Xin Zhong

Fudan University, Shanghai, Shanghai Shi, China

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Publications (6)19.03 Total impact

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    ABSTRACT: Limited published data about periprocedural myocardial injury (PMI) after successful chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) were available. The study aimed to investigate risk predictors and clinical implications of PMI after successful CTO-PCI and drug-eluting stent (DES) implantation. Between 2009and 2012, a total of 437 patients who underwent successful recanalization with DESs were included. All the cardiac troponin T (cTnT)-positive patients were excluded. As the benchmark in PMI defined as cTnT >5 × the 99th percentile ULN, the independent predictors and major adverse cardiac events (MACEs) involving cardiac death, myocardial infarction, and target-vessel revascularization were compared between the PMI group and the no PMI group. The incidence rate of PMI was 18.3% (80/437) after the index procedure. Multivariate analysis showed that calcification (OR: 2.203, confidence interval [CI] 1.262-3.845, P = 0.005), the parallel wire technique (OR: 3.178, CI 1.661-6.081, P < 0.001), and the retrograde wire technique (OR: 5.554, CI 2.275-13.558, P < 0.001) were independent predictors of PMI after successful CTO-PCI and DES implantation. Major adverse cardiac events were significantly higher in the PMI group (adjusted hazard ratio 3.704; 95% CI 1.759-7.796; P = 0.001) during the 3-year follow-up. The independent predictors of PMI after successful recanalization with DESs are calcification, the parallel wire technique, and the retrograde wire technique. Periprocedural myocardial injury after the index procedure is associated with more adverse clinical events. Further large clinical studies combined with bioinformatics are warranted to explore the implications of patients with this distinct new entity.
    No preview · Article · Mar 2015 · European Heart Journal Supplements
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    ABSTRACT: Objective : The study aimed to analyze the risk factors and long-term outcomes associated with coronary artery aneurysms (CAAs) after successful percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation in patients with CTOs. Background :There are sporadic data available on post-procedure CAAs after transcatheter revascularization for CTOs. Methods and Results: A total of 141 patients with 149 CTOs who underwent successful CTO-PCI and DES implantation with angiographic follow-up from 2004 to 2010 were included. Patients were divided into CAA group and non-CAA group according to the presence of CAAs in the follow-up angiography. The independent predictors and major adverse cardiac events (MACEs) including cardiac death, myocardial infarction (MI) and target-vessel revascularization (TVR) were compared between two groups. The incidence of CAAs was 11.4% (17/149) after index procedure. Multivariate analysis showed that age (OR: 0.925, CI 0.873-0.980, P=0.008), ostial occlusion (OR: 6.715, CI 1.473-30.610, P=0.014), the parallel wire technique (OR: 6.167, CI 1.709-22.259, P=0.005) and DES length (OR: 1.030, CI 1.002-1.058, P=0.036) were the independent predictors of CAAs after successful CTO-PCI and DES implantation. MACEs was similar between two groups (adjusted hazard ratio 0.670; 95% CI 0.160-2.808; p=0.584) during the 5-year follow-up. Conclusions : The independent predictors of CAAs after successful CTO-PCI and DES implantation are age, ostial occlusion, the parallel wire technique and DES length. CAAs after index procedure are not frequently associated with adverse clinical events under dual antiplatelet therapy. Further large clinical studies are warranted to explore the clinical implications of patients with this distinct new entity.
    Preview · Article · Jul 2014 · IJC Heart and Vessels
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    ABSTRACT: In the past decade, a number of cohort studies studies have been carried out to investigate the relationship between the insertion/deletion polymorphism of the gene encoding angiotensin-converting enzyme and risk of restenosis after percutaneous transluminal coronary angioplasties in patients. However, these studies have yielded contradictory results. Genetic association studies addressing this issue are frequently hampered by insufficient power. We therefore performed a meta-analysis of the published studies to clarify this inconsistency and to establish a comprehensive picture of the relationship between ACE I/D polymorphism and post-PTCA restenosis risk. Databases including Pubmed, EMBASE, ISI Web of Science, EBSCO, Cochrane Library databases and CNKI were searched to find relevant studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association. The random-effects model was applied, addressing heterogeneity and publication bias. A total of 33 cohort studies involving 11,099 subjects were included. In a combined analysis, the OR for post-PTCA restenosis of the ACE DD genotype was 1.61 (95% CI: 1.27-2.04; P<10(-5)). In the subgroup analysis by intervention, significantly increased risks were also found in PTCA-stent and PTCA-balloon for the DD genotype of the polymorphism. Our meta-analysis showed that the DD genotype of ACE I/D polymorphism was significantly associated with increased risk of restenosis, particularly for PTCA-stent.
    Preview · Article · Sep 2013 · PLoS ONE
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    ABSTRACT: To evaluate the clinical and angiographic outcomes of vasospastic angina patients with severe organic stenosis treated by drug-eluting stents. Between January 2006 and December 2010, severe organic stenosis (diameter stenosis more than 70%) was evidenced in 7 out of 46 vasospastic angina patients and treated with drug-eluting stents. Coronary angiography was repeated at 6 - 18 months after percutaneous coronary intervention and the patients were clinically followed up. The clinical and angiographic outcomes were observed. Nine drug-eluting stents [mean diameter 2.75 - 3.50 (3.08 ± 0.24) mm, length 24 - 33 (27.3 ± 3.6) mm] were successfully implanted in these 7 patients. Stents were implanted into left anterior descending artery (LAD) in 5 patients (71.4%), right coronary artery (RCA) in 1 patient (14.3%), both LAD and RCA in 1 patient (14.3%). Transient RCA spasm and distal LAD spasm were observed during percutaneous coronary intervention of LAD in 2 patients. Anginal attack at rest with transient ST segment elevation at V(1)-V(3) leads occurred 24 hours after LAD stenting in 1 patient. Follow-up coronary angiography showed significant in-stent restenosis or focal edge restenosis (diameter stenosis more than 50%) in 3 patients (42.9%), mild neointimal proliferation but without significant restenosis in 2 patients (28.6%), and no neointimal proliferation in 2 patients (28.6%). During clinical follow-up of 17 to 50 months after percutaneous coronary intervention, 2 patients (28.6%) remained asymptomatic, while effort angina and/or rest angina was documented in the remaining 5 patients (71.4%). Our results from this small patient cohort suggest that drug eluting stent implantation for severe organic stenosis in patients with vasospastic angina is linked with high incidence of restenosis and recurrent chest pain. Further observation in larger patient cohort is warranted to clarify the efficacy of this strategy for treating vasospastic angina patients with severe organic stenosis.
    No preview · Article · Jul 2012 · Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases]
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    ABSTRACT: To analyze the clinical and angiographic characteristics of patients with slow coronary flow (SCF). In this retrospective study, 140 patients with SCF and 140 control subjects without SCF were included. SCF were diagnosed by the combination of TIMI flow grade method and TIMI frame count method. All subjects had angiographically normal coronary arteries. The clinical and laboratory data were obtained from medical records at admission. Compared to control group, patients with SCF were younger [(57.8 +/- 10.7) years vs. (59.8 +/- 8.2) years], rate of smokers (59.3% vs. 46.4%) and diabetes mellitus (49.3% vs. 30.7%), fasting blood glucose (FBG) level [(7.8 +/- 2.8) mmol/L vs. (6.2 +/- 2.0) mmol/L, P < 0.05] and triglyceride (TG) level [(2.11 +/- 1.93) mmol/L vs. (1.67 +/- 1.01) mmol/L, P < 0.05] were higher, while high density lipoprotein cholesterol (HDL-C) level [(1.05 +/- 0.35) mmol/L vs. (1.42 +/- 0.74) mmol/L, P < 0.01] and apolipoprotein A1 (apoA1) level [(1.10 +/- 0.19) mmol/L vs. (1.31 +/- 0.31) mmol/L, P < 0.01] were lower. Among the 140 SCF patients, left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) were involved at the same time in 92 patients. Among the three vessels, RCA is the most frequent involved vessel (n = 119). After adjusting for other risk factors, current smoking (OR = 1.92, 95% CI: 1.04 - 3.57, P < 0.05), DM history (OR = 2.44, 95% CI:1.32-4.76, P < 0.01), FBG (OR = 2.13, 95% CI:1.16-3.98, P < 0.05), TG (OR = 1.47, 95% CI:1.03-2.13, P < 0.05), HDL-C (OR = 0.47, 95% CI:0.24-0.85, P < 0.05) and apoA1 (OR = 0.55, 95% CI:0.40 - 0.75, P < 0.01) were independent factors for SCF (all P < 0.05). Our results demonstrated that patients with SCF were prone to have a significant metabolic disorder compared to the control group. Patients with high levels of FBG, TG and low levels of HDL-C were more likely to suffer from SCF, which maybe explained by the development of coronary endothelium and microvascular dysfunction.
    No preview · Article · Jul 2011 · Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases]
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    ABSTRACT: To evaluate the in-hospital outcome and determinants relating to success rate of percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) using contemporary techniques. A total of 1485 patients with total occluded coronary artery were identified from January 2004 to December 2008 in Zhongshan hospital. Of them, 638 patients were affirmed as CTO and 447 patients underwent PCI. The clinical data and the in-hospital outcome of patients underwent PCI were retrospectively analyzed. Procedure success was achieved in 382 patients (85.5%). Coronary perforation (C-F type dissection or coronary perforation) occurred in 27 patients (6.0%), cardiac tamponade developed in 6 out of the 27 patients, 2 patients (0.4%) received in-hospital repeat revascularization. Two patients (0.4%) died post PCI: one died of acute stent thrombosis and the other one died of refractory heart and respiratory failure.Compared with patients of successful recanalization, patients failure to recanalization were more aged [(62.9 ± 10.4)years vs. (65.9 ± 9.9) years, P < 0.05] and excessive tortuosity (16.2% vs. 38.5%, P < 0.01), absence stump (47.1% vs. 80.0%, P < 0.01) and excessive calcification (36.9% vs. 72.3%, P < 0.01) were more common. Multiple logistic regression analysis revealed that excessive calcification (OR: 3.866, P < 0.01), absence stump (OR: 3.346, P < 0.05) and excessive tortuosity (OR: 3.055, P < 0.01) were independent predictors for the procedural failure. PCI for patients with CTO is safe and effective. Apart from progress on the equipment development, procedural success rates are closely related with the clinical and angiographic features of CTO.
    No preview · Article · Jan 2011 · Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases]