急性ST段抬高心肌梗死患者行急诊冠状动脉介入治疗术中无复流影响因素分析

目的 探讨急性ST段抬高心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者行急诊冠状动脉介入术（percutaneous coronary intervention,PCI）中发生无复流的影响因素。方法 将2012年6月至2013年1月本院收治的行急诊PCI治疗的急性STEMI患者（n=92）,分为正常复流组（n=73）和无复流组（n=19）。通过比较两组的临床症状来分析无复流发生的相关影响因素。结果 急性STEMI患者行急诊PCI后无复流发生率为20.7%（19/92）,无复流组与正常复流组相比,两组之间入院时的收缩压（SBP）、2型糖尿病患病数、肌钙蛋白T峰值、发病到再灌注时间、球囊扩张次数和靶血管植入支架数量差异均有统计学意义（P<0.05）;经多因素logistic 回归分析显示入院SBP<100 mmHg （1 mmHg=0.133 kPa）、合并2型糖尿病、球囊扩张次数、肌钙蛋白T峰值、右冠状动脉病变和发病至再灌注时间是急诊PCI术后无复流发生的危险因素。结论 急性STEMI患者行急诊PCI后无复流发生与入院SBP<100 mmHg、合并2型糖尿病、球囊扩张次数、肌钙蛋白T峰值、右冠状动脉病变及发病至再灌注时间这6种临床因素具有相关性。     

Clinical relevance of angiographic coronary collaterals during primary coronary intervention for acute ST-elevation myocardial infarction

Background Collaterals to occluded infarct-related coronary arteries （IRA） have been observed after the onset of acute ST-elevation myocardial infarction （STEMI）.We sought to investigate the impact of early coronary collateralization,as evidenced by angiography,on myocardial reperfusion and outcomes after primary percutaneous coronary intervention （PCI）.Methods Acute procedural results,ST-segment resolution （STR）,enzymatic infarct size,echocardiographic left ventricular function,and major adverse cardiac events （MACE） at 6-month follow-up were assessed in 389 patients with STEMI undergoing primary PCI for occluded IRA （TIMI flow grade 0 or 1） within 12 hours of symptom-onset.Angiographic coronary collateralization to the occluded IRA at first contrast injection was graded according to the Rentrop scoring system.Results Low （Rentrop score of 0 or 1） and high （Rentrop score of 2 or 3） coronary collateralization was detected in 329 and 60 patients,respectively.Patients with high collateralization more commonly had prior stable angina and right coronary artery occlusion,but less often had left anterior descending artery occlusion.At baseline,these patients presented with less extent of ST-segment elevation and lower serum levels of creatine kinase myocardial band （CK-MB） and cardiac troponin Ⅰ （cTnl）.Procedural success rate,STR,corrected TIMI flame count,and area under the curve of CK-MB and cTnl measurements after the procedure were similar between patients with high collateralization and those with low collateralization （for all comparisons P＞0.05）.There were no differences in left ventricular ejection fraction and rates of MACE at 6 months according to baseline angiographic collaterals to occluded IRA.Conclusions In patients with acute STEMI undergoing primary PCI within 12 hours of symptom-onset,coronary collateralization to the occluded IRA was influenced by clinical and angiographic features.Early recruitment of collaterals limits infarct size at baseline,but has no significant impact on myocardial reperfusion after the procedure and subsequent left ventricular function and clinical outcomes.     

Outcomes of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction in patients aged over 75 years

Background The optimal reperfusion strategy in elderly patients with ST-elevation myocardial infarction （STEMI） remains unclear. The purpose of this study was to evaluate the safety, in-hospital and one-year clinical outcomes for patients 〉75 years of age with STEMI receiving primary percutaneous coronary intervention （PCI）, compared with those treated by conservative approach. Methods One hundred and two patients 〉75 years of age with STEMI presented 〈12 hours were randomly allocated to primary PCI （n=50） or conservative therapy only （n=52）. The baseline characteristics, in-hospital outcome and major adverse cardiac events （MACE）, including death, non-fatal myocardial infarction and target vessel revascularization at one-year clinical follow-up were compared between the two groups. Results Age, gender distribution, risk factors for coronary artery disease, infarct site and clinical functional status were similar between the two groups, but the patients in primary PCI group received less low-molecular- weight heparin during hospitalization. Compared with conservative group, the patients in primary PCI group had significantly lower occurrence rate of re-infarction and death and shortened hospital stay. The composite endpoint for in-hospital survivals at 30-day follow-up was similar between the two groups, but one-year MACE rate was significantly lower in the primary PCI group （21.3% and 45.2%, P=0.029）. Left ventricular ejection fraction was not significantly changed in both groups during follow-up. Multivariate analysis revealed that primary PCI （OR=0.34, 95% CI： 0.21-0.69, P =0.03） improved MACE-free survival rate for STEMI patients aged 〉 75 years. Conclusion Our results indicated that primary PCI was safe and effective in reducing in-hospital mortality and one-year MACE rate for elderly patients with STEMI.     

替罗非班对急性ST段抬高型心肌梗死直接经皮冠状动脉介入术后心肌灌注和临床预后的影响

目的观察替罗非班对ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入术（PCI）后心肌灌注和临床预后的影响。方法选择75例符合直接PCI的急性STEMI患者,随机分为替罗非班实验组（38例）和对照组（37例）,实验组在PCI基础上加替罗非班,对照组直接行PCI,观察两组术后心肌缺血再灌注损伤,住院期间主要心血管事件（MACE）及临床预后。结果治疗组在PCI术前后冠脉TIMI以及TMP分级、心电图ST段回落、7d后左心室射血分数（LVEF）、主要心血管事件（MACE）发生率等方面显著优于对照组,术后肌钙蛋白I（cTnI）峰值、住院天数、出血并发症、住院期间主要心血管事件（MACE）两组之间无差异。结论对于急性STEMI行PCI前应用替罗非班可更有效地改善冠脉血流及临床预后,方法安全。     

Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China

Background:Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.     

Lower Baseline LDL Cholesterol Affects All-cause Mortality in Patients with First Percutaneous Coronary Intervention

Objective Foreign studies have reported that coronary artery disease(CAD) patients with high baseline low-density lipoprotein cholesterol(LDL-C) may have a good prognosis, which is called the “cholesterol paradox”. This study aimed to examine whether the “cholesterol paradox” also exists in the Chinese population.Methods A total of 2,056 patients who underwent the first percutaneous coronary intervention(PCI)between 2014 and 2016 were enrolled in this retrospective cohort study and classified in...     

经桡动脉急诊PCI与溶栓后早期PCI对ST段抬高型急性心肌梗死患者心功能的影响

目的 探讨经桡动脉对ST段抬高型急性心肌梗死(STEMI)患者急诊冠状动脉介入(PPCI)治疗与静脉溶栓后早期PCI对患者心功能的影响及早期PCI应用价值。 方法 选择2016年1月—2017年1月蚌埠医学院第一附属医院先后入院的92例STEMI患者分为:急诊PCI组76例(入院后立即给予急诊介入治疗),静脉溶栓后行早期PCI组16例(静脉溶栓后行早期PCI)。分析2组患者临床疗效,患者左心室舒张末期容积(LVEDV)和左室射血分数(LVEF),患者复合心血管事件的发生率。 结果 2组患者的基线结果无显著差异,溶栓后早期介入组患者冠状动脉血流TIMI 3级明显高于急诊介入组(93.7% vs. 78.9%,P<0.05);术后随访12个月,2组患者心脏超声检测左室舒张末期容积(102.2±15.3 vs. 97.6±21.5)、左室射血分数[(43.6±7.8)% vs. (46.5±5.7)%]比较差异均无统计学意义(均P>0.05),复合心血管事件(6.6% vs. 6.3%)差异无统计学意义(P>0.05)。 结论 对于首诊于无急诊介入条件基层医院的STEMI患者,溶栓后及时转运至上级医院早期行PCI安全有效。不影响患者心功能恢复,同时未增加患者复合心血管事件发生率。      

ST段抬高型心肌梗死患者fQRS与PCI治疗后ST段回落不良的相关性

目的 探讨ST段抬高型心肌梗死患者碎裂QRS(fQRS)波与经皮冠状动脉介入治疗(PCI)后ST段回落不良的关系。方法 选取确诊为ST段抬高型心肌梗死并且住院行PCI术治疗的患者300例。将300例患者分为两组,即fQRS组(197例)和无fQRS组(103例)。分析患者的相关资料。结果 无fQRS组患者肌钙蛋白(cTnI)、肌酸激酶水平低于fQRS组,左心室射血分数高于fQRS组,差异有统计学意义(P<0.05)。fQRS组的术前、术后QRS时限数值与无fQRS组相比显著增大,差异有统计学意义(P<0.05)。fQRS组术前、术后ST段回落率显著小于无fQRS组,差异有统计学意义(P<0.05)。Logistic回归分析表明,与PCI术后ST段回落不良独立相关的因素有QRS时限增量、术前碎裂QRS波。结论 存在fQRS的STEMI患者PCI术后ST段回落情况不理想,心肌血供不良,冠脉闭塞较重,心肌梗死范围较大。     

梗死相关血管PCI和择期完全PCI策略在急性ST段抬高型心肌梗死合并多支病变患者中的预后分析

目的评价开通梗死相关血管后择期完全血运重建经皮冠状动脉介入(PCI)策略和仅梗死相关血管PCI策略对急性ST段抬高型心肌梗死(STEMI)合并多支病变患者预后的影响。方法纳入2012年4月—2013年12月北京安贞医院急诊科行急诊PCI的合并多支血管病变的STEMI患者59例。根据是否在同次住院期间择期行非梗死相关血管PCI分为2组:择期完全PCI组25例和仅梗死相关血管PCI组34例。观察比较2组患者基本临床资料、冠状动脉造影和PCI情况,记录3个月内相关不良事件(包括死亡、非致死性心肌梗死、顽固性心绞痛、再次血运重建)。结果择期完全PCI组和仅梗死相关血管PCI组冠状动脉造影(包括每支血管植入支架数、支架长度、支架直径等)和PCI情况(包括发病到血管开通时间、介入操作时间、围术期用药情况等)比较,差异均无统计学意义(P>0.05),出院后用药情况(包括阿司匹林、氯吡格雷、α-受体阻滞剂等)差异亦无统计学意义(P>0.05)。随访3个月,择期完全PCI组失访1例,仅梗死相关血管PCI组失访3例。仅梗死相关血管PCI组总不良事件比例高于择期完全PCI组(38.7%vs.12.5%,x²=4.685,P<0.05)。仅梗死相关血管PCI组出现顽固性心绞痛的比例高于择期完全PCI组(32.3%vs.8.3%,x2=4.685,P<0.05)。仅梗死相关血管PCI组出现顽固性心绞痛的比例高于择期完全PCI组(32.3%vs.8.3%,x²=4.539,P<0.05)。2组均未出现死亡病例。结论择期完全处理非梗死相关血管策略能够改善STEMI合并多支病变患者预后,预防顽固性心绞痛的发生。     

尿激酶溶栓后即刻PCI与直接PCI治疗STEMI的比较

目的:比较溶栓后即刻经皮冠状动脉介入治疗(即刻PCI)与直接PCI治疗急性ST段抬高心肌梗死(STEMI)的安全性和疗效。方法:分析接受PCI治疗的连续130例STEMI患者冠脉病变及干预情况,随机分为尿激酶150万单位溶栓后即刻PCI和直接PCI两组,记录术中慢血流无血流、出血并发症、平均住院日、院内死亡率及平均18.1个月随访期间终点事件发生率。结果:两组临床特征及冠状动脉病变相似(P>0.05),即刻PCI组与直接PCI组相比,就诊-球囊时间、术中无血流慢血流、PCI成功率、出血并发症、平均住院日、院内死亡率以及18.1个月心血管事件发生事均无显著差异(P均>0.05)。结论:即刻PCI不增加出血并发症,但近期疗效和远期预后并未发现优于直接PCI。     

生物可降解涂层雷帕霉素洗脱支架在老年急诊冠状动脉介入术中的疗效观察

目的 评价生物可降解涂层雷帕霉素洗脱(Excel)支架在老年急性ST段抬高型心肌梗死(STEMI)急诊冠状动脉介入(PCI)治疗中的临床疗效.方法 回顾性分析90例年龄≥65岁STEMI靶病变血管行急诊PCI治疗患者,术后联合应用抗血小板药氯吡格雷和阿司匹林6个月,其后单用阿司匹林,观察术后12个月主要不良心脏事件及复查冠状动脉造影判定支架再狭窄(ISR)的发生率.结果 90例患者中有89例成功置入Excel支架.30 d内心源性死亡1例,脑出血死亡1例.对于存活的87例患者随访12个月,主要不良心脏事件发生率为11.2%(10/89),无再发心肌梗死、血栓事件发生.87例患者行冠状动脉造影复查,支架内病变再狭窄率为10.3%(9/87).结论 Excel支架在老年STEMI 急诊PCI 的应用中有较好的临床疗效,术后6个月的两联(氯吡格雷和阿司匹林)抗血小板治疗是安全的.     

替罗非班在急性心肌梗死行急诊PCI治疗中的应用价值

目的 探讨替罗非班在急性心肌梗死行急诊经皮冠状动脉介入(PCI)治疗中的临床应用价值.方法 选择我院心内科于2015年4月至2016年10月期间收治的92例急性ST段抬高型心肌梗死(STEMI)患者为研究对象,根据随机数表法随机分为观察组(n=48)与对照组(n=44),所有患者均接受急诊PCI治疗,其中观察组术前应用替罗非班,对照组则不予应用.比较两组患者PCI术后心肌梗死溶栓试验(TIMI)血流分级情况以及TIMI心肌灌注(TMPG)分级的变化,同时比较出血发生率及心血管不良事件发生率.结果 观察组患者PCI术后TIMI血流分级2~3级比例为95.83%,与对照组的93.18%比较差异无统计学意义(P>0.05);而观察组患者TMPG2~3级的比例为89.58%,明显高于对照组的72.73%,差异有统计学意义(P<0.05);两组患者出血发生率比较差异无统计学意义(P>0.05);观察组患者术后心血管不良事件发生率为4.17%,明显低于对照组的18.18%,差异有统计学意义(P<0.05).结论 急诊PCI术前应用替罗非班可有效改善STEMI患者冠状动脉血流及心肌灌注,从而减少心血管不良事件发生率,改善近期预后.     

替罗非班对ST段抬高型AMI患者PCI后心肌灌注及心血管事件的影响

目的观察替罗非班对ST段抬高型心肌梗死(STEMI)患者冠状动脉介入术(PCI)后心肌灌注及心血管事件的影响。方法首次因STEMI行急诊PCI治疗的102例患者,随机分为对照组50例和替罗非班组52例。对照组予常规PCI;替罗非班组于PCI中给予盐酸替罗非班,观察2组PCI术后15 min校正的TIMI帧数计数(CTFC)并进行冠状动脉血流速度测定;记录住院期间主要心血管事件(MACE)发生率。结果 2组患者术前基本资料比较,差异无统计学意义(P均>0.05);替罗非班组CTFC和冠状动脉血流速度较对照组明显改善(P<0.05);治疗24 h后血清cTnT峰值水平明显低于对照组(P<0.05);术后10 d左室射血分数(LVEF)显著高于对照组(P<0.05);30d内的MACE发生率显著低于对照组(P<0.05);2组出血并发症发生率差异无统计学意义(P>0.05)。结论在STEMI行PCI治疗时应用替罗非班,可明显改善心肌再灌注,减轻心肌损害,减少PCI术后患者MACE发生率,并且不增加出血并发症发生率。     

Coronary intervention in patients ≥75 years old with ST-elevation myocardial infarction: in-hospital and 6-month clinical outcomes

Background ST-segment elevation myocardial infarction （STEMI） in elderly patients presents specific clinical characteristics.The study on percutaneous coronary intervention （PCI） in elderly patients （≥75 years） with STEMI,however, has less been performed.Methods In the present study, 522 consecutive STEMI patients undergoing PCI within 12 hours from symptom onset were investigated, and clinical characteristics and in-hospital and 6-month outcomes of 66 elderly patients （≥75 years,group A） were compared to those of 456 younger patients （〈75 years, group B）.Results Compared to younger patients, elderly ones had more females （42.4% vs.17.8%, P 〈0.005）, a history of cerebral vascular events （7.6% vs.0.9%, P 〈0.05）, higher serum creatinine level （（96.48±31.65） mmol/L vs.（84.87±19.81）mmol/L, P〈0.005） and fewer smokers （28.8% vs.45.4%, P〈0.05）.The elderly ones had worse Killip class （Killip I class：69.7% vs.85.7%, P 〈0.05）, less drug-eluting stent implantation and lower rates of TIMI flow 3 following PCI （33.3% vs.47.1%, and 84.8% vs.94.7%, P 〈0.05 respectively）.Additionally, both in-hospital mortality and myocardial infarction rate were found to be higher in elderly patients （16.7% vs.1.5%, and 7.6% vs.2.6%, P 〈0.05 respectively）, which were also observed until 6-month follow-up （9.1% vs.0, and 6.1% vs.0, P 〈0.05 respectively=.In multivariable Cox regression analysis, serum creatinine level, history of hypertension, left anterior descending coronary artery as infarct-related artery and Killip class were independent predictors of 6-month overall death in elderly patients.Conclusions The clinical characteristics of elderly patients with STEMI after PCI are different from those of younger patients.Although PCI in this population is with a low rate of PCI failure, it is still associated with a worse outcome.     

左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响

目的 探讨左心室收缩功能对经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗的急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者预后的影响。方法 对161例PCI治疗的急性下壁STEMI患者按左心室收缩功能分为2组:左心室收缩功能障碍[左心室射血分数(left ventricular ejection fraction, LVEF)<50%]组和左心室收缩功能正常(LVEF≥50%)组。本研究的主要终点主要不良心脏事件(major adverse cardiac events, MACE)包括所有全因死亡、再发性心肌梗死、缺血驱动的血管血运重建和卒中。结果 两组患者在年龄、性别、病史、Killip分级以及症状发作时间方面比较,差异均无统计学意义(P>0.05);左心室收缩功能障碍组具有更高的病变血管支数和血栓负荷(P<0.05),其他冠状动脉造影结果和介入治疗特征,两组间差异均无统计学意义(P>0.05)。两组在1年预期MACE发生率方面比较,差异均无统计学意义(Log-rank P>0.05)。结论 在接受直接PCI治疗的急性下壁STEMI患者中,左心室收缩功能障碍的患者与左心室收缩功能正常的患者具有相似的1年临床不良事件发生率。     

早期应用替罗非班对急性STEMI行经皮冠状动脉介入的疗效观察

目的观察早期应用替罗非班对急性ST段抬高心肌梗死（STEMI）急诊行经皮冠状动脉介入治疗（PCI）及梗死相关血管的血流及梗死区心肌灌注的影响。方法将160例发病〈12h急诊行PCI的急性STEMI患者分为PCI前早期应用组及PCI前即刻应用组,各80例。观察两组PCI前后心肌梗死溶栓（TIMI）分级及梗死区心肌灌注（TMP）分级,观察PCI后30d主要心血管事件（MACE）及术后出血发生情况。结果早期应用组PCI前TIMI 3级及TMP 3级的获得率分别为31.3%、33.8%;PCI后TIMI 3级及TMP 3级分别为92.5%、75.0%;两组PCI前TIMI 3级与TMP 3级及PCI后TMP 3级比较差异均有统计学意义（P〈0.05）。结论对急性STEMI急诊行PCI的患者,早期应用替罗非班能改善梗死相关血管的血流及心肌灌注。     

PCI术中冠状动脉内注射重组人尿激酶原对STEMI患者高血栓负荷的影响

目的 评估经皮冠状动脉介入治疗（PCI）时,冠状动脉内注射重组人尿激酶原（rh-pro UK）对ST段抬高型心肌梗死（STEMI）患者高血栓负荷的影响。方法 回顾性分析2018年1月至2020年1月于六安市人民医院行PCI的88例高血栓负荷STEMI患者的临床资料。根据患者PCI术中冠脉内用药的不同,将冠状动脉内注射替罗非班的43例患者作为对照组,冠状动脉内联合注射替罗非班和rh-pro UK的45例患者作为观察组。比较两组患者TIMI血流分级、TIMI心肌灌注分级（TMPG）、ST段回落百分比（STR）、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、住院期间出血及主要不良心血管事件（MACE）发生情况。结果 观察组患者TMPG 3级的比例为97.78%、STR>70%的比例为26.67%,均高于对照组,差异有统计学意义（P<0.05）;观察组患者术后1个月LVEF、LVEDD改善,差异有统计学意义（P<0.05）;两组患者TIMI分级、住院期间出血及MACE发生率比较,差异无统计学意义（P>0.05）。结论 冠状动脉内注射rh-pro UK可更好地改善STEMI心肌灌注水平及左心室功能,同时不增加住院期间出血及MACE发生率。     

尿激酶原联合血栓抽吸对高血栓负荷的STEMI患者的疗效观察

目的 比较重组人尿激酶原与替罗非班对高血栓负荷的ST段抬高型心肌梗死患者的疗效。方法 选取2015年10月~2017年4月就诊于唐山工人医院行急诊冠状动脉造影术提示存在高血栓负荷的急性ST段抬高型心肌梗死患者90例患者为研究对象,随机分为A组（经皮冠状动脉介入治疗（PCI）术中经血栓抽吸导管于病变远端注射重组尿激酶原）44例与B组（在PCI术中经血栓抽吸后于病变近端注入替罗非班）46例。比较两组患者的一般资料、心肌组织灌注水平、住院及随访期间不良心血管事件和出血风险等发生情况。结果 在符合入选标准的90例研究对象中,平均年龄为61.53±8.53岁,男性63例（70.0%）。A、B两组患者一般资料差异均无统计学意义（P>0.05）;A、B两组患者在PCI术后恢复TIMI血流3级的比例方面比较差异无统计学意义（P>0.05）,校正的心肌梗死溶栓治疗试验帧数、心肌组织灌注分级、术后2h内ST段回落率比较差异均具有统计学意义（P<0.05）;术后随访1个月发现,A、B两组左心室射血分数比较差异有统计学意义（P<0.05）;A、B两组患者再发心绞痛、再发心肌梗死、心力衰竭、死亡、出血的发生率比较差异均无统计学意义（P>0.05）。结论 高血栓负荷的STEMI患者在PCI时冠脉内注射重组人尿激酶原联合血栓抽吸较血栓抽吸联合冠脉内注射替罗非班,能进一步提高术后的心肌组织灌注水平,降低无复流的发生率,且不会增加心脏不良事件和出血事件的发生率。     

外周血MPO、NLR、hs-CRP对ST段抬高型心肌梗死患者PCI术后主要不良心脏事件的预测价值

目的 探讨外周血髓过氧化物酶（MPO）联合中性粒细胞/淋巴细胞比值（NLR）、高敏C反应蛋白（hs-CRP）对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入术（PCI）术后主要不良心脏事件（MACE）的预测价值。方法 选取2016年5月—2020年8月南阳医学高等专科学校第一附属医院收治的178例STEMI患者行PCI治疗,术后随访1年。收集患者临床资料,测定PCI术前外周血MPO、NLR、hs-CRP,分析患者冠状动脉病变狭窄程度。分析不同病情严重程度STEMI患者外周血MPO、NLR、hs-CRP,统计患者术后1年MACE发生情况,分析影响STEMI患者PCI术后发生MACE的因素,分析外周血MPO、NLR、hs-CRP对STEMI患者PCI术后发生MACE的预测价值。结果 重度狭窄组MPO、NLR、hs-CRP均高于轻、中度狭窄组（P <0.05）,中度狭窄组均高于轻度狭窄组（P <0.05）。逐步多因素Logistic回归分析结果显示：Cys C[■=3.662(95%CI:1.507,8.899)]、MPO[■=3.725(95%CI:1.533,9.05...     

急性ST段抬高心梗直接经皮冠脉介入治疗的疗效分析研究

目的:对急性ST段抬高心梗(STEMI)患者进行直接经皮冠状动脉介入(PCI)治疗或溶栓治疗,探讨直接PCI治疗STEMI的疗效。方法:入选STEMI患者81例,分为直接PCI组(32例)和溶栓组(49例)。直接PCI,取桡动脉或股动脉为冠状动脉造影(CAG)径路,采用Judkins法行左、右冠状动脉造影,确定梗死相关动脉(IRA),采取PTCA+支架或直接支架方式仅干预IRA。溶栓治疗,重组链激酶150万单位入0.9%氯化钠溶液100 mL中半小时内滴注完毕。临床评价指标,IRA再通率、ST段回落(STR)≥50%、2周时左室舒张末径(LVDD)、左室射血分数(LVEF)、心衰、梗后心绞痛、非致死性再次心梗、死亡。结果:进门-溶栓时间平均为57 min,进门-球囊扩张时间平均为91 min。直接PCI组血管再通率高于溶栓组(P<0.05),直接PCI组STR≥50%率高于溶栓组(P<0.05),直接PCI组再次心梗、梗后心绞痛、心衰发生率低于溶栓组(P<0.05)。结论:直接PCI治疗急性ST段抬高心梗疗效优于溶栓治疗。