Objective To investingate the possible predictory of radial artery occlusion(RAO) after transradial approach and its preventive measures.Methods We prospectively assessed the occurrence of RAO in 669 consecutive patients undergoing transradial approach and 63 patients were excluded from the final study (24of them did not meet the inclusion criterium,31 patients converted to other artery approaches,6 patients lost clinical follow-up and 2 patients died).Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.The risk factors of RAO including sex,body mass index (BMI),smoking,hypertension,diabetes,dyslipidemia,puncture site,vessel spasm,and artery diameter/ sheath ratio were evaluated using a multivariate model analysis.Results Among the 606 patients,RAO occurred in 56 patients.There were no differences in sex,age,BMI,coronary lesions,rates of vessel spasm,vessel length,medication given and operation time between the 2 group of patients with vs without ROA (all P＞0.05).Univariate logistic analysis showed puncture site at 0 cm away from radial styloid and artery diameter/sheath ratio ≤ 1 were possible risk factory and puncture site ＞ 4 cm from radial styloid was possible protective factor.Further multivariate analysis showed the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P=0.033) and 8.90 (P=0.040),respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤ 1 (OR=2.45,P=0.004).Conclusions Distal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.

Objective To analyze the risk factors of repeat revascularization after percutaneous coronary intervention (PCI) in elderly patients.Methods A total of 315 patients,aged 60-99 (72.89±7.80) years hospitalized during 2004 and 2015 due to coronary heart disease and received PCI therapy in the geriatric department of Peking University First Hospital were enrolled.Patients who received repeat revascularization were divided into the target lesion repeat revascularization (TLR)group and the non target lesion revascularization (non-TLR)group.Multivariate regression analysis was performed to make comparisons with non repeat revascularization group respectively and evaluate related risk factors.The median follow-up was 62months.Results The rate of TLR was less than non-TLR in elderly patients.Multivariate regression analysis showed that diabetes mellitus (HR 4.56,95％ CI 1.94-10.75,P＜0.05) and number of stents (HR 1.55,95％ CI 1.05-2.29,P＜0.05) were related risk factor of TLR,while age (HR 0.94,95％ CI 0.90-0.98,P＜0.05),the value of LDL-C reduction (HR 2.51,95％ CI 1.56-3.99,P＜0.05),the proportion of bifurcation lesions (HR 2.24,95％ CI 1.20-4.17,P＜0.05) and residual SYNTAX score (rSS) (HR 1.07,CI95％ 1.02-1.11,P＜0.05) wererelated risk factors of non-TLI.Conclusions The incidence of non-TLR were higher than TLR in elderly patients.Increased total number of stent implantation and diabetes mellitus were related risk factors of TLR,while the lower average age,less reduction of LDL-C,increased proportion of bifurcation lesions and higher rSS were related risk factors of non-TLR.

Objective To investigate the impact of the regional cooperative chest pain center (CPC) on therapeutic time and short term outcome after primary percutaneous coronary intervention (PCI) of patients with ST segment elevated myocardial infarction.Methods 372 patients with ST segment elevated myocardial infarction were enrolled in the study who had received were operated primary PCI 18 months before and after the regional cooperative CPC was set up.There were 156 patients in the green channel group before the setup of CPC and 216 patients in the CPC group.Total ischemia time,first medical contact (FMC) time,FML-to-balloon (FMC2B) time,door-to-balloon (D2B) time,hospital mortality rates,cardiac failure rates on the next day after PCI,length of CCU stays and hospital stays were compared between the two groups.Results Compared to the green channel group,total ischemia time[(281.0±102.7)min vs.(365.2±115.6)min,P＜0.05],FMC time [(174.3±97.5) min vs.(225.4±104.6) min,P＜0.05],FMC2B time [(106.7±61.2) min vs.(139.8±75.7) min,P＜0.05] and D2B time [(75.2±45.4) min vs.(102.4±53.7) min,P＜0.05] of the CPC group were significant shorter.The rates of reaching the standard of FMC2B time (70.83％ vs.34.62％,P＜0.001) and D2B time (75.93％ vs.40.38％,P＜0.001)were significantly higher in the CPC group.Cardiac failure rates on the next day after PCI was lower in the CPC group (14.35％ vs.23.72％,P=0.021),and CCU stays was shorter [(64.3±13.72)h vs.(92.6±15.65)h,P=0.043].Conclusions Establishment of a standardized regional cooperative CPC requires combination and consideration of the characteristics of local resources FMC2B time and D2B time of STEMI patients can be shorten by a standardized CPC lending to further shortening of total ischemia time and improvement in cardiac function.

Objective To investigate the difference of late-phase of limb ischemia preconditioning (L-LIP) verse early-phase (E-LIP) on patients with percutaneous coronary intervention (PCI).Methods A total of 160 patients with unstable angina pectoris who were planned to undergo PCI were divided equally into two groups at random.The late-phase of limb ischemia preconditioning group (80 patients) were provided with L-LIP (three 5-minute inflations up to 200mmHg by applying the sphygmomanometer cuff around the right upper arm,followed by 5-min intervals of reperfusion,twice a day) 3 days before PCI.The Earlyphase of limb ischemia preconditioning group (80 patients) were provided with E-LIP (method as above)2 hours before PCI.Comparison of procedural parameters during PCI and the levels of cTnT,CK-MB,hs-CRP were made 24 hours after PCI.Estimation of the rate of adverse events at 1 year between the two groups was evaluated by Kaplan-Meier analysis.Results Compared to the E-LIP group,the rates of angina,arrhythmia and TIMI flow ≤ 2 during PCI were significantly lower in the L-LIP group (all P ＜ 0.05).At 24 hours after PCI,the levels of cTnT and CK-MB were declined more significantly in the L-LIP group[(11.52±2.41) pg/ml vs.(27.53±4.78)pg/ml,P =0.021;(14.11±2.87)Iu/L vs.(30.23±5.17)Iu/L,P =0.032].There was no difference in the level of hs-CRP between the 2 groups [(128±0.71)mg/dl vs.(1.33±0.69)mg/dl,P =0.742].The Kaplan-Meier survival curve showed that the incidence rate of adverse events in the L-LIP group at l year was lower than the E-LIP group (3.75％ vs.13.75％,P =0.024).Conclusions L-LIP is more effective to in protecting myocardial cell in patients with unstable angina pectoris undergoing elective PCI and may reduce the rate of future adverse event.

Objective To discuss the correlation of the left coronary artery morphology and occurrence of acute myocardial infarction (AMI) with left main lesion and in-hospital mortality.Methods This was a retrospective study of clinical information and angiographic data of 176 patients admitted from January 2010 to April 2015 with left main lesion in the First Affiliated Hospital of Harbin Medical University.The patients were divided into left main acute myocardial infarction group and left main non-acute myocardial infarction group,and then the left main AMI group was further divided into the survival group and the deceased group according to the situation of in-hospital death.QCA software was used to measure the anatomical morphology of left coronary artery.The anatomical morphology of left coronary artery between the two groups was compared,and univariate analysis and logistic regression analysis were applied to analyze the factors of AMI occurrence and in-hospital mortality in AMI patients with left main lesion.Results The angle between the left anterior descending artery (LAD) and the left circumflex artery (LCX) of the LM-AMI group was smaller than the non-acute myocardial infarction group (P＜0.05),but there was no significant difference in the diameter and length of left main coronary artery (LM),the diameter of LAD and LCX,the angle between LM and LAD and the angle between LM and LCX between the two groups (P＞0.05).The risk of LM-AMI in patients with the angle between LAD and LCX of ＜ 79.43°is 3.6 times right than patients with the angle between 79.43°～ 108.73°.Between the survival group and the deceased group of AMI patients with left main lesion,there were no significant differences in the diameter and length of LM,the diameter of LAD and LCX,the angle between LM and LAD,the angle between LM and LCX and the angle between LAD and LCX (P＞0.05).Conclusions There was a correlation between the angle between LAD and LCX with the occurrence of LM-AMI in patients with left main lesion.The angle between LAD and LCX of ＜ 79.43° is the independent risk factor of LM-AMI in patients with left main lesion,but there was no correlation between the left coronary artery morphology and in-hospital mortality of patients with left main AMI.

Objective To investigate the characteristics,occurrence times and management of cardiac erosion after transcatheter closure of ASD,and to discuss the mechanism and predictive factor of erosion.Methods We analyzed all the cases who received transcatheter ASD closure from September 1997 to September 2016 in our hospital retrospectively.Results 9 cases (9/6903,0.13％) were reported to have cardiac erosion events after device closure ASD of including 2 cases of acute cardiac tamponade needed pericardiocentesis,2 cases of aorta-to right-atrial fistula needed transcatheter closure or operative repair and 5 cases of perforation of the anterior leaflet of mitral valve.1 case with MV anterior leaflet perforation presented with hemolysis and required surgical repair.Cardiac erosion events were found at average 52.9±68.3 days (1-180days) after the ASD closure.Conclusions Cardiac erosion is a rare but serious complication of device closure for ASD.Erosion events are mostly attributed to device over-sizing or deficient retro-aortic rims.It is important for a strict follow-up,early deduction and timely disposition when an erosion event is identified.occurring.

Objective To investigate the effects of distal thrombolysis versus thrombus aspiration on myocardial perf usion and prognosis in patients with acute ST segment elevation myocardial infarction(AMI)during emergency percutaneous coronary intervention(PCI). Methods 96 patients with acute ST segment elevation myocardial infarction(onset<6 hours)were randomly divided into thrombolysis group and distal thrombus aspiration group. Patients in the distal thrombolysis group(n=46)received transcatheter urokinase injection to the occlusive segment followed by balloon dilatation or stenting. Patients in the thrombus aspiration group(n=50)were given thrombus aspiration after balloon angioplasty or stenting. Patients were followed up for 30 days after operation. The coronary blood flow and myocardial perfusion were compared between the 2 groups. The incidence of major adverse cardiac events(MACE)and left ventricular systolic function after 30 days were compared. Results There was 1 case in the distal thrombolysis group (0.2%)and 6 case in the thrombus aspiration group(12%)presented with TIMI fl ow≤grade Ⅱ(P=0.008). A 65.2% of patients in the distal thrombolysis and 42.0% of patients in the thrombus aspiration group achieved > 50% of ST segment resolution in 2 hours(P=0.019). At 30-day follow up,the LVEF was found higher in the thrombolysis group compared with the aspiration group(54.1±8.6)% vs.(50.8±7.3)%,P=0.047 but the LVEDD(44.3±7.2)mm vs.(46.5±6.8)mm,P=0.038 and NT-proBNP levels(117.8±71.8)μg/L vs.(161.2±72.3)μg/L,P=0.025 were found significantly lower in the thrombolysis group. Conclusions For the ST segment elevation myocardial infarction,distal thrombolysis,when compared with thrombus aspiration,may reduce the incidence of slow flow and no reflow,and may improve the left ventricular systolic function.

Objective To evaluate the status of microcirculation and to compare the short-term prognosis after elective PCI for AMI between patients with poorly controlled type2 diabetes and patients without type 2 diabetes. Methods According to the clinical history and HbA1c values,all patients were divided into 2 groups:diabetic group (group A,n=24) and non-diabetic group (group B,n=32).Basic clinical data, left ventricular end diastolic diameter (LVEDD) and left ventricular shot ejection fraction (LVEF)immediately and 3 months after operation measured by echocardiography and the result of coronary angiography were compared between the two groups. The rate of MACE 3 months after PCI was also compared. A pressure-temperature sensor wire was used to measure the index of microcirculation resistance(IMR)immediately after PCI. Results 1.The mean IMR value in group A was higher than group B(29.12±7.45)vs.(22.74±6.87);P=0.011.The HbA1c levels has positive correlation with the IMR value(r=0.324;P=0.048). 2. The mean LVEDD and the mean LVEF Rad no signifi cant diff erence between two groups before PCI. The mean LVEDD of group A at 3 months after PCI was significantly larger than group B(52.3±4.8)mm vs.(48.6±5.1)mm,P=0.019,the mean LVEF of group A 3 months post PCI was lower than that of group B(48.6±7.3)% vs.(56.1±4.7)%,P=0.003.The mean increase in LVEDD at 3 months after PCI in group A was higher than group B(4.1±6.3)mm vs.(0.8±4.4)mm, p=0.005 and the mean increase in LVEF in group A was significantly lower than in group B(–1.9±6.8)% vs. (4.3±5.4)%,P=0.007. 3. HbA1chad positive correlation with LVEDD(r=0.324,p=0.048)and its increase at 3 months postoperatively(r=–0.422,P=0.005).4. Risk estimation found type 2 diabetes was an independent risk factor for poor recovery of LVEF. The MACE rate was signifi cantly higher in Group A than in Group B(35.7% vs.9.4%,P=0.018).Conclusions Patients with type2 diabetes were more prone to suffer from coronary microcirculatory dysfunction and had poor recovery of cardiac function. Poorly controlled type 2 diabetes was an independent risk factor for poor recovery of cardiac function and short-term prognosis was worse in diabetic patients who had elective PCI.

Objective To investigate ADP-induced platelet aggregation rate(ADP-Ag),safety and efficacy of different ticagrelor dosage in elderly patients undergoing PCI. Methods 48 elderly patients aged 60 or older were enrolled. After PCI treatment, the patients received antiplatelet therapy with ticagrelor 90 mg(n=26)or 45 mg (n=22)twice daily. ADP-Ag was measured on day 3 to 7 after initial ticagrelor therapy and compared between the two different-dose ticagrelor groups. ADP-Ag ticagrelor treatment was also compared to measurement if patients were previously taking clopidogrel 75 mg daily. Major adverse cardiovascular events (MACE)and bleeding events were recorded in following 12 months. Results Inhibition of ADP-induced platelet aggregation was greater for ticagrelor 90 mg BID versus 45 mg BID(ADP-Ag(27.88±7.77)% vs.(37.87±2.90)%,P<0.05). During the follow-up period,no gastrointestinal bleedings,cerebral hemorrhage or thrombus events occurred in all patients. In ticagrelor 90 mg BID group,stent-restenosis occurred in 3 patients and they needed to take revascularization therapy. Minimal bleeding events occurred in 4 patients(15.4%)and 1 patient(4.5%) with ticagrelor 90 mg and 45 mg BID treatment,respectively. The ADP-Ag with clopidogrel 75 mg QD treatment previously was(51.18±5.55)%,and declined to(26.87±7.33)% and(38.29±2.65)% after conversion to ticagrelor 90 mg BID and 45 mg BID treatment,respectively. Conclusions Ticagrelor of 90 mg BID or 45 mg BID both inhibited ADP-induced platelet aggregation better than clopidogrel. Ticagrelor 45 mg BID was not inferior to 90 mg BID in preventing MACE and with less minimal bleeding events in elderly patients undergoing PCI.

Objective To investigate the characteristics of the serum creatinine change patterns and its clinical signifi cance in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods Two hundred and ninety-three consecutive ST elevation myocardial infarction(STEMI) patients who underwent emergent PCI were retrospectively grouped into the descending type,increasing type,stable type,U curve type and converse U curve type according to the dynamic changes serum creatinine in within 72h after PCI. The characteristics of diff erent patterns relationship of the respective pattern to the Mehran risk score,the serum creatinine changes between admission to 1 month after PCI,and the incidence of adverse events were analyzed.Results The proportion of the 5 pattern groups was 9.9%(decending type),17.7(increasing type),47.1%(stable type),4.1%(U curve type)and 21.2%(converse U curve type),respectively. The incidence of adverse events was higher in the increasing type,stable type and converse U curve type compared to the other 2 types in 1 month after PCI. Hypotension before admission and volume expansion therapy were more common in the groups of descending type and U curve type while diuretics were more frequently used in converse U curve type than descending type. The decline of creatinine from admission to 1 month after PCI were 57.9% in descending type and 27.3% in U curve type. Conclusions The dynamic change of serum creatinine presents with multiple patterns in patients undergoing emergent PCI. Hypotension before admission,volume expansion therapy,and the use of diuretics may aff ect the value of serum creatinine. The serum creatinine level at admission seems not suitable for baseline assessment to evaluate the risk of contrast-induced acute kidney injury in some patients.