Firebird药物洗脱支架治疗冠状动脉原发病变

目的　研究国产雷帕霉素药物洗脱支架 (Firebird)在原发冠状动脉 (冠脉 )病变介入治疗的安全性及疗效。方法　 132例患者接受Firebird或普通支架置入术 ,其中Firebird组 6 0例 ,Cypher支架组5 2例 ,裸支架 (Mustang)组 2 0例。比较各组支架术即刻及近期结果。结果　 3组手术成功率分别为98.3%、10 0 .0 %和 10 0 .0 % ,随访率为 88.3%、92 .3%和 85 .0 % ,硝酸脂药物停用率为 32 .1%、33.3%和2 9 .4 % ,再住院率为 5 .6 %、8.3%和 11.7% ,3组间差异均无显著性。但Mustang组较Firebird组心脏事件、再狭窄及靶血管再次血运重建发生率显著升高 (术后 3种不良事件发生率都是 17.6 %和 0 % ) (P均<0 .0 1) ;而Cypher组与Firebird组比较 ,则无差异。结论　Firebird药物洗脱支架较裸支架有效降低介入治疗术后心脏事件及再狭窄的发生率。同时提供与Cypher药物洗脱支架相似的临床疗效。     

国产可生物降解涂层支架治疗冠心病的临床研究

目的 研究EXCEL支架临床应用的安全性和有效性.方法 2008年1-10月,选择100例冠心病行PCI术并同意术后冠脉造影复查的患者,分为EXCEL组58例,Cypher组42例.观察介入治疗手术即刻成功率和住院期不良事件发生率,术后随访以及冠脉造影复查结果.结果 两组患者基本情况以及冠状动脉病变支数、类型、置入支架平均长度方面差异无统计学意义,随访结果两组主要心脏不良事件(MACE)、支架内再狭窄和血栓发生率差异无统计学意义.结论 与Cypher支架相比EXCEL支架MACE和支架内再狭窄率相似,均较低.     

重叠药物洗脱支架术治疗冠状动脉长病变的临床疗效

目的评估重叠药物洗脱支架治疗冠状动脉长病变的疗效。方法47例患者53处长病变(≥30 mm)接受重叠冠脉药物洗脱支架术治疗(DES组),47例51处病变接受重叠金属裸支架患者作为对照组(BMS组)。比较两组临床情况、造影及介入治疗特征、临床和造影随访结果。结果两组介入治疗前临床情况和冠脉造影结果无显著差异。DES组植入支架较多,病变长度、支架覆盖总长度大于对照组,且血管内径小于BMS组。DES组复发胸痛者显著少于对照组(6%和38%,P<0.01),DES术后支架内晚期管腔丢失显著低于对照组[(0.1±0.03)mm和(1.1±0.41)mm,P<0.01],支架内再狭窄和靶血管再次血运重建率显著低于对照组(4.3%和34.0%;6.4%和44.7%,P<0.01),严重心脏不良事件发生率显著降低(6%和45%,P<0.01)。结论与金属裸支架相比,重叠药物洗脱支架术治疗冠状动脉超长病变能显著降低支架内再狭窄率、靶血管再次血运重建率及严重心脏不良事件发生率。DES治疗冠脉超长病变安全有效。     

雷帕霉素洗脱支架在冠心病合并2型糖尿病中的疗效

目的　评估冠心病合并 2型糖尿病患者冠状动脉 (冠脉 )内植入雷帕霉素洗脱支架的临床疗效。方法　 10 1例 2型糖尿病患者接受冠脉内支架术 ,其中 6 7例植入雷帕霉素洗脱支架 (SES组 ) ,34例接受普通金属支架 (BMS组 )。比较两组的一般临床情况、冠脉造影和支架术 ,以及远期心脏不良事件发生率。结果　两组即刻手术成功率均为 10 0 % ,且无严重并发症发生。平均随访 1年中 ,SES组远期心脏不良事件发生率显著低于BMS组 (7.5 %比 32 .4 % ,P =0 .0 0 1)。结论　冠心病合并 2型糖尿病患者中植入雷帕霉素洗脱支架安全有效 ;与普通支架相比 ,药物洗脱支架能显著降低心脏不良事件发生率     

多枚药物洗脱支架治疗冠心病远期疗效

目的回顾性分析经皮冠状动脉介入治疗(PCI)患者植入单枚与多枚(≥3枚)药物洗脱支架远期预后差异。方法466例接受PCI治疗并植入药物洗脱支架患者,分为单个药物洗脱支架组(373例)和多枚药物洗脱支架组(93例)。比较两组的基础临床情况和12个月主要心脏不良事件(死亡、心肌梗死、靶血管血运重建)。结果与单枚药物洗脱支架组相比,多枚药物洗脱支架组有更多患者伴有高血压、糖尿病和心功能不良,随访17个月主要心脏不良事件发生率(17.2%)较单个药物洗脱支架组(8.6%)明显增加(P＜0.05)。结论与植入单个药物洗脱支架患者比较,植入多个药物洗脱支架患者远期预后不佳。     

国产可降解涂层雷帕霉素洗脱支架在冠心病介入中的应用评价

目的探讨国产可降解涂层雷帕霉素药物洗脱支架介入治疗冠心病的临床效果。方法将90例ST段抬高型心肌梗死(STEMI)患者按入院次序分为观察组与对照组,每组45例,观察组给予国产可降解涂层雷帕霉素药物洗脱支架(EXCEL)介入治疗,对照组给予国产不可降解涂层雷帕霉素药物洗脱支架(Cypher Select)介入治疗,比较两组患者疗效。结果两组患者在PCI成功率、置入支架数目、长度、术后支架内管腔丢失、节段内管腔丢失、支架内再狭窄发生率、节段内再狭窄发生率、MACE发生率均无统计学差异(P>0.05)。结论国产EXCEL与Cypher Select相比,两者对于冠心病患者的治疗均具有良好效果,但EXCEL并未降低术后患者再狭窄及血栓形成发生率。     

涂层可生物降解药物洗脱支架在大小血管病变介入治疗中的疗效比较

目的:评价国产双降解Excel药物洗脱支架(DES)在冠心病小血管病变介入治疗中的临床疗效及安全性.方法:选择212例行经皮冠状动脉介入治疗(PCI)的冠心病患者,其中小血管病变组58例,大血管病变组154例,均置入Excel DES,对比观察手术成功率、术中并发症及在1～18个月随访期间的心绞痛、猝死、主要不良心脏事件发生率及复查冠状动脉造影情况.结果:大小血管病变组手术即刻成功率分别为98.7%、98.3%,320处靶病变共置入支架420枚.术中均无严重并发症发生.小血管组2例心绞痛复发,其中1例为糖尿病者,无心肌梗死及猝死,主要不良心脏事件(MACE)发生率为1.8%.大血管组1例心梗患者术后6 h猝死,3例发生心绞痛,MACE发生率0.7%.两组均未出现迟发性支架内血栓. 结论:国产涂层可生物降解Excel DES应用于冠心病小血管病变介入治疗安全、有效,与大血管病变PCI疗效相近.     

药物洗脱支架治疗2型糖尿病合并冠心病多支血管病变的中期疗效

目的对比分析裸金属支架（BMS）与药物洗脱支架（DES）在2型糖尿病（T2DM）合并多支冠脉病变经皮冠状动脉介入治疗（PCI）应用中的安全性和中期疗效,为DES治疗此类患者提供依据。方法连续人选2002年11月-2005年6月首次接受PCI治疗的443例T2DM合并多支冠脉血管病变患者,其中BMS组226例,雷帕霉素（Cypher）支架组91例,紫杉醇（TAXUS）支架组126例,分析患者住院期间及随访6个月的临床情况。结果三组患者临床特征、手术成功率及住院期间主要不良心脏事件（MACE）发生率等指标均无明显差异。Cypher支架组中病变长度和分叉病变的比例及TAXUS支架组中3支血管和分叉病变的比例均明显高于BMS组（P〈0．05或0．01）。两DES组的造影随访再狭窄率明显低于BMS组（Cypher组3．2％、TAXUS组4．5％协BMS组37．3％,P〈0．05）,临床随访6个月MACE发生率亦明显低于BMS组（Cypher组5．7％、TAXUS组5．8％wBMS组18．5％,P〈0．01）。结论与BMS相比,T2DM合并多支冠脉血管病变患者植入Cypher支架和TAXUS支架安全性高,6个月中期疗效较理想。     

冠心病合并慢性肾功能不全患者的临床特征和PCI远期预后分析

目的 测定冠心病合并慢性肾功能不全(CRI)患者的临床特征,并探讨药物洗脱支架对这些患者冠状动脉介入治疗(PCI)的主要不良事件发生率和临床远期预后的作用.方法 973例经冠状动脉造影确诊冠状动脉明显狭窄(管腔内径减少＞50%)中,516例合并肾功能不全(CRI组),457例肾功能正常(对照组).记录两组基础临床和造影情况,每例均接受PCI治疗和术后临床随访.结果 CRI组高龄、高血压及糖尿病患者明显多于对照组,但左室射血分数显著低于对照组.CRI组冠状动脉复杂病变(C型)明显多于对照组.平均17个月随访结果显示,CRI组总病死率高于对照组(6.2%和3.3%,P＜0.05).亚组分析显示,CRI患者药物洗脱支架治疗后病死率低于普通支架(4.1%和8.5%,P＜0.05).结论 CRI患者通常冠状动脉病变严重,PCI后病死率明显增加,但药物洗脱支架较普通支架显著改善远期预后.     

Cypher支架治疗冠心病11例

目的　评价Cypher支架近期效果及远期效果。方法　对我院11例冠心病患者14处病变行经皮冠状动脉介入治疗(PCI)中置入11个Cypher支架的回顾性分析。其中男性8例,女性3例,患者年龄4 2 - 76岁;患者中合并2型糖尿病、高血压和高脂血症患者各为4、6和5例,1例患者急性前壁心肌梗死后4h行急诊PCI术。14处病变弥漫性病变4例,管状病变5例,分叉处病变2例,慢性完全性闭塞3例;使用支架直径2 .5～3.5mm ;所有患者行PCI术前1d服用肠溶性阿司匹林片和氯吡格雷各30 0mg ,置入支架后予低分子肝素钠5 0 0 0U皮下注射,每12h 1次共7d ,术后服用氯吡格雷75mg d ,6个月,术后长期服用肠溶性阿司匹林10 0mg d ;11处病变都经球囊预扩张后置入支架。结果　11处病变选择Cypher支架置入成功,术中术后无主要不良事件发生,所有患者随诊3～2 0个月。有2例患者在术后6个月及12个月行冠脉造影术,未发现支架内再狭窄。结论　只要选材恰当,手术操作规范,PCI术中选用Cypher支架治疗冠心病是安全和有效,降低再狭窄率,特别是对合并糖尿病的患者     

Small coronary vessel disease and sudden coronary death

In an attempt to determine the importance of atherosclerosis in medium-sized coronary arteries, the hearts of 20 patients dying of cardiac disease, within 24 hours of the onset of symptoms, were compared with 19 controls. Post-mortem coronary angiograms were performed and the coronary arteries dissected in detail. Severe stenoses, or complete occlusions, were present in 34 of 80 major coronary arteries in the sudden cardiac death (SCD) group and 5 of 76 in the controls. Medium-sized branch vessels were severely stenosed or occluded in 20.5 per cent (37 of 180 vessels) in the SCD group and 6.4 per cent (11 of 171 vessels) in the controls. Forty of the 48 diseased branch vessels arose from the left anterior descending artery. In the SCD group, 18 patients died from major coronary artery atheroma, one from hypertensive heart disease and only one from disease of a branch vessel. We conclude that, in most cases of SCD, careful macroscopic examination of the major coronary vessels will provide an adequate explanation for death. Detailed dissection of all medium-sized branch vessels is unlikely to be of value as a routine procedure but, at the very least, pathologists should identify and dissect the first septal and diagonal branches of the left anterior descending artery in every post-mortem.     

心电图诊断冠心病再评价

目的：通过冠状动脉造影证实心电图在诊断冠心病中的价值。方法：根据冠状动脉的造影结果，将100例患者分为冠心病组和非冠心病组，比较两组静息心电图和症状发作时心电图，了解心电图诊断冠心病的价值。结果：100例冠心病患者中54例(54％)诊断冠心病，其中静息心电图正常者26例(48％)，ST-T改变者11例(20％)，心律失常18例(33％)。而46例(46％)非冠心病患者，20例(43％)静息心电图正常，ST-T改变者8例(17％)，心律失常15例(32％)。在患者症状发作时，冠心病组动态ST-T改变者40例(74％)，而非冠心病组仅5例(10％)。结论：静息心电图在诊断冠心病中局限性很大，而症状相关性的动态ST-T改变在诊断冠心病中有较高价值。     

双源CT冠脉成像在冠脉狭窄诊断中的价值

价节段达到94.98%(625/658),图像优良率95.52%(597/625).DSCT诊断冠状动脉狭窄的敏感性、特异性、阳性预测值及阴性预测值分别为91.8%、98.3%、94.4%、97.5%,其中对左主干、左前降支及右冠状动脉的敏感性及特异性达到95%,对角支、左回旋支分支及有冠状动脉远端的诊断敏感性有所下降,分别为86.0%、71.4%、76.9%.结论 在不控制心率的情况下,DSCT诊断冠脉狭窄安全可靠,可广泛用于冠心病患者的筛查、冠状动脉手术/支架术前评估及术后随访.     

Relation of coronary vasoreactivity and coronary calcification in asymptomatic subjects with a family history of premature coronary artery disease

Electron-beam computed tomography (EBCT) allows non-invasive imaging of coronary calcification and has been promoted as a screening tool for coronary artery disease (CAD) in asymptomatic high-risk subjects. This study assessed the relation of coronary calcifications to alterations in coronary vascular reactivity by means of positron emission tomography (PET) in asymptomatic subjects with a familial history of premature CAD. Twenty-one subjects (mean age 51±10 years) underwent EBCT imaging for coronary calcifications expressed as the coronary calcium score (CCS according to Agatston) and rest/adenosine-stress nitrogen-13 ammonia PET with quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR). The mean CCS was 237±256 (median 146, range 0–915). The CCS was <100 in eight subjects and >100 units in 13. As defined by age-related thresholds, 15 subjects had an increased CCS (>75th percentile). Overall mean resting and stress MBF and CFR were 71±16 ml 100 g^–1 min^–1, 218±54 ml 100 g^–1 min^–1 and 3.20±0.77, respectively. Three subjects with CCS ranging from 114 to 451 units had an abnormal CFR (<2.5). There was no relation between CCS and resting or stress MBF or CFR (r=0.17, 0.18 and 0.10, respectively). In asymptomatic subjects a pathological CCS was five times more prevalent than an abnormal CFR. The absence of any close relationship between CCS and CFR reflects the fact that quantitative myocardial perfusion imaging with PET characterises the dynamic process of vascular reactivity while EBCT is a measure of more stable calcified lesions in the arterial wall whose presence is closely related to age.     

Relationship of epicardial fat volume to coronary plaque,severe coronary stenosis,and high-risk coronary plaque features assessed by coronary CT angiography

BackgroundAssociations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events.ObjectivesThis study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs).MethodsWe retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA). EFV was measured on NCT with the use of validated, semiautomated software. The coronary arteries were evaluated for coronary plaque type (calcified [CP], noncalcified [NCP], or partially calcified [PCP]) and coronary stenosis severity ≥70% with the use of coronary CTA. For patients with NCP and PCP, 2 high-risk plaque features were evaluated: low-attenuation plaque and positive remodeling.ResultsThere were 402 patients with a median age of 66 years (range, 23–92 years) of whom 226 (56%) were men. The EFV was greater in patients with CP (112 ± 55 cm³ vs 89 ± 39 cm³), PCP (110 ± 57 cm³ vs 98 ± 45 cm³), and NCP (115 ± 44 cm³ vs EFV 100 ± 52 cm³). In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (odds ratio [OR], 3.0; 95% CI, 1.3–6.6; P = 0.008), any high-risk plaque features (OR, 1.7; 95% CI, 0.9–3.4; P = 0.04), and low attention plaque (OR, 2.4; 95% CI, 1.1–5.1; P = 0.02) but not of positive remodeling.ConclusionsEFV is greater in patients with CP, PCP, and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high-risk plaque features, and low attenuation plaque.     

Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography

To assess the prevalence and morphological characteristics of coronary artery ectasia (CAE) with CT coronary angiography (CTCA) in comparison to conventional catheterangiography (CCA). Dual-source CTCA examinations from 677 consecutive patients (223 women; median age 57 years) were retrospectively evaluated by two blinded observers for the presence of CAE defined as a diameter enlargement ≥1.5 times the diameter of adjacent normal coronary segments. Vessel diameters and contrast attenuation within and proximal to ectatic segments were measured. CCA was used to compare measurements obtained from CTCA with the coronary flow velocity by using the thrombolysis in myocardial infarction (TIMI) frame count. CTCA identified CAE in 20 of 677 (3%) patients. CCA was performed in ten of these patients. CAE diameter measurements with CTCA (10.0 ± 5.4 mm) correlated significantly (r = 0.92, p < 0.001) with the CCA measurements (8.8 ± 4.9 mm), but had higher diameters (levels of agreement: −1.0 to 3.4 mm). Contrast attenuation was significantly lower in the ectatic (343 ± 63 HU) than in the proximal (394 ± 60 HU) segments (p < 0.01). The attenuation difference significantly correlated with the CAE ratio (r = 0.67, p < 0.01) and the TIMI frame count (r = 0.58, p < 0.05). The prevalence of CAE in a population examined by CTCA is around 3%. Contrast attenuation measurements with CTCA correlate well with the flow alterations assessed with CCA.     

冠状动脉钙化筛查：欧洲心脏放射学会及北美放射学会对心血管成像的现状分析及建议

回顾了目前有关筛查普通和特殊人群冠状动脉钙化对心脏病风险评估的现用指南和文献。结果显示不管是普通人群还是特殊人群,冠状动脉钙化零积分可以排除大部分临床相关冠状动脉性疾病。讨论了利用多层螺旋CT建立冠状动脉钙化测量标准化的重要性。     

Intraindividual comparison of 3D coronary MR angiography and coronary CT angiography

RATIONALE AND OBJECTIVES: To compare the diagnostic value of magnetic resonance (MR) and computed tomography (CT) for the detection of coronary artery disease (CAD) with special regard to calcifications. MATERIALS AND METHODS: Twenty-seven patients with known CAD were examined with a targeted, navigator-gated, free-breathing, steady-state free precession MR angiography sequence (repetition time = 5.6 milliseconds, echo time = 2.8 milliseconds, flip angle 110 degrees ) and 16-slice coronary CT angiography. Segment-based sensitivity, specificity, and accuracy for the detection of stenoses larger than 50% were determined as defined by the gold standard catheter coronary angiography along with the subjective image quality (Grade 1-4). The degree of calcifications in each segment was quantified using a standard calcium scoring tool. RESULTS: Of 115 possible segments, 7% had to be excluded in MR imaging because of poor image quality. In CT, 3% were nondiagnostic because of image quality and 15% were not evaluable because of calcifications. Values for the detection of relevant coronary artery stenoses in the evaluated segments were: sensitivity: MR imaging 85% versus CT 96%; specificity: 88% versus 96%; accuracy: 87% versus. 96%. Average subjective image quality was 1.8 for MR imaging and 1.6 for CT. Of the 15% of segments that had to be excluded from CT evaluation because of calcifications, MR imaging provided the correct diagnosis segments in 67%. CONCLUSIONS: CT provided a better image quality with superior accuracy for the detection of CAD. Despite its overall inferiority, MR imaging proved to be helpful method in interpreting coronary stenosis in severely calcified segments.     

健康体检人群行心电图与冠状动脉CTA筛查冠心病的对比分析

 

目的 探讨健康体检人群行心电图与冠状动脉CTA筛查冠心病的对比分析。方法 选取2021-05在解放军总医院第三医学中心健康医学科参加体检的3293人为研究对象,剔除未接受冠脉CTA检查的97人,未行心电图检查的10人,入选3186人,对体检结果异常心电图及冠状动脉狭窄的判断进行分析。结果 3186人中通过冠状动脉狭窄判断结果,共检出冠心病237例;异常心电图表现:ST-T改变750例,心电轴左偏137例,左室高电压83例,完全性右束支传导阻滞42例,不完全性右束支传导阻滞41例。冠心病患者中ST-T改变33.3%,高于非冠心病组的22.8%,差异有统计学意义(χ²=13.642,P＜0.05)。结论 心电图操作简单方便,在大规模人群健康体检中对冠心病有提示作用,可配合动态心电图、心脏彩超等其他检查,进行冠心病筛查。