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Aims/introduction: The cardiovascular (CV) outcomes of vildagliptin - a dipeptidyl peptidase-4 inhibitor - in patients with type 2 diabetes mellitus after acute coronary syndrome or acute ischemic stroke are unclear., Materials and Methods: We analyzed data from the Taiwan National Health Insurance Research Database on 3,750 type 2 diabetes mellitus patients with acute coronary syndrome or acute ischemic stroke within 3 months between 1 August 2011 and 31 December 2013. Clinical outcomes were evaluated by comparing 1,250 participants receiving vildagliptin with 2,500 propensity score-matched participants. The primary composite outcome included CV death, non-fatal myocardial infarction and non-fatal stroke., Results: The primary composite outcome occurred in 122 patients (9.8%) in the vildagliptin group and 263 patients (10.5%) in the control group (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.72-1.11) with a mean follow-up period of 9.9 months. No significant between-group differences were observed for CV death (HR 0.93, 95% CI 0.56-1.52), non-fatal myocardial infarction (HR 0.79, 95% CI 0.46-1.36) and non-fatal stroke (HR 0.96, 95% CI 0.74-1.24). The vildagliptin group was at similar risks of hospitalization for heart failure (HF) or coronary intervention to the control group (P = 0.312 and 0.430, respectively). For patients with HF at baseline, the risk of hospitalization for HF was similar between the vildagliptin and control groups (HR 1.04, 95% CI 0.57-1.88)., Conclusions: Among patients with type 2 diabetes mellitus after a recent acute coronary syndrome or acute ischemic stroke, treatment with vildagliptin was not associated with increased risks of CV death, non-fatal myocardial infarction, non-fatal stroke and hospitalization for HF., (© 2019 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Background: This study investigated the predictors of subsequent cardiovascular events in stable post-myocardial infarction patients in Taiwan., Methods: A total of 11,183 patients were recruited who had survived one year post-myocardial infarction without subsequent events of recurrent myocardial infarction or stroke from the Taiwan National Health Insurance Research Database. Their composite cardiovascular event rates were identified., Results: The composite cardiovascular events rate in three year follow-up in the post-myocardial infarction population was 13.8%. Corresponding event rates were 5.8% recurrent myocardial infarction, 5.0% stroke, and 5.2% death. Independent factors associated with a higher risk of ischemic events or death included heart failure (hazard ratio (HR)=1.19), hypertension (HR=1.16), age (65-75 vs <65 years: HR=1.29; 75-85 vs <65 years: HR=1.50; >85 vs <65 years: HR=1.70), diabetes (HR=1.33), prior stroke (HR=1.24), chronic kidney disease (HR=1.4), atrial fibrillation (HR=1.27), and underutilization of guideline-based medication (HR=1.73). Composite risk for myocardial infarction, stroke and death increased progressively from 4.9% in patients with zero risk factor to 100.0% in patients with eight risk factors., Conclusions: For acute myocardial infarction patients surviving one year without subsequent events of recurrent myocardial infarction or stroke, the risk of cardiovascular events remained high. Eight predictors identified patients at increased risk for subsequent cardiovascular events within the next three years. These results suggest an unmet need, particularly in patients with additional risk factors.

Background: Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL), adverse outcomes, and medical expenditure in patients with acute coronary syndrome (ACS). However, the relevant data are lacking for Chinese ACS populations, especially regarding different effects of major depression, anxiety, and comorbidity. The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression, anxiety, and comorbidity on QOL, adverse outcomes, and medical expenditure in Chinese patients with ACS., Methods: For this prospective longitudinal study, a total of 647 patients with ACS were recruited from North China between January 2013 and June 2015. Among them, 531 patients (82.1%) completed 12-month follow-ups. Logistic regression model was utilized for analyzing the association of baseline major depression, anxiety, and comorbidity with 12-month all-cause mortality, cardiovascular events, QOL, and health expenditure., Results: During a follow-up period of 12 months, 7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac re-hospitalization. Baseline comorbidity, rather than major depression/anxiety, strongly predicted poor 12-month QOL as measured by short-form health survey-12 (odds ratio [OR]: 1.77, 95% confidence interval [CI]: 1.22-2.52, P = 0.003). Regarding 12-month non-fatal MI and cardiac re-hospitalization, baseline anxiety (OR: 2.83, 95% CI: 1.33-5.89, P < 0.01; OR: 4.47, 95% CI: 1.50-13.00, P < 0.01), major depression (OR: 2.58, 95% CI: 1.02-6.15, P < 0.05; OR: 5.22, 95% CI: 1.42-17.57, P < 0.03), and comorbidity (OR: 6.33, 95% CI: 2.96-13.79, P < 0.0001, OR: 14.08, 95% CI: 4.99-41.66, P < 0.0001) were all independent predictors, and comorbidity had the highest predictive value. Number of re-hospitalization stay, admission frequency within 12 months and medical expenditure within 2 months were the highest in patients with ACS with comorbidity., Conclusions: Major depression and anxiety may predict 12-month non-fatal MI and cardiac re-hospitalization. However, comorbidity has the highest predictive value with greater medical expenditure and worse QOL in Chinese patients with ACS. And depression with comorbid anxiety may be a new target of mood status in patients with ACS.

Objective: Whether the cardiovascular (CV) outcomes of second-generation limus-eluting stents (LESs) differ from those of paclitaxel-eluting stents (PESs) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is still unclear., Methods: We used the Taiwan National Health Insurance Research Database to analyse data of 516 patients with AMI and CS diagnosed from January 2007 to December 2011. We used propensity score matching to adjust for the imbalance in covariate baseline values between these two groups. We evaluated clinical outcomes by comparing 197 subjects who used second-generation LESs to 319 matched subjects who used PESs., Results: The risk of the primary composite outcomes (i.e., myocardial infarction, coronary revascularisation or CV death) was significantly lower in the second-generation LES group than in the PES group [37.3% vs. 51.8%; hazard ratio (HR), 0.73; 95% CI: 0.56-0.95] at the 12-month follow-up. The patients who received second-generation LESs had a lower risk of coronary revascularisation (HR 0.62; 95% CI: 0.41-0.93) than those who used PESs. However, the risks of myocardial infarction (HR 0.56; 95% CI: 0.26-1.24), ischemic stroke (HR 0.73; 95% CI: 0.23-2.35), or CV death (HR 0.90; 95% CI: 0.63-1.28) were not significantly different between the two groups., Conclusions: Among patients with CS-complicating AMI, second-generation LES implantation significantly reduced the risk of coronary revascularisation and composite CV events compared to PES implantation at the 12-month follow-up., Competing Interests: The authors have declared that no competing interests exist.

Purpose Our aim was to determine whether cardiovascular (CV) risk in patients with prostate cancer (PCa) differs between those who receive androgen-deprivation therapy by surgical castration and those who receive gonadotropin-releasing hormone agonist (GnRHa) therapy. Patients and Methods By using the Taiwan National Health Insurance Research Database, we analyzed data from 14,715 patients with PCa diagnosed from January 1, 1997, through December 31, 2011. The patients were treated with bilateral orchiectomy or GnRHa therapy. We used inverse probability of treatment weighting with propensity scores to adjust for the imbalance in covariate baseline values between these two groups. Cox regression models were used to identify risk factors for myocardial infarction (MI), ischemic stroke (IS), and cardiac-related complications. Results Overall, 3,578 patients with PCa (24.3%) underwent bilateral orchiectomy and 11,137 patients (75.7%) received GnRHa therapy. Both groups had a similar risk of CV ischemic events (ie, MI or IS; hazard ratio, 1.16; 95% CI, 0.97 to 1.38) during a median follow-up time of 3.3 years. However, during the first 1.5 years of follow-up, there were higher CV ischemic events in the orchiectomy group than in the GnRHa group (hazard ratio, 1.40; 95% CI, 1.04 to 1.88), particularly in patients who were ≥ 65 years of age, had hypertension, had a Charlson comorbidity index score ≥ 3, and had a previous history of MI, IS, or coronary heart disease. Conclusion Compared with bilateral orchiectomy, use of GnRHa does not increase the risk of CV ischemic events in patients with PCa. Nonetheless, orchiectomy is associated with higher rates of CV ischemic events in older patients and those with a history of CV comorbidities within 1.5 years of initiating androgen-deprivation therapy. These findings can help clinicians decide on the optimal castration strategy for individual patients.

Background: Prior studies have suggested intraaortic balloon pump (IABP) have a neutral effect on acute myocardial infarction (AMI) patients with cardiogenic shock (CS). However, the effects of IABP on patients with severe CS remain unclear. We therefore investigated the benefits of IABP in AMI patients with severe CS undergoing coronary revascularization., Methods and Results: This study identified 14,088 adult patients with AMI and severe CS undergoing coronary revascularization from Taiwan's National Health Insurance Research Database between January 1, 1997 and December 31, 2011, dividing them into the IABP group (n = 7044) and the Nonusers group (n = 7044) after propensity score matching to equalize confounding variables. The primary outcomes included myocardial infarction(MI), cerebrovascular accidents or cardiovascular death. In-hospital events including dialysis, stroke, pneumonia and sepsis were secondary outcomes. Primary outcomes were worse in the IABP group than in the Nonusers group in 1 month (Hazard ratio (HR) = 1.97, 95% confidence interval (CI) = 1.84-2.12). The MI rate was higher in the IABP group (HR = 1.44, 95% CI = 1.16-1.79), and the cardiovascular death was much higher in the IABP group (HR = 2.07, 95% CI = 1.92-2.23). The IABP users had lower incidence of dialysis (8.5% and 9.5%, P = 0.04), stroke (2.6% and 3.8%, P<0.001), pneumonia (13.9% and 16.5%, P<0.001) and sepsis (13.2% and 16%, P<0.001) during hospitalization than Nonusers., Conclusion: The use of IABP in patients with myocardial infarction and severe cardiogenic shock undergoing coronary revascularization did not improve the outcomes of recurrent myocardial infarction and cardiovascular death. However, it did reduce the incidence of dialysis, stroke, pneumonia and sepsis during hospitalization.

Background: To investigate the cardiovascular (CV) outcomes of drug-eluting stents (DESs) versus bare-metal stents (BMSs) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS)., Methods: Data from the Taiwan National Health Insurance Research Database was analyzed between January 1, 2007 and December 31, 2011. A total of 3051 AMI patients in CS were selected as the study cohort. Their clinical outcomes were evaluated by comparing 1017 subjects who used DESs to 2034 matched subjects who used BMSs., Results: The risk of the primary composite outcome (i.e., death, myocardial infarction, stroke, and coronary revascularization) was significantly lower in the DES group compared with the BMS group [56.1% vs. 66.2%, hazard ratio (HR), 0.74; 95% CI, 0.67-0.81] with a mean follow-up of 1.35years. The patients who received DESs had a lower risk of coronary revascularization (HR, 0.78; 95% CI, 0.67-0.91) and death (HR, 0.70; 95% CI, 0.62-0.79) than those who used BMSs. However, the risks of myocardial infarction (HR, 0.89; 95% CI, 0.66-1.18), ischemic stroke (HR, 1.02; 95% CI, 0.67-1.53) and major bleeding (HR, 0.80; 95% CI, 0.56-1.14) were similar between the two groups., Conclusions: Among patients with CS complicating AMI, DES implantation significantly reduced the risk of percutaneous coronary revascularization and death compared to BMS implantation., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Data on the cardiovascular (CV) outcomes of drug-eluting stents (DES) vs. bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) under dialysis are limited., Methods and results: We analyzed the data from 42,592 AMI patients in the Taiwan National Health Insurance Research Database between 1 January 2007 and 31 December 2011. A total of 984 AMI patients under dialysis were selected as the study cohort. We evaluated the clinical outcomes by comparing 492 subjects who had DES to 492 matched subjects who had BMS. The primary composite outcomes, which included recurrent MI, coronary revascularization and CV death, were significantly lower in the DES group than in the BMS group (41.7% vs. 47.6%, hazard ratio (HR), 0.77; 95% confidence interval (CI), 0.63-0.92, P=0.005) after mean 1.2 years. The patients who received DES had a lower risk of recurrent MI (HR, 0.63; 95% CI, 0.45-0.90), CV death (HR, 0.74; 95% CI, 0.56-0.98) and all-cause mortality (HR, 0.74; 95% CI, 0.61-0.89) than those who used BMS, but a similar risk of major bleeding (HR, 0.99; 95% CI, 0.69-1.42, P=0.952) and ischemic stroke (HR, 1.15; 95% CI, 0.66-2.01, P=0.631)., Conclusions: Among AMI patients on dialysis undergoing percutaneous coronary interventions, DES implantation significantly reduced the risk of recurrent MI, CV death and all-cause mortality compared with BMS implantation.

Introduction: The level of 9-month high-sensitivity C-reactive protein (hsCRP) in predicting cardiovascular outcomes is scanty in patients at 9 months after receiving drug-eluting stent (DES) implantations. This study aims to evaluate the relationship between 9-month follow-up hsCRP levels and long-term clinical outcomes in patients at 9 months after receiving DES., Methods: A total of 1,763 patients who received 9-month follow-up angiography were enrolled and grouped according to hsCRP level 9 months after the DES implantation: group I (718 patients, hsCRP<1.0 mg/L), group II (639 patients, 1.0 ≦ hsCRP ≦ 3.0 mg/L), and group III (406 patients, hsCRP>3.0 mg/L)., Results: Group III patients had a lower cardiovascular event-free survival rate than group I or II patients during a follow-up of 64 ± 45 months (64.5% vs. 71.6% vs. 72.8%, respectively, p = 0.012). Multivariate analysis showed that a follow-up hsCRP level <3.0 mg/L was an independent predictor of a major adverse cardiovascular event (cardiac death, reinfarction, target lesion revascularization, stenting in a new lesion, or coronary bypass surgery). Group III patients had a higher restenosis rate (11.3% vs. 5.8% vs. 6.6%, respectively, p = 0.002) and loss index (0.21 ± 0.32 vs. 0.16 ± 0.24 vs. 0.18 ± 0.28, respectively, p = 0.001) than group I or II patients in 9-month follow-up angiography., Conclusions: A high 9-month follow-up hsCRP level is an independent predictor of long-term clinical cardiovascular outcomes in patients at 9 months after DES implantation. It is also associated with a higher restenosis rate, larger late loss and loss index at 9 months after DES implantation.

Background: The cardiovascular safety and efficacy of sitagliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor, in type 2 diabetic patients after acute myocardial infarction (AMI) has so far remained uncertain., Methods: We analyzed data from the National Health Insurance Research Database (NHIRD), a government-operated, population-based database, from March 1st, 2009 to December 31st, 2011. Type 2 diabetic patients hospitalized for AMI were included in our study. We compared subjects using sitagliptin with comparison group to evaluate its cardiovascular safety and efficacy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and ischemic stroke., Results: We identified a total of 3,282 type 2 diabetic patients hospitalized for AMI (mean follow-up 1.15 years). Of these patients, 547 (16.7%) who were exposed to sitagliptin were defined as the sitagliptin group and 2,735 (83.3 %) who did not use sitagliptin were the comparison group. The incidence of primary composite cardiovascular outcomes was 9.50 per 100 person-years in the sitagliptin group and was 9.70 per 100 person-years in the comparison group (hazard ratio (HR), 0.97; 95% CI, 0.73-1.29, P=0.849). Compared to the non-sitagliptin group, the sitagliptin group had similar risks of all-cause mortality, hospitalization for heart failure (HF) or percutaneous coronary intervention (PCI) with a HR of 0.82 (95% CI, 0.61-1.11, P=0.195), 0.93 (95% CI, 0.67-1.29, P=0.660), and 0.93 (95% CI, 0.75-1.14, P=0.473), respectively., Conclusion: The use of sitagliptin in type 2 diabetic patients with recent AMI was not associated with increased risk of adverse cardiovascular events.

Background: The cardiovascular safety and efficacy of sitagliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor, in type 2 diabetic patients with chronic kidney disease (CKD) after acute myocardial infarction (AMI) are unclear., Methods: We analyzed data from the Taiwan National Health Insurance Research Database between March 1st, 2009 and December 31st, 2011. A total of 1025 AMI patients with diabetes with chronic kidney disease were selected as the study cohort. The study evaluated the cardiovascular safety and efficacy of sitagliptin by comparing 205 subjects (20%) who use sitagliptin to 820 matched subjects (80%) who do not. The primary outcomes included myocardial infarction, ischemic stroke or cardiovascular death., Results: Primary composite outcomes occurred in 54 patients in the sitagliptin group (26.3%) and in 164 patients in the comparison group (20.0%) (HR, 1.32; 95% CI, 0.97-1.79; P=0.079) during the mean follow-up of 1.02years (SD=0.71years). The sitagliptin group had similar risks of ischemic stroke, all-cause mortality or hospitalization for heart failure (HF) compared to the non-sitagliptin group (P=0.938, 0.523 and 0.795 respectively). However, sitagliptin use was associated with increased risks of recurrent myocardial infarction (HR, 1.73; 95% CI, 1.15-2.58; P=0.008) and percutaneous coronary revascularization (HR, 1.43; 95% CI, 1.04-1.95; P=0.026)., Conclusions: Among type 2 diabetic patients with CKD after AMI, the use of sitagliptin was not associated with an increased risk of cardiovascular death, ischemic stroke or hospitalization for HF but was associated with increased risks of recurrent MI and percutaneous coronary revascularization., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To evaluate the clinical characteristics, in-hospital and three-year outcome in ST-elevation myocardial Infraction (STEMI) patients receiving conservative treatment (CT), thrombolytic treatment (TT) and primary percutaneous coronary intervention (PCI) in Beijing., Methods: This 12-month prospective, multicenter registry study was conducted in 19 hospitals with 808 patients with STEMI in Beijing between Jan. 2006 and Dec. 2006, 518 (64%) received PCI, 106 (16.1%) received TT and 184 (22.8%) received CT therapy. Patients were followed up for 3 years., Results: At baseline, the age of patients in CT group [(64.5 ± 13.5) years] was significantly higher than those in TT group p(57.9 ± 11.0) years] and in PCI group [ (60.4 ± 12.3) years, all P<0.01]; and the median time from symptom onset to hospital in CT group (207 min) was significantly longer than those in TT group (130 min) and PCI group (130 min, all P<0.01). Emergency Medical Service (EMS) use was significantly higher in PCI group (184/518, 35.5%) than in CT group (46/184, 27.3%) and TT group (29/107, 25.0%, all P<0.05). Health insurance holder was the highest in PCI group (P<0.01). PCI was performed less frequently than thrombolytic therapy [66.6% (345/518) vs. 80.2% (85/106)m P=0.02] during off-hours and more frequently performed in tertiary hospitals than in secondary hospitals[66.8%(437/651) vs. 52.6% (81/154, P<0.01)]. The in-hospital mortality and the cardiovascular mortality at 3 year after hospital discharge was significantly higher in CT group [9.2% (17/185) and 9.4% (15/159)] than in PCI group [3.5% (18/518), 4.5% (20/446)] and TT group [6.6% (7/106), 2.3% (2/86), all P<0.01]. Patients in PCI group had the highest adherence level of aspirin, β-blocker, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or statins at 3-years follow-up (all P<0.05). Multivariable Cox proportional hazards regression analysis showed that only PCI was associated with lower risk of cardiovascular death (HR-0.40, 95% CI:0.21-0.73, P<0.01)., Conclusions: Social and clinical setting may affect the physician's decision to provide reperfusion therapy in Beijing for STEMI patients. Better adherence of secondary preventive drugs and lower cardiovascular death are observed in STEMI patients receiving PCI during the 3-year follow-up

A 23-year-old man with no history of heart disease was admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University for an abnormal electrocardiogram of ST-T changes mimicking myocardial infarction. Catheterization revealed normal coronary and peripheral arteries. The echocardiogram and delayed enhancement cardiovascular magnetic resonance imaging indicated a markedly reduced left ventricular function and enlarged left ventricular cavity with evidence of fibrous tissue. Given the patient's history of multiple blunt trauma 7 years previously and acute myocardial infarction diagnosis at that time, he was diagnosed with traumatic myocardial infarction (TMI). We describe the natural course of such a patient with TMI. There is a possibility of spontaneous healing of coronary artery dissection induced by trauma. Although early revascularization may be helpful for preventing cardiac remodeling after TMI in some cases, more data are needed to compare the long-term outcome among different interventions in large sample cases., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We assessed whether the admission fasting plasma glucose (FPG) levels were associated with all-cause mortality and left ventricular (LV) function in older patients with acute myocardial infarction (AMI). A total of 1854 consecutive patients were categorized into 4 groups: hypoglycemia, euglycemia, mild hyperglycemia, and severe hyperglycemia. The primary outcomes were in-hospital/3-year mortality and LV function. There was a near-linear relationship between FPG and Killip class. However, no significant correlation was found between FPG levels and LV ejection fraction. Both FPG levels and Killip classes were all independent significant predictors of mortality. Compared with the euglycemia group, both the hypo- and hyperglycemia groups were associated with higher in-hospital and 3-year mortality. In older patients with AMI, the FPG values had differential influences on LV function and mortality. There was a U-shaped relationship between FPG and in-hospital/3-year mortality, and a near-linear relationship between increased admission glucose levels and higher Killip classification.

Objectives: To compare the safety and efficacy of radial artery access versus femoral artery access for percutaneous coronary intervention in acute myocardial infarction population., Methods: From June 2004 to December 2006, 446 patients with acute myocardial infarction treated with percutaneous stenting were reviewed retrospectively. The radial artery approach was used in 242 patients, and the femoral artery approach in 204 patients. The success of the procedure, procedure duration, X-ray exposition, volume of contrast, incidence of major adverse cardiac events and complications were compared between the radial artery and femoral artery approach., Results: Total procedure duration, X-ray exposition, the immediate success of the procedure and the proportion of patients with reperfusion time above 60min are higher in patients with radial artery acess than that with femoral artery access [(62.1 ± 23.4) min vs (56.8 ± 16.7) min, (2829.4 ± 1365.2) mGY vs (2352.3 ± 903.1) mGY, 4% vs 0.9% and 7.44% vs 2.94% respectively, all P < 0.05]., Conclusions: In non-selected patients with acute myocardial infarction treated with primary stent implantation, the success rate of the radial artery approach is lower than the femoral artery approach and could prolong the reperfusion time. It is suitable to change artery access immediately if abnormality is found via radial artery access.

Objective: To assess whether the relationship between abnormal fasting plasma glucose (FPG) levels and patient outcomes holds for both older men and older women with acute myocardial infarction (AMI)., Patients and Methods: From April 1, 2004, to October 31, 2006, a total of 2016 consecutive older patients (age ≥65 years) presenting with AMI were screened. Of these patients, 1854 were consecutively enrolled in the study. Patients were categorized into 4 groups: the hypoglycemic group (FPG, ≤90.0 mg/dL [to convert to mmol/L, multiply by 0.0555]; n=443, 23.9%), the euglycemic group (FPG, 90.1-126.0 mg/dL; n=812, 43.8%), the mildly hyperglycemic group (FPG, 126.1-162.0 mg/dL; n=308, 16.6%), and the severely hyperglycemic group (FPG, ≥162.1 mg/dL; n=291, 15.7%). The primary outcomes were rates of in-hospital and 3-year mortality., Results: Female patients were older and had a higher incidence of diabetes mellitus but lower rates of smoking and use of invasive therapy. Men tended to have a higher frequency of hypoglycemia, whereas women tended to have a higher frequency of hyperglycemia. No significant difference was found in in-hospital (10.9% vs 9.1%; P=.36) or 3-year (24.5% vs 24.5%; P=.99) mortality between male and female patients, and FPG-associated mortality did not vary significantly by sex., Conclusion: An increased FPG level was associated with a relatively higher risk of in-hospital mortality in men but not in women. Nonetheless, increased and decreased FPG levels at admission could predict higher mortality rates regardless of sex. There was a striking U-shaped relationship between FPG levels and in-hospital and 3-year mortality. The effect of abnormal FPG level on outcomes among older patients with AMI did not vary significantly by sex.

Objective: To assess the association between fasting plasma glucose (FPG) levels on admission and mortality in older patients with acute myocardial infarction (AMI), and compare the effects of FPG levels on outcomes in the context of contemporary treatments, including drug treatment, percutaneous coronary intervention and coronary artery bypass grafting., Methods: From April 2004 to October 2006, 1854 older (age > or =65 years) patients with AMI were enrolled in the Beijing Elderly Acute Myocardial Infarction Study (BEAMIS) consecutively. Patients were categorised into 4 groups: hypoglycaemia group (N=443, 23.9%), FPG< or =5 mmol/l; euglycaemia group (N=812, 43.8%), FPG> or = 5.1 to< or =7.0 mmol/l (5-7 mmol/l); mild hyperglycaemia group (N=308, 16.6%), FPG> or = 7.1 to< or =9.0 mmol/l (7-9 mmol/l); and severe hyperglycaemia group (N=291, 15.7%), FPG> or =9.1 mmol/l. The primary end point was in-hospital and 3-year all-cause mortality from the day of admission., Results: Compared with the euglycaemia group, hypoglycaemia or hyperglycaemia groups were all associated with higher in-hospital and 3-year all-cause mortality. There was a U-shaped relationship between admission FPG levels and short- and long-term all-cause mortality. This U-shaped relationship applied equally to subgroups in the context of contemporary treatments., Conclusions: In older patients with AMI, increased as well as decreased admission FPG levels could predict higher in-hospital and 3-year mortality. There was a striking U-shaped relationship between admission FPG levels and short- and long-term mortality. An initial admission FPG level > or = 5.1 to< or =7.0 mmol/l may be desirable because it was associated with better clinical outcomes.

Background: Delay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI., Methods: Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review., Results: The median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%), radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P < 0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P < 0.001) compared to those who interpreted their symptoms as cardiac in origin., Conclusions: Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS).

Objective: To determine whether early catheterization laboratory activation would reduce median door-to-balloon time in patients with ST elevation myocardial infarction (STEMI)., Methods: Consecutive patients with STEMI underwent primary percutaneous coronary intervention (PCI) from January 2006 to December 2008 in Beijing Anzhen Hospital were analyzed. Patients were divided into three groups. Group A included patients without prehospital ECG (n = 168), group B included patients with prehospital ECG (n = 224) and group C included patients with prehospital ECG and early telephonic notification to activate catheterization laboratory (n = 114). Primary end point was door-to-balloon time, secondary end points included peak Troponin I elevation, left ventricular ejection fraction, length of hospital stay, hospital mortality and 30 days follow-up mortality., Results: Baseline characteristics were similar among groups. Door-to-balloon time and door-to-catheter laboratory time (110 minutes, 94 minutes and 85 minutes, respectively, all P < 0.01; 91 minutes, 74 minutes and 64 minutes, respectively, all P < 0.01) were significantly shorter in group B and C than those in group A. The percentage of patients with door-to-balloon time less than 90 minutes increased significantly from 32% in group A to 43% in group B and 59% in group C (P < 0.01)., Conclusion: Early activation of catheterization laboratory by prehospital ECG and telephonic notification could markedly reduce door-to-balloon time in patients with STEMI.

Background: Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China., Methods: Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records., Results: The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P < 0.001; 55 minutes vs. 45 minutes, P = 0.035). After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays., Conclusions: There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

Objective: To determine lengths and factors associated with delay of reperfusion-decision in patients with acute ST-segment elevation myocardial infarction (STEMI)., Methods: This cross-sectional and multicenter survey was conducted in 19 hospitals from Beijing between 1 January and 31 December, 2006 and included STEMI patients receiving thrombolysis or primary percutaneous coronary intervention (PCI). Data were collected by structured interviews and medical records review within 1 week after admission. Reperfusion-decision delay was defined as time interval from the initial ECG after admission to sign of the thrombolysis or operation approval. Patients were categorized into an early decision group and a late decision group based on the 30 min cut-off time., Results: Of the 635 STEMI patients interviewed, 129 (20.3%) received thrombolysis, and the remaining 506 (79.7%) received primary PCI. The median reperfusion-decision delay was 47 min. The median door-to-needle time was 82 min, and the median door-to-balloon time was 135 min. Multivariate logistic analysis showed that awareness of the time-dependent nature of reperfusion therapy (OR = 1.723, 95% CI: 1.156-3.212, P = 0.040), pre-hospital electrocardiogram (OR = 1.566, 95% CI: 1.018-2.409, P = 0.036), cardiac function of Killip > or = 2 at admission (OR = 1.579, 95% CI: 1.004-2.483, P = 0.021) and presenting to cardiovascular specialty hospital (OR = 5.075, 95% CI: 1.380-18.655, P = 0.014) were independent predictors early reperfusion-decision delay. Patients in early decision group had significantly shorter median door-to-needle (47 vs. 103 min, P < 0.001) and door-to-balloon (100 vs. 154 min, P < 0.001) times compared to patients in late decision group., Conclusions: The main reason of the in-hospital delay of reperfusion therapy of STEMI patients is reperfusion-decision delay. New public health strategies should be developed to educate patients and their family members to increase their awareness of the importance and benefits of prompt reperfusion therapy and facilitate the pre-hospital electrocardiogram recording for STEMI patients.

Objective: To examine the current ambulance transport rates and ascertain factors associated with use of emergency medical service (EMS) in patients with acute myocardial infarction (AMI) in Beijing., Methods: Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review within 1 week after admission. Patients were categorized into the EMS group and the self-transport group according to their modes of transport to the initial hospital. Data were analyzed by descriptive statistics, univariate and multivariate logistic analysis., Results: Of the 789 patients with STEMI, only 260 (33.0%) arrived at the initial hospital by EMS, while the remaining 529 (77.0%) relied on self-transport. Multivariate logistic analysis showed that age >/= 65 years (OR: 1.530, 95%CI: 1.050 - 2.230, P = 0.027), higher education level (OR: 2.032, 95%CI: 1.257 - 3.284, P = 0.004), history of coronary artery disease (OR: 0.474, 95%CI: 1.049 - 2.458, P = 0.029), unbearable symptoms (OR: 0.592, 95%CI: 1.090 - 2.520, P = 0.008), anxiety (OR: 0.760, 95%CI: 1.238 - 3.695, P = 0.006) and attribution of symptoms to cardiac origin (OR: 0.402, 95%CI: 1.020 - 2.171, P = 0.041) were independent predictors of EMS use. However, presence of pre-infarction angina significantly decreased the likelihood of using EMS (OR: 0.626, 95%CI: 0.431 - 0.907, P = 0.013)., Conclusions: Only one-third of patients with STEMI arrived at the hospital by EMS in Beijing. Demographics, history of coronary artery disease, symptoms characteristics and cognitive factors of patients were associated with the EMS use.

Background: Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group)., Methods: Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms., Results: Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n = 160) was significantly longer than in the LH group (n = 406) (225 vs. 120 minutes, P < 0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95%CI: 1.264 - 3.155), absence of history of myocardial infarction (OR, 1.595; 95%CI: 1.086 - 3.347), non-health insurance coverage (OR, 1.931; 95%CI: 1.079 - 3.012) and absence of sense of impending doom (OR, 4.367; 95%CI: 1.279 - 14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95%CI: 1.182 - 3.661) less likely to receive primary PCI compared with those in the LH group., Conclusions: Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients' pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.

Mortality from cardiovascular diseases, such as myocardial infarction (MI), is predicted to increase dramatically in Asia-Pacific countries. However, there are few studies that estimate utilization of prophylactics, such as low-dose aspirin, in these countries. To determine this, an online survey was sent to physicians in 18 countries worldwide, and this article reports the findings from the Asia-Pacific region (N = 4372 respondents). The overall mean number of MI patients per respondent was 246 in the Asia-Pacific countries, and 55% of physicians (overall) rated their patient as having total compliance with aspirin. The use of aspirin monotherapy or combination therapy, aspirin dosage, and physician contact were all found to have a significant impact on compliance (all P < 0.00001). Educational material on the role of aspirin was ranked as the most effective measure to improve compliance. In conclusion, this survey indicates that educational initiatives on secondary prevention are urgently needed in Asia-Pacific countries.

Objective: In this randomized, open-label, multicenter, angiographic trial, we compared the efficacy and safety of tenecteplase (TNK-tPA) with alteplase (rt-PA) in Chinese patients with acute myocardial infarction., Method: Patients with acute ST-elevation myocardial infarction and pain to hospital time within 6 hours from October 2002, to March 2004 were randomly assigned a body weight-adjusted bolus of TNK-tPA (0.53 mg/kg over more than 10 s, n = 58) or front loaded rt-PA (< or = 100 mg, n = 52). Coronary angiography was performed at 90 min after initiating study drugs. All patients received aspirin and heparin (target activated partial thromboplastin time: 50-70 s). The primary end point of the trial was the rate of TIMI grade 3 flow at 90 minutes. Other end points included the rate of TIMI grade 2/3 flow at 90 minutes, all cause mortality at 30 days, the moderate/severe hemorrhage without intracranial hemorrhage (ICH) and ICH within 30 days., Results: TIMI grade 3 flow at 90 minutes (68.4% vs. 66.7%, P = 1.00), TIMI grade 2 or 3 at 90 minutes (89.5% vs. 80.4%, P = 0.278), total mortality at 30 days (13.8% vs. 9.6%, P = 0.565), the rate of moderate/severe hemorrhage (8.6% vs. 5.8%, P = 0.72) and incidence of ICH (3.5% vs. 1.9%, P = 1.00) were all similar in TNK-tPA treated patients compared to rt-PA treated patients., Conclusion: The efficacy of single-bolus, weight-adjusted TNK-tPA fibrinolytic regimen is equivalent to front-loaded alteplase in terms of the rates of TIMI grade 3 flow, TIMI 2 or 3 flow. Incidences of moderate/severe hemorrhage, ICH and 30-days mortality were similar in TNK-tPA and rt-PA treated patients.

Background: Emergency medical service plays a key role in the early recognition and treatment of ST-elevation myocardial infarction (STEMI), but studies indicate that the patients experiencing STEMI symptoms often fail to call an ambulance as recommended. This study aimed to examine the current ambulance transport frequency and ascertain predictors and reasons for not choosing ambulance transportation by the patients with STEMI in Beijing., Methods: A prospective, cross-sectional survey was conducted from January 1, 2006 through until June 30, 2007 in two tertiary hospitals in Beijing and included consecutive patients with STEMI admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review., Results: Of the 572 patients, only 172 (30.1%) used an ambulance, and the remaining 400 (69.9%) presented by self-transport. Multivariate analysis showed that age <65 years (OR: 1.220; 95% CI: 1.001-2.043), lower education level (OR: 1.582; 95% CI: 1.003-2.512), presence of pre-infarction angina (OR: 1.595; 95% CI: 1.086-2.347), and attribution of symptoms to non-cardiac origin (OR: 1.519; 95% CI: 1.011-2.284) were independent predictors for not using an ambulance. However, history of coronary artery disease (CAD), dyspnea, perceiving symptoms to be serious, and knowing the meaning of cardiopulmonary resuscitation appeared to be independent predictors of ambulance use. The main reasons for not using an ambulance were convenience and quickness of self-transport and the decreased severity of symptoms., Conclusions: A large proportion of patients in Beijing do not call for an ambulance after onset of STEMI symptoms. Several factors including demographics, previous CAD, symptoms and cognitive factors of patients are associated with the ambulance use. The public should be educated that an ambulance is not merely a transportation modality and that it also provides rapid diagnosis and treatment.

Objective: To examine the use of reperfusion strategies in elderly patients with acute myocardial infarction (AMI) and investigate the factors affecting its use., Methods: This survey population consisted of 338 consecutive elderly patients with AMI (> or = 65 years) who were admitted to the department of cardiology of Beijing Military General Hospital between December 2003 and November 2007. The patients were divided into two groups based on the receiving of reperfusion strategies: a reperfusion group (n = 252) and a non-reperfusion therapeutic group(n = 86). Qualitative data were compared between the two groups using Chi-square tests and multiple binary logistic regression was used to determine the relationship between various patient-related factors with the probability of choosing reperfusion therapies or not., Results: About 74.6% of the elderly patients with AMI received reperfusion strategies [62.2% percutaneous coronary intervention (PCI) and 12.4% thrombolysis]. Stepwise logistic regression analysis revealed that age > or = 75 years (OR = 0.255, P = 0.000), history of angina(OR = 0.570, P = 0.016) and high Killip classification (OR = 0.671, P = 0.012) were confirmed factors for receiving less reperfusion therapy. Meanwhile, inferior wall myocardial infarction (MI) with complicating right ventricular MI(OR = 4.585, P = 0.002), sweating (OR = 1.970, P = 0.016), unbearable symptoms (OR = 1.836, P = 0.038) and medical insurance (OR = 1.968, P = 0.029) were independent predictors for receiving reperfusion therapy. Intracranial hemorrhage (2.8% vs 7.1%, P = 0.000), left ventricular ejection time < 45% (12% vs 31%, P = 0.016) and mortality rate within 1 year (2.3% vs 4.7%, P = 0.039) were obviously decreased in the PCI group as compared with the thrombolysis group., Conclusions: Aging, medical history of angina, high Killip classification, inferior MI with complicating right ventricular MI, sweating, unbearable symptoms and medical insurance were independent predictors for receiving reperfusion strategies.

Objective: To analyze the primary risk factors of patients with first ST elevation acute myocardial infarction (FSTEMI) in Beijing and Shenyang area between 2004--2005. The Attributable risk percentage (ARP) and population attributable risk percentage (PARP) of every risk factor were determined., Method: A total of 426 consecutive FSTEMI patients and 426 gender and age matched healthy controls were included in this 1:1 matched case-control study., Result: Multivariate logistic regression analysis showed that following 8 primary risk factors were associated with FSTEMI: heavy smoking (OR = 3.170), diabetes (OR = 2.835), positive family history (OR = 2.243), lack of soybeans intake (OR = 2.243), higher psychological stress (OR = 2.138), lack of fish intake (OR = 1.740), lower education level (OR = 1.572) and recent adverse life events (< 6 months before FSTEMI, OR = 1.515). The ARP are 71.53%, 58.33%, 54.05%, 40.81%, 56.85%, 41.53%, 48.62%, 54.00%; the PARP are 38.79%, 10.40%, 4.69%, 33.72%, 36.03%, 24.96%, 29.56%, 14.83%, respectively., Conclusion: In this patient cohort, the harmful risk factors responsible for the development of FSTEMI in Beijing and Shenyang areas during 2004--2005 are heavy smoking, higher psychological stress, lack of soybeans intake, lower education level, lack of fish intake, recent adverse life events, diabetes and positive family history.

Background: Ambulance use expedites the definitive treatment of acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of ambulance use on the administration of early reperfusion therapies for patients with AMI in Beijing, China., Methods: Data were prospectively collected from 498 patients with ST-elevation myocardial infarction (STEMI) who were admitted within 12 hours of symptom onset to 19 hospitals in Beijing between November 1, 2005 and December 31, 2006. The baseline characteristics of and the initial management of the ambulance users and the non-ambulance users were compared., Results: Only 186 (37.3%) patients used an ambulance as transportation to the hospital. Ambulance users were, on average, older and at relatively higher risk on presentation than the non-ambulance users. After adjustment for patient and hospital characteristics, ambulance use was associated with a greater early reperfusion rate, mainly because of a greater incidence of primary percutaneous coronary intervention. In addition, ambulance users had a significantly shorter median door-to-balloon (120 compared with 145 minutes, P < 0.001) and symptom onset-to-balloon (223 compared with 300 minutes, P < 0.001) time than non-ambulance users., Conclusions: Ambulances are underused by AMI patients in Beijing. Ambulance use may lead to more frequent and faster receipt of early reperfusion therapies. New public health strategies should be developed to facilitate an increased use of ambulances by AMI patients.

Objective: To evaluate the effects of socioeconomic status on the distribution of cardiovascular risk factors and clinical treatments of patients with acute myocardial infarction in Beijing., Methods: In Beijing, a prospective, multi-center, registration study was carried out which including 800 patients who were consecutively hospitalized for ST-segment elevation acute myocardial infarction within 24 hours after event attack in 19 different hospitals in Beijing between November, 2005 and December, 2006. Indicators of socioeconomic status included self-reported personal income (< 500, 500-2000, > 2000 RMB/ month), educational attainment (< or = 12 and > 12 years) and status of medical insurance (yes/no). According to categories of education, patients were categorized into two groups of lower socioeconomic status and higher socioeconomic status. Differences of cardiovascular risk factors and clinical treatments were compared across the two groups respectively., Results: Proportion of diabetes and hyperlipidemia in patients with higher socioeconomic status was much higher than that of patients with lower socioeconomic status (P < 0.05, P < 0.01 respectively). Patients with lower socioeconomic status were more likely to be smokers (P < 0.05). The rates of receiving coronary angiography and PTCA were much lower in patients with lower socioeconomic status. Medical insurance and income were the most important two socioeconomic factors determining the use of PTCA., Conclusion: Compared to patients with lower socioeconomic status, patients with higher socioeconomic status had higher rates of hyperlipidemia and diabetes but lower smoking rate among cardiovascular risk factors. The rates of receiving interventional therapies were much lower in patients with lower socioeconomic status.

Objective: To investigate the factors associated with delay in decision to seek treatment in patients with acute myocardial infarction (AMI) in Beijing., Methods: This prospective, cross-sectional, multicenter survey was conducted from November 1, 2005 and December 31 ,2006. The participants consisted of 799 patients with STEMI admitted within 24 h of symptom onset to 19 hospitals in Beijing. Data were collected by semi-structured interviews and medical records review. The patients were categorized into an early decision group and the a late decision group based on the 30 min cut-off., Results: The median (25%, 75%) decision delay in STEMI patients was 60 (20, 180) min. Factors associated with late decision in an univariate analysis were age > or = 65 years, retirement or unemployment, history of myocardial infarction, symptom onset at home and intermittent symptoms, whereas presence of bystanders such as friends, coworkers or even strangers, unbearable symptoms, dyspnea, sweating, syncope and attribution of symptoms to cardiac origin were related to early decision. Multivariate logistic analysis showed that history of myocardial infarction, absence of syncope, intermittent symptoms, bearable symptoms and attribution of symptoms to noncardiac origin were independent predictors of decision delay > 30 min. Patients in the early decision group had more chances to receive acute reperfusion therapies (P = 0.001) and shorter time intervals from symptom onset to reperfusion therapies (P <0.001)., Conclusions: To a great extent patients with AMI in Beijing delayed in decision to seek treatment. History of myocardial infarction, symptom characteristics and symptom attribution were associated with decision delay.

Purpose: To assess clinical practices and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) in Beijing, China., Methods: This study was a prospective multicentre registry study in Metropolitan Beijing, China. Demographics, delay time, management strategy and in-hospital outcome data were collected from patients with STEMI enrolled in 19 hospitals., Results: A total of 803 patients (mean age 61+/-13 yr ,22% women and 42.1% >or= 65 yr) with STEMI were enrolled. More than half had a history of hypertension (50.4%) and current smoking (55.2%). Six hundred and fifty patients (80.9%) received reperfusion therapy: 124 (15.4% ) treated with thrombolysis and 526 (65.5% ) with primary percutaneous coronary intervention (PCI). The median door-to-needle time for thrombolysis was 83 min and door-to-balloon time for primary PCI was 132 min. Only 7% of patients treated with thrombolysis met the guidelines goal of the door-to-needle time

Objective: To investigate the correlation between Duke treadmill score (DTS) and corrected thrombolysis in myocardial infarction frame count(CTFC )in patients with coronary atherosclerotic heart disease(CAD)., Methods: Seventy-two patients with coronary atherosclerotic heart disease, who underwent treadmill exercise tests in 2 weeks before coronary angiography were enrolled in our study. All the patients were divided into 2 groups according to the value of DTS: low-risk group (DTS > or = 5) and moderate-high-risk group (DTS < 5). We evaluated the correlation between DTS and CTFC and compared the differences between the two groups., Results: DTS had a negative correlation with CTFC of left anterior descending branch (LAD), left circumflex artery (LCX) and right coronary artery (RCA)(r = -0.821,-0.730,-0.598, P<0.001). CTFC of all coronary arteries in the low-risk group was much lower than that of moderate-high-risk group [LAD: (22.27+/-3.71) frames vs (24.12+/-4.19) frames, respectively; LCX: (27.96+/-5.65) frames vs (31.28+/- 6.79) frames, respectively; RCA: (21.96+/-5.85) frames vs (24.64+/-7.33) frames, respectively], there was significant difference between the two groups., Conclusion: There was a negative correlation between DTS and CTFC of left anterior descending branch, left circumflex artery and right coronary artery in patients with CAD. The risk stratification on the basis of DTS had a notable association with CTFC. These results may provide a theoretical evidence for utilizing the non-invasive method DTS to evaluate prognosis of patients with CAD.

Objective: To define impact of spontaneous TIMI-3 flow before angioplasty on outcomes of percutaneous coronary intervention strategy and the prognosis in patients with acute myocardial infarction (AMI)., Methods: The consecutive 301 patients enrolled in the ongoing register of emergent coronary angioplasty within 12 hours from symptoms who were diagnosed as having ST elevation AMI in our hospital from 2000 to 2006 were analyzed, they were followed up for one year and the clinical characteristics and survival rates were analysed., Results: Among the 301 patients enrolled in the ongoing register of emergent coronary angioplasty, spontaneous reperfusion (TIMI-3 flow) was present in 14.6% at initial angiography. Compared with patients without TIMI-3 flow, those with TIMI-3 flow before coronary intervention were less likely to present in new-onset heart failure(2.3% versus 16%, P=0.016), Patients with initial TIMI-3 flow had significantly lower 30-day mortality (0% versus 9.3%, P=0.035) , and cardiogenic shock (0%versus 8.6%, P=0.044) and had a shorter hospital stay (P=0.008). Cumulative 1-year mortality was 0% in patients with initial TIMI-3 flow, 11.3% with TIMI 0-2 flow (P=0.019). By COX regression analysis, post procedural TIMI-3 flow was an independent determinant of survival (OR=0.285,P=0.004) , however,TIMI-3 flow before coronary intervention was not found as an independent determinant of survival significantly. The lenitive symptoms and current smoking were the independent determinants of TIMI-3 flow before coronary intervention (P=0.005, P=0.048, respectively)., Conclusion: Patients undergoing primary percutaneous transluminal coronary intervention in whom TIMI-3 flow is present before angioplasty may present with greater clinical and angiographic evidence of myocardial salvage, be less likely to develop complications related to left ventricular failure, and improve early and late survival.

Objective: This study was undertaken to assess the effect of acute hyperglycemia on the in-hospital outcomes in patients with ST-segment elevation myocardial infarction (STEMI)., Methods: Between January 2006 and July 2006, 356 patients, from 17 hospitals in Beijing were admitted to the hospitals within 24 hours after the onset of STEMI. They were divided into two groups according to the admission glucose level (cutoff value, 11 mmol/L). The in-hospital mortality and cardiovascular events were compared between the two groups. The in-hospital cardiovascular events were defined as in-hospital reinfarction, new-onset heart failure, malignant arrhythmia and stroke., Results: There were 81 (22.8%) patients with acute hyperglycemia. The in-hospital mortality rate was significantly higher in patients with acute hyperglycemia than in patients without (13.6% VS 5.1%, P = 0.009). The rate of cardiovascular events was also higher in patients with acute hyperglycemia (32.1% VS 20.4%, P = 0.027). By univariate and multivariate logistic regression analysis, high blood glucose on admission (OR, 1.615; 95% CI, 1.116 - 2.338, P = 0.011) was an independent risk factor for in-hospital outcomes., Conclusion: The rate of in-hospital mortality and cardiovascular events was significantly higher in STEMI patients with acute hyperglycemia than in patients without. high blood glucose on admission was an independent risk factor for in-hospital outcomes in patients with STEMI.

Background: Definitive treatment for heart attack is early reperfusion with either angioplasty or thrombolytic therapy, and the benefit is strictly time-dependent. Patient outcomes are improved with either therapy when initiated as soon as possible. Recognition of heart attack symptoms is logically tied to taking action to receive prompt emergency care. Inadequate knowledge of heart attack symptoms may prolong delay. The purpose of this study was to document knowledge about heart attack symptoms in Beijing residents and to identify the characteristics associated with increased knowledge of heart attack., Methods: A structured survey was conducted in 18 communities in Beijing from March 1 through June 10 in 2006. Addresses and participants were selected randomly following a stratification. The survey was designed to collect knowledge of heart attack symptoms from sampled adults in each community., Results: A total of 4627 respondents completed the questionnaires correctly, and 50.29% of them were female. Totally 64.15% of the respondents reported chest pain or discomfort (common symptoms) as a symptom of heart attack; 75.38% reported at least one of the following eight symptoms as a symptom of heart attack: back pain, shortness of breath, arm pain or numbness, nausea or vomiting, neck, jaw or shoulder pain, epigastric pain, sweating, weakness (less common symptoms); 20.36% correctly reported four or more heart attack symptoms, only 7.4% knew all the correct heart attack symptoms, and 28.94% knew about reperfusion therapy for heart attack; 31.7% reported to call 120 or 999 while having a heart attack themselves; however 89.6% reported to call 120 or 999 when someone else is suffering from a heart attack. Very old persons and those with health insurance coverage, high education level, high household income, longer living in Beijing and previous experience with heart disease had greater knowledge of heart attack symptoms., Conclusions: Public knowledge of common heart attack symptoms as well as less common heart attack symptoms is deficient in Beijing residents. But their knowledge of calling emergency medical services when someone is having a heart attack is relatively adequate. Public health efforts are needed to increase the recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute cardiac event, especially in socioeconomically disadvantaged subgroups, including persons with low education level, low household income, and no health insurance coverage.

Objective: To assess the effect of trimetazidine as an adjunctive treatment to reperfusion therapy in acute myocardial infarction., Methods: Sixty patients with acute myocardial infarction were randomized to receive trimetazidine (a loading dose of 60 mg followed by 20 mg 3 times daily) for 2 weeks (n = 32) or to be controls (n = 28). The loading dose was started early before the reperfusion therapy. Patients received intermittent ST-segment monitoring to assess the resolution of ST-segment deviation one hour after reperfusion therapy. Venous blood samples for measurement of malondialdehyde (MDA) and endothelin (ET-1) were taken immediately on admission and 1, 4, 8, 24 and 48 hours as well as 7 days after reperfusion. In-hospital and 3-months major adverse cardiac events were recorded., Results: Blinded ST-segment analysis showed that there was a more marked return towards baseline one hour after reperfusion therapy in the trimetazidine group, than in the control group [change (7.14 +/- 3.50) mm vs (3.79 +/- 1.32) mm, P = 0.041]. The measurement of plasma MDA showed that, there was a significantly lower level in the trimetazidine group 4, 8, 24, 48 hours and 7 days after reperfusion (P < 0.05). The level of plasma ET-1 was significantly lower in the trimetazidine group 8 hours and 7 days after reperfusion (P < 0.05). There was no side effect due to trimetazidine. Clinical outcomes were similar between the two groups., Conclusions: Trimetazidine is effective for the resolution of ST-segment elevation. The effect of trimetazidine against malondialdehyde and ET-1 formation suggested that it might be the mechanism of the myocardial protection.

Objective: To compare the clinical outcomes between China made sirolimus-eluting stents (SES) and bare metal stents (BMS) implantation in patients with acute myocardial infarction (AMI)., Methods: Consecutive patients with AMI underwent primary percutaneous coronary intervention (PCI) were randomly divided into SES group (n = 87) and BMS group (n = 86). The incidence of major adverse cardiac events (MACE including death, reinfarction, in-stent thrombosis, restenosis rate, target vessel revascularization) up to 6 months post PCI were assessed., Results: Postprocedure vessel patency, enzymatic release, cardiac function, and the incidence of short-term MACE were similar between the two groups (all P > 0.05). Two in-stent thrombosis was diagnosed in the SES group and bare stents group respectively (2.4% vs. 2.3%, P > 0.05). At 6 months, In-stent restenosis rate (4.5% vs. 40.0%, P < 0.01) and the in-segment restenosis rate (6.8% vs. 44.9%, P < 0.01) as well as MACE (8.0% vs. 24.4%, P < 0.01), which is mainly due to a marked reduction in the risk of target vessel revascularization (3.4% vs. 11.6%, P < 0.05) were significantly lower in SES group compared to BMS group., Conclusion: The China made SES were not associated with an increased risk of in-stent thrombosis but significantly reduced restenosis rate and MACE at 6 months post primary angioplasty in patients with AMI.

Aim: The aim of this article is to characterize the glucometabolic state of patients with coronary artery disease (CAD) in China., Methods and Results: This multicentre study recruited 3513 patients hospitalized for CAD, of whom 35.1% were admissions for acute CAD and 64.9% were elective admissions for CAD. At entry, 1153 patients had known type 2 diabetes and 97 had newly diagnosed diabetes [fasting plasma glucose level (FPG) > or =7.0 mmol/L]. Oral glucose tolerance tests (OGTTs) performed in the remaining patients revealed that 26.9% had diabetes and 37.3% had impaired glucose regulation (IGR). The prevalence of abnormal glucose regulation (AGR) was similar in the acute and elective admissions groups. Overall, the proportion of patients with diagnosed diabetes increased from 32.8% at baseline to 52.9% post-OGTT analysis. In total, 87.4% of patients with IGR and 80.5% of patients with diabetes would have remained undiagnosed if OGTTs had not been performed., Conclusion: AGR is common in patients with CAD. The prevalence of AGR is underestimated by FPG testing alone. OGTTs should be routinely used to assess the glucometabolic state of patients with CAD. Individuals identified with IGR or type 2 diabetes should receive treatment to reduce the progression of AGR and associated complications.

Objective: To investigate the relationship between thrombolysis in myocardial infarction (TIMI) risk score and efficacy of different treatment strategies in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS)., Methods: From Oct. 2001 to Oct. 2003, 545 consecutive patients with NSTE-ACS were randomly assigned to early conservative strategy (n = 284) or early invasive strategy group (n = 261). The combined cardiovascular events (a combination of cardiac death, nonfatal myocardial infarction, nonfatal heart failure and re-hospital admission due to recurrent ischemia angina) within 30 days and 6 months were analyzed and related to the TIMI risk score at admission., Results: Rehospitalization due to recurrent ischemia angina of 30 days and the combined cardiovascular events of 30 days and 6 months were significantly lower in early invasive strategy group (3.5%, 10.0%, 21.1%) compared with early conservative strategy group (8.1%, 16.9%, 28.2%, all P < 0.05). Subgroup analysis indicated early invasive strategy could significantly decrease the 30 d incidence of the combined end point events in patients with high TIMI risk score and the 6 months incidence of the combined end point events in patients with moderate and high TIMI risk score (all P < 0.01), but the incidence was similar between the two different strategies in patients with low TIMI risk score., Conclusions: Early invasive strategy may significantly reduce combined cardiovascular events in NSTE-ACS patients with moderate and high TIMI risk score compared with early conservative strategy.

Objective: To evaluate the clinical features and outcomes in patients suffering from acute myocardial infarction combined with elevated serum creatinine., Methods: We enrolled 340 consecutive patients suffering from acute myocardial infarction admitted into our hospital from 2003.2.1 - 2004.8.31. The patients were divided into the following 2 groups, 269 patients in a group with normal serum creatinine and 71 patients in a group with elevated serum creatinine, according to the normal limit of serum creatinine in our hospital. Outcomes during hospitalization were available in all the patients and one year follow-up data were also available in all the patients. The influence of baseline demographic and clinical variables on mortality at day 30 and one year during the follow-up period was evaluated by Cox proportional hazard regression to determine the independent predictors of late adverse events., Results: Elevated creatinine at baseline was present in 71 of the 340 patients. Compared with patients with normal creatinine, patients with elevated creatinine were older and more likely to have old myocardial infarction and to present with cardiac shock, heart failure, ventricular fibrillation and complete AVB. Mortality was markedly increased in patients with baseline elevated creatinine as compared with these without at day 30 (32.39% versus 4.83%, P = 0.000), during hospitalization (35.21% versus 5.20%, P = 0.000) and at 1 year (43.66% versus 11.15%, P = 0.000). By Cox regression analysis, elevated creatinine was a powerful independent hazard predictor of 30-day survival (odds ratio 4.591, 95% confidence interval 2.149 to 9.808, P = 0.000) and remained to be associated with reduced survival at 1 year (odds ratio 3.936, 95% confidence interval 2.264 to 6.845, P = 0.000)., Conclusions: Baseline elevated creatinine is associated with a markedly increased risk of 30-day death, death during hospitalization and mortality at one year in patients suffering from acute myocardial infarction and may be an independent risk factor of prognosis of acute myocardial infarction.

Objective: To investigate the effect of early invasive strategy on early and late outcomes in high-risk patients with non-ST-segment elevation acute coronary syndromes (ACS)., Methods: Five hundred and forty-five patients of ACS without ST-segment elevation were randomly assigned to an early conservative strategy (284 cases) or early invasive strategy group (261 cases), who were enrolled consecutively from Oct., 2001 to Oct., 2003. The combined cardiovascular events (a combination of cardiac death, nonfatal myocardial infarction, nonfatal heart failure and hospital readmission due to recurrent ischemic angina) within 30 days and 6 months were analyzed and the effects of early invasive strategy on early and late outcomes in high-risk patients with increased TnI or hs-CRP levels were evaluated., Results: As compared with early conservative strategy, early invasive strategy lowered the rate of hospital readmission due to recurrent ischemic angina of 30 d and the combined cardiovascular events of 30 d and 6 months (all P < 0.05). Subgroup analysis indicated early invasive strategy could significantly decrease the incidences of the combined cardiovascular events of 30 d and 6 months and the hard end point events of 6 months in patients with increased TnI or hs-CRP levels (all P < 0.01), but no such changes could be seen in patients with normal TnI or hs-CRP levels, as compared with early conservative strategy., Conclusions: Early invasive strategy decreases significantly cardiovascular events and improves the early and late outcomes in high-risk patients with increased TnI or hs-CRP levels.

Objective: To investigate the predictive value of positive troponin I (TnI) on early prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS), and to evaluate TnI as a predictor of risk for the combined end points of cardiac events in NSTE ACS., Methods: 545 patients with non-ST-elevation acute coronary syndrome were double-blind randomly enrolled in two groups of study, receiving invasive or noninvasive treatment, respectively. At admission, all patients' baseline levels of TnI and CK-MB were determined and related to outcome at 30th day and 6th month of follow-up. Aspirin, beta-blocker, ACEI and LWMH were given depending on patients' clinical condition., Results: After a follow up of 6 months, hospitalization because of recurrent angina pectoris and combined end points of cardiac events in TnI positive patients occurred much more as compared with that in the TnI negative patients and the prognosis improved with early invasive interventional treatment strategy in the TnI positive patients (P < 0.01) at 30th day and 6th month. For TnI negative patients, there was no difference between the two groups whether invasive or non-invasive therapy was given., Conclusions: There is high recurrence rate of angina pectoris and increased number of combined end points of cardiac events in positive TnI patients during follow-up period. TnI served as an important risk factor in NSTE ACS patients and active early invasive intervention therapy should be the first choice for TnI positive patients, but it makes no more benefits for TnI negative patients.

Objective: To evaluate the predicting values of thrombolysis in myocardial infarction (TIMI) risk scoring system for long-term prognosis in patients with ST segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI)., Methods: Eight clinical variables and their relative value of score derived from TIMI risk scoring system were used to determine individual's risk score. The patients with STEMI were evaluated during the period of in-hospital and followed-up at a mean of (23.9 +/- 3.8) months for major adverse cardiovascular events (MACE), including nonfatal heart failure, nonfatal re-infarction, target vessel revascularization and cardiac mortality and the predicting value of TIMI risk scores at hospital admission for total MACE were analyzed., Results: Out of 373 patients with STEMI referred for primary PCI, 89 patients were presented with MACE during the period of follow-up (average incidence: 23.9%). The presentation of the total MACE increased progressively with the rising TIMI risk scores (P < 0.05 for trends in increase of MACE). The incidence of total MACE in patients with a score > or = 8 was 9 times those with a score 0. The incidence of cardiac mortality was higher (25% vs 0, P < 0.01) and the combined incidence of cardiac mortality and nonfatal re-infarction also increased significantly (36.7% vs 2.6%, P < 0.01) in patients with a score > or = 6 than in those with a score < 6 respectively. The risk of adverse cardiovascular events increased with rising in TIMI risk scores in patients with either high or normal TnI level., Conclusions: The higher the TIMI risk score at admission, the worse the prognosis. This TIMI risk scoring system is likely to be a simple and practical tool at the bedside in quantitative risk evaluation and long-term prognosis prediction in patients with STEMI referred for primary PCI.

Objective: The purpose of the study is to prospectively investigate the safety and efficacy of anticoagulation with enoxaparin (Clexane) in UA/NQMI patients undergoing PCI procedures., Methods: UA/NQMI patients received Clexane 1 mg/kg, subcutaneously, q12h for at least 48 hours, the coronary angiography was immediately followed by PCI when indicated and is performed within 8 h after the morning injection. No additional UFH or LMWH was used during or after PCI. Blood samples were taken for further measurement of the anti-Xa activity in 176 patients., Results: 507 UA/NQMI patients were included in the study. 176 patients (93.2%) of the average anti-Xa activity value was > 0.5 IU/ml. During follow-up within 30 days, 3.2% of the patients experienced AMI and 6.7% of the patients recurrent UAP. One patient (0.2%) received revascularization and another died of duodenum perforation. The rate of minor hemorrhage was 4.7% (24 patients). In 30-days follow up, one experienced NQMI and 1 recurrent UA among angiography patients., Conclusion: Subcutaneous Enoxaparin given at least for 48 hours before PCI with out additional UFH or LMWH during or after PCI was both safe and effective in high risk UA/NQMI patients.