简介：Cardiovasculardisease(CVD)istheleadingcauseofdeathworldwide.ThisarticlefocusesoncurrentguidelinesfortheprimarypreventionofCVDandaddressesmanagementofkeyriskfactors.Dietarymodification,weightloss,exercise,andtobaccousecessationarespecificareaswherefocusedeffortscansuccessfullyreduceCVDriskonbothanindividualandasocietallevel.Specificareasrequiringmanagementincludedyslipidemia,hypertension,physicalactivity,diabetes,aspirinuse,andalcoholintake.Thesepreventiveeffortshavemajorpublichealthimplications.Astheglobalpopulationcontinuestogrow,healthcareexpenditureswillalsorise,withthepotentialtoeventuallyoverwhelmthehealthcaresystem.ThereforeitisimperativetoapplyourcollectiveeffortsonCVDpreventiontoimprovethecardiovascularhealthofindividuals,communities,andnations.

简介：BackgroundDuringprimarypercutaneouscoronaryintervention(PCI),manualthrombectomymayreducedistalembolizationandthusimprovemicrovascularperfusion.Smalltrialshavesuggestedthatthrombectomyimprovessurrogateandclinicaloutcomes,butalargertrialhasreportedconflictingresults.MethodsWerandomlyassigned10,732patientswithST-segmentelevationmyocardialinfarction(STEMI)undergoingprimaryPCItoastrategyofroutineupfrontmanualthrombectomyversusPCIalone.Theprimaryoutcomewasacompositeofdeathfromcardiovascularcauses,recurrentmyocardialinfarction,cardiogenicshock,orNewYorkHeartAssociation(NYHA)classIVheartfailurewithin180days.Thekeysafetyoutcomewasstrokewithin30days.ResultsTheprimaryoutcomeoccurredin347of5033patients(6.9%)inthethrombectomygroupversus351of5030patients(7.0%)inthePCI-alonegroup(hazardratiointhethrombectomygroup,0.99;95%confidenceinterval[CI],0.85to1.15;P=0.86).Theratesofcardiovasculardeath(3.1%withthrombectomyvs.3.5%withPCIalone;hazardratio,0.90;95%CI,0.73to1.12;P=0.34)andtheprimaryoutcomeplusstentthrombosisortarget-vesselrevascularization(9.9%vs.9.8%;hazardratio,1.00;95%CI,0.89to1.14;P=0.95)werealsosimilar.Strokewithin30daysoccurredin33patients(0.7%)inthethrombectomygroupversus16patients(0.3%)inthePCI-alonegroup(hazardratio,2.06;95%CI,1.13to3.75;P=0.02).ConclusionsInpatientswithSTEMIwhowereundergoingprimaryPCI,routinemanualthrombectomy,ascomparedwithPCIalone,didnotreducetheriskofcardiovasculardeath,recurrentmyocardialinfarction,cardiogenicshock,orNYHAclassIVheartfailurewithin180daysbutwasassociatedwithanincreasedrateofstrokewithin30days.

简介：BackgroundAlthoughalotofstudieshavebeenperformedonthelongtermoutcomeinadultswithrepairedtetralogyofFallot(TOF)indevelopedcountries,butrareinformationforprimarycorrectionofadultTOFisavailable.Theresearchfocusingontheeffectoftransanularpatch(TAP)forprimarycorrectionofTOFinadulthoodisstillabsent.Viaretrogradeanalysisof7-yearfollow-up,thisstudywasdesignedtoexploretheeffectofthetransanularpatchforprimarycorrectioninadultTOFonthesurgicaloutcome,postoperativecardiacfunctionandmorbidity,aswellastoaddressthemanagementofthecomplication.MethodsAtotalof151consecutiveadultpatients(age≥18)whounderwentprimaryradicalcorrectionofTOFform2007-2014wereselectedanddividedintoTAPandnon-TAPgroupsbasedontheEACTSdatabase.Resultsofdemographicstatisticcharacteristics,echocardiography,color-Dopplerechocardiography,cardiovascularenhancedcontrastcomputedtomography(CT),and/orcardiaccatheterization;intraoperativeinformation,postoperativeresultsandoutcomeswerereported.Duringfollow-up,shorttermwasdefinedwithin3monthsafterdischarge,andmidtermwasdefinedas6-12monthsafterdischarge.ResultsTotalpostoperativemortalitywas5.96%inallthecases,6.96%inTAPgroup,and2.78%(1/36)innon-TAPgroup.Therewasnosignificantdifferencebetweentwogroups.Follow-upperiodrangedfrom3monthsto62months.Readmissionoccurredandwasfollowedbymedicaltreatmentwithoutre-dosurgeryin6cases(3.97%).TheshorttermechocardiographydemonstratedthatpulmonaryregurgitationandshorttermtricuspidregurgitationafterdischargeinTAPgroupweremoresevere(P<0.001).Theshorttermresidualpulmonarystenosis(RVOTO)severityafterdischargeinTAPgroupwaslesssevere(P=0.018).MidtermechocardiographyafterdischargedemonstratedpulmonaryregurgitationandtricuspidregurgitationinTAPgroupwerestillmoresevere(P=0.003).TheseverityofresidualpulmonarystenosisinT

简介：Toreviewthecardiacprotectiveeffectsofwineintakeandrecommendmoderatewineconsumptionasaprimarypreventionstrategyforcoronaryarterydiseases(CAD).Systematicallyreviewformerstudiesonthewineconsumption(redwineandyellowwine)bysearchingtheMedlinedatabaseandotherrelatedcitations,andinvestigatepossibleprotectivepathways.Regularmoderatewineintakecanbenefitheartfromacutecoronarysymptom(ACS)attacking;reducetherelativeriskofmorbidityandmortalityfromCAD.Itmightnotbeimperativetoaskpeopletostopdrinking;inversely,wesuggestmoderatewineconsumptionasapreventivestrategyinCADforitsguardingcontribution.

简介：Transcatheteraorticvalvereplacement(TAVR)isincreasinglyusedforthetreatmentofhighorveryhighsurgicalriskpatientswithsevereaorticstenosis(AS)orfailingsurgicalbioprosthesis(valve-in-valve,VIV-TAVR).InTAVR,thecollapsedtranscatheterheartvalve(THV)isintroducedusingthedeliverysysteminsertedfromthefemoralartery(preferred)orotheralternativeaccesses(transapical,transaortic,transcarotid,subclavian/transinnominateortranscaval).Thedeliverysystemisthenadvanceduntilcoaxiallyalignedwiththeaorticannulus,wheretheTHVisdeployed.Thisprocedurecanbeassociatedwithcomplicationssuchasaccesssiteinjury(vascularcomplication),paravalvarleak,cerebrovasculareventsandconductiondisturbances.However,therapidacceptanceandsuccessesobservedwithTAVRhavebeenmadepossiblethroughcarefulpatientselection,preproceduralplanning(i.e.MDCTannularsizing),THVtechnology(i.e.newgenerationvalves),andproceduraltechniques(i.e.minimalistTF-TAVRandalternativepercutaneousaccessoptions),aswellasadecreaseincomplicationsasTAVRexperiencegrows.ThoughtheresultsorongoingclinicaltrialsevaluatingTAVRinintermediatesurgicalriskpatientsarepending,itislikelythatTAVRwillsoonbeapprovedforlowerriskpatientsaswell.

简介：backgroundToinvestigatetheeffectofintra-aorticballoonpumping(IABP)onno-reflowphenomenoninprimarypercutaneouscoronaryintervention(PCI)forST-ElevationMyocardialInfarction(STEMI).MethodsClinicaldataof22acutemyocardialinfarctionpatientsafterPCIwithangiographicno-reflowphenomenonwereretrospectivelyanalyzedbetweenJanuary2006andDecember2009.12patientsunderwentIABP,other10patientsascontrolgroup.Weobserveddifferenceofcardiacstructure,brainnatriureticpeptide(BNP)andventricularsystolicfunctionbetweentwogroup,aswellascardiacinjurymarkers(MYO,CK-MB,cTnI)inbothgroupsonthedaysof1,2,3,5,7,10afterthedifferentinterventions.Inaddition,cardiacstructureandventricularsystolicfunctionincludingleftatriummedialdiameter(LAMD),leftventricularmedialdiameter(LVMD),leftventricularejectionfraction(LVEF)wasevaluatedafter10days,3months,6months.Finally,statisticswasusedtoanalysisthedata.ResultsTheseveralvasoactivesubstancesaswellascardiacinjurymarkersandLAMD,LVMD,LVEFof10days,3months,6monthsofIABPgroupweresignificantdifferencewithcontrolgroup(P<0.05).BNPtargetsofIABPgroupcomparedwiththecontrolgroupnosignificantdifference(P>0.05).ConclusionsIABPhaseffectsonprognosisinSTEMIpatientswhoperformedPCIwithangiographicno-reflowphenomenon,whichisconducivetorecoveryofheartfunction.

简介：BackgroundIntravascularvolumeexpansionrepresentsabeneficialmeasureagainstcontrast-inducedacutekidneyinjury(CI-AKI)inpatientsundergoingelectiveangiographicprocedures.However,theefficacyofthispreventivestrategyhasnotyetbeenestablishedforpatientswithST-elevation-myocardialinfarction(STEMI),whoareathigherriskofthiscomplicationafterprimarypercutaneouscoronaryintervention(PCI).Inthisrandomizedstudyweinvestigatedthepossiblebeneficialroleofperiproceduralintravenousvolumeexpansionandwecomparedtheefficacyof2differenthydrationstrategiesinpatientswithSTEMIundergoingprimaryPCI.MethodsandResultsWerandomlyassigned450STEMIpatientstoreceive(1)preprocedureandpostprocedurehydrationofsodiumbicarbonate(earlyhydrationgroup),(2)postprocedurehydrationofisotonicsaline(latehydrationgroup),or(3)nohydration(controlgroup).TheprimaryendpointwasthedevelopmentofCI-AKI,definedasanincreaseinserumcreatinineof≥25%or0.5mg/dLoverthebaselinevaluewithin3daysafteradministrationofthecontrastmedium.Moreover,weevaluatedapossiblerelationshipbetweentheoccurrenceofCI-AKIandtotalhydrationvolumeadministered.Therewerenosignificantdifferencesinbaselineclinical,biochemical,andproceduralcharacteristicsinthe3groups.Overall,CI-AKIoccurredin93patients(20.6%):theincidencewassignificantlylowerintheearlyhydrationgroup(12%)withrespecttoboththelatehydrationgroup(22.7%)andthecontrolgroup(27.3%)(Pfortrend=0.001).Inhydratedpatients(earlyandlatehydrationgroups),lowerinfusedvolumeswereassociatedwithasignificantincreaseinCI-AKIincidence,andtheoptimalcutoffpointofhydrationvolumethatbestdiscriminatespatientsathigherriskwas≤960mL.ConclusionsAdequateintravenousvolumeexpansionmaypreventCI-AKIinpatientsundergoingprimaryPCI.Aregimenofpreprocedureandpostprocedurehydrationtherapywithsodiumbicarbonatea

简介：

简介：BackgroundThepresenceofachronictotalocclusion(CTO)inanon-infarct-relatedarterymightbeassociatedwithaworseprognosisinlongtermbenefitforST-segmentelevationmyocardialinfarction(STEIMI)patients.Butitstillremaincontroversial.MethodsAll383STEMIpatientsunderwentpercutaneousintervention(PCI)fromJan2015toJan2017inourcenterwereenrolledinthisprospectivestudy.Baselinecharacteristics,medicalhistory,biochemicalfindings,echocardiographicandangiographicparameters,proceduresperformedandcomplicationswererecorded.FactorsrelatedtoworseoutcomeCTOinSTEMIpatientswereanalyzedbythecoxlogisticregressionanalysisforthehazardrate(HR).ResultsInatotalof383patientsenrolledinthisstudy,85caseshadCTOinatleast1coronaryartery.Themeanfollow-upwas352days.1-yearmortalityandMACEratesinpatientswithCTOwere18.8%and11.8%,respectively.Majoradversecardiacevents(MACE)duringfollow-upweresignificantlyhigherinpatientswithCTO(HR=2.88;95%CI,1.82-4.77;P<0.001).ThemultivariateanalysisshowedasignificantassociationbetweenCTOandMACE(HR=2.1195%CI,1.27-3.88;P=0.014).ConclusionChronictotalocclusionisassociatedwithhigherriskofcomorbiditiesandhighermortality,andservesasanindependentpredictorofMACE.

简介：BackgroundIntheHORIZONS-AMI(HarmonizingOutcomeswithRevasculariZatiONandStentsinAcuteMyocardialInfarction)trial,3,602patientsundergoingprimarypercutaneouscoronaryintervention(PCI)forST-segmentelevationmyocardialinfarction(STEMI)treatedwithbivalirudinhadlowerbleedingandmortalityrates,buthigheracutestentthrombosisratescomparedwithheparin+aglycoproteinⅡb/Ⅲainhibitor(GPI).SubsequentchangesinprimaryPCI,includingtheuseofpotentP2Y12inhibitors,frequentradialintervention,andpre-hospitalmedicationadministration,wereincorporatedintotheEUROMAX(EuropeanAmbulanceAcuteCoronarySyndromeAngiography)trial,whichassigned2,218patientstobivalirudinversusheparin±GPIbeforeprimaryPCI.ObjectivesThegoalofthisstudywastoexaminetheoutcomesofproceduralanticoagulationwithbivalirudinversusheparin±GPIforprimaryPCI,giventheevolutioninprimaryPCI.MethodsDatabasesfromHORIZONS-AMIandEUROMAXwerepooledforpatient-levelanalysis.TheBreslow-Daytestevaluatedheterogeneitybetweentrials.ResultsAtotalof5,800patientswererandomizedtobivalirudin(n=2,889)orheparin±GPI(n=2,911).Theradialapproachwasusedin21.3%ofpatients,prasugrel/ticagrelorwasusedin18.1%ofpatients,andGPIwasusedin84.8%ofthecontrolgroup.Bivalirudincomparedwithheparin±GPIresultedinreduced30-dayratesofmajorbleeding(4.2%vs.7.8%;relativerisk[RR]:0.53;95%confidenceinterval[CI]:0.43to0.66;P<0.0001),thrombocytopenia(1.4%vs.2.9%,RR:0.48;95%CI:0.33to0.71;P=0.0002),andcardiacmortality(2.0%vs.2.9%;RR:0.70;95%CI:0.50to0.97;P=0.03),withnonsignificantlydifferentratesofreinfarction,ischemia-drivenrevascularization,stroke,andall-causemortality.Bivalirudinresultedinincreasedacute(<24h)stentthrombosisrates(1.2%vs.0.2%;RR:6.04;95%CI:2.55to14.31;P<0.0001),withnonsignificantlydifferentratesofsubacutestentthrombosis.Compositenetadversec

简介：BackgroundCoronaryslowflow(CSF)duringprimarypercutaneouscoronaryintervention(PCI)iscloselyrelatedtotheprognosisofpatientswithacutemyocardialinfarction(AMI).WhetherEnhancedExternalCounterPulsation(EECP)couldimprovethephenomenonandenhancecardiacfunctioninthesepatientshasnotbeenstudied.MethodsSeventy-eightAMIpatientsundergoingprimaryPCIwereenrolledanddividedinto2groups,EECPgroupandshamgroup.InEECPgroup,thepatientsweretreatedwithEECPfor30minaftercoronaryarterystentimplantation;andinshamgroup,thepatientsaftercoronaryarterystentimplantationweretreatedwithcuffswrappedfor30min.HemodynamicsandcorrectedTIMIFrameCount(cTFC)wererecordedatdifferenttimepointsinbothgroups.CRP,HCY,NT-proBNPandKillipclasswerealsodetectedbeforeoperationandaftertreatment.ResultsInEECPgroup,comparedtopre-andpost-EECPtreatment,thesystolicbloodpressure(SBP)wasmuchlower(P<0.05),diastolicbloodpressure(DBP)andmeanarterialbloodpressure(MBP)weremuchhigher(P<0.05).Theheartrate(HR)wasnotchangedduringEECPtreatment(P>0.05).Inshamgroup,SBP,DBP,MBPandHRwerenotsignificantlychangedduringtheseperiod(P>0.05).InEECPgroup,thecTFCofpatientswithCSFdecreasedsignificantlyaftertreatment(P<0.05);andtherewasnodifferenceinshamgroup(P>0.05).Comparedwithpre-EECPtreatment,CRPandHCYwereincreasedinpost-EECPtreatmentofbothgroups(P<0.05),while,theyweremuchlowerinEECPgroup(P<0.05).TheexpressionofNTproBNPwasdecreasedaftertreatmentinbothgroups(P<0.05),anditwasmuchlowerinEECPgroupthaninshamgroup(P<0.05).TheKillipclasswasmuchloweraftertreatmentthanbeforeoperationinEECPgroup(P<0.05),andtherewasnochangeinshamgroup(P>0.05).ConclusionsTheresultssuggestthatEECPishelpfulinashorttimetotheimprovementofCSFandrecoveryofcardiacfunctioninAMIpatientsduringprimaryPCI,andthatCRPandHCYmaybeinvolvedinthispr

简介：Toinvestigatethebenefitsofintracoronaryhigh-dosetirofibanduringprimarypercutaneouscoronaryintervention(PCI)forpatientswithacuteST-segmentelevationmyocardialinfarction(STEMI).MethodsFifty-eightpatientswithSTEMIpresentedwithin12hofsymptomswererandomlyallocatedtostudygroup(n=28,intracor-onaryhigh-dosetirofiban)andcontrolgroup(n=30,intravenoushigh-dosetirofiban).Theculpritvesselsweretarge-tedwithprimaryPCIinallpatients.Clinicalcharacteristics,angiographicfindings,brainnatriureticpeptide(BNP)at7-dayandin-hospitaloutcomeswerecomparedbetweengroups,aswellasleftventricularejectionfraction(LVEF)andmajoradversecardiacevents(MACE,includingdeath,reinfarction,worseningheartfailureandtargetvesselrevascu-larization)at30-dayclinicalfollow-up.ResultsComparedwiththecontrolgroup,thestudygroupshowedbetterthrombolysisinmyocardialinfarction(TIMI)flowgradesimmediatelyafterPCI(96.4%vs76.7%,P=0.02).The30-daycompositemajoradversecardiaceventsratewaslowerinthestudygroup(3.6%vs23.3%,P=0.02),andtheLVEFandBNPinthestudygroupat7dayswasbetterthanthatinthecontrolgroup(P=0.01and0.02,respec-tively).Nosignificantdifferenceinhemorrhagiccomplicationsinhospitalbetweengroupswasnoted(P=0.61).ConclusionsThestudyindicatesthatintracoronaryhigh-dosebolusadministrationoftirofibanforpatientswithSTEMIwhounderwentprimaryPCIcansignificantlyimprovethereperfusionlevelintheinfarctareaandclinicaloutcomesat30daysfollow-up.Itisbetterandsafertoapplyintravenousbolusinjectionforimprovingcoronaryflow,LVEFandshort-termclinicaloutcomes.

简介：BackgroundLargepercutaneouscoronaryintervention(PCI)centershaveshownstatisticallybetterprognosiswithtransradialapproach(TRA)comparedwithtransfemoralapproach(TFA).SowetriedtocomparetheoutcomesbetweenTRAandTFAinonehighvolumePCIcenterinST-segmentelevationmyocardialinfarction(STEMI)patientsundergoingprimaryPCI.MethodSixhundredandsixtytwoSTEMIpatientswhounderwentprimaryPCIwithstentsimplantationwereretrospectivelyincludedfromJune1,2006toApril30,2011inourhospitalandprospectivelyfollowedforoneyear.Theprimaryendpointwasdefinedasin-hospitalnetadverseclinicalevents(NACE)whichincludeddeath,myocardialinfarction(MI),stroke,targetvesselrevascularization(TVR)andmajorbleeding.Thesecondaryendpointwasdefinedas1yearmajoradversecardiovascularevents(MACE)whichincludeddeath,MIandTVR.ResultsTheoccurrenceratesofNACE(8.0%vs.17.0%,P=0.0018),accesssitecomplications(4.0%vs.10.7%P=0.0027)andaccesssite-relatedmajorbleeding(2.4%vs.6.3%,P=0.0254)wereallhigherintheTFAgroupthanintheTRAgroup.Theincidencerateof1yearMACEwassimilarbetweenTRAandTFA(8.5%vs.13.2%,P=0.0932).TheinverseprobabilitiesweightingmatchedmultivariableCoxregressionanalysisshowedTRAwasanindependentpredictoroflowerratesofin-hospitalNACE(HR:0.58,95%CI:0.34-0.99,P=0.0477),in-hospitaldeath(HR:0.31,95%CI:0.10-0.73,P=0.0499)andaccesssitecomplications(HR:0.37,95%CI:0.19-0.73,P=0.0040).ConclusionsTRAshowedgreatefficacyandsafetyforSTEMIpatientsundergoingprimaryPCIinhighvolumePCIcenters.Itshouldberecommendedasroutinepracticeinfuture,andespeciallyinthosepatientswithhighriskofbleeding.