ObjectiveTo summarize the effectiveness and safety of antiplatelet combined with anticoagulant therapy for peripheral arterial disease (PAD). MethodUsing the search strategy developed by Cochrane Collaborative Network, the relevant literature from domestic and foreign databases as of November 1, 2023 was searched and a meta-analysis of outcome indicators was conducted using Stata 14.0 software and Review Manager 5.4.1 software provided by Cochrane Collaboration Network. ResultsA total of 15 eligible literature and 15 383 patients were included, including 7 692 in the antiplatelet combined with anticoagulant therapy group (study group) and 7 691 in the control group (only antiplatelet drug therapy). The meta-analysis results showed that: ① Symptoms: The ankle brachial index [mean difference (MD) and 95% confidence interval (95%CI)=0.04(0.02, 0.06)] and the minimum lumen diameter [MD (95%CI)=0.48(0.40, 0.55)] of the study group were greater than those of the control group; The plasma D-2 dimer level of the study group was lower than that of the control group [MD (95%CI)=–0.55(–0.57, –0.52)], and the probability of the limb ischemia risk of the study group was lower than that of the control group [risk ratio (RR) and 95%CI=0.67(0.56, 0.80)]. ② Vascular patency: The probability of the vascular patency of the study group was higher than that of the control group [RR (95%CI)=1.13(1.08, 1.17)]; The subgroup analysis results: the vascular patency rate of the two antiplatelet drugs combined with anticoagulation therapy was highest among the different treatment regimens [effect size (ES) and 95%CI=0.90(0.86, 0.94)], which of the other measures in descending order was only one antiplatelet drug combined with anticoagulation therapy [ES(95%CI)=0.82(0.76, 0.89)], two antiplatelet drugs therapy [ES(95%CI)=0.79(0.72, 0.85)], and only one antiplatelet drug therapy [ES(95%CI)=0.71(0.54, 0.87)]; The probability of the vascular patency using vitamin K antagonists in the study group was higher than that in the control group [RR(95%CI)=1.15(1.10, 1.20)], which had no statistical difference using Ⅹa inhibitor between the study group and the control group [RR(95%CI)=1.04 (0.95, 1.15)]. ③ Bleeding risk: The risk of bleeding of the study group was higher than that of the control group [RR(95%CI)=1.55(1.27, 1.89)]; The subgroup analysis results: The bleeding rate of the only one antiplatelet drug therapy among the different intervention measures was the lowest [ES(95%CI)=0.02(0.01, 0.02)], which of the other measures in ascending order was only one antiplatelet drug combined with anticoagulant therapy [ES(95%CI)=0.04(0.03, 0.06)], two antiplatelet drugs therapy [ES(95%CI)= 0.08(0.06, 0.10)], and two antiplatelet drugs combined with anticoagulant [ES(95%CI)=0.12(0.06, 0.18)]; The probabilities of the bleeding occurring using the vitamin K antagonists and Ⅹa inhibitor in the study group were higher than those in the control group [RR(95%CI)=1.76(1.28, 2.42); RR(95%CI)=1.44(1.12, 1.84)]. ConclusionsFrom the results of this meta-analysis, it can be seen that the combination of antiplatelet and anticoagulant therapy can effectively improve symptoms of patients with PAD, increase vascular patency rate, but it has a certain risk of bleeding. The combination of only one antiplatelet drug combined with anticoagulant therapy might achieve an optimum clinical effect and lower bleeding risk.
Abstract： Objective To evaluate the diagnostic accuracy for the the assessment of coronary artery stenosesusing 64-multislice spiral computed tomography （64-MSCT） scanner compared with selective coronary angiography（SCA）. Methods 64-MSCT and SCA were both performed in 93 patients with 74 males and 19 females at mean age of （58.2±8.5） years in West China Hospital between April 2004 and December 2010. The cardiacrhythm of all the patients was stably sinus. Patients with initial heart rates≥90 time/min were received treatments of β-blockers. All available coronary segments（internal diameter ≥ 2.0 mm）were included in the evaluation. Lesions with ≥ 50％ luminalnarrowing were considered as significant stenosis. According to the image detail of segments and existance of artfacts,the image quality was randed Ⅰ to Ⅳ ,with rank Ⅰ to Ⅲ meeting demands of image evaluation. Evaluations had been done concerning the 64-MSCT scanner for detecting the stenosis of the variant branches or segments of the coronary artery. Results 64-MSCTprovided a full image correspondence(100%,1 238/1 238)of all the segments clearly displayed in the SCA. All of the coronary segments involved （n=1 238） met the quality demands of being evaluated as rankⅠ to Ⅲ. Considering SCA as the golden standard， overall sensitivity for classifying stenosis using 64-MSCT scannerwas 88.8%（427/481）， specificity was 91.7%（694/757）， positive predictive value was 87.1%（427/490），and negative predictive value was 92.8%（ 694/748）.While the stenosis diagnostic accuracy of proximal left circumflexbranch and the first obtuse marginal branch of left coronay artery is lower than other branches： the sensitivity of the proximal left circumflex branch was 68.3%（41/60），specificity was 60.6%（20/33），positive predictive value was 75.9%（41/54），negative predictive value was 51.3%（20/39）；the sensitivity of the first obtuse marginalbranch was 58.8%（10/17），specificity was 93.5%（58/62），positive predictive value was 71.4%（10/14），negative predictive value was 89.2%（58/65）. Arterial wall calcification and false image of cardiac movements were the maininfluence factors for accuracy of the the assessment of coronary artery stenosis with 64-MSCT scanner. Conclusion 64-MSCT scanner provids a high diagnostic accuracy in assessing stenosis of the coronary artery. The anatomical location and luminal area of coronary artery were the main influence factors of diagnostic accuracy. Thus the diagnostic accuracy in proximal left circumflex branch and the first obtuse marginal branch of left coronary artery was lower than other coronarysegments.
Objective To investigate the relationship between diabetic retinopathy (DR) and coronary atherosclerosis (CAS) in type 2 diabetes patients and other risk factors of DR. Methods A total of 118 patients of type 2 diabetes with DR (DR group), 120 patients of type 2 diabetes without DR matched in age and sex (non-DR group), and 86 normal controls (control group) were enrolled in this study. The body mass index (BMI), blood pressure (BP), fasting blood-glucose (FPG), glycosylated haemoglobin (HbA1C), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), creatinine, estimate glomerular filtration rate (eGFR) and urinary albumin excretion rate(UAER) in all the subjects were measured. Meanwhile, the incidence of CAS in the three groups was detected by 64slice multidetector computed tomography angiography (MDCTA). Assume concurrent DR as dependent variable, clinical indicators and laboratory parameters as independent variable, the risk factors were determined by Logistic regression analysis. In addition, CAS as dependent variable, DR as fixed factor, analysis of covariance was used to investigate the relationship between CAS and DR. Results The incidence of CAS in DR group was higher than that in nonDR group and control group, the differences were statistically significant (chi;2=26.9,35.5;P＜0.05). The results of Logistic regression analysis showed that systolic BP, BMI, CAS, myocardial infarction and UAER were key risk factors for DR ［odds ratio (OR)=1.02, 0.89, 4.50, 3.89, 1.34;P＜0.05］. There was a negative relationship between BMI and DR. The results of analysis of covariance showed that there was significant correlation between CAS and DR (OR=5.31, 95% confidence interval=2.62-10.60; P＜0.05). Conclusion CAS is independently associated with DR in type 2 diabetes patients. In addition, the other risk factors for DR include systolic BP, BMI, myocardial infarction and UAER.
Objective To investigate the impact of peripheral artery disease (PAD) on the short-term prognosis after coronary artery bypass grafting (CABG) in patients of different age groups. MethodsRetrospective inclusion of patients who underwent CABG at Tongji Medical College Affiliated Union Hospital of Huazhong University of Science and Technology from 2016 to 2020. Divided into four groups by age (<50 years, 50-60 years, 60-70 years, >70 years). Propensity score matching (PSM) was used to balance the baseline characteristics of PAD and non PAD patients across different age groups. The primary endpoint of the study was all-cause mortality, and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) during the perioperative period. ResultsTotally, 1 516 patients were enrolled, including the GroupⅠ (<50 years, n=167), Group Ⅱ (50-60 years, n=477), Group Ⅲ (60-70 years, n=688), and Group Ⅳ (>70 years, n=184). After PSM treatment, a total of 375 pairs of patients (75.2% male) were successfully matched. Only in the age group of 60-70 years, the in-hospital mortality rate (7.73% vs. 1.45%, P＜0.01) and MACCE incidence rate (21.26% vs. 13.04%, P=0.02) of PAD patients were significantly higher than those of the non PAD group. Further multivariate analysis suggests that PAD is an independent risk factor for in-hospital mortality (OR=3.96, P＜0.01) and MACCE (OR=1.58, P=0.04) in this group, while there is no statistically significant difference in other age groups. Conclusion: PAD significantly increases the risk of recent mortality and MACCE in CABG patients aged 60-70 years, and perioperative management needs to be optimized for this population.
Abstract: Objective To investigate the clinical results of the coronary artery bypass grafting (CABG) for coronary artery disease (CAD) patients with completed hypothyroidism. Methods Twentyone CAD patients with hypothyroidism (hypothyroidism group) operated by a single surgeon from September 2002 to June 2009 in our department were enrolled in this study. Among them, there were 6 males and 15 females. Their average age was 60.4 years old. Three patients underwent CABG with onpump beating heart; one underwent CABG with onpump arrested heart; and 17 patients underwent CABG with offpump beating heart. All patients on thyroxine replacement therapy underwent CABG after free triiodothyronine（FT3）,free thyroxin（FT4）, thyroidstimulating hormone（TSH）, total triiodothyronine（TT3） and total thyroxin（TT4） were obviously improved. At the same time, twenty CAD patients without hypothyroidism were chosen as the control group (control group). Among them, there were 6 males and 14 females with an average age of 62.1 years old. The data of thyroid gland function and clinical prognostic indicator were observed after the operation. Results For the hypothyroidism group, one patient with pericardial effusion, heart failure and low thyroxine before surgery died during the onpump operation. Among the 20 survivors who had undergone CABG with beating heart, 17 were offpump CABG patients. Followup was done for 230 months. Postoperative eject factor of the survivors were significantly higher than their preoperative eject factor (55%±21% vs. 48%±17%). Twenty patients in the control group all survived. There was no significant difference in cardiac index ［2.7±1.4 L/(min·m2) vs. 2.8±1.5 L/(min·m2), t=0.530, P=0.530］, hospital stay (12.2±4.7 d vs. 10.1±3.9 d , t=0.170, P=0.170), or mechanical ventilation time (17.6±9.1 h vs. 15.1±13.7 h, t=0.120, P=0.120) between the hypothyroidism group and the control group. Perioperative thyroxine examination showed that there was no profound impact on thyroxine by offpump CABG. Conclusions With full preparation made before operation, CABG with beating heart is comparatively safe for CAD patients with hypothyroidism. The key of the treatment is perioperative thyroxine replacement therapy. There is much risk to perform onpump CABG on patients with severe hypothyroidism.
[Abstract]The pathogenesis of aortic disease is not fully understood. Gut dysbiosis may play a role in the occurrence and development of aortic diseases. Several studies showed that the diversity of microbiota in abdominal aortic aneurysms significantly decreases and is correlated with the diameter of the aneurysm. Characteristic microbial communities associated with abdominal aortic aneurysm, such as Roseburia, Bifidobacterium, Ruminococcus, Akkermansia have been found in human and animal studies. The gut microbiota of patients with aortic dissection varies greatly. Characteristic microbial communities like Lachnospiraceae and Ruminococcus present a potential impact on the pathogenesis of aortic dissection. Bifidobacterium may be associated with Takayasu arteritis and thoracic aortic aneurysm. The gut microbiota affects the physiological functions of the host by synthesizing bioactive metabolites, which causes aortic diseases, mainly involving metabolites such as trimethylamine N-oxide (TMAO), lipopolysaccharides (LPS), tryptophan, and short chain fatty acids. More and more evidence supports the causal relationship between gut microbiota dysbiosis and aortic disease. Clarifying abnormal changes in gut microbiota may provide clues for finding potential therapeutic targets.
Objective To evaluate the effectiveness and safety of sarpogrelate hydrochloride for patients with peripheral arterial disease (PAD). Methods The randomized controlled trials (RCTs) on PAD treated by sarpogrelate hydrochloride were identified from CBM (1978 to September 2011), CNKI (1979 to May 2011), PubMed (1950 to May 2011), EMbase (1970 to May 2011) and The Cochrane Library (Issue 3, 2011). According to the criteria of the Cochrane Handbook, two reviewers independently screened the studies, extracted and cross-checked the data, and assessed the methodological quality. Then meta-analysis was conducted by using RevMan 5.0 software. Results Nine RCTs involving 522 patients and 532 limbs were included, with low methodological quality in most trials. The results of meta-analyses indicated that compared with the conventional treatment, sarpogrelate hydrochloride could reduce the area of ulcers (MD= –3.22, 95%CI –3.99 to –2.45), and it could increase the ankle-brachial index (SMD=0.49, 95%CI 0.07 to 0.91), blood flow of dorsalis pedis artery (MD=0.16, 95%CI 0.09 to 0.23) and pain-free walking distance (MD=200.87, 95%CI 3.39 to 398.36). Five trials reported the adverse effects of sarpogrelate hydrochloride, most of which were mild gastrointestinal symptoms. Conclusion Based on the review, sarpogrelate hydrochloride may have positive effect on patients with PAD. However, the evidence is not b enough due to the general low methodological quality, so the reliable conclusion has to be drawn with more high quality studies in future.
Although aortic major vessel surgery can effectively correct anatomical abnormalities and improve disease prognosis, it remains challenging to eliminate residual aortic pathology and reduce the long-term risk of cardiovascular events. In addition, patients often experience reduced exercise tolerance and impaired health-related quality of life following surgery. In recent years, exercise-based cardiac rehabilitation (ECR) has been widely promoted among patients with cardiovascular diseases, with its clinical benefits well established. However, patients undergoing surgery for aortic disease present with unique characteristics, and standard ECR protocols may not fully address their specific rehabilitation needs. There is a compelling need to develop tailored ECR strategies for this patient population. This article presents a comprehensive literature review of recent clinical studies on ECR in patients after aortic surgery, aiming to offer practical and evidence-based guidance for professionals in the field of cardiac rehabilitation.