Author: Academician Han Yaling
Globally, coronary heart disease is currently the leading cause of death and burden of disease. In 1977, Swiss-German physician Grüentzig completed the world's first percutaneous coronary luminal plasty (PTCA), ushering in a new era of interventional cardiology. In the following 40 years, percutaneous coronary interventional therapy (PCI) technology and instruments based on PTCA have developed rapidly, becoming one of the three major treatments for coronary heart disease alongside coronary artery bypass transplantation (CABG) and drug therapy.
<h1 class="pgc-h-arrow-right" data-track="2" > from imitation to innovation</h1>
Academician Han Yaling
On April 23, 1973, Chen Haozhu of Zhongshan Hospital affiliated to Fudan University and Wang Hengrun of Shanghai Sixth People's Hospital successfully performed the first case of percutaneous puncture of femoral artery selective coronary angiography in China. Since then, the interventional diagnosis of coronary heart disease has been carried out in China.
PTCA: Pioneers have pioneered interventional therapy
China has been applying PTCA technology since 1984. In 1986, Zheng Xiaolian of Xijing Hospital of the Fourth Military Medical University reported PTCA for the first time in China with 4 case reports, creating an era of interventional treatment for coronary heart disease in China. Gao Runlin of Fuwai Hospital of the Chinese Academy of Medical Sciences was the first to report PTCA with multiple branches, complex lesions and chronic complete occlusion (CTO) lesions in China. In 1989, Gao Runlin took the lead in Carrying out remedial PTCA after the failure of acute ST-segment elevation myocardial infarction (STEMI) in China, and carried out direct PTCA in the same year. In 1990, PTCA combined with cardiogenic shock was carried out, which reduced the hospital fatality rate of patients to less than 50%, reaching the international advanced level.
The development and promotion of domestic coronary heart disease interventional technology benefits from a large number of "pioneering" experts and scholars who have been struggling in the cardiovascular field for many years, such as Gao Runlin, Zhu Guoying, Jia Guoliang, Lv Shuzheng, etc., who carried out PTCAs earlier in China and made important contributions to promoting the development of interventional cardiology in China.
Bare metal stents: the main treatment for patients with coronary heart disease
In the early 1990s, intracoronal bare metal stent (BMS) insertion was carried out in China. In 1994, Gao Runlin et al. first reported the clinical results of coronary infusion into BMS in China. In 1996, Han Yaling and others of the General Hospital of the Northern Theater reported the results of the successful insertion of 19 BMS in 16 patients with coronary heart disease in the hospital, with no complications, and 16 patients who were followed up for 1 to 8 months survived, of which 1 case was restenosis. By the mid-to-late 1990s, BMS insertion developed rapidly in various parts of China and became the main treatment method for patients with coronary heart disease in China.
Drug-eluting stents: development in sync with international synchronization
China is almost in sync with the international community in the field of drug-eluting stent (DES) applications. The Cypher SELECT real-world registration study organized by Gao Runlin, the ENDEVOR China registration study hosted by Han Yaling and others and the RESOLUTE China registration study hosted by Qiao Shubin of Fuwai Hospital of the Chinese Academy of Medical Sciences laid the foundation for the wide application of DES in China.
At the same time, China's cardiovascular doctors have also begun to carry out large-scale clinical research on domestic DES, reducing medical costs. Gao Runlin presided over the TARGET series of studies, Ge Junbo of Zhongshan Hospital Affiliated to Fudan University, and Lu Caiyi of the General Hospital of the People's Liberation Army of Chinese were the first to conduct pre-market research on the first domestic coating degradable EXCEL DES, and Han Yaling presided over the multi-center "real world" research after the listing of EXCEL stents.
In addition, Han Yaling also presided over the CREDIT and I-LOVE-IT 2 series of randomized controlled studies, exploring the long-term clinical efficacy and safety of degradable domestic DES of different types of coatings. Spencer B. King III, then editor-in-chief of the Interventional Fascicle of the Journal of the American College of Cardiology, commented that clinical research in China's devices has "moved from imitation to innovation."
Biodegradable stents: at the forefront of the world
The fully biodegradable scaffold (BRS) is the fourth revolution in coronary intervention. The ABSORB China study chaired by Gao Runlin observed the efficacy and safety of imported BRS in patients with coronary heart disease in China; the Xinsorb BRS study led by Ge Junbo and the subsequent NeoVas BRS study led by Han Yaling also achieved ideal results in the research and development of domestic BRS.
In addition, the domestic 2nd generation BRS test presided over by Gao Runlin has been completed. China's BRS research and development field is very active, has entered the international frontier ranks.
In 2019, the number of PCI completed cases in China has exceeded 1 million, becoming the country with the largest number of PCI in the world. In terms of PCI-related operational technology development, perioperative treatment strategies and their device research and development, China has changed from the past "running with" to the current "running and running", and some fields have even achieved a leap of "leading".
<h1 class="pgc-h-arrow-right" data-track="41" > innovative techniques continue to emerge, and the international stage shows China's style</h1>
China carried out transreidial PCI earlier in the world, and the proportion of transreidial PCI is as high as 95%, ranking first in the world, reducing patient pain, reducing bed rest time, bleeding and other complications.
Chinese scholars used 6 F outer diameter catheters to perform complex lesions PCI through the radial artery, and Yang Yuejin of Fuwai Hospital of the Chinese Academy of Medical Sciences first reported that the left trunk bifurcation lesion PCI of the transcoidial artery was feasible, and the success rate of the operation similar to that of the transfemoral artery route could be obtained, and this technology was widely disseminated internationally through live broadcasting.
Complex high-risk coronary artery lesions such as left trunk and CTO have been considered to be a worldwide problem in the interventional treatment of coronary heart disease. In 2000, Han Yaling pioneered the cost-effective, safe and successful rate of "multi-guide wire plaque extrusion" CTO lesion opening technology, in August 2004 Han Yaling completed the first case of reverse opening CTO lesion PCI in China, Ge Junbo, Chen Jiyan of Guangdong Institute of Cardiovascular Diseases, jing Quanmin of the General Hospital of the Northern Theater, etc. actively promoted the development of reverse opening CTO technology in China. In 2005, Ge Junbo demonstrated for the first time at the American Transcatheter Cardiovascular Therapy Conference (TCT) to open the left trunk complete occlusion lesion.
In 2003, Han Yaling proposed a new surgical method of left backbone intervention - "micro-squeeze stent technology", which successfully solved the problem of increasing the risk of thrombosis and re-stenosis after double stent surgery.
In 2005, Chen Shaoliang of Nanjing First Hospital invented the double-pair kiss extrusion stent technology and presided over a series of in-depth randomized controlled studies, which confirmed its safety and efficacy against left trunk terminal bifurcation lesions and complex bifurcation lesions.
Xu Bo and others in Fuwai Hospital of the Chinese Academy of Medical Sciences found that the experience of the surgeon is directly related to the effect of left trunk PCI, suggesting the importance and necessity of strengthening technical training and experience accumulation for interventional treatment of left trunk lesions.
On the basis of a large number of clinical practices, Chinese scholars have completed more clinical studies of academic value in the field of PCI in recent years, such as the DEFINITION standard proposed by Chen Shaoliang and others, which can effectively distinguish between simple and complex bifurcation lesions of the left trunk, and provide a basis for guiding the PCI strategy of left trunk bifurcation lesions.
Chinese scholars have also conducted in-depth exploration of many contents, including the rational combination of thrombolysis and PCI, the use of statins for the prevention and treatment of contrast agent-induced acute kidney injury, and the innovation of STEMI treatment strategies, etc., marking that China's PCI treatment has entered a new stage of industry-university-research combination, independent thinking and innovative development from the first 20 years of learning and popularization of technology.
<h1 class="pgc-h-arrow-right" data-track="42" > create a model for individualized antithrombotic therapy</h1>
The improvement of the clinical efficacy of PCI is closely related to the optimization of perioperative antithrombotic therapy strategies. The Dayu registration study chaired by Gao Runlin confirmed the safety and efficacy of the novel P2Y12 receptor antagonist in china's ACS population.
The I-LOVE-IT 2 study led by Han Yaling found that the safety and efficacy of stable coronary heart disease and low-risk ACS patients receiving double antiplatelet therapy (DAPT) for 6 months after a new generation of DES surgery were not inferior to 12 months OF DAPT, which provided a safe and effective short-course DAPT strategy for patients with low-risk hypertension of coronary heart disease who could not tolerate long-term DAPT.
At the same time, the BRIGHT randomized controlled research report presided over by Han Yaling was published in full in the Journal of the American Medical Association, and for the first time proposed a new perioperative anticoagulation strategy for acute myocardial infarction: after the emergency interventional treatment of patients, the high-dose intravenous infusion time of bivarudine was extended, overcoming the problem of increasing the risk of acute stents in the clinical application of bivarudine in Europe and the United States, and was praised by JAMA as "a model that requires more personalized antithrombotic therapy".
<h1 class="pgc-h-arrow-right" data-track="43" > outlook</h1>
From the development of China's first PTCA to the series of studies of BRS, the spirit of cardiovascular interventional doctors in China has been diligently pursuing, constantly exploring and pursuing excellence throughout.
Since more than 10 years ago, China's cardiovascular doctors have been invited to introduce the research results and experience in the field of PCI in China at important international conferences, and to carry out real-time surgical broadcasting of new technologies and new instruments PCI, which is undoubtedly proud, but should not be complacent. At this stage, the original degree of innovation in the field of PCI research in China is still not high enough, and Cardiovascular doctors in China should cooperate more closely with international or domestic academic organizations and peers.
China's coronary heart disease interventional treatment technology will surely make greater breakthroughs with the overall development of national science and technology, and make greater contributions to the final victory over cardiovascular diseases that seriously threaten the health and life of our people.