OBJECTIVE: To explore the prognosis and influencing factors of ST-segment elevation myocardial infarction (STEMI) due to late stent thrombosis (LST) and very late stent thrombosis (VLST). METHODS: Patients who underwent percutaneous coronary intervention (PCI) for STEMI caused by LST and VLST at Tianjin Chest Hospital from January 2016 to June 2021 were selected as the study subjects, and long-term follow-up was conducted. The baseline clinical features, laboratory examination indicators, echocardiography results, coronary angiography and intervention treatment characteristics, and antiplatelet treatment status of patients were collected. The study endpoint was major adverse cardiovascular event (MACE), including all-cause mortality, target vessel revascularization (TVR), myocardial infarction, and recurrent stent thrombosis (RST). Patients were divided into MACE group and non-MACE group based on the occurrence of MACE. Cox regression analysis was used to determine the univariate and multivariate predictive factors for MACE occurrence in STEMI patients caused by LST and VLST during long-term follow-up after PCI. Kaplan-Meier survival curves were plotted to analyze the cumulative survival rate without MACE during follow-up in subgroups of patients with different levels of fibrinogen (Fib) and initial number of stents. The incidence of MACE among patients receiving different drug-eluting stent (DES) treatments was compared. RESULTS: A total of 418 patients diagnosed STEMI caused by LST and VLST through coronary angiography were enrolled, of which 115 had MACE and 303 did not. Among them, 404 cases (96.65%) completed follow-up, with a median follow-up time of 27.25 (18.00, 37.00) months. Cox regression analysis showed that Fib [hazard ratio (HR) = 2.840, 95% confidence interval (95%CI) was 1.329-6.066, P = 0.007], non-culprit vascular stenosis > 50% (HR = 5.974, 95%CI was 1.634-21.848, P = 0.007), initial stent quantity (HR = 3.314, 95%CI was 1.677-6.552, P = 0.001), B2/C lesions (HR = 5.463, 95%CI was 1.396-21.373, P = 0.015), and cardiogenic shock (HR = 4.141, 95%CI was 1.101-15.568, P = 0.035) were independently associated with the occurrence of MACE. The Kaplan-Meier survival curve showed that the higher the Fib level, the lower the cumulative survival rate without MACE (82.8%, 70.1%, 40.5%, P < 0.01); the more initial stents, the lower the cumulative survival rate without MACE (75.0%, 57.7%, 36.5%), with patients with initial stents ≥ 3 having the lowest cumulative survival rate without MACE (P < 0.001). A total of 210 patients (50.2%) received secondary stent treatment, and there was no significant difference in the incidence of MACE between patients receiving first and second generation DES treatment (27.3% vs. 24.7%, P > 0.05), but patients receiving first generation DES had a higher proportion of all-cause mortality (22.3% vs. 10.1%, P < 0.05). Compared with patients receiving smaller diameter DES treatment (< 2.75 mm), patients receiving larger diameter DES treatment (≥2.75 mm) had a significantly lower incidence of MACE (20.5% vs. 35.9%, P < 0.05). CONCLUSIONS Long-term clinical outcomes after PCI for STEMI due to LST and VLST are unfavorable, with a high rate of MACE. The treatment of this particular type STEMI remains challenging, re-implantation of second generation DES or a larger diameter DES (≥2.75 mm) may be beneficial.
Humans ; Percutaneous Coronary Intervention/methods* ; ST Elevation Myocardial Infarction/therapy* ; Stents ; Prognosis ; Thrombosis/etiology* ; Female ; Male ; Coronary Angiography ; Treatment Outcome ; Risk Factors ; Middle Aged ; Drug-Eluting Stents ; Proportional Hazards Models

Based on mass spectrometry(MS)-guided separation strategy, compound 1 was obtained from the roots of Rhus chinensis. By comprehensive analysis of high resolution-electrospray ionization-mass spectrometry(HR-ESI-MS), nuclear magnetic resonance(NMR) data, and quantum chemical calculation of NMR(qcc-NMR) parameters, compound 1 was elucidated as rhuslactone, a 17-epi-dammarane triterpenoid with a rare 17α-side chain. An HPLC-ELSD method for its quantification in R. chinensis was established and adopted for the quantification of rhuslactone in different batches of R. chinensis. Rhuslactone displayed a good linear relationship within the range of 0.021 3-1.07 μmol·mL~(-1 )(r=0.997 6), and the average recovery was 99.34% [relative standard deviation(RSD) 2.9%). Moreover, the results of the evaluation test of the preventive effects of rhusalctone on coronary heart disease(CHD) and thrombosis showed that rhuslactone(0.11 nmol·mL~(-1)) significantly alleviated heart enlargement and venous congestion and increased cardiac output(CO), blood flow velocity(BFV), and heart rate, thereby reducing thrombus formation in zebrafish with CHD. The effects of rhuslactone on CO and BFV were superior to that of digoxin(1.02 nmol·mL~(-1)), and its effect on improving heart rate was comparable to that of digoxin. This study provides experimental references for the isolation, identification, quality control, and application of rhuslactone from R. chinensis against CHD. It is worth mentioning that this study has discussed some omissions in the determination of the stereochemistry of C-17 in dammarane triterpenoids in the present coursebook Chemistry of Chinese Medicine and some research papers, that is, the compound may be 17-epi-dammarane triterpenoid. This paper has also proposed steps for the establishment of C-17 stereochemistry.
Animals ; Zebrafish ; Rhus/chemistry* ; Triterpenes/analysis* ; Coronary Disease ; Thrombosis

BACKGROUND: The HELIOS stent is a sirolimus-eluting stent with a biodegradable polymer and titanium oxide film as the tie-layer. The study aimed to evaluate the safety and efficacy of HELIOS stent in a real-world setting. METHODS: The HELIOS registry is a prospective, multicenter, cohort study conducted at 38 centers across China between November 2018 and December 2019. A total of 3060 consecutive patients were enrolled after application of minimal inclusion and exclusion criteria. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, non-fatal target vessel myocardial infarction (MI), and clinically indicated target lesion revascularization (TLR) at 1-year follow-up. Kaplan-Meier methods were used to estimate the cumulative incidence of clinical events and construct survival curves. RESULTS: A total of 2998 (98.0%) patients completed the 1-year follow-up. The 1-year incidence of TLF was 3.10% (94/2998, 95% closed interval: 2.54-3.78%). The rates of cardiac death, non-fatal target vessel MI and clinically indicated TLR were 2.33% (70/2998), 0.20% (6/2998), and 0.70% (21/2998), respectively. The rate of stent thrombosis was 0.33% (10/2998). Age ≥60 years, diabetes mellitus, family history of coronary artery disease, acute myocardial infarction at admission, and device success were independent predictors of TLF at 1 year. CONCLUSION: The 1-year incidence rates of TLF and stent thrombosis were 3.10% and 0.33%, respectively, in patients treated with HELIOS stents. Our results provide clinical evidence for interventional cardiologists and policymakers to evaluate HELIOS stent. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03916432.
Humans ; Middle Aged ; Sirolimus/therapeutic use* ; Drug-Eluting Stents/adverse effects* ; Prospective Studies ; Cohort Studies ; Treatment Outcome ; Risk Factors ; Time Factors ; Percutaneous Coronary Intervention/adverse effects* ; Cardiovascular Agents/therapeutic use* ; Coronary Artery Disease/therapy* ; Myocardial Infarction/etiology* ; Thrombosis/complications* ; Polymers ; Registries

BACKGROUND

Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard for the prevention of thrombotic events in patients undergoing percutaneous coronary intervention (PCI). Type 2 diabetes mellitus (DM) patients are a subgroup with a higher risk of bleeding and thrombotic events after PCI.

This meta-analysis aimed to determine whether ticagrelor monotherapy after an initial short-course DAPT is an effective and safe option in preventing thrombotic events among DM patients undergoing PC.

A systematic review and meta-analysis was done on randomized controlled trials (RCT) comparing ticagrelor monotherapy following short-course DAPT versus conventional DAPT in T2DM patients who underwent PCI. Outcome measures for major bleeding, myocardial infarction, and all-cause mortality were extracted and analyzed using a random-effects model via RevMan version 5.3.

A total of three RCTs, with 7482 patients, were analyzed. There were no significant differences in major bleeding (P = 0.26) and myocardial infarction (P = 0.66) events between the ticagrelor and DAPT groups. However, there was a higher rate of all-cause mortality in the DAPT group, which was statistically significant (risk ratio, 0.76; 95% confidence interval, 0.59–0.98; P = 0.03).

Ticagrelor monotherapy following short course DAPT and conventional DAPT have similar rates of major bleeding and myocardial infarction among DM patients undergoing PCI with DES. However, conventional DAPT has a higher incidence of all-cause mortality, which suggests that ticagrelor monotherapy after short-course DAPT may be a preferable antiplatelet strategy in DM patients undergoing PCI.

Humans ; Coronary Aneurysm/etiology* ; Mucocutaneous Lymph Node Syndrome/complications* ; Hemodynamics ; Coronary Angiography ; Thrombosis ; Risk Assessment

OBJECTIVE: To investigate the significance and distribution of oxidized low-density lipoprotein antibodies (ox-LDL-Ab) in patients with antiphospholipid syndrome (APS). METHODS: In this study, 334 patients who were hospitalized in the Department of Rheumatology and Immunology, Peking University People's Hospital were included. There were 162 APS patients, 122 patients with other autoimmune diseases without thrombosis or obstetric disease as disease control and 50 healthy controls. The clinical data and laboratory indicators were retrospectively collected. The ox-LDL-Ab, anticardiolipin (aCL) IgG/IgA/IgM, and anti-β2-glycoprotein Ⅰ (aβ2GPI) IgG/IgA/IgM were detected by enzyme-linked immunosorbent assay (ELISA). The relationship between ox-LDL-Ab and clinical and laboratory parameters were analyzed by SPSS 27.0. RESULTS: In APS group, 60.5% of patients had thrombosis, 48.1% had pregnancy morbidity, 34.0% had thrombocytopenia. The positive rates of aCL, aβ2GPI and lupus anticoagulant (LAC) were 17.9%, 34.6%, and 46.9%, respectively. The ox-LDL-Ab titers and positive rate in APS group were higher than that in healthy controls [titers: 40.8 (25.4-66.0) U/mL vs. 24.1 (12.3-36.5) U/mL, P=0.001; positive rate: 67.3% vs. 36.0%, P=0.001]. The diffe-rences in titers and positive rate of ox-LDL-Ab between APS patients and disease controls were not statistically significant [titers: 40.8 (25.4-66.0) U/mL vs. 35.9 (24.2-53.1) U/mL, P=0.118; positive rate: 67.3% vs. 61.5%, P=0.318]. The area under curve (AUC) for aβ2GPI, aCL, and ox-LDL-Ab were 0.745 (95%CI: 0.692-0.797), 0.666 (95%CI: 0.608-0.724), 0.609 (95%CI: 0.549-0.669), respectively. The Youden's index was 0.388, 0.269, and 0.132, respectively. The AUC for ox-LDL-Ab in seronegative APS patients was 0.562 (95%CI: 0.480-0.645). The sensitivity and specificity of ox-LDL-Ab in seronegative APS patients were 63.9% and 47.0%, respectively, and the Youden's index was 0.109. The ox-LDL-Ab positive group had higher positive rate of aβ2GPI (42.2% vs. 18.9%, P=0.003) and aCL (22.9% vs. 7.5%, P=0.017) than the ox-LDL-Ab negative group. There was no correlation between ox-LDL-Ab and thrombosis, coronary artery disease, pregnancy morbidity, hyperlipidemia, hypocomplementemia, and LAC positivity. CONCLUSION Ox-LDL-Ab was correlated with aCL and aβ2GPI, and no association were observed between ox-LDL-Ab and thrombosis, coronary artery disease, and pregnancy morbidity.
Pregnancy ; Female ; Humans ; Antiphospholipid Syndrome ; Antibodies, Anticardiolipin ; Retrospective Studies ; Coronary Artery Disease ; Clinical Relevance ; beta 2-Glycoprotein I ; Lupus Coagulation Inhibitor ; Lipoproteins, LDL ; Autoantibodies ; Immunoglobulin G ; Immunoglobulin A ; Thrombosis ; Immunoglobulin M

Objective: To investigate the related factors of left ventricular thrombus (LVT) formation within two weeks in patients with acute ST-segment elevation myocardial infarction (STEMI) and left ventricular aneurysm (LVA). Methods: Consecutive inpatients with acute STEMI and left ventricular aneurysm, hospitalized from January 2014 to June 2020 in the First Affiliated Hospital of Zhengzhou University, were enrolled in this retrospective study. Patients were divided into LVT group and non-LVT group according to the presence or absence of LVT. The clinical data, echocardiography findings, coronary angiography and treatments were compared between the two groups. Subgroup analysis was performed on the patients receiving primary percutaneous coronary intervention (PCI). Onset to door, door to balloon, onset to balloon time were also compared. Multivariate logistic regression was used to analyze the related factors of LVT formation early post STEMI in enrolled patients. The effects of each index in multivariate logistic regression analysis were illustrated in the forest plot. Results: A total of 144 patients were included, there were 52 cases (36.1%) in LVT group, the age was (56.4±11.2) years, and 46 (88.5%) cases were male. There were 92 cases (63.9%) in non-LVT group, the age was (61.7±11.5) years, and there were 73 (79.3%) males in this group. The patients in LVT group were younger than those in non-LVT group, the proportion of anemia, history of heavy drinking, history of chronic kidney disease, left ventricular ejection fraction (LVEF) ≤40%, preoperative thrombosis in myocardial infarction (TIMI) blood flow grade 0 and postoperative TIMI blood flow grade ≤2 were significantly higher in LVT group than those in non-LVT group (all P<0.05). The incidence of history of angina, collateral circulation of the coronary arteries, primary PCI or venous thrombolysis were significantly lower in LVT group than those in non-LVT group (all P<0.05). The percentage of anti-platelet therapy and anticoagulant therapy was similar between the two groups (all P˃0.05). Subgroup analysis in patients undergoing primary PCI showed that onset to door, door to balloon, onset to balloon time were similar between the two groups. Multivariate logistic regression analysis and forest plot showed that history of heavy drinking (OR=6.982, 95%CI 1.501-32.469, P=0.013), anemia (OR=3.373, 95%CI 1.075-10.585, P=0.037), LVEF≤40% (OR=3.016, 95%CI 1.027-8.859, P=0.045), preoperative TIMI blood flow grade 0 (OR=3.311, 95%CI 1.214-9.029, P=0.019) were positively correlated with LVT in patients with acute STEMI and LVA. History of angina (OR=0.159, 95%CI 0.058-0.441, P<0.001), collateral circulation of the coronary arteries (OR=0.189, 95%CI 0.053-0.673, P=0.010), primary PCI or venous thrombolysis (OR=0.252, 95%CI 0.093-0.682, P=0.007) were negatively correlated with LVT in patients with acute STEMI and LVA. Conclusions: History of heavy drinking, anemia, LVEF ≤40%, preoperative TIMI blood flow grade 0 are associated with increased risk of the LVT in patients with acute STEMI and LVA at early stage of the disease. However, history of angina, collateral circulation of the coronary arteries, primary PCI or venous thrombolysis are associated with lower risk of the LVT in these patients.
Aged ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Retrospective Studies ; ST Elevation Myocardial Infarction ; Stroke Volume ; Thrombosis ; Ventricular Function, Left

BACKGROUND AND OBJECTIVES: The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI.METHODS: Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10–30 cases/year), and below the 25th percentile (<10 cases/year) were defined as high, moderate, and low-volume operators, respectively. In-hospital outcomes including mortality, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were analyzed.RESULTS: The average number of primary PCI cases performed by 373 operators was 22.2 in a year. In-hospital mortality after PCI for STEMI was 571 cases (6.9%). In-hospital outcomes by operator volume showed no significant differences in the death rate, cardiac death, non-fatal MI, and stent thrombosis. However, the rate of urgent repeat PCI tended to be lower in the high-volume operator (0.6%) than in the moderate-(0.7%)/low-(1.5%) volume operator groups (p=0.095). The adjusted odds ratios for adverse in-hospital outcomes were similar in the 3 groups. Multivariate analysis also showed that operator volume was not a predictor for adverse in-hospital outcomes.CONCLUSIONS: In-hospital outcomes after primary PCI for STEMI were not associated with operator volume in the K-PCI registry.
Cohort Studies ; Death ; Hospital Mortality ; Humans ; Mortality ; Multivariate Analysis ; Myocardial Infarction ; Odds Ratio ; Percutaneous Coronary Intervention ; Retrospective Studies ; Stents ; Stroke ; Thrombosis ; Treatment Outcome

BACKGROUND AND OBJECTIVES: There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI).METHODS: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months.RESULTS: After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31–3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924).CONCLUSIONS: Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.
Aspirin ; Drug-Eluting Stents ; Hemorrhage ; Humans ; Incidence ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Stents ; Stroke ; Thrombosis

Atrial Fibrillation/complications* ; Coronary Angiography ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction/complications* ; Saphenous Vein ; Thrombosis