Background The management of complex coronary artery disease (CAD) predominantly relies on percutaneous coronary intervention (PCI), yet in-stent restenosis (ISR) remains a critical long-term complication. Emerging evidence implicates immune dysregulation in ISR pathogenesis. Case presentation We present a 74-year-old female with multivessel CAD, recurrent ISR, and comorbidities including hypertension, type 2 diabetes, and hyperlipidemia. Laboratory studies revealed hypogammaglobulinemia M (IgM: 0.306 g/L), an elevated CD4/CD8 ratio (3.24), and elevated hypogammaglobulinemia G3 (IgG3: 0.963 g/L). Intravascular imaging and PET/CT demonstrated neoatherosclerosis with peristrut inflammation. Despite multiple PCIs and guideline-directed medical therapy (GDMT), she experienced recurrent angina. Following adjunctive anti-inflammatory therapy with prednisone and immunomodulation with mycophenolate mofetil, she achieved symptomatic and angiographic stabilization. Conclusion This case suggests a potential association between immune dysregulation and recurrent ISR. Anti-inflammatory and immunomodulatory therapy may represent a novel adjunctive strategy in selected refractory cases, though causality remains speculative and requires further validation.

Early identification and management of asymptomatic carotid plaques can reduce the risk of cardiovascular and cerebrovascular events. This study aimed to explore the factors that affect carotid plaques in the Northern Chinese population and construct a nomogram for risk assessment to identify high-risk populations for carotid artery plaques. A cross-sectional study on cardiovascular factors was conducted in Shijingshan District, Beijing, from January 2022 and August to September 2023, targeting individuals aged 18 years and above. Carotid plaques were assessed via carotid ultrasound. LASSO regression was used for feature selection, logistic regression was employed to analyze risk factors, and a risk assessment nomogram was also developed.. The performance was evaluated using the area under the receiver operating characteristic curve (AUC), and the calibration was assessed through the Hosmer‒Lemeshow goodness-of-fit test. The study included a total of 828 subjects, with 558 in the normal group and 270 in the carotid plaque group. Thirty-three risk factors were included in the LASSO regression analysis as independent variables for screening. The results of the adjusted multiple logistic regression analysis show that age (OR = 6.81, 95% CI:4.371-10.758), unmarried marital status (OR = 3.475, 95% CI: 1.927-6.554), current smoking (OR = 2.318, 95% CI: 1.519-3.553), hypertension history (OR = 1.794, 95% CI: 1.123-2.860), dyslipidemia history (OR = 1.920, 95% CI: 1.149-3.215), systolic blood pressure (SBP) (OR = 1.014, 95% CI: 1.004-1.024), GLU (OR = 1.135, 95% CI: 1.017-1.272), and malondialdehyde (MDA) (OR = 1.014, 95% CI: 1.003-1.025) were associated with an increased risk of carotid plaques.In contrast, higher education levels were associated with a lower risk of carotid plaques, with education level (3) (OR = 0.436, 95% CI: 0.208-0.917) and education level (4) (OR = 0.348, 95% CI: 0.170-0.718) indicating a protective association. The constructed nomogram Risk assessment had an AUC of 0.850 (95% CI: 0.823-0.877) and demonstrated good calibration (χ2 = 13.973, P = 0.08246). By integrating age, education level, marital status, current smoking, hypertension history, dyslipidemia history, SBP, GLU and MDA, we developed a high-performance nomogram for assessment., which may be helpful for the early detection and prevention of carotid plaques in the general population. Further studies may be useful to validate the applicability in different regions and populations.

BACKGROUND:Risk assessment and treatment stratification for three-vessel coronary disease (TVD) remain challenging. This study aimed to investigate the prognostic value of left atrial volume index (LAVI) with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score II, and its association with the long-term prognosis after three strategies (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], and medical therapy [MT]) in patients with TVD.METHODS:This study was a post hoc analysis of a large, prospective cohort of patients with TVD in China, that aimed to determine the long-term outcomes after PCI, CABG, or optimal MT alone. A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital. A total of 7818 patients with available baseline LAVI data were included in the study. Baseline, procedural, and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which was a composite of all-cause death, myocardial infarction (MI), and stroke. Secondary endpoints included all-cause death, cardiac death, MI, revascularization, and stroke. Long-term outcomes were evaluated among LAVI quartile groups.RESULTS:During a median follow-up of 6.6 years, a higher LAVI was strongly associated with increased risk of MACCE (Q3: hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.06-1.37, P = 0.005; Q4: HR 1.85, 95%CI 1.64-2.09, P <0.001), all-cause death (Q3: HR 1.41, 95% CI 1.17-1.69, P <0.001; Q4: HR 2.54, 95%CI 2.16-3.00, P <0.001), and cardiac death (Q3: HR 1.81, 95% CI 1.39-2.37, P <0.001; Q4: HR 3.47, 95%CI 2.71-4.43, P <0.001). Moreover, LAVI significantly improved discrimination and reclassification of the SYNTAX score II. Notably, there was a significant interaction between LAVI quartiles and treatment strategies for MACCE. CABG was associated with lower risk of MACCE than MT alone, regardless of LAVI quartiles. Among patients in the fourth quartile, PCI was associated with significantly increased risk of cardiac death compared with CABG (HR: 5.25, 95% CI: 1.97-14.03, P = 0.001).CONCLUSIONS:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease. CABG is associated with improved long-term outcomes compared with MT alone, regardless of LAVI quartiles. When LAVI is severely elevated, PCI is associated with higher risk of cardiac death than CABG.

BACKGROUND The first-generation polymeric bioresorbable scaffolds resulted in higher than acceptable 3-year rates of device-related adverse outcomes. AIMS We aimed to assess the intermediate-term safety and performance of a novel ultrathin-strut sirolimus-eluting iron bioresorbable scaffold (IBS) in non-complex coronary lesions. METHODS The prospective, single-arm, open-label IBS first-in-human study enrolled 45 patients, each with a single de novo lesion. Enrolled patients were randomly assigned to 2 follow-up cohorts. Angiographic and imaging follow-up with intravascular ultrasound and optical coherence tomography (OCT) were conducted at 6 and 24 months in cohort 1 (n=30) and at 12 and 36 months in cohort 2 (n=15). Clinical follow-up was conducted at 1, 6 and 12 months, and annually thereafter up to 5 years. The coprimary outcomes were target lesion failure (TLF) and angiographic late lumen loss (LLL) at 6 months. RESULTS A total of 45 patients were enrolled between April 2018 and January 2019. The mean age was 53.2 years, 77.8% were male, and 26.7% had diabetes. The TLF rates were 2.2% at 6 months and 6.7% at 3 years, which in all cases were due to clinically indicated target lesion revascularisation. No deaths, myocardial infarctions or stent thromboses occurred during 3-year follow-up. In-scaffold LLL was 0.33±0.27 mm at 6 months and 0.37±0.57 mm at 3 years. By OCT, the proportion of covered struts was 99.8% at 6 months and 100% after 1 year. The 3-year strut absorption rate was 95.4%. CONCLUSIONS In this first-in-human experience, an ultrathin IBS was safe and effective for the treatment of de novo non-complex coronary lesions up to 3-year follow-up.

Objective: To evaluate the 4-year clinical outcomes of patients following Firesorb bioresorbable scaffold (BRS) implantation. Methods: The study reported the 4-year follow-up results of the FUTURE I study. FUTURE I was a prospective, single-center, open-label, first-in-man study which evaluated the feasibility, preliminary safety, and efficacy of Firesorb stent in the treatment of coronary artery stenosis. A total of 45 patients with single de novo lesions in native coronary arteries ,who hospitalized in Fuwai Hospital from January to March 2016 were enrolled. After successfully stent implantation these patients were randomized in a 2∶1 ratio into cohort 1 (n=30) or cohort 2 (n=15). The patients in cohort 1 underwent angiographic, IVUS or OCT examination at 6 months and 2 years; and cohort 2 underwent angiographic, IVUS or OCT at 1 and 3 years. All patients underwent clinical follow-up at 1, 6 months and 1 year and annually thereafter up to 5 years. The primary endpoint was target lesion failure (TLF, including cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization). Secondary endpoints included patient-oriented composite endpoint (PoCE, defined as composite of all death, all miocardial infarction, or any revascularization). Results: A total of 45 patients were enrolled and implanted with Firesorb BRS, including 35 males (77.8%), and the age was (54.4±9.3) years. At 4 years, 10 patients in cohort 1 were reexamined by coronary angiography and OCT examination. Among them, 2 patients' stents were completely degraded and absorbed. Compared with the OCT images of the other 8 patients in cohort 2 at 3 years, the degree of stent degradation was increased, and no stent adherence was found. The 4-year clinical follow-up rate was 100%. In 4-year clinical following up, 2 patients suffered PoCE (4.4%): 1 patient underwent non-target vessel revascularization the day after index procedure and target vessel revascularization (Non-target lesion revascularization) at 2-year imaging follow-up; the other patient underwent target lesion revascularization during imaging follow-up at 4 years but not due to ischemic driven. There was no scaffold thrombosis or TLF events through 4 years. Conclusions: Four years after the implantation, complete degradation and absorption of the Firsorb stent are evidenced in some patients. Firesorb stent is feasible and effective in the treatment of patients with non-complex coronary lesions.

目的:观察自拟活血化痰泻浊方治疗对高血压患者内皮细胞功能、炎症细胞因子及血流动力学的影响.方法:选取83例高血压患者,按照随机数字表法分为观察组42例、对照组41例,对照组采用常规药物治疗,观察组在对照组基础上用 自拟活血化痰泄浊方辅助治疗,比较两组患者治疗前后的内皮细胞功能、炎症细胞因子、血流动力学及不良反应.结果:与治疗前比较,治疗后两组内皮素(ET-1)、一氧化氮(NO)、肱动脉血流介导性舒张(FMD)、C反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)、大脑中动脉与基底动脉的平均血流速度(VM),阻力指数(RI)均明显改善.观察组治疗有效率(92.86％)明显高于对照组(75.61％).治疗后与对照组比较,观察组的ET-1、NO、FMD含量均明显升高(P＜0.05);CRP、IL-6、TNF-α含量均明显降低(P＜0.05);观察组患者的大脑VM明显升高,RI明显降低(P＜0.05);两组不良反应发生率无明显差异(P＞0.05).结论:自拟活血化痰泻浊方辅助治疗高血压可改善内皮细胞功能,减少炎症细胞因子水平,改善血流动力学,不增加其他不良反应.

Background: It has long been a controversial hotspot whether resting heart rate (RHR) is a risk factor or a marker for death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, is a pure RHR lowering agent. The study was aimed to investigate whether ivabradine would reduce more RHR, cardiovascular disease (CVD) mortality, and all-cause mortality than those placebo or beta-blockers. Methods: The authors performed a meta-analysis of 8 randomized controlled clinical studies (with 40,357 participants), and 3 studies of those which were ivabradine versus placebo (36,069 participants) and other 5 studies ivabradine versus beta-blockers (4288 participants) were available. The authors compared the association of the RHR reduction with death from CVD causes (2674 in 40,285 participants) and the rate of all-cause death (3143 deaths in 38,037 participants), and assessed improvement in death rates with the use of ivabradine. Results: The change of RHR from baseline to endpoint was 8 to 16 beats/min (bpm) in ivabradine group, 1 to 8 bpm in placebo group, and 4 to 24 bpm in beta-blockers group. In ivabradine versus placebo, the reduced risks of CVD mortality and all-cause morbidity were not significantly (risk ratio [RR] 1.02; 95% confidence interval [CI] 0.91-1.14, P=.737; RR: 1.00, 95% CI: 0.92-1.09, P=.992, respectively). CVD and all-cause morbidity were similar for ivabradine versus beta-blockers (RR: 1.04; 95% CI: 0.80-1.37, P=.752; RR: 1.17, 95% CI: 0.53-2.60, P=.697, respectively). Conclusions: Ivabradine had a neutral effect on mortality, suggesting that a pure RHR lowering agent did not reduce CVD mortality, all-cause mortality and improve the lifespan.

高血压、吸烟、血脂异常、糖尿病和糖耐量异常已被医学界公认为冠心病的重要危险因素,而年龄、性别、冠心病家族史、肥胖与超重、饮酒同样为冠心病的易患因素,新近发现的冠心病危险因素还有:血中同型半胱氨酸增高、胰岛素抵抗增强、血中纤维蛋白原及一些凝血因子增高、病毒及衣原体感染等.冠心病多支病变所涉范围广,病变程度重,合并症多,病情凶险,预后不良.本文对性别、高脂血症、高血压、吸烟、糖尿病、饮酒6种危险因素与冠脉多支病变的关系报道如下.

临床资料：患者男性，58岁，主因“阵发性胸闷、胸痛6年”入院。3个月前于左前降支和对角支各植入1枚支架，术后规律用药。再次行冠脉造影显示左冠脉原支架通畅、右冠脉近段狭窄80%，于右冠脉近段植入1枚支架。患者术后第2天午餐后站立时突发头晕、黑蒙，随后晕厥，数秒后意识恢复，无大小便失禁。即刻血糖4.8 mmol/L、血K+3.32 mmol/L、血红蛋白116 g/L，肌钙蛋白I、心脏超声、心电图均正常，心电监护示窦性心动过缓(45次/分)，未见恶性心律失常，故术后第3日开始停用合贝爽。但就在停合贝爽的当天晚餐和吸烟2支后出现了3次胸闷发作，硝酸甘油舌下含化或喷雾均可迅速缓解，每次持续2-5分钟。胸闷发作时心电监测示下壁导联ST段抬高伴房室传导阻滞，缓解后心电图完全恢复正常，急诊行冠脉造影未见支架内血栓形成。故诊断为冠脉血管痉挛诱发的变异性心绞痛发作，遂给予“硝苯地平5mg q6h、消心痛15mg q6h”等药物治疗和戒烟后无胸闷发作出院。至今随访半年患者无心绞痛发作。

<正>1临床资料患者男性,58岁,主因"阵发性胸闷、胸痛6年"入院。既往有高脂血症、2型糖尿病、吸烟史。心绞痛症状典型,多以剧烈活动后或晨起后出现。3个月前冠状动脉(冠脉)造影检查显示右优势型,左前降支近段狭窄80%,第一对角支狭窄90%,左回旋支开口及近段狭窄70%,第一钝缘支近段弥漫狭窄80%,右冠脉近段狭窄60%;于左前降支和对角支各置入1枚支架。术后规律口服"拜阿司匹林、氯吡格雷、欣康、盐酸地尔硫缓释片(合贝爽,90mg,1次/天)、比索洛尔(2.5mg,1次/天)"等药物治疗,症状缓解。但早、晚餐后仍有胸闷发作。入院时体格检查:心脏超声、X线胸片、生化检查包括(血脂、血糖、高敏C反应蛋白)均正常。再次行冠脉造影显示左冠脉原支架通畅、右冠脉

Mechanical circulatory support is playing an increasingly important role in the treatment of cardiogenic shock.It can correct a patient's hemodynamic disorders,and guarantee the implementation of reperfusion therapy.The intra-aortic balloon pump(IABP) is the most commonly used and mature of the mechanical systems.However,the ventricular assist device is better than the standard IABP treatment for the reversal of hemodynamic shock and metabolic parameters.More recently,the use of the percutaneous left ventricular assist device,a device that inflicts less trauma and has no cardiopulmonary bypass,is increasingly being used in clinical practice.The ECMO is being used in cases of myocarditis or for support after cardiac surgery.The future of mechanical circulatory support is small,minimally invasive,and easy to implant.

患者男性,45岁,因活动后胸闷3个月于2011年12月20日入住阜外心血管病医院.既往有高血压病、高脂血症、脂肪肝,无血液病史、药物过敏史和外伤手术史.人院后诊断为冠心病、劳力型心绞痛,查血常规(血小板计数294×109/L)、肝肾功能、凝血时间均正常,拟择期行冠状动脉介入治疗(PCI).

<正>1资料患者,男性,71岁,主因"冠脉支架术后10年,再发胸痛20d"于2010年11月15日入院。入院前20d,在快步行走、上楼梯及接触冷空气后即感胸闷、气短不适,伴有出汗,含服硝酸甘油或异山梨酯(消心痛)5min～6min后可缓解,偶有休息及睡眠中发作,当地医院冠脉CT提示:三支病变、原支架通畅,建议行冠脉造影术,故入住阜外心血管病医院。既往有高血压病10年,血压最高达180/70mmHg,平素口服卡托普利、尼福达,血

1 造影剂致心功能不全的机理 理想的造影剂应该是低抗原性、低渗性、非离子型、亲水性好、黏稠度低、化学毒性小、显影良好的化学物质,目前推荐用非离子型造影剂.就渗透压而言,低渗造影剂比高渗造影剂毒副作用明显减少,亲水性明显增加,是目前心血管领域最常用的一类造影剂.