ISSN 1671-5411 CN 11-5329/R

2018 Vol. 15, No. 2

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Comparison of the safety and efficacy of two types of drug-eluting balloons (RESTORE DEB and SeQuent Please) in the treatment of coronary in-stent restenosis: study protocol for a randomized controlled trial (RESTORE ISR China)
Lei GAO, Qin QIN, Shao-Liang CHEN, Hui CHEN, Le-Feng WANG, Ze-Ning JIN, Hui LI, Jun ZHANG, Jian-An WANG, Yang ZHENG, Guo-Sheng FU, Yun-Dai CHEN
2018, 15(2): 117-122. doi: 10.11909/j.issn.1671-5411.2018.02.004
Comparison of in-hospital outcomes between octogenarians and nonagenarians undergoing transcatheter aortic valve replacement: a propensity matched analysis
Rajkumar Doshi, Vaibhav Patel, Priyank Shah
2018, 15(2): 123-130. doi: 10.11909/j.issn.1671-5411.2018.02.001
Background Aortic valve stenosis (AS) is very common in the elderly patients above 80 years. Transcatheter aortic valve replacement (TAVR) in such patients is being increasingly performed. This study sought to assess in-hospital outcome differences between octogenarians and nonagenarians and predictors of mortality in nonagenarians undergoing TAVR with severe AS. Method The study population was derived from the National Inpatient Sample (NIS) for the years 2012–2014 using ICD-9 CM procedure codes 35.05 and 35.06 for TAVR. Hospitalizations below 80 years of age were excluded. After performing propensity score matching (1: 2), in-hospital outcomes were compared in matched cohorts. Then, multivariate model was developed to analyze predictors of in-hospital mortality in nonagenarians. Results There were 11,630 hospitalizations in the octogenarian and 5815 hospitalizations in the nonagenarian group. Primary outcome of in-hospital mortality (6% vs. 4.1%, P ≤ 0.001) was higher in nonagenarians compared to octogenarians. Secondary outcomes including stroke (3.4% vs. 2.8%, P ≤ 0.001), renal failure (18.9% vs. 17.3%, P ≤ 0.001), blood transfusion (35% vs. 32.6%, P ≤ 0.001), vascular complications (4.5% vs. 3.5%, P ≤ 0.001), and pacemaker implantation (27.8% vs. 24.8%, P ≤ 0.001) were higher in nonagenarians. There was no difference in their length of stay. Median cost (70,374$ vs. 65,381$, P ≤ 0.001) was slightly higher with nonagenarian. Conclusions Although in-hospital mortality is slightly higher in nonagenarians, it is acceptable. This difference in mortality is at least partly explained by higher complications in nonagenarians. Efforts should be made to decrease the complications which can further narrow the difference in in-hospital mortality between the groups.
Patterns of in-hospital mortality and bleeding complications following PCI for very elderly patients: insights from the Dartmouth Dynamic Registry
Shawn X Li, Hannah I Chaudry, Jiyong Lee, Theodore B Curran, Vishesh Kumar, Kendrew K Wong, Bruce W Andrus, James T DeVries
2018, 15(2): 131-136. doi: 10.11909/j.issn.1671-5411.2018.02.006
Background Very elderly patients (age ≥ 85 years) are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention (PCI). However, the relationship between bleeding and mortality in the very elderly is unknown. Methods Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission (bleeding requiring transfusion, access site hematoma > 5 cm, pseudoaneurysm, and retroperitoneal bleed) and in-hospital mortality were reported for four age groups (Results Of 17,378 patients studied, 1019 (5.9%) experienced bleeding and 369 (2.1%) died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age (mortality: 0.94%, 2.27%, 4.24% and 4.58%; bleeding: 3.96%, 6.62%, 10.68% and 13.99% for ages Conclusions Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.
New predictors of in-stent restenosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent
Jian-Long WANG, Zheng QIN, Zhi-Jian WANG, Dong-Mei SHI, Yu-Yang LIU, Ying-Xin ZHAO, Li-Xia YANG, Wan-Jun CHENG, Yu-Jie ZHOU
2018, 15(2): 137-145. doi: 10.11909/j.issn.1671-5411.2018.02.011
Background Percutaneous coronary intervention (PCI) had become the major therapeutic procedure for coronary artery disease (CAD), but the high rate of in-stent restenosis (ISR) still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus (DM) was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent (DES). Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group (n = 74) and the non-ISR group (n = 294). The independent predictors of ISR in patients with DM were explored by multivariate Cox’s proportional hazards regression models. Results A total of 368 patients (260 women and 108 men) with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients (20.11%) by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol (VLDL-C), triglyceride (TG) and uric acid (UA) levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C (HR = 1.85, 95% CI: 1.24–2.77, P = 0.002), UA (per 50 μmol/L increments, HR = 1.19, 95% CI: 1.05–1.34, P = 0.006), SYNTAX score (per 5 increments, HR = 1.34, 95% CI: 1.03–1.74, P = 0.031) and the history of PCI (HR = 3.43, 95% CI: 1.57–7.80, P = 0.003) by the multivariate Cox’s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physicians to take measures to lower the risk of ISR for the better management of diabetic patients after PCI.
Obstructive sleep apnea is associated with severity and long-term prognosis of acute coronary syndrome
Shuo JIA, Yu-Jie ZHOU, Yi YU, Si-Jing WU, Yan SUN, Zhi-Jian WANG, Xiao-Li LIU, Bright Eric King, Ying-Xin ZHAO, Dong-Mei SHI, Yu-Yang LIU, Zhi-Ming ZHOU
2018, 15(2): 146-152. doi: 10.11909/j.issn.1671-5411.2018.02.005
Background Obstructive sleep apnea (OSA) is a common disease in patients with acute coronary syndrome (ACS) and associated with an increased risk of fatal and nonfatal cardiovascular events. However, most patients in previous study were treated with bare metal stents and the sample sizes were relatively low. The goal of this study was to evaluate the influence of OSA on the severity and prognosis of patients admitted for ACS. Methods In this prospective cohort study, we enrolled patients with ACS who were hospitalized for coronary angiogram/percutaneous coronary intervention and undergone polysomnography. We divided the patients into two groups: moderate to severe OSA group [apnea-hypopnea index (AHI) > 15 events/h] and control group (AHI ≤ 15 events/h). They were followed up for up 32 months. Then, we compared the ACS severity and long-term major adverse cardiovascular events (MACE) in patients with different severity of OSA. Results Five hundred and twenty nine patients were included in the final analysis, with 76% of them being men and an average age of 59 ± 10 years. The overall mean AHI is 29 ± 19 events/h, 70.5% of them (373/529) being with moderate to severe OSA and 29.5% (156/529) assign into control group. Compared with controls, patients with moderate or severe OSA exhibited a higher prevalence of hypertension as well as higher body mass index, SYNTAX score, Epworth score and length of hospitalization. With a median follow-up duration of 30 months, accumulative rate of MACE was also higher in patients with moderate or severe OSA than that in the control group (8.6% vs. 3.2%, P = 0.028). After adjusting for baseline confounders by cox regression model, moderate to severe OSA was an independent risk factor of long-term MACE (P = 0.047, HR = 1.618, 95% CI: 1.069–3.869). Conclusions The results of this study demonstrate that moderate or severe OSA is correlated with disease severity and associated with worse long-term prognosis in ACS patients. The results raising the possibility that early diagnose and interventions of OSA could improve long-term outcomes in ACS patients.
Adherence to pharmacological and non-pharmacological treatment of frail hypertensive patients
Beata Jankowska-Polanska, Karolina Zameta, Izabella Uchmanowicz, Anna Szymanska-Chabowska, Donald Morisky, Grzegorz Mazur
2018, 15(2): 153-161. doi: 10.11909/j.issn.1671-5411.2018.02.002
Objective To investigate the relationship between frailty syndrome (FS) and adherence to pharmacological and non-pharmacological treatment for hypertension. Methods The study included 100 patients diagnosed with hypertension and treated with one or more hypotensive drugs. Results Frail patients obtained low scores (4.1 ± 2.0) for adherence to pharmaceutical treatment of hypertension, while non-frail patients obtained moderate scores (6.1 ± 2.1). Non-frail patients had higher scores in two out of four domains of the Health Behavior Inventory (HBI): positive mental attitudes (3.6 ± 0.4 vs. 3.2 ± 0.5; P = 0.006) and health practices (3.6 ± 0.5 vs. 3.2 ± 0.5; P P P P = 0.036). Education was a statistically significant independent determinant of better adherence to pharmacological treatment (β = 0.82; P = 0.012), while net income positively affected health behaviors as measured by the HBI (β = 0.39; P = 0.046). Conclusions FS is a significant independent factor contributing to worse adherence to pharmacological and non-pharmacological treatment of hypertension. Better education significantly improves patients’ adherence to the prescribed pharmacological treatment, while a good financial standing evidenced by high net income is a determinant of better adherence to health-related behaviors recommended in hypertension treatment.
Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease: a meta-analysis
Kong-Yong CUI, Shu-Zheng LYU, Xian-Tao SONG, Fei YUAN, Feng XU, Min ZHANG, Ming-Duo ZHANG, Wei WANG, Dong-Feng ZHANG, Jing DAI, Jin-Fan TIAN, Yun-Lu WANG
2018, 15(2): 162-172. doi: 10.11909/j.issn.1671-5411.2018.02.009
Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent (DES) is safe and effective compared to coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (ULMCA) disease at long-term follow up (≥ 3 years). Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction (MI) or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. Results Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint (HR = 0.94, 95% CI: 0.86-1.03). Besides, DES was significantly associated with higher incidence of MI (HR = 1.56, 95% CI: 1.09-2.22) and repeat revascularization (HR = 3.09, 95% CI: 2.33-4.10) compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke (HR = 0.80, 95% CI: 0.67-0.95) for ULMCA lesions with SYNTAX score ≤ 32. Conclusions Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity.
Treatment of coronary in-stent restenosis: a systematic review
Leos Pleva, Pavel Kukla, Ota Hlinomaz
2018, 15(2): 173-184. doi: 10.11909/j.issn.1671-5411.2018.02.007
Coronary stent implantation has significantly improved percutaneous coronary intervention and enabled the management of early complications of plain balloon angioplasty. However, a new complication has accompanied these improvements: in-stent restenosis (ISR) arising from neointimal hyperplasia. ISR after coronary angioplasty is currently one of the main limitations of this method, leading to the recurrence of exertional angina pectoris or acute coronary syndromes. The clinical incidence of ISR after bare-metal stent (BMS) implantation is approximately 20%–35%. The use of drug-eluting stents (DES) has led to a further decrease in the occurrence of ISR to 5%–10%. Evidence resulting from controlled clinical studies suggests that DES and drug-eluting balloon catheters (DEB) provide the best clinical and angiographic results in the treatment of ISR. We undertook a systematic review of the pathophysiology, diagnostics and treatment options for BMS- and DES-ISR. We discuss recent randomised studies, comparing different DES or DEB used for BMS or DES-ISR treatment, as well as the use of new biovascular scafolds and the topic of scafold restenosis.
Prediction of sudden death in elderly patients with heart failure
Ana Ayesta, Helena Martinez-Selles, Antonio Bayes de Luna, Manuel Martinez-Selles
2018, 15(2): 185-192. doi: 10.11909/j.issn.1671-5411.2018.02.008
Most heart failure (HF) related mortality is due to sudden cardiac death (SCD) and worsening HF, particularly in the case of reduced ejection fraction. Predicting and preventing SCD is an important goal but most works include no or few patients with advanced age, and the prevention of SCD in elderly patients with HF is still controversial. A recent reduction in the annual rate of SCD has been recently described but it is not clear if this is also true in advanced age patients. Age is associated with SCD, although physicians frequently have the perception that elderly patients with HF die mainly of pump failure, underestimating the importance of SCD. Other clinical variables that have been associated to SCD are symptoms, New York Heart Association functional class, ischemic cause, and comorbidities (chronic obstructive pulmonary disease, renal dysfunction and diabetes). Some test results that should also be considered are left ventricular ejection fraction and diameters, natriuretic peptides, non-sustained ventricular tachycardias and autonomic abnormalities. The combination of all these markers is probably the best option to predict SCD. Different risk scores have been described and, although there are no specific ones for elderly populations, most include age as a risk predictor and some were developed in populations with mean age > 65 years. Finally, it is important to stress that these scores should be able to predict any type of SCD as, although most are due to tachyarrhythmias, bradyarrhythmias also play a role, particularly in the case of the elderly.
Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations
Andras Vereckei, Laszlo Geller
2018, 15(2): 193-198. doi: 10.11909/j.issn.1671-5411.2018.02.012
Intravascular ultrasound guided retrograde guidewire true lumen tracking technique for chronic total occlusion intervention
Liang-Hong YING, Yuan-Sheng FAN, Yi LU, Ke XU, Chun-Jian LI
2018, 15(2): 199-202. doi: 10.11909/j.issn.1671-5411.2018.02.010
Thyrotoxicosis induced cardiogenic shock rescued by extracorporeal membrane oxygenation
Seunghwan Kim, Sang-Hoon Seol, Yun-Seok Kim, Dong-Kie Kim, Ki-Hun Kim, Doo-Il Kim
2018, 15(2): 203-204. doi: 10.11909/j.issn.1671-5411.2018.02.003