普罗布考与普伐他汀预防经皮冠状动脉介入治疗后再狭窄的对比研究

目的评价普罗布考预防经皮冠状动脉介入治疗（PCI）后再狭窄的作用。方法将准备行PCI的82例稳定型心绞痛患者随机分为普罗布考组（n=42）和普伐他汀组（n=40）。两组患者于术前4周开始服用普罗布考1 000 mg/d或普伐他汀40 mg/d。服药4周后行金属裸支架置入术。术后继续原剂量及方法服用药物至24周。出院后定期随访,术后24周复查冠状动脉造影。结果PCI后随访至24周,两组严重临床事件发生率（死亡、急性心肌梗死、卒中及紧急血运重建术）差异无统计学意义（P〉0.05）。复查冠状动脉造影结果显示普罗布考组再狭窄率（22.5%）低于普伐他汀组（36.8%,P〈0.05）,普罗布考组管腔直径狭窄率及晚期管腔丢失指数（分别为23.25%±10.08%及0.25±0.41）均低于普伐他汀组（分别为34.76%±16.99%及0.42±0.68,P〈0.05）,纯获得（2.11±1.02 mm）大于普伐他汀组（1.51±0.96 mm,P〈0.05）。而两组晚期管腔丢失比较则差异无统计学意义（P〉0.05）。结论PCI前4周应用普罗布考降低PCI后再狭窄率的作用优于普伐他汀。     

经皮冠状动脉腔内成形术后再狭窄的临床特点和再成形治疗

目的     

冠状动脉介入治疗术后再狭窄的影响因素分析

目的分析冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的影响因素,以采取防范措施。方法统计我院近2年来经皮冠状动脉介入治疗术后复查冠脉造影患者89例的临床资料。结果发生再狭窄患者有心肌梗死和糖尿病病史的例数与未发生再狭窄的患者比较,差异均有统计学意义(P<0.05)。两组患者糖尿病、心绞痛、高血压和高脂血症病史比例比较,差异无统计学意义(P>0.05)。结论急性心肌梗死和糖尿病对支架内再狭窄的发生可能有重要的影响,临床上可通过积极治疗这些疾病来达到部分预防再狭窄发生的可能。     

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.     

经皮冠状动脉介入治疗后患者并发症的观察与护理

目的探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后患者并发症的发生率、发生原因和防治措施。方法回顾性分析了458例PCI治疗后患者并发症的发生率、发生原因和护理经过。结果术后共发生并发症者69例,发生率为15.06%。其中,穿刺部位出血34例,占7.42%;局部血肿16例,占3.49%;尿潴留11例,占2.40%;低血压8例,占1.75%。69例经过积极治疗和护理,均康复出院。结论护理人员的严密观察和及时处理是保证PCI治疗后患者顺利康复的关键。     

冠心病患者经皮冠状动脉介入治疗术前后心电图缺血性J波的观察

目的 探讨经皮冠状动脉(冠脉)介入治疗(PCI)对冠心病患者心电图缺血性J波的影响及临床意义,为临床提供无创检查指标起到预警作用.方法 选择经皮冠状动脉造影确诊并行PCI治疗的冠心病患者(冠心病组)162例,其中不稳定性心绞痛(心绞痛组)108例,急性心肌梗死(心梗组)54例.记录PCI术前、术后24h内的12导联体表心电图,分别测量各导联J波的振幅和时限,分析PCI术前、术后J波的发生率及参数变化.根据狭窄的冠脉分为2个冠脉狭窄组(前降支狭窄组和右冠脉或回旋支狭窄组),观察体表12导联心电图J波的形态比较及发生率.结果 (1)PCI 术前、术后J波发生率最高为Ⅱ、Ⅲ、aVF导联,冠心病组发生率分别为33.95％、22.84％、26.54％和30.86％、19.75％、23.46％,心绞痛组发生率分别为37.04％、27.78％、31.48％和35.19％、25.00％、27.78％;而心梗组PCI术前为V5、Ⅱ、aVF、Ⅲ、V3导联J波发生率较高,术后J波发生率为V5、Ⅱ、aVF、aVL、Ⅲ导联J波发生率较高(分别为33.33％、27.78％、16.67％、12.96％、11.11％和22.22％、22.22％、14.81％、12.96％、9.26％).(2)前降支狭窄组PCI术前J波在V5、V6导联为25.78％,右冠脉或回旋支狭窄组PCI术前J波在Ⅱ、Ⅲ、aVF导联为35.37％;术后两组均在Ⅱ、Ⅲ、aVF组发生率最高,分别为21.09％和35.37％.(3)全部冠心病组在PCI术前的J波以振幅0.08 mV和时限0.02s的例数最多,PCI术后J波振幅为0.02 mV和时限0.02s例数最多.(4)全部冠心病组PCI术前J波振幅和时限在Ⅱ、Ⅲ、aVF、V3、V4导联上均大于PCI术后,差异有统计学意义[中位数(四分位数间距P25,P75)为:Ⅱ导联振幅0.05(0.05,0.10) mV比0.02(0.02,0.05) mY,P=0.00,时限0.03(0.02,0.04)s比0.02(0.02,0.03)s,P=0.00;Ⅲ导联振幅0.05(0.05,0.10) mV比0.02(0.02,0.05) mV,P=0.00,时限0.02(0.02,0.03)s比0.02(0.01,0.02)s,P=0.00;aVF导联振幅0.05(0.05,0.10)mV比0.02(0.00,0.08)mV,P=0.00,时限0.02(0.02,0.03)s比0.02(0.00,0.02)s,P=0.00;V3导联振幅0.05(0.05,0.16)mV比0.05(0.00,0.05)mV,P=0.03,时限0.02(0.02,0.04)s比0.02(0.00,0.02)s,P=0.01;V4导联振幅0.06(0.04,0.12)mV比0.01 (0.00,0.07) mV,P=0.01,时限0.04(0.04,0.05)s比0.01(0.00,0.02)s,P=0.00].结论 冠心病组和心绞痛组PCI术前、术后J波在Ⅱ、Ⅲ、aVF导联的发生率最高,而心梗组在V5、Ⅱ、Ⅲ、aVF导联较高;前降支狭窄与右冠脉或回旋支狭窄组J波分别在V5、V6与Ⅱ、Ⅲ、aVF导联的发生率最高;PCI术后,J波振幅和时限均降低,说明PCI对冠心病缺血性J波有相对较好的影响.     

冠心病患者经皮冠状动脉介入治疗死亡率的性别差异

目的确定经皮冠状动脉介入治疗(PCI)后死亡率是否存在性别差异以及女性是否是影响死亡率的独立预测因素。方法回顾性分析2004年7月1日至2005年9月30日北京安贞医院行单纯PCI治疗的2 493名患者(男性1 860例,女性633例),并进行随访,记录临床特征及随访数据。按照性别分组比较两组之间住院死亡率和总死亡率的差异。结果女性年龄较大,术前合并主要疾病的比例较男性高,而左室射血分数(LVEF)较男性好,既往心肌梗死病史及血运重建史较男性少。女性患者术后住院死亡率约是男性的10倍(女性1.1%,男性0.1%,P<0.001);中位数随访时间555 d,随访率93.4%,女性总死亡率高于男性(5%比2%,P=0.003),总死亡风险是男性的2.6倍(HR2.631,95%CI1.217~5.687,P=0.014)。结论女性PCI术后住院死亡率及总死亡率均高于男性。女性是总死亡率的独立危险因素。     

老年冠心病患者营养状况与经皮冠状动脉介入治疗后急性肾损伤的关系

目的 明确营养不良的程度是否对老年冠状动脉粥样硬化性心脏病（冠心病）患者接受经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后造影剂相关急性肾损伤（contrast-associated acute kidney injury,CA-AKI）发生存在相关性。方法 本研究纳入2015年1～12月于广东省人民医院行冠状动脉造影术（coronary angiography,CAG）的患者。采用控制性营养状况（controlling nutritional status,CONUT）评分对患者进行营养评分,根据评分0～1分为无营养不良组,2～4分为轻度营养不良组,≥5分为中重度营养不良组。主要研究终点为PCI治疗后CA-AKI发生,定义为手术后48 h内血清肌酐浓度较基线水平增加>0.3 mg/mL或50%。营养不良水平及CA-AKI发生的相关性通过Logistics回归分析进行分析。结果 本研究共1 220例接受CAG的老年冠心病患者[年龄为（69.78±6.75）岁,71.8%为男性],其中合并轻度营养不良的共567例（46.5%）...     

经皮冠状动脉介入治疗后患者疲乏状况调查研究

目的 了解经皮冠状动脉介入治疗患者在介入治疗后产生疲乏的影响因素.方法 通过采用简明健康调查量表(mecical outcomes study heslth status short form,SF-36)中的经历维度评估患者的疲乏状况,同时收集患者睡眠质量、焦虑状况等资料.结果 本组患者发生疲乏状况占75.9％.结论...     

老年患者经皮冠状动脉介入治疗后血管闭合器的临床应用

近年来国内外股动脉穿刺口的新型缝合器已用于临床 ,效果理想 ,但对股动脉血管闭合器的临床运用国内罕见报道。我们对老年患者经皮冠状动脉介入治疗 (PCI)后股动脉穿刺口用Angio Seal STSTM血管闭合器与人工压迫止血对比观察 ,探讨血管闭合器对老年患者PCI后的临床应用价值。1　对象与方法行PCI患者 1 5 6例中男 98例 ,女 5 8例 ,平均年龄 ( 70± 5 .5 )岁 ,依止血方法不同 ,分为人工压迫股动脉组 ( 78例 )和血管闭合器封堵股动脉组 ( 78例 )。人工压迫股动脉 :PCI后 4h留置股动脉鞘拔管后直接压迫股动脉穿刺部位 ,依据患者的抗凝水…     

Influence of continued smoking and some biological risk factors on restenosis after percutaneous transluminal coronary angioplasty

Objectives. To identify possible biological risk factors for restenosis following successful percutaneous transluminal coronary angioplasty (PTCA) in patients having single or multivessel disease. The effect of continued smoking on restenosis was also evaluated.
Design. In this prospective smoking controlled study all subjects had a routine angiographic restudy after 6 months. The biological risk factors assessed before angioplasty were adrenaline, endothelin, fibrinogen, lipoprotein (a) and tissue plasminogen activator.
Subjects. The study population consisted of 122 patients of whom 25% were current smokers.
Main outcome measures. Angiographic restenosis was defined as at least 50% diameter stenosis on the follow-up angiogram after an initially successful procedure.
Results. Restenosis was observed in 43% of patients. The restenosis rate was significantly lower among current smokers, but they were significantly younger and also had significantly less dilated stenoses. Multivariate analysis revealed the number of dilated stenoses, the mean inflation time, post-PTCA percentage diameter stenosis and left anterior descending coronary artery to be predictive of restenosis, while continued smoking was not. When only the lesion with the greatest loss in luminal diameter of each patient was considered, the multiple linear regression analysis revealed high endothelin level to be predictive of restenosis.
Conclusions. This study revealed high endothelin levels to be predictive of luminal narrowing after angioplasty. In addition, the number of dilated stenoses, the mean inflation time, post-PTCA percentage diameter stenosis and stenosis location in the left anterior descending artery were found to be predictive of restenosis. However, continued smoking after angioplasty did not emerge as a risk factor for restenosis.     

不稳定性心绞痛患者经皮冠状动脉介入治疗后支架内再狭窄影响因素分析

目的探讨不稳定性心绞痛(UAP)患者PCI术后支架内再狭窄的术前影响因素。方法选择成功置入雷帕霉素药物涂层支架的UAP患者157例,根据冠状动脉造影结果分为再狭窄组16例和无狭窄组141例,回顾性分析2组性别、年龄、术前收缩压、糖尿病、TC、吸烟、体重指数、体力活动、高敏C反应蛋白(hs-CRP)水平和汉密尔顿抑郁量表(HAMD)评分,COX回归模型对有差异的因素进行分析。结果与无狭窄组比较,再狭窄组患者hs-CRP和HAMD评分明显升高(P0.01);伴有抑郁症状患者hs CRP明显高于无抑郁症患者(P=0.002)。校正UAP患者术前收缩压、吸烟、糖尿病、体重指数影响后,术前hs-CRP(OR=9.205,95% CI:2.986～28.378)、TC(OR=3.762,95% CI:1.348～10.497)、HAMD评分(OR=1.376,95% CI:1.098～1.724)与术后支架内再狭窄相关。结论 PCI术前hs-CRP、TC水平和抑郁症状是UAP患者术后支架内再狭窄的独立危险因素。     

A unique pitfall in percutaneous coronary angioplasty of in-stent restenosis: guidewire passage out of the stent.

Three cases of in-stent restenosis are narrated, wherein, during balloon angioplasty of the lesion, the guidewire inadvertently exited out of the stent. The forward balloon progress was halted in this region. In the first case, the situation could only be realized when dilatation of a forcefully pushed small balloon avulsed the well-embedded stent. The mishap was averted in the subsequent two cases by reintroduction of a new guidewire. Some suggestions to avoid this eventuality are offered. Though the cases pertain to in-stent restenosis, the observations may be applicable to the procedures in general that entail passage of a guidewire through a stented area.     

抗血小板药物对冠心病支架植入术后再狭窄防治效果的观察

目的 :观察冠状动脉介入治疗术术前应用不同抗血小板药物对血中血小板活性、功能、凝血功能和术后半年再狭窄发生的影响。方法 :行经皮腔内冠状动脉成型术及支架植入术 （PCI）治疗的冠心病患者 82 6例 ,按术前服用抗血小板药物种类和服用时间分为 3组 ,第 1组 （n =383）为术前 3d服用阿斯匹林 0 .3g +抵克力得 2 5 0mg。第 2组 （n =35 6 ）为术前 3d服用阿斯匹林 0 .3g +氯比格雷 75mg。第 3组 （n =87）为急诊PCI术前 2h ,服用阿斯匹林0 .3g +氯比格雷 30 0mg ,从上述 3组中各随机抽取 30例患者 ,于PCI术前采血。采用TXYM 91型血小板聚集仪测定血小板最大聚集率 （MPAR） ,双抗夹心法 （ELISA）测定血小板α颗粒膜蛋白 （GMP 14 0 ）及血栓烷B2 （TXB2 ）的浓度。随访 82 6例患者再狭窄发生的情况。结果 :服用阿斯匹林 +氯比格雷血中血小板活性、功能及凝血功能优于服用阿斯匹林 +抵克力得。术后半年第 3组与第 2组PCI术后再狭窄发生率显著低于第一组 （P <0 .0 1）。结论 :术前服用阿斯匹林 +氯比格雷的疗效较好 ,预防再狭窄安全有效。     

Exercise stress testing,myocardial perfusion imaging and stress echocardiography for detecting restenosis after successful percutaneous transluminal coronary angioplasty: a review of performance

When chest symptoms recur in a patient who underwent percutaneous transluminal coronary angioplasty (PTCA), it is necessary to rule out restenosis (R). Three main noninvasive tests suggest the presence of R: exercise stress test (XT), myocardial perfusion imaging (MPI) and stress echocardiography (s-echo). The objectives of this review were: (1) to estimate the pretest probability of R as a function of time after PTCA in symptomatic patients and (2) to obtain an approximation of the diagnostic parameters of the XT, MPI and s-echo for detecting R. A MEDLINE search (English-language, years: 1980-2001) was conducted to identify studies examining post-PTCA functional testing for diagnosing R. Data from the studies were pooled. Comparing studies was often difficult due to varying methodology in the studies. Pretest probability of R in symptomatic patients increases in a nonlinear fashion from 20% or less at 1 month, to nearly 90% at 1-year postangioplasty. The approximated accuracy of the XT, MPI, and s-echo for detecting R was 62, 82 and 84%, respectively. During the first month after PTCA, none of the noninvasive modalities is able to accurately detect R. Late (7-9 months) after PTCA, the pretest probability of R is high and therefore the noninvasive measure may be spared. Our analysis suggests that MPI and s-echo should be preferred over the XT for diagnosing R.     

QT dispersion plus ST-segment depression: a new predictor of restenosis after successful percutaneous transluminal coronary angioplasty.

BACKGROUND: ST-segment depression during exercise testing is frequently observed in the absence of restenosis after percutaneous transluminal coronary angioplasty (PTCA). HYPOTHESIS: With the goal of improving the prediction of restenosis after PTCA, we evaluated the usefulness of ST-segment depression plus QT dispersion (QTd = QTmax - QTmin) during treadmill stress test. METHODS AND RESULTS: Fifty-six patients (37 men, 19 women, mean age 51 +/- 14 years) were evaluated with treadmill exercise testing and coronary angiography 7 +/- 5 months after PTCA. Treadmill test was positive in 30 patients and negative in 26 patients. At coronary angiography, restenosis was present in 16 patients with positive exercise electrocardiogram (ECG) and in 6 patients with negative exercise ECG. Fourteen patients with a positive stress test did not have restenosis. There was no difference in QTd values between groups at baseline (p > 0.05). Exercise QTd was 63 +/- 9 ms in patients with positive exercise test, 54 +/- 18 ms in patients with negative exercise test (p = 0.003), 71 +/- 13 ms in patients with restenosis, and 53 +/- 17 ms in patients without restenosis (p = 0.001). ST-segment depression during the stress test determined restenosis with a sensitivity of 80% and a specificity of 58%. Sensitivity and specificity of QTd of > or = 60 ms for prediction of restenosis were 83 and 61%, respectively. When QTd of > or = 60 ms was added to ST-segment depression as a condition for positive test, the sensitivity and specificity increased to 91 and 78%, respectively. QT dispersion plus ST-segment depression had higher sensitivity and specificity than either QTd or ST-segment depression alone (p < 0.05). CONCLUSION: The addition of QTd to ST-segment depression during exercise test improves the diagnostic value and can be used as a noninvasive tool in the diagnosis of restenosis after PTCA.     

Antithrombotic therapy during percutaneous coronary intervention

Ischemic complications of percutaneous coronary intervention occur commonly and are among the major limitations of the procedure. Both platelets and thrombin play an essential role in the response to the arterial injury that follows coronary intervention and in the pathophysiology of the ischemic complications of the procedure. Aspirin and heparin are essential treatments for the patient undergoing coronary intervention. Novel thrombin and platelet inhibitors are being developed that may be useful for improving both acute and long-term clinical outcomes of percutaneous coronary intervention.     

Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent.

A patient is described in which excimer laser percutaneous coronary intervention is performed inside a suboptimally expanded stent due to nondilatable calcified plaque. The use of excimer laser facilitated full expansion of the stent with a balloon.