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Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P< 0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P< 0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P< 0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P< 0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P< 0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality ( HR (95 %CI ):4.739(2.272-9.885), P< 0.01), cardiovascular mortality ( HR (95 %CI ):7.258(2.237-23.548), P= 0.001) and MACCE ( OR (95 %CI ):4.143(2.031-8.453), P< 0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality ( HR (95 %CI ): 6.387(2.533-16.104), P< 0.01), cardiovascular mortality ( HR (95 %CI ): 10.848(2.586-45.506), P= 0.001) and MACCE ( OR (95 %CI ): 4.081(1.299-12.816), P= 0.016), while not for re-hospitalization for HF ( OR (95 %CI ):1.010(0.700-1.457), P= 0.957). Conclusions: Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.

Objective: This analysis was performed to evaluate the efficacy in stroke prevention and safety of dabigatran in Chinese nonvalvular atrial fibrillation(NVAF) patients enrolled in RE-LY trial. Methods: RE-LY was an prospective, open-label, randomized, multicenter study. From March 2006 to March 2009, 541 atrial fibrillation patients at risk of stroke were recruited from 13 medical centers in China. Patients randomly received, in a blinded fashion, fixed doses of dabigatran-110 mg or 150 mg twice daily or, in an unblinded fashion, adjusted-dose warfarin. The primary efficacy endpoint was stroke or systemic embolism. The primary safety endpoint was major bleeding. Results: The incidence of stroke in the Chinese subpopulation was 1.94% per year(7 cases) in the group that received 110 mg of dabigatran (dabigatran 110) and 1.10% per year(4 cases) in the group that received 150 mg of dabigatran (dabigatran 150), as compared with 2.87% per year (10 cases) in warfarin group . Incidence of ischemic stroke was 1.11% per year(4 patients) in dabigatran 110 group, 0.82% per year(3 cases) in dabigatran 150 group and 2.01% per year(7 patients) in warfarin group. Incidence of hemorrhagic stroke was 0.28% per year(1 case) in dabigatran 110 group, 0.27% per year(1 case) in dabigatran 150 group and 0.57% per year(2 cases) in warfarin group. All-cause mortality was similar among the three treatment groups: 3.33% per year(12 cases) in dabigatran 110, 2.19% per year(8 cases) in dabigatran 150 and 2.58% per year(9 cases) in warfarin group. Incidence of major bleeding event was 0.56% per year(2 cases) in both dabigatran groups, as compared with 1.43% per year(5 cases) in warfarin group. Gastrointestinal disorders such as dyspepsia occurred in 12.8% patients of both dabigatran groups, and in 5.6% patients of warfarin group. Conclusions: Despite the descriptive statistical analysis in nature of present study due to the limited number of subjects, our subgroup analysis implies that like warfarin, dabigatran is efficacious and safe for thromboembolism prevention in Chinese patients with atrial fibrillation at risk of stroke. Clinical Trail Registry National Institutes of Health(http: //www.clinicaltrials.gov), CT00262600.

Objective: To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated with fatal arrhythmia., Methods: We analyzed data from Chinese STEMI patients with fatal arrhythmia enrolled in the CREATE trial. Predictors of 30-day mortality after STEMI were identified by univariate and multivariate logistic regression analysis using baseline and therapy variables., Results: The overall 30-day mortality of STEMI patients complicated with fatal arrhythmia among the 718 patients [(66.1 ± 11.9) years and 62.4% male] was 52.9%. Logistic regression analysis showed that age (OR = 1.82, 95%CI:1.449-2.285), anterior infarction (OR = 4.419, 95%CI:2.645-7.384), heart rate > 60 bpm (OR = 3.32, 95%CI:1.898- 5.808), killip class IV (OR = 3.686, 95%CI:1.684-8.06), admission hemoglobin A1c < 5.6% (OR = 2.564, 95%CI:1.199-5.484), no use of ACEI (OR = 1.827, 95%CI:1.099-3.038) and no use of lipid-low drugs (OR = 2.034, 95%CI:1.196-3.458) were independent risk factors for short term mortality after STEMI. The receiver operating characteristic curve for predicting the death of the baseline and clinical variable models was 0.830 (95%CI: 0.796-0.865) and 0.866 (95%CI: 0.835-0.896), respectively., Conclusion: The 30-day mortality of patients with STEMI complicated with fatal arrhythmia is high. Age, anterior infarction, heart rate > 60 bpm, killip class IV, admission hemoglobin A1c level < 5.6%, no use of ACEI and no use of lipid-low drugs are independent risk factors for 30-day mortality in these patients.

Objective: To evaluate the impact of admission heart rate (HR) on 30-day all-cause death and cardiovascular events in Chinese patients with ST-elevation acute myocardial infarction (STEMI)., Methods: A total of 7485 Chinese STEMI patients from a global randomized controlled trial (CREATE) database were divided into six groups by admission HR: < 60, 60 - 69, 70 - 79, 80 - 89, 90 - 99 and ≥ 100 bpm. The primary outcome was 30-day all-cause death; the secondary outcomes were the composite of 30-day all-cause death, reinfarction, cardiogenic shock or deadly arrhythmia., Results: Admission glucose level, proportion of female gender, incidence of anterior myocardial infarction, previous diabetes mellitus, hypertension and Killip level II-IV were significantly higher in patients with admission HR ≥ 90 bpm compared to 60 - 69 bpm group (P < 0.05). The 30-day mortality was lowest (6.3%) in the 60 - 69 bpm group and was 9.6% in HR < 60 bpm group (P < 0.05 vs. 60 - 69 bpm group). In patients with admission HR > 60 bpm, the 30-day mortality increased in proportion to higher admission HR: 8.1% in 70 - 79 bpm, 9.2% in 80 - 89 bpm, 12.6% in 90 - 99 bpm and 24.6% in ≥ 100 bpm groups (all P < 0.05 vs. 60 - 69 bpm group). The incidence of MACE was similar as that of 30-day mortality: 27.0% in < 60 bpm, 12.5% in 60 - 69 bpm, 13.7% in 70 - 79 bpm, 14.3% in 80 - 89 bpm, 17.5% in 90 - 99 bpm and 31.1% in ≥ 100 bpm groups. Multivariate analysis showed that the incidence of 30-day mortality positively correlated with the admission HR (P < 0.05) except in the patients with admission HR < 60 bpm (OR = 0.832, P = 0.299), the risk of joint endpoint events was higher in the patients with HR < 60 bpm (OR = 1.532, 95%CI: 1.201 - 1.954, P < 0.05), 90 - 99 bpm (OR = 1.436, 95%CI: 1.091 - 1.889, P < 0.05) or ≥ 100 bpm (OR = 1.893, 95%CI: 1.471 - 2.436, P < 0.001)., Conclusion: Admission HR is an independent risk factor for short-term outcome in Chinese STEMI patients.

Objective: To observe the clinical characteristics, treatment options and outcome of diabetic patients with non-ST elevation acute coronary syndromes (NSTEACS)., Methods: Consecutive patients admitted with NSTEACS from 38 centers in north China were enrolled. Medical histories, clinical characteristics, treatments and outcomes were evaluated and follow-up was made at 6, 12, and 24 months after their initial hospital admission. Cumulative event rates were compared between diabetic and non-diabetic patients., Results: There were 420 diabetic patients out of 2294 NSTEACS patients (18.3%). Diabetic patients were older [(64.9 ± 6.7) years vs. (62.3 ± 8.6) years, P < 0.01], more often women (48.1% vs. 35.3%, P < 0.05) and were associated with higher baseline comorbidities such as previous hypertension, myocardial infarction, congestive heart failure and stroke than non-diabetic patients. The incidence of antiplatelet therapy (92.1% vs. 95.0%, P < 0.05), coronary angiography (30.0% vs. 36.3%, P < 0.05) and revascularization (12.1% vs.18.8%, P < 0.05) was lower in patients with diabetes than non-diabetic patients. In hospital and 2-year mortality as well as the incidence of congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death were substantially higher in diabetic patients compared with non-diabetic patients. Multivariate Cox regression analysis revealed that age ≥ 70 years, diabetes, previous myocardial infarction, previous congestive heart failure, systolic blood pressure less than 90 mm Hg (1 mm Hg = 0.133 kPa) and heart rate more than 100 bpm at admission were risk factors for 2-year death., Conclusion: In NSTEACS, diabetes is associated with higher rate of in-hospital and 2-year death, congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death. Diabetes mellitus is a major independent predictor of 2-year mortality post NSTEACS. Status of antiplatelet therapy, coronary angiography and revascularization should be improved for diabetic patients with NSTEACS during hospitalization.

Objective: To compare the impact of the first 24 hours mean blood glucose (MBG) level and admission glucose (AG) during hospitalization on the short term mortality and combined end point events in patients with ST-segment elevation acute myocardial infarction (STEMI)., Methods: A total of 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset were included. Plasma glucose was measured at admission, 6 and 24 hours after admission, respectively. The MBG level through the first 24 hours for each patient was calculated. Patients were stratified into six groups according to their MBG levels: < 4.5, 4.5 - 5.5, 5.6 - 7.0, 7.1 - 8.5, 8.6 - 11.0 and > 11.0 mmol/L. The incidence of all-cause mortality and combined end point of death, re-infarction, cardiogenic shock, recurrence ischemia, and stroke at 7 days and 30 days post hospitalization were analyzed. Nested models were compared to determine whether logistic regression models that included MBG provided a significantly better fit than logistic regression models included AG., Results: Compared with the MBG of 4.5 - 5.5 mmol/L group, 7-day and 30-day mortality and combined end point events increased in proportion to plasma MBG level increase. Multivariate logistic regression analysis showed that elevated MBG (equal or greater than 7.1 - 8.5 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. Nested models analysis showed that the prognostic impact of MBG is superior to AG (P < 0.001) on predicting 7-day and 30-day mortality and combined end point events in this patient cohort., Conclusion: Elevated MBG (≥ 7.1 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. MBG is superior to AG on predicting short-term prognosis in this patient cohort.

Objective: To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS)., Methods: We analyzed data from Chinese patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables., Results: The overall 30-day mortality of STEMI complicated by CS among the 517 patients [(68.5 ± 10.3) years and 57.6% male] was 62.3%. Logistic regression analysis showed that the independent risk factors of death included age (OR = 1.46, 95%CI: 1.18 - 1.81), anterior infarction (OR = 2.01, 95%CI 1.29 - 3.11), admission glucose level > 7.8 mmol/L (OR = 2.17, 95%CI: 1.26 - 3.73), serum sodium concentration < 130 mmol/L (OR = 2.21, 95%CI: 1.21 - 4.04), left ventricular ejection fraction (LVEF) < 40% or sever left ventricular dysfunction (LVD) (OR = 3.78, 95%CI: 2.28 - 6.27), no emergency revascularization (OR = 3.53, 95%CI: 1.20 - 10.41) and diuretics use (OR = 1.90, 95%CI: 1.21 - 2.97). Analysis using baseline clinical variables showed that the first five risk factors mentioned above were also the baseline risk factors fro death. The receiver operating characteristic curve for predicting the death of the two models was 0.81 (95%CI: 0.77 - 0.86) and 0.80 (95%CI: 0.75 - 0.84), respectively., Conclusion: The 30-day mortality of patients with STEMI complicated by CS was over 60%. Age, anterior infarction, admission glucose level >7.8 mmol/L, serum sodium concentration < 130 mmol/L, left ventricular ejection fraction (LVEF) < 40% and no emergency revascularization were independent risk factors associated with 30-day mortality.

Objective: To analyze the clinical characteristics of 18 patients with isolated right sided infective endocarditis (RSIE) who hospitalized in our department between August 2005 and February 2009., Methods: The epidemiological and clinical data of 18 non-drug addicts with RSIE were retrospectively analyzed., Results: The incidence of RSIE accounted for 7.23% of all IE patients hospitalized in our department during the same period. Predisposing conditions were as follows: congenital heart disease (76.5%, 14/18), post operative procedures (3/18) and high dose glucocorticoids use (1/18). Fever (100%) was the most common clinical manifestation. Septic pulmonary embolism was the most prevalent complication (5/18). Staphylococci aureus (4/7) were the most common causative patho organisms, while the most common etiological organisms of left-sided and both-sided IE were Streptococci Viridans. Transthoracic echocardiography evidenced 17 cases of vegetations including 59.1% (13/22) tricuspid vegetations. There was no in-hospital death and the mean hospitalization duration was (22.0 +/- 18.9) days., Conclusions: Congenital heart diseases, but not intravenous drug abuse, were the most prevalent predisposing factors for RSIE in this cohort. Staphylococci aureus were the most common causative organisms.

Objective: To identify the risk factors associated with increased combined end points (including death, new myocardial infarction and stroke) of patients with non-ST elevation acute coronary syndrome in China., Methods: Patients with non-ST elevation acute coronary syndrome hospitalized in 38 hospitals in China were included in this registry study as part of an international multicentre registry-OASIS. Data including clinical characteristics, previous medical history, therapeutic procedure and follow-up medicines, were collected and analyzed. The follow up period was two years. Cox regression model was used to analyze the association between multiple risk factors and combined end points., Results: From April 1999 to December 2001, 2294 eligible patients were enrolled nationwide and 2294 patients finished the 2 years follow up (mean age: 62.8 +/- 8.3 years and 62.3% males). The mortality was 7.6% (174/2294), 168 new myocardial infarction and 93 stroke were recorded during follow up and the combined end point events was 365 (15.9%) at the end of the two year's follow-up. Forty-eight factors were analyzed by Cox regression model to determine the impact of these factors on the occurrence of end point event. Risk factors that promoting end points were: thrombolysis during hospitalization, heart rate more than 120 bpm at admission, current smoker, history of PTCA, length of the first hospitalization, intravenous nitrate use during hospitalization, history of heart failure, low molecular weight heparin or subcutaneous heparin use during hospitalization, former smoker, calcium antagonist use during hospitalization, history of hypertension or coronary artery disease, recurrent angina pectoris during hospitalization and age by the first hospitalization. Protective factors that reducing end point were: normal ECG at admission, use of oral nitrate, anti-platelet medicine, calcium antagonist, lipid lowering agents and angiotensin converting enzyme inhibitor during follow-up period., Conclusion: The two-years incidence of combined endpoints of death, new myocardial infarction and stroke in patients with non-ST elevation acute coronary syndromes is 15.9% in China. Fifteen factors are associated with increased and 8 factors (mostly related to regular medication use) are associated with reduced occurrence of endpoints during follow up in this cohort.

Objective: To evaluate the impact of admission blood glucose level on 30-day mortality in ST-segment elevation acute myocardial infarction (STEMI) patients with or without known diabetes., Method: This observational analysis enrolled 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset joining a global randomized controlled trial. The patients with or without known diabetes were divided into different groups by the admission blood glucose level: < 6.1 mmol/L (n = 2018), 6.1 to 7.7 mmol/L (n = 2170), 7.8 to 11.0 mmol/L (n = 1929), 11.1 to 13.0 mmol/L (n = 465), > 13.0 mmol/L (n = 864), the last three groups were defined as the hyperglycemia group. The 30-day mortality was analyzed., Result: A substantial proportion of hyperglycemic patients did not have recognized diabetes. Insulin use during hospitalization in hyperglycemic patients without known diabetes was significantly lower than that in known diabetics with similar glucose levels. Incidence of 30-day mortality increased in proportion to increasing admission glucose levels in patients without known diabetes (glucose< 6.1 mmol/L 6.8%, 6.1 to 7.7 mmol/L 8.3%, glucose > 13.0 mmol/L 18.6%, P < 0.001). In patients with known diabetes, the 30-day mortality was 16.7% with admission glucose < 6.1 mmol/L and 8.2% with admission glucose 6.1 to 7.7 mmol/L, and 22.0% with admission glucose > 13.0 mmol/L (P < 0.001). Except in patients with admission glucose > 13.0 mmol/L, the 30-day mortality was significantly higher in patients without known diabetes than in patients with known diabetes at comparable admission glucose levels (all P < 0.05)., Conclusion: Comparing with the known diabetic patients, admission hyperglycemia is common in STEMI patients without known diabetes and was associated with higher 30-day mortality compared to known diabetes patients with comparable admission glucose level with the exception of admission glucose level > 13.0 mmol/L.