曲美他嗪伍用复方丹参滴丸对冠心病一般内科治疗疗效影响的研究

目的 探讨曲美他嗪(TMZ)伍用复方丹参滴丸对冠心病一般内科治疗效果的影响。方法 以心绞痛缓解、心电图ST段抬高回落作为疗效评价指标，用1ogistic回归分析冠心病分型、治疗方式、有无陈旧性心梗等12个因素对临床疗效的影响，用比值比(OR)分析心绞痛缓解、心电图ST段抬高二项临床疗效评价指标的联系程度，分层比较TMZ伍用复方丹参滴丸对冠心病一般内科治疗效果的影响。结果 冠心病分型、治疗方式显著影响冠心病疗效，心绞痛缓解与ST段抬高回落二者联系强度中等，TMZ伍用复方丹参滴丸对冠心病一般内科治疗病例，可以改善心肌供血以及提高心肌细胞对缺血的耐受性。尤其是急性心肌梗死病例，这种作用更明显。结论 冠心病一般内科治疗病例，无论是稳定型心绞痛、不稳定型心绞痛或急性心肌梗死病例，临床应当推广使用TMZ伍用复方丹参滴丸30d以上。     

急性心肌梗死患者经皮冠状动脉介入治疗术后ST段回落不良的分析

目的探讨ST段抬高急性心肌梗死(AMI)患者直接PCI术后ST段回落不良的相关因素。方法173例符合ST段抬高AMI诊断并行直接PCI的患者,计算其心电图ST段回落指数,运用logistic回归分析影响ST段回落的相关因素。结果冠状动脉造影心肌呈色分级0/1(OR=2.936)、病变部位(OR=2.121)、胸痛开始到再灌注的时间(OR=1.314)、梗死前心绞痛(OR=1.053)是影响术后心电图ST段恢复的相关因素。结论AMI直接PCI术后心电图ST段恢复程度与上述因素有关。     

老年急性冠脉综合征患者介入治疗的临床分析

目的:探讨老年急性冠脉综合征(ACS)患者接受经皮冠状动脉介入治疗(PCI)的临床价值.方法:70岁以上老年ACS患者50例,对持续性胸痛伴(或)ST段抬高心肌梗死患者(AMI 2例,UA2例)行急诊PCI;对非ST段抬高ACS患者经规范内科治疗病情平稳1周后行PCI.结果:对70支罪犯血管进行PTCA术后置入81枚支架.49例患者随访8～24个月无心绞痛发作;1例术后2个月冠脉造影显示支架内再狭窄,经支架内再支架置入术后随访5个月无心绞痛发作.结论:对老年ACS患者及时进行PCI可获得良好效果,临床安全程度高.     

择期经皮冠状动脉介入治疗老年不稳定性心绞痛的临床研究

正不稳定性心绞痛(UA)是一组介于稳定性心绞痛(SA)与急性心肌梗死(AMI)间的临床综合征,属于非ST段抬高型急性冠脉综合征(NSTE-ACS)[1]。本研究采用回顾性队列研究法对比分析了择期PCI与OMT对老年UA患者的治疗效果及安全性,现报道如下:1资料与方法1.1一般资料随机选取2015年3月至2016年3月本院心内科住院UA患者134例,按照是否行PCI分     

经皮冠状动脉介入治疗中腺苷的心肌保护作用研究

目的评价经皮冠状动脉介入治疗(PCI)中冠状动脉内(IC)应用腺苷的心肌保护作用。方法对2004年12月至2006年4月在河北医科大学第一医院和石家庄市第三医院住院且符合入选条件的111例冠心病患者随机分为生理盐水IC注射组55例(对照组)与腺苷IC注射组56例(腺苷组)。对照组予以生理盐水,腺苷组用腺苷300μg,持续IC注射1min,观察IC心电图(IC-ECG)ST段最大抬高程度、术后心脏肌钙蛋白I(cTnI)峰值及左心室射血分数(LVEF)。急性心肌梗死(AMI)患者按心肌梗死溶栓试验血流分级对梗死相关动脉进行再通后血流评价,并分析术后1h心电图ST段抬高总和回落百分比(sumSTR)。结果腺苷组患者术后cTnI峰值低于对照组(P<0.05)。AMI时sumSTR腺苷组下降幅度较对照组明显(P<0.05);PCI后4周无论腺苷组还是对照组LVEF均比3d时有明显改善(P<0.05),4周时腺苷组LVEF较对照组改善更显著(P<0.05)。择期PCI患者腺苷组与对照组IC-ECG的ST段抬高发生率及抬高的程度低于对照组。结论PCI时IC注射腺苷,可以减轻心肌微损伤,显著缓解AMI血管开通背景下发生的缺血-再灌注损伤,并有益于改善左心功能。     

心肌缺血预适应对急性心肌梗死心电图ST段形态的影响

目的　探讨心肌缺血预适应 (IP)对急性心肌梗死 (AMI)心电图ST段形态的影响及其可能的机制。方法　 10 3例初发AMI患者按入院时心电图AMI相关导联ST段抬高的形态分为 2组 ,凹面向上抬高组 (A组 =4 6 )与凸面向上抬高组 (B组 =5 7) ,根据AMI发生前 2 4h至少出现 1次典型心绞痛的症状为标准 ,比较A组与B组各占的频率。结果　A组梗死前 2 4h内出现心绞痛 34例 ,占 73 91% ;B组为 14例 ,占 2 4 5 6 %。梗死前无心绞痛A组 12例 ,占 2 6 0 9% ;B组 4 3例 ,占 75 4 4 %。 2组比较差异有显著性 (P <0 0 1)。结论　心肌缺血预适应是AMIST段凹面向上抬高的机制之一 ,根据心电图ST段凹面抬高的AMI推断其梗死前存在缺血预适应 ,以及由于缺血预适应产生的心肌保护作用对临床有重要意义。     

急性心肌梗死墓碑形ST段抬高的临床意义

目的探讨急性心肌梗死（acute myocardial infarction，AMI）墓碑形ST段抬高的临床意义。方法将86例AMI患者以ST段抬高的特征分为两组，墓碑形抬高组36例、其他形抬高组50例。观察两组的一般临床资料（年龄、有否合并糖尿病），并比较两组AMI的发生部位、PCI前心梗后心绞痛、并发症及死亡的发生率、首次CK值、各项心电指标及PCI后心肌缺血再灌注损伤的发生率。结果两组各项临床指标及心电图指标差异均有统计学意义；墓碑形ST段抬高组PCI后心肌缺血再灌注损伤的发生率亦明显高于其他形ST段抬高组。结论墓碑形ST段抬高患者梗死部位特殊而广泛、并发症多、死亡率高、易出现心肌缺血再灌注损伤，对此类患者应高度重视并积极预防心肌缺血再灌注损伤的发生。     

曲美他嗪和复方丹参滴丸在经皮腔内冠状动脉成形术中的心肌保护作用

经皮腔内冠状动脉成形术 ( PTCA)已广泛应用于评价药物抗缺血、保护心肌的作用。曲美他嗪( TMZ)是治疗冠心病的新一种代谢性药物 ,有良好的抗心肌缺血作用 〔1〕。复方丹参滴丸具有活血化淤 ,理气止痛的功效 ,临床用于心绞痛的治疗。但PTCA前口服 TMZ和复方丹参滴丸 ,在冠状动脉(冠脉 )血流阻断时对心肌细胞急性缺血的作用未见报道。我们在 PTCA时连续记录冠脉内心电图( ICECG)变化 ,以评价球囊扩张时对心肌细胞的损伤及 TMZ和复方丹参滴丸的作用。1　对象与方法1 .1 　 对象1 999年 8月～ 2 0 0 0年 1 2月在 PTCA中记录ICECG…     

老年急性心肌梗死墓碑形ST段抬高的临床意义

目的 探讨老年人急性心肌梗死(acute myocardial infarction,AMI)墓碑形ST段抬高的临床意义. 方法 收治AMI患者468例,依据心电图ST段抬高特征,其中有墓碑形42例,根据年龄分墓碑形老年组30例,墓碑形非老年组12例,另随机选择其他形态ST段抬高50例为对照组进行多项指标分析. 结果 墓碑形老年组100%合并有基础疾病,经皮冠脉介入治疗(PCI)前心梗后心绞痛、并发症及死亡的发生率、心电图ST段抬高及出现病理性Q波的导联数、振幅明显高于墓碑形非老年组;而墓碑形组的以上各项临床及心电图指标亦明显高于其他形态组;且PCI后心肌缺血再灌注损伤的发生率亦是墓碑形老年组明显高于非老年组. 结论 墓碑形ST段抬高是AMI近期预后险恶的独立指标,尤以老年墓碑形ST段抬高者为甚,提示对此类患者应高度重视并积极预防心肌缺血再灌注损伤的发生.     

冠心病患者PCI后合并抑郁状态的调查研究

目的探讨冠状动脉粥样硬化性心脏病(冠心病,CHD)经皮冠状动脉介入治疗(PCI)后患者抑郁状态的发生率及相关影响因素。方法选取2017年7月至2017年12月于西安交通大学第一附属医院心血管内科接受PCI的438例冠心病患者为研究对象,完成基本人口社会学信息调查及疾病相关状况调查,收集相关资料并由患者本人完成中文版PHQ-9抑郁自评量表以评估患者心理状态。结果 119例(27.2%)患者存在不同程度的抑郁问题(轻度20.5%,中度5.9%,重度0.7%),其中女性患者抑郁发生率明显高于男性(35.5%vs. 24.4%,P=0.019);CHD诊断分型中的不稳定型心绞痛(UAP)患者较ST段抬高型心肌梗死(STEMI)患者及非ST段抬高型心肌梗死(NSTEMI)患者抑郁发生率高(31.0%vs. 17.1%vs. 12.1%,P=0.006);合并短暂性脑缺血发作(TIA)/脑卒中患者较非脑卒中患者抑郁发生率高(39.6%vs. 25.6%,P=0.040)。术后1月抑郁状态有明显改善,术后6月抑郁状态较1个月随访时加重;急性心肌梗死(AMI)患者术后抑郁状态的改善明显低于UAP患者(9.2%vs. 21.3%,P=0.015)。结论冠心病行PCI患者抑郁状态发生与性别、疾病状况有关。术后1月抑郁状态可改善,但随病程延长,抑郁状态又呈恶化趋势。CHD诊断分型中AMI患者术后抑郁状态改善较差,应关注术后远期心理状况。     

内脏脂肪素与冠心病的相关性及PCI术后变化

目的探讨内脏脂肪素与冠心病的相关性及 PCI 术后变化的意义。方法:90 例冠心病患者分为急性心肌梗死组 30 例、不稳定心绞痛组 30 例、稳定心绞痛组 30 例,均行冠脉造影确诊,其中 52 例患者行 PCI术。另选正常对照组 30 例 . 用酶联免疫法检测各组及PCI 术后血浆内脏脂肪素(visfatin)水平,于生化室检测肝功、肾功、血糖、血脂、高敏 C 反应蛋白(hs-CRP), 对行 PCI 术患者记录病变支数,植入支架个数及长度,最大球囊扩张压力,术后 TIMI 血流分级。结果:冠心病组 visfatin 和 hs-CRP 高于对照组,且 AMI 组和UAP 组较 SAP 组升高更明显,各组间有显著性差异(p<0.05), 冠心病组 visfatin 与 hs-CRP 水平的独立相关 (p<0.001), PCI 术后 visfatin 水平高于术前(p<0.01),且与最长支架长度和植入支架个数相关(p<0.05)。结论:血浆 visfatin 的水平反应斑块的不稳定程度,其参与冠脉硬化发生发展的过程,另外 PCI 术后 visfatin 较术前升高,可能参与术后再狭窄。     

112例不稳定型心绞痛患者介入治疗的临床评价

目的 探讨不稳定型心绞痛患者介入治疗的安全性及临床效果。方法 不稳定型心绞痛112例．反复发作时即行冠状动脉造影,明确病变后对“罪犯”血管行经皮冠状动脉介入治疗,术后残余狭窄小于10％,前向血流按心肌梗死溶栓治疗临床实验（thrombolysisinmyocardialinfarction,TIMI）血流分级3级为手术成功;随访6月,分析即时及远期效果。结果 手术成功率100％,所有病例均随访6月,其中,17例（15％）患者在经皮冠状动脉介入术后3-6个月再发心绞痛,发作时心电图或平板负荷试验提示心肌缺血,此17例均再次冠状动脉造影提示“罪犯”血管支架内再狭窄,再次行经皮冠状动脉介入术。其余病例术后6个月内未再发心绞痛。随访期间无1例再发心肌梗死或死亡。结论 早期介入治疗不稳定型心绞痛患者是有效的治疗方法,手术成功率及安全性高,近期和远期临床效果满意。     

钙化积分对冠状动脉介入治疗的稳定性冠心病患者的预测价值

目的探讨冠状动脉钙化积分（CCS）对稳定性冠心病患者经皮冠状动脉介入治疗（PCI）后近、远期预后的预测价值。方法 109例稳定性心绞痛患者在首次PCI治疗前均接受冠状动脉CT检查,计算CCS;对患者进行长期随访,记录有无死亡、非致死性心肌梗死、靶病变血运重建以及再发心绞痛入院等主要心脏事件（MACE）发生。结果 CCS与患者年龄呈正相关（r=0.42,P=0.000）,男性患者和糖尿病患者中CCS明显高于女性患者（590.8±764.5比352.8±336.3,t=2.25,P=0.026）和非糖尿病患者（693.3±912.4比413.0±464.1,t=2.11,P=0.037）。平均随访15个月（3～40个月）,Kaplan-Meier生存分析发现CCS≤300,CCS301～1000和CCS〉1000的患者累积无事件生存率差异有统计学意义（88.2%比81.6%比62.5%,Logrank7.49,P=0.024）。校正了年龄、性别、体重指数、糖尿病、高脂血症、多支病变、是否完全血运重建及PCI并发症后,多因素Cox回归分析显示CCS〉1000的患者发生MACE的风险较CCS≤300的患者增加3.44倍（HR=3.44,P=0.043）。结论 CCS是预测稳定性冠心病患者PCI治疗后发生主要心脏事件的独立危险因子,对慢性稳定性冠心病患者的预后评价具有重要意义。     

The Anti-Ischemic and Anti-Anginal Properties of Statins

Angina pectoris resulting from myocardial ischemia afflicts half of all patients with coronary heart disease (CHD). Chronic angina remains a major public health burden despite state-of-the-art therapies, and improvement in survival from myocardial infarction and CHD has only increased its prevalence. There is growing experimental and clinical evidence pointing to the anti-ischemic and anti-anginal properties of statins. Some data suggest that the degree of anti-ischemic efficacy of statins may be comparable to the current standard pharmacologic and mechanical strategies. The pleiotropic effects of statins are postulated to be primarily responsible for their anti-ischemic and anti-anginal properties. These include improvement of endothelial function, enhancement of the ischemic vasodilatory response, modulation of inflammation, and protection from ischemia-reperfusion injury. The anti-ischemic effects of statins further strengthen their role as a crucial component of the optimal medical therapy for CHD.     

Comparison of silent and symptomatic ischemia during exercise testing in men

OBJECTIVE: To compare angina and ST-segment depression during exercise testing, as markers for coronary artery disease. DESIGN: Retrospective analysis of exercise test responses and cardiac catheterization results. SETTING: A U.S. Veterans Affairs medical center. PATIENTS: Four hundred and sixteen men who were referred for the evaluation of symptoms, postmyocardial infarction testing, or both. Two hundred patients had no clinical or electrocardiographic evidence of previous myocardial infarction, whereas 216 were survivors of a previous myocardial infarction. INTERVENTIONS: All patients did a standard exercise test and had diagnostic coronary angiography with ventriculography within an average of 32 days (range, 0 to 90 days) of their exercise test. RESULTS: Two hundred patients without a previous myocardial infarction were divided into four groups: the no ischemia group had 80 patients; the angina pectoris only group had 23 patients; the silent ischemia group had 40 patients; and the ST-segment depression and angina pectoris group had 57 patients. In patients without a previous myocardial infarction, exercise-induced ST-segment depression was a better marker than exercise-induced angina for the presence of any coronary artery disease (P less than 0.005). Patients with symptomatic exercise-induced ischemia had a higher prevalence of severe coronary artery disease than did those with only silent ischemia (30% compared with 20%; 95% CI, - 7.3% to 27.0%; P = 0.005). For the 216 survivors of a myocardial infarction, divided into the same four groups, ST-segment depression again was a better marker for the presence of severe coronary artery disease compared with angina alone (P = 0.08). The prevalence rates of severe coronary artery disease in the no ischemia plus myocardial infarction group, the angina pectoris only plus myocardial infarction group, the silent ischemia plus myocardial infarction group, and the ST-segment depression and angina pectoris plus myocardial infarction group were 10%, 9%, 23%, and 32%, respectively (P less than 0.01). CONCLUSIONS: Exercise-induced ST-segment depression is a better marker for coronary artery disease than is exercise-induced angina. Symptomatic ischemia during the exercise test is a better marker for severe coronary artery disease than is silent ischemia.     

The truth and consequences of the COURAGE trial

Percutaneous coronary intervention (PCI) has played an integral role in the therapeutic management strategies for patients who present with either acute coronary syndromes or stable angina pectoris. The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial enrolled patients with chronic stable angina and at least 1 significant (> or =70%) angiographic coronary stenosis who were randomly assigned to an initial treatment of either PCI in conjunction with optimal medical therapy or optimal medical therapy alone. Although the initial management strategy of PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events, improvement in angina-free status and a reduction in the requirement for subsequent revascularization was observed. An in-depth analysis of the COURAGE trial design and execution is provided.     

90例选择性冠状动脉造影分析

目的：探讨选择性冠状动脉造影在冠心病诊断及治疗中的价值。方法：对心肌梗塞、典型心绞痛、不典型心绞痛患者共90例进行选择性冠状动脉造影，并对结果进行分析。结果：冠脉造影阳性率：心肌梗塞组占100％，典型心绞痛组占79．2％，不典型心绞痛组占37．5％。心肌梗塞组及典型心绞痛组与不典型心绞痛组比较，冠脉造影阳性率差异非常显著（P〈0．01），心肌梗塞组与典型心绞痛组比较阳性率无显著差异（P〉0．05）。结论：冠状动脉造影不仅是诊断冠心病的“金标准”，而且有益于冠心病的分型和指导治疗。     

The truth and consequences of the COURAGE trial.

Percutaneous coronary intervention (PCI) has played an integral role in the therapeutic management strategies for patients who present with either acute coronary syndromes or stable angina pectoris. The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial enrolled patients with chronic stable angina and at least 1 significant (> or =70%) angiographic coronary stenosis who were randomly assigned to an initial treatment of either PCI in conjunction with optimal medical therapy or optimal medical therapy alone. Although the initial management strategy of PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events, improvement in angina-free status and a reduction in the requirement for subsequent revascularization was observed. An in-depth analysis of the COURAGE trial design and execution is provided.     

Preprocedural statin therapy reduces the risk and extent of cardiac biomarker release following percutaneous coronary intervention

This study evaluates the association between statin therapy in patients treated by percutaneous coronary intervention (PCI) for stable angina pectoris and postinterventional myocardial injury with subsequent long-term clinical outcome. Prospectively collected data on 400 consecutive patients with stable angina pectoris or evidence of inducible myocardial ischemia were analyzed. The incidence of myocardial infarction based on postinterventional release of troponin I >1.5 ng/ml was 12% in the statin pretreated patients and 20% in those not pretreated with statin therapy (P = 0.04, odds ratio 1.84, 95% confidence interval 1.06–3.21). Of the patients experiencing a post-PCI troponin elevation >1.5 ng/ml, those pretreated with a statin pre-PCI had a lesser troponin elevation compared with those not receiving a statin pre-PCI (median: 2.9 ng/ml [1.9–11.5] vs 5.0 ng/ml [3.1–8.8]; P < 0.001). In the multivariate model, preprocedural statin therapy was identified as the only independent negative predictor of procedure-related myocardial necrosis based on postprocedural troponin elevation. In the 21-month follow-up period, statin pretreated patients were observed to have fewer deaths, revascularizations, or myocardial infarction; however, this difference was not statistically significant. These results suggest that pretreatment with statins in patients undergoing PCI for stable angina pectoris reduces the risk and extent of procedure-related myocardial injury measured by troponin release.     

Percutaneous coronary intervention versus medical therapy for coronary heart disease

Medical therapy reduces myocardial infarction and death in patients with stable coronary heart disease (CHD). In contrast, there is little evidence available to evaluate the impact of percutaneous coronary intervention (PCI) on hard endpoints in such patients. Four randomized, controlled trials have compared PCI with medical therapy. These studies have demonstrated that PCI results in an improvement in angina and exercise tolerance compared with medical therapy, but they also suggest that medical therapy may be preferable to PCI with respect to the risk of cardiac events. Interpretation of these studies has been limited by small sample size, exclusion of high-risk subjects, no or reduced use of stents, lack of a cost-effectiveness evaluation, and absence of risk factor intervention (except for Atorvastatin versus Revascularization Treatment [AVERT], which used aggressive low-density lipoprotein lowering with atorvastatin in the medical group only). The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial will permit better definition of the role of PCI in the treatment of stable or recently stabilized patients with CHD.