Gout ; Coronary Artery Disease ; Coronary Disease ; Comment ; therapy

Coronary Artery Disease ; therapy ; Fistula ; therapy ; Humans ; Percutaneous Coronary Intervention

Coronary Artery Disease ; rehabilitation ; Exercise Therapy ; Humans

PURPOSE: This study was performed to analyse the trends of risk factor management programs for patients with coronary artery disease. METHODS: Using PubMed, 35 intervention studies related to risk factor management programs among randomized controlled trials searched with the key words of coronary artery disease and coronary heart disease. Collected studies were analysed according to the characteristics of studies and participants, method and content of intervention, and outcome indicator and its effects. RESULTS: The mean period of intervention was 28.7+/-26.8 weeks, the mean frequency was 3.0+/-2.0 times per week, and the duration of one session was below 60 minuets in 65.8% of the reviewed studies. The interventions were counselling, exercise, education, and cognitive behavior therapy. Counselling was applied most frequently in previous studies. The outcomes of intervention had been measured with anthropometric, physical, physiological, psychological, behavioral, and cognitive aspects, but the effect of the intervention was inconsistent among the studies. CONCLUSION: Based on the results of this study, systematic and comprehensive cardiac rehabilitation program consisted of counselling, exercise, and education should be developed and performed for health management and relapse prevention of patients with coronary artery disease.
Cognitive Therapy ; Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Humans ; Clinical Trial ; Recurrence ; Risk Factors

Humans ; Consensus ; Coronary Angiography ; Coronary Artery Disease/therapy* ; Coronary Vessels ; Ischemia ; Myocardial Ischemia/therapy*

OBJECTIVETo investigate the feasibility and safety in treatment of coronary bifurcation lesions with 6F-guiding catheter by transradial approach.

METHODSClinical data of 1258 patients who were treated with 6F-guiding catheter by transradial approach from Oct. 2003 to Feb. 2007 were reviewed. The most common approach in the treatment of bifurcations was one-stent technique on the main branch; if the side branch was large enough and the lesion was involved in the ostium and proximal part of side branch, two-stent technique was used.

RESULTOf 295 bifurcation lesions, 204 were originally planed to be treated by one stent; but finally 2 side branches were provisional stented due to dissection in this group. Ninety-one cases were planed to use double-stent technique: 73 with crushing stent (46 step crushing, 24 modified balloon crushing, 3 reverse crushing), 5 with T-stent, 3 with Cullote-stent, 5 with modified V-stent, 5 with step kissing stent. There was no acute myocardial infarction or death occurred but 1 case was complicated with cardiac tamponade secondary from coronary perforation.

CONCLUSIONThe treatment of coronary bifurcation lesions with 6F-guiding catheter by transradial approach is a feasible and safe procedure.

Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Artery Disease ; therapy ; Coronary Vessels ; pathology ; Female ; Humans ; Male ; Radial Artery ; Stents

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

Objective: To develop a set of data elements and standardized definitions of Coronary Artery Disease and Creative Antithrombotic Clinical Research Collaboration (CardiaCare), aiming to facilitate the exchange of disparate data sources, enhance the abilities to support multicenter researches, and subsequently ensure the databases use under standardized process and criteria. Methods: The Cardiacare writing committee members reviewed data elements and definitions from published guidelines, clinical trials, databases, and standardized documents, then determined the data elements and standardized definitions, which should be included in CardiaCare. The writing committee also considered the specific domestic clinical management strategies during the establishment of Cardiacare. The resulting documents provide a series of key data elements and standardized definitions used in the management of coronary artery disease patients. Key data elements from CardiaCare could be sorted by clinical management flowsheet and outcome from hospitalization to long-term follow-up. Results: The Cardiacare standardized set comprised 864 data elements from admission to post-hospital follow-up visit. There were 8 tables in the documents, including demographic and admission information (23 elements), medical history and risk factors (102 elements), clinical presentations and diagnosis (22 elements), diagnostic and laboratory tests (111 elements), interventional diagnosis and treatment (118 elements), pharmacological therapy (213 elements), clinical outcomes (161 elements), and special subpopulations (114 elements: 87 elements for transcatheter valve replacement and 27 elements with cardiac rehabilitation). Conclusions: The Cardiacare standardized data elements set could provide support for real-world clinical research in consecutive data collection and databases mining. A wider applicability in various settings of CardiaCare needs to be explored further.
Cardiac Rehabilitation ; Coronary Artery Disease/drug therapy* ; Fibrinolytic Agents ; Humans

Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Disease ; therapy ; Guideline Adherence ; Humans ; Practice Guidelines as Topic

OBJECTIVETo evaluate the safety and efficacy of exercise rehabilitation in coronary heart disease patients post reascularization procedure.

METHODWe searched the Cochrane Central Register of Controlled Trials (CCRCT), Pubmed, Wanfang, CNKI, CBM and VIP database for randomized controlled trials (RCTs) on exercise rehabilitation for patients with coronary artery disease post percutaneous coronary intervention revascularization or coronary artery bypass grafting. Quality assessment and data collection were conducted by two reviewers independently. The data were analyzed by Review Manager 5.0.

RESULTSA total of 3 474 patients from 16 RCTs were included in this meta-analysis and patients were divided into exercise rehabilitation group (n = 1 425) and control group (n = 2 049). Meta-analysis results showed mortality rate was similar between the two groups (OR = 0.81, 95%CI 0.38-1.69, P > 0.05) and the incidence of major cardiovascular events rate (OR = 0.40, 95%CI 0.24-0.65, P < 0.01) and heart rate [mean difference (MD) = -2.82, 95%CI -4.72--0.92, P < 0.01] were significantly lower while LVEF (MD = 2.24, 95%CI 0.18-4.31, P < 0.05), the exercise metabolic equivalent (MD = 0.94, 95%CI 0.43-1.44, P < 0.01) , anaerobic threshold (MD = 1.83, 95%CI 0.67-3.00, P < 0.01) , and maximum oxygen consumption (MD = 3.22, 95%CI 2.42-4.03, P < 0.01) were significantly higher in exercise rehabilitation group than in control group.

CONCLUSIONExercise rehabilitation does not increase the risk of mortality in patients of coronary heart disease after revascularization and can effectively reduce major cardiovascular events.

Coronary Artery Bypass ; Coronary Disease ; rehabilitation ; surgery ; Exercise Therapy ; Humans ; Percutaneous Coronary Intervention ; Treatment Outcome