经皮冠状动脉介入术和冠状动脉旁路移植术对80岁以上左前支慢性闭塞患者的疗效比较

目的：比较经皮冠状动脉（冠脉）介入术（percutaneous coronary intervention,PCI）和冠脉旁路移植术（coronary artery bypass grafting,CABG）对80岁以上老年单纯左前降支慢性闭塞患者的临床疗效。方法：自2016年1月至2020年7月,73例在我院接受PCI和CABG的80岁以上单纯左前降支慢性闭塞病变的患者为研究对象,42例患者接受PCI(PCI组),31例患者接受CABG(CABG组)。详细记录2组患者的临床特征、生化指标、住院期间和1年随访期间的主要心脏不良事件（包括死亡、心绞痛复发及因心肌缺血所致的再次血运重建等）。结果：2组患者年龄、性别构成、吸烟、高血压、糖尿病、高血脂、脑卒中、陈旧性心肌梗死、既往PCI史、外周血管疾病史及SYNTAX评分差异无统计学意义（均P>0.05）,PCI组和CABG组的手术成功率（90.5%比97.1%,P=0.473）和再次血运重建率（7.89%比2.86%,P=0.667）差异无统计学意义。与CABG组相比,PCI组的费用[（7.34±1.54）万元比（11.77±1.34...     

冠状动脉旁路移植术后2型糖尿病患者接受自身血管或静脉桥介入治疗预后的比较

目的：比较冠状动脉旁路移植术（coronary artery bypass graft,CABG）后的2型糖尿病（type 2 diabetes mellitus,T2DM）患者选择自身血管或静脉桥行经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）对患者预后的影响，并探讨该类患者发生主要不良心脑血管事件（major adverse cardiac and cerebrovascular events,MACCE）的预测因素。方法：筛选了CABG术后需再次行PCI治疗的T2DM患者559例，其中488例患者接受自身血管PCI,71例患者接受静脉桥PCI。比较不同靶血管的选择对预后的影响，并采用多因素Cox回归分析发生MACCE的预测因素。主要研究终点为MACCE。结果：与自身血管PCI组相比，静脉桥PCI组患者慢血流/无复流的发生风险更高（2.8%vs.零，P=0.008）。中位随访40个月发现自身血管PCI组与静脉桥PCI组患者发生MACCE的风险相似（35.2%vs. 33.8%,P=0.916），并且两组患者发生其他终点事件，差异...     

经皮冠状动脉介入治疗对既往冠状动脉旁路移植术的冠状动脉慢性完全闭塞冠心病患者生活质量的影响

目的 观察经皮冠状动脉介入（PCI）治疗对既往冠状动脉旁路移植术（CABG）的冠状动脉慢性完全闭塞（CTO）患者生活质量的影响。 方法 连续性纳入2010年8月至2018年8月在西京医院心血管内科成功行PCI的123例患者,分为非CABG组和CABG组。收集病历资料,随访主要心血管事件（MACE）,通过SAQ量表和SF-12量表比较患者生活质量的改变。 结果 CABG组患者的左室射血分数（LVEF）和低密度脂蛋白胆固醇（LDL-C）显著低于非CABG组（P<0.01）。影像学中CABG组患者的左主干（LM）合并两支或三支冠脉病变的比例高于非CABG组,而非LM单支或两支冠脉病变比例低于非CABG组（P<0.05,P<0.01）。随访时间为PCI术后（47±3）月,CABG组患者的全因病死率高于非CABG组,在非致死性心肌梗死和临床驱动的再次血运重建率中,非CABG组高于CABG组,但差异均无统计学意义。CABG组患者的SAQ量表中躯体活动受限程度的评分高于非CABG组[（68±7）vs（59±2）分],心绞痛稳定程度的评分高于非CABG组[（70±9） vs （46±6）分],心绞痛发作频率的评分也高于非CABG组[（88±8） vs （80±6）],差异均具有统计学意义（P<0.05）。而在治疗满意程度和疾病认知程度方面无明显差异。CABG组患者的SF-12量表中生理得分高于非CABG组[（46±5）vs （39±4）分,P<0.05],但两组的心理得分的差异无统计学意义。 结论 成功PCI使既往CABG的CTO冠心病患者心绞痛症状及生活质量得到改善。     

冠状动脉搭桥与冠脉介入治疗的比较

冠状动脉旁路移植术（CABG）和经皮冠状动脉介入术（PCI）是目前治疗冠状动脉狭窄的两种主要治疗方法。CABG是半个世纪以来治疗冠心病经典手段之一,近年来由于对桥血管的选择和保护、全动脉再血管化等的重视,其近远期治疗效果明显提高。随着介入技术的发展,这项技术以其微创、安全、易于被患者所接受等特点,适应证不断扩大。本文就近年来CABG和PCI在治疗冠心病方面的发展和优势作一综述。     

再次冠状动脉重建治疗:一个不容忽视的问题

<正>冠状动脉重建术包括经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和外科冠状动脉搭桥术(coronary artery bypass grafting,CABG),是目前治疗冠状动脉疾病(coronary artery disease,CAD)最常用和最重要的手段。     

冠状动脉旁路移植术：第二支动脉桥血管的应用进展

冠状动脉粥样硬化性心脏病的治疗方式主要是药物治疗,经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）和冠状动脉旁路移植术（coronary artery bypass grafting, CABG） ;CABG是重症冠心病患者的主要治疗方式。近年来多支动脉或全动脉化旁路移植在冠状动脉外科兴起,但是除了左侧胸廓内动脉作为旁路移植黄金血管材料,第二支动脉桥血管的选择和使用仍存在很多挑战。本文将对临床常用的右侧胸廓内动脉,桡动脉,胃网膜右动脉和旋股外动脉降支应用进展作综述。     

冠状动脉介人治疗前强化他汀治疗的获益——从指南到临床

冠状动脉造影术作为诊断冠心病的金标准,在临床上应用越来越广泛,接受冠状动脉造影的患者,如有冠状动脉硬化,可根据血管硬化、狭窄的程度,选择药物治疗、介人治疗（PCI）及冠状动脉旁路移植术（CABG）。PCI现已被人们广泛接受,我国手术量年增长率已达40％,2012年诊疗数量达34万例。     

冠状动脉旁路移植术后1年内接受经皮冠状动脉介入治疗的临床特征与随访结果研究

目的:本研究旨在探讨冠状动脉旁路移植术(CABG)后1年内患者经皮冠状动脉介入治疗(PCI)的临床特征和随访结果.方法:分析总结既往在北京安贞医院接受CABG且随后1年内接受PCI的121例患者的临床数据,并进行随访.结果:患者平均年龄为60.71岁,男性占71.9％,合并糖尿病、高血压、高脂血症和吸烟史等冠心病危险因...     

冠状动脉旁路移植术和药物支架植入术远期疗效的比较

目的比较冠心病患者非药物治疗手段冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）术后的桥血管和支架的再通率。方法CABG术后和药物支架植入术后再次出现心绞痛症状的冠心病患者各40例,其年龄、性别、心肌梗死、高血压、高脂血症、心功能不全、脑卒中、药物治疗病史具有可比性。通过冠状动脉造影术比较两组患者的桥血管和药物支架的效率和寿命的远期效果。结果与行CABG患者的桥血管比较,行PCI患者的药物支架远期狭窄或者闭塞率降低34．3％。与行CABG患者的左乳内动脉（LIMA）桥血管比较,行PCI患者的左前降支的药物支架远期狭窄或者闭塞率降低14．8％。与行CABG患者的左回旋支和右冠状动脉静脉桥血管比较,行PCI患者的左回旋支以及右冠状动脉的药物支架远期狭窄或者闭塞率降低49．8％。结论冠状动脉药物支架植入术的远期通畅率较CABG明显增高,冠状动脉药物支架植入术的药物支架的效率和寿命要优于CABG的桥血管。     

经皮冠状动脉介入治疗中冠状动脉穿孔的发生及防治

经皮冠状动脉介入（percutaneous coronary intervetion,PCI）治疗在过去的20多年中取得了巨大的进步,时至今日已经成为治疗冠心病最有效的方法之一。冠状动脉穿孔（coronary artery perfora-tion,CAP）是PCI治疗中少见的并发症之一,据统计其发生率在0.1%~3.0%、一旦发生病死率高达10%[1]。冠状动脉穿孔不仅可以增加PCI的难度,同时可以导致动脉瘤、动静脉瘘、心包填塞、心肌梗死,甚至死亡。     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting

In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.     

经桡动脉穿刺冠状动脉复杂病变的介入治疗

目的　探讨复杂冠状动脉病变经桡动脉穿刺途径行介入治疗的成功率和并发症。方法　 184例复杂冠状动脉病变的冠心病心绞痛患者中 ,经桡动脉穿刺组 4 6例 ,对照组为经股动脉穿刺者 138例 ,观察两组手术成功率、术后并发症等情况。结果　经桡动脉组手术成功率为 92 .2 % ,与经股动脉组 (94 .9% )相比无明显差异 (P>0 .0 5 )。但术后与穿刺有关的并发症发生率 ,经桡动脉组明显少于经股动脉组 (10 .8% vs 2 8.3% ,P<0 .0 5 ) ;术后卧床时间也明显短于经股动脉穿刺组 (P<0 .0 1)。而经桡动脉组从穿刺开始至指引导管放置成功所需的时间长于经股动脉组(P<0 .0 5 )。结论　经选择的冠状动脉复杂病变经桡动脉途径介入治疗具有较高的成功率。经桡动脉途径术后与穿刺有关的并发症发生率低。     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.