急性ST段抬高型心肌梗死患者平均血小板体积的变化及与冠状动脉影像的关系

目的:探讨急性ST段抬高型心肌梗死（STEMI）患者平均血小板体积（MPV）变化及与冠脉影像的关系。方法: STEMI患者200例,测定MPV和血生化等实验室指标,行心脏超声检查,阅读急诊冠脉造影结果,分析直接经皮冠脉介入术后梗死相关动脉的血流。选择同期接受冠脉造影但排除冠心病的住院患者200例作为对照。结果: STEMI患者MPV显著高于对照组;校正其它影响因素后,MPV与高密度脂蛋白胆固醇（HDL-C）和左室射血分数（LVEF）呈独立负相关,与冠脉病变积分呈独立正相关;MPV于冠脉多支病变亚组显著高于单支病变亚组,左前降支为梗死相关动脉亚组显著高于左回旋支亚组,梗死相关动脉无自发性开通亚组显著高于自发性开通亚组,直接经皮冠脉介入术后没有达到TIMIⅢ级血流的亚组显著高于达到TIMIⅢ级血流的亚组。结论: STEMI患者MPV显著升高,与冠脉病变严重程度和梗死相关动脉的慢血流有密切关系。     

冠脉血流储备分数可能成为非梗死相关血管介入治疗的新标准

既往的研究发现急性ST 段抬高型心肌梗死(STEMI) 患者合并多支血管病变(MVD) 概率可高达40%，是心 肌梗死患者预后不良的主要原因之一。目前非梗死相关动脉的治疗策略存在诸多争议，且指南针对STEMI 非梗死 相关病变的处理无统一意见。冠脉血流储备分数(FFR) 较单纯冠脉造影能更直观地评价冠脉血流储备能力，可能成 为非梗死相关动脉介入治疗的标准之一。     

脑干梗死的相关危险因素及血管病变分析

目的探讨脑干梗死的危险因素及血管病变。方法选取2007年2月—2011年8月在我院住院治疗的急性脑梗死患者377例,根据颅脑MRI结果,将患者分为脑干梗死组(延髓、脑桥及中脑)和非脑干梗死组,比较两组的卒中危险因素;根据颅脑CE-MRA结果分析脑干梗死患者椎基底动脉血管病变。结果 (1)脑干梗死组糖尿病、糖耐量异常率及三酰甘油(TG)水平高于非脑干梗死组,差异有统计学意义(P<0.05);(2)脑干梗死患者椎基底动脉无狭窄者37例(37.7%),轻度狭窄者19例(19.3%),中重度狭窄者42例(43.0%)。7例中脑梗死中椎基底动脉狭窄者6例(85.7%),79例脑桥梗死中椎基底动脉狭窄者44例(55.7%),12例延髓梗死中椎基底动脉狭窄者11例(91.7%)。结论脑干梗死的危险因素不同于非脑干梗死,糖尿病、糖耐量异常及高TG多见于脑干梗死;脑干梗死多伴有椎基底动脉狭窄,脑干梗死最常见的发病机制是动脉粥样硬化。     

心肌梗死伴多支血管病变患者非梗死相关动脉处理时机的探讨

目的总结和分析因急性心肌梗死（acute myocardial infarction,AMI）伴多支血管病变行急诊经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗患者非梗死相关动脉处理情况,探讨非梗死相关动脉的处理时机。方法选择成功行急诊PCI治疗的合并多支血管病变AMI患者252例,其中未处理非梗死相关动脉用药物治疗51例,行冠状动脉动脉旁路移植术5例;而需处理非梗死相关动脉患者196例,其中7d内处理非梗死相关动脉（排除急诊PCI治疗当时同时处理非梗死相关动脉的患者）19例,7—14d内处理的患者81例,28-35d处理的患者96例。回顾性分析各组的一般临床资料,冠状动脉病变情况,观察的重点为各组3个月及6个月内主要心血管事件及再住院率。结果与其他组相比,28—35d干预组6个月内主要不良心血管事件（9．38％）、因心源性疾病二次入院率最低（10．4％）（P〈0．05）。结论在心肌梗死后第28—35天干预AMI患者非梗死相关动脉可能更有利于改善患者的预后。     

急性脑梗死患者大脑中动脉粥样硬化性重度狭窄的相关危险因素分析

<正>最近研究显示大脑中动脉深穿支合并皮层支和分水岭梗死的患者中94.40%存在相关供血动脉狭窄,重度狭窄的患者高达77.80%;直径小于或等于3.20cm单发深穿支梗死患者中18.40%存在相关供血动脉狭窄,重度狭窄的患者为1.10%。两组患者     

急性心肌梗死患者梗死相关血管与非梗死相关血管狭窄性病变的比较

目的比较急性心肌梗死(AMI)患者梗死相关血管与非梗死相关血管的狭窄性病变,探讨AMI与血管狭窄性病变的关系.方法选择35例经重组组织型纤溶酶原激活剂溶栓后,经临床及3～4周后 的冠状动脉(冠脉)造影显示再通、同时提示为双支病变的AMI者为研究对象,统计梗死相 关动脉(IRA)及非梗死相关动脉(n-IRA)的狭窄病变在≤50%、＞50%～75%、＞75%～99% 、100%4个范围内的病变数,并对冠脉病变的严重性采用Goffredo建议的冠脉病变积分法进 行分析.结果IRA≤50%的狭窄数(11例,30.6%)及＞50%～75%的狭窄数(10 例,27.8%)均显著高于n-IRA在此范围的狭窄数(3例,7%及4例,9.3%,P< 0.01),n-IRA在>75%～99%的狭窄数(31例,72.1%)及闭塞数(5例,11.6%)明 显多于IRA的狭窄数(12例,33.3%,P<0.01)及闭塞数(3例,8.3%,P <0.01).n-IRA的狭窄性病变范围积分也显著高于IRA的积分[(13.23±9.40 )∶(8.08±8.10),P<0.05].结论严重的冠脉狭窄性病变无法预测AMI的发生.     

接受直接经皮冠状动脉介入治疗ST段抬高性心肌梗死患者平均血小板体积、白细胞计数和中性粒细胞计数的变化及其与冠状动脉血流的关系

目的:观察接受直接经皮冠状动脉(冠脉)介入(PPCI)治疗的ST段抬高性心肌梗死(STEMI)患者入院时平均血小板体积(MPV)、白细胞计数(LC)和中性粒细胞计数(NC)等的变化及其与冠脉血流的关系。方法:选择179例接受PPCI治疗的STEMI患者(STEMI组),入院时测定MPV、LC、NC和血生化等指标,阅读冠脉影像资料,评估梗死相关动脉行PPCI前后的TIMI血流分级,计算梗死相关动脉行PPCI后校正TIMI血流帧数计数(CTFC)。同期冠脉造影等确诊的107例稳定型心绞痛患者作为对照(稳定型心绞痛组)。另外,根据PPCI前梗死相关动脉是否有自发性开通,将STEMI组分为PPCI前梗死相关动脉血流自发性开通亚组(50例)和无自发性开通亚组(129例);根据梗死相关动脉行PPCI后的冠脉血流,将STEMI组分为TIMI 3级亚组(148例)和未达TIMI 3级亚组(31例)。结果:与稳定型心绞痛组比较,STEMI组MPV、LC和NC显著升高(均P<0.01),血小板压积显著降低(P<0.05)。STEMI组内各亚组间比较显示,与行PPCI前梗死相关动脉自发性开通亚组比较,无自发性开通亚组MPV、LC和NC显著升高,血小板计数显著降低(均P<0.05);与行PPCI后梗死相关动脉血流达TIMI 3级亚组比较,未达TIMI 3级亚组LC、NC和血小板分布宽度显著升高(均P<0.05),MPV亦明显升高(P<0.01)。多元线性回归分析显示,MPV和NC是梗死相关动脉行PPCI后CTFC的独立影响因素。结论:STEMI患者MPV、LC和NC显著增加,MPV、LC和NC与梗死相关动脉行PPCI前后血流的受损程度有密切关系。     

经桡动脉冠状动脉介入诊疗232例临床分析

目的 探讨经桡动脉冠脉介入诊疗的可行性及安全性.方法 选择符合冠脉造影指征且Allen's试验阳性患者232例,首选以右桡动脉途径行冠脉造影,对符合介入指征者158例行介入治疗.结果 造影成功221例,成功率95.3%,失败11例,其中7例为穿刺不成功(桡动脉痉挛),另外4例因动脉狭窄或迂曲(桡动脉迂曲1例、肱动脉狭窄...     

急性心肌梗死中普伐他汀与溶栓治疗的联合应用:普伐他汀土耳其试验(PPT)

近来以溶栓方法治疗梗死相关损害显示了再梗死的倾向性。该研究是在急性心梗(AMI)中,将普伐他汀与溶栓治疗(TT)联合应用,以提高早期斑块稳定性。6个月后通过临床观察及血管造影检查评价其对死亡率、心血管事件、梗死相关动脉(IRA)狭窄和冠脉血管重建术(PTCA)后再狭窄的作用。     

关于冠脉介入治疗术中无复流研究的进展

无复流现象(NR)是指接受经皮冠状动脉介入治疗(PCI)的急性冠脉综合征患者,在心外膜梗死相关动脉(IRA)开通后,无冠脉夹层、栓塞、血栓、冠脉痉挛及狭窄等机械性阻塞证据的情况下,缺血心肌仍得不到有效血流灌注的一种现象.本文主要阐述其发病机制及防治研究的进展.     

Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome associated with thrombosis. Alternative anticoagulation to heparin is needed for HIT patients during percutaneous coronary intervention (PCI). We evaluated argatroban, a direct thrombin inhibitor, for anticoagulation in this setting. Ninety-one HIT patients underwent 112 PCIs while on intravenous argatroban (25 microg/kg/min [350 microg/kg initial bolus], adjusted to achieve an activated clotting time of 300-450 sec). Primary efficacy endpoints were subjective assessments of the satisfactory outcome of the procedure and adequate anticoagulation during PCI. Among patients undergoing initial PCIs with argatroban (n = 91), 94.5% had a satisfactory outcome of the procedure and 97.8% achieved adequate anticoagulation. Death (zero patients), myocardial infarction (four patients), or revascularization (four patients) at 24 hr after PCI occurred in seven (7.7%) patients overall. One patient (1.1%) experienced periprocedural major bleeding. For patients who had subsequent hospitalizations (mean separation of 150 days) for repeat PCI using argatroban anticoagulation (n = 21), there were no unsatisfactory outcomes. Overall, outcomes were comparable with those historically reported for heparin. Argatroban therefore is a reasonable anticoagulant option in this setting, where current options are limited.     

Ad hoc percutaneous coronary interventions in patients with stable coronary artery disease--a study of prevalence, safety, and variation in use from the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR).

OBJECTIVE: To utilize the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) to monitor the performance and safety of ad hoc PCIs. BACKGROUND: The performance of ad hoc PCI remains controversial. Patients' preference, cost, and vascular access issues favor an ad hoc strategy. Adequate time for thoughtful decision-making, scheduling complexity, informed consent, and physician reimbursement favor PCI on a subsequent day. METHODS: We analyzed results in 68,528 patients with stable angina entered in the ACC-NCDR from 2001-2003. Ad hoc PCI was evaluated in many clinical and nonclinical subgroups. A multivariable analysis was performed to determine whether ad hoc PCI had an independent relationship with complications or procedure success. RESULTS: Overall, 60.6% of patients underwent ad hoc PCI. There was no difference in ad hoc PCI mortality, renal failure, or vascular complications from staged PCI. A lower percentage of patients at high vs. low risk and with vs. without renal failure underwent ad hoc PCIs (58.6% vs.63.0% and 50.7% vs. 60.9% respectively). There was wide variation in the performance of ad hoc PCIs according to payer (70.2-60.3%), hospital PCI volume (67-50.2%), hospital owner (89.7-59.6%), and geographic area (75.5-47.4%). Ad hoc PCI per se was not independently related to PCI success or complications. CONCLUSIONS: PCI success was related to patient/lesion related factors and not to the performance of ad hoc PCIs per se. Although ad hoc PCI can be performed in more patients than at present, this strategy will never be possible in all patients at all times.     

Differences in baseline characteristics and in-hospital outcomes in patients with or without prior stroke undergoing percutaneous coronary intervention

BACKGROUND: Percutaneous coronary intervention (PCI) is increasingly used in patients with high-risk baseline characteristics. A prior stroke may identify patients who have a higher risk for post-PCI complications. However, no comparative data exist on post-PCI outcomes of patients with or without prior stroke. METHODS: Review of a PCI database of 9,088 consecutive PCIs from July 1997 to December 2002 identified 812 PCIs in patients with a history of prior stroke and 8,044 PCIs without prior stroke. RESULTS: Patients with prior stroke had high-risk baseline characteristics [diabetes, hypertension, hyperlipidemia, smoking, peripheral arterial disease, congestive heart failure, chronic renal failure, history of prior myocardial infarction and prior coronary artery bypass graft (CABG)] and high-risk coronary anatomy (p < 0.001 for each one). The triple composite (death, myocardial infarction and emergent CABG) and the triple composite plus post-PCI stroke were higher in patients with prior stroke (11.2% vs. 4.8%; p < 0.001; z = 7.617 and 12.1% vs. 5.0%; p < 0.001; z = 8.271, respectively. CONCLUSION: Patients with prior stroke constitute a high-risk PCI cohort with higher rates of in-hospital adverse events. A prior stroke history should be considered in evaluating potential candidates for PCI.     

Outcomes of Percutaneous Coronary Intervention in Atrial Fibrillation Patients Presenting With Acute Myocardial Infarction: Analysis of Nationwide Inpatient Sample Database

BackgroundAtrial fibrillation (AF) is common in patients presenting with myocardial infarction (MI). Percutaneous coronary intervention (PCI) has been shown to improve cardiovascular outcomes in MI. However, outcomes of PCI in AF patients presenting with MI remains largely unknown.MethodsWe analyzed the Nationwide Inpatient Sample (NIS) database to calculate the age adjusted mortality rate for PCI in AF patients presenting with MI between 2002 and 2011, in adults over 40 years of age. This was then compared to the mortality rate for PCI in non-AF patients with MI. Specific ICD-9-CM codes were used to identify patients and outcomes.ResultsOf 3,226,405 PCIs done during the study period, 472,609 (14.6%) PCIs were done on AF patients of which 137,870 PCIs were for MI. About 60% of these patients were male. Patients with AF were older (71.3 ± 10.6 years). Overall the number of PCIs shows a declining trend from 2002 to 2011, but for MI patients the number of PCIs appears stable over the years. The age adjusted in-hospital mortality following PCI in MI was significantly higher in AF group compared to the non-AF group (190.24 ± 17.21vs 109.08 ± 5.89 per 100,000; P < 0.01). This trend was seen during the entire study period.ConclusionsAF is prevalent in MI patients undergoing PCI. AF is associated with increased mortality following PCI for acute MI. AF is not a benign arrhythmia in MI patients and close attention is warranted in these patients to improve mortality.     

Same-day discharge after elective percutaneous coronary intervention: A single center experience

Introduction and objectivesElective percutaneous coronary intervention (PCI) has become an increasingly safe procedure. However, same day discharge (SDD) has yet to become standard practice. Our aim is to characterize the patients who underwent elective PCI and compare outcomes between the overnight stay (ONS) patient group and the group that was discharged on the same day at 24 hours and at 30 days.MethodsOne-year registry of patients who underwent an elective PCI. The possibility of SDD was established by the operator. Appropriate candidates were discharged at least four hours after the end of the intervention. The primary endpoints were defined as: Major adverse cardiac and cerebrovascular events (MACCE) — death, myocardial infarction (MI) stroke or transient ischemic attack (TIA), non-planned re-intervention — and vascular complications. Secondary endpoints were any unplanned hospital visit, readmission and re-catheterization.ResultsWe performed 155 elective PCIs. One patient was admitted to the coronary care unit; 111 patients stayed overnight (ONS Group); 43 patients were discharged the same day (SDD Group). Three patients had early (<4 hours) post procedure complications: two TIAs and one vascular access site complication. There were no MACCE between four and 24 hours, nor at 30 days. At 24 hours, two patients from the SDD group had unplanned visits. Between one and 30 days, more patients from the SDD group had unplanned visits (9.3% vs. 0.9%. p=0.02). One patient from the ONS group had a recatherization. There were no readmissions or reinterventions.ConclusionSame day discharge of selected patients who undergo elective PCIs is feasible and safe.     

Finecross微导管在冠状动脉慢性完全闭塞病变介入治疗中的应用

目的 了解Finecmss微导管在慢性完全闭塞（chronic total occlusion,CTO）病变介入治疗中的有效性和安全性.方法 对56例在茂名市人民医院行冠状动脉造影发现CTO病变并对其进行介入治疗的患者的临床资料和手术过程进行回顾性分析.结果 56例CTO病变闭塞时间为（6.8±3.2）个月;闭塞段长度（32 ±22） mm.介入治疗成功43例,其中正向33例,逆向10例.13例失败患者中,正向6例,原因为导丝不能进入血管真腔内;逆向7例中4例导丝不能穿过病变（2例微导管和1例导丝不能通过侧支循环而终止）,2例微导管不能通过闭塞病变,1例患者术中生命体征不稳定.所有患者术后住院期间无主要心血管事件发生.结论 Finecmss微导管在CTO病变的介入治疗中是安全和有效的.     

Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With Cardiogenic Shock

Background

Recent trials demonstrated a benefit of multivessel percutaneous coronary intervention (PCI) for noninfarct-related artery (non-IRA) stenosis over IRA-only PCI in patients with ST-segment elevation myocardial infarction (STEMI) multivessel disease. However, evidence is limited in patients with cardiogenic shock.

Outcomes of Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Analysis of National Inpatient Sample

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence of 15% of patients over 80 years. Coronary artery disease co-exists in 20–30% of patients with atrial fibrillation. The need for triple anticoagulation therapy makes the management of these patients challenging following PCI.MethodsNationwide inpatient sample which is a set of longitudinal hospital inpatient databases was used to evaluate the outcome of patients with AF who underwent PCI. All patients undergoing PCI between 2002 and 2011 were included in the study. Specific ICD-9-CM codes were used to identify the study patients and their outcomes.ResultsThere were 3,226,405 PCIs during the time period of the study of which 472,609 (14.6%) patients had AF. AF patients were older and predominantly male (60%). The number of PCIs had a declining trend from 2002 to 2011. Age adjusted inpatient mortality was significantly higher in PCI AF group compared to the PCI non-AF group (100.82 ± 9.03 vs 54.07 ± 8.96 per 100,000; P < 0.01). Post PCI predictors of mortality were AF (OR 1.56, CI 1.53–1.59), CKD (OR 1.41, CI 1.37–1.46), PAD (OR 1.20, CI 1.15–1.24), acute myocardial infarction (OR 2.42 CI 2.37–2.46 and cardiogenic shock (OR 13.92 CI 13.60–14.24) P < 0.001.ConclusionAF is common in patients undergoing PCI and those AF patients have a higher age-adjusted all cause inpatient mortality. There is a decline in total number of PCIs over time in US. Atrial fibrillation, chronic kidney disease, peripheral artery disease, MI and cardiogenic shock were associated with increased mortality following PCI.     

Volume-outcome relation for hospitals performing angioplasty for acute myocardial infarction: results from the Nationwide Japanese Registry.

BACKGROUND: The purpose of this study was to use a contemporary database to examine the relationship between annual hospital volume and the outcomes of percutaneous coronary interventions (PCIs) for acute myocardial infarction (AMI), given the wide spread use of coronary stents. An inverse relation exists between the number of PCIs and short-term outcome, but PCI practice has been changing with the availability of new devices such as stents. METHODS AND RESULTS: Data from the 1997 Japanese nationwide registry were analyzed to determine the relation between the annual hospital volume of PCI procedures for patients with AMI and in-hospital mortality, as well as the need for coronary artery bypass graft (CABG) surgery. A total of 129 hospitals (2,491 patients) were divided into terciles according to the annual volume. Of the procedures, 39% involved coronary stents. Median annual PCI volumes varied across terciles from low =10, middle =33, and high =89. After adjusting for patient characteristics, there was no significant relationship between volume and in-hospital mortality (trend P=0.66) and CABG (trend P=0.35). Among patients who received stents (n=958), there was no significant association between volume and either mortality or CABG. CONCLUSIONS: Using the contemporary database, there was no significant relationship between hospital volume and in-hospital outcome among AMI patients undergoing PCIs.     

Quinze anos de ecografia intravascular coronária em intervenção coronária percutânea em Portugal

IntroductionCoronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal.MethodsA retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized.ResultsA total of 118 706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C‐type or bifurcated coronary lesions, and in‐stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery.ConclusionCoronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery.