BACKGROUND & AIMS: :Abstract An accumulating number of studies are revealing that platelet reactivity above specific cut-off scores leads to exponentially increased rates of post-percutaneous coronary intervention (PCI) ischemic events. To evaluate the optimal predictive values for three different platelet function measurement assays of platelet reactivity on early clinical outcomes in Korean patients undergoing PCI, we enrolled 228 patients receiving clopidogrel prior to PCI. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow P2Y12 assay, and multiple electrode platelet aggregometry (MEA). The primary endpoint was the 30-day occurrence of ischemic events after PCI. MACE occurred in 36 patients (15.8%), including 35 patients (15.4%) with periprocedural MI and the death of one patient (0.4%). ADP-induced LTA and VerifyNow values (pre- and post-PCI) were significantly higher in patients with the subsequent occurrence of periprocedural MI, but the MEA assay data (PCI and post-PCI) displayed no significant differences (pre-PCI p=0.25 and post-PCI p=0.33). ROC curve analysis demonstrated HPR values for LTA (pre-PCI, >66% and post-PCI, >53 %, all p<0.001), VerifyNow (pre-PCI, >347 PRU and post-PCI >272 PRU, all p<0.001) and MEA (pre-PCI, >50 U and post-PCI >39 U, all p>0.05). The platelet reactivity measurements by LTA and the VerifyNow assay can discriminate the risk of 30-day ischemic events after PCI. The predictive cut-off values for adverse events are dependent on sampling time.

背景与目标： : 摘要越来越多的研究表明，超过特定临界值的血小板反应性导致经皮冠状动脉介入治疗 (PCI) 后缺血性事件的发生率呈指数增加。为了评估三种不同的血小板功能测量测定对接受PCI的韩国患者早期临床结局的最佳预测值，我们招募了228例在PCI之前接受氯吡格雷的患者。通过透光率聚集法 (LTA)，VerifyNow P2Y12测定和多电极血小板聚集法 (MEA) 测量血小板反应性。主要终点是PCI术后30天发生缺血事件。MACE发生在36例患者 (15.8% 例) 中，其中35例 (15.4% 例) 患有围手术期MI，1例死亡 (0.4% 例)。在随后发生围手术期MI的患者中，ADP诱导的LTA和VerifyNow值 (PCI前和PCI后) 显着较高，但MEA测定数据 (PCI和PCI后) 显示无显着差异 (PCI前p = 0.25和PCI后p = 0.33)。ROC曲线分析显示了LTA (PCI前，> 66% 和PCI后，> 53%，所有p<0.001) 、VerifyNow (PCI前，> 347 PRU和PCI后> 272 PRU，所有p<0.001) 和MEA (PCI前，> 50 U和PCI后> 39 U，所有p>0.05)。通过LTA和VerifyNow分析进行的血小板反应性测量可以区分PCI后30天缺血事件的风险。不良事件的预测临界值取决于采样时间。

BACKGROUND & AIMS: :As the techniques to connect percutaneous coronary intervention (PCI) balloons and the inflation syringe vary in the instructions for use and in practice, we measured the amount of air in PCI balloons after testing three connection methods to an inflation syringe. Following the preparation using one of the three methods, 114 balloons and stent balloons were tested four times. Method 1 connected the syringe and the balloon catheter directly after purging and filling the lumen, while method 3 omitted the purging and filling process. With method 2, the catheter lumen was purged, filled and fully vented via a three-way valve. The primary endpoint answered whether air remained in the balloon, and if so, the secondary endpoint indicated the total volume of remaining air. The connection with a three-way valve achieved significantly less air in the inflated balloon as compared with either direct connection approach (27% vs. 44% and 51%; p = 0.015). For the direct connection, no significant difference between purging and filling the lumen prior to making the connection or not existed. According to these findings, the best method to connect a PCI balloon to the inflation syringe while removing air involves using a three-way valve.

背景与目标： : 由于连接经皮冠状动脉介入治疗 (PCI) 球囊和充气注射器的技术在使用说明书和实践中有所不同，我们在测试了三种与充气注射器的连接方法后测量了PCI球囊中的空气量。在使用三种方法之一制备之后，测试114球囊和支架球囊四次。方法1在吹扫和填充管腔后直接连接注射器和球囊导管，而方法3省略了吹扫和填充过程。使用方法2，通过三通阀清除，填充并完全排出导管腔。主要终点回答了气球中是否残留有空气，如果是，则次要终点指示剩余空气的总体积。与任一直接连接方式 (27% 相对于44% 和51%; p = 0.015) 相比，与三通阀的连接显著减少了充气气球中的空气。对于直接连接，在进行连接之前或不存在清除和填充管腔之间没有显着差异。根据这些发现，在去除空气的同时将PCI气球连接到充气注射器的最佳方法是使用三通阀。

BACKGROUND & AIMS: BACKGROUND:Postcardiac injury syndrome (PCIS) is an inflammatory response syndrome characterized by pericardial effusion with or without pleural effusion; however, serious PCIS with peripheral hematoma of the ascending aorta and acute cerebral infarction after percutaneous coronary intervention (PCI) have not been reported. CASE PRESENTATION:This article reports a very rare case of a 40-year-old patient who developed acute pericardial and pleural effusions (both bloody), acute respiratory distress, peripheral hematoma of the ascending aorta, and acute cerebral infarction after PCI. The patient's ECG showed bow-back downward ST elevation in leads I, II, III, and V4-V6. A blood test showed significant increases in eukaryotic-cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Echocardiography and pulmonary artery computed tomography angiography (CTA) showed a large amount of pericardial effusion and pleural effusion. CTA of the thoracic and abdominal aorta showed a peripheral hematoma of the ascending aorta. A cranial computed tomography (CT) showed cerebral infarction anterior to the anterior horn of the right ventricle. After tracheal intubation, ventilator breathing support, pericardial and pleural drainage, and adrenocortical steroid (prednisone) treatment, he gradually recovered and was discharged 20 days later. CONCLUSION:We report the management of a case of serious PCIS with peripheral hematoma of the ascending aorta and acute cerebral infarction after PCI. Early diagnosis, early differential diagnosis, and early use of steroid therapy are the key in treating PCIS.

背景与目标：

BACKGROUND & AIMS: :Many scholars have studied the effect of nicorandil on perioperative myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI), but results are inconsistent. Therefore, we performed this meta-analysis. Finally, 16 articles, including 1616 patients, were included into this meta-analysis. Meta-analysis results showed that: (1) Nicorandil can reduce the level of CK-MB after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (2) Nicorandil can reduce the level of TnT after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (3) Nicorandil can reduce the incidence of adverse reactions after PCI. (4) Nicorandil cannot reduce the level of MVP after PCI, including at 12 hours and 24 hours. (5) Subgroup analysis showed that nicorandil can reduce CK-MB and TnT level at 24 hours after PCI for Chinese's population (P < 0.05), but can not reduce CK-MB and TnT level at 24 hours after PCI for non Chinese's population (P > 0.05). Our meta-analysis indicate that nicorandil can reduce myocardial injury and reduce the incidence of adverse reaction caused by PCI for Chinese's population, but is not obvious for non Chinese's population. However, this conclusion still needs to be confirmed in the future.

背景与目标： : 许多学者研究了尼可地尔对择期经皮冠状动脉介入治疗 (PCI) 患者围手术期心肌保护的影响，但结果不一致。因此，我们进行了这项荟萃分析。最后，包括1616例患者在内的16篇文章被纳入本荟萃分析。Meta分析结果表明 :( 1) 尼可地尔能降低PCI术后ck-mb水平，包括在6  、12  、18  和24  时。(2) 尼可地尔可以降低PCI后的TnT水平，包括在6  小时，12  小时，18  小时和24  小时。(3) 尼可地尔能降低PCI术后不良反应的发生率。(4) 尼可地尔不能降低PCI后的MVP水平，包括在12 小时和24 小时。(5) 亚组分析显示，尼可地尔可降低中国人群PCI后24小时ck-mb和TnT水平 (p  <  0.05)，但不能降低非中国人群PCI后24小时ck-mb和TnT水平 (p  >  0.05)。我们的荟萃分析表明，尼可地尔可以减轻中国人的心肌损伤，降低PCI引起的不良反应的发生率，但对非中国人的人群不明显。不过，这一结论仍有待日后证实。

BACKGROUND & AIMS: OBJECTIVES:To investigate the outcomes of a cohort of acute and elective percutaneous coronary intervention (PCI) patients who were discharged home 6 hours postprocedure. BACKGROUND:Contemporary PCI is safe with a low rate of acute complications. It is well established as a day procedure in elective cases; however, data are lacking in acute cases. METHODS:We describe a prospective observational audit of routine clinical practice in the 3 PCI centers in Northern Ireland. Patients were selected for same-day discharge after 6 hours of post-PCI observation. Both elective and acute coronary syndrome (ACS) cases were included. Criteria for same-day discharge were based on the technical result of the procedure rather than lesion complexity or clinical presentation. Radial access was preferred but not mandatory. Patients were contacted directly to assess for 30-day major adverse cardiovascular events (MACE). Reported events were corroborated with the general practitioner or hospital notes. RESULTS:A total of 1,059 patients were selected for same-day discharge with 30-day follow-up available for all cases. Of these, 766 (72.3%) were elective and 293 (27.7%) were ACS patients. Radial access was almost universal (98%). A total of 1,224 lesions were stented, of which 432 (40.8%) were high risk (highest risk lesion in each case by AHA/ACC classification). MACE rate at 30 days was 0.85% with a sub-acute stent thrombosis rate of 0.4%. There were no MACE events from discharge to 24 hours. CONCLUSIONS:Selected acute and elective patients with a range of lesion complexity and risk can be discharged safely home early after PCI.

背景与目标：

BACKGROUND & AIMS: AIMS:We sought to compare clinical outcomes and procedural characteristics with transradial access (TRA) versus transfemoral access (TFA) in patients who were treated with PCI for left main (LM) coronary artery disease. METHODS AND RESULTS:The EXCEL trial was a prospective, international, open-label, multicentre trial that randomised 1,905 patients with LM disease and SYNTAX scores ≤32 to PCI with everolimus-eluting stents versus coronary artery bypass grafting. The present analysis cohort consisted of 931 patients undergoing PCI with TRA or TFA, but not both. The primary endpoint was a composite of death, myocardial infarction (MI), or stroke at three years. Multivariable Cox proportional hazards regression was used to adjust for differences in baseline covariates. PCI in EXCEL was performed exclusively with TRA in 248 (26.6%) patients and with TFA in 683 (73.4%) patients. TRA patients were younger and less likely to have hypertension and chronic kidney disease. The mean number of vessels and lesions treated was higher in TFA patients, although the SYNTAX score was similar in both groups. Patients undergoing TRA and TFA had similar 30-day rates of TIMI major or minor bleeding (2.4% versus 3.8%, respectively, p=0.30). At three years, TRA and TFA patients had similar rates of the primary endpoint (15.7% versus 14.8%, adjusted HR 1.11, 95% CI: 0.73-1.69, p=0.64), as well as the individual rates of death, MI, stroke, ischaemia-driven revascularisation and stent thrombosis. CONCLUSIONS:In the EXCEL trial, PCI of LM disease with TRA was associated with comparable early and late clinical outcomes to TFA.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :In humans, protein C inhibitor (PCI) is expressed in various tissues and present in many body fluids including plasma and seminal fluid. In rodents, PCI is expressed in reproductive organs only and is absent in plasma. In this study, we characterized the tissue expression and physiological role of PCI in novel human PCI gene transgenic (TG) mice. Northern blot and immunohistochemical analyses demonstrated that human PCI is expressed in liver hepatocytes, renal epithelial cells as well as heart, brain and reproductive organs of the TG mice. This PCI tissue distribution is similar to that found in humans. PCI in plasma of TG mice showed the same immunological and functional properties as human plasma PCI. Next, we evaluated the effect of PCI on coagulation, inflammation and tissue damage in lipopolysaccharide-treated TG mice. The results suggested that PCI efficiently inhibits not only the anticoagulant and anti-inflammatory activities of exogenously injected human activated protein C (APC) but also that of endogenously produced APC in mice with endotoxemia. These findings suggest that PCI exerts a procoagulant and proinflammatory effect by inhibiting APC. We believe our results also show how useful these TG mice may be for assessing the therapeutic effect of human APC in vivo and for evaluating the role of PCI in human physiological and pathological conditions.

背景与目标： : 在人类中，蛋白C抑制剂 (PCI) 在各种组织中表达，并存在于许多体液中，包括血浆和精液。在啮齿动物中，PCI仅在生殖器官中表达，而在血浆中不存在。在这项研究中，我们表征了PCI在新型人PCI基因转基因 (TG) 小鼠中的组织表达和生理作用。Northern印迹和免疫组织化学分析表明，人PCI在TG小鼠的肝肝细胞，肾上皮细胞以及心脏，大脑和生殖器官中表达。这种PCI组织分布与人类相似。TG小鼠血浆中的PCI显示出与人血浆PCI相同的免疫学和功能特性。接下来，我们评估了PCI对脂多糖处理的TG小鼠的凝血，炎症和组织损伤的影响。结果表明，PCI不仅可以有效抑制内毒素血症小鼠外源注射的人活化蛋白C (APC) 的抗凝和抗炎活性，还可以抑制内源产生的APC。这些发现表明PCI通过抑制APC发挥促凝血和促炎作用。我们相信我们的结果还表明，这些TG小鼠对于评估人APC在体内的治疗作用以及评估PCI在人类生理和病理状况中的作用可能是多么有用。

BACKGROUND & AIMS: OBJECTIVE:We compared 1-year outcomes in insulin-treated diabetes mellitus (ITDM) and non-ITDM patients compared to nondiabetic (DM) patients following contemporary percutaneous coronary intervention (PCI). BACKGROUND:ITDM is associated with extensive atherosclerotic disease and worse cardiovascular prognosis compared to non-ITDM patients. METHODS:We evaluated PCI patients at a large tertiary center from 2010 to 2016, grouped according to diabetes and treatment status at baseline. One-year major adverse cardiac events (MACE) were defined as a composite of death, myocardial infarction (MI), or target vessel revascularization. Outcomes were adjusted using multivariable Cox regression methods. RESULTS:During the study period, 16,889 patients underwent PCI including 13.7% ITDM, 34.0% non-ITDM, and 52.3% non-DM patients. Patients with DM were younger, including more females and non-white patients, with higher body mass index and greater prevalence of prior revascularization and chronic kidney disease. Compared to others, ITDM patients more often presented with acute coronary syndrome, in-stent restenosis, or severe lesion calcification. There were no differences in discharge rates of dual antiplatelet therapy and statins, whereas beta-blockers were more commonly prescribed in DM patients. At 1-year, both ITDM and non-ITDM patients had greater risk of MACE compared with non-DM patients, and ITDM conferred greater adjusted risk than non-ITDM (ITDM = HR: 2.11, 95% CI [1.79,2.50]; non-ITDM = HR: 1.27, 95%CI [1.09,1.47]). CONCLUSIONS:The negative prognostic effect of DM following contemporary PCI is heightened in the presence of insulin treatment, compared to non-DM patients. Focus on secondary prevention, prescription of and adherence to optimal medical therapy is necessary for post-PCI risk reduction.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: AIMS:To analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. METHODS AND RESULTS:This post-hoc analysis of the DOCTORS study included non-ST elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN-III criteria. The study included N=116 patients (Age: 60.8±11.5 years/ male gender:71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN-III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN-III expansion. FFR values were respectively 0.93[0.91-0.95] vs. 0.95[0.92-0.97] in patients with optimal+ acceptable vs. unacceptable ILUMIEN-III expansion (p=0.22), 0.94[0.91-0.97] vs. 0.95 [0.93-0.97] in patients with optimal vs. non-optimal DOCTORS expansion (p=0.23) and 0.95[0.92-0.97] vs. 0.92[0.90-0.95]in patients with minimal stent area ³4.5 mm2 vs. <4.5 mm2 (p=0.03). CONCLUSIONS:In this selected population, no relationship was observed between optimal stent expansion according to ILUMIEN-III or DOCTORS OCT criteria and final post-PCI FFR values.

背景与目标：

BACKGROUND & AIMS: CONTEXT:Ticagrelor, a novel reversible antiplatelet agent, has a black box warning to avoid maintenance doses of aspirin>100mg. However, a significant ticagrelor-early percutaneous coronary intervention (PCI) interaction exists. OBJECTIVE:To discuss the inappropriateness of the black box warning for aspirin doses>100mg with ticagrelor and the appropriateness (and need) for a black box warning for ticagrelor patients needing early (within 24 hours of randomization) PCI. RESULTS:The FDA Complete Response Review for ticagrelor indicates that aspirin doses ≥ 300 mg/daily was not a significant interaction. In the ticagrelor-aspirin ≥ 300 mg cohort, all-cause mortality (through study end) and cardiovascular (CV) mortality (through study end) were not significantly increased (HR=1.27; 95% CI, 0.84-1.93, p=0.262 and HR=1.39; 95% CI:0.87-2.2, p=0.170), respectively. However, in patients treated with early (within 24 hours) PCI, ticagrelor significantly increased all-cause mortality (30 day: HR=1.89; 95% CI: 1.26-2.81, p=0.002, and through study end, HR=1.41; 95% CI,1.08-1.84, p=0.012) and increased CV mortality (30 day: HR=1.31; 95% CI: 0.97-1.77, p=0.075, and through study end, HR=1.35; 95% CI, 0.995-1.82, p=0.054) compared to clopidogrel. CONCLUSIONS:Early-PCI was more prevalent in the US versus outside-US regions (61% versus 49%). The black box warning for the use of maintenance aspirin doses over 100mg/daily with ticagrelor is inappropriate and ignores the more important, credible, and highly significant ticagrelor-early PCI adverse interaction in PLATO.

背景与目标：

BACKGROUND & AIMS: :Support vector machines (SVM) have become popular among machine learning researchers, but their applications in biomedicine have been somewhat limited. A number of methods, such as grid search and evolutionary algorithms, have been utilized to optimize model parameters of SVMs. The sensitivity of the results to changes in optimization methods has not been investigated in the context of medical applications. In this study, radial-basis kernel SVM and polynomial kernel SVM mortality prediction models for percutaneous coronary interventions were optimized using (a) mean-squared error, (b) mean cross-entropy error, (c) the area under the receiver operating characteristic, and (d) the Hosmer-Lemeshow goodness-of-fit test (HL chi(2)). A threefold cross-validation inner and outer loop method was used to select the best models using the training data, and evaluations were based on previously unseen test data. The results were compared to those produced by logistic regression models optimized using the same indices. The choice of optimization parameters had a significant impact on performance in both SVM kernel types.

背景与目标： : 支持向量机 (SVM) 已在机器学习研究人员中流行，但其在生物医学中的应用受到一定限制。已使用许多方法 (例如网格搜索和进化算法) 来优化svm的模型参数。在医学应用的背景下，尚未研究结果对优化方法变化的敏感性。在这项研究中，径向基核SVM和多项式核SVM死亡率预测模型使用 (a) 均方误差，(b) 平均交叉熵误差，(c) 接收器工作特性下的面积，和 (d) Hosmer-Lemeshow拟合优度检验 (HL chi(2))。采用三重交叉验证内环和外环方法，利用训练数据选择最佳模型，评估基于以前看不见的测试数据。将结果与使用相同指标优化的逻辑回归模型产生的结果进行比较。优化参数的选择对两种SVM内核类型的性能都有重大影响。

BACKGROUND & AIMS: :When we learn to drive, our driving instructor tells us how to check the side mirror and turn your head to check the blind spot before changing lanes. He tells us how to stop at stop signs, how to drive in slippery conditions, the safe stopping distances, and these all make our driving safe. Similarly, when we learn PCI, our mentors teach us to seat the guiding catheter co-axially, to wire the vessel safely, to deliver balloon and stents over the wire, to watch the pressure of the guiding, in order that we perform PCI safely and evade complications. In retrograde CTO PCI, there is no such published teaching. Also many individual mentors have not had the wide experience to see all the possible complications of retrograde CTO PCI and, therefore, may not be able to warn their apprentice. As the number of retrograde procedures increase worldwide, there is a corresponding increase in catastrophic complications, many of which, we as experts, can see are easily avoidable. To breach this gap in knowledge, this article describes 12 commonly met inherent traps in retrograde CTO PCI. They are inherent because by arranging our equipment in the manner to perform retrograde CTO PCI, these complications are either induced directly or happen easily. We hope this work will enhance safety of retrograde CTO PCI and avoid many catastrophic complications for our readers and operators. © 2017 Wiley Periodicals, Inc.

背景与目标： : 当我们学习驾驶时，我们的驾驶教练告诉我们如何检查后视镜，并在改变车道之前转头检查盲点。他告诉我们如何在停车标志处停车，如何在湿滑的条件下驾驶，安全的停车距离，这些都使我们的驾驶安全。同样，当我们学习PCI时，我们的导师教我们同轴放置引导导管，安全地连接血管，通过导线输送球囊和支架，观察引导的压力，以便我们安全地执行PCI并避免并发症。在逆行CTO PCI中，没有这样的公开教学。同样，许多个别导师没有广泛的经验来查看逆行CTO PCI的所有可能并发症，因此可能无法警告其学徒。随着全球逆行手术数量的增加，灾难性并发症也相应增加，我们作为专家可以看到其中许多是可以避免的。为了突破这一知识差距，本文介绍了12种常见的逆行CTO PCI固有陷阱。它们是固有的，因为通过以逆行CTO PCI的方式安排我们的设备，这些并发症要么直接诱发，要么容易发生。我们希望这项工作将提高逆行CTO PCI的安全性，并为我们的读者和操作员避免许多灾难性的并发症。©2017威利期刊公司

BACKGROUND & AIMS: :Primary percutaneous coronary intervention (PPCI) is the reperfusion treatment of choice for acute ST-elevation myocardial infarction with studies having demonstrated improved outcomes with PPCI over thrombolysis. Its use has increased substantially over the last decade, overtaking thrombolytic therapy in many countries. This has been paralleled with advances in adjunctive technology and pharmacological therapy to further improve outcome, but challenges remain for PPCI practitioners. The evidence behind PPCI is reviewed at every stage of the patient's journey.

背景与目标： : 原发性经皮冠状动脉介入治疗 (PPCI) 是急性ST段抬高型心肌梗死的首选再灌注治疗方法，研究表明PPCI比溶栓治疗效果更好。在过去的十年中，它的使用已大大增加，在许多国家超过了溶栓治疗。这与辅助技术和药理治疗的进步同时进行，以进一步改善结果，但PPCI从业者仍然面临挑战。在患者旅程的每个阶段都对PPCI背后的证据进行了审查。