Purpose: Thrombus aspiration in ST-elevation myocardial infarction (STEMI) with high thrombus burden did not improve clinical outcomes. The clinical e cacy of bailout use of platelet glycoprotein IIb/IIIa inhibitors (GPIs) in this clinical scenario remains unknown.Methods: We assessed associations between GPI use and in-hospital major bleeds, ischemic events, and mortality among STEMI patients treated with percutaneous coronary intervention (PCI) and thrombus aspiration in a nationwide acute coronary syndrome registry (the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project).Results: A total of 5,896 STEMI patients who received thrombus aspiration were identi ed, among which 56.3% received GPI therapy. In a 1-to-1 propensity-score-matched cohort, compared with STEMI patients not treated with GPI, GPI use was associated with a 69% increase in major in-hospital bleeds, with an odds ratio (OR) of 1.69, a 95% con dence interval (CI) of 1.08 to 2.65, and a nonsigni cant reduction in ischemic events (OR: 0.61, 95% CI: 0.36 to 1.06), as well as a neutral effect on mortality (OR: 0.93, 95% CI: 0.55 to 1.58). However, among patients aged < 65 years, GPI use was associated with a reduction in ischemic events (OR: 0.26, 95% CI: 0.08 to 0.77), and no signi cant increase in major bleeds (OR: 1.23, 95% CI: 0.67 to 2.25) was observed.Conclusion: In a nationwide registry, routine use of GPI following thrombus aspiration was not associated with reduced in-hospital ischemic events and mortality, but at the cost of increased major bleeding.However, for patients aged < 65 years, there may be a potential net bene t.

Background The evidence for the comparative effectiveness and safety of ticagrelor versus clopidogrel in older patients with acute coronary syndrome (ACS) is limited, especially in the acute phase of ACS. This study aimed to compare the in-hospital outcomes of ticagrelor versus clopidogrel in older patients with ACS. Methods Hospitalised ACS patients aged ≥75 years who were recruited to the Improving Care for Cardiovascular Disease in China-ACS project between November 2014 and December 2019 and received aspirin and P2Y12 receptor inhibitors within 24 h after first medical contact were included. The primary outcomes were in-hospital major adverse cardiovascular events (MACE) and major bleeding. Multivariable Cox regression was performed to evaluate the comparative effectiveness and safety of ticagrelor and clopidogrel. Inverse probability of treatment weighting (IPTW) and propensity score matching analyses were performed to evaluate the robustness of the results. Results Of 18,244 ACS patients, 18.5% received ticagrelor. Multivariable-adjusted analysis revealed comparable risks of in-hospital MACE between patients receiving ticagrelor and clopidogrel (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92–1.35). However, ticagrelor use was associated with 45% higher risk of in-hospital major bleeding compared with clopidogrel use (HR 1.45, 95% CI 1.09–1.91). Similar results were found in the IPTW analysis. Conclusions ACS patients aged ≥75 years receiving ticagrelor during the acute phase had similar risk of in-hospital MACE, but higher risk of in-hospital major bleeding compared with those receiving clopidogrel. More evidence is needed to guide the use of P2Y12 receptor inhibitors during hospitalisation in older patients with ACS. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.

Background The association between P2Y12 receptor inhibitors reloading and in-hospital outcomes in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients who were on chronic P2Y12 receptor inhibitors therapy remained underdetermined. Methods The Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC–ACS project) is a national registry active from November 2014 to December 2019. 4790 NSTEACS patients on chronic P2Y12 receptor inhibitors therapy were included. Cox proportional hazard models, Kaplan–Meier curves, and subgroup analyses were conducted. Results The NSTEACS patients who received reloading of P2Y12 receptor inhibitors were younger and had fewer comorbid conditions. The reloading group had a lower risk of major adverse cardiac events (MACE) (0.51% vs. 1.43%, P = 0.007), and all-cause death (0.36% vs. 0.99%, P = 0.028), the risks of myocardial infarction and major bleeding were not significantly different between patients with and without reloading. In survival analysis, a lower cumulative risk of MACE could be identified (Log-rank test, P = 0.007) in reloading group. In the unadjusted Cox model, reloading P2Y12 receptor inhibitors was associated with a decreased risk of MACE [HR, 0.35; 95% CI 0.16–0.78; (P = 0.010)] and all-cause death [HR, 0.37; 95% CI 0.14–0.94; (P = 0.036)]. Reloading of P2Y12 receptor inhibitors was associated with a decreased risk of MACE in most of the subgroups. Conclusions In NSTEACS patients already taking P2Y12 receptor inhibitors, we observed a decreased risk of in-hospital MACEs and all-cause mortality and did not observe an increased risk of major bleeding, with reloading. The differential profile in the two groups might influence this association and further studies are warranted. Clinical trial registration: https://www.clinicaltrials.gov (Unique identifier: NCT02306616, date of first registration: 03/12/2014)

The electrostatic field-induced electrolyte jet (E-Jet) electric discharge machining (EDM) is a newly developed micro machining method. However, the strong coupling of the electrolyte jet liquid electrode and the electrostatic induced energy prohibited it from utilization in conventional EDM process. In this study, the method with two discharge devices connecting in serials is proposed to decouple pulse energy from the E-Jet EDM process. By automatic breakdown between the E-Jet tip and the auxiliary electrode in the first device, the pulsed discharge between the solid electrode and the solid workpiece in the second device can be generated. With this method, the induced charges on the E-Jet tip can indirectly regulate the discharge between the solid electrodes, giving a new pulse discharge energy generation method for traditional micro EDM. The pulsed variation of current and voltage generated during the discharge process in conventional EDM process verified the feasibility of this decoupling approach. The influence of the distance between the jet tip and the electrode, as well as the gap between the solid electrode and the work-piece, on the pulsed energy, demonstrates that the gap servo control method is applicable. Experiments with single points and grooves indicate the machining ability of this new energy generation method.