Long-term clinical outcomes after deferral of percutaneous coronary intervention of intermediate coronary stenoses based on coronary pressure-derived fractional flow reserve

Coronary pressure-derived fractional flow reserve (FFR) has been used to evaluate functional severity of coronary artery stenoses. The cut-off point of 0.75 was considered to be the indication for percutaneous coronary intervention (PCI). In this study, we examined the prognosis of patients in whom PCI was deferred because the lesion was not significant by FFR (≥0.75). We measured FFR of 44 patients (50 lesions with angiographically intermediate stenoses by pressure wire between 2002 and 2009. Out of 44 patients (50 lesions), functionally non-significant stenoses with FFR≥0.75 were 29 patients (33 lesions) and PCI was deferred. In the remaining 15 patients (17 lesions), FFR was <0.75 and PCI was performed. Patients were followed up for an average period of 53 months with endpoints of major adverse cardiac events (MACE; cardiac death, acute coronary syndrome, PCI, and coronary artery bypass grafting). The rate of MACE was 2/29 (6.9%) in patients with FFR≥0.75 and 2/15 (13.3%) in those with FFR<0.75, and it was not statistically different between the two groups. Since long-term clinical outcomes after deferral of PCI of intermediate coronary stenoses based on FFR were excellent (annual event rate 1.6%/year), FFR is a useful index to judge the indication of PCI and risk-stratify patients for MACE.     

65岁以上老年患者冠状动脉介入治疗单中心随访研究

目的 观察年龄＞65岁老年患者经皮冠状动脉介入(PCI)的远期疗效.方法 将2003年1月至2005年1月在上海交通大学医学院附属瑞金医院心脏科行PCI治疗并完成随访的1012例患者根据年龄分为＞65岁组(583例)和≤65岁组(429例),记录各组患者的一般资料、临床特征和冠状动脉造影及PCI情况.术后每3个月通过随访记录患者所有原因病死、中风和主要心脏不良事件.比较＞65岁组患者药物洗脱支架和普通金属支架的临床疗效.结果 与年龄≤65岁组比较,年龄＞65岁组患者女性较多、体重较轻、吸烟史少,但高血压病及慢性肾功能不全多见,而且冠状动脉病变程度严重、PCI同期行肾动脉支架术患者增多、完全血运重建率和药物洗脱支架置入比例较低.平均随访17个月,年龄＞65岁组与年龄≤65岁组比较,主要心脏不良事件(12.52%对8.62%,P＜0.05)、所有原因病死率(5.83%对1.17%,P＜0.01)和所有不良事件(15.27%对9.09%,P＜0.01)发生率均增高.年龄＞65岁组患者中,药物洗脱支架组较普通金属支架组主要心脏不良事件发生率显著减少(10.14%对16.51%,P＜0.05),但心源性病死率(3.01%对4.59%,P＞0.05)和所有原因病死率(5.48%对6.42%,P＞0.05)差异无显著性意义.结论 年龄＞65岁老年患者冠状动脉支架术后远期心脏事件和所有原因病死率显著增加;药物洗脱支架可明显降低主要心脏不良事件发生率,但不能减少心源性和非心源性死亡.     

Therapy with statins and aspirin enhances long-term outcome of percutaneous coronary intervention

Aspirin is the standard therapy applied after coronary intervention, and statins are also prescribed to prevent secondary coronary heart disease. We assessed the ability of a combination of statins and aspirin to improve the longterm prognosis of patients after percutaneous coronary intervention (PCI). We collected data from 575 consecutive patients who underwent PCI. The patients were divided into groups depending on the presence or absence of statin or aspirin therapy as follows: both statin and aspirin (Group B: n = 190; 33%); aspirin only (Group A: n = 236; 41.1%); statin only (Group S: n = 53; 9.2%S); neither drug (Group N: n = 96; 16.7%). Data were statistically assessed using the Cox proportional hazard model for multivariate analysis with adjustment of baseline convariates. Sixty-eight patients died during follow-up (11 ± 3 years). Multivariate analysis showed that compared with group N, both groups S and A were independent predictors for survival from all causes [group S: hazards ratio (HR) 0.29, 95% confidence interval (CI) 0.10–0.81, P = 0.019; group A: HR 0.31, 95% CI 0.17–0.56, P < 0.0001] and cardiovascular (CV) death (group S: HR 0.16, 95% CI 0.04–0.73, P = 0.018; group A: HR 0.12, 95% CI 0.05–0.30, P < 0.001). risk for all causes and CV death was significantly lower in Group B (HR 0.25, 95% CI 0.12–0.53, P < 0.0001 and HR 0.10, 95% CI 0.03–0.31, P < 0.0001, respectively). Therapy with statins plus aspirin improves long-term clinical outcome in patients after PCI.     

冠心病合并2型糖尿病患者冠状动脉多支病变PCI与CABG术后5年随访

目的比较冠状动脉粥样硬化性心脏病(冠心病)合并2型糖尿病冠状动脉多支病变患者经皮冠状动脉介入治疗(PCI)置入药物涂层支架(DES)与冠状动脉旁路移植术(CABG)后远期疗效。方法连续入选2002年12月至2008年12月住院期间的冠心病合并2型糖尿病患者,并成功行择期血运重建的多支冠状动脉病变患者,分为CABG组(n=270),DES组(n=285)。随访5年,从术后30 d开始到5年止结束,随访包括全因死亡、心源性死亡、非致死性卒中、非致死性心肌梗死、心绞痛复发和再次血运重建的主要不良心脑血管事件(MACE)。结果入选患者随访率100%。CABG组与DES组两组间5年全因死亡率(1.11%vs.1.40%)、心源性死亡率(0%vs.0%)、非致死性卒中发生率(2.22%vs.2.81%)无统计学差异(P0.05)。DES组非致死性心肌梗死发生率(3.15%)、心绞痛复发率(17.89%)、再次血运重建率(12.28%)均高于CABG组(分别为1.11,5.56%,0.74%),差异均有统计学意义(P0.05~0.01)。结论多支冠状动脉病变合并2型糖尿病患者CABG与PCI治疗5年生存率无明显差异,但多支冠状动脉病变合并2型糖尿病患者DES支架置入远期心绞痛复发率、再次血运重建率,非致死性心肌梗死发生率高于CABG组。     

老年糖尿病合并急性冠状动脉综合征患者介入治疗后造影剂肾病发生的危险因素分析

目的探讨非离子型造影剂对于老年糖尿病合并急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后造影剂肾病(CIN)发生的影响,筛选可能的危险因素。方法选取行PCI治疗的134例老年糖尿病合并ACS患者(年龄≥65岁),选择同期无糖尿病的145例老年PCI患者进行对比,比较两组患者的年龄、术前脑钠尿肽、射血分数、25-羟维生素D、估算的肾小球滤过率(e GFR)、血白蛋白等。应用多因素Logistic回归分析筛查可能的危险因素。结果 134例老年糖尿病PCI患者发生造影剂肾病17例,发生率为12.6%,无糖尿病的145例老年PCI患者发生造影剂肾病13例,发生率8.9%,两组之间比较差异无统计学意义(P0.05);两组之间性别、围手术期用药中ACEI/ARB比较差异有统计学意义(P0.05);糖尿病组术前BNP、纤维蛋白原、血小板体积分布宽度高于非糖尿病组,25-羟维生素D低于非糖尿病组(P0.05)。对老年糖尿病合并ACS患者PCI后发生造影剂肾病行Loistic回归分析显示,纤维蛋白原、25-羟维生素D进入回归方程,为造影剂肾病发生的危险因素,术前纤维蛋白原升高增加造影剂肾病的发病风险(OR=3.403,95%CI:1.353~6.845,P=0.007),25-羟维生素D降低使造影剂肾病发生风险显著增加(OR=0.485,95%CI:0.282~0.833,P=0.009)。结论术前纤维蛋白原升高、25-羟维生素D下降使老年糖尿病合并ACS患者PCI术后造影剂肾病发生风险增加。     

Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly

Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention (PCI). Methods This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Australian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians. Results Non-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octogenarians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin (LMWH; 1.0% vs. 5.8%; P < 0.001) and glycoprotein IIb/IIIa inhibitors (2.1% vs. 9.6%; P < 0.001) was lower, while femoral arterial access was used more commonly than in younger patients (80.9% vs. 67.6%; P < 0.001). Overall, there was a non-significant trend towards higher incidence of all bleeding events in the elderly (9.2% vs. 5.8%; P = 0.12). There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups. Conclusions In this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.     

Non-HDL cholesterol is a better target for predicting periprocedural myocardial injury following percutaneous coronary intervention in type 2 diabetes

Objective: Non-HDL cholesterol (non-HDL-C) has recently been recommended as a first target for dyslipidemia management. We previously reported that LDL cholesterol (LDL-C) and non-HDL-C levels were similarly associated with periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) in patients with coronary artery disease. Here we investigated the comparative prognostic value of non-HDL-C and LDL-C for PMI following PCI in type 2 diabetes (T2D). Methods: We prospectively enrolled 1194 consecutive T2D patients with normal preprocedural cTnI undergoing PCI. Patients were divided into the two groups: group A [glycated hemoglobin (HbA1c) < 7%, n = 567] and group B (HbA1c ≥ 7%, n = 627). PMI was evaluated by cTnI analysis within 24 h. The relationship of preprocedural non-HDL-C and LDL-C levels with peak cTnI values after PCI was examined. Results: Patients in group B, with higher preprocedural non-HDL-C levels, had higher postprocedural cTnI levels (β = 0.102, P = 0.011). In the multivariable model, a 1-SD increase in non-HDL-C produced a 30% and 33% increased risk of postprocedural cTnI >3 × upper limit of normal (ULN) and >5 × ULN in group B, respectively. However, neither LDL-C nor group A patients were affected. Furthermore, patients with non-HDL-C levels ≥130 mg/dl compared with non-HDL-C levels ≤100 mg/dl were associated with a 83.3% and 71.7% increased risk of postprocedural cTnI >3 × ULN and >5 × ULN in group B, respectively. Conclusions: In poorly-controlled diabetic patients (HbA1c ≥ 7%) undergoing PCI, non-HDL-C but not LDL-C was independently associated with and increased risk of PMI, and non-HDL-C levels ≥130 mg/dl had a worse PMI risk profile compared with non-HDL-C levels <100 mg/dl.     

糖尿病对急性心肌梗死患者直接经皮冠状动脉介入治疗后左心室重构的影响

目的：心肌梗死后左心室重构与患者的临床预后密切相关,本研究旨在探讨糖尿病对急性ST段抬高心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）后左心室重构的影响。方法单中心、前瞻性入选STEMI接受急诊PCI的患者451例,其中糖尿病患者93例,非糖尿病患者358例。比较糖尿病组与非糖尿病组患者的一般临床情况、造影和介入治疗结果、术后1周和6个月心超随访左心室重构及不良心脏事件发生率。结果与非糖尿病组比较,糖尿病组患者症状至就诊时间显著延长[（399±106）min比（321±116）min,P=0.006],多支血管病变比例增高（65.6%比51.7%,P=0.02）,但两组住院期左心功能相似。PCI后6个月心超随访发现,糖尿病组患者左心室重构比例明显高于非糖尿病患者（29.0%比17.3%,P=0.01）。糖尿病（RR 2.10,95%CI 1.31-4.79, P=0.02）、前壁心肌梗死（RR 2.13,95%CI 1.31-4.19,P=0.03）及多支血管病变（RR 2.85,95%CI 1.73-4.67,P=0.01）是STEMI患者发生左心室重构的独立预测因素。临床随访显示,糖尿病组患者因心力衰竭诊断而再次住院的比例增加（12.9%比8.1%,P=0.15）。左心室重构患者（23/89例）发生不良临床事件比例显著高于无左心室重构患者（25.8%比6.6%,P＜0.001）。结论糖尿病是急性STEMI患者急诊PCI后发生左心室重构的高危因素,因此,制定糖尿病STEMI患者的综合干预策略,可能有助于进一步改善其预后。     

The impact of diabetes mellitus and hypertension on clinical outcomes in a population of Iranian patients who underwent percutaneous coronary intervention: A retrospective cohort study

There are heterogeneous data regarding the impact of diabetes mellitus (DM) and hypertension (HTN) on clinical outcomes after percutaneous coronary intervention (PCI). This study explored the effect of history of DM (hDM) and HTN (hHTN), separately and in combination with each other, on major adverse cardiac events (MACE) in short‐, mid‐, and long‐term intervals after PCI. Between 2000 and 2017, 1799 patients who had PCI were registered. They were categorized in four different groups: hDM, hHTN, hDM + hHTN, and no hDMQuery no hHTN. Incidence of myocardial infarction, revascularization, and coronary death totally considered as MACE was sought in short‐ (<24 hours), mid‐ (24 hours up to 6 months), and long‐term (more than 6 months) intervals after PCI. Among the subjects, 176 had hDM, 648 had hHTN, 370 had hDM + hHTN, and 605 were in no hDM no hHTN group. The median follow‐up time was 66.5 months. Time‐to‐event (time to the first MACE) was not significantly different between four groups. hHTN group was older and hDM group was younger at the time of enrollment PCI. Female gender was dominant only in hDM + hHTN group. Of the total, 130 patients (7.22%) experienced MACE. There was no MACE in short term, 23.07% of the MACEs were in mid‐term, and the remaining happened in long term. However, according to the rate ratio, incidence rate of MACE in mid‐tem was significantly higher than the long term. Also, MACE occurrence was significantly higher in hDM + hHTN and hHTN groups than the no hDM no hHTN group. Our study showed that the history of HTN significantly increases post‐PCI MACE rather than the history of DM. Having history of both DM and HTN synergistically raised MACE incidence. Incidence of MACE per month was higher in mid‐term than the long‐term interval.     

替米沙坦对冠状动脉介入术后糖尿病炎症因子的影响

目的观察替米沙坦对冠状动脉介入术后急性冠状动脉综合征合并糖尿病患者血炎症因子的影响。方法急性冠状动脉综合征合并糖尿病100例，在成功接受冠状动脉介入术后，随机分为替米沙坦组和常规药物组，随访6个月，用酶联免疫吸附法测定血高敏c反应蛋白、单核细胞趋化蛋白-1水平。术后6个月重复冠状动脉造影，比较两组间的晚期管腔丢失、支架再狭窄率及术后心血管不良事件发生率。结果治疗6个月时，两组的高敏c反应蛋白和单核细胞趋化蛋白～1均降低，而替米沙坦组下降更明硅（P〈0．05）。冠状动脉造影复查86例．两组支架再狭窄率差异无统计学意义，但替米沙坦组晚期管腔丢失及术后心血管不良事件发生率小于对照组。结论替米沙坦可降低冠状动脉介入术后急性冠状动脉综合征合并糖尿病患者血浆高敏C反应蛋白和单核细胞趋化蛋白-1，并可减少其介入术后晚期管腔的丢失及心血管不良事件发生率。     

尼可地尔对经皮冠状动脉介入治疗心肌损伤的影响

目的观察经皮冠状动脉介入治疗（PCI）术前服用尼可地尔对心肌损伤的影响。方法纳入行择期PCI治疗的冠心病患者100例,随机分为尼可地尔组（n=52）和常规治疗组（n=48）。常规治疗组接受冠心病及PCI术常规药物治疗,尼可地尔组在PCI术前接受7天口服尼可地尔（5mg,tid）治疗,并在PCI术前5h加服尼可地尔5mg。比较两组患者PCI术前及术后6h、18h、24h的肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）水平的变化。结果两组患者在PCI术前cTnI和CK-MB水平无差异（P〉0.05）;PCI术后6h、18h、24h,尼可地尔组cTnI和CK-MB水平均低于常规治疗组,差异均有统计学意义（P〈0.05）。结论冠心病患者择期PCI术前使用尼可地尔,对PCI术造成的心肌损伤有一定保护作用。     

替罗非班对急性冠脉综合征伴糖尿病患者介入术后心肌灌注及心肌损伤的影响

目的探讨替罗非班对急性冠脉综合征（ACS）伴糖尿病（DM）患者冠状动脉介入（PCI）术后心肌灌注及及心肌损伤的影响。方法选择ACs合并DM患者92例,随机分为两组,对照组（n=45）应用阿司匹林、氯吡格雷、低分子肝素钙抗凝等常规治疗;替罗非班组（n=47）在常规治疗基础上加用替罗非班。观察两组患者冠脉内注药20min后梗死相关动脉（IRA）的TIMI及心肌灌注血流分级,术后8h、12h、24h的心肌肌钙蛋白T（cTnT）、超敏C反应蛋白（hs—CRP）,主要不良心血管事件及出血发生率。结果术后8h、12h、24h替罗非班组的cTnT、hs—CRP均显著低于对照组（P〈O．05或P〈0．01）。冠脉内注药后20min行冠脉造影,替罗非班组IRA的TIMI及心肌灌注血流分级均显著优于对照组（P〈0．05）。替罗非班组心血管事件发生率显著低于对照组（P〈0．05）;术后30d内两组出血并发症的发生率差异无统计学意义（P〉0．05）。结论在常规抗凝基础上合用盐酸替罗非班治疗ACS合并糖尿病患者,可明显改善心肌灌注,减少心肌损伤．减少心血管事件。     

替米沙坦对冠状动脉介入术后糖尿病炎症因子的影响

目的观察替米沙坦对冠状动脉介入术后急性冠状动脉综合征合并糖尿病患者血炎症因子的影响。方法急性冠状动脉综合征合并糖尿病100例，在成功接受冠状动脉介入术后，随机分为替米沙坦组和常规药物组，随访6个月，用酶联免疫吸附法测定血高敏c反应蛋白、单核细胞趋化蛋白-1水平。术后6个月重复冠状动脉造影，比较两组间的晚期管腔丢失、支架再狭窄率及术后心血管不良事件发生率。结果治疗6个月时，两组的高敏c反应蛋白和单核细胞趋化蛋白～1均降低，而替米沙坦组下降更明硅（P〈0．05）。冠状动脉造影复查86例．两组支架再狭窄率差异无统计学意义，但替米沙坦组晚期管腔丢失及术后心血管不良事件发生率小于对照组。结论替米沙坦可降低冠状动脉介入术后急性冠状动脉综合征合并糖尿病患者血浆高敏C反应蛋白和单核细胞趋化蛋白-1，并可减少其介入术后晚期管腔的丢失及心血管不良事件发生率。     

川芎嗪防治冠心病经皮冠状动脉介入术后再狭窄的临床研究

目的　探讨中药川芎嗪防治经皮冠状动脉介入术 (PCI)后再狭窄的作用。方法　对 16 5例首次接受 PCI治疗的冠心病 (CAD)患者随机分为服用川芎嗪组和对照组。观察两组临床症状、心功能 (NYHA)状况并复查心电图、超声心动图和检验指标 ,部分病例行冠状动脉造影复查。术后随访 6～ 12个月。结果　术前和术中两组在冠心病危险因素、病变特点和手术参数等方面无显著差异 (P>0 .0 5 )。经 6～ 12个月随访 ,川芎嗪组再狭窄发生率(4 1.6 7% )明显低于对照组 (76 .19% ) ,P<0 .0 5。两组患者均未见服药不良影响。结论　川芎嗪具有防治 PCI术后再狭窄的良好临床效果 ,本研究为我国传统中药应用于 PCI术后再狭窄开辟了一条中西医结合的道路。     

经皮冠状动脉介入治疗术后电解质变化及其临床意义

目的 分析经皮冠状动脉介入治疗（PCI）术前、术后电解质变化情况及其临床意义.方法 收集行PCI病例113例,术前及术后次日均行电解质检测;术后24 h心电监测.结果 术后血钠、氯水平无明显变化,血钾水平多有不同程度下降,术后低钾组心律失常发生率较高.结论 PCI术后常可出现低钾血症,其较易导致心律失常.     

急性冠脉综合征合并恶性肿瘤患者冠脉介入术后的预后分析

目的 探讨急性冠脉综合征(ACS)合并恶性肿瘤患者经皮冠状动脉介入(PCI)后的临床特点及其预后.方法 回顾性分析2011年2月至2018年7月于解放军总医院第一医学中心心内科住院治疗的67例急性冠脉综合征合并恶性肿瘤患者的临床资料,患者行PCI后根据其结局将其分为生存组(n=54)和死亡组(n=13),采用多因素Lo...     

An increase in HbA1c after percutaneous coronary intervention raises the risk for restenosis in patients without Type 2 diabetes mellitus

Aims The influence of dynamic changes in glycated haemoglobin (HbA_1c) on restenosis after elective percutaneous coronary intervention (PCI) in patients without diabetes has not been analysed. Therefore, the rate of restenosis was investigated after elective PCI in 101 consecutive patients without diabetes mellitus in relation to dynamic changes of HbA_1c levels. Methods Follow‐up angiography was performed in all patients 4–6 months after intervention. Results Multivariate analysis demonstrated that the change in HbA_1c between first and second coronary angiography was the most powerful metabolic parameter for prediction of restenosis. The odds ratio for restenosis was 3.0 (95% CI 1.0–9.0) for any increase in HbA_1c and 1.9 (95% CI 1.1–3.5) for an HbA_1c increase of 0.2%. Conclusions Hence, chronic changes in the glucometabolic environment influence the incidence of restenosis after PCI in patients without diabetes.     

经胸超声心动图在急诊冠状动脉介入术的应用价值

目的探讨经胸超声心动图(TTE)在急诊冠状动脉介入术(PCI)的应用及其价值。方法92例胸痛患者,临床怀疑急性心肌梗死(AMI),在行急诊冠状动脉造影(CAG)之前,采用TTE从不同切面和角度,探测观察有无节段性室壁运动异常(RWMA)及其范围。对行急诊PCI的患者,术后定期复查,观察RWMA范围的变化及改善程度。结果TTE检查提示,89例存在RWMA,经急诊CAG均证实其相关冠状动脉完全或不完全闭塞,符合率100%,且其RWMA的区域与相关冠状动脉闭塞的部位及闭塞程度也明显相关。结论TTE可作为AMI诊断的可靠指标之一,也是选择适合患者作CAG、PCI以及评价急诊PCI后治疗效果的一个重要依据。