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1.
Background Myocardial bridging (MB) as a congenital condition with a reported frequency of 5%-12% in diagnostic coronary angiography may be an important factor causing myocardial ischemia. However, its frequency in the infarct-related artery (IRA) of patients with ST-elevation myocardial infarction (STEMI) and the impact upon percutaneous coronary intervention (PCI) remain undetermined. In this study, we investigated MB frequency and its impact upon primary PCI in patients with STEMI.
Methods The data of coronary angiography for 554 consecutive patients with STEMI who had undergone successful primary PCI were retrospectively analyzed to identify a frequency of MB in the IRA and its association with gender and age. According to the angiographic findings, the patients were divided into MB patients and non-MB patients. The endpoints of this study included immediate angiographic findings after primary PCI and 6-month major adverse cardiac events (MACE) (death, recurrent myocardial infarction, target lesion or vessel revascularization) between the MB patients and the non-MB patients.
Results A frequency of MB in the IRA of 46 patients (8.3%) was identified in this series; it was more common in patients ≥65 years old (36/206) than in those 〈65 years old (10/348) (17.5% vs 2.9%, P〈0.001). The trend of MB in the IRA was observed more frequently in women without significant difference than in men (10.2% vs 7.8%). TIMI grade Ⅲ flow was achieved in 91.9% (509/554) of all patients following primary PCI, in 60.9% (28/46) of the MB patients and in 94.7% (481/508) of the non-MB patients respectively (P〈0.001). The in-hospital mortality was 4.7% (26/554) in this series including 13.0% (6/46) of the MB patients and 3.9% (20/508) of the non-MB patients (P〈0.001). A significant difference in 6 months MACE was seen between the MB patients (19%) and the non-MB patients (6.2%) (P〈0.001).
Conclusions MB in the IRA is relatively common in elderly patients with STEMI with a more evident trend in women, suggesting that arteriosclerosis and plaque rupture occurs more easily in the proximal artery to MB than in younger patients. Poor TIMI grade flow in patients with MB in the IRA after primary PCI may contribute to a high in-hospital mortality rate (13%) and 6-month MACE (19%) in the MB patients. 相似文献
2.
Shen WF 《中华医学杂志(英文版)》2012,125(1):003-006
ST-segment elevation myocardial infarction (STEMI)is usually caused by acute occlusion of an infarct-related coronary artery (IRA),resulting from rupture or erosion of an atherosclerotic plaque and subsequent platelet aggregation and thrombosis.1-3Prompt reperfusion is the key aspect of the optimal management,4-7 and timely expert primary percutaneous coronary intervention (PCI) becomes the best reperfusion strategy with respect to improvement in survival and reduction of combined clinical endpoints in the treatment of STEMI.8-11 Given the high thrombotic risk of patients with STEMI,pretreatment with a high clopidogrel loading dose before primary PCI was advised to reduce distal thrombotic embolization and angiographic no-reflow and improve clinical outcomes.12,13 The use of adjunctive intravenous glycoprotein (GP) Ⅱb/Ⅲa inhibitors following oral dual-antiplatelet therapy enhances thrombus disaggregation by inhibiting fibrinogen binding to the active receptor complex and subsequently disrupting platelet cross-linking,14 and improves IRA patency and myocardial perfusion,14 and has been recommended as class Ⅱa (at the time of primary PCI) or Ⅱb (before primary angiography and PCI)indication in the recent practice guidelines for the management of patients with STEMI.9,10 Tirofiban (a small-molecule platelet GP Ⅱb/Ⅲa inhibitor) seems even more attractive,because of its consistent and rapidly reversible platelet inhibition at increased dose and efficient penetration into the platelet-fibrin thrombus.15 In a broad population of largely unselected patients undergoing primary PCI for STEMI,tirofiban was associated with a noninferior complete resolution of ST-segment elevation (an indirect measure of myocardial reperfusion after PCI14,16) compared with abciximab,17 and was well tolerated and effective in reducing ischemic acute coronary syndrome complications in patients with mild-to-moderate renal insufficiency.18 Previous studies have shown that an upstream low dose of tirofiban favorably ameliorates IRA patency and reperfusion of the infarct area compared with down-stream use,19 and routine initiation of high-bolus dose of tirofiban could further improve clinical outcome after primary PCI.20 These observations highlight that further platelet aggregation inhibition besides high-dose clopidogrel is mandated in patients with STEMI undergoing primary PCI. 相似文献
3.
Appraisal of the prognosis in patients with acute myocardial infarction treated with primary percutaneous coronary intervention 总被引:1,自引:0,他引:1 下载免费PDF全文
Acute myocardial infarction(AMI) is still the leading factor causing crippling and death in cardiovascular disease.Percutaneous coronary intervention(PCI) can significantly reduce inpatient mortality and incidence of complication.But owing to the existence of restenosis,in-stent thrombosis,etc.,recurrent post-PCI cardiovascular events and high repeatability of hospitalization,as well as its crippling rate and mortality, remain a serious threat to the society and the patients' family.Therefore,the apprais... 相似文献
4.
目的:对急性心肌梗死(AMI)患者行直接经皮冠状动脉介入治疗中应用血栓抽吸术的疗效进行评价,探讨血栓抽吸术在急性心梗患者直接经皮冠状动脉介入治疗(PCI)中的应用价值。方法:收集吉林大学中日联谊医院心内科2007年3月~2010年3月收住的急性心肌梗死患者中急诊冠脉造影提示梗死相关动脉血流TIMI 0~1级、并行PCI治疗的36例患者的临床资料。对比分析应用抽吸技术的患者及对照组的临床及造影资料。结果:对于行血栓抽吸的直接PCI患者,其心肌灌注水平高于常规PCI治疗组,但其心功能相关指标未见明显差异。结论:直接PCI是急性心肌梗死心肌再灌注的重要方法,通过血栓抽吸可改善心肌再灌注水平。 相似文献
5.
GAO Run-lin HAN Ya-ling YANG Xin-chun MAO Jie-ming FANG Wei-yi WANG Lei SHEN Wei-feng LI Zhan-quan JIA Guo-liang L Shu-zheng WEI Meng ZENG Ding-yin CHEN Ji-lin QIN Xue-wen XU Bo DU Chang-hui 《中华医学杂志(英文版)》2010,123(11):1365-1372
Background Although thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study. Methods This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (age 〈70 years) with STEMI who presented within 12 hours of symptom onset (mean interval 〉3 hours). Patients were randomized to three groups: primary PCI group (n=101); recombinant staphylokinase (r-Sak) group (n=-104); and recombinant tissue-type plasminogen activator (rt-PA) group (n=-106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow grade 〈2. Bare-metal stent implantation was planned for all patients. Results After randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time)and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time). Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P 〈0.0001, and 53.0% vs. 85.9%, P 〈0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P=-0.0222, and 68.4% vs. 85.0%, P=0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P=0.0034). Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group (10.0% vs. 1.0%, P=-0.0380, and 28.10% vs. 8.91%, P=-0.O001, respectively). Conclusions Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments. 相似文献
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Shen Ying Wu Feng Pan Chunyang Zhu Tianqi Zhang Qi Zhang Ruiyan Ding Fenghu Lu Lin Hu Jian Yang Zhenkun Shen Weifeng Wu Zonggui 《中华医学杂志(英文版)》2014,127(1):66-71
Background Collaterals to occluded infarct-related coronary arteries (IRA) have been observed after the onset of acute ST-elevation myocardial infarction (STEMI).We sought to investigate the impact of early coronary collateralization,as evidenced by angiography,on myocardial reperfusion and outcomes after primary percutaneous coronary intervention (PCI).Methods Acute procedural results,ST-segment resolution (STR),enzymatic infarct size,echocardiographic left ventricular function,and major adverse cardiac events (MACE) at 6-month follow-up were assessed in 389 patients with STEMI undergoing primary PCI for occluded IRA (TIMI flow grade 0 or 1) within 12 hours of symptom-onset.Angiographic coronary collateralization to the occluded IRA at first contrast injection was graded according to the Rentrop scoring system.Results Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralization was detected in 329 and 60 patients,respectively.Patients with high collateralization more commonly had prior stable angina and right coronary artery occlusion,but less often had left anterior descending artery occlusion.At baseline,these patients presented with less extent of ST-segment elevation and lower serum levels of creatine kinase myocardial band (CK-MB) and cardiac troponin Ⅰ (cTnl).Procedural success rate,STR,corrected TIMI flame count,and area under the curve of CK-MB and cTnl measurements after the procedure were similar between patients with high collateralization and those with low collateralization (for all comparisons P>0.05).There were no differences in left ventricular ejection fraction and rates of MACE at 6 months according to baseline angiographic collaterals to occluded IRA.Conclusions In patients with acute STEMI undergoing primary PCI within 12 hours of symptom-onset,coronary collateralization to the occluded IRA was influenced by clinical and angiographic features.Early recruitment of collaterals limits infarct size at baseline,but has no significant impact on myocardial reperfusion after the procedure and subsequent left ventricular function and clinical outcomes. 相似文献
7.
目的:观察急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(pPCI)前后心室肌跨壁复极离散度指标(QTc、Tp-Te、Tp-Tec间期)的差异。方法:回顾分析245例STEMI患者,其中行pPCI治疗(干预组)188例,未行急诊PCI(对照组)57例,采集其入院即刻及入院第3天标准12导联心电图进行分析。结果:(1)干预组患者入院第3天和入院即刻比较,QTc间期无明显变化(P =0.277),Tp-Te间期、Tp-Tec间期均明显减小(P <0.001);对照组患者入院第3天和入院即刻比较,QTc间期较前增大,Tp-Te间期、Tp-Tec间期均较前减小(P 分别为:0.018,0.003,0.001);与对照组比较,干预组入院第3天Tp-Te、Tp-Tec间期减小更明显。(2)干预组与对照组相比,住院期间恶性心律失常事件发生率降低(P < 0.05)。结论:急诊PCI术可使Tp-Te间期、Tp-Tec间期明显减小,比药物治疗可更有效地改善心室肌跨壁复极离散度,使恶性心律失常发生率降低。 相似文献
8.
目的观察冠状动脉注射替罗非班对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PCI)术中炎性介质表达的影响。方法采用随机抽样法将患者分为治疗组(46例)和对照组(37例)。采用酶联免疫吸附法检测直接PCI术中靶血管炎性介质IL-6及TXA2浓度,观察其在用药前后的变化。通过冠状动脉造影评估TIMI血流分级,PCI术后行心电图检查计算ST段回落幅度。结果经冠状动脉注射替罗非班后,治疗组IL-6、TXA2值与对照组比较差异均有统计学意义(t=2.968、2.358,P<0.05或0.01);TIMI血流改善较对照组明显(字2=4.273,P<0.05),TIMI帧数少于对照组(t=2.062,P<0.05);治疗组心电图ST段回落较对照组明显(t=2.163,P<0.05)。结论冠状动脉注射替罗非班通过抑制靶血管炎性介质IL-6及TXA2表达改善心肌灌注。相比静脉给药,冠状动脉注射替罗非班能更好地发挥抗血小板、抗炎特性,改善冠状动脉血流及心肌灌注。 相似文献
9.
目的 通过血栓抽吸导管在急性心肌梗塞(AMI)患者急诊经皮冠脉介入(PCI)治疗中的应用,以评价其可行性及有效性.方法 选择2008年6月~2010年8月在该院接受急诊介入治疗的AMI患者共106例,其中急诊介入术加血栓抽吸治疗者为观察组(n=55),同期条件相当未应用血栓抽吸治疗仅行急诊介入治疗患者作为对照组(n=51),比较两组的基础资料、术后和随访期间等情况.结果 观察组在发病距血管再通时间、直接支架置入率和术后达TIMI3级血流的情况明显好于对照组,无复流率则明显减少,两组之间差异有显著性(P<0.05).术后观察组在TnT峰值及CK-MB峰值、ST段回落率、住院期间心表、再次AMI、病死率等方面与对照组比较差异亦有显著性(P<0.05).结论 在AMI急诊PCI中应用ZEEK血栓抽吸导管安全可行,能有效的清除冠状动脉内血栓,改善心肌组织灌注,提高患者术后心功能. 相似文献
10.
The transradial access has been used for percutaneous coronary intervention (PCI) for more than 10 years. Many studies have confirmed several advantages of a radial route over the traditional transfemoral approach, some of which include a decreased incidence of access site complications, an earlier ambulation after the procedure which helps make patients more comfortable after the procedure.4-SHowever, the radial artery is easier to spasm as it is smaller than the femoral artery. This kind of phenomenon often happens when shifting from angiographic catheters to guiding catheters. 相似文献
11.
心肌梗死455例PCI后临床疗效观察 总被引:2,自引:0,他引:2
目的:观察评价不同时期心肌梗死(MI)患者经皮冠状动脉介入治疗(PCI)后即刻疗效及远期疗效. 方法:对1988-04/2001-12住西京医院的455例经PTCA(经皮冠状动脉腔内成形术)或(和)支架术并在术前已明确诊断的MI患者进行1 mo~8 a的随访. 其中69例为急性MI(AMI)后直接PCI或溶栓后补救性PCI;263例为AMI后2 mo内择期PCI和123例陈旧性MI(OMI,MI时间大于2 mo)后的PCI. 结果:在66例单纯球囊扩张术及389例结合支架术或直接支架术中,手术成功率98.5%,2例术中死亡,3例行冠状动脉旁路移植术. 382例随访1 mo,无症状存活率87.7%,死亡12例. 129例随访2~8 a,无症状存活52.7%,死亡10例. 71例有症状复查冠脉造影中,30例发生再狭窄. 结论:MI患者PCI即刻疗效好,远期无事件存活率52.7%,AMI伴多支病变或心源性休克是术后早期死亡的主要原因. 大于2 mo以上的MI患者也能在PCI中获益. 相似文献
12.
直接冠脉介入治疗急性心肌梗死临床分析 总被引:1,自引:0,他引:1
目的 探讨急性心肌梗死直接经皮冠脉介入治疗(PCI)的疗效,方法及安全性.方法 建立急性心肌梗死"绿色通道",对236例急性心肌梗死患者,采用经股动脉或经桡动脉途径常规方法,行直接PCI,观察梗塞相关动脉的开通率、血流情况、术中并发症,住院期间主要心血管事件,随访观察预后、再狭窄及再次血运重建情况.结果 呼叫到球囊开通时间为(88±36)min,227例患者成功开通梗死相关动脉.TIMI血流3级(96.2%),9例发生无再流,共植入支架235个.无严重手术并发症发生,15例心原性休克患者11例存活(73.3%),5例心肺复苏患者3例生存.住院期间死亡10例,死亡原因为心力衰竭、休克和室颤.随访期间再发心肌梗死7例,死亡4例.87例复查冠脉造影,19例再狭窄,12例再次行PCI术,3例行冠脉搭桥术.结论 直接PCI治疗急性心肌梗死安全有效,在有条件的医院可首选PCI作为急性心肌梗死治疗的方法. 相似文献
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糖尿病合并急性心肌梗死急诊介入治疗疗效 总被引:1,自引:0,他引:1
目的 评价糖尿病患者合并急性心肌梗死急诊介入治疗的疗效。方法 分析1997.2-1999.12中88例伴糖尿病与216例不伴糖尿病急性心肌梗死行急诊介入治疗患者的临床疗效。结果 糖尿病组伴心源性休克15例,死亡率为4.5%,成功率94.0%。78例成功介入治疗患者随访(11.7±7.8)月,主要不良心脏事件(MACE)发生率28.2%。不伴糖尿病组中有29例合并心源性休克,死亡率为1.9%,成功率97.1%,其中178例随访(12.6±8.3)月期间MACE发生率为18.0%。急诊介入治疗成功率两组相似,近期死亡率和中远期MACE发生率糖尿病组也无明显增高(P>0.05),女性患者的比例在糖尿病组明显增高(P=0.01)。结论 急诊介入治疗糖尿病合并急性心肌梗死安全可靠,效果佳。 相似文献
14.
急性心肌梗死患者急诊PCI术后无复流的危险因素分析 总被引:1,自引:0,他引:1
目的探讨急性心肌梗死(AMI)患者急诊PCI术后出现无复流的相关危险因素。方法发病在6h以内,或12 h内仍有持续胸痛的843名AMI患者给予急诊PCI,收集患者的临床、造影和介入治疗资料。PCI术后,根据TIMI血流分级和心肌显色分级两项结果将病人分为两组,正常血流组和无复流组。比较这两组病人基本临床资料、造影结果和手术相关资料的差异,分析AMI患者急诊PCI术后出现无复流的原因。结果急诊PCI术后无复流的发生率约为15.9%。通过单变量分析,既往MI病史、心梗Killip分级、症状至PCI时间、术前IABP应用、术前TIMl分级、病变长度、血栓负荷程度、再灌注方法与急诊PCI术后发生无复流有关(P<0.05)。多变量Logistic回归模型认为,症状至PCI时间(OR:1.60;95%CI:1.02~2.73)、术前TIMI血流分级(OR:1.1;95%CI:1.04~1.16)、病变血管长度(OR:1.40;95%CI:1.19~1.69),血栓负荷程度(OR:2.02;95%CI:1.47~2.76)可作为急诊PCI术后无复流发生的独立危险因素。结论症状至PCI时间、术前TIMI血流分级、病变血管长度和血栓负荷程度可作为AMI患者急诊PCI后发生无复流的独立预测因素。 相似文献
15.
目的分析急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入(PCI)治疗手术中及住院期间死亡率与患者侧支循环形成的关系。方法1999年3月~2006年10月于我科行急诊PCI治疗的AMI患者623例。发病至介入治疗时间为2~36h。结果患者死亡27例,死亡率为4.3%。60岁以下死亡率1.7%(4/232),60~75岁死亡率为5.0%(14/279),75岁以上患者的死亡率为8.0%(9/112)。侧支循环形成率60岁以下为91.4%(212/232),60~75岁61.6%(172/279),75岁以上37.5%(42/112)。结论PCI治疗AMI的死亡率与侧支循环形成率呈负相关。年轻患者侧支循环形成率较高,相应死亡率也较低。老年患者死亡率较高,可能与侧支循环形成率较低有关。 相似文献
16.
17.
ZHANG Qi ZHANG Rui-yan SHEN Jie ZHANG Jian-sheng HU Jian YANG Zheng-kun ZHANG Xian ZHENG Ai-fang SHEN Wei-feng 《中华医学杂志(英文版)》2008,121(23):2379-2383
Background Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.
Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis.
Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 (29.1% vs 18.6%, P=0.02) and multi-vessel (62.8% vs 44.5%, P=0.001) and triple vessel disease (32.6% vs 18.2%, P=0.002), in-hospital mortality (9.3% vs 3.8%, P=0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P=-0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P=-0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P=0.15). Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31,95% CI 1.19-9.18, P 〈0.001).
Conclusion Despite similar prevalence of stent thromb 相似文献
Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis.
Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 (29.1% vs 18.6%, P=0.02) and multi-vessel (62.8% vs 44.5%, P=0.001) and triple vessel disease (32.6% vs 18.2%, P=0.002), in-hospital mortality (9.3% vs 3.8%, P=0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P=-0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P=-0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P=0.15). Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31,95% CI 1.19-9.18, P 〈0.001).
Conclusion Despite similar prevalence of stent thromb 相似文献
18.
Background Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical outcomes of tirofiban combined with the low molecular weight heparin (LMWH), dalteparin, in primary PCI patients with acute STEMI.
Methods From February 2006 to July 2006, a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group I: 60 patients, (61.2±9.5) years), and dalteparin with tirofiban (group II: 60 patients, (60.5±10.1) years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Bleeding complications during hospitalization were also examined.
Results There were no significant differences in sex, mean age, risk factors, past history, inflammatory marker, or echocardiography between the 2 groups. In terms of the target vessel and vascular complexity, there were no significant differences between the 2 groups. During the first 7 days, emergent revascularization occurred only in 1 patient (1.7%) in group I. Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%) in group II died. Total in-hospital MACE during the first 7 days was 4 (6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in group II, however, the difference was not statistically significant. No significant intracranial bleeding was observed in either group. Four years after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%) in group II. MACE occurred in 12 (20.0%) patients in group I and in 10 (16.7%) patients in group II.
Conclusions Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH. Although there was no statistically significant difference, LMWH decreased the bleeding complications compared with UFH.
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19.
目的评价慢性肾功能不全对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)预后的影响。方法回顾性收集因STEMI在北京安贞医院接受急诊PCI的患者743例。将肾小球滤过率(eGFR)<60 mL·min-1·1.73 m-2的患者作为肾功能不全组,eGFR≥60 mL·min-1·1.73 m-2的患者作为对照组,比较2组患者的临床特点、病变特点和预后情况。结果与对照组比较,肾功能不全组患者年龄大、男性少、并发高血压和糖尿病者多、既往心肌梗死病史及多支病变者多、心功能不全(Killip分级≥2)者多(P<0.05);住院期间及随访2 a时主要心血管不良事件及病死率明显升高(P<0.05);Logistic多因素回归分析显示,eGFR<60 mL·min-1·1.73 m-2、年龄≥70岁、Killip分级≥2、糖尿病、既往心肌梗死病史、多支病变均为患者2 a内死亡的独立预测因子(P<0.05),其中eGFR<60 mL·min-1·1.73 m-2校正的相对危险度为1.93(95%可信区间:1.24~4.56,P=0.01)。结论 STE-MI接受急诊PCI治疗患者中,并发肾功能不全患者临床预后较差,而eGFR<60 mL·min-1·1.73 m-2是接受急诊PCI治疗STEMI患者预后不良的最重要危险因素。 相似文献
20.
目的:探讨替罗非班对直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者心肌灌注及临床预后的影响.方法:将AMI住院患者60例随机分为替罗非班治疗组(A组,予直接PC/+替罗非班,n=30)和对照组(B组,仅予直接PCI,n=30).比较两组间的基础临床状况、造影情况、介入治疗结果、心功能和心脏不良事件(MACE,包括死亡、再梗死、再次靶血管重建)发生率.结果:两组基础临床情况、介入治疗结果差异均无统计学意义.与B组相比,A组术后即刻心肌梗死溶栓试验(TIMI)3级复流血流差异无统计学意义(93%vs86%,P〉0.05).即刻心肌Blush分级3级(77.0%vs33.0%,P〈0.05)显著高于B组,而校正TIMI帧数[(23.5±7,6)帧和(32.1±4.2)帧,P〈0.05]显著低于B组.A组术后sT段抬高总和回落[(69.8±14.2)%和(38.6±11.7)%,P〈0.05]显著高于B组,而肌酸激酶(CK)峰值[(28.4±5.0)和(37.7±8.7)ukat/L,P〈0.05]显著低于对照组.住院期间,A,B两组左室射血分数(LVEF)[(45.8±2.7)%和(44.7±3.8)%]、左室舒张期末直径(LVEDD)[(4.95±0.31)cm和(4.99±0.27)cm]差异均无统计学意义.随访期间,A,B两组LVEF[(58.1±3.6)%和(51.1±2.4)%]、LVEDD[(5.2±0.2)cm和(5.5±0.2)cm]差异均有统计学意义(P〈0.05).两组住院期间和随访期间各项心脏事件发生率差异有统计学意义(P〈0.05).A组术后出血并发症发生率高于B组(23.3%vs7.0%),但差异无统计学意义(P〉0.05).结论:替罗非班可改善PCI的AMI患者心肌灌注及临床预后,且临床应用安全. 相似文献