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Background and Objective: Spontaneous coronary artery dissection [SCD] remains a rare and important cause of coronary artery disease [CAD]. The purpose of this study was to describe the clinical and angiographic features in SCD and to evaluate the treatment and long-term prognosis of this condition in China
Methods: This retrospective cohort study included 118 Chinese patients with SCD confirmed by coronary angiography. Clinical and angiographic features, treatment modalities and outcomes of SCD were estimated
Results: The overall prevalence of SCD was 0.15%. Age was 57 +/- 10 years; 86% patients were men; 75% presented with acute coronary syndrome [ACS]; 72% had concomitant atherosclerotic CAD. SCD often affected right coronary artery [RCA] and caused a short dissection [< 20mm]. A conservative therapy was used in 28% of patients and revascularization in 72% [percutaneous coronary intervention [PCI] 57%; coronary artery bypass grafting [CABG] 15%]. Only one patient died during hospitalization due to multiple organ failure after CABG. During a median follow-up of 43 months [range, 1 - 158 months], 32 patients had a new-onset ACS, 9 received revascularization [7 PCI and 2 CABG], and 8 died. The Kaplan-Meier estimated 12-year rates of freedom from cardiac death and ACS were both higher in revascularization versus conservative therapy [78% versus 57%; P = 0.023; 48% versus 25%, P = 0.014]. No significant difference was found in freedom from revascularization between the two therapies
Conclusions: In China, SCD was usually associated with atherosclerosis and predominantly affected male population. SCD often affected RCA and caused a short dissection. In-hospital mortality rate was low regardless of therapeutic strategy. However, a significantly better long-term prognosis was observed in the revascularization compared with conservative therapy
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Objective To compare the clinical effects of dynamic hip screw(DHS),Gamma interlocking intramedullary nail and proximal femoral nail antirotation (PFNA) in the treatment of intertrochanteric femoral fractures in elderly patients.Methods From January 2008 to June 2015,103 elderly patients with intertrochanteric femoral fracture were treated with DHS (DHS group,33 cases),Gamma nails (Gamma group,30 cases),or PFNA (PFNA group,40 cases).By the AO classification,there were 44 cases of type 31-Al,30 cases of type 31-A2 and 29 cases of type 31-A3.The 3 groups were compared in terms of incision length,operation time,intraoperative blood loss,fracture healing time,postoperative weight-bearing time,Harris scoring,and incidence of postoperative complications.Results PFNA group incurred significantly shorter incision length (5.4 ±0.5 cm) and operation time (70.8 ± 16.2 min) than DHS group (12.6 ±2.7 cm and 102.6±17.4min) and Gamma group (7.5±0.8 cmand93.0±35.9 min) (P ＜0.05).The intraoperative blood loss in PFNA group (163.2 ± 60.6 mL) was significantly less than in DHS group (280.5 ±89.8 mL) and in Gamma group (204.9 ±62.2 mL),and that in Gamma group was also significantly less than in DHS group (P ＜ O.05).PFNA group had significantly shorter weight-beating time (11.0 ± 0.8 weeks),fracture healing time(13.6 ± 1.5 weeks) and significantly higher Harris good to excellent rate (92.5％) than DHSgroup (13.3±1.0weeks,15.8 ± 1.2 weeks and 84.8％) and Gamma group (12.5±1.3 weeks,14.2 ± 1.0 weeks and 86.7％) (P ＜ 0.05).The incidence of postoperative complications in DHS group (21.2％)was significantly higher than in Gamma group(10.0％) and in PFNA group (7.5％) (P ＜ 0.05).Conclusions DHS,Gamma nail and PFNA are effective means for the treatment of intertrochanteric femoral fractures in the elderly.Intramedullary fixation,especially by PFNA,shows superiority in the clinical outcomes.
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Objective To discuss the risk factors of free wall rupture (FWR) in acute ST-segment elevation myocardial infarction (STEMI) patients. Methods We retrospectively reviewed all patients (n=1247) with STEMI hospitalized in CCU from January 2005 to July 2010. Results FWR occurred in 29 patients(2.3%). Of these 1247 patients, 128 (10.2%) patients received thrombolytic therapy, 623 (50.0%) patients underwent primary PCI. Compared to No-FWR group, FWR group has signiifcant differences in age (62.4±6.4 y vs. 66.6±8.3 y, P0.05), diabetes mellitu (55.2%vs. 23.5%, P=0.022), presence of heart failure on admission (Killip≥Ⅱ) ( 16.4%vs. 34.0%, P 100 mg/L) and thrombolytic therapy were independent risk factors of FWR. Conclusions STEMI patients with advanced age, Killip≥Ⅱ, hCRP and thrombolytic therapy were more vulnerable of FWR.