Objective: To explore the impact of body mass index (BMI) on long-term prognosis in patients of acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods: A total of 1435 consecutive STEMI patients received PCI in our hospital from 2013-01 to 2013-12 were enrolled. Based BMI (kg/m2), the patients were divided into 3 groups: Normal weight group, the patients with 18.5≤BMI<24.0, n=365, Overweight group, 24.0≤BMI<28.0, n=718 and Obese group, BMI≥28.0, n=352. The impact of BMI on major adverse cardiovascular and cerebral events (MACCE) was observed; weather BMI had predictive value for all-cause mortality and cardiac death was analyzed. Results: All-cause mortality in Obese group was lower than Normal weight group (0.6% vs 3.0%), P=0.027; while the incidences of bleeding, stroke, in-stent thrombosis, blood revascularization, re-myocardial infarction and cardiac death were similar among 3 groups. Multivariate analysis revealed that obesity was an independent predictor for all-cause death (HR=0.201, 95% CI 0.043-0.943, P=0.042), BMI was not the independent predictor for cardiac death. Conclusion: For STEMI patients after PCI treatment, the individuals with obesity had the better prognosis than those with normal weight and overweight. Obesity was an independent predictor for all-cause death and obesity paradox was applicable in such population.

Objective To analyze the differentiation status of CTL and to evaluate its clinical val-ue in patients with HIV/HCV coinfection .Methods Twenty-eight patients with HIV/HCV coinfection and twelve patients with single HCV infection were enrolled in this study .The technique of Fibro-Scan was used to evaluate liver fibrosis .The viral load of HCV was detected by real-time quantitative PCR .Flow cytometry analysis was performed to measure the differentiation status of CTL .Results Both of the levels of alanine transaminase ( ALT) and alkaline phosphatase ( ALP) in patients with HIV/HCV coinfection were signifi-cantly higher than those in patients with single HCV infection [(53.7464±48.1180) U/L vs (27.4750± 13.9850) U/L, P=0.012;(24.5071±8.1940) g/L vs (16.9667±7.1890) g/L, P=0.009].The liver stiffness of patients with HIV/HCV coinfection was higher than that of patients with single HIV infection [(5.9500, 5.8250) Kpa vs (5.1500, 1.0500) Kpa, P=0.117].Compared with the patients with single HCV infection, the patients with HIV/HCV coinfection showed higher viral loads of HCV [( 6.4768, 5.3434) lg copy/ml vs (2.6815, 1.6990) lg copy/ml, P=0.012], but lower clearance rate of HCV [32.14%vs 75%, P=0.032].Compared with the patients with single HCV infection , the patients with HIV/HCV coinfection showed lower percentages of CD 27+CD28+CTL [(28.265±15.095)%vs (18.068±10.263)%, P=0.017), but higher percentages of CD27+/-CD28+CTL [(62.449 ±14.561)% vs (71.111±12.681)%, P=0.066].A trend toward negative correlation was observed between the percent -age of CD27+CD28+CTL and the degree of liver stiffness (r=-0.310, P=0.058).Conclusion HIV in-fection could accelerate the progression of liver disease in patients with HIV /HCV coinfection by affecting the differentiation of CTL .

Objective To understand the influence of HIV infection on hepatitis C progress in patients co-infected with HIV and hepatitis C virus (HCV) and related immune mechanism. Methods Twenty eight patients co-infected with HIV/HCV and 12 patients with simplex HCV infection were enrolled. The liver function and hepatic fibrosis progress were evaluated by detecting peripheral blood and with Fibro-Scan. The viral load of HCV was detected by using real time quantitative PCR. And the percentage of Treg/CD4 +T lymphocyte cell was tested by using flow cytometry. Results The levels of ALT and ALP in HIV/HCV co-infection group were (76.16 ± 81.248)U/L,(24.507 1 ± 8.194)g/L respectively,higher than those of simplex HCV infection group [(27.475 0±13.985)U/L,(16.966 7±7.189)g/L],the differences were statistical significant. P value was 0.012 and 0.009 respectively. The liver fibrosis index in HIV/HCV co-infection group was 5.950 0-5.825 0 Kpa,higher than that in simplex HIV infection group(5.150 0-1.050 0 Kpa),and the difference was nearly statistical significant(P=0.077). The HCV viral load in HIV/HCV co-infection group was(6.476 8-5.343 4)lg copy/ml,higher than that in simplex HCV infection group[(1.699 0-2.681 5)lg copy/ml],and the rate of HCV clearance in HIV/HCV co-infection group was 32.14%, lower than that in simplex HCV infection group(75.00%). P value was 0.012 and 0.032 respectively. The percentage of Treg/CD4+T lymphocyte cell in HIV/HCV co-infection group was (7.460 0%-2.287 5%),higher than that in simplex HCV infection group (5.965 0%-2.105 0%),and the difference was significant (P=0.032). The percentage of Treg/CD4 + T lymphocyte cell was significantly related with HCV viral load(ρ=0.350,P=0.027),and HCV viral load was significantly related with the liver fibrosis index(ρ=0.487,P=0.001). Conclusion HIV infection could accelerate the progress of hepatitis C,and Treg cells were involved in this progress.

Objectives:To investigate the effects of sarcopenia on the clinical efficacy of percutaneous ver-tebral augmentation(PVA)in the treatment of osteoporotic thoracolumbar vertebral compression fracture(OTLVCF).Methods:We retrospectively analyzed the clinical data of 270 patients with OTLVCF who under-went PVA in the Second Affiliated Hospital,Air Force Military Medical University and Honghui Hospital Af-filiated to Xi'an Jiaotong University from January 2020 to December 2022.There were 109 males and 161 females;T10 vertebral fracture in 37 cases,T11 fracture in 52 cases,T12 fracture in 68 cases,L1 fracture in 72 cases,and L2 fracture in 41 cases.The patients were divided into sarcopenia group(52 cases)and non-sarcopenia group(218 cases)according to the diagnostic criteria of the European Working Group on Sar-copenia in Older People(EWGSOP),and using the dominant hand grip strength(＜28.0kg)and the skeletal mus-cle index(SMI)at L3 level(＜45.4cm2/m2)in male and the dominant hand grip strength(＜18.0kg)and SMI at L3 level(＜34.4cm2/m2)in female as the diagnostic thresholds.The general data(gender,age,height,weight,body mass fraction,fracture segment,strength of grasp and skeletal muscle index),operative data(surgical method,operative time,intraoperative blood loss,bone cement injection volume and intraoperative fluoroscopy times),and complications(cement leakage,refracture of injured vertebra,refracture of the adjacent vertebra and distal vertebral refracture)after operation of both groups of patients were collected.The visual analogue scale(VAS)and Oswestry disability index(ODI)were collected before operation and on postoperative 1d,at 1 month,6 months and 1 year postoperatively and compared between the two groups.Results:There was no statistical difference in gender,height,weight,operative method,operative time,blood loss,bone cement injection vol-ume,intraoperative fluoroscopy times,and preoperative VAS score and ODI between the two groups(P＞0.05).The patients in the sarcopenia group were older(80.3±7.9 years vs 75.7±6.8 years,P＜0.05)and had a smaller BMI(24.4±2.2kg/m2 vs 26.2±2.4kg/m2,P＜0.05).The VAS score and ODI of the two groups on ld and,at 1 month,6 months and 1 year after operation were significantly improved compared with those before operation(P＜0.05).At the same time,the VAS score and ODI in the sarcopenia group were significantly higher than those in the non-sarcopenia group on ld and,at 1 month,6 months and 1 year after operation(P＜0.05).In terms of complications,there was no significant difference in the incidence of bone cement leakage between the two groups(9.65％vs 7.34％,P＜0.05).The incidence of re-fracture of injured vertebrae,adjacent vertebrae and distal vertebrae and the total incidence of re-fracture within 1 year after operation in the sarcopenia group were significantly higher than those in the non-sarcopenia group(9.62％vs 2.75％,13.46％vs 5.05％,11.54％vs 4.13％and 33.61％vs 11.93％,P＜0.05).Conclusions:The clinical effects of vertebral augmenta-tion(PVA)in patients with sarcopenia are poorer than in non-sarcopenia OTLVCF patients,with higher verte-bral re-fracture rates within 1 year after operation.

Objective: To investigate the impact of previous coronary artery bypass grafting(CABG) on long-term outcomes in patients undergoing percutaneous coronary intervention(PCI). Methods: A total of 10 724 consecutive coronary heart disease patients undergoing PCI between January and December 2013 in Fuwai hospital were prospectively included in this research. According to CABG history, the patients were divided into CABG group(437 cases) and without CABG group(10 287 cases). The patients were followed up for 2 years. Major adverse cardiovascular and cerebrovascular events(MACCE) including death, myocardial infarction, revascularization and stroke, and in-stent thrombosis following PCI were compared between the 2 groups. Multivariate Cox regression analysis was used to identify independent risk factors of poor prognosis. Results: Compared with without CABG group, CABG group were older((61±10)years vs.(58±10)years, P<0.001), and more often had diabetes(35.7%(156/437) vs. 30.0%(3 082/10 287), P=0.012), hyperlipoidemia(73.9%(323/437) vs. 67.0%(6 888/10 287), P=0.003), previous myocardial infarction(31.1%(136/437) vs. 18.7%(1 925/10 287), P<0.001), PCI history(61.6%(269/437) vs. 23.0%(2 371/10 287), P<0.001), and cerebrovascular disease(7.1%(31/437) vs. 10.9%(1 119/10 287), P=0.013). After 2 years follow-up, rates of cardiac death(1.8%(8/437) vs. 0.6%(66/10 287), P=0.010), revascularization(11.2%(49/437) vs. 8.5%(877/10 287), P=0.049) and MACCE(15.1%(66/437) vs. 12.0%(1 231/10 287), P=0.049) were significantly higher in CABG patients than in without CABG group. There were no significant difference in all cause death(2.1%(9/437) vs. 1.2%(122/10 287), P=0.114), recurrence of myocardial infarction(2.3%(10/437) vs. 2.0%(204/10 287), P=0.600), stroke(1.1%(5/437) vs. 1.4%(140/10 287), P=0.701), and in-stent thrombosis(1.1%(5/437) vs. 0.6%(61/10 287), P=0.194). Multivariate Cox regression analysis showed that previous CABG was an independent risk factor of cardiac death(HR=2.13, 95%CI 1.02-4.46, P=0.045)and revascularization(HR=1.35, 95%CI 1.01-1.81, P=0.040). However, after propensity score matched analyses(429 pairs), previous CABG was no longer an independent risk factor of cardiac mortality (HR=0.97, 95% CI 0.37-2.54, P=0.954)and revascularization(HR=1.74, 95%CI 0.94-3.21, P=0.753). Conclusion Previous CABG is not an independent risk factor of poor prognosis in coronary heart disease patients undergoing PCI.

Objective: To observe the impact and clinical outcome of intra-aortic balloon pump(IABP) use in patients underwent percutaneous coronary intervention (PCI). Methods: From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI were enrolled.After 2 years′ follow-up, the incidence of major adverse cardiovascular and cerebrovascular events such as death, myocardial infarction, stent thrombosis, revascularization, recurrent stroke were recorded, propensity score was used to match baseline data, and the clinical outcomes in patients with IABP and non-IABP were compared. Results: The overall use of IABP was 1.3%(143/10 724), clinical and angiographic risks were significantly higher in IABP group than non-IABP group.The rate of cardiac shock was significantly higher (9.8%(14/143) vs. 0.2%(16/10 581), P<0.01) and left ventricular ejection fraction was significantly lower (54.3%±11.0% vs. 62.9%±7.2%, P<0.01) in the IABP group than in the non-IABP group.Patients in IABP group had a significantly higher rate of left main or triple-vessel disease (P<0.01), and their SYNTAX score, target lesion number, stent number were also significantly higher compared with non-IABP patients (all P<0.01). During the 2-year follow-up, all-cause mortality was significantly higher in IABP group than in non-IABP group (10.5%(15/142) vs. 1.1%(116/10 581), P<0.001). Multivariable analyses indicated that IABP was associated with increased mortality (HR=3.51, 95%CI 1.71-7.17, P=0.001). However, after propensity score matched analyses (137 pairs), IABP use was no longer an independent predictor of all-cause mortality (HR=2.09, 95%CI 0.72-6.13, P=0.177). Conclusions In this single large center of coronary heart disease in China, the IABP usage was about 1.3%.Propensity score matched analyses showed that during the 2 years′ follow-up, adverse effect including similar long-term mortality is similar between PCI patients with or without IABP after adjusting for confounders.

Objective: To evaluate the relationship between platelet distribution width(PDW) and the extent of coronary artery disease and 2-year outcome in patients received percutaneous coronary artery intervention(PCI) because of stable coronary artery disease(SCAD). Methods: We consecutively enrolled 4 293 patients who received PCI because of SCAD in Fuwai Hospital from Jan 2013 to Dec 2013, patients were followed up for 2 years. Patients were divided into three groups according to tertiles values of PDW as follows: PDW≤11.4%(1 402 patients), 11.4%12.9% (1 450 patients). Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the occurrence of death, myocardial infarction, target vessel revascularization, intra stent thrombosis and stroke during follow-up. Multivariable logistic regression was used to evaluate the relationship between PDW and the extent of CAD. Multivariable Cox regression was used to evaluate the relationship between PDW and prognosis of SCAD patients. Results: PDW was associated with diabetes mellitus, body mass index, red cell distribution width, mean platelet volume (MPV), platelet counts and glycosylated haemoglobin (P<0.05), but not associated with age, sex, estimated glomerular filtration rate (P>0.05). PDW was not correlated with the extent of CAD(P=0.990), SYNTAX score(P=0.721), no-reflow phenomenon after PCI(P=0.978). Multivariable logistic regression also showed no relationship between PDW and extent of CAD (OR=0.994, 95%CI 0.961-1.029, P=0.73). PDW was found to be an independent risk factor of 2-year cardiac death (HR=1.242, 95%CI 1.031-1.497, P=0.022), but was not an independent risk factor of all-cause death and MACCE. Conclusions PDW is not related with the extent of coronary artery disease. PDW is an independent risk factor of 2-year cardiac death, but is not an independent risk factor of all-cause death and MACCE in this patient cohort.

Objective: To investigate the in-hospital and long-term outcomes of patients with left ventricular ejection fraction (LVEF) <50% undergoing percutaneous coronary intervention (PCI) . Methods: From January to December 2013, 10 445 consecutive patients who underwent PCI in Fuwai Hospital and the LVEF value was available were prospectively included. The patients were divided into LVEF≥50% group (9 896 cases) and LVEF<50% group (549 cases) . The in-hospital and 2-year clinical outcomes were compared between the 2 groups. The association between LVEF<50% and clinical outcomes was assessed using multivariable Cox regression analysis. Results: (1) Compared with LVEF ≥50% group, LVEF< 50% group had higher rates of in-hospital all-cause death (1.1% (6/549) vs. 0.2% (17/9 896) , P<0.01) , cardiac death (1.1% (6/549) vs. 0.1% (12/9 896) , P<0.01) , in-stent thrombosis (0.7% (4/549) vs. 0.2% (18/9 896) , P<0.01) , myocardial infarction (2.4% (13/549) vs. 1.2% (121/9 896) , P<0.05) ,and major adverse cardiovascular and cerebrovascular events (MACCE) which including death, myocardial infarction, revascularization, in-stent thrombosis, and stroke (3.6% (20/549) vs. 1.4% (137/9 896) , P<0.01) . (2) A total of 10 388 (99.5%) patients completed 2-year follow-up. Compared with LVEF ≥50% group, LVEF<50% group had higher rates of 2-year all-cause death (4.7% (26/549) vs. 1.0% (101/9 896) , P<0.01) , cardiac death (4.0% (22/549) vs. 0.5% (50/9 896) , P<0.01) , in-stent thrombosis (3.1% (17/549) vs. 0.7% (71/9 896) , P<0.001) , myocardial infarction (4.2% (23/549) vs. 1.9% (186/9 896) , P<0.01) ,and MACCE (17.9% (98/549) vs. 11.8% (1 172/9 896) , P<0.01) . There were no significant differences on the rates of 2-year target-vessel revascularization, bleeding and stroke between the two groups. (3) The multivariable Cox regression analysis demonstrated that LVEF< 50% was the independent risk factor of 2-year all-cause death (HR=2.47, 95%CI 1.49-4.08, P<0.01) , cardiac death (HR=3.25, 95%CI 1.79-5.90, P<0.01) , in-stent thrombosis (HR=4.19, 95%CI 2.39-7.34, P<0.01) , myocardial infarction (HR=2.00, 95%CI 1.26-3.16, P<0.01) , and MACCE (HR=1.40, 95%CI 1.13-1.74, P<0.01) . (4) After propensity score matching, all in-hospital outcomes were similar between the two groups, including all-cause death, cardiac death, in-stent thrombosis, myocardial infarction, revascularization, bleeding, stroke, and MACCE (all P>0.05) . After propensity score matching,the multivariable Cox regression analysis demonstrated that LVEF<50% was still an independent risk factor of 2-year all-cause death (HR=3.08, 95%CI 1.37-6.89, P<0.01) , cardiac death (HR= 4.12, 95%CI 1.53-11.07, P<0.01) ,and in-stent thrombosis (HR=3.82, 95%CI 1.27-11.5, P<0.05) . Conclusion LVEF< 50% is an independent risk factor of 2-year all-cause death, cardiac death, and in-stent thrombosis in patients undergoing PCI, but it does not increase the risk of target-vessel revascularization, bleeding or stroke.

Objective: To investigate the impact of direct bilirubin on long-term prognosis of acute coronary syndrome (ACS) patients post percutaneous coronary intervention(PCI). Methods: As a prospective and observational cohort study, a total of 6 431 consecutive ACS patients underwent PCI from January to December 2013 in Fuwai hospital were included. Patients were divided into 3 groups according to tertiles values of direct bilirubin as follows: low direct bilirubin group(<2.2 μmol/L, n=2 219), moderate direct bilirubin group(2.2-3.0 μmol/L, n=2 016), and high direct bilirubin group(>3 μmol/L, n=2 196). The clinical characteristics were compared among the 3 groups, and the impact of direct bilirubin on clinical adverse events (main adverse cardiovascular and cerebrovascular events included cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis) were analyzed at 2 years after PCI. Results: (1) Percent of male patients was 66.5%(1 475/2 219), 78.0%(1 572/2 016), and 86.2%(1 892/2 196), body mass index was(25.7±3.1), (26.0±3.3),and (26.0±3.2) kg/m², the ratio of the history of old myocardial infarction was 11.9%(264/2 219), 13.0%(263/2 016),and 14.9%(328/2 196), the ratio of the current smoker was 56.3%(1 249/2 219), 59.1%(1 192/2 016),and 60.0%(1 317/2 196) in low, moderate and high direct bilirubin groups respectively, and the differences were statistically significant (P<0.01 or 0.05). (2) Two years after PCI, the all-cause mortality was 0.8%(17/2 219), 1.8%(36/2 016), and 1.5%(33/2 196) (P=0.011),the cardiogenic mortality was 0.5%(12/2 219), 1.3%(26/2 016), and 0.6%(13/2 196) (P=0.010),the ratio of myocardial infarction was 2.2%(49/2 219), 2.4%(49/2 016), and 1.4%(31/2 196)(P=0.044),the ratio of revascularization was 8.8%(195/2 219), 8.3%(168/2 016),and 8.9%(196/2 196)(P=0.783),the ratio of stroke was 1.4%(30/2 219),1.1%(22/2 016), and 1.9%(42/2 196)(P=0.076),the ratio of stent thrombosis was 0.9%(19/2 219), 1.2%(24/2 016),and 0.7%(15/2 196)(P=0.210) in low, moderate and high direct bilirubin groups, respectively. (3) Multivariable Cox regression analysis showed that, patients in moderate direct bilirubin group faced increased the risk of all-cause mortality compared with patients in the low direct bilirubin group (HR=2.23, 95%CI 1.23-4.05, P= 0.009), and the risk of all-cause mortality was similar between high direct bilirubin group and low direct bilirubin group (HR=1.84, 95%CI 0.99-3.38, P= 0.051). There were no statistically significant difference in the risks of main adverse cardiovascular and cerebrovascular events,cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis in moderate and high direct bilirubin groups compared with low direct bilirubin group (all P>0.05). Conclusion Moderate direct bilirubin level is associated with increased risk of all-cause death at 2 years after PCI compared with low level of direct bilirubin group.

Objective: To investigate the relationship between thrombolysis in myocardial infarction risk index(TRI) and the severity of coronary artery lesions and long-term outcome in acute myocardial infarction(AMI) patients undergoing percutaneous coronary intervention(PCI). Methods: A total of 1 663 consecutive AMI patients undergoing PCI between January and December 2013 in Fuwai hospital were prospectively included in this study. The severity of coronary artery lesions was evaluated using the SYNTAX score. Receiver operating characteristic(ROC) curve was used to analyze the optimal cut-off value of TRI on predicting all-cause mortality at 2 years after PCI.The patients were divided into 2 groups based on the optimal cut-off value of TRI:high TRI group (TRI ≥ 23.05, 465 cases) and low TRI group(TRI<23.05, 1 198 cases). Multivariate logistic regression analyses were used for determining the relationship between TRI and SYNTAX scores≥33. A multivariate Cox regression analyses was used to identify the influence factors of long-term outcome after PCI. Results: SYNTAX score was higher in high TRI group than in low TRI group (13.00(7.00, 20.50) vs.10.25(7.00, 17.00), P<0.001). TRI was independently associated with SYNTAX score ≥ 33 (OR=1.09,95% CI 1.03-1.16, P=0.004). After the 2 years follow-up, rates of all-cause death (4.1% (19/465) vs. 0.3% (4/1 198) , P<0.001), cardiac death (2.6% (12/465) vs. 0.2% (2/1 198) , P< 0.001) and stent thrombosis (1.7% (8/465) vs. 0.5% (6/1 198) , P=0.015) were all significantly higher in high TRI group than in low TRI group. Multivariate Cox regression analyses showed that TRI≥ 23.05 was an independent risk factor of all-cause death (HR=5.22, 95%CI 1.63-16.72, P=0.005), cardiac death (HR=8.48, 95%CI 1.75-41.07, P=0.008) and stent thrombosis(HR=3.87, 95%CI 1.32-11.41, P=0.014) at 2 years after PCI in AMI patients, but which was not the independent risk factor of major adverse cardiovascular and cerebrovascular events (HR=0.96, 95%CI 0.69-1.36, P=0.834) .The area under ROC curve of TRI ≥ 23.05 on predicting 2 years all-cause mortality in AMI patients undergoing PCI was 0.803(95%CI 0.711-0.894, P<0.001). Conclusions TRI is independently associated with SYNTAX score ≥ 33. TRI is also an independent risk factor of 2 years all-cause death, cardiac death and stent thrombosis in AMI patients undergoing PCI.