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

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

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

BACKGROUNDDevelopment of vulnerable lesions is not limited to the target lesions, but a pan-coronary process. Such lesions are identified by positive remodeling (intravascular ultrasound (IVUS) and complex lesions (angiography)). The prevalence of lesions with vulnerable characteristics in patients with stable angina was not well known. The purpose of the present study was to evaluate the relationship between coronary artery remodeling and incidence of angiographic complex lesions and its calcification in stable angina patients.

METHODSOne hundred and sixty-one stable angina patients (95 males, aged (68 +/- 11) years) with 161 de novo target lesions were studied using pre-interventional IVUS. Remodeling index was defined as the lesion divided by reference vessel area; positive remodeling was defined as remodeling index > 1.05. Besides the 161 target lesions, there were 613 angiographic lesions with > 30% diameter stenoses, classified as complex or smooth. Multiple complexes were defined as more than one complex lesion in one patient. Stenoses of at least 70% were described as tight. Calcium arc area was used as a new method to quantify coronary calcification.

RESULTSFifty-six patients had positive remodeling target lesion, while 105 did not. The overall number of lesions with a diameter stenoses > 30% was similar in patients with or without positive remodeling, and the frequency of angiographically complex lesions was higher in positive remodeling patients, especially at non-target site. Calcium arc area was smaller in patients with positive remodeling.

CONCLUSIONSPositive remodeling on intravascular ultrasound was associated with more complex lesions angiographic findings, especially at non target site. Positive remodeling was found less calcified in patients with stable angina.

Aged ; Aged, 80 and over ; Angina Pectoris ; diagnostic imaging ; pathology ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; pathology ; Coronary Vessels ; pathology ; Female ; Humans ; Male ; Middle Aged ; Ventricular Remodeling ; physiology

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

OBJECTIVETo study the occurrence, management and prognosis of fatal pulmonary embolism in patients underwent coronary intervention in our department.

METHODSeven patients had fatal pulmonary embolism after coronary intervention in six years, we analysis each patient by the occurrence, prognosis, management of the disease.

RESULTSDuring the last 6 years, 7 [five males, mean age (55.9 +/- 11.7) years, 5 after coronary angiography and 2 after percutaneous coronary intervention] patients developed fatal pulmonary embolism after PCI. All 7 patients presented respiratory and cardiac arrest within 24 hours post coronary intervention. Three patients died, one patient experienced brain death and another three patients survived and are alive without complication till now.

CONCLUSIONThe fatal pulmonary embolism is a scarce complication after coronary intervention with high acute mortality and satisfactory outcome for survivors.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism ; diagnosis ; etiology ; Treatment Outcome

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

OBJECTIVETo analyze the reason of coronary artery aneurysmal dilations in patients after sirolimus-eluting stent implantation.

METHODSLate localized aneurysmal dilations post PCI were evidenced in 4 patients (age 69.5 +/- 3.5 years, 3 males) during follow-up (24.8 +/- 1.8 months). Nine stents were implanted into 7 diseased vessels: 5 Cypher select stents in LAD; 2 Firebird stents and 1 Pixel stent in LCX; 1 Cypher select stent in RCA. Clopidogrel (75 mg/d) was used for one year.

RESULTSAll stents were implanted successfully after predilation. No acute or subacute in-stent thrombosis and MACE was recorded. Follow-up angiogram imaging at 12 months after stenting was normal in all patients. Chest pain reoccurred in these 4 patients at 16, 18, and 22 months post stent implantation and patients were rehospitalized and treated with clopidogrel, asprine, and intravenous nitroglycerin. Angiography showed aneurysmal segment at the stented site of LAD in 3 patients, and at RCA in 1 patient. The symptom disappeared after 3 days intravenous tirofiban treatments and discharged without in-hospital complications. Patients remained symptom-free 3 - 6 months post discharge.

CONCLUSIONLate localized aneurysmal dilations after sirolimus-eluting stents are related to reoccurred angina pectoris post PCI.

Aged ; Coronary Artery Disease ; therapy ; Coronary Restenosis ; therapy ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Sirolimus ; administration & dosage