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Objective To evaluate the efficacy and safety of different drugs injected via balloon catheter for no-reflow after percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI).Methods From January 2016 to December 2017,1 280 patients with STEMI were treated in Department of Cardiology,Beijing Luhe Hospital.All patients were underwent PCI and stent implantation in related infarct vessels (IRA).Among 1 280 patients no-reflow occurred in 164 cases (12.81％) during the procedure.No-reflow patients were divided into three study groups according to the order of consultation,who were given verapamil (verapamil group,55 cases),tirofiban (tirofiban group,55 cases) or nitroglycerin (nitroglycerin group,54 cases) by injection through balloon catheter.Coronary blood flow recovery (TIMI grading),myocardial perfusion level TMP grading (TMPG),average dose of drugs (mg) and adverse drug reactions (ADR) were compared among the three groups.Left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) were evaluated by echocardiography 7 and 30 d after operation.The incidence of major adverse cardiovascular events (MACE) was followed up.Results TIMI-3 ratio in verapamil,tirofiban and nitroglycerin groups was 89.90％ (49/55),91.82％ (45/55) and 61.11％ (33/54),respectively (Hc=13.920,P＜0.05).TMP-3 ratio was 72.73％(40/55) in verapamil group,65.45％ (36/55) in tirofiban group and 50.0％ (27/54) in nitroglycerin group,respectively (Hc=6.230,P＜0.05).During the procedure,one case (1.82％) had slow heart rate and one case (1.82％) had hypotension in verapamil group;three cases 5.56％) had transient hypotension in nitroglycerin group,and there was no significant difference in the incidence of ADR among the three groups (Hc=0.040,P＞0.05).There was no significant difference in LVEF and LVEDV among three groups on the d7 after operation (all P＞0.05).The improvement of LVEF and LVEDV was more significant in verapamil group on d30 after operation (all P＜0.05).One case (1.82％) of heart failure occurred in tirofiban group,three cases of heart failure and one case of recurrent myocardial infarction occurred in nitroglycerin group during six months of follow-up.There was no significant difference in the overall incidence of MACE among the three groups (Hc=0.070,P＞0.05).Conclusion Verapamil can be injected throμgh balloon catheter to restore coronary blood flow rapidly,effectively and safely,and improve left ventricular function in STEMI patients with no-reflux during PCI.
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After the application of project-based learning (PBL) and 3D printing in classroom and teaching, the integrating methods and principles of PBL and 3D printing and recent teaching resources were summarized, PBL-based 3D modeling combined with recent innovative practice of 3D printing teaching model, with the course of Computer-aided medicine as an example, showed that the new teaching mode can effectively stimulate the interests of students, and cultivate their innovative thinking.
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Objective To investigate the first medical contact to balloon ( FMC2B) time in our center and to identify the influencing factors .Methods This is a retrospective study conducted in the heart center of Beijing Luhe Hospital . A total of 140 patients undergoing primary percutaneous coronary intervention ( PCI) were enrolled between July 2013 to September 2014.Demographic data , clinical risk factors and the emergency process were evaluated .All the patients were categorized into 2 groups including:the conformed group ( patients with FMC2B<120 min for non-PCI-capable hospital and <90 min for direct arrival at Luhe hospital, n=59) and the unconformed group (n=81).Multivariant regression aralysis was done to analyse factors influencing FMC 2B time.Results Among the enrolled 140 patients, 58 patients were initially seen in a non-PCI-capable hospital , 31 patients were directly sent to Luhe hospital by ambulance and 51 patients arrived by themselves.The median FMC2B time was 106.16 min (interquartile range [ IQR ]: 77.37 -165.52 min ) and 42.1% ( 59/140 ) of the patients achieved the current recommended FMC2B time.In a multivariate logistic analysis , FMC to electrocardiographic ( ECG) within 10 min ( OR=5.61 , 95% CI 1.91-16.88 ) , admission during normal working hours ( OR=5.11 , 95%CI 1.88-13.85 ) , patient′s education level of high school or above ( OR=4.16 , 95%CI 1.53-11.34 ) , awareness of heart diseases ( OR =2.58, 95% CI 1.13 -5.91 ) were predictors of improving FMC2B. Transfer for primary PCI (OR=0.37, 95% CI 0.15-0.92) increased FMC2B.Conclusions Less than half of the patients with primary PCI achieved the goal of guidelines′recommended FMC2B time.Initial ECG, admission during normal working hours , patient′s education level and awareness of heart diseases and transfer for primary PCI are the independent predictors of FMC 2B time.
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Objective:To explore the impact of domestic bivalirudin on platelet function during emergency percutane-ous coronary intervention (PCI) .Methods :A total of 100 patients with acute ST segment elevation myocardial in-farction who recieved emergency PCI were randomly divided into unfractionated heparin group (UFH group ,n=53) and bivalirudin group (n=47) .Adenyl diphosphoric acid (ADP)-induced platelet aggregation rate was meas-ured and statistically compared between two groups before and after PCI .Results:Before emergency PCI ,there was no significant difference in ADP-induced platelet aggregation rate between two groups (P=0.99) .After emergency PCI ,ADP-induced platelet aggregation rate in bivalirudin group was significantly lower than that of UFH group [ (16.46 ± 10.23)% vs .(25.21 ± 15.91) % , P<0.01] .Conclusion:During percutaneous coronary intervention , compared with routine heparin anticoagulation , bivalirudin , as an anticoagulant , can more significantly inhibit platelet aggregation and possess antiplatelet effect .
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Objective To evaluate the effect of early intracoronary injection of tirofiban via aspiration catheter on myocardial no-reflow in elderly patients with acute ST-segment elevation myocardial infarction (STEMI).Methods 120 consecutive patients over 65 years old with AMI undergoing primary percutaneous coronary intervention (PCI) were randomized into two groups.In tirofiban group (n=60),thrombus aspiration and intracoronary tirofiban bolus (10 μg/kg prior to the first balloon inflation) via aspiration catheter were performed.In control group (n=60),thrombus aspiration was followed by primary PCI.The incidence of no-reflow and bleeding were assessed in the two groups.Results The moderate to severe bleeding (TIMI bleeding criteria) did not occur in the two groups,there's no significant difference between two groups in the incidence of minor bleeding [26.7％(16 cases) vs.21.7％ (13 cases),x2 =0.19,P=0.522].The incidence of myocardial noreflow was significantly lower in tirofiban group than in the control group [10.0％ (6/60) vs.25.0％ (15/60),x2 =4.68,P=0.031].Conclusions The intracoronary injection of tirofiban via aspiration catheter may significantly reduce the incidence of myocardial no-reflow in patients with STEMI without increasing bleeding complications.
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Objective To evaluate the feasibility and safety of ultrasound-localized percutaneous thrombin injection (ULTI) for the treatment of iatrogenic femoral pseudoaneurysm. Methods From January 2000 through October 2001, 5 patients (3 males, 2 females, age range 38～72 years) were found to have a pseudoaneurysm confirmed by ultrasound between 1 and 3 days following femoral arterial puncture. Two patients were associated with diagnostic arteriography and 3 with stent implantation. ULTI was our first choice for the treatment of ablating femoral pseudoaneurysm. All patients following ULTI were restudied within 24 hours. Results All 5 patients were initially treated with ULTI. Thrombin was injected directly into the pseudoaneurysm with a dose of 500 units over several seconds, successful ablation was visualized immediately in 4 patients, the remaining 1 patient needed ultrasound-guided compression treatment of five minutes. Follow-up at the 24th hour showed no recurrent pseudoaneurysm after initial successful ablation in any case. No distal embolization or allergic reaction occurred. Conclusion ULTI is a safe, rapid, well-tolerated, inexpensive and effective noninvasive method for the treatment of iatrogenic femoral pseudoaneurysm and should be considered as first-line therapy.