急性ST段抬高型心肌梗死直接PCI的依诺肝素应用

目的 探讨急性ST段抬高型心肌梗死病人接受直接经皮冠状动脉造影和介入治疗(PCI)中应用依诺肝素替代普通肝素的安全性和有效性.方法 将急性ST段抬高型心肌梗死病人281例随机分为依诺肝素组(n=140)和普通肝素组(n=141),依诺肝素组病人于确诊后尽早给予依诺肝素1 mg/kg皮下注射,PCI前追加依诺肝素0.3 mg/kg静脉注射,完成冠状动脉造影或直接PCI后,立即拔出鞘管.普通肝素组病人于手术前给予普通肝素25 mg静脉推注,如果造影显示适合PTCA,再追加65 mg.完成PCI后4～6 h拔出鞘管.依诺肝素组72例病人术后10、60 min测定抗Ⅹα因子活性.随访30 d,观察两组死亡、再发心肌梗死及需行血管再通术等不良事件的发生情况.结果 依诺肝素组和普通肝素组中最终行直接PCI者分别为139例和138例.依诺肝素组1例于PTCA后发生无血流,血栓负荷重,使用血栓抽吸导管抽吸血栓后血流改善,成功行支架植入术.两组PCI术后及住院期间均无急性和亚急性血栓形成.依诺肝素组病人静脉注射依诺肝素后10 min抗Ⅹα因子活性为(0.92±0.31)kU/L,60 min为(0.81±0.29)kU/L,PCI术中97.9%的病人抗Ⅹα活性＞0.5 kU/L.依诺肝素组均于术后即刻拔出鞘管,穿刺部位血肿1例;普通肝素组于术后4～6 h拔出鞘管,穿刺部位血肿7例,两组比较差异有统计学意义(χ2=4.588,P<0.05).两组30 d内均未发生死亡、再发心肌梗死及需行血管再通术等临床事件.结论 对拟行直接PCI的急性ST段抬高型心肌梗死病人应用依诺肝素替代普通肝素静脉注射是安全、有效的,术后可即刻拔出鞘管.     

急性ST段抬高型心肌梗死患者外周血apelin的水平变化及意义

目的探讨急性ST段抬高型心肌梗死患者apelin水平变化的意义与一年预后的关系。方法测定93 位接受直接PCI的
STEMI患者、30 位接受择期PCI的STEMI患者、30 位接受择期PCI的稳定型心绞痛患者及10 位健康志愿者不同时段外周血
apelin水平,同时收集相应的临床资料。行冠脉造影术后予以Gensini评分。在患者入院时及随访一年（或终点事件）时评估左
室射血分数（LVEF）。结果STEMI患者外周血apelin 水平降低,直接PCI后apelin 水平上升,差异有统计学意义;择期PCI的
STEMI患者PCI术后apelin水平无显著变化,且低于接受直接PCI的患者;apelin水平与糖化血红蛋白负相关;一年随访表明,
apelin水平降低与低LVEF相关,但难以预测一年终点事件。结论外周血apelin可能为急性ST段抬高型心肌梗死即时及预后
的参考指标。
     

Impact of angina prior to acute ST-elevation myocardial infarction on short-term outcomes after primary percutaneous coronary intervention: results from the Shanghai Registry of Acute Coronary Syndrome (SRACE)

Background  The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction (STEMI) remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention (PCI). This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI.

Methods  Among a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI (PA group) and the remaining 583 were free of anginal symptoms (non-PA group). Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups.

Results  Diabetes was less common (17.5% vs. 23.3%, P=0.04) and symptom-to-door time was shortened ((191.6±96.8) minutes vs. (357.2±341.9) minutes, P <0.001) in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery (TIMI flow grade 0–1) at initial angiography (75.0% vs. 90.7%, P <0.001), and achieved more TIMI flow grade 3 after primary PCI (84.2% vs. 78.2%, P=0.04). These were associated with higher rates of overall procedural success (95.9% vs. 91.8%, P=0.02) and of complete ST-segment resolution at 90 minutes after the procedure (51.7% vs. 40.3%, P=0.001). During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved ((53.0±8.6)% vs. (51.1±9.7)%, P=0.002) and the primary endpoint of major adverse cardiac events was reduced in the PA group (7.2% vs. 12.7%, P=0.01).

Conclusion  Presence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.

     

Comparative effects of percutaneous coronary intervention for infarct-related artery only or for both infarct- and non-infarct- related arteries in patients with ST-elevation myocardial infarction and multi-vessel disease

Background Rapid recanalization of infarct-related artery （IRA） has become the major target during primary percutaneous coronary intervention （PCI） for patients with ST-elevation myocardial infarction （MI）, but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease.
Methods A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries （luminal narrowing 〉70%） undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only （group 1）, and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction （AMI） （group 2）. Drug-eluting stents （DESs） were deployed in more than 90% of the patients.
Results The two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events （11.5% vs 15.1%, P 〉0.05） and target lesion revascularization （8.1% vs 7.6%, P 〉0.05） between the two groups. However, patients in group 1 had higher rates of recurrent angina （10.1% vs 2.1%, P 〈0.05） and depressed left ventricular ejection fraction evaluated by echocardiography （0.56±0.22 vs 0.63±0.25, P 〈0.05）.
Conclusion With the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation Mt and multi-vessel disease.     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年(≥80岁)急性心肌梗死(AMI)患者行急诊与择期经皮冠状动脉介入治疗术(PCI)的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组(AMI组)和非心肌梗死组(对照组),其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者(AMI择期组)和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率(72.2%)低于非急诊组(92.2%),差异有统计学意义(P=0.036)。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义(P<0.001,P=0.039),AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高(P<0.05)。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

The influence of diabetes mellitus on the procedural and in-hospital outcomes after elective percutaneous coronary intervention

Approximately 15% 20% of the patients undergoing percutaneous coronary intervention (PCI) procedure complicate with diabetes and this patient population continues to be a particular challenge for both the interventional cardiologist and the cardiac surgeon. It is well documented that diabetes is associated with more diffuse and severe coronary atherosclerosis.     

The process of informed consent for urgent abdominal surgery

OBJECTIVES: To assess perceptions of the informed consent process in patients undergoing urgent abdominal surgery. DESIGN: A prospective observational study was carried out using structured questionnaire-based interviews. Patients who had undergone urgent abdominal surgery were interviewed in the postoperative period to ascertain their perceptions of the informed consent process. Replies were compared to responses obtained from a control group undergoing elective surgery, to identify factors common to the surgical process and those specific to urgent surgery. Patients' perceptions of received information were also compared to the information perceived to have been provided by the consent obtainers. SETTING: Gastrointestinal surgical service of a university teaching hospital. PATIENTS: Seventy-four consecutive patients undergoing urgent abdominal surgery and 80 control patients undergoing elective surgery. MAIN MEASUREMENTS: Principal outcome measures were patients perceptions of factors interfering with the ability to give informed consent, assessment of the quality of informed consent and the degree of discussion of the expected outcomes. RESULTS: Forty-nine of the seventy-four (66%) patients undergoing urgent surgery perceived that pain did not affect their ability to give informed consent. Twenty-seven reported an adverse effect of analgesia on the ability to give informed consent. Only 22% of patients undergoing urgent surgery perceived that there had been any discussion of potential side effects and complications of surgery. CONCLUSION: The majority of patients in this series with acute intra-abdominal surgical conditions perceive that they retain the ability to give informed consent for surgery. There is a need for improved discussion of therapeutic options and likely outcomes.     

A randomized comparative study of using enoxaparin instead of unfractionated heparin in the intervention treatment of coronary heart disease

Several international multicenter studies have demonstrated that low molecular weight heparin (LMWH) was more effective than unfractionated heparin (UFH) in treating acute coronary syndrome (ACS).1-4 However, it remains uncertain whether LMWH can be used in patients undergoing percutaneous coronary intervention (PCI) instead of UFH. In an expert consensus on the use of LMWH in the catheter laboratory published in 2002,5 there were two recommendations which limited the use of LMWH in…     

ST 段抬高心肌梗死急诊冠脉介入中室颤发生的分析

目的:分析ST 段抬高心肌梗死在急诊冠脉介入中发生室颤(VF)的临床特征和冠脉造影特点.方法:对50例接受急诊冠脉介入治疗的ST段抬高心肌梗死患者进行回顾性研究,根据术中有无室颤将患者分为两组,其中9例发生心室颤动(VF组),41例患者没有发生心室颤动(无VF组).比较两组的临床特征与冠脉造影的差异.结果:两组患者的基线特征相似.VF组冠脉内溶栓占33.3%,无VF组冠脉内溶栓2.4%,两组统计学上有显著性差异(P<0.05).VF组三支病变占77.7%,无VF组占33.3%,两组统计学上有显著性差异(P<0.05).结论:(1)在ST段抬高的心梗患者在急诊冠脉介入时室颤发生可能与冠脉内急性闭塞处血栓负荷有关.(2)在ST段抬高的心梗患者在急诊冠脉介入时室颤发生与冠脉病变严重程度有关.     

Efficacy and safety of Firebird sirolimus-eluting stent in treatment of complex coronary lesions in Chinese patients: one-year clinical and eight-month angiographic outcomes from the FIREMAN registry

Background  Off-label application of drug-eluting stents (DES) during percutaneous coronary intervention (PCI) was not uncommon in daily practice, however DES in treating Chinese patients with complex lesion subset was under-investigated. The primary objective of the FIREMAN registry was to evaluate the long term efficacy and safety of the Firebird sirolimus-eluting stent (SES) in treating patients with complex coronary lesions. Here we report the mid-term of one-year clinical outcomes and eight-month angiographic follow-up results of FIREMAN registry. 

Methods  The FIREMAN registry was a prospective multi-center registry, which included 1029 consecutive patients undergoing PCI with Firebird SES implantation between September 2006 and July 2007 in 45 centers in China. The clinical follow-up was designed to be performed at 1, 6, 12, 18, 24, 30 and 36 months post index procedure, and non-mandatory angiographic follow-up at 8 months was planned. One hundred percent site monitoring was conducted.

Results  Long lesions (59.2%), multi-vessel disease (50.4%), and small vessel disease (31.6%) were mostly found in angiography. Major adverse cardiac events (MACE) occurred in 51 (5.1%) patients at 1 year clinical follow-up, including cardiac mortality in 6 (0.6%), non-fatal myocardial infarction in 11 (1.1%), and target lesion revascularization in 36 (3.5%) of the patients. Definite and probable stent thrombosis (ST) by Academic Research Consortium (ARC) definition occurred in 12 (1.36%) patients at one-year clinical follow-up. The 8-month binary restenosis rate was 5.7% in-segment and 4.3% in-stent, respectively. Late lumen loss was (0.21±0.40) mm in-segment and (0.23±0.36) mm in-stent, respectively. Furthermore, Cox regression analysis revealed that diabetes, small vessel diameter, and chronic total occlusion were independent predictors of ST.

Conclusions  The results showed that the Firebird SES was effective and safe in treating Chinese patients with complex coronary lesions and occurrence of ST rate at one-year clinical follow-up was acceptable, however further long-term follow-up was still necessary. (NCT00552656)

     

Triple antithrombotic therapy versus double antiplatelet therapy after percutaneous coronary intervention with stent implantation in patients requiring chronic oral anticoagulation: a meta-analysis

Background Whether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated.This...     

左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响

目的 探讨左心室收缩功能对经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗的急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者预后的影响。方法 对161例PCI治疗的急性下壁STEMI患者按左心室收缩功能分为2组:左心室收缩功能障碍[左心室射血分数(left ventricular ejection fraction, LVEF)<50%]组和左心室收缩功能正常(LVEF≥50%)组。本研究的主要终点主要不良心脏事件(major adverse cardiac events, MACE)包括所有全因死亡、再发性心肌梗死、缺血驱动的血管血运重建和卒中。结果 两组患者在年龄、性别、病史、Killip分级以及症状发作时间方面比较,差异均无统计学意义(P>0.05);左心室收缩功能障碍组具有更高的病变血管支数和血栓负荷(P<0.05),其他冠状动脉造影结果和介入治疗特征,两组间差异均无统计学意义(P>0.05)。两组在1年预期MACE发生率方面比较,差异均无统计学意义(Log-rank P>0.05)。结论 在接受直接PCI治疗的急性下壁STEMI患者中,左心室收缩功能障碍的患者与左心室收缩功能正常的患者具有相似的1年临床不良事件发生率。     

Direct intracoronary delivery of tirofiban during primary percutaneous coronary intervention for ST-elevation myocardial infarction

ST-segment elevation myocardial infarction (STEMI)is usually caused by acute occlusion of an infarct-related coronary artery (IRA),resulting from rupture or erosion of an atherosclerotic plaque and subsequent platelet aggregation and thrombosis.1-3Prompt reperfusion is the key aspect of the optimal management,4-7 and timely expert primary percutaneous coronary intervention (PCI) becomes the best reperfusion strategy with respect to improvement in survival and reduction of combined clinical endpoints in the treatment of STEMI.8-11 Given the high thrombotic risk of patients with STEMI,pretreatment with a high clopidogrel loading dose before primary PCI was advised to reduce distal thrombotic embolization and angiographic no-reflow and improve clinical outcomes.12,13 The use of adjunctive intravenous glycoprotein (GP) Ⅱb/Ⅲa inhibitors following oral dual-antiplatelet therapy enhances thrombus disaggregation by inhibiting fibrinogen binding to the active receptor complex and subsequently disrupting platelet cross-linking,14 and improves IRA patency and myocardial perfusion,14 and has been recommended as class Ⅱa (at the time of primary PCI) or Ⅱb (before primary angiography and PCI)indication in the recent practice guidelines for the management of patients with STEMI.9,10 Tirofiban (a small-molecule platelet GP Ⅱb/Ⅲa inhibitor) seems even more attractive,because of its consistent and rapidly reversible platelet inhibition at increased dose and efficient penetration into the platelet-fibrin thrombus.15 In a broad population of largely unselected patients undergoing primary PCI for STEMI,tirofiban was associated with a noninferior complete resolution of ST-segment elevation (an indirect measure of myocardial reperfusion after PCI14,16) compared with abciximab,17 and was well tolerated and effective in reducing ischemic acute coronary syndrome complications in patients with mild-to-moderate renal insufficiency.18 Previous studies have shown that an upstream low dose of tirofiban favorably ameliorates IRA patency and reperfusion of the infarct area compared with down-stream use,19 and routine initiation of high-bolus dose of tirofiban could further improve clinical outcome after primary PCI.20 These observations highlight that further platelet aggregation inhibition besides high-dose clopidogrel is mandated in patients with STEMI undergoing primary PCI.     

冠脉复杂病变PCI术后伊诺肝素抗凝对临床事件的影响

目的 探讨复杂病变经皮冠状动脉介入治疗（PCI）术后伊诺肝素抗凝对临床事件的影响。方法随机入选复杂冠脉病变（B2、C型病变）行PCI术后无特殊并发症患者293例,随机分为依诺肝素抗凝组与非抗凝组,对入选患者分别在术后住院期间、1个月、12个月时随访并记录主要心血管不良事件（MACEs）。结果 两组住院期间、术后1个月、术后12个月时主要心血管不良事件的发生率无明显差异,住院期间,抗凝组与非抗凝组MACEs的发生率是2.1% VS 1.4%,P＞0.9;主要出血的发生率4.8% VS 2.8%,P=0.369,小出血发生率是26.2% VS 16.1%,P=0.036; 1个月时两组间 MACEs的发生率2.8% VS 2.8%,P＞0. 9; 1年时发生率5.9% VS 5.5%,P=0.78。两组间MACEs累积发生率无显著差异（HR 0.875, 95%CI 0.337-2.273;P=0.79）。抗凝组的平均住院天数多于非抗凝组(P=0.001)。结论 复杂病变PCI术后非抗凝治疗组不仅不增加心血管事件,而且减少出血事件、缩短住院天数,该研究表明即使是复杂冠脉病变,PCI术后若无特殊并发症可无需肝素抗凝治疗。     

超短期他汀类药物治疗对非ST段抬高型急性冠脉综合征患者冠状动脉介入治疗术后再灌注及短期预后的影响

目的探讨冠状动脉介入治疗(PCI)术前超短期应用他汀类药物对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者心肌再灌注及短期预后的影响。方法将入院后72h内接受PCI的162例NSTE-ACS高危患者随机分为强化他汀治疗组和标准剂量他汀治疗组,于PCI术前服用辛伐他汀3d,观察PCI术前、术后即刻靶血管心肌梗死溶栓试验(TIMI)血流分级和心肌呈色分级(MBG)的差异,以及PCI术后24h肌酸激酶同工酶(CK-MB)的变化、PCI术后1个月心功能和主要心脏不良事件(MACE)的发生情况。结果两组间基础临床资料比较差异无统计学意义(P<0.05)。PCI术前强化组靶血管TIMI血流2～3级和MBG2～3级的比例显著高于标准组,差异有统计学意义(P<0.05)。PCI术后两组靶血管TIMI血流3级比例差异无统计学意义(P>0.05),强化组靶血管MBG2～3级的比例显著高于标准组,差异有统计学意义(P<0.05)。强化组CK-MB增高比例显著低于标准组,差异有统计学意义(P<0.05)。PCI术后1个月强化组左心射血分数(LVEF)为(0.58±0.09)%,明显好于标准组(0.53±0.08)%,差异有统计...     

血栓抽吸导管应用于急性心肌梗死患者的临床疗效。

目的评价ZEEK血栓抽吸导管应用于急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗（PCI）术中的临床效果。方法选择2008年7月至2010年3月在我院接受急诊PCI的急性ST段抬高心肌梗死患者70例,分成血栓抽吸组与常规PCI组,比较两组临床基础资料、冠状动脉造影结果,术后资料及临床1个月随访情况。结果血栓抽吸组PCI术后心肌梗死溶栓实验（TIMI）血流分级及TIMI心肌组织灌注（TMP）分级、ST段回落率、肌酸磷酸激酶（CK）及其同功酶（CK—MB）峰值均优于常规PCI组,1个月后左室射血分数（LVEF）大于常规PCI组,左室舒张末期内径（LVEDD）小于常规PCI组,差异均有统计学意义（P〈0．05）。术后1个月随访两组均未发生主要心脏不良事件。结论急性ST段抬高型心肌梗死急诊PCI中应用ZEEK血栓抽吸导管能明显减少冠状动脉及远端栓塞,有效改善心肌灌注,改善术后心脏功能。     

Age and diabetes mellitus associated with worse outcomes after percutaneous coronary intervention in a multi-ethnic Asian dialysis patient population

INTRODUCTIONThere is limited literature on clinical outcomes following percutaneous coronary intervention (PCI) in Asian dialysis patients. We evaluated the angiographic characteristics and clinical outcomes of dialysis patients treated with PCI in an Asian society.METHODSA retrospective analysis was performed of 274 dialysis patients who underwent PCI in a tertiary care institution from January 2007 to December 2012. Data on clinical and angiographic characteristics was collected. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, acute myocardial infarction (AMI) and stroke at two years.RESULTS274 patients (65.0% male, median age 62.0 years) with 336 lesions (81.8% Type B2) were treated. 431 stents (35.0% drug-eluting stents) with a mean diameter of 2.96 mm and mean length of 21.30 mm were implanted. The MACE rate was 55.8% (n = 153) at two years, from death (36.5%) and AMI (35.0%). In multivariable analysis, age and diabetes mellitus were significant predictors of both mortality (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05–1.12, p < 0.001; OR 2.65, 95% CI 1.46–4.82, p = 0.001, respectively) and MACE (OR 1.06, 95% CI 1.03–1.08, p < 0.001; OR 1.84, 95% CI 1.07–3.15, p = 0.027, respectively). Left ventricular ejection fraction (LVEF) (OR 0.97, 95% CI 0.95–0.99, p = 0.006) was a significant predictor of mortality but not MACE.CONCLUSIONAsian dialysis patients who underwent PCI had a two-year MACE rate of 55.8% due to death and AMI. Age, LVEF and diabetes mellitus were significant predictors of mortality at two years.     

Long-term clinical outcomes of patients with unprotected left main bifurcation lesions treated with 2-stent techniques

Background Currently available evidence suggests that outcomes are less favorable when left main (LM) bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique.We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients.Methods We enrolled 301 consecutive patients treated with drug-eluting stents (DES) implantation using 2-stent techniques for unprotected LM bifurcation lesions (MEDINA 1,1,1,70.5％).The 2-stent techniques included crush technique,V stenting,T stenting,and Culottes stenting.After stenting,both vessels were redilated at a high pressure before final kissing balloon (FKB).Clinical and angiographic data were analyzed.The primary endpoints were major adverse cardiac events (MACE),whichincluded death,myocardial infarction,and target lesion revascularization.Results Immediate procedural success was obtained in all cases with a FKB success rate of 95.3％.Follow-up data were available for all patients.The overall incidence of angiographic in-stent restenosis (ISR) rate was 20.3％ and most ISRs were of the focal type.During long-term follow-up (mean duration,(54±22) months),the cumulative incidence of MACE was 11.0％,with 8 (2.7％) deaths,7 (2.3％) myocardial infarctions,and 18 (6.0％) repeated lesion revascularization.MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles (p=0.001).Conclusions Although percutaneous coronary intervention (PCI) with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR,the long-term clinical follow-up is acceptable.Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI.     

青年ST段抬高型心肌梗死患者的临床、冠状动脉造影特点及预后

目的 探讨年龄≤40岁青年ST段抬高型心肌梗死(STEMI)患者的临床发病、危险因素、冠状动脉病变特点及预后.方法 回顾性分析2005年5月-2010年5月在复旦大学附属中山医院心内科行经皮冠状动脉介入治疗(PCI)的STEMI患者,按年龄段分组:青年组(≤40岁),中年组(≥41岁且≤59岁组),老年组(≥60岁).分析各组的危险因素、冠状动脉造影特点、PCI治疗情况,并随访患者12个月的预后.结果 接受直接PCI的青年STEMI患者占所有STEMI患者的2.2％.青年组的男性构成比最高(95.0％);青年组的吸烟构成比为85.0％,显著高于老年组的64.8％(P＜0.05);青年组有冠状动脉性心脏病家族史的构成比也显著高于中、老年组(P值均＜0.05).青年组单支病变构成比为65.0％,显著高于中年组的24.8％和老年组的20.6％(P值均＜0.05);罪犯血管以左前降支最为多见,在青年组达到70.0％,显著高于中年组的57.5％和老年组的45.1％(P值均＜0.05).3组间PCI治疗成功率的差异均无统计学意义(P值均＞0.05).青年组在住院期间及随访12个月时严重心力衰竭发生率显著低于老年组;虽然3组间病死率的差异无统计学意义(P＞0.05),但随访12个月时青年组主要心血管不良事件发生率显著低于中、老年组(P值均＜0.05).结论 青年心肌梗死患者的临床危险因素特征、冠状动脉病变特点及预后与老年患者均存在较大的差异,心脏功能及主要心血管不良事件等远期预后较好.     

欣维宁在急诊经皮冠状动脉介入治疗急性心肌梗死中的应用探讨

目的研究国产替罗非班（欣维宁）对急性心肌梗死病人行急诊经皮冠状动脉介入治疗的疗效及安全性。方法入选2004～2008年急性心肌梗死病人41例并同意行急诊PCI术,其中20例为对照组：常规术前口服阿斯匹林300mg、氯吡格雷300mg,术中、术后使用肝素。21例为欣维宁组：除常规用药同对照组外,术前、术中及术后使用欣维宁（国产替罗非班）,分析罪犯血管（IRA）再通情况、出血及急性、亚急性血栓事件和对血小板的影响。结果欣维宁组手术成功率99.8%,IRATIMI3级占90.48%出血率23.9%,为渗血、小血肿,无严重后果。未发生急性、亚急性血栓事件。对照组：手术成功率90%,IRA开通后TIMI3级血流占75%,出血率5%,急性、亚急性血栓形成占据15%。讨论急性心肌梗死病人行急诊经皮冠脉介入治疗术中使用欣维宁是安全有效的,提高IRA再通率,缺血、损伤心肌灌注改善显著。