OBJECTIVETo investigate the distribution of monocyte subpopulations and the changes of Toll-like receptor 4 (TLR4), CD163 and CD36 expressions in the peripheral blood of patients with hyperlipidemia of phlegm-stagnancy obstruction syndrome pattern (HLE-PSO), and to evaluate the intervening effects of Qutan Huayu Jiedu (QHJ) herbs on these parameters.

METHODSMonocytes in the peripheral blood were sorted using flow cytometry into 3 subpopulations: the CD14high CD16- (Mo1), the CD14high CD16+ (Mo2a) and the CD14low CD16+ (Mo2b) subpopulation. The percentages of various monocyte subpopulations in 83 patients and 42 matched healthy controls were determined and the levels of their surface receptors TLR4, CD163 and CD36 expressions were assayed with flow cytometer. Furthermore, patients allocated in the tested group (10 patients) and the control group (11 patients) were treated with QHJ Herbs and Qutan Huayu (QH, removing Phlegm and dissolving stagnancy but without detoxication) herbs respectively. The changes of monocyte subpopulations percentage and TLR4, CD163 and CD36 expressions were determined 4 weeks after they received treatment.

RESULTSPercentage of Mo2a subpopulation was significantly higher in HLE-PSO patients than the normal range (5.35 +/- 2.57 vs. 3.09 +/- 2.38, P < 0.01), but the deviation of the other two subpopulations in percentage was insignificant. The TLR4 expression on Mo1 monocyte in patients was lower than normal (50.73 +/- 24.45 vs. 69.92 +/- 21.06, P < 0.01), while CD163 and CD36 expressions of all three subpopulations in patients were similar to those in healthy persons respectively. After 4 weeks of treatment, a significant lowered Mo2a proportions were observed in the tested group (3.73 +/- 1.05 vs. 5.50 +/- 2.06, P = 0.043); but not in the control group (4.20 +/- 1.81 vs. 5.65 +/- 1.89, P = 0.097), while the levels of TLR4, CD163 and CD36 were not significantly altered after treatment in both groups.

CONCLUSIONSThe elevated proportions of Mo2a subpopulation and the lowered TLR4 expression in Mol subpopulation are the characteristic changes in HLE-PSO patients, which might be related with the hyperlipidemia caused immune injury in patients. QHJ herbs could effectively improve the disproportion of Mo2a subpopulation.

Aged ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; CD36 Antigens ; metabolism ; Case-Control Studies ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Flow Cytometry ; Humans ; Hyperlipidemias ; diagnosis ; drug therapy ; metabolism ; Male ; Medicine, Chinese Traditional ; Monocytes ; cytology ; drug effects ; Phytotherapy ; Receptors, Cell Surface ; metabolism ; Toll-Like Receptor 4 ; metabolism

OBJECTIVETo observe monocyte (Mo) development in wild type C57BL/6 mice and apoE gene knockout (apoE(-/-)) mice, and to evaluate the immuno-regulatory effect of Huanglian Jiedu Decoction (HJD) on peripheral Mo development in apoE(-/-) mice.

METHODSFour, 8, 12, and 16 weeks old female C57BL/6 mice were set up as control groups of different ages, while 4, 8, 12, and 16 weeks old female apoE(-/-) mice were set up as hyperlipidemia groups of different ages. Four-week old female C57BL/6 mice were recruited as a blank group. Four-week old female apoE(-/-) mice were randomly divided into the control group, the Western medicine group, and the Chinese medicine group by paired comparison, 5 in each group. Equivalent clinical dose was administered to mice according to body weight. Mice in the Western medicine group were administered with Atrovastatin at the daily dose of 10 mg/kg by gastrogavage, while those in the Chinese medicine group were administered with HJD at the daily dose of 5 g/kg by gastrogavage. Body weight was detected each week. After 4 weeks blood lipids levels (such as TG, TC, LDL-C, and HDL-C), and the proportions of Mo and Ly6c(hi) were detected.

RESULTSCompared with 4-week-old homogenic mice, the proportion of Mo decreased in 16-week-old C57BL/6 mice (P < 0.05). Levels of TC and TG, and the proportion of Ly6c(hi) subtype increased, but the proportion of Mo de- creased in 8-week-old apoE(-/-) mice (P <0. 05). Levels of TC, TG, and LDL-C increased in 12-week-old apoE(-/-) mice (P < 0.05). Levels of TC, TG, LDL-C, and HDL-C increased in 16-week-old apoE(-/-) mice (P < 0.05, P < 0.01). Compared with 8-week-old homogenic mice, the proportion of Mo decreased in 16-week-old C57BL/6 mice (P < 0.05); levels of TC and LDL-C increased in 12-week-old apoE(-/-) mice (P < 0.05); levels of TC and HDL-C increased in 16-week-old apoE(-/-) mice (P < 0.05, P < 0.01). Compared with C57BL/6 mice of the same age, TC and TG increased, HDL-C decreased (P < 0.01) in 4-and 8-week-old apoE(-/-) mice (P < 0.01); levels of TC, TG, LDL-C increased, and HDL-C level decreased in 12- and 16-week-old apoE(-/-) mice (P < 0.05, P < 0.01); the proportion of Mo increased in 4-week-old apoE(-/-) mice (P < 0.05); proportions of Mo and Ly6c(hi) increased in 8-week-old apoE(-/-) mice (P < 0.05). Compared with the blank control group, levels of TC, TG, and LDL-C, proportions of Mo and Ly6c(hi) increased (P < 0.01, P < 0.05), but HDL-C level decreased (P <0. 01) in the control group after intervention. Compared with the control group, body weight gained less in the Western medicine group and the Chinese medicine group (P < 0.05); the proportion of Ly6c(hi) subtype decreased in the Chinese medicine group (P < 0.05).

CONCLUSIONSIn development process blood lipids levels in apoE(-/-) mice are not only associated with age. Blood lipids levels induced growth changes in natural immune system are also correlated with age. In early stage of lipids development HJD intervention could correct this special immune disorder in apoE(-/-) mice.

Animals ; Apolipoproteins E ; genetics ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Gene Knockout Techniques ; Hyperlipidemias ; Lipids ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Monocytes ; physiology

OBJECTIVETo elucidate the relative factors and prognostic impact for angiographic no-reflow phenomenon during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).

METHODSA total of 930 patients with AMI who underwent primary PCI were divided into no-reflow group and normal-reflow group. Factors related to no-reflow were analyzed by logistic regression model and major adverse cardiac events (MACE) in-hospital as well as during long-term follow-up was also observed.

RESULTSNo-reflow occurred in 82 out of 930 patients. Admission glucose level (9.8 +/- 4.3 mmol/L vs. 8.5 +/- 3.5 mmol/L, P = 0.001), peak CK-MB value (369.4 +/- 167.8 U/L vs. 282.3 +/- 161.7 U/L, P < 0.01) and percentage of TIMI flow grade 0 on initial angiogram (69.5% vs. 54.5%, P = 0.009) were significantly higher and pre-infarction angina (19.5% vs. 48.1%, P < 0.01) was significantly lower in no-flow patients than normal flow patients. Logistic regression analyses showed that admission glucose level, absence of pre-infarction angina, TIMI flow grade 0 on initial angiogram and pump failure were independent predictors of no reflow. In-hospital MACE (37.8% vs. 11.3%, P < 0.01) and follow-up MACE (37.5% vs. 17.4%, P < 0.01) were also significantly higher in no-flow patients than normal flow patients. Multivariate Cox regression analysis revealed that no-reflow was an independent predictor of long-term cardiac death (relative risk 3.83, 95% confidence interval 1.71 to 5.57).

CONCLUSIONAdmission glucose level, absence of pre-infarction angina, TIMI flow grade 0 on initial angiogram and pump failure were independent risk factors for no-reflow and no-flow is an independent predictor for increased in-hospital and follow-up MACE.

Aged ; Angina Pectoris ; Angioplasty, Balloon, Coronary ; Blood Glucose ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; therapy ; Prognosis ; Treatment Outcome

BACKGROUNDRapid recanalization of infarct-related artery (IRA) has become the major target during primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (MI), but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease.

METHODSA total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries (luminal narrowing > or = 70%) undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only (group 1), and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction (AMI) (group 2). Drug-eluting stents (DESs) were deployed in more than 90% of the patients.

RESULTSThe two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events (11.5% vs 15.1%, P > 0.05) and target lesion revascularization (8.1% vs 7.6%, P > 0.05) between the two groups. However, patients in group 1 had higher rates of recurrent angina (10.1% vs 2.1%, P < 0.05) and depressed left ventricular ejection fraction evaluated by echocardiography (0.56 +/- 0.22 vs 0.63 +/- 0.25, P < 0.05).

CONCLUSIONWith the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation MI and multi-vessel disease.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; methods ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Myocardial Revascularization ; methods ; Treatment Outcome

BACKGROUNDFailure of balloon catheter passing through the occluded segment accounts for 10% - 15% of all procedures during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing.

METHODSBetween July 2000 and October 2007, 152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique. The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment, thus facilitating the balloon passing.

RESULTSBoth overall lesion and technique success rates were 91.5% (150/164). A total of 211 crushing wires were used during PCI, including 1 crushing wire for 117 (71.3%) lesions and 2 crushing wires for 47 (28.7%) lesions. Approximately 57.3% (121/211) of all crushing wires were those already used in the same procedure. Technique failure occurred in 14 lesions (8.5%). Technique failure was due to crushing wires entering false lumen (92.9%, 13/14) and coronary perforation (7.1%, 1/14). Major procedural complications included coronary perforation (1 case) and severe coronary dissection (2 cases), all of which were successfully treated.

CONCLUSIONSMulti-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI. It is feasible, economical and relatively safe with a low rate of procedural complications.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; instrumentation ; methods ; Chronic Disease ; Coronary Stenosis ; therapy ; Female ; Humans ; Male ; Middle Aged

BACKGROUNDAngioplasty in the unprotected left main coronary artery (LMCA) has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug eluting stent (DES), for treatment of unprotected LMCA disease.

METHODSBetween September 1997 and December 2005, a total of 297 consecutive patients underwent percutanous coronary intervention (PCI) on LMCA lesions in our hospital. Their in-hospital data and clinical follow-up outcomes were analyzed and those in pre-DES "era" (group I, from September 1997 to December 2002) were compared with those in DES "era" (group II, from January 2003 to December 2004. Patients in 2005 for the time of follow-up less than one year were not included in this group).

RESULTSAltogether 368 coronary stents were successfully deployed in 295 patients. Stents failed to be implanted after balloon predilation in two patients, who received coronary artery bypass graft (CABG) successfully. Bifurcation techniques for distal LMCA executed in 206 patients (69.4%, 206/297), included crossover stenting in 156 (75.7%), T stenting in 4 (1.9%), provisional T stenting in 28 (13.6%), kissing stenting in 5 (2.4%) and stent crushing in 13 (6.3%) patients. During their hospital stay, 5 (1.7%) patients died after PCI procedure, of which 4 died from cardiac origin and one of renal failure. The total in-hospital major adverse cardiac events (MACE) were 2.0% (6/297). In the follow-up period, 19 patients (6.5%) died [15 (5.1%) of cardiac death and 4 of non-fatal myocardial infarction (MI)]. Besides, 2 (0.7%) developed subacute thrombosis (SAT) and 16 (5.4%) performed target lesion revascularization (TLR). The total follow-up MACE was 14.5% (43/297). Further analysis also showed that, compared with patients in group I, those in group II apparently had more multi-vessel involvement (14.7% vs 81.9%, P < 0.001), and more bifurcation lesions (32.4% vs 72.2%, P < 0.001). After PCI, in-hospital MACE of group II was significantly lower than that in group I (1.1% vs 9.4%, P < 0.05). And the incidences of MACE, TLR and angiographic restenosis in group II were all significantly lower than those in group I (all P < 0.05) after one year follow-up.

CONCLUSIONSAs new PCI strategies and intervention devices such as DES are developed, coronary stenting, which might have brought better in-hospital and long-term outcomes than CABG, are proved to be technically successful and can be safely applied for the treatment of LMCA lesions in the experienced center for coronary intervention.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Disease ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Stents

BACKGROUNDCoronary chronic total occlusion (CTO) remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) for CTO.

METHODSClinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed.

RESULTSThere were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8% (1147/1263) and 88.9% (1445/1625), respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals > or = 15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions (P < 0.05). Procedural failure occurred in 116 patients, caused by impossibility of guide-wire (81.0%) or balloon (19.0%) to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary fistula during in-hospital period. The overall in-hospital MACE rate was 0.6% (8/1263). Drug-eluting stents were used in 198 patients without in-hospital MACE.

CONCLUSIONSIn an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; adverse effects ; Chronic Disease ; Coronary Angiography ; Coronary Disease ; diagnostic imaging ; therapy ; Drug Delivery Systems ; Female ; Humans ; Male ; Middle Aged ; Stents

BACKGROUNDLong-term efficacy and safety of tacrolimus-eluting stent (Janus) for treatment of coronary artery disease in percutaneous coronary interventions (PCI) "real world" is uncertain. The aim of this study was to evaluate the efficacy and safety of Janus stent for treating coronary heart disease in PCI daily practice, the safety of 4-month clopidogrel therapy after Janus stent implantation and the feasibility for treating patients with acute myocardial infarction (AMI) for first time.

METHODSFrom February 20, 2006 to August 26, 2006, a total of 200 patients were enrolled and randomly assigned to receive either Janus stent (n = 100) or bare metal stent (Tecnic Carbostent, n = 100). All patients were administered with clopidogrel for 4 months and aspirin for life long after stenting.

RESULTSBaseline clinical and angiographic characteristics were comparable between the two groups. AMI was present in 37% of patients with Janus and 36% with Tecnic Carbostent. At an average of 246-day follow-up, major adverse cardiac events (MACE) was 6% with the Janus stent and 15% with the Tecnic Carbostent (P = 0.038). Primary events included 1 cardiac death, 1 myocardial infarction (MI) due to subacute stent thrombosis and 13 target lesion revascularizations (TLR) due to restenosis in patients with Tecnic Carbostent and 6 TLR due to restenosis in patients with Janus stent. Although all patients had discontinued clopidogrel for an average of 126 days, there was no additional thrombotic event in the two groups.

CONCLUSIONSJanus stent is efficient in reducing MACE compared with Tecnic Carbostent at an average of 8-month follow-up. Discontinuation of clopidogrel at 4 months after PCI is safe for patients with Janus stent, including AMI patients. Long-term efficacy of Janus stent in reducing restenosis requires further study.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Disease ; therapy ; Drug Delivery Systems ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Prospective Studies ; Tacrolimus ; administration & dosage

OBJECTIVETo assess the technique and outcomes of coronary intervention treatment for patients with chronic total occlusion (CTO) lesions.

METHODSRetrospectively analyzed the data from 1148 patients with CTO who were treated by percutaneous coronary intervention (PCI) between June 1993 and December 2004. There were 1494 CTO lesions in 1458 vessels with a mean occlusion time of (49.1 +/- 31.6) months. A total of 1499 stents were implanted to those target lesions.

RESULTSTotal success rates of patients and lesions were 90.2% (1036/1148) and 88.2% (1317/1494), respectively. The success rate of PCI was declined in CTO lesions with long occlusion time, stump missing, bridging collaterals and >or= 15 mm in length (P < 0.05). Operative failures were occurred in 112 patients. Guide wire and balloon failed to pass through the occlusion accounted for 82.1% and 17.9% of all failures respectively. No death was occurred during operation, but 2 patients suffered from acute stent thrombosis and other 9 patients suffered from acute or later pericardium perforation. After procedure, there were 3 patients died and 3 patients suffered from subacute stent thrombosis during in-hospital period. The total in-hospital major adverse cardiac events rate was 0.6% (7/1148). The angina-free survival rate was 87.1% at discharge.

CONCLUSIONIn an experienced heart center, it is possible to obtain a relatively high success rate of PCI and ideal clinical outcomes in patients with CTO coronary lesions.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Chronic Disease ; Coronary Occlusion ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome

OBJECTIVETo evaluate the in-hospital outcome of patients with calcified chronic total occlusion (CTO) lesion underwent percutaneous coronary intervention (PCI).

METHODSThe clinic and lesion characteristics as well as acute PCI outcome were analyzed in 726 patients with calcified CTO [624 detected by coronary angiography (CAG) and 102 detected by intravascular ultrasound (IVUS)] and received PCI therapy from June 1995 to February 2007 in our department.

RESULTSThere were 728 diseased vessels with 732 lesions in these patients. Total procedure success rate (80.6% vs. 89.2%, P < 0.05) and the lesion success rate (80.2% vs. 88.2%, P < 0.05) were significantly lower in calcified CTO detected by CAG compared to that detected by IVUS. The causes of procedure failures in CAG detected patients were as follows: 87 guide failure, 21 balloon failure, 8 procedure related complications and 5 low TIMI blood flow (grade 2) at the end of PCI procedure. The causes of procedure failures in IVUS detected patients were as follows: 7 guide wire failure, 2 balloon failure, 1 procedure related complications and 1 patient with low TIMI blood flow (grade 2). The in-hospital major adverse cardiac events (MACE) rate was 1.1% in CAG detected calcified CTO and 1.0% in IVUS detected calcified CTO (P > 0.05).

CONCLUSIONPCI therapy resulted in satisfactory procedure success rate and in-hospital outcome for patients with calcified CTO and IVUS is helpful for further increasing the PCI procedure success rate in patients with calcified CTO.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Calcinosis ; therapy ; Coronary Angiography ; Coronary Artery Disease ; pathology ; therapy ; Coronary Occlusion ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Ultrasonography, Interventional