首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到19条相似文献,搜索用时 171 毫秒
1.
Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device (Invatec, Italy) versus Guardwire Plus device (Medtronic, USA) before percutaneous coronary intervention (PCI) were compared in patients with acute inferior ST-segment-elevation myocardial infarction (STEMI) for less than 12 hours, thrombolysis in myocardial infarction (TIMI) flow grade 0 to 1, and total occlusion of the proximal right coronary artery (≥3 mm in diameter) in a prospective randomized single-center study. Methods The primary end point was the magnitude of ST-segment resolution (STR) (>70% ) measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume (LVEDV), left ventricle ejection fraction (LVEF) and major adverse cardiac events (MACEs) including death, myocardial infarction, target vessel revascularization and stroke at 30 days.Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age ((60±14) years vs (60±13) years), male (82% vs 84%), diabetes (31% vs 28%), previous coronary artery disease (25% vs 23%), onset-to-angiogram ((350±185) min vs (345±180) min), and use of glycoprotein IIb/IIIa inhibitor (11% vs 13%). The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution >70% (57% vs 59%; P>0.05). Similar slow flow/no-reflow rates were observed in the Diver CE group (8%) and the Guardwire Plus group (7%). TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively (P>0.05). Myocardial blush grade 3 was similar (70% vs 72%; P>0.05). Thirty-day clinical outcome was comparable (LVEF, 0.54±0.12 vs 0.53±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P>0.05, respectively). Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery (≥3 mm in diameter) compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.  相似文献   

2.
Background A growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.
Methods From September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE). Results Baseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P=0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P=0.74). Aspirated thrombi were categorized as small thrombi (〈3.5 mm), moderate thrombi (3.5-7.0 mm) and large thrombi (〉7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P=0.021). Rates of dual wire utilization were 1.7% of the Diver CE and 7.2% of the ZEEK (P=0.052). There were no differences in MBG, STR and TIMI flow grade between the two groups. No differences were found in cardiac death, TLR, re-infarction, MACE, LVEDD and LVEF between the Diver CE and the ZEEK during 3-month follow-up.
Conclusions Both Diver CE and ZEEK manual aspiration catheters are effective for thrombectomy in STEMI. In clinical practice, ZEEK presents a stronger aspiration capacity for moderate to large thrombi compared with Diver CE, but Diver CE displays a trend towards better pushability and trackability than ZEEK. Differences in aspiration capacity and operability between Diver CE and ZEEK in this setting do not influence myocardial reperfusion and 3-month outcome.  相似文献   

3.
Chen B  Wang W  Zhao H  Hu D  Xu C  Zhao M  Lu M  Liu J  Wu C 《中华医学杂志(英文版)》2003,116(1):142-144
Objective To compare the efficacy of low dose recombin ant tissue-type plasminogen activator (rt-PA) thrombolysis with primary corona ry stenting after acute myocardial infarction. Methods Of 261 patients with first acute myocardial i nfarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting. Results The age, time from onset of chest pain to hosp ital presentation and infarct location between these two groups were comparable . The patency rate of the infarct-related artery (IRA) in patients in the thro mbolysis group was significantly lower than that of patients in the primary sten ting group (P<0.001). Recurrent myocardial infarction, and selective coron ary stenting of patients with thrombolytic therapy were higher than that of pat ients in the primary stenting group (7.6% vs 1.5%, P<0.05; 20.6% vs 0, P<0.001, respectively). Left ventricular ejection fraction (LVEF) in patie nts in the thrombolysis group was lower than that of the stent group (55.6%±13 .4% vs 65.8%±9.2%, P<0.001). Total hospitalization time of the thrombo lysis group was longer than that of the stent group (16±7 d vs 11±4 d, P <0.001). Mortality in the thrombolysis group was higher than that of the stent group, but this difference was not significant (6.1% vs 3.1%,P>0 .05) Conclusion Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a highe r patency rate of the IRA, better cardiac function and shorter hospitalization time.  相似文献   

4.
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.  相似文献   

5.
Relationship between coronary arterial remodeling and clinical presentation   总被引:6,自引:0,他引:6  
Objective To examine the relationship between coronary arterial remodeling and clinical presentation. Methods A total of 34 patients with acute (10 with recent myocardial infarction and 24 with unstable angina) and 26 with stable (8 with old myocardial infarction and 18 with stable angina) coronary syndrome underwent intravascular ultrasound (IVUS) before intervention. Target lesions were classified as soft or hard plaques. Quantitative measurements of cross-sectional area (CSA) of external elastic membrane (EEM), lumen and plaque were performed at the lesion site and at the proximal and distal reference sites. Remodeling index (RI) was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal reference sites. Positive remodeling was defined as RI>1.05 and negative remodeling as RI<0.95. Results Soft plaque was observed more frequently in acute than in stable coronary syndrome (59% vs 31%), whereas hard plaque was more common in stable coronary syndrome (69% vs 41%) (P=0.03). The EEM CSA (15.11±2.89 mm(2) vs 13.25±3.10 mm(2), P=0.019) and plaque CSA (10.83±2.62 mm(2) vs 9.30±2.84 mm(2), P=0.035) were significantly greater at target lesions in patients with acute rather than stable coronary syndrome, while lumen CSA and percent area stenosis were similar in both groups. RI was significantly higher (1.08±0.16 vs 0.95±0.14, P=0.002) and positive remodeling was more frequent in acute coronary syndrome (53% vs 23%, P=0.019), whereas negative remodeling was more common in stable coronary syndrome (58% vs 24%, P=0.007). Conclusions The study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling.  相似文献   

6.
Background Emerging evidence suggests that stem cells can be used to improve cardiac function in patients after acute myocardial infarction. In this randomized trial, we aimed to use Doppler tissue tracking and strain imaging to assess left ventricular segmental function after intracoronary transfer of autologous bone-marrow stem cells (BMCs) for 6 months’ follow up. Methods Twenty patients with acute myocardial infarction and anterior descending coronary artery occlusion proven by angiography were double-blindedly randomized into intracoronary injection of bone-marrow cell (treated, n=9) or diluted serum (control, n=11) groups. GE vivid 7 and Q-analyze software were used to perform echocardiogram in both groups 1 week, 3 months and 6 months after treatment. Three apical views of tissue Doppler imaging were acquired to measure peak systolic displacement (Ds) and peak systolic strain (εpeak) from 12 segments of LV walls. Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were obtained by Simposon’s biplane method. Results (1) 3 months later, Ds and εpeak over the infract-related region clearly increased in the BMCs group [Ds: (4.49±2.71) mm vs (7.56±2.95) mm, P<0.01; εpeak: (-13.40±6.00)% vs (-17.06±6.05)%, P<0.01], but not in the control group [Ds: (4.74±2.67) mm vs (5.01±3.23) mm, P>0.05; εpeak : (-13.84±6.05)% vs (-15.04±6.75)%, P>0.05]. At the same time, Ds over the normal region also increased, but the Ds enhancement was markedly higher in the BMCs group than that in the control group [(3.21±3.17) mm vs (0.76±1.94) mm, P<0.01]. Parameters remained steady from the 3rd to 6th month in either group (P>0.05). (2) LVEF in treated and control groups were almost the same at baseline (1st week after PCI) [(53.37±8.92)% vs (53.51±5.84)%, P>0.05]. But 6 months later, LVEF in the BMCs group were clearly higher than that in the control group [(59.33±12.91)% vs (50.30±8.30)%, P<0.05]. (3)There were no evident difference in EDV or ESV between two groups at baseline [EDV:(113.74±23.24) ml vs (129.94±32.72) ml , P>0.05; ESV: (57.12±18.66) ml vs (62.09±17.68) ml, P>0.05]. Three months later, EDV and ESV in the control group were markedly greater than those in the BMCs group [EDV: (154.89±46.34) ml vs (104.85±33.21) ml, P<0.05; ESV :(82.91±35.79) ml vs (49.54±23.32) ml, P<0.05]. But EDV and ESV did not change much from 3rd to 6th month in either group (P>0.05). Conclusions Emergency transplantation of autologous BMCs in patients with acute myocardial infarction helps to improve global and regional contractility and attenuate post-infarction left ventricular remodeling. Tissue tracking and strain imaging provide quick, simple and noninvasive methods for quantifying left ventricular segmental function in humans.  相似文献   

7.
Background Previous studies have compared single-photon emission computed tomography (SPECT) and electron beam computed tomography (EBCT) in detection of coronary artery disease (CAD) in patients with myocardial infarction (MI). The purpose of this study was to compare SPECT with EBCT in detection of CAD in patients with no MI.Methods One hundred and forty-seven patients with suspected CAD underwent stress-rest 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) myocardial SPECT, cardiac EBCT and coronary angiography (CAG) within one month. Of them, 73 patients (aged 52.6±10.6 years old) with no history of MI were included in this study. Coronary artery calcium (CAC) was defined as a CT value ≥130 HU within the boundary of coronary artery on EBCT. Results There were 35 and 38 patients with or without CAD according to CAG. Ninety-six percent of the patients with abnormal SPECT and CAC had a coronary arteries stenosis ≥50%, and 90.9% patients with normal SPECT and EBCT showed no CAD. The sensitivity of SPECT and EBCT in detection of CAD was comparable, and the specificity of SPECT (92.1%) was significantly higher than that of EBCT (55.3%) (P<0.005). For the detection of individual coronary artery stenosis, both sensitivity and specificity of SPECT (75.0% and 93.7%) were significantly higher than those of EBCT (53.3% and 76.7%) (P<0.025 and P<0.005, respectively). In patients without chest pain, the sensitivity and specificity of SPECT (76.9% and 91.4%) were significantly higher than those of EBCT (23.1% and 69.0%) in detection of a coronary artery stenosis of ≥50% (P<0.01 and P<0.005, respectively). However, in patients with chest pain, both sensitivity and specificity of SPECT were comparable to those of EBCT. In patients ≤45 years old, the sensitivity of SPECT (77.8%) was significantly higher than that of EBCT (27.8%) in assessing a coronary artery stenosis of ≥50% (P<0.005), and the specificity of SPECT was comparable to that of EBCT. In patients >45 years old, the specificity of SPECT (94.3%) was significantly higher than that of EBCT (70.5%) (P<0.005), and the sensitivity of SPECT was comparable to that of EBCT. Conclusion 99mTc-MIBI myocardial perfusion SPECT has higher accuracy than that of EBCT in detection of CAD in patients without MI.  相似文献   

8.
Background Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon (SRP) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery (IRA) following primary PCI in patients with ST segment elevated acute myocardial infarction (STEAMI). Methods Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin (200 µg) was “bolus” injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 µg of anisodamine was injected into IRA with SRP at 200 µg/s, while the coronary angiography (CAG) was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine, respectively. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and the diameter of IRA were calculated and analyzed by Gibson’s TIMI frame count method using quantitative computer angiography (QCA) system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery (systolic, diastolic and mean pressure) and electrocardiogram (ECG) were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI. Results No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control (P>0.05). cTFCs were decreased by 58.3%, 56.2%, and 54.6%, respectively (P<0.001), and TMPGs were increased from 1.13±0.21 grade to 2.03±0.32, 2.65±0.45 and 2.51±0.57 grades (P<0.05) at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76±0.43 to 2.71±0.46 (P<0.05) while the diameter of middle segment in re-patented coronary artery was slightly increased from (3.20±0.40) mm to (3.40±0.50) mm at the 3rd minute after intracoronary administration of anisodamine (P>0.05) as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg (P<0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P<0.05). There were no significant changes in intervals of PR, QT and QRS (P>0.05) and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events (MACE) were found during follow-up at 1 month post-PCI. Conclusions Intracoronary administration of 1000 µg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.  相似文献   

9.
Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes, P=0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P<0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) ≥2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction.Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.  相似文献   

10.
Li Z  Liu F  Fu S  Qu R  Liu Z  Wu S 《中华医学杂志(英文版)》2003,116(8):1191-1193
Objective To investigate the effects of thoracic epidural blockade (TEB) on plasma fibrinogen (FIB) levels.Methods Thirty cases of dilated cardiomyopathy (DCM) were selected randomly into a TEB group and a control group. TEB patients were subjected to a persistent TEB (T1-5), and injected with 0.5% lidocaine 3-5 ml every two or four hours for four weeks in addition to routine medicine, while patients in the control group were given routine medicine only. Plasma concentrations of FIB were measured using the micro-capillary assay. Doppler echocardiography was performed before and after the treatment. Results Plasma concentrations of FIB in two groups were greater than the normal value before the treatment. There was a significant decrease of plasma concentrations of FIB in the TEB group after the treatment (4.2±1.3 g/L vs 3.6±0.9 g/L, P<0.05), but there was no significant change in the control group (4.2±1.2 g/L vs 4.3±1.9 g/L, P>0.05). After four weeks of treatment, the left ventricular end diastolic diameters (LVEDD) of TEB patients were reduced (72±10 mm vs 69±10 mm, P<0.05) and the left ventricular ejection fraction (LVEF) of TEB patients increased significantly (33%±13% vs 44%±14%, P<0.05). In contrast, LVEDD (73±11 mm vs 73±12 mm, P>0.05) and LVEF (32%±14% vs 33%±12%, P>0.05) did not change significantly in the control group. Conclusions The results suggest that plasma FIB levels in patients with DCM were decreased by performing a TEB, in addition to a reduction of the enlarged cardiac cavity and an improvement in cardiac systolic dysfunction. TEB might contribute to lowering the occurrence of thrombus and thromboembolism in patients with DCM. TEB might be a promising therapeutic method to improve the prognosis of DCM patients.  相似文献   

11.
胡少东  郝恒剑  徐东  许骥  李静 《北京医学》2011,33(7):529-532
目的评价替罗非班对急性ST段抬高心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗术(PCI)后的心肌灌注和心功能的临床疗效。方法选择2009年1月至2010年3月收治的STEMI患者100例,随机分为替罗非班组和对照组,每组50例。替罗非班组在PCI前,在常规给药基础上静脉推注替罗非班10μg/kg,3min内注完。后予0.15μg/(kg.min)替罗非班静脉滴注36h,对照组只常规给药,不予替罗非班。冠状动脉造影观察术后冠状动脉血流TIMI分级,术后90min计算心电图ST段回落幅度,术后1周内超声心动图测定左心室射血分数(LVEF)。结果①PCI术后TIMI0~2级者,对照组29例,替罗非班组10例,2组比较有显著性差异(P〈0.05);TIMI3级者,对照组21例,替罗非班组40例,2组比较有显著性差异(P〈0.05)。②替罗非班组术后心电图ST段迅速回落者17例,对照组10例,2组比较有显著性差异(P〈0.05)。③替罗非班组LVEF(60±8),显著高于对照组的(53±10)(P〈0.05)。结论 STEMI患者直接PCI联合使用替罗非班治疗可以改善术后冠状动脉血流及心功能指标。  相似文献   

12.
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   

13.
目的 探讨血小板/淋巴细胞比值(PLR)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠脉介入术(PCI)后心肌无复流的预测价值。方法 选取2014年10月—2018年10月蚌埠市第二人民医院收治的STEMI患者118例,详细记录病史和体格检查结果,检测血小板计数(PLT)、淋巴细胞计数(LY),计算PLR;评估PCI术中情况,记录术中梗死相关动脉的病变情况,采用Gensini积分评价冠状动脉病变程度,采用TIMI血流分级将患者分为正常复流组(TIMI 3级)和无复流组(TIMI 0~2级)。结果 两组患者年龄、性别构成比、高血压、糖尿病、吸烟、卒中、发病时间、Killip分级构成比比较,差异均无统计学意义(P?>0.05);无复流组患者PLT、PLR和Gensini积分高于正常复流组(P?<0.05),其余指标两组间比较,差异均无统计学意义(P?>0.05),相关性分析显示PLR与Gensini积分呈正相关(r?=0.581,P?=0.006);多因素Logistic回归结果显示:PLR高[OlR=2.737(95% CI:1.433,5.227)]和Gensini积分高[OlR=1.490(95% CI:1.087,2.042)]为影响PCI术后心肌无复流的危险因素。ROC曲线分析结果显示以PLR为诊断模型变量,曲线下面积为0.751,以最大约登指数计算的诊断阈值为188.21,预测无复流的敏感性为70%,特异性为73%。结论 PLR与STEMI患者冠状动脉病变程度呈正相关,PLR对PCI术后心肌无复流具有一定的的预测价值。  相似文献   

14.
林丛  马骏  童宗安  官学强 《浙江医学》2011,33(5):666-668,672
目的 观察对急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入(PCI)手术中应用血栓抽吸导管联合冠状动脉内注射替罗非班的疗效.方法 选择因STEMI行直接PCI并于术中应用Thrombuster Ⅱ血栓抽吸导管联合冠状动脉内推注替罗非班的患者65例作为治疗组,以基础临床资料和冠状动脉影像特征相似并单纯行直接PCI的60例患者作为对照组,观察临床疗效.结果 治疗组在TIMI 3级血流、校正TIMI帧数、术后2 h ST段回落程度、酶峰值和峰值时间以及梗死相关血管(IRA)无复流发生率均优于对照组(P<0.05或 0.01).治疗组术后3个月左心室射血分数(LVEF)、左心室舒张末径(LVEDd)、左心室收缩末径(LVESd)及主要不良心血管事件(MACE,包括死亡、再梗死、再次靶血管重建)的发生率少于对照组(P<0.05),而术后1周时两组差异无统计学意义(P >0.05).结论 STEMI患者行直接PCI过程中应用血栓抽吸导管联合冠状动脉内推注替罗非班可减少无复流的发生,改善心肌再灌注水平及左心室功能.  相似文献   

15.
目的 探讨直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)应用血栓抽吸对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI) 患者心肌灌注及临床预后的影响。 方法 采用回顾性研究方法,纳入于河北省人民医院行PPCI的STEMI患者446例。依据术中是否应用血栓抽吸分为非血栓抽吸组(230例)和血栓抽吸组(216例)。收集临床资料和术后慢血流/无复流发生情况,记录术后12个月内主要不良心血管事件(包括心原性死亡、再发心肌梗死、靶血管血运重建)和缺血性脑卒中发生情况。 结果 与非血栓抽吸组相比,血栓抽吸组造影显示心肌梗死溶栓治疗(thrombolysis in myocardial infraction,TIMI)血栓负荷≥4级、术前TIMI血流<3级及术中替罗非班、尿激酶原的使用率更高,术中造影剂用量更多,而多支病变的比率较低,差异有统计学意义(P<0.05)。二元Logistic回归分析显示造影TIMI血栓负荷≥4级、术前TIMI血流<3级是PPCI术中使用血栓抽吸的影响因素(P<0.05)。年龄(OR=1.03,95%CI:1.004~1.056,P=0.023)、造影剂用量(OR=1.004,95%CI:1~1.008,P=0.047)是发生无复流的独立危险因素;发生慢血流/无复流组患者较正常血流组患者中术中行血栓抽吸的比率低,多因素分析显示在全体人群中血栓抽吸与慢血流/无复流无关。Killip≥2级和左主干病变是主要不良心血管事件(major adverse cardiovascular events,MACE)的独立危险因素,而他汀类药物是MACE的保护性因素;Killip≥2级是心原性死亡的独立危险因素,而他汀类药物和射血分数是心原性死亡的保护性因素。血栓抽吸是高血栓负荷人群术后发生无复流的保护性因素;年龄、造影剂用量是高血栓负荷人群发生无复流的危险因素。高血栓负荷人群两组术后12个月的MACE、心原性死亡、再发心肌梗死、靶血管重建及缺血性脑卒中发生率差异无统计学意义(P>0.05)。高血栓负荷人群两组间MACE及心原性死亡的Kaplan-Meier生存分析差异无统计学意义。Cox回归分析显示,血栓抽吸不是高血栓负荷人群MACE及心原性死亡的影响因素。 结论 血栓抽吸可降低高血栓负荷STEMI患者术后无复流和慢血流的发生率,但不能改善术后12个月的临床预后。  相似文献   

16.
目的探讨DIVER^TMCE血栓抽吸导管在急诊PCI中应用的有效性和安全性。方法将78例行急诊介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者分为血栓抽吸组(30例)及常规PCI组(48例)。比较两组患者术后即刻梗塞相关区域的心肌组织灌注分级(TMP)、术后12h ST段回落情况以及术后3个月的主要心血管事件的发生情况。结果78例研究对象中,冠状动脉造影提示36例(46.15%)存在血栓,术前46例(58.62%)TMP 0~1级。血栓抽吸组术后TMP 0~1级明显少于常规PCI组(P〈0.05),术后TMP3级明显多于常规PCI组(P〈0.05),但两组间术后TMP2级发生率并无明显差异(P〉0.05);血栓抽吸组术后梗死相关导联ST段回落多于常规PCI组(P=0.05);两组术后3个月主要心血管事件发生率无明显差异(P〉0.05)。血栓抽吸组无一例抽吸相关并发症发生。结论在STEMI患者的急诊PCI中应用DIVERTMCE血栓抽吸导管安全可行,而且可以显著改善心肌组织灌注,提高梗死相关导联ST段回落率。  相似文献   

17.
目的观察早期应用替罗非班对急性ST段抬高心肌梗死(STEMI)急诊行经皮冠状动脉介入治疗(PCI)及梗死相关血管的血流及梗死区心肌灌注的影响。方法将160例发病〈12h急诊行PCI的急性STEMI患者分为PCI前早期应用组及PCI前即刻应用组,各80例。观察两组PCI前后心肌梗死溶栓(TIMI)分级及梗死区心肌灌注(TMP)分级,观察PCI后30d主要心血管事件(MACE)及术后出血发生情况。结果早期应用组PCI前TIMI 3级及TMP 3级的获得率分别为31.3%、33.8%;PCI后TIMI 3级及TMP 3级分别为92.5%、75.0%;两组PCI前TIMI 3级与TMP 3级及PCI后TMP 3级比较差异均有统计学意义(P〈0.05)。结论对急性STEMI急诊行PCI的患者,早期应用替罗非班能改善梗死相关血管的血流及心肌灌注。  相似文献   

18.
何贵新  谭炜 《微创医学》2012,7(4):350-354
目的探讨靶血管局部肿瘤坏死因子-α(TNF-α)对急性心肌梗死患者行急诊冠脉介入(primary percutaneous coronary intervention,PPCI)术后心肌灌注的影响。方法行急诊PCI术、并行血栓抽吸术的急性ST段抬高性心肌梗死(STEMI)患者,男性116例,女性32例,平均年龄(59.7±22.8)岁。冠脉造影前,经动脉鞘取血3 mL;PCI术前,采用Export XT血栓抽吸导管在靶血管内抽吸血栓、过滤栓子等成分,分离血清备用。按照常规方法植入支架。主要终点为术后心肌呈色分级,次要终点为ST段回落幅度。血清TNF-α采用ELISA法检测。结果 MBG 0~1级患者局部TNF-α浓度为(340.7±55.4)pg/L,MBG 2级为(207.5±42.1)pg/L,MBG 3级为(137.3±33.2)pg/L,差异有显著性(P=0.00)。ST段回落≥70%患者局部TNF-α浓度为(159.2±52.4)pg/L,ST段回落<70%为(308.6±43.9)pg/L,差异有显著性(P=0.00)。外周动脉血中的TNF-α浓度与MBG分级、ST段是否完全回落没有显著相关(P>0.05)。Logistic回归显示,TNF-α最高四分位区间是心肌灌注不良的唯一预测因子,与最低的四分位区间相比,发生心肌灌注不良的几率增加2.1倍(95%置信区间:1.17~7.81)。结论急性心肌梗死患者中,靶血管局部TNF-α浓度升高与急诊PCI术后心肌灌注不良有关,全身的TNF-α浓度对术后心肌灌注的影响不显著。  相似文献   

19.
目的探讨急性下壁心肌梗死病人直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中无复流的发生情况及其危险因素。方法收集126例急性下壁心肌梗死行急诊PCI治疗病人的病历资料,采用logistic回归分析无复流发生的相关危险因素。结果126例急性下壁心肌梗死病人均成功进行急诊PCI治疗,其中有16例发生无复流,发生率12.70%。多因素logistic回归分析结果显示,急性下壁心肌梗死病人急诊PCI术中出现无复流的危险因素为糖尿病(OR=1.647,95%CI:1.242~1.845,P < 0.05)、发病至急诊PCI时间(OR=5.281,95%CI:2.782~10.018,P=0.002)、术前TIMI血流分级(≤1级)(OR=2.735,95%CI:1.040~3.062,P=0.020)和术前收缩压(OR=1.844,95%CI:1.153~3.638,P=0.015)。结论无复流在急性下壁心肌梗死病人急诊PCI术中具有较高的发生率,应对无复流发生的相关影响因素采取有效的预防措施,降低PCI术中出现无复流的风险。  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号