IntroductionCurrently, there are many diagnostic strategies for in-stent restenosis (ISR) used clinically, including invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), and Fractional Flow Reserve (FFR). CCTA is not recommended for post-stent implantation patients owing to suboptimal image quality caused by artifacts. The FFR application is limited by its procedural complexity. Precise evaluation may be achieved by using computed tomography-derived fractional flow reserve (CT-FFR), which combines computational fluid dynamics (CFD) with CCTA. Anatomical and functional assessments of ISR lesions could be integrated effectively as well in this way. However, the computational complexity and prolonged processing time may hinder its utility in clinical use.MethodsThis study is a multicenter, prospective, diagnostic study, aiming to establish a deep learning-based CT-FFR model for the accurate assessment of ISR and to validate its diagnostic performance using invasive FFR as the reference standard. This study will be carried out in Beijing Anzhen Hospital and 6 subcenters in China. We planned to prospectively enroll 331 post-stent implantation patients with available CCTA data since June 2022, and invasive FFR will be performed within 3 months when clinically indicated. Patient recruitment is currently ongoing. Among them, 250 patients from Beijing Anzhen Hospital will be used to adapt and extend the existing DEEPVESSEL model, a deep learning-based CT-FFR computational software designed for the non-invasive functional assessment of coronary artery disease and previously validated in de novo coronary lesions, for application in the assessment of in-stent restenosis (ISR), and 81 patients from the other 6 subcenters will be used in external validation. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value with their corresponding 95% confidence intervals (CIs) were calculated for CT-FFR. The receiver operating characteristic (ROC) curve was analyzed, and the area under the curve (AUC) was calculated. The McNemar test and Bland-Altman plot will be used to examine the diagnostic consistency between CT-FFR and invasive FFR. The correlation was analyzed by Spearman's correlation coefficient.Trial registration numberChiCTR2200058822.

The optimal revascularization strategy for coronary small vessel disease remains controversial due to limited lumen gain and high restenosis risk associated with stent implantation. Drug-coated balloon may offer an alternative by delivering antiproliferative drugs without leaving a permanent implant. This study aimed to evaluate the efficacy and safety of a paclitaxel-coated balloon developed by Hangzhou Revita Medical Technology Co., Ltd. for the treatment of coronary small vessel disease and very small vessel disease. This prospective, multicenter, randomized controlled trial enrolled 216 patients with reference vessel diameters between 1.5 and 2.5 mm at eight centers in China. Participants were randomly assigned (1:1) to treatment with a paclitaxel-coated balloon (Drug coated balloon group, n = 109) or a conventional balloon (Uncoated balloon group, n = 107). Patients with RVD < 2.0 mm were defined as the very small vessel disease (VSVD). The primary endpoint was in-lesion late lumen loss at 9 months. Secondary endpoints included minimal lumen diameter, percent diameter stenosis, binary restenosis, and device-oriented major adverse cardiovascular events. At 9 months, angiographic follow-up was completed in 176 patients. The drug coated balloon group showed significantly lower in-lesion LLL compared with the uncoated balloon group (0.15 ± 0.34 mm vs. 0.36 ± 0.43 mm, p < 0.001), larger MLD (1.39 ± 0.41 mm vs. 1.13 ± 0.48 mm, p < 0.001), and reduced DS

In-stent restenosis (ISR) continues to be a significant problem after percutaneous coronary intervention (PCI), negatively affecting patient care. This review offers a thorough examination of current ISR diagnostic methods - which combine anatomical and functional assessments with cutting-edge technologies - with holistic recommendations for ISR management, from optimized prevention during PCI to effective treatment. Anatomically, coronary angiography (CAG) persists as the gold standard, while intravascular ultrasound (IVUS) and optical coherence tomography (OCT) enhance stent optimization and ISR detection through high-resolution imaging. Functionally, fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) quantify ischemic risk, whereas non-invasive techniques like Computed Tomography-derived Fractional Flow Reserve (CT-FFR) and quantitative flow ratio (QFR) are transforming clinical paradigms. Multimodal imaging fusion and artificial intelligence markedly improve diagnostic accuracy and efficiency. Biomarkers and genomics are valuable tools for assessing ISR risk. Future directions emphasize integrated anatomical-functional-molecular assessments and AI-driven personalized management to refine ISR care and patient prognosis.

Vascular smooth muscle cells (VSMCs) are essential players in a wide range of physiological processes, and their phenotypic transitions are critical in the development of vascular diseases such as atherosclerosis (AS), restenosis, aortic dissection/aneurysm (AAD), chronic kidney disease (CKD), and diabetes mellitus (DM). MicroRNAs (miRNAs), a class of short non-coding RNAs, regulates key cellular functions like proliferation, migration, and apoptosis by modulating gene expression. Numerous studies have shown that various miRNAs play pivotal roles in the pathophysiological processes of VSMCs, with VSMC phenotype switching being a key factor.To harness miRNAs as therapeutic tools, researchers have focused on developing efficient delivery vectors, including exosomes, nanoparticles, and viral vectors. Recently, the exploration of miRNA characteristics and delivery mechanisms has led to the emergence of innovative systems, such as scaffold-based localized delivery methods, platelet-like fusion lipid nanoparticles(PLPs), liposome-exosome hybrid carriers, and stimulus-responsive delivery systems like miRNA micelles. These cutting-edge delivery systems not only enhance our understanding of miRNA's role in disease but also offer promising new strategies for gene therapy, paving the way for more precise and effective treatments in the future.

Objective: This study is designed to systematically assess the safety and efficacy profiles associated with varying procedural sequences of endovascular aortic repair (EVAR) and percutaneous coronary intervention (PCI) in clinical practice. Methods: We conducted a retrospective cohort analysis encompassing patients diagnosed with aortic aneurysm and concomitant coronary artery disease (CAD) who underwent EVAR at Beijing Anzhen Hospital, Capital Medical University, between January 2010 and December 2022, with planned staged (preoperative or postoperative) or simultaneous PCI. The cohort was stratified into three groups: PCI followed by EVAR, EVAR followed by PCI, and simultaneous EVAR and PCI. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, cerebrovascular events, and aortic-related complications within 12 months post-intervention. Secondary endpoints included duration of hospital stay, total hospitalization costs, and incidence of in-hospital adverse events. Multivariate logistic regression analysis was employed to identify independent predictors of the primary endpoint. Results: The study cohort comprised 374 patients, with 209 (55.9%) undergoing PCI followed by EVAR, 133 (35.6%) receiving EVAR followed by PCI, and 32 (8.5%) undergoing simultaneous EVAR and PCI. Comparative analysis revealed no statistically significant differences in the incidence of in-hospital adverse events (p = 0.867) or the risk of primary endpoint events (p = 0.645) across the three treatment groups. Notably, the simultaneous treatment group demonstrated a significantly reduced total hospital stay (10.6 days) compared to the PCI followed by EVAR group (16.0 days) and the EVAR followed by PCI group (17.2 days) (p < 0.001), accompanied by lower hospitalization costs (p = 0.002). Conclusions: For patients with aortic aneurysm complicated by CAD requiring both EVAR and PCI, simultaneous intervention appears to be a safe and feasible therapeutic option. This approach significantly reduces hospital stay duration and associated costs without increasing the risk of in-hospital adverse events or compromising 12-month postoperative outcomes. However, this exploratory finding requires validation in large-scale randomized controlled trials.

OBJECTIVE:The immunoproteasome is linked to endothelial function and may act as a proangiogenic factor. This study explored its predictive value for coronary collateral circulation (CCC) in ST-elevation myocardial infarction (STEMI) patients. METHODS:We enrolled 252 STEMI patients from April 2021 to April 2024. Plasma levels of LMP2, LMP7, and PSMB10 were measured using ELISA. ROC curves assessed predictive ability for good CCC. Univariate and multivariate logistic regression analyses identified predictors, and restricted cubic spline (RCS) analysis evaluated the dose-response relationship. Subgroup analysis was also conducted. RESULTS:Patients with good CCC had significantly higher plasma levels of immunoproteasome components. Among them, LMP7 showed the best predictive value (AUC = 0.732), with an optimal cut-off of 3.824 ng/mL. Multivariate logistic regression confirmed LMP7 ≥3.824 ng/mL as an independent predictor for good CCC [OR = 7.914 (4.127-15.174)]. RCS analysis showed a J-shaped association: the odds of good CCC increased notably when LMP7 exceeded 3.824 ng/mL. Subgroup analyses supported these findings. CONCLUSION:Higher plasma immunoproteasome levels, especially LMP7 ≥3.824 ng/mL, were independently associated with good CCC in STEMI patients, suggesting its potential role as a biomarker of collateral development.

Background: Currently, the causal relationship between lymphocyte subsets and coronary artery disease (CAD) remains unclear. Therefore, we utilized Mendelian randomization (MR) to assess the association between lymphocyte subsets and CAD. Methods: We performed a two-sample MR analysis using publicly available genome-wide association studies (GWAS) datasets. The primary method of analysis to comprehensively evaluate causal effects was the inverse variance-weighted (IVW) method. The four additional MR approaches were MR–Egger, weighted median, simple mode, and weighted mode. Sensitivity analysis incorporated Cochran's Q and MR–Egger intercept tests to identify residual heterogeneity and potential horizontal pleiotropy, respectively. The MR–PRESSO distortion test was applied to identify potential pleiotropic outliers. Leave-one-out analysis confirmed that no single single-nucleotide polymorphism (SNP) significantly affected the MR estimate. We conducted reverse MR analysis to investigate the impact of variables correlated with outcomes in forward MR analysis. Results: The IVW method revealed a significant positive association between B cell count and CAD (odds ratio (OR) = 1.08 (95% CI: 1.04, 1.11), p = 2.67 × 10-5). A similar association was observed between B cell count and myocardial infarction (MI) (OR = 1.07 (95% CI: 1.03, 1.11), p = 5.69 × 10-4). Sensitivity analyses detected no outliers, heterogeneity, or pleiotropy. The reverse MR analysis was conducted to investigate the impact of CAD and MI on B cell count, and the IVW results showed no statistical significance. Conclusions: Our study suggests that a higher absolute B cell count is linked to an increased risk of CAD and MI.

Purpose: As a non-invasive coronary functional examination, coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) showed predictive value in several non-cardiac surgeries. This study aimed to evaluate the predictive value of CT-FFR in lung cancer surgery. Method: We retrospectively collected 227 patients from January 2017 to June 2022 and used machine learning-based CT-FFR to evaluate the stable coronary artery disease (CAD) patients undergoing lung cancer surgery. The major adverse cardiac event (MACE) was defined as perioperative myocardial injury (PMI), myocardial infarction, heart failure, atrial and ventricular arrhythmia with hemodynamic disorder, cardiogenic shock and cardiac death. The multivariate logistic regression analysis was performed to identify risk factors for MACE and PMI. The discriminative capacity, goodness-of-fit, and reclassification improvement of prediction model were determined before and after the addition of CT-FFR <= 0.8. Results: The incidence of MACE was 20.7 % and PMI was 15.9 %. CT-FFR significantly outperformed CCTA in terms of accuracy for predicting MACE (0.737 vs 0.524). In the multivariate regression analysis, CT-FFR <= 0.8 was an independent risk factor for both MACE [OR=10.77 (4.637, 25.016), P<0.001] and PMI [OR=8.255 (3.372, 20.207), P<0.001]. Additionally, we found that the performance of prediction model for both MACE and PMI improved after the addition of CT-FFR. Conclusions: CT-FFR can be used to assess the risk of perioperative MACE and PMI in patients with stable CAD undergoing lung cancer surgery. It adds prognostic information in the cardiac evaluation of patients undergoing lung cancer surgery.

The ubiquitinproteasome system (UPS) is the main mechanism responsible for the intracellular degradation of misfolded or damaged proteins. Under inflammatory conditions, the immunoproteasome, an isoform of the proteasome, can be induced, enhancing the antigen-presenting function of the UPS. Furthermore, the immunoproteasome also serves nonimmune functions, such as maintaining protein homeostasis and regulating signalling pathways, and is involved in the pathophysiological processes of various cardiovascular diseases (CVDs). This review aims to provide a comprehensive summary of the current research on the involvement of the immunoproteasome in cardiovascular diseases, with the ultimate goal of identifying novel strategies for the treatment of these conditions.

The impact of coronary calcification on the diagnostic accuracy of computed tomography-derived fractional flow reserve (CT-FFR) and coronary computed tomography angiography (CCTA) remains a crucial consideration. This meta-analysis aims to compare the diagnostic performance of CT-FFR and CCTA at different levels of coronary artery calcium score (CACS). We searched PubMed, Embase, and the Cochrane Library for relevant articles on CCTA, CT-FFR, and invasive fractional flow reserve (FFR). Ten studies were included to evaluate the diagnostic performance of CT-FFR and CCTA at the per-patient and per-vessel levels in four CACS groups. Invasive FFR was used as the reference standard. Except for the CACS ≥ 400 group, the AUC of CT-FFR was higher than those of CCTA in other subgroups of CACS (in CACS < 100 (per-patient, 0.9 (95

BACKGROUND:Coronary computed tomography angiography provides valuable information for evaluating the difficulty of chronic total occlusion (CTO) percutaneous coronary intervention. This study aimed to investigate the value of CTO plaque characteristics derived from radiomics analysis for predicting the difficulty of percutaneous coronary intervention. METHODS:Patients with CTO were retrospectively enrolled from a hospital as training and internal test sets and from the other 2 territory hospitals as external test sets. Radiomics characteristics were extracted from the CTO segment on coronary computed tomography angiography. Radiomics and combined models were developed to predict successful guidewire crossing within 30 minutes (guidewire success) of CTO percutaneous coronary intervention. Subgroup analysis was conducted to investigate the influence of potential risk factors on the radiomics model performance. RESULTS:A total of 551 patients (median, 60; interquartile range, 52.00-66.00 years, 460 men) with 565 CTO lesions were finally enrolled. In the training, internal test, and external test sets, 203 of 357, 85 of 149, and 38 of 59 CTO lesions achieved guidewire success, respectively. Six radiomics features were selected for constructing the radiomics model. In the external test set, the area under the receiver operating characteristic curve of the radiomics model was significantly higher than prior prediction models (P<0.05 for all) with the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of 0.86, 74.58%, 81.58%, and 61.90%, respectively. The performance of the radiomics model was dependent on calcification, CTO location, adjacent branch(es), and operator caseload. CONCLUSIONS:CTO characteristics revealed by radiomics analysis can be used as effective imaging biomarkers for predicting guidewire success. However, the performance of the radiomics model depends on anatomic and operator factors.

Objective To investigate the early and mid-term outcomes on percutaneous coronary intervention（PCI） in patients with coronary atherosclerotic heart disease and chronic renal failure（CRF） undergoing maintenance hemodialysis. Methods From April 2013 to October 2021, patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis were retrospectively analyzed in Beijing Anzhen Hospital, Capital Medical University. The pathological characteristics of coronary artery were summarized and the major adverse cardiac event（MACE） and changes in renal function during the perioperative period and during the postoperative follow-up were analyzed. Results Among 39 patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis, 34 cases were male and 5 cases were female, and aged（58±11）years. Three-vessel lesions accounted for the largest proportion of coronary artery lesions（48.7%, 19/39）, followed by double-vessel lesions（33.3%, 13/39）, and single-vessel lesions accounted for the least（17.9%, 7/39）. Most of them were coronary artery chronic total occlusion lesions（61.5%, 24/39）. Eleven patients（28.2%） underwent simple coronary balloon angioplasty and 28 patients（71.8%） underwent coronary stent implantation. The success rate of interventional operation was 100%. The serum creatinine of 39 patients before operation, 48 h after operation and 12 months of follow-up were（789±282）,（729±264）,（828±318）μmol/L respectively, and blood urea nitrogen were（21±7）,（17±5）,（22±7）mmol/L respectively, and there was no significant difference in different time（all P＞0.05）. The incidence of perioperative MACE was 5.1%（2/39）. During the follow-up period, 10 patients（25.6%） were readmitted due to cardiac events, and coronary angiography showed that 7 patients had in-stent restenosis to varying degrees. The incidence of MACE was 17.9%（7/39） and 30.8%（12/39） at 12 and 24 months after operation, respectively. Conclusions Satisfactory early and mid-term outcomes on PCI have been achieved in patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis. In-stent restenosis is the main cause of coronary event for these patients during follow-up and close follow-up is suggested. Long-term effect needs further follow-up confirmation with more cases.

近年来随着生活水平的提高以及危险因素的增加,心血管疾病的发病率仍然处于上升趋势,也是致死和致残的主要因素.但在此数据中,隐藏着心血管疾病相关认知正在发生变化的迹象.呼吸困难和心绞痛仍是常见的主诉,然而在进行冠状动脉造影检查的患者中,将近60％的未发现明显的冠状动脉阻塞性病变[1].冠状动脉系统包括三个部分:心外膜大血管(直径500m～5mm)、前小动脉(直径100～500m)和小动脉(直径100m).冠状动脉造影主要观察冠状动脉心外膜大血管,而前小动脉和小动脉组成"冠状动脉微循环",占整个冠状动脉系统的95％,是无法通过造影进行评估的[2].

目的 本研究分别基于冠状动脉(冠脉)计算机断层血管成像(CTA)成像及冠脉造影对慢性完全闭塞病变(CTO)的斑块成分及病变特点分析,分析临床危险因素(高血压,糖尿病,肾功能不全,吸烟)与斑块成分及病理特点的关系.方法 回顾性收集2015年9月至2019年9月于北京安贞医院及北京友谊医院住院行冠脉造影证实存在单支CTO病变,且在住院前2个月内完成冠脉CTA的195例患者.应用冠脉CTA对CTO病变进行斑块成分分析,应用冠脉造影分析CTO病变特点.结果 基于冠脉CTA分析,糖尿病与非糖尿病患者相比,坏死脂核容积[55.88(26.40～98.96)vs.62.41(31.62～117.91)]、纤维脂肪斑块容积[25.08(9.93～50.18)vs.29.57(13.62～56.31)]、纤维斑块容积[17.39(3.31～45.52)vs.12.53(3.34-33.83)]、钙化斑块容积[0.85(0.00～6.44)vs.0.11(0.00～7.84)]、纤维钙化斑块容积[18.96(3.31～52.83)vs.15.42(3.34-44.34)]等方面差异无统计学意义(P＞0.05).高血压与非高血压患者相比,坏死脂核容积[58.47(26.71-101.49)vs.64.18(33.81-113.93)]、纤维脂肪斑块容积[27.07(12.61～54.45)vs.26.92(13.30～55.72)]、纤维斑块容积[12.58(3.23～42.53)vs.13.10(4.17～33.54)]、钙化斑块容积[0.12(0.00～5.94)vs.0.32(0.00～12.46)]、纤维钙化斑块容积[15.42(3.23～45.45)vs.16.85(4.17～48.35)]差异无统计学意义(P＞0.05).肾功能不全与非肾功能不全患者相比,坏死脂核容积[44.94(28.80～63.80)vs.62.38(30.69～110.81)]、纤维脂肪斑块容积[20.30(6.10～35.95)vs.27.76(13.04～55.28)]、纤维斑块容积[9.83(3.03～42.72)vs.13.10(3.43～39.81)]、钙化斑块容积[1.38(0.00～12.67)vs.0.19(0～7.40)]、纤维钙化斑块容积[12.49(3.03～45.45)vs.15.56(3.44～47.37)]差异无统计学意义(P＞0.05).吸烟与不吸烟患者相比,坏死脂核容积[67.73(35.70～124.49)vs.51.77(22.77～90.36)]、纤维脂肪斑块容积[28.53(15.10～57.89)vs.25.23(9.86～53.01)]、纤维斑块容积[13.10(3.26～34.81)vs.12.58(4.14～44.66)]、钙化斑块容积[0.19(0.00～8.80)vs.0.25(0.00～6.56)]、纤维钙化斑块容积[15.42(3.26～46.59)vs.16.44(4.14～48.36)]差异无统计学意义(P＞0.05).基于冠脉造影分析,糖尿病与非糖尿病相比,高血压与非高血压相比,肾功能不全与非肾功能不全相比,吸烟与非吸烟相比,钝头样闭塞残端、纤维帽模糊不全、闭塞段近端及远端是否存在严重病变、是否存在微通道、多节段闭塞、重度钙化、闭塞段长度＞20 mm等方面,差异无统计学意义(P＞0.05).结论 在本研究中,对于CTO患者,是否合并高血压、糖尿病、肾功能不全、吸烟等危险因素,斑块成分及病变特点无显著差异.对于术前CTO病变的斑块成分预测及病变特点预测不能完全依赖临床病史.对于CTO患者,术前冠脉CTA对于斑块成分及病变特点的评价更为重要.

Aims: We aimed to explored the association between the use of optimal medical therapy (OMT) in patients with myocardial infarction (AMI) and diabetes mellitus (DM) and clinical outcomes. Methods: Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coro-nary Syndrome (BleeMACS) is an international registry that enrolled participants with acute coronary syndrome followed up for at least 1 year across 15 centers from 2003 to 2014. Baseline characteristics and endpoints were analyzed. Results: Among 3095 (23.2%) patients with AMI and DM, 1898 (61.3%) received OMT at hospital discharge. OMT was associated with significantly reduced mortality (4.3% vs. 10.8%, p < 0.001), re-AMI (4.4% vs. 8.1%, p < 0.001), and composite endpoint of death/re-AMI (8.0% vs. 17.6%, p < 0.001). No difference was observed among regions. Propensity score matching confirmed that OMT significantly associated with lower mortality. After adjusting for confounding variables, OMT, drug-eluting stents, and complete revascularization were in-dependent protective factors of 1-year mortality, whereas left ventricular ejection fraction and age were risk factors. Conclusions: Guideline-recommended OMT was prescribed at suboptimal frequencies with geographic variations in this worldwide cohort. OMT can improve long-term clinical outcomes in patients with DM and AMI. Clinical Trial Registration: NCT02466854 June 9, 2015.

目的:应用中国专家共识制定的家族性高胆固醇血症(FH)诊断标准,对既往住院且初次诊断为急性心肌梗死(AMI)的青年患者进行FH筛查,了解FH检出率和临床特征.方法:收集2007年1月至2017年12月,北京安贞医院18～44岁初次诊断为AMI的住院患者,通过电子病历系统提取年龄、性别、一级亲属早发冠心病病史、出院诊断等一般临床资料以及高血压病史、糖尿病史、肥胖、吸烟4项动脉粥样硬化性心血管疾病传统危险因素信息以及LDL-C水平.应用中国专家共识制定的FH诊断标准,筛查FH患者.结果:共纳入初发AMI的青年患者2 781例,平均年龄(39±5)岁,男性2 657例(95.5％).FH检出率为2.3％(63/2781),男性检出率低于女性(2.1％vs.6.5％,x2=10.273,P=0.001).＜35岁组、35～39岁组和40～44岁检出率分别为3.7％(17/463)、2.6％(20/768)和1.7％(26/1550),＜35岁组FH检出率高于其他年龄组(X2=6.954,P=0.031).FH诊断患者中,一级亲属早发冠心病(CHD)家族史以父亲/母亲CHD病史构成比最高,为61.9％(39/63),4例(6.3％)父母及同胞均有CHD病史;19.0％(12/63)没有CHD传统危险因素,81.0％(51/63)具有1项或2项危险因素.81.0％(51/63)表现为ST段抬高型心肌梗死.所有FH患者造影结果均证实具有明显的狭窄.抽取年龄≥35岁且LDL-C≥3.4mmol/L研究对象,与阜外医院经FH基因检测的相同特征冠心病患者相比,中国专家共识标准FH检出率显著低于FH基因诊断结果(10.8％vs.38.1％,x2=27.767,P＜0.001).结论:应用中国专家共识制定的FH诊断标准,初发AMI的青年患者FH检出率为2.3％,可能低估此人群FH患病率;FH临床诊断患者一级亲属以父亲或母亲CHD家族史为主;大多数FH患者早发AMI是遗传和CHD危险因素共同作用的结果.

This study aimed to establish a new scoring system that includes histological quantitative features derived from coronary computed tomographic angiography (CCTA) to predict the efficiency of chronic total occlusion percutaneous coronary intervention (CTO-PCI). This study analyzed clinical, morphological, and histological characteristics of 207 CTO lesions in 201 patients (mean age 60.0 [52.0–65.0] years, 85% male), which were recruited from two centers. The primary endpoint was a guidewire successfully crossing the lesions within 30 m. The new predictive model was generated by factors that were determined by multivariate analysis. The CCTA plaque (CTAP) score that included a quantitative plaque characteristic was developed by assigning an appropriate integer score to each independent predictor, then summing all points. In addition, the CTAP score was compared with other predictive scores based on CCTA. The endpoint was achieved in 63% of the lesions. The independent predictors included previous CTO-PCI failure, the proximal blunt stump, proximal side branch, distal side branch, occluded segment bending > 45°, and high-density plaque volume (fibrous volume + calcified volume) ≥ 19.9 mm3. As the score increased from 0 to 5, the success rate of the guidewire crossing within 30 m decreased from 96 to 0%. Comparing the CTAP score with other predictive scores, the CTAP score showed the highest discriminant power (c-statistic = 0.81 versus 0.73–0.77, p value 0.02–0.07). The CTAP score showed similar results for procedural success. The CTAP score efficiently predicted the guidewire crossing efficiency and procedural success. • An increase in high-density plaque volume (fibrous + dense calcium) was more probable to reduce the efficiency of crossing and lead to procedural failure. • The new prediction scoring system with the addition of the quantitative characteristics of plaques had an improved predictive ability compared with the traditional prediction scoring system.

Aims:Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is characterized by a low success rate and an increase in complications. This study aimed to explore a new and simple classification method based on plaque composition to predict guidewire (GW) crossing within 30 min of CTO lesions.Methods:This study consecutively enrolled individuals undergoing attempted PCI of CTO who underwent coronary computed tomographic angiography (CCTA) within 2 months. Lesions were divided into soft and hard CTO groups according to the necrotic core proportion.Results:In this study, 207 lesions were divided into soft (20.3%) and hard CTO (79.7%) groups according to a necrotic core percentage cutoff value of 72.7%. The rate of successful GW crossing within 30 min (57.6 vs. 85.7%, p = 0.004) and final success (73.3 vs. 95.2%, p = 0.001) were much lower in the hard CTO group. For patients with hard CTO, previous failed attempt, proximal side branch, bending > 45 degrees calcium ≥ 50% cross-sectional area (CSA), and distal reference diameter ≤ 2.5 mm were demonstrated to be associated with GW failure within 30 min. For patients with soft CTO, only blunt entry was proved to be an independent predictive factor of GW failure within 30 min.Conclusions:Grouping CTO lesions according to the proportion of necrotic core is reasonable and necessary in predicting GW crossing within 30 min. A soft CTO with a necrotic core is more likely to be recanalized compared with a hard CTO with fibrous and/or dense calcium. Different plaque types have variable predictive factors.

目的 分析青年初发急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)后在院期间左室射血分数(LVEF)异常及其影响因素并评估规范化治疗情况.方法 回顾性分析2007年1月至12月间于北京安贞医院收治的18～44岁初次诊断为AMI并行急诊PCI的患者资料.通过电子病历系统提取患者年龄、性别、出院诊断、Killip分级等一般临床资料及高血压、糖尿史、肥胖、吸烟、血脂异常等心血管疾病传统危险因素和心脏超声检查中LVEF.结果 共纳入青年初发AMI患者1466例,其中男性1418例(96.7％),平均年龄(38.9±4.7)岁.LVEF平均水平(58.1±8.7)％,1247例(85.1％)患者LVEF≥50％;174例(11.9％)患者LVEF介于40％～49％;45例(3.1％)患者LVEF<40％.347例(23.7％)患者合并心力衰竭(心衰),其中1.7％(25/1466)为LVEF减低的心衰(LVEF<40％),16.0％(253/1466)为LVEF保留的心衰(LVEF≥50％),4.7％(69/1466)为LVEF中间值的心衰(LVEF 40％～49％).左主干病变(OR=3.35,95％CI:1.58～7.13)、左前降支病变(OR=3.76,95％CI:2.19～6.45)以及ST段抬高型心肌梗死(STEMI,OR=3.70,95％CI:2.13～6.25)与LVEF异常具有显著相关性.LVEF<50％的患者β受体阻滞剂、ACEI/ARB及利尿剂的应用率分别为:90.0％、67.1％和30.1％,β受体阻滞剂和利尿剂的应用率高于LVEF≥50％的患者.结论 青年初发AMI患者急诊PCI术后在院期间LVEF≥50％的比例高,心衰类型以LVEF保留心衰为主.左主干病变、左前降支病变以及STEMI与LVEF降低显著相关.临床需进一步规范改善心衰预后的药物应用.