Stem cell therapy for myocardial repair after myocardial infarction is a new and promising treatment modality.But the mechanism is still not very clear.Currently,stem cells are used in clinical study to evaluate its beneficial effect on repairing infarcted/hibernating myocardium after myocardial infarction and heart failure.But there is no final conclusion on the safety of stem cell transplantation.

Objective To compare the number of endothelial progenitor cells (EPCs) from peripheral blood in patients with acute myocardial infarction of young man and healthy man.Methods Eighteen young men (18 ～50 years old) with acute myocardial infarction (AMI) who were admitted at the First Affiliated Hospital of Dalian Medical University from June 2010 to April 2011 in young man were enrolled,aged (65 ～ 85 years old) men with acute myocardial infarction in 18 cases,within 24 hours of onset collected blood 2 ml.Ten cases of healthy young men (30 ～50 years old) were used as control group,fasting venous blood 2 ml.A volume (400 μl) of blood was taken to red blood cell lysis buffer hemolysis labeled with vascular endothelial growth factor (VEGF),CD34,and CD133 antibodies,and then analyzed with flow cytometry.Results The number of EPCs in peripheral blood was measured in young male AMI group.The number of EPCs in peripheral blood was (0.58 ±0.83)％ in older men.The number of EPCs in peripheral blood of AMI group was (0.04 ± 0.03) ％.For healthy controls,the number of EPCs was (0.02 ± 0.02)％.The number of EPCs was significantly higher in AMI patients compared to control group (P ＜ 0.05).However,for AMI group,the increased number of EPCs in young men was significantly greater than young female (P ＜0.01).Conclusions The number of EPCs in peripheral blood in young man AMI patients is significantly increased within 24 hours.

Objective: To analyze the information of patients with acute myocardial infarction (AMI) in a single center during last 6 years, and to distinguish the clinical differences of patients between TakoSTubo cardiomyopathy (TTC) and ST-segment elevation myocardial infarction (STEMI). Methods: A total of 1042 consecutive patients with primarily diagnosed acute anterior ST-segment elevation (STEMI) admitted in our hospital from 2008-01 to 2014-04 were retrospectively enrolled. The relevant patients were studied in 2 groups:TTC group, the patients with coronary angiography (CAG) and the contrast study of left ventricle corrected TTC diagnosis, n=10, and STEMI group, the patients received CAG within 6 hours of on set with conifrmed left anterior descending singlevessel disease at the same period of time as TTC patients,n=32. The basic clinical characteristics, levels of blood lipids, MI related biomarkers, the incidence rate of pathological Q wave, QTc interval and negative T wave in 12-lead ECG were compared between 2 groups. Results: The percentage of corrected TTC diagnosis in patients with primarily diagnosed STEMI was 1.06%. The female gender in TTC group and STEMI group was 100% vs 9%,P<0.01, TTC group had more patients with stress history before on set than that in STEMI group (70% vs 22%,P=0.02), lower levels of MI related biomarkers as CK (486 ± 249) U/L vs (716 ± 132) U/L, CK-MB (13.5 ± 17.1) mg/L vs (47.5 ± 21.9) mg/L, cTnI (22.8 ± 16.3) ng/mL vs (56.4 ± 24.0) ng/mL, allP<0.01. The age of morbidity, the ratios of hypertension, diabetes mellitus and blood lipids were similar between 2 groups. The frequency of abnormal Q-wave in ECG was similar between 2 groups, while the QTc interval was different in TTC group and STEMI group (630 ± 117) ms vs (540 ± 62) ms,P=0.001, the negative T waves in ECG leads II, III, aVF, aVR and V6 were as (100.00% vs 3.13%), (60.00% vs 6.25%), (90.00% vs 3.13%), (100.00% vs 21.88%), (100.00% vs 46.88%), allP<0.05. Conclusion: TTC patients with the main presentation as ST-segment elevation are usually having emotional or physical stress before on set, with obviously prolonged QTc interval and more frequency of negative T waves in ECG.

Objective To study the prognosis and pre-procedural independent risk factors for pa-tients with no-reflow (NR) phenomenon during percutaneous coronary intervention (PCI). Methods Pa-tients with or without NR phenomenon during PCI procedures from January 2000 to January 2005 were studied retrospectively. The clinical data preoperative and the incidence of major adverse cardiovascular events (MACE) between the two groups were compared. Univariate analysis and multivariate Logistic analysis were used to select the risk factors for NR phenomenon. Retrospectively was reviewed for (35.8 ± 15.3)months. Results The NR group had more significant incidence of MACE. Multivariate Logistic analysis showed that the predictive factors for NR were (1) Smoke index ≥ 300(OR = 2.81,95%CI: 1.61-4.38 ,P =0.007). (2) Fasting blood glucose level before PCI ≥ 11.1 mmol/L (OR = 3.39,95%CI: 1.51-4.89,P = 0.000 ). (3) Absence of angina pectoris attack within one month before PCI (OR = 2.39,95%CI: 1.22-3.78,P = 0.009). Conclusions The prognosis is poor for the PCI patients with NR phenomenon. Those patients whose fasting blood glucose level before PCI ≥ 11.1 mm01/L, smoke index ≥ 300 and absence of angina pec-toffs attack within one month before PCI have higher incidence of NR phenomenon.

Objective: To evaluate the impact of various anticoagulation antiplatelet therapy strategies on the prognosis of patients with coronary heart disease combining with atrial fibrillation. Methods: Present meta analysis was performed according to search results on English EMBASE database by computer retrieval, Pubmed, the Cochrane Central Register of Controlled Trials, Medline, Chinese CBM database, CNKI database, Wan Fang database, China science and technology papers online electronic databases, manual retrieval for important international conference proceedings up to April 30 2016. Trials published in English and Chinese language, which met the Cochrane system evaluation requirements were included and the inclusion and exclusion criteria were made based on Cochrane system evaluation requirements. The end point is the incident of major adverse cardiac events (MACE), ischemic stroke and major bleeding events. The patients were randomly assigned into triple antithrombotic therapy (aspirin+ clopidogrel+ warfarin) group and dual antiplatelet therapy (aspirin+ clopidogrel) group.The collected full-text literatures underwent further quality assessment of the risks of bias using RevMan 5.3 software. Impact of various antithrombotic therapeutic strategies on the outcome of coronary heart disease patients combining with atrial fibrillation were evaluated. Results: In this meta analysis, 12 randomized controlled trials with 11 353 patients were included. Among these patients, 3 486 patients received triple antithrombotic therapy and 7 867 patients received dual anti-platelet therapy. There was no significant difference in incidence rate of MACE (OR=0.93, 95%CI 0.74-1.18, P>0.05) and the incidence rate of ischemic stroke (OR=0.88, 95%CI 0.70-1.10, P=0.27) between the two patients groups. However, the incidence rate of major bleeding events in triple antithrombotic therapy group was twice higher than that in dual anti-platelet therapy (OR=1.94, 95%CI 1.33-2.82, P=0.000 6). Conclusion Compared with dual anti-platelet therapy strategy, coronary heart disease patients combining with atrial fibrillation who were treated by triple antithrombotic therapy strategy have the similar outcome on risk of ischemic stroke, but higher risk of major bleeding events.

Objective To analyze the characteristics of preoperative CTO lesions by coronary CT angiography (CCTA) and to compare the lesion characteristics and clinical data of patients with subsequent vs failed PCI.Methods A total of 113 patients were randomly selected and 116 vessels were analyzed by CCTA before PCI.The patients were further investigated as PCI success group vs PCI failure group according to their PCI result.Multivariate logistic regression analysis was used to determine the factors that affected the success of CTO intervention.The ROC curve was used to determine and evaluate the CT-CTO score and J-CTO score for diagnostic efficacy.Results The success rate of PCI was 55.2％.64 lesions were successfully opened,with the success rate of 72.4％.The prevalence of smoking in patients in the PCI failure group was significantly higher than that in PCI success group (65.4％ vs.42.2％,P ＜ 0.05).There were no significant differences between the two groups in age,gender,history of hypertension,diabetes mellitus,and myocardial infarction(P ＞ 0.05).Statistical differences were observed between the PCI success group and the PCI failure group in the presence of occlusion segment head-end bifurcation,occlusion severe incision,severe calcification (calcification ≥ 180°),occlusion segment length ≥ 20 mm,occlusion of calcification lesions,occlusion segment distal shape of the unambiguous of fiber cap shape of the distal occlusion segment under CCTA(P ＜ 0.05).In the PCI failure group,approximately 17.3％ of the patients had previous attempt to open the CTO lesions,which were higher than the PCI success group (9.4％).However,The difference was not statistically significant (P ＞ 0.05).Multivariate logistic regression analysis showed that the unambiguous distal fibrous cap of the occlusion segment and the occlusion of the proximal branch and the occlusion length ≥20 mm were the main factors affecting the failure of CTO intervention.In terms of prediction,the predictive value 30 CT-CTO score yielded a higher area under the ROC curve than that of the J-CTO score (0.8776 vs 0.7387,P ≤ 0.05).Conclusion CT angiography can predict the success rate of intervention for CTO lesions.Compared with J-CTO score,CT-CTO score has a higher predictive value.Unambiguous fiber cap shape,occlusion segment head end bifurcation,occlusion segment length ≥20 mm were the independent risk factors that affecting the success of CTO operation.

Objective: Late gadolinium enhancement(LGE) cardiac magnetic resonance imaging(CMR) was used to evaluate the myocardial viability of chronic total occlusion(CTO) in patients with coronary heart disease and to observe the relationship between collateral circulation and myocardium viability in these patients. Methods: This retrospective study included 40 patients with CTO diagnosed by invasive coronary angiography (CAG) from September 2015 to June 2016 in our department, all patients performed CMR examination within one week after CAG.The collateral circulation of CTO was graded with Rentrop classification as follows: poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group.According to CMR images, the delayed enhancement transmural extent of myocardial segments were scored, the ventricular wall motion of the myocardial segment were graded, and the wall motion score index (WMSI) was calculated.Spearman correlation analysis was used to analyze the relationship between the delayed enhancement transmural extent of myocardial segments and WMSI. Results: In the no or poor collateral group of 6 myocardial regions, 1 myocardial region had viable myocardium and 3 myocardial regions had no viable myocardium; in the moderate collateral group of 16 myocardial regions, 11 myocardial regions had viable myocardium and 5 myocardial regions had no viable myocardium; in the good collateral group of 24 myocardial regions, 21 myocardial regions had viable myocardium and 3 myocardial regions had no viable myocardium, there was significant difference between the groups (P=0.002). The WMSI of poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group were 1.54±0.50, 1.21±0.34 and 1.26±0.40, respectively, there was no significant difference between the groups (P=0.063). Spearman correlation analysis showed that the extent of delayed enhancement transmural extent of myocardial segment was significantly associated with WMSI (r=0.638, P<0.01). Conclusion Collateral circulation in patients with chronic total occlusion can predict myocardial viability.Increase of Rentrop grade is linked with higher possibility of the presence of viable myocardium.

Objective To evaluate the impact of different adherence mode to statins on cardiovascular adverse events in patients with coronary artery disease (CAD).Methods Electronic searches,including PubMed,Scopus,Ovid MEDLINE,Ovid EMBASE,Ovid EBM Reviews CENTRAL,CINAHL,The Cochrane Library,Ovid PsycInfo,Wanfang data,CNKI and Science & Technology Magazine Online,were performed and all related literatures of all languages were retrieval till to March 1,2015.The full text was obtained through manual retrieval,inter-library loan and document delivery service,or by contacting the author directly.According to inclusion and exclusion criteria,data was extracted dependently by two raters.The high adherence to statin was use defined by the ratio of statins cover time and the total time (proportion of days covered,PDC 80％).Data were analyzed quantitatively using RevMan 5.1.Then implement subgroup analysis was made according to different statin adherence and classification of clinical outcomes.The impact of adherence to statin on cardiovascular events (all-cause mortality,non-fatal myocardial infarction,hospitalization due to unstable angina pectoris,heart insufficiency attack) in CAD patients was evaluated.Results Present analysis enrolled eight relevant retrospective and observational studies.Because there were only few literatures describing the impact of statin adherence on clinical outcomes,we also included literatures with low adherence group (4 studies in PDC ＜ 80％,2 studies in PDC ＜40％ and 2 studies in PDC ＜20％).High adherence group includes 189 556 cases;low adherence group includes 11 384 cases.Compare with low adherence group,cardiovascular events rate reduced by 32％ in high adherence group (OR =0.68,95％ CI 0.58-0.80,P ＜ 0.001).Subgroup analysis with 4 literatures with PDC80％ or ＜ 80％ showed that the cardiovascular events prominently decreased in high adherence group compared to low adherence group (OR=0.63,95％ CI 0.53-0.76,P＜ 0.001).According to 5 literatures with all-cause mortality parameter,we also found a borderline decrease in all-cause mortality in high adherence group compared to low adherence group (OR =0.67,95％ CI 0.44-1.02,P =0.06),while non-fatal cardiovascular events were significantly reduced by 18％ in high adherence group (OR =0.82,95％ CI 0.77-0.87,P ＜ 0.001).Conclusions High adherence to statins is related to significantly lower cardiovascular events in CAD patients.

Objective: To observe the value of evaluating the coronary collateral circulation of chronic total occlusion (CTO) by transluminal attenuation gradient (TAG) and Rentrop grading, and analyze the influencing factors for coronary collateral circulation. Methods: A total of 179 CTO patients admitted to Beijing Anzhen hospital during June 2013 to August 2016 were included in this study.All patients received coronary computed tomographic angiography (CCTA) examination before coronary angiography.Finally, 75 patients (79 vessels) were enrolled.Patients were divided into two groups on the basis of Rentrop classification.The Rentrop 3 was defined as a well-developed coronary collateral circulation group, including 50 CTO vessels, Rentrop 2 or below was defined as poorly-developed collateral circulation group, including 29 vessels.TAG values in patients with various Rentrop grades were analyzed.Univariate and multivariate analysis were used to determine the predictors of collateral circulation. Results: TAG increased consistently in proportion to the angiographic extent of collateral flow (TAG was (-33.6±24.4), (-16.5±15.7) and (-12.8±15.8) HU/10 mm in patients with Rentrop grade 0 or 1, 2 and 3, respectively, P=0.007). Number of good collateral circulation vessels predicted by TAG≥15.6 HU/10 mm was 45(57.0%, 45/79), and 50 (63.3%, 50/79) by Rentrop grade (P=0.383). Prevalence of diabetes was significantly lower (20.8%(10/48) vs. 48.1%(13/27), P=0.01), while history of previous myocardial infarction (MI) was significantly higher (35.4%(17/48) vs. 11.1%(3/27), P=0.02) in patients with good collateral circulation than in patients with poor collateral circulation.The TAG of the good collateral circulation group was significantly higher than in poorly collateral circulation group ((-12.8±15.8) HU/10 mm vs. (-21.2±19.6) HU/10mm, P=0.041). Multiple logistic regression analysis revealed that history of MI (OR=0.196, 95%CI 0.041-0.936, P=0.041) and diabetes(OR=6.604, 95%CI 1.726-25.274, P=0.006) were independent predictors of coronary collateral circulation. Conclusions TAG could be used to evaluate status of coronary collateral circulation.Presence of MI history and absence of diabetes history are the two independent predictors of well-developed coronary collateral circulation in CTO patients.