老年急性ST段抬高型心肌梗死患者PCI术后不良心血管事件影响因素分析及列线图预测模型建立

目的]分析老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后不良心血管事件影响因素,并建立列线图预测模型。 [方法]选取2021年2月—2023年1月在辽宁省金秋医院接受PCI术的老年急性STEMI患者216例,依照术后院内不良心血管事件发生情况划分为发生组(n＝33)和未发生组(n＝183)。收集所有患者一般资料、实验室指标、影像学检查资料、术后用药资料,采用单因素与多因素Logistic回归分析探究不良心血管事件独立危险因素,根据独立危险因素中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、C反应蛋白/白蛋白比值(CAR)、C反应蛋白与高密度脂蛋白胆固醇比值(CHR)构建列线图预测模型,绘制校准曲线对列线图模型进行验证,并绘制受试者工作特征(ROC)曲线,分析列线图模型的预测效能。 [结果]发生组NLR、PLR、CAR、CHR水平及Gensini评分、血小板聚集率(PAR)明显较未发生组高,左心室射血分数(LVEF)明显较未发生组低(P＜0.05);Logistic回归分析结果显示,Gensini评分、LVEF、PAR、NLR、PLR、CAR、CHR是老年急性STEMI患者PCI术后发生不良心血管事件的独立危险因素(P＜0.05);根据独立危险因素构建预测老年急性STEMI患者PCI术后发生不良心血管事件风险的列线图模型,模型校准曲线与理想模型较为接近,ROC曲线显示,列线图预测不良心血管事件发生风险的ROC曲线下面积为0.914。 [结论]NLR、PLR、CAR、CHR是影响老年急性STEMI患者PCI术后发生不良心血管事件的独立危险因素,基于以上因素构建的列线图模型能有效预测老年急性STEMI患者PCI术后发生不良心血管事件的风险。     

红细胞膜总胆固醇联合Gensini评分对经皮冠状动脉介入术后急性冠脉综合征患者近期预后的评估价值研究

背景 经皮冠状动脉介入术(PCI)是一种公认的有效治疗急性冠脉综合征(ACS)的方法,但术后仍有患者在近期内会发生各种不良心血管事件,故采用一定的方法评估ACS患者PCI后近期预后具有实际意义.有研究提示红细胞膜总胆固醇(CEM)和Gensini评分对患者预后评估有积极意义.目的 分析CEM联合Gensini评分对PC...     

阻塞型睡眠呼吸暂停低通气综合征与急性冠状动脉综合征患者冠状动脉病变严重程度及预后的相关性

目的 研究阻塞型睡眠呼吸暂停低通气综合征与急性冠状动脉综合征患者冠状动脉病变严重程度及预后的相关性.方法 将急性冠状动脉综合征患者根据冠状动脉造影结果和睡眠呼吸监测结果分为单纯急性冠状动脉综合征组及急性冠状动脉综合征合并轻度、中度和重度阻塞型睡眠呼吸暂停低通气综合征组,以Gensini评分比较各组冠状动脉病变严重程度,并分析Gensini评分与呼吸暂停低通气指数和夜间最低血氧饱和度的关系.6个月内对患者进行随访,比较各组间心血管联合终点事件发生情况.结果 三个合并阻塞型睡眠呼吸暂停低通气综合征组呼吸暂停低通气指数明显高于单纯急性冠状动脉综合征组(P<0.01),而夜间最低血氧饱和度却明显低于单纯急性冠状动脉综合征组(P<0.01);合并中度和重度阻塞型睡眠呼吸暂停低通气综合征组呼吸暂停低通气指数明显高于轻度阻塞型睡眠呼吸暂停低通气综合征组(P<0.01),而夜间最低血氧饱和度则明显低于后者(P<0.01).Gensini评分合并中度和重度阻塞型睡眠呼吸暂停低通气综合征组明显高于另两组(P<0.01),且合并重度阻塞型睡眠呼吸暂停低通气综合征组的Gensini评分明显高于中度阻塞型睡眠呼吸暂停低通气综合征组(P<0.05).Gensini评分与呼吸暂停低通气指数成正相关,Gensini评分与夜间最低血氧饱和度成负相关.四组患者6个月内心血管联合终点事件发生率分别为19.35%、22.58%、32.26%和43.33%,重度阻塞型睡眠呼吸暂停低通气综合征组的心血管联合终点事件发生率显著高于单纯急性冠状动脉综合征组(P<0.05),其他各组间心血管联合终点事件差异无显著性(P>0.05).血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、阻塞型睡眠呼吸暂停低通气综合征分级是急性冠状动脉综合征患者心血管联合终点事件发生的独立预测因子.结论 中、重度阻塞型睡眠呼吸暂停低通气综合征可能是加重急性冠状动脉综合征患者冠状动脉病变严重程度的重要因素,阻塞型睡眠呼吸暂停低通气综合征会增加急性冠状动脉综合征近、中期预后的心血管联合终点事件发生率,尤其是重度阻塞型睡眠呼吸暂停低通气综合征对急性冠状动脉综合征患者的预后有显著影响,阻塞型睡眠呼吸暂停低通气综合征是急性冠状动脉综合征患者心血管联合终点事件的独立预测因子.     

经皮冠状动脉介入治疗术后炎症指标对急性冠脉综合征患者预后影响

目的 前瞻性观察接受经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）的急性冠脉综合征患者PCI术后中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）、血小板/淋巴细胞比值（platelet to lymphocyte ratio,PLR）、C反应蛋白（ C-reactive protein?,CRP）、降钙素原（procalcitonin,PCT）、白细胞介素-6（interleukin-6,IL-6）等炎症指标水平对近期预后的影响。方法　214例急性冠脉综合征患者行PCI治疗手术后次日清晨,抽取外周肘静脉血行全血细胞测定（计算NLR和PLR）和 CRP、PCT、IL-6等炎症因子检测。应用二分类Logistic 多因素回归模型分析急性冠脉综合征PCI术后主要心脏不良事件 (?major adverse cardiac events,MACE)?发生的影响因素;ROC曲线评估上述炎症指标对急性冠脉综合征患者PCI术后MACE发生的预测价值。结果　214例急性冠脉综合征患者,平均随访12月（中位数）,共累计33例患者（15.4%）出现MACE事件。应用二分类Logistic 多因素回归模型分析,发现NLR[（odds ratio,OR值）2.98,P<0.001]和急性冠脉综合征类型（OR=0.29,P=0.048）是PCI术后MACE发生的独立影响因素。ROC曲线评估分析发现,NLR、PLR、CRP、PCT、IL-6均有预测PCI术后MACE发生的价值（P<0.01）,但是NLR预测MACE发生的ROC曲线下面积最大（0.898）,NLR预测PCI术后MACE事件发生最佳切点为3.94。结论 PCI术后NLR、PLR、CRP、PCT、IL-6等炎症指标均具有预测PCI术后MACE发生的价值,而NLR的预测价值最高。PCI术后过高的NLR和急性ST段抬高型心肌梗死是急性冠脉综合症患者PCI术后MACE发生的独立影响因素。     

中性粒细胞与淋巴细胞比值与冠状动脉狭窄程度的关系

目的：研究中性粒细胞与淋巴细胞比值（NLR）与冠状动脉狭窄程度的关系,探讨NLR对冠心病患者冠状动脉病变严重程度的预测作用。方法：219例患者依据冠状动脉造影结果进行冠脉Gensini评分并根据其结果将其分为低分组（0～30分）142例和高分组（〉30分）77例,检测外周血白细胞分类计数并计算NLR,应用spss17．0软件进行统计分析。结果：①NLR在不同类型冠心病患者及冠脉正常患者之间存在差异（P〈0．05）;②以冠脉Gensini积分将患者分组后,高分组NLR与低分组间差异有统计学意义（P〈0．01）,单因素及多因素Logistic回归分析显示NLR与年龄、高密度脂蛋白胆固醇均是高Gensini积分的独立危险因素;③受试者工作特征曲线（ROC曲线）显示NLR的曲线下面积为0．658（95％CI：0．583—0．733）,且当NLR切值取2．385时,其诊断效率最高,敏感性为64％,特异性为63％。结论：NLR是冠心病的独立危险因素,可作为预测冠状动脉狭窄程度的指标。     

急性冠状动脉综合征患者经皮冠状动脉介入术后平均血小板容积对近期预后的影响

目的研究急性冠状动脉综合征(ACS)患者平均血小板容积(MPV)对经皮冠状动脉介入术(PCI)术后近期预后的影响。方法选择2015年3月至2018年3月期间在信阳市中心医院行PCI的100例ACS患者作为研究对象,根据PCI术后1年内是否发生不良心血管事件分为预后不良组及对照组。分析2组间一般临床资料、实验室指标、超声指标、PCI治疗情况的差异,采用COX模型分析预后的影响因素,采用ROC曲线分析MPV对预后的预测价值。结果预后不良组的高血压率、糖尿病率、吸烟率、MPV、C反应蛋白(CRP)、低密度脂蛋白胆固醇均高于对照组,使用血栓抽吸、替罗非班的比例低于对照组(P0.05)。经COX回归分析,吸烟、MPV升高、CRP升高是预后不良的独立危险因素(P0.05)。经ROC曲线分析,MPV对ACS患者PCI术后1年内发生不良心血管事件具有较好的预测价值,最佳截点为10.68 fL,预测的敏感度为70.73%,特异度为72.22%。Kaplan-Meier曲线分析显示,MPV增加的ACS患者不良心血管事件的发生率高于MPV正常的ACS患者(P0.05)。结论 MPV升高是ACS患者PCI术后1年内发生不良心血管事件的独立危险因素,MPV超过10.68 fL对不良心血管事件具有较好的预测价值。     

中性粒细胞/淋巴细胞比值与不稳定型心绞痛行经皮冠状动脉介入治疗的关系

目的探讨中性粒细胞/淋巴细胞比值(NLR)与不稳定型心绞痛(UAP)患者需行经皮冠状动脉介入(PCI)治疗的关系。方法选择2018年1月至2019年6月河南科技大学第一附属医院心血管内科收治的260例UAP患者为研究对象,根据冠状动脉造影结果,分为需行PCI组167例和无需行PCI组93例。收集2组患者的临床资料并进行比较。采用SPSS24.0软件进行数据处理。采用logistic回归法分析UAP患者需行PCI治疗的危险因素。受试者工作特征(ROC)曲线分析NLR对UAP患者需行PCI治疗的诊断价值。结果 2组患者年龄、糖尿病史、中性粒细胞、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、NLR水平比较,差异均有统计学意义(P0.05)。Spearman相关性分析显示,NLR与UAP患者需行PCI治疗呈正相关(r=0.353,P0.001)。多因素logistic回归分析显示NLR是UAP患者需行PCI治疗的独立危险因素(OR=1.982,95%CI 1.168～3.362)。ROC曲线分析显示,NLR预测UAP患者需行PCI治疗的曲线下面积为0.713(95%CI 0.651～0.776)。结论 NLR可作为UAP患者需行PCI治疗的预测指标之一。     

血小板与淋巴细胞比值对冠状动脉病变及介入治疗预后的预测价值

目的探讨血小板与淋巴细胞比值(PLR)对老年急性冠状动脉综合征(ACS)患者冠状动脉病变及PCI预后的预测价值。方法选择2016年5月～2018年8月我院住院治疗的老年ACS患者344例,均接受PCI及冠状动脉造影,根据PCI术后有无主要不良心脑血管事件(MACCE)分为MACCE组95例和无MACCE组249例;根据PLR判断预后界值分为高PLR组247例(PLR≥137.6)和低PLR组97例(PLR137.6)。回顾分析患者一般临床资料等,用ROC曲线确定PLR判断预后的界值,行logistic回归分析。结果 MACCE组吸烟、糖尿病、LDL-C、PLR及Gensini评分均较无MACCE组高(P0.01);PLR和Gensini评分预测PCI预后不良的曲线下面积为0.898(95%CI:0.859～0.937)和0.842(95%CI:0.794～0.891);PLR水平与Gensini评分呈正相关(r=0.654,P0.01)。高PLR组总MACCE发生率明显高于低PLR组(78.35%vs 7.69%,P0.01),术前高PLR水平是预测老年ACS患者PCI术后发生MACCE的独立危险因素(OR=2.527,95%CI:1.058～6.039,P=0.037)。结论 PLR与老年ACS患者PCI术后发生MACCE有关。     

尿酸对急性ST段抬高型心肌梗死介入治疗患者远期预后的影响

目的探讨尿酸对急性ST段抬高型心肌梗死(STEMI)行PCI患者远期预后的影响。方法选择行冠状动脉造影和PCI术的STEMI患者150例,根据PCI术后是否发生主要不良心血管事件(MACE)分为非MACE组100例和MACE组50例。比较2组一般临床资料、生化指标及冠状动脉病变情况,用ROC曲线预测PCI术后MACE发生风险。结果 MACE组Gensini积分及血清尿酸水平明显高于非MACE组[(68.13±18.20)分vs (49.20±15.43)分,(389.48±88.81)μmol/L vs (320.00±61.00)μmol/L,P=0.000]。血清尿酸和Gensini积分ROC曲线下面积分别为0.785(95%CI:0.694～0.877)和0.789(95%CI:0.703～0.876)。当血清尿酸为378.5μmol/L时,敏感性为66.7%,特异性为82.7%。Pearson相关性分析显示,血清尿酸水平与Gensini积分呈正相关(r=0.840,P0.01)。logistic回归分析显示,血清尿酸、Gensini积分是PCI术后MACE的独立危险因素(P0.05)。结论根据患者血清尿酸和Gensini积分水平可评估冠状动脉病变程度和PCI术后预后情况。     

PLR、NLR联合GRACE评分对不稳定性心绞痛患者心血管主要不良事件的预测价值

目的 探讨血小板/淋巴细胞(PLR)、中性粒细胞/淋巴细胞(NLR)联合全球急性冠状动脉事件(GRACE)评分对不稳定性心绞痛患者心血管主要不良事件的预测价值。方法 选取行冠状动脉造影确诊为不稳定性心绞痛行常规住院治疗患者364例,出院后随访1年,根据有无心血管主要不良事件发生分为预后良好组298例和预后不良组66例。比较两组性别、年龄、BMI、糖尿病史、高血压史、总胆固醇(TC)、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇、氨基末端脑钠肽前体、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、PLR、NLR、GRACE评分。采用多因素Logistic回归分析不稳定性心绞痛患者发生心血管主要不良事件的危险因素,通过受试者工作(ROC)曲线分析PLR、NLR及GRACE评分单独及其联合预测不稳定性心绞痛患者发生心血管主要不良事件的价值。结果 预后不良组与预后良好组比较,TC、LDL-C、LVEDD、LVEF、PLR、NLR及GRACE评分差异有统计学意义(P均<0.05);多因素Logistic回归分析结果显示,TC、LDL-C、LVEDD、LVEF...     

Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

BACKGROUND: In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES: To examine the performance of this strategy in a multicenter study. METHODS: Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS: The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.     

Grading the angiographic extent of collateral filling

Angiography frequently demonstrates a collateral circulation in severe coronary artery disease. An easily applicable method to quantify collateral flow might be a useful adjunct for the assessment of the hemodynamic effects of coronary artery disease. The purpose of this study was to validate a visual scaling of the extent of angiographic collateral filling by comparison with flowmeter- and microsphere-derived measurements of collateral flow. In 12 open-chest dogs, collaterals from the circumflex artery were angiographically visualized (n = 80) by creating acute critical left anterior descending artery occlusion. The extent of collateral filling was graded in four levels from 0 = no visible filling to 3 = complete epicardial filling. Collateral filling correlated with the change in flow of the collateral supplying circumflex artery (Q; r = 0.84) which was + 5.3 ±4.6% with grade 1, + 9.1 ±3.5% with grade 2 and + 14.6 ±4.7% with grade 3 (p < 0.01). In parallel, coronary flow reserve decreased from 4.1 ±0.8 with grade 0 to 2.9 ±0.2 with grade 3 (p < 0.01). Colored microspheres were injected subselectively into the circumflex artery of 9 dogs (45 injections). The ratio of microspheres counted in the collateralized myocardium of the left anterior descending artery to the total number injected increased from 0.6 ±0.9% for grade 0 to 17.1 ±2.8% with grade 3 (p < 0.01). Absolute collateral flow derived from microsphere counts averaged 5.5 ±0.9 ml/min with grade 3 and closely correlated with collateral filling grade (r = 0.88). Semiquantitative grading of angiographic collateral filling in response to acute coronary occlusion in a canine model correlates with an increase in collateral source artery flow, absolute collateral flow and a decrease in source artery flow reserve. These data suggest that this scale might be a simple but useful adjunct tool to assess the hemodynamic significance of a collateral circulation.This work was supported by a grant from the NLHBI 1 R01 HL40865. Dr. Schuhlen is the recipient of a grant from the Deutsche Forschungsgemeinschaft (#Schu657/1-1 and 1–2).     

Embolization complicating coronary angioplasty in the presence of an intracoronary thrombus

Two cases of coronary occlusion and subsequent embolization during percutaneous coronary angioplasty (PTCA) are described. Prior to PTCA, angiographic evidence of intracoronary thrombus was present. Abrupt reclosure after dilation was treated by successful redilation. However, coronary embolization of thrombus debris occurred downstream in one patient and into an adjacent coronary branch in the second patient.     

Is short-stay coronary angioplasty safe?

Percutaneous transluminal coronary angioplasty (PTCA) is usually performed as an inpatient procedure and the patients are monitored for several days afterward. Over a 13-month period, in 91 of 373 PTCA procedures, the clinical condition of the patient did not necessitate inpatient status before PTCA. PTCA was done the day of admission and discharge planned the following. Overall hospital stay was planned as less than 24 hours. PTCA was done in one vessel in 62 patients, two vessels in 24, three vessels in 3, and four vessels in 2 patients. PTCA was initially successful (less than 50% residual stenosis) in 85 patients (93%). In one of these, acute occlusion occurred the next morning and urgent bypass surgery was done. PTCA failed in 6 patients who left the catheterization laboratory with unchanged coronary anatomy. Bypass surgery was performed that day in 2 patients, on another admission in 1 patient, and medical therapy continued in the other 3 patients. Of the 88 patients not receiving same admission bypass surgery, 84 (95%) were discharged in less than 24 h. Hospitalization was prolonged (1-5 days) in 4 patients. This was because of nonobstructive dissection treated with heparin for approximately 24 h in 2 patients; a catheterization site hematoma in 1 patient, and post-PTCA noncardiac chest pain in another. No patient had inhospital myocardial infarction or death. The only late complication was in a patient treated with heparin and monitored for 2 days; 3 weeks later angina returned and he died suddenly. These data suggest PTCA can safely be done in selected patients with both single and multivessel disease in a short stay inhospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)     

LAD-right ventricular fistula complicating PTCA: Another case

Coronary perforation caused by percutaneous transluminal coronary angioplasty (PTCA) occurs rarely and most often leads to communication to the pericardial space. We report a case where PTCA caused a coronary artery rupture and fistulization to the right ventricular outflow tract. Cathet. Cardiovasc. Diagn. 42:34–36, 1997. © 1997 Wiley-Liss, Inc.     

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.     

非罪犯冠脉斑块研究的进展

加强冠心病的二级预防是目前防控急性冠脉综合征（ACS）的重要手段。本文对ACS与非罪犯冠脉斑块的关系作了综述。     

Angiographic demonstration of coronary sinus thrombosis: A potential consequence of trauma to the coronary sinus

Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.     

Coronary arteriovenous-arterial fistula

A case of multiple arteriovenous fistulae is described in an adult with coronary artery disease. One of these fistulae drained into the anterior interventricular vein, which in turn communicated with and perfused an obstructed left anterior descending coronary artery.