糖化血红蛋白水平对行PCI的非ST段抬高型心肌梗死患者远期预后的影响

目的探讨糖化血红蛋白水平与行经皮冠状动脉介入治疗(PCI)的非ST段抬高型心肌梗死(NSTEMI)患者远期预后的关系。方法连续入选2009年1月至2012年10月于西安交通大学第一附属医院、西安市中心医院及陕西省人民医院确诊为NSTEMI并行PCI的890例患者。根据是否患有糖尿病及糖化血红蛋白(HbA1c)水平分成4组:无糖尿病且HbA1c水平5.7%(n=417);无糖尿病且HbA1c水平在5.7%～6.5%(n=237);有糖尿病且HbA1c水平7.0%(n=138);有糖尿病且HbA1c水平≥7.0%(n=98)。分析不同分组患者3年不良心血管事件、全因性死亡、心血管原因死亡、再发非致死性心肌梗死、心力衰竭(心衰)再次住院、再次血运重建及脑卒中发生率。结果非糖尿病且5.7%≤HbA1c6.5%组患者与非糖尿病且HbA1c5.7%组患者相比较,有较高的3年主要不良心血管事件发生率及死亡率,且有显著性差异(P均0.05),而糖尿病且HbA1c≥7.0%组与糖尿病且HbA1c7.0%组相比较,3年主要不良心血管事件发生率及死亡率均无显著差异。且无论是否患有糖尿病,入院血糖水平均是NSTEMI行PCI患者远期不良预后的危险因素。结论在行PCI的NSTEMI合并糖尿病的患者中,HbA1c升高不是其3年主要不良心血管事件及死亡率的危险因素。在NSTEMI行PCI的非糖尿病患者中,HbA1c升高是其3年主要不良心血管事件及死亡率的危险因素。     

碎裂QRS波预测AMI患者心血管事件的价值

目的探讨碎裂QRS波(f QRS)对评价急性心肌梗死患者预后的临床价值。方法 156例急性心肌梗死患者进行常规心电图检测,将其分为fQRS组和无fQRS组,随访30±2d,比较两组患者心血管事件(MACE事件)的发生率,MACE事件包括心源性死亡事件、非致死性心血管事件,比较fQRS组内择期行经皮冠状动脉介入术(PCI)及未行PCI组心血管临床事件的发生率。结果两组共发生心血管事件42例,发生率26.9%,fQRS组心血管事件、非致死性心血管事件发生率均明显高于无fQRS组(p<0.05)。fQRS组内行择期PCI术与未行PCI术患者比较,发生各种心血管事件的风险无统计学差异(p>0.05)。结论 fQRS与急性心肌梗死预后关系密切,是一个独立预测急性心肌梗死患者心血管事件的新指标。     

老年女性非ST段抬高型心肌梗死患者临床特征及预后分析

目的 描述老年女性非ST段抬高型心肌梗死(NSTEMI)患者临床特征,探讨老年女性NSTEMI患者预后影响因素。方法 选择韩国急性心肌梗死注册研究数据库中回顾性纳入的老年NSTEMI患者2097例,男性1215例,女性882例,收集入选者基线临床资料、3年随访结果,记录主要不良心血管事件(MACE),采用二元logistic回归模型分析老年女性NSTEMI患者预后影响因素。结果 与老年男性比较,老年女性年龄更高,高血压、糖尿病、高脂血症、入院时收缩压、血浆N末端B型钠尿肽前体、Killip分级≥Ⅱ级、血管紧张素受体阻滞剂、钙离子通道阻滞剂、3年累积MACE、心源性死亡、再发非致命心肌梗死及靶血管血运重建比例明显升高,吸烟、肌酐、PCI比例明显降低,差异有统计学意义(P<0.05,P<0.01)。女性(OR=1.425,95%CI:1.045～1.944,P=0.025)、高血压(OR=1.477,95%CI:1.041～2.094,P=0.029)是老年NSTEMI患者不良预后的独立危险因素,PCI是老年NSTEMI患者预后的独立保护因素(OR=0.311,95%CI:0....     

ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后近期和远期预后的性别差异

目的:探讨ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)后近期和远期预后的性别差异。方法:连续性纳入了2013年1月至2016年1月于北京友谊医院心内科行PCI的STEMI患者909例,按照性别分为男性组(n=703)和女性组(n=206)。比较两组患者的基线特征以及近期和远期的预后情况。近期终点事件为PCI后30天内全因死亡。远期终点事件包括PCI后30个月内主要不良心血管事件(MACE,包括全因死亡、非致死性心肌梗死和血运重建的复合终点)、全因死亡、心原性死亡、非致死性心肌梗死和血运重建。结果:与男性组患者相比,女性组患者的年龄更大,合并高血压及糖尿病的比例更高(P均0.05),两组患者冠状动脉病变的严重程度以及介入干预的情况差异无统计学意义(P均0.05)。女性组PCI后30天内全因死亡的发生率显著高于男性组(5.3%vs 1.4%,P=0.001),但女性并非PCI后30天内死亡的独立危险因素(OR=2.41,95%CI:0.64～9.10,P=0.192)。多因素校正后,女性患者PCI后30个月内MACE (HR=0.91,95%CI:0.52～1.60,P=0.762)、全因死亡(HR=0.65,95%CI:0.29～1.45,P=0.300)、心原性死亡(HR=0.62,95%CI:0.27～1.45,P=0.279)、非致死性心肌梗死(HR=0.48,95%CI:0.17～1.36,P=0.172)以及血运重建(HR=1.28,95%CI:0.51～3.22,P=0.598)的发生风险均与男性患者相近,差异无统计学意义。结论:女性STEMI患者在PCI后近期预后较差,全因死亡发生率高,但远期预后与男性患者相似。     

急性ST段抬高型心肌梗死患者血小板分布宽度与急诊冠状动脉介入后心血管不良事件的关系

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者血小板分布宽度(PDW)与接受急诊经皮冠状动脉介入治疗(PCI)远期预后的关系。方法:收集2006年1月至2012年12月,发病12小时内就诊于首都医科大学附属北京安贞医院,接受急诊经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者809例。根据入院后血常规血小板分布宽度(PDW)结果分为两组:组I(PDW15%,n=601)和组II(PDW≥15%,n=208),记录两组的基本资料、血液检验结果及造影情况,采用电话及门诊随诊对患者进行定期随访,记录主要不良心血管事件(MACE)包括:心源性死亡、非致死性心肌梗死、再发心绞痛。结果:平均随访时间(52±24)个月,随访期间心源性死亡26例。两组在出现症状至PCI所需时间、LDLC、HDL-C及血小板总数(PLT)的差异有统计学意义(P0.05)。两组患者1年内MACE发生率差异无统计学意义(P0.05),两组患者远期随访总MACE发生率(18%vs.28.4%,P=0.001)及心绞痛发生率(11%vs.16.8%,P=0.028)差异有统计学意义,在心源性死亡率、非致死性心肌梗死发生率,差异无统计学意义(P0.05)。Logistic回归分析,经调整年龄、高血压史、PDW、LDL-C、HDL-C及症状至PCI时间及出院后规律服用阿司匹林等因素之后,PDW可能是STEMI患者接受急诊PCI术后远期MACE发生率的独立预测因子(OR=1.08,95%CI:1.021!1.145,P=0.008)。结论:PDW值增大可能是接受急诊PCI治疗STEMI患者远期MACE的独立预测因子。     

三种评分对经皮冠状动脉介入治疗急性非ST段抬高心肌梗死患者的预测价值比较

目的探讨ACUITY-PCI评分与GRACE评分和SYNTAX评分对接受PCI的急性非ST段抬高心肌梗死(NSTEMI)患者预后的预测价值。方法收集252例NSTEMI患者临床资料。对每例患者进行ACUITY-PCI、GRACE和SYNTAX评分,随访1年,随访终点为主要不良心血管事件(全因死亡,非致命性心肌梗死、再次血运重建)。将3种评分方法对终点事件预测价值进行比较和分析。结果 GRACE评分、SYNTAX评分及ACUITY-PCI评分预测NSTEMI患者1年主要不良心血管事件的ROC曲线下面积呈依次递增趋势,其准确性分别为0.627(95%CI:0.535⁰.720),0.671(95%CI:0.5890.720),0.671(95%CI:0.589⁰.753),0.754(95%CI:0.6890.753),0.754(95%CI:0.689⁰.802)。3种评分方法均具有良好的拟合优度,其中ACUITY-PCI评分同时具备较好的准确性和拟合优度。结论ACUITY-PCI评分可预测接受PCI的NSTEMI患者预后,其同时具备较好的准确性和拟合优度。     

不同处理方式对并发多支血管病变非ST段抬高型心肌梗死患者远期预后的影响及相关因素分析

目的比较非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)并发多支血管病变仅处理"罪犯"血管(culprit-only revascularization,COR)和一次性完全血运重建(one-time complete revascularization,CR)两种不同的处理方式对患者远期预后的影响及相关因素分析。方法入选2016年1月至2018年5月入住河北省人民医院心血管内科的患者140例,根据NSTEMI并发多支血管病变处理方式的不同,失访及资料不完整10例,将患者分为COR组(n=95)和CR组(n=35)。收集入选患者的性别、年龄、吸烟史、原发性高血压(高血压)、糖尿病、生化指标、超声心动图指标、介入手术相关指标等基线资料,比较两种不同的处理方式对NSTEMI并发多支血管病变患者远期预后的影响及相关因素分析。结果 NSTEMI并发多支血管病变患者随访时间为11.25(5.38～15.13)个月。CR组与COR组复合终点(全因死亡,再发心肌梗死,再次血运重建,心绞痛住院)比较,差异有统计学意义(8.57%vs. 6.32%,P=0.035);CR组与COR组次要终点(心绞痛复发,出血,心律失常,心力衰竭住院,脑卒中)比较,差异仍有统计学意义(48.58%vs. 23.15%,P=0.031)。二项多变量Logistic回归分析显示,在复合终点事件中,首次医疗接触时间(FMC)(β=0.005,OR=1.005,95%CI:1.000～1.010,P=0.043)是影响NSTEMI并发多支血管病变患者发生复合终点事件的危险因素;然而,在次要终点事件中,COR策略(β=-0.614,OR=0.541,95%CI:0.297～0.986,P=0.045)是影响NSTEMI并发多支血管病变患者发生次要终点事件的保护因素,可改善次要终点事件的发生。结论对于NSTEMI并发多支血管病变患者,COR可能为一个理想的策略,可改善其远期预后,是其发生次要终点事件的保护因素;首次医疗接触时间是其主要终点事件的危险因素。     

ACUITY-PCI评分对经皮冠状动脉介入治疗急性非ST段抬高心肌梗死患者的预测价值

目的:探讨ACUITY-PCI评分系统对接受经皮冠状动脉介入(PCI)治疗的急性非ST段抬高心肌梗死(NSTEMI)患者预后的预测价值。方法:收集北京安贞医院抢救中心2009-01-2012-12住院的急性NSTEMI患者进行ACUITY-PCI评分,并对入选病例进行长期随访,随访终点为全因性死亡、非致命性心肌梗死、再次血运重建。结果:随访2年,统计47例患者发生的心血管不良事件,其中低分组4例,发生率8.5%;中分组22例,发生率46.8%;高分组21例,发生率44.7%。高分组、中分组与低分组比较差异有统计学意义(log-rank P0.001)。ROC曲线分析结果显示,曲线下面积=0.727[95%CI(0.656,0.797),P0.001]。结论:ACUITYPCI评分是预测接受PCI治疗的急性NSTEMI患者预后的理想工具。     

冠状动脉介入治疗对75岁及以上非ST段抬高型心肌梗死患者远期预后的影响

目的 探讨PCI对老年(年龄≥75岁)非ST段抬高型心肌梗死(NSTEMI)患者远期预后的影响。方法 回顾性分析2018年5月1日～2020年5月1日泰州市人民医院及苏北人民医院心血管内科住院的老年NSTEMI患者209例,根据医师建议以及患者偏好分为PCI组142例,保守组67例。通过门诊复诊、电话以及住院病历系统随访,中位随访时间730 d。分析全因死亡、心力衰竭再住院发生率。使用Graphpad prism 8.0软件绘制Kaplan-Meier生存曲线。采用Cox风险模型分析PCI对全因死亡、心力衰竭再住院的影响。结果 PCI组吸烟比例明显高于保守组,年龄、肌酐水平明显低于保守组(P<0.05,P<0.01)。PCI组全因病死率、心力衰竭再住院率明显低于保守组(12.7%vs 28.4%,P<0.01;23.9%vs 38.8%,P<0.05)。Kaplan-Meier生存曲线显示,PCI组全因病死率和心力衰竭再住院率明显低于保守组(HR=0.41,95%CI:0.20～0.82,P_{log rank}=0.005;HR=0.54,95...     

急诊经皮冠状动脉介入术开通梗死相关血管时程变化对急性ST段抬高型心肌梗死早期预后的影响

目的:观察急诊经皮冠状动脉介入术(PCI)开通梗死相关血管的时程变化对急性ST段抬高型心肌梗死(STEMI)住院期间死亡率及心肌梗死后30 d内心血管事件发生率的影响.方法:急性STEMI患者213例,根据症状发生至第1次球囊扩张的时间分为3组:＜180 min组(A组,27例),180～360 min组(B组,83例),＞360 min组(C组,103例).观察各组术后30 d内主要心血管不良事件的发生率,包括心源性死亡、非致死性心肌梗死、急性亚急性支架内血栓形成.结果:症状发生到第1次球囊扩张的时间中位数为(355.3±223)min,C组老年患者(≥75岁)及女性患者相对多见,前壁梗死和心源性休克发生率较高.住院总心源性死亡率为13.6%,C组住院期间死亡率(17.5%)明显高于A组(3.7%)和B组(12.1%);急性心肌梗死的并发症心源性休克显著影响死亡率(36.5%).随访30 d,心源性休克、≥75岁高龄、女性患者心血管事件发生率显著升高.多因素回归分析显示时间延迟>360 min是影响急性STEMI早期预后的独立危险因素.结论:急诊PCI时间的延迟显著影响急性STEMI早期预后.急诊PCI时间延迟超过6h是影响早期预后的独立危险因素.     

冠状动脉介入治疗再灌注时间对急性前壁心肌梗死左室重构及远期预后的影响

目的评价冠状动脉介入治疗(PCI)再灌注时间对急性前壁心肌梗死左室重构及远期预后的影响。方法选择113例首次急性前壁心肌梗死患者,冠状动脉造影证实梗死相关动脉(IRA)完全闭塞(TIMI0～1级)。依据PCI再灌注时间分为3组,A组35例,6h内IRA成功再灌注;B组40例,6～12h内IRA成功再灌注;C组38例,12～24h内IRA成功再灌注。分别于术后即刻和6个月行冠状动脉造影及左心室造影,对比分析3组左心室造影的心功能指标:左心室舒张末容积、左心室收缩末容积、左心室射血分数、每分输出量、心脏指数,并观察1年内主要不良心脏事件(MACE)的发生情况。结果成功再灌注即刻,3组之间各项心功能参数无显著性差异。6个月时A组和B组各项心功能参数较即刻有改善趋势;C组较前下降,但均无统计学意义。1年随访期间,A、B组无死亡及再次心肌梗死事件发生。心绞痛的发生在3组中无差别。C组心力衰竭及死亡的发生均明显高于A、B组。结论前壁心肌梗死后尽早行PCI,开通IRA,可阻抑左室重构,改善心功能,减少死亡等MACE的发生,从而改善预后。     

The Terminal Part of the QT Interval (T peak to T end): A Predictor of Mortality after Acute Myocardial Infarction

Background : The terminal part of the QT interval (T peak to T end; Tp‐e)—an index for dispersion of cardiac repolarization—is often prolonged in patients experiencing malignant ventricular arrhythmias after acute myocardial infarction (AMI). We wanted to explore whether high Tp‐e might predict mortality or fatal arrhythmia post‐AMI. Methods: Tp‐e was measured prospectively in 1359/1384 (98.2%) consecutive patients with ST elevation (n = 525) or non‐ST elevation (n = 859) myocardial infarction (STEMI or NSTEMI) admitted for coronary angiography. Results : Tp‐e was significantly correlated with age, heart rate (HR), heart failure, LVEF, creatinine, three‐vessel disease, previous AMI and QRS and QT duration. During a mean follow‐up of 1.3 years (range 0.4–2.3),109 patients (7.9%) died; 25, 45, and 39 from cardiac arrhythmia, nonarrhythmic cardiac causes and other causes, respectively. Long Tp‐e was strongly associated with increased risk of death, and Tp‐e remained a significant predictor of death in multivariable Cox analyses (RR 1.5, 95% CI[1.3–1.7]). HR‐corrected Tp‐e (cTp‐e) was the strongest predictor of death (RR 1.6 [1.4–1.9]). Tp‐e and cTp‐e were particularly strong predictors of fatal cardiac arrhythmia (RR 1.6 [1.2–2.1] and RR 1.8 [1.4–2.4]). Findings were similar in STEMI and NSTEMI. When comparing two methods for measuring Tp‐e, one including the tail of the T wave and one not, the former had markedly higher predictive power (P < 0.001). Conclusion : Tp‐e, and in particular cTp‐e, were strong predictors of mortality during the first year post‐AMI, and should be further evaluated as prognostic factors additional to established post‐AMI risk factors.     

慢性完全闭塞病变对接受急诊介入治疗的急性心肌梗死患者远期预后的影响

目的:分析慢性完全闭塞(CTO)病变对接受急诊介入治疗的急性心肌梗死(AMI)患者远期预后的影响。方法:分析自2013年1月至2014年9月间纳入中国急性心肌梗死(CAMI)注册登记研究的接受急诊介入治疗的14176例AMI患者,根据冠状动脉造影的结果,将患者分为AMI合并CTO病变组(n=1235)和AMI不合并CTO病变组(n=12941)。随访2年,比较两组的临床预后,主要研究终点为死亡率,次要研究终点为包括心原性死亡、脑卒中、心力衰竭再入院、再次血运重建等的主要不良心血管事件。结果:合并CTO病变的AMI患者占8.7%(1235/14176)。随访2年,AMI合并CTO病变组的患者全因死亡率(9.9%vs.5.4%)和心原性死亡率(5.0%vs.2.6%)明显高于AMI不合并CTO病变组患者(P均<0.01)。单因素分析显示,CTO病变增加AMI患者死亡(HR=1.44,95%CI:1.02~2.03,P=0.04)和再次血运重建(HR=2.14,95%CI:1.55~2.96,P<0.01)风险。多因素回归分析显示,高龄(HR=1.07,95%CI:1.05~1.09)和就诊时存在心力衰竭(HR=2.05,95%CI:1.36~3.09)与患者2年死亡的不良预后明显相关(P均<0.01),而CTO病变不是2年死亡的独立危险因素(HR=1.33,95%CI:0.93~1.90,P=0.11)。结论:合并CTO病变的AMI患者的远期死亡率和心原性死亡率明显高于不合并CTO病变的患者。高龄和就诊时存在心力衰竭是远期死亡的独立危险因素,而CTO病变并不是远期死亡的独立危险因素。     

Non‐ST‐elevation myocardial infarction outcomes in patients with type 2 diabetes with non‐obstructive coronary artery stenosis: Effects of incretin treatment

There are insufficient data on the prognosis and management of people with type 2 diabetes who experience a non‐obstructive coronary artery stenosis (NOCS)–non‐ST‐elevation myocardial infarction (NSTEMI) event. We evaluated the 12‐month prognosis of patients with diabetes and NOCS (20%‐49% luminal stenosis) who experience a first NSTEMI as compared with patients without diabetes. In addition, we investigated the 12‐month prognosis in patients with diabetes and NSTEMI‐NOCS previously treated with incretin‐based therapy compared with a matched cohort of patients with NSTEMI‐NOCS never treated with such therapy. We categorized the patients with diabetes as current incretin users (6 months’ treatment with glucagon‐like peptide‐1 agonists or dipeptidyl peptidase‐4 inhibitors) and non‐users of incretins. The endpoint was all‐cause mortality, cardiac death, recurrent acute coronary syndrome (ACS), and heart failure. The unadjusted Kaplan–Meier analysis, and a risk‐adjusted hazard analysis showed that, all‐cause mortality, cardiac death, readmission for ACS and heart failure rates during the 12‐month follow‐up were higher in patients with diabetes and NOCS‐NSTEMI than in those with NOCS‐NSTEMI without diabetes. Among the patients with diabetes, the current incretin users had a significantly lower rate of all‐cause mortality, cardiac death and readmission for ACS at 12 months. In patients with type 2 diabetes and NOCS‐NSTEMI, we observed a higher incidence of 1‐year mortality and adverse cardiovascular outcomes, as compared with patients without diabetes with NOCS‐NSTEMI. In people with diabetes, non‐users of incretins had a worse prognosis than current incretin users.     

Comparison of five‐year outcome in African Americans versus Caucasians following percutaneous coronary intervention

Background: Studies regarding short‐term outcomes after percutaneous coronary intervention (PCI) have reported no ethnic differences and data on long‐term follow‐up is conflicting and sparse. Methods: 730 consecutive patients (67% African American) undergoing PCI from January 1999 to December 2000 at a tertiary care center in Detroit, MI, were followed up. End points studied included either all cause mortality collected from Social Security Death Index or first hospital admission after the index procedure due to myocardial infarction(MI), congestive heart failure(CHF), and revascularization (PCI or coronary artery bypass graft surgery). Results: African‐Americans undergoing PCI had significant differences in baseline cardiovascular co‐morbidity and were more likely to present with acute myocardial infarction than Caucasians. On Kaplan Meier survival analysis and log rank test, each ethnic group had equivalent survival for cumulative end points upto 6‐month follow‐up, however longer follow‐up to 5 year was characterized by lower survival rate in African Americans compared to Caucasians (41% vs. 54%, log rank P 0.01). After adjustment for potential confounders, AA ethnicity (Adjusted HR 1.62, 95% CI 1.01–1.28, P 0.04) remained a predictor of adverse cardiac outcome (Death/MI/CHF) at five‐year follow‐up (Cox regression propensity adjusted hazard analysis). Conclusions: African American patients undergoing PCI had unfavorable baseline cardiovascular characteristics but comparable short‐term outcome compared to whites. However, at 5‐year follow‐up, African Americans had worse clinical outcome, higher incidence of acute myocardial infarction, congestive heart failure and significantly lower long‐term survival. © 2008 Wiley‐Liss, Inc.     

Percutaneous coronary intervention-associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine.

In patients with chronic renal insufficiency, further decline in renal function (DRF) after percutaneous coronary intervention (PCI) is accompanied not only by adverse in-hospital events but also by increased risk of mortality and myocardial infarction at 1 year. This analysis was undertaken to determine if patients with normal renal function who develop DRF after PCI have a comparable increase in risk of death and myocardial infarction at 1 year, and whether this risk is independent of in-hospital complications (death, myocardial infarction, urgent coronary artery bypass grafting). We performed a retrospective analysis of all patients from a single center who underwent successful PCI with no major in-hospital complications who had pre-PCI serum creatinine (SCr) /= 50% of baseline). They were more likely to be older, female, non-Caucasian, diabetic and/or hypertensive. They reported more prior cerebral or peripheral vascular events. They had undergone more complex PCI and were exposed to more radiographic contrast than the 96.5% who did not develop DRF. After adjustment for baseline variables, DRF remained an independent predictor of 1-year mortality, myocardial infarction, and target vessel revascularization. In patients without prior renal impairment, DRF post-PCI is rare but is associated with an increased risk of late adverse cardiac events similar to that in chronic renal insufficiency patients.     

Association between deteriorated renal function and long-term clinical outcomes after percutaneous coronary intervention

Acute renal insufficiency after percutaneous coronary artery intervention (PCI) is a strong predictor of adverse events. However, the effect of chronic renal impairment on the long-term outcomes after PCI has not been well established. The aim of this study was to evaluate the incidence of deteriorated renal function during the chronic phase after PCI and its impact on clinical outcomes. We enrolled 282 consecutive patients who underwent PCI and had serum creatinine measured during the chronic phase (at least 3 months after PCI). We divided the study population into two groups: an advanced group that had an increase in stage of chronic kidney disease during the chronic phase, and a preserved group that included the remainder of the study population. There were 43 patients in the advanced group. We evaluated the incidence of major adverse cardiac events (MACE) that included all-cause death, nonfatal myocardial infarction, and rehospitalization with heart failure or angina pectoris. The rate of rehospitalization for heart failure and angina pectoris was significantly higher in the advanced group than in the preserved group (19.0% vs 6.8%, P < 0.01). In multivariate Cox regression analysis, the advanced group was associated with MACE (hazard ratio 3.50, 95% confidence interval 1.49-8.22, P < 0.01). Deterioration of renal function during long-term follow-up after percutaneous coronary intervention was associated with adverse cardiac events.     

中国非ST段抬高急性冠状动脉综合征患者二年随访终点事件的影响因素分析

目的 研究分析OASIS登记试验中国地区所有入选的非ST段抬高急性冠状动脉综合征患者2年随访结束时联合终点事件(包括死亡、新的心肌梗死及卒中)的发生与多种因素(包括患者基础特征及就诊状态、主要治疗措施、用药情况等)之间的关系.方法 总结38家医院非ST段抬高急性冠状动脉综合征人院患者随访至2年的资料,统计自入院至随访结束时联合终点事件的发生情况及最早出现的时间,并采用生存分析(Cox回归)模型,分析48种因素在联合终点事件发生中所起的作用.结果 自1999年4月至2001年12月共收集急性冠状动脉综合征患者资料2294例,平均年龄(62.8±8.3)岁,男性占62.3%,联合终点事件365例,发生率为15.9%.促进联合终点事件发生的危险因素主要为:患者就诊心率>120次/min(HR=2.081,95%CI:1.088～3.979)、住院期间的溶栓(HR=2.342,95%CI:1.528～3.590)及复发性心绞痛(HR=1.313,95%CI:1.033～1.670)、吸烟(HR=1.974,95%CI:1.407～2.769)、高龄(HR=1.037,95%CI:1.025～1.050)及既往心脏病史等.延缓联合终点事件发生的保护性因素主要为:就诊时心电图恢复正常,随访期间坚持应用常规药物等.结论 我国非ST段抬高急性冠状动脉综合征患者中,合并其他心血管疾病,就诊病情危重者随访时易发生联合终点事件;反之,正规应用药物治疗对终点事件的发生产生一定的保护作用.     

Association of renal insufficiency with in-hospital mortality among Japanese patients with acute myocardial infarction undergoing percutaneous coronary interventions

It is not yet clear whether a difference in in-hospital morality between patients with and without renal insufficiency undergoing percutaneous coronary intervention (PCI) exists. Therefore, the aim of the present study was to investigate if such as association exists in Japan. Data from the Tokai Acute Myocardial Infarction Study II were used. This was a prospective study of all 3274 patients admitted with acute myocardial infarction (AMI) to the 15 participating hospitals from 2001 to 2003. We abstracted the baseline and procedural characteristics as well as in-hospital mortality from detailed chart reviews. Patients were stratified into 2 groups according to the estimated creatinine clearance on admission. The creatinine clearance values were available in 2116, 107 of whom had renal insufficiency. The patients with renal insufficiency were more likely to be older, female, not independent in their daily activities, have lower body mass index and higher heart rate values on admission, lower prevalences of hypercholesterolemia and peptic ulcers, greater prevalences of diabetes, angina, previous heart failure, previous renal failure, previous cerebrovascular disease, aortic aneurysm, worse clinical course such as bleeding, and a multivessel coronary disease. Vasopressors, an intra-aortic balloon pump, and mechanical ventilation were frequently used in the patients with renal insufficiency, while thrombolytics were used less frequently. The patients with renal insufficiency had a higher in-hospital mortality rate than those without. Multivariate analysis identified renal insufficiency as an independent predictor of in-hospital death. The results suggest that renal insufficiency is an independent predictor of in-hospital death among AMI patients undergoing PCI.     

Long-term safety and effectiveness of drug-eluting stents compared to bare metal stents following successful PCI in non-ST-elevation myocardial infarction: findings from the Guthrie Health Off-Label StenT (GHOST) Registry

Background: The long‐term safety and effectiveness of drug‐eluting stents (DES) versus bare metal stents (BMS) in non‐ST‐segment elevation myocardial infarction (NSTEMI) beyond 2 years after percutaneous coronary intervention (PCI) is unknown. Methods: We studied 674 NSTEMI patients who underwent successful PCI with DES (n = 323) or BMS (n = 351). The primary study end‐points were time to occurrence of death or nonfatal recurrent myocardial infarction (MI), and stent thrombosis (ST). Secondary end‐points included time to occurrence of target vessel revascularization (TVR) and any major adverse cardiovascular event (MACE, defined as the composite of death, MI, ST, TVR). Results: The DES and BMS groups were well matched except that DES patients received dual antiplatelet therapy for a longer duration and had smaller final vessel diameter. In survival analysis, at a mean follow‐up of 1333 ± 659 days after PCI, the DES group had similar incidence of death/myocardial infarction (24% vs. 27%, log rank p = 0.23) and ST (4.0% vs. 2.6%, p = 0.18) as the BMS group. The DES patients had lower incidence of TVR (8.1% vs. 17%, p = 0.0018) but similar MACE (26% vs. 37%, p = 0.31). In multivariable analysis, DES vs. BMS implantation showed no significant impact on death/myocardial infarction [adjusted hazards ratio (HR) 1.0, 95% confidence intervals (CI) 0.7–1.4], ST (HR 1.7; CI 0.7 – 4.0), or MACE (HR 0.8; CI 0.6 – 1.1). However, TVR was lower in the DES group (HR 0.4; CI 0.3 – 0.7). Conclusion: In patients presenting with NSTEMI, DES implantation appears to be as safe as BMS implantation at long‐term follow‐up. In addition, DES are effective in reducing TVR compared to BMS. (J Interven Cardiol 2012;25:28–36)