ObjectiveTo investigate the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. MethodsWe studied the data of 1 412 patients with unstable angina who received coronary angiography examinations and completed the follow-up between July 2008 and September 2012. Serum potassium level within the first 24 hours after admission was collected. According to the serum potassium level, the patients were divided into three groups:those with a serum potassium level lower than 3.5 mmol/L, those with a level between 3.5 and 5.0 mmol/L and those with a level higher than 5.0 mmol/L. Then, we analyzed the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. ResultsThere was a U-shaped relationship between admission serum potassium level and long-term mortality that persisted after multivariable adjustment in patients with unstable angina. The all-cause mortality risk was the lowest in the group of patients with a potassium level of 3.5 to 5.0 mmol/L, whereas mortality was higher in patients with potassium level lower than 3.5 mmol/L and higher than 5.0 mmol/L [HR=1.89, 95%CI (1.13, 3.17), P=0.016; HR=1.64, 95%CI (0.40, 6.77), P=0.493]. Compared with patients with a serum potassium level between 3.5 and 5.0 mmol/L, the cardiovascular mortality risk was significantly higher in those patients with a potassium level lower than 3.5 mmol/L [HR=1.99, 95%CI (1.01, 3.94), P=0.048]. ConclusionThere is a U-shaped relationship between admission serum potassium level and long-term all-cause mortality rate, and the all-cause mortality rate and cardiovascular mortality risk was the lowest in patients with a potassium level between 3.5 and 5.0 mmol/L.
Objective To explore the clinical characteristics, in-hospital outcomes, and short-term survival of patients with acute kidney injury (AKI) in a large non-surgical cardiac intensive care unit (ICCU) in China. Methods Patients who had been admitted to the ICCU of the Department of Cardiology, West China Hospital of Sichuan University between June 2016 and May 2017 were retrospectively included. The diagnosis and staging of AKI were based on the Kidney Disease: Improving Global Outcomes criteria. The in-hospital outcomes were the composite of all-cause death or discharge against medical advice under extremely critical conditions. Patients without in-hospital composite outcomes were followed up to determine whether all-cause death occurred during the study period. The association of AKI with in-hospital composite outcomes or short-term survival was analyzed. Normally distributed quantitative data were expressed as mean±standard deviation, and non-normally distributed quantitative data were expressed as median (lower quartile, upper quartile). Results This study included 2083 patients, with an average age of (65.5±14.6) years old, and 681 (32.7%) were women. The prevalence rate of AKI was 15.0% (312/2083) (stage 1: 6.9%; stage 2: 4.9%; stage 3: 3.2%; respectively). Compared with patients without AKI, patients with AKI were older [(68.9±14.3) vs. (64.9±14.6) years old, P<0.001], had a higher Charles Comorbidity Index [4.0 (3.0, 6.0) vs. 2.0 (1.0, 3.0), P<0.001] and a greater Oxford Acute Illness Severity Score [32.0 (24.0, 41.2) vs. 21.0 (16.0, 26.0), P<0.001]. The incidence of in-hospital composite endpoint events was 8.4% (174/2083). Multiple logistic regression analysis showed that as the AKI stage increased, the risk of in-hospital composite endpoint events was higher [AKI stage 1 vs. no AKI: odds ratio (OR)=1.13, 95% confidence interval (CI) (0.57, 2.24); AKI stage 2 vs. no AKI: OR=2.21, 95%CI (1.08, 4.51); AKI stage 3 vs. no AKI: OR=10.88, 95%CI (4.50, 26.34); P for trend<0.001]. The patients without in-hospital composite endpoint events were followed up for a median time of 13.5 (10.7, 16.6) months, and the all-cause mortality rate was 5.5% (105/1909). Multiple Cox regression analysis showed that AKI was independently associated with all-cause death [hazard ratio=2.27, 95%CI (1.40, 3.69), P<0.001]. Conclusions AKI is common in the large ICCU in China and is more likely to occur in older patients who have more significant chronic illness complexity and acute illness severity. Moreover, AKI is independently associated with the in-hospital composite endpoint events and short-term survival.
ObjectiveTo systematically evaluate the outcomes of drug-eluting balloon (DEB) in treating coronary artery in-stent restenosis (ISR) by using meta-analysis and trial sequential analysis (TSA). MethodsWe searched PubMed, EMbase, The Cochrane Library（Issue 4, 2016）, CNKI, CBM, VIP and WanFang Data to collect randomized controlled trials (RCTs) regarding the treatment of ISR by DEB from inception to April 2016. After two reviewers independently screened citations, extracted data and assessed the bias risk of included studies, we carried out meta-analysis and TSA analysis by using RevMan 5.3 version and TSA v0.9 respectively. ResultsA total of 10 RCTs involving 1909 patients were included. Seven-hundred and forty-seven patients were included with regard to the comparison between DEB and POBA, 1162 patients were recruited to compare DEB and drug-eluting stents (DES). The results of meta-analysis revealed that DEB was associated with decreased mortality (OR=0.36, 95%CI 0.14 to 0.93, P=0.04), compared with that of plain old balloon angioplasty (POBA). And TSA showed that cumulative Z-curve strode the conventional threshold value but not the TSA threshold value which suggested a false positive result of meta-analysis. In comparison with that of POBA, DEB had a lower incidence of target lesion revascularization (TLR) (OR=0.16, 95%CI 0.07 to 0.38, P＜0.01). And the result of TSA displayed that the cumulative Z-curve strode both the conventional and TSA threshold value which validated the result of meta-analysis. Besides, the results of meta-analysis showed that there were no significant differences in mortality (OR=0.84, 95%CI 0.41 to 1.72, P=0.63) and TLR (OR=1.55, 95%CI 0.76 to 3.16, P=0.22) between DEB and DES. However, the result of TSA revealed that the cumulative Z-curve did not strode both the conventional and TSA threshold value, and the included sample size less was than required information size which suggested that the reliability of the meta-analysis needed more studies to confirm. While the subgroup analysis of EES revealed that DEB had a higher incidence of TLR than that of DEB (OR=3.37, 95%CI 1.59 to 7.15, P＜0.01). And the result of TSA displayed that the cumulative Z-curve strode both the conventional and TSA threshold value which validated the result of meta-analysis. ConclusionCurrent evidence shows, EES is superior to DEB in decreasing the incidence of TLR in patients with ISR, while DEB is superior to POBA. However, the comparison of DEB and other strategies on reducing of mortality in patients with ISR still needed more studies to prove.
Objective To explore the role of systolic and diastolic dysfunction in the prognosis of Chinese patients with coronary artery disease (CAD). Methods CAD patients who underwent coronary arteriography in the Department of Cardiology of West China Hospital between July 2008 and June 2012 were included in this study. All the patients underwent color Doppler echocardiographic examination. Based on patients’ systolic and diastolic cardiac function, left ventricular ejection fraction (LVEF) <55% was as the systolic dysfunction and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e’) >15 was as the diastolic dysfuntion. They were divided into normal cardiac function group (LVEF≥55%, E/e’ ratio≤15), systolic and diastolic dysfunction group (LVEF<55%, E/e’ ratio>15), diastolic dysfunction group (LVEF≥55%, E/e’ ratio>15) and systolic dysfunction group (LVEF<55%, E/e’ ratio≤15). The end points of follow-up were all-cause death and a major cardiovascular event (MACE). Results A total of 985 patients with complete echocardiographic report were included in this study. During the follow-up of (21.4±9.7) months, 46 patients (4.7%) died, and 52 (5.4%) had a MACE. Systolic dysfunction concomitant with diastolic dysfunction group and systolic dysfunction group patients had a higher risk of 36-month all-cause death (4.8%, 10.7%,P<0.001) and a higher risk of 41-month MACE (8.6%, 7.6%,P=0.028). Single factor analysis of all-cause death mortality showed that compared with the normal group, all-cause death mortality was the highest in systolic and diastolic dysfunction group (P<0.05), followed by diastolic dysfunction group (P<0.05) and systolic dysfunction group (P>0.05). Single factor analysis of MACE showed that compared with the normal group, MACE was still the highest in systolic and diastolic dysfunction group (P<0.05), followed by systolic dysfunction group (P<0.05) and diastolic dysfunction group (P>0.05). A multivariate Cox regression model analysis showed that compared with the normal group, the risk of all-cause death was the highest in the systolic and diastolic dysfunction group [hazard ratio (HR)=2.96, 95% confidence interval (CI) (1.34, 6.54),P=0.007], followed by the systolic dysfunction group [HR=1.91, 95%CI (0.67, 5.42),P=0.224] and the diastolic dysfunction group [HR=0.95, 95%CI (0.40, 2.23),P=0.905]. Conclusion Compared with normal patients, patients with either systolic or diastolic dysfunction have a poorer prognosis, and patients with systolic dysfunction concomitant with diastolic dysfunction have the poorest prognosis.
Objective To explore the risk factors for long-term death of patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF), and develop and validate a prediction model for long-term death. Methods This retrospective cohort study included 1013 patients diagnosed with AMI and reduced LVEF in West China Hospital of Sichuan University between January 2010 and June 2019. Using the RAND function of Excel software, patients were randomly divided into three groups, two of which were combined for the purpose of establishing the model, and the third group was used for validation of the model. The endpoint of the study was all-cause mortality, and the follow-up was until January 20th, 2021. Cox proportional hazard model was used to evaluate the risk factors affecting the long-term death, and then a prediction model based on those risk factors was established and validated. Results During a median follow-up of 1377 days, 296 patients died. Multivariate Cox regression analysis showed that age≥65 years [hazard ratio (HR)=1.842, 95% confidence interval (CI) (1.067, 3.179), P=0.028], Killip class≥Ⅲ[HR=1.941, 95%CI (1.188, 3.170), P=0.008], N-terminal pro-brain natriuretic peptide≥5598 pg/mL [HR=2.122, 95%CI (1.228, 3.665), P=0.007], no percutaneous coronary intervention [HR=2.181, 95%CI (1.351, 3.524), P=0.001], no use of statins [HR=2.441, 95%CI (1.338, 4.454), P=0.004], and no use of β-blockers [HR=1.671, 95%CI (1.026, 2.720), P=0.039] were independent risk factors for long-term death. The prediction model was established and patients were divided into three risk groups according to the total score, namely low-risk group (0-2), medium-risk group (4-6), and high-risk group (8-12). The results of receiver operating characteristic curve [area under curve (AUC)=0.724, 95%CI (0.680, 0.767), P<0.001], Hosmer-Lemeshow test (P=0.108), and Kaplan-Meier survival curve (P<0.001) showed that the prediction model had an efficient prediction ability, and a strong ability in discriminating different groups. The model was also shown to be valid in the validation group [AUC=0.758, 95%CI (0.703, 0.813), P<0.001]. Conclusions In patients with AMI and reduced LVEF, age≥65 years, Killip class≥Ⅲ, N-terminal pro-brain natriuretic peptide≥5598 pg/mL, no percutaneous coronary intervention, no use of statins, and no use of β-blockers are independent risk factors for long-term death. The developed risk prediction model based on these risk factors has a strong prediction ability.