Gao Runlin

The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry

Background Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population. Methods Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups. Results Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not. Conclusions Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.

e0284 Intravascular ultrasound (IVUS) characteristics of premature coronary heart disease (CHD) patients with different risk factors

Objectives To observe lesion characteristics of premature coronary heart disease (CHD) patients with different risk factors by intravascular ultrasound (IVUS). Methods Among 114 premature CHD patients examined by IVUS, quantitative method and qualitative method were adopted to analyse characteristics of coronary artery plaques, and to observe the proportion of different plaques, cross-sectional areas (CSA) surrounded by external elastic membrane, lumen CSA, plaque burden, lumen area stenosis rate and remodelling index of patients with different risk factors. Results Among the CHD patients with traditional risk factors, there is no statistical difference except in lesion extent and minimum lumen diameter among those CHD patients with hypertension. The lesions are serious and higher ratio of lipid core to plaque among those CHD patients with diabetes. More soft plaques and mixed plaques are observed among those CHD patients with hyperlipidaemia. Lesion length and the ratio of lipid core to plaque were significant difference between premature CHD patients with hyperlipidaemia and control groups. There is no difference on lesion characteristics detected by IVUS between patients with and without family history of CHD. There are more soft plaques and mixed plaques in the premature CHD patients in current smoking group (the p value were <0.05). The lesions were more serious in current smoking patients than those without smoking patients. There were more ruptured plaques in diabetes group. Positive remodelling is a common phenomenon in diabetes group, while more negative remodelling were observed in other groups. Conclusions The ratio of lipid core to plaque tends to be higher in group with risk factors than that in group without risk factors. More ruptured plaques were observed among those CHD patients with diabetes. Therefore, these risk factors should be strictly controlled in primary prevention of CHD.

e0354 Angiographic characteristics of premature coronary heart disease—analyses of single center

Background There are no large-sample published reports prospectively or consecutively assessing the angiographic characteristics of premature coronary heart disease in China. Objectives The present study was carried out to collect and analyse the clinical and angiographic characteristics in a single center. Methods From April 2004 to April 2008, based on the screening condition of male <55 years and female (<65 years), we selected premature coronary heart disease from a dedicated database of coronary angioplasty registry of the Center for Diagnosis & Treatment of Coronary Artery Disease, Fuwai Hospital. They had been subjected to coronary angiogram due to the angina pectoris or asymptomatic myocardial ischaemia in coronary heart disease. Results 4478 consecutive patients (3056 males, 1422 females), average age was (49.9±7.0) years, were defined as coronary heart disease according to clinical manifestation and coronary angiogram. Patients with unstable angina pectoris (UAP), stable angina pectoris (SAP) and without angina pectoris were 2400, 1534 and 544, respectively. The proportion of coronary heart disease, hypertension, hyperlipidaemia, diabetic mellitus (DM), smoking history, prior myocardial infarction (MI), prior percutaneous intervention (PCI), coronary artery bypass graft and history of cerebrovascular diseases were 6.7%, 53.0%, 35.3%, 20.8%, 90.3%, 43.3%, 16.6%, 1.5%, 1.1%, respectively. The ratio of eccentric lesions, concentric lesions, chronic total occlusion lesions (CTO) and calcified lesions were 93.7%, 23% and 42.8%, respectively. Comparison between UAP and SAP, there was more MI, PCI, complex lesions (B2+C), eccentric lesions and calcium lesions among 3934 patients. There were more MI, PCI, DM, hyperlipidaemia, hypertension, cerebrovascular diseases, smoking, eccentric lesions complex lesions, angulated lesions and calcified lesions in male than that in female (all p<0.05). Conclusions The ratio of sex and clinical findings are different in Chinese Premature coronary heart patients. There were more MI, PCI, complex lesions, eccentric lesions and calcified lesions in UAP group, comparison between sexes, there were higher incidences of hypertension, hyperlipidaemia, cerebrovascular disease and smoking history in male.

e0426 Proteomic analysis of plasma from patients with acute coronary syndrome

Background Proteomics is the new system biological approach to the study of proteins and protein variation on a large scale as a result of biological processes which can identificate several proteins at a given time in a sample. Proteomic analysis has provided important insights into ischaemic heart disease, heart failure, and cardiovascular pathophysiology. Blood represents one of the most accessible sources for biomarkers and has broad clinical significance. Serum or plasma samples provide an excellent source of materials for proteomic analysis. Objectives The aim of this study was to seek the special plasma molecule in the plasma protein map from the patient with acute coronary syndrome (ACS) using proteomics. Methods Plasma from 60 patients, 20 with acute myocardial infarction (AMI) and 20 with unstable angina (UA), was investigated. The control group included 20 age-matched volunteers. 2-DE-DIGE/MALDI-TOF- MS analysis was performed during the procedure. The optimal abundant proteins in plasma were removed with the polyclonal antibody affinity column. Results With 2DE-DIGE/MALDI-TOF-MS analysis, 14 different expression proteins were found in plasma of patients with ACS. (1) As compared with the control, serum amyloid A2, CP20 kDa protein, alpha-1 antitrypsin, haptoglobin beta and alpha-2chain, C6 precursor and C4, fibrinogen gammar chain and fibrin beta were up-regulated in plasma from UA and AMI patients. (2) Meanwhile, apolipoprotein A-I, A-IV and A-IV precursor, TF 11 and 7 kDa protein, transthyretin, gelsolin and gelsolin precursor isoform 1, myosin-11, HBB Truncated beta-globin were down-regulated in plasma from ACS patients. (3) Moreover, ELISA analysis showed that SAA was up-regulated and gelsolin was down-regulated in the plasma of UAP and AMI. Conclusions Various proteins involving in acute phase protein, complement system, and cytoskeleton, apolipoprotein, energy metabolism were participated in the procession of ACS. The newly discovered different proteins, serum amyloid A2 and gelsolin might be the special molecules for ACS. But further investigation should be carrying out in the future.

e0496 Comparative study of impaired with normal left ventricle function patients with triple coronary artery disease

Background Ischaemic cardiomyopathy is one of the fatal courses of coronary heart disease, its clinical characteristics and percutaneous coronary intervention (PCI) effect on it still need to be identified. Methods From April 2004 to April 2007, 4494 consecutive patients with triple coronary arteries disease identified by coronary angiogram (>70% stenosis of each vessel) in our center were divided into two groups according to left ventricle ejection fraction (LVEF) (N group: n=4129, LVEF>40%; L group: n=365, LVEF≤40%). Results Patients in L group was younger (60.6±9.72 vs 65.2±10.7 years; p<0.001). There was more previous myocardial infarction (MI) and diabetes and less hypertension and hyperlipidaemia in L group. Logistic regression analysis indicated that the age, previous MI, diabetes, previous PCI and hyperlipidaemia were independent indexes to left ventricle function of triple vessel disease. Eighty-three and 2301 patients in L and N group (22.7% and 55.7%, respectively) were treated with PCI. The follow-up period of L and N groups were 581±298 and 639±293 days, respectively. MACE rate was significantly high in L group (38.6% vs 18.9%; p<0.001), which was contributed by cardiac death, no fatal MI and TVR (9.6% vs 0.9%; p<0.001, 7.2% vs 2.0%; p<0.001 and 21.7% vs 16.0%; p=0.173, respectively). There was no difference of total stent thrombosis or its components in both groups (total: 3.9% vs 3.5%; p=1.000, early: 0.2% vs 0.9%; p=0.256, late: 0.7% vs 1.3%; p=0.404 and very late: 3.1% vs 1.3%; p=0.201, respectively). Seven month Angiographic follow-up indicated that both in-stent and in-segment restenosis rate were significantly higher in L group (21.0% vs 11.1%; p=0.034 and 24.0% vs 12.2%; p=0.018). Conclusion This one center, large sample study showed clinical characteristics of ischaemic cardiomyopathy, MI and diabetes might contribute to its morbidity, and PCI might prevent its morbidity. PCI of patients with triple coronary arteries disease and impaired left ventricle (LV) function leaded to worse outcomes when compared with normal LV function.