老年非ST段抬高急性冠状动脉综合征患者早期PCI的临床疗效分析

目的 评价老年非ST段抬高急性冠状动脉综合征(ACS)患者早期行经皮冠状动脉介入治疗(PCI)的临床疗效.方法 对58例发病在48 h以内的老年非ST段抬高ACS患者早期行PCI.观察患者术后主要不良心血管事件(包括再次心肌梗死、靶血管再次血管重建和死亡)的发生情况.结果 冠状动脉造影(CAG)显示2支或2支以上血管病变的患者占74.14%,B型和C型病变占89.66%.58例患者共干预病变血管76支,靶病变87处,置入支架96个.56例患者手术成功,手术成功率96.55%(56/58).对55例患者术后随访6～14个月,无心肌梗死和死亡发生.6例(10.91%)患者术后4～10个月复发心绞痛,5例行CAG复查,发现2例支架再狭窄和3例新的血管病变,对4例病变血管狭窄程度超过75%的患者进行了靶病变再次血管成形术.结论 老年非ST段抬高ACS患者冠状动脉病变常为复杂、多支病变,对其早期行PCI成功率高,近期及远期疗效良好,主要不良心血管事件发生率低,安全可行.     

冠状动脉杂交术治疗冠状动脉多支病变的中远期临床疗效及安全性

目的对比冠状动脉杂交术与经皮冠状动脉介入治疗(PCI)治疗冠状动脉多支病变患者中远期临床疗效及安全性。方法采用前瞻性随机对照研究,从2012年1月到2014年6月,选择行冠状动脉造影诊断为冠状动脉多支病变,适宜行冠状动脉旁路移植术(CABG)及PCI处理的冠心病患者102例,随机分为两组:冠状动脉杂交术组(n=53)和PCI组(n=49),治疗目标为达到最大限度完全血运重建。术后1、3、6、9、12个月及两年随访,术后12个月行冠状动脉造影检查,评估靶血管通畅率及SYNTAX评分,记录患者临床状况及心血管不良事件,评价两组患者两年内心血管不良事件的发生率、生存率。结果冠状动脉杂交术组造影剂用量低于PCI组(P0.001),两组IABP支持、监护室时间、LCX及RCA置入支架数差异无统计学意义(P0.05),冠状动脉杂交术组平均住院时间、总支架长度及术后hs-CRP峰值低于PCI组,冠状动脉杂交术组造影剂肾病、急性心衰、复发心绞痛及术后低血压发生率也低于PCI组(P0.05),两组院内再次心肌梗死、靶血管血运重建、脑血管意外及死亡差异无显著性(P0.05)。术后随访2.4年,平均16.2±11.3个月。随访期间冠状动脉杂交术组再次心肌梗死、靶血管血运重建、急性心衰及复发心绞痛发生率低于PCI组(分别是1.9%比8.2%、1.9%比8.2%、3.8%比12.2%、5.7%比14.3%,P0.05),两组脑血管意外、主要出血事件及死亡差异无显著性;冠状动脉杂交术组两年总死亡率为3.8%,PCI组为4.1%。冠状动脉杂交术组术后1年靶血管通畅率为94.1%,高于PCI组的85.1%,SYNTAX评分低于PCI组(P0.05)。结论与PCI术相比,冠状动脉杂交术可以减少冠状动脉多支病变患者治疗后中远期不良事件,且手术安全性高。     

高龄急性心肌梗死患者直接PCI治疗的安全性及近期疗效分析

目的探讨高龄(75岁以上)急性心肌梗死(AMI)患者行直接冠状动脉介入治疗(PCI)的安全性及住院期间的预后。方法将连续247名接受直接PCI治疗的ST段抬高的AMI患者分为3组:≥75岁为高龄组(研究组,63例),65～74岁(老年组,80例)及<65岁(低龄组,104例)患者为对照组,比较高龄组及两个对照组患者接受直接PCI治疗的安全性及住院期间的预后。结果高龄组患者的外周血管严重病变、冠状动脉多支病变及钙化弥漫性病变多于两个对照组,但三组PCI治疗的成功率相当(分别为90.5%、93.8%和95.2%,P>0.05);高龄组患者PCI后24h内肾功能恶化的发生率显著高于对照组;高龄组患者住院期间严重心血管事件(死亡、再梗死)的发生率较高(分别为12.7%、7.5%、2.9%,P=0.02)。大出血发生率差异无统计学意义。结论ST段抬高的高龄AMI患者直接行PCI治疗安全可行;但近期疗效略逊于低龄患者。     

经皮冠状动脉介入治疗冠心病10 225例经验总结

目的分析经皮冠状动脉介入治疗(PCI)的发展及现状,为进一步提高PCI水平提供借鉴。方法回顾性分析1989年8月至2007年4月沈阳军区总医院心内科10225例PCI的冠心病住院患者的17762处靶病变临床和造影基线分布特征、PCI策略及围术期结果。结果患者年龄22～92岁,平均59.9岁。合并糖尿病2057例(20.1%),急性冠状动脉综合征8647例(84.6%),急性心肌梗死(AMI)急诊PCI1428例(14.0%),心源性休克477例(4.7%),多支病变6701例(65.5%),左主干病变483例(4.7%),慢性完全闭塞病变(CTO)1795例(17.2%)。总的病例成功率为98.5%,病变成功率98.3%,其中左主干病变成功率99.6%,CTO病变成功率90.5%。支架置入占总病例数的89.8%,人均置入支架1.45枚。AMI急诊PCI患者住院病死率4.4%(63/1428),AMI合并心源性休克患者住院期病死率19.7%(42/213)。围术期总病死率1.1%(113/10225),其中术中心源性死亡2例(0.02%),术后心源性死亡80例(0.8%)。围术期急诊冠状动脉搭桥2例(0.02%),急性、亚急性支架内血栓58例(0.57%),术中慢血流或无复流127例(占AMI急诊PCI总数的8.9%),总的围术期重要并发症发生率3.6%,其中与PCI操作相关的并发症发生率0.48%。存活出院者心绞痛缓解率98.6%。结论在技术成熟的心内科,PCI适应证范围广、成功率高、并发症发生率低、近期疗效较好,可作为冠心病的首选治疗手段之一,尤其对于AMI、心源性休克、左主干病变等高危患者,PCI可显著改善患者的近期预后。     

分站式冠状动脉杂交术对比PCI术治疗冠心病多支病变的中期预后及血管通畅性研究

目的探讨分站式冠状动脉杂交术对比冠状动脉介入术治疗冠心病多支血管病变的中期临床预后及安全性。方法采用前瞻性对照研究,从2012年1月到2016年6月,入选冠心病患者106例,作为冠状动脉杂交术组(HCR组),前降支病变行微创小切口下冠状动脉旁路移植术(MIDCAB)处理,其余冠状动脉分支病变于术后7天行单纯冠状动脉介入治疗(PCI)处理;采用倾向性评分方法,匹配临床基线特征,入选106例冠状动脉多支病变患者作为PCI组,冠状动脉病变单纯行PCI处理。术后1、3、6、9、12月及2年各进行一次随访,记录主要不良心脑血管事件(MACCE)及次要终点事件。使用SYNTAX评分、Euro SCORE评估术后2年冠状动脉病变复杂及风险程度;评估2年靶血管通畅率;Kaplan-Meier法比较两组随访期间MACCE发生率及靶血管通畅生存时间;术后2年评估心功能指标,包括心脏超声参数、B型脑利钠肽、6 min步行距离。结果术后随访时间为2.3年,平均18.2±8.3个月。HCR组和PCI组MACCE发生率分别为9.5%和25.9%(P=0.035);HCR组再次血运重建率低于PCI组(4.8%比11.5%,P=0.038),心肌梗死、脑血管意外、主要出血事件、死亡差异无显著意义(P0.05);HCR组全因死亡率为0.9%,PCI组全因死亡率为4.8%(P=0.104);HCR组2年生存率为99.1%,PCI组为95.2%(P=0.532)。HCR组急性心衰、复发心绞痛发生率低于PCI组(P=0.048和P=0.011);术后2年HCR组MACCE的发生率低于PCI组(P=0.003);2年随访结束,两组总造影复查率为90.1%;HCR组术后2年随访中期靶血管通畅率为94.6%,高于PCI组的84.5%(P=0.037)。术后2年HCR组靶血管通畅率高于PCI组(P=0.042),HCR组SYNTAX评分低于PCI组(12.2±3.1比19.6±4.8,P0.001),HCR组Euro SCORE低于PCI组(2.2±1.1比2.7±1.3,P=0.031),HCR组LVEF高于PCI组(63.3%±9.4%比60.1%±8.5%,P=0.029),HCR组LVEDD、LVESD均低于PCI组(P=0.043和P=0.037),HCR组6 min步行距离高于PCI组(496±57 m比413±68 m,P=0.042)。结论分站式冠状动脉杂交术对比PCI治疗冠心病多支病变患者,2年中期随访期间不良事件发生率更低,靶血管通畅率更高。     

397例急性冠状动脉综合征急诊介入治疗的即刻和随访结果

目的分析过去59个月期间开展急诊经皮冠状动脉介入治疗(PCI)的397例急性冠状动脉综合征(ACS)患者的即刻和随访结果.方法1999年3月～2004年1月对397例ACS患者经股动脉或桡动脉施行急诊PCI.310例ST段抬高性心肌梗死(STEMI)患者施行直接PCI治疗,补救PCI治疗7例STEMI,急诊PCI治疗80例不稳定型心绞痛或非ST段抬高性心肌梗死(UA/NSTE-MI).结果直接PCI手术操作成功率99%,术中无复流发生率10.6%.42例(13.5%)应用了主动脉气囊反搏术,10例应用了远端保护装置.8例发生支架内急性/亚急性或后期支架内血栓形成,住院死亡17/310例(5.5%),6个月死亡17/250例(死亡率6.8%).补救性PCI术后6例患者的严重心肌缺血和(或)急性肺水肿的症状得到明显改善,1例合并心源性休克的多支血管病变患者术后1小时死亡.UA/NSTEMI的介入操作成功率96.3%,所有患者的临床缺血症状迅速改善.一例发生支架内亚急性血栓形成.结论直接PCI扩大了治疗STEMI的适应证,迅速使梗死相关动脉开通并恢复正常血流,在高危患者存活率高,住院时间缩短.补救性PCI是静脉溶栓治疗失败后的一种有效补救措施,但是同样具有较高风险.急诊PCI对于改善UA/NTEMI患者的缺血症状非常有效,再缺血、再梗死和再闭塞发生率低.     

1433例慢性完全闭塞病变的冠状动脉支架术治疗

目的探讨提高CTO病变PCI成功率的方法.方法对1993年6月至2004年6月实施PCI治疗的1433例CTO患者的临床资料、病变特征和PCI治疗结果进行回顾性分析.PCI人选标准有心肌缺血的主观表现或客观证据.结果男性1176例(占82.1%),女性257例(占17.9%),年龄25～86(平均59.8±11.3)岁.共涉及CTO靶血管1823支,靶病变共1855处.CTO平均闭塞时间48.3±32.6(1～204)个月.绝对性CTO(TIMI血流0级)1646支(占90.3%).有桥侧支形成的靶CTO血管339支(占17.6%).逆向侧支循环者1035支(占56.8%).刀切状CTO607支(占33.2%).CTO闭塞段≥15mm的CTO病变1042支(占57.2%).病变近端或病变处弯曲≥90度有279支(占15.3%).病变近端或病变处钙化246支(占13.5%).距闭塞处＜1mm距离有分支发出的CTO病变血管499支(占27.3%).CTO位于血管开口处为849支(占46.6%),位于血管远端434支(占23.8%).CTO靶血管共置入冠状动脉支架1853枚.支架长度平均(24.8±6.7)mm.支架直径平均(2.9±0.7)mm.72例CTO患者置入药物洗脱支架95枚,其中Cypher支架44枚、Taxus支架51枚.术中99例行临时起搏术(占6.9%);33例行IABP治疗(占2.3%).经股动脉完成1291例(占90.1%),经桡动脉完成142例(占9.9%).168例应用了双侧冠脉造影、3例应用了对侧导丝、67例应用了平行导丝(parallel)或导丝互参照(seesaw)、21例应用了双导丝(buddy)技术.行旋磨术3例.共开通1328例患者CTO靶病变1694处,全部植入支架,术终1322例患者的1688处靶病变达TIMI3级血流(89.5%),病例成功率为92.3%(1322/1433),病变成功率为91.0%(1688/1855).功能性CTO、无桥侧支CTO、鼠尾状CTO、闭塞段15mmCTO的病变成功率较高,P＜0.05.失败的105例中82例因导丝不能通过CTO病变(占失败病例的78%),23例因球囊不能跨越病变(占22%),术中无死亡病例,支架内急性血栓形成2例,心包穿孔9例(发生率0.6%).术后住院期间共死亡3例,总住院病死率为0.2%,均为PCI失败者,其中2例猝死,1例死于慢性肾衰急性发作并脑梗塞.术后支架内亚急性血栓形成4例(发生率0.3%),均经急诊PCI治愈.结论本组CTO病变及病例成功率略高于国内大多数报导,且术中无死亡等严重并发症发生.在高难度CTO的开通成功率上与国外大中心相似,可能得益于我们较多采用亲水涂层或表面超滑的硬导丝,适当地应用平行导丝、导丝互参照和双导丝技术.另外,仔细阅读造影图像,科学、合理地安排有经验的术者和手术时间,以及手术组密切协作也对提高CTO治疗成功率有一定影响.     

冠状动脉旁路移植术后再次急性冠状动脉综合征患者的冠状动脉造影分析

目的分析接受冠状动脉旁路移植术(CABG)后的患者再次发作急性冠状动脉综合征(ACS)的时间与相关血管的关系.方法从本院1997～2001年间因CABG术后再次发作ACS而入院的168例患者中,选出行再次冠状动脉造影的患者43例,男38例,女5例,平均年龄(57.9±10.2)岁,再次发作ACS时间在术后次日至11年间.分析术后再次发作ACS的时间与罪犯血管之间的关系.结果 (1)由原自身冠状动脉血管病变加重导致的ACS共19例,占44.2%,由移植血管病变导致的共24例,占55.8%,其中12例移植血管病变发生在术后半年内,占移植血管病例的50%,且大部为吻合口病变.(2)从发作时间上划分,在术后次日至半年内发作ACS的为14例,占所有分析病例的32.6%.其中12例为移植血管病变所致,占整组病例的27.9%.随时间的延长,引起ACS的相关血管既有移植血管,也有原自身冠状动脉血管远端病变加重的血管,但术后3年内发作的ACS大多数由移植血管病变引起,检出率为75%,特异度为63%(P<0.01),3年后发生的ACS主要为未移植血管的原自身冠状动脉或移植血管远端的原自身冠状动脉血管病变加重所致.(3)所分析的43例患者共置入静脉血管桥99支,病变37支,总病变率37.4%,动脉桥31支,病变9支,总病变率29.0%.两者间差异有显著性(P<0.01).(4)桥病变的发生与患者综合危险因素间无明确相关性.结论 CABG术后3年内发作的ACS,其相关移植血管病变检出率为75%,特异度为63%,尤其半年内发生ACS的患者,移植血管病变检出特异度达89%,而且大部分为吻合口病变.移植血管病变的发生率与综合危险因素之间无明确相关性,但静脉移植血管的闭塞率要高于动脉移植血管.     

强化降糖治疗对急性冠状动脉综合征合并糖尿病患者经皮冠状动脉介入治疗预后的影响

目的评价强化降糖治疗对急性冠状动脉综合征合并糖尿病（ACS＋DM）患者冠状动脉介入治疗（PCI）的效果和预后。方法选择2005年1月至2007年6月行PCI的ACS患者278例,按是否合并糖尿病分为ACS＋DM组（91例）和非糖尿病ACS组（NDMACS组,187例）,ACS＋DM组患者严格控制血糖水平,使HbAbl〈6．5％。两组均应用DES支架行PCI术治疗,ACS＋DM组和NDMACS组分别行急诊PCI术20例（22．0％）和49例（26．2％）,分别行择期PCI术71例（78．0％）和138例（73．8％）。随访36-48个月,观察手术成功率,住院期间和远期心血管事件发生率。结果ACS＋DM组患者中女性比例和三支血管病变明显高于NDMACS组,差异有统计学意义（62．6％比46．0％,P〈0．05;58．2％比33．2％,P〈0．05）。ACS＋DM组和NDMACS组PCI术成功率分别为96．7％和97．3％。两组术后并发症、住院期间心血管事件发生率和随访期间心血管事件发生率比较差异无统计学意义（P〉0．05）。结论强化降糖治疗可使ACS＋DM患者PCI术后获得与NDMACS患者同样的疗效和预后。     

直接PCI治疗高龄急性ST段抬高性心肌梗死

目的 评价高龄急性ST段抬高性心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者行直接经皮冠状动脉介入(pereutaneous coronary intervention.PCI)治疗的安全性和有效性.方法 对比分析46例高龄STEMI患者(高龄组)和64例年轻STEMI患者(年轻组)冠状动脉造影特征、直接PCI治疗的情况,即刻手术成功率、住院及随访期间主要心血管事件的发生情况.结果 高龄组与年轻组比较,冠状动脉病变多为多支病变(73.9%比28.1%,P<0.01);2组手术即刻成功率无明显差异;2组术后达到心肌梗塞溶栓(thmmbolysis in myoxardial infarction,TIMI)3级血流患者比率无明显差异;高龄组手术操作时间较年轻组长[(64.4±25.4)min比(49.7±21.8)min,P<0.05];高龄组住院期间、随访期间累计总的主要心血管事件发生率明显高于年轻组.随访期间,高龄组1例术后4个月猝死,死亡原因不明,1例术后1年死于脑出血;年轻组无死亡病例.结论 对高龄STEMI患者行直接PCI治疗是比较安全而有效的再灌注手段.     

80岁以上冠心病患者血运重建的临床结果分析

目的评价年龄≥80岁的高龄冠心病患者血运重建治疗后的近期与远期临床结果 ,探讨远期不良事件的预测因素。方法选择接受冠状动脉血运重建治疗的冠心病患者(≥80岁)63例,记录其人口学资料、临床特征、冠状动脉造影和血运重建情况以及主要不良心脑血管事件(MACCE)。对所有患者进行电话或门诊随访,多因素Cox比例风险回归模型分析远期不良事件的预测因素。结果 85.7%的患者为多支病变。分别有81.0%和19.0%的患者接受PCI和冠状动脉旁路移植术(CABG)治疗,PCI成功率为98.0%,CABG成功率为83.3%,血管重建总成功率为95.2%。院内MACCE发生率为4.8%。中位随访时间为541(444～667)d,随访率为95.2%。总MACCE发生率为14.3%,病死率为11.1%;累积生存率为88.5%,累积无MACCE生存率为83.0%。多因素Cox分析,既往血运重建史、慢性完全闭塞病变以及是否循环支持是总MACCE的独立危险因素。结论年龄≥80岁的高龄冠心病患者接受血运重建治疗安全可行,成功率较高,院内不良事件发生率较低,远期生存率较高。     

In-hospital outcome in octogenarians with acute coronary syndrome undergoing emergent coronary angiography

Very elderly patients have higher mortality rates than younger patients after acute coronary syndrome (ACS). However, the mechanism by which increasing age contributes to such mortality remains unclear. In addition, the efficacy and safety of invasive coronary procedures for octogenarians with ACS have not been well established. We compared the clinical characteristics and in-hospital outcome of 193 octogenarians (mean age, 83 years) with those of 1,462 younger patients (mean age, 64 years) with ACS who underwent emergent coronary angiography. Octogenarians included a greater number of females, had higher rates of cerebrovascular disease and multivessel disease, a higher Killip class, a higher Forrester class, and lower rates of smoking, diabetes, and hypercholesterolemia than the younger subjects. Interventions, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), were performed less frequently in octogenarians than in younger patients (88.0% versus 90.8%). The procedural success rate in octogenarians did not differ from that in younger patients. However, the in-hospital mortality rate for the octogenarians was about three times higher than for the younger patients (19.2% versus 6.9%). Multivariate analysis revealed that the predictors of in-hospital mortality in the octogenarians were a higher Killip class and a higher Forrester class. Octogenarians with ACS had fewer coronary risk factors and a similar success rate for the intervention, but had more greatly impaired hemodynamics and higher in-hospital mortality than the younger patients. Therefore, impaired myocardial reserve may contribute to a large portion of in-hospital deaths in octogenarians with ACS.     

SYNTAX积分预测冠心病复杂病变患者经皮冠状动脉介入治疗预后的作用

目的评价SYNTAX积分对冠心病3支病变和(或)左主干病变患者PCI预后的作用。方法经冠状动脉造影证实的3支病变和(或)左主干病变并接受PCI的患者1 90例。对每例患者造影结果进行SYNTAX评分,SYNTAX评分按三分位数分为:低分组、中分组和高分组,通过门诊或电话随访患者主要不良心脑血管事件(MACCE)。结果经PCI的冠心病3支病变和(或)左主干病变190例患者中,29例出现MACCE,发生率为15.3%。SYNTAX积分低分组、中分组及高分组的MACCE发生率分别为9.1%、1 6.2%及30.9%。Cox多因素分析显示,SYNTAX积分HR=2.07,95%CI:1.25～3.44,差异有统计学意义(P=0.005)。结论 SYNTAX积分是预测PCI预后的较理想工具,该积分系统也适用于我国冠心病3支病变和(或)左主干病变患者PCI术后预后的预测。     

75岁以上急性冠状动脉综合征患者介入治疗性别对比研究

目的探讨75岁及以上老年急性冠状动脉综合征患者介入治疗的临床特点及近期疗效的性别差异。方法选择75岁及以上老年急性冠状动脉综合征患者307例,男181例,女126例,统计临床特点、冠状动脉病变支数及部位、手术成功率和住院病死率。结果急性冠状动脉综合征3种临床类型分布在男性与女性差异无统计学意义,以不稳定性心绞痛和ST段抬高心肌梗死为主。男性血运重建史明显多于女性(18.8%υs 5.6%,P=0.001);女性原发性高血压明显多于男性(74.6%υs 61.3%,P=0.015),血脂异常明显多于男性(62.7%υs 46.4%,P=0.005)。冠状动脉造影男性与女性均以3支病变为主(63.0%υs 70.6%,P=0.1 60),男性双支病变明显多于女性(29.3%υs 17.5%,P=0.018)。手术成功率和院内病死率差异无统计学意义(P>0.05)。ST段抬高心肌梗死logistic回归分析显示,心源性休克、病变血管部位(左前降支)、年龄、血糖是老年患者住院死亡的独立预测因素。结论老年女性高血压和血脂异常多于男性;冠状动脉病变均以3支病变为主,男性双支病变多于女性;急性冠状动脉综合征临床类型和PCI的近期疗效无性别差异。     

85岁及以上老年冠心病患者经皮冠状动脉支架治疗的临床观察

目的 探讨85～94岁冠心病患者经皮冠状动脉支架治疗的疗效和预后.方法 回顾性分析90例85岁以上冠心病患者经皮冠状动脉支架治疗的临床和造影特点、住院期间和长期疗效.结果 90例中,21例应用金属裸支架(BMS),69例应用药物洗脱支架(DES).三支病变41例,2支病变21例,单支病变28例.手术成功率为94.4%,术前与术后TIMI-3级血流比例分别为72.2%和94.4%.手术相关并发症为15.6%,主要为冠脉夹层(11.1%).住院期间主要心血管不良事件(MACE)为7.8%,其中DES组住院期间MACE为5.8%,BMS组为14.3%.DES组出现2例严重出血.86例患者随访1年时,总的MACE为4.6%,其中DES组为6.0%,BMS组没有任何MACE.DES组出现]例脑卒中和1例严重出血.47例患者随访2年时,总的MACE为14.9%,其中DES组MACE为19.4%,BMS组无任何MACE.DES组1例发生严重出血,BMS组1例发生脑卒中.多因素COX回归分析表明,肌酐水平和高血压是影响长期预后的重要因素.结论 85岁以上冠心病患者经皮冠状动脉支架治疗手术成功牢较高,住院期间和长期的MACE事件发生率较低,并存高血压和严重.肾功能不全的患者MACE的发生率相对较高.     

Percutaneous coronary intervention in unprotected left main coronary artery stenosis: Mid-term outcomes of a single-center observational study

BackgroundPercutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected left main coronary artery (ULMCA) disease in patients with low-to–intermediate anatomic complexity or when the patient refuses CABG even after adequate counselling by heart team. We assessed the safety, in-hospital and mid-term outcomes of ULMCA stenting with drug-eluting stents (DES) in Indian patients.MethodsOur study was a retrospective analysis of patients who had undergone ULMCA PCI at a tertiary center, between March 2011 and February 2020. Clinical characteristics, procedural data, and follow-up data were analyzed. The primary outcome was a composite of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospital stay and at follow-up. The median follow-up was 2.8 years (interquartile range: 1.5–4.1 years).Results661 patients (mean age, 63.5 ± 10.9 years) had undergone ULMCA PCI. The mean SYNTAX score was 27.9 ± 10.4 and the mean LVEF was 58.0 ± 11.1%. 3-vessel disease and distal lesions were noted in 54% and 70.6% patients, respectively. The incidence of in-hospital MACCE was 1.8% and the MACCE during follow-up was 11.5% (including 48 [8.4%] cardiac deaths). The overall survival rates after one, three, five, and nine years were 94%, 88%, 84%, and 82%, respectively. The multivariate analysis revealed that age >65 years and high SYNTAX scores were independent predictors of mid to long-term mortality.ConclusionULMCA PCI with DES is safe and has acceptable in-hospital and mid-term outcomes among patients with low-to–intermediate SYNTAX score.     

CHA2DS2-VASc score as a novel predictor for contrast-induced nephropathy after percutaneous coronary intervention in acute coronary syndrome

BackgroundCHA2DS2-VASc score, used for atrial fibrillation to assess the risk of embolic complications, have shown to predict adverse clinical outcomes in acute coronary syndrome (ACS), irrespective of atrial fibrillation. This study envisaged to assess the predictive role of CHA2DS2-VASc score for contrast-induced nephropathy (CIN) in patients with ACS undergoing percutaneous coronary intervention (PCI).MethodsA total of 300 consecutive patients with ACS undergoing PCI were enrolled in this study. CHA2DS2-VASc score was calculated for each patient. These patients were divided into two groups as Group 1 (with CIN) and Group 2 (without CIN). CIN was defined as increase in serum creatinine level ≥0.5 mg/dL or ≥25% increase from baseline within 48 h after PCI. After receiver operating characteristic curve analysis, the study population was again classified into two groups: CHA2DS2-VASc score ≤3 group (Group A) and score ≥4 group (Group B).ResultsCIN was reported in 41 patients (13.6%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. Receiver operating characteristic curve analysis showed good predictive value of CHA2DS2-VASc score for CIN (area under the curve 0.81, 95% CI 0.73–0.90). Patients with a CHA2DS2-VASc score of ≥4 had a higher frequency of CIN as compared with patients with score ≤3 (56.8% vs 4.8%; p = 0.0001) with multivariate analysis demonstrating CHA2DS2-VASc score of ≥4 to be an independent predictor of CIN.ConclusionIn patients with ACS undergoing PCI, CHA2DS2-VASc score can be used as a novel, simple, and a sensitive diagnostic tool for the prediction of CIN.     

并发心房颤动对经皮冠状动脉介入治疗效果的影响

目的:探讨并发心房颤动(房颤)对冠心病患者经皮冠状动脉介入治疗(PCI)近期和远期临床结果的影响。方法:选择接受PCI治疗的冠心病患者3 893例,根据有无房颤分为无房颤组(A组,3 802例)和并发房颤组(B组,91例),分析房颤对冠心病患者PCI术后住院和随访期间不良心脑血管事件(MACCE)的影响。结果:A组与B组院内死亡、心肌梗死、脑卒中和再次血运重建发生率比较,差异无统计学意义;A组、B组随访时间中位数分别为535d、520d,B组MACCE发生率较A组有增高趋势(15.4%∶11.4%),主要为全因死亡率较高(5.7%∶1.7%,P=0.019),心肌梗死、脑卒中和再次血运重建发生率相当。结论:并发房颤的冠心病患者接受PCI术后的远期死亡率明显高于无房颤患者,房颤是预测PCI术后远期死亡率增高的独立危险因素。     

Left main coronary stenting in a non surgical octogenarian population: a possible approach

Coronary artery bypass grafting is conventionally considered the standard treatment for significant left main coronary artery (LMCA) disease. The management of LMCA disease in octogenarians is however still debated. The aim of this study was to appreciate the safety and effectiveness of percutaneous coronary intervention (PCI) for LMCA disease in octogenarians who were denied for surgical revascularization. The study included 70 consecutive patients ≥80 years of age who had undergone PCI for the treatment of LMCA and who were primary denied by our center's heart team for surgical revascularization. Mean age was 83.4±2.6 years. Mean Euroscore was 21.1±16.7 and mean Syntax score was 28.6±8.7. Overall in-hospital mortality was 11%. Mean follow-up time was 30.5±24.2 months. Overall mortality at the end of follow-up was 28%. Cardiac death was found in 18 patients and 2 patients died from terminal renal insufficiency. One patient (2%) presented with a new STEMI, 7 (11.3%) with a new non-STEMI, 13 (21%) with heart failure, and 2 (3.2%) had minor hemorrhage. There was a percutaneous target vessel revascularization in 6 (10%) patients. During follow-up, the total major adverse cerebral and cardiovascular event (MACCE including death, non-fatal acute myocardial infarction (AMI), target lesion revascularization (TLR), or stroke) was 27.4%. Stent implantation was relatively safely applied for the treatment of LMCA disease in octogenarians who were refused for surgery and who represented a high risk population. Despite a non-negligible rate of MACCE, the clinical long term outcome seems correct for this specific population with heavy basal status.