Between a Rock and a Hard Place

• SFA disease has unique challenges
• A myriad of interventional techniques have been proposed to treat calcific femoral disease
• It appears a combination of atherectomy and drug elution may be the procedure of choice in these patients
• New innovative therapies may be a viable option in the future

     

阿托伐他汀钙预治疗在急性冠状动脉综合征患者PCI术中的应用价值

目的探讨阿托伐他汀钙预治疗在急性冠状动脉综合征(ACS)患者皮冠状动脉介入术(PCI)中的应用价值。方法随机选取拟行PCI术ACS患者80例,随机分为治疗组(n=40)与对照组(n=40)。其中对照组患者为首次进行PCI治疗且术前未应用他汀类药物,治疗组患者在术前连续口服阿托伐他汀钙片3个月以上,对两组患者术前、术后12h、24h心肌损伤标记物的变化以及炎性反应进行监测,同时观察患者术后20min靶血管前向血流的TIMI血流分级情况,两组患者术后均随访1个月记录心血管事件的发生情况。结果与对照组比较,治疗组血清总胆固醇、甘油三酯水平明显低于对照组,差异有统计学意义(均P0.05)。与对照组比较,治疗组PCI术前、术后12h及24h的超敏C反应蛋白、白细胞介素-6、肌酸激酶同工酶、心肌肌钙蛋白均低于对照组(均P0.05)。治疗组PCI术前及术后的TMPG及TIMI血流分级均优于对照组(P0.05)。治疗组术中无复流现象的发生率明显低于对照组(P0.05)。治疗组术后1个月内心血管事件发生率明显低于对照组(P0.05)。结论阿托伐他汀钙预治疗在ACS患者PCI术中的应用不仅可以减轻患者心肌的损伤,降低炎性反应,还能在一定程度上改善患者术后血流灌注并降低近期心血管事件的发生率。     

鲑降钙素＋钙剂治疗原发性骨质疏松症的护理干预

目的鲑降钙素＋钙剂治疗护理干预，对原发性骨质疏松症缓解疼痛症状的临床效果。方法对100例原发性骨质疏松症患者采用降钙素＋钙剂治疗及护理干预，观察并分析患者骨关节疼痛缓解情况。结果100例原发性骨质疏松症患者，临床控制32例，占32％，显效28例，占28％，有效30例，占30％，无效10例占10％，总有效率为90％。结论鲑降钙素＋钙剂治疗及正确的护理干预指导是治疗原发性骨质疏松疼痛较好的治疗方法。     

Prognostic Value of Echocardiographic‐Derived Calcium Index in Coronary Artery Disease Diagnosed by 64‐Multidetector Computed Tomography

Purpose: To determine whether echocardiographic calcium index (ECI) calculated using transthoracic echocardiography (TTE) predicts coronary ischemic events. We also wished to determine coronary artery calcium score (CACS), the presence of obstructive coronary artery disease (CAD) and plaque composition, all of which were assessed by multidetector computed tomography (MDCT). Methods: We carried out a prospective cohort study of 82 consecutive outpatients with chest pain and low‐moderate risk of CAD, referred for noninvasive coronariography by MDCT. ECI was blindly assessed by TTE and correlated with subsequent cardiovascular events during a follow up period of 36 months. Results: ECI values of ≥7 had a sensitivity of 77.3%, a specificity of 90%, positive predictive value of 73.9%, and negative predictive value of 91.5% with respect to future coronary ischemic events. In addition, patients with ECI ≥ 7 showed a greater presence of severe calcified and obstructive CAD and a linear increase of obstructed vessels and mixed and calcified plaques, with a linear trend according to ECI values. Conclusion: ECI values of ≥7 determine poor CAD prognosis in relation to ischemic events. Furthermore, ECI ≥ 7 may serve as a marker of content of coronary artery calcium, intraluminal obstruction, and plaque composition. Therefore, ECI seems to provide prognostic information as well as information about the characteristics of the plaque of atheroma.     

血脂控制水平与冠状动脉支架置入术后支架内再狭窄的相关性研究

目的:探讨血脂控制水平与经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的相关性。方法:收集2012-01至2012-12在兰州大学第一医院心脏中心住院首次行PCI的冠心病患者211例,所有患者均常规口服双联抗血小板、他汀类药物,并于术后3~12个月再次入院行冠状动脉造影,根据造影结果分为两组,其中ISR组25例,无ISR组186例,所有入选患者于PCI术前及复查造影时采集外周静脉血,全自动生化分析仪检测总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇,定量分析两次血脂水平,探讨其与冠状动脉ISR的关系。结果:两组患者中年龄、性别、高血压患病率、冠心病家族史、术前诊断急性冠状动脉综合征、吸烟、饮酒比例等方面的差异均无统计学意义(P0.05),PCI术前总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平差异均无统计学意义(P0.05);ISR组合并2型糖尿病的患者比例(36.0%)较无ISR组(17.7%)差异有统计学意义(P=0.03)。Logistic多因素逐步回归分析显示,PCI术后总胆固醇未下降(比值比=1.07,95%可信区间:0.38~2.62,P=0.04)、低密度脂蛋白胆固醇未控制在1.8 mmol/L以下或较PCI术前未下降50%(比值比=11.33,95%可信区间:3.62~35.52,P0.01)以及合并2型糖尿病(比值比=3.00,95%可信区间:1.04~8.67,P=0.04)与ISR呈正相关。结论:PCI术后总胆固醇未下降、低密度脂蛋白胆固醇未达标是后期ISR发生的高危因素,合并2型糖尿病的患者PCI术后发生ISR的风险明显增高。     

Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Single Coronary Artery Anomaly

We report on a case of an adult male patient with previously unknown coronary anomaly and acute myocardial infarction in the territory of the left anterior descending artery (LAD). The coronary angiography showed a single coronary artery with intertruncal course, arising from the right coronary sinus, and thrombotic occlusion of the LAD. Successful transradial percutaneous coronary intervention was done with implantation of an intracoronary stent in the occluded artery. The postprocedural course was complicated by ventricular tachycardia, congestive heart failure, and mild transient renal failure. In conclusion, transradial percutaneous coronary intervention is safe and feasible in rare coronary artery anomalies even in an emergent setting. The finding of an anomalous coronary artery should not be a reason to decline performing coronary intervention. Copyright © 2009 Wiley Periodicals, Inc.     

血浆GGT水平与PCI术后支架内再狭窄的相关性研究

目的：观察PCI术后血浆GGT水平与支架内再狭窄的相关性。方法：选择70例支架植入术后8个月复查冠脉造影示无支架内再狭窄患者为对照组（A组）,60例支架内再狭窄患者为再狭窄组（B组）（狭窄程度≥50%）,采用标准方法测定其血浆GGT水平及相关生化指标,并对血浆GGT与再狭窄进行偏相关分析及多元逐步回归分析。结果：①血浆GGTB组明显高于A组（P〈0.05）;多元线性回归分析：血浆GGT与CRP水平的升高及ALP水平的降低能独立预测PCI术后支架内再狭窄（P〈0.05）。结论：血浆GGT水平对预测支架内再狭窄有一定意义。