局部心肌存活状态与冠状动脉旁路移植术后远期心血管事件的关系

目的:探讨左心室各节段心肌存活状态与冠状动脉旁路移植术(CABG)后远期心血管事件之间的关系.方法:选择我院1999-01-01至2005-12-31行CABG且术前进行了核素心肌灌注和代谢单光子发射型计算机断层显像(SPECT)存活心肌试验的冠心病患者.排除院内死亡患者后共709人进入本研究.于术后定期进行随访.调阅上述患者核医学资料,以左心室17节段对术前心肌灌注和存活情况进行半定量评分并进一步得出量化结果,在此基础上计算出左心室5节段即前壁、间壁、侧壁、下后壁、心尖的灌注和存活情况.通过COX多因素分析的统计手段探寻各节段心肌灌注、存活情况与远期心脏不良事件之间的关系.结果:平均随访时间为(3.43±2.42)年.COX多元分析表明:左心室心尖、侧壁心肌存活的情况是远期心原性死亡的独立保护性因素;左心室前壁和侧壁的心肌存活情况是远期再入院的独立保护性因素;左心室前壁、侧壁心肌存活情况是远期复合终点事件的独立保护性因素.结论:左心室前壁和心尖部、侧壁的存活心肌情况是影响远期预后重要的独立相关因素.对于前壁部分心肌梗死的患者,注重前壁再血管化的同时,亦应充分注重侧壁的完全再血管化,这对于远期预后有重要意义.     

经皮冠状动脉介入治疗导致正常冠状动脉急性血栓闭塞2例

目的报告2例急性心肌梗死患者行经皮冠状动脉介入治疗(PCI)导致相邻正常冠状动脉发生急性血栓闭塞的经过。方法1例患者在前降支行PCI时,造成正常左回旋支内急性血栓闭塞。另1例在行左回旋支PCI时,造成正常前降支内急性血栓闭塞。结果1例患者因发生前降支和回旋支急性闭塞,产生心室颤动而死亡。另1例对前降支新发血栓行PCI等抢救成功。结论对急性心肌梗死患者靶血管行PCI时,可导致血栓逆行栓塞其相邻的正常血管,造成冠状动脉急性闭塞,故在操作中注意技巧。     

核素心肌显像在冠状动脉慢性完全闭塞临床诊疗中的应用价值

冠状动脉慢性完全闭塞(CTO)较为常见且预后不良.虽然CTO患者经皮冠状动脉介入治疗(PCI)的成功率已较以往明显提高,但PCI的治疗决策仍是有争议的问题.研究表明:CTO血管支配区域是否存在心肌缺血和存活心肌可能与从PCI中获益的CTO患者的筛选及其预后密切相关.现综述应用核素心肌灌注显像和心肌代谢显像分别评估CTO...     

多巴酚丁胺~(99m)锝-MIBI心肌断层显像对预测心肌梗塞后患者冠脉病变的价值

与冠脉造影对照,用多巴酚丁胺~(99m)锝-MIBI心肌断层显像(Dobu—ECT)预测62例心肌梗塞后患者冠脉病变的价值.对所有血管有明显狭窄病变者,82%可被Dobo—ECT检出病变血管区域心肌有缺损;对多支血管病变者,有84%可被检出有多支血管供血区域心肌缺损.检测重度血管狭窄的敏感性高于中等度血管狭窄(P<0.01).Dobu-ECT对检出右冠状动脉敏感性为94%,均高于前降支或回旋支,但特异性低于前降支或回旋支,仅为63%.结论:多巴酚丁胺~(99m)锝-MIBI心肌显像能够准确识别心肌梗塞后具体冠脉病变.     

冠状动脉内膜剥脱术在冠心病外科治疗中的运用

目的 探讨冠状动脉内膜剥脱术在冠心病外科治疗中的运用,评估其临床疗效。方法 19例冠心病患者接受非体外循环冠状动脉旁路移植术,术中运用冠状动脉内膜剥脱术,分析围手术期临床资料,中期随访不良事件的发生率,总结冠状动脉内膜剥脱术的技术要点。结果 19例病例术中共行冠状动脉内膜剥脱35处,其中前降支系统7支（37%,其中前降支5支、对角支2支）,回旋支系统2支（10%）,右冠状动脉系统10支（53%,其中主干4支、后降支6支）;4例患者同时行2支血管内膜剥脱。患者无围术期心肌梗死和手术死亡;中期随访无心绞痛发作,术后1年冠状动脉CTA提示所有吻合口通畅率为92.5%。结论 冠状动脉内膜剥脱术能安全、有效地实现冠状动脉完全再血管化,近中期效果满意,是治疗弥漫性冠状动脉病变的有效方法。     

冠状动脉旁路移植术和药物支架植入术远期疗效的比较

目的比较冠心病患者非药物治疗手段冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）术后的桥血管和支架的再通率。方法CABG术后和药物支架植入术后再次出现心绞痛症状的冠心病患者各40例,其年龄、性别、心肌梗死、高血压、高脂血症、心功能不全、脑卒中、药物治疗病史具有可比性。通过冠状动脉造影术比较两组患者的桥血管和药物支架的效率和寿命的远期效果。结果与行CABG患者的桥血管比较,行PCI患者的药物支架远期狭窄或者闭塞率降低34．3％。与行CABG患者的左乳内动脉（LIMA）桥血管比较,行PCI患者的左前降支的药物支架远期狭窄或者闭塞率降低14．8％。与行CABG患者的左回旋支和右冠状动脉静脉桥血管比较,行PCI患者的左回旋支以及右冠状动脉的药物支架远期狭窄或者闭塞率降低49．8％。结论冠状动脉药物支架植入术的远期通畅率较CABG明显增高,冠状动脉药物支架植入术的药物支架的效率和寿命要优于CABG的桥血管。     

96例冠状动脉心肌桥患者临床特征及治疗体会

目的 探讨冠状动脉心肌桥的特征及临床疗效.方法 总结选择性冠脉造影1300例患者的临床资料,对96例冠状动脉心肌桥患者的特征及临床疗效进行分析.结果 96例（男性47例,48.6%）患者中心肌桥主要发生于左冠状动脉前降支94例（97.9%）、回旋支2例（2.1%）,孤立性心肌桥51例（53.1%）,合并单支病变31例（32.3%）、双支病变14例（14.6%）.所有患者均应用β受体阻滞剂和（或）钙通道阻滞剂治疗,70例症状缓解,23例伴＞70%冠状动脉固定狭窄患者对靶血管行PCI,术后症状缓解,1例行冠脉搭桥术.结论 冠状动脉心肌桥多发生于左前降支,男女检出率差异无统计学意义.孤立性心肌桥患者症状多不典型,多数药物治疗效果较好.     

320排动态容积CT冠状动脉成像与心肌灌注成像的相关性研究

目的探讨320排动态容积CT冠状动脉成像(computed tomography coronary angiography,CTCA)显示的冠状动脉狭窄程度与CT心肌灌注成像(CT myocardial perfusion imaging,CT-MPI)显示的心肌灌注缺损之间的相互关系。方法对60例冠状动脉疾病患者行CTCA及CT-MPI检查,将其结果进行统计学处理,并进行Spearman等级相关分析。结果 CTCA显示冠状动脉左前降支(left anterior descending,LAD)、左回旋支(left circumflex artery,LCX)、右冠状动脉(right coronary artery,RCA)180支,其中正常冠状动脉56支,狭窄冠状动脉124支。按照LAD、LCX、RCA三支冠状动脉供血范围统计,CT-MPI显示86支冠状动脉灌注正常,94支冠状动脉存在灌注缺损。结论冠状动脉狭窄程度与心肌灌注缺损存在正相关的关系。     

正-逆灌并选择性桥血管灌注技术在重症冠状动脉旁路移植术中的价值

目的 总结和分析顺-逆灌并选择性桥血管灌注技术在重症冠状动脉旁路移植术（coronary artery bypass grafting,CABG）中的应用价值.方法 回顾分析2010年6月至2011年12月河南省人民医院收治的重症冠状动脉粥样硬化性心脏病（冠心病）患者152例的临床资料.术前患者均常规行冠状动脉造影术,其中合并左主干病变46例,狭窄程度均大于70％,左前降支完全闭塞51例,前降支及右冠状动脉均完全闭塞29例,三支血管弥漫性病变并血管细小55例;所有手术均在体外循环下进行,术中均经冠状动脉顺灌加冠状静脉窦逆灌并选择性桥血管灌注进行心肌保护.结果 所有患者术中转流平稳,150例自动复跳,2例出现心室颤动,电除颤后顺利复跳,均顺利停机.术后5例出现低心排血量综合征,1例肾功能不全,2例低氧血症,经调整后均恢复,无死亡患者.结论 在重症CABG中,采用顺-逆灌并选择性桥血管灌注技术具有良好的心肌保护效果,能够明显改善患者的预后.     

冠状动脉造影检查对心肌桥的诊断价值

目的 探讨冠状动脉造影检查对心肌桥诊断的应用,研究心肌桥和冠状动脉粥样硬化的相关性.方法 收集1523例患者冠状动脉造影检查资料,分析心肌桥检出率,观察心肌桥的发生位置、壁冠状动脉收缩期狭窄程度、心肌桥血管合并粥样斑块的位置、斑块处管腔狭窄程度.结果 全部1523例患者中,201例患者检查结果正常,1225例患者检出粥样斑块,231例患者检出心肌桥.心肌桥检出率为15.2％,共检出心肌桥235处.心肌桥位置：右冠状动脉1处,左主干1处,旋支1处,对角支3处,左前降支229处,以左前降支中段多见,壁冠状动脉收缩期轻度狭窄为主.纯心肌桥97例.134例患者心肌桥血管合并粥样斑块144处,斑块位置：心肌桥近端111处,心肌桥段19处,心肌桥远端14处.心肌桥近端血管粥样硬化较心肌桥段、心肌桥远端发生率高,但粥样斑块的形成与壁冠状动脉收缩期的狭窄程度无显著相关（P＞0.05）.结论 心肌桥多见于左前降支中段血管,壁冠状动脉收缩期多为轻度狭窄,血管合并粥样硬化,多见于心肌桥前端,但粥样斑块的形成与壁冠状动脉收缩期狭窄程度无明显相关性.冠状动脉造影检查对心肌桥及心肌桥合并粥样硬化的诊断有重要价值.     

Benefits of coronary revascularisation in diabetic and non-diabetic patients with ischaemic cardiomyopathy: role of myocardial viability

BACKGROUND: Diabetes mellitus in patients with coronary artery disease is associated with poor outcome. In this study, the relation between myocardial viability, diabetes, coronary revascularisation and outcome was evaluated. METHODS: 129 patients (31 diabetic, 98 non-diabetic) with ischaemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability. Patients with >or=4 viable segments were defined as viable and patients with <4 viable segments as nonviable. Left ventricular ejection fraction (LVEF) was assessed before and 9-12 months post-revascularisation. At the same time-points, LV volumes were measured to evaluate LV remodelling. Finally, cardiac events were noted during 5-year follow-up. RESULTS: The extent of viable myocardium was comparable between diabetic and non-diabetic patients. After revascularisation, LVEF increased >or=5% in 44% of diabetic and in 40% of non-diabetic patients. LVEF only improved in patients with viable myocardium. Ongoing LV remodelling occurred in 36% and 35% of diabetic and non-diabetic patients respectively, and was related to non-viability, whereas viability protected against ongoing LV remodelling, both in diabetic and non-diabetic patients. Viability was the only predictor of survival after revascularisation. CONCLUSIONS: Diabetic, viable patients with ischaemic LV dysfunction exhibit improvement in LVEF post-revascularisation with prevention of ongoing LV remodelling, similar to non-diabetic patients. Myocardial viability was also the only predictor of long-term outcome.     

Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability

BACKGROUND AND AIM: The choice of optimal treatment strategy in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction is often difficult. The aim of this study was to compare long-term results of patients with chronic CAD, severe heart failure and a defined scope of myocardial viability treated with coronary revascularization, heart transplantation, or kept on medical therapy. METHODS: From 1993 to 2000, viability evaluation using low-dose dobutamine echocardiography was performed in 124 patients with CAD and LV ejection fraction 相似文献   

多普勒评价PCI对近期心肌梗死患者左室结构和功能的影响

目的：评价经皮冠状动脉介入治疗(PCI)术对近期S—T段抬高心肌梗死(STEMI）患左心室结构和功能的影响。方法：51例已确诊为近期STEMI的患，全部行冠状动脉照影检查，25例行梗死相关动脉(IRA)PCI术，其后予以常规药物治疗，26例未行介入治疗直接进行药物治疗；术前或用药前应用多普勒超声测量ESV、EDV、LVEF、WMAS、E、A、E／A、Ei、Ai、Ei／A、SV等指标，并随访3个月，进行复查。结果：介入治疗组术后3个月ESV、EDV、WMAS、Ai较术前分别下降了26．5％(P＜0．01)、15．6％(P＜0．01)、41％(P＜9．01)、26．6％(P＜0．05)，LVEF、Ei／Ai较术前提高了17．8％(P＜0．01)、35．6％(P＜0．01)。对照组随访3个月，ESV、EDV分别较初期提高了10．8％、9．6％(P均＜0．05)，IVEF降低了10．0％(P＜0．05)，两组问Ai、Ei／Ai、ESV、EDV、LVEF、WMAS均有非常显差异(P均＜0．01)。结论：PCI术可改善近期心肌梗死患的左室功能及预后。     

不同年龄急性心肌梗死患者冠状动脉病变造影分析

目的:探讨不同年龄段急性心肌梗死患者冠状动脉病变特征.方法:回顾性分析597例急性心肌梗死患者急诊冠状动脉造影结果.根据年龄分为3组:①组1,年龄<60岁,114例;②组2,年龄60～75岁,279例;③组3,年龄≥75岁,204例.应用目测法和冠状动脉病变严重度积分法分析冠状动脉造影结果.结果:①3组冠状动脉前降支(LAD)、回旋支(LCX)、右冠状动脉(RCA)3支血管发生病变的概率相似(P>0.05),但≥75岁组左主干(LM)受累的概率显著高于其余2组,P<0.01;冠状动脉病变严重程度积分无差异,分别为7.58±2.71,7.66±2.98,8.72±3.30,P>0.05;而冠状动脉病变支数随年龄增加而增加,分别为1.89±0.86,2.00±0.83,2.32±0.92,且各组间差异有统计学意义(P<0.05).②各年龄组梗死相关动脉在LM、LAD、LCX和RCA的分布差异无统计学意义(均P>0.05).年龄<60岁组、60～74岁组和≥75岁组梗死相关动脉"罪犯"病变狭窄程度差异有统计学意义(均P<0.01):临界病变(50%～75%狭窄)在各组中分布比率分别为2.6%、9.7%和2.9%;重度狭窄(76%～95%狭窄)的比率随年龄增加而增加,分别为18.4%、36.5%和45.6%;次全闭塞和完全闭塞病变的比率随年龄增加而减少,分别为79%、53.8%、51.5%.低危"罪犯"病变比率在年龄<60岁组、60～74岁组和≥75岁组中分别为53%、40%和35%,P<0.05;中危"罪犯"病变比例各年龄组差异没有显著性(P>0.05);高危"罪犯"病变比率组2和组3差异无统计学意义(P>0.05),其余各组差异有有统计学意义(P<0.05).各组即刻手术成功率分别为97.3%、96.8%和97.1%,差异无统计学意义(P>0.05).结论:不同年龄急性心肌梗死患者冠状动脉病变有不同的特点.随着年龄的增长冠状动脉病变更加复杂,但并不影响罪犯冠状动脉急诊手术即刻成功率.     

Efficacy of coronary angioplasty for the treatment of hibernating myocardium

OBJECTIVES: To determine the efficacy of coronary angioplasty as the sole method of revascularisation in patients with coronary artery disease and chronically dysfunctional but viable myocardium (hibernating myocardium), and to assess the effect of restenosis on functional outcome. DESIGN AND PATIENTS: 24 consecutive patients with hibernating myocardium were studied. Positron emission tomography was used to assess myocardial viability, blood flow, and flow reserve. One patient refused angioplasty, one had bypass surgery, and one died while waiting for an elective procedure. The procedure failed in three patients. The remaining 18 patients had repeat echocardiography, 15 had repeat coronary angiography, and nine had repeat assessments of blood flow and flow reserve at mean (SD) 17 (2) weeks after angioplasty. In three patients restenosis was documented. RESULTS: The wall motion score index in the revascularised territories improved from 1.71 (0.37) to 1.34 (0.47) (p = 0.008). Thirty of 51 dysfunctional segments improved in territories without restenosis compared with three of 14 in restenosed territories (p = 0.001). Hibernating and normal segments had comparable flows (0.82 (0.26) v 0.89 (0.24) ml/min/g; NS) while flow reserve was lower in hibernating segments (1.55 (0.68) v 2.07 (1.08); p = 0.03). In segments without restenosis flow reserve improved from 2.03 (1.25) to 2.33 (1.4) (p = 0.03). Sensitivity, specificity, and positive and negative predictive accuracy of the viability study were 97%, 77%, 82%, and 96%, respectively. After excluding patients with restenosis, specificity and positive predictive accuracy improved to 90% and 93%. CONCLUSIONS: Angioplasty improves function in hibernating myocardium, and restenosis prevents recovery; hibernating myocardium is characterised by an impairment of flow reserve; restenosis affects the diagnostic accuracy of viability studies.     

Associations between different status of myocardial ischemia and ischemiarelated negative or positive epicardial U-waves: Observations during coronary angioplasty

This study examined the relationships between the polarity of the U wave on intracoronary electrocardiogram (ECG) and the status of myocardial ischemia during angioplasty. The ECG features of ischemia-related U waves were also evaluated. Among 63 patients with intracoronary ECGs adequate for analysis of U waves, there were 26 patients showing a change of the U wave to a negative direction and 18 patients showing a change to a positive direction from baseline to coronary occlusion. Among these patients, 10 of the former showed a distinct change in polarity of the U wave from positive to negative (group A), and 7 of the latter patients showed the opposite change (group B). Patients in group B had a higher incidence of prior myocardial infarction (86% vs 30%; P < .05), presence of an abnormal Q wave on intracoronary ECG (71% vs 20%; P < .05), poor wall motion in the angioplasty-related area (100% vs 30%; P < .01), and lower left ventricular ejection fraction (55.7% +/-8.1% vs 66.6% +/- 4.5%; P < .01) than patients in group A. The remaining patients (other than groups A and B) showing U wave change in a negative (n = 16) or positive (n = 11) direction presented with similar features to those in groups A or B, respectively. The ECG features of several types of ischemia-related U wave were determined by analysis of intracoronary ECG obtained from the patients in groups A and B. In group A, the Bazett-corrected Q (positive U) interval measured at baseline (myocardial state; near normal) was significantly shorter than the Q-(negative U) interval measured during coronary occlusion (acute ischemia) (0.518 +/- 0.031 s vs 0.579 +/- 0.046 s; P < .01). In group B, the Q-(negative U) interval measured at baseline (chronic ischemia) was longer than the Q-(positive U) interval measured during angioplasty (acute-on-chronic ischemia) (0.582 +/- 0.034 s vs 0.501 +/- 0.027 s; P < .001). Thus, intracoronary ECG recorded during angioplasty in the present study revealed physiologic U wave, two types ("acute" and "chronic") of ischemia-related negative and one type ("pseudonormal") of ischemia-related positive U waves, each of which appeared in a different status of myocardial ischemia and possessed characteristic ECG features in its appearance.     

经桡动脉介入治疗冠心病的住院期间疗效和主要不良心脏事件的预测因素

目的 评价经桡动脉介入治疗冠心病的住院期间安全性和有效性及主要不良心脏事件的预测因素.方法 入选阜外心血管病医院2004年5月至2009年5月16 281例经桡动脉介入治疗冠心病患者(桡动脉组)和5388例经股动脉介入治疗冠心病患者(股动脉组).比较桡动脉组与股动脉组患者临床特征、操作特点及住院期间临床疗效,并分析经桡动脉介入治疗患者住院期间发生主要不良心脏事件(包括死亡、心肌梗死和靶病变血运重建)的预测因素.结果 与股动脉组比较,桡动脉组冠状动脉导管插入时间较长(P＜0.01),X线曝光时间、对比剂用量差异无统计学意义.桡动脉组与股动脉组操作成功率差异无统计学意义(95.5%比96.2%,P＞0.05).血管径路并发症比例桡动脉组低于股动脉组(0.1%比1.3%,P＜0.01).桡动脉组住院期间主要不良心脏事件发生率、死亡发生率均低于股动脉组(分别为1.6%比3.8%,P＜0.01;0.2%比0.4%,P＜0.01).多因素logistic回归分析表明,经桡动脉介入治疗患者住院期间发生主要不良心脏事件的独立预测因素为年龄≥65岁(OR:1.98,95%可信区间:1.50～2.61,P＜0.01)、既往心肌梗死(OR:2.14,95%可信区间:1.63～2.82,P＜0.01)、置入药物洗脱支架(OR:0.68,95%可信区间:0.47～0.98,P=0.04)、冠状动脉夹层(OR:4.08,95%可信区间:2.28～7.33,P＜0.01)、左主干病变(OR:2.12,95%可信区间:1.09～4.13,P=0.03)、支架数(OR:1.25,95%可信区间:1.09～1.43,P＜0.01)、支架总长度(OR:1.01,95%可信区间:1.00～1.02,P=0.03).结论 经桡动脉介入治疗冠心病在住院期间具有良好的有效性和安全性.年龄≥65岁、既往心肌梗死、置入药物洗脱支架、冠状动脉夹层、左主干病变、支架数、支架总长度是经桡动脉介入治疗住院期间发生主要不良心脏事件的独立预测因素.

Abstract：

Objective The purpose of this study is to evaluate the in-hospital clinical outcome of patients with coronary artery disease who underwent transradial intervention (TRI) and analyze the predictors of chinical outcome. Methods From May 2004 to May 2009, there were 16 281 patients who underwent transradial intervention, as well as 5388 patients who underwent transfemoral intervention (TFI) at our institution. The clinical characteristics, procedural characteristics, and in-hospital clinical adverse events were compared between TRI and TFI groups. Multivariable logistic regression analysis was performed to determine predictors of in-hospital major adverse cardiac events ( composite of death, myocardial infarction,or target lesion revascularization) of TRI. Results The annulations time was significantly longer for TRIthan TFI (P ＜0. 01 ), fluoroscopy time, amount of contrast agent and procedural success rate (95.5% for TRI and 96. 2% for TFI) were similar between the two groups. However, the rates of vascular complications (0. 1% for TRI group and 1.3% for TFI group, P ＜0. 01 ), incidence of in-hospital major adverse cardiac events (1.6% vs. 3. 8%, P＜ 0.01) and in-hospital death (0.2% vs. 0.4%, P＜0.01) were all significantly lower in TRI group compared with TFI group. The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI: age ≥65 ( OR: 1.98,95% CI: 1. 50 - 2. 61, P ＜ 0. 01 ), prior myocardial infarction ( OR:2. 14, 95% CI: 1.63 - 2. 82, P ＜0. 01 ), use of drug-eluting stent (DES) ( OR:0. 68, 95% CI:0. 47 - 0. 98, P = 0. 04 ), dissection during procedure (OR:4.08, 95%CI:2.28-7.33, P＜0.01), left main lesion (OR:2. 12, 95% CI:1.09-4. 13, P=0.03), number of implanted stents (OR:1.25, 95% CI:1.09 - 1.43, P ＜0.01), and total stented length (OR:1.01, 95% CI:1. 00 -1. 02 , P=0.03). Conclusions In this large single-centre patient cohort, the transradial intervention is superior to transfemoral intervention in terms of in-hospital safety and efficacy. Age ≥ 65, prior myocardial infarction, use of DES, dissection during procedure, left main lesion, number of implanted stents and total stented length were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI.     

利尿剂对氯吡格雷抗栓治疗的PCI术后急性冠脉综合征患者预后的影响

目的:探讨利尿剂对急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后氯吡格雷抗血小板治疗预后的影响。方法:根据入选和排除标准,前瞻性连续募集2009年9月~2011年9月,在解放军总医院老年心血管病研究所住院行氯吡格雷抗血小板治疗的PCI术后ACS患者,并对其心血管主要缺血终点事件(心源性死亡,非致死性心肌梗死或者脑卒中,紧急冠状动脉血运重建)和联合缺血终点事件(主要缺血终点事件及明确或可疑支架内血栓形成,复发性心肌缺血或者不稳定型心绞痛再入院治疗,非紧急血运重建)的发生情况进行为期1年的随访。分别利用Logistic多元回归、Kaplan-Meier曲线及Cox多元回归等统计方法,分析利尿剂对PCI术后经氯吡格雷抗血小板治疗的ACS患者心血管缺血终点事件的影响。结果:在750例符合入选标准的PCI术后经氯吡格雷抗血小板治疗的ACS患者中,664例患者完成了为期1年的心血管缺血终点事件的随访。对发生缺血终点事件(n=164)和未发生缺血终点事件(n=500)患者的一般情况和临床特征的单因素比较分析发现,年龄、他汀类药物、血管紧张素转化酶抑制剂/血管紧张素受体阻断剂和利尿剂的应用在两组患者之间具有显著性的差异(P0.05,P0.01)。Logistic多元回归分析发现,联合应用利尿剂是心血管主要缺血终点事件(OR:2.99,95%CI:1.37-6.54,P0.01)及联合缺血终点事件(OR:2.37,95%CI:1.53-3.68,P0.01)发生的独立危险因素。Kaplan-Meier曲线和Cox多元回归分析均发现,联合应用利尿剂的患者1年内发生联合缺血终点事件的风险显著高于未使用利尿剂的患者(P0.01)。结论:联合应用利尿剂增加了经氯吡格雷抗血小板治疗的PCI术后ACS患者心血管缺血终点事件发生的风险。     

急性心肌梗死患者PCI术前冠状动脉内应用尿激酶原的疗效和安全性分析

目的 系统评价急性心肌梗死急诊经皮冠状动脉介入治疗(PCI)术前冠状动脉内给予尿激酶原的疗效和安全性.方法 计算机检索Pubmed、Wanfang Data、CBM、CNKI 和VIP 数据库关于急性心肌梗死PCI 术前冠状动脉内应用尿激酶原的随机对照试验(RCT),同时追索纳入文献的参考文献.检索时限为建库至2020...     

介入治疗对老年人急性ST段抬高性心肌梗死预后的影响

目的 探讨介入治疗对老年急性ST段抬高性心肌梗死(STEMI)预后的影响. 方法 回顾性分析1998年6月至2008年6月我院心内科住院的STEMI患者1318例,其中老年人338例(25.6%),连续入选符合标准的老年STEMI 316例为研究对象,依据是否行冠状动脉介入治疗(PCI)分两组:PCI组136例(43.0%)和保守治疗组180例(57.0%).收集研究对象的临床资料,并随访2年评价患者预后. 结果 两组患者年龄、性别、高血压、糖尿病、血脂异常、吸烟饮酒史、家族史等比较差异均无统计学意义(P＞0.05).两组患者前壁STEMI、心功能Killip Ⅲ～Ⅳ级、静脉溶栓及恶性室性心律失常例数等比较,差异均无统计学意义(P＞0.05).随访患者急性心肌梗死二级预防:多数患者戒烟限酒、控制饮食、减轻体质量、坚持运动等,较规律服用预防心室重塑、抗血小板、抗动脉粥样硬化等药物:血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、阿司匹林、β受体阻滞剂、他汀类药物,两组间比较差异无统计学意义(均P＞0.05).2年随访发生再梗死、心功能Ⅲ～Ⅳ级住院人数和1个月病死率比较,保守治疗组均高于PCI组(分别为17.2%与2.2%,OR=9.224,95%CI=2.756～30.876;31.1%与8.1%,OR=5.132,95%CI=2.568～10.257;8.3%与1.5%,OR=6.091,95%CI=1.369～27.105,均P＜0.01).老年STEMI的1年、2年病死率比较,保守治疗组明显高于PCI组(分别为21.1%与2.2%,OR=11.864,95%CI=3.577～39.349;32.2%与4.41%,OR=10.301,95%CI=4.289～24.736,P＜0.01). 结论 PCI可减少老年STEMI发生再梗死、心功能Ⅲ～Ⅳ级住院和1个月病死率,尤其是可明显减少1年、2年病死率.因此,早期PCI可明显改善老年STEMI患者预后.