Objectives . We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background . PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods . A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results . 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p=0.034), myocardial infarction (7.1% vs. 1.8%, p<0.001), in-stent thrombosis (4.5% vs. 0.8%, p<0.001), and stroke (7.1% vs. 6.4%, p=0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243–5.347, p=0.011). Conclusion . LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.
Aims: Platelet endothelial aggregation receptor-1 (PEAR1) is a platelet transmembrane protein that plays an important role on platelet aggregation. The aim of this study was to investigate whether PEAR1 genetic variations are associated with 1-year outcomes in Chinese patients with acute myocardial infarction after percutaneous coronary intervention.
Background: Evidence on factors associated with guideline-directed secondary prevention medication (GDPM) after percutaneous coronary intervention (PCI) and its effect on the prognosis of patients with coronary artery disease (CAD) is lacking in China. Aims: To ascertain predictors of GDPM in real-world clinical practice and to assess the effect of GDPM on clinical outcomes. Design: A retrospective cohort study. Methods: Consecutive patients admitted to Fuwai Hospital between January 2013 and December 2013 were recruited. GDPM comprised aspirin, clopidogrel, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. The primary outcome was five-year major adverse cardiovascular event (MACE) (cardiac death, myocardial infarction [MI] and unplanned revascularization). Multivariable logistic regression was used to identify predictors of prescribing GDPM. Multivariable Cox regression was used to examine the relationship between GDPM and clinical outcomes. Results: 10,067 patients were followed up for a median of 5.0 years (interquartile range: 4.3–5.2), 45.1% were prescribed with GDPM. Presenting with ST-segment elevation MI (adjusted OR = 3.252 [2.832–3.736]), prior MI (adjusted OR = 2.174 [1.948–2.425]), more stents implanted (adjusted OR = 1.063 [1.022–1.106]), overweight (adjusted OR = 1.136 [1.038–1.243]), obesity (adjusted OR = 1.274 [1.100–1.476]), diabetes (adjusted OR = 1.225 [1.115–1.344]), and hypertension (adjusted OR = 3.556 [3.196–3.956]) predicted the prescription of GDPM. Advanced age (adjusted OR = 0.556 [0.379–0.816]) was associated with lower prescription rate of GDPM. Patients with GDPM had lower rate of 5-year MACE (adjusted HR = 0.889 [0.808–0.978]) relative to those without GDPM. Conclusions: Despite the benefit of GDPM in improving the prognosis of CAD patients undergoing PCI, gaps still exist in GDPM prescription in real-world clinical practice. Our study determined target populations for physicians to strive to promote the application of GDPM.
Background: Prior studies have reported controversial conclusions regarding the risk of adverse cardiovascular events in patients using proton-pump inhibitors (PPIs) combined with clopidogrel therapy, causing much uncertainty in clinical practice. We sought to evaluate the safety of PPIs use among high-risk cardiovascular patients who underwent percutaneous coronary intervention (PCI) in a long-term follow-up study. Methods: A total of 7868 consecutive patients who had undergone PCI and received dual antiplatelet therapy (DAPT) at a single center from January 2013 to December 2013 were enrolled. Adenosine diphosphate (ADP)-induced platelet aggregation inhibition was measured by modified thromboelastography (mTEG) in 5042 patients. Propensity score matching (PSM) was applied to control differing baseline factors. Cox proportional hazards regression was used to evaluate the 2-year major adverse cardiovascular and cerebrovascular events (MACCEs), as well as individual events, including all-cause death, myocardial infarction, unplanned target vessel revascularization, stent thrombosis, and stroke. Results: Among the whole cohort, 27.2% were prescribed PPIs. The ADP-induced platelet aggregation inhibition by mTEG was significantly lower in PPI users than that in non-PPI users (42.0 ± 30.9% vs. 46.4 ± 31.4%, t = 4.435, P < 0.001). Concomitant PPI use was not associated with increased MACCE through 2-year follow-up (12.7% vs. 12.5%, χ2 = 0.086, P = 0.769). Other endpoints showed no significant differences after multivariate adjustment, regardless of PSM. Conclusion: In this large cohort of real-world patients, the combination of PPIs with DAPT was not associated with increased risk of MACCE in patients who underwent PCI at up to 2 years of follow-up.
Abstract Background Stress hyperglycemia ratio (SHR), a novel biomarker of stress hyperglycemia, was proved to be a reliable predictor of short‐term adverse outcomes in patients with acute coronary syndromes (ACS). However, its impact on long‐term prognosis remained controversial. Methods A total of 7662 patients with ACS from a large nationwide prospective cohort between January 2015 and May 2019 were included. SHR was calculated by the following formula: SHR = admission glucose (mmol/L)/(1.59 × HbA1c [%]−2.59). The primary end point was a major adverse cardiovascular event (MACE) during follow‐up, a composite of all‐cause death, myocardial infarction, and unplanned revascularization. The second end point was the separate components of the primary end points. Results During a median follow‐up of 2.1 years, 779 MACE events occurred. After multivariable adjustment, ACS patients with the highest SHR tertile were significantly associated with increased long‐term risks of MACE (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.24–1.88), all‐cause death (HR 1.80, 95% CI 1.29–2.51) and unplanned revascularization (HR 1.44, 95% CI 1.09–1.91). Although significant associations between the highest SHR tertile and risks of MACE and all‐cause death were assessed in both diabetic and nondiabetic patients, the patterns of risk were different in these two groups. Conclusion Elevated SHR was independently associated with a higher risk of long‐term outcomes irrespective of diabetic status, suggesting that SHR was a potential biomarker for risk stratification after ACS.
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