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Objective To explore the clinical efficacy of intra-aortic balloon pump (IABP) as an auxiliary treatment of percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD) associated with chronic kidney disease. Methods One hundred and twenty CHD patients with concomitant chronic kidney disease and receiving PCI in our hospital from Jan. 2000 to Jul. 2014, and 123 simple CHD patients without renal dysfunction, who had undergone PCI with concomitant IABP for the cardiac pump failure, cardiogenic shock, acute left heart failure, unstable angina pectoris (UP) which was not allayed by medical treatment, or acute myocardial infarction (AMI), were selected for observation of preoperative condition, in-hospital mortality and prognosis of patients in two groups. Results There was no statistically significant difference in general clinical data including gender, age, and concomitant hypertension and diabetes, and preoperative blood lipid, AST, D-dimer, APTT, and international normalized ratio (INR) showed also no statistically significant difference before surgery between two groups of patients (P>0.05). The difference in proportion of AMI, the left main trunk and (or) three-branches involvement was of no statistical significance (P>0.05), but there was significant difference in the incidence of previous myocardial infarction, TnT, CK-MB, Cr, BUN, stent number, IABP application time (P0.05) between the two groups. Logistic regression analysis revealed that diabetes and the number of stents were independent risk factors for in-hospital and long-term mortalities. Conclusions By means of the effective cardiac assistance of IABP, CHD patients with renal insufficiency have the same short and long term clinical prognosis as simple CHD patients without renal dysfunction who has undergone PCI. Diabetes and the number of stents are independent risk factors for in-hospital and 1-year mortality. DOI: 10.11855/j.issn.0577-7402.2015.04.03

Objective To explore the risk factors for mortality after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI). Methods The patients who were admitted with STEMI to our hospital between July 2008 and November 2012 undergoing PCI during hospitalization were enrolled. Case control study was conducted to observe these patients during the follow-up period for exploring the independent predictors of survival. Results A total of 3551 consecutive patients were enrolled in this study. These patients were followed up for 5 years with a median followup time of 406[179, 892] days. A total of 106 deaths occurred during the follow-up period. Estimated 5-year survival rate was 88.6% by Kaplan-Meier method. Female, age, diabetes, stroke, dysarteriotony, renal insufficiency, elevation of creatinine kinase isoenzyme MB (CK-MB), left ventricular end diastolic dimension, anemia, anterior myocardial infarction, PCI complications and intra-aortic balloon pump (IABP) were independent risk factors for mortality, whereas complete revascularization was associated with decreased risk of mortality. Conclusions Long-term mortality rate of patients with STEMI is higher even after successful PCI. Less PCI complications and early complete revascularization are independent predictors for decreasing mortality rate during follow-up period. DOI: 10.11855/j.issn.0577-7402.2015.04.05

Objective To investigate the risk factors, clinical features and prognosis of premature ST-segment elevation myocardial infarction (STEMI). Methods In this retrospective analysis, 1428 patients who were diagnosed as premature STEMI (male ≤55 years old, female ≤65) and treated with percutaneous coronary intervention (PCI), admitted to General Hospital of Shenyang Command from July 2008 to November 2012, were divided into two groups, namely the young (≤45 years old, n=381) and middle aged (>45 years old, n=1047) groups. Clinical characteristics and prognosis of the premature STEMI patients in different age groups were summarized and compared. Results The percentage of male (97.1% vs 76.7%, P

Objective To assess impact of selective thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) on long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Methods Between Jan. 2008 and Jan. 2014, a total of 2357 STEMI patients [429 in thrombus aspiration (TA) group and 1928 in routine percutaneous coronsry intorventim (PCI) group (control group)] were eligible for the study criteria and candidates for pPCI were enrolled in this study. The reflow of the involved vessel in pPCI procedure, stent thrombosis and major adverse cardiac events (MACE) were comparatively analyzed in the two groups during hospital stay and 12-month follow-up period. Results Although the success rate of TA procedure was significantly lower in TA group compared with that in control group (P＜0.001), both the TIMI flow grade ≥2 after TA procedure and stent implantation occurred more frequently in TA group than in control group (P＜0.05). The rates of MACE and stent thrombosis showed no difference between two groups during in-hospital and 12-month follow-up period (P>0.05). But the rates of total MACE and target vessel revascularization were significantly higher in control group than in TA group (P=0.04). Conclusion Selective TA procedure before primary PCI could improve final myocardial reperfusion, reduce the incidence of MACE and improve the 1-year clinical result for STEMI patients. DOI: 10.11855/j.issn.0577-7402.2015.04.04

Background: Current randomized trials have demonstrated the effects of short-term rosuvastatin therapy in preventing contrast-induced acute kidney injury (CIAKI). However, the consistency of these effects on patients administered different volumes of contrast media is unknown. Methods: In the TRACK-D trial, 2998 patients with type 2 diabetes and concomitant chronic kidney disease (CKD) who underwent coronary/peripheral arterial angiography with or without percutaneous intervention were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard-of-care. This prespecified analysis compared the effects of rosuvastatin versus standard therapy in patients exposed to (moderate contrast volume [MCV], 200-300 ml, n = 712) or (high contrast volume [HCV], ≥300 ml, n = 220). The primary outcome was the incidence of CIAKI. The secondary outcome was a composite of death, dialysis/hemofiltration or worsened heart failure at 30 days. Results: Rosuvastatin treatment was associated with a significant reduction in CIAKI compared with the controls (2.1% vs. 4.4%, P = 0.050) in the overall cohort and in patients with MCV (1.7% vs. 4.5%, P = 0.029), whereas no benefit was observed in patients with HCV (3.4% vs. 3.9%, P = 0.834). The incidence of secondary outcomes was significantly lower in the rosuvastatin group compared with control group (2.7% vs. 5.3%, P = 0.049) in the overall cohort, but it was similar between the patients with MCV (2.0% vs. 4.2%, P = 0.081) or HCV (5.1% vs. 8.8%, P = 0.273). Conclusions: Periprocedural short-term rosuvastatin treatment is effective in reducing CIAKI and adverse clinical events for patients with diabetes and CKD after their exposure to a moderate volume of contrast medium.

Optimal strategy for the management of high on-treatment platelet reactivity (HPR), an independent predictor of ischaemic events, is not yet clear. The aim of this study was to explore the safety and efficacy of personalized antiplatelet therapy based on platelet function testing in patients with HPR. A total of 840 patients with HPR who underwent coronary stenting for acute coronary syndrome (ACS) were randomly assigned in a 1:2 ratio to receive standard dual-antiplatelet therapy ( n = 280) or platelet function-guided optimal-antiplatelet therapy ( n = 560). In the optimal group, patients initially received clopidogrel 150 mg/day on top of aspirin and switched to triple antiplatelet therapy with additional cilostazol if repeat platelet function assay after 3 days indicated a sustained HPR. The primary endpoint was the composite of all-cause death, myocardial infarction, clinically driven target vessel revascularization (TVR), or stroke. Optimal therapy resulted in significantly lower 30-day HPR rate (30.1 vs. 44.3%, P < 0.001). At 1-year follow up, optimal therapy was associated with significantly lower incidence of primary endpoint events (2.7 vs. 6.8%, P = 0.006) compared with standard therapy, mainly due to the reduction of TVR. These beneficial effects were sustained at 2 years (4.5 vs. 9.2%, P = 0.006), with similar bleeding event rates between groups (7.3 vs. 6.5%, P = 0.565). Optimal-antiplatelet therapy based on platelet function testing is effective in attenuating HPR and improving long-term outcomes for ACS patients with no increase in bleeding events.