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41.
目的 系统评价早期应用替罗非班对急性ST段抬高型心肌梗死（STEMI）经皮冠状动脉介入（PCI）术后冠脉血流及并发症影响。方法 检索PubMed、Embase、Cochrane图书馆、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）和维普中文期刊全文数据库（VIP）和万方数据库关于STEMI患者急诊行PCI并早期应用替罗非班的临床对照研究（RCT）,检索年限均为建库起至2020年4月30日。试验组为PCI术前开始应用替罗非班,对照组为PCI术中或术后应用替罗非班,数据提取和质量评价,应用RevMan 5.3软件进行Meta-分析。结果 共纳入15项RCT,共计2 214例患者。Meta-分析结果显示,术前应用替罗非班组较术中或术后用药组,PCI术后TIMI血流分级为3级（RR=1.10,95%CI=1.06~1.15,P<0.01）和（RR=1.10,95%CI=1.03~1.17,P<0.01）、ST段下落幅度（SMD=0.44,95%CI=0.17~0.70,P=0.001）和（SMD=1.85,95%CI=1.53~2.17,P<0.01）、ST段回落率（RR=1.51,95%CI=1.20~1.89,P<0.01）和（RR=1.20,95%CI=1.05~1.39,P=0.01）均显著优于术中或术后用药;术前应用组提高左心室射血分数（LVEF%）（SMD=0.46,95%CI=0.13~0.79,P=0.007）和降低主要心血管不良事件（MACE）发生率（RR=0.53,95%CI=0.39~0.73,P<0.01）均优于术中用药组。术前应用组与术后应用组的LVEF%和MACE发生率比较均无显著性差异。术前应用组出血及并发症发生率与术中及术后应用组比较均无显著性差异。结论 与PCI术中及术后应用替罗非班相比,术前应用更能显著改善STEMI患者微循环障碍、增加心肌组织有效的再灌注、减少心肌梗死范围。 相似文献
42.
目的:研究活血化瘀养心通络方辅助治疗冠心病PCI术后心绞痛患者实验室指标血清人软骨糖蛋白(YKL-40)、超敏C反应蛋白(hs-CRP)等炎症因子水平及临床疗效的影响。方法:选取2018年3月到2019年6月某院心内科收治的冠心病PCI术后再发心绞痛患者。随机分为治疗组与对照组各50例。2组均给予常规西医药物治疗,治疗组在西医药物治疗基础上增加活血化瘀养心通络方治疗。观察治疗后硝酸甘油停减率、治疗前后YKL-40、hs-CRP水平、肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、临床疗效及中医证候积分。结果:治疗后治疗组硝酸甘油停减率明显高于对照组(P<0.05)。2组治疗后YKL-40、hsCRP、TNF-α、IL-6水平均明显分别低于本组治疗前(P<0.05);治疗后治疗组YKL-40、hsCRP、TNF-α、IL-6水平均明显低于对照组(P<0.05)。治疗后治疗组显效率76.00%(38/50)明显高于对照组42.00%(21/50)(P<0.05)。2组治疗后中医证候积分均明显分别低于本组治疗前(P<0.05);治疗后治疗组中医证候积分明显低于对照组(P<0.05)。结论:在常规西医药物基础上增加活血化瘀养心通络方治疗可更显著改善冠心病PCI术后再发心绞痛患者心绞痛症状,促进相关实验室指标恢复正常。 相似文献
43.
Carlos Collet Yosuke Miyazaki Nicola Ryan Taku Asano Erhan Tenekecioglu Jeroen Sonck Daniele Andreini Manel Sabate Salvatore Brugaletta Rodney H. Stables Antonio Bartorelli Robbert J. de Winter Yuki Katagiri Ply Chichareon Giovanni Luigi De Maria Pannipa Suwannasom Rafael Cavalcante Hans Jonker Patrick W. Serruys 《Journal of the American College of Cardiology》2018,71(24):2756-2769
Background
The functional SYNTAX score (FSS) has been shown to improve the discrimination for major adverse cardiac events compared with the anatomic SYNTAX score (SS) while reducing interobserver variability. However, evidence supporting the noninvasive FSS in patients with multivessel coronary artery disease (CAD) is scarce.Objectives
The purpose of this study was to assess the feasibility of and validate the noninvasive FSS derived from coronary computed tomography angiography (CTA) with fractional flow reserve (FFRCT) in patients with 3-vessel CAD.Methods
The CTA-SS was calculated in patients with 3-vessel CAD included in the SYNTAX II (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery II) study. The noninvasive FSS was determined by including only ischemia-producing lesions (FFRCT ≤0.80). SS derived from different imaging modalities were compared using the Bland-Altman and Passing-Bablok method, and the agreement on the SS tertiles was investigated with Cohen’s Kappa. The risk reclassification was compared between the noninvasive and invasive physiological assessment, and the diagnostic accuracy of FFRCT was assessed by the area under the receiver-operating characteristic curve using instantaneous wave-free ratio as a reference.Results
The CTA-SS was feasible in 86% of patients (66 of 77), whereas the noninvasive FSS was feasible in 80% (53 of 66). The anatomic SS was overestimated by CTA compared with conventional angiography (27.6 ± 6.4 vs. 25.3 ± 6.9; p < 0.0001) whereas the calculation of the FSS yielded similar results between the noninvasive and invasive imaging modalities (21.6 ± 7.8 vs. 21.2 ± 8.8; p = 0.589). The noninvasive FSS reclassified 30% of patients from the high- and intermediate-SS tertiles to the low-risk tertile, whereas invasive FSS reclassified 23% of patients from the high- and intermediate-SS tertiles to the low-risk tertile. The agreement on the classic SS tertiles based on Kappa statistics was slight for the anatomic SS (Kappa = 0.19) and fair for the FSS (Kappa = 0.32). The diagnostic accuracy of FFRCT to detect functional significant stenosis based on an instantaneous wave-free ratio ≤0.89 revealed an area under the receiver-operating characteristics curve of 0.85 (95% CI: 0.79 to 0.90) with a sensitivity of 95% (95% CI: 89% to 98%), specificity of 61% (95% CI: 48% to 73%), positive predictive value of 81% (95% CI: 76% to 86%), and negative predictive value of 87% (95% CI: 74% to 94%).Conclusions
Calculation of the noninvasive FSS is feasible and yielded similar results to those obtained with invasive pressure-wire assessment. The agreement on the SYNTAX score tertile classification improved with the inclusion of the functional component from slight to fair agreement. FFRCT has good accuracy in detecting functionally significant lesions in patients with 3-vessel CAD. (A Trial to Evaluate a New Strategy in the Functional Assessment of 3-Vessel Disease Using SYNTAX II Score in Patients Treated With PCI; NCT02015832) 相似文献44.
Eliano P. Navarese MD PhD Lara Frediani MD David E. Kandzari MD Gianluca Caiazzo MD Angela Marella Cenname MD Bernardo Cortese MD PhD MD Tommaso Piva MD Andi Muçaj MD Carlo Tumscitz MD Francesco Paparoni MD Claudio Larosa MD Teodoro Bisceglia MD Mila Menozzi MD Paul A. Gurbel MD Jacek Kubica MD PhD 《Catheterization and cardiovascular interventions》2021,97(4):602-611
45.
Ioanna Kosmidou Shmuel Chen A. Pieter Kappetein Patrick W. Serruys Bernard J. Gersh John D. Puskas David E. Kandzari David P. Taggart Marie-Claude Morice Paweł E. Buszman Andrzej Bochenek Erick Schampaert Pierre Pagé Joseph F. Sabik Thomas McAndrew Björn Redfors Ori Ben-Yehuda Gregg W. Stone 《Journal of the American College of Cardiology》2018,71(7):739-748
Background
There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD).Objectives
This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes.Methods
In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization.Results
Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p < 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantly longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001), death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p = 0.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004).Conclusions
In patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776) 相似文献46.
Giuseppe Gargiulo Sara Ariotti Pascal Vranckx Sergio Leonardi Enrico Frigoli Nestor Ciociano Carlo Tumscitz Francesco Tomassini Paolo Calabrò Stefano Garducci Gabriele Crimi Giuseppe Andò Maurizio Ferrario Ugo Limbruno Bernardo Cortese Paolo Sganzerla Alessandro Lupi Filippo Russo Marco Valgimigli 《JACC: Cardiovascular Interventions》2018,11(1):36-50
Objectives
This study sought to assess whether transradial access (TRA) compared with transfemoral access (TFA) is associated with consistent outcomes in male and female patients with acute coronary syndrome undergoing invasive management.Background
There are limited and contrasting data about sex disparities for the safety and efficacy of TRA versus TFA for coronary intervention.Methods
In the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) program, 8,404 patients were randomized to TRA or TFA. The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACCE or major bleeding.Results
Among 8,404 patients, 2,232 (26.6%) were women and 6,172 (73.4%) were men. MACCE and NACE were not significantly different between men and women after adjustment, but women had higher risk of access site bleeding (male vs. female rate ratio [RR]: 0.64; p = 0.0016), severe bleeding (RR: 0.17; p = 0.0012), and transfusion (RR: 0.56; p = 0.0089). When comparing radial versus femoral, there was no significant interaction for MACCE and NACE stratified by sex (pint = 0.15 and 0.18, respectively), although for both coprimary endpoints the benefit with TRA was relatively greater in women (RR: 0.73; p = 0.019; and RR: 0.73; p = 0.012, respectively). Similarly, there was no significant interaction between male and female patients for the individual endpoints of all-cause death (pint = 0.79), myocardial infarction (pint = 0.25), stroke (pint = 0.18), and Bleeding Academic Research Consortium type 3 or 5 (pint = 0.45).Conclusions
Women showed a higher risk of severe bleeding and access site complications, and radial access was an effective method to reduce these complications as well as composite ischemic and ischemic or bleeding endpoints. 相似文献47.
Teruo Inoue Ryoichi Nishiki Manabu Kageyama Koichi Node 《Cardiovascular therapeutics》2004,22(4):320-333
Thrombolysis with conventional thrombolytic agents followed by percutaneous coronary intervention (PCI) had no impact on the treatment of acute myocardial infarction (AMI). However, the development of mutant type plasminogen activator (mt‐PA) has prompted us to reassess the combination of thrombolysis and PCI. Monteplase (Eisai, Co. Ltd., Tokyo, Japan) is a newly developed mt‐PA that can be administrated as a single intravenous bolus injection. We initiated a clinical trial [Combining Monteplase with Angioplasty (COMA)] to evaluate the effectiveness of monteplase followed by PCI. The AMI patients were randomly assigned to receive PCI following pretreatment with a single bolus intravenous injection of monteplase or direct PCI without monteplase. The initial coronary angiography prior to PCI showed that 36.2% of patients in the monteplase group achieved Thrombolysis in Myocardial Infarction (TIMI) 3 flow in the infarct‐related artery, compared with in only 7.9% of patients in the direct PCI group (P < 0.0001). During 24 months following PCI, major cardiac events occurred in 27.7% of patients in the monteplase + PCI group, and in 46.7% of patients in the direct PCI group without monteplase (P < 0.05). Thus, the ideal strategy for the treatment of AMI is the administration of monteplase upon arrival at a community hospital with a prompt transfer to a tertiary center for PCI. 相似文献
48.
通冠胶囊对冠心病介入术后病人GMP-140和vWF的影响 总被引：11，自引：1，他引：11
目的探讨通冠胶囊对冠心病经皮冠状动脉介入治疗(PCI)后病人血浆血小板α颗粒膜蛋白-140(GMP-140)、血管性假性血友病因子(vWF)的影响.方法将52例PCI术后的冠心病病人随机分为治疗组(西药加通冠胶囊组)与对照组(西药组).于手术当日、术后1月及术后3月检测GMP-140、vWF含量.结果治疗3月后治疗组GMP-140、vWF含量均明显低于对照组(P＜0.01,P＜0.05).结论通冠胶囊配合西药治疗能显著降低GMP-140、vWF水平,抑制血小板活化从而减少血栓形成是其重要机制之一. 相似文献
49.
急性心肌梗死多支病变患者急诊冠脉介入手术开通梗死相关动脉后,残余的非梗死相关动脉狭窄的介入治疗问题一直存在争议。现就如何评价非梗死相关动脉狭窄及如何选择最能从分期冠脉介入术中获益的患者等问题进行综述。 相似文献
50.
Michał Hawranek Marek Gierlotka Damian Pres Marian Zembala Mariusz Gąsior 《JACC: Cardiovascular Interventions》2018,11(18):1885-1893