Wang Xiaozeng

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.

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.

ASSA14-04-03 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.

ASSA14-07-02 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.

ASSA14-03-35 Effects of Omeprazole and Pantoprazole on platelet function in Acute Coronary Syndrome patients receiving clopidogrel: A Single-centre Prospective Randomised Controlled Clinical Trials

Background Proton pump inhibitors (PPIs) are usually prescribed to patients undergoing dual antiplatelet therapy to decrease the risk of gastrointestinal bleeding. However, the proportion of patients increased incidence of major adverse cardiovascular event because of interaction of PPIs and clopidogrel. The aim of the study was to assess the effect of omeprazole and pantoprazole on platelet reactivity in acute coronary syndrome patients receiving clopidogrel. Method From October 2012 to September 2013, a total of 620 consecutive acute coronary syndrome patients from Shenyang General Hospital were enrolled. All patients received clopidogrel loading dose 300 mg and aspirin 300 mg. Patients were randomised to two groups by the ratio of 1:1 and received routine dual anti-platelet treatment. The omeprazole group (aspirin 300 mg/d and clopidogrel 75 mg/d and omeprazole 20 mg/d, n = 310). The pantoprazole group (aspirin 300 mg/d and clopidogrel 75 mg/d and pantoprazole 20 mg/d, n = 310). The reversion rate of ADP which was defined as 20 μmol/L adenosine diphosphate induced platelet aggregation (by LTA) (on admission, three days and 30 days after dual antiplatelet therapy) and clinical events (stent thrombosis, MACEs, which included cardiac death, myocardial infarction or ischaemic symptoms driven target vessel revascularisation, all-cause death, TIMI) were observed. Result All groups were generally well balanced with regard to baseline demographic, clinical, and proced-ural characteristics. There were no different on platelet response to clopidogrel at three days (52.8% ± 19.3% vs 50.2% ± 19.3%, respectively, p = 0.384) and 30 days (49.9% ± 14.9% vs 49.1% ± 14.7%, respectively, p = 0.559) between omeprazole group and pantoprazole group. 1 stent thrombosis in the omeprazole group and 0 stent thrombosis in pantoprazole group (p = 0.219). 2 patients in omeprazole group were suffered from MACE (0.6%), and 3 patients in pantoprazole group (0.97%, p = 0.359). In addition, there were no major or minor bleeding in the two groups, the minimal bleeding in omeprazole and pantoprazole groups were no significantly difference (2.1% vs 2.8%, respectively, p = 0.235). There was no significantly association between the two groups for all-cause death (p = 0.687), and 1 patient died due to the traumatic brain injury in the omeprazole group. Conclusion These results suggest that the drug interaction between PPIs (omeprazole and pantoprazole)and clopidogrel does not result in ADP induced platelet aggregation. There was no apparent clinical events interaction between clopidogrel and omeprazole and pantoprazole in patients who received dual antiplatelet therapy. The clinic impact of this strategy needs to be proved by long term follow-up outcome studies.

ASSA14-04-01 Long-Term efficiency of percutaneous transluminal septal myocardial ablation for hypertrophic obstractive cardiomyopathy

Background Although percutaneous transluminal septal myocardial ablation (PTSMA) has been considered to be a new interventional technique to treat patients with hypertrophic obstractive cardiomyopathy (HOCM), few studies have reported their long term efficiency. The aims of this study was to investigate electrocardiographic date and the long term outcomes in follow-up. Methods This study included 66 patients (36 males, 48.6 ± 12.4 years) in our hospital who were treated using PTSMA from October 2001 to October 2012. The indication for PTSMA was restricted to symptomatic patients with maximal LVOTG >50 mmHg under basal conditions or >70 mmHg with provocative manoeuvres or after extrasystole. Alcohol was injected to the suitable septal branch. Clinical and echocardiogrphic follow-up date (1 month, 6 month, and every year) was completed for all patients. Results The average follow-up duration was (41.0 ± 34.0 months, range, 12–144 months). The average septal thickness 6 months after operation were significantly lower than the preoperative one (17.6 ± 3.3 mm vs 19.2 ± 3.7 mm, p = 0.032), and the long term septal walls were ever thicker (16.6 ± 4.0 mm vs 19.2 ± 3.7 mm, p = 0.015). The average left ventricular outflow tract (LVOT) 6 months after operation were significantly lower than the preoperative one (17.5 ± 1.6 mm vs 16.0 ± 1.4 mm, p = 0.002), and the long term LOVT were ever wider (19.0 ± 3.0 mm vs 16.0 ± 1.4 mm, p = 0.000). The average LVOT gradient 6 months after operation were significantly lower than the preoperative one (30.0 ± 14.7 mmHg vs 107.0 ± 49.6 mmHg, p = 0.000), and the long term LVOT gradients were ever lower (29.7 ± 25.4 mmHg vs 107.0 ± 49.6 mmHg, p = 0.000). There were 40 patients returned routinely for checkups. During the follow-up period after operation, 1 all-cause deaths and 1 cardiac death occurred. There was no case of heart transplantation, premature ventricular extrasystole, postinterventional sustained ventricular tachycardia, or other arrhythmias. The most frequent major post-procedural complication was chronic heart failure (7 among 40, 17%), NYHA classification were II-III. There were 7 patients had right complete heart block (CHB), however, no patient had syncope or resuscitation. Conclusion In this study, percutaneous transluminal septal myocardial ablations reduce septal thickness and LVOTG, as well as improve cilinical symptoms with the long term follow-up.

GW24-e1834 Long term outcome of stent implantation in 48 patients with carotid artery stenosis

Objectives The aim of this study was to determine the safety and long-term efficacy after stent implantation in patients with carotid artery stenosis. Methods 48 patients with angiographic confirmed carotid artery stenosis were recruited from January 2005 to Dec 2010. All stents were implanted into carotid artery with guidance of distal cerebral protection device in order to observe perioprative complacations and clinical efficacy. Results The mean age of all the 48 patients were 66.0 ± 6.8 years, 41 patients (85.4%) were male. There was averagely one target lesion per patient. The stenotic lesions were averagely 22.5 ± 10.3 mm in length and 88.5 ± 9.9% in degree of stenosis. Each lesion underwent 1 self-expanding stent implantation with guidance of distal cerebral protection device. The procedural success rate was 100%. The stent was averagely 7.3 ± 2.4 mm in diameter and 36.0 ± 5.5 mm in length. The degree of immediate postprocedural residual stenosis was 5.6 ± 4.5%. During the procedure, 11 patients (22.9%) patients presented with dropped heart rate, which was restored to normal after administration of 1 mg atropine; 2 patients (4.2%) arouse unilateral limb movement, which was recovered within 24 hours after treatment. No serious postprocedural complications were found. The average follow-up time was 36.2 ± 15.5 months, and follow-up rate was 93.8% (45/48). A total of 2 patients (4.4%) died, including 1 lung cancer and 1 ischaemic stroke. 4 patients (8.9%) were still attacked by dizziness, 3 patients (6.7%) had occasional numbness in limbs. There was no severe cerebral ischaemic attack, cerebral infarction or cerebral haemorrhage. From 6 to 12 months follow-up after operation, enhanced CT scans showed no in-stent restenosis in carotid. Conclusions With guidance of distal cerebral protection device, carotid artery stenting showed a long-term satisfactory safety and efficacy in carotid stenosis patients as well as high operation success rate.

ASSA14-01-05 Thrombus aspiration followed by direct stenting during primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Objectives Previous studies have reported that low final thrombolysis in myocardial infarction (TIMI) flow and/or myocardial blush grade (MBG) are independent predictors of mortality in patients with ST-elevation myocardial infarction (STEMI). Several studies with thrombus aspiration (TA) showed different results, mainly due to use of TA as an additional device not instead of balloon predilatation (BP). The aim of the present study was to assess impact of TA followed by direct stenting during primary percutaneous coronary intervention (PPCI). Methods Between Dec 2008 and Jun 2011, a total of 429 patients (107 patients in TA group and 322 patients in BP group) who were eligible for the observation criteria, admitted with STEMI (within 9 h from symptoms onset) and candidates for PPCI were enrolled. Exclusion criteria were a previous PCI on infarct-related artery, infarct-related artery < 2.5 mm in diameter, previous coronary artery bypass graft, cardiogenic shock, 3-vessel disease, left main disease, infarct-related lesion treated with balloon predilatation and TA simultaneously, and calcium or tortuous infarct-related lesion. The main indexes of this study were the TIMI flow grade, MBG, and the rate of 60-min ST-segment resolution > 50% after PCI and in-hospital major adverse cardiac events (MACE). Secondary indexes included distal embolizations of infarct-related artery, peak CK-MB release, and MACE after one year. Results Baseline clinical and angiographic characteristics, initial TIMI flow and initial MBG did not differ between the two groups. Procedural success was obtained in all patients. Stent length, number of stents per patient, and stent/vessel ratio were similar between both groups. The rate of 60-min ST-segment resolution > 50% was significantly more frequent in TA group than in BP group (69.2% vs 48.5%, P < 0.01). The TIMI flow grade after PCI was significantly higher among patients in TA group compared with BP group (2.65 ± 0.49 vs 2.44 ± 0.61, P < 0.01). Also the MBG was significantly higher among patients in TA group compared with BP group (2.86 ± 0.34 vs 2.41 ± 0.56, P < 0.01). There were 23 patients with evident distal embolizations in the group without TA and two patients in the group with TA (1.9% vs 7.1%, P < 0.05). The peak CK-MB release was significantly lower in TA group compared with the BP group (660 ± 144 U/L vs 711 ± 165 U/L, P < 0.01). There was no difference in between the groups in in-hospital MACE (0.9% vs 2.8%, P > 0.05), in 12-month cardiac mortality (1.2% vs 2.2%, P > 0.05), reinfarction rate (0.9% vs 3.1%,P > 0.05) and target vessel revascularisation (2.8 vs 6.5%, P > 0.05). But Total MACE was significantly higher in BP group compared with the TA group (6.5% vs 14.5%, P < 0.05). Conclusions Compared with conventional PCI, TA and direct stenting before primary PCI improved final myocardial reperfusion and the long-term outcome for STEMI patients.

ASSA14-03-29 Angiographic features of patients with atherosclerosis in the segments proximal to the myocardial bridge

Objectives By studying the clinical and imaging features of myocardial bridge and severe atherosclerosis lesions in the segments proximal to the myocardial bridge, compared with that of pure myocardial bridge retrospectively, to analyze the clinical and imaging characteristics of these patients. Methods The study population consisted of 2 groups (192 patients). The CHD Group included 92 patients with severe atherosclerosis lesion of luminal narrowing of ≥ 70% in the segments proximal to the myocardial bridge. The bridge group included 100 patients with symptomatic myocardial bridge lesion of systolic luminal narrow. All lesions were successfully treated with stent by standard interventional techniques. Quantitative coronary angiography was performed before and immediately after stent deployment. Results The mean age and systolic pressure in the CHD patients were more than that in the pure bridge group (58 ± 11 vs 42 ± 10 ys and 157.8 ± 9.8 vs 146.1 ± 10.2 mmHg, respectively), P < 0.05. No significant difference was found between two groups such as gender, DM, smoking, hyperlipidemia, old myocardial infarction percentage. There was a significant difference in the extent of diameter stenosis during systolic stage between CHD and bridge groups (95 ± 5% vs 90 ± 7%). But the average length from the proximal end of myocardial bridge to the ostium of LAD and the average length of myocardial bridge had not difference between two groups. Conclusions The patients with severe atherosclerosis lesion in the segments proximal to the myocardial bridge has more risk factors of CHD, the extent of diameter stenosis during systolic stage has some promotive effect on CHD.