Yuan Jinqing

THE OUTCOMES OF GENDER DIFFERENCES AFTER PERCUTANEOUS CORONARY INTERVENTION IN SMALL CORONARY ARTERIES

Objectives To examine whether gender-based differences existed in outcomes of percutaneous coronary interventions (PCIs) in the same coronary arteries. Methods A total of 1350 consecutive CAD patients undergoing PCI with lesions ≤3.0 mm in reference vessel diameter were divided into male group and female group. Angiopraphic analysis was performed by independent observes. Statistical analysis was performed using R and SPSS software. A p value <0.05 was considered statistically significant. Results (1) Clinical characteristics: Members of the female group were older, and had higher rates of angina and comorbid conditions (diabetes mellitus and hypertension) but were less likely to have had prior surgical or percutaneous coronary revascularisation procedures. (2) Angiographic lesion characteristics: The characteristics were similar except that there were significantly more bifurcation lesions, less pre-TIMI grade 3 flow and less procedural success. (3) Half-year outcomes: there was no significant difference in the rate of MACEs or other subgroups (target lesion revascularisation, actual myocardial infarction, restenosis). Conclusions Women have worse short-term outcomes after PCI when all coronary artery diameters are included. But when we select the same coronary artery diameters, women have similar rates of short-term MACEs. So maybe the diameter of coronary artery is the most importance factor contributing to gender-based differences in outcomes of percutaneous coronary interventions.

e0284 Intravascular ultrasound (IVUS) characteristics of premature coronary heart disease (CHD) patients with different risk factors

Objectives To observe lesion characteristics of premature coronary heart disease (CHD) patients with different risk factors by intravascular ultrasound (IVUS). Methods Among 114 premature CHD patients examined by IVUS, quantitative method and qualitative method were adopted to analyse characteristics of coronary artery plaques, and to observe the proportion of different plaques, cross-sectional areas (CSA) surrounded by external elastic membrane, lumen CSA, plaque burden, lumen area stenosis rate and remodelling index of patients with different risk factors. Results Among the CHD patients with traditional risk factors, there is no statistical difference except in lesion extent and minimum lumen diameter among those CHD patients with hypertension. The lesions are serious and higher ratio of lipid core to plaque among those CHD patients with diabetes. More soft plaques and mixed plaques are observed among those CHD patients with hyperlipidaemia. Lesion length and the ratio of lipid core to plaque were significant difference between premature CHD patients with hyperlipidaemia and control groups. There is no difference on lesion characteristics detected by IVUS between patients with and without family history of CHD. There are more soft plaques and mixed plaques in the premature CHD patients in current smoking group (the p value were <0.05). The lesions were more serious in current smoking patients than those without smoking patients. There were more ruptured plaques in diabetes group. Positive remodelling is a common phenomenon in diabetes group, while more negative remodelling were observed in other groups. Conclusions The ratio of lipid core to plaque tends to be higher in group with risk factors than that in group without risk factors. More ruptured plaques were observed among those CHD patients with diabetes. Therefore, these risk factors should be strictly controlled in primary prevention of CHD.

e0354 Angiographic characteristics of premature coronary heart disease—analyses of single center

Background There are no large-sample published reports prospectively or consecutively assessing the angiographic characteristics of premature coronary heart disease in China. Objectives The present study was carried out to collect and analyse the clinical and angiographic characteristics in a single center. Methods From April 2004 to April 2008, based on the screening condition of male <55 years and female (<65 years), we selected premature coronary heart disease from a dedicated database of coronary angioplasty registry of the Center for Diagnosis & Treatment of Coronary Artery Disease, Fuwai Hospital. They had been subjected to coronary angiogram due to the angina pectoris or asymptomatic myocardial ischaemia in coronary heart disease. Results 4478 consecutive patients (3056 males, 1422 females), average age was (49.9±7.0) years, were defined as coronary heart disease according to clinical manifestation and coronary angiogram. Patients with unstable angina pectoris (UAP), stable angina pectoris (SAP) and without angina pectoris were 2400, 1534 and 544, respectively. The proportion of coronary heart disease, hypertension, hyperlipidaemia, diabetic mellitus (DM), smoking history, prior myocardial infarction (MI), prior percutaneous intervention (PCI), coronary artery bypass graft and history of cerebrovascular diseases were 6.7%, 53.0%, 35.3%, 20.8%, 90.3%, 43.3%, 16.6%, 1.5%, 1.1%, respectively. The ratio of eccentric lesions, concentric lesions, chronic total occlusion lesions (CTO) and calcified lesions were 93.7%, 23% and 42.8%, respectively. Comparison between UAP and SAP, there was more MI, PCI, complex lesions (B2+C), eccentric lesions and calcium lesions among 3934 patients. There were more MI, PCI, DM, hyperlipidaemia, hypertension, cerebrovascular diseases, smoking, eccentric lesions complex lesions, angulated lesions and calcified lesions in male than that in female (all p<0.05). Conclusions The ratio of sex and clinical findings are different in Chinese Premature coronary heart patients. There were more MI, PCI, complex lesions, eccentric lesions and calcified lesions in UAP group, comparison between sexes, there were higher incidences of hypertension, hyperlipidaemia, cerebrovascular disease and smoking history in male.

e0496 Comparative study of impaired with normal left ventricle function patients with triple coronary artery disease

Background Ischaemic cardiomyopathy is one of the fatal courses of coronary heart disease, its clinical characteristics and percutaneous coronary intervention (PCI) effect on it still need to be identified. Methods From April 2004 to April 2007, 4494 consecutive patients with triple coronary arteries disease identified by coronary angiogram (>70% stenosis of each vessel) in our center were divided into two groups according to left ventricle ejection fraction (LVEF) (N group: n=4129, LVEF>40%; L group: n=365, LVEF≤40%). Results Patients in L group was younger (60.6±9.72 vs 65.2±10.7 years; p<0.001). There was more previous myocardial infarction (MI) and diabetes and less hypertension and hyperlipidaemia in L group. Logistic regression analysis indicated that the age, previous MI, diabetes, previous PCI and hyperlipidaemia were independent indexes to left ventricle function of triple vessel disease. Eighty-three and 2301 patients in L and N group (22.7% and 55.7%, respectively) were treated with PCI. The follow-up period of L and N groups were 581±298 and 639±293 days, respectively. MACE rate was significantly high in L group (38.6% vs 18.9%; p<0.001), which was contributed by cardiac death, no fatal MI and TVR (9.6% vs 0.9%; p<0.001, 7.2% vs 2.0%; p<0.001 and 21.7% vs 16.0%; p=0.173, respectively). There was no difference of total stent thrombosis or its components in both groups (total: 3.9% vs 3.5%; p=1.000, early: 0.2% vs 0.9%; p=0.256, late: 0.7% vs 1.3%; p=0.404 and very late: 3.1% vs 1.3%; p=0.201, respectively). Seven month Angiographic follow-up indicated that both in-stent and in-segment restenosis rate were significantly higher in L group (21.0% vs 11.1%; p=0.034 and 24.0% vs 12.2%; p=0.018). Conclusion This one center, large sample study showed clinical characteristics of ischaemic cardiomyopathy, MI and diabetes might contribute to its morbidity, and PCI might prevent its morbidity. PCI of patients with triple coronary arteries disease and impaired left ventricle (LV) function leaded to worse outcomes when compared with normal LV function.