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Objective: To investigate the relationship between the guidelines issued by the American College of Cardiology/American Heart Association (ACC/AHA) in 2004 and the changes in early reperfusion, drug treatment and outcome of inpatients with acute myocardial infarction (AMI) in China, and to explore what extent the guidelines are followed in the management of AMI in China, and the differences in managements and patients' outcome after its issue., Methods: A retrospective study of clinical data of 1 278 patients with AMI admitted to 12 Chinese Hospitals from January 2002 to December 2006 was carried out. They were divided into two groups: group A included 734 patients admitted from January 2002 to August 2004, and group B comprised 544 patients admitted from August 2004 to December 2006. The baseline characteristics, early reperfusion, drug treatment, reinfarction, angina pectoris, heart failure, cardiogenic shock, bleeding and death were compared between two groups. The correlation between therapeutic measure and mortality was analyzed to estimate the difference between two groups, and relationship between the differences and the guidelines issued in 2004 was also analyzed., Results: The age, sex, systolic blood pressure, history of past illness excepting old myocardial infarction of patients with AMI bore no significant difference between two groups. The incidence of Killip≥III in group B was lower significantly than that in group A (7.5% vs. 14.7%, P<0.01). Reperfusion therapy was used more often in group B than in group A (78.5% vs. 71.2%, P<0.05). And percutaneous coronary intervention (PCI) therapy was used more often in group B than in group A (71.5% vs. 61.0%, P<0.01). However, the rate of lytic treatment was lower in group B than that in group A (8.6% vs. 16.3%, P<0.01). ³ The percentage of use of antiplatelet drug and aspirin was both over 97.0%. The tidopidine was used more frequently in group A than in group B (54.9% vs. 8.3%), and the clopidogrel and glycoprotein IIIa/IIb antagonists was used more frequently in group B than in group A (83.8% vs. 27.4%, 4.8% vs. 0.7%, both P<0.01). The angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist (ACEI/ARB) were administered more frequently in group B than in group A (98.2% vs. 93.5%, P<0.01), and the increasing trend of ARB was obvious (13.6% vs. 4.4%, P<0.05), but the decreasing trend of ACEI was obvious also (84.6% vs. 89.1%, P<0.01). Heparin/low molecular heparin, β-blocker and statin were used more often in group B than in group A (97.4% vs. 94.8%, 80.1% vs. 74.8%, 87.7% vs. 82.4%, P<0.05 or P<0.01). (4) In-hospital mortality, reinfarction, angina pectoris were lower in group B than in group A (4.6% vs. 7.6%, 2.8% vs. 4.8%, 8.4% vs. 12.4%, all P<0.05). (5) Multivariate Logistic regression analysis showed that reperfusion, antiplatelet drug, statin and heparin/low molecular heparin were associated significantly with in-hospital mortality (all P<0.05)., Conclusion: After guideline was issued by ACC/AHA in 2004, the regime of early reperfusion and drug treatment in China had followed more closely the recommendations of the guidelines. At the same time, in-hospital mortality, reinfarctions, angina pectoris were decreased. And the changes in strategy of early reperfusion, antiplatelet drug, statin and heparin/low molecular heparin are closely related with in-hospital mortality. However, current management of AMI in China has not followed the recommendations of guidelines closely. It is essential to promote the use of β-blocker and ACEI/ARB drug treatment in China in accordance with the guidelines.

Background: Limited information is available about clinical outcomes following routine percutaneous coronary intervention (PCI) in the current era. This study aimed to identify predictors of adverse clinical or angiographic complications following PCI in patients from many different countries., Methods: RIVIERA is a multinational, prospective, observational study in patients undergoing elective or primary PCI. Consecutive patients (n=7962) were enrolled in 144 hospitals from 23 countries in four different continents. Primary outcome was death or myocardial infarction (MI). The mean age of the patients was 59 years and 77% were men; 92% of patients underwent elective and 8% primary PCI., Results: The rate of in-hospital outcomes was low: death 0.3%, MI 1%, any bleeding 3.4%. Angiographic complications occurred in 8.7% of patients, mainly coronary dissection (3.7%) and no reflow (2%). After multivariable analysis, the strongest independent predictors of death or MI were clinical presentation with non-ST-segment elevation acute coronary syndrome or ST-segment elevation myocardial infarction and administration of a glycoprotein (GP) IIb/IIIa inhibitor. Radial access, thienopyridine pretreatment and anticoagulation with enoxaparin were associated with a lower risk of death or MI. Female gender, PCI of coronary artery bypass graft, administration of a GP IIb/IIIa inhibitor and combined use of enoxaparin and unfractionated heparin were significantly associated with more bleeding. Radial access was the only variable associated with less bleeding., Conclusions: Routine PCI appears to be a relatively safe revascularization procedure. Many of the variables identified as predictors of adverse cardiac outcomes confirm results obtained in recent randomized PCI trials and are modifiable, suggesting that further improvements can be made.

Objective: To evaluate the effectiveness of integrative medicine (IM) on patients with coronary artery disease (CAD) and investigate the prognostic factors of CAD in a real-world setting.Methods: A total of 1,087 hospitalized patients with CAD from four hospitals in Beijing, China were consecutively selected between August 2011 and February 2012. The patients were assigned to two groups based on the treatment: Chinese medicine (CM) plus conventional treatment, i.e., IM therapy (IM group); or conventional treatment alone (CT group). The endpoint was major adverse cardiac events [MACE; including cardiac death, myocardial infarction (MI), and revascularization].Results: A total of 1,040 patients finished the 2-year follow-up. Of them, 49.4% (514/1,040) received IM therapy. During the 2-year follow-up, the total incidence of MACE was 11.3%. Most of the events involved revascularization (9.3%). Cardiac death/MI occurred in 3.0% of cases. For revascularization, logistic stepwise regression analysis revealed that age ⩾ 65 years [odds ratio (OR), 2.224], MI (OR, 2.561), diabetes mellitus (OR, 1.650), multi-vessel lesions (OR, 2.554), baseline high sensitivity C-reactive protein level ⩾ 3 mg/L (OR, 1.678), and moderate or severe anxiety/depression (OR, 1.849) were negative predictors (P<0.05); while anti-platelet agents (OR, 0.422), β-blockers (OR, 0.626), statins (OR, 0.318), and IM therapy (OR, 0.583) were protective predictors (P<0.05). For cardiac death/MI, age ⩾ 65 years (OR, 6.389) and heart failure (OR, 7.969) were negative predictors (P<0.05), while statin use (OR, 0.323) was a protective predictor (P<0.05) and IM therapy showed a beneficial tendency (OR, 0.587), although the difference was not statistically significant (P=0.218).Conclusion: In a real-world setting, for patients with CAD, IM therapy was associated with a decreased incidence of revascularization and showed a potential benefit in reducing the incidence of cardiac death or MI. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This post-marketing surveillance registry is aimed at determining the safety and reliability of the CYPHER Select Sirolimus-eluting stent (SES) in routine clinical practice. Background: Little information and angiographic follow-up data in large-scale “real world” registry is available for the CYPHER Select SES, an advanced-generation SES. Methods: This was a prospective multicenter (20 centers) registry. 1189 consecutive patients who received at least 1 CYPHER Select SES during daily clinical practice were enrolled. Patients who underwent emergency stenting for acute myocardial infarction were excluded. Results: The procedure''s success rate was 98.3% for CYPHER Select SES implantation, and follow-up rates were 98% with 100% data auditing. Target lesion revascularization (TLR) at 12 months occurred in 60 (5.14%) cases, cardiac death in 13 cases (1.11%), Q wave myocardial infarction (MI) in 5 cases (0.43%), non-Q-MI in 9 cases (0.77%), target vessel revascularization (TVR) in 67 cases (5.74%), and MACE defined as cardiac death, nonfatal MI and TLR in 76 cases (6.51%). MACE-free survival rate at 12 months was 93.7%. Angiographic follow-up at 9 months was performed in 418 (68.3%) lesions treated by CYPHER Select SES. The binary restenosis rate was 4.8% in-stent and 9.6% in-segment. Subgroup analysis showed diabetes, bifurcation lesion and combined use of different stents were independent risk factors of cumulative MACE. In-segment MLD ≤2.25 mm at post-procedure and ostial lesion was independent predictors of in-segment restenosis. Conclusions: In this registry, the MACE, TLR, angiographic late loss and binary restenosis rates of CYPHER Select SES were similar to those reported in SES randomized trials and “real world” registries. The safety and efficacy of CYPHER Select SES shown in this registry are consistent with those seen in SES studies. [Copyright &y& Elsevier]