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1.
Background Patients with end-stage renal disease have a high mortality from coronary artery disease, but the impact of moderate renal insufficiency on clinical outcomes after percutaneous coronary intervention (PCI) and the effect of drug-eluting stent implantation in these patients remain unclear. This study determined the long-term effect of moderate renal insufficiency on death and major adverse cardiac events (MACE) after stent based PCI and examined whether drug-eluting stent implantation could favourably influence clinical outcome. Methods Major adverse cardiac events and causes of mortality were determined for 1012 patients undergoing percutaneous intervention from January 1, 2002 to December 31, 2004 at Shanghai Ruijin Hospital. Based on estimated creatinine clearance levels, long term outcomes were compared between patients with estimated creatinine clearance 〈60 ml/min (renal insufficiency group; n=410) and those with estimated creatinine clearance ≥60 ml/min (control group; n=602). Subgroup analysis was also made for patients with renal insufficiency between drug eluting stent (n=264) and bare metal stent implantation (n=146) during PCI. Results During follow-up (average 17 months) after successful PCI, all causes of death (7.1% vs 2.3%, P〈0.01) and cardiac death (3.4% vs 1.0%, all P〈0.01) were significantly higher in renal insufficiency group than in control group. For patients with moderate renal insufficiency, drug-eluting stent implantation reduced significantly all causes of death (5.3% vs 10.9%, P〈0.05) and occurrence of major cardiac adverse events (15.1% vs 24.6%, P〈0.05) compared with bare metal stents. Conclusions Moderate renal insufficiency is an important clinical factor influencing the mortality after PCI in patients with coronary artery disease and the use of drug-eluting stents should be the preferred therapy for the improvement of long-term outcomes in such patients.  相似文献
2.
Although atherosclerosis has been considered to be multi-factorial disease in which genetic, environmental, metabolic factors have been implicated, the gaps remain in our knowledge of the etiopathogenesis of atherosclerosis. There is mounting evidence that inflammation plays an important role in the initiation, development as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease.1,2 Although triggers and pathways of inflammation are probably multiple and different in different clinical settings, the data from animals as well as humans including our groups indicated that an inflammatory process was involved in all stages of atherosclerosis appeared in different clinical entities.  相似文献
3.
经皮桡动脉入路直接冠状动脉介入治疗急性心肌梗死   总被引:10,自引:0,他引:10       下载免费PDF全文
目的:探讨经皮桡动脉入路介入治疗在急性心肌梗死中的应用.方法:急性心肌梗死患者107例,其中56例行直接经皮桡动脉入路冠状动脉介入(PCI)治疗(A组),51例行直接经皮股动脉入路PCI(B组),比较两组的穿刺成功率、PCI成功率、血管开通时间、手术总时间、穿刺点并发症.结果:A、B两组穿刺成功率均为100%,PCI成功率均大于96%,鞘管置入时间[(2.93±0.42) vs (3.07±0.54) min, P=0.14]、血管再通时间[(17.23±3.47) vs (16.81±4.86) min, P=0.61]、手术总时间[(47.04±7.53) vs (48.74±6.22) min, P=0.21]等差异均无统计学意义.B组穿刺点局部出血、血肿发生率(5/51, P=0.016 4)及拔管迷走反射(4/51, P=0.032 7)均明显高于A组(0/56).结论:经皮桡动脉入路介入治疗行急诊PCI是安全可行的,而且能减少穿刺点并发症.  相似文献
4.
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
5.
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
6.
目的探讨不稳定型心绞痛(UAP)患者介入治疗后超敏C反应蛋白(hs—CRP)的变化,并评估其对患者预后的影响。方法对符合条件的158例行经皮冠脉介入治疗(PCI)的UAP患者(UAP组)和91例冠状动脉造影正常患者(对照组),采用双抗体夹心法检测术前、术后24h血清hs—CRP的变化;并对UAP患者进行术后1年随访,以评价术后24h血清hs—CRP水平与首次发生主要心血管病事件的关系。结果UAP组术后24h血清hs—cRP浓度与术前的差值高于对照组[(1.08±0.89)mg/L:(0.36±0.29)mg/L,t=7.483,P=0.000];PCI术后血清hs—CRP≥3.0mg/L的uAP患者1年内首次主要心血管病事件的发生率高于hs—CRP〈3.0mg/L者(χ^2=1.267,P=0.260)。结论PCI术后24h血清hs-CRP水平是影响UAP患者1年内首次发生主要心血管病事件的一个重要因素。  相似文献
7.
Recent clinical trials with rapamycin-eluting stents ,have shown very low restenosis rates.However, the higher penetration of drug eluting stent (DES) in China is being limited by the high costs of these imported devices, especially when considering multiple stenting. Firebird (Microport Co. Ltd., China) is a rapamycin (Huadong Pharmaceutical, China) polymer-based eluting stent with reasonable cost. The objective of this study was to evaluate the safety and efficacy of using Firebird stents in routine interventional practice.  相似文献
8.
经皮冠状动脉介入治疗后外周血管并发症的护理   总被引:6,自引:2,他引:4  
目的 :对经皮冠状动脉介入治疗 (PCI)后外周血管并发症的观察 ,并初步总结护理经验。 方法 :对 388例PCI患者外周血管并发症 (PCV)及其危险因素进行统计 ,结合自己的护理实践 ,总结护理体会。 结果 :①单纯冠状动脉造影 (CAG)组出血和血肿 1 1例 ,无其他并发症。PVC发生率为 5 .2 6 % ;经皮腔内冠状动脉成形术 (PTCA)支架组出血和血肿 2 1例 ,假性动脉瘤 1例 ,动静脉瘘 1例 ,PVC发生率 1 1 .73%。PVC总发生率 8.2 5 %。②存在外周血管病变患者PVC发生率最高 (6 0 .0 0 % ) ,其次为高龄患者 (4 2 .85 % )、多次重复介入手术者 (30 .0 0 % )和止血压迫时间过长者 (2 8.0 0 % ) ,PVC发生率女性略低于男性 (6 .4 9%vs8.6 8% ) ,高血压病患者为 8.99% ,比以往报道低。 结论 :①应当加强PTCA支架组患者的护理 ;②对手术前危险因素的预测 ,有利于术后重点护理 ;③针对不同并发症 ,制订护理措施 ;④出院前伤口评估将带来益处  相似文献
9.
Background Recently, numerous randomized and controlled trials have demonstrated great advantages of drug eluting stents (DES) with respect to significant reduction of restenosis and recurrence of symptoms and improvement of clinical outcomes after percutaneous coronary intervention (PCI). Little is known about the comparative effects between DES and bare metal stents (BMS) for bifurcation angioplasty in the Chinese population. We compared the inpatient and 7-month follow-up outcomes between DES and BMS for the treatment of bifurcation lesions. Methods From April 2004 to October 2005, 291 Chinese patients [85.9% male, mean age (57.8±10.4) years] underwent DES (387 lesions) and/or BMS (297 lesions) implantation for bifurcation lesions. Clinical and angiographic follow-up was performed at 7 months. Results Compared with BMS group, patients in DES group had significantly lower rates of restenosis at main branch (9.5% vs 28.7%, P < 0.001) or side branch (14.5% vs 37.0%, P < 0.001) and major adverse cardiac events (MACE) (14.0% vs 26.3%, P = 0.000). The occurrence rate of late in-stent thrombosis did not differ between the two groups in both main (0.8% vs 0, P = 0.224) and side branches (1.4% vs 0, P = 0.198). Target lesion revascularization (TLR) was less frequent in DES group for main branch (8.3% vs 21.3%, P < 0.001) and for side branch (7.6% vs 23.5%, P < 0.001). Multivariate regression analysis revealed that total stent length (OR = 1.029, P = 0.01), postprocedural in-stent minimum lumen diameter (OR = 0.476, P = 0.03) and stent type (OR = 3.988, P = 0.0001) were independent predictors of TLR for main branch. Prior history of coronary intervention (OR = 2.424, P = 0.041), angulated lesion (OR = 2.337, P = 0.033), postdilation (OR = 0.267, P = 0.035) and stent type (DES vs BMS, OR = 5.459, P = 0.000) were independent predictors of TLR for side branch. Conclusion The implantation of DES may be associated with greater reduction of restenosis and TLR than BMS in bifurcations angioplasty.  相似文献
10.
Background Previous studies showed that blood B-type natriuretic peptide (BNP) level could predict the prognosis of acute coronary syndromes (ACS). This study investigated the evaluation value of circulating BNP for early percutaneous coronary intervention (PCI) in patients with ACS.Methods Nine hundred and sixty consecutive patients with ACS were enrolled. Circulating BNP level was measured when each patient arrived at the emergency room. All patients underwent PCI in 90 minutes in spite of contraindication. Cardiac events (death from any cause, heart failure, and recurrence of acute myocardial infarction or ACS) were recorded during follow-up. Results In patients with BNP ≥80 pg/ml, mortality from all causes within 1 month and 6 months in those underwent delayed PCI (≥6 hours) was significantly higher than those received early PCI (&lt;6 hours) (9.53% vs 3.49%, P=0.027; 13.61% vs 5.24%, P=0.010, respectively). Similarly, the incidence rate of heart failure in delayed PCI patients was significantly higher than those received early PCI within 1 month and 6 months (12.93% vs 4.66%, P=0.008; 14.97% vs 6.98%, P=0.021, respectively). The recurrence rate of acute myocardial infarction or ACS, however, was not significantly different between early PCI and delayed PCI patients in group BNP ≥80 pg/ml. In patients with BNP &lt;80 pg/ml, no significant difference was observed between early PCI and delayed PCI patients with any of the above cardiac events within 1 month or 6 months. Conclusion While early level of circulating BNP ≥80 pg/ml, the incidence of mortality and heart failure, but not recurrence of acute myocardial infarction, is significantly reduced in patients with ACS provided by early PCI.  相似文献
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