药物支架和裸支架治疗急性ST段抬高心肌梗死患者的随访研究

目的 评价药物支架和裸支架治疗急性ST段抬高心肌梗死患者疗效和预后方法217例接受了急诊经皮冠状动脉介入治疗急性ST段抬高心肌梗死患者纳入本研究,药物支架组92例、裸支架组125例,收集基线资料并随访6～38个月.结果 裸支架组的平均年龄(64.6±11.9)岁、Killip分级(2、3、4级)为25.9%和支架平均直径为(3.07±0.38)mm,均高于药物支架组(61.2±11.8)岁、12.2%和(2.91±0.40),差异有统计学意义(t=2.09,P=0.037;χ2=5.53,P=0.019;t=2.78,P=0.006),裸支架组平均左心室射血分数(55.4±11.9)%低于药物支架组(60.3±12.8)%,差异有统计学意义(t=-2.57,P=0.011).支架长度[(32.8±16.2)mm、(26.2±11.2)mm]、支架后扩张(45.7%、21.6%)、糖尿病(28.2%、16.0%)药物支架组高于裸支架组(t=-3.54,P=0.001;χ2=13.85,P=0.0002;χ2=4.77,P=0.030).随访期间,主要不良心脏事件(MACE)发生36例,药物支架组6例(6.5%),裸支架组30例(24.0%)(χ2=11.70,P＜0.01).结论 急性ST段抬高心肌梗死急诊介入治疗是安全有效的,同裸支架相比药物支架明显降低随访期MACE发生率而改善预后.     

缺血预适应改善急性心肌梗死经皮冠状动脉介入治疗的预后

目的研究梗死前心绞痛对接受PCI治疗急性心梗患者临床预后的影响。方法回顾分析122例首次发生的急性心肌梗死患者。所有患者在发病12h内进行PCI,按梗死前48h有无心绞痛分为2组,即缺血预适应组(56例)和非缺血预适应组(66例)。比较两组患者梗死相关血管PCI后血流TIMI分级、再灌注心律失常情况、心肌酶峰值浓度及出院前心脏事件发生率。结果缺血预适应组患者年龄高于非缺血预适应组(66±12比61±12,P=0.05)。非ST段抬高心肌梗死患者数量缺血预适应组明显多于非缺血预适应组,分别为30.4%和12.1%(P=0.01)。PCI后梗死相关血管无复流发生率在缺血预适应组明显低于非缺血预适应组,分别为4%和15%(P=0.03)。缺血预适应组心肌损伤标志物峰值浓度较非缺血预适应组显著降低,重度左室功能不全(LVEF40%)发生率在缺血预适应组明显低于非缺血预适应组,分别为4%和15%(P=0.03)。结论缺血预适应组急性心梗患者PCI术后心肌酶峰值明显降低,以及梗死相关血管无复流发生率和重度左室功能不全患者比例明显降低,表明缺血预适应对急性心梗患者心脏具有保护作用,改善预后。     

系统性硬化症心脏受累61例临床分析

系统性硬化症(systemic sclerosis,SSc)是一种以局限性或弥漫性的皮肤增厚、纤维化为特征,同时累及心、肺、肾、消化道等多个系统的自身免疫性疾病.病理改变为多脏器的胶原增殖弥漫性纤维化、退行性改变和血管内皮异常增生、管腔变窄.在SSc累及的脏器中,心脏是一个重要的靶器官,其临床可以表现为肺动脉高压及其继发的右心功能不全、多种心律失常、心脏瓣膜病变、心包积液、缺血性心肌病,以及收缩性和(或)舒张性心功能不全.     

冠状动脉长病变串联置入雷帕霉素和紫杉醇洗脱支架重叠部分对分支血管影响的比较

目的 回顾性分析对于冠状动脉长病变串联置入雷帕霉素洗脱支架(Cypher)与紫杉醇洗脱支架(TAXUS)时,支架的重叠部分对直径<2.0 mm的分支血管的影响.方法 回顾2004年1月至2007年10月间在北京协和医院行择期经皮冠状动脉介入治疗(PCI)且至少有1支靶血管进行了串联置入药物洗脱支架的141例患者的光盘和临床资料,排除急性心肌梗死和急性冠状动脉综合征的患者.按照置入药物洗脱支架的种类分为Cypher组和TAXUS组,对比分析两种不同的药物洗脱支架串联置入时重叠部分对直径<2.0 mm的分支血管血流的影响.结果 共有141例患者人选,其中男性115例,女性26例.共置入支架297枚,累及分支血管154支.其中Cypher支架组入选83例,TAXUS支架组入选58例.PCI术后支架重叠部位分支血管的闭塞率Cypher支架组为24.6%,TAXUS支架组为31.6%;支架重叠部位分支血管血流减慢Cypher支架组为26.3%,TAXUS支架组为68.4%.两组差异无统计学意义.多种因素回归分析结果表明:分支血管直径、分支血管开口狭窄是分支血管闭塞的独立危险因素.结论 与TAXUS组相比,Cypher组支架重叠部位较少引起分支血管闭塞,但两者差异无统计学意义.分支血管开口狭窄和分支血管直径是影响支架重叠部位分支血管闭塞的主要因素.     

药物支架和裸支架治疗急性ST段抬高心肌梗死患者的随访研究

Objective To evaluate the effects of drug-eluting stents (DES) versus bare-metal stents (BMS) on clinical outcomes in patients with acute ST-segment elevation myocardial infarction (ASTEMI) receiving primary percutaneous coronary intervention (PPCI). Methods The 217patients with ASTEMI receiving PPCI from Jan. 2005 to Dec. 2007 were enrolled in this study. And they were divided into two groups: DES group (n=92) and BMS group (n=125). The baseline characteristics including age, gender, angiographic characteristics, stents characteristics, Killip classification, cardiac troponin I(CTnI)levels, left ventricular ejection fraction(LVEF), hemoglobin levels, hypertension, diabetes, hyperlipidemia, obesity and smoking of the two groups were collected.Clinical follow-up end point were major adverse cardiac event(MACE)including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was(16.8±11.3) months (6-38 months). Results The average age (years), rate of Killip classification (class 2, 3, 4), average diameter (mm) of stent were significantly higher in BMS group than in DES group(64.6±11.9 vs. 61.2±11.8, t=2.09, P=0.037;25.9% vs. 12.2%, χ2=5.53, P=0.019;3.07±0.38 vs. 2.91±0. 40, t=2.78, P=0.006). And the average LVEF (%) was significantly lower in BMS group than in DES group (55.4±11.9 vs. 60.3±12.8, t= -2.57, P=0.011). The average length (mm) of stent, rate of stent post dilatation and diabetes were significantly higher in DES group than inBMSgroup (32.8±16.2 vs. 26.2±11.2, t=-3.54, P=0.001;45.7% vs. 21.6%, χ2=13.85, P=0. 000;28.2% vs. 16.0%, χ2=4.77, P=0.030). MACE occurred in 36 patients during clinical follow-up, 6 in DES group and 30 in BMS group. Incidence of MACE was significantly lower in DES group than in BMS group(6.5% vs. 24.0%, χ2=11.70, P＜0.01). Conclusions Using DES in ASTEMI patients is safe and may improve clinical outcomes by reducing incidence of MACE compared with BMS.     

冠脉内光学相干成像临床应用研究进展

光学相干断层成像（OCT）是一种将光学相干技术与激光扫描共焦技术相结合起来的新的医学成像技术，它利用近红外光源（波长1310nm）通过光纤维传输信号来产生冠状动脉图像，其最大优势在于它的高分辨率（径向分辨率：     

氯吡格雷用药时间对接受急诊介入治疗急性心肌梗死患者临床疗效的影响

Objective To evaluate effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Methods A total of 214 patients with acute myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. All patients were divided into two groups by duration of clopidogrel use; ＜1 year group (n=59) and ≥1 years group (n = 155). Baseline characteristics [age, gender, angiographic characteristics, Killip classification, LVEF (left ventricular ejection fraction) , CK (creatine kinase), CK-MB, CTnI (cardiac troponin-I), hemoglobin levels and history of hypertension, diabetes , hyperlipidemia, obesity and smoking ] of two groups were collected. Clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was 41.6 ± 16.3 months. MACE occurred in 28 patients. Results Rates of male, infarction site .infarction relative artery, multi-vessel disease, Killip classification (class I) , aspirin use and history of smoking, obesity, hypertension and hyperlipidemia were not different ( P ＞ 0. 05) in duration of clopidogrel use ＜ 1 year group and ≥ 1 years group. Average LVEF, hemoglobin levels and rate of drug-eluting stents were significantly lower in duration of clopidogrel use ＜ 1 year group than that in duration of clopidogrel use ≥1 years group (P ＜0. 0001 ,P ＜0. 0001 ,P=0. 0065). Average CK、CK-MB.CTnI were significantly higher in duration of clopidogrel use ≥ 1 years group than that in duration of clopidogrel use ＜ 1 year group (P ＜ 0. 0001 ). Rate of diabetes and average age were significantly higher in duration of clopidogrel use ＜ 1 year group than that in duration of clopidogrel use ≥1 years group (P =0. 0190, P ＜0. 0001 ). Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group (6.45% vs 30. 51% ,P ＜0. 01). After stopping clopidogrel use, incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group (2. 58% vs 20. 34% , P ＜ 0. 01 ) . Conclusion Primary percutaneous coronary intervention is an effective therapeutic method. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use ≥1 years group than that in duration of clopidogrel use ＜ 1 year group. Duration of clopidogrel use may influence clinical outcomes in follow-up period in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.