Guo Yonghe

Prolonged Dual Antiplatelet Therapy Improves Clinical Outcomes in High-risk Patients Implanted with Sirolimus-eluting Stents

Although a science advisory recommending 12 months of dual antiplatelet therapy after drug‐eluting stents implantation was published recently, the optimal duration of dual antiplatelet therapy has not yet been precisely determined.

Association between admission fasting plasma glucose and contrast-induced nephropathy in elderly acute myocardial infarction patients undergoing percutaneous coronary intervention

Background Despite numerous prior studies have established the association between admission randomised glucose levels and poor outcomes in patients with acute myocardial infarction (AMI), less is known regarding the correlation between the initial fasting plasma glucose (FPG) and contrast-induced nephropathy (CIN), especially in elderly AMI patients undergoing percutaneous coronary intervention (PCI). Objective The aim of this study was to assess the association between the initial FPG levels on admission and CIN in elderly patients with AMI. Methods From April 2004 to October 2006, 881 elderly patients (age ≥65 years) diagnosed with AMI undergoing PCI were enrolled in the Beijing Elderly Acute Myocardial Infarction Study (BEAMIS) consecutively. According to admission FPG levels, patients were categorised into four groups: hypoglycaemia group (N=187, 21.2%), FPG≤5 mmol/l; euglycemia group (N=412, 46.8%), FPG>5 to 7 mmol/l; mild hyperglycemia group (N=128, 14.5%), FPG>7 to 9 mmol/l; and severe hyperglycemia group (N=154, 17.5%), FPG>9 mmol/l. The primary end point was CIN, which was defined as an increase in serum creatinine >25% from baseline in the first 72 h. Results A total of 125 (14.2%) patients developed CIN. Patients with severe hyperglycemia had a onefold higher incidence of CIN than those with mild hyperglycemia (29.9% vs 14.1%, p=0.02), twofold higher incidence of CIN than those with euglycemia (29.9% vs 10.7%, p<0.001) and hypoglycemia (29.9% vs 9.1%, p<0.001). Hyperglycemia was an independent predictor of CIN. Conclusions In AMI patients undergoing PCI, hyperglycemia is associated with an increased risk for CIN.

e0508 Comparative analysis of different strategy for revascularization on effency in old woman diabetic patients with complex coronary disease

Objectives To evaluate and analysis the clinical efficacy and prognosis of two different strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and coronary artery bypass graft (CABG) in old woman diabetic patients with complex coronary disease. Background Elder, Female and Diabetic is markeble risk factor for poor prognosis after PCI and CABG. Which strategy of revascularization (PCI vs CABG) and the influence factor that could promote the choice of strategy for revascularization may be result in better outcome is uncertain in these patients. Further evaluations in adequately data are awaited to confirm the clinical benefit of two strategy. Methods 523 female patients whose age were above 75 years old with DM, multivessel disease underwent PCI (206) or CABG (317) were included studied. The choice of revascularization was dependent on clinical baseline and procedural characteristics of patients and/or physician recommendation. Major adverse cardiac events (MACE) included death, myocardial infarction and repeat coronary revascularization. Results MACE rates at 1 year is equivalent between CABG and PCI (2.1% vs 4.2% (OR 1.8; p>0.5). There was a similar risk of the combined endpoints of death (1.5% vs 2.8%), myocardial infarction (1.2% vs 1.6%) and cerebrovascular events (1.1% vs 2.3%) at 1 year, but the risk of target vessel revascularisation (TVR) was significantly higher (1.8% vs 7.8%, p<0.01). Compared with PCI patients, the lesions seem more complex. the prevalence of calcified lesions, total occlusion, collateral circulation were higher in CABG patients (p<0.01). The number of the diseased vessels was the only independent predictors of type of revascularization (PCI vs CABG). Conclusions PCI with DES placement was safe compared to CABG as a type of revascularization in elder female patients with DM and MVD at 1-year. A clinical strategy for revascularization by PCI or CABG should be carefully assessed.

e0510 Relation between clopidogrel resistance and inflammation facor in patients after coronary stenting

Objective To observe the serum levels of inflammatory cytokines in patients with clopidogrel resistance underwent PCI. Methods Platelet aggregation (PAG) induced with ADP were detected in 593 patients with unstable angina pectoris and had received coronary stenting. All patients were divided into clopidogrel resistance (CLR) group (n=333) and normal response group (n=260) according to PAG. At the same time, perpheral blood sample of all the patients were taken before, 24 h, 1 week and 1 month after implanting stents. The levels of C-reactive protein (CRP), P-selection and soluble fragment of CD40 ligand (sCD40L) in these patients were detected by enzyme linked immunosorbent assay. Results The incidence of clopidogrel resistance in 24 h, 1 week and 1 month after PCI was 35.5%, 26.9% and 19.3%. The levels of CRP (8.8±2.5 mg/dl at 24 h, 5.3±2.5 mg/dl at 1 week), P-selection (73.8±34 ng/ml at 24 h, 70.5±31.6 ng/ml at 1 week and 66.4±22.3 ng/ml at 1 month) and sCD40L (7.7±2.3 ng/ml at 24 h)had significant difference compared with the levels before and normal group (p<0.05). The CLR at 30 days after stent implanting was significantly correlated with the level of P-selection (r=1.334) and smoking (r=1.053). Conclusion The levels of CRP, P-selection and sCD40L of in some patient after undergoing coronary stenting increased and may correlated with clopidogrel resistance. The levels of P-selection and smoking were the predictor for clopidogrel resistance.

e0445 Admission hypoglycaemia and hyperglycaemia are associated with increased mortality in older patients with acute myocardial infarction

Objective The aim was 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 medical therapy, percutaneous coronary intervention and coronary artery bypass grafting. Methods From April 2004 to October 2006, 1854 older (age ≥65 years) AMI patients were enrolled in the Beijing Elderly Acute Myocardial Infarction Study (BEAMIS) consecutively. Patients were categorised into 4 groups: hypoglycemia group (N=443, 23.9%), FPG≤5 mmol/l; euglycemia group (N=812, 43.8%), 5.1 mmol/l≤ FPG≤7 mmol/l (5–7 mmol/l); mild hyperglycemia group (N=308, 16.6%), 7.1 mmol/l≤FPG≤9 mmol/l (7–9 mmol/l); and severe hyperglycemia group (N=291, 15.7%), FPG≥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 euglycemia group, hypo- or hyperglycemia 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 of 5–7 mmol/l may be desirable because it was associated with better clinical outcomes.

e0536 Comparative effects of percutaneous coronary intervention for culprit coronary artery or together with non-culprit coronary artery in patients with multi-vessel coronary artery disease

Background Rapid recanalisation of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI), but strategy for treatment of culprit and non-culprit lesions in multi-vessel coronary artery disease remains unclear. Objectives Aims to examine the 6-month outcomes for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) in multi-vessel coronary artery disease. Methods A total of 1120 patients treated with primary angioplasty between 2008 and 2009 were classified in groups of patients with multi-vessel coronary artery disease (MVD). We examined the associated 6 month outcomes following non-culprit interventions performed at the time of primary PCI. Patients were subdivided in two groups on the basis of the revascularization strategy: 1) patients undergoing PCI of the culprit coronary artery only; 2) patients undergoing PCI of both the culprit coronary artery and non-culprit coronary artery during the initial procedure. All the patients were followed up for 6-month for major adverse cardiac events (MACE). Results The two groups did not differ with respect to baseline clinical and angiographic characteristics. At 6-month, compared with PCI restricted to the culprit coronary artery only, multivessel PCI was associated with higher rates of re-infarction (7.9% vs 2.6%, p<0.001), revascularization (14.5% vs 6.8%, p<0.001), and MACEs (26.7% vs 14.8%, p<0.001). Conclusions Non-culprit coronary interventions were significantly associated with increased mortality. Our data suggest that in patients with MVD, primary PCI should be directed at the culprit coronary artery only, with decisions about PCI of non-culprit lesions guided by objective evidence of residual ischaemia at late follow-up. Further studies are needed to confirm these findings.

e0420 C-reactive protein for predicting clinical outcomes after drug-eluting stent implantation

Background Although C-reactive protein (CRP) has been proposed as a useful biomarker for predicting atherothrombosis, the association of CRP levels and clinical outcomes after drug-eluting stent (DES) implantation has not been defined. Objectives To assess the predictive value of CRP after drug-eluting stent (DES) implantation, especially the association of CRP levels with adverse clinical events, such as stent thrombosis, death, myocardial infarction (MI) and so on. Methods We evaluated 2048 consecutive patients who underwent successful DES implantation. The primary outcomes were stent thrombosis, death, myocardial infarction (MI), and target vessel revascularisation. Results After 2 years of follow-up, there were 11 stent thrombosis, 72 deaths, 113 MI, 133TVR. In multivariable Cox proportional-hazards models, the high CRP remained predictive of adverse cardiac events, elevated levels of CRP were significantly associated with increased risks of stent thrombosis (HR 4.08; 95% CI 1.91 to 11.44; p<0.001), death (HR 2.01; 95% CI 1.18 to 4.688; p=0.004), MI (HR 1.78; 95% CI 1.25 to 9.12; p=0.001), but not target vessel revascularisation (HR 1.20; 95% CI 0.59 to 1.16; p=0.62). Conclusions Elevated CRP levels were significantly associated with major coronary events after DES implantation, such as stent thrombosis, death, and MI, demonstrating the additive impacts of active inflammation and myocardial injury on prognosis after DES implantation.