经桡动脉介入术治疗急性心肌梗死的临床研究

目的探讨经桡动脉穿刺行冠状动脉介入（PCI）治疗急性心肌梗死（AMI）的可行性和安全性。方法选择AMI发病时间在12h以内的患者66例,血流动力学稳定、桡动脉搏动良好、Allen＇s试验阳性患者,用单盲法随机分为两组：经桡动脉介入组33例、经股动脉介入组33例。结果PCI总成功率为100％,桡动脉组插管成功率为96．6％（29／30）,其中1例因导管不能到位改为股动脉入径。股动脉组插管成功率为100％,两组成功率比较差异无统计学意义（P〉0．05）。罪犯血管最终开通率（TIMI 3级）挠动脉组为92．6％（28／30）,股动脉组为93．6％（34／36）,两纽比较差异无统计学意义（P〉0．05）。手术时间：桡动脉组为（43．8±19．6）min,股动脉组为（45．6±18．6）min,差异无统计学意义（P〉0．05）。术后并发症发生率两组间比较差异有统计学意义（P〈0．05）。结论经桡动脉途径急诊PCI治疗AMI是一种安全、有效、更容易被患者接受的方法,对血流动力学稳定、Allen试验阳性、桡动脉搏动良好患者可首选。     

Comparison of immediate and followup results between transradial and transfemoral approach for percutaneous coronary intervention in true bifurcational lesions

Background  A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention (PCI) in bifurcations has not been done. This study evaluated feasibility of transradial PCI (TRI) and compared the immediate and followup results with transfemoral PCI (TFI) in bifurcations.
Methods  One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients (88 lesions) in TRI group and 74 patients (101 lesions) in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification.
Results  TRI group had smaller stent diameter ((3.06±0.37) mm vs (3.18±0.35) mm, P=0.023) and postprocedural in-stent minimum lumen diameter ((2.62±0.37) mm vs (2.74±0.41) mm, P=0.029) than TFI, but there were not significant differences in in-stent subacute thrombosis rate (0% vs 1.0%, P=0.349),  target lesion revascularization (TLR) (0% vs 1.0%, P=0.349) following procedure and thrombosis (2.3% vs 1.0%, P=0.482), in-stent restenosis (12.5% vs  10.9%, P=0.731), in-segment restenosis (17.0% vs 14.9%, P=0.681), TLR (10.2% vs 13.9%, P=0.446) and TLR-free cumulative survival rate (89.8% vs 86.1%, P=0.787) at seven months followup. No death was reported in the two groups.
Conclusion  Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.

     

桡动脉入路介入治疗急性心肌梗死的临床研究

目的 评价桡动脉入路冠脉介入术(PCI)治疗急性心肌梗死(AMI)的优缺点及可行性.方法 选择2006年8月至2008年8月在本院住院的85例AMI并经桡动脉介入(TRI)患者,并与以往经股动脉介入(TFI)67例AMI患者进行对比.观察两组介入治疗时间和并发症情况.结果 TRI组85例患者中,单支病变46例(54.1%),多支病变39例(45.9%),其中完全闭塞性病变28例(32.9%);TFI组67例患者中,单支病变40例(59.7%),多支病变27例(40.3%),其中完全闭塞病变21例(31.3%),两组病例基本临床特征比较,差异无统计学意义(P>0.05).从局部麻醉到手术结束,TRI组为(54±23)min,TFI组为(47±19)min,两组比较差异无统计学意义(P>0.05).TRI组血管穿刺成功率为98.8%,TFI组血管穿刺成功率为100%,手术成功率分别为96.5%和100%.两组手术并发症发生率分别为4.7%(4/85)和23.9%(16/67),其中TRI组发生桡动脉痉挛1例,局部血肿3例.而TFI组出现局部血肿6例,动静脉瘘1例,假性动脉瘤4例,迷走神经反射5例,两组差异有统计学意义(P<0.01).结论 采用经桡动脉和经股动脉行冠状动脉介入治疗,均具有较高的成功率,但TRI组并发症发生率明显低于TFI组,故经桡动脉行PCI值得在临床上推广.     

不同途径介入治疗急性心肌梗死的对照研究

目的:比较不同途径急诊经皮冠状动脉介入治疗(PCI)对ST段抬高的急性心肌梗死的安全性和有效性.方法:收集254例发病≤12 h 的ST段抬高的急性心肌梗死患者的临床资料,比较经桡动脉急诊PCI(TRA组,n=182)与经股动脉急诊PCI(TFA组,n=72)患者的手术操作、住院情况以及随访期主要不良心脏事件(MACE)发生率.结果:两组穿刺成功率、穿刺至首次球囊扩张时间、手术成功率、住院和随访期间MACE发生率差异均无统计学意义(P>0.05).TRA组手术时间短[(36.1±16.3)min vs (40.5±15.1)min,P=0.049),依从性高(81.9% vs 26.4%,P＜0.005),血管并发症明显减少(5.5% vs 34.7%,P＜0.005),住院时间缩短[(9.2±3.0)d vs (10.8±4.2)d,P=0.003].结论:在强化抗栓条件下,相对于股动脉途径,急诊经桡动脉PCI有相似的有效性及安全性,且并发症和住院日更少.     

经皮桡动脉穿刺介入术治疗冠心病的临床应用

目的探讨经皮桡动脉穿刺行冠状动脉造影(CAG)和介入治疗的安全性及可行性。方法 2011年11月至2013年11月于明光市人民医院内科住院行选择性CAG和/或经皮腔内冠状动脉成形术(PCI)的患者174例。选择桡动脉博动良好,且Allen's试验阳性患者进入桡动脉组(n=110),余下归入股动脉组(n=64)。观察两组患者手术成功率和术后并发症情况。结果两组患者接受选择性CAG和/或PCI的手术成功率差异无统计学意义;经桡动脉介入组的假性动脉瘤、排尿困难和腰痛的发生率为10.9%、43.75%和60.94%,显著低于股动脉组,差异有统计学意义(P0.001);两组均无远端肢体缺血。结论经皮桡动脉冠状动脉造影和介入治疗安全、可行、局部并发症少,患者舒适度高,值得推广,但介入医师需要一定的经验。     

TransradialVersus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China: A Retrospective Analysis

Objective To compare hospital costs and clinical outcomes between transradial intervention (TRI) and transfemoral intervention (TFI) in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention (PCI) in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting (IPW) model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 (95%CI: CNY4419-10420). Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay (1.9 days, 95%CI: 1.1-2.7 days), shorter post-procedural stay (0.7 days, 95%CI: 0.3-1.1 days), and fewer major adverse cardiac events (adjusted odds ratio = 0.47, 95%CI: 0.31-0.73). There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI (p>0.05). Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.     

急性心肌梗死患者经桡动脉行急诊介入治疗的临床分析

目的观察经桡动脉对急性心肌梗死患者行急诊介入治疗（PCI）的可行性和安全性。方法回顾性分析2008年1月-2013年4月行急诊介入治疗（PCI）的98例急性心肌梗死患者的临床资料,其中经桡动脉途径58例（观察组）,经股动脉途径40例（对照组）,对比两组的PCI特点、手术并发症、患者依从性及住院时间等。结果两组穿刺成功率、手术成功率均为100％,X线曝光时间、射线量、造影剂用量观察组略高于或多于对照组,但两组比较差异无统计学意义（P〉0．05）。手术并发症（如假性动脉瘤、拔管时迷走反射、尿潴留）、卧床时间及住院时间观察组明显低于对照组（P〈0．05）,且观察组患者依从性较高。结论经桡动脉对急性心肌梗死患者行急诊介入治疗（PCI）安全可行,手术并发症少,值得临床推广应用。     

青年冠心病患者经皮桡动脉介入治疗36例临床分析

目的探讨经皮桡动脉入路介入治疗在青年冠心病患者中的应用。方法对36例行经桡动脉途径和40例经股动脉途径行冠脉造影（CAG）及冠脉介入治疗（PCI）的青年冠心病患者的临床资料进行分析。比较两组穿刺时间、X线暴光时间、造影时间、PCI时间、住院时间及血管并发症的发生率。结果 36例患者均首先经桡动脉穿刺,穿刺失败2例,经桡动脉途径行冠脉造影成功率100%（34/34）,行冠脉支架置入成功率76.92%（10/13）,经桡动脉途径失败者改经股动脉途径介入检查及治疗均成功。股动脉组40例患者穿刺成功。其中X线暴光时间、造影时间、PCI治疗时间、血管并发症发生率两组比较无差别意义（P〉0.05）。穿刺时间、住院时间两组比较,差异有统计学意义（P〈0.05）。结论青年冠心病患者选择经桡动脉途径行CAG及PCI是安全的方法,具有创伤小、局部并发症少等优点,值得临床推广应用。     

急性心肌梗死经桡动脉途径冠脉介入治疗效果观察

目的总结急性心肌梗死（AMI）急诊经桡动脉途径行冠脉介入（PCI）治疗的疗效。方法对69例诊断为AMI患者选择右侧桡动脉为穿刺径路行PCI治疗（A组）,对照组为20例AMI行经皮股动脉入路直接PCI的患者（B组）。随访术后3个月内的主要心血管事件（MACE）的发生率,包括死亡率、非致命性心肌梗死发生率、靶血管血运重建率（TVR）及3个月内复诊冠脉造影择期干预其他病变血管的手术率。结果3个月后随访结果显示,MACE发生率均无统计学意义（P〉0.05）;3个月内复诊冠状动脉造影及择期手术率A组明显高于B组（P〈0.05）。结论急诊行经皮桡动脉入路PCI治疗AMI有一定的安全性,还不能认为其近期MACE的发生率低于经股动脉入路,但能提高冠状动脉造影的复诊及择期手术率。     

Intracoronary adenosine improves myocardial perfusion

Background Myocardial perfusion associates with clinical syndromes and prognosis. Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours, but few data are available on late perfusion of myocardial infarction （MI）. This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography （MCE）.
Methods Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups： adenosine group （n=12） and normal saline group （n=-14）. Their history of myocardial infarction was about 3-12 weeks. Adenosine or normal saline was given when the guiding wire crossed the lesion through percutaneous coronary intervention （PCI）, then the balloon was dilated and stent （Cypher/Cypher select） was implanted at the lesion. Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI. Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software. Heart function and cardiac events were followed up within 30 days.
Results Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group （5.71：L-0.29 VS 4.95±1.22, P〈0.05）. Ischemic myocardial segment was deminished significantly after PCI, but the meliorated area was bigger in the adenosine group than in the saline group （（1.56±0.60） cm^2 vs （1.02±0.56） cm^2, P〈0.05）. The video densitometry in cntical segments was also improved significantly in the adenosine group （5.53±0.36 VS 5.26±0.35, P〈0.05）. Left ventricular ejection fraction （LVEF） was improved in all patients after PCI, but EF was not significant between the two groups （（67±6）% vs （62±7）%, P〉0.05）. There was no in-hospital or 30-day major adverse cardiac event （MACE） in the adenosine group but 3 MACE in the saline group in 30 days after     

Prospective multicenter randomized trial comparing physician versus patient transfer for primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction

Background Primary percutaneous coronary intervention （PCI） has been identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction （STEMI）. The strategy of transferring patient to a PCI center was recently recommended for those with acute STEMI who were present to PCI incapable hospitals, which include lack of facilities or experienced operators. In China, some local hospitals have been equipped with PCI facilities, but they have no interventional physicians qualified for performing primary PCI. This study was conducted to assess the feasibility, safety and efficacy of the strategy of transferring physician to a PCI-equipped hospital to perform primary PCI for patients with acute STEMI. Methods Three hundred and thirty-four consecutive STEMI patients with symptom presentation 〈12 hours in five local hospitals from November 2005 to November 2007 were randomized to receive primary PCI by either physician transfer （physician transfer group, n=165） or patient transfer （patient transfer group, n=169） strategy. Door-to-balloon time, in-hospital and 30-day major adverse cardiac events （MACE, including death, non-fatal re-infarction, and target vessel revascularization） were compared between the two groups. Results Baseline characteristics between the two groups were comparable. Thrombolysis in myocardial infarction （TIMI） 3 flow was revealed in more patients in the physician transfer group at initial angiography （17.6% vs 10.1%, P〈0.05）. The success rate of primary PCI （96.3% vs 95.4%, P〉0.05） and length of hospital stay were similar between the two groups （（15±4） days vs （14±3） days, P〉0.05）. In the physician transfer group, door-to-balloon time was significantly shortened （（95±20） minutes vs （147±29） minutes, P〈0.0001） and more patients received primary PCI with door-to-balloon time less than 90 minutes （21.2% vs 7.7%, P〈0.001）. During hospitalization, MACE occurred in 6.7% and 11.2% of patients     

Transradial approach for coronary angioplasty in Chinese elderly patients

Background The radial artery is currently regarded as a useful vascular access site for coronary procedures. This study was conducted to investigate the feasibility and safety of the percutaneous radial artery approach for angioplasty in the elderly.
Methods Two thousand and fifty-eight consecutive patients （762 elderly, age ≥65 years; and 1296 non-elderly, age 〈65 years, respectively） who underwent transradial coronary angioplasty were recruited in this study. Study endpoints included procedure success rate, procedure time, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization.
Results Elderly patients were more likely to present with unstable angina and renal dysfunction. The incidence of radial and brachiocephalic trunk anatomical tortuosity was higher in elderly patients than that in non-elderly patients （11.5% vs 3.7%; 8.9% vs 2.6%, P 〈0.01, respectively）. However, procedural success rate （94.7% vs 95.6%） and total mean procedure time （（67.9±27.3） minutes vs （58.6±38.5） minutes） for transradial coronary angioplasty were not significantly different between the two groups. Clinical course during the hospitalization was slightly worse in the elderly patients because of more adverse cardiac and cerebrovascular events after the procedure. However, the incidence of vascular complications was not significantly different between the elderly and non-elderly patients.
Conclusion Although the incidence of radial and brachiocephalic trunk anatomical tortuosity is higher in elderly patients, transradial coronary intervention can be performed with similar safety and procedural success in these patients as compared with non-elderly patients.     

Effectiveness and feasibility of transradial approaches for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective: To evaluate the efficacy and feasibility of the transradial approach for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMl). Methods: 195 patients with acute myocardial infarction were randomly divided into two groups according to the different PCI operation pathways. 105 cases were assigned to the transfemoral artery group and 90 cases to the transradial artery group. We analyzed the dam from the two groups, including the achievement ratio of paracentesis, cannulation time, the time from local anesthesia to the first time balloon inflation, the time of the total procedure, achievement ratio of PCI, incidence rate of vascular complications, total duration of hospitaliTarion, and the six-month follow-up results in both groups. Results: Our results showed that the achievement ratio of arteriopuncture, cannulation time and the time from local anesthesia to the first time balloon inflation in the transradial and transfemoral groups were 98.9% vs. 100%, 3.15 ± 1.56 min vs. 2.86 ± 0.97 min, and 18.56 ± 4.37 min vs. 17.75 ± 3.21 min,respectively. These differences between the two groups were not statistically significant. The total operating time was 29.75 ± 4.38 min for the transradial group and 27.89 ± 3.95 min(P< 0.05) for the transfemoral group. The operation achievement ratio in the transradial group was 96.7%, and 96.2% in the transfemoral group. The incidence of puncture point complications was 22% in the transradial group and 11.4% in the transfemoral group, and this difference was significant. The duration of hospitalization was 10.56 ± 2.85 days for the transradial group and 13.78 ± 3.15 days(P < 0.05) for the transfemoral group. At the six-month follow-up, the rate of survival without cardiac event was 86.1% vs. 86.4% respectively in the transradial and transfemoral groups(P > 0.05). Conclusion: The transradial approach was as effective as the transfemoral approach, and there were fewer puncture point complications as well as a shorter span of hospitalization in the transradial group. PCI via the transradial approach is safe, effective and feasible in patients with AMI.     

Magnetic navigation system assisted percutaneous coronary intervention: a comparison to the conventional approach in daily practice

Background  The benefits of the magnetic navigation system (MNS) for percutaneous coronary intervention (PCI) remain unclear, and a comparison of the MNS assisted approach to the conventional approach for PCI, when used in daily practice, is little studied. This study aimed to investigate the benefits of an MNS assisted technique as compared to the conventional technique for PCI.

Methods  Forty-eight consecutive patients scheduled for PCI were recruited between December 2009 and April 2010. MNS assisted PCIs were performed on 54 target vessels. Another 45 patients with 54 target vessels undergoing conventional PCIs were selected from a historical population of patients to match the MNS group according to the coronary lesion type (ACC/AHA classification). Emergency PCIs and chronic total occlusions were excluded from both groups. Analyses were performed using Stata 9.2 statistical software.

Results  There were no significant differences between the baseline characteristics of the MNS group and the control group. The success rates were 100.0% for the MNS assisted PCI and 98.1% for the conventional PCI, which did not reach a significant difference (P=1.000); there were also no significant differences in terms of guide wire crossing time ((51.7±30.5) seconds vs. (57.5±49.4) seconds, P=0.448), operation time ((28.4±15.9) minutes vs. (28.0±24.7) minutes, P=0.935), X-ray exposure ((458.1±350.1) µGym² vs. (558.7±451.7) µGym², P=0.197; and (94.2±80.9) mGy vs. (96.2±77.3) mGy, P=0.895) or contrast usage ((7.3±4.0) ml vs. (6.1±3.7) ml, P=0.121) between the two groups. However, a trend toward shorter guide wire crossing time and less X-ray exposure were observed for the magnetic group.

Conclusion  In daily practice, MNS assisted PCI resulted in a similar procedural success rate, operation time, and contrast usage, with a trend toward shorter guide wire crossing time and less X-ray exposure when compared to the conventional PCI.

     

经桡动脉和经股动脉途径冠状动脉介入诊疗临床对照研究

目的比较经桡动脉途径冠状动脉介入诊疗（TRI）和经股动脉途径冠状动脉介入诊疗（TFI）的优劣。方法选择2007年5月～2009年8月行冠状动脉造影和（或）冠状动脉介入治疗患者382例,按照途径分为两组：桡动脉组（R组）217例,股动脉组（F组）165例,比较两组手术成功率、并发症发生率、手术操作时间。结果手术成功率：R组94．5％（205／217）,F组96．9％（158／163）,差异无统计学意义（P〉0．05）;穿刺部位并发症发生率：R组2．7％（6／217）,F组11．5％（19／165）;CAG操作时间R组（16．7±7．5）min,G组（14．3±5．8）min。结论经桡动脉途径与经股动脉途径相比,手术成功率及操作时间相近,但局部并发症发生率低,患者痛苦小、创伤少、不需持续卧床而容易接受,值得推广。     

经桡动脉途径行急性心肌梗死经皮冠脉介入的临床研究

目的:观察经桡动脉途径行急性心肌梗死(AMI)经皮冠脉介入(Percutanous CardiacIntervention,PCI)的临床疗效及可行性和安全性.方法:入选2002年12月至2004年11月确诊AMI 96例行急诊冠脉造影和PCI(急性非ST段抬高性心肌梗死51例、急性前壁ST段抬高性心肌梗死26例、急性下后壁ST段抬高性心肌梗死19例).Allen's试验阴性者入选.冠脉造影和PCI及支架后均立即拔除动脉鞘管.观察经桡动脉途径的成功率和并发症.患者出院随访1月,评估术侧桡动脉波动情况.结果:入选患者年龄为(59.3±15.2)岁,桡动脉穿刺成功率为100%(96/96例),冠脉造影和PCI成功率均为100%;冠造显示单支血管病变39例,双支血管病变36例,多支血管病变21例.梗死相关血管完全闭塞为57例,梗死相关血管狭窄90%～99%为39例.所有患者均行球囊扩张和支架植入.术后并发症:皮下淤斑面积大于5cm×5cm的发生率6%,假性动脉瘤、全身大出血、桡动脉栓塞、手静脉栓塞、手神经损伤、迷走反射的发生率均为0,穿刺部位皮肤发生荨麻疹20例(20%),一过性眼睛辨色能力下降1例(1%),与穿刺相关的死亡0.结论:经桡动脉途径行急诊PCI是安全和可行的,且有显著优点,可在临床应大力推广和应用.     

经桡动脉冠状动脉介入治疗的疗效和安全性评价

①目的探讨经桡动脉冠状动脉介入治疗不稳定型心绞痛和急性心肌梗死的临床效果及安全性。②方法对98例冠心病病人采用经桡动脉径路介入治疗（TRI组）,118例病人采用股动脉途径进行介入治疗（TFI组）。观察比较两组穿刺成功率,手术成功率,手术时间,X线照射时间,病人住院时间,并发症发生率（穿刺部位出血、血肿等）。③结果穿刺成功率、手术成功率、置入支架情况、手术时间和X线照射时间,两组间比较无统计学意义（x^2=2．07、2．18,t=1．02～1．26,P〉0．05）;TRI组病人的住院时间小于TFI组（t=2．35,P〈0．05）。④结论经桡动脉冠状动脉介入治疗不稳定型心绞痛和急性心肌梗死是有效、安全的,可减少病人的住院时间。     

壳聚糖联合充气止血绷带对桡动脉穿刺点止血的临床效果

目的 观察壳聚糖止血敷料联合充气止血绷带应用于桡动脉穿刺点压迫止血的临床效果.方法 将经桡动脉入路实施冠状动脉介入检查和治疗的310例患者随机分为对照组和试验组,每组155例.对照组采用桡动脉充气止血绷带常规方法压迫止血,试验组使用壳聚糖止血辅料联合桡动脉充气止血绷带压迫止血.所有患者试验前至少接受阿司匹林100 mg...     

Improved outcomes from transradial over transfemoral access in primary percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction and upstream use of tirofiban

Background Transradial access has been increasingly used during primary percutaneous coronary intervention (PCI)for patients with acute ST-segment elevation myocardial infarction (STEMI) in last decade...     

经桡动脉途径行急性心肌梗死冠脉介入治疗的临床研究

目的：分析经桡动脉途径行急性心肌梗死冠脉介入治疗（Percutaneous Cardiac Intervetion,PCI）的安全性和可行性,方法：选择65例急性心肌梗死患者行急诊经桡动脉途径冠脉介入治疗。结果：100％愿意选择桡动脉穿刺途径;桡动脉穿刺成功率为98％;冠脉造影（Coronary Angiography,CAG）成功率和PCI成功率为98％;皮下游斑的发生率为5%;桡动脉痉挛的发生率为2％。结论：经桡动脉途径行急性心肌梗死冠脉介入治疗是安全可行的。