Abstract:Aim To determine the relationship between remnant cholesterol (RC) and long-term cardiovascular risk in young patients with coronary artery disease (CAD). Methods 3 200 patients with CAD hospitalized from May 2013 to November 2015 were analyzed retrospectively. They were divided into three groups according to age:young group (＜45 years old), middle-aged group (45～70 years old) and elderly group (≥70 years old); They are divided into high group and low group according to RC levels. The incidence of major adverse cardiovascular event (MACE) was statistically analyzed. KM method was used to evaluate the survival rate without MACE event, and Cox regression was used to evaluate the predictors of clinical endpoint. The dose-response relationship between RC and MACE risk was demonstrated using a restricted cubic spline (RCS) model. Results A total of 3 112 patients were followed up (97.25%), including 160 in young group, 2 390 in middle-aged group, and 562 in elderly group. The median follow-up time was 7.36 years. Among them, 864 cases (27.8%) experienced MACE events. KM curve showed that RC was not a predictor of long-term MACE in patients with CAD of all ages (P＞0.05), nor was it a predictor of MACE in middle-aged and elderly groups (P＞0.05). KM curve and Cox regression showed that RC was an independent predictor of long-term MACE in premature CAD patients, and the risk of MACE increased by 1.07 times for every 1 mmol/L increase in RC (HR=2.7,5%CI:1.35～3.17, P＜0.01). Through calculation and verification, it was found that the optimal cutoff value of RC for predicting the occurrence of MACE in premature CAD patients was 0.94 mmol/L, and the risk of MACE in premature CAD patients with RC＞0.94 mmol/L increased by 1.98 times (HR=2.8,5%CI:1.41~6.32, P＜0.01); Conversely, the risk of MACE was reduced by 66% in premature CAD patients with RC＜0.94 mmol/L (HR=0.4,5%CI:0.16～0.71, P＜0.01). Conclusion RC is an independent predictor of long-term MACE occurrence in premature CAD patients (7.36 years). The optimal cutoff value of RC in this population is 0.94 mmol/L. Controlling RC below 0.94 mmol/L is able to reduce the risk of MACE by 66% in premature CAD patients.

Abstract:Aim To study the effect of remote ischemic postconditioning (RIPostC) on the clinical prognosis of patients with ST-segment elevation myocardial infarction (STEMI) who received direct percutaneous coronary intervention (PCI) and to evaluate the health economics. Methods A total of 309 patients with STEMI diagnosed in the First Affiliated Hospital of Xinjiang Medical University from February 2016 to October 2018 were enrolled in this prospective study.According to the random number table, the patients were divided into two groups:the RIPostC group (n＝155) and the control group (n＝154). Patients in RIPostC group completed three rounds of ischemic postconditioning of lower extremities before direct PCI. The area under creatine kinase isoenzyme (CK-MB), major adverse cardiac events (MACE) and direct medical expenses were compared between the two groups. The average out-of-hospital follow-up was 1.5 years. The incidence of out-of-hospital MACE and the direct medical expenses of re-admission were compared between the two groups. Results The cumulative release of CK-MB within 48 hours after admission in the RIPostC group was lower than that in the control group (P＜0.05). The incidence of total MACE in the RIPostC group was lower than that in the control group (P＜0.05). The incidence of out-of-hospital total MACE in the RIPostC group was lower than that in the control group (P＜0.05), and the out-of-hospital mortality rate was lower than that in the control group (P＜0.05). The cumulative incidence of MACE events in the two groups was compared by Kaplan-Meier curve. The results showed that the Kaplan-Meier curve was significantly separated 50 days after PCI, and the cumulative incidence of out-of-hospital total MACE in the RIPostC group was lower than that in the control group (P＜0.05). The direct medical expenses during hospitalization and re-admission in the RIPostC group were lower than those in the control group (P＜0.05), respectively. Conclusion As an adjuvant therapy in the treatment of PCI, RIPostC can not only improve the clinical prognosis of patients with STEMI, but also reduce the economic burden of patients.

Abstract:Aim To investigate the predictive value of red blood cell distribution width (RDW) for major adverse cardiac events (MACE) in patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods 243 clinical cases with acute STEMI after PCI was retrospectively studied. The incidence of MACE in all patients during hospitalization were carefully recorded. The predictive value of RDW for the incidence of MACE in patients with acute STEMI after PCI was analyzed by the receiver operating characteristic(ROC) curve of RDW levels. All the patients were divided into the high RDW group and the low RDW group according to the best cut-off point we determined. The differences of baseline data, laboratory data, coronary angiography, echocardiographic tissue Doppler imaging and the incidence of MACE were compared between the two groups. Results ROC curve showed that the area under the working characteristic curve of subjects with MACE predicted by RDW was 0.634 (95%CI:0.543～0.725,P＜0.05). When the optimal cut-off point of RDW levels was 13.35%, the sensitivity of predicting MACE was 52.5%, the specificity was 68%. The rate of MACE in the high RDW group(RDW≥13.35%) was higher than in the low RDW group(RDW＜13.35%)(24.42% vs 12.10%, P＜0.05). The multivariate Logistic regression analysis showed that the high RDW levels may be associated with MACE in acute STEMI patients after PCI treatment during hospitalization(OR=3.7,5%CI:1.275～7.093,P＜0.05). Conclusion RDW may be an independent risk factor for MACE in STEMI patients after PCI during hospitalization.

Abstract:Aim To compare the middle and long term prognosis and analyze the influencing factors of chronic total occlusion (CTO) in different branches of coronary artery after percutaneous coronary intervention (PCI) revascularization. Methods A total of 122 patients with CTO confirmed by selective coronary angiography were divided into different branches of lesions according to the lesion location of CTO(left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA)). 113 of them were tried to implement PCI, and the prognosis (survival rate, major adverse cardiac events, left ventricular function) of those with successful PCI and non-revascularization (including unsuccessful PCI and non-PCI) were observed through following up. The middle and long term effects of different branches of CTO after revascularization were compared, and the clinical factors that affect the prognosis were analyzed. Results Among the 113 CTO patients who underwent PCI, 81 cases were successfully revascularized (including 30 cases of RCA, 32 cases of LAD, 5 cases of LCX and 14 cases of two or more branches lesions). The cumulative event-free survival rate in the successful PCI revascularization group was significantly higher than that in the non-revascularization group (70.4% vs 58.5%, P=0.042) during the mean follow-up of (26.7±20.7) months, and the total incidence of adverse events was significantly lower than that in the non-revascularization group (24.7% vs 56.1%, P=0.021). In RCA group, LAD group and two or more CTO lesions group, the incidence of recurrent angina pectoris, heart failure, MACE and all-cause death in those successfully treated with revascularization were significantly lower than that of non-revascularization group (P value of these groups was 0.2,0.7,0.013, respectively). There was no significant difference in LCX group (P=0.408). The total increased left ventricular EF ((3.1±1.4)%) after successful PCI in all patients with CTO was significantly higher than that in the non-revascularization group ((0.3±1.2)%, P=0.038). The ΔEF ((3.6±1.7)%, (4.1±1.8)%,Pü value =0.5,0.038), ΔLAD (P value =0.1,0.035), ΔLVEDD (P value=0.2,0.024), ΔLVESD (P value=0.8,0.031) and ΔRAD (P value=0.7,0.028) after successful revascularization in the RCA group and LAD group was significantly different compared with the same group of patients without revascularization. There was no significant difference about ΔEF(P value=0.5,0.475), ΔLAD (P value = 0.5,0.236), ΔLVEDD (P value=0.7,0.381), ΔLVESD (P value =0.8,0.341), ΔRAD (P value =0.6,0.256) in LCX group and two or more branches group after successful PCI revascularization. Cox proportional risk regression analysis showed that the prognostic factors of CTO patients after PCI revascularization included diabetes history (95%CI:1.253～8.449, P=0.015), serum total bilirubin (95%CI:0.874～0.996, P=0.038), serum uric acid levels(95%CI:1.001～1.007, P=0.006) and J-CTO scores (95%CI:1.135~5.325, P=0.012). Conclusions Successful PCI revascularization of coronary CTO lesions can improve the overall cumulative event-free survival rate in the middle and long term. However, there are differences in the incidence of recurrent angina pectoris, heart failure, MACE, all-cause death and the improvement of left ventricular EF in different branches of CTO lesions. Diabetes history and higher J-CTO scores increases the risk of middle and long term death in CTO patients.

Abstract:Aim To explore the relationship between the TG/HDLC ratio and in-hospital MACE in acute coronary syndrome (ACS) after percutaneous coronary intervention(PCI). Methods A total of 214 ACS patients receiving primary PCI admitted in our hospital from January 2014 to January 2015 were enrolled in this study. Multivariate analysis was conducted to assess whether TG/HDLC ratio was the independent predictor for in-hospital MACE occurrence.And the subjects were divided into three groups according to TG/HDLC ratio. The differences OR of in-hospital MACE between low TG/HDLC ratio group (n＝66), middle TG/HDLC ratio group (n＝74)and high TG/HDLC ratio group (n＝74) were compared. Results After adjusting for age, smoking, hypertension, diabetes, and severity of angiographic coronary disease by the multivariate Logistic regression model, the LogTG/HDLC ratio was the independent risk factor for in-hospital MACE(OR=6.0,5%CI was 1.90~25.06, P=0.003). ACS patients with the higest tertile of TG/HDLC ratio exhibited multivariable-adjusted OR of 3.27 for in-hospital MACE compared with ACS patients with the lowest quartile of TG/HDLC ratio. Conclusion The TG/HDLC ratio is a powerful independent predictor of MACE.

Abstract:Aim To evaluate the late clinical efficacy and safety of anti-platelet therapy between ticagrelor and clopidogrel in unstable angina pectoris after selective PCI. Methods A total of 135 unstable angina pectoris after selective PCI was collected from Nanfang Hospital during January 2014 to December 2014. All patients were divided into ticagrelor group (n＝55) and clopidogrel group (n＝80) according to different anti-platelet therapeutic regimen. Follow-up period was at least 6 months. The endpoints included recurrence rate of angina pectoris, incidence of major adverse cardiac events (MACE), bleeding events and dyspnea. Results The average follow-up time in the ticagrelor group and the clopidogrel group was 13.0±3.2 months and 13.7±3.0 months. The recurrence rate of angina pectoris in the ticagrelor group [18.2% (10/55)] and clopidogrel group [27.5% (22/80)] showed no significant difference (P＝0.21). The incidence of MACE in the ticagrelor group (3/55) and clopidogrel group (6/80) showed no significant difference (P＝0.9).The incidence of bleeding events in the ticagrelor group (9/55) and clopidogrel group (17/80) showed no significant difference (P＝0.48). But the incidence of dyspnea in the ticagrelor group (9/55) and clopidogrel group (4/80) showed significant difference (P＝0.03). Conclusion The late clinical efficacy of anti-platelet therapy with ticagrelor was significant in unstable angina pectoris after selective PCI, and without increasing the risk of bleeding.

Abstract:Aim Fever （body temperature,BT>37.5℃） was a commonly clinic scenery in acute ST-segment elevation myocardial infarction （STEMI） patients with primary percutaneous coronary intervention （PPCI）,while whether it has adverse effect on those patients with short-term prognosis was still unknown. Our study was mainly to observe its short-term adverse effect in STEMI patients with PPCI. Method With a retrospective analysis of 282 STEMI patients undergone PPCI,all patients’ BT peak in hospital was measured and divided into two groups,the fever group （BT>37.5℃） and the control group （BT≤37.5℃）. Compared two groups in the incidence of major adverse cardiac events （including cardiac death,non-fatal myocardial infarction and revascularization）. Results 106 patients were in the fever group with the percentage of 37.6% （106/282）. The white blood cells count,high-sensitivity C reactive protein and troponin I levels in the fever group were obviously higher than that in the control group,the frequency of myocardial infarction in past history and the left ventricular ejection fraction were much lower in the fever group,and there was no significant difference in hypertension,hyperlipidemia,angiography,diabetes mellitus and interventional treatment. The major adverse cardiac events at the sixth month were significantly higher in the fever group. Conclusion The fever is a predicted factor to poor short-term prognosis in STEMI patients with PPCI.

Abstract:Aim To observe the effect of different atorvastatin calcium loading doses on prognosis of unstable angina pectoris （UAP） patients before percutaneous coronary intervention （PCI）. Methods 90 UAP patients were randomly divided into 3 groups （30 patients per group）,after admission,the low-dose group was given 20 mg of atorvastatin calcium everyday in combination with 20 mg of atorvastatin calcium 2 h to 4 h before PCI.The medium-dose group was given 40 mg of atorvastatin calcium everyday in combination with 40 mg of atorvastatin calcium 2 h to 4 h before PCI.The high-dose group was given 60 mg of atorvastatin calcium everyday in combination with 60 mg of atorvastatin calcium 2 h to 4 h before PCI.All patients underwent PCI within 48 h to 72 h after admission.Observe the changes of creatine kinase isoenzyme （CKMB）,cardiac troponin I （cTnI）,high-sensitivity C-reactive protein （hs-CRP） of each group before and after PCI and the major adverse cardiac events （MACE） within 30 days after PCI. Results cTnI and hs-CRP of high-dose group after 24 hours of operation were significantly lower than the low-dose group （P<0.05）.The incidence of myocardial infarction related to PCI of low-dose group,medium-dose group and high-dose group of patients was 23%,13% and 0% （P<0.01） respectively.The incidence of MACE of high-dose group was significantly lower than low dose-group （23% versus 0%,P＝0.005）.The follow-up for 30 days after PCI,three groups had no death and target vessels reascularization event occur. Conclusion Short-term pretreatment with 60 mg atorvastatin calcium each day can reduce significantly procedural myocardial infarction in UAP patients undergoing elective PCI.

Abstract:Aim To investigate the effect and security of Cypher~ TM stent (sirolimus-eluting stent) in patients with coronary heart disease (CHD). Methods 348 CHD cases were treated with 436 Cypher~ TM stents. Among the 348 patients, 86 had ST-segment elevation acute myocardial infarction (AMI), 21 had non-ST-segment elevation AMI, 149 had unstable angina and 92 had stable angina. As for lesion characteristics, diffuse disease was found in 88 cases (25.3%), bifurcation lesions in 62 cases (17.8%), chronic total occlusion lesions in 55 cases (15.8%), in-stent restenosis in 15 cases. The immediate angiographic outcome, six months follow-up results with major cardiac event (MACE) and angiographic follow-up at 6 months had been assessed. Results A successful stenting procedure was achieved in 99.3% patients with CHD. Acute and sub-acute stent thrombosis occurred in 2 patients, late stent thrombosis with AMI occurred in 1 patient. There was 1 case death during the 6 months follow-up. The MACE rate during hospitalization was 0.6% and during 6 months follow-up was 2.9%. Angiographic follow-up at 6 months showed that in-stent restenosis rate (ISR) was 7.1% (restenosis within the stents was 1.8%), the late loss in lesion was 0.16 mm (in-stent was 0.20 mm). The target vessel revascularization (TLR) rate was 5.4%. Conclusion Cypher~ TM stent implantation in CHD is safe and effective, and the ISR rate and TLR rate are significantly lower than that of bare metal stents.