简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

简介：AbstractBackground:Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).Methods:In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results:A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n= 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions:Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration:Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.

简介：BackgroundTheimpactofincompleterevascularization(IR)onadverseoutcomesafterpercutaneouscoronaryinterventionremainsinconclusive,andfewstudieshaveexaminedmortalityduringfollow-upslongerthan5years.TheobjectiveofthisstudyistotestthehypothesisthatIRisassociatedwithhigherriskoflong-term(8-year)mortalityafterstentingformultivesselcoronarydisease.MethodsandResultsAtotalof13016patientswithmultivesseldiseasewhohadundergonestentingpro-cedureswithbaremetalstentsin1999to2000wereidentifiedintheNewYorkState'sPercutaneousCoronaryInterventionReportingSystem.Alogisticregressionmodelwasfittopredicttheprobabilityofachievingcompleterevascularization(CR)inthesepatientsusingbaselineriskfactors;then,theCRpatientswerematchedtotheIRpatientswithsimilarlikelihoodsofachievingCR.Eachpatient'svitalstatuswasfollowedthrough2007usingtheNationalDeathIndex,andthedifferenceinlong-termmortalitybetweenIRandCRwascompared.ItwasfoundthatCRwasachievedin29.2%(3803)ofthepatients.Forthe3803pair-matchedpatients,therespective8-yearsurvivalrateswere80.8%and78.5%forCRandIR(P=0.04),respectively.TheriskofdeathwasmarginallysignificantlyhigherforIR(hazardratio=1.12;95%confidenceinterval,1.01-1.26,P=0.04).The95%bootstrapconfidenceintervalforthehazardratiowas0.98to1.32.ConclusionsIRmaybeassociatedwithhigherriskoflong-termmortalityafterstentingwithBMSinpatientswithmultivesseldisease.Moreprospectivestudiesareneededtofurthertestthisassociation.

简介：AbstractBackground:The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients.Methods:We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission.Results:From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45–0.86; P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52–1.25; P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51–1.23; P = 0.308).Conclusions:In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making.Clinical trial registration:NCT02880605. https://www.clinicaltrials.gov.

简介：为可勃起的机能障碍的当代的治疗通常向老人被指向并且普遍雇佣药理学或设备相关治疗选择。阴茎revascularization，用microvascular动脉绕过外科的技术，是非药理学，non-device-related，和为有被瓦克拉夫·米查尔博士首先在1973描述的可勃起的机能障碍的人的改造外科的策略。当代的阴茎revascularization尝试到‘；cure'纯arteriogenic在有在远侧的内部pudendal的动脉的闭塞的病理的年轻人的可勃起的机能障碍，对从钝骨盆、会阴或阴茎的损伤的焦点的endothelial损害第二等的普通阴茎或近似的cavernosal动脉。microvascular吻合在腹上部的施主晚辈和接受者之间被塑造背面的阴茎动脉。增加的灌注压力理论上经由穿孔被传达到cavernosal动脉从背面的动脉的分支。这篇文章将与可勃起的机能障碍，利用的当前的外科的技术和外科的结果在年轻人考察钝导致损伤的焦点的动脉的闭塞的疾病的历史，指示和pathophysiology。阴茎revascularization的当代的使用是一种逻辑、想要的治疗学的选择试图在支撑了钝骨盆、会阴或阴茎的损伤的年轻人颠倒可勃起的机能障碍。

简介：Fortheestablishmentofdirectrevascularicationoftheischemicmyocardium,aNd:YAGlaserwithawavelengthof1060nmandanopiticfiberdiameterof500umwasusedtocreate20to25transmuralchannelsinthecentralischemicregionoftheleftventricleafterthecoronarywasligatured.Thechannelswerecreatedfromtheepicard1alsurfacetotheendocardiumandeachchannelreceivedabout64joulesofthe

简介：Tileterm‘percutaneouscoronaryintervention'(PCI)isusedtodescribevariousproceduresthatcanbeusedtomechanicallyimprovemyocardialperfusionwithoutresortingtosurgery.Themostcommonprocedureispercutaneoustransluminalcoronaryangioplasty(PTCA),usuallywithimplantationofanintracoronarystent.Othermethodsmaybeappropriateinsmallsubsetsofpatients.Morethan1millionPCIprocedureswereperformedworldwidein2000.

简介：Coronaryarterybypassgrafting(CABG)isenteringaneweraasminimallyinvasivetechniques,off-pumpsurgeryandtotal'arterialrevascularizationhavefotmdrolesinthesurgicaltreatmentofpatientswithcoronaryarterydisease.Thecontinueddevelopmentofthetechniquesofpercutaneouscoronaryintervention(PCI)isalsohavinganimpactonthetypeofpatientreferredforCABG.

简介：ObjectivesTounderstandtheeffectofcarvedilolonthecoronaryvascularendothelialfunctionofthepatientswithcoronaryheartdiseaseafterpercutaneoustransluminalcoronaryangioplasty(PTCA).Methods51cases,havingoneormorethantwobranchesnarrow(≥70%),werediagnosedbycoronaryangiography.Thesepatientsweredividedrandomlyintocarvedilolgroup(n=28)andcontrolgroup(n=23)whodidnottakecarvedilol.Endothelin(ET)andnitrodioxide(NO)levelsofperipheralbloodweremeasuredbeforeandafterPTCA,beforeandaftertwoweeksbytakingcarvedilol.ResuitsComparedwiththeETandNOlevelsbeforePTCA,ETweremarkedlyincreasedandNOweredecreasedafterPTCA(p<0.05);comparedwiththeETandNOlevelsbeforetakingcarvedilol,ETweredecreasedandNOwereincreasedaftertwoweek(p<0.05),buttheETandNOlevelsofthecontrolgroupdidnotchangeintheperiodoftwoweeksobservation(p>0.05).ConclusionsCarvedilolmayimprovethecoronaryvascularendothelialfunctionafterPTCA.

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简介：Thereareseveraltechniquesforperformingcoronaryatheroscleroticplaquemodification,knownasatherectomy.Historically,clinicaltrialsshowmostlyequivalencebetweenvariouscoronaryatherectomytechniques,balloonangioplasty,andpercutaneouscoronarystenting.Inthelastseveralyearstheuseofagivenatherectomytechniquehasbeenmostlyasameansoffacilitatingstentdeliveryinvesselsthatareheavilycalcified.Noclinicaltrialshaveshownsuperiorityofanyatherectomymethodovermorestandardtechniquesofpercutaneouscoronaryintervention.Thisreviewbeginswithadiscussionofdirectionalatherectomy,whichisnolongeravailable.Therotationalatherectomytechniqueanditsclinicaltrialdataarepresented.Orbitalatherectomyisthendiscussedindetail,includingtherelevantclinicaltrials.Finally,laseratherectomytechniquesarereviewed,andthepertinenttrialdataarepresented.Lastly,futuredirectionsaredetailed.

简介：Coronaryarterycalcification(CAC)isasanindependentriskpredictorofcardiovasculardiseaseandcanclassifyanindividual’sriskofatheroscleroticcardiovasculardisease,particularlyinintermediate-riskindividuals.Also,CACprogressionisassociatedwithgreaterratesofcardiovascularevents.ThisarticleprovidesavailabledataandexpertrecommendationsforCACbasedoncurrentpublications.WefocusontheutilityofCACforstratificationofindividualsanddescribeitsdiagnosticvalueinidentifyingpatientsatrisk.WealsodescribetheimportantabilityofCACtoderiskapatientwithascoreofzero.

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简介：Myocardialperfusioniswellcontrolledbyadjustmentofvasomotortoneofre-sistancevessels.Thestaticandsamedynamicaspectsofcoronaryflowcontrolcanwellbedescribedbyassumingfeedbackfromtissueoxygenpressuretothecoronaryvessel.Theseresistancevesselsaresmallarteriesfrom400/mandlessinarteriolesdownto10/m.Itisnotclearyethowvesselsofdifferentsizecanbeunderthecon-troloftissuefactorsandhowadaptationoftoneinlargervesselsistunedtothatofsmallerones.

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简介：BackgroundSeveralstudieshavereportedanassociationofhyperglycemiawithincreasedmortalityandcomplicationsinhospitalpatientswithacutecoronarysyndrome(ACS).However,theinfluenceofstresshyperglycemia(SH)onthemedium-andlong-termprognosesinACSpatientshasnotyetbeendetermined.MethodsRandomvenousbloodglucoselevelsweredeterminedin433ACSpatientsandthepatientsweredividedintotwogroupsbasedonbloodglucoseresultsanddiseasehistories.The171patientsincludedintheexperimentalgrouphadnohistoryofdiabetes,hadnodiabetesand/orglucosemetabolismdisordersduringhospitalizationandfollow-upandhadfastingbloodglucoselevelsof≥7.0mmol/Landrandombloodglucoselevels≥11.1mmol/L.The262patientsincludedinthecontrolgrouphadnohistoryofdiabetes,hadnodiabetesand/orglucosemetabolismdisordersduringhospitalizationandfollow-up,andhadfastingbloodglucoselevels<6.1mmol/Landrandombloodglucoselevels<7.8mmol/L.Basicclinicalinformation,coronaryangiographiclesioncharacteristics,PCIsuccessrate,complicationrate,incidenceandmorbidityrateofcardiovasculareventsduringthehospitalizationperiodand6yearsoffollow-upwerecomparedbetweenthetwogroups.ResultsTherewasnosignificantdifferenceinage,genderordiseasehistorybetweenthetwogroups.Thetriglyceridelevelsandtheleftventricularejectionfractionsweresignificantlyhigher(P=0.00)andsignificantlylower(P=0.03)intheexperimentalgroupthaninthecontrolgroup,respectively.BothgroupsweresubjectedtocoronaryangiographyandPCI.ThePCIsuccessratesofthetwogroupsdidnotdiffersignificantly(P=0.63).TheexperimentalgrouphadmoretypeB2lesions,butfewertypeAlesionscomparedwiththecontrolgroup.Theexperimentalgrouphadsignificantlymorestentsimplantedcomparedwiththecontrolgroup(P<0.05).Thecardiovasculareventsweresignificantlyincreased(P=0.01)intheexperimentalgroupcomparedwiththecontrolgroup1yearafterdischarge.Thein

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简介：ObjectivesTostudyclinicalandcoronaryangiographicfindingsinpatientswithbothcoronaryheartdiseases(CHD)andtype2diabetesmellitus(T2DM).Methods215patientswithCHDconfirmedbycoronaryangiographywereinvolvedinthisstudy.Thepatientsweredividedintotwogroups:74CHDpatientswithT2DM(meanage64.7±8.2years,male/female47/27),and141CHDpatientswithoutT2DM(meanage66.2±9.2years,male/female100/41).Theclinicalfeaturesandthedatafromselectivecoronaryangiographieswerecomparedbetweentype2diabeticandnon-diabeticCHDpatients.ResultsComparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromacutemyocardialinfarction,silentischemiaandseverearrhythmias(P＜0.01,P＜0.05),andhadhigherserumtriglyceridesandapo-lipoproteinB,alongwithincreasedserumuricacid(P＜0.01,P＜0.05),increasedleftventricularenddiastolicdiameter(P＜0.01),anddecreasedleftventricularejectionfraction(P＜0.001).Comparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromtriplevesseldisease(P＜0.01),severecoronaryarterystenosis,completeocclusionsanddiffuselesions(P＜0.001).ConclusionsSevereclinicalmanifestation,leftventriculardysfunction,diffuseorcomplicatedlesionsofcoronaryarteriesweremorecommoninpatientswithbothCHDandT2DM,itsuggeststhatthetype2diabeticCHDpatientshavepoorprognosis.

简介：Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear