Zhao Yingxin

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.

CARDIAC RESYNCHRONISATION THERAPY EFFECTS COMPARE OF THE SURGERY EPICARDIAL LEAD VERSUS CORONARY SINUS LEAD PLACEMENT

Objectives Cardiac resynchronisation therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement. Two strategies (coronary sinus vs epicardial) for left ventricular (LV) pacing were compared. Methods 33 patients with ejection fraction <35%, widen QRS (168±19 ms) and heart failure were enrolled. For left ventricular stimulation coronary sinus (CS) leads were placed in 19 pts. In 14 patients epicardial (Epi) leads were implanted with video-assisted thoracoscopy. Results All the Epi-lead cases and 13 cases in CS-lead group received the LV lead implantation at the latest activated site examined by Tissue Doppler Imaging. For the entire series QRS-duration decreased from 168±19 to 128±14 ms (P<0.05) without difference between groups. The Epi-lead group got better left ventricle resynchronisation effect than the coronary sinus lead group. There was no hospital mortality in the entire series. The LV lead implantation procedure time was 53.4±16.3 min for Epi-lead group and 136±35.1 min for the CS-lead group (p<0.05). During the follow up there was clinical cardiac function improvement (15/19 in CS-lead group vs 13/14 in Epi-lead group, p>0.05). Threshold of the CS-leads increased significantly compared to Epi-leads (15.7 month control: 2.3±1.6 V vs 1.02±0.4 V/0.5 ms), which had no increase (p<0.05). One case died in the CS-lead group and none died in the Epi-lead group during the follow up. One patient in Epi-lead group and two cases in CS-lead group re-admitted because of the serious heart failure. Conclusions Surgical Epi-lead placement for the resynchronisation therapy is a safe and reliable technique and should be considered as an equal alternative.

Matched case-control study on mechanism of radial artery spasm

Objects The aim of this study is to discuss preliminarily the relationship between vaso-active substances and radial artery spasm (RAS), and provide theoretical evidence for the prevention of RAS. Methods This is a prospective, matched case-control study. The patients who suffered from RAS during coronary angiography were enrolled, and the patients without RAS were matched 1:2 according to same gender, similar age (within 2 years). The diagnostic criteria are clinical definition of RAS based on a questionnaire which was documented by angiography. Blood samples were obtained before the procedure, and were tested for nitric oxide, endothelin-1, prostacyclin, thromboxane A2 and norepinephrine. Logistic regression was made to find out the risk factors of RAS. Results Sixty patients suffered form RAS and 120 patients without RAS were enrolled. The concentration of nitric oxide (63.5875±21.2763 vs 55.6425±18.1542, p=0.351) and thromboxane A2 (0.9768±0.1953 vs 0.7824±0.2051, p=0.284) was of no difference between the RAS group and the control group. The concentration of endothelin-1 (298.5839±65.3291 vs 81.4391±20.4283, p<0.001) and norepinephrine (202.3721±38.3829 vs 56.4828±15.6025, p=0.005) was higher, prostacyclin (8.8294±2.5322 vs 15.5430±4. 8267, p=0.038) was lower in RAS group. Multiple regression showed that endothelin-1 (OR 2.954, 95% CI 1.569 to 5.354, p=0.005) and norepinephrine (OR 4.642, 95% CI 2.619 to 8.332, p=0.018) were the risk factors of RAS during the procedure. Conclusions Multiple regression showed that endothelin-1 and norepinephrine were the risk factors of RAS during the procedure.

e0534 The assessment of significance of intermediate coronary stenosis with intravascular ultrasound

Objective To compare the detection of stenosis by angiography and identified angiographic predictors of severe luminal stenosis on intravascular ultrasound (IVUS) in patients with intermediate coronary stenosis. Methods 450 patients with coronary intermediate stenosis by quantitative coronary angiography (QCA) and underwent IVUS assessment of the lesions artery. The results from IVUS and QCA were compared using unpaired t-test. Multiple regression analysis was performed to identify parameters that could predict the presence of severe stenosis on IVUS. Results A total of 780 stenotic coronary lesions were classified as intermediate by QCA. There was a right correlation between IVUS and QCA with respect to percentage of stenosis, minimum luminal diameter was (2.04±0.18) mm vs (2.0±0.17) mm, respectively, the correlation index R=0.627. Reference segment diameter was (3.28±0.19) mm vs (3.17±0.21) mm, respectively, the correlation index R=0.782. In contrast, there was a difference in the assessment luminal diameter stenosis with minimum luminal area. The stenosis detected by IVUS could find the severity of stenosis, could reduce much MACE relatively. Conclusions In patients with angiographically intermediate lesions, the frequency of severe stenosis detected by IVUS were high, indicating that angiography underestimated the severity of stenosis. Smoking and Hypertension could be used to stratify these lesions into groups with higher risk of MACE.

e0535 The ability of optical coherence tomography for assessment of intermediate coronary stenosis comparison with quantitative coronary angiography

Objective Optical coherence tomography is a new intravascular imaging method with a high resolution of approximately 10 μm. This study aims to examine quantitative optical coherence tomography (OCT) derived measurements intermediate coronary stenosis from quantitative coronary angiography (QCA). Methods 240 patients with coronary intermediate stenosis by quantitative coronary angiography (QCA) and underwent OCT assessment of the lesions artery. The results from QCA and OCT were compared using unpaired t-test. Multiple regression analysis was performed. The latter of MACE was significantly lower than that by QCA detected. Results A total of 118 stenotic coronary lesions were classified as intermediate by QCA. Subgroup of the plaque was analysed, OCT could estimate the fibrous cap thickness, and it was 122±24.7 μm), the reference segment diameter was 3.06±0.12 mm), the minimum luminal diameter was 1.94±0.12 mm). The minimum luminal area was 4.8±1.17 mm2). At 12 months of clinical follow-up, 8 patients was found to have MACE. It was much lower than QCA group. Conclusions In patients with angiographically intermediate lesions, the frequency of severe stenosis detected by OCT were high, indicating that angiography underestimated the severity of stenosis. This unique resolution of OCT suggests that it may be well suited for identifying vulnerable plaques in patients at risk. Optical coherence tomography is a feasible imaging modality in patients and allows us to identify quantitative plaque characters, such as fibrous cap, vulnerable plaque.

e0596 Role of monocyte chemoattractant protein-1 on large arterial structural and functional change in prehypertensive subjects

Background and Objects Elevated blood pressure causes a change in vascular remodelling and arterial stiffeness. Dynamic development of the inflammatory reaction may play a role in the early increase of blood pressure. Monocyte chemoattractant protein-1 (MCP-1) which has a chemotactic effect on monocytes/macrophages, is an initial factor of inflammation. However, whether monocyte chemoattractant protein-1 (MCP-1) is altered in the change of large arterial structure and function in prehypertensive subjects has been incompletely investigated. Method According to the criteria of JNC7, 160 subjects were divided into three groups: (1) normotensive group (n=57), (2) prehypertensive group (n=50) and (3) hypertensive group (n=53). Brachium-ankle pulse wave velocity (BaPWV) was measured by an automatic waveform analyser (Form PWV/ABI) and carotid artery intima-media thickness (IMT) was determined ultrasonographically. MCP-1 mRNA level were obtained by real time RT-PCR. Result In prehypertensives, MCP-1, baPWV and IMT levels are higher than that in normotensives (p<0.01) and lower than that in hypertensives (p<0.01). MCP-1 mRNA level correlated linearly and significantly with baPWV and IMT (p<0.01), even after adjustments for confounding variables. Conclusions Large artery remodelling has been found in prehypertensive subjects. PWV and IMT were closely related to the level of blood pressure. MCP-1 may play a role structural and functional vascular changes in prehypertensive subjects.

e0500 Association between red blood cell distribution width (RDW) and all-cause mortality in patients undergoing percutaneous coronary intervention

Background Red blood cell distribution width (RDW) has been shown to be an independent predictor of mortality in patients with coronary artery disease and in patients with heart failure. However, there are limited clinical studies about the prognostic value of RDW in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). We aimed to examine the association between RDW on admission and the risk of all-cause mortality in patients with CAD undergoing PCI. Methods We analysed RDW values on admission in 800 consecutively adult patients, who were admitted to our hospital undergoing PCI for CAD. In all patients, a baseline blood sample was collected for routine haematological testing, at the same time the plasma level of high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR) and B-type natriuretic peptide (BNP) were tested as well; patients who were anaemic at baseline were excluded. All patients were followed prospectively for all-cause mortality. Results After a median follow up of five (IR 4.6–5.6) years, there were a total of 48 (6%) deaths. RDW was analysed as a categorical variable with empirically determined cut points of 13.2 and 14.5 (low RDW <13.2, medium RDW >/=13.2 to <14.5, high RDW >/=14.5) based on differences in HR for death among RDW deciles. In univariate analysis, higher RDW was a significant predictor of mortality (p<0.01), HR for death in patients with high RDW relative to low RDW was 5.1 (95% CI (CI): 2.0 to 13.0). In the high RDW group, the values of hsCRP, ESR and BNP were higher than that in the low or medium group (p<0.05). Conclusions As RDW is widely available to clinicians as a part of the complete blood cells count, and therefore incurs no additional costs. Higher RDW might be a strong and independent predictor of long-term mortality in patients undergoing PCI who were not anaemic at baseline. Neurohumoral activation may be a mechanistic link between increased RDW and adverse events in patients with CAD undergoing PCI.

e0536 Comparative effects of percutaneous coronary intervention for culprit coronary artery or together with non-culprit coronary artery in patients with multi-vessel coronary artery disease

Background Rapid recanalisation of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI), but strategy for treatment of culprit and non-culprit lesions in multi-vessel coronary artery disease remains unclear. Objectives Aims to examine the 6-month outcomes for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) in multi-vessel coronary artery disease. Methods A total of 1120 patients treated with primary angioplasty between 2008 and 2009 were classified in groups of patients with multi-vessel coronary artery disease (MVD). We examined the associated 6 month outcomes following non-culprit interventions performed at the time of primary PCI. Patients were subdivided in two groups on the basis of the revascularization strategy: 1) patients undergoing PCI of the culprit coronary artery only; 2) patients undergoing PCI of both the culprit coronary artery and non-culprit coronary artery during the initial procedure. All the patients were followed up for 6-month for major adverse cardiac events (MACE). Results The two groups did not differ with respect to baseline clinical and angiographic characteristics. At 6-month, compared with PCI restricted to the culprit coronary artery only, multivessel PCI was associated with higher rates of re-infarction (7.9% vs 2.6%, p<0.001), revascularization (14.5% vs 6.8%, p<0.001), and MACEs (26.7% vs 14.8%, p<0.001). Conclusions Non-culprit coronary interventions were significantly associated with increased mortality. Our data suggest that in patients with MVD, primary PCI should be directed at the culprit coronary artery only, with decisions about PCI of non-culprit lesions guided by objective evidence of residual ischaemia at late follow-up. Further studies are needed to confirm these findings.