Objective To evaluate the clinical efficacy of cutting balloon angioplasty (CBA) for treating lesions in small coronary arteries. Methods The diameter for reference of coronary artery is less than 2.7mm which is considered as “small vessel”. CBA procedures were performed on 25 lesions in 22 patients. Results The procedure was successfully obtained in 21 lesions(84%). Seven severe stenotic lesions (diameter of stenosis≥90%) underwent dilatation with small conventional balloon(1.5 mm diameter). Bail out stenting was performed in 2 lesions because of severe dissections. Failure of cutting balloon to pass through the stenosis in one lesion. During follow up, 5 patients had recurrence of coronary angina and 3 of them underwent coronary angiography for check up, In stent restenosis (ISR) occurred in one patient, which was successfully redilated using CBA. One patient had total occlusion of the diagonal branch with ISR of LAD. One patient developed new lesion in other coronary artery.Conclusions CBA is safe and effective, and provides a new therapeutic strategy for lesions in the small coronary arteries.

0.05)compared to bare metal stents.Conclusion Age is an important clinical factor influencing mortality rate after PCI in patients with coronary artery disease,and the use of drug-eluting stents should be the preferred for the improvement of long-term outcomes in the elderly.

Objective To evaluate the role of intravasc ular ultrasound (IVUS) in determining strategy for coronary artery stenosis of intermediate severity.Methods The study population consisted of 75 patients who had de novo coronary lesions of intermediate severity (40% to 70% diameter stenosis) in coronary angiography. IVUS examination was performed in all patients using standard methodology. Minimal lumen cross-sectional area (MLA) ≤ 4.0- mm 2 or percent area stenosis≥60% were identified as an IVUS index of functionally severe coronary stenosis, and used as an indication of coronary stenting. Major adverse cardiac events (cardiac death, acute myocardial infarction and recurrent angina) and the use of nitrates were recorded during follow-up. Results There were 44 patients (59%) with functional coronary artery stenosis, and all underwent successful coronary stenting. Acute coronary syndromes, soft plaque and positive coronary arterial remodeling were more common compared with the remaining 31 patients (41%) only treated medically. During a mean of (14?7) months of follow-up, there was no cardiac death and acute myocardial infarction. Readmission occurred in 5 patients (11%) due to in-stent restenosis in patients with interventional therapy and 4 patients (13%) due to exacerbation of coronary artery stenosis in patients with medical therapy. The use of nitrates was discontinued in 18(41%) and 14(45%) patients treated with interventional therapy and medical therapy, respectively. Conclusions It is valuable to perform IVUS examination in clinical decision making for intermediate coronary artery stenosis. IVUS criteria of MLA≤ 4.0- mm 2 or area stenosis≥60% may be a reliable index of functional coronary stenosis, determining the therapeutic strategy in patients with intermediate coronary artery stenosis.

Objective To evaluate the clinical efficacy of coroflex (BRAUN, Germany) intracoronary stent. Methods To retrospectively analyze the immediate angiographic and clinical follow-up outcomes of 81 patients (pts) receiving coroflex intracoronary stenting. Results 88 coroflex intracoronary stents were implanted in 81 pts. According to ACC/AHA classification, 38 lesions were type A-B 1, 50 lesions were type B 2-C. 52 lesions were de novo, 22 were suboptimal results after PTCA and 14 lesions were bailout for dissections. Stent deployment was successful in 82/88 (93.2%). High-pressure (16-18 atm) balloon was used for stent deployment in 3 lesions with severe calcification. Dissection was occurred at distal of stent in 2 lesions but no inducing flow reduction. Angiography showed TIMI 2 grade after intracoronary stenting in 1 diffused lesion. There were no adverse events occurred during hospital stay. Clinical follow-up of in 75 pts were conducted for 7.5?3.0 (3-13) months, there were no cardiac death or myocardial infarction reported. Complain of angina (CCS class Ⅰ) occurred in 17 pts (22.7%). Repeat angiography was performed in 7 pts, there were 2 in-stent restenosis with successful revascularization. Conclusion Coroflex intracoronary stenting appears to be safe and effective in the treatment of coronary lesions with favorable outcomes.

Objective To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods During the period of January 2004-January 2008, primary PC1 was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital. The clinical data were retrospectively analyzed. Major adverse cardiac events (MACE), including death, reoccurrence of myocardial infarction and target vessel revascularization, in patients with major bleeding were compared with that in patients without major bleeding. Results Compared to patients without bleeding, the patients with bleeding were older (70.0 ± 8.9 years vs 64.9 ± 12.7 years, P = 0.04), mainly the females (51.9% vs 23.1%, P = 0.001) and treated more often with glycoprotein (GP) Ⅱb/Ⅲa receptor inhibitor (88.9% vs 69.4%, P = 0.03) or intra-aortic balloon pump (7.4% vs 1.3%, P = 0.02). In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively, which were significantly higher than that in the patients without bleeding (5.7% and 14.3%, with P = 0.008 and P = 0.002, respectively). Multivariate analysis indicated that patient aged over 70 years, feminine gender and use of GP Ⅱb/Ⅲa receptor inhibitor were independent predictors for the occurrence of major bleeding. The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure (OR 2.79, 95% CI: 2.21-5.90, P < 0.001). Conclusion In patients with acute STEMI, the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment. Feminine gender, aged patient and use of GP Ⅱb/Ⅲa receptor inhibitor are independent predictors to increase the danger of major bleeding.

Objective To investigate the influence of diabetes mellitus (DM) on left ventricular(LV) remodeling in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Methods Four hundred and fifty-one consecutive patients with acute STEMI treated by primary PCI were prospectively enrolled in the current study. Baseline, angiographic and PCI features and prevalence of LV remodeling at one-week during hospitalization and 6-month clinical follow-up by two-dimensional echocardiography were compared between 93 diabetic and 358 non-diabetic patients. Results Despite similar baseline clinical and angiographic characteristics, symptom-to-door time was longer (399±106 min vs. 321±116 min, P=0.006) and prevalence of multivessel disease was higher (65.6%vs. 51.7%, P=0.02) in diabetic patients. More patients in diabetic group had LV remodeling at 6-month clinical follow-up (29.0%vs. 17.3%, P=0.01), and DM was an independent predictor of LV remodeling (RR 2.1, 95%CI 1.31-4.79, P=0.02). The rate of rehospitalization due to heart failure did not differ between diabetic and non-diabetic patients (12.9%vs. 8.1%, P=0.15), however, more adverse events occurred in patients with LV remodeling comparing to those without LV remodeling (25.8% vs. 6.6%, P < 0.001). Conclusions Diabetic patients with STEMI often have an increased risk of LV remodeling after treated by primary PCI. Thus, comprehensive therapeutic strategy for diabetic patients presented with STEMI is required considering the poor prognosis of these patients with LV remodeling.

Objective:To optimize the extraction process of Shenqi Lixin capsules through pharmacodynamic evaluation combined with orthogonal experiments with multi-index comprehensive evaluation.Methods:The congestive heart failure(CHF) model was established by intraperitoneal injection of doxorubicin in rats,and the LVEDD,LVESD,FS and LVEF of CHF rats were used as the indicators to screen the extraction process of the samples (process A was with the whole decoction of herbs and process B was with heterophylla powder mixed with the other herbs after boiling).The single factor tests and orthogonal tests were used to optimize the extraction process by taking the contents of astragaloside and tanshinone ⅡA and the quality of the decocted material as the indices,and adding water amount,decocting times and duration as the influencing factors.Results:Pharmacodynamic experiments indicated that the improvement effects of the samples from process B on cardiac symptoms and cardiac function in CHF rats were better than that of the samples from process A.The other medicinal materials were decocted by 12-fold amount of adding water,and repeated for 12 times with one hour for each time.The average extraction rate of astragaloside and tanshinone ⅡA was 61.82% and 50.07%,respectively,which was proven by the verification experiments.The average weight of the decoction was 6.02 g.Conclusion:The optimized extraction process of Shenq Lixin capsules is scientific,reasonable,stable and reliable.

Objective To investigate the preventive and therapeutic effect of Bushen Jiedu prescription on ionizing radiation induced sex hormone disorder.Methods Totally 72 adult rats with half male and half female were randonly divided into 6 groups,including control group,radiation group,Bushen Jiedu prescription group with male and female,with 12 rats in each group.After adaptive breeding for 2 d,the rats of Bushen Jiedu prescription group were given 0.2 ml water soluble granules of Bushen Jiedu prescription (1.38 g/ml) by gavage once a day for 10 days.At 11 d,the rats were irradiated by 5 Gy of 60Co γ-rays.24 h after radiation,6 rats in each group were executed to measure the level of sex hormone.The other rats were further gavaged with Bushen Jiedu prescription or its control once a day for 14 d,then were executed for sex hormone testing.Results At 1 d after radiation,the estrogen (E2) of female of Bushen Jiedu prescription group was significantly higher than that of radiation group (t =2.686,P ＜ 0.01).Compared with control group,the levels of follicule-stimulating hormone (FSH) (t =4.305,4.642,P ＜0.01) of male and female,the levels of luteinizing hormone (LH) of male radiation group,and Bushen Jiedu prescription group were increased (t =4.537,2.336,P ＜ 0.01).At 14 d after radiation,the levels of testosterone and luteinizing hormone in male rats of radiation group was higher than those in control group (t =-3.730,2.963,P ＜ 0.05),and the levels of E2 and progesterone of female was lower than those in control group (t =-5.424,-3.178,-2.690,-3.215,P＜0.01).Conclusions Ionizing radiation can induced sex hormone disorder,and Bushen Jiedu prescription can effectively inhibit this alteration,which indicates that Bushen Jiedu prescription is an ideal radiation protectant.

OBJECTIVETo examine the relationship between coronary arterial remodeling and clinical presentation.

METHODSA total of 34 patients with acute (10 with recent myocardial infarction and 24 with unstable angina) and 26 with stable (8 with old myocardial infarction and 18 with stable angina) coronary syndrome underwent intravascular ultrasound (IVUS) before intervention. Target lesions were classified as soft or hard plaques. Quantitative measurements of cross-sectional area (CSA) of external elastic membrane (EEM), lumen and plaque were performed at the lesion site and at the proximal and distal reference sites. Remodeling index (RI) was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal reference sites. Positive remodeling was defined as RI > 1.05 and negative remodeling as RI < 0.95.

RESULTSSoft plaque was observed more frequently in acute than in stable coronary syndrome (59% vs 31%), whereas hard plaque was more common in stable coronary syndrome (69% vs 41%) (P = 0.03). The EEM CSA (15.11 +/- 2.89 mm(2) vs 13.25 +/- 3.10 mm(2), P = 0.019) and plaque CSA (10.83 +/- 2.62 mm(2) vs 9.30 +/- 2.84 mm(2), P = 0.035) were significantly greater at target lesions in patients with acute rather than stable coronary syndrome, while lumen CSA and percent area stenosis were similar in both groups. RI was significantly higher (1.08 +/- 0.16 vs 0.95 +/- 0.14, P = 0.002) and positive remodeling was more frequent in acute coronary syndrome (53% vs 23%, P = 0.019), whereas negative remodeling was more common in stable coronary syndrome (58% vs 24%, P = 0.007).

CONCLUSIONSThe study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling.

Aged ; Coronary Disease ; diagnostic imaging ; pathology ; physiopathology ; Coronary Vessels ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Ultrasonography

Objective To evaluate the influence of the gene polymorphisms of matrix metalloproteinase(mmp)-1 ,-2,-3 and -9 on coronary atherosclerotic plaque progression. Methods During the period of January 2005-December 2008, 80 patients with coronary heart disease underwent two times coronary angiography at authors' hospital. Based on the angiographic findings, the patients were classified into plaque progression group (n = 31 ) and plaque non-progression group (n = 49). Coronary atheroselerotic plaque progression was arbitrarily defined as that the minimal lumen diameter (MLD) of coronary artery showed a decrease ≥ 0.4 mm on the second coronary angiography. The detailed history and clinical examination results were collected, including serum concentrations of lipid profiling, fasting glucose and hs-CRP. Genotypings for polymorphic variances of MMP-1 (-1607 G/GG), MMP-2 (-955 A/C), MMP-3 (-1612 5A/6A ) and MMP-9 (-1562 C/T) were performed by polymerase chain reaction (PCR) and sequencing analysis in two groups.Comparison of the clinical characteristics and polymorphisms between two groups was made to assess their effects on coronary atherosclerotic plaque progression. Results More female patients and patients with acute coronary syndrome (ACS) were noted in patients with plaque progression compare to those with no progression (41.9% vs. 18.4%, P < 0.05 and 77.4% vs. 46.3%, P < 0.01, respectively).The serum hs-CRP level also significantly increased in group with plaque progression (0.26 ± 0.44 mg/L vs.0.02 ± 0.14 mg/L, P < 0.01). Multivariable logistic regression analysis revealed that serum hs-CRP concentration and ACS were independent risk factors of coronary atherosclerotic plaque progression (OR:12.63,95% CI:1.45-110.29, P < 0.05 and OR:2.99,95% CI:1.04-8.63, P < 0.05, respectively). The frequencies of 6A/6A genotype and 6A allele of MMP-3 promoter at location -1612 were significantly higher in group with plaque progression than that in group with no progression (87.1% vs. 53.1%, P < 0.01 and 93.5% vs. 75.5%, P < 0.01, respectively). However, no significant differences in the distribution of MMP-1,-2 and -9 polymorphisms existed between two groups. Conclusion ACS, feminine gender, high serum hs-CRP concentration and 5A/6A polymorphism in the MMP-3 gene promoter are closely associated with coronary atherosclerotic plaque progression. In addition, 5A/6A polymorphism of MMP-3 can be used as a marker for plaque progression.