ISSN 1671-5411 CN 11-5329/R

2017 Vol. 14, No. 10

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Impact of chronic kidney disease on mortality in older adults treated with pacemaker implantation
Fabio Fabbian, Alfredo De Giorgi, Matteo Guarino, Michele Malagu, Matteo Bertini
2017, 14(10): 597-603. doi: 10.11909/j.issn.1671-5411.2017.10.007
Objective To investigate whether chronic kidney disease could negatively impact survival in older adults needing pacemaker implantation after admission for bradyarrhythmias. Methods This retrospective observational study considered 538 older adults consecutively admitted, who had been followed-up for 31 ± 20 months. Subjects with poor short-term prognosis were excluded. Charlson comorbidity index (CCI) and estimated glomerular filtration rate (eGFR) was calculated, along with the independent relationship between all-cause mortality and clinical data. Hazard Ratio (HR) was calculated by Cox regression analysis. Results Mean age of the population was 85 ± 3.7 years, and causes for implantation were atrioventricular block in 51.9% and other bradyarrhythmias in 48.1% of cases. Mean eGFR was 58.3 ± 24 mL/min per 1.73 m2, and mean CCI was 3.65 ± 2.28. Death for all-causes was recorded in 213 subjects. Deceased patients were older, had lower eGFR, higher comorbidity, higher prevalence of myocardial infarction, congestive heart failure, cerebrovascular disease, dementia and chronic pulmonary disease. Age (HR: 1.081, 95% CI: 1.044–1.119; P P P = 0.033) were predictors of death. Conclusions Renal dysfunction, as well as comorbidity, impacts negatively survival of older adults treated with pacemaker implantation because of bradyarrhythmias.
Effect of Chinese national holidays and weekends versus weekday admission on clinical outcomes in patients with STEMI undergoing primary PCI
Liang TANG, Peng-Fei CHEN, Xin-Qun HU, Xiang-Qian SHEN, Yan-Shu ZHAO, Zhen-Fei FANG, Sheng-Hua ZHOU
2017, 14(10): 604-613. doi: 10.11909/j.issn.1671-5411.2017.10.003
Background Data regarding the influence of weekends and Chinese national holiday’s admission on the outcomes of patients with ST-elevated myocardial infarction (STEMI) is lacking. This study sought to investigate the effect of Chinese national holidays and weekend admission on outcomes in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods Patients presenting with STEMI within 12 h of symptom onset who underwent PPCI were retrospectively enrolled. The primary outcome of in-hospital mortality and major adverse cardiovascular events in patients presenting Chinese national holidays and weekends versus weekdays was evaluated. Results A total of 441 STEMI patients were enrolled in this study. Of these, 129 (29.3%) patients were admitted during Chinese national holidays and weekends and 312 (70.7%) during weekdays. Patients admitted during holidays and weekends were more likely to present with Killip class III-IV. Patients admitted during holidays and weekends experienced a significantly longer door-to-balloon time, symptom onset-to-door time as well as symptom onset-to-balloon time. The in-hospital mortality between patients presenting holidays and weekends versus weekdays was comparable. However, patients admitted during holidays and weekends have a significantly higher rate of in-hospital major adverse cardiovascular events. Multivariate analysis demonstrated that holidays and weekends admission was independently associated with adverse outcomes. Conclusions In China, STEMI patients undergoing PPCI during national holidays and weekends have worse in-hospital outcomes compared to those admitted during weekdays. These findings suggest that continuous efforts should be undertaken to enhance the Chinese healthcare system and to ensure that comparable outcomes are achieved for all STEMI patients regardless of time of presentation.
Combined thrombectomy and intracoronary administration of glycoprotein IIb/IIIa inhibitors improves myocardial reperfusion in patients undergoing primary percutaneous coronary intervention: a meta-analysis
Xiao-Wei NIU, Jing-Jing ZHANG, Ming BAI, Yu PENG, Zheng ZHANG
2017, 14(10): 614-623. doi: 10.11909/j.issn.1671-5411.2017.10.002
Background Suboptimal myocardial reperfusion is common in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Furthermore, it results in increased infarct size and mortality rates. We performed a meta-analysis to evaluate the role of aspiration thrombectomy (AT) combined with intracoronary administration of glycoprotein IIb/IIIa inhibitors (GPI) in the improvement of myocardial reperfusion and clinical outcomes. Methods PubMed, Embase, Web of Science, and CENTRAL databases were searched for randomized controlled trials (RCTs) investigating combined AT and intracoronary GPI treatment versus AT alone. Outcomes of interest were thrombolysis in myocardial infarction myocardial perfusion grade (TMPG), infarct size (IS) assessed by cardiac magnetic resonance imaging, left ventricular ejection fraction (LVEF), major adverse cardiac events (MACE) at short-term (≤ 1 month) and long-term (6?12 months) follow-up, and bleeding complications during the hospital stay. Results Eight trials involving 923 patients were included. Compared with AT alone, combined AT and intracoronary GPI significantly increased TMPG 3 flow (RR: 1.15, 95% CI: 1.04 to 1.26), reduced IS [mean difference (MD): ?3.46, 95% CI ?5.18 to ?1.73], and improved LVEF (MD: 1.44, 95% CI: 0.54 to 2.33). Furthermore, GPI use decreased the risk of MACE at long-term follow-up (RR: 0.60, 95% CI: 0.37 to 0.98). There was no significant difference between the two groups in the incidence of minor and major bleeding complications. Conclusions Our findings showed that compared with AT alone, combined AT and intracoronary GPI treatment resulted in improved myocardial reperfusion, better cardiac function, and MACE-free survival benefits at the long-term follow-up for patients with STEMI undergoing PPCI.
Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly
Vimalraj Bogana Shanmugam, Dennis T Wong, Hashrul Rashid, James D Cameron, Yuvaraj Malaiapan, Peter J Psaltis
2017, 14(10): 624-631. doi: 10.11909/j.issn.1671-5411.2017.10.005
Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention (PCI). Methods This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Australian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians. Results Non-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octogenarians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin (LMWH; 1.0% vs. 5.8%; P vs. 9.6%; P vs. 67.6%; P vs. 5.8%; P = 0.12). There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups. Conclusions In this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.
Age related differences and outcome of patients with Takotsubo syndrome
Aydin Huseynov, Ibrahim El-battrawy, Uzair Ansari, Katja Schramm, Xiaobo Zhou, Siegfried Lang, Martin Borggrefe, Ibrahim Akin
2017, 14(10): 632-638. doi: 10.11909/j.issn.1671-5411.2017.10.001
Background Takotsubo syndrome (TS) is an important cardiac disease that affects predominantly postmenopausal women. This study was conducted to determine the impact of age on the short- and long-term outcome of TS patients. Methods & Results The data from a collective of 114 TS patients with a mean follow-up of 1591 ± 1079 days was retrospectively analysed. The study population was divided into two groups (≤ 65 and > 65 years) so as to evaluate the impact of age on the short- and long-term mortality of TS patients. In-hospital events like life-threatening arrhythmias (14.58% vs. 9.09%; P = 0.036), need for mechanical respiratory support (41.66% vs. 28.78%; P = 0.15) as well as inotropic agent use (22.91% vs. 15.15%; P = 0.29), although not reaching the statistical cut-of, tended to occur more often in the younger group. Heart failure was more common in the elderly age group (P = 0.03). The use of multivariate analysis ruled out age as a significant marker of long term mortality (HR: 1.0; 95% CI: 0.9–1.0; P = 0.60). Conclusions Age does not influence the clinical course of TS in terms of the short- as well as long-term outcome. The study revealed a higher incidence of life threatening arrhythmias in the younger patient age-group and a higher incidence of heart failure among the older group of patients.
Spontaneous type 1 pattern, ventricular arrhythmias and sudden cardiac death in Brugada Syndrome: an updated systematic review and meta-analysis
Ahmed Bayoumy, Meng-Qi GONG, Ka Hou Christien Li, Sunny Hei Wong, William KK Wu, Guang-Ping LI, George Bazoukis, Konstantinos P Letsas, Wing Tak Wong, Yun-Long XIA, Gary Tse
2017, 14(10): 639-643. doi: 10.11909/j.issn.1671-5411.2017.10.010
Topical anaesthesia before transradial approach for supraoartic vessels angiography and stenting in the elderly: a feasible alternative
Gianluca Rigatelli, Marco Zuin, Fabio Dell’Avvocata, Dobrin Vassiliev
2017, 14(10): 644-648. doi: 10.11909/j.issn.1671-5411.2017.10.009
Cardiac resynchronization therapy improved the clinical outcomes in pacemaker patients upgraded to biventricular device
Han JIN, Wei HUA, Li-Gang DING, Jing WANG, Hong-Xia NIU, Min GU, Cong XUE, Shu ZHANG
2017, 14(10): 649-651. doi: 10.11909/j.issn.1671-5411.2017.10.006
Transient severe mitral regurgitation after paroxysmal supraventricular tachycardia in patient with WPW syndrome
Yun-Seok Song, Sang-Hoon Seo, Dong-Kie Kim, Ki-Hun Kim, Doo-Il Kim
2017, 14(10): 652-653. doi: 10.11909/j.issn.1671-5411.2017.10.004
Reversal of Wolff-Parkinson-White Syndrome induced dilated cardiomyopathy via resynchronization and subsequent accessory pathway ablation
Long-Bin LIU, Chang-Zuan ZHOU, Hui LIN, Li-Ping MENG, Chang BIAN, Yu ZHANG, Hang-Yuan GUO
2017, 14(10): 654-656. doi: 10.11909/j.issn.1671-5411.2017.10.008
Comments to “Neutrophil-to-lymphocyte ratio compared to N-terminal pro- brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure”
Kahraman Cosansu, Cagin Mustafa Ureyen
2017, 14(10): 657-658. doi: 10.11909/j.issn.1671-5411.2017.10.011