紫杉醇洗脱支架治疗冠状动脉硬化性心脏病近期效果

目的 评价紫杉醇洗脱支架(PES,商品名TAXUS)治疗冠状动脉硬化性心脏病患者的近期效果及安全性。方法 对2003年7月至2004年11月在我院接受PES植入治疗的300例患者的即刻疗效和随访结果进行总结与分析。结果 300例患者共处理350处病变,植入支架355枚,其中B2型以上复杂病变248处(70.9%),小管径支架(2.50~2.75mm)94处(26.5%)、长支架(>20mm)130处(36.6%);术中未发生严重并发症,手术成功率100%。随访250例(83.3%),平均随访6个月(1~15个月),8例(2.7%)患者有心绞痛样发作,其中2例冠状动脉造影复查无支架再狭窄病变,1例于术后5个月发生心肌梗死,2例因非心源性因素死亡。结论 PES治疗冠状动脉硬化性心脏病近期效果明显,且较为安全。     

药物洗脱支架治疗冠状动脉粥样硬化性心脏病效果及对预后的影响

目的观察药物洗脱支架治疗冠状动脉粥样硬化性心脏病效果及对预后的影响。方法选择2014年5月—2016年2月青海省心脑血管病专科医院心律失常二科诊治的冠状动脉粥样硬化性心脏病患者134例作为研究对象,按照治疗方式的不同分为观察组与对照组各67例,在对患者常规治疗的基础上,观察组采用置入药物洗脱支架治疗,对照组加用阿托伐他汀治疗。对比分析2组患者治疗前后血压(SBP、DBP、PP)、血脂(TC、HDL-C、LDL-C)、炎性因子(IL-6、TNF-α、CRP),MR心肌灌注评分、心功能、血液流变力学指标、冠状动脉造影结果,以及随访1年患者并发症发生情况。结果治疗后2组患者的血压、血脂、炎性因子水平均较治疗前改善(P均<0.01),观察组患者的血压、血脂、炎性因子改善较对照组更明显(P均<0.01);左室代谢总评分、左室灌注总评分、LVEF明显高于对照组(t=3.967、2.053、2.254,P=0.000、0.014、0.026),而LVEDD低于对照组(t=2.077,P=0.040);观察组NpI、Np、Nbh及EAI水平低于对照组(t=20.860、10.360、17.316、12.787,P均=0.000),最小管腔直径大于对照组(t=4.143,P=0.000),直径狭窄程度小于对照组(t=5.648,P=0.000);随访1年观察组患者并发症总发生率20.90%低于对照组的80.60%(χ~2/P=47.772/0.000)。结论在冠状动脉粥样硬化性心脏病治疗中置入药物洗脱支架疗效更显著,且置入药物洗脱支架在近、远期疗效均优于药物治疗。     

紫杉醇洗脱支架在复杂病变中的应用

经皮冠状动脉介入治疗（percutaneous coronary interventions，PCIs）已经成为血运重建的主要方法。这一飞跃是建立在大量重要的随机试验基础上的。由于Gruntzig的开创性工作，临床心脏病的治疗取得了两项重大革命。第一项是Sigwart和Puel于1986年引入了裸金属支架，继而于1987年出现了在即将闭塞或急性闭塞血管球囊成形术后植入支架的报道。     

可降解涂层与永久涂层药物洗脱支架治疗冠状动脉粥样硬化性心脏病合并糖尿病患者的近期疗效

目的比较可降解涂层药物洗脱支架与永久涂层药物洗脱支架在冠状动脉粥样硬化性心脏病（简称冠心病）合并糖尿病患者中的应用疗效。方法回顾性分析240例择期行经皮冠状动脉介入术（PCI）置入药物洗脱支架治疗冠。0病合并糖尿病患者。其中112例患者置入可降解涂层药物洗脱支架（观察组）,128例患者置入永久涂层药物洗脱支架（对照组）,术后进行随访,观察患者的疗效及临床主要不良心脏事件的发生情况。结果平均随访时间（360±65）d。观察组与对照组在总死亡、靶病变重建、靶血管重建、支架内血栓形成及主要不良心脏事件等方面比较差异均无统计学意义（P〉0．05）。结论可降解涂层药物洗脱支架用于冠心病合并糖尿病患者PCI后近期疗效与永久涂层药物洗脱支架相当,其远期效果有待进一步研究。     

药物洗脱支架治疗无保护左主干病变的疗效观察

目的评价药物洗脱支架置入术与冠脉旁路移植术对冠脉无保护左主干病变患者的近远期临床疗效。方法收集本院2008年2月～2010年2月120例冠心病患者,其中80例置入药物洗脱支架(DES组),40例进行冠脉旁路移植术(CABG组),观察两组临床疗效。结果两组患者临床特征比较差异无显著性(P>0.05),两组脑血管事件、再次血管重建、急性肾衰、急性心梗、心绞痛复发率、死亡率等方面比较差异均无显著性(P>0.05)。结论药物洗脱支架治疗无保护左主干病变有较好临床疗效,临床随访结果理想。     

药物洗脱支架治疗冠状动脉支架内再狭窄的临床观察

目的观察药物洗脱支架治疗冠脉支架内再狭窄的临床疗效。方法对入选的患者行药物洗脱支架治疗,术后观察心脏不良反应事件的发生情况。结果 44例患者中发生不良反应事件22例,其中胸痛复发19例,TVR7例,ISR处原支架的类型是影响术后疗效的重要因素,本研究认为DES术后ISR的疗效好于BMS术后ISR（P=0.002）。而患者的年龄、性别、病变血管的直径和病变部位、病变的严重程度以及DES涂层材料的不同与治疗效果无明显的相关性。结论药物洗脱支架是治疗冠状动脉支架内再狭窄的有效手段。     

药物洗脱支架治疗冠状动脉支架内再狭窄的临床观察

目的观察药物洗脱支架治疗冠脉支架内再狭窄的临床疗效。方法对入选的患者行药物洗脱支架治疗,术后观察心脏不良反应事件的发生情况。结果 44例患者中发生不良反应事件22例,其中胸痛复发19例,TVR7例,ISR处原支架的类型是影响术后疗效的重要因素,本研究认为DES术后ISR的疗效好于BMS术后ISR(P=0.002)。而患者的年龄、性别、病变血管的直径和病变部位、病变的严重程度以及DES涂层材料的不同与治疗效果无明显的相关性。结论药物洗脱支架是治疗冠状动脉支架内再狭窄的有效手段。     

药物洗脱支架治疗冠状动脉支架内再狭窄的疗效

目的探讨药物洗脱支架治疗冠状动脉支架内再狭窄(ISR)的疗效。方法33例患者经冠状动脉造影确定为ISR,对33处ISR进行植入药物洗脱支架并随访。结果随访(19.1±4.8)月,6例有心绞痛或可疑心绞痛发作的患者中,5例复查冠状动脉造影,其中1例TAXUS支架植入术后9个月发生心肌梗死,冠状动脉造影见支架内完全闭塞,其他造影者均未发现支架内再狭窄。结论药物洗脱支架治疗ISR成功率高,长期随访结果满意。     

冠状动脉斑块旋磨联合药物洗脱支架术对不同年龄段老年钙化治疗效果的对比分析

目的 探讨冠状动脉粥样硬化性心脏病(以下简称冠心病)严重钙化患者的年龄对冠状动脉旋磨联合药物洗脱支架治疗效果及其安全性的影响。方法 选取2016年1月至2017年12月连续在首都医科大学附属北京安贞医院接受冠状动脉内旋磨和药物洗脱支架植入治疗的198例冠心病患者为研究对象,分为≥65岁组116例和<65岁组82例,比较两组旋磨治疗的基线特征、并发症、1年主要不良心血管事件,包括因心肌梗死、再次血运重建及死亡。结果 ≥65岁组和<65岁组围术期合并症的发生率分别为18.9％、13.3％,差异无统计学意义 (P=0.202)。两组患者1年主要不良心血管事件比较,差异无统计学意义(P=0.320)。结论 冠状动脉内旋磨和药物洗脱支架治疗老年冠心病严重钙化的效果及安全性,不受患者的年龄影响。     

经桡动脉入路冠状动脉造影联合支架植入术治疗老年冠状动脉粥样硬化性心脏病患者的效果

目的 分析经桡动脉入路冠状动脉造影联合支架植入术治疗老年冠状动脉粥样硬化性心脏病患者的效果.方法 选取2017年8月至2019年5月确山县人民医院收治的78例老年冠状动脉粥样硬化性心脏病患者作为研究对象.依照手术方案将患者分为对照组和观察组,各39例.给予对照组患者经股动脉入路冠状动脉造影联合支架植入术治疗.给予观察组...     

Drug-eluting stent for the treatment of small coronary lesion: comparison between sirolimus- and paclitaxel-eluting stent

Background  Patients with small coronary lesions are at increased risk for repeat interventions after coronary angioplasty and stenting. The efficacy of drug-eluting stents (DES) has been demonstrated to improve the outcomes of these patients and is a focus of interest. Currently, two platforms of DES are available (sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES)). However, it has less been known that DES, SES vs PES, is superior for the treatment of small coronary lesions.
Methods  In this retrospective study, 87 consecutive patients with 151 lesions underwent implantation of coronary SES (n=68) and PES (n=83). Quantitative coronary angiography (QCA) was performed at the time of stent implantation and subsequently at 8 months post-stenting. Small vessel disease was defined as lesions in vessels with diameter 2.5 mm measured by QCA. Major adverse cardiac events (MACE) including death, thrombosis, nonfatal myocardial infarction and target lesion revascularization (TLR) were compared between the two groups.
Results  Baseline clinical characteristics and angiographic parameters were similar between the two groups. At clinical and angiographic follow-up, overall thrombosis rates were similar in both groups (0 vs 1.2%, P>0.05). The TLR and in-segment restenosis were not significantly different (19.1% vs 25.3%; 10.3% vs 10.8%, P=0.365 and P=0.913 respectively) between the two groups. The in-stent restenosis rate, however, was significantly higher in the PES group (4.4% vs 21.7%; P=0.002). Similarly, the late loss was significantly higher in the PES group ((0.140.38) mm vs (0.490.61) mm; P<0.001).
Conclusions  In this small sample-size, non-randomized study, the data indicated that implantation of SES for the treatment of patients with small coronary lesion showed more favorable results in respect of restenosis compared with PES implantation.

     

可降解涂层与永久性涂层药物洗脱支架治疗冠心病合并糖尿病患者的有效性及安全性研究

目的 比较可降解涂层与永久性涂层药物洗脱支架治疗冠心病合并糖尿病患者的远期疗效及安全性.方法 回顾性分析2008年1月至2012年12月我院确诊为冠心病合并糖尿病并行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者364例,男性261例,女性103例,145例植入可降解涂层药物洗脱支架,219例植入永久性涂层药物洗脱支架;对比术后两组患者主要不良心血管事件(main adverse cardiac events,MACE)的发生情况.结果 两组患者在临床一般基线资料、冠脉病变特征等方面均无统计学差异(P＞0.05).可降解涂层组与永久性涂层组相比,两组在心源性死亡(1.4％ vs 1.9％)、非致死性心肌梗死(0.7％ vs 0.9％)、支架内血栓(2.1％ vs2.3％)、靶血管血运重建(2.8％ vs 2.8％)方面差异均无统计学意义(P＞0.05).结论 永久性涂层药物洗脱支架和可降解涂层药物洗脱支架治疗冠心病合并糖尿病患者均有效,且两者安全性无明显差异.     

A comparison of clinical and angiographic outcomes after Excel bioabsorbable polymer versus Firebird durable polymer rapamycin-eluting stent for the treatment of coronary artery disease in a “real world” setting: six-month follow-up results

Background Several clinical trials have shown that rapamycin-eluting stents significantly reduce the risk of restenosis after percutaneous coronary intervention (PCI). The Firebird stent and the Excel stent (coated with bioabsorbable polymer) are two different types of rapamycin-eluting stents made in China, both have been recently approved for clinical use in China by State Food and Drug Administration. However, it is unclear whether there are differences in safety and efficacy between the two types of stents in daily practice. Methods In the month of June 2006, a total of 190 consecutive patients were treated exclusively with Firebird stents (n=93, Firebird group) or Excel stents (n=97, Excel group) in our center and were included in this study. The frequency of major adverse cardiac events (MACE, a composite of death, myocardial infarction or target lesion revascularization), binary restenosis, and late lumen loss and stent thrombosis during a six-month follow-up period were compared between the two groups.Results Patient and lesion characteristics were comparable between the groups. Major adverse cardiac event rates were low in hospital and at 6 months (2.1% in the Excel group and 0% in the Firebird group, P﹥0.05). The 6-month angiographic in-stent restenosis rate was 0% in both groups, with an associated late loss of (0.15 ± 0.21) mm versus (0.14 ± 0.20) mm (P=0.858) and the in-segment restenosis rate was also 0% for the Excel group and the Firebird group. There was no definite stent thrombosis identified in either group during the six-month follow-up period and only one patient in the Excel group had probable stent thrombosis in hospital. Conclusions Results from this mid-term, single-center study showed that both of the Firebird and the Excel rapamycin eluting stent had similar effects on reducing the incidence of MACE and the risk of restenosis (both in-stent and in-segment binary restenosis) after PCI in daily practice.     

Triple antiplatelet therapy for clopidogrel resistance with stent malapposition: a case report

Drug-eluting stent thrombosis has become a major safety concern after percutaneous coronary intervention （PCI） because of its close association with sudden death or ST-elevation myocardial infarction. The occurrence rate of stent thrombosis ranged from 0.6%-2.6% after selective PCI, and increased dramatically with premature cessation of antiplatelet treatment. Recent PCI guidelines generally recommend dual antiplatelet therapy with aspirin and clopidogrel for at least one year for all drug-eluting stent recipients at low risk of bleeding. However, whether dual antiplatelet therapy is sufficient for preventing late or very late stent thrombosis remains unclear. Here we reported a patient who suffered several episodes of drug-eluting stent thrombosis even on dual antiplatelet therapy.     

Comparison of the incidence of late stent thrombosis after implantation of different drug-eluting stents in the real world coronary heart disease patients: three-year follow-up results

Background Late stent thrombosis （LST） is still concerned by interventions cardiologists in daily clinical practice. This study aimed to compare the incidence of LST after implantation of different drug-eluting stents （DES） in coronary heart disease （CHD） patients in the real world.Methods From December 2001 to February 2009, a total of 11 875 consecutive CHD patients undergone DES implantation were enrolled in this single-center registery study. Patients with acute ST-segment elevation myocardial infarction, mixed DES implantation, restenosis lesions, and patients who could not take dual antiplatlet medication and those who were contraindicated for coronary interventional treatment were excluded. All patients were treated with completed dual antiplatelet medications for at least 9 months after DES deployment. The follow-up was completed by outpatient visits, letter correspondence, phone calls and coronary angiography. Definite LST was diagnosed auording to the Academic Research Consortium （ARC） definition.Results Cypher or Cypher Select stents were implanted in 4104 cases, Taxus or Taxus Liberty stents in 2271 cases and Firebird stents （Chinese rapamycin-eluting stents） in 5500 cases. One-year follow-up was completed in 9693 patients, including 3346 cases with Cypher or Cypher Select stents, 1529 cases with Taxus or Taxus Liberty stents and 4818 cases with Firebird stents. Two- and three-year follow-up results were obtained in 7133 and 4353 patients, respectively, including 2410 and 1760 cases with Cypher or Cypher Select stents, 1285 and 900 cases with Taxus or Taxus Liberty stents as well as 3438 and 1693 cases with Firebird stents. One-year follow-up results showed that the incidence of LST was 1.08% in patients with Cypher or Cypher Select stents, 1.24% in those with Taxus or Taxus Liberty stents and 0.71% in those with Firebird stents; there was no significant difference between those with Cypher or Cypher Select and Firebird stents, but there was significant difference between those with Taxus or Taxus Liberty and Firebird stents （P=0.044）. The incidence of LST at the 2- and 3-year follow-up was 1.33% and 1.70% in those with Cypher or Cypher Select stents, 1.40% and 1.70% in those with Taxus or Taxus Liberty stents, and 0.83% and 0.95% in those with Firebird stents, respectively. There were no significant differences among the three groups.Conclusions This study indicates that first-generation DES are acceptable to treat complex coronary lesions, and there is no significant difference of LST for three different DES.     

自拟活血通络方治疗冠心病PCI术后心绞痛

目的：评价自拟活血通络方治疗冠心病经皮冠状动脉介入术（ PCI）术后心绞痛的有效性及安全性。方法选择80例PCI术后心绞痛患者,采用随机数字表将研究对象分为对照组40例,给予冠心病PCI术后西医规范化抗心绞痛治疗;治疗组40例,在对照组治疗的基础上加服活血通络方水煎剂200 mL/次,2次/d,观察心绞痛发作次数及持续时间、24 h动态心电图变化、中医临床证候积分变化、短期预后及不良反应。结果2组治疗后心绞痛发作次数、持续时间均明显减少,差异有统计学意义（ P﹤0.01）;治疗组心绞痛持续时间缩短更为明显（ P﹤0.05）。2组治疗后心电图缺血发作次数、缺血总时间、缺血最长持续时间、室性早搏个数均减少（P﹤0.05）,治疗组改善更为显著（P﹤0.05）。治疗后2组中医证候积分均下降（P﹤0.05）,治疗组患者下降幅度明显大于对照组（ P﹤0.05）。治疗组短期预后优于对照组（ P﹤0.05）。结论在西医规范化抗心绞痛治疗基础上采用活血通络方治疗冠心病PCI术后心绞痛可提高临床疗效,改善短期预后。     

Rapid development of late stent malappositon and coronary aneurysm following implantation of a paclitaxel-eluting coronary stent

Late stent malapposition （LSM）, an unusual intravascular ultrasound （IVUS） finding at follow-up,has been reported to be more common alter drug-eluting stem （DES） implantation than after bare metal stent （BMS） implantation. However, there has been no clear elucidation of time course and mechanism. We reported a case who developed LSM and coronary aneurysm very early after paclitaxel-eluting stent （PES） implantation. A review of the literature reveals no previous report describing rapid development of LSM and coronary aneurysm after PES implantation.     

冠状动脉粥样硬化性心脏病患者经皮冠状动脉介入治疗术后心脏康复治疗的疗效

目的观察冠状动脉粥样硬化性心脏病(简称冠心病)患者经皮冠状动脉介入治疗(PCI)术后心脏康复治疗对患者心功能恢复和生活质量提高的临床意义。方法选择首次进行PCI的冠心病患者78例分为康复训练组(40例)和对照组(38例)。2组患者均采用常规药物治疗。康复训练组患者于PCI术后开始进行不同阶段、不同运动强度的康复训练,对照组进行普通的冠心病知识教育。2组患者均在治疗前和治疗3个月后进行6 min步行试验(6-MWT)、脑钠肽(BNP)、超声心动图检查。结果与治疗前比较,治疗后2组患者6-MWT、BNP均有改善,差异有统计学意义(P<0.05);康复训练组治疗后6-MWT、BNP改善更明显,与对照组比较,差异有统计学意义(P<0.05)。与治疗前比较,治疗后2组患者左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)均有改善,差异有统计学意义(P<0.05);康复训练组治疗后LVEDD及LVEF改善显著,与对照组比较,差异有统计学意义(P<0.05)。结论心脏康复训练对冠心病患者PCI术后心功能改善和生活质量提高有重要价值。