Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy B...Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001).Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.展开更多
Background Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction （LVEF） represent a high risk group of patients for coronary revascularization. There are limited data on ...Background Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction （LVEF） represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population. Methods Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF 〈40% （low ejection fraction （EF）） and 4144 patients had LVEF _〉40%. In-hospital and long-term outcomes were examined according to LVEF. Results The estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group （19.64% vs. 8.73%, Log-rank test： P 〈0.01; 10.30% vs. 1.33%, Log-rank test： P 〈0.01, and 10.32% vs. 2.28%, Log-rank test： P 〈0.01 respectively）, but there was no difference in the rates of target vessel revascularization （6.18% vs. 6.11%, Log-rank test： P=0.96）. Using the Cox proportional hazard models, LVEF 〈40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events （OR （95% CI）： 4.779 （2.369-9.637）, 2.673 （1.353-5.282）, and 1.827 （1.187-2.813） respectively）, but was not a statistically significant risk factor for target vessel revascularization （OR （95% CI）： 1.094 （0.558-2.147））. Conclusion Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.展开更多
Background：The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score Ⅱ （SS-Ⅱ） can well predict 4-year mortality in patients with complex coronary artery disease （CAD）,and guide...Background：The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score Ⅱ （SS-Ⅱ） can well predict 4-year mortality in patients with complex coronary artery disease （CAD）,and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention （PCI）.However,there is lack of data regarding the utility of the SS-Ⅱ in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents （DES）.The purpose of the present study was to evaluate the ability of the SS-Ⅱ to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES.Methods：Totally,573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied.According to the tertiles of the SS-Ⅱ,the patients were divided into three groups：The lowest SS-Ⅱ tertile （SS-Ⅱ ≤20）,intermediate SS-Ⅱ tertile （SS-Ⅱ of 21-31）,and the highest SS-Ⅱ tertile （SS-Ⅱ ≥32）.The survival curves of the different groups were estimated by the Kaplan-Meier method.Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-Ⅱ and 5-year mortality.The performance of the SS-Ⅱ with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic （ROC） curve.The predictive ability of the SS-Ⅱ for 5-year mortality was evaluated and compared with the SS alone.Results：The overall SS-Ⅱ was 27.6 ± 9.0.Among patients in the lowest,intermediate and the highest SS-Ⅱ tertiles,the 5-year rates of mortality were 1.6%,3.2%,and 8.6%,respectively （P =0.003）;the cardiac mortality rates were 0.5%,1.9%,and 5.2%,respectively （P =0.014）.By multivariable analysis,adjusting for the potential confounders,the SS-Ⅱ was an independent predictor of 5-year mortality （hazard ratio：2.45,95% confidence interval：1.38-4.36;P=0.002）.The SS-Ⅱ demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone （the area under the ROC curve was 0.705 and 0.598,respectively）.Conclusion：The SS-Ⅱ is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES,and demonstrates a superior predictive ability over the SS alone.展开更多
目的探讨脑小血管病(cerebral small vessel disease,CSVD)患者的血清尿酸(uric acid,UA)水平与步态运动学特征间关系。方法回顾性分析2023年1月至2023年12月就诊于广州中医药大学附属中山中医院神经内科·康复科且诊断为CSVD的患...目的探讨脑小血管病(cerebral small vessel disease,CSVD)患者的血清尿酸(uric acid,UA)水平与步态运动学特征间关系。方法回顾性分析2023年1月至2023年12月就诊于广州中医药大学附属中山中医院神经内科·康复科且诊断为CSVD的患者。收集一般资料,对患者进行三维步态分析,结合步态结果将患者分为轻度步态障碍组(0~1分)、中度步态障碍组(2~3分)和重度步态功能障碍组(4~5分),记录CSVD影像总负荷及UA等血清学结果。分析UA水平与CSVD步态障碍之间的关系。结果本研究纳入CSVD患者共105例,根据步态障碍严重程度分组,轻度步态障碍组40例,中度步态障碍组49例,重度步态障碍组16例。中度步态障碍组的血清UA[(358.43±13.44)μmol/L]高于轻度步态障碍组血清UA[(336.00±12.48)μmol/L],重度步态障碍组的血清UA[(289.94±11.88)μmol/L]低于轻、中度步态障碍组(P<0.05),重度步态障碍组的蒙特利尔认知评估量表评分(21.38±0.13)低于轻、中度步态障碍组(28.05±0.09;25.22±0.10)(P<0.05);CSVD影像学总负荷重度组的步宽[(13.26±2.80)cm]相比轻、中度组[(11.22±1.70)cm vs.(11.65±2.70)cm]增加(P<0.05),CSVD影像学总负荷重度组左侧摆动相(35.90%)相比轻、中度组(38.50%vs.37.20%)下降(P<0.05);Spearman相关分析显示血清UA水平与脑微出血呈负相关(r=-0.20,P=0.04),高尿酸血症与脑萎缩呈负相关(r=-0.20,P=0.04);在轻中度步态障碍组患者中,高尿酸血症与步态障碍总负荷之间呈正相关(r=0.25,P=0.02),高尿酸血症与右侧步速(r=-0.22,P=0.04)、右侧步幅(r=-0.29,P<0.01)、左侧步速(r=-0.32,P<0.01)、左侧步频(r=-0.29,P<0.01)、左侧步幅(r=-0.26,P=0.01)均呈负相关。结论CSVD轻中度步态障碍患者中,UA水平及高尿酸血症的发生与步态障碍总负荷呈正相关,步态障碍以双侧步速、双侧步幅、左侧步频减少为主要特征。展开更多
基金supported by National Program on Key Basic Research Project(973 Program,No.2010CB732601)National High-Tech Research and Development Program of China(863 Program,No.2015AA020407)+5 种基金Beijing Municipal Science&Technology Commission(No.Z191100006619106)National Natural Science Foundation of China(Nos.81470380 and 81770365)National Key Research and Development Program of the Ministry of Science and Technology of China during the"13^(th)Five-Year Plan"(No.2016YFC1301301)National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(No.NCRC2020013)Key Project of Yunnan National Regional Medical Center for Cardiovascular Diseases(No.202002AA310100-14)Beijing United Heart Foundation(No.BJUHFCSOARF201901-19)
文摘Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001).Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.
文摘Background Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction （LVEF） represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population. Methods Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF 〈40% （low ejection fraction （EF）） and 4144 patients had LVEF _〉40%. In-hospital and long-term outcomes were examined according to LVEF. Results The estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group （19.64% vs. 8.73%, Log-rank test： P 〈0.01; 10.30% vs. 1.33%, Log-rank test： P 〈0.01, and 10.32% vs. 2.28%, Log-rank test： P 〈0.01 respectively）, but there was no difference in the rates of target vessel revascularization （6.18% vs. 6.11%, Log-rank test： P=0.96）. Using the Cox proportional hazard models, LVEF 〈40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events （OR （95% CI）： 4.779 （2.369-9.637）, 2.673 （1.353-5.282）, and 1.827 （1.187-2.813） respectively）, but was not a statistically significant risk factor for target vessel revascularization （OR （95% CI）： 1.094 （0.558-2.147））. Conclusion Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.
文摘Background：The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score Ⅱ （SS-Ⅱ） can well predict 4-year mortality in patients with complex coronary artery disease （CAD）,and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention （PCI）.However,there is lack of data regarding the utility of the SS-Ⅱ in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents （DES）.The purpose of the present study was to evaluate the ability of the SS-Ⅱ to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES.Methods：Totally,573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied.According to the tertiles of the SS-Ⅱ,the patients were divided into three groups：The lowest SS-Ⅱ tertile （SS-Ⅱ ≤20）,intermediate SS-Ⅱ tertile （SS-Ⅱ of 21-31）,and the highest SS-Ⅱ tertile （SS-Ⅱ ≥32）.The survival curves of the different groups were estimated by the Kaplan-Meier method.Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-Ⅱ and 5-year mortality.The performance of the SS-Ⅱ with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic （ROC） curve.The predictive ability of the SS-Ⅱ for 5-year mortality was evaluated and compared with the SS alone.Results：The overall SS-Ⅱ was 27.6 ± 9.0.Among patients in the lowest,intermediate and the highest SS-Ⅱ tertiles,the 5-year rates of mortality were 1.6%,3.2%,and 8.6%,respectively （P =0.003）;the cardiac mortality rates were 0.5%,1.9%,and 5.2%,respectively （P =0.014）.By multivariable analysis,adjusting for the potential confounders,the SS-Ⅱ was an independent predictor of 5-year mortality （hazard ratio：2.45,95% confidence interval：1.38-4.36;P=0.002）.The SS-Ⅱ demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone （the area under the ROC curve was 0.705 and 0.598,respectively）.Conclusion：The SS-Ⅱ is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES,and demonstrates a superior predictive ability over the SS alone.
