Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinica...Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus （DM） was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent （DES）. Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group （n = 74） and the non-ISR group （n = 294）. The independent predictors of ISR in patients with DM were explored by multivariate Cox＇s proportional hazards regression models. Results A total of 368 patients （260 women and 108 men） with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients （20.11%） by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol （VLDL-C）, triglyceride （TG） and uric acid （UA） levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C （HR = 1.85, 95% CI： 1.24-2.77, P = 0.002）, UA （per 50 μmol/L increments, HR = 1.19, 95% CI： 1.05 1.34, P = 0.006）, SYNTAX score （per 5 increments, HR = 1.34, 95% CI： 1.03-1.74, P = 0.031） and the history ofPCI （HR = 3.43, 95% CI： 1.57-7.80, P = 0.003） by the multivariate Cox＇s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physi- cians to take measures to lower the risk oflSR for the better management of diabetic patients after PCI.展开更多
BACKGROUND Tanscatheter left atrial appendage(LAA)closure and minimally invasive thoracoscopic LAA occlusion are local interventions of LAA for stroke prevention in patients with nonvalvular atrial fibrillation(NVAF)....BACKGROUND Tanscatheter left atrial appendage(LAA)closure and minimally invasive thoracoscopic LAA occlusion are local interventions of LAA for stroke prevention in patients with nonvalvular atrial fibrillation(NVAF).However,the safety and efficacy of these methods have not been compared.This prospective cohort study aimed to assess the safety and efficacy of those two treatment approaches for stroke prevention in NVAF patients.METHODS Two hundred and nine recurrent NVAF patients who received radiofrequency ablation were enrolled.These pa-tients were treated with transcatheter LAA closure or thoracoscopic LAA occlusion.The patients were followed up from the first postoperative day and evaluated for efficacy endpoints(stroke/transient ischemic attack(TIA),systemic embolism(SE),and death)and a safety endpoint(bleeding events).Perioperative complications were recorded.RESULTS After a median follow-up of 1.8 years(383 patient-years),the overall rate of the composite efficacy endpoints was similar between the two groups(3.8 vs.2.7 events per 100 patient-years;HR=0.71;95%CI:0.225−2.237;P=0.559).However,regarding primary safety endpoint,there were 1.5 bleeding events per 100 patient-years in the thoracoscopic LAA occlusion group,com-pared with 6.4 in transcatheter LAA closure group(HR=0.246;95%CI:0.074−0.819;P=0.022).The incidence of operative com-plications was 3/138(2.17%)in thoracoscopic LAA occlusion group and 1/71(1.41%)in transcatheter LAA closure group.CONCLUSIONS Thoracoscopic LAA occlusion and transcatheter LAA closure have similar efficacy in preventing stroke in NVAF patients.However,the thoracoscopic group had fewer bleeding events than the transcatheter group,but the former group required a longer hospital stay.展开更多
Objective The aim is to evaluate the association between baseline platelet count （PC） and severe adverse outcomes following percu- taneous coronary intervention （PCI） in current real-world practice. Methods A tota...Objective The aim is to evaluate the association between baseline platelet count （PC） and severe adverse outcomes following percu- taneous coronary intervention （PCI） in current real-world practice. Methods A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low （〈 150 × 1000μ.L）, normal （150-300 × 1000μL）, and high （≥ 300 × 1000μL） baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. Results In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively （P = 0.259）. Similarly, mortality rates during long-term follow-up （median 23.8 months） for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively （P = 0.079）. After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups （0.5%, 0.3%, and 0.3%, respectively; P = 0.320）. After multivariate adjustment, low or high baseline PC did not signi- ficantly increase the risk of major bleeding. Conclusion There is no significant association between baseline PC and severe adverse out- comes following PCI in current real-world practice.展开更多
文摘Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus （DM） was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent （DES）. Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group （n = 74） and the non-ISR group （n = 294）. The independent predictors of ISR in patients with DM were explored by multivariate Cox＇s proportional hazards regression models. Results A total of 368 patients （260 women and 108 men） with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients （20.11%） by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol （VLDL-C）, triglyceride （TG） and uric acid （UA） levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C （HR = 1.85, 95% CI： 1.24-2.77, P = 0.002）, UA （per 50 μmol/L increments, HR = 1.19, 95% CI： 1.05 1.34, P = 0.006）, SYNTAX score （per 5 increments, HR = 1.34, 95% CI： 1.03-1.74, P = 0.031） and the history ofPCI （HR = 3.43, 95% CI： 1.57-7.80, P = 0.003） by the multivariate Cox＇s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physi- cians to take measures to lower the risk oflSR for the better management of diabetic patients after PCI.
基金Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(code:ZYLX201303,XMLX201601)the grant from National Key Research and Development Program of China(2017YFC0908800).
文摘BACKGROUND Tanscatheter left atrial appendage(LAA)closure and minimally invasive thoracoscopic LAA occlusion are local interventions of LAA for stroke prevention in patients with nonvalvular atrial fibrillation(NVAF).However,the safety and efficacy of these methods have not been compared.This prospective cohort study aimed to assess the safety and efficacy of those two treatment approaches for stroke prevention in NVAF patients.METHODS Two hundred and nine recurrent NVAF patients who received radiofrequency ablation were enrolled.These pa-tients were treated with transcatheter LAA closure or thoracoscopic LAA occlusion.The patients were followed up from the first postoperative day and evaluated for efficacy endpoints(stroke/transient ischemic attack(TIA),systemic embolism(SE),and death)and a safety endpoint(bleeding events).Perioperative complications were recorded.RESULTS After a median follow-up of 1.8 years(383 patient-years),the overall rate of the composite efficacy endpoints was similar between the two groups(3.8 vs.2.7 events per 100 patient-years;HR=0.71;95%CI:0.225−2.237;P=0.559).However,regarding primary safety endpoint,there were 1.5 bleeding events per 100 patient-years in the thoracoscopic LAA occlusion group,com-pared with 6.4 in transcatheter LAA closure group(HR=0.246;95%CI:0.074−0.819;P=0.022).The incidence of operative com-plications was 3/138(2.17%)in thoracoscopic LAA occlusion group and 1/71(1.41%)in transcatheter LAA closure group.CONCLUSIONS Thoracoscopic LAA occlusion and transcatheter LAA closure have similar efficacy in preventing stroke in NVAF patients.However,the thoracoscopic group had fewer bleeding events than the transcatheter group,but the former group required a longer hospital stay.
文摘Objective The aim is to evaluate the association between baseline platelet count （PC） and severe adverse outcomes following percu- taneous coronary intervention （PCI） in current real-world practice. Methods A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low （〈 150 × 1000μ.L）, normal （150-300 × 1000μL）, and high （≥ 300 × 1000μL） baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. Results In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively （P = 0.259）. Similarly, mortality rates during long-term follow-up （median 23.8 months） for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively （P = 0.079）. After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups （0.5%, 0.3%, and 0.3%, respectively; P = 0.320）. After multivariate adjustment, low or high baseline PC did not signi- ficantly increase the risk of major bleeding. Conclusion There is no significant association between baseline PC and severe adverse out- comes following PCI in current real-world practice.
