血运重建优化策略对老年T2DM合并ACS冠脉多支病变患者预后的影响

目的 探讨血运重建优化策略对老年2型糖尿病（T2DM）合并急性冠脉综合征（ACS）冠脉多支病变（MVD）患者预后的影响。方法 根据不同血运重建策略将2015年1月至2016年5月行经皮冠脉介入术（PCI）的95例老年T2DM合并ACS的MVD患者分为完全血运重建（CR）组与部分血运重建（IR）组。比较两组基线资料、冠脉造影结果、介入治疗情况、术后1年主要心血管不良事件（MACE）及生活质量的差异。结果 两组性别、年龄、吸烟史、高血压病史、高脂血症病史、药物使用情况、冠脉造影结果比较差异均无统计学意义（P>0.05）;CR组置入支架数多于IR组（P<0.05）;术后1年全因死亡、心源性死亡、再次血运重建、非致死性心肌梗死发生率两组比较差异无统计学意义（P>0.05）,CR组心绞痛复发率低于IR组（P<0.05）;CR组总体健康、生理功能、生理职能、躯体疼痛、社会功能、情感职能、活力、精神健康差值（术后1年数值-术前数值）均高于IR组（P<0.05）。结论 IR和CR对老年T2DM合并ACS的MVD患者预后相当,但CR对改善心绞痛症状和提高患者生活质量较优。     

Primary percutaneous coronary intervention on older patients with acute ST-segment elevation myocardial infarction: analysis of its risk factors

Objective： The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction （STEMI） following primary percutaneous coronary intervention （PCI）. Methods： A total of 136 patients older than 60 years with STEMI who received successful PCI were included in this study. The patients were classified in 2 age groups： patients 〉75 years and 〈75 years of age. The extent of coronary artery lesions was measured by quantitative coronary artery angiography （QCA）. Subjects were tracked for subsequent cardiovascular events： cardiac death, myocardial infarction, heart failure, percutaneous coronary intervention, coronary artery bypass and stroke. Results： Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than patients〈75y （P〈0.05）, the procedural success did not make difference between the two groups. In 12 months follow-up of 136 study participants, there occurred 39 CV events ： cardiac death （five patients）, heart failure （nineteen patients）, and stroke （six patients）. Three patients received coronary bypass grafts and six patients underwent PCI. Heart failure and overall cardiovascular event rates were higher in older patients compared with those in patients〈75y. The main adverse clinical events （MACE） for the old group were a little higher comparing with the younger in 12-month follow-up （P=-0.029 6 and P=-0.043 4）. Multivariate cox analysis identified that a diagnosis of diabetes （HR 2.495, 95%CI 1.224 to 5.083, P= 0.011 8） and time from symptom（HR 1.450, 95%CI 1.143 to 1.841, P= 0.008 2） to PCI as independent predictors of CV events after adjustment of all entered baseline variables. Conclusion： Our study suggests that drug-eluting stent implantation in older patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time from symptom onset to PCI may decrease cardiovascular events in old patients following PCI.     

不同血运重建方式对冠心病合并非重度左心功能不全患者预后的影响

目的 比较经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)对冠心病合并非重度左心功能不全患者预后的影响.方法 选择2011年1月至2013年1月在首都医科大学宣武医院住院的冠心病合并非重度慢性心力衰竭行血运重建患者412例为研究对象,根据血运重建方式分为PCI组268例和CABG组144例.随访截止至2016年1月,随访主要终点事件为全因病死率,次要终点事件为非致死性心肌梗死、再次血运重建及主要不良心血管事件(MACE)发生率,比较PCI组与CABG组长期预后的差别.结果 随访时间5(3,6)年,其中PCI组失访28例(10.4％),CABG组失访17例(11.8％).住院期间总MACE、死亡、非致死性心肌梗死、靶血管血运重建(TVR)发生率两组间比较,差异无统计学意义(P＞0.05);心功能变化比较,PCI组有效比例高于CABG组,无效比例PCI组低于CABG组(P＜0.05).随访期间,PCI组累积全因病死率低于CABG组(7.8％vs.19.4％,P＜0.05),总MACE发生率低于CABG组(38.1％vs.43.8％,P＜0.05);PCI组累积非致死性心肌梗死发生率、累积TVR率与CABG组的差异无统计学意义(P＞0.05).Cox模型多因素分析矫正后,PCI组总MACE发生率(HR=1.357,95％CI 1.105～1.729),全因病死率(HR=0.426,95％CI 0.121 ～ 0.753)仍低于CABG组(P＜0.05);TVR率、非致死性心肌梗死的差异无统计学意义(P＞0.05).结论 冠心病合并非重度心功能不全患者行PCI安全有效,与CABG组相比心功能改善更明显,可降低全因病死率和MACE.     

外周血MPO、NLR、hs-CRP对ST段抬高型心肌梗死患者PCI术后主要不良心脏事件的预测价值

目的 探讨外周血髓过氧化物酶(MPO)联合中性粒细胞/淋巴细胞比值(NLR)、高敏C反应蛋白(hs-CRP)对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)术后主要不良心脏事件(MACE)的预测价值.方法 选取2016年5月—2020年8月南阳医学高等专科学校第一附属医院收治的178例STEMI患者...     

冠状动脉完全闭塞再血管化的远期预后评估

目的比较经皮冠状动脉介入治疗（PCI）,冠状动脉旁路手术（CABG）和药物治疗慢性冠状动脉完全闭塞病变的长期预
后。方法本研究为回顾性队列研究,患者选自解放军总医院心内科导管室2008~2009年间首次行冠状动脉造影的住院病人,
将慢性闭塞患者分为PCI组、CABG组和药物治疗组,对患者进行为期5年的随访,以严重不良心血管事件（MACE）作为终点。
结果PCI组录入患者192例、CABG组48例、药物治疗组13例。基线资料在3组中基本相同。但药物治疗组LDL及总胆固醇
水平较高（P<0.05）。CABG组SYNTAX积分明显较高（P<0.05）。共发生MACE事件43例,CABG组MACE事件23%,药物治
疗和PCI 术后MACE分别为15%和16%,差异无统计学意义（P>0.05）。PCI 和CABG术后的全因死亡为10%,药物治疗组为
15%,差异无统计学意义（P=0.62）。CABG术后发生脑卒中的比例较高为8%,PCI术后为3%,差异无统计学意义（P>0.05）。3
种治疗方法的生存曲线基本重叠,没有统计学差异。结论尽管再血管化治疗的即刻效果明显,但本研究未能显示闭塞病变采
取CABG、单纯药物治疗和PCI术对远期预后有明显影响,但是CABG的中风发生率偏高。
     

他汀药物预治疗对高龄冠心病患者支架术预后的影响

目的 探讨术前他汀类药物治疗对高龄冠心病患者经皮冠状动脉支架治疗近期和远期预后的影响.方法 回顾性分析90例85岁以上冠心病患者术前他汀应用情况,观察其对预后的影响.结果 90例患者中,33例经皮冠状动脉介入(PCI)术前接受他汀治疗,57例PCI术前未接受他汀治疗.80例(88.9%)为急性冠状动脉综合征.术前接受他汀治疗组血脂异常、既往心肌梗死病史、既往PCI、开口病变、药物涂层支架(DES)植入比例比例略高.住院期间主要心血管不良事件(MACE)发生率要低于术前未接受他汀治疗组(3.0%比10.5%,P=0.05).随访1年时MACE发生率两组相似(6.1%与3.8%,P=0.07).整个研究人群1年生存率较高.结论 他汀预治疗对高龄冠心病支架术后可能降低住院期间MACE,而不一定能改善1年预后.     

冠心病介入治疗患者非高密度脂蛋白胆固醇达标情况与预后的关系研究

背景　低密度脂蛋白胆固醇（LDL-C）是冠心病的一个重要危险因素,多数国际指南一致推荐将LDL-C作为高胆固醇血症患者的主要治疗目标,但是否应同时使用LDL-C和非高密度脂蛋白胆固醇（non-HDL-C）作为心血管疾病二级预防的指标在国内外仍有争议。目的　探讨non-HDL-C达标情况与冠心病患者经皮介入冠状动脉治疗（PCI）术后不良心血管事件再发的关系,并比较non-HDL-C和LDL-C达标情况对冠心病患者远期预后的预测价值。方法　于2019年4月对2002—2008年因冠心病行PCI治疗的665例患者随访3年的资料进行分析,根据二级预防6个月后的血脂（non-HDL-C、LDL-C）达标情况进行分组,采用Kaplan-Meier生存曲线、Log-Rank检验和Cox比例风险回归模型分析血脂达标情况与终点事件〔主要心血管不良事件（MACE）〕的关系。结果　在真实世界里,665例冠心病患者在PCI术后经过6个月的二级预防后,分别有25.71%（171/665）、27.07%（180/665）的患者达到了指南推荐LDL-C或non-HDL-C的标准,有17.29%（115/665）的患者LDL-C和non-HDL-C水平同时达标。LDL-C达标组与不达标组MACE发生率分别为32.7%（56/171）、35.8%（177/494）;non-HDL-C达标组与不达标组的MACE发生率分别为25.6%（46/180）、38.6%（187/485）。LDL-C达标组与不达标组二者风险曲线未见明显差异（P=0.545）;non-HDL-C达标组的MACE累积发病率明显低于non-HDL-C不达标组（P=0.010）;仅non-HDL-C达标组与仅LDL-C达标组相比,差异无统计学意义（P=0.127）。采用Cox比例风险回归分析校正年龄、性别、BMI、吸烟史、冠心病类型、共病情况等传统风险因子后发现,与LDL-C达标组相比,LDL-C不达标组的HR为1.16〔95%CI（0.83,1.61）,P=0.386〕;与non-HDL-C达标组相比,non-HDL-C不达标组远期MACE发生风险较高,HR为 1.61〔95%CI（1.12,2.30）,P=0.009〕。结论　冠心病PCI术后患者远期心血管不良事件发生风险与non-HDL-C达标与否有关,而与LDL-C治疗达标情况无关,因此,non-HDL-C可能是较LDL-C更适合的冠心病PCI术后血脂异常治疗监测靶点。     

原发性干燥综合征合并冠心病患者接受冠状动脉介入治疗术后的长期预后分析

目的 分析合并原发性干燥综合征（pSS）的冠状动脉性心脏病（CAD）患者接受经皮冠状动脉介入治疗术（PCI）后的长期预后。方法 收集43例自2009年1月~2013年12月在首都医科大学附属北京友谊医院接受PCI治疗的pSS患者的临床资料,回顾性分析pSS患者的临床表现、冠状动脉病变特点,并对入选患者进行平均3年的长期随访。结果 43例患者中有34例（79.1%）具有≥2个传统冠心病危险因素,其中以高血压、高脂血症最为多见。74.4%的患者冠状动脉弥漫性长病变（>30mm）,平均SYNTAX 积分为29.6±6.2。入选患者共置入78枚药物涂层支架。术后平均3年随访期间因心力衰竭再入院累积发生率高达23.3%。结论 合并pSS的CAD患者冠状动脉病变以弥漫性长病变为主;此类患者接受PCI治疗后以心力衰竭再入院多见。     

Coronary stenting versus bypass surgery in heart failure patients with preserved ejection fraction

Background  The optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear. The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF.

Methods  From July 2003 through September 2005, a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥50%) underwent PCI (n=350) or CABG (n=570). We compared the groups with respect to the primary outcome of mortality, and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE), including death, myocardial infarction, stroke and repeat revascularization, at a median follow-up of 543 days.

Results  In-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs. 2.5%, adjusted P=0.016). During follow-up, there was no significant difference in the two groups with regard to mortality rates (2.3% vs. 3.5%, adjusted P=0.423). Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs. 4.0%, adjusted P <0.001), mainly due to higher rate of repeat revascularization (adjusted P <0.001). Independent predictors of mortality were age, New York Heart Association (NYHA) class and chronic total occlusion.

Conclusion  Among patients with CAD and HFPEF, PCI was shown to be as good as CABG with respect to the mortality rate, although there was a higher rate of repeat revascularization in patients undergoing PCI.

     

左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响

目的 探讨左心室收缩功能对经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗的急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者预后的影响。方法 对161例PCI治疗的急性下壁STEMI患者按左心室收缩功能分为2组:左心室收缩功能障碍[左心室射血分数(left ventricular ejection fraction, LVEF)<50%]组和左心室收缩功能正常(LVEF≥50%)组。本研究的主要终点主要不良心脏事件(major adverse cardiac events, MACE)包括所有全因死亡、再发性心肌梗死、缺血驱动的血管血运重建和卒中。结果 两组患者在年龄、性别、病史、Killip分级以及症状发作时间方面比较,差异均无统计学意义(P>0.05);左心室收缩功能障碍组具有更高的病变血管支数和血栓负荷(P<0.05),其他冠状动脉造影结果和介入治疗特征,两组间差异均无统计学意义(P>0.05)。两组在1年预期MACE发生率方面比较,差异均无统计学意义(Log-rank P>0.05)。结论 在接受直接PCI治疗的急性下壁STEMI患者中,左心室收缩功能障碍的患者与左心室收缩功能正常的患者具有相似的1年临床不良事件发生率。     

Age-based clinical and angiographic outcomes after sirolimus-eluting stent implantation in patients with coronary artery disease

Background Advanced age independently predicts early and late mortality and major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI）. Randomized clinical trials indicate that siroUmus-eluting stent （SES） implantation reduces target lesion revascularization （TLR）, but there are limited data on the impact of age on outcomes following SES implantation in patients with coronary artery disease （CAD） in real-world practice. Methods A total of 333 CAD patients with 453 lesions were enrolled in this study. Subjects were divided into two groups according to age： a young group （〈65 years old, 244 patients with 369 lesions） and elderly group （≥65 years old, 89 patients with 113 lesions）. Clinical follow-up and quantitative coronary angiography （QCA） were performed seven months after PCh Results Baseline clinical, demographic, angiographic, and procedural chararcteristics were similar in both groups, except that there were more female patients in the elderly group （21.3% vs 9.8%, P=-0.006）. Primary success rate was similar in both groups （96.5% in young group vs 95.7% in elderly group, P〉0.05）. During angiographic follow-up at 7 months, binary in-stent restenosis and in-segment restenosis rates were not significantly different between the two groups （4.7% vs 1.8%; 9.7% vs 8.8%, P〉0.05 respectively）. Both sub-acute and late thrombosis rates were similar in the two groups （0.3% vs 0.9% and 1.2% vs 0.9%, P〉0.05 respectively. TLFI was not significantly different between the two groups （6.5% vs 3.5%;P=-0.246）. The rates of bleeding, stroke, angina rehospitalization during the, follow-up period were also similar in both groups （P〉0.05 respectively）. Conclusion Despite a high-risk clinical profile, coronary SES implantation can be safely and effectively performed in elderly patients with a similar procedural success rate, a low complication rate, and excellent 7-month outcomes.     

Efficacy and safety of Shexiang Baoxin pill (MUSKARDIA) in patients with stable coronary artery disease: a multicenter,double-blind,placebo-controlled phase IV randomized clinical trial

Background:The Shexiang Baoxin Pill (MUSKARDIA) has been used for treating coronary artery disease (CAD) and angina for more than 30 years in China. Nevertheless, methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce. The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy (OMT) in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months. Both groups received OMT according to local tertiary hospital protocols. The primary outcome was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. Secondary outcomes included all-cause mortality, non-fatal MI, non-fatal stroke, hospitalization for unstable angina or heart failure, peripheral revascularization, angina stability and angina frequency.Results:In all, 99.7% of the patients were treated with aspirin and 93.0% with statin. After 2 years of treatment, the occurrence of MACEs was reduced by 26.9% in the MUSKARDIA group (MUSKARDIA: 1.9% vs. placebo: 2.6%; odds ratio = 0.80; 95% confidence interval: 0.45–1.07; P = 0.2869). Angina frequency was significantly reduced in the MUSKARDIA group at 18 months (P = 0.0362). Other secondary endpoints were similar between the two groups. The rates of adverse events were also similar between the two groups (MUSKARDIA: 17.7% vs. placebo: 17.4%, P = 0.8785).Conclusions:As an add-on to OMT, MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD. Moreover, the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD. The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registrationchictr.org.cn, No. ChiCTR-TRC-12003513     

Outcomes of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction in patients aged over 75 years

Background The optimal reperfusion strategy in elderly patients with ST-elevation myocardial infarction （STEMI） remains unclear. The purpose of this study was to evaluate the safety, in-hospital and one-year clinical outcomes for patients 〉75 years of age with STEMI receiving primary percutaneous coronary intervention （PCI）, compared with those treated by conservative approach. Methods One hundred and two patients 〉75 years of age with STEMI presented 〈12 hours were randomly allocated to primary PCI （n=50） or conservative therapy only （n=52）. The baseline characteristics, in-hospital outcome and major adverse cardiac events （MACE）, including death, non-fatal myocardial infarction and target vessel revascularization at one-year clinical follow-up were compared between the two groups. Results Age, gender distribution, risk factors for coronary artery disease, infarct site and clinical functional status were similar between the two groups, but the patients in primary PCI group received less low-molecular- weight heparin during hospitalization. Compared with conservative group, the patients in primary PCI group had significantly lower occurrence rate of re-infarction and death and shortened hospital stay. The composite endpoint for in-hospital survivals at 30-day follow-up was similar between the two groups, but one-year MACE rate was significantly lower in the primary PCI group （21.3% and 45.2%, P=0.029）. Left ventricular ejection fraction was not significantly changed in both groups during follow-up. Multivariate analysis revealed that primary PCI （OR=0.34, 95% CI： 0.21-0.69, P =0.03） improved MACE-free survival rate for STEMI patients aged 〉 75 years. Conclusion Our results indicated that primary PCI was safe and effective in reducing in-hospital mortality and one-year MACE rate for elderly patients with STEMI.     

急性心肌梗死经桡动脉途径冠脉介入治疗效果观察

目的总结急性心肌梗死（AMI）急诊经桡动脉途径行冠脉介入（PCI）治疗的疗效。方法对69例诊断为AMI患者选择右侧桡动脉为穿刺径路行PCI治疗（A组）,对照组为20例AMI行经皮股动脉入路直接PCI的患者（B组）。随访术后3个月内的主要心血管事件（MACE）的发生率,包括死亡率、非致命性心肌梗死发生率、靶血管血运重建率（TVR）及3个月内复诊冠脉造影择期干预其他病变血管的手术率。结果3个月后随访结果显示,MACE发生率均无统计学意义（P〉0.05）;3个月内复诊冠状动脉造影及择期手术率A组明显高于B组（P〈0.05）。结论急诊行经皮桡动脉入路PCI治疗AMI有一定的安全性,还不能认为其近期MACE的发生率低于经股动脉入路,但能提高冠状动脉造影的复诊及择期手术率。     

血清脂联素与冠心病介入治疗患者的预后关系

目的探讨血清脂联素水平对冠心病患者介入治疗（PCI）后主要不良心血管事件的预测价值。方法用双抗体夹心ELISA法检测153例行经皮冠脉介入治疗的冠心病患者血清ANP水平,按血清ANP的水平将患者分为两组,高ANP组（ANP≥4.7mg/L）,低ANP组（ANP〈4.7mg/L）,随访12月,观察两组在主要不良心血管事件（猝死、心肌梗死、再狭窄、再次血管重建）的差别。结果在12个月的随访中,发生非致死性心血管事件28例和心血管原因导致的死亡5例。高ANP组患者心血管事件发生率明显低于低ANP组（P〈0.05）;经过Logistic回归分析,PCI前血清ANP水平（OR=2.72,CI=1.76～5.14,P=0.033）和高敏C反应蛋白（OR=1.61,CI=0.92～4.21,P=0.043）对PCI术后再发主要不良心血管事件（MACE）具有独立预测价值。结论血清脂联素水平对冠心病介入治疗后主要不良心血管事件的发生提供一定的预测价值。     

Long-term outcome of patients of over 85 years old with acute coronary syndrome undergoing percutaneous coronary stenting: a comparison of bare metal stent and drug eluting stent

Background Patients aged over 85 years have been under-represented in percutaneous coronary intervention （PCI） trials despite an increase in referrals for PCI. The long-term safety and efficacy of percutaneous coronary stenting in patients aged over 85 years with acute coronary syndrome （ACS） remain unclear. Moreover it is unknown whether there are differences between bare metal stent （BMS） and drug eluting stent iDES） in this special population.
Methods A total of 80 patients with ACS aged over 85 years undergoing stenting （BMS group n=21 vs DES group n=59） were retrospectively studied. In-hospital, one year and overall clinical follow-up （12-36 months） of major adverse cardiac events （MACEs） including cardiac deaths, myocardial infarction, target lesion revascutarization （TLR） and target vessel revascularization （TVR） as well as stroke and other major bleeding were compared between the two groups.
Results In the entire cohort, the procedure success rate was 93.8% with TIMI-3 coronary flow post-PCI in 93.8% of the vessels and the procedure related complication was 17.5%. The incidence of in-hospital MACEs in BMS group was higher （14.3% vs 6.8%, P=0.30）. The 1-year incidence of MACEs in DES group was 7.0% while there was no MACE in the BMS group. Clinical follow-up for 12-36 months showed that the overall survival free from MACE was 82.9% and the incidence of MACE in the BMS group was lower （5.3% vs 21.1%, P=0.20）. Multivariate regression analysis showed that the creatinine level （OR：. 1.013; 95%CI： 1.006-1.020; P=0.004） and hypertension （OR; 3.201; 95%CI： 1.000-10.663; P=0.04） are two major factors affecting the long-term MACE.
Conclusions Percutaneous coronary stenting in patients aged over 85 years is safe and provides good short and tona-term efficacy. Patients with renal dvsfunction and hvoertension may have a relatively hiah incidence of MACE.     

WMR、RDW、NLR水平与急性心肌梗死患者PCI术后发生主要不良心血管事件的关系

目的 分析白细胞计数与平均血小板体积比值(WMR)、红细胞分布宽度(RDW)、中性粒/淋巴细胞比值(NLR)水平与急性心肌梗死(AMI)发病人群经皮冠状动脉介入治疗(PCI)术后主要不良心血管事件(MACE)发生的关系.方法 选取2018年1月—2019年12月海南省人民医院收治的262例AMI患者,均行PCI术,根据...     

益气活血凉血生肌方药对气虚血瘀证冠心病冠状动脉介入术后生活质量的干预作用

目的 观察气虚血瘀证冠心病患者冠状动脉介入术后应用益气活血凉血生肌方对其生活质量的影响。 方法 采用数字表法将来自北京中医药大学东方医院心内科131例成功行冠状动脉介入术的冠心病患者随机分为治疗组(n=68)、对照组(n=63),两组均接受冠心病二级预防常规,治疗组于手术日起加用益气活血凉血生肌方药2个月,随访时间为2个月,以中医症状体征积分、西雅图量表评分为主要观察指标。 结果 治疗组西雅图心绞痛量表评分显著高于对照组(P<0.05),治疗组胸闷、瘀血、气短、乏力积分改善显著优于对照组(P<0.05)。 结论 给予冠心病冠状动脉介入术后患者益气活血凉血生肌方药治疗,可显著改善气虚血瘀症状、提高生活质量。     

Age and diabetes mellitus associated with worse outcomes after percutaneous coronary intervention in a multi-ethnic Asian dialysis patient population

INTRODUCTIONThere is limited literature on clinical outcomes following percutaneous coronary intervention (PCI) in Asian dialysis patients. We evaluated the angiographic characteristics and clinical outcomes of dialysis patients treated with PCI in an Asian society.METHODSA retrospective analysis was performed of 274 dialysis patients who underwent PCI in a tertiary care institution from January 2007 to December 2012. Data on clinical and angiographic characteristics was collected. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, acute myocardial infarction (AMI) and stroke at two years.RESULTS274 patients (65.0% male, median age 62.0 years) with 336 lesions (81.8% Type B2) were treated. 431 stents (35.0% drug-eluting stents) with a mean diameter of 2.96 mm and mean length of 21.30 mm were implanted. The MACE rate was 55.8% (n = 153) at two years, from death (36.5%) and AMI (35.0%). In multivariable analysis, age and diabetes mellitus were significant predictors of both mortality (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05–1.12, p < 0.001; OR 2.65, 95% CI 1.46–4.82, p = 0.001, respectively) and MACE (OR 1.06, 95% CI 1.03–1.08, p < 0.001; OR 1.84, 95% CI 1.07–3.15, p = 0.027, respectively). Left ventricular ejection fraction (LVEF) (OR 0.97, 95% CI 0.95–0.99, p = 0.006) was a significant predictor of mortality but not MACE.CONCLUSIONAsian dialysis patients who underwent PCI had a two-year MACE rate of 55.8% due to death and AMI. Age, LVEF and diabetes mellitus were significant predictors of mortality at two years.     

高龄急性冠状动脉综合征患者治疗策略初探

目的:评价经皮冠状动脉介入治疗(PCI)、冠状动脉旁路移植术(CABG)和药物治疗对高龄急性冠脉综合征(ACS)患者的初步疗效.方法:将高龄(年龄≥75岁)、诊断为ACS、经冠状动脉造影证实至少1支血管直径狭窄≥70%、并且分别接受PCI、CABG和单纯药物治疗的147例患者,分为PCI组(50例)、CABG组(43例)和药物治疗组(54例),观察每组治疗后30天与1年时的死亡、非致死性MI以及再次血运重建术(TVR)等主要心血管不良事件(MACE)的发生情况,并探讨MACE与血脂、高敏C-反应蛋白(hsCRP)之间的关系,进行统计学处理.结果:从近期疗效看,CABG组的院内死亡率最高,与PCI组和药物治疗组比较具有显著性差异(P＜0.05);从远期疗效看,药物治疗组远期心性死亡率最高22.2%,PCI组远期死亡率显著低于药物治疗组(P=0.001),CABG组低于药物治疗组但无显著性差异(P=0.058),而PCI组与CABG组的远期死亡率没有显著差异(P=0.068);且发生MACE的患者入院时血脂和hsCRP水平均显著高于非MACE的患者(P＜0.05).结论:高龄ACS患者可以从早期的血运重建治疗尤其是PCI中获益,CABG作为一种"储备"措施更适用于症状难以控制、不适合做PCI的病人.但是该结果尚需大样本、多中心临床试验证实.