简介：BackgroundTotheeffectofpercutaneouscoronaryintervention(PCI)onplasmalevelofN-terminalpro-Btypenatriureticpeptide(NT-proBNP)inpatientswithcoronaryheartdisease(CHD)andnormalleftventricularfunction.MethodsOnehundredandfivepatientswithCHDandnormalventricularfunctionwereenrolled.BloodsamplesforassessmentofNT-proBNPandcTn-TwerecollectedbeforeandafterPCI.ResultsThemeanleftventricularejectionfractionwas60.3±5.3%.Afterrevascularization,theleveloflgNT-proBNPwassignificantlyreduced(2.40±0.44vs2.23±0.43,P<0.001).SubgroupanalysisshowedthattheleveloflgNT-proBNPwasconsistentlydecreasedindifferentclinicalclassifications(stableangina45,unstableangina31andacutemyocardialinfarction29)andtarget-vesselrevascularization(leftanteriordescendingartery30,leftcircumflexartery26andrightcoronaryartery49),andin99patientswithoutelevationofpost-proceduralcTnT,butitshowedatrendofnon-significantincreasein6patientswithelevatedcTn-T.ConclusionsOurstudydemonstratesthatsuccessfulPCIreducesplasmaNT-proBNPconcentrationinpatientswithCHDandnormalventricularfunction.ThisimplicatesthattheimpactofPCIshouldbeconsideredintheinterpretationofNT-proBNPchangeinclinicalpractice,andfurtherstudiesarenecessarytoinvestigatethedirectand/orindirecteffectofmyocardialischemiaonBNP/NT-proBNP.

简介：BackgroundMonocytetohighdensitylipoproteinratio(MHR)hasbeenconsideredasanovelparameterrelatedwithadverserenalandcardiovascularoutcomes.InthisstudyweinvestigatedtheassociationofMHRwithmajoradverseclinicalevents(MACEs)inpatientswithtype2diabetesmellitus(T2DM)undergoingelectivepercutaneouscoronaryintervention(PCI).MethodsConsecutiveT2DMpatientstreatedwithelectivePCIwereprospectivelyrecruitedbetweenJuly2008-January2016inDepartmentofCardiologyofPanyuCentralHospital.Subjectswerecategorizedintotwogroups:aspatientswhodevelopedMACEs(MACEs+)andpatientswhodidnotdevelopMACEs(MACEs-)duringhospitalization.MACEsweredefinedasthecompositeendpoints,includingall-causemortality,oracuteheartfailure,ortargetvesselrevascularization,orstrokeorrecurrentangina.ResultsAtotalof418patientswereincludedinthestudy.64patientsdevelopedMACEs(15.3%).IntheMACEs(+)patients,monocyteswerehigher(1.12[0.78-1.42]vs.0.72[0.68-0.92]109/L,P<0.01)andHDLcholesterollevelswerelower(0.87[0.72-1.21]vs.0.96[0.81-1.11]mmol/L,P<0.01).Inaddition,MHRwassignificantlyhigherintheMACEs(+)group(1.12[0.91-2.09]vs.0.73[0.54-0.93]109mmol/L,P<0.01).ThecutoffvalueofMHRforpredictingMACEswas22,withasensitivityof81%andaspecificityof75.1%(areaunderthecurve0.79,P<0.001).Inmultivariatelogisticregressionanalysis,MHRremainedanindependentfactorcorrelatedwithMACEs(OR=3.97,95%CI=1.38-11.5,P<0.01).ConclusionHigherMHRlevelsmaypredictMACEsdevelopmentafterelectivePCIinT2DMpatients.

简介：BackgroundDespiteobservationssuggestingabenefitforlateopeningoftotallyoccludedinfarct-relatedarteriesaftermyocardialinfarction,theOccludedArteryTrial(OAT)demonstratednoreductioninthecompositeofdeath,reinfarction,andclassIVheartfailureovera2.9-yearmeanfollow-up.Follow-upwasextendedtode-terminewhetherlatetrendswouldfavoreithertreatmentgroup.MethodsandResultsOATrandomized2201stablepatientswithinfarct-relatedarterytotalocclusion>24hours(calendardays3-28)aftermyocardialinfarction.Patientswithsevereinducibleischemia,restangina,classⅢ-Ⅳheartfailure,and3-vessel/leftmaindiseasewereexcluded.Weconductedextendedfollow-upofenrolledpatientsforanadditional3yearsfortheprimaryendpointandangina(6-yearmediansurvivorfollow-up;longest,9years;12234patient-years).Ratesoftheprimaryendpoint(hazardratio,1.06;95%confidenceinterval,0.88-1.28),fatalandnonfatalmyocardialinfarction(hazardratio,1.25;95%confidenceinterval,0.89-1.75),death,andclassIVheartfailureweresimilarforthepercutaneouscoronaryintervention(PCI)andmedicaltherapyalonegroups.Nointeractionsbetweenbaselinecharacteristicsandtreatmentgrouponoutcomeswereobserved.Thevastmajorityofpatientsateachfollow-upvisitdidnotreportangina.TherewaslessanginainthePCIgroupthroughearlyinfollow-up;by3years,thebetweengroupdifferencewasconsistently<4patientsper100treatedandnotsignificantlydifferent,althoughtherewasatrendtowardlessanginainthePCIgroupat3and5years.The7-yearrateofPCIoftheinfarct-relatedarteryduringfollow-upwas11.1%forthePCIgroupcomparedwith14.7%forthemedicaltherapyalonegroup(hazardratio,0.79;95%confidenceinterval,0.61-1.01;P=0.06).ConclusionsExtendedfollow-upoftheOATcohortprovidesrobustevidencefornoreductionoflong-termratesofclinicaleventsafterroutinePCIinstablepatientswithatotallyocclud

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简介：BackgroundIntheHORIZONS-AMI(HarmonizingOutcomeswithRevasculariZatiONandStentsinAcuteMyocardialInfarction)trial,3,602patientsundergoingprimarypercutaneouscoronaryintervention(PCI)forST-segmentelevationmyocardialinfarction(STEMI)treatedwithbivalirudinhadlowerbleedingandmortalityrates,buthigheracutestentthrombosisratescomparedwithheparin+aglycoproteinⅡb/Ⅲainhibitor(GPI).SubsequentchangesinprimaryPCI,includingtheuseofpotentP2Y12inhibitors,frequentradialintervention,andpre-hospitalmedicationadministration,wereincorporatedintotheEUROMAX(EuropeanAmbulanceAcuteCoronarySyndromeAngiography)trial,whichassigned2,218patientstobivalirudinversusheparin±GPIbeforeprimaryPCI.ObjectivesThegoalofthisstudywastoexaminetheoutcomesofproceduralanticoagulationwithbivalirudinversusheparin±GPIforprimaryPCI,giventheevolutioninprimaryPCI.MethodsDatabasesfromHORIZONS-AMIandEUROMAXwerepooledforpatient-levelanalysis.TheBreslow-Daytestevaluatedheterogeneitybetweentrials.ResultsAtotalof5,800patientswererandomizedtobivalirudin(n=2,889)orheparin±GPI(n=2,911).Theradialapproachwasusedin21.3%ofpatients,prasugrel/ticagrelorwasusedin18.1%ofpatients,andGPIwasusedin84.8%ofthecontrolgroup.Bivalirudincomparedwithheparin±GPIresultedinreduced30-dayratesofmajorbleeding(4.2%vs.7.8%;relativerisk[RR]:0.53;95%confidenceinterval[CI]:0.43to0.66;P<0.0001),thrombocytopenia(1.4%vs.2.9%,RR:0.48;95%CI:0.33to0.71;P=0.0002),andcardiacmortality(2.0%vs.2.9%;RR:0.70;95%CI:0.50to0.97;P=0.03),withnonsignificantlydifferentratesofreinfarction,ischemia-drivenrevascularization,stroke,andall-causemortality.Bivalirudinresultedinincreasedacute(<24h)stentthrombosisrates(1.2%vs.0.2%;RR:6.04;95%CI:2.55to14.31;P<0.0001),withnonsignificantlydifferentratesofsubacutestentthrombosis.Compositenetadversec

简介：BackgroundCoronaryslowflow(CSF)duringprimarypercutaneouscoronaryintervention(PCI)iscloselyrelatedtotheprognosisofpatientswithacutemyocardialinfarction(AMI).WhetherEnhancedExternalCounterPulsation(EECP)couldimprovethephenomenonandenhancecardiacfunctioninthesepatientshasnotbeenstudied.MethodsSeventy-eightAMIpatientsundergoingprimaryPCIwereenrolledanddividedinto2groups,EECPgroupandshamgroup.InEECPgroup,thepatientsweretreatedwithEECPfor30minaftercoronaryarterystentimplantation;andinshamgroup,thepatientsaftercoronaryarterystentimplantationweretreatedwithcuffswrappedfor30min.HemodynamicsandcorrectedTIMIFrameCount(cTFC)wererecordedatdifferenttimepointsinbothgroups.CRP,HCY,NT-proBNPandKillipclasswerealsodetectedbeforeoperationandaftertreatment.ResultsInEECPgroup,comparedtopre-andpost-EECPtreatment,thesystolicbloodpressure(SBP)wasmuchlower(P<0.05),diastolicbloodpressure(DBP)andmeanarterialbloodpressure(MBP)weremuchhigher(P<0.05).Theheartrate(HR)wasnotchangedduringEECPtreatment(P>0.05).Inshamgroup,SBP,DBP,MBPandHRwerenotsignificantlychangedduringtheseperiod(P>0.05).InEECPgroup,thecTFCofpatientswithCSFdecreasedsignificantlyaftertreatment(P<0.05);andtherewasnodifferenceinshamgroup(P>0.05).Comparedwithpre-EECPtreatment,CRPandHCYwereincreasedinpost-EECPtreatmentofbothgroups(P<0.05),while,theyweremuchlowerinEECPgroup(P<0.05).TheexpressionofNTproBNPwasdecreasedaftertreatmentinbothgroups(P<0.05),anditwasmuchlowerinEECPgroupthaninshamgroup(P<0.05).TheKillipclasswasmuchloweraftertreatmentthanbeforeoperationinEECPgroup(P<0.05),andtherewasnochangeinshamgroup(P>0.05).ConclusionsTheresultssuggestthatEECPishelpfulinashorttimetotheimprovementofCSFandrecoveryofcardiacfunctioninAMIpatientsduringprimaryPCI,andthatCRPandHCYmaybeinvolvedinthispr

简介：Toinvestigatethebenefitsofintracoronaryhigh-dosetirofibanduringprimarypercutaneouscoronaryintervention(PCI)forpatientswithacuteST-segmentelevationmyocardialinfarction(STEMI).MethodsFifty-eightpatientswithSTEMIpresentedwithin12hofsymptomswererandomlyallocatedtostudygroup(n=28,intracor-onaryhigh-dosetirofiban)andcontrolgroup(n=30,intravenoushigh-dosetirofiban).Theculpritvesselsweretarge-tedwithprimaryPCIinallpatients.Clinicalcharacteristics,angiographicfindings,brainnatriureticpeptide(BNP)at7-dayandin-hospitaloutcomeswerecomparedbetweengroups,aswellasleftventricularejectionfraction(LVEF)andmajoradversecardiacevents(MACE,includingdeath,reinfarction,worseningheartfailureandtargetvesselrevascu-larization)at30-dayclinicalfollow-up.ResultsComparedwiththecontrolgroup,thestudygroupshowedbetterthrombolysisinmyocardialinfarction(TIMI)flowgradesimmediatelyafterPCI(96.4%vs76.7%,P=0.02).The30-daycompositemajoradversecardiaceventsratewaslowerinthestudygroup(3.6%vs23.3%,P=0.02),andtheLVEFandBNPinthestudygroupat7dayswasbetterthanthatinthecontrolgroup(P=0.01and0.02,respec-tively).Nosignificantdifferenceinhemorrhagiccomplicationsinhospitalbetweengroupswasnoted(P=0.61).ConclusionsThestudyindicatesthatintracoronaryhigh-dosebolusadministrationoftirofibanforpatientswithSTEMIwhounderwentprimaryPCIcansignificantlyimprovethereperfusionlevelintheinfarctareaandclinicaloutcomesat30daysfollow-up.Itisbetterandsafertoapplyintravenousbolusinjectionforimprovingcoronaryflow,LVEFandshort-termclinicaloutcomes.

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简介：BackgroundCreatinekinase-MB(CK-MB)elevationafterpercutaneouscoronaryintervention(PCI)hasbeenassociatedwithincreasedriskformortality.Althoughmoststudieshavedefinedperiproceduralmyocardialinfarction(pMI)asanelevationinCK-MB>3×upperlimitofnormal(ULN),useofdifferentCK-MBassaysandvariationinsite-specificdefinitionsoftheULNmaylimitthevalueofsuchrelativethresholds.MethodsandResultsWeuseddatafromthemulticenterEvaluationofDrug-ElutingStentsandIschemicEvents(EVENT)registrytoexaminetheimpactofvariationsinsite-specificthresholdsforCK-MBelevationontheincidenceofpMIaswellastherelationshipbetweenabsolutepeaklevelsofCK-MBafterPCIand1-yearmortality.Thestudycohortconsistedof6347patientswhounderwentnonemergentPCIandhadnormalCK-MBatbaseline.Acrossthe59studycenters,theULNforCK-MBrangedfrom2.6to10.4ng/mL(median,5.0ng/mL),andtherewasaninverserelationshipbetweenthesite-specificULNandtheincidenceofpMI(definedasCK-MBelevation>3×ULN).AlthoughanypostprocedureelevationofCK-MBwasassociatedwithanadverseprognosis,incategoricalanalyses,onlyCK-MB≥50ng/mLwasindependentlyassociatedwithincreased1-yearmortality(hazardratio,4.71;95%confidenceinterval,2.42to9.13;P<0.001).SplineanalysisusingpeakCK-MBasacontinuousvariablesuggestedagraded,nonlinearrelationshipwith1-yearmortality,withaninflectionpointat≈30ng/mL.ConclusionsAmongunselectedpatientsundergoingPCI,thereisagradedrelationshipbetweenCK-MBelevationafterPCIand1-yearmortalitythatisparticularlystrongforlargeCK-MBelevations(>30to50ng/mL).FuturestudiesthatincludepMIasaclinicalendpointshouldconsiderusingacorelaboratorytoassessCK-MB(toensureconsistency)andraisingthethresholdfordefiningpMIabovecurrentlevels(toenhanceclinicalrelevance).

简介：BackgroundItiswellknownthattherewasasignificantlinkbetweenpreproceduralbloodglucoselevelsandshort-termandlong-termadverseoutcomesinpatientsundergoingelectivePCI.However,theroleofpre-proceduralbloodglucoselevelsasapredictorofadverseeventsinCKDpatientswhounderwentPCIoutofestablisheddiabeteshasyettobeidentified.MethodsInourstudy,weconductedaprospectivestudyof331acutecoronarysyndrome(ACS)patientswithCKDwhounderwentPCIoutofestablisheddiabetes.Patientsweredividedintotwogroupsbasedonpre-proceduralglucoselevels(hypoglycemia<7.0mmol/L;hyperglycemia≥7.0mmol/L).Allpatientswerefollowedupprospectivelyformajoradversecardiovascularevents(MACEs)andmortalityfor6months.ResultsInourcohort,hyperglycemiapatientsreportedahigherincidenceofin-hospitalmortalitythanhypoglycemiapatients(7.5%vs.0%,P<0.001).Hyperglycemiapatientsreportedasignificantlyhigherrateof6-monthMACEs(10%vs.2.4%,P=0.007),allcausemortality(7.5%vs.1.6%,P=0.015),andcardiovascularmortality(6.2%vs1.6%,P=0.041)comparedwithhypoglycemiapatientswithpre-proceduralglucoselevels<7.0mmol/L.Multivariateanalysisdisclosedthatapre-proceduralglucoselevel≥7.0mmol/LwasasignificantindependentpredictorofMACEs(OR=2.53,95%CI1.68-17.15,P=0.004),allcausemortality(OR=4.6,95%CI1.10-18.84,P=0.036),andcardiovascularmortality(OR=6.2,95%CI1.53-24.94,P=0.011)at6monthsinpatientsafterPCI.ConclusionThestudysuggestedthatpre-proceduralglucoselevelsareassociatedwithshort-termcardiovascularoutcomeCKDpatientswhounderwentPCIwithoutestablisheddiabetesinthesettingofACS.

简介：BackgroundPriorrandomizedtrialshaveshownreducedbleedingwithbivalirudincomparedwithunfractionatedheparin(UFH)inpatientsundergoingpercutaneouscoronaryintervention(PCI).However,itisnotknownifthisbenefitisalsopresentwhenUFHdosesaremoretightlycontrolled(asmeasuredbyactivatedclot-tingtime,ACT).MethodsandResultsPatientsenrolledintheEVENT(EvaluationofDrug-ElutingStentsandIschemicEvents)registry,weredividedinto3groups,basedontheantithromboticdrugusedduringPCI(UFHmonotherapy,UFH+glycoproteinIIb-IIIareceptorinhibitor[GPI],orbivalirudinalone).Propensityscorematchingwasusedtoadjustformeasuredcovariates(89variables)andtocomparebivalirudinversusUFHmonotherapyandbivalirudinversusUFH+GPIgroups.TheUFHgroupswerestratifiedbasedonACTachieved(optimalACTdefinedas250-300forUFHmonotherapyand200-250whenGPIwasalsoused).Theprimarybleedingoutcomewasin-hospitalcompositebleeding,definedaseventsofaccesssitebleeding,ThrombolysisInMyocardialInfarctionmajor/minorbleeding,ortransfusion.Primary(in-hospitaldeath/myocardialinfarction)andsecondaryischemicoutcomes(death/MI/unplannedrepeatrevascularizationat12months)werealsoevaluated.Propensityscorematchingyielded3022patientsfortheUFHmonotherapyversusbivalirudincomparisonand3520patientsfortheUFH+GPIversusbivalirudincomparison.BivalirudinusewasassociatedwithnumericallylowerbleedingratesatallcategoriesofachievedACTwhencomparedwithUFH(low,optimal,highACT:2.5%versus4.7%,1.9%versus6.0%,3.1%versus4.8%,respectively)orheparin+GPIgroups(low,optimal,highACT:0.0%versus2.7%,2.7%versus5.2%,2.4%versus6.1%,respectively)andwasnotassociatedwithanystatisticallysignificantincreaseineitherprimaryorsecondaryischemicoutcomes.ConclusionsAmongunselectedpatientsundergoingPCI,bivalirudinuseduringPCIwasassociatedwithalowerriskofbleedingatall