Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiograph...Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the fimctional significance of bifurcation lesions. The fractional flow reserve （FFR） is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.展开更多
Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which f...Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome （ACS）. Methods Patients aged 〉 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease （CAD）--specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression. Results Of the 352 patients, 152 （43.18%） were considered frail according to the study instrument （5-7 on the scale）, and 93 （26.42%） were considered moderately or se- verely frail （6-7 on the scale）. Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients （P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively）. Adjusted for sex, age, severity of coro- nary artery diseases （left main coronary artery lesion or not） and co-morbidities （CAD specific index） by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes： all-canse mortality [Hazard Ratio （HR） = 5.393; 95% CI： 1.477-19.692, P = 0.011] and unscheduled return visit （HR - 2.832; 95% CI： 1.140-7.037, P = 0.025）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.展开更多
ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life （QOL） after co-ronary artery bypass （CABG） surgery.MethodsA total of 180 CABG patients （mean a...ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life （QOL） after co-ronary artery bypass （CABG） surgery.MethodsA total of 180 CABG patients （mean age of 63.5 ± 10.1 years, 82.2% males） completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons （35% of sample）. After adjustment for covariates, delirium was significantly associated with depression [odds ratio （OR）： 1.08; 95% confidence interval （CI）： 1.03-1.13,P = 0.003], anxiety （OR： 1.07; 95% CI： 1.02-1.13,P= 0.01） and stress （OR： 1.05; 95% CI： 1.00-1.09,P= 0.03）. Preoperative depression scores were associated with poorer QOL including bodily pain （β =-0.39,P = 0.013）, vitality （β=-0.32,P = 0.020）, social functioning （β=-0.51,P≤0.001）, emotional role function （β=-0.44,P = 0.003） and general health （β=-0.33,P = 0.038）. Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.展开更多
BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （...BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）. This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up （P〈0.001）, the CABG relative to PCI group showed more significant improvements in angina frequency （P= 0.044） and quality of life （P= 0.028）. In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency （OR： 1.62, 95%CI： 1.09-4.63,P= 0.042） and quality of life （OR： 2.04, 95%CI： 1.26-6.92,P= 0.038） relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.展开更多
Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy and left ventricular apical ballooning syndrome, is characterized by transient systolic dysfunction of the apical and mid-segments of the left vent...Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy and left ventricular apical ballooning syndrome, is characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle with the abscence of coronary occlusion, This disease typically occurs in postmenopausal women of an advanced age after emotional or physical stress. Although the prognosis is generally favorable, acute fatal complications have been reported in a small subset of patients. Some patients died with acute cardiac complications, on the other hand, other patients died with underlying critical illness which triggered stress-induced cardiomyopathy.展开更多
Depression is a common medical problem and is more prevalent among patients with coronary artery disease. Whether early detection and treatment of depression will enhance cardiovascular outcome is uncertain. Obviously...Depression is a common medical problem and is more prevalent among patients with coronary artery disease. Whether early detection and treatment of depression will enhance cardiovascular outcome is uncertain. Obviously, the safety and efficacy of the anti-depression drugs is an important link. This article reviews the patho-physiologic and behavioural links between depression and cardiovascular disease progression, the treatment of depression, and the potential benefits of anti-depressants in patients with coronary disease.展开更多
To the Editor I have read the article entitled ＂Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft＂ by Anatol＇evna, et al. with great int...To the Editor I have read the article entitled ＂Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft＂ by Anatol＇evna, et al. with great interest. The investigators reported that independent predictors of postoperative atrial fibrillation （POAF） after coronary artery bypass graft （CABG） in eld- erly patients were left atrium dimension （LA） and the in- creased postoperative concentration of Interleukin （IL）-6, IL-8 and superoxide dismutase.展开更多
Objective To investigate the relationships between vascular factors and plaque morphology in the patients with acute coronary syndrome（ACS）. Methods Intravascular ultrasound（lVUS） was performed on 56 consecutively...Objective To investigate the relationships between vascular factors and plaque morphology in the patients with acute coronary syndrome（ACS）. Methods Intravascular ultrasound（lVUS） was performed on 56 consecutively enrolled patients with ACS. Cytometric bead array for seven vascular factors（sPE,t-PA, MCP-1, IL-8,1L-6,sVCAM-1, and sCD40L） was measured by cytometry. The others biomarkers were tested by ELISA or biochemistry. Differences in bio-factors were compared between vulnerable plaque and non- vulnerable plaque groups, accte myocardial infarction （AMI） and ustable angina （UA） patients, and occurring plaque rupture. The relationship between the parameters of morphology and vascular factors was analyzed. Results There were positive correlations between sVCAM-lsPE, sVCAM-I-sCD40L, sCD40L-sPE, IL-6-ILS,ILS-MCP1, and MCPI-sVCAM-1; CRP （18.868±4.907mg/L vs 5.806±3.553 mg/L）and IL-6 （19.5 pg/ml [9.2 - 44.6 pg/ml]vs 5.3 pg/ml [2.3- 13.4 pg/ml]）were elevated in the vulnerable plaque group（P 〈0.05）. sCD40L（473.82± 126.11 vs 237.94± 34.78 pg/ml）,sPE （107.21±39.90 vs 49.06 ±5.61ug/L） and MCP-1（132.42 ± 17.85 vs 127.17±13.27 pg/ml） were increased in the plaque rupture group（P 〈 0.05）;There was correlation between tPA and plaque morphology（P 〈 0.05）. Increases in sCD40L, MCP-1, sPE, and TC were independent factors for plaque rupture. Conclusions IL-6 and CRP may be biomarkers for vulnerable plaque and for diagnosis ofAMI, sCD40L, MCP-1 and sPE are potential markers when for plaque rupture patient present with severe ACS.展开更多
文摘Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the fimctional significance of bifurcation lesions. The fractional flow reserve （FFR） is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.
文摘Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome （ACS）. Methods Patients aged 〉 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease （CAD）--specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression. Results Of the 352 patients, 152 （43.18%） were considered frail according to the study instrument （5-7 on the scale）, and 93 （26.42%） were considered moderately or se- verely frail （6-7 on the scale）. Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients （P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively）. Adjusted for sex, age, severity of coro- nary artery diseases （left main coronary artery lesion or not） and co-morbidities （CAD specific index） by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes： all-canse mortality [Hazard Ratio （HR） = 5.393; 95% CI： 1.477-19.692, P = 0.011] and unscheduled return visit （HR - 2.832; 95% CI： 1.140-7.037, P = 0.025）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.
文摘ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life （QOL） after co-ronary artery bypass （CABG） surgery.MethodsA total of 180 CABG patients （mean age of 63.5 ± 10.1 years, 82.2% males） completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons （35% of sample）. After adjustment for covariates, delirium was significantly associated with depression [odds ratio （OR）： 1.08; 95% confidence interval （CI）： 1.03-1.13,P = 0.003], anxiety （OR： 1.07; 95% CI： 1.02-1.13,P= 0.01） and stress （OR： 1.05; 95% CI： 1.00-1.09,P= 0.03）. Preoperative depression scores were associated with poorer QOL including bodily pain （β =-0.39,P = 0.013）, vitality （β=-0.32,P = 0.020）, social functioning （β=-0.51,P≤0.001）, emotional role function （β=-0.44,P = 0.003） and general health （β=-0.33,P = 0.038）. Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.
文摘BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）. This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up （P〈0.001）, the CABG relative to PCI group showed more significant improvements in angina frequency （P= 0.044） and quality of life （P= 0.028）. In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency （OR： 1.62, 95%CI： 1.09-4.63,P= 0.042） and quality of life （OR： 2.04, 95%CI： 1.26-6.92,P= 0.038） relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.
文摘Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy and left ventricular apical ballooning syndrome, is characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle with the abscence of coronary occlusion, This disease typically occurs in postmenopausal women of an advanced age after emotional or physical stress. Although the prognosis is generally favorable, acute fatal complications have been reported in a small subset of patients. Some patients died with acute cardiac complications, on the other hand, other patients died with underlying critical illness which triggered stress-induced cardiomyopathy.
文摘Depression is a common medical problem and is more prevalent among patients with coronary artery disease. Whether early detection and treatment of depression will enhance cardiovascular outcome is uncertain. Obviously, the safety and efficacy of the anti-depression drugs is an important link. This article reviews the patho-physiologic and behavioural links between depression and cardiovascular disease progression, the treatment of depression, and the potential benefits of anti-depressants in patients with coronary disease.
文摘To the Editor I have read the article entitled ＂Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft＂ by Anatol＇evna, et al. with great interest. The investigators reported that independent predictors of postoperative atrial fibrillation （POAF） after coronary artery bypass graft （CABG） in eld- erly patients were left atrium dimension （LA） and the in- creased postoperative concentration of Interleukin （IL）-6, IL-8 and superoxide dismutase.
文摘Objective To investigate the relationships between vascular factors and plaque morphology in the patients with acute coronary syndrome（ACS）. Methods Intravascular ultrasound（lVUS） was performed on 56 consecutively enrolled patients with ACS. Cytometric bead array for seven vascular factors（sPE,t-PA, MCP-1, IL-8,1L-6,sVCAM-1, and sCD40L） was measured by cytometry. The others biomarkers were tested by ELISA or biochemistry. Differences in bio-factors were compared between vulnerable plaque and non- vulnerable plaque groups, accte myocardial infarction （AMI） and ustable angina （UA） patients, and occurring plaque rupture. The relationship between the parameters of morphology and vascular factors was analyzed. Results There were positive correlations between sVCAM-lsPE, sVCAM-I-sCD40L, sCD40L-sPE, IL-6-ILS,ILS-MCP1, and MCPI-sVCAM-1; CRP （18.868±4.907mg/L vs 5.806±3.553 mg/L）and IL-6 （19.5 pg/ml [9.2 - 44.6 pg/ml]vs 5.3 pg/ml [2.3- 13.4 pg/ml]）were elevated in the vulnerable plaque group（P 〈0.05）. sCD40L（473.82± 126.11 vs 237.94± 34.78 pg/ml）,sPE （107.21±39.90 vs 49.06 ±5.61ug/L） and MCP-1（132.42 ± 17.85 vs 127.17±13.27 pg/ml） were increased in the plaque rupture group（P 〈 0.05）;There was correlation between tPA and plaque morphology（P 〈 0.05）. Increases in sCD40L, MCP-1, sPE, and TC were independent factors for plaque rupture. Conclusions IL-6 and CRP may be biomarkers for vulnerable plaque and for diagnosis ofAMI, sCD40L, MCP-1 and sPE are potential markers when for plaque rupture patient present with severe ACS.
