OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicent...OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.展开更多
Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outco...Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.展开更多
BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidel...BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.展开更多
BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials e...BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.展开更多
BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,ma...BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,may influence the risks and benefits of percutaneous coronary intervention(PCI)in these patients.AIM To evaluate the impact of frailty status on in-hospital outcomes among patients aged≥75 years with NSTEMI undergoing PCI.METHODS We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged≥75 years undergoing PCI.Patients were stratified into three frailty categories using the Hospital Frailty Risk Score.Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.RESULTS Among 456690 NSTEMI admissions,37.95%,50.71%,and 11.34%were categorized as low,intermediate,and high frailty,respectively.PCI use declined with increasing frailty(35.0%in low vs 7.5%in high;P<0.001).Adjusted mortality was lower with PCI across all frailty levels[odds ratios(OR):0.27(low),0.37(intermediate),0.43(high);all P<0.001].However,the mortality benefit was attenuated with increasing frailty(interaction OR:1.56 and 1.83 for intermediate and high vs low frailty;P<0.001).Frailty was independently associated with higher odds of complications,including acute kidney injury,respiratory failure,delirium,and bleeding.PCI was associated with shorter hospital stays in low(-0.90 days)but longer in the high-frail category(+2.47 days;P<0.001),and increasing frailty correlated with significantly higher hospital charges.CONCLUSION In elderly NSTEMI patients,PCI conferred a survival benefit across all frailty strata,although with a diminishing magnitude as frailty increased.Frailty correlated with increased complications and healthcare resource utilization.展开更多
Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to e...Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.展开更多
Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We comp...Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.展开更多
BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the...BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.展开更多
BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chine...BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chinese population.This study aimed to develop and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events(MACCE)in elderly Chinese patients with ACS.METHODS A retrospective analysis was conducted using two independent cohorts of ACS patients aged≥65 years who underwent percutaneous coronary intervention:the derivation cohort(n=1674)and the validation cohort(n=2333).Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion.A final nomogram incorporating ten variables was constructed.Model performance was evaluated in terms of discrimination[concordance index(C-index)and area under the receiver operating characteristic curve(AUC)]and calibration(calibration plots).RESULTS The 2-year incidence of MACCE was 12.5%(n=210)in the derivation cohort and 15.6%(n=364)in the validation cohort.The nomogram demonstrated good discrimination,with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort,respectively;significantly outperforming the GRACE risk score(P<0.001).Calibration plots showed good agreement between the predicted and observed outcomes.Patients classified as the high-risk group by the nomogram had a significantly higher MACCE incidence compared to that of the low-risk group(log-rank P<0.001).CONCLUSIONS This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention.It outperformed the GRACE score in both discrimmination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.展开更多
BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress...BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.展开更多
Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifes...Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.展开更多
BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vesse...BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.展开更多
Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous cor...Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.展开更多
BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI ca...BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.展开更多
Co-occurrence of acute ischemic stroke and acute myocardial infarction,named concomitant cerebrocardiac infarction,is a rare yet critical medical challenge.Optimal management strategies remain undefined,particularly f...Co-occurrence of acute ischemic stroke and acute myocardial infarction,named concomitant cerebrocardiac infarction,is a rare yet critical medical challenge.Optimal management strategies remain undefined,particularly for ST-segment elevation myocardial infarction.This editorial discusses a case report by Zheng and Liu,where a 27-year-old male with simultaneous acute transmural anterior myocardial infarction and acute ischemic stroke was treated with urgent thrombolysis followed by elective percutaneous coronary intervention.We offer a perspective on the rationale behind this combined approach,discussing the delicate balance of addressing acute stroke and myocardial infarction.This commentary highlights the critical need for further research and clinical discussion to develop evidence-based strategies for optimal patient care in these complex,time-sensitive cases,encouraging critical evaluation of current practices.展开更多
BACKGROUND A psychological sense of coherence(SOC)in percutaneous coronary intervention(PCI)patients is important for disease prognosis,and there is considerable variation between their symptoms.In contrast,network an...BACKGROUND A psychological sense of coherence(SOC)in percutaneous coronary intervention(PCI)patients is important for disease prognosis,and there is considerable variation between their symptoms.In contrast,network analysis provides a new approach to gaining insight into the complex nature of symptoms and symptom clusters and identifying core symptoms.AIM To explore the psychological coherence of symptoms experienced by PCI patients,we aim to analyze differences in their associated factors and employ network analysis to characterize the symptom networks.METHODS A total of 472 patients who underwent PCI were selected for a cross-sectional study.The objective was to investigate the association between general patient demographics,medical coping styles,perceived stress status,and symptoms of psychological coherence.Data analysis was conducted using a linear regression model and a network model to visualize psychological coherence and calculate a centrality index.RESULTSPost-PCI patients exhibited low levels of psychological coherence, which correlated with factors such as education,income, age, place of residence, adherence to medical examinations, perceived stress, and medical coping style.Network analysis revealed that symptoms within the sense of psychological coherence were strongly interconnected,particularly with SOC2 and SOC8, demonstrating the strongest correlations. Among these, SOC10 emergedas the symptom with the highest intensity, centrality, and proximity, identifying it as the most central symptom.CONCLUSIONThe network model has strong explanatory power in describing the psychological consistency symptoms ofpatients after PCI, identifying the central SOC symptoms, among which SOC10 is the key to overall SOCenhancement, and there is a strong positive correlation between SOC2 and SOC8, emphasizing the need to considerthe synergistic effect of symptoms in intervention measures.展开更多
BACKGROUND Glycated hemoglobin(HbA1c)is a well-established biomarker for diagnosing and managing diabetes.However,its prognostic significance in patients without diagnosed diabetes undergoing percutaneous coronary int...BACKGROUND Glycated hemoglobin(HbA1c)is a well-established biomarker for diagnosing and managing diabetes.However,its prognostic significance in patients without diagnosed diabetes undergoing percutaneous coronary intervention(PCI)remains uncertain.This systematic review and meta-analysis evaluates the association between elevated HbA1c levels in the prediabetic range(≥5.7%)and adverse cardiovascular outcomes in this population.AIM To investigate the association between elevated HbA1c levels in the prediabetic range and adverse outcomes in patients without diagnosed diabetes undergoing PCI.METHODS We systematically searched PubMed,EMBASE,and Cochrane Central through April 2025 for studies comparing clinical outcomes in coronary artery disease(CAD)patients without a prior diabetes diagnosis,stratified by HbA1c levels(≥5.7% vs<5.7%).Risk ratios(RR)with 95%confidence intervals(CI)were pooled using a random-effects model.Statistical analysis was performed using R software(version 4.3.2).Primary outcomes were long-term allcause mortality and major adverse cardiovascular events(MACE);secondary outcomes included short-term mortality and cardiac death.RESULTS Ten studies involving 32403 patients(mean age:60 years;29% female)were included.Elevated HbA1c levels in patients without diagnosed diabetes were significantly associated with increased risk of long-term all-cause mortality(RR:1.30;95% CI:1.10-1.54;P<0.01;I2=41%)and MACEs(RR:1.31;95% CI:1.01-1.69;P=0.04;I2=61%).Although the risks of short-term all-cause mortality(RR:1.16;95% CI:0.88-1.53;P=0.29;I2=1%)and cardiac mortality(RR:1.76;95% CI:0.85-3.67;P=0.13;I2=94%)were elevated,they did not reach statistical significance.Sensitivity analyses confirmed the robustness of the findings despite moderate to high heterogeneity in some outcomes.CONCLUSION Among CAD patients without diagnosed diabetes,elevated HbA1c levels in the prediabetic range(≥5.7%)are independently associated with worse long-term outcomes following PCI.HbA1c may serve as a valuable biomarker for post-PCI risk stratification in this metabolically at-risk group.展开更多
BACKGROUND Coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)are well-established treatments for multivessel coronary artery disease(CAD),a condition where multiple heart arteries are nar...BACKGROUND Coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)are well-established treatments for multivessel coronary artery disease(CAD),a condition where multiple heart arteries are narrowed.A newer approach,fractional flow reserve(FFR)-guided PCI,uses a specialized measurement to select which artery blockages to treat,aiming to enhance patient outcomes.Despite its adoption,the comparative effectiveness of FFR-guided PCI vs CABG remains unclear,particularly regarding key health outcomes such as survival,heart-related complications,and the need for further procedures.AIM To evaluate the safety and effectiveness of FFR-guided PCI compared to CABG in patients with multivessel CAD.METHODS This meta-analysis followed standard reporting guidelines and included randomized controlled trials(RCTs)comparing FFR-guided PCI with CABG in patients with multivessel CAD.We searched medical databases,including PubMed,EMBASE,ScienceDirect,and ClinicalTrials.gov,from their start to May 2025.We calculated combined risk ratios(RRs)with 95%confidence intervals(95%CIs)to analyze the data.RESULTS Three RCTs were analyzed.There was no notable difference in all-cause mortality between FFR-guided PCI and CABG(RR=1.01,95%CI:0.78-1.31,P=0.93).However,FFR-guided PCI showed higher rates of major adverse cardiac events(MACEs;RR=1.30,95%CI:1.11-1.52,P=0.001),myocardial infarction(RR=1.49,95%CI:1.11-2.01,P=0.009),and repeat revascularization(RR=2.25,95%CI:1.78-2.85,P<0.00001).Stroke rates were comparable between the two treatments(RR=0.80,95%CI:0.54-1.20,P=0.28).CONCLUSION FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD.However,CABG results in fewer MACEs,myocardial infarctions,and repeat procedures.展开更多
Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in...Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in multivessel coronary artery disease(CAD).The pooled analysis found no significant difference in all-cause mortality or stroke,yet CABG was superior in reducing myocardial infarction,major adverse cardiac events,and repeat revascularization.These results confirm CABG’s durability even in the era of physiological lesion assessment and second-generation drug-eluting stents.From a traditional Chinese medicine(TCM)perspective,multivessel CAD corresponds to syndromes such as“heart vessel obstruction”and“Qi and blood stagnation”,in which local blockage is compounded by systemic imbalance.While revascularization addresses the structural impediment to blood flow,TCM approaches,including herbal medicine,acupuncture,and lifestyle therapy,aim to improve microcirculation,reduce inflammation,and support recovery,potentially mitigating recurrent ischemic events.This commentary argues that future research should integrate optimal revascularization strategies with rigorously evaluated TCM interventions to address both the anatomical and systemic dimensions of CAD and improve long-term patient outcomes.展开更多
Coronary intervention is an important method for the treatment of coronary heart disease,which can improve the myocardial blood supply function of patients to a great extent.The nursing and rehabilitation after corona...Coronary intervention is an important method for the treatment of coronary heart disease,which can improve the myocardial blood supply function of patients to a great extent.The nursing and rehabilitation after coronary intervention are very important for patients.In view of this,this article analyzed the rehabilitation and nursing of patients after coronary intervention,and put forward some strategies,only for the reference of colleagues.展开更多
基金supported by the National Key Research and Development Program of China(No.2022YFC3602500)Beijing High-level Public Health Technical Talents Construction Project(Discipline Leader-03-24)Beijing Hospitals Authority’s Ascent Plan(DFL20240601).
文摘OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.
文摘Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.
基金was given by a 2017 Research Grant of the Italian Society of Interventional Cardiology (SICI-GISE)
文摘BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.
文摘BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.
文摘BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,may influence the risks and benefits of percutaneous coronary intervention(PCI)in these patients.AIM To evaluate the impact of frailty status on in-hospital outcomes among patients aged≥75 years with NSTEMI undergoing PCI.METHODS We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged≥75 years undergoing PCI.Patients were stratified into three frailty categories using the Hospital Frailty Risk Score.Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.RESULTS Among 456690 NSTEMI admissions,37.95%,50.71%,and 11.34%were categorized as low,intermediate,and high frailty,respectively.PCI use declined with increasing frailty(35.0%in low vs 7.5%in high;P<0.001).Adjusted mortality was lower with PCI across all frailty levels[odds ratios(OR):0.27(low),0.37(intermediate),0.43(high);all P<0.001].However,the mortality benefit was attenuated with increasing frailty(interaction OR:1.56 and 1.83 for intermediate and high vs low frailty;P<0.001).Frailty was independently associated with higher odds of complications,including acute kidney injury,respiratory failure,delirium,and bleeding.PCI was associated with shorter hospital stays in low(-0.90 days)but longer in the high-frail category(+2.47 days;P<0.001),and increasing frailty correlated with significantly higher hospital charges.CONCLUSION In elderly NSTEMI patients,PCI conferred a survival benefit across all frailty strata,although with a diminishing magnitude as frailty increased.Frailty correlated with increased complications and healthcare resource utilization.
文摘Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.
文摘Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.
文摘BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.
基金supported by the National High Level Hospital Clinical Research Funding(2025-GSP-QN-31&2022-GSP-QN-1)the Young Talent Program of the Academician Fund(YS-2022-002)the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)(2023-I2M-1-002)。
文摘BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chinese population.This study aimed to develop and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events(MACCE)in elderly Chinese patients with ACS.METHODS A retrospective analysis was conducted using two independent cohorts of ACS patients aged≥65 years who underwent percutaneous coronary intervention:the derivation cohort(n=1674)and the validation cohort(n=2333).Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion.A final nomogram incorporating ten variables was constructed.Model performance was evaluated in terms of discrimination[concordance index(C-index)and area under the receiver operating characteristic curve(AUC)]and calibration(calibration plots).RESULTS The 2-year incidence of MACCE was 12.5%(n=210)in the derivation cohort and 15.6%(n=364)in the validation cohort.The nomogram demonstrated good discrimination,with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort,respectively;significantly outperforming the GRACE risk score(P<0.001).Calibration plots showed good agreement between the predicted and observed outcomes.Patients classified as the high-risk group by the nomogram had a significantly higher MACCE incidence compared to that of the low-risk group(log-rank P<0.001).CONCLUSIONS This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention.It outperformed the GRACE score in both discrimmination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.
基金supported by the National Natural Science Foundation of China(No.62135002)the Key Research and Development Program of Heilongjiang Province(No.2022ZX01A28).
文摘BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.
文摘Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.
基金supported by the CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-008)the National High Level Hospital Clinical Research Funding(No.2023-GSP-GG-2&No.2023-GSP-QN-34&No.2023-GSPRC-05).
文摘BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.
文摘Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.
文摘BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.
文摘Co-occurrence of acute ischemic stroke and acute myocardial infarction,named concomitant cerebrocardiac infarction,is a rare yet critical medical challenge.Optimal management strategies remain undefined,particularly for ST-segment elevation myocardial infarction.This editorial discusses a case report by Zheng and Liu,where a 27-year-old male with simultaneous acute transmural anterior myocardial infarction and acute ischemic stroke was treated with urgent thrombolysis followed by elective percutaneous coronary intervention.We offer a perspective on the rationale behind this combined approach,discussing the delicate balance of addressing acute stroke and myocardial infarction.This commentary highlights the critical need for further research and clinical discussion to develop evidence-based strategies for optimal patient care in these complex,time-sensitive cases,encouraging critical evaluation of current practices.
基金Supported by the Self-funded Research Project of Health Commission of Guangxi Zhuang Autonomous Region,No.Z-A20220509.
文摘BACKGROUND A psychological sense of coherence(SOC)in percutaneous coronary intervention(PCI)patients is important for disease prognosis,and there is considerable variation between their symptoms.In contrast,network analysis provides a new approach to gaining insight into the complex nature of symptoms and symptom clusters and identifying core symptoms.AIM To explore the psychological coherence of symptoms experienced by PCI patients,we aim to analyze differences in their associated factors and employ network analysis to characterize the symptom networks.METHODS A total of 472 patients who underwent PCI were selected for a cross-sectional study.The objective was to investigate the association between general patient demographics,medical coping styles,perceived stress status,and symptoms of psychological coherence.Data analysis was conducted using a linear regression model and a network model to visualize psychological coherence and calculate a centrality index.RESULTSPost-PCI patients exhibited low levels of psychological coherence, which correlated with factors such as education,income, age, place of residence, adherence to medical examinations, perceived stress, and medical coping style.Network analysis revealed that symptoms within the sense of psychological coherence were strongly interconnected,particularly with SOC2 and SOC8, demonstrating the strongest correlations. Among these, SOC10 emergedas the symptom with the highest intensity, centrality, and proximity, identifying it as the most central symptom.CONCLUSIONThe network model has strong explanatory power in describing the psychological consistency symptoms ofpatients after PCI, identifying the central SOC symptoms, among which SOC10 is the key to overall SOCenhancement, and there is a strong positive correlation between SOC2 and SOC8, emphasizing the need to considerthe synergistic effect of symptoms in intervention measures.
文摘BACKGROUND Glycated hemoglobin(HbA1c)is a well-established biomarker for diagnosing and managing diabetes.However,its prognostic significance in patients without diagnosed diabetes undergoing percutaneous coronary intervention(PCI)remains uncertain.This systematic review and meta-analysis evaluates the association between elevated HbA1c levels in the prediabetic range(≥5.7%)and adverse cardiovascular outcomes in this population.AIM To investigate the association between elevated HbA1c levels in the prediabetic range and adverse outcomes in patients without diagnosed diabetes undergoing PCI.METHODS We systematically searched PubMed,EMBASE,and Cochrane Central through April 2025 for studies comparing clinical outcomes in coronary artery disease(CAD)patients without a prior diabetes diagnosis,stratified by HbA1c levels(≥5.7% vs<5.7%).Risk ratios(RR)with 95%confidence intervals(CI)were pooled using a random-effects model.Statistical analysis was performed using R software(version 4.3.2).Primary outcomes were long-term allcause mortality and major adverse cardiovascular events(MACE);secondary outcomes included short-term mortality and cardiac death.RESULTS Ten studies involving 32403 patients(mean age:60 years;29% female)were included.Elevated HbA1c levels in patients without diagnosed diabetes were significantly associated with increased risk of long-term all-cause mortality(RR:1.30;95% CI:1.10-1.54;P<0.01;I2=41%)and MACEs(RR:1.31;95% CI:1.01-1.69;P=0.04;I2=61%).Although the risks of short-term all-cause mortality(RR:1.16;95% CI:0.88-1.53;P=0.29;I2=1%)and cardiac mortality(RR:1.76;95% CI:0.85-3.67;P=0.13;I2=94%)were elevated,they did not reach statistical significance.Sensitivity analyses confirmed the robustness of the findings despite moderate to high heterogeneity in some outcomes.CONCLUSION Among CAD patients without diagnosed diabetes,elevated HbA1c levels in the prediabetic range(≥5.7%)are independently associated with worse long-term outcomes following PCI.HbA1c may serve as a valuable biomarker for post-PCI risk stratification in this metabolically at-risk group.
文摘BACKGROUND Coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)are well-established treatments for multivessel coronary artery disease(CAD),a condition where multiple heart arteries are narrowed.A newer approach,fractional flow reserve(FFR)-guided PCI,uses a specialized measurement to select which artery blockages to treat,aiming to enhance patient outcomes.Despite its adoption,the comparative effectiveness of FFR-guided PCI vs CABG remains unclear,particularly regarding key health outcomes such as survival,heart-related complications,and the need for further procedures.AIM To evaluate the safety and effectiveness of FFR-guided PCI compared to CABG in patients with multivessel CAD.METHODS This meta-analysis followed standard reporting guidelines and included randomized controlled trials(RCTs)comparing FFR-guided PCI with CABG in patients with multivessel CAD.We searched medical databases,including PubMed,EMBASE,ScienceDirect,and ClinicalTrials.gov,from their start to May 2025.We calculated combined risk ratios(RRs)with 95%confidence intervals(95%CIs)to analyze the data.RESULTS Three RCTs were analyzed.There was no notable difference in all-cause mortality between FFR-guided PCI and CABG(RR=1.01,95%CI:0.78-1.31,P=0.93).However,FFR-guided PCI showed higher rates of major adverse cardiac events(MACEs;RR=1.30,95%CI:1.11-1.52,P=0.001),myocardial infarction(RR=1.49,95%CI:1.11-2.01,P=0.009),and repeat revascularization(RR=2.25,95%CI:1.78-2.85,P<0.00001).Stroke rates were comparable between the two treatments(RR=0.80,95%CI:0.54-1.20,P=0.28).CONCLUSION FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD.However,CABG results in fewer MACEs,myocardial infarctions,and repeat procedures.
文摘Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in multivessel coronary artery disease(CAD).The pooled analysis found no significant difference in all-cause mortality or stroke,yet CABG was superior in reducing myocardial infarction,major adverse cardiac events,and repeat revascularization.These results confirm CABG’s durability even in the era of physiological lesion assessment and second-generation drug-eluting stents.From a traditional Chinese medicine(TCM)perspective,multivessel CAD corresponds to syndromes such as“heart vessel obstruction”and“Qi and blood stagnation”,in which local blockage is compounded by systemic imbalance.While revascularization addresses the structural impediment to blood flow,TCM approaches,including herbal medicine,acupuncture,and lifestyle therapy,aim to improve microcirculation,reduce inflammation,and support recovery,potentially mitigating recurrent ischemic events.This commentary argues that future research should integrate optimal revascularization strategies with rigorously evaluated TCM interventions to address both the anatomical and systemic dimensions of CAD and improve long-term patient outcomes.
基金Taicang Medical and Health Application Basic Research Guidance Project,“Research on Monitoring the Personalized Pressure of Pneumatic Tourniquet in Knee Arthroscopic Surgery Based on Popliteal Artery Blood Flow Ultrasound”(Project No.:2024TCYLZD03)。
文摘Coronary intervention is an important method for the treatment of coronary heart disease,which can improve the myocardial blood supply function of patients to a great extent.The nursing and rehabilitation after coronary intervention are very important for patients.In view of this,this article analyzed the rehabilitation and nursing of patients after coronary intervention,and put forward some strategies,only for the reference of colleagues.
