BACKGROUNDIn patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.

METHODSFrom a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences.

RESULTSAt a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.

CONCLUSIONSOur study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

Angioplasty, Balloon, Coronary ; methods ; Chronic Disease ; Coronary Angiography ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; therapy ; Coronary Occlusion ; surgery ; therapy ; Drug-Eluting Stents ; Humans ; Prospective Studies

Based on data comparing coronary-artery bypass grafting (CABG) with medical therapy, the current guidelines recommend CABG as the treatment of choice for patients with left main coronary artery (LMCA) disease. Percutaneous coronary intervention (PCI) can be selectively performed in patients who are candidates for revascularization but who are ineligible for CABG. Current evidence indicates that stenting results in mortality and morbidity rates compared favorably with those seen after CABG. Data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to choose PCI with stenting as an alternative treatment option for such patients. In addition, these data may inform future guidelines and support the need for well-designed, adequately powered, prospective, randomized trials comparing the two revascularization strategies.
Angioplasty, Transluminal, Percutaneous Coronary/adverse effects/*methods ; Coronary Artery Bypass/*methods ; Coronary Artery Disease/*surgery/*therapy ; Humans ; Stents/adverse effects

OBJECTIVETo compare the perioperative outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of complex coronary artery disease and left ventricular dysfunction.

METHDOSThe clinical data of 966 patients admitted to our hospital from January 2003 to December 2013 with coronary artery disease and left ventricular dysfunction (ejection fraction ≤50%) were retrospectively reviewed. Among the patients, 386 underwent CABG and 580 received PCI. After matching for EuroSCORE risk factors and preoperative echocardiographic parameters, 135 patients with CABG and 135 with PCI were enrolled in this study. With hospital mortality and perioperative major complications as the endpoints, the early outcomes of the procedures were evaluated. Perioperative echocardiography was performed to evaluate the change of left ventricular geometry and function.

RESULTSCompared with CABG group, PCI group had significantly higher incidences of chronic lung disease (8.1% vs 0.7%, P=0.003) and recent myocardial infarction (64.4% vs 31.9%, P=0.000) but significantly lower left-main disease (12.6% vs 23.7%, P=0.018); the other baseline characteristics were comparable between the two groups. Patients with CABG had a greater number of treated target vessels than those with PCI (2.90±0.81 vs 1.67±0.73, P=0.000), and complete revascularization was more common in CABG group (94.8% vs 51.8%, P=0.000). No significant difference was found in perioperative variations of LVEF between the two groups, but patients with CABG had a greater variation in LVEDD than those with PCI. The hospital mortality and other major complications were similar between the two groups.

CONCLUSIONBoth CABG and PCI are safe and reliable revascularization strategies for complex coronary artery disease and left ventricular dysfunction, but CABG can achieve a higher rate of complete revascularization and better improves the left ventricular function.

Coronary Artery Bypass ; Coronary Artery Disease ; surgery ; therapy ; Echocardiography ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Ventricular Dysfunction, Left ; therapy ; Ventricular Function, Left

BACKGROUNDDrug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes. However, the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.

METHODSWe searched Medline, the Cochrane Library and other internet sources, without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES. Safety endpoints were ST (definite, definite/probable), mortality, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).

RESULTSWe identified 15 randomized controlled trials (n = 17 068) with a weighted mean follow-up of 20.6 months. There was no statistical difference in the incidence of definite/probable ST between durable polymer- and biodegradable polymer- DES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P = 0.22. Biodegradable polymer DES had similar rates of definite ST (RR 0.94, 95% CI 0.66-1.33, P = 0.72), mortality (RR 0.94, 95% CI 0.82-1.09, P = 0.43), MI (RR 1.08, 95% CI 0.92-1.26. P = 0.35), MACE (RR 0.99, 95% CI 0.91-1.09, P = 0.85), and TLR (RR, 0.94, 95% CI 0.83-1.06, P = 0.30) compared with durable polymer DES. Based on the stratified analysis of the included trials, the treatment effect on definite ST was different at different follow-up times: ≤ 1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES.

CONCLUSIONSBiodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES. Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.

Coronary Artery Disease ; drug therapy ; surgery ; Drug-Eluting Stents ; Humans ; Polymers ; administration & dosage ; Thrombosis

BACKGROUNDThe hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events (MACCE) in patients with multivessel disease undergoing hybrid coronary revascularization.

METHODSThe data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification (GRC) calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization.

RESULTSDuring a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power (area under curve (AUC)) of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 (95% confidence interval 0.42 - 0.77), 0.65 (0.47 - 0.82), 0.57 (0.39 - 0.75) and 0.65 (0.46 - 0.83), respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 (P = 0.86), 5.39 (P = 0.37), 13.81 (P = 0.32) and 0.02 (P = 0.89), respectively.

CONCLUSIONSIn patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Artery Bypass ; adverse effects ; methods ; Coronary Artery Disease ; mortality ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged

BACKGROUNDMore and more percutaneous coronary intervention were done from radial artery approach. But the great limitation of radial artery approach and main failure cause of transradial coronary intervention is smaller size and more variations of a radial artery approach. The aim of the study is to explore the features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention.

METHODSA total of 1400 patients who underwent scheduled first time transradial coronary angiography between July 2007 and September 2010 were enrolled. Radial arteriography was performed in all patients to detect the anatomical variations of this vessel. All patients' radial and ulnar artery inner diameters were measured using a computer assisted quantification method. A detailed patient history was recorded. Multivariate Logistic regression analysis was performed to evaluate the predictive value of variables (including age, gender, ethnicity, height, weight, body mass index, smoking, diabetes, hypertension and dyslipidemia) in arterial tortuosities and variations of this vessel.

RESULTSIn southern Chinese populations, there were no significant differences in the diameters of the forearm arteries: the mean radial artery inner diameter was (3.04 ± 0.43) mm in ethnic Han Chinese and (3.05 ± 0.42) mm in ethnic Zhuang Chinese, P > 0.05), the mean ulnar artery inner diameter was (3.03 ± 0.38) mm in Han Chinese and (3.05 ± 0.36) mm in Zhuang Chinese, P > 0.05). It was estimated that the inner diameter of the radial artery was not smaller than a 6F Cordis sheath in 86.1% of male patients and in 57.0% of female patients, and not smaller than a 7F Cordis sheath in 59.3% of male patients and 24.9% of female patients. The factors found to positively affect the size of the radial artery were sex (bj = 0.309, P < 0.01), weight (bj = 0.103, P < 0.01), and diabetes mellitus (bj = -0.088, P < 0.01) was found to negatively affect radial artery size. Arterial tortuosities occurred in 12.1% of patients and arterial variations in 4.1%. The incidence of tortuosities and variations included radial artery tortuosity (3.6%), high origin of radial artery (1.7%), radial artery loop (0.6%), double radial artery (0.1%), brachial artery tortuosity (0.4%), double brachial artery (0.1%), subclavian artery tortuosity (5.4%), small subclavian artery (0.4%), right retro-esophageal subclavian artery (0.6%), brachiocephalic trunk tortuosity (2.8%), small brachiocephalic artery (0.1%), and brachiocephalic artery anomaly (0.4%). For people in Guangxi province, tortuosities of the subclavian artery and radial artery are the most common among the vascular tortuosities of the radial artery approach. The overall rate of transradial procedural success was 96.1%. Procedural failure was more common in patients with anomalous radial artery approach than in patients with normal radial artery approach (22.8% vs. 1.8%, P = 0.000). According to multivariate Logistic regression analysis, age (OR = 2.695, 95%CI 2.232 - 3.253, P = 0.000), female gender (OR = 5.127, 95%CI 3.000 - 8.762, P = 0.000), height (OR = 0.612, 95%CI 0.465 - 0.807, P = 0.000), body mass index (OR = 2.377, 95%CI 1.834 - 3.082, P = 0.000), hypertension (OR = 1.668, 95%CI 1.132 - 2.458, P = 0.010), hyperlipidemia (OR = 1.273, 95%CI 1.425 - 2.049, P = 0.034) and smoking (OR = 5.750, 95%CI 3.636 - 9.093, P = 0.000), were independently associated with arterial tortuosities of the radial artery approach. Female gender was independently associated with arterial variations of the radial artery approach (OR = 3.613, 95%CI 3.208 - 7.826, P = 0.000).

CONCLUSIONSThe diameters of the radial and ulnar arteries between the Han people and the Zhuang people in southern Chinese populations are similar. In a transradial operation, the most southern Chinese populations, the use of a 6F sheath and guiding catheter is safe, and using a 7F sheath and guiding catheter is feasible in some selected patients. Radial arterial tortuosities and variations in southern Chinese populations are relatively common and are a significant cause of the failure of transradial coronary procedure. Old age, female gender, short stature, high body mass index, hypertension, hyperlipidemia and smoking, were independently associated with an increased risk of arterial tortuosity. In addition, female gender was an independent predictor of arterial variations.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Asian Continental Ancestry Group ; Coronary Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; surgery

OBJECTIVETo compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO).

METHODSThe patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years.

RESULTSA total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06).

CONCLUSIONOur study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.

Chronic Disease ; Cohort Studies ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Occlusion ; surgery ; therapy ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Stroke ; epidemiology ; Treatment Outcome

BACKGROUNDCoronary artery perforation (CAP) is a rare but severe complication of percutaneous coronary intervention (PCI). The aim of our study was to evaluate the effect and safety of transcatheter embolization by autologous fat particles in the treatment of CAP.

METHODSOnce the CAP was confirmed, a little autologous subcutaneous fatty tissue was obtained from the groin of the patient and then was made into 1 mm × 1 mm fat particles. The perforated vessel was embolized by fat particles via a micro-catheter. There were eight patients undergoing transcatheter embolization by autologous fat particles in the treatment of CAP during PCI in Peking University Third Hospital from February 2009 to June 2014, and the clinical data of these patients were collected and analyzed retrospectively.

RESULTSThe lesion morphology of the patients was classified based on the American College of Cardiology/American Heart Association Task Force classification, there were one patient with Class B2 lesion and seven patients with Class C lesions (there were five patients with chronic total occlusion lesions). According to the Ellis classification of CAP, there were six patients with Class II perforations and two patients with Class III perforations. The causes of perforation included that seven patients induced by guide wire and one patient by balloon predilation. Three patients had pericardial effusion. All of the eight patients with CAP underwent transcatheter embolization by autologous fat particles. Coronary angiography confirmed that all of them were embolized successfully. There was no severe complication after the procedure. The coronary angiography of one patient at 1 week and another patient at 2 years after the embolization showed that the embolized arteries had recanalized. The median follow-up time was 20.3 months (8.8-50.2 months), the event-free survival rate was 100%.

CONCLUSIONSTranscatheter embolization by autologous fat particles was an effective, safe, cheap, and easy way to treat the perforation of small vessels during PCI.

Aged ; Coronary Artery Disease ; surgery ; therapy ; Coronary Vessels ; surgery ; Embolization, Therapeutic ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; methods ; Retrospective Studies

OBJECTIVETo evaluate the clinical efficacy of treatment for regulating Pi and protecting Xin (abbr. as CHM) and its effect on quality of life (QOL) in patients after coronary artery bypass grafting (CABG).

METHODSOne hundred and six patients, who were planned to undergo CABG were assigned into two groups, the 51 patients in the control group were treated with conventional Western medicinal treatment (WM) and the 55 patients in the experimental group were treated by WM with additional medication of CHM constituted mainly by modified Huxin Recipe. The changes of symptoms and heart function were observed and the patients' QOL was evaluated by SF-36 Scale.

RESULTSAfter being treated for 3 months, the total scores of symptoms in the experimental group was significantly improved in comparing with that in the control group (P < 0.01), the clinical efficacy on symptoms of TCM and improvement of heart function were superior to those in the control group (P < 0.05) respectively. The scores in terms of pain, vitality, role of emotion, mental health, health transition of patients in the experimental group according to SF-36 scale were significantly higher than those in the control group (P < 0.05 or P < 0.01).

CONCLUSIONTreatment for regulating Pi and protecting Xin by modified Huxin Recipe can improve the recovery process of patients after CABG, elevate patients' heart function, symptoms and QOL.

Aged ; Combined Modality Therapy ; Coronary Artery Bypass ; Coronary Artery Disease ; drug therapy ; surgery ; Diagnosis, Differential ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Postoperative Period ; Quality of Life

OBJECTIVETo study the TCM syndrome differentiation rules in coronary artery bypass grafting (CABG) patients during peri-operation period.

METHODSAccording to the Guideline for Clinical Trail of Traditional Chinese New Drugs and experience of Professor DENG Tie-tao, the standard of TCM syndrome differentiation for CABG patients was established, with which 161 CABG patients were classified before and two weeks after CABG operation.

RESULTSBefore CABG, the qi stagnation and blood stasis syndrome type was the type most commonly seen (46.0%), the next in turn was the phlegm stagnation type (24.8%), the yang-qi deficiency type (15.5%), and the yin-blood deficiency type (13.7%). While after CABG, the phlegm stagnation syndrome type was the most frequently occurred one (35.9%), then in turn was the yang-qi deficiency type (30.8%), the yin-blood deficiency type (21.2%) and the qi stagnation with blood stasis type (12.2%).

CONCLUSIONFor patients before CABG, the pathological characteristic is mostly the deficiency in root with excess in superficiality, and the commonest syndrome is the qi stagnation with blood stasis type. For patients after CABG, both deficiency and excess is the pathological characteristic, the Xin-qi and Xin-yang deficiency syndrome the commonest type, and with phlegm as the main pathologic factor.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Bypass ; Coronary Artery Disease ; drug therapy ; surgery ; Diagnosis, Differential ; Female ; Humans ; Intraoperative Period ; Male ; Medicine, Chinese Traditional ; Middle Aged