Changyan Wu

Duration of dual antiplatelet therapy after implantation of the first-generation and second-generation drug-eluting stents.

ObjectiveThis study was carried out to determine the effect of the use of dual antiplatelet therapy (DAPT) for more than 12 months on long-term clinical outcomes in patients who had undergone a percutaneous coronary intervention with the first and second generations of drug-eluting stents (DES). BackgroundThe potential benefits of the use of DAPT beyond a 12-month period in patients receiving DES have not been established clearly. Moreover, it is also unclear whether the optimal duration of DAPT is similar for all DES types. MethodsA total of 2141 patients with coronary artery disease treated exclusively with Cypher sirolimus-eluting stents (SES) or Endeavor zotarolimus-eluting stents (ZES) were considered for retrospective analysis. The primary endpoint [a composite of all-cause mortality, nonfatal myocardial infarction (MI), and stroke] was compared between the 12-month DAPT and the >12-month DAPT group. ResultsA total of 1870 event-free patients on DAPT at 12 months were identified. The average follow-up was 28.2±7.4 months. The primary outcomes were similar between the two groups (4.1% 12-month DAPT vs. 1.9% >12-month DAPT; P=0.090). Incidences of death, MI, stroke, and target vessel revascularization did not differ significantly between the two groups. Subgroup analysis showed that in the patients with hypertension, >12-month DAPT significantly reduced the occurrence of death/MI/stroke compared with that in the 12-month DAPT group (P=0.04). In patients implanted with SES, the primary outcome was significantly lower with the >12-month DAPT group (5.2% 12-month DAPT vs. 1.6% >12-month DAPT; P=0.016), whereas in patients with ZES, the primary outcome was comparable between the two groups (2.3% 12-month DAPT vs. 2.0% >12-month DAPT; P=0.99). ConclusionIn our study, for all patients, >12-month DAPT in patients who had received DES was not significantly more effective than 12-month DAPT in reducing the rate of death/MI/stroke. Our findings, that patients who received SES benefit from >12-month DAPT whereas extended use of DAPT was not significantly more effective in those implanted with ZES, implied that the optimal duration of DAPT was different depending on different types of DES.

Circulating endothelial microparticles and miR-92a in acute myocardial infarction

Microparticles (MPs) and miRNAs have been shown to play important roles in coronary artery disease (CAD) by monitoring endothelial dysfunction. The present study aims to investigate the diagnostic value of endothelial MPs (EMPs) and miRNAs (miR-92a or miR-23a) as biomarkers in distinguishing patients with acute myocardial infarction (AMI) from those with CAD. Plasma samples from 37 patients with AMI, 42 patients with stable CAD (SCAD), and 35 healthy adults were collected for investigation in the present study. The numbers of CD31+/CD42b− MPs, CD31+/CD42b+ MPs, and CD31−/CD42b− MPs were measured by flow cytometry and the levels of miR-92a and miR-23a were analyzed using reverse transcription-quantitative PCR. Moreover, cardiac troponin I (cTnI) expression was detected by ELISA to serve as a routine diagnostic parameter. The number of CD31+/CD42b− was higher in AMI group than those in SCAD and healthy groups. Besides, the expression of miR-92a was higher in AMI group compared with two other groups. Furthermore, evidence showed that there was a positive correlation between the levels of CD31+/CD42b− MPs and miR-92a. Finally, the receiver operating characteristic (ROC) curve revealed that the area value under the curve of CD31+/CD42b− MPs, miR-92a and cTnI was 0.893, 0.888, and 0.912 respectively. CD31+/CD42b− MPs and miR-92a might have great potential to provide diagnostic value for AMI and could probably regulate the endothelial dysfunction in AMI patients.

Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease

Background:There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events. Methods:All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results:Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group. Conclusions:During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.

The relationship between revascularization extent and the long-term prognosis of patients with stable angina pectoris and three-vessel disease treated by percutaneous coronary intervention in the era of drug-eluting stents.

The effects of revascularization extent (RE) on the long‐term prognosis of patients with stable angina pectoris and 3‐vessel disease who underwent percutaneous coronary intervention were unknown.

Impact of mean platelet aggregation degree on long-term clinical outcomes among patients undergoing a complex percutaneous coronary intervention.

Objective The aim of this study was to evaluate the association between the mean platelet aggregation degree and long-term clinical outcomes in patients receiving a complex percutaneous coronary intervention (CPCI). Patients and methods We screened 2141 patients after a percutaneous coronary intervention (PCI) treated with aspirin and clopidogrel. CPCI was defined as a procedure targeted to at least one of the following: left main disease, bifurcation lesion, ostial lesion, chronic total occlusion, and small-vessel stenting. ADP-induced platelet aggregation was serially measured by light transmission aggregometry at least three times after PCI and the mean value was calculated. The population was categorized on the basis of the mean ADP degree and the presence of CPCI. The primary endpoint measured was a major adverse cardiovascular and cerebral event (MACCE). Results A total of 1245 patients enrolled in the study were divided into four groups: group A (CPCI and ADP≥40%), group B (CPCI and ADP<40%), group C (non-CPCI and ADP≥40%), and group D (non-CPCI and ADP<40%). The median follow-up was 29.9 months. The Cox multivariate analysis suggested that group A was an independent risk factor for MACCE (hazard ratio: 2.70, 95% confidence interval: 1.25–5.81; P<0.001). Compared with group A, the remaining groups (groups B, C, and D) had a lower rate of MACCE. When group C was set as the reference, groups B and D had similar risks for primary endpoints. Conclusion Patients undergoing CPCI with a high mean ADP degree are at a high risk for MACCE. Serial platelet function testing is therefore important in patients receiving CPCI.

Unprotected left main coronary artery disease after revascularization : effect of diabetes on patient outcomes.

ObjectiveIt is unknown whether the effect of diabetes on patients with unprotected left main coronary artery (LMCA) disease differs according to the different revascularization strategies. This study was conducted to evaluate the impact of diabetes on patients with unprotected LMCA disease treated with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).Patients and methodsWe prospectively enrolled 823 consecutive patients with unprotected LMCA disease who had drug-eluting stent (DES; n = 331) implantation or underwent CABG (n = 492) in the study. We compared the effects of diabetes on clinical outcomes according to different revascularization strategies.ResultsAmong 823 eligible patients enrolled, 226 had diabetes. In the DES population, no significant differences were observed in occurrences of death, cardiac death, repeat revascularization, stroke, and major adverse cardiac and cerebrovascular events. However, the risks of the composite of death/myocardial infarction (MI)/stroke (21.5 % DM vs. 7.2 % non-DM; p = 0.001) and MI (15.4 % DM vs. 1.6 % non-DM; p = 0.000) were significantly higher in the diabetic patients than those without diabetes. In the CABG population, similar rates of all clinical endpoints were observed between the diabetic and nondiabetic group.ConclusionDiabetes was associated with worse outcome in patients undergoing DES implantation for the treatment of unprotected LMCA disease. However, its negative prognostic impact was not found among patients undergoing CABG.ZusammenfassungZielOb sich die Auswirkungen eines Diabetes mellitus auf Patienten mit koronarer Herzkrankheit (KHK) des ungeschützten Hauptstamms (LMCA) bei verschiedenen Revaskularisierungsstrategien unterscheiden, ist nicht bekannt. Die vorliegende Studie wurde durchgeführt, um den Einfluss eines Diabetes auf Patienten mit KHK des ungeschützten LMCA zu untersuchen, die entweder mittels perkutaner Koronarintervention (PCI) oder mit einem Koronarbypass (CABG) behandelt wurden.MethodenAn der Studie nahmen 823 konsekutive Patienten mit KHK des ungeschützten LMCA teil, bei denen die Versorgung mit der Implantation von medikamentenfreisetzenden Stents (DES, n = 331) oder einem CABG (n = 492) erfolgte. Es wurden die Auswirkungen eines Diabetes auf klinische Ergebnisse in Abhängigkeit von den verschiedenen Revaskularisierungsstrategien verglichen.ErgebnisseVon 823 für die Studie geeigneten Patienten wiesen 226 einen Diabetes mellitus (DM) auf. In der DES-Gruppe wurden keine signifikanten Unterschiede hinsichtlich des Auftretens von Todesfällen, Herztod, wiederholter Revaskularisierung, Schlaganfall und schweren unerwünschten kardialen und zerebrovaskulären Ereignissen (MACCE) beobachtet. Allerdings war das Risiko für den zusammengesetzten Endpunkt aus Tod/Herzinfarkt/Schlaganfall (21,5 % DM vs. 7,2 % ohne DM; p = 0,001) und Herzinfarkt (15,4 % DM vs. 1,6 % ohne DM; p = 0,000) bei Patienten mit Diabetes signifikant höher als bei Patienten ohne. In der CABG-Gruppe wurden ähnliche Raten aller klinischen Endpunkte für die Gruppen mit und ohne Diabetes beobachtet.SchlussfolgerungEin Diabetes mellitus stand mit einem schlechteren Ergebnis bei Patienten mit DES-Implantation zur Therapie einer KHK des ungeschützten LMCA in Zusammenhang. Jedoch war der negative prognostische Einfluss des Diabetes nicht bei Patienten mit CABG festzustellen.

Unprotected left main coronary artery disease after revascularization@@@Koronare Herzkrankheit des ungeschützten linken Hauptstamms nach Revaskularisierung: Effect of diabetes on patient outcomes@@@Einfluss von Diabetes mellitus auf das Ergebnis für den Patienten

ObjectiveIt is unknown whether the effect of diabetes on patients with unprotected left main coronary artery (LMCA) disease differs according to the different revascularization strategies. This study was conducted to evaluate the impact of diabetes on patients with unprotected LMCA disease treated with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).Patients and methodsWe prospectively enrolled 823 consecutive patients with unprotected LMCA disease who had drug-eluting stent (DES; n = 331) implantation or underwent CABG (n = 492) in the study. We compared the effects of diabetes on clinical outcomes according to different revascularization strategies.ResultsAmong 823 eligible patients enrolled, 226 had diabetes. In the DES population, no significant differences were observed in occurrences of death, cardiac death, repeat revascularization, stroke, and major adverse cardiac and cerebrovascular events. However, the risks of the composite of death/myocardial infarction (MI)/stroke (21.5 % DM vs. 7.2 % non-DM; p = 0.001) and MI (15.4 % DM vs. 1.6 % non-DM; p = 0.000) were significantly higher in the diabetic patients than those without diabetes. In the CABG population, similar rates of all clinical endpoints were observed between the diabetic and nondiabetic group.ConclusionDiabetes was associated with worse outcome in patients undergoing DES implantation for the treatment of unprotected LMCA disease. However, its negative prognostic impact was not found among patients undergoing CABG.ZusammenfassungZielOb sich die Auswirkungen eines Diabetes mellitus auf Patienten mit koronarer Herzkrankheit (KHK) des ungeschützten Hauptstamms (LMCA) bei verschiedenen Revaskularisierungsstrategien unterscheiden, ist nicht bekannt. Die vorliegende Studie wurde durchgeführt, um den Einfluss eines Diabetes auf Patienten mit KHK des ungeschützten LMCA zu untersuchen, die entweder mittels perkutaner Koronarintervention (PCI) oder mit einem Koronarbypass (CABG) behandelt wurden.MethodenAn der Studie nahmen 823 konsekutive Patienten mit KHK des ungeschützten LMCA teil, bei denen die Versorgung mit der Implantation von medikamentenfreisetzenden Stents (DES, n = 331) oder einem CABG (n = 492) erfolgte. Es wurden die Auswirkungen eines Diabetes auf klinische Ergebnisse in Abhängigkeit von den verschiedenen Revaskularisierungsstrategien verglichen.ErgebnisseVon 823 für die Studie geeigneten Patienten wiesen 226 einen Diabetes mellitus (DM) auf. In der DES-Gruppe wurden keine signifikanten Unterschiede hinsichtlich des Auftretens von Todesfällen, Herztod, wiederholter Revaskularisierung, Schlaganfall und schweren unerwünschten kardialen und zerebrovaskulären Ereignissen (MACCE) beobachtet. Allerdings war das Risiko für den zusammengesetzten Endpunkt aus Tod/Herzinfarkt/Schlaganfall (21,5 % DM vs. 7,2 % ohne DM; p = 0,001) und Herzinfarkt (15,4 % DM vs. 1,6 % ohne DM; p = 0,000) bei Patienten mit Diabetes signifikant höher als bei Patienten ohne. In der CABG-Gruppe wurden ähnliche Raten aller klinischen Endpunkte für die Gruppen mit und ohne Diabetes beobachtet.SchlussfolgerungEin Diabetes mellitus stand mit einem schlechteren Ergebnis bei Patienten mit DES-Implantation zur Therapie einer KHK des ungeschützten LMCA in Zusammenhang. Jedoch war der negative prognostische Einfluss des Diabetes nicht bei Patienten mit CABG festzustellen.

Predictive Ability of the SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery Score II for Long-term Mortality in Patients with Three-vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention Treated with Second-generation Drug-eluting Stents

Background:The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score II (SS-II) can well predict 4-year mortality in patients with complex coronary artery disease (CAD), and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention (PCI). However, there is lack of data regarding the utility of the SS-II in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents (DES). The purpose of the present study was to evaluate the ability of the SS-II to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES. Methods:Totally, 573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied. According to the tertiles of the SS-II, the patients were divided into three groups: The lowest SS-II tertile (SS-II ⩽20), intermediate SS-II tertile (SS-II of 21–31), and the highest SS-II tertile (SS-II ≥32). The survival curves of the different groups were estimated by the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-II and 5-year mortality. The performance of the SS-II with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic (ROC) curve. The predictive ability of the SS-II for 5-year mortality was evaluated and compared with the SS alone. Results:The overall SS-II was 27.6 ± 9.0. Among patients in the lowest, intermediate and the highest SS-II tertiles, the 5-year rates of mortality were 1.6%, 3.2%, and 8.6%, respectively (P = 0.003); the cardiac mortality rates were 0.5%, 1.9%, and 5.2%, respectively (P = 0.014). By multivariable analysis, adjusting for the potential confounders, the SS-II was an independent predictor of 5-year mortality (hazard ratio: 2.45, 95% confidence interval: 1.38–4.36; P = 0.002). The SS-II demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone (the area under the ROC curve was 0.705 and 0.598, respectively). Conclusion:The SS-II is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES, and demonstrates a superior predictive ability over the SS alone.

Unprotected left main coronary artery disease after revascularization

ObjectiveIt is unknown whether the effect of diabetes on patients with unprotected left main coronary artery (LMCA) disease differs according to the different revascularization strategies. This study was conducted to evaluate the impact of diabetes on patients with unprotected LMCA disease treated with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).Patients and methodsWe prospectively enrolled 823 consecutive patients with unprotected LMCA disease who had drug-eluting stent (DES; n = 331) implantation or underwent CABG (n = 492) in the study. We compared the effects of diabetes on clinical outcomes according to different revascularization strategies.ResultsAmong 823 eligible patients enrolled, 226 had diabetes. In the DES population, no significant differences were observed in occurrences of death, cardiac death, repeat revascularization, stroke, and major adverse cardiac and cerebrovascular events. However, the risks of the composite of death/myocardial infarction (MI)/stroke (21.5 % DM vs. 7.2 % non-DM; p = 0.001) and MI (15.4 % DM vs. 1.6 % non-DM; p = 0.000) were significantly higher in the diabetic patients than those without diabetes. In the CABG population, similar rates of all clinical endpoints were observed between the diabetic and nondiabetic group.ConclusionDiabetes was associated with worse outcome in patients undergoing DES implantation for the treatment of unprotected LMCA disease. However, its negative prognostic impact was not found among patients undergoing CABG.ZusammenfassungZielOb sich die Auswirkungen eines Diabetes mellitus auf Patienten mit koronarer Herzkrankheit (KHK) des ungeschützten Hauptstamms (LMCA) bei verschiedenen Revaskularisierungsstrategien unterscheiden, ist nicht bekannt. Die vorliegende Studie wurde durchgeführt, um den Einfluss eines Diabetes auf Patienten mit KHK des ungeschützten LMCA zu untersuchen, die entweder mittels perkutaner Koronarintervention (PCI) oder mit einem Koronarbypass (CABG) behandelt wurden.MethodenAn der Studie nahmen 823 konsekutive Patienten mit KHK des ungeschützten LMCA teil, bei denen die Versorgung mit der Implantation von medikamentenfreisetzenden Stents (DES, n = 331) oder einem CABG (n = 492) erfolgte. Es wurden die Auswirkungen eines Diabetes auf klinische Ergebnisse in Abhängigkeit von den verschiedenen Revaskularisierungsstrategien verglichen.ErgebnisseVon 823 für die Studie geeigneten Patienten wiesen 226 einen Diabetes mellitus (DM) auf. In der DES-Gruppe wurden keine signifikanten Unterschiede hinsichtlich des Auftretens von Todesfällen, Herztod, wiederholter Revaskularisierung, Schlaganfall und schweren unerwünschten kardialen und zerebrovaskulären Ereignissen (MACCE) beobachtet. Allerdings war das Risiko für den zusammengesetzten Endpunkt aus Tod/Herzinfarkt/Schlaganfall (21,5 % DM vs. 7,2 % ohne DM; p = 0,001) und Herzinfarkt (15,4 % DM vs. 1,6 % ohne DM; p = 0,000) bei Patienten mit Diabetes signifikant höher als bei Patienten ohne. In der CABG-Gruppe wurden ähnliche Raten aller klinischen Endpunkte für die Gruppen mit und ohne Diabetes beobachtet.SchlussfolgerungEin Diabetes mellitus stand mit einem schlechteren Ergebnis bei Patienten mit DES-Implantation zur Therapie einer KHK des ungeschützten LMCA in Zusammenhang. Jedoch war der negative prognostische Einfluss des Diabetes nicht bei Patienten mit CABG festzustellen.