Spontaneous coronary dissection associated with myocardial bridge causing acute myocardial infarction

Spontaneous coronary artery dissection （SCAD） is a rare cause of myocardial ischemia, myocardial infarction and sudden-cardiac death.This disease mainly occurs in young women with oral contraceptive or during the peripartum period, without risk factors for coronary artery disease. Although SCAD results in a hemorrhagic separation of the intima and the media, and creates a false lumen, leading to distal myocardial ischemia, infarction and sudden death, the causes and the optimal management for this challenging condition are still controversial.     

经PCI 治疗ST 段抬高型心肌梗死患者碎裂QRS 波与SYNTAX Ⅱ评分的关系

目的 探讨经皮冠状动脉介入治疗（PCI）ST 段抬高型心肌梗死（STEMI）患者碎裂QRS（fQRS）与SYNTAX Ⅱ评分的相关性。方法 84 例PCI 治疗的STEMI 患者在PCI 前、后进行标准十二导联心电图（ECG）检测。评估所有患者SYNTAX 评分和SYNTAX Ⅱ评分。所有患者行经胸超声心动图检查。结果 20 例（23.8%）STEMI 患者ECG 检查有fQRS。SYNTAX Ⅱ评分中位数为27（22.9 ～ 33.8）。fQRS（+）组SYNTAX Ⅱ评分高于fQRS（-）组（35.3 VS 25.8）（P <0.05）。高SYNTAX Ⅱ评分STEM 患者,ECG 上fQRS 导联数量也相应地增加。结论 经PCI 治疗STEMI 患者fQRS 及fQRS 导联数量与SYNTAX Ⅱ评分相关。     

OUTCOMES OF INVASIVE STRATEGY TO PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROMES

To compare the outcomes of an invasive with a conservative strategy in the management of patients with non-ST-elevation acute coronary syndromes. Methods From January 2000 to June 2001,505 patients presenting with unstable angina or non-Q wave myocardial infarction were divided into two groups (conservative vs. invasive) according to management strategy. Patients assigned to an early invasive strategy underwent coronary angiography within 7d of enrollment after intensive antiplatelet, antithrombotic and antiangina therapy and revascularization as appropriate. All patients were followed up at least 6 months. The primary endpoints were cardiac death and acute myocardial infarction. Recurrence angina and readmission were the secondary endpoint. Results There were 194 patients in conservative group and 311 patients in invasive group. Overall, coronary angiography was performed in 100% and 56%, and revascularization in 93% and 52% in the invasive and conservative groups, respectively. During a mean of 11 5. 7 months ( range 6 ~ 24 months) of follow-up, the occurrence of primary endpoint was significantly lower in the invasive group than that in the conservative group (3.9% vs8. 2% , P =0. 036). The rate of recurrent angina (48% vs 17% , P =0. 001 ) , readmission (41% vs 13% , P =0. 001 )and revascularization ( 12% vs 35%, P =0. 001 ) was also significantly lower in patients assigned to invasive strategy. Conclusion The study indicates that the early invasive approach may be the preferred strategy in patients with unstable angina or non-Q wave myocardial infarction.     

急性冠脉综合征患者血清sFas水平变化分析

目的: 探讨血清可溶性Fas (solubleFas,sFas)水平与急性冠脉综合征(acute coronary syndrome,ACS)的关系。方法: 采用酶联免疫吸附双抗体夹心ABC-ELISA方法,测定22例急性冠脉综合征患者(ACS组)和10例对照组受试者血清sFas的水平,其中ACS组中21例同时应用该方法进行血清肌钙蛋白I(cTnI)定量检测。结果: ACS组患者血清sFas水平均明显高于对照组(P<0.01);ACS患者中cTnI升高组(MI)与正常组(UA)血清sFas水平差异无显著性(P>0.05)。结论: 高水平的血清sFas与急性冠脉综合征有关,可能在易损斑块的破溃过程中扮演重要角色。     

超声检查颈动脉粥样硬化病变及其局部血流动力学的变化

超声诊断颈动脉粥样硬化（ Ｃ Ａ Ｓ）１０１ 例。发现 Ｃ Ａ Ｓ 组平均颈总动脉内膜中层厚度（ Ｉ Ｍ Ｔ） 较对照组明显增厚（ Ｐ ＜ ０ ．０１） ;而颈总动脉收缩期最大峰值血流速度（ Ｍ Ａ Ｘ） 、舒张期血流速度（ Ｍ Ｉ Ｎ） 、阻力指数（ Ｒ Ｉ） 和血管管径两组间比较无明显统计学差异;颈动脉粥样硬化斑块好发于颈动脉分叉部（ Ｂ Ｉ Ｆ）（ 占４５８ ％ ） ,多为扁平斑（ 占４２ ％ ） ,属早期病变,其对颈总动脉 Ｍ Ａ Ｘ, Ｍ Ｉ Ｎ 及 Ｒ Ｉ 似无影响。     

Interventional therapy of coronary artery disease in China：retrospective and perspective

Coronary artery disease is the most common cardiovascular disease and constitutes the major cause of death in China. The interventional treatment of coronary artery disease has developed rapidly during the last decade, with the number of percutaneous coronary intervention （PCI） procedures being around 147 300 in the year of 2007. The number is expected to be elevated greatly in the coming years because of great improvement in national health care system and interventional expertise This article reviews the current status of coronary intervention in China.     

Correlation among obstructive sleep apnea syndrome, coronary atherosclerosis and coronary heart disease

Epidemiologic investigations have shown that the morbidity of obstructive sleep apnea syndrome （OSAS） among adults is 2%-4%, among the population aged 30 years and over is 4.63%, and among patients with hypertension or coronary atherosclerostic disease （CAD） is as high as 30%-50%.1 Many studies have indicated that OSAS may be closely associated with the development of CAD since increased incidence and mortality of CAD were found in OSAS patients. However, although it has been confirmed that OSAS is an independent risk factor for hypertension, its exact correlation with CAD has not been entirely elucidated. The aim of the present study was to explore the correlation between the degrees of OSAS and CAD with the application of coronary artery angiography （CAA）, Gensini scoring evaluation system, and other risk factors which may contribute to CAD.[第一段]     

冠状动脉粥样硬化影像学成像方法的研究进展

冠状动脉斑块是病人发生急性冠状动脉综合征的直接原因。因此,一种准确的冠状动脉成像方法在临床中有重要意义。随着影像学的发展,CT冠状动脉造影、冠状动脉MR血管成像、冠状动脉血管造影、血管内超声成像、光学相干断层成像、冠状动脉血管镜、分子影像学已经成为诊断冠状动脉粥样硬化的重要手段。     

冠状动脉支架术治疗416例择期无保护左冠状动脉主干病变的2年随访

目的探讨冠状动脉支架术治疗择期无保护左冠状动脉主干（ULMCA）病变的安全性和术后平均2年的临床效果。方法回顾分析1997年9月至2007年1月在沈阳军区总医院接受冠状动脉支架植入术的416例ULMCA的病例资料。结果治疗对象中病变位于远端分叉处291例（70．0％）。ULMCA靶病变共植入支架503枚,人均植入支架（1．2±0．7）枚。支架植入成功率99．5％,住院期间无死亡病例,靶病变重建2例,主要不良心脏事件（MACE）发生率0．5％（2／416）。随访期内共死亡16例（3．9％）,其中心源性死亡12例（2．9％）。造影随访136例（33．1％）,靶病变发生再狭窄20例（再狭窄率14．7％,20／136）,其中14例行冠状动脉搭桥术,6例植入药物洗脱支架。ULMCA病变择期行PCI后总的MACE发生率为8．3％（34／411）。结论冠状动脉支架术治疗择期无保护ULMCA病变的技术成功率、围术期安全性均较高,平均随访2年疗效较好。降低PCI术后再狭窄和MACE发生率的有效策略（如药物洗脱支架的选择和植入方法等）值得进一步探讨。     

颈动脉粥样斑块及内中膜厚度与冠心病的相关性分析

目的 探讨颈动脉粥样斑块及内中膜厚度(IMT)与冠心病(CHD)发生的关系.方法 对145例疑诊CHD先后作颈动脉超声检查测量IMT和观察粥样斑块及冠状动脉造影.结果 非CHD 44例,CHD 101例,IMT为(0.75±0.10)mm和(0.99±0.29)mm;颈部斑块发生率25%(11/44)和77.22%(78/101).两组比较差异有统计学意义(P<0.005).硬斑块组发生CHD最高96.55%,软斑块组次之83.33%,无斑块组最低41.07%,各组间比较差异均有统计学意义(P<0.005).以IMT≥0.85mm或出现斑块来预测CHD,敏感性77.22%,特异性81.81%,阳性预测值83.72%.结论 颈动脉粥样斑块及内中膜厚度增加与CHD密切相关,采用颈动脉超声检查可预测CHD发生.     

冠状动脉支架术后再狭窄发生机制的血管内超声观察

目的:应用冠状动脉造影(CAG)及血管内超声(IVUS)研究冠脉内支架术后再狭窄的发生机制. 方法:以成功留置冠脉内支架,于6 mo后进行复查的92名患者118处病变(其中前降支53处病变、回旋支32处病变、右冠状动脉33处病变)为对象,进行CAG及IVUS检查,以CAG直径狭窄率≥50%为支架内再狭窄. 根据冠状动脉造影结果将患者分为支架再狭窄组(39例)和无再狭窄组(79例),通过IVUS观察两组冠脉内支架术后及随访时参考段血管面积、最小支架截面积、最小血管内膜腔截面积、新生内膜面积、支架体积及新生内膜体积. 结果:两组支架置入术后即刻及随访时参考段血管面积、最小支架截面积、支架体积无显著性差异 (P>0.01),随访时再狭窄组最小血管内膜腔截面积较无再狭窄组明显减小[(2.3±1.1) mm2 vs (5.4±1.8) mm2, P＜0.01];而新生内膜面积及体积较无再狭窄组明显增大[(4.7±1.5)mm2 vs (1.6±0.8) mm2, (121.1±31.9) mm3 vs (54.3±11.4) mm3, P<0.01]. 结论:支架内再狭窄主要以内膜增生为主,而与血管重构及支架弹性回缩无明显关系.     

高龄冠心病患者介入治疗的临床分析

目的探讨高龄冠心病患者行冠状动脉介入治疗(PCI)的临床疗效及安全性。方法回顾性分析45例行PCI治疗的高龄冠心病患者的临床资料,观察其冠状动脉造影结果、介入治疗成功率、并发症及术后随访情况。结果 45例患者成功41例,总成功率91.1%,植入支架50只,并发症发生率为11.1%,术后随访6～12个月,3例再次出现胸痛发作,其中1例为原有支架闭塞;1例急性心肌梗死死亡。结论 PCI治疗高龄冠心病患者成功率高,是一种安全、有效方法。     

Cholesterol goal achievement and lipid-lowering therapy in patients with stable or acute coronary heart disease in Singapore: results from the Dyslipidemia International Study II

INTRODUCTIONDyslipidaemia is a major risk factor for coronary heart disease (CHD). There is a lack of data on the extent of lipid abnormalities and lipid-lowering therapy (LLT) in Singapore.METHODSThe Dyslipidemia International Study (DYSIS) II was a multinational observational study of patients with stable CHD and hospitalised patients with an acute coronary syndrome (ACS). A full lipid profile and use of LLT were documented at baseline, and for the ACS cohort, at four months post-hospitalisation.RESULTS325 patients were recruited from four sites in Singapore; 199 had stable CHD and 126 were hospitalised with an ACS. At baseline, 96.5% of the CHD cohort and 66.4% of the ACS cohort were being treated with LLT. In both cohorts, low-density lipoprotein cholesterol (LDL-C) levels were lower for the treated than the non-treated patients; accordingly, a higher proportion of patients met the LDL-C goal of < 70 mg/dL (CHD: 28.1% vs. 0%, p = 0.10; ACS: 20.2% vs. 0%, p < 0.01). By the four-month follow-up, a higher proportion of the ACS patients that were originally not treated with LLT had met the LDL-C goal (from 0% to 54.5%), correlating with the increased use of medication. However, there was negligible improvement in the patients who were treated prior to the ACS.CONCLUSIONDyslipidaemia is a significant concern in Singapore, with few patients with stable or acute CHD meeting the recommended European Society of Cardiology/European Atherosclerosis Society goal. LLT was widely used but not optimised, indicating considerable scope for improved management of these very-high-risk patients.     

Correlation between acute coronary syndrome classification and multi-detector CT characterization of plaque

Objective To determine if multi-detector CT (MDCT) characterization of plaque is corre-lated with the classification of acute coronary syndrome (ACS). Methods Altogether 1900 patients were examined by MDCT from December 2007 to May 2009, of whom 95 patients fulfilled the criteria of ACS. Those patients were divided into the discrete plaque group (n=61) and diffuse plaque group (n=34) based on the findings in MDCT. The clinical diagnosis of ACS and CT results were analyzed, including segment stenosis score, segment involvement score, 3-vessel plaque score, left main score, calcification score, and re-modeling index. The incidences of major adverse cardiac events in follow-up period were also recorded. Results The patients of the diffuse plaque group were older than those of the discrete plaque group (P<0.0001). The diffuse plaque group presented more cases of hypertension, pe-ripheral artery disease, diabetes, and heart failure than discrete plaque group (all P<0.05). All the 5 patients with ST-segment elevation myocardial infarction were found in discrete plaque group. The segment stenosis score of the discrete plaque group was lower than that of the diffuse plaque group (5.15±3.55 vs. 14.91±5.37, P<0.001). The other four scores demonstrated significant inter-group difference as well (all P<0.05). The remodeling index of the discrete plaque group was higher (1.12±0.16 vs. 0.97±0.20, P<0.05). Follow-up data showed that major adverse cardiac events occurred more frequently in diffuse plaque group than in discrete group (29.41% vs. 11.48%, P=0.0288). Conclusions Characteristics of discrete and diffuse plaques may be significantly different among different classes of ACS. The diffuse plaque may present higher risk, correlated to higher mortality. The diagnosis of discrete and diffuse plaques by MDCT would provide a new insight into the prognosis and treatment of ACS.     

平板运动试验和冠状动脉造影诊断冠心病267例的对比分析

目的:探讨影响平板运动试验(TET)结果的相关因素,以提高TET诊断冠状动脉粥样硬化性心脏病(冠心病)的准确性.方法:选取疑诊冠心病患者267例,先后行TET和冠状动脉造影(CAG)检查.以CAG结果为冠心病的诊断标准,对比TET与CAG,计算TET的敏感性、特异性,并对影响TET真阳性和假阳性的各项临床资料进行统计学分析.结果:①CAG阳性187例,其中TET阳性121例,阴性66例;CAG阴性80例,其中TET阳性38例,阴性42例,测得敏感性64.7%,特异性52.5%,假阳性47.5%,假阴性35.3%.②TET真假阳性临床相关资料分析,有典型心绞痛、糖尿病病史以及ST段下移＞0.2 mV,运动中诱发心绞痛的患者真阳性高于假阳性;运动中ST段的改变出现在Ⅱ,Ⅲ,aVF导联时假阳性高于真阳性;出现ST段损伤型抬高的患者均为真阳性.结论:对TET的结果,应结合TET中心电图变化的导联和ST段改变的形式和程度,根据患者的临床资料,建立新的诊断模式,提高诊断的准确性.     

血清胱抑素C预测急性冠脉综合征患者冠脉血管严重程度的价值

目的 探讨血清胱抑素C预测急性冠脉综合征(acute coronary syndrome, ACS)患者冠状动脉血管严重程度的价值。方法 ACS患者195例作为观察组,行冠状动脉造影检查将ACS病例按照血管病变数分为单支病变组91例、双支病变组67例和多支病变组37例。选取同期有ACS类似症状,但经冠脉造影检查排除冠心病的39例作为对照组。检测所有患者入院24h内血清Cys C水平。比较各组中Cys C值的差异性,判断其与ACS患者冠脉血管严重程度的相关性。结果 ACS患者单支病变组、双支病变组和多支病变组血清Cys C值差异有统计学意义(1.27±0.30mg/L vs 1.34±0.44mg/L vs 1.51±0.59mg/L,P＜0.05);Cys C高四分位组的Gensini积分显著大于低四分位组(50.00±37.37 vs 30.24±22.25,P＜0.05);通过箱式图可以看出随着血管病变支数的增加,Cys C的中位数有增加的趋势。两者的Spearman等级相关系数为0.1576,P=0.0278;多因素有序logistic预测模型显示血清Cys C水平预测血管病变数的的OR值为2.09(95%CI 1.1382~3.8295,P＜0.05)。结论 血清Cys C水平与ACS患者冠脉血管严重程度相关。     

Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention

Background More and more percutaneous coronary intervention were done from radial artery approach.But the great limitation of radial artery approach and main failure cause of transradial coronary inter...     

颈动脉内-中膜厚度及斑块与冠状动脉粥样硬化的关系分析

目的：评价颈动脉粥样硬化与冠状动脉粥样硬化的关系。方法：113例行冠状动脉造影患者根据病变血管支数分成四组：正常、单支病变、双支病变及三支病变组,分别进行颈动脉超声检测。结果：随着冠状动脉病变程度增加,其最大内-中膜厚度及斑块发生率亦随之增加,经统计分析（P〈0.01,P〈0.05）均有显著意义。结论：颈动脉粥样硬化与冠状动脉粥样硬化之间有较密切的关系,颈动脉超声检测可用于预测冠状动脉粥样硬化的严重程度。     

急性冠脉综合征患者颈动脉斑块与血清IL-6、sIL-6R的关系

目的:观察急性冠脉综合征(ACS)患者颈动脉斑块与血清白细胞介素-6(IL-6)和可溶性白细胞介素-6受体(s IL-6R)的关系。方法:85例ACS患者作为病例组,80例其它原因入院的冠心病患者作为对照组,彩色超声诊断仪检测颈动脉粥样斑块情况,ELISA法测定血清中的IL-6和s IL-6R水平,分析ACS患者颈动脉斑块稳定性与血清IL-6、s IL-6R水平的相关性。结果:病例组中具有颈动脉斑块不稳定斑块的患者比例明显高于对照组,差异具有统计学意义(P<0.05);病例组患者血清IL-6水平明显高于对照组,而s IL-6R水平明显低于对照组,差异有统计学意义(P<0.05);ACS患者血清IL-6水平与颈动脉斑块的不稳定性呈正相关关系(OR=3.85,P<0.05),ACS患者血清s IL-6R水平与颈动脉斑块的不稳定性呈负相关关系(OR=0.81,P<0.05)。结论:ACS患者IL-6和s IL-6R可作为预测ACS患者颈动脉粥样斑块稳定性的辅助指标。