Nie Bin

Impact of preprocedural high-sensitivity C-reactive protein on contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention.

We assessed the impact of preprocedural high-sensitivity C-reactive protein (hsCRP) on the incidence of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (p-PCI). We retrospectively studied 1452 patients with STEMI undergoing p-PCI. Baseline clinical characteristics, CIN incidence, and other inhospital clinical outcomes were compared among hsCRP quartiles; 212 (14.6%) patients developed CIN. The overall inhospital mortality rate was 4.5% (65 patients). Univariate analysis revealed CIN incidence was significantly associated with hsCRP, with 7.44% for quartile Q1 (<3.00 mg/L), 12.6% for Q2 (3.00-5.90 mg/L), 16.9% for Q3 (5.91-11.4 mg/L), and 21.49% for Q4 (>11.4 mg/L; P < .001). Patients with a higher hsCRP experienced a higher rate of inhospital complications. After adjusting for potential confounders, hsCRP >6.50 mg/L was significantly associated with the occurrence of CIN. Preprocedural hsCRP levels are significantly related to the incidence of CIN in patients with STEMI undergoing p-PCI.

e0520 Statin effects in stent thrombosis induced by rapamycin releasing from drug-eluting stents through KrÜppel-Like Factor 2 overexpression

Objects As we studied before, rapamycin released from drug-eluting stents (DESs) affected the antithrombogenic function of endothelial cells through Krüppel-Like Factor 2 (KLF2) decrease. However, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are known to modulate endothelial function by inducing KLF2. Here we report that statin-induced expression of KLF2 can reverse stent thrombosis. Methods We observed the effect of rapamycin on expression of KLF2, endothelial NO synthase (eNOS), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1) and tissue factor (TF) in Human Umbilical Vein Endothelial Cells (HUVECs). And then KLF2 mRNA was induced by treatment with multiple statins in a concentration-dependent manner. The mRNA and protein were mensurated by RT-PCR and Western Blot Analysis. Furthermore, activation of KLF2 was evaluated by Electrophoretic Mobility Shift Assay (EMSA). Results Rapamycin made the expression and activation of KLF2 strongly reduce by 75.6% and 78.2% so as to induce long-term coronary endothelial dysfunction. In HUVECs, rapamycin made basal eNOS and t-PA decrease by 80% and 87.8%, while making basal PAI-1 and TF increase by 2.5 and 1.5-fold. After treatment by statins (especially lovastatin), the expression of KLF2 was increased by 3.8-fold nearly reversing to normal state. Conclusions Taken together, these observations indicate that statin-dependent induction of KLF2 provides a new treatment for stent thrombosis induced by rapamycin releasing from drug-eluting stents.

e0519 Rapamycin suppress KrÜppel-Like Factor 2 expression: mechanism of endothelial dysfunction associated with drug-eluting stents

Objects Although rapamycin released from drug-eluting stents (DESs) affect the antithrombogenic function of endothelial cells, the exactly mechanisms underlying these effects are incompletely understood. We hypothesised that Krüppel-Like Factor 2 (KLF2), a novel and potent regulator of endothelial gene expression, might play an important role in stent thrombosis. Methods We observed the effect of rapamycin on expression of KLF2, endothelial NO synthase (eNOS), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1) and tissue factor (TF) in Human Umbilical Vein Endothelial Cells (HUVECs). Then, with overexpression of KLF2, we mensurated the above mentioned mRNA and protein, respectively. The mRNA and protein were mensurated by RT-PCR and Western Blot Analysis. Furthermore, activation of KLF2 was evaluated by Electrophoretic Mobility Shift Assay (EMSA). Results Rapamycin made the expression and activation of KLF2 strongly reduce by 75.6% and 78.2% so as to induce long-term coronary endothelial dysfunction. In HUVECs, rapamycin made basal eNOS and t-PA decrease by 80% and 87.8%, while making basal PAI-1 and TF increase by 2.5 and 1.5-fold. Overexpression of KLF2 strongly induced eNOS and t-PA expression and reduced PAI-1 and TF expression, reversing protein above-mentioned near to normal state. Conclusions The data indicated that rapamycin strongly inhibited the expression of KLF2, meanwhile, reduced anticoagulants (eNOS and t-PA) and induced procoagulants (PAI-1 and TF). KLF2 played an important role in stent thrombosis owing to rapamycin-induced endothelial dysfunction, which might be a part of mechanism of stent thrombosis associated with DESs.

e0515 The value of examination of forearm artery using Doppler ultrasound before trans

Objective To explore the value of examination of fore arm artery using Doppler ultrasound before transradial coronary intervention (TRI). Methods Consecutive patients undergoing elective TRI were screened. Including criteriors were as follows: positive Allens test result of right radial artery (RRA). The primary endpoints included the procedural success rate and incidence of vascular related complications. The secondary endpoints were: the average diameter of fore arm diameter and anatomic variations of approach. Results A total of 1863 patients were eligible and assigned to ultrasound group (931 cases) and convention group without ultrasound examination (932 cases). The baseline clinic characteristics in two groups were comparable. 181 cases of anatomic variation in RRA approach were detected before procedure. Among these, approach in 13 cases changed to other routes from RRA. The procedural success rate in ultrasound group and convention group was similar (98.0% vs 97.2%, p=0.292). The incidence of vascular complications in ultrasound group was significantly lower than convention group (8.7% vs 11.6%, p=0.039). Regarding artery perforation and radial artery occlusion, the incidences of those in ultrasound group occurred less frequently (p=0.025 and 0.028, respectively). Conclusions Examination of fore arm artery using Doppler ultrasound could not only detect anatomic variations and reduce vascular complication effectively, but also be helpful to selective suitable approach and instruments.

e0513 Plasma NGAL Could early predict contrast-induced acute kidney injury after percutaneous coronary interventions

Objective To examine the changing trend of plasma Neutrophil gelatinase-associated lipocalin (NGAL) after contrast exposure and to elucidate whether NGAL was good early biomarker for diagnosis of contrast induced acute kidney injury (CIAKI). Method 231 patients undergoing percutaneous coronary intervention were enrolled. Blood samples were collected before and 2, 4, 8, 24, and 48 h after procedure. NGAL was measured with ELISA kit. CIAKI was defined as an increase in the serum creatinine values of ≥25% or ≥44.2 μmol/L. Receiver-operating characteristic (ROC) curves were generated and the area under the curve (AUC) calculated. Results At baseline, the plasma NGAL (69.4±29.8 ng/ml) was correlated positively with creatinine (90.9±20.4 μmol/L) (r2=0.341, p<0.001) The plasma NGAL increased at 2 h and reached peak at 8 h and decreased at 24 h after procedures. Among all the patients, 29 patients (12.6%) developed CIAKI. The sensitivity, specificity, and ROC curve for prediction of CIN were excellent for the 2 h plasma NGAL (75%, 89%, and 0.90, respectively). Conclusion NGAL seems to be a potential early biomarker for CIAKI.

e0490 Safety and feasibility of transradial coronary angiography at the outpatient clinic

Objective To evaluate the safety and feasibility of transradial coronary angiography at the outpatient clinic. Methods From February, 2008 to June, 2008, 100 outpatients who received transradial coronary angiography in Anzhen Hospital were included in this analysis, and 100 inpatients who underwent coronary angiography were selected as control group. Primary endpoints included success rate, percentage of angiographic catheter use with different diameters, adverse events during the procedure (such as death, malignant arrhythmia, acute myocardial infarction, coronary artery spasm, coronary artery dissection, perforation or occlusion, etc.) and after the procedure (such as death, acute myocardial infarction, upper limb haematoma, osteofascial compartment syndrome, radial artery pseudoaneurysm or occlusion, etc.). Results The success rate (100% vs 100%), procedure duration time (12.5±3.4) min vs (10.8±3.6) min, p =0.517) and exposition time (4.3±1.0) min vs (4.1±1.0) min, p =0.629) were similar between the outpatient and inpatient groups. Radial and coronary artery spasm were the main adverse events during the angiography, and haematoma was the main adverse event after the angiography. There were no significant differences of adverse events between the 2 groups. the total cost of the outpatient group was significantly lower than the inpatient control group (4012±238) yuan vs (5329±371) yuan, p<0.01). Expenditure including chemical tests, medicine, nursing care, Room & Board all decreased significantly. Conclusion Transradial coronary angiography application at the outpatient clinic was safe and feasible for stable patients, and this procedure could decrease the medical expenditure and shorten the admission time.

e0509 Effency of triptolide-coated stent on prevent restenosis

Objective The aim of this study is to test the efficacy and safety of triptolide-coated stent on anti-inflammatory and inhibiting intimal hyperplasia compared with that of a drug eluting stent and a bare metal stent in a pig after angioplasty. Methods 15 triptolide-coated stents (TCS), 12 drug eluting stent (Cypher select) and 12 bare metal stents (BMS) were deployed with oversizing (stent/artery ratio 1.1:1) in a porcine coronary arteries. Coronary angiography, histopathologic and inflammatory markers levels were carried out and analysed at week 4 after stenting. Results The distribution of stented vessels, diameter of reference vessels, and post-procedural minimal lumen diameter were compared in each group. At week 4 follow-up, quantify coranary angiography (QCA) showed that the minimal lumen diameter were greater, and percent stenosis and late lumen loss in the triptolide-coated stent group and DES group were less than that of the bare metal stents group. In the histopathologic analysis, compared to BMS group, the injury score, inflammation score in TCS group and DES group were decreased, p<0.05, and there were significant reduced neointimal area and enlarged Lumen area in TCS, DES group as well. Conclusion Triptolide-coated stent showed the similar effect of preventing restenosis through inhibition of neointimal hyperplasia as DES and anti-inflammation acts after coronary angioplasty in pigs.

e0514 The safety and feasibility of repeated percutaneous transradial coronary intervention in the same route

Background The radial approach has been increasingly used as an alternative to femoral access. And more procedures of repeated transradial coronary intervention (r-TRI) are performed. Few data about r-TRI has been obtained. Therefore, we tried to investigate the safety and feasibility of repeated transradial coronary intervention (r-TRI) in the same route. Methods A total of 423 consecutive eligible patients undergoing repeated TRI were enrolled in r-TRI group, and 846 patients with initial TRI were assigned to i-TRI group in a 2- to-1 ratio matched by ages and gender. The primary endpoint included the success rate of procedure and incidence of vascular related complications. Results The baseline clinical characteristics in two groups were comparable. The success rate of procedure in r-TRI and i-TRI was similar (96.0% vs 97.5%, p=0.130). In subgroup analysis (coronary angiography only or angiography with percutaneous coronary intervention), the similar result was also observed. The puncture numbers and incidence of radial artery spasm in r-TRI group were significant higher than i-TRI group (p=0.034 and p<0.001, respectively). The other procedural outcomes in two groups were identical. With respect to the incidence of overall vascular related complication and independent event, there were no significant difference in spite of higher incidence in r-TRI group (1.2% vs 0.7%, p=0.521). The patients in i-TRI group had more comfortable feeling than r-TRI group (p<0.001). Conclusions Repeated TRI produces an equal success rate and a lower vascular complication when compared to initial TRI. It should be considered as an acceptable and safe procedure.

e0499 Long term clinical follow-up of patients with versus without overlapping drug eluting stents for long coronary lesions

Background Drug-eluting stents (DSE) markedly reduce the rate of in stent restenosis, but limited data exists as to the long-term outcome in patients with long coronary lesions (≥40 mm) undergoing multiple overlapping DES implantation of in native coronary vessels. Methods A total of 11073 consecutive patients undergoing percutaneous coronary intervention (PCI) with drug eluting stent were retrospectively were screened. Interventions for in stent restenosis, bypass graft, and primary PCI were excluded. All other patients (n=1411) receiving ≥2 overlapping drug-eluting stents and total stent length in target lesion ≥40 mm for de novo coronary arteries were retrospectively analysed. The clinical outcomes of those patients were compared with consecutive patients with multiple drug-eluting stents implantation but without overlapping stents. An age-matched (±5 years) control group with the same total number of stents and similar total stent length (±10 mm) in target vessel was collected from the total population undergoing PCI with DES during the same study period. Patients were followed up either by telephone or by visiting outpatient clinic. Results Successfully matching and complete clinical follow-up was achieved in 522 pairs. Median clinical follow-up duration was 35.0 months (IQR 24.3–46.4); Mean total length and number of stents in target vessel was 65.2±24.4 mm and 2.4±0.7, respectively. Nineteen percent lesions in the overall cohort were chronic total occlusions and 9% involved left main or bifurcation lesions. Patients with overlapping DSE stints were associated with significantly increased overall major adverse cardiac event rate (MACE) (18.4% vs 11.9%, p=0.004), which was largely driven by significantly higher incidence of target vessel revascularisation (8.8% vs 5.2%, p=0.028). Whereas all cause mortality (5.2% vs 4.2%, p=0.559), myocardial infarction (5.0% vs 4.0%, p=0.551) and ARC defined definite or probable stent thrombosis rates (2.3% vs 1.5%, p=0.499) were comparable in patients with or without overlapping DES. Conclusion Coronary stenting for long lesions (≥40 mm) using overlapping drug-eluting stents presented in over 12% of patients undergoing PCI in routine clinical practice and was associated with acceptable clinical outcome during median 35.0 months follow-up.