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Objective: To assess plasma renin activity (PRA) of renal veins in patients with unilateral renal artery atherosclerotic stenosis and its relationship with blood pressure changes after renal artery stenting., Methods: Fifty patients with significantly unilateral renal artery stenosis (lumen loss > or = 70%) and coronary artery stenosis were included. Bilateral renal vein and peripheral PRA and angiotensin II were determined and their relations with blood pressure changes after stenting were analyzed., Results: All patients were revascularized successfully for both coronary and renal artery stenosis. PRA in the ischemic kidney was significantly higher than that in the contralateral kidney (1.44 +/- 1.73 ng.ml(-1).h(-1) vs 1.27 +/- 1.57 ng.ml(-1).h(-1), P = 0.04). Ischemic and contralateral renal vein renin ratio (RVRR) was > or = 1.5 in 14 patients (28%) (renal vascular hypertension, RVH group). During follow-up (12 +/- 9 months), blood pressure returned to normal in 9 patients after revascularization, 7 were of RVH group (50%) and 2 were in control group (6%) (P < 0.001). Multivariate logistic analysis indicated RVRR > or = 1.5 was significantly related to the decrease of hypertension after renal artery stenting (OR = 3.15, 95% CI = 1.49 approximately 5.97, P = 0.02)., Conclusions: PRA was significantly increased in the ischemic kidney in about one-third of patients with unilateral renal artery stenosis. Hypertension could be controlled easily to normal value after renal artery stenting in half of the patients with RVRR > or = 1.5. Measurement of renal vein renin activity in patients with renal artery stenosis is very useful in evaluating the effects of renal artery stenting on hypertension.

Objective: To analyse the impact of sirolimus-eluting stents (SES) on long-term outcomes in patients with coronary artery disease (CAD) and diabetes., Methods: Among 1004 patients with CAD undergone percutaneous coronary intervention (PCI), 84 diabetic and 250 non-diabetic patients received SES, 168 diabetic and 502 non-diabetic patients had bare metal stent (BMS) implantation. Baseline clinical characteristics, interventional procedures (coronary angiography and PCI), occurrence of major adverse cardiac events (MACE), and MACE-free survival rates at one year during follow-up were compared., Results: During follow-up (average 16.2 months), patients (with and without diabetes mellitus) who received SES had similar occurrence of MACE (4.8% vs. 3.6%, P = 0.744) and MACE-free survival rates at one year (95.0% vs. 96.7%, P = 0.602). However those received BMS had a higher occurrence of MACE in diabetes mellitus than that in non-diabetic patients (31.0% vs. 21.7%, P = 0.015). MACE-free survival rate at one year was lower in diabetic patients with BMS than that in non-diabetic patients with BMS (74.2% vs. 86.8%, P = 0.001)., Conclusion: Implantation of sirolimus-eluting stents may reduce the major adverse cardiac events and the frequency of repeat intervention in patients with diabetes mellitus.

Objective: To investigate whether the number of circulating endothelial progenitor cells (EPCs) correlate with the severity of coronary stenosis in patients with stable coronary artery disease (CAD)., Methods: 80 consecutive patients who underwent coronary angiography (exclusion of acute coronary syndrome and myocardial infarction) were enrolled. Physical examination and blood tests were performed to assess the disease severity and cardiovascular risk factors. Circulating EPCs as measured by the number of CD133/KDR double positive cells were detected by FACS., Results: The number of EPCs inversely correlated with age, creatinine clearance (Ccr) and left ventricular mass index (LVMI) (P = 0.004, 0.015, 0.014 respectively). Patients with hypertension showed significant reduction in number of EPCs compared to those without hypertension (P = 0.004). Moreover, the number of EPCs in patients with coronary artery disease was significantly lower than that of those with normal coronary artery (P < 0.01). EPCs also inversely correlated with angiographic Gensini score (n = 49, r = -0.305, P = 0.039)., Conclusions: In patients with stable CAD, the numbers of circulating EPCs correlate with the severity of CAD as well as cardiovascular risk factors.

Objective: To observe the long-term outcomes following coronary stenting in diabetic patients with coronary artery disease., Methods: This cohort study comprised 808 consecutive patients with coronary artery disease who underwent elective coronary stenting, including 174 diabetic patients and 634 non-diabetic patients. The long-term follow-up outcomes were compared., Results: Procedural success rate was similar (96.0% vs 96.1%). Follow-up rate was 95.3%. Mean follow-up duration was (19 +/- 7.8) months (ranged from 6 to 42 months). Compared with non-diabetic patients, diabetic patients had less improvement of cardiac function (52.2% vs 61.0%), more re-admission (42.7% vs 32.5%), and higher occurrence rates of major adverse cardiac events (30.6% vs 22.2%), angiographic restenosis rate (19.1% vs 12.5%) and mortality (10.2% vs 4.6%). Logistic regression analysis indicated that diabetes mellitus was an independent predicator of death (odd ratio 2.20, 95% CI 1.12 approximately 4.33, P = 0.022) and restenosis (odd ratio 1.66, 95% CI 1.04 approximately 2.67, P = 0.035)., Conclusion: Diabetic patients undergoing elective coronary stenting have acceptable long-term outcomes, but diabetes mellitus is still independently associated with worse late prognosis.

Objective: To evaluate the immediate and mid-term efficacy of coronary stenting in patients with acute coronary syndrome (ACS) and renal dysfunction., Methods: Sixty-three ACS patients with renal dysfunction were included (RD group) and 63 contemporaneous ACS patients with normal renal function served as a control group. The clinical characteristics, stenting procedure and follow-up information were compared between the two groups., Results: Patients in the RD group had higher basic serum creatinine levels [(177 +/- 31) micro mol/L vs (98 +/- 21) micro mol/L, P < 0.001], lower left ventricular ejection fraction (0.45 +/- 0.10 vs 0.50 +/- 0.09, P < 0.05) and increased prevalence of multivessel coronary artery disease (84% vs 65%, P < 0.05) as well as > 50% renal artery stenosis (27% vs 8%, P < 0.05). There was no statistical difference in procedural success rate and major adverse cardiac events occurrence during a mean follow up time of 27 months (13% vs 8%, P = 0.38). In the RD group, the mean level of serum creatinine was significantly decreased [(177 +/- 31) micro mol/L vs (147 +/- 11) micro mol/L, P < 0.05] and 9 (69%) patients with renal artery stent implantation had normal creatinine levels during follow-up., Conclusions: Coronary stenting is a safe and effective therapy for ACS patients complicated with renal dysfunction, two thirds of patients receiving renal stent implantation had normal serum creatinine during follow-up.

Objective: To evaluate the urine microglobulin change after interventional therapy in patients with renal artery stenosis., Methods: According to the results of renal artery angiography, 69 consecutive patients with coronary heart disease were divided into 2 groups, including 44 patients with severe renal artery stenosis RAS (luminal narrowing > 70%, group I) and 25 patients with atherosclerotic lesion in renal artery (luminal narrowing > 50% but < 70%, group II). The urine alpha(1), beta(2)-microglobulin (alpha(1), beta(2)-MG) were measured respectively. The successful procedural rates, rates of complication, serum creatitine and the urine alpha(1), beta(2)-MG 3 months after procedure were also recorded. The acute results and long-term follow-up outcomes were compared between the 2 groups., Results: Urine alpha(1)-MG [(5.2 +/- 2.5) microg/L vs (3.0 +/- 2.7) microg/L, P > 0.001] and beta(2)-MG [(377 +/- 173) microg/L vs (202 +/- 184) microg/L, P > 0.001] were significantly higher in group I than in group II. However, the urine alpha(1)-MG of the 2 groups did not exceed the normal range (<6 microg/L). The urine beta(2)-MG [(237 +/- 187) microg/L vs (377 +/- 173) microg/L, P > 0.01] 3 months after stenting procedure in group I were significantly decreased. There were no significance change in urine alpha(1)-MG in group I and both the microglobulins in group II during follow-up. There was significant difference in improvement of blood pressure between the 2 groups (62.5% vs 9.1%, P > 0.01). As compared with group II, group I patients had more re-admission (22.5% vs 9.1%), renal failure (5% vs 0) and higher mortality (5% vs 0). However, these measurements did not differ significantly. Multivariate analysis revealed that persistent elevation of urine beta(2)-MG was an independent predictor of severe events (including re-admission and renal failure) after renal artery stenting (OR = 3.01, 95% CI 1.01 - 8.95, P = 0.036)., Conclusions: Severe RAS causes damage of tubular reabsorption. Renal artery stenting improves tubular function, but in patients with persistent elevation of beta(2)-MG, the rates of re-admission and renal failure remain high.