OBJECTIVETo investigate the nationwide status of intervention therapy for heart diseases (hIT) in Chinese medicine and integrated medical hospitals in China, and to push forward the development of intervention technique.

METHODSHospitals met the inclusion criteria were screened out by searching the "database of hospitals and medical institutions in China" from the Chinese Medical Network; and related materials from them were gathered with questionnaires by mail.

RESULTSReply was gathered from 239 of the 250 questionnaires mailed, by which, it was known that hIT has been carried out in 37 hospitals, until May 2009, a total of 34 327 cases of coronary angiography was completed, percutaneous coronary intervention (PCI) was performed in 12 670 patients with coronary heart disease, 3 631 patients received pacemaker implantation, 2 187 cases of radiofrequency catheter ablation, and 652 cases of congenital heart disease related interventional therapy were accomplished. Additional, 13 hospitals (35.1%) had annually completed more than 200 cases of coronary angiography or 100 cases of PCI.

CONCLUSIONShLT technique has been developed to a definite extent in Chinese medicine/integrated medical hospitals, which plays an important role in promoting the integrative medical research on cardiovascular diseases. However, related policy, support and normalization are necessary for its healthy and well-ordered development.

China ; Coronary Angiography ; statistics & numerical data ; Coronary Disease ; therapy ; Female ; Heart Diseases ; therapy ; Hospitals ; Humans ; Male ; Percutaneous Coronary Intervention ; statistics & numerical data ; Surveys and Questionnaires

BACKGROUNDThe impact of body mass index (BMI) on the clinical outcomes after percutaneous coronary intervention (PCI) in patients ≥ 75 years old remained unclear.

METHODSA total of 1098 elderly patients undergoing PCI with stent implantation were recruited. Patients were divided into four groups by the value of BMI: Underweight (≤ 20.0 kg/m 2 ), normal weight (20.0-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ) and obese (≥ 30.0 kg/m 2 ). Major clinical outcomes after PCI were compared between the groups. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACEs), which included death, myocardial infarction (MI) and target vessel revascularization. The secondary endpoint was defined as 1 year death. Logistic regression analysis was performed to adjust for the potential confounders.

RESULTSTotally, 1077 elderly patients with available BMIs were included in the analysis. Patients of underweight, normal weight, overweight and obese accounted for 5.6%, 45.4%, 41.5% and 7.5% of the population, respectively. Underweight patients were more likely to attract ST-segment elevation MI, and get accompanied with anemia or renal dysfunction. Meanwhile, they were less likely to achieve thrombolysis in MI 3 grade flow after PCI, and receive beta-blocker, angiotensin converting enzyme inhibitor or angiotensin receptor blocker after discharge. In underweight, normal weight, overweight and obese patients, in-hospital MACE were 1.7%, 2.7%, 3.8%, and 3.7% respectively (P = 0.68), and 1 year mortality rates were 5.0%, 3.9%, 5.1% and 3.7% (P = 0.80), without significant difference between the groups. Multivariate regression analysis showed that the value of BMI was not associated with in-hospital MACE in patients at 75 years old.

CONCLUSIONSThe BMI "obese paradox" was not found in patients ≥ 75 years old. It was suggested that BMI may not be a sensitive predictor of adverse cardiovascular events in elderly patients.

Aged ; Aged, 80 and over ; Body Mass Index ; Female ; Humans ; Logistic Models ; Male ; Percutaneous Coronary Intervention ; statistics & numerical data ; Treatment Outcome

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the status of health-promoting behaviors in patients after percutaneous coronary intervention (PCI) and explore what factors affect healthy lifestyle behaviors. METHODS: A total of 120 patients with coronary artery disease after PCI was included in this study. The Health Promoting Lifestyle Profile (HPLP) II was used to assess health-promoting lifestyle behavior. Data analysis was performed by t-test, analysis of variance, and multiple linear stepwise regression analyses. RESULTS: The average age of the participants was 60.10±9.84 (range, 37–81) years old. Among the participants, 86.7% were men and 13.3% were women. In all, 24.2% of the patients had an excellent level of health-promoting lifestyle and 74.2% had a moderate level of health-promoting lifestyle. The spiritual growth scores were the highest, while stress management and physical activity scores were the lowest. The level of health-promoting lifestyle was higher for people with higher income and a diagnosis of stable angina. CONCLUSIONS: Healthcare providers should focus on promoting physical exercise and stress management for patients after PCI. It is also necessary to keep an eye out for patients with low income and severe illness to encourage a health-promoting lifestyle in these subsets of patients.
Angina, Stable ; Cardiovascular Diseases ; Coronary Artery Disease ; Diagnosis ; Exercise ; Female ; Health Personnel ; Health Promotion ; Humans ; Life Style ; Male ; Motor Activity ; Percutaneous Coronary Intervention ; Statistics as Topic

PURPOSE: Evidence suggests that technological innovations and reimbursement schemes of the National Health Insurance Service may have impacted the management of coronary artery disease. Thus, we investigated changes in the practice patterns of coronary revascularization. MATERIALS AND METHODS: Revascularization and in-hospital mortality among Koreans > or =20 years old were identified from medical claims filed between 2006 and 2010. The age- and sex-standardized procedure rate per 100000 person-years was calculated directly from the distribution of the 2008 Korean population. RESULTS: The coronary revascularization rate increased from 116.1 (95% confidence interval, 114.9-117.2) in 2006 to 131.0 (129.9-132.1) in 2010. Compared to the rate ratios in 2006, the rate ratios for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in 2010 were 1.16 (1.15-1.17) and 0.80 (0.76-0.84), respectively. Among patients who received PCI, the percentage with drug-eluting stents increased from 89.1% in 2006 to 93.0% in 2010. In-hospital mortality rates from PCI significantly increased during the study period (p=0.03), whereas those from CABG significantly decreased (p=0.01). The in-hospital mortality rates for PCI and CABG were higher in elderly and female patients and at the lowest-volume hospitals. CONCLUSION: The annual volume of coronary revascularization continuously increased between 2006 and 2010 in Korea, although this trend differed according to procedure type. A high percentage of drug-eluting stent procedures and a high rate of in-hospital mortality at low-volume hospitals were noted.
Adult ; Aged ; Aged, 80 and over ; Coronary Artery Bypass/*statistics & numerical data/trends ; Coronary Artery Disease/*surgery ; Drug-Eluting Stents ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Revascularization/*methods/*trends ; Percutaneous Coronary Intervention/*statistics & numerical data/trends ; Republic of Korea/epidemiology

Objective: To analyze factors associated with unplanned revascularization (UR) risk in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). Methods: A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied. Results: The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%, 6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio ( ) = 2.320; 95% confidence interval ( ): 1.643-3.277; < 0.001], time of procedure ( = 1.006; 95% : 1.001-1.010; = 0.014), body mass index ( = 1.104; 95% : 1.006-1.210; = 0.036), incomplete revascularization (ICR) ( = 2.476; 95% : 1.030-5.952; = 0.043), and age ( 1.037; 95% : 1.000-1.075; = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux ( = 0.618; 95% : 0.531-0.719; < 0.001), second-generation durable polymer drug-eluting stent ( 0.713; 95% : 0.624-0.814; < 0.001), left anterior descending artery involvement ( = 0.654; 95% : 0.530-0.807; < 0.001), and age ( = 0.992; 95% : 0.985-0.998; = 0.014), were independently associated with decreased two-year UR risk. While, Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score ( = 1.024; 95% : 1.014-1.033; < 0.001) and ICR ( = 1.549; 95% : 1.290-1.860; < 0.001) were negatively associated with two-year UR risk. Conclusion Specific factors were positively or negatively associated with short- and medium-long-term UR following PCI.
Adult ; Aged ; China ; Coronary Artery Disease ; surgery ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; adverse effects ; statistics & numerical data ; Percutaneous Coronary Intervention ; adverse effects ; statistics & numerical data ; Risk Factors ; Treatment Outcome

BACKGROUND/AIMS: While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI. METHODS: In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated. RESULTS: There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE. CONCLUSIONS: In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups.
Aged ; Drug-Eluting Stents/*statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/mortality/*surgery ; Percutaneous Coronary Intervention/*instrumentation/statistics & numerical data ; Reoperation/statistics & numerical data ; Republic of Korea/epidemiology ; Retrospective Studies ; Treatment Outcome ; *Ultrasonography, Interventional

We investigated the effects of weekend admission on adverse cardiac events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Patients with NSTEACS treated with percutaneous coronary intervention (PCI) were divided into a "weekend group" and a "weekday group" according to the emergency room arrival time. The primary outcome was 30-day major adverse cardiac events (MACE) including cardiac death, recurrent myocardial infarction, repeat revascularization, and urgent PCI. Of 577 patients, 168 patients were allocated to the weekend and 409 patients to the weekday group. The incidence of 30-day MACE was significantly higher in the weekend group (Crude: 15.5% vs. 7.3%, P = 0.005; propensity score matched: 12.8% vs. 4.8%, P = 0.041). After adjustment for all the possible confounding factors, in Cox proportional hazard regression analysis, weekend admission was associated with a 2.1-fold increased hazard for MACE (HR, 2.13; 95% CI, 1.26-3.60, P = 0.005). These findings indicate that weekend admission of patients with NSTE-ACS is associated with an increase in 30-day adverse cardiac event.
Acute Coronary Syndrome/*complications/mortality/therapy ; Adult ; Aged ; *Death ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*epidemiology ; Patient Admission ; Percutaneous Coronary Intervention/*statistics & numerical data ; Propensity Score ; Proportional Hazards Models ; Time Factors ; Treatment Outcome

BACKGROUNDSince 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas.

METHODSIn the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively.

RESULTSSTEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872).

CONCLUSIONSDespite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

Aged ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Hospital Mortality ; Hospitals ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; ST Elevation Myocardial Infarction ; epidemiology ; mortality ; surgery ; Surveys and Questionnaires

OBJECTIVES: This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. METHODS: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. RESULTS: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for beta-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. CONCLUSIONS: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.
Adrenergic beta-Antagonists/therapeutic use ; Age Factors ; Aged ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases/complications/drug therapy/*epidemiology ; Diabetes Complications ; Diabetes Mellitus/diagnosis ; Female ; Humans ; Hypercholesterolemia/complications/diagnosis ; Hypertension/complications/diagnosis ; Male ; Middle Aged ; Percutaneous Coronary Intervention/*statistics & numerical data/trends ; Prevalence ; Registries/statistics & numerical data ; Risk Factors ; Smoking ; Time Factors