Objective To evaluate the effect of end-stage renal disease(ESRD)hemodialysis(HD)on the prognosis of elderly patients undergoing drug-eluting stent(DES)implantation.Methods A retrospective trial was conducted on 4219 consecutive patients(＞60 years old)undergoing DES treatment at Guro Hospital of Korea University from March 2003 to July 2021,and those with GFR ≥ 1 5 ml/(min·1.73 m2)but not on dialysis were assigned into the non-ESRD group(n=4102)and the others on dialysis into the ESRD group(n=117).Based on their baseline data,a propensity score matching(PSM)model was established,including 183 cases of the non-ESRD group and 99 cases of the ESRD group.The patients were followed up for 1,3 and 5 years,and the incidences of MACE and other endpoint events were recorded during the period.Kaplan-Meier sur-vival curve was plotted,and PSM and multivariate Cox regression models were employed to verify the endpoint events.Results Before PSM,the elderly ESRD group had obviously larger propor-tions of hypertension,diabetes,peripheral vascular disease and other diagnoses than the elderly non-ESRD group(P＜0.01).Univariate Cox regression analysis showed that ESRD was a risk fac-tor for all-cause mortality in the elderly patients at 1,3 and 5 years after DES implantation(P＜0.05,P＜0.01);a risk factor for MACE at 3 and 5 years after implantation(HR=2.67,95％CI:1.73-4.10,P=0.000;HR=2.65,95％CI:1.79-3.90,P=0.000);and a risk factor for develo-ping TVR,TLR,NTVR and revascularization at 5 years after surgery(P＜0.05,P＜0.01).Kaplan-Meier survival curve showed that the incidence of MACE in the elderly ESRD group was higher than that in the elderly non-ESRD group at 5-year follow-up(Plog rank=0.006).Conclusion ESRD significantly increases the risk of long-term MACE after DES implantation in elderly patients.

Objective To investigate the predictive value of combined plasma gluconic acid(GA),fumaric acid(FA),and pseudouridine levels at admission for acute kidney injury(AKI)in elderly patients with acute myocardial infarction(AMI).Methods A total of 78 elderly AMI patients transferred from Emergency Department to Coronary Care Unit in Fuwai Hospital during Decem-ber 2021 and July 2022 were enrolled in this prospective study.They were divided into AKI group(40 cases)and non-AKI group(38 cases)according to whether they developed AKI during hospi-talization.Plasma levels of GA,FA and pseudouridine were quantitatively detected with liquid chromatography-tandem mass spectrometry.ROC curve was plotted to assess the predictive value of these three plasma metabolites for AKI in AMI patients.Multivariate logistic regression analy-sis was applied to analyze the clinical risk factors for AKI.Results There were no statistical differences in the plasma levels of GA,FA and pseudouridine between the AKI group and the non-AKI group(P＞0.05).ROC curve analysis revealed that the plasma levels of the three indicators had no predictive value for the development of AKI in elderly AMI patients(AUC=0.576,95％CI:0.449-0.704,P=0.246;AUC=0.595,95％CI:0.467--0.721,P=0.154;AUC=0.563,95％CI:0.435-0.692,P=0.337).Multivariate logistic regression analysis revealed that left ventricu-lar ejection fraction(LVEF)was an independent predictor for AKI development in elderly AMI patients(OR=0.923,95％CI:0.870-0.978,P=0.007).Conclusion Plasma GA,FA and pseud-ouridine cannot predict the development of AKI in elderly AMI patients,while,LVEF is an inde-pendent predictor for the development.

Objective To investigate the predictive value of serum lipoprotein-associated phospho-lipase A2(Lp-PLA2)for long-term prognosis of elderly patients with stable coronary heart dis-ease(CHD).Methods A retrospective trial was conducted on 198 patients with stable CHD ad-mitted to our hospital from January 2016 to December 2018.All of them were followed up for 5 years,and divided into adverse cardiovascular event group(n=42)and control group(n=156)according to whether adverse cardiovascular events occurred during follow-up.Clinical features and Lp-PLA2 level were compared between the two groups.The predictive value of Lp-PLA2 for adverse cardiovascular events was analyzed in elderly patients with stable CHD within 5 years.Re-sults The adverse cardiovascular event group had significantly older age(74.95±7.02 vs 70.17±6.30 years,P=0.000),larger proportions of diabetes(54.76％vs 27.56％,P=0.001),of coronary artery stenosis ≥75％(69.05％vs 47.44％,P=0.013)and of left ventricular ejection fraction(LVEF)＜50％(50.00％vs 28.21％,P=0.008),and higher Lp-PLA2 level(478.38±187.54 U/L vs 308.17±126.73 U/L,P=0.000)when compared with the control group.The AUC value of age and Lp-PLA2 was 0.683(95％CI:0.590--0.776,P＜0.001)and 0.763(95％CI:0.677--0.848,P=0.763),respectively,in predicting the long-term prognosis in elderly patients with stable CHD.Multivariate logistic regression analysis showed that age,diabetes,coronary artery stenosis ≥75％,LVEF＜50％and Lp-PLA2 were independent influencing factors for adverse cardiovascular events within 5 years in elderly patients with stable CHD(P＜0.05,P＜0.01).Con-clusion Increased Lp-PLA2 level is associated with adverse cardiovascular events within 5 years in patients with stable CHD.

Objective To investigate the expression of serum human cartilage glycoprotein 39(YKL-40)and soluble growth stimulating gene 2 protein(sST2)in elderly patients with acute myocardial infarction(AMI)and their relationship with myocardial fibrosis and myocardial injury.Methods From January 2020 to April 2023,a cohort of 212 AMI patients admitted in Department of Cardiovascular Diseases of Dongguan Hospital of Traditional Chinese Medicine were enrolled and assigned into the patient group,and another 80 ostensibly healthy volunteers taking physical examinations during the same period were subjected and served as control group.Serum levels of YKL-40 and sST2 and the indicators related myocardial fibrosis and injury[including hyaluronic acid(HA),type Ⅲ procollagen(PCⅢ),type Ⅲ procollagen amino terminal peptide(PⅢNP),cardiac troponin Ⅰ(cTnⅠ),creatine kinase isoenzyme(CK-MB),and N-terminal B-type natriuretic peptide precursor(NT-proBNP)]at admission were detected,and the correlation of serum YKL-40 and sST2 levels with myocardial fibrosis and injury was analyzed.According the occurrence of ma-jor adverse cardiovascular events(MACE)during 28-day follow-up,the patients were stratified in-to MACE(68 cases)and non-MACE(144 cases)subgroups.Multivariate logistic regression analysis was employed to analyze the determinants of serum YKL-40,sST2,myocardial fibrosis,and myocardial injury to the occurrence of MACE.Results The patients had significantly higher serum levels of YKL-40,sST2,PCⅢ,HA,PⅢ NP,cTnⅠ,CK-MB and NT-proBNP than the con-trol group(P＜0.01).Both serum YKL-40 and sST2 levels were positively correlated with the levels of PC Ⅲ,HA,PⅢ NP,cTnⅠ,CK-MB and NT-proBNP.The serum levels of YKL-40,sST2,PCⅢ,HA,PⅢNP,cTnⅠ,CK-MB and NT-proBNP were obviously higher in the MACE sub group than the non-MACE sub group(P＜0.01).Multivariate logistic regression analysis indicated that YKL-40(OR=1.964,95％CI:1.643-2.348,P=0.000),sST2(OR=2.457,95％CI:2.020-2.989,P=0.000),PC Ⅲ(OR=1.654,95％CI:1.312-2.084,P=0.000),HA(OR=1.505,95％CI:1.185-1.912,P=0.001),PⅢ NP(OR=1.483,95％CI:1.120-1.963,P=0.006),cTnⅠ(OR=1.365,95％CI:1.102-1.690,P=0.004),CK-MB(OR=1.514,95％CI:1.009-2.272,P=0.045)and NT-proBNP(OR=1.824,95％CI:1.011-3.290,P=0.046)were influencing factors for MACE in elderly AMI patients.Conclusion Serum YKL-40 and sST2 levels are abnormally higher in elderly AMI patients,and are closely associated with myocardial fibrosis and injury.

Objective To investigate the changes in peripheral blood galectin-3(Gal-3)and platelet to lymphocyte ratio(PLR)and their relationship with ventricular remodeling in elderly patients over 75 years old with acute myocardial infarction(AMI)after PCI.Methods A total of 86 AMI patients(aged ≥75 years)undergoing elective PCI in our hospital from March 2021 to September 2023 were recruited in this study.According to ventricular remodeling occurred or not after PCI,they were divided into ventricular remodeling group(39 cases)and non-ventricular remodeling group(47 cases).Gal-3 level and PLR were detected and calculated before and in 3 and 5 d after PCI,and the results were compared between the two groups.Multivariate logistic regression anal-ysis was used to analyze the relationship of Gal-3 and PLR with ventricular remodeling in elderly AMI patients after PCI,and ROC curve was plotted to study the predictive value of the two indi-cators for ventricular remodeling.Results In the elderly AMI patients,the levels of Gal-3 and PLR were decreased in 3 and 5 d after PCI than before operation,and the levels at 5 d were lower than those of 3 d after operation(P＜0.05).The ventricular remodeling group had obviously high-er levels of Gal-3 and PLR in peripheral blood than the non-ventricular remodeling group before and in 3 and 5 d after PCI(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that Gal-3(OR=1.986,95％CI:1.017-2.875,P=0.007)and PLR(OR=1.774,95％CI:1.132-2.428,P=0.014)were risk factors for ventricular remodeling in AMI patients after PCI.ROC curve indicated that the AUC value of combined Gal-3 and PLR before PCI in predicting ventricu-lar remodeling in the AMI patients after PCI was 0.882(95％CI:0.824-0.941),which was supe-rior to the value of the two indicator alone(P＜0.05).Conclusion The levels of Gal-3 and PLR in peripheral blood are lower in the elderly AMI patients after PCI than before PCI,and the two in-dicators are risk factors for ventricular remodeling in these patients after PCI.Combined detection of them has high predictive value for ventricular remodeling in the patients.

Objective To investigate the effect and clinical efficacy of dapagliflozin on homocysteine(Hcy),uric acid(UA),and cystatin C(Cys C)in elderly patients with type 2 diabetes mellitus(T2DM)complicated by nephropathy and hypertension.Methods A total of 292 patients diag-nosed with T2DM nephropathy and hypertension admitted to our hospital between December 2022 and June 2023 were retrospectively recruited,and based on their medication regimens,they were divided into dapagliflozin group(147 cases)and control group(145 cases).After all of them were followed up for 3 months,the serum levels of Hcy,UA,cys C,urinary microalbumin/urinary creatinine ratio(UACR),estimated glomerular filtration rate(eGFR),and other metabolism-related indicators were measured and compared before and after treatment.Pearson correlation analysis was used to determine the correlation between Hcy and UA,while logistic regression analysis was employed to identify risk factors for proteinuria among the patients with T2DM ne-phropathy and hypertension.Results After treatment,the BMI,SBP,DBP,FBG,glycosylated Hb,TC,TG,LDL-C,UA,Cys C,Hcy,insulin resistance index(HOMA-IR),and UACR were all decreased in comparison to their levels before treatment(P＜0.05).Dapagliflozin treatment resul-ted in more significant declines in BM1,FBG,LDL-C,UA,Cys C,Hcy,HOMA-IR,and UACR when compared with the control group(P＜0.05,P＜0.01).Pearson correlation analysis revealed that the relationship between Hcy and UA was positively correlated across the entire population(r=0.560,P＜0.01),as well as among males(r=0.510,P＜0.01)and females(r=0.640,P＜0.01).Multivariate logistic regression analysis identified female gender,diabetic peripheral neu-ropathy,TC,eGFR,and Hcy ≥15 μmol/L as independent risk factors for proteinuria among eld-erly patients with T2DM nephropathy and hypertension(P＜0.05,P＜0.01).Conclusion Dapa-gliflozin,a novel antidiabetic agent,may offer further renal protection by lowering Hcy and UA levels in patients with T2DM nephropathy and hypertension.It can potentially decelerate the pro-gression of proteinuria and improve patient's outcomes.

Objective To investigate the impact of hemoglobin(Hb)level on the risk of all-cause mortality in elderly patients with stable coronary artery disease(SCAD)treated by percutaneous coronary intervention(PCI).Methods A retrospective cohort study was conducted on 195 elderly SCAD patients treated by PCI in our hospital from June 2016 to December 2017,a total of 180 case were followed up.They were divided into four groups based on quartiles of Hb levels:Q1 group[≤122(108.28±12.53)g/L,n=47],Q2 group[122＜Hb≤137(130.07±4.33)g/L,n=43],Q3 group[137＜Hb≤148(142.67±3.10)g/L,n=46],and Q4 group[＞148(158.36±8.50)g/L,n=44].Their clinical data were collected and compared among the groups.All patients were followed up,with all-cause mortality as endpoint.Cox regression analysis was used to evaluate the impact of Hb level on all-cause mortality in elderly SCAD patients treated by PCI.Results For the 180 patients with complete follow-up,the median follow-up time was 703(415,1121)d,and the incidence of all-cause mortality was 10.00％(totally 18 deaths).And the incidence was 25.50％(12 deaths),7.00％(3 death),4.30％(2 deaths)and 2.30％(1 death)in Q1,Q2,Q3,and Q4 groups,respectively,with statistically significant differences(P＜0.01).Univariate Cox regression analysis showed age was a risk factor for all-cause death(P＜0.01),while Hb level,BMI,smoking history,dyslipidemia,and aspirin use were a risk facotr for all-cause death(P＜0.05,P＜0.01).Further multivariate Cox regression analysis revealed Hb level was a risk facotr for all-cause death(HR=0.96,95％CI:0.93-0.99,P＜0.01).The risk of all-cause mortality was 3.68 times higher in the Q1 group than the Q2 group(HR=3.68,95％CI:1.01-13.45,P＜0.05),and there was no correlation in the incidence between the Q3 and Q4 groups(P＞0.05).Conclusion Low Hb level is an independent predictor for all-cause mortality in elderly SCAD pa-tients after PCI.

Objective To explore the risk factors and prognosis of cardiogenic shock in elderly pa-tients with acute myocardial infarction(AMI).Methods A retrospective trial was conducted on 398 AMI patients admitted to our hospital from January 2020 to December 2023.Based on occur-rence of cardiogenic shock during hospitalization or not,they were divided into a cardiogenic shock group(n=99)and a control group(n=299).Clinical characteristics were compared between the two groups to analyze the risk factors of cardiogenic shock,and the impact of cardiogenic shock on the prognosis was investigated.Results The cardiogenic shock group had significantly larger pro-portions of aged ≥80 years,diabetes,coronary artery lesion ≥2 branches,left main coronary ar-tery disease,history of myocardial infarction than the control group(P＜0.05,P＜0.01).Aged 80 years,diabetes,diseased branches ≥2,left main artery disease and history of myocardial infarc-tion were independent influencing factors of cardiogenic shock in elderly AMI patients(OR=2.280,95％CI:1.294-4.017,P=0.004;OR=2.326,95％CI:1.281-4.225,P=0.006;OR=3.868,95％CI:2.145-6.975,P=0.000;OR=3.587,95％CI:1.868-6.886,P=0.000;OR=4.040,95％CI:1.951-8.365,P=0.000).Based on these relevant risk factors,a prediction model was constructed.The AUC value of the model in the training set was 0.799(95％CI:0.736-0.862),while the value for the validation set was 0.737(95％CI:0.634-0.840).Hosmer-Lemeshow Goodness of Fit test showed the model had good reliability(x2=7.117,P=0.524).The in-hospital mortality rate was significantly higher in the cardiogenic shock group than the control group(12.12％vs 0.67％,P=0.000).Conclusion Cardiogenic shock can lead to poor prognosis in elderly AMI patients.Aged ≥80 years,diabetes,diseased branches ≥2,left main ar-tery disease and history of myocardial infarction are independent risk factors for cardiogenic shock.

Objective To investigate the long-term effect of frailty on heart failure with reduced ejection fraction(HFrEF)in elderly patients.Methods A retrospective analysis was conducted on 245 HFrEF patients aged ≥75 years admitted to our hospital from October 2017 to October 2020 due to acute exacerbation of chronic heart failure(HF).Based on their clinical frailty scale(CFS)score,they were divided into frailty group(1-4,135 cases)and non-frailty group(5-9,110 cases).Their general clinical data,clinical medication,and prognosis were compared between the two groups,and the influencing factors for frailty and death were analyzed.Results Faster heart rate,higher NT-proBNP level,and larger proportions of male,diabetes,coronary heart disease,≥5 chronic diseases,LVEF ≤35％,anemia and increased troponin I level,while lower BMI,eGFR and score of activity of daily living scale were observed in the frailty group than the non-frailty group(P＜0.05,P＜0.01).The frail group had significantly lower utilization rates of angiotensin converting enzyme inhibitors(ACEI),angiotensin receptor blockers(ARB),angiotensin receptor enkephalin inhibitors(ARNI)β receptor blockers,and sodium-glucose cotransporter 2 inhibitors than the non-frailty group(P＜0.01).Additionally,the frailty group exhibited a higher incidence of emergency room visits/readmissions within 3 months and 2-year mortality than the non-frailty group(P＜0.05,P＜0.01).Binary logistic regression analysis revealed that ≥5 chronic diseases,LVEF ≤ 35％,BMI,and GFR were independent risk factors for frailty(OR=0.167,95％CI:0.064-0.453,P=0.000;OR=0.306,95％CI:0.160-0.586,P=0.000;OR=0.868,95％CI:0.786-0.958,P=0.005;OR=0.966,95％CI:0.943-0.991,P=0.007),while ≥5 chronic disea-ses and frailty were independent risk factors for death in HF patients(P＜0.05).Conclusion The incidence of frailty is high in elderly HF patients with HFrEF.They have poor compliance to guideline directed drug therapy(GDMT).Frailty is an independent risk factor for long-term mor-tality in the patients.

Objective To investigate the correlation between triacylglycerol-rich lipoprotein choles-terol(TRL-C)level and the severity of coronary artery disease in elderly patients with coronary heart disease(CHD).Methods A total of 220 elderly CHD patients who underwent coronary an-giography in our hospital from January 1 to December 31,2020 were enrolled in this study.They were divided into mild coronary artery disease group(SYNTAX score 1-22,158 cases)and mod-erate to severe coronary artery disease group(SYNTAX score ≥23,62 cases).Logistic regression analysis and ROC curve analysis were used.Results Compared with the mild coronary artery dis-ease group,the moderate and severe coronary artery disease group had significantly lower albu-min,apolipoprotein(Apo)A and platelet count,while increased cTnT,NT-proBNP and TRL-C levels(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that TRL-C was a risk factor(OR=4.450,95％CI:1.572-12.599,P=0.005),while albumin was a protective factor for coronary artery disease(OR=0.880,95％CI:0.794-0.977,P=0.016).ROC curve analysis indi-cated that the AUC value of TRL-C for diagnosing moderate to severe coronary lesions was 0.655(95％CI:0.580-0.731).Conclusion TRL-C has a predictive value for the severity of coronary artery disease in elderly CHD patients,and has a predictive value for moderate to severe coronary artery disease.