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Coronavirus disease 2019 (COVID-19) pandemic poses great challenge on public health globally. To clarify the impact of COVID-19 pandemic on in-hospital management and outcomes for ST-segment elevation myocardial infarction (STEMI) patients in the nonepicenter. We enrolled consecutive STEMI patients who visited Fuwai Hospital from January to March, 2020 (N = 73) and also established a historical control including all consecutive STEMI patients in the same period of 2019 (N = 95). The primary outcome was defined as a composite endpoint of all-cause death, heart failure, cardiac shock, and cardiac arrest during hospitalization. Emergency response for COVID-19 resulted in a significant 77.6% reduction in the number of primary percutaneous coronary intervention, and a trend toward higher rate of primary composite endpoint (15.1% vs 11.6%, P = 0.51). COVID-19 pandemic results in a significant reduction in emergent reperfusion therapy, and a trend toward higher in-hospital adverse events risk., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: During coronavirus disease 2019 (COVID-19) epidemic, reducing the number of invasive procedure and choosing conservative medication strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unavoidable. Whether this relatively conservative strategy will impact in-hospital outcome for NSTEMI patients remains unclear., Methods and Results: The current study included all consecutive NSTEMI patients who visited the emergency department in Fuwai Hospital from February 1 to March 31, 2020 and all the NSTEMI patients in the same period of 2019 as a historical control. Very-high-risk patients were defined as clinical presentation of heart failure, cardiac shock, cardiac arrest, recurrent chest pain, and life-threatening arrhythmias. The primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of all-cause death, recurrent myocardial infarction, or heart failure. A total of 115 NSTEMI patients were enrolled since the outbreak of COVID-19, and a total of 145 patients were included in the control group. There was a tendency toward higher MACE risk in 2020 compared with 2019 (18.3% vs. 11.7%, p = .14). Among very-high-risk patients, early percutaneous coronary intervention (PCI) strategy in 2019 was associated with reduced MACE risk compared with delayed PCI in 2020 (60.6% [20/33] in 2020 vs. 27.9% [12/43] in 2019, p = .01)., Conclusions: COVID-19 pandemic results in a significant reduction in immediate/early PCI and a trend toward higher adverse event rate during hospitalization, particular in very-high-risk patients., (© 2020 Wiley Periodicals LLC.)

Purpose: The ischemic/bleeding trade-off of continuing dual antiplatelet therapy (DAPT) beyond 1 year after PCI for patients with high thrombotic risk (HTR) as endorsed by 2018 ESC/EACTS myocardial revascularization guidelines remain unknown., Methods: Patients undergoing coronary stenting between January 2013 and December 2013 from the prospective Fuwai registry were defined as HTR if they met at least 1 ESC/EACTS guideline-endorsed HTR criteria. A total of 4578 patients who were at HTR and were events free at 1 year after the index procedure were evaluated. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause death, myocardial infarction, or stroke)., Results: Median follow-up period was 2.4 years. > 1-year DAPT with clopidogrel and aspirin significantly reduced the risk of MACCE compared with ≤ 1-year DAPT (1.9% vs. 4.6%; hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.27-0.54; P < 0.001), driven by a reduction in all-cause death (0.2% vs. 3.0%; HR, 0.07; 95% CI, 0.03-0.15). Cardiac death and definite/probable stent thrombosis also occurred less frequently in prolonged DAPT group. Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred similarly between both groups (1.1% vs. 0.9%; HR, 1.11; 95% CI, 0.58-2.13; P = 0.763). Similar results were found using multivariable Cox model, propensity score-matched, and inverse probability of treatment weighting analysis., Conclusions: Among patients with ESC-endorsed HTR who were free from major ischemic or bleeding events 1 year after coronary stenting, continued DAPT beyond 1 year might offer better effectiveness in terms of atherothrombotic events and comparable safety in terms of clinically relevant bleeding compared with ≤ 1-year DAPT. ESC-HTR criteria is an important parameter to take into account in tailoring DAPT prolongation.

Background: Whether the underlying risk of high bleeding risk (HBR) influences the relationship of high thrombotic risk (HTR) features with adverse events after drug-eluting stent implantation remains unclear. The purpose of this study was to evaluate (1) the prognostic effect of ESC guideline-endorsed HTR features on long-term clinical outcomes and (2) whether the outcomes of HTR versus non-HTR features vary by HBR status., Methods: Ten thousand one hundred sixty-seven consecutive patients who underwent percutaneous coronary intervention between January 2013 and December 2013 were prospectively enrolled in Fuwai PCI Registry. Patients who are at HTR were defined as: diffuse multivessel disease in diabetic patients, chronic kidney disease, at least three stents implanted, at least three stents lesions treated, bifurcation with two stents implanted, total stent length > 60 mm, or treatment of chronic total occlusion. The definition of HBR was based on the Academic Research Consortium for HBR criteria. The primary ischemic outcome was major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis. The primary bleeding outcome was clinically relevant bleeding, defined according to Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding., Results: With a 2.4-year median follow-up, 4430 patients (43.6%) having HTR experienced a significantly higher risk of MACE (hazard ratio [HR] adjust : 1.56, 95% confidence interval [CI]: 1.34-1.82; P < 0.001) and device-oriented composite endpoint (composite of cardiac death, target-vessel MI, and target lesion revascularization) (HR adjust : 1.52 [1.27-1.83]; P < 0.001), compared to those having non-HTR. The risk of clinically relevant bleeding did not differ between groups (HR adjust : 0.85 [0.66-1.08]; P = 0.174). Associations between HTR and adverse events were similar in HBR and non-HBR groups, without evidence of interaction (all P interaction  > 0.05); however, adverse event rates were highest among subjects with both HTR and HBR., Conclusions: ESC guideline-endorsed HTR was associated with significantly increased risk of MACE without any significant differences in clinically relevant bleeding. The presence of HBR does not emerge as a modifier of cardiovascular risk for patients at HTR, suggesting more potent and longer antiplatelet therapy may be beneficial for this patient population.

Background: On 7th June, 2018, a primary school in Beijing, China notified Shunyi CDC of an outbreak of acute respiratory disease characterized by fever and cough among students and resulting in nine hospitalization cases during the preceding 2 weeks. We started an investigation to identify the etiologic agent, find additional cases, develop and implement control measures., Methods: We defined probable cases as students, teachers and other staffs in the school developed fever (T ≥ 37.5 °C) with cough or sore throat; or a diagnosis of pneumonia during May 1-June 31, 2018. Confirmed cases were probable cases with Mycoplasma pneumoniae detected in oropharyngeal (OP) swabs by quantitative real-time polymerase chain reaction (qPCR). We searched case by reviewing school absenteeism records and interviewing students, teachers and staff in this school. Oropharyngeal swabs were collected from symptomatic students. Two qPCR) assay, a duplex qPCR assay, and sequencing were performed to determine the pathogen, genotype and macrolide resistance at the gene level, respectively., Results: From May 1st to June 31st, 2018, we identified 55 cases (36 probable and 19 confirmed), of whom 25 (45%) were hospitalized for complications. All cases were students, none of the teachers and other staffs in the school were with similar symptoms. The attack rate (AR) was 3.9% (55/1398) for all students. The cases were mainly male (58%), with an age range of 7-8 years (median: 7 years). 72% (18/25) of inpatients had radiograph findings consistent with pneumonia, and some cases were hospitalized for up to 4 weeks. Pathogen detection results indicated that Mycoplasma pneumonia (M. pneumoniae) P1 type 1 was the causative agent in this outbreak, and the strain harbored one point mutation of A to G at position 2063., Conclusions: The infections by macrolide-resistant M. pneumoniae are not always mild and pneumonia was common and M. pneumoniae could causes serious complications which require long-term hospitalization. In the future infectious disease prevention and control practice, M. pneumoniae should be paid more attention. It is necessary to establish and improve the pathogen and drug resistance surveillance system in order to prevent and control such mutated strains of M. pneumoniae from causing future outbreaks or epidemics in China.

Nitrate (NO 3 - ) is a key component of secondary inorganic aerosols and PM 2.5 . However, the contributions of nitrogen oxides (NO x ) emission sources to NO 3 - in PM 2.5 remain poorly constrained. This study measured nitrogen (N) isotopes of NO 3 - collected at Beijing in 2014. We observed that δ 15 N-NO 3 - ) in PM 2.5 collected at Beijing in 2014. We observed that δ 15 N-NO 3 - values in PM 2.5 (-2.3‰ - 19.7‰; 7.3 ± 5.4‰ annually) were significantly higher in winter (11.9 ± 4.4‰) than in summer (2.2 ± 2.5‰). The δ 15 N differences between source NO x and NO 3 - in PM 2.5 (hereafter as Δ values) were estimated by a computation module as 7.8 ± 2.2‰ - 10.4 ± 1.6‰ (8.8 ± 2.4‰). Using the Δ values and δ 15 N values of NO x of Beijing were mainly caused by those of NO x sources to NO 3 - in PM 2.5 were further estimated by the SIAR model. We found that seasonal variations of δ 15 N-NO 3 - values in PM 2.5 of Beijing were mainly caused by those of NO x contributions from coal combustion (38 ± 10% in winter, 20 ± 9% in summer). Annually, NO x from coal combustion, vehicle exhausts, biomass burning, and microbial N cycle contributed 28 ± 12%, 29 ± 17%, 27 ± 15%, and 16 ± 7% to NO 3 - in PM 2.5 , respectively, showing actually comparable contributions between non-fossil NO x (43 ± 16%) and fossil NO x (57 ± 21%). These results are useful for planning the reduction of NO x emissions in city environments and for elucidating relationships between regional NO x emissions and atmospheric NO 3 - pollution or deposition., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the long-term outcomes of percutaneous coronary intervention (PCI) in patients with previous ischemic stroke., Background: Ischemic stroke and coronary artery disease (CAD) are leading causes of death that often coexist with each other. With the increased use of PCI in high-risk patients with CAD, the association between prior ischemic stroke and cardiovascular/cerebrovascular events in patients with CAD undergoing PCI has been a topic of interest., Methods: We enrolled 10,300 consecutive patients who had undergone PCI from January 2013 to December 2013 and classified them into the prior ischemic stroke group (n = 1,106) and no prior ischemic stroke group (n = 9,194). The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCEs) during follow-up. The secondary endpoints included each component of the primary endpoint and stent thrombosis (ST)., Results: Overall, 10.7% patients had a history of ischemic stroke. At a median 29-month follow-up, MACCEs following PCI occurred with 2-year incidences of 15.4% in the prior ischemic stroke group and 11.7% in the no prior ischemic stroke group. Cox regression analysis demonstrated that prior ischemic stroke was independently associated with a higher risk of MACCEs (adjusted hazard ratio [HR] = 1.294; 95% confidence interval [CI]: 1.100-1.522; P = 0.002), recurrent stroke (adjusted HR = 2.463; 95% CI: 1.729-3.507; P = 0.000), and ST (adjusted HR = 1.787; 95% CI: 1.075-2.971; P = 0.025). A high residual syntax score and low renal function were independent risk factors for MACCEs., Conclusions: Increased concern and active treatment strategies are needed in patients undergoing PCI who have a history of ischemic stroke., (© 2019 Wiley Periodicals, Inc.)