地尔硫卓干预冠心病患者PCI术后再狭窄的疗效

目的探讨地尔硫卓对冠心病经皮冠状动脉介入治疗(PCI)术后再狭窄的影响。方法选择冠心病PCI术后患者93例为研究对象,将其随机分为治疗组和对照组,治疗组患者在常规治疗措施的基础上给予地尔硫卓;对照组患者术后仅采用常规治疗,随访半年,观察两组再狭窄率。结果 6个月复查时对照组再狭窄率为14.58%,治疗组为2.22%,再狭窄率差异有统计学意义(P<0.05)。结论 PCI术后在常规治疗基础上加用地尔硫卓可显著降低再狭窄率及心脏不良事件发生率。     

丹蛭冰麝复方中药单体胶囊干预PCI术后再狭窄疗效研究

目的探讨丹蛭冰麝复方中药单体胶囊干预冠心病的介入治疗(PCI)术后再狭窄的临床疗效及对血管内皮功能的影响。方法选择贵阳中医学院第二附属医院及南昌大学附属九江医院2013年1月~2016年1月住院治疗的70例术前冠脉造影结果示冠状动脉狭窄≥50%的PCI手术成功患者,随机分为观察组和对照组(n=35),对照组进行西药常规治疗,观察组在西药常规治疗的基础上,于手术后当天加服丹蛭冰麝复方中药单体胶囊,3次/d,连服6个月,术后6个月复查两组患者的冠状动脉造影。结果观察组冠心病介入治疗(PCI)术后再狭窄率为5.7%优于对照组介入治疗术后再狭窄率为14.2%,且两组ET-l、NO有极显著差异(P0.05),IXBZ有显著差异(P0.05),不良事件发生率两组间无显著差异(P0.05)。结论丹蛭冰麝复方中药单体胶囊可以有效防治PCI术后再狭窄的发生,改善血管内皮细胞功能。减少PCI术后心绞痛的复发率,血瘀证症状明显改善,不增加各种不良事件(如死亡,肝肾功能损害,致命性大出血)。     

冠心病患者首次经皮冠状动脉介入治疗后支架内再狭窄的随访研究

研究显示冠心病患者经皮冠状动脉介入治疗(PCI)后再狭窄率约30%,在术后1～3个月再狭窄率最高。本研究旨在探讨冠心病患者经PCI治疗后再狭窄的原因,为进一步治疗和预防PCI后再狭窄提供临床理论依据。1.对象与方法:对676例经冠状动脉造影(管腔狭窄≥50%)证实为冠心病的患者进行PC     

心痛舒方防治冠心病PCI术后再狭窄的临床研究

目的观察心痛舒方对冠心病病人PCI术后再狭窄及不良心血管事件发生的干预作用。方法选择2015年5月—2016年10月在我院住院行PCI术的冠心病病人100例,随机分为两组。对照组(常规治疗组)50例和治疗组(常规治疗+心痛舒方)50例,治疗组在对照组基础上加服心痛舒方(中药制剂),每天1次,每次100mL,连续服药3个月,两组病人随访6个月,观察术后不良心血管事件发生率及支架内再狭发生率。结果术后随访6个月,再发心绞痛8例,其中治疗组2例(4%),对照组6例(12%),对照组发生非致死性急性心肌梗死1例(2%),上述9例病人均再次PCI治疗。两组均未发生心源性死亡病例。两组相比较,在发生急性心肌梗死和心源性死亡方面差异无统计学意义(P0.05)。治疗组心绞痛、再次血运重建、联合心血管事件发生率较对照组低(P0.05)。两组介入前后冠脉血管狭窄程度、最小管腔直径、管腔早期获得差异均无统计学意义(P0.05);6个月复查造影:病变血管管腔直径对照组较治疗组明显增加(P0.05),再狭窄发生率治疗组较对照组低(6%vs 18%,P0.05)。结论心痛舒方对冠心病病人PCI术后再狭窄的预防有一定作用。     

PTX3与急性冠脉综合征病人支架内再狭窄及预后的相关性研究

目的探讨外周血长正五聚蛋白3(PTX3)对冠心病经皮冠状动脉介入治疗(PCI)效果及预后的预测价值。方法选择在我院择期行PCI,并在术后9～12个月复查冠状动脉造影的急性冠脉综合病人162例,根据冠状动脉造影结果分为再狭窄组和非狭窄组。所有病人均于冠状动脉造影前及冠状动脉支架植入术后24h采集外周静脉血标本,应用酶联免疫法测血浆PTX3水平。结果 PCI术后血浆PTX3水平明显升高;再狭窄组明显高于非狭窄组;Logistic回归分析显示,血浆PTX3与支架再狭窄、12个月的主要心血管事件(MACE)独立相关。结论 PTX3可能在冠状动脉支架再狭窄过程中起一定作用,可作为冠状动脉支架再狭窄及MACE事件的可靠炎症预测因子。     

血浆视黄醇结合蛋白4水平与PCI术后支架内再狭窄的相关性研究

目的探讨血浆视黄醇结合蛋白4(RBP4)水平与经皮冠状动脉介入治疗(PCI)术后支架内再狭窄的相关性。方法选取2015年1月—2017年7月在我院住院行冠状动脉造影及PCI术,并在术后6～12个月复查冠状动脉造影的病人105例,根据复查造影的结果将病人分为支架再狭窄组(ISR组)和非支架再狭窄组(非ISR组),比较两组临床资料。并采用多元Logistic回归模型探讨RBP4水平与支架内再狭窄的关系。结果 105例病人中12例发生了支架内再狭窄。与非ISR组相比,ISR组血浆RBP4水平显著高于非ISR组,差异有统计学意义(P0.05)。多元Logistic回归模型结果显示,RBP4水平每升高5μg/mL,支架内再狭窄风险增加36%[OR=1.36, 95%CI(1.24～3.48),P=0.023]。结论 RBP4水平升高能够独立增加冠心病病人PCI术后支架内再狭窄的发生风险。     

氧化低密度脂蛋白、高敏C反应蛋白与冠状动脉支架置入术后再狭窄的关系

目的:探讨氧化低密度脂蛋白(ox-LDL)、高敏C反应蛋白(hs-CRP)与经皮冠状动脉介入治疗(PCI)术后支架内再狭窄的相关性。方法:45例患者PCI术后6~12个月内接受冠状动脉造影复查,其中18例有再狭窄作为再狭窄组,27例无再狭窄作为对照组。2组术后均接受阿司匹林、波立维、他汀类等药物治疗。取2组患者PCI术前、后冠状动脉造影复查时血浆标本,采用酶联免疫吸附法(ELISA)检测血浆ox-LDL水平,超敏免疫比浊法检测血浆hs-CRP水平,酶法测定血脂水平。结果:①再狭窄组PCI术后ox-LDL、hs-CRP水平较术前均明显升高[(1.32±0.35)∶(0.53±0.17)mg/L、(4.82±1.44)∶(3.50±1.18)mg/L],均P0.01;对照组PCI后ox-LDL、hs-CRP水平较术前明显下降[(0.32±0.13)∶(0.55±0.13)mg/L、(2.28±0.71)∶(3.37±1.25)mg/L],均P0.05。②再狭窄组和对照组PCI术前ox-LDL、hs-CRP水平差异无统计学意义,再狭窄组PCI术后ox-LDL、hs-CRP水平显著高于对照组(均P0.01)。③再狭窄组和对照组术后TC、TG、LDL-C水平均较术前明显下降(P0.05),但2组间PCI术前和术后比较均差异无统计学意义(P0.05)。④再狭窄组和对照组术前、术后ox-LDL和hs-CRP水平均呈正相关。结论:PCI术后再狭窄患者血浆ox-LDL及CRP水平明显升高,二者可作为PCI术后再狭窄的预测指标。     

soL-CXCL16、SAA、Cys-C水平与PCI术后冠状动脉再狭窄的相关性

目的探讨血清淀粉样蛋白(SAA)、可溶性趋化因子16(so L-CXCL16)、胱抑素C(Cys-C)与冠心病经皮冠状动脉介入术(PCI)后再发狭窄的关系。方法选取2013年1月至2017年12月在四川大学华西医院实施PCI治疗后再狭窄患者60例(狭窄组)、选取同期PCI治疗未发生冠状动脉狭窄的患者60例(未狭窄组),对比两组患者的血清so L-CXCL16、SAA、Cys-C、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、置入支架数目、置入支架长度、治疗药物的情况。结果狭窄组和未狭窄组的年龄、性别、血清TG、TC、HDL-C、LDL-C、FPG、治疗药物的情况差异无统计学意义(P 0. 05);狭窄组的Hb A1c、置入支架数目显著高于未狭窄组(P 0. 05);狭窄组的so L-CXCL16、SAA、Cys-C显著高于未狭窄组(P 0. 05);冠心病患者PCI术后血清so L-CXCL16、SAA、Cys-C水平升高、患者的Hb A1c高水平是患者PCI术后发生冠状动脉再狭窄的危险因素(P 0. 05)。结论冠心病患者PCI术后发生冠状动脉再狭窄受到多种因素的影响,血清so L-CXCL16、SAA、Cys-C水平升高是其危险因素之一。     

PCI术前Lp(a)、MAU蛋白水平与冠心病术后冠状动脉再狭窄的关系研究

目的探讨经皮冠状动脉介入术(PCI)前血清脂蛋白(a)[Lp(a)]、尿微量白蛋白(MAU)水平与冠心病病人术后冠状动脉再狭窄的关系。方法选取2016年4月—2017年4月我院接受PCI治疗的120例冠心病病人,随访12个月后进行冠状动脉造影。失访4例、死亡4例。将再次发生冠状动脉狭窄的病人33例作为再狭窄组,未再出现冠状动脉狭窄的79例病人作为对照组。比较两组术前一般资料、血清Lp(a)、MAU水平,探讨Lp(a)、MAU水平与病人发生冠状动脉再狭窄的关系。结果两组总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、血肌酐、尿酸、收缩压(SBP)、舒张压(DBP)、吸烟史、冠状动脉病变部位、支架直径、支架长度、规范用药情况比较,差异均无统计学意义(P0.05);再狭窄组血清LDL-C水平显著高于对照组(P0.05);再狭窄组Lp(a)、MAU水平显著高于对照组(P0.05);多因素Logistic回归分析结果显示:PCI术前Lp(a)、LDL-C、MAU水平升高是冠心病病人术后发生支架内再狭窄的独立危险因素(P0.05)。结论 PCI术前病人的Lp(a)、MAU水平升高会增加冠心病病人术后发生支架内再狭窄的风险。     

血浆 IP10水平与冠心病患者 PCI 术后支架内再狭窄的关系

目的：探讨血浆IP10水平与冠心病患者经皮冠状动脉介入治疗（PCI）术后支架内再狭窄的关系。方法选取行PCI的冠心病患者（均植入冠状动脉支架）, PCI术后半年复查冠状动脉造影,结果示支架内再狭窄且狭窄程度≥参照血管50％患者17例为支架内再狭窄组（ ISR组）;造影提示支架内再狭窄＜50％或无再狭窄患者95例为支架内无再狭窄组（ NSR组）;另选冠状动脉造影示冠状动脉狭窄程度＜50％的胸痛患者106例作为对照组。比较三组血浆IP10水平。结果 NSR组血浆IP10水平高于对照组,但两组比较P＞0．05;ISR组血浆IP10水平明显高于NSR组（P＜0．05）。结论支架内再狭窄患者血浆IP10水平明显高于支架内无再狭窄者;IP10有可能作为评价PCI术后支架内再狭窄发生风险的一项独立预测指标。     

两种国产西罗莫司洗脱支架治疗ST段抬高型心肌梗死患者的疗效和安全性研究

目的 比较两种国产西罗莫司洗脱支架(Excel与Firebird)对急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入治疗(PCI)的有效性和安全性.方法 入选我院急性STEMI患者249例,根据植入支架类型,随机分为Excel支架组136例(54.6%)和Firebird支架组113例(45.4%).随访6～24个月,平均12个月行定量冠状动脉造影复查.比较两组患者手术即刻成功率,术后住院及随访过程中主要不良心脏事件(包括心原性死亡、再发心肌梗死和靶病变血运重建)发生率及晚期管腔丢失、支架再狭窄、支架内血栓发生率.结果 两组患者术前临床基线特征及冠状动脉病变情况、直接PCI术后即刻情况差异均无统计学意义(P＞0.05);术后平均12个月随访中,两组患者死亡分别为2例(1.47%)与1例(0.88%),无心原性死亡,非致死心肌梗死分别为1例(0.74% )与1例(0.88%),靶血管再次血运重建分别为2例(1.47%)与2例(1.77%),差异无统计学意义(均P＞0.05).定量冠状动脉造影随访两组支架内最小管腔内径、节段内最小管腔内径、支架内晚期管腔丢失、节段内晚期管腔丢失,差异无统计学意义(均P＞0.05);支架内再狭窄、节段内再狭窄、支架内血栓形成的发生率差异亦无统计学意义(均P＞0.05).结论 STEMI患者直接PCI应用两种国产西罗莫司洗脱支架均有效、安全.

Abstract：

Objective To compare the efficacy and safety of two kinds of homemade sirolimus-eluting stents (Firebird and Excel) for treatment of acute ST segment elevation myocardial infarction (STEMI) in patients who underwent percutaneous coronary intervention (PCI). Methods The 249 consecutive patients with STEMI who underwent PCI were randomly divided into two groups: Excel group (n=136) and Firebird group (n=113). They were followed up for 6-24 months, and coronary angiography was reviewed average 12 months later. The primary endpoints were major adverse cardiac events, including death, reinfarction and target vessel revascularization. The second endpoints included late luminal loss and restenosis 12 months after treatment. Results There were no significant differences in baseline data, coronary arterial lesion before operation, and immediateness condition after PCI between the two groups (all P＞0.05). Within follow-up, there were 2 (1.47%) death cases and 1 (0.88%) death case, 1 (0.74%) and 1 (0.88%) nonfatal myocardial infarction case, 2 (1.47%) and 2 (1.77%) target vessel revascularization cases in the two groups respectively (all P＞0.05). There were no significant differences in late luminal loss of in-stent and in-segment, the rates of in-stent restenosis, in-segment restenosis and stent thrombosis, the in-stent minimal lumen diameter and in-segment minimal lumen diameter between the two groups (all P＞0.05). Conclusions The two kinds of homemade sirolimus-eluting stents may have similar efficacy and safety in patients with STEMI treated with primary PCI.     

The correlation between the level of Lp-PLA2 and coronary instent restenosis after PCI

Background Coronary in-stent restenosis(ISR) is an important complication of percutaneous coronary intervention(PCI). However, the relationship between lipoprotein associated phospholipase A2(Lp-PLA2) level and coronary ISR after PCI is rarely reported. Methods 30 patients with coronary ISR after PCI were recruited as the experimental group, 63 patients without coronary ISR after PCI were served as the control group. Lp-PLA2, hypersensitive C-reactive protein(Hs-CRP) and Low density lipoprotein cholesterol(LDL-C) were measured respectively. Smoking, hypertension, diabetes mellitus and other related factors were recorded. The relationships between these factors and restenosis of coronary stent after PCI were analyzed. Results The correlation analysis showed statistically significant(P0.05) between the level of Lp-PLA2, Hs-CRP and the restenosis of coronary stent after PCI, and that Lp-PLA2 level was an independent risk factor for coronary ISR after PCI. The correlation of Lp-PLA2 to ISR was superior to that of Hs-CRP to ISR. Conclusion The increased level of Lp-PLA2 is correlated to coronary ISR after PCI. Therefore, plasma level of Lp-PLA2 may be used as a clinically useful marker for coronary ISR prediction in patients undergoing PCI.     

药物洗脱支架置入术后晚期支架内再狭窄患者再次介入治疗的短期预后及危险因素分析

目的:本研究旨在探索老龄和非老龄药物洗脱支架置入术后晚期支架内再狭窄(L-ISR)患者的临床特征,再次经皮冠状动脉介入治疗(PCI)后的短期预后及相关危险因素。方法:共入选218例在我院初次置入药物洗脱支架并于2016年因L-ISR而需要再次入院接受治疗的患者。根据患者年龄分为老龄组(年龄≥65岁,n=77)和非老龄组(年龄<65岁,n=141)。患者的入院特征、临床表现以及介入治疗特点和手术结果等被纳入分析评估,并随访患者PCI后12个月内的主要不良心血管事件(MACE)包括心原性死亡、非致死性心肌梗死及靶病变血运重建(TLR)。结果:L-ISR患者中75.7%的患者因不稳定性心绞痛入院,64.7%的患者再次置入支架。与非老龄组相比,老龄组有更高比例的脑卒中、心房颤动、既往冠状动脉旁路移植术并且支架置入至发现支架内再狭窄的时间更长,体重指数(BMI)更小、冠心病家族史比例更低(P均<0.05)。两组患者入院时的临床症状表现相似,主要表现为不稳定性心绞痛,其他基线资料比较差异均无统计学意义(P均>0.05)。与老龄组患者相比,非老龄组患者的MACE发生率较高,但差异无统计学意义(6.4%vs 3.9%,P=0.546)。多因素回归分析发现,左心室收缩功能障碍(OR=6.317,95%CI:1.145~34.843, P=0.034)是L-ISR患者介入治疗后短期MACE发生的独立危险因素。结论:左心室收缩功能障碍与L-ISR患者短期MACE发生相关。在临床实践中,识别该类人群可能更有助于L-ISR患者的危险分层和二级预防。     

ACE基因I/D多态性与冠状动脉支架内再狭窄相关性研究

目的研究冠状动脉内行药物洗脱支架置入术患者,术后支架内再狭窄发生情况与ACE基因I/D多态性的关系。方法所有患者行冠状动脉造影检查,PCR方法测定ACE基因型。根据血管造影结果分为再狭窄组（病变狭窄≥50%）和无再狭窄组（病变狭窄〈50%）。采用SPSS18.0软件比较再狭窄组与无再狭窄组的临床基本特征、冠脉造影资料,以及与ACE基因型的关系。结果此次研究共纳入396名行药物洗脱支架置入术的冠心病患者,支架内再狭窄发生40例,再狭窄率为10.1%。再狭窄组与无再狭窄组的临床基本资料、冠脉造影资料均无显著性差异（P〉0.05）。再狭窄组的ACEDD基因型35.56%、ACEDI基因型16.39%、ACEII基因型3.85%。再狭窄组与ACE基因I/D多态性具有相关性（P〈0.001）。结论冠状动脉内行药物洗脱支架置入术患者术后支架再狭窄发生与ACEDD基因型具有显著相关性。     

Prospective randomized study of argatroban versus heparin anticoagulation therapy after percutaneous coronary intervention for acute myocardial infarction

OBJECTIVES: Argatroban, a selective thrombin inhibitor, is expected to decrease acute coronary re-occlusion and restenosis via direct suppression of thrombin generation after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. This study evaluated the effect of argatroban compared with heparin as an adjunctive anticoagulation therapy after PCI in patients with acute myocardial infarction. METHODS: Fifty-four consecutive patients with acute myocardial infarction underwent PCI within 6 hr from the onset and were randomly allocated to receive argatroban (argatroban group: n = 27) or heparin (heparin group: n = 27) after PCI. Each drug was administered intravenously for 72 hr. Coronary angiography was repeated at 1 and 6 months after the onset of acute myocardial infarction. In-hospital cardiac events, bleeding complications, and long-term outcome were surveyed. RESULTS: Baseline clinical and angiographic variables were similar in the two groups. Acute coronary re-occlusion and major hemorrhagic complications did not occur in either group. Minor bleeding complications, such as hematoma of the puncture sites, occurred significantly less frequently in the argatroban group than in the heparin group (4% vs 30%, p < 0.05). After 6 months, there were no significant differences in restenosis rate and target vessel recanalization rate between the two groups. Subgroup analyses revealed no significant differences in restenosis rate between patients treated with only balloon angioplasty and stent implantation. CONCLUSIONS: Argatroban provides similar prevention of acute thrombotic events and restenosis compared with heparin. However, argatroban might reduce bleeding complications in patients with acute myocardial infarction after PCI.     

药物洗脱支架治疗冠状动脉小血管病变的疗效分析

目的通过分析比较裸金属支架(BMS)与药物洗脱支架[DES,包括雷帕霉素(Cypher)支架和紫杉醇(TAXUS)支架]治疗冠状动脉小血管病变疗效的差异,为DES治疗多支及单支小血管病变冠心病提供依据。方法连续入选2002年12月至2005年5月沈阳军区总医院首次接受经皮冠状动脉介入治疗(PCI)、靶血管为小血管病变且达到完全血运重建的486例患者,其中多支小血管病变(多支)150例。分为BMS组214例(多支63例)、Cypher组140例(多支46例)和TAXUS组132例(多支41例),对比分析各组患者住院期间及随访6个月的临床情况。结果3组患者冠脉病变特点、PCI成功率及住院期间主要不良心脏事件(MACE)发生率等指标差异均无显著性(P>0·05)。冠脉造影随访显示,两个DES组再狭窄率均明显低于BMS(Cypher组4·9%,TAXUS组7·5%对BMS组29·2%,P<0·05),随访期间MACE发生率亦明显低于BMS(Cypher组2·9%,TAXUS组3·9%对BMS组12·0%,P<0·01)。进一步分析多支小血管病例,发现两个DES组的再狭窄率及随访期间MACE发生率仍然明显低于BMS组(再狭窄率Cypher组6·7%,TAXUS组7·1%对BMS组37·5%,P<0·05;MACE发生率Cypher组4·1%,TAXUS组4·8%对BMS组21·0%,P<0·05)。结论Cypher和TAXUS支架治疗小血管病变安全可行,疗效显著,治疗多支小血管病变可得到相同的疗效。     

不同冠状动脉重建术治疗非ST段抬高急性心肌梗死的效果

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)治疗非ST段抬高急性心肌梗死(NSTEAMI)的临床效果。方法98例NSTEAMI患者入院后行PCI和CABG治疗,进行12个月的随访,比较两组患者的一般临床资料、冠状动脉造影血管病变情况及心源性病死率、再发心绞痛以及再入院率和再次血运重建术率。结果CABG组三支和完全闭塞冠状动脉病变例数明显高于PCI组(87.23%vs.47.06%,87.23%vs.23.53%,P<0.05),随访12个月两组患者在心源性病死率、合并心律失常和再次血管重建术发生率(P>0.05)差异无统计学意义。而在心绞痛复发和再次住院率经皮冠状动脉成形术组高于CABG组(21.57%vs.6.38%,23.52%vs.6.38%,P<0.05)。结论对NSTEAMI患者入院后行PCI与CABG治疗是安全的血运重建的重要手段,应根据患者的具体情况采用合理的血运重建方式,以达到最佳重建冠状动脉血流的结果,改善患者的预后。     

Coronary artery bypass surgery versus percutaneous coronary intervention with drug-eluting stent implantation in patients with multivessel coronary disease

BACKGROUND: Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after percutaneous coronary intervention (PCI). This study compared the clinical outcomes of PCI using DES versus coronary artery bypass graft (CABG) in patients with multivessel coronary artery disease (MVD) in real-world. METHODS: From January 2003 to December 2004, 466 consecutive patients with MVD underwent revascularization, 235 by PCI with DES and 231 by CABG. The study end-point was the incidence of major adverse cardiovascular events (MACEs) at the first 30 days after procedure and during follow-up. RESULTS: Most preoperative characteristics were similar in the two groups, but left main disease (24.7% vs 2.6%, P<0.001) and three-vessel disease (65% vs 54%, P = 0.02) were more prevalent in CABG group. The number of coronary lesions was also greater in CABG group (3.7 +/- 1.1 vs 3.3 +/- 1.1, P<0.001). Despite higher early morbidity (3.9% vs 0.8%, P = 0.03) associated with CABG, there were no significant differences in composite MACEs at the first 30 days between the two groups. During follow-up (mean 25+/-8 months), the incidence of death, myocardial infarction, or cerebrovascular event was similar in both groups (PCI 6.3% vs CABG 5.6%, P = 0.84). However, bypass surgery still afforded a lower need for repeat revascularization (2.8% vs 10.4%, p = 0.001). Consequently, overall MACE rate (14.5% vs 7.9%, P = 0.03) remained higher after PCI. CONCLUSION: PCI with DES is a safe and feasible alternative to CABG for selected patients with MVD. The reintervention gap was further narrowed in the era of DES. Aside from restenosis, progression of disease needs to receive substantial emphasis.     

Comparison of clinical outcomes using stents versus no stents after percutaneous coronary intervention for proximal left anterior descending versus proximal right and left circumflex coronary arteries

Previous studies have demonstrated that proximal left anterior descending (LAD) stenoses have higher rates of restenosis after angioplasty than stenoses in other coronary segments. Stenting strategies may reduce this high rate of LAD restenosis. The study population included 1,289 patients with proximal coronary artery stenoses treated with percutaneous coronary interventions (PCI) with or without stents for single-vessel coronary disease between 1994 and 1999. Patients were divided into 4 groups: non-stent PCI in the proximal LAD artery (n = 168), non-stent PCI in proximal right/circumflex artery (n = 217), stent in the proximal LAD artery (n = 364), and stent to proximal right/circumflex artery (n = 540). Procedural success was higher in the stenting groups, but there were no significant differences in the major in-hospital events between the different lesion locations among the groups. At 1-year follow-up, there was no difference in mortality or myocardial infarction between the groups. There was no significant difference in the rate of target lesion revascularization (TLR) in the patients with proximal LAD stents compared with the patients with proximal right/circumflex coronary artery stents (10.1% vs 13.8%, p = 0.11). In the patients who did not receive stents with proximal narrowings, there was a significant increase in TLR in the LAD group compared with the right/circumflex group (21.1% vs 12.5%, p = 0.04). Thus, patients with proximal stenoses treated with non-stenting strategies have lower procedural success than those treated with stenting strategies; the patients with proximal LAD non-stent PCI have significantly higher rates of clinical restenosis than patients with proximal right and circumflex stenoses. A stenting strategy for proximal LAD stenoses appears to attenuate the differences of clinical restenosis noted after non-stent PCI.     

尿微量白蛋白与冠心病支架植入术后1年再狭窄的相关性

目的:分析尿微量白蛋白（MAU）与冠心病患者行支架植入术后1年支架内再狭窄的相关性。方法: 收集2009年3月~2011年6月我科139例冠心病经皮冠状动脉介入治疗患者,支架植入术前检测患者MAU,术后1年根据患者冠状动脉造影结果分为再狭窄组和未狭窄组。结果: 再狭窄组患者MAU水平［(59±16) mg/L］显著高于未狭窄组患者［(39±15) mg/L］ （P<0.05）;再狭窄组中单支病变［(40±3) mg/L］、两支病变［(55±5) mg/L］和三支病变［(82±11) mg/L］患者MAU水平比较差异有统计学意义（P<0.05）。结论: 冠心病患者支架植入术后1年支架内再狭窄与患者支架术前的MAU水平相关,MAU是支架术后再狭窄的很好预测指标。