Objective: To study the prognostic impact of chronic total occlusion (CTO) on non-infarct-related artery (non-IRA) in patients of acute ST-elevation myocardial infarction (STEMI) with emergent primary percutaneous coronary intervention (PCI).
Methods: In this prospective study, a total of 185 consecutive acute STEMI patients received early stage primary PCI in our hospital from 2010-01to 2011-06 were enrolled. The patients were divided into 2 groups:non-CTO group, n=160 and CTO group, n=25. The patients were followed-up for 1 year and the primary endpoint events included the hospitalization for angina, re-MI, heart failure or revascularization and cardiac death.
Results: ①There were more patients with diabetes and three vessel disease in CTO group than those in non-CTO group (40.0%vs 20.0%, P=0.049) and (68.0%vs 36.3%, P=0.003);LVEF in CTO group was lower than non-CTO group (40.0 ± 20.1%vs 51.3 ± 15.3%, P<0.05).②The cardiac mortalities at 6-month and 1-year followed-up period were higher in CTO group than those in non-CTO group (26.3%vs 6.1%, P=0.013) and (31.6%vs 8.4%, P=0.010);1-year primary endpoint events were higher in CTO group (52.6%vs 16.8%, P=0.001). ③Multivariate regression analysis revealed that non-IRA combining CTO (HR=3.889, 95%CI 1.239-4.206, P=0.020), cardiac shock (HR=3.229, 95%CI 2.760-3.725, P=0.012) and three vessel disease (HR=2.008, 95%CI 1.549-3.372, P=0.040) were the independent predictors for 1-year mortality in patients of acute STEMI with primary PCI.
Conclusion: Non-IRA combining CTO in STEMI patients with primary PCI are usually having poor prognosis.

ObjectiveTo observe the in-hospital and long-term results in patients with drugeluting stenting age≥70 years with unprotected left main (UML) coronary artery disease.MethodsIn this retrospective study, 100 patients with UML disease were enrolled. Death, myocardial infarction, repeated revascularization and composite end points during follow-up were compared between groups aged ≥70 years and control aged ＜70 years.ResultsThere was no remarkable distinction between the two groups in cardiovascular risk factors, anatomic findings of coronary artery disease and stent variables. No significant differences were found between the two groups in procedure success rate[96.2％ (50 cases) vs. 97.9％ (47 cases) ,x2 = 1.75, P＞0.05] and in-hospital mortality [3.8％ (2 cases) vs. 2.1％ ( 1 case), x2 = 0.27, P ＞0.05]. Patients were clinically followed for an average time of 22.0 months in the elderly group and 23.0 months in the control group (t= -0.78, P＞0.05). There were no significant differences in death[3.9％(2 cases) vs. 2.1％(1 case) ,x2 =2.51,P＞0.05], myocardial infarction[7.7 ％ (4 cases) vs. 4.2 ％ (2 cases), x2 = 0.55, P＞0.05], repeated revascularization [13.5％ (7 cases) vs. 12.5％(6 cases) ,x2 =0.02, P＞0.05]and composite endpoints of death, myocardial infarction and repeated revascularization[30.7％ (16 cases)vs. 18.8％ (9 cases),x2 = 1.92, P＞0.05] between the elderly group and the control group.ConclusionsThe procedure success rate and in-hospital mortality of drug-eluting stent implantation in elderly patients aged≥70 years old with unprotected left main coronary artery are comparable to group aged＜70 years. The main endpoints including death, myocardial infarction and repeated revascularization are favorable at about 2 years clinical follow up. It is safe and efficacious to implant drug-eluting stent in patients aged ≥70 years old with unprotected left main coronary artery.

Objective To investigate the clinical characteristics and prognosis of acute myocardial infarction(AMI) patients with gastrointestinal bleeding (GIB) in the elderly.Methods Total 325 elderly patients with AMI were divided into AMI control group (n=304,patients without gastrointestinal bleeding around the period of AMI),GIB-post-AMI (n=14,patients developing gastrointestinal bleeding after AMI) group and AMI-post-GIB (n=7,patients with gastrointestinal bleeding subsequently suffered an AMI) group.The clinical characteristics and combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal AMI,heart failure and stroke were analysed.Results (1) Estimated glomerular filtration rate (eGFR) became lower in the patients with GIB-post-MI (61.9+27.3) ml · min-1 · 1.73 m2 compared with AMI control patients (77.3+27.9) ml · min-1 · 1.73 m2,P＜0.05.Multivariate regression analysis revealed that the relative risk from a decreased eGFR for developing gastrointestinal bleeding after AMI in elderly patients was 0.980 (95％CI:0.960-0.999,P＜0.05).(2) There were significantly less patients adopting anti-platelet and anti-coagulant medications in AMI-post-GIB group and less patients applying aspirin in GIB-post-AMI group as compared with AMI control group,respectively (P＜0.05).AMIpost-GIB patients had significantly lower hemoglobin (74 + 14) g/L than GIB-post-AMI patients (111±25) g/L,P＜0.01.More MI-post-GIB patients (6 cases,85.7％) versus GIB-post-AMI patients (4 cases,28.6％)underwent blood transfusion( P＜0.05).There were significantly less patients adopting PCI and thrombolytic therapy in AMI-post-GIB group as compared to AMI control patients (P＜0.01).(3) The combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal MI,heart failure and stroke in GIB-post-MI group were significantly higher than in AMI control group[42.9％ (6/14) vs.17.8％ (54/304),P＜0.05].Conclusions Reduced eGFR is an important predictor for elderly AMI patients developing gastrointestinal bleeding which makes it difficult to take anti-platelet and anti-coagulant medication and to receive revascularization treatment,usually with worse prognosis.

Objective:To evaluate the diagnostic value of coronary angiography-based fractional flow reserve(caFFR)versus a wire-based fractional flow reserve(FFR)in elderly patients with stable ischemic heart disease.Methods:A total of 168 patients(186 vessels)who underwent a pressure wire(PW)-based FFR measurement from Jan.2015 to Dec.2019 in Beijing hospital were enrolled and analyzed retrospectively.Coronary angiography images and matched steady-state aortic pressure of patients were sent to the core laboratory for caFFR measurement under the blind method.All patients were divided into the non-elderly group(<65 years, n=93)and the elderly group(≥65 years, n=75). The diagnostic value of caFFR was evaluated by using the wire-based FFR cut-off value of ≤0.80 as the reference standard.The correlation and consistency of caFFR and wire-based FFR were analyzed, and compared between the non-elderly and elderly groups.Results:The caFFR had a good correlation and consistency with wire-based FFR in the elderly group( r=0.796, P<0.01). In non-aged versus elderly groups, diagnostic accuracy of caFFR was 91.9% versus 93.1%, diagnostic sensitivity of caFFR was 91.8% vs.93.2%, diagnostic specificity of caFFR was 92.3% vs.93.0%, all P>0.05.The area under the receiver-operating characteristic curve of caFFR had no significant difference between the non-elderly and elderly patients(0.964 vs.0.972, Z=0.00823, 95% CI: -0.037-0.052, P>0.05). Conclusions:The caFFR has a good diagnostic correlation and consistency with wire-based FFR in the elderly group, and caFFR's diagnostic performance in the elderly is similar to that in the non-elderly patients.

Objective To analyze the clinical characteristics of hospital-acquired pneumonia in bedridden patients aged 90 years and over.Methods From January 1,2015 to August 1,2015,40 bedridden elderly patients(≥90 years)with hospital-acquired pneumonia admitted to Beijing Hospital were assigned into the observation group,with 40 non-bedridden elderly patients (≥ 90 years)with community acquired pneumonia serving as the control group.Basic clinical data,infection symptoms and inflammation markers,and changes in serological test results before and after pneumonia were compared between the groups.Results Compared with the control group,the observation group had much lower body mass index(20.7± 1.2)kg/m2 vs.(25.1 ± 3.1) kg/m2 (t=-8.43,P＜0.01),and was accompanied with more diseases and associated with more symptoms during infection (all P＜ 0.05).Meanwhile,patients with lung infections in the observation group were more likely to have atrial fibrillation,often with increased levels of brain natriuretic peptide(1 047.9 ± 193.5) pg/L vs.(3 387.8± 763.8) μg/L (t =-3.39,P＜0.01) and abnormalities in troponin,but without obvious elevations of inflammatory markers such as white blood cells,C reactive protein and procaleitonin.Conclusions Bedridden patients aged 90 years and over with hospital-acquired pneumonia may show atypical clinical presentations and increased accompanying symptoms.Comprehensive geriatric assessment is critical for good prognosis.

Objective To evaluate the clinical impact of percutaneous coronary intervention (PCI)on prognosis in elderly patients(≥70 years old)with coronary artery chronic total occlusion (CTO). Methods A total of 445 consecutive patients with a angiography-confirmed CTO lesions registered from January 2011 to December 2013 were divided into the elderly group(≥70 years)and the non-elderly group(< 70 years).The primary endpoints measured were defined as the composite outcomes of hospitalization due to angina,re-infarction,heart failure,repeat re-vascularization,and cardiac death at 36 months follow-up. Results The elderly group included 200 patients(44.9%) and the non-elderly group included 245 patients(55.1%).During the follow-up,the proportions of coronary lesion were significantly higher in the elderly group with left main(LM)disease(45, 22.5%),three-vessel disease(166,83.0%)and J-CTO score≥2(64,32.0%)than in the non-elderly group with diseases of LM,three-vessel,and J-CTO score ≥ 2〔(34,13.9%);(180,73.5%);(57, 23.3%),respectively〕(χ2 =5.607,5.782,4.243;P=0.018,0.016,0.039).T he ratio of the patients undergoing PCI-reperfusion therapy of CTO was higher in non-elderly group(109/275,39.6%)than in elderly group(53/222,23.9%)(χ2 =13.891,P<0.001),while CTO PCI success rate was similar between the two groups(38 patients,71.7% vs.90 patients,82.6%,χ2 = 2.541,P= 0.111).The elderly group versus non-elderly group showed that the 3-year cardiac mortality rate was 12.5%(25 patients)versus 3.3%(8 patients)(χ2 =13.677,P<0.011),and the incidence rate of 3-year primary endpoint was 31.5%(63 patients)versus 22.9%(56 patients)(χ2 =4.199,P=0.040).Among the elderly group,patients without CTOs re-vascularized by PCI had a greater tendency toward higher risk of hospitalization due to angina,re-infarction,heart failure,or repeat re-vascularization than patients with CTOs re-vascularized by PCI(34/149,22.8% vs.3/33,9.1%,χ2 =3.143,P=0.076),while they had comparable incidence of 3-year cardiac death(19/149,12.8% vs.5/33,15.2%,χ2 = 0.007,P=0.933).Multivariate analysis revealed that after adjusting for baseline and procedure differences,LM combined with three vessel disease(OR= 3.804,95% CI:1.274 to 11.356,P= 0.017)remained an independent predictor for 3-year cardiac mortality in elderly patients with CTOs. Conclusions Elderly patients with CTO have mostly a serious coronary artery disease and a poor prognosis.Although CTO is re-vascularized by PCI,long-term clinical outcome seems not more to be improved in elderly patients with CTOs.LM combined with three-vessel disease might be an independent predictor for 3-year cardiac mortality in elderly CTO patients.

Objective To analyze the safety and efficacy of coronary rotational atherectomy in elderly patients with coronary heart disease.Methods A total of 107 consecutive patients with coronary artery disease receiving rotational atherectomy from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into an ≥75 years group(n=44)and a ＜75 years group (n=63).We compared the characteristics of rotational atherectomy,peri-procedural complications,instant procedure success rates and 1-year cardiovascular events,including angina,re-infarction,hospitalization due to heart failure,repeat revascularization and cardiac death.Results There was no significant difference in the target coronary vessel,reference vessel diameter,maximal diameter of the burr and ratio of maximal diameter of the burr to reference vessel diameter between the two groups(all P＞0.05).Compared with ＜75 years patients,more ≥75 years patients used 2 burrs(10 cases or 22.7％ vs.4 cases or 6.3％,P =0.013),while there was no significant difference in terms of burr size,rotational time,maximal rotational speed,pre-and post-dilation pressure between the two groups (all P＞0.05).The incidence of peri-procedural complications had no significant difference between the ≥75 years group and the ＜75 years group(8 cases or 18.2％ vs.13 cases or 20.6％,P =0.753).One case of burr entrapment occurred in each group with successful retrieval.The procedure success rate was 96.8％(61 cases)in the ＜75 years group and 100％ in the ≥75 years group(P=0.640).No acute or sub-acute stent thrombosis or urgent coronary artery bypass graft occurred in the two groups during hospitalization.No cardiac death occurred in either group.Conclusions Coronary rotational atherectomy is effective and safe in elderly patients with coronary disease with a high instant procedure success rate.

Minute pulmonary meningothelial-like nodules (MPMNs) are benign small lesions in the lungs, with similar pathological characteristics to the meningeal epithelium. MPMNs have similar imaging manifestations to malignant tumors, which can lead to misdiagnosis in clinical practice. There is no consensus on the pathogenesis of MPMNs, with some suggest that MPMNs derive from reactive proliferation, while others suggest that MPMNs share a common origin and molecular mechanism with meningiomas in the central nervous system. Understanding the characteristics of MPMNs and studying their pathogenesis will help improve the understanding and diagnosis of MPMNs. In this article, we reviewed the clinical, pathological, imaging characteristics, differential diagnosis and pathogenesis of MPMNs. We also analyze the existing research advances regarding the pathogenesis and propose prospects for further research.
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