Liu Yuyang

Chronic kidney disease and the risk of stent thrombosis after percutaneous coronary intervention with drug-eluting stents†

Chronic kidney disease (CKD) has been demonstrated to be associated with adverse clinical outcomes for patients with coronary artery disease (CAD). However, data on relation of CKD and stent thrombosis (ST) after drug‐eluting stent (DES) implantation are limited.

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.

The effect of exogenous creatine phosphate on myocardial injury after percutaneous coronary intervention.

Objective: To evaluate the effect of exogenous creatine phosphate (CP) on myocardial injury after percutaneous coronary intervention (PCI). Method: Four hundred patients were divided to receive conventional therapy (control group) or 3-day intravenous infusion of CP after PCI (CP group). Levels of creatine kinase MB (CK-MB) and troponin I (TnI) were measured before and on postprocedural day 3. Results: Postprocedural CK-MB and TnI in the CP group were significantly increased compared to the control group. In the CP group, 8.0% and 5.0% of patients had an increase in CK-MB 1 to 3 times and >3 times, respectively, which were significantly lower than that of the control group (19.0% and 9.0%, respectively); 12.0% and 10.0% of patients had an increase in TnI 1 to 3 times and >3 times, respectively, which were significantly lower than that of the control group (21.0% and 18.0%, respectively). Conclusion: Exogenous CP was helpful to reduce myocardial injury after PCI.

Safety and efficacy of the XIENCE V everolimus-eluting stent compared to the resolute zotarolimus-eluting stent in small vessels

Background The second generation drug-eluting stents have been shown to improve angiographic and clinical outcomes after percutaneous myocardial revascularisation, but its performance in small coronary arteries has not been investigated. Objectives To evaluate the safety and efficacy of the XIENCE V everolimus-eluting stent (EES) compared to the Resolute zotarolimus-eluting stent (ZES) in small vessels. Methods In this study, we studied a cohort of 412 patients with small coronary vessels (reference diameter <2.75 mm). EES (54.1% of pts) and ZES (45.9% of pts) were used in our study. Results Mean angiographic in-stent and in-segment late loss was non-significantly less in the EES group compared with the ZES group, (0.16±0.51 vs 0.18±0.44 mm; p=0.209 for in-stent; 0.12±0.36 mm vs 0.13±0.28 mm; p=0.387 for in-segment). EES resulted in a non-significant reduction in composite major adverse cardiac events at 1 year (6.4% vs 8.2%; p=0.130). At 1 year, the rate of non-Q-wave myocardial infarction was also the same in both groups (p=0.055). Conclusions In patients with small vessel coronary arteries, the XIENCE V EES was not superior to the Resolute ZES.

Influence of abnormal fasting plasma glucose on left ventricular function in older patients with acute myocardial infarction

Objective We assessed whether the admission fasting plasma glucose (FPG) levels were associated with all-cause mortality and left ventricular (LV) function in older patients with acute myocardial (AMI). Methods A total of 1854 consecutive patients were categorised into four groups: hypoglycaemia, euglycemia, mild hyperglycemias and severe hyperglycemias. The primary outcomes were in-hospital/3-year mortality and LV function. Results There was a near-linear relationship between FPG and Killip class. However, no significant correlation was found between FPG levels and LV ejection fraction. Both FPG levels and Killip classes were all independent significant predictors for mortality. Compared with the euglycemia group, both the hypo- and hyperglycemias were associated with higher in-hospital and 3-year mortality. Conclusions In older patients with AMI, FPG values had differential influences on LV function and mortality. There was a U-shaped relationship between FPG and in-hospital/3-year mortality, and a near-linear relationship between increased admission glucose levels and higher Killip classification.

Visualisation of expanded conus branch for overfilled with contrast medium

Case Study A 74-year-old male was admitted with atypical chest pain. Transradial coronary angiography revealed that there was no obstructive disease in left anterior descending artery (LAD) or circumflex artery (LCX; figure A). When performing right coronary angiography with a five French Tiger shaped universal catheter (Terumo Corporation, Japan), the conus branch was super selected. Furthermore, expansion of conus branch was observed after overfilling with contrast medium (white arrow in panel B of the Figure). The catheter was removed immediately. Visualisation of expanded conus branch persisted for about 40 s, then the stain disappeared radically (Figure C). Under the circumstances, there was no significant change in symptoms, vital signs or electrocardiogram. Then the angiography was continued and revealed a nearly normal right coronary artery and conus branch (Figure D). Serial ultrasound cardiogram tests were performed and no pericardial effusion were found. We deduced that expansion of conus branch should be attributed to the artery overfilling with contrast medium. Special curve of the universal catheter facilitated super selection of conus branch when performing right coronary angiography, and overfilling with contrast medium could result in conus branch expansion, rupture, malignant arrhythmia, etc. This is a profound example of this phenomenon. And as far as we know, this is the first report in the literature. We should do our best to avoid super selection of conus branch and overfilling with contrast medium in order to decrease such complications.

Different effect of follistatin-related protein (FRP)in ox-LDLinduced endothelial cell and vascular smooth muscle cell apoptosis

Background The development of atherosclerosis proceeds through multiple maladaptive pathways that begins with endothelial cell (EC)injury caused by oxidised low-density lipoprotein (ox-LDL) which plays a critical role. Proliferation and migration of vascular smooth muscle cells (VSMCs) also play an important role in atherosclerosis. Data from our lab and other studies show that Follistatin related protein (FRP), which is expressed in the vasculature, suggesting that FRP has cardioprotective effects on the development of atherosclerosis. Objective In this study, we determined whether FRP protects against EC and VSMC apoptosis induced by ox-LDL. Methods Human umbilical vein endothelial cells (HUVECs) and aortic VSMCs were isolated and treated with ox-LDL and recombinant FRP. We measured the activation of signaling molecules of Bcl-2, AKT and Bad by Western blots and detected the apoptosis cell by flow cytometer (FCM) in EC and VSMCs which were treated by ox-LDL or/and FRP in different concentration. Results In vitro experiments showed that the effect of FRP on EC and VSMC apoptosis was different. The effect of FRP on EC apoptosis was mediated by upregulation of expression of the antiapoptosis protein Bcl-2. But the effect of FRP on VSMCs apoptosis was no prominent protection. Conclusion FRP maintains EC viability by preventing apoptosis via Bcl-2 upregulation and it has no prominent effect in protecting VSMCs from apoptosis.

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.