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Objectives: This study sought to investigate the relationship between occlusion length and long-term outcomes of patients with recanalised chronic total occlusion (CTO) lesion., Design: A retrospective cohort study., Setting: Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China PARTICIPANTS: Consecutive patients with successfully recanalised CTO were included from January 2010 to December 2013., Primary and Secondary Outcome Measures: The primary endpoint of the present study was a composite event of all-cause death and myocardial infarction (MI). The secondary endpoints included target lesion revascularisation (TLR) and target vessel revascularisation (TVR)., Results: A total of 1987 patients were included and 1801 (90.6%) subjects completed 5-year follow-up in this study. Based on occlusion length, the patients were divided equally into two groups: short (length <15 mm, n=957) and long (length ≥15 mm, n=1030) CTO group. Kaplan-Meier survival curve showed no significant difference in the risk of the composite primary endpoint between short and long CTO groups (p=0.242). Receiver operating characteristic curve analysis also established occlusion length ≥15 mm as a cut-off value for predicting TLR and TVR, with an area under the curve of 0.604 (95% CI: 0.569 to 0.638, p<0.001) and 0.605 (95% CI: 0.572 to 0.638; p<0.001). Kaplan-Meier analysis revealed that the risks for TLR (p=0.002) and TVR (p=0.002) were higher in a patient with long CTO lesion. Multivariate Cox analysis also identified long CTO lesion as an independent predictor of TLR (HR: 1.539, 95% CI: 1.033 to 2.293; p=0.034) and TVR (HR: 1.476, 95% CI: 1.012 to 2.151; p=0.043)., Conclusion: Patients with long CTO lesion did not show a higher risk of death and MI after recanalisation, but had higher risks of TLR and TVR. Lesion with occlusion length ≥15 mm should be under close surveillance for restenosis after recanalisation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aim: To explore the prevalence of unknown diabetes (DM) or prediabetes (pre-DM) in "nondiabetic" patients and its association with 2-year clinical outcomes after primary percutaneous coronary intervention (PCI)., Methods and Results: 5202 consecutive "nondiabetic" patients who underwent primary PCI at Fuwai Hospital from January to December 2013 were prospectively enrolled. The patients were grouped according to their glycemia status: unknown DM (HbA1c ≥ 47 mmol/L; FPG≥ 7.0 mmol/L), pre-DM (HbA1c 39-47 mmol/L; FPG: 5.6-6.9 mmol/L) and normoglycemia (NG, HbA1c < 39 mmol/L; FPG < 5.6 mmol/L). The main endpoint was 2-year major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and target vessel revascularization. A total of 905 patients had unknown DM, and 3407 patients had pre-DM. Unknown DM and pre-DM were associated with aging (p < 0.001); a greater proportion of hypertension (p < 0.001), previous myocardial infarction (p < 0.001), and chronic kidney disease (p = 0.004). During the 2-year follow-up, the rate of MACE was significantly higher in the unknown DM and pre-DM groups than in the NG group (8.1% vs. 5.8% vs. 4.1%, respectively, p = 0.001). Multivariate analyses demonstrated that unknown DM was associated with a 1.9-fold higher event risk compared to NG (95% CI: 1.2-2.8)., Conclusions: The prevalence of abnormal glucose metabolism was high in "nondiabetic" Chinese PCI patients. Patients with unknown DM and pre-DM had higher event risks than those with NG. In "nondiabetes" patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify patients with an increased event risk., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2019. Published by Elsevier B.V.)

Background: With the advancements of percutaneous coronary interventions (PCI), it is not clear whether unprotected left main (ULM) coronary artery disease (CAD) remains an independent predictor of adverse outcomes after PCI therapy. We have therefore carried out a large cohort study to investigate the impact of ULM disease on 2-year clinical outcomes in Chinese patients undergoing contemporary PCI treatment., Methods and Results: From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI were prospectively collected. Two-year clinical outcomes were compared for patients undergoing ULM PCI and non-ULM PCI. Among the 10 724 patients, 272 (2.5%) patients underwent ULM PCI. Overall, these patients had higher baseline clinical risks of CAD and more extensive CAD compared with non-ULM PCI patients. During the 2-year follow-up, patients who underwent ULM PCI experienced higher incidence of cardiac death (2.2 vs. 0.7%; log-rank P=0.002), myocardial infarction (7.0 vs. 1.9%; log-rank P<0.001), stroke (2.9 vs. 1.3%; log-rank P=0.02), and definite and probable stent thrombosis (3.3 vs. 0.5%; log-rank P<0.001), than patients who underwent non-ULM PCI. However, the rates of revascularization (7.4 vs. 8.7%; log-rank P=0.48), target vessel revascularization (5.5 vs. 5.0%; log-rank P=0.66), and major adverse cardiac and cerebrovascular events (15.1 vs. 12.0%; log-rank P=0.11) were not significantly different between the groups. When performing adjusted Cox regression after propensity score matching, ULM PCI was not an independent risk factor of any clinical events (all P>0.05)., Conclusion: In this large cohort of patients who underwent modern PCI, ULM PCI patients had higher baseline clinical risks and poorer prognosis during 2-year follow-up. However, after multivariate analysis, ULM PCI was not an independent risk factor of any clinical adverse events.