糖化血红蛋白对直接冠状动脉介入术后心肌组织灌注的影响

目的:观察糖化血红蛋白(HbA1c)水平对急性心肌梗死(AMI)患者接受直接冠状动脉介入(PCI)术后心肌组织灌注的影响。方法:选择因AMI行直接PCI的患者492例,根据HbA1c水平将所有患者分为HbA1c≥6.5%组189例和HbA1c<6.5%组(对照组)303例。通过观察TIMI心肌灌注(TMP)分级、心肌blush分级(MBG)及术后ST段回落率(STR),评价2组患者的术后心肌组织灌注及预后。结果:与对照组比较,HbA1c≥6.5%组的病变血管数、术中出现无复流/慢血流比例、住院期间病死率及梗死相关动脉开通时间显著增加,而术后达到TIMI血流3级、MBG 3级、TMP 3级和STR的比例及LVEF均明显降低(均P<0.05)。多因素分析结果显示,HbA1c≥6.5%是影响术后STR(OR=2.156,95%CI:1.057～4.328,P=0.036)及住院期间病死率(OR=1.021,95%CI:0.418～2.412,P=0.022)的独立危险因素。结论:HbA1c升高的AMI患者心肌组织灌注较差,住院期间病死率高。应重视这些高危患者,并尽早处理,从而改善患者的预后。     

糖化血红蛋白水平在急性心肌梗死患者中的预后意义

目的:探索糖化血红蛋白(HbA1c)水平在急性心肌梗死患者中与预后的关系。方法:回顾性分析1 952例急性心肌梗死患者,根据既往病史及HbA1c水平分为四组:已诊断糖尿病组(既往有糖尿病病史或应用降糖药物)492例、新诊断糖尿病组(住院期间诊断糖尿病,HbA1c≥6.5%)128例、糖尿病前期组(HbA1c 5.7%~6.4%)783例和非糖尿病组(HbA1c5.7%)549例,随访25.6个月,以单因素和多因素分析法评估四组间住院及随访期间预后的差异。结果:住院期间上述四组患者的死亡率分别是4.88%、3.91%、3.96%和2.91%,差异无统计学意义(P=0.435)。随着HbA1c水平的升高,全因死亡、非致死性心肌梗死及再住院率均升高,但组间差异无统计学意义。四组复合终点主要不良心脏事件(MACE)发生率分别是39.84%、35.94%、33.97%和27.87%,差异有统计学意义(P=0.001)。以非糖尿病组为对照,其他三组的比值比(OR)及95%可信区间(CI)分别是1.33(1.05~1.69)、1.45(0.97~2.18)和1.71(1.32~2.22),趋势P值为0.001。经基线各项其他指标校正后,差异仍有统计学意义(趋势P值为0.008)。结论:急性心肌梗死患者随访期间MACE发生率随着HbA1c水平的升高而升高,但未发现其与住院死亡率的关系。对于急性心肌梗死患者应常规筛查HbA1c,必要时可适当进行生活方式或药物的干预。     

急性冠脉综合征患者入院时糖化血红蛋白水平对住院死亡的影响

目的:研究急性冠脉综合征(ACS)患者入院时糖化血红蛋白(HbA1c)和住院死亡之间的相关性。方法:回顾性分析2008-01-2013-12于我院心内科住院的517例ACS患者的临床资料。按入院时HbA1c值将患者分为3组:≤5.6%组(286例)、5.7%~6.4%组(114例)和≥6.5%组(117例)。比较各组患者基线资料、住院期间治疗及住院死亡率的差异。对影响ACS患者住院死亡率的因素进行Cox回归分析。结果:517例患者中,急性ST抬高心肌梗死患者330例(63.8%),急性非ST段抬高心肌梗死患者100例(19.3%),不稳定型心绞痛患者87例(16.8%)。与入院时HbA1c正常的患者相比,HbA1c升高的患者平均年龄较大、伴心力衰竭和卒中病史及Killip分级Ⅰ级的比例较高(P均0.05)。入院时肌钙蛋白水平较高、左室射血分数(LVEF)较HbA1c正常患者低(P均0.05)。但入院后接受经皮冠脉介入(PCI)治疗的比例较低(P0.05)。住院期间3组死亡率分别是5.6%、7.9%和14.5%(P0.05)。Cox回归分析显示,调整了性别、年龄、既往病史、入院时生命体征、ACS类型和住院期间主要治疗措施后,入院时HbA1c≥6.5%仍是影响住院死亡的独立危险因素(HR=2.247,95%CI 1.462~4.287,P=0.012),但入院时HbA1c5.7%~6.4%未显著增加住院死亡风险(HR=1.105,95%CI0.832~1.436,P=0.125)。结论:ACS患者入院时HbA1c水平和住院死亡有关,入院时HbA1c≥6.5%显著增加住院死亡风险,而HbA1c5.7%~6.4%对住院死亡无显著影响。     

糖化血红蛋白水平对行PCI的非ST段抬高型心肌梗死患者远期预后的影响

目的探讨糖化血红蛋白水平与行经皮冠状动脉介入治疗(PCI)的非ST段抬高型心肌梗死(NSTEMI)患者远期预后的关系。方法连续入选2009年1月至2012年10月于西安交通大学第一附属医院、西安市中心医院及陕西省人民医院确诊为NSTEMI并行PCI的890例患者。根据是否患有糖尿病及糖化血红蛋白(HbA1c)水平分成4组:无糖尿病且HbA1c水平5.7%(n=417);无糖尿病且HbA1c水平在5.7%～6.5%(n=237);有糖尿病且HbA1c水平7.0%(n=138);有糖尿病且HbA1c水平≥7.0%(n=98)。分析不同分组患者3年不良心血管事件、全因性死亡、心血管原因死亡、再发非致死性心肌梗死、心力衰竭(心衰)再次住院、再次血运重建及脑卒中发生率。结果非糖尿病且5.7%≤HbA1c6.5%组患者与非糖尿病且HbA1c5.7%组患者相比较,有较高的3年主要不良心血管事件发生率及死亡率,且有显著性差异(P均0.05),而糖尿病且HbA1c≥7.0%组与糖尿病且HbA1c7.0%组相比较,3年主要不良心血管事件发生率及死亡率均无显著差异。且无论是否患有糖尿病,入院血糖水平均是NSTEMI行PCI患者远期不良预后的危险因素。结论在行PCI的NSTEMI合并糖尿病的患者中,HbA1c升高不是其3年主要不良心血管事件及死亡率的危险因素。在NSTEMI行PCI的非糖尿病患者中,HbA1c升高是其3年主要不良心血管事件及死亡率的危险因素。     

糖化血红蛋白对中青年心肌梗死的影响研究

目的探讨糖化血红蛋白(HbA1c)对中青年心肌梗死的影响。方法选取2008年2月—2014年2月巴中市中心医院心血管内科诊断并收治的中青年心肌梗死患者586例作为病例组,同期在本院接受冠状动脉造影但无心肌梗死的中青年521例作为对照组,比较两组受试者的血清HbA1c水平。根据血清HbA1c水平将病例组患者分为正常组(HbA1c6.5%,n=221例)和高值组(HbA1c≥6.5%,n=365例),比较两组患者一般资料。中青年心肌梗死危险因素的分析采用多因素Logistic回归分析。结果高值组患者并发症发生率高于正常组,Killip分级重于正常组(P0.05);病例组患者血清HbA1c水平高于对照组(P0.05);血清HbA1c升高是中青年心肌梗死的独立危险因素〔OR=1.750,95%CI(1.44,2.37),P0.05〕。结论血清HbA1c水平升高是中青年心肌梗死的独立危险因素。     

HbA1c与冠状动脉病变部位及程度的关联分析

目的:本研究通过观察糖尿病前期患者中HbA1c水平及冠状动脉(冠脉)造影结果,明确HbA1c与冠脉病变程度及部位间的关联。方法:连续入选142例经冠脉造影确诊的冠心病患者,同时空腹血糖及口服糖耐量试验诊断为糖尿病前期状态。根据HbA1c水平分为3组:A组,HbA1c≤5.5%;B组,5.5%HbA1c≤6.0%;C组,6.0%HbA1c6.5%。计算Gensini积分及冠脉病变血管数,比较各组间冠脉Gensini积分及病变血管数差异,并评价HbA1c与积分间的关联。结果:随着HbA1c水平的升高,冠脉病变血管数量也有所增加(P0.05),C组与A组和B组比较,3支血管病变的比例最高(38%∶23%∶10%,P=0.008);随着HbA1c水平的升高,冠脉Gensini积分也逐渐升高,C组明显高于其余两组[(11.52±7.56)∶(9.60±4.92)∶(6.99±4.42),P=0.002];而且HbA1c与冠脉Gensini积分有明显关联(回归系数0.29;P=0.001)。研究发现HbA1c水平与冠脉病变部位(近端/远端)无明显关联(P0.05)。结论:在冠心病合并糖尿病前期患者中,HbA1c水平是冠脉病变程度的独立危险因素。     

40岁以下不同性别青年急性心肌梗死患者的临床特点及院内和远期预后分析

目的:分析40岁以下不同性别青年急性心肌梗死(AMI)患者的临床特点,住院期间和远期预后及不良事件的预测因素。方法:连续入选2012-01-01至2015-08-31在北京安贞医院确诊为AMI的青年(年龄≤40岁)患者685例,依据性别将患者分为两组,男性组650例,女性组35例。收集比较两组患者的基线资料、临床特征、住院期间不良事件发生情况,对所有患者进行电话随访,记录分析远期主要不良心血管事件(MACE)发生情况及危险因素。结果:男、女性组患者比例分别94.89%和5.11%;男性组平均年龄高于女性组[(35.53±4.21)岁vs(34.05±4.98)岁,P=0.046],男性组冠状动脉左主干病变比例(3.2%vs 11.4%,P=0.012)、院内急性心力衰竭发生率(8.3%vs25.7%,P=0.001)均低于女性组。随访时间中位数(四分位数)727.0(411.5,1 102.0)天,男性组有46例(7.1%)发生MACE事件,女性组为2例(5.7%),差异无统计学意义(P=0.758)。超敏肌钙蛋白I水平升高[比值比(OR)=1.003,95%可信区间(CI):1.001~1.006,P=0.020)和冠状动脉多支血管病变(OR=1.964,95%CI:1.018~3.790,P=0.044)是青年男性患者远期MACE的独立预测因素;经皮冠状动脉介入治疗(PCI,OR=0.475,95%CI:0.241~0.936,P=0.031)是男性患者远期预后的保护因素。结论:40岁以下青年AMI患者以男性为主;男性平均年龄大于女性,女性患者左主干病变比例更高,住院期间更易发生急性心力衰竭;超敏肌钙蛋白I水平升高、冠状动脉多支血管病变增加青年男性MACE发生率,而PCI对男性患者预后有利。     

糖化血红蛋白对糖尿病伴冠心病患者PCI后主要心血管不良事件的影响

目的:研究糖化血红蛋白(HbA1c)对糖尿病伴冠心病患者经皮冠状动脉介入治疗术(PCI)后主要心血管不良事件(MACE)的影响。方法:选择本院收治的100例PCI术后糖尿病伴冠心病患者,根据HbA1c水平分为HbA1c6.5%组(48例),HbA1c≥6.5%(52例)。比较两组患者PCI术前C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、血沉(ESR)以及白细胞介素6(IL-6)水平,同时观察两组患者在PCI术后6个月以及24个月时MACE发生率。结果:与HbA1c6.5%组比较,HbA1c≥6.5%组术前血清CRP[(18.5±6.2)mg/L比(25.8±4.2)mg/L]和TNF-α[(32.4±12.3)ng/L比(48.3±11.8)ng/L]水平明显升高(P均0.01);术后6个月,HbA1c≥6.5%组心梗发生率明显高于HbA1c6.5%组(9.62%比0,P=0.028);术后24个月,与HbA1c6.5%组比较,HbA1c≥6.5%组心梗(2.08%比15.38%)和病变血管再狭窄(12.50%比32.69%)发生率明显升高(P均0.05)。结论:糖尿病伴冠心病患者经皮冠状动脉介入治疗术后糖化血红蛋白水平低的预后较好。     

HbA1c水平与急性心肌梗死患者并发心室电风暴的关系探讨

目的探讨糖化血红蛋白（HbA1c）水平与急性心肌梗死（AMI）患者并发心室电风暴的关系。方法首次AMI患者108例,根据HbA1c水平分为HbA1c正常组（〈6.5%）与HbA1c增高组（≥6.5%）,所有AMI患者发病后72 h内进行心电监护记录电风暴发病情况及30 d内的全因病死率。结果 HbA1c增高组AMI患者入院72 h内记录到电风暴的发生率及30 d内病死率高于HbA1c正常组（P均〈0.05）。结论 HbA1c增高组AMI患者心室电风暴的发生率明显增高,预后差,值得警惕。     

高血糖对急诊PCI患者住院与随访预后的影响

目的:探讨接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高心肌梗死(STEMI)患者,其高血糖水平对住院及长期随访预后影响。方法:入选我院诊断STEMI,起病12h内行急诊PCI的患者218例,根据入院即刻血糖水平及口服葡萄糖耐量实验结果分为血糖正常组(108例)、高血糖组(60例)和糖尿病(DM)组(50例)。评估各组心功能指标,住院及随访1年预后;采用Logistic回归分析STEMI行急诊PCI者死亡率的影响因素。结果:与血糖正常组比较,糖尿病组住院死亡率(1.9%比10.0%)显著上升;高血糖组和糖尿病组女性2支以上血管病变(41.2%比68.8%比66.7%),植入2个以上支架(14.7%比50.0%比55.6%)比例显著升高(P0.05或0.01);多因素Logistic回归分析显示,Killip分级、NT-proBNP、病变血管数目和人体质量指数是这种患者住院病死率独立危险因素(OR=1.012~5.923,P均0.05),女性是住院和1年内随访死亡率的强独立危险因素(OR=20.376、7.227,P均0.01)。结论:急性ST段抬高心肌梗死伴高血糖行急诊PCI术者死亡率明显升高,女性尤甚。     

老年女性急性心肌梗死患者近期死亡的影响因素分析

目的探讨老年女性急性心肌梗死患者发病情况及近期死亡的影响因素。方法选择初发急性ST段抬高心肌梗死后收治入院的女性患者共336例,根据年龄分为2组:老年组298例,非老年组38例。回顾性分析比较2组患者一般临床资料、发病特点和发病后30d内死亡情况,采用多元logistic回归分析年龄对女性急性心肌梗死患者近期死亡的影响。结果老年组患者年龄、血肌酐明显高于非老年组患者,而左心室射血分数明显低于非老年组患者,差异有统计学意义(P0.05,P0.01);老年组患者近期病死率明显高于非老年组患者(25.8% vs5.3%,P0.01)。年龄≥60岁的女性是急性心肌梗死后30d死亡的独立危险因素,其死亡危险较非老年组患者高6.6倍(OR=6.553,95% CI:1.183～36.294,P0.01)。结论老年女性急性心肌梗死患者具有更高的近期病死率。年龄≥60岁、发病至入院时间、空腹血糖、严重心律失常和急性左心功能不全是预测女性急性心肌梗死患者近期死亡的独立预测因素。     

Predictive value of HbA1c level for in-hospital acute coronary syndrome patients with diabetes

Background Diabetes mellitus (DM) is the major risk factor of coronary artery disease (CAD), and the control status of blood sugar has direct effect on the prognosis of CAD. HbA1c is the important parameter reflecting control status of blood sugar, however, it is unclear about the value of in-hospital HbA1c in patients with acute coronary syndrome (ACS). Methods A retrospective analysis was performed for 236 in-hospital diabetic patients with ACS. Patients were stratified into two groups according to HbA1c level when admission (Well controlled group (HbA1c≤7.0%) and High HbA1c group (HbA1c > 7.0% ); major adverse cardiovascular events (MACE) group and Non-MACE group). In-hospital MACE and mortality were set as the observation target. Results 282 patients (112 in Well controlled group and 170 in High HbA1c group) were enrolled, of which 146 (51.77%), 63 (23.34%), and 73 (25.89%) patients respectively had unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Inhospital all-cause mortality and in-hospital MACE were both similar in Well controlled group and High HbA1c group (6.25% vs. 7.06% and 15.18% vs. 16.47%, P > 0.05). In MACEs, cardiac death (4.46% vs. 5.29%), recurrent myocardial infarction (2.68% vs. 2.94%), hemorrhage events (5.35% vs. 5.29%), malignant arrhyth- mia (6.25% vs. 5.29%), cardiac shock (4.46% vs. 4.12%), acute heart failure (8.93% vs. 10.0%), revascularization (4.46% vs. 5.29%) were also all similar in both two groups. In addition, there were no significant difference in HbA1c level between MACE group and Non-MACE group. Single-factor logistic regression analysis showed that HbA1c was not a risk factor for in-hospital MACE (P > 0.05) 1 . Conclusion The present study sug-gests that admission HbA1c is not the risk factor of in-hospital MACE in ACS patients with diabetes.     

The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction

BACKGROUND:

Glycosylated hemoglobin (HbA1c) level on admission is a prognostic factor for mortality in patients with and without diabetes after myocardial infarction. In the present study, the authors examined the relationship between admission HbA1c level and myocardial perfusion abnormalities in patients with acute myocardial infarction.

METHODS:

One hundred consecutive patients with acute myocardial infarction who were treated with thrombolytic therapy were included in the present prospective study. Blood glucose and HbA1c levels of all patients were measured within 3 h of admission. Patients were divided into three groups according to HbA1c level: 4.5% to 6.4% (n=25), 6.5% to 8.5% (n=28) and higher than 8.5% (n=47). All patients then underwent exercise thallium-201 imaging and coronary angiography to determine ischemic scores and the number of diseased coronary arteries four weeks after admission.

RESULTS:

Seven patients died within the four-week follow-up period. There was a significant relationship between admission HbA1c level and mortality (P=0.009). Furthermore, there was a significant relationship between HbA1c level and total ischemic scores in patients with acute myocardial infarction (r=0.482; P=0.001). Ischemic scores increased as HbA1c levels increased in patients with acute myocardial infarction.

CONCLUSIONS:

The results demonstrated that admission plasma glucose and HbA1c levels are prognostic factors associated with mortality after acute myocardial infarction.     

Prognostic value of admission plasma glucose and HbA in acute myocardial infarction.

OBJECTIVE: Stress hyperglycaemia increases the risk of mortality after acute myocardial infarction in diabetic and in non-diabetic patients. We aimed to determine the contribution of admission plasma glucose and HbA(1c) on post-acute myocardial infarction prognosis. PATIENTS AND METHODS: Admission plasma glucose and HbA(1c) were simultaneously measured in all patients consecutively hospitalized for acute myocardial infarction. Patient survival was measured on 5 and 28 days after admission. Patients were defined as having 'previously diagnosed diabetes' (personal history of diabetes defined using ADA 1997 criteria), 'no diabetes', those without previously diagnosed diabetes and HbA(1c) below 6.5%, or 'possible diabetes', i.e. those without previously diagnosed diabetes and HbA(1c) above 6.5%. RESULTS: Of the 146 patients included, four had died by day 5 and 14 by day 28. Admission plasma glucose was higher in patients who had died by day 28 (11.7 +/- 5.8 vs. 8.0 +/- 3.3 mmol/l, P = 0.002), whereas HbA(1c) was not (6.4 +/- 1.9 vs. 6.1 +/- 0.8%, NS). Admission plasma glucose was significantly higher in those who had died by day 28 after adjustment on HbA(1c). A multivariate analysis, including sex, age and heart failure prior to acute myocardial infarction, showed that admission plasma glucose concentration was an independent predictor of survival after acute myocardial infarction. Twenty-seven of the patients had previously diagnosed diabetes and 119 had no history of diabetes. Eleven were found to have possible diabetes. Admission plasma glucose was significantly higher in previously diagnosed diabetes (11.1 +/- 5.6) than in the other groups: 7.7 +/- 2.9 in non-diabetes, 8.2 +/- 2.1 in possible diabetes (P < 0.0001). The relationship between HbA(1c)-adjusted admission plasma glucose and mortality after acute myocardial infarction was also found in the non-diabetes group. CONCLUSIONS: Admission plasma glucose, even after adjustment on HbA(1c), is a prognostic factor associated with mortality after acute myocardial infarction. Acute rather than the chronic pre-existing glycometabolic state accounts for the prognosis after acute myocardial infarction.     

心率水平对急性心肌梗死患者长期预后的影响

目的:观察急性心肌梗死(AMI)患者出院时心率水平与预后的关系。方法:连续入选2003年至2004年我院AMI患者904例,随访728例,根据出院时心率水平分为55～70次/min(A组)、71～80次/min(B组)、81～90次/min(C组)及>90次/min(D组)4组,随访4.5年。结果:1.随出院时心率水平的增加,3～4年时左心室射血分数(LVEF)明显降低,D组及C组因心力衰竭再次心肌梗死,心绞痛再住院率及1年、2年及3年病死率显著高于A组与B组,差异有统计学意义(P<0.05)。2.多因素分析结果显示出院时心率水平是随访期间再住院率及病死率的独立影响因素(OR=1.645,95%CI:1.390～3.018,P=0.005)。结论:过快的心率是AMI患者死亡及再住院的强预测因子,对AMI患者应严格控制心率,从而改善预后。     

高龄心肌梗死患者临床特点和住院期转归

目的评价高龄心肌梗死患者临床特点、住院期间不良事件和病死率。方法收集初发急性ST段抬高心肌梗死患者974例临床资料,按照患者年龄分为高龄组（≥75岁,n=161）和对照组（〈75岁,n=813）,对两组临床特点（包括性别、年龄、吸烟、化验指标、并存疾患）、治疗方案、住院并发症和病死率进行比较。结果与对照组相比,高龄组女性以非典型症状为首发表现者更多,从症状发作到医院就诊所需时间更长,心、肾功能更差,存在较多的并患疾病。对照组患者血脂异常、吸烟的比例更高。高龄组服用B受体阻滞剂的比例明显低于对照组。高龄患者住院期间经历了更多的不良事件,包括心律失常、心源性休克、心力衰竭。高龄组住院病死率为18．4％,显著高于对照组患者（P〈0．001）。结论高龄心肌梗死患者一般状态较差,多合并其他系统疾患,接受再灌注治疗的比例较低,住院期间不良事件发生率和住院病死率高。     

糖化血红蛋白水平与冠心病患者介入术后服用抗血小板药物效应的分析

目的 探讨HbA1c异常是否与服用抗血小板药物效应有关. 方法 选取经皮冠状动脉介入治疗（PCI）术后联合服用氯吡格雷和阿司匹林1周的患者88例,采用流式细胞术和血栓弹力图检测服用阿司匹林、氯吡格雷的效应性. 结果 HbA1c≥6.5％组二磷酸腺苷（ADP）、花生四烯酸（AA）抑制率低于HbA1c＜6.5％组（P＜0.05或P＜0.01）,PAC-1高于HbA1c＜6.5％组（P＜0.05）. 结论 HbA1c≥6.5组血小板活化标记物PAC-1高于HbA1c＜6.5％组,高HbA1c患者氯吡格雷效应低下的概率增加,对阿司匹林效应无影响.     

心功能和心率减速力对急性心肌梗死心力衰竭的预后研究

目的 探讨心功能指标与心率减速力值对急性心肌梗死（AMI）心力衰竭患者的预后价值.方法 应用24h动态心电图和心脏超声检测100例急性心肌梗死心力衰竭患者和100例非急性心肌梗死患者的心功能指标和心率减速力、心率加速力值,并进行预警分析.结果 冠状动脉病变：100例AMI心力衰竭患者1支病变30例、2支病变55例、3支病变15例;100例非急性心肌梗死患者1支病变60例、2支病变35例、3支病变5例,两组比较差异有统计学意义（P＜0.05）.1年内死亡：AMI心力衰竭患者组LVIDD66.4 mm、LVEF 26.0％、FS 14.4％、DC≥4.5 ms 3例（3.00％）; LVIDD 68.2 mm、LVEF 24.6％、FS 12.8％、DC2.6～4.4 ms 8例（8.00％）;LVIDD 69.8 mm、LVEF 22.8％、FS 11.4％、DC≤2.5 ms 15例（15.00％）,P＜0.05;非急性心肌梗死患者组LVIDD 47.0 mm、LVEF 50.4％、FS 26.8％、DC 2.6～4.4 ms 2例（2.00％）;LVIDD 47.2 mm、LVEF 48.8％、FS 24.6％、DC 2.6 ms 3例（3.00％）,P＜0.05.AMI心力衰竭患者组LVIDD 68.2 mm、LVEF24.6％、FS 12.8％、AC≤-8.0 ms2例（2.00％）;LVIDD 69.8 mm、LVEF 22.8％、FS 11.4％、AC≤-7.0 ms 3例（3.00％）,P＜0.05;非急性心肌梗死患者组LVIDD 47.2 mm、LVEF 48.8％、FS 24.6％、AC≤-7.0ms 1例（1.00％）,余均无死亡病例.AMI心力衰竭患者组与非急性心肌梗死患者组比较,P＜0.05.结论 心功能指标结合心率减速力值能定量分析和测定迷走神经作用的强度,对急性心肌梗死猝死高危人群筛选与预警有较强的实用价值.     

经桡动脉介入治疗冠心病的住院期间疗效和主要不良心脏事件的预测因素

目的 评价经桡动脉介入治疗冠心病的住院期间安全性和有效性及主要不良心脏事件的预测因素.方法 入选阜外心血管病医院2004年5月至2009年5月16 281例经桡动脉介入治疗冠心病患者(桡动脉组)和5388例经股动脉介入治疗冠心病患者(股动脉组).比较桡动脉组与股动脉组患者临床特征、操作特点及住院期间临床疗效,并分析经桡动脉介入治疗患者住院期间发生主要不良心脏事件(包括死亡、心肌梗死和靶病变血运重建)的预测因素.结果 与股动脉组比较,桡动脉组冠状动脉导管插入时间较长(P＜0.01),X线曝光时间、对比剂用量差异无统计学意义.桡动脉组与股动脉组操作成功率差异无统计学意义(95.5%比96.2%,P＞0.05).血管径路并发症比例桡动脉组低于股动脉组(0.1%比1.3%,P＜0.01).桡动脉组住院期间主要不良心脏事件发生率、死亡发生率均低于股动脉组(分别为1.6%比3.8%,P＜0.01;0.2%比0.4%,P＜0.01).多因素logistic回归分析表明,经桡动脉介入治疗患者住院期间发生主要不良心脏事件的独立预测因素为年龄≥65岁(OR:1.98,95%可信区间:1.50～2.61,P＜0.01)、既往心肌梗死(OR:2.14,95%可信区间:1.63～2.82,P＜0.01)、置入药物洗脱支架(OR:0.68,95%可信区间:0.47～0.98,P=0.04)、冠状动脉夹层(OR:4.08,95%可信区间:2.28～7.33,P＜0.01)、左主干病变(OR:2.12,95%可信区间:1.09～4.13,P=0.03)、支架数(OR:1.25,95%可信区间:1.09～1.43,P＜0.01)、支架总长度(OR:1.01,95%可信区间:1.00～1.02,P=0.03).结论 经桡动脉介入治疗冠心病在住院期间具有良好的有效性和安全性.年龄≥65岁、既往心肌梗死、置入药物洗脱支架、冠状动脉夹层、左主干病变、支架数、支架总长度是经桡动脉介入治疗住院期间发生主要不良心脏事件的独立预测因素.

Abstract：

Objective The purpose of this study is to evaluate the in-hospital clinical outcome of patients with coronary artery disease who underwent transradial intervention (TRI) and analyze the predictors of chinical outcome. Methods From May 2004 to May 2009, there were 16 281 patients who underwent transradial intervention, as well as 5388 patients who underwent transfemoral intervention (TFI) at our institution. The clinical characteristics, procedural characteristics, and in-hospital clinical adverse events were compared between TRI and TFI groups. Multivariable logistic regression analysis was performed to determine predictors of in-hospital major adverse cardiac events ( composite of death, myocardial infarction,or target lesion revascularization) of TRI. Results The annulations time was significantly longer for TRIthan TFI (P ＜0. 01 ), fluoroscopy time, amount of contrast agent and procedural success rate (95.5% for TRI and 96. 2% for TFI) were similar between the two groups. However, the rates of vascular complications (0. 1% for TRI group and 1.3% for TFI group, P ＜0. 01 ), incidence of in-hospital major adverse cardiac events (1.6% vs. 3. 8%, P＜ 0.01) and in-hospital death (0.2% vs. 0.4%, P＜0.01) were all significantly lower in TRI group compared with TFI group. The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI: age ≥65 ( OR: 1.98,95% CI: 1. 50 - 2. 61, P ＜ 0. 01 ), prior myocardial infarction ( OR:2. 14, 95% CI: 1.63 - 2. 82, P ＜0. 01 ), use of drug-eluting stent (DES) ( OR:0. 68, 95% CI:0. 47 - 0. 98, P = 0. 04 ), dissection during procedure (OR:4.08, 95%CI:2.28-7.33, P＜0.01), left main lesion (OR:2. 12, 95% CI:1.09-4. 13, P=0.03), number of implanted stents (OR:1.25, 95% CI:1.09 - 1.43, P ＜0.01), and total stented length (OR:1.01, 95% CI:1. 00 -1. 02 , P=0.03). Conclusions In this large single-centre patient cohort, the transradial intervention is superior to transfemoral intervention in terms of in-hospital safety and efficacy. Age ≥ 65, prior myocardial infarction, use of DES, dissection during procedure, left main lesion, number of implanted stents and total stented length were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI.     

急性心肌梗死患者血糖水平与恶性室性心律失常发生的相关性

目的探讨急性心肌梗死(简称心梗)患者血糖水平与院内发生恶性室性心律失常的关系.方法回顾分析急性心梗临床病例资料1 118例,根据入院后空腹血糖水平将心梗患者分为三组:血糖＜6.99 mmol/L(A)组,7.00～11.09 mmol/L(B)组,≥11.10 mmol/L(C)组,按入院时有无糖尿病史分为非糖尿病组和...