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 assess the efficacy and safety of antiplatelet threapy after transcatheter aortic valve implantation.Methods Databases including PubMed , EMBASE, MEDLINE, the Cochrane Library, CMB and CNKI were searched to collect the randomized controlled trials ( RCTs) and cohort study trials ( CSTs ) about the efficacy and safety of antiplatelet threapy after transcatheter aortic valve implantation.The literature was screened according to the inclusive and exclusive criteria by two reviewers independently.The quality was evaluated.The data were extracted and meta-analyses were performed by using RevMan 5.3 software.Results 4 trials were included, of which 2 were RCTs involving 199 patients, and 2 were cohort studies involving 441 patients.Efficacy analysis showed that there were no differences between mono versus dual antiplatelet therapy in terms of 30-day rates of stroke ( OR 0.55 ,95%CI:0.22-1.35 ,P =0.19 ) , myocardial infarction ( OR 1.70 , 95% CI:0.25 -11.65 , P =0.59 ) , and all-cause mortality ( OR 0.77 , 95% CI:0.40 -1.49 , P =0.44 ) .Safety analysis showed that mono antiplatelet therapy had lower incidence of bleeding events , compared to dual antiplatelet therapy ( OR 0.37 , 95%CI:0.23-0.59,P<0.0001).Conclusions Mono versus dual antiplatelet therapy in the prevention of stroke , myocardial infarction and all-cause mortality after TAVI has similar protective effects .Mono antiplatelet threapy presents lower bleeding event rate .Due to limited quality and quantity of the included studies , the above conclusions need to be verified by more high quality studies .

Objective Excimer laser coronary atherecomy ( ELCA) has been recently used for the treatment of complex coronary lesions including calcified stenosis , chronic total occlusions and in-stent restenosis. Such complex lesions are difficult to adequately treat with balloon angioplasty and /or intracoronary stenting.The aim of this study was to introduce our early experiences in using ELCA in China . Methods Fifteen patients were enrolled through our center from March 2015 to April 2016 , and excimer laser coronary angioplasty was performed on 15 lesions.Eleven patients were previously failed cases either from uncrossable balloon ( 9 lesions ) or expandable balloon ( 6 lesions ) . The procedure and clinical endpoints were recorded .Results Laser catheter with 0.9 mm diameters were used in all 15 coronary lesions.All the lesions were successfully crossed with laser catheter and finally dilated with balloon .The procedural success rate was 100%.Drug eluting stents ( DES ) were implanted in 86.7% lesions and 2 cases were treated with drug eluting balloon .Clinical success was obtained in all patients (100%).There was no dissection , major side branch occlusion , spasm, no-reflow phenomenon nor acute vessel closure . Conclusions This study shows that laser-facilitated coronary angioplasty is a simple , safe and effective device for the management of complex coronary lesions .

Objective To investigate the predictive value of plasma gelsolin in the prognosis of patients with ST-sgement elevation myocardial infarction ( STEMI ) and undergone primary percutaneous coronary intervention ( PCI ) .Methods The study included 206 patients with STEMI and undergone primary PCI, 148 patients with stable angina pectoris and received elective PCI and 80 healthy volunteer as the health population (NP) control.Blood samples were taken at admission on day 1, 3, 5, 7 and 9 to determine the plasma gelsolin level .Patients′baseline clinical characteristics , blood biochemistry tests results , details of operation and their cardiovascular risk factors were recorded .Major adverse cardiovascular events (MACE) within one year were recorded.Results (1) Compared to the stable angina group and the NP group, the level of plasma gelsolin of STEMI patients were obviously decreased at various time points ( all P<0.05 ) .There were no statistical differences between the stable angina group and the NP group .( 2 ) Patients with STEMI were catagorized into MACE group (n=78) and non-MACE group (n=128) according their follow up record in 1 year.The level of plasma gelsolin in patients with MACE were lower than the non-MACE group ( P <0.05 ) with the minimum value detected on day 7.Among patients complicated with MACE (n=78), they were further devided into the deceased group (n=18) and the survival group (n=60).Plasma gelsolin levels were lower in the deceased group with satistical differences found on day 5, 7 and 9.(3) Single factor Logistic regression analysis showed that the level of plasma gelsolin on day 7 was independent risk factor of MACE within one year ( P =0.014 ) .( 4 ) Setting the cutoff value of plasma gelsolin on day 7 as 21.7 mg/L,the sensitivity and speciticity for the MACE in STEMI patients treated with primary PCI within one year were 82.1%and 81.4%respectively , with the area under the receiver operator characteristic curve ( ROC ) was 0.854 ( 95% confidence interval 0.732 -0.961 , P <0.01 ) . Conclusions Plasma gelsolin levels are correlated with the severity of STEMI lesions and plasma gelsolin can be used as predicting factor of prognosis .

Objective To investigate the influence of high frequency electrosurgical equipment ( HFEE) application in cardiac implantable electronic device ( CIED) implantation procedure on the rate of pocket hematoma .Methods Patients who received CIED implantation in General Hospital of Shenyang Military Region were analyzed retrospectively .HFEE was applied during CIED implantation procedure in every patient who was classified into HFEE group .Other patients without HFEE application were classified as the control group . Patients with or without bleeding tendency were sub-classified into the bleeding tendency subgroup or non-bleeding tendency subgroup respectively .Bleeding tendency subgroup was further divided into heparin bridging group and direct implantation group .The occurance rate of CIED pocket hematoma was recorded in all groups .Results A total of 3884 patients were enrolled .There were 3115 patients in the HFEE group and 769 patients in the control group .The baseline data of two groups was similar.The overall rate of CIED pocket hematoma in the total patient population during perioperative period were 2.2%(86/3884), and the rate of long term pocket infection or rupture in patients with CIED pocket hematoma was 10.5%(9/8).In the HFEE group, the rate of pocket hematoma was lower than that in the control group (1.5%vs.5.2%, P<0.001).The rates of CIED pocket hematoma in respective subgroups in the HFEE group including the bleeding tendency subgroup ( 1.8% vs.11.5%, P=0.004 ) , the non-bleeding tendency subgroup ( 1.4% vs.4.7%, P<0.001 ) and the heparin bridging group ( 2.0% vs. 11.5%, P=0.046 ) were markedly decreased as compared with the corresponding subgroups in the control group.In the control group , the rate of CIED pocket hematoma in the bleeding tendency subgroup was higher than that in the non-bleeding tendency subgroup (11.5%vs.4.7%, P=0.0046).In HFEE group, there was no significant difference in the rate of CIED pocket hematoma between bleeding tendency subgroup and non-bleeding tendency subgroup; and there was also no significant difference in the rate of CIED pocket hematoma between the heparin bridging group and the direct implantation group .Conclusion Application of HFEE in CIED implantation procedure could reduce the incidence of pocket hematoma , and there was no significant difference in the incidence of pocket hematoma in patients with or without oral anticoagulation or antiplatelet agents.

Objective To analyze the real world status of traditional known cardiovascular risk factors in patients with coronary heart disease ( CHD ) .Methods 6040 in-hospital patients with CHD or suspected CHD undergoing angiography from 01/01/2013 to 02/28/2015 were retrospectively analyzed . According to angiography result , patients with severe coronary artery lesion and undergoing percutaneous coronary intervention (PCI) were enrolled in the PCI group (n=2808) and patients without severe coronary artery lesion and not undergoing PCI or CABG were enrolled in the No-PCI/CABG group (n=3232).Patients in the PCI group were further divided into 3 subgroups which were STEMI group , NSTEMI/UA group and stable angina (SA) group.Results (1) Compared with the No-PCI/CABG group, patients in the PCI group have higher ratio of male patients (75.4% vs.53.1%, P<0.0001), older average age (64.83 ±0.20 vs. 63.39 ±0.18 years old , P <0.0001 ) , and higher existing rates of traditional risk factors including hypertension (66.7%vs.54.7%, P<0.0001 ) , diabetes/impaired glucose tolerance ( IGT ) ( 37.0% vs. 20.8%, P<0.0001), stroke(7.0%vs.5.4%,P=0.0098)and chronic kidney disease (CKD) (4.3%vs. 2.8%, P=0.001 ) , but there was no statistic difference in existing rates of dyslipidemia between the two groups.(2)In the PCI group,female patients had higher prevalence of hypertension (74.1%vs.64.3%, P<0.001), diabetes/IGT (42.5%vs.35.3%, P=0.0007) and stroke (9.4%vs.6.2%, P=0.0054) than the male patients.There were no significant sex difference in these comorbidities as above in No-PCI/CABG group.Female patients had higher prevalence of dyslipidemia than male patients in both PCI and No -PCI/CABG groups.(3) Among all the 3 PCI subgroups, STEMI patients presented with youngest average age (62.54 ±0.45 vs.65.15 ±0.28 vs.66.17 ±0.34 years old, P<0.0001) and highest male patient ratio (83.9%vs.72.9% vs.72.3%, P<0.0001).Patients in the SA subgroup had the highest prevalence of hypertension and prior revascularization including PCI and CABG .Patients in the NSTEMI/UA subgroup had the highest rates of diabetes/IGT.No significant differences were observed in the prevalence of dyslipidemia , CKD and stroke among all the subgroups .Conclusions Hypertension and diabetes are the leading risk factors of coronary artery disease , and prior revascularization is also an important cause of stable angina and NSTEMI /UA undergoing PCI.Patients requiring PCI were found to be more of male gendor , but female patients has higher prevalence of traditional cardiovascular risk factors including hypertension , diabetes/IGT or stroke than male patients.