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Supplemental Digital Content is available in the text, Background Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions. Methods Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses. Results At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was –11.3% (95% confidence interval: –16.3% to –6.3%, Psuperiority

Background The efficacy and safety of PCSK-9 inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China is unknown. Objective To describe the real world effectiveness of initiated with PCSK-9 inhibitors combined with statins compared with statins among patients with very high risk of ASCVD and underwent percutaneous coronary intervention (PCI). Methods This is a prospective study, enrolled patients from 32 hospitals between January to June 2019. The lipid control rate and incidence of cardiovascular events over 6 months were compared between two groups. A propensity score-matched analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for cardiovascular events. Results In a total of 3063 patients, 89.91% had received moderate or high-intensity statin therapy before PCI, but only 9.47% had LDL levels below 1.4mmol/L at baseline. In the PSM selected patients, LDL level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81% (P

To explore the efficiency and safety of bivalirudin in patients undergoing emergency percutaneous coronary intervention via radial access.Bivalirudin reduces bleeding risks over heparin in patients undergoing PCI. However, bleeding advantages of bivalirudin in patients undergoing transradial intervention is uncertain.In the BRIGHT trial, 1,723 patients underwent emergency PCI via radial access, with 576 patients in the bivalirudin arm, 576 in the heparin arm and 571 in the heparin plus tirofiban arm. The primary outcome was 30-day net adverse clinical event (NACE), defined as a composite of major cardiac and cerebral events or any bleeding.30-day NACE occurred in 5.7% with bivalirudin, 7.8% with heparin alone (vs. bivalirudin, P = 0.159), and 10.3% with heparin plus tifofiban (vs. bivalirudin, P = 0.004). The 30-day bleeding rate was 0.9% for bivalirudin, 2.3% for heparin (vs. bivalirudin, P = 0.057), and 5.8% for heparin plus tirofiban (vs. bivalirudin, P 0.001). Major cardiac and cerebral events (4.9 vs. 5.7 vs. 4.6%, P = 0.899), stent thrombosis (0.5 vs. 0.5 vs. 0.7%, P = 0.899) and acquired thrombocytopenia (0.2 vs. 0.5 vs. 0.9%, P = 0.257) at 30 days were similar among three arms. The interaction test for PCI access and randomized treatment showed no significance on all bleeding (P 0.05).The bleeding benefit of bivalirudin was independent of artery access. Bivalirudin lead to statistical reduction on bleeding risks in comparison to heparin plus tirofiban, and only small numerical difference in comparison to heparin, with comparable risks of ischemic events and stent thrombosis in patients with acute myocardial infarction (AMI) undergoing emergency transradial PCI. © 2016 Wiley Periodicals, Inc.

Although several studies have suggested that intensive statin pretreatment could reduce the incidence of procedure-related myocardial infarction in western population, the data on the effect in Asian patients have been still limited. The aim of the study was to investigate the efficacy and safety of intensive atorvastatin load in Chinese patients undergoing elective PCI. A total of 1202 patients with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) scheduled to undergo PCI received either intensive statin treatment (80 mg atorvastatin daily × 2 days before PCI and 40 mg daily × 30 days after PCI) or usual care. The primary endpoint was incidence of major adverse cardiac events (cardiac death, myocardial infarction, or unexpected target vessel revascularization) within 30 days after PCI. Safety endpoints include the incidence of contrast induced nephropathy (CIN), ALT/AST >3 upper limit of normal (ULN), CK >5 ULN. The incidence of 30-day MACE did not significantly differ between the intensive group and control group (19.4 vs 18.3%, P = 0.63). Multivariate analysis revealed age (OR = 1.024, 95% CI 1.003–1.045, P = 0.023) and total stent length as an independent predictor of 30-day MACE (OR = 1.012, 95% CI 1.007–1.018, P < 0.0001). The incidence of CIN was comparable between intensive group and control group (4.09 vs 4.39%, P = 0.795). No significant differences were observed in other safety profile at all follow-ups between treatment groups. The ISCAP trial demonstrated that serial intensive atorvastatin therapy did not improve the clinical outcome with similar safety profile comparing with usual care among Chinese patients undergoing elective PCI.

Objective We aimed to investigate the association between the 5A/6A promoter polymorphism in the matrix metalloproteinase 3 ( MMP3 ) gene and in-stent restenosis (ISR) in a regional Chinese population. Methods A total of 818 patients who underwent primary implantation of drug-eluting stents were enrolled and received a 6-month follow-up angiography and DNA genotyping of the 5A/6A polymorphism. Results ISR was found in 36.9% of all patients (302 ISR vs. 516 no ISR). The genotype proportion of 6A6A was significantly increased in ISRs (74.2% ISR vs. 66.8% no ISR), whereas the allele frequency of 5A was significantly decreased in ISR patients (25.8%) compared with controls who did not undergo ISR (33.1%). Conclusions Our data indicate that the MMP3 6A6A genotype is a genetic susceptibility factor for ISR after coronary stent placement, but the 5A allele can lower the risk for patients within 6 months after stenting. Therefore, genotyping 5A/6A in the MMP3 promoter is suggested for patients who undergo coronary stent implantation.

Objective The aim of this study was to investigate the correlations between risk factors such as hypertension and the complex degrees of coronary arterial lesions (CAL). Methods We selected 462 patients with coronary heart disease (CHD) with confirmed the stenosis (≥50 %) in at least one major coronary artery on coronary angiography and divided them into the “CHD with hypertension” group (CHD-HT, n = 306) and the CHD group (n = 156). The characteristics of CAL and the occurrence of 2-year postoperative major adverse cardiac cerebrovascular events (MACCE) in the two groups were observed. Results The mean SYNTAX scores (SS) was higher in the CHD-HT group than in the CHD group (P

To explore diagnostic performance of mean platelet volume (MPV) for acute myocardial infarction (AMI) of patients with acute coronary syndrome (ACS).We compared MPV and other indicators of 1,524 patients with ACS. Among them, 880 patients were diagnosed with AMI, 344 were diagnosed with unstable angina pectoris and 350 were the control group.The level of MPV in ACS group was significantly higher than the control group (9.5 ± 1.34fL versus 7.9 ± 1.03fL, P0.001). Additionally, MPV of AMI group was higher than unstable angina pectoris (9.4 ± 1.30fL versus 9.2 ± 1.42fL, P0.001). Increased MPV could be identified as an early independent predictor of AMI (odds ratio = 1.957, 95% CI: 1.389-2.758, P0.001). The area under the receiver operating characteristic curves curve for MPV combined with troponin I (TnI) was 0.816, the sensitivity (68.81%) and the specificity (97.98%) at the best cut-off value were higher than using MPV or TnI alone respectively.MPV has been shown as an independent risk factor for early onset of AMI and can be applied to assist AMI diagnosis of ACS patients. Additionally, measuring MPV in conjunction with TnI levels can improve the diagnostic performance of TnI with higher sensitivity and specificity.

To investigate the association between inflammatory mediators, matrix degrading enzymes and acute coronary syndrome (ACS) and the impact of early reperfusion therapy on circulating biomarkers.Peripheral serum levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and matrix metalloproteinase-9 (MMP-9) were determined in 134 patients with ACS. These biomarkers were serially monitored in ten patients with intravenous thrombolytic therapy (IVT).Serum levels of IL-6, hs-CRP and MMP-9 were higher in unstable angina (UA) and myocardial infarction (MI) groups than in control or SA group (p0.05). Peripheral IL-6 level in patients with MI was greater after percutaneous coronary intervention (PCI) (p0.01) or IVT (p0.05). Serial concentration determination revealed marked elevation of serum IL-6 and MMP-9 levels, both reaching peak values (like creatine kinase-MB).Elevated levels of IL-6, hs-CRP and MMP-9 provide a link between inflammation, matrix degradation and the development and progression of ACS. IL-6 and MMP-9 appear to be released mainly from vulnerable plaque or necrotic myocardium during the acute phase of MI.

Objectives To develop a simplified risk score of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for Han Chinese. Methods A retrospective study was performed on 1500 patients for the development dataset, who had undergone PCI from January 2008 to May 2010. And one thousand patients treated in the same period were selected for the validation set. Logistic regression analysis was applied to identify risk factors for CIN. Based on the OR, the sum of the integers was a total risk score for each patient. Results (1) Among the 1500 patients, CIN occurred in 246 patients and the overall incidence of CIN was 16.4%. (2) Eleven identified variables were identified as risk factors for CIN (with weighted integer): diabetes (3 score), hypotension (3 score), Left ventricular ejection fraction (LVEF≤45%) (3 score), eGFR 2 (3 score), age>70 years (2 score), myocardial infarction (2 score), emergency PCI (2 score), anaemia (2 score), decreased high-density lipoprotein (HDL) concentration ( 200 ml (2 score), low permeability contrast agent (1 score). (3) The sum of the integers was a total risk score for each patient. The incidence of CIN was 5.2% in low risk group (≤4), 13.6% in the moderate risk group (5–10), 32.3% in the high risk group (11–14) and 59.0% in the very high risk group (≥15). (4) The model demonstrated good discriminative power in the validation population, showing that the increasing risk score was strongly associated with CIN (c-statistic=0.82). Conclusions This simple scoring system proposed here provides a good estimate of the risk of CIN after PCI for Han Chinese. This risk score can be used for the prevention and treatment of CIN.

Objectives To observe the effect of different doses of atorvastatin combined with different dose of probucol on the level of serum uric acid in patients undergoing coronary angiography or percutaneous coronary intervention (PCI). Methods 208 cases enrolled in our study were randomly divided into three groups: Standard combining treatment group (n=55): Atorvastatin 20 mg qn and Probucol 0.25 g/bid; Intensively combining treatment group (n=79): Atorvastatin 40 mg qn and Probucol 0.5 g/bid, with a further dose of Atorvastatin 40 mg and Probucol 0.5 g 2 h before the angioplasty; Intensive Atorvastatin group (n=74): Atorvastatin 40 mg qn, with a futher dose of Atorvastatin 40 mg 2 h before the angioplasty. Blood urea nitrogen (BUN), serum creatinine (Scr), serum uric acid (SUA), and estimated glomerular filtration rate (eGFR) (through MDRD method) of all patients were tested at the times of 24 h before and 24 h after the procedure. Results (1) After operation, BUN of all groups decreased; Scr in Standard combining treatment group and Intensive Atorvastatin group increased significantly; while eGFR decreased only in Standard combining treatment group (p 0.05); (2) SUA in Standard combining treatment group and Intensively combining treatment group decreased significantly after operation (p 0.05). (3) For hypertensive patients, Scr in Standard combining treatment group and Intensive Atorvastatin group increased significantly (p Conclusions Preoperative combination treatment of Atorvastatin and Probucol could reduce perioperative serum uric acid9s level, what9s more with a intensive treatment of future dose of Atorvastatin 40 mg and Probucol 0.5 g 2 h before the angioplasty could also improve CIAKI. For hypertensive patients, intensively combining treatment could not only reduce serum uric acid9s level, but also improve CIAKI.