分叉病变对急性心肌梗死急诊介入治疗效果的影响

目的:探讨分叉病变对ST段抬高型急性心肌梗死（STEMI）患者急诊冠脉介入治疗（PCI）效果的影响。方法: 318例连续入选的STEMI患者在发病12 h内行PCI,根据冠脉造影提示是否为分叉病变分为分叉组（n=92）和非分叉组(n=226)。结果: 分叉组PCI的成功率为86％,与非分叉组(84%)相比无显著差异。两组30 d主要不良事件也无统计学差异(分叉组与非分叉组:6% vs. 7%)。结论: STEMI患者急诊PCI治疗分叉病变的即刻和近期疗效与无分叉病变相近。     

血栓负荷重对老年急性心肌梗死患者急诊介入治疗预后的影响

目的探讨血栓负荷重对老年ST段抬高急性心肌梗死患者急诊经皮冠状动脉介入治疗（PCI）预后的影响。方法73例老年ST段抬高急性心肌梗死患者在发病12h内行急诊PCI。根据冠状动脉造影后血栓负荷状态分为血栓负荷重组（n=26）和血栓负荷轻组（n=47）,同时监测PCI后血流、肌酸激酶MB型同工酶（CK-MB）峰值、住院期间的射血分数（EF）和病死率。结果梗死相关血管内血栓负荷过重的发生率为35.6%,多见于右冠状动脉内。血栓负荷重组患者行PCI后TIMI3级血流的发生率明显低于血栓负荷轻组;血栓负荷重组的CK-MB峰值和近期死亡率明显高于血栓负荷轻组。结论血栓负荷过重是老年急性心肌梗死患者急诊PCI预后的危险因素。     

急性ST段抬高型心肌梗死伴高血栓负荷患者急诊及择期经皮冠状动脉介入治疗策略研究

背景 部分急性ST段抬高型心肌梗死(STEMI)患者在急诊经皮冠状动脉介入治疗(PCI)中因有大量血栓残留而不能行支架植入,而此类患者急诊及择期PCI策略是一个值得深入研究的问题.目的 探讨急性STEMI伴高血栓负荷患者急诊及择期PCI策略,以为此类患者今后的治疗积累经验.方法 回顾性选取2014年8月—2019年8月...     

后扩张在老年急性ST抬高心肌梗死行急诊PCI中的临床应用

目的探讨后扩张在老年急性ST抬高心肌梗死行急诊PCI中的临床应用效果。方法选取2015年11月至2017年10月于我院诊断急性ST抬高心肌梗并行急诊冠脉支架植入的老年患者372例为研究对象, 其中228例患者支架后行非顺应性高压球囊后扩张为观察组, 未行后扩张者144例为对照组。术中观察无复流或慢血流发生率;随访1年,观察主要不良心血管事件发生率（MACE）,支架内血栓发生率及靶病变重建率。结果在老年急性ST抬高心肌梗死行急诊PCI患者中,与对照组相比,观察组无复流及慢血流发生率（1.8%&1.4%）差异无统计学意义（P ＞0.05）,而支架内血栓形成（0.0%&1.4%）,不良心血管事件发生率（0.9%&4.9%）及再次血运重建率减少（0.4% &4.2%）（P <0.05）,差异有统计学意义。结论老年急性ST抬高心肌梗死急诊PCI时行后扩张, 可以减少支架内血栓形成及血运重建, 减少主要不良心血管事件,对提高患者的预后意义重大。     

血栓抽吸在高血栓负荷急性前壁心肌梗死患者急诊介入中的应用

目的：探讨血栓抽吸在高血栓负荷急性前壁心肌梗死患者急诊经皮冠状动脉介入（PCI）治疗中的有效及安全性。方法：选取2020年1月至2021年9月,在首都医科大学附属北京安贞医院行急诊PCI的高血栓负荷急性前壁心肌梗死患者共151例。根据是否行血栓抽吸术分为血栓抽吸+PCI组（n=84）和单纯PCI组（n=67）。比较两组患者术后即刻的TIMI血流分级、心肌呈色（MBG）分级以及随访6个月内的心血管不良事件和卒中的发生率。结果：两组患者在高血压、吸烟、糖尿病、GP Ⅱb/Ⅲa受体拮抗剂使用率、住院至球囊扩张时间（D-to-B）等基本临床资料方面,差异无统计学意义（P>0.05）。两组患者术后TIMI血流分级及MBG分级差异无统计学意义（P>0.05）,随访6个月内心血管不良事件和脑卒中的发生率也差异无统计学意义（P>0.05）。结论：血栓抽吸并未改善高血栓负荷前壁心肌梗死的患者的预后及心肌的再灌注水平,也未增加卒中的发生风险。     

易化的经皮冠脉介入治疗——急性心肌梗死治疗新策略

急性心肌梗死再灌注治疗的方法主要包括溶栓和紧急经皮冠脉介入治疗,其中溶栓治疗简单易行,但再灌注不充分,并且再闭塞率高;而直接经皮冠脉介入治疗,可以恢复心外膜血管的血流,血管的开通率高,但是只有在有条件的医院才能进行,而对于急性心肌梗死来讲,血管开通的时间是最重要的,因此,人们试图通过将溶栓治疗和经皮冠脉介入治疗联合应用来发挥各自的优势,尽量减少缺陷来尽快恢复心脏血流供给,也就是采用易化经皮冠脉介入治疗的方法来治疗急性ST段抬高心肌梗死,从而获得梗死相关动脉更早的开通和更高的开通率。     

性别对ST段抬高的急性心肌梗死急诊冠脉介入治疗预后的影响

目的: 探讨性别对ST段抬高的急性心肌梗死（STEMI）患者急诊冠脉介入治疗（PCI）预后的影响。方法: 164例STEMI患者急诊PCI后,观察其临床及冠脉介入治疗特征和院内全因死亡率。结果: 女性患者的平均年龄较大,并发糖尿病的比例较高,低密度脂蛋白胆固醇较高,梗死相关血管介入治疗前TIMI Ⅲ级血流的比例较高,而吸烟率和入院时的舒张压明显较低。但两组的梗死相关血管内血栓发生率、PCI后TIMI Ⅲ级血流的比例及院内病死率均无统计学差异。结论: 性别对STEMI患者急诊PCI近期预后无明显影响。     

延续性护理在急性心肌梗死患者介入治疗术后的应用效果观察

目的观察延续性护理在急性心肌梗死(acute myocardial infarction,AMI)行经皮冠脉介入治疗(percutaneous coronary intervention,PCI)术后患者中的应用效果。方法将2014-08~2016-02间该院收治AMI并行PCI治疗的患者78例按随机数字表法分为观察组和对照组,每组39例,其中对照组予以心内科常规护理,而观察组在常规护理的基础上实施延续性护理干预,所有患者随访6个月。比较随访期间两组患者心血管不良事件发生情况、治疗依从性,同时采用生活质量综合问卷(GQOLI-74)比较两组患者生活质量。结果随访期间,观察组不良事件发生率为12.82%,低于对照组的35.89%,差异有统计学意义(P0.05);随访结束时,观察组服药、复查、饮食、运动方面的依从性调查结果均优于对照组,差异有统计学意义(P0.05);观察组GQOLI-74问卷中躯体功能、心理功能、社会功能以及物质生活状态方面均优于对照组,差异有统计学意义(P0.05)。结论延续性护理有助于降低院外心血管不良事件发生风险,提高治疗依从性,改善生活质量,效果显著。     

血栓抽吸联合冠脉内给予法舒地尔对急性心肌梗死急诊PCI后无复流的影响

目的评价急诊经皮冠脉介入治疗（PCI）中应用血栓抽吸联合冠脉内给予法舒地尔对急性心肌梗死无复流的影响、疗效及安全性。方法选择2011年7月至2012年12月我科收治的急性sT段抬高心肌梗死行急诊PCI,梗死相关动脉（IRA）术前TIMI〈1级的患者160例,随机分为观察组和对照组各80例。两组患者手术方法相同,出现无复流现象后分别经冠脉给予法舒地尔和硝酸甘油。观察两组注射药物后TIMI血流分级、TMPG分级、心电图sT段回落、左室射血分数、左室舒张末期内径及住院期间的主要心血管事件。结果观察组TIMI血流分级、TMPG分级、心电图sT段回落、左室射血分数均高于对照组（P〈0．05）,观察组左室舒张末期内径及住院期间的MACE发生率低于对照组（P〈O．05）。结论AMI行急诊PCI血栓抽吸联合冠脉内给予法舒地尔可改善冠脉血流和梗死区的心肌再灌注,改善近期预后,是安全有效的。     

急诊心脏介入治疗中无复流现象预防措施的效果观察

目的 探讨ST段抬高型急性心肌梗死患者行急诊经皮冠脉介入治疗术(PCI)出现无复流现象的原因及预防措施.方法 选择ST段抬高型急性心肌梗死患者202例,无急诊PCI治疗禁忌证,随机分为3组,分别给予常规PCI治疗、血栓抽吸和冠脉内注入血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂后PCI等不同的治疗,监测患者PCI治疗后血浆脑钠肽前体(pro-BNP)和PCI术后冠脉造影TIMI血流分级,记录患者住院时间和28 d死亡率.结果 三组患者间发病至梗死相关血管开通时间、总平均住院时间、PCI治疗术后28d死亡率差异无统计学意义.常规PCI治疗组无复流现象的发生率高于血栓抽吸组和冠脉内注入血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂组,并且血浆pro-BNP明显高于后者.结论 心肌梗死患者PCI术后无复流的发生与冠脉内微血栓形成有关,通过血栓抽吸和冠脉内注入血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂的方法可以有效减少无复流的发生.     

血栓抽吸在老年急性ST段抬高型心肌梗死患者直接介入治疗中的应用

目的:探讨经皮冠状动脉内血栓抽吸术在血栓负荷重的急性ST段抬高型心肌梗死老年患者直接介入治疗(PCI)中的应用。方法:选择2009-01-2010-12期间在我院接受直接PCI的急性ST段抬高型心肌梗死老年患者117例,其中直接介入术加血栓抽吸治疗者为血栓抽吸组,共44例;仅行常规直接PCI者73例为对照组。研究初级终点为术后TIMI 3级血流率,次级终点为随访6个月的左心室射血分数(LVEF)、主要心血管病事件(MACE)发生率及纽约心功能分级。结果:血栓抽吸组术后TIMI 3级高于对照组,达到95.5%,术后肌酸激酶同工酶及TnI达峰时间稍提前于对照组,但与对照组比较均差异无统计学意义;随访6个月结果显示,累计MACE发生率在血栓抽吸组和对照组分别为4.6%和9.5%,差异无统计学意义,LVEF在住院1周时血栓抽吸组及对照组分别为[(51.4±9.2)%︰(48.0±11.8)%,P>0.05],随访6个月时分别为[(54.5±6.8)%︰(49.9±10.5)%,P<0.05];6个月时血栓抽吸组纽约心功能分级优于对照组,但差异无统计学意义。结论:血栓抽吸可以改善血栓负荷重的老年患者急诊PCI术后TIM...     

Mortality differences among patients with in-hospital ST-elevation myocardial infarction

BackgroundIn‐hospital ST‐elevation myocardial infarction (STEMI) is associated with a higher mortality rate than out‐of‐hospital STEMI. Quality measures and universal protocols for treatment of in‐hospital STEMI do not exist, likely contributing to delays in recognition and treatment.HypothesisTo analyze differences in mortality among three subsets of patients who develop in‐hospital STEMI.MethodsThis was a multicenter, retrospective observational study of patients who developed in‐hospital STEMI at six United States medical centers between 2008 and 2017. Patients were stratified into three groups: (1) cardiac, (2) periprocedure, or (3) noncardiac/nonpostprocedure. Outcomes examined include time from electrocardiogram (ECG) acquisition to cardiac catheterization lab arrival (ECG‐to‐CCL) and survival to discharge.ResultsWe identified 184 patients with in‐hospital STEMI (mean age 68.7 years, 58.7% male). Group 1 (cardiac) patients had a shorter average ECG‐to‐CCL time (69 minutes) than group 2 (periprocedure, 215 minutes) and group 3 (noncardiac/nonpostprocedure, 199 minutes). Compared to group 1, survival to discharge was lower for group 2 (OR 0.33, P = .102) and group 3 (OR 0.20, P = .016). After adjusting for prespecified covariates, the relationship between group and survival showed a similar trend but did not reach statistical significance.ConclusionsPatients who develop in‐hospital STEMI in the context of a preceding procedure or noncardiac illness appear to have longer reperfusion times and higher in‐hospital mortality than patients admitted with cardiac diagnoses. Larger studies are warranted to further investigate these observations. Health systems should place an increased emphasis on developing quality metrics and implementing quality improvement initiatives to improve outcomes for in‐hospital STEMI.     

Impact of intravascular ultrasound guidance in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Objectives: The aim of this study was to examine the utility of routine intravascular ultrasound (IVUS) guidance in patients with acute myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) with stent implantation. Background: Stent thrombosis (ST) is a serious complication of PCI with stent implantation for patients presenting with acute MI. Mechanical factors such as incomplete stent expansion and smaller stent diameters are known to correlate with ST and restenosis. IVUS guidance for stent deployment is reported to reduce these events in stable patients. Methods: We analyzed a cohort of 905 consecutive patients who underwent primary PCI for acute MI and were discharged alive. The clinical outcomes of 382 patients who underwent IVUS‐guided PCI were compared to those of 523 patients who did not. Patients who presented with cardiogenic shock and rescue PCI were excluded. The primary composite endpoint of death, MI, and target lesion revascularization at 1‐year follow‐up was systematically indexed and a propensity score was performed with regard to the use of IVUS‐guided PCI. Results: Patients undergoing IVUS‐guided PCI were older, more diabetic and hypertensive, but presented with less history of previous MI. The severity of coronary artery disease was balanced between both groups. The number of treated lesions and stents used was higher in the IVUS‐guided group, with a longer procedural duration. The overall rates of the composite primary outcome were similar (14.5% vs. 14.3%, P = 0.94) as were the rates of definite and probable stent thrombosis at 1 year (2.1% vs. 2.1%, P = 0.99) in the IVUS‐guided and no‐IVUS groups, respectively. After multivariate and propensity score adjustment, IVUS guidance was not an independent predictor for the primary endpoint. Conclusion: This study does not support the routine use of IVUS guidance for stent deployment in patients who present with acute MI and undergo primary PCI. © 2009 Wiley‐Liss, Inc.     

冠脉内小剂量替罗非班在急性STEMI急诊介入时应用观察

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)时冠脉内小剂量应用替罗非班对介入治疗安全性和有效性。方法:入选77例STEMI急诊介入治疗患者,全部患者入院后立即给予阿司匹林300 mg嚼服,氯吡格雷300 mg口服,随机分为替罗非班组(试药组,39例)和对照组(38例,未用替罗非班)。PCI术后梗死相关血管的心肌梗死溶栓(TIMI)血流分级、术后24 h ST段完全回落率、术后1周左心室射血分数(LVEF)、术后30 d主要心血管事件(死亡、再发心肌梗死、靶血管血运重建、反复心绞痛发作)及TIMI出血事件作为评价指标。结果:术前两组患者基线资料(年龄、性别、危险因素)差异无统计学意义。术后即刻TIMIⅢ级血流获得率试药组明显高于对照组(P0.05)。术后24h ST段完全回落率及1周时LVEF试药组明显高于对照组(均P0.05,P0.01)。术后30 d随访两组主要心血管事件和主要出血事件的发生率差异均无统计学意义。结论:对急性STEMI患者急诊介入治疗时,冠脉内应用小剂量替罗非班可以获得较好的即刻造影结果,且安全、有效。     

血清总25-(OH)D对急性心肌梗死患者近期预后的影响

目的探讨血清总25羟基维生素D[25-(OH) D]对急性心肌梗死患者近期预后的影响。方法选取急性心肌梗死且行急诊经皮冠状动脉介入治疗(PCI)的患者共1 324例,收集其临床资料并检测血清总25-(OH) D水平,随访1年记录主要不良事件。根据是否发生主要不良事件分为事件组及对照组,回顾性分析两组患者临床特点。根据血清总25-(OH) D水平将患者分为维生素D缺乏组、不足组及正常组,分析三组患者的临床特点及预后差异。结果发生不良事件组217人,对照组1 107人。事件组25-(OH) D水平低于对照组(P=0. 007)。维生素D缺乏组与不足组患者非致死性心肌梗死、非计划血运重建发生率及高血压、糖尿病患病率均高于维生素D正常组。单因素COX分析结果提示维生素D缺乏及不足与PCI术后1年内发生不良事件相关(维生素D缺乏OR=2. 621,95%CI 1. 048～6. 553,P=0. 039;维生素D不足OR=2. 750,95%CI 1. 076～7. 031,P=0. 035)。ROC曲线分析25-(OH) D预测1年内未发生不良反应的灵敏度和特异性分别为56. 5%、59. 0%。结论低水平血清25-(OH)D是急性心肌梗死患者PCI术后发生主要不良事件的危险因素。     

Impact of thrombus aspiration on angiographic and clinical outcomes in patients with ST-elevation myocardial infarction

BackgroundPrimary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) may be limited by thrombus embolization. Export aspiration catheter (EAC) is a thrombectomy device which may enhance angiographic results, but its impact on clinical outcomes is unclear. This trial objective was to assess the impact of EAC on angiographic and clinical outcomes in patients with STEMI.MethodsAll STEMI patients undergoing primary or rescue PCI in a tertiary care center were included. Patients were divided in two groups according to the use of the EAC. Patients were followed up prospectively for death, reinfarction, revascularization, or stroke. Thrombolysis In Myocardial Infarction (TIMI) flow in the culprit vessel was assessed before and after PCI.ResultsIncluded in the analysis were 535 patients. EAC was used in 165 patients before angioplasty (Group 1) and 370 patients underwent PCI without thrombus aspiration (Group 2). More patients in Group 1 had initial TIMI flow 0–1 compared to Group 2 (88% vs. 62%, P<.001). Proportion of patients with a final TIMI flow 3 was the same in both groups (89.1% vs. 87.6% for Groups 1 and 2, respectively; P=.67). An analysis restricted to patients with initial TIMI flow 0–1 yielded similar results. No difference in clinical outcomes was observed between the two groups (P=.70).ConclusionsSelective use of the EAC based on the judgment of operators results in excellent angiographic and clinical results. Further clinical investigation is needed to definitely answer whether thromboaspiration needs to be performed in all STEMI patients undergoing primary PCI.     

血栓抽吸联合低剂量替罗非班对老年急性ST段抬高型心肌梗死患者心肌再灌注水平及安全性的影响

［摘要］： 目的 评价血栓抽吸联合冠脉内注射低剂量替罗非班对老年高血栓负荷急性ST段抬高型心肌梗死（acute ST-segment elevation myocardial infarction,STEMI）患者直接经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后心肌再灌注水平及安全性的影响。 方法 选取2014年1月至2019年1月于马鞍山临床学院行PCI的老年STEMI高血栓负荷患者127例,随机分为观察组62例及对照组65例,观察组在常规PCI之前联合应用血栓抽吸和冠脉内注射低剂量替罗非班治疗,对照组采用常规PCI治疗。比较两组患者术后临床效果、出血事件及主要心脏不良事件（major adverse cardiac events,MACE）发生情况。 结果 术后观察组梗死相关动脉的TIMI血流3级、2h心电图ST段回落>50%、LVEF均显著高于对照组[TIMI血流3级：57例(91.9%)与49例(75.4%),χ2=2.295,P=0.040;心电图ST段回落>50%：50例(80.6%)与40例(61.5%),χ2=5.611,P=0.018;LVEF值：(52.7±3.5)%与(50.95±5.0)%,t=2.229,P=0.028];观察组CK-MB峰值、碎裂QRS波、心包积液均低于对照组[CK-MB峰值：(274.4±173.1)U/L与(334.5±154.0)U/L,t=2.069,P=0.041;碎裂QRS波：24例（38.7%）与38例（55.5%）,χ2=4.955,P=0.026;心包积液：6例（9.5%）与15例（23.1%）,χ2=4.128,P=0.042];术后30天,观察组小/微出血事件多于对照组[小/微出血事件：7例（11.3%）与4例（6.2%）,χ2=4.019,P=0.043],大出血和卒中事件两组间无显著性差异(P>0.05）;术后6个月,MACE事件两组间无显著性差异(P>0.05）。 结论 血栓抽吸联合冠状动脉内注射低剂量替罗非班可改善老年高血栓负荷STEMI患者心肌再灌注水平,同时不增加严重出血风险,具有较高的临床应用价值。     

不同剂量替格瑞洛在老年急性心肌梗死病人PCI术后抗血小板治疗中的有效性与安全性

目的比较低剂量替格瑞洛(180 mg负荷量,续贯60 mg每日2次口服)与标准剂量替格瑞洛(180 mg负荷量,续贯90 mg每日2次口服)在老年急性心肌梗死(AMI)病人经皮冠状动脉介入术(PCI)术后抗PLT治疗中的有效性与安全性。方法研究共入选196例成功接受PCI治疗的老年AMI病人,随机分为低剂量替格瑞洛组和标准剂量替格瑞洛组,详细记录病人住院期间及随访1年的主要不良心脑血管事件(MACCE)与出血事件。结果低剂量替格瑞洛组住院期间及随访至1年MACCE发生率与标准剂量替格瑞洛组相比,差异无统计学意义。住院期间2组小出血(8.4%比18.6%,P=0.061)和大出血发生率(1.1%比2.9%,P=0.622)差异无统计学意义;低剂量替格瑞洛组随访1年小出血发生率显著低于标准剂量替格瑞洛组(16.8%比36.9%,P=0.002),大出血方面2组差异无统计学意义(1.1%比3.9%,P=0.371)。Kaplan-Meier生存分析显示,低剂量替格瑞洛组1年无MACCE生存率与标准剂量替格瑞洛组相比,差异无统计学意义(P=0.823)。结论AMI病人PCI术后接受小剂量替格瑞洛较常规剂量相比,不增加MACCE事件发生率,同时可降低小出血风险。