PAS方案治疗动脉粥样硬化血栓形成型脑梗死的疗效

目的 探讨抗血小板、调脂和抗氧化联合治疗(PAS方案)动脉粥样硬化血栓形成型脑梗死患者急性期的疗效及预后.方法 收集2008年3月至2010年7月来我院神经内科住院治疗的550例动脉粥样硬化血栓形成型脑梗死患者,平均年龄(64.54±11.60)岁.入选患者分为三组:抗血小板治疗组、抗血小板联合他汀类调脂治疗组和PAS治疗组.随访12个月,其中10例失访,根据改良Rankin评分(mRS)评价各组患者预后,比较改善率、复发率、预后不良发生率和病死率的差异.结果 PAS治疗组在随访3个月和12个月时预后不良发生率、复发率和病死率明显低于其他两组(P<0.05),而改善率高于其他两组(P<0.05);随访3个月和12个月抗血小板联合他汀类调脂治疗组预后不良发生率和病死率低于抗血小板治疗组,但两者复发率比较无统计学差异(P>0.05).结论 抗血小板、他汀类调脂和抗氧化联合治疗能改善动脉粥样硬化血栓形成型脑梗死患者的预后,明显降低预后不良的发生率和病死率.     

急性期抗血小板及调脂治疗对缺血性卒中患者预后影响的前瞻性随访研究

目的：探讨缺血性卒中患者急性期抗血小板、调脂治疗与预后的关系。方法：收集自2007年1月～2008年5月在卒中单元病房住院治疗的1016例急性缺血性脑卒中患者,男630例,女386例,平均年龄64．54±11．60岁。根据是否服用抗血小板的药物和是否应用他汀类调脂药进行分组,分别分为使用组和未使用组。应用N1HSS评分了解各组入院时、随访3月和随访12月后的神经功能缺损程度,根据改良Rankin评分（mRs）评价各组患者预后、复发率和病死率的差异。结果：缺血性脑卒中男性患者发病年龄较女性患者早（P〈0．001）。其中使用抗血小板治疗927例,随访3月及12月抗血小板治疗组神经功能缺损程度较术使用者轻,NIHSS评分比较有显著性差异（P〈0．05）,使用抗血小板治疗组改善明显（P〈0．05）,预后不良发生率和病死率均较术使用背低（P〈0．001）,然而,复发率在两组之间比较无差异（P〉0．05）。同样,使用他汀类调脂药者随访3月和随访12月的病死率和预后不良发生率均低于未使用组（P〈0．001）,但复发率在两组之间比较无差异（P〉0．05）。结论：使用抗血小板药及他汀类调脂药将能改善患者预后,明显降低缺血性卒中患者的预后不良的发生率和病死率。     

2479例缺血性脑卒中登记患者三年随访研究

目的探讨卒中单元缺血性脑卒中登记患者正规降压治疗,抗血小板治疗和调脂治疗对其短期与长期预后的影响。方法收集2009年1月~2010年5月在卒中单元病房住院治疗的急性缺血性脑卒中患者2479例,男1638例,女841例,其中缺血性脑卒中合并高血压1784例,分为联合降压组361例和联合降压调脂组1423例;不合并高血压695例,分为单纯抗血小板组85例和联合调脂组610例,各组分别予抗血小板和(或)调脂和(或)降压药物治疗,均随访3年。比较3个月、1年和3年后,不同治疗方案患者预后不良发生率、复发率和病死率的差异。结果随访1年时,联合降压调脂组患者病死率和预后不良率均低于联合降压组(11.95%vs 24.93%,45.89%vs58.17%,P0.01);随访1年和3年时,复发率亦低于联合降压组(12.23%vs 27.98%,14.97%vs 27.15%,P0.01)。随访3个月时,联合调脂组患者病死率低于单纯抗血小板组(7.87%vs 15.29%,P0.05);随访1年和3年时,联合调脂组患者病死率、复发率和预后不良率均低于单纯抗血小板组(P0.05,P0.01)结论联合强化调脂,长期平稳有效降压和坚持抗血小板治疗可降低缺血性脑卒中的复发率,病死率和预后不良率。     

氯吡格雷、阿托伐他汀对不稳定型心绞痛患者IL-6、hs—CR及预后的影响

目的探讨氯吡格雷、阿托伐他汀对不稳定型心绞痛患者白介素6（IL-6）、超敏c反应蛋白（hs．CRP）及预后的影响,为治疗及预测预后提供指导依据。方法将60例不稳定型心绞痛患者随机分为观察组和对照组各30例,对照组予阿司匹林、关托洛尔、硝酸甘油、钙拮抗剂和低分子肝素等常规抗心绞痛治疗,观察组在对照组用药基础上给予阿托伐他汀及氯吡格雷治疗。比较两组治疗后心绞痛症状改善程度、心电图改善情况、治疗前后hs．CRP、IL-6水平及6个月后两组不良心血管事件发生率。结果治疗后观察组心绞痛症状改善程度与对照组比较,差异有统计学意义（M=1．998,P=0．0042）;心电图疗效评价,两组比较差异有统计学意义（M=1．948,P=0．0075）。治疗后两组hs．CRP、IL-6水平均较治疗前降低,差异有统计学意义（P〈0．05）;观察组比对照组下降更明显,差异有统计学意义（P〈0．05）。随访6个月,观察组不良心血管事件发生率（3．3％）明显低于对照组（20．0％）（P〈0．05）。结论氯吡格雷、阿托伐他汀联用治疗不稳定型心绞痛疗效确切,能降低hs-CRP、IL-6水平,预防心血管事件的发生,明显改善预后,值得临床推广应用。     

中西医结合治疗老年不稳定型心绞痛疗效观察

目的观察黄芪注射液联合银杏叶提取物注射液治疗不稳定型心绞痛的临床疗效。方法将80例不稳定型心绞痛气虚血淤证患者随机分为对照组和观察组（各40例）。对照组予西医常规治疗,如扩张心血管、抗血小板聚集、抗心肌缺血、稳定动脉粥样硬化斑块、调脂等治疗。观察组在此基础上加静滴黄芪注射液合银杏叶提取物注射液,每日1次,两组疗程均为2周。观察两组临床疗效、心电图改善及血脂变化情况。结果观察组和对照组缓解心绞痛的总有效率分别为92．5％和67．5％,心电图总有效率分别为87．5％和55．0％,两组比较差异均有统计学意义（P〈0．05）。观察组治疗后血脂多项指标均有改善,与对照组相比差异有统计学意义（P〈0．05或P〈0．01）。结论中西医结合治疗在改善心绞痛症状、心电图以及调脂方面,有满意疗效。     

尤瑞克林治疗急性脑梗死的疗效与安全性观察

目的观察尤瑞克林治疗急性脑梗死的疗效及安全性。方法将91例急性脑梗死患者随机分为两组,对照组给予抗血小板药、调脂等常规治疗,治疗组在常规治疗基础上给予尤瑞克林,疗程14d。评定两组治疗前及治疗后第7、14天的神经功能缺损评分（NIHSS）及颅脑CT检测梗死灶体积。结果治疗后两组NIHSS均显著降低（P〈0．01）,第7、14天治疗组NIHSS下降较对照组更为明显（P〈0．05）;治疗组总有效率远高于对照组（P〈0．01）;治疗后两组梗死部位体积均有缩小,治疗后第7、14天治疗组梗死部位体积与对照组相比显著减小（P均〈0．05）。结论尤瑞克林可以改善急性脑梗死患者的神经功能,缩小脑梗死灶体积,能有效治疗脑梗死。     

阿托伐他汀对脑梗死患者血小板GMP140、CD62P和CD63水平的影响

目的：观察阿托伐他汀对急性脑梗死患者血浆血小板仅颗粒膜蛋白（GMP-140）、P-选择素（CD62p）和溶酶体膜蛋白（CD63）水平的影响，探讨阿托伐他汀对脑梗死患者血小板活化功能的抑制作用。方法：120例急性脑梗死患者随机分为阿托伐他汀组和常规治疗组，以60例健康体检者作为正常对照组，采用双抗体夹心酶联免疫吸附法和流式细胞术分别测定治疗前和治疗4周时血浆GMP-140、CD62p和CD63水平，并应用美国国立卫生院卒中量表评分（NIHSS）标准对治疗前后进行评分。结果：急性脑梗死患者血浆GMP140、CD62p和CD63水平显著高于正常对照组（P〈0．001），且NIHSS评分与GPM-140、CD62p和CD63水平呈线性相关（r分别为0．899、0．887和0．823，P均〈0．01）。阿托伐他汀组治疗后血浆GMP-140、CD62p和CD63水平均较治疗前显著下降（P〈0．05），而常规治疗组治疗前后无明显变化。阿托伐他汀组和常规治疗组NIHSS评分明显高于治疗前（P〈0．05），且阿托伐他汀组显著优于常规治疗组（P〈0．05）。结论：阿托伐他汀能降低急性脑梗死患者血浆GMP-140、CD62p和CD63水平，具有抑制血小板活化和促进神经功能恢复的作用。     

丹红注射液辅助治疗大动脉粥样硬化型急性脑梗死效果观察

目的观察丹红注射液辅助治疗大动脉粥样硬化型急性脑梗死的效果。方法将255例大动脉粥样硬化型急性脑梗死患者随机分成观察组129例和对照组126例,均给予常规治疗,观察组另予丹红注射液治疗,疗程为15 d,治疗前后检测血小板活化标记物血小板膜糖蛋白Ⅱb/Ⅲa（PAC-1）、P选择素（CD62p）及血小板聚集率（PAG）,治疗后第15、30、90天行改良Rankin评分（mRs）评价预后。结果治疗15 d后两组PAC-1、CD62p、PAG水平均较治疗前降低（P均〈0.05）,而治疗组较对照组下降更明显（P均〈0.05）;用药后第15、30、90天两组mRs与前一时间点相比降低（P均〈0.05）,治疗组较对照组降低更明显（P均〈0.05）。结论丹红注射液可抑制血小板活化、抗血小板聚集,从而改善大动脉粥样硬化型脑梗死患者的预后。     

强化他汀类药物对伴有应激性高血糖的急性心肌梗死患者急诊介入治疗预后的影响

目的观察强化他汀类药物治疗对伴有应激性高血糖的急性ST段抬高性心肌梗死患者急诊冠状动脉介入术（PCI）后30d内预后的影响。方法52例患者在常规抗血小板治疗的基础上,随机接受常规剂量阿托伐他汀治疗（A组：n=25）或强化阿托伐他汀（B组：n=27）治疗,对比分析两组的心肌标志物、超声心动及术后不良心脏事件的发生情况。结果B组心力衰竭发生率低于A组（P〈0．05）;术后1周B组左室射血分数高于A组（P〈0．05）。结论强化他汀治疗组能够改善伴有应激性高血糖的急性ST段抬高心肌梗死患者急诊PCI术后1周内左室射血分数及30d内心衰发生率。     

瑞舒伐他汀与阿托伐他汀对ACI并高脂血症、CAS患者血脂及CAS斑块的疗效比较

目的比较瑞舒伐他汀与阿托伐他汀对急性脑梗死（ACU并高脂血症、颈动脉粥样硬化（CAS）患者血脂及CAS斑块的疗效。方法选择ACI并高脂血症及CAS患者90例,随机分为A组、B组各45例,A组口服瑞舒伐他汀、B组口服阿托伐他汀治疗,疗程均为6个月。治疗前及治疗6个月后检测两组血脂、C反应蛋白（CRP）,以及颈动脉内膜一中膜厚度（IMT）及斑块面积、数量。结果疗程结束后,两组血清TC、LDL-C、TG、CRP降低,HDL—C升高,但A组LDL-C及CRP降低较B组明显（P均〈0．05）;两组颈部IMT较治疗前明显降低,但A组斑块面积缩小较B组明显（P均〈0．05）;A组药物不良反应发生率低于B组（P〈0．O5）。结论瑞舒伐他汀与阿托伐他汀均有明显的调脂、抗动脉粥样硬化作用,但瑞舒伐他汀控制ACI并高脂血症及CAS斑块的疗效优于阿托伐他汀。     

缺血性脑卒中二级预防治疗的依从性研究

目的采取有效措施减少缺血性脑卒中再发,对缺血性脑卒中或短暂性脑缺血发作(TIA)患者采取ABCDE策略,观察患者出院后1年能否维持高水平药物治疗符合率。方法选择缺血性脑卒中或TIA患者178例,采取ABcDE策略进行规范的二级预防。观察患者出院时及出院后1年二级预防中抗血小板、降压、降糖和他汀类药物治疗的符合率。结果 178例患者中既往有缺血性脑卒中或TIA史126例,其住院前抗血小板治疗比例为41.3%,服用降压、降糖和他汀类药物治疗比例分别为89.9%、83.3%和13.5%;155例完成出院1年随访,降压治疗符合率为100%,抗血小板治疗符合率为97.2%,降糖和他汀类药物治疗符合率为98.2%和84.3%。结论采取ABCDE策略对缺血性脑卒中或TIA患者进行规范干预后,明显缩小二级预防循证证据与临床实践之间的差距,患者出院1年药物治疗符合率维持在较高水平。     

Antiplatelet therapy in the prevention of ischemic vascular events: literature review and evidence-based guidelines for drug selection.

BACKGROUND: New antiplatelet drugs are being developed and many clinical trials evaluating the benefits of antiplatelet drugs for the secondary prevention of ischemic events in patients with atherosclerotic vascular disease have been performed. HYPOTHESIS: An updated systematic review and evidence-based guidelines for the appropriate selection of antiplatelet drugs may be beneficial to physicians and healthcare organizations attempting to create or update current clinical practice guidelines or clinical pathways aimed at caring for these patients. METHODS: (1) A systematic review of the recent literature on the relative efficacy and safety of aspirin, ticlopidine, and clopidogrel was undertaken; (2) an evidence-based, expert panel approach using a modified Delphi technique to create explicit guidelines for prescribing antiplatelet therapy was instituted; and (3) the recommendations of an expert panel were summarized. RESULTS: Consensus guidelines were developed for the utilization of aspirin, ticlopidine, or clopidogrel for the prevention of ischemic events in patients with manifestations of atherosclerotic vascular disease (prior myocardial infarction, prior ischemic stroke, or established peripheral arterial disease) who are at increased risk for recurrent ischemic events. Based on efficacy and safety, clopidogrel was recommended as the drug of choice for patients with established peripheral arterial disease; aspirin or clopidogrel should be considered in patients with prior myocardial infarction (with clopidogrel favored for patients who have had a recurrent event while on aspirin or in whom aspirin is contraindicated); aspirin or clopidogrel should be considered as first-line treatment in patients with prior ischemic (nonhemorrhagic) stroke--however, clopidogrel is the favored drug in patients in whom other antiplatelet drugs are either contraindicated or who have had recurrent events while on therapy. CONCLUSIONS: Myocardial infarction, ischemic stroke, and peripheral arterial disease are all clinical manifestations of the same underlying disease process (atherosclerosis), with thrombus formation on the disrupted atherosclerotic plaque (atherothrombosis) being a common precipitating factor of ischemic events in patients suffering from these disorders. An evidence-based approach was used to develop a practice guideline, based on available published evidence, for the appropriate utilization of antiplatelet agents (aspirin, ticlopidine, or clopidogrel). These guidelines may be of use to multidisciplinary teams wishing to create or update clinical guidelines or clinical pathways which address the care of patients with atherosclerotic vascular disease. New antiplatelet agents such as clopidogrel may be more effective and associated with lower risk of selected adverse effects (such as gastrointestinal distress, gastrointestinal hemorrhage, and neutropenia) than those previously used to prevent thrombus formation in the setting of atherosclerotic arterial disease. Combination antiplatelet therapy is being evaluated as an option for those patients who experience recurrent events on a single antiplatelet agent.     

北京地区缺血性脑卒中或短暂性脑缺血发作二级预防的研究

目的对入院的缺血性脑卒中或短暂性脑缺血发作(TIA)患者采取ABCDE策略治疗,分析患者出院后能否维持高水平药物治疗的符合率。方法选择2007年8～12月连续收入北京地区21家医院神经内科病房的缺血性脑卒中和(或)TIA患者1166例,记录患者二级预防中抗血小板、降压、降糖及调脂药物等治疗情况,出院后对患者进行随访,分析出院后90d、6个月和1年二级预防中抗血小板、降压、降糖和调脂治疗的符合率。结果 1166例患者中,复发性脑卒中541例,其抗血小板治疗比例为58.4%,降压、降糖和他汀类药物治疗比例分别为82.3%、85.3%和14.2%。出院后,完成90d、6个月及1年随访的患者分别为1012例、1012例和981例,其二级预防中抗血小板、降压、降糖和调脂治疗的符合率维持在较高水平。结论复发性脑卒中二级预防现状不容乐观,采取ABCDE策略治疗,对入院的缺血性脑卒中或TIA患者进行规范干预后,明显缩小二级预防循证证据与临床实践的差距,患者出院后,二级预防治疗的符合率维持在较高水平。     

Antiplatelet and anticoagulant therapy in patients with giant cell arteritis

OBJECTIVE: Vision loss and cerebrovascular accidents often complicate giant cell arteritis (GCA). Antiplatelet and anticoagulant therapy reduce the risk of stroke in other populations. We sought to determine whether antiplatelet or anticoagulant therapy reduces ischemic complications in patients with GCA. METHODS: A retrospective chart review for patients with GCA was conducted. Included patients fulfilled modified 1990 American College of Rheumatology criteria for GCA. Collected information included demographic data, dates of antiplatelet or anticoagulant use, vision loss or stroke, and presence of bleeding complications and cerebrovascular risk factors. RESULTS: A total of 143 patients were included with a mean followup period of 4 years. The cohort included 109 women (76%) and 34 men (24%) with a mean age of 71.8 years. A total of 104 patients (73%) had a biopsy-proven diagnosis. Eighty-six patients (60.1%) had received long-term antiplatelet or anticoagulant therapy, including 18 (12.6%) who did not start therapy until after an ischemic event had occurred. Antiplatelet agents or anticoagulants were not used in 57 patients (39.9%). Overall, 11 of 68 patients (16.2%) had an ischemic event while receiving antiplatelet or anticoagulant therapy, compared with 36 of 75 patients (48.0%) not receiving such therapy (P < 0.0005). Univariate analysis failed to show a statistical difference between groups in regard to cerebrovascular risk factors, age, sex, or biopsy-proven diagnosis. Bleeding complications occurred in 2 patients receiving aspirin, 1 patient receiving warfarin, and 5 patients who did not receive anticoagulant or antiplatelet therapy. CONCLUSION: Antiplatelet or anticoagulant therapy may reduce the risk of ischemic events in patients with GCA. An increased risk of bleeding complications was not observed.     

Meta-Analysis of Secondary Prevention of Cryptogenic Stroke

BackgroundCryptogenic stroke and embolic stroke of undetermined source (ESUS) are a frequently encountered categories of ischemic stroke with an uncertain cause.MethodsWe analyzed all randomized clinical trials (RCTs) that evaluated antithrombotic therapy and patent foramen ovale (PFO) closure in cryptogenic stroke and/or ESUS. We calculated aggregate hazard ratios (HRs) using direct and network meta-analysis. The primary outcome was recurrent ischemic stroke.ResultsTen RCTs with a total of 16,876 patients, randomizing 32,143 patient-years of follow-up (mean age 61.2 ± 13.5 with 39.2% female) were identified. Anticoagulation therapy was associated with significantly reduced recurrent ischemic stroke compared with antiplatelet therapy (HR = 0.66; [95% confidence interval (CI) = 0.47–0.94]). Meta-regression analysis showed significantly reduced recurrent stroke with longer duration of therapy, and significantly increased events with advanced age. Significant interactions were observed based on the presence of PFO, stroke type, and anticoagulant used. There were no significant differences with regard to the composite ischemic outcome, transient ischemic attack, any death, major bleeding, or intracranial bleeding. In the network meta-analysis, compared to antiplatelet therapy, warfarin (HR = 0.31; [95% credible interval (CrI) = 0.12–0.68]) and PFO closure (HR = 0.14; 95% CrI = 0.05–0.31]) were associated with significantly reduced recurrent ischemic stroke. In rank order, PFO closure was associated with the best outcome, followed by warfarin.ConclusionsAmong patients with cryptogenic stroke, anticoagulation therapy, as compared with antiplatelet therapy is associated with lower rate of recurrent stroke. The small sample size and high heterogeneity with regards to bleeding outcomes require further large trials. In patients with PFO, closure and warfarin are associated with the lowest rates of recurrent stroke.     

Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks

BACKGROUND: Patent foramen ovale (PFO) is found in up to 50% of patients less than 55 years of age who have had a stroke. Therapeutic options include no therapy, antiplatelet therapy, warfarin and surgical closure of the PFO. OBJECTIVES: To determine the relative and attributable risks of PFO for recurrent cerebral ischemic events in young patients with stroke or transient ischemic attacks. The predictors of recurrent cerebral ischemic events and the effects of different therapies on recurrence rates were sought. DESIGN: Follow-up of a retrospective cohort of patients with cryptogenic stroke or transient ischemic attacks identified from an echocardiography database. SETTING: University-based regional neurology referral centre. PATIENTS: Consecutive group of 90 patients less than 60 years of age who underwent transesophageal echocardiography following a cryptogenic transient ischemic attack (TIA) or stroke (cerebrovascular accident [CVA]) between 1991 and 1997. INTERVENTIONS: Structured telephone interviews and chart reviews. RESULTS: Fifty-two patients had a PFO, and 38 patients did not have a PFO. During a mean follow-up of 46 months, 19 recurrent cerebral ischemic events (12 TIA and seven CVA) occurred in 14 patients with PFO, and eight recurrent events (three TIA and five CVA) occurred in six patients without PFO. The recurrence rates were 12% and 5%/patient/year in the PFO and control groups, respectively, for a crude recurrence rate ratio of 2.39 (95% CI 1.01 to 6.32, P < 0.03). The attributable risk of PFO in recurrent neurological events was 7%/patient/year. In a Cox regression model, predictors of recurrent neurological events were presence of PFO (hazard ratio 5.27, 95% CI 1.58 to 17.6, P < 0.007), history of migraine (hazard ratio 4.54, 95% CI 1.11 to 18.52, P < 0.035), hypertension requiring therapy (hazard ratio 3.5, 95% CI 1.33 to 9.01, P < 0.01), and antiplatelet or no therapy instead of warfarin therapy (hazard ratio 2.88, 95% CI 1.11 to 8.7, P < 0.04). Fourteen patients underwent surgical closure of PFO; there were no neurological recurrences during a mean follow-up of 43 months (crude incidence rate difference 12%/patient/year, 95% CI 6.6 to 17.9, P < 0.02). CONCLUSIONS: Patients with PFO had a significantly higher rate of recurrent cerebral ischemic events than those without PFO. Surgical PFO closure prevented any recurrences during a mean follow-up of 43 months. Warfarin was better than antiplatelet therapy or no therapy in preventing recurrences.     

The role of warfarin and aspirin in secondary prevention of stroke

Antithrombotic therapy plays a central role in secondary prevention after ischemic stroke and transient ischemic attack. The choice among warfarin, aspirin, and other antiplatelet agents, however, depends on the cause of stroke and other individual patient characteristics. The use of warfarin anticoagulation in patients with atrial fibrillation and ischemic stroke has demonstrated robust reductions in risk of recurrent events, comparable with those achieved in primary prevention. Warfarin may also be recommended for patients with other high-risk cardioembolic sources of stroke. The role of warfarin in noncardioembolic ischemic stroke is more controversial. The Warfarin Aspirin Recurrent Stroke Study found no evidence of superiority of warfarin over aspirin in stroke patients overall, nor in any major stroke subtype, including those patients with patent foramen ovale. In post-hoc analyses, there was some evidence of benefit with warfarin in patients with cryptogenic stroke without hypertension. Risks of major bleeding did not differ significantly between warfarin and aspirin groups. For most patients with noncardioembolic strokes, therefore, antiplatelet therapy is the preferred option, although clinician experience still dictates practice in individual situations. Newer antiplatelet agents, and the combination of novel agents with aspirin, are also finding a role in stroke prevention as clinical trial data become available.     

合并糖尿病或胰岛素抵抗的缺血性卒中患者的抗血小板治疗

糖尿病是缺血性卒中患者抗血小板治疗后发生血小板高反应性的独立预测因素,而后者与卒中复发风险增高密切相关.糖尿病或胰岛素抵抗患者血小板反应性增高的机制与多种因素有关,一些血液循环分子可作为预测血小板反应性增高的标记物.监测新型抗血小板药治疗后的血小板反应性,可为合并糖尿病或胰岛素抵抗的缺血性卒中患者的个体化抗栓治疗提供依据.     

有缺血性卒中史的冠心病患者经皮冠状动脉介入治疗的长期疗效

目的 探讨接受经皮冠状动脉介入治疗(PCI)且既往有缺血性卒中史的冠心病患者的临床特点和长期随访的结果.方法 回顾性分析北京协和医院2003年1月至2007年12月连续行PCI的2053例患者的临床资料,并随访至2009年12月.随访终点事件包括全因死亡、心原性死亡、支架内血栓形成、靶病变再次血管重建、再次心肌梗死、脑梗死.统计随访期间患者主要出血事件的发生率.结果 共随访1945例冠心病患者,其中222例患者既往有缺血性卒中病史.与非缺血性卒中患者比较,有缺血性卒中史患者的年龄较大(P =0.000),高血压患病率(P=0.000)、糖尿病患病率(P =0.005)和多支病变(P=0.000)比例较高.患者随访时间为(35.0±19.6)个月.与非缺血性卒中患者比较,有缺血性卒中史患者的心原性死亡(8.5％比3.9％,P =0.002)、再次脑梗死(5.8％比1.4％,P =0.000)的发生率较高,服用双联抗血小板时间差异无统计学意义[(13.77±11.33)个月比(13.94±11.33)个月,P=0.986],主要出血事件的发生率差异无统计学意义(5.8％比3.6％,P=0.100),而脑出血的发生率较高(1.8％比0.5％,P=0.028).结论 与非缺血性卒中患者比较,既往有缺血性卒中史的冠心病患者有更高的危险因素患病率,冠状动脉受累的部位更多,随访期间心原性死亡和再次脑梗死的发生率更高,在不减少双联抗血小板治疗时间的情况下脑出血的发生率更高.