Objective To explore the role of systolic and diastolic dysfunction in the prognosis of Chinese patients with coronary artery disease (CAD). Methods CAD patients who underwent coronary arteriography in the Department of Cardiology of West China Hospital between July 2008 and June 2012 were included in this study. All the patients underwent color Doppler echocardiographic examination. Based on patients’ systolic and diastolic cardiac function, left ventricular ejection fraction (LVEF) <55% was as the systolic dysfunction and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e’) >15 was as the diastolic dysfuntion. They were divided into normal cardiac function group (LVEF≥55%, E/e’ ratio≤15), systolic and diastolic dysfunction group (LVEF<55%, E/e’ ratio>15), diastolic dysfunction group (LVEF≥55%, E/e’ ratio>15) and systolic dysfunction group (LVEF<55%, E/e’ ratio≤15). The end points of follow-up were all-cause death and a major cardiovascular event (MACE). Results A total of 985 patients with complete echocardiographic report were included in this study. During the follow-up of (21.4±9.7) months, 46 patients (4.7%) died, and 52 (5.4%) had a MACE. Systolic dysfunction concomitant with diastolic dysfunction group and systolic dysfunction group patients had a higher risk of 36-month all-cause death (4.8%, 10.7%,P<0.001) and a higher risk of 41-month MACE (8.6%, 7.6%,P=0.028). Single factor analysis of all-cause death mortality showed that compared with the normal group, all-cause death mortality was the highest in systolic and diastolic dysfunction group (P<0.05), followed by diastolic dysfunction group (P<0.05) and systolic dysfunction group (P>0.05). Single factor analysis of MACE showed that compared with the normal group, MACE was still the highest in systolic and diastolic dysfunction group (P<0.05), followed by systolic dysfunction group (P<0.05) and diastolic dysfunction group (P>0.05). A multivariate Cox regression model analysis showed that compared with the normal group, the risk of all-cause death was the highest in the systolic and diastolic dysfunction group [hazard ratio (HR)=2.96, 95% confidence interval (CI) (1.34, 6.54),P=0.007], followed by the systolic dysfunction group [HR=1.91, 95%CI (0.67, 5.42),P=0.224] and the diastolic dysfunction group [HR=0.95, 95%CI (0.40, 2.23),P=0.905]. Conclusion Compared with normal patients, patients with either systolic or diastolic dysfunction have a poorer prognosis, and patients with systolic dysfunction concomitant with diastolic dysfunction have the poorest prognosis.
Objective To evaluate and select essential medicine for the treatment of coronary heart disease by means of evidence-based approaches based on the burden of disease for township health centers located in eastern, central and western regions of China. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) 11 clinical guidelines on coronary heart disease were included, three of which are evidence-based guidelines. (2) Totally, those guidelines contained 61 medicines (of 13 classes). (3) According to WHOEML (2011), NEML (2009), CNF (2010), other guidelines and the quantity and quality of evidence, we made a b recommendation for nitroglycerin, isosorbide dinitrate, metoprolol, nifedipine, verapamil, enalapril and aspirin as essential medicine for coronary heart disease. We made a weak recommendation for amlodipine, clopidogrel, heparin, propranolol, simvastatin and streptokinase. (4) 13 recommended medicines have been marketed in China and their prices were affordable. (5) Results of domestic low-quality studies indicated that nitroglycerin, isosorbide dinitrate, metoprolol, aspirin and heparin were effective for coronary heart disease. We didn’t find systematic reviews or pharmacoeconomic studies on the recommended medicines in Chinese literature databases. Conclusion For coronary heart disease: (1) We offer a b recommendation for nitroglycerin, isosorbide dinitrate, metoprolol, nifedipine, verapamil, enalapril and aspirin and a weak recommendation for propranolol, amlodipine, clopidogrel, heparin, simvastatin and streptokinase. (2) There is lack of high-quality evidence from relevant domestic studies, especially on pharmacoeconomic evaluation. (3) We propose that more studies should be carried out on clinical guideline of coronary heart disease and pharmacoeconomic comparison should be also made between recommended medicine and medicine of the same class.