Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease

Background:

There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.

Methods:

All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.

Results:

Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.

Conclusions:

During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.     

Predictive Ability of the SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery Score II for Long-term Mortality in Patients with Three-vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention Treated with Second-generation Drug-eluting Stents

Background:

The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score II (SS-II) can well predict 4-year mortality in patients with complex coronary artery disease (CAD), and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention (PCI). However, there is lack of data regarding the utility of the SS-II in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents (DES). The purpose of the present study was to evaluate the ability of the SS-II to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES.

Methods:

Totally, 573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied. According to the tertiles of the SS-II, the patients were divided into three groups: The lowest SS-II tertile (SS-II ≤20), intermediate SS-II tertile (SS-II of 21–31), and the highest SS-II tertile (SS-II ≥32). The survival curves of the different groups were estimated by the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-II and 5-year mortality. The performance of the SS-II with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic (ROC) curve. The predictive ability of the SS-II for 5-year mortality was evaluated and compared with the SS alone.

Results:

The overall SS-II was 27.6 ± 9.0. Among patients in the lowest, intermediate and the highest SS-II tertiles, the 5-year rates of mortality were 1.6%, 3.2%, and 8.6%, respectively (P = 0.003); the cardiac mortality rates were 0.5%, 1.9%, and 5.2%, respectively (P = 0.014). By multivariable analysis, adjusting for the potential confounders, the SS-II was an independent predictor of 5-year mortality (hazard ratio: 2.45, 95% confidence interval: 1.38–4.36; P = 0.002). The SS-II demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone (the area under the ROC curve was 0.705 and 0.598, respectively).

Conclusion:

The SS-II is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES, and demonstrates a superior predictive ability over the SS alone.     

经皮冠状动脉介入治疗老年冠心病临床疗效观察

目的：对经皮冠状动脉介入治疗老年冠心病的临床疗效进行观察与体会分析。方法：选取经皮冠状动脉介入术治疗的78例老年冠心病患者作为观察组,再选取予以药物保守治疗的75例老年冠心痛患者进行对比研究（即对照组）,同时对两组患者QTd、HRV以及冠心病者生活质量测评专用量表（SAQ）进行观察和评定、记录,且对其结果进行统计学处理分析。结果：不同时间段QTd、HRV相应指标变化结果显示观察组患者在治疗后10d、治疗后30d分别与治疗前相比P〈0．01、P〈0．05,对照组治疗后30d与治疗前相比P〈0．05,而两组患者相应时间段各指标相比P〈0．05;观察组患者生活质量在治疗后30d优于治疗后10d,治疗后10d优于治疗前;同时观察组患者生活质量优于对照组。结论：经皮冠状动脉介入治疗老年冠心痛效果显著且有效,值得临床推广。     

Effect of Transcatheter Embolization by Autologous Fat Particles in the Treatment of Coronary Artery Perforation During Percutaneous Coronary Intervention

Background:

Coronary artery perforation (CAP) is a rare but severe complication of percutaneous coronary intervention (PCI). The aim of our study was to evaluate the effect and safety of transcatheter embolization by autologous fat particles in the treatment of CAP.

Methods:

Once the CAP was confirmed, a little autologous subcutaneous fatty tissue was obtained from the groin of the patient and then was made into 1 mm × 1 mm fat particles. The perforated vessel was embolized by fat particles via a micro-catheter. There were eight patients undergoing transcatheter embolization by autologous fat particles in the treatment of CAP during PCI in Peking University Third Hospital from February 2009 to June 2014, and the clinical data of these patients were collected and analyzed retrospectively.

Results:

The lesion morphology of the patients was classified based on the American College of Cardiology/American Heart Association Task Force classification, there were one patient with Class B2 lesion and seven patients with Class C lesions (there were five patients with chronic total occlusion lesions). According to the Ellis classification of CAP, there were six patients with Class II perforations and two patients with Class III perforations. The causes of perforation included that seven patients induced by guide wire and one patient by balloon predilation. Three patients had pericardial effusion. All of the eight patients with CAP underwent transcatheter embolization by autologous fat particles. Coronary angiography confirmed that all of them were embolized successfully. There was no severe complication after the procedure. The coronary angiography of one patient at 1 week and another patient at 2 years after the embolization showed that the embolized arteries had recanalized. The median follow-up time was 20.3 months (8.8–50.2 months), the event-free survival rate was 100%.

Conclusions:

Transcatheter embolization by autologous fat particles was an effective, safe, cheap, and easy way to treat the perforation of small vessels during PCI.     

辛伐他汀对PCI术后血浆可溶性Fas因子的影响

目的探讨老年冠心病患者经皮冠状动脉介入治疗术前后血浆可溶性Fas因子的改变以及与再狭窄的关系,并通过给予辛伐他汀干预治疗,观察其对血浆可溶性Fas因子的影响。方法选择行经皮冠状动脉介入治疗术的老年患者35例(老年PCI组),再根据6个月后回访冠状动脉造影结果又分为再狭窄组(21例)和无再狭窄组(14例);选择同期行皮冠状动脉介入治疗的非老年患者35例(非老年PCI组,冠心病组)和同期冠状动脉造影正常者35例为正常对照组;另选择同期行PCI治疗40例老年患者作短期辛伐他汀干预观察,干预组和对照组各20例,采用酶联免疫吸附测定血浆可溶性Fas因子水平。结果:经皮冠状动脉介入治疗术后再狭窄组血浆可溶性Fas(513±135ng·L-1)显著高于正常对照组,(51±14ng·L-1)、非老年PCI组(146±28ng·L-1)和无再狭窄组(142±30ng·L-1)(P均<0.01);非老年PCI组和无再狭窄组血浆可溶性Fas也高于正常对照组(P均<0.01);而非老年PCI组和无再狭窄组之间血浆可溶性Fas差异无显著性。择期冠状动脉介入治疗术后6h血浆可溶性Fas水平急剧增高;术后3d对照组血浆可溶性Fas升高达最高峰,辛伐他汀治疗组则显著降低(分别为1987±413和1124±253ng·L-1,P<0.01);术后7d对照组仍维持在高水平,治疗组下降至最低水平(分别为1325±237和598±104ng·L-1,P<0.01)。结论冠心病患者血浆可溶性Fas因子水平明显增高,并在行经皮冠状动脉介入治疗后进一步增高,且以老年人显著;再狭窄患者血浆可溶性Fas因子水平明显高于无再狭窄患者,辛伐他汀干预可显著降低血浆可溶性Fas因子水平,提示对接受经皮冠状动脉介入治疗的老年患者更应强调调脂、抗炎及稳定斑块的治疗。     

年龄对冠心病患者PCI术后长期结果的影响

目的:了解年龄对冠心病患者在冠脉介入治疗(PCI)后长期临床结果的影响。方法:接受PCI治疗的患者584例,按年龄是否达到60岁分为老年组和非老年组:老年组315例,非老年组269例。收集一般临床资料及冠脉病变情况并进行长期临床随访(3月～49月),详细记录临床主要不良事件的发生情况。结果:与非老年患者相比,老年组有更多的女性(29.84%对10.41%,P<0.01)患者,合并高血压(59.37%对49.07%,P<0.05)较多,以急性冠脉综合症为表现的(72.1%对57.25%,P<0.01)较多,但其冠脉较小[(2.97±0.36)mm对(3.06±0.36)mm,P<0.01],但吸烟较少(36.51%对69.89%,P<0.01)。两组患者的临床主要不良事件的发生情况无显著差异,但老年组全因性死亡(3.49%对1.12%,P=0.061)及心因性死亡(2.86%对0.74%,P=0.061)有增高趋势。经过校正不匹配的基线因素后的偏相关分析显示,老年与全因性死亡(r=0.0789,P=0.061)及心因性死亡(r=0.0751,P=0.074)呈正相关趋势,而年龄与之呈显著的正相关(r=0.0983,P=0.019及r=0.0896,P=0.033)。结论:老年患者在PCI治疗后的长期临床预后较好,因此PCI治疗老年患者安全有效。     

多媒体干预在择期冠脉介入手术患者心理护理的应用研究

目的:探讨多媒体干预对择期冠脉介入手术患者负性情绪和生活质量的影响。方法:将200例择期进行冠状动脉介入治疗的患者随机分为对照组和多媒体组各100例,对照组给予常规护理,多媒体组在此基础上采取多媒体干预。护理干预前后分别采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对两组患者的负性情绪进行评分比较,护理干预后采用生活质量量表(SF-36)对两组患者的生活质量水平进行比较。结果:护理干预后多媒体组患者焦虑、抑郁评分明显低于对照组,患者生活质量显著优于对照组,差异有统计学意义(P<0.05)。结论:对择期冠脉介入手术患者应用多媒体干预不仅可以有效地改善患者的负性情绪,还能够提高其生活质量。     

冠心病患者择期冠状动脉介入治疗术前口服大剂量阿托伐他汀预防对比剂肾病

目的了解冠心病患者择期冠状动脉介入治疗（percutaneous coronary intervention,PCI）术前服用大剂量阿托伐他汀对血清高敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）及肾功能的影响。方法选择冠心病择期冠状动脉造影检查需要PCI治疗的患者173例,随机分为大剂量阿托伐他汀组（AS组,n=76）和常规治疗组（C组,n=97）,治疗7天后行PCI术。术前和术后检测血清hs-CRP、血清肌酐（serum creatinine,SCr）,计算肾小球滤过率（glo-merular filtration rate,GFR）。结果两组患者术前24h血hs-CRP水平,低于入院时（t=2.413和2.309,P〈0.05）和术后48h（t=2.087和2.368,P〈0.05）;AS组PCI术前24h和术后48h血清hs-CRP均低于C组（t=2.007和2.275,P〈0.05）。两组PCI术后SCr较术前升高（t=2.464和2.392,P〈0.05）,GFR较术前降低（t=2.496和2.573,P〈0.05）;术后AS组SCr低于C组（t=2.337,P〈0.05）,GFR高于C组（t=2.145,P〈0.05）。AS组对比剂肾病（contrast-induced nephropathy,CIN）发生率低于C组（6.58%vs16.49%,χ^2=3.93,P〈0.05）。结论冠心病择期PCI患者术前服用大剂量阿托伐他汀对CIN可能有良好的预防作用,机制可能与显著抑制炎症反应有关。     

急诊经皮冠状动脉介入治疗的伦理问题探讨

急性心肌梗死是心血管疾病急危重症,急诊经皮冠状动脉介入术（percutaneous coronary intervention,PCI）是急性心肌梗死治疗的首选方法.在临床实践中存在适应证模糊、不能有效沟通、治疗欠公平等伦理学问题,影响了急诊PCI的合理应用和发展,甚至导致医患纠纷的发生.通过对患者生命权、知情权、公平权等权利的重视,在医学伦理学的基本原则下指导介入技术的实施,使其可以更好地为患者服务.     

Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

Background:

It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD.

Methods:

From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221) of the cohort. All these patients were divided into two groups: CE + CABG group (Group A) and CABG alone group (Group B). All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student''s t-test respectively.

Results:

Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38), which was more often than that in Group B (3/183). At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50). There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention.

Conclusions:

Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.     

UA患者PCI联合应用腺苷对心肌损伤和临床预后的影响

目的:评价不稳定型心绞痛(UA)患者冠脉介入治疗(PCI)后联合静脉应用腺苷心肌损伤和预后的影响。方法:60例备行PCI的UA患者随机分配到腺苷组(A组,30例)和对照组(B组,30例)。测定并定量分析PCI术前后血清肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)。随访两组PCI术后3个月内主要不良心血管事件(MACE)的发生率。记录使用腺苷治疗期间不良事件的发生率。结果:PCI术后48h内A组cTnI的峰值和累积释放值均低于B组(P<0.05)。两组CK-MB峰值和累积释放值差异均无统计学意义(P>0.05)。PCI术后3个月内A组MACE发生率低于B组,无统计学差异(P>0.05)。在使用腺苷治疗期间,没有与使用腺苷相关的严重不良反应发生。结论:在阿司匹林、氯吡格雷抗血小板治疗的基础上,UA患者PCI联合静脉应用腺苷能减少PCI术后微量心肌损伤,并有进一步降低PCI术后3个月内MACE发生率的趋势。     

替罗非班对冠脉综合征患者经皮冠状动脉介入治疗后凝血功能的调控作用

目的研究替罗非班术后辅助干预对冠脉综合征患者经皮冠状动脉介入术(PCI)治疗后凝血功能的调控作用。方法选取我院2010年12月至2013年12月冠脉综合征患者98例,随机分为观察组与对照组两组,每组49例。观察组患者在PCI术后给予替罗非班辅助干预,对照组患者在PCI术后不给予辅助干预。比较两组患者手术前后血小板聚集率(PAg T)、活化凝血时间(ACT)、抗凝血酶(AT)、可溶性CD40配体(s CD40L)、基质金属蛋白酶-9(MMP-9)、高敏C反应蛋白(hs-CRP)等因子变化情况,比较两组患者术后部分凝血酶原时间(a PTT)、凝血酶原时间(PT)和凝血酶时间(TT)等凝血指标水平。结果观察组患者PAg T水平较对照组显著较低(P0.05),ACT和血浆AT水平较对照组显著较高(P0.05);观察组患者的s CD40L、Hs-CRP、MMP-9等血清炎性因子水平较对照组显著较低(P0.05);观察组患者术后a PTT、PT、TT等凝血指标较对照组无差异(P0.05)。结论冠脉综合征患者PCI介入治疗后给予替罗非班干预能抑制血小板聚集,有加强抗血小板的作用,患者血清中炎性因子水平降低,血管内皮功能得到改善。     

替格瑞洛对冠心病患者经皮冠状动脉介入治疗术后冠脉微循环功能的影响

目的研究替格瑞洛对冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后冠脉微循环功能的影响。方法选取2013年9月至2014年9月在我院进行PCI手术的冠心病患者76例为研究对象,抽签随机分为观察组(替格瑞洛)与对照组(氯吡格雷),每组38例。两组入院后均进行药物治疗与常规护理,住院期间均给予扩冠、他汀类药物、B他受体阻断剂、低相对分子质量肝素。两组术前均给予阿司匹林肠溶片,对照组加入氯吡格雷联合治疗,观察组加入替格瑞洛联合治疗。比较两组治疗前后凝血酶元时间(PT)、血小板聚集率(PAgT)和纤维蛋白原(Fbg)含量、循环抵抗指数(IMR)、冠脉血流储备(CFR);观察治疗期间出血事件发生情况;电话和门诊随访治疗后6个月、1年、2年心血管事件发生率。结果治疗后观察组PT、PAgT和Fbg值(P0.05);观察组治疗后的IMR值为(26.80±5.97),显著低于对照组(29.87±6.14),CFR值为(2.23±0.51),显著高于对照组(1.84±0.44)(P0.05);观察组治疗期间出血事件发生率为2.63%,明显低于对照组15.79%(P0.05),观察组治疗后6个月、1年、2年内心血管不良事件发生率分别为5.26%、10.53%、13.16%,均显著低于对照组21.05%、28.95%、34.21%(P0.05)。结论对冠心病患者PCI术后给予替格瑞洛抗血小板治疗,可获得优于氯吡格雷对凝血功能与冠脉微循环功能的改善效果,并降低短期、中远期心血管不良事件的发生率。     

经桡动脉途径行冠心病介入治疗

目的:探讨经桡动脉行冠心病介入治疗的安全性及临床疗效.方法:选择Allen's试验阴性的住院冠心病病人31例接受经桡动脉介入治疗.结果:共植入支架42枚.经桡动脉介入成功30例,成功率96.8%,术后平均住院日(2.7±0.7)天.1例出现桡动脉痉挛,改用股动脉途径行介入治疗后成功.治疗病例无死亡,1例出现前臂血肿,未行特殊处理痊愈.结论:只要患者适应证选择得当,操作规范,经桡动脉途径行冠心病介入治疗是安全、可行的.     

强化他汀对急性冠状动脉综合征经皮冠状动脉介入治疗后的疗效观察

目的：探讨强化他汀治疗对急性冠状动脉综合征经皮冠状动脉介入治疗后短期疗效及安全性。方法从我院2014年5月至2016年5月收治的急性冠状动脉综合征患者中抽选410例,给予患者经皮冠状动脉介入治疗,并强化患者的降脂治疗,给予其每日40mg阿托伐他汀口服治疗,观察并比较本组患者治疗前和治疗1个月后的血脂水平变化情况,评价其临床疗效和安全性。结果强化他汀治疗1个月后,本组410例患者的TC、TG、LDL-C等临床指标较治疗前均有明显下降,前后比较有统计学意义,P<0.05;治疗前和治疗后患者的ALT、Cr水平比较差异不大,无统计学意义,P＞0.05;本组患者血脂达标率为96.59%;410例患者在治疗期间共有31例患者发生不良反应(7.56%)。结论强化他汀治疗对急性冠状动脉综合征经皮冠状动脉介入治疗患者具有良好的疗效,给予患者介入治疗后早期服用大量阿托伐他汀,能显著降低其血脂水平,且不良反应发生率低,安全有效,值得临床推广。     

冠心病患者介入治疗前后血管内皮生长因子水平的变化

目的探讨经皮冠状动脉介入治疗(PCI)前后冠心病患者血管内皮生长因子(VEGF)水平的变化及临床意义.方法观察组为98例行PCI连续观察的冠心病患者,对照组为40例冠状动脉造影正常患者.采用酶联免疫吸附双抗夹心法测定血清VEGF水平.结果VEGF水平在PCI术前随血管狭窄程度升高而增加,术后即刻VEGF水平较术前有显著性下降,72 h升高,7 d达到峰值.结论VEGF在PCI术前诱导新生血管形成,减轻心肌缺血;术后早期促进相关血管内膜修复和平滑肌细胞增生.     

介入治疗冠状动脉左主干病变临床研究

目的研究经皮冠脉介入术（PCI）和冠脉旁路移植术（CABG）对冠状动脉左主干病变的疗效和安全性.方法回顾性收集2005年5月至2008年10月在昆明医学院附一院及云南省内部分医院心内科住院治疗的30例左冠状动脉主干病变行PCI治疗的患者为PCI组,另收集2007年3月至2008年10月在昆明医学院附一院心外科住院治疗的16例冠状动脉搭桥治疗左主干病变患者为CABG组.观察PCI组及CABG组患者的临床特征.并对上述两组患者进行随访,观察死亡、非致死性心肌梗死、靶血管血运重建术、脑血管事件等终点事件的发生情况及心绞痛复发情况.结果两组的临床特征基本相近.PCI组有5例（16.7%）左主干末端分叉病变达到Ⅲ级病变,而CABG组8例（50.0%）左主干末端分叉病变达到Ⅲ级病变,P=0.045,差异有统计学差异.PCI组中药物洗脱支架（DES）应用占绝对优势（97.0%）,左主干病变支架置入成功率为100%.两组在心绞痛复发率、再次心肌梗死、血运重建率、主要不良心脏事件（MACE）发生率、主要不良心脑事件（MACCE）发生率均无统计学意义.PCI组中急性冠脉综合症（ACS）与非ACS远期疗效比较在心绞痛复发率（29.4%VS0.0%,P〈0.05）及MACE发生率（41.2%VS7.6%,P〈0.05）差异有统计学意义.结论 （1）经选择无保护左主干病变PCI治疗的疗效与CABG治疗左主干病变比较PCI是可行和安全的,并取得较好的近远期疗效.（2）急性冠脉综合征可能是影响心绞痛复发率及MACE的因素之一.     

冠心病患者颈动脉超声检测的比较分析

目的：通过对冠心病患者进行颈动脉超声检查,探索冠心病与颈动脉IMT、斑块之间的关系。方法选取2006年1月-2010年12月来我院就诊的147例冠心病患者作为病例组,同时选取同期来院就诊的119例非冠心病患者为对照组,并用高频探头测量两组人群的LCCA-IMT、RCCA-IMT,观察是否有斑块形成。结果病例组和对照组之间年龄、性别、吸烟史差异均无统计学意义（P〉0.05）。病例组LCCA-IMT和RCCA-IMT增厚、斑块形成发生率均高于对照组,差异都有统计学意义（P〈0.00001）。结论颈动脉超声检查可为冠心病的早期诊断提供依据。     

顽固性高血压合并冠心病PCI后有效降压12例临床分析

目的探讨顽固性高血压合并冠心病患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后能有效降压的原因,以提高对顽固性高血压综合治疗的认识。方法回顾2006年1月-2010年11月在玉林红十字会医院诊治的12例顽固性高血压合并冠心病经PCI治疗后能有效降压患者的临床资料,并结合相关文献进行分析。结果冠脉造影结果提示12例患者中,3例存在三支病变,3例两支病变,6例单支病变,狭窄程度75%～完全闭塞。所有患者均成功行PCI治疗,植入支架数1～5枚,平均(2.3±1.2)枚。PCI后12例患者血压控制在(89～138)/(64～83)mm Hg之间,平均收缩压(121±12)mm Hg,平均舒张压(69±6)mm Hg。所有患者血压均得到有效控制,有效率100%。结论顽固性高血压合并冠心病患者,血压控制不佳时,可考虑先行PCI治疗。