瑞舒伐他汀对急性冠脉综合征患者血清炎性介质水平和颈动脉斑块的影响

目的分析急性冠脉综合征(ACS)应用瑞舒伐他汀治疗对炎性介质和颈动脉斑块的影响。方法选择2010年3月至2011年3月我院心内科收治的84例ACS患者,随机平均分为两组,对照组(42例)给予常规ACS治疗方案,研究组(42例)在对照组治疗的基础上给予瑞舒伐他汀10 mg/d,睡前口服。分别对两组患者在治疗前后检测炎性介质IL-6、TNF-α和MMP-9,并观察治疗前后颈动脉超声变化情况。结果两组治疗后IL-6、TNF-α和MMP-9水平均较治疗前显著下降(P<0.05),但研究组下降更明显(P<0.05)。研究组治疗后颈动脉斑块大小、数量、厚度和IMT均较治疗前显著减少(P<0.05);而对照组治疗后虽然斑块大小、数量、厚度和IMT均较治疗前减少,但无统计学意义(P>0.05)。结论 ACS患者应用瑞舒伐他汀有抗炎作用,能改善斑块炎症反应,稳定粥样斑块。     

瑞舒伐他汀对急性冠脉综合征患者血浆炎症细胞因子和颈动脉斑块的影响

目的探讨瑞舒伐他汀对急性冠脉综合征(ACS)患者血浆炎症因子和颈动脉粥样硬化斑块的影响。方法将72例ACS患者分为瑞舒伐他汀组和对照组。对照组入院后立即均按照ACS治疗方案进行治疗,瑞舒伐他汀组在对照组上述治疗的基础上予以瑞舒伐他汀片10mg/d,每晚睡前口服,连用6个月。两组患者分别于治疗前后进行血浆炎症细胞因子TNF-α、MMP-9和IL-6的检测,并观察患者治疗前后颈动脉彩色多普勒超声的变化。结果两组患者治疗前血浆TNF-α、MMP-9和IL-6水平比较无统计学差异(P>0.05)。治疗6个月后,血浆TNF-α、MMP-9和IL-6水平均较治疗前明显下降,具有统计学差异(P<0.05或P<0.01),且瑞舒伐他汀组下降幅度更明显(P<0.05)。两组患者治疗前斑块大小、厚度、数量和IMT比较无统计学差异(P>0.05)。治疗6个月后,瑞舒伐他汀组斑块大小、厚度、数量和IMT均较治疗前明显减小,具有统计学差异(P<0.05),而对照组治疗前后斑块大小、厚度、数量和IMT虽有减少,但无统计学差异(P>0.05)。结论瑞舒伐他汀对ACS患者具有抗炎作用,能改善血管内斑块的炎症反应,从而降低颈动脉内膜厚度,减少颈动脉粥样斑块的大小和厚度,稳定动脉粥样斑块,改善心肌缺血症状。     

瑞舒伐他汀对老年急性冠脉综合征患者血浆内皮微粒的影响

目的探讨老年急性冠脉综合征(ACS)患者应用不同剂量瑞舒伐他汀治疗后血浆内皮微粒(EMP)及血脂水平的变化。方法 76例老年ACS患者随机分为瑞舒伐他汀10 mg组(低剂量组)、20 mg组(高剂量组)各38例。两组治疗前后分别应用流式微球技术检测外周血CD31+/CD42b-EMP水平,全自动生化仪检测血脂水平。结果治疗2 w后,两组血浆CD31+/CD42b-EMP水平均较治疗前下降,而高剂量组与低剂量组相比血浆CD31+/CD42b-EMP下降更明显(P<0.05)。两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)-C水平较治疗前下降,高剂量脂蛋白胆固醇(HDL)-C较治疗前升高,高剂量组TC、TG、LDL-C水平下降幅度较低剂量组明显增大,高剂量组HDL-C上升幅度较低剂量组更明显(均P<0.05)。血浆EMP与TG、LDL-C呈线性相关(r=0.541、0.538,P<0.05)。与HDL-C呈负相关(r=-0.303,P<0.05)。结论每日1次20 mg瑞舒伐他汀对老年ACS患者是安全的,能迅速调节血脂水平,降低血浆EMP水平,减轻内皮功能障碍,从而稳定粥样硬化斑块,尽早获益。     

急性冠脉综合征患者短期大剂量瑞舒伐他汀治疗安全性和有效性的研究

目的：探讨急性冠脉综合征（ACS ）患者住院期间短期大剂量瑞舒伐他汀强化治疗的安全性和有效性。方法将急性冠脉综合征患者131例随机分为他汀强化组与常规组,强化组入院即给予瑞舒伐他汀20mg顿服,住院期间予瑞舒伐他汀20mg/晚口服;常规治疗组入院起予瑞舒伐他汀10mg/晚口服。强化组及常规组患者均于入院时及入院1周检测相关生化指标。结果治疗前两组患者年龄、性别、合并疾病、吸烟、肥胖情况及肌酐（Cr ）、肌酸激酶（CK ）、肾小球滤过率（GFR）比较差异无统计学意义（ P＞0.05）,常规组谷丙转氨酶（ALT）水平高于强化组,差异有统计学意义（ P＜0.05）。治疗1周时,两组的ALT、AST均较前升高,差异有统计学意义（ P＜0.05）。但均值仍在正常范围内,两组间ALT ,AST升高大于3倍的比例无显著差异;所有患者治疗前后Cr、CK、GFR水平比较差异无统计学意义（ P＞0.05）。治疗1周后,两组的甘油三脂（TG ）、总胆固醇（TC ）、低密度脂蛋白（LDL-C ）均较前明显下降,强化治疗组LDL-C水平下降更显著,差异均有统计学意义（ P＜0.01）。常规组治疗1周,HDL-C无明显改变,而强化组患者HDL-C水平明显升高,差异有统计学意义（ P＜0.01）。结论瑞舒伐他汀20mg短期强化治疗安全性与10mg相同,且能迅速有效降低患者胆固醇水平,提高高密度脂蛋白水平。     

瑞舒伐他汀对急性冠脉综合征血浆细胞因子水平的影响及临床价值分析

目的探讨瑞舒伐他汀对急性冠脉综合征(ACS)血浆细胞因子的影响。方法 87例ACS患者分为瑞舒伐他汀组44例和阿托伐他汀组43例,其中根据瑞舒伐他汀剂量又分为瑞舒伐他汀20 mg组22例和瑞舒伐他汀10 mg组22例,治疗6月;另选35例在我院体检中心体检的健康人群作为对照组。对比各组血浆炎症细胞因子水平、检测斑块的形状和回声情况、大小、数量和厚度,同时测量分叉内膜厚度(IMT)。结果瑞舒伐他汀20 mg组、瑞舒伐他汀10 mg组在血清肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)、基质金属蛋白酶(MMP-9)和超敏C-反应蛋白(hs-CRP)水平明显低于阿托伐他汀组(P0.05)。瑞舒伐他汀20 mg组、瑞舒伐他汀10 mg组在斑块厚度、IMT减少方面,明显优于阿托伐他汀组,但瑞舒伐他汀20 mg组与瑞舒伐他汀10 mg组比较未见明显差异。结论 ACS患者早期服用小剂量瑞舒伐他汀可降低血浆细胞因子水平,减轻反应炎症,稳定动脉粥样斑块,从而降低严重心血管病发生率,改善ACS患者的预后。     

阿托伐他汀与瑞舒伐他汀对颈动脉粥样硬化患者的作用比较

目的探讨阿托伐他汀与瑞舒伐他汀在预防颈动脉粥样硬化患者发生脑梗死中的作用以及对肝功能的影响。方法 160例颈动脉粥样硬化患者随机分为两组。阿托伐他汀组给予阿托伐他汀钙片,每晚20mg,瑞舒伐他汀组给予瑞舒伐他汀片,每晚10mg。观察使用不同他汀片治疗后肝功能异常发生率。结果使用不同他汀片治疗一年中脑梗死发生率相比有统计学意义(χ2=4.74,P<0.05);一年内肝功能异常发生率有统计学意义(χ2=4.10,P<0.05)。结论瑞舒伐他汀比阿托伐他汀具有较强稳定颈动脉粥样斑块的作用,减少了脑梗死的发生,而且在长期发挥治疗作用的同时,肝功能出现异常的发生率要低于阿托伐他汀。     

瑞舒伐他汀对脑梗死并CAS斑块患者的疗效观察

目的 观察瑞舒伐他汀对脑梗死并颈动脉粥样硬化（CAS）斑块患者的临床疗效.方法 对75例脑梗死并CAS斑块患者采用常规疗法加瑞舒伐他汀治疗.治疗前后检测其血脂及血清C反应蛋白（CRP）,用彩超检查颈动脉内膜-中层厚度（IMT）及颈动脉斑块、数量变化.结果 治疗后6个月,患者血脂明显改善,双侧颈动脉IMT明显降低、颈动脉斑块明显缩小（P＜0.05或＜0.01）.结论 瑞舒伐他汀可有效地降低脑梗死并CAS斑块患者的血脂及血清CRP,稳定并逆转CAS斑块,降低缺血性脑血管事件发生.     

阿托伐他汀对急性冠脉综合征的治疗效果观察

目的观察阿托伐他汀对急性冠脉综合征(ACS)患者血脂变化及其对预后的影响。方法将72例ACS患者随机分为实验组(42例)和对照组(30例),观察血脂变化、心脏事件发生情况。结果对照组治疗前后血脂无明显变化,实验组治疗后血脂明显下降(P0.05),与对照组比较,实验组治疗后心脏事件发生率明显下降(P0.05)。两组治疗前后无明显不良反应。结论ACS患者应用阿托伐他汀可以调节血脂并改善预后。     

瑞舒伐他汀短期治疗急性冠脉综合征患者血清MMP-9水平变化研究

目的通过观察瑞舒伐他汀短期治疗急性冠脉综合征（ACS）患者基质金属蛋白酶-9（MMP-9）水平变化,探讨瑞舒伐他汀对ACS患者炎症反应及稳定斑块的影响。方法选择ACS患者69例及正常对照组30名,ACS患者在常规治疗基础上采用瑞舒伐他汀短期（2周）治疗,比较治疗前后血清MMP-9的水平变化。结果 ACS患者治疗前血清MMP-9水平显著高于对照组;瑞舒伐他汀治疗2周后,血清血清MMP-9水平显著低于治疗前,但仍显著高于正常对照组。结论 ACS患者存在着高水平的MMP-9,在经过瑞舒伐他汀短期治疗后血清MMP-9水平显著降低,显示瑞舒伐他汀可降低炎症反应及稳定斑块,动态检测血清MMP-9水平变化可作为ACS发生的预测指标。     

瑞舒伐他汀钙对急性冠脉综合征患者血清炎症因子及内皮功能的影响

目的探讨瑞舒伐他汀钙对急性冠脉综合征(ACS)患者血清炎症因子及血管内皮因子的影响。方法将70例ACS患者随机平均分为对照组和观察组。两组患者均予相同的常规治疗,对照组在常规基础上加阿托伐他汀钙(20 mg/d),观察组加用瑞舒伐他汀钙(10 mg/d),两组疗程均为8 w。观察并比较两组患者在溶栓后血脂、血清炎症因子的变化及不良反应。结果两组患者治疗前各项指标比较差异无统计学意义。疗程结束后,两组患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平较治疗前下降,高密度脂蛋白胆固醇(HDL-C)水平较治疗前升高,而观察组TC、TG、LDL-C下降幅度、HDL-C上升幅度较对照组更明显(P<0.05)。两组患者肿瘤坏死因子(TNF)-α、基质金属蛋白酶(MMP)-9、超敏C反应蛋白(hs-CRP)、内皮素(ET)水平均较治疗前降低,一氧化氮(NO)水平较治疗前升高,但观察组炎症因子及内皮因子改善水平更显著(P<0.05)。术后3个月内,观察组患者发生心绞痛3例,心肌梗死0例,心脏事件发生率为8.6%;对照组出现心绞痛3例,心肌梗死1例,心脏事件发生率为11.4%,两组患者心脏事件发生率差异无统计学意义(P>0.05)。结论瑞舒伐他汀钙可有效改善ACS患者血脂水平,抑制体内炎症反应,改善损伤的血管内皮功能,降低术后3个月心脏事件发生率。     

Healed Culprit Plaques in Patients With Acute Coronary Syndromes

BackgroundHealed plaques, morphologically characterized by a layered phenotype, are frequently found in subjects with sudden cardiac death. However, in vivo data are lacking.ObjectivesThe purpose of this study was to determine the prevalence, morphological characteristics, and clinical significance of healed culprit plaques in patients with acute coronary syndromes (ACS) using optical coherence tomography (OCT).MethodsA total of 376 ACS patients (252 ST-segment elevation myocardial infarction [MI] and 124 non–ST-segment elevation acute coronary syndrome) who had undergone pre-intervention OCT imaging of the culprit lesion were enrolled. Patients were stratified according to the presence of layered phenotype, defined as layers of different optical density at OCT. Clinical and laboratory data, OCT characteristics, and 1-year outcome were compared between the 2 groups.ResultsAmong 376 patients, 108 (28.7%) healed plaques were identified. Hyperlipidemia, diabetes, and history of MI were more frequent in patients with healed plaques (44.4% vs. 33.2%; p = 0.041; 35.2% vs. 23.5%; p = 0.021; and 15.7% vs. 6.3%; p = 0.009, respectively). High-sensitivity C-reactive protein was significantly higher in patients with healed plaques (median 4.98 mg/l [interquartile range: 1.00 to 11.32 mg/l] vs. 3.00 mg/l [interquartile range: 0.30 to 10.15 mg/l]; p = 0.029). Plaque rupture (64.8% vs. 53.0%; p = 0.039), thin cap fibroatheroma (56.5% vs. 42.5%; p = 0.016), and macrophage accumulation (81.1% vs. 63.4%; p = 0.001) were common in the layered group. OCT also revealed greater area stenosis in plaques with layered phenotype (79.2 ± 9.5% vs. 74.3 ± 14.3%; p = 0.001). The incidence of major adverse cardiovascular events was similar between the 2 groups, except that the all-cause rehospitalization rate was higher among healed plaques (32.7% vs. 16.5%; p = 0.013).ConclusionsHealed plaques, a signature of prior plaque destabilization, were found at the culprit site in more than one-quarter of ACS patients. Such patients more frequently were diabetic, were hyperlipidemic, or had a history of MI. Healed plaques frequently showed OCT features of vulnerability with evidence of local and systemic inflammation. The combination of plaque vulnerability, local inflammation, and greater plaque burden in addition to systemic inflammation may outweigh the protective mechanism of plaque healing and predispose those plaques to develop occlusive thrombus.     

Calcified Plaques in Patients With Acute Coronary Syndromes

Objectives

This study conducted detailed analysis of calcified culprit plaques in patients with acute coronary syndromes (ACS).

经皮冠状动脉介入治疗对急性冠状动脉综合征患者内皮功能的影响

目的了解急性冠状动脉综合征患者的内皮功能及经皮冠状动脉介入治疗对内皮功能的影响。方法共入选120例急性冠状动脉综合征患者及30例正常对照者,采用高分辨率彩色多普勒超声仪,测定肱动脉内皮依赖性血流介导的血管舒张功能及非内皮依赖性硝酸甘油介导的血管舒张功能。急性冠状动脉综合征患者按有无接受经皮冠状动脉介入治疗分为两组,观察两组患者基线及3个月的内皮依赖性血流介导及非内皮依赖性硝酸甘油介导的血管舒张功能。结果急性冠状动脉综合征患者的内皮依赖性血流介导的血管舒张功能明显低于正常对照组(8.29±5.11比10.64±3.82,P=0.029),而两组间非内皮依赖性硝酸甘油介导的血管舒张功能无明显差别(20.37±9.29比18.41±5.83,P=0.226);经皮冠状动脉介入治疗组术后3个月的内皮依赖性血流介导的血管舒张功能较术前明显降低(5.26±7.20比7.86±5.51,P=0.037),而药物治疗组的内皮依赖性血流介导的血管舒张功能前后对比无明显变化(7.14±6.99比7.91±4.52,P=0.401);内皮依赖性血流介导的血管舒张功能在两组之间及各组治疗前后无统计学差别(P>0.05)。结论急性冠状动脉综合征患者存在内皮功能受损;经皮冠状动脉介入治疗进一步加重内皮功能障碍。     

Frailty and Outcome in Elderly Patients With Acute Coronary Syndrome

Background

Frailty is superior to chronological age as a predictor of outcome. The Edmonton Frail Scale (EFS) is a simple valid measure of frailty, covering multiple important domains, with scores ranging from 0 (not frail) to 17 (very frail). The purpose of this pilot study was to assess the EFS in a group of elderly patients with acute coronary syndrome (ACS).

Methods

The EFS was administered to 183 consecutive patients with ACS aged ≥ 65 years admitted to a single centre in Edmonton, Alberta, Canada.

Results

Scores ranged from 0-13. Patients with higher EFS scores were older, with more comorbidities, longer lengths of stay (EFS 0-3: mean, 7.0 days; EFS 4-6: mean, 9.7 days; and EFS ≥ 7: mean, 12.7 days; P = 0.03), and decreased procedure use. Crude mortality rates at 1 year were 1.6% for EFS 0-3, 7.7% for EFS 4-6, and 12.7% for EFS ≥ 7 (P = 0.05). After adjusting for baseline risk differences using a “burden of illness” score, the hazard ratio for mortality for EFS ≥ 7 compared with EFS 0-3 was 3.49 (95% confidence interval [CI], 1.08-7.61; P = 0.002).

Conclusions

The EFS is associated with increased comorbidity, longer lengths of stay, and decreased procedure use. After adjustment for burden of illness, the highest frailty category is independently associated with mortality in elderly patients with ACS. Further work is needed to determine whether the use of a validated frailty instrument would better delineate medical decision making in this important, often disadvantaged population.     

Feasibility of Coronary Access in Patients With Acute Coronary Syndrome and Previous TAVR

ObjectivesThe aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR).BackgroundImpaired coronary access after TAVR may be challenging and particularly in acute settings could have deleterious consequences.MethodsIn this international registry, data from patients with prior TAVR requiring urgent or emergent CA were retrospectively collected. A total of 449 patients from 25 sites with acute coronary syndromes (89.1%) and other acute cardiovascular situations (10.9%) were included.ResultsSuccess rates were high for CA of the right coronary artery (98.3%) and left coronary artery (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the right coronary artery (99.6% vs 95.9%; P = 0.005) but not for CA of the left coronary artery (99.7% vs 98.7%; P = 0.24). PCI of native coronary arteries was successful in 91.4% of cases and independent of valve type (short SFP 90.4% vs long SFP 93.4%; P = 0.44). Guide engagement failed in 6 patients, of whom 3 underwent emergent coronary artery bypass grafting and another 3 died in the hospital. Among patients requiring revascularization of native vessels, independent predictors of 30-day all-cause mortality were prior diabetes, cardiogenic shock, and failed PCI but not valve type or success of coronary engagement.ConclusionsCA or PCI after TAVR in acute settings is usually successful, but selective coronary engagement may be more challenging in the presence of long SFPs. Among patients requiring PCI, prior diabetes, cardiogenic shock, and failed PCI were predictors of early mortality.