cOptical coherence tomography application as guiding in percutaneous coronary intervention procedure one year follow up survey

Background Optical coherence tomography （OCT） is increasingly used in the process of percutaneous coronary intervention （PCI）, but there is still lack of data about the significance of OCT in the process of PCI. The study aimed to investigate the long term value of OCT in the procedure of PCI. Methods One hundred sixty-five patients with coronary artery disease and implanted drug eluting stents were enrolled in the retrospective study. OCT was performed after stent implantation to detect the complications in 82 patients, who were named as OCT group. And the other 83 patients without OCT application served the control group. Incidence of the angina pectoris, acute myocardial infarction, revascularization and cardiac sudden death was observed in the two groups during one year follow-up. Results At one year clinical follow-up, the incidences of angina and revascularization in OCT group were significantly lower than those in control group （angina： 3.66% vs. 18.07%, P 〈 0.05; revascularization： 2.44% vs. 12.04%, P 〈 0.05）, the incidence of acute myocardial infarction was not significantly different （2.44% vs. 4.82%, P 〉 0.05）. Conclusions OCT is a feasible technique for guidance of coronary interventions, and its application during PCI procedure can improve the clinical outcome.     

Hybrid minimally invasive coronary artery revascularization

Background Hybrid coronary revascularization(HCR) is an alternative coronary revascularization strategy that combines a minimally invasive, survival advantage of the left internal mammary artery(LIMA)-left anterior descending(LAD) coronary artery bypass with less-invasive percutaneous coronary intervention(PCI)to non-LAD coronary lesions by using drug-eluting stents. We report our experience of hybrid minimally invasive approach in 15 patients. Methods From December 2012 to October 2013, 15 patients underwent revascularization of the left anterior descending artery through minimally invasive coronary artery bypass grafting(MIDCAB). All patients by endoscopic assist beating heart coronary artery bypass grafting. Seven patients were scheduled for a hybrid procedure. Percutaneous coronary intervention of non- LAD was performed 3 to 5 days preoperatively. Demographic data, perioperative outcome, and annual follow-up were obtained from all the patients. Results In-hospital mortality was 6.67%. The rate of conversion to full median sternotomy was 13.3%. Ventilation time was 6.9 ± 5.1 h. Blood loss volume was 241 ± 67.8 mL. ICU stay was21.3 ± 10.8 h. Hospital postoperative stay lasted for 7.5 ± 1.3 days. Prior to PCI patients showed 100% patent LIMA(Tables 3 and 4). A mean follow-up was 8.5 months. One year graft patency rate was 100%(8 / 8patients for 254-slice tomography). Two patients required reintervention. Conclusions Minimally invasive hybrid coronary revascularization is a safe, feasible and efficacious approach with good results and should be performed in selected patients by surgeons with experience in minimally invasive bypass surgery plus collaboration with cardiologists. eluting stents.     

Ministernotomy for minimally invasive coronary artery bypass grafting

Background Through a ministernotomy ＂J shaped approach, left internal mammary artery （LIMA） bypass grafting to the left anterior descending artery （LAD） can be performed safely off-pump. To achieve a complete revascularization, percutaneous coronary interventions （PCI） with drug eluting stent implantation to other coronary arteries was used. We reported outcomes of the treatment of multivessel coronary artery disease with minimally invasive coronary artery bypass （MICAB） and PCI. Methods Between January 2009 and Dec 2012, 14 patients （11 males, 3 females, mean age was 64.8 _ 10.1 years. Two-vessel disease account for 35.7% （5/14） of these patients, three-vessel disease 64.2% （9/14） （Table 1）. All patients underwent a minimally invasive coronary artery bypass grafting via mini-sternotomy ＂J＂ shaped approach. Seven patients were followed by PCI, 7 for obtuse marginal circumflex, 5 for right coronary artery （RCA）. Angiographic assessment of graft patency was performed in all patients during the PCI procedure. The clinical follow-up period lasts from 11-24 months. Results The in-hospital mortality was 0%. There was neither conversion to a full median sternotomy nor intraoperative complications. Ventilation time was 6.6 ＋_ 4.1 h. Blood loss ranged 341 ＋_ 78.8 mL. ICU stay ranged 22.3 _ 12.8 h. Hospital postoperative stay lasted for 6.5 ＋ 1.6 days. Prior to PCI patients showed 100% patent left internal mammary artery. One patient had mediastinitis （Tables 2-3）. Rate of freedom from cardiac reintervention during the follow-up period was 92.8% （13/14）. Conclusions The inferior J-shaped sternotomy is simple, reproducible, and the safest technique for performing minimally invasive coronary bypass surgery. MICAB ＋ PCI is also safe, feasible and efficacious.     

Situation of antithrombotic therapy in elderly patients with atrial fibrillation and acute coronary syndrome

Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients(more than 60 years old) with non-valvular atrial fibrillation(NVAF) and acute coronary syndrome(ACS) / percutaneous coronary intervention(PCI).Methods This study enrolled 381 elderly patients [mean age(69.95 ± 8.41) years; 289 males, 92 females]with NVAF and ACS / PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups: triple therapy(TT) group, dual antiplatelet therapy(DAT) group,vitamin K antagonist(VKA) plus single antiplatelet therapy(SAT) group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients(9.97%) received TT and 300 patients(78.74%) received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2-VASc≥2 and HAS-BLED 3. Conclusions Elderly patients who suffered NVAF and ACS / PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT.     

Effect of jailed balloon technique on side branch protection in percutaneous coronary intervention for bifurcation lesions

Background Data comparing the jailed balloon technique （JBT） and conventional jailed wire technique （JWT） during percutaneous coronary intervention （PCI） for bifurcation lesions is scanty. Methods From January 2013 to June 2013, 192 consecutive patients undergoing elective PCI for de novo Medina 1,1,1 bifur- cation lesions were enrolled in this study. JBT and JWT were applied to protect the side branch （SB） at the discretion of the operator. Procedural outcomes were compared between the JBT and the JWT group. Results Seventy-four patients were treated with JBT and 118 with JWT. Proportion of patients achieving TIMI 3 flow in main branch （MB） was similar in both groups while in SB it was much lower in JWT group compared with JBT group （74.6% vs. 93.2%, P = 0.001）. In addition, patients in JWT group showed higher incidence of periprocedural myocardial infarction （MI） compared with patients in JBT group （11.9% vs. 2.7%, P = 0.008）. Similar tendency was observed in SB occlusion （18.6% vs. 5.4%, P = 0.009）. No device-related complications were observed in both groups. Conclusion JBT is an effective and safe measure to protect the SB during PCI for bifurcation lesions.     

Increasing Uric Acid Concentration in Elderly With Ischemic Cardiomyopathy

Objectives Plasma uric acid （UA） concentration was suspected to elevate in elderly with ischemic cardiomyopathy （ICM）. Methods We analyzed the data of 235 elderly aged 60 years and older with coronary heart disease： silent myocardial ischemia or angina pectoris confirmed by angiography. Among these patients, 154 had ICM defined as left ventricular end-diastolic diameter （LVDd） male 〉 55 mm, female 〉 50 mm （mean. 63.51 ± 7.70 mm） measured by echocardiography. Difference in UA was analyzed between patients with and without ICM. Results There was significant increase of UA in ICM compared with non-ICM （432.82 ± 143.05 umol/L vs 361. 06 ± 137.35 umol/L, P 〈 0. 05 ） ; and UA was positively related to LVDd （ r = 0. 25, P 〈 0. 05 ）. Conclusions There was significant increase of UA in elderly with ICM due to longterm silent myocardial ischemia and angina pectoris. Moreover, UA was positively related to LVDd. （ S Chin J Cardiol 2009; 10（4） ： 212 -215）     

A Comparative Study on Post-intervention Use of Tirofiban or Enoxaparin in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Objectives To evaluate the efficacy and safety of post procedure use of platelet glycoprotein Ⅱb/Ⅲ a receptor in- hibitor （PGI） or low molecular weight heparin （LMWH） in patients with acute coronary syndrome （ACS） undergoing dual anti-platelet loading therapy and percutaneous coronary intervention （PCI）. Methods This was a prospective randomized grouping controlled study in 174 patients with ACS received aspirin 300 mg plus clopidogrel 600mg loading before PCI. After procedure, patients were randomized to intravenous tirofiban for 12 -24 hours （tirofiban group） or subcutaneous enoxaparin for 5 days （enoxaparin group）. Cardiac ischemic events, major bleeding complications, minor bleeding complications, thrombocytopenia, and vascular access complications in both groups were investigated. Results Cardiac ischemic events, major bleeding complications, minor bleeding complications, thrombocytopenia, and vascular access complications in tirofiban group were 8.0% , 3.4% , 6.8% , 3.4% , and 3.4% , respectively. In enoxaparin group, aforementioned event rates were 7%, 2. 3%, 6. 0%, 2. 3%, and 5.8%, respectively. No statistical significance was found between two groups. Conclusions In the setting of dual anti-platelet medication loading and PCI for the treatment of ACS, it is effective to use tirofiban or enoxaparin for aggressive post procedure antithrombotic therapy. It comes with a very low major bleeding complication rate. Use of GPI for 12 to 24 hours was comparable to use of LMWH for 5 days in efficacy and safety.     

Effects of Late Reperfusion on Left Ventricular Function and Its Relationship With Viable Myocardium After Acute Myocardial Infarction in Patients With or Without Diabetes

Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）     

心绞痛患者PCI术前大剂量阿托伐他汀对围手术期心肌损伤的影响

经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）是所有采用经皮穿刺方法减轻冠状动脉狭窄的各种心导管技术的总称,早期PCI术主要是指经皮冠状动脉内血管成形术（percutaneous transluminal coronary angioplasty,PTCA）.自从1977年Gruzentig在瑞士完成世界上第一例PTCA后,心血管造影的临床应用日趋广泛,成为临床上判断冠状动脉病变部位和程度的＂金标准＂.     

替罗非班在急性冠脉综合征患者中的应用

急性冠脉综合征（acute coronary syndromes,ACS）是严重危害人类健康的一类疾病,包括不稳定型心绞痛（unstable angina pectons,UAP）、急性非ST段抬高型心肌梗死（non—ST segment elevated myocardial infarction,NSTEMI）和急性ST段抬高型心肌梗死（ST segment elevated myocardial infarction,STEMI）及猝死,     

Comparison Between Upstream Tirofiban and Downstream Tirofiban in Patients With Non-ST-segment Elevation Acute Coronary Syndromes at High-risk Undergoing Percutaneous Coronary Interventions： Efficacy and Safety

Objectives To compare the efficacy and safety of upstream tirofiban with downstream tirofiban in patients with non- ST-segment elevation acute coronary syndromes （NSTE-ACS） at high-risk undergoing percutaneous coronary intervention （PCI）. Methods Two hundred and four patients with NSTE-ACS at high-risk undergoing PCI were randomized to upstream （4 -6 hours before coronary angiography） tirofiban or downstream （with the guidewire crossing the lesion） tirofiban. We evaluated myocardial damage after PCI by qualitatively analyzing cardiac troponin I （cTnI） and MB isoenzyme of creatine kinase （CK-MB）. Platelet aggregation inhibition and thrombolysis in myocardial infarction （TIMI） flow grade were assessed. The incidences of major adverse cardiac events （MACE） at 24-hour, 90-day and 180-day after PCI were followed up. The incidences of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results There were 102 patients with NSTE-ACS randomly assigned to upstream group and downstream group respectively. The peak serum levels of cTnI within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.34 vs 0. 61 ; P 〈 0.05 ）. Post-procedural cTnI elevation within 48 hours was significantly less frequent among patients who received upstream tirofiban than downstream tirofiban （63 % vs 82%, P 〈 0. 05 ）. The peak serum levels of CK-MB as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （ 15 vs 18 and 38% vs 43% ; respectively; P 〉 0. 05 ）. ECG changes and the inhibition of platelet aggregation between two groups were similar （ P 〉 0.05 ）. Although the inci- dences of MACE at 90-day and 180-day after PCI were not statistically different, they were consistently lower with upstream tirofiban （3 % vs 6% and 6% vs 16% ; P 〉 0.05 ）. The incidences of bleeding complications and thrombocyto- penia were similar in the two groups （ 11% vs 9% ; P 〉 0.05 ）. Conclusions Among patients with NSTE-ACS at high-risk undergoing PCI, upstream tirofiban is associated with attenuated myocardial damage without increasing complications. （ S Chin J Cardiol 2009; 10（4） ： 179 -185）     

入院即刻血糖与急性冠脉综合征

入院即刻血糖可能反映机体在应激性刺激过程中产生的应激反应的强烈程度。入院即刻血糖的水平与体内炎症反应强度、血容量、血小板聚集及黏附等存在相关性。对入院即刻血糖的研究可以为评估急性冠脉综合征（acute coroary syndrome,ACS）患者的预后提供新的指标。现就入院即刻血糖的特性与急性冠脉综合征的关系作一综述。     

Prognosis of acute coronary syndrome complicated by stress hyperglycemia after percutaneous coronary intervention therapy

Background Several studies have reported an association of hyperglycemia with increased mortality and complications in hospital patients with acute coronary syndrome （ACS）. However, the influence of stress hyperglycemia （SH） on the medium- and long-term prognoses in ACS patients has not yet been determined. Methods Random venous blood glucose levels were determined in 433 ACS patients and the patients were divided into two groups based on blood glucose results and disease histories. The 171 patients included in the experimental group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up and had fasting blood glucose levels of I〉 7.0 mmol/L and random blood glucose levels 1〉 11.1 mmol/L. The 262 patients included in the control group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up, and had fasting blood glucose levels 〈 6.1 mmoL/L and random blood glucose levels 〈 7.8 mmol/L. Basic clinical information, coronary angiographic lesion characteristics, PCI success rate, complication rate, incidence and morbidity rate of cardiovascular events during the hospitalization period and 6 years of follow-up were compared between the two groups. Results There was no significant difference in age, gender or disease history between the two groups. The triglyceride levels and the left ventricular ejection fractions were significantly higher （P = 0.00） and significantly lower （P = 0.03） in the experimental group than in the control group, respectively. Both groups were subjected to coronary angiography and PCI. The PCI success rates of the two groups did not differ significantly （P = 0.63）. The experimental group had more type B2 lesions, but fewer type A lesions compared with the control group. The experimental group had significantly more stents implanted compared with the control group （P 〈 0.05）. The cardiovascular events were significantly increased （P = 0.01） in the experimental group compared with the control group 1 year after discharge. The incidence of cardiovascular events did not differ significantly between the two groups 1-2 years after discharge. The event incidences were significantly higher （P -- 0.05） in the experimental group than in the control group at the end of follow-up. The experimental group was more prone to myocardial infarction and ischemic target vessel revascularization than the control group, but the control group was more prone to unstable stenocardia and heart failure than the experimental group. The psychogenic mortality of the two groups were similar. The interval and the overall mortality rates （P = 0.054） of the two groups were also similar. Conclusions Patients with ACS complicated by SH were more likely to have cardiovascular events 1 year after PCI, whereas SH did not affect the mid- or long-term prognoses of these patients. SH is an independent risk factor for cardiovascular events.     

罕见冠状动脉畸形成功PCI一例

1病例资料 患者老年男性,62岁,以“阵发性胸闷、胸痛10余天”为主诉入院。既往史：高血压3-4年,血压最高160／110mmHg（1mmHg=0．133kPa）,一直口服药物治疗,血压控制欠佳。     

急性冠脉综合征抗血小板治疗新进展

急性冠脉综合征（acute coronary syndromes,ACS）是以冠状动脉粥样硬化斑块破溃,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征。     

Predictive treadmill score to identify coronary artery disease

Background Exercise treadmill testing(ETT) is widely used for the diagnosis of coronary artery disease(CAD).The high false-positive and false-negative rates hamper its clinical application.Hypothesis:We examined a hypothesis that combined ETT and risk-factors of CAD to develop an easily applied predictive treadmill score(PTS) and the superiority of the novel score over the conventional ETT criteria was tested.This score can improve the diagnostic accuracy of treadmill testing for Chinese patients with suspected CAD and plan management strategies for such patients.Methods The present study comprised a retrospective analysis of 300 ETTs of Chinese patients with chest pain referred to suspected CAD who also had coronary angiography within one month after ETT.Clinical characteristics and ETT results of those with and without angiographic CAD were compared.A logistic regression model was used to construct a PTS that could accurately predict clinically significant CAD,defined as the presence of at least one 70 % angiographic stenosis in a major epicardial coronary artery.The accuracy of the new PTS was compared to conventional criteria of ETT for CAD diagnosis.Results The study included 185 patients with clinically significant CAD(61.6 %) and 115(38.4 %) without CAD.Patients with significant CAD were older,more cigarettes smokers,and had higher prevalence of hypercholesterolemia,diabetes mellitus and serum CRP concentration.The PTS for CAD was derived from the logistic regression equation:Y(-1,1) =-6.94 + 0.07Age + 0.56Smoking + 0.7DM + 0.6TC /HDL + 0.6ST + 3.5Symptom-0.01HR.According to the derived Y value,the study subjects were classified as low,intermediate and high risk CAD groups,if Y -1,-1 ≤ Y ≤ 1,and Y 1 respectively.The area under the curve(AUC) of our PTS on the receiver operating curve(ROC) was 0.863.Using the PTS,the specificity,false-positive rate and the predictive accuracy for CAD detection were significantly improved compared to conventional ETT diagnostic criteria(73.6% vs.56.9%;26.4% vs.43.1%;77.6% vs.71.8%,P 0.05).Conclusions A new predictive treadmill score for CAD diagnosis was validated and found superior to the conventional criteria of ETT for the diagnosis of CAD in Chinese patients presenting with chest pain.     

心肌血流储备分数在冠心病诊断及介入治疗中的应用研究进展

冠状动脉造影（CAG）是目前诊断冠心病最常用和最重要的手段,是进一步行经皮冠状动脉介入治疗（PCI）或冠脉搭桥术（CABG）的金标准。但是随着对冠脉血流动力学及病理学研究的不断深入,单纯冠脉造影提供的形态学已不能满足临床对狭窄病变解剖特征和生理功能评价的需要。     

Relationship between cortisol rhythms and depressive women with coronary heart disease

Background Major depressive disorder has been identified as a risk factor for cardiovascular disease (CVD). The underlying mechanisms linking depression and CVD are not fully understood, one of the mechanisms in women is disturbed cortisol regulation. The aim of this study was to evaluate cortisol rhythm in suspected female CVD patients with depression. Methods A total of 80 female patients with suspected CVD (typical angina pectoris or under a non-typical symptoms plus positive exercise tests or positive myocardial perfusion scans) were recruited. Four blood samples for cortisal were taken over the day and night. Depression was assessed using the Beck Depression Inventory (BDI). Results Forty-three (53.8 %) patients were diagnosed as definite CVD on angiography,while the remainder did not. Cortisol showed a typical diurnal pattern, with peaks in the morning and low down in the evening. The cortisol slope over the day was flatter in depressed patients with CVD (P 0.01), but was not related to depression in patients without CVD (P = 0.096). This effect was due to the combination of lower cortisol early in the day and higher cortisol in the evening in more depressed CVD patients, independent of age, education, household income, marital status, living alone and and sleeping. Comparison of cortisol secretion rhythm in total patients between the CVD group and non-CVD group, BDI≥10 group and BDI 10 group, the differences were not significant (P 0.05). Conclusions The flat cortisol rhythms of depressive CVD patients may be associated with the progression of CVD in women.     

药物洗脱支架的研发现状和展望

近年来,在第一代药物洗脱支架（drug—elutingstents,DESs）并发的支架内血栓形成（stentthrombosis,ST）的机制研究基础上,国内外研发产业为了防止血管再内皮化过程的延迟和减少ST的发生,特别是降低晚期sT（1atestentthrombosis,     

肌钙蛋白诊断老年急性冠脉综合征的意义

心肌肌钙蛋白Ｔ（cTnt）是调节心脏肌肉收缩的肌钙蛋白复合体组成之一,健康人血液中含量很低,在心肌损伤时释放入血,具有在血中出现时间早、灵敏度高、诊断窗口时间长等优点,被认为是心肌损伤的特异性标志物.