Abstract:Aim To explore the influencing factors of major adverse cardiovascular events (MACE) after drug-eluting stent (DES) implantation in young and middle-aged patients with coronary artery disease (CAD). Methods Retrospective study data from the First Affiliated Hospital of Zhengzhou University were extracted from the Dryad database, and young and middle-aged CAD patients who received DES were divided into MACE group (n＝57) and non MACE group (n＝321) according to whether MACE occurred during the follow-up period. Clinical data including age, gender etc. were compared between the two groups, and the variables with significant differences between the two groups were substituted into Logistic regression model to screen the influencing factors of MACE after DES implantation in young and middle-aged CAD patients. Value of influencing factors predicting occurrence of MACE after DES implantation in young and middle-aged CAD patients was evaluated by plotting ROC curve and calculating the area under the curve (AUC). ResultsStent diameter in MACE group was significantly smaller than that in non MACE group (P＜0.001), the number of left main coronary artery lesion in MACE group was significantly higher than that in non MACE group (P＜0.05). Multivariate Logistic regression analysis indicated that stent diameter (OR＝0.4,5%CI:0.084～0.405, P＜0.001) and left main coronary artery lesion (OR＝9.9,5%CI:2.291～37.904, P＝0.002) were the independent risk factors of MACE after DES implantation in young and middle-aged CAD patients. The risk of MACE after DES implantation in young and middle-aged CAD patients significantly decreased when the stent diameter was ＞3 mm. The AUC of stent diameter combined with left main coronary artery lesion predicting occurrence of MACE after DES implantation in young and middle-aged CAD patients was 0.700 (95%CI:0.623～0.776). Conclusion The smaller stent diameter and left main coronary artery lesion are the influencing factors of the occurrence of MACE after DES implantation in young and middle-aged patients with CAD, and should be emphasized by clinical practitioners.

Abstract:Aim To investigate the risk factors of in-stent restenosis (ISR) within 2 years after the implantation of drug-eluting stent (DES) in patients with coronary heart disease and type 2 diabetes, and construct a Nomogram prediction model. Methods Clinical data of patients with coronary heart disease and type 2 diabetes who received DES at the Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen from January 2010 to February 2020 were retrospectively analyzed. The PASS estimation model generates cohort sample size, which was divided into ISR group (DES-ISR) and non-ISR (non-DES-ISR) group based on the results of coronary angiography. The single factor and conditional multivariate Logistic regression analysis were performed on the parameters with statistical significance between the two groups, and the Nomogram prediction model was constructed and its reliability was verified in the validation cohort. Results A total of 1 741 cases were included in model generated cohort, 233 cases (13.4%) were diagnosed with ISR within 2 years after implantation of DES. Conditional multivariate Logistic regression analysis showed that the predictor of DES-ISR was estimated glomerular filtration rate (eGFR)＜60 mL/(min·1.73 m2) (OR＝2.7,5%CI:1.41～5.47, P＝0.003), dyslipidemia (OR＝1.0,5%CI:1.30～2.78, P＝0.001), fasting blood glucose (FPG) ≥6.5 mmol/L (OR＝5.0,5%CI:3.05～9.92, P＜0.001), multivessel coronary artery disease (OR＝7.6,5%CI:3.27～16.11, P＜0.001), diffuse coronary artery disease (OR＝1.0,5%CI:1.13～2.88, P＝0.014), primary PCI operation time ≥60 min (OR＝2.2,5%CI:1.13～6.05, P＝0.024) and emergency PCI (OR＝2.0,5%CI:1.48～3.28, P＜0.001). The model validation cohort contained 102 cases, the risk of DES-ISR increased with the increase of the Nomogram scores. The area under the receiver operating characteristic (ROC) curve of the Nomogram model was 0.791 (95%CI:0.753～0.829, P＝0.019). Conclusions The anatomical characteristics of coronary artery and PCI procedures are important predictors of DES-ISR. Nomogram can effectively identify high-risk groups of DES-ISR and provide effective decision-making information for follow-up and intervention of high-risk groups.

Abstract:Aim To analyze the efficacy and safety of bioabsorbable polymer-coated drug-eluting stents in patients with coronary heart disease and diabetes mellitus. Methods The study searched database both at home and abroad, and retrieved the clinical randomized controlled trial (RCT) of comparison of bioabsorbable polymer-coated drug-eluting stent (BP-DES) and durable polymer-coated drug-eluting stent (DP-DES) in patients with coronary heart disease and diabetes mellitus. The efficacy and safety were evaluated by target lesion failure rate, target vessel revascularization rate, target lesion revascularization rate and cardiogenic mortality rate. Results A total of 14 RCT were included, of which 3 855 patients were treated with BP-DES and 2 916 patients with DP-DES, with a mean follow-up of 2.9 years. The overall target lesion failure rate of BP-DES versus DP-DES was 13.5% versus 12.8% (RR:1.7,5% CI:0.88～1.29, P=0.50). The overall cardiac mortality rate of BP-DES versus DP-DES was 6.2% versus 5.4% (RR:1.0,5%CI:0.90～1.34, P=0.35), and the overall target lesion and target vessel revascularization rates were not statistically different. There were no statistically significant differences in subgroup analysis according to follow-up time. Conclusion In patients with coronary heart disease and diabetes, BP-DES has a similar safety and efficacy profile to DP-DES.

Abstract:Aim To compare the efficacy and safety of bare metal stent (BMS), drug-coated balloon (DCB) and drug-eluting stent (DES) in coronary heart disease patients with high bleeding risk (HBR). Methods Domestic and international electronic databases were searched to collect randomized controlled clinical trials of DCB or DES vs. BMS in coronary heart disease patients with HBR, Meta-analysis was performed using Revman 5.3 software. The primary endpoints of this study were to compare the target lesion revascularization (TLR) rate, recurrent myocardial infarction rate, cardiogenic mortality rate and bleeding rate of DCB and DES vs. BMS in coronary heart disease patients with HBR. The secondary endpoints were to indirectly compare the TLR rate, recurrent myocardial infarction rate, cardiogenic mortality rate and bleeding rate of DCB and DES, so as to compare the clinical effect of the three. Results In coronary heart disease patients with HBR, compared with BMS group, DCB group and DES group had lower TLR rate (RD＝－0.4,5%CI:－ 0.05～0.03, P＜0.05), lower cardiogenic mortality rate (RD＝－0.2,5%CI:－0.04～－0.01, P＜0.05), and lower recurrent myocardial infarction rate (RD＝－0.3,5%CI:－0.05～0.01, P＜0.01). Compared with DES group, DCB group had lower TLR rate (0% vs. 5.5%, RR＝0.6,5%CI:0.00～0.98, P＝0.05) and recurrent myocardial infarction rate (0% vs. 5.8%, RR＝0.6,5%CI:0.00～0.93, P＜0.05). Patients in the three groups were treated with very short dual antiplatelet therapy (DAPT) program, and there was no significant difference in bleeding rate among the three groups. Conclusion In coronary heart disease patients with HBR, DCB and new generation DES combined with short-term DAPT have higher efficacy and safety than BMS.

Abstract:Aim To study the efficacy of rotational atherectomy (RA) versus balloon pre-dilated combined with drug eluting stent(DES) implatation in the treatment of heavily calcified coronary lesions. Methods The study selected patients with heavily calcified coronary lesions admitted in Fuyang City Peoples Hospital from October 2017 to October 2018 who were going to receive PCI. The patients were divided into two groups according to the random number table, which were the RA combined with DES group (observation group, n=32) and the balloon pre-dilated combined with DES(control group, n=40). Prospective randomized controlled study was performed. The treatment characteristics and perioperative complications were compared between the two groups. The risk factors of major adverse cardiovascular and cerebrovascular events (MACCE) within 6 months were analyzed. Results The average stent diameter was significantly higher in the observation group than in the control group (3.25 (3.0,3.50) mm vs 3.00 (2.1,3.25) mm, P=0.002). The number of balloon pre-dilated,pre-dilated maximum pressure, the number of balloon post-dilated and post-dilated maximum pressure were significantly lower in the observation group than in the control group(P＜0.05). The lumen diameter after PCI was significantly larger in the observation group than in the control group((3.34±0.28) mm vs (3.15±0.27) mm, P=0.005). The procedural success rate of the observation group (96.9%) was higher than that of the control group (92.9%), the incidence of total MACCE in the observation group (9.4%) was lower than in the control group (22.5%), but there is no significant differences between the two groups(P＞0.05). The previous PCI(risk ration:1.5,5%CI:0.030～0.691, P=0.015) and the maximum pressure of balloon pre-dilated(risk ration:2.6,5%CI:0.721～0.988, P=0.035) were independent risk factors for MACCE within 6 months. Conclusions For severely calcified coronary lesions with a SYNTAX score of 23 to 32, RA has tendencies to improve the procedural success rate and reduce short-term adverse events. The previous PCI and the maximum pressure of pre-dilated were independent risk factors for MACCE within 6 months.

Abstract:Aim To evaluate the efficacy and safety of paclitaxel-coated balloon (PCB) in the treatment of primary macroangiopathy of coronary artery (vessel diameter≥2.8 mm). Methods A prospective, randomized and controlled study was conducted in 100 consecutive patients with coronary heart disease who underwent coronary intervention in our hospital from January 2013 to December 2016. The patients were randomly divided into PCB group and drug-eluting stent (DES) group, with 50 cases in each group. The basic clinical data, the results of immediate coronary intervention and re-examination of angiography, and the long-term incidence of major adverse cardiovascular events were compared between the two groups. Results (1)There were no significant differences in age, blood pressure, blood lipid, smoking, past hypertension, diabetes mellitus and PCI history between the two groups (P＞0.05). (2)The ratio of single coronary artery lesion in PCB group was lower than that in DES group (60.0% vs 70.0%, P＝0.02). There was no significant difference in the ratio of double vessel lesions, three vessel lesions and left main vessel lesions between the two groups (P＞0.05). (3)There was no significant difference in preoperative minimal lumen diameter (MLD) between PCB group and DES group (P＜0.05). The MLD of PCB group was smaller than that of DES group immediately after operation, and the MLD of follow-up was larger than that of DES group (P＜0.05). There was no significant difference in late lumen loss between the two groups. (4)There was no significant difference in the incidence of major adverse cardiovascular events between PCB group and DES group. There were no deaths or recurrent acute myocardial infarction events in both groups during the follow-up period. Conclusion PCB is safe and effective in the treatment of primary macroangiopathy of coronary artery, and the long-term positive vascular remodeling is better than DES to some extent.

Abstract:Aim To investigate the effectiveness of the same and different drug-eluting stent in the treatment of coronary drug-eluting stent restenosis. Methods PubMed, OVID, Embase, Cochrane Library, Wanfang Database, China Journal Full-text Database(CNKI), Chinese Biomedical Literature Database (CBM), VIP Database (VIP) were retrieved. The materials of the treatment in coronary drug-eluting stent restenosis with the same and different drug-eluting stent were collected,10 studies were withdrawed, including 1680 patients. The RevMan5.2 analysis software was used in systematic review. Control test database computer retrieval to 2015 October. Results The different drug-eluting stent treatment in coronary drug-eluting stent restenosis was found to reduce the odds of target lesion revascularization (OR＝0.3,5%CI was 0.55~0.96, P＝0.02) and major adverse cardiovascular events (OR＝0.2,5%CI was 0.54~0.96, P＝0.03). There was no difference between the two groups in rates of death (OR＝1.3,5%CI was 0.49~2.16, P＝0.95) or myocardial infarction (OR＝0.9,5%CI was 0.24~1.41, P＝0.23). Conclusion For patients with restenosis after drug-eluting stent implantation, different drug-eluting stents are more benefit than the same drug-eluting stent implantation.

Abstract:Aim To assess the efficiency of rotational atherectomy （RA） with drug-eluting stents （DES） for heavily calcified lesions. Methods By retrospective analysis of 31 cases of severe calcified coronary atherectomy with interventional treatment of patients, 13 patients were carried out under the guidance of intravascular ultrasound （IVUS）, and we analyzed the clinical characteristics, immediate success rate of percutaneous coronary intervention （PCI）, and cardiac events of hospitalization and long-term follow-up results. Results The mean age of 31 patients was 71.81±10.70 years,and 22 patients were male, 9 patients were female. Their coronary artery were confirmed as severely calcified coronary by angiography, including single-vessel disease in 2 cases （6.5%）, double vessel disease in 7 cases （22.6%）, three lesions in 15 cases （48.4%）, left main （LM）＋three lesions in 1 case （3.2%）, LM disease in 6 cases （19.4%）. Rotational atherectomy target vessel in LM-left anterior descending artery （LAD） was 2 cases （6.5%）, LAD was 22 cases （70.9%）, left circumflex artery （LCX） was 2 cases （6.5%）, LAD＋LCX was 1 case （3.2%）, right coronary artery （RCA） was 4 cases （12.9%）. 1 case （3.2%） needed intra-aortic balloon pump （IABP） intraoperation, 6 cases （19.4%） were presented with coronary dissection and 2 cases （6.5%） were with slow flow, but all of them were successfully implemented with rotational atherectomy and stent implantation. Serum troponin T, serum creatine kinase-MB, and serum creatinine had no significant difference. 13 cases were carried out by IVUS, and the minimum lumen diameter, the smallest diameter stenosis rate, the effective area of ？？the lumen had significantly statistical difference pre- and post-operative, respectively（2.0±0.3 mm vs 3.6±0.8 mm, 74.5%±6.8% vs 20.3%±12.5%, 4.0±1.4 mm2 vs 10.7±5.5 mm2, P＝0.000）. With an average follow-up 10.4±6.4 months, no angina, acute myocardial infarction, sudden cardiac death, target vessel revascularization occurred. Conclusions The combination of rotational atherectomy with stents may selectively ablate calcific plaque and may increase the success rate of the PCI.

Abstract:Aim To retrospectively assess the effectiveness and safety of China-made drug eluting stent （CM-DES） implantation for the treatment of mild-to-modest calcified lesions in patients with acute coronary syndrome （ACS）.Methods Three hundred and twenty consecutive patients of ACS with 434 ischemia related lesions were implanted with CM-DES and received 6～12 months angiographic follow-up. The patients were divided into two groups according to whether the calcification exists or not: non-calcification groups （n267） and calcification group （n167）. Lesions treated with CM-DES were subjected to quantitative coronary angiography （QCA） at immediately and 6～12 months following stenting. Results Baseline clinical, demographic or angiographic characteristics were well comparable between the two groups. At follow-up, no differences were found between the two groups regarding in-stent restenosis （ISR） and in-segment restenosis rate （ISRR） （ISR: 3.9% vs. 4.3% P0.079 ISRR: 8.9% vs. 10.7%, P0.449）. The similar result was also observed concerning the target lesion revascularization （5.1% vs. 6.7% P0.401）. Besides, no difference about in-stent late loss （ISLL） and overall thrombosis rate （TR） was detected in both groups （ISLL: 0.18±0.42 mm vs. 0.19±0.43 mm TR: 1.7% vs. 1.4%, P>0.05 respectively）. Conclusion Our results indicated that implantation of CM-DES for patient of ACS with mild-to-modest calcified lesions was effective and conferred to similar outcomes compared with non-calcified coronary arteries without additional increase in major adverse cardiac events.

Abstract:Aim To study the effects of three kinds of domestic rapamycin drug-eluting stents（rapamycin drug-eluting stent, biodegradable rapamycin drug-eluting stents and polymer-free rapamycin drug-eluting stent） on serum secretory phospholipase A2 （sPLA2） and high sensitivity C-reactive protein （hs-CRP） levels after stents implantation. Methods 126 patients with unstable angina pectoris （UAP） by angiography were divided into Firebird 2 generation group （33 cases）, Excel group （43 cases） and Nano group （50 cases）, the patients without coronary heart disease （CHD） by coronary angiography during the same period were selected as the control group, serum concentration of sPLA2 and hs-CRP were determined before and at 24 h after coronary intervention. Results Clinical data had no difference in the four groups, and angiography characteristics had no significant differences in the three stent groups （P>0.05）. Serum concentration of sPLA2 and hs-CRP in the three stent groups were significantly higher than those of the control group before and at 24 h after coronary intervention （P<0.01）, but there were no significant differences between the three stent groups. Serum concentration of sPLA2 and hs-CRP at 24 h were significantly higher in each group than those in preoperative （P<0.05）. Compared with preoperative at 24 h, serum concentration of sPLA2 and hs-CRP in the three stent groups were significantly higher than those in the control group （P<0.01）, but there were no significant differences between the three stent groups. Conclusion Three kinds of domestic rapamycin drug-eluting stent implantation can induce the increase of serum sPLA2 and hs-CRP concentrations in short-term, but the inflammatory factor levels had no obvious differences between the three stent groups.