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To explore if CHA2DS2 VASc score can predict substrate for persistent atrial fibrillation ( AF) and outcome post catheter ablation of AF.From January 2011 to December 2012,116 patients underwent catheter ablation of persistent AF in our department and were enrolled in this study. CHA2DS2VASc score was calculated as follows: two points were assigned for a history of stroke or transient ischemic attack and age ≥ 75 and 1 point each was assigned for age ≥ 65, a history of hypertension, diabetes,recent cardiac failure, vessel disease, female. Left atrial geometry ( LA) was reconstructed with a 3.5 mm tip ablation catheter with fill-in threshold 10 in CARTO system. The mapping catheter was stabled at each endocardial location for at least 3 seconds for recording. The electrogram recordings at each endocardial location were analyzed with a custom software embedded in the CARTO mapping system. Interval confidence level (ICL) was used to characterize complex fractionated atrial electrograms (CFAEs) . As the default setting of the software, ICL more than or equal to 7 was considered sites with a highly repetitive CFAEs complex. CFAEs index was defined as the fraction of area of ICL more than or equal to 7 to the left atrial surface. The CFAEs index and outcome of catheter ablation among different CHA2DS2VASc groups were compared.Of the 116 patients, CHA2DS2VASc was 0 in 33 patients, 1 in 31 patients and ≥ 2 in 52 patients. Left atrial surface ((121.2 ± 18.9) cm2, (133.6 ± 23.8) cm2, (133.9 ± 16.1) cm2, P = 0.008), left atrial volume ((103.6 ± 24.8) ml, (118.3 ± 27.8) ml, (120.9 ± 20.9) ml, P = 0.005) and CFAEs index (44.6% ± 22.4%, 54.2% ± 22.2%, 58.7% ± 23.1%, P = 0.023) increased in proportion with increasing CHA2DS2VASc. ICLmax, ICLmin and CFAEs spatial distribution were similar among the three groups. During the mean follow-up of (13 ± 8) months, the recurrence rate were 36.4%, 35.5%, 55.8% among the three groups (P = 0.025).A high CHA2DS2VASc score is associated with extensive AF substrate and higher recurrence rate post catheter ablation of persistent AF.

Background: The aim of the present study was to compare the effects of drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in patients suffering from chronic stable angina with multivessel disease, involving significant proximal stenosis in the left anterior descending artery (LAD). Methods and Results: All consecutive patients suffering from chronic stable angina with multivessel disease involving significant proximal LAD stenosis underwent DES implantation (n=600) or CABG (n=709) at our institution. At 2 years, the unadjusted mortality was significantly lower in the DES group than in the CABG group (2.2% vs 5.2%, P=0.004), but the adjusted risk of death was similar (odds ratio (OR) 0.74, 95%CI 0.28-1.97, P=0.555). Furthermore, both the adjusted rate of nonfatal myocardial infarction and cerebrovascular events was also comparable. However, the unadjusted and adjusted risk of major adverse cardiac cerebrovascular events in the DES was significantly higher than in the CABG (13.3% vs 9.6%, OR 2.71, 95%CI 1.56-4.74, P

Patients with coronary artery disease accompanied by severe left ventricular dilatation (LVD) are at higher risk for heart failure and death. However, their clinical and angiographic profiles, short- and long-term outcomes after revascularization are unknown. A total of 4,283 patients (median age

Background The prevalence of the cardiovascular risk factors is growing. The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in-hospital and long term prognosis of CAD with metabolic syndrome, and to determine which factor that influencing the CAD prognosis most. Methods The DESIRE (Drug-Eluting Stent Impact on Revascularization) registry represents a database of 2368 patients with coronary artery disease (CAD) between Jul, 2003 and Sep, 2004. Media long-term follow-up was 3.5 years (293–1855 days). Metabolic syndrome was based on modified the Adult Treatment Panel (ATP) III Definition of the Metabolic Syndrome in 2005, using body mass index (BMI) instead of waist circumference. We tested the ability of MS and its components to predict the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascularization. Results Presence of MACCE was predicted only by MS (adjusted OR (OR)=1.319, 95% CI 1.020 to 1.706, p=0.035) but not other risk factors of cardiovascular (such as elder, male, smoking, high LDL cholesterol, CAD family history). MS was present in 45.6% (high FG 44.5%; high TG 45.0%; low HDL 50.8%; high BP 61.4%; high BMI 60.7%). After follow-up in 3.5 years, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (18.9% vs 15.6%, p=0.036). In multivariable model of five factors of MS, MACCE was predicted by high FG (fasting glucose) (OR=1.047, CI 1.005 to 1.091) and low HDL (OR=0.777, CI 0.610 to 0.989). MS confers a higher risk of long-term MACCE in CAD patients with (OR=1.258, CI 1.010 to 1.607) or without diabetes (OR=1.139, CI 1.004 to 1.505). Conclusions The metabolic syndrome has primary predictive ability for MACCE in CAD patients, carried primarily by high FG and low HDL. MS confers a higher risk of long-term MACCE in CAD patients with or without diabetes.

Objectives We examined the association between glycaemic control determined by fasting glucose levels before elective PCI and the outcomes in diabetic patients undergoing elective revascularization. Background Patients with diabetes mellitus (DM) have a worse clinical outcome after PCI than patients without DM, but whether optimal glycaemic control before PCI could improve the prognosis is not clear. Methods The DESIRE-2 (Drug-Eluting Stent Impact on Revascularization-2) was a single-center registry of coronary revascularization in our institution between July 1st 2003 and Sep 30th 2005. A total of 434 diabetic patients undergoing elective PCI were enrolled in this study. Optimal glycaemic control was defined as fasting glucose =126 mg/dl. Median follow-up duration after the index intervention was 523 days. Results The average patient age was 61.0±9.8 years; 69.8% of the patients were men. The patients with optimal glycaemic control were older than the suboptimal control group (62.1±9.46 vs 59.6±10.41). Compared with diabetic patients with optimal glycaemic control, those with suboptimal glycaemic control had similar rates of total mortality (3.3% vs 3.9%, p=0.762) and major adverse cardiac and cerebral events (15.9% vs 12.4%, p=0.308). In a multiple Cox regression analysis, total cholesterol level (HR 1.009, 95% CI 1.002 to 1.016, p=0.013) and number of lesion (HR 2.070, 95% CI 1.340 to 3.199, p=0.001) were significant independent predictors of MACCE. Conclusions In diabetic patients undergoing elective PCI, optimal glycaemic control did not improve clinical prognosis. These data suggest that aggressive treatment of DM to achieve fasting glucose

Background Hypertension was an independent risk factor for affecting the prognosis of patients with ACS. But the effect of blood pressure levels at admission on prognosis in ACS patients without history of hypertension was not clear. Methods The DESIRE-2(Drug-Eluting Stent Impact on Revascularization-2) was a single-center registry of coronary revascularization in our institution between July 1 st 2003 and Sep 30 th 2005. The study excluded the patients with prior history of hypertension and myocardial infarction, the patients admitted to hospital with ST-segment elevated myocardial infarction and stable coronary artery disease, and the patients without detailed document record. Major adverse cardiac and cerebral events (MACCE) were the combination endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke and revascularization. Results The study enrolled 982 patients and divided into three groups according to the first measurement of blood pressure levels at admission. The 207 patients with blood pressure less than 120/80 mm Hg defined as normal blood pressure group, 209 patients with blood pressure more than 140/90 mm Hg as hypertension group, other patients as prehypertension group. Among three groups, there was no difference in age, gender, prior history of diabetes mellitus, coronary revascularization and smoking, body mass index, left ventricular ejection fraction, the levels of glomerular filtration rate, haemoglobin, total cholesterol, low density lipoprotein cholesterin, fasting glucose, glycolated haemoglobin. Severity of coronary artery and utilisation ratio of aspirin, β blocker, calcium channel blocker were similar in three groups. More patients taken statins (67.7%, 55.3%, 58.3%, p=0.013) and ACEI (41.1%, 27.6%, 27.8%, p=0.002) during the hospitalisation in hypertension group. Duration of follow-up in the normal, prehypertension and hypertension group was 522 days, 539 days and 523 days respectively. The in-hospital MACCE rates was similar in three groups, but higher follow-up MACCE rates (11.0%, 5.7%, 9.5%, p=0.035) and follow-up mortality rates (2.6%, 0.8%, 0%, p=0.026) in hypertension group. Conclusion The higher blood pressure levels at admission in non ST-segment elevated ACS patients without prior history of hypertension had poorer prognosis, but the history and clinical features were similar to patients with normal blood pressure.