老年急性冠脉综合征直接冠状动脉支架植入远期疗效观察

目的探讨老年急性冠脉综合征患者直接冠状动脉支架植入后远期临床疗效。方法选择老年急性冠脉综合征患者24例,非经球囊预扩张直接植入冠状动脉支架,随访观察患者远期临床疗效。结果经选择性冠状动脉造影检查,选择符合入选标准的34处病变,成功直接植入冠状动脉支架32个,无急性期并发症。进行(26.29±14.72)个月的随访,术后胸痛发生率8.3%,支架植入后再狭窄率12.5%。结论直接冠状动脉支架植入治疗老年急性冠脉综合征切实可行,并且具有较好的远期临床疗效。     

直接冠状动脉支架植入治疗冠心病的疗效观察

随着对冠状动脉治疗效果的深入研究以及冠状动脉内支架工艺的进步,许多病变即使不进行预扩张也可以将支架植入,因此,支架植入必须进行预扩张的观念受到挑战。已有较多的研究证实,冠心病患者直接冠状动脉植入是可行、安全的方法。本文对此报告如下。1 对象和方法 对象 1998年1月～2002年7月间共126例冠心病患者在冠状动脉造影后入选。男97例,女29例,年龄35～73岁,平均(58.7±8.4)岁,91例为稳定型心绞痛,35例为不稳定型心绞痛。43例合并有高血压,27例有糖尿病,31例有高脂血症。11例患者射血分数<40％。经造影后的入选标准为:有经皮腔内冠状动脉成形术(PTCA)适应证的冠心病患者,并除外下述情况:①弥漫长节段病变>25mm;②血管直径<2.5mm;③严重钙化病变;④狭窄近段血管严重扭曲;⑤严重     

冠脉内支架植入治疗急性心肌梗死的疗效观察

对急性心肌梗死(AMI)行冠脉内支架植入，既减少了原位再梗死的发生率及PICA后再狭窄所致的急性冠脉事件发生，同时死亡率、恶性心律失常、严重心力衰竭的发生有明显减少，远期心脏功能也较前有了明显的改善。本报告68倒(支架植入77个)急诊支架植入的疗效，并与84例AMI非介入治疗作比较。     

急性心肌梗死直接支架植入术4例报告

目的：提高急性心肌梗死的生存率，减少并发症。方法：对确诊心肌梗死且在6小时内的病人作急诊冠状动脉造影，对于病变处直接植入支架。结果：4例病人共植入支架5枚，均获成功。结论：对于急性心肌梗死的病人进行直接支架植入术可提高患的生存率、减少并发症、缩短住院时间、提高生活质量。     

冠状动脉内植入支架治疗急性心肌梗死18例

冠状动脉(冠脉)内支架可有效治疗因冠脉内膜撕裂引起的并发症，但由于急性心肌梗死(AMI)时冠脉内存在血栓，故冠脉内支架是否可应用于AMI一直存有争议。近年国内外学者报道用冠脉内支架治疗AMI取得良好的临床效果。本文报告笔者采用冠脉内植入支架治疗18例AMI患者的初步体会。     

冠状动脉内直接支架植入对冠状动脉微循环的影响

目的探讨选择性冠状动脉病变不作球囊预扩张的直接支架植入术对冠状动脉微循环的影响。方法选择急性冠状动脉综合征（ACS）92例，随机分为直接支架植入A组（47例）和球囊预扩张后支架植入B组（45例），选择的病变均为A型或B1型病变，以造影剂心肌染色（TMP）分级法、TIMI计帧法和支架植入术前后心肌酶的变化作为心肌组织灌注成功和冠状动脉微循环栓塞形成的诊断标准。结果（D两组支架植入成功率均为100％。②TMP分级：A组TMP3级34例（72％），B组TMP3级21例（47％），两组间有显著性差异（P〈0.05）。③TIMI帧数：A组支架植入前后TIMI帧数虽有增加，但无统计学差异（P〉0．05）；B组支架植入前后TIMI帧数明显增加，有统计学意义（P〈0．05）；两组间术后增加的TIMI帧数比较，B组比A组增加明显，有统计学差异（P〈0．05）。④心肌酶学变化：A组术前术后比较无统计学意义（P〉0．05），B组术前术后变化有统计学意义（P〈0．05），两组之间比较有统计学明显差异（P〈0．001）。结论冠状动脉（A型或B1型病变）内直接支架植入，冠状动脉微循环栓塞的发生率低，心肌组织血流灌注程度高。     

直接冠状动脉支架置入术治疗急性心肌梗死临床研究

本文对我院收治的 2 0例急性心肌梗死 (AMI)患者进行总结 ,旨在探讨AMI患者应用直接冠状动脉支架置入术治疗的安全性和有效性。1　材料与方法1.1临床资料　我院 2 0 0 0年 7月至 2 0 0 2年 8月间收治的发病 6小时内的AMI患者 2 0例。其中男 14例 (70 % ) ,女 6例(30 % ) ,年龄     

雷帕霉素药物洗脱支架治疗急性ST段抬高性心肌梗死早期疗效观察

目的探讨雷帕霉素药物洗脱支架（Cypher^TM）在急性ST段抬高性心肌梗死（STEMI）经皮冠状动脉介入治疗（PCI）中的早期疗效。方法选择2004年1月至2005年6月的STEMI患者100例,随机分为两组：药物支架组50例和普通支架组50例,所有患者均于发病12 h内行急诊PCI治疗,一组置入Cypher^TM,另一组置入普通支架。比较两组支架置入情况及早期临床事件发生率。结果100例患者急诊PCI治疗均获得成功。药物支架组95支梗死相关血管（IRA）的99处病变置入98枚药物洗脱支架,普通支架组77支IRA的81处病变置入83枚普通支架。药物支架组1例介入治疗后第3天猝死。药物支架组和普通支架组相比较,手术成功率及PCI后造影结果和临床结果比较差异均无统计学意义。随后对99例病人进行了1-6个月随访,药物支架组有较低的再狭窄率和较少的心血管事件发生率（6.0%、16.0%和8.0%、14.0%,P〈0.01）。结论STEMI患者在PCI中应用Cypher^TM支架早期临床效果优于普通支架。     

冠状动脉内支架置入术治疗急性心肌梗死恢复期患者

目的　探讨冠状动脉内支架治疗急性心肌梗死恢复期患者近期、远期疗效。方法　对 11例急性心肌梗死恢复期患者行冠状动脉内支架治疗 ,梗死相关血管共 13支 ,A型病变 7支 ,B型病变 5支 ,C型病变 1支。结果　共置入支架 15只 ,成功率 10 0 % ,血管直径平均狭窄由术前 80 %～ 10 0 % ,降至术后 0± 10 %。平均随 11 4± 3 2个月 ,超声心动图检查左室射血分数、短轴缩短率、A E、术前为 41 6 %± 4 8%、2 9 8%± 5 6 %、1 36± 0 2 8;术后分别为 5 1 5 %± 9 3 % (P >0 0 5 )、34 5 %± 7 6 7% (P >0 0 5 )、0 93± 0 45 (P <0 0 5 )。99mT MIBI静息心肌灌注显像缺血心肌节段数 ,术前为 5 4± 2 2 ,术后为 3 3± 1 6 (P <0 0 5 )。硝酸甘油介入99mTc MIBI心肌灌注显像检查显示心肌缺血节段数术后较术前减少 (P <0 0 5 )。结论　冠脉内支架术可改善急性心肌梗死恢复期患者预后     

急诊冠状动脉内支架植入治疗急性心肌梗死——围术期死亡和近期预后的研究

为评价急性心肌梗死(AMI)患者急诊经皮冠状动脉腔内成形(PTCA)和冠状动脉内支架植入围术期死亡和近期预后的影响因素,通过对74例行急诊冠状动脉内支架植入的AMI,术后6个月内的临床随访和冠状动脉造影随访,进行多因素相关回归分析。结果表明,多支病变患者的糖尿病、高血压和高血脂的合并比例明显高于单支病变患者;总围术期内死亡率为5.4％,剔除合并心源性休克患者后,死亡率为1.4％;12例75岁以上的患者中,2例死于心源性休克,1例死于心脏破裂,5例心源性休克患者死亡3例;术中非致命性合并症的发生率在单支和多支病变组之间差异无显著性(P>0.05);多元回归分析表明血流动力学状态和患者的年龄是决定AMI患者围术期死亡的独立相关因素;多支病变患者术后6个月内心脏事件发生率明显高于单支病变组;术前和术后6个月内的患者左心室射血分数(LVEF)明显改善;而且单支和多支病变组之间术后6个月时的LVEF之间无显著性差异。     

泮托拉唑对急性心肌梗死行经皮冠状动脉支架植入术患者消化道出血的预防

目的观察泮托拉唑在急性心肌梗死经皮冠状动脉支架植入术(PCI)治疗中对消化道出血的预防效果。方法急性心肌梗死行PCI患者87例分为观察组45例和对照组42例,对照组给予常规治疗,观察组在常规治疗基础上加用泮托拉唑,观察2组患者住院期间PCI成功率、并发症、病死率及7 d内消化道出血发生情况。结果观察组和对照组消化道出血的发生率分别为4.4%和21.4%,观察组明显低于对照组(P<0.05)。结论急性心肌梗死PCI治疗中预防性使用泮托拉唑能有效防止消化道出血的发生。     

急性心肌梗死患者补救性冠状动脉支架置入对血清C-反应蛋白的影响

目的:探讨急性心肌梗死(AMI)患者静脉溶栓失败后延迟及补救性冠状动脉支架置入术对血清C-反应蛋白(CRP)的影响。方法:43例AMI且静脉溶栓失败患者分为A、B2组,A组26例溶栓后2周行冠状动脉造影并对病变血管置入冠状动脉支架;B组17例溶栓后90min急诊对“罪犯血管”补救性置入冠状动脉支架。分别于溶栓前、冠状动脉支架置入术后24h、48h、72h及第7d采集静脉血测定CRP。于入院即刻、发病后8h、10h、12h、14h、16h、24h采静脉血测定血清肌酸激酶同工酶(CK-MB)。结果:A组溶栓前CRP为(7.82±4.35)mg/L,术后24h、48h、72hCRP水平和溶栓前比较差异无统计学意义(P>0.05),术后7d((2.81±1.56)mg/L)CRP水平较溶栓前降低(P<0.01)。B组溶栓前CRP为(6.98±4.27)mg/L,补救性冠状动脉支架置入术后24h、48h、72hCRP水平高于溶栓前(P<0.01);术后第7dCRP水平与溶栓前比较差异无统计学意义(P>0.05)。A、B2组溶栓前CK-MB水平均高于正常值,2组比较差异无统计学意义(P>0.05);和A组相比,B组发病后14h、16h、24h血清CK-MB水平均降低,差异有统计学意义(P<0.05)。结论:AMI静脉溶栓失败时补救性冠状动脉支架置入术可引起血清CRP水平升高,然后缓慢降低,可能与局部炎症反应有关。     

Outcomes after primary coronary intervention with drug-eluting stent implantation in diabetic patients with acute ST elevation myocardial infarction

Background Drug-eluting stent (DES) has been used widely for the treatment of patients with acute coronary syndrome with or without diabetes mellitus during percutaneous coronary intervention (PCI), but its long-term safety and efficacy in diabetic patients with acute ST elevation myocardial infarction (STEMI) remain uncertain. This study aimed to investigate the clinical outcomes after primary coronary intervention with DES implantation for diabetic patients with acute STEMI, compared with non-diabetic counterparts. Methods From December 2004 to March 2006, 56 consecutive diabetic patients (diabetic group) and 170 non-diabetic patients (non-diabetic group) with acute STEMI who underwent primary PCI with DES implantation in 3 hospitals were enrolled. Baseline clinical, angiographic, and procedural characteristics, as well as occurrence of major adverse cardiac event (MACE) including cardiac death, non-fatal recurrent myocardial infarction (re-MI) and target vessel revascularization (TVR) during hospitalization and one-year clinical follow-up were compared between the two groups. Results Patients in diabetic group were more hyperlipidemic (69.6% and 51.8%, P=0.03) and had longer time delay from symptom onset to admission ((364±219) minutes and (309±223) minutes, P=0.02) than those in non-diabetic group. The culprit vessel distribution, reference vessel diameter, and baseline TIMI flow grade were similar between the two groups, but multi-vessel disease was more common in diabetic than in non-diabetic group (82.1% and 51.2%, P&lt;0.001). Despite similar TIMI flow grades between the two groups after stenting, the occurrence of TIMI myocardial perfusion grade (TMPG) ≥2 was lower in diabetic group (75.0% vs 88.8% in non-diabetic groups, P=0.02). The MACE rate was similar during hospitalization between the two groups (5.4% vs 3.5%, P=0.72), but it was significantly higher in diabetic group (16.1%) during one-year follow-up, as compared with non-diabetic group (6.5%, P=0.03). The cumulative one-year MACE-free survival rate was significantly lower in diabetic than in non-diabetic group (78.6% vs 90.0%, P=0.02). Angiographic stent thrombosis occurred in 5.4% and 1.2% of the patients in diabetic and non-diabetic group, respectively (P=0.19). All of these patients experienced non-fatal myocardial infarction.Conclusions Although the early clinical outcomes were similar in diabetic and non-diabetic patients with acute STEMI treated with DES implantation, the cumulative MACE-free survival at one-year follow-up was worse in diabetic than in non-diabetic patients. More effective diabetes-related managements may further improve the clinical outcomes of diabetic cohort suffering STEMI.     

直接PTCA对急性心肌梗死的QT离散度的影响

目的　观察直接PTCA对急性心肌梗死 (AMI)患者QT离散度 (QTd)及QTc离散度 (QTcd)的影响。方法　对 30例AMI患者行直接PTCA ,使病变血管血流达到TIMI血流 3级 ,于PTCA术前、术后 2h、4 8h作同步 12导心电图并测量QTd及QTcd ,然后与 30例正常人对照。结果　AMI组与正常对照组间QTd及QTcd有极显著差异 (P <0 .0 1)。有室性心律失常的AMI患者其QTd和QTcd高于无室性心律失常患者 ,但差异无显著性(P >0 .0 5 ) ,PTCA术后其QTd和QTcd下降 (P <0 .0 1) ,室性心律失常好转。结论　成功的直接PTCA可降低AMI患者的QTd和QTcd ,减少室性心律失常的发生 ,改善预后     

Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation

Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in the drug-eluting stent （DES） era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.
Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission （RD group）, and the remaining 533 patients had normal renal function （non-RD group）. The primary endpoint was 30-day major adverse cardiac events （MACE, including death, non-fatal reinfarction, and target vessel revascularization）, and the secondary endpoint was subacute stent thrombosis.
Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 （29.1% vs 18.6%, P=0.02） and multi-vessel （62.8% vs 44.5%, P=0.001） and triple vessel disease （32.6% vs 18.2%, P=0.002）, in-hospital mortality （9.3% vs 3.8%, P=0.03）, and MACE rate during hospitalization （17.4% vs 7.7%, P=-0.006） were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group （76.7% vs 89.9%, P=-0.0003）. Angiographic stent thrombosis occurred in 3 （3.5%） and 7 （1.3%） of patients in the RD group and non-RD group, respectively （P=0.15）. Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up （Hazard ratio （HR） 3.31,95% CI 1.19-9.18, P 〈0.001）.
Conclusion Despite similar prevalence of stent thromb     

Research of transmyocardial stent to treat acute myocardial infarction

Objectives To explore the feasibility, safety and efficacy of transmyocardial stent to treat acute myocardial infarction. Methods 24 Chinese mini swines have been divided into 2 groups randomly：group myocardial infarction （group MI n1 = 14） and group transmyocardial stent（group ST n2 = 10）. In group MI, acute myocardial infarction animal model has been established by the ligation of the left descending coronary artery. In group ST, after the establishment of the model, 3 transmyocardial stents were implanted. 4 weeks later, echocardiography and pathological analysis have been done. Results The density of blood vessel in group ST is 6.47 ± 0.60/HP which is significandy higher than the group MI. At the same time, left ventricular ejection fraction and regional wall motion score index （WMSI） in group ST are ameliorated significandy compared with group MI. Conclusion It is feasible and safe to implant transmyocardial stents in acute myocardial infarction model. Although the channel can＇ t remain patent in long term, the prolonged stimulation can cause moderate-serious inflammatory reaction and proficient angiogenesis.     

Recurrent acute myocardial infarction after 32 months: very late stent thrombosis after sirolimus-eluting stent implantation

Recent analyses have suggested that implantation of drug-eluting stents （DES） is associated with a higher rate of very late stent thrombosis when compared with bare metal stents （BMS）. According to Academic Research Consortium （ARC） definition,1 very late stent thrombosis refers to events occurring more than 12 months following stent placement. This complication is evident with sirolimus-eluting stents （SES） as well as polymer-based paclitaxel-eluting stents （PES）,     

急性心肌梗死患者急诊冠脉介入术中血栓抽吸对再灌注的影响

目的：评价急性心肌梗死（AMI）患者行急诊经皮冠状动脉介入（PCI）治疗中予血栓抽吸治疗的有效性及安全性。方法：选择诊断为AMI并行急诊PCI治疗的患者60例,分为两组,其中血栓抽吸＋PCI组30例,PCI组30例。观察两组患者的心肌酶峰值、ST段抬高最高导联术后2 h回落幅度、超声心动图、冠脉造影术中血流情况及院内心脏不良事件发生率。结果：与PCI组比较,血栓抽吸＋PCI组肌酸激酶峰值明显下降、ST段回落幅度明显增大、心脏功能和结构及心肌组织灌注明显改善。结论：血栓抽吸术的应用可改善心脏的结构和功能,并且是安全的。     

老年急性心肌梗死患者冠状动脉内支架置入术的临床评估

目的评价老年急性心肌梗死(AMI)患者梗死相关动脉支架置入术的疗效及安全性.方法对35例年龄≥70岁的老年急性心肌梗死患者在发病12 h以内行梗死相关动脉直接经皮冠状动脉腔内成形术(PTCA)加冠状动脉内支架置入术.梗死相关动脉:前降支18例(51.4%),回旋支8例(22.9%),右冠状动脉9例(25.7%).心肌梗死溶栓治疗临床试验(TIMI)血流:0级9例,Ⅰ级16例,Ⅱ级10例.结果35例患者中34例介入治疗成功(成功率97.1%),梗死相关动脉共置入支架41个,术中无死亡发生.术后TIMI血流3级为32例(91.4%).术后第2天死亡1例,死于脑出血.临床总成功率为94.3%(33/35).随访32例,1例出现心绞痛,冠状动脉造影示再狭窄,行PTCA加冠状动脉内支架置入术;2例出院后因心力衰竭再次入院治疗;其余29例未再发生心绞痛.结论急诊PTCA加冠状动脉内支架置入术对老年AMI患者具有理想的即刻和长期疗效.合理选择器械、操作技术熟练和围手术期并发症处理经验是保证老年急诊PTCA加冠状动脉内支架置入术获得高成功率的3个关键.     

雷帕霉素洗脱支架在ST段抬高性急性心肌梗死患者PCI中的应用

目的 探讨雷帕霉素洗脱支架(SES)在急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的近、远期疗效及安全性.方法 226例确诊为STEMI患者分为金属裸支架(BMS)组(n=98)和SES组(n=128),分别植入BMS和SES,对比观察术后30 d内及30 d～1年两组主要心脏事件(MACE)[心脏性死亡、非致死性心肌梗死、靶血管再次血运重建率(TVR)]的发生率.结果 术后30 d内两组MACE发生率差异无统计学意义(P＞0.05).与BMS组相比,术后30 d～1年SES组MACE发生率显著降低(分别为5.7%和14.9%,P＜0.01),主要与TVR显著降低有关(分别为3.3%和11.7%,P＜0.01);两组间再次非致死性心肌梗死(分别为0.8%和1.1%)及心脏性死亡(分别为1.6%和2.1%)的发生率差异无统计学意义(均P＞0.05).结论 STEMI患者采用SES治疗1年内疗效明显优于BMS,两者安全性相似;长期疗效及安全性还需要进一步临床研究证实.