Off-pump coronary artery bypass grafting versus on-pumpcoronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

INTRODUCTION Conventional coronary artery bypass graftin(CCABG) with cardiopulmonary bypass (CPB) habeen accepted as an effective and safe treatment fomulti-vessel coronary heat disease. CPB may stilcontribute to the operation field because of threlatively easier technical requirement; but it alscauses a serious systematic inflammatory reactiowhich will lead to dysfunction of important organand higher cost for the patients. Off-pump coronarartery bypass grafting (OPCABG) has r…     

Is the routine screening for significant atherosclerotic renal artery stenosis during coronary angiography/intervention indispensable?

We read the article "Screening for significantatherosclerotic renal artery stenosis with a regressionmodel in patients undergoing transradial coronaryangiography/intervention" by Pu et al. (2012), pub-lished in Journal of Zhejiang University-SCIENCE B(Biomedicine & Biotechnology), with great interest.     

Association of matrix metalloproteinase-9 C1562T polymorphism and coronary artery disease: a meta-analysis简

Objective

Many investigations have studied the associations between matrix metalloproteinase-9 (MMP-9) C1562T polymorphisms and coronary artery disease (CAD). However, the conclusions of these studies were inconsistent. Therefore, this study was aimed at clarifying the association between MMP-9 C1562T polymorphisms and CAD in a large-scale meta-analysis.

Methods

The PubMed and Embase databases were retrieved to collect all publications on the association between MMP-9 C1562T polymorphisms and CAD. Then the odd ratios (ORs) and 95% confidence intervals (95% CIs) for C1562T TT+TC versus CC genotype between CAD and the control groups were evaluated. Subgroup analysis was also performed according to different races. The meta-analysis was performed by Stata 10.0.

Results

Sixteen case-control studies were included in our meta-analysis, involving 11 032 CAD patients and 4628 non-CAD controls. Compared with C allele carriers, East Asian T allele carriers TT+TC had a significantly higher risk of CAD (OR=1.43; 95% CI: 1.03–1.99; P=0.031); however, there were no significant associations in Western populations (OR=1.06; 95% CI: 0.96–1.18; P=0.240) or West Asians (OR=1.13; 95% CI: 0.75–1.70; P=0.565). When further analyzing the association between C1562T polymorphisms and myocardial infarction (MI, the most serious type of CAD), the risk of TT+TC genotype versus CC genotype for MI was significantly higher for the overall (OR=1.21; 95% CI: 1.04–1.40; P=0.012) and for East Asians (OR=1.58; 95% CI: 1.26–1.97; P=0.000) but not in Western populations (OR=1.12; 95% CI: 0.99–1.26; P=0.078).

Conclusions

Our meta-analysis suggested an obvious ethnic difference in the association between MMP-9 C1562T polymorphisms and CAD. MMP-9 C1562T polymorphism was significantly related to CAD in East Asians. However, no significant associations were observed in either West Asians or Western populations.     

Estrogen receptor α gene PvuII polymorphism and coronary artery disease: a meta-analysis of 21 studies简

The association between the estrogen receptor α gene (ESR1) PvuII polymorphism (c.454-397T>C) and coronary artery disease (CAD) is controversial. Thus, we conducted a meta-analysis to evaluate the relationship. Data were collected from 21 studies encompassing 9926 CAD patients and 16 710 controls. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the relationship between PvuII polymorphism and CAD. The polymorphism in control populations in all studies followed Hardy-Weinberg equilibrium. We found a significant association between ESR1 PvuII polymorphism and CAD risk in all subjects. When the data were stratified by region, a significant association between ESR1 PvuII polymorphism and CAD risk was observed in Asian populations but not in Western populations. The current study suggests that ESR1 PvuII polymorphism has an important role in CAD susceptibility.     

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Objective

To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent (DES) implantation in patients with complex coronary lesions.

Methods

From August 2006 to August 2012, 253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study.

Results

The overall procedure success rate was 98% with the cost of two (0.8%) coronary perforations, three (1.2%) dissections, five (2.0%) slow flows or no flows, three (1.2%) peri-procedure myocardial infarctions, and two (0.8%) in hospital deaths. During follow-up (mean three years), one (0.4%) patient died, two (0.8%) patients had acute myocardial infarction, 14 (5.5%) had restenosis, and target lesion revascularization occurred in eight patients (3.2%).

Conclusions

Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions, especially calcified and non-dilatable lesions.     

Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat

Objective: There is a remarkable lack of scientific evidence to support the option to use alpha-stat or pH-stat management, as to which is more beneficial to brain protection during deep hypothermic CPB. This study examined cortical blood flow (CBF), cerebral oxygenation, and brain oxygen consumption in relation to deep hypothermic CPB with alpha-stat or pH-stat management. Methods: Twenty-two pigs were cooled with alpha-stat or pH-stat during CPB to 15℃ esophageal temperature. CBF and cerebral oxygenation were measured continuously with a laser flowmeter and near-infrared spec-troscopy, respectively. Brain oxygen consumption was measured with standard laboratory techniques. Results: During CPB cooling, CBF was significantly decreased, about 52,2%±6.3% (P<0.01 vs 92.6%±6.5% of pH-stat) at 15℃ in alpha-stat, whereas there were no significant changes in CBF in pH-stat. While cooling down, brain oxygen extraction (OER) progressively decreased, about 9.5%±0.9% and 10.9%±1.5% at 15℃ in alpha-stat and     

Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth？

Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone. Methods: Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS) was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction. Results: Ten out of 24 patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction. Conclusion: Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.     

Polymorphisms in the genes for coagulation factor II,V,VII in patients undergoing coronary angiography

INTRODUCTIONCoronaryarterydisease (CAD)continuestobethemajorcauseofmorbidityandmortalityinourcountry .TheactivityofbloodcoagulationfactorshasbeenshowntobeanimportantriskindicatorforCAD .However,circulatinglevelsofcoagulationfactorsmaynotaccuratelyreflectt…     

Influence of education and working background on physicians’ knowledge of secondary prevention guidelines for coronary heart disease: results from a survey in China

Background and objective  

In clinical practice, the standard of secondary prevention for coronary heart disease (CHD) is quite disappointing in China. The physicians’ shortage of knowledge of secondary prevention guidelines is thought to be a key factor contributing to the inadequate and delayed translation of guidelines into clinical practice. The purpose of this study is to investigate the influence of physicians’ characteristics, including their education and work experience, on their knowledge of secondary prevention in China.