BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

OBJECTIVE: To investigate the serum level of lumican (LUM) and its clinical correlation with disease and immune activities in patients with rheumatoid arthritis (RA). METHODS: The serum LUM levels in both RA patients and health controls (HCs) were detected by enzyme-linked immunosorbent assay (ELISA). The clinical and laboratory data of the patients were collected. The LUM levels in the patients with different clinical features were analyzed. The correlation between the clinical data, laboratory parameters, and serum LUM levels were also analyzed. Independent samples t test, Spearman correlation were used for statistical analysis. Analysis of variance and Kruskal-Wallis test, the least significant difference (LSD)-t test and Bonferroni correction were used for statistical analysis. The Pearson Chi-square test was used for comparison of the rates between the groups. Statistical significance was set at P < 0.05. RESULTS: The levels of LUM were elevated in the RA patients than in the HCs (P < 0.000 1). Serum LUM levels were correlated with the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), immunoglobulin A (IgA), titers of platelet (PLT) and 28-joint disease activity score (DAS28, all P < 0.05). Next, we compared the serum LUM levels in the RA patients with different characteristics, and no difference was found in serum LUM levels between early-RA and RA, the same to RA with different gender (P>0.05). The levels of serum LUM were elevated in the RF positive patients (P < 0.000 1), and in the RF and anti-CCP positive patients (P < 0.05) than in the RA patients with negative RF whether the anti-CCP was positive. In addition, no differences were found between the RA patients with negative RF whether the anti-CCP was positive (P>0.05). All the levels of serum LUM were elevated in the RA patients with different CRP or ESR than in the HCs (P < 0.05), and the serum LUM levels in the RA patients with elevated ESR and CRP were significantly elevated in those with normal ESR and CRP (P < 0.05). Additionally, the results demonstrated that serum LUM levels were positively associated with RA disease activity, and they were declined in RA sustained remission than those in middle or high disease activity (P < 0.05). Furthermore, no difference was found between the RA patients in remission and HCs (P>0.05). No differences were found in the RA patients with and without complications including interstitial pneumonia disease, Sjögren's syndrome, thyroid gland diseases and osteoporosis (P>0.05). The LUM positivity rates were significantly elevated in the RF positive patients than the RF negative patients in RA (P < 0.05). CONCLUSION LUM, a cyclocitrullinated protein, might be a promising biomarker which could reflect both disease activity and immune activity in RA.
Humans ; Arthritis, Rheumatoid/immunology* ; Lumican/blood* ; C-Reactive Protein/metabolism* ; Female ; Male ; Rheumatoid Factor/blood* ; Middle Aged ; Adult ; Chondroitin Sulfate Proteoglycans/blood* ; Blood Sedimentation ; Keratan Sulfate/blood* ; Enzyme-Linked Immunosorbent Assay ; Aged

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.