BACKGROUND:The non-exercise estimated cardiorespiratory fitness (eCRF) has been recognized as an important predictor of mortality among the general population. This study sought to evaluate the relationship between eCRF and mortality from all causes, cardiovascular disease (CVD), and cancer in hypertensive adults. METHODS:We included 27,437 adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) III and 10 NHANES cycles from 1999 to 2018. Multivariate Cox proportional hazard models were used to assess the hazard ratios and 95% confidence intervals (CIs) of eCRF for mortality. RESULTS:A total of 8,023 deaths were recorded throughout a median 8.6-year follow-up, including 2,338 from CVD, and 1,761 from cancer. The eCRF with per 1 metabolic equivalent increase was linked to decreased risk of all-cause (adjusted HR 0.78, 95% CI: 0.75-0.81) and CVD mortality (adjusted HR 0.79, 95% CI: 0.74-0.84), rather than cancer mortality (adjusted HR 0.94, 95% CI: 0.86-1.03). Moreover, a stronger protective effect of eCRF was observed for females (HR 0.66 (95% CI: 0.62-0.72) versus HR 0.78 (95% CI: 0.73-0.83), Pinteraction < 0.001 for all-cause mortality; HR 0.70 (95% CI: 0.61-0.80;) versus HR 0.82 (95% CI: 0.73-0.92), Pinteraction = 0.026 for CVD mortality) compared with males. Findings did not significantly differ in subgroup analyses and sensitivity analyses. CONCLUSIONS:Among adults with hypertension, eCRF was inversely related to all-cause and CVD mortality, but not cancer mortality. A significant interaction effect existed between sex and eCRF. Further studies are needed to verify this association in different populations.

BackgroundData on drug-coated balloons (DCB) for de novo coronary chronic total occlusion (CTO) are limited. We aimed to investigate the long-term outcomes of substitution of drug-eluting stents (DES) by DCB.MethodsWe compared the outcomes of less DES strategy (DCB alone or combined with DES) and DES-only strategy in treating de novo coronary CTO in this prospective, observational, multicenter study. The primary endpoints were major adverse cardiovascular events (MACE), target vessel revascularization, myocardial infarction, and death during 3-year follow-up. The secondary endpoints were late lumen loss (LLL) and restenosis until 1-year after operation.ResultsOf the 591 eligible patients consecutively enrolled between January 2015 and December 2019, 281 (290 lesions) were treated with DCB (DCB-only or combined with DES) and 310 (319 lesions) with DES only. In the DCB group, 147 (50.7%) lesions were treated using DCB-only, and the bailout stenting rate was relatively low (3.1%). The average stent length per lesion in the DCB group was significantly shorter compared with the DES-only group (21.5 ± 25.5 mm vs. 54.5 ± 26.0 mm, p < 0.001). A total of 112 patients in the DCB group and 71 patients in the DES-only group (38.6% vs. 22.3%, p < 0.001) completed angiographic follow-up until 1-year, and LLL was much less in the DCB group (−0.08 ± 0.65 mm vs. 0.35 ± 0.62 mm, p < 0.001). There were no significant differences in restenosis occurrence between the two groups (20.5% vs. 19.7%, p > 0.999). The Kaplan–Meier estimates of MACE at 3-year (11.8% vs. 12.0%, log-rank p = 0.688) was similar between the groups.ConclusionPercutaneous coronary intervention with DCB is a potential “stent-less” therapy for de novo CTO lesions with satisfactory long-term clinical results compared to the DES-only approach.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a new class of potent lipid-lowering drugs. Oxidized low-density lipoprotein (ox-LDL) is the key pathogenic factor leading to atherosclerosis. However, its effect on ox-LDL levels has not been clinically reported. The clinical data of 290 very high-risk atherosclerotic cardiovascular disease (ASCVD) patients diagnosed in the First Affiliated Hospital of Zhengzhou University from May 2022 to October 2022 were collected retrospectively. According to whether evolocumab (a PCSK9 inhibitor) was used after percutaneous coronary intervention (PCI), they were divided into evolocumab group (153 cases) and statin monotherapy group (137 cases). At hospital admission, ox-LDL, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoproteinA1 (apoA1), apolipoprotein B-100 (apoB), lipoprotein (a) [Lp(a)], and high-sensitivity reactive protein (hs-CRP) levels were collected and used as baseline data. After two weeks of treatment, ox-LDL in the evolocumab group and statin monotherapy group were significantly lower than those before treatment (p<0.05). The decrease of ox-LDL in the evolocumab group was more than in the stain monotherapy group (p<0.05). In conclusion, PCSK9 inhibitors reduce ox-LDL levels in very high-risk ASCVD patients in a short time.

Background Current research results show that drug-coated balloons (DCB) have unique advantages in the treatment of in-stent restenosis, small vessel disease, bifurcation lesions, and de novo lesions, but the data regarding rotational atherectomy (RA) followed by DCB treatment in calcified lesions, especially severe coronary artery calcification (CAC), are limited. Methods A retrospective study was conducted on 318 individuals with severe CAC who underwent RA-assisted PCI at the First Affiliated Hospital of Zhengzhou University from May 2018 to July 2021. Among them, 57 patients (RA/DCB group) were treated with DCB, and 261 patients (RA/DES group) were treated with drug-eluting stents (DES). The two groups' clinical baseline data, lesion characteristics, intraoperative complications, in-hospital adverse events, and major adverse cardiovascular and cerebrovascular events (MACCE) were compared throughout the follow-up period. Results The baseline clinical data, intraoperative complications, and in-hospital adverse events were not significantly different between the two groups. The anatomical categories in the RA/DES group were more complex and included left main coronary disease, bifurcation disease, and multivessel disease. Although target lesion revascularization (13.79% vs. 7.02%) and MACCE (18.77% vs. 12.28%) occurred more frequently in the RA/DES group than in the RA/DCB group, there was no statistically significant difference ( p > 0.05). Multivariate Cox regression analysis showed that bifurcation lesions (HR 2.284, 95% CI 1.063–4.908, p = 0.034), total length of DCB/DES (HR 1.023, 95% CI 1.005–1.047, p = 0.014) and SYNTAX score (HR 1.047, 95% CI 1.013–1.082, p = 0.006) were independent risk factors for MACCE during the follow-up period. Conclusion Drug-coated balloon treatment after rotational atherectomy appears safe and effective in selected severe coronary artery calcification.

Background:Coronary artery calcification (CAC) is associated with high rates of restenosis and adverse clinical events after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Objectives:The aim of this study was to evaluate the long-term clinical outcomes of drug-coated balloon (DCB)-only treatment for de novo lesions with and without CAC. Methods:Patients with de novo coronary disease treated with the DCB-only strategy were retrospectively enrolled from three centers and categorized into a CAC group and a non-CAC group. The primary endpoint was the target lesion failure (TLF) rate during the 3-year follow-up. Secondary endpoints included the occurrence of major adverse cardiac events (MACEs), target lesion revascularization (TLR), cardiac death, myocardial infarction (MI) and any revascularization. Propensity score matching (PSM) was conducted to assemble a cohort of patients with similar baseline characteristics. Results:A total of 1,263 patients with 1,392 lesions were included, and 243 patients were included in each group after PSM. Compared with the non-CAC group, the incidence rates of TLF (9.52% vs. 4.94%, odds ratio [OR]: 2.080; 95% confidence interval [CI]: 1.083-3.998, P = 0.034) and TLR (7.41% vs. 2.88%, OR: 2.642; 95% CI: 1.206-5.787, P = 0.020) in the CAC group were higher. The incidence rates of MACE (12.35% vs. 7.82%, OR: 1.665; 95% CI: 0.951-2.916, P = 0.079), cardiac death (2.06% vs. 2.06%, OR: 0.995; 95% CI: 0.288-3.436, P = 0.993), MI (1.23% vs. 0.82%, OR: 2.505; 95% CI: 0.261-8.689, P = 0.652) and any revascularization (12.76% vs. 9.67%, OR: 1.256; 95% CI: 0.747-2.111, P = 0.738) were similar between groups. Conclusions:CAC increased the incidence of TLF and TLR without a substantial increase in the risk of MACE, cardiac death, MI, or any revascularization in patients treated with DCB-only angioplasty during the 3-year follow-up.

目的:探索冠状动脉(冠脉)旋磨术(RA)联合药物涂层球囊(DCB)治疗严重冠脉钙化病变的疗效.方法:连续入选2018年5月—2021年7月就诊于郑州大学第一附属医院因冠脉严重钙化行RA的患者318例,根据不同治疗方案分为RA/DCB组(57例)和RA/药物洗脱支架(DES)组(261例).比较两组一般临床资料、冠脉病变特征、术中并发症、院内不良事件、随访期间主要心脑血管不良事件(MACCE)发生率.结果:两组基线临床资料、术中并发症、院内不良事件均差异无统计学意义.RA/DES组较多合并左主干病变、分叉病变、弥漫性病变等复杂解剖类型(均P＜0.05).随访期间RA/DES组MACCE(18.77％vs.12.28％)及靶病变血运重建(13.79％vs.7.02％)发生率较RA/DCB组升高,但差异无统计学意义.多因素Cox回归分析显示,分叉病变(HR=2.284,95％CI:1.063～4.908,P=0.034)、植入物总长度(HR=1.023,95％CI:1.005～1.047,P=0.014)、SNYT AX 评分(HR:1.047,95％CI:1.013～1.082,P=0.006)是 RA-PCI 术后远期 MACCE 发生的危险影响因素.结论:RA联合DCB可对部分适合的钙化病变进行安全有效的治疗.

BACKGROUND:Controversy exists as to the optimal treatment approach for ostial left anterior descending (LAD) or ostial left circumflex artery (LCx) lesions. Drug-coated balloons (DCB) may overcome some of the limitations of drug-eluting stents (DES). Therefore, we investigated the security and feasibility of the DCB policy in patients with ostial LAD or ostial LCx lesions, and compared it with the conventional DES-only strategy.METHODS:We retrospectively enrolled patients with de novo ostial lesions in the LAD or LCx who underwent interventional treatment. They were categorized into two groups based on their treatment approach: the DCB group and the DES group. The treatment strategies in the DCB group involved the use of either DCB-only or hybrid strategies, whereas the DES group utilized crossover or precise stenting techniques. Two-year target lesion revascularization was the primary endpoint, while the rates of major adverse cardiovascular events, cardiac death, target vessel myocardial infarction, and vessel thrombosis were the secondary endpoints. Using propensity score matching, we assembled a cohort with comparable baseline characteristics. To ensure result analysis reliability, we conducted sensitivity analyses, including interaction, and stratified analyses.RESULTS:Among the 397 eligible patients, 6.25% of patients who were planned to undergo DCB underwent DES. A total of 108 patients in each group had comparable propensity scores and were included in the analysis. Two-year target lesion revascularization occurred in 5 patients (4.90%) and 16 patients (16.33%) in the DCB group and the DES group, respectively (odds ratio = 0.264, 95% CI: 0.093-0.752, P = 0.008). Compared with the DES group, the DCB group demonstrated a lower major adverse cardiovascular events rate (7.84% vs. 19.39%, P = 0.017). However, differences with regard to cardiac death, non-periprocedural target vessel myocardial infarction, and definite or probable vessel thrombosis between the groups were non-significant.CONCLUSIONS:The utilization of the DCB approach signifies an innovative and discretionary strategy for managing isolated ostial lesions in the LAD or LCx. Nevertheless, a future randomized trial investigating the feasibility and safety of DCB compared to the DES-only strategy specifically for de novo ostial lesions in the LAD or LCx is highly warranted.

Background Drug-coated balloons (DCB), alone or in combination with drug-eluting stents (DES), may be used to treat diffuse coronary lesions. We aimed to explore the efficacy and safety of DCB in patients with diffuse coronary lesions. Methods Consecutive patients with diffuse coronary lesions (lesion length > 25 mm) who underwent DCB and/or DES between January 2015 and December 2019 were included in this prospective, observational, multicenter study. The DCB group included 355 patients (360 lesions), of which 142 patients (143 lesions, 39.7%) received the DCB-only strategy and 213 patients (217 lesions, 60.3%) received the hybrid strategy (DCB combined with DES). The DES group included 672 patients (831 lesions) treated with DES alone. Target lesion revascularization (TLR) during 3-year follow-up was the primary outcome of interest. The secondary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction, and target vessel revascularization. Results The two groups had comparable baseline clinical and lesion characteristics. Lesion length was similar (43.52 ± 16.46 mm vs. 44.87 ± 15.80 mm, P = 0.181), but the stent length in the DCB group was significantly shorter (24.02 ± 23.62 mm vs. 51.89 ± 15.81 mm, P < 0.001). Ten lesions (2.8%) in the DCB group received bailout stents. Over 3 years of follow-up, no significant difference in TLR incidence between the groups (7.3 vs. 8.3%, log-rank P = 0.636) was observed. Incidence of MACE also did not differ significantly (11.3 vs. 13.7%, log-rank P = 0.324). No thrombosis events occurred in the DCB group, while four patients (0.6%) in the DES group experienced stent thrombosis (log-rank P = 0.193). Moreover, similar TLR and MACE rates were observed between DCB-only and hybrid strategies (TLR: 6.4 vs. 8.0%, log-rank P = 0.651; MACE: 11.4 vs. 11.2%, log-rank P = 0.884). Conclusion Long-term outcomes show that the efficacy and safety of the DCB strategy (DCB alone or combined with DES) are similar to those of DES alone in diffuse coronary lesions. These findings suggest that this strategy is a promising alternative for select patients with diffuse coronary lesions.

BACKGROUND Currently, there is no optimal treatment strategy for ostial left anterior descending (LAD) or ostial left circumflex artery (LCx) lesions. This study explored effectiveness and safety of drug-coated balloons (DCB) in individuals presenting with ostial LAD or LCx lesions. METHODS A total of 137 patients with de novo ostial LAD or LCx lesions scheduled for DCB treatment were prospectively recruited into the study. After mandatory lesion preparation, DCB-only or hybrid strategy [DCB + drug-eluting stent (DES)] were performed on 120 patients (87.59%). The primary endpoint was the rate of 2-year target lesion revascularization (TLR). Rates of major adverse cardiovascular events (MACE), cardiac death, target vessel myocardial infarction (TVMI), and vessel thrombosis were explored as the secondary outcomes. Quantitative coronary angiography software was used to analyze coronary angiograms. RESULTS Of the participants, 58 were treated with DCB-only and 62 with hybrid strategy. Relative to the DCB-only group, patients in the hybrid group had longer target lesions (15.47 ± 10.08 vs. 36.85 ± 9.46 mm, P<0.001) and higher Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) scores (23.47 ± 5.22 vs. 29.98 ± 3.18, P<0.001). During follow-up (731 ± 64 days), neither the primary endpoint (TLR) nor the secondary endpoints (including MACE, cardiac death, TVMI, and vessel thrombosis) differed statistically between the two groups (all P > 0.05). Treatment strategy (DCB-only or hybrid) was not a significant risk factor for TLR. Patients who underwent DCB-only exhibited less late lumen loss compared with the patients who underwent hybrid strategy (-0.26 ± 0.59 vs. 0.42 ± 0.47 mm, P<0.001) at 1-year angiographic follow-up. CONCLUSIONS With regards to safety and efficacy, the strategy of DCB as a standalone therapy was similar in comparison with the hybrid strategy of DCB + DES for ostial LAD and ostial LCx lesions. This approach might be effective and technically easy in treating ostial LAD and LCx diseases.

目的 评估PCSK9抑制剂依洛尤单抗对他汀治疗后存在残余风险的超高危急性冠脉综合征(ACS)患者的早期治疗效果.方法 按照纳排标准纳入2019年10月至2021年12月于郑州大学第一附属医院诊断为超高危ACS已服用他汀类药物治疗后接受依洛尤单抗注射液1支(140 mg)腹部皮下注射的患者118例,主要随访观察入院后、用药后3 d、用药后30 d的低密度脂蛋白(LDL-C)、高敏C反应蛋白(hs-CRP)水平及其变化情况;据基线LDL-C、hs-CRP水平将入选人群分为4组:A组(46例)、B组(50例)、C组(8例)、D组(14例),对他汀治疗后超高危ACS患者的残余风险进行分析,评估依洛尤单抗抑制剂在不同残余风险的患者中早期治疗作用有无差异;通过门诊或者电话随访用药后30 d内有无用药不良反应及不良心脑血管事件.结果 在他汀治疗后的超高危ACS患者中,使用依洛尤单抗后早期即能迅速降低患者的LDL-C水平,降脂幅度不受基线LDL-C、hs-CRP水平的影响;对于仅存在残余炎症风险的患者(C组)用药后30 d的LDL-C的降幅低于残余胆固醇风险与炎症风险共存者(A组)、仅存在胆固醇风险的患者(B组)、无残余风险的患者(D组);对于hs-CRP来说,用药后3 d各组hs-CRP水平较基线升高,用药后30 d较用药后3 d下降.结论 超高危ACS患者合并因素多,即使使用他汀治疗后仍存在较高的残余风险,在他汀基础上加用PCSK9抑制剂早期即可迅速降低ACS超高危患者的LDL-C水平,早期降幅不受基线LDL-C、hs-CRP水平的影响;用药后30 d,对于存在残余胆固醇风险与残余炎症风险共存的患者以及仅存在残余胆固醇风险的患者获益大于仅存在残余炎症风险的患者;应用依洛尤单抗后也会对hs-CRP产生一定影响.

AimsAn increasing body of evidence suggests that drug-coated balloon (DCB) angioplasty represents a valuable option for revascularization in selected patients with coronary bifurcation disease. However, there remains a paucity of real-world observational evidence on the efficacy of DCB in left main (LM) true bifurcation lesion. We compared clinical and angiographic outcomes of hybrid [DCB + drug-eluting stent (DES)] versus DES-only strategy (provisional stenting or two-stent strategies) in de novo LM true bifurcated lesions.MethodsThe primary endpoint was the 2-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (CD-TLR). A routine 1-year angiographic follow-up was scheduled. Propensity-score matching was utilized to assemble a cohort of patients with similar baseline characteristics.ResultsAmong 1077 eligible patients, 199 who received DCB treatment and 398 who were assigned to DES therapy had similar propensity scores and were included in the analysis. TLF within 2 years occurred in 13 patients (7.56%) assigned to DCB group, and 52 patients (14.36%) assigned to DES group (odds ratio: 0.487; 95% confidence interval: 0.258–0.922; P = 0.025; Log-rank P = 0.024). Compared with the DES group, the DCB group resulted in a lower rate of CD-TLR (2.91% vs. 9.42%; P = 0.007). Cardiac death, TVMI, all-cause mortality, and stent thrombosis were comparable between both groups. Patients treated with DES-only were associated with a higher late lumen loss (0.42 ± 0.62 mm vs. 0.13 ± 0.42 mm, P < 0.001) compared with the DCB group at 1 year. In sensitivity analysis, the DCB group also presented a lower incidence of TLF, CD-TLR and stent thrombosis both compared to the two-stent strategy and compared to provisional stenting (Ps < 0.05).ConclusionThe 2-year results of PCI utilizing DCB for LM true bifurcation lesions are superior to employing DES alone in terms of safety and effectiveness.

目的 探讨早发和晚发冠心病患者发生支架内再狭窄(ISR)的临床特点及危险因素差异.方法 收集2018年1月至2019年12月在郑州大学第一附属医院接受经皮冠状动脉介入(PCI)术治疗的972例冠心病患者的手术资料及临床资料,根据有无ISR及NECP-ATP Ⅲ规定分为ISR组102例、非ISR组870例,其中早发冠心病组492例(ISR组50例、非ISR组442例),晚发冠心病组480例(ISR组52例、非ISR组428例),分析早发与晚发冠心病患者支架内再狭窄的临床特点及危险因素差异.结果 ISR组患者高血压、糖尿病、冠心病家族史比例、糖化血红蛋白(HbA1c)水平、低密度脂蛋白胆固醇(LDL-C)水平、多支病变比例、支架数及总支架长度较非ISR组高,高密度脂蛋白胆固醇(HDL-C)水平较非ISR组低(P＜0.05);早发ISR组吸烟比例、冠心病家族史比例、LDL-C水平、多支病变比例、支架数及总支架长度较非ISR组高,HDL-C水平较非ISR组低(P＜0.05);晚发ISR组高血压、糖尿病比例、HbA1c水平、多支病变比例、支架数及总支架长度较非ISR组高,支架直径较非ISR组小(P＜0.05).多因素logistic回归分析显示,总体患者中冠心病家族史、HbA1c、LDL-C、总支架长度是ISR的独立危险因素,早发组中冠心病家族史、LDL-C、总支架长度是ISR的独立危险因素;晚发组中高血压、糖尿病、HbA1c、总支架长度、支架直径是ISR的独立危险因素.结论 不同年龄人群发生ISR的危险因素存在差异,早发冠心病ISR患者具有更多的冠心病家族史和更高的LDL-C水平,晚发冠心病ISR患者存在更多的高血糖、高血压以及更小的靶病变血管.更多更长的支架植入会增加所有冠心病患者发生ISR的风险.

Although drug-eluting stents are the most common interventional devices for patients with coronary disease, drug-coated balloons (DCBs) represent a novel therapeutic alternative in certain scenarios. This prospective, observational all-comers study explored the clinical outcomes of DCB use in patients with coronary lesions. All patients treated with DCBs were enrolled in this study, including patients with in-stent restenosis (ISR) or de novo lesions. The primary outcome was the target lesion revascularization (TLR) rate at one year. We enrolled 2306 patients with 2660 lesions and performed DCB angioplasty in 399 patients (17.3%) with ISR and 1907 patients (82.7%) with de novo lesions. During follow-up (366 ± 46 days), the TLR rate was lower in the de novo lesion group (1.31%) compared to the ISR group (7.02%) [odds ratio (OR) 0.176, 95% confidence interval (CI) 0.101–0.305, p < 0.001]. Patients with de novo lesions had a lower yearly incidence of MACE compared to ISR patients (2.73 vs. 9.27%, respectively, OR 0.274, 95% CI 0.177–0.424, p < 0.001) and a lower incidence of any revascularization (5.09 vs. 13.03%, OR 0.358, 95% CI 0.251–0.510, p < 0.001). No significant differences between groups were observed in the rates of cardiac death (OR 0.783, 95% CI 0.258–2.371, p = 0.655) or MI (OR 0.696, 95% CI 0.191–2.540, p = 0.573). DCB angioplasty in this all-comers, real-world, prospective study was safe and efficient with low TLR and MACE rates. Thus, DCB appears to be an attractive alternative for the stent-less treatment of de novo coronary lesions. ISR in-stent restenosis; OR odds ratio; CI confidence interval; TLR target lesion revascularization; MACE major adverse cardiovascular events; MI myocardial infraction. MACE defined as the composite outcome of cardiac death, myocardial infarction, and target vessel revascularization. Any revascularization includes any percutaneous coronary intervention, and coronary artery bypass grafting.

Background. Diabetes is an independent risk factor for coronary artery disease and portends adverse prognosis in diabetic patients undergoing percutaneous coronary intervention (PCI) compared to nondiabetic patients. Few studies are currently available regarding the relationship between diabetes duration and major adverse cardiac events (MACEs) post-PCI. This study is aimed at assessing the association between diabetes duration and major adverse cardiac events after PCI. Methods. A total of 302 cases of diabetic patients undergoing an elective PCI with drug-eluting stent (DES) deployment and or percutaneous transluminal coronary angioplasty (PTCA) using a drug-coated balloon (DCB) were prospectively studied. We divided patients into three groups based on diabetes duration: <5 years group ( n = 165 ), 5–10 years’ group ( n = 72 ), and ≥10 years’ group ( n = 65 ). Angiographic and clinical follow-up were conducted 12 months after the procedures for all the patients and at any given time during the study when needed. Results. A significantly higher rate of myocardial infarction (MI) in diabetic patients with the longest diabetes duration (7.7% vs. 0% and 0.6%, P = 0.001 ) was observed compared with groups of shorter duration. Repeat coronary revascularization was found to be significantly higher in the >10-year group than was it in groups with shorter duration of diabetes (23.1% vs. 19.4% and 9.10%, P = 0.03 ). After adjustment for confounding risk factors, longer diabetes duration remained an independent predictor of MI (hazard ratio (HR): 5.525, confidence interval (CI): 1.273-23.978, P = 0.022 ) and repeat revascularization (HR: 1.608, CI: 1.058-2.443, P = 0.026 ). Repeat revascularization was significantly related to the progression of nontreated lesions (De novo lesions 20% vs. 18% and 7.3%, P = 0.009 ) compared to previously treated lesions (target lesion revascularization (TLR) 3% vs. 1.3% and 2%, P = 0.774 ). However, all-cause mortality was not significantly different among the groups (3.1% vs. 5.6% and 0.6%, P = 0.06 , HR: 2.403, CI: 0.464-12.436, P = 0.293 ). Conclusion. Diabetes duration was associated with significant differences in major adverse cardiac events after the percutaneous coronary intervention; the longest diabetes duration portended higher rates of MACEs than shorter duration at the 12-month follow-up.

人工心脏起搏是目前临床上治疗症状性心动过缓最有效和最成熟的方式,其挽救了数以万计患者的生命[1].右室心尖部是既往最常用的起搏部位,许多临床研究证实右室心尖部起搏会改变心脏正常激动顺序,使心室收缩失同步导致心功能不全、瓣膜反流及心房颤动(房颤)等[2-3].

目的:比较心房颤动(房颤)患者冷冻球囊消融(CBA)与射频导管消融(RFCA)术后新发无症状脑梗死(NACI)的发生情况和预后.方法:连续入选2017年7月至2019年6月符合纳入和排除标准的267例房颤患者,随机分为CBA组(n=133)与RFCA组(n=134).术前和术后24 h内行头颅3.0T MRI检查,记录基线、术中和术后资料.采用二元Logistic回归分析评估房颤消融术后发生NACI的危险因素.进行1年临床随访,记录房颤复发及脑血管事件发生情况.结果:CBA组和RFCA组患者的临床基线资料相似,消融术后NACI(15.04％vs.12.69％)和1年房颤复发率(24.19％vs.25.95％)差异也均无统计学意义(P均>0.05).二元Logistic回归分析显示,既往脑卒中史(OR=3.113,95％CI:1.444～6.714)、术中电转复(OR=3.148,95％CI:1.399～7.138)和手术时间(OR=1.027,95％CI:1.005～1.050)均是消融术后发生NACI的危险因素(P均<0.05).随访1年时,术后出现NACI的患者中缺血性脑卒中的发生率明显高于未出现NACI的患者(10.81％vs.1.83％;OR=6.485,95％CI:1.546～27.195,P=0.011),死亡(2.70％vs.0.46％)和血管性认知障碍(5.41％vs.1.38％)发生率有升高趋势,但差异均无统计学意义(P均>0.05).结论:房颤患者CBA和RFCA术后NACI的发生率相似,术后出现NACI的患者预后不良.

Background. Relative to nondiabetic patients, percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) is associated with inferior clinical outcomes. We aimed to evaluate the outcomes of drug-coated balloon (DCB) in diabetic versus nondiabetic patients. Methods and Results. In this observational, prospective, multicenter study, we compared the outcomes of patients with and without DM after undergoing PCI with DCBs. Target lesion failure (TLF) was analyzed as primary endpoint. Secondary endpoints were the rates of target lesion revascularization (TLR), major adverse cardiovascular events (MACE), cardiac death, myocardial infarction (MI), and any revascularization. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. Among 2,306 eligible patients, 578 with DM and 578 without DM had similar propensity scores and were included in the analyses. During follow-up (366±46 days), compared with DM patients, patients without DM were associated with a lower yearly incidence of TLF (2.77% vs. 5.36%; OR, 1.991; 95% CI, 1.077 to 3.681; P=0.025) and TLR (1.90% vs. 4.15%; OR, 2.233; 95% CI, 1.083 to 4.602; P=0.026). No significant differences were observed with regards to rates of MACE (OR: 1.580, 95% CI: 0.912-2.735; P=0.100), cardiac death (OR: 1.608, 95% CI: 0.523-4.946; P=0.403), MI (OR: 4.042, 95% CI: 0.855-19.117; P=0.057), and any revascularization (OR: 1.534, 95% CI: 0.983-2.393; P=0.058). Conclusions. Diabetic patients experience higher TLF and TLR rates following DCB angioplasty without substantial increase in the risk of MACE, cardiac death, MI, or revascularization.

Background. The revascularization of small vessels using drug-eluting stents remains challenging. The use of the drug-coated balloon is an attractive therapeutic strategy in de novo lesions in small coronary vessels, particularly in the diabetic group. This study aimed to assess the outcomes of DCB-only angioplasty in small vessel disease. Methods. A total of 1198 patients with small vessel disease treated with DCB-only strategy were followed. Patients were divided into the diabetic and nondiabetic groups. Clinical and angiographical follow-up were organized at 12 months. The primary endpoints were target lesion failure and secondary major adverse cardiac events. Results. There was a significantly higher rate of target lesion failure among diabetic patients compared to nondiabetic [17 (3.9%) vs. 11 (1.4%), P = 0.006 ], taken separately, the rate of target lesion revascularization significantly differed between groups with a higher rate observed in the diabetic group [9 (2%) vs. 4 (0.5%), P = 0.014 ]. Diabetes mellitus remained an independent predictor for TLF (HR: 2.712, CI: 1.254–5.864, P = 0.011 ) and target lesion revascularization (HR: 3.698, CI: 1.112–12.298, P = 0.033 ) after adjustment. However, no significant differences were observed between groups regarding the target vessel myocardial infarction (0.6% vs. 0.1%, P = 0.110 ) and MACE [19 (4.4%) vs. 21 (2.7%), P = 0.120 ]. Conclusion. Drug-coated balloon-only treatment achieved lower incidence rates of TLF and MACE. Diabetes is an independent predictor for target lesion failure and target lesion revascularization at one year following DCB treatment in small coronary vessels. We observed no significant differences between groups regarding MACE in one year.

目的:观察不同类型心脏疾病中血清可溶性ST2(sST2)水平的变化及在不同心功能分级中的差异.方法:选取2019年2月 2020年5月郑州大学第一附属医院心内科收治的扩张型心肌病30例,冠心病30例,非瓣膜性心房颤动(房颤)30例,选取同期健康体检者20例作为对照组.比较不同类型心脏疾病sST2水平差异及不同心功能分级(NYHA分级)sST2水平差异.结果:与对照组(17.90±7.21) ng/ml比较,扩张型心肌病及冠心病组sST2升高显著,分别为(33.38±15.46) ng/ml、(27.73±12.65) ng/ml,差异有统计学意义(P＜0.05).随心功能分级的增加,sST2水平逐渐升高,组间比较差异有统计学意义(P＜0.05).sST2与氨基末端脑钠肽前体(NT-proBNP)联合诊断对心力衰竭严重程度诊断的准确性为92.5％.结论:sST2在不同类型心脏疾病中的水平不同,且与心功能分级呈正相关.

目的 比较比伐芦定与肝素应用于非ST段抬高急性冠脉综合征(NSTE-ACS)患者经皮冠状动脉介入(PCI)术中的效果.方法 连续纳入2018年6月至2019年8月于郑州大学第一附属医院诊断为NSTE-ACS并行PCI治疗的500例患者,其中比伐芦定组(50例)和采用1:1倾向评分匹配法筛选出肝素组(50例),比较两组患者术前、用药后5 min、用药后30 min、术后即刻、停药后1 h、停药后2 h的活化凝血时间(ACT),并观察两组患者30 d内出血及主要心脑血管不良事件(MACCE)的发生情况.结果 两组患者在用药后5 min ACT均>250 s.PCI术前两组患者ACT比较,差异无统计学意义(P>0.05).用药后5 min、用药后30 min、术后即刻比伐芦定组ACT高于肝素组,差异有统计学意义(P<0.05).停药后1、2 h比伐芦定组ACT低于肝素组,差异有统计学意义(P<0.05).术后30 d随访,两组患者出血事件及MACCE发生率比较,差异无统计学意义(P>0.05).结论 与肝素相比,比伐芦定应用于NSTE-ACS行PCI术的患者,术中抗凝稳定性更好,术后短期内并没有增加出血及MACCE事件发生.