儿童厌食症危险因素的1∶4配比病例对照研究

目的:探索儿童厌食症发生的危险因素?方法:以社区为基础的1∶4配比病例对照研究,结合问卷调查和血清维生素A测定,采用条件Logistic回归模型分析危险因素?结果:多因素条件Logistic回归分析显示,儿童进食不定量(OR=1.500,95%CI=1.071~2.101,P = 0.018)?挑食偏食(OR=1.780,95%CI=1.267~2.501,P = 0.001)?家长强制儿童进食(OR=2.133,95%CI=1.491~3.054,P < 0.001)?患有消化道疾病(OR=3.106,95%CI= 1.955~4.933,P < 0.001)?近2周患有呼吸道感染(OR=1.669,95%CI=1.112~2.513,P = 0.013)?出生后喂养困难(OR=1.946,95%CI=1.284~2.950,P = 0.002)以及血维生素A缺乏(OR=3.222,95%CI=1.660~6.256,P = 0.001)与厌食症存在显著关联?结论:应该纠正儿童不良饮食习惯,普及科学知识以及适时补充维生素A,以减少儿童厌食症的发生?     

糖皮质激素静脉冲击疗法与常规口服治疗在Graves眼病中应用的Meta分析

目的:评价糖皮质激素静脉冲击疗法与常规口服治疗应用于Graves眼病的临床有效性及安全性?方法:以计算机及手工检索国内外比较糖皮质激素静脉冲击疗法及常规口服治疗在Graves眼病患者中应用的随机对照研究(RCT),按照Cochrane系统评价方法,筛选文献?评价纳入文献质量,使用Revman5.2软件进行系统统计分析?结果:共检索到相关文献54篇,评价后纳入5项研究,共265例患者,其中糖皮质激素静脉冲击疗法组134例,常规口服治疗组131例?Meta分析研究结果显示:①临床效果:糖皮质激素静脉冲击治疗组较常规口服治疗组可有效改善患者临床活动度评分(WMD=0.82,95%CI:0.61~1.03,P < 0.001)?突眼度(WMD = 0.62,95%CI:0.11~1.12,P = 0.02)?眼裂宽度(WMD = 0.72,95%CI:0.14~1.30,P = 0.01),但两组在改善复视方面无明显统计学差异(OR = 1.51,95%CI:0.77~2.95,P = 0.23)?②安全性:静脉冲击疗法组较口服治疗组有较低的不良事件发生率(OR = 0.16,95%CI:0.08~0.30,P < 0.001)?结论:与常规口服治疗组比较,静脉冲击疗法对Graves眼病具有更好的治疗效果,且安全性高?     

BioMatrix Biolimus A9生物可降解支架治疗冠心病安全性和有效性的Meta分析

目的系统评价BioMatrix Biolimus A9生物可降解支架(BioMatrix BES)用于经皮冠状动脉介入术的安全性和有效性。方法计算机检索Cochrane临床对照试验中心注册库、PubMed数据库,检索时限自2005年1月—2015年12月,搜集针对BioMatrix BES与金属裸支架(BMS)或第二代药物洗脱支架(DES)有效性和安全性比较的随机对照试验(RCT)。采用RevMan 5.2软件对纳入的试验结果进行Meta分析。结果共纳入4项研究计6 063例患者,术后随访9~12个月。Meta分析显示:BioMatrix BES在主要不良心血管事件发生率(OR=0.79,95%CI 0.55~1.13,P=0.20)、心源性病死率(OR=0.89,95%CI 0.62~1.28,P=0.53)、心肌梗死发生率(OR=0.94,95%CI 0.57~1.54,P=0.80)、靶血管血运重建率(OR=0.66,95%CI 0.36~1.23,P=0.19)、靶病变血运重建率(OR=0.64,95%CI 0.34~1.21,P=0.17)、支架内血栓形成率(OR=0.64,95%CI 0.37~1.11,P=0.11)等方面均与DES或BMS相似。结论 BioMatrix BES在冠状动脉介入术后1年内的安全性和有效性方面均不劣于传统的BMS或DES。     

血管内超声以及冠状动脉造影引导下支架植入术效果比较的meta分析

目的血管内超声(IVUS)引导植入支架的效果目前仍存在争议,该研究旨在探讨血管内超声以及传统造影(Angiography)引导下支架植入效果在临床上的优劣比较。方法全面检索2000年1月—2014年6月国内外研究文献,筛选出符合评价标准的文献,采用Rev Man5.0软件进行分析。以支架植入术后死亡、心肌梗死、靶血管血运重建、支架内血栓形成以及主要心血管不良事件为主要临床终点,分析血管内超声与血管造影植入支架效果之间的差异。结果血管内超声引导下支架植入术后心肌梗死(RR=0.67,95%CI:0.56~0.81;Z=4.08,P<0.0001)、靶血管血运重建(RR=0.76,95%CI:0.66~0.87;Z=3.87,P=0.0001)、支架内血栓形成(RR=0.62,95%CI:0.47~0.82;Z=3.35,P=0.0008)以及主要不良事件(RR=0.82,95%CI:0.73~0.91;Z=3.62,P=0.0003)的发生率均低于传统造影下支架植入术,差别有统计学意义。结论说明血管内超声支架植入术能显著降低术后心梗、靶血管血运重建、支架内血栓及主要不良时间的发生,相比传统冠脉造影更能让患者获益。     

药物洗脱支架与金属裸支架置入术后对糖尿病患者远期死亡、心肌梗死和支架血栓发生情况的影响

目的本研究通过比较糖尿病患者置入金属裸支架(bare metal stents,BMS)vs药物洗脱支架(drug eluting stents,DES)后发生死亡、心肌梗死(myocardial infarction,MI)、再次血运重建和支架血栓的情况,以评价糖尿病患者置入DES后的远期安全性和有效性。方法本研究于2003年7月～2005年12月连续入选了834例因冠心病合并糖尿病在首都医科大学附属北京安贞医院心内科行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者,按置入支架类型将患者分为DES组(n=583)和BMS组(n=251)。主要终点事件为24个月时全因病死率;次要终点事件为24个月时非致死性MI、再次血运重建以及主要不良心血管事件(major adverse cardiac events,MACE)的发生率。结果本研究结果经多因素回归分析显示,DES组明显降低了24个月时死亡[3.2%vs 5.1%,危险比(hazard ratio,HR)0.34,95%可信区间(confidential interval,CI)0.12～0.94,P=0.038]和心性死亡的风险(2.2%vs 4.4%,HR=0.29,95%CI:0.13～0.87,P=0.027),非致死性MI和心性死亡与非致死性MI复合终点发生风险比较差异无统计学意义;明确和可能的支架血栓的发生风险比较差异也没有统计学意义(1.9%vs 2.0%,HR=0.96,95%CI:0.51～2.17,P=0.351)。DES明显降低了再次血运重建的风险(10.5%vs 20.7%,HR=0.24,95%CI:0.11～0.78,P<0.001)和靶血管再次血运重建的风险(8.9%vs 17.1%,HR=0.33,95%CI:0.16～0.87,P<0.001);与BMS组比较DES组的MACE的风险也明显降低,差异有统计学意义(15.8%vs 27.9%,HR=0.19,95%CI:0.09～0.85,P<0.001);其主要与DES组患者的死亡和靶血管再次血运重建的风险降低有关。结论与BMS相比,DES可显著降低糖尿病患者的24个月时死亡、再次血运重建和MACE的风险,而未增加非致死性MI和支架血栓的风险。置入DES后死亡风险的降低原因,主要与DES降低再狭窄后的死亡和MI风险,获得更高的完全血运重建率以及未增加支架血栓的风险相关。     

药物涂层球囊与药物洗脱支架治疗急性心肌梗死的Meta分析

目的 对比药物涂层球囊和药物洗脱支架在接受急诊冠状动脉介入治疗的急性心肌梗死(acute myocardial infarction,AMI)患者中的疗效。方法 通过计算机检索万方、中国知网、PubMed、Cochrane Library等数据库,筛选符合条件的临床研究。采用Rev-Man 5.4软件进行统计学分析。结果 最终纳入7项研究,共905例患者,包括球囊组418例,支架组487例。Meta分析结果表明,两种治疗方案在主要心血管不良事件 (OR=1.00,95%CI:0.55~1.82, P=1.00)、心源性死亡(OR=1.04,95%CI:0.32~3.34, P=0.95)、再发心肌梗死(OR=1.11,95%CI:0.38~3.21, P=0.85)、靶血管血运重建(OR=4.93,95%CI:0.83~29.39, P=0.08)、靶病变血运重建(OR=0.51,95%CI:0.19~1.38, P=0.18)等方面比较差异无统计学意义;球囊组患者晚期管腔丢失优于支架组(MD=-0.22, 95%CI:-0.32~-0.12, P＜0.001)。结论 药物涂层球囊治疗AMI的效果不劣于药物洗脱支架,相比支架置入有更少的晚期管腔丢失。     

应用胰管外支架对术后胰瘘影响的Meta分析

目的:评价在胰十二指肠切除术中使用胰管外支架对术后胰瘘发生的影响?方法:检索万方?中国知网?Sinomed中文数据库和PubMed?Web of Science?CochraneCentral Register of Controlled Trials外文数据库,筛选有关胰管外支架放置与否的临床随机对照研究为纳入文献,选择危险比(risk ratio,RR)及95%的可信区间(confidenceintervals,CI)为合并效应量,对提取数据进行Meta分析?结果:共有6篇文献符合纳入标准,其中胰管外支架组280例,无支架组281例?Meta分析结果显示两组在胰瘘率(RR = 0.54,95%CI:0.39 ~ 0.74),特别是在B?C级胰瘘(RR = 0.55,95%CI:0.37 ~ 0.82)及胰管无扩张的胰瘘(RR = 0.50,95%CI:0.34 ~ 0.73)上的差异具有统计学意义(P < 0.05)?同时两组在术后总并发症率和住院时间上的差异亦具有统计学意义(P < 0.05)?然而,两组在病死率?腹腔脓肿?腹腔出血?胃排空减慢?输血?二次手术?手术时间?术中失血量上的差异均无统计学意义(P > 0.05)?结论:应用胰管外支架可以有效减少术后胰瘘的发生,并且有利于术后病程的改善?该法安全可行,值得临床推广应用?     

早期微量喂养对我国低出生体重儿的效果评价——meta分析

目的:为评价早期微量喂养对我国低出生体重儿的相关影响?方法:主题词交叉联合检索中国生物医学文献?中国学术期刊全文?万方?维普数据库?获得建库以来至2014年相关文献,检索MEDLINE 以发现国内研究者在非中文期刊上发表的非重复报告?结果:共纳入24个临床试验,①早期微量喂养组达全胃肠时间短于对照组(WMD= -5.73;95%CI:-6.68~-4.78;P < 0.01);②早期微量喂养组每日体重增长高于对照组(WMD= 3.64;95%CI:1.85~5.44;P < 0.001);③早期微量喂养组恢复至出生体重时间短于对照组(WMD=-2.59;95%CI:-3.35~-1.83;P < 0.001);④早期微量喂养组新生儿坏死小肠结肠炎(NEC)发生率与对照组无明显差异(OR= 0.70;95%CI:0.35~1.41;P=0.32);⑤早期微量喂养组喂养不耐受发生率明显低于对照组(OR= 0.38;95%CI:0.24~0.60;P < 0.001);⑥早期微量喂养组低血糖发生率低于对照组(OR= 0.19;95%CI:0.10,0.35;P < 0.001)?结论:早期微量喂养患儿在达足量肠内营养时间?恢复至出生体重时间?体重增长等方面优于静脉营养组;同时可减少低血糖?NEC?喂养不耐受等并发症的发生?     

普拉格雷和氯吡格雷对冠心病患者疗效和安全性的Meta分析

目的比较普拉格雷(prasugrel)与氯吡格雷(clopidogrel)治疗冠心病的疗效和安全性。方法计算机检索Pub Med、Medline、Cochrane Central Register of Controlled Trials、CNKI全文数据库,收集2006年1月~2014年6月公开发表的有关普拉格雷和氯吡格雷疗效比较的随机对照试验(RCT),手检已获文献的参考文献、会议摘要及相关网站。对文献质量进行严格评价后,对符合要求的RCTs进行资料提取并采用Rev Man5.0软件进行Meta分析。结果共纳入5项RCTs,Meta分析显示,普拉格雷组与氯吡格雷组之间全因病死率(OR=0.94,95%CI:0.86~1.16,P=0.32)、心肌梗死(MI)发生率(OR=0.82,95%CI:0.68~1.00,P=0.05)、脑卒中发生率(OR=0.96,95%CI:0.75~1.22,P=0.72)均无统计学意义;普拉格雷组主要不良心脏事件(MACE)发生率(OR=0.45,95%CI:0.34~0.59,P=0.000)、支架内血栓发生率(OR=0.79,95%CI:0.63~0.98,P=0.04)均低于氯吡格雷组,但大出血发生率(OR=1.26,95%CI:1.03~1.55,P=0.02)高于氯吡格雷组。结论在冠心病双重抗血小板治疗中,第2代P2Y12二磷酸腺苷受体拮抗剂普拉格雷能更显著降低MACE发生率、支架内血栓发生率,在全因病死率、MI发生率、脑卒中发生率与氯吡格雷相似,但能增加大出血的风险。     

达比加群酯对非瓣膜性房颤患者抗凝治疗效果及安全性的Meta分析

目的评价达比加群酯对非瓣膜性房颤患者抗凝治疗的效果及安全性。方法检索有关达比加群酯对非瓣膜性房颤患者抗凝治疗的随机对照试验及多中心对照研究等文献,并进行质量评估,采用RevMan 5.2对符合条件的研究进行Meta分析,评价达比加群酯对非瓣膜性房颤患者的抗凝效果及安全性。结果符合纳入标准的文献共7篇(中文1篇,英文6篇),总样本量为33 502例。Meta分析显示,与华法林比较,达比加群酯明显降低房颤患者脑卒中发生率(OR=0.82,95%CI 0.73⁰.93,P=0.001)、全因出血率(OR=0.86,95%CI 0.790.93,P=0.001)、全因出血率(OR=0.86,95%CI 0.79⁰.95,P=0.003)及颅内出血发生率(OR=0.42,95%CI 0.290.95,P=0.003)及颅内出血发生率(OR=0.42,95%CI 0.29⁰.62,P=0.001);而动脉栓塞率(OR=0.75,95%CI 0.450.62,P=0.001);而动脉栓塞率(OR=0.75,95%CI 0.45¹.25,P=0.28)及全因死亡率(OR=0.91,95%CI 0.821.25,P=0.28)及全因死亡率(OR=0.91,95%CI 0.82¹.00,P=0.06)无明显差异。结论达比加群酯可有效降低房颤患者脑卒中、全因出血及颅内出血的风险,疗效优于传统药物华法林且安全性高。     

Can “Hybrid stent implantation” improve long-term safety without adversely affecting efficacy when treating multilesion coronary artery disease in the drug-eluting stent era?

Background  Though drug-eluting stent (DES) almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decrease the use of DES, probably improving the long-term safety but not affecting efficacy adversely when treating multilesion coronary artery disease in the DES era.

Methods  From April 2004 to October 2006, 848 patients with multilesion disease underwent hybrid stent implantation. During the same period 5647 patients with multilesion coronary heart disease were treated by exclusive DES implantation in Fu Wai Hospital. According to propensity score matching, we chose 823 pairs of patients with multileison coronary artery disease for inclusion into our study. We obtained the 24-month clinical outcome including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We used Cox’s proportional-hazard models to assess relative risks of all the outcome measures after propensity match.

Results  At 24 months, patients in the hybrid stent implantation group showed a significantly higher risk of TLR (8.39% vs. 3.28%, HR 2.38, 95% CI: 1.50–3.70), TVR (11.07% vs. 6.32%, HR 1.61, 95% CI: 1.15–2.27) and MACE (13.75% vs. 8.75%, HR 1.37, 95% CI: 1.02–1.85). No significant difference was apparent in terms of mortality (1.22% vs. 1.70%, HR 0.55, 95% CI: 0.24–1.25), MI (1.95% vs. 2.31%, HR 0.73, 95% CI: 0.37–1.42), or thrombosis (definite+probable) (0.73% vs. 1.58%, HR 0.40, 95% CI: 0.15–1.05).

Conclusions  In patients with multilesion coronary artery disease, the exclusive DES implantation was associated with significantly lower risks of TLR, TVR and MACE, and the hybrid stent implantation did not result in any significant improvements regarding safety issues. Prospective studies are needed to confirm our results.

     

Long-term outcome of patients of over 85 years old with acute coronary syndrome undergoing percutaneous coronary stenting: a comparison of bare metal stent and drug eluting stent

Background Patients aged over 85 years have been under-represented in percutaneous coronary intervention （PCI） trials despite an increase in referrals for PCI. The long-term safety and efficacy of percutaneous coronary stenting in patients aged over 85 years with acute coronary syndrome （ACS） remain unclear. Moreover it is unknown whether there are differences between bare metal stent （BMS） and drug eluting stent iDES） in this special population.
Methods A total of 80 patients with ACS aged over 85 years undergoing stenting （BMS group n=21 vs DES group n=59） were retrospectively studied. In-hospital, one year and overall clinical follow-up （12-36 months） of major adverse cardiac events （MACEs） including cardiac deaths, myocardial infarction, target lesion revascutarization （TLR） and target vessel revascularization （TVR） as well as stroke and other major bleeding were compared between the two groups.
Results In the entire cohort, the procedure success rate was 93.8% with TIMI-3 coronary flow post-PCI in 93.8% of the vessels and the procedure related complication was 17.5%. The incidence of in-hospital MACEs in BMS group was higher （14.3% vs 6.8%, P=0.30）. The 1-year incidence of MACEs in DES group was 7.0% while there was no MACE in the BMS group. Clinical follow-up for 12-36 months showed that the overall survival free from MACE was 82.9% and the incidence of MACE in the BMS group was lower （5.3% vs 21.1%, P=0.20）. Multivariate regression analysis showed that the creatinine level （OR：. 1.013; 95%CI： 1.006-1.020; P=0.004） and hypertension （OR; 3.201; 95%CI： 1.000-10.663; P=0.04） are two major factors affecting the long-term MACE.
Conclusions Percutaneous coronary stenting in patients aged over 85 years is safe and provides good short and tona-term efficacy. Patients with renal dvsfunction and hvoertension may have a relatively hiah incidence of MACE.     

血管内超声成像的临床应用价值

目的 通过前瞻性临床研究,探讨血管内超声成像（IVUS）的临床应用价值。方法 437例冠心病或可疑冠心病患者同时行冠脉造影（CAG）和IVUS检查,包括135例CAG正常者的IVUS检查结果,52例介入治疗前后CAG和IVUS的比较,150例钙化病变CAG和IVUS比较及47例IVUS、53例CAG引导支架置入的心脏事件比较。结果 IVUS能发现CAG正常患者的冠状动脉继样硬化病变。CAG会高估冠状动脉腔内成形术（PTCA）介入效果。与CAG比较,IVUS能比较准确地判断介入治疗的效果及其并发症,并可阐明PTCA的机制,IVUS引导支架置入显著减少心脏事件的发生。结论 IVUS与CAG的区别在于冠脉造影只能显示冠状动脉腔的造影剂轮廓;而IVUS则显示了绝然不同的血管解剖,通过血管截面积成像识别血管内膜腔及管壁的结构,IVUS在引导冠心病的介入治疗中也具有重要作用。     

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: outcomes of 3-year clinical follow-up

Background  The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation.  

Methods  A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n=83) or BMS (n=108) implantation in the infarction related artery according to physician’s discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups.

Results  The clinical follow-up duration was 3 years ((41.7±16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P=0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P=0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P=0.379) and stent thrombosis (1.20% vs. 1.85%, P=0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P=0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P=0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n=73) and paclitaxel-eluting stents (PES, n=10) subgroups (2.74% vs. 20.00%, P >0.05).

Conclusions  This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.     

Efficacy of stenting for unprotected left main coronary artery disease in 297 patients

Background Angioplasty in the unprotected left main coronary artery （LMCA） has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug eluting stent （DES）, for treatment of unprotected LMCA disease. Methods Between September 1997 and December 2005, a total of 297 consecutive patients underwent percutanous coronary intervention （PCI） on LMCA lesions in our hospital. Their in-hospital data and clinical follow-up outcomes were analyzed and those in pre-DES ＂＇era＂ （group I, from September 1997 to December 2002） were compared with those in DES ＂era＂ （group Ⅱ, from January 2003 to December 2004. Patients in 2005 for the time of follow-up less than one year were not included in this group）. Results Altogether 368 coronary stents were successfully deployed in 295 patients. Stents failed to be implanted after balloon predilation in two patients, who received coronary artery bypass graft （CABG） successfully. Bifurcation techniques for distal LMCA executed in 206 patients （69.4%, 2061297）, included crossover stenting in 156 （75.7%）, T stenting in 4 （1.9%）, provisional T stenting in 28 （13.6%）, kissing stenting in 5 （2.4%） and stent crushing in 13 （6.3%） patients. During their hospital stay, 5 （1.7%） patients died after PCI procedure, of which 4 died from cardiac origin and one of renal failure. The total in-hospital major adverse cardiac events （MACE） were 2.0% （6/297）. In the follow-up period, 19 patients （6.5%） died [15 （5.1%） of cardiac death and 4 of non-fatal myocardial infarction （MI）]. Besides, 2 （0.7%） developed subacute thrombosis （SAT） and 16 （5.4%） performed target lesion revascularization （TLR）. The total follow-up MACE was 14.5% （431297）. Further analysis also showed that, compared with patients in group I, those in group II apparently had more multi-vessel involvement （14.7% vs 81.9%, P〈0.001）, and more bifurcation lesions （32.4% vs 72.2%, P〈0.001）. After PCI, in-hospital MACE of group II was significantly lower than that in group I （1.1% vs 9.4%, P〈0.05）. And the incidences of MACE, TLR and angiographic restenosis in group II were all significantly lower than those in group I （all P〈0.05） after one year follow-up. Conclusions As new PCI strategies and intervention devices such as DES are developed, coronary stenting, which might have brought better in-hospital and long-term outcomes than CABG are proved to be technically successful and can be safely applied for the treatment of LMCA lesions in the experienced center for coronary intervention.     

Long-term efficacy and safety of drug-eluting stent implantation for patients with multiple coronary chronic total occlusions

Background Data on the efficacy and safety of drug-eluting stent （DES） for treatment of multiple coronary chronic total occlusion （CTO） lesions are scanty. The aim of the present study was to compare the long-term outcomes of DES versus bare metal stent （BMS） implantation for multiple coronary CTO lesions.Methods We analyzed 188 patients who underwent coronary stenting for at least two de novo CTO lesions in our center from November 2000 to November 2006. Among them, 118 patients （62.8%） received DES and 70 patients （37.2%） received BMS implantation after the recanalization for CTO lesions. All patients were followed up for up to 5 years for the occurrence of major adverse cardiac events （MACE）. Long-term survival rates were estimated with the Kaplan-Meier method.Results There were no significant differences in baseline clinical characteristics and procedural success rate between DES group and BMS group. Compared with the BMS group, the DES group showed a significantly higher rate of long CTO （≥15 mm） （62.0% vs. 50.6%, P=0.023）. The number of stents per lesion （1.39±0.71 vs. 1.17±0.66, P=0.007） and the mean length of stents in the DES group were also higher than those in the BMS group （（40.8±11.4） mm vs. （23.4±8.7） mm, P〈0.001）. But the mean diameter of stents in the DES group was smaller than that in the BMS group （（3.1 ±0.2） mm vs. （3.3±0.5） mm, P〈0.001）. Average follow-up time was 4.8±0.7 （1.5-5.0） years in the BMS group and 4.3±0.5 （1.3-5.0） years in the DES group. Both the 5-year cumulative survival rates and the target vessel revascularization （TVR）-free survival rates of the DES group were significantly higher than those in the BMS group （83.1% vs. 72.9%, Log-rank P=0.044; 77.1% vs. 62.9%, Log-rank P=0.009）. The cumulative MACE-free survival rates in the DES group were significantly higher than those in the BMS group （71.2% vs. 51.4%, Log-rank P=0.001）. Multivariable Cox regression analysis demonstrated that DES implantation for multiple CTO lesions could significantly reduce the long-term MACE risk after percutaneous coronary intervention （PCI） （HR. 0.436; 95%C/ 0.327-0.665, P 〈0.001）. Age over 65 years （HR. 2.018; 95%CI1.491-3.127, P〈0.001） and left ventricular ejection fraction 〈50% （HR. 1.494; 95%CI1.125-2.376, P 〈0.001） were identified as the independent predictors of long-term MACE.Conclusion This study demonstrates the long-term （up to 5 years） efficacy and safety of DES for treatment of multiple coronary CTO lesions, and its superiority compared to BMS in reducing the rates of TVR and MACE.     

Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly

Objectives:

To investigate whether intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) could improve clinical outcomes compared with angiography-guided PCI in the treatment of unprotected left main coronary artery stenosis (ULMCA) in the elderly.

Methods:

This controlled study was carried out between October 2009 and September 2012, in Qinhuangdao First Hospital, Hebei Province, China. One hundred and twenty-three consecutive patients with ULMCA, aged 70 or older, were randomized to an IVUS-guided group and a control group. The occurrence of major adverse cardiac events (MACE): death, non-fatal myocardial infarction, or target lesion revascularizations) were recorded after 2 years of follow-up.

Results:

The IVUS-guided group had a lower rate of 2-year MACE than the control group (13.1% versus 29.3%, p=0.031). The incidence of target lesion revascularization was lower in the IVUS-guided group than in the control group (9.1% versus 24%, p=0.045). However, there were no differences in death and myocardial infarction in the 2 groups. On Cox proportional hazard analysis, distal lesion was the independent predictor of MACE (hazard ratio [HR]: 1.99, confidence interval [CI]: 1.129-2.367; p=0.043); IVUS guidance was independent factor of survival free of MACE (HR: 0.414, CI: 0.129-0.867; p=0.033).

Conclusion:

The use of IVUS could reduce MACE in elderly patients undergoing ULMCA intervention.Intravascular ultrasound (IVUS) may help to evaluate the target lesion and ensure adequate stent expansion during percutaneous intervention. A meta-analysis1 reviewed 5 studies and showed that there were no difference in death, non-fatal myocardial infarction (MI), and major adverse cardiac events (MACE) between IVUS-guided percutaneous coronary intervention (PCI) and angiography-guided PCI using bare-metal stents, other studies,2-5 showed that IVUS use could reduce adverse clinical events compared with angiography guidance. Intravascular ultrasound use may have more benefit in left main (LM) PCI using drug-eluting stent. A recently published study5 demonstrated that survival free of MACE at 3 years was higher in the IVUS group, and the incidence of stent thrombosis was lower in the IVUS group. However, the recent studies did not focus on the elderly, which are a sector of the population that is increasing in China. The elderly patients with unprotected left main coronary artery (ULMCA) generally have multi vessel disease and several risk factors. Due to the influence of culture and faith, these patients would choose PCI rather than coronary artery bypass graft in China. Does IVUS provide clinical benefit for these elderly patients? There are no controlled randomized trials to answer this question. Thus, the purpose of the present study is to investigate whether the IVUS-guided PCI is superior to the angiography-guided PCI during the long-term clinical follow-up in the elderly patients with ULMCA.     

Impact of weight gain following smoking cessation on one-year outcome after drug-eluting stent implantation

Background  Weight gain following smoking cessation increases cardiovascular risk, but its effects on prognosis after percutaneous coronary intervention (PCI) remain unclear. This study aimed to investigate the relationship between weight gain post smoking cessation and one-year clinical outcome in patients who underwent PCI with drug-eluting stent (DES).

Methods  A total of 895 consecutive male smoking patients were divided into quitters (n=437) and continuers (n=458) according to their smoking status after PCI. Weight gain, major adverse cardiac events (MACE, including cardiac deaths, myocardial infarction and revascularization), and recurrent angina were recorded during follow-up for one year.

Results  Average weight gain in quitters was more than that in continuers (1.5 kg vs. –0.03 kg, P <0.001). Weight was unchanged or increased by more than 1.5 kg in 78.17% of continuers, while 50.57% of quitters had a weight gain of less than 1.5 kg. Compared with continuers, MACE in quitters was significantly reduced after PCI (6.12% vs. 4.81%, P=0.049), especially recurrent angina (13.97% in continuers vs. 9.84% in quitters, P=0.027). After adjusting for weight gain and other factors, smoking cessation was independently associated with a lower risk of MACE and recurrent angina (OR=0.73, P=0.035). However, weight gain >1.5 kg (OR=1.55, P=0.026) could curtail the benefits from smoking cessation.

Conclusions  Weight gain may reduce the benefits of smoking cessation after PCI with DES implantation. Thus, although smoking cessation is recommended after PCI, weight control should also be highly encouraged for these patients.     

Comparison of a five-year clinical outcome between Chinese women and men with de novo coronary disease treated with implantation of a drug-eluting stent: a three-center, prospective, registry study

Background  The gender-based differences in adverse events after drug-eluting stent (DES) implantation between Chinese women and men have not been fully studied. The present study aimed to compare the 5-year clinical outcome after DES implantation in Chinese women and men.

Methods  Chinese women (n=298) and men (n=698) with newly diagnosed de novo coronary lesions were studied after DES implantation. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) over a 5-year follow-up, including myocardial infarction (MI), cardiac death, and target vessel revascularization (TVR). Propensity score matching (PSM) was used to compare the adjusted MACE rates between sexes.

Results  Women differed in body habitus and had increased fasting cholesterol. Fewer women presented with MI, and they had better cardiac function with less complex disease. The unadjusted rate of MI at 3 years (2.1%) and 5 years (5.0%) and MACE (25.2%) at 5 years in men was significantly higher than that of women (0.3%, 1.0% and 17.8%, P=0.050, P=0.032, and P=0.011, respectively). After PSM, the adjusted adverse events between sexes were similar. The stent thrombosis rate rapidly increased after 2 years in men.

Conclusions  There were significant gender-based differences in baseline characteristics. Chinese men had equivalent outcomes to women after DES after adjustment by PSM. The increased rate of MI in men was attributed to an increased unadjusted rate of MACE.