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Objective:To explore the application of optical coherence tomography (OCT) in the interventional diagnosis and treatment of intermediate coronary disease.Methods:Patients were enrolled during January 2017 to January 2019, in the Department of Cardiology, the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine.The patient whose diagnosis was confirmed as intermediate coronary artery lesion by coronary angiography then underwent coronary OCT examination.The general information, disease history, drug use, biochemical indicators and OCT imaging indicators were collected.Results:(1)A total of 75 borderline lesions were detected in 69 patients with coronary heart disease, including 52 cases of left anterior descending artery (LAD) (75.4%), 4 cases of left circumflex artery (5.8%, 4/69), and 19 cases (27.5%, 19/69) of right coronary artery (RCA). (2) According to the analysis of the plaque characteristics of borderline lesions OCT, 7 cases were accompanied with thrombosis, 6 cases with plaque rupture, 25 cases with thin fiber cap lipid plaque, 49 cases with macrophages, 35 cases with microvascular, 35 cases with cholesterol crystallization, 3 cases with ulcer and 6 cases with intimal dissection.(3)The median of the minimum lumen area (MLA) determined by OCT was 2.9 mm 2.In the MLA<2.9 mm 2 group, C-reactive protein (CRP) ((2.92±2.44) mg/L vs.(1.98±1.30) mg/L, P=0.045), total cholesterol (TC) ((4.13±0.78) mmol/L vs.(3.74±0.75) mmol/L, P=0.041), low density lipoprotein cholesterol ((2.77±0.83) mmol/L vs.(2.22±0.78) mmol/L, P=0.007), small and dense LDL ((1.02±0.44) mmol/L vs.(0.80±0.34) mmol/L, P=0.024), lipoprotein a ((1.16±0.17) mg/L vs.(0.95±0.09) mg/L, P=0.042) were significantly higher than those in MLA≥2.9 mm 2 group.(4). According to the interventional strategy, patients were divided into two groups: percutaneous coronary intervention (PCI) group (N=16) and non-PCI group (N=59). The area stenosis (AS%) ((68.58±4.90)% vs.(63.10±7.09)%, P=0.001), diameter stenosis (DS%) ((65.65±6.91)% vs.(60.77±8.41)%, P=0.024), lipid plaque curvature ((245.3±41.0)° vs.(189.8±99.6)°, P=0.001), lipid plaque length ((19.11±6.40) mm vs.(14.72±9.30) mm, P=0.035) were deteriorated significantly in the PCI group than those in non-PCI group, the differences were all of them were statistically significant.(5)The incidence of 1-year major cardiovascular adverse events (MACE) was 6.25% in Oct guided PCI group and 5.08% in patients without PCI.There was no significant difference between the two groups ( P=0.317). Conclusion:According to the OCT assessment in the intermediate coronary lesions, it is found that the smaller the luminal area, the higher the serum LDL cholesterol level.More Interventional therapy were performed in the vulnerable plaques with large lipid cores.Decision-making for intermediate lesion was highly depended on the plaque tissue characteristics, rather than just MLA size.
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Objective: To explore therapeutic effect of in-hospital intravenous alprostadil injection on patients with acute myocardial infarction (AMI) complicated diabetic nephropathy (DN) undergoing percutaneous coronary intervention (PCI), and evaluate their long-term prognosis.Methods: A total of 80 AMI + DN patients undergoing PCI were selected from our hospital.They were randomly divided into alprostadil group (n=40) and routine treatment group (n=40).Renal function after PCI, cardiac function during hospitalization, serum creatinine (Scr) level on 72h after PCI and incidence of major adverse cardiovascular events (MACE) within one-year follow-up were compared between two groups.Results: Compared with routine treatment group on 72h after PCI, there was significant reduction in Scr level [(126.92±35.28) μmol/L vs.(104.32±22.91) μmol/L], and significant rise in estimated glomerular filtration rate [eGFR, (55.23±31.48) ml·min-1·1.73m-2 vs.(62.14±36.23) ml·min-1·1.73m-2] in alprostadil group, P0.05 all.Conclusion: Intravenous alprostadil injection based on routine treatment possesses significant therapeutic effect on renal function in AMI + DN patients after PCI, and it's safe
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Objective:To explore therapeutic effect and prognosis of thrombus suction in patients with acute ST seg-ment elevation myocardial infarction (STEMI)during percutaneous coronary intervention (PCI).Methods:A total of 105 STEMI patients were enrolled and divided into thrombus suction + PCI group (n=34,received thrombus suction + PCI therapy)and routine PCI group (n=71,received routine PCI treatment).Postoperative TIMI flow, cardiac function during hospitalization,incidence of major adverse cardiovascular events (MACE)and rehospitaliza-tion within one-year follow-up after PCI were compared between two groups.Results:Compared with routine PCI group,there were significant reductions in peak values of creatine kinase isoenzyme [CK-MB,(236.62± 133.00) ng/ml vs.(186.47±69.20)ng/ml]and creatine kinase [CK,(2833.39± 198.70)ng/ml vs.(2129.59± 199.40) ng/ml],peak time of CK-MB [(12.38±6.70)h vs.(9.65±3.90)h]and CK [(12.80±8.10)h vs.(9.68± 3.50)h]after blood flow recovery,P 0.05. Conclusion:Thrombus suction is help for improving patients condition,reducing enzymology level may be effect improving prognosis.
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Objective To explore the status and influencing factors of sub-health in inpatient caregivers.Methods A total of 432 caregivers met the inclusion criteria were enrolled.Suboptimal health status questionnaire (SHSQ-25) was used to evaluate the status of sub-health.Sub-health was defined as SHSQ-25 score ≥ 35.100 people undertaking routine physical examinations were enrolled as control group.The incidence and influencing factors of sub-health in caregivers were analyzed.Results (1) The caregivers group valued higher in SHSQ-25score significantly (36.9 ± 8.6 vs.27.5 ± 13.0,P ＜ 0.05).The incidence of sub-health was obviously higher in caregiver group than that in control group (69.9％ vs.39.0％,P ＜ 0.05).(2) A significant difference in the SHSQ-25 scores between female caregivers and male caregivers was observed (37.9 ± 9.0 vs.34.6 ± 7.1,P ＜0.05).The SHSQ-25 score was positively related with age (r =0.578,P ＜ 0.05) and accompanying time (r =0.507,P ＜ 0.05).Parents,children,or spouses of patients got higher scores than other types of caregivers (38.1 ±8.1 vs.31.1 ±8.8,P＜0.05).(3) Among the sub-health caregivers,only 10.9％ of them were aware of their sub-health status.Conclusion The incidence of sub-health may be higher in inpatient caregivers than the general population.Gender,age,accompanying time,and the relationship between patients and caregivers may be influencing factors for sub-health.Effective action should be taken to improve the health status of caregivers.
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Objective To investigate the clinical character istics of contrast-induced nephropathy(CIN)in patients with coronary artery disease after they used contrast media.Methods 268 patients used contrast media were divided into normal coronary artery group and pathological coronary artery group according to the results of angiography.And the pathological coronary artery group were divided into lesion with single-vessel group,lesion with doublevessel group and lesion with multi-vessel(or left main vessel lesion)group.The 268 patients also were divided into 3 groups according to the dose of contrast media,low dose group,middle dose group and high dose group.Analyse the relativity of grade of coronary artery disease,dose of contrast media and level of serunl ereatinine(Scr)after determination the level of Scr.Results Scr didn't increase after received contrast media in normal coronary artery group,while increased in the pathological COronary artery group and the increase Was remarkable(P＜0.05).The morbidity of CIN in the pathological coronary artery group was up to 14.5%with statistical significance(P＜0.05)from 0%in the normal group.And the recovery of Scr was slow in pathological coronary artery group.The level of Scr was still high with statistical significance in the forth day after angiography(P＜0.05).The dosages of contrast media significandy affected on the Scr and the rate of CIN.The higher dose of contrast media,the higher rate of CIN.Conclusion The CIN could be caused in patients with coronary artery disease,the dosages of contrast media should be controlled strictly.