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A Review of Double Kissing Crush Stenting in Coronary Bifurcation Lesions 冠状动脉分叉病变双吻合术的研究进展
Pub Date : 2022-09-01 DOI: 10.1097/CD9.0000000000000058
T. Kwan, Patricia W. Lin
Double kissing (DK) crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes. This review evaluates all DK crush clinical trials and studies. It also reveals the contemporary technique steps by steps as well as the trouble shooting with illustrated clinical scenarios. Among all the available evidence, the DK crush technique is superior when compared to the provisional stenting technique for complex bifurcation lesion. DK crush stenting provides the best evidence-based approach to complex bifurcation lesions especially the left main coronary artery bifurcation lesions. Future direction of how to make this DK crush technique better is also proposed.
由于其优越的随机研究数据和良好的临床效果,双吻压碎支架治疗冠状动脉分叉病变已在世界范围内受到欢迎。本综述评估了所有的DK粉碎临床试验和研究。它也揭示了当代技术的一步一步,以及故障排除与插图临床场景。在所有可用的证据中,与复杂分叉病变的临时支架置入技术相比,DK粉碎技术是优越的。DK粉碎支架置入术是治疗复杂冠状动脉分支病变,尤其是左主干分支病变的最佳循证方法。并提出了进一步完善DK粉碎技术的发展方向。
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引用次数: 1
Provisional Stenting: A Contemporary Relook at the Strategy and Lingering Issues 临时支架植入术:策略和遗留问题的当代重新审视
Pub Date : 2022-09-01 DOI: 10.1097/CD9.0000000000000064
G. Choo, K. Gurupparan
Bifurcation lesions are encountered and treated in up to 1 in 5 cases of percutaneous coronary intervention (PCI). Such lesions pose a technical challenge to PCI, leading to lower procedural success and a higher rate of long-term adverse events. However, each bifurcation is unique in terms of anatomy and pathological presentation. There is no “one size fits all” strategy for coronary bifurcation PCI. Nevertheless, in most scenarios, provisional stenting is the preferred technique. This method is easy to apply and involves a logical stepwise escalation approach that is highly successful and safe.
五分之一的经皮冠状动脉介入治疗(PCI)患者会遇到分叉病变并进行治疗。这种病变对PCI构成了技术挑战,导致手术成功率较低,长期不良事件发生率较高。然而,就解剖学和病理学表现而言,每个分叉都是独特的。冠状动脉分叉PCI不存在“一刀切”的策略。然而,在大多数情况下,临时支架植入术是首选技术。这种方法易于应用,并且涉及一种非常成功和安全的逻辑逐步升级方法。
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引用次数: 1
Impact of Coronary Chronic Total Occlusion on Long-term Clinical Outcome in Patients with Unprotected Left Main Disease Undergoing Percutaneous Coronary Intervention 冠状动脉慢性完全闭塞对经皮冠状动脉介入治疗无保护左主干病变患者长期临床结果的影响
Pub Date : 2022-09-01 DOI: 10.1097/CD9.0000000000000071
I. Sheiban, Filippo Figini, Valeria Gaspartto, C. Moretti, F. Leonardo, Shaoliang Chen, F. D’Ascenzo
Objectives: Reported data regarding the prevalence, prognostic impact, and safety and efficacy of revascularization of coronary chronic total occlusion (CTO) in patients with left main coronary artery (LMCA) disease who undergo percutaneous coronary intervention (PCI) are scarce. The aim of the present study was to compare clinical outcomes among patients with LMCA disease undergoing PCI. Outcomes were compared between those with and without coronary CTO and between those with CTO who had successful and unsuccessful CTO recanalization procedures. Methods: All consecutive patients with significant LMCA disease (>50% stenosis at coronary angiography) who underwent PCI between July 2014 and December 2018 were retrospectively included in our study. The primary endpoint of the study was long-term mortality. Secondary endpoints included the incidence of myocardial infarction, repeat percutaneous or surgical revascularization, stroke, and stent thrombosis. Results: Between July 2014 and December 2018, 578 patients underwent PCI for LMCA disease at Pederzoli Hospital and University of Turin were enrolled. They were divided into 3 groups: group A: 374 (65%) patients without CTO, group B: 108 (19%) patients with untreated or unsuccessfully treated CTO, and group C: 96 (17%) patients with successfully treated CTO. At a median follow-up of (1090 ± 279) days, there were no statistically significant differences between the groups in terms of the primary and secondary endpoints. However, there was a trend towards higher mortality in patients with untreated or unsuccessfully treated CTO (13% vs. 19% vs. 14% in groups A, B, and C, respectively; P = 0.12). The primary and secondary endpoints were further analyzed based on the presence or absence of myocardial viability: subgroup C1: 54 (56%) patients with successful percutaneous transluminal coronary angioplasty (PTCA) having viability, and subgroup C2: 42 (44%) patients with successful PTCA not having viability. There was a trend toward a statistically significant higher rate of death among patients in group B, who underwent unsuccessful recanalization with viable myocardium (19% vs. 9% vs. 19% in groups B, C1, and C2, respectively, P = 0.05). On multivariable analysis, the propensity for successful revascularization of CTO was associated with a reduced risk of death (P = 0.01; odds ratio, 0.75; 95% confidence interval: 0.62–0.87). Conclusions: Among patients with LMCA disease undergoing PCI, CTO represents a common finding associated with worse prognosis. Successful revascularization of CTO in patients with viable myocardium appears to significantly improve prognosis.
目的:关于接受经皮冠状动脉介入治疗(PCI)的左主干冠状动脉(LMCA)患者冠状动脉慢性完全闭塞(CTO)血运重建的患病率、预后影响、安全性和有效性的报道数据很少。本研究的目的是比较接受PCI的LMCA疾病患者的临床结果。比较有和没有冠状动脉CTO的患者以及有CTO的成功和不成功的CTO再通手术的患者的结果。方法:回顾性纳入2014年7月至2018年12月期间接受PCI治疗的所有患有严重LMCA疾病(冠状动脉造影狭窄>50%)的连续患者。该研究的主要终点是长期死亡率。次要终点包括心肌梗死、重复经皮或手术血运重建、中风和支架血栓形成的发生率。结果:2014年7月至2018年12月,在Pederzoli医院和都灵大学,578名患者因LMCA疾病接受了PCI治疗。他们被分为3组:A组:374名(65%)无CTO的患者,B组:108名(19%)CTO未治疗或治疗失败的患者,C组:96名(17%)CTO治疗成功的患者。中位随访(1090 ± 279)天,两组之间在主要终点和次要终点方面没有统计学上的显著差异。然而CTO未治疗或治疗失败的患者死亡率有上升趋势(a、B和C组分别为13%、19%和14%;P=0.012)。根据心肌活力的存在与否,进一步分析主要和次要终点:C1亚组:54(56%)成功经皮冠状动脉腔内成形术(PTCA)的患者C2亚组:42例(44%)成功PTCA患者没有生存能力。B组患者的死亡率有统计学意义上更高的趋势,这些患者接受了存活心肌再通失败(B组、C1组和C2组分别为19%对9%对19%,P=0.05)。在多变量分析中,CTO成功血运重建的倾向与死亡风险的降低有关(P=0.01;比值比0.75;95%置信区间:0.62-0.87)。结论:在接受PCI的LMCA疾病患者中,CTO是一种常见的预后较差的发现。在有存活心肌的患者中成功进行CTO血运重建似乎可以显著改善预后。
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引用次数: 1
Rationale and Design of a Randomized Controlled Trial of Bivalirudin with a Prolonged High-Dose Infusion Versus Heparin Monotherapy During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction: The BRIGHT-4 Trial 急性ST段抬高型心肌梗死患者初次经皮冠状动脉介入治疗期间长期大剂量输注双缬氨酸与肝素单药治疗的随机对照试验的原理和设计:BRIGHT-4试验
Pub Date : 2022-08-23 DOI: 10.1097/CD9.0000000000000068
Zhenyang Liang, Yi Li, G. Stone, Yaling Han
Intravenous anticoagulant therapy is critical to prevent ischemic events without increasing the risk of bleeding in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Heparin and bivalirudin are the most commonly used adjunctive anticoagulant agents during PPCI. However, the superiority of the 2 most optimal regimens with these agents in patients undergoing PPCI remains controversial. The BivaliRudin with prolonged high-dose Infusion durinG PPCI versus Heparin Trial 4 (BRIGHT-4) is a large-scale, prospective, multicenter, active-control, parallel-group, open-label, randomized trial designed to test whether bivalirudin with a post-PCI high-dose infusion is superior to heparin monotherapy in STEMI patients undergoing PPCI. A total of 6000 patients will be enrolled and randomly assigned to receive bivalirudin or heparin in a 1:1 ratio. Patients allocated to the bivalirudin group will be treated with a high-dose bivalirudin infusion (1.75 mg/(kg·h)) after PCI for 2 to 4 hours. In the heparin group, the use of glycoprotein IIb/IIIa inhibitors will be reserved for the development of procedural thrombotic complications. The efficacy and safety of bivalirudin will be evaluated at 30 days, 6 months, and 12 months after the randomization. The primary endpoint is a composite of all-cause death or Bleeding Academic Research Consortium (BARC) types 3 to 5 bleeding at 30 days after randomization. The BRIGHT-4 study protocol has received approval from the ethics committee of General Hospital of Northern Theater Command (Shenyang, China). The procedures set out in this protocol are in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice guidelines. The results will be published following the Consolidated Standards of Reporting Trials statement in a peer-reviewed scientific journal (Trial registration number: NCT03822975).
静脉抗凝治疗对于st段抬高型心肌梗死(STEMI)患者进行初级经皮冠状动脉介入治疗(PPCI),在不增加出血风险的情况下预防缺血事件至关重要。肝素和比伐鲁定是PPCI期间最常用的辅助抗凝剂。然而,在PPCI患者中使用这些药物的两种最优方案的优越性仍然存在争议。比伐鲁定在PPCI期间长时间大剂量输注与肝素相比的试验4 (BRIGHT-4)是一项大规模、前瞻性、多中心、主动对照、平行组、开放标签、随机试验,旨在检验比伐鲁定在pci后大剂量输注是否优于肝素单药治疗STEMI患者接受PPCI。总共6000名患者将被纳入研究,并随机分配以1:1的比例接受比伐鲁定或肝素治疗。分配到比伐鲁定组的患者在PCI后给予高剂量比伐鲁定输注(1.75 mg/(kg·h)) 2 ~ 4小时。在肝素组,糖蛋白IIb/IIIa抑制剂的使用将保留用于程序性血栓并发症的发展。比伐鲁定的有效性和安全性将在随机化后30天、6个月和12个月进行评估。主要终点是随机分组后30天的全因死亡或学术研究联盟(BARC) 3 - 5型出血的综合结果。BRIGHT-4研究方案已获得中国沈阳北方战区总医院伦理委员会的批准。本议定书中规定的程序符合《赫尔辛基宣言》和良好临床实践指南的原则。研究结果将按照试验综合报告标准发表在同行评议的科学期刊上(试验注册号:NCT03822975)。
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引用次数: 0
Effects of Simvastatin on Endoplasmic Reticulum Stress-Mediated Apoptosis in Atherosclerotic Calcification 辛伐他汀对动脉粥样硬化钙化中内质网应激介导的细胞凋亡的影响
Pub Date : 2022-06-30 DOI: 10.1097/CD9.0000000000000050
Jianhua Li, Libo Zhao, Zhe Zhou, Lin Liu, X. Zou, Weihao Xu, Li-Wen Fan, Muyang Yan, Shengqi Wang
Objective: The effectiveness of statins in reducing atherosclerotic calcification remains controversial. The aim of this study was to confirm that simvastatin reduces atherosclerotic calcification and stabilizes plaque by restricting endoplasmic reticulum stress (ERS)-mediated apoptosis. Methods: Twenty-four 8-week-old male apolipoprotein E (ApoE)-/- mice (C57BL/6J genetic background) were selected and randomly divided into model (n = 12) and simvastatin (n = 12) groups. Twelve male C57BL/6J mice were selected as control group (n = 12). The mice were adaptively fed for 2 weeks and were put on a high-fat diet thereafter. After 9 weeks, they were treated with simvastatin (20 mg/kg) or phosphate-buffered saline daily for 8 weeks. Aortic sinus samples were obtained from ApoE-/- and C57BL/6J mice for hematoxylin and eosin, von Kossa, alizarin Red S, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, and immunohistochemical staining after in vivo treatment with simvastatin. In addition, mouse vascular smooth muscle cells were analyzed after exposure to simvastatin in vitro. Results: Administration of simvastatin in vivo drastically attenuated the atherosclerosis, calcification, and apoptosis, and decreased the serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The expression levels of glucose-regulated protein, 78 kDa (GRP78), C/EBP homologous protein (CHOP), and caspase 12 (CASP12) in the aortic sinus decreased in the simvastatin group compared with the model group. In vitro, simvastatin or simvastatin plus ERS inhibitor (taurine) attenuated calcification and apoptosis, and reduced the expression of ERS-related proteins GRP78, CHOP, and CASP12. Conclusion: Treatment with simvastatin suppressed atherosclerotic calcification. This effect may be mediated through the inhibition of ERS-related apoptosis.
目的:他汀类药物在减少动脉粥样硬化钙化方面的有效性仍然存在争议。本研究的目的是证实辛伐他汀通过限制内质网应激(ERS)介导的细胞凋亡来减少动脉粥样硬化钙化并稳定斑块。方法:选择24只8周龄雄性载脂蛋白E(ApoE)-/-小鼠(C57BL/6J遗传背景),随机分为模型组(n=12)和辛伐他汀组(n=12中)。选择12只雄性C57BL/6J小鼠作为对照组(n=12)。对小鼠进行适应性喂养2周,之后进行高脂肪饮食。9周后,每天用辛伐他汀(20mg/kg)或磷酸盐缓冲盐水治疗8周。从ApoE-/-和C57BL/6J小鼠获得主动脉窦样本,用于苏木精和伊红、von Kossa、茜素红S、末端脱氧核苷酸转移酶介导的dUTP缺口末端标记以及辛伐他汀体内治疗后的免疫组织化学染色。此外,在体外暴露于辛伐他汀后,对小鼠血管平滑肌细胞进行分析。结果:辛伐他汀体内给药可显著减轻动脉粥样硬化、钙化和细胞凋亡,并降低血清甘油三酯、总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白的水平。与模型组相比,辛伐他汀组主动脉窦中葡萄糖调节蛋白、78kDa(GRP78)、C/EBP同源蛋白(CHOP)和胱天蛋白酶12(CASP12)的表达水平降低。在体外,辛伐他汀或辛伐他汀加ERS抑制剂(牛磺酸)减轻钙化和细胞凋亡,并降低ERS相关蛋白GRP78、CHOP和CASP12的表达。结论:辛伐他汀治疗可抑制动脉粥样硬化钙化。这种作用可能是通过抑制ERS相关的细胞凋亡来介导的。
{"title":"Effects of Simvastatin on Endoplasmic Reticulum Stress-Mediated Apoptosis in Atherosclerotic Calcification","authors":"Jianhua Li, Libo Zhao, Zhe Zhou, Lin Liu, X. Zou, Weihao Xu, Li-Wen Fan, Muyang Yan, Shengqi Wang","doi":"10.1097/CD9.0000000000000050","DOIUrl":"https://doi.org/10.1097/CD9.0000000000000050","url":null,"abstract":"Objective: The effectiveness of statins in reducing atherosclerotic calcification remains controversial. The aim of this study was to confirm that simvastatin reduces atherosclerotic calcification and stabilizes plaque by restricting endoplasmic reticulum stress (ERS)-mediated apoptosis. Methods: Twenty-four 8-week-old male apolipoprotein E (ApoE)-/- mice (C57BL/6J genetic background) were selected and randomly divided into model (n = 12) and simvastatin (n = 12) groups. Twelve male C57BL/6J mice were selected as control group (n = 12). The mice were adaptively fed for 2 weeks and were put on a high-fat diet thereafter. After 9 weeks, they were treated with simvastatin (20 mg/kg) or phosphate-buffered saline daily for 8 weeks. Aortic sinus samples were obtained from ApoE-/- and C57BL/6J mice for hematoxylin and eosin, von Kossa, alizarin Red S, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, and immunohistochemical staining after in vivo treatment with simvastatin. In addition, mouse vascular smooth muscle cells were analyzed after exposure to simvastatin in vitro. Results: Administration of simvastatin in vivo drastically attenuated the atherosclerosis, calcification, and apoptosis, and decreased the serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The expression levels of glucose-regulated protein, 78 kDa (GRP78), C/EBP homologous protein (CHOP), and caspase 12 (CASP12) in the aortic sinus decreased in the simvastatin group compared with the model group. In vitro, simvastatin or simvastatin plus ERS inhibitor (taurine) attenuated calcification and apoptosis, and reduced the expression of ERS-related proteins GRP78, CHOP, and CASP12. Conclusion: Treatment with simvastatin suppressed atherosclerotic calcification. This effect may be mediated through the inhibition of ERS-related apoptosis.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":"2 1","pages":"209 - 217"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48559969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A New Coronavirus Estimation Global Score for Predicting Mortality During Hospitalization in Patients with COVID-19. 预测COVID-19患者住院期间死亡率的新型冠状病毒估计全球评分
Pub Date : 2022-06-01 DOI: 10.1097/CD9.0000000000000052
Hesong Zeng, Xingwei He, Wanjun Liu, Jing Kan, Liqun He, Jinhe Zhao, Cynthia Chen, Junjie Zhang, Shaoliang Chen

Objective: Coronavirus disease 2019 (COVID-19) exists as a pandemic. Mortality during hospitalization is multifactorial, and there is urgent need for a risk stratification model to predict in-hospital death among COVID-19 patients. Here we aimed to construct a risk score system for early identification of COVID-19 patients at high probability of dying during in-hospital treatment.

Methods: In this retrospective analysis, a total of 821 confirmed COVID-19 patients from 3 centers were assigned to developmental (n = 411, between January 14, 2020 and February 11, 2020) and validation (n = 410, between February 14, 2020 and March 13, 2020) groups. Based on demographic, symptomatic, and laboratory variables, a new Coronavirus estimation global (CORE-G) score for prediction of in-hospital death was established from the developmental group, and its performance was then evaluated in the validation group.

Results: The CORE-G score consisted of 18 variables (5 demographics, 2 symptoms, and 11 laboratory measurements) with a sum of 69.5 points. Goodness-of-fit tests indicated that the model performed well in the developmental group (H = 3.210, P= 0.880), and it was well validated in the validation group (H = 6.948, P= 0.542). The areas under the receiver operating characteristic curves were 0.955 in the developmental group (sensitivity, 94.1%; specificity, 83.4%) and 0.937 in the validation group (sensitivity, 87.2%; specificity, 84.2%). The mortality rate was not significantly different between the developmental (n = 85,20.7%) and validation (n = 94, 22.9%, P= 0.608) groups.

Conclusions: The CORE-G score provides an estimate of the risk of in-hospital death. This is the first step toward the clinical use of the CORE-G score for predicting outcome in COVID-19 patients.

目的:冠状病毒病2019 (COVID-19)以大流行的形式存在。住院期间死亡是多因素的,迫切需要一种风险分层模型来预测COVID-19患者的住院死亡。本研究旨在构建一个风险评分系统,用于早期识别院内治疗中死亡概率高的COVID-19患者。方法:回顾性分析来自3个中心的821例确诊的COVID-19患者,分为发展组(n = 411, 2020年1月14日至2020年2月11日)和验证组(n = 410, 2020年2月14日至2020年3月13日)。基于人口学、症状和实验室变量,从发育组建立了用于预测院内死亡的新型冠状病毒估计全球(CORE-G)评分,然后在验证组中评估其表现。结果:CORE-G评分包括18个变量(5个人口统计学变量、2个症状变量和11个实验室测量变量),总分为69.5分。拟合优度检验表明,该模型在发育组中表现良好(H = 3.210, P = 0.880),在验证组中验证良好(H = 6.948, P = 0.542)。发育组受试者工作特征曲线下面积为0.955(敏感性为94.1%;特异性为83.4%),验证组为0.937(敏感性为87.2%;特异性,84.2%)。发育组(n = 85,20.7%)和验证组(n = 94, 22.9%, P = 0.608)死亡率无显著差异。结论:CORE-G评分提供了院内死亡风险的估计。这是临床使用CORE-G评分预测COVID-19患者预后的第一步。
{"title":"A New Coronavirus Estimation Global Score for Predicting Mortality During Hospitalization in Patients with COVID-19.","authors":"Hesong Zeng,&nbsp;Xingwei He,&nbsp;Wanjun Liu,&nbsp;Jing Kan,&nbsp;Liqun He,&nbsp;Jinhe Zhao,&nbsp;Cynthia Chen,&nbsp;Junjie Zhang,&nbsp;Shaoliang Chen","doi":"10.1097/CD9.0000000000000052","DOIUrl":"https://doi.org/10.1097/CD9.0000000000000052","url":null,"abstract":"<p><strong>Objective: </strong>Coronavirus disease 2019 (COVID-19) exists as a pandemic. Mortality during hospitalization is multifactorial, and there is urgent need for a risk stratification model to predict in-hospital death among COVID-19 patients. Here we aimed to construct a risk score system for early identification of COVID-19 patients at high probability of dying during in-hospital treatment.</p><p><strong>Methods: </strong>In this retrospective analysis, a total of 821 confirmed COVID-19 patients from 3 centers were assigned to developmental (<i>n</i> = 411, between January 14, 2020 and February 11, 2020) and validation (<i>n</i> = 410, between February 14, 2020 and March 13, 2020) groups. Based on demographic, symptomatic, and laboratory variables, a new Coronavirus estimation global (CORE-G) score for prediction of in-hospital death was established from the developmental group, and its performance was then evaluated in the validation group.</p><p><strong>Results: </strong>The CORE-G score consisted of 18 variables (5 demographics, 2 symptoms, and 11 laboratory measurements) with a sum of 69.5 points. Goodness-of-fit tests indicated that the model performed well in the developmental group (<i>H</i> = 3.210, <i>P</i> <i>=</i> 0.880), and it was well validated in the validation group (<i>H</i> = 6.948, <i>P</i> <i>=</i> 0.542). The areas under the receiver operating characteristic curves were 0.955 in the developmental group (sensitivity, 94.1%; specificity, 83.4%) and 0.937 in the validation group (sensitivity, 87.2%; specificity, 84.2%). The mortality rate was not significantly different between the developmental (<i>n</i> = 85,20.7%) and validation (<i>n</i> = 94, 22.9%, <i>P</i> <i>=</i> 0.608) groups.</p><p><strong>Conclusions: </strong>The CORE-G score provides an estimate of the risk of in-hospital death. This is the first step toward the clinical use of the CORE-G score for predicting outcome in COVID-19 patients.</p>","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":"2 2","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/33/cd9-2-69.PMC9749948.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10474767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current Status and Challenges of Valvular Heart Disease Interventional Therapy 瓣膜性心脏病介入治疗的现状与挑战
Pub Date : 2022-06-01 DOI: 10.1097/cd9.0000000000000049
Yi Zhang, T. Xiong, Yu-liang Feng
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引用次数: 1
Non-Ischemic, Non-Hypoxic Myocardial Injury, and Long-Term Mortality in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study. 2019冠状病毒病患者的非缺血性、非缺氧心肌损伤和长期死亡率:一项回顾性队列研究
Pub Date : 2022-06-01 DOI: 10.1097/CD9.0000000000000044
Fajiu Li, Xijie Zhu, Ziyang Zhu, Yinjian Yang, Zhuang Tian, Duolao Wang, Shi Chen, Xiaoyan Gao, Yalin Xu, Bo Zhang, Wei Yu, Min Liu, Xiqi Xu, Chenghong Li, Shuyang Zhang

Objective: Cardiac damage is commonly reported in patients with coronavirus disease 2019 (COVID-19) but its prevalence and impact on the long-term survival of patients remain uncertain. This study aimed to explore the prevalence of myocardial injury and assess its prognostic value in patients with COVID-19.

Methods: A single-center, retrospective cohort study was performed at the Affiliated Hospital of Jianghan University. Data from 766 patients with confirmed COVID-19 who were hospitalized from December 27, 2019 to April 25, 2020 were collected. Demographic, clinical, laboratory, electrocardiogram, treatment data and all-cause mortality during follow-up were collected and analyzed.

Results: Of the 766 patients with moderate to critically ill COVID-19, 86 (11.2%) died after a mean follow-up of 72.8 days. Myocardial injury occurred in 94 (12.3%) patients. The mortality rate was 64.9% (61/94) and 3.7% (25/672) in patients with and without myocardial injury, respectively. Cox regression showed that myocardial injury was an independent risk factor for mortality (hazard ratio: 8.76, 95% confidence interval: 4.76-16.11, P< 0.001). Of the 90 patients with myocardial injury with electrocardiogram results, sinus tachycardia was present in 29, bundle branch block in 26, low voltage in 10, and abnormal T-wave in 53.

Conclusions: COVID-19 not only involves pneumonia but also cardiac damage. Myocardial injury is a common complication and an independent risk factor for mortality in COVID-19 patients.

目的:2019冠状病毒病(COVID-19)患者常报告心脏损伤,但其患病率及其对患者长期生存的影响尚不确定。本研究旨在探讨COVID-19患者心肌损伤的患病率并评估其预后价值。方法:在江汉大学附属医院进行单中心、回顾性队列研究。收集2019年12月27日至2020年4月25日住院的766例新冠肺炎确诊患者的数据。收集和分析随访期间的人口学、临床、实验室、心电图、治疗资料和全因死亡率。结果:766例中重度新冠肺炎患者中,86例(11.2%)在平均随访72.8 d后死亡。心肌损伤94例(12.3%)。心肌损伤组和非心肌损伤组的死亡率分别为64.9%(61/94)和3.7%(25/672)。Cox回归显示心肌损伤是死亡的独立危险因素(风险比:8.76,95%可信区间:4.76 ~ 16.11,P 0.001)。90例有心电图的心肌损伤患者中,窦性心动过速29例,束支传导阻滞26例,低压10例,t波异常53例。结论:COVID-19不仅涉及肺炎,还涉及心脏损伤。心肌损伤是新冠肺炎患者常见的并发症,也是死亡的独立危险因素。
{"title":"Non-Ischemic, Non-Hypoxic Myocardial Injury, and Long-Term Mortality in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study.","authors":"Fajiu Li,&nbsp;Xijie Zhu,&nbsp;Ziyang Zhu,&nbsp;Yinjian Yang,&nbsp;Zhuang Tian,&nbsp;Duolao Wang,&nbsp;Shi Chen,&nbsp;Xiaoyan Gao,&nbsp;Yalin Xu,&nbsp;Bo Zhang,&nbsp;Wei Yu,&nbsp;Min Liu,&nbsp;Xiqi Xu,&nbsp;Chenghong Li,&nbsp;Shuyang Zhang","doi":"10.1097/CD9.0000000000000044","DOIUrl":"https://doi.org/10.1097/CD9.0000000000000044","url":null,"abstract":"<p><strong>Objective: </strong>Cardiac damage is commonly reported in patients with coronavirus disease 2019 (COVID-19) but its prevalence and impact on the long-term survival of patients remain uncertain. This study aimed to explore the prevalence of myocardial injury and assess its prognostic value in patients with COVID-19.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study was performed at the Affiliated Hospital of Jianghan University. Data from 766 patients with confirmed COVID-19 who were hospitalized from December 27, 2019 to April 25, 2020 were collected. Demographic, clinical, laboratory, electrocardiogram, treatment data and all-cause mortality during follow-up were collected and analyzed.</p><p><strong>Results: </strong>Of the 766 patients with moderate to critically ill COVID-19, 86 (11.2%) died after a mean follow-up of 72.8 days. Myocardial injury occurred in 94 (12.3%) patients. The mortality rate was 64.9% (61/94) and 3.7% (25/672) in patients with and without myocardial injury, respectively. Cox regression showed that myocardial injury was an independent risk factor for mortality (hazard ratio: 8.76, 95% confidence interval: 4.76-16.11, <i>P</i> <i><</i> 0.001). Of the 90 patients with myocardial injury with electrocardiogram results, sinus tachycardia was present in 29, bundle branch block in 26, low voltage in 10, and abnormal T-wave in 53.</p><p><strong>Conclusions: </strong>COVID-19 not only involves pneumonia but also cardiac damage. Myocardial injury is a common complication and an independent risk factor for mortality in COVID-19 patients.</p>","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":"2 2","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/35/cd9-2-77.PMC9749942.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10780650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chinese Guideline for Percutaneous Coronary Intervention in Patients with Left Main Bifurcation Disease 中国左主干分叉疾病患者经皮冠状动脉介入治疗指南
Pub Date : 2022-04-24 DOI: 10.1097/CD9.0000000000000074
The coronary left main (LM) artery is characterized by large caliber, length varying from <8 to >15 mm, and 2 large daughter vessels branching from it; it supplies blood to a large area (>75%) of the myocardium. LM bifurcation lesion is defined as the presence of atherosclerosis involving either or both of the 2 daughter vessels. Thus, the optimal strategy of revascularization for diseased LM has been an interesting research topic for a long time. With developments in percutaneous techniques, design, and materials of drug-eluting stents; intravascular imaging; new generation of antiplatelet medications; and particularly recent pooled evidence from randomized clinical trials comparing percutaneous coronary intervention with coronary artery bypass grafting, implantation of a drug-eluting stenting with or without other approved techniques is considered an important therapeutic approach for LM bifurcation lesions. Mirroring the anatomical complexity of the LM, stenting LM bifurcations is technically demanding, and intraprocedural complications can be catastrophic given the large amount of jeopardized myocardium. Therefore, the Chinese Society of Cardiology designed a writing committee with members from 3 working groups (ie, clinical research, intravascular imaging and physiology, and interventional cardiology) for the first time, to write a guideline on percutaneous treatment for LM bifurcation lesions, with view to improve the procedural quality and clinical outcomes. This guideline consists of introduction, anatomical description of the LM tree, risk stratification, strategies of revascularization, antiplatelet strategy, follow-up, and long-term management for patients with LM bifurcation lesions.
冠状动脉左主干(LM)的特征是大口径,长度从15毫米不等,并有2条大的子血管从其分支;它为心肌的大面积(>75%)提供血液。LM分叉病变被定义为存在涉及2个子血管之一或两者的动脉粥样硬化。因此,长期以来,病变LM的最佳血运重建策略一直是一个有趣的研究课题。随着药物洗脱支架经皮技术、设计和材料的发展;血管内成像;新一代抗血小板药物;特别是最近来自随机临床试验的汇总证据,将经皮冠状动脉介入治疗与冠状动脉旁路移植术进行比较,在有或没有其他批准技术的情况下植入药物洗脱支架被认为是治疗LM分叉病变的重要方法。反映了LM的解剖复杂性,支架植入LM分叉在技术上要求很高,并且考虑到大量受损心肌,手术中的并发症可能是灾难性的。因此,中国心脏病学会首次设计了一个由临床研究、血管内成像与生理学、介入心脏病学三个工作组成员组成的写作委员会,编写经皮治疗LM分叉病变的指南,以提高手术质量和临床效果。本指南包括引言、LM树的解剖描述、风险分层、血运重建策略、抗血小板策略、随访和LM分叉病变患者的长期管理。
{"title":"Chinese Guideline for Percutaneous Coronary Intervention in Patients with Left Main Bifurcation Disease","authors":"","doi":"10.1097/CD9.0000000000000074","DOIUrl":"https://doi.org/10.1097/CD9.0000000000000074","url":null,"abstract":"The coronary left main (LM) artery is characterized by large caliber, length varying from <8 to >15 mm, and 2 large daughter vessels branching from it; it supplies blood to a large area (>75%) of the myocardium. LM bifurcation lesion is defined as the presence of atherosclerosis involving either or both of the 2 daughter vessels. Thus, the optimal strategy of revascularization for diseased LM has been an interesting research topic for a long time. With developments in percutaneous techniques, design, and materials of drug-eluting stents; intravascular imaging; new generation of antiplatelet medications; and particularly recent pooled evidence from randomized clinical trials comparing percutaneous coronary intervention with coronary artery bypass grafting, implantation of a drug-eluting stenting with or without other approved techniques is considered an important therapeutic approach for LM bifurcation lesions. Mirroring the anatomical complexity of the LM, stenting LM bifurcations is technically demanding, and intraprocedural complications can be catastrophic given the large amount of jeopardized myocardium. Therefore, the Chinese Society of Cardiology designed a writing committee with members from 3 working groups (ie, clinical research, intravascular imaging and physiology, and interventional cardiology) for the first time, to write a guideline on percutaneous treatment for LM bifurcation lesions, with view to improve the procedural quality and clinical outcomes. This guideline consists of introduction, anatomical description of the LM tree, risk stratification, strategies of revascularization, antiplatelet strategy, follow-up, and long-term management for patients with LM bifurcation lesions.","PeriodicalId":72524,"journal":{"name":"Cardiology discovery","volume":"2 1","pages":"134 - 144"},"PeriodicalIF":0.0,"publicationDate":"2022-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42146217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Blood Pressure Lowering for the Secondary Prevention of Stroke 降低血压对中风的二级预防
Pub Date : 2022-03-01 DOI: 10.1097/CD9.0000000000000048
S. Funakoshi, Miki Kawazoe, Kazuhiro Tada, Makiko Abe, H. Arima
Abstract Hypertension is one of the most important modifiable risk factors for stroke, and greater than 50% of all stroke events are estimated to be attributable to elevated blood pressure (BP). Randomized trials and meta-analyses have demonstrated that reducing BP is the most effective and generalizable strategy for preventing recurrent stroke. Based on currently available evidence, BP should be reduced to below 140/90 mmHg in all patients during the chronic post-stroke phase and to below 130/80 mmHg when well-tolerated.
高血压是卒中最重要的可改变危险因素之一,据估计,超过50%的卒中事件可归因于血压升高。随机试验和荟萃分析表明,降低血压是预防卒中复发最有效和最普遍的策略。根据现有的证据,在慢性卒中后阶段,所有患者的血压应降至140/90 mmHg以下,在耐受良好的情况下应降至130/80 mmHg以下。
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Cardiology discovery
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