NT-proBNP水平对ACS患者冠脉病变及介入治疗后左室功能的预测价值

目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者N端B型脑钠肽前体(N-terminal pro-B-type natriureticpeptide,NT-proBNP)与冠状动脉病变严重程度及心功能的相关性。方法入选住院的急性心肌梗死(acute myocardial in-farction,AMI)患者60例,不稳定型心绞痛(unstable angina,UA)患者62例。分别于患者入院时、冠脉介入治疗(PCI)术后即刻、术后1月及3月通过电化学发光法测定血NT-proBNP水平;分析各组不同时期NT-proBNP水平与左室射血分数(ejectionfraction,EF)、左心室舒张末期内径(end-diastolic dimension,EDD)及左心室收缩末期内径(end-systolic dimension,ESD)相关性;并比较两组术后6月主要心脏不良事件(major adverse cardiac events,MACE)发生率。结果①AMI组不同时间点血NT-proBNP水平显著高于UA组,差异有统计学意义(P<0.05)。②术后即刻及术后1、3月AMI组患者NT-proBNP水平分别与住院期间及术后左室EF值负相关(P<0.01);UA组患者术后即刻及术后1月NT-proBNP水平分别与住院期间及与术后左室EF值负相关(P<0.01)。③AMI组术后即刻NT-proBNP>1 205 pg/ml组及UA组术后即刻NT-proBNP>265 pg/ml组术后6月MACE发生率明显增高。结论 ACS患者NT-proBNP水平与冠状动脉病变严重程度以及术后心功能相关,与远期MACE事件发生率相关,可作为ACS患者PCI术后心血管事件危险评估的预测指标。     

急性冠脉综合征介入治疗后脑钠肽水平与心血管事件关系探讨

目的:探讨急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术后48h血浆脑钠肽(BNP)水平变化与近、远期心血管事件关系。方法:对92例ACS患者常规进行术前和术后治疗并规范化行PCI术,术后48h行BNP测定,A组血浆BNP水平>80pg/ml,B组血浆BNP水平<80pg/ml;观察两组住院期间及术后6个月心血管事件发生率。结果:A组住院期间心血管事件发生率明显高于B组(P<0.01);但两组术后6个月心血管事件发生率无明显差异(P>0.05)。结论:ACS患者行PCI术,术后48hBNP浓度仅能预测近期预后而对远期预后无明显的预测作用。     

血清脂蛋白相关磷脂酶A2对急性冠脉综合征PCI术后心血管事件的临床预测

目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)对急性冠脉综合征(ACS)经皮冠状动脉介入术(PCI)后心血管事件(MACE)的临床预测价值。方法选择2012年12月至2016年5月我科住院确诊ACS患者203例,PCI术前检测血清Lp-PLA2水平,根据Lp-PLA2检测中位数分为高水平组与低水平组,术后随访6个月观察MACE发生情况。结果单支冠脉病变低水平组(35例、42.3%)高于高水平组(30例,27.3%),三支冠脉病变高水平组(43例,39.1%)高于低水平组(21例,25.3%),差异有统计学意义(P<0.05);冠脉病变Gensini积分高水平组(76.49±25.67)高于低水平组(57.81±21.46),差异有统计学意义(P<0.05);PCI术后6个月MACE发生率高水平组(13例,11.8%)高于低水平组(4例,4.8%),差异有统计学意义(P<0.05)。结论血清Lp-PLA2水平对ACS患者PCI术后6个月内MACE发生具有一定的临床预测价值。     

血浆心型脂肪酸结合蛋白水平在急性冠脉综合征患者PCI术后心肌损伤及预后的预测价值

目的探讨急性冠脉综合征(ACS)患者经皮冠脉介入治疗术(PCI)前后血浆心型脂肪酸结合蛋白(H-FABP)水平及对术后心肌损伤和预后的预测价值。方法留取169例ACS患者胸痛症状发作6～10 h的PCI术前血标本,酶联免疫法测定H-FABP,入选患者按H-FABP(<11.82 g/L和≥11.82 g/L)浓度进行分组。记录Gensini冠脉病变评分,并观察ACS患者PCI术后30 d心源性死亡和主要心脏不良事件(MACE)发生率。结果 H-FABP水平与冠脉病变支数和Gensini冠脉病变评分均呈正相关(=0.754、0.842,<0.05);2组术后30 d的MACE发生率为11.49%和4.88%(>0.05)。多变量逐步Logistic回归分析表明,H-FABP、UA和左主干病变是ACS患者PCI后30d发生MACE的危险因素(均<0.05)。结论 H-FABP水平变化有助于早期识别PCI术后心肌损伤,PCI术前H-FABP水平升高是ACS患者PCI术后再发MACE的独立危险因素。     

老年急性冠脉综合征患者PCI术后发生心力衰竭的影响因素

目的 探讨老年急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后发生心力衰竭的影响因素,为临床早期制定预防性干预措施,降低老年ACS患者PCI术后发生心力衰竭风险提供参考依据。方法 选取南阳市中心医院2019年1月至2023年1月收治的行PCI术治疗的350例老年ACS患者。PCI术后随访6个月,根据是否发生心力衰竭将350例老年ACS患者分为无心衰组和心衰组。收集并比较无心衰组和心衰组患者的临床资料;二元logistic回归分析老年ACS患者PCI术后发生心力衰竭的影响因素。结果 PCI术治疗6个月后,350例老年ACS患者中发生心力衰竭73例,心力衰竭发生率为20.86%。两组年龄、心功能分级、冠脉狭窄程度、冠脉病变支数、合并心律失常、血清N末端前脑利钠肽(NT-proBNP)、D-二聚体(D-D)、血尿酸(SUA)水平、左心室射血分数(LVEF)比较,差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,年龄大、心功能分级≥Ⅲ级、冠脉重度狭窄、冠脉多支病变支数、合并心律失常、血清NT-proBNP、D-D、SUA水平升高、LVEF下降是老年AC...     

院前脉压对STEMI患者MACE发生率及心肌功能血清指标的影响

目的研究不同的院前脉压数值对急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入术(PCI)治疗后主要心血管不良事件(MACE)发生率及血清内肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTn-I)及血浆氨基末端脑钠尿肽前体(NT-proBNP)水平的影响。方法以2014年1月至2016年10月期间于上海市第十人民医院行PCI治疗的急性STEMI患者为研究对象,根据脉压分为:H组:脉压60 mmHg;M组:脉压20~60 mmHg;L组:脉压20 mmHg。观察3组患者冠脉病变程度,检测PCI术前及术后TIMI血流情况,同时记录血清CK-MB、cTn-I、NT-proBNP峰值,对比PCI术后MACE的发生率。结果冠脉病变血管数及部位由轻到重依次为M组、H组、L组,组间两两比较差异有统计学意义(P0.05);PCI术前,罪犯血管血流情况为M组优于H组,L组次于H组,3组间差异有统计学意义(P0.05),PCI术后3组间差异无统计学意义(P0.05);PCI围术期,CK-MB、cTn-I、NT-proBNP峰值水平均表现为:L组H组M组,组间两两比较差异有统计学意义(P0.05);PCI术后,3组患者的MACE发生率为L组H组M组,且L组显著高于M组,差异有统计学意义(P0.05)。结论脉压水平越低,急性STEMI患者于PCI术后的MACE发生率以及血清CK-MB、cTn-I、NT-proBNP水平越高,提示脉压对急性STEMI患者PCI术后的MACE发生率有一定的预测作用。     

血浆醛同酮水平对急性冠脉综合征患者冠脉病变及预后的预测价值

目的：探讨急性冠脉综合征（ACS）患者血浆醛固酮（Aldo）水平对冠状动脉病变严重程度的影响及与患者近期预后的关系。方法：选择2010年1月-2011年1月在本院心内科住院并行冠脉造影检查的ACS患者166例,冠脉造影检查前于升主动脉根部采取血标本,测定醛同酮水平,按醛固酮水平高低分为三组：A组（Aldo〈100ng／ml）,B组（100ng／ml≤Aldo≤200ng／ml）及C组（Aldo〉200ng／ml）。根据冠脉造影结果,分析各组ACS患者醛固酮水平与冠脉病变严重程度的关系;并观察ACS患者经皮腔冠脉内介入治疗（PCI）术前醛固酮水平对术后近期预后（6个月）的影响。结果：三组ACS患者随Aldo水平升高,多支血管病变、冠脉B2／C型病变、冠脉病变狭窄程度积分（Gensini积分）均明辊增高,组间差异有统计学意义（P〈0．05或P〈0．01）;多因素Logistic回归分析显示醛固酮是ACS患者PCI术后6个月内MACE发生的独立预测因子。结论：ACS患者血浆醛同酮水平与冠脉病变严重程度相关,醛同酮水平的高低对ACS患者PCI术后的近期预后有预测价值。     

血小板与淋巴细胞比值和中性粒细胞与淋巴细胞比值与急性冠脉综合征患者经皮冠脉介入术后短期预后的相关性分析

目的 探讨急性冠脉综合征(ACS)患者行经皮冠脉介入术(PCI)前外周血中血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)和术后短期主要心血管不良事件(MACE)的关系。方法 回顾性分析郑州大学第一附属医院508例行PCI术的ACS患者(ACS组),以同时段129例健康体检人群为对照组。收集临床资料,并且术后随访6个月,统计ACS患者PCI术后MACE发生情况。单因素和多因素logistic回归模型分析影响ACS患者PCI术后MACE的危险因素。受试者工作特征曲线(ROC)分析PLR、NLR对ACS以及MACE事件的预测价值。结果 ACS组血肌酐、血小板、中性粒细胞、PLR、NLR高于对照组(P<0.05),而高密度脂蛋白、淋巴细胞、LVEF均低于对照组(P<0.05)。ROC结果显示,PLR、NLR以及联合预测ACS的曲线下面积(AUC)分别为0.776、0.822、0.886。多因素logistic回归分析显示,PLR、NLR均是影响ACS患者PCI术后发生MACE事件的独立危险因素(P<0.05)。PLR、NLR单独预测发生MACE的AUC为0...     

冠状动脉CT血管造影定量参数联合血清NT-proBNP、sdLDL-C对冠状动脉粥样硬化性心脏病患者治疗后主要心血管不良事件的预测价值

目的 探讨冠状动脉CT血管造影(CCTA)定量参数与联合血清N末端脑利钠肽原(NT-proBNP)、小而密低密度脂蛋白胆固醇(sdLDL-C)对冠状动脉粥样硬化性心脏病(简称冠心病)患者经皮冠状动脉介入(PCI)术后主要心血管不良事件(MACE)的预测价值。方法 招募2019年2月至2021年2月我院收治的248例拟行PCI的冠心病的患者,术前行CCTA检测获得血流储备分数(FFRCT)并检测血清NT-proBNP、sdLDL-C水平。术后随访1年,统计随访期间MACE发生情况,多因素Logistic回归分析影响冠心病患者PCI术后发生MACE的危险因素,绘制受试者工作特征曲线(ROC)分析FFRCT联合NT-proBNP、sdLDL-C预测冠心病患者PCI术后发生MACE的价值。结果 248例患者中随访失联2例,余246例患者发生MACE62例(MACE组),未发生MAC E184例(非MACE组)。MACE组FFRCT低于非MACE组(P<0.05),血清NTproBNP、sdLDL-C水平高于非MACE组(P<0.05)。多因素Logistic回归分析结果 显示年龄、...     

介入治疗对急性冠脉综合征B型尿钠肽的影响及临床意义

目的：探讨经皮冠状动脉介入治疗（PCI）对急性冠脉综合征（ACS）术后48hB型尿钠肽（PRO—BNP）水平的影响及其预测近、远期心血管事件的临床意义。方法：将2007年1月～2010年1月我院收治的80例ACS患者随机分为对照组和观察组,每组各40例,分别在术前和术后给予常规治疗和在常规治疗的同时行规范化PCI术。对术后48h的PRO—BNP水平进行检测,同时观察术后3、6个月的心血管事件发生率,评价其与PRO—BNP水平的关联性。结果：术后48h,PRO—BNP出现不同程度的下降,但观察组下降程度显著高于对照组,差异有统计学意义（P〈0．05）。其中,PRO—BNP浓度〈800pg／ml的患者比例及PRO—BNP水平显著优于PRO—BNP浓度〉800pg／ml患者的相应指标,差异均有统计学意义（均P〈0．05）;术后3个月,PRO—BNP〈800pg／ml与PRO—BNP〉800pg／ml心血管事件发生率比较,差异有高度统计学意义（P〈0．01）;术后6个月,二者比较,差异无统计学意义（P〉0．05）。结论：PCI对于ACS的治疗效果确切、显著,可有效降低血浆PRO—BNP水平,PRO—BNP水平对于术后短期心血管事件具有预测价值,对于远期的预测价值不明显。     

急性冠脉综合征高龄患者PCI术后影响预后危险因素临床分析

目的:分析影响急性冠脉综合征高龄患者PCI术后预后的危险因素。方法:选取3年来我科住院72例接受PCI术的急性冠脉综合征患者,按年龄分为:高龄组,年龄≥75岁,共36例;低龄组,年龄<75岁,共36例。分析高龄患者PCI术后的HbA1c、NT-proBNP、血小板聚集率(PAGR)与随访1年后LVEF、LVEDd值的相关性。比较两组的主要不良心脏事件(MACE),即再梗塞率及死亡率之间的差异。结果:高龄患者的NT-proBNP、PAGR与LVEF值呈负相关关系,相关系数为-0.891和-0.901,与LVEDd值呈正相关关系,相关系数为0.857和0.924。而HbAlc与LVEF、L-VEDd值无明显相关性。两组的MACE(再梗塞率及死亡率)部存在差异性,P值分别为0.0148与0.0254。结论:急性冠脉综合征高龄患者PCI术后MACE较低龄患者发生率高,且心脏功能与NT-proBNP及PAGR有相关性。     

血栓抽吸导管在ACS急诊PCI中的临床应用研究

目的探讨血栓抽吸导管治疗在ACS常规急诊PCI中的临床疗效。方法选择2010年1月-2011年5月我院住院行急诊经皮冠状动脉介入（PCI）治疗的93例急性ST段抬高型心肌梗死和高危、极高危非ST段抬高急性冠脉综合症（ACS）患者,随机分为联用ThrombusterⅡ血栓抽吸导管治疗为A组（51例）,同期未应用血栓抽吸导管治疗为B组（42例）。比较两组患者术后心肌梗死溶栓（TIMI）血流、校正TIMI帧数（CTFC）、术后心肌呈色分级（BMG）、术后ST段抬高回落幅度及左心室射血分数（LVEF）、住院期间主要心血管不良事件（MACE）有无差异。结果 A组TIMI血流3级、CTFC、BMG、术后ST段抬高回落幅度及LVEF均优于B组,差异均有统计学意义（P〈0.05）。两组患者院内MACE发生率比较,差异无统计学意义（P〉0.05）。结论在ACS常规急诊PCI中联用ThrombusterⅡ血栓抽吸导管治疗可显著改善患者TIMI血流、心肌组织水平灌注及术后心功能,但住院期间MACE的发生率无差异。     

Use of B-type natriuretic peptide in evaluation of early percutaneous coronary intervention in patients with acute coronary syndrome

Background Previous studies showed that blood B-type natriuretic peptide (BNP) level could predict the prognosis of acute coronary syndromes (ACS). This study investigated the evaluation value of circulating BNP for early percutaneous coronary intervention (PCI) in patients with ACS.Methods Nine hundred and sixty consecutive patients with ACS were enrolled. Circulating BNP level was measured when each patient arrived at the emergency room. All patients underwent PCI in 90 minutes in spite of contraindication. Cardiac events (death from any cause, heart failure, and recurrence of acute myocardial infarction or ACS) were recorded during follow-up. Results In patients with BNP ≥80 pg/ml, mortality from all causes within 1 month and 6 months in those underwent delayed PCI (≥6 hours) was significantly higher than those received early PCI (&lt;6 hours) (9.53% vs 3.49%, P=0.027; 13.61% vs 5.24%, P=0.010, respectively). Similarly, the incidence rate of heart failure in delayed PCI patients was significantly higher than those received early PCI within 1 month and 6 months (12.93% vs 4.66%, P=0.008; 14.97% vs 6.98%, P=0.021, respectively). The recurrence rate of acute myocardial infarction or ACS, however, was not significantly different between early PCI and delayed PCI patients in group BNP ≥80 pg/ml. In patients with BNP &lt;80 pg/ml, no significant difference was observed between early PCI and delayed PCI patients with any of the above cardiac events within 1 month or 6 months. Conclusion While early level of circulating BNP ≥80 pg/ml, the incidence of mortality and heart failure, but not recurrence of acute myocardial infarction, is significantly reduced in patients with ACS provided by early PCI.     

Prognostic Value of NT-proBNP in Stable Coronary Artery Disease in Chinese Patients after Percutaneous Coronary Intervention in the Drug-eluting Stent Era

Objective The predictive value of N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with stable coronary artery disease(SCAD) in the drug-eluting stent era is not yet clear. We aimed to evaluate the prognostic value of NT-proBNP in SCAD patients after percutaneous coronary intervention(PCI). Methods We examined 4,293 consecutive SCAD patients who underwent PCI between January 2013 and December 2013 in Fuwai Hospital, China. The primary endpoint was all-cause death. NT-proBNP levels were measured before PCI using Elisa kits(Biomedica, Austria). The indication for PCI was based on the degree of coronary stenosis and evidence of ischemia. Results Among 3,187 SCAD patients with NT-proBNP data, after a 2-year follow-up, NT-proBNP levels were predictive for all-cause death in the SCAD population [area under the receiver operating characteristic curve, 0.768; 95% confidence interval(CI), 0.687-0.849; P 0.001]. At the optimum cutoff point of 732 pg/mL, the sensitivity and specificity of death was 75.0% and 72.3%, respectively. In a multivariable Cox regression model, the death hazard ratio was 6.43(95% CI, 2.99-13.82; P 0.001) for patients with NT-proBNP levels ≥ 732 pg/mL, compared with 732 pg/mL. Conclusion NT-proBNP is a strong predictor of 2-year death with SCAD after PCI in the drug-eluting stent era.     

血浆IL-18对ST段抬高性急性心肌梗死住院期间不良临床事件的预测价值

目的研究血浆IL-18对ST段抬高性急性心肌梗死（STEAMI）患者住院期间发生不良临床事件的预测价值。方法随机选取发病时间小于12h的STEAMI患者96例,均行冠状动脉介入治疗（PCI）。以ELISA法检测血浆IL-18水平,并根据检测结果将其分为高IL-18水平组和低IL-18水平组。比较两组患者的临床特征,观察住院期间复合不良临床事件（包括心源性死亡、非致死性心肌梗死、心力衰竭、心源性休克等）的发生情况,分析IL-18与相关指标的相关性。结果高IL-18水平组33例,低IL-18水平组63例。与低IL-18水平组比较,高IL-18水平组患者年龄、左主干病变的患病率、前壁心肌梗死发生率、进展性心力衰竭比例、肌钙蛋白I（cTnI】峰值、入院白细胞数、胸痛至球囊扩张的时间以及尿酸水平均发生明显变化（P〈0．05或001）。STEAMI患者血浆IL-18仅与cTnl水平显著正相关（P〈0．01）。年龄≥74岁、入院时IL-18≥450pg／ml、左主干存在病变、术后TMP分级≤I级均是STEAMI患者住院期间复合不良临床事件的独立预测因素（P〈0．05或001）;IL-18≥450pg／ml、左主干存在病变、术后TMP分级≤I级、2型糖尿病均是STEAMI患者住院期间发生死亡或非致死性心肌梗死的独立危险因素（P〈0.05或0．01）。结论入院时血浆IL-18水平与STEAMI患者PCI术后住院期间复合不良临床事件有关,可用于STEAMI的早期危险分层。     

Protective effect of Chinese herbs for supplementing qi, nourishing yin and activating blood circulation on heart function of patients with acute coronary syndrome after percutaneous coronary intervention

Objective:To investigate the effects of Chinese herbs for supplementing qi,nourishing yin and activating blood circulation on heart function of patients with acute coronary syndrome(ACS)after successful percutaneous coronary intervention(PCI).Methods:One hundred patients with ACS after successful PCI were randomly assigned to a Western medicine(WM)treatment group(WMG)and a combined treatment group (CMG)treated by Chinese herbs for supplementing qi,nourishing yin and activating blood circulation,besides Western medicine treatment,with 50 cases in each group.Both treatment courses were 6 months.The followup was scheduled at baseline,6 months and 1 year after PCI,and New York Heart Association(NYHA) functional class,Chinese medicine(CM)symptom scores,blood stasis syndrome scores,and major adverse cardiovascular events(MACE)were observed,serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP)and hyper-sensitivity C-reactive protein(Hs-CRP)were measured,an echocardiogram was conducted to examine left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV),inter-ventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),and ventricular wall motion index(VWMI).Results:Compared with the baseline, LVEF significantly increased(P<0.01),and CM symptom scores,blood stasis syndrome scores,VWMI, LVEDV,LVESV,NT-proBNP,and Hs-CRP all decreased(P<0.01)in both groups at 6 months and at 1 year after PCI.There were no significant differences in all the above parameters at 1 year vs those at 6 months after PCI(P>0.05).VWMI,LVEDV,LVESV,NT-proBNP,Hs-CRP,LVEF,and CM symptom and blood stasis syndrome scores were all improved obviously in CMG than those in WMG(P<0.05 or P<0.01)at 6 months and at 1 year after PCI.There were no significant differences in NYHA functional class between CMG and WMG at different follow-up timepoints;it was notable that P value was 0.054 when comparing the cases of NYHA functional class between the two groups at 1-year follow-up.During the 1-year follow-up,3 MACE and 11 MACE occurred in CMG and WMG,respectively;the MACE rate in CMG was lower than that in WMG (6%vs 22%,P<0.05).Conclusion:Chinese herbs for supplementing qi,nourishing yin and activating blood circulation could improve heart function,reduce the CM symptom scores and blood stasis syndrome scores, and decrease the incidence of MACE in patients with ACS after successful PCI.     

急性心肌梗死冠脉多支病变介入治疗效果分析

目的探讨急性心肌梗死多支病变介入治疗单纯重建犯罪血管,与多支病变同时重建对病人远期预后的影响。方法2001-11~2005-01,我院心内科连续154例急性心肌梗死病例入选,均为冠脉造影多支病变、经过选择性冠脉内支架置入术(PCI)治疗并获得随访的急性心肌梗死患者,将仅接受犯罪血管重建者与多支病变血管支架植入者分为两组,药物治疗相同,各例定期于心血管门诊或电话随访。结果两组一般情况比较无明显差异、随访期内坚持药物治疗、术中长支架使用无明显差异(均P>0.05);而犯罪血管干预组糖尿病患者比例明显高、心电图ST段抬高者明显少;术后LVEF<0.40和血清肌酐升高者比例明显高增高;不稳定心绞痛、心肌梗死、血管重建等心血管事件明显增多(均P<0.05);心血管死亡略高,但无统计学差异(P>0.05),非心血管死亡明显高于多支血管重建组(P<0.05)。结论急性心肌梗死多支血管病变介入治疗单纯重建犯罪血管者预后较差,非心血管死亡增多,主要为糖尿病肾病的肾功衰竭。     

血浆纤维蛋白原和载脂蛋白AⅠ水平与急性冠脉综合征患者PCI术后近期预后的关系研究

[目的]通过观察行PCI术的急性冠脉综合征(ACS)患者血浆纤维蛋白原(FIB)及载脂蛋白AⅠ(ApoAⅠ)水平与患者PCI术后30 d内不良心血管事件(MACE)发生率的关系,探讨用FIB及ApoAⅠ水平对ACS患者PCI术后近期预后进行预测的可能性。[方法]测定121例入院后行PCI术的ACS患者,包括不稳定心绞痛(UA)组(n=53),急性心肌梗死(AMI)组(n=68),和64例除外器质性心脏病确诊为心血管神经症者(对照组)的血浆FIB、ApoAⅠ和ApoB水平。根据FIB水平将所有ACS患者分为:Ⅰ组(n=83):FIB<4 g/L,Ⅱ组(n=38):FIB≥4 g/L;按ApoAⅠ水平将所有ACS患者分为:Ⅲ组(n=78):ApoAⅠ≥1.0 g/L;Ⅳ组(n=43):ApoAⅠ<1.0 g/L。分别比较Ⅰ组和Ⅱ组,Ⅲ组和Ⅳ组患者PCI术后30 d的主要MACE的发生情况,分析影响ACS患者PCI术后近期预后的危险因素。[结果](1)AMI组FIB水平显著高于UA组和对照组(P<0.01)。AMI组与UA组同对照组比较ApoAⅠ明显降低(P<0.01),AMI组ApoAⅠ水平低于UA组(P<0.05)。(2)AMI组与UA组分别同对照组比较,ApoAⅠ/ApoB的比值差异有非常显著性意义(P<0.01)。(3)在MACE中,Ⅱ组与Ⅰ组比较,严重心律失常、充血性心力衰竭、心室壁瘤、心源性休克的发生率明显增加(P<0.05)。Ⅳ组与Ⅲ组比较,充血性心力衰竭发生率上有明显差异(P<0.05);Ⅱ组与Ⅰ组比较,Ⅳ组与Ⅲ组比较总事件率差异有非常显著性意义(P<0.01)。[结论]不同FIB和ApoAⅠ水平是影响ACS患者PCI术后近期预后的主要危险因素。     

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