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Sex differences in the long-term prognosis of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing alcohol septal ablation (ASA) remain unclear, especially in the Chinese Han population.This cohort study included 320 HOCM Chinese Han patients who underwent ASA because of symptomatic left ventricular outflow tract (LVOT) obstruction. Patients were grouped according to sex: females (mean±standard deviation age [SD] 50.7±6.8 years) and males (mean±SD age 52.6±7.3 years). Individuals were followed over the long term.Pre-procedure, women had more symptoms (New York Heart Association [NYHA] class III-IV 67.3% vs 56.3%, p=0.03), more atrial fibrillation (23.5% vs 14.6%, p=0.047) than men. Transient complete atrioventricular block after ASA was more common in woman than in men (34.0 vs 23.4%; p=0.048). Residual LVOT gradient, post-procedural residual left ventricular wall thickness, NYHA functional class, and adverse arrhythmic events were comparable between the two groups. The 10-year survival rate (77% vs 89%, p=0.037) and the annual adverse arrhythmic event rate (1.3% vs 0.4%, p0.01) following ASA were significantly worse in women compared with men. Kaplan-Meier analysis showed a significantly lower survival in women compared with men (p=0.023). In multivariable modelling, female sex remained independently associated with higher all-cause mortality (hazard ratio, 1.12; 95% confidence interval, 1.08-1.27; p=0.03) when adjusted for age, NYHA class III-IV symptoms, and other cardiovascular comorbidities.Female patients with HOCM undergoing ASA tended to have more severe symptoms and adverse arrhythmic events. The 10-year survival rate after ASA was significantly worse in women compared with men with HOCM. Sex may need to be considered as an important factor in the clinical management of patients with symptomatic HOCM.

Yong Wang, Xiao-jiao Zhang, Hong-wei Zhao, Chengfu Wang, Defeng Luo, Qingkun Meng, Yu Zhu, Jie Tao, Baojun Chen, Yi Li, Aijie Hou, Bo Luan Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang City, Liaoning Province 110016, People’s Republic of ChinaCorrespondence: Bo Luan; Aijie HouDepartment of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang City, Liaoning Province 110016, People’s Republic of ChinaTel +86-17702488970Email luanbo2016@163.com; 1758624242@qq.comBackground: Retrograde microcatheter collateral channel (CC) tracking after successful wiring of septal CC is crucial for retrograde revascularization of coronary chronic total occlusion (CTO). However, the incidence, predictors, and strategies for failure of retrograde microcatheter CC tracking after successful wiring of septal CC remain unclear.Methods: In total, 298 patients with CTO who underwent retrograde septal CC PCI between January 2015 and May 2019 were retrospectively analyzed. Clinical data were compared to investigate the predictors of initial microcatheter tracking failure.Results: The initial and final microcatheter tracking success rates were 79.2% (236/298) and 96.6% (288/298), respectively. The procedural success rate was 94.0% (280/298). The right coronary artery-to-left anterior descending artery septal ratio (48.4% vs 33.1%, p=0.037) and CC tortuosity (34.6% vs 20.8%, p=0.045) were significantly higher in the initial microcatheter CC tracking failure group than in the successful tracking group. Multivariate logistic regression analysis revealed that severe collateral tortuosity (odds ratio [OR]: 13.241, 95% confidence interval [CI]: 3.429– 27.057, p=0.038), CC entry angle of < 90° (OR:4.921, 95% CI: 1.128– 9.997, p=0.002), CC exit angle of < 90° (OR:5.037, 95% CI: 2.237– 11.182, p=0.004), use of Finecross MG as initial microcatheter (OR:1.826, 95% CI: 1.127– 3.067, p=0.035), and shunning initial retrograde application of Guidezilla (OR:0.321, 95% CI: 0.267– 0.915, p=0.024) were variables independently associated with initial microcatheter CC tracking failure in patients with CTO undergoing retrograde septal CC PCI.Conclusion: The overall initial microcatheter CC tracking failure was 20.8%. Severecollateral tortuosity, CC entry, and exit angle of < 90°, use of Finecross MG as initial microcatheter, and shunning initial retrograde application of Guidezilla were variables independently associated with initial microcatheter CC tracking failure in patients with CTO undergoing retrograde septal PCI.Keywords: coronary chronic total occlusion, retrograde microcatheter tracking, collateral channel, predictor

Chronic heart failure (CHF) seriously affects the quality of patients' lives. Sacrubitril/valsartan is a combination angiotensin receptor-neprilysin inhibitor, a new therapeutic drugs to treat CHF.This study aims to observe the impact of sacrubitril/valsartan on clinical treatment and high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-brain natriuretic peptide (NT-ProBNP) serum levels, the improvement of the left atrial diameter (LAD) and left ventricular end diastolic dimension (LVEDD), and the left ventricular ejection fraction (LVEF) in patients with CHF.120 patients were randomly divided into a sacrubitil/valsartan group and a valsantan group, with 60 cases in each. Patients in the sacrubitil/valsartan group were administered sacrubitril/valsartan; while in the valsantan group, they were administered valsartan. The clinical effects, adverse reactions, and rehospitalization were observed eight weeks later, and hs-cTnT and NT-ProBNP serum levels and LAD, LVEDD, and LVEF were assayed.There were 53 cases of positive effect in the sacrubitil/valsartan group and 42 in the valsartan group (P0.05). Eight participants demonstrated adverse reactions in the sacrubitil/valsartan group, while 17 in the control group (P0.05). Hs-cTnT and NT-ProBNP serum levels, the measurements of LAD, LVEDD, and LVEF in the sacrubitil/valsartan group before the treatments were (24.47 ± 7.54) pg/mL, (10,356.94 ± 5,447.68) pg/mL, (49.41 ± 5.22) mm, (68.06 ± 6.20) mm and (31.12 ±6.65) %; in the valsartan group were (29.752 ± 10.03) pg/mL, (9,518.17 ± 5,905.17) pg/mL, (49.65 ± 4.91) mm, (67.06 ± 3.97) mm, and (30.41 ± 6.11) % (P0.05), while in the sacrubitil/valsartan group, the values decreased after the treatments to (17.92 ± 4.74) pg/mL, (3,881.59 ± 2,087.79) pg/mL, (42.18 ± 4.87) mm, (60.35 ± 7.12) mm and (45.35 ± 4.49) %; in the valsartan group to (25.81 ± 7.36) pg/mL, (6,278.35 ± 2,643.11) pg/mL, (46.53 ± 4.80) mm, (64.51 ± 4.34) mm, and (36.47 ± 5.21) % (P0.05). There were significant differences within the same group, before and after treatments (P0.05).Sacrubitril/valsartan treatment of patients with CHF improves their symptoms and is deserving of clinical application. This is also evident from significantly improved levels of serum hs-cTnT and NT-ProBNP and the left ventricular function.

Objectives: In this study, we aimed to explore the influence of right-to-left shunt (RLS) presence on the clinical features of migraine and to follow-up on the post-operative curative effec...

Objectives To assess the efficacy and safety of bivalirudin during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in high-bleeding-risk elderly patients. Background Bivalirudin reduces PCI-related bleeding; however, its efficacy and safety in patients with CTO, especially elderly patients with a high bleeding risk, remain unclear. Methods This single-center prospective randomized controlled trial assigned 123 high-bleeding-risk elderly patients with CTO to either the unfractionated heparin (UFH) group (n = 55) or the bivalirudin group (n = 68). The primary efficacy endpoint was the incidence of major adverse cardiac events (MACEs) during hospitalization and at the 6-month follow-up. The safety endpoint was bleeding or procedure (access)-related complications after PCI. Results MACE incidence was 17.6% and 20.0% in the bivalirudin and UFH groups, respectively (P = 0.82). Bleeding Academic Research Consortium (BARC) type 1-2 bleeding events during hospitalization were comparable between the groups (UFH: 10.9% vs. bivalirudin: 8.8%, P = 0.77). No BARC type 3-5 bleeding events or severe procedure (access)-related complications (subcutaneous hematoma >5 cm) occurred in either group. At the 6-month follow-up, MACE incidence was comparable between the groups (UFH: 3.6% vs. bivalirudin: 1.5%, P = 0.59). The Kaplan-Meier analysis revealed that MACE-free survival rates were comparable between the groups (P = 0.43). One case of BARC type 3-5 bleeding (fatal intracranial hemorrhage) was observed in the UFH group at the 6-month follow-up. Conclusions Bivalirudin and UFH showed comparable efficacy and safety in elderly patients with a high bleeding risk, undergoing PCI for CTO lesions.

Objectives. To assess the effectiveness and safety of ARW for vascular recanalization in CTO patients. Background. Chronic total occlusion (CTO) of coronary artery accompanied with large branch distal to the occluded segment (

Objective. To explore the feasibility and safety of the active retrograde backup (ARB) for treatment of chronic total occlusion (CTO) during retrograde percutaneous coronary intervention (PCI). Background. Guiding support plays an important role in guidewire and microcatheter coronary channel (CC) tracking in retrograde PCI therapy for patients with CTO. However, the feasibility and safety of retrograde active use of a mother-and-child catheter are still unclear. Patients and Methods. A total of 271 consecutive patients with CTO who underwent retrograde PCI between January 2015 and January 2020 were retrospectively analyzed. Clinical data of two groups were compared to evaluate the feasibility and safety of ARB. Results. Of the 271 patients, 69.0% (187/271) underwent therapy through the septal branch, 31.0% (84/271) through the epicardial collateral channel, and 47.6% (129/271) through active retrograde extra backup with a mother-and-child catheter to facilitate retrograde microcatheter collateral CC tracking. The time of wire CC tracking was shorter in the ARB group than that in the non-ARB group (25.4 ± 8.5 vs 26.4 ± 9.7, p=0.348), but there was no significant difference. The duration of the retrograde microcatheter tracking (10.2 ± 3.8 vs 15.5 ± 6.8, p=0.012) and the retrograde approach (62.8 ± 20.3 vs 70.4 ± 24.3, p=0.026) in the ARB group was significantly shorter than that in the non-ARB group. The radiation dose (223.6 ± 112.7 vs. 295.2 ± 129.3, p=0.028), fluoroscopy time (50.6 ± 21.3 vs 62.3 ± 32.1, p=0.030), and contrast volume (301.8 ± 146.7 vs 352.2 ± 179.5, p=0.032) in the ARB group were significantly lower than that in the non-ARB group. There were no life-threatening procedural complications in either group. Complications unrelated to ARB included two cases of donor-vessel dissection, one case of CC perforation, and two cases of target-vessel perforation. There was no statistically significant difference in major adverse cardiac and cerebrovascular events between the groups during hospitalization p>0.05. Conclusion. ARB is feasible, safe, and conducive to guidewire and microcatheter CC tracking in the recanalization of coronary CTO. It improves procedural efficiency and is worthy of further promotion.

Background Patients with coronary chronic total occlusion (CTO) require effective antiplatelet therapy after percutaneous coronary intervention (PCI). Ticagrelor has more pronounced platelet inhibition than clopidogrel. However, the most appropriate dose of ticagrelor in East Asian populations remains unclear. Method We compared ticagrelor (180 mg loading dose, 90 mg twice daily thereafter and 120 mg loading dose, 60 mg twice daily thereafter) and clopidogrel (300 mg loading dose, 75 mg daily thereafter) for prevention of cardiovascular events in 525patients with CTO undergoing PCI. Results The rate of in-hospital major adverse cardiac and cerebral events (MACCE) was not different between the groups. At 1-year follow-up, target vessel revascularization (TVR) in both ticagrelor groups were significantly lower than that in the clopidogrel group (p = 0.047); TVR was significantly decreased in 60 mg ticagrelor compared to standard dose clopidogrel (p = 0.046). At 1-year follow-up, overall MACCE in both ticagrelor groups were significantly lower than that in the clopidogrel group (p = 0.023). Kaplan–Meier analysis showed MACCE-free survival was significantly higher in both ticagrelor groups than in the clopidogrel group (p = 0.024). During hospitalization, minor bleeding was significant increased in the 90 mg ticagrelor group (p = 0.021). At 1-year follow-up, risk of major and minor bleeding were significantly increased in the 90 mg ticagrelor group. Conclusion In East Asian patients with CTO undergoing PCI, 60 mg ticagrelor was as effective as 90 mg, at the same time significantly reduced risk of bleeding.

Background The usefulness of the CHA2DS2-VASC risk score (CVRS) in predicting the occurrence of contrast-induced nephropathy (CIN) among patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI) remains unclear. Method A total of 239 patients with CTO who underwent PCI were included in this study. They were divided into 3 groups according to the CVRS: low-risk group (1 point, n = 64), intermediate-risk group (2 points, n = 135), and high-risk group (≥3 points, n = 40). Baseline serum creatinine was determined upon admission before the procedure. The serum creatinine level was monitored for 72 h post-procedure to determine the occurrence of CIN. Results The total incidence of CIN in patients with CTO who underwent PCI was 16.3%. The average CVRS in the CIN group was significantly higher than that in the non-CIN group (3.1 ± 1.2 VS 2.1 ± 1.1, P

Objective To evaluate the safety and feasibility of percutaneous coronary intervention and antiplatelet therapy in patients who have undergone endovascular graft exclusion. Methods From January 2005 to July 2007, percutaneous transluminal intervention (PCI) was performed in 13 patients who had undergone endovascular graft exclusion for the treatment of either acute or chronic Stanford B aortic dissection. Anticoagulant and antiplatelet treatments were administered according to the standard protocol. Patients were followed up for a mean period of 11months. Clinical characteristics, false lumen thrombosis and angiographic data were collected. Results PCI was technically successful in all 13 patients and no severe complications, including death, paraplegia or renal failure occurred during hospitalization. Complete false lumen thrombosis was observed in all patients within 6months. There were no major complications such as death, dissection rupture, or aneurysm development during the follow-up period. Conclusion Our data suggested that PCI and standard antiplatelet therapy are feasible and safe in patients who have undergone endovascular stent graft exclusion for Stanford B aortic dissection.

BACKGROUND: Rapid recanalization of infarct-related artery (IRA) has become the major target during primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (MI), but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease. METHODS: A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries (luminal narrowing > or = 70%) undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only (group 1), and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction (AMI) (group 2). Drug-eluting stents (DESs) were deployed in more than 90% of the patients. RESULTS: The two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events (11.5% vs 15.1%, P > 0.05) and target lesion revascularization (8.1% vs 7.6%, P > 0.05) between the two groups. However, patients in group 1 had higher rates of recurrent angina (10.1% vs 2.1%, P < 0.05) and depressed left ventricular ejection fraction evaluated by echocardiography (0.56 +/- 0.22 vs 0.63 +/- 0.25, P < 0.05). CONCLUSION: With the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation MI and multi-vessel disease.

Background Failure of balloon catheter passing through the occluded segment accounts for 10% - 15% of all procedures during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing. Methods Between July 2000 and October 2007, 152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique. The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment, thus facilitating the balloon passing. Results Both overall lesion and technique success rates were 91.5% (150/164). A total of 211 crushing wires were used during PCI, including 1 crushing wire for 117 (71.3%) lesions and 2 crushing wires for 47 (28.7%) lesions. Approximately 57.3% (121/211) of all crushing wires were those already used in the same procedure. Technique failure occurred in 14 lesions (8.5%). Technique failure was due to crushing wires entering false lumen (92.9%, 13/14) and coronary perforation (7.1%, 1/14). Major procedural complications included coronary perforation (1 case) and severe coronary dissection (2 cases), all of which were successfully treated. Conclusions Multi-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI. It is feasible, economical and relatively safe with a low rate of procedural complications.

Background Long-term efficacy and safety of tacrolimus-eluting stent (Janus) for treatment of coronary artery disease in percutaneous coronary interventions (PCI) "real world" is uncertain. The aim of this study was to evaluate the efficacy and safety of Janus stent for treating coronary heart disease in PCI daily practice, the safety of 4-month clopidogrel therapy after Janus stent implantation and the feasibility for treating patients with acute myocardial infarction (AMI) for first time. Methods From February 20, 2006 to August 26, 2006, a total of 200 patients were enrolled and randomly assigned to receive either Janus stent (n = 100) or bare metal stent (Tecnic Carbostent, n = 100). All patients were administered with clopidogrel for 4 months and aspirin for life long after stenting. Results Baseline clinical and angiographic characteristics were comparable between the two groups. AMI was present in 37% of patients with Janus and 36% with Tecnic Carbostent. At an average of 246-day follow-up, major adverse cardiac events (MACE) was 6% with the Janus stent and 15% with the Tecnic Carbostent (P = 0.038). Primary events included 1 cardiac death, 1 myocardial infarction (MI) due to subacute stent thrombosis and 13 target lesion revascularizations (TLR) due to restenosis in patients with Tecnic Carbostent and 6 TLR due to restenosis in patients with Janus stent. Although all patients had discontinued clopidogrel for an average of 126 days, there was no additional thrombotic event in the two groups. Conclusions Janus stent is efficient in reducing MACE compared with Tecnic Carbostent at an average of 8-month follow-up. Discontinuation of clopidogrel at 4 months after PCI is safe for patients with Janus stent, including AMI patients. Long-term efficacy of Janus stent in reducing restenosis requires further study.

BACKGROUND Angioplasty in the unprotected left main coronary artery (LMCA) has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug eluting stent (DES), for treatment of unprotected LMCA disease. METHODS Between September 1997 and December 2005, a total of 297 consecutive patients underwent percutanous coronary intervention (PCI) on LMCA lesions in our hospital. Their in-hospital data and clinical follow-up outcomes were analyzed and those in pre-DES "era" (group I, from September 1997 to December 2002) were compared with those in DES "era" (group II, from January 2003 to December 2004. Patients in 2005 for the time of follow-up less than one year were not included in this group). RESULTS Altogether 368 coronary stents were successfully deployed in 295 patients. Stents failed to be implanted after balloon predilation in two patients, who received coronary artery bypass graft (CABG) successfully. Bifurcation techniques for distal LMCA executed in 206 patients (69.4%, 206/297), included crossover stenting in 156 (75.7%), T stenting in 4 (1.9%), provisional T stenting in 28 (13.6%), kissing stenting in 5 (2.4%) and stent crushing in 13 (6.3%) patients. During their hospital stay, 5 (1.7%) patients died after PCI procedure, of which 4 died from cardiac origin and one of renal failure. The total in-hospital major adverse cardiac events (MACE) were 2.0% (6/297). In the follow-up period, 19 patients (6.5%) died [15 (5.1%) of cardiac death and 4 of non-fatal myocardial infarction (MI)]. Besides, 2 (0.7%) developed subacute thrombosis (SAT) and 16 (5.4%) performed target lesion revascularization (TLR). The total follow-up MACE was 14.5% (43/297). Further analysis also showed that, compared with patients in group I, those in group II apparently had more multi-vessel involvement (14.7% vs 81.9%, P < 0.001), and more bifurcation lesions (32.4% vs 72.2%, P < 0.001). After PCI, in-hospital MACE of group II was significantly lower than that in group I (1.1% vs 9.4%, P < 0.05). And the incidences of MACE, TLR and angiographic restenosis in group II were all significantly lower than those in group I (all P < 0.05) after one year follow-up. CONCLUSIONS As new PCI strategies and intervention devices such as DES are developed, coronary stenting, which might have brought better in-hospital and long-term outcomes than CABG, are proved to be technically successful and can be safely applied for the treatment of LMCA lesions in the experienced center for coronary intervention.

To assess the therapeutic effect and safety of drug eluting stent for the patients with anterior wall myocardial infarction by left anterior descending artery occluded abruptly.From January 2004 to December 2008, 302 patients with anterior wall myocardial infarction in 12 hours from chest pain to treatment were treated. But only 189 patients were recruited and randomly divided into drug eluting stent group (n = 95) and bare metal stent group (n = 94). The occurrence of cardiac death, stent thrombosis, reinfarction, target vessel revascularization and re-hospitalization because of heart function failure was compared.There was no difference in cardiac death [3/95 (3%) vs 7/94 (7%), P = 0.206], reinfarction [1/95 (1%) vs 5/94 (5%), P = 0.112] and re-hospitalization because of heart function failure [8 (8%) vs 5 (5%), P = 0.434]. Compared with those in bare metal stent group, the patients in drug eluting stent group has a lower rate of target vessel revascularization [2 (2%) vs 13 (14%), P = 0.009] and composite therapeutic effect endpoints [12 (13%) vs 25 (27%), P = 0.011]. There was no difference in safety endpoint or stent thrombosis [1 (1%) vs 4 (4%), P = 0.204].In patients with anterior wall myocardial infarction by left anterior descending artery occluded abruptly, drug eluting stent decreases the rate of target vessel revascularization. But it has no increased stent thrombosis.

Data on the efficacy and safety of drug-eluting stent (DES) for treatment of multiple coronary chronic total occlusion (CTO) lesions are scanty. The aim of the present study was to compare the long-term outcomes of DES versus bare metal stent (BMS) implantation for multiple coronary CTO lesions.We analyzed 188 patients who underwent coronary stenting for at least two de novo CTO lesions in our center from November 2000 to November 2006. Among them, 118 patients (62.8%) received DES and 70 patients (37.2%) received BMS implantation after the recanalization for CTO lesions. All patients were followed up for up to 5 years for the occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method.There were no significant differences in baseline clinical characteristics and procedural success rate between DES group and BMS group. Compared with the BMS group, the DES group showed a significantly higher rate of long CTO (or = 15 mm) (62.0% vs. 50.6%, P = 0.023). The number of stents per lesion (1.39 +/- 0.71 vs. 1.17 +/- 0.66, P = 0.007) and the mean length of stents in the DES group were also higher than those in the BMS group ((40.8 +/- 11.4) mm vs. (23.4 +/- 8.7) mm, P0.001). But the mean diameter of stents in the DES group was smaller than that in the BMS group ((3.1 +/- 0.2) mm vs. (3.3 +/- 0.5) mm, P0.001). Average follow-up time was 4.8 +/- 0.7 (1.5 - 5.0) years in the BMS group and 4.3 +/- 0.5 (1.3 - 5.0) years in the DES group. Both the 5-year cumulative survival rates and the target vessel revascularization (TVR)-free survival rates of the DES group were significantly higher than those in the BMS group (83.1% vs. 72.9%, Log-rank P = 0.044; 77.1% vs. 62.9%, Log-rank P = 0.009). The cumulative MACE-free survival rates in the DES group were significantly higher than those in the BMS group (71.2% vs. 51.4%, Log-rank P = 0.001). Multivariable Cox regression analysis demonstrated that DES implantation for multiple CTO lesions could significantly reduce the long-term MACE risk after percutaneous coronary intervention (PCI) (HR: 0.436; 95%CI 0.327 - 0.665, P0.001). Age over 65 years (HR: 2.018; 95%CI 1.491 - 3.127, P0.001) and left ventricular ejection fraction50% (HR: 1.494; 95%CI 1.125 - 2.376, P0.001) were identified as the independent predictors of long-term MACE.This study demonstrates the long-term (up to 5 years) efficacy and safety of DES for treatment of multiple coronary CTO lesions, and its superiority compared to BMS in reducing the rates of TVR and MACE.

The patients with unprotected left main coronary artery (ULMCA) stenosis and chronic total occlusion (CTO) lesions at the left anterior descending (LAD) artery are often recommended for bypass surgery. However, some of these patients are deemed inoperable or are at high risk for surgery. In this study, we explored strategies and evaluated the efficacy of percutaneous coronary intervention for the treatment of ULMCA stenosis complicated by LAD CTO.From November 2001 to July 2009, 78 patients with ULMCA stenosis and LAD CTO lesions were selectively treated with stenting. Six patients (7.7%) refused surgery due to their young age (or = 40 years), and the other 72 patients (92.3%) were unsuitable for surgery. Reasons for poor surgical candidacy included advanced age (80 years), chronic obstructive pulmonary, unsuitable distal target vessels for bypass, EuroSCOREor = 6, and so on. Four different strategies were applied based on the degree of left main stenosis and the ostial diameter and involvement of the left circumflex.Total procedural success was achieved in 94.9%, there were no deaths or thromboses. Five patients (6.4%) experienced non-Q-wave myocardial infarction in hospital. At long-term follow-up ((52 +/- 28) months), there were 3 cardiac deaths (3.8%) and 4 (5.1%) nonfatal myocardial infarctions. Angiographic follow-up was performed in 50 patients (64.1%), and target vessel revascularizations were required in 10 patients (12.8%), among which 4 nonfatal myocardial infarction patients included. The rate of major adverse cardiac events was 16.7% (13/78).This study indicates that percutaneous intervention can be performed safely in high risk surgical patients with ULMCA and LAD CTO lesions based on individual therapeutic strategies. It may be feasible to apply this technique in selected patients mentioned above.

To evaluate the long-term outcomes of successful or failed revascularization in patients with chronic total occlusions (CTO).The clinical data of 1332 consecutive patients underwent percutaneous coronary intervention (PCI) for CTO between June 1993 and December 2006 in our hospital were analyzed. These patients were divided into two groups according to the procedural success (n = 1202) or failure (n = 130).Overall success rate of procedure was 90.2% (1202/1332). The patients in CTO success group experienced a superior 10-year survival rate (76.9% vs. 64.6%, log rank P = 0.012) and a significantly higher no major adverse cardiovascular event (MACE) survival rate (41.8% vs. 27.6%, log rank P0.001) compared to the patients in CTO failure group. During the long-term follow-up, the proportion of patients who accepted coronary artery bypass grafting (CABG) was significantly lower in CTO success group than that in the CTO failure group (4.3% vs. 14.6%, P0.001).Successful PCI procedure leads to increased long-term survival and MACE-free survival and the reduced need for CABG for patients with CTO lesions.

Currently intra-aortic balloon pump (IABP) has been widely used in patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI). However, few studies have been done with regard to the clinical outcome and safety of IABP in assisting PCI in aged patients with ACS. The purpose of the present study was to evaluate the safety of IABP in different age groups of patients with ACS.Data on 292 ACS patients who received IABP-assisted PCI in Shenyang General Hospital of People's Liberation Army were retrospectively analyzed. More specifically, the successful rate, mortality and complications associated with the treatment were compared between the senior (/= 60 years old) and the non-senior (60 years old) groups of patients.The attack rate of non-ST segment elevation ACS was significantly higher in the senior group than in the non-senior group (38.8% vs 21.1%, P0.01). The incidence of the IABP-associated complications was not significantly different between both groups (P0.05).The clinical outcome and safety of IABP-assisted PCI in the elderly patients were comparable to that for the non-elderly patients.

SDF-1 has been demonstrated to be involved in the pathophysiology of atherosclerosis. This study was aimed to investigate whether the SDF1-3′A polymorphism (rs1801157) is associated to myocardial infarction (MI) in a sample of Chinese Han population. A total of 560 patients with MI and 532 controls were enrolled in the study. The SDF1-3′A polymorphism was determined by polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) analysis. A significant difference in genotype distribution and allele frequency was observed between patients and controls (P = 0.003 and P = 0.001, respectively). The A allele carriers had a significantly reduced MI risk compared with the GG homozygotes (OR, 0.69; 95% CI, 0.52–0.92; adjusted P = 0.007) in a logistic regression model after controlling conventional risk factors. The present study showed a significant association between the SDF1-3′A polymorphism and MI in Chinese Han population.

To evaluate the in-hospital outcome of patients with calcified chronic total occlusion (CTO) lesion underwent percutaneous coronary intervention (PCI).The clinic and lesion characteristics as well as acute PCI outcome were analyzed in 726 patients with calcified CTO [624 detected by coronary angiography (CAG) and 102 detected by intravascular ultrasound (IVUS)] and received PCI therapy from June 1995 to February 2007 in our department.There were 728 diseased vessels with 732 lesions in these patients. Total procedure success rate (80.6% vs. 89.2%, P0.05) and the lesion success rate (80.2% vs. 88.2%, P0.05) were significantly lower in calcified CTO detected by CAG compared to that detected by IVUS. The causes of procedure failures in CAG detected patients were as follows: 87 guide failure, 21 balloon failure, 8 procedure related complications and 5 low TIMI blood flow (grade 2) at the end of PCI procedure. The causes of procedure failures in IVUS detected patients were as follows: 7 guide wire failure, 2 balloon failure, 1 procedure related complications and 1 patient with low TIMI blood flow (grade 2). The in-hospital major adverse cardiac events (MACE) rate was 1.1% in CAG detected calcified CTO and 1.0% in IVUS detected calcified CTO (P0.05).PCI therapy resulted in satisfactory procedure success rate and in-hospital outcome for patients with calcified CTO and IVUS is helpful for further increasing the PCI procedure success rate in patients with calcified CTO.

Endovascular stent-graft treatment has emerged as an alternative for patients with type B aortic dissection (AD), either at acute or chronic phase, in selected patients. This study aimed to investigate the results of endovascular stent-graft repair for acute and chronic type B AD.From May 2002 to July 2007, 67 patients with type B AD were treated by endovascular stent-graft placement. There were 32 patients in the acute phase (AAD group) and 35 patients in the chronic phase (CAD group). The patients were followed up from 1 to 65 months (average, 17 +/- 16 months). The immediate and follow-up clinical outcomes were documented and compared between the 2 groups.Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 67 patients. Compared with patients in the CAD group, those in the AAD group had higher percentages of pleural effusion (15.6% vs 0, P = 0.02) and visceral/leg ischemia (21.9% vs 2.9%, P = 0.02). Procedure related complications, including endoleak and post-implantation syndrome occurred more frequently in AAD group than in CAD group (21.9% vs 2.9% and 31.3% vs 8.6%, respectively; P = 0.02 and P = 0.02). Kaplan-Meier analysis showed no significant difference in survival rate at 4 years between the 2 groups (86.4% vs 92.3%, P = 0.42 by Log-rank test). But the 4-year event-free survival rate was higher in patients with chronic dissection than in patients with acute dissection (96.2% vs 73.9%; P = 0.02 by Log-rank test).Endovascular repair with stent-graft was safe and effective for the treatment of both acute and chronic type B AD. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.

Background: The residual drug carriers on drug-eluting stents (DES) surfaces are considered to be one of the most significant reasons causing late thrombosis. There is no documented data currently available on the safety/benefit profile beyond 6 months of EXCEL stent, a novel sirolimus-eluting stent with biodegradable polymer coating, in treating patients with coronary artery disease (CHD). Objective: To evaluate the long-term efficacy and safety of EXCEL stent on treating CHD patients. Methods: Between February and March 2006, a consecutive cohort of complex patients treated with the EXCEL stent was prospectively enrolled in this single-center registry. Antiplatelet protocol was 6-month dual antiplatelet therapy with clopidogrel and aspirin followed by aspirin alone indefinitely. The primary outcome was major adverse cardiac events (MACE) at 12 months. Secondary outcomes included in-segment and in-stent late lumen loss and binary restenosis rate measured by quantitative coronary angiography (QCA) analysis at 8 months postindex PCI procedure. Results: A total of 100 patients with 153 lesions were included in this analysis. Most lesions (83.0%) were classified as complex (B2/C). At 12 months, four patients (4.0%) experienced MACE, which were four target-lesion revascularizations due to in-stent restenosis (ISR). All patients received follow-up up to 24 ± 0.4 months and no cardiac death, MI, and in-stent thrombosis occurred during the 6 months of dual antiplatelet therapy or the subsequent 15 months of aspirin treatment alone. QCA analysis of 112 lesions from 75 patients showed 3.6% (4/112) in-stent lesion restenosis, 5.4% (6/112) in-segment lesion restenosis, 0.12 ± 0.34 mm in-stent late lumen loss, and 0.08 ± 0.35 mm in-segment late lumen loss. Conclusions: In this single-center experience with complex patients and lesions, the EXCELTM stent implantation with 6-month dual antiplatelet treatment proved to markedly reduce the incidence of 24-month ISR and MACE. These preliminary findings require further validation by large scale, randomized trials. © 2008 Wiley-Liss, Inc.

The use of paclitaxel-eluting stents (PES) for the treatment of unprotected left main coronary artery (LMCA) disease is controversial. Between January 2003 and December 2006, a total of 287 patients undergoing percutaneous coronary intervention for LMCA lesions were consecutively registered. Of those patients, 178 received PES and 109 received bare-metal stents (BMS). Estimated perioperative mortality rates were 7.3% and 6.8% for the BMS and PES groups, respectively (p=0.51). PES recipients had distal left main bifurcation lesions more frequently compared with BMS recipients (72 vs 42%, p0.01). At an average follow-up of 35 months, the rates of major adverse cardiac events (4.5 vs 23.9%, adjusted odds ratio [OR] 0.23, 95% confidence interval [CI] 0.09 to 0.58, p0.001) and target-lesion revascularization (2.2 vs 13.8%, adjusted OR 0.26, 95% CI 0.08 to 0.83, p0.001) were significantly lower in the PES group than in the BMS group. Overall thrombotic event rates were 1.1% and 4.6% in the PES and BMS groups, respectively (p=0.08). Angiographic follow-up was performed in 61% and 59% of PES and BMS recipients, respectively. The angiographic restenosis rate was significantly lower in the PES group as compared with the BMS group (3.7 vs 23.4%, p0.001). In conclusion, PES implantation provides a safe, effective therapy for unprotected LMCA disease and decreases the risk of major adverse cardiac events compared with BMS at a mean follow-up of 35 months.

To evaluate the safety and effectiveness of stenting for selective unprotected left main coronary artery (ULMCA) disease.The clinical data of 416 patients with ULMCA who underwent selective percutaneous coronary intervention (PCI) were analyzed.In 291 of the 416 patients (70.0%), the ULMCA lesions were located in the distal bifurcation site. A total of 503 stents were successfully deployed in 414 patients and the mean stent number was (1.2+/-0.7) stents per patient. The success rate of stenting procedure was 99.5%. During hospital stay, no patient died. The major adverse cardiac event (MACE) during in-hospitalization was 0.5% (2/416). The target lesion revascularization (TLR) rate was 4.9%. During the follow-up 16 (3.9%) patients died including 12 cases (2.9%) of cardiac death. Angiography during follow-up conducted on 136 (33.1%) patients showed that binary in-stent restenosis occurred in 20 patients (14.7%, 20/136). TLR was performed by coronary artery bypass graft in 14 patients and by drug eluting stent (DES) implantation in 6 patients respectively. The total MACE rate was 8.3% (34/411).Safe and with favorable clinical outcome, selective coronary stenting for ULMCA lesions can achieve a high technical success rate.

BACKGROUND Coronary chronic total occlusion (CTO) remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) for CTO. METHODS Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed. RESULTS There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8% (1147/1263) and 88.9% (1445/1625), respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals > or = 15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions (P < 0.05). Procedural failure occurred in 116 patients, caused by impossibility of guide-wire (81.0%) or balloon (19.0%) to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary fistula during in-hospital period. The overall in-hospital MACE rate was 0.6% (8/1263). Drug-eluting stents were used in 198 patients without in-hospital MACE. CONCLUSIONS In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions.

To elucidate the relative factors and prognostic impact for angiographic no-reflow phenomenon during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).A total of 930 patients with AMI who underwent primary PCI were divided into no-reflow group and normal-reflow group. Factors related to no-reflow were analyzed by logistic regression model and major adverse cardiac events (MACE) in-hospital as well as during long-term follow-up was also observed.No-reflow occurred in 82 out of 930 patients. Admission glucose level (9.8 +/- 4.3 mmol/L vs. 8.5 +/- 3.5 mmol/L, P = 0.001), peak CK-MB value (369.4 +/- 167.8 U/L vs. 282.3 +/- 161.7 U/L, P0.01) and percentage of TIMI flow grade 0 on initial angiogram (69.5% vs. 54.5%, P = 0.009) were significantly higher and pre-infarction angina (19.5% vs. 48.1%, P0.01) was significantly lower in no-flow patients than normal flow patients. Logistic regression analyses showed that admission glucose level, absence of pre-infarction angina, TIMI flow grade 0 on initial angiogram and pump failure were independent predictors of no reflow. In-hospital MACE (37.8% vs. 11.3%, P0.01) and follow-up MACE (37.5% vs. 17.4%, P0.01) were also significantly higher in no-flow patients than normal flow patients. Multivariate Cox regression analysis revealed that no-reflow was an independent predictor of long-term cardiac death (relative risk 3.83, 95% confidence interval 1.71 to 5.57).Admission glucose level, absence of pre-infarction angina, TIMI flow grade 0 on initial angiogram and pump failure were independent risk factors for no-reflow and no-flow is an independent predictor for increased in-hospital and follow-up MACE.

To evaluate short-term efficacy and safety of triple antiplatelet regimen (cilostazol combined with clopidogrel and aspirin) in patients who underwent percutaneous coronary intervention (PCI).From October 2001 to April 2005, a total of 3135 patients underwent PCI in the General Hospital of Shenyang Command, People's Liberation Army, of which 1103 were treated with cilostazol 100 mg twice a day for 6 months in addition to aspirin and clopidogrel for 3 - 12 months as triple antiplatelet therapy regimen (triple group) after PCI, and 2032 of which received aspirin and clopidogrel for 3 - 12 months as dual antiplatelet therapy regimen after PCI (control group). The data of the incidence rates of major adverse cardiac events (MACE), subacute in-stent thrombosis (SAT), and hemorrhage events within 30 days after PCI of the two groups were retrospectively analyzed.The baseline clinical characteristics were comparable between these two groups. However, the proportions of the patients receiving stent implantation, with multivessel coronary artery diseases, and receiving PCI for unprotected left main trunk diseases of the triple group (91.3%, 68.3%, and 7.1% respectively) were all significantly higher than those of the control group (89.1%, 63.3%, and 4.6%, P0.05, P0.01, and P0.01). The proportion of patients with chronic total occlusions who received PCI in the triple group was 10.8%, significantly lower than that of the control group (13.4%, P0.05). No death occurred during procedure in both groups. The 30 d mortality and the rate of MACE with 30 days after PCI of the triple group were 0.4% and 1.3%, both significantly lower than those of the control group (1.6%, and 2.6%, both P0.05). However, there were no significant differences in the incidence rates of SAT and major hemorrhage events between these 2 groups (0.7% vs 1.0% and 0.3% vs. 0.2% respectively, both P0.05).This novel triple antiplatelet regimen (aspirin and clopidogrel combined with cilostazol) for PCI patients is safe and more efficient than the dual antiplatelet therapy regimen (clopidogrel and aspirin) in reducing mortality and incidence of MACE in a short-term period.

To compare the clinical effects of rapamycin-eluting stent implantation and coronary artery bypass grafting (CABG) in treatment of the patients with multi-vessel coronary disease.From January 2002 to December 2004, 262 patients with multi-vessel coronary disease underwent CABG, and 250 age, clinical characteristics, and characteristics of coronary disease-matched patients chose to receive rapamycin-eluting stent implantation. 6-9 months after the treatment angiography of the coronary artery was conducted. All the patients were followed up for 19 +/- 14 months. The clinical outcomes were compared.No intra-operative death occurred in the rapamycin-eluting stent implantation group with an operation success rate of 100%, significantly higher than that of the CABG group with 9 intra-operative deaths and an operation success rate of 96.6% (P0.01). Three perioperative deaths occurred in the rapamycin-eluting stent implantation with a perioperative death rate of 1.2%, not significantly different from that of the CABG group (1.9% with 5 perioperative deaths). The total death rate during hospitalization of the rapamycin-eluting stent implantation group was 1.2%, significantly lower than that of the CABG group (5.3%, P0.05). The rate of in-hospital major adverse cardiac event (MACE) of the rapamycin-eluting stent implantation group was 1.6%, significantly lower than that of the CABG group (5.3%, P0.05). There was no significant difference in MACE rate and angina pectoris recurrence during follow-up and event-free survival rate between these 2 groups.A better treatment for the patients with multi-vessel coronary disease, rapamycin-eluting stent implantation has the clinical effects comparable to those of the CABG.

To evaluate the in-hospital effect of emergency percutaneous coronary intervention (PCI) on aged patients with acute myocardial infarction (AMI) and diabetes mellitus.The clinical data of 556 patients agedor = 60 with AMI hospitalized from December 1995 to April 2005, who underwent emergency PCI within 24 hours after the onset, including 127 cases complicated with diabetes mellitus (Group DM) and 429 cases without diabetes (non-diabetes mellitus group, Group ND), were analyzed respectively.There were not significant differences in age, sex, smoking rate, hypertension rate, myocardial infarction (MI) rate, and time between onset and treatment between these 2 groups. However, the percentages of anterior wall AMI rate, non-ST elevation myocardial infarction, Killip III-IV grade, and intra-aortic balloon pump (IABP) application of Group DM were 58.3%, 13.4%, 27.6%, and 16.5%, all significantly higher than those of Group ND (46.4%, 6.8%, 27.6%, and 8.6%, P0.001, 0.02, 0.03, and 0.01). In Group DM, 59.1% of the infarction related artery was left anterior descending branch, and in Group ND 45.0% of the infarction related artery was left anterior descending branch (P0.05). The rate of triple vessel disease in Group DM was 77.2%, significantly higher than that of the Group ND (60.8%, P0.01). There were no significant differences in the PCI immediate success rate, intra-operational no-reflow rate, post-PCI complication rate and mortality during hospitalization between the two groups.Emergency in-hospital PCI is effective on aged AMI patients with diabetes mellitus.

To explore the in-hospital effect of percutaneous coronary intervention (PCI) on patients with acute coronary syndrome (ACS).The clinical data of 4670 hospitalized patients with ACS, 1750 with acute myocardial infarction (AMI, 37.5%) within 30 days and 2920 with unstable angina pectoris (62.5%), undergoing PCI from August 1989 to October 2004, were analyzed.The total success rate of PCI procedure was 98.1% (4579/4670) for all patients, and the patency rate of infarction related artery of emergency PCI was 98.2% (825/840) in the patients with AMI onset within 24 h. The complication rate related to PCI procedure was 6.5% (304/4670). The total in-hospital mortality was 1.1% (52/4670) and the mortality during PCI procedure was 0.04% (2/4670). The duration from admission to PCI was 3.5 days +/- 2.1 days and the whole hospital stay was 12 days +/- 8 days.The success rate of PCI procedure in patients with ACS is high, while the in-hospital mortality and the complication rates are low, which shows that PCI has an ideal short-term effect in patients with ACS.

To assess the technique and outcomes of coronary intervention treatment for patients with chronic total occlusion (CTO) lesions.Retrospectively analyzed the data from 1148 patients with CTO who were treated by percutaneous coronary intervention (PCI) between June 1993 and December 2004. There were 1494 CTO lesions in 1458 vessels with a mean occlusion time of (49.1 +/- 31.6) months. A total of 1499 stents were implanted to those target lesions.Total success rates of patients and lesions were 90.2% (1036/1148) and 88.2% (1317/1494), respectively. The success rate of PCI was declined in CTO lesions with long occlusion time, stump missing, bridging collaterals andor= 15 mm in length (P0.05). Operative failures were occurred in 112 patients. Guide wire and balloon failed to pass through the occlusion accounted for 82.1% and 17.9% of all failures respectively. No death was occurred during operation, but 2 patients suffered from acute stent thrombosis and other 9 patients suffered from acute or later pericardium perforation. After procedure, there were 3 patients died and 3 patients suffered from subacute stent thrombosis during in-hospital period. The total in-hospital major adverse cardiac events rate was 0.6% (7/1148). The angina-free survival rate was 87.1% at discharge.In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and ideal clinical outcomes in patients with CTO coronary lesions.

Background Cervical auscultation (CA) is an affordable, non-invasive technique used to observe sounds occurring during swallowing. CA involves swallowing characterization via stethoscopes or microphones, while accelerometers can detect other vibratory signals. While the effects of fluid viscosity on swallowing accelerometry signals is well understood, there are still open questions about these effects on swallowing sounds. Therefore, this study investigated the influence of fluids with increasing thickness on swallowing sound characteristics. Method We collected swallowing sounds and swallowing accelerometry signals from 56 healthy participants. Each participant completed five water swallows, five swallows of nectar-thick apple juice, and five swallows of honey-thick apple juice. These swallows were completed in neutral head and chin-tuck head positions. After pre-processing of collected signals, a number of features in time, frequency and time-frequency domains were extracted. Results Our numerical analysis demonstrated that significant influence of viscosity was found in most of the features. In general, features extracted from swallows in the neutral head position were affected more than swallows from the chin-tuck position. Furthermore, most of the differences were found between water and fluids with higher viscosity. Almost no significant differences were found between swallows involving nectar-thick and honey-thick apple juices. Our results also showed that thicker fluids had higher acoustic regularity and predictability as demonstrated by the information-theoretic features, and a lower frequency content as demonstrated by features in the frequency domain. Conclusions According to these results, we can conclude that viscosity of fluids should be considered in future investigations involving swallowing sounds.