1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mo...1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.展开更多
BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary...BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.After 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.展开更多
Background To report quality control methods and baseline reproducibility data of the ultrasound measurements of carotid artery intima-media thickness in the project of Establishment of an Integrated System for Corona...Background To report quality control methods and baseline reproducibility data of the ultrasound measurements of carotid artery intima-media thickness in the project of Establishment of an Integrated System for Coronary Heart Disease Prevention and Treatment. Methods Standard ultrasound scanning and measuring protocols were established by the study group. All sonographers and readers were trained by the carotid ultrasound core lab and all digital ultrasound images were centrally read. Ten subjects were scanned twice （with 1 week interval） by 2 sonographers independently and images were read by a single reader to evaluate the sonographer variability. Twenty subjects＇ images were read twice （with 1 week interval） by a single reader to assess the reader variability and the reproducibility of IMT measured at different carotid segments. Results The intraclass correlation （ICC） of intra- and inter-sonographer and intra- reader for mean IMT measurements was 0.99, 0.98 and 0.97 respectively; while for max IMT, it was 0.97, 0.99 and 0.95 respectively. Among different carotid segments and sites, ICC for mean 1MT measurements of common carotid （CCA）, carotid artery bulb （Bulb）, internal carotid artery （ICA）, overall near wall and overall far wall was 0.97, 0.99, 0.89, 0.93 and 0.98 respectively. Conclusion The reproducibility of IMT measurements according to our protocol is acceptable, although better reproducibility is found when measuring the mean IMT than max IMT, CCA and Bulb IMT than ICA IMT, and far wall IMT than near wall IMT.展开更多
Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort...Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.展开更多
BACKGROUND Catheter ablation for atrial fibrillation(AF)is commonly performed worldwide.However,the clinical charac-teristics of hospitalized patients with AF and national trends in catheter ablation at tertiary hospi...BACKGROUND Catheter ablation for atrial fibrillation(AF)is commonly performed worldwide.However,the clinical charac-teristics of hospitalized patients with AF and national trends in catheter ablation at tertiary hospitals in China remain unreported.METHODS This study used the Chinese national database(Hospital Quality Monitoring System)from 2013 to 2016,which is a mandatory database that collects the front page of patients’medical records for hospital accreditation,to describe the clinical cha-racteristics of patients with AF as an overall cohort and as subgroups divided by catheter ablation and sex.RESULTS Of 597,919 AF patients first admitted,57,983 patients underwent catheter ablation[56,384 cases(97.2%)of radiofre-quency ablation and 1599 cases(2.8%)of cryoablation]at 746 tertiary hospitals.Nearly 10%of patients hospitalized with AF at ter-tiary hospitals in China underwent catheter ablation,and the percentage of patients undergoing catheter ablation was on the rise bet-ween 2013 and 2016,and the number of cases increased by 2.5 times.Compared with AF patients who did not undergo catheter ablation,those who did were younger,more frequently male,and had fewer baseline comorbidities.Although the overall CHA_(2)DS_(2)-VASc score revealed over half of the patients were high-risk,patients who underwent catheter ablation were mostly low-risk(71.2%of males and 59.1%of females).Considering in-hospital adverse events,the overall pericardial tamponade and all-cause death incidences were 0.2%(0.6%in the ablation group)and 1.2%(0.1%in the ablation group),respectively;both of which were higher in females than males.CONCLUSIONS In this study,AF patients who underwent catheter ablation were relatively young,had a low thrombosis risk,and had few comorbidities and adverse events.Females were older and experienced more complications than males.展开更多
文摘1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.
基金We thank all hospitals and staff participating in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project.The CCC-ACS Project is a collaborative project of the American Heart Association and the Chinese Society of Cardiology.The American Heart Association received funding from Pfizer through an independent grant for learning and change and AstraZeneca as a quality improvement initiative.
文摘BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.After 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.
文摘Background To report quality control methods and baseline reproducibility data of the ultrasound measurements of carotid artery intima-media thickness in the project of Establishment of an Integrated System for Coronary Heart Disease Prevention and Treatment. Methods Standard ultrasound scanning and measuring protocols were established by the study group. All sonographers and readers were trained by the carotid ultrasound core lab and all digital ultrasound images were centrally read. Ten subjects were scanned twice （with 1 week interval） by 2 sonographers independently and images were read by a single reader to evaluate the sonographer variability. Twenty subjects＇ images were read twice （with 1 week interval） by a single reader to assess the reader variability and the reproducibility of IMT measured at different carotid segments. Results The intraclass correlation （ICC） of intra- and inter-sonographer and intra- reader for mean IMT measurements was 0.99, 0.98 and 0.97 respectively; while for max IMT, it was 0.97, 0.99 and 0.95 respectively. Among different carotid segments and sites, ICC for mean 1MT measurements of common carotid （CCA）, carotid artery bulb （Bulb）, internal carotid artery （ICA）, overall near wall and overall far wall was 0.97, 0.99, 0.89, 0.93 and 0.98 respectively. Conclusion The reproducibility of IMT measurements according to our protocol is acceptable, although better reproducibility is found when measuring the mean IMT than max IMT, CCA and Bulb IMT than ICA IMT, and far wall IMT than near wall IMT.
基金provided by Isuru Wijesoma from MediTech Media(Singapore),which was funded by AstraZeneca in accordance with Good Publication Practice(GPP3)guidelines。
文摘Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.
基金supported by the China-WHO Biennial Collaborative Projects 2016–2017(No.2016/648722–0).
文摘BACKGROUND Catheter ablation for atrial fibrillation(AF)is commonly performed worldwide.However,the clinical charac-teristics of hospitalized patients with AF and national trends in catheter ablation at tertiary hospitals in China remain unreported.METHODS This study used the Chinese national database(Hospital Quality Monitoring System)from 2013 to 2016,which is a mandatory database that collects the front page of patients’medical records for hospital accreditation,to describe the clinical cha-racteristics of patients with AF as an overall cohort and as subgroups divided by catheter ablation and sex.RESULTS Of 597,919 AF patients first admitted,57,983 patients underwent catheter ablation[56,384 cases(97.2%)of radiofre-quency ablation and 1599 cases(2.8%)of cryoablation]at 746 tertiary hospitals.Nearly 10%of patients hospitalized with AF at ter-tiary hospitals in China underwent catheter ablation,and the percentage of patients undergoing catheter ablation was on the rise bet-ween 2013 and 2016,and the number of cases increased by 2.5 times.Compared with AF patients who did not undergo catheter ablation,those who did were younger,more frequently male,and had fewer baseline comorbidities.Although the overall CHA_(2)DS_(2)-VASc score revealed over half of the patients were high-risk,patients who underwent catheter ablation were mostly low-risk(71.2%of males and 59.1%of females).Considering in-hospital adverse events,the overall pericardial tamponade and all-cause death incidences were 0.2%(0.6%in the ablation group)and 1.2%(0.1%in the ablation group),respectively;both of which were higher in females than males.CONCLUSIONS In this study,AF patients who underwent catheter ablation were relatively young,had a low thrombosis risk,and had few comorbidities and adverse events.Females were older and experienced more complications than males.
