Lamy A.,Hamilton Health Sciences |
Devereaux P.J.,Hamilton Health Sciences |
Prabhakaran D.,Center for Chronic Disease Control |
Taggart D.P.,University of Oxford |
And 21 more authors.
New England Journal of Medicine | Year: 2012
BACKGROUND:The relative benefits and risks of performing coronary-artery bypass grafting (CABG) with a beating-heart technique (off-pump CABG), as compared with cardiopulmonary bypass (on-pump CABG), are not clearly established. METHODS:At 79 centers in 19 countries, we randomly assigned 4752 patients in whom CABG was planned to undergo the procedure off-pump or on-pump. The first coprimary outcome was a composite of death, nonfatal stroke, nonfatal myocardial infarction, or new renal failure requiring dialysis at 30 days after randomization. RESULTS:There was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (9.8% vs. 10.3%; hazard ratio for the off-pump group, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P = 0.59) or in any of its individual components. The use of off-pump CABG, as compared with on-pump CABG, significantly reduced the rates of blood-product transfusion (50.7% vs. 63.3%; relative risk, 0.80; 95% CI, 0.75 to 0.85; P<0.001), reoperation for perioperative bleeding (1.4% vs. 2.4%; relative risk, 0.61; 95% CI, 0.40 to 0.93; P = 0.02), acute kidney injury (28.0% vs. 32.1%; relative risk, 0.87; 95% CI, 0.80 to 0.96; P = 0.01), and respiratory complications (5.9% vs. 7.5%; relative risk, 0.79; 95% CI, 0.63 to 0.98; P = 0.03) but increased the rate of early repeat revascularizations (0.7% vs. 0.2%; hazard ratio, 4.01; 95% CI, 1.34 to 12.0; P = 0.01). CONCLUSIONS:There was no significant difference between off-pump and on-pump CABG with respect to the 30-day rate of death, myocardial infarction, stroke, or renal failure requiring dialysis. The use of off-pump CABG resulted in reduced rates of transfusion, reoperation for perioperative bleeding, respiratory complications, and acute kidney injury but also resulted in an increased risk of early revascularization. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.). Copyright © 2012 Massachusetts Medical Society.
Lamy A.,Hamilton Health Sciences |
Devereaux P.J.,Hamilton Health Sciences |
Prabhakaran D.,Center for Chronic Disease Control |
Taggart D.P.,University of Oxford |
And 21 more authors.
New England Journal of Medicine | Year: 2013
BACKGROUND: Previously, we reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new renal failure requiring dialysis between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report results on quality of life and cognitive function and on clinical outcomes at 1 year. METHODS: We enrolled 4752 patients with coronary artery disease who were scheduled to undergo CABG and randomly assigned them to undergo the procedure off-pump or on-pump. Patients were enrolled at 79 centers in 19 countries. We assessed quality of life and cognitive function at discharge, at 30 days, and at 1 year and clinical outcomes at 1 year. RESULTS: At 1 year, there was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (12.1% and 13.3%, respectively; hazard ratio with off-pump CABG, 0.91; 95% confidence interval [CI], 0.77 to 1.07; P=0.24). The rate of the primary outcome was also similar in the two groups in the period between 31 days and 1 year (hazard ratio, 0.79; 95% CI, 0.55 to 1.13; P=0.19). The rate of repeat coronary revascularization at 1 year was 1.4% in the off-pump group and 0.8% in the on-pump group (hazard ratio, 1.66; 95% CI, 0.95 to 2.89; P=0.07). There were no significant differences between the two groups at 1 year in measures of quality of life or neurocognitive function. CONCLUSIONS: At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294). Copyright © 2013 Massachusetts Medical Society.
Han Y.,General Hospital of Shenyang Military Command |
Guo J.,Capital Medical University |
Zheng Y.,Jilin University |
Zang H.,No 463 Hospital Of Pla |
And 20 more authors.
JAMA - Journal of the American Medical Association | Year: 2015
Importance: The safety and efficacy of bivalirudin compared with heparin with or without glycoprotein IIb/IIIa inhibitors in patients with acutemyocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are uncertain. OBJECTIVE To determine if bivalirudin is superior to heparin alone and to heparin plus tirofiban during primary PCI. Design, Setting, and Participants: Multicenter, open-label trial involving 2194 patients with AMI undergoing primary PCI at 82 centers in China between August 2012 and June 2013. Interventions: Patients were randomly assigned to receive bivalirudin with a post-PCI infusion (n = 735), heparin alone (n = 729), or heparin plus tirofiban with a post-PCI infusion (n = 730). Among patients treated with bivalirudin, a postprocedure 1.75mg/kg/h infusion was administered for a median of 180 minutes (IQR, 148-240 minutes). Main outcomes and Measures: The primary end pointwas 30-day net adverse clinical events, a composite of major adverse cardiac or cerebral events (all-cause death, reinfarction, ischemia-driven target vessel revascularization, or stroke) or bleeding. Additional prespecified safety end points included the rates of acquired thrombocytopenia at 30 days, and stent thrombosis at 30 days and 1 year. Results: Net adverse clinical events at 30 days occurred in 65 patients (8.8%) of 735 who were treated with bivalirudin compared with 96 patients (13.2%) of 729 treated with heparin (relative risk [RR], 0.67; 95%CI, 0.50-0.90; difference, -4.3%, 95%CI, -7.5%to -1.1%; P = .008); and 124 patients (17.0%) of 730 treated with heparin plus tirofiban (RR for bivalirudin vs heparin plus tirofiban, 0.52; 95%CI, 0.39-0.69; difference, -8.1%, 95%CI, -11.6%to -4.7%; P < .001). The 30-day bleeding rate was 4.1%for bivalirudin, 7.5%for heparin, and 12.3%for heparin plus tirofiban (P < .001). There were no statistically significant differences between treatments in the 30-day rates of major adverse cardiac or cerebral events (5.0%for bivalirudin, 5.8% for heparin, and 4.9% for heparin plus tirofiban, P = .74), stent thrombosis (0.6%vs 0.9%vs 0.7%, respectively, P = .77), acquired thrombocytopenia (0.1%vs 0.7%vs 1.1%; P = .07), or in acute (<24-hour) stent thrombosis (0.3%in each group). At the 1-year follow-up, the results remained similar. Conclusions and Relevance: Among patients with AMI undergoing primary PCI, the use of bivalirudin with a median 3-hour postprocedure PCI-dose infusion resulted in a decrease in net adverse clinical events compared with both heparin alone and heparin plus tirofiban. This finding was primarily due to a reduction in bleeding events with bivalirudin, without significant differences in major adverse cardiac or cerebral events or stent thrombosis.
Han Y.,Shenyang Northern Hospital |
Zhu G.,WuHan Asia Heart Hospital |
Han L.,CangZhou Central Hospital |
Hou F.,Changchun Central Hospital |
And 19 more authors.
Journal of the American College of Cardiology | Year: 2014
Objectives This study sought to evaluate the safety and efficacy of rosuvastatin in preventing contrast-induced acute kidney injury (CI-AKI) in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). Background CI-AKI is an important complication after contrast medium injection. While small studies have shown positive results with statin therapy, the role of statin therapy in prevention of CI-AKI remains unknown. Methods We randomized 2,998 patients with type 2 DM and concomitant CKD who were undergoing coronary/peripheral arterial angiography with or without percutaneous intervention to receive rosuvastatin, 10 mg/day (n = 1,498), for 5 days (2 days before, and 3 days after procedure) or standard-of-care (n = 1,500). Patients' renal function was assessed at baseline, 48 h, and 72 h after exposure to contrast medium. The primary endpoint of the study was the development of CI-AKI, which was defined as an increase in serum creatinine concentration ≥0.5 mg/dl (44.2 μmol/l) or 0.25% above baseline at 72 h after exposure to contrast medium. Results Patients randomized to the rosuvastatin group had a significantly lower incidence of CI-AKI than controls (2.3% vs. 3.9%, respectively; p = 0.01). During 30 days' follow-up, the rate of worsening heart failure was significantly lower in the patients treated with rosuvastatin than that in the control group (2.6% vs. 4.3%, respectively; p = 0.02). Conclusions Rosuvastatin significantly reduced the risk of CI-AKI in patients with DM and CKD undergoing arterial contrast medium injection. (Rosuvastatin Prevent Contrast Induced Acute Kidney Injury in Patients With Diabetes [TRACK-D]; NCT00786136).
Li C.,Wuhan University |
Yang G.,Wuhan University |
Ruan J.,Huazhong University of Science and Technology |
Ruan J.,Wuhan Asia Heart Hospital
Biochemical and Biophysical Research Communications | Year: 2012
Macrophage recruitment to sites of inflammation is an essential step in host defense. However, the signals regulating the mobilization of these cells are still not fully understood. Sphingosine-1-phosphate (S1P), a pleiotropic bioactive lipid mediator, is known to regulate an array of biological activities in various cell types. Here, we investigated the roles of S1P and S1P receptors (S1PRs) in macrophage migration in vitro. Furthermore, we explored the cross-talk between transforming growth factor-β1 (TGF-β1) and S1P signalling pathways in this process. We found that S1P exerted a powerful migratory action on RAW264.7 macrophages, as determined in Boyden chambers. Moreover, by employing RNA interference technology and pharmacological tools, we have demonstrated that S1PR1, but not S1PR2 and S1PR3, is required for S1P-induced macrophage migration. Importantly, we observed a pronounced increase in sphingosine kinase-1 (SphK1) mRNA expression and subsequently increase in S1P production, following transforming growth factor-β1 (TGF-β1) stimulation in RAW264.7 macrophages. The expression of S1PR1, but not S1PR2 and S1PR3, was also significantly up-regulated after TGF-β1 stimulation. Interestingly, exogenously added S1P-induced up-regulation of SphK1 and the synthesis of additional S1P, suggesting a self-amplifying loop of S1P to enhance macrophage migration. In conclusion, our results reveal that SphK1/S1PR1 signalling axis is induced by TGF-β1 and stimulates cell migration in RAW 264.7 macrophages. This study provides new clues for the molecular mechanisms of macrophage recruitment during inflammation. © 2012 Elsevier Inc.
Zheng P.,Wuhan Asia Heart Hospital
Chinese Critical Care Medicine | Year: 2012
Objective: To investigate significance of plasma brain natriuretic peptide (BNP) on evaluation of cardiac function in children with congenital heart disease (CHD). Methods: One hundred and fifty-three children with CHD were enrolled. Plasma level of BNP was measured by enzyme linked immunosorbent assay (ELISA) at 24 hours after cardiac operation. The left ventricular ejection fraction (LVEF) was examined by echocardiogram at the same time. Cardiac index (CI) was measured with thoracic impedance method (CI1) and pulse indicator continuous cardiac output (PiCCO) system (CI2) at the same time. Correlation between BNP, LVEF, CI1 and CI2 was analyzed. The length of mechanical ventilation, the length of intensive care unit (ICU) stay, the length of hospital stay, and mortality were compared between BNP < 140 ng/L group (group A, n = 108) and BNP > 140 ng/L group (group B, n = 45). Results: The average plasma BNP level of 153 children with CHD was (168.8 ± 71.6) ng/L. The average LVEF was 0.409 ± 0.137, CI1 was (51.7 ± 15.0) ml·s-1·m-2, and C12 was (61.7 ± 11.7) ml·s-1·m-2. Plasma BNP showed negative correlation with CI1 and CI2 (r1 = -0.79, r2 = -0.79, both P < 0.01). LVEF showed positive correlation with CI1 and CI2 (r1 = 0.68, r2 = 0.68, both P < 0.01). CI1 showed positive correlation with CI2 (r = 0.88, P < 0.01). The length of mechanical ventilation (hours), the length of ICU stay (days), and the length of hospital stay (days) in group B were significantly longer than those in group A (the length of mechanical ventilation: 39.7 ± 11.6 vs. 26.4 ± 13.5, the length of ICU stay: 4.9 ± 1.3 vs. 2.5 ± 0.9, the length of hospital stay: 15.9 ± 5.1 vs. 11.2 ± 3.7, all P < 0.01). Mortality of two groups showed no statistical difference. Conclusion: Plasma BNP was useful for post operative evaluation of cardiac function among the children with CHD, and also to predicting the outcome of the patients.
Luo H.,Zhengzhou University |
Wang J.,Zhengzhou University |
Qiao C.,Zhengzhou University |
Zhang X.,Zhengzhou University |
And 2 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014
Objective Minimally invasive cardiac surgery is becoming a safe and cosmetic alternative to standard median sternotomy (SMS). In the present retrospective study, we reviewed our results and experience with the totally thoracoscopic (TTS) and right vertical infra-axillary thoracotomy (RVIAT) techniques for atrial septal defect closure compared with SMS. Methods From December 2010 to February 2012, 198 patients underwent repair of atrial septal defect using the TTS technique (n = 66), RVIAT (n = 59), or SMS (n = 73). Cardiopulmonary bypass was achieved peripherally in the TTS group and directly in the RVIAT and SMS groups. Results The procedures were performed successfully in all 3 groups, and no in-hospital mortality occurred. No patient required conversion to SMS in the TTS group, although 2 patients did so in the RVIAT group. The cardiopulmonary bypass time was 87.26 ± 21 minutes in the TTS group, 41.81 ± 13.97 minutes in the RVIAT group, and 36.99 ± 10.84 minutes in the SMS group (P <.01). The crossclamp time was 32.86 ± 13.36, 22.54 ± 9.08, and 19.23 ± 6.92 minutes in the TTS, RVIAT, and SMS groups, respectively (P <.01). The total incision length in the SMS group (7.45 ± 1.54 cm) was longer than that in the other groups (TTS group, 5.21 ± 0.63 cm; RVIAT group, 6.48 ± 1.37 cm); the difference was statistically significant (P <.01). Conclusions The TTS technique and RVIAT can both be performed with favorable cosmetic and acceptable clinical results for closing atrial septal defects. They are promising alternatives to SMS and merit additional study. © 2014 by The American Association for Thoracic Surgery.
Yan J.-J.,Huazhong University of Science and Technology |
Zhang Y.-N.,Huazhong University of Science and Technology |
Liao J.-Z.,Huazhong University of Science and Technology |
Ke K.,Wuhan Asia Heart Hospital |
And 5 more authors.
Oncotarget | Year: 2015
Hepatocellular carcinoma (HCC) is a worldwide malignance and displays marked vascular abnormalities and active metastasis. MicroRNAs (miRNAs) have been shown to play important roles in regulating tumor properties in cancer, however, whether miR-497 contributes to HCC angiogenesis or metastasis remains unclear. In this study, we found that miR-497 was significantly down-regulated in HCC tissue samples and cell lines. Gain-of-function and loss-of-function studies revealed that miR-497 could repress both the pro-angiogenic and metastatic ability of HCC cells. Subsequent investigations disclosed that miR-497 directly inhibited the 3'-untranslated regions (UTRs) of vascular endothelial growth factor A (VEGFA) and astrocyte elevated gene-1 (AEG-1). Furthermore, overexpression of these targets antagonized the function of miR-497. Based on nude mouse models, we demonstrated that overexpression of miR-497 significantly repressed microvessel densities in xenograft tumors and reduced pulmonary metastasis. In conclusion, our findings indicate that miR-497 downregulation contributes to angiogenesis and metastasis in HCC.
Lu J.G.,Wuhan Asia Heart Hospital
Zhonghua xin xue guan bing za zhi | Year: 2011
To investigate the clinical manifestations of patients with pulmonary artery hypertension (PAH) associated with hereditary hemorrhagic telangiectasia (HHT). This retrospective analysis summarized the clinical features of 6 patients with PAH associated with HHT hospitalized at department of cardiology in Cardiovascular Institute and Fuwai Hospital between January 2006 and May 2009. The mean age of the 6 patients (3 male) was 34 years (8 - 67 years). Recurrent epistaxis were present in all patients, there were 4 patients with severe PAH and 2 patients with moderate PAH. All of the six patients with PAH associated with HHT were misdiagnosed at the first hospital visit. Clinical symptoms were significantly improved in 4 patients and remained unchanged in 2 patients combined hepatic venous malformation post medical therapy. Misdiagnosis for patients with PAH associated with HHT is a common phenomenon in daily clinical practice. Patients could benefit from the corresponding medical therapy after the establishment of the correct diagnosis.
Liu Y.,Wuhan Asia Heart Hospital
Zhonghua wai ke za zhi [Chinese journal of surgery] | Year: 2011
To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG). The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. Standard and logistic EuroSCORE were higher in MECC group than the others (P < 0.01). The operative time and the number of distal anastomosis of off-pump group were less than MECC and cECC groups (P < 0.05), while no difference between MECC group and cECC group. Intrinsic coagulation (activated partial thromboplastin time) were much more prolonged early postoperatively in cECC group, and higher than in MECC group and off-pump group at 2 h, 6 h and 12 h postoperatively (P < 0.05), but no difference in extrinsic coagulation (prothrombin time) among three group. Adjusted by hematocrit of the same sample, free hemoglobin level rose up during the ECC procedure and reached the maximum at the end of ECC in cECC group and MECC group, but the levels were more higher in cECC group than in MECC group (P < 0.05). The draining volume during the first 24 h after operation of cECC group was larger than MECC group and off-pump group (P < 0.05). Although the decreased platelet count perioperatively and more consumed of the blood products in cECC group, but no difference among the three groups. MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.