不同年龄冠心病患者冠状动脉介入治疗临床特征分析

目的:比较不同年龄组接受冠状动脉介入治疗(PCI)的冠心病住院患者的临床特点,为加强冠心病的一级预防和二级预防提供依据。方法:收集2005年6月至2008年6月在安贞医院心脏内科接受PCI治疗的1428例冠心病患者住院期间的临床资料,对不同年龄组血压、血脂、血糖及吸烟等传统危险因素的合并及控制情况进行比较,并对住院期间的药物治疗情况进行分析和比较。结果:1.60岁以下的青、中年患者占47.7%;在接受PCI治疗的患者中女性在青、中年年龄组中的比例显著低于老年前期及老年组。2.各年龄组患者入院时有血脂异常和糖尿病的比例均较低,而合并高血压的比例较高。3.青年(45岁以下)、中年(45～59岁)、老年前期(60～74岁)和老年(75～89岁)各年龄组患者入院时有高血压、糖尿病的比例随着年龄的增加而增加,而吸烟、饮酒等不良生活习惯的患者比例随着年龄的增加而减少。4.各年龄组患者入院时血压、血糖及血清胆固醇的控制状况均较差。结论:目前住院接受PCI治疗的患者中,青、中年患者占了近50%,并且大部分患者血压、血糖和血清胆固醇均在正常范围,因此,在冠心病的一级预防和二级预防中除了控制传统的危险因素外,还应研究和预防其它心血管病发病的危险因素。     

In-hospital antithrombotic therapy and outcomes of elderly patients on warfarin undergoing percutaneous coronary intervention: Insights from the WAR-STENT registry

In the patients on warfarin undergoing percutaneous coronary intervention included in the prospective, multicentre, observational WAR-STENT registry, age ≥75 years was associated with a significant increase in in-hospital major bleeding, length of hospitalization, and use of bare-metal stents, with no differences in the peri-procedural management and antithrombotic therapy.     

钙化积分与冠状动脉多支病变介入术后预后的相关性

目的 研究冠状动脉钙化积分（CCS）与冠状动脉多支血管病变患者经皮冠状动脉介入治疗（PCI）后近、远期预后的关系.方法 入选145例冠状动脉多支血管病变的冠心病患者,在PCI治疗前均接受了多排螺旋CT （MDCT）检查并计算CCS.根据CCS水平将患者分为三组：CCS≤100、CCS=101～400和CCS＞400组.记录患者PCI操作相关并发症,随访记录患者PCI术后主要不良心血管事件（MACE）情况.结果 CCS＞400组患者Syntax积分[（23.5＆#177;8.8）比（17.9＆#177;8.5）,P＜0.001]、三支血管病变的比率（75.4％比56.3％,P=0.015）和PCI操作相关并发症发生率（21.5％比5.0％,P=0.005）均显著高于CCS≤400组患者.所有患者随访360～2542 d（中位数952 d）,Kaplan-Meier生存分析显示CCS≤100、CCS=101～400和CCS＞400组患者累积无事件生存率差异无统计学意义（84.6％比78.0％比64.6％,P=0.141）.但女性患者中累积无事件生存率差异有统计学意义（100.0％比75.0％比50.0％,Log rank 6.836,P=0.033）.结论 在冠状动脉多支血管病变患者中CCS与PCI预后有关,CCS＞400提示较高的PCI并发症发生率.女性患者CCS越高PCI预后越差.     

冠状动脉旁路移植术后行PCI患者特点分析

目的:探讨冠状动脉旁路移植术后行经皮介入治疗(PCI)患者的临床及造影特点,为冠脉旁路移植术后患者治疗策略的选择提供参考. 方法:分析150例搭桥术后行PCI患者的临床及造影特点. 结果:患者平均年龄(62.3±9.3)岁,左室射血分数(59.1±6.6)％.150例患者均为冠状动脉多支血管病变,共处理罪犯病变197处,其中自身血管153处,动脉桥血管2处,静脉桥血管42处.所有患者均行PCI治疗,无再流发生率为12.7％,其中16例为桥血管病变,3例自身冠状动脉病变,桥血管介入治疗较自身血管介入治疗后其心肌标志物升高明显,无术中死亡病例. 结论:PCI是冠状动脉搭桥术后心肌缺血患者的有效治疗手段,心功能和血管病变造影特点是成功治疗的关键.     

行经皮冠状动脉介入术老年人的冠状动脉病变特点

目的调查老年人行经皮冠状动脉介入术的冠心病患者冠状动脉病变特点。方法对比老年与中青年冠心病患者的临床特点、冠状动脉造影所见病变特点及经皮冠状动脉介入术疗效。结果老年组冠状动脉病变支数为(1.8±0.8)支;中青年组平均为(1.4±0.7)支。差异有统计学意义(P=0.024)。老年组单支病变18例,双支病变14例,3支病变10例;中青年组单支病变33例,双支病变9例,3支病变5例。老年组有心肌梗死史6例(14%),中青年组有心肌梗死史18例(38%),差异有统计学意义(P<0.02)。术后6个月电话随访生存率为99.2%。问卷随访(21±9)个月,其中出现心血管不良事件4例,老年组1例,中青年组3例;6例经皮冠状动脉介入术不满意者,术后症状未改善,其中老年组2例,中青年组4例(P>0.05)。结论老年冠心病患者冠状动脉病变程度较重,多支血管病变多见。应选择合适病例进行经皮冠状动脉介入术治疗。     

女性冠心病患者冠状动脉介入治疗长期预后

目的:了解女性冠心病患者在接受冠状动脉介入治疗(PCI)后的长期临床疗效.方法:584例经PCI治疗的患者,被分为女性组(122例)和男性组(462例),收集其一般临床资料及PCI治疗情况,并进行长期(3～49个月)临床随访,详细记录患者临床主要不良事件的发生情况.结果:男性患者的全因性死亡率(0:3.03%,P＞0.05)及心因性死亡率(0:2.98%,P＞0.05)有增高趋势,女性患者因心脏病再住院率(15.57%:9.96%,P＜0.05)显著增加,但2组患者其他临床主要不良事件差异无统计学意义.经过校正不匹配因素的偏相关分析显示,男性与心因性死亡(r=0.0874,P＜0.05)及全因性死亡(r=0.0970,P＜0.05)呈正相关.结论:女性患者PCI治疗的长期临床预后良好.     

高龄女性冠心病患者冠状动脉造影特点及介入治疗的疗效

目的:探讨高龄女性冠心病患者的冠状动脉造影介入治疗特点及近远期的疗效。方法:在2004年1月~2006年3月行冠状动脉介入治疗的患者中,入选183例女性患者,根据年龄分为高龄女性组(年龄≥75岁,48例)和非高龄女性组(年龄<75岁,135例),同时入选同期77例高龄男性组患者作为对照。回顾性分析这些患者的临床及冠状动脉病变特点、即刻手术成功率和近远期主要心脏不良事件。结果:与非高龄女性组相比,高龄女性组表现为更多的危险因素及基础疾病丛集(P<0.05),多见冠状动脉多支病变及复杂病变(P<0.01),住院期间及远期随访严重心脏不良事件发生率高。与高龄男性组相比,高龄女性也表现为更多的危险因素及基础疾病丛集(P<0.05),尽管冠状动脉病变分布及严重程度相似(P>0.05),但住院期间及远期随访严重心脏不良事件发生率高(P<0.05)。高龄女性与高龄男性患者的总病死率差异无统计学意义,在校正了基线特征后,女性患者的危险降低(OR=0.82,95%CI0.675~0.989,P<0.05)。结论:高龄女性冠心病患者常伴有多种危险因素及基础疾病,冠状动脉病变严重复杂,近远期主要心脏不良事件发生率高,总病死率与高龄男性患者差异无统计学意义。     

One-year clinical outcomes in patients with very small coronary artery disease treated with drug-eluting stents: An observational study in the Indian population

Percutaneous coronary intervention (PCI) in very small vessel coronary arteries is challenging due to adverse short-term as well as long-term outcomes. This single-arm, open-label, observational study assessed 1-year clinical outcomes of drug-eluting stents (DES) in Indian patients undergoing PCI for symptomatic very small-calibre coronary artery disease. It enrolled 66 Indian patients with 74 very small coronary artery lesions (reference vessel diameter: ≥2.0 and ≤ 2.25 mm); eligible for implantation with 2.25 mm DES. The primary endpoint of major adverse cardiovascular events (MACE) was 3.0% indicating favourable 1-year clinical outcomes of DES in very small coronary artery lesions in Indian patients.     

Impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement: Insights from the FRANCE‐2 registry

Background

Coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of CAD distribution before TAVR on short‐ and long‐term prognosis remains unclear.

Hypothesis

We hypothesized that the long‐term clinical impact differs according to CAD distribution in patients undergoing TAVR using the FRench Aortic National CoreValve and Edwards (FRANCE‐2) registry.

Methods

FRANCE‐2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centers. Three‐year mortality was assessed in relation to CAD status. CAD was defined as at least 1 coronary stenosis >50%.

Results

A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of the patients presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk profile and in logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (from 19.3% ± 12.8% to 21.9% ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44%, respectively, in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD, hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78‐1.07). A significant lesion of the left anterior descending (LAD) was associated with higher 3‐year mortality (HR: 1.42; 95% CI: 1.10‐1.87).

Conclusions

CAD is not associated with decreased short‐ and long‐term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long‐term survival and the need for revascularization before or at the time of TAVR should be validated in a randomized control trial.

     

Long-term clinical impact of serum albumin in coronary artery disease patients with preserved renal function

Background and aims

Low serum albumin level is reportedly associated with worse clinical outcomes in patients with chronic kidney disease (CKD). However, associations between decreased serum albumin level and outcomes in non-CKD patients with coronary artery disease (CAD) remain unclear. Therefore, we aimed to evaluate the prognostic value of serum albumin concentrations in stable CAD patients with preserved renal function.

Incidence and angiographic predictors of collateral function in patients with stable coronary artery disease scheduled for percutaneous coronary intervention.

OBJECTIVES: To investigate the incidence and angiographic predictors of functional collateral perfusion in patients with stable coronary artery disease, scheduled for elective PCI. BACKGROUND: Functional collateral perfusion is defined as a Pw/Pa ratio>or=0.24. Since this can only be measured intracoronary, it is important to investigate baseline clinical and angiographic predictors for functional collateral perfusion. METHODS: Collateral perfusion was measured during balloon inflation, with the use of a pressure-monitoring guide wire. Baseline clinical and angiographic characteristics were analyzed and collateral grading was done according to Rentrop's classification for coronary angiograms. RESULTS: Functional collateral perfusion was found in 40 of the 89 patients (45%). Angiographic signs of collaterals (Rentrop>or=1) were present in 15 of the 89 patients. Of the 40 patients with the functional collateral perfusion 11 patients (28%) had Rentrop>or=1; of the 49 patients without functional collaterals there were 4 patients with Rentrop>or=1 (8%) (P=0.02). There were no significant differences in baseline clinical characteristics or in other angiographic characteristics. CONCLUSIONS: In patients with stable coronary artery disease scheduled for elective PCI, 45% have functional collaterals. Rentrop's angiographic classification can be used to predict the presence or absence of functional collaterals, however with a rather modest positive and negative predictive value.     

Bivalirudin use in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Insights from the prospective,multi-centre EUROVISION registry

Abstract

Background: The effectiveness of bivalirudin in patients undergoing percutaneous coronary intervention for acute myocardial infarction has been tested in clinical trials, but its use in a real-world scenario has never been reported.

Methods: From the total number of patients enrolled in the EUROVISION registry, 678 subjects affected by ST-elevation myocardial infarction were selected and included in the analysis. Posology and usage patterns of bivalirudin, as evaluated by dose and time of drug bolus and infusion administered, were evaluated. The 30-day outcome has been assessed by efficacy and safety endpoints.

Results: All patients received an initial intravenous bolus of bivalirudin (0.70 ± 0.25 mg/kg) followed by an infusion (1.58 ± 0.47 mg/kg/h; duration: 60 [30, 107] min) in 99.3% of cases. An additional bolus (0.49 ± 0.06 mg/kg) was administered in 9.3% of patients. Bivalirudin infusion was prolonged after procedure in 62.2%. Death occurred in 2.1% of patients, non-fatal myocardial reinfarction in 0.3%, unplanned revascularization in 0.6% and non-fatal stroke in 0.4%. Acute stent thrombosis was not observed. Major bleeding occurred in 1.5% of patients.

Conclusions: Bivalirudin usage in the setting of primary PCI provided excellent results in terms of 30-day outcome even in a real-world population.     

The platelet-to-lymphocyte ratio as a predictor of all-cause mortality in patients with coronary artery disease undergoing elective percutaneous coronary intervention and stent implantation

Background

There is no data regarding the association between the platelet-to-lymphocyte ratio (PLR) and long-term mortality in patients with stable coronary artery disease (SCAD). The aim of this study is to evaluate the utility of the pre-procedural PLR for predicting long-term, all-cause mortality in patients with SCAD undergoing percutaneous coronary intervention (PCI) and stent implantation.

Methods

We analyzed a total of 2959 consecutive patients with SCAD who underwent PCI (balloon angioplasty followed by stent implantation or direct stenting) between July 2006 and December 2011 at our institution. The patients were stratified into tertiles according to their admission PLR. The association between the PLR value and the outcomes was assessed using Cox proportional regression analysis after adjusting for clinical angiographic and laboratory data.

Results

During median follow-up of 1124 days, mortality was highest in patients with PLR within the 3rd tertile as compared to the 2nd and the 1st tertile (11.0% vs 8.7% vs. 9.6%, respectively, p = 0.03). PLR remained associated with mortality in multivariable analysis including clinical variables, ejection fraction and angiographic parameters HR (per 10 units increase) = 1.02 [95%CI,1.01 ÷ 1.04, p = 0.006]. After adjustment for the eGFR and hemoglobin levels, PLR was however no longer significantly associated with mortality.

Conclusion

PLR has potential predictive value in patients with SCAD, which has not been reported previously, but statistical significance disappears after adjusting for estimated glomerular filtration rate (eGFR) and hemoglobin levels as a potential confounding variable.     

Depression is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: Results from the RESEARCH registry

Background

Depression has been associated with poor prognosis in patients with coronary artery disease (CAD), but little is known about the impact of depression on long-term mortality. We examined whether depression was associated with 7-year mortality in patients treated with percutaneous coronary intervention (PCI), after adjusting for socio-demographic and clinical characteristics, anxiety, and the distressed (Type D) personality.

Methods

The sample comprised a cohort of consecutive PCI patients (N = 1234; 72.0% men; mean age 62.0 ± 11.1 years, range [26–90] years) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. At baseline (i.e., 6 months post-PCI), patients completed the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and the Type D scale (DS14) to assess Type D personality. The endpoint was defined as all-cause mortality.

Results

The prevalence of depression (HADS-D ≥ 8) was 26.2% (324/1236). After a median follow-up of 7.0 ± 1.6 years, 187 deaths (15.2%) from any cause were recorded. The incidence of all-cause mortality in depressed patients was 23.5% (76/324) versus 12.2% (111/910) in non-depressed patients. Cumulative hazard functions differed significantly for depressed versus non-depressed patients (log-rank X² = 25.57, p < .001). In multivariable analysis, depression remained independently associated with all-cause mortality (HR = 1.63; 95% CI [1.05–2.71], p = .038), after adjusting for socio-demographic and clinical characteristics, anxiety, and Type D personality.

Conclusions

Depression was independently associated with a 1.6-fold increased risk for 7-year mortality, above and beyond anxiety and Type D personality. Future studies are warranted to further elucidate the potential pathways linking depression to long-term mortality following PCI.     

Atorvastatin administration after percutaneous coronary intervention in patients with coronary artery disease and normal lipid profiles: impact on plasma adiponectin level

BACKGROUND: There is controversy about the effects of statins on plasma adiponectin, and the impact of percutaneous coronary intervention (PCI) on plasma adiponectin level is still unknown. We investigated the impact of Atorvastatin on plasma adiponectin levels in coronary artery disease (CAD) patients with stable angina and normal lipid profiles after PCI. METHODS: Sixty CAD patients with stable angina and normal lipid profiles scheduled for PCI, and not on statins, were randomly assigned to either no treatment (control group) or the Atorvastatin treatment (Atorvastatin group). Atorvastatin administration was started immediately after PCI. Blood samples were obtained immediately after PCI and again 3 and 6 mo later. Fasting plasma adiponectin concentrations were measured using a radioimmunoassay kit. RESULTS: After PCI, there were statistically significant decreases in adiponectin levels in the Atorvastatin group at 3 and 6 mo (8.66 +/- 0.69 versus 6.87 +/- 0.55 and 7.12 +/- 0.71 microg/mL at 0, 3, and 6 mo, respectively), despite the anti-inflammation and lipid-lowering effects of Atorvastatin. There were no statistically significant changes in adiponectin levels in the control group. There was significant positive association between baseline plasma adiponectin and high-density lipoprotein (HDL) levels. Changes of adiponectin level were not associated with the changes of high-sensitivity C-reactive protein (hs-CRP) and lipid profiles in the Atorvastatin group. CONCLUSIONS: Our study confirmed the benefits of Atorvastatin on anti-inflammation and anti-atherosclerosis, but we also found that Atorvastatin had a negative effect on the adiponectin system. The anti-inflammatory, anti-atherogenic effects of Atorvastatin are not affected by decreased adiponectin levels.     

药物洗脱支架治疗糖尿病多支冠脉病变

目的 探讨药物洗脱支架治疗糖尿病多支冠脉病变患者的安全性和可行性,并与冠脉旁路移植术的疗效进行比较.方法 150例糖尿病多支冠脉病变患者,84例行药物洗脱支架置入术(DES组),66例行冠脉旁路移植术(CABG组).比较两组住院期和随访期不良心血管事件(死亡、心肌梗死、再次血管重建术和脑血管意外)的发生情况.结果 两组的大多数临床和冠脉病变特征相似,CABG组左主干病变(30%比4%,P=0.001)和三支病变(70%比54%,P=0.045)显著增多,完全血管重建化率更高(82%比67%,P=0.037).住院期CABG组术后病死率显著增高(6.1%比0%,P=0.022),但两组总体不良心血管事件发生率仍相似(2.4%比9.1%,P=0.069).在平均(18±8)个月随访期,DES组再次血管重建化率显著增加(13.1%比3.0%,P=0.03),导致总体不良心血管事件发生率增高(21.4%比9.1%,P=0.041),其中相当部分(45%)由于病变进展所致.结论 药物洗脱支架置入术应用在糖尿病多支冠脉病变患者中安全可行,缩小了再次血管重建化发生率上与冠脉旁路移植术的差距.     

Gender differences in clinical outcomes of acute myocardial infarction undergoing percutaneous coronary intervention: insights from the KAMIR-NIH Registry

BackgroundThere are numerous but conflicting data regarding gender differences in outcomes following percutaneous coronary intervention (PCI). Furthermore, gender differences in clinical outcomes with acute myocardial infarction (AMI) following PCI in Asian population remain uncertain because of the under-representation of Asian in previous trials.MethodsA total of 13, 104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015 were classified into male (n = 8021, 75.9%) and female (n = 2547, 24.1%). We compared the demographic, clinical and angiographic characteristics, 30-days and 1-year major adverse cardiac and cerebrovascular events (MACCE) in women with those in men after AMI by using propensity score (PS) matching.ResultsCompared with men, women were older, had more comorbidities and more often presented with non-ST segment elevation myocardial infarction (NSTEMI) and reduced left ventricular systolic function. Over the median follow-up of 363 days, gender differences in both 30-days and 1-year MACCE as well as thrombolysis in myocardial infarction minor bleeding risk were not observed in the PS matched population (30-days MACCE: 5.3% vs. 4.7%, log-rank P = 0.494, HR = 1.126, 95% CI: 0.800-1.585; 1-year MACCE: 9.3% vs. 9.0%, log-rank P = 0.803, HR = 1.032, 95% CI: 0.802-1.328; TIMI minor bleeding: 4.9% vs. 3.9%, log-rank P= 0.215, HR = 1.255, 95% CI: 0.869-1.814).ConclusionsAmong Korean AMI population undergoing contemporary PCI, women, as compared with men, had different clinical and angiographic characteristics but showed similar 30-days and 1-year clinical outcomes. The risk of bleeding after PCI was comparable between men and women during one-year follow up.