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

The existing contents and standards for the standardized residents training are incomplete. Clinical management guidelines and expert consensus should be included in the standardized residents training, since they are very important for clinical decisions. Some guidelines and expert consensus have been included in the standardized residents training in our cardiovascular department,and with the problem-based teaching method, the quality of standardized residents training was improved in the cardiovascular department of ShengJing hospital.

Objective To prospectively evaluate the sensitivity and specificity of ankle brachial index (ABI) in the diagnosis of lower extremity arterial disease(LEAD)by using conventional digital subtraction angiography (DSA) as the reference standard, and to research the threshold value of ABI screening test for diagnosis. Methods A total of 383 consecutive patients (245 men and 138 women, mean age (64.1±11.7) years] underwent conventional DSA and ABI measurement. Receiver operator characteristics (ROC) analysis was performed to assess possible threshold values for predicting the LEAD in these patients. Results Conventional DSA was used as the gold standard in defining≥50% luminal stenosis for the diagnosis of LEAD. 0. 95 was the overall cutoff of ABI which was associatcd with 93.0% sensitivity, 85.0% specificity, 8.81 positive likelihood ratio(+LR) and 0. 23 negative likelihood ratio(-LR) for detection of hemodynamically significant stenosis (lesions>≥50%) in all 383 subjects (P<0.01). The area under the ROC curve was 0. 953(95%CI 0.920～0.985). Conclusions ABI measurement is an accurate and reliable non-invasive alternative to conventional DSA in the diagnosis of lower extremity arterial disease. And the cut-off 0.95 is the threshold ABI value for detecting LEAD in Chinese population.

BACKGROUND: Valsartan is an antagonist of angiotensin Ⅱ (Ang Ⅱ ) receptor. Many researches have proved that it can protect heart tissue. Val-PREST suggests that valsartan with a long-term administration can decrease restenosis rate in stent; however, effect of valsartan on restenosis rate of Chinese population is still unclear presently.OBJECTIVE: To evaluate the effect of oral valsartan for 6 months on patients with coronary heart disease (CHD) who undertook successful intervention therapy.DESIGN: Multicenter, double blind, randomized, and controlled evaluation and prospective design.SETTING: Beijing Friendship Hospital Affiliated to Capital Medical University; Beijing Anzhen Hospital Affiliated to Capital Medical University; Peking Union Hospital; People's Hospital of Peking University; Beijing Tongren Hospital Affiliated to Capital Medical University; Beijing Shijingshan Hospital; Beijing Fuxing Hospital Affiliated to Capital Medical University;Beijing Chuiyangliu Hospital.PARTICIPANTS: Eight three-grade A hospitals in Beijing participated in the study. Since December 2002 to October 2003, a total of 200 patients who underwent bare mental stent implantation were consented, but 196 patients were recruited in the end. All 196 patients were randomized into valsartan group (100 cases) and control group (96 cases).METHODS: Basic medicines in the two group included aspirin, clopidogrel, nitrides, statins, β-receptor antagonists, calcium channel antagonists, etc. Additionally, Patients in valsartan group were also given valsartan (Beijing Nuohua Pharmaceutical Co. Ltd., batch number: SD 34004) in a dosage of 80 mg a day. Both groups were followed-up once a month for total 6 months.MAIN OUTCOME MEASURES: ① Major adverse cardiac events within 6 months on clinics (death, non-fatal myocardial infarction, hospitalisation once more due to recurrent myocardial ischemia, and target vessel revascularization); ② Results of duplicated coronary angiography or exercise treadmill test (ETT) of partial patients within 6 months.RESULTS: ① Two patients (2%) in valsartan group were excluded in this study because of intolerance, so 194 patients were involved in the final analysis. ② No significant differences of baseline characteristics in terms of lesion type, the number of diseased vessels and the cardiac function were found between the two groups (P ＜ 0.05). ③ During the period of 6-month follow-up, one case died in control group. One acute myocardial infarction occurred in each group, whilst one case undertook target vessel revascularization in valsartan group. It was found that the proportion of recurrent cardiac events was lower in valsartan group than that in control group (11.2% vs. 15.6%). However, this difference did not reach the statistic significance. ④ During the period of 6-month duplicated contrast examination, one case had restenosis of in-stent in valsartan group. ⑤ The positive rate of exercise treadmill test (ETT) was lower in valsartan group (25.7%) than that in control group (36.4%), but there was no statistic difference.CONCLUSION: Six-month oral valsartan on patients with coronary heart disease who undertook successful intervention therapy can decrease the trend of recurrent cardiac events and positive rate of ETT.

Objective To study mortality of acute myocardial infarction caused by acute left main coronary artery occlusion.The objectives of this analysis were to determine the effect of primary PCI and the impact of cardiogenic shock on acute myocardial infarction caused by acute left main coronary artery occlusion.Methods From 1999 to 2005,of 752 consecutive patients with acute myocardial infarction,16 patients had acute left main coronary artery occlusion with TIMI flow≤2.All patients were given primary PCI.Results Of these 16 patients,9(56.25%)died in hospital,and 7(43.75%)discharged.In the survival group reperfusion was successful in 100% of patients,as opposed to 44.44% in the mortality group(P=0.019).Cardiogenic shock was overt in 12(75.00%)patients,42.86% of the survival group and 100% of the mortality group(P=0.020).Shock patients had higher in-hospital mortality than stable patients(75 % vs 0%,odds=4.0,95%CI 1.50~10.66,P=0.019).Conclusion Patients presenting with AMI caused by acute left main coronary artery occlusion and cardiogenic shock have poor survival regardless of primary PCI.Nevertheless,primary PCI is a feasible and effective procedure,and it may save lives in this clinical setting.

Objective The aim of this study was to evaluate the value of QT dispersion and heart rate variability in predicting early ventricular fibrillation during hospitalization after acute myocardial infarction.Methods Seventy-two patients underwent 24-hour Holter monitoring within 6 hours after onset of acute myocardial infarction.They were divided into 2 groups,VF group (12 cases) and Non-VF group (60 cases),based on whether they had experienced an episode of ventricular fibrillation during their hospitalization.Index of QT dispersion and heart rate variability were calculated on the basis of 24 hours Holter recording.Results The HRV indexes showed significant difference (respectively,.P.