血流储备分数指导下完全血运重建对非ST段抬高型急性冠脉综合征多支血管病变患者预后的影响

目的探讨血流储备分数(FFR)指导下完全血运重建对非ST段抬高型急性冠脉综合征(NSTE-ACS)多支血管病变患者预后的影响。方法 100例NSTE-ACS多支血管病变患者随机分为FFR指导下功能性完全血运重建组(FFR组)和单纯冠状动脉造影(CAG)指导下完全血运重建组(CAG组),比较两组人均支架植入数量、住院费用等经皮冠状动脉介入(PCI)资料;患者术后随访12个月,比较两组心绞痛发作次数、左室射血分数(LVEF)和主要不良心血管事件(MACEs)发生率。采用SPSS 19.0统计学软件分析处理数据,组间比较采用t检验或卡方检验。结果 FFR组人均支架植入数量[(2.0±1.5)vs(3.5±1.8)枚,P0.01]和住院费用[(43 905±26 242)vs(65 884±20 489)元,P=0.04]较CAG组显著降低;术后1个月心绞痛发作次数[(2.3±0.7)vs(4.1±0.5)次]和LVEF[(62.7±6.8)%vs(54.7±7.9)%]改善情况优于CAG组;术后12个月FFR组再次血运重建[4.1%(2/49)vs 17.8%(8/45),P=0.03]和MACEs发生率[8.2%(4/49)vs 24.4%(11/45),P=0.03]较CAG组显著降低。结论 FFR指导下功能性完全血运重建减少支架植入数量和住院费用,有效改善术后1个月心绞痛症状和心功能,降低术后12个月MACEs发生率,NSTE-ACS多支血管病变患者短期获益明显。     

血管内超声指导经皮冠状动脉介入治疗对非ST段抬高型急性冠脉综合征临界病变患者预后的影响

目的观察血管内超声(IVUS)指导经皮冠状动脉介入(PCI)治疗对非ST段抬高型急性冠脉综合征(NSTE-ACS)临界病变患者临床预后的影响。方法入选2016年6月至2017年1月陕西省第四人民医院心血管内科冠状动脉造影(CAG)提示可行PCI术的NSTE-ACS临界病变患者100例,随机数字表法分为IVUS组和血流储备分数(FFR)组各50例,术后随访12个月,比较2组患者主要不良心血管事件(MACEs)发生情况。结果 IVUS组和FFR组患者病变血管直径[(3.5±0.7)vs(3.0±0.5)mm]、狭窄程度[(62.6±5.0)%vs(57.2±7.5)%]、病变长度[(20.2±8.8)vs(23.5±10.7)mm]、PCI相关并发症发生率[8.0%(4/50)vs 4.0%(2/50)]等差异无统计学意义(P0.05);相比FFR组患者,IVUS组患者支架植入率较高[56.0%(28/50)vs 38.0%(19/50)],但差异无统计学意义(P0.05)。术后随访12个月MACEs发生率差异无统计学意义[18.8%(9/48)vs 14.3%(7/49),P=0.55]。结论对于NSTE-ACS临界病变患者,IVUS指导血运重建治疗的短期临床预后不劣于FFR指导。     

早期分次经皮冠状动脉介入干预非梗死相关动脉对STEMI患者预后的影响

目的探讨早期分次经皮冠状动脉介入治疗(PCI)干预非梗死相关动脉(Non-IRA)对急性ST段抬高型心肌梗死患者(STEMI)预后的影响。方法选择陕西省第四人民医院心血管内科于2015年1月~2016年12月住院治疗的120例STEMI多支血管病变患者,随机分为早期分次PCI组(急诊PCI成功开通梗死相关动脉后3~7 d干预Non-IRA)和再次入院PCI组。比较两组患者基线资料、病变特征、住院期间并发症和院内主要不良心血管事件(MACE)发生率,术后对患者进行6个月随访,比较两组患者心绞痛发作次数、心功能改善情况和MACE发生率。结果早期分次PCI组住院时间[(7.5±1.5)d vs.(11.5±2.3)d,P=0.02]及住院费用[(67658±30242)元vs.(79864±24980)元,P=0.04]低于再次入院PCI组,差异有统计学意义,且未增加住院期间并发症[11例(18.3%)vs.5例(8.3%),P=0.11]和院内MACE事件[4例(6.7%)vs.2例(3.3%),P=0.68]发生率,差异有统计学意义;随访6个月时,早期分次PCI组心绞痛症状[(1.8±0.5)vs.(3.1±0.6),P=0.04]和心功能[(57.7±3.3)vs.(52.0±5.2),P=0.03]改善情况优于再次住院PCI组,差异有统计学意义,MACE事件发生率[(17.2%)vs.(10.5%),P=0.30]差异无统计学意义。结论早期分次PCI干预Non-IRA是安全可行的,降低了住院时间和费用,且未增加住院期间并发症和院内MACE发生率,患者短期预后不劣于再次住院PCI治疗。     

一次与分次经皮冠状动脉介入术完全血运重建对非ST段抬高型心肌梗死多支血管病变患者预后的影响

目的探讨一次经皮冠状动脉介入治疗(PCI)完全血运重建对非ST段抬高型心肌梗死(NSTEMI)多支血管病变患者短期预后的影响。方法本研究为回顾性研究。选择2016年1月至2017年1月在陕西省第四人民医院住院治疗的NSTEMI多支血管病变患者为研究对象,根据介入性完全血运重建治疗策略的不同分为一次PCI组(60例)和分次PCI组(98例),比较两组围术期资料和主要并发症;术后随访12个月,比较两组心功能改善情况和主要不良心血管事件发生率。结果两组的年龄、性别、合并症、心功能和心肌酶等基线资料无明显差异(均为P>0.05)。此外,两组患者双支病变比例和人均支架置入数量均相似(均为P>0.05),但一次PCI组患者平均病变血管数量(2.2±0.6比2.8±0.5)、住院时间[(5.0±3.5)d比(11.2±6.4)d]和住院费用[(50 862.2±21 300.0)元比(66 522.1±27 445.0)元]较分次PCI组显著降低(均为P<0.05)。一次PCI组主要并发症较分次PCI组有增加趋势(13.3%比7.1%),但差异无统计学意义(P=0.21)。随访12个月,一次PCI组患者LVEF优于分次PCI组(59.6%±2.7%比54.2%±4.9%,P=0.03),且MACE发生率较分次PCI组显著降低[6(10.3%)比22(23.7%),P<0.0001]。结论本研究提示一次PCI完全血运重建可减少住院时间和住院费用,改善患者心功能和降低术后MACE发生率。     

高龄冠心病患者冠状动脉不完全血运重建的中远期疗效

目的探讨不完全血运重建与完全血运重建在高龄冠心病患者介入治疗中的疗效,及对中远期预后的影响。方法连续选择75岁以上高龄冠心病接受PCI治疗的145例患者,回顾性分析,临床基线特征、PCI操作特点、住院期间事件和6个月以上中远期预后事件。分析高龄患者中完全血运重建与不完全血运重建两组间临床、介入治疗、院内事件及中远期预后的差异。结果 145例患者中53例（36.6）进行了完全血运重建,92例（63.4）进行了不完全血运重建。与完全血运重建组相比,不完全血运重建组患者多支病变和tandenm病变显著增多（94.6vs.50.9,P〈0.01;1.06±0.91vs.0.50±0.61,P〈0.01）,SYNTAX积分也更高（27.46±15.65vs.13.80±8.90,P〈0.01）;PCI病变成功率和操作成功率均显著下降（91.4vs.100.0,P〈0.05;88.7vs.100.0,P〈0.01）。然而两组间临床成功率及住院期间主要不良事件的差异无统计学意义。中远期随访结果显示,不完全血运重建组较完全血运重建组主要心脑血管不良事件（MACCE）发生比例显著升高（17.4vs.7.5,P〈0.05）,但Logistic多因素回归分析显示不完全血运重建并非中远期MACCE的独立危险因素（OR=23.348;95CI：0.183～78.124;P=0.114,）。Kaplan-Meier生存分析显示,两组无MACCE生存曲线无统计学差异（LogRankP=0.155）。结论高龄冠心病患者完全血运重建难度更大、手术风险更高,而不完全血运重建并未增加远期MACCE的发生率,辅以药物治疗可能达到理想的治疗效果。     

分期经皮冠状动脉介入术完全血运重建对高危非ST段抬高型急性冠脉综合征多支血管病变患者预后的影响

目的:比较分期与一次经皮冠状动脉介入术(PCI)完全血运重建对高危非ST段抬高型急性冠脉综合征(NSTE-ACS)多支血管病变患者预后的影响。方法:根据完全血运重建策略的不同将高危NSTE-ACS患者分为分期PCI组(n=128)和一次PCI组(n=58),比较两组治疗和主要并发症的情况;患者术后随访12个月,比较两组主要不良心血管事件(MACE)的发生率。结果:分期PCI组主要并发症发生率显著低于一次PCI组(6.25%对15.51%,P=0.042)。随访至术后3个月,分期PCI组MACE的发生率较一次PCI组显著降低(P0.05),随访至术后12个月,分期PCI组MACE的发生率较一次PCI组有降低趋势,但差异无统计学意义。结论:分期PCI完全血运重建安全有效,可作为高危NSTE-ACS多支血管病变患者优先选用的介入治疗策略。     

直接完全血运重建对老年急性ST段抬高型心肌梗死合并多支血管病变患者预后影响的前瞻性分析

目的本研究旨在比较老年急性ST段抬高型心肌梗死(STEMI)合并多支血管病变患者采取不同策略血运重建对预后的影响。方法前瞻性分析2012年9月至2015年8月就诊于首都医科大学附属北京安贞医院心内科接受急诊经皮冠状动脉(冠脉)介入治疗(PCI)且符合STEMI合并多支病变(病变血管≥2支)、年龄≥60岁的281例患者,按冠脉血运重建情况分为直接完全血运重建组(77例),分次血运重建组(204例)。结果两组患者性别构成比、高血压、糖尿病、冠脉病变情况等均无明显差异;住院期间直接完全血运重建组急性血栓事件发生率明显高于分次血运重建组(6.5%vs.1.5%,P=0.032),但两组患者住院期间的心衰发生率(1.0%vs. 1.3%,P=0.329)、心脏压塞(0 vs.0,P=1.000)、出血并发症(2.5%vs. 2.6%,P=0.840)、外周血管血栓事件发生率(1.0%vs. 1.3%,P=0.329)无明显差别;平均随访24.9±5.8月,随访期间两组患者的心源性死亡发生率(1.8%vs. 2.0%,P=0.811)、再梗死发生率(5.4%vs. 5.2%,P=0.442)、卒中(4.4%vs. 3.9%,P=0.643)、再次血运重建比例(7.8%vs. 6.5%,P=0.589)和再住院率(48.0%vs. 50.6%,P=0.529)无显著差别。结论与分次血运重建组相比,直接完全血运重建策略对老年急性ST段抬高型心肌梗死合并多支血管病变的患者预后无显著改善,而且有增加术后急性血栓事件的风险。     

药物洗脱支架与冠脉搭桥术对老年三支冠脉病变的疗效及费用分析

目的比较药物洗脱支架(PCI)与冠状动脉搭桥术(CABG)对老年三支冠脉病变的治疗效果及费用。方法选取2007年4月—2008年11月进行冠脉血运重建的176例三支病变的老年患者(年龄60～79岁),其中PCI组106例,CABG组70例。通过术后6个月和12个月随访比较两组终点事件和治疗费用。结果 PCI组平均住院及术后住院日较CABG组明显缩短(10.77±4.92)d比(46.20±16.19)d,(7.68±4.11)d比(19.51±10.04)d;PCI组完全血运重建率与CABG组相比差异有统计学意义(26.4%比100%,P0.001)。两次随访两组死亡、心梗及脑卒中发生率无明显差异;PCI组的再血管化治疗高于CABG组(P0.05);心绞痛及胸闷气短差异无统计学意义(P0.05);CABG组伤口疼痛发生率显著高于PCI组(P0.05)。总MACCE事件CABG组虽显著低于PCI组(10.0%比21.7%,P=0.04),但将PCI组中计划内分次进行的血运重建从总MACCE中除去后,两组间差异无统计学意义(P=0.09)。联合终点事件两组间亦差异无统计学意义(P=0.08)。总住院费用及药物费用CABG组显著高于PCI组(P0.001)。手术费用两者相似(P=0.83)。术后治疗费用PCI组显著高于CABG组(P0.001)。1年总费用CABG组显著高于PCI组(P0.001)。两组中完全血运重建者1年费用总和CABG组仍显著高于PCI组(P0.001)。术后PCI组抗血小板及他汀用药显著优于CABG组。结论对老年三支冠脉病变患者进行药物洗脱支架与冠脉搭桥术的疗效和费用进行综合分析后,提示药物洗脱支架治疗优于冠脉搭桥。     

血流储备分数指导下ST段抬高型心肌梗死多支血管病变患者非梗死相关血管分期完全血运重建的临床研究

目的评估血流储备分数(FFR)在急性ST段抬高型心肌梗死(STEMI)多支血管病变患者非梗死相关血管(non-IRA)分期经皮冠状动脉介入治疗(PCI)完全血运重建中的临床价值。方法选取陕西中医药大学第二附属医院心血管内科2015年6月至2016年5月已成功行PCI开通梗死相关血管(IRA),拟分期PCI治疗(间隔≥7 d)non-IRA的STEMI多支血管病变患者90例,按随机数字表法分为FFR指导下完全血运重建组(FFR组)45例和冠状动脉造影指导下完全血运重建组(CAG组)45例。FFR组狭窄>90%的non-IRA病变直接行PCI治疗,对狭窄70%~90%的病变行FFR检查,仅对FFR<0.80的non-IRA行PCI治疗;CAG组对狭窄≥70%的non-IRA依据术者经验行PCI治疗,处理的靶血管参照血管直径≥2.5 mm。比较两组PCI时间、支架置入数量、造影剂用量、住院时间、住院费用和围术期并发症,随访患者术后6个月主要不良心脑血管事件发生情况。结果 FFR组支架置入数量[(1.68±0.75)枚比(2.83±0.54)枚,t=7.662,P<0.001]和造影剂用量[(164.8±35.7)ml比(195.0±41.9)ml,t=4.271,P=0.04]均明显少于CAG组;术后随访6个月,FFR组再次血运重建率显著低于CAG组(4.7%比19.5%,P=0.04),两组主要不良心脑血管事件发生率差异无统计学意义(均为P>0.05)。结论 STEMI多支血管病变患者在FFR指导下对non-IRA行分期完全血运重建可减少支架置入数量、造影剂用量及术后6个月再次血运重建率。     

不同类型急性冠状动脉综合征患者经皮冠状动脉介入治疗后心肺耐力特征分析

目的:探讨不同类型急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后心肺功能差异。方法:采用回顾性研究方法,连续入选首都医科大学附属北京友谊医院,心脏康复数据库中2017年5月至2018年12月,行PCI术的ACS患者48例,根据临床诊断分为ST段抬高型心肌梗死(STEMI)组和非ST段抬高型急性冠状动脉综合征(NSTE-ACS)组,通过心肺运动负荷试验和6 min步行距离评估其心肺功能特点。结果:与STEMI组患者相比,NSTE-ACS组既往心绞痛病史的比例更多(62.9%vs. 23.1%,P=0.01),支架置入数更多(P=0.03),LVEF更高[(65.4±5.9)%vs.(57.4±5.6)%,P0.05],而STEMI组行急诊PCI以及室壁运动异常的比例均显著高于NSTE-ACS组(76.9%vs.零,P=0.00;84.6%vs. 28.6%,P=0.001)。STEMI组和NSTE-ACS组在心肺运动负荷试验各个指标以及6 min步行距离结果,差异无统计学意义(P0.05)。STEMI组和NSTE-ACS组患者的峰值公斤耗氧量占预计值的百分比分别为(67.23±15.50)%和(68.74±11.57)%,提示ACS患者心肺耐力下降。两组患者的峰值负荷占预计值的百分比分别为(66.54±14.23)%和(75.11±20.08)%,提示ACS患者运动能力减退。此外,NSTE-ACS组患者的峰值耗氧量、峰值负荷量均与6 min步行距离间存在显著的正相关(r=0.42,P=0.01;r=0.45,P=0.004),而STEMI组患者上述参数间无显著相关性(P0.05)。不管是NSTE-ACS组还是STEMI组,其峰值耗氧量与LVEF之间均没有显著的线性关系(P0.05)。结论:单中心回顾性分析显示, PCI术后的ACS患者,不论是STEMI组还是NSTE-ACS组,均表现为心肺耐力和运动能力的下降。NSTE-ACS组患者的峰值耗氧量与6 min步行距离呈正相关。在临床上,特别是对于NSTE-ACS患者而言,6 min步行试验可能是一个有效便捷的评估手段,用以指导和制定心脏康复处方,以便更好地开展和推广心脏康复。     

Treatment of ruptured coronary aneurysm with a novel covered stent

Coronary artery aneurysms are relatively rare but have been diagnosed with increasing frequency since the advent of coronary arteriography. Their reported incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery (RCA), accounting for over 40% of all cases. The most common etiology amongst adults remains atherosclerosis accounting for 50% of coronary aneurysms. We describe the first use of a novel flexible pericardium covered stent for successful treatment of a ruptured coronary aneurysm in 76 year old lady. © 2008 Wiley‐Liss, Inc.     

Techniques for palmaz-schatz stent deployment in lesions with a large side branch

Palmaz-Schatz coronary stent implantation in lesions with a large side branch are reported. The first case describes how to manage plaque shifting after stent implantation. The second and third cases demonstrate a kissing balloon predilatation and stent dilatation technique of a bifurcational lesion. The final case demonstrates a stent implantation technique through the stent struts of a previously deployed stent.     

Stenting with the half (disarticulated) palmaz-schatz stent

A total of 110 half (disarticulated) Palmaz-Schatz coronary stents were implanted in 102 patients. Procedural success rate was 98%. Elective stenting was performed in five patients. The others received half stents for bail-out situations, including short dissections, relapsing stenoses, dissections not adequately covered by a full stent, ostial stenoses, and thrombus containing lesions. Seventeen patients received no anticoagulation except aspirin. Complications included one procedural death, three acute occlusions (resulting in one Q and two non-Q wave myocardial infarctions), and one non-Q wave infarction related to side branch closure. Stenting with the half Palmaz-Schatz coronary stent is an effective technique. It allows stenting in situations where a full stent may not be ideally suited. Use of only half a stent reduces thrombogenicity and halves costs.     

Association of coronary calcification with obstructive disease in coronary arteries in Indian patients

A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age 51.4 +/- 9.4 years) catheterized for cardiac diseases other than coronary artery disease (CAD) were subjected to the same protocol of fluoroscopy and coronary angiography to exclude incidental CAD in view of their age. CAC was present in 240 patients (20.0%) in Group I. Of these, 200 (83.4%) had triple-vessel disease (TVD); 20 (8.3%) had double-vessel disease (DVD); 19 (7.9%) had single-vessel disease (SVD); and 37 (15.4%) patients had left main coronary disease (LMCAD). Only one of these patients had insignificant CAD considered as "normal" coronary arteries (NC). Incidence of LMCAD, TVD, DVD, SVD, and NC in patients without CAC was 4.4%, 56.3%, 18.2%, 14.0%, and 11.5%, respectively. Incidence of CAC in patients with LMCAD, TVD, DVD, SVD, and NC was 48.1%, 28.1%, 10.8%, 13.0%, and 1.0% respectively. In Group II (n = 120), 24 patients (20%) had CAD, CAC was present in 5 patients with CAD (20.9%), and in two patients without CAD (2%). CAC is relatively uncommon in Indian CAD patients. Its presence, however, indicates severe multivessel disease.     

Coronary angioplasty of a posterolateral branch with severe proximal vessel tortuosity

We present a case of a patient who experienced recurrent angina 15 months after coronary bypass surgery. A single lesion distal to a graft anastomosis was identified in the posterolateral coronary artery. There were two severe angulations, each greater than 90° proximal to the lesion, with access possible only through the saphenous vein graft to the posterior descending artery. For ultimate success, such challenging anatomy required a combination of an array of guidewires, secondary support catheters, and a deflecting balloon. Cathet. Cardiovasc. Diagn. 41:426–429, 1997. © 1997 Wiley-Liss, Inc.     

药物洗脱支架置入术与冠状动脉旁路移植术治疗冠心病多支病变的临床对比研究

目的:探讨药物洗脱支架(DES)治疗冠心病多支冠状动脉(冠脉)病变患者的临床疗效,并与冠脉旁路移植术进行比较.方法:入选2005-01-2008-01在我院行血管重建术的215例冠心病多支冠脉病变患者,其中114例行DES置入术(DES组),101例行冠脉旁路移植术 (CABG组).比较2组住院期和随访期不良心血管事件(死亡、非致死性心肌梗死、再次血管重建术和脑血管意外)的发生情况.结果:2组的临床和冠脉病变特征相似, 与DES组比较,CABG组左主干病变(29.2%∶5.0%,P<0.01)、LVEF<50%发生率(39.7%∶19.2%,P<0.01) 和完全血管重建率(81.2%∶58.8%, P<0.01)较高.住院期2组总体不良心血管事件发生率无明显差异,但CABG组住院期病死率有增高趋势(6.9%∶1.8%,P＞0.05).平均临床随访12～36(17±9)个月,2组总体不良心血管事件发生率仍无明显差异(9.6% ∶13.4%,P＞0.05) ,但DES组再次血管重建的发生率较CABG组有增高趋势(9.8%∶2.1%,P＞0.05).结论:DES置入术应用在冠心病多支冠脉病变患者中安全可行,总体不良心血管事件发生率与CABG无明显差异.     

Angiographic outcomes with biodegradable polymer and permanent polymer drug‐eluting stents

Background : In the Intracoronary Stenting and Angiographic Results: Test Efficacy of 3 Limus‐Eluting Stents (ISAR‐TEST‐4) trial, we demonstrated the noninferiority of biodegradable polymer (BP) sirolimus‐eluting stent to permanent polymer (PP) sirolimus/everolimus‐eluting stent (Cypher/Xience‐V) on the basis of clinical outcomes. In this study, we compare the antirestenotic efficacy of these stents in ISAR‐TEST‐4 patients with paired angiographic studies. Methods : Patients with de novo coronary lesions in native vessels (excluding left main lesions) were randomly assigned to receive a BP stent or a PP stent. Endpoints of interest of this study were in‐stent late lumen loss, in‐segment binary restenosis, and restenosis morphology at 6–8‐month follow‐up angiogram. Results : Of the 2,603 patients (3,372 lesions) enrolled in ISAR TEST‐4 trial, 2,016 patients (2,637 lesions) underwent repeat angiographic examination 6–8 months after randomization: 1,006 patients (1,323 lesions) treated with BP stents and 1,010 patients (1,314 lesions) treated with PP stents. No difference was observed between BP and PP stents in in‐stent late lumen loss (0.24 ± 0.6 vs. 0.26 ± 0.5 mm, respectively, P = 0.49) or in in‐segment binary restenosis (11.6% [153 lesions] vs. 11.8% [155 lesions], P = 0.85). Focal pattern of restenosis was observed in the majority of patients receiving either BP or PP stents. The diffuse pattern of restenosis was observed in 26.8% of patients treated with BP stent and 26.5% of patients treated with PP stent (P = 0.79). Conclusion : Angiographic characteristics of restenosis after BP‐based limus‐eluting stents are similar to those of PP‐based limus‐eluting stents. © 2011 Wiley‐Liss, Inc.