Effects of persistent platelet reactivity despite aspirin therapy on cardiac troponin I and creatine kinase-MB levels after elective percutaneous coronary interventions

BACKGROUND: Creatinine kinase-MB (CK-MB) and cardiac troponin I (cTnI) elevations are highly specific for myonecrosis after percutaneous coronary intervention (PCI). Aspirin is used to prevent thrombotic complications. Several studies have shown that some individuals exhibit a reduced or completely missing antiplatelet response to aspirin. The aim of this study is to investigate the effects of platelet reactivity despite aspirin therapy on CK-MB and cTnI levels after elective percutaneous coronary interventions despite 600 mg loading dose of clopidogrel. METHODS: One hundred fourteen (mean age 61.2+/-9.3 years, 78.1% male) patients receiving 300 mg daily enteric coated aspirin for at least 7 days with documented coronary artery disease were included in the study. Platelet reactivity despite aspirin was measured by platelet function analyzer (PFA)-100 collagen/epinephrine cartridge. Blood samples for CK-MB and cTnI were obtained before and at 6, 24, and 36 h after the PCI. Persistent platelet reactivity was defined when collagen/epinephrine closure time<165 s. RESULTS: A total of 87 (76.4%) patients were noted to have normal platelet reactivity (Group A), and 27 (23.6%) had persistent platelet reactivity (Group B). The elevations of CK-MB and cTnI levels were statistically significant within the groups (both P<0.001). However, there were no significant differences in the CK-MB and cTnI levels of the groups at baseline and after PCI for all studied hours. CONCLUSION: Persistent platelet reactivity was not associated with increased risk of CK-MB, cTnI elevations in low-to-intermediate risk PCI patients.     

Impact of anemia on nonfatal coronary events after percutaneous coronary interventions

Anemia is associated with higher rates of cardiovascular events in patients with heart failure, acute myocardial infarction, and in patients undergoing coronary artery bypass graft surgery. Although studies have focused on fatal coronary events in anemic patients following percutaneous coronary intervention (PCI), data is lacking regarding nonfatal coronary events. The aim of our study was to analyze the incidence of anemia in patients who developed nonfatal events after successful PCI, and to make a comparison with event-free patients. Forty-nine consecutive patients with and 51 without nonfatal coronary events (nonfatal myocardial infarction, coronary artery bypass grafting, or repeat PCI) during the 1-year follow-up after the index PCI procedure were included in the study. Anemia was defined using World Health Organization (WHO) criteria as a hematocrit value at initial presentation <39% for men and <36% for women. Baseline hematocrit levels were measured before the procedure. Baseline clinical, lesion, and procedural characteristics were comparable in both groups. Anemia was present in 33.8% of men and 30.4% of women. The incidence of anemia in patients with nonfatal coronary events was 46.9% and 15.7% in the event-free group, which was significantly different (P = 0.001). Anemia was found to be an independent risk factor for nonfatal coronary events in PCI patients (odds ratio: 2.24, 95% confidence interval: 1.05–4.79; P = 0.036). In conclusion, anemia is an important risk factor for predicting nonfatal coronary events after PCI. Although previous studies have shown its impact on fatal events, this study has demonstrated that anemia also has a role in nonfatal thrombotic coronary events and restenosis.     

冠状动脉介入术前高负荷量氯吡格雷预治疗的近期疗效

目的:对比观察拟行冠状动脉(冠脉)介入术患者术前服用高负荷剂量氯吡格雷600 mg与常规负荷剂量300 mg预治疗的有效性及安全性.方法:选取100例拟行冠脉介入术的患者,术前随机分别给予600 mg(50例)或300 mg(50例)负荷剂量氯吡格雷预治疗.分别检测2组服药前、服药后16、36 h二磷酸腺苷(ADP)诱导的血小板最大凝集率(MPAR),随访术后30 d和6个月主要临床心血管事件(包括死亡、心肌梗死、紧急靶血管血运重建、脑卒中等)和出血事件的发生情况.结果:服药后16 h,氯吡格雷600 mg组较之300 mg组对ADP(5μmol/L和20μmol/L)诱导的MPAR产生更大的抑制作用[ADP 5μmol/L,(21.83±18.04)%:(14.79±9.18)%,P＜0.05];[ADP 20μmol/L,(22.12±14.81)%:(15.67±10.15)%,P＜0.05)].而服药后36 h,2组ADP(5μmol/L和20μmol/L)诱导的MPAR率分别降低[ADP5μmol/L.(16.70±15.42)%:(12.94±10.34)%,P＞0·05]和[20μmol/L :(14.14±13.16)%:(10.19±9.49)%,P＞0.05].氯吡格雷600 mg组30d和6个月主要临床心血管事件发生率较300 mg组显著减少(P＜0.05,P＜0.01).2组30 d和6个月出血事件差异均无统计学意义.结论:冠脉介入术患者术前服用高负荷剂量氯吡格雷600 mg较之常规负荷剂量300 mg预治疗能更大程度抑制血小板凝集.同时可显著改善临床预后.     

急性心肌梗死后择期冠脉介入治疗对左室重构和心功能的影响

目的探讨急性心肌梗死（AMI）后择期经皮冠状动脉介入（PCI）治疗对左心室重构和心功能的影响。方法112例AMI患者,分为PCI组和药物治疗组,PCI组于发病后1～2周内行PCI治疗,所有患者于发病后1～2周时、4周和24周时行超声心动图（UCG）检查,观察左心室收缩末容积指数（LVESVI）、左心室舒张末容积指数（LV-EDVI）和左室射血分数（LVEF）。结果行PCI治疗后,血管再通率为100%,术后4周和24周的LVESVI、LVEDVI和LVEF均明显优于术前,与药物治疗组比较有显著性差异（P<0.05）。结论AMI后择期PCI治疗能够有效抑制左心室重构,改善心功能。     

经皮冠状动脉介入性治疗并发急性心脏压塞15例的诊断与处理

目的 急性心脏压塞是经皮冠状动脉介入性洽疗少见但严重的并发症之一。本文旨在总结分析此并发症的诊断、处理方法与临床效果。方法 回顾分析西京医院自1992年2月至2003年5月间行经皮冠状动脉介入性治疗的2326例冠心病患者，其中确诊为心脏压塞的患者15例占同期冠状动脉介入性治疗病例的0．64％。冠状动脉介入术中或术后患者突然出现烦躁、难以纠正的低血压、心率减慢等提示心脏压塞的症状与体征，X线示心脏搏动减弱伴心影扩大，超声心动图发现心包内液性暗区、冠状动脉造影发现局部造影剂外渗漏人心包腔。除一般抢救与治疗措施外，尽快采用常规心包穿刺抽液或中心静脉导管置入法引流心包积血。采用灌注球囊或带膜支架治疗制止冠状动脉出血，必要时行外科手术治疗。结果 15例心脏压塞患者中，8例在导管室行介入性治疗术中诊断，7例在术后延迟出现(30min～8h，平均4．5h)。8例患者仅行心包穿刺引流而解除心脏压塞；4例患者行灌注球囊／带膜支架治疗及心包穿刺引流后解除心脏压塞；3例病情严重者经外科处理。6例患者采用常规心包穿刺抽液方法，其中4例成功解除心脏压塞，2例经外科处理成功；9例患者采用中心静脉导管置入法，其中8例成功解除心脏压塞，1例经外科处理。结论 急诊床旁超声心动图和X线检查对于诊断冠状动脉介入治疗并发的急性心脏压塞有重要意义。心包穿刺引流是解除心脏压塞的首选治疗方法，中心静脉导管置入引流法是一种快速、安全、准确的方法。灌注球囊、带膜支架治疗及外科手术是处理心脏压塞的重要措施。     

Effect of cardiac rehabilitation programme following elective percutaneous coronary angiography on depressive symptoms: A cohort study

BackgroundDepression is a common condition in cardiac patients. We investigated the effect of cardiac rehabilitation on depressive symptoms as detected by Beck depression inventory II score (BDI) in patients who underwent percutaneous coronary intervention (PCI).MethodsIn this cohort, 95 patients met our criteria. Patients were then studied in two groups based on their participation in the rehabilitation program to rehabilitation (exposure) and the control (non-exposure) groups. The control group consisted of those who only participated in the introductory session and decided not to continue the program. Finally, demographic and clinical parameters as well as the BDI scores were compared between the study groups.ResultsData of 35 patients who completed rehabilitation program was compared with 60 patients who did not. There was no significant difference between the study groups regarding the demographic and clinical variables, except for a higher frequency of family history for CAD in the control group (p < 0.001). The frequency of the patients with no or mild depression was significantly higher in the rehabilitation group than the controls (p = 0.02). There was also a significant increase in the BDI score of the control group and a significant decrease in the rehabilitation group (p < 0.001). After adjustment for confounders (family history and severity of CAD), not attending the rehabilitation program was a strong risk factor for depression (OR = 10.8, 95% CI: 1.3, 88.5; P = 0.027).ConclusionOverall, this study showed that not attending cardiac rehabilitation program following elective PCI was a risk factor for depression.     

冠状动脉病变介入治疗后血浆B型利钠肽和肌钙蛋白I的变化

目的观察不同类型冠状动脉病变介入治疗前后血液B型利钠肽(BNP)及心肌肌钙蛋白I(cTnI)的变化。方法选取接受冠状动脉介入治疗的患者52例,根据冠状动脉病变血管累及范围分为单支病变组、双支病变组,分别测定两组患者术前、术后6、24、48h BNP,cTnI水平,并记录术中球囊扩张时间、扩张次数、造影剂用量。结果单支病变组球囊扩张时间、扩张次数及造影剂用量均小于双支病变组(P<0.05);两组术后6h BNP水平均高于术前(P<0.05),术后24h达峰值;两组术后24h cTnI水平显著升高(P<0.05),但单支病变组BNP、cTnI峰值水平低于双支病变组(P<0.05)。结论多支病变或复杂病变患者介入治疗后BNP、cTnI水平升高明显,提示应进行术前危险评估,术后应给予适当药物辅助治疗改善预后。     

经皮冠状动脉介入术相关的围手术期心肌梗死对远期心功能的影响

目的:观察经皮冠状动脉介入术(PCI)相关的围手术期心肌损伤患者血清脑钠肽(BNP)和心功能的变化,并评估围手术期心肌梗死对远期心功能的影响。方法:根据1 187例行PCI的冠心病患者术前、术后12~24 h血清心肌钙蛋白I(cTn I)分为无心肌损伤组、心肌损伤组和心肌梗死组。检测术前、术后3~6 h、12~24 h的血清BNP,比较术前、术后1年的超声心动图左心室射血分数(LVEF)值及舒张早期左房室瓣血流速度与舒张晚期左房室瓣血流速度比值(E/A值)。观察再次入院率、再次心肌梗死及再次血管重建的发生率。结果:PCI相关心肌梗死的发生率为8.59%(102例),心肌损伤的发生率为14.15%(168例)。心肌梗死组PCI术前及术后3~6 h、12~24 h血清BNP分别为(30±22)、(70±36)、(211±59)ng/L;心肌损伤组为(33±23)、(57±29)、(118±60)ng/L;无心肌损伤组为(32±33)、(42±38)、(66±55)ng/L。术后BNP水平较术前显著上升(P<0.05),且心肌梗死组和心肌损伤组术后BNP水平高于无心肌损伤组(P<0.05)。1年的随访中,因心绞痛或心力衰竭再次入院率、再次心肌梗死及再次血管重建的发生率在3组中有显著差异(P     

心脏康复治疗对冠心病PTCA术后患者血脂的影响

目的：探讨心脏康复治疗对经皮冠状动脉腔内成形术（PTCA）后患者血脂的影响。方法：224例行PTCA术后的患者被分为康复组（110例）和PTCA对照组（114例），康复组接受运动康复治疗，而对照组不参加任何运动训练。分别测量两组患者入选时及治疗8周后的血脂水平。结果：经过8周心脏康复治疗，康复组患者血脂水平低于对照组（P〈0．05）。结论：心脏康复治疗能明显改善PTCA术后患者的血脂水平。     

冠状动脉介入术后6小时内肌钙蛋白T和术后早期临床事件的关系

目的分析介入术后6小时内肌钙蛋白T(cTnT)与术后早期临床事件的关系.方法术前和术后6 h内测定115例行冠状动脉介入治疗患者的cTnT值,分析术后6 h内不同cTnT值与早期不良临床事件(心绞痛复发、症状性低血压和二次介入治疗)发生的关系.结果术后6h内cTnT＞0.1 ng/ml检出率高于CK-MB(20.9%vs 9.6%,P=0.017),患者术后早期心绞痛复发率增高;当cTnT为0.01～0.1 ng/ml时,患者术后早期症状性低血压的发生率明显增高.Logistic回归分析表明,术后6h内cTnT＞0.01ng/ml增加了早期不良临床事件发生危险性(OR=7.8,P=0.0002).结论冠状动脉介入术后cTnT增高(＞ 0.1ng/ml)及微量cTnT(0.01～0.1 ng/m1)与术后早期不良临床事件发生的危险性增高可能密切相关.     

Anxiety in patients undergoing percutaneous coronary interventions

Objective

Many patients undergoing percutaneous coronary intervention (PCI) experience symptoms of anxiety; however, it is unclear whether anxiety is an issue in the early recovery period and the types of factors and patient concerns that are associated. This study set out to determine the patterns of anxiety and concerns experienced by patients undergoing PCI and the contributing factors in the time period surrounding PCI.

Methods

A convenience sample of patients undergoing PCI (n = 100) were recruited, and anxiety was measured using the Spielberger State Anxiety Inventory immediately before the PCI, the first day postprocedure, and 1 week postdischarge. Patients were also asked to identify their most important concern at each time. Independent predictors of anxiety at each time were determined by multiple regression analysis.

Results

Anxiety scores were highest pre-procedure (35.72, standard deviation [SD] 11.75), decreasing significantly by the postprocedure time (31.8, SD 10.20) and further still by the postdischarge time (28.79, SD 9.78) (repeated-measures analysis of variance: F = 39.72, P < .001). The concerns patients identified most frequently as most important were the outcome of the PCI and the possibility of surgery pre-procedure (37%) and postdischarge (31%), and the limitations and discomfort arising from the access site wound and immobility postprocedure (25%). The predictor of anxiety at the pre-procedure time was taking medication for anxiety and depression (b = 7.12). The predictors of anxiety at the postprocedure time were undergoing first-time PCI (b = 4.44), experiencing chest pain (b = 7.63), and experiencing pre-procedural anxiety (b = .49). The predictors of anxiety at the postdischarge time were reporting their most important concern as the future progression of CAD (b = 7.51) and pre-procedural anxiety (b = .37).

Conclusion

Symptoms of anxiety were common, particularly before PCI. These symptoms are important to detect and treat because pre-procedural anxiety is predictive of anxiety on subsequent occasions. Patients who have had chest pain or their first PCI should be targeted for intervention during the early recovery period after PCI, and information on CAD should be provided postdischarge.     

Baseline inflammation is not predictive of periprocedural troponin elevation after elective percutaneous coronary intervention

High-sensitivity C-reactive protein predicts future cardiovascular events in both healthy individuals and patients with unstable and stable coronary syndromes. Few data are available about the incidence and the relation to inflammation of troponin elevation following percutaneous coronary intervention (PCI), a potential predictor of longterm outcome. We sought to confirm the impact of embolization on long-term outcome and evaluate the ability of baseline inflammation to predict troponin elevation induced by PCI. We prospectively analyzed 200 patients treated by PCI for stable or Braunwald IIA class unstable angina. The patients were recruited between January 1997 and May 1999, and the population was followed during a mean follow-up of 32 months. Major adverse cardiac events (MACEs) were defined as the occurrence of death, myocardial infarction or recurrent angina requiring repeat PCI, or coronary artery bypass grafting. During the follow-up period, 58 MACEs were observed. By multivariate analysis, independent predictors for the occurrence of MACEs were unstable angina and troponin I level after PCI (P < 0.0001 for both). No correlation was found between baseline inflammation and significant troponin I elevation post PCI and by multivariate analysis, no biological variable was a predictor of troponin I elevation post PCI. Baseline inflammation cannot predict onset of minor myonecrosis damage (expressed by troponin elevation) induced by PCI, a significant predictor of long-term outcome in this setting.     

Safety and efficacy of suture-mediated closure after percutaneous coronary interventions.

Percutaneous coronary interventions (PCI) performed with concomitant use of heparin and platelet inhibitors are safe procedures with reported vascular complication rates of approximately 6.1%. EPILOG investigators demonstrated that utilizing a low-dose heparin regimen with abciximab, along with early sheath removal, vascular access-related bleeding was significantly lower than that reported in EPIC. Recently, a suture-mediated closure (SMC) device has been reported to be safe, appears effective, and may improve patient comfort by allowing early ambulation. We conducted a retrospective analysis (January 1999 to March 2000) of complication frequencies among PCI patients who underwent SMC and those who had manual compression (non-SMC). Furthermore, we compared the overall rates of complications to patients who underwent PCI prior to the introduction of SMC (1995-1998). When comparing the current cohort to the historical cohort, there was a significant decrease in the number of retroperitoneal bleeds (0.3% vs. 0.9%; P = 0.003), hematomas (5% vs. 9%; P < 0.001), pseudoaneurysms (1.2% vs. 2.7%; P < 0.001), and need for vascular surgery (0.9% vs. 2.8%; P < 0.001). There was no difference in the number of arterio-venous fistulas and a slight increase in transfusion needs (12% vs. 10%; P = 0.03). Within the current cohort, there was no difference in the vascular complications between SMC and non-SMC PCI patients, although there were lower rates of pseudoaneurysms (0.5% vs. 1.8%; P = 0.02) and transfusion requirements (72/880 vs. 132/874; P < 0.001). These results suggest that the complication rates for SMC are not different and may be lower when compared to non-SMC patients after PCI. At our institution, the practice of early sheath removal and less aggressive heparin dosing has led to a decrease in vascular complication rates and a 66% reduction in vascular surgeries on post-PCI patients. Because of the limitations of retrospective analyses, further studies will be necessary to confirm these findings.     

经皮冠状动脉介入治疗并发心包积液及心脏压塞的临床分析

目的 了解经皮冠状动脉介入治疗(PCI)中心包积液／心脏压塞发生率、发生的相关因素、处理以及预后，为PCI的正确操作及合理选用器械提供参考。方法 分析了1246例PCI资料，包括住院病历、PCI操作记录、护理记录和影像学资料，判定心包积液／心脏压塞发生原因、时间、临床表现、处理方式和结果。结果 共8例心包积液(0．64％)、3例心脏压塞(0．24％)，其中10例(91％)在导管室确诊，1例(9％)延期发现。冠状动脉造影直接发现导引钢丝和／或球囊致冠状动脉穿孔9例(81．8％)，其中球囊通过冠状动脉破口未扩张2例，球囊通过冠状动脉破口并扩张1例，冠状动脉穿孔多发生在慢性完全闭塞性病变(CTO)；通过临床表现、超声心动图证实起搏电极导线致右心室穿孔2例(18．2％)，均出现在心肌梗死后患者。球囊通过冠状动脉破口并扩张1例，发生迟发性心脏压塞，6h后急诊外科干预引流后治愈；右心室临时起搏电极导管穿破右心室2例，1例行心包穿刺术，另1例心包穿刺后留置猪尾导管引流2d成功治愈。结论 冠状动脉及右心室穿孔是PCI并发心包积液／心脏压塞的主要原因，前者多发生在CTO患者，后者易出现于心肌梗死后患者。正确的操作方法及合理的器械选择可能减少此并发症的发生。冠状动脉穿孔较心室穿孔易于诊断，心包积液／心脏压塞多数能在导管室早期发现，并能得以合理的处理。     

冠状动脉介入治疗后心肌钙蛋白T的动态变化及原因分析

目的：了解成功行经皮冠状动脉介入治疗（PCI）病人的心肌肌钙蛋白T（cTnT）水平的动态改变及临床意义。方法：选择成功行PCI术的68例患者，在术前、术后6h、24h分别检测肌酸激酶（CK）、肌酸激酶同功酶（CK-MB）及cTnT水平，并分析相关因素。结果：PCI术后CK—MB升高7例（10．3％）。cTnT术后升高32例（47．1％），C型病变：在cTnT升高组中17例（53．1％），与cTnT正常组10例（27．8％）比较有显著差异（P=0．0330）。三支血管病变：cTnT升高组中13例（40．6％），与cTnT正常组5例（13．9％）比较有显著差异（P=0．0126）。cTnT升高的原因和扩张压力总和、扩张次数及扩张时间有关（P=0．0072，P=0．0002，P=0．0213），支架长度和支架直径也和cTnT水平有关（P=0．0156，P=0．0012）。结论：PCI术后可引起CK-MB、cTnT水平轻度升高，在检测心肌损伤方面cTnT较CK、CK—MB更敏感。病变的复杂程度及手术操作的强度与cTnT水平升高有关。     

Self-management of coronary heart disease in older patients after elective percutaneous transluminal coronary angioplasty

Objective To explore how older patients self-manage their coronary heart disease (CHD) after undergoing elective percutaneous transluminal coronary angioplasty (PTCA). Methods This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients (n = 93) approximately three months after elective PTCA. The study was conducted in two phases. Quantitative data collected in Phase 1 by means of a self-administered survey were subject to univariate and bivariate analysis. Phase 1 findings informed the purposive sampling for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualitative data were analysed using thematic analysis. This paper will primarily report the findings from a sub-group of older participants (n = 47) classified as 65 years of age or older. Results 78.7% (n = 37) of participants indicated that they would manage recurring angina symptoms by taking glyceryl trinitrate and 34% (n = 16) thought that resting would help. Regardless of the duration or severity of the symptoms 40.5% (n = 19) would call their general practitioner or an emergency ambulance for assistance during any recurrence of angina symptoms. Older participants weighed less (P = 0.02) and smoked less (P = 0.01) than their younger counterparts in the study. Age did not seem to affect PTCA patients’ likelihood of altering dietary factors such as fruit, vegetable and saturated fat consumption (P = 0.237). Conclusions The findings suggest that older people in the study were less likely to know how to correctly manage any recurring angina symptoms than their younger counterparts but they had fewer risk factors for CHD. Age was not a factor that influenced participants’ likelihood to alter lifestyle factors.     

Prognostic value of cardiac troponin-I levels following catheter-based coronary interventions

This study has examined the prognostic significance of troponin-I (Tn-I) levels after catheter-based coronary interventions in coronary arteries and saphenous vein grafts lesions. Tn-I and creatine kinase-MB (CK-MB) fraction levels were measured at 6 and 18 to 24 hours after catheter-based coronary intervention in 1,129 consecutive patients with normal preintervention plasma levels of Tn-I, and CK-MB levels below the cutoff for myocardial infarction. Patients were stratified according to maximal postangioplasty Tn-I levels. Group I (n = 784) had no elevated Tn-I (<0.15 ng/ml), group II (n = 170) had Tn-I at 0.15 to 0.45 ng/ml, and group III (n = 175) had Tn-I elevation >0.45 ng/ml. Major in-hospital complications (death, 0-wave infarction, and emergent coronary bypass grafting) and out-of-hospital intermediate-term (8 months) outcomes were compared between the 3 groups. Tn-I elevation >0.45 ng/ml was associated with increased risk of mortality (group III, 1.6%; group II, 0.6%; and group I, 0.1%; p = 0.019) and major in-hospital complications (3.2%, 1.7%, and 0.5%; p = 0.004). There was no difference in death (1.8%, 3.2%, and 2.4%; p = 0.74), Q-wave infarction (0.6%, 0%, and 0.3%; p = 0.66), or target lesion revascularization (10.1%, 9.0%, and 9.3%; p = 0.86) between the 3 groups at follow-up. Cardiac event-free survival was similar between groups (p = 0.3). By multivariate analysis, Tn-I >0.45 ng/ml was an independent predictor for major in-hospital complications (odds ratio 2.1, 95% confidence interval 1.2 to 3.9, p = 0.01). The degree of risk was also associated with the conjoint elevation of Tn-I and CK-MB levels (odds ratio 1.1, 95% confidence interval 1.02 to 1.2, p = 0.01). We conclude that Tn-I levels >3 times the normal limit and conjoint elevation of Tn-I and CK-MB levels after coronary angioplasty are associated with increased risk of major in-hospital complications, but have no incremental risk of adverse intermediate-term (8 months) clinical outcomes.     

冠状动脉支架术后血浆肌钙蛋白I对预后的影响

目的探讨不稳定性心绞痛患者经皮冠状动脉介入术(PCI)后血浆肌钙蛋白I(cTnI)对预后的预测价值。方法选择172例单支病变接受PCI术的不稳定性心绞痛患者,术后24h抽取静脉血化验cTnI,观察12～25个月的严重心脏不良事件。结果术后cTnI升高组(n=51)的严重心脏不良事件明显高于术后cTnI正常组(17.65%vs7.44%,P<0.05),cTnI升高组的血脂水平、他汀类药物、植入支架枚数、球囊预扩张时间、术前hsCRP水平与cTnI正常组比较,差异有统计学意义。结论cTnI的升高对PCI术后患者的预后有着重要的影响,尽早、足量的他汀类药物以及关注炎症的相关指标可使病人获益更大。     

Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures

Background

Access-site vascular complications (ASVC) in patients undergoing trans-radial coronary procedures are rare but may have relevant clinical consequences. Data regarding the optimal management of radial-access-related ASVC are lacking.

Methods

During a period of 6 years we prospectively collected ASVC. ASVC were defined as any complication requiring ultrasound examination or upper limb angiography. ASVC were categorized according to the timing of diagnosis: “very early” (in the cath lab), “early” (after cath lab discharge, but during the hospital stay) and “late” (after hospital discharge). The need of surgery (primary end-point) and the development of neurological hand deficit (secondary end-point) were assessed.

Results

Fifty-seven radial-artery related ASVC were collected. ASVC diagnosis was obtained by upper limb angiography in 25 patients (44%) and by Doppler in 32 patients (56%). Surgery was required in 6 cases (11%), the remaining patients receiving successful conservative management (which included prolonged local compression). Three patients (who received surgery) exhibited a mild neurological hand deficit in the follow-up. Need for surgery differed significantly according to timing of diagnosis as it occurred in 1 of 26 patients (3.8%) with “very early” diagnosis, in 1 of 21 patients (4.8%) with “early” diagnosis, and in 4 of 10 patients (40%) with “late” diagnosis (p = 0.026).

Conclusions

ASVC are diagnosed with different timing after trans-radial procedures. Conservative management including local compression allows successful management in the majority of ASVC. Prompt recognition is pivotal as late diagnosis is associated to the need for surgery.