Objective The aim of our study was to evaluate the efficacy and safety of tirofiban in patients with acute coronary syndromes with thrombus-containing lesions.Methods We randomized 38 acute coronary syndromes(ACS)patients with thrombus-containing lesions into tirofiban group and control group.In the tirofiban group,10～30 mL of tirofiban was administered intracoronar before and/or after percutanous transluminal coronary angioplasty(PTCA),then stent was implanted as needed.Intravenous tirofiban was used for 24～48 hours after the procedure.In the control group,standard percutanous coronary intervention(PCI)was used for the patients.TIMI thrombosis grade,TIMI blood flow,no reflow and/or slow flow,corrected TIMI frame count(cTFC),myocardial blush grade(MBG),left ventricular eject fraction(LVEF)were measured in the two-dimensions untrasonography;major adverse cardiac events(MACE)and bleeding were observed.Results TIMI thrombosis grade and cTFC decreased more in the tirofiban group than that of the control group[0.90?0.14 vs 1.53?0.54,P

Background To document the pharmacotherapy of chronic heart failure (CHF) and to evaluate the adherence to treatment guidelines in Australian population.Methods The pharmacological management of 677 patients (female 46.7%,75.5±11.6 years) with CHF was retrospectively analyzed.Results The use of angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and fl-blockers were 58.2%and 34.7%,respectively.Major reasons for non-use of ACE inhibitors/ARBs were hyperkalemia and elevated serum creatimne level.For patients who did not receive β-blockers,asthma and chronic obstructive pulmonary disease were the main contraindications.Treatment at or above target dosages for ACE inhibitors/ARBs and β-blockers was low for each medication (40.3% and 28.9%,respectively).Conclusions Evidenced-based medical therapies for heart failure were under used in a rural patient population.Further studies are required to develop processes to improve the optimal use of heart failure medications.

BACKGROUND:Clinical trials have shown that oral administration of valsartan can decrease in-stent restenosis after stent implantation.But whether valsartan used locally also has the sanle effect and the possible mechanism should be validated.OBJECTIVE:To observe the effect of valsartan-eluting stents on collagen deposition in neointima and AT2 receptor expression after implanting valsartan-eluting stents into rabbit abdominal orta.DESIGN:Randomized and controlled animal experiment.SETTING:Beijing Friendship Hospital.MATERIALS:The experiment was performed at the Laboratory of Beijing Friendship Hospital between October 2004 and March 2006.Fifteen New Zealand white rabbits,irrespective of gender,weighing 2.75-3.25 kg were selected(Animal Laboratory of Beijing Friendship Hospital).The rabbits were adaptively fed for one week.All the operations of rabbits during the experiment were accorded with animal ethical standards.Valsartan powder was presented as a gift by Novartis.China;Reagent of MASSON was provided by Department of Pathology of Beijing Friendship Hospital;1%picrosirius solution was provided by the Department of Pathology of China-Japan Friendship Hospital:Mice-anti-rabbit monoclonal AT2 antibody was product of Santa Cruz Biotechnology (USA);Envision reagent was purphased from Dako;primers were synthesized by SBS Genetech(SBS).METHODS:①The animals were randomized into bare-metal stent group,carrier-eluting stent group and valsartan-eluting stent group with 5 animals in each group.All rabbits were implanted with corresponding types of above-mentioned stents into abdominal aortas down below renal artery.②Quantitative angiography before,immediately after and 3 months after stent implantation were performed to compare vascular diameters of the aortas.③Three months Iater,the rabbits were executed after anaesthesia.The vessels with stents were processed with HE staining.Indices of the vascular neointimal formation,I.e. iBrier and external elastic membrane luminal area,the maximal intimal thickness,neointimal area and stenosis area percent were measured.④The collagen deposition in neointima was observed through MASSON staining,and the type of collagen was identified through picrosirius stain.⑤The expressions of AT2R mRNA and proteins were also compared by RT-PCR and immunohistochemistry among three groups.MAIN OUTCOME MEASURES:①The diameters of aorta with stent at different time;②Inner and extemal elastic membrane luminal area,the maximal intimal thickness,neointimal area and stenosis area percent;③Collagen deposition and type of collagen of the aorta with stent;④AT2R mRNA and protein expressions.RESULTS:Of 15 rabbits selected in the experiment,1 rabbit of the bare-metal stent group died during stent implanting,and 1 of the carrier-eluting stent group died during breeding after stenting.Finally,13 rabbits were included in final analysis.①There were no significant differences in the mean aortic diameters between any two of the three groups before,immediately after and 3 months after stent implantation(P＞0.05).②A larger 1uminal area and a less neointimal hyperplasia in valsartan eluting-stents group were found compared with the other two groups(P＜0.01).③MASSON staining showed that collagen deposition was rich in neointima of bare-metal stent group and carrier-eluting stent group while rare in neointima of valsartan eluting stent group.Pierosirius staining suggested that the deposited collagen was type Ⅲ collagen predominantly accompanied by type Ⅰ collagen around stents struts;the type Ⅲcollagen deposition was obviously decreased in valsartan eluting stent group.④AT2R protein only expressed in adventitia of bare-metal stet group and arrier-eluting stent group while expressed in all layers of valsartan eluting-stents group.The AT2R mRNA/a-Actin mRNA of valsartan eluting stent group was significantly higher than that in the other two groups(P＜0.01).CONCLUSION:Valsartan eluting-stents inhibits neointimal hyperplasia after stenting by decreasing collagen deposition.especially collagen Ⅲ.The mechanism may be related with the upregulation of AT2R mRNA and protein expressions by valsartan-eluting stent.

Objective To evaluate the effectiveness of immediate quantitative coronary angiography (QCA) analysis in percutaneous coronary intervention (PCI). Methods The parameters of QCA and conventional methods before and after PCI were compared and statistics was performed by using t test or ANOVA methods. Results One hundred and two patients were enrolled in our study. Significant differences between QCA and conventional methods were found in evaluation of lesion length [ ( 22.9 ± 8.9 ) mm vs (24. 8 ± 10. 6) mm,t = 9. 63, P < 0. 05 ], stenosis diameter [ (3.0 ± 0.4 ) mm vs (2. 9 ± 0. 7) mm, t = 6. 31, P < 0. 05 ] and stenosis area [ ( 87. 8 ± 10. 7 ) mm2 vs ( 85.0 ± 12.9 ) mm2, t = 2. 54, P < 0.05 ], and also in different vessels. Stenosis diameter and stenosis area after stenting in target lesion were lower than the international standards. Conclusion Immediate QCA analysis can be effective in directing stent implantation.

Objective To evaluate the clinical effectiveness of a new and easy-to-use thrombus-aspirating device for primary percutaneous trans-radial coronary intervention (PCI). Method From March 2006 to June 2008, fifty acute myocardial infarction (AMI) patients with angiographic evidence of high-burden coronary throm-bus treated with thrombus aspiration were enrolled in a single center retrospective study. Thrombotic clot was aspi-rated before stent was implanted in the infarct-related coronary artery. Thrombolysis in myocardial infarction(TIMI) flow, corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade(TMPG), and rate of no-reflow were observed with coronary augiography. Acute thrombosis and subacute thrombosis in stent during hospital stay were investigated. Myocardial ischemic events, revascularization and mortality during the following period were also in-vestigated. Paired t -test was used for statistical analysis. Results Thrombus was completely removed in 35 pa-tients (70%) and partially removed in 15 patients (30%) seen immediately after thrombus aspiration. There were significant improvements both in postoperative TIMI flow (0 vs. 2.7±0.5, P <0.01) and TMPG (0 vs. 2.6±0.8, P <0.01), while cTFC was 20.2±16.8 after the thrombus aspiration. No severe complication occurred during and after operation. Conclusions Trans-radial thrombas-aspiration in primary PCI is clinically safe and feasible. The use of aspiration catheter (ZEEK) is a simple and effective approach to the treatment of coronary artery stenosis associated with thrombus because it elevates the successful rate of treatment,reduces the incidence of no-reflow,and results in better prolonged-term outcome.

Objective To investigate the risk factors,clinical and coronary angiographic characteristics in women less than 50 years with coronary heart disease(CHD).Methods One hundred and twenty-six women less than 50 years were divided into CHD group and non-CHD group according to the result of coronary angiography(CAG).Risk factors,clinical and coronary angiographic characteristics were investigated retrospectively.Results In 6395 cases who were given CAG in the corresponding time period,126(1197%)women were less than 50 years,and 44 cases were confirmed as having CHD by CAG[CHD group,mean age(46.8±3.6)years)].Meanwhile 82 cases were in non-CHD group[mean age(45.4±4.3)years)].The incidence rate of hypertension[77.3%(34/44)vs 26.8%(22/82)],diabetes mellitus[34.1%(15/44)vs 4.9%(4/82)],hyperlipidemia[43.2%(19/44)vs 7.3%(6/82)],family history of CHD[43.2%(19/44)vs 7.3%(6/82)],and risk factors of family history of CHD[52.3%(23/44)vs 12.2%(10/82)]had significant difference between CHD group and non-CHD group(P<0.01).88.6%(39/44)CHD palients were acute coronary syndrome,50.0%(20/44)lesion was one-vessel lesion.Left anterior descending coronary was involved most easily.The degree of calcification was lighter.The type.of lesion was mostly localized and segmented.Conclusions Hypertension,hypedipidemia,diabetes mellitus,family history of CHD,and risk factors of family history of CHD are the major risk faetom in women less than 50 years with CHD. The possibility of CHD is higher when having classical angina and multiple risk faetom.

Objective To investigate the coronary characteristics and interventional treatment results of coronary artery patients on dialysis due to uremia.Methods Twenty-five cases coronary artery disease patients,including 3 cases with stable coronary disease,7 cases with ST elevation myocardial infarction,and 15 cases with non-ST elevation myocardial infarction,who were treated with uremia dialysis from January 2001 to December 2014 in Friendship Hospital of Beijing Affiliated to Capital Medical University were selected.Emergency or regular coronary angiography was done after admission,and coronary angiography characteristics of vascular lesions and interventional treatment outcomes,clinical results during hospitalization and 12-month follow-up were observed.Results (1) The proportion of three-vessel disease of 19 cases,moderate and severe calcification of 20 cases,and diffuse disease of 11 cases were observed in coronary artery disease with dialysis.No differences were found in the proportion of three-vessel disease(x2=1.08,P=0.58),moderate and severe calcification(x2 =0.48,P =0.79),and diffuse disease (x2 =4.52,P =0.11) among the groups of stable coronary disease,ST elevation myocardial infarction and non-ST elevation myocardial infarction.(2) The interventional therapy in 24 patients with coronary heart disease complicated with uremia was successful,and the average total operation time was (55.3±7.1) min,the average contrast volume was (126.0±12.6) ml.There was 1 case with complication of side branch occlusion.(3) Cardiovascular events rates during hospitalization and after 12-month follow-up were 20.0％ (5/25) and 48.0％ (12/25),respectively.Conclusion In coronary artery patients with uremic on dialysis,the proportion of three-vessel disease,moderate and severe calcification,and diffuse disease are relatively high.The success rate of intervention therapy is high and safe but with a relatively high cardiac events during hospitalization and 12-month follow-up.

Objective To investigate the safety and effectiveness of left internal mammary artery (LIMA) angiography via right transradial approach with 5F universal coronary angiography catheter. Methods Left internal mammary artery (LIMA) angiography via right transradial approach with 5F universal coronary angiography catheter was performed following coronary angiography in 86 patients.The success rate of the procedure, the result of LIMA angiography, the time to LIMA, the volume of contrast, the incidence of complications and bypass vessels in patients who received coronary artery bypass grafting (CABG) were recorded and analysed. Results The success rate was 97.6%(84/86), and the result of LIMA angiography was satisfied; the time to LIMA was (6.5 ± 2.8) min, and the volume of contrast was (17.6 ± 11.1) ml;the incident of complications was 4.7%(4/86);56 patients received CABG. LIMA was harvested in all cases and left radial artery in 53 cases. Conclusions LIMA angiography via right transradial approach with 5F universal coronary angiography catheter is safe and effective, and it has significant sense to patients who will receive CABG.

Objective:To investigate the current situation of insomnia in patients with acute coronary syndrome (ACS), and analyze the influencing factors of insomnia in the ACS patients, so as to provide information on the development of new strategies for the treatment of insomnia in ACS patients.Methods:This is a multicenter and prospective observational study. A total of 771 ACS patients who met the criteria were selected from March 2013 to June 2015. The baseline social demographic information, sleep quality questionnaire, general anxiety disorder scale-7(GAD-7),patient health questionnaire-9(PHQ-9), short-form 12 health survey questionnaire(SF-12), and enhancing recovery in coronary heart disease patients social inventory(ESSI) were completed within 7 days after admission. Logistic regression analyses were used to analyze the influencing factors of insomnia in ACS patients.Results:A total of 741 subjects with valid questionnaires were collected, including 510 males (68.8%) and 231 females (31.2%). Among them, 487 (65.7%) subjects had at least one insomnia symptom: 308 (41.6%) subjects had difficulty in falling asleep, 369 (49.8%) subjects were easy to wake at night, 116 (15.7%) subjects woke up earlier than they expected, 74 (10.0%) subjects experienced both woke up earlier and difficulty in falling asleep, and 53 (7.2%) subjects woke up earlier, woke up at night and had difficulty in falling asleep at the same time. Logistic regression analyses showed that before admission physical activity ( OR =0.636, 95% CI 0.411-0.984), depression ( OR=1.908, 95% CI 1.101-3.305) and low social support ( OR=0.278, 95% CI 1.198-3.301) were independent factors of insomnia in ACS patients. Conclusions:Nearly 2/3 ACS patients have symptoms of insomnia. Difficulty in falling asleep and easy to wake up at night are the most common manifestations. Physical activity, depression and social support independently are associated with insomnia.

Objective To summarize the experience and technique of complex transradial percutaneous coronary intervention ( PCI) using a 4F KIWAMI ST01 catheter with Mother-Child technique for patients with coronary heart disease. Methods Retrospectively analyzed the data from 30 patients who had received PCI using a 4 F catheter with Mother-Child method. Results PCI were performed on a total of 30 patients with complex lesions. Angiographic success was achieved in 100% of lesions. 19 patients were found to have moderate-to-severe calcified lesions, 13 patients had chronic total occlusion ( CTO ) , 11 patients had moderate-to-severe tortuous lesions, and 6 patients had moderate-to-severe angulated lesions. Four patients suffered from in-stent restenosis. 4 F catheter with Mother-Child method was used in all patients, and all 4F catheters successfully passed through the target lesions with all stents implanted in place along the 4 F catheter. There were no 4 F catheter-related complications in all patients. Conclusions Use of 4F catheter with Mother-Child method is safe and effective for patients where stent delivery is difficult by the conventional method.