血栓抽吸联合替罗非班对急性下壁心肌梗死的介入治疗作用

目的:观察血栓抽吸导管(ZEEK)抽吸血栓及注入抗栓药物替罗非班对急性下壁心肌梗死介入治疗的效果。方法:需经皮冠状动脉介入治疗(PCI)的急性下壁心肌梗死患者174例,随机分为两组:ZEEK组(n=75),用ZEEK反复抽吸血栓后,经ZEEK注入替罗非班至梗死相关血管(IRA)后行PCI;对照组(n=99),除不进行血栓抽吸外,其余同ZEEK组。比较两组患者的血流改善情况及预后。结果:与对照组比较,ZEEK组术后ST段回落(STR)70%比例(85.33%vs 58.59%)和远端血流分级(TIMI)3级比例(89.33%vs 60.61%)均高于对照组(P0.05);肌酸激酶同工酶(CK-MB)峰值(71.28±10.92V/L vs 98.63±12.71V/L)、峰值时间(11.67±3.23hvs 14.85±3.75h)和校正的TIMI帧数(CTFC)(25.60±6.10vs33.10±6.20)均显著低于对照组(P0.05);两组术后STR50%比例(97.33%vs 93.94%)无明显差异(P0.05),术后3个月两组均未发生主要不良心脏事件(MACE)。结论:在急性下壁心肌梗死患者行PCI前采用ZEEK抽吸血栓和注入替罗非班可改善心肌再灌注和减少心脏损伤。     

ST段抬高型急性心肌梗死43例急诊介入治疗近期疗效观察

目的：评价急诊介入治疗ST段抬高型急性心肌梗死（STEAMI）的临床疗效。方法：对43例STEAMI患者在发病12h内行急诊PCI治疗,42例植入支架。结果：ST段抬高型急性心肌梗死患者43例中,手术后获得前向血流TIMI3级42例（97．7％）,死亡1例（2．3％）。存活的42例患者术后随访30d,无一例发生再次心肌梗死或死亡。结论：急诊PCI治疗STEAMI,成功率高,住院病死率低,近期预后良好。     

术前不同时机应用替罗非班对高危急性冠脉综合征PCI术患者血流、炎症反应和心肌灌注的影响

目的探讨术前不同时机应用替罗非班对高危急性冠脉综合征(ACS)经皮冠状动脉介入(PCI)术患者血流、炎症反应和心肌灌注的影响。方法随机将在我院行PCI术的104例高危ACS患者分为对照组和研究组,每组52例。两组患者均应用替罗非班,对照组在PCI术开始时应用,研究组在PCI术前4~6h应用。比较两组心肌梗死溶栓(TIMI)血流分级、C反应蛋白(CRP)、可溶性CD40配体(sCD40L)、TIMI心肌灌注分级(TMPG)。结果(1)两组治疗后TIMI血流分级2~3级和TMPG2~3级患者例数明显多于治疗前(P0.05),且研究组治疗后TMPG2~3级患者例数明显多于对照组(P0.05);(2)研究组治疗后CRP与sCD40L水平均明显低于治疗前,且治疗后sCD40L水平低于对照组(P0.05)。结论 PCI术前早期应用替罗非班对高危ACS患者的冠状动脉血流和心肌血供具有一定的改善作用,还可有效抑制患者的炎症反应。     

直接经皮冠状动脉介入治疗80岁以上急性心肌梗死患者的临床评价

目的 探讨直接经皮冠状动脉介入(PCI)治疗80岁以上急性心肌梗死(AMI)患者的临床疗效和安全性.方法 94例80岁以上AMI患者,入院后直接PCI.观察手术成功率、并发症、住院病死率和主要心脏不良事件,出院前测定左心室射血分数(LVEF).结果 冠状动脉造影示梗死相关血管(IRA)心肌梗死溶栓治疗(TIMI)m流分级0～1级,除2例心源性休克患者术中因室颤死亡,其余病例均成功开通IRA,操作成功率97.9%.术后76例血流TIMI 3级,16例TIMI 2级.术后6例因左心功能衰竭死亡.26例心功能Killip Ⅲ级以上者使用主动脉内球囊反搏(IABP)辅助循环,持续反搏时间78～154(98.3±34.5)h.多支病变者除18例3支病变外均在术后3～7 d行非IRA的PCI.住院总病死率8.5%(8/94),Killip Ⅲ级以上者病死率30.8%(8/26).仅3.3%(3/92)发生需输血的出血并发症.住院期间无主要心脏不良事件发生.生存的86例患者出院前测LVEF中位值为43%(26%～62%).存活者术后30 d和180 d主要心脏不良事件发生率分别为1.2%和4.6%.结论 对于80岁以上老年AMI患者行直接PCI安全可行,且成功率较高.     

比伐芦定冠脉联合静脉注射对急性冠脉综合征行经皮冠状动脉介入治疗患者凝血功能和心功能的影响

目的:探讨比伐芦定冠脉联合静脉注射对急性冠脉综合征(Acute Coronary Syndrome,ACS)行经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)患者凝血功能和心功能的影响.方法:将我院2018年6月至2020年10月期间97例ACS行PCI患者按照计算机分组法分为两组,对照组48例给予外周静脉注射比伐芦定0.75 mg?kg-1治疗,试验组49例患者采用静脉联合冠脉注射比伐芦定1.75 mg?(kg·h)-1维持至术后3～4 h治疗,术中和术后即刻观察两组手术相关情况、凝血功能、出血情况、心功能.结果:术后即刻,试验组活化部分凝血酶原时间、凝血酶时间、左心室射血分数水平高于对照组,TIMI心肌灌注分级<Ⅲ级情况优于对照组,试验组TIMI血流帧数计数水平、血小板计数、血浆脑钠肽前体、肌酸激酶同工酶峰值水平低于对照组(P<0.05),术中活化凝血时间达标率、出血率与对照组比较无统计学差异(P>0.05).结论:比伐芦定冠脉内联合静脉注射应用于ACS行PCI患者可改善手术情况、心功能和凝血功能,不影响出血情况和ACT达标.     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年（≥80岁）急性心肌梗死（AMI）患者行急诊与择期经皮冠状动脉介入治疗术（PCI）的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组（AMI组）和非心肌梗死组（对照组）,其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者（AMI择期组）和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率（72.2%）低于非急诊组（92.2%）,差异有统计学意义（P=0.036）。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义（P〈0.001,P=0.039）,AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高（P〈0.05）。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

PCI术中注射地尔硫卓对急性心肌梗死患者早期心功能的影响

目的 探讨经皮冠状动脉介入治疗（PCI）急性心肌梗死（AMI）术中应用地尔硫卓对患者早期心功能的影响。方法 选择我院2018年1月~12月拟行PCI的AMI患者107例,随机分为对照组54例和实验组53例。对照组术中带孔球囊通过罪犯血管后在病变远端推注8 ml生理盐水,实验组则推注8 ml地尔硫卓,随访半年,比较两组术后24 h肌酸激酶同工酶（CK-MB）、肌钙蛋白Ⅰ（CTnⅠ）、氨基末端脑钠肽前体（NT-proBNP）、PCI术后TIMI血流分级、TIMI心肌灌注（TMP）分级、PCI术后1周及6个月内左心射血分数（EF）、左室缩短率（FS）及左室舒张末期内径（LVEDD）及主要心血管不良事件（MACE）。结果 PCI术后实验组TIMI血流分级及TMP分级均优于对照组,差异具有统计学意义（P＜0.05）;术后24 h两组CK-MB、CTnⅠ、NT-proBNP均较治疗前改善,且实验组CK-MB、CTnI、NT-proBNP优于对照组,差异具有统计学意义（P＜0.05）;术后1周实验组EF、FS、LVEDD均优于对照组,术后6个月实验组EF、FS及LVEDD分别为（58.32±7.10）%、（37.09±5.56）%、LVEDD（47.39±4.46）mm,优于对照组的（42.05±5.67）%、（29.03±9.51）%、（48.81±6.16）mm,差异有统计学意义（P＜0.05）;术后6个月实验组MACE发生率低于对照组,差异有统计学意义（P＜0.05）。结论 AMI患者PCI术中应用地尔硫卓能提高患者的TIMI血流分级、TMP分级,改善患者心肌功能,且安全性高,值得应用。     

导管血栓抽吸联合药物洗脱支架治疗急性心肌梗死疗效观察

目的 评价经导管冠状动脉内血栓抽吸,并联合雷帕霉素药物洗脱支架置入术治疗急性心肌梗死(AMI)的安全性及疗效.方法 AMI患者急诊冠状动脉造影显示冠状动脉内大量血栓者21例,其中男性19例,女性2例,年龄(59±13)岁,发病时间(8±13)h(3～24h).使用DiverCE抽吸导管进行冠状动脉内血栓抽吸,然后置入雷帕霉素药物洗脱支架治疗.术后冠状动脉造影观察冠状动脉扩张效果及梗死相关血管血流,随访住院及术后9～12个月主要心血管事件.结果 21个梗塞相关动脉经血栓抽吸,所有即刻前向血流较术前均有改善,TIMI血流由抽吸前的0.62±0.80级至抽吸后2.76±0.44级.P＜0.000 1.共21枚雷帕霉素药物洗脱支架(Partner12枚,Firebird 7枚,Excel 2枚)成功置入21个梗塞相关动脉,17例(81%)接受直接支架置入术,4例(19%)行球囊预扩张后置入支架.血流达TIMI 3级19例,支架置入后血流进一步改善者3例,住院期间1例心力衰竭加重,余20例住院及术后3个月无主要心血管事件发生.术后9～12个月随访中无死亡、再发AMI及靶血管血运重建,1例患者因心力衰竭加重再入院治疗.结论 经导管直接血栓抽吸是处理冠状动脉内血栓的一种简单、安全有效的方法.联合置入雷帕霉素药物洗脱支架可进一步提高AMI患者急诊介入治疗的手术即刻、近期疗效及远期疗效.     

急性心肌梗死直接PCI术后QT离散度变化的研究

目的观察直接冠状动脉介入术(PCI)对急性心肌梗死(AMI)患者QT离散度(QTd)的影响.方法 115例发生于12H以内的急性心肌梗死患者,均行直接PCI治疗,并达到TIMI血流3级,观察治疗前后QTd的变化.结果治疗前QTd较正常显著延长(P<0.01),PCI成功后2天QTd较术前明显缩短.结论成功的PCI术能显著缩短AMI的QTcd,改善预后.QTcd可以作为一种简单、可靠的判定AMI再通的临床指标.     

硝普钠与硝酸甘油对陈旧性心肌梗死患者经皮冠状动脉介入术中无复流心肌微循环的影响

目的:比较冠脉内应用硝普钠与硝酸甘油对心肌梗死患者经过冠状动脉介入(PCI)术开通后术中无复流心肌微循环的影响。方法:选取2015-01—2017-04期间入我院心内科并行PCI术开通闭塞血管后出现无复流现象的陈旧性心肌梗死患者42例,采用随机数字法分为硝普钠组(n=22)和硝酸甘油组(n=20),分别在术中经微导管于冠状动脉内注射硝普钠200μg或硝酸甘油200μg,采用指引导管分别送入多普勒导丝和压力导丝,记录比较两组用药前后冠脉血流储备分数(FFR)和冠状动脉血流储备(CFR),并比较用药后10min两组冠脉TIMI血流分级。结果:42例患者均顺利完成手术,给药前两组FFR、CFR比较差异无统计学意义(P0.05),用药后,硝普钠组CFR明显升高,且高于硝酸甘油组用药后(P0.05),两组给药后FFR值差异无统计学意义(P0.05),两组TIMI血流较给药前均有改善,但差异无统计学意义(P0.05)。结论:硝普钠较硝酸甘油能明显改善陈旧性心梗患者PCI术中无复流心肌微循环。     

Thrombosuction utilizing an export aspiration catheter during primary percutaneous coronary intervention in acute myocardial infarction

PURPOSE: Effective myocardial reperfusion after primary PCI for an AMI in lesions with a thrombus is limited by distal embolization and the slow/no reflow phenomenon. We evaluated the efficacy of a thrombus reduction technique using an export aspiration catheter for thrombosuction during primary PCI. MATERIALS AND METHODS: We analyzed 62 patients with AMIs who underwent primary PCI and had a thrombi burden during thrombosuction using an EAC (EAC group; n=31) or without thrombosuction (control group; n=31). RESULTS: Thrombosuction with an EAC was performed safely in all the patients in EAC group without any complications. After the PCI, restoration to a TIMI flow grade 3 was significantly more frequent in the EAC group (26/31 vs. 20/31, p < 0.05). However, the TIMI perfusion grade did not differ between the two groups. Further, the corrected TIMI frame counts were lower in the EAC group (23.9 +/- 15.1 vs. 34.8 +/- 22.5, p < 0.05). Although there was no statistical significance, a greater incidence of distal embolization was observed in the control group (16.1%, 5/31) as compared to the EAC group (0/31) (p= 0.056). However, the incidence of major adverse cardiac events at 1 and 6 months did not differ between the two groups. CONCLUSION: For AMIs, thrombosuction with an EAC before or during PCI is a safe and potentially effective method for restoration of the coronary flow.     

入院血糖对急性心肌梗死患者介入治疗后住院死亡率的预测价值

目的探讨入院即刻血糖水平对急性心肌梗死（AMI）患者行经皮冠状动脉介入（PCT）治疗后住院死亡率的预测价值。方法因急性心肌梗死在笔者所在医院行急诊PCI治疗的非糖尿病患者456例,其中男性319例,女性137例,年龄29～85岁,平均年龄61．30岁。按入院即刻血糖（SG）水平分为3组：SG〈7．8mmol/L为A组248例,7．8mmol／L≤SG≤11.1mmol／L为B组156例,SG〉11．1mmol/L为C组52例,分别对3组患者住院期间心力衰竭、恶性心律失常、心脏性死亡,再梗死、梗死后心绞痛及主要不良心脏事件（MACE）的发生率进行对比分析。结果在年龄、性别、冠心病家族史、吸烟、既往高血压、心房纤颤、前降支和右冠状动脉病变、多支病变、梗死后心绞痛、胸痛发作至PCI时间等方面3组之间差异均无统计学意义（P〉0．05）;而C组多于一个部位心肌梗死、入院Killip’s分级≥2级的比例明显多于A、B两组（P〈0．05）;C组白细胞计数明显高于A、B组（P〈0．05）;在肌酸激酶（CK）、肌酸激酶同功酶峰值（CK／CK—MB）及住院期间左心室射血分数方面3组差异均有统计学意义（P〈0．05）;C组急性心力衰竭的发生率明显高于A、B组;C组心肌梗死再发生率亦高于A组,而B、C组未显示差异有统计学意义;C组恶性心律失常发生率明显高于A组,A、B组差异亦有统计学意义（P〈0．05）;而MACE发生率及住院期间死亡率分别为C组46．2％和13．7％,B组34．0％和4．5％,A组19．0％和1．6％,3组之间差异均有统计学意义（P〈0．001）。结论入院即刻血糖升高的急性心肌梗死患者实施急诊PCI治疗后院内死亡率及总的心血管事件发生率高,提示预后不良。     

Clinical Outcomes of Ticagrelor in Korean Patients with Acute Myocardial Infarction without High Bleeding Risk

BackgroundAlthough ticagrelor is known to increase the bleeding risk compared to clopidogrel in East Asian patients, its clinical benefits in patients with acute myocardial infarction (AMI) without high bleeding risk (HBR) remains unknown.MethodsA total of 7,348 patients who underwent successful percutaneous coronary intervention (PCI) from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), between November 2011 and December 2015, were divided into two groups according to the Academic Research Consortium for HBR criteria (KAMIR-HBR, 2,469 patients; KAMIR-non HBR, 4,879 patients). We compared in-hospital major adverse cardiovascular events (MACEs, defined as a composite of cardiac death, non-fatal myocardial infarction, or stroke), and the thrombolysis in myocardial infarction (TIMI) major bleeding between ticagrelor and clopidogrel in the KAMIR-HBR and the KAMIR-non HBR groups, respectively.ResultsAfter propensity score matching, ticagrelor had a higher incidence of in-hospital TIMI major bleeding than clopidogrel in all patients (odds ratio [OR], 1.683; 95% confidence interval [CI], 1.010–2.805; P = 0.046) and the KAMIR-HBR group (OR, 3.460; 95% CI, 1.374–8.714; P = 0.008). However, there was no significant difference in in-hospital TIMI major bleeding between ticagrelor and clopidogrel in the KAMIR-non HBR group (OR, 1.436; 95% CI, 0.722–2.855; P = 0.303). No differences were observed in the cumulative incidences of in-hospital and 6-month MACEs between ticagrelor and clopidogrel in both groups.ConclusionsThe bleeding risk of ticagrelor was attenuated in Korean patients with AMI without HBR. Appropriate patient selection could reduce in-hospital bleeding complications associated with ticagrelor in Korean patients with AMI who underwent successful PCI.     

阿托伐他汀对ACS患者PCI术后血清MCP-1、IL-10和hs-CRP水平的影响

目的：探讨阿托伐他汀对经皮冠脉介入术（PCI）术后血清单核细胞趋化蛋白-1（MCP-1）、白细胞介素-10（IL-10）和高敏C反应蛋白（hs-CRP）的影响。方法：62例接受PCI术的ACS患者随机分为两组,分别给予阿托伐他汀20mg（A组,n=31）和10mg（B组,n=31）每日一次口服。于术前及术后24h、1周测定血清hs-CRP、MCP-1和IL-10水平。MCP-1、IL-10检测采用酶联免疫吸附法,hs-CRP采用免疫比浊法。结果：①术后24h两组hs-CRP、MCP-1水平升高（P均〈0．01）;术后1周两组均低于术后24h（P均〈0．01）,B组下降较A组更明显（P〈0．05）。②两组IL-10水平术后24h升高（P〈0．05）;术后1周进一步升高（P均〈0．01）,B组明显高于A组（P〈0．01）。③MCP-1／IL-10比值A组术后24h高于术前（P〈0．05）;术后1周两组均低于术前和术后24h（P〈0．01）,B组较A组下降更著（P〈0．01）。④血清hs-CRP、MCP-1水平和MCP-1／IL-10与阿托伐他汀剂量负相关（P均〈0．01）,IL-10与阿托伐他汀剂量正相关（P〈0．01）。结论：①ACS患者PCI术后24h血清hs-CRP、MCP-1、IL-10水平和MCP-1／IL-10比值均明显高于术前。②术后1周血清hs-CRP、MCP-1水平和MCP-1／IL-10水平降低,IL-10水平显著升高,以20mg组为著。③血清hs-CRP、MCP-1和MCP-1／IL-10与阿托伐他汀剂量负相关,IL-10水平与阿托伐他汀剂量正相关。     

40岁以下青年急性心肌梗死PCI术后 双心护理的临床效果

目的 分析40岁以下青年急性心肌梗死(AMI)PCI患者双心护理的效果。方法 选取2016年1月~2017年12月于我院心内科住院行急诊PCI术的急性心肌梗死患者70例,随机分为实验组和对照组,每组35例。实验组术后予以双心护理,对照组术后予以常规护理。观察两组护理满意度、术后并发症情况以及院外用药依从性。结果 实验组护理满意度高于对照组（97.14%vs 91.43%）,差异具有统计学意义（P＜0.05）;实验组并发症发生率低于对照组（5.71% vs 22.86%）,差异具有统计学意义（P＜0.05）;实验组院外用药依从性优于对照组（91.43% vs 74.29%）,差异具有统计学意义（P＜0.05）。结论 对40岁以下青年AMI患者,在尽早开通闭塞血管,挽救濒死心肌的同时,护理人员给予双心护理,可提高护理满意度和院外用药依从性,降低并发症发生率,对PCI术后恢复有更好的效果。     

择期经皮冠脉介入术对急性心肌梗死心肌微循环的作用

目的应用心肌声学造影(MCE)评价急性心肌梗死(AMI)患者择期经皮冠脉介入术(PCI)前后的心肌微循环。方法选择20例AMI患者,在择期PCI治疗前、后分别应用声诺维(SonoVue)静脉注射,行间歇触发、二次谐波MCE检查,应用声学密度分析软件(AD)定量测定心肌微循环内造影剂的声学峰值强度(PI)、曲线下面积(AUC)。结果治疗前梗死相关节段的PI、AUC明显低于正常灌注节段(P<0.001);择期PCI治疗后梗死节段的PI、AUC仍明显低于正常节段(P<0.001),但较PCI前明显升高(P<0.001),校正后的PIr、AUCr亦明显升高(P<0.001);而正常灌注节段的PI、AUC在PCI前后无明显变化(P>0.05)。结论MCE可定量评定AMI患者的心肌微循环;择期PCI可改善AMI患者梗死节段的微循环。     

Effects of renal impairment on cardiac remodeling and clinical outcomes after myocardial infarction

How renal function influences post-acute myocardial infarction (AMI) cardiac remodeling and outcomes remains unclear. This study evaluated the impact of levels of renal impairment on drug therapy, echocardiographic parameters, and outcomes in patients with AMI undergoing percutaneous coronary intervention (PCI). A total of 611 patients diagnosed with AMI underwent successful PCI, and two echocardiographic examinations were performed within 1 year after AMI. Patients were categorized according to Group 1: severely impaired estimated glomerular filtration rate (eGFR)<30, Group 2: mildly impaired 30≤eGFR<60, Group 3: potentially at risk 60≤eGFR<90 and normal eGFR≥90 ml/min/1.73 m2. During the 5-year follow-up period, the primary endpoints were cardiovascular mortality and outcomes. Patients with worse renal function (eGFR<30) were older and had a higher prevalence of hypertension and diabetes, but relatively few were smokers or had hyperlipidemia. Despite more patients with lesions of the left anterior descending artery, those with worse renal function received suboptimal guideline-directed medical therapy (GDMT). Notably, patients with worse renal function presented with worse left ventricular function at baseline and subsequent follow-up. Kaplan-Meier analysis revealed increased cardiovascular death, development of heart failure, recurrent AMI and revascularization in patients with worse renal function. Notably, as focusing on patients with ST elevation MI, the similar findings were observed. In multivariable Cox regression, impaired renal function showed the most significant hazard ratio in cardiovascular death. Collectively, in AMI patients receiving PCI, outcome differences are renal function dependent. We found that patients with worse renal function received less GDMT and presented with worse cardiovascular outcomes. These patients require more attention.     

红细胞压积变化对急性ST段抬高型心肌梗死患者临床预后的影响

目的 探讨红细胞压积的变化对急性ST段抬高型心肌梗死（STEMI）接受急诊经皮冠状动脉支架植入术患者的临床预后的影响。方法 连续性纳入我院心肌梗死绿色通道收治行急诊支架植入患者603例,根据住院期间红细胞压积的变化分为A组（红细胞压积降低组,255例）和B组（红细胞压积升高组,348例）。收集两组患者资本资料、手术相关信息、化验室资料、住院期间临床事件、1个月内临床事件以及1年内临床事件并予以统计分析。结果 A组年龄大于B组[（60.33±11.06）岁 vs（58.44±10.88）岁,P＜0.05],B组脑血管病史发生率高与A组（13.50% vs 8.24%,P＜0.05）,A组梗死相关动脉中血栓病变发发生率高于B组（97.25% vs 88.51%,P＜0.05）。支架植入后最终TIMI血流:3级血流A组较B组高（85.88% vs 79.02%,P＜0.05）。A组较B组住院期间心源性死亡发生率低（0 vs 2.01%,P＜0.05）;出院1年内LVEF低于B组[（55.53±6.42）% vs （57.19±6.82）%,P＜0.05];出院1年室壁运动异常发生率高于B组（92.88% vs 87.69%,P＜0.05）。结论 住院期间红细胞压积升高增加STEMI患者在院期间心源性死亡的发生,红细胞压积降低预示着心功能的下降及室壁运动功能受损。