The polytetrafluoroethylene-covered stent: a device with multiple potential advantages

The polytetrafluoroethylene (PTFE)-covered stent has emerged in the past year as a device with multiple potential advantages. Its structure (a sandwich composed of a layer of PTFE membrane between two stents) makes this the ideal tool for treating coronary ruptures, and for excluding coronary aneurysms. Furthermore, this device may be useful in the treatment of aortocoronary vein graft stenosis. In the present review, the authors summarize experiences with covered stents, and focus attention on available data on the implantation of PTFE-covered stents in human beings to treat coronary ruptures, aneurysms and aortocoronary vein graft stenosis.     

Safe and effective direct implantation of a new stent through 5 F. guiding catheters with delivery from the radial artery: initial results of a prospective registry

OBJECTIVES: To evaluate the safety and efficacy of the direct implantation of a new stent via the radial artery through a 5 F. guiding catheter. Background advances in the design of stents and stent delivery systems have facilitated the performance of direct stenting and the use of thinner guiding catheters. METHODS: This registry enrolled prospectively 125 patients (147 lesions, 20.4% AHA/ACC class B2/C) who underwent elective percutaneous coronary revascularization procedures for stable or unstable angina between November 2000 and March 2001. RESULTS: Cannulation of the radial artery was attempted in 92.7% and was successful in 91.0% of cases. Direct stenting was successful in 88.7% of lesions and procedural success was 99.3%. In-hospital major adverse cardiac events occurred in 1.6% of cases (one death, one semi-urgent coronary artery bypass operation). The final rate of successful stent implantation through 5 F. guiding catheters was 96.7%. There were no access-site-related complications. Failure to cross the lesion occurred in 10% of attempts. At a mean follow-up of 7 ± 2.8 months after discharge from hospital, 79% of patients had remained free of angina, and 89% had remained free of ischemic events. CONCLUSIONS: Direct stenting with a new stent design was safe, effective, and could be accomplished through 5 F. guiding catheters with favorable long-term clinical outcomes. (Int J Cardiovasc Intervent 2003; 5: 72-76)     

曲美他嗪对冠状动脉介入治疗患者的心脏保护作用

目的 评价曲美他嗪对经皮冠状动脉介入治疗(PCI)患者的心肌保护作用.方法 在国内5家医院入选拟进行介入治疗的稳定性或不稳定性心绞痛患者共101例,随机分为曲美他嗪组(54例)和对照组(47例).曲美他嗪组在术前(5±2)d开始服用曲美他嗪20 mg,3次/d,手术当天至少提前30 min给予60 mg负荷最,术后继续服用4周.对照组给予常规药物治疗.观察术中心绞痛发作及心电图变化情况;检测术前、术后12 h及24 h磷酸肌酸激酶同工酶浓度;观察术前、术后4周的心脏功能变化.结果 曲美他嗪组介入治疗术中心绞痛发生率显著低于对照组,差异有统计学意义(0%比25.5%,P<0.001).术中球囊扩张时曲美他嗪组出现缺血性心电图改变的比例小于对照组(60.8%比78.3%,P<0.05).PCI术后4周曲美他嗪组左室射血分数值高于对照组[(66.6±7.1)%比(63.0±7.7)%,P=0.03].结论 PCI围手术期应用曲美他嗪可以减少术中心绞痛发作,减轻心肌损伤,进一步改善PCI术后的左心功能.     

急性冠状动脉综合征支架置入与血小板活化的临床研究

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者行冠状动脉(冠脉)内支架置入术前、后血小板活化指标的变化。方法利用流式细胞术(flowcytometry,FCM)和单克隆抗体测定45例不稳定型心绞痛(unstable angina pectoris,UAP)与37例急性心肌梗死(acute myocardial in-farction,AMI)患者外周血中血小板膜糖蛋白CD62p,CD63和凝血酶敏感蛋白(thrombin-sensitive protein,TSP)的阳性表达率,并与45例冠脉造影正常者相对照。结果FCM可简单、迅速地检测血小板的活化功能。ACS患者支架置入后CD62p,CD63和TSP的阳性表达率均显著高于支架置入前;ACS组治疗前亦高于对照组。结论急性冠脉综合征伴随血小板活化,介入治疗进一步加强血小板的活化。     

Impact of previous percutaneous transluminal coronary angioplasty and/or stenting revascularization on outcomes after surgical revascularization: insights from the imagine study

Aim: To determine the impact of previous coronary artery revascularizationby percutaneous transluminal coronary angioplasty and/or stenting(PCI) on outcome after subsequent coronary artery bypass grafting(CABG). Methods and results: The ischaemia management with Accupril post-bypass Graft viaInhibition of the coNverting Enzyme (IMAGINE) trial, conductedbetween November 1999 and September 2004, tested whether earlyinitiation of an angiotensin-converting enzyme inhibitor post-CABG,in stable patients with LVEF 40%, would reduce cardiovascularevents. Of the 2489 patients included in the IMAGINE trial,undergoing their first operation, 430 had a history of PCI priorto surgery (PCI group), and 2059 were referred to surgery withoutprevious PCI (non-PCI group). There was a significant increasein the primary IMAGINE endpoint in the PCI group, HR = 1.53[1.17–1.98], P = 0.0016. Coronary revascularization, HR= 1.80 [1.13–2.87], P = 0.014, unstable angina requiringhospitalization, HR = 2.43 [1.52–3.89], P = 0.0002, werethe two individual components that significantly increased inthe PCI group, even when adjusted for baseline characteristics(age, sex, history of myocardial infarction or stroke, diabetes,treatment group, or off-pump surgery). Conclusion: Patients with left ventricular ejection fraction 40% havinga history of PCI prior to surgery had a worse outcome post-CABGthan those with no prior PCI. Further studies are needed toinvestigate whether these results apply for drug eluting stents.     

Acute severe thrombocytopenia after c7E3 Fab (abciximab) therapy in a patient with unstable angina and stenting of the right coronary artery. Occurrence of subacute stent thrombosis and safe readministration of the GPIIb/IIIa inhibitor tirofiban

This paper reports a case of acute severe thrombocytopenia (platelet count: 1 &#50 10 9 /liter) occurring within minutes of an initial abciximab bolus during coronary angioplasty and stenting in a patient with unstable angina. After six days with platelets again in the normal range the patient developed stent thrombosis. The stent was reopened and the glycoprotein receptor inhibitor tirofiban (Aggrastat) was administered without any adverse effects on platelet count. Antibodies against heparin-platelet factor 4 complexes could be excluded. Allo- and autoantibodies (IgG, IgA, IgM) directed against platelets with and without binding of abciximab could not be detected by indirect and direct platelet fluorescence antiglobulintest. A possible activation or lysis of the platelets by abciximab could also be excluded by an in vitro bleeding test investigating the effect of abciximab on heparin and citrate blood of the patient and two healthy donors. The mechanisms of abciximab-induced thrombocytopenia in this case remain unclear. The possible mechanisms are discussed. (Int J Cardiovasc Intervent 2000; 3: 185-188)     

磺达肝癸钠在急性ST段抬高心肌梗死患者冠状动脉介入治疗围术期应用的安全性和有效性评价

目的评价接受经皮冠状动脉介入治疗（PCI）的急性ST段抬高心肌梗死（STEMI）患者应用磺达肝癸钠的临床疗效、安全性及预后。方法回顾性分析2010年3月至2011年7月沈阳军区总医院STEMI患者1184例,其中接受PCI的患者为1098例（磺达肝癸钠组527例及依诺肝素组571例）,观察接受PCI的患者住院期间出血情况、院内再发心肌梗死发生率、冠状动脉病变特点及住院和随访期间（1个月）死亡率。结果接受PCI的磺达肝癸钠组与依诺肝素组比较：两组院内再发心肌梗死发生率[2.3%（12/527）比2.6%（15/571）,P=0.708]、出院30 d死亡率[4.0%（21/527）比4.9%（28/571）,P=0.387]差异无统计学意义,但磺达肝癸钠组院内大出血发生率显著降低[1.7%（9/527）比3.7%（21/571）,P=0.045]且差异具有统计学意义。磺达肝癸钠组中替罗非班组（PCI术中应用替罗非班）的血流TIMI分级Ⅲ级获得率显著高于标准治疗组（PCI术中未应用替罗非班）[94.5%（206/218）比79.0%（244/309）,P〈0.001],但出血发生率两组间差异无统计学意义[1.83%（4/218）比1.62%（5/309）,P=0.850]。两组住院及随访期间主要心血管事件发生率差异均无统计学意义（P均〉0.05）。结论磺达肝癸钠对STEMI患者行PCI是安全的,联合替罗非班可以显著改善PCI术后的冠状动脉血流及临床预后,并且降低院内大出血风险。     

老年急性冠状动脉综合征患者介入术中应用替罗非班的疗效和安全性

目的 探讨老年急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)中应用替罗非班的疗效和安全性. 方法 将256例高危ACS患者,随机分为替罗非班组(替罗非班+PCI,130例)和常规PCI组(126例),替罗非班组又根据年龄分为老年组(68例,≥60岁)和非老年组(62例,<60岁)2个亚组.两组患者PCI术后罪犯血管的心肌梗死溶栓治疗(TIMI)3级血流达标率、校正的TIMI帧计数(CTFC)、心肌灌注分级(TMPG),以及36 h和30 d的主要心脏不良事件发生率作为疗效观察指标.并观察两组患者术后血小板减少和出血并发症的发生率. 结果 替罗非班组PCI术后TIMI3级血流发生率较常规PCI组高,但差异无统计学意义(93.6%比91.3%,χ~2=1.02,P=0.313),TMPG 3级所占比例替罗非班组高于PCI组(83.1%比67.5%,χ~2=4.05,P=0.046),CTFC示替罗非班组血流快于PCI组(31.6±7.7比23.8±6.1,t=2.49,P=0.026).两组在36 h和30 d的主要心脏不良事件发生率差异均有统计学意义(6.9%比19.0%,χ~2=6.30,P=0.013;3.8%比11.90%,χ~2=5.82,P=0.018).与常规PCI组比较,替罗非班组TIMI轻度出血的发生率有增加趋势(20.2%比15.2%,χ~2=3.65,P=0.065).亚组分析表明,老年组轻度出血并发症的发生率较非老年组稍增高(25.0%比14.5%,χ~2=4.98,P=0.026),但两组严重出血事件发生率和血小板减少发生率均相似. 结论 老年ACS患者介入术中使用替罗非班是有效和安全的,其疗效优于常规治疗,但轻度出血风险有可能增加.     

The new world of cardiac interventions: a brief review of the recent advances in non-coronary percutaneous interventions

Advances in cardiovascular interventional techniques have allowed percutaneous treatment of conditions that either previously required open operations or have not been amenable to treatment. Conditions such as atrial and ventricular septal defects and patent foramen ovale are now amenable to percutaneous closure using implantable devices. A number of strategies have evolved to reduce the risk of stroke such as percutaneous occlusion of the left atrial appendage for patients in atrial fibrillation. Valvular heart disease and complications of its repair are approachable via the percutaneous route. Percutaneous pulmonary and aortic valve replacements have been performed in humans. There are evolving techniques for repair of the mitral valve and of prosthetic paravalvular leaks using devices such as the Amplatzer septal occluder to repair the defects without the need for repeat open heart surgery. Hypertrophic cardiomyopathy with left ventricular outflow tract obstruction can now be approached using alcohol septal ablation with results comparable to the surgical technique. These advances have occurred as a result of improvement in the design of the devices used as well as a better understanding of the pathophysiology of conditions. Many of these techniques are in evolution and in this paper we review some of the recent developments in this dynamic area of interventional cardiology.     

光学相干断层成像和血管内超声在冠状动脉介入手术中的应用

目的 应用光学相干断层成像(OCT)及血管内超声(IVUS)检测技术评价冠状动脉内粥样硬化斑块的稳定性,并指导支架置入,检测血管对置入支架后即刻和中远期的反应.方法 选择2008年2-7月间的27例患者,进行冠状动脉造影、OCT及IVUS检查,共检查了30支血管,其中8处为药物支架植入术后血管,并对19处病变进行了支架置入.结果 除外支架置入的8例(置入6个月～4年)外,其余22例病变行OCT及IVUS检查,发现稳定性斑块5例,不稳定斑块17例,其中OCT检出内膜小撕裂4例(IVUS未检出,P＞0.05),冠状动脉撕裂伴夹层病变5例(IVUS检出1例,P＞0.05),血栓形成5例(IVUS检出1例,P＞0.05),偏心斑块伴薄纤维帽12例(IVUS检出2例,P＜0.01).8例曾经进行支架治疗的患者,造影、OCT和IVUS发现2例再狭窄;OCT显示支架内膜覆盖良好,IVUS小能精确看到内膜;OCT检测出1例患者有支架后瘤样扩张.对17例不稳定性斑块及2例支架再狭窄病例行支架置入术,术后支架膨胀不良发生率26.0%,OCT及IVUS检出率相同;支架贴壁不良发生率63.2%,IVUS榆出率低于OCT(10.5%比63.2%,P＜0.01);支架近远端撕裂10.5%,IVUS均不能检出;内膜脱垂发生率52.6%,IVUS检出率低于OCT(10.5%比52.6%,P＜0.05).结论 OCT与IVUS相比,在不稳定性斑块检测准确度方面明显优于IVUS,更能精确指导冠状动脉支架置人.IVUS在操作简便性及反映斑块负荷方面要优于OCT.     

40岁以下冠心病患者的介入治疗

目的　评价 40岁以下冠心病患者接受经皮冠状动脉腔内介入治疗的近期和远期疗效。　方法　选择 82例冠心病患者 (≤ 40岁 )行经皮冠状动脉腔内成形术 (PTCA)及支架植入治疗。结果　 82例患者 95处病变行血管重建治疗 ,手术成功率达 97 5 6 % ;狭窄改善程度由 84 5 %± 11 8%降至 4 0 %± 1 2 % ;1例 (1 2 2 % )因手术失败行冠状动脉旁路移植术 ;无一例发生严重并发症。临床随访 75例 (35～ 5 2个月 ,平均 42 1± 6 8个月 ) ,3例死亡 (2例为非心源性 ) ,3例发生心肌梗死 ;靶血管再手术率为 12 10 % ,总再狭窄率为 31 43% ,支架再狭窄率为 13 16 % ;87 8%的患者无任何症状。结论　冠状动脉介入治疗对青年冠心病患者有良好的近期和远期疗效 ,安全性高 ,并发症少。     

急性冠状动脉综合征介入治疗前应用依诺肝素有效性和安全性研究

目的　前瞻性的评价无ST段抬高的急性冠状动脉 (冠脉 )综合征患者接受冠脉介入治疗前应用依诺肝素的安全性和有效性。方法　急性冠脉综合征患者入院后给予依诺肝素 1mg/kg ,皮下 ,1 /1 2h ,至少 48h ,在最后一次注射后 8h内行介入检查或治疗。术中 /术后不再追加肝素或低分子肝素。部分病人术后集中测定抗Xa因子活性。结果　 50 7例患者完成了本研究。 1 76例 (93 .2 % )的患者抗Xa因子活性 >0 .5IU/ml。30d内的随访中 ,急性心肌梗死 1 6例 (3 .2 % ) ,再发不稳定性心绞痛 34例 (6 .7% ) ,1例 (0 .2 % )进行了血运重建 ,1例死亡 (十二指肠穿孔 )。轻微出血 2 4例 ,占 4 7%。30d后的随访有 1例发生非Q波心肌梗死 ,1例再发不稳定性心绞痛。结论　高危急性冠脉综合征病人皮下注射依诺肝素至少 48h ,最后一次注射 8h内行介入检查或治疗 ,不再给抗凝制剂 ,对病人安全有效     

Drug eluting balloon versus drug eluting stent in percutaneous coronary interventions: Insights from a meta-analysis of 1462 patients

Background

Drug eluting balloons (DEB) have been developed to overcome the limitations of drug eluting stents (DES), but clinic results of various DEB studies are still not consistent. Thus, we performed a meta-analysis to compare outcomes of DEB and DES for the treatment of coronary artery disease (CAD).

Methods

Medline/Web databases were searched for studies comparing DEB and DES for obstructive CAD, reporting late lumen loss (LLL) and rates for overall mortality, myocardial infarction (MI), stent thrombosis (ST) and target lesion revascularization (TLR).

Results

8 studies (1462 patients) were included in the meta-analysis. Compared with DES, DEB treated patients showed non-significantly higher LLL (weighted mean difference [WMD] 0.32, 95% confidence interval [CI] − 0.15 to 0.78, P = 0.18) and non-significantly higher rate of binary restenosis (odds ratio [OR] 1.40 [0.68–2.48], P = 0.36). Mortality (OR 1.13[0.54–2.37], P = 0.74), MI (OR 0.95, [0.50–1.80], P = 0.87), ST (OR 1.12, [0.34–4.19], P = 0.77) and TLR rates (OR 1.19[0.60–2.38], P = 0.61) were similar between the 2 treatments. A pre-specified meta-regression analysis showed that LLL WMD and TLR OR were inversely correlated to the prevalence of diabetes (P < 0.0001) and directly correlated to reference coronary diameters (P < 0.001).

Conclusions

The present meta-analysis showed that compared to DES, DEB use resulted in similar clinical efficacy and safety. Thus DEB could be considered a reasonable alternative to DES for the treatment of CAD in selected clinical settings (Clinicaltrials.gov identifier: NCT01760200).     

血浆P-选择素和内皮素-1预测冠状动脉内支架术后早期再狭窄的价值

目的探讨急性冠状动脉综合征(ACS)患者经皮介入治疗(PCI)术后血浆P-选择素及内皮素-1(ET-1)的动态变化对预测术后发生支架内再狭窄的价值。方法对108例行PCI手术的ACS患者,分别于术前和术后即刻、1周、2周、1个月、3个月、6个月采集外周静脉血,4℃离心分离血浆,-70℃保存备测。所有患者术后6个月常规行冠状动脉(冠脉)造影(CAG)。根据冠脉造影结果分为冠脉再狭窄组和无再狭窄组,并分析两组血浆P-选择素及ET-1的水平。结果随访中4例患者死亡,均为急诊PCI患者,4例失访,余100例根据冠脉造影结果分为冠脉再狭窄组(n=16)和无再狭窄组(n=84)。两组ACS患者血浆P-选择素及ET-1在术后即刻达高峰,较术前明显增加,冠脉无再狭窄组术后24h恢复至术前水平,2周降至正常,术后1个月、3个月、6个月在正常基线范围内上、下波动。冠脉再狭窄组血浆P-选择素和ET-1术后2周没有降至正常,而呈持续性升高,并在术后3~6个月出现第2次高峰,与无再狭窄组相比差异有统计学意义。结论ACS患者PCI术后早期(1~2周)P-选择素及ET-1持续升高,并在术后3~6个月出现第2次高峰,则冠脉发生再狭窄的危险性高。P-选择素及ET-1可作为预测早期冠脉再狭窄的参考指标。     

Visualization of coronary arteries and coronary stents by low dose 320-slice multi-detector computed tomography in a patient with atrial fibrillation

Cardiac multi-detector computed tomography (MDCT) is widely used in the diagnosis of coronary disease. However, the predictive value of this technique is limited in the presence of atrial fibrillation and coronary stents. Here we present a case showing the ability of the new 320-slice MDCT to assess coronary anatomy in a patient with atrial fibrillation and coronary stents.     

冠心病患者介入治疗前后血浆白细胞介素-8变化与早期并发症的关系

目的 :探讨经皮冠状动脉介入治疗 (PCI)前后血浆白细胞介素 8(IL 8)的变化与早期并发症的关系。方法 :观察 12 1例冠心病患者PCI中和PCI后 30d内并发症 ,用ELISA法测定血浆IL 8和血清C 反应蛋白(CRP) ,流式细胞仪测定中性粒细胞表面 β2 黏合素Mac 1(CD11b/CD18)受体表达。结果 :12 1例中 16例出现早期并发症。16例早期并发症患者PCI前、后血浆IL 8、CRP、CD11b/CD18差值水平明显高于无早期并发症患者(均P <0 .0 5 )。随着IL 8、CRP、CD11b/CD18三分层由低到高 ,早期并发症明显增高 (均P <0 .0 5 )。经过多变量Logistic回归分析 ,PCI前IL 8、糖尿病对早期并发症具有独立预测价值。PCI后早期并发症组血浆IL 8差值与CD11b/CD18差值之间呈明显正相关 (r =0 .776 ,P <0 .0 1)。结论 :PCI后早期并发症的发生与PCI前存在的炎性反应程度有关。血浆IL 8水平正常者对PCI后早期并发症具有独立的阴性预测价值。     

70岁及以上患者冠状动脉无保护左主干病变支架置入术后的随访研究

目的 观察年龄70岁及以上患者无保护左主干病变经皮冠状动脉介入治疗(PCI)预后的近期和长期临床随访结果。 方法 回顾性分析100例无保护左主干病变行药物洗脱支架置入患者临床资料,比较年龄70～90岁组(52例)和37～69岁组(48例)的病死率、心肌梗死、再次血运重建及其综合终点。 结果 两组危险因素、血管病变及置入支架等基线资料比较,差异无统计学意义（均P＞0.05）。70～90岁组和37～69岁组手术成功率分别为96.2％(50例)与97.9％（47例）,差异无统计学意义(x2=1.75,P＞0.05),住院病死率分别为3.8％（2例）与2.1％（1例）,差异无统计学意义（x2 =0.27,P＞0.05）。两组平均随访时间分别为（22.0±2.5）个月与（23.0±11.7）个月,差异无统计学意义（t=-0.78,P＞0.05）。随访期间70～90岁与37～69岁组病死率、心肌梗死、再次PCI分别为3.8％（2例）与2.1％（1例）、7.7％（4例）与4.2％（2例）和13.5％（7例）与12.5％(6例),差异无统计学意义（x2值分别为2.51、0.55、0.02,均P＞0.05）,死亡、心肌梗死及再次血运重建综合终点分别为30.8％（16例）与18.8％（9例）,差异无统计学意义(x2= 1.92,P＞0.05)。 结论 70岁及以上患者冠状动脉无保护左主干病变药物洗脱支架置入手术成功率高,长期随访安全有效。     

经桡动脉介入治疗冠心病的住院期间疗效和主要不良心脏事件的预测因素

目的 评价经桡动脉介入治疗冠心病的住院期间安全性和有效性及主要不良心脏事件的预测因素.方法 入选阜外心血管病医院2004年5月至2009年5月16 281例经桡动脉介入治疗冠心病患者(桡动脉组)和5388例经股动脉介入治疗冠心病患者(股动脉组).比较桡动脉组与股动脉组患者临床特征、操作特点及住院期间临床疗效,并分析经桡动脉介入治疗患者住院期间发生主要不良心脏事件(包括死亡、心肌梗死和靶病变血运重建)的预测因素.结果 与股动脉组比较,桡动脉组冠状动脉导管插入时间较长(P＜0.01),X线曝光时间、对比剂用量差异无统计学意义.桡动脉组与股动脉组操作成功率差异无统计学意义(95.5%比96.2%,P＞0.05).血管径路并发症比例桡动脉组低于股动脉组(0.1%比1.3%,P＜0.01).桡动脉组住院期间主要不良心脏事件发生率、死亡发生率均低于股动脉组(分别为1.6%比3.8%,P＜0.01;0.2%比0.4%,P＜0.01).多因素logistic回归分析表明,经桡动脉介入治疗患者住院期间发生主要不良心脏事件的独立预测因素为年龄≥65岁(OR:1.98,95%可信区间:1.50～2.61,P＜0.01)、既往心肌梗死(OR:2.14,95%可信区间:1.63～2.82,P＜0.01)、置入药物洗脱支架(OR:0.68,95%可信区间:0.47～0.98,P=0.04)、冠状动脉夹层(OR:4.08,95%可信区间:2.28～7.33,P＜0.01)、左主干病变(OR:2.12,95%可信区间:1.09～4.13,P=0.03)、支架数(OR:1.25,95%可信区间:1.09～1.43,P＜0.01)、支架总长度(OR:1.01,95%可信区间:1.00～1.02,P=0.03).结论 经桡动脉介入治疗冠心病在住院期间具有良好的有效性和安全性.年龄≥65岁、既往心肌梗死、置入药物洗脱支架、冠状动脉夹层、左主干病变、支架数、支架总长度是经桡动脉介入治疗住院期间发生主要不良心脏事件的独立预测因素.

Abstract：

Objective The purpose of this study is to evaluate the in-hospital clinical outcome of patients with coronary artery disease who underwent transradial intervention (TRI) and analyze the predictors of chinical outcome. Methods From May 2004 to May 2009, there were 16 281 patients who underwent transradial intervention, as well as 5388 patients who underwent transfemoral intervention (TFI) at our institution. The clinical characteristics, procedural characteristics, and in-hospital clinical adverse events were compared between TRI and TFI groups. Multivariable logistic regression analysis was performed to determine predictors of in-hospital major adverse cardiac events ( composite of death, myocardial infarction,or target lesion revascularization) of TRI. Results The annulations time was significantly longer for TRIthan TFI (P ＜0. 01 ), fluoroscopy time, amount of contrast agent and procedural success rate (95.5% for TRI and 96. 2% for TFI) were similar between the two groups. However, the rates of vascular complications (0. 1% for TRI group and 1.3% for TFI group, P ＜0. 01 ), incidence of in-hospital major adverse cardiac events (1.6% vs. 3. 8%, P＜ 0.01) and in-hospital death (0.2% vs. 0.4%, P＜0.01) were all significantly lower in TRI group compared with TFI group. The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI: age ≥65 ( OR: 1.98,95% CI: 1. 50 - 2. 61, P ＜ 0. 01 ), prior myocardial infarction ( OR:2. 14, 95% CI: 1.63 - 2. 82, P ＜0. 01 ), use of drug-eluting stent (DES) ( OR:0. 68, 95% CI:0. 47 - 0. 98, P = 0. 04 ), dissection during procedure (OR:4.08, 95%CI:2.28-7.33, P＜0.01), left main lesion (OR:2. 12, 95% CI:1.09-4. 13, P=0.03), number of implanted stents (OR:1.25, 95% CI:1.09 - 1.43, P ＜0.01), and total stented length (OR:1.01, 95% CI:1. 00 -1. 02 , P=0.03). Conclusions In this large single-centre patient cohort, the transradial intervention is superior to transfemoral intervention in terms of in-hospital safety and efficacy. Age ≥ 65, prior myocardial infarction, use of DES, dissection during procedure, left main lesion, number of implanted stents and total stented length were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI.     

经皮冠状动脉介入治疗后患者住院期间合并上消化道出血分析

目的评价接受PCI的患者术后住院期间合并上消化道出血（UGH）的发生率、影响因素及转归。方法选择2002年9月至2006年3月接受PCI的2279例冠心病患者,其中21例患者PCI后发生UGH,分析所有患者的临床特点及预后,讨论影响UGH发生的预测因素。结果年龄≥70岁、女性、合并糖尿病、消化性溃疡病史、以急性冠状动脉综合征人院的患者UGH发生率较高;PCI术中应用血小板糖蛋白Ⅱb／Ⅲa受体拈抗剂以及接受急诊PCI的患者UGH发生率相对较高;发生UGH的患者住院期间及随访6个月总的主要心脑血管不良事件（死亡、心肌梗死、靶血管重建、脑卒中）发生率显著高于未发生UGH的患者（23．0％比9．3％,P〈0．01）;发生UGH的患者平均住院时间明显延长（13．8d比5．1d,P〈0．001）;年龄≥70岁[比值比（OR）值2．23,95％可信区间（CI）1．01～4．13,P〈0．01]、以急性冠状动脉综合征人院（OR值1．91,95％CI0．57～2．52,P〈0．05）以及消化性溃疡病史（OR值1．02,95％CI0．17～2．25,P〈0．05）是PCI患者术后住院期间发生UGH的预测因素。结论接受PCI的患者住院期间UGH发生率为0．92％,年龄≥70岁、以急性冠状动脉综合征入院及消化性溃疡病史是发生UGH的预测因素,合并UGH的患者住院及6个月随访主要不良心脑血管事件发生率增加。