ObjectiveTo investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF).MethodsFrom 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared.ResultsAll patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036).ConclusionFor elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.
ObjectiveTo investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA.MethodsFrom July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed.ResultsA total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05).ConclusionPreoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.
Objective To assess the quality of randomised controlled trials on traditional Chinese medicine (TCM) for coronary heart disease (CHD) angina published from 1977 to 2002. Method We did electronic search in Medline, Embase and hand searched 83 journals of traditional Chinese medicine (the earliest published in 1977 and the latest in June 2002). We assessed the quality of obstained studies. Results Four hundred and forty articles met the criteria,of which 33 (7.5%) described randomization. None of them mentioned allocation concealment; 94.77% (417 studies) mentioned diagnosis criteria; only one mentioned the calculation basement of sample size; 84.09% (370 studies) mentioned comparability of baseline. Fifty three studies (12.05%) noted double-blind; 28 studies used single blind. Twenty-five studies used double-blind. Drop-outs were described in 7 cases without intention-to-treat (ITT); 159 studies applied statistical methods properly, while 4 did not. Ten studies never mentioned statistical methods; 73.18％ (322 studies) used forms to express their results. Conclusions Till now, the quantity and quality of RCTs of traditional Chinese medicine for coronary heart disease angina were inadequate. Some well designed scientific methods were not adequately applied.
ObjectiveTo summarize surgical strategies, early and long-term outcomes of concomitant surgical treatment for patients with both coronary artery disease (CAD) and lung cancer (LC). MethodsWe retrospectively analyzed clinical data of 15 patients who underwent concomitant surgical treatment for both CAD and LC in Xinhua Hospital, School of Medicine of Shanghai Jiaotong University from January 2006 to January 2014. There were 11 male and 4 female patients with their age of 52-73 years. Preoperative clinical staging of LC was stageⅠtoⅡb (TNM), and postoperative pathological result of most patients (11 patients) was adenocarcinoma. All the patients had normal heart and pulmonary function. All the 15 patients received off-pump coronary artery bypass grafting (OPCAB) via median sternotomy. After OPCAB, 9 patients underwent radical LC resection via median sternotomy, and 6 patients underwent radical LC resection with video-assisted thoracoscopic surgery (VATS). ResultsThere was no in-hospital death or newonset myocardial infarction. Pathological diagnosis included squamous LC in 4 patients and adenocarcinoma in 11 patients. Pathological TNM staging wasⅠb in 4 patients, Ⅱa in 6 patients, andⅡb in 5 patients. Postoperative complications included arrhythmias, atelectasis, and pulmonary infection. All the patients were followed up for 6 months to 5 years. Three patients died during follow-up. None of the patients received redo revascularization or LC resection. ConclusionConcomitant OPCAB and LC resection is a safe and efficacious treatment choice for patients with both CAD and LC.
Objective To evaluate the effect of a nurse-supported patient self-managed home-based cardiac rehabilitation programme for promoting quality of life of patients with coronary heart disease. Methods 167 eligible patients were randomly assigned to an intervention group (n=83) and a control group(n=84). Patients in the intervention group joined a 12-week nurse-supported patient self-managed cardiac rehabilitation programme that included medication management, angina management, physical exercise, smoking cessation, dietary management, and family support besides the conventional care. Chinese Version SF-36 was used to assess the quality of life. Data collection was conducted at programme entry, programme exit, and three months follow-up. Results On completion of the programme, patients in the intervention group demonstrated significantly better improvements in six SF-36 quality of life domains, including general health, physical functioning, role-physical, bodily pain, mental health, and vitality. The effect on physical functioning and role-physical maintained at three months follow-up.Conclusions A nurse-supported patient self-managed home-based cardiac rehabilitation intervention has a positive impact on the quality of life of patients with coronary heart disease.
Objective Danshen dripping pill (DSP) and tongxinluo capsule (TXL) are popular Chinese medicinal products and often compared with isosorbide dinitrate (ISDN) in treating angina pectoris. Hundreds of randomized controlled trials (RCTs) about DSP and TXL have been published; however, there has been no systematic review on comparing DSP with TXL. This study aims to provide a comprehensive PRISMA-compliant systematic review with sensitivity analysis and subgroup analysis to valuate indirectly the efficacies of DSP and TXL in treating angina pectoris. Methods RCTs published between 1994 and 2009 on DSP and TXL in treating angina pectoris for four or more weeks were retrieved from databases. The qualities of RCTs included were evaluated with Jadad scale. Meta-analysis was performed on overall effects of symptomatic and electrocardiographic (ECG) improvements. Odds ratios (OR) and 95% confidence intervals (95%CI) were used to measure the effect size. Subgroup analysis, sensitivity analysis and meta-regression were conducted on basic characteristics of RCTs. Results 65 RCTs with 6 969 participants were included. Average Jadad score was 2.11. Overall ORs were 3.66 (95%CI 2.67 to 5.02) for TXL versus ISDN and 2.38 (95%CI 1.90 to 2.99) for DSP versus ISDN. There was a significant difference (W=521.5, P=0.049 45) in ORs between DSP and TXL. Statistical analyses found no significant factors affecting overall efficacies of TXL and DSP. The rates of adverse events under DSP and TXL treatments were 2.37% and 2.11%, respectively. Conclusion DSP and TXL are more effective than ISDN in treating angina pectoris. TXL might be more effective than DSP. However, further RCTs of larger scale, multi-centre/country, longer follow-up periods and higher quality are still required to verify.
【摘要】 目的 研究合并2型糖尿病的冠心病患者冠狀動脈病變程度與血清視黃醇結合蛋白4（retinol-binding protein 4，RBP4）水平的相關性。 方法 2008年10月-2010年4月選擇性冠狀動脈造影確診的冠心病患者共120例，分為單純冠心病組（A組）60例和冠心病合并糖尿病組（B組）60例，檢測血糖、血脂、胰島素以及脂聯素、RBP4水平；根據冠狀動脈造影結果，以Gensini評分評判冠狀動脈病變程度。 結果 B組空腹血糖、胰島素、RBP4均顯著高于A組（Plt;0.05）；冠狀動脈病變程度更重（Plt;0.05）。相關性分析顯示RBP4水平與低密度脂蛋白膽固醇、胰島素抵抗和冠狀動脈病變積分呈正相關（r=0.312、0.322、0.314，Plt;0.05）。與脂聯素水平呈負相關（r=-0.362，Plt;0.01）。 結論 冠心病合并2型糖尿病患者RBP4明顯升高，且與冠狀動脈狹窄程度呈正相關。【Abstract】 Objective To explore the relationship between the level of serum retinol-binding protein 4 (RBP4) and the extent of coronary lesions in coronary heart disease (CHD) patients accompanied with type 2 diabetes mellitus (T2DM). Methods A total of 120 patients with CHD diagnosed by coronary arteriongraphy between October 2008 and April 2010 were enrolled. The patients were divided into two groups: CHD group (60 patients); CHD accompanied with T2DM group (60 patients). The levels of serum insulin, adiponectin and RBP4 were measured. All the patients underwent coronary angiography and the extent of coronary lesions was assessed quantitatively based on the Gensini′s scoring system. Results The levels of serum insulin, plasma RBP4 and the extent of coronary artery stenosis in CHD accompanied with T2DM group were significantly higher than those in CHD group (Plt;0.05). Correlation analysis showed that the level of RBP4 was positively correlated with LDL-C, insulin resistance index and the coronary artery narrow degree（r=0.312, 0.322, 0.314; Plt;0.05); and negatively correlated with adiponectin (r=-0.362, Plt;0.01). Conclusion The significant elevated plasma RBP4 in CHD patients accompanied with T2DM is positively correlated with the extent of coronary artery lesion.
Objective To explore the effects of aggressive lipid lowering therapy and its influence on cardiovascular events using lipitor (20 mg daily) for Chinese people after percutaneous coronary intervention (PCI). Methods We did a double-blind and randomized controlled trial. From July 2005 to June 2006, 120 patients with PCI procedure who were discharged from the Shanghai Chest Hospital were randomly divided into aggressive lipid lowering group (atorvastatin 20 mg daily, n=60) and an ordinary lipid lowering group (atorvastatin 10 mg daily, n=60). The trial treatment was administered from the day of PCI to the third month after PCI. Atorvastatin at 10 mg daily was then used until one year after PCI. Blood biochemistry, cardiovascular events and drug adverse reactions were compared between the two groups. Results Among the 120 patients, 5 discontinued treatment and 4 more withdrew from the study. Therefore 115 and 111 were included in our main analyses [Comment from Mike: it is not ITT if the 5 who discontinued treatment are excluded] and a per-protocol (PP) analysis, respectively. Baseline clinical characteristics were comparable between the two groups. The reduction in TG and the increase in HDL-C were similar between the two groups (Pgt;0.05), but the reductions in LDL-C and TC were significantly different between the two groups (Plt;0.05). This was observed from the beginning of follow-up to the third month after PCI. In the PP analysis, the percentage of patients whose LDL-C met the predefined requirement at the third month in the 20 mg group was significantly higher than in the group receiving the lower dose (87.03% vs. 70.17%, P=0.031). A similar result was also obtained if the patients who withdrew were retained in the analysis (P=0.044). The change in C reaction protein (CRP) from baseline at the first and the third month was significantly different between the two groups (Plt;0.05), but become relatively stable at the sixth month (Pgt;0.05). The mean follow-up duration was 6.5±3.0 months in the higher dose group, with 1 case of recurring angina pectoris and 1 case of revascularization were identified. It was 7.2±3.6 months in the 10 mg daily group, with 3 cases of recurring angina pectoris, 1 case of nonfatal myocardial infarction, 2 cases of revascularization and 1 case of sudden cardiogenic death. The difference in the Kaplan-Meier event curves was of borderline statistical significance from the fourth month (P=0.048). Drug adverse reactions were mild and myopathy was not identified in any patients. Conclusions After PCI procedure, the use of atorvastatin 20 mg daily for aggressive lipid lowering was safe and effective.