Percutaneous Coronary Intervention In China Research Articles

The prevalence and outcomes in STEMI patients aged ≥75 undergoing primary percutaneous coronary intervention in China

ObjectiveTo investigate the prevalence and outcomes of primary percutaneous coronary intervention (PCI) in Chinese patients with ST-segment elevation myocardial infarction (STEMI) aged ≥75 years. MethodsWe identified STEMI patients aged ≥75 years between 2013 and 2014 from a multicenter registry. The primary outcome was all-cause mortality. The secondary outcome was major adverse cardiac and cerebrovascular event (MACCE) including a composite of all-cause mortality, cardiac death, recurrent MI, stroke, revascularization, and major bleeding. Hazard ratios (HR) and associated 95% confidence interval (CI) were calculated. ResultsApproximately 32.9% (n = 999) patients received primary PCI. Primary PCI was associated with lower risks of two-year all-cause mortality (18.0% vs. 36.4%; adjusted HR: 0.54, 95% CI: 0.45 to 0.65, P < 0.0001), MACCE (28.7% vs. 43.5%; adjusted HR: 0.68, 95% CI: 0.59 to 0.80, P < 0.0001), and cardiac death (10.0% vs. 23.6%; adjusted HR: 0.49, 95% CI: 0.38 to 0.62, P < 0.0001) relative to no reperfusion (n = 2041) in patients aged ≥75 years. The better outcomes in two-year all-cause mortality, MACCE, and cardiac death were consistently observed in STEMI patients aged ≥85 years. No differences were observed in recurrent MI, stroke, revascularization, and major bleeding between the two groups. Additionally, in patients with relatively high-risk profiles such as cardiogenic shock or delaying hospital admission, primary PCI was also superior to no reperfusion. ConclusionPrimary PCI may decrease two-year all-cause mortality, MACCE, and cardiac death in STEMI patients aged ≥75 years, even in these with age ≥85 years, cardiogenic shock, or delaying hospital admission. However, primary PCI was underutilized in Chinese clinical practice.

Net clinical benefit of clopidogrel versus ticagrelor in elderly patients carrying CYP2C19 loss-of-function variants with acute coronary syndrome after percutaneous coronary intervention

Background and aimsElderly patients with acute coronary syndrome (ACS) tend to choose clopidogrel over potent P2Y12 receptor inhibitor such as ticagrelor after percutaneous coronary intervention (PCI) in China considering higher risks of bleeding. CYP2C19 genotype is regarded as a major factor influencing the efficacy of clopidogrel. The present study aims to investigate the efficacy and safety of ticagrelor relative to clopidogrel in elderly ACS patients after PCI in China with reduced CYP2C19 metabolism. MethodsBetween January 2016 and March 2019, 2751 ACS patients over 65 years old with CYP2C19 loss-of-function (LOF) variants after PCI were enrolled. All patients were treated with aspirin and P2Y12 receptor inhibitor, among whom 2056 received clopidogrel and 695 received ticagrelor. Net adverse clinical events (NACE), a composite of cardiac death, myocardial infarction (MI), ischemic stroke, target vessel revascularization and clinically relevant bleeding including Bleeding Academic Research Consortium (BARC) types 2, 3, 5 bleeding, were compared between the two groups at 12 months after PCI. Propensity score matching (PSM) was conducted to balance the baseline characteristics between the two groups. ResultsBefore and after PSM, NACE was significantly increased in ticagrelor group compared with clopidogrel group at 12 months post PCI (Before PSM, 15.18% vs. 25.61% p<0.001; After PSM, 11.66% vs. 26.01% p<0.001). MACE was comparable between the two groups (Before PSM, 5.45% vs. 5.32% p>0.999; After PSM, 3.59% vs. 5.38% p=0.146). BARC types 2, 3, 5 bleeding events were significantly increased in patients treated with ticagrelor relative to clopidogrel (Before PSM, 10.31% vs. 21.01% p<0.001; After PSM, 8.22% vs. 21.38% p<0.001), which was mainly attributed to a higher incidence of BARC type 2 bleeding events in ticagrelor group (Before PSM, 8.12% vs. 18.56% p<0.001; After PSM, 6.43% vs. 18.83% p<0.001). ConclusionsIn the present real-world study, selection of ticagrelor over clopidogrel showed a significant increase in NACE with a higher incidence of bleeding and similar ischemic events in elderly ACS patients carrying CYP2C19 LOF variants after PCI.

Factors influencing return to work 3 months after percutaneous coronary intervention in young and middle-aged patients with coronary heart disease: A single-center, cross-sectional study.

Today, patients with coronary heart disease (CHD) are becoming younger and younger, and after percutaneous coronary intervention (PCI), most patients want to resume their occupations. The return to work of patients with CHD post PCI in China, however, has received little research attention. So, the goal of this study was to investigate the variables impacting the return to work following PCI in young and middle-aged patients with CHD in Wuxi and to offer a reference basis for the development of targeted interventions. This study was executed at the Affiliated Hospital of Jiangnan University. We selected 280 young and middle-aged patients who underwent PCI for CHD as the study subjects and gathered general data about them while they were hospitalized. At 3 months after PCI, we surveyed the subjects with the return to work self-efficacy questionnaire, the Chinese version of the brief fatigue inventory, and the social support rating scale, and obtained information about their return to work. The factors affecting patients' returning to work were analyzed using binary logistic regression. The final 255 cases were included in the study, of which 155 (60.8%) were successfully returned to work. Binary logistic regression showed that women (OR = 0.379, 95%CI:0.169,0.851), ejection fraction ≥50% (OR = 2.053, 95%CI:1.085,3.885), the brain-based job types (OR = 2.902, 95%CI:1.361,6.190), the kind of employment requiring both mental and physical capacity (OR = 2.867, 95%CI:1.224,6.715), moderate fatigue (OR = 6.023, 95%:1.596,22.7251), mild fatigue (OR = 4.035, 95%:1.104,14.751), return to work efficacy (OR = 1.839, 95%:1.140,3.144), and social support (OR = 1.060, 95%:1.003,1.121) were independent influences on patients' return to work at 3 months after PCI (All P<0.05). In order to help patient return to work as soon as possible, healthcare professionals should focus on those who are female, have worked mainly in physical activities, have low return-to-work self-efficacy, have severe fatigue, have low social support, and have poor ejection fraction.

The Later Status and Impact Factors of Physical Activity among Patients after Percutaneous Coronary Intervention in China.

Objectives: In this study, we investigated the physical activity status and impact factors in patients after percutaneous coronary intervention in China. Methods: This cross-sectional survey was conducted from January to October 2019. A total of 260 participants were recruited in the cardiovascular department who had successfully undergone percutaneous coronary intervention after one year for physical re-examination at 2 hospitals in Henan Province. They were investigated using 5 questionnaires - the International Physical Activity Questionnaire-Long Form, the Exercise Self-efficacy Questionnaire, the Multi-dimensional Fatigue Scale, the Social Support Rating Scale, and the Hospital Anxiety and Depression scale. Results: After percutaneous coronary intervention, most patients were at low and moderate intensity physical activity and 60.8% of patients did not meet the recommended amount of guidelines. Through the analysis of the influencing factors of physical activity in patients with coronary heart disease stent implantation, the status of physical activity was affected by the NYHA classification, LVEF, exercise self-efficacy, fatigue, and social support. Conclusions: The level of physical activity of patients after percutaneous coronary intervention needs to be improved further. In clinical practice, nursing practitioners should strengthen the health education of patients' exercise rehabilitation to improve the level of physical activity and reduce the occurrence of cardiovascular events.

First-in-human evaluation of an independently developed Chinese robot-assisted system for percutaneous coronary intervention.

Several studies have proved the safety and feasibility of robot-assisted percutaneous coronary intervention (PCI) in reducing the occupational hazards of interventionists while achieving precision medicine. However, an independently developed robot-assisted system for PCI in China has not yet emerged. This study aimed to evaluate the safety and feasibility of a robot-assisted system for elective PCI in China. This preclinical trial included 22 experimental pigs and preliminarily supported the safety and feasibility of the ETcath200 robot-assisted system for PCI. Then, eleven patients with coronary heart disease who met the inclusion criteria and had clinical indications for elective PCI were enrolled. PCI was performed using a robot-assisted system. The primary outcomes were clinical success (defined as visual estimated residual stenosis < 30% after PCI and no major adverse cardiovascular events during hospitalization and within 30 days after PCI) and technical success (defined as the ability to use the robot-assisted system to complete PCI successfully without conversion to the traditional manual PCI). Eleven patients were included in this clinical trial. A drug-eluting stent with a diameter of 3 mm (interquartile range: 2.75-3.5 mm) and a length of 26 mm (interquartile range: 22-28 mm) was deployed in all patients. The clinical success rate was 100%, with no PCI-related complications and no in-hospital or 30-day major adverse cardiovascular events, and the technical success rate was 100%. The results strongly suggest that the use of the independently developed robot-assisted system in China for elective PCI is feasible, safe, and effective.

Trends in percutaneous coronary intervention in China: analysis of China PCI Registry Data from 2010 to 2018

Background and purpose: In the past 30 to 40 years, percutaneous coronary intervention (PCI) in China has greatly improved. The State Ministry of Health established a quality control (QC) system in 2009, and all medical centers were required to report their PCI cases. We analyzed the data from the QC system to describe the current status and development of PCI in China. Methods: PCI case data during a period from 2010 to 2018 were extracted from the online QC system. Data quality was audited by QC centers at the provincial level. Statistical analysis was mainly descriptive. Trend analysis was conducted by recoding the year as a continuous variable in linear regression or logistic regression. Results: The number of medical centers reporting PCI cases was 941 in 2010, and increased to 1,788 in 2018. Total number of PCI cases reported online to the QC system was 236,717 in 2010, and increased to 705,970 in 2018. Estimate of the actual case number that included those reported offline only (based on offline audit by provincial QC centers) was 284,936 in 2010, and increased to 915,256 in 2018. The most common indication for PCI was unstable angina (52.9%–59.1%), followed by ST elevation myocardial infarction (STEMI; 25.0%–27.4%). Majority of the PCI procedures were performed via the radial artery (65.4% in 2010 and 90.7% in 2018). Angiography detected a left main lesion in 5%, single-vessel disease in 38.7% to 44.4%, two-vessel disease in 22.3% to 27.5%, and three-vessel disease in 27.0% to 28.7% of the patients. The rate of primary PCI for STEMI in all STEMI cases was 28.0% in 2010, and increased to 45.9% in 2018. The average number of stents implanted per case was 1.63 in 2010, and decreased to 1.46 in 2018. There was a trend for decreasing mortality (0.31% in 2010; 0.26% in 2018). Conclusions: The number of PCI cases in China increased steadily during a period from 2010 to 2018, with stable mortality rate. Transradial access is the dominant PCI route. The rate of primary PCI for STEMI increased substantially, but remained relatively low.

Assessment of Clinical Features in HIV-Infected Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention in China.

Objectives We aimed to compare coronary risk factors, burden of coronary artery disease (CAD), and 1-year prognosis of people living with HIV (PLWH) and HIV-negative controls who underwent percutaneous coronary intervention (PCI) for acute coronary syndromes (ACSs). Background Cardiovascular disease is drawing more and more attention in PLWH since effective antiretroviral therapy (ART) has been available. Clinical characteristics and outcomes of PLWH undergoing PCI for ACS in China remain unknown. Methods We compared demographic characteristics, angiographic features, and 1-year outcomes of 48 PLWH versus 48 HIV-negative controls matched for age (±2 years), sex, diabetes mellitus, and year of PCI (±2 years) in Beijing Ditan Hospital, Capital Medical University from January 2008 to November 2020. Results In PLWH (mean age: 53.6 ± 10.6 years, 95.8% male, and 79.2% on ART), high-density lipoprotein cholesterol was lower than in HIV-negative controls; however, the statin use was more common, the incidence of hypertension was lower, and low-density lipoprotein cholesterol, and the body mass index were significantly lower than in controls. Two groups had a similar extent of coronary atherosclerosis as measured by the presence of multivessel diseases and the median Gensini score; however, lesions of PLWH were longer and were more likely to locate at the proximal segment of the coronary artery. In addition, the risk of major adverse cardiac and cerebrovascular events at 1 year was similar in both groups. Conclusion PLWH undergoing PCI displayed similar CAD burden and 1-year prognosis compared with HIV-negative patients. Early detection of cardiovascular risk factors and appropriate secondary prevention of CAD in PLWH might alleviate the risk of severe adverse cardiovascular events.

Evolving Antithrombotic Treatment Patterns for Patients With Nonvalvular Atrial Fibrillation and Acute Coronary Syndrome or Underwent Percutaneous Coronary Intervention in China: A Cross-Sectional Study.

ObjectiveAntithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) concomitant with the acute coronary syndrome (ACS) or underwent percutaneous coronary intervention (PCI) is challenging and has evolved in recent years. However, real-world data on this issue about antithrombotic regimens at discharge and its evolving trend were relatively scarce, especially in China.MethodsA total of 2,182 patients with NVAF and ACS/PCI were enrolled from 2017 to 2019. A total of 1,979 patients were finally analyzed and divided in three sequential cohorts: cohort 1 (2017), n = 674; cohort 2 (2018), n = 793; and cohort 3 (2019), n = 512. Baseline characteristics and antithrombotic therapy at discharge were analyzed by cohort.ResultsIn our cross-sectional study, the majority of patients (59.6%) received dual antiplatelet therapy (DAPT). Over the 3 years, DAPT prescription reduced from nearly 70% to <50% (P trend < 0.001), while triple therapy (TT)/double therapy (DT) increased from 27.2 to 50.0% (P trend < 0.001). This trend was also seen in different subgroups stratified by CHA2DS2-VASc score, HAS-BLED score, coronary artery disease type, or management type, and was validated after multivariate adjustment. Persistent atrial fibrillation and history of congestive heart failure, hypertension, diabetes mellitus, and stroke/transient ischemic attack/systemic embolism were the independent predictors of TT/DT use, while ACS, PCI, or advanced chronic kidney disease was related with more DAPT prescription.ConclusionThere is a shift of antithrombotic regime at discharge for patients with NVAF with recent ACS/PCI with reducing DAPT prescription and increasing TT/DT prescription. While the appropriate antithrombotic regimen for patients with NVAF having ACS/PCI is still underused in China.

Patterns of Adherence to Secondary Prevention Measures Among Chinese Patients With Coronary Artery Disease: A Longitudinal Study.

Adherence to secondary prevention measures among patients with coronary artery disease (CAD) affects patient prognosis, whereas patients' adherence behaviors change over time. The aims of this study were to identify adherence trajectories to secondary prevention measures including medication-taking and a heart-healthy lifestyle and to estimate predictors of adherence trajectories among patients with CAD. This longitudinal study enrolled 698 patients with CAD who received a percutaneous coronary intervention in China. Demographics, clinical characteristics, adherence to secondary prevention measures, and patient-related factors including disease knowledge, self-efficacy, and health literacy were measured during hospitalization. Adherence behaviors were followed at 1, 3, and 6 months, and 1 year after discharge. Group-based trajectory models estimated adherence trajectories, and multinomial logistic regression identified trajectory group predictors. Four trajectory groups were identified for medication-taking adherence: sustained adherence (39.9%), increasing and then decreasing adherence (23.1%), increasing adherence (23.4%), and nonadherence (13.6%). The 3 adherence trajectory groups for a heart-healthy lifestyle were sustained adherence (59.7%), increasing adherence (28.3%), and nonadherence (12.0%). Married patients were more likely (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.56-7.52) to have sustained adherence to medication-taking. However, patients with higher disease knowledge were less likely (OR, 0.93; 95% CI, 0.87-0.99) to be adherent. Patients who were not working (OR, 2.25; 95% CI, 1.03-4.92) had higher self-efficacy (OR, 1.21; 95% CI, 1.08-1.37). Those with higher health literacy (OR, 1.18; 95% CI, 1.01-1.38) were more likely to have sustained adherence to a heart-healthy lifestyle. However, patients having no coronary stents (OR, 0.36; 95% CI, 0.19-0.70) were less likely to have done so. Trajectories of adherence to secondary prevention measures among mainland Chinese patients with CAD are multipatterned. Healthcare providers should formulate targeted adherence support, which considers the influence of disease knowledge, self-efficacy, and health literacy.

Abstract 15223: Comparison of Net Clinical Benefit Between Clopidogrel-based and Ticagrelor-based Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention in China

Introduction: Dual antiplatelet therapy (DAPT) increases the bleeding risk, which might outweigh the benefits of reduction in ischemic events in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). This study aimed to evaluate the difference in net clinical benefits of clopidogrel-based DAPT compared with ticagrelor-based DAPT in ACS patients undergoing PCI in a real-world setting in China. Method: This study was conducted on three pre-existing PCI patient databases, two were from nation-wide studies with similar prospective designs and time-span: the BRIC-ACS(I) study and the COSTIC study, and other was from a tertiary hospital-maintained PCI patient database. The primary endpoint was net adverse clinical and cerebral event (NACCE), which was a composite of all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke and BARC ≥ 2 (excluding BARC 4) bleeding within 12 months after discharge. The efficacy outcome, major adverse cardiovascular events (MACE), was defined as a composite of all-cause death, non-fatal MI, and non-fatal stroke. The safety outcome was defined as BARC ≥ 2 (excluding BARC 4) bleeding. Kaplan-Meier survival curves, and Cox regression were applied to analyze the difference between the two groups after propensity score matching (PSM). Results: A total of 7,236 adult ACS patients who underwent PCI in the period of Jan 2014 to Oct 2017 were analyzed. Of them, 4,330 patients were included in post-PSM analyses. Patients prescribed clopidogrel and aspirin had a significant lower risk of NACCE within 12 months after discharge relative to those prescribed ticagrelor and aspirin [5.4% vs. 8.3%, hazard ratio (HR) = 0.63, 95% CI: 0.50 - 0.80]. While the two groups did not vary significantly in the risk of MACE (2.9% vs. 3.1%, HR = 0.91, 95% CI: 0.64 - 1.28), clopidogrel-based DAPT was associated with a significant lower risk of BARC ≥ 2 (excluding BARC 4) bleeding (2.9% vs. 5.5%, HR = 0.50, 95% CI: 0.37 - 0.68) compared to ticagrelor-based DAPT. Conclusion: In this real-world study, post-PCI ACS patients prescribed clopidogrel-based DAPT were associated with a reduction in NACCE and bleeding events without significant difference in MACE, compared to patients treated with ticagrelor-based DAPT.

Effects of nicorandil on myocardial infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: study design and protocol for the randomized controlled trial.

Previous studies have shown that nicorandil has a protective effect on cardiomyocytes. However, there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction (STEMI) compared to the current standard of percutaneous coronary intervention (PCI) regimen. The CHANGE (China-Admini stration of Nicorandil Group) study is a multicenter, prospective, randomized, double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China, aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocar dial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.

Prediction of Changes in Adherence to Secondary Prevention Among Patients With Coronary Artery Disease.

Healthcare providers are concerned about adherence to provider recommendations in coronary artery disease management. Seeking patient-related factors influencing changes in adherence over time is necessary for formulating suitable intervention measures-especially among diverse populations. To explore whether health literacy, self-efficacy, and disease knowledge predict changes in adherence over time (between baseline and 3 months) to secondary prevention recommendations for Chinese coronary artery disease patients. A longitudinal study was performed for 662 patients following percutaneous coronary intervention in China. Self-reported data were collected at baseline during hospitalization and at a 3-month telephone follow-up. Variables included demographics, health literacy, self-efficacy, disease knowledge, and adherence to secondary prevention recommendations for medication taking and a heart-healthy lifestyle. Multinomial logistic regression identified predictors of adherence changes over time. Patients were categorized into three groups: sustained/declined to nonadherence between baseline and 3 months, improved to adherence, and sustained adherence. The number of patients in sustained/declined to nonadherence group was small. Absence of stents predicted sustained/declined to nonadherence to medication and lifestyle over time. Health literacy was not associated with adherence changes over time. Higher self-efficacy scores were associated with lower likelihood of sustained/declined to nonadherence to a healthy lifestyle over time, whereas higher disease knowledge scores were associated with higher sustained/declined to nonadherence to medication. Adherence to secondary prevention 3 months after discharge was relatively good in Chinese patients with coronary artery disease who received percutaneous coronary intervention. Absence of stents and lower self-efficacy can predict the poor adherence changes, which should be considered in formulating follow-up care.

TCTAP A-072 Effect of Periprocedural Bleeding on Clinical Outcomes in Elderly Patients Undergoing Percutaneous Coronary Intervention in China

Periprocedural bleeding during the percutaneous coronary intervention (PCI) has been shown to be associated with worse short and long-term outcomes. However, the effect of periprocedural bleeding on elderly patients still needs to be further determined. This study sought to explore the effect of

Clopidogrel Versus Aspirin for the Treatment of Acute Coronary Syndrome After a 12-Month Dual Antiplatelet Therapy: A Cost-effectiveness Analysis From China Payer's Perspective

PurposeMonotherapy with either aspirin or clopidogrel is recommended for long-term use after discontinuation of dual-antiplatelet therapy (DAPT) for acute coronary syndrome (ACS) management after percutaneous coronary intervention (PCI). The present study is to evaluate the cost-effectiveness of clopidogrel versus aspirin after 12-month DAPT for patients with ACS who underwent PCI in China. MethodsA 2-part model was developed to estimate the cost-effectiveness of clopidogrel compared with aspirin. The short-term part was a decision tree that included health states such as myocardial infarction (MI), stroke, MI and stroke, cardiovascular death, and death from other causes with a treatment horizon of 1 year (base case), 2 years or 3 years after 12-month DAPT. Major bleeding was included. The long-term (lifetime) part was a Markov model that included different health states such as MI, after MI, stroke, after stroke, and death. Drug acquisition cost and other direct medical costs were based on pricing records, literature, and expert panels. Clinical outcomes and utilities were based on literature. The model output included incremental cost-effectiveness ratio of quality-adjusted life-years (QALYs) and total costs per patient. Both 1-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were conducted. FindingsIn the base–case scenario, the total costs of the treatment with clopidogrel and aspirin were ¥12,590 ($1849/€1590) and ¥10,642 ($1563/€1344), respectively; the total QALYs of the 2 patient populations were 9.7341 and 9.6894, respectively. The incremental cost-effectiveness ratio of ¥43,593 ($6402/€5515) per QALY gained was lower than 3 times of gross domestic product (GDP) per capita in China (¥161,940, $23,786/€20,449). Both 1-way sensitivity analysis and PSA confirmed the robustness of the results. PSA results indicated that clopidogrel was cost effective versus aspirin in 80.5% of the simulations, considering >3 times the GDP per capita as the threshold. Results in other scenarios (clopidogrel or aspirin for 2 or 3 years after 12-month DAPT) also indicated that clopidogrel was more cost effective than aspirin for patients with ACS after 12-month DAPT. ImplicationsCompared with aspirin monotherapy, clopidogrel monotherapy for 1 year after 12-month DAPT was cost effective for patients with ACS who underwent PCI in China. Furthermore, when the duration of clopidogrel the monotherapy extended up to 3 years, clopidogrel was still cost effective compared with aspirin. The study was limited by lack of high-quality efficacy data among the Chinese population.

Literature analysis and countermeasure research on preoperative visit of percutaneous coronary intervention patients

Objective To analyze the present situation of the preoperative visit for percutaneous coronary intervention (PCI) patients at home and abroad,and provide the reference for the preoperative visit of percutaneous coronary intervention in China. Methods We searched PubMed,Embase,Web of Science,CNKI,WanFangData,VIP,and CBM database by the computer.Then the articles for up to December 2017 which in accordance with inclusion criteria were analyzed by descriptive analysis. Results A total of 25 papers were included from 1983 to 2016, which had involved 8 articles in English and 17 in Chinese.The study of abroad began in 1983,and in China the first was in 2004.From 2008, the number of literatures were uptrend.The contents of the study were mainly about demand survey,current situation analysis,technology and effect evaluation,which the largest number of PCI visit was the aspect of effect evaluation,accounting for 68% (17/25) of the total literature. Conclusion There is a high requirement for PCI information before the operation, but there is lack of unified standard content and process for PCI visits both at home and abroad.It is important measures to strengthen the training of specialized nurses for cardiovascular intervention and formulate standardization content and procedure of preoperative visit in order to development and further improvement of preoperative visit. Key words: Coronary intervention; Preoperative visit; Literature analysis

PCV41 - Clopidogrel Versus Aspirin For The Treatment Of Acute Coronary Syndrome After A 12-Month Dual Antiplatelet Therapy: A Cost-Effectiveness Analysis From China Payer’s Perspective

Abstract Purpose Monotherapy with either aspirin or clopidogrel is recommended for long-term use after discontinuation of dual-antiplatelet therapy (DAPT) for acute coronary syndrome (ACS) management after percutaneous coronary intervention (PCI). The present study is to evaluate the cost-effectiveness of clopidogrel versus aspirin after 12-month DAPT for patients with ACS who underwent PCI in China. Methods A 2-part model was developed to estimate the cost-effectiveness of clopidogrel compared with aspirin. The short-term part was a decision tree that included health states such as myocardial infarction (MI), stroke, MI and stroke, cardiovascular death, and death from other causes with a treatment horizon of 1 year (base case), 2 years or 3 years after 12-month DAPT. Major bleeding was included. The long-term (lifetime) part was a Markov model that included different health states such as MI, after MI, stroke, after stroke, and death. Drug acquisition cost and other direct medical costs were based on pricing records, literature, and expert panels. Clinical outcomes and utilities were based on literature. The model output included incremental cost-effectiveness ratio of quality-adjusted life-years (QALYs) and total costs per patient. Both 1-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were conducted. Findings In the base–case scenario, the total costs of the treatment with clopidogrel and aspirin were ¥12,590 ($1849/€1590) and ¥10,642 ($1563/€1344), respectively; the total QALYs of the 2 patient populations were 9.7341 and 9.6894, respectively. The incremental cost-effectiveness ratio of ¥43,593 ($6402/€5515) per QALY gained was lower than 3 times of gross domestic product (GDP) per capita in China (¥161,940, $23,786/€20,449). Both 1-way sensitivity analysis and PSA confirmed the robustness of the results. PSA results indicated that clopidogrel was cost effective versus aspirin in 80.5% of the simulations, considering >3 times the GDP per capita as the threshold. Results in other scenarios (clopidogrel or aspirin for 2 or 3 years after 12-month DAPT) also indicated that clopidogrel was more cost effective than aspirin for patients with ACS after 12-month DAPT. Implications Compared with aspirin monotherapy, clopidogrel monotherapy for 1 year after 12-month DAPT was cost effective for patients with ACS who underwent PCI in China. Furthermore, when the duration of clopidogrel the monotherapy extended up to 3 years, clopidogrel was still cost effective compared with aspirin. The study was limited by lack of high-quality efficacy data among the Chinese population.

Comparison of Physician Visual Assessment With Quantitative Coronary Angiography in Assessment of Stenosis Severity in China

Although physician visual assessment (PVA) of stenosis severity is a standard clinical practice to support decisions for coronary revascularization, there are concerns about its accuracy. To compare PVA with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China. A cross-sectional study (2012-2013) of a random subset of 1295 patients from the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Prospective PCI Study was carried out. The PEACE Prospective PCI study recruited a consecutive sample of patients undergoing PCI at 35 hospitals in 18 provinces of China. The coronary angiograms of this subset of participants were reviewed using QCA by 2 independent core laboratories blinded to PVA readings. Differences between PVA and QCA assessments of stenosis severity for lesions for which PCI was performed and variation of these differences among hospitals and physicians, stratified by the diagnosis of acute myocardial infarction (AMI). In patients without AMI, the mean (SD) age was 62 (10) years, and 217 (31.5%) were women; in patients with AMI, the mean (SD) age was 60 (11) years, and 153 (25.2%) were women. The mean (SD) percent diameter stenosis by PVA was 16.0% (11.5%) greater than that by QCA in patients without AMI and 10.2% (12.3%) in those with AMI (P < .001 for both comparisons). In patients without AMI, of 837 lesions with 70% or more stenosis by PVA, 427 (50.6%) were less than 70% by QCA; in patients with AMI, similar patterns were observed to a lesser extent. Among patients without AMI, only 4 (0.47%) lesions were additionally assessed with fractional flow reserve. Among 30 hospitals, the difference between PVA and QCA readings of stenosis severity varied from 7.6% (95% CI, 0.4%-14.7%) to 21.3% (95% CI, 17.1%-24.9%) among non-AMI patients. Across 57 physicians, this difference varied from 6.9% (95% CI, -1.4%-15.3%) to 26.4% (95% CI, 21.5%-31.4%). For coronary lesions treated with PCI in China, PVA reported substantially higher readings of stenosis severity than QCA, with large variation across hospitals and physicians. These findings highlight the need to improve the accuracy of information used to guide treatment decisions in catheterization laboratories.

TCT-487 Plasma Big Endothelin-1 and Stent Thrombosis: An Observational Study in Patients undergoing Percutaneous Coronary Intervention in China

TCT-487 Plasma Big Endothelin-1 and Stent Thrombosis: An Observational Study in Patients undergoing Percutaneous Coronary Intervention in China

Plasma big endothelin-1 and stent thrombosis: An observational study in patients undergoing percutaneous coronary intervention in China

IntroductionStent thrombosis (ST) is a rare but catastrophic complication of percutaneous coronary intervention, leading to poor prognosis. Endothelin-1 (ET-1) plays an important role in endothelial dysfunction and thrombogenesis. However, the impact of big ET-1 level on ST in patients with coronary stenting is unknown. We aimed to evaluate big ET-1 level as a potential predictor of ST in patients undergoing percutaneous coronary intervention. Materials and methodsFrom January 2013 to December 2013, 8106 consecutive patients underwent successful coronary stent implantation and were prospectively enrolled in this study. Patients were stratified into three groups based on plasma big ET-1 level at admission. ResultsThe incidence of definite and probable ST at 2years postoperatively was 0.84%; ST incidence was lowest in the low big ET-1 group (0.56%), highest in the high big ET-1 group (1.48%), and intermediate in the medium big ET-1 group (0.74%, log-rank p=0.001). Compared with the low big ET-1 group, the multivariate-adjusted hazard ratio (HR) for ST in the high big ET-1 group was 2.06 (95% confidence interval (CI) 1.14–3.73, p=0.017). In subgroup analyses, high big ET-1 level was independently associated with ST in patients with acute coronary syndrome (HR 2.29, 95% CI 1.03–5.06, p=0.041), but not in those with stable coronary artery disease (p=0.331), and tended to be associated with older age. ConclusionsPlasma big ET-1 level is a valuable independent predictor of ST in patients with coronary stents, especially in the acute coronary syndrome population.

Development of percutaneous coronary intervention in China

Development of percutaneous coronary intervention in China