in the ASA group died during the follow-up. One patient received pacemaker during the peri-procedural period, 1 patient was implanted with two-chamber pacemaker due to Ⅲ° atrioventricular block at 10 years after operation in the ASA group. Survival free of all-cause mortality of ASA group at 5 and 10 years was 97.9% and 97.9%, respectively, which was comparable to the medical therapy group (P=0.231). Survival free of HCM-related mortality was similar between the two groups (P=0.397). Conclusions: Compared with medical therapy in mildly symptomatic patients with HOCM, long-term survival rate is similar after ASA. Meanwhile, ASA can remarkably reduce LVOTG and improve the clinical status of the patients. Therefore, ASA may be used as an alternative therapy for mildly symptomatic HOCM patients.

BACKGROUND:Danon disease is typically associated with cardiomyopathy and ventricular pre-excitation. The study aimed to characterize the clinical profile of Danon disease, analyze electrocardiographic (ECG) and electrophysiologic features, and investigate their association with Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathways (FVPs). METHODS AND RESULTS:Clinical course, family history, ECG and electrophysiological data were collected from 16 patients with Danon disease. Over 0.4-8 years of follow up, 1 female patient died suddenly, and 5 male patients died of progressive heart failure by age 13-20 years. Family history analysis revealed that 3 mothers experienced hospitalization or death for heart failure at age 28-41 years. There was 100% penetrance for ECG abnormalities in 13 patients with original ECGs. Short PR intervals and delta waves were present in 9 and 8 patients, respectively. There were significant age-associated increases in the QRS complex width (r=0.556, P=0.048) and the number of leads with notched QRS (r=0.575, P=0.04). Four patients who underwent electrophysiological studies all had FVPs, and 2 of them still had left-side atrioventricular pathways. CONCLUSIONS:Danon disease causes a malignant clinical course characterized by early death caused by heart failure in both genders and progressive ECG changes as patients age. The pre-excited ECG pattern is related to FVPs and WPW, which is suggestive of extensive cardiac involvement.

Objective The purpose of this study was mainly to determine the midterm outcome of septal myectomy (SM) and medical therapy (MT) in mildly symptomatic patients (NYHA class II) with hypertrophic obstructive cardiomyopathy (HOCM). Methods The study cohort consisted of 184 mildly symptomatic patients with HOCM evaluated in Beijing Anzhen Hospital, Capital Medical University between March 2001 and December 2017, including 82 patients in the SM group and 102 patients in the MT group. Overall survival and HCM-related survival were mainly observed. Results The average follow-up time was 5.0 years. Compared to patients accepting MT, patients treated with SM were associated with comparable overall survival (96.5% and 93.1% vs. 92.9% and 83.0% at 5 and 10 years, respectively; P = 0.197) and HCM-related survival (98.7% and 98.7% vs. 94.2% and 86.1% at 5 and 10 years, respectively; P = 0.063). However, compared to MT, SM was superior at improvement of NYHA class (1.3 ± 0.6 vs. 2.1 ± 0.5, P < 0.001) and mean reduction of resting left ventricular outflow (LVOT) gradient (78.5 ± 18.6% vs. 28.3 ± 18.4%, P < 0.001). Multivariate analysis suggested that resting LVOT gradient in the last clinical examination was an independent predictor of all-cause mortality (HR = 1.017, 95%CI: 1.000–1.034, P = 0.045) and HCM-related mortality (HR = 1.024, 95%CI: 1.005–1.043, P = 0.012) in the entire cohort. Conclusion Compared with MT, SM had comparable overall survival and HCM-related survival in mildly symptomatic HOCM patients, but SM had advantages on improving clinical symptoms and reducing resting LVOT gradient. Resting LVOT gradient in the last clinical examination was an independent predictor of all-cause mortality and HCM-related mortality.

Objective: To evaluate the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/shaft lesions in patients with unprotected left main coronary artery (ULMCA). Method: A total of 271 patients with isolated ostial/midshaft lesions in unprotected left main coronary artery who received drug-eluting stents (DES) implantation between January 2003 and July 2009 in Beijing An Zhen Hospital were consecutively enrolled . The endpoints of the study were all-cause death, repeat revascularization, myocardial infarction (MI) and stroke. Cox regression was carried out to analyze the all-cause mortality. Meanwhile, multivariate logistic regression analysis was performed to determine the independent risk factors of all-cause death. Results: The mean age of the patients was (62±10) years, and 201 of them (74.2%) were male. The median follow-up was 12.5 years (interquartile range: 10.1-14.5 years). During the follow-up, 46 patients (17.0%) died, of whom 20 (7.4%) died of a cardiovascular cause. A total of 38 (14.0%) cases suffered a MI, and 15 (5.5%) cases suffered a stroke. Repeat revascularization was performed in 63 (23.2%) cases. Multivariate logistic regression analysis showed that age (HR=1.041, 95%CI: 1.003-1.081, P=0.033), creatinine (HR=1.028, 95%CI:1.014-1.042, P<0.001) and diabetes mellitus (HR=1.924,95%CI: 1.053-3.514, P=0.033) were independent risk factors of all-cause death, whereas left ventricular ejection fraction (LVEF) (HR=0.972, 95%CI:0.953-0.992, P=0.007) was a protective factor. Conclusions: During a median follow-up of 12.5 years, the prognosis of PCI for left main ostium/shaft lesion was good. Age, creatinine and diabetes mellitus are independent risk factors of all-cause death.

Treatment of unprotected left main coronary artery (ULMCA) disease with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) has developed rapidly during the past decades. The optimal revascularization strategy has been a subject of debate, with several randomized controlled trials and meta-analyses comparing outcomes of CABG and PCI.[1] However, patients with prior cerebrovascular events (CVEs) were often excluded from coronary revascularization trials. There is a strong association between coronary artery disease (CAD) and prior CVEs.[2] Approximately one in eight patients with CAD has a history of CVEs, and that particular patient is at higher risk of worse outcomes after coronary revascularization than patients with CAD alone.[3] The reason for the co-occurrence of CAD and CVEs might be that atherosclerosis is a diffuse process that may affect different vascular beds including coronary artery and cerebral artery. To date, there are no guidelines providing advice on the optimum modality of revascularization for patients with prior CVEs. It gradually became clear that CABG is the standard care for patients with complex lesions, and PCI with drug-eluting stents (DES) is an acceptable option for patients with less complicated diseases. Thus, CABG seems like a better choice for patients with prior CVEs. But it is also pointed out by trials that more strokes occurred after CABG than PCI.[4] Currently, no study has assessed the impact of prior CVEs and compared outcomes in real-world patients with ULMCA disease and CVEs treated with PCI vs. CABG. We conducted a real-world, single-center, retrospective study of patients with ULMCA disease including prior CVEs to facilitate this comparison. All of the consecutive patients who underwent PCI or CABG were retrospectively analyzed if they were aged >18 years and diagnosed with ULMCA disease (left main artery stenosis ≥50%) in the Department of Cardiology and Department of Cardiac Surgery at Beijing Anzhen Hospital between January 2005 and March 2010. Either DES placement or CABG was performed at the discretion of the cardiologist and patients. Coronary angioplasty and stent implantation were carried out in accordance with the operator's criteria following the center's usual practice. CABG was performed with standard bypass techniques. The internal thoracic artery was preferentially used for revascularization of the left anterior descending artery. The therapeutic effects of the procedures on patients were determined by telephone or timely outpatient follow-up. The study was approved by the Human Research Committee of Capital Medical University (No. 2019055X). Informed consent was obtained from all individual participants included in the study. The main purpose of this study was to evaluate the risk of adverse consequences in ULMCA disease patients with previous CVEs undergoing revascularization and to determine whether patients with prior CVEs are more likely to benefit from PCI or CABG. CVEs were defined as prior stroke, transient ischemic attack (TIA), or carotid artery disease. The research team assessed and collected the presence of these events in each patient. The end-point during the follow-up was major adverse cardiac and cerebral events (MACCE), defined as the synthesis of all-cause death, myocardial infarction (MI), stroke, and target vessel revascularization (TVR). We defined TVR as any surgical or interventional revascularization performed on previously treated vessels. Categorical variables were presented as absolute values and frequencies. Continuous variables were tested for normality using the Kolmogorov-Smirnov test and were presented as mean standard deviation or median (interquartile range). Differences between groups were tested using χ2 test or the Fisher exact test for discrete variables and Student's t test or Wilcoxon rank-sum test for continuous variables, as appropriate. The Kaplan-Meier and log-rank methods were performed to compare event rates. Univariable and multivariable Cox proportional hazard models were constructed to compare risks for the outcomes between groups. Variables with P ≤ 0.1000 and clinically relevant covariates irrespective of their statistical relevance (such as sex and age) in univariable analyses were candidates for inclusion in the multivariable Cox proportional hazard models. The relationship between prior CVEs and PCI vs. CABG on prognosis was further explored through interaction analysis. All statistical analyses were performed using SPSS version 17.0 for Windows (SPSS Institute Inc., Chicago, IL, USA). A two-sided P < 0.0500 was considered statistically significant. All of the 2043 ULMCA disease patients enrolled had data regarding prior CVEs status recorded in the electronic system, 274 (13.4%) of whom had prior CVEs. The baseline characteristics, angiographic, and procedural findings of the entire study population are shown in Supplementary Table 1, https://links.lww.com/CM9/A673. Overall, patients with prior CVEs were older with a significantly higher incidence of hyperlipidemia, hypertension, and peripheral vascular disease. Additionally, patients with prior CVEs were more likely to have chronic total occlusion (CTO) and were less likely to achieve complete revascularization than those without CVEs. There were no significant differences in the distributions of sex, smoking history, previous revascularization, left ventricular ejection fraction, creatinine, family history of CAD, multivessel disease (MVD), modality of revascularization, old myocardial infarction, and other relevant diseases between patients with and without prior CVEs. Among 274 patients with prior CVEs, 130 and 144 underwent PCI and CABG, respectively. Among 1769 patients who did not have prior CVEs, 918 and 851 underwent PCI and CABG, respectively. The median follow-up period was 21.53 (interquartile range 14.00–28.33) months. The incidence of endpoints for patients with or without prior CVEs are shown in Supplementary Table 2, https://links.lww.com/CM9/A673. Overall, patients with vs. those without prior CVEs experienced significantly higher rates of MACCE (32.3% vs. 23.6%; hazard ratio [HR]: 1.96; 95% confidence interval [CI]: 1.37–2.81; P < 0.0001) driven by increased rates of MI (8.4% vs. 7.3%; HR: 3.02; 95% CI: 1.51–6.04; P < 0.0001), with no significant differences in all-cause death (both cardiovascular and non-cardiovascular) or TVR. The incidence of stroke in patients with CVEs was higher than those without CVEs, but the difference was not significant (3.7% vs. 3.0%; HR: 2.15; 95% CI: 0.78–5.94; P = 0.0550). After adjusting for age, history of hyperlipidemia, hypertension, peripheral vascular disease, and other relevant influential factors, the Cox regression analysis showed a higher MACCE incidence (adjusted HR: 2.11; 95% CI: 1.54–2.89; P < 0.0001), a higher MI incidence (adjusted HR: 2.24; 95% CI: 1.28–3.91; P = 0.0050), and a higher stroke incidence (adjusted HR: 3.64; 95% CI: 1.24–10.74; P = 0.0190) in the patients with vs. without prior CVEs. There were still no differences in the incidence of all-cause death or TVR between patients with and without prior CVEs. The baseline characteristics, angiographic, and procedural findings of patients with prior CVEs are shown in Supplementary Table 3, https://links.lww.com/CM9/A673. There were no significant differences between patients who undergone PCI and CABG. The incidences of endpoint for patients with or without prior CVEs stratified by different revascularization modalities are shown in Supplementary Table 4, https://links.lww.com/CM9/A673. The mortality was higher after PCI in patients with prior CVEs but lower after PCI compared with CABG in patients without prior CVEs (Pinteraction: 0.7500). In patients with prior CVEs, MI occurred in 12.7% (16/130) of patients after PCI and in 4.4% (6/144) of patients after CABG (HR: 3.03; 95% CI: 1.19–7.75), whereas in those without CVEs, the MI rates were 13.7% (30/918) and 2.4% (18/851), respectively (HR: 1.62; 95% CI: 0.90–2.90) (Pinteraction: 0.6200). A significant interaction was present such that the rate of stroke was lower after PCI compared with CABG in patients with and without prior CVEs (Pinteraction: 0.0200) but the rate of TVR was higher after PCI compared with CABG in patients with and without prior CVEs (Pinteraction: <0.0001). As a result, the composite rate of death, MI, stroke, and TVR favored CABG in patients with and without prior CVEs (Pinteraction: 0.5400). Kaplan-Meier survival curves are shown in Supplementary Figure 1. https://links.lww.com/CM9/A750. The current retrospective observational cohort study evaluated and compared outcomes after revascularization with PCI vs. CABG in real-world patients with ULMCA disease and known CVEs. The key research findings are as follows: (1) compared with patients without prior CVEs, those with CVEs were more likely to have comorbidities; (2) the rate of composite endpoint, MACCE, was remarkably increased in patients with vs. without prior CVEs, driven by increased rates of MI after both PCI and CABG; (3) the rates of all-cause death, MI, and TVR favored CABG but the stroke rate favored PCI in patients with and without prior CVEs; and (4) the composite rate of death, MI, stroke, and TVR favored CABG in patients with and without prior CVEs. ULMCA disease patients with prior CVEs were older with a higher incidence of hyperlipidemia, hypertension, peripheral vascular disease, and CTO compared with those without CVEs. These statuses are linked to similar predisposing risk factors and genetic predisposition. The reason might be that atherosclerosis is a diffuse process that may affect different vascular beds with considerable overlaps between coronary, cerebrovascular, and peripheral arterial disease.[5] Moreover, atrial fibrillation caused by aging and systemic vascular risk factors can also result in embolic stroke.[6] Clinical variables including patient's age, comorbidities, as well as coronary anatomy were considered in the decision-making whether to conduct a complete or incomplete revascularization strategy.[7] Patients with CVEs often present with MVD and comorbidities, thus they were less likely to undergo complete revascularization in PCI. The incidents of all-cause death, MI, and TVR favored CABG but stroke favored PCI. The interaction between CVEs and revascularization modality for stroke and TVR was significant, leading to a higher rate of MACCE in PCI patients. Information about whether patients with prior CVEs more suitable for PCI or CABG remains limited. Consistent with prior studies, CABG is associated with a higher risk of perioperative stroke than PCI. Although the incidence of perioperative stroke gradually decreases over time, the rate remains 2.1% to 5.2%, and the mortality remains 0% to 38%.[8] Since stroke is one of the most fatal and devastating complications of CABG surgery, the etiology of stroke after CABG surgery is complex and multifactorial. Early strokes often arise from particulate and gaseous embolism during surgery. The reason for delayed strokes is likely the prothrombotic postoperative state causing by continuous cellular inflammatory responses and platelet activation. However, patients with the previous stroke also showed higher risks for all-cause death and stroke after PCI than those without stroke.[9] Given all these data, our findings support the view that previous CVEs should not be the reason to favor PCI instead of CABG. Therefore, the heart team should consider all factors that may affect the prognosis in an all-round way, and then choose the revascularization modality. Although this is the first real-world analysis of its kind to date, it does have the limitations of retrospective design and non-randomized nature leading to selection bias and ascertaining bias. Because it is a single-center study, a modest number of patients (274) had prior CVEs, and subsequent analysis is inherently underpowered. Owing to insufficient data to calculate the score, our registry did not capture data on the SYNTAX score of patients, a factor that affects outcomes, and therefore, did not appear in the regression analyses. Larger trials are necessary to determine whether PCI is beneficial to patients with previous CVEs. Conflicts of interest None.

OBJECTIVE:The aim of this study was primarily to determine efficacy after alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class II) with hypertrophic obstructive cardiomyopathy (HOCM), as compared to medical therapy.METHODS:This retrospective study included 163 mildly symptomatic patients with HOCM evaluated in Beijing Anzhen Hospital between March 2001 and August 2019, consisting of the medical group (n = 105) and the ASA group (n = 58). All-cause mortality and HCM-related death were mainly observed.RESULTS:Follow-up was completed in 161 patients and the median follow-up was 6.0 years. Compared to medically treated patients, patients post-ASA had comparable survival free of all-cause mortality (98.3% and 95.1% vs. 93.0% and 83.1% at 5 and 10 years, respectively; p = 0.374). Survival free of HCM-related death was also similar between ASA and medical groups (98.3% and 95.1% vs. 94.3% and 86.2% at 5 and 10 years, respectively; p = 0.608). However, compared to medical therapy, ASA had advantages on the improvement of NYHA class (1.4 ± 0.6 vs. 2.1 ± 0.5, p = .000) and lower occurrence of new-onset atrial fibrillation (AF) (7.8% vs. 20.4%, p = .048). Multivariate analysis demonstrated that resting LVOT gradient at the last clinical check-up was an independent predictor of all-cause mortality (HR = 1.021, 95%CI 1.002-1.040, p = .027).CONCLUSION:This registry suggests that mildly symptomatic patients with HOCM treated with ASA have comparable survival to that of medically treated patients, with the improvement of NYHA class and lower occurrence of new-onset AF. All-cause mortality is independently associated with resting LVOT gradient at the last clinical check-up.

Objective:To analyze the clinical characteristics and long-term prognosis of implantation of drug-eluting stents (DES) for elderly patients with unprotected left main artery (ULM) disease.Methods:A total of 414 patients (327 males and 87 females) who underwent DES implantation were enrolled in the Department of Cardiology, Beijing Anzhen Hospital from January 2005 to March 2010, with a mean age of (61.5±10.7) years old. The patients were divided into two groups according to age: 300 cases in the group of age <70 years old, and 114 cases in the group of age ≥70 years old. The clinical characteristics and long-term prognosis of two groups were compared.Results:In the group of age ≥ 70 years old, the proportion of female was higher (31.6% vs 17.0%, P=0.001) and the incidence of chronic total occlusion (CTO) ( P=0.020), hypertension ( P=0.018) and cerebrovascular disease ( P=0.013) were higher than those in the group of <70 years old. All-cause mortality and cardiac mortality were also higher than those in the group of <70 years old ( P=0.025, P=0.013). The follow-up period was (21.4±9.6) months. After adjusting for multiple clinical factors, there were no statistical differences of incidence of the total major adverse cardiac and cerebral events (MACCE), myocardial infarction, cerebrovascular events, and revascularization recurrence between the two groups. But all-cause mortality ( HR=3.790, 95 %CI: 1.271-11.298, P=0.017) and cardiac mortality ( HR=17.424, 95 %CI: 2.440-124.410, P=0.004) in the group of age ≥70 years old were still remarkably higher than those in the group of <70 years old. Conclusions:Age is an independent risk factor for increased mortality after DES stent implantation in ULM disease. DES stent implantation in age ≥70 years old patients with ULM disease is considered feasible, but it needs to be treated with caution.

Objective To evaluate a very long-term clinical outcomes of patients treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/shaft lesions in unprotected left main coronary artery (ULMCA).Methods & Results A total of 472 patients with isolated ostial/shaft lesions in ULMCA were enrolled,who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital.The major endpoints of this study were death,repeat revascularization,non-procedural myocardial infarction (MI) and stroke.The median follow-up was twelve years (interquartile range:9.4-14.0 years) in the overall patients.There were no significant differences of incidence of death (23.3％ vs.25.6％,P =0.227),repeat revascularization (27.3％ vs.28.4％,P =0.423),non-procedural MI (20.0％ vs.14.5％,P =0.561),and stroke (6.1％ vs.9.3％,P =0.255)between PCI and CABG groups before multivariate adjusting.After adjusting covariates with multivariate Cox hazard regression model,there were still no significant differences between PCI and CABG groups.Conclusions During the median follow-up of twelve years,we found that PCI with DES was as effective and safe as CABG in patients with left main ostial/shaft lesion in this observational study.

目的:在二代支架时代,糖尿病对不同血运重建策略治疗无保护左主干冠状动脉疾病患者的影响尚未可知.方法:回顾性入选823例无保护左主干冠状动脉疾病的患者,其中接受二代药物洗脱支架(DES)置入治疗的患者331例(糖尿病患者,n=99;非糖尿病患者,n=232),接受冠状动脉旁路移植术(CABG)患者492例(糖尿病患者,n=127;非糖尿病患者,n=365).我们根据不同的血运重建策略比较了糖尿病对临床结果的影响.结果:在接受血运重建的无保护左主干病变患者中,糖尿病患者占27.5％(226/823).经过平均25.3个月的随访后发现,在接受DES治疗的人群中,糖尿病患者与非糖尿病患者的全因死亡率、心源性死亡率、血运重建发生率、卒中和主要不良心脑血管事件的发生率没有显著差异.然而,在全因死亡/心肌梗死/卒中联合终点(糖尿病组21.5％vs.非糖尿病7.2％,P=0.001)及心肌梗死发生率(糖尿病组15.4％vs.非糖尿病组1.6％,P＜0.001)中,糖尿病患者明显高于非糖尿病患者.在接受CABG治疗的群体中,糖尿病组和非糖尿病组所有临床终点发生率相似.结论:在二代药物洗脱支架治疗无保护左主干病变的患者中,合并糖尿病的患者较非糖尿病组预后较差,在接受CABG的患者中,糖尿病和非糖尿病组预后相似.

目的:探讨药物洗脱支架(DES)置入术和冠状动脉旁路移植术(CABG)治疗无保护左主干病变(ULM)患者伴左心室收缩功能不全(LVSD)的临床疗效.方法 :回顾性分析冠状动脉左主干病变合并LVSD患者的临床参数和预后.共纳入326例合并LVSD的ULMCA患者,并按LVEF分层.139例40％(重度LVSD)(DES,n= 104;CABG,n = 35),187例40％

Objective: To evaluate long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention(PCI) with drug-eluting stents(DES) for ostial/shaft lesions in unprotected left main coronary artery(ULMCA). Method: A total of 259 patients with isolated ostial/midshaft lesions in unprotected left main coronary artery were enrolled consecutively who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital. The endpoints of the study were death, repeat revascularization, myocardial infarction (MI) and stroke. Time to the primary endpoint was evaluated according to the Kaplan-Meier method, and the log-rank test was applied to compare the incidence of the endpoint. Adjusted risks for adverse outcomes were compared by multivariate Cox proportional hazard regression analyses. Results: A total of 259 patients were included, including 149 in PCI group and 110 in CABG group. And 193(74.5%) cases were males.The age was (61.4±9.8) years old. The median follow-up was 10.1 years (interquartile range 8.3 to 11.2 years) in the overall patients. There were no significant difference for the incidence of death [37.0% vs. 43.1% ，P=0.143] , MI [34.0% vs. 19.4% ，P=0.866], stroke [6.4% vs. 11.7% ， P=0.732], repeart revascularization [33.6% vs. 39.9% ，P=0.522] between PCI group and CABG group before multivariate adjusting，according to the incidence calculated with Kaplan-Meier. After adjusting covariates such as age, left ventricular ejection fraction（LVEF） and serum creatine with multivariate Cox hazard regression model, there was still no significant difference between the two groups. Conclusions: PCI with DES is as effective and safe as CABG in patients with left main ostium/shaft lesion during a median follow-up of 10.1 years.

OBJECTIVE To analyze the long-term prognosis of undergoing drug-eluting stent implantation (DES) or coronary artery bypass grafting (CABG) in patients with unprotected left main (ULM) coronary artery disease complicated with chronic renal failure (CRF). METHODS Patients with UML coronary artery disease complicated with CRF admitted to the department of cardiology intensive care unit (ICU) and cardiac surgery ICU of Beijing Anzhen Hospital Affiliated to Capital Medical University were enrolled. According to the estimated glomerular filtration rate (eGFR), the patients were divided into two layers, and the clinical characteristics of DES patients and CABG patients were analyzed. Log-Rank method and Cox regression were used to analyze the coronary artery disease and long-term clinical prognosis of patients with two surgical strategies. RESULTS A total of 353 patients were enrolled, including 150 patients with eGFR < 45 mL×min-1×1.73 m-2 (DES 67 cases, CABG 83 cases), eGFR 45-59 mL×min-1×1.73 m-2 in 203 cases (DES 80 cases, CABG 123 cases). In terms of demography and clinical history, compared with CABG group, DES group had lower proportion of complete revascularization and lower proportion of chronic totalocclusion (CTO) and multi vessel disease in each eGFR level. All patients were followed up for an average of (30.74±15.05) months. Log-Rank analysis showed that there was no significant difference in the incidence of major cardiovascular and cerebrovascular adverse events (MACCE), all-cause death, cardiogenic death and stroke between DES group and CABG group in each eGFR level. In eGFR 45-59 mL×min-1×1.73 m-2, the proportion of target vessel revascularization (TVR) in DES group was higher than that in CABG group (18.8% vs. 0.8%, P < 0.01); in eGFR < 45 mL×min-1×1.73 m-2, the incidence of myocardial infarction in DES group was higher than that in CABG group (10.4% vs. 1.2%, P < 0.05). Cox analysis showed that after adjusting for age, gender, history of hypertension, diabetes, left ventricular ejection fraction, smoking history, previous cerebrovascular disease, complete revascularization, multiple vessel disease and CTO, TVR proportion in DES group was still higher than that in CABG group in eGFR 45-59 mL×min-1×1.73 m-2 [hazard ratio (HR) = 46.463, 95% confidence interval (95%CI) was 4.558-473.693, P = 0.001]; in eGFR < 45 mL×min-1×1.73 m-2, the incidence of myocardial infarction in DES group was still higher than that in CABG group (HR = 14.098, 95%CI was 1.123-176.988, P = 0.040), there was no difference in TVR proportion between the two methods. CONCLUSIONS eGFR < 45 mL×min-1×1.73 m-2 is an independent risk factor for DES in ULM patients. DES is safe and effective for ULM patients with CRF, but for patients with more severe CRF (eGFR < 45 mL×min-1×1.73 m-2), there was more myocardial infarction in DES group than that in CABG group, which should be carefully selected.

目的:本研究旨在对比经皮冠状动脉介入术(PCI)和冠状动脉旁路移植术(CABG)治疗高龄(≥65岁)无保护左主干病变(ULMCA)的长期预后.方法:入选2003年1月至2009年7月,北京安贞医院行PCI或CABG治疗的高龄(≥65岁)ULMCA患者427例(210例行PCI置入药物洗脱支架,217例行CABG),研究终点包括全因死亡、心肌梗死、再次血运重建、卒中、心源性死亡/心肌梗死/卒中联合硬终点以及主要不良心脑血管事件(MACCE,包括心原性死亡、非致命性心肌梗死、卒中及再次血运重建的联合终点).Cox比例风险模型用以计算风险比(HR)及95％可信区间(CI),及多因素分析.结果:随访时间7.0(5.2,8.1)年,校正前结果显示,心源性死亡/心肌梗死/卒中联合硬终点发生率CABG组显著高于PCI组(HR=1.544,95％CI:1.003～2.375,P=0.048).卒中发生率CABG组显著高于PCI组(HR=3.089,95％CI:1.332～7.162,P=0.009).再次血运重建发生率PCI组显著高于CABG组(HR=0.278,95％CI:0.159～0.486,P＜0.001).全因死亡率两组间差异无统计学意义(HR=1.545,95％CI:0.951～2.510,P=0.079).非致命性心肌梗死发生率两组间差异无统计学意义(HR=0.619,95％CI:0.314～1.222,P=0.167).MACCE发生率两组间差异无统计学意义(HR=0.770,95％CI:0.550～1.079;P=0.129).经Cox多因素分析校正后,CABG组心源性死亡/心肌梗死/卒中联合硬终点发生率仍显著高于PCI组(P=0.048),CABG组卒中发生率显著高于PCI组(P=0.011),PCI组MACCE发生率显著高于CABG组(P=0.027),主要由于PCI组较CABG组显著升高的再次血运重建率(P＜0.001),死亡、心肌梗死经校正后两组间差异无统计学意义.结论:CABG较PCI治疗高龄ULMCA患者的卒中发生率及心源性死亡、卒中、心肌梗死联合终点发生率显著升高,PCI组再次血运重建率显著升高.

Objective Septal reduction therapies were recommended for drug-refractory patients with hypertrophic ob-structive cardiomyopathy(HOCM).To explore and compare the effectiveness and safety in patients with hypertrophic obstruc-tive cardiomyopathy(HOCM) treated with surgery myectomy(SM) and alcohol septal ablation(SA).Methods The clinical data of 260 patients performed SA(n=184) or SM(n=76)between September 2002 and September 2014 in our institute were retrospectively reviewed.The t-test, rank sum test and chi-square test were used to compare the differences between the two groups, and the Cox regression model was used for multivariate survival analysis.All-cause mortality, cardiac cause death(peri-operative death were included ) , heart function improvement , procedure-related complications and permanent pacemaker de-pendence( PPM) constituted the main contents of this study .Results Compared with patients treated with SM , patients un-dergone SA were poor heart function status(2.97 ±0.29 vs 2.50 ±0.56, P =0.01), more prevalence of atrial fibrillation( 15.14％ vs 6.80％, P=0.046) and longer follow-up period[(5.4 ±3.8) years vs(2.5 ±2.2) years, P =0.01)].All-cause mortality for SA and SM were 3.3％ and 14.5％ respectively(P=0.001).The fatal cardiac events of SA and SM were 1.63％ and 13.16％ respectively(P<0.001).Sudden cardiac arrest were the main cardiac cause death for both patients trea-ted with SA and SM.The cardiac death of left ventricular systolic dysfunction was main found in patients treated with SM . Heart function improvement(NYHA) after SA and SM were 1.23 ±0.61 and 0.88 ±0.64 respectively(all P <0.01).And SA had a lower procedure-related PPM implantation(1.63％ vs 4.20％, P<0.05).Conclusion Our results shown that SA have survival advantage, lower PPM and similar heart function improvement compared with SM for refractory patients with HOCM.

Objective To analyze the correlation between calcification factors and fractional flow reserve derived from CT (CT?FFR). And to evaluate the diagnostic efficacy of CT?FFR in coronary artery lesions with calcification compared with that of invasive FFR. Methods Sixty?five patients (74 coronary artery vessels) who were admitted to Beijing Anzhen Hospital from July 2014 to December 2016 were included in this study retrospectively. All patients had completed CCTA (coronary CT angiography), coronary angiography and invasive FFR measurements, and had coronary lesions contain calcifications. The evaluation of CCTA data included quantitative analyses of plaque components, coronary artery stenosis, and CT?FFR measurements. The patients′basic data were grouped and compared according to the FFR values. The measurement data was tested by independent?samples t tests, and the categorical data were analyzed by χ2 tests. Quantitative measurements of plaques were compared between groups using independent?sample t tests or rank sum tests based on FFR and CT?FFR values. The reproducibility of CT?FFR measurement software was evaluated by inter?class correlation coefficient (ICC) and the Youden index was calculated to determine the threshold for CT?FFR diagnosis of ischemia. Pearson or Spearman correlation analyses were used to assess the correlations between CT plaque quantitative indicators, CT?FFR and invasive FFR. Multivariate logistic regression analysis was used to analyze the predictors of ischemia by FFR and CT?FFR. In contrast to invasive FFR results, the sensitivity, specificity, negative predictive value, positive predictive value (PPV) of CT?FFR in the diagnosis of coronary ischemic lesions were evaluated, and the diagnostic consistency was evaluated by the Bland?Altman method. Results Compared with invasive FFR, CT?FFR had a more significant correlation with calcification volume and ratio of calcification in plaques (r=-0.519 and－0.547, respectively, both P=0.001). Multivariate logistic regression analysis showed that plaque length was a predictor of invasive FFR in the diagnosis of pathological ischemia ( OR=1.13, 95%CI : 1.05—1.23, P=0.002), and was associated with CT?FFR to determine pathological ischemia. In addition to plaque length ( OR=1.10, 95%CI : 1.02—1.18, P=0.010), the predictor also included ratio of calcification in plaque ( OR=1.09, 95%CI: 1.03—1.15, P=0.003). Compared with invasive FFR results, the diagnostic sensitivity of CT?FFR was 79.1%, the specificity was 80.6%, the PPV was 85.0%, and the area under the ROC curve was 0.78. The result for the diagnosis of ischemia lesion by using CT?FFR had significant statistical differences with the results by according coronary artery stenosis (χ2=10.05, P=0.002; χ2=34.71, P=0.001; χ2=7.65, P=0.006; Z=2.10, P=0.029). The Bland?Altman analysis showed a mean difference of －0.01 (-0.26—0.25) between the CT?FFR and the invasive FFR. Conclusions There is no significant correlation between the proportion of calcification components of coronary plaque and the presence or absence of myocardial ischemia, but the proportion of calcification in plaque will affect the result that is evaluated by CT?FFR. However, compared with CT?based stenosis evaluation, CT?FFR can still significantly improve the ability of CCTA to diagnose ischemia lesion with calcification.