Effect of tirofiban plus clopidogrel and aspirin on primary percutaneous coronary intervention via transradial approach in patients with acute myocardial infarction

Background Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention （PCI）. Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction （STEMI） patients. We evaluated this on STEMI patients who underwent primary PCI （p-PCI） via transradial artery approach. Methods Consecutive patients were randomized into tirofiban group （n=-72） or placebo group （n=-78）. Angiographic analysis included initial and final thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the thrombotic vessel. Platelet aggregation rate （PAR）, creatine phosphokinase （CPK）, CPK isoenzyme MB （CPK-MB） and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events （MACE） were followed up for 6 months. Results The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group （all P 〈0.05）. Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications. Conclusions Intravenous tirofiban infusion, in additi     

The influence of admission glucose on epicardial and microvascular flow after primary angioplasty

Background Patients with elevated admission glucose levels may be at increased risk of death after myocardial infarction, independent of other baseline risk factors and more severe coronary artery disease. However, data regarding admission glucose and epicardial and microvascular flow after primary angioplasty is limited. Methods Angioplasty was performed in 308 ST-segment elevated myocardial infarction patients. Patients were divided into 3 groups on the basis of admission glucose level： group 1, 〈7.8 mmol/L; group 2, （7.8 - 11.0） mmol/L; and group 3, ≥ 11.0 mmol/L. Results Compared with group 1, patients in group 2 and group 3 were more often female and older. Triglycerides （TG） in group 3 were significantly higher than group 1. At angiography, they more frequently had 2-vessel or 3-vessel disease. In the infarct-related artery, there was no relationship between hyperglycemia and thrombolysis in myocardial infarction （TIMI） 3 flow after percutaneous coronary intervention （PCI） （89.7%, 86.0% and 86.3%, P=NS）. However, corrected TIMI frame count （CTFC） in group 2 and group 3 were more than group 1. TIMI myocardial perfusion grade （TMPG） 0-1 grade among patients with hyperglycemia after PCI were more frequent （30.9% and 29.0% vs 17.3%, P〈0.05）. There was less frequent complete ST-segment resolution （STR） and early T wave inversion among patients with hyperglycemia after PCI. Conclusion Elevated admission glucose levels in ST-segment elevation myocardial infarction patients treated with primary PCI are independently associated with impaired microvascular flow. Abnormal microvascular flow may contribute at least in part to the poor outcomes observed in patients with elevated admission glucose.     

Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction: a multicenter randomized clinical trial

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.     

Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation

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     

Gender differences in efficacy of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

Background The clinical outcome of percutaneous coronary intervention （PCI） is poorer in women than that in men. This study aimed at comparing the impact of gender difference on the strategy of primary PCI in patients with acute ST-segment elevation myocardial infarction （STEMI）.
Methods Two hundred and fifty-nine patients with STEMI who underwent primary PCI within 12 hours of symptom onset were enrolled. The male group consisted of 143 men aged 〉55 years, and a female group included 116 women without age limitation. Procedural success was defined as residual stenosis 〈20% with thrombolysis in myocardial infarction flow grade 〉2 and without death, emergency bypass surgery or disabling cerebral events during the hospitalization. The rate of major adverse cardiac events （MACE）, including death, nonfatal myocardial infarction and target vessel revascularization during follow-up, was recorded.
Results Female patients were more hypertensive and diabetic and with fewer cigarette smokers than male counterparts. The prevalence of angiographic 3-vessel disease was higher in the female group, but the procedural success rate was comparable between the two groups （94.4% vs 92.2%）. The occurrence rate of MACE did not differ during the hospitalization （4.2% vs 6.0%, P=0.50）, but was significantly higher in the female group during follow-up （mean （16.0±11.2） months） than that in the male group （5.4% vs 0.7%, P=0.02）.
Conclusion Despite a similar success rate of primary PCI and in-hospital outcomes in both genders, female patients with acute STEMI still have a worse prognosis during the long-term follow-up.     

Effect of PercuSurge Distal Protection Device in Acute Myocardial Infarction during Primary Percutaneous Coronary Intervention

Objective To evaluate the efficiency and safety of PercuSurge DPD in coronary intervention in patients with acute myocardial infarction undergoing PCI treatment within 72 hours. Methods This was a prospective cohort study of patients with AM. From December 2003 to December 2005, 174 acute myocardial infarction patients who received primary coronary intervention were included into this study. Patients were divided into DPD and control group according to whether Percusurge DPD was attempted during emergency PCI. The basic clinical characteristics, angiographic results, and follow up data before discharge were compared. TIMI flow grades and myocardial blush grades were performed in all cases after emergency PCI. Results The device was successfully deployed in 78 of 87 patients, the visible red, white debris or red clastic thrombosis were aspirated in 72 of 78 patients in DPD group. Post- PCI Thrombolysis in Myocardial Infarction （TIMI） grades and myocardial blush grades were significantly higher in DPD group than in control group. Post-PCl no-reflow, distal embolization and 30-day major adverse cardiac events were significantly higher in control group than in DPD group, whereas TIMI grades, myocardial blush grades and minimal lumen diameter were significantly increased after using the export aspiration. Conclusion PercuSurge DPD can be used safely and effectively in coronary intervention in the thrombus laden arteries such as AMI.     

Effects of Qishen Yiqi Dripping Pills (芪参益气滴丸) in Reducing Myocardial Injury and Preserving Microvascular Function in Patients Undergoing Elective Percutaneous Coronary Intervention: A Pilot Randomized Study

Objectives:To evaluate the effect of treatment with Qishen Yiqi Dripping Pills(芪参益气滴丸,QSYQ) on myocardial injury and myocardial microvascular function in patients undergoing elective percutaneous coronary intervention(PCI).Methods:Eighty patients undergoing elective PCI were randomly assigned to QSYQ and control groups.The QSYQ group received QSYQ at a dosage of 0.5 g 3 times daily(3–7 days before PCI and then daily for 1 month) and regular medication,which comprised of aspirin,clopidogrel,statin,β-blocker,and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the absence of contradiction.The control group received only the regular medication.The index of microcirculatory resistance(IMR) was measured at maximal hyperemia after PCI.The fractional flow reserve was measured before and after the procedure.Troponin Ⅰ levels were obtained at baseline and 20–24 h after the procedure.Results:Pre-PCI troponin Ⅰ levels between the two groups were similar(0.028±0.05 vs.0.022±0.04 ng/m L,P=0.55).However,postPCI troponin Ⅰ levels in the QSYQ group were significantly lower than that in the control group(0.11±0.02 vs.0.16±0.09 ng/m L,P0.01).IMR values were significantly lower in the QSYQ group as compared to the control group(16.5±6.1 vs.31.2±16.0,P0.01).Multivariate analysis identified QSYQ treatment as the only independent protective factor against IMR 32(odds ratio=0.29,95% confidence interval:0.11–0.74,P=0.01).Conclusion:The present study demonstrated the benefit of QSYQ in reducing myocardial injury and preserving microvascular function during elective PCI.     

Intracoronary nitroprusside in the prevention of the no-reflow phenomenon in acute myocardial infarction

Background No-reflow phenomenon during percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dysfunction, which is closely associated with a worse prognosis. This study aimed to evaluate intracoronary nitroprusside in the prevention of the no-reflow phenomenon in AMI.
Methods Ninety-two consecutive patients with AMI, who underwent primary PCI within 12 hours of onset, were randomly assigned to 2 groups： intracoronary administration of nitroprusside （group A, n=46）, intracoronary administration of nitroglycerin （group B, n=46）. The angJographic results were observed. The real-time myocardial contrast echocardiography （RT-MCE）, including contrast score index （CSI）, wall motion score index （WMSI）, transmural contrast defect length （CDL） and serious WM abnormal length （WML） were recorded at 24 hours and 1 week post-PCI. High sensitivity C-reactive protein （Hs-CRP） was examined by immune rate nephelometry. N-terminal prohormone brain natriuretic peptide （NT-proBNP） was tested with enzyme-linked immunosorbent assay. Patients were followed up for six months. Major adverse cardiac events （MACE） were recorded. Results The incidence of final TIMI-3 flow in group A was much higher than that in Group B （P 〈0.05）, final corrected TIMI frame count （cTFC） in group A decreased significantly than that in group B （P 〈0.01）. The CSI, CDL/LV length, WMSI and WL/LV length in group A were significantly lower than that in group B （P 〈0.01）. Levels of Hs-CRP and NT-proBNP at 1 week post-PCI decreased significantly in group A than that in group B （P 〈0.01）. Patients were followed up for 6 months and the incidence of MACE in group A was significantly lower than that in group B （P〈0.05）.
Conclusion Intracoronary nitroprusside can improve myocardial microcirculation, leading to the decrease of the incidence of no-reflow phenomenon and better prognosis.     

Intracoronary adenosine improves myocardial perfusion

Background Myocardial perfusion associates with clinical syndromes and prognosis. Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours, but few data are available on late perfusion of myocardial infarction （MI）. This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography （MCE）.
Methods Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups： adenosine group （n=12） and normal saline group （n=-14）. Their history of myocardial infarction was about 3-12 weeks. Adenosine or normal saline was given when the guiding wire crossed the lesion through percutaneous coronary intervention （PCI）, then the balloon was dilated and stent （Cypher/Cypher select） was implanted at the lesion. Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI. Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software. Heart function and cardiac events were followed up within 30 days.
Results Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group （5.71：L-0.29 VS 4.95±1.22, P〈0.05）. Ischemic myocardial segment was deminished significantly after PCI, but the meliorated area was bigger in the adenosine group than in the saline group （（1.56±0.60） cm^2 vs （1.02±0.56） cm^2, P〈0.05）. The video densitometry in cntical segments was also improved significantly in the adenosine group （5.53±0.36 VS 5.26±0.35, P〈0.05）. Left ventricular ejection fraction （LVEF） was improved in all patients after PCI, but EF was not significant between the two groups （（67±6）% vs （62±7）%, P〉0.05）. There was no in-hospital or 30-day major adverse cardiac event （MACE） in the adenosine group but 3 MACE in the saline group in 30 days after     

Correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction undergoing direct percutaneous coronary intervention

Background Balloon release pressure may increase the incidence of no reflow after direct percutaneous coronaryintervention （PCI）. This randomized controlled study was designed to analyze the correlation between balloon releasepressure and no-reflow in patients with acute myocardial infarction （AMI） undergoing direct PCI.Methods There were 156 AMI patients who underwent PCI from January 1, 2010 to December 31, 2012, and weredivided into two groups according to the stent inflation pressure： a conventional pressure group and a high pressure group.After PCI, angiography was conducted to assess the thrombolysis in myocardial infarction （TIMI） grade with related artery.Examinations were undertaken on all patients before and after the operation including cardiac enzymes, total cholesterol,low-density lipoprotein, blood glucose, homocysteine, 13-thromboglobulin （I3-TG）, Hamilton depression scale （HAMD） andself-rating anxiety scale （SAS）. After interventional therapy, the afore-mentioned parameters in both the conventionalpressure group and high pressure group were again analyzed.Results The results showed that CK-MB, HAMD, SAS were significantly different （P 〈0.05） in all patients after PCI,especially the CK-MB in the high pressure group （（25.7_＋7.6） U/L vs. （76.7＋11.8） U/L）. CK-MB, HAMD, SAS, and I3-TGwere comparative before PCI but they were significantly changed （P 〈0.05） after intervention. No-reflow phenomenonoccurred in 13 patients in the high pressure group, which was significantly higher than in the conventional pressure group（17.11% vs. 6.25%, P 〈0.05）.Conclusion In stent implantation, using a pressure less than 1823.4 kPa balloon to release pressure may be the betterchoice to reduce the occurrence of no-reflow followinq direct PCI.     

ST段抬高急性心肌梗死合并2型糖尿病患者PCI前后CTFC和TMPG的变化

目的探讨ST段抬高的急性心肌梗死(STEMI)合并2型糖尿病(DM)患者经皮冠状动脉介入治疗(PCI)前后校正的心肌梗死溶栓治疗临床实验(TIMI)帧数(CTFC)及TIMI心肌灌注分级(TMPG)的变化以及对其预后的影响。方法回顾性分析行PCI的STEMI患者97例,其中STEMI合并DM组34例(DM组),单纯STEMI组63例(对照组),测定2组梗死相关动脉(IRA)的TIMI、CTFC和TMPG,并分析两组住院期间和PCI治疗6个月后的主要心脏不良事件(MACE)的发生率。结果与对照组比较,DM组的年龄、体重指数、既往心梗史、多支血管病变和高血压发生率均明显升高(P<0.05),肌酸激酶(CPK)显著增加(P<0.05),前降支病变明显增多(P=0.01),CTFC明显增加(P<0.001),TMPG明显减少(P=0.008),左室射血分数(LVEF)显著降低(P<0.01)。住院期间2组MACE发生率无显著差异,6个月随访期间DM组较对照组明显增加(P<0.05)。结论STEMI合并2型DM患者行PCI治疗后的心肌再灌注明显改善,但与无DM的STEMI患者相比心肌灌注减少,梗死范围大,心功能降低,远期预后差。     

体重指数对急性心肌梗死介入治疗患者的影响

【目的】观察体重指数（body mass index,BMI）对急性sT段抬高性心肌梗死患者直接经皮冠状动脉介入治疗术（percutaneous coronary intervention,PCI）后的心肌灌注及预后的影响。【方法】对我院心内科接受直接PCI治疗的116例资料完整的急性ST段抬高性心肌梗死患者进行了回顾性分析。根据患者BMI分为2组：A组（n=35）BMI〈25kg／m^2,B组（n=81）BMI≥25kg／m^2。评估PCI术后TIMI血流分级及TMPG心肌灌注分级;发病后1周内行超声心动图检查测定左心室射血分数（left ventricular ejection fraction LVEF）,评价心脏收缩功能。【结果】（1）冠脉造影结果中两支及以上血管病变：两组未见统计学差异（P〉0.05）。（2）PCI术后梗死相关血管TIMI血流分级3级：两组无明显差异（P〉0.05）。（3）PCI术后心肌灌注分级（TMPG）0-2级：A组低于B组（P〈0.05）。（4）PCI术后1周内超声心动图左室射血分数（EF值）：A组高于B组（P〈0.05）。【结论】BMI高的急性ST段抬高性心肌梗死患者在介入治疗后的心肌灌注差、心功能差。     

缺血后处理对急性心肌梗死患者冠脉血流的影响

目的:观察缺血后处理(ischemic postconditioning,IPC)对接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(ASTEMI)患者冠脉血流的影响。方法:发病12h内且接受直接PCI治疗的ASTEMI患者106例,随机分为对照组(行标准PCI操作)和缺血后处理组(在标准PCI操作基础上于梗死相关动脉再通后给予3轮30s/次的缺血后处理)。观察术中冠脉血流情况、术后心肌坏死标志物及炎症标志物水平。结果:两组患者基线临床情况、冠脉病变及PCI治疗情况一致,缺血后处理组术中无复流(NRF)发生率低于对照组(8.0%VS 23.2%,P=0.033);ST段完全回落率高于对照组(96.0%VS 83.9%,P=0.042);尽管术毕时梗死相关动脉TIMI血流无差异,但CTFC及Blush血流好于对照组(P<0.05);缺血后处理组术后CK-MB和高敏肌钙蛋白T(Hs-TnT)均低于对照组[(258.3±87.8)U/L VS(306.6±94.4)U/L,P=0.008;(3 582.08±1 731.40)ng/L VS(4 501.34±1 554.4)ng/L,P=0.005]。同样,术后缺血后处理组的高敏C反应蛋白(Hs-CRP)水平亦低于对照组[(29.25±46.13)mg/L VS(32.20±43.50)mg/L,P=0.048]。结论:3轮30s/次的缺血后处理可以通过减轻缺血再灌注损伤降低ASTEMI患者术中NRF发生率。     

高危ACS患者PCI术前早期和即刻应用替罗非班对冠脉血流和心肌灌注的影响

目的：探讨经皮冠状动脉介入治疗（PCI）术前早期或即刻应用替罗非班对高危急性冠脉综合征（ACS）患者冠脉血流和心肌灌注的影响。方法：78例高危ACS患者随机分为早期组（PCI术前4-6h给予替罗非班,n=39）与即刻组（PCI术中导丝通过病变时立即给予替罗非班,n=39）,对比两组患者血清心肌肌钙蛋白Ⅰ（cTnI）、心肌激酶同工酶（CK—MB）、血小板聚集率（PAR）、心电图ST段改变、TIMI血流分级、TIMI心肌灌注分级、主要心脏不良事件（MACE）以及不良反应发生率。结果：与给药前相比,两组患者给药后cTnI、CK—MB均明显增高（P〈0．01）,PAR显著降低（P〈0．01）,但给药后两组患者此3项指标差异均无统计学意义（P〉0．05）;术后两组患者TIMI血流分级以及TMPG分级均显著改善（P〈0．01）,且术后早期组患者TMPG分级显著优于即刻组（P〈0．05）;给药后两组患者ST段压低程度显著减轻（P〈0．01）,缺血导联数目显著减少（P〈0．01）,且给药后早期组患者ST段压低程度显著低于即刻组（P〈0．01）;两组患者术后MACE发生率及不良反应发生率比较均无统计学差异（P〉0．05）。结论：替罗非班应用于高危ACS患者PCI围手术期能够有效增加心肌灌注,改善患者心肌缺血状态,早期应用效果更佳。     

替罗非班在急性心肌梗死行急诊PCI治疗中的应用价值

目的 探讨替罗非班在急性心肌梗死行急诊经皮冠状动脉介入(PCI)治疗中的临床应用价值.方法 选择我院心内科于2015年4月至2016年10月期间收治的92例急性ST段抬高型心肌梗死(STEMI)患者为研究对象,根据随机数表法随机分为观察组(n=48)与对照组(n=44),所有患者均接受急诊PCI治疗,其中观察组术前应用替罗非班,对照组则不予应用.比较两组患者PCI术后心肌梗死溶栓试验(TIMI)血流分级情况以及TIMI心肌灌注(TMPG)分级的变化,同时比较出血发生率及心血管不良事件发生率.结果 观察组患者PCI术后TIMI血流分级2~3级比例为95.83%,与对照组的93.18%比较差异无统计学意义(P>0.05);而观察组患者TMPG2~3级的比例为89.58%,明显高于对照组的72.73%,差异有统计学意义(P<0.05);两组患者出血发生率比较差异无统计学意义(P>0.05);观察组患者术后心血管不良事件发生率为4.17%,明显低于对照组的18.18%,差异有统计学意义(P<0.05).结论 急诊PCI术前应用替罗非班可有效改善STEMI患者冠状动脉血流及心肌灌注,从而减少心血管不良事件发生率,改善近期预后.     

急性心肌梗死患者PCI延时与无延时应用比伐芦定的对照研究

  目的  评价急性心肌梗死(AMI)患者接受经皮冠状动脉介入治疗(PCI)时无延时比伐芦定联合仅冠脉内替罗非班方案的疗效和安全性。  方法  选取2020年4月—2021年3月蚌埠市第二人民医院心内科收治的150例AMI患者,采用随机数字表法随机分为2组: 试验组(无延时组,75例)和对照组(延时组,75例)。观察2组患者术后TIMI血流分级(TFG)及校正的TIMI血流帧数计数(cTFC),术后90 min心电图ST段回落(STR)情况,术后第7天心功能指标,术后30 d内所有出血事件及术后30 d主要不良心血管事件(MACE)。  结果  2组TFG、cTFC、术后90 min心电图STR(Z=0.524,P=0.770)、MACE(1.3% vs. 0,P=0.999)、左心室射血分数[(49.5±6.6) vs. (50.6±5.7),t=-1.092,P=0.276]、左心室舒张末期内径[(50.0±8.9) mm vs. (51.2±7.6) mm,t=-0.888,P=0.376]及室壁运动异常(86.7% vs. 90.1%,χ2=0.597,P=0.440)比较,差异均无统计学意义。试验组30 d内出血事件显著少于对照组,差异有统计学意义(5.3% vs. 18.7%,χ2=6.221,P=0.035)。  结论  对于急性心肌梗死接受直接PCI的患者,无延时比伐芦定联合仅冠脉内替罗非班方案,疗效确定且具有更佳的安全性,是临床实践中可供选择的治疗方案。      

冠状动脉内注射替罗非班对急性冠脉综合征介入治疗中无复流的影响

目的评价冠状动脉内应用替罗非班对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)中无复流的临床疗效。方法在行PCI治疗中发生无复流的ACS患者分别经冠状动脉内注入替罗非班(替罗非班组,n=21)和维拉帕米(维拉帕米组,n=24),两组手术方法相同。观察两组注射药物后首次和PCI中末次造影图像,评估TIMI血流分级、校正的TIMI帧数(cT-FC),同时测定PCI术后7 d、14 d的左室射血分数(LVEF)、肌酸激酶同工酶(CK-MB)血小板计数(PLT),两组术后3 d内出血及术后30 d内主要心血管事件(MACE),并进行统计学比较。结果冠状动脉内注射药物后首次及PCI结束前末次冠脉造影均显示:替罗非班组TIMI3级血流比例明显高于对照组;替罗非班组cTFC帧数明显少于对照组;PCI术后7 d、14 d的LVEF均高于对照组,CK-MB均低于对照组,差异均有统计学意义(P0.05);PLT两组间差异无统计学意义。两组术后3 d内出血、术后30 d内MACE比较无统计学意义(P0.05)。结论冠状动脉内注射替罗非班可以增加ACS患者PCI术中发生无复流后冠状动脉血流和心肌组织灌注,降低术后炎症反应程度。     

解毒活血方对经皮冠状动脉介入术患者围术期心肌损伤的影响

目的观察解毒活血配方颗粒冲服对经皮冠状动脉介入术(PCI)患者的围术期心肌损伤的影响。方法 160例接受PCI术的心绞痛患者随机分为解毒活血组(n=84)和对照组(n=76),解毒活血组给予常规治疗同时术前第7天给予解毒活血配方颗粒冲服,每日1剂。对照组给予基础药物治疗。测定PCI术前及术后12 h、24 h的血清肌酸激酶同工酶(CK-MB)和肌钙蛋白I(cTn I)浓度。结果解毒活血组PCI术后12 h、24 h cTn I和CK-MB水平均显著低于对照组(P=0.0038,P=0.027 6;P=0.001 2,P=0.002 7)。解毒活血组患者术后cTn I和CK-MB升高大于正常值3倍者构成比均显著低于对照组(P=0.008 2,P=0.007 6)。结论术前给予解毒活血配方颗粒对于PCI围手术期病人的心肌损伤具有一定的保护作用。     

替罗非班对急性ST段抬高心肌梗死急诊直接经皮冠脉介入治疗疗效的影响

目的:探讨替罗非班对急性ST段抬高心肌梗死(STEMI)急诊直接经皮冠脉介入治疗(PCI)疗效的影响。方法:入选111例接受急诊PCI治疗的急性STEMI患者,随机分为替罗非班组(66例)和对照组(55例)。比较并分析两组基本临床情况、介入后的TIMI血流分级、平均住院天数、7d后的LVEF、ST段回落、cTnI和CK-MB的峰值。结果:与对照组相比,替罗非班治疗组TIMI 3级血流差异无统计学意义(95%对87.5%,P>0.05),但CK-MB峰值[(212.02±102.98)μg/L对(278.30±116.96)μg/L,P<0.05],cTnI峰值(46.36±36.00)μg/L对(57.78±30.56)μg/L,P<0.05]及平均住院天数[(9.36±4.76)d对(15.67±6.91)d,P<0.01],ST段回落[(6.97±3.66)mm对(4.35±2.17)mm,P<0.01];7d后的LVEF[(53±7)%对(45±8)%,P<0.01]均显著优于对照组。结论:替罗非班能明显改善急性ST段抬高心肌梗死急诊PCI疗效。