Usefulness of early dobutamine stress echocardiography for the assessment of risk of restenosis after percutaneous coronary interventions

BACKGROUND: The increasing role of percutaneous coronary interventions (PCI) in the treatment of coronary artery disease and relatively high restenosis rate following PCI require the introduction of available, easy to perform and cost-effective tests that would enable detection of restenosis after PTCA and identification of patients at particularly high risk of restenosis. AIM: To estimate the predictive value of early dobutamine stress echocardiography (DSE) for the assessment of risk of coronary restenosis. METHODS: Thirty-nine patients with a single coronary vessel disease after PCI were enrolled in this study. DSE was performed twice--2 to 3 days after the procedure and repeated after 8 to 12 months. All patients underwent coronary angiography after one-year follow-up. RESULTS: Data analysis of direct pre- and postprocedural echocardiography showed that the wall motion score index decreased significantly (p <0.0001), whereas ejection fraction increased significantly after the intervention when compared with baseline (p <0.0001). Restenosis was detected in 8 out of 10 subjects with positive DSE test and in 3 out of 29 subjects with negative DSE test. In a group of 11 patients with restenosis confirmed in the coronary angiography, one-year follow-up DSE was found positive in 9 patients (80% test sensitivity) but in two cases results were false negative. Negative test was observed in 27 out of 28 individuals without restenosis (90% test specificity). CONCLUSIONS: DSE is highly sensitive and specific in prediction and detection of restenosis after PCI. DSE performed early after PCI is safe.     

Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification

Radiocontrast-induced nephropathy (RCIN) after percutaneous coronary intervention (PCI) is associated with grave consequences, but risk stratification of patients has not been well elucidated. This analysis derived a time-insensitive score to predict the risk of RCIN after PCI. A derivation cohort (1993 to 1998) and a validation cohort (1999 to 2002) comprised 20,479 patients who underwent PCI. RCIN after PCI was defined as a ≥1.0 mg/dl increase in serum creatinine. Variables having an independent correlation for RCIN after PCI were used to derive the RCIN risk score from the derivation cohort and were tested in the validation cohort. RCIN occurred in 2% of patients after PCI. Independent variables (with weighted scores) include estimated creatinine clearance <60 ml/min (2), urgent PCI (2), intra-aortic balloon pump use (2), diabetes mellitus (1), congestive heart failure (1), hypertension (1), peripheral vascular disease (1), and contrast volume >260 ml (1). The incidence of RCIN after PCI increased with each unit increase in score (p <0.0001, concordance statistic 0.89). No patient with a score ≤1 developed nephropathy, whereas 26% of patients with a score ≥9 developed RCIN after PCI (p <0.0001). Propensity score analysis showed that patients who developed RCIN after PCI, irrespective of the need for hemodialysis, had higher in-hospital rates of major adverse cardiac events (odds ratio 15, 95% confidence interval 11 to 20, p <0.0001). RCIN occurred in 2.0% of PCI patients and was associated with a 15-fold increase in adverse cardiac events. The RCIN risk score was a clinical assessment tool with excellent predictive ability in identifying the larger population at risk for nephropathy in whom preventative strategies are indicated.     

Usefulness of stress echocardiography for risk stratification and prognosis of patients with left ventricular hypertrophy

The purpose of this study was to evaluate the role of stress echocardiography in the risk stratification and prognosis of patients with left ventricular (LV) hypertrophy. One thousand two patients (mean age 62 +/- 13 years, 35% men) with LV hypertrophy (defined by LV mass index >115 g/m(2) for men and >95 g/m(2) for women) were evaluated. LV mass was calculated using the linear dimension method, as recommended by the American Society of Echocardiography. The calculation of relative wall thickness was performed using the formula (2 x posterior wall thickness)/LV internal diameter. Concentric and eccentric LV hypertrophy were defined as relative wall thicknesses > or =0.42 and <0.42 cm, respectively. Follow-up (2.6 +/- 1.1 years) for confirmed myocardial infarction and cardiac death (n = 71) was obtained. Four hundred seventy-three patients (47%) had concentric hypertrophy, and 529 patients (53%) had eccentric hypertrophy. In patients with either concentric or eccentric LV hypertrophy, stress echocardiography was able to effectively risk-stratify normal versus abnormal subgroups (event rate 1.1% vs 4.9% per year, p <0.0001), whereas stress electrocardiography was unable to do so. In the cohort with normal stress echocardiographic results, patients with concentric LV hypertrophy had an event rate 5 times higher than those with eccentric LV hypertrophy (event rate 1.7% vs 0.3% per year, p = 0.007). In conclusion, stress echocardiography effectively risk-stratifies patients with LV hypertrophy compared with stress electrocardiography. Normal stress echocardiographic results in patients with concentric LV hypertrophy indicate a worse prognosis than in patients with eccentric LV hypertrophy, probably reflecting decreased sensitivity in this cohort. However, abnormal stress echocardiographic results portend a worse prognosis in patients with either concentric or eccentric LV hypertrophy.     

冠心病患者大动脉扩张性对冠状动脉介入术的预后评价

目的探讨大动脉扩张性对冠心病患者经皮冠状动脉介入术（PCI）预后的评价。方法将316例行PC I治疗的冠心病患者根据颈—股脉搏波传导速度（CFPWV）分成Ⅰ组（0-10.0 m/s）、Ⅱ组（10.1-13.0 m/s）、Ⅲ组（〉13.0 m/s）,计数冠脉病变血管支数,评价冠脉病变严重程度,并随访（20.9±4.4）个月,记录主要心血管事件（MACE）。结果三组间比较,Ⅲ组年龄偏大,糖尿病、心肌梗死和高血压病史者多,C型病变和三支病变常见（P〈0.05）。Ⅲ组与Ⅰ与Ⅱ合并组比较,主要不良心血管事件（MACE）发生率显著增加（P均〈0.05）。多因素Logistic分析显示,CFPWV与MACE发生率呈正相关。结论CFPWV与冠脉病变的严重程度、PCI远期MACE发生率密切相关,是心血管疾病独立的强有力的预测因子,可用于指导临床早期干预。     

PAMI评分用于急性ST段抬高心肌梗死介入治疗患者的预后评价

目的探讨将来自于临床试验的介入治疗心肌梗死的危险评分(PAMI评分)应用于普通患有ST段抬高心肌梗死(STEMI)并接受直接PCI治疗的患者,评判其预测价值,以及冠状动脉病变程度与左心室射血分数对危险分层的意义。方法应用PAMI评分对2002年3月至2004年5月因STEMI连续行直接PCI的患者206例进行危险分层,并电话随访6个月至1年的死亡率。计数资料应用秩和检验,计量资料用独立样本t检验,并应用非条件logistic回归分析各变量与发病后6个月的死亡率的关系。结果随访到的183例患者中,PAMI评分在0~2分者有88例,3~5分者有54例,6~8分者有17例,≥9分有24例,死亡率分别为1·1%(1/88),3·7%(2/54),17·6%(3/17),41·7%(10/24),4组之间差异有统计学意义。Logistic回归分析显示冠状动脉血管病变支数是介入治疗后STEMI患者的危险因素(相对危险度10·186),而左心室射血分数(LVEF)则为保护性因素(相对危险度0·849)。PAMI评分联合冠状动脉3支病变及入院48h内的LVEF值可以增强死亡率的预测价值。结论PAMI危险评分可以作为简便易行的方法评价直接PCI治疗后STEMI患者的死亡率,同时联合冠状动脉病变程度与左心室射血分数可以增加预测价值的精确性。     

经胸超声心动图在急诊冠状动脉介入术的应用价值

目的探讨经胸超声心动图(TTE)在急诊冠状动脉介入术(PCI)的应用及其价值。方法92例胸痛患者,临床怀疑急性心肌梗死(AMI),在行急诊冠状动脉造影(CAG)之前,采用TTE从不同切面和角度,探测观察有无节段性室壁运动异常(RWMA)及其范围。对行急诊PCI的患者,术后定期复查,观察RWMA范围的变化及改善程度。结果TTE检查提示,89例存在RWMA,经急诊CAG均证实其相关冠状动脉完全或不完全闭塞,符合率100%,且其RWMA的区域与相关冠状动脉闭塞的部位及闭塞程度也明显相关。结论TTE可作为AMI诊断的可靠指标之一,也是选择适合患者作CAG、PCI以及评价急诊PCI后治疗效果的一个重要依据。     

Cardiac troponin I for risk stratification following percutaneous coronary artery intervention in acute coronary syndromes.

The cardiac troponins have been shown to provide prognostic information allowing risk stratification of patients with acute coronary syndromes (ACS). The benefit of early percutaneous coronary intervention (PCI) in this setting has been highlighted by the FRISC II study. We assessed the pattern of release of cardiac troponin I (cTnI) following PCI in patients with ACS and evaluated its prognostic value for major adverse cardiac events (MACE): death, Q-wave myocardial infarction (QWMI), and repeat revascularization at follow-up. cTnI was sampled at baseline and 6, 14, and 24 hr following PCI in 73 patients presenting with unstable and post-MI angina. Clinical follow-up was obtained in all 73 patients at a mean period of 43 +/- 19.9 weeks (range, 11-68 weeks). Patients were stratified into two groups according to whether cTnI remained unchanged or fell below baseline 24 hr post-PCI (group 1, n = 47) or increased above baseline 24 hr following PCI (group 2, n = 26). MACE occurred in 4 (8.5%) of patients in group 1 (QWMI = 1, CABG = 1, re-PCI = 2) and in 19 (73%) of patients in group 2 (death = 1, QWMI = 2, CABG = 2, re-PCI = 14; chi-square = 32.34, P < 0.0001). The positive predictive value of rising cTnI within 24 hr following PCI for MACE at follow-up was 0.73 and the negative predictive value was 0.92 (specificity = 83%, sensitivity = 86%; odds ratio = 29.18, 95% CI = 7.62-110.64, P < 0.0001). cTnI is an inexpensive and widely applicable tool that offers reliable prognostic information for the risk stratification of patients undergoing coronary revascularization in the setting of acute coronary syndromes and may identify a group of patients at particular risk of repeat PCI.     

Troponin ratio and risk stratification in subjects with acute coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND: Cardiac enzyme release after percutaneous coronary intervention (PCI) seems to play a role in risk stratification. After PCI, CK-MB plasmatic concentrations three times above the upper level of normal (ULN) are currently the most used risk stratification parameters. We sought to assess whether peak cardiac troponin I (cTn-I) concentration/base concentration ratio (PBTR) may act as a predictor of major adverse cardiac events (MACEs) after PCI, regardless of cTn-I ULN. METHODS: We evaluated 326 consecutive patients with acute coronary syndrome (ACS) who underwent PCI. Baseline and post-PCI cTn-I values were evaluated over serial blood samples every 6h for at least 72h. Patients were further divided into four groups according to their PBTR values (<1, 1-4, 4-10, >10). MACEs were recorded over a 6-month follow-up period. Patients with primary PCI or unsuccessful PCI were excluded from the study. RESULTS: Higher values of PBTR significantly correlated with a worse prognosis at 6 months (<1, 16.30% of MACEs; 1-4, 19.42%; 4-10, 24.39%; >10, 35.63%; p<0.05), both in Q-wave myocardial infarction (MI) and unstable angina (UA) subgroups. The correlation remained statistically significant, even considering subjects with peak cTn-I less than three times the ULN (p < 0.05) and after correction for age, gender, risk factors, diagnosis (MI versus UA), and peak cTn-I levels in a multiple Cox' regression analysis (HR 1.62, p<0.05). CONCLUSIONS: PBTR is an independent predictor of MACEs after PCI in a 6-month follow-up period. This risk stratification tool may be useful to predict adverse events in PCI patients, even in the case of apparently non-elevated peak cTn-I concentrations.     

Usefulness of preprocedural platelet aggregation to predict restenosis after percutaneous coronary intervention

We investigated whether the assessment of small platelet aggregates before percutaneous coronary intervention (PCI) could predict restenosis after PCI. This was a prospective cohort study that enrolled 189 consecutive patients who had coronary artery disease. In multiple logistic regression analysis, higher levels of preprocedural small platelet aggregates were independently associated with restenosis after PCI. Measurement of small platelet aggregates may serve as a useful clinical variable for stratifying patients who present for PCI.     

Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery

Transthoracic echocardiography (TTE) is frequently ordered before noncardiac surgery, although its ability to predict perioperative cardiac complications is uncertain. To evaluate the incremental information provided by TTE after consideration of clinical data for prediction of cardiac complications after noncardiac surgery, 570 patients who underwent TTE before major noncardiac surgery at a university hospital were studied. Preoperative clinical data and clinical outcomes were collected prospectively according to a structured protocol. TTE data included left ventricular (LV) function, hypertrophy indexes, and Doppler-derived measurements. In univariate analyses, preoperative systolic dysfunction was associated with postoperative myocardial infarction (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.1 to 7.0), cardiogenic pulmonary edema (OR 3.2, 95% CI 1.4 to 7.0), and major cardiac complications (OR 2.4, 95% Cl 1.3 to 4.5). Moderate to severe LV hypertrophy, moderate to severe mitral regurgitation, and increased aortic valve gradient were also associated with major cardiac events (OR 2.3, 95% CI 1.2 to 4.6; OR 2.2, 95% CI 1.1 to 4.3; OR 2.1, 95% CI 1.0 to 4.5, respectively). In logistic regression analysis, models with echocardiographic variables predicted major cardiac complications significantly better than those that included only clinical variables (c statistic 0.73 vs 0.68; p <0.05). Echocardiographic data added significant information for patients at increased risk for cardiac complications by clinical criteria, but not in otherwise low-risk patients. In conclusion, preoperative TTE before noncardiac surgery can provide independent information about the risk of postoperative cardiac complications in selected patients.     

Usefulness of tirofiban among patients treated without percutaneous coronary intervention (TIMI high risk patients in PRISM-PLUS)

Although the efficacy of glycoprotein IIb/IIIa inhibition in non-ST-elevation acute coronary syndromes is greatest in patients who undergo percutaneous coronary intervention (PCI), it was hypothesized that high-risk patients managed without PCI also benefit. The TIMI risk score was calculated for 1,570 patients randomized to tirofiban plus heparin versus heparin in the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms trial. In high-risk patients (score > or =4) treated without PCI, tirofiban reduced the risk for death, myocardial infarction, and refractory ischemia at 30 days (28.8% vs 21.9%; odds ratio [OR] 0.69, p = 0.04). This benefit was similar in magnitude as that for patients who underwent PCI (32.4% vs 22.2%; OR 0.60, p = 0.06). No benefit was evident in low-risk patients.     

Role of cardiac troponin T in the long-term risk stratification of patients undergoing percutaneous coronary intervention.

AIMS: To investigate the long-term prognostic significance of pre- and post-procedure troponin T (TnT) elevations in patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: TnT and CK-MB were measured pre- and post-procedure in 212 patients undergoing PCI. Major adverse events (composite of death, myocardial infarction and revascularization) were ascertained 6 years later. Pre-procedural TnT was a significant independent predictor of time to major events (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.16-2.64) and death or myocardial infarction. Post-procedural TnT elevation above normal was the only independent predictor of the primary end-point at 1 year (HR 2.39, 95% CI 1.09-5.26) but was not significantly related to event-free survival throughout follow-up. Post-PCI elevation of TnT 5x above normal, however, did significantly predict time to events during the entirety of follow-up. By contrast, CK-MB was not an independent predictor in any of the analyses. CONCLUSIONS: Our study confirms the long-term prognostic value of pre-procedural TnT elevation in patients undergoing PCI, and demonstrates the superior predictive ability of a post-procedural increase in TnT 5x normal for long-term adverse events. Whether the prognostic significance of smaller post-procedural TnT elevations extends beyond the intermediate-term awaits further investigation.     

Usefulness of dipyridamole stress echocardiography for predicting graft patency after coronary artery bypass grafting

Noninvasive techniques often provide controversial results in patients who have coronary artery bypass grafts (CABGs). Vasodilator stress echocardiography allows semi-simultaneous imaging of CABG flow and segmental left ventricular wall motion. To assess the comparative and additive value of regional flow and function for noninvasive evaluation of graft patency status, we evaluated 110 consecutive patients who underwent CABG and who were scheduled for coronary angiography. All patients underwent stress echocardiography with dipyridamole (0.84 mg/kg) and atropine (1 mg), including wall motion analysis by 2-dimensional echocardiography and Doppler evaluation of flow reserve of each CABG. Echocardiographic findings were compared with angiographic data. Four patients had inadequate acoustic windows. The remaining 106 patients had 226 grafts performed. Stress echocardiography showed 67% sensitivity, 91% specificity, and 71% accuracy for identification of 50% to 100% stenosis in the graft or in the recipient coronary vessel. There was a fair agreement with angiography (kappa coefficient 0.60). Identification of impaired coronary bypass flow reserve (i.e., <1.9 for internal mammary grafts and <1.6 for saphenous vein grafts) by Doppler had 91% sensitivity, 88% specificity, and 89% accuracy for graft stenosis. There was good agreement with angiographic findings (kappa 0.77). The combination of the 2 techniques achieved 93% sensitivity, 93% specificity, and 93% accuracy, showing a very good agreement with the patency status of the grafts as evaluated at angiography (kappa 0.85). The combined assessment of wall motion and flow reserve in patients who underwent CABG is feasible and provides an accurate estimate of graft patency status by increasing sensitivity of stress echocardiography and specificity of Doppler flow reserve.     

动脉僵硬度对介入治疗患者的危险分层及预后评价

目的探讨动脉僵硬度对PCI患者的危险分层和预后评价。方法选择冠心病并行PCI的患者316例,均进行颈-股脉搏波传导速度(cfPWV)检测评价动脉僵硬度。根据cfPWV水平将患者分为3组,Ⅰ组67例(cfPWV0-10.0 m/s),Ⅱ组98例(cfPWV)0.1-13.0 m/s),Ⅲ组151例(cfPWV>13.0 m/s)。记录患者临床特征、术后并发症和随访主要心血管事件(MACE)发生率,并行相关分析。结果与Ⅰ组和Ⅱ组比较,Ⅲ组年龄偏大,糖尿病、心肌梗死和高血压所占比例多,C型病变和3支病变多见(p<0.05)。术后并发症发生率、远期非致死性心肌梗死和血运重建发生率显著增加(P<0.05)。cfPWV与MACE发生呈正相关(OP=1.98,95%CI:1.039-3.770)。结论 cfPwV与冠状动脉病变的严重程度及PCI后远期MACE发生率增加密切相关。     

Multimarker risk stratification approach and cardiovascular outcomes in patients with stable coronary artery disease undergoing elective percutaneous coronary intervention

AimsWe studied the utility of multimarker risk stratification approach to predict cardiovascular outcomes in patients with stable coronary artery disease, undergoing elective percutaneous coronary intervention (PCI).MethodsWe prospectively evaluated 302 consecutive patients with stable coronary artery disease and normal CPK-MB and cardiac troponin T levels, and who underwent elective PCI at our institution. The following cardiac biomarkers were measured before and between 12 and 24 h post-procedure: CK-MB, cardiac troponin T, hs-CRP, and NT-ProBNP. Patients were followed up for a minimum of 6 months.ResultsPost-PCI, CPK-MB levels were elevated but below myocardial infarction (MI) range in 70 patients (23%), and in the MI range in 6 patients (2%). Troponin T levels were detectable but below the 99th percentile (microleak) in 32 patients (10.6%) and elevated above the 99th percentile (periprocedural MI) in 104 patients (34.4%). At 9 months’ follow-up, 1% died, 2% had stable angina, 10.3% had non-fatal MI, and 87.7% remained asymptomatic. There was no significant difference in clinical events among groups stratified by elevation of one biomarker or multiple biomarkers.ConclusionSingle or multiple biomarker strategy in patients with normal baseline biomarkers failed to predict major cardiac events after PCI over medium-term follow-up.     

老年冠心病患者介入治疗术后对比剂肾损伤发生率及危险因素分析

目的探讨老年冠心病患者PCI术后对比剂肾损伤(contrast-induced nephropathy,CIN)发生情况及危险因素。方法选取行PCI的老年冠心病患者945例,按照CIN诊断标准分为CIN组150例和非CIN组795例,比较2组相关因素的差异,应用多元logistic回归分析探讨CIN危险因素。结果 945例老年患者中,150例发生CIN,CIN发生率为15.9%。2组患者年龄、心肌梗死、糖尿病、低血压、红细胞计数、血红蛋白、贫血、LVEF、术前肾小球滤过率(GFR)、对比剂剂量等比较,差异有统计学意义(P<0.01)。多元logistic回归分析,心肌梗死、糖尿病、贫血、低血压、LVEF≤45%、GFR≤60 ml/(min·1.73 m~2)、急诊PCI、对比剂剂量>200 ml是老年冠心病患者CIN的危险因素(P<0.05,P<0.01)。结论 CIN是老年冠心病患者PCI术后一种不容忽视的并发症,患者行PCI时,应引起临床医师的格外重视。     

冠心病介入治疗术后患者综合健康教育干预效果初探

目的探讨冠心病经皮冠状动脉介入治疗（PCI）术后患者综合健康教育干预模式的应用,并检验其效果。方法选取2012年1月至2012年3月106例行PCI术的患者,随机分为观察组和对照组各53例。对照组给予常规术后护理及宣教,观察组在此基础上采用综合健康教育模式,比较出院6个月、12个月冠心病心血管危险因素控制效果及再住院率情况。结果术后6个月,观察组血压（BP）、低密度脂蛋白胆固醇（LDL-C）及有氧活动达标率均显著高于对照组,差异有统计学意义（P＜0.05）,而体质量指数（BMI）、空腹血糖、心电图（ECG）及再住院率与对照组间差异则无统计学意义（P＞0.05）;术后12个月,观察组BP、LDL-C、BMI、ECG、有氧活动达标率及再住院率均显著高于对照组,差异有统计学意义（P＜0.05）。结论实施综合健康教育干预,显著控制了PCI术后的危险因素,在一定程度上降低了患者的再住院率。     

Dobutamine-atropine stress echocardiography for risk stratification in patients with chronic left ventricular dysfunction

ObjectiveTo assess the prognostic value of sustained improvement, scar and inducible ischemia with or without viability in patients with chronic left ventricular dysfunction (LVD).BackgroundDobutamine-atropine stress echocardiography (DASE) accurately detects scar, reversible dysfunction and the extent of coronary artery disease in LVD.MethodsThree hundred fifty consecutive patients (age 62 ± 13 years, mean ± SD, 215 men/135 women) with moderate to severe LVD (LVEF < 40%, mean 30 ± 8%) underwent DASE and were followed for ≥18 months. Dobutamine-atropine stress echocardiographic findings were classified according to sustained improvement in all vascular territories, scar, inducible ischemia (worsening wall motion at peak dose only or biphasic responses) and their extent.ResultsSustained improvement occurred in 83 patients (24%), scar alone in 99 (28%) and inducible ischemia in 168 (48%, with biphasic responses in 104). Ischemia was induced in all vascular territories in 26 patients. Patients with sustained improvement or scar alone were treated medically, whereas 46% (78/168) with inducible ischemia were revascularized (coronary bypass surgery, n = 67 or angioplasty, n = 11). There were 76 hard events including cardiac death in 59, nonfatal myocardial infarction in 11, and resuscitated sudden death in 6. Hard events were rare in sustained improvement (5%, 4/83), uncommon in scar (13%, 13/99) and common (p < 0.01) in medically treated patients with inducible ischemia (59%, 53/90). Cardiac deaths were especially common (p < 0.01) in patients with biphasic responses (55%, 28/51). Inducible ischemia independently predicted hard events (χ²= 75.35, p < 0.001) along with reduced LVEF at peak dose (χ²= 8.38, p = 0.004). Hard cardiac events were uncommon (8%, 6/78, p < 0.001) in patients with inducible ischemia who underwent early revascularization.ConclusionsInducible ischemia during DASE was the major determinant of outcome in LVD and independent of clinical data and left ventricular function. Improved wall thickening alone and scar alone predicted good outcome. Survival of patients with inducible ischemia was better after revascularization.     

护理干预对冠状动脉介入术患者的影响

冠状动脉造影检查（CAG）及冠状动脉介入治疗（PCI）,现已成为诊断和治疗冠状动脉病变的重要手段,技术也日趋成熟。因其创伤小、恢复快、疗效显著而被越来越多的心脏病患者所接受。虽然接受介入术的患者都经过了术前教育,但大多数患者真正来到导管室后,仍会产生许多的心理问题,这些不良情绪直接影响了手术的进程。因此采取相应的护理干预来预防和缓解这些不良情绪是非常必要的。