Objectives:To investigate the risk factors of acute myocardial infarction(AMI)patients with a family history of premature coronary heart disease(FHpCHD)in China and analyze the relationship between these risk factors and premature myocardial infarction.Methods:Using data form the Chinese Acute Myocardial Infarction(CAMI)Registry which enrolled a total of 28 070 patients with AMI from 108 hospitals between January 1,2013 to September 30,2014.We compared the demographic data,cardiovascular risk factors,clinical characteristics,and prognosis in AMI patients with and without FHpCHD.FHpCHD is defined as the history of myocardial infarction,angina,sudden cardiac death and/or revascularization(including coronary artery bypass grafting and percutaneous coronary intervention)among first-degree relatives(father,mother,brother and sister)aged≤55 years old for men or≤65 years old for women.The risk factors included obesity,hypertension,diabetes,hyperlipidemia,unhealthy diet,lack of physical activity,smoking,and frequent alcohol consumption.The correlation between family history and premature AMI was calculated by the multivariate Logistic regression analysis.The risk contribution values of the affected first-degree relatives were determined by applying the Shapley algorithm.Results:A total of 893 cases(4.12%)of AMI patients had FHpCHD.Among patients with premature AMI,467 cases(6.20%)had FHpCHD.AMI patients with FHpCHD were younger,and had a higher proportion of male,obesity/overweight,hypertension,hyperlipidemia,and stroke history,unhealthy lifestyle(such as frequent alcohol consumption and current smoking),and a higher proportion of multi-vessel lesions in coronary angiography compared to those without FHpCHD(all P<0.05).AMI patients with FHpCHD had a significantly higher proportion of risk factors(P<0.01).After adjusting for sociodemographic factors,lifestyle,and cardiovascular risk factors,multivariate Logistic analysis revealed that FHpCHD was significantly associated with premature AMI(OR=1.793,95%CI:1.553-2.070,P<0.0001).The calculation using the Shapley algorithm showed that the father had the highest risk contribution value(40.27%).Conclusions:AMI patients with FHpCHD exhibit a clustering of family unhealthy lifestyle and cardiovascular risk factors,with an earlier onset age and more severe coronary artery disease.FHpCHD is associated with AMI,independent of lifestyle and cardiovascular risk factors.

Objective:Investigate the impact of calcification on the long-term outcomes of patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI).Methods:A retrospective cohort study was conducted. Patients who underwent PCI and had at least one CTO lesion at Fuwai Hospital between January 2010 and December 2013 were consecutively enrolled. Calcification was evaluated by coronary angiography, and patients were divided into two groups: moderate/severe calcification group and non/mild calcification group. Clinical follow-up was completed up to 5 years. Incidence of PCI-related complications and immediate procedural outcomes were compared between two groups, and the primary endpoint was the target lesion failure (TLF) at 5 years after PCI. Clinical follow-up endpoint events were analyzed using Kaplan-Meier survival analysis with log-rank test, and Cox multivariate regression model was used to evaluate the relationship between calcification and TLF.Results:The study included 2 659 CTO patients with an age of (57.2±10.5) years, of whom 442 (16.6%) were female, and among whom 13.5% (360/2 659) had moderate/severe calcification. Compared with the non/mild calcification group, the moderate/severe calcification group had a higher incidence of PCI-related complications (43.2% (156/361) vs. 32.5% (772/2 374), P<0.001) and procedural failure (34.3% (124/361) vs. 24.3% (577/2 374), P<0.001). Additionally, the moderate/severe calcification group showed a higher risk of the primary endpoint event (TLF) during the 5-year follow-up (19.8% vs. 15.3%, log-rank P=0.028). Higher incidence of cardiac death was observed in moderate/severe calcification group (5.7% vs. 2.7%, log-rank P=0.003). Cox multivariate regression analysis revealed that moderate/severe calcified plaques remained an independent risk factor for 5-year TLF after CTO-PCI ( HR=1.34, 95% CI: 1.01-1.79, P=0.043). Conclusion:Compared with CTO patients with non/mild calcification, those with moderate/severe calcification have higher procedural failure and complication rates, as well as poorer long-term prognosis, mainly due to an increase in cardiac death.

Objectives:To investigate the risk factors of acute myocardial infarction(AMI)patients with a family history of premature coronary heart disease(FHpCHD)in China and analyze the relationship between these risk factors and premature myocardial infarction.Methods:Using data form the Chinese Acute Myocardial Infarction(CAMI)Registry which enrolled a total of 28 070 patients with AMI from 108 hospitals between January 1,2013 to September 30,2014.We compared the demographic data,cardiovascular risk factors,clinical characteristics,and prognosis in AMI patients with and without FHpCHD.FHpCHD is defined as the history of myocardial infarction,angina,sudden cardiac death and/or revascularization(including coronary artery bypass grafting and percutaneous coronary intervention)among first-degree relatives(father,mother,brother and sister)aged≤55 years old for men or≤65 years old for women.The risk factors included obesity,hypertension,diabetes,hyperlipidemia,unhealthy diet,lack of physical activity,smoking,and frequent alcohol consumption.The correlation between family history and premature AMI was calculated by the multivariate Logistic regression analysis.The risk contribution values of the affected first-degree relatives were determined by applying the Shapley algorithm.Results:A total of 893 cases(4.12%)of AMI patients had FHpCHD.Among patients with premature AMI,467 cases(6.20%)had FHpCHD.AMI patients with FHpCHD were younger,and had a higher proportion of male,obesity/overweight,hypertension,hyperlipidemia,and stroke history,unhealthy lifestyle(such as frequent alcohol consumption and current smoking),and a higher proportion of multi-vessel lesions in coronary angiography compared to those without FHpCHD(all P<0.05).AMI patients with FHpCHD had a significantly higher proportion of risk factors(P<0.01).After adjusting for sociodemographic factors,lifestyle,and cardiovascular risk factors,multivariate Logistic analysis revealed that FHpCHD was significantly associated with premature AMI(OR=1.793,95%CI:1.553-2.070,P<0.0001).The calculation using the Shapley algorithm showed that the father had the highest risk contribution value(40.27%).Conclusions:AMI patients with FHpCHD exhibit a clustering of family unhealthy lifestyle and cardiovascular risk factors,with an earlier onset age and more severe coronary artery disease.FHpCHD is associated with AMI,independent of lifestyle and cardiovascular risk factors.

Objective:Investigate the impact of calcification on the long-term outcomes of patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI).Methods:A retrospective cohort study was conducted. Patients who underwent PCI and had at least one CTO lesion at Fuwai Hospital between January 2010 and December 2013 were consecutively enrolled. Calcification was evaluated by coronary angiography, and patients were divided into two groups: moderate/severe calcification group and non/mild calcification group. Clinical follow-up was completed up to 5 years. Incidence of PCI-related complications and immediate procedural outcomes were compared between two groups, and the primary endpoint was the target lesion failure (TLF) at 5 years after PCI. Clinical follow-up endpoint events were analyzed using Kaplan-Meier survival analysis with log-rank test, and Cox multivariate regression model was used to evaluate the relationship between calcification and TLF.Results:The study included 2 659 CTO patients with an age of (57.2±10.5) years, of whom 442 (16.6%) were female, and among whom 13.5% (360/2 659) had moderate/severe calcification. Compared with the non/mild calcification group, the moderate/severe calcification group had a higher incidence of PCI-related complications (43.2% (156/361) vs. 32.5% (772/2 374), P<0.001) and procedural failure (34.3% (124/361) vs. 24.3% (577/2 374), P<0.001). Additionally, the moderate/severe calcification group showed a higher risk of the primary endpoint event (TLF) during the 5-year follow-up (19.8% vs. 15.3%, log-rank P=0.028). Higher incidence of cardiac death was observed in moderate/severe calcification group (5.7% vs. 2.7%, log-rank P=0.003). Cox multivariate regression analysis revealed that moderate/severe calcified plaques remained an independent risk factor for 5-year TLF after CTO-PCI ( HR=1.34, 95% CI: 1.01-1.79, P=0.043). Conclusion:Compared with CTO patients with non/mild calcification, those with moderate/severe calcification have higher procedural failure and complication rates, as well as poorer long-term prognosis, mainly due to an increase in cardiac death.

Background: Apolipoprotein A-I (ApoA-I) is a key cardioprotective lipoprotein. Nevertheless, it remains unclear how ApoA-I relates to ischemic risk across glucose metabolism statuses in patients with coronary artery disease (CAD). This study investigated whether glucose metabolism status influences the association between ApoA-I and ischemic risk in CAD patients. Methods: This cohort study included 10,724 consecutive CAD patients undergoing percutaneous coronary intervention, who were classified into diabetes mellitus (DM), pre-DM, and normal glucose regulation (NGR) groups. The primary clinical endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction, revascularization, and stroke. Results: Of the 10,232 patients ultimately included, 2,139 (20.9%) experienced MACCE over 5 years. A significant interaction was observed between ApoA-I levels and glucose metabolism status (P for interaction=0.041). In the DM group, an L-shaped association between ApoA-I and MACCE was found, with lower ApoA-I levels linked to a higher risk of MACCE (P for non-linearity= 0.044). Multivariate Cox regression analysis showed that patients in the lowest quintile of ApoA-I had a 1.327-fold increased risk of MACCE compared to those at the lowest risk (hazard ratio, 1.327; 95% confidence interval, 1.097 to 1.604). However, no significant association was observed in the pre-DM or NGR groups (both P>0.05). Conclusion This large-scale, 5-year follow-up study is the first to demonstrate that lower ApoA-I levels are associated with increased MACCE risk in CAD patients with DM, highlighting the potential value of ApoA-I in risk stratification and as a therapeutic target.

Aim To analyze the influencing factors of adverse cardiovascular events in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),and to establish a nomogram prediction model.Methods A total of 216 elderly patients with acute STEMI who underwent PCI in Jinqiu Hospital of Liaoning Province from February 2021 to January 2023 were selected and divided into occurrence group(n=33)and non-occurrence group(n=183)according to the occurrence of postoperative adverse cardiovascular events.General data,laboratory indicators,imaging information,and postoperative medication data of all patients were collected.Univariate and multivariate Logistic regression analysis were used to explore independent risk factors for adverse cardiovas-cular events.A nomogram prediction model was constructed according to independent risk factors of neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),C-reactive protein/albumin ratio(CAR),C-reactive protein to high density lipoprotein cholesterol ratio(CHR),calibration curve was drawn to verify the nomogram model,and receiv-er operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of the predictive model for column line diagrams.Results The levels of NLR,PLR,CAR,CHR,Gensini score,and platelet aggregation ratio(PAR)were significantly higher in occurrence group than those in non-occurrence group,left ventricular ejection fraction(LVEF)was significantly lower in occurrence group(P＜0.05).Logistic regression analysis showed that Gensini score,LVEF,PAR,NLR,PLR,CAR and CHR were independent risk factors for adverse cardiovascular events after PCI in elderly acute STE-MI patients(P＜0.05).The column-line diagram model for predicting the risk of adverse cardiac events after PCI in eld-erly acute STEMI patients was constructed based on independent risk factors,and the calibration curve of the model was close to the ideal model,and the ROC curve showed that the area under the ROC curve for the prediction of the risk of ad-verse cardiovascular events in the elderly acute STEMI patients was 0.914.Conclusion NLR,PLR,CAR and CHR are independent risk factors for adverse cardiovascular events in elderly acute STEMI patients after PCI,and the nomogram model constructed based on these factors can effectively predict the risk of adverse cardiovascular events in elderly acute STEMI patients after PCI.

Objective::Data comparing the outcomes of MiStent (Micell Technologies, Durham, North Carolina, USA) microcrystalline biodegradable polymer (BP) drug-eluting stent (DES) and those of another post-marketing BP-DES, TIVOLI (EssenTech, Beijing, China) are rare. This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent (SES) system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective, single-blinded, multicenter, randomized trial (NCT02448524), which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio. The primary endpoint was a non-inferiority comparison of in-stent late lumen loss (LLL) by quantitative coronary angiography at 9 months. The secondary endpoint was device-related clinical cardiovascular composite events (target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization) and 1-year outcomes. Results::A total of 428 patients (216 patients in the MiStent group and 212 patients in the TIVOLI group) were enrolled and included in an intention-to-treat analysis. MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months ((0.23 ± 0.37) mm vs. (0.34 ± 0.48) mm, P for non-inferiority <0.001, P for superiority = 0.02). Although without significant difference, the rate of TLF in MiStent was quantitatively lower than that in TIVOLI (3.70% vs. 6.60%; P = 0.17). Conclusion::Compared with TIVOLI BP-SES, the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.

Objective::Data comparing the outcomes of MiStent (Micell Technologies, Durham, North Carolina, USA) microcrystalline biodegradable polymer (BP) drug-eluting stent (DES) and those of another post-marketing BP-DES, TIVOLI (EssenTech, Beijing, China) are rare. This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent (SES) system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective, single-blinded, multicenter, randomized trial (NCT02448524), which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio. The primary endpoint was a non-inferiority comparison of in-stent late lumen loss (LLL) by quantitative coronary angiography at 9 months. The secondary endpoint was device-related clinical cardiovascular composite events (target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization) and 1-year outcomes. Results::A total of 428 patients (216 patients in the MiStent group and 212 patients in the TIVOLI group) were enrolled and included in an intention-to-treat analysis. MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months ((0.23 ± 0.37) mm vs. (0.34 ± 0.48) mm, P for non-inferiority <0.001, P for superiority = 0.02). Although without significant difference, the rate of TLF in MiStent was quantitatively lower than that in TIVOLI (3.70% vs. 6.60%; P = 0.17). Conclusion::Compared with TIVOLI BP-SES, the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.

Humans ; Cohort Studies ; Body Mass Index ; Percutaneous Coronary Intervention ; Coronary Artery Disease ; Inflammation ; Treatment Outcome ; Risk Factors