Objective　To observe the influence of pre-infarction angina on ventricular function and prognosis of first acute myocardial infarction in old people. Methods　76 first acute myocardial infarction old patients was divided into two groups: angina pectoris group (n=42); no angina pectoris group (n=34). Global left ventricular function was assessed by echocardiography, arrhythmia, cardiogenic shock, heart failure, post-infarction angina and mortality was observed in hospital. Results　The rate of cardiogenic shock and heart failure and mortality was lower in angina pectoris group (33.3% vs 58.8%; 2.4% vs 23.5%), LVEF and E/A was higher in angina pectoris group (0.52±0.056 vs 0.45±0.03,0.86±0.29 vs 0.54±0.35), P<0.05. Conclusion　pre-infarction angina possesses the protecting effects on ventricular function of first acute myocardial infarction in old people, and can improve the prognosis of first acute myocardial infarction in old people.

Objective　To study the factors effecting the formation of the ventricular aneurysm post myocardial infarction (MI) and evaluate the diagnostic methods.Methods　23 MI patients with ventricular aneurysm confirmed by left ventricular angiography were observed for electrocardiogram (ECG), echocardiogram (ECHO), coronary disease and collateral vessels formation. Results　All patients had LAD disease, 65.2% patients had three coronary disease, and those with class Ⅲ collateral vessels circulation only 17.4%. Compared to ECHO by which only 4 patients were found aneurysm, the positive rate by ECG was 82.6%. Conclusion　Patients with multiple coronary disease and without enough collateral vessels are expected to form ventricular aneurysm. ECG is more sensitive than ECHO for diagnosis of ventricular aneurysm post MI

Objective To investigate the efficacy of infusion Diltiazem for patients with refractory angina pectoris. Methods　10 patients with refractory angina pectoris received continuous intravenous Diltiazem 40～150 μg/min (2.4～9 mg/h) for 48 hours after cessation of intravenous nitroglycerin and oral β-blokers. Results　With the single therapy of Diltiazem, 7 patients (70%) got satisfied results: 5 were free from and 2 were relieved of symptom; With the combination therapy of Diltiazem and intravenous nitroglycerin 60～120 μg/min after failed with Diltiazem alone, 3 (30%) patietns got satisfied results: 1 was free from and 2 were relieved of symptom. There is no severe side effects, including hypotension, bradycardia, cardiac function deterioration. Acute myocardial infarction, death and emergency interventional therapy did not occurred in all the 10 patients during the therapy period. Coronary angiography were performed in 8 patients within 1 week after the patients were stabled, 5 patients received PTCA and stent implantation and 3 patients received CABG. Conclusions　Continuous intravenous Diltiazem 40～150 μg/min (2.4～9 mg/h) or combination with intravenous nitroglycerin 60～120 μg/min is an efficient and safe therapy for patients with refractory angina pectoris.

Objective　To evaluate the treatment of in-stent restenosis with rotational atherectomy and balloon angioplasty. Methods　The rotational atherectomy and 4～6 atm low pressure balloon angioplasty was performed in 3 patients with in-stent restenosis and follow up after treatment. Results　All cases were succeeded. The bradycardia occurred in one patient was quickly disappeared without treatment, two other patients were found no effect on heart rate, hemodynamic performance, global LV function, or regional wall motion. No complications, angina, death or other coronary event occurred during the follow up for 6～12 months. Two of them was performed coronary angiography after 6 months and showed the diameter of target vessel was less than 30% as compared with that on coronary angiography which performed immedately after operation. Conclusion　The management of in-stent restenosis in target vessels using a combination of rotational atherectomy and balloon angioplasty is safe and efficient.

Objective　The aim of our study was to examine the utility of a mutielectrode basket catheter (MBC) in the mapping and Ablation of atrial tachycardias (ATs). Methods and Results　This study of ATs was conducted in 15 patients. The MBC recording and pacing capabilities, mapping performance and ablation with MBC was evaluated. Stable endocardial electrograms were recorded in 88±4% of electrodes. 64±5% electrode pairs could be used to stimulate the heart. Earliest endocardial activation was recorded from MBC and standard catheters were 41±9 and 45.9±8 m before the onset of P-wave,respectively (P=0.21). Ablation successed in 7 patients (87.5%). Conclusion　The MBC allows comprehensive and reliable endocardial mapping during ATs, which facilitates successful ablation in the patients with ATs.

Objective To evaluate the effect of Diver CE aspiration thrombus catheter used in patients during the recovery of acute myocardial infarction (AMI) with percutaneous coronary intervention (PCI). Methods A total of 50 AMI patients were enrolled from January 2010 to December 2011. Twenty-ifve patients received PCI and used the Diver CE aspiration thrombus catheter (aspiration group);and the other 25 patients received routine PCI (routine PCI group). The basic characteristics, PCI characteristics, myocardial perfusion indexes and clinical data were compared and analyzed. Results There was no statistically difference between two groups in basic characteristics. Compared with the routine PCI group, higher rate of myocardial blush grade 3 but lower thrombus scores were found in the aspiration group. The incidence of no-lfow or slow-lfow were also lower in aspiration group (all P<0.05). The LVEF after 6 and 12 months were higher in the aspiration group (both P<0.05), no difference in MACE between the two groups. Conclusions Using the Diver CE thrombus aspiration in PCI is a simple and safe by method for treatment of acute myocardial infarction with high thrombosis burden. It can improve reperfusion decrease the rates of no-relfow on slow-relfow and can improve the long-term left ventricular function.

Objective To evaluate the outcome of ST-segment elevation myocardial infarction (STEMI) patients received different reperfusion therapies. Methods The 238 consecutive STEMI patients were enrolled from February 2012 to December 2012. According to the current guideline of PCI and the choice of patients, the patients were divided into the groups of percutaneous coronary intervention (PCI), ifbrinolysis, and conservative medication. The major adverse cardiac events (MACE) was analyzed in a follow up of 6 months. Results (1) The enrolled patients included the 210 patients received PCI (88.2%), 14 patients received fibrinolysis (5.9%) and 14 patients received conservative medication (5.9%).The Median time of D2B was 110minutes.(2) The rate of late stent thrombosis was signiifcant higher in BMS than DES (n=2, 2.8%vs 0, P < 0.05) . (3) The PCI group had a signiifcantly higher incidence of stroke than the ifbrinolysis group and the conservative medication group (1.0%vs 0, P < 0.05;1.0%vs 0, P<0.05). (4) The PCI group had a signiifcantly higher incidence of bleeding compared to the thrombolysis group and the medication group (1.0% vs 0, P < 0.05; 1.0% vs 0%, P < 0.05). Conclusions The majority of STEMI patients received PCI;The D2B time, which was required<90 minutes in guideline of PCI, was found delayed in our study;Compared to ifbrinolysis and conservative medication, PCI showed better clinical outcomes of STEMI patients.

Objective To investigate the effectiveness and safety in pediatric patients (Age≤14 years) with hypertrophic obstructive cardiomyopathy (HOCM) treated by percutanous transluminal septal myocardial ablation (PTSMA). Methods Retrospectively analyzed the data from four pediatric(age≤14 years) patients with HOCM treated by PTSMA from March 2004 to June 2012, including their clinical data, coronary angiography and the results of PTSMA to evaluate the complication and clinical outcome after PTSMA. Results The left ventricular outlfow tract pressure gradient (LVOTPG) at rest decreased after operation when compared with pre-lablation level (32.0 mm Hg vs 80.0 mm Hg, P>0.05). The LVOTPG after premature beat decreased with signiifcant difference after ablation (40.0 mm Hg vs 122.5 mm Hg, P<0.05). During opration and hospitalization, 1 patient developed right bundle branch block, and another patient developed complete atrioventricular block, Both patients’ arrhythmia received after temporary pacing and medical treatment. No death and major clinical adverse event recorded after operation and during the 12 months follow up. Conclusions PTSMA was effective and safe for children with HOCM.

Objective Compare the efifcacy and safety of drug eluting stent (DES) for treatment of in stent restenosis (ISR) and coronary de novo lesions. Methods Patients treated with DES for ISR and de novo lesions in Beijing Anzhen Hospital between October 2008 and December 2011 were followed up for 1 year. All lesions were divided into ISR and de novo group. Major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction (MI) and clinical target lesion revascularization (TLR) were the primary endpoints. Results The study population consisted of 204 patients in the ISR group and 494 patients in the de novo group. Baseline clinical and angiographic parameters were comparable between the two groups. The rate of diabetic was higher in the ISR group than that in the de novo group (36.6%to 27.1%, P < 0.05). The diameter of coronary artery was smaller in the ISR group than that in the de novo group (2.72±0.36 to 3.08±0.54, P<0.01). The rate of TLR in the ISR group was higher than that in the de novo group (10.7%to 17.2%, P<0.05;14.2%to 21.1%, P<0.05),contributing to higher MACE in ISR group. Conclusions DES implantation is safe and effective for treatment of ISR lesions, but the rate of TLR is higher compared to treatment of de novo lesions.

Objective To analyze the relationship between fasting plasma glucose (FPG) level and complexity of coronary artery lesions in patients with coronary stenosis by angiography. Methods The data of clinic and coronary angiogram (CAG) were retrospectively collected in 929 patients with established coronary stenosis by coronary angiography at Peking University Third Hospital from January 2009 to January 2011. The patients were grouped according to SYNTAX score, and the relationship between FPG level and SYNTAX score were analyzed using bivariate, Multivariate stepwise regression and logistic regression analysis. Results ①929 patients were devided into three groups:47 cases into low risk group (score<22), 189 into moderate risk group (score≥22 and<33) and 639 into high risk group (score≥33). Intergroup analysis showed that age (P=0.000), FPG level [5.20 (4.70,6.30) mmol/L, 5.70 (4.90,7.15) mmol/L, 5.80 (5.30,7.60) mmol/L, P=0.000], proportions of FPG abnormality [283 (40.8%), 100(52.9%), 28(59.6%), P=0.001] and patients with diabetes history (P=0.003) were increased along with SYNTAX score elevated.②Correlation analysis showed correlativity (r=0.167, P=0.000) between SYNTAX score and FPG. In non-diabetes history subgroup, correlation between SYNTAX score and FPG remained signiifcant (r=0.149, P=0.000). However, in diabetes history subgroup, the correlation was not significant. ③ Multivariate stepwise regression analysis showed an independent correlation between FPG and SYNTAX score (β=0.452, P=0.002). In non-diabetes history subgroup, the correlation remained significant (β=1.039, P=0.000).④ When moderate-high risk group serve as dependent variable, and age, gender, CAD risk factors and FPG serve as independent variables, logistic regression analysis screened out two variables:age (whole group:OR 1.033, 95%CI 1.017 ~ 1.049, P=0.000;non-diabetes history subgroup:OR 1.039, 95%CI 1.020 ~ 1.059, P=0.000) and FPG (whole group: OR 1.114, 95% CI 1.038 ~ 1.195, P=0.003; non-diabetes history subgroup:OR 1.299, 95%CI 1.088 ~ 1.387, P=0.001). Conclusions FPG is likely to relfect complexity of coronary artery lesions and predict SYNTAX score in patients with coronary stenosis, especially in patients without diabetes history.