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101.
急性冠脉综合症的动脉粥样硬化程度及内皮功能改变 总被引：1，自引：7，他引：1
目的:探讨动脉粥样硬化及内皮功能与急性冠脉综合症(ACS)的关系。方法:以二维超声测定的颈动脉内中膜厚度(IMT)和硬化斑块指数(Plaque index,PI)作为衡量动脉粥样硬化程度的指标,测定肱动脉内径作为血管内皮舒张功能的指标。ACS组56例,对照组26例。结果:ACS组的IMT、动脉粥样硬化斑块检出率、PI明显大于对照组(P<0.05～<0.01)。ACS组与对照组相比,肱动脉内皮依赖性血管舒张功能明显受损(P<0.001),内皮非依赖性舒张功能则无明显变化(P>0.05)。结论:急性冠脉综合症患者存在严重颈动脉粥样硬化,其内皮依赖性血管舒张功能明显受损。 相似文献
102.
Tom Hsun-Wei Huang Kalpa De Silva Usaid K. Allahwala Edward J. Danson Pasi K. Karjalainen Olli A. Kajander Ravinay Bhindi 《Cardiovascular Revascularization Medicine》2019,20(1):16-21
Objective
This study aimed to assess the pathophysiological differences between saphenous vein grafts (SVG) and native coronary arteries (NCA) following presentation with non-ST elevated myocardial infarction (NSTEMI).Background
There is accelerated pathogenesis of de novo coronary disease in harvested SVG following coronary artery bypass (CABG) surgery, which contributes to both early and late graft failure, and is also causal in adverse outcomes following vein graft PCI. However in vivo assessment, with OCT imaging, comparing the differences between vein grafts and NCAs has not previously been performed.Methods
We performed a retrospective, observational, analysis in patients who underwent PCI with adjunctive OCT imaging following presentation with NSTEMI, where the infarct-related artery (IRA) was either in an SVG or NCA.Results
A total of 1550 OCT segments was analysed from thirty patients with a mean age of 66.3 (±9.0) years were included. The mean graft age of 13.9 (±5.6) years in the SVG group. OCT imaging showed that the SVG group had evidence of increased lipid pool burden (lipid pool quadrants, 2.1 vs 2.7; p?=?0.021), with a reduced fibro-atheroma cap-thickness in the SVG group (45.0?μm vs 38.5?μm; p?=?0.05) and increased burden of calcification (calcified lesion length?=?0.4?mm vs 1.8?mm; p?=?0.007; calcified quadrants?=?0.2 vs 0.9; p?=?0.001; arc of superficial calcium deposits?=?11.6° vs 50.9°; p?=?0.007) when compared to NCA.Conclusion
This OCT study has demonstrated that vein grafts have a uniquely atherogenic environment which leads to the development of calcified, lipogenic, thin-capped fibro-atheroma's, which may be pivotal in the increased, acute and chronic graft failure rate, and may underpin the increased adverse outcomes following vein graft PCI. 相似文献103.
Pierluigi Tricoci L. Kristin Newby Robert M. Clare Sergio Leonardi C. Michael Gibson Robert P. Giugliano Paul W. Armstrong Frans Van de Werf Gilles Montalescot David J. Moliterno Claes Held Philip E. Aylward Lars Wallentin Robert A. Harrington Eugene Braunwald Kenneth W. Mahaffey Harvey D. White 《JACC: Cardiovascular Interventions》2018,11(9):856-864
Objectives
In 13,038 patients with non–ST-segment elevation acute coronary syndrome undergoing index percutaneous coronary intervention (PCI) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non–ST-Segment Elevation Acute Coronary Syndrome) and TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trials, the relationship between PCI-related myocardial infarction (MI) and 1-year mortality was assessed.Background
The definition of PCI-related MI is controversial. The third universal definition of PCI-related MI requires cardiac troponin >5 times the 99th percentile of the normal reference limit from a stable or falling baseline and PCI-related clinical or angiographic complications. The definition from the Society for Cardiovascular Angiography and Interventions (SCAI) requires creatine kinase–MB elevation >10 times the upper limit of normal (or 5 times if new electrocardiographic Q waves are present). Implications of these definitions on prognosis, prevalence, and implementation are not established.Methods
In our cohort of patients undergoing PCI, PCI-related MIs were classified using the third universal type 4a MI definition and SCAI criteria. In the subgroup of patients included in the angiographic core laboratory (ACL) substudy of EARLY ACS (n = 1,401) local investigator– versus ACL-reported angiographic complications were compared.Results
Altogether, 2.0% of patients met third universal definition of PCI-related MI criteria, and 1.2% met SCAI criteria. One-year mortality was 3.3% with the third universal definition (hazard ratio: 1.96; 95% confidence interval: 1.24 to 3.10) and 5.3% with SCAI criteria (hazard ratio: 2.79; 95% confidence interval: 1.69 to 4.58; p < 0.001). Agreement between ACL and local investigators in detecting angiographic complications during PCI was overall moderate (κ = 0.53).Conclusions
The third universal definition of MI and the SCAI definition were both associated with significant risk for mortality at 1 year. Suboptimal concordance was observed between ACL and local investigators in identifying patients with PCI complications detected on angiography. (Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRA·CER] [Study P04736]; NCT00527943; EARLY ACS: Early Glycoprotein IIb/IIIa Inhibition in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome [Study P03684AM2]; NCT00089895) 相似文献104.
Karam Ayoub Meera Marji Gbolahan Ogunbayo Ahmad Masri Ahmed Abdel-Latif Khaled Ziada Srikanth Vallurupalli 《JACC: Cardiovascular Interventions》2018,11(18):1862-1868
Objectives
This study sought to evaluate the impact of chronic thrombocytopenia (cTCP) on clinical outcomes after percutaneous coronary intervention (PCI).Background
The impact of cTCP on clinical outcomes after PCI is not well described. Results from single-center observational studies and subgroup analysis of randomized trials have been conflicting and these patients are either excluded or under-represented in randomized controlled trials.Methods
Using the 2012 to 2014 National (Nationwide) Inpatient Sample database, the study identified patients who underwent PCI with or without cTCP as a chronic condition variable indicator. Propensity score matching was performed using logistic regression to control for differences in baseline characteristics. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest included in-hospital post-PCI bleeding events, post-PCI blood and platelet transfusion, vascular complications, ischemic cerebrovascular accidents (CVAs), hemorrhagic CVAs, and length of stay.Results
Propensity matching yielded a cohort of 65,130 patients (32,565 with and without cTCP). Compared with those without cTCP, PCI in patients with cTCP was associated with higher risk for bleeding complications (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 2.05 to 2.72; p < 0.0001), requiring blood transfusion (OR: 2.10; 95% CI: 1.80 to 2.24; p < 0.0001), requiring platelet transfusion (OR: 11.70; 95% CI: 6.00 to 22.60; p < 0.0001), higher risk for vascular complications (OR: 1.94; 95% CI: 1.43 to 2.63; p < 0.0001), ischemic CVA (OR: 1.60; 95% CI: 1.20 to 2.10; p = 0.01), and higher in-hospital mortality (OR: 2.30; 95% CI: 1.90 to 2.70; p < 0.0001), but without a significant difference in hemorrhagic CVA (OR: 1.50; 95% CI: 0.70 to 3.10; p = 0.27).Conclusions
In this large contemporary cohort, patients with cTCP were at higher risk of a multitude of complications, including higher risk of in-hospital mortality. 相似文献105.
目的：莱文征结合心肌梗死溶栓疗法危险评分（TIMI 危险评分）与单独运用 TIMI 危险评分比较,探讨两种方法在急性胸痛患者筛选急性冠脉综合征（ACS）的临床价值。方法对171例胸痛患者随机分成试验组81例（TIMI 危险评分＋莱文征阳性）与对照组90例（TIMI 危险评分）,根据患者的 TIMI 危险评分值,将其分成低分组（0～2分）、中分组（3～4分）与高分组（5～7分）,在3个分值段内分别比较单独应用 TIMI 危险评分与 TIMI危险评分联合莱文征阳性对 ACS 发生率的差异性。结果TIMI 危险评分低分组中,用试验组方法13例,3例诊断为 ACS,筛查率为23．08％,用对照组方法11例,2例诊断为 ACS,筛查率为18．18％。两者进行χ2检验,差异无统计学意义（P ＞0．05）;TIMI 危险评分高分组患者中,用试验组方法41例,33例诊断为 ACS,筛查率为80．49％,用对照组方法46例,35例诊断为 ACS,筛查率为76．09％,进行χ2检验,差异无统计学意义（P ＞0．05）;在 TIMI危险评分中分组（3～4分）患者中,用试验组方法27例,20例诊断为 ACS,筛查率为74．07％。用对照组方法33例,17例诊断为 ACS,筛查率为51．52％。两者进行χ2检验,差异有统计学意义（P ＜0．05）。在中分组中,运用TIMI 危险评分联合莱文征与冠脉造影术这一金指标进一步比较后,发现运用 TIMI 危险评分联合莱文征诊断ACS 的敏感性为86．84％,特异性为90．91％,诊断符合率为88．33％（P ＜0．001）。结论TIMI 危险评分结合莱文征后,在中分组急性冠脉综合征的发生率比单独运用 TIMI 危险评分的发生率高,与单独运用 TIMI 危险评分系统相比,可以更好地预测 ACS 的发生,可以作为在急性胸痛患者筛选急性冠脉综合征的一项简单、有效工具。 相似文献
106.
目的：探讨血清基质金属蛋白酶-9（MMP-9）及白细胞介素-6（IL-6）与急性冠脉综合征（ACS）患者冠状动脉斑块稳定性的相关性。方法：38例ACS患者作为观察组,行冠状动脉CT造影及冠脉造影检查;38例健康体检人员作为对照组,两组人员均接受血清MMP-9及IL-6检测,并在两组之间以及不同类型动脉粥样硬化斑块ACS患者中进行对比分析。结果：观察组血清MMP-9及IL-6水平明显高于对照组,差异具有统计学意义（P〈0．01）;且软斑块患者MMP-9及IL-6水平均明显高于混合斑块,差异具有统计学意义（P〈0．05）;而混合斑块患者又明显高于硬斑块（P〈0．05）;同时ACS患者血清MMP-9与IL-6水平呈正相关（r=0．724,P〈0．01）。结论：血清MMP-9及IL-6可作为斑块稳定性评估的重要指标,进而对ACS患者的早期干预治疗提供客观依据。 相似文献
107.
108.
109.
Kyung Woo Park Si-Hyuck Kang Jin Joo Park Han-Mo Yang Hyun-Jae Kang Bon-Kwon Koo Byoung-Eun Park Kwang Soo Cha Jay Young Rhew Hui-Kyoung Jeon Eun Seok Shin Ju Hyeon Oh Myung-Ho Jeong Sanghyun Kim Kyung-Kuk Hwang Jung-Han Yoon Sung Yun Lee Tae-Ho Park Hyo-Soo Kim 《JACC: Cardiovascular Interventions》2013,6(9):932-942
110.