The angiographic and clinical outcomes after coronary stenting in patients with metabolic syndrome

BackgroundMetabolic syndrome (MetS) is regarded as a risk factor for coronary artery disease (CAD). But the influence of MetS on morbidity and mortality after stent implantation in CAD patients remains unknown.MethodsThis article presents a meta-analysis of available data on the association between the MetS and the risk of angiographic and clinical outcomes following stent implantation.ResultsMetS was associated with a significant increased risk of post-stent all-cause mortality (odd ratio (OR), 2.17, 95% CI, 1.56–3.01), in-lesion restenosis (OR, 1.35, 95% CI, 1.00–1.84) and major adverse cardiac events (MACE) (OR 1.35, 95% CI 1.13–1.61) in CAD patients. Even with drug-eluting stent (DES) implantation, significant increased risk in all-cause mortality (OR, 2.25, 95% CI, 1.61–3.15) and MACE (OR 1.42, 95% CI 1.14–1.76) were remain in patients with MetS. However, the OR of cardiovascular (CV) mortality (1.25, 95% CI 0.71–2.22), MI (1.27, 95% CI 0.87–1.85) and TLR (OR 1.21, 95% CI 0.96–1.53) was not statistically different between the patients with and without metabolic syndrome.ConclusionsMetabolic syndrome is an important risk factor in patients with CAD following stent implantation. Although DES implantation decreased the incidence of angiographic events, further progress in adequate treatment of MetS is still required to improve the clinical outcome.     

85岁及以上老年冠心病患者经皮冠状动脉支架治疗的临床观察

目的 探讨85～94岁冠心病患者经皮冠状动脉支架治疗的疗效和预后.方法 回顾性分析90例85岁以上冠心病患者经皮冠状动脉支架治疗的临床和造影特点、住院期间和长期疗效.结果 90例中,21例应用金属裸支架(BMS),69例应用药物洗脱支架(DES).三支病变41例,2支病变21例,单支病变28例.手术成功率为94.4%,术前与术后TIMI-3级血流比例分别为72.2%和94.4%.手术相关并发症为15.6%,主要为冠脉夹层(11.1%).住院期间主要心血管不良事件(MACE)为7.8%,其中DES组住院期间MACE为5.8%,BMS组为14.3%.DES组出现2例严重出血.86例患者随访1年时,总的MACE为4.6%,其中DES组为6.0%,BMS组没有任何MACE.DES组出现]例脑卒中和1例严重出血.47例患者随访2年时,总的MACE为14.9%,其中DES组MACE为19.4%,BMS组无任何MACE.DES组1例发生严重出血,BMS组1例发生脑卒中.多因素COX回归分析表明,肌酐水平和高血压是影响长期预后的重要因素.结论 85岁以上冠心病患者经皮冠状动脉支架治疗手术成功牢较高,住院期间和长期的MACE事件发生率较低,并存高血压和严重.肾功能不全的患者MACE的发生率相对较高.     

Drug-Eluting Versus Bare Metal Stents in Saphenous Vein Graft Intervention: An Updated Comprehensive Meta-Analysis of Randomized Trials

BackgroundDrug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results.MethodsPubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL).ResultsOverall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 [0.51, 0.85]; p = 0.002), TVR (OR 0.47 [0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 [0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months.ConclusionIn this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes.     

Are drug-eluting stents safer and more effective than bare-metal stents in patients with acute myocardial infarction?

Questions about the long-term safety over the beneficial effects of drug-eluting stents (DES) have grown. We compared the long-term safety and efficacy of DES and bare-metal stents (BMS) in patients with acute myocardial infarction (AMI). A total of 1,017 AMI patients treated with stent implantation were followed for 3 years; 660 (64.9%) patients were treated with at least one DES and 357 (35.1%) patients were treated with at least one BMS. The primary endpoints were total mortality and the composite of major adverse cardiac events (MACE) including total mortality, re-MI, target lesion revascularization (TLR), and coronary artery bypass graft. At 3-years, the overall risks of cardiac and all-cause mortality were not different between the groups. However, the use of DES significantly decreased TLR (17.4% versus 7.1%, adjusted hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.30 to 0.65) and the composite of MACEs (27.2% versus 19.5%, adjusted HR 0.65, 95% CI 0.48 to 0.87) with no differences in MI. The risk of MACE up to 1 year (HR 0.56, 95% CI 0.39 to 0.80) was higher in BMS patients, whereas from 1 year to 2 years (HR 0.55, 95% CI 0.27 to 1.10) and from 2 years to 3 years (HR 1.13, 95% CI 0.56 to 2.28), it was similar between the groups. The use of DES does not have a significant effect on overall long-term clinical survival compared with that of BMS in AMI patients. However, the use of DES reduced the need for re-intervention and the risk of MACE, mostly within 1 year.     

Prevalence and impact of metabolic syndrome in patients with multivessel coronary artery disease and acute coronary syndrome

Background and aimsMetabolic syndrome (MetS) is associated with increased incidence of diabetes and cardiovascular diseases in patients initially free from these diseases. However, its prognostic value in patients with established coronary artery diseases remains controversial. Therefore, we aimed to illustrate the prevalence and investigate the impact of MetS in patients with multivessel coronary artery disease (MVD) and acute coronary syndrome (ACS).Methods and resultsThis was a large registry of consecutive patients with ACS referred to primary percutaneous coronary intervention (PCI) and those with MVD were eligible for this analysis. MetS was defined based on modified Adult Treatment Panel III definition. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction and stroke. A total of 2532 patients were included in the current analysis and 993 (39.2%) of them had MetS. The prevalence of MetS increased from 2010 to 2016 (p _{for trend} = 0.005). In patients over 60 years old, the prevalence of MetS decreased with aging (p _{for trend} = 0.002). Female subjects had a higher prevalence than their male counterparts (61.5% verse 32.9% and p < 0.001). Over a median follow-up of 2.3 years, MetS was not significantly associated with MACE (adjusted 95% CI from 0.92 to 1.54).ConclusionMetS was frequently observed in patients with MVD and ACS. Patients with MetS were more likely to be young and female. However, it was not an independent predictor for MACE after primary PCI in those patients.     

Comparison between drug-eluting and bare metal stent on ST-elevation myocardial infarction outcome: Should second-generation drug-eluting stent be preferred?

Background and purposeAlthough several studies reported that drug-eluting stents (DES) are able to reduce restenosis incidence without increasing mortality, concerns still exist about their safety in ST-segment elevation myocardial infarction (STEMI) patients mainly for a possible higher rate of in-stent thrombosis. Recent evidence suggests a better safety profile of second-generation DES, but data on their outcome in STEMI are still poor. In this study we evaluated the impact on mortality and target lesion revascularization (TLR) of DES or bare metal stent (BMS) implantation in STEMI patients submitted to primary angioplasty.Methods and subjectsWe analyzed mortality and TLR in 1150 STEMI patients during a mean 43-month follow-up after DES (44.6%) or BMS (55.4%) implantation. A propensity score method was used to minimize bias. During follow-up, 223 deaths occurred.Essential resultsUnadjusted for potential confounders, DES implantation was associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.40; 95%CI 0.30–0.54] and TLR (HR 0.55; 95%CI 0.36–0.86); this latter was confirmed after propensity score analysis (HR 0.39; 95%CI 0.21–0.67). Second- (n = 179) vs. first- (n = 337) generation DES showed a further reduction in TLR (HR 0.17; 95%CI 0.05–0.57). Adjusted analyses showed a significant reduction in the combined end-point of all-cause mortality or TLR after both first- and second-generation DES vs. BMS implantation with a trend to a lower risk for second- vs. first-generation DES.Principal conclusionsDES implantation in STEMI patients showed a significant reduction in TLR and in the combined endpoint of TLR or mortality. Second-generation DES showed a more protective effect on the combined endpoint, suggesting that they would be preferred in this setting.     

Clinical outcomes following drug-eluting versus bare metal stent implantation for lesion subsets excluded from pivotal clinical trials: findings from the GHOST Study (Guthrie Health System Off-Label StenT Study)

Objectives: We assessed outcomes of patients undergoing drug-eluting stent (DES) vs. bare metal stent (BMS) implantation for complex lesions excluded from pivotal clinical trials of DES.
Background: Although DES improve target vessel revascularization (TVR) and major adverse cardiovascular events (MACE) compared to BMS in randomized trials, data on safety and efficacy of DES in complex lesions are insufficient.
Methods: In a single-center registry of 1,354 patients who underwent stent implantation for complex lesions between July 2001 and December 2005, we compared the incidence of death, death or myocardial infarction (MI), stent thrombosis [definite or probable by the Academic Research Consortium (ARC) criteria], TVR, and MACE between patients who received DES (n = 483) versus those who received BMS (n = 871). Mean duration of follow-up was 494 versus 838 days in DES and BMS groups, respectively.
Results: Clinical outcomes in DES versus BMS groups were as follows: death 5.2% versus 11.5% (log-rank P = 0.042); death/MI 11.2% versus 16.7% (P = 0.47), stent thrombosis 2.9% versus 2.6% (P = 0.61), TVR 6.6 versus 18.5% (P < 0.0001), MACE 14.9% versus 29.7% (P = 0.0002), respectively. After adjustment for baseline differences, DES implantation was associated with lower TVR (adjusted hazards ratio HR = 0.38, 95% CI 0.26–0.56, P < 0.0001) and MACE (HR = 0.56, CI 0.42–0.74, P < 0.0001) without significant impact on other outcomes. In 933 patients who underwent DES (n = 483) or BMS (n = 450) implantation in the year 2003 or later, DES implantation similarly lowered TVR and MACE without affecting other outcomes.
Conclusions: Our findings support the safety and efficacy of DES in patient subsets excluded from pivotal randomized clinical trials of DES.     

Metabolic syndrome predicts 10-year mortality in non-diabetic patients following coronary artery bypass surgery.

Background Metabolic syndrome (MetS) is a risk factor for cardiovascular disease and mortality, but, the relationship between MetS and survival after coronary artery bypass grafting (CABG) remains unclear. Methods and Results The outcomes of patients with and without MetS were analyzed. Patients who had undergone CABG at Juntendo University Hospital between January 1984 and December 1992 were enrolled. The survival search was performed by the end of 2000. The patients were categorized by the existence of preoperative MetS using the modified American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definition with body mass index instead of waist circumference. MetS was present in 551 (46.6%) patients and absent in 632 (53.4%). Preoperative MetS was associated with long-term poor prognosis in terms of all-cause death (hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.03-1.74; p=0.028) and cardiac death (HR 2.31; 95% CI 1.36-3.92; p=0.002) in non-diabetic patients. These differences in the mortality of the 2 groups were more obvious after 10 years. However, among the patients with diabetes, the presence of MetS was not related to long-term mortality. Conclusions Preoperative MetS predicted increased all-cause and cardiac mortality, especially after 10 years, in non-diabetic patients undergoing CABG. (Circ J 2008; 72: 1481 - 1486).     

Long-term safety and effectiveness of drug-eluting stents compared to bare metal stents in ST elevation myocardial infarction: findings from the Guthrie Health Off-label Stent (GHOST) Registry

Background: Multiple randomized trials and observational studies have shown drug‐eluting stents (DES) to be safe and effective at 3‐year follow‐up in stent thrombosis (ST)‐segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). However, outcomes data beyond 3–4 years after DES implantation are sparse. Methods: We studied 554 STEMI patients who underwent successful PCI with either DES or bare metal stent (BMS). Primary study end‐points were time to occurrence of ST and the composite of death or myocardial infarction (MI). Secondary end‐points were time to occurrence of major adverse cardiac events (MACEs) and discrete events that comprise MACE (death, MI, and target vessel revascularization [TVR]). Outcomes of the DES and BMS groups were assessed by survival analysis and multivariable Cox regression. Results: There were 205 (37%) patients who received DES and 349 (63%) patients who received BMS. At a median follow‐up of 41.4 months after PCI, there were no differences in the unadjusted incidence of ST (ST, 3.4 vs. 4.3%, log‐rank P = 0.61) and MI (6.8% vs. 8%, P = 0.61) between DES versus BMS groups, respectively. However, DES implantation was associated with lower unadjusted incidence of death or MI (11% vs. 23.5%, P = 0.0002), MACE (16% vs. 34%, P < 0.0001), death (6.3% vs. 17%, P = 0.0004), and TVR (9.8% vs. 18%, P = 0.008) than BMS implantation. In multivariable analyses, DES implantation was associated with significantly lower incidence of MACE (adjusted HR = 0.47 [95% CI: 0.31–0.76], P = 0.0007) than BMS implantation. Conclusion: In our study of STEMI patients, DES implantation was safer than BMS implantation and was associated with lower MACE at long‐term follow‐up. (J Interven Cardiol 2012;25:118–125)     

Treatment of saphenous vein graft lesions with drug-eluting stents: immediate and midterm outcome

OBJECTIVES: The purpose of the present report was to evaluate clinical and angiographic outcomes of drug-eluting stent (DES) implantation in saphenous vein graft (SVG) lesions. BACKGROUND: The safety and efficacy of DES implantation for the treatment SVG lesions remains uncertain. METHODS: We evaluated in-hospital and six-month outcomes in 61 consecutive patients treated with DES in SVG lesions from March 2002 to March 2004 (DES group), as compared to 89 consecutive patients treated with bare-metal stents (BMS) in the 24 months immediately before the introduction of DES (BMS group). Major adverse cardiac events (MACE) including death, myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and at six-month follow-up. RESULTS: The rate of in-hospital MACE was similar between the two groups (6.6% vs. 5.6%, p = 1.0). Cumulative MACE at six months was 11.5% in the DES group and 28.1% in the BMS group (p = 0.02). The DES group had a significantly lower incidence of in-segment restenosis (10.0% vs. 26.7%, p = 0.03), TLR (3.3% vs. 19.8%, p = 0.003), and TVR (4.9% vs. 23.1%, p = 0.003). By Cox regression analysis, diabetes (hazard ratio [HR]: 3.03; 95% confidence interval [CI]: 1.33 to 6.90; p = 0.008), usage of BMS (HR: 2.53; 95% CI: 1.07 to 5.97; p = 0.03), and age of SVG (HR: 1.10; 95% CI: 1.02 to 1.19; p = 0.02) were identified as predictors of MACE at six-month follow-up. CONCLUSIONS: Compared to BMS implantation, DES implantation in SVG lesions appears safe with favorable and improved mid-term outcomes.     

糖尿病合并脓毒症患者的主要不良心血管事件及全因死亡发生风险分析

目的 探讨糖尿病合并脓毒症患者住院30天内主要不良心血管事件（MACE）的发生特点及全因死亡的发生风险。方法 共纳入720例脓毒症患者,根据是否合并糖尿病分为合并糖尿病组252例和无糖尿病组468例,比较两组患者MACE及全因死亡的发生情况及住院第1～15天(D₁₅)和第16～30天(D₃₀)MACE发生特点。结果 合并糖尿病组患者的MACE发生率为36.5%,明显高于无糖尿病组的22.2%（P<0.05）,但两组患者急性脑血管意外发生率比较差异无统计学意义（P＞0.05）;合并糖尿病组患者的全因死亡发生率为25.0%,明显高于无糖尿病组的15.6%（P<0.05）。两组患者D₁₅的急性冠脉综合征、急性心力衰竭、严重心律失常、心源性死亡发生率分别高于比同组D₃₀（P<0.05）,但两组D₁₅和D₃₀的急性脑血管意外发生率同组内比较差异均无统计学意义（P>0.05）。多因素logistic回归分析结果显示,糖尿病是脓毒症患者发生MACE的独立预测因素(P<0.05)。结论 合并糖尿病的脓毒症患者住院30天期间MACE和全因死亡的发生率明显升高,有效控制血糖可能减少合并糖尿病的脓毒症患者MACE和全因死亡的发生。     

Safety and efficacy of second‐generation drug‐eluting stents compared with bare‐metal stents: An updated meta‐analysis and regression of 9 randomized clinical trials

The efficacy of second‐generation drug‐eluting stents (DES; eg, everolimus and zotarolimus) compared with bare‐metal stents (BMS) in patients undergoing percutaneous coronary intervention was challenged recently by new evidence from large clinical trials. Thus, we aimed to conduct an updated systematic review and meta‐analysis of randomized clinical trials (RCTs) evaluating the efficacy and safety of second‐generation DES compared with BMS . Electronic databases were systematically searched for all RCTs comparing second‐generation DES with BMS and reporting clinical outcomes. The primary efficacy outcome was major adverse cardiac events (MACE); the primary safety outcome was definite stent thrombosis. The DerSimonian and Laird method was used for estimation of summary risk ratios (RR). A total of 9 trials involving 17 682 patients were included in the final analysis. Compared with BMS, second‐generation DES were associated with decreased incidence of MACE (RR: 0.78, 95% confidence interval [CI]: 0.69‐0.88), driven by the decreased incidence of myocardial infarction (MI) (RR: 0.67, 95% CI: 0.48‐0.95), target‐lesion revascularization (RR: 0.47, 95% CI: 0.42‐0.53), definite stent thrombosis (RR: 0.57, 95% CI: 0.41‐0.78), and definite/probable stent thrombosis (RR: 0.54, 95% CI: 0.38‐0.80). The incidence of all‐cause mortality was similar between groups (RR: 0.94, 95% CI: 0.79‐1.10). Meta‐regression showed lower incidences of MI with DES implantation in elderly and diabetic patients (P = 0.026 and P < 0.0001, respectively). Compared with BMS, second‐generation DES appear to be associated with a lower incidence of MACE, mainly driven by lower rates of target‐lesion revascularization, MI, and stent thrombosis. However, all‐cause mortality appears similar between groups.     

老年急性ST段抬高心肌梗死患者应用国产雷帕霉素药物洗脱支架5年临床随访

目的评估老年急性ST段抬高心肌梗死(STEMI)患者应用国产支架的长期安全性。方法入选年龄≥60岁的急性STEMI患者113例,随机分为国产雷帕霉素药物洗脱支架(DES)组56例和金属裸支架(BMS)组57例。随访5年,观察支架内血栓形成和主要心脏不良事件(MACE)发生率情况。结果 5年随访期间,DES组与BMS组病死率分别为7.1%和7.0%(P>0.05);DES组靶病变重建、MACE分别为10.7%、23.2%,BMS组分别为28.1%、42.1%(P<0.05)。DES组支架内血栓、极晚期支架内血栓发生率分别为8.9%、3.6%;BMS组分别为7.0%、1.8%,2组比较差异无统计学意义。结论老年急性STEMI患者应用国产雷帕霉素DES较BMS明显降低MACE,且极晚期血栓发生率无明显升高。     

Meta-Analysis of Provisional Versus Systematic Double-Stenting Strategy for Left Main Bifurcation Lesions

ObjectiveWe sought to compare the clinical outcomes with provisional versus double-stenting strategy for left main (LM) bifurcation percutaneous coronary intervention (PCI).BackgroundDespite two recent randomized controlled trials (RCTs) and several observational reports, the optimal LM bifurcation PCI technique remains controversial.MethodsPubMed, Cochrane Central Register of Controlled-Trials (CENTRAL), Clinicaltrials.gov, International Clinical Trial Registry Platform were leveraged for studies comparing PCI bifurcation techniques for LM coronary lesions using second-generation drug eluting stents (DES). The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes of interest were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), target vessel or lesion revascularization, and stent thrombosis.ResultsTwo RCTs and 10 observational studies with 7105 patients were included. Median follow-up duration was 42 months (IQR: 25.7). Double stenting was associated with a trend towards higher incidence of MACE (odds ratio [OR] 1.20; 95 % confidence interval [CI] 0.94 to 1.53) compared with provisional stenting. This was mainly driven by higher rates of target lesion revascularization (TLR) (OR 1.50; 95 % CI 1.07 to 2.11). There were no statistically significant differences in the incidence of all-cause mortality, cardiovascular mortality, MI, or stent thrombosis. On subgroup analysis according to the study type, provisional stenting was associated with lower MACE and TLR in observational studies, but not in RCTs.ConclusionFor LM bifurcation PCI using second-generation DES, a provisional stenting strategy was associated with a trend towards lower incidence of MACE driven by statistically significant lower rates of TLR, compared with systematic double stenting. These differences were primarily driven by observational studies. Further RCTs are warranted to confirm these findings.     

The association between ankle-brachial index and cardiovascular or all-cause mortality in metabolic syndrome of elderly Chinese.

The ankle-brachial index (ABI) is a non-invasive, reliable measurement of lower-extremity ischemia. A low ABI is associated with increased risk of coronary heart disease, stroke and death. However, the relationship between ABI and all-cause mortality or cardiovascular disease (CVD) mortality in patients with metabolic syndrome (MetS) has not been well studied. Accordingly, we here investigated the association between ABI and all-cause and CVD mortality in an elderly Chinese population with MetS. A total of 2,274 MetS patients diagnosed under the criteria proposed by the International Diabetes Federation were divided into two groups based on repeated ABI measurement over a period of 13.6 months: ABI相似文献   

Safety of drug-eluting stents in patients with left ventricular dysfunction undergoing percutaneous coronary intervention

Recent studies have reported a higher incidence of late stent thrombosis in patients undergoing drug-eluting stent (DES). Reduced left ventricular (LV) ejection fraction (EF) is considered a risk factor for this complication after both bare-metal stent (BMS) and DES implantation. Therefore, the aim of this study was to evaluate the safety of DES on long-term follow-up in patients with LV dysfunction undergoing percutaneous coronary intervention. We retrospectively selected all patients with an EF <45% undergoing percutaneous coronary intervention with implantation of >/=1 sirolimus- or paclitaxel-eluting stent at our institution. The primary endpoint of the study was all-cause mortality, retrieved using both Social Security Database and hospital records. We also compared the results of this group with a historical cohort of patients with LV dysfunction undergoing BMS implantation; 121 patients who received >/=1 DES were enrolled. The mean LVEF was 36 +/- 8%, with 20 patients (16%) with a LVEF 相似文献   

不同种类冠状动脉药物洗脱支架混合使用87例临床研究

目的观察在同一冠心病患者体内混合使用不同种类的药物洗脱支架(DES)对长期预后的影响。方法2003年1月至2004年10月按先后顺序入选223例接受DES治疗的冠心病患者,将其中87例接受两种或两种以上DES者(Cypher,Firebird,Taxus)作为观察组,136例仅接受一种DES治疗者作为对照组,在支架手术后5~10个月进行冠状动脉造影随访,并观察冠心病临床事件的发生情况。结果观察组61例(70.1%)及对照组93例(68.4%)术后半年接受冠状动脉造影复查,再狭窄率分别为观察组(5例)8.2%及对照组(7例)7.5%(P>0.05)。随访发现临床事件总发生率分别是术后4周观察组4.6%及对照组3.7%,术后6个月8.6%及7.1%(P>0.05)。结论不同种类DES混合应用安全、有效,与对照组比较并不增加临床事件的发生率。     

The impact of influenza vaccination in patients with cardiovascular disease: An overview of systematic reviews

Whether influenza vaccination can play a prognostic role in patients with cardiovascular (CV) disease (coronary artery disease (CAD), heart failure, stroke, peripheral artery disease (PAD)) is still not completely well-established. We conducted this overview of systematic reviews (SR) evaluating the effects of influenza vaccination in secondary prevention of CV disease.An electronic search was performed in the MEDLINE (to November 2019). Eligibility criteria included SR evaluating the effect of influenza vaccination in patients with CV disease. The risk of bias of the included systematic reviews was evaluated using the ROBIS tool. All-cause mortality, CV mortality, major adverse cardiovascular events (MACE) and hospitalizations were evaluated. Whenever required, data were recalculated through a random-effects meta-analysis to obtain pooled data for the patients at secondary CV prevention.The search process yielded four SR: two in CAD, one in heart failure and one in stroke. There were no SR evaluating the vaccine in PAD. The risk of bias was unclear (2 SR) and high (2 SR). Influenza vaccination in patients with CAD showed a risk reduction in all-cause mortality (data recalculated), cardiovascular mortality and MACE, particularly in patients with recent acute coronary syndrome. In patients with heart failure, vaccination was associated with a decreased risk of all-cause mortality. There was a non-significant trend in recurrent stroke risk reduction in patients with previous stroke.The available evidence suggests that influenza vaccination was associated with a protective effect in CAD and HF patients. However, these results need to be clarified with higher quality evidence studies.     

血浆氧化三甲胺水平对冠心病患者预后的预测作用:剂量-反应Meta分析

目的:探讨冠心病患者的血浆氧化三甲胺(TMAO)水平与主要不良心血管事件(MACE)以及全因死亡风险之间的关系.方法:计算机检索2020年7月前发表并收录在PubMed、EMBASE、中国知网、万方等数据库中评估冠心病患者血浆TMAO水平与MACE(心血管死亡、心肌梗死、脑卒中、血管重建、再入院)及全因死亡风险相关性的...     

Meta-analysis Comparing Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting for Non-ST Elevation Acute Coronary Syndrome in Patients With Multivessel or Left Main Disease

Outcomes of patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) with multivessel coronary disease (MVD) and/or unprotected left main coronary artery disease (CAD) revascularized with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is not well defined. MEDLINE/PubMed and EMBASE/Ovid were queried for studies that investigated PCI vs CABG in this disease subset. The primary outcome was major cardiac adverse events (MACE) at 30 days and long-term follow-up (3-5 years). The final analysis included 9 studies with a total of 9299 patients. No significant difference was observed between PCI and CABG in 30 days MACE (risk ratio [RR] 0.96; 95% confidence interval [CI] 0.38-2.39, all-cause mortality, myocardial infarction, and stroke. A meta-regression analysis revealed patients with a history of PCI had higher risk of MACE with PCI as compared with CABG. At long-term follow-up, PCI compared with CABG was associated with higher risk of MACE (RR 1.52; 95% CI 1.28-1.81), myocardial infarction, and repeat revascularization, while no difference was observed in the risk of stroke and all-cause mortality. In patients with NSTE-ACS and MVD or unprotected left main CAD, no differences were observed in the clinical outcomes between PCI and CABG at 30 days follow-up. With long-term follow-up, PCI was associated with a higher risk of MACE.