Angioplasty, Balloon, Coronary ; Chronic Disease ; Coronary Disease ; therapy ; Coronary Occlusion ; therapy ; Humans

Humans ; Hyperplasia ; etiology ; Male ; Middle Aged ; Prosthesis Failure ; Stents ; Tomography, Optical Coherence ; adverse effects ; Tunica Intima ; pathology

BACKGROUNDBoth non-alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) are closely associated with many metabolic disorders. Invasive coronary angiography (CAG) is a common approach as an intervention for CAD. However, the association between angiographic severity of coronary artery and NAFLD remains controversial. This study aimed to evaluate the relationship between NAFLD and CAD.

METHODSTotally 542 consecutive patients who planned to undergo CAG due to a suspected CAD were enrolled. Abdominal computed tomography (CT) was performed before angiography to detect NAFLD. CAD was defined as stenosis of at least 50% in at least one major coronary artery. The severity of CAD was assessed by the number of vessels affected and the vessel score multiplied by the severity score (Gensini score). Significant stenosis was defined as 70% or greater reduction in lumen diameter. A probability value of P < 0.05 was considered statistically significant.

RESULTSOf 542 patients studied, 248 (45.8%) were found to have NAFLD by abdominal CT, and 382 patients (88%) were found to have significant CAD by CAG. Age, diabetes mellitus, waist circumference, body mass index, and obesity were associated with NAFLD. According to the results of Logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG (odds ratio (OR), 95% confidence interval (CI): 7.585 (4.617-12.461); P < 0.001). NAFLD was significantly more common in patients as CAD severity increased (P < 0.001).

CONCLUSIONSThe presence of NAFLD is associated with high severity of CAD, requiring that patients with abdominal obesity be also investigated for NAFLD. Patients with NAFLD should be closely followed up for the presence and severity of CAD.

Aged ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; pathology ; Fatty Liver ; diagnostic imaging ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease

OBJECTIVETo collect data on percutaneous coronary intervention (PCI) performed in mainland China.

METHODSQuestionnaires 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, β = 0.06, P < 0.05) and the number of the hospitals performed more than 100 PCI per year (β = 434.23, P < 0.05), and negatively correlated with local population number (β = 0.49, P < 0.05). There were no correlation between the ratio of the hospitals performed more than 100 PCI per year (β = -2746.35, P > 0.05) and the ratio of people with medical insurance (β = -855.78, P > 0.05).

CONCLUSIONSFrom 2005, PCI rose 23.87% per year in mainland China. There are significant differences among provinces on the development of PCI.

Angioplasty, Balloon, Coronary ; statistics & numerical data ; China ; Hospitals ; Humans

OBJECTIVEPost percutaneous coronary intervention (PCI) major cardiac event rate is high in patients with high platelet aggregability. We observed the effects of intensive antiplatelet therapy in these patients.

METHODSADP-induced platelet inhibition rates were less than 30% after 24 h treatment with Clopidogrel (300 mg) in 402 patients out of 1556 patients who underwent PCI in our institute between January 2004 to June 2006. These patients were randomly divided into control group (Clopidogrel 75 mg/d and aspirin 100 mg/d, n = 201) or treatment group (Clopidogrel 75 mg/d and aspirin 100 mg/d plus cilostazol 200 mg/d, n = 201). Major adverse cardiac events were analyzed after 6 months treatments.

RESULTSPatients with ADP-induced platelet inhibition rates < 30% were significantly lower in treatment group compared to control group after 28 days treatments (9.4% vs. 89.6%, P < 0.05). Thrombosis complication (0.5% vs. 3.0%), death (0 vs. 1.0%), non-fatal myocardial infarction (0.5% vs. 1.5%), hemorrhagic (6% vs. 4%) rates were similar between treatment and control group while target vessel revascularization rate was significantly lower in treatment group compared to control group (6.5% vs. 15.9%, P < 0.05). Total MACE rate was therefore significantly lower in treatment group than that in control group (13.5% vs. 25.4%, P < 0.05).

CONCLUSIONIntensive anti-platelet treatment could significantly reduce major cardiac event rates in patients with high platelet aggregability after percutaneous coronary intervention.

Aged ; Angioplasty, Balloon, Coronary ; Aspirin ; therapeutic use ; Coronary Artery Disease ; drug therapy ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; Platelet Aggregation Inhibitors ; therapeutic use ; Platelet Count ; Ticlopidine ; analogs & derivatives ; therapeutic use

OBJECTIVETo 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.

METHODSRabbits 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 x kg(-1) x 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.

RESULTSPlasma 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 + or - 4.1) pg/ml vs. (13.9 + or - 2.2) pg/ml (P < 0.001), (20.7 + or - 4.1) pg/ml vs. (13.2 + or - 2.6) pg/ml (P < 0.001); 60 minutes: (15.8 + or - 2.6) pg/ml vs. (13.5 + or - 1.6) pg/ml (P < 0.05), (15.8 + or - 2.6) pg/ml vs. (12.1 + or - 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 + or - 1.6) ng/ml] was significantly lower in the IR group than in the ischemic group [(11.6 + or - 1.6) ng/ml, P < 0.05] and sham group [(10.1 + or - 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 + or - 0.11 vs. 0.54 + or - 0.06, P < 0.01).

CONCLUSIONUpregulated 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.

Animals ; Blood Proteins ; metabolism ; Lipoproteins ; blood ; Myocardial Reperfusion Injury ; blood ; Rabbits ; Thromboplastin ; metabolism

BACKGROUNDInflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein (CRP) is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 (MMP-9) is highly over-expressed in the vulnerable regions of a plaque. Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.

METHODSPatients with newly diagnosed unstable angina pectoris from clinical presentation and ECG, who were undergoing coronary angiography from April 2007 to April 2009, were included in this study. A total of 170 subjects were enrolled in the study. Before angiography, the baseline clinical data (mainly including conventional risk factors) was collected. These patients were divided into two groups, a non-plaque group (G1) which included 55 patients with no significant stenosis or less than 20% stenosis in at least one of the major coronary artery branches, and a plaque group (G2) which included 115 patients with at least one of the major coronary artery branches unstable angina pectoris with at least 50% stenosis of one major coronary artery. The patients presenting with calcified nodules of a major coronary artery were excluded from this study. We examined the serum levels of MMP-9 for all cases by multi-effect enzyme-linked immunosorbent assay.

RESULTSThere was a significant difference in the serum levels of MMP-9 between the two groups (P < 0.001). The percentage of patients with hypertension, diabetes and current smokers were significantly different between the two groups (P = 0.034, P = 0.031, and P = 0.044 respectively). The univariate Logistic regression analyses of risk factors showed that smoking was the main risk factor for angina in the non-plaque group with the OR being 1.95 (95%CI 1.02 - 3.75). Hypertension, diabetes mellitus were negatively related with the occurrence of angina in the non-plaque group with the ORs being 0.50, and 0.36, respectively (95%CI 0.26 - 0.96 and 0.14 - 0.94). The MMP-9 level was negatively related to the occurrence of angina in the non-plaque group with an OR of 0.59 (95%CI 0.47 - 0.81).

CONCLUSIONSThere is a significantly difference in MMP-9 levels between the plaque and non-plaque groups. Current smoking has a significant influence on unstable angina patients without documented plaques. The serum MMP-9 level may be a significant biomarker which can help differentiate patients with unstable angina with plaques from those with unstable angina but without plaques.

Aged ; Angina, Unstable ; blood ; metabolism ; physiopathology ; C-Reactive Protein ; metabolism ; Coronary Angiography ; Coronary Artery Disease ; blood ; metabolism ; physiopathology ; Coronary Vessels ; metabolism ; pathology ; Female ; Humans ; Male ; Matrix Metalloproteinase 9 ; blood ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Smoking ; adverse effects

BACKGROUNDMany studies have examined gender related differences in the presenting symptoms, management and prognosis of patients with acute coronary syndrome (ACS). Much data are available from industrialized countries, in which ACS is a major cause of morbidity and mortality, but relatively little information has been obtained from China, where an epidemic of cardiovascular disease is starting to emerge. The purpose of this study was to assess the differences in clinical practice in a national Chinese sample.

METHODSA total of 12 medical teaching hospitals participated in CRACE. Data collection began in 2001 and continued until 2004, 1301 patients with ACS were enrolled into the study. We compared the clinical demographics, different therapies and outcomes in hospitals between female and male patients with ACS.

RESULTSPatients had an average age of 63.13 years (ranging from 27 to 93 years) and 318 female and 983 male subjects were enrolled. Female subjects were older than male patients (67.23 years vs 61.80 years, P < 0.0001). The incidence of angina, heart failure, diabetes mellitus and hypertension in the female group was higher than in male group (73.6% vs 62.3%, P < 0.0001; 8.2% vs 5.7%, P = 0.031; 30.8% vs 18.6%, P < 0.0001 and 66.4% vs 56.8%, P = 0.001 respectively), but the incidence of smoking was less in the female group than in the male group (6.6% vs 66.2%, P < 0.0001). More male patients presented with ST-segment elevation myocardial infarction (STEMI) compared with female patients (48.5% vs 39%, P = 0.002). With the exception of beta-blocker administration, no differences were found among medications including aspirin, ACEI, lipid lowering agents and low-molecular-weight heparin (LMWH) between female and male patients presenting with ACS in hospitals. Compared with male patients with non-ST-segment elevation (NSTE) ACS, female subjects were more prone to receive beta-blockers (75.1% vs 63.4%, P = 0.001). Among STEMI and NSTE-ACS patients, fewer female subjects received reperfusion therapy compared with male subjects (37.1% vs 26.8%, P = 0.013 for STEMI; 53.6% vs 37.2 %, P < 0.0001 for NSTE-ACS). Recurrent angina was more often seen in the female group of patients with the whole spectrum of ACS (25% vs 14.5%, P = 0.005 for STEMI; 29.4% vs 20.2%, P = 0.001 for NSTE-ACS) as was true for patients with congestive heart failure. There was no significant difference in in-hospital death rates between the two groups with ACS (5.6% vs 7.1%, P = 0.2 for STEMI, and 2.1% vs 1.4%, P = 0.738 for NSTE-ACS).

CONCLUSIONSFemale patients with ACS were older than male subjects and thus more often had concomitant diseases but less often had a history of smoking. They less often received reperfusion therapies and more often had higher in-hospital recurrent angina. However, there was no significant difference in in-hospital mortality between the female and male patients.

Acute Disease ; Adult ; Age Factors ; Aged ; China ; epidemiology ; Coronary Disease ; epidemiology ; mortality ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; epidemiology ; Registries ; Sex Characteristics

OBJECTIVETo collect data on percutaneous coronary intervention (PCI) performed in inland of China.

METHODSQuestionnaires on PCI were distributed to all hospitals capable of performing PCI through national society of cardiology. Data from 2006 and 2007 were reported in this report.

RESULTS(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 provinces accounted for 66.7% of total PCI in inland of China (Beijing 15.4%; Guangdong 8.0%; Liaoning 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 than 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).

CONCLUSIONFrom 2006 to 2007, number of PCI increased significantly in inland of China, there were about 50% hospitals with PCI number less than 50 per year and 1.56 stents per patient were implanted and 97.8% implanted stents were DES.

Angioplasty, Balloon, Coronary ; statistics & numerical data ; China ; Coronary Restenosis ; Humans ; Registries

OBJECTIVEThe purpose of this registry is to collect data on percutaneous coronary interventions (PCI) performed in various provinces in mainland China in 2005.

METHODSQuestionnaires were send to all hospitals in China and data on PCI, PCI case numbers and type of stents were collected.

RESULTS(1) PCI is available in 754 hospitals among the 30 provinces and there are more than 50 hospitals performing PCI in 4 provinces: Shandong (70), Beijing (60), Guangdong (60) and Shanghai (50); (2) A total of 95 912 PCIs were performed among the 30 provinces and about 50% of these procedures were finished in five provinces (Beijing: 20%, Shanghai: 8.9%, Shandong: 7.6%, Liaoning: 6.1% and Shanxi 6.0%; (3) PCI numbers were more 1000 in 7 hospitals, between 500 - 999 in 13 hospitals, between 300 - 499 in 41 hospitals, between 100 - 299 in 149 hospitals and less than 100 in more than 50% of all hospitals; (4) In several regions with higher GDP such as Jiangsu Province, Zhejiang Province, Guangdong Province, Shandong Province and Hainan Province, the rate of PCI/total population is significantly lower than other regions with comparable GDP and there is a potential for higher PCI numbers in the future; (5)Around 60% stents implanted were drug eluting stents.

CONCLUSIONPCI procedures is popular in mainland China now, especially in regions with higher GDP. Around 60% implanted stents were drug eluting stents.

Angioplasty, Balloon, Coronary ; statistics & numerical data ; China ; epidemiology ; Drug Delivery Systems ; Humans ; Registries ; statistics & numerical data ; Stents