何源
中国国家心血管疾病中心阜外医院
OBJECTIVE:We aimed to adapt the visual estimation for Risk prEdiction of side-branch OccLusion in coronary bifurcation interVEntion (V-RESOLVE) score to enable risk prediction for side-branch (SB) occlusion using only baseline coronary angiogram data.BACKGROUND:The V-RESOLVE score, which comprises angiographic factors at baseline and after lesion preparation, is a validated tool for predicting SB occlusion risk in coronary bifurcation intervention.METHODS:To develop and validate the new scoring system, we used data pertaining to 1,545 patients and another 1,286 consecutive patients. Baseline V-RESOLVE was derived from V-RESOLVE by replacing the two pre-stenting angiographic factors with the corresponding preprocedural characteristics, while maintaining the scoring standard itself. We evaluated the diagnostic performance of baseline V-RESOLVE for predicting SB occlusion and preformed risk stratification with characterization of non-high-risk and high-risk lesions.RESULTS:The area under the receiver operating characteristic curves was similar between baseline V-RESOLVE and V-RESOLVE (0.735 vs 0.756, P = 0.191), with good calibration for baseline V-RESOLVE (Hosmer-Lemeshow P = 0.714). Upon categorization by the baseline V-RESOLVE score, high-risk lesions (score: 14-43) demonstrated significantly higher rate of SB occlusion than did non-high-risk lesions (score: 0-13) (17.31% vs 4.74%, P < 0.01). Considering the V-RESOLVE-based risk stratification as reference, baseline V-RESOLVE had an integrated discrimination index of -1.81% (P = 0.052), and net reclassification improvement of -3.34% (P = 0.509). Upon validation, baseline V-RESOLVE provided satisfactory diagnostic performance and risk stratification.CONCLUSIONS:Baseline V-RESOLVE predicts SB occlusion in coronary bifurcation intervention based solely on the preprocedural angiographic results.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2019
OBJECTIVES:This study aimed to assess the risk stratification value of the SYNTAX Score II (SS II) in consecutive PCI patients and to analyze whether the predictive ability of SS II was consistent in patients with complex and non-complex coronary artery disease.BACKGROUND:SS II was designed for patients with complex coronary artery disease and has been validated by a number of studies in such patients.METHODS:The SS II for PCI was assessed in 10,072 consecutive patients who underwent PCI in Fuwai Hospital from January to December 2013. The patients were stratified according to SS II tertiles and divided into two subgroups: one-vessel or two-vessel disease (1 or 2VD) group (n = 5,709) and left main (LM) and/or three-vessel disease (3VD) group (n = 4,363). The endpoint was 30-month all-cause death following PCI procedure.RESULTS:The high SS II group showed significantly higher 30-month mortality. Multivariate analyses showed that in the all-patients cohort and the two subgroups, SS II was an independent predictor of 30-month mortality (P < 0.0001). Based on receiver operating characteristic curves analysis, SS II showed moderate discrimination ability for 30-month mortality (C-statistics = 0.68, Hosmer-Lemeshow test P value >.05) and appeared to have better discrimination ability in the LM and/or 3VD subgroup (C-statistics = 0.631 vs. 0.722 for 1 or 2VD and LM and/or 3VD subgroups).CONCLUSIONS:SS II was able to risk-stratify patients and predict 30-month mortality in all PCI patients. The discrimination ability of SS II appeared to be better in the LM and/or 3VD subgroup.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2019
OBJECTIVES:To describe procedural details of the double rewire (DR) crush technique, a novel modified crush technique, and report the clinical outcomes of patients who underwent the procedure.BACKGROUND:In the management of complex bifurcation lesions, there is a need to use elective two-stent techniques that stent the side branch (SB) before main vessel (MV) stenting and keep SB open.METHODS:We studied 48 patients with 49 bifurcation lesions who underwent percutaneous coronary intervention (PCI) using the DR-crush technique between January and December 2013. Baseline, postprocedural, and follow-up quantitative coronary angiographic analyses were performed. Procedural characteristics and clinical outcomes at follow-up were assessed.RESULTS:Majority of the patients (60.4%, 29/48) had acute coronary syndrome. Most bifurcation lesions (77.6%, 38/49) were classified as Medina 1, 1, 1. Final kissing balloon inflation was successfully performed in all patients. After PCI, MV and SB of all patients had Thrombolysis In Myocardial Infarction 3 blood flow. None of the patients had MV or SB diameter stenosis ≥50% after PCI. At a mean follow-up period of 2.4 years, target vessel revascularization occurred in 2.1% and myocardial infarction in 2.1%. No deaths occurred in this period.CONCLUSIONS:The DR-crush technique is feasible in coronary bifurcation stenting. Patients who underwent this procedure had relatively low incidence of adverse events. Larger studies are warranted for further confirmation of the findings.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2019
OBJECTIVES:This study sought to validate the V-RESOLVE score system.BACKGROUND:The V-RESOLVE score was developed to predict the risk of side branch (SB) occlusion after stenting in the main vessel (MV) of coronary bifurcation lesions based on visual estimation of the angiographic data, but it needed to be validated.METHODS:From January to June 2013, 1,286 patients with 1,820 bifurcation lesions undergoing elective intervention with provisional strategy were included. Angiographic data before MV stenting were reviewed, and the V-RESOLVE score was calculated. SB occlusion was defined as any decrease in thrombolysis in myocardial infarction (TIMI) flow grade or the absence of flow in the SB after MV stenting. The statistical performance of the prediction model was assessed by its discrimination, calibration, and clinical usefulness.RESULTS:SB occlusion occurred in 222 (12.20%) of 1,820 bifurcation lesions. The discrimination of the V-RESOLVE score for the validation cohort was good [C-statistic: 0.80, 95% confidence interval (CI) 0.77-0.84]. Regarding calibration performance, the calibration-in-the-large was -0.03 (95% CI: -0.181 to 0.12), while the combined predictive effect was slightly enlarged (calibration slope: 1.25, 95% CI: 1.081-1.41) and, mainly attributed to the stronger predictive effect of the diameter stenosis of the SB before MV stenting. Stratified by the V-RESOLVE score, the SB occlusion rate was significantly higher in the high-risk group (26.18%) than in the non-high-risk group (3.48%).CONCLUSIONS:The V-RESOLVE score system is a useful tool to help risk prediction for SB occlusion and decision-making in bifurcation intervention.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2018
Coronary heart disease (CHD) is associated with complex metabolic disorders, but its molecular aetiology remains unclear. Using a novel nontargeted metabolomics approach, we explored the global metabolic perturbation profile for CHD. Blood samples from 150 patients with severe obstructive CHD and 150 angiographically normal controls were collected. Metabolic fingerprinting was performed by ultra-high performance liquid chromatography coupled to quadruple time-of-flight mass spectrometry (UHPLC-QTOF/MS) technique. After adjusting for CHD traditional risk factors and metabolic batch, a comprehensive list of 105 metabolites was found to be significantly altered in CHD patients. Among the metabolites identified, six metabolites were discovered to have the strongest correlation with CHD after adjusting for multiple testing: palmitic acid (β = 0.205; p < 0.0001), linoleic acid (β = 0.133; p < 0.0001), 4-pyridoxic acid (β = 0.142; p < 0.0001), phosphatidylglycerol (20:3/2:0) (β = 0.287; p < 0.0001), carnitine (14:1) (β = 0.332; p < 0.0001) and lithocholic acid (β = 0.224; p < 0.0001); of these, 4-pyridoxic acid, lithocholic acid and phosphatidylglycerol (20:3/2:0) were, to the best of our knowledge, first reported in this study. A logistic regression model further quantified their positive independent correlations with CHD. In conclusion, this study surveyed a broad panel of nontargeted metabolites in Chinese CHD populations and identified novel metabolites that are potentially involved in CHD pathogenesis.
Scientific reports 2017
OBJECTIVES:To investigate the predictors of and generate a risk prediction method for periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) using the new PMI definition proposed by the Society for Cardiovascular Angiography and Interventions (SCAI).BACKGROUND:The SCAI-defined PMI was found to be associated with worse prognosis than the PMI diagnosed by other definitions. However, few large-sample studies have attempted to predict the risk of SCAI-defined PMI.METHODS:A total of 3,371 patients (3,516 selective PCIs) were included in this single-center retrospective analysis. The diagnostic criteria for PMI were set according to the SCAI definition. All clinical characteristics, coronary angiography findings and PCI procedural factors were collected. Multivariate logistic regression analysis was performed to identify independent predictors of PMI. To evaluate the risk of PMI, a multivariable risk score (PMI score) was constructed with incremental weights attributed to each component variable according to their estimated coefficients.RESULTS:PMI occurred in 108 (3.1%) of all patients. Age, multivessel treatment, at least one bifurcation treatment and total treated lesion length were independent predictors of SCAI-defined PMI. PMI scores ranged from 0 to 20. The C-statistic of PMI score was 0.71 (95% confidence interval: 0.66-0.76). PMI rates increased significantly from 1.96% in the non-high-risk group (PMI score < 10) to 6.26% in the high-risk group (PMI score ≥ 10) (P < 0.001).CONCLUSIONS:Age, multivessel treatment, at least one bifurcation treatment, and total treated lesion length are predictive of PMI. The PMI score could help identify patients at high risk of PMI after PCI. © 2017 Wiley Periodicals, Inc.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2017
BACKGROUND:Major side branch (SB) occlusion is one of the most serious complications during percutaneous coronary intervention (PCI) for bifurcation lesions. We aimed to characterize the incidence and predictors of major SB occlusion during coronary bifurcation intervention.METHODS:We selected consecutive patients undergoing PCI (using one stent or provisional two stent strategy) for bifurcation lesions with major SB. All clinical characteristics, coronary angiography findings, PCI procedural factors and quantitative coronary angiographic analysis data were collected. Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion. SB occlusion after main vessel (MV) stenting was defined as no blood flow or any thrombolysis in myocardial infarction (TIMI) flow grade decrease in SB after MV stenting.RESULTS:Among all 652 bifurcation lesions, 32 (4.91%) SBs occluded. No blood flow occurred in 18 lesions and TIMI flow grade decreasing occurred in 14 lesions. In multivariate analysis, diameter ratio between MV/SB (odds ratio [OR]: 7.71, 95% confidence interval [CI]: 1.53-38.85, P = 0.01), bifurcation angle (OR: 1.03, 95% CI: 1.02-1.05, P < 0.01), diameter stenosis of SB before MV stenting (OR: 1.05, 95% CI: 1.03-1.07, P < 0.01), TIMI flow grade of SB before MV stenting (OR: 3.59, 95% CI: 1.48-8.72, P < 0.01) and left ventricular eject fraction (LVEF) (OR: 1.06, 95% CI: 1.02-1.11, P < 0.01) were independent predictors of SB occlusion.CONCLUSIONS:Among clinical and angiographic findings, diameter ratio between MV/SB, bifurcation angle, diameter stenosis of SB before MV stenting, TIMI flow grade of SB before MV stenting and LVEF were predictive of major SB occlusion after MV stenting.
Chinese medical journal 2015
Occlusion of small side branch (SB) may result in significant adverse clinical events. We aim to characterize the predictors of small SB occlusion and incidence of periprocedural myocardial injury (PMI) in coronary bifurcation intervention.Nine hundred twenty-five consecutive patients with 949 bifurcation lesions (SB ≤ 2.0 mm) treated with percutaneous coronary intervention (PCI) were studied. All clinical characteristics, coronary angiography findings, PCI procedural factors, and quantitative coronary angiographic analysis data were collected. SB occlusion after main vessel (MV) stenting was defined as no blood flow or any thrombolysis in myocardial infarction (TIMI) flow grade decrease in SB after MV stenting. Multivariate logistic regression analysis was performed to identify independent predictors of small SB occlusion. Creatine kinase-myocardial band activity was determined by using an immunoinhibition assay and confirmed by mass spectrometry. Incidence of PMI between no SB occlusion group and SB occlusion group was compared.SB occlusion occurred in 86 (9.1%) of 949 bifurcation lesions. Of SB occlusion, total occlusion occurred in 64 (74.4%) lesions and a decrease in TIMI flow occurred in 22 (25.6%) lesions. True bifurcation lesion, irregular plaque, predilation in SB, preprocedural SB TIMI flow grade, preprocedural diameter stenosis of distal MV, preprocedural diameter stenosis of bifurcation core, bifurcation angle, diameter ratio between MV and SB, diameter stenosis of SB before MV stenting, and MV lesion length were independent risk factors of SB occlusion. We observed a significantly higher incidence of PMI in each cutoff level in patients with SB occlusion compared with those without SB occlusion.True bifurcation lesion, irregular plaque, and 8 other predictors were independent predictors of SB occlusion. Patients with small SB occlusion had significant higher incidence of PMI.
Medicine 2015
OBJECTIVES:We aimed to investigate the effect of bifurcation angle (BA) on side branch (SB) occlusion after main vessel (MV) stenting.BACKGROUND:BA is thought to impact the risk of SB occlusion in coronary bifurcation patients undergoing percutaneous coronary intervention (PCI).METHODS:A total of 1,171 consecutive patients with 1,200 bifurcation lesions undergoing one stent or provisional two stent techniques were studied. The lesions were divided into low angle and high angle groups using the median BA (52°). Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion.RESULTS:SB occlusion occurred in 88 (7.33%) of 1,200 bifurcation lesions treated with the one stent technique or MV stenting first strategy. The rate of SB occlusion was significantly higher in the high angle group (63/600, 10.5%) than the low angle group (25/600, 4.2%) (P < 0.001). The rate of SB occlusion increased significantly across quartiles of BA as follows: from 3.63% in the first quartile of BA, to 4.71% in quartile II, to 8.14% in quartile III to 12.97% in quartile IV (P < 0.001). Multivariable analysis showed that high angle was an independent predictor of SB occlusion (odds ratio: 1.026, 95% confidence intervals: 1.014-1.037, P < 0.001). Plaque distribution at the same side of SB, MV Thrombolysis in Myocardial Infarction flow grade before stenting, pre-procedural diameter stenosis of bifurcation core, diameter ratio between MV/SB and diameter stenosis of SB before MV stenting were also independent predictors of SB occlusion.CONCLUSIONS:High BA was an independent predictor of SB occlusion after MV stenting. The occlusion risk of SB with a high BA should not be ignored.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2015
