多支冠状动脉病变完全及不完全介入性血运重建1年疗效的比较

目的比较多支冠状动脉病变患者经皮冠状动脉介入术（PCI）进行完全性和不完全性血运重建术后1年的临床疗效。方法分析1995年6月-2004年9月接受PCI的2579例冠心病患者，其中完全性血运重建组2278例（88．3％），不完全性血运重建组301例，对比分析两组PCI术后1年的随访结果。结果不完全性血运重建组患者中3支血管病变、复杂B2／C型病变、完全闭塞病变的比例均高于完全性血运重建组（P〈0．01），术前靶血管狭窄程度亦较后者严重（P〈0．05）；完全血运重建组PCI成功率明显高于不完全血运重建组（96．4％vs94．0％，P〈0．05）。对2426例患者进行了12个月的随访，总随访率为94．1％。两组造影复查率、造影复查再狭窄率无显著差异（56．4％vs55．3％，15．2％vs19．2％，P均〉0．05）。完全性血运重建组患者心绞痛复发率和主要不良心脏事件发生率均显著低于不完全性血运重建组（5．7％vs9．2％，P〈0．05；21．2％vs31．6％，P〈0．01）。结论多支冠状动脉病变行介入完全性血运重建的患者1年长期临床疗效优于不完全性血运重建者。     

老年冠心病患者介入治疗血运重建方式临床疗效分析北大核心CSCD

目的探讨接受经皮冠状动脉介入治疗(PCI)伴多支病变高龄冠心病患者达到完全血运重建(CR)或部分血运重建(ICR)对临床预后的影响。方法连续纳入2015年1月至2015年9月确诊为冠状动脉多支病变并接受PCI高龄患者(≥75岁)257例,根据PCI情况分为CR组与ICR组。对比两组患者临床基本资料、PCI情况、院内及随访期间主要心脑血管不良事件(MACCE)。结果 CR组患者171例(66.53%),ICR组患者86例(33.47%)。ICR组患者伴有高血压病史、糖尿病病史,入院诊断急性非ST段抬高型心肌梗死、闭塞病变,术后1、3个月出现胸闷、心慌等不适症状及二次住院率比例均明显高于CR组(P<0.05)。两组术后院内、术后1、3、6个月MACCE发生率差异均无统计学意义(P>0.05)。结论伴多支病变高龄冠心病患者ICR并未增加PCI术后MACCE风险,但二次住院率与术后不适症状发生率增加,远期预后有待进一步观察。     

血运重建策略对老年急性ST段抬高型心肌梗死冠脉多支血管病变患者预后影响

目的探讨两种血运重建策略对老年急性ST段抬高型心肌梗死(STEMI)冠脉多支血管病变患者预后的影响。方法选取空军军医大学唐都医院心血管内科自2006年1月1日至2014年6月30日收治的215例诊断为STEMI并给予支架植入的老年患者为研究对象。按照血运重建策略将患者分为完全性血运重建组(n=85)与不完全性血运重建组(n=130)。比较两组患者的一般资料及主要不良心血管事件(MACE)发生率。结果不完全血运重建组MACE发生率为30.0%(39/130),显著高于完全血运重建组的14.1%(12/85),两组间比较,差异有统计学意义(P<0.05)。两组患者心源性死亡、缺血驱动血运重建、再发心肌梗死、顽固性心绞痛及全部出血事件发生率比较,差异无统计学意义(P>0.05);而完全血运重建组心力衰竭及全因死亡的发生率均显著低于不完全血运重建组,两组间比较,差异有统计学意义(P<0.05)。结论完全性血运重建显著降低了STEMI多支血管病变患者经皮冠状动脉介入治疗术后3年MACE发生风险,且显著减少了心力衰竭与全因死亡发生率。     

冠状动脉左主干狭窄72例临床分析及不同治疗方法的疗效比较

目的:观察左冠状动脉主干病变(LMCA)患者的临床特征,并比较药物治疗、经皮冠状动脉介入术(PCI)及冠状动脉旁路移植术(CABG)这三种治疗方法的近期及远期疗效.方法:回顾性收集2007年1月～2009年6月在我院住院治疗的保存完整的72例LMCA患者的临床资料及CAG结果.根据左主干管径狭窄程度定50%～69%为Ⅰ级病变,70%～89%为Ⅱ级病变,90%～99%为Ⅲ级病变,100%完全闭塞为Ⅳ级病变.根据其他冠脉受累情况分为:单纯左主干组、左主干+1支组、左主干+2支组及左主干+3支组.2009年11月～12月对上述患者进行了随访,观察死亡、非致死性心肌梗死、再次进行冠脉血运重建术等终点事件的发生情况及心绞痛复发情况.结果:①临床资料比较:左主干病变总的心绞痛发生率为83.3%,各组比较差异无显著性(P＞0.05).心肌梗死发生率为59.7%,LM并3支组与其余各组比较差异有显著性(P＜0.05),单纯LM组射血分数明显高于LM并3支组(P＜0.01)和LM并2支组(P＜0.05);②.单纯左主干组6例(8.3%),左主干+1支组6例(8.3%),左主干+2支组11例(15.3%),左主干+3支组49例(68.1%).左主干Ⅰ级病变32例(44.4%),Ⅱ级病变21例(29.2%),Ⅲ级病变18例(25%),完全闭塞1例;③.近期疗效:药物治疗、PCI及CABG组之间差异无显著性(P＞0.05).远期疗效比较:血运重建组的死亡率和心肌梗死发生率显著低于药物治疗组(P＜0.05).PCI与药物治疗两组间的血运重建率没有差异(P＞0.05),这两组的血运重建率明显高于CABG组(P＜0.05).心绞痛复发的情况,PCI及CABG组与药物治疗组比较有显著性差异(P＜0.05).结论:经过选择的无保护LMCA病变支架置入术是可行和安全的,并可取得较好近、远期疗效.冠状动脉血运重建,无论是PCI还是CABG对于左主干病变均比单纯药物治疗有延长寿命,减少远期终点事件的作用.     

血管内超声指导介入治疗冠状动脉分叉病变临床研究

目的探讨血管内超声（IVUS）对冠状动脉真性分叉病变介入治疗的指导作用及对远期预后的影响。方法选取2010年4月至2014年1月接受双支架治疗的冠状动脉分叉病变患者62例,随机分为IVUS组（32例）和冠状动脉造影组（30例）,比较两组冠状动脉主支和分支近端和远端最小管腔直径（MLD）、最小管腔横截面积（MLA）、参照管腔直径（RLD）及病变长度、植入支架直径和长度,并记录术后12个月支架内血栓、靶病变血运重建（TLR）、主要不良心血管事件（MACE）。结果 IVUS组主支和分支MLD 高于冠状动脉造影组（P＞0.05）,MLA、RLD、植入支架直径和长度均高于冠状动脉造影组（P＜0.05）,IVUS组支架内血栓、TLR、MACE发生率均低于冠状动脉造影组（P＞0.05）。结论 IVUS指导经皮冠脉介入治疗（PCI）双支架植入治疗冠状动脉分叉病变,有助于优化支架植入,改善PCI远期预后。     

多枚药物洗脱支架治疗冠心病远期疗效

目的回顾性分析经皮冠状动脉介入治疗(PCI)患者植入单枚与多枚(≥3枚)药物洗脱支架远期预后差异。方法466例接受PCI治疗并植入药物洗脱支架患者,分为单个药物洗脱支架组(373例)和多枚药物洗脱支架组(93例)。比较两组的基础临床情况和12个月主要心脏不良事件(死亡、心肌梗死、靶血管血运重建)。结果与单枚药物洗脱支架组相比,多枚药物洗脱支架组有更多患者伴有高血压、糖尿病和心功能不良,随访17个月主要心脏不良事件发生率(17.2%)较单个药物洗脱支架组(8.6%)明显增加(P＜0.05)。结论与植入单个药物洗脱支架患者比较,植入多个药物洗脱支架患者远期预后不佳。     

冠心病合并慢性肾功能不全患者的临床特征和PCI远期预后分析

目的 测定冠心病合并慢性肾功能不全(CRI)患者的临床特征,并探讨药物洗脱支架对这些患者冠状动脉介入治疗(PCI)的主要不良事件发生率和临床远期预后的作用.方法 973例经冠状动脉造影确诊冠状动脉明显狭窄(管腔内径减少＞50%)中,516例合并肾功能不全(CRI组),457例肾功能正常(对照组).记录两组基础临床和造影情况,每例均接受PCI治疗和术后临床随访.结果 CRI组高龄、高血压及糖尿病患者明显多于对照组,但左室射血分数显著低于对照组.CRI组冠状动脉复杂病变(C型)明显多于对照组.平均17个月随访结果显示,CRI组总病死率高于对照组(6.2%和3.3%,P＜0.05).亚组分析显示,CRI患者药物洗脱支架治疗后病死率低于普通支架(4.1%和8.5%,P＜0.05).结论 CRI患者通常冠状动脉病变严重,PCI后病死率明显增加,但药物洗脱支架较普通支架显著改善远期预后.     

碘克沙醇对单支及多支血管病变患者冠状动脉 介入治疗临床预后研究

目的探讨碘克沙醇对单支及多支血管病变患者行经皮冠状动脉介入治疗(PCI)的主要不良心脑血管事件(MACCE)及对比剂诱发的急性肾功能损伤(CI-AKI)差异。方法选取自2013年10月至2015年10月中国30个中心入选的3 042例行冠状动脉支架植入术患者为研究对象。根据病变血管支数不同将患者分为单支病变(SV)组(n=2 618)与多支病变(MV)组(n=424)。主要研究终点为PCI术后72 h MACCE[包括靶病变再次血运重建(TLR)、卒中、支架内血栓、心源性死亡、非致死性心肌梗死(MI)]及CI-AKI,次要终点为PCI后72 h至30 d的MACCE发生情况。记录并比较两组患者终点事件发生率。结果 SV组患者PCI手术时间、水化总体积、碘克沙醇用药时间、碘克沙醇体积低于MV组,术后水化比例、术前及术后均水化比例高于MV组,两组比较比较,差异均有统计意义(P<0.05)。两组患者病变血管、病变分级、术前心肌梗塞溶栓血流比较,差异有统计学意义(P<0.05)。两组患者主要终点事件比较:SV组MACCE、MI发生率低于MV组,两组比较,差异有统计学意义(P<0.05)。两组患者次要终点比较:SV组TLR发生率、支架内血栓发生率低于MV组,两组比较,差异有统计学意义(P<0.05)。结论应用碘克沙醇行PCI治疗后,MV患者住院期间的MACCE及MI发生率较SV患者增加,CI-AKI发生率无差异;术后72 h至30 d MV患者TLR及支架内血栓风险增加。     

伴多支血管病变超高龄急性冠状动脉综合征患者不同介入策略疗效观察

目的 评价经皮冠状动脉介入治疗(PCI)中完全血运重建对伴发多支血管病变超高龄(＞80岁)急性冠状动脉综合征患者的安全性和有效性.方法 2012年9月至2014年9月82例经冠状动脉造影证实为多支血管病变并入院接受PCI术治疗的80岁以上急性冠状动脉综合征患者入选本研究,其中45例仅作罪犯血管血运重建,37例作完全血运重建.观察记录两组患者临床特征、住院期间和1年随访期间主要心血管不良事件(MACE)如全因死亡、心绞痛复发和心肌缺血再次血运重建等,以及对比剂肾病发生率.结果 两组患者年龄、性别、吸烟史、伴高血压病、伴糖尿病、伴高脂血症、脑卒中史和既往PCI史无明显差异.完全血运重建组和罪犯血管血运重建组患者对比剂肾病发生率分别为8.1％(3/37)、13.3％(6/45),差异无统计学意义(P=0.457);MACE发生率分别为8.1％(3/37)、40.0％(18/45),差异有统计学意义(P=-0.022),其中心绞痛复发率分别为2.7％(1/37)、20.0％(9/45)(P=0.041).结论 伴发多支血管病变超高龄(＞80岁)急性冠状动脉综合征患者接受PCI术完全重建血运治疗是安全、有效的.     

速度向量成像技术评价颈总动脉管壁弹性与冠心病及其病变程度的相关性

目的 应用速度向量成像(velocity vector imaging,VVI)技术评价冠心病(coronary artery disease,CAD)患者颈总动脉管壁弹性及其与冠状动脉病变程度的相关性,探索无创评估冠状动脉病变程度的方法.方法 根据冠状动脉造影结果选取冠心病患者60例,分别为单支病变组19例,双支病变组19例,多支病变组22例,另外选取冠状动脉造影、心电图及常规超声心动图检查结果正常者20例作为对照组.应用VVI技术定量分析各组颈总动脉短轴各壁平均收缩期峰值速度(Vs)、峰值应变(Ss)及峰值应变率(SRs),计算冠脉阻塞积分(coronary artery obstacle score,CAOS)并进行对比分析.结果 颈总动脉短轴各壁平均Vs、Ss及SRs测值:多支病变组与双支病变组均低于正常对照组(P＜0.05),多支病变组低于单支病变组(P＜0.05),单支病变组与正常对照组对比无统计学意义.颈总动脉短轴各壁平均Vs与CAOS积分呈负相关(P＜0.05).结论 VVI技术检测冠心病患者颈总动脉短轴各壁平均Vs、Ss及SRs随冠状动脉病变程度加重明显降低,有望成为早期无创预测冠心病病变程度的新指标.     

ECG gated thallium 201 myocardial images: value in detecting multivessel disease in patients on anti anginal therapy 1-3 months after myocardial infarction

ECG gated 201Tl scintigraphy was compared to non gated images for detecting 2-3 vessel disease 1-3 months after a first uncomplicated myocardial infarction. In all, 111 patients on anti anginal treatment underwent coronary arteriography and stress thallium imaging; 39 showed single vessel disease (SVD), and 72 multivessel disease (MVD). Sensitivity of black and white analog images was 82% for SVD and 8% for MVD. Sensitivity of computerized colored static images was 87% for SVD and 33% for MVD. For gated images, sensitivity was 100% and 92% in patients with SVD and MVD respectively. Specificity for detecting MVD was 95% for black and white images, 77% for computerized colored static images, and 69% for ECG gated images. Thus, ECG gated exercise 201TL scintigraphy is useful for predicting the extent of coronary artery disease 1-3 months after myocardial infarction in patients on anti anginal therapy.     

ECG gated thallium 201 myocardial images: Value in detecting multivessel disease in patients on anti anginal therapy 1–3 months after myocardial infarction

ECG gated²⁰¹T1 scintigraphy was compared to non gated images for detecting 2–3 vessel disease 1–3 months after a first uncomplicated myocardial infarction. In all, 111 patients on anti anginal treatment underwent coronary arteriography and stress thallium imaging; 39 showed single vessel disease (SVD), and 72 multivessel disease (MVD). Sensitivity of black and white analog images was 82% for SVD and 8% for MVD. Sensitivity of computerized colored static images was 87% for SVD and 33% for MVD. For gated images, sensitivity was 100% and 92% in patients with SVD and MVD respectively. Specificity for detecting MVD was 95% for black and white images, 77% for computerized colored static images, and 69% for ECG gated images. Thus, ECG gated exercise²⁰¹TL scintigraphy is useful for predicting the extent of coronary artery disease 1-3 months after myocardial infarction in patients on anti anginal therapy.     

药物洗脱支架治疗2型糖尿病合并冠心病多支血管病变的中期疗效

目的对比分析裸金属支架（BMS）与药物洗脱支架（DES）在2型糖尿病（T2DM）合并多支冠脉病变经皮冠状动脉介入治疗（PCI）应用中的安全性和中期疗效，为DES治疗此类患者提供依据。方法连续人选2002年11月-2005年6月首次接受PCI治疗的443例T2DM合并多支冠脉血管病变患者，其中BMS组226例，雷帕霉素（Cypher）支架组91例，紫杉醇（TAXUS）支架组126例，分析患者住院期间及随访6个月的临床情况。结果三组患者临床特征、手术成功率及住院期间主要不良心脏事件（MACE）发生率等指标均无明显差异。Cypher支架组中病变长度和分叉病变的比例及TAXUS支架组中3支血管和分叉病变的比例均明显高于BMS组（P〈0．05或0．01）。两DES组的造影随访再狭窄率明显低于BMS组（Cypher组3．2％、TAXUS组4．5％协BMS组37．3％，P〈0．05），临床随访6个月MACE发生率亦明显低于BMS组（Cypher组5．7％、TAXUS组5．8％wBMS组18．5％，P〈0．01）。结论与BMS相比，T2DM合并多支冠脉血管病变患者植入Cypher支架和TAXUS支架安全性高，6个月中期疗效较理想。     

Myocardial perfusion imaging after coronary revascularization: a clinical appraisal

Revascularization procedures, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), are performed in many patients with coronary artery disease. Despite the effectiveness of these procedures, different follow-up strategies need to be considered for the management of patients after revascularization. Stress myocardial perfusion single-photon emission computed tomography (MPS) is a suitable imaging method for the evaluation of patients who have undergone PCI or CABG, and it has been used in the follow-up of such patients. Radionuclide imaging is included in the follow-up strategies after PCI and CABG in patients with symptoms, but guidelines warn against routine testing of all asymptomatic patients after revascularization. After PCI, in the absence of symptoms, radionuclide imaging is recommended and indicated as appropriate after incomplete or suboptimal revascularization and in specific asymptomatic patient subsets. On the other hand, the value of MPS late after CABG in risk stratification has been demonstrated even in the absence of symptoms. Thus, given the adverse outcome associated with silent ischaemia, it can be speculated that all patients regardless of clinical status should undergo stress testing late after revascularization. Larger prospective studies are needed to assess whether stress MPS will have an impact on the outcome in asymptomatic patients after revascularization.     

Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography

Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD.The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.     

Triage of patients with suspected coronary artery disease using multislice computed tomography

RATIONALE AND OBJECTIVES: Several studies have shown that multislice computed tomography (MSCT) has a high sensitivity and specificity for detecting coronary artery stenoses. The aim of the present study was to investigate whether MSCT can reliably triage patients with suspected coronary artery disease (CAD) to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or no revascularization. MATERIALS AND METHODS: A total of 123 patients with suspected CAD who were referred for conventional coronary angiography (CATH) additionally underwent MSCT (16*0.5 mm detector collimation). Therapeutic decisions made on the basis of CATH and MSCT strictly following current guidelines for treatment of CAD were compared with decisions made by a cardiac surgeon and an interventional cardiologist. Only MSCTs with at least adequate image quality in all coronary segments were included in the analysis (94/123). RESULTS: Decisions made on the basis of MSCT and CATH according to guidelines did not differ significantly (agreement of 88%, 82 of 94, P = .319). The therapeutic decisions made by the interventional cardiologist and the cardiac surgeon based on CATH differed significantly (overall agreement of 79%, 74 of 94 cases, P < .001; cardiologist: 78% PCI and 22% CABG versus surgeon: 38% PCI and 62% CABG), whereas there was 100% agreement regarding decisions for or against invasive treatment. CONCLUSIONS: MSCT shows good agreement with CATH in triaging patients with suspected CAD to CABG, PCI, or no revascularization. The choice of revascularization procedure is significantly more strongly influenced by whether an interventional cardiologist or a cardiac surgeon makes the decision than by the diagnostic test on which the decision is based.     

冠脉病变支数对冠脉介入治疗术后1年主要心脑血管事件影响

目的探讨冠脉病变支数对冠脉介入治疗术后1年主要心脑血管事件(MACCE)的影响。方法选取2012年1月至2013年3月连续就诊于沈阳军区总医院心血管内科经皮冠状动脉介入治疗的冠心病患者5 702例,其中,单支病变患者1 731例,多支病变患者3 971例,利用倾向性评分匹配对比研究方法,找出与单支病变最匹配的1 731例多支病变患者进行对比研究。采取电话、再住院及信访调查,观察患者的临床特点、生化指标、介入手术资料对MACCE发生的影响。主要终点为介入治疗术后1年MACCE发生情况,包括全因死亡、再次心肌梗死、靶病变/靶血管再次血运重建、脑血管意外。结果两组患者全因死亡、非致死性心肌梗死、缺血性卒中、再次血运重建发生率比较,差异均无统计学意义(P>0.05)。多支病变组心源性死亡发生21例,占1.2%,单支病变组心源性死亡发生10例,占0.6%,两组间比较,差异有统计学意义(P<0.05)。结论冠脉病变支数与冠脉介入治疗术后1年MACCE有关,多支血管病变患者心源性死亡率高。     

Serial changes in left ventricular global and regional function during exercise after percutaneous transluminal coronary angioplasty; effect of complete coronary revascularization

In order to evaluate the effect of complete coronary revascularization (CR) with PTCA on global LV function at rest and during exercise, EF, LV volumes and systolic blood pressure/end-systolic volume index (SP/ESVI) were assessed in 23 patients with CR before, 14 days after (early FU) and 4 to 12 months after PTCA (late FU) by first-pass radionuclide angiography (FRNA). The subjects were divided into 3 groups in this study, G-I which consisted of 14 patients with continued CR, G-II, 9 patients with discontinued CR due to restenosis and G-C, 7 normal subjects. To further assess anterior (Ant) and apical (Ap) regional EFs, 15 patients with dilatation of left anterior descending artery were subdivided into 9 patients with continued success (G-I LAD) and 6 patients with restenosis (G-II LAD). Exercise-induced global LV dysfunction improved significantly both at early FU and late FU in G-I, however improved insignificantly at early FU and did not change at late FU in G-II. Even response to exercise (delta EF, % delta SP/ESVI) at late FU in G-I was significantly (p less than 0.05) less than those in G-C. Regional dysfunction during exercise already improved significantly (Ant: p less than 0.05, Ap: p less than 0.01) at early FU in G-I LAD, but did not improve sufficiently in G-II LAD. In conclusion, FRNA may be useful for the assessment of completeness of coronary revascularization by PTCA and may give guidelines for repeat angiography.     

外周支架在经皮冠状动脉介入治疗中的应用

目的评价PALMAZ BLUE.014外周支架(简称BLUE支架)在经皮冠状动脉介入治疗(PCI)中的疗效和安全性。方法经冠状动脉造影确诊5例冠心病患者,其参照血管直径≥5.0 mm(简称大冠状动脉),术中采用BLUE支架,共置入5枚,其中前降支3枚,右冠状动脉2枚。结果 5枚支架均顺利置入冠状动脉狭窄段,支架置入术后,残余狭窄≤10%。住院期间及术后随访6~12个月,所有患者均未出现胸痛或胸闷症状,未发生支架内血栓、心肌梗死及再次血管重建。术后6~12个月均复查冠状动脉造影,5枚支架内未见明显再狭窄。结论 BLUE支架用于PCI术,安全性好,疗效满意,可作为大冠状动脉冠心病患者PCI治疗的策略之一。