冠心病患者介入治疗前后血清C-反应蛋白变化与心血管事件和再狭窄的关系

目的探讨冠心病患者介入治疗前后血清C-反应蛋白(CRP)水平变化与术后住院期间及术后6个月内心血管事件和再狭窄发生的关系.方法选择97例住院接受经皮冠状动脉腔内成形术(PTCA)及单支病变的冠状动脉支架置入术(CS)冠心病患者[其中30例稳定型心绞痛(SAP)和67例急性冠脉综合征(ACS)]术前及术后48h测定血清CRP水平.按术后CRP水平分为2组,即A组(CRP水平＜3.0mg/L,n=35)及B组(CRP水平≥3.0mg/L,n=62),分析并记录患者术后1周以及术后6个月内心血管事件及支架内再狭窄发生等情况.结果ACS组PT-CA术后48h血清CRP水平较术前明显升高(P＜0.01);血清CRP水平ACS组比SAP组明显升高(P＜0.01);B组术后1周内的心血管事件发生率显著高于A组(P＜0.05);B组术后6个月的心血管事件及支架内再狭窄发生率显著大于A组(P＜0.01).结论PTCA术后48h血清CRP水平较术前增高,是单支冠状动脉病变支架置入术后6个月内预后的预测指标,提示术后近、远期的临床疗效与支架置入术后血管壁的炎症反应增强有关.     

糖尿病合并分叉病变患者单双支架介入策略的比较

目的 探讨糖尿病合并冠状动脉分叉病变人群采用单双支架策略的预后差异.方法 回顾性研究了入选DK-Crush Ⅰ-Ⅳ系列试验的糖尿病合并冠状动脉真性分叉病变患者211例.其中,单支架策略组(PS组)119例,双支架策略组(DS组)92例,均使用了雷帕霉素洗脱支架.PS组于下述情况以“T”支架术式置入分支支架:(1)分支血管残余狭窄≥50％;(2)TIMI血流小于3级;(3)合并B型以上夹层.DS组采用DK-Crush技术56例(60.9％),“T”型支架置入技术26例(28.3％),Culotte技术置入10例(10.9％).无论DS组抑或PS组在支架置入后均强调完成分支高压后扩张和主、分支最终球囊对吻( FKI).主要研究终点为术后9个月内的主要不良心脏事件(MACE,包括心源性死亡、非致死性心肌梗死、再发心绞痛,再次靶血管重建),次要研究终点为9个月时血管造影主支和分支血管再狭窄.结果 9个月随访期内DS组与PS组的发生MACE分别为12例(13.0％)和14例(11.8％),两组间差异无统计学意义(x2=0.079,P＞0.05).随访血管造影主支再狭窄DS组与PS组分别为10例(10.9％)和12例(10.1％),组间比较无差异统计学意义(x2=0.034,P＞0.05),但分支再狭窄DS组18例(19.6％)显著低于PS组46例(38.7％)x2=8.948,P=0.003.结论 在糖尿病合并冠状动脉分叉病变患者中,单支架策略与双支架策略的9个月随访期的主要不良心脏事件无差异,但双支架策略显著减少了分支再狭窄.     

70岁以上冠心病患者支架植入术治疗效果及安全性评估

目的 评价70岁以上冠心病患者冠状动脉内支架植入后的治疗效果及其安全性.方法 回顾性比较95例70岁以上和321例70岁以下冠心病患者冠状动脉内支架植入术后,两组患者的治疗效果和心绞痛复发、再狭窄,急性心肌梗死、死亡、靶血管血运重建等主要心脏不良事件的发生情况. 结果 (1)两组患者病变支数(χ2=0.52,0.47,0.21,P均>0.05)及病变累及部位(χ2=1.02,1.23,1.17,P均>0.05)构成比较,差别无统计学意义;(2)两组患者冉狭窄发生率比较,差别无统计学意义(χ2=1.03,P>0.05);(3)两组患者急性心肌梗死发生率比较,差异无统计学意义(χ2=0.67,P>0.05).70岁以上组远期主要心脏不良事件(MACE)、心绞痛复发、靶血管血运重建、死亡分别为13.4%、6.0%、3.7%、2.4%,高于70岁以下组的8.4%、4.4%、1.5%、0.7%(2/321)(χM2分别为3.21、2.98、4.12、3.65,P均<0.01). 结论 70岁以上和70岁以下冠心病两组患者冠状动脉内支架植入术治疗效果相近,主要心血管病事件中除急性心肌梗死发生率外,差异有统计学意义.70岁以上冠心病患者冠状动脉内植入支架是安全有效的,主要心血管病事件比70岁以下冠心病患者发生率要高.     

TAP技术与必要性支架术处理冠状动脉分叉病变的疗效对比

目的 对比分析TAP技术与必要性支架术在处理边支大于2.0 mm冠状动脉分叉病变的临床效果.方法 将患者随机分为必要性支架组和TAP组.入选病例的冠状动脉造影均证实为MEDINA(1,1,1)型分叉病变,主支血管参考直径≥2.5 mm,边支血管参考直径≥2.0 mm.主要研究终点:术后12个月主要不良心血管事件的发生率和支架血栓发生率.次要终点包括:术后8个月冠状动脉造影随访再狭窄率、手术操作时间、曝光时间、对比剂用量、手术操作成功率、手术相关心肌梗死.结果 TAP组均完成最终对吻球囊扩张.12个月随访结果显示,TAP组主要不良心血管事件和必要性支架组差异无统计学意义(13.0%比12.1%,P＞0.05).两组均发生1例支架血栓事件.TAP组与必要性支架组术后24 h操作相关心肌梗死发生率差异无统计学意义(8.7%比5.2%,P＞0.05).两组在手术时间、X线曝光时间、对比剂用量差异无统计学意义.8个月冠状动脉造影结果显示,必要性支架组边支开口再狭窄明显高于TAP组(17.1%比3.8%,P＜0.05),总体再狭窄率两组差异无统计学意义.结论 TAP技术在处理大分支冠状动脉分叉病变的有效性及长期安全性方面不亚于必要性支架术.     

雷帕霉素洗脱支架对糖尿病患者经皮冠状动脉介入治疗的远期影响

目的分析雷帕霉素洗脱支架(SES)对糖尿病患经皮冠状动脉介入治疗后的远期影响。方法采用回顾性研究方法,在1004．例接受冠状动脉内支架术治疗的冠心病患中,84例糖尿病和250例非糖尿病患置入SES;168例糖尿病和502例非糖尿病患置入普通支架。记录并比较一般临床资料、冠状动脉造影及冠状动脉内支架术情况、远期心脏事件发生率和1年无心脏事件生存率。结果随访期间(平均16．2个月),SES组中糖尿病亚组和非糖尿病亚组的远期心脏事件发生率为4．8％比3．6％,P=0．744;1年无心脏事件生存率为95．0％比96．7％,P=0．602,两亚组差异均无统计学意义。但BMS组中,糖尿病亚组的远期心脏事件发生率显高于非糖尿病组(31.0%比21．7％,P=0．015);两亚组的1年无心脏事件生存率分别为74．2％比86．8％(P=0．001)。结论SES能显改善糖尿病患冠状动脉支架术的远期疗效,降低靶病变再狭窄和远期心脏事件的发生率,提高1年无心脏事件生存率。     

药物洗脱支架联用普通金属支架治疗多支冠状动脉病变的疗效评价

目的探讨多支冠状动脉病变患者药物洗脱支架与普通金属支架(普通支架)联用预防再狭窄的疗效及安全性。方法801例行多支冠状动脉内支架置入术达到完全血运重建的冠心病患者分3组。药物洗脱支架组206例、药物洗脱支架与普通支架联用组(联用组)158例及普通支架组437例。比较3组支架术后近期及远期结果。结果3组患者冠心病危险因素、心功能、冠状动脉病变程度、支架术成功率及并发症发生率均无显著差异。术后平均随访(17.3±10.9)个月,总随访率和造影随访率无显著差异。联用组普通支架置入于31.3%的前降支病变(均为A、B1型病变)及81.6%的回旋支病变和69.9%的右冠状动脉病变。与普通支架组相比,药物洗脱支架组和联用组造影再狭窄率明显降低,分别为20.3%vs7.3%和8.8%(P均<0.05),且主要不良心脏事件发生率均较低,分别为18.4%vs6.5%和9.9%(P均<0.05)。但药物洗脱支架组与联用组相比上述各指标无显著差异。结论多支冠状动脉病变患者单用药物洗脱支架或合理联用普通支架后再狭窄率降低,安全性近似,均优于单用普通支架。     

冠心病合并2型糖尿病药物洗脱支架置入远期预后及影响因素研究

目的观察冠心病合并2型糖尿病(DM)患者置入药物洗脱支架(DES)的远期预后及其影响因素分析。方法入选2006年3月至2009年3月沈阳医学院沈洲医院冠心病合并DM患者253例,首次冠脉介入(PCI)治疗置入DES,随访12个月以上,记录主要不良心血管事件(MACE)及支架内血栓(ST),支架内再狭窄,再发心绞痛发生情况。结果平均随访时间为(13.1±3.6)个月,42例(17.87%)发生MACE、ST及再发心绞痛,发生事件组冠心病家族史,既往急性心肌梗死者,左主干PCI,多支血管病变,CTO病变,病变数及重度病变明显多于非事件组(P0.05);急性心肌梗死及CTO为影响远期预后的独立危险因素。结论对于冠心病合并DM患者DES可降低再狭窄率,患者远期预后与自身病情及病变有关,综合危险因素管理更为重要。     

药物洗脱支架与金属裸支架对非糖尿病患者冠状动脉局限病变的8个月疗效

目的评估非糖尿病冠心病患者,药物洗脱支架与金属裸支架对于治疗冠状动脉局限病变的8个月疗效.方法自身冠状动脉首次介入治疗病变(在线定量冠状动脉造影分析直径≥3.0 mm,长度≤15 mm)的非糖尿病患者入选本研究,148例患者分为药物洗脱支架组(n=81)和金属裸支架组(n=67),两组的基本临床特征和冠状动脉造影结果无显著差异.术前、术后和8个月随访时进行定量冠状动脉造影分析,并在住院期间,30天和8个月时观察不良心脏事件的发生.结果支架置入成功率均为100%.住院期间靶病变重复血管重建率,在药物洗脱支架组和金属裸支架组无显著性差异(1.2%和0%,P=0.36).在术后30天时两组均无支架内血栓形成.8个月随访时,定量冠状动脉造影分析显示,支架内最小管腔直径药物洗脱支架组明显大于金属裸支架组,有极显著性差异(P＜0.01);支架内远期管腔丢失、病变内远期管腔丢失、支架内狭窄直径、病变内狭窄直径药物洗脱支架组明显低于金属裸支架组有显著性差异(P＜0.05～0.001).两组支架内再狭窄率(8.64% vs 17.91%,P=0.09)和病变节段再狭窄率(11.11% vs 17.91%,P=0.24)均无显著性差异,但支架内再狭窄率比数比为0.8985(95%的可信区间0.7887;1.0237).结论药物洗脱支架对于治疗非糖尿病、自身冠状动脉局限病变患者安全有效,两组支架内再狭窄率虽无显著性差异,但药物洗脱支架有降低再狭窄率的趋势.     

血管内超声指导下对小血管病变的介入治疗

目的评价血管内超声(IVUS)对小血管病变介入治疗的临床意义。方法回顾性分析2010年10月²013年2月于我院接受介入治疗的单支小血管(≤2.5mm)病变患者共237例,其中,IVUS指导下介入治疗的患者105例(Ⅰ组),冠状动脉造影(CAG)指导下介入治疗的患者132例(Ⅱ组)。分析2组患者基线资料、病变特点、介入治疗及随访期间心脏不良事件和再狭窄情况。结果 2组患者介入治疗均成功,Ⅰ组和Ⅱ组置入支架直径[(2.50±0.40)mmvs(2.34±0.37)mm]、支架长度[(28.75±7.77)mmvs(35.78±10.45)mm]、支架高压后扩张(91.4%vs55.3%)和支架内再狭窄(1.9%vs 7.6%)比较,差异有统计学意义(P=0.002,P=0.000,P=0.000,P=0.042);2组串联支架、CAG随访比较差异无统计学意义(P>0.05)。2组患者住院及随访1、3和6个月期间,均无主要不良心脏事件发生。结论对于小血管病变的介入治疗,IVUS具有较好的指导作用。     

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.     

2型糖尿病对冠状动脉左主干病变介入治疗预后的影响

目的:探讨合并2型糖尿病对接受经皮冠状动脉介入治疗(PCI)的冠状动脉左主干病变患者预后的影响.方法:回顾性分析中国医学科学院阜外医院2004年1月至2015年12月接受PCI的冠状动脉左主干病变的患者3960例.根据患者是否合并2型糖尿病分为糖尿病组(1084例)和非糖尿病组(2876)例.收集纳入患者的临床资料、实...     

Diabetes mellitus and unstable coronary artery disease: improved clinical outcome of coronary artery stenting in an era of glycoprotein IIb/IIIa inhibitors and lipid-lowering therapy

OBJECTIVE: The short- and long-term clinical outcomes of coronary artery stenting in diabetic patients with unstable coronary artery disease were assessed and compared with a cohort of non-diabetic patients in the context of platelet glycoprotein IIb/IIIa inhibitors and lipid-lowering therapy. METHODS: The study population comprised 252 consecutive patients with unstable angina who underwent coronary artery stenting; of these 46 were diabetic and 206 were non-diabetic. In-hospital results and clinical outcome during follow-up (24 +/- 13 months, range 7-56 months) were obtained in all patients without major in-hospital complications. Survival curves and multivariate models for any late clinical event were reported. RESULTS: A high clinical success rate and no difference in in-hospital complications between the two groups of patients were observed. Complete revascularization rate was similar in diabetic and non-diabetic patients (48% compared with 52%). A greater proportion of diabetic than non-diabetic patients received IIb/IIIa inhibitors during the procedure and lipid-lowering drugs at hospital discharge (87% compared with 46%, P=0.001 and 83% compared with 61%, P=0.006 respectively). At 2-year clinical follow-up, the incidences of death and myocardial infarction were similar in both groups; the need for any revascularization was only slightly higher in diabetic patients (P=NS). Incomplete revascularization and multi-vessel disease were independent predictors of any revascularization. CONCLUSIONS: Coronary artery stenting combined with glycoprotein IIb/IIIa inhibitor infusion and long-term lipid-lowering therapy is an effective therapeutic strategy in diabetic patients with unstable coronary artery disease and is associated with good short- and long-term results, comparable to those observed in non-diabetic patients.     

2型糖尿病合并急性冠状动脉综合征患者血运重建预后的评价

目的探讨2型糖尿病合并急性冠状动脉综合征(acute coronary syndrome,ACS)患者经血运重建治疗对远期预后的影响。方法选择ACS患者424例,根据是否合并糖尿病分为糖尿病组(120例)和无糖尿病组(304例)。分析两组患者冠状动脉造影、冠状动脉支架置入术的临床资料以及两组患者术后2年的随访资料。结果糖尿病组患者冠状动脉3支、多支、闭塞性病变比率明显高于无糖尿病组(P<0.05):糖尿病组患者不完全血运重建的比率高于无糖尿病组,完全血运重建的比率低于无糖尿病组(P<0.05):糖尿病组惠青生活质量改善率低于无糖尿病组,重大心血管事件的发生率高于无糖尿病组(P<0.05)。结论糖尿病合并ACS患者冠状动脉以3支、多支、重度、闭塞病变为主的特点,且其远期预后较差。     

老年糖尿病合并冠心病患者的冠状动脉病变与其临床症状及预后的关系

目的探讨老年糖尿病（DM）合并冠心病（CAD）患者的冠状动脉病变与其临床症状及预后的关系。方法对100例老年DM合并CAD患者（DM组）和102例老年非DM合并CAD患者（NDM组）的冠脉造影结果、Holter结果和随访期内所发生的心脏事件进行统计分析，分别记录各组的冠脉病变特点、24h心肌缺血特点、严重心律失常发生率和心脏事件发生率。结果DM组冠脉三支病变、弥漫性病变比例、血管狭窄数目明显高于NDM组（分别为42．0％对18．6％，P〈0．001、37％对23．5％，P〈0．05、3．51±1．64对2．10±1．12，P〈0．05）；其Holter结果显示：24h心肌缺血发作次数、ST段压低幅度、ST段压低总时间、缺血发作平均时间和严重心律失常发生率也明显高于NDM组[分别为（5．9±1．7）次对（3．2±0．9）次、（2．8±0．7）mm对（1．8±0．5）mm、（56．1±5．2）min对（33．4土2．8）min、（11．3±3．1）min对（6．2±1．8）min和54．0％对26．5％，P分别〈0．05、〈0．05、〈0．05、〈0．05和〈0．0013；Hoher记录到的心肌缺血发作时，临床发生典型心绞痛症状的比例DM组明显低于NDM组（为8．0％对19．6％，P〈0．05）；随访期内，DM组发生心脏不良事件的比率明显高于NDM组（10％对4．9％，P〈0．05）。结论老年DM合并CAD患者的冠脉三支病变比例明显高于NDM患者；Hoher监测到这类患者的心肌缺血发作次数、缺血程度、缺血持续的时间以及严重心律失常的发作次数也明显高于NDM患者，但临床上多缺乏典型的心绞痛症状，不易引起人们的重视；随访期内心脏事件的发生率高于NDM患者，提示预后不良。     

Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients

Patients with diabetes mellitus are at increased risk for repeat interventions and mortality after coronary angioplasty and stenting. The efficacy of sirolimus-eluting stents (SESs) to improve the outcomes of these patients is a focus of interest. In the first 1,407 patients treated with SESs at our institution, 492 were diabetic (insulin dependent diabetes mellitus [IDDM], n = 160 and non-insulin-dependent DM [NIDDM], n = 332). The in-hospital and 1- and 6-month clinical outcomes were compared with those of 915 patients without DM (non-DM). The baseline characteristics were similar, except for more women, obesity, previous myocardial infarction, coronary artery bypass grafting, and renal insufficiency in the DM group (p <0.001). Compared with non-DM patients, DM patients had higher in-hospital (p <0.05) and 1-month mortality (p = 0.02). IDDM patients had more in-hospital renal failure (p = 0.04) and Q-wave myocardial infarctions (1.6% vs 0%, p = 0.04) compared with NIDDM patients, and higher mortality (3.1% vs 0.8%, p = 0.04) and subacute stent thromboses (2.3% vs 0.5%, p = 0.07) than non-DM patients at 30 days. At 6 months, DM patients had a higher incidence of Q-wave myocardial infarction, target lesion revascularization-major adverse cardiac events, and composite of death and Q-wave myocardial infarction than non-DM patients (6.0% vs 2.7%, p = 0.01). Late outcomes between the IDDM and NIDDM groups were similar. Multivariate analysis showed diabetes and acute renal failure as independent predictors of target lesion revascularization-major adverse cardiac events. In conclusion, our data showed that, despite a reduction in repeat revascularization, coronary intervention with SESs in diabetic patients is limited by higher mortality at 1 month and a higher incidence of Q-wave myocardial infarction and target lesion revascularization-major adverse cardiac events at 6 months compared with non-DM patients. Careful surveillance is required in IDDM patients undergoing SES implantation.     

Initial and follow-up results of the European Seaquence coronary stent registry

The primary objective of the present study was to assess the feasibility and the safety of the Seaquence stent (CathNet-Science) deployment for the treatment of coronary artery disease and the event-free survival of patients treated with this coronary stent. The study was conducted as a multicenter, prospective, observational registry. Patients with stable or unstable angina pectoris who were candidates for percutaneous coronary intervention with elective stenting of one single de novo lesion in a native coronary artery > or =3 mm in diameter were included in the study. Clinical follow-up was performed at 1 month and 9 months. Major adverse coronary events (MACE), that is, cardiac death, myocardial infarction, and target vessel revascularization (re-PTCA or CABG), were recorded over a period of 9 months. Using this stent, a 99% in-hospital success rate was achieved. A total of 17 patients presented MACE (8.7%) during the whole follow-up period and target lesion revascularization was needed for 14 (7.1%) patients. Using multivariate analysis only some clinical parameters (patients treated for unstable angina, with a history of CABG or of female gender) were found as independent predictors of MACE after coronary stenting. Procedural related factors, angiographic characteristics, or reference diameter were not found to influence clinical outcome. Because the study was performed in patients with a high proportion of complex lesions (relative high-risk nonselected population with nearly one third calcified lesions, many long and type B2 and C lesions) we can conclude that the coronary Seaquence stent can be considered as a stent of reference in routine practice.     

120例无保护左主干冠状动脉病变药物洗脱支架术的临床疗效和随访研究

目的探讨药物洗脱支架(DES)在无保护左主干冠状动脉(LMCA)病变的疗效。方法回顾性分析符合条件连续的120例无保护LMCA病变患者行DES的疗效,将其分为分叉病变组(80例)和非分叉病变组(40例)两组,根据病变特点行单支架术或双支架术,分析其支架术的操作特点,住院期间及出院后随访其主要心脏不良事件(MACE,包括死亡、非致死性心肌梗死及靶病变重建)及支架内血栓形成(ST)的情况。结果两组间的临床基线情况差异无统计学意义,共106(88.3%)例患者完成随访,分叉病变组更多使用血管内超声(IVUS)指导治疗(但P>0.05),分叉病变组33例行双支架术,非分叉病变组5例行双支架术(P=0.001),住院期间无MACE及支架内血栓(ST)发生,出院随访平均(26.3±14.5)个月,MACE11例(9.2%),总共死亡3例(2.8%),都是SYNTAX积分及EuroSCORE均属高危的患者,非致死性心肌梗死2例(1.9%),靶病变重建(TLR)6例(5.7%),造影再狭窄6例(占造影随访患者的15.8%),两组ST各1例,两组间MACE差异无统计学意义(7.5%比12.5%,χ2=0.801,P=0.503)。结论在选择性患者行DES治疗无保护LMCA病变不论是否分叉病变近远期的安全性和有效性可以接受。     

Short- and long-term results after multivessel stenting in diabetic patients

OBJECTIVES: The present study evaluated clinical outcomes in diabetic patients after multivessel stenting. BACKGROUND: Multivessel angioplasty studies have reported decreased survival in diabetic patients undergoing conventional balloon angioplasty compared with coronary artery bypass graft surgery (CABG). However, several studies have demonstrated excellent procedural success and acceptable clinical outcomes after multivessel stenting. METHODS: Multivessel stenting was performed in 689 patients with 1,639 native coronary lesions. Patients were classified into three groups according to diabetes mellitus (DM) status: 1) no DM (501 patients/1,200 lesions); 2) DM treated with oral agents (102 patients/235 lesions); and 3) DM treated with insulin (86 patients/204 lesions). RESULTS: Procedural success was high overall. In-hospital CABG was higher in diabetics treated with insulin compared with the other two groups (3.5% vs. 0.4% vs. 1.0%, p = 0.02). There were no significant differences in the incidence of in-hospital cardiac death and myocardial infarction. Diabetic patients treated with oral agents or insulin had higher one-year target lesion revascularization rates than non-diabetic patients (25% vs. 35% vs. 16%, p < 0.001). Lower one-year survival was observed in diabetic patients treated with either oral agents or insulin, compared with non-diabetic patients (85% vs. 86% vs. 95%, p < 0.001). On multivariable analysis, DM was an independent predictor of one-year mortality, myocardial infarction, and target lesion revascularization after multivessel stenting. CONCLUSIONS: Despite a high technical success rate of multivessel stenting, diabetic patients, especially those treated with insulin, have higher in-hospital CABG, higher subsequent revascularization rates, and lower one-year survival than non-diabetic patients.     

二代支架时代数据中糖尿病对无保护左主干患者不同血运重建术预后的影响

目的:在二代支架时代,糖尿病对不同血运重建策略治疗无保护左主干冠状动脉疾病患者的影响尚未可知。方法:回顾性入选823例无保护左主干冠状动脉疾病的患者,其中接受二代药物洗脱支架(DES)置入治疗的患者331例(糖尿病患者,n=99;非糖尿病患者,n=232),接受冠状动脉旁路移植术(CABG)患者492例(糖尿病患者,n=127;非糖尿病患者,n=365)。我们根据不同的血运重建策略比较了糖尿病对临床结果的影响。结果:在接受血运重建的无保护左主干病变患者中,糖尿病患者占27.5%(226/823)。经过平均25.3个月的随访后发现,在接受DES治疗的人群中,糖尿病患者与非糖尿病患者的全因死亡率、心源性死亡率、血运重建发生率、卒中和主要不良心脑血管事件的发生率没有显著差异。然而,在全因死亡/心肌梗死/卒中联合终点(糖尿病组21.5%vs.非糖尿病7.2%,P=0.001)及心肌梗死发生率(糖尿病组15.4%vs.非糖尿病组1.6%,P<0.001)中,糖尿病患者明显高于非糖尿病患者。在接受CABG治疗的群体中,糖尿病组和非糖尿病组所有临床终点发生率相似。结论:在二代药物洗脱支架治疗无保护左主干病变的患者中,合并糖尿病的患者较非糖尿病组预后较差,在接受CABG的患者中,糖尿病和非糖尿病组预后相似。     

Value of peri-procedural B-type natriuretic peptide levels in predicting cardiac events after elective percutaneous coronary intervention

OBJECTIVE: B-type natriuretic peptide (BNP) has diagnostic and prognostic value in a wide variety of cardiac disorders including heart failure and acute coronary syndromes. We aimed to evaluate the prognostic value of baseline and post-procedural BNP levels in predicting major adverse cardiac events (MACE) in stable coronary artery disease (CAD) patients undergoing elective percutaneous coronary intervention (PCI). METHODS: Blood samples for BNP were obtained before, 1 hour and 24 hours after PCI of stable CAD patients who underwent elective PCI for de novo lesions in native coronary arteries. Patients were followed for 12 months for the occurrence of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, hospitalization with angina or repeat revascularization. RESULTS: Among the 95 patients with one-year follow-up data 22 had MACE. Baseline clinical and procedural characteristics of patients with and without MACE were similar. Only EF was significantly lower (P < 0.001) and complex lesion type was significantly more common in patients with MACE (P = 0.012). All measured plasma BNP levels were significantly higher in patients with MACE compared to those free of MACE (baseline P < 0.001, 1st hour P = 0.001 and 24th hour P < 0.001). Multiple logistic regression analysis identified the EF (P = 0.026) and 24th hour BNP (P = 0.002) as independent predictors of MACE. If baseline or post-PCI 1st hour BNP levels were put into analysis instead of post-PCI 24th hour BNP the predictive value of BNP lost its significance (both P > 0.05). CONCLUSION: Post-PCI 24th hour BNP is an independent predictor of MACE during 12 months of follow-up after elective successful PCI.