Objective:To externally validated the intra-aortic balloon pump (IABP) shockⅡ score and CardShock score for predicting in-hospital mortality in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and compared them with the Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score.Methods:According to the inclusion and exclusion criteria, patients admitted to the cardiac care center (CCU) of our center from December 2010 to May 2019 were enrolled in this study. Patients’ baseline characteristics, in-hospital interventions, and outcomes were collected. The APACHEⅡ score was calculated during hospitalization by clinicians and collected by researchers. Two researchers independently calculated the IABP-ShockⅡ score and CardShock score; any disagreement was discussed with the third researcher. The performance of risk scores was evaluated by discrimination and calibration. The discriminative ability of risk scores was evaluated using the area under the receiver operating characteristic curve (AUC) and compared by the Delong method. The calibration of these risk scores was examined by the Hosmer-Lemeshow goodness-of-fit test. The calibration plot was also built.Results:A total of 150 patients enrolled in our study, and the in-hospital mortality was 60%. According to the IABP-ShockⅡ score, patients scored as low risk (0-2), moderate risk (3-4), and high risk (5-9) had in-hospital mortality of 29%, 68%, and 80%, respectively. According to the CardShock score, patients scored as low risk (0-3), moderate risk (4-5), and high risk (6-9)had in-hospital mortality of 21%, 57%, and 82%, respectively. According to the APACHEⅡ score, patients scored<20, 20-30, and >30 had in-hospital mortality of 19%, 69%, and 93%, respectively. For predicting the in-hospital mortality, the APACHEⅡ score demonstrated excellent discrimination (AUC=0.90, 95% CI: 0.84-0.95). The IABP-ShockⅡ score and CardShock score showed good discrimination (AUC=0.76, 95% CI: 0.68-0.83 and AUC=0.79, 95% CI: 0.72-0.85). The discriminative ability did not significantly differ between the IABP-ShockⅡ score and the CardShock score (0.76 vs 0.79, P>0.05), but both of which were significantly lower than the APACHEⅡ score (0.76 vs 0.90, P<0.05, and 0.79 vs 0.90, P<0.05). At the same time, it was not significantly different between the IABP-ShockⅡ score and the CardShock score (0.76 vs 0.79, P>0.05). All of these three scores were adequately calibrated according to the Hosmer-Lemeshow goodness-of-fit test ( P>0.05).The calibration plot showed accurate calibration of these three scores. Conclusions:Although less accurate than the APACHEⅡ score, the IABP-ShockⅡ score and CardShock score can show accurate prediction for in-hospital mortality of AMI-CS patients.

Objective: To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: This retrospective study included 321 STEMI patients who underwent PPCI at Beijing Chaoyang hospital from January 2013 to March 2014. Patients were divided into the PPCI group (189 cases) and the PPCI plus thrombus aspiration group (132 cases). Baseline and perioperative clinical data, procedural characteristics were collected, and primary endpoint events including all-cause death, re-myocardial infarction, and coronary revascularization and secondary endpoint events including cardiac death, recurrent angina, target lesion revascularization, and stent thrombosis were recorded during the follow-up. Results: There were no significant difference between PPCI group and PPCI plus aspiration group in age ((59.8±12.5) years old vs. (58.3±14.4) years old, P=0.060) and male ratio (82.5% (156/189) vs. 82.6% (109/132), P=0.993). The number of disease vessels (1.59±0.81 vs. 1.47±0.70, P=0.039) and the prevalence of left anterior descending as infarction related artery (52.3% (69/132) vs. 38.6% (73/189), P=0.022) were significantly higher in the PPCI plus aspiration group than that in the PPCI group.The symptom onset time (3.0 (2.0,4.8) hours vs. 4.0 (2.0,7.0) hours, P=0.027) and myocardial ischemia time (3.9 (2.7,6.2) hours vs. 4.7 (2.9,7.9) hours, P=0.022) were significantly in the PPCI plus aspiration group than in the PPCI group. The percent of thrombolysis in myocardial infarction (TIMI) thrombosis score≥ grade 4 (92.4% (122/132) vs. 75.1% (142/189), P<0.001)and postoperative TIMI flow grade 3 (70.5% (93/132) vs. 60.8% (115/189), P=0.003) was significantly higher in the PPCI plus aspiration group than in the PPCI group. The PPCI group patients were followed up for (31.6±7.5) months, and PPCI plus aspiration group patients were followed up for (32.2±6.7) months (P=0.466). During the follow-up period, there was no significant difference in the incidence of primary endpoint events between the PPCI plus aspiration group and the PPCI group (17.1% (22/129) vs. 16.9% (31/184), P=0.962). Recurrent angina was more frequent in the PPCI plus aspiration group than in the PPCI group (25.6% (33/129) vs. 16.3% (30/184), P=0.044). There was no significant difference in cardiac death (3.1% (4/129) vs. 3.3% (6/184), P=1.000), target lesion revascularization (3.9% (5/129) vs. 3.3% (6/184), P=0.765), and stent thrombosis (3.1% (4/129) vs. 2.7% (5/184), P=1.000) between the PPCI plus aspiration group and the PPCI group. Multivariate Cox regression analysis showed that the number of diseased vessels (RR=1.901, 95%CI 1.217-2.970, P=0.005) and postoperative TIMI flow grade (RR=0.455, 95%CI 0.221-0.934, P=0.032) were the risk factors for coronary revascularization after PPCI. The number of diseased vessels was a risk factor for major endpoint events after PPCI (RR=1.421, 95%CI 1.017-1.986, P=0.040). Conclusion The incidence of clinical events is similar in patients with STEMI treated with PPCI alone or PPCI plus aspiration.

Objective:To study the protective effects of Danhong injection ( DH) on myocardial damage induced by doxorubicin ( DOX) in Lewis tumor bearing mice. Methods:The model of Lewis lung cancer in mice was established by underarm injecting tumor cells, and then randomly divided into four groups:the model control group, DOX group, DH group and DH+DOX group. After the experiment, myocardial and tumor tissue were separated from Lewis tumor bearing mice, and the excised tumors were weighted. The activities of lactate dehydrogenase ( LDH) , creatine kinase ( CK) , manganese superoxide dismutase ( SOD) , catalase ( CAT) and glu-tathione peroxidase ( GPx) , and the content of malondialdehyde ( MDA) were determined by a colorimetric method. Flow cytometry was used to determine the levels of apoptosis, reactive oxygen species (ROS) and mitochondrial membrane potential (△Ψm). Re-sults:Compared with that in the model control group, a significant decrease of tumor weight was shown in both DOX group and DH+DOX group (P<0. 01). DH had no significant influence on the anticancer function of DOX. The activity of LDH and CK, and the ap-optosis in myocardium cells significantly increased (P<0. 01). Compared with DOX group, the activities of LDH and CK, and the ap-optosis significantly decreased in DH+DOX group (P<0. 01). The activities of △Ψm, SOD, CAT and GPx significantly increased (P<0.05orP<0.01). ThecontentofMDAandROSgenerationbothdecreased(P<0.01).Conclusion:DHhasnosignificantin-fluence on the antitumor effect of DOX. The combination of DH and DOX shows cadioprotective effect on the myocardial damage through improving mitochondrial antioxidant defense capacity, ameliorating oxidative stress and maintaining △Ψm homeostasis.

Objective To explore the feasibility and safety of carotid artery stenting (CAS) via right transradial approach (TRA).Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA.Patients were divided into the right carotid artery group (RCA),bovine left carotid artery group (B-LCA),nonbovine carotid artery group (NB-LCA) according to the lesion location.Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique(CLRET).Results CAS were successful in all cases (100％),the differences of the operation time and fluoroscopy time among RCA group,B-LCA group and NB-LCA group were not significant.In NB-LCA group,CLRET were applied in 10 cases (55.56％,10/18),includeing 8 cases with type Ⅲ aortic arch(100％,8/8)and 2 cases with type Ⅱ aortic arch (33.33％,2/6).The CLRET prolonged the operation time and fluoroscopy time [(39.45 ±7.27) min vs.(30.80±4.66) min;(11.84 ± 2.05) min vs.(9.91 ± 1.45) min,P ＜0.05).There was no cerebrovascular events and puncture point complications in perioperative period.Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible,especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.

Objective: To study the clinical outcomes of stent-thrombosis (ST) at different times in patients after drug-eluting stent (DES) implantation.
Methods: A total of 131 coronary angiography conifrmed ST patients in our hospital from 2005-01 to 2015-04 were studied. According to the time of ST occurrence, the patients were divided into 2 groups: Early ST group, ST occurred ≤30 days,n=42 and Late ST group, ST occurred >30 days,n=89. The in-hospital and follow-up information was collected; clinical outcomes were compared between 2 groups.
Results: The in-hospital MACE occurrence rate in Early ST group was higher than that in Late ST group (16.7% vs 4.5%),P=0.04. There were 123 patients survived to discharge and they were followed-up for the median of 38.00 (15.00, 62.00) months. Kaplan-Meier analysis estimated that the MACE-free survival was similar between 2 groups (41.9% vs 36.3%), P=0.43.
Conclusion: In-hospital MACE occurrence was higher in early ST patients, while the long term prognosis was similar between the early and late ST patients for whom with DES implantation.

Objective To study the risk factor and prognosis of concurrent depression in elderly patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI). Methods Two hundred and ninety-five AMI patients who received PCI and whose clinical data were complete were selected. Depression was determined by a self-rating scale (SDS), and was confirmed when SDS standard score≥53 scores. The patients were divided into 2 groups according to the ages:senium (age ≥ 60 years, 144 cases) group and younger group (age<60 years, 151 cases). Multiple Logistic regression analysis was used to analyze the related factors of depression. The patients were followed up for 1 year, and the rehospitalization rate, incidence of major adverse cardiovascular events (MACE) and left ventricular ejection fraction (LVEF) at 12 months were compared. Results The incidence of depression in senium group was significantly higher than that in younger group: 41.7%(60/144) vs. 21.2%(32/151), and there was statistical difference (P<0.05). Female gender, hypertension and type 2 diabetes mellitus were the independent risk factor for depression in patients with AMI after PCI (P<0.05). In senium group, the rehospitalization rate and incidence of MACE in patients with depression were significantly higher than those in patients without depression: 18.3% (11/60) vs. 6.0% (5/84) and 15.0% (9/60) vs. 4.8%(4/84), the LVEF was significantly lower than that in patients without depression:(41.50 ± 2.25)%vs. (49.76 ± 2.93)%, and there were statistical differences (P<0.05). The LVEF in patients with depression of senium group was significantly lower than that in patients with depression of younger group:(41.50 ± 2.25)%vs. (51.50 ± 2.32)%, and there was statistical difference (P<0.05). Conclusions The elderly AMI patients treated with PCI have higher rates of depression. Female gender, hypertension and type 2 diabetes mellitus are the important risk factor for depression after PCI. Depression has a significant effect on the prognosis of AMI patients, especially on LVEF in elderly patients.

Objective To explore the safety and feasibility of guiding catheter passing through spasmodic vessels in patients undergoing percutaneous coronary intervention (PCI) via radial artery access by the aid of PCI guiding wire and balloon .Methods The clinical data of 33 coronary artery disease (CAD) patients undergoing PCI via radial artery access with radial artery or (and) brachial artery spasm ( group A ) were retrospectively analyzed .Among all these patients , guiding catheters were delivered through the spasmodic vessels successfully by the aid of PCI guiding wires and balloons .The clinical data of other 38 CAD patients having PCI during the same period performed by other operators via radial artery or ( and ) brachial artery approach and experienced vessel spasm were anlysed as the control ( group B ) .All patients in group B received conventional anti-spasm management during PCI .All vessel spasm was identified by angiography.For patients in group A , a diameter of 0.014 inch guiding wire was chosen to pass through the spasmodic vessel segment carefully and gently .The diameter of balloon should be chosen according to the diameter of guiding catheter .A balloon diameter of 2.0 mm and 2.5 mm was corresponded to 6F and 7F guiding catheter respectively .The balloon was advanced to the tip of guiding catheter , keeping a half in catheter and a half in vessel followed by inflating the balloon with a pressure of 8 atm.The balloon was kept inflated the guiding catheter was pushed in vitro carefully and slowly until the catheter passed through the spasmodic vessel segment .Then the balloon was deflated and pulled out together with PCI guiding wire . Exchanged a diameter of 0.035 inch wire and completed the positioning of guiding catheter .After finishing the PCI, radial or ( and) brachial angiography was performed again to observe if spasm disappeared and to determine if there any contrast medium exudation .For patients in group B , routine approach was applied including administration of nitroglycerine , diltiazem or nitroprusside etc . to relieve vessel spasm. Results The location of vessel spasm was similar in group A and group B ( P=0.150 ) , and the incidence rate of spasm in brachial artery was higher than that in radial artery in both groups .The chance of guiding catheter crossing the spasmodic vessel segment was significantly higher in group A than in group B ( 100%vs.39.5%, P=0.00).In patients whose guiding catheter could pass through the spasmodic vessel segment successfully , time spent in group A was shorter than in group B ( P=0.000 ) .The patient number which time spent was less than five minutes , five to 15 minutes and more than 15 minutes was 30 and 2 ( 90.1%vs.13.3%) , 3 and 7 ( 9.9% vs.46.7%) and 0 and 6 ( 0% vs.40.0%) in group A and in group B respectively.The incidence of forearm hematoma was lower in group A than in group B without statistical difference [6.1%(2/33) vs.18.4%(7/38), P =0.113].Conclusions It is safe and feasible for passing guiding catheter through spasmodic vessels during PCI via radial artery access by the aid of PCI guiding wire and balloon .

Cardiovascular Diseases ; Cell Proliferation ; Humans ; MicroRNAs ; Muscle, Smooth, Vascular

[Abstrct] In 2008, Beijing Chaoyang Hospital of Capital Medical University was certified as cardiovascular interventional therapy tralning base of National Health and Family Planning Commission (former Ministry of Health). In accordance with the requirements of the measures for the management of tralning base, and according to the characteristics of tralning students in combination with the clinical teaching experience, skills of teaching for tralning base were summed up as the following: in strict accordance with the syllabus requirements , systematic and standardized tralning were emphasized . Emphasis on theoretical study which combined closely with actual operation was also established. After the tralning, all students who received tralning can do coronary angiography and PCI for simple lesion in accordance with the requirements of the syllabus. All tralnees passed unified national exam organized by the Ministry of Health and got the qualification for interventional therapy.

Objective To discuss the feasibility, safety and validity of the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral traumatic pseudoaneurysm (TPA). Methods During the period from June 2012 to April 2014, a total of 8 patients with peripheral TPA were admitted to the Department of Vascular and Endovascular Surgery of Shanghai Changzheng Hospital . The clinical data were retrospective analyzed. The lesions were located at the common carotid artery (n=4), vertebral artery (n=1), subclavian artery (n=1) and superficial femoral artery (n=2). On the basis of acute and chronic TPA classification and different therapeutic principles, endovascular repair with ViabahnTM self-expanding covered stent was employed in 8 patients. Intraoperative angiographic findings, the size and number of the implanted stent, and the immediate angiographic results after stent implantation were recorded. All the patients were followed up to evaluate the improvement of the symptoms, the effectiveness of the repair of TPA cavity, and the occurrence of endoleak or restenosis. Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 8 patients, with a technical success rate of 100%. Angiography performed immediately after stent implantation showed that complete repair of TPA cavity was obtained in all patients, the distal segment of the parent artery was patent, and no endoleak was observed. The sizes of the stent used in the patients were 8×50 mm (n=2) and 9×50 mm (n=2) in common carotid artery, 6×50 mm (n=1) in vertebral artery, 11×100 mm (n=1) in subclavian artery, and 8×100 mm (n=2) in superficial femoral artery. The patients were followed up for 6-30 months (mean of 14.3 months), and the clinical symptoms disappeared in all patients. CT angiography indicated that there was no endoleak or restenosis. Conclusion Based on the different therapeutic principles, the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral TPA is technically simple and micro-invasive, and clinically feasible with reliable effect and safety. Therefore, this technique can be employed as a first-line therapy option for peripheral TPA.