Xuming Yang

Brachial Pulse Pressure and Cardiovascular or All-Cause Mortality in the General Population: A Meta-Analysis of Prospective Observational Studies

This study aimed to quantitatively evaluate the predictive value of brachial pulse pressure and cardiovascular or all‐cause mortality in the general population based on prospective observational studies by conducting a meta‐analysis. Only prospective observational studies investigating baseline brachial pulse pressure and cardiovascular or all‐cause mortality risk were selected from PubMed and Embase databases until July 2013. Fourteen studies involving 510,456 participants were analyzed. Pooled risk ratio (RR) of cardiovascular and all‐cause mortality for the highest vs lowest brachial pulse pressure category was 1.80 (95% confidence interval [CI], 1.49–2.17) and 1.32 (95% CI, 1.23–1.41), respectively. Pooled RR of cardiovascular and all‐cause mortality per 10 mm Hg pulse pressure increment was 1.13 (95% CI, 1.10–1.17) and 1.09 (95% CI, 1.07–1.11), respectively. Wide brachial pulse pressure is associated with greater risk of cardiovascular and all‐cause mortality. However, more well‐designed studies specifically on age and sex are needed to further confirm these findings.

The mitochondrial tRNA(Met) 4454T > C variant may not be associated with essential hypertension in Han Chinese population.

According to a previous report, Zhu et al. (2009) analyzed the mitochondrial tRNA (mt-tRNA) sequence variants in Han Chinese patients with essential hypertension (EH). By clinical evaluation and genetic screening, they claimed the pathogenicity of 4454T4C variant on the two lines of evidence in lymphoblastoid cell line established from the proband: (1) reduction in oxygen consumption rate; (2) this variant was only presented in patients but absent in health controls. However, a proof-reading of the complete mtDNA sequence that was determined by Zhu et al. (2009) identified five missing variants at positions 73, 8701, 12,705, 14,766 and 15,301, which were expected for individual belonged to East Asia haplogroup M9 (Fan & Yao, 2011). Apparently, the complete list of mtDNA sequence variants was still incomplete; it remained unresolved whether some other unrecorded mutations had an influence in the clinical manifestation of EH. Assigning pathogenicity of a base substitution in mt-tRNA genes required the evaluation of evolutionary conservation of the base involved. For this purpose, we performed an alignment of tRNA sequence from 17 vertebrate species, as displayed in Figure 1, it is quite obvious that this variant is not evolutionary conserved and may not have an effect on clinical expression of EH (Conservation Index1⁄4 17.6%). To determine the possible role of 4454T4C variant, the secondary structure of tRNA gene with and without this variant were analyzed by MFOLD program (http://mfold.rit.albany.edu)

Impacts of intensive follow-up on the long-term prognosis of percutaneous coronary intervention in acute coronary syndrome patients – a single center prospective randomized controlled study in a Chinese population

Objectives To investigate the impact of cardiologist-coordinated intensive follow-up on the long-term prognosis of percutaneous coronary intervention in Chinese patients. Methods We recruited 964 patients who had acute coronary syndrome and underwent successful percutaneous coronary intervention in the First Hospital Affiliated to Henan University of Science and Technology, China. Participants were randomly assigned into the intensive follow-up (n = 479) and usual follow-up group (control group, n = 485). They received secondary prevention education during hospitalization and telephone follow-ups after discharge. The control group received telephone calls from nurses, while the intensive follow-up group received telephone calls and medical consultations from cardiologists. Both groups were followed up for 36 months. Results (1) At 36 months, the proportions of all-cause death, cardiac death and cumulative major adverse cardiovascular events (MACEs) were 5.3%, 4.4% and 18.6% in the intensive follow-up group. These events were significantly lower than in the control group (10.1%, 9.3 % and 28.8% (p = 0.004, p = 0.003 and p < 0.001). (2) Multivariable Cox regression analysis identified intensive follow-up as an independent predictor of survival, cardiac death-free survival and MACE-free survival. (hazard ratio (HR) = 0.487, 95% confidence interval (CI) 0.298–0.797, p = 0.004; HR = 0.466, 95% CI 0.274–0.793, p = 0.005; HR = 0.614, 95% CI 0.464–0.811, p = 0.001). Kaplan–Meier analysis revealed that patients in the intensive follow-up groups had longer survival (log rank = 8.565, p = 0.003), cardiac death-free survival (log rank = 8.769, p = 0.003) and MACE-free survival (log rank = 15.928, p < 0.001). (3) The average medical cost was significantly less in the intensive follow-up group, especially the cost for re-hospitalization (US

Clinical evaluation of thrombus aspiration combined with tirofiban in patients with acute myocardial infarction with elective percutaneous coronary intervention

582.74 ± 1753.20 vs. US

Effect of vitamin D on ventricular remodelling in heart failure: a meta-analysis of randomised controlled trials

999.32 ± 2434.57, p = 0.003). The bleeding events were similar. (4) Patients in the intensive follow-up group had significantly better controls of cardiovascular risk factors and medication adherence. Conclusions A cardiologist-coordinated intensive follow-up program markedly decreased cardiovascular risk factors, reduced medical costs, promoted medication adherence and improved the long-term prognosis of patients after percutaneous coronary intervention in the Chinese population.

Early application of an intra-aortic balloon pump in patients with ST-segment elevation acute myocardial infarction scheduled for elective percutaneous coronary intervention

Objective: To compare the efficacy and safety of combined treatment with thrombus aspiration and intracoronary tirofiban in patients with acute myocardial infarction (MI), with elective percutaneous coronary intervention (PCI). Methods: Patients undergoing elective PCI during recovery from acute MI were randomized into two groups; the intervention group received thrombus aspiration and intracoronary tirofiban; the control group received conventional PCI. Baseline clinical characteristics, postoperative coronary blood flow (thrombolysis in myocardial infarction [TIMI] grade), TIMI myocardial perfusion (TMP) grade, no/slow reflow rate and cardiac function (measured by echocardiography 1 month postoperatively) were evaluated. Major adverse cardiac event rate and bleeding complications during surgery (and at 1 month and 1 year postoperatively) were also evaluated. Results: A total of 80 patients were included. Postoperatively, the number of patients with TIMI flow grade 3 and the mean TMP grade were both significantly higher, and the no/slow reflow rate was significantly lower, in the intervention group versus the control group. Echocardiography indicated that cardiac function was significantly improved in the intervention group compared with the control group. There were no major complications in either study group. Conclusion: Thrombus aspiration combined with intracoronary tirofiban during recovery from acute MI was effective and relatively well tolerated.

Plasminogen activator inhibitor-1 4G/5G polymorphism is associated with coronary artery disease risk: a meta-analysis

Objectives The level of vitamin D is considered to be associated with the development and progression of heart failure (HF). However, it is still unclear whether supplementation of vitamin D could improve ventricular remodelling in patients with HF. This study aimed to systematically evaluate the influence and safety of additional vitamin D supplementation on ventricular remodelling in patients with HF. Design This study is a meta-analysis of randomised controlled trials (RCTs). Setting The PubMed, EMBASE, CNKI, Cochrane library, Web of Science databases and grey literature were searched for RCTs regarding the effect of vitamin D on ventricular remodelling in patients with HF (from database creation to October 2017). RevMan V.5.3 software was employed for data analysis. Participants Seven RCTs with a total of 465 patients, including 235 cases in the vitamin D group and 230 cases in the control group, were included. Primary and secondary outcome measures Left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) and the incidence of adverse reactions. Results Compared with the control group, a decrease in the LVEDD (mean difference (MD)=−2.31 mm, 95% CI −4.15 to −0.47, p=0.01) and an increase in the LVEF (MD=4.18%, 95% CI 0.36 to 7.99, p=0.03) were observed in the vitamin D group. Subgroup analysis also revealed a reduced LVEDD in adults (>18 years) and adolescents (<18 years) of the vitamin D group relative to that in those of the control group. High-dose vitamin D (>4000 IU/day) was more effective at reducing the LVEDD than low-dose vitamin D (<4000 IU/day). Moreover, vitamin D supplementation was more effective at reducing the LVEDD and increasing the LVEF in patients with reduced ejection fraction than in patients without reduced ejection fraction. Conclusion Vitamin D supplementation inhibits ventricular remodelling and improves cardiac function in patients with HF. Trial registration number CRD42017073893.

Biodegradable Polymer Drug-Eluting Stents Versus Second-Generation Drug-Eluting Stents for Patients With Coronary Artery Disease: An Update Meta-Analysis

Objective This study evaluated the effect of early application of intra-aortic balloon pump (IABP) counterpulsation in patients with ST-segment elevation acute myocardial infarction (STEMI), scheduled for elective percutaneous coronary intervention (PCI). Methods Patients who had experienced STEMI for 12–72 h received (IABP group) or did not receive (control group) IABP counterpulsation for 3–5 days before PCI. Results One hundred patients were included. Frequencies of infarct-related artery thrombolysis in acute myocardial infarction (TIMI) flow rate classes 0, I and II in the IABP group (11.5, 1.9 and 7.7%, respectively) were significantly lower than in the control group (29.1, 14.6 and 22.9%, respectively) before PCI. After PCI, the frequency of TIMI class III flow rate in the IABP group (96.2%) was significantly higher than that in the control group (81.3%). Four weeks after PCI, the left ventricular ejection fraction (LVEF) was significantly higher, and the incidence of major cardiac events was significantly lower, in the IABP group compared with the control group. Conclusions Early use of IABP counterpulsation in STEMI patients scheduled for PCI was effective, with a favourable safety profile. IABP counterpulsation reduced the incidence of major adverse cardiac events and improved LVEF. However, IABP devices must be used at an early stage, to obtain optimal results.