冠心病患者MHR与冠脉狭窄程度的相关性及其临床意义

目的 探讨冠心病患者单核细胞数与高密度脂蛋白胆固醇比值（MHR）与冠状动脉狭窄程度的相关性及其临床意义。 方法 冠脉造影患者407例，根据造影结果分冠心病组（冠脉狭窄程度≥50%）306例和对照组（冠脉狭窄程度<50%）101例，冠脉狭窄程度用Gensini积分表示，收集并比较两组临床资料差异，采用多因素Logisitic回归分析影响冠脉狭窄程度的因素，采用Pearson相关分析MHR与Gensini积分相关性，采用ROC曲线分析MHR诊断冠心病的价值。 结果 冠心病组Gensini积分、MHR、单核细胞计数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇高于对照组（均P<0.01），高密度脂蛋白胆固醇低于对照组（P<0.01）；多因素Logisitic回归分析显示MHR是影响冠脉狭窄程度的独立因素（Wald χ2=10.397，P<0.01）；Pearson相关分析示冠心病患者MHR与冠脉Gensini积分呈正相关（r=0.672，P<0.05）；ROC曲线显示MHR曲线下面积为0.742（95%CI:0.693-0.792），当MHR截断点为0.35时，其诊断效率最高，灵敏度为62.7%，特异度为77.2%，准确度为73.5%。 结论 冠心病患者MHR是冠脉狭窄程度的独立相关因素，可作为临床诊断冠心病的重要参考指标。     

经皮冠状动脉介入治疗术后急性、亚急性支架内血栓形成的危险因素分析

目的:探讨经皮冠状动脉(冠脉)介入治疗(PCI)后急性、亚急性支架内血栓形成(AST/SST)的危险因素及其冠脉造影特点,以早期识别高危患者并减少该并发症的发生。方法:回顾性分析2007-01至2011-01收治的冠心病行PCI术者5 129例的临床资料,其中冠脉造影证实AST/SST(AST/SST组)43例。按年龄、性别(3∶1)匹配原则抽取PCI术后未出现AST/SST者120例作为对照组。采用logistic回归模型分析AST/SST的独立危险因素。结果:AST/SST平均时间(4.1±5.7)d。院内死亡率13.95%(6/43)。AST/SST组糖尿病比例及血肌酐、空腹血糖高于对照组(P<0.05);AST/SST组支架置入前1周内心绞痛发作及1个月内急性心肌梗死史比例均高于对照组(P<0.05、<0.01),差异均有统计学意义。左心室射血分数、血压、血脂等各项指标差异均无统计学意义。冠脉造影AST/SST组出现B2/C病变比例、支架贴壁不良比例和支架数目均高于对照组,差异均有统计学意义(P<0.05～0.01)。应用条件lo-gistic回归分析确定PCI术后AST/SST的独立危险因素:糖尿病(比值比1.447,95%可信区间1.101～1.902,P=0.008)、急性心肌梗死(比值比7.177,95%可信区间1.956～26.328,P=0.003)、多支架置入(比值比2.186,95%可信区间1.326～3.604,P=0.002)、支架贴壁不良(比值比7.590,95%可信区间1.389～41.475,P=0.019)是AST/SST的独立危险因素,高左心室射血分数(比值比0.988,95%可信区间0.979～0.998,P=0.016)是PCI术后并发AST/SST的保护因素(P均<0.05)。结论:糖尿病、急性心肌梗死、多支架置入、支架贴壁不良是PCI术后并发AST/SST的独立危险因素。高左心室射血分数是PCI术后并发AST/SST的保护因素。     

中性粒细胞与淋巴细胞比值结合CHA2DS2-VASc评分与急性冠脉综合征的相关性

目的 探讨运用中性粒细胞与淋巴细胞比值（NLR）结合CHA2DS2-VASc评分系统对急性冠脉综合征患者（ACS）冠状动脉病变程度和行经皮冠状动脉介入(PCI)治疗中住院期间心血管事件的预测价值。 方法 分析2016年1月～2019年1月芜湖市第二人民医院因为发生ACS行PCI治疗的患者657（男 471、女 186)例;年龄(76±14）岁,所有入选患者均利用CHA2DS2-VASc评分系统进行评分,记录患者的临床基本资料、NLR、PCI手术相关信息、实验室检查结果,住院时间和住院期间发生的主要不良心血管事件(MACE);记录手术中冠状动脉病变情况和相关SYNTAX评分,分3组:低危组（评分≤22）（n＝332）;中危组（评分23～32）（n＝230）;高危组（评分≥33）（n＝95）。分别采用单因素和多因素logistic回归分析确定CHA2DS2-VASc评分结合NLR能否预测冠状动脉病变程度（SYNTAX评分评价）和住院期间MACE。 结果 logistic回归分析表明冠状动脉病变程度和住院MACE的危险因素包括吸烟史、NLR、慢性肾脏病变、CHA2DS2-VASc评分(P<0.01);多元回归分析CHA2DS2-VASc评分≥3（OR值3.028,95%可信区间1.627-5.517,P<0.01）,NLR≥5.23（OR值2.901,95%可信区间1.260-5.370,P＜0.01）是冠状动脉病变程度SYNTAX评分高危组独立预测因子。多因素Cox逐步回归分析CHA2DS2-VASC评分（HR值1.365,95%可信区间1.120-1.702,P<0.01）和NLR（HR值2.20,95%可信区间1.120-4.520,P<0.05）与ACS住院病死率相关。 结论 NLR和 CHA2DS2-VASc评分具有判定ACS冠状动脉病变严重程度和住院期间MACE的预测价值,可用于PCI手术前评估及危险分层,确定相应的治疗方案,降低ACS患者PCI手术中无复流和住院MACE的发生。     

药物涂层球囊在急性ST段抬高型心肌梗死介入治疗中安全性和有效性

目的 观察急性ST段抬高型心肌梗死（STEMI）患者行经皮冠状动脉介入（PCI）术时，应用药物涂层球囊治疗的安全性和有效性。 方法 选取2018年（9～12）月共80例因STEMI就诊于我科的患者，将受试对象随机分为药物涂层球囊治疗组（球囊组，n=38）和药物洗脱支架（DES）治疗组（支架组，n=42）。术后常规随访1年，了解术后1个月、6个月和1年的心脏彩超左心功能、主要不良心血管事件（MACEs）发生率，术后1年时复查冠脉造影了解两组晚期管腔丢失（LLL）情况。 结果 术后6个月和1年随访时，两组心脏彩超左室射血分数（LVEF）和左室舒张末期内径（LVEDD）均较住院期间有所改善（P<0.05），两组之间比较差异无统计学意义。球囊组靶病变LLL为（?0.12±0.46）mm，而支架组靶病变LLL为（0.14±0.37）mm（P<0.05）。1年内球囊组MACEs发生率为11%，支架组MACEs事件发生率12%，两组比较差异无统计学意义。 结论 STEMI行PCI治疗时单纯DCB治疗是安全有效的，并且在1年随访期内显示出良好的临床结果。     

血浆miR-142a-5p水平预测急性肺损伤患者28天病死率的价值

目的：探讨急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）后血液中单核细胞计数/高密度脂蛋白的比值（MHR）与主要不良心血管事件（MACE）的相关性。方法： 收集接受PCI的120例ACS患者的临床资料，分为院内出现MACE组和正常出院组（ND组），比较2组患者的MHR水平，采用Logistic回归分析各因素与ACS患者发生MACI的关系，采用Spearman分析法分析MHR与Gensini评分相关性；采用受试者工作特征曲线(ROC)分析MHR对MACE的预测价值。结果： MACE组患者年龄、高血压、Gensini评分、MHR、载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB） 、脂蛋白（LP）、尿酸（UA）水平明显高于ND组（P均＜0.05），MHR、LP(a)为ACS患者的独立危险因素（P均＜0.05），MHR与Gensini评分呈正相关(r=0.832，P＜0. 05)， MHR的预测临界值为9.45，MHR≥9.45的患者1年内再次住院率明显高于MHR＜9.45的患者。结论： 血清MHR与ACS患者PCI术后冠状动脉病变的严重程度呈正相关，可作为ACS患者PCI术后发生院内MACE的独立预测因素。     

血脂控制水平与冠状动脉支架置入术后支架内再狭窄的相关性研究

目的:探讨血脂控制水平与经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的相关性。方法:收集2012-01至2012-12在兰州大学第一医院心脏中心住院首次行PCI的冠心病患者211例,所有患者均常规口服双联抗血小板、他汀类药物,并于术后3~12个月再次入院行冠状动脉造影,根据造影结果分为两组,其中ISR组25例,无ISR组186例,所有入选患者于PCI术前及复查造影时采集外周静脉血,全自动生化分析仪检测总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇,定量分析两次血脂水平,探讨其与冠状动脉ISR的关系。结果:两组患者中年龄、性别、高血压患病率、冠心病家族史、术前诊断急性冠状动脉综合征、吸烟、饮酒比例等方面的差异均无统计学意义(P0.05),PCI术前总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平差异均无统计学意义(P0.05);ISR组合并2型糖尿病的患者比例(36.0%)较无ISR组(17.7%)差异有统计学意义(P=0.03)。Logistic多因素逐步回归分析显示,PCI术后总胆固醇未下降(比值比=1.07,95%可信区间:0.38~2.62,P=0.04)、低密度脂蛋白胆固醇未控制在1.8 mmol/L以下或较PCI术前未下降50%(比值比=11.33,95%可信区间:3.62~35.52,P0.01)以及合并2型糖尿病(比值比=3.00,95%可信区间:1.04~8.67,P=0.04)与ISR呈正相关。结论:PCI术后总胆固醇未下降、低密度脂蛋白胆固醇未达标是后期ISR发生的高危因素,合并2型糖尿病的患者PCI术后发生ISR的风险明显增高。     

三种数据对冠心病患者冠状动脉病变严重程度的诊断价值

目的 探讨血清中性粒细胞百分比与白蛋白比值（NPAR）、中性粒细胞数与高密度脂蛋白胆固醇比值（MHR）、肌酸激酶同工酶MB（CK-MB）对冠心病患者冠状动脉病变严重程度的诊断价值。 方法 连续纳入2016 年1 月～2018 年12月承德医学院附属医院心内科收治的3937例冠心病患者作为研究对象,对冠脉造影结果进行Gensini评分,将 Gensini 评分<14分的患者作为轻症组(n=1339),Gensini评分≥14分患者作为重症组(n=2598)。收集所有患者的临床资料,记录CK-MB、NPAR、MHR。建立二元Logistic回归模型和受试者工作特征(ROC)曲线,分析单项指标以及联合检测对冠状动脉病变严重程度的预测价值。 结果 冠脉病变重症组患者血清NPAR、MHR和CK-MB水平显著高于轻症组(P<0.01)。二元Logistic回归结果示,血清NPAR、MHR和CK-MB是影响冠状动脉病变程度与评估冠脉严重程度的危险因素 (P<0.05)。上述得出,预测模型为 P =1 /［1 + e－(?0.522+0.11×NPAR +0.54×MHR + 0.06×CK-MB)］。ROC曲线显示血清NPAR、MHR及CK-MB的曲线下面积分别为0.775、0.618和0.615,而三者联合检测的预测概率为0.80,显著高于单个指标。 结论 冠心病患者血清NPAR、MHR、CK-MB与患者冠状动脉病变严重程度密切相关,上述指标联合应用,可以非常显著的提高对冠心病患者病情严重程度的预测价值。     

超高龄冠心病患者冠状动脉介入术后的随访研究

目的 分析接受经皮冠状动脉介入（PCI）治疗的超高龄患者的随访资料，探讨影响患者预后的危险因素。 方法 入选行冠脉支架植入术1年以上并接受冠状动脉造影复查的患者共397例，根据年龄是否≥80岁分为超高龄组（n=67）与对照组（n=330）。比较两组的临床资料特点、晚期支架内再狭窄率以及超声心动指标，对患者进行长期随访，分析不良心血管事件的发生率。采用Logistic回归分析影响预后的危险因素。 结果 超高龄组患者平均年龄（83 ± 3）岁，明显高于对照组患者（63 ± 9）岁 （P<0.01）。超高龄组患者晚期支架内再狭窄率为40%，对照组患者为32%，组间差异无统计学意义。与对照组患者比较，超高龄组患者白细胞（P<0.05）、血红蛋白含量（P<0.01）、总三碘甲腺原氨酸（T₃）（P<0.01）以及游离T₃ （P<0.01）的水平均偏低；而高血压（P<0.05）及血清肌酐（P<0.01）水平偏高；与对照组患者超声心动结果比较，超高龄组患者室间隔厚度偏大，左室舒张末径偏小，差异有统计学意义（P<0.05）。两组患者射血分数无统计学差异。随访期间，超高龄组的不良事件发生率比对照组显著增加（P<0.01），两组不良事件的构成比例无显著差异；年龄是影响PCI患者预后的独立危险因素。 结论 超高龄PCI患者合并其他系统疾病更常见，远期预后更差。年龄是影响PCI手术远期预后的独立危险因素。     

急性冠脉综合征患者PCI前后血浆Alarin和Leptin水平变化的意义

目的 通过测定急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）前后血浆Alarin和瘦素（Leptin）的水平变化,探究两者的变化规律在ACS患者中的意义。 方法 收集2019年12月～2020年12月期间于承德医学院附属医院行PCI治疗的ACS患者100例,分为急性心肌梗死（AMI）组46例,不稳定型心绞痛（UA）组54例,同期选取经冠脉造影检查证实无冠脉病变的患者33例为对照组,再根据Gensini评分体系将ACS患者分为A（Gensini评分>50分）、B（Gensini评分25-50分）、C（Gensini评分<25分）三组。采用酶联免疫测定所有患者术前5 min、术后24 h血浆Alarin及Leptin水平,比较各组患者基本临床资料及各实验室指标的差异,并分析Alarin、Leptin与Gensini评分的相关性。 结果 与对照组相比,UA组性别和吸烟史统计数值均升高,统计学差异均为P<0.05;AMI组性别和吸烟史统计数值均升高,统计学差异分别为P<0.01和P<0.05,其余指标差异无统计学意义。AMI组与UA组术前与术后血浆Alarin与Leptin水平高于对照组（均P<0.01）。与本组术前比较,AMI组Alarin水平升高（P<0.05）,Leptin水平升高（P<0.01）,UA组Alarin水平升高（P<0.01）,Leptin水平升高（P<0.05）。ACS患者术前、术后血浆Alarin与Leptin水平均呈正相关,且术前Alarin、术前Leptin、术后Leptin水平与Gensini评分呈正相关（均P<0.05）。比较各Gensini评分亚组血浆Alarin与Leptin水平变化。与C组比较,A组术前Alarin,术前术后Leptin升高（P<0.05）。与B组比较,A组术前Alarin,术前术后Leptin升高（P<0.05）。与本组术前比较,A B组Leptin及C组Alarin均升高（P<0.05）。 结论 ACS患者血浆Alarin与Leptin在PCI术后均有升高,两者可以很好地评估ACS患者的炎症严重状态,可用于评估PCI术后支架内再狭窄及冠状动脉新病变发生的可能。     

血清甲状旁腺素水平与急诊PCI慢复流、室性心律失常的相关性与预测价值

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者血清甲状旁腺素（PTH）水平与急诊经皮冠状动脉介入治疗（PCI）术中慢复流、围手术期（急诊室至术后72h）室性心律失常（VAs）的相关性与预测价值。 方法 连续性入选112例因STEMI接受急诊PCI治疗的患者,利用二分类Logistic回归分析模型评估PTH与慢复流及VAs是否独立相关,绘制ROC曲线评价其预测价值。 结果 PTH是介入术中慢复流（OR=5.768, 95%CI: 1.808-18.402, P<0.01）及围手术期中高危VAs（OR=18.278, 95%CI: 4.881-68.445, P<0.01）的独立预测因子,预测慢血流的ROC曲线下面积（AUC）为0.737 (95%CI: 0.634-0.841, P<0.01),其截断点为PTH=65.5pg/ml,灵敏度75%,特异度72%;预测VAs时,AUC为0.837 (95%CI: 0.759-0.914, P<0.01),截断点为PTH=61.9pg/ml,灵敏度82%,特异度73%。 结论 血清PTH水平与STEMI患者急诊PCI术中慢复流及围手术期VAs有一定相关性,并有较好的预测价值。     

急性冠脉综合征患者经皮冠状动脉介入术后院内MACE发作风险预测模型构建

目的 探讨急性冠脉综合征患者经皮冠状动脉介入术后院内MACE发生的独立危险因素，并构建风险预测模型。 方法 选取2019年6月～2021年6月我院治疗的276例急性冠脉综合征患者，依据患者经皮冠状动脉介入术后院内是否发生MACE分为MACE组（73例）和非MACE组（203例）。单因素分析两组患者的临床病理特征，多因素Logistic回归分析急性冠脉综合征患者经皮冠状动脉介入术后院内发生MACE的危险因素，使用ROC曲线来评价模型。 结果 276例急性冠脉综合征患者经皮冠状动脉介入术后院内MACE的发生率为26.45%；两组患者的临床资料比较，结果发现，MACE组患者年龄≥60（P<0.05）、吸烟（P<0.05）、饮酒史（P<0.05）、高血压（P<0.01）、心功能Killip分级≥3（P<0.05）、糖尿病（P<0.05）占比均高于非MACE组；BMI（P<0.05）、中性粒细胞计数（P<0.05）、WBC（P<0.05）、NT-Pro BNP（P<0.01）、LDL-C（P<0.05）、Scr（P<0.01）、C反应蛋白（P<0.01）、总胆固醇（P<0.05）、甘油三酯（P<0.01）、血糖（P<0.05）、D-二聚体（P<0.01）、肌钙蛋白（P<0.01）显著高于非MACE组；淋巴细胞计数（P<0.01）、红细胞计数（P<0.01）、血红蛋白浓度（P<0.01）、血钠（P<0.05）、血钙（P<0.01）、尿酸（P<0.05）、白蛋白（P<0.01）显著低于非MACE组。多因素Logistic回归分析结果表明年龄（P<0.05）、吸烟（P<0.05）、WBC（P<0.01）、NT-proBNP（P<0.05） 以及Scr（P<0.01）是ACS患者PCI术后院内发生MACE的独立危险因素，LVEF是保护因素（P<0.05）。6项独立影响因素总分为279.14，对应风险值为0.82，预测ACS患者PCI术后院内发生MACE的概率为82 %。ROC曲线分析显示，模型ROC曲线下面积为0.846，95 %置信区间为0.781~0.878，灵敏度与特异度分别为85.36 %和87.74 %，表明该模型预测能力较强。 结论 年龄、吸烟、WBC、NT-proBNP及Scr是ACS患者PCI术后院内发生MACE的独立危险因素，LVEF是保护因素。     

CHD并发EH患者MHR与冠脉狭窄程度的关系

目的 探讨冠心病(coronary heart disease,CHD)并发原发性高血压(enssential hypertension,EH)患者单核细胞/高密度脂蛋白胆固醇比值(monocyte/high density lipoprotein cholesterol ratio,MHR)与冠脉病变严重程度的相关性...     

Initial culprit-only versus initial multivessel percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: results from the Ibaraki Cardiovascular Assessment Study registry

We investigated clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) treated for initial culprit-only or by initial simultaneous treatment of nonculprit lesion with culprit lesion. Optimal management of multivessel disease in STEMI patients treated by primary percutaneous coronary intervention (PCI) is still unclear in the drug-eluting stent era. We compared clinical outcomes of 274 STEMI patients (69.3 ± 11.8 years, 77 % men) in the Ibaraki Cardiovascular Assessment Study registry who underwent initial culprit-only (OCL, n = 220) or initial multivessel PCI of nonculprit lesion with culprit lesion (NCL, n = 54) from April 2007 to August 2010. Major adverse cardiac and cerebrovascular events (MACCE) included all-cause death, myocardial infarction (MI), target-vessel revascularization (TVR), and cerebrovascular accident (CVA). Patients in the NCL group were older and had higher Killip class and lower estimated glomerular filtration rate than those in the OCL group. MI, TVR, CVA, and stent thrombosis were not significantly different between the two groups. Incidences of all-cause death and MACCE were lower in the OCL than in the NCL group (all-cause death: 10.9 % vs 31.5 %, P < 0.05; MACCE: 27.7 % vs 46.2 %, P < 0.05). After adjusting for patient characteristics, NCL remained at significantly higher risk compared with OCL for in-hospital and all-cause death (P = 0.001, respectively), and MACCE were not significantly different (odds ratio 1.95, 95 % confidence interval 0.94–4.08; P = 0.07) between groups. Initial multivessel PCI was associated with significantly increased risk of in-hospital death, all-cause death, and MACCE, which was somewhat attenuated in a multivariable model, but the numerically excessive risk with NCL still persisted.     

Outcomes of nonstenting percutaneous coronary intervention in patients with rheumatoid arthritis

The aim of the present study was to explore the outcomes of percutaneous coronary intervention (PCI) in patients with rheumatoid arthritis (RA) and coronary heart disease. We identified 25,367 patients from the National Health Insurance Research Database who underwent nonstenting PCI in Taiwan in 2007. Of these patients, 240 had been diagnosed with RA. As a comparison group, we selected 1,200 patients who were matched with the study group by gender and age. We performed conditional logistic regression analysis to compare the outcomes of PCI between the 2 groups. We found no significant differences in the rates of in-hospital mortality (2.5% vs 3.1%, p = 0.628), 90-day readmission for PCI (8.3% vs 7.2%, p = 0.559), or 365-day readmission for PCI (22.5% vs 19.2%, p = 0.236) between the patients with and without RA. Similarly, the conditional logistic regression analyses revealed that patients with RA had no greater adjusted odds of in-hospital mortality (odds ratio 0.94, 95% confidence interval 0.37 to 2.36), 90-day readmission for PCI (odds ratio 1.20, 95% confidence interval 0.37 to 2.36), and 365-day readmission for PCI (odds ratio 1.30, 95% confidence interval 0.92 to 1.83) than the comparison group. In conclusion, our study did not find an increased risk of adverse outcomes among patients with RA after PCI.     

Long-term outcomes with use of intravascular ultrasound for the treatment of coronary bifurcation lesions

Percutaneous coronary intervention (PCI) of bifurcation lesions remains challenging with a higher risk of adverse outcomes. Whether adjunctive intravascular ultrasound (IVUS) imaging improves outcomes of PCI of bifurcation lesions remains unclear. This study sought to determine the long-term clinical outcomes associated with using IVUS for percutaneous treatment of coronary bifurcation lesions. From April 2003 through August 2010, 449 patients with 471 bifurcation lesions underwent PCI with (n = 247) and without (n = 202) the use of IVUS. Clinical outcomes (death, myocardial infarction [MI], periprocedural MI, stent thrombosis, target vessel revascularization [TVR], and target lesion revascularization [TLR]) were compared between patients undergoing PCI with and without IVUS using univariate and propensity score-adjusted analyses. Most patients (61%) presented with acute coronary syndrome and 89% of bifurcations lesions were Medina class 1,1,1. After propensity score adjustment, use of IVUS was associated with significantly lower rates of death or MI (odds ratio 0.38, 95% confidence interval 0.20 to 0.74, p = 0.005), death (odds ratio 0.40, 95% confidence interval 0.18 to 0.88, p = 0.02), MI (odds ratio 0.37, 95% confidence interval 0.14 to 0.98, p = 0.04), periprocedural MI (odds ratio 0.45, 95% confidence interval 0.20 to 0.97, p = 0.04), TVR (odds ratio 0.28, 95% confidence interval 0.14 to 0.53, p <0.0001), and TLR (odds ratio 0.27, 95% confidence interval 0.14 to 0.53, p = 0.0003) compared to no IVUS. In conclusion, IVUS-guided treatment of complex bifurcation lesions was associated with significantly lower rates of adverse cardiac events at late follow-up. Further study is warranted to evaluate the role of IVUS guidance in improving long-term outcomes after PCI of bifurcation lesions.     

MHR与急性ST段抬高型心肌梗死的患者Gensini评分的关系

目的 探讨单核细胞和高密度脂蛋白胆固醇的比值（MHR）与急性ST段抬高型心肌梗死（STEMI）以及Gensini评分的关系,了解MHR对STEMI的预测价值。方法 纳入南京医科大学第二附属医院行冠脉造影并确诊为STEMI的患者132例,并选取同期行冠脉造影结果为正常的82例患者为对照组,比较两组之间的一般资料及实验室检查;根据Gensini评分三分位法将STEMI组分为低危组、中危组及高危组,比较三组患者的一般资料及实验室检查结果;单因素及多因素Logistic回归分析STEMI的独立影响因素、Gensini评分高危的独立影响因素,并绘制受试者工作特征（ROC）曲线评价MHR对STEMI患者Gensini评分高危的预测价值。结果 (1)STEMI组的患有高血压病（P<0.05）比例高于对照组,男性、吸烟、糖尿病、白细胞计数、中性粒细胞计数、单核细胞计数、肌酐值、MHR等项目比例数值均高于对照组（均P<0.01）。(2)与低危组比较,中、高危组的年龄高（P<0.05）、MHR升高（P<0.01）、病变支数升高（P<0.01）;高危组的中性粒细胞计数升高（P&...     

Does percutaneous coronary intervention in non-culprit vessels improve the prognosis of acute myocardial infarction complicated by pump failure?

OBJECTIVES: To evaluate whether percutaneous coronary intervention (PCI)in non-culprit vessel lesions improves the short-term prognosis of acute myocardial infarction complicated by pump failure. METHODS: Fifty-six patients with acute myocardial infarction in hemodynamic subset 4 of Forrester's classification at hospitalization underwent PCI for multiple vessel lesions within 12 hr (6.1 +/- 3.4 hr) of the onset of acute myocardial infarction. No patients had left main trunk lesion. Twenty patients also underwent PCI for non-culprit vessel lesions (multivessel PCI group: M-PCI), but the remaining 36 did not (culprit vessel PCI group: C-PCI). The in-hospital prognosis was investigated from the hospital records. RESULTS: Complete revascularization was accomplished in 18 patients(90%)in the M-PCI. The rates of all in-hospital death were almost equivalent in both groups (M-PCI 30% vs C-PCI 42%, p = 0.21), but the rate of cardiac deaths was higher in the C-PCI than in the M-PCI (42% vs 15%, p < 0.05). Overall major adverse cardiac events occurred more often in the C-PCI than in the M-PCI(58% vs 25%, p < 0.05). Multivariate logistic regression analysis showed complete revascularization(odds ratio 0.11, 95% confidence interval 0.02-0.95, p < 0.05)and duration from onset of acute myocardial infarction to PCI < 6 hr (odds ratio 0.25, 95% confidence interval 0.06-0.98, p < 0.05) were negative predictors of in-hospital cardiac death, and prior myocardial infarction (odds ratio 4.97, 95% confidence interval 1.09-22.67, p < 0.05) was a positive predictor. CONCLUSIONS: PCI of non-culprit vessel lesions might improve the short-term prognosis of patients with acute myocardial infarction and pump failure.     

Meta-analysis of ten trials on the effectiveness of the radial versus the femoral approach in primary percutaneous coronary intervention

The radial approach in primary percutaneous coronary intervention (PCI) has been recently assessed in both randomized and observational studies. However, observational studies have several biases that favor the radial approach. We conducted a meta-analysis of randomized controlled trials to compare the clinical outcomes of radial and femoral approach in primary PCI for ST-segment elevation myocardial infarction. The outcomes of interest included death, major bleeding, vascular complications/hematoma, and procedure time. The data were pooled using random-effects models. Ten randomized controlled trials involving 3,347 patients met our inclusion criteria. The radial approach was associated with improved survival (odds ratio 0.53, 95% confidence interval 0.33-0.84) and reduced vascular complications/hematoma (odds ratio 0.35, 95% confidence interval 0.24-0.53). A nonsignificant trend was found toward reduced major bleeding with the radial approach (odds ratio 0.63, 95% confidence interval 0.35-1.12). The procedural time with the radial approach was longer by < 2 minutes (mean difference 1.76 minutes, 95% confidence interval 0.59-2.92). In conclusion, in patients undergoing primary PCI, the radial approach is associated with lower short-term mortality. When feasible, the radial approach should be the favored route in primary PCI.     

Preprocedural white blood cell count and major adverse cardiac events late after percutaneous coronary intervention in saphenous vein grafts

Elevation of white blood cells (WBCs) is associated with worse outcomes in patients with coronary artery disease (CAD), including patients undergoing percutaneous coronary intervention (PCI) of native coronary arteries, but this relation has not been studied in patients with saphenous vein graft disease undergoing PCI. A total of 530 patients who underwent PCI of saphenous vein grafts from May 1997 to July 2002 were followed for >3 years. Major adverse coronary events (MACEs) were assessed as a composite of death, myocardial infarction, or revascularization during follow-up (mean 2.7 years). Patients with MACEs (n = 287) were younger and had more thrombotic and ostial lesions (p < 0.05) than those without MACEs (n = 243). The preprocedural WBC count was also significantly higher in the MACE group than in the non-MACE group (8.1 x 10(3)/mul, range 6.6 to 10.1, vs 7.0 x 10(3)/mul, range 5.6 to 8.2; p < 0.001). After adjusting for covariates, multiple logistic regression analysis revealed the preprocedural WBC count to be an independent predictor for MACEs (odds ratio 1.2; 95% confidence interval 1.1 to 1.3, p < 0.001). Patients in the highest quartile of the preprocedural WBC level had a significantly increased risk of MACEs (lowest vs highest quartile, 41.3% vs 72.4%; odds ratio 3.7; 95% confidence interval 2.2 to 6.3). Thus, an elevated preprocedural WBC count is associated with increased risk of MACEs in patients undergoing PCI for saphenous vein graft lesions.