Safety of percutaneous coronary intervention during uninterrupted oral anticoagulant treatment

Aims: Uninterrupted anticoagulation (UAC) is assumed to increase bleedingand access-site complications. A common consensus is to postponepercutaneous coronary interventions (PCI) to reach internationalnormalized ratio (INR) levels < 1.5–1.8. Methods and results: To assess the safety and feasibility of UAC, we analysed retrospectivelyall consecutive patients (n = 523) on warfarin therapy referredfor PCI in four centres with a policy to interrupt anticoagulation(IAC) before PCI and in three centres with a long experienceon UAC during PCI. Major bleeding, access-site complications,and major adverse cardiac events (death, myocardial infarction,target vessel revascularization, and stent thrombosis) wererecorded during hospitalization. In the IAC group, warfarinwas withdrawn for a mean of 3 days prior to PCI (mean INR 1.7).In the UAC group, mean INR value was 2.2. Glycoprotein IIb/IIIa(GP) inhibitors (P < 0.001) and low-molecular-weight heparins(P < 0.001) were more often used in the IAC group. Majorbleeding and access-site complications were more common in theIAC group (5.0% vs. 1.2%, P = 0.02 and 11.3% vs. 5.0%, P = 0.01,respectively) than in the UAC group. After adjusting for propensityscore, the group difference in access-site complications remainedsignificant [OR (odds ratio) 2.8, 95% CI (confidence interval)1.3–6.1, P = 0.008], but did not remain significant inmajor bleeding (OR 3.9, 95% CI 1.0–15.3, P = 0.05). Inmultivariable analysis, femoral access (OR 9.9, 95% CI 1.3–75.2),use of access-site closure devices (OR 2.1, 95% CI 1.1–4.0),low-molecular-weight heparin (OR 2.7, 95% CI 1.1–6.7)and old age predicted access-site complications, and the useof GP inhibitors (OR 3.0, 95% CI 1.0–9.1) remained asa predictor of major bleeding. Conclusion: Our study shows that PCI is a safe procedure during UAC withno excess bleeding complications.     

A randomized trial of low osmolar ionic versus nonionic contrast media in patients with myocardial infarction or unstable angina undergoing percutaneous transluminal coronary angioplasty

Objectives. The purpose of this study was to determine prospectively whether the differences in anticoagulant and antiplatelet effects of ionic and nonionic contrast media alter angiographic or clinical outcomes in patients with unstable ischemic syndromes undergoing percutaneous transluminal coronary angioplasty.Background. The interaction of platelets and thrombin with the endothelium of injured vessels contributes to thrombosis and restenosis after coronary angioplasty. Case reports and retrospective observations have reported an increased risk of thrombosis with the use of nonionic contrast media.Methods. A total of 211 patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty were randomized to receive nonionic or ionic low osmolar contrast media. Coronary angiograms were assessed by a technician blinded to the study contrast media, and clinical events were monitored by an independent nurse for 1 month.Results. Patients receiving the ionic media were significantly less likely to experience decreased blood flow during the procedure (8.1% vs. 17.8%, p = 0.04). After the angioplasty, residual stenosis, vessel patency, the incidence of moderate to large thrombi and use of adjunctive thrombolytic therapy were similar between the two groups. However, patients receiving ionic media had fewer recurrent ischemic events requiring repeat catheterization (3.0% vs. 11.4%, p = 0.02) and repeat angioplasty during the initial hospital stay (1.0% vs. 5.8%, p = 0.06). One month after angioplasty, patients receiving ionic contrast media reported significantly fewer symptoms of any angina (8.5 vs. 20.0%, p = 0.04) or of angina at rest (1.4% vs. 11.8%, p = 0.01) and a reduced need for subsequent bypass surgery (0% vs. 5.9%, p = 0.04), compared with patients receiving the nonionic media.Conclusions. These findings demonstrate that in patients with unstable ischemic syndromes undergoing coronary angioplasty, the use of ionic low osmolar contrast media reduces the risk of ischemic complications acutely and at 1 mouth after the procedure. Therefore, low osmolar ionic contrast media should be strongly certified when performing interventions in patients with unstable angina or myocardial infarction.     

Extensive exfoliative dermatitis induced by non-ionic contrast medium Iodixanol (Visipaque) used during percutaneous coronary intervention

Cor triatriatum is a rare congenital defect in which a fibromuscular membrane divides the left atrium into two distinct chambers. We described a case of cor triatriatum with interesting Doppler flow signal in a 39-year-old female. The diagnosis was confirmed on cardiac catheterization and surgery.     

Cardiac events after low osmolar ionic or isosmolar nonionic contrast media utilization in the current era of coronary angioplasty.

OBJECTIVES: Our study aimed to compare the isosmolar nonionic dimer iodixanol and the low osmolar ionic agent ioxaglate in the current era of percutaneous coronary intervention (PCI), using clopidogrel, enoxaparine, direct stenting, and drug eluting stent. BACKGROUND: Previous studies have suggested an association between thrombus-related events and type of contrast media. METHODS: Our prospective single-center study included 498 consecutive patients who were assigned to receive either iodixanol (n = 231) or ioxaglate (n = 267). The primary endpoint was the cumulative rate of in-hospital major adverse clinical events (MACE). A secondary endpoint was the rate of angiographic or procedural complications. RESULTS: Clinical and angiographic baseline characteristics and procedural data were similar in the 2 groups. A peak anti-Xa > 0.5 IU/ml was obtained in 97% in both groups. Glycoprotein IIb/IIIa inhibitors were used in 42% of patients. Coronary stenting was performed in 91% of patients, with direct stenting in 70%, and drug-eluting stent in 28% of patients. In-hospital MACE was more frequent in patients receiving iodixanol compared with those receiving ioxaglate (4.8% vs. 0.3%, P < 0.005). This difference was mainly related to the appearance of a large thrombus during PCI (6% with iodixanol vs. 0.3% with ioxaglate, P < 0.0001). In multivariate analysis, independent predictors of in-hospital MACE were use of iodixanol (P < 0.01), the higher number of stent used (P < 0.008), bifurcation/ostial lesion (P < 0.01), and balloon dilation before stenting (p < 0.001). CONCLUSIONS: In our study reflecting the current era of PCI, thrombus-related events are more frequent with the isosmolar nonionic dimer iodixanol than with the low osmolar ionic agent ioxaglate.     

Early hemodynamic reactions of an ionic low osmolar and a nonionic contrast medium

In eighty patients with different cardiac diseases the theoretically claimed reduced cardiovascular side effects in ionic and non-ionic low osmolar contrast media compared to those in conventional ionic and high-osmolar contrast media were tested during heart catheterization. The randomized application showed that there were only few reactions during left ventricle angiography and they did not differ between various ejections, while during selective coronary angiography in most cases heart rate and aortic pressures dropped significantly (p less than 0.05). These alterations were significantly (p less than 0.05) stronger in the conventional ionic and high-osmolar ioxitalamat (Telebrix 350) than in the ionic and non-ionic low-osmolar ioxaglat (Hexabrix) or non-ionic low-osmolar iopamidol (Solutrast 370).     

冠状动脉介入治疗中冠状动脉夹层形成的多因素回归分析

目的:探讨影响冠状动脉介入治疗(PCI)中冠状动脉夹层形成的独立危险因素。方法:回顾性分析142例住院期间行经PCI患者的临床和血管造影及处理资料。用单因素和多因素回归方法分析了患者性别、年龄、靶病变形态学、术中球囊扩张等24个变量与冠状动脉夹层发生的关系。结果:在单因素分析中发现:并发糖尿病者,多支病变,B型、C型病变,靶血管病变长度>15mm,夹层组高于对照组;偏心性病变,钙化病变比例夹层组显著高于对照组。球囊扩张次数夹层组明显高于对照组。多元Logistic回归分析发现:病变长度>15mm、偏心性病变、钙化病变、病变直径狭窄率、球囊扩张次数是PCI中冠状动脉夹层形成的独立危险因素。结论:靶血管直径狭窄率、病变长度>15mm、偏心性病变、钙化病变、球囊扩张次数是冠状动脉夹层形成的最重要的独立危险因素。且具有一定的预测价值。     

Comparison of high and low osmolar roentgen contrast media in quantitative coronary angiography

In 48 patients undergoing diagnostic coronary angiography changes of mean diameters of angiographically "normal" coronary segments after intracoronary injections of diatrizoate 76% or iopromide 370 performed in different intervals, were analyzed with a computer-assisted contour detection system (CAAS). Four study protocols were applied, differing in respect to the type of contrast medium administered and/or to the timing of the reference- and control-angiograms in the course of diagnostic coronary angiography. Coronary angiograms in identical projections were performed before (= reference) and directly after (1. control = C1) diagnostic angiography of the left coronary artery by injection of either diatrizoate 76% (group 1, 10 patients) or iopromide 370 (group II, 11 patients). Additional coronary angiograms were performed 1, 3, 6, and 10 min after C1. During diagnostic angiography in either group about eight dye injections were performed in about seven min. With diatrizoate 76% a significant coronary dilation averaging 18.9 +/- 6.7% (p less than 0.001) was observed at C1, depending on the number of diagnostic dye injections performed per min (mean 1.2 +/- 0.3) and on the interval between the last diagnostic injection and C1 (mean 73 +/- 35 s). Coronary dilation persisted up to the sixth minute (6.2 +/- 4.6%, p less than 0.01). With iopromide 370 a small but significant coronary dilation was observed merely at C1 (5.8 +/- 4.3%, p less than 0.05). In two other studies coronary angiograms were performed in identical projections immediately following complete diagnostic coronary angiography (reference) and in addition after 3, 4, 5, 6, 10, and 20 min (group III, 18 patients) and after 10, 20, and 30 min, respectively (group IV, 9 patients) by administration of diatrizoate 76% as the only contrast medium. Short injection intervals (1 min) resulted in a mild coronary dilation (mean up to 2.4 +/- 4.1% compared to reference; p less than 0.05), longer intervals (3-10 min) resulted in a marked diameter reduction (averaging up to -9.7 +/- 9%; p less than 0.05), probably a consequence of the return of coronary vasomotor tone to baseline levels. These results suggest that in quantitative coronary angiographic studies (e.g., testing coronary vasomotility) non-ionic contrast media should preferably be applied, and adequate injection intervals (greater than 2 min) are mandatory. In intervention- and follow-up studies based on repeated coronary angiograms dye-induced changes of coronary vasomotor tone can be avoided by premedication with vasodilating drugs, e.g. nitrates, and/or calcium antagonists.     

Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention

Background: At the Istituto di Clinica Medica Generale e Cardiologia (Florence, Italy), the widespread use of percutaneous coronary intervention (PCI) has markedly changed the hospital course of patients with acute myocardial infarction (AMI). These patients are typically transferred to the coronary care unit (CCU) only after primary PCI, whereas during the thrombolytic era, patients were first admitted to CCU before reperfusion. Objectives and Methods: The incidence, timing and setting of complications from symptom onset to hospital discharge in 689 consecutive AMI patients undergoing PCI were evaluated. Results: Ventricular fibrillation occurred in 11% of patients, and most episodes (94.7%) occurred before or during PCI. Of all patients, 6.3% developed complete atrioventricular block (CAVB), and in 86.3% of these cases, the CAVB occurred before or during PCI; in 94.5%, a CAVB resolution occurred in the catheterization laboratory (CL). Thirty-one patients (4.5%) had impending shock on admission to the CL. Cardiogenic shock developed in 2 9 patients (4.2%), mostly in the prehospital phase or in the CL. Only four patients (less than 1%) developed cardiogenic shock later during their hospital course. Similarly, circulatory and ventilatory support, as well as temporary pacing and cardiac defibrillation, were used mostly in the prehospital phase or in the CL. During the CCU stay, 45 patients (6.5%) had hemorrhagic or vascular complications, and the incidence of post-PCI ischemia and early reocclusion of the culprit vessel were low (2.1% and 0.6%, respectively). Thus, cardiac complications usually associated with AMI were observed mainly before hospital admission or in the CL during the reopening of the target vessel. These complications were rarely observed after a successful PCI. Conclusions: For AMI patients, the CL is not only the site of PCI, it is also where most life-threatening cardiac complications are observed and treated.     

ST段抬高急性心肌梗死直接经皮冠状动脉介入治疗与溶栓或保守治疗的对比研究

目的评价对ST段抬高急性心肌梗死(AMI)患者直接经皮冠状动脉介入治疗(PCI)的临床疗效.方法将2000年4月至2004年4月入院的458例ST段抬高AMI患者,非随机分为有创组(PCI治疗)205例和无创组(静脉溶栓或药物保守治疗)253例,比较两组死亡率、主要心血管事件发生率、再梗死率以及第2周超声心动图检查左室舒张末期前后径(EDD)和左心室射血分数(LVEF),并根据冠状动脉造影结果,分成单支、双支、三支病变组,探讨不同病变支数对左室功能的影响.结果205例PCI患者中,术中造影显示单支血管病变66例(32.2%),双支病变68例(33.2%),三支病变71例(34.6%),手术成功率99%,共置入支架228枚,术后194例(94.6%)患者梗死相关动脉(IRA)达TIMI 3级血流;有创组与无创组比较,住院30 d死亡率为2.9%vs9.1%(P＜0.01),主要心血管事件发生率为9.8%vs26.5%(P＜0.005),再梗死率为2.0%vs8.7%(P＜0.005);有创组第2周超声检查LVEF水平显著高于无创组[(59.87%±8.32%)vs(54.43%±10.21%),P＜0.001],EDD水平显著低于无创组[(53.02±5.51)mm vs(56.82±7.66)mm,P＜0.001];有创组中单支血管病变组的LVEF比双支和三支血管病变组高(P＜0.01),而EDD低于后两者(P＜0.01).结论直接PCI能及时有效地开通IRA,挽救濒死心肌,改善左室功能,明显降低死亡率,手术成功率高,是AMI获得早期再灌注的首选治疗措施.     

择期冠状动脉介入治疗中并发严重心律失常分析

目的探讨择期经皮冠状动脉介入治疗（PCI）中心律失常发生的危险因素。方法纳入2000年1月~2011年12月在我院行PCI发生严重心律失常患者资料,回顾性统计分析相关危险因素。结果 12年PCI术中严重心律失常累计发生率为5.7%,2005年后发生率明显下降。严重心律失常相关危险因素包括：右冠开口或左主干病变、有心力衰竭或心肌梗死病史。结论右冠开口或左主干病变、有心力衰竭或心肌梗死病史均为PCI中严重心律失常发生的危险因素,提高临床技能及改善临床仪器设备可使得严重心律失常的发生率逐渐降低。     

经皮冠状动脉介入治疗时无再流现象的处理

目的初步探讨冠状动脉(冠脉)内注射尿激酶及地尔硫对经皮冠状动脉介入治疗(PCI)中“靶血管”病变无再流现象的临床疗效。方法86例急性冠脉综合征患者实施介入治疗出现靶血管的无再流,首先给予冠脉内硝酸甘油,其78例血流无改善,并将其分为3组:A组26例,交替给予尿激酶及地尔硫冠脉内注射,尿激酶最大量20×104U,地尔硫最大量2mg;B组24例,给予地尔硫冠脉内注射,每次500μg,最大量2mg;C组28例,给予尿激酶冠脉内注射,最大量20×104U。结果A组26例TIMI血流明显改善,P<0.01。B组18例TIMI血流改善,P<0.05;6例无改善者继续予尿激酶1×105～2×105U推注后TIMI血流3级者4例,TIMI血流2级者2例。C组20例TIMI血流改善,P<0.05;8例无改善者继续予地尔硫500μg～2mg推注后TIMI血流3级者6例,TIMI血流1级者2例,其中术后24小时死亡1例。3组相比,术后A组TIMI血流改善更为显著,P<0.05。结论无再流现象与靶血管远端的冠脉微血栓形成及痉挛均有关,PCI中给予冠脉内小剂量尿激酶及地尔硫安全有效,应在今后处理中推广应用。     

经皮冠状动脉介入治疗中腺苷的心肌保护作用研究

目的评价经皮冠状动脉介入治疗(PCI)中冠状动脉内(IC)应用腺苷的心肌保护作用。方法对2004年12月至2006年4月在河北医科大学第一医院和石家庄市第三医院住院且符合入选条件的111例冠心病患者随机分为生理盐水IC注射组55例(对照组)与腺苷IC注射组56例(腺苷组)。对照组予以生理盐水,腺苷组用腺苷300μg,持续IC注射1min,观察IC心电图(IC-ECG)ST段最大抬高程度、术后心脏肌钙蛋白I(cTnI)峰值及左心室射血分数(LVEF)。急性心肌梗死(AMI)患者按心肌梗死溶栓试验血流分级对梗死相关动脉进行再通后血流评价,并分析术后1h心电图ST段抬高总和回落百分比(sumSTR)。结果腺苷组患者术后cTnI峰值低于对照组(P<0.05)。AMI时sumSTR腺苷组下降幅度较对照组明显(P<0.05);PCI后4周无论腺苷组还是对照组LVEF均比3d时有明显改善(P<0.05),4周时腺苷组LVEF较对照组改善更显著(P<0.05)。择期PCI患者腺苷组与对照组IC-ECG的ST段抬高发生率及抬高的程度低于对照组。结论PCI时IC注射腺苷,可以减轻心肌微损伤,显著缓解AMI血管开通背景下发生的缺血-再灌注损伤,并有益于改善左心功能。     

远端血栓保护装置PercuSurge用于急性冠状动脉综合征经皮冠状动脉介入治疗

目的　评价在高危急性冠状动脉综合征 (ACS)患者的经皮冠状动脉介入治疗 (PCI)过程中联合应用远端血栓保护装置PercuSurge预防远端血栓栓塞的安全性及有效性。方法　 15 4例ACS患者接受了PCI。其中 ,74例ACS患者 (男 6 5例 ,女 9例 ,平均年龄 5 7± 10岁 ,ST段抬高心肌梗死 5 3例 ,不稳定型心绞痛及非ST段抬高心肌梗死 2 1例 )在PercuSurge装置的保护下进行PCI(PercuSurge组 ) ;80例ACS患者 (男 6 8例 ,女 12例 ,平均年龄 (5 6± 10岁 ,ST段抬高心肌梗死 5 8例 ,不稳定型心绞痛及非ST段抬高心肌梗死 2 2例 )进行无保护的常规PCI(对照组 )。首要研究终点是院内和 30d的MACE。次级研究终点是PCI术后的TIMI血流和PercuSurge的临床疗效及并发症。结果　两组全部病例均成功地置入血管支架 ,PercuSurge组全部成功放置PercuSurgeGuardWire保护装置 ,平均阻滞球囊直径 4 8± 0 6mm ,平均阻滞时间 9± 7min。PercuSurge组术后TIMI 3级血流率显著高于对照组(94 5 9%与 81 2 5 % ,P <0 0 5 )。并发症包括 1例血管夹层 (1 35 % )、1例远端小血管血栓栓塞(1 35 % )、1例PercuSurge导丝所致血管穿孔 (1 35 % )。PercuSurge组院内及 30d主要不良心脏事件(MACE)显著低于对照组 (分别为 4 0 5 %与 16 2 5 %、2 70     

Adverse reactions of low osmolality contrast media during cardiac angiography: a prospective randomized multicenter study.

A multicenter study was performed to determine the incidence of adverse reactions to two contrast media with similar low osmolality during cardiac angiography. The study was of a randomized double-blind design comparing ioxaglate (an ionic dimer) and iopamidol (a nonionic compound) and included 500 patients; 250 patients received ioxaglate and 250 iopamidol. There were 58 adverse reactions attributed to the contrast media in the ioxaglate group and 29 in the iopamidol group (p less than 0.001). Chest pain occurred in 11 patients in the ioxaglate group compared with 5 in the iopamidol group (p = 0.123). Nausea or vomiting was present in 20 and 2 patients, respectively (p less than 0.0003). Allergic adverse reactions, such as bronchospasm, urticaria and itching, occurred in 15 of the ioxaglate group and only 1 of the patients receiving iopamidol (p less than 0.0007). Fifty-two patients in the ioxaglate group had a known allergic history (not to contrast medium) or asthma, whereas 77 receiving iopamidol had a similar history. Seven of the 52 ioxaglate-treated patients developed an allergic adverse reaction compared with none of the 77 in the iopamidol group (p = 0.001). Of 41 patients receiving ioxaglate who were premedicated with diphenhydramine, 4 had an allergic adverse event. In the iopamidol group 45 patients received similar premedication and none had an allergic adverse reaction (p less than 0.03). Thus, this multicenter study shows that adverse reactions occur more often with ioxaglate than with iopamidol and that patients with an allergic history have a greater risk with ioxaglate therapy compared with iopamidol.     

Effects of an ionic versus a nonionic low osmolar contrast agent on the thrombotic complications of coronary angioplasty

An increasing body of evidence suggests that the potential for thrombotic complications is greater with nonionic than with ionic contrast agents. This is a particularly important consideration in the highly thrombogenic setting of percutaneous transluminal coronary angioplasty (PTCA). To explore this issue further, 500 consecutive patients undergoing PTCA were prospectively randomized to receive the low osmolality ionic ioxaglate or the nonionic agent iohexol. The number of acute thrombotic in-laboratory events was significantly less in the ioxaglate than in the iohexol group (8 versus 18; P < 0.05), but there was no significant difference between the 2 groups as regards the number of out-of-laboratory acute rethrombotic events. With multivariate analysis, use of the nonionic agent rather than the ionic agent emerged as an independent predictor of acute in-laboratory rethrombosis. These data suggest that, in the performance of PTCA, an ionic, rather than a nonionic, should be the preferred contrast agent. © 1993 Wiley-Liss, Inc.     

达肝素与普通肝素对血浆抗凝血因子Ⅹa活性及活化凝血时间影响的对比研究

目的探讨冠心病患者择期PCI及冠状动脉造影术中应用达肝素替代普通肝素的可行性和有效性。方法共入选拟行择期PCI的患者87例,分为普通肝素组（10 000 IU）、小剂量（5 000 IU）达肝素组和大剂量（10 000 IU）达肝素组,分别于用药前及全部剂量的药物注射后10 min、20 min、1 h、2 h及4 h采血,测定活化凝血时间（ACT）及血浆抗凝血因子Ⅹa活性。结果（1）普通肝素组、小剂量达肝素组和大剂量达肝素组ACT均在全部剂量的药物注射后10 min升高至峰值,分别为524.68±278.32 s、191.26±39.35 s、304.20±42.71 s（P〈0.05）;其后各组ACT开始逐渐回落,在4 h后降至最低。（2）三组抗凝血因子Ⅹa活性均在药物全部注射后20 min达到峰值,分别为0.80±0.11 IU/mL、0.72±0.10 IU/mL及0.72±0.09 IU/mL,但各组间差异无统计学意义（P〉0.05）。结论与普通肝素相比,达肝素用于PCI中可达到手术所需抗凝效果。     

Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study.

AIMS: Retrospective studies and post hoc analyses have suggested that mild elevations in the creatine kinase-MB (CK-MB) isoenzyme following percutaneous coronary intervention (PCI) may be associated with an increased risk of death in the long term. However, this finding is still controversial, and the prognostic significance of elevations of more sensitive markers of myocardial damage, such as the cardiac troponins, has not been established. In this multicentre prospective cohort study, we evaluated the influence of post-procedural elevations of CK-MB and troponin I (cTnI) on long-term mortality. METHODS AND RESULTS: The CK-MB and PCI study included 3494 consecutive patients undergoing PCI from February 2000 to October 2000 in 16 Italian tertiary centres. Blood samples were collected at baseline, and at 8-12 and 18-24 h after the procedure, and were analysed in a core biochemistry laboratory. CK-MB elevation was detected in 16% of the patients, and was associated with increased 2-year mortality [7.2 vs. 3.8%; odds ratio (OR): 1.9; 95% confidence interval (CI): 1.3-2.8; P<0.001). The degree of CK-MB elevation (peak CK-MB ratio) independently predicted the risk of death (adjusted OR per unit: 1.04; 95% CI: 1.01-1.07; P=0.009). A cTnI elevation was detected in 44.2% of the cases and was not associated with a significant increase in mortality (4.9 vs. 4.0%; OR: 1.2; 95% CI: 0.9-1.7; P=0.2). CONCLUSION: Post-procedural elevations of CK-MB, but not cTnI, influence 2-year mortality.     

The pathogenesis and treatment of no-reflow occurring during percutaneous coronary intervention

No-reflow is one of the major causes of postinterventional rise of cardiac enzyme and myocardial infarction (MI). This complication is associated with substantial morbidity and mortality after percutaneous coronary intervention (PCI). During and after a no-reflow episode, the patient can suffer from severe chest pain, hypotension, bradycardia, hemodynamic collapse, MI, congestive heart failure, and death. Every effort should be taken to reduce the incidence of this complication. The distal embolic protection device has been shown to decrease this risk in saphenous vein graft (SVG) interventions but not in native coronaries. On the other hand, the use of glycoprotein IIb/IIIa receptor antagonists have been effective in reducing the occurrence of no-reflow during PCI of native coronaries but not during SVG interventions. The treatment of no-reflow is based on the intracoronary administrations of medications that induce maximal vasodilatation in small distal coronary vasculature. The most commonly used drugs in this setting are adenosine, nitroprusside, and verapamil. The goal of this study was to review the pathogenesis and treatment of no-reflow in patients undergoing PCI.     

中国经皮冠状动脉介入治疗的康复程序(讨论稿)

国内、外研究证明经皮冠状动脉介入治疗(PC I)后的患者是适合心脏康复的对象[1,2];PC I后患者经心脏康复医疗(教育、运动、)较对照组可显著增加运动贮量[3~5,11,12],降低血脂水平[5,11,12],显著改善心功能,减少心肌耗氧量[7,8],显著减少再狭窄[9,11],减少并发症[11,12]。康复运动有效的机制可能是运动可显著减少血内皮素水平,提高血一氧化氮、降钙素基因相关肽水平[10],提高纤溶酶的活性,降低血小板的活性,抑制平滑肌细胞增生,从而扩张冠状动脉,增加运动贮量,减少冠脉血栓形成,减轻或逆转动脉硬化病变[2]。目前国内、外尚未见PC I后康复…