Efficacy of Sirolimus-Eluting Stents Compared with Paclitaxel-Eluting Stents in an Unselected Population with Coronary Artery Disease: 24-Month Outcomes of Patients in a Prospective Non-randomized Registry in Southern Turkey

Background: The efficacy of drug-eluting stents has been shown in randomized trials, but some controversy exists regarding which stent sirolimus-eluting or paclitaxel-eluting is more effective in unselected Turkish patients. Therefore, we investigated the clinical outcomes of patients who were treated with one type of these drug-eluting stents in the real world.Methods: We created a registry and prospectively analyzed data on a consecutive series of all patients who presented to our institution with symptomatic coronary artery disease between February 2005 and March 2007 and who were treated with the sirolimus- or the paclitaxel-eluting stent. The follow-up period after stent implantation was approximately 24 months. The primary end point was a major cardiac event, and the secondary end point was stent thrombosis. Informed consent was obtained from all subjects, and the study protocol was approved by the local ethical committee.Results: In total, 204 patients were treated with either the sirolimus-eluting stent (n = 103) or the paclitaxel-eluting stent (n = 101). The lesions in the 2 arms of the study were treated similarly by conventional technique. At 24-month follow-up, patients who received the paclitaxel-eluting stent showed significantly higher rates of non-Q-wave myocardial infarction (1.9% vs 5.9%; P: .002), target vessel revascularization (1.9% vs 4.9%; P: .002), coronary artery bypass graft surgery (1.9% vs 6.9%; P: .001), and late stent thrombosis (1.9% vs 3.9%, P: .002).Conclusions: Patients who received the sirolimus-eluting stent showed better clinical outcomes compared with those who had the paclitaxel-eluting-stent.     

Comparison of clinical outcomes of Chinese men and women after coronary stenting for coronary artery disease：a multi-center retrospective analysis of 4,334 patients

The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention（PCI） with stent remain unclear.The present study was aimed to compare clinical outcomes in such two populations.From May 1999 to December 2009,4,334 patients with acute myocardial infarction（MI）,unstable angina,stable angina,or silent ischemia,who underwent PCI,were registered at our centers.Among these,3,089 were men and 1,245 were women.We compared these groups with respect to the primary outcomes of MI and secondary outcomes including a composite of major adverse cardiac events（MACE） including cardiac death,MI,target lesion revascularization,target vessel revascularization（TVR）,stent thrombosis（ST）,definite ST and probable ST at one-year follow-up.Chinese male patients had a higher MACE rate（13%vs.10.7%,P =0.039）,mainly led by TVR（9.09%vs.6.98%,P=0.024） at one year,which was significantly different than female patients.Chinese male and female patients showed a significant difference on MACEs.However,there was no significant difference with respect to MI between these groups.     

Effects of combination therapy with celecoxib and doxycycline on neointimal hyperplasia and inflammatory biomarkers in coronary artery disease patients treated with bare metal stents

Purpose

Cyclooxygenase (COX)-2 and matrix metalloproteinase (MMP)-9 play a key role in the pathogenesis of in-stent restenosis. We investigated the effect of a short-term therapy of celecoxib, a COX-2 inhibitor, with or without doxycycline, an MMP inhibitor, after coronary stenting on inflammatory biomarkers and neointimal hyperplasia.

Materials and Methods

A total of 75 patients (86 lesions) treated with bare metal stents were randomized into three groups: 1) combination therapy (200 mg celecoxib and 20 mg doxycycline, both twice daily), 2) celecoxib (200 mg twice daily) only, and 3) non-therapy control. Celecoxib and doxycycline were administered for 3 weeks after coronary stenting. The primary endpoint was neointimal volume obstruction by intravascular ultrasound (IVUS) at 6 months. The secondary endpoints included clinical outcomes, angiographic data, and changes in blood levels of inflammatory biomarkers.

Results

Follow-up IVUS revealed no significant difference in the neointimal volume obstruction among the three treatment groups. There was no difference in cardiac deaths, myocardial infarctions, target lesion revascularization or stent thrombosis among the groups. Blood levels of high-sensitivity C-reactive protein, soluble CD40 ligand, and MMP-9 varied widely 48 hours and 3 weeks after coronary stenting, however, they did not show any significant difference among the groups.

Conclusion

Our study failed to demonstrate any beneficial effects of the short-term therapy with celecoxib and doxycycline or with celecoxib alone in the suppression of inflammatory biomarkers or in the inhibition of neointimal hyperplasia. Large scale randomized trials are necessary to define the role of anti-inflammatory therapy in the inhibition of neointimal hyperplasia.     

Comparison of bypass surgery with drug-eluting stents in diabetic patients with left main coronary stenosis

Purpose

Several studies have compared the effects of coronary stenting and coronary-artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients.

Materials and Methods

We evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a "serious outcome" composite of death, myocardial infarction, or stroke; and target-vessel revascularization).

Results

In-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018).

Conclusion

In this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.     

Genetic variations of the apolipoprotein B gene in Turkish patients with coronary artery disease

Background:?The results of studies that clarify the association of genetic markers at the apolipoprotein B (apo?B) gene (EcoRI and XbaI polymorphisms) with coronary artery disease (CAD) are not consistent and suggest that the effect is context dependent (dependent on ethnicity and sex). The present study represents the first investigation of the apo B gene polymorphisms in Turkish patients with CAD and their influence on lipid levels.

Aim:?The study investigated the association of apo B gene EcoRI and XbaI polymorphisms with CAD and with variation in lipid levels (total cholesterol (T-Chol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), and triacylglycerol (TAG)).

Subjects and methods:?The study group was composed of 150 individuals with angiographically documented CAD and 100 angiographically proven to be healthy controls. PCR-RFLP was used to determine the DNA polymorphisms of the apo B gene.

Results:?The frequencies of apo B genotypes detected with EcoRI (AA, AG, GG) and XbaI (CC, CT, TT) did not differ significantly between case and control subjects. A significant association between EcoRI genotypes and T-Chol (p?≤?0.05), and LDL-Chol (p?≤?0.001) was observed only in CAD patients. Patients with the AA genotype had higher levels of serum T-Chol and LDL-Chol compared with AG. With logistic regression analysis the XbaI TT genotype was found to be associated with CAD prevention. However, no significant differences in lipid variables were determined for the XbaI polymorphisms in the patients with CAD.

Conclusions:?Apo B EcoRI genotypes were not found as risk factors for CAD, whereas XbaI TT genotype was detected to prevent against CAD in our study group.

Résumé. Arrière plan: Les résultats des études qui clarifient l’association des marqueurs génétiques du gène B (apo B) de l’alipoprotéine (polymorphismes EcoRI et XbaI) avec la maladie coronarienne (MC), ne sont pas satisfaisants et suggèrent que l’effet est dépendant du contexte (dépendance par rapport au sexe et à l’ethnicité). Cette étude est la première recherche sur les polymorphismes EcoRI et XbaI du gène apo B chez des patients turcs souffrant de MC et sur leur influence sur les niveaux lipidiques.

But: L’étude explore l’association des polymorphismes EcoRI et XbaI du gène apo B avec la MC et avec la variation des niveaux lipidiques?: cholestérol total (Chol-T), cholestérol de lipoprotéines de haute densité (Chol-LHD), cholestérol de lipoprotéines de basse densité (Chol-LBD) et glycéroltriacyl (GTA)

Sujets et méthodes. Le groupe étudié est composé de 150 individus présentant une angiographie de MC et de 100 individus a angiographie saine. La technique de RFLP-PCR a été utilisée pour déterminer les polymorphismes d’ADN du gène apo B.

Résultats: Les fréquences des génotypes de apo B détectées avec EcoRI (AA, AG, GG) et XbaI (CC, CT, TT) ne diffèrent pas significativement entre patients et contrôles. Une association significative entre génotypes EcoRI et Chol-T (p?≤?0,05) ainsi qu’avec Chol-LBD (p?≤?0,001) n’a été observée que chez les patients à MC. Les patients de génotype AA ont un niveau plus élevé que ceux de génotype AG pour les niveaux de Chol-T et de Chol-LBD dans le sérum. Par analyse de régression logistique, on trouve que le génotype XbaI TT est associé à la prévention de la MC. On n’a cependant pas trouvé de différence significative des variables lipidiques qui serait déterminée par les polymorphismes XbaI chez les patients MC.

Conclusion: Les génotypes apo B EcoRI n’apparaissent pas être des facteurs de risque pour la MC, tandis qu’il apparaît que le génotype XbaI TT protège de la MC dans le groupe étudié.

Zusammenfassung. Hintergrund: Die Ergebnisse von Studien, die die Beziehung zwischen genetischen Markern auf dem Apolipoprotein B (Apo B)-Gen und koronarer Herzkrankheit (coronary artery disease, CAD) klären, sind nicht vereinbar und legen nahe, dass der Einfluss vom Zusammenhang abhängt (je nach ethnischer Zugehörigkeit und Geschlecht). Die vorliegende Studie ist die erste Untersuchung von Apo B-Gen-Polymorphismen und ihrem Einfluss auf Lipidspiegel bei Türkischen Patienten mit CAD.

Ziel: Die Studie untersuchte die Beziehung von Apo B-Gen EcoRI- und XbaI-Polymorphismen mit CAD und mit der Schwankung der Lipidspiegel (Gesamtcholesterin (total cholesterol, T-Chol), High-density lipoprotein Cholesterin (HDL-Chol), Low-density lipoprotein Cholesterin (LDL-Chol) und Triacylglycerol (TAG)).

Probanden und Methoden: Die Studiengruppe bestand aus 150 Personen mit angiographisch dokumentierter CAD und 100 angiographisch gesicherten gesunden Kontrollen. PCR-RFLP wurden benutzt um DNS-Polymorphismen des Apo B-Gens zu bestimmen.

Ergebnisse: Die Häufigkeiten der Apo B-Genotypen, die mit EcoRI (AA, AG, GG) und XbaI (CC, CT, TT) bestimmt wurden, unterschieden nicht signifikant zwischen Patienten und Kontrollpersonen. Eine signifikante Beziehung zwischen EcoRI-Genotypen und T-Chol (p?≤?0,05) und LDL-Chol (p?≤?0,001) wurde nur bei CAD-Patienten beobachtet. Patienten mit dem Genotyp AA hatten höhere Serumspiegel von T-Chol und LDL-Chol, verglichen mit AG. Unter Verwendung einer logistischen Regressionsanalyse fand sich, dass der XbaI TT-Genotyp vor CAD schützt. Allerdings wurden keine signifikanten Unterschiede bei den Lipidvariablen hinsichtlich von XbaI-Polymorphismen bei Patienten mit CAD gefunden.

Zusammenfassung: Es wurde nicht gefunden, dass Apo B EcoRI-Genotypen Risikofaktoren für das Auftreten einer CAD darstellen, allerdings zeigte sich in unserer Studiengruppe, dass der XbaI TT-Genotyp gegen CAD schützt.

Resumen. Antecedentes: Los resultados de los estudios que tratan de aclarar la asociación de los marcadores genéticos en el gen de la apolipoproteína B (apo B) (polimorfismos EcoRI y XbaI) con la enfermedad arterial coronaria (EAC), no son consistentes y sugieren que el efecto depende del contexto (es dependiente de la etnicidad y del sexo). El presente estudio constituye la primera investigación sobre los polimorfismos del gen apo B en pacientes turcos con EAC y su influencia sobre los niveles lipídicos.

Objetivo: El estudio investigó la asociación de los polimorfismos EcoRI y XbaI del gen apo B con la EAC y con la variación en los niveles lipídicos (colesterol total (Col-T), colesterol asociado a lipoproteínas de alta densidad (Col-HDL), colesterol asociado a lipoproteínas de baja densidad (Col-LDL) y triacilglicerol (TAG)).

Sujetos y Métodos: El grupo estudiado estaba compuesto por 150 individuos con EAC documentada angiográficamente y 100 controles sanos, comprobados mediante un angiograma. Se utilizó la PCR-RFLP para determinar los polimorfismos del ADN del gen apo B.

Resultados: Las frecuencias de los genotipos apo B detectados con EcoRI (AA, AG, GG) y XbaI (CC, CT, TT) no diferían significativamente entre los casos y los controles. Se observó una asociación significativa entre los genotipos EcoRI y los niveles de Col-T (p?≤?0,05) y Col-LDL (p?≤?0,001), sólo en pacientes con EAC. Los pacientes con el genotipo AA tenían niveles más altos de Col-T y de Col-LDL séricos comparados con los de genotipo AG. Mediante un análisis de regresión logística se encontró que el genotipo XbaI TT estaba asociado con la prevención de la EAC. Sin embargo, en los pacientes con EAC no se encontraron diferencias significativas en las variables lipídicas para los polimorfismos XbaI.

Conclusiones: No se ha encontrado que los genotipos apo B EcoRI sean factores de riesgo para la EAC, mientras que se detectó que el genotipo XbaI TT prevenía contra la EAC en el grupo estudiado.     

Lymphotoxin alpha LTA+496C allele is a risk factor for periodontitis in patients with coronary artery disease

Periodontitis and coronary artery disease (CAD) are inflammatory diseases and associated with each other. The major histocompatibility complex (MHC) region carries genes involved in immune response and inflammation. We investigated whether the MHC genes correlate with the presence of periodontitis or with the occurrence of periodontal pathogens in patients with CAD. Blood and saliva samples from CAD patients (n = 106) were collected at the time of hospitalization. Nine MHC genetic markers [human leukocyte antigen (HLA)-A, HLA-B, HLA-DRB1, lymphotoxin alpha (LTA) +253(a/g), +496(C/T), +633(c/g), +724(C/A), C4A and C4B)] were typed. Based on panoramic tomography, patients were categorized into nonperiodontitis and periodontitis groups. Two major periodontal pathogens, Aggregatibacter (Actinobacillus) actinomycetemcomitans and Porphyromonas gingivalis, were cultivated and polymerase chain reaction-amplified from salivary samples. Serum immunoglobulin (Ig)A and IgG antibody levels to these pathogens were measured. In the univariate analysis, LTA+496C allele (OR = 5.29; 95% CI = 2.07-13.51, P = 0.00027), and the occurrence of P. gingivalis in saliva (OR = 4.74; 95% CI = 1.64-13.70; P = 0.002) were more frequent in periodontitis when compared with nonperiodontitis. Similarly, serum IgA antibody level against the pathogen was increased in periodontitis (P = 0.048). In the multiple logistic regression analysis, when a wide range of covariates was included, the LTA+496C allele (OR = 10.87; 95% CI = 3.23-36.60; P = 0.00012) and the elevated serum IgA antibody level against P. gingivalis (OR = 1.56; 95% CI = 1.05-2.30; P = 0.026) remained as significant risk factors for periodontitis. In conclusion, the major finding of this study is that the LTA+496C allele is associated with periodontitis in patients with CAD.     

Concomitant multi-vessel disease is associated with a lower procedural death rate in patients treated with percutaneous coronary interventions within the left main coronary artery (from the ORPKI registry)

IntroductionIn this study, we aimed to distinguish differences in the procedural complication rate in a group of patients undergoing percutaneous coronary interventions (PCI) of the left main coronary artery (LMCA) between patients with isolated LMCA disease and multi-vessel disease (MVD) with LMCA involvement and to identify their predictors.Material and methodsWe assessed 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) regarding all PCI procedures performed in Poland in 2015 and 2016. We extracted data of 1,819 patients with isolated LMCA disease and 3,718 patients with MVD and LMCA involvement. We compared those two groups in terms of procedural complications and their predictors.ResultsThe overall rate of procedural complications was significantly higher in patients treated with LMCA PCI both in the group of patients with isolated LMCA (6.5%) and the group with MVD with LMCA involvement (7.3%) compared to the non-LMCA PCI group (1.9%, p = 0.002). Multivariate analysis confirmed that MVD with LMCA involvement is an independent predictor of decreased risk of procedural death in the overall group of patients undergoing PCI of the LMCA (odds ratio: 0.583; 95% confidence interval: 0.4–0.848; p = 0.005).ConclusionsThe MVD involvement in patients treated with PCI of the LMCA may play a protective role. Patients with isolated LMCA involvement undergoing PCI should be subjected to special care and protected by various methods, such as devices to support left ventricle function.     

Cholesterol ester transfer protein,apolipoprotein E and lipoprotein lipase genotypes in patients with coronary artery disease in the Turkish population

The aim of this study was to compare patients with coronary artery disease (CAD) to healthy objects, in order to explore a possible association between CAD and the variants in the gene encoding cholesterol ester transfer protein (CETP), apolipoprotein E (Apo E) and lipoprotein lipase (LPL). The relationship between CETP MspI, apo E and LPL PvuII gene polymorphisms and serum lipids were investigated in 173 patients with CAD and 111 healthy controls. The frequency of Apo epsilon4 (p < 0.05) and CETP M1 (p < 0.01) alleles were higher in the CAD group than in the control group. In the CAD group, those with the Msp M1 allele had higher levels of total cholesterol (TC) (p = 0026) and low-density lipoprotein cholesterol (LDL-C) than those with the Msp M2 allele. Subjects with an epsilon2 allele had the lowest levels of TC and LDL-C, while subjects with the epsilon4 allele had the highest. In the control group, CETP, the Msp M2 allele was associated with a higher level of high-density lipoprotein cholesterol (HDL-C) (p = 0.012) than the Msp M1 allele. The distributions of LPL genotype and allele did not differ between the CAD and control groups. The present study demonstrates that the CETP Msp1 and Apo E gene polymorphisms are associated with variations in lipids in patients with CAD and healthy controls in Turkish population.     

Early and long-term prognosis of patients with coronary artery disease treated with percutaneous coronary interventions in 2005. Experience of single large-volume PCI center

PurposeThe progress which has been made in interventional cardiology contributes to the gradual improvement of the results of CHD (coronary heart disease) therapy. The aim of the study was the assessment of early and long-term prognosis in all the patients with CHD treated invasively in one large-volume PCI center in 2005.Material and Methods1390 consecutive patients with CHD treated with PCI in 2005 were included in the analysis. Patients with ST-elevation myocardial infarction (STEMI) accounted for 50% of cases, patients with stable angina (SA) amounted to 25%, and patients with non-ST elevation acute coronary syndromes (NSTE-ACS) constituted 25%. Mean follow-up was 738 (±237) days.ResultsThe highest mortality during the hospitalization was noted within the STEMI group(SA vs. NSTE-ACS vs. STEMI; 0% vs. 0.3% vs. 4.1%, respectively; p<0.001). The highest mortality during a 2-year follow-up was also observed in the STEMI group (SA vs. NSTE-ACS vs. STEMI, 6.3% vs. 8.5% vs. 13.8%, respectively; p<0.001). Multiple regression model showed that independent risk factors for death during the follow-up were: age, glycaemia at admission, heart rate, blood pressure, ejection fraction, STEMI, ineffective PCI (R=0.3613; F(10.131)=19.672; p<0.0001 for the model).ConclusionsThe highest relative increase of mortality after the discharge of patients with CHD undergoing PCI referred to the patients with NSTE-ACS. However, in the real life PCI practice STEMI patients have the worst hospital and long-term prognosis. Well recognized risk factors for death in patients with CHD are still of great importance in negative prognosis of patients undergoing PCI.     

Association of natriuretic peptide polymorphisms with left ventricular dysfunction in southern Han Chinese coronary artery disease patients

Background: Left ventricular dysfunction (LVD) occurs with myocardial ischemia and coronary artery disease (CAD). The natriuretic peptide system has compensatory vasodilatory, natriuretic and paracrine effects on LVD and subsequent heart failure. The aim of this study was to investigate the relationship between natriuretic peptide polymorphisms and risk of LVD in CAD patients. Methods: We recruited 747 consecutive Southern Han Chinese patients with angiographically confirmed CAD, 201 had a reduced left ventricle ejection fraction (LVEF ≤45%, LVD group) and 546 had a preserved left ventricle ejection fraction (LVEF >45%). The reduced and preserved LVEF groups were matched by gender and age. Taqman assays were performed to identify five polymorphisms in the NPPA-NPPB locus (rs5065, rs5063, rs632793, rs198388 and rs198389). Results: Single-locus analyses found no significant difference in the allele and genotype frequencies of the reduced and preserved LVEF group, even after adjusting for confounding factors. Subgroup analyses performed by hyperlipidemia (HLP) demonstrated 3 polymorphisms, rs632793 (OR = 0.31, 95% CI 0.1-0.93, P = 0.04), rs198388 (OR = 0.26, 95% CI 0.09-0.79, P = 0.02) and rs198389 (OR = 0.26, 95% CI 0.09-0.80, P = 0.02) were associated with the reduced risk of LVD. No CAD-susceptible haplotypes were identified. Multifactor dimensionality reduction analysis did not detect any gene-to-gene interactions among the five loci. Three loci (rs5063, rs632793 and rs198388) formed the best model with the maximum testing accuracy (39.89%) and cross-validation consistency (10/10). Conclusion: Three NPPA-NPPB polymorphisms (rs632793, rs198388 and rs198389) were associated with reduced risk of LVD in CAD patients with HLP.     

药物涂层球囊与药物洗脱支架治疗老年2型糖尿病并冠状动脉小血管病变的安全性比较

文题释义：雷帕霉素药物洗脱支架：由金属裸支架基体、雷帕霉素药物涂层和输送系统3部分组成。支架材料选用316L医用不锈钢,表面涂覆药物(雷帕霉素)和高分子载体混合涂层;输送系统即快速球囊扩张导管,选用医用尼龙高分子材料。适用于冠状动脉狭窄或闭塞引起的心肌缺血或心绞痛,病变血管直径在2.5-4.0 mm之间,病变长度在14.0-36.0 mm之间,经皮冠状动脉介入术后结果不满意,病变残留狭窄明显,经皮冠状动脉介入后出现急性的和/或预兆性堵塞。雷帕霉素是一种新型大环内酯类免疫抑制剂,通过不同的细胞因子受体阻断信号传导,阻断T淋巴细胞及其他细胞由G₁期至S期的进程,发挥免疫抑制效应。紫杉醇药物涂层球囊：由2部分组成,一个标准的血管成形术球囊导管来提供基础的输送装置,扩张靶向病变部位;另一部分是药物涂层,其在球囊表面的紫杉醇量为3 μg/mm²;主要靠药物在血管内壁的释放发挥作用。球囊扩张20 s时药物释放达到了接近90%,在45 s时药物已经释放率94%以上;药物丢失率平均值控制在5%以内。紫杉醇药物涂层球囊可用于治疗小血管病变、分叉病变、部分冠状动脉血管原发病变,以及不能耐受或不适合长期服用抗血小板药物的患者。药物涂层球囊虽然能有效地抑制血管平滑肌细胞再生,但不能有效抑制血管壁弹性回缩,后者在血管再狭窄中起着至关重要的作用。背景：研究发现药物涂层球囊可减少冠状动脉小血管病变晚期管腔丢失,术后6个月主要不良心血管事件发生率与药物洗脱支架相似,但其对于老年2型糖尿病并冠状动脉小血管病变患者疗效目前尚缺乏临床研究。目的：比较药物涂层球囊与药物洗脱支架治疗老年2型糖尿病并冠状动脉小血管病变的的疗效及安全性。方法：选择2016年1月至2018年9月焦作市人民医院收治的老年2型糖尿病并冠状动脉小血管病变患者122例,按照数字表法随机分为药物洗脱支架组(n=62)和药物涂层球囊组(n=60)。两组均先用半顺应性球囊进行预扩张,随后植入对应的支架材料。术前及术后即刻、6个月、12个月分别进行选择性定量冠状动脉造影,观察两组患者靶病变最小管腔直径、残余狭窄程度、管腔增加及晚期管腔丢失等指标;术后随访6,12个月的主要不良心血管事件及出血事件。研究经焦作市人民医院医学伦理学委员会审核批准(201503)。结果与结论：①药物涂层球囊组手术成功率高于药物洗脱支架组(P=0.028);②术后即刻,药物涂层球囊组最小管腔直径及管腔增加均小于药物洗脱支架组(P均< 0.001),残余狭窄程度大于药物洗脱支架组(P < 0.001);③术后6个月,药物涂层球囊组靶血管晚期管腔丢失小于药物洗脱支架组(P < 0.001),靶血管血运重建率及主要不良心血管事件发生率低于药物洗脱支架组(P=0.028,0.010);④术后12个月,药物涂层球囊组最小管腔直径大于药物洗脱支架组(P=0.033),残余狭窄程度及晚期管腔丢失小于药物洗脱支架组(P=0.028,P < 0.001),靶血管血运重建率、主要不良心血管事件发生率及出血事件发生率均低于药物洗脱支架组(P=0.008, 0.002,0.019);⑤结果表明,药物涂层球囊治疗老年2型糖尿病并冠状动脉小血管病变操作相对简单易行,手术成功率高,可减少残余狭窄程度及晚期管腔丢失,降低靶血管血运重建率、主要不良心血管事件发生率及出血事件发生率,临床预后优于药物洗脱支架。 ORCID: 0000-0001-7227-6792(郑海军) 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Plasma oxidized low-density lipoprotein is an independent risk factor in young patients with coronary artery disease

Objectives: Oxidized low-density lipoprotein (ox-LDL) is considered to be a key factor of initiating and accelerating atherosclerosis. The objective of this study was to investigate the role of ox-LDL in young patients with coronary artery disease (CAD). Methods: 128 consecutive angiographically proven young CAD patients (aged ≤ 55 years) were enrolled, and 132 age-matched non-CAD individuals (coronary angiography normal or negative finding by coronary ultrafast CT) were set as control group. Conventional risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking) were evaluated in the two groups. Ox-LDL was measured by competitive ELISA. Framingham risk score (FRS) and absolute 10-year CAD events risk were calculated for each individual. Results: Male sex was more prevalent in group CAD than in control (87.5% vs. 62.1%; P < 0.01). There were significant differences in smoking history (P < 0.01) and triglyeride (TG) and ratio of apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) (both P < 0.05) but no remarkable difference in other conventional risk factors (all P > 0.05) between group CAD and control. Level of ox-LDL was significantly higher in group CAD than in control (P < 0.01). Multivariate logistic regression showed that male sex (OR, 4.54; 95%CI, 1.76–9.77), smoking quantity (OR, 2.78; 95%CI, 1.34–4.25), TG (OR, 1.42; 95%CI, 1.18–2.83), ApoB/ApoA1 (OR, 1.73; 95%CI, 1.32–4.23), and ox-LDL (OR, 2.15; 95%CI, 1.37–6.95) were independently correlated with CAD in young patients. Area under the curve (AUC) of receiver operating characteristic (ROC) curve of TG, ApoB/ApoA1, and ox-LDL was 0.831, 0.866, and 0.935, respectively (P < 0.001). Conclusions: Ox-LDL is an important independent risk factor for CAD in young patients after adjusting other risk factors such as smoking, TG, and ApoB/ApoA1.     

Increased frequency of apolipoprotein B signal peptide sp24/24 in patients with coronary artery disease. General allele survey in the population of Taiwan and comparison with Caucasians

Apolipoprotein B (apoB) signal peptide ( sp ) polymorphism was characterized by polymerase chain reaction in blood samples of 58 coronary artery disease (CAD) patients and 319 control individuals of Chinese Han ethnic origin in Taiwan. In the CAD group, 77% of the observed alleles were sp27 (sp with 27 amino acids), and the remaining 23% sp24 (sp with 24 amino acids). The frequency distributions of the apoB sp allele in the control group were 0.81 for sp27 and 0.19 for sp24. The genotype distributions were 0.64 sp27/27, 0.26 sp27/24 and 0.10 sp24/24 in the CAD group; 0.64 sp27/27. 0.33 sp27/24 and 0.03 sp24/24 in the control group. The frequency of sp24/24 was significantly higher ( p = 0.012) in the CAD group than in the control group. Several studies have shown that the frequency of sp24/24 is higher in hyperlipidemic than in normolipidemic groups. This marker is probably in linkage disequlibrium with some other atherogenic genes. Our study shows that the differences in both apoB signal peptide alleles and sp27/27 and sp27/24 genotype distributions are statistically significant between the Taiwanese and Caucasians.