ISSN 1671-5411 CN 11-5329/R

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2019 Vol. 16, No. 6

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Calcium channel blocker monotherapy versus combination with renin-angiotensin system inhibitors on the development of new-onset diabetes mellitus in hypertensive Korean patients
Yong Hoon Kim, Ae-Young Her, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Yoonjee Park, Dong Oh Kang, Won Young Jang, Woohyeun Kim, Woong Gil Choi, Tae Soo Kang, Jihun Ahn, Sang-Ho Park, Ji Young Park, Min-Ho Lee, Cheol Ung Choi, Chang Gyu Park, Hong Seog Seo
2019, 16(6): 439-447. doi: 10.11909/j.issn.1671-5411.2019.06.003
Background In real practice, two or more antihypertensive drugs are needed to achieve target blood pressure. We investigated the comparative beneficial actions of combination therapy of renin-angiotensin system inhibitors (RASI), with calcium channel blockers (CCB) over CCB monotherapy on the development of new-onset diabetes mellitus (NODM) in Korean patients during four-year follow-up periods. Methods A total of 3208 consecutive hypertensive patients without a history of diabetes mellitus who had been prescribed CCB were retrospectively enrolled from January 2004 to December 2012. These patients were divided into the two groups according to the additional use of RASI (the RASI group, n = 1221 and the no RASI group, n = 1987). Primary endpoint was NODM, defined as a fasting blood glucose ≥ 126 mg/dL or hemoglobin A1c ≥ 6.5%. Secondary endpoint was major adverse cardiac events (MACE) defined as total death, myocardial infarction (MI) and percutaneous coronary intervention (PCI). Results After propensity score-matched (PSM) analysis, two propensity-matched groups (939 pairs, n = 1878, C-statistic = 0.743) were generated. The incidences of NODM (HR = 1.009, 95% CI: 0.700–1.452, P = 0.962), MACE (HR = 0.877, 95% CI: 0.544–1.413, P = 0.589), total death, MI, PCI were similar between the two groups after PSM during four years. Conclusions The use of RASI in addition to CCB showed comparable incidences of NODM and MACE compared to CCB monotherapy in non-diabetic hypertensive Korean patients during four-year follow-up period. However, large-scaled randomized controlled clinical trials will be required for a more definitive conclusion.
Drug-eluting balloons versus new generation drug-eluting stents for the management of in-stent restenosis: an updated meta-analysis of randomized studies
Lei GAO, Ya-Bin WANG, Jing JING, Ming ZHANG, Yun-Dai CHEN
2019, 16(6): 448-457. doi: 10.11909/j.issn.1671-5411.2019.06.002
Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis % (DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD = ?0.18, 95% CI: ?0.31– ?0.04, P P P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.
Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction
Jin-Wen TIAN, Mei ZHU, Feng-Qi WANG, Ke LI, Chao-Fei ZHOU, Bo LI, Min WANG, Jue-Lin DENG, Bo JIANG, Jing BAI, Yi GUO, Rong-Jie JIN, Zhao ZHANG, Ying LIN, Ji-Hang WANG, Shi-Hao ZHAO, Ming-Zhi SHEN
2019, 16(6): 458-467. doi: 10.11909/j.issn.1671-5411.2019.06.004
Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.
Value of a comprehensive geriatric assessment for predicting one-year outcomes in patients undergoing transcatheter aortic valve implantation: results from the CGA-TAVI multicentre registry
Martijn S. van Mourik, Nathalie van der Velde, Giulio Mannarino, Marie-Pierre Thibodeau, Jean-Bernard Masson, Gennaro Santoro, Jan Baan, Sofie Jansen, Jana Kurucova, Martin Thoenes, Cornelia Deutsch, Andreas W. Schoenenberger, Andrea Ungar, Peter Bramlage, M Marije Vis
2019, 16(6): 468-477. doi: 10.11909/j.issn.1671-5411.2019.06.001
Background In a three-month report from the CGA-TAVI registry, we found the Multidimensional Prognostic Index (MPI) and Short Physical Performance Battery (SPPB) to be of value for predicting short-term outcomes in elderly patients undergoing transcatheter aortic valve implantation (TAVI). In the present analysis, we examined the association of these tools with outcomes up to one year post-TAVI. Methods CGA-TAVI is an international, observational registry of geriatric patients undergoing TAVI. Patients were assessed using the MPI and SPPB. Efficacy of baseline values and any postoperative change for predicting outcome were established using logistic regression. Kaplan-Meier analysis was carried out for each comprehensive geriatric assessment tool, with survival stratified by risk category. Results One year after TAVI, 14.1% of patients deceased, while 17.4% met the combined endpoint of death and/or non-fatal stroke, and 37.7% the combined endpoint of death and/or hospitalisation and/or non-fatal stroke. A high-risk MPI score was associated with an increased risk of all-cause mortality (aOR = 36.13, 95% CI: 2.77–470.78, P = 0.006) and death and/or non-fatal stroke (aOR = 10.10, 95% CI: 1.48–68.75, P = 0.018). No significant associations were found between a high-risk SPPB score and mortality or two main combined endpoints. In contrast to a worsening SPPB, an aggravating MPI score at three months post-TAVI was associated with an increased risk of death and/or non-fatal stoke at one year (aOR = 95.16, 95% CI: 3.41–2657.01). Conclusions The MPI showed value for predicting the likelihood of death and a combination of death and/or non-fatal stroke by one year after TAVI in elderly patients.
Approach to a patient with pulmonary hypertension
Chakradhari Inampudi, Anna R Hemnes, Alexandros Briasoulis
2019, 16(6): 478-481. doi: 10.11909/j.issn.1671-5411.2019.06.007
Pulmonary hypertension is a common clinical condition that can complicate various cardiac and respiratory abnormalities. Interest in pulmonary hypertension has grown remarkably among the scientific community in the last decade. It is now clear based on the scientific advances have paved the way in understanding the effects of abnormal pulmonary hemodynamics development and its antecedent consequences on the right heart in reducing the quality of life and survival of the patient.
An overview of end-of-life issues in a cardiology department. Is the mode of death worse in the cardiac intensive care unit?
Lourdes Vicent, Vanesa Bruña, Carolina Devesa, Jorge García-Carreño, Iago Sousa-Casasnovas, Miriam Juárez, Francisco Fernández-Avilés, Manuel Martínez-Sellés
2019, 16(6): 482-489. doi: 10.11909/j.issn.1671-5411.2019.06.010
Device-related thrombosis on atrial septal defect occluder after simultaneous closure of left atrial appendage and atrial septal defect: a case report
Lu HE, Ya-Juan DU, Ge-Sheng CHENG, Yu-Shun ZHANG
2019, 16(6): 490-494. doi: 10.11909/j.issn.1671-5411.2019.06.009
In elderly population prophylactic anticoagulation favors early detection of digestive track cancers: an observational study in eastern Poland
Malgorzata Szlendak, Wojciech Myslinski, Jerzy Mosiewicz, Wojciech Barud
2019, 16(6): 495-497. doi: 10.11909/j.issn.1671-5411.2019.06.008
Intravascular ultrasound-guided “extended” reverse controlled antegrade and retrograde subintimal tracking technique using a cutting balloon for recanalizing chronic coronary total occlusion with a side branch
Yong-Tai GONG, Jian-Qiang LI, Li SHENG, Dang-Hui SUN, Yue LI
2019, 16(6): 498-501. doi: 10.11909/j.issn.1671-5411.2019.06.005
Successful opening in-stent chronic total occlusion lesion of coronary artery by excimer laser coronary angioplasty
Jing BAI, Hai-Xia WANG, Jiang-Tao WANG, Jing ZHAO, Liang PENG, Xue-Dong YANG, Zhe TANG, Shaheena Nazneen, Gao-Kun WANG, Yu WANG
2019, 16(6): 502-506. doi: 10.11909/j.issn.1671-5411.2019.06.006