Background In recent years, the prevalence rate of acute coronary syndrome (ACS) in Chinese young women has been increasing significantly, becoming one of the main causes of death in young females. A matter of constant concern is what is the characteristics and differences in risk factors between young women with ACS and without ACS. This study aimed to investigate the characteristics and difference of risk factors in Chinese young women with ACS and to provide references for ACS prevention and treatment. Methods A 1:1 case-control study was conducted to evaluate risk factors of 415 young females with ACS (ACS group) who underwent PCI treatment and 415 young females without ACS (control group) who were hospitalized and confirmed by coronary angiography to exclude coronary heart disease from January 2010 to August 2016. The average age of the cases in groups was respectively (40.77 ± 4.02) and (40.57 ± 4.01) years-old (P > 0.05). Results The risk factors in ACS group were overweight (64.10%), hypertension (49.88%), hyperlipidemia (40.72%), diabetes (23.37%), depression or anxiety (16.63%), gynecological diseases (16.39%), Hyperuricemia (14.94%), family history of early-onset CHD (14.94%), hyperhomocysteinemia (11.33%), hypothyroidism (9.64%), hypercholesterolemia (8.43%) and high C-reactive protein (7.47%), and were significant difference (P < 0.01) compared with that of the control group. The average number of risk factors per case in ACS group was significantly more than that of control groups (P < 0.01). Regression analysis showed that hyperlipidemia, hyperhomocysteinemia, overweight (obesity), high CRP, hypertension, hypothyroidism, gynecological diseases, depression or anxiety, cardiac insufficiency, hypercholesterolemia, diabetes, oral contraceptives, family history of early-onset CHD, and autoimmune diseases were independent risk factors (P < 0.01). The bivariate correlation analysis between CRP level and age was r = − 0.158 (P < 0.01). The result showed the younger ACS patient is the higher serum CRP. Conclusion The independent risk factors of ACS in young women are hyperlipidemia, hyperhomocysteinemia, overweight, high CRP, hypertension, hypothyroidism, gynecological diseases, depression or anxiety, cardiac insufficiency, hypercholesterolemia, diabetes, oral contraceptives, family history of early-onset CHD, and autoimmune diseases. The co-existence of multiple risk factors is the main cause suffering from ACS in young women.

In conclusion, the current meta-analysis indicates that CRP rs3093059 (T>C) polymorphism may be associated with decreased risk of MI, especially among Asian populations.

Background. C-reactive protein (CRP) is one of the most common oxidative indexes affected by many diseases. In recent years, there have been many studies on CRP, but the relationship between CRP levels and the cardiovascular risk in the Chinese young female population is still unclear. The purpose of this work is to explore the predictive value of CRP for the cardiovascular risk in the Chinese young female population. Methods. The study is conducted by 1 : 1 case-control to retrospectively analyze 420 young women with acute coronary syndrome (ACS group) who underwent percutaneous coronary intervention (PCI) and 420 young women (control group) who underwent coronary angiography (CAG) to exclude coronary heart disease from January 2007 to December 2016. All patients are divided into three subgroups according to CRP values: subgroup 1: CRP < 1.0   mg / L ( n = 402 ); subgroup 2: 1.0   mg / L ≤ CRP ≤ 3.0   mg / L ( n = 303 ); subgroup 3: CRP > 3.0   mg / L ( n = 135 ). The levels of CRP were observed in the two groups and three subgroups. Results. A total of 840 patients were analyzed. The mean duration of follow-up was 66.37 ± 30.06 months. The results showed that the level of CRP in the ACS group was significantly higher than that in the control group ( 1.30 ± 1.70 vs. 3.33 ± 5.92 , respectively, p < 0.001 ), and patients with higher CRP levels were associated with a significantly increased rate of major adverse cardiovascular events (MACE) (7.0% vs. 8.9% vs. 19.30%, respectively, p < 0.05 ). After adjustment for baseline covariates, CRP level was still an independent predictor for the incidence of MACE, either as a continuous variable or as a categorical variable. There was a significantly higher rate of all-cause mortality and myocardial infarction in patients with higher CRP values during follow-up. Conclusions. The research results show that high CRP is associated with increased risk of ACS in the Chinese young female population. Risk stratification with CRP as an adjunct to predict clinical risk factors might be useful in the Chinese young female population.

To explore the key points of a novel "crowbar effect" approach to improve the success rate of recanalization of CTOs. METHODS: One hundred and fifty-seven patients with CTO were treated with PCI using the regular antegrade guide wire approach. Of them, 36 patients (22.9%) showed that while the first guide wire was inserted into the CTO lesions, a small balloon had difficulty passing through the CTO lesions. For those patients, the new crowbar effect technique was used to allow the balloon to pass through the lesions. RESULTS:The coronary CTO vessels in 35 patients (97.2%) were completely opened. Coronary perforation occurred in 5 patients (13.8%). This perforation was properly treated and did not lead to serious complications. CONCLUSION: The crowbar effect technique proved successful as an alternative antegrade method for opening CTO. The procedure of this novel method is easy to accomplish and success rates are high.Keywords: Coronary artery, chronic total occlusion, percutaneous coronary intervention, crowbar effect technique, success rate [1] IntroductionCoronary chronic total occlusion (CTO) lesions refer to coronary artery occlusions that are present for at least three months. The benefits of CTO recanalization include symptom relief, improved regional and global left ventricular function, improved quality of life, and better long-term survival rate versus failed recanalization CTO treatments with percutaneous coronary intervention (PCI) [1][2][3]. Successful revascularization may improve angina, increase exercise capacity, reduce the possibility of the late coronary artery bypass graft (CABG) surgery [4], and improve quality of life. CTO lesions are typically complex, and associated with atheromatous plaque, thrombosis, and fiber endangium proliferation. The recanalization of CTO lesions is one of the most challenging PCI procedures [4][5][6] and has been called "the last frontier" of PCI. The primary reasons for this are associated with the technical complexity, poor * Corresponding author: Tongku Liu, Affiliated Hospital of Beihua University, Jilin, Jilin, China. E-mail: liutongku2010 @163.com.

Objectives To evaluate the difference of long-term outcomes of ST-segment elevation acute myocardial infarction (STEMI) treated by immediate PCI and delayed PCI. Methods 326 patients with STEMI were treated by percutaneous coronary intervention (PCI) in our hospital from January 2006 to January 2010. Among 326 patients 186 patients were treated by immediate PCI and stenting (immediate PCI group) and 140 patients were treated by delayed PCI and stenting (delayed PCI group). All patients were followed 25-72 months with an average 51.6 ± 13.7 months by telephone or outpatient service or in-hospital. The major adverse cardiac events (MACE), the cardiac structure and function estimated by echocardiography and infarct size estimated by the QRS point system were recorded during the follow-up. 107 cases (57.5%) in immediate PCI group and 88 cases (62.9%) in delayed PCI group were followed by echocardiography (MACE included cardiac death, nonfatal myocardial infarction, target lesion revascularisation, late stent thrombosis and rehospitalisation due to heart failure). Results The rate of MACE was 23.1% (43/140 cases) in immediate PCI group and 38.6% (54/186 cases) in delayed PCI group (P < 0.05). The rate of cardiac death, nonfatal myocardial infarction, target lesion revascularisation and late stent thrombosis in immediate PCI group and delayed PCI group was respectively 5.4% and 6.4% (P > 0.05), 4.8% and 8.6% (P > 0.05), 8.6% and 8.7% (P > 0.05), 2.2% and 2.9% (P > 0.05), but the rate of rehospitalisation due to heart failure in immediate PCI group and delayed PCI group was respectively 4.3% and 11.4% (P < 0.05). The decrease rate of QRS score-estimated myocardial infarction (MI) size by initial and follow-up electrocardiograms was 0.384 ± 0.167 (initial 16.36 ± 0.08 and follow-up 10.06 ± 5.91) in immediate PCI group and 0.18 ± 0.13 (initial 16.50 ± 8.34 and follow-up 10.44 ± 6.38) in delayed PCI (P < 0.05). The left ventricular end-diastolic dimension (LVDd) was 46.6 ± 6.7 mm (initial) and 47.4 ± 5.7 mm (follow-up) in immediate PCI group and 47.8 ± 6.1 mm (initial) and 50.1 ± 6.7 mm (follow-up) in delayed PCI group, which were significant difference (P < 0.05) between the two groups. Left ventricular ejection fraction (EF) was 56.7 ± 6.3% (initial) and 59.9 ± 5.9% (follow-up) in immediate PCI group, and 55.0 ± 6.9% (initial) and 51.9 ± 6.4% (follow-up) in delayed PCI group, which was significant difference (P < 0.05) between two groups. Conclusions The rate of MACE in delayed PCI is higher than that in immediate PCI for patients with STEMI. The rate of rehospitalisation due to heart failure in delayed PCI is higher then that in immediate PCI.