Objective To investigate the role of plasma tissue factor (TF) and tissue factor pathway inhibitor-1 (TFPI-1) level and to observe the effect of extrinsic TFPI-1 on no-reflow (NR) in a rabbit model of ischemia/reperfusion. Methods Rabbits were randomized into four groups (n = 10 each): ischemic- reperfusion group (IR, subjected to 120 minutes of coronary artery occlusion and followed by 60 minutes of reperfusion); ischemic- reperfusion TFPI-1 group (100 ng/kg bolus and 1 ng · kg~(-1) · min~(-1) infusion during reperfusion) ; ischemic group (subjected to 180 minutes of coronary artery occlusion) and sham group. The NR area and ischemic area were determined by thioflavin S and Evan's blue staining in vivo. Plasma TF and TFPI-1 levels were measured before operation, before and at 120 minutes post coronary artery ligation, 10 and 60 minutes after reperfusion by ELISA. Results Plasma TF and TFPI-1 levels before and at 120 minutes post coronary artery ligation were similar among the four groups (all P > 0.05). At 10 and 60 minutes after reperfusion, the plasma TF levels in the IR group was significantly higher than those in ischemic group and sham group [10 minutes: (20.7 ±4. 1) pg/ml vs. (13.9 ±2. 2)pg/ml(P <0. 001), (20.7±4. l)pg/ml vs. (13.2±2.6) pg/ml(P<0. 001); 60 minutes; (15.8±2.6) pg/ml vs. (13.5± 1.6) pg/ml(P<0.05), (15.8 ±2.6) pg/ml vs. (12.1 ±0.7) pg/ml (P < 0. 001)] while the plasma TFPI-1 levels were similar among IR, ischemic and sham groups at 10 minutes after reperfusion and at 60 minutes after reperfusion (all P >0. 05). TFPI-1 level [(9.7 ± 1. 6) ng/ml] was significantly lower in the IR group than in the ischemic group [(11.6 ±1.6) ng/ml, P < 0. 05] and sham group [( 10. 1 ±1.3) ng/ml, P < 0. 01] . TF mRNA expression in the NR area in IR group was significantly up-regulated compared to the ischemic group (P<0. 05) and sham group (P <0. 001 ) while TFPI-1 mRNA expression was similar between IR group and ischemic group ( P > 0. 05 ) . NR severity in the ischemic-reperfusion TFPI-1 group was significantly attenuated compared to IR group (0. 39 ±0. 11 vs. 0.54±0.06, P<0.01). Conclusion Upregulated TF mRNA expression in the NR area and increased plasma TF level during reperfusion period, reduced plasma TFPI-1 level during reperfusion period as well as attenuated NR severity by extrinsic application of human rTFPI-1 in this model suggested an important role in the pathogenesis of the NR phenomenon.

Objective To investigate the cost-utility of percutaneous coronary intervention(PCI)in China.Mcthods A total of 630 patients from 13 cities undergoing PCI during the first half year of 2006 were enrolled in this study.The 36 items derived from the short form of health survey(SF-36)were applied prospectively in these patients before and 9 months after PCI.The cost per every incremental mark of SF-36 and quality adjusted life year(QALY)were calculated.Results(1)The age was lower than 60 years old in more than 50%patients.(2)In terms of detailed costs,material costs accounted for 82.5%of the hospitalization costs.medications costs accounted for 6.8%,and operation fee accounted for 5.9%.These 3 iterns comprised 95.2% of overall hospitalization costs,and 69.8% material costs were the cost for stents.(3)The average re-admission hospitalization costs were 17 841.5 RMB in 44 patients who were rehospitalized due to occurrence of major adverse cardiac events.(4)Follow-up made at months 1,3,6,9,and 12 post index procedure showed that an average cost for postoperative drug treatment was 831.50RMB per month,and most patients spent 400.0 RMB for drug treatment per month.(5)The average quality of life score increased by 20.59 post PCI(P<0.05 vs.pre-PCI).The cost-effective analysis indicates that the cost per every incremental mark of SF-36 was 3975.7 RMB.The cost per every QALY gained was 59 898.3 RMB.Conclusion PCI is effective for patients with coronary heart disease and the cost per QALY in China was positioned in an acceptable range.

Objective To collect data on percutaneous coronary intervention (PCI) performed in mainland China. Methods Questionnaires on PCI were distributed to all hospitals capable of performing PCI through national society of cardiology. Data in calendar year 2008 were analyzed. Results (1) 182 312 PCI were performed in mainland China in 2008 ( +26. 02% vs. 2007) , average PCI rate was 1. 39 per 10 000 people. (2) PCI was performed in 1061 hospitals and 171. 83 PCI was performed per hospital. Among them, there were 461 hospitals performed more than 100 PCI (+54. 18% vs. 2007). (3) The number of PCI performed among provinces was positive correlated with local per capita gross domestic product ( GDP, P =0. 06, P <0. 05) and the number of the hospitals performed more than 100 PCI per year ( p =434. 23, P < 0. 05) , and negatively correlated with local population number ( p = 0.49, P < 0. 05 ). There were no correlation between the ratio of the hospitals performed more than 100 PCI per year( P =- 2746. 35, P > 0. 05) and the ratio of people with medical insurance ( p = - 855. 78, P > 0. 05 ). Conclusions From 2005, PCI rose 23. 87% per year in mainland China. There are significant differences among provinces on the development of PCI.

Objective To explore the associations between fasting serum lipids and high-sensitivity C-reactive protein ( hsCRP).Methods Serum triglyceride ( TG),high-density lipoprotein cholesterol (HDL-C) and hsCRP were measured in residents of Chengdu,China.Subjects with potential factors which might influence lipids and hsCRP were excluded,580 subjects [ mean age ( 62.3 ± 6.6 ) years ; male:58.7％ ] were finally recruited by random sampling methods.Results There was a weak positive relationship between TG and hsCRP ( r =0.108,P =0.01 ) and a weak negative relationship between HDLC and hsCRP (r =- 0.197,P ＜ 0.001 ),this was also true in the sub-group with BMI ＜ 24 kg/m2 ( r =0.236,-0.140 respectively,all P ＜0.001 ).In subjects with BMI ＜24 kg/m2,the hsCRP concentration was significantly higher in subjects with higher TG or lower HDL-C ( all P ＜ 0.05 ).hsCRP increased in proportion with the degree of dyslipidemia.After adjusting for gender,age,TC,LDL-C,fasting blood glucose,systolic blood pressure,diastolic blood pressure,history of hypertension and diabetes,smoking and alcohol drinking,logistic regression analysis showed that the odds ratio for increased hsCRP was 1.970 in subjects with either increased TG or lower HDL-C (P =0.105) and 9.098 in subjects with both higher TG or lower HDL-C levels (P =0.031 ).However,the observed relationship between TG,HDL-C and hsCRP in subjects with BMI ＜ 24 kg/m2 could not be observed in subjects with subjects with BMI ＞ 24 kg/m2despite significant more cardiovascular risk factors in these subjects.Conclusions A weak positive correlation between TG and hsCRP as well as a weak negative correlation between HDL-C and hsCRP was evidenced in the whole cohort suggesting dyslipidemia might be related to enhanced inflammatory status.However,this relationship is not observed in subjects with BMI ＞ 24 kg/m2 despite existence of more cardiovascular risk factors in these subjects.

Background It has been proven that ultrasonic destruction of microbubbles can enhance gene transfection efficiency into the noncardiac cells, but there are few reports about cardiac myocytes. Moreover, the exact mechanisms are not yet clear; whether the characteristic of microbubbles can affect the gene transfection efficiency or not is still controversial.This study was designed to investigate whether the ultrasound destruction of gene-loaded microbubbles could enhance the plasmids carried reporter gene transfection in primary cultured myocardial cell, and evaluate the effects of microbubbles characteristics on the transgene expression in cardiac myocytes.Methods The β-galactosidase plasmids attached to the two types of microbubbles, air-contained sonicated dextrose albumin (ASDA) and perfluoropropane-exposed sonicated dextrose albumin (PESDA) were prepared. The gene transfection into cardiac myocytes was performed in vitro by naked plasmids, ultrasound exposure, ultrasonic destruction of gene-loaded microbubbles and calcium phosphate precipitation, and then the gene expression and cell viability were analyzed.Results The ultrasonic destruction of gene-loaded microbubbles enhanced gene expression in cardiac myocytes compared with naked plasmid transfection ((51.95±2..41) U/g or (29.28±3.65) U/g vs. (0.84-0.21) U/g, P ＜0.01), and ultrasonic destruction PESDA resulted in more significant gene expression than ASDA ((51.95e2.41) U/g vs. (29.28±3.65)U/g, P ＜0.05). Ultrasonic destruction of microbubbles during calcium phosphate precipitation gene transfection enhanced 3-galactosidase activity nearly 8-fold compared with calcium phosphate precipitation gene transfection alone ((111.35±11.21) U/g protein vs. (14.13±2.58) U/g protein, P＜0.01). Even 6 hours after calcium phosphate precipitation gene transfection, ultrasound-mediated microbubbles destruction resulted in more intense gene expression ((35.63±7.65)U/g vs. (14.13±2.58) U/g, P＜0.05 ).Conclusions Ultrasonic destruction of microbubbles might be a promising method for the delivery of non-viral DNA into cardiac myocytes, and the gene tranfection is related to the characteristics of microbubbles.

Objective To collect data on percutaneous coronary intervention(PCI)performed in inland of China.Metbotis Questionnaires on PCI were distfibuted to all hospitals capable of performing PCI through nationaJ society of cardiology.Data from 2006 and 2007 were reported in this report.Remlts (1)In 2007,144 673 PCI were performed in 870 hospitals compared to 112 580 PCI performed in 1078 hospitals in 2006.Number of PCI in 2007 increased more rapidly compared to 2006 in three provinces(Fujian 327.3%:Anhui 115.1%and Guangdong 86.9%).(2)In 2007,the number of PCI performed in ten proyinces accounted for 66.7% of total PCI in inland of China(Beijing 15.4%;Guangdong 8.0%;Lianning 6.9%;Shandong 6.9%;Shanghai 6.1%;Henan 5.8%;Zhejiang 4.7%;Jiangsu 4.4%;Shanxi 4.4%and Hebei 4.2%).(3)There were 299(34.4%)hospitals with PCI number more than 100 in 2007 compared with 290(29.6%)hospitals in 2006;there were 507 hospitals with PCI numbers less tIlan 50 in 2006.(4)In 2006,there were 86 974 patients received PCI in 672 hospitals and 135 658 stents were implanted and 97.8%of implanted stents were drug eluting stents(DES).Conclusion From 2006 to 2007,nomber of PCI increased significantly in inland of China,there were about 50%hospitals with PCI number less than 50 per year and 1.56 stenta per patient were implanted and 97.8%implanted stents were DES.

Objective To assess the relationship between pregnancy associated plasma protein-A (PAPP-A)and culprit coronary plaque morphology in patients with unstable angina(UA).Methods Sixtyeight UA patients undergoing diagnostic coronary angiography and intravascular ultrasound were included in this study.A sandwich enzyme-linked immunosorbent assay technique was used to assay the circulating PAPP-A.Plaque characteristics of culprit lesion were analyzed for UA patients with various PAPP-A levels.Results PAPP-A level was significantly higher in high-risk UA than in non-high-risk UA[(19.9±20.1)mIU/L vs.(6.9 ±5.7)mIU/L,P=0.002].Optimal threshold of PAPP-A to prediet high-risk UA was determined as 11.0 mIU/L with a sensitivity of 78.6%and a specificity of 77.5%.Patients with higher PAPP-A level(≥11.0 mIU/L)was associated with larger external elastic membrane cross-sectional area,plaque area and more plaque burden compared with patients with lower PAPP-A Ievel(all P<0.01).Positive remodeling,attenuated plaque and plaque rupture were significantly more often in patients with higher PAPP-A than in patients with lower PAPP-A level(all P<0.01).PAPP-A≥11.0 mIU/L(OR=5.921,P=0.014)and attenuated plaque(OR=7.541,P=0.038)were independent risk predictors for high-risk UA.Conclusions PAPP-A was associated with instability of culprit plaque in UA patients.PAPP-A≥11.0 mIU/L and attenuated plaque were independent predictors for high-risk UA.

Objective To investigate the impact of the stents coated with sirolimous and anti-CD34 antibody on the short-term re-endothelialization and the long-term restenosis in Chinese Minipigs.Methods Three different types of stents [ bare-metal stent ( BMS ),sirolimous-eluting stent ( SES ) and anti-CD34 antibody and sirolimous-coated stent (ASES) ] were randomly implanted in the coronary arteries of 22Chinese Minipigs.At two weeks after stenting,coronary angiography and optical coherence tomography (OCT) were performed in 10 experimental animals.At three months after stenting,coronary angiography and OCT were performed in the remaining 12 experimental animals.Histopathologic examination was performed on the coronary artery segments containing stent after the animals were executed.Results (1) No in-stent thrombosis and parietal thrombus were found by coronary angiography,OCT and histopathologic examination at two weeks post stenting.OCT analysis showed that the covered ratio of stent struts by neointima in ASES group was higher than in SES group [ ( 55.56 + 35.27 ) ％ vs.(41.82 +23.28 ) ％,P ＜ 0.05 ].The mean thickness of neointima in ASES group was significantly higher than in SES group [(89.0+5.0)1.μn vs.(32.0 +4.9) μm,P＜O.O1] and BMS group [(89.0 +5.0) μm vs.(44.0 ± 7.2) μm,P ＜ 0.01].Histopathologic and scanning electron microscopy examinations demonstrated that the covering level and quality of stent struts by neointima in BMS and ASES group were both better than in SES group.(2) At three months follow-up,quantitative coronary angiography analysis found that late instent lumen loss in ASES group was significantly lower than in BMS group [ (0.18 ±0.06)mm vs.(0.35 ±0.06)mm,P ＜ 0.05].OCT analysis showed that the percent neointimal hyperplasia in ASES and SES group was significantly lower than in BMS group [ ( 34.75 + 2.64) ％ and ( 35.63 + 2.07 ) ％ vs.(48.28 ±3.25) ％,both P ＜ 0.01 ].Histopathologic analysis demonstrated that the percent areal restenosis of ASES and SES group were both significantly lower than that of BMS group [ (28.65 + 5.64)％ and (29.33 ±6.07)％ vs.(46.18 +8.25)％,both P ＜0.05].Conclusion The stents coated with anti-CD34 antibody and sirolimous can attenuate the inhibitory effect of sirolimous on the re-endothelialization at two weeks after stenting and the anti-hyperplasia effect of sirolimous at three months after stenting.

Objective To analyze the risk factors related to in-hospital bleeding for patients with acute coronary syndrome (ACS).Methods Clinical and therapeutic data of 3807 patients who were registered with acute coronary syndrome in SINO-GRACE in China from March 2001 to December 2007 were reviewed.A total of 57 patients were grouped to bleeding group and 234 out of the remaining 3750 patients without bleeding were randomly chosen and served as non-bleeding group.Hemorrhage-related factors were screened and compared between the two groups.Unitary logistic regression analysis was performed to detect the possible factors related to hemorrhage.Factors with P ＜ 0.1 were further analyzed by stepwise regression method and multivariate conditional logistic regression analyses.Results (1) Age,history of coronary artery bypass graft (CABG),previous hemorrhage,renal failure and heart failure as well incidence of acute coronary syndrome were significantly higher in bleeding group than in non-bleeding group (all P ≤0.05).Patients were more often treated with clopidogrel and glycoprotein (GP) Ⅱ b/Ⅲ a receptor antagonist in bleeding group than in non-bleeding group.(2) Single factor logistic regression analysis showed that age ＞70 years,history of previous bleeding,renal failure,heart failure,clopidogrel and GP Ⅱ b/Ⅲ a receptor antagonists use,non-ST-segment elevation myocardial infarction,inferior wall,lateral myocardial infarction,CABG were risk factors for bleeding (all P ＜ 0.05).(3) Multivariate logistic regression analysis showed that history of renal failure (OR =19.77,95％ CI 4.38-89.18,P ＜ 0.01) and clopidogrel (OR =19.77,95％ CI 4.38-89.18,P ＜ 0.01) and GP Ⅱ b/Ⅲ a receptor antagonist (OR =343.57,95％ CI 40.39-999.99,P ＜ 0.01) use were the independent risk factors for bleeding.Conclusion Our results show that renal failure history and clopidogrel and GP Ⅱ b/Ⅲ a receptor antagonist use are independent risk factors for in-hospital bleeding in patients with acute coronary syndrome.

Background Cilostazol is a newly developed antiplatelet drug that has been widely applied for clinical use. Its antiplatelet action appears to be mainly related to inhibition of intracellular phosphodiesterase activity. Recently,cilostazol has been used for antiplatelet therapy after coronary bare metal stent implantation for thrombosis and restenosis prevention. This prospective randomized and double blind trial was designed to investigate the safety and efficacy of cilostazol for the prevention of late restenosis and acute or subacute stent thrombosis.Methods One hundred and twenty patients who underwent elective stent were randomly assigned to treatment group with cilostazol 200 mg/d (n = 60), clopidogrel 75 mg/d and aspirin 100 mg/d or to control group with clopidogrel treatment 75 mg/d (n = 60) and aspirin 100 mg/d. Follow-up coronary angiography was performed 6-9 months later.Results Nine months major adverse cardio-cerebral event (MACCE) were lower in treatment groups (P＜0.05).The quantitative coronary angiography (QCA) at 6 months follow-up showed that minimum lumen diameter(MLD) was higher in treatment group than that of control group [(2.14±0.52)mm vs (1.82 ±0.36)mm, P＜0.05].Late lumen loss (LL) [(0.82 ± 0.42)mm vs (1.31 ± 0.58)mm; P＜0.01 ], restenosis rate (RR) (14% vs 32%; P＜0.05)and target lesion revascularizaion (TLR) rate (5% vs 17%; P＜0.05) were lower in treatment group than in control group.Conclusion Cilostazol therapy is an effective regimen for prevention not only stent thrombosis but also RR and TLR through reducing MLD without the risk of increasing bleeding.