非ST段抬高急性冠脉综合征的早期介入干预

急性冠脉综合征（ACS）是导致冠心病患者死亡的主要原因。ACS包括ST段抬高、非ST段抬高的心肌梗死（NSTE-MI）和不稳定型心绞痛（UA）。ACS可分为ST段抬高的ACN（STE-ACS），即ST段抬高的急性心梗（STEMI）和非ST段抬高的ACS（NSTE-ACS），后者包括不稳定性心绞痛和非ST段抬高的急性心梗（NSTEMI）。其共同病理生理是冠状动脉在粥样硬化病变基础上，发生了斑块破裂形成血栓。产生了急性狭窄或闭塞所致。近20年来，随着ST段抬高心肌梗死治疗手段的成熟与推广，以及非ST段抬高的ACS比例的不断升高，非ST段抬高ACS已成为心血管疾病研究的热点和难点。     

非ST段抬高急性冠脉综合征治疗进展

急性冠脉综合征(acute coronary syndrome，ACS)包括：不稳定心绞痛(unstable angina，UA)、非ST段抬高心肌梗死(non—ST segment elevation myocardial infarction，NSTEMI)、ST段抬高心肌梗死(ST segment elevation myocardial infarction，STEMI)、心源性猝死。ACS的现代分类：目前主要是根据心电图ST段是否抬高而将其分成ST段抬高的ACS和非ST段抬高ACS，前者绝大多数为STEMI，后者包括UA和NSTEMI。     

血府逐瘀汤治疗非ST段抬高的急性冠脉综合征42例临床研究

急性冠脉综合征（ACS）包括不稳定型心绞痛（UAP）、非ST段抬高型心肌梗死（NSTEMI）、ST段抬高型心肌梗死（STEMI），前两者也称为非ST段抬高的急性冠脉综合征（NSTE—ACS）。目前主要根据心电图ST段是否抬高，将ACS分成ST段抬高的ACS和非ST段抬高的ACS。ACS发病的病理基础是冠状动脉内血栓形成，其中血小板活化是血栓形成的关键和始动因素，而炎症反应与血小板活化、血栓形成关系密切。     

低分子肝素在急性冠状动脉综合征中的合理应用

急性冠状动脉综合征（ACS）是以冠状动脉粥样硬化斑块破裂或糜烂，继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征。根据心电图表现分为非ST段抬高型ACS（包括不稳定心绞痛和非ST段抬高心梗）和ST段抬高型ACS（指ST段抬高心梗）。针对ACS有药物和非药物等多种治疗措施，其中，应用低分子肝素（LMWH）抑制凝血酶，预防血栓形成是积极有效的措施之一。     

急性冠脉综合征的干预策略

1　概念急性冠脉综合征[1 ] (ACS)是从不稳定型心绞痛 (UA)到Q波心肌梗死 (QMI)的一组病症 ,在诊断和病理生理上是一连续体。它包括UA、非Q波心肌梗死 (NQMI)、QMI及缺血性心脏猝死。1.1　目前根据临床干预的效果及策略将ACS分为ST段抬高的ACS和ST段不抬高的ACS。ST段不抬高的ACS包括UA和NQMI ,所谓ST段不抬高包括ST段压低和不压低。其中有人统计NQMI有 5 0 %左右ST段不压低[2 ] ,所以在诊断时应予以注意。难以区分非ST段抬高病人是属UA还是NQMI主要靠心肌损伤标记物CK -MB(>正常值上限两倍 )、CTnT ,CTnI只要…     

冠心病药物治疗研究进展

冠心病主要包括稳定型心绞痛、不稳定型心绞痛、非ST段抬高型心肌梗死和ST段抬高型心肌梗死.UAP、NSTEMI、STEMI统称为急性冠脉综合征(ACS).ACS又分为ST段抬高型急性冠脉综合征(STEACS) 和非ST 段抬高型急性冠脉综合征(NSTEACS).     

急性冠状动脉综合征与炎症标志物的研究进展

急性冠脉综合征(acute coronary syndromes，ACS)是一组冠状动脉粥样硬化斑块破裂、血栓形成或血管痉挛而致急性或亚急性心肌缺血的临床综合征，包括ST段抬高的ACS(ST段抬高的心肌梗死)和无ST段抬高的ACS(不稳定性心绞痛和无ST段抬高的心肌梗死)。炎症和氧化应激是的重要发病机制。     

急性冠状动脉综合征的调脂治疗

急性冠状动脉综合征(ACS)包括不稳定心绞痛(UA)、非Q波急性心肌梗死(AMI)和Q波AMI。动脉粥样硬化(AS)是发生ACS的基本原因,冠状动脉粥样硬化斑块突然破裂,诱发冠状动脉急性血栓形成是ACS发生的主要机制。近年来许多学者根据心电图是否有ST段的抬高将ACS分为ST段抬高的ACS与无ST段抬高的ACS,认为ST段抬     

急性冠状动脉综合征的综合诊治

急性冠脉综合征包括不稳定性心绞痛(UA)、非Q波心肌梗塞(NQMI)、Q波心肌梗塞及缺血性心脏猝死。根据心电图有无ST段抬高而将急性冠脉综合征(ACS)分成ST段抬高的ACS及非ST段抬高的ACS，后者包括UA及非Q波心肌梗塞，合成为不稳定性冠状动脉疾病(UCAD)。     

低分子量肝素治疗急性冠状动脉综合征86例分析

急性冠状动脉综合征(ACS)包括不稳定型心绞痛(UA)、非Q波心肌梗死(NQMI)、Q波心肌梗死(QMI)及缺血性心脏猝死.根据心电图有无ST段抬高而将ACS分成ST段抬高的ACS及非ST段抬高的ACS,后者包括UA及绝大部分NQMI,两者合称为不稳定性冠状动脉病(UCAD).ACS治疗上主张对患者进行"预治疗"应积极抗血小板、抗凝、抗缺血治疗或血运重建,本文旨在观察加用低分子量肝素对ACS的临床疗效.     

Soluble CD40 ligand is associated with angiographic severity of coronary artery disease in patients with acute coronary syndrome

Background Recently,studies have disclosed soluble CD40 ligand （sCD40L） during atherosclerosis development and plaque destabilization.The objective of the present study was to test the hypothesis that sCD40L levels are higher in acute coronary syndrome （ACS） patients with a greater extent of angiographic coronary involvement.Methods This cross-sectional study examined ACS patients who underwent coronary angiography by measuring their sCD40L levels.In order to estimate the serum levels of sCD40L,10 ml of peripheral venous blood was drawn within 24 hours of admission.sCD40L levels were measured using an enzyme-linked immunosorbent assay （ELISA,RapidBio,West Hills,CA,USA）.Demographic data,presence of concomitant diseases,ACS characteristics,and angiographic findings were evaluated.A review of medical records and patient interviews were conducted to assess coronary risk factors.And the severity of coronary artery disease was evaluated using the Gensini score index.Results Two hundred and eighty-nine patients were included in the study,of whom 186 were male,with an average age of 64.1±10.0 years.Median sCD40L levels were 1.7 ng/ml （0.3-7.3 ng/ml） and Gensini scores were 50 （0-228）.After adjusting for demographic variables and cardiovascular risk factors,the Gensini score was associated with the natural logarithm of the sCD40L level （Coefficient b=0.002,95％ CI 0.000-0.003,P=0.029）.Conclusion sCD40L levels were independently associated with angiographic severity of coronary artery disease in patients with ACS.     

Coronary artery anomalies: the left main coronary artery or left anterior descending coronary artery originating from the proximal of right coronary artery

Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1.3% based published series.1＇2 The most common coronary anomaly is separate origin of the left anterior descending coronary artery （LAD） and left circumflex coronary artery （LCX） from the left sinus of the Valsalva. The second most common anomaly is the origin of the LCX artery from the right coronary artery （RCA） or right sinus of the Valsalva. We present two cases of coronary artery anomalies： one is the left main coronary artery （LMCA） arising from the proximal RCA, the other is the LAD originating from the proximal RCA.     

Platelet-Leukocyte Interaction and Thrombosis

Cerebrocardiac thrombotic disease such as acute myocardial infarction and acute ischemic stroke cause significant morbidity and mortality. Present therapies for these diseases besides anttcoagulation and fibrinolysis mainly aim toward limiting platelet adhesion and aggregation processes. However, their incomplete effectiveness suggests that other mechanisms may be important. Although the underlying cellular and molecular mechanisms of pathogenesis are complex, an early event in vessel injury is the adhesion of platelets and leukocytes to the damaged arterial wall. Recent studies havedemonstrated that the patients with acute coronary syndrome and ischemic stroke have not only increased interaction between platelets（ homotypic aggregates） but also increased interaction between platelets and leukocytes（heterotypic aggregates） detectable in circulating blood, and that the heterotypic aggregation contribute significantly to these disease progression.     

Coronary heart disease: incidence, risk factors and interventions in Jiaozhou of Shandong province

Background Coronary heart disease （CHD） is the most common type of heart disease and cause of heart attacks.This study investigated the epidemiological characteristics of CHD and its risk factors in Jiaozhou,Shandong province,to ultimately find a way of reducing the prevalence of cardiovascular disease,and to provide a theoretical basis for establishing a cardiovascular disease management path under the regional medical collaborative mechanism.Methods A questionnaire survey was performed including 1 952 people aged 35 years or older who were questioned by means of stratified,cluster,proportional sampling to investigate the prevalence of CHD and its risk factors.The data were inputted into SPSS11.0 statistical software for processing and analysis.We advised the local medical institutions to establish health files for the residents with CHD and risk factors.They were followed up regularly.Their risk factors and life-style were monitored,and advice was given as to proper medications.Green channels were established,and the patients were transmitted in a timely manner to superior hospitals for better treatment if the necessary treatments were not available in the local hospitals.The control of risk factors was observed after the follow-up for half a year.Results In Jiaozhou,the rates of coronary artery disease,hypertension,diabetes,hyperlipidemia and overweight were 8.15％,28.54％,11.43％,35.46％,and 18.70％ respectively.The rates of hypertension,diabetes,hyperlipidemia and overweight were higher than the data published in ＂The report of Chinese cardiovascular disease 2012＂; which are 24％,9.7％,18.6％,and 9.7％,respectively.The control of risk factors improved significantly after the guidance of the residents lifestyle and medication for six months.Conclusions The high prevalence of coronary artery disease in Jiaozhou is closely related to age,gender,diet structure,family history of cardiovascular disease,hypertension,diabetes,hyperlipidemia,overweight,and unhealthy lifestyle.Under the regional medic     

Two congenital coronary abnormalities affecting heart function: anomalous origin of the left coronary artery from the pulmonary artery and congenital left main coronary artery atresia

Background The anomalous origin of the left coronary artery （LCA） from the pulmonary artery （ALCAPA） and congenital left main coronary artery atresia （CLMCA-A） are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients （13 males and 10 females,aged ranging from 2.5 months to 65 years） identified with ALCAPA were classified into infantile type （age of onset younger than 12 months,16 cases） and adult type （age of onset older than 12 months,7 cases）.Four patients were diagnosed with CLMCA-A （three males and one female,aged ranging from 3 months to 2 years）.The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination：Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography：pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in adult type.In ech     

Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

Background Outcomes in patients requiring coronary artery bypass graft （CABG） surgery have been improved with devices such as the intra-aortic balloon pump （IABP）.Good coronary collateral circulation （CCC） has been shown to reduce mortality in patients with coronary artery disease （CAD）.We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group （14 （50％） vs.4 （13％）,P=0.013）.Preoperative hemoglobin level （OR：0.752; 95％ CI,0.571-0.991,P=0.043）,chronic obstructive pulmonary disease （OR：6.731; 95％ CI,1.159-39.085,P=0.034） and poor CCC grade （OR：5.750; 95％ CI,1.575-20.986,P=0.008） were associated with post-CABG in-hospital mortality.Poor CCC grade （OR：4.853; 95％ CI,1.124-20.952,P=0.034） and preoperative hemoglobin level （OR：0.624; 95％ CI,0.476-0.954,P=0.026） were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.     

Correlation between low tube voltage in dual source CT coronary artery imaging with image quality and radiation dose

The influence of low tube voltage in dual source CT（DSCT） coronary artery imaging on image quality and radiation dose and its application value in clinical practice were investigated. Totally, 300 cases of chest pain with low body mass index（BMI 〈18.5 kg/m2） subjected to DSCT coronary artery imaging were prospectively enrolled. The heart rate in all patients were greater than 65/min. The retrospective ECG gated scanning mode and simple random sampling method were used to assign the patients into groups A, B and C（n=100 each）. The patients in groups A, B and C experienced 120-, 100-, and 80-kV tube voltage imaging respectively, and the image quality was evaluated. The CT volume dose index（CTDIvol） and dose length product（DLP） were recorded, and the effective dose（ED） was calculated in each group. The image quality scores and radiation doses in groups were compared, and the influence of tube voltage on image quality and radiation dose was analyzed. The results showed that the excellent rate of image quality in groups A, B and C was 95.69%, 94.72% and 96.33% respectively with the difference being not statistically significant among the three groups（P〉0.05）. The CTDIvol values in groups A, B and C were 51.35±12.21, 21.28±7.13 and 6.34±3.34 mGy, respectively, with the difference being statistically significant（P〈0.05）. The ED values in groups A, B and C were 9.27±1.63, 4.56±2.29 and 2.29±1.69 mSv, respectively, with the difference being statistically significant（P〈0.05）. It was suggested that for the patients with low BMI, the application of DSCT coronary artery imaging with low tube voltage can obtain satisfactory image quality, and simultaneously, significantly reduce the radiation dose.     

ONTARGET系列研究带来对阻断RAS治疗策略的进一步思考

1同一个研究，不同的解释 继HOPE研究之后，2008年3月发表的ONTARGET研究（Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial）再次证明了血管紧张素转换酶抑制剂（angiotensin converting enzyme inhibitors，ACEI）雷米普利是抗动脉粥样硬化的标准对照药。进一步丰富了ACEI的临床试验证据。     

Inflammatory response, drug-eluting stent and restenosis

Cardiovascular diseases are the major cause of mortality in the Western world and it is expected that this will rem-ain so during the foreseeable future. 1 Among them, coronary artery disease （CAD） is the most important underlying cause of death due to cardiovascular disease.^2 Current treatment of pattents with CAD includes mainly risk factor management, drug therapy and revascularization techniques.     

Wire trapping technique combined with retrograde approach for recanalization of chronic total occlusion

Coronary chronic total occlusion （CTO）, defined as a ,total occlusion of duration 〉3 months, remains a technical challenge for the interventional cardiologists. The major limitation in percutaneous coronary intervention （PCI） of CTO is the inability to penetrate and cross the occlusion with a guidewire. It was reported that the immediate angiographic success rate varied from 50% to 70% using the standard antegrade techniques.1 To improve this suboptimal success rate, the authors firstly introduced retrograde approach through the collateral channels as a novel technique and successfully recanalized a left main CTO using this technique when demonstrating the live cases in Transcatheter Cardiovascular Therapeutics （TCT） 2005. Recently, modified techniques based on the retrograde approach have demonstrated that this approach could provide a high success rate with PCI.3-5 In the present report, we described a new method, wire trapping technique combined with retrograde approach, which was applied successfully in three patients with CTO.