非ST段抬高急性冠状动脉综合征患者妊娠相关血浆蛋白A水平与冠状动脉介入治疗预后的关系

目的探讨非ST段抬高急性冠状动脉(冠脉)综合征患者循环妊娠相关血浆蛋白A(PAPP-A)水平与经皮冠脉介入治疗(PCI)术预后的关系。方法检测86例单支冠脉病变的非ST段抬高急性冠脉综合征患者(不稳定型心绞痛58例,非ST段抬高急性心肌梗死28例)PCI术前PAPP-A和高敏C反应蛋白(hs-CRP)水平,考察其冠脉病变形态和术前术后罪犯血管供血区域的TIMI心肌灌注分级(TMPG),分析它们与术后随访1年内的主要心血管事件联合终点之间的关系。结果与无心血管事件患者比较,有心血管事件的患者术前hs-CRP水平较高(P=0.016),PAPP-A水平也明显升高[(28.55±20.21)mIU/L比(19.37±15.24)mIU/L,P=0.007],男性患者、高脂血症患者和有复杂病变的患者也较多。随访(9.7±3.0)个月期间,19例(22%)患者发生心血管事件;低PAPP-A的患者无心血管终点事件生存率较高(log rank=7.881,P=0.049),而PAPP-A≥15.41 mIU/L是强的联合终点事件预测因子(OR=2.23,95%CI:1.27～5.33,P=0.021)。结论 PAPP-A水平对单支血管病变的非ST段抬高急性冠脉综合征患者PCI术后的中期预后有预测作用。     

非ST段抬高急性冠状动脉综合征患者的早期紧急介入治疗

目的评价非ST段抬高急性冠状动脉综合征(acute coronary syndrome,ACS)患者早期应用紧急经皮冠状动脉介入治疗(PCI)的临床疗效。方法2000年1月至2005年9月我院收治的385例中、高危非ST段抬高ACS患者,根据药物治疗后病情变化,分别在入院1~2 d内(233例,紧急介入组)或3~14 d(152例,延迟介入组)行冠状动脉造影(CAG)及PCI。所有“罪犯”病变均予治疗,介入方法有经皮冠状动脉腔内成形术(PTCA) 支架、直接置入支架等。观察两组手术成功率、心绞痛缓解时间、住院时间和PCI后30 d及6个月心源性死亡、心绞痛复发等不良心脏事件发生率。结果紧急介入组手术成功率与延迟介入组相似,分别为98.1%和95.5%(P>0.05),但入院至心绞痛缓解时间分别为(2.9±1.1)d和(6.0±3.6)d(P<0.05);住院时间分别为(9.7±4.3)d和(14.2±6.6)d(P<0.05);在住院期间,两组患者均无急性心肌梗死、猝死及心功能恶化发生。30 d随访期间紧急介入组总不良心脏事件发生率较延迟介入组明显减少,二者分别为2.9%和14.1%(P<0.01)。结论在条件具备的介入中心,由经验丰富和技术娴熟的介入治疗医生施行或在其指导下,对非ST段抬高ACS患者进行早期紧急介入治疗是积极、有效的治疗措施,近、远期临床效果较满意,手术成功率及安全性较高,可作为大多数非ST段抬高ACS患者的首选治疗策略。     

非ST段抬高的急性冠状动脉综合征患者早期介入治疗与单纯药物治疗对预后的影响

目的探讨非ST段抬高急性冠状动脉综合征(ACS)患者早期介入治疗与单纯药物治疗对预后的影响。方法收集2005年9月至2007年11月入院的非ST段抬高ACS患者共181例临床资料,分成单纯药物治疗组和介入治疗组,随访患者发病30d和6个月心血管不良事件的发生率。结果与早期单纯药物治疗相比,早期介入治疗能够降低30d和6个月时心血管不良事件(P<0.05)。经随访,中危患者早期介入治疗组与药物治疗组30d时心血管不良事件发生率分别为8.1%和9.5%,6个月随访时分别为11.7%和15.0%,差异均无统计学意义(P>0.05);高危患者心血管不良事件30 d时的发生率分别为14.6%和43.4%,6个月时发生率分别为25.8%和86.9%,差异均有统计学意义(P<0.05)。结论对于中危患者早期介入治疗和药物保守治疗对心脏事件的影响差异无统计学意义,而对于高危患者早期介入治疗可显著降低近期和远期的心脏事件的发生率。     

不同时间窗干预非ST段抬高型急性冠状动脉综合征疗效观察

目的 比较非ST段抬高型急性冠状动脉综合征患者早期干预和延迟干预的有效性和安全性.方法 本试验为多中心随机研究,将入选的非ST段抬高型急性冠状动脉综合征患者分配至早期组(24 h内接受冠状动脉造影)和延迟组(36 h后接受冠状动脉造影),接受介入治疗或冠状动脉旁路移植术.主要终点是180 d随访时死亡、心肌梗死、卒中的复合终点,次要终点是180 d随访时死亡、心肌梗死、难治性缺血、卒中、再次血运重建.结果 共有815例患者入选,主要终点事件发生率早期组为9.0%,延迟组为14.6%(P=0.01).次要终点事件(180 d死亡、心肌梗死或难治性缺血复合终点)的发生率早期组为14.6%,延迟组为22.0%(P=0.01).180 d心肌梗死发生率延迟组高于早期组(10.8%比5.2%,P=0.00).另一个次要终点事件(180 d死亡、心肌梗死、难治性缺血、卒中或再次血运重建复合终点)的发生率早期组为26.7%,延迟组为30.4%(P=0.25).结论 早期干预可以减少非ST段抬高型急性冠状动脉综合征患者再发心肌梗死的发生率.     

介入治疗对老年人急性ST段抬高性心肌梗死预后的影响

目的 探讨介入治疗对老年急性ST段抬高性心肌梗死(STEMI)预后的影响. 方法 回顾性分析1998年6月至2008年6月我院心内科住院的STEMI患者1318例,其中老年人338例(25.6%),连续入选符合标准的老年STEMI 316例为研究对象,依据是否行冠状动脉介入治疗(PCI)分两组:PCI组136例(43.0%)和保守治疗组180例(57.0%).收集研究对象的临床资料,并随访2年评价患者预后. 结果 两组患者年龄、性别、高血压、糖尿病、血脂异常、吸烟饮酒史、家族史等比较差异均无统计学意义(P＞0.05).两组患者前壁STEMI、心功能Killip Ⅲ～Ⅳ级、静脉溶栓及恶性室性心律失常例数等比较,差异均无统计学意义(P＞0.05).随访患者急性心肌梗死二级预防:多数患者戒烟限酒、控制饮食、减轻体质量、坚持运动等,较规律服用预防心室重塑、抗血小板、抗动脉粥样硬化等药物:血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、阿司匹林、β受体阻滞剂、他汀类药物,两组间比较差异无统计学意义(均P＞0.05).2年随访发生再梗死、心功能Ⅲ～Ⅳ级住院人数和1个月病死率比较,保守治疗组均高于PCI组(分别为17.2%与2.2%,OR=9.224,95%CI=2.756～30.876;31.1%与8.1%,OR=5.132,95%CI=2.568～10.257;8.3%与1.5%,OR=6.091,95%CI=1.369～27.105,均P＜0.01).老年STEMI的1年、2年病死率比较,保守治疗组明显高于PCI组(分别为21.1%与2.2%,OR=11.864,95%CI=3.577～39.349;32.2%与4.41%,OR=10.301,95%CI=4.289～24.736,P＜0.01). 结论 PCI可减少老年STEMI发生再梗死、心功能Ⅲ～Ⅳ级住院和1个月病死率,尤其是可明显减少1年、2年病死率.因此,早期PCI可明显改善老年STEMI患者预后.     

高龄患者非ST段抬高急性冠状动脉综合征介入治疗的差异

目的 比较非ST段抬高急性冠状动脉(冠脉)综合征不同年龄患者介入治疗的疗效和安全性.方法 非ST段抬高的急性冠脉综合征患者随机分配至早期介入组(24 h内接受冠脉造影)和延迟介入组(36 h后接受冠脉造影).主要研究终点为180 d随访时死亡、心肌梗死(MI)、卒中的复合终点.结果 共有815例患者入选,其中≥75岁患者198例,＜75岁患者617例.≥75岁患者主要终点事件发生率明显高于＜75岁患者(18.7%比9.2%,P=0.00).＜75岁患者早期介入组主要终点事件发生率明显低于延迟介入组(6.5%比12.5%,P=0.01).≥75岁患者早期介入组和延迟介入组间主要终点事件发生率差异无统计学意义(16.5%比21.3%,P=0.39).结论 非ST段抬高急性冠脉综合征介入治疗中≥75岁患者病死率和新发MI发生率高于＜75岁患者;＜75岁患者早期介入治疗可减少MI的发生率,≥75岁患者早期和延迟介入治疗差异无统计学意义.

Abstract：

Objective To investigate the effect and safety of early intervention and delayed intervention therapy on elderly patients and younger patients with non-ST segment elevation acute coronary syndrome. Methods The patients with non-ST segment elevation acute coronary syndrome were randomly divided into early intervention group (coronary angiography taken within 24 hours after grouping) and delayed intervention group ( coronary angiography taken after 36 hours after grouping). The primary endpoint was a composite endpoint of death, myocardial infarction and stroke during 180 days follow-up. Results A total of 815 patients were enrolled, including 198 elderly patients aged 75 years and above, and 617 younger patients aged below 75 years. The elderly patients had a greater incidence of the primary endpoint than that of younger patients ( P = 0. 00). The primary endpoint of early intervention group were obviously lower than that of delayed intervention group of younger patients ( P = 0. 01 ). There was no significant difference in primary endpoint incidence of early intervention group and delayed intervention group of the elderly patients (P =0. 39). Conclusions The elderly patients with non-ST segment elevation acute coronary syndrome who underwent intervention had greater incidence of death and myocardial infarction. Early intervention reduced the rate of myocardial infarction for the younger patients. There was no significant difference in primary endpoint incidence between early intervention and delayed intervention among elderly patients.     

介入治疗对老年人急性ST段抬高性心肌梗死预后的影响

Objective To investigate the effect of percutaneous eoronary intervention (PCI) on the prognosis of acute ST-segment elevation myocardial infarction (ASTEMI) in the elderly.Methods The 1318 ASTEMI patients in our hospital from June 1998 to June 2008 were retrospectively analyzed. Among them, 338 (25.6%) elderly patients were over 60 years old, and 316patients consistent with inclusion and exclusion criteria were consecutively enrolled in our research.Then they were divided into two groups: PCI group (136 cases, 43.0%) and conservative drug treatment group (180 cases, 57. 0%). The clinical data of study objects were collected. Then they were followed up regularly for two years. Results There were no statistically significant differences between the two groups in mean age, gender, hypertension, diabetes, dyslipidemia, excess smoking,wine and family history (all P＞ 0.05). And there were no statistically significant differences in anterior wall STEMI, Killip Ⅲ-Ⅳ class, thrombolysis therapy and malignant ventricular arrhythmia (all P＞0. 05). Most of the objects proceeded therapeutic lifestyle improvements, such as giving up smoking, restricting wine, regulating diet, losing weight and insisting on exercises, and so on.Secondary prevention drugs of acute myocardial infarction including angiotensin converting enzyme inhibitor, angiotensin receptors blockers, beta receptor, aspirin and statins were regularly administrated in the two follow-up years. In the retrospective research, incidence rates of reinfarction, NYHA (New York Heart Association) Ⅲ-Ⅳ class heart function and one-month mortality were much higher in conservative treatment group than in PCI group (17.2% vs. 2. 2%, OR=9. 224,95% CI: 2. 756-30. 857; 31.1% vs. 8.1%,OR=5.132, 95%CI: 2. 568-10. 257; 8. 3% vs. 1.5%,OR= 6. 091, 95% CI: 1. 369-27. 105, respectively; all P ＜ 0. 01). Above all, one and two-year mortalities were much higher in conservative treatment group than in PCI group (21.1% vs. 2. 2 %,OR=11.864, 95%CI: 3.577-39.349; 32.2% vs. 4.4%, OR=10.301, 95%CI: 4.289-24.736,respectively; all P＜0. 01). Conclusions PCI may reduce the re-infarction, NYHA Ⅲ-Ⅳ class heart function and one-month mortality, especially so in view of the one and two-year mortality. PCIcan significantly improve the prognosis of ASTEMI in the elderly.     

HDL-C对经皮冠状动脉介入治疗ST段抬高性心肌梗死预后的影响

目的:探讨HDL-C水平对接受急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高性心肌梗死(STEMI)患者住院期间预后的影响。方法:回顾性分析352例接受急诊PCI的STEMI患者的临床资料,根据入院空腹HDL-C水平分成HDL-C降低组(HDL-C<1.04mmol/L,125例)和HDL-C正常组(HDL-C≥1.04mmol/L,227例)。比较2组住院期间病死率和联合心脏事件的发生情况。结果:与HDL-C正常组比较,HDL-C降低组的Killip分级≥Ⅱ级比例和既往糖尿病史比例增加,TC、LDL-C水平下降,TG水平增加(均P<0.05)。HDL-C降低组的住院期间病死率较HDL-C正常组增加(P<0.01),但2组联合心脏事件发生率差异无统计学意义。多因素Logistic回归分析显示,HDL-C是患者住院期间病死率的独立危险因素(P<0.01)。结论:对于接受急诊PCI的STEMI患者,HDL-C水平降低与住院期间病死率增加有关。HDL-C是接受急诊PCI的STEMI患者住院期间病死率的独立危险因素。     

不同时间段介入治疗非ST段抬高急性冠状动脉综合征的近期疗效

目的　比较发病后不同时间段介入治疗非ST段抬高急性冠状动脉 (冠脉 )综合征的近期疗效以确定早期介入治疗的时间窗。方法　选择 2 0 0 1年 1月至 2 0 0 4年 6月间进行介入治疗的非ST段抬高急性冠脉综合征患者 15 0例 ,根据介入治疗开始的时间分为发病后 <2 4h ,2 4～ 72h和 >72h组 ,比较各组的冠脉介入治疗成功率 ,术后胸痛缓解率 ,术后血流TIMI分级改善率 ,术中、术后并发症发生率 ,住院天数的长短。结果　各组间PCI成功率、术后胸痛缓解率、术后血流TIMI分级改善率均无明显差异。术中并发症 <2 4h组较其他组明显高 (2 3 3%比 8 3% ,P <0 0 5 )。结论　非ST段抬高的急性冠脉综合征患者不同时间介入治疗在院期间的近期疗效是相当的 ,但 <2 4h组术中并发症发生率高 ,从安全性及效价比的角度考虑 ,2 4～ 72h为非ST段抬高的ACS早期介入治疗较为合适的时间选择。     

国产西罗莫司洗脱支架早期介入治疗非ST段抬高急性冠状动脉综合征

目的分析国产西罗莫司洗脱支架早期介入治疗非ST段抬高的急性冠状动脉综合征的疗效。方法采用回顾性分析研究方法,在88例非ST段抬高的急性冠状动脉综合征患者置入国产西罗莫司洗脱支架,随访住院及术后1年内主要心脏不良事件发生率和无心脏事件生存率。结果随访1年中,不稳定心绞痛复发8例,非ST段抬高心肌梗死1例,再次冠状动脉内支架治疗2例,无死亡病例。结论国产西罗莫司洗脱支架早期介入治疗非ST段抬高的急性冠状动脉综合征安全、有效,并发症少,再狭窄率低。     

早期服用氯吡格雷对急性冠状动脉综合征患者介入治疗近期临床预后的影响

目的探讨冠状动脉(冠脉)介入治疗(PCI)术前早期使用氯吡格雷能否较术前临时用药进一步改善非ST段抬高的急性冠脉综合征(NSTE-ACS)患者的近期预后。方法将拟行早期PCI治疗的NSTE-ACS患者随机分为早期用药组和对照组。早期用药组272名患者于入院临床诊断明确后立即开始服用氯吡格雷(首次给负荷量300mg,后以75mg/d维持)。对照组共入选265名患者,于冠脉造影后决定选择PCI治疗时开始用药,首次服用氯吡格雷300mg,术后以75mg/d维持。比较两组在PCI术后30d内死亡、支架血栓、心肌梗死、再发心绞痛和靶血管血运重建等心脏不良事件(MACE)的发生率。结果两组患者在临床病情、冠脉病变及支架置入治疗等方面比较,差异无统计学意义。PCI术后30d内早期用药组死亡、支架血栓、心肌梗死和靶血管血运重建等联合事件的发生率显著低于对照组。结论PCI术前早期使用氯吡格雷能够明显减少NSTE-ACS患者心血管不良事件的发生率,显著改善患者PCI术后的近期预后。     

国产替罗非班在高龄急性冠状动脉综合征患者介入治疗中的应用

目的评价高龄(≥70岁)非ST段抬高急性冠状动脉综合征(ACS)患者冠状动脉介入治疗(PCI)中应用国产血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班的安全性和近期疗效。方法108例行PCI的非ST段抬高ACS患者按年龄分为高龄组(≥70岁,42例)和非高龄组(<70岁,66例),分析两组基础资料特征、即刻手术成功率、出血和血小板减少发生率;观察住院和随访30天期间不良心血管事件(再发心绞痛、心肌梗死、心力衰竭及猝死)。结果高龄组甘油三酯、脂蛋白a高于非高龄组,体重指数和吸烟比例低于非高龄组(P均<0.05);高龄组多支病变比例高于非高龄组(71%比39%,P<0.01);两组PCI即刻成功率均为100%。高龄组发生小出血5例、血小板减少6例;非高龄组小出血2例,血小板减少2例;两组均无大出血发生。高龄组血小板减少及总副反应发生率高于非高龄组(P均<0.05),小出血发生率差异无统计学意义(P>0.05)。高龄组住院和随访期间再发心绞痛5例、心肌梗死1例、心力衰竭2例、猝死0例;非高龄组再发心绞痛7例、心力衰竭1例,无心肌梗死和猝死。两组间复合心血管事件发生率差异无统计学意义(P>0.05)。结论高龄非ST段抬高ACS患者PCI中应用国产替罗非班是安全的。     

Influence of gender on long-term mortality in patients presenting with non-ST-elevation acute coronary syndromes undergoing percutaneous coronary intervention

Although an invasive strategy has predominately been studied in men with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs), its role in low-risk women is unclear. We sought to examine gender differences in a real-world registry of patients with NSTE-ACS who underwent percutaneous coronary intervention (PCI). Patients with NSTE-ACS undergoing PCI at the Cleveland Clinic, Cleveland, Ohio from 2003 through 2007 (n = 1,874) were included. In-hospital and long-term mortalities were assessed. Cox proportional hazards models were constructed to study the influence of gender on mortality. Interactions with age and biomarker status were examined. Women were older and had a higher incidence of co-morbid conditions compared to men. They had a smaller reference vessel diameter compared to men. Despite these characteristics there was no overall difference in in-hospital (1.4% vs 1.6%) or long-term (14.6% vs 15.8%) mortality between men and women. However, there was evidence of a significant effect modification by age (p = 0.012) and troponin status (p = 0.0073) for long-term mortality such that women <60 years of age, especially those who were troponin negative, had more than a twofold increase in long-term mortality compared to men (p = 0.007). In conclusion, although overall mortality rates are similar between men and women undergoing PCI for NSTE-ACS, women <60 years old with negative biomarkers have a higher mortality than their men peers.     

对接受介入治疗的急性冠状动脉综合征患者的慢性肾脏病调查

目的探讨中国急性冠脉征接受介入治疗患者中慢性肾脏病的患病率及危险因素。方法对于全国20个中心的1854例在2007年2月1日以前接受介入治疗的急性冠脉综合征患者进行病史采集、肾脏损伤指标及相关危险因素的检测。结果在1793例资料完整的患者中,白蛋白尿的患病率为10.6%,肾功能下降的患病率为10.0%,血尿或非感染性白细胞尿的患病率为7.1%。在急性冠脉综合征接受介入治疗的患者中慢性肾脏病的患病率为22.8%,知晓率为11.3%。多因素logistic回归提示,性别、既往慢性肾脏病病史、高血压、糖尿病、贫血、高尿酸血症、尿蛋白阳性以及年龄每增加10岁均是肾小球滤过率(eGFR)低于60ml.min-1.1.73m-2的危险因素。结论慢性肾脏病在急性冠脉综合征接受介入治疗的患者中患病率高,但临床中自我知晓率明显偏低,对所有因急性冠脉综合征而住院的患者尤其那些合并相关危险因素的患者应进行eGFR估算。     

Long-term prognostic implication of extracardiac vascular disease in patients undergoing percutaneous coronary intervention

Patients with extracardiac vascular disease were identified from 2,372 consecutive percutaneous coronary intervention (PCI) cases performed between 1997 and 2001. After multivariate adjustment, we found the presence of extracardiac vascular disease to be associated with a significantly higher risk for late mortality (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.0 to 2.0, p = 0.029). When extracardiac vascular disease was separated into cerebrovascular disease and peripheral vascular disease, cerebrovascular disease was less common but was associated with a trend towards worse survival.     

国产氯吡格雷对急性冠脉综合征经皮冠脉介入术的疗效

目的：研究国产氯吡格雷用于非ST段抬高急性冠脉综合征（NSTEACS）急诊经皮冠脉介入（PCI）治疗患者的疗效及安全性。方法：确诊NSTEACS并接受急诊PCI的患者176例,分成国产氯吡格雷组（接受泰嘉治疗,89例）和进口氯吡咯雷组（接受波立维治疗,87例）。PCI治疗前两组分别接受泰嘉、波立维每日600mg。PCI后每日分别接受75mg至1年以上。观察两组患者的疗效及不良反应的发生情况。结果：国产氯吡格雷组与进口氯吡格雷组达到的完全血运重建率（79．8％比89．3％．P=0．477）,主要不良心脑血管事件（MACCE）发生率（9．0％比6．9％,P=0．608）,不良反应的发生率（5．6％比8．0％,P=0．523）均无显著差异。结论：国产氯吡格雷（泰嘉）治疗急性非ST段抬高心肌梗死的疗效和安全性与进口氯吡格雷相当。