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Backgroud Data on the efficacy of percutaneous coronary intervention (PCI) for treatment of multiple coronary chronic total occlusion (CTO) lesions are scanty. The optimal revascularisation strategy for multiple coronary CTO disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and PCI. The aim of the present study is to compare the long-term outcomes of DES implantation for multiple coronary CTO lesions compared with CABG. Methods We analysed 261 patients who underwent coronary angiography for at least two de novo CTO lesions in our centre from November 2000 to November 2006. Among them, 118 patients (45.2%) received DES implantation after recanalisation for CTO lesions and 143 patients (54.8%) received CABG. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularisation) and hospitalisation costs were compared. Long-term survival rates were estimated with the Kaplan-Meier method. Results Patients in the CABG group were likely to have hyperlipidemia, diabetes mellitus, multivessel disease and higher euroSCORE. The mean follow-up was 4.2 ± 0.7 years in the CABG group and 4.3 ± 0.5 years in the DES group. Total hospitalisation costs were lower (p = 0.017) in the CABG group (median: 107 thousand Yuan) than in the DES group (median: 156 thousand Yuan). Rates of MACCE at 12 months were higher in the PCI group (16.9% vs 11.2% for CABG; P = 0.179), but not statistically significant, in large part because of an increased rate of repeat revascularisation (15.3% vs 7.0%, p = 0.016). The overall survival rate (CABG: 73.4% and DES: 76.2% at 5 years, p = 0.599) and the TVR-free survival rate did not differ between the groups. Conclusions This study demonstrates the long-term (up to 5 years) efficacy and safety of DES for treatment of multiple coronary CTO lesions. The long-term survival rate of PCI with DES was comparable to that of CABG for the treatment of multiple coronary CTO. PCI with DES was more costly than CABG. PCI using DES might be an alternative to CABG in selected patients with multiple coronary CTO disease.

Objective To investigate the feasibility of coronary graft vessel angiography by the left radial approach. Methods The 45 patients with coronary artery bypass grafting (CABG) history were enrolled from January, 2012 to June, 2014. All the patients were divided to two groups according to the angiography approach. Coronary bypass graft angiographies in one group of 13 another group of 32 patients were done by the femoral approach. Success rate of angiography, time of vein graft angiography, time of left internal mammary artery (LIMA) angiography, numbers of conduct, volume of contrast were observed. The complications at the puncture point including haemorrhage, hematoma, false aneurysm, arteriovenous fistula were noticed. Results There were no difference in success rate of angiography, time of vein graft angiography, numbers of conduct, volume of contrast between the two groups. The time of LIMA angiography was shorter in the left radial approach group than it in the femoral approach group (4.7 ± 4.4 min vs 9.6 ± 6.3 min, p = 0.023). There was no difference in complication after procedure between the two groups. Conclusion It is feasible that the coronary bypass graft vessel angiography is done by the left radial approach, especially for the LIMA angiography because of less time and simple manipulate. The bypass graft vessel angiography done by the left radial approach should be the first choice for the experienced manipulator.

Background The best option on the treatment of coronary bifurcation lesions is a subject of considerable debate. However, recent evidence suggests that bifurcation lesions might be treated by drug-eluting stent on both branches using the modified mini-crush (MMC) technique with a low rate of major adverse cardiac event and restenosis. This retrospective study sought to assess the clinical and angiographic long-term outcome after implanting drug-eluting stents in the bifurcation lesions of left anterior descending artery (LAD) with the Cullotte technique and MMC technique. Methods From April 2003 to January 2013, 445 patients were consecutively treated with either MMC technique (MMC group, n = 141) or Cullotte technique (Cullotte group, n = 304). The results of in-hospital and 12-month clinical follow-up were analysed. The indexes of in-hospital, angiographic restenosis at 12-months and major adverse cardiac events (MACE) including death, myocardial infarction or any target lesion revascularisation were evaluated. Results The mean 12-month angiographic follow-up was completed in 63 patients (44.7%) of MMC group and in 118 patients (38.8%) of Cullotte group. The MMC group compared with the Cullotte group had significantly shorter operative time and lower main or side branches restenosis (hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.20 to 0.85; p = 0.016; and HR 0.52, 95% CI 0.27–0.99; P = 0 .047, respectively). So, the MMC group compared with the Cullotte group had significantly lower revascularisation (HR 0.57, 95% CI 0.31–0.97; p = 0.023). After a propensity score adjustment, 2-year cumulative major adverse cardiac events were similar between groups (p = 0.16). Conclusions The "modified mini-crush technique" with DES can be safely performed giving complete coverage of the ostium of side branches and optimising side branch access. Both techniques of bifurcation treatment met high procedural success with low complication rates and similar major adverse cardiac event long-term outcome. However, the MMC technique minimised the stent structs in main branch, yields a lower restenosis rate at main or side branches.

Background Previous studies have reported that low final thrombolysis in myocardial infarction (TIMI) flow and/or myocardial blush grade (MBG) are independent predictors of mortality in patients with ST-elevation myocardial infarction (STEMI). Several studies with thrombus aspiration (TA) showed different results, mainly due to use of TA as an additional device instead of balloon predilatation (BP). Objective The aim of the present study was to assess impact of TA followed by direct stenting during primary percutaneous coronary intervention (PPCI). Methods Between Dec 2008 and Jun 2011, a total of 429 patients (107 patients in TA group and 322 patients in BP group) who were eligible for the observation criteria, admitted with STEMI (within 9 h from symptoms onset) and candidates for PPCI were enrolled. Exclusion criteria were a previous PCI on infarct-related artery, infarct-related artery balloon predilatation and TA simultaneously, and calcium or tortuous infarct-related lesion. The main indexes of this study were the TIMI flow grade, MBG, and the rate of 60-min ST-segment resolution > 50% after PCI and in-hospital major adverse cardiac events (MACE). Secondary indexes included distal embolizations of infarct-related artery, peak CK-MB release, and MACE after one year. Results Baseline clinical and angiographic characteristics, initial TIMI flow and initial MBG did not differ between the two groups. Procedural success was obtained in all patients. Stent length, number of stents per patient, and stent/vessel ratio were similar between both groups. The rate of 60-min ST-segment resolution > 50% was significantly more frequent in TA group than in BP group (69.2% vs 48.5%, P flow grade after PCI was significantly higher among patients in TA group compared with BP group (2.65 ± 0.49 vs 2.44 ± 0.61, P ± 0.34 vs 2.41 ± 0.56, PP ± 144 U/L vs 711 ± 165 U/L, P There was no difference in between the groups in in-hospital MACE (0.9% vs 2.8%, P > 0.05), in 12-month cardiac mortality (1.2% vs 2.2%, P > 0.05), reinfarction rate (0.9% vs 3.1%, P > 0.05) and target vessel revascularization (2.8 vs 6.5%, P > 0.05). But Total MACE was significantly higher in BP group compared with the TA group (6.5% vs 14.5%, P Conclusions Compared with conventional PCI, TA and direct stenting before primary PCI improved final myocardial reperfusion and the long-term outcome for STEMI patients.

Objectives To investigate effects of intravenous versus intra-coronary injection of tirofiban on myocardial reperfusion during primary PCI in patients with STEMI. Methods A total of 314 patients admitted to our hospital with myocardial infarction within 12 hours were enrolled in this study. Three hundred milligrams aspirin and 600 mg clopidogrel were given before PCI. Patients were randomised into intra-coronary injection or intravenous injection of tirofiban (10 μg/kg). Primary endpoints included disappear of ST segments elevation, myocardial reperfusion grade, infarction size by cardiac biomarker and major adverse cardiac events within 30 days. Second endpoints include clinical events of bleeding. Results There was no difference in rate of disappear of ST segments elevation (57% vs 58%). TIMI flow was better in intra-coronary group (84% vs 67%) and there was more myocardial reperfusion grade 2 (81% vs 63%). There was no difference in cardiac bio-marker level. There was no difference in rate of thrombocytopenia or major organ bleeding. Conclusions Intra-coronary injection of tirofiban during primary PCI in patients with STEMI can results in better myocardial reperfusion grade, smaller infarction size, and better reperfusion, but has no effects on short-term prognosis. There was no increase of major clinical bleeding, so it is safe.

Background By studying the clinical and imaging features of myocardial bridge and severe atherosclerosis lesions in the segments proximal to the myocardial bridge, compared with that of pure myocardial bridge retrospectively, to analyse the clinical and imaging characteristics of these patients. Methods The study population consisted of 2 groups (192 patients). The CHD Group included 92 patients with severe atherosclerosis lesion of luminal narrowing of ≥ 70% in the segments proximal to the myocardial bridge. The bridge group included 100 patients with symptomatic myocardial bridge lesion of systolic luminal narrow. All lesions were successfully treated with stent by standard interventional techniques. Quantitative coronary angiography was performed before and immediately after stent deployment. Results The mean age and systolic pressure in the CHD patients were more than that in the pure bridge group (58 ± 11 vs 42 ± 10 ys and 157.8 ± 9.8 vs 146.1 ± 10.2 mmHg, respectively), P vs 90 ± 7%). But the average length from the proximal end of myocardial bridge to the ostium of LAD and the average length of myocardial bridge had not difference between two groups. Conclusions The patients with severe atherosclerosis lesion in the segments proximal to the myocardial bridge has more risk factors of CHD, the extent of diameter stenosis during systolic stage has some promotive effect on CHD.

Objective To investigate the feasibility and safety of wire technique for the treatment of chronic coronary artery occlusion. Methods 135 patients with chronic coronary artery occlusion who received coronary artery inner bracket operations by retrograde wire technique following failure of routine transcutaneous antegrade wire technique, or estimating difficulty in the antegrade operation, were followed up last 8 years by angiography or on telephone. The data of 135 CTO patients undergoing PCI for a CTO from August 2004 were analysed. Retrograde wire technique was performed successfully in 128 patients with chronic coronary artery occlusion. The average occlusion lasts more than 3.3 years. PCI was successfully performed in 110 CTO patients with 2–3 coronary collateral blood flow circulationby author (JING) independently, including 64 LAD CTO and 76 RCA CTO. The average of 128 patients were treated by using 3.6 drug-eluting stents, 4.6 guidewires, 1.7 microcatheters and intravascular contrast media 320ML. The successful rate of guided catheter placement by right radial and right femoral approach was very high (96.4%). The successful rate of antegrade wire into regtrograde microcatheter in catheter 39.4% was higher (P Results and Conclusions Conclusion method is feasibility and safety for patients. Careful evaluation on CTO lesion is a key to obtain a relatively high success rate of PCI. Retrograde wire technique significantly increases the success rate of procedure in patients who failed in antegrade wire technique. Exquisite operating and select equipment are important too. It confirmed its good effect for patients with coronary artery inner bracket operation.

Objective To evaluate the efficacy and security of percutaneous coronary intervention (PCI) supported by intra-aortic balloon pump (IABP) for patients with high risk coronary heart disease. Methods We retrospectively reviewed immediate success rate of PCI, in-hospital survival rate and complications of 624 patients with high risk coronary heart disease who underwent PCI supported by IABP in our institution from January 2000 to October 2011. Results Out of all the 624 patients, 71% were ST-elevation myocardial infarction (STEMI), 21% were none ST-elevation myocardial infarction (NSTEMI) and 8% were unstable angina pectoris (UAP). The patients (averagely aged 68 years and 71% were males) suffered from hypertension (78%), family history of coronary heart disease (34%), abnormal metabolism of serum lipids (69%) and diabetes (45%). The latter two seemed presenting more frequently in patients with acute myocardial infarction (AMI). The incidence of major adverse cardiovascular events (MACE) in STEMI and NSTEMI group was significantly higher than that in UAP group (3.1% and 2.9% vs. 0.01%, P P Conclusions The success rate of PCI for patients with high risk coronary heart disease is extremely high when IABP support was applied, with an ideal prognosis and decreased complications. This method is clinically safe and efficient with high feasibility. The advantages become more evident when treating patients with AMI complicated by high risk of cardiogenic shock.

Objective To evaluate the long-term efficacy of covered stent implantation to the patients with coronary perforation occurred in percutaneous coronary intervention (PCI). Methods From June 2004 to March 2011, a total of 8 cases received 8 covered stents implantation because of coronary perforation in our centre. Ellis grade III coronary perforation occurred in 7 patients, and Ellis grade I in 1 patient. The patients took clopidogrel 75 mg/d for 2 years, and 100 mg/d for lifetime. The major adverse cardiac events (MACE) were observed in the 8 patients through long-term follow-up. Results There were 5 males and 3 females in the 8 patients who aged 63–76 (mean 69.3 ± 4.7) years. Six patients had multi-vessel disease. The target vessels were left anterior descending artery (LAD) in 7 patients. Calcified lesions emerged in 3 patients and total occlusion lesions in 3 patients. In addition to 2 patients with balloon dilating after guidewire into the false lumen, the coronary artery perforation of the remaining six patients were associated with too high pressure of stent expansion or balloon dilating. Pericardial tamponade happened in 7 patients, and pericardial effusion of 100–470 ml was drained by pericardiocentesis. Implanted covered stents average diameter was 3.3 ± 0.3mm, and average length was 21.3 ± 4.1mm. All perforation of the patients were successfully closed, while no patients died in PCI. During follow-up of 0.6–67 months (mean 35.3 ± 25.1 months), 2 patients died. Nineteen days after PCI, one patient died of multiple organ failure due to lung infection. Thirteen months after PCI, another patient died of cardiac sudden death. One patient was hospitalised with angina pectoris after 53 months, and the symptoms was relieved. The imaging was not reviewed. After 6 months one patient received multi-slice CT examination, and no restenosis was found. He was currently asymptomatic. The remaining four patients were reviewed coronary angiography after 15–67 months. Only one patient showed LAD stent restenosis and received target vessel revascularization. The remaining 3 patients had no restenosis within the stent. During the entire follow-up, restenosis rate was 20% (1/5), mortality rate was 25% (2/8) and MACE rate was 50% (4/8). If follow-up after PCI was 12 months, MACE rate decreased to 25% (2/8). Conclusions Treatment of covered stent to coronary perforation can achieve good long-term efficacy. A two-year dual antiplatelet drugs can be effective in preventing covered stent thrombosis.

Objective To observe the efficacy of percutaneous coronary intervention (PCI) in maintenance hemodialysis (MHD) patients with acute coronary syndrome (ACS). Methods From January 2008 to October 2011, we completed PCI in the 38 MHD patients with ACS in our hospital hemodialysis Division, including 23 males and 15 females, aged 48–74 (mean 64.2 ± 8.2) years old. Protopathy were diabetic nephropathy in 25 cases, hypertensive renal disease in 11 cases, chronic glomerulonephritis in 2 cases; 33 patients were unstable angina, 4 patients were acute non-ST-segment elevation myocardial infarction, and 1 patients was acute ST-segment elevation myocardial infarction. 1 day before PCI, all patients took aspirin 300 mg and clopidogrel 300 mg, then took clopidogrel 75 mg for 1 year and aspirin 100 mg for lifetime. The results of coronary angiography were observed. All cases received 1-year follow-up about the adverse cardiovascular and cerebrovascular events (MACCE). Results coronary angiography showed all patients with multi-vessel disease, double-vessel disease in 28 patients (73.7%) and three-vessel disease in 10 patients (26.3%). All patients were deployed with drug-eluting stents (DES). Implanted stents diameter were an average of 3.0 ± 0.3mm, and length were an average of 37.7 ± 23.9mm. The angina symptoms disappeared in all patients, while no intraoperative deaths happened. Postoperative angina occurred in 4 cases (10.5%), which relieved after medication adjustment and no one accepted coronary angiography again. NO acute myocardial infarction happened. 1 patient died of acute left ventricular failure, and 1 patient died of cerebral haemorrhage. MACCE occurred in 5.3%. Conclusions Interventional therapy can improve quality of life and survival in MHD patients with ACS.