Han Yaling

A randomised comparison of biodegradable polymer- and permanent polymer-coated platinum-chromium everolimus-eluting coronary stents in China: the EVOLVE China study

AIMS The EVOLVE China randomised study sought to evaluate the clinical safety and effectiveness of the SYNERGY bioabsorbable polymer-coated everolimus-eluting stent (EES) for the treatment of patients with coronary heart disease in China. METHODS AND RESULTS Eligible patients with de novo native coronary artery lesions were randomised (1:1) to receive the SYNERGY or PROMUS Element Plus stent. The primary endpoint was in-stent late loss at nine months. Secondary endpoints included death, MI, revascularisation, and stent thrombosis up to 12 months. A total of 412 subjects were randomised (205 SYNERGY; 207 PROMUS Element Plus) at 14 sites in China from October 2013 to July 2014. SYNERGY was non-inferior to PROMUS Element Plus for the primary endpoint of nine-month in-stent late loss: SYNERGY 0.20±0.33 mm vs. PROMUS Element Plus 0.17±0.38 mm with an upper one-sided 97.5% confidence interval of the difference (0.10 mm), significantly less than the non-inferiority margin (0.15 mm; p<0.0008). Clinical adverse event rates were low and not significantly different between groups at nine and 12 months (all p>0.05). CONCLUSIONS In the EVOLVE China trial, the SYNERGY bioabsorbable polymer-coated EES was noninferior to the PROMUS Element Plus permanent polymer-coated EES for the primary endpoint of late loss at nine months.

Influence of distal extension of false lumen on adverse aortic events after TEVAR in patients with acute type B aortic dissection.

OBJECTIVE To investigate the clinical outcomes influenced by distal extension of false lumen in acute type B aortic dissection (TBAD) patients following thoracic endovascular aortic repair (TEVAR). METHODS From April 2002 to January 2013, 264 TBAD patients treated with TEVAR were retrospectively enrolled. The IIIa group exhibited a distal false lumen above the diaphragm (n = 70), and the IIIb group exhibited a distal false lumen under the diaphragm (n = 194). The morphological characteristics and adverse events (30-day and >30 days) were recorded and evaluated. RESULTS There were no significant differences between the two groups regarding the demographics, comorbidity profiles, or initial feature of computed tomography angiography. The incidence of true lumen compression and branch involvement were significantly increased in the IIIb group compared with the IIIa group (8.6% vs. 25.3%, respectively; 15.7% vs. 36.1%, respectively, both P < 0.05). The 30-day mortality rate was 1.0% (2/194) in the IIIb group, whereas the IIIa group was zero. The incidence of early adverse events, the 5-year cumulative freedom from adverse events, and the 5-year cumulative freedom from all-cause mortality rate were not significantly different between the IIIa and IIIb groups (2.9% vs. 6.7%, 81.4%, and 80.4%, and 95.7% vs. 93.8%, respectively, all P > 0.05). Log-rank tests also indicated there was no significant difference. CONCLUSIONS There was no significant difference between the IIIa and IIIb groups in the 5-year morality and adverse aortic events following TEVAR. The distal extension of false lumen prior to TEVAR does not influence the long-term morality and adverse aortic events in acute TBAD.To investigate the clinical outcomes influenced by distal extension of false lumen in acute type B aortic dissection (TBAD) patients following thoracic endovascular aortic repair (TEVAR). Methods: From April 2002 to January 2013, 264 TBAD patients treated with TEVAR were retrospectively enrolled. The IIIa group exhibited a distal false lumen above the diaphragm (n = 70), and the IIIb group exhibited a distal false lumen under the diaphragm (n = 194). The morphological characteristics and adverse events (30‐day and >30 days) were recorded and evaluated. Results: There were no significant differences between the two groups regarding the demographics, comorbidity profiles, or initial feature of computed tomography angiography. The incidence of true lumen compression and branch involvement were significantly increased in the IIIb group compared with the IIIa group (8.6% vs. 25.3%, respectively; 15.7% vs. 36.1%, respectively, both P < 0.05). The 30‐day mortality rate was 1.0% (2/194) in the IIIb group, whereas the IIIa group was zero. The incidence of early adverse events, the 5‐year cumulative freedom from adverse events, and the 5‐year cumulative freedom from all‐cause mortality rate were not significantly different between the IIIa and IIIb groups (2.9% vs. 6.7%, 81.4%, and 80.4%, and 95.7% vs. 93.8%, respectively, all P > 0.05). Log‐rank tests also indicated there was no significant difference. Conclusions: There was no significant difference between the IIIa and IIIb groups in the 5‐year morality and adverse aortic events following TEVAR. The distal extension of false lumen prior to TEVAR does not influence the long‐term morality and adverse aortic events in acute TBAD.

ASSA13-11-15 Efficacy and Safety of Fondaparinux During Thrombolytic Therapy in Acute ST-Elevation Myocardial Infarction Patients

Objective To assess efficacy and safety of Fondaparinux during thrombolytic therapy in acute ST-elevation myocardial infarction patients. Methods From November 2011 to April 2012, patients with acute ST-elevation myocardial infarction and pain to hospital time within 6 hours were received thrombolytic therapy by recombinant tissue-type plasminogen activator (rt-PA). Before thrombolytic therapy, patients were randomly assigned to Fondaparinux group (2.5mg, n = 30) or standard heparin group (60U/kg, maximum 4000U, n = 32). Coronary angiography or PCI were performed at 90min after initiating study drugs. Primary endpoints of the trial were the rate of TIMI grade 3 flow at 90minutes. other endpoints included incidence of all cause mortality at in-hospital, 30 days and 6 months, major bleeding and minor bleeding at in-hospital, 30d and 6 months. Results (1) There were no difference of primary endpoints (Fondaparinux group vs heparin group, 64.6% vs 62.5%, p = 0.158). (2) PCI procedure: Successful rate of immediate post-procedure was 100%. The average number of stents per patient was 1.1 ± 0.4 and the average diameter and length of stent were (3.0 ± 0.7) and (21.2 ± 3.1) mm. (3) Safety: No significant difference existed between fondaparinux group and heparin group in major bleeding (in-hospital, 30d and 6 months, p > 0.05). However, the fondaparinux group had a lower prevalence of mild bleeding than heparin group (in-hospital and 30d, p ± 2.1months. ➀ Fondaparinux group had a lower mortality of in-hospital but has no statistical difference (p > 0.05). ➁ Mortality at 30d and 6 months were all similar in Fondaparinux treated patients compared to heparin treated patients (p > 0.05). Conclusions Fondaparinux, which can reduce the time of reperfusion with decreasing mortality and mild haemorrhage, is feasible and safe for the patients with STEMI during thrombolysis therapy.

GW28-e1149 Three-dimensional reconstruction analysis of the esophagus, left atrium, and pulmonary veins: Implications for cryoablation of atrial fibrillation

To assess the posterior left atrial–esophageal relationship throughout the cryoablation of atrial fibrillation, avoiding esophageal injury and even more severe complication of post procedure atrial esophageal fistula. From July 2016 to September 2016, 36 consecutive atrial fibrillation patients

GW28-e1153 Study of Intrinsic QRS Complex Duration Changes 6 Months After Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) is one of the important advances in the treatment of ventricular systolic heart failure (HF) in recent years. It can reduce the mortality and improve the quality of life of patients. Patients who had response to CRT were often accompanied with a reversal of

ASSA14-12-16 Comparative analysis of left trans-radial approach and trans-femoral approach in coronary bypass graft vessel angiography

Objective To investigate the feasibility of coronary graft vessel angiography by the left radial approach. Methods The 45 patients with coronary artery bypass grafting (CABG) history were enrolled from January, 2012 to June, 2014. All the patients were divided to two groups according to the angiography approach. Coronary bypass graft angiographies in one group of 13 another group of 32 patients were done by the femoral approach. Success rate of angiography, time of vein graft angiography, time of left internal mammary artery (LIMA) angiography, numbers of conduct, volume of contrast were observed. The complications at the puncture point including haemorrhage, hematoma, false aneurysm, arteriovenous fistula were noticed. Results There were no difference in success rate of angiography, time of vein graft angiography, numbers of conduct, volume of contrast between the two groups. The time of LIMA angiography was shorter in the left radial approach group than it in the femoral approach group (4.7 ± 4.4 min vs 9.6 ± 6.3 min, p = 0.023). There was no difference in complication after procedure between the two groups. Conclusion It is feasible that the coronary bypass graft vessel angiography is done by the left radial approach, especially for the LIMA angiography because of less time and simple manipulate. The bypass graft vessel angiography done by the left radial approach should be the first choice for the experienced manipulator.

ASSA14-02-09 The strategy of radiofrequency catheter ablation in special left accessory pathway

Objective To explore the strategy of radiofrequency catheter ablation in special left accessory pathway. Methods From January 2013 to December 2013, total 288 patients with left accessory pathway were ablated in our hospital. Among them, special left accessory pathways were found in 13 patients. Gap phenomenon was found in 6 patients, slow accessory pathway in 2 patients, combination with persistent left superior vena cava in 3 patients, peripheral vascular serious circuity in 1 patient, combination with atrial fibrillation and atrial flutter in 1 patient. All the patients were ablated through aortic retrograde approach, transseptal approach and via coronary sinus approach. Results Thirteen patients were all ablated successful. Eight patients were ablated through aortic retrograde approach, and four patients with left side accessory pathway were accomplished through transseptal approach, and one patient were ablated via coronary sinus. The success rate was 100%, and complication was not occurred. Gap phenomenon was found in 6 patients with no adverse transmission above 400 ms stimulation and with adverse transmission under 350 ms stimulation. Heart rate and blood pressure were decreased in one patient with persistent left superior cave during ablation. ST-T changing in ECG was confirmed no coronary artery disease, and considered left boundle branch block. Two patients with slow accessory pathway were ablated in left free wall where VA was not fused. One patient with poliovirus and peripheral vascular serious circuity was ablated through transseptal approach after failure via aortic retrograde approach. One patient with atrial fibrillation and atrial flutter was ablated in coronary vein successful. Conclusions During ablation in left accessory pathway, we may get into trouble in some cases. After identifying carefully and ablation through different methods, high success rate was still obtained.

ASSA14-04-03 The Clinical Characteristics and Coronary Angiography Features of Patients with Apical Hypertrophic Cardiomyopathy

Objective To analyse the clinical characteristics and coronary angiography features of patients with Apical Hypertrophic Cardiomyopathy (AHCM). Methods The baseline features, clinical characteristics and coronary angiography features were retrospectively analysed. Results 25.9% of all the Hypertrophic Cardiomyopathy (HCM) patients were diagnosed with AHCM patients (99 cases vs 382 cases). The mean age of males were younger than famales onset (52.0 ± 11.5 years vs 58.4 ± 10.5 years, p = 0.009). The major clinical characteristics were chest pain, dyspnea, angina and palpitation with 74.7%, 54.5%, 50.5% and 28.3% respectively (74, 54, 50 and 28 cases). Complications were hypertention, diabetes mellitus and hyperlipemia with 35.4%,12.1% and 4.0% respectively (35, 12 and 4 cases). 12-lead electrocardiogram (ECG) revealed sinus rhythm and left ventricular hypertrophy voltage on 72 patients (72.7%), and the gaint negative T waves were presented on 80 patients (80.8%) (maximum depth 2.4 mv). On echocardiography, mean apical wall thickness, interventricular septum thickness and left ventricular outflow tract gradient were 19 ± 8 mm, 16 ± 5 mm and 40 ± 49 mmHg respectively. Left ventricular angiography revealed left ventricular apex thickening in different degrees (maximum thickness 40 mm). A majority of patients (98.0%) revealed the “Spades” except for 2 cases described as similar “Spades”and “Ballet foot” respectively. Conclusions The AHCM, with a higher morbidity, generally have a benign prognosis. Left ventricular angiography should be performed when [1] electrocardiography and echocardiography are failed to diagnose.

ASSA14-03-36 Guanxinkeli protects myocardial cells from ischemia-reperfusion injury in rats via JNK signal pathway

Background To study the protective effect and potential mechanism of Guanxinkeli (GXKL) which may plays an important role in resisting the reperfusion injury of the ischaemic myocardium on myocardial ischemia and reperfusion injuries. Methods Thirty-six rats were randomly divided into three groups: control group, ischemia reperfusion injury group and GXKL group, there were 12 rats in each group. The rat hearts were subjected to 15 min ischemia, followed by 30 min reperfusion. HR, LVDP, LVEDP and ± dp /dtmax were recorded before ischemia and at 30 min of reperfusion. The coronary effulents were collected before ischemia and at 30 min of reperfusion to measure the CK and LDH activity and the arrhythmia scores were determined. JNK protein Level was derermined by western blotting assay. Results GXKL enhanced LVEDP, LVDP and ± dp /dtmax. The arrhythmia score, CK and LDH activities in GXKL group were lower than those in ischemia and reperfusion group. The phosphorylated JNK protein was also lower in GXKL group. Conclusions GXKL may obviously improve the anti-ischaemic myocardial ischemia/reperfusion ability, increase myocardial contraction force, alleviate arrhythmia, the protective effect may be correlated with JNK signalling pathway.

ASSA14-07-02 Comparision of metoprolol succinate sustained-release tablets and metoprolol tartrate tablets on cardiac function in patients with chronic congestive heart failure

Background To investigate the effect of Metoprolol succinate sustained-release tablets and Metoprolol tartrate tablets on cardiac in chronic congestive heart failure patients. Methods 182 patients with clinical data, who suffered with chronic congestive heart failure were collected, and 67 cases were excluded. The patients were divided into 2 groups according to the different types of dosage forms: Metoprolol succinate sustained-release tablets group and Metoprolol Tartrate Tablets group. Patients in Metoprolol Tartrate Tablets group took 25 mg-50 mg Metoprolol Tartrate Tablets every day, while patients in the other group took 23.75–95 mg metoprolol succinate sustained-release tablets every day. Average heart rate, LVDd, EF, BUN and Crea were measured. Results Compared with Metoprolol Tartrate Tablets, Metoprolol succinate sustained-release tablets decreased average heart rate in chronic congestive heart failure patients (64.0 ± 5.4 vs 69.5 ± 7.6, p < 0.05). The two groups had no difference in LVDd, EF, BUN and Crea. Conclusions Metoprolol succinate sustained-release tablets decreased average heart rate in chronic congestive heart failure patients compared with Metoprolol Tartrate Tablets. The effect on cardiac and renal function was equal.