ABSTRACT
Objective To investigate the effects of Tirofiban combined with thrombus aspiration on myocardial reperfusion and no-reflow after percutaneous coronary intervention (PCI)in elderly patients with ST-segment elevation myocardial infarction (STEMI).Methods A total of 185 patients with STEMI were randomly divided into a control group(n=93)and a study group(n=92).The control group received direct stenting or percutaneous coronary angioplasty before stent placement.The study group received an intracoronary injection of Tirofiban 10 μg/kg,thrombus aspiration,and then balloon dilatation or direct coronary stenting.Postoperative recovery was compared between the groups,and major adverse cardiovascular events(MACE) were recorded.Results The incidence of no-reflow,the thrombolysis in myocardial infarction,the corrected (TIMI)frame count (CTFC)and the peak of plasma creatine kinase MB isoenzyme(CK MB)were lower in the study group than in the control group[(no reflow,8 cases or 8.7 ％ vs.21cases or 22.6 ％,x2 =6.752,P ＜0.05;CTFC,(26.4±8.7)frame vs.(34.5± 8.2)frame,t =6.517,P＜0.05;CK-MB peak,(114.5±25.7)U/L vs.(226.3 ± 27.6) U/L,t =28.506,P ＜ 0.05].The proportion of patients with descent of ST segment elevation of more than 50％ and the left ventricular ejection fraction(LVEF)were higher in the study group than in the control group[83 cases or 90.2％ vs.72 cases or 77.4％,x2=5.581,P＜0.05;(56.2±8.6) ％ vs.(48.8±10.5)％,t =5.241,P＜0.05].The TIMI grading was better in the study group than in the control group (Z =1.984,P ＜ 0.05).The incidence of mild bleeding during treatment had no significant difference between the study group and the control group(20.7％ or 19 cases vs.15.1％ or 14 cases,x2 =0.99,P =0.32).There was no significant difference in the incidence of MACE events during hospitalization or one-year follow-up between the two groups(x2=2.394,0.452,P ＞ 0.05).Conclusions Tirofiban combined with thrombus aspiration can improve myocardial reperfusion in elderly patients with STEMI after PCI,and has excellent clinical value.
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Objective To analyse the risk factors of vulnerable plaque biomarker and to construct an early warning system. Methods Ninety patients with suspected acute coronary syndrome (ACS) hospitalized during December 2012 and December 2013 were selected. The coronary artery lesions were divided into type I, II and III plaque groups by the morphology of atherosclerotic plaque. Serum SAA, PLGF, sCD40L and Npt were measured. The results of SAA, PLGF, sCD40L and Npt were compared. Logistic regression model was fitted to explore the main influencing factors of the vulnerable plaque. Results SAA, PLGF, sCD40L, and Npt were main influencing factors of the vulnerable plaques, and the ORs were 1.61, 1.88, 1.96 and 1.79 respectively. Conclusion The detection of SAA, PLGF, sCD40L and Npt biochemical markers in patients with chest pain is important for predicting the vulnerable plaque and guiding clinical treatment.
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Objective To observe the effects of adenosine and adenosine receptor agonist on the expression of inter?leukin-18 (IL-18) in patients with unstable angina (UAP), and the mechanism of adenosine receptor agonists thereof. Meth?ods Fifteen UAP and 15 healthy volunteers were included in this study. The effects of adenosine and the selective adenos?ine receptor agonists on the expression of IL-18 were measured by enzyme-linked immunosorbent assay (ELISA). Results The lower concentration of adenosine (1-100μmol/L) increased the expression of IL-18 in UAP group;whereas the higher concentration of adenosine (1 mmol/L) inhibited the expression of IL-18. The adenosine A1 receptor agonist and A3 receptor agonist increased the expression of IL-18, while the adenosine A2a receptor agonist inhibited the expression of IL-18. There was no significant effect for A2b receptor agonist on the expression of IL-18. Conclusion The lower concentrations of ade?nosine can enhance the expression of IL-18 through adenosine A1 and A3 receptors in UAP. The higher concentrations of ade?nosine can inhibit the expression of IL-18 through adenosine A2a receptors. Adenosine can promote IL-18 expression in lower concentrations.
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Objective To analyze the clinical effect and complication of trans-radial and femoral artery for percutaneous coronary intervention (PCI) in patients with coronary heart disease.Methods Totally 153 patients with coronary heart disease undergoing PCI were divided into radial artery and femoral artery groups.X-ray exposure time,operation time,the success rates of puncture and operation,in-bed time and complication were recorded. Results There were no significant differences in X-ray exposure time[(17±5)min vs.(16±6)min,t=0.61,P=0.57],operation time [(49± 9) min vs. (48 ± 11) min,t=0.59,P =0.61],the success rates of puncture (98.7％ vs.100.0％,x2 =0.47,P=0.53) and operation (96.0％ vs.96.2％,x2 =0.14,P=0.64) between radial artery and femoral artery groups.However,the complication rates was higher in femoral artery group than in radial artery group (17.9％ vs.2.7 ％,x2 =9.54,P=0.002),in-bed time was shorter in radial artery group than in femoral artery group [(4.5 ± 1.2)h vs.(13.2 ±4.6)h,t=2.12,P =0.003]. Conclusions The trans-radial artery PCI is safe,effective and feasible,with less complications and shorter in-bed time.