冠脉PCI诱导的循环内皮祖细胞变化与大动脉硬度的关系

目的探讨稳定型冠心病患者PCI治疗前后循环内皮祖细胞(EPCS)水平改变与大动脉硬度及冠脉病变程度的关系。方法行择期PCI治疗冠心病患者共40例,45～60岁;按肱-踝脉搏波传播速度(baPWV)分为动脉硬度显著增加组(baPWV>正常2个标准差)和动脉硬度轻度增加组(baPWV<正常1个标准差),每组20例;2组PCI(球囊扩张和支架置入)总时间限制在30 min以内;采用冠脉Syntax评分评价冠脉病变严重程度;双抗体CD34/CD133标记流式细胞仪检测PCI前和术后48小时EPCS水平,计数20000个细胞,记录百分比差值。结果两组年龄、BMI、血压、血脂、血糖等基线资料无显著差异;与动脉硬度轻度增加组相比,动脉硬度显著增加组冠脉Syntax评分值显著增加(9.2±6.8 vs.13.5±7.0,P<0.05),循环CD34+/CD133+细胞百分数显著下降(0.09±0.04 vS.0.04±0.03;P<0.05)。PCI诱导的循环EPCS变化水平与syntax评分值和baPWV负相关。结论循环EPCs水平在PCI围手术期的变化可能预测冠脉病变和全身动脉硬化严重程度。结合PCI围手术期EPCs变化水平和大动脉硬度检测可能预测冠心病PCI患者的预后。     

红细胞分布宽度与冠状动脉病变严重程度有相关性

目的 目的探讨红细胞分布宽度（RDW）与冠心病患者冠状动脉病变严重程度的关系。方法 连续入选行冠脉造影患者219例,其中不稳定型心绞痛(UAP)118例,急性心肌梗死（AMI）101例,其中包括急性ST段抬高型心肌梗死(STEMI)52例,急性非ST段抬高型心肌梗死(NSTEMI)49例。所有患者均检测RDW及 N末端脑钠肽前体（NT-proBNP）等相关指标,并对患者冠脉病变情况进行SYNTAX评分,根据SYNTAX评分将所有患者分为低积分组（评分≤32分,n=139）与高积分组（评分>32分,n=80）。通过单因素分析和Pearson相关分析确定RDW与冠状动脉严重程度的关系。结果 高积分组RDW〔（13.7±0.9）%〕显著高于低积分组〔（12.4±1.4）%〕,差异有统计学意义（P<0.05）。冠状动脉2支及以上病变患者的RDW显著高于单支病变组（P<0.05)。Pearson相关分析显示RDW与SYNTAX评分呈显著正相关（r=0.252,P<0.01）。NT-proBNP升高组比NT-proBNP正常组的RDW〔（13.4±0.8） vs.（12.5±1.0）%〕明显升高,差异有统计学意义（P<0.05）。结论 冠心病患者RDW与冠心病冠脉病变严重程度具有显著相关性。     

血清脂蛋白(a)与冠心病患者SYNTAX评分的相关性研究

目的:探讨冠心病患者血清脂蛋白(a)水平与反映冠状动脉病变严重程度的SYNTAX评分的关系。方法:回顾性分析104例行冠状动脉造影检查的冠心病患者,根据SYNTAX评分结果分为低危组(0~22分)40例、中危组(23~32分)37例和高危组(≥33分)27例,采用Spearman相关性分析和多元线性回归分析脂蛋白(a)水平与SYNTAX评分的相关性。结果:高危组脂蛋白(a)水平与中、低危组比较显著增高(4.95±1.45)vs.(4.81±1.23)vs.(4.70±1.30)mg/L(P<0.05)。Spearman相关分析显示:高血压、糖尿病、吸烟和脂蛋白(a)与SYNTAX评分呈正相关(P<0.05)。多元线性回归分析显示:糖尿病、吸烟和脂蛋白(a)与SYNTAX评分呈正相关(P<0.05)。结论:血清脂蛋白(a)水平与SYNTAX评分正相关,随着血清脂蛋白(a)水平的升高,冠状动脉病变严重程度加重,可作为判断冠状动脉病变严重程度的参考指标之一。     

SYNTAX积分预测冠心病复杂病变患者经皮冠状动脉介入治疗预后的作用

目的评价SYNTAX积分对冠心病3支病变和(或)左主干病变患者PCI预后的作用。方法经冠状动脉造影证实的3支病变和(或)左主干病变并接受PCI的患者1 90例。对每例患者造影结果进行SYNTAX评分,SYNTAX评分按三分位数分为:低分组、中分组和高分组,通过门诊或电话随访患者主要不良心脑血管事件(MACCE)。结果经PCI的冠心病3支病变和(或)左主干病变190例患者中,29例出现MACCE,发生率为15.3%。SYNTAX积分低分组、中分组及高分组的MACCE发生率分别为9.1%、1 6.2%及30.9%。Cox多因素分析显示,SYNTAX积分HR=2.07,95%CI:1.25～3.44,差异有统计学意义(P=0.005)。结论 SYNTAX积分是预测PCI预后的较理想工具,该积分系统也适用于我国冠心病3支病变和(或)左主干病变患者PCI术后预后的预测。     

冠状动脉支架术后血浆超敏C-反应蛋白水平变化

目的研究冠状动脉支架术后超敏C-反应蛋白(hs-CRP)水平的变化,探讨PCI术后再狭窄的发生机制。方法置入支架的冠心病稳定型心绞痛患者83例入选本研究,男59例,女24例,年龄(57±9)岁,DES组43例,BMS组40例。另选同期住院行冠脉造影检查显示冠状动脉不同程度狭窄,而未行PCI的冠心病患者35例为对照组,男30例,女5例,年龄(59±11)岁。分别于术前和术后48、72 h、2 w和1个月后取静脉血,测定血浆hs-CRP水平,术前三组患者临床特征及冠脉造影显示的病变特征相似具有可比性。结果术后48、72 h DES组和BMS组患者较单纯进行冠脉造影的冠心病患者血浆hs-CRP水平显著升高〔分别为(8.34±2.78)、(15.11±3.37)vs(4.51±2.97)mg/L,P<0.01;(8.98±3.56)、(13.63±4.28)vs(3.82±2.65)mg/L,P<0.01〕;同时,DES组血浆hs-CRP水平较BMS组显著降低〔分别为(8.34±2.78)vs(15.11±3.37)mg/L,P<0.01;(8.98±3.56)vs(13.63±4.28)mg/L,P<0.01〕。结论 PCI术后可显著升高血浆hs-CRP水平,但DES与BMS相比,可明显降低血浆hs-CRP水平,表明DES可明显抑制PCI术后诱发的急性炎症反应,有降低再狭窄率的可能。     

冠状动脉病变中低危合并糖尿病患者临床特点及介入术后远期预后研究

目的探讨合并糖尿病、冠状动脉病变解剖中低危(SYNTAX评分≤32)的冠心病患者, 经皮冠状动脉介入治疗(PCI)术后远期预后的影响因素。方法本研究为前瞻性单中心观察性研究。连续纳入2013年1至12月在阜外医院行PCI且SYNTAX评分≤32、合并糖尿病的患者。根据患者SYNTAX评分水平分为SYNTAX评分≤22组和23≤SYNTAX评分≤32组。主要终点是5年心原性死亡、再发心肌梗死, 次要终点包括5年全因死亡和重复血运重建。采用Cox比例风险回归模型分析PCI术后远期预后的影响因素。结果共纳入3 899例糖尿病合并冠心病患者, 年龄(59.4±9.8)岁, 其中男性2 888例(74.1%)。SYNTAX评分≤22组3 450例, 23≤SYNTAX评分≤32组449例。术后5年, 与SYNTAX评分≤22组相比, 23≤SYNTAX评分≤32组患者重复血运重建发生率更高[18.9%(85/449)比15.2%(524/3 450), log-rankP=0.019], 两组全因死亡、心原性死亡和再发心肌梗死发生率差异无统计学意义(log-rankP均>0.05)。多因素...     

内皮微粒CD31~+/CD42b~-水平、颈动脉内膜中层厚度与冠状动脉病变程度的相关性

目的探讨冠心病患者血浆内皮微粒CD31~+/CD42b~-水平、颈动脉内膜中层厚度(CIMI)与冠状动脉病变程度的关系。方法选取该院2015年1~6月收治的冠心病患者137例,根据冠状动脉造影结果及临床表现,将患者分为冠状动脉造影正常(对照)组42例,单支病变组35例,双支病变组29例,三支及多支病变组31例,患者行颈动脉超声检查,检测血浆内皮微粒CD31~+/CD42b~-水平,分析冠状动脉病变程度与内皮微粒、CIMI的相关性。结果与对照组比较,冠心病组CD31~+/CD42b~-内皮微粒水平及CIMT明显升高〔(1 307.29±382.68)mmol/L vs(835.98±260.85)mmol/L;(0.98±0.13)〕mm vs(0.83±0.11)mm,P0.05〕。与对照组比较,随着冠状动脉病变程度的加重,CD31~+/CD42b~-内皮微粒水平及CIMT明显增加(P0.05)。多元Logistic回归分析显示CD31~+/CD42b~-内皮微粒水平及CIMT增厚与冠心病严重程度呈独立正相关(OR=2.330,95%CI:1.635~6.356;OR=3.957,95%CI:1.125~4.784,P0.05)。结论血浆内皮微粒CD31~+/CD42b~-水平及CIMI与冠状动脉病变程度具有相关性,通过检测内皮微粒及CIMI可预测冠状动脉的病变程度。     

纤维蛋白原与急性冠脉综合征患者冠状动脉病变严重程度的关系研究

背景急性冠脉综合征(ACS)患者纤维蛋白原升高与患者预后不良有关,但其对ACS患者冠状动脉病变严重程度的影响尚不清楚。目的探讨纤维蛋白原与ACS患者冠状动脉病变严重程度的关系。方法选取2019年1—5月首都医科大学附属北京天坛医院重症监护病房收治的ACS患者108例,根据SYNTAX评分分为轻度病变组(SYNTAX评分<23分,n=74)和中重度病变组(SYNTAX评分≥23分,n=34)。比较两组患者一般资料〔包括性别、年龄、体质指数(BMI)、高血压发生情况、糖尿病发生情况、脑血管疾病发生情况、冠心病病史、吸烟史〕、实验室检查指标〔包括脑钠肽(BNP)、总胆固醇、粒细胞/淋巴细胞比值、平均血小板体积、纤维蛋白原、同型半胱氨酸、估算的肾小球滤过率〕;纤维蛋白原与ACS患者SYNTAX评分的相关性分析采用Pearson相关分析;ACS患者冠状动脉病变严重程度的影响因素采用多因素Logistic回归分析。结果(1)两组患者男性比例、年龄、BNP、纤维蛋白原比较,差异有统计学意义(P<0.05);两组患者BMI、高血压发生率、糖尿病发生率、脑血管疾病发生率、有冠心病病史及吸烟史者所占比例、总胆固醇、粒细胞/淋巴细胞比值、平均血小板体积、同型半胱氨酸、估算的肾小球滤过率比较,差异无统计学意义(P>0.05)。(2)Pearson相关分析结果显示,纤维蛋白原与ACS患者SYNTAX评分与呈正相关(r=0.348,P<0.05)。(3)多因素Logistic回归分析结果显示,年龄〔OR=1.119,95%CI(1.021,1.226)〕、纤维蛋白原〔OR=3.458,95%CI(1.038,11.523)〕是ACS患者冠状动脉病变严重程度的影响因素(P<0.05)。结论纤维蛋白原与ACS患者冠状动脉病变程度呈正相关,是ACS患者冠状动脉病变严重程度的独立影响因素。     

经皮冠状动脉介入术对NSTE-ACS患者校正后QT离散度和校正后JT离散度的影响

目的探讨经皮冠状动脉介入术(PCI)治疗对非ST抬高型急性冠脉综合征(NSTE-ACS)患者心肌去极化和复极化心电参数的影响。方法研究纳入2013年于该院心内科住院病人180例,入院诊断为NSTE-ACS男118例,女62例,平均年龄(65.6±10.3)岁,住院期间均行冠状动脉造影检查并成功行球囊扩张及支架植入术。术前和术后24 h内分别行12导联体表心电图检查。测量的心电图(ECG)参数包括QRS时限、QT间期及校正后的QT间期、JT间期及校正后的JT间期,以最长QT间期与最短QT间期之差作为QT离散度,对测值行比较分析。结果对经皮冠状动脉介入术前及术后24 h内患者心电图比较发现,术前和术后24 h内患者平均QRS时限〔(0.09±0.01)s vs(0.08±0.01)s,P=0.01〕、平均校正QT离散度〔(0.09±0.04)s vs(0.06±0.04)s;P=0.001〕、平均校正后JT离散度〔(0.08±0.03)s vs(0.06±0.01)s;P=0.001〕均有显著性差异。在其他ECG参数方面二者无显著差异。结论对NSTE-ASC患者成功行经PCI治疗后,其校正后QT离散度和校正后JT离散度显著减低。     

臂踝脉搏波速度评估冠心病患者冠脉病变程度的临床价值

目的:研究臂-踝脉搏波传导速度(baPWV)评估冠心病患者冠脉病变程度的临床价值。方法:选择我院206例冠心病患者,按照冠脉造影心脏外科与介入治疗狭窄冠脉研究评分(SYNTAX)积分分为轻度组(74例,SYNTAX积分23分),中度组(72例,SYNTAX积分23~32分)和重度组(60例,SYNTAX积分32分)。并选择同期正常健康体检者80例为健康对照组。检测并比较各组baPWV、踝臂指数(ABI)与颈-股脉搏波传导速度(cfPWV)的差异。应用Pearson相关分析分析冠心病患者baPWV、cfPWV及ABI与SYNTAX积分的相关性;应用多元Logistic回归模型分析baPWV、cfPWV及ABI是否为SYNTAX积分的危险因素。结果:与健康对照组比较,轻度组,中度组和重度组baPWV[(1.2±0.3)m/s比(1.5±0.4)m/s比(1.8±0.6)m/s比(2.0±0.7)m/s]和cfPWV[(1.3±0.5)m/s比(2.5±0.7)m/s比(2.9±0.8)m/s比(3.4±0.7)m/s]均显著升高(P0.05或0.01),且重度组中度组轻度组,两两比较有显著差异(P均0.05);ABI显著降低[(1.02±0.32)比(0.82±0.24)比(0.73±0.16)比(0.56±0.09)],且重度组中度组轻度组,两两比较均有显著差异(P均0.05)。Pearson相关分析显示baPWV、cfPWV水平与SYNTAX积分显著正相关(r=0.613,P=0.007及r=0.528,P=0.023),而ABI水平与SYNTAX积分无相关性。多元Logistic回归分析表明糖尿病,高血压,baPWV及cfPWV是SYNTAX积分的危险因素(OR=4.016~5.809,P0.05或0.01)。结论:baPWV检测能有效评估冠心病患者冠脉病变程度。     

The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction

BackgroundIn patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), Global Registry for Acute Coronary Events (GRACE) score is a valid tool for risk stratification. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score is an angiographic scoring system to guide the decision-making between coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI). The aim of the present study was to assess the accuracy of the GRACE score in predicting the severity and extent of coronary artery stenosis by SYNTAX score.MethodsA total of 330 patients with acute coronary syndrome (ACS) were enrolled in the study. For every patient, the GRACE score was calculated. All patients underwent coronary angiography within 2 days and the SYNTAX scoring system was used to evaluate the severity and extent of coronary stenotic lesions. Based on ROC curve analysis, the cut-off value of GRACE score that could predict SYNTAX score ≥ 23 was calculated.ResultsGRACE score was 107.12 ± 34.4 in patients with SYNTAX SCORE < 23 and 134.80 ± 48.3 in patients with SYNTAX score ≥ 23 (p value = 0.001). A positive correlation was observed between the GRACE score and angiographic SYNTAX score (r = 0.34 p < 0.001). We found that a GRACE score of 109 is the optimal cut-off to predict SYNTAX score ≥ 23 with a sensitivity of 73.5% and specificity of 60% (p < 0.001). Its negative predictive value was 94.0%.ConclusionGRACE score had significant but modest value to predict the severity and extent of coronary artery stenosis in patients with ACS.     

The association between increased carotid intima–media thickness and SYNTAX Score in coronary artery disease: A single center study

BackgroundCarotid artery lesions frequently coexist with coronary arterial disease (CAD). The aim of this study was to investigate the relation between carotid intima-media thickness (CIMT) and the extent of CAD and whether CIMT could be predictive of severity of coronary atherosclerosis.MethodsCoronary angiography and carotid ultrasound evaluations of 100 consecutive patients with CAD who had undergone elective coronary angiography were reviewed. IMT was measured at both carotid arteries. CIMT and severity of CAD relationship based on SYNTAX score was assessed. The relation between CIMT and cardiovascular risk factors was determined.ResultsMean overall SYNTAX score was 15.76 + 4.82. Mean right CIMT was 0.86 ± 0.29 and mean left CIMT was 0.83 ± 0.24. There were no significant correlation between the SYNTAX score and CIMT (r: 10, P: 30). There was significant relationship between hypertension,diabetes and CIMT (P: 0.01).Conclusionwe found no relationship between CIMT and SYNTAX score in patients who underwent coronary angiography. Diabetes mellitus and hypertension are related to increased carotid intima-media thickness.     

Predictors of long‐term outcomes after bypass grafting versus drug‐eluting stent implantation for left main or multivessel coronary artery disease

Background : We assessed predictors of long‐term outcomes after coronary artery bypass grafting (CABG) versus those after percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) in 3,230 patients with left main or multivessel coronary artery disease (CAD). Methods and Results : Data were pooled from the BEST, PRECOMBAT, and SYNTAX trials. Age, chronic kidney disease, chronic obstructive lung disease, left ventricular dysfunction, and peripheral arterial disease (PAD) were common predictors of all‐cause mortality. Diabetes mellitus, previous myocardial infarction (MI), and SYNTAX score were independent predictors of all‐cause mortality in the PCI group, but not in the CABG group. In the CABG group, age was the only risk factor for MI; left ventricular dysfunction, hypertension, and PAD were risk factors for stroke. On the other hand, in the PCI group, incomplete revascularization and previous MI were risk factors for MI; age and previous stroke for stroke. In addition, chronic kidney disease significantly correlated with a composite outcome of death, MI, or stroke in the CABG group, and incomplete revascularization and previous MI in the PCI group. Conclusions : Simple clinical variables and SYNTAX score differentially predict long‐term outcomes after CABG versus those after PCI with DES for left main or multivessel CAD. Those predictors might help to guide the choice of revascularization strategy. © 2017 Wiley Periodicals, Inc.     

SYNTAX Score and Outcomes of Coronary Revascularization in Diabetic Patients

Purpose of Review

This review describes the dynamic relationship between diabetes mellitus (DM) and coronary artery disease (CAD) with respect to different revascularization strategies and how angiographic tools such as the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score can supplement clinical decision-making.

Recent Findings

The SYNTAX score characterizes the anatomical extent of CAD in terms of the number of lesions, functional importance, and complexity. Studies not limited to patients with DM suggest that percutaneous coronary intervention (PCI) is a reasonable alternative to coronary artery bypass grafting (CABG) in patients with low-medium SYNTAX scores, while patients with high SYNTAX scores should be revascularized with CABG if operable. Similar findings were also observed for diabetes patients with multivessel disease in retrospective pooled analysis. The SYNTAX II score combines anatomical and clinical risk to improve upon the decision regarding the optimal revascularization strategy. The SYNTAX II score can be applied to patients with DM.

Summary

The SYNTAX scores provide guidance to clinicians faced with determining the optimal revascularization strategy in patients with DM and advanced CAD. Using a heart team approach, the information can be considered along with other factors that influence PCI or CABG risk.

     

冠心病患者血尿酸水平与冠状动脉病变程度的相关性分析

目的:探讨血清UA水平与冠状动脉病变严重程度的关系。方法:回顾性分析2011年6月至2012年6月,在我科住院行冠状动脉造影检查者408例。根据造影结果,分为冠状动脉正常组和冠心病组,并根据SYNTAX评分,将冠心病组分为低危组(1～22分)、中危组(23～32分)及高危组(>33分)。测定空腹UA水平、空腹血脂:包括TC、TG、HDL-C及LDL-C。比较各组患者血脂、血UA水平。男性UA以<416μmol/L为正常值,女性以<357μmol/L为正常值,再将患者分为高UA组和正常UA组,比较两组SYNTAX评分,并进行相关性分析。结果:SYNTAX评分高危组、中危组与正常组比较TC、LDL-C显著增高,而正常组、低危组间差异无统计学意义(P>0.05)。SYNTAX评分高危组、中危组与同性别冠状动脉正常组比较,血UA水平显著增高。正常UA组与高UA血症组在年龄、性别、TC、TG、HDL-C及LDL-C的差异无统计学意义(P>0.05)。高UA血症组患者的冠状动脉SYNTAX评分显著高于正常血UA组。多元Logistic回归分析表明血UA水平与冠状动脉病变程度相关。结论:血UA是冠状动脉病变严重程度的相关危险因素,随着血UA水平的增高,冠状动脉病变程度增加。     

Aortic stiffness is an independent predictor of left ventricular function in patients with coronary heart disease

Although aortic stiffness plays an important role in patients with coronary artery disease (CAD), the influence of aortic stiffness on left ventricular systolic function has not yet been fully evaluated. In the present study, we measured brachial-ankle pulse wave velocity (baPWV), which is a new index of aortic stiffness, in patients with CAD (CAD group, n = 170, 67 +/- 9 years old) and without CAD (non-CAD group, n = 81, 63 +/- 8 years old), and evaluated the relationship between baPWV and left ventricular systolic function in patients with CAD. baPWV in the CAD group was significantly higher than that in the non-CAD group (1,794 +/- 350 vs. 1,469 +/- 292 cm/s, p < 0.05), although both systolic and diastolic blood pressure were comparable between the two groups. In the CAD group, the baPWV was higher in patients with three-vessel disease than that in patients with one-vessel disease (1,885 +/- 542 vs. 1,720 +/- 373 cm/s, p < 0.05). In the CAD group, multivariate analysis demonstrated that baPWV and pulse pressure independently correlated with left ventricular ejection fraction (LVEF). In conclusion, in patients with CAD, baPWV, which is a simple marker of aortic stiffness, increases with CAD severity and correlates with left ventricular systolic function independent of CAD severity.     

不同冠心病危险评分评估ACS患者多支血管病变PCI术后2年预后的比较

目的 评价不同冠心病危险评分方法对急性冠脉综合征（ACS）患者多支病变经皮冠状动脉介入（PCI）治疗术后长期预后评价能力。方法 连续入选住院ACS并行PCI患者192例,收集临床资料包括性别、年龄、临床诊断、心脏及周围血管超声、血脂、肾功能等临床资料,进行SYNTAX、SYNTAX II、临床SYNTAX、EuroScoreII评分、ESRS危险分层,同时进行2年临床随访,随访主要不良心脑血管事件（MACCE,包括全因死亡、卒中、冠脉血运重建、心力衰竭、心绞痛住院治疗）。结果 发生MACCE 24例,其中心源性死亡5例,卒中死亡2例,血运重建7例,缺血性卒中6例,心衰4例。MACCE组和无事件组的SYNTAX评分、SYNTAX II评分、临床SYNTAX 和EuroScoreII评分分别为(18±6)与(15±7)分（P<0.05）、(29±5)与(27±8)分(P<0.05)、(41±16)与(36±22)分（P<0.05）、(4.0±3.6)与(2.7±2.1)分（P<0.05）。ESRS高危、低危组事件发生率分别为29%和21%,与无事件组比较,P<0.05。SYNTAX评分、SYNTAX II评分、临床SYNTAX评分、EuroScoreII评分和ESRS预测2年终点事件的曲线下面积分别为0.631、0.631、0.630、0.634和0.656（均P<0.05）。5种评分方法危险分层均与2年MACCE相关。结论 SYNTAX评分、SYNTAX II评分、临床SYNTAX评分、EuroScore2以及ESRS危险分层对ACS行PCI后MACCE的预测能力无显著差异。     

冠心病患者糖代谢状态对脉搏波速度影响研究

目的 研究冠心病患者糖代谢状态对脉搏波速度(baPWV)的影响.方法 198例冠心病患者分为糖代谢正常(NGT)组、糖调节受损(IGR)组、糖尿病组,测定臂踝baPWV,并记录年龄、性别、冠心病危险因子、血脂、炎症因子等指标.结果 糖尿病组baPWV(1807±381)cm/s显著高于NGT组[(1615士248)cm/s,P=0.000]及IGR组[(1674±277)cm/s,P=0.035].多元逐步线性回归分析显示,年龄和高敏C反应蛋白(hsCRP)水平为总体baPWV独立影响因子.糖尿病组baPWV独立影响因子为年龄和糖化血红蛋白水平.结论 冠心病患者随着处于糖代谢状态的不同阶段(糖代谢正常、糖调节受损、糖尿病),baPWV有增快趋势,尤其是合并糖尿病的冠心病患者baPWV较NGT、IGR患者差异有统计学意义.血糖控制情况与动脉僵硬度相关.     

Therapeutic Options for Left Main,Left Main Equivalent,and Three-Vessel Disease

Patients with left main, left main equivalent, and three-vessel coronary artery disease (CAD) represent an overlapping spectrum of patients with advanced CAD that is associated with an adverse prognosis. Guideline-directed medical therapy is a necessary but often insufficient treatment option, as such patients frequently need mechanical revascularization by either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). In patients with advanced CAD presenting with acute myocardial infarction, PCI, of course, is the preferred treatment option. For stable patients with advanced CAD, CABG surgery remains the standard of care. However, observations from the SYNergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) trial suggest that PCI may be a useful alternative in patients with three-vessel disease with a low SYNTAX score as well as in patients with left main disease and a low or intermediate SYNTAX score. In the subset of patients with diabetes mellitus, the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease trial unequivocally demonstrated the superiority of CABG surgery in improving outcomes. The findings of the recently published Everolimus-Eluting Stent System versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization and Nordic–Baltic–British Left Main Revascularization study trials point to a favorable role for PCI in certain low-to-moderate risk patients with left main stem disease.