简介：BackgroundManypatientshavesymptomssuggestiveofcoronaryarterydisease(CAD)andareoftenevaluatedwiththeuseofdiagnostictesting,althoughtherearelimiteddatafromrandomizedtrialstoguidecare.MethodsWerandomlyassigned10,003symptomaticpatientstoastrategyofinitialanatomicaltestingwiththeuseofcoronarycomputedtomographicangiography(CTA)ortofunctionaltesting(exerciseelectrocardiography,nuclearstresstesting,orstressechocardiography).Thecompositeprimaryendpointwasdeath,myocardialinfarction,hospitalizationforunstableangina,ormajorproceduralcomplication.SecondaryendpointsincludedinvasivecardiaccatheterizationthatdidnotshowobstructiveCADandradiationexposure.ResultsThemeanageofthepatientswas60.8±8.3years,52.7%werewomen,and87.7%hadchestpainordyspneaonexertion.ThemeanpretestlikelihoodofobstructiveCADwas53.3±21.4%.Overamedianfollow-upperiodof25months,aprimaryend-pointeventoccurredin164of4996patientsintheCTAgroup(3.3%)andin151of5007(3.0%)inthefunctional-testinggroup(adjustedhazardratio,1.04;95%confidenceinterval,0.83to1.29;P=0.75).CTAwasassociatedwithfewercatheterizationsshowingnoobstructiveCADthanwasfunctionaltesting(3.4%vs.4.3%,P=0.02),althoughmorepatientsintheCTAgroupunderwentcatheterizationwithin90daysafterrandomization(12.2%vs.8.1%).ThemediancumulativeradiationexposureperpatientwaslowerintheCTAgroupthaninthefunctional-testinggroup(10.0mSvvs.11.3mSv),but32.6%ofthepatientsinthefunctional-testinggrouphadnoexposure,sotheoverallexposurewashigherintheCTAgroup(mean,12.0mSvvs.10.1mSv;P<0.001).ConclusionsInsymptomaticpatientswithsuspectedCADwhorequirednoninvasivetesting,astrategyofinitialCTA,ascomparedwithfunctionaltesting,didnotimproveclinicaloutcomesoveramedianfollow-upof2years.

简介：BackgroundArrhythmogenicrightventricularcardiomyopathy(ARVC)isamajorcauseforsuddencardiacdeathduetoventriculartachycardia.Litterisknownaboutitslong-termoutcomesinChineseARVCpatients.Thepurposeofthisstudywastoevaluatethelong-termclinicaloutcomesinpatientswithARVCandtoclarifytheriskfactorsofcardiacevents.MethodsFortysubjectsfulfillingmodifiedTaskForcecriteriawereincludedinthisstudy.Informationonclinicalpresentation,electrocardiographicandcardiacimagingfindings,andlong-termoutcomeofcaseswereinvestigated.ResultsAveragefollow-upperiodfromonsetwas57.5±42.6months.Themeanageatonsetofsymptoms(32.2±12.7years)andmalepredominance(85.0%)weresimilartothatreportedinotherstudies.Palpitationswerethemostfrequentsymptom(82.5%).T-waveinversionwasthemostcommonpresentingabnormalityonresting12-leadECG(75%).Ventriculartachycardiawithleftbundlebranchblockmorphologywassubsequentlydocumentedinatotalof28(70%)subjectsduringastudyperiod.Thecumulativemortalityratewas7.5%.ConclusionClinicalpresentationinChineseARVCpatientswassimilartothatreportedinotherstudies.ARVCisassociatedwithearlymortalitythatisdifferenttoothercountrypopulation.

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简介：TheadoptionoftransradialaccessintheUnitedStatesandinternationallyhasbeengrowingoverthepastfewyears.Inthepopulationofpatientspresentingwithacutecoronarysyndromes,particularlyST-elevationmyocardialinfarction,transradialaccesshasthebenefitoffewervascularandbleedingcomplicationsandlowermortalityratesovertransfemoralaccess.Wewillexaminethecurrentevidencesupportingtransradialaccessforseveralpatientpopulations,includingthosepatientspresentingwithacutecoronarysyndromes.Wewillreviewtheliteratureregardingthelearningcurvefortransradialaccesswithnewoperators,aswellasexperiencedtransfemoraloperatorsnewtotransradialaccess.Finally,wewillinvestigatetheroleoftransradialaccessinsame-daydischargeforstablepatientsundergoingpercutaneouscoronaryintervention.

简介：Take-homeMessages.TherecentlypublishedACC/AHAcholesterolguidelinesrecommendfixed-dosestatintherapyforthoseatrisk,andalthoughnotrecommendedasfirstlinetherapy,nonstatintherapiesarerecommendedwhenlessthananticipatedtherapeuticresponsetostatintherapyoccursorwhenpatientsarenotabletotoleratestatintherapy.Nonstatincholesterol-loweringdrugsshowntoreduceatheroscleroticcardiovasculardisease(ASCVD)eventsinrandomizedcontrolledtrials(RCTs)arepreferred.Noevidencewasfoundtosupporttheuseofspecificlow-densitylipoprotein(LDL)-cholesteroltargetlevels.

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简介：BackgroundMonocytetohighdensitylipoproteinratio(MHR)hasbeenconsideredasanovelparameterrelatedwithadverserenalandcardiovascularoutcomes.InthisstudyweinvestigatedtheassociationofMHRwithmajoradverseclinicalevents(MACEs)inpatientswithtype2diabetesmellitus(T2DM)undergoingelectivepercutaneouscoronaryintervention(PCI).MethodsConsecutiveT2DMpatientstreatedwithelectivePCIwereprospectivelyrecruitedbetweenJuly2008-January2016inDepartmentofCardiologyofPanyuCentralHospital.Subjectswerecategorizedintotwogroups:aspatientswhodevelopedMACEs(MACEs+)andpatientswhodidnotdevelopMACEs(MACEs-)duringhospitalization.MACEsweredefinedasthecompositeendpoints,includingall-causemortality,oracuteheartfailure,ortargetvesselrevascularization,orstrokeorrecurrentangina.ResultsAtotalof418patientswereincludedinthestudy.64patientsdevelopedMACEs(15.3%).IntheMACEs(+)patients,monocyteswerehigher(1.12[0.78-1.42]vs.0.72[0.68-0.92]109/L,P<0.01)andHDLcholesterollevelswerelower(0.87[0.72-1.21]vs.0.96[0.81-1.11]mmol/L,P<0.01).Inaddition,MHRwassignificantlyhigherintheMACEs(+)group(1.12[0.91-2.09]vs.0.73[0.54-0.93]109mmol/L,P<0.01).ThecutoffvalueofMHRforpredictingMACEswas22,withasensitivityof81%andaspecificityof75.1%(areaunderthecurve0.79,P<0.001).Inmultivariatelogisticregressionanalysis,MHRremainedanindependentfactorcorrelatedwithMACEs(OR=3.97,95%CI=1.38-11.5,P<0.01).ConclusionHigherMHRlevelsmaypredictMACEsdevelopmentafterelectivePCIinT2DMpatients.