1.Intermediate coronary lesions:prognostic evaluation of plasma osteoprotegerin in elderly patients
Qingmiao YANG ; Shuzheng LYU ; Yundai CHEN ; Xiantao SONG ; Fei YUAN
Chinese Journal of Geriatrics 2016;35(5):474-477
Objective To investigate the evaluation of plasma osteoprotegerin (OPG) measurement for assessing the prognosis of intermediate coronary lesions in elderly patients.Methods We retrospectively analyzed patients met the inclusion criteria of suspicious chest pain or confirmed coronary artery disease (CHD),and intermediate stenosis lesions (20 % ~ 70 %) in 3 main coronary arteries served as target vessels for qualitative comparative analysis (QCA).Plasma OPG level was detected by protein array method,and the concentration of hypersensitive C-reactive protein (hs-CRP)was determined by enzyme-linked immunosorbent assay(ELISA).Clinical endpoints were followed up.Results A total of 890 patients with intermediate coronary stenosis were enrolled in this study,and were divided into<60 years of age group(n=370)and ≥ 60 years of age group(n=520).There were statistical differences in age,smoking history,hypertension history,triglycerides (TG),high-density lipoprotein cholesterol(HDL-C),white blood cell count,OPG,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI)between the two groups.The morphological indices in coronary lesions assessed by QCA had no differences between the two groups.During a median of 24 months of follow-up,58 patients(l1.2%)had clinical endpoints events.Age,smoking history,hypertension history,TC,TG,HDL-C,white blood cell count,levels of OPG above-median,hs-CRP,SBP,DBP,and BMI were used as the independent variables,and the clinical end events as the dependent variable.Forward stepwise logistic regression analysis showed that HDL-C,levels of OPG above-median,hs-CRP were the independent risk factors in elderly patients.The risk of cardiovascular events in patients with levels of OPG above-median was 2.510 fold higher than those with levels of OPG below-median.Conclusions The high levels of OPG and hs-CRP are the independent risk factors for the occurrence of coronary heart disease in the elderly with intermediate coronary lesions.
2.Repeated sub-acute stent thrombosis: a case report.
Jing DAI ; Shuzheng LYU ; Xiantao SONG ; Hong LIU ; Rui TIAN ; Xin CHEN ; Changjiang GEI ; Yuan ZHOU ; Feng XU
Chinese Journal of Cardiology 2014;42(3):254-255
Aged
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Humans
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Male
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Stents
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adverse effects
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Thrombosis
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etiology
3.Hypersensitivity to ticagrelor and low response to clopidogrel: a case report
Jing DAI ; Shuzheng LYU ; Changjiang GE
Asia Pacific Allergy 2017;7(1):51-53
Ticagrelor is widely used to treat acute coronary syndrome. Hypersensitivity reaction of ticagrelor is rarely recognized. A low response to clopidogrel, which occurs in up to 23% of patients, is an independent risk factor for stent thrombosis. Management of patients with a low response to clopidogrel and ticagrelor hypersensitivity who are undergoing antithrombotic therapy remains to be a challenge. Herein, we report a patient with low response to clopidogrel and ticagrelor hypersensitivity, who was successfully managed using aspirin and warfarin.
Acute Coronary Syndrome
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Aspirin
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Humans
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Hypersensitivity
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Risk Factors
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Stents
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Thrombosis
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Warfarin
4.Predictive value of coronary CT angiography in chronic total occlusion lesions interventional therapy
Song CUI ; Yalei CHEN ; Rui WANG ; Yi HE ; Jianan SU ; Rui TIAN ; Changjiang GE ; Fei YUAN ; Rongchong HUANG ; Xiantao SONG ; Shuzheng LYU
Chinese Journal of Interventional Cardiology 2017;25(6):331-336
Objective To analyze the characteristics of preoperative CTO lesions by coronary CT angiography (CCTA) and to compare the lesion characteristics and clinical data of patients with subsequent vs failed PCI.Methods A total of 113 patients were randomly selected and 116 vessels were analyzed by CCTA before PCI.The patients were further investigated as PCI success group vs PCI failure group according to their PCI result.Multivariate logistic regression analysis was used to determine the factors that affected the success of CTO intervention.The ROC curve was used to determine and evaluate the CT-CTO score and J-CTO score for diagnostic efficacy.Results The success rate of PCI was 55.2%.64 lesions were successfully opened,with the success rate of 72.4%.The prevalence of smoking in patients in the PCI failure group was significantly higher than that in PCI success group (65.4% vs.42.2%,P < 0.05).There were no significant differences between the two groups in age,gender,history of hypertension,diabetes mellitus,and myocardial infarction(P > 0.05).Statistical differences were observed between the PCI success group and the PCI failure group in the presence of occlusion segment head-end bifurcation,occlusion severe incision,severe calcification (calcification ≥ 180°),occlusion segment length ≥ 20 mm,occlusion of calcification lesions,occlusion segment distal shape of the unambiguous of fiber cap shape of the distal occlusion segment under CCTA(P < 0.05).In the PCI failure group,approximately 17.3% of the patients had previous attempt to open the CTO lesions,which were higher than the PCI success group (9.4%).However,The difference was not statistically significant (P > 0.05).Multivariate logistic regression analysis showed that the unambiguous distal fibrous cap of the occlusion segment and the occlusion of the proximal branch and the occlusion length ≥20 mm were the main factors affecting the failure of CTO intervention.In terms of prediction,the predictive value 30 CT-CTO score yielded a higher area under the ROC curve than that of the J-CTO score (0.8776 vs 0.7387,P ≤ 0.05).Conclusion CT angiography can predict the success rate of intervention for CTO lesions.Compared with J-CTO score,CT-CTO score has a higher predictive value.Unambiguous fiber cap shape,occlusion segment head end bifurcation,occlusion segment length ≥20 mm were the independent risk factors that affecting the success of CTO operation.
5.Analysis of risk factors for non-reflow phenomenon during primary percutaneous coronary intervention in patients with first acute ST-segment-elevation myocardial infarction
Clinical Medicine of China 2018;34(2):105-109
Objective To investigate the risk factors of non?reflow phenomenon during primary percutaneous coronary intervention ( PPCI ) in patients with first acute ST?segment?elevation myocardial infarction ( STEMI ) . Methods Four hundred and forty?eight first acute STEMI patients who had PPCI from January 2007 to October 2010 in Beijing Anzhen Hospital were enrolled in this study. All patients were divided into two groups according to thrombolysis in myocardial infarction( TIMI) coronary flow grade during PPCI:non?reflow group(44 cases,TIMI 0?2 grade) and control group(404 cases,TIMI 3 grade). The basic clinical data, radiographic findings and operative data of the two groups were compared. The risk factors of non?reflow during PPCI operation in the first acute STEMI patients were analyzed. Results Non?reflow phenomenon occurred in 44 cases in the non?reflow group and 404 cases in the control group,the incident rate was 9. 82%(44/448) . Logistic regression analysis showed that the differences between the two groups in the completely block of culprit vessel,intraoperative bradycardia( preoperative heart rate ≥60 times / min,persistent or transient intraoperative heart rate < 60 times / min) ,age,percentage of neutrophils and other parameters were statistically significant ( P<0. 05) . Multivariate Logistic regression analysis showed that intraoperative bradycardia ( OR=3. 106,95% CI:1. 584~6. 090) and age ( OR=1. 040,95% CI: 1. 010~1. 070) could be used as independent risk factors for predicting non?reflow in PPCI. Conclusion Age of the patient and the occurrence of bradycardia may be independent risk factors for predicting the non reflow of PPCI in the first acute STEMI patients.
6. Association between collateral circulation and myocardial viability evaluated by cardiac magnetic resonance imaging in patients with coronary artery chronic total occlusion
Jianan LI ; Lijun ZHANG ; Yi HE ; Yalei CHEN ; Rongchong HUANG ; Shuzheng LYU ; Xiantao SONG
Chinese Journal of Cardiology 2017;45(7):579-584
Objective:
Late gadolinium enhancement(LGE) cardiac magnetic resonance imaging(CMR) was used to evaluate the myocardial viability of chronic total occlusion(CTO) in patients with coronary heart disease and to observe the relationship between collateral circulation and myocardium viability in these patients.
Methods:
This retrospective study included 40 patients with CTO diagnosed by invasive coronary angiography (CAG) from September 2015 to June 2016 in our department, all patients performed CMR examination within one week after CAG.The collateral circulation of CTO was graded with Rentrop classification as follows: poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group.According to CMR images, the delayed enhancement transmural extent of myocardial segments were scored, the ventricular wall motion of the myocardial segment were graded, and the wall motion score index (WMSI) was calculated.Spearman correlation analysis was used to analyze the relationship between the delayed enhancement transmural extent of myocardial segments and WMSI.
Results:
In the no or poor collateral group of 6 myocardial regions, 1 myocardial region had viable myocardium and 3 myocardial regions had no viable myocardium; in the moderate collateral group of 16 myocardial regions, 11 myocardial regions had viable myocardium and 5 myocardial regions had no viable myocardium; in the good collateral group of 24 myocardial regions, 21 myocardial regions had viable myocardium and 3 myocardial regions had no viable myocardium, there was significant difference between the groups (
7.Association between genetic variants in the adiponectin gene and premature myocardial infarction
Min ZHANG ; Yu PENG ; Shuzheng LYU
Chinese Journal of Cardiology 2016;44(7):577-582
Objective To investigate the relationship between adiponectin gene polymorphisms and premature myocardial infarction (PMI).Methods A total of 306 PMI patients of Beijing Anzhen Hospital were identified from March 2013 to January 2015 using the case-control method,412 patients with normal coronary angiography results served as the control group.17 single nucleotide polymorphisms (SNPs) in adiponectin gene were selected and genotyped using mass spectrometry.The Chi-squared test was used to compare allele and genotype frequencies between PMI and control groups.The plasma adiponectin concentrations were measured using enzyme-linked immunoassay,and the relationship was analyzed between adiponectin level and SNPs.Results There was no significant difference in allele frequencies and in genotype frequencies between PMI patients and controls (P >0.05).Multivariate logistic regression models were used to estimate the correlation in additive,dominant and recessive genetic models,respectively.Analysis showed that rs2241766T > G was significant associated with PMI risk in a addition model in Chinese Han population(OR =1.446,95% C1 1.006-2.079,P =0.035),and rs12629945G > A was significant association with PMI risk in a dominant model in Chinese Han population(OR =1.609,95% CI 1.006-2.573,P =0.041).Adiponectin levels in PMI group were significantly lower than in control group ((863.3 ± 112.8)μg/L vs.(910.4 ± 117.1) μg/L,P =0.042).Adiponectin levels were significantly lower in patients with the homozygous mutation genotype (GG) compared to patients with the heterozygote mutant and wild type genotypes (GT + TT) in adiponectin gene rs2241766 T > G polymorphisms ((859.4 ± 98.1) μg/L vs.(908.9 ± 113.1) μg/L,P =0.032).Conclusion The rs2241766T > G and rs12629945G > A polymorphisms in the adiponectin gene were associated with PMI in Chinese Han population.Rs2241766T > G polymorphisms is linked with lower plasma adiponectin levels,and increased risk of PMI.
8. Comparison on the long-term outcomes post percutaneous coronary intervention or coronary artery bypass grafting for bifurcation lesions in unprotected left main coronary artery
Bangguo YANG ; Xianpeng YU ; Fang CHEN ; Shuzheng LYU ; Quan LI ; Jiqiang HE ; Fei YUAN
Chinese Journal of Cardiology 2017;45(1):19-25
Objective:
To compare the long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention(PCI) with drug-eluting stents (DES) for bifurcation lesions in unprotected left main coronary artery (ULMCA).
Methods:
A total of 663 consecutively patients with unprotected left main bifurcation disease (defined as stenosis≥50%) who received either drug-eluting stents (DES) implantation (
9.Novel completed biodegradable polymer sirolimus-eluting stent versus durable polymer sirolimus-eluting stent in de novo lesions: nine-month angiographic and three-year clinical outcomes of HOPE trial.
Fei YUAN ; Xin CHEN ; Xiantao SONG ; Dongqi WANG ; Zheng ZHANG ; Weimin LI ; Zhanquan LI ; Hui LI ; Xinyi CHEN ; Yong HUO ; Lefeng WANG ; Caiyi LU ; Qinghua LU ; Bo XU ; Wei LI ; Shuzheng LYU ; null
Chinese Medical Journal 2014;127(14):2561-2566
BACKGROUNDDrug-eluting stents (DES) with durable polymer have significantly reduced restenosis and target vessel revascularization compared with bare metal stents. Durable polymer has been linked with persistent inflammation of vessel wall and delayed endothelial healing that may increase the risk of late and very late stent thrombosis. This study sought to evaluate the efficacy and safety of HELIOS completed biodegradable polymer sirolimus-eluting stent (SES) in de novo coronary lesions.
METHODSTotally, 287 patients with one or two de novo coronary lesions (lesion length ≤ 38 mm and reference vessel diameter 2.5-4.0 mm) were enrolled in the HOPE study, a prospective, multicenter, randomized, non-inferiority trial. Patients were randomized to treatment either with HELIOS completed biodegradable polymer SES (n = 142) or PARTNER durable polymer SES (n = 145). The primary endpoint was angiographic in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint included stent thrombosis and major adverse cardiac events including cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR).
RESULTSThe 9-month in-stent LLL in the HELIOS group was similar to the PARTNER group, (0.16 ± 0.22) mm vs. (0.19 ± 0.30) mm (P = 0.28). The difference and 95% confidence interval were -0.03 (-0.09, 0.04), and the P value for non-inferiority <0.01. Major adverse cardiovascular event (MACE) occurred in 7.9% vs. 8.2%, MI in 2.4% vs. 3.0%, TLR in 5.5% vs. 3.0%, and stent thrombosis in 0 vs. 1.5%; and events were comparable between the HELIOS group and PARTNER group at three-year follow-up (all P > 0.05). The three-year cardiac death was lower in the HELIOS group, but with no significant difference, 0 vs. 3.0% (P = 0.12).
CONCLUSIONSIn the HOPE trial, the novel completed biodegradable polymer SES HELIOS was non-inferior to the durable polymer SES PARTNER with respect to nine-month in-stent LLL in de novo coronary lesions. The incidence of other clinical endpoints was low for both of the stents in three-year follow-up.
Adult ; Aged ; Angiography ; Coronary Artery Disease ; surgery ; Coronary Restenosis ; prevention & control ; Drug-Eluting Stents ; Humans ; Middle Aged ; Percutaneous Coronary Intervention ; Polymers ; chemistry ; therapeutic use ; Sirolimus ; therapeutic use ; Titanium ; chemistry ; Treatment Outcome ; Young Adult