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1.
Coronary heart disease (CHD) is one of the leading causes of morbidity and the most common cause of death in older adults. Paradoxically, elderly patients tend to be systematically excluded from randomized-controlled cardiovascular trials, which complicates decision-making in this population. Management of CHD in the elderly is frequently more difficult in virtue of chronic comorbid conditions and aging-intrinsic dynamics. Despite these challenges, the number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. Elderly patients in many registries and large clinical series exhibit even a greater benefit from interventional procedures than younger patients, but they have a higher rate of overall complications. We present an overview of the current available evidence of PCI in older adults with stable and unstable CHD, including comparisons between drug-eluting and bare-metal stents, transfemoral and transradial access, and methods of revascularization. Adjuvant antiplatelet and antithrombotic therapies are also discussed. 相似文献
2.
目的:观察厄贝沙坦对老年非ST段抬高型心肌梗死(NSTEMI)者血清肝细胞生长因子(HGF)水平的影响。方法选择2013年10月~2014年5月哈尔滨医科大学附属第四医院老年NESTMI患者38例,将入选患者中因各种原因不能服用厄贝沙坦的17例患者作为对照组,余21例为药物组。对照组给予硝酸酯药物、β受体阻滞剂、阿托伐他汀、拜阿司匹林、低分子肝素等常规治疗;药物组在此基础上给予常规治疗联合厄贝沙坦(150 mg/d)。分别于治疗前、治疗后第7天、治疗后第14天检测两组患者血清超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy);采用酶联免疫吸附试验检测血清中HGF含量。结果治疗后第14天时药物组血清hs-CRP及Hcy水平均较治疗前明显降低(P<0.05),且明显低于对照组(P<0.05);治疗后第7天两组患者血清HGF水平明显高于治疗前(P<0.05),但药物组明显低于对照组(P<0.05);两组患者治疗后第14天时HGF水平均较治第7天下降(P<0.05),但两组组差异无统计学意义(P>0.05)。结论老年非NSTEMI患者应用厄贝沙坦2周时可使血清中hs-CRP、Hcy水平明显下降,厄贝沙坦可降低老年NSTEMI患者血清HGF水平。 相似文献
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Postdischarge management of patients with acute coronary syndrome is often suboptimal, despite their high risk of a subsequent event. Updated American College of Cardiology/American Heart Association guidelines emphasize the need for aggressive modification of risk factors and treatment with antiplatelet, antihypertensive, and lipid-lowering agents commenced in-hospital and continued long-term. Antiplatelet therapy involving aspirin and clopidogrel is the mainstay of secondary risk reduction. Increased adherence to medication and risk factor modification at discharge has been demonstrated with acute care quality improvement initiatives. Extension of these initiatives to postdischarge care will provide data on medication adherence post acute coronary syndrome and functional outcomes in the community setting. Successful secondary prevention of cardiovascular events requires implementation of evidence-based guidelines by physicians, and adherence to pharmacotherapy and lifestyle modifications by patients. Primary care physicians are well placed to influence adherence through their ongoing relationships with patients and can save lives by implementing secondary risk reduction measures after discharge. 相似文献
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Michał Hawranek Marek Gierlotka Damian Pres Marian Zembala Mariusz Gąsior 《JACC: Cardiovascular Interventions》2018,11(18):1885-1893
Objectives
The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery.Background
A routine use of IABP is contraindicated in patients with myocardial infarction and CS. There are no data regarding the subpopulation of patients who may benefit from such support besides patients with mechanical complications of myocardial infarction.Methods
Prospective nationwide registry data of patients with myocardial infarction and CS treated with PCI between 2003 and 2014 were analyzed. Patients were initially stratified into 2 groups according to final infarct-related artery Thrombolysis In Myocardial Infarction (TIMI) flow grade after PCI: those with successful primary PCI (TIMI flow grades 2 or 3) and those with unsuccessful primary PCI (TIMI flow grades 0 or 1). Outcomes of patients with or without IABP treatment in each group were analyzed and compared.Results
In the unsuccessful PCI group, patients in whom IABP was applied had lower in-hospital, 30-day, and 12-month mortality. IABP support in this group of patients was an independent predictor of lower 30-day mortality (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.89; p = 0.002). Conversely, in patients with successful PCI, IABP was an independent predictor of higher 30-day mortality (HR: 1.18; 95% CI: 1.08 to 1.30; p = 0.0004).Conclusions
IABP is associated with a lower risk of 30-day mortality in patients with myocardial infarction complicated by CS, in whom primary PCI was unsuccessful. 相似文献7.
8.
Fröhlich GM Schoch B Schmid F Keller P Sudano I Lüscher TF Noll G Ruschitzka F Enseleit F 《International journal of cardiology》2012,154(3):328-332
Background
Takotsubo cardiomyopathy (TC) usually is not recognized until heart catheterization reveals typical wall motion abnormalities in the absence of significant coronary artery disease. It was our aim to identify TC by its unique cardiac biomarker profile at an early stage and, preferably, with non-invasive procedures only.Methods
Ratios of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and myoglobin, NT-proBNP and troponin T (TnT), NT-proBNP and creatinekinase-MB (CK-MB) were compared in patients with TC (n = 39), patients with ST-elevation myocardial infarction (STEMI, n = 48) and patients with non-ST-elevation myocardial infarction (NSTEMI, n = 34). Biomarkers were recorded serially at admission and at the three consecutive days. Optimal cut-off values to distinguish TC from STEMI and NSTEMI were calculated with receiver operator characteristic (ROC) curves.Results
At admission a NT-proBNP (ng/l)/myoglobin (μg/l) ratio of 3.8, distinguished TC from STEMI (sensitivity: 89%, specificity: 90%), while a NT-proBNP (ng/l)/myoglobin (μg/l) ratio of 14 separated well between TC and NSTEMI (sensitivity: 65%, specificity: 90%). Best differentiation of TC and ACS was possible with the ratio of peak levels of NT-proBNP (ng/l)/TnT (μg/l). A cut-off value of NT-proBNP (ng/l)/TnT (μg/l) ratio of 2889, distinguished TC from STEMI (sensitivity: 91%, specificity: 95%), while a NT-proBNP (ng/l)/TnT (μg/l) ratio of 5000 separated well between TC and NSTEMI (sensitivity: 83%, specificity: 95%).Conclusions
TC goes along with a singular cardiac biomarker profile, which might be useful to identify patients with TC among patients presenting with acute coronary syndromes (ACS). 相似文献9.
Günter Christ Thomas Hafner Jolanta M. Siller-Matula Marcel Francesconi Katharina Grohs Eva Wilhelm Andrea Podczeck-Schweighofer 《Thrombosis research》2013
Introduction
Current guidelines still recommend the bolus and infusion administration of glycoprotein IIbIIIa inhibitors in patients with high-risk acute coronary syndrome undergoing percutaneous coronary intervention. We sought to evaluate the extent of platelet inhibition by a blocking and bridging strategy with intracoronary abciximab bolus-only administration and oral loading of adenosine diphosphate receptor antagonists.Patients and methods
Fifty-six consecutive high-risk acute coronary syndrome patients with bolus-only abciximab administration (0.25 mg/kg i.c.) and loading with 600 mg clopidogrel (55%) or 60 mg prasugrel (45%) were included in this study. Platelet aggregation induced by thrombin receptor-activating peptide and adenosine diphosphate was measured by multiple electrode aggregometry up to 7 days.Results
Thrombin receptor-activating peptide induced platelet aggregation was significantly suppressed for a minimum of 48 h (45 ± 17 U) and returned to a normal range (> 84 U) after 6 days (90 ± 26 U; p < 0.001). Co-medication with prasugrel significantly reduced adenosine diphosphate-induced (p = 0.002) and thrombin receptor-activating peptide-induced (p = 0.02) platelet aggregation compared with clopidogrel throughout the observation period. No stent thrombosis or repeat myocardial infarction occurred at 30-day follow-up.Conclusions
Immediate blocking of platelet aggregation in high-risk acute coronary syndrome patients by intracoronary abciximab bolus-only administration and bridging to prolonged inhibition via oral blockade of ADP receptors effectively inhibited overall platelet reactivity for at least 48 h, questioning the value of continuous abciximab infusion. Co-medication with prasugrel vs. clopidogrel synergistically augmented platelet inhibition. 相似文献10.
Marc Laine Richard Toesca Julie Berbis Corinne Frere Pierre Barnay Michel Pansieri Jean-Pascal Peyre Pierre Michelet Jacques Bessereau Elise Camilleri Olfa Helaf Marjorie Camaleonte Franck Paganelli Françoise Dignat-George Laurent Bonello 《Thrombosis research》2013