血流储备分数与冠状动脉造影指导不稳定型心绞痛患者临界病变介入治疗效果的比较

目的 分析血流储备分数（FFR）与冠状动脉造影（CAG）指导的不稳定型心绞痛患者临界病变介入治疗的效果.方法 回顾性分析2012年9月1日至2013年9月30日在北京大学人民医院心脏中心行CAG显示为临界病变且行FFR检查的不稳定型心绞痛患者,共收集41例患者的50处血管病变,与同时期行CAG的不稳定型心绞痛临界病变病例进行1：3匹配,分析其随访期间的主要不良心血管事件（包括心绞痛无缓解、再次靶血管血运重建、非致死性心肌梗死和心源性死亡）.结果 FFR介入治疗组共21例25处血管病变;FFR药物治疗组共20例25处血管病变;CAG介入治疗组共63例75处血管病变;CAG药物治疗组共60例75处血管病变.FFR介入治疗组术后的FFR平均值为（0.86±0.07）,有4例4处血管（16％）的术后FFR≥0.94,达到了介入治疗结果理想的标准;有13例17处血管（68％）的术后FFR在0.80～0.94的可接受范围内;其余4例4处血管（16％）的术后FFR＜0.80.FFR指导治疗的2组病例和CAG指导治疗的2组病例术后总的主要不良心血管事件（包括死亡、非致死性心肌梗死、再次靶血管血运重建和心绞痛缓解情况）差异有统计学意义（P=0.000）.在随访过程中4组均无心源性死亡病例,非致死性心肌梗死的发生率在各组间的差异无统计学意义.心绞痛缓解情况在FFR指导治疗的两组中最为明显,明显缓解的比例高于CAG指导治疗的两组,而明显缓解＋部分缓解的比例达到了100％,也高于CAG指导治疗的两组（P=0.002）,差异有统计学意义.再次靶血管血运重建的情况在FFR指导治疗的两组中也明显低于CAG指导治疗的两组,尤其是FFR药物治疗组无再次靶血管血运重建事件发生.而CAG药物治疗组在随访过程中由于心绞痛无明显缓解等原因再次行靶血管血运重建的比例最高（P=0.008）,差异有统计学意义.结论 采用FFR检查可以准确的识别不稳定型心绞痛患者临界病变是否缺血,用于指导介入治疗可以降低术后的主要不良心血管事件.     

血流储备分数指导经皮冠状动脉介入治疗术中非罪犯中度狭窄血管治疗策略的研究

目的：通过测量血流储备分数（FFR）,决定是否对不稳定型心绞痛多支血管病变患者经皮冠状动脉介入治疗（PCI）术中非罪犯中度狭窄血管行介入治疗,并观察临床转归。方法本研究入选不稳定型心绞痛多支血管病变患者,首先对已明确的罪犯血管行PCI治疗后,针对非罪犯中度狭窄血管按照单双号分为对照组（非支架组）和观察组（FFR指导下行PCI组）。其中,观察组FFR＜0.8的患者对中度狭窄血管行PCI治疗,术后再次行FFR检测,确保FFR≥0.95。观察终点事件为全因死亡、非致死性心肌梗死、再次血运重建发生率以及心绞痛临床表现。结果共纳入71例患者,对照组35例;观察组36例,其中FFR≥0.8的患者23例,FFR＜0.8的患者13例。两组患者无主要终点事件和再次血运重建生存率分别比较,差异均有统计学意义（P＜0.05）;无全因死亡与非致死性心肌梗死生存率分别比较,差异均无统计学意义。针对靶血管不良事件的统计学分析显示,两组再次血运重建（观察组5.6%,对照组31.4%）及非致死性心肌梗死（观察组5.6%,对照组28.6%）发生率分别比较,差异均有统计学意义（P＜0.05）。结论不稳定型心绞痛患者中,使用压力导丝测出的FFR值来决定是否对非罪犯中度病变进行血运重建是安全的。FFR结合冠状动脉造影指导PCI治疗较单纯冠状动脉造影指导PCI的不良事件发生率显著减少,尤其在再次血运重建方面,并且心绞痛临床表现显著缓解。     

不同血运重建方式对冠心病合并糖尿病患者近期和远期临床结果的影响

目的比较在广泛使用药物涂层支架（drug-eluting stent，DES）的时代，不同血运重建方式对冠心病合并糖尿病患者近期和远期临床结果的影响。方法DESIRE（Drug-Eluting Stent Impact on Revascularization）为单中心回顾性注册研究，入选了两个不同时间段即非DES时代及DES时代接受血运重建治疗的3763例患者。本研究选取DES时代的冠心病合并糖尿病患者670例（包括既往有糖尿病病史者和本次入院新诊断糖尿病者），根据血运重建方式分为经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）组和冠状动脉旁路移植术（coronary artery bypass graft，CABG）组。不良心血管事件定义为全因死亡、致死／非致死性心肌梗死、致死／非致死性卒中或再次血运重建的复合终点。结果两组基线情况无明显差异。PCI组的院内不良心血管事件低于CABG组（0．5％比4．1％，P=0．001），主要为死亡率较低（0．5％比3．3％，P=0．012）。PCI组和CABG组分别随访592．6-I-121．3d及581．5-I-148．3d，两组随访率相似（92％比89．7％，P=0．311），两组远期不良心血管事件差异无统计学意义，PCI组有增高趋势（14．2％比9．0％，P=0．056），主要为再次血运重建的患者较多（8．5％比2．1％，P=0．001），随访中死亡、非致死性心肌梗死和非致死性卒中的发生率相似。结论在广泛使用DES的时代，行PCI的冠心病合并糖尿病患者院内不良心血管事件发生率低于CABG，主要为院内死亡率低。两组远期不良心血管事件发生率差异无统计学意义，但PCI组的再次血运重建率较高。     

紫杉醇微孔载药支架与进口雷帕霉素药物洗脱支架治疗冠心病的临床效果比较

目的:比较紫杉醇微孔载药支架和进口雷帕霉素药物洗脱支架在经皮冠状动脉介入治疗中的临床疗效。方法: 筛选73例行经皮冠状动脉介入治疗术的冠心病患者,随机分为两组,紫杉醇微孔载药支架组（紫杉醇组,35例）和进口雷帕霉素药物洗脱支架组（雷帕霉素组,38例）。支架植入术后6个月复查冠状动脉造影（CAG）。随访6个月,对比两组支架内血栓形成、主要心血管不良事件（包括心源性死亡、非致死性心肌梗死、靶病变血运重建）和支架内再狭窄发生率。结果: 随访6个月,两组均未出现急性、亚急性和晚期支架内血栓形成、非致死性心肌梗死和心源性死亡。心绞痛、支架内再狭窄和靶病变血运重建发生率均无统计学差异。结论: 紫杉醇微孔载药支架与进口雷帕霉素药物洗脱支架在治疗冠状动脉简单病变时具有相同的近、中期临床疗效和安全性。     

血流储备分数在冠状动脉左主干临界病变中的应用

目的分析、比较血流储备分数(FFR)与冠状动脉造影(CAG)在指导冠状动脉左主干临界病变治疗中的应用。方法选择经CAG证实病变程度为冠状动脉左主干临界病变的冠心病患者187例,分为CAG药物治疗组、CAG介入治疗组、FFR药物治疗组、FFR介入治疗组。CAG药物治疗组未行经皮冠状动脉介入(PCI)治疗,仅进行规范的冠心病二级预防药物治疗;CAG介入治疗组根据术者经验及患者临床症状、相关辅助检查决定行PCI治疗;FFR药物治疗组是对FFR0.80的病变不进行PCI治疗,而给予规范的冠心病二级预防药物治疗;FFR介入治疗组是对FFR≤0.80的病例行PCI治疗。所有患者均给予最优化的冠心病二级预防药物治疗。术后随访12个月,观察随访期间的主要不良心脏事件(包括心血管病死亡、非致死性心肌梗死、靶血管血运重建)和加拿大心血管病学会(CCS)心绞痛分级情况。结果随访结果发现,4组患者均未发生心血管病死亡和CCSⅣ级的心绞痛发作;与CAG指导下的药物治疗组和介入治疗组比较,FFR指导下的药物治疗组和介入治疗组的非致死性心肌梗死、靶血管血运重建和CCSⅠ~Ⅲ级心绞痛发作情况明显降低,差异有统计学意义(P0.05)。结论 FFR在冠状动脉左主干临界病变治疗中有一定指导意义。     

经皮高速旋磨治疗冠状动脉钙化分叉病变：单中心经验

目的 评价旋磨术在冠状动脉钙化分叉病变治疗中的作用.方法 选择2006年7月至2013年1月大庆油田总医院旋磨治疗冠状动脉分叉病变患者48例,术后观察冠状动脉造影和治疗结果、住院期间和12个月的主要不良心血管事件（包括心源性死亡、介入治疗相关心肌梗死和靶血管再次血运重建）以及心绞痛的发生情况.结果 43例（89.6％）只旋磨主支,4例（8.3％）同时旋磨主支和边支,1例（2.1％）只旋磨边支.1例旋磨术中发生急性闭塞,1例旋磨术中出现慢血流;43例（89.6％）只在主支置入支架,4例（8.3％）采用双支架术,1例（2.1％）只在边支置入支架.主支置入支架后3例边支发生急性闭塞,1例边支次全闭塞,边支闭塞后球囊扩张边支,血流均恢复TIMI Ⅲ级.住院期间无死亡和靶血管再次血运重建病例,共有6例（12.5％）发生介入治疗相关心肌梗死.术后12个月随访1例非心源性死亡,1例靶血管再次血运重建,无心源性死亡、心肌梗死病例.结论 经皮冠状动脉内旋磨术是治疗分叉病变的安全、有效方法.     

血流储备分数指导下介入治疗冠脉临界病变对NSTE-ACS患者预后的影响

目的 观察血流储备分数（fractional flow reserve,FFR）指导下介入治疗冠脉临界病变对非ST段抬高型急性冠脉综合征（NSTE-ACS）患者短期预后的影响。 方法 选取西京医院心血管内科冠状动脉造影（CAG）确定单支冠脉狭窄程度为50%~70%且拟行经皮冠状动脉介入（PCI）治疗的192例NSTE-ACS患者为研究对象,按随机数字表将患者分为CAG组（n=96）和FFR组（n=96）,患者随访12个月,比较两组患者再发心绞痛和主要不良心血管事件（MACE）的发生情况。 结果 与CAG组比较,FFR组再发心绞痛和MACE事件发生率均显著降低（P<0.05）。 结论 FFR指导下PCI治疗冠脉临界病变可更显著降低术后1年MACE事件发生率。     

冠状动脉轻度狭窄急性胸痛低危患者的短期预后

目的探讨冠状动脉CT成像显示为轻度狭窄（狭窄程度25％～50％）的急性胸痛低危患者的短期预后以明确其是否需要进一步行诊断性检查。方法纳入2008年3月。2012年2月邯郸市中心医院心肌梗死溶栓（TIMI）危险评分为低危、冠状动脉CT成像显示为轻度狭窄的急性胸痛患者215例。通过观察患者30天内的主要不良心血管事件（心肌梗死、不稳定心绞痛、冠状动脉血运重建和心血管死亡）,以明确行进一步诊断检查的必要性。结果30d随访期间,仅1例患者（0．5％）发生了主要不良心血管事件（95％CI：0％～2．6％）,该患者在住院期间第3次复查肌钙蛋白T时呈阳性结果。无患者发生心血管死亡或需要血运重建。结论冠状动脉CT成像显示为轻度狭窄的急性胸痛患者近期发生主要不良心血管事件的可能性非常低,对此类患者行系列心脏生物学标志物检查有可能获益,但无需行进一步诊断检查。     

急性心肌梗塞经桡动脉冠状动脉介入治疗远期疗效

目的：探讨急性心肌梗塞（AMI）后延迟经桡动脉冠状动脉腔内成形术及支架术治疗的远期疗效。方法：133例AMI患者被分为经皮冠状动脉介入治疗组（PCI组）和非PCI组,PCI组于发病后平均13d行PCI术。随访两组患者的心脏事件发生率。结果：随访期间,与非PCI组相比,PCI组患者主要不良心血管事件发生率明显降低（80％比27．3％,P〈0．05）,左室射血分数明显提高[（42±6．9）％比（57．4±3．5）％,P〈0．05]。结论：急性心肌梗塞后延迟冠状动脉介入治疗可减少患者的心脏事件发生。     

尿微量白蛋白与冠心病PCI术后再狭窄临床观察

支架内再狭窄（ISR ）是指经皮冠状动脉介入治疗（PCI ）术后的植入支架的冠状动脉阶段内在冠状动脉造影上显示其血管管腔内径再次出现狭窄（或管腔丢失）≥50％,可伴或不伴有相关临床症状、不良心血管事件（指死亡,心肌梗死,再次冠状动脉血运重建治疗的发生）［1］,PCI术后出现ISR是一个复杂的多因素综合协调作用的结果,至今机制尚不十分明确,作为血管内皮功能障碍的标志-尿微量白蛋白（MAU ）,与冠状动脉病变程度及其对PCI术后发生主要心脏不良事件（MACE ）密切关系,但是MAU对PCI术后出现ISR有多大的预测价值,有待进一步研究。本文旨在通过对冠心病PCI术1年后行冠状动脉造影再狭窄患者MAU水平的分析,探讨尿微量白蛋白升高程度与支架术后再狭窄的关系。     

Diastolic regional wall motion asynchrony in patients with hypertension

Left ventricular regional wall motion was analyzed from angiographic ventriculograms in 51 subjects, 18 of these served as controls, 10 were hypertensive with coronary artery disease, and 23 had a history of hypertension without coronary artery disease. All normal subjects showed normal synchronous wall motion throughout the cardiac cycle. In 10 patients with coronary artery disease and hypertension at the time of catheterization, the major determinant of regional abnormality was coronary artery lesion (sensitivity=83%, specificity=95%). Patients who had a history of hypertension and no ischemic disease, were further subdivided into three groups, 4 who were normotensive, 4 with borderline pressures and 15 hypertensive at the time of cardiac catheterization. All normotensive, 3 of the borderline hypertensive, as well as one hypertensive (without coronary artery disease) patients showed normal wall motion. In one patient with borderline pressure and 14 of 15 hypertensive patients diastolic regional asynchrony was detected. Apical region was most commonly affected in these patients. This suggests the importance of treating hypertension in patients and the possible reversibility of abnormal wall motion with treatment.     

Borderline coronary lesions may lead to serious coronary events--long-term outcome in 65 conservatively treated patients

BACKGROUND: The choice of optimal therapy in a patient with borderline coronary lesion is difficult. The long-term outcome of conservatively treated patients has not yet been well defined. AIM: To analyse long-term outcome in patients with a borderline lesion in a single coronary artery who were selected for conservative treatment. METHODS: The study group consisted of 65 patients (mean age 59.4+/-7.4 years, 48 males) with (1) stable angina (CCS class I/II), (2) isolated single borderline coronary lesion (40-70% stenosis demonstrated by quantitative coronary angiography) and (3) no demonstrable ischaemia during non-invasive tests. Patients with heart failure, left ventricular ejection fraction <50% or acute coronary syndrome within 6 months preceding the study were not included. All patients were prescribed statins, angiotensin converting enzyme inhibitors and aspirin. Follow-up end-points included cardiac death, new myocardial infarction (MI) with or without ST segment elevation and revascularisation of the target coronary artery. RESULTS: The follow-up duration was 18.4+/-8.5 months (range 12-33, median 18 months). Forty nine (75%) patients remained free from angina during daily activity. Coronary events occurred in 16 (25%) patients, including three (5%) serious complications -- sudden death, new MI with ST elevation and new MI without ST elevation. The remaining 13 (20%) patients underwent percutaneous revascularisation of the target coronary artery. Coronary angiography was repeated in 16 (25%) patients. When the patients were divided into two groups according to the follow-up results (with or without coronary event), no differences in the clinical characteristics, lesion localisation and length or degree of stenosis were noted. CONCLUSIONS: (1) Conservatively treated patients with stable angina and borderline coronary stenosis have a high rate of coronary events, especially revascularisation, during a long-term follow-up. (2) Clinical parameters and quantitative coronary angiography do not identify those patients with borderline coronary lesions who are at increased risk of future coronary events.     

糖化血红蛋白水平与冠状动脉病变支数及心功能的相关性研究

目的：探讨血清糖化血红蛋白（HbA1c）水平与冠心病患者冠状动脉病变支数和心功能的关系。方法对253例入住我院并接受冠状动脉造影检查确诊为冠心病的患者,按HbAlc水平分为3组：正常组（HbA1c≤5.6％,n=75）、临界组（HbA1c 5.7％～6.4％,n=85）、升高组（HbA1c≥6.5%,n=89）。根据冠状动脉病变支数分为单支病变组（n＝95）、双支病变组（n＝103）和多支病变组（n＝55）,分析HbA1c水平与冠状动脉病变支数及心功能的相关性。结果 HbAlc水平与冠状动脉病变支数呈正相关（r=0.75,P＜0.01）。HbAlc水平三支病变组高于双支病变组,双支病变组高于单支病变组,临界组和升高组的左心室舒张末期内径（LVEDd）及B型脑钠肽（BNP）均高于正常组,左心室射血分数（LVEF）均低于正常组,升高组的LVEDd及BNP高于临界组、LVEF低于临界组（均P＜0.01）。HbAlc水平与LVEDd及BNP水平均呈正相关（r=0.73、0.62,均P＜0.05）,与LVEF呈负相关（r=-0.58,P＜0.05）。结论 HbAlc增高者冠状动脉病变支数较多,左心室腔较大,心功能较差。     

Low-density lipoprotein cholesterol goal attainment among Malaysian dyslipidemic patients

The aim of the present study was to evaluate Malaysian dyslipidemic patient treatment practices and outcomes. Factors contributing to success in reaching treatment goal were determined. A retrospective review of the records of dyslipidemic patients who attended the Universiti Sains Malaysia Hospital in 2007 was conducted. All the patients were receiving standard recommended doses of statins. Records were analysed for 890 patients. Patients were divided into three categories: 384 patients (43.1%) had coronary heart disease or coronary heart disease risk equivalents, 216 patients (24.3%) had moderate risk for coronary heart disease and 290 patients (32.6%) had low risk. Statins were the most commonly prescribed drug group (92%), of which atorvastatin was the most commonly prescribed drug (50.6%). The overall success rate for reaching goal was 64.2%. The percentages of patients achieving low-density lipoprotein cholesterol targets in the coronary heart disease and coronary heart disease risk equivalents, moderate, and low-risk groups were 50.5, 66.7, and 80.3%, respectively (p < 0.001). Multiple logistic regression showed achievement of therapeutic goal declined with increasing risk group. The baseline low-density lipoprotein cholesterol value was inversely related to therapeutic goal attainment. An inadequate proportion of dyslipidemic patients achieved the National Cholesterol Education Program therapeutic goals for low-density lipoprotein cholesterol, especially those in the coronary heart disease and coronary heart disease risk equivalent group. The achievement of this goal was dependent on baseline low-density lipoprotein cholesterol levels.     

心理支持对冠心病伴抑郁患者心率震荡的影响

目的 探讨心理支持对冠心病合并抑郁患者心率震荡的影响。方法 选择在我院心内科住院及门诊确诊的冠心病患者110例,应用Zung抑郁自评量表评定抑郁状况。其中有50例冠心病伴抑郁患者被选为研究对象。50例患者随机分为观察组25例和对照组25例。观察组在常规药物治疗基础上辅以心理支持疗法。所有入选患者均接受动态心电图检查,分别于入选后当日及治疗后2周测量窦性心率震荡的参数TO、TS及SDS评分。结果 观察组患者抑郁症状较对照组进一步改善,心率震荡进一步增强。结论 冠心病合并抑郁患者心率震荡明显减弱,联合药物治疗和心理干预可进一步提高患者的心率震荡,改善迷走神经的功能,进一步改善预后。     

Postprandial hypertriglyceridemia in non-diabetic patients with coronary artery disease

BACKGROUND: Hypercholesterolemia has been established as a major independent risk factor for coronary artery disease, but the role of hypertriglyceridemia, is still controversial in this regard. Postprandial hypertriglyceridemia has been reported to be a predisposing factor for coronary events. Present study was undertaken to assess postprandial hypertriglyceridemia in non-diabetic patients with coronary artery disease. METHODS AND RESULTS: 60 subjects aged over 35 years, who had undergone coronary angiography, were included in this case-control study. Subjects having secondary hyperlipidemia were excluded. The case group had significant stenosis in at least one coronary artery while the control group had normal coronary arteries on angiography. Triglyceride level was evaluated in fasting non-stressful situation as well as three hours after a heavy breakfast (bread, butter and jam, approximately 460 kcal). It was defined as normal (<150 mg/dl), borderline (150-200 mg/dl) and high (>200 mg/dl) according to NCEP guidelines, 2001. The mean fasting triglyceride level in control and case group was 141+/-54 v. 162+/-60 mg/dl respectively (statistically not significant). The mean postprandial triglyceride level, in control and case group was 163+/-60 v. 265+/-98 mg/dl, respectively (p<0.05). In the case group, 63.3%, 3.3%, and 33.3%, and in the control group 70%, 16.7% and 13.3% had normal, borderline and high fasting triglyceride levels, respectively (p<0.05). 3.3%, 23.3%, 73.3% of the cases and 50%, 36.7%, 13.3% of the controls had normal, borderline and high postprandial triglyceride levels, respectively (p<0.05). CONCLUSIONS: Considering that the triglyceride levels were higher in postprandial state, fat tolerance test can be used as a complementary test in evaluation of lipid profile in patients with coronary artery disease with normal fasting triglyceride levels.     

Asynchronous segmental early relaxation of the left ventricle

Asynchronous left ventricular segmental early relaxation (SER) is an angiographic finding with unclear pathophysiological mechanism. We analyzed 158 consecutive, technically adequate left ventricular cineangiograms of patients undergoing diagnostic cardiac catheterization. Patients with valvular disease, cardiomyopathy, or borderline coronary artery disease (50-74% lumen diameter reduction) were excluded. The patients were divided according to the presence or absence of coronary artery disease, segmental early relaxation, and left ventricular asynergy. Significant coronary artery disease was detected in 127 patients (80%), segmental early relaxation in 63 (40%), and asynergy in 85 (54%). Forty-five percent of patients with unobstructed arteries and 38% with significant coronary artery disease exhibited segmental early relaxation. Twenty-nine percent of patients with coronary artery disease and no asynergy, had segmental early relaxation, while this phenomenon was present in patients with coronary artery disease and asynergy. Since coronary artery disease subgroups are difficult to compare in terms of left ventricular mechanics, two groups of normal patients, 15 with and 14 without segmental early relaxation, were further evaluated: Left ventricular pressure, heart rate, dPdT, left ventricular diastolic volume and wall thickness were not significantly different. Left ventricular end-systolic volume index was 30.3 ± 4.6 ml/m² in patients with segmental early relaxation and 22.5 ± 5.1 ml/m² in those without segmental early relaxation (p < 0.01), while peak wall stress was 332.4 ± 66.6 dynes/cm² × 10³ and 272.2 ± 47.1 dynes/cm² × 10³, respectively (p < 0.02). A third group of patients with segmental early relaxation and coronary artery disease had a repeat left ventricular angiogram after nitroglycerin: Segmental early relaxation disappeared in 12 (group A) and persisted in 4 (group B). After nitroglycerin, end-systolic volume index decreased by 22% ± 8% in group A and by 1% ± 8% in group B (p < 0.005), while wall stress decreased by 24% ± 12% in group A and did not change in group B (p < 0.01). We conclude that segmental early relaxation, is (1) a very common finding (40% of the entire group); (2) frequent among normals (48%); (3) not a reliable predictor of coronary artery disease; (4) appears to be directly related to end-systolic volume index and wall stress; (5) disappears following nitroglycerin when this drug decreases end-systolic volume index and wall stress.     

冠心病合并轻中度慢性肾脏病患者PCI后支架内再狭窄的相关因素分析

目的 分析冠状动脉粥样硬化性心脏病(冠心病)合并轻中度慢性肾脏病患者冠状动脉(冠脉)药物洗脱支架术后支架内再狭窄(ISR)的相关因素.方法 选择陕西省人民医院心内科自2015年11月至2018年9月行药物洗脱支架置入且合并轻中度慢性肾脏病的冠心病患者189例,术后9～15月复查冠脉造影后,分为支架术后再狭窄组和无再狭窄...     

Long-term outcome of conservatively treated patients with borderline coronary lesions--role of the fractional flow reserve measurement

BACKGROUND: Coronary fractional flow reserve (FFR) has been recommended as one of the functional methods which can be used to establish indications for revascularisation in patients with borderline coronary lesions. AIM: To assess long-term outcome of patients with borderline coronary lesions in whom the decision to implement conservative treatment was based on the results of FFR. METHODS: The study group consisted of 41 patients (13 females, mean age 61+/-9 years) who had CCS class II angina, an isolated borderline (40-70%) coronary lesion and FFR >0.75. All patients received 40 mg of simvastatin, angiotensin converting enzyme inhibitor and aspirin. The follow-up duration ranged from 7 to 32 months (mean 15.2+/-7.1, median 14.5 months). The analysed end-points included cardiac death, myocardial infarction (MI) (with or without ST segment elevation) and revascularisation of the target coronary artery. RESULTS: The mean FFR value in the whole study group was 0.91+/-0.05. Three (7%) patients had complications during follow-up: one patient developed MI, and two had coronary artery stenosis progression, requiring angioplasty. These patients had similar clinical and angiographic characteristics as well as FFR values as patients without complications. Among patients with uneventful outcome, in 33 (87%) anginal symptoms improved whereas in the remaining 5 (13%) patients CCS class did not change. Patients with angina alleviation were older and had higher FFR values than patients without improvement (63+/-8 vs 48+/-6 years, p=0.0005; and 0.92+/-0.05 vs 0.86+/-0.08, p=0.04, respectively). CONCLUSIONS: In patients with borderline coronary lesions and stable angina, angioplasty can be delayed on the basis of the FFR results. This approach is safe and is associated with an asymptomatic long-term follow-up in more than 90% of patients.     

肾功能损害与冠心病的相关性探讨

目的探讨肾功能损害与冠心病的关系。方法将263例冠心病患者按肾功能检测结果分为肾功能损害组（观察组）141例、肾功能正常组（对照组）122例。比较两组冠脉造影检查结果及空腹血糖、血脂、血压等冠心病相关危险因素。结果观察组3支冠脉病变发生率、冠脉弥漫性病变发生率、血管病变支数、冠脉病变积分均显著高于对照组（P均〈0.01）,3支冠脉病变者血清肌酐（SCr）及尿微量蛋白（MAU）水平显著高于1支病变者（P〈0.01）;SCr及MAU与冠脉病变程度、年龄、血糖、收缩压呈正相关,与左室射血分数呈负相关（P均〈0.05）。结论冠心病伴肾功能损害者冠脉病变支数及病变积分显著增加,冠脉弥漫性病变及狭窄程度加重;保护肾功能、控制血压及血糖水平,注重保护靶器官是防治冠心病心血管事件的重要措施。