The HV interval and 12-lead ECG morphology of LPF-VT may help predict the successful site of origin and prove useful in guiding an effective ablation strategy.

Background The efficacy and safety of PCSK-9 inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China is unknown. Objective To describe the real world effectiveness of initiated with PCSK-9 inhibitors combined with statins compared with statins among patients with very high risk of ASCVD and underwent percutaneous coronary intervention (PCI). Methods This is a prospective study, enrolled patients from 32 hospitals between January to June 2019. The lipid control rate and incidence of cardiovascular events over 6 months were compared between two groups. A propensity score-matched analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for cardiovascular events. Results In a total of 3063 patients, 89.91% had received moderate or high-intensity statin therapy before PCI, but only 9.47% had LDL levels below 1.4mmol/L at baseline. In the PSM selected patients, LDL level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81% (P<0.001) in statins group after 6 months. The proportion of LDL[?]1.0mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins group, and the proportion of LDL[?]1.4mmol/L increased from 10.36% to 47.69% and 2.99% to 18.43% (P<0.001 for both). PCSK-9 inhibitor significantly reduced the incidence of cardiovascular events versus statins treatment (2.07% vs 8.29%, HR, 0.24, 95% CI, 0.12-0.51). Conclusion In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL levels and risk of cardiovascular events among patients with very high risk of ASCVD.

Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis &gt;50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

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BackgroundAmong patients with diabetes mellitus (DM) and chronic coronary syndrome (CCS), non-culprit lesions (NCLs) are responsible for a substantial number of future major adverse cardiovascular events (MACEs). Thus, we aimed to establish the natural history relationship between adverse plaque characteristics (APCs) of NCLs non-invasively identified by coronary computed tomography angiography (CCTA) and subsequent MACEs in these patients.MethodsBetween January 2016 and January 2019, 523 patients with DM and CCS were included in the present study after CCTA and successful percutaneous coronary intervention (PCI). All patients were followed up for MACEs (the composite of cardiac death, myocardial infarction, and unplanned coronary revascularization) until January 2022, and the independent clinical event committee classified MACEs as indeterminate, culprit lesion (CL), and NCL-related. The primary outcome was MACEs arising from untreated NCLs during the follow-up. The association between plaque characteristics detected by CCTA and primary outcomes was determined by Marginal Cox proportional hazard regression.ResultsOverall, 1,248 NCLs of the 523 patients were analyzed and followed up for a median of 47 months. The cumulative rates of indeterminate, CL, and NCL-related MACEs were 2.3%, 14.5%, and 20.5%, respectively. On multivariate analysis, NCLs associated with recurrent MACEs were more likely to be characterized by a plaque burden &gt;70% [hazard ratio (HR), 4.35, 95% confidence interval (CI): 2.92–6.44], a low-density non-calcified plaque (LDNCP) volume &gt;30 mm3 (HR: 3.40, 95% CI: 2.07–5.56), a minimal luminal area (MLA) &lt;4 mm2 (HR: 2.30, 95% CI: 1.57–3.36), or a combination of three APCs (HR: 13.69, 95% CI: 9.34–20.12, p &lt; 0.0001) than those not associated with recurrent MACEs. Sensitivity analysis regarding all indeterminate MACEs as NCL-related ones demonstrated similar results.ConclusionsIn DM patients who presented with CCS and underwent PCI, half of the MACEs occurring during the follow-up were attributable to recurrence at the site of NCLs. NCLs responsible for unanticipated MACEs were frequently characterized by a large plaque burden and LDNCP volume, a small MLA, or a combination of these APCs, as determined by CCTA.

Aims: β-blockers are underused in Chinese patients with coronary heart disease. The prescribed dose is often low. The aim of this study was to investigate the effect of metoprolol succinate doses of 95 mg and 190 mg on heart rate (HR) control, as well as drug tolerance, in Chinese patients with stable angina, low-dose β-blocker use and unsatisfactory HR control.Methods: This was a multicenter, randomized, open-label, parallel-group trial in 15 clinical sites. Patients with stable angina, taking low-dose β-blockers (equivalent to metoprolol succinate 23.75-47.5 mg/day), and having a resting HR of ≥ 65 bpm were enrolled and randomized to either the metoprolol 95-mg group or the 190-mg group. The change in 24-h average HR from baseline recorded by Holter monitoring and the percentages of patients with resting HR controlled to ≤ 60 bpm were compared between the two groups.Results: Two hundred thirty-one patients entered the intent-to-treat population for the main analysis. The change in 24-h average HR from baseline was -0.62 ± 0.66 bpm in the 95 mg group and -2.99 ± 0.62 bpm in the 190 mg group (p = 0.0077) after 8 weeks of treatment. The percentages of patients with resting HR controlled to ≤ 60 bpm were 24.1% (95% CI: 16.35%, 31.93%) and 40.0% (95% CI: 31.05%, 48.95%), respectively (p = 0.0019). Only 4 and 2 of the patients, respectively, discontinued the study drugs because of hypotension or bradycardia.Conclusions: The metoprolol succinate dose of 190 mg is superior to the 95 mg dose in terms of HR control, in Chinese patients with stable angina, low-dose β-blocker use and unsatisfactory HR control. Both doses were well tolerated.

Background: Atherogenic index of plasm (AIP) has been identified as a risk factor for cardiovascular disease (CVD) and an independent predictor of mortality. However, it remains unknown whether AIP level may predict mortality in patients with diabetes and acute coronary syndrome (ACS). Methods: A total of 2531 consecutive patients with type 2 diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into tertiles according to admission AIP level. The AIP was calculated as the base 10 logarithm of the ratio of the fating concentration of triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C). The primary endpoints were all-cause death and cardiovascular death. Multivariate cox hazard regression analysis were performed to calculate the hazard ratio(HR)and 95％confidence interval(CI)．C-statistics, continuous net reclassification improvement(NRI)，and integrated discrimination improvement(IDI) were calculated to evaluate the added prognostic value of AIP beyond the established mode for prediction of death．Results: During 3-year follow-up, all-cause death events occurred in 142 cases and cardiovascular death events occurred in 120 cases, respectively. The risk of all-cause death and cardiovascular death increased with AIP tertiles at a 3-year follow-up. The Kaplan-Meier curves showed that significant differences in event-free survival rates among AIP tertiles(all-cause mortality: p=0.006; cardiovascular mortality: p=0.003).Multivariate cox hazard regression analysis revealed that AIP was independently associated with all-cause death (HR: 3.859, 95% CI:1.926-7.734; p<0.001) and cardiovascular death (HR:4.723, 95% CI: 2.243-9.946; p<0.001). Addition of AIP to the established mode for mortality prediction was not associated with a significant improvement in the C-statistics value but there were significant improvements in reclassification for all-cause death (NRI: 0.198, p=0.022; IDI: 0.008, p=0.016) and cardiovascular death (NRI: 0.260, p=0.006; IDI: 0.010, p=0.021).Conclusions: Admission AIP was independently correlated with long-term mortality in patients with type 2 diabetes and ACS. These findings suggest that AIP may optimize the mortality prediction among patients with diabetes and ACS.