BackgroundDespite the widespread use of inhalation therapy, patients with chronic obstructive pulmonary disease (COPD) frequently experience suboptimal disease control due to medication nonadherence, improper inhaler use technique, and inappropriate device selection, which collectively impair health-related quality of life (HRQoL). Pharmacist-led interventions may help address these gaps. Interventions based on the information-motivation-behavioral skills model and supported by digital tools can improve adherence and self-management. This study evaluates the efficacy of a multifaceted pharmaceutical care intervention for COPD delivered through digital tool support. ObjectiveThe primary objective is to compare the change in HRQoL, measured using the St George’s Respiratory Questionnaire, between the intervention and control groups from baseline to 12 months. Secondary objectives are to assess changes in medication adherence (Test of Adherence to Inhalers), quality of life (EQ-5D-5L), COPD-related medical costs, and patient-reported pharmacy service experience. MethodsThis 1-year cluster randomized controlled trial evaluates a multifaceted pharmaceutical care intervention in adults with moderate to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease, stages 2-4) who have confirmed suboptimal inhaler practice but remain matched to an appropriate inhaler device based on peak inspiratory flow rate measured using a digital tool. In total, 34 hospital-based cough and wheeze pharmaceutical care clinics were recruited and randomized (1:1) to either an intervention or a control group. The target sample size is 15 patients per site. Participants in the intervention group will receive tailored support using electronic adherence monitoring, inhaler use technique assessments, and peak inspiratory flow rate to optimize device selection and self-management. Participants in the control group will receive usual pharmaceutical care. Descriptive statistics will be used to summarize participant characteristics and outcomes. Linear mixed effects models will be used to compare primary and secondary outcomes. Subgroup analyses will explore effects by age, sex, education level, place of residence, and smoking status. Pharmacy service survey data will be analyzed qualitatively. ResultsThe trial was registered on July 15, 2024. Recruitment started on November 9, 2024, and enrollment was completed by December 31, 2025. As of December 31, 2025, we enrolled 454 participants, of whom 16 (3.5%) had completed the 12-month follow-up. The trial is expected to be completed by December 31, 2026, with results planned for publication in 2027. ConclusionsThis multifaceted, pharmacist-led pharmaceutical care intervention may provide a scalable model for improving COPD management and HRQoL. If effective, the digitally supported program, grounded in the information-motivation-behavioral skills model, could be implemented in more than 1000 cough and wheeze pharmaceutical care clinics nationwide. Trial RegistrationChinese Clinical Trial Registry ChiCTR2400086943; https://tinyurl.com/75a9phbw International Registered Report Identifier (IRRID)DERR1-10.2196/82806

Introduction Chronic obstructive pulmonary disease (COPD) represents a major public health challenge in China, with management delivered across all levels of the health system. Medication burden may undermine medication adherence and health-related quality of life (HRQoL), yet the pathways linking these factors remain unclear. This study evaluated the association between medication burden and HRQoL and examined whether medication adherence mediates this relationship from a multilevel health system perspective. Methods A multicentre cross-sectional study was conducted across healthcare institutions participating in the Cough and Wheeze Pharmaceutical Care Clinic network between September 2023 and September 2024. Medication burden was assessed using the total prescribed drugs and the Medication Regimen Complexity Index (MRCI). HRQoL was measured using the EuroQol 5-Dimension 5-Level Questionnaire, and adherence was evaluated with the Adherence to Refills and Medications Scale. Structural equation modelling assessed direct and indirect pathways, and mediation effects were estimated using percentile bootstrapping with 5000 resamples. Sensitivity analyses examined the robustness of the findings. Results A total of 2125 patients with COPD were included. Participants had a median of 1 (IQR 0–2) prescribed medications and a median MRCI of 8.0 (range 0.0–13.5). A higher number of medications was significantly associated with poorer HRQoL both directly (estimate = –0.025, 95% CI –0.038 to –0.012) and indirectly via lower adherence (estimate = –0.007, 95% CI –0.010 to –0.003). While MRCI demonstrated no significant direct association with HRQoL, an indirect effect through adherence was observed (estimate = –0.001, 95% CI –0.002 to –0.001). All findings remained consistent across sensitivity analyses. Conclusions Across multiple levels of the healthcare system, medication adherence partially mediated the association between medication burden and HRQoL in patients with COPD. These findings highlight medication regimen optimisation and adherence support as important public health strategies for improving patient-centred COPD care.

BACKGROUND:The novel thin-strut sirolimus-eluting iron bioresorbable scaffold (IBS) demonstrated safety and efficacy in a nonrandomized first-in-human study. OBJECTIVES:The objective of this study was to compare the IBS with contemporary metallic cobalt chromium everolimus-eluting stents (CoCr-EES) in patients with coronary artery disease. METHODS:IRONMAN-II was a prospective, multicenter, single-blinded, noninferiority randomized trial across 36 centers in China. Eligible patients had myocardial ischemia and 1 or 2 de novo target lesions. Patients were randomly assigned (1:1) to IBS or CoCr-EES, with allocation masked. Optical coherence tomography (OCT) was performed in the first 25 participant pairs. Clinical follow-up was scheduled at 1, 6, and 12 months, and annually to 5 years, with angiographic and OCT follow-up at 2 years. The primary endpoint was 2-year angiographic in-segment late lumen loss (LLL). Powered secondary endpoints included target vessel quantitative flow ratio (QFR) and OCT-derived cross-sectional mean flow area. Other secondary endpoints included target lesion failure (cardiac death, target vessel myocardial infarction [MI], or ischemia-driven target vessel revascularization), the patient-oriented composite endpoint (all-cause death, MI, or any revascularization), their individual components, and device thrombosis. RESULTS:Between March 10 and December 13, 2022, 518 patients were randomized to IBS (n = 259) or CoCr-EES (n = 259). At 2 years, lesion-level in-segment LLL was 0.28 (0.52) mm with IBS and 0.23 (0.43) mm with CoCr-EES (difference: 0.08 mm; 95% CI: -0.02 to 0.18; Pnoninferiority = 0.03). Mean QFR was 0.90 (0.13) with IBS and 0.92 (0.09) with CoCr-EES (difference: -0.02; 95% CI: -0.04 to 0; Pnoninferiority = 0.05). Mean OCT flow area was 6.92 (3.48) mm2 with IBS and 6.64 (2.44) mm2 with CoCr-EES (difference: 0.27; 95% CI: -0.09 to 0.63; Pnoninferiority < 0.0001). Two-year target lesion failure occurred in 7.4% of IBS patients and 5.4% of CoCr-EES patients (HR: 1.37; 95% CI: 0.69-2.73; P = 0.37). No significant between-group differences in the rates of patient-oriented composite endpoint, death, or MI were present between the 2 groups. No scaffold thromboses occurred in the IBS group, whereas 1 stent thrombosis occurred with CoCr-EES. Binary restenosis and revascularization rates were higher with IBS, however, most such events were non-ischemia-driven. CONCLUSIONS:In IRONMAN-II, the sirolimus-eluting IBS was noninferior to CoCr-EES for 2-year in-segment LLL, QFR, and OCT-derived flow area. Clinical event rates were also comparable between groups although non-ischemia-driven revascularization rates were higher after IBS. Longer-term follow-up is necessary to demonstrate whether late benefits are realized after complete IBS resorption. (A Clinical Investigation to Evaluate the Safety and Efficacy of IBS in Patients With Coronary Artery Disease; NCT05206084).

Background:Characterising treatment patterns and costs is essential for understanding healthcare utilisation and informing cost management. We aimed to assess these aspects among hospitalised patients with cardiomyopathy. Methods:We conducted a multicentre study at 11 tertiary hospitals across China, systematically extracting electronic medical records from 2017 to 2022. Factors associated with medical costs were analysed using generalised linear regression with cluster-robust standard errors. Findings:Among 15,764 medical records of adult inpatients with cardiomyopathy, medical therapy alone (81.5%; 12,853/15,764) was the most common treatment pattern. The mean direct medical cost per hospitalisation for all admissions was $6294 ($11,564) and the median cost was $2152 (IQR $1248, $4931), with variation across cardiomyopathy subtypes. Admissions to the national centre (Exp(β) 1.529 [95% confidence interval 1.242-1.882]), New York Heart Association functional class III/IV (Exp(β) 1.371 [1.169-1.608]), and combination therapies (vs. medical therapy alone: medical and interventional Exp(β) 6.685 [5.098-8.766]; medical and surgical 7.537 [6.213-9.143]; all three 10.718 [7.579-15.157]) were associated with higher costs, whereas insurance coverage (Exp(β) 0.773 [0.642-0.932]) was associated with lower costs. Interpretation:This study provides evidence on inpatient medical costs and their associated factors, serving as a reference for understanding the real-world cost profile and informing cost management of cardiomyopathy in tertiary healthcare settings. Funding:The Noncommunicable Chronic Diseases-National Science and Technology Major Project, the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences, the National High Level Hospital Clinical Research Funding, and the Science and Technology Department of Heilongjiang Province.

OBJECTIVES:To evaluate the efficacy of dual antiplatelet therapy (DAPT) for three months versus 12 months in saphenous vein graft occlusion while reducing bleeding risk. DESIGN:Multicentre, non-inferiority, double blind, randomised controlled trial. SETTING:13 cardiac surgery centres in China, with enrolment between February 2023 and July 2024. PARTICIPANTS:2300 participants aged 18 to 80 years who underwent elective primary coronary artery bypass grafting with ≥1 saphenous vein graft. INTERVENTIONS:Participants were randomly assigned (1:1) to receive DAPT (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily) for 12 months or the same dual antiplatelet regimen for the first three months, followed by placebo plus aspirin for nine months. MAIN OUTCOME MEASURES:The primary outcomes were saphenous vein graft occlusion at one year (non-inferiority) and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding (superiority). Secondary outcomes were major adverse cardiovascular events (MACCE), saphenous vein graft failure, venous or arterial graft stenosis, and venous or arterial graft occlusion. RESULTS:2290 patients (mean age 61.5 (standard deviation (SD) 8.4) years, 20.6% (n=472) women) were included in the modified intention-to-treat set. The mean number of saphenous vein graft segments was 2.5 (SD 0.8). 2070 patients (90.4%) with a total of 5125 saphenous vein graft segments were assessed at one year. Saphenous vein graft occlusion occurred in 280 of 2596 (10.8%) in the three month DAPT group and 283 of 2529 (11.2%) in the 12 month DAPT group (absolute difference -0.31%, 95% confidence interval (CI) -3.13% to 2.52%; P=0.008 for non-inferiority). During a median follow-up of 368 (interquartile range 358-382) days, BARC type 2, 3, or 5 bleeding occurred in 95 patients (8.3%) in the three month DAPT group and 149 patients (13.2%) in the 12 month DAPT group (absolute difference -4.67%, 95% CI -7.18% to -2.16%; P<0.001). The number needed to treat to prevent one bleeding event was 21 (95% CI 13 to 46). MACCE occurred in 26 (2.3%) patients in the three month DAPT group and 27 (2.7%) in the 12 month DAPT group (absolute difference -0.11%, 95% CI -1.48% to 1.26%). The findings for other secondary outcomes were also similar between the two groups. CONCLUSIONS:A three month DAPT strategy was non-inferior to the 12 month DAPT strategy in saphenous vein graft occlusion and was superior in reducing bleeding risk. TRIAL REGISTRATION:ClinicalTrials.gov NCT05380063.

Objective: We aimed to examine the association between hospital level and 5-year mortality among ST-segment elevation myocardial infarction (STEMI) patients in China, and identify factors explaining these differences. Methods: We analyzed data from the China Acute Myocardial Infarction (CAMI) registry, which enrolled 12,697 STEMI patients from 108 hospitals across 31 provinces in mainland China between January 2013 and September 2014, with follow-up through January 1, 2020. Patients were categorized according to initial admission at provincial-, prefecture-, or county-level hospitals. The primary outcome was 5-year all-cause mortality. Kaplan–Meier estimates and multivariable Cox proportional hazards models were used to assess mortality risk across hospital levels, with competing risk models applied for cardiovascular deaths. Prespecified subgroup analyses evaluated effect modification by demographic and clinical factors. In addition, a multiple mediation framework was employed to quantify the contribution of patient characteristics and treatment differences to hospital-level disparities in long-term survival. Results: Among 12,697 patients (mean age, 62.8 years; 75.7% male), the 5-year all-cause mortality was 19.8%, 25.3%, and 36.2% at provincial-level, prefecture-level, and county-level hospitals, respectively. After multi-variable adjustment, compared with patients treated at provincial-level hospitals, the adjusted HRs for all-cause mortality were 1.24 (95% CI, 1.11-1.39) at prefecture-level hospitals and 1.54 (95% CI, 1.34-1.78) at county-level hospitals (P for trend <.001). Similar trends were observed for cardiovascular mortality. Subgroup analyses indicated that the disparities were most pronounced among patients with overweight or obesity, history of prior heart failure, those with cardiogenic shock at admission, and those with onset-to-arrival time>12h. Mediation analysis suggested that primary PCI use, age, and socioeconomic factors contributed substantially to the observed differences in mortality. Conclusions: In this nationwide cohort of STEMI patients, initial treatment at lower-level hospitals was associated with significantly higher long-term mortality. These findings highlight the need to improve access to timely, evidence-based care and to strengthen regional referral systems and treatment capacity at lower-tier hospitals to reduce outcome disparities.

While Western studies often show an inverse association between occupational status and cardiovascular mortality, its impact on acute myocardial infarction (AMI) characteristics and prognosis in Eastern middle-income countries remains unclear. Using data from the multi-center prospective China Acute Myocardial Infarction (CAMI) registry from January 2013 to January 2016, 11,318 admission AMI patients aged 18–60 years were stratified by occupation: white-collar (22.1

Background:Early revascularization enables ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS) to initiate oral beta-blockers once hemodynamic stability is achieved, but the impact of such initiation on prognosis remains unknown. We aimed to describe the clinical use of oral beta-blockers and assess its impact on long-term outcomes in STEMI patients with CS in a real-world setting. Materials and methods:The China Acute Myocardial Infarction registry (CAMI) is a prospective observational study that enrolls patients with acute myocardial infarction from three-level hospitals across 31 administrative regions in mainland China. Among 19,112 STEMI patients in the CAMI registry, a total of 744 STEMI patients who presented with CS at admission were analyzed. Multivariate regression models were used to evaluate the impact of in-hospital oral beta-blockers on 2-year outcomes. Inverse probability treatment weighting (IPTW) score was further used to address biases between the groups with and without oral beta-blockers. The primary endpoint was all-cause death. Results:42.7% (n = 318) of the patients initiated in-hospital oral beta-blockers; these patients were in better states and more likely to receive primary percutaneous coronary intervention and secondary prevention at discharge. The crude 2-year all-cause mortality was 41.7%, with a lower rate in patients who received oral beta-blockers (24.2% vs. 54.8%, P < 0.001). However, after multivariate adjustment, patients who received oral beta-blockers showed a non-significant increase in 2-year mortality compared with non-users (HR = 1.29, 95% CI: 0.95-1.75, P = 0.099), and this increase became statistically significant in the subgroup of county-level hospitals (HR = 1.79, 95% CI: 1.03-3.09, P = 0.038, P-interaction = 0.010). Furthermore, after balancing the baseline covariates using IPTW and further adjusting for discharge medications, initiation of oral beta-blockers during hospitalization increased the risk of 2-year all-cause mortality (HR = 1.59, 95% CI: 1.18-2.13, P = 0.002). Conclusion:No benefit of in-hospital oral beta-blockers initiation on long-term all-cause mortality was found in Chinese STEMI patients with CS, and a trend toward increased mortality existed, especially in small-scale hospitals with insufficient experience in CS treatment.

Chronic stress (CS) is recognized as a contributing factor to the progression of atherosclerosis (AS), but the molecular mechanisms within the central nervous system (CNS) remain poorly understood. In this study, we established mouse models for CS and AS, including normal control (CON), AS, CS, and AS + CS groups, and analyzed gene expression in brain tissues. We identified Cxcr4 and Gng4 as key genes differentially expressed in response to AS and CS. Elevated expression of CXCR4 and GNG4 in the frontal cortex was observed in the CS and AS + CS groups compared to the CON and AS groups. CS not only induced neuronal damage but also exacerbated AS progression, as evidenced by larger atherosclerotic plaque areas in the AS + CS group, increased abdominal aorta intima‒media thickness (IMT), and reduced abdominal aorta lumen diameter (AUD) in the CS and AS + CS groups. The upregulation of Cxcr4 and Gng4 in brain tissue correlated positively with IMT and negatively with AUD, and their combined expression demonstrated strong predictive potential for IMT and AUD. Furthermore, Cxcr4 and Gng4 mRNA levels were significantly positively correlated. Additionally, CXCR4 and GNG4 colocalized, interacted, and formed stable complexes, both of which were detectable in neurons. Moreover, CS upregulated circulating levels of CXCL12, CXCR4, GNG4, and pro-inflammatory cytokines (IL-6, IL-1β). These findings suggest that CS-induced upregulation of CXCR4 and GNG4 in brain tissue and serum may amplify inflammatory responses and contribute to the progression of AS, highlighting potential therapeutic targets for stress-related cardiovascular diseases. • Chronic stress induced neuronal damage, exacerbated circulating inflammatory responses and AS progression. • Cxcr4 and Gng4 were identified as hub genes associated with both chronic stress and atherosclerosis, chronic stress increased the expression of CXCR4 and GNG4 in the brain tissue and serum. • The upregulation of Cxcr4 and Gng4 in brain tissue correlated positively with abdominal aorta intima‒media thickness (IMT) and negatively with abdominal aorta lumen diameter (AUD), and their combined expression demonstrated strong predictive potential for IMT and AUD. • Cxcr4 and Gng4 mRNA levels were significantly positively correlated, CXCR4 and GNG4 colocalized, interacted, and formed stable complexes, both of which were detectable in neurons.

Background:To assess the consequence of different degrees of missing primary endpoint data for randomized controlled trials and to find the influence factors. Methods:PubMed, Cochrane Library, EMBASE and ClinicalTrials.gov were searched up to Nov 30, 2023. We included trials of the drug-coated balloon/drug-eluted stent with angiographic outcomes as the primary endpoint. The tipping-point analysis was used to deal with the missing data for the primary endpoint. The inconsistency rate, tipping-point standardized effect size (SES) and tipping-point ratio were used to assess the result robustness. Results:A total of 101 trials were included, which had 109 trial comparisons. Among them, 89 (81.7%) comparisons had superior/non-inferior conclusions (H0 rejected); 85 (78.0%) comparisons had a missing rate of ≥10%, and 30 (27.5%) comparisons had a missing rate of ≥20%. For H0 rejected comparisons with a missing rate of ≥10%, the median of inconsistency rate, tipping-point SES and tipping-point ratio was 32.2% (IQR 19.7%, 45.4%), 0.90 (IQR 0.17, 1.79) and -1.53 (IQR -2.43, -0.39). A higher missing rate and a larger (worse) observed-target SES were associated with a more unreliable result. Conclusion:A high dropout rate and inflated target effect size could cause an unreliable result. We emphasize a robust evaluation of the results for clinical trials with missing data for the primary endpoint.

This paper examines the effect of accounting information comparability on the fulfilment of corporate ESG responsibilities and its mechanism with the A-share listed companies in China from 2009 to 2022 and finds that: the higher the accounting information comparability, the more actively the companies can fulfil their ESG responsibilities, and its facilitating effect is mainly achieved by alleviating the financing constraints and curbing the degree of managerial myopia. Through robustness and endogeneity tests, the above conclusions still hold. The results of this study enrich the research content of accounting information comparability, further expand the research field of factors influencing the fulfilment of ESG responsibilities, and provide some references for promoting sustainable economic development.

Objective: To investigate the prevalence and outcomes of primary percutaneous coronary intervention (PCI) in Chinese patients with ST-segment elevation myocardial infarction (STEMI) aged >= 75 years. Methods: We identified STEMI patients aged >= 75 years between 2013 and 2014 from a multicenter registry. The primary outcome was all-cause mortality. The secondary outcome was major adverse cardiac and cerebrovascular event (MACCE) including a composite of all-cause mortality, cardiac death, recurrent MI, stroke, revascularization, and major bleeding. Hazard ratios (HR) and associated 95% confidence interval (CI) were calculated. Results: Approximately 32.9% (n = 999) patients received primary PCI. Primary PCI was associated with lower risks of two-year all-cause mortality (18.0% vs. 36.4%; adjusted HR: 0.54, 95% CI: 0.45 to 0.65, P < 0.0001), MACCE (28.7% vs. 43.5%; adjusted HR: 0.68, 95% CI: 0.59 to 0.80, P < 0.0001), and cardiac death (10.0% vs. 23.6%; adjusted HR: 0.49, 95% CI: 0.38 to 0.62, P < 0.0001) relative to no reperfusion (n = 2041) in patients aged >= 75 years. The better outcomes in two-year all-cause mortality, MACCE, and cardiac death were consistently observed in STEMI patients aged >= 85 years. No differences were observed in recurrent MI, stroke, revascularization, and major bleeding between the two groups. Additionally, in patients with relatively high-risk profiles such as cardiogenic shock or delaying hospital admission, primary PCI was also superior to no reperfusion. Conclusion: Primary PCI may decrease two-year all-cause mortality, MACCE, and cardiac death in STEMI patients aged >= 75 years, even in these with age >= 85 years, cardiogenic shock, or delaying hospital admission. However, primary PCI was underutilized in Chinese clinical practice.

Background There is a lack of individualised prediction models for patients hospitalised with chronic obstructive pulmonary disease (COPD) for clinical practice. We developed and validated prediction models of severe exacerbations and readmissions in patients hospitalised for COPD exacerbation (SERCO).Methods Data were obtained from the Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry study (NCT02657525) in China. Cause-specific hazard models were used to estimate coefficients. C-statistic was used to evaluate the discrimination. Slope and intercept were used to evaluate the calibration and used for model adjustment. Models were validated internally by 10-fold cross-validation and externally using data from different regions. Risk-stratified scoring scales and nomograms were provided. The discrimination ability of the SERCO model was compared with the exacerbation history in the previous year.Results Two sets with 2196 and 1869 patients from different geographical regions were used for model development and external validation. The 12-month severe exacerbations cumulative incidence rates were 11.55% (95% CI 10.06% to 13.16%) in development cohorts and 12.30% (95% CI 10.67% to 14.05%) in validation cohorts. The COPD-specific readmission incidence rates were 11.31% (95% CI 9.83% to 12.91%) and 12.26% (95% CI 10.63% to 14.02%), respectively. Demographic characteristics, medical history, comorbidities, drug usage, Global Initiative for Chronic Obstructive Lung Disease stage and interactions were included as predictors. C-indexes for severe exacerbations were 77.3 (95% CI 70.7 to 83.9), 76.5 (95% CI 72.6 to 80.4) and 74.7 (95% CI 71.2 to 78.2) at 1, 6 and 12 months. The corresponding values for readmissions were 77.1 (95% CI 70.1 to 84.0), 76.3 (95% CI 72.3 to 80.4) and 74.5 (95% CI 71.0 to 78.0). The SERCO model was consistently discriminative and accurate with C-indexes in the derivation and internal validation groups. In external validation, the C-indexes were relatively lower at 60–70 levels. The SERCO model discriminated outcomes better than prior severe exacerbation history. The slope and intercept after adjustment showed close agreement between predicted and observed risks. However, in external validation, the models may overestimate the risk in higher-risk groups. The model-driven risk groups showed significant disparities in prognosis.Conclusion The SERCO model provides individual predictions for severe exacerbation and COPD-specific readmission risk, which enables identifying high-risk patients and implementing personalised preventive intervention for patients with COPD.

BACKGROUND:The previous first-in-human study established the preliminary safety and effectiveness of the novel thin-strut iron bioresorbable scaffold (IBS). The current study aims to directly compare the imaging and physiological efficacy, and clinical outcomes of IBS with contemporary metallic drug-eluting stents (DES). METHODS:A total of 518 patients were randomly allocated to treatment with IBS (257 patients) or metallic DES (261 patients) from 36 centers in China. The study is powered to test noninferiority of the IBS compared with the metallic everolimus-eluting stent in terms of the primary endpoint of in-segment late lumen loss at 2 years, and major secondary endpoints including 2-year quantitative flow ratio and cross-sectional mean flow area measured by optical coherence tomography (OCT) (limited to the OCT subgroup, 25 patients in each group). CONCLUSION:This will be the first powered randomized trial investigating the safety and efficacy of the novel thin-strut IBS compared to a contemporary metallic DES. The findings will provide valuable evidence for future research of this kind and the application of metallic bioresorbable scaffolds.

At least 12 months of dual antiplatelet therapy (DAPT) is 1 of the standards of care following percutaneous coronary intervention in patients with acute coronary syndrome. However, study on prolonged DAPT for patients with acute myocardial infarction (AMI) without revascularization is limited. We studied 1,744 patients with AMI without revascularization from the China Acute Myocardial Infarction registry between January 2013 and September 2014. These patients were on DAPT and did not experience AMI, stroke, or bleeding events at the 12-month follow-up. We divided them into 2 groups: 12-month DAPT group (DAPT for at least 12 months but <18 months) and 18-month DAPT group (DAPT for at least 18 months). The primary outcome was 24-month all-cause death. Overall, 1,221 patients (70.0%) took DAPT for ≥12 months but <18 months, whereas 523 patients (30.0%) took DAPT for ≥18 months. The proportion of patients at high ischemic risk and the proportion of patients at high bleeding risk were similar in the 2 groups. At 24 months, the all-cause mortality rate of the 18-month DAPT group was significantly lower than that for the 12-month DAPT group (3.7% vs 5.9%, p = 0.0471). The adjusted hazard ratio for all-cause death also showed statistical significance (0.59, 95% confidence interval 0.35 to 0.99, p = 0.0444). In conclusion, DAPT for at least 18 months appears to be associated with lower 24-month mortality for non-revascularization AMI patients without events within 12 months after onset.

Objective: To investigate the association of calf circumference (CC), mid-upper arm circumference (MUAC) and their derivative indexes (waist-to-arm and waist-to-calf circumference ratio) with prevalence of hypertension. Methods: A total of 47,677 individuals aged 35–70 years with measurement of CC, MUAC and blood pressure were available for analysis. CC and MUAC were measured under standardized training. The association of CC and MUAC with hypertension were tested in logistic regression analyses and reported as odds ratio (OR) with 95% CI. Subgroup analysis for BMI was conducted. Results: CC and MUAC were positively correlated with hypertension in the crude model. When adjusted for the BMI and waist, larger CC and MUAC were associated with a lower hypertension prevalence rate. It was stable after adjusted for demographic characteristics, lifestyle behaviors and health status [OR of 0.96(0.91, 1.03), 0.90(0.83, 0.97), and 0.85(0.80, 0.90) for Q2, Q3, and Q4 for CC, P for trend < 0.05, respectively; OR of 1.00(0.94, 1.07), 0.94(0.88, 1.00), and 0.82(0.76, 0.88) for Q2, Q3, and Q4 for MUAC, P for trend < 0.05, respectively]. Larger waist-to-arm and waist-to-calf circumference ratios were correlated with a higher risk of hypertension. For the overweight (BMI 24–28 kg/m2) group, as the CC or MUAC increased, a significant trend for a lower prevalence of hypertension was observed [OR of 0.87(0.77, 0.98), 0.84(0.75, 0.95), and 0.79(0.69, 0.90) for Q2, Q3, and Q4 for CC, P for trend < 0.05, respectively; OR of 0.86(0.76, 0.97), 0.77(0.69, 0.87), and 0.71(0.63, 0.80) for Q2, Q3, and Q4 for MUAC, P for trend < 0.05, respectively].

Background: High medication burdens are common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore the associations of medication regimen complexity index (MRCI) with medication adherence and clinical outcomes among patients with acute exacerbations of COPD (AECOPD) after hospital discharge. Methods: Data were obtained from a nationwide cohort study of inpatients with AECOPD in China. MRCI scores were calculated using the medication list 30 days after discharge and separated into COPD-specific and non-COPD MRCI scores. Medication adherence was measured by the withdrawal rate of COPD or inhaled long-acting bronchodilators 6 months after discharge. Clinical outcomes included re-exacerbations and COPD-related readmissions during the 30-day to 6-month follow-up period. The associations of MRCI with medication withdrawal and clinical outcomes were evaluated using univariate and multivariate logistic regressions. Potential covariates included sociodemographic factors, year of COPD diagnosis, post-bronchodilator percentage predicted forced expiratory volume in 1 s, mMRC score, CAT score, and comorbidities. Results: Among the 2853 patients included, the median total MRCI score was 7 [interquartile range (IQR), 7−13]. A high MRCI score (>7) was presented in 1316 patients (46.1%). Of the MRCI score, 91% were COPD specific. The withdrawal rates of the COPD and inhaled long-acting bronchodilators were 24.2% and 24.4%, respectively. Re-exacerbation and COPD-related readmission rates were 10.2% and 7.5%, respectively. After adjusting for covariates, patients with high total MRCI scores were less likely to discontinue COPD drugs [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.52−0.74] and inhaled long-acting bronchodilators (OR, 0.68; 95%CI, 0.57−0.81); conversely, these patients were more likely to experience re-exacerbation (OR, 1.64; 95% CI, 1.27−2.11) and readmission (OR, 1.57; 95% CI, 1.17−2.10). Conclusion: MRCI scores were relatively low among post-hospitalized patients with AECOPD in China. Higher MRCI scores were positively associated with adherence to COPD or inhaled medications, and risk of re-exacerbation and readmission. Registration: ClinicalTrials.gov identifier: NCT02657525.