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Abstract:As China enters the aging society, the proportion of the elderly patients with coronary heart disease (CHD) is increasing gradually. The elderly CHD patients have more cardiovascular risk factors, and suffer greater risks of thrombosis and bleeding after percutaneous coronary intervention (PCI) than younger ones, which deserves more attention. In this paper, we reviewed the progress in PCI in the elderly CHD patients and made some suggestions for improving the treatment of PCI in these patients.

Abstract:Objective To investigate the long-term outcomes of percutaneous coronary intervention (PCI) in the old female patients with left main coronary artery (LMCA) disease. Methods A total of 302 female patients with LMCA disease who underwent PCI in our department from December 1997 to October 2012 were enrolled and retrospectively analyzed in this study. They were divided into the old group [≥65 years, with age of (72.0±4.31) years, n＝156] and non-old group [＜65 years, with age of (55.5±7.06) years, n＝146]. The time of follow-up was (42.0±19.3) months in both groups after successful angioplasty. The basic clinical and angiographic characteristics, immediate results of PCI and major adverse cardiac event (MACE) defined as target vessel revascularization, acute myocardial infarction, and sudden cardiac death were analyzed between 2 groups during follow-up. Results The ratio of patients with hypertension and acute myocardial infarction were higher in old group than in non-old group, but with no significant difference between them (P＞0.05). Compared with non-old group, the Syntax score of the old group was significantly higher [(26.6±8.49) vs (23.5±9.10), P＜0.01]. All procedures were successfully completed in all-patients in both groups. The procedural strategies, the length and diameter of stent in LMCA and the ratio of drug eluting stent implantation were not significantly different between two groups. Meanwhile, the rate of MACE, stent thrombosis and all cause death were not significantly different between two groups. Conclusion PCI can be performed in old female LMCA patients successfully and safely. Anti-platelet therapy and optimized procedures will improve the long-term clinical outcomes of PCI in old females with LMCA disease.

Abstract:Objective To observe the clinical features of the elderly coronary heart diseases (CHD) patients who had underwent percutaneous coronary intervention (PCI), and analyze the gender differences in risk factors for CHD and the prognosis after PCI. Methods A total of 4 927 elderly CHD patients (＞65 years old) who had underwent PCI in Shenyang General Hospital of Shenyang Military Command from July 2008 to November 2012 were enrolled in this study. There were 3 049 males and 1 878 females in this retrospective study. Clinical features, coronary angiographic results, PCI outcomes, peri-operative medications of antithrombotic agents and other cardiovascular drugs, and incidence of in-hospital major adverse cardiocerebrovascular events (MACCE) were collected and analyzed for gender differences and clinical features. Results Among the risk factors for CHD, the prevalence of smoking and the morbidity of renal dysfunction were significantly higher in the males than in the females (51.5% vs 15.3%, P＜0.01; 22.1% vs 15.3%, P＜0.01). While, the women had higher body mass index (BMI) [(24.8±4.4) vs (24.5±3.7)kg/m2, P＜0.05], older age of onset [(72.6±4.8) vs (72.2±5.4) years, P＜0.01], and higher proportion of morbidities such as hypertension and diabetes (70.5% vs 60.8%, P＜0.01; 32.2% vs 24.9%, P＜0.01) than the men. There was no significant difference in the overall incidence of in-hospital MACCE between the male and female patients. However, the females had significantly higher mortality than the males (0.6% vs 0.1%, P＜0.01). Conclusion The elderly female CHD patients undergoing PCI have severer burden of risk factors and poor prognosis than their male counterparts.

Abstract:目的 探讨老年冠心病（CHD）患者经皮冠状动脉介入（PCI）围术期药物治疗的特点。方法 回顾性分析2008年7月至2012年11月在沈阳军区总医院接受PCI治疗的13 049例CHD患者的临床资料，比较非老年人（＜60岁，n＝5810）、低龄老年人（60～74岁，n＝5640）及高龄老年人（≥75岁，n＝1599）在PCI围术期药物治疗上的差异。结果 随年龄增长，患者合并高血压、心律失常、肾功能不全、卒中等基础疾病的比例显著增高。溶栓治疗的比例随年龄增长呈明显阶梯型下降趋势（17.5% vs 14.3% vs 7.2%；P＜0.001）。围术期应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂随年龄增长显著降低（32.4% vs 27.2% vs 11.0%；P＜0.001）。低龄老年组和非老年组围术期应用负荷剂量阿司匹林（99.3% vs 98.4%）和氯吡格雷（93.7% vs 93.8%）、高维持剂量阿司匹林（55.4% vs 55.9%）的比例无明显差异（均P＞0.05），但均显著高于高龄老年组（88.7%，P＜0.001；91.5%，P＝0.006；47.6%，P＜0.001）。3组患者围术期应用肝素的比例无显著差异，但老年患者应用磺达肝癸钠的比例高于非老年患者（35.9% vs 38.0% vs 38.7%；P＝0.026）。老年患者接受心血管基础药物治疗（包括血管紧张素受体Ⅱ抑制剂、钙离子通道阻滞剂、利尿剂、洋地黄、硝普钠等）的比例显著高于非老年患者。结论 老年CHD患者PCI围术期应用溶栓及抗栓治疗的比例显著低于非老年患者，而其他心血管基础药物治疗的比例则显著增高。

Abstract:Objective To investigate the clinical features and prognosis of percutaneous coronary intervention (PCI) for acute anterior ST-elevation myocardial infarction (STEMI) in the elderly patients. Methods Clinical data of 1 284 elderly STEMI patients with age ≥60 years who underwent PCI from Jan 2001 to Sep 2012 in our department were collected in this study. There were 643 cases of acute anterior myocardial infarction (the anterior group), and 641 cases with infarction at other parts of the heart (the control group). The incidence of major adverse cardiovascular events (MACE) was recorded and analyzed in both groups during their hospitalizations and 1-year follow-up. Results The percentage of the patients with cerebrovascular diseases, myocardial infarction and hypertension was significantly lower in the anterior group than in the control one (P＜0.05, P＜0.01). While the former group had higher percentages in proportion of males, KILLIP≥Ⅱ, and heart rate＞90 beats/min at admission than the latter one (P＜0.05 and P＜0.01). There was no significant difference in other clinical baseline information between the 2 groups (P＞0.05). In the application of angiotensin converting enzyme inhibitors, significantly more β-blockers, nitrates and diuretics were used in the anterior group than in the control one(P＜0.01). And the anterior group had a higher proportion of multi-vessel disease, a higher mean stent length and a higher average number of stents than the control group (P＜0.01). In 1 year after PCI, the cardiac mortality was obviously higher [6.8% (43/632) vs 3.5% (22/629), P＜0.01], and the rate of target vessel revascularization [4.7%(30/632) vs 9.4%(59/629), P＜0.01] was statistically lower in the anterior group than in the controls. The patients (≥75 years) had higher incidence of MACE than the other patients (＜75 years) [25.4% (30/118) vs 15.8% (81/514), P＜0.05]. Conclusion The elderly patients with acute anterior STEMI are more common in the males, with poor cardiac function, multivessel disease, severe illness, and more stents in PCI, but with a lower rate of long-term target vessel revascularization. The (≥75 years) patients have the higher incidence of MACE and poorer prognosis.

Abstract:Objective To determine the guiding value of treadmill exercise test (TET) in the treatment of coronary intermediate lesions in proximal or middle left anterior descending artery (LAD). Methods Eight coronary heart disease patients with moderate coronary artery stenosis (diameter stenosis 30%?70%) in proximal or middle LAD and without obvious lesions in other coronary arteries admitted in our department from June 2012 to March 2014 were enrolled in this study. The patients were 6 males (75%) and 2 females (25%), at an age of (54.88±8.95) (ranging from 44 to 68) years. Coronary angiography was carried out on the patients within 3d after admission. TET would be done if the patient was found to have coronary intermediate lesions only in the proximal or middle LAD. The patient would be treated with intervention if the positive result was found in TET. Otherwise the patient would be treated with the optimal drug strategy. Results Among the patients with the diameter stenosis of 30%?70%, TET was positive in 2 patients who were treated with intervention. The 6 patients negative to TET were treated with the optimal drug strategy. During the follow-up of 1 month to 1 year, the 2 patients accepting intervention had no any discomfort such as chest pain, and the 6 patients with drug treatment also felt well and reported no serious adverse cardiac event. Conclusion TET plays an important role in guiding the treatment of coronary intermediate lesions in proximal and middle LAD.

Abstract:目的 探讨老年（≥60岁）急性非ST段抬高型心肌梗死（NSTEMI）患者早期经皮冠状动脉介入治疗（PCI）的必要性及安全性。方法 收集2011年1月至2012年12月期间在沈阳军区总医院心血管内科住院诊断为NSTEMI并且接受PCI治疗的439例老年（≥60岁）患者。依据入院时的临床检查及化验指标，对每名患者进行全球急性冠状动脉事件注册（GRACE）评分，以评分结果进行分组（低危组评分≤140、高危组评分＞140），比较两组的冠状动脉病变特点、PCI的术后并发症发生率、住院期间及术后1年内主要不良心脏事件（MACE）和终点事件的发生率。结果 两组患者共入选439例，其中男性273例，女性166例，男性平均年龄68.4岁，女性平均年龄70.3岁。比较两组冠状动脉病变特点，高危组更多合并双支或三支血管病变（P＜0.05），差异有统计学意义（P＜0.05）。比较两组总的终点事件发生率，全因死亡终点事件发生率和住院期间死亡终点事件发生率，差异均无统计学意义（P＞0.05）。亚组分析：两组年龄≥80岁患者之间以及高危组中年龄≥80岁与＜79岁两者之间总的终点事件发生率的比较，差异无统计学意义（P＞0.05）。高危组≥80岁与＜79岁两者之间的死亡（包括非心源性及心源性）终点事件发生率比较，差异无统计学意义（P＞0.05）。结论 GRACE评分是一种应用广泛、快速的心血管疾病评价方法，可以对临床预测并指导患者的早期干预，尤其对于老年NSTEMI患者进行早期干预治疗具有指导意义，并对其冠状动脉血管病变程度及复杂性有一定预测价值。

Abstract:Objective To investigate the causes of death of retired military veterans in who died in Changhai Hospital. Methods Causes of death were analyzed and sequenced based on the medical records of 172 inpatients who died in Changhai Hospital from March 1985 to January 2013. Results The five leading causes of death were Tumor (41.9%), nervous system (16.9%), circulatory system (15.7%), respiratory system (10.5%), and endocrine and metabolic diseases (7.6%). The five leading disease entities of death were tumor (42.4%), coronary heart disease (12.8%), chronic obstructive pulmonary diseases (8.7%), cerebral infarction (8.1%) and diabetes (7.6%). The eight leading causes of death in tumor due to tumors were lung cancer (35.6%), pancreatic cancer (9.6%), colorectal cancer and gastric cancer (both 8.2%), prostate cancer and liver cancer (both 5.5%), lymphoma and multiple myeloma (both 4.1%). Conclusion Tumor is the leading cause of death in hospitalized retired military veterans. And cardiovascular and cerebrovascular diseases are also the primary causes of death in these elderly patients. So we should continue to strengthen the prevention and treatment of tumor and cardiovascular and cerebrovascular diseases.

Abstract:目的 了解老年髋部骨折患者围术期情况及术后1年结局并探讨进一步降低手术风险、提高手术疗效的可能措施。方法 回顾性地分析复旦大学附属华东医院2010年1月～12月因髋部骨折住院并施行手术治疗的老年患者234例（年龄≥60岁），通过病史查阅及电话随访，记录患者年龄、性别、髋部骨折类型、手术前后营养状况（BMI、血浆白蛋白水平、血红蛋白水平）、日常生活能力、认知功能、主要伴发疾病、手术方式、麻醉方式、术后并发症等。结果 （1）老年人占髋部骨折总数92.36%（278/301），女性多于男性。（2）术前身体状况多处于ASA Ⅱ～Ⅲ级之间，认知功能多在正常或轻度减退，心功能多在NYHA Ⅰ～Ⅱ级；术前主要营养指标均处于正常值低限；高血压病、心血管病、糖尿病、神经系统疾病、慢性支气管炎、肺部感染等是常见伴发疾病。（3）术后30d及1年的死亡率分别为2.99%和13.68%；术后生活自理能力完全恢复、部分恢复及无改善的患者各占64.32%，25.55%和10.13%；骨折类型、骨折前患者BMI、手术类型、术后并发症及术前身体状况对手术效果具有显著性意义（P＜0.05）。结论 老年髋部骨折应及时进行手术治疗，充分进行多学科评估和术前准备，选择合适的手术及麻醉方式，加强围术期管理，降低术后潜在并发症。

Abstract:Objective To determine the value of mean platelet volume (MPV) and platelet large cell ratio (P-LCR) in the diagnosis of acute coronary syndrome (ACS) in patients with chest pain. Methods A total of 83 chest pain patients with identified ACS and 56 chest pain patients without cardiovascular disease in our hospital from January to June 2013 were subjected in this study. Their venous blood samples were collected within 6 h of onset for platelet parameters. Mean comparison between the 2 groups and logistic regression analysis were used to find the effective platelet parameters, and receiver operating characteristic (ROC) curve analysis was used to evaluate their diagnostic significances for ACS. Results ACS group had significantly lower platelet than the non-cardiac chest pain group [(191.28±67.07)×109 vs (236.75±64.09)×109/L)], and significantly higher MPV [(11.88±1.24) vs (10.73±1.08)fL], platelet distribution width (PDW) [(15.54±1.87) vs (13.40±2.35)fL] and P-LCR [(47.49±9.55)% vs (35.11±10.00)%] (all P＜0.05). There was no statistical difference in the platelet parameters among different types of ACS patients (P＞0.05). Logistic regression analysis showed that P-LCR and MPV were auxiliary diagnostic indicatos for ACS. ROC curve analysis showed that the cut-off was 0.15μg/L, 38.5%, 11.05fL, and 19.0U/L, respectively, for troponin I (TnI), P-LCR, MPV and creatine kinase-MB (CK-MB), and their areas under the curve were 0.987, 0.817, 0.754 and 0.598, respectively. Their sensitivity was 97.3%, 92.8%, 71.1% and 45.8% respectively, the specificity were 90.3%, 64.3% 62.5%, and 73.2% respectively, and the diagnostic accuracy were 100%, 80%, 72.6%, and 67.2%, respectively for TnI, P-LCR, MPV and CK-MB. Conclusion MPV and P-LCR are helpful in the early diagnosis of ACS, and can be seperately used as auxiliary diagnostic indicators of ACS in patients with chest pain. Because of their high diagnostic accuracy, the 2 parameters can be served as a reference for early prediction and differential diagnosis of ACS.

Abstract:Objective To investigate the general condition and distribution of diseases in the death of the elderly patients, and analyze the change profile of serum high-sensitivity C-reactive protein(hs-CRP) and blood lipids in the patients died of coronary heart disease (CHD). Methods Clinical data of 97 died patients hospitalized in our department from 2009 to 2012 were collected and retrospectively analyzed. The patients were divided into 2 groups according to their causes of death being CHD or not. Their serum levels of hs-CRP and lipids were analyzed. Results The total mortality in our department at that period was 0.89%, with 1.12% for males, significantly higher than that for the females (0.69%, P＜0.05). The top 5 diseases of death cause were acute myocardial infarction, chronic congestion heart disease, pulmonary infection, sudden cardiac death and multiple valvular heart diseases. The serum level of total cholesterol (TC) was significantly higher in CHD-caused death group than in non-CHD one (P＜0.05). But there was no significant difference in the levels of hs-CRP, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) between the 2 groups (P＞0.05). Conclusion CHD is the major cause of death in the elderly people. TC level is obviously higher in the elderly died patients with CHD than those without the disease.

Abstract:Objective To analyze the efficacy and safety of the procedures dominated by circumferential pulmonary vein ablation and combined with other catheter ablation approaches, guided by CARTO system in the treatment of the elderly atrial fibrillation (AF), and also to analyze the risk factors for recurrence. Methods A total of 50 elderly AF patients admitted in our department from July 2009 to July 2011 were recruited in this study. There were 37 males and 13 females, with age ranging from 60 to 76 (66.78±4.09) years. There were 43 cases of paroxysmal AF, 5 cases of persistent AF, and 2 cases of permanent AF (＜2 years). A procedure dominated by circumferential pulmonary vein ablation and supplemented by other ablation strategies was applied under the guidance of CARTO system, and the primary endpoint of ablation was complete isolation of pulmonary vein. After a continuous follow-up for 12 months after the surgery, the surgical success rate, recurrence rate, recurrence-related factors and the incidence of complications were analyzed. Results The success rate of 50 patients achieved 100% immediately after the surgery, and the rate reduced to 80% in postoperative follow-up of 1 year after ablation. One case (2%) suffered from cardiac tamponade, which was relieved by cardiac catheterization. Two cases (4%) had pericardial effusion without tamponade symptoms, 1 (2%) had bilateral exudative pleural effusion, and 2 (4%) experienced hematoma at the puncture site. In 6 months after the radiofrequency ablation, 40 patients maintained sinus rhythm successfully (success group) and got left atrial diameter (LAD) reduced in size at various extents by cardiac ultrasound examination. However, no significant change in LAD was observed in the 10 patients who failed to maintain sinus rhythm (recurrence group). The mean difference of LAD before and after treatment was (4.64±1.12)mm in success group and (0.40±0.61)mm in recurrence group (P＜0.01). The left ventricular ejection fraction in the both groups remained no significant change before and after surgeries. In 12 months after surgery, 10 cases (20%) suffered recurrence in total, and 2 of them (4%) were permanent AF, 3 (6%) of persistent AF, and 5 (10%) of paroxysmal AF. The elderly persistent AF, permanent AF and preoperative LAD were risk factors for recurrence after radiofrequency catheter ablation. Conclusion CARTO-guided radiofrequency catheter ablation is safe and efficient in the treatment of the elderly AF.

Abstract:Objective To determine the influence of peroxisome proliferator-activated receptor (PPAR)-β/δ agonist, GW501516 (GW), on the cardiac function in aged septic rats. Methods The aged rat model of sepsis was established by cecal ligation and puncture surgery (CLP). Totally 50 aged rats (24 months old) were randomly divided into 4 groups: control group (Con, n＝5), sham operation group (Sham, n＝6), CLP group (n＝19), CLP+GW501516 (0.05mg/100g) group (n＝20). The mortality of the aged rats was recorded within 48 h after the CLP surgery. In 48h after CLP, the heart rate, stroke volume (SV), cardiac index (CI), left ventricular end-diastolic diameter and left ventricular end-diastolic volume were evaluated by echocardiography. Results CLP+GW group had significantly reduced mortality compared with CLP group (15.0% vs 42.1%, P＜0.05). The echocardiographic results showed that GW501516 resulted in greatly declined heart rate [(318.55±16.65) vs (411.16±10.1) beats/min, P＜0.01], and extremely increased SV and CI in 48h after surgery [(470.71±111.6) vs (171.47±39.85)ml/beat, P＜0.05; (185.00±41.2) vs (102.05±19.94)ml/(min·mm-2), P＜0.05] when compared with simple CLP operation. Left ventricular end-diastolic diameter and left ventricular end-diastolic volume were also significantly improved in CLP+GW501516 group compared with CLP group[(8.02±0.66) vs (5.65±0.45)mm, P＜0.05; (5.13±1.00) vs (1.75±0.39)ml, P＜0.01]. Conclusion Early application of PPARβ/δ agonist GW501516 reduces the mortality and improves cardiac systolic and diastolic function in aged septic rats.

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Abstract:Aortic intramural hematoma (IMH) is a potentially fatal entity in the spectrum of acute aortic syndrome. It is prone to evolve into aortic dissection, and then followed by aortic rupture, aneurysm or absorption without further sequelae. So, prompt recognition and appropriate intervention are quite essential. However, not all aortic IMH presents typical symptoms, and early diagnosis may be hard and even missed. It is relatively rare for aortic IMH manifesting acute abdominal pain at the begining. In this paper, we reported a 68-year-old man presenting with acute abdominal pain as the early symptom of aortic IMH, which was not recognized immediately, and even misdiagnosed as some abdominal diseases. The disease was identified after radiological examination. Emergency physicians should pay attention to aortic IMH only presenting acute abdominal pain, so as to make early diagnosis and appropriate management.

Abstract:As a common physical sign in the elderly, orthostatic hypotension is an independent risk factor of cardi cerebro vascular diseases and falls, and also increases all-cause mortality. Nowadays, continuous noninvasive blood pressure measurement systems are increasingly used in the study of orthostatic hypotension, and usually combined with head-up tilting. Furthermore, orthostatic hypotension is classified by hemodynamic parameters. This review focused on two acknowledged classification systems, morphological classification and physiological classification.

Abstract:Asymmetric dimethylarginine (ADMA) is an inhibitor of endogenous nitric oxide synthase (NOS), which inhibits the formation of vasoactive substance, nitric oxide (NO), and further results in endothelial dysfunction. Some studies have shown that ADMA may cause the occurrence and development of memory impairment and dementia through being involved in cerebral blood flow reduction, atherosclerosis, leukoaraiosis and oxidative stress. So, interference of synthesis or metabolism of ADMA may bring forward a new means to prevent and treat cognitive impairment.