Background Several factors determine the efficacy of warfarin anticoagulation in patients with non-valvular atrial fibrillation (NVAF). This study aimed to use data from the Chinese Atrial Fibrillation Registry study to assess the control of anticoagulation therapy in Chinese patients with NVAF treated with warfarin. Material/Methods From the Chinese Atrial Fibrillation Registry study the anticoagulant use and dosing, the time in therapeutic range (TTR) of the international normalized ratio (INR), and standard deviation of the observed INR values (SD INR ), and their influencing factors were evaluated. Results The median INR and SD INR were 2.04 (IQR 1.71–2.41) and 0.50 (IQR, 0.35–0.69), respectively. The median TTR was 51.7% (IQR, 30.6–70.1%) and only 25.1% had a TTR ≥70%. Age was ≥70 years (OR, 0.72; 95% CI, 0.55–0.94; P=0.015), bleeding history (OR 0.48; 95% CI, 0.23–0.89; P=0.029), the use of a single drug (OR, 0.62; 95% CI, 0.42–0.92; P=0.016), more than drug (OR, 0.60; 95% CI, 0.41–0.88; P=0.009), and lack of assessment of bleeding risk (OR, 0.72; 95% CI, 0.54–0.97; P=0.033) were associated with TTR <70% (INR 2.0–3.0). Coronary heart disease (CHD) and peripheral artery disease (PAD) (OR, 0.69; 95% CI, 0.52–0.90; P=0.007) and diabetes mellitus (OR, 0.79; 95% CI, 0.62–0.99; P=0.044) were associated with increased variability in INR (SD INR ≥0.5). Conclusions In Chinese patients with NVAF, warfarin anticoagulation was associated with lower TTR and less stable anticoagulation than in current guidelines, and risk factors for reduced safety and efficacy were identified.

Because SARS-COV2 entry into cells is dependent on angiotensin converting enzyme 2 (ACE2) and angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) increase ACE2 activity, the safety of ACEI/ARB usage during the coronavirus disease 2019 (COVID-19) pandemic is a controversial topic. To address that issue, we performed a meta-analysis following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of the Embase, MEDLINE, PubMed, and Cochrane Library databases identified 16 case-control studies examining the effect of ACEI/ARB on the incidence of COVID-19 and its severity. ACEI/ARB usage was associated with an increased risk of COVID-19 morbidity (odds ratio (OR) 1.20, 95% confidence interval (CI) 1.07-1.33, P=0.001) among the general population but not in a hypertensive population (OR 1.05, 95% CI 0.90-1.21, P=0.553). ACEI/ARB usage was not associated with an increased risk of COVID-19 morbidity (coefficient 1.00, 95% CI 1.00-1.00, P=0.660) when we adjusted for hypertension in the general population. ACEI/ARB usage was also not associated with an increased risk of severe illness (OR 0.90, 95%CI 0.55-1.47, P=0.664) or mortality (OR 1.43, 95%CI 0.97-2.10, P=0.070) in COVID-19 patients. Our meta-analysis revealed that ACEI/ARB usage was not associated with either the increased risk of SARS-COV2 infection or the adverse outcomes in COVID-19 patients.

ObjectiveTo detect the value of B-type natriuretic peptide (BNP), white blood count (WBC), Creatinine, TNT and CK-MB in predicting acute myocardial infarction (AMI) mortality in patients aged 80 and over. Methods Mortality is defined as all-cause death rate during hospitalisation. The discrimination (c statistic) was evaluated. Results 384 patients presenting with ST segment elevation AMI (STEMI) and non-STEMI were enrolled. The mortality was 23.4%. The overall discriminatory capacity of BNP, WBC, Creatinine, TNT and CK-MB was 0.755 (95%CI: 0.7–0.811), 0.658 (95%CI: 0.593–0.723), 0.647 (95%CI: 0.578–0.716), 0.626 (95%CI: 0.562–0.690) and 0.619 (95%CI: 0.558–0.679), respectively. The discriminatory capacity of the BNP was good. Conclusions BNP is a useful risk predictor for hospital mortality of AMI patients aged 80 and over.

ObjectiveTo investigate the gender difference of bleeding in acute myocardial infarction patients aged 80 and over. Methods Life-threatening bleeding and major or minor bleeding is defined according to TIMI criteria. In a cohort of AMI patients aged ≥ 80 years from 2003 to 2012 at CCU department in fuxing hospital, the bleeding condition and the gender difference of bleeding was evaluated. Results 386 patients presenting with ST segment elevation AMI (STEMI) and non-STEMI were enrolled, which included 189 male and 197 female. Bleeding was observed in 37.6% of male and in 43.1% of female, Pearson chi-square showed that there was no gender difference in bleeding during hospitalisation, X2 = 1.248, P = 0.264. In the male patients, 2.8% of TIMI life-threatening bleeding, 19.7% of major and 77.5% of minor bleeding were discovered. 4.7% of TIMI life-threatening bleeding, 7.1% of major bleeding and 88.2% of minor bleeding were observed in the female patients. There was no significant gender difference in TIMI bleeding, X2 = 5.802, P = 0.057. Conclusions Our study demonstrates that no significant gender difference in TIMI bleeding in oldest-old patients with AMI is discovered.