急性冠状动脉综合征合并肾功能不全的支架术治疗

目的　评估急性冠状动脉 (冠脉 )综合征合并肾功能不全患者经皮腔内支架术的预后。方法　 6 3例急性冠脉综合征合并肾功能不全行冠脉内和或肾动脉支架植入术患者 (肾功能不全组 ) ,随机选取同期 6 3例一般情况匹配 ,肾功能正常行介入治疗患者 (对照组 )。比较两组临床特征、血管造影、支架术及随访情况。结果　肾功能不全组患者血清肌酐水平显著增高 [(177± 31) μmol/L比(98± 2 1) μmol/L ,P <0 0 0 1]、左室射血分数减低 (0 4 5± 0 10比 0 5 0± 0 0 9,P <0 0 5 ) ,冠脉多支病变增多 (84 %比 6 5 % ,P <0 0 5 )且肾动脉狭窄发生率显著增高 (2 7%和 8% ,P <0 0 5 ) ,13例患者在冠脉支架术同时行肾动脉支架术 (比较对照组 2例 ,P <0 0 5 ) ;两组冠脉支架术手术成功率和术中并发症相似 ;随访表明 ,肾功能不全组严重心脏不良事件发生率较高 (13%和 8% ,P =0 38) ,平均血清肌酐水平较术前降低 (177± 31μmol/L和 14 7± 11μmol/L ,P <0 0 5 ) ,9例 (6 9% )肾动脉狭窄患者肾动脉支架术后血清肌酐恢复正常。结论　急性冠脉综合征合并肾功能不全患者冠脉支架术安全、有效 ,2 / 3接受肾动脉支架术患者术后血清肌酐恢复正常。     

老年左心室功能不全患者行冠状动脉内支架术

目的　评价左心室功能不全对老年冠心病患者选择性冠状动脉内支架术安全性和远期预后的影响。方法　4 76例老年冠心病患者行选择性冠状动脉内支架术 ,其中 73例左心室射血分数 <4 0 % (左心室功能不全组 ) ,4 0 3例左心室射血分数≥ 4 0 % (对照组 )。分析两组患者手术结果和远期预后。结果　两组支架术成功率 (95 .8%和95 .9% )和手术并发症相似 (2 .2 %和 2 .7% ,P >0 .0 5 )。在 (16± 8.4 )个月随访期中 ,左心室功能不全组死亡率较对照组显著增高 (14 .1%和 3.2 % ,P =0 .0 0 1)。多因素分析显示 ,左心室射血分数是老年患者冠状动脉内支架术后远期死亡的独立预测因素 (RR 0 .95 0 ,95 %CI0 .919～ 0 .981,P =0 .0 0 2 )。结论　左心室功能不全的老年冠心病患者选择性冠状动脉内支架术安全 ,但远期死亡风险较高     

左室功能不全患者冠状动脉内支架术疗效及预后的研究

冠状动脉支架术的普及和主动脉内球囊反搏泵的应用 ,使左室功能不全患者进行介入治疗的危险性大大降低。本文旨在评估冠状动脉内支架术对左室功能不全冠心病患者的疗效及预后作用。1　对象与方法将经二维超声心动图检查并行冠状动脉支架术的冠心病患者分为两组 :①左室功能不全组 ,66例 ,男 5 2例 ,女 1 4例 ,年龄 43～ 87( 63± 9)岁 ,左室射血分数 (LVEF) 0 .30± 0 .0 4 ( 0 .1 6～ 0 .35 ) ;②左室功能正常组 ,66例 ,男 5 2例 ,女 1 4例 ,年龄 45～78( 61± 7)岁 ,LVEF 0 .5 8± 0 .0 9( 0 .45～ 0 .71 )。两组LVEF比较 ,P <0 .0 …     

冠状动脉内直接支架术对无再流现象的影响

目的　评价冠心病患者冠状动脉 (冠脉 )内直接支架术对术后无再流的影响。方法　包括 12 7例接受冠脉内直接支架术的患者 (直接支架组 )和一般情况匹配的 12 7例球囊扩张后行冠脉支架术的患者 (常规支架组 ) ,比较两组的一般情况、冠脉造影及介入治疗即刻和临床随访结果。结果　直接支架组患者冠脉狭窄程度较轻 (82 %± 6 %和 87%± 11% ,P <0 0 5 ) ,支架置入术最终扩张压力明显增高 [(15± 5 )atm和 (12± 3)atm ,P <0 0 5 ],11例 (8 7% )支架置入后发生无血流现象 [常规支架组18例 (14 2 % ) ,P =0 17]。随访期两组严重心脏不良事件发生率差异无显著性 ;但无血流组患者严重心脏不良事件发生率显著增高 (4 8%和 8% ,P =0 0 0 1)。结论　冠脉内直接支架或常规支架术对术后无血流现象发生的影响差异无显著性 ;初次冠脉支架术后发生无血流现象患者预后较差。     

无保护左主干病变的介入治疗及随访结果

目的 :探讨无保护左主干病变患者冠状动脉 (冠脉 )内支架术的近、远期疗效。方法 :共选择 8例均无冠脉搭桥术史的左主干病变患者行冠脉内支架术 ,其中左主干近中段病变 5例 ,远段分叉病变 3例 ,其中 2例的左室射血分数 <4 0 % ,总结分析其临床、左主干病变特点、手术成功率及随访结果。结果 :左主干支架术的成功率为 10 0 % ,无残余狭窄或残余狭窄率 <10 % ,无任何严重并发症如支架内血栓形成、急性心肌梗死、紧急外科冠脉搭桥术或死亡等。术后随访 5～ 15 (10± 3.5 )个月 ,无一例死亡。临床心绞痛复发 1例 ,重复冠脉造影证明为前降支的新生病变所致 ;2例左室功能不全患者的左室射血分数提高了 15 %以上 ;5例复查了冠脉造影 ,其中 4例的原支架内基本无再狭窄 ;1例有 30 %再狭窄 (为前述症状复发的患者 )。结论 :支架置入术治疗无保护左主干病变疗效显著 ,是值得考虑的治疗手段 ;正确的病例选择和娴熟的操作技巧是手术成功的关键     

冠脉内成形及支架术前后QT离散度的变化

目的　探讨冠脉内成形及支架术对冠心病患者QT离散度的影响。方法　对成功实施了冠脉内成形及支架术的冠心病患者 5 0例 ,记录术前 1天与术后第 1天、第 7天的 12导联心电图 ,计算各QTd、QTcd。结果　冠心病患者冠脉内成形及支架术前 1天、术后第 1天、第 7天QTd和QTcd分别为72 1± 9 3ms和 6 9 5± 8 8ms、5 8 3± 5 2ms和 5 7 4± 5 1ms、4 1 6± 3 6ms和 4 0 2± 3 2ms,术后QTd及QTcd均显著低于术前 (P <0 0 5 )。结论　冠脉内成形及支架术可使冠心病患者QTd明显缩短。     

糖尿病患者冠状动脉内支架术后的远期疗效

目的　探讨糖尿病患者选择性冠状动脉 (冠脉 )内支架术的远期疗效。方法　 80 8例冠心病患者行选择性冠脉内支架术 ,其中糖尿病组 174例 ,非糖尿病组 6 34例。随访两组患者远期结果。结果　两组支架术成功率 (96 0 %和 96 1% )相似。平均随访 (19± 7 8)个月 (6～ 4 2个月 ) ,临床随访率为 95 3%。随访期内 ,与非糖尿病组相比 ,糖尿病组心功能改善者 (5 2 2 %比 6 1 0 % )较少 ,再住院率 (4 2 7%比 32 5 % )增加 ;且心脏事件 (30 6 %比 2 2 2 % )、再狭窄 (19 1%比 12 5 % )及总死亡(10 2 %比 4 6 % )均显著增加。多因素分析显示 ,糖尿病为死亡 (OR =2 2 0 ,95 %CI 1 12～ 4 33,P =0 0 2 2 )和再狭窄 (OR =1 6 6 ,95 %CI 1 0 4～ 2 6 7,P =0 0 35 )的独立预测因素。结论　糖尿病患者选择性冠脉内支架术远期结果可以接受 ,但糖尿病仍是远期不良预后的独立预测因素。     

左室收缩功能不全患者二尖瓣血流频谱及肺静脉血流频谱的变化

20 0 0年 1 0月～ 2 0 0 1年 1 2月 ,我们测定了冠心病、扩张型心肌病左室收缩功能正常与收缩功能不全患者的肺静脉、二尖瓣口血流频谱及肺动脉压、房室内径等指标 ,并与正常对照组进行了比较。现报告如下。1　资料与方法1 .1　一般资料　选择门诊或住院冠心病、扩张型心肌病患者 63例 ,根据超声心动图左室射血分数( LVEF)和左室短轴缩短率 ( FS)分为两组。 A组 (左室收缩功能不全组 ) 30例 ,男 1 8例 ,女 1 2例 ,年龄 30～ 74岁 ,平均 ( 5 3.2± 6.3)岁 ;LVEF<5 0 % ,FS<2 5 %。B组 (左室收缩功能正常组 ) 33例 ,男 2 3例 ,女1 0例 ,…     

年轻冠心病患者冠状动脉裸支架术即刻及长期疗效随访

目的评估年轻冠心病患者(<45岁)冠状动脉(冠脉)内支架术的长期疗效。方法选65例年龄<45岁的患者接受冠脉内支架术治疗(年轻组),随机同期选取65例年龄>45岁行冠脉内支架术患者作为对照组。比较两组一般情况、冠脉病变、介入治疗及3年临床随访情况。结果年轻组患者心梗68%比对照组35%多见,P<0.05;单支冠脉病变患者明显增多(83%比57%,P=0.001);介入治疗后达到完全血运重建者增多(95%比78%,P=0.004)。平均随访87±13月,年轻组患者再发胸痛及再次住院发生率明显高于对照组(分别为35%和17%,P=0.02,28%和14%,P=0.05),新生病变发生率明显高于对照组(分别为23%和9%,P=0.03;35%和17%,P=0.02)。结论年轻患者冠脉裸支架术完全血运重建率高,术后心脏事件的发生主要由新生冠脉病变引起。冠脉支架植入术可作为年轻冠心病患者的可选治疗方式之一。     

80岁及以上老年人冠状动脉内支架术疗效和安全性的观察

目的　评价年龄因素对冠心病患者选择性冠状动脉 (冠脉 )内支架术疗效和安全性的影响。　方法　连续 5 0 2例冠心病患者行选择性冠脉内支架术 ,根据年龄分组 :80～ 87岁 48例 ,70～ 79岁 143例 ,60～ 69岁 169例 ,3 5～ 5 9岁 142例。比较 4组支架术成功率及随访结果。　结果　 4组支架术成功率分别为 97 9%、97 2 %、97 6%和 96 5 % ,并发症率为 6 3 %、9 8%、7 1%、2 1% ,差异无显著性 (均为P >0 0 5 )。随访 1～ 3 0个月 ,平均 (12 0± 4 8)个月 ,随访率为 92 3 %。 4组的心绞痛复发分别为 2 7 9%、41 4%、5 0 3 %和 48 4% ,80～ 87岁组心绞痛复发显著少于 60～ 69岁组和 3 5～ 5 9岁组(均为P <0 0 5 ) ,但硝酸酯药物停用率 (4 1 9%、3 4 6%、3 0 7%和 3 5 5 % )、再入院率 (2 7 9%、3 6 8%、3 0 7%和 3 4 7% )、心功能改善率 (5 5 8%、44 4%、48 4%和 5 7 3 % )、心脏事件发生率 (18 6%、2 1 1%、2 4 8%和 2 1 0 % )和病死率 (7 0 %、3 8%、2 6%和 1 6% )差异无显著性 (均为P >0 0 5 )。　结论　年龄因素对冠脉内支架术的疗效和安全性无显著影响 ,80岁以上患者选择性冠脉内支架术安全、成功率高 ,近期疗效好     

Immediate and one-year outcome of intracoronary stent implantation in small coronary arteries with 2.5-mm stents

BACKGROUND: The role of coronary stenting in the treatment of stenoses in small coronary arteries with use of 2.5-mm stents is not well defined. METHODS AND RESULTS: Between January 1995 and August 1999, 651 patients with stenoses in small coronary arteries were treated with 2.5-mm stents (n = 108) or 2.5-mm conventional balloon angioplasty (BA) (n = 543). Patients who received treatment with both 2.5-mm and > or =3.0-mm stent placement or balloons were excluded. Procedural success and complication rates as well as 1-year follow-up outcomes were examined. Baseline clinical characteristics were similar between the two groups, except patients in the stent group were more likely to have hypertension and a family history of coronary artery disease and less likely to have prior myocardial infarction. Angiographic success rates were higher in the stent group (97.2% vs 90.2%, P =.02). In-hospital complication rates were comparable between the two groups. Among successfully treated patients, 1-year follow-up revealed no significant differences in the survival (96.2% vs 95.2%, P =.89) or the frequency of Q-wave myocardial infarction (0% vs 0.4%, P =.60) or coronary artery bypass grafting (8.4% vs 6.8%, P =.89) between the stent and BA groups, respectively. However, patients in the stent group were more likely to have adverse cardiac events (35.4% vs 22.1%, P =.05). Stent use after excluding GR II stent use, however, was not independently associated with reduced cardiac events at follow-up (relative risk 1. 3 [95% confidence interval 0.8-2.3], P =.30). CONCLUSIONS: Intracoronary stent implantation of stenoses in small coronary arteries with 2.5-mm stents can be carried out with high success and acceptable complication rates. However, compared with BA alone, stent use was not associated with improved outcome through 1 year of follow-up.     

冠心病患者左心功能的改变

目的:观察不同程度冠心病患者左心功能的变化。方法;78例冠心病患者分成稳定性心绞痛(SA)、不稳定性心绞痛(UA)、急性心肌梗死(AMI)和陈旧性心肌梗死(OMI)4组,并与30例健康成人(对照组)比较。采用无创伤自动检测仪及彩色多普勒血流显像仪测定心功能指标;心排血指数(CI),外周阻力(TPR),左室射血前期(PEP)及左室射血时间(LVET);左室收缩功能:射血分数,每搏量,心搏出量;左室舒张功能:A峰,E峰,峰值速度比值,峰值充盈,标准化充盈速度。结果:AMI和OMI组心功能明显减低(P<0.01):CI减少,TPR增高,PEP延长,LVET缩短,左室收缩功能减弱,舒张功能降低;UA和SA组心功能减低(P<0.05～<0.01);AMI和OMI组比UA和SA组心功能减低有显著差异(P<0.05)。结论;冠心病随病情加重,心功能明显恶化。     

Results of percutaneous drug‐eluting stent implantation for unprotected left main coronary disease according to left ventricular systolic function

Objectives: We aimed to appraise the early and long‐term outcome after percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) in patients with unprotected left main disease (ULM) and left ventricular systolic dysfunction (LVD). Background: PCI with DES has being performed with increasing frequency in subjects with ULM and LVD, but few specific data are available. Setting and Patients: We identified patients undergoing PCI with DES for ULM at our Center and distinguished those with ejection fraction (EF) >50% from those with 40% <EF ≤50% and those with EF ≤40%. The primary end‐point was the rate of major adverse cerebro‐cardiovascular events (MACCE, ie death, myocardial infarction [MI], stroke, repeat PCI or bypass surgery). Results: A total of 197 patients were included, 57.4% with EF >50%, 32.0% with 40% <EF ≤50%, and 10.6% with EF ≤40%. In‐hospital mortality was significantly higher in those with EF ≤40% (9.5% vs. 0 and 3.2%, P < 0.001). A total of 96% patients were followed for 23 ± 14 months, yielding a MACCE rate of 44.2% (41.6% in those with EF >50%, 41.6% in those with 40% <EF ≤50%, and 61.9% in those with EF ≤40%, P = 0.4). Specifically, death occurred in 2.7%, 7.9%, and 28.6% (P < 0.001), cardiac death in 1.8%, 4.8%, and 23.8% (P = 0.001), MI in 8.0%, 7.9% and 0 (P = 0.4), and TVR in 15.9%, 11.1% and 33.3% (P = 0.6). Conclusion: Systolic ventricular dysfunction is highly correlated with in‐hospital and long term death rates in patients undergoing PCI with DES for ULM disease. However it does not confer an increased risk of nonfatal adverse events or stent thrombosis. © 2009 Wiley‐Liss, Inc.     

Safety of drug-eluting stents in patients with left ventricular dysfunction undergoing percutaneous coronary intervention

Recent studies have reported a higher incidence of late stent thrombosis in patients undergoing drug-eluting stent (DES). Reduced left ventricular (LV) ejection fraction (EF) is considered a risk factor for this complication after both bare-metal stent (BMS) and DES implantation. Therefore, the aim of this study was to evaluate the safety of DES on long-term follow-up in patients with LV dysfunction undergoing percutaneous coronary intervention. We retrospectively selected all patients with an EF <45% undergoing percutaneous coronary intervention with implantation of >/=1 sirolimus- or paclitaxel-eluting stent at our institution. The primary endpoint of the study was all-cause mortality, retrieved using both Social Security Database and hospital records. We also compared the results of this group with a historical cohort of patients with LV dysfunction undergoing BMS implantation; 121 patients who received >/=1 DES were enrolled. The mean LVEF was 36 +/- 8%, with 20 patients (16%) with a LVEF 相似文献   

雷帕霉素洗脱支架治疗多支冠状动脉病变的临床研究

目的:探讨多支冠状动脉病变患者置入雷帕霉素洗脱支架(Cypher支架)预防再狭窄的疗效及安全性。方法:2001年12月-2004年5月连续725例接受多支冠状动脉支架置入术的冠心病患者,剔除急性心肌梗死及再次血运重建患者。Cypher支架组187例,普通金属支架(普通支架)组538例。比较两组支架术后的近期及远期结果。结果:除糖尿病患者比例在Cypher支架组较高外,两组患者冠心病危险因素、心功能、冠状动脉病变严重程度、介入手术成功率及并发症发生率均无显著差异。690例患者平均随访(18.8±11.7)个月,Cypher支架组和普通支架组造影随访率分别为52.4%vs58.2%(P>0.05)。尽管Cypher支架组患者冠心病危险因素多、平均年龄63.5岁、不稳定性心绞痛占66.3%、糖尿病占41.6%、3支血管病变占57.8%、B2/C型复杂病变占86.2%,但造影复查再狭窄率和主要不良心脏事件(MACE)发生率均明显低于普通支架组(3.1%vs16.6%,5.5%vs16.7%,P均<0.01),心功能改善率高于普通支架组(63.1%vs30.6%,P<0.01)。两组完全血运重建率无显著差异(81.3%vs86.8%,P>0.05),但发生MACE的患者中,Cypher支架组不完全血运重建者比例高于普通支架组(60.0%vs23.5%,P<0.05);两组发生MACE的患者中完全血运重建患者比例均低于本组总的完全血运重建率(Cypher支架组:40.0%     

延期支架置入对高血栓负荷ST段抬高急性心肌梗死预后的影响

目的研究高血栓负荷的ST段抬高急性心肌梗死（STEMI）患者血栓抽吸后,延迟置入支架对患者预后的影响。方法选取129例血栓积分评分≥2分,经皮冠状动脉球囊扩张成形术（PTCA）和（或）血栓抽吸后血栓积分评分≤2分的STEMI患者纳入本研究,随机分为即时支架组（65例）和延期支架组（64例）。结果两组患者支架置入后TIMI积分、术后2 h ST段回落≥50%比较,差异均无统计学意义;而TIMI心肌灌注分级（TMP）积分即刻支架组显著低于延期支架组,差异有统计学意义（P〈0.001）。延期支架组术后6个月较入院时左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）降低,左心室射血分数（LVEF）升高,其中LVEDV降低差异有统计学意义（P〈0.05）;即时支架组6个月后较入院时LVEDV、LVESV升高,LVEF降低,其中LVESV升高（P〈0.05）和LVEF降低（P〈0.001）差异有统计学意义。术后30 d内两组间主要不良心血管事件（MACE）及主要出血事件比较,差异均无统计学意义。术后12个月时,两组心源性死亡、再发心肌梗死、靶血管血运重建比较,差异均无统计学意义（P〈0.05）,但即时支架组心力衰竭发生率较延期支架组显著增多（P〈0.05）,使得即时支架组MACE事件发生率较延期支架组显著升高（P〈0.05）。两组间比较,延期支架组住院天数较即时支架组增多,差异有显著统计学意义（P〈0.001）,且住院费用显著增多,差异有显著统计学意义（P〈0.001）。结论对于高血栓负荷的STEMI患者,经PTCA、血栓抽吸、强化抗栓处理后延迟行支架置入,可更好地改善患者的心肌灌注,减少心力衰竭的发生,从而使MACE事件发生率下降,但延期支架置入术患者的住院天数和住院费用会相应增加。     

Treatment of Peripheral Pulmonary Stenoses

Background: Peripheral pulmonary artery stenosis is a relatively frequent anomaly responsible for right ventricular hypertension, significantly affecting the quality of life and the long-term prognosis of patients with congenital heart disease. Balloon angioplasty has been used to relieve pulmonary artery stenosis, but immediate and long-term results have not been completely satisfactory. Conversely, stent implantation seems a promising and more effective technique for the treatment of this vascular anomaly. Methods: Between April 1987 and September 1997, indication for interventional cardiac catheterization has been estabilished for 150 patients. Balloon angioplasty was performed in 120 patients (162 procedures) and stent implantation in 60 patients (79 stents). In 30 patients, both procedures have been carried out. Indication was based on the presence of right ventricular hypertension (right ventricular/systemic peak systolic pressure ratio ≥ 0.5), right ventricular dysfunction, or a markedly unbalanced pulmonary blood flow, especially after bidirectional cavopulmonary anastomosis. Criteria for technical success of balloon dilation were defined as a ≥ 50% increase in the predilation diameter, a ≥ 50% decrease in the transstenotic pressure gradient, or a ≥ 20% decrease in the right ventricular-to-aortic pressure ratio. Mean balloon/stenosis diameter ratio was 3.0 ± 0.7 (range 1.8–4.2). Time between primary surgery/balloon angioplasty and stent implantation was 18 ± 7 months (range 8–21 months). Stainless steel balloon-expandable endovascular stents were maximally dilated to 12–18 mm of diameter, and high-pressure dilations were performed to further expand the stent, if necessary. Results: After balloon angioplasty, the diameter of the stenotic segment increased from 3.1 ± 0.3 to 5.1 ± 1.4 mm (P < 0.01), the gradient across the stenotic segment dropped from 51 ± 19 to 28 ± 8 mmHg (P < 0.01), and the right ventricular/systemic peak pressure ratio decreased from 0.81 ± 0.20 to 0.65 ± 0.15 (P < 0.05). No significant difference between procedures with low-pressure and high-pressure dilation was recorded. Success rates using the above-mentioned criteria could be assessed as high as 60%. After stent implantation, the diameter of the stenotic segments increased from 3.5 ± 1.2 to 13.2 ± 3.4 mm (P < 0.01), the pressure gradient across the stenotic segment dropped from 53 ± 30 to 13 ± 10 mmHg (P < 0.01), and the mean right ventricular/systemic pressure ratio decreased from 0.84 ± 0.2 to 0.40 ± 0.15 (P < 0.01). Immediate overall success for balloon angioplasty was achieved in 73 of 120 patients compared with 58 of 60 patients submitted to stent implantation (60% vs 97%, P < 0.001). The complication rate was 6.9% (5/162 procedures) in the balloon angioplasty group and 1.2% (1/79 implants) in the stent group. Restenosis has been recorded in 25% of the balloon group patients, in respect to 2% of the stent group. Conclusions: Peripheral pulmonary stenosis (PPS) is an important factor conditioning outcome of patients with congenital heart defects. Balloon angioplasty may be technically effective, but it often fails if clinical criteria and impact on patient's outcome are considered. In our experience, the use of high-pressure balloons did not change the success rate of balloon dilation. Stent implantation seems to offer a better and more definitive approach for the relief of PPS.     

吸烟对冠心病支架植入术患者预后的影响

目的:探讨吸烟对冠心病支架植入术患者预后的影响。方法:入选2006年8月～2010年8月在我院行冠脉支架植入术患者378例,术后随访两年,根据患者术后是否吸烟将其分为戒烟组(237例)和吸烟组(141例),比较吸烟对两组患者预后的影响。结果:随访两年后,与戒烟组比较,吸烟组患者心绞痛(13.1%比22.0%)、非致死性心梗(1.3%比4.9%)发生率明显升高(P<0.05);而两组患者在全因死亡率(2.9%比2.8%)、因心脏病再住院率(11.0%比8.5%)的差异无显著性(P>0.05)。结论:吸烟对冠心病支架植入术后患者有一定的影响,再发心绞痛及非致死性心肌梗死率显著升高。