目的 探讨血细胞比容(HCT)与择期经皮冠状动脉介入(PCI)治疗患者术后病死率的关系.方法 回顾性选取2016年1月至2017年1月在首都医科大学附属北京安贞医院心内科接受择期PCI治疗且术前有HCT记录的患者2437例,根据世界卫生组织关于贫血的诊断标准(男性HCT<39％,女性HCT<36％)将患者分为低HCT组(1067例)和正常HCT组(1370例).比较2组患者临床特点及术后病死率的差异,分析患者术后病死率的影响因素.结果 低HCT组患者住院期间应用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂比例低于正常HCT组[61.0％(651/1067)比65.4％(896/1370)],合并左主干病变和慢性完全闭塞病变比例高于正常HCT组[3.8％(41/1067)比2.6％(35/1370)、12.9％(138/1067)比9.6％(132/1370)](均P<0.05).所有患者平均随访1.5年,低HCT组患者术后死亡48例(4.5％),正常HCT组患者术后死亡15例(1.1％),组间比较差异有统计学意义(P<0.001).多因素Cox回归分析结果显示,低HCT是患者PCI术后病死率增加的独立危险因素(风险比=3.080,95％置信区间:1.441～6.583,P=0.004).结论 低HCT是择期PCI患者术后病死率增加的独立危险因素.

Objective This study was performed to assess the prevalence of nonalcoholic fatty liver (NAFL) in patients with symptomatic congestive heart failure (CHF) and compare the clinical features with those of patients without NAFL. Methods In total, 102 patients with CHF were divided into NAFL and non-NAFL groups according to their hepatic ultrasonography findings. All patients underwent transthoracic echocardiography and cardiac magnetic resonance examination. Follow-up was performed for major cardiovascular events (MACE) and readmission due to heart failure at 1, 3, 6, and 12 months after the index hospitalization. Results NAFL was detected in 37 of 102 patients (36.27%). Compared with the non-NAFL group, patients with NAFL were younger, had a higher body mass index and left ventricular (LV) mass index, and had more severe fibrosis. MACE and readmission occurred in 15 patients in the NAFL group and 29 patients in the non-NAFL group, without a significant difference. Linear regression analysis revealed that after adjusting for confounders, NAFL was independently associated with the LV fibrosis size and the ratio of the LV fibrosis size to the LV mass index. Conclusions NAFL is present in more than one-third of patients with CHF and is associated with the severity of LV fibrosis.

To analyze the influence of different genders on the choice of revascularization methods and prognosis in coronary artery disease (CAD) patients.The clinical data of patients in the DESIRE (Drug-eluting Stent Impact on Revascularization) study who underwent intervention were analyzed and followed up for major adverse cardiac and cerebrovascular events (MACCE) from Jul.1st,2003 to Sep.30th,2005.The median follow-up time of 3 809 patients was 540 days.Female patients were less likely to have history of myocardial infarction,smoking,revascularization and cardiac insufficiency,while they were older and had higher prevalence of other cardiovascular risk factors than men.Though male patients had higher proportion of left main stenosis,multi-vessel disease and chronic total occlusion,female gender was an independent influential factor of choosing PCI for revascularization (OR =1.235,95 ％ CI=1.009 ～ 1.511,P=0.041).In patients with left main stenosis and three vessel CAD with high CAD burden,female tended to have percutaneous coronary intervention (PCI) rather than CABG (P=0.016).COX regression showed that revascularization method was one independent protective factors of prognostic status (P＜0.001).Among revascularization patients,female patients are more likely to be treated by PCI,which is also true for those with indication for CABG.Patients treated with PCI experienced higher incidence of MACCE during follow up.Female patients would benefit similarly as male patients from CABG therapy,while patients with indication for CABG or diabetes would benefit more.

Objective: This study investigated the influence of asymptomatic hyperuricemia on the prognosis of patients who had undergone elective percutaneous coronary intervention (PCI). Methods: A total of 3 452 consecutive patients , who had preoperative serum uric acid level record and were without gout, underwent elective PCIs between July 2009 and September 2011 were included in this study. Patients were divided into two groups based on their preoperative serum uric acid levels. The association between baseline serum uric acid levels and postoperative mortality was investigated through 1.5 years of follow up. Results: Of the 3 452 patients in the study population, 516 had elevated uric acid and 2 936 had normal uric acid.Patients in the elevated uric acid group were older, more frequently had prior history of hypertension, stroke, myocardial infarction and interventional procedure, less likely to have prior history of diabetes mellitus.Other significant differences included higher white blood cell, total cholesterol and triglyceride levels; lower left ventricular ejection fraction, estimated glomerular filtration rate and high density lipoprotein (HDL) levels, more companied by multivessel disease, more PCI lesions, lower complete revascularization rate.More patients with elevated uric acid level were treated with ACEI/ARB and diuretics at the time of hospital discharge.The results of a multivariate Cox regression analysis revealed that preoperative elevated uric acid was an independent predictive factor for mortality after adjustment for other factors (hazard ratio 3.252, 95% confidence interval 1.902-5.560, P<0.001). Conclusion: Asymptomatic hyperuricemia is an independent predictive factor of mortality in patients undergoing elective PCI.

Objective To investigate the relation among soluble growth stimulation express gene 2 protein (sST2),N-terminal pro-brain natriuretic peptide(NT-proBNP),high sensitivity cardiac troponin Ⅰ(hs-cTnⅠ) and prognosis of patients with heart failure.Methods A total of 173 patients with heart failure were enrolled from May 2015 to November 2015 in the Beijing Anzhen Hospital,Capital Medical University.Levels of sST2,NT-proBNP and hs-cTnⅠ were tested on admission.The relation among sST2,NT-proBNP and hs-cTnⅠ with 1 year incidence of major adverse cardiovascular events (MACE) was analyzed.Results During 1 year follow-up,MACE occurred in 52 cases.Levels of sST2,NT-proBNP and hs-cTnⅠ on admission in MACE group(n =52) were significantly higher than those in non-MACE group(n =121) [41.2 (25.5,62.8) μg/L vs 29.1 (21.6,38.8) μg/L,4 758 (1 978,9 000) ng/L vs 2 799 (1 446,6 073) ng/L,0.05 (0.02,0.09) μg/L vs 0.03 (0.01,0.06) μg/L] (P ＜ 0.05).Cox regression analysis showed that the level of sST2 on admission was an independent predictor of MACE(hazard ratio =2.133,confidence interval:1.011-4.502,P =0.047).Receiver operating characteristic curve analysis showed that sST2,NT-proBNP and hs-cTnⅠ were predictive factors of cardiovascular events [area under curve (AUC) =0.660,0.644,0.659];the predictive value of combination of 3 indicators (AUC =0.705) was higher than that of sST2,NT-proBNP and hs-cTnⅠ alone(P =0.013,0.008,0.031).Kaplan-Meier survival analysis showed that the cumulative survival rate in patients with sST2 ≥39.393 μg/L was significandy lower than that in patients with sST2 ＜ 39.393 μg/L(P ＜ 0.05).Conclusion The concentration of sST2 on admission can be an independent predictive factor of prognosis of heart failure;combined detection of sST2,NT-proBNP and hs-cTnⅠ can improve the prediction.

Objective: Previous studies have revealed that the red blood cell distribution width (RDW) was associated with long-term prognosis in patients undergoing percutaneous coronary intervention (PCI). However, they did not exclude patients with anemia. This study, thus, investigated the association between RDW and prognosis in non-anemia patients. Methods: A total of 2 732 patients underwent elective PCI from July 2009 to September 2011 were enrolled in the study. These patients were divided into two groups based on their baseline median RDW levels: low RDW group (RDW<12.1%) and high RDW group (RDW≥12.1%). All the subjects were followed up for an average period of 18 months and the associations between baseline RDW levels and postoperative mortality were analyzed. Results: Patients in the high RDW group were elder and had more women than those in low RDW group. Most of them had prior history of hypertension, stroke, myocardial infarction, but few of them were current smokers. Subjects in the high RDW group had higher systolic blood pressure and total cholesterol levels, and lower erythrocyte mean corpuscular volume, hemoglobin level, estimated glomerular filtration rate level, and left ventricular ejection fraction. Moreover, more subjects in the high RDW group were combined with left main, ostial and chronic total occlusion lesion, and had a lower complete revascularization rate. The postoperative mortality was significantly higher in the high RDW group than that in the low RDW group (2.4% vs 0.6%, P<0.001). Multivariate Cox regression analysis revealed that preoperative high RDW level was an independent risk factor for postoperative mortality after adjustment of other factors (HR 3.930, 95%CI 1.600-9.656, P=0.003). Conclusion: High RDW might be a marker for the postoperative mortality in non-anemic patients undergoing elective PCI.

Background Large-scale clinical research on the relationship between red blood cell distribution width (RDW) and intermediate-term prognosis in elderly patients with coronary artery disease (CAD) is lacking. Thus, this study investigated the effects of RDW on the intermediate-term mortality of elderly patients who underwent elective percutaneous coronary intervention (PCI). Methods Data from 1891 patients >= 65 years old underwent elective PCI from July 2009 to September 2011 were collected. Based on preoperative median RDW (12.3%), the patients were divided into two groups. The low RDW group (RDW < 12.3%) had 899 cases; the high RDW group (RDW >= 12.3%) had 992 cases. The all-cause mortality rates of the two groups were compared. Results Patients in the high RDW group were more likely to be female and accompanied with diabetes, had lower hemoglobin level. The mean follow-up period was 527 days. During follow-up, 61 patients died (3.2%). The postoperative mortality of the high RDW group was significantly higher than that of the low RDW group (4.3% vs. 2.0%, P = 0.004). After adjusting other factors, multivariate Cox regression analysis revealed that preoperative high RDW was significantly associated with postoperative all-cause mortality (hazard ratio: 2.301, 95% confidence interval: 1.106-4.785, P = 0.026). Conclusions Increased RDW was an independent predictor of the increased intermediate-term all-cause mortality in elderly CAD patients after elective PCI.

AIMS:Percutaneous revascularisation triage has not been evaluated in randomised controlled trials of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel disease. As a result, current guidelines are not available. The objective of our meta-analysis was to investigate the use of percutaneous coronary intervention (PCI) in culprit and non-culprit vessels.METHODS AND RESULTS:We undertook a meta-analysis of controlled studies where patients were assigned to multivessel PCI or culprit vessel PCI. Summary odds ratios (OR) for all-cause mortality, myocardial infarction, unplanned revascularisation and major adverse cardiac events (MACE) were calculated using random- or fixed-effect models. Six registry studies (n=5,414) were included in this meta-analysis. There was no difference in the rate of mortality (OR, 0.85; 95% CI: 0.70 to 1.04; p=0.114) or myocardial infarction (OR, 0.75; 95% CI: 0.43 to 1.32; p=0.319) between the two treatment groups. Multivessel PCI may decrease long-term MACE (OR, 0.69; 95% CI: 0.51 to 0.93; p=0.015) and unplanned revascularisation (OR, 0.64; 95% CI: 0.45 to 93; p=0.018) compared with culprit vessel PCI.CONCLUSIONS:No significant difference was demonstrated in the long-term risk of myocardial infarction and mortality between multivessel PCI and culprit vessel PCI. Therefore, multivessel PCI may be a safe and reasonable option for NSTE-ACS patients with multivessel disease.

The acute inflammatory response of high-pressure post-dilation with non-compliant balloon (HPNC) after drug-eluting stent (DES) deployment remains still unknown. We sought to evaluate the inflammatory effects and clinical outcomes of HPNC after DES implantation. We enrolled consecutive patients

目的:分析老年(≥65岁)冠心病合并高血压患者接受血运重建后影响其预后的因素.方法:3 457例接受了血运重建,包括经皮冠状动脉介入治疗(PCI)和冠状动脉移植术(CABG)的老年冠心病患者血压情况分为两组,高血压组[BP≥140/90mmHg(1 mmHg=0.133 kPa),n=2 002]和对照组(即血压正常组,BP＜ 140/90mmHg,n=1 455),对患者进行电话或门诊随访,随访的中位数为555d,比较两组间临床情况和预后的差异.结果:两组间总病死率和主要不良心血管事件(MACCE)发生率差异有统计学意义,其中总病死率高血压组与血压正常组为(3.5％vs.1.2％,P ＜0.001),MACCE为(14.2％ vs.10.5％,P=0.001).高血压组与对照组相比,两组间在如下方面存在显著差异:吸烟史(35.6％ vs.55.4％,P＜0.001),脑血管病史(13.2％ vs.8.8％,P＜0.001),周围血管病史(2.9％vs.1.6％,P =0.012);ST段抬高心肌梗死(STEMI)为(15.3％ vs.11.1％,P=0.004),不稳定性心绞痛(66.1％ vs.61.2％,P=0.004);多支病变(43.8％ vs.35.5％,P＜0.001),左主干病变(9.4％vs.6.4％,P=0.001),支架内再狭窄(ISR)为(3.5％vs.2.2％,P=0.028);完全血运重建率(70.9％ vs.77.7％,P＜0.001).Cox多因素回归分析发现,多支病变(HR=2.077,95％ CI:1.129～3.819,P=0.019)是影响老年冠心病合并高血压患者总病死率的独立危险因素,而脑血管病史(HR=1.550,95％CI:1.092 ～2.200,P=0.014)、左主干病变(HR=1.890,95％ CI:1.198 ～2.982,P=0.006)、多支病变(HR=1.505,95％ CI:1.248～1.814,P＜0.001)是影响其MACCE的危险因素.结论:与对照组相比,老年高血压合并冠心病患者的总病死率和MACCE发生率高.多支血管病变是老年高血压并冠心病患者血运重建后总病死率增加的独立危险因素,而脑血管病史、左主干病变、多支血管病变是其MACCE发生率增加的独立危险因素.

目的:了解慢性肾功能不全对冠状动脉病变的影响.方法:连续入选2005年3月至2011年3月,于我院接受冠状动脉造影(coronary angiography,CAG)检查的患者共1 394例,根据患者入院肾小球滤过率(estimated glomerular filtration rate,eGFR)检查结果分为肾功能正常(n=671)、轻度肾功能减退(n =253)和中重度肾功能减退(n=62)三组.比较各组患者的临床特点以及冠状动脉病变严重程度.结果:各组患者在性别比例、年龄、体质量指数(BMI)、急性冠状动脉综合征(acute coronary syndrome,ACS)患病比例、高血压病史、糖尿病史、心力衰竭病史、脑血管病史、SBP、HbA1c、TG、TC和LDL-C等方面,均差异有统计学意义(P＜0.05).中重度肾功能减退的患者冠状动脉病变程度严重的比例,显著高于其余两组高,2支病变(P =0.001)、3支病变(P=0.001)、左主干病变(P =0.001)、LAD近端病变(P =0.027)以及开口病变(P =0.005)所占比例显著升高.多因素分析,校正其他因素后,慢性肾功能不全是冠状动脉病变严重程度的独立预测因素(RR =2.33,95％ CI:1.74 ～5.10).结论:慢性肾功能不全与冠状动脉病变严重程度有密切相关性.

Percutaneous coronary intervention (PCI) is currently the most commonly used revascularization technique in the management of symptomatic coronary disease. However, late stent thrombosis (LST) and in-stent restenosis (ISR) are the most serious late complication related to PCI. Traditionally, intimal hyperplasia after bare metal stent (BMS) implantation has been considered stable, with an early peak between 6 months and 1 year and a late quiescent period thereafter. Recent studies have reported that one-third of the patients with ISR after BMS implantation presented with acute coronary syndrome (ACS), which is not regarded as clinically benign. Seung-Jung et al1 reported that in-stent neoatherosclerosis is the final common pathway of late stent failure. Here we report a patient presenting ACS in whom intravascular ultrasound (IVUS) imaging showed very late thrombosis due to atheromatous changes and neointima plaque rupture 12 years after BMS implantation. A 74-year-old man presented with recurrent angina symptoms 12 years after BMS implantation. The patient had a history of PCI due to angina pectoris in 2001. At that time, the coronary angiogram showed a 90% stenosis at the proximal left anterior descending (LAD) artery and an 80% stenosis at the proximal first diagonal (Figure 1). A BMS (R Stent, 3.5 mm×28 mm, Orbus Neich Medical, Inc., USA.) was implanted at the proximal LAD and only percutaneous transluminal coronary angioplasty was performed at the proximal first diagonal. There were no evidences of ISR or LST upon follow-up coronary angiogram seven months after index PCI. Pharmacologic treatment after PCI included dual anti-platelet therapy with aspirin 100 mg/d and ticlopidine 500 mg/d for three months. During twelve years of follow-up at the local clinic, he had not complained of chest pain while on his medication.Figure 1. A:: Initial angiography showing in-stent restenosis in proximal left anterior descending artery (white arrow). B: Final angiography showing a drug-eluting stent implanted in the target segment. C: Intravascular ultrasound (IVUS) showing normal segment in the proximal part of bare-metal stent. D: IVUS showing in-stent restenosis (Minimal stent area was 4.0 mm2, plaque burden was 75.9%.). E: Stent thrombosis (white arrow). F: Plaque rupture (white arrow).Substernal chest pain at rest had recurred from days before admission. Two days after admission, his coronary angiogram revealed focal 80% in-stent restenosis with luminal haziness on the proximal LAD and 50%-60% stenosis at the mid right coronary artery (RCA). Thrombosis was suspected to occur after ISR which was confirmed by IVUS (Figure 1). Images demonstrated a well expanded previously deployed BMS and remarkable neointimal proliferation causing luminal narrowing (minimal luminal area=4.0 mm2, plaque burden=75.9%). It was observed that in-stent thrombosis was secondary to neointimal plaque ruptured and 2 new-generation drug eluting stents (Xience V, 3.0 mm×28 mm and 3.0 mm×15 mm Abbott, IL, USA) were successfully implanted to cover the previously stented lesion. IVUS revealed a well expanded previous ISR lesion (minimal stent area=5.2 mm2) (Figure 1). The patient has been clinically stable for 8 months after PCI. Previously, much attention was directed on ISR after BMS implantation which has been reported to be 15%-60% depending on patient co-morbidities, vessel size, and lesion complexity.2 The main mechanism of ISR is neointimal proliferation. Nevertheless, LST is also pertinent to the BMS. A large retrospective study reported that the cumulative incidence of stent thrombosis after BMS implantation was 0.5% at 30 days, 0.8% at 1 year, 1.3% at 5 years, and 2.0% at 10 years.3 A longer-term follow-up study demonstrated a triphasic luminal response after BMS placement characterized by an early restenosis, an intermediate regression, and a late luminal re-narrowing likely related to neoatherosclerosis beyond 4 years. Evidence of de novo neoatherosclerosis based on histology, angiography, and intravascular images provides a new insight for the mechanism of late BMS failure. Histology findings in 299 autopsy cases proved the characters of neoatherosclerosis after BMS.4 They include (1) Neoatherosclerosic changes occurred in significantly longer implant durations in BMS; (2) The incidence of atherosclerotic change in proximal lesion was significantly higher; (3) Unstable plaque, i.e., thin-cap, fibroatheroma and ruptured plaques with thrombosis were seen in BMS, with the majority of duration after BMS implantation being >5 years; (4) The incidence of neoatherosclerosis did not differ between patients with stent related death and those with non-stent related death in BMS; (5) Younger age, longer implant duration and underlying unstable plaque were independent risk factors for neoatherosclerosis. Neointimal atherosclerotic change following BMS implantation is rarely reported and usually occurs beyond 5 years. Ultimately, it is also possible that the neointima with advanced atherosclerotic degeneration ruptures and leads to further neointimal progression as well as to late thrombotic events. Very LST after BMS implantation might be attributable to neointimal plaque rupture. Despite several previous reports suggesting neointimal atheromatous changes after stenting, and IVUS-documented ruptured plaque in neointima, there have been few reports of atherosclerotic progression with ruptured plaques of in-stent intima. In this longer follow-up case, IVUS revealed neointimal plaque rupture, which is not a benign condition. The incidence of atherosclerosis in BMS at autopsy has not been examined systematically. Although angiography and multimodal imaging have consistently supported de novo atherosclerotic neointimal changes in BMS, more data are needed to further clarify the clinical implication of this pathology. In this case, we implanted two new-generation drug eluting stents to cover the previously stented lesion. We also used IVUS to examine stent expansion after deployment. And IVUS was used to define the nature of the lesion before treatment and assess procedural outcome after stent implantation. What can we do to prevent in-stent neoatherosclerosis? First, anti-inflammatory therapy and lipid management can reduce the occurrence of neoatherosclerosis and the incidence of ISR and very LST. Additionally, in theory biodegradable stents and polymer-free stents will largely decrease inflammatory reaction around the stent, which can also reduce the duration of intimal healing delay.5 The use of biodegradable stents in the future may play an important role in reducing the occurrence of neoatherosclerosis.

目的:分析超质量和肥胖急性冠状动脉综合征(ACS)患者超敏C反应蛋白(hs-CRP)水平与冠状动脉病变复杂程度之间的关系.方法:入选2012年1月至2012年12月,于北京安贞医院行冠状动脉造影并确诊为ACS的患者304例,根据体质量指数(BMI)分为肥胖ACS组[BMI ≥27(kg/m2)] 84例、超质量ACS组[24≤BMI＜ 27/(kg/m2)] 133例,正常体质量ACS对照组[18.5≤BMI＜ 24/(kg/m2)]87例.根据造影结果,按狭窄病变血管数分为单支病变及多支病变(2支病变以上);采用Gensini积分方法对冠状动脉狭窄程度进行定量评分,检测hs-CRP水平,分析hs-CRP与Gensini积分之间关系.结果:超质量和肥胖ACS患者hs-CRP水平显著高于对照组,超质量和肥胖ACS患者冠状动脉多支血管病变者较多,发生ACS的年龄较早;超质量和肥胖ACS患者hs-CRP水平与Gensini积分之间成显著正相关.结论:与正常体质量ACS患者相比,超质量及肥胖ACS患者的hs-CRP水平较高;血清hs-CRP水平与Gensini积分正相关,hs-CRP对于预测超质量和肥胖ACS患者冠状动脉病变复杂程度有一定价值,超质量及肥胖者应加强冠心病的一级预防.

目的了解低血红蛋白血症对冠状动脉病变的影响。方法选择接受冠状动脉造影（ coro-nary angiography ，CAG）检查且资料完整的患者共1024例，根据患者入院血红蛋白检查结果分为正常组（无贫血组）和低血红蛋白血症组（贫血组），其中贫血组228例，无贫血组796例。比较2组患者的临床特点以及冠状动脉病变严重程度。结果贫血组患者除具有年龄较大，女性、糖尿病、脑血管病史、慢性肾功能不全病史、急性冠脉综合征比例较高的特点外，2支病变（41．2％比35．9％， P ＜0．01）、3支病变（36．4％比25．6％， P ＜0．01）、左主干病变（5．3％比2．6％， P ＝0．004）以及LAD近端病变（56．6％比48．6％， P＝0．017）所占比例显著高于无贫血组。多因素分析，校正其他因素后，低血红蛋白血症是冠状动脉病变严重程度的独立预测因素（RR1．46，95％CI 1．02～1．89， P ＝0．01）。结论低血红蛋白血症是冠状动脉病变严重程度的独立预测因素。

Objective To compare the rates of mortality,mycardial infarction （MI） ,repeat revascularization and stent thrombosis after percutaneous coronary intervention （PCI） with implantation of stents for diabetics versus nondiabetics with multivessel disease to evaluate the im-

Objective:This observational study compared percutaneous coronary intervention(PCI) with drug eluting stents(DES) vs.coronary artery bypass grafting(CABG) among the elderly patients(≥75 years) suffering stable coronary heart disease with multivessel disease for short-term and long-term clinical outcomes.Methods: We consecutively included 363 the elderly patients(≥75 years) suffering stable coronary heart disease with multivessel disease who underwent either PCI with DES(n=269) or CABG(n=94) in our institution from July 2003 to December 2005.The primary endpoints was major adverse cardiac and cerebrovascular event(MACCE) at 24 months,the secondary endpoints were all cause death,nonfatal myocardial infarction(MI),cerebrovascular events,repeat revascularization and the composite of all cause death,nonfatal MI or cerebrovascular events at 24 months.Results: Patients undergoing CABG had significantly lower in-hospital adverse outcome rates for mortality(7.4% vs.1.9%,P=0.023),nonfatal MI(3.2% vs.0%,P=0.023),and MACCE(10.6% vs.1.9%,P=0.001).After adjusted with Cox regression,the risk of primary end points at 24-month was not significantly different [22.3% vs.15.2%,Hazard ratio(HR): 1.62,95% confidence interval(CI): 0.63 to 3.31,P=0.379] between CABG and DES;moreover,all cause death,cardiac death,nonfatal MI,cerebrovascular events and subsequent repeat revascularization at 24 months were also similar.However,CABG significantly increased the risk of the composite of all cause death,nonfatal MI or cerebrovascular events at 24 months(19.1% vs.8.2%,HR: 3.87,95% CI: 1.14 to 12.37,P=0.009).Conclusion: In a real-world elderly patients(≥75 years) population,CABG may increase the risk of the composite endpoints of all cause death,nonfatal MI or cerebrovascular events at long terms compared with DES without decreasing the risk of repeat revascularization,or MACCE.

Objective This observational study compared the rates of death,myocardial infarction(MI),repeat revascularization and stent thrombosis after implantation of drug eluting stents(DES) versus bare metal stents(BMS) in unselected patients with diabetes mellitus to evaluate the long-term efficacy and safety of DES.Methods We consecutively included 834 diabetic patients who underwent either DES(n=583) or BMS(n=251) in our institution from July 2003 to December 2005.The primary end point was all-cause mortality at 24 months,the secondary end points were the occurrence of nonfatal MI,cerebrovascular events and repeat revascularization and major adverse cardiac events(MACE) at 24 months.Results After adjusting with Cox regression,the risk of mortality in the DES group was significantly lower than that in the BMS group(3.2% vs 5.1%,hazard ratio of DES vs BMS 0.58,95% confidence interval 0.12 to 0.94,P=0.038),similar outcome had also been found in the adjusted risk of cardiac mortality(2.2% vs 4.4%,HR=0.29,95% CI: 0.13~0.87,P=0.027) at 24 months,although the adjusted risk of nonfatal MI and the composite of the cardiac mortality and nonfatal MI was similar.DESs was not associated with increased risk of stent thrombosis(2.7% vs 3.2%,HR=0.61,95% CI: 0.17~1.32,P=0.144).The MACE rate was also lower in the DES group(15.8% vs 27.9%,HR=0.19,95% CI: 0.09~0.85,P0.001) due to less mortality and less repeat revascularization with DES(10.5% vs 20.7%,HR=0.24,95% CI: 0.11~0.78,P0.001).Conclusion In a real-world diabetic patient population,DES was related to reduced mortality,repeat revascularization and MACE rates at long-term follow-up compared with BMS without increased risk of stent thrombosis,or nonfatal MI.The survival benefits of DES resulted from reducing revascularization procedures for restenosis which could account for the reduction in mortality and MI,higher rate of complete revascularization and no additional risk of stent thrombosis.

Objective:To investigate short-term and long-term prognosis of the patients with different states of cardiac function after receiving PCI.Method:The study was the retrospective registered study in the single center,including 2 234 patients received PCI.All patients were divided into 3 groups by left ventricular ejection fraction(LVEF): A group, LVEF≤40%(n=106);B group,LVEF 41% to 49%(n=205);C group,LVEF≥50%(n=1 923).The time of follow-up was more than one year.The mortality and the MACCE were compared among 3 groups.Result:The in-hospital mortality in A,B,C group were 2.8%,0.5%,0.2%,respectively,P0.01.The long-term mortality in A,B, C group were 5.7%,4.4%,1.6%,respectively,P0.01.The in-hospital MACCE rates in A,B,C group were 5.7%,2.0%,1.0%,respectively,P0.01. The long-term MACCE rates in A,B,C group were 18.8%,11.6%,11.7%,respectively,P0.05.The COX regression showed that A group had the highest risk of death(HR 3.646,95%CI 1.517-8.762);B group had higher risk of death(HR 2.184,95%CI 1.321-5.684).Conclusion:The patients with LVEF≤40% have higher long-term mortality than the patients with LVEF41%.

随着生活方式的改变和生活工作压力越来越大,冠心病(coronary artery disease,CAD)的发病呈明显上升趋势,且有明显发病年轻化的特点.本研究旨在回顾性地分析早发冠心病患者(男性年龄<55岁,女性年龄<65岁)的冠脉病变特点及经皮冠脉介入治疗(percutaneous coronary interyention,PCI)术后预后的特点.

Objective To evaluate the short-term and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) compared with those with non-STEMI after percutaneous coronary intervention (PCI). Method The DESIRE Ⅱ (Drug-Eluting Stent Impact on Revascularization Ⅱ) was a single-center registered retrospective study of coronary revascularization in our institution between July 2003 and September 2009.Data of demographics, clinical features and revascularization record of STEMI and non-STEMI patients from the DESIRE Ⅱ trial were analyzed. The patients were followed up in OPD or by telephone after discharge. MACCE (major adverse cardiocerebral events) including death, neo-myocardial infarction, stroke and revascularization were recorded. The clinical outcomes of patients of two types were evaluated. Results There were 6005 patients studied with a median follow-up of 566 days. A total of 1009 STEMI and non-STEMI patients were analyzed. The patients with non-STEMI ( n = 206) had higher prevalence of hypertension and history of higher frequency of myocardial infarction as well as revascularization compared with patients with STEMI ( n = 803). The patients with non-STEMI had higher ratio of treatment for multivessel disease (43.7% vs. 34.4%, P = 0.039). There were no significant differences in in-hospital mortality and long-term outcomes (one year survival rate: 96% vs. 98%)between patients with STEMI and non-STEMI. The predictors of 1-year mortality were LVEF and blood creatine.Conclusions Despite different chnical features, patients with STEMI and non-STEMI after PCI had similar both short-term and long-term outcomes.