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Objective: To evaluate the post-operative mortality of left ventricular end-diastolic pressure (LVEDP) during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: We retrospectively analyzed 255 patients with new onset of STEMI who received primary PCI in our hospital and all patients received LVEDP measurement before coronary artery opening. According to LVEDP value, the patients were divided into 2 groups: LVEDP≤14 mmHg group,n=155 and LVEDP>14 mmHg group,n=100. The post-operative mortality up to 6 months was observed, and the effect of LVEDP on death rate was studied by Cox regression analysis. Results: Compared with LVEDP≤14 mmHg group, the patients in LVEDP>14 mmHg group had the 6 months mortality at HR=4.26, 95% CI (1.13-16.08),P=0.03. Relevant study presented that LVEDP was slightly related to LVEF (r=-0.267, P=0.001) and BNP (r=-0.154,P=0.041). Multi-regression analysis indicated that with adjusted LVEF and BNP, LVEDP was the independent predictor for post-operative mortality up to 6 months in acute STEMI patients after PCI. Conclusion: The LVEDP value measured during PCI procedure is the independent predictor for mortality after PCI in patients with new onset of STEMI.
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Objective To evaluate the outcome of ST-segment elevation myocardial infarction (STEMI) patients received different reperfusion therapies. Methods The 238 consecutive STEMI patients were enrolled from February 2012 to December 2012. According to the current guideline of PCI and the choice of patients, the patients were divided into the groups of percutaneous coronary intervention (PCI), ifbrinolysis, and conservative medication. The major adverse cardiac events (MACE) was analyzed in a follow up of 6 months. Results (1) The enrolled patients included the 210 patients received PCI (88.2%), 14 patients received fibrinolysis (5.9%) and 14 patients received conservative medication (5.9%).The Median time of D2B was 110minutes.(2) The rate of late stent thrombosis was signiifcant higher in BMS than DES (n=2, 2.8%vs 0, P < 0.05) . (3) The PCI group had a signiifcantly higher incidence of stroke than the ifbrinolysis group and the conservative medication group (1.0%vs 0, P < 0.05;1.0%vs 0, P<0.05). (4) The PCI group had a signiifcantly higher incidence of bleeding compared to the thrombolysis group and the medication group (1.0% vs 0, P < 0.05; 1.0% vs 0%, P < 0.05). Conclusions The majority of STEMI patients received PCI;The D2B time, which was required<90 minutes in guideline of PCI, was found delayed in our study;Compared to ifbrinolysis and conservative medication, PCI showed better clinical outcomes of STEMI patients.
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Objective To investigate the changes of autonomic nerve function of coronary heart disease (CHD) patients with panic disorder(PD). Methods All the subjects who met with the diagnostic code of CHD and PD were divided into CHD group(n=40) ,PD group(n=36) ,comorbid CHD and PD group(n=27) ,and 40physical examinee were recruited as normal control group. They had a 24 hours Holter ECG monitoring by time and frequency domain analysis of heart rate variability. ANOVA analysis was utilized to statistic the collected data. Results Compared with normal controls,the patients of others groups had every indexs of HRV were reduced. The indexs of HRV of comorbid CHD and PD were lower than the patients of CHD or PD group. The score of time domain SDNN(70.40 ± 14.74)ms,SDANN(91.72 ± 24.46)ms,PNN50(2.83 ±2.07)%, RMSSD( 15.66 ±7.45)ms,frequency domain LF(647.54 ± 129.24)ms2, HF(596. 16± 127.66) ms2 in comorbid CHD and PD. There were significant differences with others groups(P ＜ 0.05 ). Conclusion The autonomic nervous functional of the patients with CHD and PD were in disorder. The autonomic nervous functional disorder of the patients with comorbid CHD and PD was more severe.
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Objective To provide clinical experience in the treatment and prevention of complicated acute cardiac tamponade in the course of heart interventional therapy. Methods To analyse the clinical features of patients with acute cardiac tamponade and to investigate the possible underlying mechanism. Results Twenty-one cases experienced acute cardiac tamponade when undergoing heart interventional therapy. Among all the 21 patients with acute cardiac tamponade, 11 occurred from percutaneous coronary interention(PCI) ,6 from the radiofrequency catheter ablation , 1 from the closure of atrial rspetal with amplaty closure service, 1 from the percutaeous balloon mitral valvuloplasty ( PBMV), 2 from temporary pacemaker implantation. Eighteen patients were successfully rescued left no serious sequelae. Three cased died, including two PCI-related death and one temporary-pacemaker-installation-related death. Conclusion Any heart interventional operation is at the risk to cause acute cardiac tamponade. Early identification and appropriate treatment is the key to successful rescue.
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Objective To investigate the effects of docosahexaenoic acid (DHA) on action potential (AP)and transient outward potassium channel (Ito) in rat ventricular myocytes in order to evaluate the anti-arrhythmia mechanism of DHA. Method The rat ventricular myocytes were isolated by using enzyme digestion method. AP and Ito of individual ventricular myocyte were recorded by using patch-clamp technique in whole-cell configuration at room temperature. The effects of DHA on AP and Ito were observed when it was applied in 0 μmol/L, 20 μmol/L, 40 μmol/L, 60 μmol/L, 80 μmol/L, 100 μmol/L and 120μmol/L separaterly. Results The 25%,50% and 90% of action potential duration (APD25, APD50 and APD90) were gradually prolonged with the escalation of concentration of DHA ( P ＜ 0.05, n= 20). The effects of DHA of different concentrations on AP maximal velocity (Vmax), AP amplitude (APA) and AP overshoot (OS) did not produce significantly different results (P ＞ 0.05, n= 20). The degree of blockade of Ito was concentration-dependent as different concentrations of DHA were applied, and as the concentration of DHA was escalated, the I-V curves went downwards, the stably inactivated curves shifted to the lift, and the time taken for recovery from inactivation prolonged ( P ＜ 0.05, n =20). However, the different concentrations of DHA did not produce different effects on stably activated curves ( P＞ 0.05). The Itos were blocked to (2.61 ± 0.26)%, (21.79±4.85)%, (63.11 ± 6.57)%, 75.52±7.26 ) %, (81.82 ± 7.63) % and (84.33 ± 8.25) % by the above given concentrations of DHA respectively under given potential equaling to + 70 mV( P ＜ 0.05, n = 20), and the half-effect concentration (EC50) of DHA on Ito was(49.11±2.68) umol/L. Conclusions The effects of DHA on APD and Ito may be one of the anti-arrhythmia mechanism of DHA.
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To evaluate the feasibility, safety and efficacy of percutaneous stent implantation for treating left main coronary artery (LMCA) stenosis. Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention (PCI) at 6 medical centers in China were enrolled. Procedural data and clinical outcomes were obtained from all patients. Results From January 2001 to December 2004, 138 patients (79 males and 59 females; mean age: 69.7±5.8 years)underwent PCI for LMCA stenosis. Bare metal stents (BMS) were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003 (BMS group);. Drug eluting stents (DES) were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004 (DES group). Procedural success rate of the 138 cases was 98% (135/138). One patient (0.7%) with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure. During a mean follow up period of 21.3 ± 5.6 months, one patient died from renal failure, one from sudden cardiac death, 4 underwent target lesion revascularization (TLR) in the BMS group, which all occurred in patients with bifurcational lesions; whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR. Conclusions (1) PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals. (2) BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA. (3) DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.
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Objective To study the relationship between chlamydia pneumoniae and coronary heart disease.Methods Serology and PCR for detecting chlamydia pneumoniae were conducted in groups of non coronary heart disease(NCHD),stable angina pectoris(SAP),unstable angina pectoris(UAP)and acute angina pectoris(SAP),unstable angina pectoris(UAP)and acute myocardial infarction(AMI).Results No significant difference was found in serology among each group.The positive rate of PCR of CHD group was higher than that of CHD group,and the positive rates of PCR of both UAP and AMI were higher than that of SAP group.There was no significant difference between the positive rates of PCR of UAP and AMI group.Conclusion Chlamydia pneumoniae contributes to the formation of coronary heart disease and the ustability of plaque.
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0. 05). Level of sCD40L was significantly decreased in the tirofiban group after PCI compared with the control (3.17?1.01 ?g/L vs 4.05?0.96 ?g/L, P