老年2型糖尿病合并冠心病患者冠状动脉造影及临床特点分析

目的了解老年2型糖尿病合并冠心病患者的临床及冠状动脉病变的造影特点。方法对185例经冠状动脉造影诊断的老年冠心病患者分为两组:有糖尿病组(DM)和无糖尿病组(NDM),分析比较了两组的临床表现及冠状动脉病变的造影特点。结果(1)两组间年龄、吸烟、高血压及心肌梗死率的差异均无显著性意义。甘油三酯(TG)水平DM组较NDM组高(P<0.05)。(2)两组病变血管数量及侧支循环形成情况比较差异无显著性,两组的病变血管分布状况相似。(3)两组冠脉狭窄支数、狭窄程度比较差异均无显著性,DM组的冠脉狭窄范围较NDM组广泛(3.17vs2.44,P<0.05),DM组冠状动脉狭窄<50%的血管片段数高于NDM组。结论老年糖尿病合并冠心病患者的冠状动脉更倾向于弥漫性病变,高TG可加重DM的冠状动脉病变。     

糖尿病合并冠心病冠状动脉病变特点观察

目的　探讨糖尿病合并冠心病冠状动脉病变特点。方法　回顾广东省心血管病研究所 1997～ 1999年冠状动脉造影有阳性发现的病例 ,分为糖尿病组和非糖尿病组(两组均为 6 1例 ) ,分析两组间冠状动脉病变支数及病变类型的差异及不同糖尿病病程患者的冠状动脉病变支数、病变类型的差异。结果　糖尿病组冠状动脉单支病变发生率低(P <0 0 1) ,2支、3支血管病变发生率高 (P <0 0 5 )。A型病变的比例低 (P <0 0 5 ) ,C型病变比例高 (P <0 0 1)。糖尿病不同病程组间的单支、双支、三支血管病变发生率无显著差异 (P >0 0 5 ) ,而糖尿病病程长于 5年组的A型病变较短于 5年组比例低 ,C型病变比例高 (P <0 0 5 )。结论　合并糖尿病的冠心病冠状动脉病变广泛而严重 ,且随着糖尿病的发展而发展。     

糖尿病患者的冠状动脉病变特点

目的　比较糖尿病与非糖尿病患者冠状动脉造影确定的冠状动脉病变。方法　回顾性分析 15 64例确诊为糖尿病和非糖尿病患者冠状动脉造影各支血管病变的特点。结果　 ( 1) 84例糖尿病患者中有 74例 ( 88.10 % )并发冠状动脉病变 ,而 14 80例非糖尿病患者中有 82 4例 ( 5 5 .68% )患有冠状动脉病变 ,两组差异显著。 ( 2 ) 74例糖尿病并冠状动脉病变中 ,36例为多支病变( 48.65 % ) ,38例有弥漫性冠状动脉病变 ( 5 1.35 % ) ,42例有小血管病变 ( 5 6.76% ) ;而 82 4例冠状动脉病变的非糖尿病患者中 ,2 86例为多支病变 ( 34 .71% ) ,64例有弥漫性冠状动脉病变 ( 7.77% ) ,2 2 8例有小血管病变 ( 2 7.67% )。结论　与非糖尿病患者相比较 ,糖尿病患者的冠状动脉病变发生率高 ,而且 ,冠状动脉的多支病变、弥漫性病变及小血管病变的发生率显著高     

2型糖尿病合并冠心病患者心电图及冠脉造影结果的分析

目的探讨2型糖尿病合并冠心病的心电图和冠脉造影特点。方法对在我院住院经冠脉造影确诊为冠心病的2型糖尿病患者53例作为观察组；随机选择同期住院不合并2型糖尿病的冠心病患者53例作为对照组。分析两组患者的心电图与冠脉造影结果。结果冠心病合并2型糖尿病患者，冠状动脉三支病变的发生率、受累血管总数、弥漫性病变血管数明显高于非糖尿病组（p〈0．05），单支病变的发生率明显低于非糖尿病组（p〈0．05），而双支病变、左主干病变、100％闭塞血管相比无显著性差异（p〉0．05）。ST-T改变导联在Ⅱ、Ⅲ、aVF、V4、V5、V6导联出现的频率高，但与冠脉病变的支数无明显关系。结论冠心病合并2型糖尿病患者，冠状动脉三支病变的发生率、受累血管总数、弥漫性病变血管数明显高于非糖尿病冠心病患者；心电图ST-T改变导联与冠脉病变的支数无明显关系，冠脉病变的严重程度与心电图缺乏对应性关系。     

合并糖尿病患者行冠状动脉左主干病变介入治疗的疗效分析

目的探讨冠状动脉左主干病变合并糖尿病患者行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的疗效。方法回顾性分析87例(糖尿病组36例,非糖尿病组51例)冠状动脉左主干病变患者接受PCI治疗的临床资料,比较糖尿病与非糖尿病患者行冠状动脉左主干PCI治疗的方法、疗效和随访结果。结果两组基线资料比较,差异无统计学意义(P0.05)。除外糖尿病组左主干合并前降支病变的比例高于非糖尿病组外,两组病变部位及合并病变冠状动脉分支的比例比较,差异无统计学意义(P0.05)。两组支架植入成功率比较,差异无统计学意义[100%(36/36)vs.98%(50/51),P0.05]。两组介入治疗的各项结果比较,差异无统计学意义(P0.05)。两组PCI治疗后1年各项冠状动脉造影及血管内超声检查结果比较,差异无统计学意义(P0.05),随访期间冠状动脉造影和血管内超声检查均未发现左主干支架内有局部血栓的影象学表现。共83例患者随访到2007年12月,临床随访率95.4%(83/87),随访时间(31.8±6.3)个月。至随访结束,2例死亡,病死率2.4%(2/83),共有7例复发心绞痛,4例经造影证实为左主干支架内再狭窄。结论合并糖尿病的左主干病变患者,在血管内超声指导下进行介入治疗可以获得与非糖尿病患者相同的治疗效果。     

心电图预测急性下壁心肌梗死罪犯血管失败原因探讨

目的探讨心电图预测急性下壁心肌梗死罪犯血管失败的原因。方法回顾性分析68例急性下壁ST段抬高型心肌梗死患者的心电图和冠状动脉造影资料,将心电图预测罪犯血管与冠状动脉造影一致和不一致的患者归为匹配组和不匹配组,比较两组间的多支病变数和冠状动脉优势型分布。结果分别有56例和12例患者归为匹配组和不匹配组。左冠状动脉优势型在不匹配组明显多于匹配组(41.67%vs 14.29%,P0.05)。双支病变和三支病变/左主干病变患者在不匹配组和匹配组间均差异无统计学意义(50.00%vs 26.78%;33.33%vs 42.86%,P0.05)。结论左冠状动脉优势型是心电图预测急性下壁ST段抬高型心肌梗死罪犯血管失败的主要原因。     

2-型糖尿病对冠状动脉病变影响的分析

目的探讨2-型糖尿病(T2DM)对冠状动脉病变的影响。方法回顾性分析近4年492例选择性冠状动脉造影的住院病例,比较T2DM与非糖尿病患者冠状动脉病变的特点,包括病变程度、累及的血管数目。结果与非糖尿病组比较,T2DM组冠状动脉发生病变更多见(P<0.01),左回旋支(LCX)、右冠状动脉(RCA)发生病变的比例高于非糖尿病组(均P<0.01),T2DM组3支血管均发生病变的比例显著增高(P<0.01));经协方差分析,T2DM组与非糖尿病组在冠状动脉病变的程度上存在显著差异(F=2.56,P=0.001),在累及血管的数目上亦存在有统计学意义的差异(F=2.109,P=0.011)。结论T2DM患者更容易发生冠状动脉病变,且冠状动脉病变的程度较重、受累及的血管数目较多。     

老年糖尿病患者冠状动脉造影的临床特点分析

目的探讨老年糖尿病患者选择性冠状动脉造影的临床应用价值。方法回顾分析选择性冠状动脉造影检查的老年糖尿病患者550例,同期选择老年非糖尿病患者600例,根据冠状动脉造影结果进行对照分析。结果糖尿病组中冠状动脉显示正常或基本正常(≤50%)108例,诊断冠心病的患者442例中,受累血管974支,单支血管病变115例,2支血管病变115例,3支血管病变119例,重度狭窄及慢性闭塞93支。和对照组相比冠心病的发病率和病变程度具有显著性差异(P<0.05)。结论老年糖尿病患者的冠状动脉狭窄率显著高于非糖尿病患者。     

2型糖尿病合并冠心病患者冠状动脉造影及眼底荧光血管造影结果分析

目的 探讨2型糖尿病合并冠心病患者冠状动脉造影及眼底荧光血管造影的特点。方法 对203例2型糖尿病合并冠心病患者的冠状动脉造影及眼底荧光血管造影结果，按照不同年龄或总胆固醇（TC）分组进行对比分析，并应用多因素logistic回归分析探讨影响血管造影特点的危险因素。结果 不同年龄组之间随着年龄的增长，冠状动脉的单支血管病变比例降低，三支血管病变及左主干受累比例增高，视网膜病变亦增多并趋于严重，而其在TC异常组与TC正常组之间的差别无统计学意义；Logistic回归分析显示冠状动脉的病变程度与血糖、年龄、甘油三酯、性别等因素相关，视网膜病变程度与血糖和年龄相关。结论 不同年龄组2型糖尿病合并冠心病患者的血管造影结果存在明显差异，年龄的增长能同时加重2型糖尿病合并冠心病患者的冠状动脉病变和视网膜病变。     

冠心病合并2型糖尿病患者冠状动脉造影特点分析

经冠状动脉造影检查确诊的冠心病患者574例,其中合并T2DM的135例和随机选取124例单纯冠心病患者的临床资料和冠状动脉病变情况进行比较.结果两组在年龄、吸烟方面无统计学意义.但体重指数、高血压、血脂异常较了非糖尿病组高(P＜0.05),受累血管病变总比例高,糖尿病组以前降支、右冠状动脉、C型病变为多冠状动脉受累范围广,双支、三支血管病变发生率明显高(P＜0.05).结论合并T2DM使冠心病患者冠状动脉病变加重且弥漫.     

Revisiting the culprit lesion in non-Q-wave myocardial infarction. Results from the VANQWISH trial angiographic core laboratory

OBJECTIVE: We sought to determine the underlying coronary anatomy and characterize the culprit lesion after non-Q-wave myocardial infarction (NQWMI). BACKGROUND: Although the culprit lesion and infarct-related artery often are easily identified with coronary angiography after Q-wave MI, the culprit lesion after NQWMI has not been well characterized. Small retrospective studies have suggested that the absence of Q-waves on an electrocardiogram is due to incomplete occlusion of the infarct-related artery. METHODS: Coronary angiograms from 350 patients randomized to the early invasive strategy in the Veterans Affairs Non-Q-Wave Infarction Strategies in-Hospital (VANQWISH) trial were systematically analyzed in an angiographic core laboratory. A consensus panel identified the culprit lesion and the infarct-related artery using prespecified criteria for complex lesion morphology and acute versus chronic occlusions. Severity of angiographic disease and left ventricular function also were analyzed. Patients with a single identified culprit lesion were compared with those who had multiple apparent culprits and those without an identifiable culprit lesion. RESULTS: A single culprit lesion was identified in only 49% of patients undergoing early angiography after NQWMI. The majority of patients either had no identifiable culprit (37%) or multiple apparent culprit lesions (14%). A single incomplete occlusion of the infarct-related artery was found in only 36% of patients, and an isolated acute occlusion of the infarct-related artery occurred in 13%. Patients without an identifiable culprit lesion had severe coronary disease (obstructive coronary artery disease [CAD] in 84%) but no complex lesion morphology. There was no difference in angiographic severity of disease comparing patients with and without identifiable culprit lesions. Patients with a single incomplete occlusion of the infarct-related artery were more likely to undergo percutaneous transluminal coronary angioplasty than other patients, whereas patients with multiple culprit lesions were more frequently treated with coronary artery bypass grafting. CONCLUSIONS: Coronary angiography early after NQWMI frequently identifies severe obstructive CAD, but a single identifiable culprit lesion was identified in <50% of patients. Multiple culprit lesions were seen in 14% of patients. An angiographic culprit lesion could not be identified in more than one-third of patients undergoing coronary angiography as part of an invasive strategy.     

Percutaneous transluminal coronary angioplasty of the "culprit lesion" for management of unstable angina pectoris in patients with multivessel coronary artery disease

The efficacy of 1-vessel percutaneous transluminal coronary angioplasty (PTCA) directed at the presumed angina-producing stenosis, or "culprit lesion," in the treatment of unstable angina pectoris and multivessel coronary artery disease (CAD) was assessed in 27 patients with unstable angina refractory to optimal medical therapy. Eighteen patients had 2-vessel and 9 had 3-vessel CAD. The culprit lesion was identified in all patients by analysis of the qualitative appearance of the coronary lesions and detection of angiographic evidence of plaque fissuring or coronary thrombosis. Intracoronary filling defects were evident in 26% and eccentric stenoses with irregular edges were noted in 41% of patients. Subtotal obstructions were seen in 33%. Confirmation of the identity of the culprit lesion was also available in 78% of patients by analysis of the pattern and distribution of spontaneous electrocardiographic changes. The PTCA primary success rate was 89%, with no procedure-related complications. All patients in whom PTCA was successful had immediate resolution of their unstable angina. Follow-up of the successfully treated patients after a mean of 16 months (range 12 to 20) showed maintenance of long-term clinical improvement, with only 17% of patients having recurrent angina. These data suggest that 1-vessel PTCA of the culprit lesion may serve as a feasible therapeutic option in the treatment of selected patients with multivessel CAD and unstable angina.     

冠状动脉口部病变介入治疗中Szabo技术应用的安全性和可行性

目的分析冠状动脉口部病变PCI中造影和血管内超声(intra vascular ultrasonography,IVUS)结果 ,评价Szabo技术的成功率、安全性和可行性。方法回顾性分析Szabo技术治疗冠状动脉口部病变患者39例PCI结果。结果经桡动脉途径31例(79.5%),经股动脉途径8例(20.5%)。罪犯血管为左前降支26例(66.7%),右冠状动脉5例(12.8%),左回旋支及钝缘支3例(7.7%),后降支5例(12.8%)。支架置入后,对30例(76.9%)罪犯血管和9例(23.1%)边支血管进行了IVUS检查。手术成功36例(92.3%)。所有患者造影成功率为100%。IVUS检测罪犯血管准确支架置入到口部患者29例(96.7%)和支架近端轻度凸出患者1例(3.3%)。结论 Szabo技术用于冠状动脉口部病变PCI中是安全可行的,而且具有极高的造影成功率。经过IVUS检查证实大部分支架在冠状动脉口部病变处能准确置入。     

未绝经女性患者冠状动脉事件临床特点分析

目的 分析未绝经女性患者冠状动脉事件的临床特点.方法 回顾性分析1995-2007年间于北京协和医院接受诊治的未绝经女性冠心病患者47例,已绝经女性冠心病患者172例和未绝经非动脉粥样硬化性冠状动脉疾病女性患者(non-AS CAD组)18例的临床表现.结果 (1)与已绝经冠心病组比较:未绝经冠心病组的高血压、糖尿病、高脂血症的发生率较低(均P<0.01),既往发生胸痛较少(14.9%比82.6%,P<0.01),冠心病危险因素个数较少(1.04±0.98比2.21±0.10,P<0.01),急性冠状动脉综合征(ACS)较多(83.0%比48.8%,P<0.01);冠状动脉造影显示以单支病变为主(70.2%比29.1%,P<0.01),冠状动脉病变积分(Gensini评分)较低(10.5±7.2比56.5+27.0,P<0.01);logstic回归发现,肥胖是未绝经女性冠心病患者独立的危险因素(OR =3.655,95%CI:1.15～11.59,P=0.028).(2)18例non-AS CAD患者占疑诊冠心病未绝经女性患者中的28%,其中16例以ACS起病.与未绝经冠心病组比较,血生化指标、危险因素、冠状动脉病变情况等差异均无统计学意义.结论 未绝经女性冠心病患者较已绝经女性冠心病患者合并高血压、糖尿病、高脂血症者少,冠心病危险因素少;既往发生胸痛较少,以ACS起病多见;肥胖是独立的危险因素.非动脉粥样硬化性冠状动脉疾病也是引起未绝经女性患者发生冠状动脉事件的重要原因.     

糖尿病合并冠心病患者的冠脉造影分析

目的 旨在观察２型糖尿病合并冠心病患者的冠脉病变情况。方法 应用ＪＵＤＫＩＮＳ方法对６６例２型糖尿病合并冠心病患者进行冠脉造影检查,并与６６例年龄,性别配对的非糖尿病冠心病患者比较。结果 ２型糖尿病患者的冠脉病变多数是三支血管病变,其病变弥漫,且数目多;并且糖尿病的病程越长,越易发生多支血管病变,造成治疗上的困难。结论２型糖尿病的及早预防,合理有效的治疗对冠心病的防治甚为重要。     

In unstable angina or non-ST-segment acute coronary syndrome, should patients with multivessel coronary artery disease undergo multivessel or culprit-only stenting?

OBJECTIVES: We examined the safety and efficacy of nonculprit multivessel compared with culprit-only stenting in patients with multivessel disease presenting with unstable angina or non-ST-segment elevation myocardial infarction (non-ST-segment elevation acute coronary syndromes [NSTE-ACS]). BACKGROUND: In patients presenting with NSTE-ACS, multivessel coronary artery disease (CAD) is associated with adverse outcome. METHODS: Patients with multivessel CAD and NSTE-ACS that underwent percutaneous coronary intervention were included. The culprit lesion was defined by reviewing each patient's angiographic report, electrocardiogram, echocardiogram and, if available, nuclear stress test. All patients had at least 2 vessels with > or =50% stenosis, and the angiographic severity of CAD was assessed using the Duke Prognostic Angiographic Score. Patients with coronary bypass grafts, chronic total occlusions, and those with uncertain culprit lesions were excluded. Our end point was the composite of death, myocardial infarction, or any target vessel revascularization. RESULTS: From January 1995 to June 2005, 1,240 patients with ACS and multivessel CAD underwent percutaneous coronary intervention with bare-metal stenting and met our study criteria. Of these, 479 underwent multivessel and 761 underwent culprit-only stenting. There were 442 events during a median follow-up of 2.3 years. Multivessel intervention was associated with lower death, myocardial infarction, or revascularization after both adjusting for baseline and angiographic characteristics (hazard ratio 0.80; 95% confidence interval 0.64 to 0.99; p = 0.04) and propensity matched analysis (hazard ratio 0.67; 95% confidence interval 0.51 to 0.88; p = 0.004). CONCLUSIONS: In patients with multivessel CAD presenting with NSTE-ACS, multivessel intervention was significantly associated with a lower revascularization rate, which translated to a lower incidence of the composite end point compared with culprit-only stenting.     

Relation of spontaneous reperfusion in ST-elevation myocardial infarction to more distal coronary culprit narrowings

Spontaneous reperfusion (SR) of the infarct-related artery may occur in patients with ST-segment-elevation myocardial infarctions (STEMIs). Limited data are available on the angiographic characteristics of these patients. The objective of this study was to determine if there are differences in the distance of the culprit lesion from the coronary ostium in patients with STEMIs with and without SR. Patients who presented with acute STEMIs<12 hours after pain onset and who underwent coronary angiography were entered into the study. Measurement of the distance from the coronary ostium to the culprit lesion was performed. A total of 469 patients with STEMIs were included in the study, of whom 77 met criteria for SR (significant relief of chest pain associated with >or=50% resolution of ST-segment elevation on follow-up electrocardiography) and 392 did not. A highly significant difference was seen in ostial to culprit lesion distance, with the culprit lesions in the SR group being more distal than those in the non-SR group (45+/-22 vs 39+/-20 mm, p<0.009). In conclusion, the findings of this study demonstrate that the location of the culprit lesion in patients with STEMIs who undergo SR is more distal in the involved artery than in patients with STEMIs who do not undergo SR.     

冠心病合并非胰岛素依赖型糖尿病患者冠状动脉造影特点

目的 探讨冠心病（ＣＨＤ）合并非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者的临床及冠状动脉（冠脉）造影特点。方法 对冠脉造影病例进行临床表现和血管造影资料对照分析。结果 冠心病合并ＮＩＤＤＭ者倾向于聚集多种心血管危险因素（高血压、血脂异常）。ＮＩＤＤＭ对女性的血脂异常影响似乎更为显著。与非糖尿病的冠心病虱相比,冠心病合并ＮＩＤＤＭ者不稳定心绞痛多见,且女性心肌梗死危险性增高。其冠脉血管受累程度高且弥漫性     

Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study

OBJECTIVES: We examined the association between the features of the culprit lesion in coronary artery disease (CAD) and clinical presentation as shown by intravascular ultrasound (IVUS). BACKGROUND: The association between coronary remodeling pattern and clinical presentation of CAD is unclear. METHODS: We analyzed 125 selected patients who underwent preintervention IVUS. Acute myocardial infarction (AMI) and unstable angina pectoris (UAP) were categorized as an acute coronary syndrome (ACS), and stable angina pectoris (SAP) and old myocardial infarction (OMI) as stable CAD. Coronary remodeling patterns and plaque morphology of the culprit lesion obtained by IVUS were analyzed in terms of their association with clinical presentation or angiographic morphology. RESULTS: Angiographically complex lesions were associated with ACS and OMI. In patients with a complex lesion, positive remodeling was observed more frequently than in those with a simple lesion. In AMI and UAP, positive remodeling was observed more frequently than in SAP and OMI (82% vs. 78% vs. 33% vs. 40%, respectively, p < 0.0001). The remodeling ratio was greater in AMI and UAP than in SAP and OMI (1.26 +/- 0.15 vs. 1.11 +/- 0.10 vs. 0.94 +/- 0.11 vs. 0.96 +/- 0.13, respectively, p < 0.0001). Furthermore, within ACS, the remodeling ratio was greater in AMI than in UAP (1.26 +/- 0.15 vs. 1.11 +/- 0.10, respectively, p < 0.05), whereas the frequency of positive remodeling was not different. CONCLUSIONS: Positive remodeling was more frequently observed in ACS than in stable CAD. Moreover, the degree of positive remodeling was greater in AMI than in UAP. These results may reflect the impact of remodeling types and its degree in the culprit lesion of CAD on clinical presentation.